McKnight’s website has an article about Medicare overpayments (i.e. fraud) to nursing homes and estimate that the amount could be $130 million. Where did all the money go?

The federal investigation into these overpayments state that the Medicare program might have paid too much for hospital and laboratory services including double payments for services.  As a result of its findings, OIG recommended (not ordered) that the Centers for Medicare & Medicaid Services instruct payment contractors to "re-examine" records for overpayments and then move to recover them where appropriate. It also suggested CMS test and refine payment system protocols designed to identify such overpayments.

The full audit report is available at

 KSPR News has an article about a nursing home in Kansas that has introduced the video game Nintendo Wii to the residents.  This assists them in mobility, activity, and social interaction.  The activities director says a group of nursing home residents stay young by playing a game meant for their grandkids.  The activity room at the Ozark Nursing and Care Center is packed when it’s time for Wii.   When they play Wii, a light weight controller allows them to play a game they normally couldn’t.   There are more than physical benefits.  It gives the residents a sense of life outside the skilled nursing center.  

 The activities director says they’re sticking with bowling for now because it’s the easiest. They’d like to slowly introduce boxing and Guitar Hero. I hope this becomes universal in all nursing homes.

The NY Times has an informative article on the multi-disciplinary approach needed to prevent pressure ulvers in nursing home residents. 

The article defines a pressure ulcer as an area of skin breakdown that occurs when sustained pressure cuts off blood circulation — usually in patients confined to their beds nursing homes — a bedsore can result in a wound so deep (sometimes to the bone) and painful that some patients require narcotics. If a bedsore becomes infected, the complications can be fatal.

Experts estimate that two million Americans suffer from pressure ulcers each year, usually through some combination of immobility, poor nutrition, dehydration and incontinence.  New research requires a team approach, enlisting everyone from nurses and nursing assistants to laundry workers, nutritionists, maintenance workers and even in-house beauticians.

In a study of a collaborative program involving 52 nursing homes around the country, The Journal of the American Geriatrics Society reported last August that team efforts had reduced the number of severe pressure ulcers acquired in-house by 69 percent. 

Dr. Joanne Lynn, who helped begin the project when she was a senior natural scientist with the RAND Corporation (she has since joined the Medicare centers), said the goal was to educate nursing home workers in bedsore prevention and to encourage them to come up with creative, low-tech solutions of their own. “It was a combination of education, cheerleading and something like systems engineering,” Dr. Lynn recalled.

Nutrition including additional protein, special mattresses made of high-density foam to reduce pressure in key areas, keeping feet elevated, repositioning frequently, keeping incontinent residents dry with routine changes, and proper fitting clothes are easy low tech solutions to preventing the developement or worsening of pressure ulcers. 

Clinicians document four stages of pressure ulcers, in which Stages 1 and 2 are superficial sores and Stages 3 and 4 are deep wounds that result from death of the skin and underlying tissues.

Dr. Horn, of the Institute for Clinical Outcomes Research, praised the collaborative as “the first major national effort driven by Medicare to reduce pressure ulcers.” But she said that better outcomes could be achieved if more nursing homes improved their documentation, so that all of the information on a given resident, including details on eating, urinary and bowel function, appeared on a single sheet, with key reminders to nursing assistants and other staff members about best practices.

Bedsores are “a major quality-of-life issue, and a self-esteem issue,” said Joanie Jones, a nurse at David Place in Nebraska. “No one wants to have sores on their bottom. I don’t care how old you are. You still want your skin intact.”

South Florida has an article from Violette King, president of Nursing Home Monitors, a non-profit, all-volunteer advocacy group for nursing home safety about improper discharges and evictions of residents from nursing homes.  She encourages the media to put a spotllight on the injustices that occur daily in nursing homes throughout the country because the exposure will hurt the profits and therefore will deter bad behavior.

Long-term care facilities spend a lot of money to make sure that their beds are full. They know very well that bad publicity translates into the anathema of empty beds. Legislation to require facilities to give a reason for discharge should be spurred on by the media to add more protective measures. Legislators are under immense pressure from the many long-term care lobbyists who swarm their offices.

Involuntarily discharging a resident can lead to serious setbacks and even death from what is known as "transfer trauma." There are only three acceptable reasons for evicting a resident: The facility can no longer meet the resident’s needs, the resident or Medicaid has failed to pay the bill, or the resident is a danger to him/herself or to others. The burden of proof should always be on the facility to prove its case, which should be done at a proper hearing where legal assistance is provided for residents who cannot afford an attorney.

