The Dallas Morning News had an article about the amount of money Texas provides to nursing home residents who are on Medicaid.  The article emphasizes that the amount of money is directly related to the quality of care and shows how Texas treats its most vulnerable citizens.

Texas’ Medicaid program only reimburses nursing homes an average of $112.79 per patient per day – less than 48 other states.  Texas remains 30 percent below the national average of $163.27 per day.  Patient advocates and industry experts say Texas’ 49th-place ranking means that nursing homes can’t pay employees competitive wages. That in turn leads to high staff turnover, which hurts residents’ care.  It is no surprise that 28 percent of Texas’ 1,100 nursing homes received the worst rating and only 10 percent scored the best when Medicare announced its new nursing home ratings late last year.

The reimbursements now don’t even cover nursing homes’ actual costs and would need to increase to at least $125 a day for facilities to break even.  Skilled nursing care costs tens of thousands of dollars a year, so many nursing home residents eventually exhaust their personal assets and qualify for Medicaid, the federal-state health care program for the poor.

Nursing homes have tried to hold the line on their labor costs, but that leads to high staff turnover. It’s difficult to compete with hospitals, which pay better, so nursing homes routinely lose registered nurses, licensed vocational nurses and nurses’ aides.  "The average annual turnover rate is 87 percent for certified nurses’ aides," said Pearl Merritt, who leads a center task force on long-term care. "It’s a challenge to maintain high-quality care in a revolving-door environment."

Nurses’ aides can work at a McDonald’s for more than what Texas nursing homes are willing to pay them.

 

 

The Edmond Sun had a recent article about a 131 page investigative report that supports complaints against a nursing home in Oklahoma.  One of the complaints includes a lack of an effective system for investigating and reporting abuse and failure to consult with a resident’s physician when there was an injury.  The investigation was triggered by a Sept. 16, 2008, incident at Grace Living Center. On that day, a resident, Lester Pendergraft, allegedly sexually assaulted a 67-year-old resident.   Pendergraft has been charged with one count of rape by instrumentation.

A meager $10,000 penalty resulting from the investigation has been proposed by the Centers for Medicare and Medicaid Services. 

Documentation showed the victim’s daughter was notified at 8:45 a.m., 1 hour and 35 minutes after the incident occurred at 7:10 a.m. Edmond Police arrived shortly after they were notified, at about 9 a.m. The victim’s doctor was called between 8:15-8:25 a.m., shortly after he arrived at his office.

On Sept. 25, the detective assigned to the case said, “The facility did a poor job of protecting the evidence.” He said facility staff threw away evidence and washed the victim’s bed linens and clothing and Pendergraft’s clothing.   Why would the facility do that unless they were trying to cover up what happened?

According to the report, the facility’s staff should immediately notify the director of nurses and the doctor, get the resident out of harm’s way and assess the resident whenthere is an allegation of abuse or neglect.  “The resident was not assessed timely after the incident,” the report stated.

The detective said someone in charge said to another officer that he felt  “The situation was being blown out of proportion.”

Citizen advocate Wes Bledsoe, founder of A Perfect Cause, an advocacy organization for disability and elder rights, said when he read the report he was “deeply disturbed."  Bledsoe said what was most shocking was that the incident happened in the first place, that evidence was destroyed with either intent or by incompetence and that a staff member voiced concern about police blowing the situation out of proportion.  Furthermore, there were warning signs before the incident that Pendergraft posed a threat to residents. Pendergraft was entering rooms of residents without reason or explanation who could not call out for help.

According to the report, a certified nurse aide reported before the Sept. 16 incident that she observed Pendergraft touch another resident who was dependent on staff for assistance. The same day, Pendergraft was seen pulling up the shirt of still another resident who was dependent on staff for assistance.

 

The Pittsburgh Tribune Review had an article about the recent jury trial against a nursing home in a wrongful death lawsuit in which the family of a woman claims the nursing home was negligent in her care and caused her death.  The family of Olive Shaffer contends she received inadequate care during her stay at Harmon House in Mt. Pleasant.   Shaffer fell several times while living in the nursing home and died July 22, 2003, from injuries she sustained in her falls.

Jurors were given evidence that workers at the nursing home falsified records, violated internal policies which make up the standard of care, and were negligent in supervising Shaffer.   The Shaffer family contends that Shaffer fell several times in the nursing home in June, and the staff made insufficient efforts to prevent her from taking more tumbles.

The nursing home had a management company (Grane Healthcare Co) that was responsible for implementing policies and procedures and training staff on fall prevention. In the lawsuit, the family said Shaffer fell twice on July 15, 2003, and she suffered catastrophic injuries, including brain swelling. She died from her injuries a week later, according to the suit.

