Kindred Healthcare which owns and operates dozens if not hundreds of long term care facilities in the U.S. made very impressive profits despite the tough economic times.  See report here.

Net income rose by 30% in the fourth quarter compared with the same quarter a year earlier.

Profits rose to $21.2 million in the fourth quarter, up from $16.3 million in 2007. Consolidated revenues also increased by 5% to a total of $1.1 billion, according to the company’s quarterly report. Diluted earnings per share were $0.56, compared with $0.51 the year before.

"The quarter was highlighted by a strong rebound in our hospital business and the significant strengthening of our financial position as we move into 2009," Kindred CEO Paul Diaz said in a statement. "Our nursing centers continued to report stable operating results despite some softness in our
Medicare volumes."

In light of the good financial news, Kindred Healthcare adjusted its 2009 earnings per share range forecast to $1.35 to $1.45, up from $1.30 to $1.45.

With profits like these, how can they claim they need more tort reform? had a flattering story about the profitable Ensign Group who owns and operates dozens of nursing homes throughout the country.  I guess if you were looking at it from the point of view of profits and business models instead of quality of care, the flattery may be deserving.

The article mentions that despite the bad economic times for most workers and consumers, Ensign Group has money to spare in credit-challenged times and are taking advantage of the market.  Ensign picked up two nursing homes in California and Texas to ring in the new year.

Chief Executive Christopher Christensen says the holding company is actively seeking more long-term care properties in the West. Last week, the company acquired four in Colorado. Since its founding a decade ago, Ensign has acquired its way to 67 facilities in seven Western states: California, Arizona, Texas, Washington, Utah, Idaho and now Colorado.

At the end of the third quarter, Ensign had $56.4 million in cash, including $35.6 million generated since the first of the year. Other funds came from the remaining proceeds from its November 2007 initial public offering, some of which had already been used for other asset buys and upgrades.

"Adding such facilities obviously has a negative impact on our short-term overall operating metrics," he said, "but also represents tremendous upside opportunity as we turn them around."

Though Ensign has yet to report fourth-quarter and full-year earnings, analysts polled by Thomson Reuters estimate that profit grew 13% in 2008 to $1.32 a share. For 2009, earnings are seen growing 22%.

Ensign’s balance sheet is one of the strongest in the industry, with a debt-to-capital ratio of 29%.  From a demographic perspective, the industry itself is well-positioned for growth. 

Seniors 85 and older are skilled nursing homes’ prime demographic. That population will grow 80% to 9.6 million by 2030. That translates to a compounded annual growth rate of 2.4%.

Nursing home spending is forecast to rise 5.1% a year to $210.9 billion by 2016, from $105.7 billion in 2002, according to the Centers for Medicare and Medicaid Services.

Meanwhile, nursing home beds have been declining, from 1.8 million in 2000 to 1.5 million in 2007.

The oldest Americans aren’t the only users. Nursing homes are also benefiting from a growing number of younger, short-term, post-acute-care patients, such as those recovering from joint replacements and other surgeries. A lot of them are the still-active baby boomers.

Medicare and managed care firms are increasingly steering these patients to skilled nursing units rather than pricier rehab centers.

They reimburse Ensign and other nursing operators at higher rates than Medicaid, which pays for the bulk of nursing homes’ mainstay elderly residents. "On a per-patient basis, Medicaid is least preferred because reimbursements are at the lowest rate per day." Medicaid payments accounted for 42% of Ensign’s third-quarter revenue, which rose 12% from the earlier year to a record $116.3 million. Medicare made up 32%, while managed care comprised almost 14% and private insurers 12%.

Government reimbursements, though, remain a key risk because of cost-cutting pressures. A Medicare rate cut to skilled nursing homes was reversed in August when the Centers for Medicare and Medicaid Services approved a 3.4% increase to account for inflation.

State Medicaid budgets are also under pressure. "Forty-four states are projecting budget shortfalls in the next fiscal year (starting in July). I’m personally modeling flat rates for both Medicaid and Medicare, which most people view as a worst-case scenario."

Ensign also remains under the cloud of a whistle-blower investigation the Justice Department began in 2006, said to be related to Medicare claims submitted for rehab services. Search warrants issued in mid-December focused on six nursing homes in Southern California.



Somebody sent me this article from  It is about The Carlyle Group having to sell their corporate jets.  The Carlyle Group owns and operates the ManorCare nursing homes throughout the country.  They are notorious for under-staffing and neglect.  Below is part of the article although the Cityfile website has additional information.

