Advocates’ Event Targets Major Cause of Infections in Health Care Settings: Clostridium Difficile (C. diff)

by William J. Beerman, Sr.

I’ll be attending the 2018 Peggy Lillis Foundation (PLF) National Clostridium Difficile (C. diff) Advocates Summit on Monday, April 9, at the Milken Institute School of Public Health, George Washington University, in Washington, DC.

The summit will be streamed live on Monday from 9 a.m. to 5 p.m. EST. You can register at tiny.cc//2018summit. The summit will offer training for new and experienced advocates with presentations and panel discussions featuring leaders in C. diff prevention and treatment, healthcare policy, state government, patient advocacy, and grassroots organizing.

On Tuesday I’ll join other summit participants who will go to Capitol Hill to provide information about C. diff to federal legislators and staffers. One government policy issue is that C. diff is often omitted as a cause of death on death certificates, and PLF would like to have guidelines established to ensure it is recorded when appropriate.

PLF points out that C. diff is the most common cause of infectious diarrhea in healthcare settings. It caused nearly 500,000 infections in one year, and 29,000 deaths. In nursing homes, the infection interferes with residents’ rehabilitation therapy and recovery as it causes uncontrollable diarrhea, fever, nausea, abdominal cramping, dehydration, loss of appetite, and death in some cases.

The disease, which can be triggered by administration of antibiotics, was a major cause of the demise of my mother, Mary Regina Beerman, who died in 2011 after a short stay in a nursing home.

More information is available at the Peggy Lillis Foundation Website, https://peggyfoundation.org/ or its Facebook Page, https://www.facebook.com/PeggyFoundation/

@peggyfund’s 2018 #cdiffsummit

The Well-Connected and the Politically Powerful Weigh in on Government Nursing Home Policy

by William J. Beerman, Sr.

Former HHS Secretary Price during a meeting with American Health Care Association members. From left are Neil Pruit, Jr., Mike Cheek, Bob Hagan, Price, Tom Coble, AHCA President and CEO Mark Parkinson, and Dr. David Gifford.

Here’s an example showing that elections do matter, and so does access to power.

On June 12, 2017, the American Health Care Association (AHCA), which is an association of operators of 13,000 nursing homes and other facilities for the elderly, issued a news release about their leaders meeting with President Trump’s then-new Secretary of Health and Human Services, Tom Price.

The AHCA’s news release about its meeting with Price said:

“AHCA members discussed with Secretary Price the need for responsible regulation that supports and incentivizes quality improvement. Recent regulatory changes impose both redundant and unnecessary stipulations on providers and are not focused on improving care at the bedside. AHCA members specifically noted that some of the practices detailed in the Requirements of Participation, which the Centers for Medicare & Medicaid Services (CMS) issued last October, interfere with person-centered care and day-to-day operations.”

On July 7, 2017, less than a month after the AHCA met with Secretary Price, CMS, an arm of HHS that oversees nursing homes at the federal level, released a memorandum intended to lessen fines levied against nursing homes that have not complied with health and safety standards. CMS followed up with memos on October 27 and November 24 that reduced civil monetary penalties and delayed for 18 months enforcement of regulations in the Requirements of Participation that were set to take effect just days after the November 24 memo.

I mentioned the Price-AHCA meeting in my book, “Mary Regina’s nursing home,” along with the fact that Price, a former congressman, had received almost a half million dollars in congressional campaign contributions from the health sector, and that Price, also a physician, wanted to limit legal options available to aggrieved health care patients.

AHCA and National Center for Assisted Living (NCAL) President and CEO Mark Parkinson is no lightweight stranger to politics. He is the former governor of Kansas and served as lieutenant governor under former Kansas Governor Kathleen Sebelius, who actually became HHS secretary herself under President Obama. Parkinson is also the developer of 10 elder care facilities.

