The Associate Press had this story today.   Fifty-six nursing homes are among the worst in their states and are being called out in an effort to goad them into providing proper patient care.

Lawmakers and advocacy groups complain that too many facilities get cited for serious deficiencies but don’t make adequate improvement, or do so only temporarily.

The homes in question are among more than 120 designated as a "special focus facility." CMS began using the designation to identify homes that need more oversight.   The homes on the list got not only the special focus designation, but also registered a lack of improvement in a subsequent survey. 

There are about 16,400 nursing homes nationwide. About 1.5 million elderly people live in nursing homes. Taxpayers spend about $72.5 billion a year to pay the cost of nursing home care.

The AARP also applauded the administration’s action.

"People in nursing homes have a right to know how well they’re performing," said David Certner, director of legislative policy for AARP, an advocacy group for people 50 and older. "Their families certainly have a right to know what kind of care their relatives are receiving and if that care is substandard."

Here is the link to the list.

A nursing home abuse bill, the Elder Justice Act, has been under consideration in Congress but has yet to be passed. Although nursing home and elder abuse are serious and growing problems, the nursing home abuse bill has never even been voted on. While no one in Congress opposes the nursing home abuse legislation, few are trying to push it through the legislative process.

But the issue of nursing home abuse should be getting more attention, just based on the shear numbers of elderly affected by this crime. Though it concedes that the true number is probably much higher, The National Center on Elder Abuse estimates at least one in 20 nursing home patients has been the victim of abuse.

According to the National Center’s study, 57% of nurses’ aides working in long-term care facilities admitted to having witnessed, and even participating in, acts of abuse. The report sites systemic problems within the nursing home industry, like inadequate pay for workers and chronic understaffing, as contributing to the epidemic of abuse. There are nearly 1.4 million Americans living in nursing homes right now, and that number is expected to more than double in the next decade. As it does, advocates for the elderly and disabled fear that incidences of abuse will continue to climb as well. 

The Elder Justice Act would set up separate elderly justice offices in the U.S. Departments of Justice and Health and Human Services, provide $400 million for state adult protective services over four years and create a federal coordinating committee among agencies to monitor and direct the government’s efforts. The bill would also establish forensic centers around the country to probe elderly abuse cases and give local prosecutors more support in bringing cases. And it would penalize nursing homes if they did not report crimes swiftly. 

Staffing became an issue in the recent Kentucky Governor’s race.  Democrat Steve Beshear said that Kentucky needs to consider requiring minimum staffing levels at nursing homes, but Gov. Ernie Fletcher said the corporate owners should be allowed to determine how many nurses they hire.

Last night, Beshear said Fletcher’s administration has failed to protect seniors, citing a news story that indicated the number of citations for nursing homes has declined since the Republican became governor in 2003.

"We don’t have enough inspectors to go and enforce" laws that apply to nursing homes, said Beshear, a Democrat.

"I think it’s time to look at minimum staffing numbers," he said. "We’ve got to make sure the profit motive doesn’t interfere with the care motive."

Fletcher said the state doesn’t need to set minimum numbers of nurses for nursing homes saying that the state can ensure adequate care in other ways.

"We’ve closed nursing homes that needed to be closed," he said.

See article here.

The New York Times recently had an interesting article regarding Congressional leaders questioning the policy and practice of the insurance industry in long term care settings.  The top-ranking Republican on the Senate Finance Committee has asked 11 long-term care insurance companies to explain “troubling data” regarding how policyholders’ claims are handled and paid.

Senator Charles E. Grassley of Iowa, referred to data collected by the National Association of Insurance Commissioners, which indicated that nationwide complaints about long-term care insurance rose 92 percent from 2001 to 2006. The data also indicated that complaints involving claim denials resulted, in a majority of cases, in reversals that favored consumers.

“This is a pattern of error not typically found in other lines of health-related insurance,” the association wrote.

Senator Grassley has asked the largest long-term care insurers to provide detailed information on how policyholder claims, inquiries and denials are handled and whether employees receive rewards for denying claims.

This week, Mr. Grassley also asked the Government Accountability Office to examine how private equity ownership had affected the quality of care in nursing homes. In particular, Mr. Grassley asked the agency to examine how many nursing homes had been bought by private investment groups and how conditions had changed after those homes were acquired, and to examine the number of health and safety deficiencies cited by regulators at those homes.

A report in The Times last month said that private equity firms had bought thousands of nursing homes and then often cut expenses and staff, sometimes below minimum legal requirements, to increase profits.

The nursing home industry has also faced questions recently. The Service Employees International Union, one of the biggest labor unions, sent letters to Congress this week asking lawmakers to examine the proposed acquisition of HCR Manor Care, the nation’s largest nursing home chain, by the Carlyle Group, a private equity firm. “Profit for investors cannot come at the price of patient safety and care,” the union said in a statement.

The acquisition of Manor Care is not yet complete. But, the Carlyle Group said, “We expect to maintain the same high quality care that seniors and their families have come to expect.”

U.S. Senator Barack Obama today released a statement on the report in the New York Times on nursing homes.

"The news that some private equity firms have been boosting profits at the nursing homes they own by cutting essential staff and compromising the quality of care for our seniors is unconscionable and unacceptable. America’s workers and America’s seniors deserve better, and the American public deserves to know exactly what’s going on in these nursing homes."

‘I led the fight in Illinois to pass the Hospital Report Cards Act that required hospitals to disclose details on nurse staffing and the quality of care so that the everyone was aware how well their health care system worked. When I’m President, this kind of transparency will be a part of my universal health care reform that provides every American with affordable, quality health care."

I wish South Carolina enforced the nursing home rules and regulations and issue fines when neglect has occurred. To my knowledge, SC has never fined any "for profit" nursing home.

