Category Archives: Nursing.Homes

Chicago nursing home fined after residents overdose on heroin

Source: David Jackson and Gary Marx, Chicago Tribune, November 14, 2016

State and federal health officials are seeking penalties totaling more than $100,000 from a North Side nursing home after five residents overdosed on heroin inside the facility in February, the Tribune has learned. The residents of Continental Nursing & Rehabilitation Center were hospitalized and recovered, but at least two used heroin again hours after they were returned to the facility, even though they were supposed to be on close watch, Illinois public health department inspectors allege. One of the two overdosed again. … Illinois law requires nursing homes to notify the Department of Public Health of unusual events that put patients at risk, but state officials said they learned of that case only when the Tribune filed a query about it. The federal Centers for Medicare & Medicaid Services, or CMS, has imposed civil monetary penalties totaling $76,000 for alleged violations in the February incident. Continental is contesting an additional $25,000 fine from the state public health department, which says the facility failed to properly monitor and treat residents with drug addictions. … Continental, which has housed a mix of older residents and younger adults with mental illness, did not admit deficiencies when it outlined corrective actions it would take — plans that were accepted by CMS in April. “The facility has ceased admitting any residents with active substance use,” its plan said. In a brief interview with the Tribune, Continental part-owner Moishe Gubin said he was not aware of any heroin overdoses or other problems at the facility. … Continental is part of a rapidly growing, South Bend, Ind.-based nursing home operation that includes more than 50 facilities in eight states, records show. Their 13 northern Illinois facilities include one that earned a top, five-star rating for overall quality from CMS. Four others, including Continental, were given a one-star quality rating, the lowest possible, and police and public health inspection records have alleged unsanitary conditions and negligent care at Continental and some other northern Illinois homes. Medicaid and Medicare last year paid those 13 facilities a total of roughly $150 million, and the facilities reported a combined 2015 profit of $6 million, according to cost reports filed with the state. Similar data was not available for a recently added 14th northern Illinois facility. …

A manager hired to help developmentally disabled people misappropriates more than $58,000

Source: Audit Connection Washington, August 22, 2016

The Department of Social and Health Services (DSHS) oversees supported living agencies, which provide services to individuals with developmental disabilities. A house manager runs the daily operations of the supported living home such as purchasing food, completing payroll, and paying bills. Last year, Friendship House in Enumclaw fired the house manager for paying bills late and keeping poor records. Once the house manager was fired, other staff took over the Friendship House’s finances. After reviewing the records, they quickly became suspicious and called the local police department. A detective found the former manager wrote more than 200 checks to herself totaling $58,856. … A member of the Board of Directors for the house informed the detective that he got “into a bad practice” of signing blank checks for the manager, trusting that she would use the money for its intended purpose.

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Florida’s Medicaid privatization raises costs, not quality

Source: F. Douglas Stephenson, Social Justice Solutions, November 3, 2016

You might think that we learned the lesson of discredited managed care in the 1990s. The term “managed care” is confusing to many, but really amounts to managed reimbursement rather than managed care. A set prospective annual payment is made by federal/state governments, as in the case of Florida Medicaid managed care, to cover whatever services patients will receive over the coming year. There is therefore a built-in incentive for managed care organizations to skimp on care and pocket more profits. The same problem is back in Florida in the form of privatized Medicaid managed care, facilitated further by the Affordable Care Act. More than one-half of Medicaid beneficiaries are now in privatized plans, which have been catching on in Florida and many states based on the unproven theory that private plans can enable access to better coordinated care and still save money. That theory is not just unproven, it is patently wrong as the state forecasters are now discovering. Medicaid will eat up 45.9 percent of growth in general revenue over the next three years, ballooned by approval of a 7.7 percent increase in payment to private managed care plans. …

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Florida says privatizing Medicaid cut costs, but insurers say they’re underpaid by state
Source: Daniel Chang, The Miami Herald, July 17, 2015

In less than a year, Florida’s switch to privately managed healthcare for more than 3 million poor, disabled and elderly residents has achieved one of its primary goals: cutting costs for Medicaid, the public health insurance program for low-income people that accounted for roughly one-fifth or about $9.5 billion of state spending last year. But the savings may be short lived after the private companies that took over insuring Florida’s Medicaid patients asked for a mid-year raise of nearly $400 million, and a 12 percent rate increase starting Sept. 1. That has state health officials, including Elizabeth Dudek, head of the Agency for Health Care Administration, worried that “the vast majority” of Medicaid savings from the first year could be wiped out if Florida gives in to the insurers’ demands.

