WREG reported that maggots were found inside the wound from an amputation according to police.  Memphis Police said they are investigating an elder abuse case involving a patient.  According to a police report, the elderly resident of Ashton Place was transferred to the hospital after he started running a high fever. Hospital workers discovered five open wounds to different parts of his body and a bruise to his stomach during treatment.  Ambulance service employees also said they had found the man in feces.

“Even the police got violently ill witnessing that,” the victim’s daughter said.  “I’ve been in the medical field for a while and this is one of the worst I’ve ever witnessed and this is my father,” the victim’s daughter said. “It’s indicative he wasn’t getting basic care.”

As nurses were treating the individual, they discovered the staples had not been removed from his right leg and the bandages were labeled “October 7.”

 

HCR ManorCare, one of the largest U.S. nursing home operators, has a deadline tomorrow in a dispute over unpaid rent, a growing problem in an industry where eviction would put thousands of elderly out on the street.  In a lawsuit filed in August, HCR ManorCare’s landlord, Quality Care Properties Inc, said the chain owes more than $300 million in rent at its 292 skilled nursing and assisted living locations.  Many nursing home chains spun off their properties to real estate companies over the last decade to siphon money and increase profits.  ManorCare is the largest senior housing chain in financial distress but other over leveraged chains are losing profits because of mismanagement, declining reimbursements, higher management costs, and increased federal scrutiny over improper billing.

ManorCare must respond tomorrow.  Generally, a landlord can evict a tenant who fails to pay rent.

“However, because the leased properties care for approximately 30,000 patients – many of whom are elderly, vulnerable and require specialized care – abrupt eviction could cause substantial harm,” Quality Care said in its lawsuit, filed in California state court on August 17.

With more skilled nursing facilities defaulting on leases, property owners are increasingly looking to receiverships as an alternative to evictions or bankruptcy, lawyers and advisers told Reuters.

A receiver can ensure continuity of care for patients and residents while preparing the facility for a transition to a new owner or operator. The process is cheaper and more stable than bankruptcy proceedings.

 

AARP reported on CNN’s investigation into Nuedexta. “A “little red pill” being aggressively marketed to long-term care residents is bringing in more than $100 million a year in Medicare money for its manufacturer, even though it “may be unnecessary or even unsafe,” CNN is reporting.”

“The drug, Nuedexta, is approved to treat pseudobulbar affect (PBA), a relatively rare condition marked by uncontrollable laughing or crying. However, the pill “is being propelled by a sales force focused on expanding the drug’s use among elderly patients suffering from dementia and Alzheimer’s disease, and high-volume prescribing and advocacy efforts by doctors receiving payments” from manufacturer Avanir Pharmaceuticals, CNN reported.”

The full report, which also contains details about possible health risks of Nuedexta, can be found at CNN.com.

The Washington Post reported how Big Pharma bullied and bought the Federal Drug Administration and Drug Enforcement Administration.  In April 2016, Congress stripped the DEA of its most potent weapon against large drug companies suspected of spilling prescription narcotics onto the nation’s streets.  For years, some drug distributors were fined for repeatedly ignoring warnings from the DEA to shut down suspicious sales of hundreds of millions of pills, while they racked up billions of dollars in sales. One internal DEA memo obtained by The Post and “60 Minutes” noted that the bill essentially eliminates the agency’s power to file immediate suspension orders of drug shipments. The new law “is fixing a problem that doesn’t need fixing,” a DEA official wrote.

The new law made it virtually impossible for the DEA to freeze suspicious narcotic shipments from the companies. That powerful tool had allowed the agency to immediately prevent drugs from reaching the street.  The chief advocate of the law that hobbled the DEA was Rep. Tom Marino, a Pennsylvania Republican who is now President Trump’s nominee to become the nation’s next drug czar.

Political action committees representing the industry contributed at least $1.5 million to the lawmakers who sponsored or co-sponsored four versions of the bill, including nearly $100,000 to Marino and $177,000 to Hatch. Overall, the drug industry spent $106 million lobbying Congress on the bill and other legislation between 2014 and 2016, according to lobbying reports.

