KXAN out of Texas reported the arrest of nursing home employee Amy Eileen Vela who  is accused of stealing numerous pieces of jewelry worth about $16,000 from an 80-year-old patient diagnosed with dementia living at Wyoming Springs Assisted Living and Memory Care.

The daughter of the victim told investigators on Dec. 7, she noticed several pieces of jewelry missing from her mother’s room. The pieces included a gold, blue topaz, diamond ring, a gold lapis diamond ring, and a diamond bracelet.

Investigators were given a list of employees working the wing the victim lived in. Officers found that Vela pawned two rings on Dec. 9, that allegedly matched the description provided by the victim.

Vela admitted to stealing the jewelry. She brought back the diamond bracelet which she still had at her home. Vela told officers she was having money troubles and needed the money for Christmas.

 

The Miami Herald’s Jay Weaver reported the cliche story of greed and loathing in Miami represented by the disgusting Philip Esformes.  “FBI agents arrested Esformes in July 2016 and he suddenly became the poster boy for the biggest Medicare fraud case in the country. He was charged with bilking $1 billion out of the federal healthcare program for the elderly and disabled, while his vast business assets and bank accounts were frozen.”

According to the Justice Department’s indictment, Esformes is accused of exploiting his network of about 20 Miami-Dade skilled-nursing and ALFs to fleece the taxpayer-funded Medicare program by filing false claims for services that were not necessary or not provided over the decade leading up to his arrest.  Esformes is also accused of referring his own network of patients to convicted healthcare-fraud offenders, including Guillermo and Gabriel Delgado, who are serving prison time. The brothers admitted swindling Medicare for mental-health, prescription-drug, and home-healthcare services, and they ultimately helped federal investigators target the Miami Beach executive.

Esformes was also charged with obstructing justice because prosecutors say he plotted in 2015 with the Delgado brothers to help one of them leave Miami for Israel to avoid trial. Unbeknown to Esformes, the co-conspirators, who had already been charged with sharing Medicare patients with him in the alleged kickback scheme, recorded a two-hour conversation with him before Esformes was indicted the following year. The secret recording was carried out as part of the brothers’ cooperation deal with the feds to plead guilty.

Esformes was back in court for one final hearing asking for another delay before he goes to trial by himself on Feb. 11., two and half years after Esformes’ arrest.  Esformes is standing trial alone because all of his co-conspirators have already pleaded guilty, including a physician’s assistant, Arnaldo Carmouze, and a former Larkin Community Hospital outpatient director, Odette Barcha. In January, both admitted that they recycled Medicare patients through the hospital and Esformes’ network of nursing homes and ALFs in an elaborate bribery scheme that prosecutors say was orchestrated by the healthcare executive.

His father, Morris Esformes, a Chicago rabbi who made a fortune in the healthcare business, is footing the son’s legal bills. Father and son were once partners in a similar chain of skilled-nursing and assisted-living facilities in Chicago before expanding to Miami.

Justice Department officials — along with South Florida’s U.S. attorney, the FBI, and Health and Human Services agents — described the Esformes prosecution as the nation’s biggest Medicare fraud case.

Prosecutors said his healthcare network as well as other co-conspirators billed $1 billion for fraudulent medical services since 2009. In turn, Medicare paid Esformes’ skilled-nursing and assisted-living facilities and the Delgado brothers’ healthcare operations about $500 million.

The Telegram reported that Beaumont Rehabilitation & Skilled Nursing Center nursing home has agreed to pay $1 million to settle a wrongful death lawsuit filed after a resident died from injuries she suffered in a fall that should and could have been prevented.

Candilou C Hitchcock filed the lawsuit in 2017 after her mother, Betty “Betsy” (Ford) Crane, fell while residing at the nursing home on July 29, 2015, and died Aug. 7 of blunt force head trauma.  Ms. Crane, who suffered from dementia and had a history of at least 21 falls while at the facility, suffered the fatal fall after an employee forgot to turn on the alarm on the woman’s chair to notify staff when she got up.

The nursing home further failed to notify the physician or nurse practitioner, delaying seeking hospital care; and failed to inform the state Department of Public Health as required, Ms. Hitchcock maintained in the lawsuit

 

Live5News reported that The Veterans Victory House is being fined thousands of dollars a day for failing to comply with Medicare and Medicaid guidelines after investigators with the South Carolina Department of Health and Environmental Control made visits to the nursing home.  Surveys were conducted in Dec. 2018 and January of this year.  According to the document, the Veterans Victory House was not in what is called substantial compliance with the Medicare and Medicaid guidelines.  The agency found actual harm to the residents at the nursing home.

According to the documents, the nursing home is being fined $15,000 a day and $515 a day until the facility comes into compliance. The infractions and fines against Veterans Victory House are in a report by the Centers for Medicare and Medicaid Services.  Veterans Victory House will not be paid any Medicare or Medicaid claims for newly admitted residents. The Feds are giving the facility until Jun. 14 to comply with the guidelines or face the total loss of Medicare and Medicaid funding.

