KDVR reported that Colorado police finally have a warrant out for the arrest of Gwendolyn Kentris after months of investigating an elder-abuse case at Ralston Creek Neighborhood Assisted Living.  A 41-page report details how seven witnesses describe what happened between caregiver Kentris and a 74-year-old vulnerable woman with Alzheimer’s dementia.  Several witnesses stated Kentris pushed the elderly woman, Karlene O’Brien. They also allege Kentris pinned O’Brien to the bed while forcing her to cross her arms and swore at her. One witness told police that O’Brien was traumatized, saying, “‘She’s gonna’ kill me. She’s gonna’ kill me’.”

Kentris has a lengthy criminal history, including 14 felony convictions related to assault and drugs.  Kentris told police she received no formal training beyond a four-day orientation.  The report said Kentris admits to holding the elderly woman locked in her room for 20 to 30 minutes, which is against the assisted living home’s rules.

I mean, you put your trust in somebody to take care of your loved one,” Karlene’s husband Robert said. “She was punched in the face — black eyes, split lip.”  Police found multiple bruises and cuts on the elderly woman’s body and later found that she had a fractured wrist, according to the report.

The warrant for Kentris’ arrest includes charges of assault and false imprisonment.  She is also accused of assaulting another patient at Ralston Creek as well.

McKnight’s reported the ongoing saga at Maplewood Sauk Prairie in Wisconsin.  The Wisconsin Department of Health and Human Services said female residents at Maplewood Sauk Prairie were in danger because there was not enough supervision of registered sex offender Galen J. Malisch, according to a lengthy report from the Centers for Medicare & Medicaid Services.  Malisch is accused of groping female residents in separate incidents. He faces two felony counts of second-degree sexual assault of a mentally ill victim, along with misdemeanor charges.

The administrator and director of nursing are in trouble for trying to cover-up the sexual assault investigation involving multiple residents.  The state said both leaders attempted to intimidate staff and threatened their jobs around discussing the investigation.   Evidence suggests that the administrative staff told employees to stay quiet during a state investigation of the assaults. One employee told an investigator “we all knew,” the newspaper reported. A social worker says she told the administrator and nursing director months ago that Malisch was a registered sex offender, the newspaper added.

A federal judge sentenced Daniel Benson, former Chief Operating Officer for American Senior Communities (Indiana’s largest nursing home chain), to five years in prison for his part in a long-running kick-back and fraud scheme.  Benson was sentenced by Indiana Southern District Judge Tonya Walton Pratt for his part in a scheme that lasted for six years and shook down companies doing business with the nursing home firm for $16 million.

Benson’s sentence was the result of a plea agreement where he pleaded guilty to charges of conspiracy to commit wire, mail and health care fraud; conspiracy to violate the anti-kick-back stature and money laundering. Benson’s sentencing follows that of former ASC CEO James Burkhart to nine and a half years in federal prison for his participation in the scheme.

Prosecutors claim the men, along with two other defendants used the allure of contracts with the company to get additional money out of vendors. The company used inflated invoices, shell companies and kick-backs to funnel the money into their private accounts.

The men used their scheme to get money from vendors providing everything from American Flags to pharmacy services.

Benson and Burkhart were indicted by a federal grand jury in the case along with Steven Ganote and Burkhart’s brother, Joshua Burkhart. Those two men along with another co-defendant David Mazanowski are set for sentencing yet this month in the Southern District of the U.S. Federal Court.

Newsweek reported the sad abuse and loss of dignity for a resident at Bentley Senior Living center in Jefferson, Georgia.  Three assisted living center employees were arrested by Georgia police after the trio appeared in a profanity-laden Snapchat video surrounding a dying elderly woman.  The caregivers were seen smoking a vape pen and yelling curse words at the camera as the woman laid dying from a recent stroke in the background. The Snapchat video they posted online was labeled “The End.”

The Jefferson Police Department told the Athens Banner-Herald the three women made the June 13 Snapchat video inside the Bentley Senior Living center in Jefferson, Georgia. The employees were in the hospice care room of a 76-year-old resident and were waiting on a hospice nurse.

Jefferson Police charged Jorden Lanah Bruce; Mya Janai Moss; and Lizeth Jocelyn Cervantes Ramirez for exploiting an elderly and disabled person.  Bruce, Moss and Ramirez were supposed to be monitoring and caring for the critically ill woman but instead, “one of them was smoking a vape pen, they were using profanities and making obscene hand gestures at the camera,” police alleged.

Days after the June 13 video recording was made, another employee at the senior living facility discovered and reported the lewd Snapchat story. All three women were arrested on June 22 and were employed at the facility at the time of their arrest.

