Researchers estimate nearly 800,000 preventable adverse drug events may occur in nursing homes each year. Many of these incidents could be prevented with safety practices such as medication reconciliation, a process in which health care professionals, such as physicians, pharmacists and nurses, review medication regimens to identify and resolve discrepancies when patients transfer between health care settings. In nursing homes, both registered nurses (RNs) and licensed practical nurses (LPNs) often are responsible for this safety practice. A recent study by a University of Missouri gerontological nursing expert found, when observed, these nurses often differed in how they identified discrepancies. Recognizing the distinct differences between RNs and LPNs could lead to fewer medication errors and better patient care.

Amy Vogelsmeier, assistant professor in the MU Sinclair School of Nursing, says because pharmacists and physicians often are unavailable, both RNs and LPNs equally are responsible for practices such as medication reconciliation and other activities to coordinate care once patients enter nursing homes.

Vogelsmeier said RNs often are understaffed in nursing homes, though their clinical education and experience give them a greater sense of the “bigger picture,” which leads to better outcomes.

Right now in the industry, RNs and LPNs often are used interchangeably but inappropriately,” Vogelsmeier said. ‘The solution is not to replace LPNs with RNs but to create collaborative arrangements in which they work together to maximize the skill sets of each to provide the best possible care for patients.”

She says assigning RNs and LPNs complementary roles that maximize their abilities will improve patient care and satisfaction. Additionally, Vogelsmeier said offering LPNs enhanced training opportunities may help them build the cognitive skills necessary to work in the current nursing home environment.

“Nursing home care is more complex than it was 10 years ago,” Vogelsmeier said. “People used to move into nursing homes and stay there the rest of their lives, but now they’re using nursing homes to transition between hospitals and their homes. Patients in nursing homes are sicker, and their stays are shorter. That demands better nursing staff coordination of care.”

The study, “Medication Reconciliation in Nursing Homes: Thematic Differences Between RN and LPN Staff,” was published in the Journal of Gerontological Nursing and was funded by the John A. Hartford Foundation and the University of Iowa Gerontological Nursing Interventions Research Center. Vogelsmeier’s coauthors include Jill Scott-Cawiezell from the University of Iowa and Ginette Pepper from the University of Utah. See article here.



Market Watch reported that Assisted Living Concepts, Inc. reported net income of $7.3 million in the fourth quarter of 2011 as compared to $5.4 million in the fourth quarter of 2010. Excluding the One-Time Items described below, net income in the quarters ended December 31, 2011 and 2010 would have been $6.3 million and $5.5 million, respectively.

"Fourth quarter results blossomed with the momentum we built up in quarter three," commented Laurie Bebo, President and Chief Executive Officer. "We continued to see improvements in workers compensation and general and professional liability expenses. We believe these items combined with our private pay strategy, increased occupancy and other careful cost controls resulted in record operating income for the fourth quarter and all of 2011."

For the year ended December 31, 2011, ALC reported net income of $24.4 million as compared to $16.5 million in the year ended December 31, 2010. Excluding the One-Time Items described below, net income in the years ended December 31, 2011 and 2010 would have been $22.1 million and $18.2 million, respectively

Assisted Living Concepts, Inc. and its subsidiaries operate 211 senior living residences comprising 9,325 residents in 20 states. ALC’s senior living residences typically consist of 40 to 60 units and offer a supportive, home-like setting. Residents may receive assistance with the activities of daily living either directly from ALC employees or through our wholly owned home health subsidiaries. ALC employs approximately 4,200 people.


The New York Times had an article on the need for health care professionals for an aging population. Specialized programs for geriatric medicine, dentistry and mental health is one way that health care professionals can gain more specific knowledge and training to recognize and provide comprehensive care for the growing number of people 65 years old and up.  Doctors do not flock to practice geriatrics because Medicare reimbursement is comparatively low. The average geriatric specialist made $183,523 in 2010 — less than half that year’s $392,885 median for dermatologists, according to the Physician Compensation and Production Survey.

The federal government underwrites some fellowships and is asking for $54 million, up $11 million from last year, in the next budget for such training, especially for Geriatric Education Centers at dozens of medical schools and major medical centers. Prestigious organizations like the Institute of Medicine have warned of a looming scarcity of medical professionals ill-equipped to deliver quality treatment.

The Hartford Foundation and the Atlantic Philanthropies have supported a wide-ranging effort, at more than 300 hospitals, to provide nurses with geriatric training, in a program called Niche (Nurses Improving Care for Healthsystem Elders).


