The website Nursing Home Compare, published by the Centers for Medicare & Medicaid Services, is a resource for researching nursing home options for loved ones. The number of falls that lead to injury are a critical category of concern for nursing home residents, however, a University of Chicago researcher has found that the data used by Nursing Home Compare to report patient safety related to falls is highly inaccurate.

“This is a substantial amount of underreporting and is deeply concerning because without good measurement, we cannot identify nursing homes that may be less safe and in need of improvement,” Sanghavi said.

Falls are a leading cause of death among the over-65 population, and they can lead to other serious injuries. Patients become fearful of walking again for fear of reinjury, yet falls are considered widely preventable. They are a discrete event that is easy to identify and record, compared to other clinical conditions on Nursing Home Compare such as pressure ulcers or infections, so there should be a wealth of reliable data.

“That’s why falls are a patient safety measure on Nursing Home Compare,” Sanghavi said. “They reflect how well a nursing home does at preventing these injuries.”

Nursing Home Compare has faced prior scrutiny for using self-reported data. Sanghavi’s own research was sparked by a 2014 New York Times investigation into serious deficiencies found in nursing homes rated five stars by Nursing Home Compare.

“I found it odd that Nursing Home Compare would use self-reported data,” she said. “Having worked with Medicare claims data, I thought I could use it to study MDS reporting. The Medicare claims we used are hospital bills. They want to get paid and should not have an interest in nursing home public reporting. That’s why they are a more objective source than the self-reported data from nursing homes.”

Based on her results, Sanghavi suggests that the Centers for Medicare & Medicaid Services change their evaluation criteria for falls on Nursing Home Compare.

“They should use an objective source, like claims data,” she said. “It should be relatively easy for them to do, since they already have the data. There are other claims-based measures already used on Nursing Home Compare.”

EHR systems can track a patient’s vital signs, prescriptions, and health records, forcing the medical profession into a new era of electronic healthcare. With the advancement of technology, major medical corporations are starting to switch over to an electronic healthcare record (EHR) system that may increase efficiency in the health care market but several issues have been raised in cases where the new system has failed resulting in death. This often happens in nursing home cases that we prosecute.

In reviewing state and federal court filings about EHR wrongdoing, Kaiser Health News (KHN) and Fortune found around 24 cases of safety and installation concerns. In the case of Midwest Regional Medical Center in Oklahoma, doctors were finding the device unable to accurately track specific drug prescriptions and dosages correctly, creating the possibility for a major health and safety concern with their patients. This suit claimed that the hospital chain based out of Tennessee gained millions of dollars in the promised government subsidies by fraudulently covering up and ignoring flaws in the EHR systems from the Oklahoma hospital. Other suits claimed that corporations knowingly falsified government-mandated reviews, put in place to ensure the patient’s safety, just to receive federal subsidies. KHN found that nearly 28% of doctors and 5% of hospitals who claimed to have met government standards failed later audits to the system.

These systems were created and encouraged by the health care industry to eliminate medical errors that are caused by stupid mistakes or false documentation. Congress, in 2009, granted subsidies from $44,000 to $64,000 if they switched to this new electronic system and completed an “open book test” on the program. In order to receive the funding promised, doctors and vendors have turned towards “doctoring” their programs in order to receive certification. And this is only the start of the fraudulent system.

Corporations such as Community Health Systems (CHS), Medhost, and eClinicalWorks deny any allegations brought to court, reaching million dollar settlements without admitting any wrongdoing.

It’s a new era of health care fraud. Hospitals and doctors going unchecked and are putting their patient’s lives at risk for a big payout. In the end, the ones suffering from this fraud are patients, and it is up to whistleblowers and federal offices to enlighten the world on the abuse of power from doctors, hospitals, and corporations alike.

 

How can you trust numbers when they are self-reported and directly affect the rating of the nursing home?  A new study proves that nursing homes do not report quality measures such as falls. University of Chicago researchers found 150,828 major-injury falls that occurred at nursing homes were reported in hospital claims. Just 57.5% of those were reported on the MDS item (J1900C) used by Nursing Home Compare.   Falls data used by the Nursing Home Compare website “may be highly inaccurate,” says researchers whose new study shows that nursing homes fail to report major-injury falls.

The study assessed the accuracy of nursing home self-reporting of major injury falls on the MDS. Researchers used data from Medicare claims between 2011 and 2015 for the investigation. The data was then compared to MDS 3.0 assessments submitted by providers during those same years.

About 62.9% of major-injury falls were reported for long-stay residents on the MDS item, while 47.2% were reported for short-stay residents. Findings also showed that major-injury falls in white residents were reported at a higher rate than non-white residents — 64.5% compared to 37.4%.

“Our study indicates an urgent need to assess the value and limits of patient safety measurement that is based on the MDS. Given the amount of research that has been based on the MDS, it may be important to revisit some of our understanding of nursing home quality of care,” the authors wrote.

Full findings were published in Health Services Research.

