The Reading Eagle had an incredible story about Joseph Schwartz who grew his New Jersey-based nursing home chain, Skyline Healthcare LLC, from about two dozen homes to 120 scattered across 10 states until the chain collapsed amid allegations of fraud, abuse, and waste.  Skyline’s financial collapse forced the state Department of Health to remove managers at seven of its homes in Pennsylvania only a year after it approved the company to operate them.Schwartz had a history of unethical and illegal behavior prior to Skyline.  In Florida, he was accused of diverting insurance premiums that should have been spent on employee health care claims.  In addition to the Florida lawsuit, that record includes a 2009 Pennsylvania lawsuit from a pharmacy claiming breach of contract, several business liens and a $2,500 New York State Insurance Department fine from a decade ago, levied when Schwartz, without a license, helped a company act as an insurance broker.

“I want to know how the state didn’t know,” said Robinson, who works at Rose City Nursing and Rehabilitation in Lancaster. “These people are doing business in your state.”

Documents obtained under Pennsylvania’s Right-to-Know Act prove that Pennsylvania relied on unverified and incredible self-reported information.  Consequently, hundreds of nursing home residents in Pennsylvania were put at risk and employees were put in an untenable position, attempting to care for patients that Skyline could no longer afford to feed or medicate.

The conditions became so dire that Skyline employees tried to shield their residents from the fallout. Employees interviewed for this story described purchasing, at their own expense, snacks for sick patients and gasoline for company vans to transport them. Staff also reported hiding cash in a freezer to pay wary vendors who refused to accept Skyline’s checks.

At least two-thirds of the facilities Schwartz’s Skyline began to manage were former Golden Living homes. In Pennsylvania, those homes had a long history of quality issues, dating to Beverly Healthcare’s management before Golden Living took ownership in 2006. Those issues included insufficient staffing. A proper staffing level is universally recognized as the key to making good care possible.

In Kansas, Department of Aging and Disability Secretary Timothy E. Keck filed a lawsuit alleging that Schwartz and his wife and sons “deliberately withheld premium payments from employees’ paychecks for health insurance and other benefits but did not purchase health insurance for the employees.”

The Schwartzes either lacked the capital to meet their payroll obligations, the suit alleged, “or converted the funds to their own use,” according to the complaint.

 

 

McKnight’s had another interesting story about the staffing problems at nursing homes and how that affects the quality of care provided. A new analysis based on a survey of directors of nursing by The American Association of Directors of Nursing Services finds that the staffing crisis impacts the morale, effectiveness, and burnout of nursing leaders.  The new study shows that staffing shortages are damaging nurse leaders’ job satisfaction rates, hastening burnout among the top ranks.

About 75% of respondents cited staffing shortages as their top challenge, and 63% said they do not have adequate staff to properly care for residents. Those shortages are forcing nurse leaders to the frontlines, with about 66% saying they are routinely providing direct resident care. Balancing work and personal life is important to nurse leaders, but such interruptions to their work routines are causing problems, they reported.

“Work-life balance is a challenge,” said Amy Stewart, R.N., vice president of curriculum development for the affiliated American Association of Post-Acute Care Nursing. “And when you look at that, you also see that work-life balance is interrupted by the fact that they are being pulled into the role of caregiver.”

AADNS gathered its information from about 15,000 directors of nursing working in the long-term care field. It also includes DON/DNS salary comparisons, along with staff turnover rates and trends. The 2019 AADNS Director of Nursing Services Work Study and Salary Report is available for purchase.

 

 

The State newspaper reported that the Magnolias Assisted Living in Myrtle Beach officially closed their doors last week after giving their elderly residents just 48 hours to vacate.  Magnolias manager Ben Read issued a letter to residents, families and employees explaining that residents would have to move out by 5 p.m. Wednesday. He said the facility’s former administrator Denise Graham was to blame for the abrupt closure.

“While still employed by Magnolias, Denise proceeded to contact Magnolias residents and families telling them that their loved ones wanted to leave Magnolias and follow her to Carolina Gardens,” the letter stated. “We have lost virtually all of those residents which in turn decimated Magnolias cash flow to remain in operation.”