 

 

 

A new study proves that families of nursing home residents are more likely to be satisfied with facilities that have higher staffing levels and are nonprofits, a new study finds.  Oh and water is wet.  Of course, quality care and satisfaction go hand in hand with proper staffing!

In the study, the researchers compared federal data on nursing home facility characteristics with results from surveys filled out by families of nursing home residents in Minnesota and Ohio.

The two states differ in nursing home occupancy rates, percentage of for-profit versus nonprofit facilities, reimbursement rates and other significant factors and policies, the researchers noted.

Despite these differences, a number of similar factors were associated with higher satisfaction among family members in both states.

Those factors included: more registered nurses, certified nursing assistants, and activities staff; a higher Medicare payer-mix; and less need for intensive nursing care among patients.

Higher levels of satisfaction were also seen with nursing homes that were smaller in size, located in rural areas, not owned by a for-profit company or affiliated with a chain, and higher bed occupancy rates.

The study was published recently in the Journal of Applied Gerontology.

“The findings show that facility-level factors associated with higher family satisfaction are rather similar to the ones we already know predict resident satisfaction as well,” said study leader Tetyana Shippee. She is an associate professor in the University of Minnesota’s School of Public Health, in Minneapolis.

“This report reinforces that the role of family members is so important, as residents often can’t advocate for themselves, especially those with dementia and cognitive impairment, who are at highest risk for injury and premature death,” Shippee added in a university news release.

It also shows that family members can “help keep watch on nursing homes and ensure quality of care for residents,” Shippee noted.

As part of her continuing research, Shippee said she will look at how the link between family satisfaction and nursing home characteristics can be used to create nationwide nursing home assessment tools.

SOURCE: University of Minnesota, news release, December 2018

WSBTV reported on the bizarre story of Riverside Nursing Home who attempted to get rid of one of their residents by calling an Uber.  Now the family wants answers.  The resident suffers from dementia and Alzheimer’s. “It didn’t feel right. That’s just not the way you treat people,” the woman’s daughter-in-law, Angie Conner, said.  The family has made two complaints to the state and other families told Channel 2’s Tyisha Fernandes they have filed complaints, too.

The Connor family did not want to put their 78-year-old mother in a nursing home, but when her Alzheimer’s and dementia got worse last year, they felt like they had no choice.  “We had to make the decision that somebody had to take care of her 24/7,” daugther Becky Mills told Fernandes.

The family placed her in the Riverside Nursing Home in February. Six months later, they said they noticed her oxygen tank wasn’t working properly and that officials were scheduling unnecessary appointments without the family’s approval.

“Because they bill Medicaid and Medicare. It’s just like, no, you’re not going to have a test done just to make money off it,” Mills said.

So they made a complaint to state officials.  that is when the nursing home retaliated.

Then, the family learned the nursing home sent their mother to her appointment in an Uber by herself when the medical transport didn’t show up. The doctor’s office called the family.

“I couldn’t believe it. Because of her situation with dementia, she was frightened. She didn’t know where she was at,” Conner said.

Fernandes called the Riverside Nursing Home for two days but no one ever called her back.

Another family who didn’t want to talk on camera said they have had trouble too.

“It’s not every nurse and it’s not every CNA. But it’s in there. There’s a lot of residents in there – if you can get to them they can tell you some things,” the woman said.

 

According to the article a 2016 PennLive investigation, Failing the Frail, found that 46 nursing home residents died in Pennsylvania from 2013 to 2015 due to care-related errors by nursing homes. The investigation also uncovered that despite a lawsuit and promises to oversee the nursing facilities with better care, they still have not improved. One coroner has a solution.

A Pennsylvania county coroner, Scott Grim, plans to promote a law that requires a coroner to examine the death of those in the care of nursing homes whether it is ruled as a natural death, accidental, homicide or etc. Grim, Lehigh County coroner, believes that the law would prevent deaths from neglect or abuse from going unnoticed by the state.  A coroner would then ask the nursing home a series of questions about the deceased, such as how they died, their medical history and any recent trauma. If the coroner suspects any foul play, they will then conduct a full investigation of the deceased.

Arkansas and Missouri, have laws requiring nursing homes and assisted living facilities to report all deaths to their local coroners and Scott Grim believes that adopting the law in Pennsylvania will prevent any intended or neglectful deaths in nursing facilities.

North Carolina Health News reported that North Carolina has $29 million dollars in the CMS fines/penalties fund that is sitting mostly unused. The money — including $13 million during the past three fiscal years — has accrued from fines as large as $1.16 million levied by federal regulators against individual North Carolina nursing homes.  Nursing homes or other parties can get grants from the money, known as “civil money penalty,” or CMP funds, after approval from DHHS and the federal Centers for Medicare and Medicaid Services, or CMS.

