South Carolina Nursing Home Blog

Profits Over People

Ray Mullman — Wed, 16 May 2012 13:55:50 -0500

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.

"Questions are the Answer"

Ray Mullman — Wed, 16 May 2012 07:44:19 -0500

Sarah Mars is a Public Affairs Specialist at the Agency For Healthcare Research and Quality. She was nice enough to send me the below information to share.

When patients become more actively involved in their own health, there’s a much stronger likelihood their health outcomes will be better.

That’s why “Questions are the Answer,” a new public education initiative from the U.S. Agency for Healthcare Research and Quality (AHRQ), encourages patients to have more effective two-way communication with their doctors and other clinicians.

“Questions are the Answer” features a website -- www.ahrq.gov/questions -- where you will find these free educational tools to use with your patients:

· A 7-minute video featuring real-life patients and clinicians who give firsthand accounts on the importance of asking questions and sharing information – this tool is ideal for a patient waiting room area and can be set to run on a continuous loop.

· A brochure, titled “Be More Involved in Your Health Care: Tips for Patients,” that offers helpful suggestions to follow before, during and after a medical visit.

· Notepads to help patients prioritize the top three questions they wish to ask during their medical appointment.

Clinicians can request a free supply of these materials by calling AHRQ at 1-800-358-9295 or sending an email to AHRQpubs@ahrq.hhs.gov.

Falsification of Records

Ray Mullman — Tue, 15 May 2012 13:15:27 -0500

The Duluth News Tribune reported that two nursing home employees were fired after falsifying medical records. Two nurses at Cook Nursing Home failed to conduct blood sugar tests on seven residents, and then filed reports on insulin levels with made-up numbers, according to Minnesota Department of Health documents. Insulin was then withheld or given to residents based on the falsified numbers. No criminal charges were filed yet.

This type of willful falsification typically is a result of inadequate staffing. Not enough staff to get everything done so they take shortcuts. A full investigation into the staffing data at the facility is necessary.

Debt Collectors at Hospitals

Ray Mullman — Tue, 15 May 2012 07:15:27 -0500

The N.Y. Times reported the horrible practice of debt collection agencies interrogating and intimidating emergency room visitors and others recovering at the hospital. "This and other aggressive tactics by one of the nation’s largest collectors of medical debts, Accretive Health, were revealed by the Minnesota attorney general, raising concerns that such practices have become common at hospitals across the country."

The harsh tactics include "embedding" debt collectors as employees in emergency rooms and demanding that patients pay before receiving treatment, and discouraging them from seeking emergency care at all. These methods were disclosed in hundreds of company documents released by the attorney general. The company’s workers had access to health information in violation of federal privacy laws. Accretive last year reported $29.2 million in profit, up 130 percent from a year earlier.

"Concerns are mounting that the cozy working relationships will undercut patient care and threaten privacy, said Anthony Wright, executive director of Health Access California, a consumer advocacy coalition. “The mission of these companies is in direct opposition to the supposed mission of these hospitals.”"

Employees were told to stall patients entering the emergency room until they had agreed to pay a previous balance, according to the documents. Employees in the emergency room, for example, were told to ask incoming patients first for a credit card payment. If that failed, employees were told to say, “If you have your checkbook in your car I will be happy to wait for you,” internal documents show. In March 2011, doctors at one hospital complained that such strong-arm tactics were discouraging patients from seeking lifesaving treatments.

Money Tied to Standards

Ray Mullman — Mon, 14 May 2012 13:23:23 -0500

The News-Messenger had a good article on how new regulations in Ohio will require nursing homes to show that they're providing quality and comfortable care for their residents or risk losing funding. Future funding for nursing homes could be tied to whether they reduce the number of times their residents go to the hospital, for instance, or increase the number of bathrooms that are wheelchair accessible.

For now, effective July 1, nursing homes must meet any five out of 20 standards or risk losing nearly 10 percent -- $16 per patient per day -- of their full Medicaid payments for services they provide. Some of the standards are based on staffing levels, facilities and resident satisfaction.