The nursing home’s defense is 1) Old people fall  2)  Falls happen and 3) Falls are not preventable. The only way to prevent it is to tie them up.

I hope the jury listens to the evidence and the defense’s frivolous and misleading arguments and awards substantial damages.

 

McKnight’s had an article about President Obama’s budget and how it will affect nursing homes.  It may be too early to tell but it looks like nursing home reimbursements will increase under the new budget.  Many nursing home operators are praising President Obama’s proposed 2010 budget for provisions that would help educate and train nurses.   The budget also proposes “bundling” of some Medicare funding for post-acute care.  The goal of bundled payments is to lower hospital readmission rates and decrease the overall cost of health care.

Larry Minnix, the CEO of the American Association of Homes and Services for the Aging, highlighted another part of the budget: a proposal to allocate $1 billion “to capitalize and launch the Affordable Housing Trust Fund to develop, rehabilitate and preserve affordable housing and increased funding for the project-based rental assistance program to preserve 1.3 million affordable rental units will help moderate income elders find and keep a place to call home.

 

Carolinalive.com had an article about the recent outbreak of a highly contagious virus at a Murrells Inlet nursing home. The South Carolina Department of Health and Environmental Control (DHEC) reports as many as 75 people have suffered symptoms of norovirus at the NHC nursing home in Murrells Inlet.

The virus is a stomach flu and can be spread if infection controls are not in place and practiced among the staff in the nursing home.   This is of particular concern for the elderly — as they can easily become dehydrated and can cause fatalities.

The nursing home is not releasing any information.  No visitors will be allowed until the virus is under control.
 

The AARP published a study of Tennessee nursing homes. They concluded that as staffing levels increased, the number of lawsuits against the facility dropped dramatically.  This seems obvious but nursing homes still only staff to the minimum levels anyway.   The report also concludes that tort restrictions on damages or caps does not increase the quality of care.  In other words, the savings that the nursing homes get with tort reform are not passed on to the residents but rather go into the pockets  of the corporate owners as profit.   Here is the link to the report.

We have also uploaded it here www.scnursinghomelaw.com/uploads/file/qualitynursinghomereporttn2009.pdf

Wickedlocal.com had a recent article about the wrongful death of a resident caused by the neglect and incompetence of the nursing home staff.  This death was clearly preventable if the facility was not understaffed and the employees were doing their jobs.

Julia McCauley was a resident who on the morning of Aug. 17, 2004, rolled her wheelchair unattended out the front door of the Life Care Center of Acton, and tumbled down a flight of stairs causing her death.  McCauley was not wearing a doctor-prescribed WanderGuard bracelet designed to set off an alarm and lock the doors if McCauley got too close to the exit.

Attorney General Martha Coakley’s office believes that McCauley’s death could have been avoided had she been wearing her electronic bracelet and that the nursing home’s parent company, Life Care Centers of America, is culpable.

Of course, Life Care Center officials deny any wrongdoing and refuse to accept responsibility.  What ever happened to accountability?  Life Care Center is charged with manslaughter and neglect of a long-term care facility resident.   If convicted, the Tennessee-based corporation would only face a possible fine not to exceed $6,000.

Life Care operates more than 200 facilities in 28 states, including several that have come under scrutiny in the past.  In 2005, the company paid $2.5 million to resolve allegations of billing Medicaid and Medicare for services that were never provided or were useless to the residents of a Lawrenceville, Ga., facility.

The Acton facility in the past was fined $2,112 in the fall of 2005 and $11,147 in December 2006 for various deficiencies found during routine state checks. In July 2007, state and federal regulators imposed fines totaling more than $164,000 for deficiencies that jeopardized residents’ safety. But the fines were rescinded after the facility promised to correct the deficiencies.

 

 

 

 

The Eldercare Work Force Alliance is a group of 25 national organizations joined together to address the immediate and future work force crisis in eldercare. It was formed in response to the Institute of Medicine’s 2008 report, "Retooling for an Aging America: Building the Healthcare Work Force."

Eldercare employs millions of individuals in the United States, and is projected to be the fastest-growing employment sector within the health care industry. Strengthening these caregiving occupations not only is vital to our social infrastructure and improving the quality of care, but also has the potential to drive long-term economic growth, particularly within low-income communities.

Alliance members believe that we can and must create a health care workforce that meets the needs of older adults and their families. As recommended by the IOM, our proposed solutions include:

Require a minimum of 120 hours of training for certified nursing aides and home health aides, including explicit geriatric care and gerontological content; and create minimum training standards/competencies for non-clinical direct-care workers.

