The Anderson Independent Mail had two articles on national for-profit nursing home chain Orianna.  See articles here and here.  Orianna Health Systems is a Tennessee-based company that runs 13 Upstate nursing homes, more than any other provider.

One article discussed the quality of care issues at Orianna’s facilities in Greenville where residents complained that staff members were slow to respond to call lights; some reported waiting 50 minutes for requested pain medication without receiving it, according to the inspection report. A resident interviewed that afternoon said “call lights often yield no response and sometimes the resident must yell or shout for assistance.”

Another resident complained that staff members “seem upset that you rang your bell and they tell you to wheel yourself around,” according to the report, which also listed nine grievances that had been filed between March and August about slow responses to call lights.  Citing the failure to respond to call lights in a timely manner, the inspection report found that the nursing home had not provided care “that keeps or builds each resident’s dignity and respect of individuality.”

Linville Court at Cascades Verdae was one of three Upstate nursing homes where inspectors found a number deficiencies that exceeded state and national averages between April 5 and Aug. 25, according to the most recent records from the Centers for Medicare & Medicaid Services.

A total of 12 deficiencies were found at Greenville Rehabilitation and Healthcare Center, according to a July 19 inspection report. Eight deficiencies were found at The Arboretum at the Woodlands nursing home in Greenville, according to a May 4 inspection report.

One of the deficiencies at Greenville Rehabilitation and Healthcare Center involved a January incident in which a certified nursing assistant verbally abused a resident. The nursing assistant later resigned, according to the inspection report.

Another deficiency listed in the inspection report involved the nursing home’s failure to adequately address a 22-pound weight loss by a resident during a six-week period. The nursing home was also cited for a medication error rate of 11.1 percent, which is more than twice the acceptable rate.

The inspection report cited numerous environmental problems at the nursing home, including the presence of flies in the kitchen and other areas. The report said a resident was seen swatting files with a wash cloth in an activity/dining room.

Other deficiencies included a failure to provide proper treatment to prevent bed sores or heal existing bed sores and a failure to store, cook and serve food in a safe and clean way, according to the inspection report.

A state inspector also visited The Arboretum at the Woodlands in June in response to a complaint. According to the inspection report, a staff member was found asleep in the nursing home’s living room during an 11 p.m. to 7 a.m. shift on May 25.

Mikki Meer, chief operating officer for Orianna Health Systems, said in an email that her company “is proud of the continued improvement demonstrated in the recent survey results of its South Carolina facilities.”

Meanwhile the second article explains why the quality of care at Orianna’s nursing homes has gone down.  Orianna has serious financial problems as a result of mismanagement and the siphoning of funds to the corporate owner’s pockets.  Orianna has now fallen behind on lease payments for its facilities to Omega Health Investors, a Maryland-based healthcare real estate investment trust.

Taylor Pickett, Omega’s CEO, reported that since 2014, the occupancy rate at Orianna’s facilities has declined from 92 percent to 89 percent and expenses have grown by 6 percent while revenues increased only 2 percent.

As recently as July, Orianna was operating 48 skilled nursing facilities with 5,000 total beds in 11 states, according to the company’s website. The latest version of the website says the company is now managing 43 skilled nursing facilities with a total of 4,500 beds in seven states.

  • Nine of Orianna’s homes agreed to pay $4.46 million to settle lawsuits involving the deaths of 20 residents. That total includes three settlements adding up to $752,500 that were approved after last year’s name changes.
  • Inspectors found at least 525 deficiencies at the company’s Upstate nursing homes, according to the Centers for Medicare & Medicaid Services. The deficiencies included instances of neglect, possible cases of abuse that were not investigated and medication errors, as well as failures to eliminate hazards, properly prepare meals and treat residents with dignity. The most dangerous deficiencies resulted in 26 fines totaling nearly $495,000.
  • The company’s nursing homes were responsible for 47 percent of the inspection-related deficiencies and 49 percent of fines at Upstate nursing homes. Orianna’s facilities account for 38 percent of the overall nursing home beds in the region.

