The Washington Post reported on a novel – and seemingly effective – method of restoring the minds of dementia-stricken residents: recreating nostalgic environments to provoke their memories and stimulate their brains.  Allowing residents to see, hear, and touch items from their youth help their cognition and sometimes increase their functional capabilities.

The New York Times had an interesting article on how the Dutch are helping elderly residents from falling.  Falling can be a serious thing for older adults. Aging causes the bones to become brittle, and broken ones do not heal as readily.  The Dutch, like many elsewhere, are living longer than in previous generations, often alone. As they do, courses that teach them not only how to avoid falling, but how to fall correctly, are gaining popularity.  The classes are designed for people over 65.

There is the “Belgian sidewalk,” a wooden contraption designed to simulate loose tiles; a “sloping slope,” ramps angled at an ankle-unfriendly 45 degrees; and others like “the slalom” and “the pirouette.”  The obstacle course was clinically devised to teach them how to navigate treacherous ground without having to worry about falling, and how to fall if they did.  In order to learn, the students start by approaching the mats slowly, lowering themselves down at first. Over the weeks, they learn to fall.  Hundreds of similar courses are taught by registered by physio- and occupational therapists across the Netherlands.

 

 

CNBC reported how Trump’s reckless ObamaCare moves have increased the numbers of uninsured after years of steady decline.  The number of Americans without health insurance increased by about 3.2 million in the first year of Donald Trump’s presidency, which featured a series of efforts to undercut the Obamacare law, a new survey finds.  A total of 12.2 percent of all adults now lack health insurance, an increase of 1.3 percentage points since the last quarter of 2016, according to the Gallup-Sharecare Well-Being Index.

The spike in the uninsured rate over the course of 2017 is the biggest single-year increase measured since the survey started asking Americans about their health insurance status in 2008.

The tax bill passed by Congress last month included that gutting of the Obamacare individual mandate. The Congressional Budget Office has estimated that 13 million more Americans would become uninsured in the next decade because of that repeal, although some analysts say the increase will be less dramatic than that.

Meanwhile, insurance profits keep going through the roof.  UnitedHealth Group CEO Dave Wichmann told investors the company will reap $1.7 billion in additional earnings this year because of the tax cuts which slashed the corporate tax rate.  UnitedHealth is the largest health care company on the planet with $10.6 billion in profit and $201 billion of revenue in 2017, according to its latest earnings report. The higher cash flow will add to UnitedHealth’s political and financial sway in the health care system.

The Anderson Independent Mail had two articles on national for-profit nursing home chain Orianna.  See articles here and here.  Orianna Health Systems is a Tennessee-based company that runs 13 Upstate nursing homes, more than any other provider.

One article discussed the quality of care issues at Orianna’s facilities in Greenville where residents complained that staff members were slow to respond to call lights; some reported waiting 50 minutes for requested pain medication without receiving it, according to the inspection report. A resident interviewed that afternoon said “call lights often yield no response and sometimes the resident must yell or shout for assistance.”

Another resident complained that staff members “seem upset that you rang your bell and they tell you to wheel yourself around,” according to the report, which also listed nine grievances that had been filed between March and August about slow responses to call lights.  Citing the failure to respond to call lights in a timely manner, the inspection report found that the nursing home had not provided care “that keeps or builds each resident’s dignity and respect of individuality.”

Linville Court at Cascades Verdae was one of three Upstate nursing homes where inspectors found a number deficiencies that exceeded state and national averages between April 5 and Aug. 25, according to the most recent records from the Centers for Medicare & Medicaid Services.

A total of 12 deficiencies were found at Greenville Rehabilitation and Healthcare Center, according to a July 19 inspection report. Eight deficiencies were found at The Arboretum at the Woodlands nursing home in Greenville, according to a May 4 inspection report.

One of the deficiencies at Greenville Rehabilitation and Healthcare Center involved a January incident in which a certified nursing assistant verbally abused a resident. The nursing assistant later resigned, according to the inspection report.

Another deficiency listed in the inspection report involved the nursing home’s failure to adequately address a 22-pound weight loss by a resident during a six-week period. The nursing home was also cited for a medication error rate of 11.1 percent, which is more than twice the acceptable rate.

The inspection report cited numerous environmental problems at the nursing home, including the presence of flies in the kitchen and other areas. The report said a resident was seen swatting files with a wash cloth in an activity/dining room.

Other deficiencies included a failure to provide proper treatment to prevent bed sores or heal existing bed sores and a failure to store, cook and serve food in a safe and clean way, according to the inspection report.

A state inspector also visited The Arboretum at the Woodlands in June in response to a complaint. According to the inspection report, a staff member was found asleep in the nursing home’s living room during an 11 p.m. to 7 a.m. shift on May 25.

Mikki Meer, chief operating officer for Orianna Health Systems, said in an email that her company “is proud of the continued improvement demonstrated in the recent survey results of its South Carolina facilities.”