In a letter released February 20, 2018, 11 Democrat U.S. senators and one independent senator wrote to new HHS Secretary Alex Azar and to Seema Verma, administrator of CMS, explicitly criticizing CMS over the three CMS memoranda from July, October, and November 2017, and characterizing the memoranda as “a string of actions…that will inevitably weaken the safety of our nation’s nursing homes and put patients, many of whom are elderly and wholly reliant on this care, at greater risk.”

The letter from the senators said: “It is abundantly clear that when health and safety are compromised, when errors occur, or in the worst cases, when patients are harmed, there must be a wide range of strong enforcement actions available….That is why we are so alarmed that CMS seems intent on rolling back or delaying enforcement of regulations that are meant to keep nursing homes safe for the patients they serve.

“We will not and cannot accept CMS’ actions that fail to keep nursing homes held to the highest possible standards when it comes to patient care and safety, and we urge CMS to reconsider these policies immediately.”

The letter was signed by Senators Richard Blumenthal (D-CN), Amy Klobuchar (D-MN), Robert P. Casey, Jr. (D-PA), Elizabeth Warren (D-MA), Catherine Cortez Masto (D-NV), Tina Smith (D-MN), Bernard Sanders (I-VT), Kirsten Gillibrand (D-NY), Jack Reed (D-RI), Edward J. Markey (D-MA), Cory A. Booker (D-NJ), and Sherrod Brown (D-OH).

Support for nursing home residents is not a strictly partisan issue. The 11 Democrats who signed the letter are among 47 Democrats in the 100-member Senate. For example, the two Democrat senators from my state of New Mexico were not among the signers. In a case where Republicans demonstrated that nursing home patients are not exclusively a Democrat concern, in Minnesota, a group of Republican state senators led by Karin Housley held a press conference to “demand accountability, transparency, and immediate attention” to state nursing home oversight failures in Minnesota. Their protests led to the resignation of the state health commissioner in December 2017.

The AHCA seems to have demonstrated it can be successful with the current administration in opposing regulations it disagrees with. The organization also contends that Medicaid payments fall about $25 per patient-day or $7 billion a year short of what is needed to meet standards of nursing home care. If what AHCA says is true, then Congress should remedy the funding problem.

But if Congress accepts the AHCA argument and provides more money, the appropriation law should include safeguards such as effective oversight to ensure that the additional money is spent on improving patient care and that it does not generate unreasonable profits for the operators.

I delayed publishing this article and sent it to the AHCA and HHS to give them an opportunity to comment. The AHCA replied that it had nothing to add, but HHS did not respond.

When the EMTs are rolling, it’s too late to start preparing for a nursing home experience

By William J. Beerman, Sr.

If you’re told to find a nursing home for a loved one, will you be adequately prepared?

In my case, I received a phone call as the Fourth of July weekend approached back in 2011. The call was  from a cousin who lived near my mother in a city 1,700 miles away from where I was living. My cousin told me that my mother, who had been living independently at age 85, had tripped over a footstool in her apartment and had broken a hip.

Prior to this, I had made some cursory efforts to prepare for my mother’s decline. I had purchased and browsed a book on eldercare, and I had called A Place for Mom to inquire about assisted living facilities. But after that phone call about my mother’s broken hip, I quickly realized that I was unprepared and utterly incompetent to deal with the nursing home crisis that was unfolding.

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Fed-Up with Abuses, Career Speech Pathologist Writes Exposé about Nursing Home Care

by William J. Beerman, Sr.

A speech pathologist who has provided patient services in 40 different nursing homes during her career has published an exposé about the excessive lengths to which some nursing homes will go to make more money. The book is entitled, Nursing Homes to Rehabilitation Centers.

I spoke with the author, Phyllis Ayman of Greenwich, CT, for 2 hours recently by phone and we compared notes. While my book, Mary Regina’s nursing home, approaches the subject from the point of view of a patient’s son who happened to be a retired journalist, and describes the inadequacy of the government oversight system, Phyllis has the perspective of a healthcare-provider insider who, as a staunch patient advocate for improved quality care, frequently found herself at odds with nursing home managers and administrators.