The Department of Housing and Urban Development is selling a group of nursing homes it took over 18 months ago after the biggest default in the history of a government mortgage insurance program that provides support to the nursing home industry. The housing agency has managed the chain, Rosewood Care Centers, with the help of a court-appointed receiver since the previous owners defaulted on $146 million in government-guaranteed mortgages.  The agreement involves Greystone, a New York real estate finance firm, for the chain of Chicago-area elder care facilities. Greystone is a major lender to the nursing home industry, and was servicing Rosewood’s mortgages when the former owners defaulted.

Greystone was identified as the incoming owner of the Rosewood chain in a licensing application filed in December with the Illinois Department of Public Health. The application documents indicate that Greystone will own and operate the facilities through a series of shell and sham limited liability companies. The firm also intends to rename each of the facilities, according to the application.

The default raised questions about the department’s oversight of a decades-old mortgage insurance program that backs 15 percent of the nation’s nursing homes.  It is not clear how Greystone is paying for the facilities, or if the firm is getting any credit from HUD for the losses it may have incurred in the default.

HUD solicited bids for the Rosewood facilities — a dozen nursing homes and one assisted living center — until the end of May, but it has repeatedly and suspiciously declined to disclose the name of the prospective buyer or the purchase price. According to court filings, there were four bids for the properties, which the department had valued at $95 million. The department has spent nearly $30 million since August 2018 to make up for shortfalls in funding at the Rosewood facilities and to pay for repairs.

Court records also show that federal securities regulators are close to reaching a financial settlement with a former owner of the Rosewood facilities. The Securities and Exchange Commission in September charged a Chicago-area rabbi, Zvi Feiner, with defrauding a group of Orthodox Jewish investors who had put money into the Rosewood properties and other elder care facilities. HUD said in court documents that the owners had improperly diverted millions of dollars in federally insured funds to another nursing home that was not part of the program. Mr. Feiner paid a $1 million penalty to HUD this summer for failing to file several years of audited financial reports required by the mortgage insurance program.

Recently, I read about a murder at a nursing home in Florida.  Apparently, a 95-year-old man in a nursing home was killed by a trespasser. Police were told a nurse walked past the victim’s room when she noticed an unknown male sitting on top of the victim’s chest with a pillow over his face, according to police.

The nurse yelled out for another nurse to call 9-1-1 and the unknown male took off running from the facility while police were called. No word yet on how he gained entrance to the facility, but there is a notice on the door explaining that visitors must be buzzed in if they are trying to enter the premises outside of normal business hours (8 AM- 8 PM).

According to police, dispatchers received a call from a nurse at Tiffany Hall Nursing and Rehabilitation Center shortly after midnight saying “someone tried to hurt a patient.” When police arrived on scene they found an adult male dead.

Where was the supervision?  How could no one hear what was going on?

When police arrived, they set up a perimeter and searched the area with a K-9 unit but police say they were unable to find the unknown male, who was only described as a white male.

 

 

A resident who was sexually assaulted in her Balboa Nursing & Rehabilitation Center nursing home in October has filed a claim against the facility operators, alleging they failed to provide proper security and staffing to keep her and other residents safe. The claim states that employees at Balboa routinely left the back door open, which allowed a man to slip inside, walk past a nursing station and reach the second floor where the victim lived.

Staff heard the woman and her roommates scream for help and saw a naked man dash out of the building. The woman’s arm was broken in the assault, but she is recovering and now living in a different skilled nursing home. Using DNA evidence, San Diego police arrested Lusean Arline, 49, about a week later. He has pleaded not guilty to charges related to the incident. He had just been released from prison after a conviction for following two women and exposing himself.

The state Department of Public Health opened an investigation of Balboa within a week of the assault and issued findings that the facility failed to maintain safe and secure premises. Employees would leave the building’s back door open on a regular basis, despite problems of loitering and trespassing at the building and in the neighborhood. The facility failed to hire sufficient security and staffing to keep costs low.

“This is a terribly shocking case, one that is most unfortunate and violates our trust we place in these facilities when we place a loved one in their care,” the woman’s attorney, William Berman. “This could have happened to any female resident at Balboa.”

The state’s online records show Balboa Healthcare, Inc. as the legal name of the 194-bed nursing facility since 2005. The records say eight complaints were filed against the nursing home in 2019, with 14 findings of “deficiencies” involving pain medications, diet and accommodation for a disability. The government levied a $2,000 fine in one case. In 2018, the records show, 10 complaints were filed with seven findings of deficiency. In 2017, 18 complaints were filed with 19 deficiencies found.

As we have discussed previously, nursing homes often abandon residents and kick them out of the facility without legal justification.  The facility must have a reason and give the resident time to find a new home.  There is a problem in this country where the facility makes up a reason the kick “low paying” residents (i.e. those on Medicaid) so they can replace the resident with a high paying resident (i.e. private insurance, Medicare, Hospice,etc.).