The pair of 21-year-old employees, Bruce and Moss, were released from custody after posting bond. But 19-year-old Ramirez is still being held by U.S. Immigration and Customs Enforcement officials.

Georgia’s legal code defines separates elderly exploitation into both felony and misdemeanor crimes. The charge is defined as anyone “who knowingly and willfully exploits a disabled adult, elder person, or resident, willfully inflicts physical pain, physical injury, sexual abuse, mental anguish, or unreasonable confinement upon a disabled adult, elder person, or resident, or willfully deprives of essential services a disabled adult, elder person, or resident.”

The website Futurity, which publishes academic literature, published a JAMDA study showing the need for advance practice registered nurses (APRNs) to work full time in nursing homes.  Nursing homes hoping to provide the best care to their residents need to budget for hiring APRNs, according to new research.

The new study, which appears in the Journal of American Medical Directors Association, finds significant evidence that APRNs have a positive effect on improving outcomes for nursing home residents.

“Never before have there been such clear findings of the impact of APRNs on quality measures that are key to five-star ratings for all nursing homes in the country,” says Marilyn Rantz, professor of nursing in the Sinclair School of Nursing at the University of Missouri. “Star ratings are used by consumers when they are trying to find the best quality of care for their loved ones.”

Since 2012, Rantz has been leading the Missouri Quality Initiative for Nursing Homes, a partnership between MU, Centers for Medicare and Medicaid Services, and state Medicaid groups that was initiated to improve care at nursing facilities in the St. Louis area.

Since its launch, the effort has significantly reduced hospitalizations and lowered health care costs. In the latest study, researchers examined the specific impact APRNs had on quality measures used in nursing homes.

APRNs were embedded full time in 16 nursing homes that were participating in the nursing home initiative. They were expected to help the nursing home staff and leadership reduce unnecessary hospital and emergency room visits, improve resident health outcomes, and reduce overall health care spending. Researchers compared their efforts to 27 nursing homes that didn’t have full-time APRNs on staff.

Overall the nursing homes with APRNs had much better results in commonly used measures of quality of care, including fewer:

  • Falls that led to major injury.
  • Residents who experienced pressure ulcers and urinary tract infections.
  • Residents who had a catheter left in their bladder, had to be physically restrained, or had lost too much weight.
  • Residents who required assistance with physical activities or needed antipsychotic medication.

“We were really excited to see these results to help consumers and providers offer the best care for their residents,” Rantz says “Hiring APRNs is a common-sense solution as they keep residents healthier and reduce avoidable hospitalizations.”

Source: University of Missouri

Original Study DOI: 10.1016/j.jamda.2017.10.014

After the nursing home industry got caught gaming the system and inflating their staffing numbers, 1,400 nursing homes have lower star ratings in Nursing Home Compare staffing levels.  The decrease in star ratings were mostly caused by inadequate numbers of registered nurses or from a failure to report reliable staffing information.  The Centers for Medicare & Medicaid Services updated the ratings on July 25, leaving 1,387 out of 15,616 facilities (nearly 9%) with the lowest ratings for staffing, per a Kaiser Health News analysis.

Kaiser’s analysis found that for-profit nursing homes had 16% fewer staff than nonprofits. It also found that for-profits had one registered nurse for every 43 residents, compared to one RN to every 28 residents at nonprofit facilities. On weekends on average, there were 11% fewer nurses providing direct care and 8% fewer aides, Kaiser reported. On the best-staffed days, one certified nursing assistant or aide oversaw nine residents on average, but on the worst-staffed days, an aide was responsible for 16 residents.

The biggest surprise in the data related to a lack of registered nurses.  CMS requires only a minimum eight hours a day for registered nurse in every facility. The facilities with a one-star staffing rating had a lack of a registered nurse for a “high number of days” over three months, provided unverifiable information to the government or didn’t supply payroll data in any way, Kaiser reported. Downgraded homes had a week or more without any registered nurses, according to the analysis.

The lower rankings doesn’t mean staffing has declined, said David Gifford, M.D., the American Health Care Association Vice President of Quality & Regulatory Affairs.  “While staffing is one of many important metrics in quality care, what really matters are health outcomes and customer satisfaction,” he said in a statement. “The changes to the CMS Five-Star system doesn’t mean that staffing or quality has actually changed in the past several months.”

Huh?  I guess it was crappy before they caught inflating the numbers for higher star ratings!

Two days after a front-page New York Times article blasted understaffing at U.S. nursing homes, the Elder Justice Coalition called for Congress to investigate.  The New York Times story used the first round of Payroll-Based Journal data to make its case that nursing homes’ self-reported staffing data — which the government accepted until last year — was often bogus.  The bipartisan group issued a statement calling “for immediate Congressional hearings into a disturbing report issued this weekend pointing to chronic staff shortages in nursing homes.”

