Senior Living News Wire

The senior care industry can expect increased Medicare fraud scrutiny in the next couple years as the Obama administration seeks to recoup program dollars to help fund health insurance coverage expansion, according to a senior member of a law firm’s Healthcare Practice Group. 

“[Because of] healthcare reform, President Obama will try to find any Medicare fraud or abuse they can to reclaim money,”  said John Durso, JD, partner at Ungaretti and Harris, at Life Services Network’s annual meeting and expo in May. “[The administration] is focusing on that in our Medicare programs, in nursing homes and hospitals, to try to fund the expansion of healthcare reform to those who are currently uninsured.”

Under healthcare reform, more than 21 million people will become eligible for Medicaid-funded insurance coverage if all states participate in the program expansion, according to the Kaiser Family Foundation. While state spending is only expected to increase by about 3%, federal spending on the Medicaid program would rise 26% to nearly $1 trillion. 

The federal government has promised to cover 90-100% of care costs for the expected millions of new Medicaid beneficiaries at a time when state and federal Medicaid budgets are already strained. It’s led the Obama administration to look for ways to redistribute or recoup dollars from its other programs, such as through cracking down on fraud, said Durso. 

“It’s real money if they find people doing something wrong. They can hit them up for [re]payments out of their next Medicare payment,” he said. “It could be a huge money source.”

In fiscal year 2012, the Department of Health and Human Services and Department of Justice reported recovering $4.2 billion in taxpayer dollars from individuals and companies that had been fraudulently billing Medicare for reimbursements. Durso expects that amount to rise in fiscal year 2013 as the government redoubles efforts to prevent and halt Medicare fraud and crack down on fraudsters. 

Already in 2013, The Ensign Group (NASDAQ:ENSG) has reached an agreement with the Department of Justice to resolve Medicare overpayment allegations in a settlement that could reach $48 million. 

Life Care Centers, the nation’s third-largest nursing home chain, is currently under federal investigation, accused of overbilling Medicare millions of dollars for unnecessary or excessive therapy. 

Grace Healthcare LLC, a Chattanooga, Tenn.-based nursing home manager, has also been a False Claims Act target accused of billing for medically unnecessary rehabilitation therapy. The company and its affiliate have agreed to pay $2.7 million to resolve the allegations.

Another False Claims Act recouped $700,000 from Fairfax Nursing Center, a Virginia-based skilled nursing facility accused of billing Medicare for providing “excessive and medically unnecessary” therapy services to Medicare beneficiaries. 

Skilled nursing providers aren’t the only care providers facing scrutiny. 

“Opportunity for fraud is more prevalent in hospital settings than in nursing home settings,” Durso said. But skilled nursing facilities, like hospitals, chase referrals allowing them to bill for certain revenue-producing services, such as rehab. 

To avoid Medicare’s hammer of justice, he cautions, know the rules—and follow them.  

Written by Alyssa Gerace

Senior housing developers may still encounter difficulty obtaining financing for ground-up projects despite reports of the increasing availability of capital, and future growth plans play a crucial role in what kind of capital they pursue.   

Just because real estate investment trusts (REITs) enjoy a low cost of capital doesn’t mean they’re the best source of new construction financing—something the REITs themselves will acknowledge.

For Sabra Health Care REIT’s pipeline agreement with First Phoenix, for example, the REIT is supplying a relatively small amount of pre-development financing—just enough to get the project off the ground—with plans to buy the asset upon stabilization.  

“With our purchase option on the back end, it provides them with leverage for a traditional mortgage lender to provide them with more reasonably priced mortgage financing for development,” says Harold Andrews, CFO of Sabra (NASDAQ:SBRA). 

While the Department of Housing and Urban Development (HUD) and government sponsored entities Fannie Mae and Freddie Mac are highly utilized for acquisition and refinancing loans, developers are largely turning to regional banks to finance new senior housing projects. 

The vast majority of development that’s being done is capitalized with private equity from individuals or investors which is then paired with small or community-size banks who are doing construction lending, says Zeke Turner, chairman and CEO of private development company Mainstreet Property Group.

Because of the risk involved with new projects that aren’t stabilized, REIT financing generally bears a higher interest rate compared to a community bank. But it also generally eliminates the need for the developer to come up with any of their own equity, and when that’s factored in, the rates can become more similar, says Turner.

“If a REIT is going to be involved, they’ll finance a majority of the real-estate. They’re taking development risk, and putting dollars in during construction, buying into a project like any other investor would,” he says. 

Rates aside, a developer’s objectives can determine whether REIT financing is preferred above bank financing. 

“If you have the equity [needed to put into a project] and you’re happy with doing a single project with no regard to volume, you’re probably better off doing it on your own books through a mezzanine program, and then sell the project when it’s stabilized,” Turner says. “If you don’t have the equity or want to do development at a certain pace because you see opportunity in the industry, you’re much better off to pair with a REIT.” 

The Leo Brown Group, a relatively new entrant into the senior housing space with two projects in the works and a couple more recently completed, has been utilizing regional bank financing so far for its projects. But it hasn’t ruled out a REIT relationship for future projects, says the company’s vice president, Michael Wagner. 

The company operates its completed projects through a subsidiary, Traditions Management, which Wagner says has contributed to its success with obtaining financing for new projects despite being an industry newcomer, entering the market in 2006. The development-and-operations model is also part of the reason the company has been using bank financing to keep control over its assets. 

“We’re not looking to build our projects and then flip them,” Wagner says. “We want to continue operating them, and in some markets we may want to hold on to the real estate and operations.”

However, there are “ongoing discussions” with certain REITs, Wagner says, as in some circumstances it could make sense to sell the underlying real estate of an asset while still managing the community.

