Extendicare Announces Significant 2014 Profits

It is surprising to hear long term care push the fiction that Medicare and Medicaid don’t pay enough with profits like this.  http://www.marketwatch.com/story/extendicare-announces-2014-second-quarter-results-2014-08-06-1717337?reflink=MW_news_stmp

In our practice, we frequently see stand-alone facilities create the façade of corporate impoverishment, when in reality taxpayer money goes straight to do-nothing shell corporations and owners.  One of the greatest problems in healthcare today is the pressure on for-profit facilities to satisfy shareholders/owners, rather than focus on patient care.

Stark & Stark Spotlight on Continuing Care Retirement Communities

Acquiring continuing care—in a community setting—requires a major financial investment by both the consumer and the provider. For the consumer, doing so may involve spending most or all of a lifetime of savings; and for the provider, delivering promised services during the resident’s stay requires sound financial and actuarial management. The following will assist consumers or potential residents in considering Continuing Care Retirement Communities (CCRC).  

Continuing Care Retirement Communities Defined

Dedicated to adults who are usually, at least, 55-years old, CCRCs—sometimes referred to as a “lifecare” communities—combine living accommodations, and continuing care, including health-care provisions. As a resident’s age and needs increase, the CCRC must increase the service it provides to the resident.

Continuing Care

When a CCRC provides continuing care, the care will progress or increase as the resident’s needs increase. Continuing care may include one or more of the following components:

A.      Independent Living — A living unit chosen by the resident for his or her exclusive use, in which the resident can live and function independently.

B.      Assisted Living or Personal Care — Should a resident require assistance or supervision with one or more activities of daily living, then, depending on the facility and the degree of care needed, assistance to a resident may be given in a variety of settings. Possibilities include: (1) assistance in the resident’s living unit, (2) transfer to a residential health care unit which is located within the community, and (3) transfer to a designated supervised unit specifically reserved by the provider for assisted living within the community.

C.      Long Term Care or Nursing Home — When a resident can no longer function independently and requires constant supervision or care, that care will be provided in a long term care facility, commonly known as a nursing home.

Potential residents should find out which components a CCRC offers, as well as how the CCRC defines, manages, and charges for the components. The CCRC must disclose and detail that information in a Disclosure Statement, and in the Contract.

The Contract

Residents must enter into a contract with the CCRC, agreeing to purchase service and the right to live in a specific unit: Unlike Adult Retirement Communities, it is not an agreement to lease or purchase property. Thus, if the resident meets the CCRC’s health and financial requirements, it will provide continuing care for the resident’s lifetime, if the resident desires.

Continuing Care Offered Through Different Plans

A CCRC will offer continuing care through three basic contract plans, described as follows:

A.      The All-Inclusive Plan — The fees in this plan pay for shelter, residential services, and amenities; and long-term nursing care, as needed, at no additional cost, except for adjustments of operating costs due to inflation. There are some slight variations among facilities, but, generally, in an All-Inclusive plan the health care costs are paid through all of the fees paid to the facility by all of the residents, regardless of individual resident needs.

B.      The Modified Plan — This plan also includes shelter, residential services, and amenities. However, this plan covers only a portion of health care offered, usually for a specified time in the long-term facility (nursing home). After the specified time, the resident who needs the care pays for it at an additional charge, or the resident will pay for the health care at a fee which is less than the fee charged to non-residents.

C.      Fee-for-Service Plan — This plan usually includes shelter, residential services and amenities, and sometimes emergency health care. It usually guarantees access to long-term care, but the resident who receives care will pay for it as an additional cost. Monthly fees vary according to the type of plan, size of the living unit, number of occupants, and number of services included in the contract.

The fees a resident pays will vary according to the type of plan, size of the living unit, number of occupants, and number of services included in the contract.

The Fees

To access the CCRC’s living accommodations and other services, a resident must, typically, pay three separate fees: the application, entrance, and monthly service fee.

A.      An Application Fee — may be nonrefundable and as high as $500, but no greater;

B.      An Entrance Fee — is a one-time lump sum of money paid to the CCRC for the occupancy of an independent-living unit, and for the provision of health care.

C.      A Monthly Service Fee — is charge that residents pay the provider in return for the services identified in the contract. Because the monthly service fee is subject to inflation, increases in the monthly service fee should be expected.

