Nursing Home Law Blog : Nursing Home Lawyer & Attorney : Stark & Stark Law Firm : Elder Care, Senior Care

Families for Better Care – a citizen’s advocacy organization – showed in a recent study that the largest publicly traded nursing home chains remained very profitable despite Medicare payment cuts last year.  The director of Families for Better Care, Brian Lee, believes that the profits are driven by lower nursing hours and less care based on a study conducted last fall.

‘“The reason care declines in nursing homes is that executives unnecessarily target labor costs to offset any reimbursement adjustments,” Lee said. “While this obviously maintains a robust bottom line for investors and cushy CEO salaries, the decline in frontline staff puts residents in jeopardy for harm while simultaneously creating dangerous working conditions for employees.”’
 

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A new study conducted by Center For Medicare Advocacy (CMA) concludes that while “some for-profit nursing facilities give excellent care and some not-for-profit nursing facilities give poor care – the general rule is documented in study after study: not-for-profit nursing facilities generally provide better care to their residents.”

While each nursing home is truly different, knowing the facts before choosing a facility is key.
You can read the full study results online here. 

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While many people have no formal medical training, having a parent that suffers from Alzheimer’s or dementia can give people a crash course in anti-psychotic, anti-depressant, and anti-anxiety medications.  Often times, these family members tell me they did not like the fact that their parent or loved one was taking these medications because it turned their parent “into a zombie,” had potential serious side effects, or just didn’t work. 

It appears that, in two articles today (available here and here), these family members may be right about the drugs not working.  Both articles discuss findings that some medications may not be as effective as previously thought, and that doctors are not getting the full picture with some of these drugs.

The articles find that some medical journals “continue to paint an overly rosy picture of the effectiveness of new drugs” and “selectively left out unflattering results.”

It’s important to know the medications your loved one is prescribed.  A family member spends the most amount of time with a resident and is best positioned to know what effect a drug is having on someone.  It cannot hurt to ask question.

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I just happened upon an excellent website (http://www.neverevents.org/), promoting the value of 11 years of “Never Events” as establishing safer practices in our hospitals. This site is authored by a physician and notes that another physician, Ken Kizer, MD, former CEO of the non-profit, National Quality Forum (NQF), first introduced this term in 2001. 

Since then, insurance companies, health organizations and later, the U.S. government, came on board – to support the notion that failing to protect the consumer public from preventable errors has devastating consequences for this nation. Topping the list on this site are preventable pressure ulcers.

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I recently met with Robert Ramsey of Garden State CLE to discuss the possible dangers facing Alzheimer's patients who reside in assisted living facilities when there is a "locked ward". Rob and I discuss why this source of abuse commonly happens, how I prepare for a case which includes this sort of abuse, and the genesis of the "Resident's Rights" statutes that now guides my practice.

The video is also available in a full-length version for those interested in obtaining CLE credits on this issue. For more information on how to register for these credits, visit the Garden State CLE's website, or feel free to contact me with any additional questions.

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Recently, I had the opportunity to review a long term care insurance policy. The document was confusing and full of exceptions. It was difficult for me to believe that the people who bought the policy could understand what it said.

Even worse is when a person who has paid for a long term care insurance policy is having difficulty getting the benefits. That is what some plaintiffs in California are alleging – that the company’s claims process is "designed to frustrate and confuse policyholders with needless demands for irrelevant information.”

While long term care insurance can be terrific protection for a family’s assets if long term care or home care is needed, not all policies or insurance companies are the same.  It certainly can’t hurt to have someone familiar with insurance products review a policy before purchase.  Many certified financial planners can review policies, or can assist in purchasing a policy best for the individual.  Researching companies before buying the products is also a good idea.

Insurance is only good if it works when you most need it! 
 

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A new study confirms that a large percentage of nursing home residents are prescribed anti-depressants, or selective serotonin reuptake inhibitors (SSRIs). While in most cases, anti-depressants are beneficial to the well being of the residents, in patients suffering from dementia, they can significantly increase the risk of falls - leading to serious injuries, and even death.

Researchers from the Netherlands recently reported that a study, which included 248 nursing homes, shows that anti-depressants were used on over 13,000 patients of which more than 650 sustained injuries. These falls occurred in 152 out of the 248 nursing homes included in the study. Additionally, 38 residents fell once during the time of the study, while 114 had multiple falls. Of those 650 falls, 220 resulted in serious injury, or even death.

It is imperative that these facilities conduct interdisciplinary care meetings to ensure that the proper protocols are followed, in order to reduce the risk of life-threatening accidents.

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While nursing homes should always look to prevent bed sores – a painful and sometimes deadly condition – a recent study conducted revealed that the prevention of bed sores is also cost effective.

