Monthly Archives: February 2020

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The Trump administration announced morning that it would cut Medicaid benefits with “Healthy Adult Opportunity” which would give states the option to receive their federal Medicaid funding as a block grant, or a lump sum, to cover vulnerable citizens.  However, red states will use this “option” to limit spending and the size of the overall program and then share in the alleged cost savings with the federal government.  Many Republican lawmakers said they want to cut the benefits because of the high cost of providing coverage — states only have to pay 10 percent of the total bill for Medicaid expansion under the terms of the ACA.

Consumer advocates and experts maintain that it will lead to limits on benefits and decrease enrollment numbers for a program that provides health care coverage to 70 million Americans. Detractors further said the guidance allows states to shrink provider payments without permission, limit access to prescription drugs, impose premiums on beneficiaries and impose a number of roadblocks to eligibility.

That would have the largest impact on adults who receive care through Medicaid expansion, a program under the Affordable Care Act that provides care up to 138 percent of the poverty level.

Dozens of House Democrats warned that block grants would be detrimental to the viability of Medicaid and patient outcomes because of the negative fallout it would have for Americans who get health care coverage through the “safety-net health program.”

“Medicaid block grants necessitate cost-cutting measures like restricting enrollment, decreasing provider reimbursement, and limiting eligibility and benefits through managed care,” the representatives wrote in the letter, which was organized by Rep. Joe Kennedy, D-Mass. “These actions endanger the lives of the most vulnerable patients, the population Medicaid was created to protect.”

“I’m disappointed to see the administration is effectively removing the access to affordable and needed care that people have under Medicaid through this,” said Jessica Schubel, a senior policy analyst focused on Medicaid at the Center on Budget and Policy Priorities. “Lifesaving prescription drugs could be at jeopardy, states could make decisions that could cause thousands of people to lose coverage, and states would bear more financial risk since federal funding would not adjust to meet the need for unexpected costs from recessions and public health emergencies, like the coronavirus.”

Medical groups and health advocates assert that this will only have negative health outcomes for poor patients and cash-strapped hospitals.

“The document issued today by CMS appears to rewrite bedrock provisions of Medicaid, an activity which is beyond the scope of CMS’s power,” said Jane Perkins, legal director for the National Health Law Program, an advocacy group representing low-income individuals and families. “Only Congress is tasked with making these changes. Our legal team is carefully investigating the enforcement and litigation options at this time.”

The Opioid Crisis under the Trump Administration has gotten progressively worse.  For years, nursing homes have resisted caring for patients on medication-assisted treatment for OUD.  However, some nursing homes are at the forefront of treatment options.  For example, Cape Regency Rehabilitation & Health Care Center provides one-on-one meetings with a licensed drug and alcohol counselor and management of suboxone medication as part of the nursing home care.  Instead of chemically restraining residents, facilities are helping residents overcome their addictions. Advocates for patients with opioid use disorder say denying them access to nursing home care is discriminatory.

Cape Regency is owned by Athena Health Care Systems.  They send residents to recovery meetings on site and at a nearby church and helps residents with opioid use disorder find appropriate housing after they are discharged, including sober housing if appropriate.

John Seaman, a licensed drug and alcohol counselor, said he runs staff training sessions on caring for residents with opioid use disorder, or OUD, and wishes more nursing homes would admit patients with the disorder. Seaman, who divides his time between Cape Regency and Cape Heritage Rehabilitation & Health Care Center in Sandwich, estimates that one-third of the nursing home’s residents in the long-term care and short-term care units have substance use disorders.

“OUD patients require an additional set of services related to counseling, transportation, activities, security and other needs,” said Tara Gregorio, president of Massachusetts Senior Care, a professional organization for nursing homes, senior residences and assisted living centers. “The federal skilled nursing facility oversight regulations do not address the special needs of OUD nursing facility residents, which place nursing home facilities at great risk for enforcement actions” and deficiencies, Gregorio said in an email to Cape Cod Times.

 

 

State lawmakers are considering House Bill 262, which would require long-term care facilities, including assisted living facilities, to notify the county coroner’s office when there are deaths, the Augusta Chronicle reported.  If passed, the legislation would allow coroners to conduct death investigations that would exonerate providers against potential abuse claims, or identify neglect or abuse cases, proponents argued.

“Many nursing home residents die of natural causes. (But) sadly, in our state and across the country, we have seen terrible cases of what looks like abuse or neglect of nursing home residents,” said Melanie McNeil, Georgia’s long-term care ombudsman.