You can add The Carlyle Group to the long, long list of financial firms looking to cut back on their private jet budgets. The Washington-based private equity giant that counts members of the Bush family as investors is now looking to unload its 2004 Gulfstream G450. Like its rivals, it’s been a challenging few months for Carlyle, which was ranked the largest private equity firm last year by Private Equity International. In December, the firm announced plans to slash 10 percent of its staff—the first layoffs in Carlyle’s 20-year history—and it also said it planned to close down its Silicon Valley office. The jet broker responsible for selling the G4 didn’t indicate how much Carlyle is hoping to get for the plane. (Similar models run about $30 million.) But if you’re in the market for a jet that’s made its fair share of trips to Kennebunkport and Crawford, you may want to set aside a little extra to replace all the gaudy gold plating in the bathroom and kitchen. Photos and detailed specs after the jump.

A worker at a Sudbury nursing home has been charged with sexually molesting a patient while another patient slept in the same room. Prosecutors said that 46-year-old Kofi Agana sexually assaulted the 62-year-old woman who had recently suffered a stroke at Sudbury Pines Extended Care.  Agana was held on only $500 bail after pleading not guilty.

Agana has worked as an aide at Sudbury Pines since August.  Agana went into the room of a 62-year-old woman who had a stroke which greatly limited her ability to speak. Agana closed the bedroom door nearly all the way which is a violation, and began rubbing the woman’s breast.  He then grabbed her arms and held them down when he touched her genitals area, the prosecutor said.   The assault was discovered when another aide noticed the victim acting strangely toward Agana. "She was acting agitated – she was trying to get away from him."

"She’s very responsive to questions asked to her," said investigators. "She pointed to various areas of her body and she indicated it involved the defendant."

Prosecutors asked Judge Robert Greco to set bail at $10,000, noting the seriousness of the crime. He also said there was another allegation where a patient being transferred from a bed to a wheelchair said Agana fondled her. He was not charged for that, the prosecutor said. had an article about a nursing home employee caught in a drug bust.   This kind of incident seems to be happening more and more around the country’s nursing homes.

Melanie Curry is a Licensed Practical Nurse who worked at the Fiddler’s Green Manor nursing home.  The Wyoming county drug task force was monitoring Curry.  When Curry moved from Wyoming county to Springville the drug task force alerted the Erie County Sheriff’s Office. "As a result of information they had provided to us we had her under surveillance," says Erie County Sheriff Timothy Howard.

Police say Curry was stealing hydrocodone pills from the nursing home residents.  The investigation came to a head when nursing home officials say an undercover officer made contact with Curry and made arrangements to meet for a drug buy right outside Fiddler’s Green Manor. "(Officers) actually witnessed the drug sale of about 11 pills in front of the nursing home," says Howard.

Curry is now facing a felony sale of narcotics charge as well as misdemeanors of petit larceny and drug possession.   Fiddler’s Green Manor says this is an isolated incident, and patient care is their first priority.

The Daily Herald had a story about another woman found dead outside a nursing home.  Nursing homes have a duty to properly staff and supervise the residents especially when they know a resident is demented or confused and attempts to wander off the premises. 

The article mentions that authorities are investigating the death of an 89-year-old Itasca nursing home resident, found in her nightgown and bare feet outside in subfreezing temperatures.  Sarah Wentworth died last week at the Arbor of Itasca.

Police said they received a 911 call and rushed to the private facility at 5:43 a.m.  By that time, the resident was unresponsive but covered in blankets, lying on a gurney inside the facility.  Nursing home staff reported they tried to revive Wentworth after finding her in an outdoor courtyard. She was pronounced dead shortly later. She had dementia, but the nursing home never documented a history of wandering off.

The circumstances that led to her tragic preventable death have sparked at least three investigations. Itasca Police Chief Scott Heher said police uncovered conflicting information after interviewing the nine Arbor employees who were on duty. He said police were told Wentworth was sleeping in her bed during a 3 a.m. well-being check, but that she disappeared by 5 a.m. when staff looked in on her again. An employee reported hearing an alarm door sound, but Heher said it was not investigated beyond a cursory hallway check.

Police question whether the 3 a.m. check ever occurred. Furthermore, Wentworth was not dressed in the same clothing when police arrived as she was earlier that morning.   Her clothing could not be found.

"I think she wandered out there alone," Chief Heher said. "It’s an absolute tragedy. There are a number of mechanisms in place at the Arbor to ensure these things don’t happen. Obviously, there was a systems breakdown that night. We’re investigating to see if criminal charges apply."

