U.S. Medicare Monday proposed a $690 million increase in payments to nursing homes. The 3.3-percent increase would go to nursing facilities that provide skilled nursing and rehabilitation care to Medicare beneficiaries, according to the Centers for Medicare & Medicaid Services.

Under the new payment schedule, called the skilled nursing facility prospective payment system, the daily rate for room, board, medical care and other expenses would be increased. Current payments are based on a 1997 market basket, but the proposal would update rates using a 2004 market basket.

Hopefully, this increase will lead to more staff who are better trained.

It is horrible how the U.S government treats war veterans.  This article discuss how a Phoenix, Az nursing home for veterans was cited for negligence because of mismanagement and understaffing.

State review blames staffing shortage for nursing home troubles.  A state government-run nursing home for veterans suffered from staffing shortages, poor morale and mismanagement.

The Governor’s Arizona State Veteran Home Review Team report said the Phoenix nursing home had problems with nursing shortages, high personnel turnover, poor organization and lack of direction from state administrators.   The vets home has been fined by federal regulators for poor care and some cases of patient negligence.

When two residents at a nursing home in Santa Cruz got eviction notices last March, they decided to fight them. They called Linda Robinson of Advocacy Inc., a Santa Cruz nonprofit, to help them file appeals with the state Department of Health Services. A little more than a year later, the issue is being resolved according to an April 11 memo signed by Kathleen Billingsley, deputy director of the state health department.

The April 11 memo affects nearly 900 nursing home patients in Santa Cruz County as well as 1,400 nursing homes statewide with more than 133,000 beds.

"In a year, dozens, maybe hundreds, of [eviction] notices are sent," Connors said. "They get issued way too often in my experience. Patients have the right to be protected from arbitrary transfers"

Billingsley’s April 11 memo to district managers covered policy and procedures for appealing eviction notices. It also said staff must receive training to make sure policy and procedures are followed.

Last year, a lawsuit was filed, complaining about a backlog of nursing-home complaints. This month, a state auditor, reporting on 17,000 complaints filed over two years, said the department had not completed about 60 percent of its investigations in a timely fashion.

See article here.

I have been surfing around on the internet today, and was looking at one of David Swanner’s most recent blog posts, where he talks about Stephanie Mencimer’s blog, The Tortelinni.  That led me to a post on there about tort reform and nursing homes.  That got me thinking . . .

This is an issue we deal with a great deal, and that we fight against every day – the idea that "frivolous lawsuits" are increasing insurance premiums for nursing homes to the point that they might have to close their doors.  Never mind the evidence the feds are not providing the oversight needed to prevent abuse and neglect in nursing homes in the first place.  Nevermind the amount of money some nursing homes are making.  Just look at this example.  $959 million in one quarter?!

What no one is talking about is the actual lawsuits being filed against these nursing homes.  What no one thinks about is what if it was your mother, your father, your husband or wife who lived in a nursing home where staff wouldn’t answer the call bell to take them to the bathroom, forcing them to lie in their own feces or urine for hours – add to that pressure sores without bandages, so that urine and feces soak into open wounds.  What no one thinks about is what if your family member was given the wrong medication which led to brain damage or even death?  This is not made up stuff, these are the kinds of cases we see all too often.  Put yourself in that position, and then lets talk about "frivolous lawsuits."

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Drug-maker freebies can lead to harm for patients, a new report from the highly respected New England Journal of Medicine warns. Consumers have reason to be concerned about the study’s findings.

Gifts (bribes?) showered upon doctors by drug- and medical device-makers have become so pervasive that they are a standard part of every physician’s practice. 94 percent physicians have a  relationship with the drug industry, according to a study scheduled to be published Thursday in the New England Journal of Medicine.

Consumers should care about such relationships because drug companies market the most expensive brand names; gift-giving influences prescribing behavior and therefore how much patients spend on prescriptions.

The study proves that many doctors do not follow the AMA voluntary guidelines. It notes, for example, that 35 percent of respondents accept reimbursement for continuing medical education or for travel, food or lodging for medical meetings.

A National Survey of Physician–Industry Relationships
E. G. Campbell and Others

I saw this article about a nursing home resident with dementia who killed his roommate and thought "how could this happen?" but then I read an article where a murder suspect was moved to a nursing home.  The suspect was charged in connection with a quadruple homicide. See story here

With the graying of the population and the incarceration of so many citizens on Medicaid, nursing homes will need to adapt at receiving dangerous criminals into facilities. This may lead to violence and tragedy in many nursing homes.