“We think there is more activity out there. In the last couple years you’ve seen these big portfolios get purchased by some of the REITs, and there aren’t as many opportunities for investment-grade assets,” he says. “REITs are recognizing that, and are turning to new opportunities on the development side.”

Retaining ownership of assets is key for the LaSalle Group, a developer with a 14-year track record and a similar development-and-operations structure through its affiliated management company, Autumn Leaves. 

“Historically, we have not been sellers,” says Brenda Brantley, CFO at memory care community developer The LaSalle Group. “The REITs are very aggressive right now, but can’t always [accommodate for] start-up costs and lease-up risk. You still have to bring in an equity partner or fund the equity yourself. Historically, our interests have not been aligned to make that structure work.” 

Instead, she says, The LaSalle Group provides repeat business to its “long-lasting” relationships with banks that are generally community-size and larger. 

Written by Alyssa Gerace 

While the federal Medicaid program is reportedly safe from cuts in President Obama’s forthcoming fiscal year 2014 budget, the same is not true for Medicare and Social Security, writes the New York Times.

Next week, the president is expected to formally propose cuts to Social Security and Medicare in his annual budget, according to administration officials, in what the N.Y. Times calls a “significant shift in fiscal strategy.”

The White House budget plan is scheduled to be sent to Capitol Hill on Wednesday. In previous years, the president’s budgets have essentially been declared “dead on arrival” by Republicans, but this plan contains compromises, says the Times.

In addition to containing some tax increases, the budget also proposes a new inflation formula for calculating Social Security benefits, called chained CPI, although there will be some financial protections for low-income and very elderly beneficiaries, says the Times citing administration officials.

Using the chained CPI formula—said to more accurately measure inflation compared to how it’s currently calculated—will reduce the cost of living adjustment (COLA) payments for Social Security benefits and could eventually reduce spending by $216 billion in a 10-year time frame, along with generating $124 billion in revenue, according to an estimate from the Congressional Budget Office. That translates to a total deficit reduction of $340 billion, not counting interest savings. 

The Medicare program will also likely see more cuts, amounting to $400 billion in savings. Those savings will mostly come from reductions in payments to healthcare providers, according to the Times, which could potentially affect skilled nursing providers. The president is expected to also propose tying Medicare coverage costs to income. 

Under the president’s budget plan, projected annual deficits would be reduced by $1.8 trillion in the next 10 years, replacing the sequester’s $1.2 trillion in deficit reduction. 

Read more at the New York Times.

Written by Alyssa Gerace

A pilot program focusing on transitions between levels of care—including hospitals and skilled nursing facilities—has yielded hugely successful outcomes in reducing rehospitalizations, with the potential of spreading to more post-acute senior care settings. 

Healthcare reform initiatives have emphasized reducing preventable hospital readmissions, and in October, the Centers for Medicare & Medicaid Services (CMS) began implementing reimbursement cuts to hospitals with higher-than-expected readmission rates.

While preventing rehospitalizations might not prove to be an easy fix, a session during the Aging in America Conference in Chicago last week suggested that collaboration between various health providers can be one way to significantly reduce them. 

Through funding from both CMS and the Administration on Aging (AoA), the Aging & Independence Services (AIS) and Aging and Disability Resource Connection (ADRC) have been able to achieve significant reductions in hospital readmissions through the Care Transitions Intervention (CTI) Program.

“I truly believe that all communities that are a part of this program have the opportunity to learn from one another and make system-wide changes to reduce readmissions in this country,” said AIS Aging Program Administrator Brenda Schmitthenner in a conference session about the CTI program.

During a CTI pilot in 2009, a partnership between Sharp Memorial Hospital in San Diego and AIS/ADRC saw only seven readmissions from a total sample of 88 patients. 

Developed by Eric Coleman, MacArthur Fellow and Professor at the University of Colorado School of Medicine, the CTI model incorporates what are called the “Four Pillars” of criteria to ease a patient’s transition period from the hospital to a skilled nursing facility or the home.

These Four Pillars include the establishing and maintaining of patients’ personal health records, medication lists, specialist follow-ups and recognition of “Red Flags,” or symptoms of chronic illness.

Sharp Memorial Hospital ended up adopting the CTI Program following the success of the pilot, and now it has expanded to the University of California San Diego Medical Center and Scripps Mercy Hospital.

The CTI model even led to the birth of another initiative to reduce hospital readmissions called the San Diego Care Transitions Partnership (SDCTP) Design.

To design SDCTP, AIS collaborated with a variety of San Diego health care providers as well as the UCSD Health System with the central mission of improving quality of care for patients during transition periods, while also reducing readmissions for high-risk beneficiaries.

“SDCTP is committed to reducing readmissions by 20% in two years,” says Schmitthenner. “Failure is not an option.”

The program also looks to include what it calls “care enhancement,” which entails providing transportation, durable medical equipment not covered by Medicare, and homemaker assistance, including medication pickup and shopping errands.

Additionally, some key elements of care enhancement also include coordination with the patient’s care team, hospital visit-discharge assessment, and home visits 24-72 hours of discharge.

The SDCTP will serve approximately 21,000 fee-for-service Medicare patients with various interventions that include: using assessment tools to conduct risk screening, using a high-risk health care coach to coordinate care and handoff to other providers upon discharge, using a pharmacist for medication education, as well as transitioning patients into palliative care and hospice.

Currently, Schmitthenner says the SDCTP design team is customizing an IT solution for invoicing, data collection, monitoring and reporting to compile a database that shows what hospitals provided which types of interventions.

The transition between care settings can sometimes induce harmful side effects on a patient’s physical well-being, according to the American Medical Directors Association, making programs that focus on coordinated care during these transitional periods necessary to ensure patients leaving institutional settings remain healthy during the recovery process.

