Injuryboard Commentary - Nursing Home

Nursing Homes Still Profitable during the Recession

Beth Janicek — Wed, 18 Nov 2009 15:13:43 GMT

To many people our recent recession is old news. By now, everyone is used to the downturn in the economy, the rising unemployment rate, foreclosures, and the stock market falling. Despite the weekly news of corporations declaring bankruptcy, some businesses are actually still showing nice profits. For instance, large Nursing home ownership companies are still profitable.

The Ensign Group, Inc. which is in the business of skilled nursing, rehabilitation care services, hospice care and assisted living companies recently reported record results for the third quarter of the fiscal year 2009. The company recorded total revenue of $132.9 million, which is up 14.3% from the $116.3 million recorded last year at this time.

Kindred Healthcare, the Louisville long-term care company recorded revenue growth in each of its three divisions – hospitals, nursing homes, and rehabilitation. The company recorded revenue for the July-to-September period of $1.06 billion, which is a 6% raise. Shares went down to about 4% in after-hours trading.

Five Star Quality Care, Inc. announced its total revenues for the third quarter of 2009 to be $297.2 million, a 5.9% increase from the same period last year.

It is great that these large companies are still profitable. However, I believe that they need to take these profits and put them back into the long-term care facilities. The extra funds could help improve living and safety conditions for residents by better staffing the facilities and by doing a better job of training the employees.

Originally posted at InjuryBoard by Beth Janicek

AstraZeneca Allegedly Paid Psychiatrist to Over-Prescribe Anti-Psychotic Medication to Patients

David Mittleman — Sun, 15 Nov 2009 10:00:00 GMT

The pharmaceutical giant AstraZeneca may have found it’s most lucrative salesman yet when they discovered Chicago psychiatrist Dr. Michael Reinstein. Indeed, Reinstein was allegedly bringing the company a small fortune in sales by promoting the anti-psychotic drug Seroquel to his mentally ill patients in Chicago-area nursing homes. Furthermore, Reinstein allegedly published research findings that promoted the effectiveness of the drug.

AstraZeneca allegedly paid Reinstein over $490,000 over a decade to peddle their drug. During the same time period, Reinstein faced accusations from his colleagues at the Maxwell Manor nursing home where he worked that he overmedicated his patients. In fact, complaints from patients were so bad that a security guard had to accompany Reinstein on his visits to the nursing home. Some staffers even accused him of convincing patients to take the powerful antipsychotic drug by promising them they would receive passes to leave the nursing home. However, Maxwell Manor closed its doors in 2000, after state officials shut it down for inadequate care and wretched conditions. Now Dr. Reinstein works for other Chicago-area nursing homes and apparently has continued his drug-peddling ways.

While it isn’t illegal for doctors to be paid for conducting research on behalf of drugmakers, health professionals who have encountered Dr. Reinstein have had similar concerns as those of his former colleagues at Maxwell Manor. For example, the case manager at Grasmere Place nursing home in Chicago wondered why Dr. Reinstein put his patients on twice as many drugs as other psychiatrists at the nursing home. There is not a federal lawsuit against AstraZeneca for their actions in paying Dr. Reinstein to allegedly over-prescribe Seroquel. Specifically, court documents show that Reinstein ordered Seroquel for as many as 1,000 Chicago-area Medicaid patients per year, which cost taxpayers as estimated $7.6 million per year. AstraZeneca maintains that they did not profit from the increase in Seroquel sales in Chicago. Rather, they continue to argue that they paid Dr. Reinstein for his promotional work and research only.

