The Des Moines Register reported that 2 nursing homes and their corporate masters were fined a combined total of $875,000.

One of the violators was HCM Management Inc., which runs 11 Iowa nursing homes, and it has agreed to pay $200,812 for allegedly employing workers who had been barred from working in federally funded health care facilities.

Separately, the inspector general’s office entered into a settlement agreement with Bethany Lutheran Home, a 121-bed Council Bluffs nursing home that apparently overbilled the government for Medicaid and Medicare therapy claims.  The settlement that they pay $675,000 to the federal government and enter into a so-called “corporate integrity agreement” that requires the home to provide additional staff training in determining what services can legally be billed by nursing homes to Medicaid and Medicare. It also creates additional layers of oversight that apply to Bethany Home’s billing practices and quality of care.

 

 

The News Observers recently reported that a registered nurse at Britthaven nursing home in Chapel Hil, N.C. plead guilty in the death of resident Rachel Holliday.  Almore is guilty of involuntary manslaughter and patient abuse, and six additional counts of felony patient abuse involving other residents in her unit.

Almore administered unauthorized, unsafe levels of morphine to the residents which ultimately resulted in the death of one and injuries of the other six.  None of the victims were prescribed morphine.

Sadly, the sentencing in this case did not nearly reflect the severity of the crimes. Almore was only sentenced to a mere 5 months in jail for her crimes and was even given credit for the 107 days she served prior to her sentencing. The facility, after a state investigation, was fined only $20,000.

The Denver Post had a follow up to the recent article on the $3.2 million jury verdict against Pioneer Healthcare (owned and operated by Grace Healthcare) for neglecting resident Henry Frazier.  Frazier developed a fist-size necrotic abscess from a bedsore at the nursing home — and died in hospice.  Pictures show a gaping hole in Frazier’s buttocks, spreading to his scrotum and other areas.  The family reported their father’s gaping wound to police and state Adult Protective Services as well as to the state health department. The family said none took any action.  The U.S. Government Accountability Office has cited similar cases from state after state, where neglect and abuse is ignored or dismissed by "timid" oversight.

The article argues that the jury somehow got it wrong just because government bureaucrats failed to find a violation or fine the facility for the neglect.  One expert found Frazier had suffered 16 facility-acquired infections at Pioneer and an "appalling" 34 injuries.  "National safety panels consider Stage 4 bedsores such as Frazier’s to be "never events," so unthinkable in a health facility that they include electrocuting a patient or amputating the wrong limb."

State health departments go easy on corporate owners in even the most egregious cases.  "State survey agencies frequently fail to cite facilities for harming residents, even when they find serious injuries," said a report by the National Citizens’ Coalition for Nursing Home Reform, now called Consumer Voice.

Private lawsuits are one way for families to fight back.   

 

 

As reported in an article from the HuffPost by Carole Herman, neglect and abuse are rampant in nursing homes. These reoccurring issues can be attributed, in part, to the lack of government standards or regulations.  As the article explained, the state agencies that are charged with overseeing the nursing homes fail to fix problems including the epidemic of short-staffing.  These overlooked issues diminish the quality of care but cut the facility’s costs and increase their profits. 

A Consumer Report in September of 2006 found that while nursing homes are receiving increased monies from tax dollars, their issues are still not being corrected. The increase in tax money is instead being used to increase profits, which increases their investors’ returns, and increases the money available for political contributions.

It is easy to see why there is such a lack of government initiative to correct these issues since government officials themselves are seeing a cut of the profits. It is an absolute disgrace that these agencies, who are being trusted to care for a human being, continue to be more concerned with increasing their profits than delivering an acceptable standard of care.

The Hartford Courant had an article on the tragic death of a nursing home resident who choked on a peanut butter and jelly sandwich.  It was well known that the patient needed assistance while eating.  Because of short staffing, the resident was left unattended with the fatal sandwich. 

State inspectors said staff members at Torrington Health and Rehabilitation Center, whose parent company is Spectrum Healthcare Torrington, were required to carefully monitor the elderly patient, who suffered from mental illness and pulmonary disease. The staff was instructed by doctors to encourage the resident to eat slowly and take small bites, and to cue the resident to chew and swallow. Food had to be cut up in small pieces.  Despite this treatment plan, inspectors reported, "staff failed to supervise the resident when the resident was left unattended with a peanut butter and jelly sandwich.”

The patient was found unconscious. Medics performed CPR and the ambulance report indicated the resident’s airway was completely blocked with peanut butter. The patient died at a hospital of cardiac and respiratory arrest, and choking, according to the state Department of Public Health inspection reports.

 

The Republic reported that advocates for the elderly are objecting with Kansas Gov. Sam Brownback’s choice of Barbara Hickert to be the state’s long-term care ombudsman, raising concerns that consumers’ best interests will be ignored, and abuse and neglect will be covered up.  This is the third person coming from the nursing home industry to hold the post.  Brownback has appointed several people with nursing home ties, including Aging Secretary Shawn Sullivan and Joe Ewert as commissioner for licensure, certification and evaluation. Sullivan was a Wichita nursing home administrator and Ewert worked for LeadingAge Kansas.

"I’m not overstating it, it’s life or death," said Mitzi McFatrich, executive director of Kansas Advocates for Better Care. "Right now, there’s a heavy weight on the provider side. The concern is that consumer needs will be second to industry."

It’s extremely rare for someone from the nursing home industry to be appointed as state ombudsman.  Mark Miller, the ombudsman for New York and vice president of the National Association of State Long-Term Care Ombudsman Programs, said "I can’t think of a single colleague. I think that’s something the average person would have a question about," Miller said. "’Where do this person’s allegiances lie?’"

