The indictment alleges that the men ran about 70 nursing homes in Texas and other states and were responsible for a $200 million operation but hid their control of the facilities. Payroll companies: More than 150 sham payroll companies were created to avoid paying taxes, according to the indictment.

A former Hurst nursing home executive who crisscrossed the Atlantic as part of a tax-evasion scheme pleaded guilty Wednesday to conspiring to cheat the IRS out of $34 million.

As part of a plea agreement, Larry G. May will cooperate with the prosecution of two of his former North Texas business associates, who the government said helped control the nursing homes involved.  May, Stephen Michael Ewing of Bedford and Gary R. Trebert of Frisco were indicted in March on 29 federal counts including mail fraud, making false statements to a government agency, and defrauding the IRS and the U.S. Health and Human Services Department.

May also pleaded guilty Wednesday to perjuring himself by signing false tax returns for 63 nursing homes with payroll taxes totaling $4.45 million.  

Here is an interesting article about attorney Ken Connor’s appearance for an advocacy group for nursing home reform.  The seminar was titled "Nursing Homes: A Failed Experiment,".  Connor’s appearance was sponsored by the advocacy group Kentuckians for Nursing Home Reform.

Connor said he classified nursing homes as "a failed experiment" because the current system puts the economics of the provider ahead of the life, health and safety of the residents.

"In other words, they put profit over people; they put revenue over residents," he said.

To increase profit, Connor said, staffing is cut. And some nursing homes are run by businessmen who have never been doctors or nurses and don’t have any expertise in the medical field. They are, however, good at making money.

It’s important for people to be educated about this issue — to know what to do if they are confronted with a problem and know where to file a complaint. It’s also good to know where to find support.

Connor urged the crowd to pay attention to signs such as pressure ulcers, infections, urine and feces-stained bed linen and foul odors. Also, the hollow eyes and parched tongues of loved ones display the lack of time devoted to them.

Connor said nursing home problems are pervasive throughout the country.   "Corral your congressmen and senators and make them understand the breadth of the problem," he said.

Kentuckians for Nursing Home Reform work to change state law so criminal background checks and random drug tests are required for all nursing home employees. They are fighting to ensure there is a minimum staffing standard.

Kentucky has cited about one in four nursing homes for serious deficiencies that caused "actual harm" or "immediate jeopardy". 

Violations of "accident hazards" were the most frequently cited survey flaw across the nation in September, according to the Centers for Medicare & Medicaid Services. These hazards typically cause falls and injuries to occur.  The agency said 35.2% of the facilities cited were written up for F-tag 323.

Next on the list was a frequent No. 1 entry in the Top Ten list: F-tag 371 ("store, prepare, distribute and serve food") at 33.9%. This is very disturbing considering the importance of dietary and nutritional aspects for maintaining and improving the health of elderly residents especially to prevent or heal pressure ulcers.

Filling out the top five were: F-309 (each resident must receive care for highest well-being) at 27.7%; F-281 (services must meet professional standards of quality) at 26.9%; and F-279 (Facility must develop comprehensive care plan with objectives/timetables.  

All information was culled from CMS’ Online Survey, Certification and Reporting (OSCAR) data.

The headquarters of The Carlyle Group, a Wall Street Investment corporation that made our blog a few weeks ago when we wrote about its involvement with Habana Health Care Center (see Wall Street and Nursing Homes? and Nursing Home Profits), was the site of a demonstration Monday, October 22nd by nursing home advocates.  The Carlyle Group is in the process of taking over Manor Care Inc., a Toledo, Ohio-based nursing home chain with facilities across the country.  Manor Care has several facilities in South Carolina.  

The Washington Business Journal reports that the demonstration was organized by SEIU Healthcare, a health care workers union, and it’s purpose was to express worries caregivers and advocates have about the quality of care residents will receive after the the takeover as well as the status of jobs within the facilities.  As we blogged in previous articles mentioning The Carlyle Group, there is much data to support the fact that staffing numbers are cut and care quality goes down when Carlyle is involved.

On Monday, Carlyle made a pledge to quality care at Manor Care facilities saying that education, training, and staffing levels would ensue proper clinical care and all federal and state regulations would be met.  A Carlyle higher-up stated that "Manor Care is poised to become an even stronger health care provider under Carlyle’s ownership." 

A statement released by Carlyle said the acquisition of Manor Care is expected to be completed by the end of November.  I suppose only time will tell if Carlyle will uphold their promise to provide quality care to the residents of the former Manor Care facilities.  A statement released by the executive vice-president of the union that organized Monday’s event says advocates will continue to hold Carlyle Group "accountable for improving care and staffing at Manor Care." 

The Washington Business Journal also reported that the demonstration was planned to continue on Tuesday at Capitol Hill to lobby Congress to "hold hearings on private equity ownership of nursing homes."  

