Ila Swan: patient advocate


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Just How Bad Is Nursing Home Care?

Below, is a summary of:

  1. Representative Henry Waxmans Report
  2. Government Accounting Report release in July 1998.
  3. A Nation Wide Survey of overdrugging of nursing home patients.
  4. Government Accounting Report on Nursing Home Bankruptcies released Sept. 2000.
  5. One of dozens of reports of the Criminal Behavior by MANY LARGE NURSING HOME CHAINS.

Summary of Rep. Waxman's Report on Nursing Homes

So, just how bad is nursing home care? One third of the nursing home residents are being abused. 30% of the nursing home residents are caused actual harm or death. Over 50% are being given wrong drugs. 10 out of the 15 largest nursing home chains have been charged with: Fraud and/or unjust enrichment, racketeering, wire fraud et.seq. AND HUNDREDS OF NURSING HOMES HAVE FILED BANKRUPTCY. GAO Reports the bankruptcies are due to BAD BUSINESS DECISIONS AND/OR their greed.

BAD AS BAD CAN BE! ONLY 2% OF CA. NURSING HOMES GIVE CARE MEETING THE STANDARDS OF THE LAW. In essence our government in many cases is paying criminals to care for our loved ones and our JUSTICE SYSTEM refuses to put these criminal in prison. Is it the MOB? I believe it is.

Full Congressional Report (.pdf file)
[posted at:]

GAO Report

California Nursing Homes: Care Problems Persist Despite Federal and State Oversight.

[HEHS-98-202, July 27, 1998, 53 pages] Overall, despite federal and state oversight, some California nursing homes are not being monitored closely enough to guarantee the safety and welfare of their residents. Unacceptable care continues to be a problem in many nursing homes. GAO found that nearly one in three California nursing homes was cited by state surveyors for serious or potentially life-threatening care problems. Moreover, GAO believes that the extent of serious care problems portrayed in federal and state data is likely to be understated. Nursing homes generally could predict when their annual on-site reviews would occur and, if inclined, could take steps to mask problems. GAO also found irregularities in homes' documentation of the care provided to their residents, such as missing pages of clinical notes needed to explain a resident's injury later observed by a physician.

Finally, GAO found many cases in which California Department of Health Services surveyors did not identify serious care problems, including dramatic weight loss, failure to prevent bed sores, and poor management of incontinence. Even when the states identified serious shortcomings, the Health Care Finance Administration's (HCFA) enforcement policies have not ensured that the deficiencies are corrected and stay that way. For example, California state surveyors cited about one in 11 nursing homes in GAO's analysis--accounting for more than 17,000 resident beds--for violations in both of their last two surveys that resulted in harm to residents. Yet HCFA generally took a lenient stance toward many of these facilities.

GAO recommends a less predictable schedule of inspections for all nursing homes and prompt imposition of sanctions when violations are found. GAO summarized this report in testimony before Congress; see: California Nursing Homes: Federal and State Oversight Inadequate to Protect Residents in Homes With Serious Care Violations, by William J. Scanlon, Director of Health Financing and Systems Issues, before the Senate Special Committee on Aging. GAO/T-HEHS-98-219, July 28 (16 pages).

Chart: Distribution of 1,370 California Nursing Homes By Seriousness of Violations Cited , 1995-1998

Prescription Drug Use In Nursing Homes

A three-part report entitled, "Prescription Drug Use in Nursing Homes" (OEI-06-96-00080, OEI-06-96-00081, OEI-06-96-00082). The reports looked at drug use in nursing homes by a nationwide survey of consultant pharmacists who conduct drug regimen reviews in nursing homes on a monthly basis as well as a review of actual medical records of nursing home residents in Texas nursing homes.

Other problems the study found include:

  • 16 percent of residents had no prescription in their records to support one or more of the drugs in their regimen for which a prescription is generally required. Additionally, 14 percent of residents are taking over-the-counter medications without physician orders.
  • 17 percent of residents were taking medications inappropriate for their dietary requirements.
  • 8 percent of residents were being given drugs inappropriate for their plan of care and 6 percent were receiving drugs judged inappropriate based on their physical assessments.
  • 23 percent of the patient records indicated patients having been prescribed medications for which the records showed no orders or receipts to indicate the patient actually received the medication.
  • 20 percent of residents' records indicated use of at least one drug generally considered to be inappropriate for the elderly. (Several of the drugs among those considered inappropriate are psychoactive drugs, including certain antidepressants, anti-anxiety drugs, sedative and hypnotic drugs). Of these, 21 percent had more than one such drugs in use.
  • The reports also identified that some residents may be experiencing unnecessary adverse side effects and drug interactions as a result of inadequate monitoring of medications. As evidence of this, OIG cites their findings that:
  • 19 percent of records gave no indication of monitoring of medication side effects. 23 percent of records gave no indication that required lab work had been done. 19 percent of records gave no indication that necessary physical assessments had been conducted.
  • Drugs were being given that cause known side effects documented in the resident record, for example: 14 percent of residents experiencing constipation, 8 percent of residents experiencing falls, and 5 percent with symptoms of depression. Adverse side effects related to medications being given were identified in 9 percent of residents' medical records.
  • 21 percent of residents received medications know to interact negatively with other drugs included in their medication regimens.
  • Nearly one third of residents received more than one drug from the same class of drugs. This is often considered a potential hazard because they may produce similar side effects which are additive. For this reason, such combination drug use is usually avoided unless it is required to achieve the necessary level of effect. When this is the case very close drug monitoring should be in place, but 19 percent of records indicated no such monitoring.
  • Misuse of drugs is not the only problem besetting the nation's nursing home residents. Data indicates overuse of even the most stringently regulated drugs as well. Since the passage of the Nursing Home Reform Act of 1987 (OBRA), federal regulations have required that psychoactive drugs be used only when absolutely necessary to treat an appropriate diagnosis or severe symptoms and only for as long as necessary. Despite the regulations, use of psychoactive drugs in the nation's nursing homes has soared from 26.4 percent of all residents in 1991 to 50.3 percent in 1999.