Richard Bloxham, a paraplegic man from Oklahoma claims he was kicked out of his nursing home on New Year’s Eve.  Richard says he lived at Hillcrest for six months before being told he had to be out by January 27th.  Authorities told Hillcrest that a court order is needed for an eviction.

“I was supposedly a danger to other residents and myself. Which was a lie,” said Bloxham.  The 34-year-old wheelchair-bound paraplegic Bloxham is obviously not a danger to others at the facility.  But after a short stay in the hospital, Richard returned on New Year’s Eve only to be told he wasn’t allowed in the building.

“I go to the hospital and they act like they don’t even know what I’m talking about,” said Bloxham. ”They were just trying to get me out quicker.”

However, officials at the Hillcrest Nursing Home are holding firm on this ridiculous assertion and refuse to allow Bloxham back.

He called Moore Police, who spoke with Hillcrest COO Tammy Whorton.  The police report quotes the officer who investigated, “The staff on scene did not have any issues with Richard”.  Going on to say, “They did not agree with the decision.”  The report also says Tammy admitted to telling Richard “he had until the 27th to gather his belongings and vacate the facility.”

 

A jury has awarded $10.5 million to Carolyn Boerste who had to have her leg amputated after University of Louisville Hospital personnel left a sponge inside her during heart surgery years earlier.  Boerste was only 54 when she underwent bypass surgery in 2011 and nurses left an 18-by-18-inch sponge inside her.  The hospital failed to discover and then lied about it for years.  The verdict included $1 million in punitive damages and about $8 million for pain and suffering for Boerste. 

On March 10, 2011, Boerste underwent bypass surgery. The surgery successfully improved blood flow to the legs of Boerste, who was a diabetic. However, Dr. Marvin Morris, a vascular surgeon, inadvertently transected a renal vein, causing a “bloody mess” and a medical crisis.  The incident occurred just before lunch, and a nurse testified that nurses did not do a “lunch sponge count” required by hospital policy. Nurses viewed the policy as a “mere guideline” and not the “standard”.

Alex Spanko covers the skilled nursing industry for Aging Media Network, with a particular focus on the intersection of finance and policy. He recently wrote a great article discussing the decline in occupancy at the nation’s nursing homes.  Occupancy “stayed flat between the most recent two quarters, but the proportion of residents covered under Medicaid hit a record high — while the share of bread-and-butter Medicare residents fell to a record low.”

Medicaid accounted for 67.6% of resident days at nursing facilities in the third quarter of 2019, according to the most recent data analysis from the National Investment Center for Seniors Housing & Care (NIC).  However, fee-for-service Medicare, the gold standard for nursing homes with daily rates higher than all other payer sources, dipped to a record low of 10.9% of patient days.

The difference, from a financial standpoint, is stark: Traditional FFS Medicare provided reimbursements of $523 per day in the third quarter, NIC’s analysis found, compared to just $214 per day for Medicaid. That $214 daily average revenue per Medicaid patient day actually represents a high water mark since 2012 as well.

The gain in overall day share translated to revenue mix, with Medicaid accounting for a record-high 51.5% of nursing home income in the third quarter; Medicare revenue mix slid to 20.7%.

Consisting primarily of Medicare Advantage, managed Medicare accounted for about 6.3% of all patient days; these plans reimbursed at a rate of $431 per patient day, a slight drop, for a total revenue share of 9.8%.

“Medicaid is continuing to apply pressure to state budgets, because reimbursement rates are not keeping up with rising labor and other operating costs,” NIC chief economist Beth Mace said in a statement announcing the results. “This is not just a rural state issue. Continued growth in Medicaid may also be contributing to financial and budgetary pressures for bigger states like New York and Massachusetts.”

The nation’s nursing homes were 83.6% full in the third quarter, NIC found, a decrease of just a tenth of a point from the second quarter — and a 48-basis-point increase from June 2018.

“The fact that skilled mix decreased 50 basis points and occupancy was relatively flat in the third quarter suggests that Medicaid demand is helping to stabilize occupancy,” NIC concluded.

NIC senior principal Bill Kauffman echoed that sentiment in the statement.

“After a period of declining and then flat occupancy rates, the data this quarter suggest increased demand for skilled nursing from Medicaid patients is driving continued occupancy stability,” Kauffman said. “It’s too early to know if this trend will continue into the fourth quarter.”

 

The growth of spending on nursing home services and continuing care retirement communities (CCRCs) increased by 1.4% to $168.5 billion according to the latest figures released by the Office of the Actuary at the Centers for Medicare & Medicaid Services.  That is ridiculous.  The quality of care should be much higher.

Overall, spending on nursing and CCRC services made up 5% of the total U.S. healthcare spending in 2018.

Healthcare spending increased 4.6% to reach $3.6 trillion in 2018.

Spending on hospital care reached $1.2 trillion and made up 33% of total healthcare spending in 2018.

Additionally, spending on home health care services reached $102.2 billion, an increase of 5.2%, Medicare and Medicaid made up 75% of home health spending in 2018, the report stated.