The National Memo reported on Trump’s plan to allow nursing homes to neglect and abuse vulnerable elderly resident to the point of death and not be subject to a fine.  Reacting to the demands of lobbyists and their campaign contributions, the Trump administration has struck down several regulations that increase the safety and well-being of residents. The New York Times reports that this now means several common citations that used to result in fines will either see reduced penalties or no penalties at all.

“The fines, designed to prod nursing homes into treating elderly Americans with more care, respect, and dignity, were put in place by President Barack Obama and sought to make the institutions answerable to standards put together by Medicare.”

According to federal data, CMS since 2013 has cited nearly 6,500 nursing homes for serious violations discovered during inspections required under Medicare and has fined about two-thirds of those facilities. The nursing homes were most commonly cited for bedsores, failing to protect patients from avoidable accidents, mistreatment, and neglect, Kaiser Health News reports.

STAT News reported on the pioneering geriatrician Dr. Bill Thomas and the 330-square-foot, plywood-boned home he calls a Minka.  The structure is warm, light, and surprisingly roomy, in a studio loft sort of way. Four oversize windows look out onto the lake, a shed-style roof rising to the view.  In the back corner, across from a big bathroom compliant with the Americans with Disabilities Act, sits a full-size bed. On the other side of a plumbing-filled wall from the bathroom is a kitchen and countertop, made from Ikea components. (The term “Minka” has Japanese origins, as a traditional house for rural dwellers, typically those of modest financial means.)

The idea sounds, in one sense, simple: create and market small, senior-friendly houses like this one and sell them for around $75,000, clustered like mushrooms in tight groups or tucked onto a homeowner’s existing property so caregivers or children can occupy the larger house and help when needed.  The initiative has turned Thomas into a rare breed: the physician homebuilder, and it pits him not only against the nursing home industry, but also the housing industry, with its proclivity for bigger and bigger spaces.

“I spent my career trying to change the nursing home industry,” he said. “But I’ve come to realize it’s not really going to change. So now what I’ve got to do is make it so people don’t need nursing homes in the first place. That what this is about.

Thomas wants to help people grow older on their own turf and terms, while helping spare them the fiscal and physical stress of maintaining  homes.  In so doing, he hopes to shield them from the mouth of a funnel that too often summons elders to a grim march — from independent living, to assisted living, to nursing homes, to memory units, and to the grave.

Thomas said he’s less interested in growing wealthy from the idea than in changing the culture of senior housing.

The News-Gazette reported the lawsuit filed against the Champaign County Nursing Home in connection with the death of Sonya J. Kington, a 78-year-old Alzheimer’s resident who died of hyperthermia after being left unsupervised outside the home.  According to an investigation by the coroner’s office, video footage from inside the nursing home appeared to show Ms. Kington entering the courtyard at 1:47 p.m. It isn’t until about 5:15 p.m. that staff members are seen searching for her.

Her limp body was found in an exterior courtyard on a hot day when the high temperature reached 87 degrees.  At the time she was found in the courtyard, Ms. Kington was lying in direct sunlight, her skin was “very hot to touch” and she had vomit on both sides of her mouth.  Ms. Kington’s death was caused by hyperthermia brought on by exposure to hot weather.

The suit alleges that the nursing staff at the nursing home “failed in their duty to provide the necessary services and treatments to prevent the death of Ms. Kington in failing to properly secure the facility and in failing to properly supervise Ms. Kington.”

Reuters reported that nursing home landlord Quality Care Properties Inc has agreed to cut rents for HCR ManorCare.  However, ManorCare, a national for-profit nursing home chain, already owes more than $300 million in back rent and acknowledged it will struggle to pay even the reduced amount, according to a regulatory filing.  Toledo, Ohio-based ManorCare, with more than 250 skilled nursing and assisted living facilities across the United States, is struggling as government Medicaid and Medicare reimbursement rates fail to keep pace with rising costs.  Quality Care, a real estate investment trust (REIT), relies on the nursing home chain for more than 90 percent of its revenues.