The Kokomo Tribune reported that two former owner/operators of nursing homes agreed to plead guilty in a kickback scheme involving millions of dollars.  American Senior Communities CEO James Burkhart and Chief Operating Officer Daniel Benson have reached plea agreements that could put them in prison for decades.

Burkhart and Benson were indicted in 2016 along with Burkhart’s friend, Steven Ganote, and Burkhart’s brother, Joshua Burkhart. Ganote and Joshua Burkhart also have reached plea deals.

Federal prosecutors who indicted the men on a total of 32 counts say they took part in a kickback scheme between January 2009 and September 2015 that netted them $16 million. Prosecutors said the men used shell companies to falsify and inflate costs of goods and services, which enabled them to steal discounts and rebates, and conceal kickbacks during the six-year period.

Prosecutors said the men used the money to buy lavish items, such as vacation homes, jewelry and gold bars.

The company manages nearly 100 senior care facilities, including 60 locations under a contract with Marion County’s public health agency. The county is home to Indianapolis.

More than three months after Oak Terrace Healthcare Center  nursing home closed with little warning, many families and former patients  are waiting for refunds and wondering why they were put through such stress.  Oak Terrace’s two most recent administrators blame Home Life Companies, the Delaware, Ohio-based business whose top officials made all the key decisions involving Oak Terrace, for what they say was the company’s greed, ignorance and lack of vision.

The residents — they didn’t have any interest in them except as a source of revenue,” former Oak Terrace administrator Tom Mullins told The State Journal-Register.′  Mullins said he isn’t satisfied with Oak Terrace’s finger-pointing and claims of poverty.  Home Life Companies, which says on its website that it manages long-term care communities in several states, mostly in the Midwest and South, could transfer money from its headquarters to pay him and vendors, Mullins said.

One lesson from the Oak Terrace situation may be that families should investigate a long-term care facility’s finances as much as possible, and ask questions when they see evidence of problems such as empty halls, said Megan Jizmagian, the Springfield-based regional long-term care ombudsman.

David Mabry, who was administrator from January until late August, when Mullins took over, said he realized Oak Terrace wasn’t properly billing Medicaid when he arrived in January. After many frustrating communications with Home Life over spending, he said he resigned after he was instructed to begin transferring Medicaid patients to other nursing homes and reduce staffing levels. “There were so many things that needed to be fixed in the building, it was incredible,” said Mabry, who is certified as a nursing home administrator and licensed practical nurse.

 

MSN reported the patient dumping by University of Maryland Medical Center.  The hospital’s security guards had just wheeled a patient to a bus stop, and in the freezing temperatures they left her there. The only thing she had on was a hospital gown. It’s called “patient dumping” and it doesn’t just happen in Baltimore. In 2007, “60 Minutes” investigated the practice of removing homeless patients from Los Angeles hospitals and leaving them downtown.

Imamu Baraka was walking past a Baltimore hospital when he noticed something he says he’ll never forget.

“It’s about 30 degrees out here right now,” Baraka says in a recording of the encounter. “Are you OK, ma’am? Do you need me to call the police?” he asks.  “Come on and sit down,” Baraka repeatedly says to the patient in the recording. “I’m going to call and get you some help.”

In a statement, the University of Maryland Medical Center said that they “share the shock and disappointment of many who have viewed the video. In the end we clearly failed to fulfill our mission with this patient.”

The man who recorded the video called 911, and says medics ended up taking the patient back to the same hospital. Now a review is underway that could lead to personnel action against the hospital employees involved.

The federal government is launching an effort to stop nursing homes from discharging residents illegally.

Discharges and evictions lead the list of complaints that state long-term care ombudsmen receive each year. In 2015, these advocates for nursing home residents received more than 9,000 such complaints.

In a memo to state officials, the Centers for Medicare and Medicaid Services (CMS), which oversees nursing homes, said it has begun an examination of this widespread problem and will explore ways to combat it.