Written by Jason Oliva

Senior Living Properties, LLC has settled a religious discrimination lawsuit with the Equal Employment Opportunity Commission (EEOC) after an administrator refused to accommodate an employee’s religious beliefs that restricted her from working on Sundays, telling her that “God would excuse her.” 

The EEOC announced on Monday that the Texas-based assisted living community operator will pay $42,500 as part of the settlement. The company must also amend its written anti-discrimination policy to include language regarding Title VII of the Civil Rights Act of 1964 prohibiting religious discrimination and requiring employers to make reasonable accommodations to employees’ and applicants’ sincerely-held religious beliefs—including beliefs necessitating not working on a particular day or days of the week—as long as it doesn’t pose an “undue hardship.”

The dietary services manager at Senior Living Properties’ Sweetwater Healthcare Center in Sweetwater, Tex., sought to be excused from working on Sundays based on religious observances consistent with her Christian faith, according to the EEOC’s lawsuit. During most of the three years she worked at the company, the employee was not required to work on Sundays and Senior Living Properties respected this work schedule.

That changed when a new administrator was hired at the community, according to the EEOC, at which point the new administrator told the dietary services manager “in no uncertain terms” that she would have to be available to work on Sundays.

The administrator allegedly told her that “God would excuse her from this religious restriction because she worked in the health care field,” said the EEOC. The lawsuit alleged that the new administrator dismissed the employee’s requests to not work on Sundays and told her if she wouldn’t comply, “there’s the door.”

“Requiring an employee to choose between her faith and a job to which she is dedicated is not only ill-advised management, but illegal,” said Devika Seth, senior trial attorney for the EEOC’s Dallas District Office, in a statement about the case. “We hope this settlement presents an example of how matters involving religious beliefs can be better addressed in the workplace.”

As part of the settlement agreement, Senior Living Properties must also conduct annual training for three years on the law against religious discrimination in the workplace; employees’ rights to have their religious beliefs accommodated in the workplace; the types of accommodations that may be granted to employees due to their religious beliefs; and the proper procedure for investigating complaints. 

“An employee’s religious beliefs should never be dismissively disregarded,” noted Robert A. Canino, regional attorney for the Dallas District Office. “Under the law, it is important for an employer examine whether a conflict between a work requirement and the faith-based practice of an individual can be resolved.”

Written by Alyssa Gerace

An assisted living operator is putting the United States Department of Agriculture (USDA) to the test by implementing its senior dietary and wellness program in three of the communities it manages. 

Bradley, Ill.-based BMA Management has teamed up with Eastern Illinois University (EIU) for a broader implementation of the USDA’s Eat Smart, Live Strong program, which was originally developed to promote nutrition and exercise for adults ages 60 to 74. 

The program encourages seniors to increase their daily intake of fruits and vegetables and participate in at least 30 minutes of moderately intense physical activity each day. 

It was introduced first at BMA’s Charleston, Ill. location, by virtue of its close proximity to the EIU campus. The management company worked with EIU in the fall of 2012 to test how best to implement Eat Smart, Live Strong in an assisted living environment, and continue to keep residents involved. 

Programs that promote activities of daily living can also help seniors maintain their independence, says BMA. BMA is currently working with Jacquelyn Frank, Ph.D., coordinator of the Master of Arts in Gerontology program at EIU, to implement Eat Smart, Live Strong at three other Heritage Woods communities it manages in Centralia, Flora, and Mt. Vernon, Ill.  

The average age of residents in assisted living communities is 86.9 years old, according to a study from MetLife—somewhat older than the age range the Eat Smar, Live Strong program was developed to target. However, the program has already garnered interest  among residents, as more than 60 have signed up to participate. 

Over four weeks, residents will be required to attend weekly educational programs on nutrition and exercise conducted by an EIU graduate student from the Gerontology school.

“Our emphasis is on helping residents achieve and maintain as much independence as possible for as long as possible,” says Julie Simpkins, vice president of marketing for BMA Management.

In conjunction with introducing the Eat Smart, Live Strong program at the testing communities, BMA Management made several adjustments to its food service and activities programs, according to Simpkins.

“Exercise classes are offered every day of the week, more fruits and vegetables were added to the menu, and we are enhancing the types of refreshments that we serve at activities and special events,” she says.

Written by Jason Oliva

The Centers for Medicare and Medicaid Services (CMS) announced on Thursday yet another initiative seeking to improve care coordination while lowering Medicare costs and involving hospitals, skilled nursing facilities, and other care providers: bundled payments.

More than 500 organizations will begin participating in the Bundled Payments for Care Improvement initiative, implemented under the Affordable Care Act with a purpose of testing how bundled payments for episodes of care can result in more coordinated care for beneficiaries at reduced cost to Medicare.

“The objective of this initiative is to improve the quality of health care delivery for Medicare beneficiaries, while reducing program expenditures, by aligning the financial incentives of all providers,” said Acting Administrator Marilyn Tavenner in a statement.

The initiative includes four models of bundling payments depending on the type of healthcare providers involved and the services included in the bundle.

Based on model type, CMS will bundle payments for services Medicare beneficiaries receive during an episode of care, with a goal of encouraging hospitals, physicians, skilled nursing facilities, home health agencies, and other relevant care providers to work together to improve health outcomes while lowering costs.

Organizations of providers participating in the bundled payments initiative will agree to provide a discount to CMS from expected payments for each episode of care, while working with their provider partners to reduce hospital readmissions, duplicative care, and complications in an attempt to lower costs through care improvement.

The 32 awardees in payment Model 1 will begin testing bundled payment for acute care hospital stays as early as April 2013.

