Author Site for William J. Beerman, Sr
Companion content for the book, audiobook and e-book, Mary Regina's nursing home
I wanted to post the recent statement by Sen. Ron Wyden about nursing homes to help it get the widest circulation possible. It is self-explanatory.
The statement reads in part “…one of the challenges this country faces today is ensuring that seniors in nursing homes are safe and well cared-for. Our best nursing homes meet a high standard of care, but tragically, not all do.”
Click to see the statement.
By William J. Beerman, Sr.
Over the decades, bad nursing homes have hemorrhaged a ceaseless stream of scandals and lawsuits alleging neglect and serious harm to patients.
Yet the world of nursing homes comes close to looking like single-payer health care. The American Health Care Association (AHCA) reports that 71 percent of nursing home revenues come from the government: 57 percent from Medicaid and 14 percent from Medicare. Some nursing homes get virtually ALL of their revenue from Medicaid.
So, in light of our experience with nursing homes, should single-payer health care advocates be more careful about what they ask for?
AHCA is a non-profit federation of state health organizations, together representing more than 13,500 non-profit and for-profit nursing facilities, assisted living facilities, and other facilities that care for approximately 1 million elderly and disabled individuals each day.
AHCA says the payments the nursing home industry gets from Medicaid fall short of what the nursing homes need to fully comply with regulations by $25 per Medicaid-patient-day, or collectively by $7 billion a year.
The nursing home operators say they are plagued by excessive and inappropriate regulations and costly questionable lawsuits that consume money that could be better spent at the bedside.
Hundreds of thousands of people have filed formal complaints about nursing homes, while in recent years, as the number of complaints rose, the number of government enforcement actions declined.
There are many good nursing homes, and many poor ones. Medicare.gov rates nursing homes on a scale, with one star equating to “much below average” and five stars meaning “much above average.” The rating for “average” is three stars. For example, a search I did in 2016 for nursing facilities in Pennsylvania belonging to the Golden Living chain, which is the subject of a contested Pennsylvania Attorney General consumer-protection lawsuit, turned up 36 Golden Living nursing homes. Two had five stars, seven had four, 10 had three, seven had two, and 10 had one star. So, 47 percent were below average (one or two stars). Some below-average nursing homes stay open for years and continue to receive government funds.
Critics say nursing homes can game the Five-Star rating system and that the system does not consider the opinions of the residents. Nursing home workers told investigators in multiple states that managers knew when state inspectors were coming. A Florida state nursing home regulator, Bertha Blanco, was sentenced in December 2017 to prison for selling confidential inspection schedules and copies of patient complaints to nursing home operators for $100,000 in bribes.
The overseer of nursing homes is the would-be single payer: the government. The inspectors generally are state health departments, which in turn follow regulations issued by the Centers for Medicare & Medicaid Services (CMS), a part of the Department of Health and Human Services (HHS).
On the west coast, the California Advocates for Nursing Home Reform released a white paper in December that the organization says summarizes major problems in long-term care in California. It begins: “The quality of nursing home care in California has never been worse.”
On the east coast, New York State Senator Rob Ortt (R-North Tonawanda) announced in a televised news conference December 27 that he was introducing new nursing home regulatory bills because: “Since I have been in office, the quality of care in the nursing homes across our state has been a persistent issue and it has continually gone unaddressed.”
U.S. Senator Bob Casey (D-PA) has been criticizing government oversight of nursing homes for decades. When he was Pennsylvania’s auditor general in 1998, he issued a scathing audit report about the state health department’s oversight of nursing homes. It was entitled “Residents in Jeopardy.” In a 1998 news release Casey said the Pennsylvania Department of Health had “failed miserably” in its oversight of nursing home care. Casey followed up with another audit report entitled “Residents Still in Jeopardy.”
More recently, current Pennsylvania Auditor General Eugene DePasquale issued a report critical of the health department’s oversight of nursing homes in 2016, and ongoing state attorney general lawsuits in Pennsylvania and New Mexico describe horrendous conditions that AG investigators found in nursing homes.