Originally posted at InjuryBoard by David Mittleman

New Website to Help Families Learn About Nursing Homes

Billy Cunningham — Sat, 14 Nov 2009 08:40:00 GMT

The National Citizens for Nursing Home Reform (http://www.nccnhr.org/ ), a consumer advocacy group for nursing home residents and caregivers in nursing, homes, announced that the Brown University Center for Gerontology and Healthcare Research has introduced a website designed for nursing home researchers that provides data on nursing home care in the US. The website states that its goal is to allow researchers to trace relationships between state policies, local market forces and the quality of long-term care and enable policymakers to craft state and local guidelines that promote high-quality, cost-effective, equitable care for older Americans. NCCNHR believes the site will also be enthusiastically received by many consumer advocates looking for detailed data and more sophisticated comparison tools than provided on other website such as Nursing Home Compare.

The interactive database, www.LTCfocUS.org, incorporates information from a number of government sources-Medicare reimbursement claims, OSCAR (CMS's Online Survey, Certification and Reporting system), the MDS (Minimum Data Set), and Brown's own survey of state Medicaid policies Users can interact with the website by creating interactive maps and tables with comparative information about states, counties, or individual nursing homes. All data provided on the website are also available to download.

The website provides the type information that users can employ to choose up to five variables. It allows the user to create a chart comparing all nursing homes in a state. The broad range of variables from which to choose includes number of beds; for-profit and chain status; percent of Medicare and Medicaid beds; Alzheimer's units; occupancy rates; age ranges, gender and race of residents; direct care staffing (RN, LPN, CNA); acuity of care; certain MDS quality measures; source of admissions (hospital or home); and 30-day rehospitalization rates (a potential indicator of quality not found on Nursing Home Compare).

The website is sponsored by the National Institute on Aging-funded Shaping Long-Term Care in America project housed at the Brown center. While its stated purposes are to "allow researchers to trace clear relationships between state policies and local market forces and the quality of long-term care" and to allow policymakers "to craft state and local guidelines that promote high-quality, cost-effective, equitable care to older Americans," NCCNHR recommends that consumer go to this site to perform their researches about nursing homes in their areas before placing a loved one there. The more you can know about your options for placing loved one in a nursing home , the better equipped you'sll be to help prevent any nursing home negligence or abuse.

Originally posted at InjuryBoard by Billy Cunningham

Caps on Damages Make No Sense

Billy Cunningham — Sat, 07 Nov 2009 11:14:08 GMT

The Republican proposal on health care reform has provisions to limit compensation for non-economic injuries to persons injured or killed as the result of medical malpractice including residents of nursing home who are neglected or abused. Most of my practice over the past 23 years of my 35 year career has been representing nursing home residents. I began thinking of how I would tell clients and/or their families that nursing home neglect and abuse was included in the medical negligence bill proposed. How do I explain that injuries to the elderly, vulnerable members of our society are limited? Here are people who cannot protect themselves, who rely on nursing homes for their safety and well being, and to provide a quality of life that Congress knows what the limit of those injuries are? I thought of all the cases that I have handled involving injuries in nursing homes. The following are actual examples of victims of nursing home neglect and abuse that under the standard proposed by the Republicans would be limited in any award against the nursing home that caused the injuries or death the award.

Mr. A. who had a grapefruit sized vaginal malignant tumor that the nursing home never knew about- death case.

Mr. B. , an Alzheimer patient in a ‘special unit’ who despite no other physical diseases developed multiple state 4 pressure sores, contractures and severe weight loss – death case.

Mr. C., a smoker, who was strapped in a wheelchair and unwatched burned to death when a lighter caught his clothing on fire.

Mrs. D who was overdosed with psychotropic medications to keep her quiet and while trying to escape the torture fell in a bush and lost an eye. After this incident she was moved to a nursing home that properly cared for and weaned her off the psychotropic medications. She was discharged and the last I heard was playing the slot machines in Biloxi. Personal injury case.

Mr. E. who was beaten to death by another nursing home resident who had previously beaten other resident. No precaution was taken to protect any of these residents.

Mr. F. who was demented and known to have a desire to leave the facility and fell from an open window. death case

Mr. G. who went in a nursing home for a 21 days rehabilitation after hip surgery and developed a pressure sore so big on his leg that the leg had to be amputated- personal injury case.

