The L.A. Times had an article about finding a good nursing home for a loved one.  The article refers to Eric Carlson, a Los Angeles attorney with Justice in Aging, a national organization that works to fight poverty among seniors.  Carlson wrote “20 Common Nursing Home Problems and How to Resolve Them,” a consumer guide available free at www.justiceinaging.org.

Carlson and other experts highlight a few of the common problems faced by nursing home residents and their families.

Medicaid discrimination. Nursing homes rely heavily on reimbursement from Medi-Cal, California’s health insurance program for people with low incomes. The vast majority of facilities are Medi-Cal certified, meaning that they accept its reimbursement.   In California, about two-thirds of nursing home residents have all or part of their costs paid for by the Medi-Cal program, according to statistics from the California Assn. of Health Facilities.  But because Medi-Cal pays lower rates than most other sources of reimbursement, advocates say patients often receive second-class treatment.

“You’re more likely to get very low-level custodial care” when covered by Medi-Cal, Carlson says.

Nursing home staff may tell you that Medi-Cal doesn’t pay for certain types of care, such as rehabilitative services, Carlson says. But if the facility is Medi-Cal certified and the care is medically necessary, it is required to provide it.

Poor care planning. “The biggest complaint we get is the plain lack of care, not letting families get involved in the care planning and not following the care plan,” McGinnis says.

In addition, both the patient and his or her family have a right to be involved in deciding what kind of care will be delivered. Despite that, families are often iced out of the process, Carlson says.

Refusing to readmit after hospitalization. When Medi-Cal-funded nursing home residents are sent to the hospital for treatment, their beds must be held for seven days, during which time the home continues to be paid by Medi-Cal.

Instead, many nursing homes simply refuse to take the patients back — with the hope of replacing them with higher-paying patients.  Nursing homes, McGinnis says, would much prefer to have Medicare rehab patients because they may get paid as much as $600 a day compared with an average of $186 a day from Medi-Cal.

Fight back. Free support is available to families who need help getting the care to which they’re entitled.

The California State Long-Term Care Ombudsman Program works with patients and families to identify and investigate complaints: Call 800-334-9473, or contact the California Department on Aging at www.aging.ca.gov

California Advocates for Nursing Home Reform provides legal assistance, and its website,www.canhr.org, has a host of consumer fact sheets and other free resources.

Carlson says families get better care when they know their rights and speak up.

“Stand up for yourself,” he says. Doing so will not only help you and your loved ones, Carlson says: “You’re benefiting the whole system.”

In an article from CJonline.com, the author describes how some homes are trying to make it easier for potential patients to stay in their nursing homes. Aldersgate Village’s recovery center is a transition place for patients who have left the hospital but are not strong or healthy enough to return home. Many times these patients require short term rehabilitation, something that is traditionally done in nursing homes. However, as president and CEO Jerry Ney said, “Nobody wants to go to a nursing home.”

Thus, they have created an environment separate from the nursing home which is specifically for short stay patients requiring physical rehabilitation. The area is in a separate wing of the home, with its own facilities including dining and living spaces, private rooms, and therapy rooms. Marsha Anderson, marketing director for Topeka Presbyterian Manor said, “They feel very much like a nice hotel room.”

WBTW reported the following:

Two nursing homes in the Grand Strand and Pee Dee areas have been named in a report for repeat violations of health or fire procedures.  Heritage Home of Florence, located at 515 South Warley Street, was named in the report, along with The Lakes at Litchfield, located at 120 Lakes at Litchfield Drive in Pawleys Island.

The Coalition for Quality Care, a national coalition that supports quality care, used federal inspection records to name the nursing homes which had three or more years of repeat health violations.

The violations for Heritage Home of Florence include failure to create individual health care plans for patients, improperly installed electrical wiring causing a potential fire hazard, and improper storage of food. The Lakes at Litchfield is documented for having improper storage of food.