Increase compensation for direct-care workers through means such as: a) establishing minimum standards for wages and benefits paid under public programs, and b) targeting reimbursements to ensure that public funds directly improve compensation for direct-care workers.

Increase compensation for clinical professionals and educators with geriatric and gerontological expertise—they will be needed to care for our frailest elders and their families, and to help educate the rest of the workforce.

Increase funding for federal and state programs that support development of geriatrics faculty and clinician training—such as Title VII and Title VIII.

Implement federal and state programs that provide incentives—such as loan forgiveness—to those entering careers caring for older adults.
 

Seattle Post-Intelligencer had an article about the recent SEC complaint filed against Sunwest for fraud.  Sunwest Management Inc. runs one of the largest chains of nursing homes in the country.

The SEC asserts that Sunwest lied to investors about its operations, concealed risks from them and exposed them to massive losses before Sunwest’s collapse.  The SEC also asked for an emergency court order freezing the assets of Sunwest.  Sunwest, which manages 250 senior housing projects in 37 states, had defaulted on a number of loans last year after it began to run out of cash and couldn’t tap into any more credit.

The government alleges that Sunwest misled investors by telling them the company had never missed a payment and would generate 10 percent returns. "In reality, at least half of the homes managed by Sunwest had been losing money, and investors were taking on huge risk for illusory profits."

McKnight’s followed up with an article describing the fraud as a Ponzi scheme.  Sunwest defrauded investors out of roughly $300 million in a Ponzi scheme.  According to the SEC, Sunwest raised $300 million from 1,300 investors between 2006 and 2008. Investors thought they were purchasing partial ownership of one of Sunwest’s facilities, and had been guaranteed an annual return of 10%.   Instead, Sunwest placed the money in one fund that it used to pay operating expenses, investor returns and other costs. Investors were never informed that many of the facilities they thought they had invested in were actually losing money.

I wonder how much money the officers and directors stole from the company before the collapse.  These people should share a jail cell with Bernie Madoff.

The nursing home industry spends millions of dollars per year on lobbyists, propaganda, and campaign contributions trying to get immunity, caps on damages, and passing legislation making it near impossible for victims of neglect and abuse from getting compensated.  However, it is clearly not needed nor is it consistent with the constitutional right to a jury trial.

The Ensign Group recently disclosed record results for the fourth quarter of fiscal year 2008.

Fourth Quarter Highlights Include:
Total revenue was $123.9 million, up 13.7%, compared to $109.0 million for the prior year quarter; Skilled mix by revenue increased 268 basis points to 46.4%;
EBITDA grew by $3.8 million to $16.5 million, an increase of 30.0% over the fourth quarter of 2007;
Same store operational skilled nursing occupancy increased by 62 basis points to 83.0%; and
Consolidated net income for the quarter was $7.9 million, compared to $6.2 million the year before, an improvement of 26.2%.

 

Fiscal 2008 Highlights Include:
Total revenue was $469.4 million, up 14.1%, compared to $411.3 million for the prior year;
Overall skilled mix by revenue increased 372 basis points to 46.9%;
Same store skilled revenue mix increased 370 basis points to 47.2%;
EBITDA grew by $14.0 million to $57.7 million, a 32.0% increase over fiscal 2007; and
Net income grew by 34.0% to $27.5 million from $20.5 million, while the net margin increased to 5.9%, up from 5.0% in 2007.
 

_________________

Sunrise disclosed reported financial results and operating data for the fourth quarter and the full-year 2008.  The Company reported revenues of $435.6 million and $1.7 billion for the fourth quarter and twelve months ended December 31, 2008, respectively, as compared to $403.0 million and $1.6 billion for the fourth quarter and twelve months ended December 31, 2007.

___________________

NHC also disclosed significant increase in revenue.  Revenues for the fourth quarter increased 7.22% from $153,865,000 to $164,969,000. Annual revenues increased 8.51% from $598,034,000 to $648,943,000.

_______________________

Advocat also had a great year.  They disclosed that revenue increased 2.9% to $74.3 million in the fourth quarter of 2008, compared to $72.2 million in the third quarter of 2008.   Net income from continuing operations was $1.3 million in the fourth quarter compared to $0.7 million in the third quarter.

For the fourth quarter of 2008 compared to the fourth quarter of 2007, key highlights include the following:  Revenue increased 4.3% to $74.3 million in 2008, compared to $71.2 million in 2007. Net income from continuing operations was $1.3 million in 2008 compared to $1.8 million in 2007. Diluted income per common share was $0.21 in the fourth quarter of 2008 compared to $0.28 in
2007.

With this type of revenue and profit, why does the nursing home industry keep lying to the public about the need for more restrictions on legitimate claims for compensation?  Greed is the only explanation.