Regulation

The State of New Jersey has regulated CCRCs since 1987 through the Continuing Care Retirement Community Regulation and Financial Disclosure Act (N.J.S.A. 52:27D-330 et seq.) The protects consumers by strengthening the CCRC’s long-term financial stability, and by requiring CCRCs to disclose a important information to the consumer before the consumer spends money and signs a contact.  The Disclosure Statement describes services, financial stability, fees, and other contract terms. Anyone considering a CCRC may acquire that statement directly from the CCRC.

More Information

The New Jersey Department of Community Affairs provides more information about CCRCs in its publication titled: Continuing Care Retirement Communities: A Guide Book for the New Jersey Consumer

A Call for Action to Address Abuse of Older Americans

Last month, the Department of Justice (DOJ) and the Department of Health and Human Services (HHS) announced a framework for tackling the challenges to elder-abuse prevention and prosecution. In doing so, the departments called on all Americans to take a stand against elder abuse, neglect, and financial exploitation.

The framework, known as the The Elder Justice Roadmap, directly addresses “a problem that has gone on too long . . . by offering comprehensive and concrete action items for all of the stakeholders dedicated to combating the multi-faceted dimensions of elder abuse and financial exploitation,” explained Associate Attorney General Tony West.

But as the Stark & Stark Nursing Home Litigation Group has continued emphasize: we must do more in New Jersey and Pennsylvania.

Accordingly, the DOJ has developed an interactive, online curriculum to teach legal aid and other civil attorneys to identify and respond to elder abuse. And HHS is developing a voluntary national-adult protective-services (APS) data system, which collects national data on adult mistreatment. The system will “help to identify and address many gaps about the number and characteristics of adults who are the victims of maltreatment and the nature of services that are provided by APS agencies to protect these vulnerable adults.”

Here—in New Jersey and Pennsylvania—local communities, families, and individuals can take the following important steps:

1.      Learn the signs of elder abuse. The National Center on Elder Abuse, a program of the Administration on Aging at ACL, has developed a helpful Red Flags of Abuse Factsheet that lists the signs of and risk factors for abuse and neglect; and

2.      Report suspected abuse when you see it. Contact your local adult protective services agency. Phone numbers for state or local offices can be found at the National Center for Elder Abuse website (New Jersey, Pennsylvania), or call 1-800-677-1116.

Associate Attorney General West said it best: “We must take a stand to ensure that older Americans are safe from harm and neglect. For their contributions to our nation, to our society, and to our lives, we owe them nothing less.”

If you or a loved one has any questions regarding elder abuse or neglect, contact Stark & Stark today.

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Staffing Issues May Affect the Quality of Care Rendered in Nursing Homes

When families are considering whether to use nursing-home services to care for their loved ones, they must consider various issues in determining whether a nursing home is capable of providing adequate care. Among other issues, a family must determine how well a nursing home staffs its operations.

For example, roughly 450 nursing-home care workers recently announced their intentions to go on strike to address the unfair labor practices occurring across four different facilities owned by the same company. But even before the workers commence their strike, the elderly residents within those facilities, and their families, have already endured the catastrophic effects stemming from underpaid staff, and the accompanying understaffed environment.

Understaffing, often, prevents facilities from delivering appropriate care to residents, and thus leads to neglect and abuse. For understaffed facilities, evidence shows increased incidents of—among other critical issues—pressure ulcers, catheterized patients, urinary tract infections; as well as an increased likelihood of death. At the same time, a facility must maintain adequate staffing to assist residents with eating, and to encourage their independence in feeding themselves. Without adequate staffing, facilities threaten residents with malnutrition and dehydration.

Furthermore, an underpaid staff may cause low morale, which will likely affect the quality care rendered to the residents, particularly for critical and labor intensive care such as frequent and regular turning and repositioning—often at least every two hours—of residents at risk of developing debilitating pressure ulcers. 

The dangers of understaffing in nursing homes is clear, and government regulators have attempted to reduce the negative effects by requiring all Medicare-participating nursing homes to meet the requirements specified in the Federal Nursing Home Reform Act. That legislation requires nursing homes to have enough staff to provide all necessary care to all patients on a 24-hour basis.

No one ever expects a family member or friend to be the victim of neglect or abuse in a nursing home. However, despite government regulations, residents of nursing homes often suffer the negative effects of underperforming facilities.

When someone you care about has been the victim of nursing-home negligence or abuse, the problems can seem overwhelming. Stark & Stark’s Nursing Home Litigation Group will advise you of your loved one’s legal rights, and will aggressively prosecute a claim whenever our investigation reveals any instances of negligence or abuse.

