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Category: Nursing Homes

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 Business First—Medical Panel to Review Skilled-Nursing Home Lawsuits

“Advocates for nursing and assisted-living homes in Kentucky hope the Kentucky General Assembly again will consider legislation that would establish a medical panel to review lawsuits against skilled-nursing facilities,” reports Business First. “Nursing home operators in the state backed such a law during the 2012 legislative session. That bill got a hearing in the House of Representatives’ Health and Welfare Committee but never came to a vote.” “Some industry officials, including Lubarsky, have said Kentucky being a high-cost state for liability claims could undermine Louisville’s efforts to cast itself as a hub for aging care companies.” Read more

From Leading Age (N.Y. Chapter)—Managed Care Shift Too Speedy for Medicaid Beneficiaries 

“[The New York Department of Health] has already published an aggressive timeframe for the transition to mandatory managed care enrollment [for Medicaid beneficiaries] across the geographic areas of the state. LeadingAge New York emphasizes again that the potential negative consequences of not managing these transition issues properly are such that they could undermine the entire process,” said James W. Clyne, Jr., President/CEO of New York’s Leading Age chapter during his testimony for a Public Hearing on Medicaid Transition to Care Management for Long Term Care. “The availability of an array of high quality home and community based services is absolutely critical to the success of the managed care model. Leading Age New York believes that the speed and unpredictability with which the state is seeking to implement major change raises a cautionary note over how the transition process could evolve, and what it could mean for services in the community.” Read more

From WTTW (Ill.)—Shortage of LGBT Senior Housing

“They’re a minority that are often on the sidelines of society. And when it comes to affordable housing, their struggles can be overwhelming,” reports WTTW’s Chicago Tonight. “They are low-income lesbian, gay and transgendered senior citizens. There’s an estimated 40,000 of them in the Chicago area, and now, for the first time in the Midwest, a housing development geared toward the LGBT community is going up in Chicago. While discrimination based on sexual identity is illegal in Chicago, some LGBTQ seniors say they believe it still happens — but often it’s not blatant.” Read more

From The Seattle Times (Wash.)—Seattle Nursing Home Permanently Closes

Local nursing home Life Care Center of West Seattle closed for good last week after 16 years in operation, causing 99 employees to be laid off. Corporate parent Life Care Centers of America, a national company based in Cleveland, Tenn., said it transfered about 70 residents to other facilities in the region,” reports The Seattle Times. ”Todd Fletcher, vice president for Life Care’s Northwest division, said the company was unable to continue operating the West Seattle facility, at 4700 SW Admiral Way, because of the difficult economic environment and steep maintenance requirements.” Read more

From the Associated Press for The Wall Street Journal—Nursing Home Evacuees of Hurricane Sandy in Grim Limbo

“Hundreds of elderly and disabled New Yorkers who were hurriedly evacuated from seaside nursing homes and assisted living residences after Superstorm Sandy are still in a grim limbo two months later, sleeping on cots in temporary quarters without such comforts as private bathrooms or even regular changes of clothes,” reports the Associated Press. “For eight weeks, close to 190 patients forced out of the flooded Rockaway Care Center in Queens have been shoehorned into every available space at the 240-bed Bishop Hucles. Most still didn’t have beds last week. Instead, they bunked on rows of narrow, increasingly filthy Red Cross cots in rooms previously used for physical therapy or community activities. More than a dozen slept nightly in the nursing home’s tiny chapel.” Read more

From NIC (Md.)—Delta Between AL & IL Occupancy Rates in Baltimore Market

“As of the third quarter of 2012, Baltimore’s seniors housing occupancy was 91.0%, which is 110 basis points above its cyclical low,” says NIC. “Somewhat unique to Baltimore is the large delta between independent living and assisted living occupancy rates. As of the third quarter of 2012, independent living occupancy was 93.2%, compared to 86.5% in assisted living, a difference of 670 basis points.” Read more

From Grand Forks Herald (N.D.)—Community Support Aids North Dakota Nursing Home Re-opening 

“Osnabrock, N.D., will get its community cornerstone back when the Osnabrock Nursing Home opens, probably by spring,” reports the Grand Forks Herald. “The tiny Cavalier County community of 134 lost its nursing home in July, with the closing of the Osnabrock Good Samaritan Center. A local advisory board, which formed immediately after the closing was announced by Sioux Falls, S.D.,-based Good Samaritan, expects to have an administrator hired in early January, according to Tim Seavey, interim administrator and a registered nurse who lives in Osnabrock.” “‘We had a fund-raiser two weekends ago and brought in over $25,000,’ Seavey said. ‘We just continue to have great community support.’” Read more

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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

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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 read the full article. 

From Kaiser Health News—Are ACOs Doomed to Fail?