When you look at the data which shows that medical malpractice is a very miniscule part of the cost of health care, you have to ask yourself whether proposed limits are fnecessary for health care reform or fair to the victims.

Originally posted at InjuryBoard by Billy Cunningham

Contact You Congressman to Pass the Fairness in Nursing Home Arbitration Act

Billy Cunningham — Sat, 31 Oct 2009 10:53:09 GMT

Last January I wrote a blog on the Fairness in Nursing Home Arbitration Act (then Senate Bill . 2838 and now Senate Bill 512) The last report from Congress is that the bill was referred to committee in July. I said then that we all need to keep an eye out for the bill and write our Senators. With Congress in the midst of debating and considering the health package now is a good time to ask them to pass this bill to protect our elderly.

The bill would amend the Federal Arbitration Act (FAA) to invalidate mandatory binding arbitration contracts that are unfair to the elderly because they take away their right to be heard in a court of law and increase their vulnerability to neglect and abuse in a care facility.

The bill does not prohibit arbitration. Rather, it would ensure that the resident or his or her representative could voluntarily choose arbitration after a dispute arose. If arbitration is truly fair and efficient, as some have argued, then both sides should be able to voluntarily choose arbitration after - not before - a dispute arises.

I have seen nursing home corporations insert forced arbitration clauses in their contracts and have them signed by residents who have dementia, by family members who are told they have to sign the whole agreement or their loved one will not be admitted and by the nursing homes own employees who forge signatures. Why do the nursing homes want arbitration so badly? Because it means they will never be held publicly accountable for their actions, no matter how egregious their conduct. Then when a decision is made by most likely a hand-picked arbitrator, the patient is denied the opportunity for judicial review.

On the other hand, if allowed to utilize the court system, society benefits from an open legal process that exposes nursing homne neglect and abuse. One of the most important benefits of civil lawsuits is the discovery process, which often discloses shoddy corporate practices, such as staff reductions, that lead to neglect. Forced arbitration, on the other hand, restricts residents’ ability to get information and keeps abusive business practices hidden.

So again I urge you to contact your representatives in Congress and let’s get this bill passed!

Originally posted at InjuryBoard by Billy Cunningham

The Consumer's Role in the Nursing Home/Healthcare Reform Battle

Billy Cunningham — Sat, 24 Oct 2009 12:10:28 GMT

Health care reform is the big issue today- as it should be. But how will it affect our elderly in nursing homes? Nursing home owners say they are looking at $16 billion dollars in cuts from Medicare over the next 10 years. Is that so? The Washington, DC-based Center for Medicare Advocacy (http://www.medicareadvocacy.org/ ) reviews reports from the Government Accountability Office (GAO) and the Medicare Payment Advisory Commission (MedPAC) and advises that those reports show that Medicare overpays nursing homes billions of dollars a year. MedPAC found that the aggregate profit margins for freestanding nursing facilities exceeded 10 percent for seven years in a row. In 2007, their profit margin was 14.5 percent. Moreover, they didn’t add staff. So the Center for Medicare Advocacy believes that the nursing home operators are pocketing much of the profits, rather than reinvesting them. The reports also cannot account for money paid out to associated groups who own the property, manage the facility etc.

We read every day about Congress wrestling with health care reform. Hand in hand with Congress are the groups we refer to as lobbyist- there to make sure their particular industry is protected. One of those groups, of course, is the nursing home industry, which claims it is facing a $16 billion cut in direct support from Medicare over the next 10 years, as well as Medicaid cuts in many states.

The nursing home operators warn that further cutbacks in Medicare-which are part of the reform legislation– will drive many facilities out of business. Some homes are laying off employees now, and a few have recently closed. We are also seeing the nursing home reduce Registered Nurses with Licensed Practical Nurses in many areas. Meanwhile, the need for these institutions is increasing. As the number of people going into nursing homes increases so does the level of nursing care.