Often times the nursing home doctor protects the nursing home by incorrectly designating a cause of death on the death certificate that is inconsistent with the neglect and abuse suffered by the resident.  A new proposal in Georgia would take away a nursing home’s ability to sign death certificates, and protect the integrity of the process. Even if a coroner just spot checks, having an independent professional evaluate a body to confirm cause of death could have a huge impact and serve as a deterrent to abuse and neglect.

“Nursing homes often conduct their own in-house investigations of potentially criminal allegations, and law enforcement is never notified,” William Loomer, of the Crimes Against the Vulnerable and Elderly task force, told the news organization.

“The success of this bill would not only ensure that an impartial investigation of every nursing home death is conducted by the coroner, but I believe it would increase public confidence in the nursing home’s practices in the long run,” he added.

Last April, the Office of Inspector General for the Department of Health and Human Services reported there are an average of 7,100 nursing home patients who suffer a serious adverse health event each year. More than 100,000 more patients suffer less serious adverse events. More than half of those life-threatening and endangering events could have been prevented.

William Loomer, who leads the local Crimes Against the Vulnerable and Elderly task force, said his team is seeing an increase in nursing home reports of possible neglect and abuse.

 

 

 

The Centers for Medicare and Medicaid Services has flagged more than 50 nursing homes in the Carolinas.  The credible allegations range from sexual abuse to a maggot infestation inside a resident’s wound, according to federal inspection records.  Maggot infestation should never occur if proper care is being provided.

Nursing Home Compare has a new icon next to nursing homes with a history of abuse or neglect. The warning, a red circle with a hand inside, is part of an effort by the federal government to better alert the public before a loved one is placed in a nursing home.

The rolling alerts, which went into last year, are for facilities cited on inspection reports for one or both of the following:

  1. abuse that led to harm of a resident within the past year
  2. abuse that could have potentially led to harm of a resident in each of the last two years

Federal records show that many nursing homes have staffing numbers dropped as facility records show the patient population only decreased slightly. Some nursing homes dispute the figures even though they are based on information created and provided by the facility. They argue the nursing homes fail to report everything accurately.

Inspection records from the Centers for Medicare and Medicaid Services also showed the following violations across the greater Charlotte area.

  • Inspection records from January 2019 identify White Oak Manor in Charlotte for failing to protect two residents from sexual abuse by another resident.
  • Inspection records from February 2019 identify Pruitthealth-Rockingham, where a nursing assistant hit a cognitively impaired resident on her face with a closed fist.
  • Inspection records from 2018 identify Olde Knox Commons at the Villages of Mecklenburg in Huntersville, where a nursing assistant slapped a cognitively impaired resident and failed to prevent the abuse of two residents.
  • Inspection records from 2018 identify Bethany Woods Nursing and Rehabilitation Center in Albemarle for failing to supervise a resident who wandered out of the facility.
  • Inspection records from 2018 identify Meadowwood Nursing Center, now called The Ivy at Gastonia, for failing to provide incontinence care for eight hours, forcing a resident to lie in urine and feces.
  • Inspection records from 2018 identify Alexandria Place in Gastonia for allowing a maggot infestation inside a resident’s wound.
  • Centers for Medicare and Medicaid Services most recently added an alert to Lancaster Convalescent Center, after citing the facility in February 2019 for failing to ensure a resident was free from sexual abuse by another resident.
  • The federal government also recently added an alert to Salisbury Center after a 2019 inspection where “the facility failed to initiate medical treatment and pain relief for a resident that was complaining of hip, ankle, and back pain after falling in her room.” Records show the resident had a fractured ankle and had a break of the tibia and fibula.

NJ.com reported that a severely-disabled man who was living at Monmouth Care Center nursing home filed suit against the facility because administrators failed to protect him from being molested by a registered sex offender who was also residing there as a patient. In a lawsuit filed in Superior Court in Monmouth County, the man’s family says Monmouth Care Center officials were aware of Schymanski’s history as a sex offender, but did not provide proper supervision.

William Schymanski, 67, was charged with aggravated criminal sexual contact in May 2018 after he was found molesting another patient, who has cerebral palsy and is non-verbal, according to a police report.  Schymanski also failed to properly register his current address under Megan’s Law. New Jersey’s Megan’s Law database lists Schymanski as a Tier 2, repetitive compulsive sex offender from a 1985 sexual assault conviction.

My brother requires 24/7 care. When he needed to be placed in a facility, I thought they were going to serve his best interests and be safe,” the man’s brother and legal guardian told NJ Advance Media. “I trusted them. This incident changed that.”