A nursing home was fined $100,000—the most severe penalty under state law—after investigators ruled that poor health care led to the death of a 76-year-old patient.
Pleasant Care Convalescent of Petaluma operates a 54-patient facility where a woman died March 12 from an infection, said Norma Arceo, a spokeswoman for the California Department of Public Health.

The woman developed an infection and died from complications in a hospital eight days later, Arceo said. Records showed the patient had extensive cavities and food debris throughout her mouth, causing large swelling in her neck. 

Here is the full article

Below is from the SC DHEC website. DHEC is the state agency that has the responsibility to oversee and supervise nursing homes in SC.  Typically, they do nothing.

Do you have a complaint to file?
We ask that you carefully read the following information before filing a complaint. If you have supporting documents, please submit a copy – do not send originals. Listed below is the information you will need in order to mail or phone in your complaint.

Investigation and resolution of complaints are a critical Division of Health Licensing responsibility. A complaint is defined as an allegation that relates to a condition, events relative to a licensed activity, or to an activity subject to licensure. The Department is required to investigate any written or verbal complaint which indicates that there may be a violation of the licensing standards.

Any individual making a complaint against a licensed activity or provider may do so anonymously. If a complainant reveals his/her identity and requests confidentiality, the Department will not disclose the complainant’s identity unless mandated by state or federal law.

Your complaint will be assigned to an inspector who will determine if the Department can assist you. Written acknowledgement of our receipt of your complaint will be sent to you. Because of record keeping requirements and the need for accuracy, we ask that your complaint be submitted in writing, however you may call us with your concerns.

To generate an investigation, the Department must receive a complaint from an individual regarding an expression of discontentment, concern, and/or distress which may involve the conduct of the staff, conditions of the activity, care of the clients, etc., in an activity licensed by the Department. These expressions of concern could also involve a potentially unlicensed activity which may be operating illegally. In all instances, there must be an identification of a possible violation of a licensing standard.

Once an investigation is completed, the inspector will send a written report to you. Please contact the Department if your complaint is resolved before you hear from us.

The Department cannot always resolve complaints to the satisfaction of all complainants; however, we will investigate the complaint based on the facts, the appropriate regulation(s), and advise you of our findings. Our complaint inspectors are knowledgeable about the regulations and have access to attorneys who provide legal guidance for the staff.

Complaints regarding concerns not under the jurisdiction of the Department may be referred to another state agency or local authorities as appropriate.

Complaints concerning abuse – physical, sexual or psychological, or financial exploitation, or neglect or abandonment of a resident, (whether the incident occurred inside or outside of the facility) will be referred to the Lieutenant Governor’s Office on Aging, (800) 868-9095.

Complaints concerning Medicare and Medicaid should be referred to the Department’s Certification Division.

It is preferable that you try to resolve your own complaint before contacting the Division of Health Licensing. However, if you have exhausted your efforts to resolve the problem without success, contact us for assistance.

The Department receives a large number of complaints which require varying lengths of time to resolve. Your patience is appreciated and we will contact you as soon as possible.

Jim Perrow, Customer Service
DHEC Health Licensing
2600 Bull Street
Columbia, SC 29201
(803) 545-4370
(803) 545-4212 (Fax)

 At a hearing this month concerning the state of the nursing home industry 20 years after the landmark Nursing Home Reform Act (better known as OBRA ‘87), Senate Special Committee on Aging Chairman Herb Kohl (D-WI) addressed the deficiencies of a system that has allowed some poorly performing nursing homes to escape penalties.

Testimony by the Government Accountability Office (GAO) presented at the hearing concludes that many nursing homes shown to be providing substandard care are still not being subjected to any sanctions, and are therefore not be motivated to make the lasting improvements necessary to protect the health and safety of residents.

According to the GAO, in 2006 nearly one in five nursing homes nationwide was cited for poor care or, more specifically, care that can cause actual harm to residents.

“Without question, the Nursing Home Reform Act improved nursing home care in this country. Today, many of the nation’s 16,000 nursing homes are providing adequate or excellent care. But shamefully, quite a few nursing homes are getting away with providing a lot less, putting a good number of the seniors living in long-term care facilities at risk. This is unacceptable, and raises questions about how and why our enforcement system is failing,” said Chairman Kohl. “This committee has a long history of closely scrutinizing the quality of nursing home care, and we intend to reaffirm that commitment.”

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State and federal officials announced today a $550,000 settlement in a fraudulent medical billing case against Green Valley Pavilion of Smyrna.

Members of the Delaware Attorney General’s Office medicaid fraud control unit and the U.S. Attorney’s Office determined that some of Green Valley’s employees were altering patient charts in order to get more money from the Delaware Medicaid Program.

Because the investigation showed that none of the nurses personally profited from the scheme, state and federal prosecutors pursued Green Valley for restitution due to Medicaid. After months of negotiations, Green Valley agreed to pay more than a half million dollars.

“Caregivers have been sharply reminded of their responsibilities to their patients, and nursing home owners are on notice that they will be held responsible for the acts of their employees,” said Deputy Attorney General Dan MIller, the lead prosecutor in the case. “We have already seen a drop in the amount of questionable reimbursement requests submitted to the Medicaid program.”

See article here

An Orleans County nursing home has been fined $75,900 by the federal government for failing to comply with quality care requirements.

Orchard Manor was cited for civil money penalties based on a survey in November. Civil money penalties are given out by the Centers for Medicare and Medicaid Services.

According to The Monitor, the amount of Orchard Manor’s penalty “does not reflect a 35 percent reduction as the facility did not waive its right to a hearing as permitted under law.”

Leroy Village Green Residential Health Care Facility in Leroy, Genesee County, also made the civil money penalties list, being fined $3,412.50 for results from an October survey.