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.




The Chicago Sun Times had an article about the excessive cost of long term care.  Long-term care costs are surging again and the most expensive option — a private nursing home room — may soon top $100,000 per year.  This is shocking considering the epidemic of abuse and neglect in the nursing home industry.

The median cost of care increased an average of 4.5 percent this year, according to a survey released by Genworth Financial. The cost of home health aide services rose 6 percent, to $21.50 an hour. Private nursing home care now costs more than $97,000.

“Long-term care can impose a crushing financial burden on individuals or families in part because Medicare, the federal health coverage program for people over age 65, provides limited help. That can force people who don’t have private coverage to spend down their assets until they qualify for the government’s health insurance program for the poor, Medicaid.”


Reuters had an interesting article about a recent study showing that nursing home care is increasingly being delivered by specialized nurses and physician assistants instead of medical doctors.  “One of the problems is that many nursing homes have no regular doctors, since it is not a requirement,” Dr. Mitchell Katz, director of the Los Angeles County Health Agency told Reuters Health by email. “Most nursing home patients have a private doctor who signs the orders for the nursing care, but it is at an office where they may not be able to get to the nursing home on a regular basis.”

“In the past decade, the number of doctors in nursing homes has dropped as the number of “skilled nursing facility specialists” has almost doubled, the researchers report in JAMA Internal Medicine.”

The research team found that the proportion of physicians who had ever billed for care delivered in these facilities fell from 13.7 percent to 9.8 percent. Although the number of physicians classified as skilled nursing facility specialists rose from 1,496 to 2,225, that represented an increase from just 0.3 percent of all physicians to 0.5 percent.

WSPA reported on the new $41 million 108-bed facility to house honorably discharged vets, paying about $34 per day.  County leaders decided on a location, but aren’t revealing where the 35 acre property is going to be.  The state is building three new veterans nursing homes, including one in Cherokee County.  According to the United States Department of Veterans Affairs, a 2014 survey found more than 100,000 Vietnam War veterans in South Carolina.

“We need to do everything we can to make sure our veterans are taken care of,” said Cherokee County Veterans Service officer Todd Humphries.

The facility will come from federal and state funding. Humphries says it would also bring almost 200 jobs to the area.

“There will be doctors, nurses, dieticians – all sorts of medical staff and non-medical staff,” he said.

Once the federal dollars start rolling in, county officials hope to break ground as early as 2019.

While many senior citizens sleep less than younger adults, they actually need the same amount of sleep in order to stay healthy. Continue reading to learn more about seniors and sleep.

Studies have shown that 13% of men and 36% of women who are age 65 or older require at least 30 minutes to fall asleep. This inability to fall asleep quickly (if at all) is often coupled with frequent waking throughout the night. While it is true that sleeping patterns change as we age, it is important that senior citizens get the amount of sleep they need to stay healthy.

How Much Sleep Do Senior Citizens Need?

The average person needs seven to nine hours of sleep per night to perform at their best. Though many senior citizens get less sleep than the recommended amount, they actually still need these critical hours of rest.

While the specific amount of sleep needed varies from person to person, it does not change as we age. In other words, if you required 7 hours of sleep in your mid-twenties, you will likely need a similar amount of rest for the remainder of your life. So, while many senior citizens may seem spry, despite rising before dawn, there may be a plethora of underlying issues. Read More →

I saw the below on MedGadget and thought it was worth sharing.

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As part of the Affordable Care Act’s provisions, expansion of Medicaid benefits has become available to all state governments that accepted the deal in 2014. Many states, however, are declining to participate in the expansion, despite the fact that it would be allocating tax dollars, already given to the federal government by the states, back to their poorest residents to cover their Medicaid costs. The plan outlined in the ACA provides for 100 percent of the funding of the expansion through 2016, and 90 percent of funding through 2022, which would go towards providing those who fall into the Medicaid eligibility gap with health insurance. Qualifying individuals whose total income falls up to 138 percent of the federal poverty line would then be covered with the health insurance they need so they won’t have to rely solely on over-capacitated free health clinics for health care.

While it would seem that any state governor would welcome a chance to provide healthcare for their most underprivileged residents, many governors are actually declining to accept the funds for Medicaid expansion because it is a provision of President Obama’s Affordable Care Act. South Carolina, North Carolina, and Georgia are among the 19 states that currently are not expanding Medicaid. These 19 states in total represent 6 million Americans, who would be eligible for coverage under the expansion, who are not receiving health insurance because their states have failed to expand the program. South Carolina, North Carolina, and Georgia have 292,000, 593,000, and 682,000 residents, respectively, who will go without health insurance because of the states’ failure to accept the expansion.

Recognizing that this is a partisan issue, many Senate Democrats have begun to ask their Republican governors to put politics aside and “do the right thing” by expanding Medicaid in their states. Proponents of expansion say that everyone will save money by insuring individuals who would otherwise cost hospitals billions of dollars by seeking treatment without health insurance.  Supporters of expansion are still calling for a change of mind (and heart) by the governors who are against the effective policy.