USA Today reported that home health care companies made an average 19.4% profit in 2010, a report shows, prompting the independent board that oversees Medicare to again ask Congress to lower reimbursement rates for these companies.  The Medicare Payment Advisory Commission (MedPAC) reports each March about trends in overall Medicare spending and how to save money. Their latest findings include:

•The government saved money by increasing the use of generic drugs for Medicare recipients. Beneficiaries who pay some share of their drug costs are more likely to use generics than lower-income patients who don’t have to pay, the study showed.

•Medicare Part D spending for prescription medications rose from $42.5 billion in 2006 to $59 billion in 2011.

•Medicare Advantage enrollment grew to 12.1 million beneficiaries in 2011. That counters predictions by opponents of the 2010 health care law who said Medicare Advantage payments would drop.

The home health care industry is fighting a proposed law that would require them to pay employees minimum wage and overtime. They argue that seniors will have to pay more money and will have to have several caregivers, rather than one who can stay all the time, because the companies won’t have the money they need to pay those benefits. But Mark Miller, MedPAC’s executive director, said the board expects the industry to see a 19.8% profit margin in 2013 from Medicare.


The Washington Post reported that Cigna Corp. CEO David M. Cordani’s total compensation climbed 25 percent valued at $18.9 million last year.  Cigna is the fourth-largest commercial health insurer in the United States, based on enrollment.  This is exactly what is wrong with a for profit health care system.   The young executive, who became CEO in 2010, also received $62,865 for security alarm installation and maintenance in 2011 after the company gave him $48,733 for the same thing the previous year.

Health insurers have taken criticism in recent years for giving their top executives big compensation hikes while the cost of insurance continues to outpace inflation and growth in wages. 


The Billings Gazette had an article about the guilty plea and sentence of Perry Vandeventer to between four and six years in prison and ordered him to payback only $41,000 in restitution for embezzlement.  Vandeventer was the chief financial officer of Shepherd of the Valley nursing home.  Vandeventer pleaded guilty to one count of obtaining money under false pretenses from Shepherd of the Valley. Vandeventer was blamed for accelerating the financial decline at the nursing home in late 2010 that led to its acquisition by a Minnesota company.

"From his hiring in early 2008 to January 2011, Vandeventer defrauded the nursing home by submitting bogus receipts for contractors who never did any work, obtaining cash advances for travel including trips he didn’t take, and obtaining money for books, education expenses and dues for purposes unrelated to the nursing home’s business, according to court records. He also used nursing home credit cards to pay for a computer, books, meals in Denver restaurants, vehicle repair, fuel, and a personal speeding ticket in Casper Municipal Court, according to court records."

Kaiser Health News reported a new way to fight the Medicare fraud which is rampant in the nursing home industry.  Federal officials have overhauled Medicare billing statements to make it easier to find bogus charges. The new, more consumer friendly format includes larger type and explanations of medical services in plain English.  And for those who might need an incentive to scour their bills, the new statements promise a reward of up to $1,000 for a tip that leads to uncovering fraud.

"You can make a difference!" the revamped statement says. "Last year Medicare saved taxpayers $4 billion – the largest sum ever reported in a single year thanks to people who reported suspicious activity to Medicare."

Currently, Medicare Summary Notices can run more than a dozen pages for those with multiple doctor visits and treatments, and they are full of medical jargon and abbreviations that can hide mistakes or cover up fraud that drive up Medicare costs and can jeopardize future services for beneficiaries.   The redesigned form also aims to make Medicare services clearer and more accessible.

CMS has come out with a new paper stating that extensive research finds that the type of nursing home ownership and sponsorship affects the quality of care that facilities provide to their residents.  "Extensive research finds that the type of nursing home ownership and sponsorship affects the quality of care that facilities provide to their residents."   PDF is attached.

Excerpts from the report are below:

Both "impressionistic evidence" and empirical research documented differences in
quality related to ownership. For-profit and chain-operated nursing facilities tended to devote fewer resources to direct patient care, resulting in poorer quality of care for residents. 