Are the nursing home owners trying to defeat healthcare reform because Medicare benefits reduction will affect care .or their bottom line? Is the advocacy center right that profits are really higher than reported? Nursing home owners have been known to put their own profits before people. There are cuts in Medicaid. We should all be concerned about the care our elderly will receive.

Knowing what is going on in your local nursing homes is probably the best each of us can do on an individual level. Check them out carefully before placing your loved one in a nursing home. The earlier you know what to look for to prevent nursing home neglect or abuse, the better for your loved one. Here are some cites that will give you information about getting good care: the National Coalition for Nursing Home Reform http://www.nccnhr.org/ , a governmental agency, the National Center Elder Abuse Http://ncea.aoa.gov , and Medicare web site http://www.medicare.gov/nursing/overview.asp.

There are warning signs that nursing home abuse or neglect may have occurred. It is not uncommon to hear reports of various forms of violence and irresponsible, inhumane treatment being inflicted upon residents, including: physical assault and battery ; sexual assault and battery; rape; deprivation of food and water; unreasonable or unwarranted physical or chemical restraint; withholding of needed medication ; overmedicating; suspicious injuries; appearance of untreated wounds, cuts, bruises, welts; reports by residents of being slapped, struck, pushed, shaken, beaten or likewise mistreated; improper confinement; serious injuries requiring emergency treatment or hospitalization; and incidents that result in broken bones, especially a fractured hip.

Originally posted at InjuryBoard by Billy Cunningham

97-Year-Old Man Dies After Nursing Home Allegedly Ignored Sore on Penis

David Mittleman — Wed, 21 Oct 2009 10:07:21 GMT

The son of 97-year-old Charles Bradley is suing the Everett Care & Rehabilitation nursing home facility in Everett, Washington after his father’s genitals allegedly disintegrated from penile cancer and ultimately contributed to his death.

According to court documents, Charles Bradley entered the nursing home in 2004 because of the usual ailments associated with old age. He continued to live in the nursing home until two weeks prior to his death on March 31, 2008. He apparently had a sore on his penis, which the hospital staff ignored until he was rushed to the emergency room on March 13, 2008. The injury to his penis was purportedly undiagnosed penile cancer.

The attorney for Bradley’s son argues that Everett Care & Rehabilitation staff allowed Bradley’s injury to worsen for months without care. According to the complaint, staff at the center noticed the wound while changing Bradley’s diaper in November 2007. The staff member who initially noticed the wound notified the care manager, however, that manager failed to notify Bradley’s doctor. Instead, Bradley’s wound continued to fester for the next four months and his genitals continued to disintegrate. Finally, when Bradley arrived at the Providence Medical Center on March 13^th, he was initially diagnosed with pneumonia. However, doctors soon discovered the wound on his penis and determined that he had penile cancer.

The plaintiff’s attorney argues that Everett Care & Rehabilitation violated their promise to care for Charles Bradley. The lawsuit specifically seeks to hold the center accountable for allegedly failing to protect the elderly. Indeed, while the center refuses to discuss specifics on the incident, citing patient privacy concerns, they have not explicitly denied error. In fact, they have already received one citation from the Department of Social and Health investigators for failing to meet quality of care requirements designated by federal laws.

Originally posted at InjuryBoard by David Mittleman

Nursing Home Residents Death Caused By Abuse

Mike Bryant — Mon, 12 Oct 2009 16:31:00 GMT

A Minnesota Department of Health report found that White Community Hospital and Nursing Home staff in Aurora dropped a resident several feet while being moved in a sling from her bed to a wheelchair. As a result she suffered broken bones that contributed to her death. The hospital's internal investigation said the employee failed to follow the resident's care plan, which said such a transfer required two staff members.

Hubert Humphrey talked about the way a society is doing could be judged by the way they cared for their elderly. This story is a example of treatment at it's lowest.

Nursing Homes are often medical necessary for many families. They can be very expensive. They are the residents homes surrounded by professionals in charge of caring for them. The place they should always feel safe.

