The Claude Pepper Center at FSU uses information and data from multiple sources to help inform policy makers, researchers, teachers, the media and the general public about the health, long term care and income security challenges confronting the nation’s older citizens.

In pursuing this mission, The Center has generated several articles, book chapters, reports, op ed columns and blog postings that can be found in the Social Media and Reports section of the website.

All of our activities are dedicated to sustaining the senator’s view that “the national attitude toward old people has made a 180-degree turn. More and more, younger generations have come to realize that in their elders they have a precious and useful asset, not a burden. Old people are the same persons they were when they were young. Some may not hear so well, may have to wear glasses, maybe are a step slower when they walk. But they are not useless, and they must not be treated as outcasts, as more and more Americans have come to realize.”

Nursing homes are increasingly owned by private investment groups who manage them through complex administrative structures that make the assignment of responsibility for deficiencies in care provided to the residents very difficult. These investment groups also tend to reduce operational costs by reducing the staff who provide care (RNs and CNAs) creating greater potential that residents will receive less care of adequate quality than they need. These concerns have been exacerbated by the fear among advocates for higher quality care in nursing homes that the Trump administration will reduce the already inadequate regulatory framework for maintaining an acceptable level of quality of care in nursing homes.

The following articles address several dimensions of the quality of care concerns. We will continue to track developments in this area over the next several months.

Important Articles:

Reports

Authorities say a 76-year-old woman found dead outside the Ohio nursing home where she lived died of hypothermia.

The Putnam County sheriff is investigating Phyllis Campbell’s death at the Hilty Home in Pandora, roughly 50 miles southwest of Toledo.

Campbell was found outside the facility on a Sunday morning, when temperatures around much of Ohio were still below freezing.

The sheriff’s office says an autopsy showed Campbell died from hypothermia. Authorities haven’t released details about what happened.

The facility is part of Mennonite Home Communities of Ohio, whose CEO said by email Wednesday that it’s grieving Campbell’s death and extending sympathies to her family. CEO Laura Voth says administrators are working with authorities to conduct a thorough investigation but can’t publicly discuss details of the case.

The Star Tribune reported on the tragic and preventable death of Delores Rowan.  Rowan suffocated and died on May 31, according to the Ramsey County medical examiner’s office. The woman’s injuries included fresh bruising on her neck, the autopsy found.  The facility is at fault for allowing Rowan’s head to become trapped between the mattress and the bed’s grab bar.

Langton Place, which is operated by Presbyterian Homes, “had no policy, procedure or system to ensure the proper sizing of mattresses, the fit of the grab bars [or the proper] space between the mattresses and the grab bar device to reduce the risk of entrapment,” according to a state Health Department report released last week.  The report said a nurse saw the resident on her back and asleep about 4 a.m. In a routine check 90 minutes later, the woman was discovered with her head wedged between the mattress and a grab bar. Resuscitation efforts failed.

Her husband, Michael Rowan, said that his wife’s suffocation “wasn’t the only problem we had with that place.”  Langton Place one day ran out of the liquid nutrition she was fed through a tube. He also said she came down with cellulitis, a bacterial skin infection, and needed to be hospitalized. He said he also found caked feces in his wife’s pubic area.

The Nonprofit Quarterly had an article explaining  that nonprofits produce better outcomes for less money than for-profits do. Prime among these fields are hospice and long-term care. The research is relatively consistent: Do mission-driven nonprofit organizations deliver higher quality care to elders? When it comes to nursing homes, it appears the answer is a decisive “yes.

Multiple studies over the last two decades indicate that for-profit ownership of nursing homes, particularly for-profit chain ownership, correlates with substandard care.

Since the 1990s, corporate chain ownership has grown steadily and now dominates the market. Today, nonprofits own less than one in four nursing homes, while for-profits control nearly 70 percent. (The remaining five to six percent are government facilities.)

The latest analysis of nursing home ownership comes from Kaiser Health News (KHN), which examined organizations with complex corporate structures that can be used to pad the pockets of owners while protecting them from lawsuits.

Increasingly, KHN explains, owners of nursing homes outsource services to multiple entities in which they also have an ownership interest. For example, buildings are owned by real estate trusts, while the nursing home is leased by a management company. Physical therapy services, pharmacy services, dining, and maintenance can all be outsourced to sister companies.

Nearly three in four nursing homes outsource much of their business to related companies, according to KHN. This includes some nonprofit organizations as well. These structures, when not used to make and hide profits, can be cost efficient, with related companies charging the nursing home less than average for their services. But this is not normally the case.

In an examination of federal inspection, staffing and financial records nationwide, KHN found that nursing homes structured with related entities showed significant shortcomings. Homes with complex corporate structures:

  • employed, on average, 8 percent fewer nurses and aides;
  • averaged 53 validated complaints per 1000 beds, as compared to 32 per 1000 beds in independent homes; and
  • were subject to 22 percent more fines for quality deficiencies, and paid penalties averaging seven percent more than independent homes.

