AARP published an article on their website about the GAO Report detailing the lack of regulatory oversight for the emerging and very profitable assisted living industry.

“State Medicaid agencies are required to protect the health and welfare of residents in their assisted living facilities, including monitoring cases of abuse, neglect or exploitation. Yet 26 state agencies could not tell federal investigators how many critical incidents of this kind had occurred in the homes and other places under their supervision, the U.S. Government Accountability Office reported this week.”

State agencies also varied in what types of incidents they monitored, the GAO found. “A number of states did not identify other incidents that may indicate potential harm or neglect, such as medication errors [seven states] and unexplained death [three states],” says the report titled “Medicaid Assisted Living Services.”  See GAO Report on ALFs.

“Thirty-four states made information about critical incidents available to the public by phone, website or in person,” the report says, “while another 14 states did not have such information available at all.”

The reporting gaps prompted the GAO to recommend that federal officials keep a closer watch on state agencies to see that they properly monitor conditions in nursing homes and other facilities to protect residents.

The investigators recommended clarification of state requirements and annual reporting of critical incidents. Officials at the Department of Health and Human Services concurred with the need to clarify and said they would consider requiring yearly state reports.

Agencies in 48 states reported spending more than $10 billion on assisted living services in 2014, covering more than 330,000 beneficiaries.

The New York Times had an incredible (and scary) article on assisted living facilities. Billions of dollars in government spending is flowing to assisted living industry even as it operates under vague standards and limited supervision. “Federal investigators say they have found huge gaps in the regulation of assisted living facilities, a shortfall that they say has potentially jeopardized the care of hundreds of thousands of people served by the booming industry.”

The federal government lacks even basic information about the quality of assisted living services provided to low-income people on Medicaid according to the Government Accountability Office, a nonpartisan investigative arm of Congress.  The report provides the most detailed look to date at the role of assisted living in Medicaid, one of the nation’s largest health care programs. Titled “Improved Federal Oversight of Beneficiary Health and Welfare Is Needed,” it grew out of a two-year study requested by a bipartisan group of four senators.  See GAO Report on ALFs here.

States reported spending more than $10 billion a year in federal and state funds for assisted living services for more than 330,000 Medicaid beneficiaries, an average of more than $30,000 a person, the Government Accountability Office found in a survey of states.

States are supposed to keep track of cases involving the abuse, neglect, exploitation or unexplained death of Medicaid beneficiaries in assisted living facilities. But more than half of the states were unable to provide information on the number or nature of such cases.

Just 22 states were able to provide data on “critical incidents — cases of potential or actual harm.” In one year, those states reported a total of more than 22,900 incidents, including the physical, emotional or sexual abuse of residents.

Congress has not established standards for assisted living facilities comparable to those for nursing homes. In 1987, Congress adopted a law that strengthened the protection of nursing home residents’ rights, imposed dozens of new requirements on homes and specified the services they must provide.

Healthcare Finance News reported on how many for-profit chains are cheating the Five-Star Quality Rating System on Nursing Home Compare. The five-star rating system that Medicare uses to compare nursing homes is made up of three components: employing a base score from an on-site inspection, along with two scores from information on staffing and quality reported by the facility.  These overall ratings have climbed higher as self-reported scores have inexplicably trended upward.

A new study of nursing homes in California, the nation’s largest system, by faculty at Florida Atlantic University and the University of Connecticut found that nursing homes inflate their self-assessment reporting to improve their score in the Five-Star Quality Rating System employed by Medicare to help consumers.   Among the findings were that nursing homes that have more to gain financially from higher ratings are more likely to improve their overall rating through self-reporting.

The report states “We find a significant association between the changes in a nursing home’s star rating and its profits, which points to a financial incentive for nursing homes to improve the ratings.”

The National Memo reported on Trump’s plan to allow nursing homes to neglect and abuse vulnerable elderly resident to the point of death and not be subject to a fine.  Reacting to the demands of lobbyists and their campaign contributions, the Trump administration has struck down several regulations that increase the safety and well-being of residents. The New York Times reports that this now means several common citations that used to result in fines will either see reduced penalties or no penalties at all.

