The Department of Health and Human Services released a report titled “Questionable Billing by Skilled Nursing Facilities.” The title says it all… but we’re still going to comment.

In recent years, government analyses have discovered improprieties in the amount of Medicare dollars billed by–and paid to–to skilled nursing facilities (a general term that includes nursing homes and other long-term care facilities). We’d like to be clear that Medicare dollars are OUR dollars, yours and mine. Medicare dollars are paid from our tax dollars. So as you read the rest of this blog, keep in mind that this story is personal to everyone in the United States, regardless of whether or not you know anyone in a nursing home.

Here’s a summary of this very long, dry government report:

1. Within two years, from 2006 to 2008, skilled nursing facilities (from here on, I’ll simply refer to this as “facilities”) increased billing for the most expensive therapies by 11%…even though the ages and diagnoses of residents didn’t change. (Translation: Similar resident groups, with higher billing = facilities billed for unused  or unneeded expensive therapies.)
2. For-profit facilities were far more likely than not-for-profit facilities to bill for expensive therapies. AND, the facilities most likely to bill for higher-cost therapies were owned by large chains. (Question: Is this how “for-profits” make more profits?)
3. Some facilities were found to have a pattern of routinely billing Medicare for higher-cost therapies, and/or for having residents stay longer. (Translation: Some facilities routinely abuse the billing system…and now the government knows which ones they are.)

The recommendations to remedy the problems are for Medicare to monitor payments more closely…to change the current method for figuring out how much therapy is needed…to keep a closer eye on those facilities (especially the chains) that seem to have a bigger problem with unusual or “questionable” billing.

For more details without having to read the report itself, Paula Span wrote a really nice opinion piece in The New York Times. In it, Ms. Span says:

Families looking into nursing home care for their elders already have reason to be conscious of the distinctions between for-profit and nonprofit homes. For years, studies have found that nonprofits do better on some vital measurements.

“It’s consistent. The for-profits have the worst staffing ratios and poorer quality based on the number of deficiencies — violations of federal requirements — and the most serious deficiencies,” said Charlene Harrington, professor emeritus of social and behavioral sciences at the University of California, San Francisco, who has led a lot of that research.

In a new study, not yet published, Dr. Harrington also has found that of all forms of ownership, homes owned by the 10 largest chains fared worse than other for-profits. “These facilities are reporting the highest acuity levels” — meaning the most serious conditions for patients — “and the worst staffing,” she told me. “Facilities are supposed to increase their staffs when people are sicker.”

In addition, professor of health polity and management at Texas A&M Catherine Hawes notes that while there are some for-profit facilities that provide good care, in general these facilities have to spend more money making stockholders or owners happy (and possibly wealthy).

“If I had to rely on a single piece of information, deciding about a facility for myself or a loved one, I would choose based on ownership status,” [Dr. Hawes] said.

(Translation: The expert would choose the average not-for-profit facility over a for-profit facility.)

If you have any legal questions about long-term care facilities, check out our dedicated nursing home page: HensonFuerst Nursing Home Abuse and Neglect. If you have questions, HensonFuerst has answers.

WRAL reports that Hill Forest Rest Home in Chatham County (Goldston, NC) had its license suspended today after an on-site visit found that conditions presented:

“…an imminent danger to the health, safety and welfare of the residents, and … emergency action is required to protect the residents,” officials [from the Adult Care Licensure Section of the Division of Health Service Regulation] said in a letter to Warren Gold, administrator of Gold Care Inc. in Rocky Mount, which runs the retirement home. [from WRAL.com]

The 24 residents of the facility are being relocated.

According to the news report, Hill Forest has a long tradition of substandard care. In 2008 and 2009, inspections turned up several violations, including lack of food for the residents. In March 2010, its license was revoked, but residents remained because the owner of Hill Forest Rest Home appealed the decision.

WRAL’s article makes it sound as though things went from bad to much, much worse:

An April inspection found moldy showers, roaches and flies in the kitchen, residents using bed sheets to cover windows for privacy and bathroom doors propped open, according to state Department of Health and Human Services records. A follow-up inspection in June found violations of fire and electrical codes and exterior doors that didn’t lock properly, records show.