“The law was the crowning achievement of a multifaceted campaign by the drug industry to weaken aggressive DEA enforcement efforts against drug distribution companies that were supplying corrupt doctors and pharmacists who peddled narcotics to the black market. The industry worked behind the scenes with lobbyists and key members of Congress, pouring more than a million dollars into their election campaigns.”

By then, the opioid war had claimed 200,000 lives. Overdose deaths continue to rise. There is no end in sight.  Drug industry officials and experts blame the origins of the opioid crisis on the overprescribing of pain pills by doctors.

The Huffington Post reported on Medicaid cuts in Iowa.  “The aging population is fueling what some health experts call an “Alzheimer’s tsunami” for which Iowa, and the rest of the nation, is ill-prepared. Unless a cure is found, an estimated 7.1 million Americans age 65 and older could have Alzheimer’s by 2025, almost a 35 percent increase, according to the Alzheimer’s Association. Iowa’s 65-plus population is above the national average.   In South Carolina, the total number of cases of Alzheimers in 2015 was 86,000; 120,000 are expected by 2025, according to Alzheimer’s Association estimates.

But instead of preparing for the onslaught, Iowa and other states have begun tightening Medicaid, the only government program that pays for nursing home care, in ways that increase the burden on those with Alzheimer’s and their loved ones.

Medicaid, typically seen as the government health insurance program for people with low incomes and those with disabilities, spends about one-quarter of its $4.8 billion in annual funding in Iowa for nursing home care. The program pays for half the nursing home residents in the state, according to the Kaiser Family Foundation.

Already, Iowa’s move last year to a Medicaid system managed by three for-profit companies is affecting people diagnosed with Alzheimer’s and their caregivers.

Kathy Horan, vice president of AbbeHealth Aging Services, which operates adult day health centers in Marion, Cedar Rapids and Iowa City, said managed care organizations, or MCOs, that coordinate Medicaid recipients’ care have started to decrease the number of days covered at those centers.

Dove Press had clinical guidelines on prescribing psychotropic medication for nursing home residents with dementia on their website.

Objective: The aim of this study was to identify factors influencing the prescribing of psychotropic medication by general practitioners (GPs) to nursing home residents with dementia.

Subjects and methods: GPs with experience in nursing homes were recruited through professional body newsletter advertising, while 1,000 randomly selected GPs from south-eastern Australia were invited to participate, along with a targeted group of GPs in Tasmania. An anonymous survey was used to collect GPs’ opinions.

Results: A lack of nursing staff and resources was cited as the major barrier to GPs recommending non-pharmacological techniques for behavioral and psychological symptoms of dementia (BPSD; cited by 55%; 78/141), and increasing staff levels at the nursing home ranked as the most important factor to reduce the usage of psychotropic agents (cited by 60%; 76/126).

Conclusion: According to GPs, strategies to reduce the reliance on psychotropic medication by nursing home residents should be directed toward improved staffing and resources at the facilities.

The Telegram reported the Aug. 7 death and cover-up of Walter E. Haddad.  State and federal agencies investigated the suspsicious circumstances surrounding the death of Haddad who died after he fell and hit his head, and nursing home staff covered up the fall rather than send him to the hospital.

The report said that after hearing a loud thud about midnight on Aug. 6, a certified nurse assistant and a licensed practical nurse found Mr. Haddad lying on the floor and they put him back in his bed.  No assessment by a registered nurse was done. The CNA told investigators that he did not report the fall, as required by the facility, because the LPN had asked him not to.

“However, staff did not complete a thorough clinical evaluation or neurological assessment on (Mr. Haddad), which resulted in a delay of transfer to the hospital for evaluation of possible injury,” investigators said in the report.

Mr. Haddad’s daughter, Lorna Haddad, took issue with the report. She said staff should have been more careful because they knew that her father, who helped found the nursing home, had a history of falls. The retired accountant had moved into the nursing home last year, after Parkinson’s disease left him prone to falls. She said notification of his fall risk was posted throughout his area of the facility.

“I think the report is meaningless,” she said. “The fact that he didn’t have an alarmed bed or an alarmed chair is alarming.”

The report in general said professional standards of quality were not met because of the actions or inactions of the staff.  Every time a patient falls, injury or not, they’re required to call the physician and the patient’s family.

