The Anderson Independent Mail had two articles on national for-profit nursing home chain Orianna.  See articles here and here.  Orianna Health Systems is a Tennessee-based company that runs 13 Upstate nursing homes, more than any other provider.

One article discussed the quality of care issues at Orianna’s facilities in Greenville where residents complained that staff members were slow to respond to call lights; some reported waiting 50 minutes for requested pain medication without receiving it, according to the inspection report. A resident interviewed that afternoon said “call lights often yield no response and sometimes the resident must yell or shout for assistance.”

Another resident complained that staff members “seem upset that you rang your bell and they tell you to wheel yourself around,” according to the report, which also listed nine grievances that had been filed between March and August about slow responses to call lights.  Citing the failure to respond to call lights in a timely manner, the inspection report found that the nursing home had not provided care “that keeps or builds each resident’s dignity and respect of individuality.”

Linville Court at Cascades Verdae was one of three Upstate nursing homes where inspectors found a number deficiencies that exceeded state and national averages between April 5 and Aug. 25, according to the most recent records from the Centers for Medicare & Medicaid Services.

A total of 12 deficiencies were found at Greenville Rehabilitation and Healthcare Center, according to a July 19 inspection report. Eight deficiencies were found at The Arboretum at the Woodlands nursing home in Greenville, according to a May 4 inspection report.

One of the deficiencies at Greenville Rehabilitation and Healthcare Center involved a January incident in which a certified nursing assistant verbally abused a resident. The nursing assistant later resigned, according to the inspection report.

Another deficiency listed in the inspection report involved the nursing home’s failure to adequately address a 22-pound weight loss by a resident during a six-week period. The nursing home was also cited for a medication error rate of 11.1 percent, which is more than twice the acceptable rate.

The inspection report cited numerous environmental problems at the nursing home, including the presence of flies in the kitchen and other areas. The report said a resident was seen swatting files with a wash cloth in an activity/dining room.

Other deficiencies included a failure to provide proper treatment to prevent bed sores or heal existing bed sores and a failure to store, cook and serve food in a safe and clean way, according to the inspection report.

A state inspector also visited The Arboretum at the Woodlands in June in response to a complaint. According to the inspection report, a staff member was found asleep in the nursing home’s living room during an 11 p.m. to 7 a.m. shift on May 25.

Mikki Meer, chief operating officer for Orianna Health Systems, said in an email that her company “is proud of the continued improvement demonstrated in the recent survey results of its South Carolina facilities.”

Meanwhile the second article explains why the quality of care at Orianna’s nursing homes has gone down.  Orianna has serious financial problems as a result of mismanagement and the siphoning of funds to the corporate owner’s pockets.  Orianna has now fallen behind on lease payments for its facilities to Omega Health Investors, a Maryland-based healthcare real estate investment trust.

Taylor Pickett, Omega’s CEO, reported that since 2014, the occupancy rate at Orianna’s facilities has declined from 92 percent to 89 percent and expenses have grown by 6 percent while revenues increased only 2 percent.

As recently as July, Orianna was operating 48 skilled nursing facilities with 5,000 total beds in 11 states, according to the company’s website. The latest version of the website says the company is now managing 43 skilled nursing facilities with a total of 4,500 beds in seven states.

  • Nine of Orianna’s homes agreed to pay $4.46 million to settle lawsuits involving the deaths of 20 residents. That total includes three settlements adding up to $752,500 that were approved after last year’s name changes.
  • Inspectors found at least 525 deficiencies at the company’s Upstate nursing homes, according to the Centers for Medicare & Medicaid Services. The deficiencies included instances of neglect, possible cases of abuse that were not investigated and medication errors, as well as failures to eliminate hazards, properly prepare meals and treat residents with dignity. The most dangerous deficiencies resulted in 26 fines totaling nearly $495,000.
  • The company’s nursing homes were responsible for 47 percent of the inspection-related deficiencies and 49 percent of fines at Upstate nursing homes. Orianna’s facilities account for 38 percent of the overall nursing home beds in the region.

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.

WALB reported the complaints about the horrific conditions at Pinewood Nursing Home.  Virginia Toombs said her brother was living in horrible conditions at the nursing home during the last year of his life.  “It was the most disgusting thing I’ve seen in my whole life,” said Toombs.  “I’m glad he’s in heaven. I prefer him to be in heaven than in that place any day,” said Toombs.

Roaches everywhere, a sight that will make will make your skin itch.  “Everywhere I tried to sit in the room with my brother who was dying. They were in the bed. My brother was on an oxygen machine and they were crawling on the oxygen machine,” said Toombs.

Toombs said she brought it to the attention of some of the staff there who said they were already aware of the issue.

“I said, ‘This is disgusting. How can you all even work here?'” said Toombs.

