ABC News out of Chicago, Illinois reported the sentencing of nursing home employee Marty Himebaugh for criminal neglect that led to the death of 6 nursing home residents.  In 2006 six patients died from over-medication of morphine.  Himebaugh, a nurse for Woodstock Residence Nursing Center pleaded guilty to one count of criminal neglect and the five other charges were dropped.

Himebaugh will not serve any jail time.  Himebaugh was sentenced to only two years of probation. There are still civil cases against Himbaugh that have yet to come to court.  One of the plaintiff attorneys for one family was frustrated with the prosecution’s inability to prove the range of charges found during the investigation.

Business Week and The Washington Post both had interesting articles on the profitable hospice industry.  Nursing homes often push hospice on residents who are not terminal.  The nursing home then relies on the hospice employees to take care of the resident.  Medicare-paid hospice include visits from a nurse and chaplain, plus an extra weekly bath.  Much better than typical Medicaid paid services for nursing home residents. The government often pays twice for hospice patients in nursing homes — about $137 a day to the hospice provider from Medicare, and about $200 a day to the nursing facility from Medicaid, which covers the indigent elderly.

Hospice care has become a growth industry, with $14 billion in revenues, 1,800 for-profit providers and a base of Medicare-covered patients that doubled to 1.1 million from 2000 to 2009.  "Compensation based on enrollment numbers, pay to nursing- home doctors who double as hospice medical directors and gifts to the nursing facilities have helped fuel the boom, according to an examination of 1,000 pages of court documents and interviews with more than 45 current and former hospice employees, patients and family members."

Publicly traded companies have created hospice chains through serial takeovers in the last decade. Hospice buyouts and investments by for profit private-equity firms have led to inflated enrollments and unnecessary expense.  There are allegations that bribes and kickbacks are used for referrals.  Nursing homes have been offered diapers, wheelchairs, nutritional supplements and other supplies in return for patient referrals. Under various federal statutes, paying for patient referrals or compensating employees based on the number of Medicare patients recruited is illegal but enforcement is nonexistent. 

Under Medicare rules, patients are only eligible or hospice if two doctors certify that they have six months or less to live. They can stay on hospice indefinitely if a doctor recertifies their terminal illness every 60 days.  Doctors sign off on whatever the nursing home says because they are the "eyes and ears" for the doctors.

The inspector general of the Health and Human Services Department is finally investigating hospice marketing practices and financial relationships with nursing facilities. The inquiry was prompted by a 2009 report by the Medpac commission, a congressional advisory body, that found hospices “aggressively marketed” to nursing-home patients, and paid incentives to medical directors for “inappropriate” referrals and enrollments.

The Stark Law is designed to ensure that doctors refer patients based on who provides the best care, not based on who is paying them.  However, seven pending or settled lawsuits against hospice companies say that enrollment-based incentives led to admitting patients who didn’t qualify for hospice care.

The rise of for-profit hospice care since 2000 has helped drive a 60 percent increase in the average time patients spend in hospice, to 86 days in 2009, according to Medpac. The average stay of the 10 percent of patients who remained in hospice the longest soared 71 percent to 240 days. That means at least 110,000 patients weren’t facing imminent death when they were admitted.  Profit margins on healthier patients who survive for years with minimal care can exceed 20 percent, according to Medpac. 

 

 

Auburnpub.com published the tragic story of Geraldine Burke who passed away in the Cayuga County nursing home in 2009 after being given the wrong medication for 18 days. The county will pay $88,000 to her estate.  Burke passed away on April 11, 2009, and her son, Wayne Burke, filed the lawsuit against the county.

 

For more than two weeks before Burke’s death, three different nurses at the county nursing home gave her the wrong medication.  In just 18 days, she lost eight pounds, developed an inflamed large intestine and became lethargic and dehydrated, according to a report by the state Department of Health.. The autopsy showed that the medication led directly to her death. The family was not informed of the mistake until after she passed away.  Burke said that he is mostly upset by the attempt to hide the facts; he has yet to receive a copy of her autopsy and stated that, “I still don’t know anything to this day.”

 

The nursing home paid a $12,000 fine to the Department of Health.  Wayne Burke will receive $88,334 from the county and $47,654 from HealthDirect, a subsidiary of Kinney Drugs. The county had sued Kinney Drugs, claiming it had breached an implied warranty by prescribing the wrong medication.  

 

The News and Advance out of Lynchburg, VA reported the need and importance of dental care in nursing homes.  Patrick Britton-Harr is the president and chief executive officer of Senior Dental Services. Senior Dental Services is a relatively new company out of Maryland but most of their work is done in the Virginia area. They are currently serving 25 plus facilities in Virginia

Briton-Harr states that, “All of our equipment is portable” and all of their procedures are done in the nursing homes. This is beneficial to the nursing home and patients as many of the patients are on Medicaid which does not cover transportation for dental services but will pay for dental services. Also patients with dementia or senility can remain in an environment that is more familiar, and this helps to prevent them from becoming uncooperative.

Britton-Harr said it could have a beneficial impact for facilities. Poor oral hygiene can be linked to many diseases, he said. This could in turn save the nursing home money in not having to treat these diseases. The company hires local dentist so that they can have rapid service in place for incidents such as chipped teeth. Senior Dental Service also comes to the nursing homes once a month and will break a patient’s appointment up in to separate visits for ones who have difficulty keeping their mouth open for normal appointment times.

 

The Hartford Courant had an article on South Windsor nursing home.  The nursing home was mismanaged and now is in financial trouble.  Often when a nursing home is mismanaged or to increase profits, the operator cuts the raw food budget, dietary supplements, and staffing leading to poor nutrition and weight loss.  Adequate staffing is needed to help assist residents with eating and to provide dietary supplements.  Often these "shortcuts" save money but cause complications.  Investigators found two residents with significant weight loss at South Windsor.

State health inspectors examined treatment records for a patient at the South Windsor Rehabilitation and Nursing Center who had dwindled to 121 pounds from 139 pounds over several months.  There was no indication that any dieticians, nurses or doctors intervened to stop the weight loss.  The notes and reports reflect the 11 percent drop in weight, and suggest the cause may have been the discontinuation of a dietary supplement.   More than 10% is significant and leads to malnutrition, pressure ulcers, falls, infections, and death.  A second patient dropped 22 pounds from July to September. After inspectors inquired, a dietician recommended that the patient be examined for dehydration.

The state Department of Public Health only fined the facility $865. The maximum fine for this category of violation is ridiculously low at $3,000.  The facility was placed in bankruptcy receivership early this year. Money problems had overtaken the parent company, Connecticut Health of South Windsor, in 2010.