The Las Vegas Review Journal reported the increase and profitability of "specialty hospitals."  "The 14 local facilities that filed reports with the Nevada Department of Health and Human Services showed an operating profit of $54.7 million in 2011 compared with a $28.8 million loss for the general hospitals, excluding one quarter in which the University Medical Center failed to report."

"While general hospitals emphasize certain practices, they are staffed and equipped to take care of a wide variety of conditions. By contrast, specialty hospitals — in keeping with the name — stick to tightly defined areas such as long-term acute care for people not needing full hospitalization but too ill to go home, physical rehabilitation, mental illness and substance abuse."

 

Of course, hospitals are obligated to treat anyone who arrives at the emergency room, while all admissions to specialty hospitals are pre-arranged by physician referral which allows specialty hospitals to choose people based on payor source or insurance.

 

 

New York’s Democrat and Chronicle had an interesting article on an activist judge overturning legislation that would prevent waste, fraud, and abuse in nursing homes that receive taxpayer money through Medicaid and Medicare programs.   The law required operators to get written approval from the commissioner of the Department of Health to spend for personal expenses beyond 3 percent of their facility’s revenues from the previous year.  Why would they allow any money to be used for the operator’s personal expenses?

"Since 1977, the state has restricted operators from running their homes in the red. In 2008, the legislature required operators to notify the health commissioner in writing before withdrawing more than 3 percent of its annual Medicaid revenues from the prior year. Homes didn’t need permission to make a withdrawal, as long as they had sufficient funds. In 2009, the legislature imposed a 60-day freeze on all profits beyond a fixed threshold and required that the homes ask permission to withdraw in a current year more than 3 percent of the prior year’s Medicaid revenues."

“It was an intrusion by the government on owners’ personal rights to spend their own money as they see fit,” said Thomas G. Smith, partner at Harter Secrest & Emery who argued the appeal. But it is not their money, it is taxpayer funds meant to provide care and services to the residents.  The state strictly regulates homes, and among the requirements is that they have enough in the bank to cover the cost of caring for residents.

 “The government has the right to make sure regulated businesses that are taking public money and dealing with the public remain solvent,” Smith said. “You still have the obligation to make sure you have enough assets to provide for a quality of care.”


The NY Daily News had a great article on the case of nursing home Administrator Ruby Weston.   After years of delays, was justice served?   Ruby Weston operated two "non-profit" nursing homes that were funded by taxpayers’ money in Brooklyn, New York.  Despite the facade of non-profit, Ruby Weston and her family profited from these homes by robbing the facilities of the funds needed to properly care for the residents.

After years of this hoax, her fraudulent and questionable financial dealings were revealed by the press in 2004.  Finally, after charges were brought against her eight years ago, she is finally paying only $871,000 in a settlement. Of this settlement, $821,000 will go to supplement the Marcus Garvey Home and $50,000 will go to paying the state for legal expenses.  Pretty good deal considering she paid herself personal paychecks of upwards of $380,000 in 2009, a bonus of $500,000 after construction of the Ruby Weston Manner in 1995, an annual salary of $500,000 to herself and upwards of $1 million to her son.

“It is inexcusable for someone to profit at the expense of elderly, frail and vulnerable New Yorkers in nursing homes,” Attorney General Eric Schneiderman said.

“I’m glad to hear about the money, but what it comes down to is that residents were cheated for years and years from the care they deserved,” said Richard Mollot, executive director of the Long Term Care Community Coalition and a longtime advocate for nursing home residents. “It’s sad.”

See articles at North Country Gazette and Legal News Line.
 

The Polk County Crime Examiner reported the conviction of nursing home owner/operator George Dalyn Houser of Atlanta on charges of conspiring with his wife to defraud the Medicare and Medicaid programs by billing them for “worthless services” in the operation of three deficient nursing homes.   The nursing homes suffered from food shortages bordering on starvation, leaking roofs, virtually no nursing or housekeeping supplies, poor sanitary conditions, major staff shortages, and safety concerns,  As hundreds of residents were neglected, Houser spent taxpayer money on real estate, vacations, and other luxuries.  Evidence proved that Houser diverted at least $8 million of Medicare and Medicaid funds to his personal use. Staffing shortages, employee injuries, high tunrover rate, and poor employee benefits were a major problem as it is in most for profit facilities.