Phyllis and I agree that our respective books make a complementary pair.

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Resignation of State Health Commissioner, Other Sensational Events, Focus Attention on Senior Care in Minnesota

By William J. Beerman, Sr.

(This article was originally posted December 21 but was accidentally deleted. It was reposted December 27)

Stunning news developments have put the government oversight system for senior care facilities in Minnesota in the spotlight.

Several Republican state senators decried nursing home oversight problems in Minnesota at a press conference December 12 after a five-part Minneapolis Star-Tribune newspaper series in November described breakdowns in the state Health Department’s handling of elder abuse complaints, and a fired Health Department official filed a whistleblower complaint November 13.
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Last Defendant Enters Prison in Colossal Home Health Fraud Case

The prosecution phase of a huge home health care fraud case came to a conclusion November 28 when the last defendant in the case reported to the Federal Bureau of Prisons to begin serving a 120-month sentence.

The defendant, Cynthia Stiger of Dallas, age 52, also has been ordered to pay $23.6 million in restitution. Her attorney, Scott Miller Anderson of Dallas, said an appeal for her is continuing in the Fifth U.S. Circuit Court.

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Trustee Pleads Guilty in Scheme to Embezzle Money From Client Trust Accounts

ALBUQUERQUE – Paul Donisthorpe, 62, pleaded guilty November 27 in federal court in Albuquerque, N.M., to wire fraud and money laundering charges arising out of a fraudulent scheme to embezzle more than $4.8 million from client trust accounts managed by Desert State Life Management (DSLM), a trust company he operated and controlled.  Donisthorpe entered the guilty plea under a plea agreement that recommends that he be sentenced to 8 to 12 years of imprisonment followed by a term of supervised release to be determined by the court.  The plea agreement also requires that Donisthorpe pay $4,812,857 in restitution to the victims of his crimes and that he forfeit the proceeds of his criminal activities.

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Although Disputing Allegations, Catholic Health to Pay $6 Million in DOJ Settlement

Skilled nursing care provider Catholic Health System, Inc., of Buffalo — some of whose facilities are currently rated highly by the federal government — has agreed to pay $6 million to resolve federal false-claims allegations against a subsidiary.

Catholic Health continues to dispute the allegations. Catholic Health said it agreed to the settlement with the U.S. Department of Justice (DOJ) because the cost of continuing to defend the case would have diverted more resources from patient care.

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How many care givers does your nursing home really have?

(The following article is from the e-newsletter of the California Advocates for Nursing Home Reform. (www.canhr.org) It contains links at the bottom of the article to information from all 50 states and the District of Columbia made more easily accessible by the Long Term Care Community Coalition.)

Interested in knowing about registered nurse (RN) or weekend staffing levels at a nursing home or how often it falls below California minimum staffing requirements? Data released . . . by the Centers for Medicare and Medicaid Services (CMS) can help answer these important questions and more. The data is the first installment of nursing home staffing information CMS is collecting pursuant to the Affordable Care Act that is intended to give the public a more complete and accurate picture of actual staffing levels in Medicare and Medicaid certified nursing homes.

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Is Repackaging of Leftover Nursing Home Drugs a Victimless Crime?

By William J. Beerman, Sr.

A Pittsburgh area institutional pharmacist who filled prescriptions for nursing home residents was sentenced in federal court to 2 years probation and 150 hours of community service on October 17 after being convicted of conspiracy in a fraud scheme. According to the U.S. Department of Justice (DOJ), MedFast pharmacy drivers picked up leftover drugs from nursing homes. Then, the Beaver County manager for MedFast oversaw repackaging of the picked-up drugs for reuse in other prescriptions.