Phase 1 (January to July 2013) of Models 2, 3, and 4 also began as of Thursday, with more than 100 participants partnering with more than 400 provider organizations. Phase 1 participants will receive new data from CMS on care patterns and learn how to improve care, and are generally expected to go on to participate in Phase 2, where approved participants can opt to take on financial risk for episodes of care starting in July 2013.

Model 3, specifically, relates to episodes of care triggered by an acute care hospital stay and will begin at initiative of post-acute care services with a participating skilled nursing facility, inpatient rehabilitation facility, long-term care hospital, or home health agency.

As of Jan. 31, 14 new organizations and their partners have been selected to participate in Phase 1 of Model 3, including the following senior care organizations and companies:

• Kindred Healthcare
• Chatsworth at Wellington Green
• The Evangelical Lutheran Good Samaritan Society
• Golden Living

CMS and the Obama Administration have announced numerous initiatives with similar goals of improving care coordination, reducing hospital readmissions, and lowering costs to Medicare.

“Research has shown that bundled payments can align incentives for providers—hospitals, post acute care providers, doctors, and other practitioners—to partner closely across all specialties and settings that a patient may encounter to improve the patient’s experience of care during a hospital stay in an acute care hospital, and during post-discharge recovery,” says CMS on its website.

Whether these initiatives work depends in part on the willingness of healthcare providers to participate and accept financial risk.

“Many providers have tended to look at managed care as something that was anathema,” says Val Halamandaris, president of the National Association for Home Care and Hospice (NAHC), mentioning some providers’ fears that managed care won’t pay a fair rate of reimbursement relevant to Medicare or private pay.

“People were skeptical at getting involved in managed care organizations, and were afraid they’d get caught in these situations to provide care even at their detriment if they’re losing money,” he says. “[Now,] people are saying, maybe I can work with managed care. We can collaborate—we need to persuade them we’re the best ally they can find in the healthcare spectrum and can help them become more efficient.”

Involving post-acute care providers in these initiatives is a must, says nursing home trade group the American Health Care Association (AHCA).

“We support the pilot, and we’re going to work closely with our four member organizations who have been selected to participate in Bundled Payments for Care Improvement,” says Greg Crist, vice president of public affairs at AHCA, adding that “too much is unknown at this point about the bundling policy. However, it’s important that post-acute involvement is a part of this—we see that as a key to success on any bundling initiative.”

Click here to view the lists of awardees for Model 1 and participants for Phase 1.

Written by Alyssa Gerace

The former chief executive officer and chief financial officer of Caremerica Inc. each received 60-month jail sentences and were ordered to pay restitution of more than $4.8 million after pleading guilty to conspiracy to defraud the Internal Revenue Service (IRS), the Department of Justice announced.

Ronald E. Burrell and Michael R. Elliott are the former CEO and CFO, respectively, of Caremerica, Inc., a Leland, N.C.-based assisted living management company the two owned and operated. Burrell was the president and CEO for Caremerica, the Caremerica assisted living communities operated by the company, and other related companies, while Elliott, formerly a certified public accountant, served as CFO and tax return preparer for the Caremerica companies.

The two were responsible for ensuring the Caremerica companies collected, reported, and paid federal employment taxes to the IRS, but during their time as corporate officers between about 2003 and 2006, the companies accrued more than $4.5 million in employment tax liabilities.

Additionally, Burrell and Elliott filed, or caused to be filed, false IRS forms that reported full payment of the employment taxes that were due when in fact only a “small fraction” of the taxes—or none at all—were paid, according to the charging documents cited by the Department of Justice. 

In 2003, Burrell and Elliott acquired majority ownership of Partners Pharmacy Services Inc. (PPS), which provided prescription drug and related services to the Caremerica assisted living communities. In April 2005, the two sold PPS to a subsidiary of leading long-term care pharmacy services provider Omnicare, Inc.

Burrell and Elliott received $1.6 million and $1.4 million, respectively, when the transaction closed, and the sale proceeds were disbursed at a time when the IRS was trying to collect unpaid employment taxes from the Caremerica companies as well as from Burrell personally, say the court documents.

In order to prevent the IRS from discovering their PPS proceeds, the two officers “took active steps to conceal them,” according to the Department of Justice, including Burrell forming a nominee company in his wife’s name through which he funneled some of his portion of the sale proceeds to avoid IRS collection action.

As a result of these concealment efforts, Burrell reportedly deceived the IRS into accepting a $29,000 settlement on a $300,000 personal tax liability, and then opened another assisted living community with proceeds from the sale of the pharmacy services company. Meanwhile, Elliott directed his share of the sale proceeds to be wired into his then-girlfriend’s bank account.

Burrell and Elliott then filed false 2005 federal income tax returns that omitted the PPS proceeds, and the two “obstructed justice by making false statements under oath” in bankruptcy proceedings and in IRS disclosure forms, says the Department of Justice. 

The two were sentenced on Jan. 16 in Wilmington, N.C. 

Written by Alyssa Gerace

Home- and community-based services (HCBS), initially touted as a cost-saving method of delivering long-term care compared to institutional settings, may not actually be a significantly superior setting in which to receive care, suggests a report from the Agency for Healthcare Research and Quality (AHRQ).

AHRQ reviewed several studies comparing different long-term care models and concluded there’s not enough evidence to truly assess their relative effectiveness in relation to each other. It may be more accurate to simply consider HCBS as a preferred model among consumers, rather than one that provides better care at a lower cost, the report’s authors say. 

“The weakness of the literature stands in sharp contrast to the importance of the topic,” says the AHRQ. “Many stakeholders want to know about the relative effectiveness of alternative modes of LTC. As budgets tighten and as demographically driven demand increases, states and other entities are seeking more efficient ways to deliver LTC.”