Quality Care was spun off in 2016 by larger REIT HCP Inc, which had acquired the ManorCare assets from private equity firm Carlyle Group LP in 2010 for $6.1 billion.  Quality Care shares fell 3.4 percent to $13.54 on Tuesday.

New York Times article published January 2nd uncovers the self-dealing practice of nursing home corporate owners outsourcing goods and services to companies that they also control or have a financial interest.  These so-called “related party transactions” are a way of avoiding accountability for neglect and abuse.  These arrangements allow owners to put together advantageous contracts in which their nursing homes pay higher rates for rent, supplies, and services while the owners pocket the higher profits, which aren’t recorded on the nursing home’s accounts.  These complicated undisclosed “arrangements” make it difficult for neglected and abused residents to be compensated for injuries caused by the related companies for siphoning money intended for the care and well-being of the nursing home residents.

An analysis from Kaiser Health News revealed that “nursing homes that outsource to related organizations tend to have significant shortcomings: They have fewer nurses and aides per patient, they have higher rates of patient injuries and unsafe practices, and they are the subject of complaints almost twice as often as independent homes.”

■ Homes that did business with sister companies employed, on average, 8 percent fewer nurses and aides.

■ As a group, these homes were 9 percent more likely to have hurt residents or put them in immediate jeopardy of harm, and amassed 53 substantiated complaints for every 1,000 beds, compared with 32 per 1,000 beds at independent homes.

■ Homes with related companies were fined 22 percent more often for serious health violations than independent homes, and penalties averaged $24,441 — 7 percent higher.

“Almost every single one of these chains is doing the same thing,” said Charlene Harrington, a professor emeritus of the School of Nursing at the University of California, San Francisco. “They’re just pulling money away from staffing.”

Ernest Tosh, a lawyer in Texas who helps other lawyers untangle nursing company finances, said owners often exerted control by setting tight budgets that restricted the number of nurses the homes could employ. Meanwhile, “money is siphoned out to these related parties,” he said. “The cash flow gets really obscured through the related party transactions.”

“Nearly three-quarters of nursing homes in the United States — more than 11,000 — have such business dealings, known as related party transactions, according to an analysis of nursing home financial records by Kaiser Health News. Some homes even contract out basic functions like management or rent their own building from a sister corporation.

Contracts with related companies accounted for $11 billion of nursing home spending in 2015 — a tenth of their costs — according to financial disclosures the homes submitted to Medicare.

The L.A. Times reported the problem with infection control at nursing homes, and the lack of enforcement by investigators.  “Basic steps to prevent infections — such as washing hands, isolating contagious patients and keeping ill nurses and aides from coming to work — are routinely ignored in the nation’s nursing homes, endangering residents and spreading hazardous germs.”

Inspection records show nurses and aides are often not familiar with basic protocols, such as wearing protective clothing when coming into contact with contagious residents and isolating them from others in the home and visitors. Others are not trained properly on how to clean patients. Still others, in a rush and understaffed, take shortcuts that compromise sanitary precautions

Infections, most of which are avoidable, cause a quarter of the medical injuries Medicare beneficiaries experience in nursing homes, according to a federal report. They are among the most frequent reasons residents are sent back to the hospital. By one government estimate, healthcare-associated infections may result in as many as 380,000 deaths each year.

A Kaiser Health News analysis of four years of federal inspection records shows 74% of nursing homes have been cited for lapses in infection control — more than for any other type of health violation.  However, only 1 of 75 homes found deficient in those four years has received a high-level citation that can result in a financial penalty, the analysis found.  Only 161 homes among the 12,056 that violated infection-control rules were cited at those higher levels since 2014, according to Kaiser Health News’ analysis.