Accountable care organizations are widely touted as one of the most effective cost-containing measures of the 2010 federal health law. Yet they have a great deal in common with the integrated delivery networks of the 1990s, leaving some wondering whether the bold experiment might come to the same disappointing end,” reports Kaiser Health News. “I don’t think these things are going to work,” says Lawton R. Burns, who wrote a Health Affairs commentary on the topic along with his colleague Mark V. Pauly of the University of Pennsylvania’s Wharton School. “ACOs in the end are going to end up costing more money and not necessarily deliver on the quality either.” Read more

From the New York Times—Nursing Home Faulted for Care Quality During Superstorm

“Amid the worst hurricane to hit New York City in nearly 80 years, the home, the Promenade Rehabilitation and Health Care Center, failed to provide the most basic care to its patients, according to interviews with five employees, federal, city and hospital officials, and shelter directors. Although nursing home officials say they cannot be blamed for what happened, the State Health Department has opened an investigation into Promenade’s actions,” reports The New York Times. ”Cold, thirst, fear: The situation grew so dire that the next evening, as the vestiges of the storm blew across the peninsula, ambulances arrived, evacuated the nearly 200 patients over several hours and deposited them in emergency shelters in the city. In most cases, no Promenade staff member accompanied the patients, and many patients traveled without their medical records. Both are violations of state regulations. Interviews with employees indicate that Promenade failed to carry out basic responsibilities, including adding staff for the storm as required by the state, stocking enough medicine and flashlights, and preparing patients’ records in case of evacuation.” Read more

From TribLive—Western Pa. Senior Care Providers Shift Focus of Service

“The largest nonprofit provider of senior-living services in Western Pennsylvania plans to focus more on short-term nursing care and services in home- and community-based settings, and less on long-term, institutionalized care for residents after experiencing several years of deficits among some of its entities, an official said. “I think it’s really looking at how we can maximize the quality of quality of life and provide quality care in the most cost-effective manner,” said Paul Winkler, president and chief executive officer of Presbyterian SeniorCare in Oakmont,” reports TribLive. “Presbyterian is one of many providers of senior services statewide that are being challenged by more low-income seniors qualifying for government-funded Medicaid coverage, which is insufficient to cover the cost for nursing care, and an increase in the need for free personal care, experts said.” Read more

Assisted Living Today’s List of Top 20 College Courses for Geriatrics & Senior Care

“Demand for senior care professionals is already strong, and as baby boomers grow older, the need for qualified caregivers, policy makers, researchers and providers of elder care services will only grow. Opportunities for new and returning students to study gerontology are abounding,” says Assisted Living Today. View the list.

From the AFL-CIO Blog: Fair Labor Wage Case Goes to Supreme Court 

“The AFL-CIO has filed a friend of the court brief in a case before the U.S. Supreme Court in which an employer is attempting to avoid paying its workers back wages. The case centers on a Pennsylvania nurse, Laura Symczyk, Genesis Healthcare Corp. and methods employers are using to get around paying wages due under the Fair Labor Standards Act (FLSA),” writes the AFL-CIO blog. “In December 2009, Symczyk filed suit in federal court alleging Genesis had failed to pay her and other employees for time actually worked during what were supposed to be scheduled meal breaks, payment that is required by the FLSA. She filed suit on behalf of herself and “similarly situated” workers. But unlike class-action suits for other employment claims in which workers who are part of the “class” are automatically included unless they opt out, FLSA suits require workers to opt in if they wish to be part of the action. Employers, says AFL-CIO Associate General Counsel Matt Ginsburg, are using the opt-in requirement to seek to limit their liability.” Read more

From the Columbia Daily Tribune (Mo.)—MU Gets $14.8 Million HHS Grant for Nursing Home Care

“The University of Missouri Sinclair School of Nursing announced this morning that it had received a nearly $15 million grant for a nursing home project,” reports the Columbia Daily Tribune. “The project will aim to reduce avoidable hospitalizations for nursing home residents, improve patient care and lower health care costs. The grant from the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services will help provide funding to put advanced practice registered nurses in 16 nursing facilities in the St. Louis area and will be distributed over four years.” Read more

From Vindy.com (Ohio)—Medicaid Cuts Force Nursing Home to Displace 14 Residents

“Fourteen residents will have to find a new place to live by next Friday because Valley Renaissance Healthcare Center, a nursing facility on South Avenue, is planning to end its respiratory-care program,” reports Vindy.com. ”The move is part of a growing trend in which nursing homes eliminate services for high-risk patients who require high-cost treatment, especially in light of cuts in Medicaid and Medicare reimbursements. Over the past year, Medicaid reimbursements for Ohio’s 958 nursing homes have been cut by 5.8 percent, which is expected to save taxpayers $360 million over two years… [C]uts at Valley Renaissance resulted in a 6.66 percent decrease in per diem Medicaid funding. So, while the facility received $160 per patient per day in 2011, it gets only $152 per patient per day in 2012.” Read more

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Connecticut-based Spectrum Healthcare, which operates six nursing homes in the state, has filed for bankruptcy protection in an effort to eliminate some of its $27 million of debt and reduce operating costs, reports the Hartford Courant.

