An analysis of Medicare data shows that nearly half of Georgia nursing homes recently were found “below average’’ or “much below average’’ in their staffing levels of registered nurses.  This is similar to the analysis for South Carolina nursing homes.

RNs are the highest-trained caregivers required to be on staff in a nursing home, and the only qualified staff to assess the residents.  They are also needed to supervise LPNs and CNAs.  Medicare mandates that every facility have a registered nurse working at least eight hours every day at the bare minimum.  This applies to facilities with 44 beds or 220 beds!

Medicare rates RN staffing based on the average number of hours worked by registered nurses and nurse administrators for each resident. The ratings range from “much below average” to “much above average.”  Of Georgia’s 346 nursing homes that were rated, 163, or 47 percent, received “much below average” or “below average” ratings of RN staffing based on Medicare data from January through March of this year, as reported by Kaiser Health News.

Medicare recently began collecting and publishing payroll data on the staffing of nursing homes as required by the Affordable Care Act.  Payroll records revealed lower overall staffing levels than facilities had self-reported, especially among RNs.

Melanie McNeil, Georgia’s long-term-care ombudsman, told GHN on Monday that she wasn’t surprised by the staffing findings.

Not enough staff is a common concern that ombudsman representatives hear from residents, family and sometimes even staff,’’ she said.

RN staffing is important because direct-care workers may notice changes in a resident but they don’t have the training that RNs do to recognize what the change means and what action to take,’’ McNeil said.

“For years, advocates have been urging specific staffing ratios for direct care workers and nurses, including an RN 24 hours a day,’’ she added. “As a state, we should provide more incentives for individuals to enter these professions, including better wages and tuition forgiveness.”

When nursing homes are short-staffed, nurses and aides scramble to deliver meals, transport bedbound residents to bathrooms and answer calls for pain medication, KHN reported. Essential tasks such as repositioning a patient to prevent bedsores can be overlooked when workers are overburdened, sometimes leading to avoidable hospitalizations.

“We’ve just begun to leverage this new information to strengthen transparency and enforcement with the goals of improved patient safety and health outcomes,” the CMS said in a statement to KHN.

Kathy Floyd of the Georgia Council on Aging said overall staffing levels are low. “Advocates and providers are talking about possible solutions to Georgia’s lower staffing levels. I hope our next governor will look at provider reimbursement rates and please, please tie increases to quality measures.”

The new payroll data, analyzed by Kaiser Health News, showed that for-profit nursing homes averaged 16 percent fewer staff than did nonprofits, even after accounting for differences in the needs of residents. The biggest difference was in the number of registered nurses: At the average nonprofit, there was one RN for every 28 residents, but at the average for-profit, there was only one RN for every 43 residents.

The data also revealed that nursing homes have large fluctuations in staffing. The average nursing home had one licensed nurse caring for as few as 17 residents or as many as 33, depending on the day. On the best-staffed days, each certified nursing assistant or other aide cared for nine residents, but on the worst-staffed days, each aide was responsible for 16 residents, KHN reported.

Weekend staffing was particularly sparse. On weekends on average, there were 11 percent fewer nurses providing direct care and 8 percent fewer aides, according to the KHN report.

On June 4, 2015, a report by the Georgia Department of Public Health revealed that Zeni was one of 35 residents and staff infected with scabies in the Shepherd Hills Nursing Home owned and operated by the national for-profit chain SavaSeniorCare.

Melinda Ballenger is accused of stealing money from the accounts of the nursing home residents at Golden Age, owned and operated by the infamous national for-profit chain, SavaSeniorCare LLC.  The same chain is being sued by the United States of America for Medicare fraud and False Claims Act violations in Tennessee.  Ballenger also handled accounts for Inman Health Care, where similar missing funds were discovered in a preliminary audit.  Inman Health Care is also owned and operated by SavaSeniorCare LLC.

A routine audit by Sava’s  corporate consultants discovered that at least $6,900 was missing from accounts set up by patients to pay for extra food, haircuts, clothing and other expenses. The administrator said the only person with access to the accounts was Ballenger.  The administrator said a complete audit has not been finalized, but that there may be more money missing.

Ballenger resigned and was arrested and charged with breach of trust, more than $1,000.

Gena Randolph, a South Carolina speech therapist, was convicted in federal court for a scheme where she stole $2 million from federal health care programs, according to a media release from U.S. Attorney Sherri A. Lydon.  Randolph could be sentenced to more than 30 years behind bars after being convicted of health care fraud that included bogus claims of speech therapy for dead people, according to the U.S. attorney’s office.

