Nursing home opposition hasn’t slowed a proposal to let Louisiana families install video camera systems in their loved ones’ nursing home rooms. Under the legislation, the cameras would be voluntary. The costs would have to be paid by the nursing home patient or family member. Any roommate — or a legal guardian — would have to agree to the camera installation. Nursing homes would be prohibited from ousting or retaliating against residents who choose to install the monitoring device.

Supporters said it would give family members the ability to monitor their loved ones from afar.  The nursing home industry lobbyists allege that live-streamed video could be hacked, facilities’ private medical records could be targeted and privacy could be threatened.  Many state senators seemed incredulous at the ridiculous objections raised by the Louisiana Nursing Home Association.

“I mean, really?” said Sen. Norby Chabert, a Houma Republican who pushed back against the claims.   Chabert said the nursing homes’ opposition seemed to suggest they don’t want people to be able to see their family members in real time. “That’s kind of fishy to me,” he said.

Supporter Lucie Titus, who said her mother, an Alzheimer’s patient, was unable to explain injuries she suffered in a nursing home. Titus asked to install a video camera system in her mother’s room and was refused by home administrators. She believes if she could have seen what caused her mother’s injuries, treatment could have been quicker and involved less pain. Titus filed a lawsuit to set up the video monitoring, but her 92-year-old mother died in November 2017 before the issue was resolved.

The Arkansas Times reported the suspicious and mysterious payment from the nursing home industry to legislators considering tort reform.  The Southwest Times Record continues its excellent reporting on a mysterious payment sent by a major player in the nursing home lobby to a company owned by former state Sen. Jake Files (previous coverage on Arkansas Blog here). Files pleaded guilty in federal court earlier this year to unrelated charges of wire fraud, bank fraud and money laundering.

An $80,000 wire transfer from a nursing home executive (a business partner of nursing home magnate Michael Morton) was sent to Files’ company in 2014 just a week after an effort was filed to legislatively refer a proposed constitutional amendment to voters that would have limited damages in civil lawsuits. The situation looks smelly enough that a county prosecutor recently wrote a letter to a federal prosecutor asking whether the transfer had been made in “violation of federal law,” an FOI request by the Times Record revealed.

Previous reporting by the Times Record uncovered the $80,000 wire transfer to Files’ Fort Smith company FHH Construction from David Norsworthy, part-owner in more than a dozen nursing homes in the state with Michael Morton. The transfer took place on Nov. 24, 2014 according to documents provided to the Times Record. A week earlier, on Nov. 17, 2014, a resolution was filed by Sen. Eddie Joe Williamsone of the nursing home lobby’s most reliable soldiers, to send a proposed constitutional amendment limiting civil damages to voters.

That resolution ended up dying in committee (a follow-up attempt to get the measure on the ballot by petition was ultimately blocked by the courts). However, a similar effort in 2018, co-sponsored by Files, will be on the ballot as Issue 1 this fall, the so-called “tort reform” amendment. The measure is strongly supported by the nursing home lobby. It would impose caps on the damages that places like nursing homes would have to pay out if a jury found that abuse led to pain, suffering, or death.

Norsworthy — who in addition to co-owning nursing homes has also been a business partner of Morton’s in a health insurance company for Medicare Advantage patients, Arkansas Superior Select — is a board member of Arkansas Health Care Association, the lobbying arm of the nursing home industry (which is pushing hard for Issue 1). In 2014, when Morton’s term was up for his seat on the state commission that oversees the issuance of permits to nursing homes, Governor Hutchinson tapped Norsworthy to replace him (Morton was under federal investigation at the time). Norsworthy continues to serve on that commission; his term is up this year but he plans to re-apply, according to commission staff.

Morton funneled large amounts of money in recent years to various candidates friendly to his interests, in part via a scheme arranged by Gilbert Baker, the former state legislator and lobbyist. The defrocked judge Mike Maggio pleaded guilty in 2015 to taking a bribe to reduce a verdict by millions of dollars in a negligence case involving one of Morton’s nursing homes, around the same time that Baker had arranged multiple contributions from Morton to Maggio for a planned campaign for Court of Appeals. Baker and Morton deny any wrongdoing and have not been charged.

Baker’s partner, Linda Leigh Flanagin, was with Baker when they approached Morton about Baker’s scheme to set up multiple PACs (thus dodging campaign contribution limits) that could funnel additional Morton dollars to candidates, including Maggio. In a deposition, Flanigan also described meetings she had with Morton to discuss efforts to enact “tort reform” to limit damages for maltreatment by nursing homes.