“The fines, designed to prod nursing homes into treating elderly Americans with more care, respect, and dignity, were put in place by President Barack Obama and sought to make the institutions answerable to standards put together by Medicare.”

According to federal data, CMS since 2013 has cited nearly 6,500 nursing homes for serious violations discovered during inspections required under Medicare and has fined about two-thirds of those facilities. The nursing homes were most commonly cited for bedsores, failing to protect patients from avoidable accidents, mistreatment, and neglect, Kaiser Health News reports.

The Hill reported that the nursing home industry (and their campaign contributions to Trump and the Republicans) have reaped the rewards.  The Trump administration is rolling back the use of fines against nursing homes that have neglected and abused resident sin their care.  The nursing home industry demanded the change in the Medicare program’s penalty protocols, The New York Times reported.  According to the Times, nearly 6,500 nursing homes have received at least one citation for a serious violation since 2013 and only two-thirds of those have been fined by Medicare.  Under the new rules, regulators are now discouraged from giving nursing homes fines, in some cases. Fines for some homes may also be decreased as a result of the new guidelines.

The American Health Care Association had argued that inspectors were focused on quality of care instead of “assisting” the facilities.

“It is critical that we have relief,” Mark Parkinson, the group’s president, wrote in a letter to Donald Trump, then president-elect, in December 2016.

The Centers for Medicare and Medicaid Services (CMS) is responsible for developing standards for rehabilitation facility and nursing home care (includes rehabilitation facilities) and ensuring those standards are met. Every nursing home that accepts Medicare and/or Medicaid is required by law to abide by the regulatory standards developed by CMS.

However, Federal regulations designed to protect the safety and well-being of residents in the nation’s nursing homes are facing mounting pressure from Congress.  A group of 146 lawmakers, many of whom have received substantial campaign contribution from the nursing home industry, has urged the Trump Administration to revise safety standards in nursing homes.   The industry contributed more than $2.5 million to the campaigns of 128 lawmakers who signed the letters, according to the website FollowTheMoney .org, which trackspolitical contributions.  The industry gave a total of more than $1.98 million to 104 House members, and $587,000 to 24 Senators, who signed the letters seeking the re-evaluation of the standards, according to FollowTheMoney.

Nursing home experts, and advocates for residents contend the regulations are needed for safety, quality of care, and transparency; the measures will expand care plans, offer greater freedom for residents, increase the amount of training for nurses and aides caring for residents with dementia and provide grievance officers to help handle complaints.  Nursing home residents have higher needs than in 1991, when federal regulations were first enacted. Nursing home care is one step below the hospital setting and half of all residents have a form of dementia.

The changes in the standards offer greater focus on residents’ safety and well-being, according to the National Consumer Voice for Quality Long Term Care , an advocacy organization in Washington, D.C. For instance, says the organization, the changes:

  • Would stress greater residents’ freedoms in choice, from food selection to daily schedules, such as when to go to bed and when to wake up. Also, visitors can stop by at any time.
  • Require nursing homes to perform a baseline care assessment within 48 hours of a resident’s arrival. The plan sets out initial goals for residents, including physician and dietary orders. Under the previous regulations, nursing homes could take up to three weeks to develop a care plan.
  • Include a grievance officer at each facility, who would handle complaints of residents and families. An infection prevention specialist would be added as well. This would not require an additional hire, as a nurse on staff, with increased training, could be assigned the position.
  • Add enhanced training for nurses’ aides to deal with residents suffering from dementia.

Advocates for nursing home residents have pushed for years for the CMS to come up with specific regulations for nursing homes regarding the number of nurses and nurse’s aides needed per shift.

Ashton Place Health and Rehabilitation Center nursing home has been hit with record fines after inspectors found widespread neglect resulting in actual harm to multiple patients including one who died after transfer to a hospital showed widespread wounds with maggots that apparently had gone untreated.  A male patient who was admitted to the home on July 26 of this year with no visible wounds ended up being transferred to a hospital for ulcers and ultimately died on Oct. 11 where hospital staffers found maggots in wounds that appeared to be untreated.