If you have a family member in a nursing home , it is important to look around on each visit. Be vigilante in certain areas. Look for signs of Physical Abuse, Neglect, and Verbal/Emotional abuse. If you see signs of abuse:

Contact the Nursing Home Administrator and tell them your concerns.
Contact the Minnesota Board of Aging.
Contact the police department in the municipality where the abuse occurred.

It's important that we protect all of those that have contributed to society and who are the most vulnerable.

Originally posted at InjuryBoard by Mike Bryant

Home Health Care Nursing Risks Face The Elderly

Wayne Parsons — Mon, 12 Oct 2009 15:49:13 GMT

When it comes to elderly care, most of us immediately worry about the living conditions of the patient. Are his nurses treating him well? Does she receive the attention and stimulation that she needs? These are important questions, but they only tell half of the story. As a recent study from the Columbia University Mailman School of Public Health reveals, we must also pay attention to the health and welfare of the nurses themselves.

Home healthcare is the fastest growing healthcare sector in the United States. Although few studies have examined the conditions of employees in the industry, the results from Columbia provide grounds for concern. More than seven out of every 100 nurses have suffered (or, based on statistical analysis and projections, will suffer in the future) a needle-stick injury, meaning that over 100,000 of these injuries occur in an average year. Considering that dirty needles can transfer AIDS, hepatitis, and a host of other blood-borne pathogens, it seems worthwhile to examine ways to improve working situations inside patient’s homes.

The study revealed several risk factors for increased injury incidence. Smoke, pollution, pests, and just plain dirtiness were all found to elevate rates of needle-sticks. Additionally, nurses who had been exposed to acts of violence were more than three times as likely to accidentally hurt themselves.

This problem will not be easy to fix. The home healthcare industry is largely unregulated, and, even though nurses are almost always expected to notify health care officials if they find breaches of sanitary or hygienic standards, they are under almost no obligations to report violence. The only solution, it seems, is self-regulation. Healthier, happier nurses means healthier, happier, patients, a correlation that will become especially important our elderly population continues to expand.

Originally posted at InjuryBoard by Wayne Parsons

Nonprofit Nursing Homes Provide Better Care

Don Greiwe — Thu, 01 Oct 2009 08:01:00 GMT

A group of doctors from around the world have came together to take a hard look at the relationship between nursing homes and profiteering, and the results reaffirm what many of us would have guessed: Nonprofit nursing homes provide better care than for-profit nursing homes.

Dr. Gordon Huyatt, the senior author of the study, stated “the reason patients' quality of care is inferior in for-profit nursing homes is that administrators must spend 10 percent to 15 percent of revenues satisfying shareholders and paying taxes,” and as a result, “For-profit providers cut corners to ensure shareholders achieve their expected return on investment.”

Looking at 82 different statistical studies taken into account, 40 significantly favored nonprofit facilities. This means that in 40 of the 82 reports, it was obvious that patients received better care at the nonprofit facilities compared to for-profit facilities. On the flip side, only 3 of those studies favored for-profit facilities. The remaining 39 studies had inconsistent findings and were not counted either way. The study looked at four major factors in determining quality of care:

More or higher quality staffing;
Lower rates of pressure ulcers;
Less use of physical restraints; and
Fewer deficiencies cited by regulatory agencies.

These findings have significant implications for patients across America. Of the roughly 80,000 patients who have bedsores, 7,000 of those can be attributed to for-profit ownership. Additionally, the study went on to predict that if all the current for-profit nursing homes converted to nonprofit, 500,000 hours a DAY would become available to residents without additional cost.

There are many ways to interpret the study data, but the overall conclusion is clear: nonprofit nursing homes offer better care than for-profit ones. These sorts of studies may be very important in the health care reform debate, as many reformers push for an increase in “evidence-based medical treatment.”

Moving forward, if you or a loved one needs the care of a nursing home, look into whether that home is for-profit or not, because it clearly should be a factor to consider.

Originally posted at InjuryBoard by Don Greiwe