Resource Use Reports

Ray Mullman — Mon, 14 May 2012 07:59:36 -0500

Kaiser Health News reported on the new "resource use" reports which show the amount patients cost on average as well as the quality of the care doctors provided. The reports also showed how Medicare spending on each doctor's patients compared to their local peers. In the reports, Medicare measures the average payments it made for each doctor’s patients, as well as subgroups of patients with common chronic conditions, such as chronic obstructive pulmonary disease, diabetes and heart failure. Medicare adjusts the costs to take into account differences in patients' age, gender, poverty and history of medical conditions. The "resource use" reports are one of the most visible phases of the government's effort to figure out how to enact a complex, delicate and little-noticed provision of the 2010 health care law: paying more to doctors who provide quality care at lower cost to Medicare, and reducing payments to physicians who run up Medicare's costs without better results.

Making providers routinely pay attention to cost and quality is widely viewed as crucial if the country is going to rein in its health care spending, which amounts to more than $2.5 trillion a year. Efforts have already begun to change the way Medicare pays hospitals, physicians and other providers who agree to work together in new alliances known as "accountable care organizations."

Medicare officials are trying to refine the way they judge doctors as they follow the health care law's directive to phase in the new payment system, called a Physician Value-Based Payment Modifier, starting in 2015. It will initially apply only to physician groups and some specialists selected by the government, but by 2017 the payment change is supposed to apply to most if not all doctors. Although the program is still being devised, it will become reality for many doctors starting in January, because CMS plans to base the 2015 bonuses or penalties on what happens to a doctor's patients during 2013.

Stealing from a dying resident

Ray Mullman — Sun, 13 May 2012 13:55:24 -0500

WSBT reported another arrest of two nursing home employees accused of stealing from a resident who was in the final days of her life. Alice Phillips and Kendra Echols were arrested and charged with multiple counts of fraud and forgery. Maria Partin was a resident at the Liberty Village Nursing Home where they worked as Certified Nursing Assistants.

Her family discovered $4,000 in small purchases on Partin's bank statement. Muncie Police Detective Robert Scaife examined surveillance video from several Muncie stores where the purchases were made. He said the video showed Phillips and Echols buying all kinds of things.

"How Does It Feel?"

Ray Mullman — Sun, 13 May 2012 07:35:01 -0500

Kaiser Health News had an article on the failure of doctors to provide recommended interventions for chronic health issues. "Large numbers of seniors aren’t receiving recommended interventions that could help forestall medical problems and improve their health, according to a new survey from the John A. Hartford Foundation." Medicare pays doctors about three times their ordinary office visit rate for asking about older adults’ ability to function, evaluating their mood, recommending preventive services, and connecting them with community resources during wellness visits.

Notably, one-third of older adults said doctors didn’t review all their medications, even though problems with prescription and over-the-counter drugs are common among the elderly, leading to over 177,000 emergency room visits every year. More than two-thirds of the time doctors and nurses didn’t ask older patients whether they’d taken a tumble or provide advice about how to avoid tripping on carpets or slipping on the stairs. 62 percent of seniors said doctors and nurses hadn’t inquired about whether they were sad, depressed or anxious.

The results, which cover a period of 12 months, speak to doctors’ and nurses’ lack of training in geriatric medicine. Providers need to recognize that “care of an 80 year old differs from that of a 50 year old,” said Dr. Rosanne Leipzig, professor of geriatrics at the Mount Sinai School of Medicine in New York.

Staff Accused of Stealing

Ray Mullman — Sat, 12 May 2012 13:47:32 -0500

WLWT reported the arrest of Heather Wilson, a nursing home worker, accused of stealing from patients including wedding rings. Family members said 27-year-old Heather Wilson has admitted to stealing from some of her patients. A nurse's aide noticed that the resident's jewelry was gone earlier this month. Officials with the Hamilton County Sheriff's Office said Wilson stole jewelry from three other residents and pawned the items off. Wilson refused to speak with News 5 on Friday.