However, this is not the first time Randolph has been in trouble with the law which begs the question:  Why was she able to participate in the Medicare program at all?

Randolph was convicted in 2012 for filing false claims with the South Carolina Medicaid Program.  That conviction meant Randolph “was prohibited from working for any provider to perform services paid for, in whole or in part, by Medicare and Medicaid,” according to the U.S. attorney.  In spite of that, Randolph continued to submit claims to Medicare and Medicaid, “only she was disguising her ownership and control over Palmetto Speech and Language Associates and Per Diem Healthcare Services.”

Evidence presented in her trial showed how Randolph executed her scheme.  Randolph “submitted claims both for speech therapy services that either were provided by other speech therapists, and for services that were never rendered at all.”   Randolph even “submitted claims for services to beneficiaries who were dead,” Lydon’s office reported.

 

 

The Greenville News recently published a story about a different kind of hero–Dr. Michael Mayes.  Since 2010, he’s worked mostly in secret to gather information, turn it over to the government and help build a federal case to expose national Medicare fraud that affected his own patients on Hilton Head — and those around South Carolina and the nation too.  If Mayes hadn’t risked his career, relationships with fellow physicians and future job prospects, the fraud could still be going on today.

His work exposed a national scam where physicians ordered panels of lab tests that were not medically necessary for their patients and received illegal kickbacks. As a result, Medicare, and other government healthcare programs, paid upward of $500 million in fraudulent claims.  Mayes’ whistleblower lawsuit, the first of three, was filed under seal in 2011 and later taken over by the federal government. His name was not revealed until 2015 when the first settlement in the case was announced.

He was the only physician to come forward.  The taxpayers of South Carolina owe him a debt for his courage and integrity.

The federal anti-kickback statute, which prohibits laboratories from “offering or paying any renumeration, in cash or kind, directly or indirectly, to induce or influence physicians” to order tests that “may be paid for by federal health care programs,” according to the federal complaint.

In June 2011, a lawsuit was filed alleging Berkeley, BlueWave Healthcare Consultants and LipoScience “routinely” paid kickbacks to physicians to convince them to order tests. LipoScience was later dropped from the suit, because what it had done was “significantly less egregious” than the others.  Later, Health Diagnostic Laboratory, Singulex and Quest Diagnostics — a company that purchased Berkeley in 2011 — were added to the suit.

In January 2012, Quest Diagnostics decided to stop offering the payments to physicians.  When the payments stopped, Mayes noticed physicians stopped ordering the tests.

“Once they stopped paying for the tests, the number of tests ordered was drastically reduced,” Gaudette said. “In my opinion, money had a lot to do with it.”

According to the federal complaint, Quest then tried to get doctors to continue ordering the tests by offering to pay phlebotomists’ salaries and leasing office space from the practices, among other things.  One cardiologist said his practice was bringing in $17,000 a month by ordering the tests, or about $200,000 a year.

In June 2014, the Office of Inspector General issued a special fraud alert about these payments to physicians.

In 2015, Health Diagnostic Laboratory and Singulex agreed to pay $48.5 million to settle claims that they violated the False Claims Act.

And in 2016, Quest Diagnostics agreed to pay $6 million to settle the same allegations.

Mayes testified as a witness for the government — the only whistleblower to do so — in January 2018 in Charleston. Three individuals associated with Health Diagnostic Laboratory and BlueWave chose not to settle and were tried by jury. The jury sided with the government after the two-week trial. In May, a $114 million judgment against the three was announced.

Health Diagnostic Laboratory filed for bankruptcy, and trustees have since filed suit against individual physicians who received a “significant” amount of money from the kickbacks, Mayes said.

Mayes, and the other whistleblowers, helped put an end to the scheme.  Part of choosing to talk about the case, Mayes said, is because he believes patients should be aware of fraud, and those who commit it should be held responsible.

According to Medicare.gov, here are a few precautions patients can take to protect themselves from fraud:

▪ Save dates, receipts and statements for healthcare services you receive.

▪ Compare your records with statements from Medicare to make sure the services and dates match up. If those records don’t match, it’s possible Medicare was billed for services you didn’t receive.

▪ If a charge seems incorrect, call the provider’s office to inquire about it.

▪ If you suspect there is Medicare fraud, report it online or by calling 1-800-633-4227.