Despite the filing, the operator plans to keep all of its facilities in operation during the restructuring. 

Filing for bankruptcy protection gives the company a time-out on paying some of its bills while it comes up with a plan for a more financially sustainable operation.

Spectrum owns nursing homes in Hartford, Manchester, Derby, Torrington, Ansonia and Winsted.

The filing is the latest sign of the financial pressures faced by nursing homes in Connecticut, where it is estimated that facilities could need as much as $90,155 a year to care for a resident, according to the trade group for 150 of the facilities.

Seven other nursing homes have entered bankruptcy in the past five years, and two of those either closed or are closing

The state and federal government pay most nursing home bills, with 69 percent covered through Medicaid, and 15 percent of patients, in for short-term rehabilitation stays, through Medicare.

On average, the state pays Spectrum $87,902.95 a year for its Medicaid patients, higher than the state average of a little more than $83,000.

Because nursing home care is so costly, and because many people would prefer to stay in their homes as long as they can, the state allows Medicaid money to pay for home health care services, a program called “money follows the person.”

In its bankruptcy filing, Spectrum said that policy has meant people are delaying entry into nursing homes, and said that is one reason occupancy is dropping. According to the state, in July, 619 of Spectrum’s 716-bed capacity was in use, for an occupancy rate of 86.5 percent.

The operator’s 2011 revenues of $67.3 million were not enough to cover all of its expenses, as Spectrum lost nearly $1.7 million that year, according to its bankruptcy filing. 

Read the full story at the Hartford Courant.

Written by Alyssa Gerace

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Unnecessary rehospitalizations cost Medicare millions of dollars each year, and with many seniors cycling from hospitals to skilled nursing facilities and back again, it’s paramount for nursing homes to figure out how to reduce readmissions.

As many as 60% of these rehospitalizations are preventable, writes Forbes, and they cost taxpayers millions of dollars each year. Health care reform has put a large focus on hospitals cutting their readmission numbers—starting in October, their Medicare reimbursements will reflect their performance—and it’s in nursing homes’ best interests to figure out how they can help. 

…[N]ursing facilities and their partner hospitals are taking steps to cut these readmissions. In researching a new article for the journal Health Progress, published by the Catholic Health Assn., I had the chance to visit and talk to some of the nation’s most creative senior service providers. And I learned about both the challenge of reducing hospital readmissions and some cutting-edge solutions.

Some of these initiatives are being driven by new Medicare rules. Among them: On Oct 1, Medicare will begin cutting payments to hospitals where too many patients are readmitted within 30 days of discharge. While the initial penalties are relatively modest and for only three conditions—heart failure, pneumonia, and heart attacks—they will gradually stiffen. And the new rules seem to have changed the mindset of many hospital administrators.

Increasingly, hospitals are improving discharges and keeping a close eye on patients after they leave. No longer do they abandon their patients once they roll out the front door. Many are putting transition programs in place—often using care managers, social workers, or nurses—to assist patients who are discharged to home. And slowly, they are beginning to work more closely with nursing facilities—both skilled nursing and long-stay nursing homes—to reduce readmissions.

At the same time, the best nursing facilities are making big changes of their own. They include:

  • Increasing staff and improving training for nurses and aides to help them identify and treat situations that can lead to hospitalizations. At Wheaton-Franciscan Healthcare in Wisconsin, nursing facility aides are trained to identify warning signs in heart failure patients and how to communicate what they see to staff nurses. These steps often prevent a crisis before it occurs.
  • Working with primary care doctors to encourage them to allow the nursing facility to treat many acute episodes rather than ordering patients back to the hospital.
  • Asking patients, residents, and their families whether they want to be hospitalized. When Hebrew Senior Life asked patients at its post-acute care nursing facility in Boston what they wanted, it discovered many preferred to stay where they were. Now, the HSL system is expanding this program to residents of its long-stay nursing home.

Nursing home trade group the American Health Care Association has challenged its members to reduce rehospitalizations 15% by 2015, and the Centers for Medicare and Medicaid Services has its own initiative to reduce avoidable hospitalizations from nursing facilities by funding organizations that partner with nursing homes to enhance on-site services and supports to residents and ensure a healthy, safe transition from the hospital. 

Read the full article at Forbes

Written by Alyssa Gerace

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Most people learn the importance of washing hands to get rid of germs and harmful bacteria as children in pre-school, but that training wears off for some and it’s starting to show in the nation’s nursing homes, reports the New York Times’ New Old Age blog, citing a rise in deficiencies for ‘hand hygiene.’

