Both The Chicago Tribune and The Indianapolis Star had articles about the for-profit company, American Senior Communities, paying $376,432 in penalties to settle a complaint that it employed seven workers who were ineligible under federal rules for reasons including the loss of licenses and a criminal conviction.  American Senior Communities is one of Indiana’s largest nursing home operators and operates a chain of nursing homes owned by the public agency that runs the Marion County Health Department and Wishard Memorial Hospital.

Attorney General Greg Zoeller said in a release that the settlement will enhance safety in Indiana nursing homes and help control government health-care costs.  The Indiana Medicaid Fraud Control Unit, a division of the Office of the Indiana Attorney General, called the problem to the attention of the federal Office of the Inspector General in spring 2009.

ASC employed seven people in its Indiana nursing homes who were excluded from participation in federal health-care programs. ASC received federal payments for the work of the individuals when it "knew or should have known" they were excluded and that ASC should not collect federal reimbursement for their services.

"The settlement that American Senior Communities LLC of Indianapolis agreed to pay is the largest settlement agreement the Indiana Attorney General’s Office has received in a Medicaid excluded-provider case to date," the release said.

Reasons for an employee or contractor being excluded from the federal program can range from convictions for serious criminal offenses to losing a professional license.

It is the responsibility of health-care providers to regularly check lists of excluded workers and contractors.



Golden Living has created a new, in-house consulting pharmacy company that will focus on medication safety and patient outcomes. Golden Clinical Rx Services is based on a clinical pharmacist model that will make certified geriatric pharmacists (CGPs) part of the interdisciplinary clinical teams that care for Golden LivingCenter patients.

“Making pharmacists part of our interdisciplinary clinical teams will better ensure the safe and appropriate use of medications for Golden LivingCenter patients.”

“Managing medications is a complex process, especially for patients of skilled nursing facilities, many of whom have chronic conditions and are prescribed multiple drugs,” said Robert Warnock, DPh, Senior Vice President of Pharmacy Services for Golden Living. “Making pharmacists part of our interdisciplinary clinical teams will better ensure the safe and appropriate use of medications for Golden LivingCenter patients.”

Using the Almaga™ Unified Intelligence System (UIS) data management system and other technologies, pharmacists and pharmacy assistants in Clinical Intervention Centers will remotely monitor patients’ medications.  So these well-compensated pharmacists will not be in the facility nor will they ever see the residents.  Their orders may reduce drug costs and increase profits.

Golden Living is one of the largest providers of healthcare services in the U.S. Golden Living companies operate skilled nursing and assisted living facilities.  The Golden Living "family of companies" include Golden LivingCenters, Aegis Therapies, AseraCare Hospice and Home Health, and 360 Healthcare Staffing.

There are more than 300 Golden LivingCenters in 21 states. Golden Living also offers assisted living services at more than 40 locations. In addition, the Golden Innovations companies partner with more than 1,000 nursing homes, hospitals and other health care organizations in 37 states and the District of Columbia.

Collectively, the Golden Living "family of companies" has more than 40,000 employees who provide healthcare to more than 60,000 patients every day.

PACE programs serve persons who are 55 and older, live in the PACE service area, need a nursing home level of care, and are able to live safely in the community at the time of enrollment. PACE has been successful at enabling enrollees to continue living in the community by utilizing an interdisciplinary team that both plans and delivers care for each enrollee and a risk-based financing model that rewards effective provision of preventive and primary care. PACE organizations are responsible for all the care and services that each enrollee needs, including hospital stays and nursing home placement.

PACE is funded through Medicare, Medicaid and private finances. It has been a recognized provider type since 1997. Currently there are 75 PACE sponsors operating in 29 states with more programs on the way.

Programs of All-inclusive Care for the Elderly (PACE) were one of three programs researchers identified as models of long term care that are effective, efficient and less expensive than traditional long term care in a study whose findings appear in the most recent issue of the Journal of the American Medical Association (JAMA, November 3, 2010).

The researchers examined all peer-reviewed studies of comprehensive primary care models for older adults with multiple conditions published between 1999-2010. From this review, they identified four processes that are present in most successful models of primary care for these patients:

•Development of a comprehensive patient assessment that includes a complete review of all medical, psychosocial, lifestyle and values issues

•Creation and implementation of an evidenced-based plan of care that address all of the patient’s health needs.

Communication and coordination with all who provide care for the patient.

•Promotion of the patient’s (and their family caregiver’s) engagement in their own health care.