Good profits and lack of oversight lead to far too many unscrupulous characters going into the nursing home industry. When a resident or the family complain about needs that are not met as agreed, the facility all too often asks them to leave.  Threat of eviction has a chilling, silencing effect on families who usually have no other choice for placement.

RN Karen Mowers has an article in The Daily Star newspaper which discusses how a family should choose a nursing home.  However, many times a person goes into a nursing home from the hospital. In those situations, often the family does not have time and relies on the social services person at the hospital to decide. This is a mistake.  The consumer should have the final say. 

Ms. Mowers has some good tips to assist you in choosing the right nursing home for your loved one.
Begin by researching the nursing homes in your area by reviewing The Centers for Medicare and Medicaid Services’ website,, that provides a section titled "Nursing Home Compare."   Comparisons can be made in relation to quality, staffing ratios, survey reports and fire safety deficiencies.   (This information can be unreliable depending on the enforcement of your state’s regulatory agency)

Contact other resources such as hospital discharge planners, social workers, physicians and your local Office for the Aging or ombudsman (volunteer resident advocate) who can be contacted through the local Office for the Aging as well. 

Formal visits or tours can be scheduled through the Department of Social Services, or you could just stop by and take a look around. Visit with residents, families and staff as you look around, and observe the activities.

Other things to be considered when selecting a nursing home:  Bed availability, staffing, activities, policies, services and fees, preventative care programs, nutritional services, and treatment options.

Karen Mowers, a registered nurse with a Bachelor of Science degree, is director of nursing services in the Fox Nursing Home.
. has a great summary of the bill introduced by Senators Kohl and Grassley aimed at improving the quality of care in nursing homes with more and better information for consumers on the Nursing Home Compare Website published by The Centers for Medicare & Medicaid Services.   Supporting the bipartisan bill are the Service Employees International Union (SEIU) and the National Citizens’ Coalition for Nursing Home Reform (NCCNHR).

The bill:

? Enables the residents and the government to know who actually owns the nursing home

? Strengthens accountability requirements for individual facilities and nursing home chains, including annual independent audits for nursing home chains

? Improves Nursing Home Compare by including a nursing home’s ownership information, the identity of participants in the Special Focus Facility program, a standardized complaint form and links to nursing home inspection reports

? Provides more transparency of a nursing home’s expenditures by requiring more detail in cost reporting

? Provides for improved reporting of nurse staffing information so that apples-to-apples comparisons can be made across nursing homes

? Brings uniformity and structure to the nursing home complaint process by requiring a standardized complaint form and complaint resolution processes that includes complainant notification and response deadlines

? Strengthens available penalties by making them more meaningful. 

Instead of imposing civil money penalties (CMPs) up to $10,000, the Secretary would be able to impose a range of penalties of up to $100,000 for a deficiency resulting in death, $3,000-$25,000 for deficiencies at the level of actually harm or immediate jeopardy and not more than $3,000 for other deficiencies. 

The Secretary would be able to reduce CMPs for facilities that do not appeal CMPs and for self-reporting deficiencies below the immediate jeopardy level or the actual harm level if the harm is found to be a “pattern” or “widespread” or those resulting in death. 

Penalties must be collected within 90 days, following a hearing.

? Equips the Secretary with tools to address corporate-level problems in nursing home chains by giving the authority to develop a national independent monitor program specific to multistate and large intrastate nursing home chains

? Provides greater protection to residents of nursing homes that close by requiring advance notice of the closure as well as the development of a transfer and relocation plan of residents

? Requires a study on the role that financial issues play in poor-performing homes

? Requires a study on best practices for the appointment of temporary management for nursing homes as well as barriers

? Requires a study on barriers to purchasing facilities with a record of poor care

? Authorizes demonstration projects for nursing home “culture change” and for improving resident care through health information technology

? Improves staff training to include dementia management and abuse prevention training as part of pre-employment training

? Requires a study on increased training requirements either in content or hours for nurse aides and supervisory staff

Hopefully, this bill will pass Congress and get proper funding in the budget.

Nursing home operators with severe care deficiencies could face civil money fines up to $100,000 – 10 times the current maximum – under a new bill set to be introduced today in the U.S. Senate.

Federal health officials also will develop a national monitoring program for addressing corporate-level problems among nursing home chains, according to provisions of the "Nursing Home Transparency and Improvement Act of 2008"  supported by Sens. Herb Kohl (D-WI) and Charles Grassley (R-IA)

Nursing home transparency is a main focus of the bill, which would add information on facility ownership, special-focus facilities, standardized complaint forms and nursing home inspection reports to the Nursing Home Compare Web site. It also would empower the Department of Health and Human Services secretary to develop a national independent monitoring program that would oversee large nursing home chains.

