Articles Posted in nursing home news

On February 28, 2022, the White House announced new reform measures to better the quality of care and the safety of skilled nursing facility residents, as well as to “crack down on bad actors” operating nursing homes.   In his State of the Union address, President Biden called on the Centers for Medicare & Medicaid Services (CMS) to set and maintain higher standards for “sufficient staffing” of nursing homes.  CMS is now conducting research to determine the minimum level and type of staffing requirements needed and plans to propose rule changes to existing regulations within the year.  The effect of these policy changes is that skilled nursing facilities may face having federal funding pulled should they refuse to comply with these minimum safety standards.

California long-term care facilities are subject to a number of regulations governing the type, number, and training of staff at facilities caring for elderly adults.  For example, under federal law, a skilled nursing facility “must have sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care.”  (42 C.F.R. § 483.30.)  Similarly, under California law, a skilled nursing facility “shall employ an adequate number of qualified personnel to carry out all of the functions of the facility” (Health & Safety Code § 1599.1(a).)

It is well established that understaffing in nursing homes and assisted living facilities directly lead to substandard care.  Understaffing contributes to and can cause avoidable illness, injury, and death, and is positively correlated with elder abuse and neglect.  However, there is often a conscious decision by managers, directors, and administrators to understaff their facilities, with explicit knowledge that understaffing will negatively impact the overall quality of care provided to residents.  (See, e.g., California Watch, Nursing Homes Received Millions while Cutting Staff, Wages (July 29, 2011).)

The consequences of lack of communication between hospitals and skilled nursing facilities (SNFs) are not new knowledge. According to a 2013 study, in the U.S. alone, more than 5 million patients transition from hospital to SNFs yearly. These transitions heavily rely on the thorough communication of healthcare professionals and paraprofessionals to ensure adequate care for patients. However, hospitals and local SNFs typically operate as separate entities causing a myriad of miscommunication. Communication issues that may happen between the facilities include incomplete, contradicting and/or mismatching verbal and written care plans. These problems may cause SNF staff to delay—or never deliver—proper care for patients, resulting in potentially fatal consequences. For example, noting the wrong medication can cause a stroke patient to relapse into another stroke and an avoidable hospital readmission. While many factors can be used as scapegoats to explain these mistakes, these problems are not new, and as professionals in the field, SNFs should establish better communication and points of accountability before accepting a patient to ensure the dignity and quality of care of patients. A recent study published by the Journal of the American Geriatrics Society by multiple medical doctors have indicated that a significant number of hospital readmissions from SNFs were likely preventable.

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A billionaire owner of one of America’s biggest nursing home chains has just been convicted of intentionally overbilling federal healthcare programs.  According to a recent article from Forbes, the Life Care Centers of America owner, Forrest Preston, has agreed to pay $145 million to settle the government lawsuit.  This settlement, announced on October 24th, is by far the largest ever obtained by the Department of Justice from a nursing home company.

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Older adults are the fastest growing segment of our population and one the most vulnerable group of people in the world. Older adults are most likely to suffer from chronic health problems.  More than half are patients with a dementing illness, and half of those people are at high risk of being victims of abuse or neglect.  Financial abuse of elderly Americans is usually difficult to identify, commonly hidden by fear and shame and far too often quieted by the debilitation of mental impairment.  Yet the abuse is as commonplace as it is reprehensible—and appalling.  A recent study found that older adults are scammed out of almost $3 billion every year.  It is likely that this is only the tip of the iceberg, however, because most financial elder abuse cases are never reported.

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According to a recent McKnight’s article, Genesis Healthcare LLC has been found guilty of False Claims Act allegations for a skilled nursing facility in Arlington, VA and is subject to pay $600,000.  A statement from the Department of Justice, Eastern District of Virginia reported that Potomac Center staff neglected to implement patient care activities as recorded in the resident medical record of a patient and failed to provide certain care activities corresponding to a physician order for over a month in the year 2008.

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Obesity is becoming an increasing problem for the older adult population, and that includes residents in nursing homes and assisted living facilities. These care facilities are having more and more difficulty caring for this new group of severely obese patients. According to a recent article published in The New York Times, the number of obese older adults becoming nursing home residents is growing faster than the ability of nursing homes to handle them. “We don’t have adequate staff. We don’t have adequate equipment. We don’t have adequate knowledge,” says Cheryl Phillips, senior vice president of LeadingAge, an association of nonprofit sponsors of services for elderly people.

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Older adults in nursing homes and assisted living facilities are now vulnerable to a new kind of abuse—abusive photos on social media. ProPublica recently reported 35 cases since 2012 in which staff members of these care facilities secretively posted pictures or videos of residents, some of whom were without clothing. These photos are not only embarrassing and dehumanizing for these older adult victims, they are breaching their privacy, stripping them of their dignity, and, even, breaking the law.

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According to a recent article from Medical News Today, the American Academy of Orthopaedic Surgeons (AAOS) Board of Directors authorized the Appropriate Use Criteria (AUC) for treatment and rehabilitation of older adult patients with hip fractures, as well as postoperative direction to facilitate in preventing the recurrence of fractures.

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