This sounds like common sense: If you work in a nursing home, you wash your hands when you start your shift and again before you leave. You wash your hands (or, in some cases, use an alcohol-based antimicrobial) before and after any direct contact with residents. Before you help someone with tooth-brushing, bathing, eating or using the toilet. Before and after handling a catheter or taking a finger-stick blood sample or changing a dressing. Or handling used bed linens. Or blowing your own nose.

In fact, these are not only common-sensical habits; they’re prescribed by guidelines from the Centers for Medicare and Medicaid, part of the process by which the nation’s nursing homes are inspected and certified.

Yet the percentage of nursing homes cited for deficiencies in “hand hygiene” has been rising in recent years. Inspectors found such deficiencies in fewer than 7.4 percent of nursing homes from 2000 to 2002, but by 2009 found them in close to 12 percent. Some states did better: Hand hygiene citations in Pennsylvania in 2009 came from just 6 percent of facilities. Some fared much worse: Michigan that year was at 15 percent.

One reason cited by the University of Pittsburgh gerontologist Nicholas Castle, a veteran nursing home researcher whose team uncovered this trend, was the growing emphasis on infection control, which means that “surveyors are probably looking harder than they used to” — not a bad thing.

But the study, published in the Journal of Applied Gerontology, also indicated that understaffing and insufficient training played a part. “Most facilities understand the importance of hand washing,” Dr. Castle said in an interview. “It’s a question of having the staff and resources to implement what they know they should be doing.”

…You would think the most direct route to improvement would be to add more staff and raise Medicaid reimbursements for nursing homes. But in the current economic and governmental climate, Dr. Castle noted, “they’re unlikely to get either and they have to do more with less,” which may be the most dispiriting element of all.

The trend is alarming considering the “fierce” infections that can lurk in health care settings, says the blog post, especially as the elderly are often more susceptible.

“Infections picked up in health care settings represent their single greatest cause of sickness and death, the reason underlying a quarter of all hospitalizations from long-term care facilities,” it says. 

Read the full piece at the New York Times.

Written by Alyssa Gerace

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As assisted living regulations evolve, Medicare and Medicaid reimbursements fluctuate, and healthcare reform begins to take effect, many states are facing their own challenges as they continue to develop, operate, and implement new rules and programs. Here is a collection of long-term care related news bites from across the nation.

From the CourierPress.com (Ind.)—State Gets $78 Million for Home, Community Services

Indiana is getting $78 million to help seniors and people with disabilities live in their communities instead of nursing homes or other facilities. The Centers for Medicare and Medicaid Services announced the grant Tuesday. The money was provided under the federal health care law,” reports the CourierPres.com. “The CDC says in a news release that states are eligible for the grants if less than half of their total long-term care spending goes toward home and community-based services.” Read more

From the Montgomery Advertiser (Ala.)—State Nursing Home Assoc. Pushing Amendment for Medicaid Funding

The Alabama Nursing Home Association is pushing a lot of chips into the campaign for the Sept. 18 amendment, [which] would transfer approximately $437 million from the Alabama Trust Fund to the General Fund during the next three years, roughly $145 million annually,” reports the Montgomery Advertiser. “…without the transfer, [non-education] services likely would have to be cut significantly. The cuts could fall especially hard on Alabama Medicaid, which makes up a significant portion of the state’s General Fund. With over two-thirds of nursing home residents on Medicaid, John Matson, a spokesman for the Nursing Home Association, said the vote is an urgent matter for members.” Read more

From the CalaverasEnterprise.com (Calif.)—Nursing Home Staffers Threaten Walk-Out

“Union health care workers and representatives from two area nursing homes head back to the bargaining table Wednesday, the second time in a month those parties will look to crack an ongoing dispute over wage freezes and workload increases,” reports CalaverasEnterprise.com. “Service Employee International Union workers at Mark Twain Convalescent Hospital could be on strike by the end of the week, according to Lauren McDaniels, a restorative nursing aide at Sonora’s Avalon Care Center. Avalon spokesperson Barbara Lillemon suggested tighter industry margins have played a big part in the protracted contract negotiations, talks she characterized as a “back-and-forth” over cost of living increases.” Read more

From the Wall Street Journal—Rising Retiree Health Costs for Aging New Yorkers

“State and local governments in New York will have to come up with an additional quarter of a trillion dollars to pay the entire tab for retiree health care, according to a new report.The $250 billion bill for retiree health coverage is up from $210 billion two years ago, said the study issued by the Empire Center for New York State Policy on Wednesday. Referred to as “other post-employment benefits,” or OPEB, the unfunded obligations represent a troubling strain on budgets,” reports the Wall Street Journal. “Public employers have to disclose their liabilities, but they don’t have to budget for it. Instead, as in most states, New York budgets use an accounting method known as “pay as you go” that sets aside just enough to pay the tab for the year ahead. Critics of the practice say it masks future costs, passing an ever-larger buck to future taxpayers.” Read more

