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A Better Option for Long-Term Care

grandmas-birthday-433128-m.jpgOur team of nursing home negligence attorneys receives similar complaints by families with elderly loved ones, concerned over the true quality of care they are receiving. Families rarely see actual instances of abuse or neglect, rather noticing their loved one's physical, mental and emotional health steadily decline.

Residents who are neglected or abused in nursing homes often become malnourished, reclusive, overmedicated - more simply, not themselves. Nursing homes have been operated the same way for decades, to meet government regulations and qualify for Medicare and Medicaid reimbursements.

Increasingly, nursing home chains are being bought out by large corporations so that now more than one-third of all American nursing homes are run by large, for-profit companies.

The nursing home industry is in desperate need of reform. There are a few pioneers looking toward the future, however. Our population is rapidly aging - by 2050, about one-third of American citizens will be 65 years or older and about 4% will be 85 or older.

Big, for-profit nursing home chains offer long-term care at relatively inexpensive rates. They are able to lower rates by implementing various cost-saving features, such as industrial cafeteria, shared bedrooms, and overworking staff.

The Green House Project and Large-Scale Change


Among those with an optimistic plan for future care for the elderly and disabled include the Green House Project, which we wrote extensively about here and here. The hard truth is that nursing homes hinder resident freedom and happiness; studies show that depression among residents is significant. Perhaps it is the approach altogether that is wrong: tightly controlled lonely institution devoid of personal or loving atmosphere. Profits and economic efficiency are of the utmost importance, rather than the residents or staff quality.

Concepts like the Green House Project aim to remedy this inherent problem. In 2000, Dr. Bill Thomas decided to build a nursing home from scratch that was affordable, could accept Medicare and Medicaid patients, and, most importantly, appeared more like a home than an institution. The first was built in Tupelo, Mississippi.

Each Green House has 10-12 private bedrooms with attached bathrooms (which helps control infection), surrounding communal living and kitchen areas. There are certified nurse assistants and the primary caregivers, which take care of food preparation, housekeeping, and activities for residents, among other duties. The team also works closely with other Green House staff, so they may manage their own schedules and decision-making processes.

In the 15 years since the first Green House opened (there are now nearly 175 in 27 states), several studies have shown exceptional results. These studies show that Green House staff is happier with their jobs and more likely to stay in their positions, residents enjoy a higher quality of life, and families are happier with the settings than traditional nursing homes.

The Green House Project places emphasis on radical culture change within long-term care facilities. Residents get a say in the menu plans, for example, and the care is centered on each unique person's needs. The staff feel empowered because they can organize their own schedules and are coached in their positions, instead of ordered to meet certain goals by executives.

Perhaps the best part is that Green Houses are affordable - more than half of residents are on Medicaid. Residents are not only happier, but healthier as well. One study found the rate of hospitalization per year was about seven percentage points lower for Green House patients compared to those in a traditional nursing home. Employees like their jobs, are not rushed through their duties, and thus are far less likely to abuse or neglect residents.

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Extendicare Pays $38 Million for Poor Care

April 21, 2015

wheelchair-945156-m.jpg One of the country's largest nursing home chains was recently hit with a $38 million negligence and fraud settlement. This type of healthcare fraud is common in poorly-operated nursing homes throughout the country. Any evidence or suspicion of fraud is a red flag of systemic negligence in a nursing home.

Extendicare was charged with billing Medicare and Medicaid for unnecessary and inappropriate services, such as physical therapy, in 33 nursing homes. Extendicare owns and operates 150 nursing homes in 11 states. This is the largest settlement in the Justice Department's history involving nursing home fraud.

Prosecutors for the federal government said that Extendicare failed to hire enough nurses to properly care for residents in its facilities. Understaffing of this nature is rampant in nursing home owned by large chains and can lead to severe problems, such as more frequent falls and bedsore development

They went on to say that the care provided at these 33 facilities was so poor that many residents became dehydrated, malnourished, and suffered infections. This led to unnecessary hospitalizations, head injuries, and a considerable decrease in quality of life.

Whistleblowers Reporting Fraud, Saving Lives


The claims against Extendicare's nursing homes were first filed by a whistleblower in Ohio who accused the company of poor care. Another whistleblower in Pennsylvania also accused the company of inflating their Medicare reimbursements, providing unnecessary care to residents to increase how much they could bill the government. More information on the Pennsylvania whistleblower can be found here.

Medicare reimburses healthcare centers based on the amount of rehabilitation services a resident needs. Nursing homes, particularly for-profit chains, often exaggerate how much rehab a resident needs to milk money from Medicare and Medicaid. The nursing home chain Ensign, for example, recently agreed to a $48 million settlement for similar fraud charges.

The Obama Administration has made nursing home investigation and prosecution a top priority in the justice system. Overall, investigators go after nursing homes that defraud Medicare and Medicaid, and then pursue problems with resident care such as understaffing and overmedication. Poor care and government fraud go hand in hand: if a nursing home is unethical enough to subject residents to unnecessary treatments, it is surely taking other measures to cut costs at the expense of resident safety.

Thus, prosecuting nursing homes for health care fraud not only protects taxpayer funds, but protects the health and safety of residents as well. This was demonstrated in Extendicare's suit by internal emails shown in court. One Extendicare executive expressed concern that a resident with a seizure condition was physically unable to participate in physical therapy. He described this as a "missed opportunity ... a financial loss of 2300 bucks."

The settlement included terms requiring Extendicare to enter a five-year integrity agreement. This will have an independent monitor assess Extendicare facility's staffing levels among other quality measure to make sure it is making improvements. Fortunately, this agreement applies to all 150 Extendicare nursing homes in the U.S.