Last year, about 20 years after his “Still in Jeopardy” audit, Casey was among a group of 12 U.S. senators who sent a letter to HHS Secretary Alex Azar and CMS Administrator Seema Verma saying in essence that they were alarmed that proposed easing of nursing home regulations was putting nursing home residents “at greater risk.”
The senators cited a report by the HHS Office of Inspector General (OIG) from 2014 that found that, during a Medicare-covered stay, nearly a third of nursing home patients experienced an adverse event or an incident that led to temporary harm, with 59 percent of these events being considered preventable. “More alarming,” said the senators, “is that during the one-month period that OIG reviewed, Medicare incurred a cost of $208 million due to hospitalizations (of nursing home residents) alone and found that adverse events contributed to 1,538 deaths, most of which had not been anticipated.”
So, one must wonder, is the government system that oversees and largely funds our nursing homes ready to take over all of our health care?
William J. Beerman, Sr., is a retired former journalist whose mother’s nursing home experience motivated him to write Mary Regina’s Nursing Home, a book about nursing homes and government oversight of nursing homes (www.WBeerman.com). Besides his home page, William maintains a Facebook Page, Nursing Home Monitor.
The article reproduced below, by Jordan Rau of Kaiser Health News, is an excellent one in which Rau adds some perspective for a directive issued by Centers for Medicare & Medicaid Services (CMS) about monitoring of weekend nursing home staffing.
Lack of a nurse on duty on weekends, night shifts, or otherwise, raises a sometimes overlooked question: In the absence of a nurse, who is administering medications?
In my book, Mary Regina’s Nursing Home, I discuss a situation in which I visited my mother’s nursing home at 5:30 one morning in 2011 in an attempt to find out why my mother was being heavily drugged, or “zonked.” It appeared that possibly a nurse assistant, who would not be allowed to administer medication in a nursing home setting in Pennsylvania, had been doing so, with serious adverse consequences for my mother. I suspect this situation occurred because a nurse or nurses called off for the night shift on a weekend, or possibly no nurse was scheduled at all to administer medications.
When I complained in writing about this situation to the nursing home’s director of nursing, she confirmed in a phone call to me that the staff person should not have administered the medications — morphine and klonopin — and should have consulted a supervisor. When the state health department conducted an abbreviated onsite investigation of my complaint, the director of nursing was not present that day, and the health department refused to follow-up by revisiting the nursing home or even calling the director of nursing. The DOH instead declared that no medication error had occurred.
During the year of their investigation of my complaint, 2012, the DOH took only two enforcement actions statewide against nursing homes, compared to a high of 171 in 2003, and an average of 63.5 for the period 2002-2015.
The federal government announced plans Friday to crack down on nursing homes with abnormally low weekend staffing by requiring more surprise inspections be done on Saturdays and Sundays.
The federal Centers for Medicare & Medicaid Services said it will identify nursing homes for which payroll records indicate low weekend staffing or that they operate without a registered nurse. Medicare will instruct state inspectors to focus on those potential violations during visits.
“Since nurse staffing is directly related to the quality of care that residents experience, CMS is very concerned about the risk to resident health and safety that these situations may present,” the agency said in a notification to state inspection offices.
The directive comes after a Kaiser Health News analysis found there are 11 percent fewer nurses providing direct care on weekends on average, and 8 percent fewer aides.
Residents and their families frequently complain the residents have trouble getting basic help — such as assistance going to the bathroom — on weekends. One nursing home resident in upstate New York compared his facility to a weekend “ghost town” because of the paucity of workers.
Richard Mollot, executive director of the Long Term Care Community Coalition, an advocacy group in Manhattan, welcomed the new edict but said it was only necessary because state inspectors have not been properly enforcing the rules already on the books.
“The basic problem is the states don’t take this seriously,” Mollot said. “How many studies do we have to have, year after year, decade after decade, saying it all comes down to staffing, and there are very few citations for inadequate staffing and virtually all of them are identified as not causing any resident harm?”