 “PACE is innovative because it allows a team of health and service professionals to take responsibility for all aspects of a senior’s care,” Bloom said. “Because our payment does not change based on the services we provide , we can be creative in delivering care and service focused on the unique needs of each older adult and their family in the right place, in the right measure and at the right time.”

PACE is both financially and clinically responsible for enrollees when they need hospital or nursing home care. The all-inclusive nature of PACE provides financial incentives to provide less expensive primary and preventive care.

 The study was conducted by lead researchers Chad Boult, MD, MPH, MBA, Johns Hopkins School of Public Health, Baltimore, MD and G. Darryl Wieland, PhD, MPH, research director of Geriatrics Services at Richland Hospital, Columbia, SC and USC Department of Medicine’s Clinical Geriatrics faculty.

The National PACE Association works to advance the efforts of Programs of All-inclusive Care for the Elderly (PACE) to support, maintain, safeguard and promote the provision of quality, comprehensive and cost-effective health care services for frail older adults. More information on NPA and PACE is available at

 Robert Greenwood

Vice President of Public Affairs

National PACE Association

Alexandria, VA

w (703) 535-1522


Reuters reported the DOJ settlement with Mylan Inc for a 2006 lawsuit over illegal Medicare and Medicaid reimbursements to pharmacists and other healthcare providers. As part of the settlement, Mylan subsidiary Dey has agreed to pay $280 million.  Mylan bought the drug division in 2007 from Merck KGaA, after the lawsuit was filed. Under the acquisition agreement, Merck is responsible for paying the full amount of the settlement as well as all costs related to reimbursement lawsuits involving Dey.

Bloomberg News had an article about increases of Medicare payments to nursing home owners and operators.   Morgan Keegan analyst Robert Mains said the nursing home industry sector will post strong earnings growth in 2011 due to a "favorable Medicare reimbursement environment and stable operating costs."  The national for profit chains will take advantage of the increases in Medicare payments because they have the "economies of scale" to do so.

In October, Medicare changed the payment system which pays nursing homes per patient day, with rates based on acuity and the complexity of the services each patient receives. The system allows operators to make more money to treat patients with major illnesses.

Shares of The Ensign Group Inc. rose 20 cents to $23.75, while Kindred Healthcare Inc.’s stock added 5 cents to $19.04. National HealthCare Corp.’s shares increased 4 cents to $46.68. Skilled Healthcare Group Inc.’s stock rose 3 cents to $8.94.

Hopefully, they will use the increase to hire and train additional staff…….but that would hurt their profits.

Celina Jacobson at recently shared an article with us titled  “20 Incredibly Educational Alternative Medicine Blogs”.  We thought it was informative and wanted to share it.

Many nursing homes do not offer any options on treatment including alternative treatments that are effective in other countries.  When you choose a nursing home, ask them if they offer alternative medical treatments.


 Real estate investment trust Ventas, Inc.,completed the purchase of 58 private-pay senior living communities from affiliates of Sunrise Senior Living, Inc., for $186 million. The deal includes the assumption of Sunrise’s share of mortgage debt totaling $144 million.  Ventas now owns 100% of all 79 of its senior living communities managed by Sunrise.


Prior to the acquisition, Ventas had ownership interests ranging between 15% and 25% in these 58 communities, which have a current occupancy exceeding 89%.


Ventas and Sunrise have also completed modifications to the management agreements between the companies for all 79 Sunrise-managed senior living communities now wholly owned by Ventas. The management fee for April 1 through December 31, 2010, is 3.5% of revenues, and the management fee for 2011 is 3.75% of revenues.


Read more:


Ventas to Purchase Remaining Sunrise Interests for $41 Million


Ventas to Acquire Atria Senior Living for $3.1 Billion


 The National Center for State Courts has the best, most accurate state court statistics in America. (That’s where most lawsuits are brought.)  Every year, NCSC does a phenomenal job tracking these and it recently released its most recent data, covering the year 2008.   Basically, tort case filings, including medical malpractice cases, are dropping like a rock. But guess what are flooding the civil courts? Debt collections. Take a look:

"Contracts comprise an increasingly large share of civil caseloads" (p. 26) (These cases are largely debt collections.)  "Contract caseloads continue to climb" (p. 27)

In 2008, monetary disputes (contract and small claims cases) accounted for 73 percent of civil cases in 7 states reporting (up 4 percent from 2007), while tort cases represented less than 5 percent of civil caseloads in those states. (p. 26)