As for Files, about six months after his company received the $80,000 from Norsworthy, he received a $30,000 loan from lobbyist Bruce Hawkins, as first reported by the Arkansas Blog.  Hawkins’ name came up at the periphery of the Maggio case.  Hawkins had used the same attorney Baker had, Chris Stewart, to set up a series of political action committees for a similar bundling scheme. Those PACs received some of the money aimed at Maggio. In a deposition, Hawkins testified that he moved to distance himself after he got tied up through news articles in the effort to aid Maggio, in part by a contribution made by Stewart from one PAC without Hawkins’ approval.

Files got into his own hot water with federal investigators in a separate matter related to misuse of General Improvement Fund money appropriated by the legislature in 2016 and pledging a forklift he did not own as collateral for a $56,700 bank loan. Files admitted to misdirecting more than $25,000 in taxpayer money for a sports complex his construction company was supposed to build and pocketing GIF funds for personal purposes. He faces sentencing in federal court this summer.

The Tribune reported the tragic consequences of allowing a nursing home resident to smoke without proper supervision and safety attire.

The father of a 55-year-old mentally impaired man living at a nursing home in San Luis Obispo alleges that staff there negligently gave the partially paralyzed and wheelchair-bound man a cigarette and lighter shortly before he was found in a patio area “engulfed in flames.”  Compass Health, Inc., owns and operates Mission View Health Center.

A lawsuit filed by Floyd Lewelling, on behalf of his son Jeffrey Lewelling, says that staff at Mission View  should not have given the man his own lighter nor left him alone in the designated smoking area.  They should also provide a smoking apron.

The Lewelling family seeks an unspecified amount of monetary damages for dependent adult abuse and neglect, negligence and violations of resident rights.

Fox2Now had a sad story about a nursing home resident covered in bruises with no explanation.  Bessie Wamsley is laying in a hospital bed covered in bruises and bumps. She has two black eyes, bruising inside her ear and marks on her face and neck. Doctors tell her family they don’t think she’s going to survive.  Her family is demanding answers as their grandmother lies in a hospital bed covered in bruises. The injuries occurred while she was in the care of Country View Nursing Facility in Bowling Green.

“The doctors kind of have the feeling that whatever happened to her lead up to the seizure and the stroke,” says Bella Avila.  The facility never notified her family that her grandmother was hurt because they don’t have power of attorney.  Staff later told them Bessie fell out of bed.

Police obtained Bessie’s medical records that show she was taken to the hospital for a fall on April 19 and was sent back to the nursing home. She says according to police, 10 days later she was sent back to Pike County Memorial and then flown to DePaul Hospital.

“Then the doctors and nurses came in to talk with us and said that if it happened on April 19, the bruising wouldn’t be that fresh,” she says.

“She can’t move. I don’t see her going out of bed. She can’t walk. She can’t be on her own let alone roll herself up,” says Jennifer Reeves, her other granddaughter.

This isn’t the first time the family has noticed injuries.

“She’s had many bruises before. They said she bumped it on the table or that she’s on blood thinners, so she bruises easily, and they always just kind of blew us off. We went up there before and she was missing a fingernail and we asked how and they said she slammed it in her drawer or something,” says Avila.

“I want my grandma back. I want justice for whatever happened. There’s other families that could be going through this and it’s not fair to them. We need answers,” says Reeves.

 

Freelance Contribution by Karen Weeks

Having a conversation with a loved one about their end-of-life arrangements can be overwhelming and can lead to anxiety, depression, and stress for everyone involved. Whether it’s due to a long terminal illness or advanced age, it can be extremely difficult to think about the next phase for your loved one, and it’s never easy to figure out how to begin.

One thing to keep in mind is that this topic should be approached with compassion and care. Remember, too, that there may be many people affected by these arrangements, so it’s important to take them into consideration as well. Think of the best ways to gently broach the subject so that you can help your loved one as much as possible during this difficult time, and remember to include your siblings or other close family members in the conversation when the time is right. If you’re unsure about timing, read this helpful guide.

 

Some ways to get started include:

 

Looking for an opening

You may feel at a loss for how to bring up making arrangements, so think about what your loved one’s needs might be. If they’re ill, ask them if there’s anything they want to talk about, or whether there is anything they need help with. Often, this will open up the path for a frank discussion about the next steps. If your loved one is of an advanced age, it might be helpful to ask whether there is anything they want to take care of or anything you can help them accomplish.