States have the primary responsibility for policing the nation’s nursing homes, but state regulators have to at a minimum follow federal rules that list specific reasons a facility can legally evict a resident. A nursing home can force a resident to leave only if at least one of the following conditions is met:

  • The resident’s clinical or behavioral status endangers the safety of others at the facility. The reason most often reported for patients’ being discharged against their will is “behavioral, mental and/or emotional expressions” of distress, CMS says.
  • The resident’s care is not being paid for. This is another common reason for such forced discharges. This can happen when individuals who had been paying privately run out of resources and enroll in Medicaid, which reimburses nursing homes less than they receive from private-pay patients. It also happens when Medicare residents shift to being covered under Medicaid.
  • Transfer or discharge is necessary for the resident’s welfare and the facility cannot meet his or her needs. The CMS memo notes that a nursing home should determine whether it can adequately care for an individual before that person is admitted. Once someone becomes a resident, the memo says, “it should be rare” for that facility to later say it cannot meet that individual’s needs.
  • The resident no longer needs the services the nursing home provides.
  • The resident’s continued presence endangers the health of others at the nursing home.
  • The nursing home is closing.

Discharges that violate federal regulations “can be unsafe and/or traumatic for residents and their families,” the memo says, adding that nursing home residents are sometimes left homeless or hospitalized for months when they are evicted.

 

The National Memo reported on Trump’s plan to allow nursing homes to neglect and abuse vulnerable elderly resident to the point of death and not be subject to a fine.  Reacting to the demands of lobbyists and their campaign contributions, the Trump administration has struck down several regulations that increase the safety and well-being of residents. The New York Times reports that this now means several common citations that used to result in fines will either see reduced penalties or no penalties at all.

“The fines, designed to prod nursing homes into treating elderly Americans with more care, respect, and dignity, were put in place by President Barack Obama and sought to make the institutions answerable to standards put together by Medicare.”

According to federal data, CMS since 2013 has cited nearly 6,500 nursing homes for serious violations discovered during inspections required under Medicare and has fined about two-thirds of those facilities. The nursing homes were most commonly cited for bedsores, failing to protect patients from avoidable accidents, mistreatment, and neglect, Kaiser Health News reports.

STAT News reported on the pioneering geriatrician Dr. Bill Thomas and the 330-square-foot, plywood-boned home he calls a Minka.  The structure is warm, light, and surprisingly roomy, in a studio loft sort of way. Four oversize windows look out onto the lake, a shed-style roof rising to the view.  In the back corner, across from a big bathroom compliant with the Americans with Disabilities Act, sits a full-size bed. On the other side of a plumbing-filled wall from the bathroom is a kitchen and countertop, made from Ikea components. (The term “Minka” has Japanese origins, as a traditional house for rural dwellers, typically those of modest financial means.)

The idea sounds, in one sense, simple: create and market small, senior-friendly houses like this one and sell them for around $75,000, clustered like mushrooms in tight groups or tucked onto a homeowner’s existing property so caregivers or children can occupy the larger house and help when needed.  The initiative has turned Thomas into a rare breed: the physician homebuilder, and it pits him not only against the nursing home industry, but also the housing industry, with its proclivity for bigger and bigger spaces.

“I spent my career trying to change the nursing home industry,” he said. “But I’ve come to realize it’s not really going to change. So now what I’ve got to do is make it so people don’t need nursing homes in the first place. That what this is about.

Thomas wants to help people grow older on their own turf and terms, while helping spare them the fiscal and physical stress of maintaining  homes.  In so doing, he hopes to shield them from the mouth of a funnel that too often summons elders to a grim march — from independent living, to assisted living, to nursing homes, to memory units, and to the grave.

Thomas said he’s less interested in growing wealthy from the idea than in changing the culture of senior housing.

The News-Gazette reported the lawsuit filed against the Champaign County Nursing Home in connection with the death of Sonya J. Kington, a 78-year-old Alzheimer’s resident who died of hyperthermia after being left unsupervised outside the home.  According to an investigation by the coroner’s office, video footage from inside the nursing home appeared to show Ms. Kington entering the courtyard at 1:47 p.m. It isn’t until about 5:15 p.m. that staff members are seen searching for her.