Some 150 million people worldwide are expected to be affected by dementia by 2050. And while there are many ways people can change their behavior to lower their risk of heart disease and cancer–such as eating a healthy diet, exercising and avoiding or stopping smoking–there are few similar steps that have been scientifically proved to reduce the risk of degenerative brain disorders like Alzheimer’s. Genes play a prominent role in determining who will develop the disease, and age is also a major factor–neither of which are under human control.  That’s why Alzheimer’s experts have focused their attention on developing drug treatments for the disease.

Wake Forest Baptist Medical Center sought people with hypertension to volunteer for a study called SPRINT MIND which was designed to test whether aggressively lowering blood pressure would have an effect on people’s risk of cognitive decline, including symptoms of dementia related to Alzheimer’s disease.  So far the trial’s results are the first solid confirmation that lowering blood pressure reduces the risk of both mild cognitive impairment (MCI), a degree of brain decline that’s considered the gateway to dementia.   The study provides the strongest evidence yet that there may be something in people’s control that lowers their risk of cognitive decline. The results of the trial, which was funded by various agencies in the National Institutes of Health, were presented at the annual meeting of the Alzheimer’s Association in Chicago in July and immediately buoyed the hopes of Alzheimer’s experts.

The SPRINT MIND study involved more than 9,300 elderly people who had had heart problems or were at higher risk of developing heart disease–some because they had high blood pressure. They were randomly told to lower their blood pressure to either less than 120 mm Hg or 140 mm Hg systolic. (Current guidelines, revised in 2017 after the study began, now recommend that most people keep the upper number, or systolic pressure, under 130 mm Hg.) They were tested over an average of three years on various cognitive skills, including memory and processing of new information.

After an average of three years, people who lowered their blood pressure to less than 120 mm Hg lowered their risk of developing MCI or probable dementia as measured by the tests by 15%, compared with people who lowered their blood pressure to 140 mm Hg.

There are finally some promising drugs for Alzheimer’s that are now being tested.  These could be the first to actually slow or even reverse the damage to brain nerves that cause memory loss, disorientation and other problems related to thinking skills. The latest studies on two drugs, BAN2401 and aducanumab, show they may shrink the amount of disease-causing protein plaques in the brain and could even slow the progression of cognitive decline.

 

Significant staffing fluctuations exist at nursing homes across the country, and methods of measuring often mask gross under-staffing. The Recent analysis from Kaiser Health found four significant findings:

1. The analysis found 25 percent of facilities did not report registered nurses at work during October, November and December 2017. Federal officials require “sufficient staffing to meet the needs of the residents”, including a minimum eight hours daily for a registered nurse and a licensed nurse (LPN/LVN) around the clock.  However, this minimum time applies to facilities with 44 residents or 220 residents.

2. Seventy percent of nursing homes had lower staffing based on actual payroll as opposed to the self-reported numbers provided by the nursing homes.

3. The average resident-to-nurse ratio on best-staffed weekdays was 18 to 1, compared to 20 to 1 on best-staffed weekends. For worst-staffed weekdays and weekends, those ratios were 30 to 1 and 38 to 1, respectively.

4. There also were fluctuations with aides directly caring for residents on weekends compared to weekdays. On best-staffed weekdays, the resident-to-aide ratio was 9 to 1 compared to 14 to 1 on worst-staffed weekdays. On weekends, those ratios increased to 10 to 1 and 17 to 1, respectively.

 

Last September, a bill was passed by the Pennsylvania Judiciary Committee which would limit punitive damages against nursing homes who are found guilty of neglect, abuse, and other misconduct. The specious argument for the bill was that, without a cap on those damages, out-of-state lawyers were specifically targeting nursing homes and forcing them to pay so much money that the facilities would fall into bankruptcy, leaving elderly people who couldn’t take care of themselves without a place to go. The end result would be an entire state where there are no nursing homes or long-term care facilities because no business would want to risk it.  A ridiculous argument without any basis in reality.  Punitive damages are meant to deter the repetition of the conduct so that the neglect and abuse does not happen again.

When the bill went to the Pennsylvania House of Representatives, it was struck down in a 103-91 vote. Those in opposition to it argued that there were so few cases like these in Pennsylvania each year that those claims and predictions were unfounded. Most cases against nursing homes resolve before trial because those facilities fear what a jury might award after hearing about the abuse and neglect suffered by the residents because of corporate greed and mismanagement.