Feds give permission to privatize long-term Medicaid care
Source: Kathleen Haughney, Sun Sentinel, February 4, 2013

The Obama administration Monday gave Florida permission to transfer part of its Medicaid program to private health-care companies beginning this summer.

The state will enroll 87,000 Medicaid patients — low-income seniors needing long-term care – in one of five health-care plans that were selected last month to cover patients living in 11 districts around the state. The companies include American Eldercare, Sunshine State Health Plan, United HealthCare of Florida, Coventry Health Care of Florida and Amerigroup Florida.

In 2011, the Legislature approved a shift from fee-for-service to managed care for most of its 3.3 million Medicaid population, in hopes of curbing soaring costs of the $22-billion program. But the shift requires a “waiver” from the U.S. Health and Human Services Administration, which pays about 58 percent of the program’s total cost.
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Nursing home operator from Chicago jailed as feds allege $1 billion scheme

Source: David Jackson and Gary Max, Chicago Tribune, October 4, 2016

For years, wealthy nursing home operator Philip Esformes seemed to live in perpetual motion, using private jets to travel between his Water Tower Place condominium and his mansions in Miami and Los Angeles. Now federal authorities are applying extraordinary court pressure to keep Esformes locked in a Florida detention cell where he awaits trial for allegedly orchestrating an unprecedented $1 billion Medicaid and Medicare bribery and kickback scheme … His confinement in the Miami Federal Detention Center marks a new challenge for a business family that has withstood two decades of Justice Department probes and Tribune investigations into allegations of patient abuse, corruption and substandard conditions at their Illinois, Florida and Missouri nursing home facilities. From their Lincolnwood offices, Esformes and his father and business partner, Morris Esformes, took in millions of dollars annually from federal programs for the sick and disabled. … The Esformeses sold their Illinois nursing facilities about four years ago but kept their headquarters in the Chicago suburbs as they continued to operate 20 or so homes in Florida, government records and Tribune interviews show. The new federal indictment alleges that Philip Esformes and a handful of Miami co-conspirators bilked Medicaid and Medicare for 14 years by cycling some 14,000 patients through various Esformes facilities, where many received unnecessary or even harmful treatments. Drug addicts were allegedly lured to the facilities with promises of narcotics, and prosecutors say some received OxyContin and fentanyl without a physician’s order to entice them to stay. In recent court filings, prosecutors have gone beyond the allegations of the indictment to reveal new claims of patient harm and corruption. …

Pay for Success sounds straightforward, but getting it right may take a while

Source: Margaret J. Krauss, NewsWorks, October 6 2016

… Pay for Success contracts are a fairly new idea. The first U.S. program launched in New York in 2012. They’re also known as social impact bonds.  Whatever you call them, a Pay for Success contract is essentially a loan from the private sector to government in service of the public good. Pennsylvania identified five areas of focus: early childhood care and education; education, workforce preparedness, and employment; public safety; health and human services; and long-term living and home- and community-based services. … Theoretically, though, everyone wins: service providers have long-term commitments from funders to do good work; funders get to invest their money in programs they believe in; the government saves money and serves people in need; and people in need get tangible, effective help. And all of the decisionmaking relies on evidence.  While it’s good to reward effective work, particularly since budgets are limited and lots of people need help, proving that societal change translates into financial savings every time can be tricky. In an article for the Stanford Social Innovation Review, V. Kasturi Rangan and Lisa A. Chase write that Pay for Success could be detrimental to the very populations that governments, funders, and service providers are trying to help. … It will be a while until Pennsylvania can gauge the success of Pay for Success. But the state, as well as the Harvard Kennedy School, the Corporation for National and Community Service Social Innovation Fund and the Pritzker Children’s Initiative, has invested a lot of time in trying to get this first round right: design and development for the two programs has been ongoing since January 2016. …