Quality of care is now frequently evaluated across three domains. The three domains, first identified by A. Donabedian, are: structure (resources used to provide care; e.g., staffing); process (actions used to provide care; e.g., restraints); and outcomes (end results for patients; may be bad
outcomes, e.g., pressure ulcers, or good outcomes). Consistently, research in the quality of
nursing home care since the IoM report has reported that not-for-profit nursing facilities have higher nurse staffing levels and fewer health care deficiencies than their for-profit counterparts. For-profit facilities, particularly those owned by multistate chains, are more likely to reduce spending on care for residents and to divert spending to profits and corporate overhead

In 2011, the first-ever analysis of the ten largest for-profit nursing home chains reported that
between 2003 and 2008, compared to all other ownership groups, facilities owned by the top ten
for-profit chains had:
The lowest staffing levels;
The highest number of deficiencies identified by public regulatory agencies; and
The highest number of deficiencies causing harm or jeopardy to residents.

The Government Accountability Office (GAO) reported in 2011 that nursing facilities acquired
between 2004 and 2007 by the top ten private equity firms:
Had more total deficiencies than not-for-profit facilities;
Reported lower total nurse staffing ratios; and
Showed capital-related cost increases and higher profit margins, compared to other

In 2010, the GAO reported that compared to other nursing facilities, Special Focus Facilities
(i.e., those identified by CMS as among the poorest performing facilities nationwide):
Are more likely to be part of a chain and for-profit, compared to other facilities;
Have fewer registered nurses per resident day; and
Are ranked lower on CMS’s Five-Star System.

The GAO reported in 2009 that compared to other nursing facilities, Special Focus Facilities,
which have more deficiencies and more serious deficiencies than other facilities, are:
More likely to be for-profit;
More likely to be part of chain; and
Have almost 24% fewer RNs/resident/day and fewer nursing staff at all levels/resident/day.

In September 2007, an investigative report in The New York Times found that:
Nursing facilities owned by private equity firms were 41% more profitable than other nursing
One facility it focused on, in the year after its takeover by a private equity firm, cut the
number of registered nurses in half and cut spending on nursing supplies, activities for
residents, and other supplies, leading to poorer resident care.

A recent study by LeadingAge New York, the association that represents not-for-profit nursing
facilities in New York State, found that not-for-profit facilities:
Performed better on most measures than for-profit facilities in the state;
Had fewer residents using antipsychotic drugs or with physical restraints;
Had lower hospitalization rates, and more discharges to home;
Had more nursing staff and fewer survey deficiencies and spent more money per day on
nursing costs and food.

A review and meta-analysis of 82 studies comparing quality of care in for-profit and not-for-profit
nursing facilities reported that nearly all the studies found higher quality, higher staffing, and fewer
pressure sores in not-for-profit facilities. Not-for-profit facilities had better outcomes on four
key measures of quality:
"More or higher quality staffing;"
Lower prevalence of pressure ulcers;
Lower prevalence of restraints; and
Fewer government-cited deficiencies.

The authors estimated that if all nursing homes in the United States were operated on a not-forprofit basis:
7,000 residents with pressure sores would not have them;
Residents would receive 500,000 more hours of nursing care each day.

The L.A. Times reported that the price of drugs widely used by elderly Americans grew by almost double the rate of inflation from 2005 to 2009, according to a new study by the AARP.

The average retail price over the five-year period for the 469 drugs most often used by AARP members grew by 25.6%, compared to the 13.3% rise in inflation over the same period, according to the report.

The report also says that 406 of the 469 most commonly used drugs are used to treat chronic conditions and that the average cost of taking such medicines for chronic conditions was $1,152 higher in 2009 than it was five years earlier.


USA Today recently had a disturbing article about the Medicare fraud involving the nation’s largest drugmakers.    The multinational companies have paid at least $8 billion in fines for repeatedly defrauding Medicare and Medicaid over the past decade.  They only remain in business because they hold a monopoly on life saving medications.  Government investigators can exclude these companies from providing medications to Medicaid and Medicare beneficiaries as punishment for prior fraud, but that would leave beneficiaries without drugs patented through a particular company.

Pfizer alone has paid almost $3 billion in fines since 2002 and entered into three corporate integrity agreements with the Department of Health and Human Services aimed at preventing future fraud. Pfizer’s 2009 settlement was for improperly promoting the use of drugs for purposes other than those for which they were approved by the government.

Merck paid $1.6 billion in fines since 2008, Medicare and Justice Department records show, to resolve claims it was not paying proper rebates to the government.  Merck’s 2008 settlement involved claims the company paid illegal kickbacks to health care providers in exchange for prescribing its drugs.

Pharmaceutical companies altogether spent more than $200 million lobbying Congress in 2011, including $12 million spent by Pfizer. At least 12 pharmaceutical and medical device companies are lobbying specifically against a House bill, HR 675, that complements Grassley’s.