CMS said it will identify potential violators by analyzing payroll records that nursing homes are now required to submit. Those records, which became public this year, showed lower staffing than what facilities had previously told inspectors during their visits, according to the KHN analysis.
“CMS takes very seriously our responsibility to protect the safety and quality of care for our beneficiaries,” CMS Administrator Seema Verma said in a statement.
The nursing home industry criticized the heightened scrutiny.
“Unfortunately, today’s action by CMS will enforce policies that makes it even more difficult to meet regulatory requirements and hire staff,” said Dr. David Gifford, senior vice president of quality and regulatory affairs at the American Health Care Association, an industry trade group, in a written statement. “Rather than taking proactive steps to address the national workforce shortage long-term care facilities are facing, CMS seems to be focusing on a punitive approach that will penalize providers and make it harder to hire staff to meet the shared goal of increasing staffing.”
Currently, a tenth of inspections must occur during “off hours,” which can be either a weekend, or during a weekday before 8 a.m. or after 6 p.m. But for facilities that Medicare identifies as having lower weekend staffing, half of those off-hour inspections—or 5 percent of the total — must be performed on Saturdays or Sundays.
Medicare requires nursing homes to have a registered nurse on site for at least eight hours every day, but according to the payroll records, a quarter of nursing homes reported no registered nurses available at least one day during a three-month period. Since July, Medicare’s Nursing Home Compare website for consumers has highlighted homes that lack sufficient registered nurses and lowered their star ratings. Nursing Home Compare has downgraded ratings for 1,402 of 15,600 facilities for gaps in registered nurse staffing, records show.
The new directive instructs inspectors to more thoroughly evaluate staffing at facilities Medicare flags. The edict does not mean a flurry of sudden inspections. Instead, Medicare wants heightened focus on those nursing homes when inspectors come for their standard reviews, which take place roughly once a year for most facilities.
But what may appear to be staffing scarcities in payroll records may instead be clerical problems in which nurse hours are not properly recorded, say some nursing home officials.
Katie Smith Sloan, president of LeadingAge, an association of nonprofit providers of aging services, said in a statement that some homes are still struggling to adapt to the new data collection rules.
“We’ve been voicing our concerns to CMS and will continue to do so,” she said.
KHN’s coverage of these topics is supported by John A. Hartford Foundation and The SCAN Foundation
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
NOVEMBER 20, 2018–The Centers for Medicare & Medicaid Services (CMS) announced upcoming efforts to support better care and outcomes for nursing home residents under the Civil Money Penalty Reinvestment Program (CMPRP). This three-year initiative aims to improve residents’ quality of life by equipping nursing home staff, administrators and stakeholders with technical tools and assistance to enhance resident care, CMS said.
“CMS is committed to ensuring nursing home residents are safe and receive quality care,” said CMS Administrator Seema Verma. “We are pleased to offer nursing home staff practical tools and assistance to improve resident care and positively impact the lives of individuals in our nation’s nursing homes.”
As part of the CMPRP, CMS said it will develop a variety of work products for nursing home professionals, such as staff competency assessment tools, instructional guides, training webinars and technical assistance seminars. These supports aim to help staff reduce adverse events, improve dementia care and strengthen staffing quality, including by reducing staff turnover and enhancing performance, CMS said.
This initiative is one of several CMS has underway to strengthen safety and health outcomes for nursing home residents, the agency said. For example, the Nursing Home Compare website and facility Star Ratings are resources CMS provides to help consumers and their caregivers make informed healthcare decisions. These resources are updated and expanded frequently, recently with the addition of payroll-based data on nursing home staffing, which can serve as one indicator of the quality of care, CMS said. In addition to the CMPRP, CMS also operates the National Partnership to Improve Dementia Care in Nursing Homes, which helps reduce the rate of inappropriate prescribing of antipsychotic drugs in this population.
The CMPRP is funded by federal civil money penalties, which are fines nursing homes must pay CMS by law when they are noncompliant with certain regulations and there are serious concerns about the safety and quality of care they provide. Most penalties collected are returned to states to fund state-based projects that benefit nursing home residents, and CMS retains a portion of the funds for similar federal initiatives.
