On June 12, 2019, a report released by the Health and Human Services’ Office of the Inspector General revealed that Nursing Home Abuse remains largely unreported. The report estimates that one-in-five high-risk hospital emergency room Medicare claims for treatment provided during the 2016 calendar year were the result of potential abuse or neglect, including injury of unknown source, of beneficiaries residing in skilled nursing facilities (SNF).

The report revealed that nursing homes are failing to comply with regulations established by the Centers for Medicare and Medicaid Services (CMS). Under these regulations, SNFs are required to report incidents of abuse and neglect to Survey Agencies, who are then required to report the incidents to the CMS or local enforcement agencies. However, both SNFs and Survey Agencies have been failing to meet their federal requirements. Currently, the CMS may not be doing all they can to prevent abuse as it does not require all potential incidents to be tracked in the Automated Survey Processing Environment Complaints/Incidents Tracking System.

The Office of Inspector General (“The Office”) is urging CMS to take action since “preventing, detecting, and combating elder abuse requires CMS, Survey Agencies, and SNFs to meet their responsibilities.”

The Office suggests that CMS work with Survey Agencies to train SNF staff on identifying and recording all potential incidences of abuse or neglect. They also suggest that CMS require Survey Agencies to record and track all incidents of potential abuse or neglect in SNFs, as well as all referrals made to local law enforcement and other agencies. CMS concurred with these recommendations and stated they are creating a plan to ensure more accurate reporting in the future.

McKnight’s reported on an analysis that shows nursing homes where a majority of residents are black or Latino were more likely to receive a penalty in the first year of the Value-Based Purchasing Program. Nursing homes with more than 50% of residents who are black were nearly 25% more likely to be penalized by the Centers for Medicare & Medicaid Services compared to facilities with mostly white patients, according to the findings published July 1.  The study looked at how nursing homes that serve minority populations were impacted by fines and bonuses that were first doled out last October. About 85% of nursing homes with mostly Hispanic or Latino residents received a penalty, versus about 72% of white-majority homes.

“The patterns of performance among SNFs serving vulnerable populations underlie concerns about incentive-based approaches to quality improvement,” researchers from UMass reported in Health Affairs. “While SNFS that perform poorly should not be rewarded for delivering lower-quality care, it is concerning that vulnerable populations may be disproportionately affected by penalties.”

The data also strongly correlated penalties with high-Medicaid populations.  Most likely because they get less reimbursement so they spend less on staff.

 

New data from The Centers for Medicare & Medicaid Services (CMS) ranked North Carolina the 33rd worst state when it comes to the number of complaints at nursing homes. North Carolina families have demanded more regulation by state agencies after filing complaints on local nursing homes.

Fayetteville native Margie Whitehead said her family filed complaints on a Fayetteville nursing home in the past. “This can’t go on. It just can’t, “said Margie Whitehead. “I would find him wet, find him scratched up or find him scarred up. I would find him laying as I left him. Because I always would date and time his diapers when I put them on at night.” Whitehead took photos of her brother’s body when she was unsure of how he was cared for at the facility. CBS 17 blurred some the photos because of their graphic nature. The pictures  showed sores, bruises, and scratches on his face, back, and abdomen.

After taking her complaints to the nursing home staff, she contacted The NC Department of Health and Human Services (DHHS). The agency is over is N.C. Division of Health Service Regulation (DHSR). DHSR is the state department that specifically oversees nursing homes complaints.

“When I called the state department, they told me they had to actually see the event taken place. Although I had pictures and showed them pictures, they told me they had to actually see it for themselves. They had to actually be present when things happened,” said Whitehead.

But Whitehead decided to speak out about her brother, after our story on another family at Whispering Pines. In April 2019, Tracey Ervin contacted CBS 17 after documenting her mother’s living conditions at the Whispering Pines. She recorded cell phone video from inside of the facility.  “This is the fourth day in a row that I’ve been coming in here and finding findings,” Ervin told the staff. “You can already see right, urine!”

“I’m angry. I’m frustrated….all the above and then more,” she explained to CBS 17.

“Hold people accountable for what they do. They have to be held accountable for what they do,” said Whitehead.

WSPA recently reported on one of the scarier facts about the nursing home industry:  Nursing facilities fail to report thousands of serious cases of potential neglect and abuse of Medicare beneficiaries even though the federal government requires such reporting.

Auditors with the Health and Human Services inspector general’s office investigated incidents where the patient was taken straight from a nursing facility to a hospital emergency room. Scouring Medicare billing records, they estimated that in 2016 about 6,600 cases reflected potential neglect or abuse that was not reported as required. Nearly 6,200 patients were affected.

Mandatory reporting is not always happening, and beneficiaries deserve to be better protected,” said Gloria Jarmon, head of the inspector general’s audit division.

Overall, unreported cases worked out to 18% of about 37,600 incidents in which a Medicare beneficiary was taken to the emergency room from a nursing facility in circumstances that raised red flags.  CMS agreed with the inspector general’s recommendations to ramp up oversight by providing clearer guidance to nursing facilities about what kinds of episodes must be reported, improving training for facility staff, requiring state nursing home inspectors to record and track all potential cases and monitoring cases referred to law enforcement agencies.