The rise in for-profit nursing home chains is pervasive - over 70% of nursing homes are now for-profit - at the cost of elderly, sick and vulnerable residents. These chains operate to please investors, not residents, and skimp on the most critical aspects of care like trained nurses and medical supplies.

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Overuse of Psychiatric Drugs in Nursing Homes Widespread

March 4, 2015

4083394575_687d6ae782_o.jpgOur nursing home negligence lawyers often write on the overuse of dangerous medications in nursing homes - a practice known as chemical restraint - on this blog. It is an extremely important, insidious issue that has been hidden by nursing homes for far too long. Recently, federal investigators urged Medicare to take immediate action to stop chemical restraint after investigations found widespread drug abuse.

The findings of this federal investigation are scheduled for release on Monday, March 9, 2015, so check back for more details at that time. Throughout his tenure, President Obama has been working with nursing homes to curtail the use of dangerous drugs; specifically, the use of antipsychotic drugs, which have Black Box Warnings against use in elderly patients with dementia.

Antipsychotic drugs include: Risperdal, Haldol, Zyprexa, Abilify, Seroquel, Geodon and clozapine. These drugs are intended only for patients with psychotic conditions, such as schizophrenia or severe bipolar disorder. Many of these drugs, Risperdal particularly, are used inappropriately in the general population as well as in nursing homes. More information on Risperdal injury lawsuits can be found here.

According to federal investigators, the Department of Health and Human Services (which oversees Medicare and Medicaid) has done little to reduce antipsychotic drugs use in the elderly. Doctors sometimes prescribe these drugs to elderly patients with combative symptoms of dementia, such as hitting or yelling. This is not only extremely dangerous, but it is abusive and negligent as well.

Understaffing Leads to Inappropriate Drug Use


Chemical restraints are common practice in nursing homes that have an inadequate number of employees. Because the staff is overworked, they are unable to care for each resident properly, particularly those who need more individual care and attention. In order to subdue, restrain, or make it easier to care for these residents, they are dosed with antipsychotic drugs.

Dementia is a complex and not-well-understood disease that causes severe changes in personality and mood, frequently resulting in agitation, violence or agitation. Understaffed nursing homes often turn to chemical restraints to suppress these symptoms of dementia, despite repeated warnings from the FDA.

According to these warnings, antipsychotic drug use in dementia patients is associated with increased risk of death and, if the patient survives, a severely decreased quality of life. The drugs can also increase the risk of serious falls, fractures, hospitalizations and other severe complications.

Chicago Psychiatrist Given $600,000 to Prescribe Antipsychotic


In February 2014 a psychiatrist in Chicago pled guilty to taking illegal kickbacks to prescribe clozapine (brand name Clozaril or FazaClo). Dr. Michael J. Reinstein received more than $600,000 to give this drug to thousands of elderly and mentally ill patients at 30 nursing homes. As a result of the lawsuit against him, Reinstein will pay $3.79 million to federal and state governments.

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New Guidelines Cause Nursing Home Quality Score Drop

February 20, 2015

last-station-nursing-home-4.jpegIn our latest nursing home post we detailed the new guidelines for Medicare's Nursing Home Compare website and how it could impact the quality scores of more than 15,000 American nursing homes. It was just confirmed that about a third of these nursing homes are getting lower scores because of the strengthened guidelines. Nursing home negligence lawyers at Pintas & Mullins explain these new quality scores.

Nursing Home Compare is a widely-used website run by the government, which scores nursing homes based on a five-star system. This site is used by millions of Americans in deciding which facility is best suited for their loved one. Unfortunately, the site has also come under intense criticism for its ratings system and its many flaws.

In response to criticism, Medicare has taken quite a few steps forward in revising the rating system. One of the most meaningful improvements was the inclusion of anti-psychotic drug use in nursing homes. Anti-psychotics, like Seroquel or Zyprexa, are frequently used in nursing homes - illegally - to subdue unruly or difficult residents. This is extraordinarily dangerous, as the FDA has repeatedly warned that anti-psychotic drugs can cause premature death in elderly people with dementia.

In addition to this new drug data, Medicare will also use more complex metrics to make sure the staffing levels are correct. Most of the information on Nursing Home Compare is self-submitted by nursing homes, including staff levels and quality measure.

Obviously, there is much concern regarding the validity of this self-reported data. There is really nothing stopping nursing homes from over-reporting how well they staff their facilities and generally overstating how well the facilities are run. The only data that is actually submitted by Medicare itself is information on the government inspections.

As stated, the new Nursing Home Compare rating system uses more refined metrics to confirm staffing levels. After these new metrics were put in place, more than 60% of nursing homes on the site got lower quality of care scores. Nearly 30% dropped one star overall, and about 3% of nursing homes dropped two stars.

This is the first time the five-star system has at all changed since 2008. Only about 340 nursing homes (out of 15,000) saw their overall ratings improve in response to the new metrics.

It is important to highlight that thousands of nursing homes hot the lowest possible score possible on anti-psychotic drug use. Alarmingly, 20% of the 15,000 nursing homes received just one star in the anti-psychotic drug use category for giving these medications to residents who do not have psychiatric conditions.

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Government Agrees to Tougher Nursing Home Evaluations

February 18, 2015

n-a-3280.jpgOur nursing home negligence lawyers recently reported on the broken system the government created to rate and compare nursing homes. After massive outcry from the public and industry insiders, the federal government is now taking immediate action to strengthen the Nursing Home Compare website so many families rely on to find quality nursing homes.