Read said the business lost over $40,000 in revenue when roughly 20 residents followed Graham to Carolina Gardens. The business also exhausted more than $35,000 in external borrowings and all personal and family funds in the last 45 days to maintain operations.

Read also said a potential sale fell through at the last minute.

McKnight’s had an article about Congressional leaders concerned over the off label and unsafe use of anti-psychotic medications in nursing homes. Rep. Richard Neal (D-MA) sent a letter to the Centers for Medicare & Medicaid last month, asking for explanation on how SNFs and Medicare plans are acting to address such prescriptions. He wants the agency to specify how many Medicare dollars go toward adverse events stemming from inappropriate prescribing, and any links they might have to nursing home staffing levels.

The latest CMS data shows that nursing homes are making minimal progress in decreasing anti-psychotic prescribing. At the end of 2011, almost 24% of residents received an anti-psychotic medication. Since then, there has been a decrease to a national prevalence of 14.6% in the second quarter of 2018, the agency reported.

“Unfortunately, CMS’ data are still extremely disappointing, showing that progress reducing inappropriate use of anti-psychotics in nursing homes has slowed,” he wrote. “Moreover, I am concerned that the ‘improvement’ is not the result of changed prescribing behavior but, instead, stems from some nursing homes falsifying psychosis diagnoses, making incidence of this contra-indicated prescribing appear improved when it is, in fact, not.”

 

KnoxPages reported that Michelle Engelbach, chief executive officer of the Ohio Eastern Star Home, told Exchange Club members that what she wants them to remember is “living is so much more than dying.”  “I am on a mission about spreading the word home vs. institution,” said Engelbach.

Recapping the expansion of services and recent construction at the Ohio Eastern Star Home to Exchange Club members on Friday, Michelle Engelbach noted that the campus offers everything from home health services to rehabilitation to independent and assisted living.

Noting that individuals become lonely, helpless, and bored under the desensitized institutional model, which includes set routines and structure such as required eating times, Engelbach said, “That’s not home. So we are trying to change the philosophy and say ‘it’s not what’s convenient for the staff.’”

That new philosophy is called The Eden Alternative, and it’s based on the notion that human beings thrive in garden-like environments.

The first step in changing the philosophy is referring to individuals as residents or elders rather than patients. Engelbach explained that an elder is still a living, breathing person alive in his or her environment.

“If you go into a nursing home and if you hear someone say, ‘oh, the patient you want to see is over there,’ chances are they are still operating in the institutional model,” she said.

Under The Eden Alternative, human and animal companionship is the antidote to loneliness, the opportunity to give as well as receive care is the antidote to helplessness, and varied and spontaneous daily life is the antidote to boredom.

Engelbach said the healthcare neighborhoods provide those antidotes. Pets, outings, plants, and children are among the activities the neighborhoods encourage. As an example of spontaneity, she cited the time a resident helped toilet paper the office of a caregiver.

One of the principles guiding The Eden Alternative is the idea that medical treatment should be the servant of genuine human caring, never its master. Engelbach said that all too often individuals are told “don’t get up, you might fall,” or “you can’t eat cake, you’re diabetic.”

“That’s so wrong on so many levels,” she said. “It’s all about how I want to live my life. … Yes, I might fall, but I am going to get up and walk around because I don’t want to sit in my chair. If you wake up at 10 o’clock and want pancakes, you should be able to get that because that’s what you do at home.”

The Eden Alternative also de-emphasizes top-down bureaucratic authority. Instead, it places decision-making in the hands of the elders or those closest to them.

“Living is so much more than not dying. That’s what I want everyone to take away,” Engelbach told the Exchange Club members. “A nursing home is not a place to go to die.”

Recognizing the proven health benefits that animals bring to elders, The OESH is embarking on the creation of a campus dog park. Diane Henwood, director of development for the OESH, said the park will be an enclosed grassy area and include canine agility equipment. Easily accessible to residents and visitors, patio seating and shade trees will be available for elders and their families to enjoy.