The 98-page inspection report cites multiple cases of patients suffering actual physical harm due to failure to follow a physician’s orders, failure to administer prescribed drugs and failure to inform physicians’ of their patients deteriorating condition.  According to the report, the home’s medical director stated, “I have support, no direction. I have talked (to them) about the staff they have here. I don’t have much confidence in them.”

The fines totaling $50,000 were imposed on the 211-bed nursing home.  In addition to the fines Tennessee Health Commissioner John Dreyzehner ordered a rare freeze of any new admissions to the facility and appointed a monitor to oversee its operations.

Neglect and poor care was also detailed for other patients, including a female patient suffering from ovarian cancer whose worsening condition was not reported to her doctor. She died on Oct. 24.

 The report was highly critical of managers at the facility and noted that top officials contended they were unaware of the problems reported by direct care staffers.  What is worse?  Knowing of a problem and ignoring it or not even being aware of what is going on at the facility?

See article at Commercial Appeal.

WFAA had a troubling investigative report on the care provided at nursing homes in Texas.  Part One is here.  Part Two investigates the nursing home industry hiring criminals to care for our loved ones.  A six-month WFAA investigation found 200 aides certified to work in North Texas nursing homes have serious or violent criminal histories.

The most troubling part is that current regulations in Texas allow many certified nurse aides (CNAs) with criminal histories to work in nursing homes legally.  The WFAA investigation found CNAs who have been “convicted of crimes that should make them ineligible to work, yet slipped through the regulatory cracks — and continue to remain state certified and employable.”

The WFAA review found CNAs with arrests for crimes that include the following: aggravated assault with a deadly weapon; continuous violence against family; injury to a child; abandoning a child; aggravated robbery; aggravated sexual contact with a child; and burglary.

There are three major oversight flaws, according to the WFAA findings.

Loophole 1: Inadequate initial background checks

The first involves the initial certification.

The state requires DPS to conduct a criminal background check prior to an applicant being certified. That’s different from Texas requirements in other industries, for example, like child daycare in which a national background check using fingerprints is required.

The WFAA review found the DPS checks apparently fail to uncover various state convictions. That’s resulted in nurse aide applicants getting certified, though they should be barred for life.

Loophole 2: No background check on re-certification

A second flaw appears in the re-certification process. The state requires a nurse aide to get re-certified every two years, yet does not require regulators to re-check a CNA’s criminal background.  Instead, any further background checks fall to the nursing homes.

WFAA found individuals who commit crimes that should bar them from work – and have their certification pulled – yet remain certified and employable.

Loophole 3: Deferred adjudication probation

The third and most common loophole WFAA found is buried in the state’s regulations. It says if you commit a serious or violent crime, you are eligible to become a CNA as long as you don’t have a “final conviction.”  WFAA found dozens of nurse aides who pleaded guilty to violent crimes. But since they got probation, the law allows the nursing homes to keep hiring them.

That means a nurse aide can commit a serious or violent crime, gain deferred adjudication, and successfully fulfill the terms of their probation, to avoid a “final conviction.” The individual, though often pleading guilty to a serious or violent crime to gain probation, remains eligible to be a CNA.

This can be very dangerous to any resident but especially those with dementia.  At minimum wage, a nurse aide must clean, bathe and feed as many as 30 residents at a time. That’s compounded by Texas’ lack of minimum staffing level requirements.

They have dementia, Alzheimer’s, symptoms that cause them to have a lack of communication,” said Ernest Tosh, an attorney who handles nursing home abuse cases across the United States.

They can’t express exactly what happened, which is why violent offenders should be screened out from working in these facilities,” Tosh said. “They can physically or sexually assault an individual and there be no repercussions because that individual can’t identify them or communicate what happened.”

I think our state needs to recognize that nursing homes are not as poor as they claim to be,” said J.T. Borah, an attorney who specializes in nursing home abuse and neglect. “If the industry were to finance and staff at the level they were supposed to, they could afford better employees. They could have better applicants.”

 

CBS12 Investigates uncovered reports of true horror stories happening at nursing homes across the country that should have been reported to law enforcement.  These cases include life threatening falls, starvation, even sexual assaults that were not reported.

 “We found that CMS, the Centers for Medicare and Medicaid Services didn’t have adequate controls in place to detect these potential instances of abuse or neglect,” said Curtis Roy, Assistant Regional Inspector General for Audit Services, OIG.

