It’s no secret that some nursing homes will neglect their residents in the interest of their own greed for profits and wealth, but less well known is the fact that those nursing homes are often rewarded by the government for that mistreatment. NPR recently published an article on this topic, citing statistics like one in five nursing home residents sent from hospitals on Medicare are returned to the hospital within thirty days.

Rather than taking care of their patients to the best possible extent, hospitals and nursing homes choose to send them back and forth to one another because it benefits them financially. For one thing, it’s cheaper for each facility to treat a patient as little as possible. For another, both hospitals and nursing homes have historically received encouragement from the government for this behavior, getting financial rewards for things like admission, readmission, and discharge to and from the facility.

As an example, an elderly woman could be admitted to a hospital for a severe injury. She could then be transferred from there to a nursing home earlier than the injury demands because it’s in the hospital’s financial interest to move her out as fast as possible. Then, at the nursing home, she doesn’t receive the care she needs because the place is understaffed and it costs more money than they wish to pay to properly treat and rehabilitate her. So she gets sicker and they eventually send her back to the hospital. This act of “boomeranging” patients back and forth is well known in the world of health policy.

Noticing this trend, the government has begun its efforts toward fixing the situation. According to NPR, “In 2013, Medicare began fining hospitals for high readmission rates in an attempt to curtail premature discharges and to encourage hospitals to refer patients to nursing homes with good track records.” There are also plans to incentivize nursing homes to improve in similar ways.

These moves are a step in the right direction, but most believe there’s still a lot to do here in the interest of patient care.

The Stamford Advocate reported that St. Camillus Center was fined only $6,000 by Connecticut’s health department and three employees were fired following the death of a resident who hadn’t been checked on for 12 hours.  The footage also showed staff had not opened the door to the resident’s room or checked on the resident between 6:26 p.m. on Feb. 15 and 5:19 a.m. on Feb. 16.

In the Feb. 16 incident in Stamford, a resident with lung cancer was found unresponsive and without a pulse, according to DPH, and video footage subsequently showed staff waited 10 minutes to administer CPR.  The resident was taken to the hospital and later pronounced dead. A registered nurse, licensed practical nurse and nurse aide subsequently were terminated, DPH said.

Past incidents at St. Camillus

2016 – Inspectors report observing 40 violations at the nursing home over the past year, including an incident in which a nursing aide called patients fat. As a result of the observations from unannounced visits in 2015 and 2016, the nursing home failed to meet certain state Department of Health standards during annual licensing inspections.

2014 – The facility receives a $1,680 fine related to protection of patients’ rights and/or failure to monitor patient condition.

2010 – The state Department of Social Services threatened to shut down the center and revoke its eligibility to collect Medicaid after investigators find patients’ health in immediate jeopardy.

According to Medicare’s website, St. Camillus has 124 beds and has not received any federal penalties or payment denials by Medicare in the last three years. However, the site received a lower-than-average health inspection rating a year ago after being cited nine times for deficiencies in quality of life and care as well as other issues.

 

 

Tracey Mitchell was fine with the notion of placing her father in the care of a nursing home when it became necessary, and while he was there everyone was happy with the quality of care in the facility. In the years before the lawsuit when Mitchell’s father was a resident, there was no discussion of fees or bills for her father’s stay.  But when Mitchell was served a lawsuit years into his stay, alleging she owed $49,000 for her father’s care, she was stunned.

When her father was admitted, Mitchell told the facility, Alaris Health at Cherry Hill, he didn’t have the means to pay, so she was told to file for Medicaid in his place and then to sign his admissions agreement.  Then she was just told one day, mere months before her father’s death, that she owed the facility a massive amount of money. It turned out the document she signed on her father’s behalf put her next in line to pay whatever costs her father or Medicaid couldn’t take on, though before this time she’d never received a bill.

Even more stunning, when Mitchell consulted her attorney about the matter, she found out the contract she signed was illegal. In the document she is named a “third party to guarantee payment,” meaning whatever costs weren’t payed by her father or Medicaid, she would cover. However, under federal law and New Jersey state law, it is illegal for a nursing home to hold a third party liable for those costs.

The case is now over, but plenty of people are vulnerable to the kind of experience this family had. According to Mitchell’s lawyer, “[His] theory is if they sue 10 people like this, they will find maybe one with an attorney who knows the law and nine will pay.” It’s incredibly easy for a nursing home to find that a resident’s bills haven’t been payed off by the patient themselves or Medicaid and find the solution in an unknowing family member. Experts say the best course of action is to work with an attorney or a Medicaid specialist before signing these kinds of contracts to avoid running into issues with them later.

New York Magazine recently published an article on findings that the Purdue Pharma company was aware of its product OxyContin’s popularity and addictive nature long before the company’s executives admitted in testimony under oath.  They intentionally ignored and covered up the dangers to exploit consumers and increase their profits.

In the 1990’s, when OxyContin was created, it was dubiously advertised as less addictive than other painkillers and much safer for long-term use than its competitors. Of course, knowing now the opioid crisis America faces, this is not the case. But when asked about their knowledge of their drug’s popularity in the world of drug abuse, Purdue’s top executives said they didn’t know until the early 2000’s.