DOJ said drugs from different manufacturers with different lot numbers and different expiration dates were commingled in pharmacy stock bottles after the pharmacy picked them up from nursing homes. When it was necessary for pharmacy employees to enter lot numbers and expiration dates as they filled new prescriptions, the employees were instructed to use inaccurate and false information, rendering the drugs “misbranded,” according to DOJ. In addition, DOJ said Medicare, Medicaid, and other insurers were not reimbursed for the unused drugs, but they were billed for the illegal, “misbranded” leftover drugs used to fill new prescriptions.

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Guilty Plea in Nursing Home Bribery Case; Sentencing Set

In a further development regarding an article I posted October 9, Bertha Blanco, a former regulatory specialist with the Florida oversight agency for skilled nursing facilities (SNFs) and assisted living facilities (ALFs), filed a guilty plea October 13 on a charge that, as a public official, she corruptly solicited and received bribes directly or indirectly from operators of SNFs and ALFs.

Blanco has admitted selling to SNF and ALF operators information about complaints filed on behalf of patients/residents of SNFs and ALFs with the State of Florida’s SNF and ALF oversight agency. She also admitted that she sold schedules for unannounced facility inspections planned by the agency.

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Yes, at least one nursing home oversight employee did take bribes

How much bribe money might someone be willing to pay for a confidential schedule of upcoming “unannounced” state oversight inspections at nursing homes?

Three thousand dollars per schedule was the going price in one case in Florida, according to an affidavit filed recently by a special agent for the U.S. Department of Health and Human Services, Office of the Inspector General (OIG).

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Nursing Home Complaint Statistics Still Going Up

The general trend in which more and more people file complaints about nursing homes — a trend that spans more than a decade – seems to be continuing.

The U. S. Department of Health and Human Services (HHS), Office of the Inspector General (OIG), issued a “data brief” on September 28, 2017 announcing that, “Overall, states received one-third more nursing home complaints in 2015 than in 2011,” while the number of nursing home residents decreased 3 percent.

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Updates: Are Some Nursing Home Residents Still in Jeopardy?

Are some nursing home residents still in jeopardy today, after countless scandals over the decades? Reports that many of them ARE, indeed, come from various sources. Among them are a critical newsletter article about California nursing homes, and a study report that says hospitals don’t give patients enough information to enable them to competently choose a good skilled nursing home:

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Attorneys General in PA, 16 Other States, Oppose Pre-Dispute Nursing Home Arbitration Clauses

8/8/2017

HARRISBURG — Continuing the fight to protect the most vulnerable Pennsylvanians from predatory business practices, Attorney General Josh Shapiro today called on the Centers for Medicare and Medicaid Services to reject efforts to roll back protections that allow nursing home patients who have been victimized to have their day in court.

Attorney General Shapiro and 16 other Attorneys General sent comments to the Center for Medicare and Medicaid Services, recommending that CMS keep in place a rule that prohibits pre-dispute arbitration clauses in nursing home and long-term care contracts. Pre-dispute arbitration clauses require seniors to waive their rights to go to court to resolve any dispute with a nursing home.

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CMS Announces 1 Percent Raise for Skilled Nursing Facilities

On August 1, 2017, the Centers for Medicare and Medicaid Services (CMS) announced it was giving a rate raise to Skilled Nursing Facilities (SNF) of 1 percent, or a an estimated total raise of $370 million for Fiscal Year 2018. For perspective, nursing home operators have been contending Medicaid payments fall $23 to $25 per resident per day, or $7 billion a year, short of what they need to provide adequate care.

CMS issued the following statement.

The 2018 Skilled Nursing Facility (SNF) Prospective Payment System Final Rule increases Medicare payment rates by 1.0 percent for FY 2018, as statutorily-required by section 411(a) of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which is an aggregate impact of $370 million from payments in FY 2017. The rule revises and rebases the SNF market basket index by updating the base year data from FY 2010 to 2014 and by adding a new cost category for Installation, Maintenance, and Repair Services. The rule also finalizes updates to the SNF Quality Reporting Program, including replacing the pressure ulcer measure with an updated version, adopting new functional status measures and publicly displaying new measures. In addition, it finalizes policies for the SNF Value-Based Purchasing Program for FY 2019, the first year this program will impact Medicare payments and the requirements regarding the composition of professionals for the survey team.

