Aviv REIT, Inc. ("Aviv" or the "Company") (NYSE: AVIV) announced it has acquired four post-acute and long-term care skilled nursing facilities ("SNFs") in Texas and Illinois in two separate transactions for $20.0 million.

One of the SNFs is located in Texas and is triple-net leased to existing Aviv operator Fundamental Long Term Care ("Fundamental"), an operator of 102 facilities in 13 states, and one of the largest operators in the U.S., and the other three SNFs are located in Illinois and triple-net leased to existing Aviv operator Bridgemark Healthcare ("Bridgemark"), an operator of ten facilities in Illinois. These investments have a blended initial cash yield of 9.9%, annual escalators and initial lease terms of seven and ten years, respectively.

"Our relationship-oriented growth strategy continues to produce accretive acquisitions, as Fundamental and Bridgemark brought both of these transactions exclusively to us," said Craig M. Bernfield, Chairman and Chief Executive Officer of Aviv. "Fundamental is a new operator relationship for us this year, and with this transaction, they are now our seventh largest operator. Fundamental, like our other sophisticated and experienced operators, is able to partner with hospitals, physicians groups and managed care organizations because they provide quality care in an efficient and low-cost setting. The prospects for the SNF industry remain attractive and, given our pure-play focus, we are in a strong position to be a beneficiary of today’s evolving healthcare environment."


The government’s Five-Star system for rating nursing homes does not reflect the quality of life experienced by residents with preserved cognition, according to newly published research in the online edition of JAMDA.  Investigators from a variety of institutions, funded in part by the American Geriatrics Society, interviewed about 300 long-stay nursing home residents with preserved cognitive functioning.

The survey scores did not correspond with the number of stars earned by the residents’ nursing homes through the Centers for Medicare & Medicaid Services’ quality rating system, the team found. Physical impairment and depression both were found to diminish quality of life. Pain was not associated with quality of life — a finding the researchers said was “notable.”


Kaiser Health News had an interesting article about Medicare spending.  One out of every five dollars Medicare spends goes to nursing homes, home health services or other post-acute facilities and services. The spending varies greatly between states.

The article contains a chart that breaks down Medicare’s 2011 spending into five broad categories.   Spending has been adjusted for the different wage scales Medicare pays as well as special payments such as for hospitals that teach residents. The spending per Medicare beneficiary has been adjusted to take into account different illness levels among states’ Medicare beneficiaries. The figures include only traditional “fee for service” Medicare spending on beneficiaries age 65 and older. Spending on Medicare managed care plans, also known as Medicare Advantage, is not included.

In South Carolina, 17.25% of Medicare money went to long term care with $9,506.41 spending per capita with 525,501 Medicare beneficiaries.

Senior Housing News reported that Medicare Payment Advisory Commission (MedPAC) is recommending Congress to cut Medicare reimbursements to the nursing home industry in the coming years. The total profit margin for the nursing home industry was 1.8% last year, according to MedPAC.  But looking at freestanding skilled nursing facility Medicare margins, nursing homes had a 13.8% margin in 2012, marking the 13th year of profits above 10%, according to a MedPAC presentation during a Dec. 12-13 Meeting Brief.

MedPAC has long held that Medicare reimbursements should not be used to offset Medicaid underpayments, adding in the December 2013 presentation that “subsidizing Medicaid through Medicare payments is poor policy.”   MedPAC has previously called for rebasing Medicare‘s prospective payment system (PPS) for skilled nursing facilities and reducing reimbursements by 4% in 2016 with additional reductions in subsequent years, and is now renewing that recommendation.



USA Today reported that States with their own health insurance exchanges reported an increase of 30% to 40% in enrollments.  In the first week of December, 50,000 people signed up for insurance in California. Last week, 15,000 people were signing up every day.  “We’re seeing huge interest,” said Peter Lee, director of California’s exchange, during a conference call sponsored by Families USA, a health care advocacy group that supports the Affordable Care Act. Six months ago, “no American knew about” the state exchanges.

In Connecticut, Kevin Counihan, chief executive officer for Access Health CT, said 47,000 people have enrolled, and the site is seeing 1,400 enrollments a day. It also is receiving three times the number of phone calls as when the website launched.

In Kentucky, enrollments have increased 40% since Thanksgiving, said Carrie Banahan, executive director of the Kentucky Health Benefit Exchange. As of Wednesday, 92,000 people had enrolled, about 70,000 of whom signed up for Medicaid.