Charlene Harrington, professor emeritus of the School of Nursing at the University of California-San Francisco, who has extensively studied for-profit nursing homes, told KHN, “Almost every single one of these chains is doing the same thing. They’re just pulling money away from staffing.” In numerous studies, staffing has been shown to be a critical variable in quality care delivery.

Complex corporate structures not only undermine care for nursing home residents; they also provide a legal screen for owners, making it difficult for consumers to hold owners accountable.

To bring related companies into a lawsuit, attorneys must persuade judges that all the companies were essentially acting as one entity and that the nursing home could not make its own decisions. Often that requires getting access to internal company documents and emails. Even harder is holding owners personally responsible for the actions of a corporation—known as “piercing the corporate veil.”

Perhaps more importantly, it is time to rethink public policies that favor corporate ownership of nursing homes, as Charlene Harrington argues: “The considerable evidence from observational studies that care delivered in for-profit facilities is inferior to public or nonprofit services supports the need to develop new policies that would favor the development and maintenance of public and nonprofit homes.

CBS Chicago reported on the tragic case of Letasha Mims who suffered from severe mental-health issues, including dementia, and ended up needing full-time care at Alden-Wentworth Rehabilitation.  Her mother, Mary Mims, says her daughter died after suffering repeated abuse and neglect at a nursing home. That same nursing home is facing nearly 90 lawsuits against it. Letasha died in 2014. What she went through is difficult for her mom to handle.

Mims says Letasha couldn’t speak or use her arms or legs, yet was repeatedly left in her own feces. Mims took pictures to document the alleged neglect, which she says resulted in bed sores and wounds.

“I’ve never seen a wound as bad as my daughter’s. It was all the way to the bone,” Mims says.

She says there were even bugs in her daughter’s bed and that Letasha went through drastic weight loss – Mims says because of starvation.

Letasha had a sexually transmitted disease and was treated for it but the facility failed to call police.  Mims says her 36-year-old daughter was nonverbal and incapable of giving consent to sex.  Because no rape kit test was done on the nursing home resident, there is no chance of ever catching the offender.

 

 

CNN had an article with a video showing a resident assaulting another resident for several minutes before staff intervened.  The video is tough to watch.  The beating, which was first reported by the Gainesville Sun, lasted on and off for nearly 2 minutes. The beating occurred October 3 in a secure unit of Good Samaritan, a 45-bed assisted living facility.  It occurred in a common area of a secured unit within the facility while other residents ate and watched television mere feet away. The video of a resident beating another resident raises new questions about the safety of the elderly in places meant to protect and care for them.

In the video, a 52-year-old resident is seen punching an 86-year-old resident with dementia more than 50 times as the older man lay curled up on the floor. The younger resident accused the older resident of eating his cupcake, according to law enforcement.  At the time the beating took place, there was no staff member attending to residents in the unit, and no one had been assigned to monitor the unit’s video surveillance, according to official reports.
The video was taken by the facility’s closed circuit surveillance system in October and later turned over to the police, who shared it with CNN.
The facility — the Good Samaritan Retirement Home in Williston — had a history of violations, and more sanctions in the past five years than any other assisted living facility in Florida. In December, two administrators were arrested in connection with separate incidents on charges of neglect of the elderly.  One of the facility’s administrators, Nenita Alfonso Sudeall, later broke down and cried as she told police she was “overwhelmed” at the facility, which she said was short-staffed and had poorly trained employees, according to a police report.
The elderly resident was hospitalized with bruising and swelling to his face, as well as hip pain, according to the police report.
Also earlier this year, a CNN report found that the federal government has cited more than 1,000 nursing homes for mishandling or failing to prevent alleged cases of rape, sexual assault and sexual abuse at their facilities between 2013 and 2016.
“There are far too many cases of abuse and neglect happening in nursing homes and assisted living facilities,” said Brian Lee, executive director of Families for Better Care, a national advocacy organization for residents and their families. “We’ve been seeing cases for decades. This one incident in Florida shows how bad the problem can be.”

St. Louis Today had an editorial about the recent NY Times report on the outsourcing of management and “back office”support services to companies owned and operated by the owners of the nursing home. These business dealings, known as related-party transactions.  In the nursing home industry, however, with its reliance on taxpayer dollars, related-party transactions can also encourage insider dealing, maximizing profits for the outside vendors while siphoning off funds needed for patient care and staffing.

“So the question of who’s profiting from meeting — or not meeting — their needs is a matter of great public import. People’s lives can and do hang in the balance.”