The morning after he fell, Mr. Haddad told several staff about the incident. The only thing that they did was to give him Tylenol. When Mr. Haddad’s family came to visit, he told them that he had fallen the night before and hit his head. Staff told the family that there was no report of a fall and that Mr. Haddad may have been mistaken or confused. When his speech became slurred and he complained of neck pain, he was taken to the trauma unit at UMass Memorial Medical Center, where he died.

The Santa Fe New Mexican reported that Casa Real nursing home in Santa Fe owned and operated by Preferred Care Partners Management Group has at least temporarily improved persistent quality-of-care problems enough to resume billing Medicare and Medicaid for newly admitted residents.  Casa Real is one of only two homes in Santa Fe that accept Medicare and Medicaid patients.

For more than two months, Casa Real had been barred from charging Medicare or Medicaid for new residents after the Centers for Medicare and Medicaid Services found the nursing home wasn’t in compliance with federal care standards.

Inspections this year turned up a long list of problems, including medication errors, expired food and drugs on shelves, unreported resident injuries and assault, poor care of bed sores, nursing understaffing and inadequate safeguards against the spread of dangerous infections.

The former director of nursing at Casa Real from May to August has accused management of forging patient records in an attempt to show the facility was in compliance with care standards dealing with monitoring of medication effects on residents.  Of course, she was soon fired.

The August inspection found residents weren’t receiving medications as directed by their physicians and that the nursing home wasn’t doing enough to ensure that residents didn’t receive unnecessary drugs, including psychotropic medications.

The federal agency in May designated Casa Real as a “special focus facility” because of its poor record of complying with care standards, and it said the nursing home would be subject to more frequent inspections. The designation is given to the nation’s poorest-performing nursing homes and is meant to address the “yo-yo” problem of facilities routinely falling in and out of compliance with care standards.

The state Attorney General’s Office is suing Preferred Care, alleging it has defrauded Medicaid by having insufficient staff to meet the needs of residents at its Santa Fe nursing homes, as well as its facilities in five other New Mexico communities. Preferred Care has denied the allegations.

The Hill had an article on the False Claims Act.  The FCA authorizes private individuals to sue anyone they think is defrauding the federal government. Individuals filed more than 4,700 FCA actions between 2009 and June 2016. The Act provides for treble damages. The spoils are divided among the person alleging the fraud, his attorneys, and the federal government. In 2014, the Department of Justice reported that FCA “recoveries” totaled $5.79 billion. Health care lawsuits accounted for $2.3 billion of that.

The federal government must investigate the claims in every FCA case. The initial investigation is done under seal. Defendants may be investigated for years, but not know about it until their business documents are subpoenaed. The individual alleging fraud can proceed with a case even if the government decides against it.

Increasingly sophisticated groups of attorneys choose to continue. They sue any entity that receives federal payments, claiming that the failure to comply with administrative standards constitutes fraud. At the time the act was passed, the goal was to prosecute fraud cases in which a contractor billed the United States for nonexistent or worthless goods or services.

 

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.”

 

NPR had an article about the effect of Medicaid cuts on nursing home residents.  The nation has 1.4 million nursing home residents — two-thirds of whom are covered by the state-federal health care program for people with low incomes or those with disabilities.  Medicaid pays less than other forms of insurance. As a result, nursing homes make more than 10 percent on Medicare residents, but lose about 2 percent on the rest of their residents because so many have care paid for by Medicaid.

“Nursing homes that rely the most on Medicaid tend to provide the worst care for their residents — not just the people covered by the program but also those who pay privately or have Medicare coverage.”

The reason for the disparity in quality of care, researchers have found, is that nursing homes with the most Medicaid residents can’t afford as many nurses and aides so they operate short-staffed. ”

The average five-star home has enough nurses and aides to provide 5.4 hours of care a day for each resident, while the average one-star home provides 3.0 hours of daily care per resident. At the best-staffed homes (five stars), only 4 of 10 residents are on Medicaid, meaning the remainder of residents are more lucrative for those facilities. At the worst-staffed homes (one star), 7 of 10 residents are on Medicaid.”

At nursing homes with worst inspection records (one star), an average 65 percent of residents are on Medicaid. Places with the best inspection records (five stars) have an average 47 percent of residents on Medicaid.