If the June violations of fire and electrical codes didn’t cause an immediate shut-down of the facility, it makes one wonder what the inspectors found this time around.

People in nursing homes, rest homes, retirement homes, and assisted nursing facilities deserve the best care a society has to offer, not the worst. Residents and their families should never have been subjected to this kind of a nightmare…one that lasted, presumably, for several years. It’s shameful that Warren Gold and Gold Care, Inc., seem to have put playing the system above caring for senior citizens.

Stories like these are exactly why HensonFuerst Attorneys spend every day fighting for the rights of abused and neglected elderly residents. Thousands of other seniors are stuck in homes just like Hill Forest, individuals who are at the mercy of the facilities they live in. People who need someone to stand up for their rights…and their basic human dignity.  The HensonFuerst nursing home abuse team provides a voice for those who cannot always speak up for themselves, and for families who don’t know how to make things better for their loved ones.

If you suspect abuse or neglect at any long-term care facility, please don’t hesitate to contact our office. We’ll walk you through your options, and help you take legal action to get your loved ones to safety. Our phone lines are open 24 hours a day, 7 days a week, so someone is always here to answer your call (1-800-4LAW-MED). You can also visit our Nursing Home Abuse webpage:  HensonFuerst Nursing Home Abuse page.

Remember, if you have questions, the attorneys of HensonFuerst have answers.

According to an article on WRAL.com, the North Carolina Department of Health and Human Services (DHHS) has recommended that the Centers for Medicare and Medicaid Services fine Britthaven of Chapel Hill nursing home for violations that led to the hospitalization of six patients in February. One patient, 84-year-old Rachel Holliday, died.

Ms. Holliday and eight other patients tested positive for opiates, powerful and controlled pain medications–and many of them had not been prescribed opiates at all.

Angela Almore, 44, of 724 Berwick Valley Lane in Cary, was indicted in June on one count of second-degree murder and six counts of felony patient abuse. Almore worked as a registered nurse at Britthaven. Prosecutors allege that Almore drugged the patients to make them more manageable. [from WRAL.com]

After an extensive investigation, the DHHS Nursing Home Licensure Section found that Britthaven of Chapel Hill “didn’t ensure patients were protected from abuse, its services didn’t meet professional standards, unnecessary drugs were prescribed and significant medication errors occurred.”

The requested fines were $2,500.00 for each violation, for a total of $20,000.00.

HensonFuerst’s Nursing Home Abuse team continues to conduct an independent investigation into these and other episodes of nursing home abuse and neglect. If you have questions about potential abuse, we’re here to provide answers. Call us anytime, day or night, at 1-800-4LAW-MED.

But perhaps even more disturbing, however, is a study by Consumer Reports that found that state regulators fined only 50% of nursing homes whose misconduct warranted fines. Make no mistake about it—pressure sores, malnutrition, dehydration, and falls in nursing homes are not the inevitable consequence of old age and ill health.  They are, all too often, the result of understaffing of nursing homes and the resulting inability of the staff on hand to provide the care their residents need and deserve. 

Click to read “Old Age Ain’t For Sissies” published by the Center for a Just Society.

The Department of Health and Human Services now says you can’t have copies of inspection reports that might explain how your loved one in nursing home care came to have a broken bone, or bruises. The request for reports on such incidents “divert employees from their federal survey, certification and enforcement responsibilities,” said Michael Leavitt, HHS secretary.

HensonFuerst Nursing Home blog viewers are encouraged to contact HHS and express their concerns about this new Rule.  

The U.S. Department of Health and Human Services

200 Independence Avenue, S.W.
Washington, D.C. 20201
Telephone: 202-619-0257
Toll Free: 1-877-696-6775

Click to read the entire article appearing on www.timesgazette.com

A new government study finds violations at 94% of America’s nursing homes.   This  is a sad reflection on the current state of care provided in nursing homes .  Click HERE for the link to the government study.