From Kaiser Health News—Calif. Pilot Offers Caveats for Moving ‘Dual Eligibles’ to Managed Care

“As federal officials evaluate state proposals to move millions of the nation’s poorest and sickest individuals into managed care plans, they might consider a recent report from the California HealthCare Foundation,” reports Kaiser Health News. “The report analyzed California’s year-long transition of 240,000 low-income seniors and people with disabilities from fee-for-service plans into managed care as part of a federally approved demonstration project. [Christopher] Perrone [deputy director of the California HealthCare Foundation's Health Reform and Public Program's Initiative] notes that California state officials, health plans and others involved in the waiver program made “enormous effort” to develop the initiative. Nonetheless, the report noted several problems.” Read more

From AHCA—Louisiana, Mississippi Successfully Weather Hurricane Threat

“Skilled nursing care associations from the states of Louisiana and Mississippi today heralded their respective disaster response plans as the last remnants of Hurricane Isaac left their borders,” says the American Health Care Association. “In all, Louisiana evacuated 12 centers and over 1,200 residents and patients with no reported fatalities or serious injury, while an additional 55 facilities were forced to rely on generator power but did not evacuate. In Mississippi, just ten centers shifted briefly to generator power during the brunt of the hurricane, yet evacuated no facilities and reported no serious injuries.”

From the Huffington Post—DOJ: Fla. Unnecessarily Warehousing Disabled Kids in Nursing Homes

“Federal investigators say Florida officials are violating federal law by unnecessarily warehousing hundreds of children with disabilities in nursing homes,” writes the Huffington Post. “The Department of Justice sent a letter to Attorney General Pam Bondi this week, saying that in visits to six nursing homes around the state investigators identified numerous children who didn’t need to be there and “would benefit from moving home with their families or other community settings.” Federal officials concluded the state has made it difficult for children to get medical services that would allow them to move home.” Read more

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As assisted living regulations evolve, Medicare and Medicaid reimbursements fluctuate, and healthcare reform begins to take effect, many states are facing their own challenges as they continue to develop, operate, and implement new rules and programs. Here is a collection of long-term care related news bites from across the nation.

From the Centers for Medicare & Medicaid Services (CMS)—Mass. Becomes First State to Join Dual Eligibles Care Demo 

“Massachusetts will become the first State to partner with CMS in the Financial Alignment Demonstration (the Demonstration) to test a new model for providing Medicare-Medicaid enrollees with a more coordinated, person-centered care experience,” CMS announced on Aug. 23. “Massachusetts is the first State to enter a Memorandum of Understanding (MOU) with CMS to participate in the Demonstration and test the capitated Financial Alignment model.  The Commonwealth and CMS will contract with Integrated Care Organizations (ICOs) that will oversee and be accountable for the delivery of covered Medicare, Medicaid, and expanded services for Medicare-Medicaid enrollees ages 21-64 in the Commonwealth.  As a result, 110,000 Medicare-Medicaid enrollees in Massachusetts will have an opportunity to choose better, more coordinated care.” Read more

From the San Francisco Chronicle—Ohio Takes Next Step to Better Coordinate Medical Care for Seniors

Ohio is one step closer to implementing changes aimed at better coordinating medical care for some of the state’s sickest and most expensive patients.
Gov. John Kasich’s administration wants to streamline the way health care is delivered to Ohioans enrolled in both Medicaid and Medicare,” reports the San Francisco Chronicle.”The state wants to better link the two programs so that the beneficiaries only have to work with a single entity to receive the services. Individuals would get a care manager to help them with medical decisions and to live independently if they are still at home. ”If they are 86 years old, living at home and cannot get out, then how is that different than being institutionalized?” McCarthy said. “So just living at home isn’t the important part, you need to have those social interactions and be connected to the community. And that’s a part of what we’re trying to do with this project.” Ohio is hoping to become the second state after Massachusetts to take part in a dual-eligible project with the federal government, McCarthy said.” Read more

From the San Francisco Chronicle—N.C., Feds Reach Agreement on Adult Care Homes

“The state of North Carolina and the federal government signed an agreement Thursday that could move thousands of residents in adult care homes with serious mental illness into community housing and avoids potential costly litigation,” reports the San Francisco Chronicle. “The agreement signed by state Health and Human Services acting Secretary Al Delia and federal attorneys says by mid-2020 the state will provide affordable housing for 3,000 slots for people who otherwise would be living in adult care homes or mental hospitals. At least 100 slots will be available by next July, the agreement said. No one will be forced to move from an adult care home to the community, although the agreement requires proof residents are making informed choices.” Read more