The report defines long-term care as differing from acute or episodic medical interventions by nature of its being integrated into people’s daily lives over an extended time. It spans three areas: assistance with activities of daily living including meal preparation, grocery shopping, transportation, and other routine activities; housing; and medical care.

While it’s often associated with institutional settings such as nursing homes, long-term care is also provided in a variety of home- and community-based care settings ranging from a recipient’s home to assisted living and encompassing adult day care. 

More than 11 million people need long-term care to assisted them with ADLs, according to the study. The majority (55%) are 65 or older, and an estimated two-thirds of Americans in this age group will eventually need some type of long-term care for an average of two years, according to projections.

Nearly 1.4 million people currently reside in nursing homes.mMedicaid finances about 40% of the nation’s total long-term care spending, and nursing home care accounts for about 64% of the program’s spending for older adults and the disabled. 

Costs for those receiving nursing home care generally exceed those receiving HCBS, and as a result, many state governments have increasingly prioritized HCBS as a method to restrain long-term care costs, the study notes, especially as consumers have largely expressed a preference for care in home and community settings. 

That has translated to a faster growth in spending for HCBS than for nursing homes. Medicaid spending on HCBS more than doubled between 1995 and 2009 from 19% to 43%. Out-of-pocket expenditures account for about 22% of long-term care spending, with private long-term care insurance covering about 9%.

Consumer preference for HCBS may not directly correlate to better—or less expensive—care.

The report’s authors were hard-pressed to make any sort of conclusions in regard to cost comparisons between assisted living and nursing homes, or whether there’s a significant disparity in the rate of change in physical function, cognition, and mental health, citing low-strength of insufficient evidence. 

On average, nursing home residents were more physically and cognitively impaired than HCBS recipients and assisted living residents, although mental health and clinical status outcomes were mixed. 

Better research is needed “to address questions related to LTC delivered through HCBS versus nursing homes, including the changes in outcome  trajectories over time, harms, and costs,” the authors say. 

Access the full report. 

Written by Alyssa Gerace

The Center for Medicare & Medicaid Studies (CMS) has announced 35 new Community-based Care Transitions Program (CCTP) sites in 23 states, five of which feature skilled nursing facilities as participating members.

A five-year program that’s part of the Affordable Care Act, the CCTP now has 82 sites that are testing models to improve care transitions from hospitals to other post-acute care settings, thereby reducing costly, unnecessary readmissions for high-risk Medicare beneficiaries.

About 20% of Medicare beneficiaries, or 2.6 million seniors, are readmitted to hospitals within 30 days of being discharged, according to CMS. This costs the program more than $26 billion every year.

Although hospitals have traditionally been the main player in seeking to reduce readmission by focusing on components leading to rehospitalization that they are responsible for, including the quality of care during the initial hospital visit and the discharge planning process, CMS says it’s “clear” there are multiple factors along the care continuum impacting readmissions. 

Identifying key drivers of rehospitalizations is the first step toward implementing appropriate interventions to reduce or prevent them, causing CMS to create the CCTP program. The initiative’s goal is to “encourage a community to come together and work together to improve quality, reduce cost, and improve patient experience” through sites that coordinate care between various post-acute care providers. 

Skilled nursing facilities and home health agencies are represented in five of the new sites that have recently joined the program, in Colorado, Florida, Mississippi, and New York. The sites including or partnering with senior care organizations include:

• Denver Regional Council of Governments (Colorado)
• Catholic Health Care Transitions Services, Inc. (Florida)
• West Central Florida Area Agency on Aging (Florida)
• Three Rivers Planning & Development District (Mississippi)
• Isabella Geriatric Center (New York)

“The presence of these [CCTP site] facilities speaks to the importance of post-acute and skilled nursing centers in the care transitions from hospitals,” says Greg Crist, vice president of public affairs at nursing home trade group the American Health Care Association. “We’ve made reducing rehospitalizations a key quality goal profession-wide. This year is no different.  If we can enhance those successful transitions while keeping the process free of complexities, everyone wins and costs can come down.”

Find out more about each new Community-based Care Transitions Program site. 

Written by Alyssa Gerace

Progressive changes to the Affordable Care Act (ACA) slated for 2014 look to benefit baby boomers more so than any other age group, reports USA Today. 

The recession has victimized boomers the most, USA Today suggests, as retirement “nest egg” funds continue to shrink as health care costs rise, not to mention increases in unemployment for the aging demographic.  

But as the federal government moves forward with upcoming changes to the ACA, boomers might begin to see some turnaround in their health care benefits, largely by way of less discrimination in age and payment.

USA Today writes:

Based on their age alone, Boomers have to pay prices that are five to seven times higher than younger Americans, according to AARP. But if early retirees can wait  until the ACA takes effect, it will change the playing field…

Beginning in 2014, the law is supposed to prevent insurers from denying coverage to those who have a pre-existing condition. On Nov. 20, the Obama administration said that it was moving forward to implement provisions to ban discrimination and protect consumers fro possible insurance abuses .

The ACA also will do away with lifetime and annual dollar limits on benefits, and it will limit the age rating so that a Boomer can only pay three times as much as a younger person. 

Changes to the ACA could even spark further changes, suggests USA Today, such as Boomers receiving a fixed amount of money from employers as a form of health benefit, called a premium reimbursement. Retirees could then use this money to choose insurance at their state exchange marketplace, writes USA Today.

Read the full USA Today article here. 

Written by Jason Oliva

While a Department of Housing an Urban Development program to convert government-subsidized multifamily apartment units into affordable senior housing is a step in the right direction, it doesn’t meet tremendous—and growing—demand, driving the need for a scalable model.