Meanwhile the second article explains why the quality of care at Orianna’s nursing homes has gone down.  Orianna has serious financial problems as a result of mismanagement and the siphoning of funds to the corporate owner’s pockets.  Orianna has now fallen behind on lease payments for its facilities to Omega Health Investors, a Maryland-based healthcare real estate investment trust.

Taylor Pickett, Omega’s CEO, reported that since 2014, the occupancy rate at Orianna’s facilities has declined from 92 percent to 89 percent and expenses have grown by 6 percent while revenues increased only 2 percent.

As recently as July, Orianna was operating 48 skilled nursing facilities with 5,000 total beds in 11 states, according to the company’s website. The latest version of the website says the company is now managing 43 skilled nursing facilities with a total of 4,500 beds in seven states.

  • Nine of Orianna’s homes agreed to pay $4.46 million to settle lawsuits involving the deaths of 20 residents. That total includes three settlements adding up to $752,500 that were approved after last year’s name changes.
  • Inspectors found at least 525 deficiencies at the company’s Upstate nursing homes, according to the Centers for Medicare & Medicaid Services. The deficiencies included instances of neglect, possible cases of abuse that were not investigated and medication errors, as well as failures to eliminate hazards, properly prepare meals and treat residents with dignity. The most dangerous deficiencies resulted in 26 fines totaling nearly $495,000.
  • The company’s nursing homes were responsible for 47 percent of the inspection-related deficiencies and 49 percent of fines at Upstate nursing homes. Orianna’s facilities account for 38 percent of the overall nursing home beds in the region.

The Kokomo Tribune reported that two former owner/operators of nursing homes agreed to plead guilty in a kickback scheme involving millions of dollars.  American Senior Communities CEO James Burkhart and Chief Operating Officer Daniel Benson have reached plea agreements that could put them in prison for decades.

Burkhart and Benson were indicted in 2016 along with Burkhart’s friend, Steven Ganote, and Burkhart’s brother, Joshua Burkhart. Ganote and Joshua Burkhart also have reached plea deals.

Federal prosecutors who indicted the men on a total of 32 counts say they took part in a kickback scheme between January 2009 and September 2015 that netted them $16 million. Prosecutors said the men used shell companies to falsify and inflate costs of goods and services, which enabled them to steal discounts and rebates, and conceal kickbacks during the six-year period.

Prosecutors said the men used the money to buy lavish items, such as vacation homes, jewelry and gold bars.

The company manages nearly 100 senior care facilities, including 60 locations under a contract with Marion County’s public health agency. The county is home to Indianapolis.

More than three months after Oak Terrace Healthcare Center  nursing home closed with little warning, many families and former patients  are waiting for refunds and wondering why they were put through such stress.  Oak Terrace’s two most recent administrators blame Home Life Companies, the Delaware, Ohio-based business whose top officials made all the key decisions involving Oak Terrace, for what they say was the company’s greed, ignorance and lack of vision.

The residents — they didn’t have any interest in them except as a source of revenue,” former Oak Terrace administrator Tom Mullins told The State Journal-Register.′  Mullins said he isn’t satisfied with Oak Terrace’s finger-pointing and claims of poverty.  Home Life Companies, which says on its website that it manages long-term care communities in several states, mostly in the Midwest and South, could transfer money from its headquarters to pay him and vendors, Mullins said.

One lesson from the Oak Terrace situation may be that families should investigate a long-term care facility’s finances as much as possible, and ask questions when they see evidence of problems such as empty halls, said Megan Jizmagian, the Springfield-based regional long-term care ombudsman.

David Mabry, who was administrator from January until late August, when Mullins took over, said he realized Oak Terrace wasn’t properly billing Medicaid when he arrived in January. After many frustrating communications with Home Life over spending, he said he resigned after he was instructed to begin transferring Medicaid patients to other nursing homes and reduce staffing levels. “There were so many things that needed to be fixed in the building, it was incredible,” said Mabry, who is certified as a nursing home administrator and licensed practical nurse.

 

MSN reported the patient dumping by University of Maryland Medical Center.  The hospital’s security guards had just wheeled a patient to a bus stop, and in the freezing temperatures they left her there. The only thing she had on was a hospital gown. It’s called “patient dumping” and it doesn’t just happen in Baltimore. In 2007, “60 Minutes” investigated the practice of removing homeless patients from Los Angeles hospitals and leaving them downtown.

Imamu Baraka was walking past a Baltimore hospital when he noticed something he says he’ll never forget.

“It’s about 30 degrees out here right now,” Baraka says in a recording of the encounter. “Are you OK, ma’am? Do you need me to call the police?” he asks.  “Come on and sit down,” Baraka repeatedly says to the patient in the recording. “I’m going to call and get you some help.”

In a statement, the University of Maryland Medical Center said that they “share the shock and disappointment of many who have viewed the video. In the end we clearly failed to fulfill our mission with this patient.”

The man who recorded the video called 911, and says medics ended up taking the patient back to the same hospital. Now a review is underway that could lead to personnel action against the hospital employees involved.

The federal government is launching an effort to stop nursing homes from discharging residents illegally.