States that have expanded Medicaid coverage and spent millions promoting their exchanges are seeing an increasing diversity among the people buying insurance and the types they are purchasing. The numbers show interest in buying insurance is increasing after the initial problems that hurt the site when it launched Oct. 1.

The plans are set up so people can compare benefits and costs of each insurer, and they’re laid out as “metals” so people can quickly determine a benefit level. The levels, starting with the lowest, are bronze, silver, gold and platinum.




Here is a link to a $50 million dollar verdict recently rendered in a medical malpractice case in Washington state.  The case involved the tragic and preventable wrongful birth against a hospital and a lab that failed to detect a severe genetic problem in a fetus.  Returning its verdict, the jury found Valley Medical Center and LabCorp staff failed to spot a disabling genetic disorder in the child during tests conducted at the parents’ request.  The child’s father was a carrier for the disease, and the couple sought the test to determine whether to continue the pregnancy.  Due to errors made in testing, Rhea and Brock Wuth were told their son Oliver did not have the chromosomal abnormality. When Oliver was born, however, he did have the problem and will require 24-hour care for the rest of his life.

The focus of the trial was the hospital’s business practices of short cuts and understaffing that created the circumstances for the needless error to occur.  Understaffing at the lab, cuts in the maternal fetal medicine clinic and a focus by these institutions on maximizing revenue rather than ensuring safety.  LabCorp wasn’t provided crucial documentation, and lab staff failed to notice its absence.

“It was a complete failure of the checks and balances you’re supposed to have in medicine, and a betrayal of the faith my clients placed in them,” attorney Gardner said.  This presented the plaintiff with a great theme, “You can’t let the business of medicine get in the way of the practice of medicine.”



A deadly bacterial outbreak in a nursing home has affected 13 people in Alabama, including one death.  All of the cases in Alabama could be traced back to one nursing home. Many of the sick were residents, but some visitors were affected as well. The residents and visitors were exposed to Legionnaires’ disease, a serious bacterial infection spread by breathing in contaminated water vapor.  Roughly 5-30% of cases are fatal, and the disease is more serious in the elderly and those with weakened immune systems.

The facility remained open while under investigation, although the source of the infection had not been found as of the writing of the referenced articles. See International Business News and the Examiner.

Some residents have now been removed from the facility by worried families.  The son of one resident spoke out about his anger, telling how he was informed by the Department of Public Health about the incident, instead of receiving communication from the nursing home about the danger to his mother’s life.

Proper maintenance of water systems is a key to preventing Legionnare’s outbreaks. While the source of the outbreak is unknown, the bacteria typically grows in a warm wet environment, and is spread by the water vapor carrying the germs being put into the air. Could more rigorous upkeep and sanitization practices have prevented the outbreak? Also, why were the families not informed of the danger by the facility, instead of waiting for the State to step in? Were they hoping that no one would find out?

This incident comes on the heels of the largest outbreak of Legionnaires’ ever recorded in Ohio, which also stemmed from a retirement community. The outbreak in Ohio was responsible for 5 deaths and 39 others who became seriously ill.

Long term care facilities should not be a hotbed for deadly bacteria when the risk could be reduced greatly by proper maintenance of the water system and eliminating or cleaning the warm, wet areas where the bacteria grow.

Former administrator of the Gill Odd Fellows Home in Ludlow is proving to be an odd fellow indeed.  According to Valley News, Leslie Anne Whittington was suspended for unprofessional conduct.  Whittington served as the home’s administrator from 2006 to 2010 where she engaged in a number of questionable behaviors and decisions, including when Whittington went “beyond her scope of ability and training.”  Whittington also disagreed with a doctor’s order about a dying patient’s medication and recommending falsely diagnosing patients so they would be moved to psychiatric facilities.

The court agreed with original findings that Whittington had engaged in a number of activities of improper conduct and improperly interfering with medication administration.  However, the Vermont Supreme Court held the punishment may have been too harsh.  The court overturned Whittington’s five-year license suspension and returned that issue to the administrative law officer to re-examine.

Why would anyone allow her to operate a nursing home again?

Nursing home residents now have one more thing to worry about, reports Bayou Buzz.  A bookkeeper at Vicksburg Convalescent Center in Mississippi pled guilty to stealing over $100,000 from elderly residents.

Elderly residents of nursing homes are vulnerable adults, and are often the victim of theft by people they trust such as bookkeepers, office managers, and leading administrators. Lee Ray Martin had been stealing from residents at the home for months before anyone noticed. This is partially a result of the lax investigation into nursing home workers, where many workers don’t even go through background checks.