Reports on more than a dozen other unrelated Arbor complaints are listed on the state’s Web site.  The facility has a one-star rating, much below average, based on prior complaints, staffing levels and the results of its three most recent inspections, according to the Federal Centers for Medicare & Medicaid Services.


Ken Connor is a lawyer and co-author of "Sinful Silence: When Christians Neglect Their Civic Duty." He is also Chairman of the Center for a Just Society. For more articles and resources from Mr. Connor and the Center for a Just Society, go to  Below is his article "Old age for Sissies" which I found on the Renew America website.

"Rise in the presence of the aged, show respect for the elderly and revere your God. I am the LORD."
-Leviticus 19:32 NIV

Old age ain’t for sissies — especially if you happen to be living in one of America’s 15,000 nursing homes.

While there are some fine facilities for the long term care of the elderly, many nursing homes have become dangerous places for the residents who live there. I know because I have seen their suffering up close and personal. As a trial lawyer, I represent many victims of abuse and neglect in nursing homes and assisted living facilities across the country.

But you don’t have to take my word for it.

A recent Department of Health and Human Services report found that 94% of America’s nursing homes have been cited for violating federal health and safety standards. Perhaps even more disturbing, however, is a study by Consumer Reports that found that state regulators fined only 50% of nursing homes whose misconduct warranted fines.

Pressure ulcers (bed sores) are all too common among the elderly in nursing homes. They develop as a result of leaving a resident in one position for too long without turning or repositioning them. Pressure from a mattress or chair on a bony prominence deprives the resident’s tissue of blood flow and the skin breaks down. While "bed sores" sound benign, they are not. I have seen countless pressure ulcers that penetrate to the bone. They are gaping wounds that are often infected and foul smelling as a result of contamination with urine and feces. They develop because short-handed staff frequently don’t have enough time to turn or reposition residents, or even to clean them up after they have soiled themselves. Malnutrition is estimated to plague up to 65% of nursing home residents and countless others suffer from avoidable dehydration — all because harried staff don’t have time to assist with feeding or to provide fluids to thirsty residents. Still others suffer broken bones resulting from falls and the lack of supervision. Often this occurs when the resident’s call light isn’t responded to in a timely fashion and the resident attempts to get to the bathroom without assistance in order to avoid soiling themselves.

Make no mistake about it — pressure sores, malnutrition, dehydration, and falls in nursing homes are not the inevitable consequence of old age and ill health. They are, all too often, the result of understaffing of nursing homes and the resulting inability of the staff on hand to provide the care their residents need and deserve. Shockingly, government studies show that more than half of nursing homes fall below the "minimum" staffing standard proposed by the Health Care Financing Administration (n/k/a the Center for Medicare and Medicaid Services) of two hours of care each day from certified nursing assistants, and nine out of ten homes fall below the HCFA "optimal" standard of 2.9 hours of care each day from certified nursing assistants. Iowa Senator Chuck Grassley rightly observed, "More than half the nation’s nursing homes don’t meet a minimum benchmark for staffing. That means residents don’t get fed enough. They don’t get turned to prevent bedsores. They end up in the hospital much more often than they should."

But why wouldn’t nursing homes provide adequate staffing to take care of their frail elderly residents? Two words: "corporate greed," the same two words that are at the root of our current economic meltdown. You see, the largest expense of a nursing home’s budget is "labor." Nursing home executives have learned that one surefire way to increase the profitability of their homes is to reduce costs by "shorting" the staff. That pumps up the bottom line. In the process, however, residents who depend on the staff for their basic needs are shortchanged.

One example from the New York Times is informative: Habana Health Care Center was taken over by private investment firms in 2002. The firms immediately cut the staff, reducing the number of registered nurses (RNs) by 50%. Budgets for care were slashed. Fifteen residents died and their families sued the home for negligent care. Regulators warned the home time and again, but received no response. These procedures are commonplace. Sixty percent of homes which have been bought out by private investment firms in recent years have cut their number of RNs, sometimes to illegal levels.

The offending nursing homes often try to conceal their perfidy by falsifying patients’ charts. In an attempt to deceive state inspectors about the level of care being delivered, nursing homes frequently host "charting parties" where staff will hastily fill in blanks in patients’ charts. The result is that they often chart care as having been given on non-existent days (February 31), or after the resident is dead, or, perhaps, before the resident was even admitted to the facility. Sometimes, they will chart care as having been given despite the fact that the identified care giver wasn’t at work (a review of the employee time cards reveals this fraud). Such actions no doubt account for John T. Bentivoglio’s statement in the Washington Post on February 4, 2000 that, "A number of high flying nursing home chains appear to have incorporated defrauding Medicare as part of their business strategy." At the time he made that statement, Mr. Bentivoglio served as Special Counsel for Health Care Fraud at the Justice Department. His statement is no less true today than when he first uttered it.

