In This Issue
As illustrated by a recent New York Times cover story
, nursing homes throughout the country are rapidly adopting a “new” business model: attract lucrative short term patients paying through Medicare, and then throw them out once their Medicare coverage ends. Read More...
CANHR-sponsored legislation has done well so far in 2015. AB 348 (Brown), a bill that would finally establish deadlines for the Department of Public Health to complete nursing home complaint investigations is off to the Assembly floor for a vote after an amendment pushing its implementation date back to January 1, 2018. AB 601 (Eggman), to establish criteria for RCFE ownership suitability and require transparent RCFE ownership disclosure, has advanced to the Senate. SB 33 (Hernandez), reforming the Medi-Cal estate recovery program, has moved to the Senate floor.
The Kern County District Attorney has accused Ally Care Group and Senior Veterans Benefits Advocates of financial elder abuse. These groups are alleged to be ripping off aging veterans by helping them get government benefits, then overcharging the in-home health care services they provide for them.
Click here to read more about the case...
S. 843, known as the “Improving Access to Medicare Coverage Act”, was introduced March 24 by U.S. Senators Sherrod Brown (D- OH), Susan Collins (R-ME), Bill Nelson (D-FL) and Shelley Moore Capito (R-WV). The bill would establish a 90-day appeal period following its passage for those who had a qualifying hospital stay and were denied skilled nursing care after Jan. 1, 2015. Every year thousands of Medicare patients who spend time in a hospital for “observation” but are not actually admitted find that, not only are they likely to be subject to substantial hospital costs not covered by Medicare Part A, but they are not eligible for nursing home coverage after they are discharged. Under S. 843, patients’ time under “observation status” would count toward the requisite three-day hospital stay for coverage of skilled nursing care.
Click here to read the bill...
This week, the U.S. Department of Justice announced its case against two California nursing homes has been settled
. The defendants agreed to pay $3.8 million dollars to settle false claims allegations that the facilities had dangerously overdrugged multiple residents over several years.
In addition to the financial settlement, the nursing homes entered into a “corporate integrity agreement”
to provide five years of federal oversight to ensure better care. The agreement is quite disappointing. It makes no mention of improved dementia care or reduced use of chemical restraints, even though both issues were at the heart of the false claims case (e.g., “defendants persistently overmedicated elderly and vulnerable residents”).
Unfortunately, the corporate integrity agreement looks like a boilerplate contract whereby the nursing homes agree to set up bureaucratic layers (“compliance officer,” “compliance committee,” “quality of care program”) to make sure they are following the basic laws and regulations already applicable to nursing homes. That seems like a lot of work to achieve standards that have been required for nearly thirty years. We hoped for more.
A look at the drugging rates at the defendant nursing homes indicate the federal lawsuit has had little impact on the quality of care the residents are receiving. Antipsychotic use at one defendant facility rose 22% from the second quarter 2014 (before the lawsuit) to the fourth quarter 2014 (after the lawsuit) to a whopping 27.71% overall while use at the other defendant facility rose 45% in the same period. Clearly, the lawsuit did not trigger any soul-searching in the defendant nursing homes and we do not expect the corporate integrity agreement to either.
We’re pleased the federal government took a stand for quality nursing home care and targeted illegal and immoral drugging practices in the process. We’re also pleased the government received a partial refund for care that was truly grossly inadequate. Nonetheless, we’re disappointed the chemical restraint band likely plays on in Watsonville.
A Maryland nursing home has been fined $380,750 for placing a resident in a locked unit and prohibiting one of her daughters from visiting. The fine, recently upheld by a federal appeals board, is noteworthy for two reasons: one, it involves a large, six-figure fine and two, locking up nursing home residents and restricting their visitation happens all of the time.
The case involved a resident in her 70’s who had lived at NMS Healthcare of Hagerstown for years. Following a brief hospitalization, she was moved to a locked unit in the facility and denied egress from the unit and from the facility itself. The move was approved by one of the resident’s daughters - acting as agent under a power of attorney - but she lacked any legal authority to confine her mother in a locked unit. The agent/daughter also approved a visitation restriction that prohibited the resident’s other daughter from visiting.
The appeals board was definitive: nursing home residents may not be confined against their will or have access restricted to family members, even if a power of attorney agent has consented. “Otherwise, nursing facilities could be turned into prisons in which family members lock their relatives away purely for the sake of convenience. . . . Residents of nursing facilities have rights and those rights include the right to freedom of movement.”
For guidance on dealing with nursing home false imprisonment issues, please see CANHR’s publication Your Right to Leave. For guidance on dealing with nursing home visitation issues, please see Your Right to Visit. The appeals board decision can be seen here.