Free speech, misleading advertising and claims of censorship will all come into play as the Georgia Supreme Court decides the case of three nursing home companies and the law firm of Wilkes and McHugh who ran newspaper ads against them.  In 2016, Wilkes and McHugh, which operates nationwide, along with one of its lawyers, took out ads in three local papers about three local nursing homes: Rockdale Healthcare Center in Conyers, Powder Springs Transitional Care and Rehab in Powder Springs, and Bonterra Transitional Care and Rehab in Atlanta.

The ads truthfully stated that each nursing home “has been cited” for regulatory violations uncovered by the surveys that the Georgia Department of Community Health conducts as required by federal law.  The nursing homes objected that many of the citations in the ads were several years old and had since been remedied. The ads did not disclose any alleged harm had come to any patients but the nursing homes claim harm is implied as a result of the cited deficiencies.

In October 2017, the nursing homes sued the law firm and attorney Gary Wimbish, alleging that the ads were false, fraudulent, deceptive and misleading, and they failed to comply with the requirements of Georgia Code, which restricts the use of nursing home survey report data in advertisements unless specific disclosures accompany the ads.

Under Georgia law an advertiser must state the “number of findings and deficiencies cited in the statement of deficiencies on the basis of the survey and a disclosure of the severity level for each finding and deficiency.” The statute also requires an advertiser referencing a survey to include a “disclosure of whether each finding or deficiency caused actual bodily harm to any residents and the number of residents harmed thereby.” The nursing homes argued the ads failed to follow these directives.

In November, the day before a scheduled hearing, Wilkes & McHugh filed a motion to dismiss/strike the nursing homes’ motion for injunctive relief under Georgia’s Anti-SLAPP statute.

SLAPP stands for “Strategic Lawsuit Against Public Participation” and describes a lawsuit that is filed to silence or intimidate critics. The Cobb County trial court ruled against the law firm and denied McHugh’s motion to dismiss the lawsuit based on the Anti-SLAPP statute.

Wilkes & McHugh are now appealing that decision to the state Supreme Court.

“This case involves a misguided effort by three nursing home companies to suppress constitutionally protected advertising speech concerning a state agency’s findings of health and safety deficiencies at nursing homes,” the law firm’s attorneys argue in briefs. “Such speech enjoys extensive protections under state and federal law.”

The Concord Monitor allowed Brendan Williams, the president and CEO of the New Hampshire Health Care Association, to share his thoughts. His excellent editorial is below.

“Give the Trump administration credit: Having failed to get congressional authorization to decimate the Medicaid safety net for the poor, it is now trying to circumvent Congress in its dogged attempt to cut the lifeline that 62 percent of nursing home residents, for example, depend upon.

The administration would reportedly do this by unilaterally imposing “block grants” or “caps” upon state Medicaid spending. This would upend the traditional formula where the federal government matches state spending on no less than a dollar-for-dollar basis, based upon a state’s per capita personal income relative to the national average. There are 14 states, including ours, where the federal government pays only 50 percent of the overall Medicaid cost of nursing home care, while in Mississippi it pays the most: 76.39 percent of the cost.

This scheme could not come at a worse time for nursing home care. Nursing homes throughout the country are closing due to inadequate state funding. In tiny Selby, S.D., (population around 642) residents had to raise $500,000 to keep their town’s nursing home from closing. How much more would they have had to come up with if there was a new restriction upon how much state spending the federal government would match? In Texas, the state’s largest nursing home provider filed for bankruptcy in December, citing Medicaid reimbursement.

In New Hampshire, nursing home rates went up only 17 cents per resident per day on Jan. 1. And yet New Hampshire has the nation’s second-oldest population and its third-lowest unemployment rate.

Providers are already struggling to recruit, and retain, caregivers within limited means. President Trump advertised himself to New Hampshire voters, on Twitter (of course), as “the first and only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid.” Yet as president he has incessantly sought to break this promise, perhaps now to offset the bankrupting costs of the tax breaks he pushed – which are creating record deficits.