States are under tremendous pressure to find cheaper, better ways to work with their highest-cost clients, says Michelle Norris, Senior Vice President of  Business Development and Public Policy at Columbus, Ohio-based National Church Residences, especially with the nation’s rapidly expanding healthcare budget and the aging demographics.

On a state level, many governments are looking for the most cost-effective way to care for the oldest, frailest populations, she says, and many times it’s departments concerned with healthcare—such as Medicaid—who are initiating conversations with other agencies and organizations. As a substantial amount of this high-cost population can be found in federally-subsidized housing,  communication channels are opening between housing and healthcare providers to prevent moves into expensive institutional settings that are heavily Medicaid-funded.

“Policy and budget constraint issues everywhere are driving conversation between state departments, and now they’re talking to developers to enlist their help,” says Norris.

Demand for affordable senior housing is already staggering. As of 2006, for every one person living in a Section 202 housing (Supportive Housing for the Elderly) unit, there were 10 people on a wait list for that unit, according to an AARP Public Policy Institute study.

HUD’s Assisted Living Conversion program, which provides about $30 million a year to eligible projects designated for seniors owned by private, nonprofit entities, “infuses some dollars to address those needs,” says Naren Dhamodharan, president of NDA Consultants, LLC, a Massachusetts-based consulting firm that works with non-profits throughout the country to achieve innovate housing solutions with the help of federal grants.

NDA Consultants works primarily with organizations seeking HUD’s ALC program grants, usually an 18-24 month process from initially putting together and submitting an application to the completion of the grant.

Throughout the country, people are aging in place, and this is true for those residing in federally-subsidized housing as well. Program funding can be used to convert all or some units into assisted living or service-enriched housing. “It blends programs nicely for seniors so they don’t have to move out as they get older, or delays the move,” says Dhamodharan.

While NCR didn’t initially participate in the competitive process to receive HUD grants for the program, the not-for-profit entered the mix when Ohio started offering Medicaid waivers NCR could use in conjunction with the HUD program.

Not every organization receiving the HUD grant is like NCR, which has a “very robust” housing property management side along with a “very large and significant” healthcare team in two separate business units that work together to serve residents, says Norris.

NCR’s first project renovated 32 units for senior housing. With the help of an approximately $3 million grant, the building received overall capital improvements, with renovations for each unit to make them modern and ADA accessible. Common spaces were added, including a dining area, professional kitchen, and community center.

Once the renovation was complete, the organization was able to use a Medicaid waiver in combination with the rental subsidy to pay for services necessary to keep people in their homes rather than a nursing facility.

“These are very high-demand units,” says Norris, who says that her organization’s perpetually-full units can create complications for extensive renovations. If it’s not possible to shift residents from one side of a building to the other when performing renovations or upgrades, organizations must find adequate housing for each resident until the project is complete.

Between 2000, when the program began, and 2012, Dhamodharan’s company has helped facilitate the conversion of about 1,800 units to assisted living or service-enriched housing, he says. HUD awarded grants to 11 organizations in 2012, but the competitive grant process leaves many without funding for more conversions.

HUD isn’t trying to be the “complete solution” for the growing affordable senior housing demand, says Norris. Rather, they’re creating pilots that allow conversations to be held across government agencies at state and federal levels with provider organizations and and other funding sources.

For-profit housing providers are not eligible for the program, but the initiative could create innovative funding models that could be marketable on a larger scale, says Norris.

“It’s a way to serve as a catalyst to try to enhance housing in a way that addresses some of the needs without having folks go straight to high-cost institutional settings,” she says. ”We’re now trying to figure out a way to make this scalable. We’re in conversations with state agencies to talk about ways to take this to the market using a bond program [such as social impact bonds] or other innovative financing models,” she says.

“If that happens, it’s no longer necessary to use HUD, and no longer necessary to only be a nonprofit housing provider.”

Th beauty of this program, says Dhamodharan, is that subsidized housing works.

“People are paying ‘x’ percent of their income for rent, and then they have some funds available to support the service expenses. Because of the nature of the tenant, they’re naturally in line with third-party funding streams like Medicare and Medicaid,” he says. “There’s a lot of opportunity, I believe, that even for-profit companies have in creating these kinds of affordable models, because not everyone can afford [traditional senior housing].”

With more organizations involved, more units could get funding to become service-enriched. NCR is currently in talks with various entities from the philanthropy side to state Medicaid programs and the Ohio Housing Finance Authority. “We’re working on figuring out a model to propose to the state for something that’s similar to what HUD did, but without needing HUD to provide the capital,” Norris says, adding that there’s a “strong possibility” something could be developed in 2013.

Written by Alyssa Gerace

A deficit-reducing budget deal may inadvertently boost senior housing and care community occupancy in upcoming quarters, indicated by a correlation between the amount of funding for programs to help older Americans age in place and the number of low-care residents in nursing homes.

States that have invested in their community-based service networks, particularly in home-delivered meal programs, have proportionally fewer low-care nursing home residents, according to “The Relationship between Older Americans Act Title III State Expenditures and Prevalence of Low-Care Nursing Home Residents,” published recently in Health Services Research. 

Researchers Dr. Kali S. Thomas, a postdoctoral fellow at Brown University’s Center for Gerontology and Healthcare Research, and Dr. Vincent Mor, Professor of Community Health in the Public Health Program of the Brown University School of Medicine, used state program reports and nursing home-level data to examine the relationship between state spending on Older Americans Act services and the percentage of low-care residents in nursing homes. 