Perhaps White House Principal Deputy Press Secretary said it best when he said, “The states that have blocked Medicaid expansion face a consequential choice: They can score short-term political points by attacking the Affordable Care Act and blocking Medicaid, or they can take action to save taxpayer dollars and extend access to thousands of citizens to quality affordable health care. For those politicians with the courage to put the interests of their state and their citizens ahead of politics, it shouldn’t be a tough choice.”

Own or lease? This is a common question that senior facility operators have. Experts agree that there is no “one size fits all” answer to this question. What is right for one operator or facility may not be for another one. With so much at stake, how can an operator be sure that he is making the right decision for his facility?

Cambridge Realty Capital has created an informative and compelling video series, “Message from the Founders”, to answer some of these common questions, providing insights based on hands-on experience in the industry.

“Owning vs. Leasing in Senior Housing” specifically addresses the critical question, “Should I buy or should I lease?” and is available for viewing 24 hours per day on Cambridge Realty Capital’s YouTube Channel, “ePulseLive.”

Cambridge Realty Capital’s “Message from the Founders” page.

Privately owned since its founding in 1983 as a real estate investment banker specializing in commercial real estate properties, Cambridge today has three distinctive business units: FHA-insured HUD loans, conventional financing, and investments and acquisitions. The company is one of the nation’s leading nursing home, assisted living and healthcare debt and equity capital providers, with more than 500 closed transactions totaling more than $4.6 billion since the early 1990’s, when the firm began its specialization in providing senior housing capital.

Nursing homes with visiting physicians or providers should uncover their troubled histories with Medicaid or Medicare programs in other states or face billing nightmares, and worse, federal scrutiny.  Reuters investigation has revealed that practitioners often go undetected as practitioners in one state after being involved with or kicked out of programs in another state.

Reuters found that more than one in five of the thousands of doctors and other healthcare providers in the U.S. prohibited from billing Medicare are still able to bill state Medicaid programs – a violation of the Affordable Care Act provision that requires states to suspend the billing privileges of most providers who have been “terminated” or “revoked” by another state or Medicare, Reuters reported.

The news organization exposed about 1,800 providers who had slipped under the radar. After reviewing the list, 32 states and the District of Columbia supplied data showing they paid at least $79 million to 269 of the providers after their terminations elsewhere. Reuters said possibly “hundreds of millions” of such claims have likely been made since so much of it goes unnoticed because of inadequate state and federal data.

Georgia’s health department terminated optometrist Dr. Jeffrey Sponseller on Feb. 20, 2013, the same day he pleaded guilty to Medicare fraud. He claimed that in a single day, he conducted 177 eye exams that would have taken 132 hours to perform.  Sponseller remained on South Carolina’s Medicaid rolls for almost a year afterward, until Reuters asked about him.  Sponseller, now serving a 33-month sentence in federal prison, was unavailable for comment.

If you hadn’t brought this to our attention, we don’t know when we would have known about this,” said Kim Cox, director of communications for the South Carolina Department of Health and Human Services. South Carolina has not attempted to recoup the money.  


The Banghor Daily News reported that the owner of several assisted living facilities will pay $300,000 to resolve a federal lawsuit charging it allowed a subcontractor, RehabCare Group East, Inc., to routinely submit inflated Medicare claims for rehabilitation.  The federal government charged that before Oct. 1, 2011, Rousseau submitted or caused the submission of inflated Medicare claims for providing “unreasonable, unnecessary, unskilled rehabilitation therapy, or therapy that was not provided at all,” Ortiz said.  The federal government alleges that even after Oct. 1, 2011, Rousseau Management failed to prevent a number of other practices of RehabCare Medicare reimbursement, including automatically placing patients in the highest reimbursement level and reporting that time spent providing unskilled palliative care was time spent on skilled therapy.

In March, Bangor nursing home Ross Manor agreed to pay $1.2 million to resolve similar allegations concerning claims for therapy purportedly provided by RehabCare Group East, Inc. The rehab provider was part of similar settlements in Massachusetts, Minnesota and Missouri.

Rousseau Management Inc. owns Horizons Living and Rehab Center, Skolfield House, and Dionne Commons in Brunswick and previously provided administrative management services to Amenity Manor nursing home in Topsham.

Rousseau Management subcontracted with RehabCareGroup East, Inc., a subsidiary of Kindred Healthcare, Inc., to provide rehabilitation therapy at Horizons Living and Rehab Center and Amenity Manor, according to a release from Massachusetts U.S. Attorney Carmen M Ortiz.

These defendants allegedly made decisions based on profitability, rather than on patient care,” Vincent B. Lisi, special agent in charge of the Federal Bureau of Investigation in Boston, said in the release. “These actions not only affect patients, but have a ripple effect on taxpayers who pay into the system. The FBI will continue to work with all of our law enforcement partners to make sure those who abuse the health care system are brought to justice.”