Staff at the facility saw Schymanski attempting to pull down the man’s pants in April 17, 2018. His brother told police he didn’t receive a voicemail about the incident until three days later, according to the police report. The incident was not reported to police, according to the attorney for the alleged victim, Daryl Zaslow.

Police were called May 1 after Schymanski was again seen with the other patient – this time molesting the man as they both sat in wheelchairs, police said in the report. Schymanski was arrested and charged at the time, and has since been transferred to another facility. Schymanski denied molesting the man when confronted by officers, according to the police report.

Zaslow said that after the April incident, the Monmouth Care Center failed to do mandatory reporting or research that would have brought Schymanski’s past history of assault to their attention. He alleges the center also violated multiple statutes, such as the New Jersey Nursing Home Residents’ Bill of Rights, by not properly monitoring residents or notifying local law enforcement or state authorities of the initial incident.

“It’s just horrible,” said Zaslow of the Edison-based law firm Eichen Crutchlow Zaslow LLP. “These are our most vulnerable people and (Monmouth Care Center) swept it under the rug. They’re under a legal obligation to protect these members of our society.”

 

A federal judge sentenced President Donald Trump’s friend, longtime operative Roger Stone, to only 40 months in prison for lying to Congress and tampering with a witness in an effort to protect Trump. Stone was convicted at trial in November of charges related to false statements and threatening a witness.

He was not prosecuted, as some have complained, for standing up for the president, he was prosecuted for covering up for the president,” said Judge Amy Berman Jackson about Stone.  “The truth still exists, the truth still matters. Roger Stone’s insistence that it doesn’t … are a threat to our most fundamental institutions,” Jackson said. “There was nothing unfair, phony, or disgraceful about the investigation or the prosecution.” Jackson said.

If Stone is pardoned, his conviction would be voided, and he would not face any criminal sentence after Attorney General William Barr and Trump improperly interfered in the prosecution due to political considerations and because of Trump’s long relationship with Stone. Barr forced the nonpartisan U.S. attorney for the District of Columbia to recommend a ridiculously lenient prison term than the seven to nine years that guidelines mandate.  The four trial prosecutors quit the case in protest.

More than 2,000 former Justice Department employees have publicly called on Barr to resign for his reversal of the career prosecutors’ sentencing recommendation in the case.

“Each of us strongly condemns President Trump’s and Attorney General Barr’s interference in the fair administration of justice,” the letter said, specifically citing the Stone case.

 

 

 

Trent Tolbert is a piece of s&*%.  This SOB paid himself more than $36,000 a month at New Beginnings Care LLC, the nursing home business he co-founded in 2011, and drove a company-financed Porsche, according to court documents.  But Tolbery stiffed vendors. The water and the power bills went past due, and state bed taxes weren’t remitted.

Then in December 2015, state inspectors found numerous violations of standards in patient care. Among other findings, inspectors said staff didn’t provide timely patient incontinence care, didn’t prevent avoidable pressure ulcers and failed to administer antibiotics.  Medicaid and Medicare payments were cut off.

Eight nursing homes operated by New Beginnings have closed or will close by the end of March. New Beginnings’ legal team will spend Friday in U.S. Bankruptcy Court in Chattanooga to try to hang on to the seven nursing homes the business still operates. It calls them “keepers” in court filings, in contrast to two “non-keeper” facilities still due to close and six “closed” facilities.

A home in Youngstown, Ohio, closed Jan. 29 after state inspectors found it was understaffed because workers quit over not being paid. At least seven of the 44 residents wore two layers of adult diapers “saturated” with urine or feces, the inspection found, and residents weren’t being repositioned in bed to prevent skin breakdown, including one who had ulcers on both heels.

One of the issues is a self-serving revolving line of credit that allowed Tolbert to siphon or divert funds away from the care and needs of the residents into his pockets.  New Beginnings owes $2.8 million to Gemino Healthcare Finance for the revolving line of credit. Many chains use lines of credit to hide the siphoning of funds.

Tolbert and New Beginnings’ co-founder, Debbie Jones — who made $24,000 a month and also drove a company-leased Porsche — filed for Chapter 11 bankruptcy Jan. 22. The duo previously held executive positions at two Chattanooga-area nursing home businesses: Grace Healthcare and Life Care Centers of America.

New Beginnings owes close to $7 million to unsecured creditors, or those without collateral, according to court filings, with the highest amount being $1 million owed to the Bureau of TennCare.  It had $63 million in revenue in 2015, court filings say. But it listed its assets as less than $50,000.