Neglect and abuse of elderly patients can be difficult to expose. Investigators say many cases are not reported because vulnerable older people may be afraid to tell even friends and relatives much less the authorities. In some cases, neglect and abuse can be masked by medical conditions. Investigators found that nursing facility staff and even state inspectors had an unclear and inconsistent understanding of reporting requirements.

The nursing facilities covered by the report provide skilled nursing and therapy services to Medicare patients recovering from surgeries or hospitalization. Many facilities also play a dual role, combining a rehabilitation wing with long-term care nursing home beds.

 

 

The Berkshire Eagle investigated Sweet Brook Rehabilitation & Nursing Center in Williamstown, Ma.  The troubled nursing home may have its license to operate revoked following a new federal report detailing how staff failed to prevent multiple incidents of physical and sexual abuse among residents with cognitive impairments.

In February, the nursing home was added to the federal government’s list (Special Focus Facility) of the worst-performing facilities in the country. The addition to the list meant Sweet Brook was in “immediate jeopardy” of losing funding.

The federal report details multiple incidents of alleged abuse between December 2018 and February, according to the Eagle, including a Feb. 7 incident where a resident reportedly held the hand of a “severely cognitively impaired” resident over their exposed genitals, forcing the person to sexually gratify them.  That incident and several others occurred in a day room referred to as “the man cave,” the Eagle reported.

The report showed “no documentation” that the facility had staff supervise the “man cave” while residents were inside, according to the newspaper.  Neither party had the mental capacity to consent, a social worker said.

Reports of other incidents reported at the home can be found on the CMS website. One incident report details a resident being left to sit in a soiled adult undergarment for long periods of time.

According to Medicare, the nursing home has faced two fines in the past three years including a $288,267 fine on Sept. 11, 2017 and a $5,355 fine on April 11, 2017.

The Centers for Medicare and Medicaid Services announced that it will post a monthly list of underperforming nursing homes. CMS said that roughly once a year, it performs a health and safety survey of all nursing homes that care for Medicare and Medicaid patients. More than 500 facilities are identified with significant health and safety issues, but less than 20 percent are subject to additional oversight.  CMS maintains the list of facilities that perform poorly on the survey, but only public discloses which nursing homes are receiving the oversight. That’s despite the two groups “being indistinguishable” in terms of quality, according to the report.

Dr. Kate Goodrich, CMS’s chief medical officer, said this lack of surveillance is due to funding limitations and an increase in the number of long-term care facilities.  “That has made it challenging … to do all the work that is necessary to oversee these nursing homes,” said Goodrich. “But we do believe that if we had an increase in our budget, that we would be able to have more robust oversight with this increase in our workload.”

CMS selects facilities for the Special Focus Facility program, which provides additional oversight, with input from state officials. The federal agency said it asks a state which of several nursing homes most needs additional surveying, which occurs every six months.

CMS said the best way to evaluate a facility’s quality is its online comparison tool for nursing homes, which bases rankings on not only the health survey, but also on staffing levels and performance measures. It is possible for a nursing home to have a low survey score, but still rank well due to higher numbers in the other two categories.

About 1.3 million Americans are nursing home residents, cared for in more than 15,700 facilities. At least 400 facilities nationwide had a “persistent record of poor care” as of April, but they were not included along with a shorter list of homes that get increased federal scrutiny and do have warning labels, according to a Senate report released.  The Trump Administration has kept secret the names of hundreds of nursing homes around the country found by inspectors to have serious ongoing health, safety or sanitary problems.

Budget cuts cause the problem by reducing money available for the focused inspections that are required for nursing homes on the shorter list, according to documents and interviews. As recently as 2010, there was room for 167 nursing homes in the special focus program and 835 candidates. That’s now down to as many as 88 special focus slots and up to 440 candidates.  Federal budget cuts in 2014 reduced the number of available slots.

The secrecy undermines the federal commitment to ensure transparency for families struggling to find nursing homes for loved ones and raises questions about why the names of some homes are not disclosed while others are publicly identified.

“We’ve got to make sure any family member or any potential resident of a nursing home can get this information, not only ahead of time but on an ongoing basis,” said Sen. Bob Casey, D-Pa., who along with Sen. Pat Toomey, R-Pa., issued the report.

“When a family makes the hard decision to seek nursing home services for a loved one, they deserve to know if a facility under consideration suffers from systemic shortcomings,” said Toomey.

The senators released a list provided them by the Centers for Medicare and Medicaid Services, or CMS, of nursing homes with documented problems whose names were not publicly disclosed by the government.  The report and list were provided exclusively to The Associated Press and to PennLive.com.

CMS does publicly disclose names of a smaller group of about 80 nursing homes that are getting special scrutiny to help them resolve documented quality problems. They’re in what’s called the Special Focus Facility program. Nursing homes that don’t improve can be cut off by Medicare and Medicaid. The nearly 400 facilities that are candidates for the shorter list “qualify for the program because they are identified as having a ‘persistent record of poor care’ but are not selected for participation as a result of limited resources at (CMS),” said the report from Casey and Toomey.