 

Finding comfort

If your loved one finds comfort in the church, talk to the pastor or priest in charge and ask about any ideas they may have about beginning the conversation. They may know of a sermon, song, prayer, or Bible passage that will help your loved one during this difficult time, or they may be able to make a home visit to give your family comfort.

 

Talk…and listen

For individuals who are facing the end of life, there are many conflicting emotions, and some can be overwhelming. They may be worried about how their family members will fare without them, or they may have a long list of things they wanted to accomplish. They may be in pain, either physical or emotional, and not know how to talk about it. Having a conversation with your loved one about their feelings is a great way to help them come to grips with the reality of their situation, but it’s important to listen to them as well. Let them vent, and refrain from using statements that are made purely for comfort, such as “You’re going to be around for a long time.” Doing so will only create false hope and diminish your loved one’s feelings.

 

Consider asking for help

For many people who are living with a terminal illness, hospice care is a wonderful choice. It allows for a measure of dignity while assisting with arrangements and end-of-life care. Do some research into local hospices alongside your loved one and find out about payment options and exactly what they offer.

 

Wills and advance directives

Ask your loved one if they have a will or advance directive in the event of their hospitalization. Having a plan may help them feel that loose ends are tied up and allow them to face the end without stress or anxiety. You can find more information on advance healthcare directives here.

Remember that your loved one may have a hard time talking and thinking about their end-of-life arrangements, so let them guide the conversation after you begin. If it’s too overwhelming for them, allow them to rest before you bring it up again, or try a different approach.

Freelance Contribution by Jessica Walters

After deciding to move your loved one into a nursing home or other assisted living facility, it’s tough for family members not to worry about how the adjustment is going. Even if you have selected a top-rated nursing home in South Carolina, it can still be a difficult process for families to make sure that their loved one has everything he or she needs. Fortunately, there are many simple changes that can be made to a senior citizen’s residents to make life a little easier.

While not all seniors will need to make changes to their new residence, seniors with limited mobility may find that the standard rooms in a nursing home are not easy to navigate and live in. Since mobility is the most common disability in people age 65 and older, with nearly 40% having difficulty walking or climbing, it is imperative that seniors’ spaces in nursing homes are adjusted to being mobility-friendly. When designing an accessible space for seniors, there are certain changes that family members or nursing homes can do to be successful.

Making Updates for Easy Storage 

Seniors with limited mobility essentially have challenges completing the tasks that allow them to get through the day, such as walking across a room or getting out of bed. As a consequence of chronic diseases like arthritis or diabetes, limited mobility can lead to impaired strength and little to no balance. This means that it may be difficult for seniors to do things as simple as reaching things in storage or putting needed items away.

Since getting things out of storage and putting things away requires mobility, it is beneficial to adjust a senior citizen’s room in a nursing home to include easy storage. Some improvements that can be made include:

o   Hanging shelves, coat or towel hooks, and towel racks lower on the walls

o   Put most-used cookware on the easy-to-reach shelves (often the lower shelves)

o   Make emergency items (flashlights, first aid kits, fire extinguishers) easy to access

o   Install shelves that can be pulled out, instead of having to reach far inside cabinets

There are also many new technological innovations that can ease daily tasks and pains from arthritis, like reach-extenders (claw-like grabbers) and easy can openers or lid-turning gadgets. By researching tools for the home that are designed to ease aches and pains, you can replace all of the items you use on a daily basis with an easier, senior-friendly version. While making these adjustments may not seem like a huge undertaking, it will greatly improve a senior’s independence, giving them the chance to complete small tasks throughout the day more easily.

Installing Additional Modifications to Bathroom

Another area of focus that can be improved for the sake of seniors with limited mobility is the bathroom. While most nursing homes will incorporate easily accessible bathrooms, complete with grab bars along the bathtubs and lowered toilets, there are still other modifications that can be installed to make a senior’s life even easier.

For one, if seniors with limited mobility have the option of renovating their bathroom, it might make sense to install a walk-in shower instead of having a bathtub. This will eliminate the barrier that requires seniors to step over the edge of the tub, which can lead to falls. Depending on the parameters of your renovation, you can also install a bench or seat in the shower so that the senior does not have to stand while bathing. Adding non-slip appliqué to the floor is another great idea for increased safety.