Tort caseloads have continued to decrease, falling by 6 percent from 2007 to 2008 in 13 general jurisdiction courts reporting, whereas contract caseloads rose sharply, increasing by 27 percent in those courts over the same time period. (p. 27)

From 1999 to 2008, tort caseloads in 13 general jurisdiction courts reporting decreased 25 percent, while contract caseloads grew 63 percent. (p. 27)  "Incoming contract cases are nine times that of torts" (p. 27)

After examining incoming tort and contract rates in 11 states in 2008 the researchers found that "[w]hen tort and contract caseloads are examined side by side, contracts dominate in every jurisdiction. With the overall and median proportion of contracts in these 11 states above 90 percent, and given their growing numbers, contract case processing is doubtless an increasing concern for all state courts." (p. 27)

Automobile cases comprise the majority of tort caseloads (p. 28)   "Data from 17 unified and general jurisdiction courts indicate that automobile accident litigation generally comprises the majority of tort caseloads, with proportions ranging from 18 to 69 percent." (p. 28)

"Like other torts, medical malpractice claims continue to decline" (p. 31)  "Just as torts typically represent a single-digit proportion of civil caseloads, medical malpractice cases comprise a similar proportion of torts. Despite their continued notoriety, rarely does a
medical malpractice caseload exceed a few hundred cases in any one state in one year."
(p. 31)

Long-term data show a 15 percent decline in medical malpractice filings in general jurisdiction courts in seven states from 1999 to 2008. (p. 31)

So, where exactly is this lawsuit crisis?


Maria Wells recently sent us an article they recently published entitled 10 Great Ways to Make Friends After Retirement that I thought would be nice to share during this holiday season.

Staying involved and having friends is a great way to stay mentally and physically healthy in nursing homes.

Poliakoff and Associates wishes everyone a Merry Christmas and Happy Holidays!!

Valerie Neff Newitt is senior associate editor at ADVANCE who recently wrote an interesting but disturbing article called "When Nurses Kill".  The article reminds us why background checks and vigilant supervision of employees are necessary at nursing homes.  Much of the information in the article came from Professor John Field.

"There’s nothing more counterintuitive than the idea of a nurse killing a patient – on purpose. The notion of a bedside provider easing a suffering patient into euthanasia may be morally abhorrent to some, but there is at least a motivation of compassion in the deed. But imagine, if you will, the idea of a nurse intent on inflicting bodily harm and death on sometimes fully defenseless patients. It is an idea that passes all understanding."

Field offered a whirlwind tour of global serial killers, noting that the most notorious multiple murderers in Switzerland, Germany, Austria, United Kingdom, Canada and the U.S., all happened to be healthcare workers. And in four of those six countries, that worker was a nurse.

The heinous act is one seen ’round the world. Field told of an Italian nurse who kept notes on how she injected air into five patients causing death by embolism; a Scottish nurse who injected patients with insulin; a German RN who killed 22 nursing home patients; a Brit nurse who specifically killed babies; an Egyptian nurse who was romantically rejected by a neurosurgeon prompting her to kill 22 of his patients; a Swiss provider who injected tranquilizers before placing plastic bags over victims’ faces. And these killers can be homegrown, as well. Field talked of a Massachusetts RN who killed off war veterans and a Texan nurse who injected bleach into his patients’ veins. In Georgia one nurse manipulated care to induce codes. "Then he would conveniently be on the scene to save the day, and become the hero of the moment," told Field. But there were the times when he simply couldn’t save the patients he put into death’s pathway.

And to prove that it could happen close to home, Field mentioned nurse Charles Cullen, who by his own account murdered as many as 40 patients across 16 years of practice at 10 institutions in Pennsylvania and New Jersey.

Field said vigilance on the part of observant nurses remains the key to stopping such tragic behavior.  He pointed to "red flags" published in 2003 by forensic nurse Kelly M. Pyrek detailing questionable behaviors that might be indicative of murderous behavior. Field suggested every nurse:

must never dismiss the possibility that a nurse may be murdering patients;
keep clear and open lines of communication at the workplace;
be aware of Pyrek’s "red flags"
find out if others share suspicions you may have;
report suspicions if they are strong and well-grounded
never tolerate aberrant behavior; you are entitled to professional conduct from colleagues.
Field concluded by proclaiming that hospitals must do their part to minimize such a tragic possibility by maintaining a culture of respect, supportiveness, reflection, open communications and zero tolerance for "bad or mean" behaviors from anyone