From TheTownTalk.com—2,500 Deficiencies Reported at Louisiana Nursing Homes in 18 Months

“In the past 18 months, Medicare inspectors have found 2,594 examples of substandard care — some similar to those causing Chambers’ death — at nursing homes across the state, according to U.S. Centers for Medicare and Medicaid Services inspection reports. The data recently was compiled and made available by the independent non-profit media group ProPublica,” reports TheTownTalk.com.”The deficiencies range from seemingly minor infractions, such as a potted plant placed in a possibly hazardous location, to major violations, such as beatings of patients, hiring workers with violent criminal backgrounds or failing to protect residents from fellow patients with aggressive behavior. In an email, Louisiana Department of Health and Hospital officials said statewide nursing homes are committed to quality care. “We follow national best practices and we are confident that we have all procedures in place to ensure the health and safety of Louisiana’s nursing home residents,” the department said.” Read more

From The Times-Picayune (La.)—Nursing Homes Better Prepared for Hurricane Isaac Than Previous Storms

“Across Louisiana, dozens of hospital patients, nursing home residents and people with special medical needs were moved to safer ground before Hurricane Isaac’s Gulf Coast landfall. At a special medical shelter at the Louisiana State University Field House in Baton Rouge, 71 people had taken shelter by Tuesday morning, including 48 patients and 23 caregivers,” reports The Times-Picayune. “The Field House has a capacity of 300. At least eight nursing homes and four hospitals in southeast and south central Louisiana had also evacuated, including roughly 80 patients from Bayside Healthcare Center nursing home in Gretna who were transported after midnight in the early hours of Tuesday morning. The days leading up to the storm’s arrival highlighted improvements in medical preparedness since Hurricanes Katrina and Gustav. “So many things are so different this time than last time,” DeSalvo said.” Read more

From the Charlotte Observer (N.C.)—More Retirees Heading to Charlotte Area

In recent months, Marian Ingram, a real estate agent in Keller Williams’ Ballantyne office, has watched as more seniors from around the country look for new homes here. Ingram specializes in working with people 55 and over,” reports the Charlotte Observer. “Many are still choosing the Charlotte area to be near children and grandchildren who already live here. Retirement industry professionals refer to these seniors as “trailers,” because they’re following their children. Aging newcomers will find a variety of senior housing in the Charlotte area. They range from developments that cater to active seniors to continuing care retirement communities equipped with assisted living and nursing facilities.” Read more

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Medicare is planning on eventually introducing a payment system for skilled nursing facilities that’s based on the quality of care being given rather than on costs and resources, but first it needs to figure out a system for doing so by analyzing results from its three-year “Nursing Home Value-Based Purchasing Demonstration” project, which ended on July 1. 

The national incentive pay program for nursing homes to provide superior quality in order to receive better payments is an initiative of the Affordable Care Act, but it will be several years in coming, according to a Department of Health and Human Services report to Congress on the demonstration project. 

More than 180 nursing homes across Arizona, New York, and Wisconsin took part in the demonstration project, which gathered data on nursing staffing, potentially avoidable hospitalizations, clinical measures, and information about deficiencies from state survey inspections. The information is currently being reviewed and analyzed—a process that could take more than a year—but initial results are mixed, according to researchers. 

During the pilot program, participating facilities were given incentives based on two criteria: whether they improved performance, and whether they appeared in the top 20% of nursing homes, based on a composite score. Those ranking in the top 10% got a higher Medicare payment.

However, the facilities showed varying levels of performance, with Wisconsin nursing homes achieving substantial savings, which could lead to significant incentive payments, while savings at Arizona facilities were more modest, and New York nursing homes didn’t see any savings. 

“The results are somewhat disconcerting,” David Grabowski, a professor of health policy at Harvard Medical School and lead investigator responsible for evaluating the demonstration project, is quoted as saying in a Kaiser Health News article on the report. “There does appear to be some opportunity for cost savings, but we don’t have a good sense yet as to whether this (demonstration project) will actually improve the quality of care.”

However, health policy experts remain optimistic that the current system can be transformed into a “higher performing, value-driven” healthcare system. 

“Harnessing the significant and growing purchasing power of Medicare in this [skilled nursing] sector can provide incentives for providers to improve the quality of care for their patients,” wrote HHS. “MedPAC stated that linking payments to beneficiary outcomes could help improve SNF quality and redistribute payments from low-quality to high-quality providers.”

The Centers for Medicare and Medicaid Services (CMS) views the implementation of this sort of quality-based payment program as an important step in revamping how Medicare pays for healthcare services, says HHS, aiming to hold providers accountable for the quality of care they provide to Medicare beneficiaries, promote more effective, efficient and high quality care processes, and address the variation in quality across care settings. 