The conviction is the first time that a defendant has been convicted after a federal court trial for submitting claims for payment for worthless services. The court found by clear evidence that the evidence showed “a long-term pattern and practice of conditions at defendant’s nursing homes that were so poor, that, in essence, any services that the defendant actually provided were of no value to the residents.”

The Medicare and Medicaid programs require nursing homes to provide sufficient dietary, pharmaceutical, and environmental service to care for their residents’ needs.  Leaky roofs, foul odors and mold were common.  Flies, mosquitoes and other insects, as well as rodents easily entered the homes through ill-fitting screens and doors.   Employees spent their own money to buy milk, bread, and other groceries so that residents would not starve. Employees also bought nursing supplies for the residents, cleaning supplies for the homes. Some employees also washed the residents’ laundry in laundromats or in their own homes.

“It almost defies the imagination to believe that someone would use millions of dollars in Medicare and Medicaid money to buy real estate for hotels and a house while his elderly and defenseless nursing home residents went hungry and lived in filth and mold,” said United States Attorney Sally Quillian Yates. “We will continue to aggressively protect our most vulnerable citizens and hold accountable those who prey on the elderly and steal precious healthcare dollars.”

"According to an FBI press release, between July 2004 and September 2007, Houser billed Medicare and Medicaid approximately $39.4 million, and they paid him $32.9 million based on his certifications and promises that he was providing the residents of the nursing homes with a safe,clean environment with nutritional meals, medical care, and services that would promote or enhance the residents’ quality of life."

The Huffington Post recently published a story about Laura Carstensen’s book, A Long Bright Future. The story corrects five major misconceptions about growing older.

1.  Older people are not actually miserable. In fact, aside from individuals with dementia-related illnesses, age actually seems to improve mental health. Older people tend to emphasize the big picture instead of stressing about smaller details like their younger counterparts. They enjoy themselves and treasure their time more.

2.  DNA has power, but a healthy lifestyle is equally as important. People that live longer have lived a healthy lifestyle of not smoking, drinking in moderation, exercise, maintaining a healthy weight, and develop healthy coping mechanisms, not necessarily superior DNA.

3.  Working hard your entire life and saving all the fun for retirement is not necessarily a good idea. It may be better to have more leisure time over the course of life instead of saving it all until after the work is done and the children are older.

4.  It is not the older population that is overwhelming the world’s population, but rather higher birth rates and lower infant and child mortality rates in developing countries that are producing the population growth.

5.  Aging is not a solitary activity, but one that everyone faces. As it is a reality for everyone, humanity seems to age together.

 

Arizona’s KPHO had a disturbing video courtesy of Youtube of nursing home administrators "goofing off".  The video shows two administrators at the East Mesa Healthcare Center, "a nursing home which advertises caregivers who exceed expectations."   In the video, the administrators are dressed in costumes as they pretend to practice for the Tough Mudder race using the same equipment that the residents use for their physical therapy.

In one scene, the administrators get a jolt from the electrotherapy machine. CBS 5 News learned of the video when another employee at the facility sent us the YouTube link, saying that they were appalled by what they called unprofessional behavior displayed in the video.

If this is how the boss acts, how do the unlicensed nurse aides conduct themselves?

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Galesburg News reports on a new piece of legislation to be passed before the House in Illinois that would eliminate the ability to fine Nursing homes after serious injury or death.

The House Bill 5849 passed before the House unanimously and was the brainchild of Republican David Leitch.  This Bill leaves nursing home residents more vulnerable and at risk without any means of protection and creates more bureaucracy in the system of Nursing home review. Despite its unanimous passage, law makers still say: “ It is not a perfect bill. We will continue to work with the sponsors. We certainly still have some concerns, too.” 

Advocates for nursing home reform say this is a threat to advancements made on Nursing home reforms. Opponents of the bill sight its unanimous passage to lack of involvement from Public Health, who should have voiced concerns over the rights of nursing home residents.

In the state of Illinois, the passage of this bill will allow Nursing homes more room to get out of fines and citations through an appeals process. This bill will also lengthen the time of review on cases which resulted in serious injury or death, cases that need immediate action. The state of Illinois is aiding legislation which will allow Nursing homes more power and more abilities to avoid citations and fines through a system of bureaucracy.