Under the new program, CMS will collaborate with industry experts to develop an ongoing series of toolkits and technical assistance intended to help nursing home staff and management improve care delivery and thereby residents’ quality of life.
On November 20, CMS released its first toolkit in the CMPRP series, the Nursing Home Staff Competency Assessment and its supporting materials. The competency assessment is designed to help nursing home frontline and management staff evaluate their skills. It includes several questions to gauge staff knowledge about behavioral, technical and resident-based capabilities. Additional toolkits will follow under the series heading “Building on a Culture of Quality: Your Guide to Resident-Centered Care.”
For additional information on the Civil Money Penalty Reinvestment Program, visit https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/LTC-CMP-Reinvestment.html.
NEW YORK, NEW YORK November 15, 2018—As hospital stays shorten, continued care following hospitalization is now a common part of recovery for many patients who undergo major surgery or experience serious illness. Each year, approximately one in five hospital patients in the United States, including some 300,000 New Yorkers, require such care—in rehabilitation centers, in nursing homes, at home, or in their communities. Yet too often, patients and their families do not have the critical information and support they need to carefully assess their options and make the best possible decisions.
United Hospital Fund (UHF) conducted a year-long inquiry, supported by the New York State Health Foundation (NYSHealth), to better understand why hospital discharge planning can fall short despite well-intentioned efforts by hospital staff, and today released the first in a series of reports based on that work. The report, Difficult Decisions About Post-Acute Care and Why They Matter, spotlights the many factors that can hinder informed decision-making and limit care choices.
The stakes are high—patients who receive care from lower-quality providers have higher rates of complications and worse outcomes. But patients and family caregivers may not be aware that quality of care varies, and they must choose a provider when they are stressed and under pressure. While most patients and families ask their care team for help with decision-making, many discharge planners will not offer direct advice because of concerns about complying with federal regulations that limit hospitals from recommending specific providers.
Information on post-acute care that is available online also has many limitations. It can be hard to gather and interpret, much of it is too technical, and there are gaps and barriers for those with limited English proficiency, literacy, numeracy or research skills. Mistrust of information on the Internet is an issue as well.
“There’s simply too much at stake to leave sick patients and their families on their own to research and evaluate post-acute care options,” said Lynn Rogut, director of quality measurement and care transformation at UHF and co-author of the report. “They need assistance from health care professionals to identify the best possible choices.”
Today’s report is the first in a four-part series on the Difficult Decisions project, which combined inputs from patients and their families, health care providers, researchers, policymakers, and other stakeholders with UHF’s own research to identify promising approaches for supporting decision-making at discharge. Forthcoming reports will focus on the experiences of patients and family caregivers and the perspectives of health care providers; they will also identify strategies and policy levers that could help make a difference.
“Arranging for post-acute care can be among the hardest decisions patients and their families have to make, especially when emotions are running high and they’ve been under the stress of dealing with an illness,” said David Sandman, Ph.D., President and CEO of NYSHealth. “Although there are resources available, many families are unaware of their options. These are tangible solutions to help patients and their families make the best care choices for themselves.”
“Our goal with these reports is to bring attention to this significant issue, which affects the health and well-being of many vulnerable New Yorkers,” said UHF president Anthony Shih, MD, MPH. “But, as with all our projects, the larger aim is continuous improvement of our health care system overall.”
The report can be downloaded from UHF’s website here.
About United Hospital Fund Foundation
United Hospital Foundation works to build a more effective health care system for every New Yorker. An independent, nonprofit organization, we analyze public policy to inform decision-makers, find common ground among diverse stakeholders, and develop and support innovative programs that improve the quality, accessibility, affordability, and experience of patient care. For more on our initiatives and programs, please visit our website at www.uhfnyc.org and follow us on Twitter.
The California Advocates for Nursing Home Reform (CANHR) reports that the California Department of Public Health (DPH) has posted lists of the California nursing homes that have sought its approval to staff below the minimum staffing requirements the Legislature adopted last year in SB 97.