Additionally, one of the most impressive bathroom innovations that has been developed to make seniors lives easier is aging-in-place toilets. Though some models can be quite costly, these toilets are designed to automatically raise and lower the lid, washing areas within the bowl that are hard to reach, and even heat the seat. These toilets are growing in popularity and can improve a senior’s safety when bending down or reaching over to use the toilet. 

Upon moving into a nursing home or assisted living facility, there are certain updates that you can make to simplify day-to-day tasks that might be otherwise be difficult for seniors with limited mobility.

Fox4KC reported that Joy Titus is now banned from Redwood of Independence after filing a complaint against the nursing home last month about her husband’s treatment in the dementia unit. The state of Missouri is investigating the company running the nursing home which has a troubled history, including an ongoing wrongful death lawsuit.

Joy was forced to make a painful choice and sent her husband to the rehabilitation center just after Christmas 2016.

“The guilt is so overwhelming. It’s almost impossible to live with — that I’m not taking care of him myself,” she said.

But Joy felt good about the facility, knowing her mom had gotten good care there, as had a few family friends. It was an added bonus the facility was just 5 minutes from her home.  “I had no qualms about taking him there,” Joy said.

But she said things rapidly changed in April 2017 when Redwood Post Acute Network bought the place. In June, her husband escaped from a window and wasn’t found for hours.

“The care, just got to be less and less,” she said.

In November 2017, state and federal inspections and complaints reveal patients repeatedly missing medications. In one case, a diabetic patient didn’t get insulin for four days, and their blood sugar went extremely high. Staff took a “couple hours” before anything was done.

In March 2018, a wrongful death lawsuit was filed against Redwood after an epilepsy patient allegedly failed to get medicine and died.

For Joy, the last straw came two weeks ago when she went to visit Richard.  “I walked in, and he was naked from the waist down. In the middle of the hall. With four women in chairs, sitting there watching him, and he`s covered in feces.  And I hollered and hollered for help, and there was no help,” she said.  “My husband was saying over and over, ‘They hurt me. They hurt me. Get me out of here,’” Joy said.

Richard’s now in a new nursing home, and his outlook is already improving.  “He’s calm.  No anxiety attacks,” Joy said.

She’s now hoping others learn from her ordeal and is encouraging others to check online inspection reports from Medicare and the state before choosing a nursing home for your loved one. Then make regular check-up visits and report any concerns you have.

 

The L.A. Times reported on a state audit that shows that California health regulators allow poor care at nursing homes around the state, and the number of incidents that could cause serious injury or death has increased significantly in recent years.  The state auditor singled out the California Department of Public Health for specific criticism, saying it had not performed necessary inspections or issued timely citations for substandard care. The audit also found that the department’s nursing home licensing decisions were inconsistent and lacking in transparency.  We have the same problems in South Carolina.

In California, confirmed cases of substandard care at nursing homes statewide increased by 31% from 2006 to 2015, according to the audit. And incidents of nursing home noncompliance that caused or could have caused serious injuries or fatalities rose by 35% in the same period.  Safety and accountability problems at nursing homes across the United States are rampant. Federal inspection reports, for example, show that infection control is routinely ignored. At the same time, the Trump administration has scaled back the use of penalties to punish nursing homes that put residents at risk of injury.

The audit showed that in the vast majority of cases where investigators found problems that could severely harm patients, the public health department failed to cite or fine the facility involved.  The quality of care at nursing homes will be critical as baby boomers age and demand for these services grows.

The state audit also investigated three large private nursing home operators whose net incomes have skyrocketed over the past decade — from less than $10 million each in 2006 to between about $35 million and $54 million in 2015. The report confirmed that the owners of the three companies are increasing their profits by doing business with companies they own or in which they have a financial interest, and siphoning money away from patient care to these “related entities”.  The three companies, Brius Healthcare Services, Plum Healthcare Group and Longwood Management Corp., paid between $37 million and $66 million to related companies from 2007 to 2015, according to the audit.

Kaiser Health News found last year that about three-quarters of nursing facilities in the country outsource services to companies that they control or in which they have an interest.  The obvious and inherent risks of such arrangements are that owners will inflate their prices to increase cross-company profits, and that it is easier for commonly owned companies to engage in fraud and conceal it.

Michael Connors, with California Advocates for Nursing Home Reform, expressed alarm that nursing home operators are making such big profits by doing business with their own companies. Nursing home chains are using these deals to “siphon off money intended for care in order to pad and hide profits” — and that hurts residents, he said.