Individuals were identified as low-care if they weren’t classified in the two lowest functioning RUG-III classifications, special rehab or clinically complex, and didn’t require any physical assistance for the following activities of daily living: bed mobility, toileting, transferring, and eating. The researchers looked at state-specific personal care, homemaker, chore, home-delievered meals, adult day care/health, and case management service expenditures in OAA registered programs. 

“In recent years, there has been an increase in expenditures on long-term services and supports aimed at keeping older adults in the community,” Thomas told SHN. “Accompanying these increases, we have seen a reduction in both nursing home occupancy and the percentage of residents in nursing homes who could perhaps be better served in less restrictive environments.”

The study found that increases in funding for HCBS were accompanied by a decrease in the proportion of low-care nursing home residents, from 17.9% in 2000 to 12.6% in 2009. 

Home-delivered meals were found to be especially helpful in keeping seniors with few significant ADLs out of nursing homes. Every additional $25 states spent on home-delivered meals was associated with a one-percentage-point decrease in the low-care nursing home population. 

These types of meal-based programs, in particular, are often “the first in-home service that older adults receive and can often serve as a primary access point for other HCBS,” Thomas and Mor cite the Administration on Aging, and also provide an “essential” service to caregivers by helping them maintain their own health and well-being.

The challenge for states and the Centers for Medicare & Medicaid Services (CMS) will be to build and invest in systems and programs that divert unnecessary nursing home placement for individuals who can successfully remain in their communities, the researchers conclude.

However, many states are facing huge budget constraints and frozen or reduced Medicaid funding. That’s not expected to get better, especially down the road as states who have expanded their Medicaid budgets will start getting less federal funding for additional beneficiaries. As states are forced to make cuts to Medicaid budgets, many home- and community-based programs stemming from the Older Americans Act may be the first to have their funding reduced.

With the fiscal cliff deadline approaching, many states’ Meals on Wheels programs are already thought to be in danger—a crucial component to low-care seniors’ ability to remain in their homes, the study suggests. That in turn could lead to more seniors entering nursing homes, or in some cases, residential care communities. 

“It is reasonable to assume that cutting the budget for these programs would reduce the ability for many older adults to remain independent in their homes,” Thomas confirmed to SHN. 

Access the study here. 

Written by Alyssa Gerace

Here’s a collection of news bites pertaining to the senior housing and long-term care industries, gathered from around the nation. Many of the articles are state-specific, but could eventually have national implications or influence senior care trends. Click the links to access the full article. 

From The New York Times: The New Old Age blog—CLASS Act Making a Comeback?

“Now that President Obama has won a second term, the Supreme Court has ruled the Affordable Care Act constitutional and the election has made Congressional attempts to repeal it unlikely, a few advocates for the elderly are quietly talking about resurrecting the Class Act, or some variant of it,” reports The New York Times: The New Old Age blog. “There’s a window of opportunity now,” said Connie Garner, director of the advocacy group Advance Class. “The stars are lined up to have a productive conversation.”  Interestingly, the actuary who lost his job, Robert Yee, agreed that the program could be successful. He had not completed the research when the ax fell, but “from an actuarial perspective, we can make this work,” he told me at the time.” Read more…

From Politico: Nursing Home Provider Tax Faces Cuts, Limits Under Medicaid Budget Discussion

“Almost all the states use provider taxes to help fund their Medicaid programs, but the Obama administration says some are essentially using them to game the system — by taxing them, giving the money back and then claiming that money as state spending that the feds have to match,” reports Politico. “That plan would have ratcheted down the amount of Medicaid provider taxes that states are allowed to collect, producing $26.3 billion in federal savings. That’s much less of a sting than the $44 billion in savings recommended by the 2010 Simpson-Bowles deficit commission, which called for the eventual elimination of provider taxes.” Read more…

From 10TV.com (Ohio)—Illegal Drugs Discovered in Nursing Home 

“Employees said they made a drug discovery on a vending machine inside the Heartland-Fairfield Nursing Center. Fairfield County sheriff’s investigators believe it’s LSD, a hallucinogenic drug popular in the 1960′s, rarely seen circulating in Central Ohio today,” reports 10TV.com. “Detectives said a cleaning crew discovered a sheet of the drug about the size of a business card, during a routine cleaning. They believe it had been there for two or three days. The nursing center turned it over to investigators, who are now working to determine who left it there and why.” Read more…

From MyDesert.com (Calif.)—Senior Care Facility to Close After Operating Losses

“Desert Regional Medical Center is looking to close its skilled nursing facility in the first quarter after operating at a loss for at least a year,” reports MyDesert.com. “The 34-bed unit on the fourth floor of the Palm Springs hospital currently houses 15 patients and employs 30 full-time and four part-time employees, said Rich Ramhoff, a hospital spokesman. A definitive date for closure has not yet been set.” Read more…

From the GAO—CMS Needs to Eliminate Duplication, Improve Efficiency of Medicaid Program

The Government Accountability Office recently released a study on the Medicaid Integrity Program, conducted because Medicaid has the second-highest estimated improper payments of any federal program reporting such data. The report assesses the efficiency and effectiveness of the Medicaid Integrity Group (MIG), created to oversee and support state program integrity activities. GAO found that CMS should take steps to eliminate duplication in the program to reduce inefficiency related to hiring separate review and audit contractors for MIG’s National Medicaid Audit Program, and made several recommendations to strength and improve the program. Read more. 