On a related note, there have also been issues with registered sex offenders becoming residents of nursing homes.  More often than not, neither family members nor residents are aware that this is occurring.  We found a website recently that family members and residents can use to search by facility, city or state to see which nursing homes sex offenders are currently living in, and I thought that was a great thing to have – for more information, click here.

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I recently read an interesting article about CNAs in nursing homes.  CNAs change adult diapers, clean soiled residents and help the elderly dress, eat and shower among other duties.  Unfortunately, these employees who handle so much of the daily, essential care needed by nursing home residents are underpaid.  The article states that the average pay for new CNAs is less than $8 an hour, only a dollar or so above minimum wage.

As a result of the low pay and demanding job description, CNA turnover is as high as 170 percent at some facilities.  Dale Patterson, vice president and chief financial officer of Evergreen Healthcare Management says about CNAs, "It’s hard work.  And on a relative scale (employees say) ‘I can flip hamburgers for the same pay or I can take care of old people with incontinence problems.’…So of course turnover is high."  Gary Weeks, executive director of the Washington Health Care Association industry group says that many CNAs qualify for food stamps and other public benefit programs.

Low pay for CNAs also means lower quality of care for residents in nursing homes.  Facilities with high numbers of Medicaid patients report "losing" money because of low government reimbursements for such patients.  Less revenue means lower pay.  These facilities spend an average of 44 fewer minutes on direct care of patients each day, they have more patients spending most of their day in bed and a higher percentage of patients with pressure ulcers.  This adds pressure to the nurses who end up overmedicating residents or using chemical restraints.  Larry Minnix, President & CEO of the American Association of Homes and Services for the Aging backs this theory up by stating "The best proxy for quality that we have is staffing."

Starting pay for a CNA in upstate South Carolina has recently been increased about $8.50 per hour.

The Government Accountability Office (GAO) has finally concluded what we all knew to be true:  Nursing homes go unpunished for the abuse and neglect suffered by residents. See story here

Federal health officials impose only minimal penalties on nursing homes repeatedly cited for mistreatment of patients.  As a result, nursing homes cycle in and out of compliance with federal standards and pose a continued threat to the health and safety of patients.

”Some of these homes repeatedly harmed residents over a six-year period and yet remain in the Medicare and Medicaid programs,” said the report, to be issued this week by the Government Accountability Office, an investigative arm of Congress.

The Department of Health and Human Services ”fails to hold homes with a long history of harming residents accountable for the poor care provided,” the investigators said.

Congress established stringent standards for nursing homes in 1987. In 1998, the GAO reported that ”homes can repeatedly harm residents without facing sanctions.”  About 1.5 million people live in the nation’s 16,400 nursing homes on any given day.

The GAO said federal health officials hesitated to impose fines of more than $200 a day, in part because they believed that larger penalties ”could bankrupt some homes.” Fines are generally so small that nursing homes view them as a ”cost of doing business,” with ”no more effect than a slap on the wrist,” the report said.

Here is a good example where a nursing home was fined for overmedicating a resident and then officials withdrew the fine!

Many residents are totally reliant on staff for care, and rely on the federal Medicare program to pay the bills. The problem at nursing homes is poor staffing.  I just read an article that discusses the issue and explains how and why it is a system wide problem.

The article talks about an investigation that found the staffing shortage wasn’t an oversight.  The homes and their upper management were "padding their balance sheets on the backs of helpless residents in their care".

“They were all trying to make a buck,” said Alan Peak, an FBI agent in the white collar crimes unit. The probe revealed criminal conditions at the nursing homes—residents suffering from bed sores, malnutrition, beatings, neglect—all the result of their management company’s directives to cut costs. Meanwhile, managers rewarded themselves handsomely for their efficiency.

The fraud prosecution is one of the first of its kind. While systematically cutting back on service at the nursing homes, management continued to collect money from Medicare and Medicaid for services they knew were inadequate, or in some cases not performed at all.

The management company and its CEO, as well as the nursing homes, pled guilty last fall to fraud conspiracy charges. In February, the CEO was sentenced to 18 months in prison, and the nursing homes were each fined $180,000. The company president was sentenced April 20 to two months in prison for his role.