The WYDaily reported the tragic death of a nursing home resident from a preventable improper transfer, and the family’s search for answers and justice.  Lee Cleveland Scruggs, the executor of the estate of Fannye Doris Holden Scruggs Rorer, is suing Williamsburg Landing in a neglect lawsuit, stating the home was, at times, negligent in their care of Rorer.  Court documents allege Rorer fell “at the hands of” staff on April 15, 2016, while being transferred from her bed into a hoyer lift. The lift is used for mostly or completely immobile patients.  Rorer died eight days after her fall.

“At all pertinent times, Fannye was a helpless, mentally compromised, one-eyed amputee with inter alia limited communication ability, who was totally dependent on defendant… for her basic activities of daily living … and everything else,” according to a civil complaint filed in the Williamsburg-James City County Circuit Court.

According to court documents, Rorer was a resident patient at Woodhaven Hall at Williamsburg Landing from April 2011 to April 23, 2016, when she died.  In those five years, the family paid over $600,000 for her care, the complaint said.

The complaint cites multiple surveys completed by the Virginia Department of Health in 2015 and 2016 which cited the nursing home for safety violations, including not immediately notifying a doctor when a patient fell, not developing an “appropriate” care plan for another patient, and more.  The complaint states Rorer was injured at least six times during transfers using a hoyer lift in the months leading up to her fall and death.

Rorer was dropped around 5:40 a.m. April 15, 2016, while being transferred out of her bed by a single nursing assistant. Employees later told Rorer’s family the transfer should have been made by two people, the complaint states.  X-rays after the fall showed Rorer had multiple compression fractures on her lumbar spine.

 

Modern Healthcare reported that CMS, the federal agency that regulates nursing homes, will  propose a new pay model called  Patient-Driven Payment Model which would replace the resource utilization groups model they are paid under now. This is the second time in two years the CMS has suggested a payment model to replace resource utilization groups. The proposed Patient-Driven Payment Model (PDPM), a switch from last spring’s originally pitched RCS-1, will replace the Resource Utilization Group system, or RUG-IV, used to categorize Part A residents into various payment groups based on their level of need.  The nursing home industry panned last year’s proposed model, known as the Resident Classification System, because it used outdated data to establish payments.

The nursing home lobbyists are worried that the new model could pay them less for services provided to Medicare patients.  The CMS said the new system should save nursing homes 2 million administrative hours annually, or $200 million per year in labor costs.  CMS also announced an $850 million pay raise for skilled nursing facilities for fiscal 2019.

The CMS pays skilled-nursing facilities on a prospective fee schedule, which means they are a paid a predetermined amount for services they provide. The current skilled-nursing pay system separates patients into two broad care categories based on the level of care they require: patients who need general nursing services and patients who need physical, occupational and speech therapy.

The new system will have five patient categories: nursing, non-therapy ancillary, physical therapy, occupational therapy and speech training in an attempt to add more precision to the payment system so providers receive more accurate reimbursement reflecting the costs for care of all SNF residents, according to the CMS.  The proposals would allow rehabilitation physicians to conduct some meetings without being physically in the room and also remove overly prescriptive admission documentation requirements.

The CMS proposed restricting group and concurrent therapy use in order to ensure that patients can receive individual sessions when clinically appropriate. In the past, SNFs would overutilize group therapy hours because they weren’t subject to the same limitations as individual sessions. The agency also worried the providers over-relied on group sessions to curb employee hours and costs.

Under the proposal, concurrent and group therapy can only account for 25% of the overall therapy a SNF provides.  The new system will make it easier for patients and providers to figure out which nursing facilities excel at care for patients with certain conditions like heart failure. Providers and patients may choose send patients to specific facilities based on their performance under the new model, Macmillan said.

The Medicare Payment Advisory Commission, HHS’ Office of Inspector General and others have criticized current nursing home payment strategy for years because it gives nursing homes incentives to bill higher intensity rehab codes to maximize reimbursement.  Between 2002 and 2016, the share of days classified into rehabilitation classifications in SNF facilities increased from 78% to 94%, according to MedPAC. The share of days assigned to the highest rehabilitation classifications codes increased from 7% to 58%.

The proposed rule for Fiscal 2019 also updates the SNF Quality Reporting Program to add costs of current measures so that CMS can better evaluate when the price outweighs the benchmarking benefit.  But the agency does expect to begin publicly displaying the four assessment-based quality measures, as well as displaying two years worth of data connected to community discharges and Medicare spending per beneficiary.