Thus far, 344 skilled nursing facilities have applied for “workforce shortage” waivers, while 391 facilities applied for “patient needs” waivers. The massive numbers of waiver requests expose the rampant understaffing in California nursing homes, CANHR said. Moreover, the waiver process is having the perverse effect of DPH endorsing understaffing at California’s most poorly staffed nursing homes rather than enforcing the (highly inadequate) minimum staffing requirements, CANHR said.
The federal government’s requirement for nursing homes to electronically report their staffing levels is a step in the right direction but obviously does not resolve staffing problems. The federal government does not have numerical minimum staffing requirements.
See the latest CANHR newsletter
William J. Beerman, Sr. has been invited to appear on the “All About Books” radio show on KTAL-LP, 101.5 FM in Las Cruces, NM from 12:30-1 p.m., Friday, November 9. He will talk about his book, “Mary Regina’s Nursing Home,” with host Lynn Moorer.
The book is a journalistic novel that wraps a human-interest story around factual information about nursing homes and the government oversight systems for nursing homes. The wide-ranging book includes coverage of New Mexico Attorney General Hector Balderas’s lawsuit against a New Mexico nursing home chain. Details about the book are presented on the website https://www.wBeerman.com
By William J. Beerman, Sr.
Recent court actions determined that two major lawsuits by state attorneys general (AGs) against nursing home chains will continue.
In one case, the Pennsylvania Supreme Court on September 24, 2018 reinstated a suit that the state’s Commonwealth Court had dismissed. In the second case, a court-administered status conference September 27, 2018 in New Mexico determined that an AG suit against a nursing home chain will remain alive — but stayed (suspended) — pending legal determinations in separate bankruptcy court proceedings. A spokesman for the New Mexico AG Office in Santa Fe said the office expects that another status hearing on the stayed case will be held in about 6 months.
The Pennsylvania case involves the Golden Living/Golden Gate senior care chain, and the New Mexico case is about the Preferred Care chain. Both cases are covered extensively in my book, Mary Regina’s Nursing Home, and the Pennsylvania Supreme Court’s September 24 opinion is posted on my website, https://wbeerman.com under the index listing “Litigation-Related Documents.” Also posted there is the earlier Commonwealth Court decision, a dissenting judge’s minority opinion, and the AG’s complaint in the Preferred Care case.
Both the New Mexico and Pennsylvania cases essentially alleged that the nursing homes had not provided all the care for which they billed. My book includes the arguments presented by the nursing home chains as well.
A statement by Preferred Care, Inc., of Plano, Texas, said it filed Chapter 11 bankruptcy proceedings in November 2017 to allow it to remain in business as it defended against 163 personal injury cases. A lawyer for Golden Living did not respond to my request for comment on the Pennsylvania Supreme Court decision.
When the Pennsylvania Commonwealth Court dismissed the Golden Living case, concerns were raised that attorney general lawsuits might no longer be a viable tool to enforce standards of care in nursing homes. The various reasons why are contained in the Commonwealth Court opinion and in a dissenting minority opinion by one of the Commonwealth Court judges.
“The Supreme Court’s decision allowing our lawsuit against this nursing home chain to continue is a significant victory for Pennsylvania seniors and their families,” said Attorney General Josh Shapiro.
Under the Supreme Court ruling, the state can recover public funds charged for services not provided – “a win for taxpayers,” Shapiro said.
“This ruling allows my team to hold businesses accountable for deceptive, misleading practices under our Commonwealth’s consumer protection law,” Shapiro said.
Mary Regina’s Nursing Home reports on state AG lawsuits and AG research that encompass 65 nursing homes and more than 1 million patient-days of nursing home care. The investigations for the AG lawsuits elicited reports on nursing home operations from former employees such as certified nurse’s assistants (CNAs) who became confidential witnesses for the AGs. Their insider view of nursing home operations is reported in the book. The investigations looked not only at how residents were treated, but at how the nursing homes interacted with oversight agencies and with their parent corporations.
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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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." Read More
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.