 

McKnight’s had an interesting article about using electronic medical records to predict dementia in residents.  Nearly half of nursing home residents, 47.8%, have received a diagnosis of Alzheimer’s disease or another dementia, according to the Center for Disease Control and Prevention.  An Indiana-based research team wants to deploy its algorithms into clinics in an effort to identify patients at risk for developing Alzheimer’s and related dementia. The noninvasive method uses machine learning to analyze data from electronic medical records to screen for dementia risks. Researchers recently completed a randomized trial for the screening method and found “no harm.”

“The great thing about this method is that it’s passive, and it provides similar accuracy to the more intrusive tests that are currently used,” lead researcher Dr. Malaz Boustani, MPH, said.

“This is a low-cost, scalable solution that can provide substantial benefit to patients and their families by helping them prepare for the possibility of life with dementia and enabling them to take action,” he added.

A new tool recently developed by Swedish researchers is able to accurately predict the life expectancy of dementia patients.

Palm Valley Rehabilitation and Care Center was negligent in the care of a resident so the resident sued.  The nursing home moved to dismiss the case and demand the case be heard by an arbitrator.  The Arizona courts disagreed.  The facility won’t be allowed to use arbitration in a wrongful death lawsuit that stemmed from a wheelchair accident involving a resident, an appeals court ruled.

The signed agreement between Palm Valley Rehabilitation and Care Center and the resident’s son required arbitration to solve disagreements over medical services.  The resident’s son sued the facility for wrongful death, negligence and violating the Adult Protective Services Act following a wheelchair accident involving his mother in March 2016, court documents explained. According to the Arizona Court of Appeals, the pushing of a wheelchair doesn’t count as a “medical service” and doesn’t fit within the scope of the agreement — meaning the facility can’t compel arbitration to solve the dispute.

A certified nursing assistant was pushing the wheelchair when his mother’s foot got tangled with a loose cord, causing her to fall head first onto the floor and breaking her neck. She later died from the injuries.

Palm Valley had argued that the case is a medical malpractice lawsuit under Arizona’s Medical Malpractice Act. The court disagreed, saying the facility’s definition of medical malpractice in the arbitration clause was too narrow.

MarketWatch had a great article last month on the problem of wrongful eviction or involuntary discharge of nursing home residents.  Eviction stories like those mentioned in the article happen to thousands of nursing home and assisted living residents each year. One common reason residents are told to move out: behavioral issues related to dementia or mental illness. But experts say these discharges are often unwarranted. Often agitation and anger are a form of communication to notify caregivers of neglect, pain, hunger, thirst, fear or boredom.

Involuntary discharge [from nursing homes] is the number one complaint that [long-term care] ombudsmen have had to deal with for the past seven years,” says Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care.  More than 10,000 consumers complained about involuntary discharges in 2018, according to national ombudsman data.

In 1987, Congress passed the landmark Nursing Home Reform Act, guaranteeing a set of comprehensive rights for residents, such as the right to receive adequate care, to be treated with dignity and respect and to make personal choices about how you dress or spend your time.  Included in the Nursing Home Reform Act is a section on a resident’s right to remain in a nursing home, unless a transfer or discharge “is necessary to meet the resident’s welfare” or “is needed to protect the health and safety of other residents or staff.”

The nursing home must give a resident at least 30 days notice, put the reason for the discharge in writing, indicate where the person will be moved and include contact information for the state ombudsman.

Residents have the right to appeal. If the eviction is due to nonpayment, the resident has the right to remain in the nursing home if the person has applied for Medicaid assistance and is awaiting a decision.

In 2016, the Centers for Medicare and Medicaid Services (CMS) revised the nursing home regulations. CMS found that some nursing homes were inappropriately claiming they could not meet a resident’s needs.

With the new regulations, the nursing home has to document specifically what the unmet need is, what attempts they took…and what services the new place is providing that the original place says they couldn’t provide.

 

But if a formal discharge letter is sent, saying the family has 30 days to move the person, there are several steps to take.

The first is to contact the long-term care ombudsman. If regulations are being followed, the nursing home should have sent a copy of the letter to the ombudsman at the same time as the resident.

The ombudsman should be your advocate, although this is not always the case. Sometimes the ombudsman is more an advocate for the nursing home than the resident.

Ask the ombudsman what assessments have been conducted and what measures the care facility took to ameliorate the difficulty. Find out what services the staffers say they are unable to provide, and ask if the new place has them.

If you feel the discharge is unfair and not in your loved one’s interest, appeal the decision to the facility.