NPR Series Family Matters

Ray Mullman — Sat, 12 May 2012 07:26:01 -0500

NPR had an article as part of a series on how to prepare for taking care of aging parents. NPR is following three multigenerational households to highlight the importance of family financial planning. The series, Family Matters, will continue in installments each Tuesday into June.

"While aging is inevitable, planning for the costs associated with dependency in the latter phase of life doesn't come easily to most Americans."

"But with Americans living so much longer now, the younger generation has to do more thinking about how they might care for parents who have exhausted their savings."

"Experts say any serious plan for caring for aging parents must begin — not with discussions about money — but with a legal document designating someone as having "power of attorney." That paperwork grants authority to another individual to handle decisions if a loved one can't make them as a result of illness or memory loss."

CNA Worker Protection

Ray Mullman — Fri, 11 May 2012 13:49:29 -0500

Kaiser Health News reported new worker protections for nursing home aides. Nursing aides have the nation’s second highest rate of work-related injuries or illness. Nursing aides, orderlies and attendants� suffer a higher rate of work-related injuries or illnesses than even “hand laborers and freight, stock and material movers.” In 2010, work-related injuries and illness was 2.3 times higher in the nursing and residential care sector than all private industry overall, according to the Bureau of Labor Statistics.

Nursing aides and other health care workers can slip or fall or strain themselves trying to lift people or equipment. They also face unique hazards such as workplace violence, exposure to “bloodborne pathogens,” infectious diseases such as tuberculosis or dangerous chemicals and drugs.

The U.S. Department of Labor’s Occupational Safety and Health Administration has a new program, the National Emphasis Program for Nursing and Residential Care Facilities, which calls for increased outreach efforts and a rise in inspections of on-the-job hazards. The new program plans to offer specific guidance on ergonomics and workplace violence, according to OSHA.

90% of All Nursing Homes

Ray Mullman — Fri, 11 May 2012 07:02:41 -0500

In the article Criminals in Nursing Homes, it was stated that federal data had found up to 90 percent of all nursing homes employ people who have been convicted of at least one crime. A nursing home should be a safe environment for its residents and ensure that they are in a facility that will tend to their needs and ensure they live a comfortable life. Sadly, for millions of nursing home residents, nursing home abuse and neglect at the hands of criminal employees is a reality.

There are several indications that nursing home abuse or neglect has taken place. Some of these signs are physical in nature such as unexplained bruises, broken bones, or skin tears and cuts. Others will be emotional such as aggravation, depression, and unusual behaviors. These are typically the result of inadequate staff to care for its residents or violent predators who have been hired by a nursing home inflicting intentional harm on your loved one.

We need a nationwide standard requiring nursing homes to conduct a criminal background check and not to hire those with records for any violent behavior or drug abuse.

Audit Discovers Overpayments

Ray Mullman — Thu, 10 May 2012 13:34:26 -0500

NY Comptroller Thomas DiNapoli and State auditors discovered that the New York State Health Insurance Program erroneously overpaid up to $11 million for special items like implants, drugs and evaluation procedures for public employees that were not provided. Two audits show contract insurers Blue Cross and Blue Shield and United Health Care failed to effectively monitor bills, with one showing Empire overpayments in 57 percent of claims reviewed and another showing 12 percent of United payments for special patient evaluations were unwarranted.

The state program contracts with the insurers for hospitalization, medical and surgical coverage for active and retired state, local government and school district employees and dependents. Auditors faulted hospital and provider billing. See article online at WSJ.

Lowering Costs by Competitive Bidding

Ray Mullman — Thu, 10 May 2012 07:16:03 -0500

The Washington Post had an interesting article on the benefits of competitive bidding to keep health care costs low. A yearlong experiment with competitive bidding for power wheelchairs, diabetic supplies and other personal medical equipment produced $200 million in savings for Medicare. The pilot program will expand in search of even greater dividends to combat waste, fraud, and abuse. By shifting to competitive bidding with a limited number of approved suppliers in each area, Medicare will save nearly $26 billion from 2013-2022, the government estimates, and reduce costs for seniors without cutting benefits.