Click here to see the full report and to look up specific violations for each home in South Carolina.

Tri-City Herald and KCRQ had articles on the nursing home, The Perry Health Care Center, that neglected three patients that were transferred there after a state mental hospital closed.  One of the patients died and another suffered a broken leg. The Perry Health Care Center faces up to $13,500 in fines.

The inspection reports don’t identify patients by name, but the Des Moines Register interviewed family members who identified the three patients as Jim Hanson, Colleen Scassellatti and Carole Scalise, all of whom had been longtime residents of the Clarinda mental hospital before it closed.

Hanson had severe dehydration and a collapsed lung when he was hospitalized shortly before his death. Scassellatti suffered a broken leg in the shower, and Scalise wasn’t given her prescribed medication for six days.

Inspectors said nursing home staff acknowledged after Hanson’s death that they should have done a better job of monitoring the 65-year-old. Hanson’s brother and legal guardian, Tim Hanson of Altoona, said he was disgusted that nursing home staff repeatedly failed to assess his brother’s condition.  Tim Hanson said the most frustrating part of this is that state officials assured him the Perry nursing home was prepared to care for fragile psychiatric patients.

With Scassellatti, inspectors said the home’s staff was careless when helping her shower, and she fell while she was being lifted because a safety belt wasn’t used properly.

The third patient, Scalise, didn’t receive a drug that’s supposed to prevent blood clots for six days in July because the nurses couldn’t find it on the medication cart.  Janice Scalise said her sister’s condition deteriorated after she was transferred to the Perry facility. Carole Scalise was recently transferred to a different nursing home which specializes in treating elderly people with mental illnesses.

 

My hometown paper, The Spartanburg Herald, reported the sale of Cherokee County’s nursing home to MFI Healthcare LLC for $9 million.  The funds received from the sale of the facility would be set aside in a savings account, allowing the county to keep taxes low.  The Cherokee County nursing home is commonly referred to as The Peachtree Center.

Peachtree Centre Administrator Cindy Matthews said the facility provides skilled nursing, short-term rehabilitation and assisted living for residents. The county has owned the facility since 1973 when it started with 44 skilled nursing beds, Matthews said. Currently, 100 of the 111 beds at the facility are filled.

Matthews said the facility’s annual budget is $8 million, which includes funding through Medicaid, Medicare and private insurance. Matthews said once the sale is finalized, employees at the center will be evaluated during a 60-day period to determine whether they will keep their jobs.

Matthews said MFI Healthcare plans to continue operating The Peachtree Center as a skilled-nursing home facility. County Administrator Holland Belue said the sale will be finalized after paperwork is filed with the state Department of Health and Human Services and state Department of Health and Environmental Control.

HealthitOutcomes reported an interesting partnership between Yelp and ProPublica that is bringing medical information to the review site. Yelp will provide statistics for 4,600 hospitals, 15,000 nursing homes, and 6,300 dialysis clinics across the country, compiled by ProPublica from their own data and that of the Centers for Medicare and Medicaid Services (CMS). Updates will be provided quarterly.

As performance ratings and efficiency become increasingly important in healthcare, particularly with the Centers for Medicare & Medicaid Services (CMS) tying reimbursements to HCAHPS scores, public review sites are popping up to help consumers make the best decisions about their healthcare providers.

“Now the millions of consumers who use Yelp to find and evaluate everything from restaurants to retail will have even more information at their fingertips when they are in the midst of the most critical life decisions, like which hospital to choose for a sick child or which nursing home will provide the best care for aging parents,” Yelp CEO Jeremy Stoppelman said in a blog post.

The healthcare statistics will include:

  • Quality of doctor communication compared to state average in hospitals.
  • Whether hospital rooms are quiet at night compared to state average.
  • Emergency room wait times for hospitals.
  • Number of beds in nursing homes, as well as any fines paid out over the past three years and the number of serious deficiencies reported.
  • The number of dialysis stations in a particular clinic, and the rate of hospital readmission versus standard, and the rate of patient survival compared to the standard.

