April 17, 2015

Alleged Cover-Up after Resident Fall and Injury at South Holland Home

by Levin & Perconti

Fall and Injury at The Villa

As if things could not get any worse for nursing homes and nursing home residents in the South Holland, Illinois area, there is now more news of a horrific incident in which a nursing home resident at The Villa at South Holland suffered severe injuries. The victim in this case suffers from dementia and is thus unable to speak and unable to move on her own volition. Due to her inability to move on her own, nursing home staffers are supposed to employ what is called a “hoyer lift” in order to lift and move the resident.

However, in this particular instance, a registered nurse (RN) directed a certified nursing assistant (CNA) to move the patient directly. When one of them inadvertently stepped on the resident’s blanked and caused her to fall out of her wheelchair, the resident fell to the floor and suffered a major head wound. She was subsequently taken to the emergency room, where she had to receive nine staples in her head to mend the gash on the back of her head.

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April 15, 2015

As Elderly Population Grows, Long-Term Insurance Scales Down

by Levin & Perconti

We have written before about how the elderly population will continue to grow in the years to come, as the members of the enormous baby boomer population enter their golden years. As they grow older, the need for various levels of third-party care will be necessary or at least preferred to keep them as healthy as possible and in some cases allow them to lead relatively independent lives. As this segment of the population grows, the costs of caring for so many will increase, possibly putting a strain on finances and the abilities of insurance companies to adequately cover care for their policyholders.

Life Spans & Insurance

In recent decades, in addition to health insurance, other long-term insurance policies such as life insurance were considered essential parts of planning ahead for the eventual need for care in later years. In recent news, however, this fact-of-life type of insurance is on the cusp of becoming much less affordable, and thus much less available to the growing crop of elderly Americans. The expectations about life spans of policyholders and how much it would cost to care for them influenced policy provisions and premium rates, yet this sector has apparently hit a breaking point because those past assumptions have not matched the current reality as costs increase for an aging but still living part of the population.

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April 13, 2015

Rauner Proposed Budget Would Slash Home Services

by Levin & Perconti

In recent news and a recent post in this blog space, it was reported and discussed that new Illinois Governor Bruce Rauner has submitted his new budget for the next fiscal year in 2016, and that budget as proposed does not take it easy on certain public services in the area of health care. For one, the governor proposed to cut Illinois’s Medicaid spending by approximately $1.5 billion, lowering spending to approximately $19 billion, and affecting close to 3.6 million Illinoisans who rely on that public health insurance benefit.

These cuts are projected to effectively reduce hospital budgets by 13% statewide which could lead to not only lesser care but job losses at those hospitals. Approximately $216 million would be lost for nursing homes that make those reimbursements for caring for patients on Medicaid. Pharmaceutical expenses would also be cut by around $40 million if this budget goes through, and the budget for substance abuse treatment would decrease by approximately 20% to $99 million in 2016 (down from $124 million). Furthermore, the Rauner budget is overall slated to hit social services hard in general, and estimated to cut approximately $400 million from the Illinois Department of Health and Human Services budget.

Cuts to Home Services

One specific target of cuts is the Illinois Home Services program, which provides in-home assistance for those residents with certain physical disabilities. The budget proposal calls for a reduction of $110 million from that program’s fund. This assistance gives individuals the chance to do things like work and support their loved ones, while leading an independent life outside of the strictures of a nursing home. In general, the program entails workers to check in on patients at their homes in lieu of round-the-clock staff at a nursing facility. This is also consistent with the general growing trend toward community-based nursing care in which individuals can stay at home or in a more community-oriented place and receive the one-on-one attention they need. It is theorized that this environment is more positive and avoids the unfortunate pitfalls at some nursing homes where abuse may occur, or simple negligence leaves residents without the attention they need.

Home Services May be More Cost Efficient

According to some advocates for the disabled, in the case of the Illinois Home Services program it actually may cost the state less to help fund these in-home services, than to cover costs associated with nursing home care, which is a big business and can be quite costly. Under the proposed budget, the cuts would actually be a byproduct of the state changing the eligibility criteria for the program to make it stricter. Disability advocate group Access Living warn this could mean close to 10,000 individuals (or one-third of the program’s participants) will lose that assistance, as also reported in the Chicago Tribune and on progressillinois.com. These same advocates report that Illinois Medicaid saves $17,000 per person each year thanks to the home services program.

Implications of the Cuts

Current participants in the program, if ruled ineligible under the new budget guidelines, may not be able to support their families with the help of the periodic assistance under the home services program. If these cuts are implemented as part of the next year’s budget, it will likely mean less home services care for the physically disabled. It may also mean that patients who are denied eligibility and removed from the program may have to enter nursing home facilities for care, potentially costing the state more money in the long-run, and putting these individuals in possibly less suitable environments. Stay tuned as budget negotiations continue in the capital.

See Related Blog Posts:

Governor Rauner Seeks to Cut Medicaid by $1.5 Billion

Revamped Rating System Downgrades Nearly One-Third of Homes

April 10, 2015

Protection for Nursing Home Employees and Whistleblowers who Stand Up for the Elderly

by Levin & Perconti

Effective July 29, 2010, the Illinois General Assembly amended the Nursing Home Care Act to include what it termed “whistleblower protection”. 210 ILCS 45/3-810 (West 2010). Section 3-810 specifically provides a private right of action for nursing home employees who are retaliated against for reporting or threatening to report to a supervisor or a public body any action or incidents they believe to be a violation of the law, a rule, or a regulation regarding care and treatment of nursing home residents. Prior to this amendment, Illinois Courts did not recognize a private right of action for nursing home employees who reported violations and were retaliated against. In Young v. Alden Gardens of Waterford, Bethany Young, RN filed suit alleging, in part, that she was retaliated against for refusing to falsify medical records on November 9, 2009. The trial court dismissed her claim under Section 3-810 based on the fact that the Nursing Home Care Act did not provide a private right of action for retaliatory discharge at the time the conduct occurred. The court noted that because the amendment affected a substantive change in the law, it could not be applied retroactively to Young’s claim. Young v. Alden Gardens of Waterford, LLC, 2015 IL App (1st) 131887 ¶ 11.