The facility has a 1-star overall rating.

In August of 2015, the Federal Department of Health and Human Services and Centers for Medicare and Medicaid Services listed on its inspection report that the pest control company revealed to the inspector that the bill was not paid from July 2015 to December 2015 with a total of $1,313.00 owed to the pest control company.

Live roaches were found in two rooms, and dead roaches were found in the conference room.

In the most recent inspection completed five months ago, it details a much bigger problem.

They found bugs on a variety of surfaces on the walls, bulletin boards, and behind toilets.

The pest problem also mentioned rats.

The inspection report details that ‘The administrator revealed that the pest control company comes to the facility on a monthly and as-needed basis. She stated to the inspector that she felt as if the pest control program was effective.’

“Your parents in their last days or your family members they need to be in the best of care in their last days and not in a facility where their health is already bad and being infested by roaches and rats just makes it worse,” said Toombs.

When we reached out to the facility, their administrator gave us a statement saying “We are not aware of a pest control problem. We have pest control come twice a month. Any issues in the inspections have been taken care of.”


Next Avenue had an interesting article on how 4 states have lowered nursing home admissions. Nursing home care is the most expensive form of long-term care. According to the 2017 Genworth Cost of Care report, a private room in a nursing home now costs an average of $97,455 per year. A semi-private room runs more than $85,000.

“If you are hospitalized at age 65 or older, there is a one in five chance you will be discharged to a nursing home.   Certain states — like Minnesota, Maine, Oregon and Connecticut — have implemented policies that lower the chances of getting “stuck” in a nursing home, said Wendy Fox-Grage, a senior strategic policy advisory with the AARP Policy Institute and co-author of “State Strategies to Reduce the Risk of Long-Term Nursing Home Care After Hospitalization.”  The new report, released Oct. 6, highlights some of those innovative policies.

Minnesota: ‘Return to Community’

Minnesota uses “community living specialists” to work with older adults to get them back to their communities. The community living specialists, who are nurses or social workers, assist the nursing home to identify new residents who may want to return home. Then, after the residents return home, the community living specialists follow up with them to make sure they are getting the services and support they need over the following months.

Another Minnesota initiative lauded in the report is its Performance-Based Incentive Payment Program. This program rewards nursing homes with incentive payments for designing projects to lower their numbers of long-term residents.

Oregon: Downsizing Nursing Homes

Oregon does a better-than-average job of keeping people out of nursing homes by providing services in the community: just 3.3 percent of state residents age 85 and older live in nursing homes. (The national average is 9.5 percent, according to the AARP report.)

A 2013 law provided a financial incentive for nursing homes to buy another facility and then take the excess capacity out of use — a process known as “buy and close.” Some providers have diversified into hospice care, assisted living, home health and independent living, the report said.

Connecticut: Home Care for Older Adults

Connecticut’s Home Care Program for Elders provides financial assistance for home care services so older adults can delay or avoid going to a nursing home. There are varying levels of service depending on a person’s financial resources, but unlike other programs, those who don’t qualify for Medicaid are not automatically excluded.

The services may include housekeeping, companion services, home-delivered meals, a personal emergency response system, adult day care, assisted living, mental health counseling and minor home modifications. Family caregivers can receive payments of between $42.58 and $107.06 per day.

The program “represents a significant state investment in the delivery of home care services to people who, despite being at risk for nursing home admission, do not qualify for Medicaid,” the report said.

Maine: Getting to People Early

Maine has been working since the 1990s to limit nursing home admissions to the people who most need them, according to the report. It does that, in part, by mandating medical assessments before admission. Maine also provides prospective residents and their families with a “community plan of care,” which gives information about services they may be able to use instead of going to a nursing home.

The program also provides individuals with a service plan that has estimates of how much the home care services will cost. The service plan doubles as an authorization for payment by Medicaid, if the person qualifies, or the state-funded home- and community-based care services program.




Go Upstate reported that Cherokee County will be the home of a state-run veterans nursing home but state funding has not been confirmed.  Because the facility will be owned by the state, the $41 million needed for construction will come from the state budget.

Cherokee County County Council purchased a 60-acre parcel of land from the Batts family for $463,000.  The county is now in the final stages of transferring the land to the state so that the development process can begin.

“The commitment from the state was that this would be one of the sites they would build on as soon as they were funded,” he said. “We have an eight-year reversal of the land, which means the state has eight years to construct the facility. If they don’t, the land will come back to the county.”

Currently, South Carolina has three state veterans nursing home facilities — E. Roy Stone Veterans Pavilion in Columbia, Veterans’ Victory House in Walterboro and Richard Michael Campbell Veterans Nursing Home in Anderson.