Nursing Home Oversight Has Blind Spots, Author Says

Nursing Home Oversight System Has Blind Spots, Author Says 

NEWS PROVIDED BY William J. Beerman, Sr. Jul 12, 2017, 10:00 ET

LAS CRUCES, N.M., July 12, 2017 /PRNewswire/ -- As debates rage over the future of health care in America, a new book claims that the government's current system for overseeing nursing homes allows unhealthy nursing home conditions to persist or recur year after year.

"The oversight system has blind spots," said retired journalist and certified internal auditor William J. Beerman, Sr., who has just released a 380-page book entitled "Mary Regina's nursing home."

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AHCA Members Meet with HHS Secretary

AHCAPressOffice@ahca.org
(202) 898-3165

FOR IMMEDIATE RELEASE

(L-R) Neil Pruitt, Jr, Mike Cheek, Bob Hagan, Secretary Tom Price, Tom Coble, Mark Parkinson, and Dr. David Gifford

6/12/2017

Washington, D.C. – Last Monday, American Health Care Association (AHCA) President and CEO Mark Parkinson joined association members to meet with the Secretary of Health and Human Services (HHS) Tom Price, M.D., to discuss challenges the long term care profession faces as the nation’s population ages and the importance of maintaining access to quality long term care.

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Genesis Healthcare Agrees to Pay $53.6 Million

JUSTICE NEWS
Department of Justice
Office of Public Affairs

June 16, 2017

Genesis Healthcare Inc. Agrees to Pay Federal Government $53.6 Million to Resolve False Claims Act Allegations Relating to the Provision of Medically Unnecessary Rehabilitation Therapy and Hospice Services

The Justice Department announced today that Genesis Healthcare Inc. (Genesis) will pay the federal government $53,639,288.04, including interest, to settle six federal lawsuits and investigations alleging that companies and facilities acquired by Genesis violated the False Claims Act by causing the submission of false claims to government health care programs for medically unnecessary therapy and hospice services, and grossly substandard nursing care. Genesis, headquartered in Kennett Square, Pennsylvania, owns and operates through its subsidiaries skilled nursing facilities, assisted/senior living facilities, and a rehabilitation therapy business.

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Appeals court upholds $2.5 million award

New Mexico Appeals Court Upholds $2.5 Million Jury Award to Family in Nursing Home Case.

The decision, by the Court of Appeals of the State of New Mexico, came in the case of the Estate of Inez Martinez vs the Las Cruces, NM nursing home, Village at Northrise (VNR) and parent companies.

On April 15, 2010, Inez Martinez, age 82, was admitted to VNR where she was to recuperate from pacemaker implantation surgery for an anticipated stay of 20 days, according to the court decision. She was discharged on May 5, 2010, by order of her attending physician, who was credentialed to see patients at the facility. Martinez died shortly thereafter as a result of sepsis caused by a wound infection (staph) at her incision, according to the court decision.

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Anxiety over nursing homes

Survey Sponsors Say Baby Boomers Are Anxious About Massachusetts Nursing Homes

A new survey of 250 Massachusetts Baby Boomers shows overwhelming anxiety about nursing homes with 90 percent of those surveyed fearing a move into a nursing home, according to a news release issued April 25, 2017 by the survey sponsor, Massachusetts Advocates for Nursing Home Reform (MANHR).

Ninety-two percent of respondents do not support the nursing home industry’s attempts to reduce protections for nursing home residents, MANHR said. Eighty eight percent felt nursing homes in Massachusetts did not have enough staff to provide quality care.

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