McKnight’s website has an article about Medicare overpayments (i.e. fraud) to nursing homes and estimate that the amount could be $130 million. Where did all the money go?

The federal investigation into these overpayments state that the Medicare program might have paid too much for hospital and laboratory services including double payments for services.  As a result of its findings, OIG recommended (not ordered) that the Centers for Medicare & Medicaid Services instruct payment contractors to "re-examine" records for overpayments and then move to recover them where appropriate. It also suggested CMS test and refine payment system protocols designed to identify such overpayments.
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The full audit report is available at http://www.oig.hhs.gov/oas/reports/region1/10600503.pdf.

 KSPR News has an article about a nursing home in Kansas that has introduced the video game Nintendo Wii to the residents.  This assists them in mobility, activity, and social interaction.  The activities director says a group of nursing home residents stay young by playing a game meant for their grandkids.  The activity room at the Ozark Nursing and Care Center is packed when it’s time for Wii.   When they play Wii, a light weight controller allows them to play a game they normally couldn’t.   There are more than physical benefits.  It gives the residents a sense of life outside the skilled nursing center.  

 The activities director says they’re sticking with bowling for now because it’s the easiest. They’d like to slowly introduce boxing and Guitar Hero. I hope this becomes universal in all nursing homes.

Washington Post has a great article by Marie-Therese Connolly about demographics and elderly abuse.  Ms. Connolly worked at the DOJ and has years of experience with the nursing home industry.  Below are some excerpts.

As though declining health, impending mortality and other challenges weren’t hard enough, too often old age is also plagued by abuse, neglect and exploitation.

Science has extended our lives dramatically: In 1900, Americans’ average life expectancy was 47. By 2000, it was 77, and it’s still rising.  Estimates of the prevalence of elder abuse vary wildly, but by some reports there could be up to 5 million cases a year, with 84 percent going unreported. All other factors being equal, victims of even relatively minor mistreatment are three times more likely to die prematurely than those who are not victimized.

Furthermore, our nation is in the midst of three seismic demographic shifts that will put seniors at even greater risk for mistreatment. Older people are living longer, until they’re frailer and more vulnerable. They are increasingly alone in old age, given that families are smaller and more geographically and emotionally dispersed. And the pool of potential caregivers is aging and shrinking. We need 30,000 geriatricians: We have only 9,000.

Neglect may sound more benign than abuse, but it usually lasts longer, is harder to prove and prosecute, and can be just as lethal.   Thirty percent of seriously ill elders surveyed have told researchers that they would rather die than go to a nursing home.  But while neglect of one person is tragic, systemic neglect by a facility or chain housing numerous residents can be catastrophic.

Facility owners may extract millions in profits, leaving insufficient funds to care for residents. Insulated by corporate structure, casting blame on facility staff, they are rarely held accountable.  But the news about staffing, the most critical factor in the quality of long-term care, is bleak: A government study in 2002 concluded that more than half of the nation’s nursing homes are understaffed at levels that harm residents. Nursing homes receive $80 billion from Medicare and Medicaid annually to care for 1.5 million residents.  Yet not a single federal employee works on elder abuse issues full-time.

Marie-Therese Connolly, a fellow at the Woodrow Wilson International Center for Scholars, is former coordinator of the Department of Justice’s Elder Justice and Nursing Home Initiative.

The Kansas City Star has an article about a study from the National Senior Citizens Law Center discussing clauses in nursing home agreements that violate the law.  Some admission agreements skirt state and federal laws, misleading consumers about the care they can expect and inducing them to sign away critical consumer protections.  Advocates for the elderly said the study raised serious questions about how some nursing homes operate.

The National Senior Citizens Law Center, a Washington-based nonprofit legal advocacy group for seniors and elder-care lawyers, reviewed 175 admission agreements voluntarily provided by nursing homes. The study found agreements which improperly limited a nursing home’s obligations. Others allowed discharges for vague reasons, or stuck relatives with bills they legally didn’t owe.

Toby S. Edelman, a spokesman for the Center for Medicare Advocacy in Washington, said similar studies in other states also show “ongoing concerns” with nursing home agreements.

The Missouri study found that nursing homes protect themselves by persuading seniors to waive their right to a jury trial. In 18 percent of the agreements, seniors were required to submit a dispute to arbitration, rather than sue in court.   Trial lawyers contend they have successfully fought the provisions in court as unconstitutional and unenforceable in health-care cases.