Stark & Stark Shareholder Speaks at 2014 AAJ Annual Convention

Stark & Stark Shareholder, David R. Cohen, Esq. spoke on the topic “Advocacy Track: Social Media and Technology” at the 2014 American Association for Justice Annual Convention in Baltimore, Maryland. Mr. Cohen is a member of Stark & Stark’s Accident & Personal Injury Group and Chair of the firm’s Nursing Home Litigation Group. Mr. Cohen concentrates his practice in nursing home negligence and abuse claims, elder abuse and assisted living facility litigation. If you would like to see a photo of this event, click here.

 

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New Jersey and Pennsylvania Nursing Homes Have Plenty of Room for Improvement

The second edition of the State Long-Term services and Supports (LTSS) Scorecard (2014), sponsored, in part, by the AARP, assigned New Jersey a 26th, and Pennsylvania a 42nd, overall ranking based on performance across twenty-six indicators, grouped into five dimensions, which include (1) affordability and access, (2) choice of setting and provider, (3) quality of life and quality of care, (4) support for family caregivers, and (5) effective transitions.

LTSS help persons-in-need perform activities of daily living that would be difficult or impossible for them to perform on their own. Services and supports are delivered in a variety of settings, but nearly everyone prefers to remain at home. When families must rely on nursing homes to provide those services and supports, family caregivers often attempt to provide oversight to ensure that care rendered by the nursing home or assisted-living facility is appropriate.

A Closer Look at the Effective Transitions Dimension

The Scorecard ranked New Jersey at 36 and Pennsylvania at 28 in the effective-transitions dimension, which shows that states that rely heavily on nursing homes for LTSS also demonstrate less effective transitions across care settings. That means that individuals with complex needs are more likely to experience inappropriate and costly hospitalizations and inadequate support in moving from a nursing home back into the community. This dimension aligns well with the quality of life and quality of care dimension.

The Scorecard explains that “unnecessary transitions among settings are disruptive, especially to people with dementia, and can increase the risk of medical errors. Moreover, when they occur at the end of life, they can indicate poor management of care or overly aggressive treatment.”

Notably, high ranking states tend to minimize disruptive transitions and focus more on helping nursing-home residents return to their homes and communities. Accordingly, states must actively facilitate those transitions. That is: provide adequate support  for movement from nursing homes back to the home- and community-based settings that most people prefer.

If you or a loved one has any questions regarding nursing home neglect, contact Stark & Stark today. 

 

Boston Nursing Home Cuts Wages of Workers

Shortly after Lexington took over this nursing home, plans were made to cut wages of important healthcare providers by as much as 40%.  This represents a true danger to those residents.  For more information, read here.

Nursing Home Resident Presses On to Attend D-Day Ceremony in Normandy

As a veteran myself, I loved this amazing story from England.  Bernard Jordan is a 90 year-old WWII D-Day veteran.  Unfortunately, he was originally unable to go to the ceremony commemorating the 70th anniversary of the D-Day landing because his request to take the tour attending was made too late.   Undeterred, Mr. Jordan, who is cognitively intact and able to make daily trips into the town where he lives (and once was mayor), just got on a bus and went himself.  He wore his war medals under his jacket.

I love this story because I find at times people are tempted to see the elderly in nursing homes as just a sick person with dementia at the end of their life.  This story perfectly illustrates that nursing home residents are not the sum total of their medical records.  That in many cases they lived amazing lives and accomplished great things – including participating in the largest amphibious assault in world history. 

Cheers to Mr. Jordan.  You can read the Today News article by clicking here.

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Residents Not "Improving" May Now Get Physical, Occupational Therapy if Helping

I have heard many stories over the years of families that fight to keep a nursing home resident getting physical, occupational, or speech therapy. It used to be that if there was a determination that a resident wasn’t progressing anymore, then Medicare or Medicaid did not pay, and the therapy was discontinued. 

Many families were unhappy. Even though their mom or dad was not improving, the therapy was still beneficial – getting their resident moving or out of bed was simply good for them. They had to go through a lengthy appeals process.

Now however, after an important lawsuit filed against CMS, they are changing their policy.  The New York Times reports that “[b]ecause of the settlement, the agency updated its policy manuals last year. The revisions make clear that if treatment is needed to prevent or slow further deterioration in a patient’s condition, ‘coverage cannot be denied based on the absence of potential for improvement or restoration.’ The update applies to therapy provided in nursing homes, in outpatient clinics and at home.”

