Medicare 5-Star Rating...Does It Mean Anything??

An excellent article by Katie Thomas in today's New York Times caught my attention. In the past, I've written about Medicare's 5-star rating system and how it can be a tool to help you select a nursing home. "Not so fast" says Ms. Thomas.

Ms. Thomas writes: "top-ranked nursing homes have been given a seal of approval that is based on incomplete information and that can seriously mislead consumers, investors and others about the conditions at the homes." Ms. Thomas goes on to report: "The Medicare ratings, which have become the gold standard across the industry, are based in large part on self-reported data by the nursing homes that the government does not verify." In fact: "Only one of the three criteria used to determine the star-ratings -- the results of annual health inspections -- relies on assessments from independent reviewers. The other measures -- staff levels and quality statistics -- are reported by the nursing homes and accepted by Medicare, with limited exceptions, at face value."

Based on the NYT's analysis of data, Ms. Thomas states: "The Times analysis shows that even nursing homes with a history of poor care rate highly in the areas that rely on self-reported data. Of more than 50 nursing homes on a federal watch list for quality, nearly two-thirds hold four- or five-star ratings for their staff levels and quality statistics. The same homes do not fare as well on the sole criterion that is based on an independent review. More than 95 percent of the homes on the watch list received one or two stars for the health inspection, which is conducted by state workers."

A system weighted so heavily in favor of unverified information provided by the facilities being graded is the textbook definition of "the wolf guarding the hen house." At the end of the day, as a person looking for a proper placement in a nursing home, you have do your research and not blindly rely on the Medicare ratings. Caveat Emptor. 

Where Have I Been?

I apologize for not getting important information about nursing home issues out in quite a while. Truth be told, I was involved in defending a client in a federal criminal case which took up virtually all of my available time. My client was charged with over 80 counts. The trial lasted 44 days and, at the end of it, my client was acquitted of 36 counts of conspiracy and wire fraud. Unfortunately, he was convicted of 44 counts of securities fraud. Last week, he was sentenced to a term of imprisonment of 36 months (3 years), far, far, below the sentence recommended by the United States Sentencing Commission's Sentencing Guidelines, which was 235 to 293 months (19.5 to 24.4 years). My fight on behalf of my client will continue in the appeal from his conviction.

Be that as it may, expect to see more regular postings in this space regarding issues of interest to my readers.

Elopement, Dementia and Winter - A Fatal Combination

A tragic story from Portland, Oregon, underlines the unspeakable consequences when a resident of an adult care home elopes from the facility. The resident, Mr. Koller, age 69, suffered from severe dementia.

According to the report, the care center's staff noticed he was missing and notified the authorities. Heartbreakingly, Mr. Koller was found dead in a backyard near the care facility. He was not dressed for the cold weather. 

From my perspective, there is critical information missing from the report. For example, what was the elapsed time from when staff last saw Mr. Koller and when they noticed he was missing? How long after the facility knew Mr. Koller was missing before someone contacted the authorities for outside assistance. Finally, what precautions did the facility have in place to prevent such a tragedy.

A close eye needs to be kept on people who suffer from severe dementia. Adequate precautions need to be taken to prevent elopement by these folks. A facility should have the staff and resources to ensure all residents, including those who suffer from severe dementia, are kept safe.

If adequate steps are not taken, a fatal tragedy can occur.  

Are You On The Hook For Footing Your Loved One's Nursing Home Bill?

A recent article in Forbes, Howard Glickman, discusses a decision from Pennsylvania where the court determined the son of a nursing home resident was responsible for the $93,000.00 nursing home bill. How can this be you ask? According to Mr. Glickman, Pennsylvania, along with some 29 other states have what are known as "filial responsibility statutes—laws that impose a duty on adult children to care for their indigent parents." Approximately two-thirds of the states having such laws "allow long-term care providers to sue family members to recover unpaid costs."

In Idaho,up until July 1, 2011, there was a law governing "reciprocal duties of support." This law stated it was the duty of a "child or children of any poor person who is unable to maintain himself or herself by work, to maintain such poor person to the extent of his or her ability." This law, however, was repealed. Does that mean a nursing home will not do all it can to recover its bill? Of course not.