Lamentably, there is little media coverage of elder abuse. Perhaps that’s because much of it goes on behind the closed doors of nursing homes. Perhaps it’s because our culture is obsessed with youth and no one wants to contemplate getting old. Or perhaps it’s because we simply devalue the elderly — after all, many of them have substantially degraded mental and physical abilities. For whatever reason, no one seems to pay much attention to elder abuse these days.

The Ethics and Public Policy Center is a rare exception. It recently acknowledged that elder abuse is on the rise: "According to a National Center on Elder Abuse survey, more than 565,000 cases of suspected elder abuse were reported in 2003 — an increase of nearly 20 percent from 2000." But, mark it down: things are only going to get worse. The perfect storm is brewing. A massive age wave has begun. The over-65 population will more than double between 2010 to 2040. The leading edge of the Baby Boomers is approaching retirement age. Huge numbers of Boomers will need nursing home care. They will overwhelm existing capacity, and they will do so at a time when America’s old age entitlement programs are on the verge of collapse. In 2017, Social Security’s cash flow is projected to go negative, and in 2019 Medicare is slated to go broke. Meanwhile, our national consensus has shifted from a sanctity of life ethic to a quality of life ethic. The elderly suffering the ravages of time — strokes, dementia, disability — do not score well using quality of life calculus. It will become easier to view them as "disposable" when they cost more to maintain than they produce.

Americans need to wake up to the implications of what it means to become a mass geriatric society. Individuals need to prepare now for the years when they will live in decline. Families must prepare to assume a greater role in caring for their aging loved ones. The church must acknowledge that the elderly are part of the "least among us" and reach out to lend a helping hand. Government needs to get its head out of the sand and prepare for a crisis that will make Hurricane Katrina look like a walk in the park. And the nursing home industry must mend its ways and be held fully accountable whenever it abuses, neglects or exploits those it has agreed to care for.

We all have a stake in averting this crisis. Only the dead don’t grow old.

© Ken Connor

Seattle Post Intelligencer had an article about the recent increases in evictions in nursing homes.
Contact the Washington Long-Term Care Ombudsman program, call 800-562-6028, or visit if you need help.  The article reveals one example where a woman was evicting and died shortly after being evicted.  Henderer grew depressed and refused to leave her room for meals. As her move approached, she quietly asked her guardian: "Why can’t I just die here?"  Three days after moving out, Henderer’s congestive heart failure worsened. A month later, she died.

Health care costs rise (along with corporate profits) despite Medicaid rates not increasing.  Quality of care gets compromised and nursing homes are forcing out sick, elderly and frail residents who cut into profits because they are too expensive to care for.  No official data exist on eviction counts, but discharge complaints have climbed to record highs.

The Washington Long-Term Care Ombudsman program handled more than 700 such complaints last year, nearly a 50 percent increase over the year before. Nationally, discharge-related complaints have more than doubled in a decade — to 12,000 in 2007, according to the U.S. Administration on Aging.

Another woman evicted from West Woods wandered outside one night before her move, barefoot and in a nightgown, saying she wanted "to fall down and die in the cold," Ryan said.

In Grays Harbor County last year, an evicted mentally ill man left his boarding home a week after moving in, and was found dead near some railroad tracks. In other areas, evicted residents have ended up in homes nearly a hundred miles away from loved ones.

In 2007, Seattle University forced out 115 residents when it decided to convert its nursing home into office and class space. Three months later, 14 of the residents had died.

Social workers have a name for such a swift decline after a move: "transfer trauma."

Homes can legally evict a resident who fails to pay, becomes dangerous or has needs a home can’t meet.   Federal law bars nursing homes from kicking out residents solely because of Medicaid so they often find some other excuse. Advocates say many homes find ways to bend the laws such as the broad "can’t meet needs" reason to force out difficult or expensive residents.

One of the most common types of eviction is when homes send a resident to the hospital and refuse to take him back, in a practice that resident advocates call "dumping."  Advocates say that dumping rarely occurs to private-pay people, but to Medicaid residents such as Florence Wade, who had lived at the Regency at Tacoma Rehabilitation Center for roughly three years.

