VTDigger reported the arrest of Kareen McGregor on suspicion of second-degree assault, a felony, and simple assault, a misdemeanor for assaulting an 88-year-old patient. Police allege that McGregor, a licensed nursing assistant at the Genesis nursing home, poured water over the head and face of a female patient, then placed clothing around the patient’s head and neck to impede her breathing.

The police investigation involved speaking with members of the patient’s family, who were the first to report the incident.  Police also spoke with staff and other patients who witnessed the incident.  They found bruising on the resident.

Genesis, which operates more than 500 nursing homes and other health facilities nationally, is the largest nursing home operator in both New Hampshire and Vermont.

 

Fox Business reported on the U.S. health epidemic of diabetes as more than 114 million Americans are now living with diabetes or pre-diabetes, according to a report released by the Centers for Disease Control and Prevention (CDC) Opens a New Window..

The International Diabetes Federation reports that the number of people living with diabetes worldwide has tripled since 2000, costing $850 billion annually.  According to the CDC, Type 2 diabetes accounts for 90% to 95% of all diabetes Opens a New Window.cases and is linked to obesity and an inactive lifestyle.

 

 

The Clarion Ledger reported the $1.25 million settlement between U.S. Department of Justice and Hyperion for allegations of false Medicare and Medicaid claims for  “grossly substandard care” at a Lumberton nursing home.  The government alleges that from October 2005 to May 2012, Hyperion made claims to Medicare and Medicaid for providing effectively worthless services to the nursing home residents.  The poor quality care caused the facility’s residents to suffer pressure ulcers, falls, dehydration and malnutrition, among other physical, mental and emotional harms, the government says.

Hyperion Foundation, a Georgia not-for-profit entity (Hyperion), Julie Mittleider, Hyperion’s former president, AltaCare Corp., a Georgia corporation engaged in nursing home management, Douglas Mittleider, AltaCare’s chief executive officer,  Long Term Care Services Inc. and Sentry Healthcare Acquirors Inc., and others have agreed to pay the settlement for alleged substandard care to residents at the Oxford Health and Rehabilitation nursing home in Lumberton. The nursing home was operated from late 2005 through mid-2012 by AltaCare, under a contract with Hyperion.

For example, the United States alleges that Hyperion failed to meet the nutritional needs of residents, failed to administer medications to residents as prescribed by their physicians, over-medicated residents, hired insufficient staff to care for them and diverted Medicare and Medicaid funds to other entities affiliated with Douglas or Julie Mittleider, leaving the facility unable to pay for its basic operations, including food, heat, air conditioning, pest control and cleaning. 

“When operators of nursing homes harm our most vulnerable citizens and break the law by defrauding our government for grossly substandard or worthless services, we will bring to bear all the resources of the federal Government in order to rectify these terrible actions,” Southern District of Mississippi U.S. Attorney Mike Hurst said in the news release. “I commend our attorneys and investigators for resolving this travesty with one of the largest healthcare fraud settlements involving a single nursing home. We will continue the Department of Justice’s long-standing commitment to protecting the elderly.”

The lawsuit was filed under the qui tam provisions of the False Claims Act, which permit private parties to sue on behalf of the government for the submission of false claims and share in any recovery.  The False Claims Act authorizes the United States to intervene and take over primary responsibility for the action, as it did in this case.  The amount to be recovered by the private whistleblower has not been determined.

St. Louis Today reported that infamous and disgraced nursing home company CEO Johnnie Mac Sells admitted stealing more than $667,000 from Medicaid and been sentenced to 41 months in federal prison.  Now , he also admits to stealing from employees’ 401(k) accounts and health benefit plans, although he may face no more time in prison.

Sells waived indictment by a grand jury and pleaded guilty in U.S. District Court to two counts: stealing from an employee benefit plan and stealing from a health care benefit program.

 Assistant U.S. Attorney Dorothy McMurtry told U.S. District Judge Henry Autrey that money for their 401(k) plans was withheld from Legacy Health Systems employees’ pay from August to October 2016, but was not added to their accounts. Employees didn’t know because Sells failed to file annual reports, she said.  She also said that there was more than $800,000 in the plan in December 2015, and nothing 15 or 16 months later.
 McMurtry said that the employee health care plan was terminated in May 2016 for nonpayment, but Sells continued to withhold a total of $20,000 from employee paychecks. Those employees only found out they didn’t have health insurance when their health claims were rejected, she said. McMurtry said there was more than $124,000 of unpaid health claims.

Legacy Health, the Sells family business, once employed 1,600 who cared for 2,000 patients in 27 facilities across Missouri, Kentucky and Tennessee.  But by 2016, there were only three nursing homes left. And patients in Benchmark Healthcare were going hungry while Sells spent Medicaid money on strippers, gambling, pet care and country club fees, prosecutors have said.

A Post-Dispatch investigation documented the company’s fall.