In a remarkable story published Dec. 31, Kaiser Health Newsreported that the owners of nearly three-quarters of the 15,600 nursing homes in the United States buy a wide variety of goods and services from companies in which they have a financial interest or control. Nursing home owners can rent the land to themselves at above-market rates, or own the staffing company that provides nursing care and management.

 Relative to homes that don’t have related-party transactions, Kaiser reported, nursing homes that do deal with related parties have an average of 8 percent fewer aides and nurses on staff and are 9 percent more likely to have injured a resident or put him at risk. They have 35 percent more complaints and are fined 22 percent more frequently by government regulators.

For nursing home owners, a complex web of related-party transactions can offer a shield against lawsuits or governments seeking restitution for Medicaid overpayments.

This is outrageous. America’s vulnerable elderly shouldn’t be a profit center. Government should protect people and tax dollars, not profits.

The New York Post reported that New York’s Attorney General Eric Schneiderman announced a settlement with a shady real-estate group that bought city nursing homes and flipped them to developers who sought to convert them into luxury condos.  The settlement between the attorney general and The Allure Group includes measures to reform the process that led to the closure of Rivington House on the Lower East Side and CABS Nursing Home in Brooklyn — in addition to levying $2 million in penalties to the developers, Schneiderman said.

“We’re requiring Allure to open new health-care facilities in Brooklyn and the Lower East Side, and make major improvements to its Harlem facility, while also providing $1.25 million to nonprofits serving vulnerable New Yorkers.”

As part of the settlement, Allure must create a new health facility on the Lower East Side to “fill health-care gaps caused by the closure of Rivington House,” Schneiderman said.

After purchasing the CABS nursing home in Bed-Stuy in 2015, Allure allegedly forced out frail patients — leading to the untimely deaths of some residents, according to a lawsuit filed in Brooklyn Supreme Court. The court papers charge that Allure repeatedly lied during the bidding process.

The settlement with the attorney general also requires Allure to open a “new Central Brooklyn health-care facility to offset lost health care services resulting from the closing of the CABS Nursing Home.”

 

Cleveland19 reported that Alice Ramsey pleaded guilty to patient abuse and reckless homicide in the death of an 85-year-old patient at the Hubbard Road Meadows Group Home in Madison.

Mary Srpan was injured in an incident at the group home on Jan. 3, 2017. She was brought to the Lake Hospital Madison Emergency Department and died on Jan. 17, 2017.  It has not been explained or released how Srpan was injured.

The New York Times had a great article explaining how and why for profit chains game the system by siphoning funds to owners instead of to patient care.  Contracts with “related companies” accounted for $11 billion of nursing home spending in 2015 — a tenth of their costs — according to financial disclosures the homes submitted to Medicare.  A Kaiser Health News analysis of inspection and quality records reveals that nursing homes that outsource to related organizations tend to have significant shortcomings: They have fewer nurses and aides per patient, they have higher rates of patient injuries and unsafe practices, and they are the subject of complaints almost twice as often as independent homes.  For-profit nursing homes utilize related corporations more frequently than nonprofits do, and have fared worse than independent for-profit homes in fines, complaints and staffing, the analysis found. 

“In what has become an increasingly common business arrangement, owners of nursing homes outsource a wide variety of goods and services to companies in which they have a financial interest or that they control. Nearly three-quarters of nursing homes in the United States — more than 11,000 — have such business dealings, known as related party transactions, according to an analysis of nursing home financial records by Kaiser Health News. Some homes even contract out basic functions like management or rent their own building from a sister corporation, saying it is an efficient way of running their businesses and can help minimize taxes.”

“These arrangements offer an additional advantage: Owners can arrange highly favorable contracts in which their nursing homes pay more than they might in a competitive market. Owners then siphon off higher profits, which are not recorded on the nursing home’s accounts.”

“Such corporate webs bring owners a legal benefit, too: When a nursing home is sued, injured residents and their families have a much harder time collecting money from the related companies — the ones with the full coffers. Courts set a high bar for plaintiffs to bring these ancillary companies into their cases.”

“Almost every single one of these chains is doing the same thing,” said Charlene Harrington, a professor emeritus of the School of Nursing at the University of California, San Francisco. “They’re just pulling money away from staffing.”

Kaiser Health News’s analysis of inspection, staffing and financial records nationwide found shortcomings at other homes with similar corporate structures:

■ Homes that did business with sister companies employed, on average, 8 percent fewer nurses and aides.

■ As a group, these homes were 9 percent more likely to have hurt residents or put them in immediate jeopardy of harm, and amassed 53 substantiated complaints for every 1,000 beds, compared with 32 per 1,000 beds at independent homes.

■ Homes with related companies were fined 22 percent more often for serious health violations than independent homes, and penalties averaged $24,441 — 7 percent higher.