Blistering report details nursing home deaths

Source: Kay Lazar, Boston Globe, August 12, 2016

Braemoor Health Center nurses and aides lacked the training to revive a dementia patient suffering an apparent heart attack, and the patient died, according to a blistering state report released Thursday. The troubled Brockton nursing home then failed to report the death to the state health department because, nurses told investigators, the patient “had no family.” Braemoor’s administrator, meanwhile, told investigators the nursing home’s clinical team decided against reporting the death because of recent “bad press” about the nursing home’s parent company, Synergy Health Centers. The 70-page report into the deaths of that patient, in April, and another in March, paints a picture of a nursing home in chaos, with scant staff training in basic life-support care, machines needed to deliver life-saving oxygen standing empty, defective equipment used to restore a regular cardiac rhythm during a sudden heart attack, and missing alarms needed to protect dementia patients from wandering out of the building. … Braemoor is one of 11 Massachusetts nursing homes owned by Synergy Health Centers of New Jersey, a problem-plagued company that was slapped in April with what regulators characterized as unusually steep federal fines after two deaths at the company’s Wilmington facility, Woodbriar Health Center. …

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Nursing home owners profited as complaints rose
Source: Kay Lazar, Boston Globe, December 23, 2015

Braemoor Health Center is a modest nursing home in Brockton, licensed to care for 120 residents. But Larry Lipschutz, who owns the property, was able to wring $1.8 million in pay out of it last year, according to state records. His son, Avi “Zisha” Lipschutz, who holds the state license to run the nursing home, extracted nearly $900,000 from Braemoor as payments to a realty company and four management firms he owns. As the owners were taking hundreds of thousands of dollars out of Braemoor, the nursing home racked up three and a half times as many health and safety problems as the state average, federal documents show. … Over the past year, a portrait has emerged of substandard care in many of the nursing homes run by Braemoor’s owner, Synergy Health Centers. Poor treatment of patients’ festering pressure sores. Medication errors. Inadequate staff training. Now, a Globe investigation shows that as father and son were paying themselves handsomely, Synergy apparently provided false information when applying for nursing home licenses. The Globe’s review also found that Synergy and its affiliated companies assembled a string of 11 nursing homes with little state scrutiny of the backgrounds of top executives, including Larry Lipschutz, who faces tens of thousands of dollars in fines because of previous business dealings. …

Resolutions to sell county nursing homes tabled for study

Source: Rick Miller, Olean Times Herald, August 4, 2016

Resolutions before the Cattaraugus County Legislature seeking buyers for the county nursing homes in Olean and Machias were tabled Wednesday by the Human Services Committee for more study. … Vickman, a former employee of the Machias nursing home and a longtime supporter, added, “We aren’t able to tell the public where we are (financially).” She argued for hiring a consultant to come up with a five-year plan much like the Center for Governmental Research report from 2012. Vickman also said the committee needed to meet again to decide what information and projections it needed. Committee member Barbara Hastings, D-Allegany, said the nursing homes’ independent auditor, Michael McCarthy, is scheduled to deliver an annual report later this month, suggesting the committee hold off taking any action until after hearing his report. … While it’s not easy to follow the county nursing homes’ finances, both forecast 2016 deficits of less than $1 million each. The Pines Healthcare and Rehabilitation Center in Olean has sufficient reserves to cover a $890,500 deficit, so it isn’t on the property tax levy — except for the $1 million cost of its share of intergovernmental transfer (IGT) funding. The Pines Healthcare and Rehabilitation Center in Machias budgeted for a $889,268 deficit after the IGT money is applied but does not have any fund balance. When the $889,268 Machias deficit is added to the nearly $2 million cost to obtain the federal IGT money through the state, the overall impact on the property tax levy is more than $2.8 million. … One point Rose Teachman, president of CSEA, made in her remarks to lawmakers that talks on a 70-point list of cost-saving measures suggested by the union were beginning to bear fruit when they were discontinued. There are alternatives to selling the nursing homes, she said. Legislators abruptly sent the resolutions back to committees for more study at last week’s meeting. …

