Articles Tagged with Elder Support

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HCR ManorCare, the second largest nursing home operator in the United States, filed for Chapter 11 bankruptcy protection on March 4 and will transfer ownership to its landlord, Quality Care Properties Inc.  This is the latest among several signs of dysfunction in the senior housing industry.

Quality Care Properties is set to become the full owner of ManorCare’s skilled nursing, assisted living, hospice and homecare businesses across the United States.  ManorCare was the nation’s largest skilled nursing facility operator during the last decade; however by 2016 it had dropped down to number 2.

The Toledo, OH based HCR ManorCare had owed its landlord more than $300 million in unpaid rent. In a filing with U.S. Bankruptcy Court in the District of Delaware, ManorCare said revenues have failed to cover monthly rent obligations since 2012 which was a year after the master lease was signed.

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A new study released this week by the Human Rights Watch found that many nursing home residents are needlessly being given antipsychotic drugs.  The 157 page report titled “They Want Docile’: How Nursing Homes in the United States Overmedicate People with Dementia,” found that approximately 179,000 people, mostly those suffering from dementia, are being given antipsychotic drugs every week in US nursing homes in an attempt to control their behavior. Facilities administer these drugs without the proper diagnosis and in many cases without obtaining informed consent from residents or their families.  This is also being done in the face of an FDA warning that these drugs can almost double the risk of death for elderly dementia patients.

The drugs are being predominately used for their sedative effect, rather than any medical benefits.  Nursing homes are using these drugs as a cost-effective and simple way for understaffed and overwhelmed facilities to control its residents.  Many nursing homes have an inadequate amount of staff to properly care for the amount of residents in their facilities.  This leads to the staff cutting corners and finding shortcuts to deal with the stress of caring for elderly dementia residents.  However, it is the residents that suffer when the staff cut these corners.

Federal law requires that nursing facilities fully inform their residents about their treatment and the resident has the right to refuse that treatment. There are also some state laws that require informed consent in order for these antipsychotic medications to be given to nursing home residents. The study found that many nursing home staff members admitted to often failing to obtain consent or even to attempting to do so.

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Quality rating systems and report cards for healthcare facilities are intended to give consumers more information about choosing the best quality hospital or nursing home.  A study performed by Marcelo Perraillon, a Health economist of the Colorado School of Public Health at CU Anschutz, sought to determine whether the form in which that information is conveyed to consumers mattered.  Perraillon assessed whether a simplified rating system used by the Nursing Home Compare website encouraged consumers to choose higher rated nursing homes.

Perraillon used a statistical method called regression continuity to illustrate that consumers do respond to public reporting of nursing homes quality information and are actually using the data to make better decisions about care.  He published his findings on December 28 in the American Journal of Health Economics under the title “Consumer Response to Composite Ratings of Nursing Home Quality.”

The main finding was that nursing homes that attained an additional star, in the 1 to 5 star system, gained more admissions. However, this consumer response to this system change was not universal.  Low-rated nursing homes in poorer areas which take mostly Medicaid patients still saw high admissions.  Residents of those areas don’t have a lot of options when it comes to selecting a nursing home facility so they can’t benefit from the rating system in the same way.  Those facilities in the poorer areas do not have the same incentive to improve their rating because admissions are already high due to the lack of choice.

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One of the most difficult decisions families have to face is deciding to put a loved one in a nursing home. They want to make sure they are placing their family member in a safe environment where they will receive the proper care they need.

Many of those families rely on a government rating system to determine which facilities are the best.  The Five-Star Quality Rating System employed by Centers for Medicare & Medicaid Services (CMS) is a source of information to help consumers make an informed decision when choosing a nursing home.  The Medicare Nursing Home Compare website features a quality rating system that gives each nursing home a rating of between 1 (much below average) and 5 stars (much above average). The nursing home is given a star rating in three areas, self-reported staffing, self-reported quality measures, and health inspections.  The facility is also given an overall star rating.

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A new study of California nursing homes (the nation’s largest system of nursing homes) discovered that some nursing homes have inflated their self-reporting to improve their score in the rating system.  The study was done by faculty at Florida Atlantic University and the University of Connecticut and published in the Production and Operations Management journal under the title “Winning at All Costs: Analysis of Inflation in Nursing Homes’ Rating System”The rating system was implemented in 2008 and this study used data from 2009 to 2013.

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Pennsylvania Governor Tom Wolf’s administration is putting out a new Medicaid feature that’s aimed to decrease the number of enrollees in nursing homes in the future.  It is also intended to lessen a large expense for the state, which has a rapidly growing elderly population.  This plan has been in place in many other states for years and provides the road map for how it can be administered in Pennsylvania.

This new feature will have a financial incentive to get enrollees the medical care and services they need in their home instead of in the nursing home, where it can be twice as expensive.

The savings under this plan will be substantial. It is around $62,000 per year for nursing home care and about half that for the care at home.  There are over 50,000 Pennsylvania nursing home residents that are covered under Medicaid.

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Pennsylvania Attorney General Josh Shapiro is part of a coalition of 16 State Attorneys General and the Attorney General from the District of Columbia who sent a letter to the Centers for Medicare & Medicaid Services (CMS) hoping to protect nursing home patients.

These states are recommending that CMS keep in place its current pro-patient rule.  The existing rule protects patients’ rights by prohibiting pre-dispute arbitration clauses in nursing home and other long-term care contracts.  The current regulation was adopted on October 4, 2016, by CMS and a proposed rule would reverse the prohibition on binding pre-dispute arbitration clauses in Long-Term Care facility contracts.  Pre-dispute arbitration clauses require seniors to waive their rights to go to court to resolve any disputes with a nursing home.

In the August 7th letter, the Attorneys General stated in their comments “Pre-dispute binding arbitration agreements in general can be procedurally unfair to consumers, and can jeopardize one of the fundamental rights of Americans; the right to be heard and seek judicial redress for our claims. This is especially true when consumers are making the difficult decisions regarding the long-term care of loved ones. These contractual provisions may be neither voluntary nor readily understandable for most consumers. Often consumers do not recognize the significance of these provisions, if they are aware of them at all, especially in the context of requiring care in a nursing home.”

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Whether to move a loved one into an assisted living home or hire an in-home caregiver is a difficult decision. Families can feel pressure to continue providing care for an aging adult despite signs that it might be time to explore other options. Other times families may find themselves unsure as to whether a loved one may need around the clock care.

While there is rarely a clear sign that it is time to move an aging family member to an assisted living home or hire an in-home caregiver, Caring.com recently published a list of eleven signs that family members and caregivers can look for to help in making that decision. Here are some highlights from that article: Continue reading →