 

The Wall Street Journal’s Market Watch reported the "astonishing" profits of the nursing home industry.   Nursing homes remain highly profitable.  Year-end earning statements for publicly traded nursing homes show a thriving enterprise with companies reporting “strong balance sheets” and “better than expected operating results.” One company’s annual revenues spiked nearly 200%.  

Brian Lee is the Executive Director of Families for Better Care.  Families for Better Care, Inc. is a citizen advocacy organization dedicated to quality resident care in nursing homes and other long-term care settings. Executive Director Brian Lee served as Florida’s State Long-Term Care Ombudsman for most of the past decade.

“The industry’s analysts framed the Medicare adjustment as an eventual doomsday for the nation’s nursing home market. But the industry’s own reports show quite the opposite, revealing surging revenues, strong profits, and expansion through acquisitions,” said Lee. “The industry is wallowing in strong profits while failing to consistently provide quality care.” 

The reason care declines in nursing homes is that executives unnecessarily target labor costs to offset any reimbursement adjustments,” Lee said. “While this obviously maintains a robust bottom line for investors and cushy CEO salaries, the decline in frontline staff puts residents in jeopardy for harm while simultaneously creating dangerous working conditions for employees.”

“Lawmakers must demand greater transparency and disclosure from nursing home companies and their affiliates. This will allow payment systems to be restructured, guaranteeing taxpayer dollars go directly to resident care and safety,” Lee commented.

A recent study by the University of California-San Francisco shows a steady decline in nursing hours for Medicare-licensed facilities and an unacceptably high level of deficiencies.

 

 

An article in Modern Medicine calls for new strategies to address the issue of Vitamin D deficiency in female nursing home residents. The article cites a study that has found large number of elderly female residents deficient in Vitamin D during the winter months. It reports increased risk of death in women already suffering from low levels of the vitamin.

Experts blame the deficiency on a combination of low exposure to sunlight, dietary causes as well as the inability of the aged skin to receive the vitamin. 25-hydroxyvitamin D (25[OH]D) concentrations are known to increase the risk of death in the general population. Researchers have now begun trace these deficiencies to the mortality of elderly females. In a study of 961 female patients from 95 nursing homes in Austria, 92.8% were found to have levels of 25-hydroxyvitamin D below the required amount. 269 deaths were noted 27 months later. Experts urgently recommend strategies to address the deficiency and advise supplementation in the elderly female population.

The New York Times reported an interesting trend of nursing homes hiring blue collar workers to the ranks of their nursing staff.   The article by Tess Vigeland reported a current trend of factory, warehouse, and auto-industry workers, laid off as their companies went abroad, filling vacant positions as male nurses in retirement homes.  

The state of Michigan reported a shortage in nurses will reach 18,000 workers by 2015.  It appears the labor force is adapting to fill this vacuum.  Institutions such as Oakland University in Rochester, Massachusetts have designed programs specifically to retrain members of the labor force seeking a career shift into the nursing profession. The College of Nursing and Wayne State University in Detroit has reported large numbers of former manufacturing workers entering their program.

The Federal Trade and Readjustment Actassists workers who lose their jobs due to foreign competition.  The Trade and Readjustment Act provides tuition for workers to participate in retraining programs such as the nursing school at Wayne State University. Retraining time is determined by the level of nursing the student wishes to pursue. Workers seeking a career change have their pick among levels of nursing requiring training lasting as long as 4 years to 8 months.  

There is a high rate of applicants being turned away from training programs becuase lack of faculty and class room space. It would appear the demand for nurses is as high as the demand for training. The workers are here to meet the shortage but schools cannot accommodate them fast enough. Where the shortage of nurses is projected to reach 500,000 by 2015, the American Association of Colleges of Nursing reports a total of 67,000 applicants turned away in 2010 due to the shortage of training programs. This is unfortunate as male RNs, CNAs, and LPNs are called a “hot commodity” at retirement across the United States. As the percentage of male nurses has only risen to 9.6% since 2000, men seeking a new career in nursing can be assured to find a new career on the spot.