 

WDTN reported on the sad state of nursing homes in Ohio.  Nursing homes are supposed to be a place of care, rehabilitation, and cleanliness but many are not living up to that standard.

Bev Laubert is Ohio’s Long Term care ombudsman. She’s an expert on nursing homes. She says these surveys can tell you if nursing homes follow the rules. “These are minimums, so if a nursing home isn’t meeting the minimums it calls into question how high do they go. How high of quality do they provide?” said Long-term Care Ombudsman Bev Laubert. CMS tries to answer that question for families. It even has a rating system in place.  “A one star home is a problem,” said Laubert.

Before you put your loved one in a nursing home, do your homework, visit the facility and ask questions.

“You just intuitively pick up stuff. It tells you, look at the residents. Look at how their hair is combed, look at whether they are shaved. Are they out of their rooms? Simple little things,” said Jones.

Ventas Inc. announced that it would spin off 355 skilled nursing facilities and outpatient recovery centers into a new real-estate investment trust, the latest sign of the growing interest in highly specialized medical properties, which carry risk but have the potential for high returns.  The new company could have a market value of more than $5 billion based on trading multiples for similar companies, said Green Street Advisors, a research firm. Ventas, one of the largest owners of health-care properties, said the spin off would produce annual profit between $315 million and $320 million.

Demand for such facilities is rising as private insurers push patients to use skilled nursing facilities and outpatient facilities as an alternative to costly, prolonged hospital stays. As a result, larger companies are buying up such facilities, leading to more consolidation. “Broadly speaking, I think we’re seeing skilled nursing going from a fragmented private market to a consolidated public market,” Mr. Tyler said.

In October, Omega Healthcare Investors Inc. agreed to buy competitor Aviv REIT Inc. for $1.65 billion, creating the largest REIT focused solely on skilled nursing properties.

According to Green Street, buyers of skilled-nursing home assets are putting them in separate companies due to the high valuation the market has assigned to such properties. Omega’s shares, which have risen nearly 20% in the last six months, trade at a premium of 60% to the value of the company’s underlying assets. By comparison, shares of Ventas were trading at a 20% premium to their net asset value as of last week, while most REITs are currently trading at a premium of about 5%.

Overall, REITs that specialize in health care properties produced total returns of 35.5% last year, including dividends, making them the second-best performing real estate sector after apartments.

The National Investment Center for Seniors Housing & Care, a Maryland nonprofit that tracks investment in the medical real estate sector, reported that sales transactions involving senior housing and nursing care facilities rose 17.4% between 2013 and 2014, from $14.8 billion to $17.4 billion. Last year’s deals in the sector amount to nearly six times the annual dollar amount of deals in the first years of the downturn in 2008 and 2009.

REIT executives and analysts say that partnerships between large REITs and smaller operators of senior care and nursing facilities are becoming more common.

In August, Health Care REIT Inc., with a market value of $27 billion the largest REIT focused on medical properties, announced a partnership with Mainstreet Property Group, which develops senior housing properties and post-acute care centers, where patients receive treatment and live-in buildings that resemble hotels, complete with private rooms and even high-end dining facilities, after surgeries and other hospital procedures.

Under the deal the two companies struck, Mainstreet will complete construction of 62 post-acute and assisted living facilities using loans from Health Care REIT, which will retain exclusive rights to buy the portfolio, worth an estimated $1.4 billion, once it is built.

“Inpatient care at hospitals is becoming less and less relevant,” said Scott Brinker, Health Care REIT’s chief investment officer. “When we’re talking about an older person who has just had knee surgery, for example, and needs to recover for 20 days or so, that recovery is happening in a post-acute facility, rather than in a hospital. There’s been a significant increase in demand for that. Consumers want it, the payers want it, the providers want it. It’s a huge opportunity for growth.”