Oftentimes, in the flurry of paperwork signed upon admission of a loved-one to a nursing home, the facility will have a financial responsibility document executed by a loved one. This is just one more reason documents provided by a nursing home or assisted living facility must be carefully reviewed prior to signing. You could be putting yourself and your assets on the hook for your parent's nursing home bill.

Memorial Day 2012 - Take A Moment To Remember And Thank A Veteran

Memorial Day was first observed in 1868, when flowers were placed on the graves of Union and Confederate soldiers at Arlington National Cemetery. Today, we continue to honor those who made the ultimate sacrifice for our country by placing flags...row upon row of flags...at veterans cemeteries around the country and, indeed, around the world.

Let us not, however, forget those veterans who are still living. There are three veterans homes in Idaho: Boise, Lewiston and Pocatello. This Memorial Day, take time to remember what the day is all about, go to one of these sacred places, and thank a veteran for all he or she has done for you, your children, your country and, indeed, the world.

These wonderful people would never think to ask for our thanks. It is, however, our duty to let them know how much they are appreciated. This Memorial Day, thank a veteran for all you have. Without them, I cannot begin to imagine what a different place the world would be.

Faking Resident Insulin Test Results Gets Nurses Fired in Minnesota

According to a report in the Devils Lake Journal, two nurses from a Duluth, Minnesota, nursing home have been fired for faking residents' blood sugar results. The Minnesota Department of Health and Welfare's investigation of this matter revealed the faked results were utilized to "give or deny insulin" to seven residents. Remarkably, neither nurse was criminally charged.

How did the investigation into this matter begin? A resident mentioned she did not recall having her blood sugar checked or receiving insulin the day before. This just goes to show you: as a nursing home resident or a resident's loved one, it is critical for you to voice your concerns regarding your care...or, lack thereof. Oftentimes, nursing home resident's concerns are "poo-pooed" by staff. Make sure your voice is heard and your concerns noted. If not, at least in Idaho, there are advocates for the resident. As I have previously written, Idaho 's community ombudsman program is there to help.

If you believe you or a loved one is not receiving the medical care prescribed by their doctor, be sure to speak up. If you do not receive the results you believe you are entitled to, you should contact an attorney who is familiar with the requirements of nursing homes and discuss the matter.

Better Economic Times Are Not Necessarily Good For Nursing Home Residents

In a recent paper published by the Center for Retirement Research at Boston College poses an interesting hypothesis. When the economy improves, nursing home deaths increase due to the simple reason nurses and health aides caring for the elderly decrease during economic booms. Frankly, this hypothesis is not at all surprising to me.

According to the authors: "[T]ight labor markets constrain the already scarce number of workers available for hire by nursing homes.... A greater scarcity of these front-line caregivers may have a direct impact on the elderly, causing them to die in greater numbers when the unemployment rate is declining."

In my experience, nursing homes pay their staff relatively poorly. They recruit less-than-stellar job candidates. As I often explain to my potential nursing home abuse and neglect clients: "Your aide can be flipping burgers at a McDonald's one day and caring for you the next." Although this may be an exaggeration, it is not much of one.

I believe, based upon my experience in pursuing justice on behalf of those injured by the negligence of nursing homes and their employees that staffing levels and quality of staff have a direct impact on nursing home residents' safety and well being. Honestly, who would argue otherwise.

If you or a loved one has suffered an injury in a nursing home you should contact an attorney who has experience in this area of the law in order to protect your rights. As I tell people, you don't have to hire me or my Firm, but you do need to hire an attorney to ensure the playing field is level with the facility...heaven knows it has an attorney on its side!

Nursing Home Profits: "Astonishing"

According to a recent Wall Street Journal Market Watch press release, the nursing home industry is doing just fine, thank you very much. This is true despite the fact Medicare reimbursements were reduced back in 2011.

Families for Better Care, Inc. is a citizen advocacy organization dedicated to quality resident care in nursing homes and other long-term care settings. Executive Director Brian Lee served as Florida’s State Long-Term Care Ombudsman for most of the past decade. According to Mr. Lee: “The industry’s analysts framed the Medicare adjustment as an eventual doomsday for the nation’s nursing home market. But the industry’s own reports show quite the opposite, revealing surging revenues, strong profits, and expansion through acquisitions. The industry is wallowing in strong profits while failing to consistently provide quality care.”

