It is now official, an 82-year-old man was murdered in his nursing home in Dorval, Canada. He was found just a few weeks before Christmas last year with severe injuries and was rushed to the hospital, only to die from the wounds inflicted on him a few days later. The local coroner has determined his death to be murder and a homicide investigation is underway. The nursing home and the staff who were present at the time of his attack are the obvious starting point for questioning. More details are currently unavailable while the investigation is underway. CBC has an article on its site.
New data shows that patients may pay tens of thousands more for the same treatments if they pick the wrong facility. Even within the same community, different hospitals are charging wildly varying prices without a lot of regulation. Between states the numbers are troublingly different as well. A joint replacement for a Medicare patient in Maryland might run around $21,000. That same procedure in California can run a staggering $88,000. Meanwhile, a South Carolina patient will see an average bill of $57,000.
In an attempt to promote transparency and help patients navigate the healthcare marketplace 34 states currently require hospitals to report certain charges and reimbursement rates. Lawmakers in other states are introducing legislation which attempts to increase transparency in the industry. Only 10 states have established statewide databases of statistical information from health insurance claims. Utah, one of the frontrunners in providing cost and quality comparison tools for public, allows employees to compare insurer contracted charges, not just the non-discounted billed charges. The new healthcare marketplaces provided under the Affordable Healthcare Act (sometimes known as “Obamacare”) are expected to benefit healthcare consumers and have an impact on total cost of care for individuals. See full article here.
As the baby boomer generation ages, the already growing and profitable nursing home industry is primed for a boom. With 63% of residents on Medicaid and another 14% on Medicare, the temptation for unscrupulous nursing homes to puff up government reimbursement claims with fraudulent information is growing rapidly as well. Fraudulent claims include billing for unnecessary rehabilitation services, billing for expensive supplies and equipment that was not used or necessary, improperly classifying patients in order to inflate reimbursements, and ordering unnecessary medical tests.
Some fraud involves kickback arrangements for patient referrals and sweetheart arrangements with hospitals or pharmacies. The details and schemes may vary but this type of fraud is illegal and in violation of the False Claims Act. Both the facilities and their corporate owners who are lining their pockets with government money can be liable for this type of fraud.
Fraud of this nature doesn’t just affect the current residents, who aren’t benefiting from the money which is meant to provide care for them. It can also affect future generations, who may see a Medicare and Medicaid system which cannot support both the ballooning costs of the baby boomers as well as unchecked greed and fraudulence from for-profit facilities. See article at Justice News Flash.
Some nursing homes are finding ways to go after the children of their patients for medical expenses by using language in intake forms that identifies them as “responsible parties.” Typically elderly patients have someone act as their agent, or have a power of attorney, but signing as a responsible party may open the door for the nursing home to come after the children directly for any debts after their family member’s death. Some states are passing laws making this a reality for all patients, but in others the family must be aware of the specific language in the documents provided to them. See article from Palm Beach Post.
Newaygo County nursing home had a serious breach of patient privacy when an employee used her phone to Snapchat a photo of an elderly resident. At least one employee used the Snapchat app to send a patient’s photo, but more may have been involved. Though Snapchat is an app which claims the data doesn’t stay on the site or another person’s phone, but as digital experts have said, that data is stored somewhere. Given to a specialist, that data could be recovered, which means that Snapchatting a resident’s photo is a serious breach of privacy. Authorities did confiscate one employee’s phone in the investigation. See article here.
HealthDay News reported on a recent study that showed that 37% of falls in nursing homes result in head injury. The study was published Oct. 7 in the CMAJ (Canadian Medical Association Journal). People hit their head on the floor in 63 percent of such cases, most often striking hard flooring, such as tile or linoleum. Sixteen percent struck their head on furniture and 13 percent hit their head on a wall. The risk for head impact was much higher for forward falls than for backward falls, and attempts to use the arms to break falls were ineffective, according to a journal news release.
“Although we cannot identify why hand impact was generally ineffective in halting downward movement and preventing head impact, likely causes include ineffective arm placement; non-optimal muscle tone or muscle activation at impact; and insufficient strength in upper-limb, neck and trunk muscles, which is amenable to improvement through resistance training,” the researchers wrote.
Creating a safer environment is a suggestion — such as adding a flooring sub-layer that is soft enough to cushion the impact but not so soft that it impairs balance.
The U.S. National Institute on Aging has more about older adults and falls.
Two caretakers at the Bell Avenue Nursing Center in Elk City, OK have been charged in the death of a 76 yr old patient. Elisha Embley and Licilia Garcia were both charged for concealing a crime and conspiracy to conceal a crime. Embley has also been charged with second degree felony murder-neglect by a caretaker, abuse by a caretaker, and neglect by a caretaker. The 76 yr old was injured during a transfer from the bed to a wheelchair, resulting in life threatening injuries. The patient later died. See article here.
Richard L. Wilson, 70 yr old resident of McCrea Manor Nursing & Rehabilitation Center was killed when the electricity at the home went out. Wilson couldn’t breathe on his own and the electricity caused his breathing machine to stop working, resulting in his death. A jury awarded Wilson’s family $375,000 in compensatory damages and an undisclosed settled amount of punitive damages. The damages were increased because the facility didn’t have backup power for all of their rooms and they had a previous power outage where Mr. Wilson had to be taken to the hospital. See full article here.
In a Kentucky blog, our flawed system is analyzed to see where we’re going wrong with nursing home care. Instead of responding to wrongful death suits with updated policies, the industry pushes for tort reform and pays lobbyists to keep legislators from regulating the industry. Nursing homes have learned that it’s cheaper to pay a fine every now and then than to implement appropriate policies and increase staffing to levels necessary for proper care. Budget cuts in Washington are decreasing accountability for these homes because there are fewer regulators to watch them. We place our elderly in nursing homes and leave them there to be abused, neglected, and to eventually die. We forget about them and their struggle.
A man who suffered severe pressure ulcers due to neglect sued a nursing home, which tried to force him through arbitration. The evidentiary showing by the plaintiff met the burden to prove that the clause was prohibitively expensive. The good news is that the Arizona court struck down as unconscionable an arbitration clause that imposed enormous fees on an individual before the individual could go to arbitration.
In Clark v. Renaissance West, a man sued a nursing home for medical malpractice, alleging that neglect had caused him to develop a severe pressure ulcer that caused enormous problems. An Arizona state Court of Appeals held that the man had proven that the arbitration clause would impose prohibitively expensive costs of arbitration on him before he could pursue his claim, and it struck down the clause as unconscionable.
The court held that a plaintiff alleging that an arbitration clause would be prohibitively expensive has the burden of showing specific facts proving that claim, with reasonable certainty. The plaintiff had an expert who testified about the average hourly rates of arbitrators in the area (hundreds of dollars an hour), and who testified that the complexity of the plaintiffs’ claims would require him to put forward testimony from enough expert and fact witnesses that an arbitration hearing on his claims would likely take five days. The plaintiff — a retiree with a fixed income — would have had to pay $22,800 to arbitrate his claims, and he couldn’t afford it.
“An arbitration agreement may be substantively unconscionable if the fees and costs to arbitrate are so excessive as to ‘deny a potential litigant the opportunity to vindicate his or her rights,’” citing Harrington, 211 Ariz. 241.