The study contends the agreements also thwart federal law by inserting provisions making it easier to evict residents. Federal law sets out six conditions that justify evicting a resident.

Carlson, the study’s author, said that under the federal reform law nursing homes cannot require a relative or a friend to become financially liable for nursing home expenses. Yet, the study found that 19 percent of the admission agreements required a financial guarantee “in direct violation” of federal law.   Such “co-guarantor clauses” are becoming more common.

Foxbusines.com has a good article about the difficulty the government has in evaluating funding levels for Medicaid.  The article insists that an expansive view of nursing homes industry is needed to determine funding needs.

The Bush Administration’s FY 2009 budget will include no Medicare funding update to help care for the growing number of seniors who need high acuity nursing home care.  The Alliance for Quality Nursing Home Care will work to demonstrate that Medicare funding decisions can be accurately determined only by taking a more expansive, complete view of the industry’s operating environment. 

This White House has often cited the work of the Medicare Payment Advisory Commission (MedPAC).   Alan G. Rosenbloom, President of the Alliance, stated, "On behalf of nursing home patients and the hundreds of thousands of caregivers who serve them, we are disappointed that again, MedPAC’s flawed funding policy guidance is being adopted, and superseding the economic realities experienced by providers in the long term care marketplace.  By failing to consider the substantial Medicaid payment shortfalls to nursing homes in formulating its recommendations, MedPAC provides the Administration, Congress and the public a flawed basis upon which to assess the funding landscape, and to ultimately determine the best policy." 

Medicare funding is important when states are cutting Mediciad to balance their budgets. 

SOURCE The Alliance for Quality Nursing Home Care

So its time for another one of my little rants.  There’s money to be made in the nursing home business, just like there’s money to be made in the assisted living business.  However, do you suppose the people actually doing the work are making the money?  If you said "no", you’re right. 

I ran across an article about Atria Senior Living, which is owned by a investment fund affiliated with Lazard, a large Wall Street firm.   Reportedly, the CEO of Lazard earned nearly $23 million in 2006 and is worth more than $2 billion.   Want to know how much the employees on the floor at Atria make?  Try $8 – $10 an hour. 

The employees of several Atria facilities decided to join together to unionize, but Atria and Lazard apparently began threatening and intimidating the workers not to unite.   There are so many victims here – residents that probably don’t get the quality of care they deserve, due to short staffing, or high turnover which leads to inconsistent care; and of course employees who are out there hands on caring for elderly residents and receiving "peanuts" in return.

What’s wrong with this picture?  When do we say 1) the elderly (our mothers, fathers, grandparents) are more important than million dollar salaries and 2) the people that choose to be their caregivers should be adequately compensated for it.

I’m not saying that CEO’s don’t work.  I was raised by one, and he still works hard every day.  I am saying that people deserve to be compensated for caring for our family members.  I am saying that nursing homes and assisted living facilities cost thousands a month to reside there.  A great deal of what you’re paying for is someone to care for you.  Those caregivers should be compensated accordingly.

For more information, visit www.improveassistedliving.org.

The News & Observer of Raleigh has an interseting article about the "new philosophy" of limiting or preventing nursing home residents from being in a wheelchair as long as the resident wants.

The article argues that older people’s health, mobility and self-image can suffer from too much time in wheelchairs. More than 24,000 North Carolina nursing home residents – about two-thirds of the total population – use wheelchairs as their main means of getting around.   

Ways to limit unnecessary wheelchair use are part of a movement that gives priority to the well-being of residents and their caregivers, above the functions of the nursing home or convenience of the staff.

The Midwest-based group called GROW – Get Residents Out of Wheelchairs – has taken up the cause on a national level. The nonprofit urges nursing homes to help residents use regular chairs, couches, recliners when sitting "is considered the norm and socially accepted." That includes for meals, TV watching, socializing with family and friends, and resting when tired.

Advocates acknowledge that wheelchairs have their uses for certain residents at certain times.
Advocates and academics say the downsides to spending too much time in a wheelchair are varied, but specific. They include a greater chance of pressure sores, significant discomfort and physical strain from operating chairs.

In addition, people in wheelchairs can be perceived as less able and are even spoken to differently in what becomes a self-perpetuating cycle of helplessness. Perhaps most importantly, loss of mobility can begin within a few days if someone starts using a wheelchair instead of walking.