The release goes on to note: "A recent study by the University of California-San Francisco shows a steady decline in nursing hours for Medicare-licensed facilities and an unacceptably high level of deficiencies."

Do not let the nursing home industry fool you by crying poverty due to funding cutbacks. The numbers don't lie. In 2011, one company, Adcare Health Systems posted record annual revenues of $151.4 million, which is an increase of 198% over the previous year. Another company, Kindred Health Care, reported an increase in consolidated revenues of 27% to $5.5 billion compared to $4.4 billion in previous year. If that's "hard times" ...don't we all wish our times were that hard?

Staffing cutbacks effect nursing home residents every day. No matter what the industry says, those cutbacks are not because of a lack of funding. They are nothing more than a business decision...a decision that puts profits over people.

Poor Conditions Lead To Nursing Home Residents' Deaths - Is A Fine Enough??

Let me get this straight: The California Department of Public Health performed investigations into the deaths of residents at the following facilities: Fountain View Subacute and Nursing Center in Los Angeles; Motion Picture and Television Hospital in Woodland Hills; and Downey Care Center in Downey. The Department found conditions at the facilities contributed to the deaths of three residents. So what did the Department do? It imposed fines on the facilities. FINES?!

According to an article in the Los Angeles Times, The resident at Fountain View: "The patient, who had a history of falls, was not properly supervised at the nursing home. When he was found on the floor, no one knew how long he had been there, according to the department." For this, the Department levied a fine of $75,000.00.

The Motion Picture and Television Hospital was fined $80,0000.00 when "a 90-year-old Alzheimer's patient who was in a wheelchair died a week after falling down a stairwell, according to a report. She had previously fallen down the same set of stairs."

Downey Care Center received a $75,000.00 fine for for "failing to monitor a patient's blood glucose level after she was released from a hospital in 2010. The woman died from a diabetic coma."

Each and every one of these deaths was preventable. Each and every one of the families of the residents were irreversibly and unnecessarily harmed by the facility's negligence. Each and every one of these families likely has grounds for a lawsuit against the facility.

In this era of personal accountability, I hope the fines imposed by the California Department of Public Health were just the beginning of holding the facility accountable for its negligence. Making sure nursing homes and assisted living facilities are accountable for their negligence in caring for their residents is what I do. I do it because I believe when a loved one's care is entrusted to a Nursing home or assisted living facility, they have a duty to make sure they do every reasonable thing to ensure no harm comes to that resident.

Drinking In Assisted Living Facilities - Is There A Problem?

In a recent New York Times "The New Old Age" post, author Paula Span broached the subject of drinking problems in assisted living facilities. Ms. Span references a study performed by a University of Pittsburgh "team" to determine whether there is, indeed, a problem. The short answer remains: No one really knows.

The "study" referenced by Ms. Span was conducted by interviewing "[m]ore than 800 aides working in assisted living facilities in Pennsylvania." Why weren't the actual residents interviewed? First, funding was insufficient to conduct such a study. Second, there's a little thing called denial! The specter of alcohol abuse in assisted living facilities is certainly raised in article, however. Consider these statistics:

  • Nearly 70 percent of assisted living residents drank alcohol.
  • More than a third drank daily.
  • Twelve percent had abused alcohol (defined as drinking enough to cause “physical or psychosocial harm”) in the past three months.
  • Almost 20 percent had experienced an apparent influence on their health from alcohol use in the past three months.

Ms. Span also points out the fact that, because so many assisted living facility residents are on medications, the interaction between alcohol and medicine is a real problem. Finally, the research reveals what we all know...as you age, you can no longer drink as much as you used to be able to drink without adverse affect.

As Ms. Span says: "So might the two or three beers with friends that caused no harm 30 years ago be contributing to your father’s falls now that he is in assisted living? Guess who has been elected to start that conversation." 

It is up to you! Check on your loved one. Just because an assisted living facility allows drinking, does not mean it is the right thing to do! On the other hand, it may not be as bad as you think!