Morris freeholders defend privatizing nursing home as Democrats oppose it

Source: Ben Horowitz, NJ.com, August 2, 2016

The plan to privatize Morris County’s Morris View Healthcare Center, a 283-bed nursing home, was carefully studied before the freeholders decided to issue a request for proposals, according to a county spokesman. … The privatization plan, approved by the all-Republican board in a 5-2 vote, has emerged as an election issue, with two Democratic freeholder candidates opposing it and saying the board needs to get more public input before moving forward. Ragonese took issue with an article published on Nj.com on Friday which reported that a similar leasing arrangement at the 1,000-bed Bergen Regional Medical Center in Paramus has proven problematic. … The privatization arrangement for Morris View was recommended in a study completed for the freeholders by Perselay Associates, a consulting company, which cited rising costs as the main reason. Perselay projected that the tax-supported subsidy for Morris View will increase from the $6.8 million incurred in 2015 to $15.5 million by 2020. Perselay cited dropping reimbursement rates from Medicaid and other sources along with rising costs to pay employees, including higher payments for their health care benefits. … Two Democratic candidates for freeholder, Rozella Clyde and Mitchell Horn, both oppose what the freeholders are doing. Clyde is urging the freeholders to delay circulating the request for proposals for six months, so that there may be more public input. She pointed out that the resolution for the request for proposals was not listed on the freeholders’ agenda last week but was added “at the last minute.” …

The State Paid Nearly $28 Million for a Flawed System That Fails to Meet the Needs of Its Veterans Homes

Source: California Department of Veteran Affairs, Report 2015-121, June 2016

Our audit concerning the development and implementation of the California Department of Veterans Affairs’ (CalVet) Enterprise-Wide Veterans Home Information System (system) revealed the following:

  • The system has not improved the efficiency of the homes’ process for documenting medical care nor has it reduced reliance on paper because of system flaws.
  • System instability and concerns about functionality resulted in CalVet implementing fewer system functions at some homes, thereby limiting CalVet’s ability to provide more efficient care for veterans. …
  • CalVet did not exercise adequate oversight of its system project. It did not complete or partially completed six of the 12 required management oversight plans to ensure effective project management. It hired one contractor to provide both independent project oversight and independent verification and validation services, and those services were inadequate.

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Public Sector Unions and Privatization: Evidence From the Eldercare Sector in Danish Municipalities

Source: Søren Kjær Foged and Lasse Aaskoven, Journal of Public Administration and Research Theory, June 22, 2016

Abstract:
Privatization varies considerably among local governments. One of the oft-listed explanations is the ability of public employees to block privatization. However, many studies on the influence of public employees on privatization do not use very precise measures of the influence of public employees, they have been unable to isolate a one-way effect, and the studies have not been attentive to whether the effect varies for different market forms. In this article, we focus on privatization in Denmark through a voucher market without price competition for eldercare services. Using new data for all 98 Danish municipalities in 2012, we are able to measure the strength of the public eldercare union as well as the number of the public eldercare workers relative to the number of local voters. We find that the increased union strength measured in terms of union density at the municipal level leads to substantially and significantly less privatization through the voucher market. By comparison, the estimated relationship between the relative number of public workers and privatization does not reach statistical significance. Features of the voucher market and qualitative evidence suggest that the union influence primarily goes through a direct user channel, that is through union influence directed at the service users, whereas a minor effect possibly runs through a political channel, that is lobbying directed at the local politicians.