Solutions are readily available in concept, but harder in reality. The GROW Coalition wants a requirement that nursing homes carry out a resident assessment before placing anyone in a wheelchair. In addition, lowered staffing ratios would let a center’s caregiver take more time with slow-moving residents.

Easier access to meals and other services should mean that more North Carolina nursing-home residents will be able to stay healthy and mobile.

I realize that this post might be a bit off topic but it shows the arrogance of insurance companies and their contempt and disdain for the rule of law.  Nursing home attorneys routinely see this when the insurance companies refuse to provide nursing home records or when they state an elderly resident’s life is not worth much because "they were already going to die" or when they blame neglect on resident complaince.

Allstate Insurance Co. told a judge that they refuse to produce key records to the Court no matter how much the Court fines them.  Judge Michael Manners has already fined them $25,000 a day since mid September — a total of $2.4 million and growing.

Last month the Missouri Supreme Court ordered the documents produced. At issue are the so-called McKinsey documents which show how Allstate set up a claims scheme in the 1990s that shortchanges clients while earning the insurance company huge profits.

Allstate still refuses to disclose the damaging documents.

The case stems from a car wreck seven years ago on Interstate 70. Allstate client Paul Aldridge of Hawaii ran into the back of a truck and severely injured the driver. He is suing Allstate for bad faith for refusing to pay the claim for years.

Here is an interesting article about attorney Ken Connor’s appearance for an advocacy group for nursing home reform.  The seminar was titled "Nursing Homes: A Failed Experiment,".  Connor’s appearance was sponsored by the advocacy group Kentuckians for Nursing Home Reform.

Connor said he classified nursing homes as "a failed experiment" because the current system puts the economics of the provider ahead of the life, health and safety of the residents.

"In other words, they put profit over people; they put revenue over residents," he said.

To increase profit, Connor said, staffing is cut. And some nursing homes are run by businessmen who have never been doctors or nurses and don’t have any expertise in the medical field. They are, however, good at making money.

It’s important for people to be educated about this issue — to know what to do if they are confronted with a problem and know where to file a complaint. It’s also good to know where to find support.

Connor urged the crowd to pay attention to signs such as pressure ulcers, infections, urine and feces-stained bed linen and foul odors. Also, the hollow eyes and parched tongues of loved ones display the lack of time devoted to them.

Connor said nursing home problems are pervasive throughout the country.   "Corral your congressmen and senators and make them understand the breadth of the problem," he said.

Kentuckians for Nursing Home Reform work to change state law so criminal background checks and random drug tests are required for all nursing home employees. They are fighting to ensure there is a minimum staffing standard.

Kentucky has cited about one in four nursing homes for serious deficiencies that caused "actual harm" or "immediate jeopardy". 

The headquarters of The Carlyle Group, a Wall Street Investment corporation that made our blog a few weeks ago when we wrote about its involvement with Habana Health Care Center (see Wall Street and Nursing Homes? and Nursing Home Profits), was the site of a demonstration Monday, October 22nd by nursing home advocates.  The Carlyle Group is in the process of taking over Manor Care Inc., a Toledo, Ohio-based nursing home chain with facilities across the country.  Manor Care has several facilities in South Carolina.  

The Washington Business Journal reports that the demonstration was organized by SEIU Healthcare, a health care workers union, and it’s purpose was to express worries caregivers and advocates have about the quality of care residents will receive after the the takeover as well as the status of jobs within the facilities.  As we blogged in previous articles mentioning The Carlyle Group, there is much data to support the fact that staffing numbers are cut and care quality goes down when Carlyle is involved.

On Monday, Carlyle made a pledge to quality care at Manor Care facilities saying that education, training, and staffing levels would ensue proper clinical care and all federal and state regulations would be met.  A Carlyle higher-up stated that "Manor Care is poised to become an even stronger health care provider under Carlyle’s ownership." 

A statement released by Carlyle said the acquisition of Manor Care is expected to be completed by the end of November.  I suppose only time will tell if Carlyle will uphold their promise to provide quality care to the residents of the former Manor Care facilities.  A statement released by the executive vice-president of the union that organized Monday’s event says advocates will continue to hold Carlyle Group "accountable for improving care and staffing at Manor Care." 

The Washington Business Journal also reported that the demonstration was planned to continue on Tuesday at Capitol Hill to lobby Congress to "hold hearings on private equity ownership of nursing homes."