As average hospital stays have shortened to 4.5 days in 2012 from 7.3 days in 1980, patients who a generation ago would have fully recuperated in hospitals now frequently conclude their recoveries in nursing homes.  “You’ve got this influx of vulnerable patients but the staffing models are still geared more to the traditional long-stay resident,” said Dr. Nimalie Stone, the Centers for Disease Control and Prevention’s medical epidemiologist for long-term care. “[That] kind of care is so much more complicated that facilities need to consider higher staffing.”

The Hill reported that the nursing home industry (and their campaign contributions to Trump and the Republicans) have reaped the rewards.  The Trump administration is rolling back the use of fines against nursing homes that have neglected and abused resident sin their care.  The nursing home industry demanded the change in the Medicare program’s penalty protocols, The New York Times reported.  According to the Times, nearly 6,500 nursing homes have received at least one citation for a serious violation since 2013 and only two-thirds of those have been fined by Medicare.  Under the new rules, regulators are now discouraged from giving nursing homes fines, in some cases. Fines for some homes may also be decreased as a result of the new guidelines.

The American Health Care Association had argued that inspectors were focused on quality of care instead of “assisting” the facilities.

“It is critical that we have relief,” Mark Parkinson, the group’s president, wrote in a letter to Donald Trump, then president-elect, in December 2016.

The Centers for Medicare and Medicaid Services (CMS) is responsible for developing standards for rehabilitation facility and nursing home care (includes rehabilitation facilities) and ensuring those standards are met. Every nursing home that accepts Medicare and/or Medicaid is required by law to abide by the regulatory standards developed by CMS.

However, Federal regulations designed to protect the safety and well-being of residents in the nation’s nursing homes are facing mounting pressure from Congress.  A group of 146 lawmakers, many of whom have received substantial campaign contribution from the nursing home industry, has urged the Trump Administration to revise safety standards in nursing homes.   The industry contributed more than $2.5 million to the campaigns of 128 lawmakers who signed the letters, according to the website FollowTheMoney .org, which trackspolitical contributions.  The industry gave a total of more than $1.98 million to 104 House members, and $587,000 to 24 Senators, who signed the letters seeking the re-evaluation of the standards, according to FollowTheMoney.

Nursing home experts, and advocates for residents contend the regulations are needed for safety, quality of care, and transparency; the measures will expand care plans, offer greater freedom for residents, increase the amount of training for nurses and aides caring for residents with dementia and provide grievance officers to help handle complaints.  Nursing home residents have higher needs than in 1991, when federal regulations were first enacted. Nursing home care is one step below the hospital setting and half of all residents have a form of dementia.

The changes in the standards offer greater focus on residents’ safety and well-being, according to the National Consumer Voice for Quality Long Term Care , an advocacy organization in Washington, D.C. For instance, says the organization, the changes:

  • Would stress greater residents’ freedoms in choice, from food selection to daily schedules, such as when to go to bed and when to wake up. Also, visitors can stop by at any time.
  • Require nursing homes to perform a baseline care assessment within 48 hours of a resident’s arrival. The plan sets out initial goals for residents, including physician and dietary orders. Under the previous regulations, nursing homes could take up to three weeks to develop a care plan.
  • Include a grievance officer at each facility, who would handle complaints of residents and families. An infection prevention specialist would be added as well. This would not require an additional hire, as a nurse on staff, with increased training, could be assigned the position.
  • Add enhanced training for nurses’ aides to deal with residents suffering from dementia.

Advocates for nursing home residents have pushed for years for the CMS to come up with specific regulations for nursing homes regarding the number of nurses and nurse’s aides needed per shift.

The Daily Beast had an interesting article about the immoral and unethical practice of evicting poor and disabled residents from nursing homes.  “Complaints about allegedly improper evictions and discharges from nursing homes are on the rise in California, Illinois and other states, according to government data. These concerns are echoed in lawsuits and by ombudsmen and consumer advocates.”  In California alone, such complaints have jumped 70 percent in five years, reaching 1,504 last year.  Many patients end up with no permanent housing or regular medical care after being discharged.