Humphries said with the number of veterans in South Carolina closing in on one million, three facilities are simply not enough. Humphries said veterans and their families are driving 100 miles or more to access existing facilities.

“The bed wait for a state veteran’s nursing home in this state, today, is about six months,” he said. “That’s a big red flag when we have a population of more than 800,000 veterans.”

 In addition to the Cherokee County facility, others are planned in Florence County and Columbia, Humphries said.

Each nursing home will have 108 beds, and Humpries said having one in Cherokee County will provide better access for veterans within the county and those in surrounding counties like Spartanburg, York and Chester.


The Rand Corporation issued a press release about their new study showing that the average American’s lifetime risk of using a nursing home is substantially greater than previous research has suggested.  Among persons age 57 to 61, 56 percent will stay in a nursing home at least one night during their lifetime, according findings published online by the journal Proceedings of the National Academy of Sciences.

Previous studies have generally corroborated the U.S. Department of Health and Human Services’ estimate that only 35 percent of older Americans are likely to use a nursing home in their later years.

The average nursing home stay was 272 nights and for 10 percent of the study group, the stay was much longer—more than 1,000 nights. Out-of-pocket spending was similarly skewed, with 5 percent of older Americans needing long stays costing $47,000 or more over their lifetime.

“It is important to provide individuals and families a reliable assessment of the likelihood of entering a nursing home in retirement,” said Michael Hurd, lead author of the study and a senior principal researcher at RAND, a nonprofit research organization. “This information could help people make better decisions about how they or their loved ones will pay for the care they are likely to need.”



The graying of the U.S. population and growing numbers of Americans needing expensive, long-term care for dementia could cause the rate of nursing home use to keep rising and increase pressure on Medicaid to cover the costs.

“People think of Medicaid as being for the indigent, which is true at younger ages,” he said. “But Medicaid is the most important payer for nursing homes, covering a greater proportion of costs than individuals and families pay out-of-pocket. At older ages, Medicaid is an insurance program that many of us may need to use.”


Having children, the study notes, does not lessen the chances of needing a nursing home in old age, but can reduce the length of the stay and cut the associated costs by as much as 38 percent. Having daughters able to provide in-home care was correlated with even larger savings.

Funding for the study was provided by the National Institute on Aging. Other authors of the study are Pierre-Carl Michaud and Susann Rohwedder.

The RAND Labor and Population program examines issues involving U.S. labor markets, the demographics of families and children, policies to improve socio-economic well being, the social and economic functioning of the elderly, and economic and social change in developing countries.

SC Now reported on the progress for a new Veterans Affairs nursing home in Florence.  U.S. Sen. Lindsey Graham says Florence will get the major Veteran Affairs facility that’s been talked about locally for months.

Graham was in Florence last month for the grand opening ceremony of the county’s new VA Administration Building.  He reassured everyone that a new VA nursing home is in the works with support in Washington, D.C.

“There will be one coming to Florence,” he said. “There’s a real big demand and a short supply, and a VA nursing facility is a lot less expensive for our veterans. Of all the things lacking in the VA, quality nursing homes are at the top. Many of them, like the one in my hometown, have a waiting list a mile long.”

Officials close to the project have said the Florence facility is expected to take up approximately 20 acres, contain more than 100 beds, bring roughly 110 new VA staff members and come with a price tag of $35 million to $40 million.

State Senate President Pro Tempore Hugh K. Leatherman Sr. of Florence first spoke of the project last November, saying he was working to get one facility in Florence and another in the Upstate, as opposed to a larger facility in Columbia.

Though details were not provided, Leatherman said that land acquisition in Florence is being finalized on National Cemetery Road near the Florence Stockade. “There are a lot of veterans in the Pee Dee, and many of them don’t have the means to drive across the state, and neither do many of their families. It’s more beneficial to the people of this state to have multiple facilities.”

Graham said spending more money on veteran’s care will pay off in the long run with veterans of Vietnam aging and veterans of wars in the Middle East not far behind.

“The VA and the defense department is just a small percentage of overall spending,” Graham said. “About 74 percent of government spending is Medicare, Medicaid and other entitlement programs. The VA isn’t what’s putting us in debt; it’s the unlimited growth of entitlements.”

The Casper Star Tribune reported the settlement between SavaSeniorCare d/b/a Poplar Living Center and resident Gilbert Arellano.  The lawsuit involved a facility employee driving a van into the blind resident standing near the curb waiting for a ride in March 2014. Arellano was knocked to the ground, and injured.  The nursing home did not have someone stand with Arellano while he waited for his ride on the handicap ramp and the man was unable to avoid the danger himself because he is legally blind, the suit says. The suit alleges the facility failed to meet the legal standard of care because it is understaffed, did not accompany Arellano to the curb and allowed an employee to “negligently operate” a company van.