Nursing Home Compare, located here, is the Medicare website that ranks, grades, and compares almost every nursing home in the country. One of the largest problems with this website is that much of the information on the nursing homes are self-reported by the facilities. More often than not, the self-reported quality measures were much, much higher than the quality of care residents actually received.

Chemical Restraints Taken into Consideration


This meant that many negligent and poorly-run nursing homes were rated highly on Nursing Home Compare when, in reality, they were understaffed and residents were routinely mistreated. Understaffed nursing homes often use drugs to control or subdue residents - a practice known as chemical restraints - which is a major focus of the government's new overhaul.

Specifically, the government is making it harder for nursing homes to get high-quality rankings by increasing the scrutiny on antipsychotic drug use. Antipsychotics are medications like Seroquel, Zyprexa, Abilify and Risperdal that should never be given to elderly people with dementia, as it increases their risk of death. These drugs should ONLY be given to patients with severe mental conditions, such as schizophrenia, psychotic depression and bipolar disorder.

The grades on Nursing Home Compare are in the form of five-star ratings. The system was created in 2008 as a critical tool to help concerned, confused families determine the best nursing home to place their loved ones. The site profiles more than 15,000 nursing homes, comparing them based on: quality measures, staffing levels, and government inspections.

Both staffing levels and quality measures are determined, as mentioned, by self-reported data. This is problematic for obvious reasons; nursing homes should not be held to the honor code when they are responsible for the health and safety of our country's most vulnerable citizens.

The "quality measures" section involves many factors, such as how many residents develop bed sores or are injured in falls. In the new government guidelines, this group will now also measure how many residents receive antipsychotic drugs. This information will still be reported to Medicaid by the nursing homes themselves. There are also new guidelines establishing verification of self-reported staffing levels.

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Nursing Homes Sued for Overmedicating, Defrauding Medicaid

December 8, 2014

5257948497_f5428013aa_b.jpgThe New Mexico attorney general recently filed a lawsuit against one of the country's largest nursing home chains, Preferred Care Partners Management Group, for defrauding Medicaid and causing the neglect and mistreatment of residents. Nursing home negligence lawyers at Pintas & Mullins detail this lawsuit and the horrific consequences of inadequate care.

The lawsuit specifically names 11 nursing homes, although it could have larger implications in other states if it is successful. Preferred Care Partners is based in Texas, with nursing homes in about 10 other states including Iowa and Florida. According to the suit, the chain purposefully understaffed its nursing homes in the pursuit of higher profits, at the expense of the physical and emotional well-being of its residents.

In a related story, NPR recently reported on one of the most pronounced and dangerous problems in American nursing homes: overmedicating residents. These two stories are closely related and impact one another because staff that work at chronically understaffed nursing homes often turn to pharmaceuticals to "restrain," or "subdue" the residents they do not have time to care for.

An estimated 300,000 nursing home residents are currently on antipsychotic drugs to suppress aggression or anxiety. Antipsychotic drugs, like Seroquel or Risperdel, all come with a black box warning (the FDA's most strict warning) to alert patients of the increased risk of death. The FDA also specifically states that most antipsychotic drugs should not be prescribed to elderly patients with dementia.

In fact, in 2013 the agency released a public health advisory, warning that certain antipsychotic drugs were associated with increased mortality among these patients. Several clinical studies, along with the tragic premature death of countless people, prompted the FDA to make this public announcement. The drugs are proven to cause significantly higher death rates, along with infections and heart failures in this demographic.

How, you may ask, are hundreds of thousands of elderly dementia patients still receiving antipsychotics? The crux of this issue can be explained through the lawsuit in New Mexico and its implications. Preferred Care Partners is accused of profiting from falsely billing Medicaid while understaffing its facilities and giving residents substandard care.

Improperly staffed nursing homes are unable to deliver suitable care to its residents, which results in overmedicating residents, leaving residents in soiled clothes and beds, ignoring restroom requests, and higher rates of serious falls. Other allegations against Preferred include neglecting to bathe residents, failing to assist them with meals, and residents suffering from dehydration and malnutrition.

The New Mexico attorney general is claiming that Preferred billed Medicare and Medicaid for services that were not provided, or were fundamentally worthless. Federal law also prohibits the use of antipsychotics in residents who do not have a psychological disorder, such as schizophrenia or bipolar disorder.

More often than anyone would like to believe, understaffed nursing homes give residents these drugs to control them in a practice called "chemical restraint." Powerful, dangerous drugs are given to residents with dementia who express severe anxiety, unruliness, agitation, and other difficult-to-control behaviors. Understaffed facilities simply do not have the time to care for these residents, so they subdue them with drugs.

The vast majority of dementia patients experience behavioral and psychological symptoms at some point. That is simply the nature of the disease, and it is often why residents are placed in nursing homes to begin with: so they can be in a safe environment with medical professionals. In order to give someone an antipsychotic drug, there needs to be a medical need and when the drugs are prescribed needlessly, the effects are obvious.

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Country's Worst Nursing Homes Receive Federal Insurance

November 17, 2014

last-station-nursing-home-4.jpegThe Center for Public Integrity recently revealed that hundreds of the country's lowest-rated nursing homes are receiving federally-backed, guaranteed mortgages. This assistance is worth billions of dollars, so why is it being given to facilities that harm residents and do not meet federal safety standards? Nursing home lawyers at Pintas & Mullins offer an investigation into this issue.