The coalition specifically asks that hearings focus on the response by Centers for Medicare & Medicaid Services to the report since “staffing shortages went unnoticed.” The group also wants changes to CMS’s star-rating system, which employs a bell curve to rate facilities’ performances, “to prevent this problem in the future.”

 

 

Last year, Trump added $1.5 trillion to the national debt to ensure tax cuts for corporations and the wealthy. Now, the White House is warning Congress that the United States cannot afford to add $1.6 billion to the deficit to expand health-care options for veterans.

In a letter, the Trump administration demanded that lawmakers fund a popular veterans’ health-care program — which allows former troops to spend public funds on private doctors and hospitals — with cuts to other parts of the budget. Democrats, and some top Senate Republicans, prefer to raise the current caps on discretionary spending instead.

When Republican Congress passed its omnibus budget bill back in March, the private veterans’ health-care program was on the mandatory side of the ledger. This was an accounting trick that allowed Republican lawmakers (who knew that federal spending on the program was going to increase) not to account for its cost when setting a discretionary budget.

But last month, president Trump signed a law that reorganized veterans’ health care, and shifted funding for the private program into the discretionary column. This did not significantly increase the overall cost of domestic spending — but it did lift the price tag on the discretionary budget above previously set caps; It produced a budget shortfall that wasn’t a product of changes in fiscal reality, so much as in accounting practices.

McKnight’s reported on the Hospital & Healthcare Compensation Service, which just released its “Continuing Care Retirement Community Salary & Benefits Report 2018-2019,” in conjunction with LeadingAge.  Nursing home administrators in continuing care retirement communities saw their pay increase according to a new survey. On average, salaries for such leaders swung upward by about 2.14%, year over year, to almost $114,000 in 2018.  The same administrators earned about $111,500 the previous year.

Meanwhile, those working as assistant nursing home administrators in CCRCS — also referred to as “life plan communities” — saw their pay jump by about 3.24%, year over year, up to nearly $80,0000.

This year’s study incorporates information from 520 CCRCs, encompassing nearly 80,000 employees.

Nursing home administrators at these communities received an average bonus, meanwhile, of about $13,500, representing about 12% of annual salary. Those working at smaller campuses, with less than 300 units earned a little less on average ($108,000) when compared to their counterparts in larger facilities of 300-plus units ($117,000).

This is the 21st annual iteration of the salary survey, which also includes pay info for 46 management positions, and another 53 non-management titles. The full report is available online for $350, or $275 for LeadingAge members.

The Columbus Dispatch reported on how significant and frequent staffing fluctuations affect the quality of care provided to nursing home residents.  Consistency and personal attention lead to better-quality care but that is not provided according to the recent analysis by Kaiser Health News and The New York Times.  There are particularly large shortfalls on weekends, the analysis said.

Of 56 nursing facilities throughout central Ohio, 12 have average staffing levels, 11 are below average, 11 are much-below average, 17 are above average and five are much-above average, the analysis found.  At the local facilities rated much-below average, the number of residents assigned to nurses fluctuated by nearly 11 people on their best-staffed and worst-staffed days. The number of residents assigned to nurse’s aides at these homes fluctuated by about six people.

The analysis proves the staffing problems are worse than thought, following a switch in how nursing facilities report their staffing levels to the federal Centers for Medicare and Medicaid Services.  Until recently, nursing homes self-reported unverified data for two weeks and were then inspected, meaning homes could potentially anticipate an inspection and temporarily bring in more staff and “game the system,” the analysis said.  About 70 percent of the nation’s nursing homes reported lower staffing using the new data-reporting method, with an average decrease of 12 percent, the analysis found.

Now, all nursing facilities must provide daily payroll records to verify their staffing levels, following a mandate from the Affordable Care Act of 2010 that more accurately illustrates how staffing levels vary from day-to-day. Data from 2017 became publicly available earlier this year and is now being factored into facilities’ overall five-star ratings.  However, payroll records include overtime, sick leave, and vacation days therefore even payroll records will inflate the number of staff actually providing care to the residents.

In light of the findings, the Elder Justice Coalition is calling for congressional hearings to address how staffing shortages slipped under the radar. Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, said her group is continuing to lobby for minimum-staffing requirements.

“We suspect insufficient staffing is the root cause of a number of our complaints,” said Erin Pettegrew, Ohio’s acting long-term-care ombudsman.

Insufficient staffing leads to negative outcomes and serious issues. Residents who need help getting to the bathroom, for example, may try to go on their own if nobody comes to help, which could lead to a dangerous fall. Or residents could be asked to use unneeded incontinence products, which could cause pressure sores, infections and unnecessary hospitalizations.