Hopefully, enforcement of Resident’s Rights and prevention of neglect and abuse will start to become a national political issue before the huge influx of baby boomers need nursing home care.  I am sure the corporate lobbyists for the industry will delay or gut the final legislation.

In many of our neglect and abuse cases, the victim is unable to testify regarding the bad care because of dementia or death.  I read an article today about a man who is competent and speaking up for his rights and the rights of others at the facility where he lives.  Mr. Crawley is a competent 48 year old man who resides at Sunrise Rehabilitation & Care in Marion, N.C.   "I am not being treated like, I feel, as a human being," said Crawley. 

Crawley became a paraplegic as a result of a car wreck in 1982. His 81-year-old father, Joe Crawley Sr., can no longer take care of him and he started living at Sunrise Rehab on Oct. 15. For the first two weeks there, the staff didn’t give him a bath or shower.  "I don’t know what is going on here," he said. "It seems like they make a lot of errors in simple things."

Crawley said his elderly roommate will talk incoherently and constantly yell about having to urinate, and, rather than listening to him, the staff will shut the door. With the heater running, that makes the room get hot for both Crawley and his roommate. He said he has called the nurse’s station to have the door opened but is ignored.

His sister said the staff once left a feces-soiled blue pad on his wheelchair for more than two hours. His father, who visits him twice a week, found it and thought his son had had an accident. He bagged up the soiled pad and took it to the nurse’s desk.  "That’s an unsanitary condition and that’s neglect," said Pilgrim.

Crawley said he’s confined in his bed 21 hours a day.   This will increase the likelihood of developing pressure ulcers. 

Crawley added he’s paying $879 a month to stay at Sunrise Rehab, which leaves him with just $30 out of his monthly disability check. He wishes he could go someplace else.

"I don’t know if they think I am incoherent or lost my faculties or don’t know what is going on," he said. "But I do know what is going on. I need more than anything to be transferred to a place that deals with wound care."

"They are neglecting the people," said Buckner. "That is why there is a waiting list at Autumn Care."

The official Web site for Medicare contains information about nursing homes across the nation. The site states that Sunrise Rehab had 11 health deficiencies, which are above the state and national averages. One of the deficiencies included failure to "write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents’ property."  Another deficiency found on May 10 by inspectors was failure to "give professional services that meet a professional standard of quality."

In addition, inspectors found on Aug. 30 that Sunrise Rehab failed to "make sure that residents are safe from serious medication errors" and it also failed to "make sure that the nursing home area is free of dangers that cause accidents."

See full article here.

Washington Post has a great article by Marie-Therese Connolly about demographics and elderly abuse.  Ms. Connolly worked at the DOJ and has years of experience with the nursing home industry.  Below are some excerpts.

As though declining health, impending mortality and other challenges weren’t hard enough, too often old age is also plagued by abuse, neglect and exploitation.

Science has extended our lives dramatically: In 1900, Americans’ average life expectancy was 47. By 2000, it was 77, and it’s still rising.  Estimates of the prevalence of elder abuse vary wildly, but by some reports there could be up to 5 million cases a year, with 84 percent going unreported. All other factors being equal, victims of even relatively minor mistreatment are three times more likely to die prematurely than those who are not victimized.

Furthermore, our nation is in the midst of three seismic demographic shifts that will put seniors at even greater risk for mistreatment. Older people are living longer, until they’re frailer and more vulnerable. They are increasingly alone in old age, given that families are smaller and more geographically and emotionally dispersed. And the pool of potential caregivers is aging and shrinking. We need 30,000 geriatricians: We have only 9,000.

Neglect may sound more benign than abuse, but it usually lasts longer, is harder to prove and prosecute, and can be just as lethal.   Thirty percent of seriously ill elders surveyed have told researchers that they would rather die than go to a nursing home.  But while neglect of one person is tragic, systemic neglect by a facility or chain housing numerous residents can be catastrophic.

Facility owners may extract millions in profits, leaving insufficient funds to care for residents. Insulated by corporate structure, casting blame on facility staff, they are rarely held accountable.  But the news about staffing, the most critical factor in the quality of long-term care, is bleak: A government study in 2002 concluded that more than half of the nation’s nursing homes are understaffed at levels that harm residents. Nursing homes receive $80 billion from Medicare and Medicaid annually to care for 1.5 million residents.  Yet not a single federal employee works on elder abuse issues full-time.

Marie-Therese Connolly, a fellow at the Woodrow Wilson International Center for Scholars, is former coordinator of the Department of Justice’s Elder Justice and Nursing Home Initiative.