The Department of Housing and Urban Development (HUD) insures mortgage loans through a little-known program with little to no oversight. Throughout the country, nursing homes (and particularly for-profit chains) routinely receive HUD-guaranteed loans, regardless of the quality of care they provide.

Another federal agency, the Department of Health and Human Services (HHS) rates the country's nursing homes based on annual health inspections, staffing levels, and resident care. Take, for example, the Alden Alma Nelson Manor nursing home in Rockford, Illinois, which consistently earns the lowest possible quality rating from HHS, and has earned these abysmal ratings for the better part of a decade. Alden Alma recently paid hundreds of thousands of dollars in fines for the deaths of three residents and incidents of abuse and sexual assault. Despite this, Cambridge Realty Capital approved a $12 million mortgage for the facility, and the HUD insured the loan.

Another Illinois facility that received an HUD loan, the Crossroads Care Center in Woodstock, has a federal one-star rating. It was also fined about $360,000 for the deaths of six residents, including allegations that a nurse purposefully overmedicated and killed residents. That nurse, Marty Himebaugh, was found guilty of felony criminal neglect.

Again, despite this, in 2013 Crossroads Care received $4.4 million in a HUD-backed loan, it's second since 2001. Similarly, the Alden Wentworth Rehabilitation nursing home on Chicago's South Side received a $10.6 million HUD loan, even after a beloved resident fell four stories at the home, prompting a senate hearing. Two years before the loan, another resident died after wrongfully receiving narcotics for three weeks.

Stories like this abound throughout Illinois and the rest of the country. HUD officials claim that they are not made aware of safety and health issues, yet how this can be true is disconcerting. Why is there no system by which HUD employees must check a facility's quality of care before financing it? Why is there no emphasis put on regulatory enforcement, or communication between agencies - particularly when it comes to our nation's most vulnerable citizens?

The Center for Public Integrity states that this type of situation is not uncommon: since 2001, hundreds of the worst-ranked nursing homes in the country have received HUD-guaranteed loans, worth about $2.5 billion. In fact, the number of one-star nursing homes receiving HUD insurance rose every year between 2009 and 2012.

An esteemed nursing professor at University of California at San Francisco said that this HUD pattern points to serious issues about the communication - or lack thereof - between government agencies, an outrageous lack of oversight, and the improper use of public funding. There hasn't been any public scrutiny over the HUD's practices, which makes a bad problem even worse.

How, When, and Why This is Allowed


As mentioned, these loans are made possible by a little-known federal program: the National Housing Act of 1959, which was enacted by Congress to make it easier for nursing homes to secure loans on reasonable terms. It was created in effort to provide a reliable stream of income to nursing homes, which previously had trouble finding loans.

This may seem like a good thing, but the program means that if nursing homes default on the loans, the public pays (about $187 million in defaults have been incurred since 1959). These mortgages have been granted to over 7,000 nursing homes; currently, about 13% of all nursing homes have HUD-guaranteed loans.

About 240 nursing homes with a one-star rating have HUD loans, with Ohio having the most of any other state (30). In Illinois, 20 one-star nursing homes have HUD loans, and California ranked third among states. For-profit nursing homes make up the large majority of one-star loan recipients, with corporations owning two-thirds (despite representing only about half of all nursing homes nationwide). Experts believe that the HUD should restrict its guaranteed loans to only non-profit nursing homes, which generally run higher quality and safer facilities. This makes sense. The government should not be financing large, for-profit, multi-billion dollar corporations.

Part of the reason these facilities are able to get away with the death and demise of residents while still securing financial backing is because the owners spend hundreds of thousands in donations to political candidates.

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Investigation Finds Nursing Home Care Lower Than Families Believe

November 12, 2014

last-station-nursing-home-7.jpgIn every nursing home throughout the country, staffing levels directly affects the quality of care residents receive. Far too many nursing homes are understaffed, under-funded, and not giving residents the comprehensive care they need. Nursing home abuse lawyers at Pintas & Mullins highlight a recent investigation by the Center of Public Integrity, which found that families may be overestimating the amount of care their loved one is receiving.

The Center for Public Integrity is a nonprofit, nonpartisan organization that recently compiled years of data from Medicare databases on nursing home staffing levels. The Center analyzed data from more than 10,000 nursing homes throughout the country and found that a staggering 80% of facilities report higher levels of registered nursing care to consumer websites than in actual reports to Medicare.

Notably, eight out of then ten states with the largest differences in reporting are in the south; and Arkansas and Louisiana's self-reported staffing levels were more than twice the actual numbers reported to Medicare.

The self-reporting system referred to in this report is the Nursing Home Compare website, which is extraordinarily popular and used by millions of families to find the "best" nursing home for their loved one. We have written about this website and its deficiencies in the past; the posts can be found here.

Experts believe - and are proven correct - that the staffing levels on this website are artificially inflated and, in many cases, extremely overestimated. Families who are looking to place loved ones in nursing homes have few resources at their disposal for finding the best facility. Making matters worse, most are given only a few days to find a facility after their loved ones are discharged from hospital or rehabilitation centers.

As a result, families rely on websites like Nursing Home Compare, and genuinely believe that their loved one is in a well-staffed, high-quality nursing home when that is quite far from the reality. It is only after an avoidable injury or extreme deterioration in health that the truth becomes known, and quite often, that comes too late.

Further complicating the issue, some data indicates that at least 700 nursing homes in the U.S. (and 250 in Illinois alone) have staffing levels that are actually lower than what is required by state law. Only 33 states and Washington D.C. directly mandate staffing requirements.