Discharges and evictions lead the list of complaints that state long-term care ombudsmen receive each year. In 2015, these advocates for nursing home residents received more than 9,000 such complaints.

In a memo to state officials, the Centers for Medicare and Medicaid Services (CMS), which oversees nursing homes, said it has begun an examination of this widespread problem and will explore ways to combat it.

States have the primary responsibility for policing the nation’s nursing homes, but state regulators have to at a minimum follow federal rules that list specific reasons a facility can legally evict a resident. A nursing home can force a resident to leave only if at least one of the following conditions is met:

  • The resident’s clinical or behavioral status endangers the safety of others at the facility. The reason most often reported for patients’ being discharged against their will is “behavioral, mental and/or emotional expressions” of distress, CMS says.
  • The resident’s care is not being paid for. This is another common reason for such forced discharges. This can happen when individuals who had been paying privately run out of resources and enroll in Medicaid, which reimburses nursing homes less than they receive from private-pay patients. It also happens when Medicare residents shift to being covered under Medicaid.
  • Transfer or discharge is necessary for the resident’s welfare and the facility cannot meet his or her needs. The CMS memo notes that a nursing home should determine whether it can adequately care for an individual before that person is admitted. Once someone becomes a resident, the memo says, “it should be rare” for that facility to later say it cannot meet that individual’s needs.
  • The resident no longer needs the services the nursing home provides.
  • The resident’s continued presence endangers the health of others at the nursing home.
  • The nursing home is closing.

Discharges that violate federal regulations “can be unsafe and/or traumatic for residents and their families,” the memo says, adding that nursing home residents are sometimes left homeless or hospitalized for months when they are evicted.

 

The National Memo reported on Trump’s plan to allow nursing homes to neglect and abuse vulnerable elderly resident to the point of death and not be subject to a fine.  Reacting to the demands of lobbyists and their campaign contributions, the Trump administration has struck down several regulations that increase the safety and well-being of residents. The New York Times reports that this now means several common citations that used to result in fines will either see reduced penalties or no penalties at all.

“The fines, designed to prod nursing homes into treating elderly Americans with more care, respect, and dignity, were put in place by President Barack Obama and sought to make the institutions answerable to standards put together by Medicare.”

According to federal data, CMS since 2013 has cited nearly 6,500 nursing homes for serious violations discovered during inspections required under Medicare and has fined about two-thirds of those facilities. The nursing homes were most commonly cited for bedsores, failing to protect patients from avoidable accidents, mistreatment, and neglect, Kaiser Health News reports.

STAT News reported on the pioneering geriatrician Dr. Bill Thomas and the 330-square-foot, plywood-boned home he calls a Minka.  The structure is warm, light, and surprisingly roomy, in a studio loft sort of way. Four oversize windows look out onto the lake, a shed-style roof rising to the view.  In the back corner, across from a big bathroom compliant with the Americans with Disabilities Act, sits a full-size bed. On the other side of a plumbing-filled wall from the bathroom is a kitchen and countertop, made from Ikea components. (The term “Minka” has Japanese origins, as a traditional house for rural dwellers, typically those of modest financial means.)

The idea sounds, in one sense, simple: create and market small, senior-friendly houses like this one and sell them for around $75,000, clustered like mushrooms in tight groups or tucked onto a homeowner’s existing property so caregivers or children can occupy the larger house and help when needed.  The initiative has turned Thomas into a rare breed: the physician homebuilder, and it pits him not only against the nursing home industry, but also the housing industry, with its proclivity for bigger and bigger spaces.

“I spent my career trying to change the nursing home industry,” he said. “But I’ve come to realize it’s not really going to change. So now what I’ve got to do is make it so people don’t need nursing homes in the first place. That what this is about.

Thomas wants to help people grow older on their own turf and terms, while helping spare them the fiscal and physical stress of maintaining  homes.  In so doing, he hopes to shield them from the mouth of a funnel that too often summons elders to a grim march — from independent living, to assisted living, to nursing homes, to memory units, and to the grave.

Thomas said he’s less interested in growing wealthy from the idea than in changing the culture of senior housing.

The News-Gazette reported the lawsuit filed against the Champaign County Nursing Home in connection with the death of Sonya J. Kington, a 78-year-old Alzheimer’s resident who died of hyperthermia after being left unsupervised outside the home.  According to an investigation by the coroner’s office, video footage from inside the nursing home appeared to show Ms. Kington entering the courtyard at 1:47 p.m. It isn’t until about 5:15 p.m. that staff members are seen searching for her.

Her limp body was found in an exterior courtyard on a hot day when the high temperature reached 87 degrees.  At the time she was found in the courtyard, Ms. Kington was lying in direct sunlight, her skin was “very hot to touch” and she had vomit on both sides of her mouth.  Ms. Kington’s death was caused by hyperthermia brought on by exposure to hot weather.

The suit alleges that the nursing staff at the nursing home “failed in their duty to provide the necessary services and treatments to prevent the death of Ms. Kington in failing to properly secure the facility and in failing to properly supervise Ms. Kington.”