Foam mattresses which reduce pressure were found to be cost-effective 82% of the time as opposed to using standard mattresses. This simple change could save on average $115 per resident. Additionally, foam cleansers for incontinence were found to be cost-effective 94% of the time, as opposed to traditional soap and water, which results in an average savings of $179 per resident.

On average, roughly 10% of residents in long-term care facilities have a pressure ulcer. And for those residents, treatments are critical early on in order to prevent a serious, and even life-threatening condition. A better solution to this problem is prevention. Nursing homes and assisted living facilities can, and should, prevent these problems from happening rather than treating them after the fact. Most importantly, not only are these prevention techniques the right thing to do, but they also save money for the facility!

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A recent article in the Star Ledger, Stronger safeguards needed in N.J. hospitals, nursing homes, asks the questions, “Should corporate lobbyists decide whether safe equipment and procedures are needed if you or a loved one have to go to a hospital or nursing home? Or should health care professionals make those decisions?”

All too often high power corporate interests utilize lobbyists to cut corners, increase profits and put patients at tremendous risk. In this recent article, we see how this plays out in ways that not only harm nursing home residents and hospital patients, but also places healthcare workers at risk. 

 

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I have had cases where a person suffers from a bed sore that is so large the spinal column is visible, and yet the cause of death listed on the death certificate states, “natural causes”, or “dementia”, or “Alzheimer’s”.  While we may still pursue a claim to hold those responsible for the large and painful wound accountable, it is frustrating to the family that the bed sore is not listed on the death certificate. 

We are currently prosecuting cases where had a resident not been taken to the hospital and died in the nursing home, the true cause of death would have never been discovered. 

Unfortunately, this situation is far from unusual. As reported in ProPublica, suspicious elder deaths are rarely investigated.  According to the article, autopsies performed on seniors are increasingly rare even though the United States population aged 65 and older has grown. From 1972-2007, the number of autopsies performed on seniors dropped from 37% to just 17% percent. Additionally, of the 1.8 million seniors who died in 2008, autopsies were performed on only 2%, and only performed on 1% for those elderly who passed away in nursing homes or care facilities.

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The Federal Government has joined in a Whistleblower suit, which alleges that AseraCare, a national hospice company owned by Golden Living, wrongly took advantage of Medicare’s hospice benefit by pressuring its employees to place people into hospice who weren’t dying. The suit states that AseraCare first recruited patients who are eligible for skilled nursing care for 20 days, for which Medicare pays the entire bill. After 20 days, when Medicare requires patients pick up a part of the tab, AseraCare had the nursing homes send the patients to hospice, according to the lawsuit. In hospice, AseraCare would collect a flat payment from Medicare for each day they are enrolled.

We will follow this story on our blog and the recurring problem that appears to be growing on a national basis throughout both nursing homes and assisted living facilities. Here is an article relating to the government’s press release on the suit.

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With the passing of the Affordable Care Act (ACA), this nation has seen the beginning of a dramatic shift in both the delivery of healthcare and the means by which payment is made for medical services.  Under the ACA, a new type of medical agency was created, known as Accountable Care Organizations (ACO). These entities are required to coordinate all levels of care in a fashion that is both more efficient and better focused on the provision of quality care.

As we have written on our blog, hospitals will no longer be paid to rectify medical errors which have been deemed as “never events.” This is a class of medical error which non-profit research groups and the federal government alike have determined to be wholly unacceptable in the hospital context. ACO’s are being organized to help prevent the occurrence of never events.

At present, we may be at a crossroads in terms of whether ACO’s will be lead by physicians or hospitals.  Either scenario has its share of opportunities and pitfalls. The New England Journal of Medicine has been following ACO issues and includes some excellent commentary.

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When first selecting a nursing home, the majority of people I meet have very little knowledge of how nursing homes work, how they operate, and how they are regulated.  Making this situation worse is the fact that selecting a nursing home must often happen quickly.

With a lack of knowledge, many people choose a nursing home solely because it looks clean and may have some modern amenities.  While these are factors a person may consider, the most important thing regarding any nursing home is that there is adequate staffing – with enough good and caring people to do the work.  Some excellent facilities are simply plain buildings with cinderblock walls and outdated furniture. 

A new study that confirms lowered staffing equals poor quality of care at some of the country’s largest for-profit nursing homes was reported in a recent article. 

The results were certainly not surprising and already known by most people working in the industry.  So, why are nursing home companies not hiring enough staff?  Simply put, to increase profit.  Staffing costs are one of the top expenses in a nursing home, and in order to drive up profits some nursing home companies staff their facilities at the bare minimum necessary to keep a facility out of trouble with the government.  

When selecting a nursing home, questions about staffing should certainly be expected.  A response that a facility tries only to meet government staffing regulations may not be good enough.  Additionally, good facilities tend to keep employees for a longer time.  A high turnover rate for aides and nurses may indicate a troubled facility.

Asking the right questions can be the key to avoiding a poorly staffed and substandard facility.  
 

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