In January, Wade, 85, went to the hospital for pneumonia and a urinary tract infection. The nursing home refused to take her back, saying she had been uncooperative with caregivers in using a hydraulic lift to move her.   The home then accused her of not doing a "bed hold" — which she never had to do in the past — and said the room was gone anyway. Someone else had moved in. The eviction left Arnold with one stressful option: a nursing home 45 minutes away — too far for regular visits from friends and family.

With assisted living costing residents $3,000 to $6,000 a month, and nursing homes costing up to $10,000 a month, homes still claim they lose money on each Medicaid resident. On average the state pays out about $5,000 a month for a nursing home resident,


John Leland of The NY Times wrote a great article about technologies helping people with health problems at home instead of in an institutional setting like a nursing home.

He writes that a flurry of new technologies are designed to enable the frail, elderly, or those who simply live alone to live independently and avoid expensive trips to the emergency room or nursing homes.   The article has several great examples.

Bertha Branch, 78, discovered the power of a system called eNeighbor when she fell to the floor late one night without her emergency alert pendant and could not phone for help.  A wireless sensor under Ms. Branch’s bed detected that she had gotten up. Motion detectors in her home registered that she had not left the area in her usual pattern and relayed that information to a central monitoring system, prompting a call to her telephone to ask if she was all right.   When she did not answer, that incited more calls — to a neighbor, to the building manager and finally to 911, which dispatched firefighters to break through her door. She had been on the floor less than an hour when they arrived.

Technologies like eNeighbor come with great promise of improved care at lower cost and the backing of large companies like Intel and General Electric.

But the devices are not usually covered by the government or private insurance plans.  Ms. Branch, who has severe diabetes and heart disease, said she could not live on her own without the system, built by a Minnesota company called Healthsense.

The cost for Ms. Branch’s basic system, supplied by a health care provider called New Courtland as part of a publicly financed program, is about $100 a month, far less than a nursing home, where the costs to taxpayers can exceed $200 a day. In the two years Mrs. Branch has had the system, she has fallen three times and been stuck once in the bathtub, each time unable to call for help without it.

Joseph Hayduk, 86, a retired Air Force lieutenant colonel, is greeted by a voice from a small box: “Good morning. It is now time to record your vital signs.” Mr. Hayduk has been using the device since 2006, after his second heart attack, through a program run by Meridian Health. The program asked him a series of questions regarding his medical condition and relays that information to Meridian Health.  There, a nurse calls all 18 patients in the program daily, starting with the ones whose data call for urgent attention. “This system’s invaluable to me, not only physically, but psychologically,” he said. “I don’t want to be in assisted living. That’s for people in wheelchairs and walkers.”

Philip Marshall, 85, another Meridian Health patient, uses a system tied to his cellphone to help him remember his medications. Mr. Marshall has high blood pressure and macular degeneration, and takes 10 pills a day. He cannot see a clock or work the buttons on most phones, so he uses a Jitterbug, a phone with big buttons and limited functions.

Drug compliance is one of the biggest problems for the elderly, especially those with memory loss. Until Mr. Marshall got Meridian’s Jitterbug system, his daughter Melanie, 55, said she had to leave work several times a month to help him with his drugs. “I’m answering the phone in meetings,” she said. “He’d forget whether he took a pill or whether he was supposed to take a pill.”

The system, which costs $20 a month, calls him after he is scheduled to take a pill and asks if he has taken it; if not, it asks him why not and sends automated alerts to his daughters.

This is the ultimate goal of personal health monitoring — that people who know they are being watched may modify their behavior to better their health.

The future of these technologies, and the terabytes they gather, can involve unprecedented information about the whereabouts and well-being of older people. In a program with Intel, Dr. Kaye is combing motion data for patterns that indicate the onset of dementia, years before the decline shows up on cognitive tests.


MSNBC had an article about a resident who was unsupervised and was able to leave the facility unattended.  Authorities are investigating the death of the female resident.   Reports indicate that Dorotha Gifford apparently walked out of the Heartland of Woodridge home without any of the staff noticing.  Several hours passed before Gifford was discovered missing.  Employees searched the grounds and found her dead outside at about 2:30 p.m. Gifford was pronounced dead shortly after she was found.

Temperatures hovered only a few degrees from zero for  the day she was missing. The cause of death is mostly like exposure to the cold. 

The home is owned by HCR ManorCare.  They released a statement to the media refusing to accept responsibility.

The article does not mention if she was a known wanderer or if there were locks or alarms on the door.  It also doesn’t mention how long she was missing or if the facility was properly staffed that day.  I hope there is an investigation and we find out some of the answers to these questions.