Kansas City, Missouri Police are investigating the alleged rape of an 80-year-old woman at a Northland nursing home.   While management vehemently denies anything happened, a medical examination shows otherwise. 

The 80-year-old woman was found naked from the waist down Wednesday afternoon.

According to the police report, the victim’s daughter noticed bruising in her private area and asked if anyone touched her there. The victim replied, "Yes, it was hell."

Police said they have not had a chance to talk to the victim because the nursing home has given her sedatives.  They hope to speak with her soon.

Here is a sample Power of Attorney that anyone can print and use as long as it is notarized and signed properly.  This power of attorney does not authorize the POA to sign an arbitration agreement and prohibts the POA from waiving the signatory’s right to a jury trial.  This should help combat the hidden arbitration clauses that the nursing home industry hides in their admissions paperwork.

Huberto Garmon says when his mother died on July 15th no one from the Resort Nursing Home where she was staying contacted him to let him know.   “Not only did I find out that she passed away, but she passed two and a half months ago,” said Garmon.

In fact, Garmon claims staffers told him on several occasions that his 86-year-old mother, who was suffering from kidney failure, was either getting treatment at the nursing home or at Peninsula Hospital. He says he found out only this week that she had died.

“I’m thinking that she’s at the nursing home,” he said. “I know they’re going to call me, because if they contacted me for an authorization for an operation, they’ll contact me if it happens, so we didn’t know nothing until I called to say I wanted to go and visit her.”

Garmon says when he tried to get to the bottom of what happened, both the hospital and the nursing home began pointing fingers at each other.

“After experiencing what he did, my client wants to make sure no one else will experience what he did and very often that cannot be accomplished unless some appropriate action, some formal action is taken,” said his attorney Everett Hopkins.

Garmon says he also wants to retrieve his mother’s body from a cemetery for unclaimed remains, and give her a proper goodbye.

The New York Times recently had an interesting article regarding Congressional leaders questioning the policy and practice of the insurance industry in long term care settings.  The top-ranking Republican on the Senate Finance Committee has asked 11 long-term care insurance companies to explain “troubling data” regarding how policyholders’ claims are handled and paid.

Senator Charles E. Grassley of Iowa, referred to data collected by the National Association of Insurance Commissioners, which indicated that nationwide complaints about long-term care insurance rose 92 percent from 2001 to 2006. The data also indicated that complaints involving claim denials resulted, in a majority of cases, in reversals that favored consumers.

“This is a pattern of error not typically found in other lines of health-related insurance,” the association wrote.

Senator Grassley has asked the largest long-term care insurers to provide detailed information on how policyholder claims, inquiries and denials are handled and whether employees receive rewards for denying claims.

This week, Mr. Grassley also asked the Government Accountability Office to examine how private equity ownership had affected the quality of care in nursing homes. In particular, Mr. Grassley asked the agency to examine how many nursing homes had been bought by private investment groups and how conditions had changed after those homes were acquired, and to examine the number of health and safety deficiencies cited by regulators at those homes.

A report in The Times last month said that private equity firms had bought thousands of nursing homes and then often cut expenses and staff, sometimes below minimum legal requirements, to increase profits.

The nursing home industry has also faced questions recently. The Service Employees International Union, one of the biggest labor unions, sent letters to Congress this week asking lawmakers to examine the proposed acquisition of HCR Manor Care, the nation’s largest nursing home chain, by the Carlyle Group, a private equity firm. “Profit for investors cannot come at the price of patient safety and care,” the union said in a statement.

The acquisition of Manor Care is not yet complete. But, the Carlyle Group said, “We expect to maintain the same high quality care that seniors and their families have come to expect.”

I recently read an article about Charles Grassley, Republican Senator from Iowa who is on the Senate Finance Committee asking long term care insurance companies to explain how they are handling policy holders’ claims.  This is the quote I love the most:  "Many long-term care insurers have recently announced that they are raising premiums because they underestimated how many policy holders would eventually make claims."  Hmm, that’s interesting.  You’re selling insurance for long-term care to the elderly – can’t you just assume that most of these people will eventually make a claim?  Or are the insurance companies betting that people will die before they need nursing home care? 

Its sad that people pay into the insurance companies for coverage, and then get the run-around to collect on their claims.  And worse than that, my guess is that many of these "insured" are not in the position to stay on the phone arguing with the insurance company in an effort to get the claims paid – and the insurance company probably bets on this too.

Additionally, Senator Grassley has asked the Government Accountability Office to look at the effect of private equity ownership on quality of care in nursing homes.  According to a recent NY Times article, the number of serious health deficiencies is 19% higher in homes owned by investment firms than in average nursing homes, indicating most likely that these firms are putting profits over people.  One of the things that Senator Grassley points out is that the public is in the dark about nursing home deficiencies, and about the extensiveness of deficiencies industry wide. 

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