WALB reported the complaints about the horrific conditions at Pinewood Nursing Home.  Virginia Toombs said her brother was living in horrible conditions at the nursing home during the last year of his life.  “It was the most disgusting thing I’ve seen in my whole life,” said Toombs.  “I’m glad he’s in heaven. I prefer him to be in heaven than in that place any day,” said Toombs.

Roaches everywhere, a sight that will make will make your skin itch.  “Everywhere I tried to sit in the room with my brother who was dying. They were in the bed. My brother was on an oxygen machine and they were crawling on the oxygen machine,” said Toombs.

Toombs said she brought it to the attention of some of the staff there who said they were already aware of the issue.

“I said, ‘This is disgusting. How can you all even work here?'” said Toombs.

The facility has a 1-star overall rating.

In August of 2015, the Federal Department of Health and Human Services and Centers for Medicare and Medicaid Services listed on its inspection report that the pest control company revealed to the inspector that the bill was not paid from July 2015 to December 2015 with a total of $1,313.00 owed to the pest control company.

Live roaches were found in two rooms, and dead roaches were found in the conference room.

In the most recent inspection completed five months ago, it details a much bigger problem.

They found bugs on a variety of surfaces on the walls, bulletin boards, and behind toilets.

The pest problem also mentioned rats.

The inspection report details that ‘The administrator revealed that the pest control company comes to the facility on a monthly and as-needed basis. She stated to the inspector that she felt as if the pest control program was effective.’

“Your parents in their last days or your family members they need to be in the best of care in their last days and not in a facility where their health is already bad and being infested by roaches and rats just makes it worse,” said Toombs.

When we reached out to the facility, their administrator gave us a statement saying “We are not aware of a pest control problem. We have pest control come twice a month. Any issues in the inspections have been taken care of.”

 

Forbes reported on Omega Healthcare Investors (OHI) which has long been a popular choice for income advisors. The real estate investment trust focuses on nursing homes and health care facilities–sectors that benefit from an aging population.  Based in Hunt Valley, Maryland, Omega is a real estate investment trust that provides financing and capital to the long-term health care industry, especially skilled nursing facilities.  The company owns or holds mortgages on more than 900 assisted living facilities, nursing homes and specialty hospitals in the United States and Britain. Omega recently announced the acquisition of 15 skilled nursing facilities in Indiana, which will make it the nation’s largest owner of post-acute-care centers.

Omega Healthcare Industries just raised its dividend for the 21st straight quarter.  The stock now pays an amazing 9%. This is only the third time in the last ten years that Omega Healthcare has paid this much.

Overall, the big picture for skilled nursing facility demand looks great. The industry, which is actually seeing supply decrease as demand increases, is projected to be in a supply deficit within the decade.  Total patient days at skilled nursing facilities are increasing, and are projected to accelerate higher in the coming years.

U.S. News had an interesting article discussing how Louisiana’s payments to private nursing homes for taking care of Medicaid patients have risen substantially over the last decade increasing profits even as their occupancy rates stayed flat, according to an audit.  The state Medicaid program spent $8.7 billion in federal and state dollars on nursing home care for people who are elderly or disabled from 2006 through 2016, as daily rates paid to about 260 nursing homes increased 54 percent from $112.34 to $172.82.  In the last budget year that ended June 30, Medicaid payments to the facilities reached $1 billion.  Occupancy rates over the same period, however, “have generally remained the same,” growing by less than 1 percent.

One easy explanation is that the nursing home industry is powerful and a hefty campaign contributor at the state capitol.  In fact, inadequate monitoring and enforcement caused the department to fail to recoup $3.2 million in Medicaid payments for ineligible patients in 2014.

 “Even with the increasing payments to nursing facilities, Louisiana continues to rank poorly in regards to quality of care,” auditors wrote.
 Auditors also said the Louisiana Department of Health needs to improve its oversight of payments to ensure they’re accurate. They said the agency should issue penalties for late cost reports from nursing homes and tougher sanctions for facilities that have repeat audit violations.

The L.A. Times reported the latest on the beneficial effects of ObamaCare.   A report – based on a state-by-state survey of data collected by the federal government – provides powerful new evidence that insurance gains made through the 2010 healthcare law are helping millions of patients get needed medical care.  Americans are no longer putting off doctor visits or struggling with medical bills, according to a new report examining the effect of the Affordable Care Act.

“The Affordable Care Act has put access to healthcare in reach for millions of Americans, particularly for people in states that embraced the law,” conclude the authors of the report, published by the nonprofit Commonwealth Fund.  Across the country, the law is credited with extending health coverage to more than 20 million previously uninsured Americans and dropping the nation’s uninsured rate to the lowest levels ever recorded.

An increasing number of studies have found similarly dramatic improvements in patients’ access to care after they get coverage.

“The fact is health insurance helps people get access to care, gets them better preventive care and more regular care for chronic medical conditions,” said Dr. Benjamin Sommers, a health policy researcher at Harvard who has extensively studied the effect of health insurance.

Between 2013 and 2016, the share of adults reporting that they delayed medical care because of concerns about cost declined in 45 states.