This means that even if mom or dad is not improving but therapy is helping, they may be able to still get the therapy. This is good news for seniors and their families.

You can read the full article by clicking here.

 

Nursing Homes Struggle to Hide Behind Corporate Entities

When I first began doing long-term care litigation, I assumed one owner was responsible for the conduct of their nursing home and stood behind a facility.  I’ve since learned that this is not normally the case.

Typically, filing a lawsuit against a nursing home or assisted living facility requires significant corporate research.  The plaintiff may have to sue holding companies, limited liability corporations, real estate companies, corporate partnerships, limited liability partnerships, and other corporate entities just in order to hold the right person responsible.

We call this the corporate shell game.

Many nursing homes fragment their companies in order to avoid liability and hide assets.  These are the entities we trust to care for some of the most vulnerable people in our community.

Fortunately, this practice is getting more difficult to pull off.  Obamacare has made it mandatory to disclose all entities that have an interest in a facility.  They can no longer hide behind various fake companies.

An interesting article in McKnight’s highlights this issue and recent fixes at both the federal and state level.  You can read the article by clicking here.

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New Blood Test Predicts Development of Alzheimer's

Alzheimer’s can be a devastating illness that we see in many of our cases.  Good news from the front against this disease is that a new blood test was developed that can accurately predict the development of the disease.  While not yet fully available to the public, when it is it could have wide ranging possibilities. 

Knowing in advance that the disease is a real possibility will give people the ability to plan for a time when they may not be able to care for themselves – to purchase long term care insurance, draft a proper will, and make sure a power-of-attorney is in place.  It will also give patients the ability to take medical steps immediately to prevent or treat the disease as early as possible.

You can read the full VOA article here.

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New Study Illustrates Problems with Sedentary Lifestyle

If you’re over 60, the next time someone tells you to “take a hike” it might not be a bad idea.   

A new study shows how problematic a sedentary lifestyle can be.  The study found that adults over the age of 60 spend roughly 9 sedentary hours per day, and that “[e]very additional hour adults over age 60 spend sitting increases by 50% their risk of being disabled for activities of daily living such as bathing, dressing and walking”.

Exercise generally is linked to better health, both physically and mentally.  Turn off the TV and take a walk instead.  You’re far better off. 

To read the full article describing the study, please click here

Pressure Sores are Preventable

There is a great PBS interview of a former CEO who talks quite candidly about preventability of pressure ulcers (bedsores) and the misdirection of health care in America. Please click here to see that interview. 

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Elderly Man Dies After Being Left in Burning Sun Due to Understaffing

Many times, when I tell people the facts of our cases they cannot believe them.  Sometimes, the care and neglect the elderly suffer is simply stunning. 

This story from Florida is both horrifying and yet not surprising.  In a ManorCare facility in Florida, an elderly man died with second and third degree burns after being left out in the sun for almost 4 hours.  It is another example of a stressed facility with too many residents to care for.  It’s all about profit.  In a drive for profits, staffing gets slashed because it’s the biggest expense.  While most aides and nurses care about their residents, there is just not enough of workers to get the work done.

This was born out by a former employee of that facility who stated “she watched as conditions got worse over the past six years as budgets were slashed.”

The same employee went on to say “’A nursing assistant who would normally give daily care to eight patients is now up to nine, 10 or 11 patients,’” she said.  The former employee added that if it’s the night shift, an aide could have as many as 20 patients to look after.”

To read the full article, please click here.

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A Real Cause of Increased Costs in Health Care is Fraud, Not Lawsuits

Even though lawsuits and litigation comprise only a small portion of the cost of health care – less than 1 percent – attorneys constantly get blamed for the rise in medical expenses.

You can read the statistics, which come from a study done by John Hopkins University School of Medicine and reported in the UPI, here.

A real driver of health care costs is fraud.  A recent L.A. Times article chronicles that the Ensign Group Inc., which operates nursing homes along the West Coast, just settled with the government to reimburse $48 million due to fraudulently inflated Medicare bills.  The facilities were billing for unnecessary work, or work that was never done – mostly in the areas of physical, occupational, and speech therapy. The company would have gotten away with it of not for an employee that spoke up and brought the truth to light.

You can read the full article here.

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