The plan for this program will link payment to performance to “improve value for Medicare beneficiaries and other residents residing in SNFs by promoting the development and use of robust quality measures to allow patients and providers to assess the quality of skilled and non-skilled care furnished in SNFs,” says the report. “[T]he emphasis on Medicare beneficiares’ functional status can help prepare them for discharge to a less intensive non-institutional setting.” 

Access the report to Congress

Written by Alyssa Gerace

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The owners of the former Beechwood Restorative Care Center have been awarded a $25 million settlement from the state of New York on grounds that state Department of Health officials retaliated against the nursing home because of its owners’ frequent challenges to state regulations, reports the local ABC News affiliate.

Another article in the Democrat and Chronicle gave more background: Brook Chambery and his mother, Olive Chambery, used to own the now-closed Beechwood nursing home and alleged their facility had to shut down as a direct result of the state’s actions.

The two owners made “frequent challenges” to state regulations citing the nursing home for deficiencies in care, says the article. The nursing home ceased operation in 1999 after the state revoked its operating license, which the owners considered “an extreme act by the state and proof of its vendetta.”

The nursing home was valued at about $18 million, and the settlement also brought into consideration lost wages for both Brook Chambery and his mother, who was the facility’s administrator. 

For its part, the state contended the nursing home had not corrected some “serious problems” in patient care, but the Chamberys argued that Beechwood provided “much better care than other facilities.”

Read the Democrat and Chronicle piece.

Written by Alyssa Gerace

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Long-term care provider AdCare Health Systems, Inc. (NYSE:ADK) has agreed to purchase a South Carolina skilled nursing facility for $4.2 million.

The 84-bed facility generations an estimated $3.8 million in gross annualized revenues, according to its most recent financials.

The acquisition is expected to close in the fourth quarter of 2012 and will be financed with a traditional bank loan. 

“This transaction supports our aggressive M&A strategy of targeting underperforming skilled nursing properties for facility optimization,” said Boyd Gentry, AdCare’s president and chief executive officer. “Our optimization strategy leverages our regional teams to increase facility occupancy and Medicare census, as well as optimize reimbursement and patient care. We expect this strategy to generate a significant increase in revenues.”

AdCare has now put 48 senior care facilities under contract since beginning its M&A program, with plans to complete acquisitions on at least eight more properties in the second half of 2012. 

Written by Alyssa Gerace

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Long-term care pharmaceutical provider Omnicare (NYSE:OCR) has agreed to settle a whistleblower lawsuit alleging it had paid a kickback when acquiring a pharmacy company and submitted false reimbursement claims to government health insurers, but has denied wrongdoing in court papers, reports Bloomberg Businesweek

The Covington, Ky.-based nursing home drugs supplier acquired Total Pharmacy Services LLC in 2004 for $25 million. Whistleblower Maureen Nehls’ lawyer said in the 2007 lawsuit filing that the acquisition “held no assets, aside from a small inventory”—meaning most of the purchase price amounted to a kickback for long-term contracts. 

Bloomberg reports:

Lawyers told a federal judge in Chicago yesterday that they reached a “settlement in principle” to resolve a 2007 lawsuit by whistle-blower Maureen Nehls, a court docket entry shows. The terms, if final, weren’t entered into the docket. U.S. District Judge John J. Tharp Jr. set a hearing for Sept. 25.

Nehls claims Omnicare’s $25 million purchase of Total Pharmacy Services LLC in 2004 included a kickback to one of its owners, Philip Esformes, and his father, Morris. That payment helped Omnicare win contracts with nursing homes owned or controlled by Morris Esformes and gave the company thousands of elderly and disabled customers, according to the complaint.

Nehls sued in Boston with [fellow whistleblower Adam] Resnick under the U.S. False Claims Act, which lets whistle-blowers sue on behalf of the government and share in any recovery. The U.S. Justice Department declined in January 2010 to join the case. They also sued under false claims laws in Illinois and Florida.

On May 11, Omnicare settled a case with the Justice Department for $50 million. The agency called it the “largest controlled substance settlement in history,” and said Omnicare gave nursing home residents medicines without a prescription, with missing prescription information or without documentation.

The former owners of Total Pharmacy Services LLC, Philip Esformes and his father, Morris Esformes, were not included in the settlement, Bloomberg notes.

“Philip Esformes understands that Omnicare made a business judgment to reach a settlement in this case,” said Philip Esformes’ lawyer, Michael Pasano, in an email to Bloomberg. “That settlement in no way speaks to Mr. Esformes’s position, and Mr. Esformes continues to emphatically emphasize he has done nothing wrong and is in no way liable in this matter.”

Read the full piece.

Written by Alyssa Gerace 

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Starting in October, Medicare will penalize more than 2,000 hospitals whose readmission numbers have been deemed excessive, says Kaiser Health News. As a result of those penalties, the hospitals will collectively lose about $280 million in Medicare payments in the next year, part of a federal push to start reimbursing care providers based on the quality of care that’s being given.