“CMS acknowledged that that they are not doing the data match to identify cases of neglect,” added Roy. “They also acknowledged that they have not identified any instances of nursing home staff not reporting cases as required.”

The audit found 38 cases that were so bad, by law the nursing homes were required to contact local law enforcement. But, they didn’t do it.

CMS must initiate protocols to adhere to a long-standing federal statute that requires nursing homes to report abuse cases to police and other state agencies immediately or risk fines of up to $300,000.

“They don’t care about those fines,” explained attorney Joe Landy. “It is business as usual. It is cheaper to pay those fines to keep these facilities understaffed with people that are not properly trained while they make record setting profits.  “It exposed what is a long-standing problem in Florida,” said Landy. “It exposed a nursing home that was making a huge amount of money with no accountability whatsoever.”

The Sun Sentinel had a great article on new reforms to increase safety in Florida nursing homes.  A dozen bills to reform nursing homes are under consideration in the Florida Legislature after 14 people died at a Hollywood, Florida, nursing home that lost power during Hurricane Irma.  Many of the bills require nursing homes and assisted living facilities to have generators capable of powering air conditioning in the event of a power loss.

The latest give new teeth to Florida’s Long-Term Care Ombudsman program, which records show has regularly turned up fewer complaints each year under Gov. Rick Scott.  The Ombudsman program, which is supposed to look out for residents in Florida’s 683 nursing homes and thousands of assisted living facilities, would be allowed to conduct undercover operations inside nursing homes, posing as patients or employees, to look for abuse and neglect.

The big boost to the state Ombudsman program is unique among the many bills. Another novel portion requires facilities to allow residents’ families to monitor them electronically as a safeguard against abuse.

The multitude of other bills includes:

SB 284: Filed by state Sen. Lauren Book, D-Plantation, this bill requires nursing homes and assisted living facilities to have generators that can power air conditioning in the event of a loss of power, and requires the Agency for Health Care Administration to conduct an unannounced inspection at least every 15 months to check and make sure the generator is in working order. The bill requires facilities to have enough fuel to power generators for five days.

HB 479: Filed by state Rep. Patricia Williams, D-Lauderdale Lakes, this bill requires an unannounced inspection by AHCA every four months. It also requires nursing homes and assisted living facilities to have generators to power air conditioning and enough fuel to last for five days.

HB 327: Filed by state Rep. David Richardson, D-Miami Beach, this bill requires AHCA to carry out an announced inspection each May before hurricane season and requires facilities to have generators that can power air conditioning and enough fuel to last four days.

SB 372: Filed by state Sen. Rene Garcia, R-Hialeah, this bill would require generators to power air conditioning and enough fuel for four days. It also requires AHCA to carry out an announced inspection in May before the start of hurricane season. Additionally, it requires the Public Service Commission to ensure that utility companies treat nursing homes and assisted living facilities with at least 50 residents that offer critical medical care as high priorities, similar to hospitals.

HB 443: Filed by state Rep. Emily Slosberg, D-Boca Raton, requires nursing homes and assisted living facilities to have current contact information on file with both residents and the state Long-Term Care Ombudsman. It also mandates that residents be allowed to access personal records on file at the facility.

SB 830: Filed by Farmer, this bill is identical to HB 443.

SB 558: Filed by state Sen. Daphne Campbell, D-Miami, this bill requires all health care facilities that provide overnight care — including nursing homes and assisted living facilities — to have generators that can power air conditioning and enough fuel for four days. The generators must be able to maintain conditions throughout an entire facility.

HB 435: Filed by state Rep. Larry Lee, D-Port St. Lucie, this bill establishes a matching grant program, funded with $5 million every year through 2023, so that facilities buying generators can get a dollar-for-dollar matching grant from the state on a first-come, first-serve basis. The grant is open to both public and private facilities.

HB 437: Filed by Lee as well, this bill requires facilities to have generators and enough fuel for seven days.

HB 331: Filed by Slosberg, this bill adds new language to the state’s patients bill of rights, requiring facilities to send an explanation for any relocation in writing to both a resident and the Long-Term Care Ombudsman.