Real Patients, Real Harm


Too many Americans read stories like this and think it's a problem that does not, or will not apply to them. As the baby boomers grow older, however, more and more Americans will need to be placed in nursing homes in the coming decades, and it is often their families who will have to make the decision.

In its report, the Center for Public Integrity detailed the story of a resident admitted to nursing homes in Little Rock, Arkansas, and her family's experiences. Edna Irving was placed in Chenal Heights Health and Rehabilitation Center when she was 80-years-old. Her daughters believed the facility provided quality care based on the upper-class neighborhood it was in and high ratings on the Nursing Home Compare website.

Just one week after being admitted, however, Edna was hospitalized for a bowel obstruction. After being admitted back into Chenal Heights, her daughter went to check on her and found her lying in her own feces. A month later, Edna fell from her wheelchair, suffering a large laceration to her forehead. One week after this Edna developed a urinary tract infection because of inadequate catheter care.

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Illinois Ranks Last in Nursing Home Safety

October 7, 2014

elderly-woman-her-view.jpgA recent nursing home report card gave Illinois an "F" grade, putting our state at the bottom of national rankings for nursing home care. The report card is issued once per year by Families for Better Care, a nursing home resident advocacy group. The elder neglect lawyers at Pintas & Mullins take a closer look at this nursing home report card and why Illinois is ranked so poorly.

Families for Better Care scores each state based on eight factors, including:

1. The average amount of time professional nurses or assistants spend per resident per day
2. The percentage of nursing homes with above average professional nursing staff
3. The percentage of nursing homes with above average health inspections
4. The percentage of nursing homes with deficiencies and severe deficiencies

Severe deficiencies are defined as a violation that places residents in immediate jeopardy, or actual reports of resident abuse, neglect, injury or death. In total, 11 states received a failing grade, including many of our surrounding states, such as Missouri, Michigan, Iowa, and Indiana.

The most obvious difference between the best states for nursing homes and the worst is the amount of time staff spends with residents every day. Unfortunately, Illinois is among the most inadequate places for hiring and retaining enough staff to properly care for residents.

On the brighter side, there are quite a few nursing homes in Central Illinois that consistently do a great job caring for residents and keeping staff and safety levels up. In the state overall, one in four nursing homes cited a severe deficiency within the past year.

Government Takes Action


The conditions in American nursing homes are a serious issue needing immediate attention, and although individual legislators are largely failing to act, federal agencies are attempting to take the reins. The agency that oversees nursing homes, the Centers for Medicare and Medicaid Services (CMS), recently issued a press release on a quality improvement initiative.

The press release details two initiatives aimed at improving the quality of nursing home care. The first is the expansion and strengthening of the Five Star Quality Rating System for nursing homes, which we recently wrote about here. This rating system is widely used and trusted by families who need to place a loved one in a nursing home but are unsure where to start looking. The system, however, is immensely flawed, which is why CMS is taking measures to improve it.

The second initiative CMS will establish new conditions for the home health agency, which deliver care to patients living at home. Starting in 2015, CMS will make changes to the Five Star system by conducting random inspections in a sample of nursing homes, verify staffing reporting with payroll information, increase the number and type of quality measures used to rate facilities, and improve the methods they use to score nursing homes.

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End-of-Life Care Needs National Overhaul

September 19, 2014

Most families with loved ones in nursing homes know that our current healthcare system is inadequate for people nearing the end of life. Our nursing homes are understaffed and underfunded, we continue to pour money into treating illnesses instead of patients, and the population as a whole are living longer and longer. Elder law attorneys at Pintas & Mullins offer a glimpse into this complex problem, and what prompted a national committee to call for a large-scale overhaul. 9735923071_7906977312_b.jpg

In the mid-1800s, life expectancy ranged around 45 years; today, the life expectancy is around 80 years. The factors driving this are multi-faceted and not exclusive only to rich or developed nations - every nation's citizens are enjoying longer lifespans. Although there are obvious, unprecedented benefits to this, there is also considerable worry regarding our nation's healthcare.

The Institute of Medicine recently appointed 21 nonpartisan officials to a committee to discuss, research, and attempt to fix how we handle end-of-life care in the United States. The committee released a report on Wednesday, including recommendations to change current Medicare and Medicaid policies. The simple truth is that, if nothing is done, our healthcare costs will balloon out of control, leaving no resources leftover for other social issues.

Many changes will take congressional action to accomplish, such as providing better long-term coverage for elderly Medicaid patients. Other ideas would take a science and research overhaul, to emphasize living healthily into old age instead of just tacking on a few more years in the nursing home. In other words, instead of treating ailments after they happen, we must focus on prevention.

Many elderly people, particularly those in nursing homes, live out their last years in progressive disability and illness. If elderly patients received the care they personally desired, would they not be happier and, in turn, healthier? Instead of trying to treat elderly patients retroactively, officials are trying to urge Medicare and other insurers to have conversations with patients on advance care planning, well before that time comes.

Major Restructuring

The panel was made up of experts from all fields, including lawyers, doctors and nurses, insurers, aging experts, and even religious leaders. In their report, titled "Dying in America," they ask for a major restructuring of our health care delivery programs, along with elimination of the current incentive programs that encourage expensive tests and treatments with no real value.

Our current insurance system reimburses doctors for performing procedures or implanting medical devices, regardless of whether it is the right or wanted choice for that patient. This type of fee-for-service medicine is the center from which the change must come. Panel members were adamant on this point - saying that if the current law does now allow this to change, then the law itself must change.