Then, the Justice Department produced a report with proof that Purdue Pharma knew about OxyContin’s addictive nature and abuse by the late 1990s, only years after the drug was first produced.

Though the administration handling the case at the time did not view it as anything more than a misbranding case, this corporation’s lack of action against the harm its product caused is shameful at the least.

The West Virginia Record reported on a lawsuit by the estate administrator against Saddle Shop Road Operations LLC, which does business as Hilltop Center, Genesis Healthcare Corp. and Brian Chapman, alleging that the deceased, Harold Gene Nutter, received improper care while he was a resident of the Hilltop Center nursing facility.

Estate administrator Charles Fitzwater filed a complaint May 3 in Fayette Circuit Court, alleging that Nutter suffered serious and permanent injuries on May 8, 2017 that resulted in his death.

Fitzwater also alleges that Nutter’s surviving family members have suffered sorrow, mental anguish and loss of society, companionship, comfort and guidance, as a result of the negligence of the defendants in providing inadequate health care and protective and support services to the decedent.

Specifically, the plaintiff claims the defendants failed to employ a sufficient number of staff and failed to ensure that residents received the proper care, treatment, hydration and hygiene requirements.

The plaintiff requests a trial by jury and seeks a judgment against defendants for damages, attorney’s fees, costs and expenses, punitive damages and other relief that the court deems just. He is represented by Jonathan R. Mani of Mani, Ellis & Layne PLLC in Charleston.

Signature Healthcare is a national for-profit nursing home chain with more than two dozen facilities in Tennessee.  The government started an investigation in 2014 when two whistleblowers started collecting evidence on their own.  LeeAnn Holt and Kristi Emerson, both of whom are occupational therapists from Columbia, collected reams of anecdotes — in part, because they were concerned they might get in trouble themselves.  That evidence is the basis of the $30 million settlement in the Medicare fraud case between the federal government and Louisville-based Signature Healthcare, which operates more than 100 facilities in 17 states.

According to court documents, state and federal investigators discovered Signature was “knowingly submitting false claims to Medicare for rehabilitation therapy services that were not reasonable or necessary” at 115 of its facilities. Investigators said that led to a total of $232 million in false claims. The company also allegedly forged documents submitted to Tennessee’s Medicaid or Tenncare program, leading to another $12 million in fraudulent reimbursements.  So they stole $232 million but only had to pay a settlement of $30 million.  Who says crime doesn’t pay?

The complaint against Signature Healthcare (download here) accuses the company of systematically administering occupational, physical and speech therapy when it wasn’t warranted and withholding care when government reimbursements were already maxed out. According to the suit, the unnecessary therapy pushed patients into a category where the facility was reimbursed more per day for those patients, often hitting precisely the 720-minute per week threshold for maximum payment.  Holt and Kristi Emerson are the whistle-blowers who exposed a company-wide system of over-billing the federal government by Signature Healthcare.

“There were a couple of times when things happened with patients where we would just look at each other and say, ‘We can’t do this. We just cannot do this any more,'” LeeAnn Holt recalled.  Holt recalls a patient with advanced cancer who just wanted to spend time with her family rather than continue with therapy.

“She just put her hand on the therapist and said, ‘Honey, you need to go work with somebody that can really benefit from this.’ And you know, when you have a patient that is telling you that, you really have to stop and take inventory of what is going on here.”

Emerson says she hopes the case will still inspire other health care workers to push back when they feel pressured to do procedures they deem medically unnecessary.

“We can’t just blame these corporations for all of this,” she says. “We have to shoulder as therapists some of the responsibility because we’ve allowed this to get this bad.”

The women say before filing their suit, they repeatedly went to administrators all the way up to the corporate office.

“And no one was doing anything. And the more we reported, the more they came in and just started pushing back on us,” Emerson explained.

Emerson and Holt were let go amid the investigation and have found it difficult to find stable work. “No one really wants a whistleblower in their building,” Emerson says.

But now they will split roughly $6 million as their share of the settlement. Whistleblowers are entitled to 15 percent to 25 percent of the total.

 

Certified nursing assistants that bathe, dress and provide 95% of the care to residents at New Jersey nursing homes may get some help from Gov. Phil Murphy.  An identical bill cleared the state Legislature two years ago but was vetoed by former Gov. Chris Christie.

Legislation is progressing that will increase of staffing levels of these unlicensed caregivers.  Under the proposed law, nursing homes would have staffing ratios to meet: Facilities would be required at a minimum to having one certified nursing assistant on staff for every eight residents on a morning shift, no more than 10 per aide in the afternoon and no more than 16 per aide overnight.  This is great news for the residents and caregivers in New Jersey.

By the way, South Carolina only requires ratios of at least 1 CNA to 9 residents on first shift; 1 CNA to 13 residents on second shift; and 1 CNA to 22 residents on third shift.  This were established in the mid-1980s and are now considered insufficient and unsafe.  That is why the regulations include the following language:  “Additional staff members shall be provided if the minimum staff requirements are inadequate to provide appropriate care and services to the residents of a facility.”