The growing millions in the fund are supposed to be spent on programs to ensure better lives for the people who live in the state’s 429 nursing homes. But during the past three years, only $406,057 — about 1.4 percent of the current stash — was spent. The money went mostly to a handful of smaller-scale “culture change” projects designed to improve residents’ lives at individual nursing homes.

A recent email from Becky Wertz, section chief at the Division of Health Service Regulation, Nursing Home Licensure & Certification Section in the state’s Department of Health and Human Services sought new proposals on how to spend the money.  The email went to more than 30 nursing-home administrators, advocates for older people and others with a stake in the welfare of long-term care residents.

More than $25 million in  fund has gone unused at a time when the state’s 60-plus generation is projected to outnumber those younger than 18 this year.  Advocates have argued in vain to the General Assembly that people older than 60 require help — such as transportation and Meals on Wheels — that would add millions to the state’s budget.

“The idea that you use money from fines to improve quality is a good idea,” said Thomas Konrad, a former health policy and research professor at UNC-Chapel Hill who continues to study and consult in long-term care issues. “Preventing people from having to go to nursing homes might be a good use of this money.”

To put the $28.9 million in perspective, it amounts to about two-thirds of the $44 million annual budget of the state’s Division of Aging and Adult Services, which saw its state appropriation fall between the  2016-17 and 2018-19 fiscal years. And more than 10,000 people annually sit on waiting lists (for monetary aid to help them to remain in their homes) paid for in part by the $30-million-plus that North Carolina contributes to Home and Community Care Block Grant services. That block grant, which also receives federal funding, pays for programs that have a goal of keeping people out of long-term care.

According to CMS, each state develops its own plans on how it will “reinvest” the fines paid by its nursing homes. However, the federal agency must approve plans and also has to check annually on whether and how a state is using its pot of money, a CMS spokesman said.

“Each project idea and budget must be reviewed for reasonableness, which may cause rejection of project ideas that do not meet state or CMS criteria,” the spokesman said.

Each state must spend a “reasonable” amount of its penalty funds annually, but no percentage is spelled out.

In addition, states are required to publicize the use of civil money penalties, making known how much is approved for projects, the identities of contractors and the results of projects that receive the funds.

 

McKnight’s had an interesting article referencing Green Street Advisors analysis blaming “greedy” landlords for the financial problems in the nursing home industry.  Both ignore the fact that the landlord and the corporate operator both siphon funds from the facilities away from patient care to increase the profit margins.  The report notes that nursing facilities are typically subject to long-term, triple-net leases where tenants are required to cover all operating and capital expenditures. But that coverage has been “squeezed” in recent years because of interest rate increases, slumping demand, increased labor costs, and managed care plans putting pressure on lengths of stay.

The article states the obvious that “rents are likely too high in the skilled nursing industry and will need to drop to foster a healthier relationship between owner and operators, a new report advises”.  In the analysis, Green Street Advisors urges landlords “don’t be greedy.” It suggests that SNF rents may need to drop by 10% on average to strike the right balance where both parties benefit.  The only losers are the caregivers and residents.  The SNF industry will remain “under pressure” if the revenue side of the ledger fails to grow to keep up with rising rents, said Dan Hermann, president and CEO of Ziegler.

“The key takeaway is that ‘win-win’ relationships are the optimal outcome for skilled nursing operators and landlords,” Lukas Hartwich, lead healthcare sector analyst for the Newport, CA, firm and author of the report, told McKnight’s. “An important factor in ‘win-win’ relationships for SNFs is a sustainable level of rent coverage.”  Green Street urges landlords to set “sustainable” rent levels, that both allow their tenants to profit, and collect enough cash to fund capital expenditures — around 2% to 3% —for those buildings.

“Facilities that fall short in these two areas are destined to spiral downward,” they write. Calculating profitability can be tricky, but the firm estimates that a tenant’s share of facility revenues should be about 7% to make its operations sustainable.

Four prominent real estate investment trusts must drop their rents to strike that win-win balance, the report notes: LTC properties (6%), Sabra Health Care (7%), Omega Healthcare Investors (11%) and Welltower (12%). Sabra and Omega have notably feuded with tenants in the past year over rent costs, with the former’s largest operator, Senior Care Centers, filing for bankruptcy in December, citing ballooning lease costs.

The authors also note that their analysis does not account for “dramatic changes in the operating environment,” such as government reimbursement levels, and assumes inflationary growth of revenue and expenses over time.

“The REIT model — forget whether it’s nursing, just any real estate asset — is premised on continuous escalations,” he told McKnight’s. “Your question when you have continuous escalations is: How will the balance of your expenses be escalating, and can your revenues escalate at the same level?”

He added that when REIT executives factor in inflation and flat revenues it is understood that “eventually the model is going to break.”

And that’s why people have been exiting the nursing home industry for years on the REIT side,” Hermann added.