Instead of extensive, complex surgeries, elderly patients far and wide prefer low-tech services focused on home-based care and pain management. In this vein, medical groups need to greatly increase training for palliative care and establish guidelines for patients who wish to avoid extensive procedures but still wish to be treated compassionately. Not only would this make heath care more satisfying for those patients, but it would lower the overall burden on the system in terms of dollars.

Ezekiel Emanuel recently wrote an article in The Atlantic stating, very bluntly, that he hopes to die at age 75. He discusses the type and amount of health care he would consent to after 75, and he is adamant that stretching out old age is not the life he wants. He cites statistics from various studies showing, among other things, that half of American women aged 80 and older had a functional limitation.

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Medicare Star Ratings May Do More Harm Than Good

August 26, 2014

2454143641_00d9fa44e5_o.jpgChoosing a nursing home for yourself or a loved one can be among the most decisions difficult of your life. In a culture increasingly dependent on the internet, Medicare's nursing home ranking website is exceedingly popular. There are more than 15,000 nursing homes in the United States; trying to find the right one is overwhelming, which is why systems that rank facilities are so widely used.

Nursing home lawyers at Pintas & Mullins and throughout the country are concerned that these online ranking systems are actually causing much more harm than good. Here, we delve into this matter and the reality of Medicare's five-star system.

The New York Times recently published an in-depth, wonderfully written yet harrowing account of how Medicare's ratings allow nursing homes to cheat the system - and ultimately elderly patients. Although the five-start Medicare program is relatively new (it was established in 2009), it has become exceedingly popular. Consider this scenario: your elderly mother lives with you, and one day she falls and breaks her leg, requiring emergency surgery and rehabilitation. After surgery, the hospital gives you just one day to choose a rehab center for recovery. Pressed for time and overwhelmed by the situation, you turn to Medicare.gov for help.

This is exactly what happened to the Chandler family, of Sacramento, California, in 2011. Wanting to keep her close to home, the Chandlers placed their 90-year-old mother in Rosewood Post-Acute Rehab, which had a five-star rating on Medicare.gov. Like so many others, they did not know how the rating system actually worked, and the hotel-like appearance of Rosewood comforted them. They placed Essie May Chandler in Rosewood for a six month stay.

In her six months at Rosewood, Essie lost 40 pounds, fell 11 times, had massive bruising across her body, and broke both her legs. Another six months after she returned home to her family, she passed away. The Chandlers now live with this guilt, clearly unable to forgive themselves.

What Went Wrong


Medicare's ranking system is based on three factors: inspection reports, staffing levels, and quality measures. These last two criteria rely only on data the nursing home self-reports to the government; and the feds never go in to check if the numbers are accurate. Therefore there is not much deterring nursing homes from over-reporting and sending false data to Medicare to boost their ratings.

To say the basis of this system is incomplete or lacking would be an understatement. It seriously misleads consumers because of its flaws and because it does not account for important factors, like complaints filed, or fines and enforcement actions. If that information was factored in, it is unlikely Rosewood would have five stars; from 2009 to 2013, officials received about 150 complaints and reports of problems at Rosewood, which is twice the state average.

To investigate further, Times reporters interviewed current and former residents at Rosewood, most of who said they did not think the facility deserved a five-star rating. Many residents live in a room with two other people, the facility is understaffed, and basic supplies are scarce. Rosewood has also recently been named in about a dozen lawsuits (including several resident deaths) from families who accuse staff of mistreatment and substandard care.

When injured residents or their families sue nursing homes for negligence or abuse, they quite often have to go up against the nursing home's parent companies. Rosewood, for instance, is actually operated by North American Health Care, which also owns more than 30 other nursing facilities. This offers a glimpse into why Rosewood appears so well-run on the outside, but fails its residents so egregiously.

North American Health Care is a for-profit corporation, focused on pleasing investors and increasing the bottom line. The nursing home industry is made up primarily of corporations like North American Health Care, who own dozens, if not hundreds of nursing homes. Understaffing, failing to keep up with supplies, and overcrowding rooms actually help boost profits, though cause grave harm to residents.

Many nursing homes have expertly learned how to play the rating game - one analysis shows that even facilities with illustrious histories of inadequate care have high ratings in the self-reported criteria. Case in point: of 50 nursing homes on federal watch for poor quality, two-thirds have four or five stars for quality data and staff levels, while the state-reported health inspections earned them one or two stars.

Continue reading "Medicare Star Ratings May Do More Harm Than Good" »

Illinois Revokes License of Nursing Home Psychiatrist

August 13, 2014

78217195_07b2df9cdb_o.jpgA popular Chicago psychiatrist, Dr. Michael Reinstein, recently had his license suspended by the Illinois medical board due to his illegal prescribing of clozapine, an antipsychotic. He prescribed the dangerous drug to countless nursing home residents despite clear and irrefutable evidence that it could cause premature death in the elderly. Nursing home abuse lawyers at Pintas & Mullins highlight this case and how residents succumb to corrupt doctors.

According to investigative reports, Reinstein, who worked out of an office in the Uptown neighborhood of Chicago, gave clozapine to more than half of all his patients. Clozapine is a powerful antipsychotic drug, recommended for patients as a last resort. It can cause seizures, serious drops in white blood cells, heart wall inflammation, and death.

Reinstein received at least $350,000 in illegal payments from clozapine's manufacturer - a fact that came to light after a joint investigation by the Chicago Tribune and ProPublica, a non-profit advocacy group. After this investigation, the Illinois Department of Financial and Professional Regulation stepped in, beginning a two-year legal fight.