The legislation would send a message to nursing home operators “that they need to staff adequately in their facilities,” given that the Garden State ranks among the bottom in the nation for average nursing aide staffing-hours per patient.

Several states have passed similar staffing ratio laws but they need to pay a living wage so the jobs are attractive to qualified and compassionate caregivers.  “Despite how difficult it is, it’s a very low paying job — with many (nursing assistants) only making $12 or $13 per hour,” CNA Lloyd-Bollard said. “It’s not right that caregivers have to do two or three jobs to make ends meet. These are the people responsible for caring for our state’s most vulnerable people; we should support them.”

Jeanitha Louigene, a certified nursing assistant of 27 years, is certain it’s having an effect on the quality of care provided by nursing facilities. “I really feel sorry for the residents,” she said. “With the amount of residents we have at once, we really don’t have time for them — they may want to talk, but we can’t do that. We have one person taking care of sometimes 15 or more residents, who are needing the bathroom, water or are in pain. We have multiple people calling for us. But we can only be in one place at one time.”

LoHud.com had an article about the ten questions to ask before admitting a loved one to a nursing home.

What follows are questions to get answered before picking a nursing home.

1. How long has the nursing director worked there? High staff turnover can be a sign of problems while staff retention and longevity is a good sign.

2. How many registered nurses work there, and what is the ratio of licensed nurses to certified nursing assistants? Studies show strong positive relationships between registered nurse staffing levels and quality in nursing homes.

3. Is the staff friendly? Get a sense of how long they’ve worked there and if they like it by talking to them.

4. How good is the food? Visit on a Saturday or Sunday around lunch or dinnertime to see if you would eat what is served and maybe have a meal yourself.

6. Do you see good activities listed on the home’s calendar and are they really going on? Determine how staff works to engage residents.

7. How do residents look? If residents don’t appear clean, comfortable and neat, this could be a red flag.

8. What do state inspectors say? Ask to see the most recent inspection report and research other reports on your state regulatory agency’s website; in New York, it’s the New York Department of Health.

 9. What do federal regulators say about the home? Go to the Medicare.gov Nursing Home Compare website to review the nursing home’s star rating and other information.

10. Is the home a member of a reputable trade association in your state such as Greater New York Health Care Facilities Association? Membership requires meeting certain standards, and members are kept up-to-date on best practices and regulations.

For more, go to Medicare.gov.

Sources: USA TODAY Network, AARP, Medicare.gov, National Institute on Aging, New York Department of Health, Aging Life Care Association, Agency for Health Care Administration

Newson6 reported on a resident’s family seeking answers in a lawsuit against Grace Living Center. Twila Knight was 57 when she checked in at Grace Living Center to recover from a fall.  At the facility, Twila suffered from falls, custodial neglect, and a pressure ulcer injury.  The family of a former resident is suing Grace Living Center claiming the staff failed to monitor, treat, diagnose and care for their loved one.

The center’s Medicare health inspection rating is one out of five stars.  The health inspection report shows the rating is the lowest possible score. And it’s rate of long-stay patients developing pressure ulcers is 12.6 percent more than double the national average.

Knight’s family is suing the nursing home for negligence claiming the staff also failed to properly treat bed sores she got in their care. The family is also claiming the staff was verbally abusive and failed to address her dietary needs, weight loss, and medication needs.

“There has to be special mattresses put in place, there has to be turning that’s done, you have to make sure that people are getting up,” said the family’s attorney Mark Edwards.

“We rely on these places to take care of our most fragile. And what’s happening is we have businesses that are putting profits over people,” said Edwards.

 

New York Magazine had an article about Trump’s decision to withdraw protections from people with pre-existing conditions claiming their are “unconstitutional”.  Republicans kept versions of the Affordable Care Act’s protections for people with preexisting conditions in all of their health-care bills last year.  Now Trump and Sessions are attempting to take them away.

“Specifically, the Justice Department announced that it would not defend the Affordable Care Act from a challenge brought by a group of red states, which claims that Congress’s repeal of the individual mandate renders the rest of the law unconstitutional — as that provision is not severable from the rest. This is a legal claim so radical and ill-supported it made the National Review blush. The notion that Congress is not constitutionally allowed to eliminate the ACA’s insurance mandate — unless it also repeals the law’s other regulations of the health-care market — is not some sacred principle of constitutional originalists. Rather, it’s a transparently ad hoc rationalization for the judiciary to veto a duly-passed expansion of the safety net. And yet, Attorney General Jeff Sessions concluded that his department could make no honest argument against the plaintiffs’ case.”

“Out-of-pocket health-care costs are rising for virtually everyone in the United States. Drug prices are resolutely high, premiums on the individual market are skyrocketing (thanks to the GOP’s tireless efforts to sabotage said market), and the average deductible for those with employer-provided insurance has increased by nearly 400 percent since 2006. The Democratic Party’s prescription is for the government to impose price controls, while further subsidizing ordinary Americans’ health-care costs by raising taxes on the rich (the party is internally divided over the details of its policy, but united on its general direction). The Republican Party, by contrast, is beholden to reactionary interests who want the government to cut public spending on health care, so as to finance ever-lower taxes on the wealthy and corporations.”