Since the incident, Arellano has had pain and numbness in his right arm.  The amount of the settlement reached on Nov. 1 could not be disclosed because of a confidentiality agreement.

The suit also alleges that SavaSeniorCare, the company that owns the Casper nursing home, kept staff numbers low and didn’t adequately train employees to save money, thus endangering the residents. That allegation is repeated across many of the other lawsuits. The Centers for Medicare and Medicaid Services also cited Poplar Living Center for understaffing the facility.

According to its website, SavaSeniorCare operates more than 230 nursing homes across the country, including two more in Wyoming: Cheyenne Healthcare Center and the Sheridan Manor.

“The nursing home’s settlement was the most recent conclusion to six wrongful death or personal injury lawsuits filed against it in the last six years. Repeated inspections by the Centers for Medicare and Medicaid Services also detail a pattern of understaffing, improper care and unsafe building conditions.”
The facility is on the Special Focus Facility list that needs close monitoring because of a “history of persistent poor quality of care.”   Inspection records show a pattern of the for-profit Sava nursing home failing to employ enough staff to keep residents safe, take care of residents who showed signs of depression and investigate complaints of neglect.
Improper wound care is repeatedly cited in the reports. The presence of pressure ulcers is an indicator of neglect and short-staffing.  One resident arrived at the facility in January 2015 without any wounds but developed open sores on her buttocks and legs in March.  The nursing home administrator told inspectors in January, “I’m nowhere near where I want to be in terms of staffing,” according to the agency’s Jan. 15 report.  According to a March 2015 report, there were many nights where only one nurse and one nurse’s assistant were in the building to care for more than 100 residents — many of whom require assistance to use the bathroom and navigate other simple tasks.

The reports repeatedly note that the nursing home fails to adequately record, investigate and resolve complaints about living conditions.  Residents who needed help using the bathroom reported they often waited long periods of time — sometimes up to eight hours — before they were taken to the restroom. One resident wandered the halls of the facility just after 8 p.m. March 29, 2015, with urine-soaked pants for at least 25 minutes before being helped.

Residents also told inspectors that the food served was inedible. A district manager who sampled a meal of steak and noodles also said the food was “not palatable,” according to the reports.

Families of previous residents have sued Poplar Living Center at least six times in the past six years alleging that negligence led to the death and serious injury of their loved ones. The nursing home settled four of those suits for undisclosed amounts and one is still ongoing.

NPR reported on what hospitals can and do tell patients looking for information on long term care alternatives.  “For years, many hospitals simply have given patients a list of all the skilled nursing facilities near where they live and told them which ones have room for a new patient. Patients have rarely been told which homes have poor quality ratings from Medicare or a history of public health violations, according to researchers and patient advocates.”

This is how some residents get admitted to bad facilities without the family knowing. Now, new rules will allow and require information to be shared.

Hospitals must provide patients with all nearby options, but the new rule says hospitals “must assist the patients, their families, or the patient’s representative in selecting a post-acute care provider by using and sharing data” about quality that is relevant to a particular patient’s needs for recovery.  The rule was drafted in October 2015.

Kindred Healthcare is exiting the skilled-nursing home business to focus on its better-performing home health, rehabilitation and long-term acute-care hospital units.  Kindred once operated 300 facilities and has been pruning the number over the years.  Kindred, ranks as the tenth largest nursing facility company in terms of skilled bed capacity. As of the end of last year it operated 90 facilities in 18 states, with a total of 11,535 beds.

The decision to leave the skilled nursing sector is the “final step in a process that began years ago,” Benjamin Breier, president and CEO of the Louisville-based long-term care provider said.

“We are taking proactive strategic steps to position Kindred for long-term success against the backdrop of dynamic changes in the healthcare services industry,” Breier said. “Our plan to exit the skilled nursing facility business, together with the significant cost realignment initiative we are undertaking in connection with the exit, are substantial steps forward in our continuing effort to transform Kindred’s strategy and growth profile to enhance shareholder value.”

The company forecasts annual revenues of $7.2 billion for 2016, a number slightly lower than initial estimates due to “significant headwinds facing the skilled nursing facility business,” Breier added.

Kindred Healthcare and Ventas Inc., a healthcare real estate investment trust, have reached a deal that will hasten its exit from the skilled nursing home business. Kindred has agreed to pay Ventas $700 million for 36 nursing homes Ventas owns and leases to Kindred. Kindred contractually needed consent from Ventas to sell or transfer the homes to another operator.

Kindred remains “optimistic” about the potential growth for its home health, hospice, community care, long-term acute care and inpatient rehabilitation facility businesses, he said. When the reorganization is complete, approximately 50% of revenues will come from the home health division, the company announcement said.