In a statement, CMS said its starred ratings on the Nursing Home Compare website are already the best yardstick “for consumers to understand and use.” About 2,900 nursing homes have the lowest one-star overall rating.

 

 

The Washington Post had an interesting article on the unintended consequences of Trump’s decisions on nursing home residents.

In December 2017, Trump proudly “deregulated” the nursing home industry.  However, certain regulations were essential to protect vulnerable and disabled nursing home residents, and to prevent waste, fraud, and crime in Medicare payments.

Nursing homes regulations were always poorly enforced and few administrations made them a priority. President Obama attempted to craft policies to put pressure on poorly managed facilities. In 2014, he issued policy guidelines that urged regulators to issue daily fines against nursing homes for infractions until those violations were remedied. By 2016, that approach applied to two-thirds of cases. He also issued a rule that would have barred facilities from requiring that disputes with residents be settled in private arbitrations that limit the companies’  exposure.

Trump rolled back these policies. The number of per-day fines plummeted. The ban on mandatory arbitration was blocked. Trump delayed the enforcement of new health and safety requirements by 18 months, much to the delight of the nursing home industry. Less accountability for nursing homes that treat their residents poorly. 

“They were fighting it, and they got a lot of what they wanted,” said Toby Edelman, a senior policy attorney and expert on nursing home regulation at the nonprofit Center for Medicare Advocacy.

 The Kaiser Family Foundation published an analysis that found that under the Trump administration, the average fine levied against nursing homes that have endangered or injured residents dropped from a high of $41,260 in 2016 to $28,405 in the first quarter of 2018.   This is important because elder care is a multibillion-dollar field, and nursing homes have revenue in the millions of dollars. Small, one-off fines barely register in this context.

CMS’s record looks even uglier when it comes to how it’s regulating the worst of the worst in the industry — nursing homes known as “special focus facilities.” These are the nursing homes cited for a pattern of serious infractions: residents falling; medication not getting to patients; staff slapping residents for not cooperating with treatment; bed sores neglected for so long that they become gaping, bloody wounds.

Edelman has been closely tracking these nursing homes, especially those that the federal government classified as having “not improved” since they were first listed as special focus facilities. She has found that the Trump administration has largely pulled back its enforcement of them.

McKnight’s recently reported that the Government Accountability Office strongly urged the Centers for Medicare & Medicaid Services to respond to recommendations made in the GAO January 2018 report on assisted living.  It has already been more than a year!

The GAO said it will continue to monitor actions taken by the Department of Health and Human Services in response to its recommendation, one of 404 “priority recommendations” — 54 of them at HHS — that were open as of April 7. The agency said it sent letters to the heads of the HHS, Veterans Affairs, and Defense departments “urging them to continue focusing on these issues.”

The 2018 report, “Medicaid Assisted Living Services: Improved Federal Oversight of Beneficiary Health and Welfare is Needed” contained a to-do list for CMS including reporting of deficiencies in care and services provided to Medicaid beneficiaries in assisted living communities.

Investigators recommended that CMS Administrator Seema Verma:

  1. Provide guidance and clarify requirements for states regarding their monitoring and reporting of deficiencies in assisted living communities.
  2. Establish standard Medicaid reporting requirements that all states could use to annually report information on critical incidents.
  3. Ensure that all states submit annual reports for home- and community-based services waivers on time, as required.

These all seem reasonable and CMS has somewhat addressed #1 and 2.

 

 

Massachusetts Attorney General Maura Healey announced settlements with seven nursing homes over systemic failures that led to five residents’ deaths and several injuries.  The failures identified by Healey’s office include allegations of staff ignoring serious injuries that led to two residents bleeding to death. They also include a fatal medication error, failure to treat residents with histories of substance abuse, and allowing a resident with a history of wandering to escape from a locked, supposedly secure unit.

Healey’s office said it weighed the evidence and determined civil enforcement was the best way to improve safety and quality in these nursing homes.  The settlements impose fines on the nursing homes ranging from $30,000 to $200,000. Five of them will be required to upgrade staff training and policies, conduct annual audits of their progress, and report that progress to the attorney general’s office for three years.

One company, Synergy Health Centers, has been banned from operating any taxpayer-funded nursing homes in Massachusetts for seven years.  Synergy is a troubled New Jersey company that started buying Massachusetts nursing homes in 2012 and quickly ran into problems with serious patient injuries as it bought 10 more facilities.

Candi Hitchcock, whose mother, Betsy Crane, died in one of the cases, said she is still grieving her mother’s horrific death. Crane, a resident at Beaumont Rehabilitation and Skilled Nursing Center, fell at least 19 times because staff failed to adequately intervene. She died after the 20th fall. “She was my best friend, and our family had to watch her bleed out from head trauma over 10 days and die an unnecessarily painful death,” Hitchcock said.

Hitchcock said she discovered her mother bleeding from her head hours after that fall in late July 2015. Hitchcock said she pleaded with nurses for help, and eventually one applied a Band-Aid. But the 89-year-old woman complained of not feeling well and staff eventually sent her to the hospital. By then it was too late. The internal bleeding was too great.