Reinstein has repeatedly denied any wrongdoing in his practice, and is seeking an to stop his license suspension in Cook County Circuit Court. He claims that every clozapine prescription was medically necessary, despite immense payments from the drugs' manufacturer, Teva Pharmaceuticals. Reinstein reportedly received $50,000 every year from Teva in a "consulting agreement."

In addition to this annual agreement, Reinstein also received numerous gifts from Teva, including free travel to and from Miami, fishing trips, lavish dinners, a boat cruise, and many tickets to sporting events. He enjoyed these gifts from 2003 to about 2009, when the investigation began, and Reinstein, undoubtedly feeling the heat, asked the drug maker to stop payments.

The legal battle is not looking promising for Reinstein. In March of this year, Teva agreed to pay a $27.6 million fine over claims that it paid Reinstein to prescribe the drugs. Another 2012 lawsuits against the disgraced doctor is currently pending in federal court regarding hundreds of thousands of false Medicare and Medicaid claims.

Nursing Home Deaths Tied to Clozapine


In addition to his Uptown clinic, Reinstein also served as a psychiatric medical director at over a dozen local nursing homes; one year he issued more prescriptions for clozapine than all doctors in Texas combined. It is impossible to understate how much damage he single-handed caused in the lives and wellbeing of his patients. At least three patients died of clozapine intoxication while under his care, and countless others lost their quality of life from this powerful antipsychotic drug.

One of his victims was a 50-year-old man named Alvin Essary, who was a resident at Somerset Place nursing home when he died in 1999. According to his medical records, he had over five times the toxic level of clozapine in his blood at the time of his death. Consequently, Essary's family sued Reinstein for his negligence, ultimately settling for about $85,000.

Another of Resinstein's patients was just 27 when she died of medication intoxication. According to investigations, Reinstein increased the dosage for Wendy Cureton at twice the recommended pace, and combined the drug with a sedative despite clear medical warnings not to do so. After yet another dosage increase, Cureton collapsed and died.

Continue reading "Illinois Revokes License of Nursing Home Psychiatrist " »

When and How to Choose Hospice Care

June 18, 2014

116482438_79d50d4e57_o.jpgAs Americans age, they are making greater use out of hospice care, which is offered to terminally ill patients at the end of their lives. Deciding to place yourself or a loved one into hospice care can be one of the most difficult of a person's life, and many are unaware that they have a choice of programs. Elder law attorneys at Pintas & Mullins offer some advice and a few tips on how to choose the right hospice.

Hospice programs involve comprehensive care for those near the end of their lives; the focus is on comfortable, at-home care, to relieve pain as much as possible. Although most hospice patients receive care in their homes, it is possible to receive hospice care while residing in a nursing home, even for those on Medicare.

Unfortunately, during the time most are considering a hospice program, they are in the midst of a health care crisis or have just received dire news. In other words, they are typically not in the best state of mind to research in-depth on the programs available to them. The good news is that hospice choices are growing, and now available in most communities throughout the country.

It is important to remember that, like nursing homes, hospices are sometimes run by large, for-profit corporations that may not always have the patients' best interests at heart. This is why doing research before choosing a facility is so important - not every hospice provides the same quality of care.

Advocacy groups like the American Hospice Foundation have been around for many years, collecting data on U.S. hospices during that time. Soon (within the next two to four years), it will release a tool to help consumers compare hospice programs using evaluations conducted by both primary caregivers and Medicare and Medicaid.

Knowing What to Ask


Before that becomes available, families need to do their own work, interviewing different hospice programs within their communities. During these interviews, caregivers often come to patient's homes and answer any questions they may have. How receptive they are to these questions and requests is the first indicator of how well a program is run.

Second, it is important to choose a program that has a solid foundation; avoid hospices that have only been around for a few months or even up to a year. The more established and stable a hospice is the better. You may be able to glean knowledge from friends, doctors or nurses who have heard about that program's reputation.

Third, ask about the staff's response times, whether they will be available in evenings and weekends, and how long the patient will need to wait in an urgent situation. Additionally, consumers should ask about the services the hospice provides. Although there is a set or standard services most are expected to give, the degrees and intensities of these vary.

For example, "continuous care," refers to the very last hours or days of someone's life, when 24/7 care is necessary. Ask the hospice if they will provide a caregiver at home during this time, if they will see the patient through to their death, and if the family will be supported. Another important service is inpatient facilities, in case complex health issues arise. Most hospices rent out units in hospitals or nursing homes to care for their patients who need additional services.

Continue reading "When and How to Choose Hospice Care" »

The Six Worst Nursing Home Facilities in California

March 26, 2014

There are about 1,300 long-term care nursing facilities in California, where over 300,000 residents are cared for. Unfortunately, most nursing homes are run by for-profit corporations, which aim to make money by caring for our nation's elderly. Nursing home negligence attorneys at Pintas & Mullins highlight the six worst offenders in the nursing home industry in California.

4083404157_4715434f19.jpg The six companies outlined in this article were featured in by an elder law advocacy group in California, Stop Elder Abuse (Stop EA). This coalition specializes in identifying and exposing the companies with extensive records or harming or neglecting patients. All six nursing home chains are private corporations that knowingly place profits over patients, leaving elderly residents at risk of systemic abuse and neglect.

The six worst nursing home offenders in California are:

1. North American Healthcare (NAHC)
2. Longwood Management
3. Golden LivingCenters (previously Beverly Enterprises)
4. Sava SeniorCare
5. Emeritus
6. Vitas Innovative Hospice Care

Many of these companies operate on a national level, with hundreds of facilities. It is not difficult to see how this type of business model, when applied to compassionate care, can lead to widespread abuse. We will explore each corporation in detail below.