No one wants a business which neglects or abuses the elderly to have a lighter punishment purely out of reverence for the job they were supposed to but did not do. The nursing home industry and their well paid lobbyists will continue to attack the constitutional right to a jury trial to avoid accountability for their acts of greed and indifference to the safety and well-being of the vulnerable adults in their care.

Galen Malisch is a registered sex offender.  The staff taking care of him at the Maplewood nursing home in Sauk City, Wisconsin knew it but failed to protect the other residents in the facility.  In fact, the facility tried to prevent an investigation into his behavior.  However, a 110 page federal report details the sexual assaults of residents by Malisch and the facility’s attempts to cover the assaults up to avoid responsibility.

This comes after another resident reported him, and he admitted to multiple similar incidents to the police, leading to many charges including two felony counts of second-degree sexual assault of a mentally ill victim, which alone are worth up to 40 years in prison.

Cases like this are far too common within nursing home communities. Sexual predators are admitted to the facilities without informing the other residents or their families.  These predators are not properly supervised allowing them to assault fellow residents who are weaker than them physically and/or mentally.

It’s not something anyone wants to talk about because the mere thought is so disturbing, but in and of itself the problem of sexual assault at nursing homes is its own issue. Patients or employees can be perpetrators, and the situation is not helped by the veils under which so many nursing homes operate. Misconduct and assaults happen, then they either go unreported or covered up, and the facility is allowed to save face.

The more investigations like the one into Glen Malisch’s stay at the Maplewood nursing home, the better things will get. But until these nursing homes drastically improve their foresight and determination to give quality care, this problem of looking the other way and making allowances for abusers will not disappear.

Here is a message from Johnny Felder, a good lawyer and a great guy, trying to make a difference.  Please support!

“Friends and family, as you all know my daughter Anna was diagnosed in 2008 with Type 1 (insulin dependent) diabetes. Since her diagnosis, Anna has taken on this challenge head on with a fearless, confident, unwavering determination that has inspired her entire family and many of our close friends.  Anna has been a JDRF youth ambassador, spoken about the need to for diabetes research, led a walk team every year since her diagnosis, traveled to Washington DC to raise awareness and lobby for federal support of critical legislation as a JDRF youth delegate representing the state of South Carolina and even joined me for a JDRF ride where Anna and I rode a combined 160 miles to raise money and help Anna and millions of other people facing the challenges diabetes presents.  Last year Anna was a starter for her high school’s state championship basketball team and this fall is enrolling in college.  And due in large part to your past support Anna has now fully transitioned to an “artificial pancreas system” – YES!!!!!!

 With all of this incredible life changing, actually life saving, progress I have decided to ride again this year in honor of my daughter.  The ride is November 3, 2018 in Santa Fe NM.  I plan to ride again and the goal is to raise $5,000.  The training and fund raising begin now!
 If you would like to help us this year, please visit my ride page through the link below.  Thank you and God Bless!!

 

 

There are now 15 class action lawsuits against California nursing homes alleging intentionally understaffed facilities which produce poor results for their patients. Spearheaded by Garcia, Artigliere & Medby and the Arns Law Firm, the cases center mostly on facilities in Southern California and the Bay Area, many of which are controlled and operated by Shlomo Rechnitz and/or Rockport Administrative Services LLC.

1 out of every 14 nursing homes in California is controlled in some way by Shlomo Rechnitz, many of which were purchased in bankruptcy court.

Before all of these class action suits, there was the story of South Pasadena Convalescent Hospital, a business of Rechnitz’s from which a mentally unstable patient was able to walk freely out the door and light herself on fire, dying from her injuries. South Pasadena Convalescent was soon decertified, a very rare distinction which removes government funding from care facilities such as these.

Experts are alarmed with the frequency of decertification of Rechnitz’s businesses, of which they received three within three months as opposed to the other three that have been given statewide over the course of three years. In a state where nursing home negligence is a massive problem and it’s rare that facilities and their parent corporations are singled out by authorities, facilities under Shlomo Rechnitz’s purview have been subject to investigation, citations, and fines.

These 15 suits are mostly on the grounds of negligence, that the businesses put patients in danger by understaffing facilities in order to save money on employees and increase their profits.   Where residents deserved certain levels of care and so many hours of attention from skilled nurses, they were dangerously deprived so the companies overseeing them could save a dime. These aren’t the first suits of this kind in California, but they will hopefully shed light on the larger issues in nursing homes and neglect issues