From the New York Times—Nursing Homes Told to Reinstate Workers

“A federal judge in Hartford has ordered a Connecticut nursing home chain to reinstate nearly 600 workers who have been on strike since July 3, and to rescind the pension and health care cuts it had imposed,” reports the N.Y. Times. ”Judge Robert N. Chatigny of the United States District Court in Connecticut ruled on Tuesday night that the nursing homes’ owner, HealthBridge Management, had broken the law by refusing to bargain in good faith and by imposing the cuts before a true negotiating impasse had been reached. Judge Chatigny issued an injunction that ordered HealthBridge to reinstate the workers by next Monday, even if it means ousting hundreds of the replacement workers hired to run the nursing homes after the strike began.” Read more…

From Columbus Business First (Ohio)—Senior Care Providers Wary of Dual Eligible Shift

“Operators of Ohio’s nursing homes and assisted-living centers have 10 months to change their financial model after the state got approval for a pilot program to improve the health and reduce the medical costs for a fragile population disabled enough and poor enough to qualify for both government insurance programs. The government hopes to save $243 million over the program’s three years,” reports Columbus Business First. ”The businesses providing that care hope it’s a true reduction in duplication and unneeded services, rather than a hit to their already slim bottom lines. “In a year, all of our payments are going to shift from the government to private health plans,” said Tom Slemmer, CEO of National Church Residences, the nation’s largest nonprofit developer of affordable senior housing and a LeadingAge member.” Read more…

Technology to facilitate aging in place—whether in the home or in a senior living community setting—continues to make strides, evidenced in this round-up that features a mobile app for caregivers to coordinate care, a new fall-prevention and PERS platform, and a home safety telephone system marketed as an affordable PERS alternative. Also in the news is a federal report faulting Medicare for being vulnerable to fraud and abuse in its shift to implementing electronic medical records, while two health information exchanges seek to prove their benefits ahead of federal funding running out. Read on:

1. Philips: Mobile App Allows Caregivers to Coordinate Care

Royal Philips Electronics (NYSE:PHG) recently released CarePartners Mobile, a new mobile app designed to help family caregivers coordinate care for their loved ones. 

“CarePartners Mobile allows people to spend more time caregiving, and less time trying to determine what needs to be done and who is doing it,” said Mark Sabalauskas, senior product manager, Philips Lifeline. “The app also taps in to the growing trend of using mobile technology to communicate, organize our lives and improve our health. As this trend continues to grow, Philips is leading the way, providing services where and how they are most effectively delivered.”

The free app, which is available for iPhone and Android, streamlines care coordination, and enables caregivers to create, manage, and view upcoming caregiving tasks using a shared to-do list, assign tasks to individuals and see what tasks still need volunteers, and syncs tasks they’re responsible for directly to smartphone calendars, among other functions. 

2. SearchHealthIT: Health Information Exchange Benefits Paper-Bound Nursing Homes

“Two health information exchanges—The Great Lakes HIE in Michigan and the Keystone HIE in Pennsylvania—are throwing technology at a major meaningful use policy paradox that affects vulnerable, elderly patients at the worst possible times. By doing so, they could be demonstrating the type of health information exchange benefits that privately and publicly funded HIEs have been seeking in order to prove their economic viability as federal grants are due to expire,” writes SearchHealthIT. “Nursing homes were left out of federal EHR incentives, but they’re the parties who typically hold their patients’ up-to-date advance directives. When these patients—some of them incapable of making their own health care decisions—get ambulanced to hospitals or go to doctors’ offices for treatments, their caregivers are required to collect advance directives from 50% of patients, per the stage 2 meaningful use criteria.” Read more…

3. New York Times: Medicare Faulted on Shift to Electronic Records

“The conversion to electronic medical records—a critical piece of the Obama administration’s plan for health care reform—is “vulnerable” to fraud and abuse because of the failure of Medicare officials to develop appropriate safeguards, according to a sharply critical report to be issued Thursday by federal investigators,” reports The New York Times. “…the report says Medicare, which is charged with managing the incentive program that encourages the adoption of electronic records, has failed to put in place adequate safeguards to ensure that information being provided by hospitals and doctors about their electronic records systems is accurate.” Read more…

4. Care Technology Systems: New Fall-Prevention Platform

Care Technology Systems, Inc.’s newest product offering is an Active-PERS device that has been added to its Fall Detection by Logic System. 

The new pendant can help caregivers respond to falls in a timelier fashion, even if the senior fails or is unable to press the pendant’s alert button. Here’s how it works: 

“While standard PERS requires the user to push a button to notify caregivers of a fall, we know that in 83% of the times a senior who uses PERS isn’t wearing their pendant, and can’t alert others when they’ve fallen,” said Jim Anderson, founder and president of Care Technology Systems. “So, we’ve integrated an accelerometer that actively monitors senior activity as a part of a larger alert system and can tell us whether a fall has occurred and automatically summon help.”

The system also can receive activity information from the device on a regular basis, called Motion Scoring, that can track patterns to help predict falls and thus prevent them. This could result in significant healthcare cost savings, Care Technology Systems believes, especially as hospitalization costs for falls average around $17,500, according to recent statistics. 

5. VTech: CareLine Phone System for Independent Senior Living

VTech Communications, a subsidiary of VTech Holdings Ltd. (HKSE:303), recently introduced the CareLine home safety telephone system meant for seniors still living at home. The system’s features are designed to meet seniors’ daily communication needs and include large displays, reminder capabilities, volume boost, and a wearable pendant with one-button dialing that directly calls people that seniors communicate with most. VTech is marketing the system as an affordable alternative to a PERS (personal emergency response system). 

The pendant allows users to make and receive calls, listen to voicemail messages, review missed calls, confirm the date and time or receive programmed reminders for medication, appointments, or other events. The user or a family member can set reminders directly through the corded phone base or with a phone call; when it’s the set time, the system will remind the user with a light and audio cue. The pendant can also be used to get immediate emergency assistance. Users can press one of two speed-dial keys or use a voice command to call self-programmed contacts such as 911, a family member, or trusted friend or neighbor.