KUNC reported on how New Mexico is trying to prove that low staffing is Medicare fraud. One of the key factors in providing quality care in nursing homes is simply having enough staff to take care of the needs of the residents. The federal government found that about a quarter of all nursing home complaints can be traced back to low staffing levels. And studies have causally connected low staff levels to poor care and deficiencies.
The state’s Attorney General is suing a chain of nursing homes because the facilities were so severely under-staffed, they couldn’t possibly have provided the care they charged for. Now New Mexico wants its money back.
Lino Lucero is “confidential witness #1” in the lawsuit. In 2007 he and his wife Linda made the tough decision to send Linda’s mother, Polly Duran, to a nursing home. So he and his wife brought his mother-in-law to a nursing home in Santa Fe called Casa Real. They visited frequently, sometimes daily. There were always appalling discoveries. Linda Lucero frequently cleaned her mother up and changed her sheets. The Luceros also noticed that Duran was losing weight and growing frail. Even though the doctor had told the staff that Duran needed to have her food cut into bite-size pieces, they did not always do so. So sometimes, she didn’t eat.
Lucero almost apologizes for describing the conditions there. “Not to be a distasteful person,” he says, “but the smell and the stench… not only from her, but from the other residents that were there, was horrible and deplorable. You’d walk in and you’d wish you had a mask.”
“These are companies that profited and made hundreds and hundreds of millions of dollars in revenue,” about 80 percent of which came from the state of New Mexico in the form of Medicaid payments, says Hector Balderas, New Mexico’s attorney general.
In addition to Casa Real, there are six more nursing homes owned by Preferred Care Partners Management Group that are targets of this suit. “We’re trying to recover dollars back for the taxpayers of New Mexico,” says Balderas. The state is also trying to recover funds on behalf of private-pay residents.
But Balderas says that, more than money, the lawsuit is about the elderly and disabled residents of nursing homes “who suffered unnecessarily, sitting there in their own feces, sitting there in urine, developing bed sores. And some of this lack of care even resulted in death.”
So far, there are 31 confidential witnesses in this case — former nursing home employees as well as families like the Luceros. But what makes New Mexico’s suit novel, isn’t the personal accounts. It’s the data the state gathered to support its argument .
State attorneys used time and motion studies – a concept borrowed from industrial engineering — that show how long it takes health care staffers to do individual tasks. They focused on activities considered “basic care,” such as bathing, feeding, and turning residents so that they don’t get bed sores.
The attorney general’s office then compared those findings with the care required by the actual residents of the targeted nursing homes. The conclusion? It was physically impossible for the number of people employed at these nursing homes to provide the care required by the residents. So when the nursing homes billed for that care, they were lying.
They should be doing everything they can to make sure that the health, safety and welfare of these residents is met,” says Balderas, echoing the federal standards for nursing homes.