The movement toward managed care puts more emphasis on where patients go once they’ve been discharged from the hospital, and the senior living industry has an opportunity to position itself as post-acute care partners who can effectively keep people from returning to an acute care setting. 

Kaiser Health News reports

With nearly one in five Medicare patients returning to the hospital within a month of discharge, the government considers readmissions a prime symptom of an overly expensive and uncoordinated health system. Hospitals have had little financial incentive to ensure patients get the care they need once they leave, and in fact they benefit financially when patients don’t recover and return for more treatment.

Nearly 2 million Medicare beneficiaries are readmitted within 30 days of release each year, costing Medicare $17.5 billion in additional hospital bills. The national average readmission rate has remained steady at slightly above 19 percent for several years, even as many hospitals have worked harder to lower theirs.

The penalties, authorized by the 2010 health care law, are part of a multipronged effort by Medicare to use its financial muscle to force improvements in hospital quality. In a few months, hospitals also will be penalized or rewarded based on how well they adhere to basic standards of care and how patients rated their experiences. Overall, Medicare has decided to penalize around two-thirds of the hospitals whose readmission rates it evaluated, the records show.

A total of 278 hospitals nationally will lose the maximum amount allowed under the health care law: 1 percent of their base Medicare reimbursements. 

The maximum penalty will increase after this year, to 2 percent of regular payments starting in October 2013 and then to 3 percent the following year. This year, the $280 million in penalties comprise about 0.3 percent of the total amount hospitals are paid by Medicare.

Some of the 2,211 hospitals facing penalties in October are top-ranked institutions, Kaiser notes, while others have made a conscious effort to reduce readmissions but haven’t seen measurable improvements. 

The article also talks about concerns that have been raised over the penalizations, especially for hospitals whose primary patient census may be more prone to readmissions for various reasons, including race and socio-economic status. 

Read the full piece

Written by Alyssa Gerace

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Three men have agreed to collectively pay more than $5 million after being busted for misleading the Department of Housing and Urban Development (HUD) in order to get HUD-insured mortgage refinancing for three Oklahoma nursing homes, says the Department of Justice. 

Philip Green and Jerry Max Jiles, the owners of Bartlesville Health Care Center, Inc., and Virgil M. Harry, Jr., the former president of the Harry Mortgage Company, will pay $5.325 million to resolve allegations that they knowingly made false statements in applications to HUD to get mortgage refinancing for the three nursing homes.

The trio allegedly made false statements regarding the eligible existing indebtedness of those nursing homes—the Bartlesville facility, the Mannford Health Care Center, and the Owasso Nursing Care Center Inc.—so they could get cash from the HUD-insured mortgage refinancing, in violation of HUD rules and requirements. 

In 2008, the mortgage loan for the Bartlesville home defaulted and the facility closed, resulting in a loss to HUD through the $3.2 million mortgage insurance claim. 

Jiles and Green each agreed to pay $2.625 million, while Harry was ordered to pay $75,000. 

Written by Alyssa Gerace

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Long-term care provider Kindred Healthcare, Inc. (NYSE:KND) announced on Monday that it had signed a definitive agreement to acquire home healthcare provider IntegraCare Holdings, Inc., a portfolio company of private equity firm Flexpoint Ford LLC, for a purchase price of $71 million in cash plus up to $4 million more based on 2013 earnings.

The transaction will be financed with operating cash flows and proceeds from Kindred’s revolving line of credit; IntegraCare will have no outstanding long-term debt at closing. 

IntegraCare provides home health, hospice, and community services and operates in 47 locations across Texas. The company currently generates annualized revenues of approximately $71 million with an EBIDTA of approximately $9 million. 

Kindred currently operates three nursing and rehabilitation centers, nine long-term acute care hospitals, three inpatient rehabilitation facilities, and one hospital-based sub-acute unit within IntegraCare’s existing service areas. The transaction provides an expansion platform into additional markets throughout the south of Texas, including the Houston market where Kindred already has a large presence. 

“This transaction will add further size and scale to our growing home health and hospice business. With IntegraCare, our home health and hospice division will have a revenue run rate in excess of $200 million and over 100 locations,” said Paul Diaz, CEO of Kindred, in a statement. “We believe that the continued expansion of our continuum of post-acute care services in our key cluster markets supports the growing interest among patients, physicians, hospital systems and public and private payors for high-quality, patient-centered integrated care.”

Kindred expects the transaction to close by the end of the third quarter of 2012; it is still subject to several regulatory approvals and other conditions. The acquisition is expected to result in a slight gain to Kindred’s earnings in 2012, and $0.07 and $0.09 per diluted share gain to earnings in 2013.

Written by Alyssa Gerace

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