North American HealthCare

This company operates 35 facilities in four states, however none of them use the NAHC name. The U.S. Department of Health and Human Services (HHS) investigated NAHC in 2010 for suspected fraudulent billing, among other allegations. The feds found that 64% of NAHC patients were billed to the highest category of Medicare and Medicaid, which is reserved for only the sickest, most specialized patients (the national average is 9%).

There has also been much contention within the company over employee organization. Arguably, nursing home employees are the most important, critical part of how well residents are cared for. If staff is underappreciated and overworked, they simply will not have the time or resources to properly care for residents. This leads to significant problems in nursing homes, such as sepsis from untreated bedsores, the spread of infections, and overmedicating residents. It is unsurprising to learn, then, that NAHC has been subject to several civil suits over elder abuse and neglect, one of which resulted in a $29 million award to the victim's family.

Longwood Management

Longwood operates over 30 facilities in California, extracting money from each arbitrarily, to pay shareholders. This leaves its facilities unable to address critical patient needs, placing residents in immediate harm.

Golden LivingCenters

This corporation owns over 300 facilities throughout the country, with 20 in California. The company has been federally investigated for making false claims to Medicare and Medicaid and subjecting residents to substandard services that caused great harm. Former employees have said the company is run on fear and intimation, and that they had to beg for new wheelchairs and mattresses.

Golden was recently hit with a class action lawsuit for its failure to disclose the true nature of its business. Plaintiffs claim that Golden did not provide sufficient nursing staff, deceived and misled vulnerable elderly residents into becoming residents.

Sava SeniorCare

Sava ranks among the nation's largest nursing home chains, with 26 facilities in California. It has also been subject to extensive litigation over negligent and abusive resident care. Sava is known for hiring staff that is untrained, unqualified, unlicensed, and ill-equipped to handle the careful care of senior citizens.

Emeritus

Emeritus is the country's largest for-profit assisted living operator, with more than 500 facilities. It is a publically traded company, so the bottom line drives everything. Staffing is always kept to a bare minimum, training is nearly nonexistent, and health and safety codes rarely followed. Unsurprisingly, Emeritus is constantly in the midst of lawsuits from victims of abuse and neglect, but since they rake in about $1 billion in revenue each year, they can afford the litigation. PBS Frontline recently aired a special on their poor practices and million-dollar lawsuit payouts.

Vitas Innovative

Vitas is an end-of-life hospice company, which enjoys about $1 billion in revenue every year. The company was sued by the federal government in 2013 for - what else - improperly billing Medicare and Medicaid. Providing hospice care is an immense and incredibly important responsibility. Knowing that hospice companies are motivated by finances rather than compassionate care is disheartening to say the least.

Vitas encourages staff to admit as many patients as possible, regardless of medical status. The consequences of this practice are far-reaching, but most acutely felt by the elderly residents themselves, who so rarely get the help they need.

Continue reading "The Six Worst Nursing Home Facilities in California" »

The Elderly in the ER

March 18, 2014

6336510146_e76da8e697.jpgOur team of nursing home negligence lawyers recently wrote on the alarmingly high rate of elder injury from medical care (one third of nursing home residents are injured by medical errors). Unfortunately, nursing home residents are often admitted to the emergency rooms, where the staff knows next-to-nothing about the person they are taking care of. Here we have outlined a few ways those in the industry are trying to fix this.

Dr. Pauline Chen recently wrote a blog for the New York Times on the subject, asking whether emergency rooms are at all safe for the elderly. In her piece, Dr. Chen recounts the story of an elderly man she once treated in the ER for a serious infection. The man lived alone, was overwhelmed by the information given to him in the ER, and none of the staff had been trained in coordinating the complex care elderly patients often require.

Finally, unsure how to proceed, an older nurse suggested they just admit the man to the hospital. It would cost more, and was likely unnecessary, but it was the only way they could ensure he received proper care. This case is far from uncommon, and the number of older Americans who need immediate or complex health care is expected to increase substantially over the next few decades.

Because our healthcare system is already short of primary care and geriatric caregivers, many elderly people will wind up in the ER for things like infections or falls. Emergency rooms themselves, however, are usually overwhelmed by patients and doctors and nurses are required to get through patients as quickly as possible.

With elderly patients, particularly those with dementia or other cognitive conditions, working quickly is not only dangerous but nearly impossible. Many nursing home residents suffer from numerous physical and cognitive ailments, take several different types of drugs (which are difficult to remember), and have trouble remembering other important details.

Medical experts recognize this danger and are taking measures to improve it. Among their calls for action, these specialists assert that medical centers need to update their facilities to meet the needs of elderly patients. More specifically, they recommend that hospitals:

• Hire or train staff on caring for older patients
• Screen for dementia
• Install non-slip flooring
• Train staff on social factors elderly patients may require, such as transportation
• Have walkers, canes and other medical equipment on-hand
• Assistance with prescriptions

Is Telemedicine the Answer?

Others suggest that nursing homes start using telemedicine systems, which would let residents see a doctor through video conference. If a resident gets sick or injured, outside physicians can use video chat to see and speak to them. In a recent study on these types of systems in nursing homes, facilities that regularly used the service sent fewer residents to the hospital. That study, published in Health Affairs, can be found here.

However, simply making this type of service available in nursing homes does not guarantee that staff will properly use it. There is widespread issues inherent in the American nursing home industry, most poignantly how overworked the understaffed these facilities truly are.

Continue reading "The Elderly in the ER" »