Her limp body was found in an exterior courtyard on a hot day when the high temperature reached 87 degrees.  At the time she was found in the courtyard, Ms. Kington was lying in direct sunlight, her skin was “very hot to touch” and she had vomit on both sides of her mouth.  Ms. Kington’s death was caused by hyperthermia brought on by exposure to hot weather.

The suit alleges that the nursing staff at the nursing home “failed in their duty to provide the necessary services and treatments to prevent the death of Ms. Kington in failing to properly secure the facility and in failing to properly supervise Ms. Kington.”

Reuters reported that nursing home landlord Quality Care Properties Inc has agreed to cut rents for HCR ManorCare.  However, ManorCare, a national for-profit nursing home chain, already owes more than $300 million in back rent and acknowledged it will struggle to pay even the reduced amount, according to a regulatory filing.  Toledo, Ohio-based ManorCare, with more than 250 skilled nursing and assisted living facilities across the United States, is struggling as government Medicaid and Medicare reimbursement rates fail to keep pace with rising costs.  Quality Care, a real estate investment trust (REIT), relies on the nursing home chain for more than 90 percent of its revenues.

Quality Care was spun off in 2016 by larger REIT HCP Inc, which had acquired the ManorCare assets from private equity firm Carlyle Group LP in 2010 for $6.1 billion.  Quality Care shares fell 3.4 percent to $13.54 on Tuesday.

New York Times article published January 2nd uncovers the self-dealing practice of nursing home corporate owners outsourcing goods and services to companies that they also control or have a financial interest.  These so-called “related party transactions” are a way of avoiding accountability for neglect and abuse.  These arrangements allow owners to put together advantageous contracts in which their nursing homes pay higher rates for rent, supplies, and services while the owners pocket the higher profits, which aren’t recorded on the nursing home’s accounts.  These complicated undisclosed “arrangements” make it difficult for neglected and abused residents to be compensated for injuries caused by the related companies for siphoning money intended for the care and well-being of the nursing home residents.

An analysis from Kaiser Health News revealed 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.”

■ 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.

“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.”

Ernest Tosh, a lawyer in Texas who helps other lawyers untangle nursing company finances, said owners often exerted control by setting tight budgets that restricted the number of nurses the homes could employ. Meanwhile, “money is siphoned out to these related parties,” he said. “The cash flow gets really obscured through the related party transactions.”

“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.

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.

The L.A. Times reported the problem with infection control at nursing homes, and the lack of enforcement by investigators.  “Basic steps to prevent infections — such as washing hands, isolating contagious patients and keeping ill nurses and aides from coming to work — are routinely ignored in the nation’s nursing homes, endangering residents and spreading hazardous germs.”

Inspection records show nurses and aides are often not familiar with basic protocols, such as wearing protective clothing when coming into contact with contagious residents and isolating them from others in the home and visitors. Others are not trained properly on how to clean patients. Still others, in a rush and understaffed, take shortcuts that compromise sanitary precautions

Infections, most of which are avoidable, cause a quarter of the medical injuries Medicare beneficiaries experience in nursing homes, according to a federal report. They are among the most frequent reasons residents are sent back to the hospital. By one government estimate, healthcare-associated infections may result in as many as 380,000 deaths each year.

A Kaiser Health News analysis of four years of federal inspection records shows 74% of nursing homes have been cited for lapses in infection control — more than for any other type of health violation.  However, only 1 of 75 homes found deficient in those four years has received a high-level citation that can result in a financial penalty, the analysis found.  Only 161 homes among the 12,056 that violated infection-control rules were cited at those higher levels since 2014, according to Kaiser Health News’ analysis.

As average hospital stays have shortened to 4.5 days in 2012 from 7.3 days in 1980, patients who a generation ago would have fully recuperated in hospitals now frequently conclude their recoveries in nursing homes.  “You’ve got this influx of vulnerable patients but the staffing models are still geared more to the traditional long-stay resident,” said Dr. Nimalie Stone, the Centers for Disease Control and Prevention’s medical epidemiologist for long-term care. “[That] kind of care is so much more complicated that facilities need to consider higher staffing.”