Government Accounting Report on Nursing Home Bankruptcies

[released Sept. 2000, REPORTNUM: T-HEHS-00-192]

NURSING HOMES Aggregate Medicare Payments Are Adequate Despite Bankruptcies

Statement of Laura A. Dummit, Associate Director Health Financing and Public Health Issues Health, Education, and Human Services Division Testimony Before the Special Committee on Aging, United States Senate

United States General Accounting Office

Mr. Chairman and Members of the Committee: I am pleased to be here today as you discuss the causes of the bankruptcies of large corporations owning nursing homes, particularly whether recent Medicare payment reforms affected the bankruptcies, and implications for nursing home residents. Those payment reforms, set forth in the Balanced Budget Act of 1997 (BBA), were enacted to control rapid spending growth for Medicare- covered services furnished in nursing homes- spending growth that was neither sustainable nor readily linked to demonstrated changes in beneficiary needs. The reforms altered the financial incentives inherent in the former cost- based payment system to reward providers for delivering care efficiently.

Since the BBA provisions were implemented, five large nursing home chains- comprising almost 1,800 of the nation's 17,000 nursing homes- have filed for bankruptcy protection under Chapter 11 of the U. S. Bankruptcy Code. These bankruptcies and the large reported losses of these companies have received much public attention because of the number of homes involved and because of the fear that residents will be displaced if nursing homes close. Because the distribution of these facilities is concentrated, the potential threat of closure looms much larger for some states than for others. Almost half of the nursing homes in New Mexico and Nevada, for example, are operating in bankruptcy, compared with the national average of about 12 percent. Twelve other states have more than 20 percent of their homes operating in bankruptcy.

Many providers have blamed Medicare policies and the BBA for their financial difficulties and have pressured the Congress to undo some of the act's payment reforms. In response, the Congress has monitored the results of these reforms and made certain modifications in the Balanced Budget Refinement Act of 1999 (BBRA). But many in the industry argue that more changes are needed and are calling for higher payments.

Calls for increased payments come at a time when federal budget surpluses and reduced Medicare outlays could make it easier to consider increases in Medicare payment rates. However, in view of the coming surge in the Medicare- eligible population, the Comptroller General has cautioned repeatedly that projected Medicare spending threatens to absorb ever- increasing shares of the nation's budgetary and economic resources. Without meaningful reform, demographic trends alone will drive Medicare spending to levels that will prove unsustainable for future generations of taxpayers.


[Among dozens of other reports]:

Vencor Faces $1 Billion Claim; U.S. Seeking Medicare Repayments

The Washington Post, 3/14/2000:   "The Justice Department said yesterday that it is entitled to recoup $ 1 billion from Vencor Inc., accusing one of the nation's largest nursing-home companies of knowingly defrauding the government since 1992."

But Vencor, like several big nursing-home chains, is operating under the protection of a federal bankruptcy court. So it is unclear how much taxpayers could recover even if the Justice Department prevails in its civil claims. The government might have to stand in line to collect along with other creditors.

Justice spokesman Charles Miller wouldn't explain the department's case. But he said it involves "the knowing submission of false claims to the government" and "fraudulent schemes between 1992 and the present."

Last month, Beverly Enterprises Inc., the nation's largest operator of nursing homes, settled charges that it defrauded Medicare by agreeing to pay $175 million--most to be deducted from future Medicare payments. The government said it settled for less than half the alleged loss to taxpayers to avoid causing "financial hardship" for the company. Though troubled, Beverly has not filed for bankruptcy protection.

Sun Healthcare Group Inc., a big nursing-home chain now in bankruptcy reorganization, has reported that it is a defendant in whistle-blower suits accusing it of false claims. Sun reported that the Justice Department has joined one of the suits and has informed Sun of "a number of outstanding inquiries."

Nursing home pleads guilty to defrauding federal Medicare program

[San Jose Mercury News: 2/4/2000]:   SAN JOSE, Calif.    Beverly Enterprises Inc., the nation's largest nursing-home chain, pleaded guilty Thursday to defrauding the federal Medicare program out of hundreds of millions of dollars in a six-year, cross-country corporate scheme that included two South Bay facilities, one in Sunnyvale and another in Los Gatos.

Under a plea agreement with federal prosecutors, Beverly Enterprises will pay a $170 million civil penalty and a $5 million criminal fine, as well as divest itself of 10 nursing homes implicated in the Medicare fraud scandal. In addition to the HylondS Health Care and Rehabilitation Center in Sunnyvale and Terreno Gardens facility in Los Gatos, Beverly will have to relinquish its facility in San Francisco.

The $170 million settlement is one of the largest the Justice Department has obtained for Medicare fraud.

The federal investigation arose out of a whistle-blower suit filed by a former Beverly executive who maintained the chain's falsification of charges for nursing services cost the Medicare program as much as $460 million between 1992 and1998.

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