The report also found only 151 complaints from a total population of 2.3 million Medicare recipients in the nine metropolitan areas that were involved in the pilot program. As a result, the program is expanding to a total of 100 cities next year, along with a national mail order program for diabetes supplies such as blood sugar testing kits. Hopefully, the whole country will eventually participate.

Nine categories of medical equipment are included in the program: oxygen supplies, standard power wheelchairs, complex power wheelchairs, mail-order diabetic supplies, tube-feeding supplies and equipment, sleep apnea machines and equipment, hospital beds, walkers, and certain types of mattresses.

Obamacare = $1.3 billion in rebates this year

Ray Mullman — Wed, 09 May 2012 13:07:58 -0500

The L.A. Times recently reported that U.S. consumers and businesses will receive an estimated $1.3 billion in rebates from insurance companies this year, according to a new study by the nonprofit Kaiser Family Foundation quantifying a key early benefit of the healthcare law that President Obama signed in 2010. Obama’s healthcare law requires insurers to spend a minimum portion of customers’ premiums on medical care, a provision championed by consumer groups concerned that companies were hiking premiums to pay for executive salaries, shareholder dividends and other expenses unrelated to their customers’ care.

Starting last year, if insurers did not meet these targets – known as medical loss ratios – they had to pay rebates this year to people enrolled in their plans. The Kaiser study, which analyzed rate documents filed with state regulators nationwide, found 486 health plans nationwide that will be required to pay rebates, with the largest number in the individual market forpeople who do not get health coverage through work. A third of all consumers in this market will be eligible for a rebate.

The authors of the Kaiser report noted that the new requirements likely mitigated some rate hikes, however, in part by pushing insurers to seek smaller premium increases than they might have. “Greater regulatory scrutiny of private insurance is improving value and helping to get excess costs out of the system,” said Kaiser President and Chief Executive Drew Altman.

Billion dollar Fine for Risperdal

Ray Mullman — Wed, 09 May 2012 07:01:48 -0500

The L.A. Times reported the $1.1 billion fine imposed by a federal judge in Arkansas litigation against Johnson & Johnson after a jury found that the companies downplayed and covered up risks associated with taking the antipsychotic drug Risperdal. Circuit Judge Tim Fox determined that Johnson & Johnson and subsidiary Janssen Pharmaceuticals Inc. committed nearly 240,000 violations of the state's Medicaid fraud law — or one for each Risperdal prescription issued to state Medicaid patients over a 31/2-year period. Each violation carried a $5,000 fine, the state's mandatory minimum amount, bringing the total to more than $1.1 billion. Fox issued an additional $11 million fine for more than 4,500 violations under the state's deceptive practices act, but he rejected the state's request to levy fines in excess of the $5,000 minimum for the Medicaid violations.

Arkansas was one of several states to sue over Risperdal. A South Caroline judge upheld a $327-million civil penalty against J&J and Janssen in December 2011. Meanwhile, Texas reached a $158-million settlement with the companies in January in which they didn't admit fault.

Political Donations

Ray Mullman — Tue, 08 May 2012 13:28:16 -0500

The nursing home industry is donating large amounts of money to politicians who protect their interests especially their profits. Several articles have mentioned the $175,000 given to Republican Utah Senator Orrin Hatch. If he wins reelection, Hatch may be chair of the committee that has jurisdiction over the tens of billions of Medicare and Medicaid dollars that flow annually to nursing homes. Maybe they should use that money to hire staff.

A political action committee representing radiologists has spent about $77,000 supporting his candidacy through print ads and other activities conducted. The contributions show how some interest groups are demonstrating their support for Hatch beyond the $10,000 limit that political action committees must abide by when contributing directly to a candidate’s campaign.