Despite the growing interest in skilled nursing and post-acute care centers, Ventas is still betting big on hospitals. Unrelated to the spinoff, Ventas also announced it would buy hospital operator Ardent Medical Services Inc. for $1.75 billion in cash. Ms. Cafaro said hospitals are still “at the top of the food chain in the health care business,” and benefiting from an influx of newly-insured patients.

See full article at The Wall Street Journal and Forbes.

Mary Ersek is a nurse and a professor of palliative care at the University of Pennsylvania School of Nursing.  She wrote an editorial for the New York Times.

Despite efforts to keep frail elders in their own homes, increasing numbers of people with dementia are likely to spend time in a nursing home. Nursing homes have evolved into a major industry. There are now over 15,000 nursing homes in the United States, which can house up to 1.7 million people. There is widespread fear about nursing home care, which in many cases is warranted.  Recently, for example, NPR ran a series of stories about the inappropriate use of dangerous antipsychotics in nursing homes. Before that, The New York Times published a heart-wrenching story about a woman’s harrowing efforts to rescue her father from the nursing home and allow him to die in his own home.

 However, there are national efforts to change nursing home culture, and many facilities have made strides in creating homelike environments and adopting care practices that are driven by residents’ and families’ preferences. We need to examine what works in the best nursing homes and apply their methods to all facilities

There are several names for the efforts to transform institutional long-term care, including relationship-centered care, person-centered care and cultural transformation. Common to all of them are the principles of palliative care: maximizing comfort and pleasure rather than cure or rehabilitation and providing care that is consistent with residents’ and families’ preferences. The major driver for care is what the resident and family want.

A critical element of this approach as applied to dementia care is training caregivers to understand the possible reasons for dementia-related behaviors that reflect distress and unmet needs. For example, agitation is common in people with dementia and is often treated with anti-psychotic medications. An alternative approach is to identify possible triggers to the behavior and intervene by changing the environment or routines.

Nursing homes across the country have developed and implemented their own system of person-centered, palliative care. A few have translated their approach into training programs, such as Comfort Matters and the Avila Institute of Gerontology. Other transformative projects are partnerships between academic institutions and community nursing homes.

The New York Times reported changes to the Nursing Home Compare website on CMS.gov.  The federal government announced that it was changing the way it measures nursing homes, essentially adjusting the curve that it uses to rate homes to make it more difficult for them to earn coveted four- and five-star government ratings.  Under the changes, scores are likely to fall for many homes, federal officials said, although they did not provide specific numbers.

“In effect, this raises the standard for nursing homes to achieve a high rating,” said Thomas Hamilton, the director of the survey and certification group at the Centers for Medicare & Medicaid Services, which oversees the ratings system.  Nursing homes are scored on a scale of one to five stars on Nursing Home Compare, the widely used federal website that has become the gold standard for evaluating the nation’s more than 15,000 nursing homes even as it has been criticized for relying on self-reported, unverified data.

In August, The New York Times reported that the rating system relied so heavily on unverified information that even homes with a documented history of quality problems were earning top ratings. Two of the three major criteria used to rate facilities — staffing levels and quality measures statistics — were reported by the homes and not audited or verified by the federal government.

In October, the federal government announced that it would start requiring nursing homes to report their staffing levels quarterly — using an electronic system that can be verified with payroll data — and that it would begin a nationwide auditing program aimed at checking whether a home’s quality statistic was accurate. 

The changes were part of a further effort to rebalance the ratings by raising the bar for nursing homes to achieve a high score in the quality measures area, which is based on information collected about every patient. Nursing homes can increase their overall rating if they earn five stars in this area. The number of nursing homes with five stars in quality measures has increased significantly since the beginning of the program, to 29 percent in 2013 from 11 percent in 2009.

The updated ratings will also take into account, for the first time, a nursing home’s use of antipsychotic drugs, which are often given inappropriately to elderly patients with dementia.