Perhaps the Trump administration figures these caregivers, and their vulnerable wards, are so powerless that it can further disregard them. They’re just poor women, right? But it would not only be nursing home care that would suffer. Home- and community-based services for Medicaid long-term care would be victimized, too. Our nation’s roughly 2.1 million home care workers make a median wage of $11.03 an hour, according to PHI. More than half must rely upon public assistance themselves, in many cases while serving those on public assistance. But maybe they, too, are easy to ignore. After all, 87 percent are women, and 30 percent are immigrants. Many of those immigrants come from “hole countries” – as Trump has described them.

In signing Medicare and Medicaid into law in 1965, an emotional President Lyndon Johnson stated that “there are those alone in suffering who will now hear the sound of some approaching footsteps coming to help.” If only those were the footsteps those suffering now hear.

 

A Sangamon County jury has compensated a family $6.75 million for the wrongful death and neglect of their loved one, Robert Folder, who died in 2014 after a fatal incident at Lewis Memorial Christian Village nursing home.  Folder was being loaded into a van outside the nursing home when the van’s wheelchair lift became stuck, according to a lawsuit filed by his widow Mary and the couple’s two sons. While the van’s driver called for help, the lift sprang upward without warning, catapulting Folder to the ground, according to the lawsuit and a report prepared by the Illinois Department of Public Health. Folder suffered a broken neck.

Mary Folder was present and asked that the staff call 911, according to the lawsuit. Instead, the nursing home’s staff wheeled her husband back into the nursing home, then transferred him from his wheelchair to a bed without checking for neck injuries. Robert Folder wasn’t taken to a hospital until an hour after the mishap. He died less than three weeks later.

According to Folder’s death certificate, he died of respiratory failure caused by a broken neck. He’d been admitted to the nursing home five months earlier after suffering a broken leg.

The state fined the nursing home $50,000 after finding the wheelchair lift had broken parts and hadn’t been properly maintained. Federal regulators levied a $344,500 fine.

 

CTVNews reported the tragic death of the mother of former Canadian politician Gilles Duceppe who froze to death just outside of her Montreal seniors’ residence early one Sunday morning. She had frozen to death after mistakenly heeding a fire alarm from a nearby building.

The coroner’s office, which is investigating the incident at the Residence Lux Gouverneur, confirmed to CTV Montreal that the woman was Duceppe’s mother, Helene Rowley Hotte.  Montreal police said a fire alarm was set off in a building in the seniors’ home complex at 4:15 a.m., but a notice followed indicating residents in Rowley Hotte’s building did not need to evacuate.

Rowley Hotte, who had hearing problems, likely hadn’t understood that she didn’t need to evacuate and exited the building. Once she made her way out of the building, she was unable to get back inside because the door was locked, police said. Staff at the facility told CTV Montreal the doors automatically unlock when an alarm sounds, but re-lock once it’s disarmed.

Nearly seven hours later the fire alarm, police received a call about a woman lying in the snow. They said she likely died from hypothermia.  At the time, it was about -20 C outside due to a severe winter storm, according to Environment Canada.

 

McKnight’s reported on the tragic death of a resident in Minnesota.  The assisted living facility was negligent using a mechanical lift and sling to transfer a vulnerable adult from an electric wheelchair to a bed after the resident sustained a head injury and died two days later. GoldPine Home “failed to adequately train staff, failed to determine the appropriate sling size, and failed to maintain the mechanical lift according to manufacturer’s recommendations,” the Minnesota Department of Health said in a 29-page report issued Dec. 26.

According to the health department report, two unlicensed workers were involved in the Aug. 7 evening transfer of a resident (not identified in the report) who had multiple sclerosis and was taking warfarin, a blood thinner, due to a history of a blood clot. During the transfer, the resident reportedly slipped out of the sling opening, hit his or her head on the leg of the lift and began bleeding from the head.

The resident died in a hospital two days later. “The death certificate indicated that as a consequence of falling from the mechanical lift, s/he died of a traumatic subdural hematoma (burst blood vessel). Contributing factors included warfarin therapy,” the report stated.

During a staff interview, it was determined the preventative maintenance of the mechanical lift had not been performed,” the report said. “There was not a system in place to ensure the appropriate size sling. In addition, staff did not sign off when trained on the mechanical lift policy.”