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Galesburg News reports on a new piece of legislation to be passed before the House in Illinois that would eliminate the ability to fine Nursing homes after serious injury or death.

The House Bill 5849 passed before the House unanimously and was the brainchild of Republican David Leitch.  This Bill leaves nursing home residents more vulnerable and at risk without any means of protection and creates more bureaucracy in the system of Nursing home review. Despite its unanimous passage, law makers still say: “ It is not a perfect bill. We will continue to work with the sponsors. We certainly still have some concerns, too.” 

Advocates for nursing home reform say this is a threat to advancements made on Nursing home reforms. Opponents of the bill sight its unanimous passage to lack of involvement from Public Health, who should have voiced concerns over the rights of nursing home residents.

In the state of Illinois, the passage of this bill will allow Nursing homes more room to get out of fines and citations through an appeals process. This bill will also lengthen the time of review on cases which resulted in serious injury or death, cases that need immediate action. The state of Illinois is aiding legislation which will allow Nursing homes more power and more abilities to avoid citations and fines through a system of bureaucracy.

 

McKnight’s had an article about thenew GAO Report showing that The Centers for Medicare & Medicaid Services need to make serious improvements in the tools it uses to evaluate the quality of nursing home care.  The Government Accountability Office conducted an investigation to determine whether CMS was doing an adequate job in monitoring implementation of the Quality Indicator Survey process. The GAO found that CMS has not established quality measures or performance goals to evaluate if QIS objectives are being met.

Both the GAO and the Department of Health and Human Services recommended that CMS “routinely monitor the extent to which progress is being made in meeting the objectives of the QIS and systematic methods for monitoring and facilitating states’ efforts to implement the QIS.”

 

The Center for Medicare Advocacy recently published a press release on the failure of nursing homes participating in the "Advancing Excellence in America’s Nursing Homes"–an industry program to self-police and improve quality of care.  Below are excerpts of the press release:

Many nursing facilities that are identified by the federal government as among the facilities providing the poorest quality of care to residents in the country – the Special Focus Facilities (SFFs) – participate in the nursing home industry’s voluntary quality improvement campaign, Advancing Excellence in America’s Nursing Homes.  Forty-three percent of all facilities identified by the Centers for Medicare & Medicaid Services (CMS) as SFFs have participated in Advancing Excellence for more than two years.

Participation in Advancing Excellence has neither prevented facilities from being identified as SFFs nor helped them improve the quality of care they provide to residents to warrant removal from the SFF list.  That nursing facilities participating in a quality improvement campaign are nevertheless identified by the federal government as among the most poorly performing facilities in the country demonstrates, once again, that voluntary quality improvement efforts by the nursing home industry do not guarantee high quality of care for residents and cannot replace a strong public regulatory system.

Each month, CMS identifies nursing facilities that are providing the poorest care to their residents, as determined by federal deficiencies cited in the prior three years. There are 15,568 nursing facilities in the United States. Only 150 facilities (less than 1%) were identified by CMS as SFFs that were either newly added to the SFF list or had not shown improvement as of December 15, 2011.

Advancing Excellence in America’s Nursing Homes
Advancing Excellence is a voluntary quality improvement initiative implemented by the nursing home industry and others in October 2006.   When Advancing Excellence was implemented in 2006, facilities chose at least three goals from among eight available goals. Four goals were clinical goals – reducing high risk pressure ulcers, reducing the use of daily physical restraints, improving pain management in long-stay residents, and improving pain management in short-stay residents.  Four goals were non-clinical – setting individualized quality improvement targets; assessing resident satisfaction, family satisfaction, or both; measuring and reducing staff turnover; and consistent assignment of staff to residents.

Participation in Advancing Excellence has neither prevented nursing facilities from being identified as SFFs nor helped them improve the quality of care they provide to residents so that they are removed from the SFF list.  SFFs are defined as among the 1% of worst performing nursing facilities in the country, yet they participate in Advancing Excellence at high rates. Many facilities appear to have participated in Advancing Excellence when they were first identified as SFFs. Participation in the Campaign clearly has not improved their performance.
These findings give little reason to believe that Advancing Excellence is making a difference in improving quality of care and quality of life for residents. And they provide no reason to believe that voluntary quality improvement campaigns can be a substitute for an independent, objective, public regulatory system

The Center for Medicare Advocacy reported that allowing facilities to self report key data on staffing, quality of care, and complaints does not work.  See report here. The Centers for Medicare & Medicaid Services (CMS) identifies nursing facilities that are providing the worst care to their residents. These facilities, called Special Focus Facilities (SFFs), receive extra attention from the survey agency – at least two surveys each year and enhanced enforcement activities.

The Center concludes that facilities’ self-reported staffing and quality measure data cannot be relied on to provide an accurate picture of a nursing facility. This conclusion refutes the nursing home industry’s claim that facilities can effectively regulate themselves.  In light of SFFs’ "over-reporting" [read lying] of their staffing levels and quality measures, the Center for Medicare Advocacy recommends that:

Staffing and quality measures not be reported on Nursing Home Compare for any SFFs;

 No SFF be given more than one star on their composite scores unless and until it graduates from the SFF program;

 Pain not be used as a quality measure for any facility on Nursing Home Compare.

 The Center for Medicare Advocacy study shows that SFFs often report high staffing and high quality measures, despite their extremely poor performance on publicly-conducted, objective surveys. The study did not evaluate whether all other nursing facilities’ self-reported staffing levels and quality measures are similarly inconsistent with their survey results.