Nursing homes rely heavily on federal reimbursements for profits. The federal government’s Medicare program is projected to spend about $31 billion on nursing home care in 2012. Medicaid, a federal-state partnership, will spend about $45 billion with nursing homes, according to Health and Human Services Department projections.

The nursing home industry's lobbying group, The Alliance for Quality Nursing Home Care, represents 12 companies owning about 1,400 properties throughout the county. The Alliance for Quality Nursing Home Care provided the largest donation of the year, $100,000, records show. The group then kicked in another $75,000 this year already.

Although the money was given with no strings attached, according to Republican party officials, there is little illusion as to its real purpose: to buy influence.

See articles at McKnight's, CBS, and Business Week.

The Problem with Arbitrary Caps on Damages

Ray Mullman — Tue, 08 May 2012 07:04:57 -0500

There are legal, ethical, and moral issues that arise when the government imposes legislation to limit the amount of damages a person or their family can be compensated from a jury. One circumstance (there are many) has raised this inherent unfairness. Last year in my hometown, a children's train derailed in a public park -- killing a child and seriously injuring 28 others -- but the law said all the victims could only split $600,000 to help compensate for their loss including paying back insurance for medical bills. All of the victims are children. One family’s medical bills alone exceed the $600,000 that the 29 affected families are supposed to share. The medical bills far exceeded the $600,000 so the victims of the gross negligence that allowed the accident to happen would get nothing. Nothing for the loss of a child.

Recently, the politicians got together to discuss a bill that would raise that cap on awards that government agencies and non-profit groups can be ordered to pay, meaning victims of future accidents would have more money to help pay their bills. The increase is small and meaningless--it should increase every year based on the growth of healthcare costs and/or inflation.

Of course, special interests like the S.C. Association of Counties, insurance companies, and "charitable" organizations have put pressure on the politicians to do nothing and let the bill to increase the caps die on the Senate floor. A ridiculous compromise bill would leave the arbitrary caps alone but give local government agencies the option to set up assistance funds to help pay the medical expenses of victims injured on public property. Everyone knows that the option would never be used.

Abuse Caught on Tape

Ray Mullman — Mon, 07 May 2012 07:47:13 -0500

An Oklahoma facility Quail Creek Nursing home claims to be just as outraged as the community concerning two of its employees being arrested for neglect and abuse in April of 2012. Two staff members of Quail Creek, Lucy Waithira Gakunga, 23, and Caroline Kaseke, 28, were caught on video abusing a 96-year old patient. Family members of the patient were concerned that someone was stealing from the patient so they placed a hidden camera in her room. Gakunga was seen slapping the patient with a glove and then forcing the glove into the patient’s mouth. All the while Kaseke stood by and watched. Both women were fired from Quail Creek.

Two articles on this can be found at NewsOK and News9.

I wish every family could place a hidden camera to protect their loved ones from assault and neglect.

Another Abuse Arrest

Ray Mullman — Sun, 06 May 2012 13:52:44 -0500

At 2:30am on April 13, 2012 at Ponce Care Center in St Augustine a care taker was witnessed holding a pillow over a resident’s face. Martin Robinson Aniello was charged with elderly abuse of an 81 year old female nursing home patient with dementia when a supervisor called the St Johns County Sheriff’s office. Why wasn't he charged with attempted murder?

According to the facility’s statement he was fired immediately after his arrest. It was reported that the Aniello said, “Don’t hit me; If you keep this up, I will take you to the shower room,” when he was spotted as he threw the pillow at the head board. The official report said that the patient had a history of screaming, “Stop, don’t do that,” (which is what attracted Aniello’s co-worker on Friday morning) and that these incidents had occurred while she was being showered or changed.

This is not the first time that a Ponce Care Center employee has been arrested. The first being Frances Melissa Neal, 25 charged with battery of a person 65 or older. Aniello was questioned when this incident occurred and stated that he had witnessed it but had heard the patient yell “ow”.

Articles on this can be found at The Florida Times-Union, St. Augustine, and Historic City News.