The percentage of adults at risk of being in poor health who had not been to the doctor in the previous two years declined in 37 states.

And the share of working-age adults with high out-of-pocket medical bills fell in 35 states between 2013-14 and 2015-16, according to the report, which is based on census data and national health surveys overseen by the Centers for Disease Control and Prevention.

These gains were particularly pronounced among low-income Americans, who have arguably benefited most from the 2010 law’s coverage expansion.

 

The Pittsburgh Post-Gazette had an interesting article about the danger of entrapment in bedside rails and restraints after prominent Pittsburgher Robert Frankel’s recent accidental strangulation from entrapment in bed rails at the Charles Morris Nursing and Rehabilitation Center nursing home highlighted a danger that has concerned regulators and consumer advocates for years.  Mr. Frankel, a businessman, arts patron and father of a state legislator, was pronounced dead of accidental asphyxiation from “compression of the neck” after being found on the floor of his room. A state Health Department inspection report said he was “lying with his body on the floor and his neck between the air mattress and the side rail.”

Are they too dangerous or a necessary safety intervention?  The risk of injuries from bed rail use, particularly in the case of dementia patients like Mr. Frankel, has been among the issues cited in a successful effort over the past two decades to reduce a variety of dangerous restraints that restricted nursing home residents.  The FDA, which regulates hospital beds as a medical device, counted 531 rail-related deaths from 1985 to 2013, the most recent period in which it did an analysis.

The safety movement has been driven primarily by the goal of enhancing the dignity and independence of residents, who were once often tied to their beds or wheelchairs. However, other interventions don’t necessarily achieve their goal of enhanced safety including bed rails and alarms attached to beds or patients’ clothing.  Those include placing adjustable beds low to the floor, using protective padding beside the bed and having staff learn and follow residents’ patterns for needing assistance getting to the bathroom.  The only truly effective intervention is proper supervision which can only be achieved with adequate staffing.

Even when portable bed rails and hospital bed rails are properly designed to reduce the risk of entrapment or falls, are compatible with the bed and mattress, and are used appropriately, they can present a hazard to certain individuals, particularly to people with physical limitations or altered mental status, such as dementia or delirium,” the U.S. Food and Drug Administration reports on its website.

The state report on Mr. Frankel’s death said the nursing home was using rails not to protect him from falling out of bed, but to help him in repositioning himself due to his physical limitations. Such use of side railings is better accepted by consumer advocates, because their purpose is then as an “enabler” serving to promote independence of residents, but facilities are still supposed to ensure safety.  For dementia patients, in particular, rails can be hazardous from attempts to climb over them, as well as the entrapment issues. They can fall from greater heights and incur more serious injuries, most notably to the head.

As part of a comprehensive update of nursing home regulations adopted in 2016, the federal Centers for Medicare & Medicaid Services became more restrictive on use of full side rails. Residents must be assessed for risk of entrapment beforehand and steps must be taken to ensure that beds and rails are properly designed for use with one another, avoiding dangerous gaps.

 

The Conversation reported on the epidemic of resident to resident assaults in nursing homes.  Many preventable deaths in nursing homes are a result of aggression between residents. This most commonly occurs in people with dementia, their research has found.  Published in the Journal of the American Geriatrics Society, they examined records for all resident-to-resident aggression-related deaths among nursing home residents reported to a coroner in Australia between 2000 and 2013.

Their study examined the frequency and nature of resident-to-resident aggression resulting in the most severe outcome – death. In their analysis, almost 90% of residents involved in resident-to-resident aggression had a diagnosis of dementia. Three-quarters had a history of behavioral problems, including wandering and verbal and physical aggression, which are common symptoms of dementia.

The rising global prevalence of dementia, particularly in the nursing home population, means aggressive behaviors between residents will increasingly be an issue. Two high-level reports on elder abuse in aged care in Australia have recommended better reporting systems so we can understand and prevent all such deaths in nursing homes.

Resident-to-resident aggression is an umbrella term that includes physical, verbal or sexual interactions that are considered to be negative, aggressive or intrusive. These behaviors can cause serious physical harm or psychological distress.

The prevalence of aggression between nursing home residents is difficult to determine. Recent research estimates at least 20% of nursing home residents in the US were involved in such incidents.

Most incidents appeared to be unprovoked, or were triggered by communication issues or a perceived invasion of personal space. Importantly, only one of the 18 studies reported a single death as the result of physical resident-to-resident aggression.

Our research found most exhibitors of aggression (85.7%) were male. The risk of death from aggression between residents was twice as high for male as for female residents. Those who exhibited aggression towards other residents were often younger and more recently admitted to the nursing home than their targets.

Incidents commonly involved a “push and fall”. Seven (25%) related deaths resulted in a coronial inquest, but criminal charges were rarely filed.

However, this is likely to be just the tip of the iceberg as there is much potential for underreporting and misclassification of resident-to-resident aggression deaths. We have limited data on how often incidents of aggression between residents in Australia occur but do not result in death.