Advocates say such decisions are often money-driven, placing profits over people: Medicare covers patients for just a short time after they are released from hospitals. After that, these critics say, many nursing homes don’t want to accept the lower rates paid by Medicaid, the public insurance program for low-income residents.

Among other recent cases of allegedly improper discharges:

*In October, California’s attorney general moved to prevent a Bakersfield nursing home administrator from working with elderly and disabled people, while he awaits trial on charges of elder abuse and wrongful discharge. State prosecutors said one patient was falsely informed that she owed the home money, then sent to an independent living center even though she could not “walk or toilet on her own.”

*A pending lawsuit by Maryland’s attorney general alleges a nursing home chain, Neiswanger Management Services (NMS), illegally evicted residents, sending them to homeless shelters or other inadequate facilities to free up bed space for higher-paying patients.

*Last month, a 73-year-old woman with diabetes and heart failure sued a Fresno, Calif., nursing home for allegedly leaving her with an open wound on a sidewalk in front of a relative’s home. The suit said conditions in the residence were unsafe and a family member refused to allow her inside. The state cited the home in July and issued a $20,000 fine.

Federal law allows a nursing home to discharge or evict a patient when it cannot meet the resident’s needs or the person no longer requires services; if the resident endangers the health and safety of other individuals; or if the patient has failed, after reasonable and appropriate notice, to pay.  The law also generally requires a home to provide 30 days’ notice before discharging a patient involuntarily and requires all discharges be safe and orderly.

 

 

 

Freelance Contribution by Jessica Walter

The recent US World & News Report indicated that out of 183 nursing homes graded in South Carolina, 15% were considered as top performing while 13% were rated as the worst. In this assessment, several criteria were used such as health inspections, quality of resident care and staffing. Healthcare inspections in nursing homes are seen in their totality. Hence, inspectors look at several components including ensuring residents are cared for adequately by hiring enough staff to look after them and protecting them from neglect. Health inspections also include medications management and safe storage & preparation of food.  Cleanliness and hygiene are imperative in nursing home settings to ensure that patients are safeguarded from diseases and infections.

The Elderly Have Weak Immune Systems

Overall, good hygiene practices are important to prevent bacteria and germs from contaminating the nursing home. This means that toilets and bathrooms must be properly sanitized to inhibit bacteria and germs from spreading that can cause the elderly to become sick or acquire infections.

The kitchen is an area that must be kept spotless and sanitary because this is where food storage and preparation occur. To prevent contamination, countertops, utensils, and materials must be clean. Food handlers must wash their hands properly before touching anything. Among the elderly, this is critical because they have weaker immune systems whether due to the normal effects of aging or to a chronic illness. Mature adults are at high risk of getting infections and diseases. If food is prepared in unsanitary conditions and meals are contaminated, the probability of getting foodborne illnesses among seniors is high. The elderly, age 65 years and above, is predisposed to morbidity and mortality due to foodborne gastroenteritis compared to younger groups (Smith, 1998). According to the same study, practicing a healthy lifestyle, paying attention to personal hygiene, sanitary food preparation habits, exercise and balanced diets can reduce the incidence of foodborne diseases and infections among older adults.

Poor Hygiene and Sanitation Constitute Neglect

Often, poor sanitation in nursing homes is a result of inadequate staff. There are not enough personnel to take care of the facilities round the clock or nurses to care for patients. Administrators might forget to contract professionals to clean and maintain structures. Failure to keep the premises clean can cause infections and diseases among the elderly. Seniors whose personal hygiene are not monitored and addressed by the nursing home staff are also at high risk for getting ill which can result in complications and even death. Disregard for the sanitation & hygiene in a nursing home and its patients constitute a form of neglect. The nursing home is, in effect, liable for medical complications that arise due to lack of cleanliness or hygiene.

Regular cleaning and sanitation of nursing home premises are instrumental in protecting the health of patients. Without proper sanitation and hygiene, seniors are susceptible to diseases and foodborne infections that can cause complications and even death.