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April 9, 2015

Medicare Fraud in Illinois Highlights Importance of Law Enforcement

by Levin & Perconti

Recent news provides another example of the effort of medical providers, such as nursing homes, to defraud the government through healthcare fraud. The agencies are Adonis Inc. and BestMed-Care Services Ltd., headquartered in Dolton, Illinois. The operator of two nursing home agencies in Illinois was arrested and charged with healthcare fraud. The allegations specified that he stole over $5 million “for unnecessary home care services” for nearly four years. The charge carries a maximum penalty of 10 years behind bars and a fine of the greater of $250,000 or twice the amount of the fraud.

The charges stem from the agencies paying a marketing company to refer patients to them for ostensibly “free services” only to tell the patients they needed certain care from skilled nurses, and then billing Medicare for providing that unnecessary care. This also included filing falsified nursing assessments for these patients. This most recent case again puts the spotlight on the importance of Medicare and Medicaid Fraud Units. In this case, the Medicare Fraud Strike Force’s investigation led to this arrest. It also highlights the importance of our laws in combating Medicare and Medicaid fraud to protect the system and patients:

False Claims Act

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April 7, 2015

Use of Antipsychotic Medications Drops since Start of CMS Initiative

by Levin & Perconti

When a person must decide on a nursing home, or their loved ones must choose one for them, there are so many factors and considerations that go into making that crucial and life-impacting decision. One of the many pieces of criteria should be the nursing home’s record of use of antipsychotic drugs to control and subdue residents. The use of antipsychotic drugs in the past was a more commonplace and accepted way to restrain patients, especially those who suffered from some type of psychosis, dementia or Alzheimer’s and could become easily irritable or even violent.

However, the use of such medications has come to be considered an improper form of chemical restraint by so many, as it can cause irreversible physical and/or mental damage, push the patient into a drug dependency, or into a hard cycle of uppers, suppressants and other medications in between. Medical providers, including nursing home doctors and nurses, have also typically used these drugs because of the ease of administering them rather than taking alternative, more humane and chemical-free methods.

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April 5, 2015

State Bill Would Make Inspection Information Inadmissible in Court

by Levin & Perconti

In the world of medical care and specifically nursing homes and long-term care facilities, the authority and resources of the federal and state governments to inspect and evaluate nursing home performance, quality of care, staffing levels, and overall compliance with relevant law and regulations, is paramount.

This keeps nursing homes honest, pushes them to hire and train staff appropriately, and to ensure that abuse is eliminated and that residents get the proper attention and treatment rather than have their health and lives risked by neglect. In recent news, and as we’ve discussed in this space numerous times in recent months, the federal government’s rating system was found to have been faulty, limited, and relied on unverified self-reported data from nursing homes when ranking them and evaluating them for consumers. Investigations and inspections are thus all vital parts of this effort, and the federal and certain state governments have ramped up efforts to meet this oversight obligation.

New Proposed Nursing Home Law

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April 2, 2015

West Virginia Judge Will Not Recuse in Nursing Home Case

by Levin & Perconti

We previously posted about a fascinating situation in the West Virginia judicial system involving an apparent conflict of interest by a judge on the state’s highest bench, and a nursing home case. The Chief Justice of the West Virginia Supreme Court, the state’s highest court, was called upon to recuse herself from a case before the court that found against a nursing home at the trial level and resulted in a $90 million award to the family of an elderly nursing home resident that passed away after nearly three weeks at the facility.

There was conflict over whether the resident’s dementia led to her ultimate death, or if it was dehydration from a possible neglect by nursing home staffers that led to her death. The high court upheld the ruling against the Heartland Nursing Home, also refusing to throw out punitive damages, and modifying the damages award to reduce it to about $48 million. The Chief Justice wrote the majority opinion rendering the decision in the plaintiff’s favor. The case went up on appeal in part on the argument that state law capped certain medical malpractice damages. The controversy over the Chief Justice’s involvement in that case centered on over $30,000 in campaign contributions she received for her re-election campaign and that was coincidentally arranged for by the attorney of the plaintiff in the Heartland case, who himself reportedly made a contribution of $1,000. This attorney also bought a Learjet plane for $1 million from the Chief Justice’s husband.

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March 31, 2015

Abuse Case in Texas Shows Vulnerability of Elderly and Those with Alzheimer’s

by Levin & Perconti

Illinois has unfortunately ranked toward the very bottom when it comes to quality of care at nursing homes and long-term care facilities in rankings by an independent watchdog organization. Of the states just below us, Texas ranks at the very bottom, and recent news of another awful case of abuse at a nursing home there makes one wonder if there will be enough timely and substantial improvement. Earlier this month, a nursing home employee was arrested on charges of physically abusing an elderly resident. That resident also happens to suffer from Alzheimer’s disease. This awful event underscores the importance of monitoring nursing homes and being careful to hire and monitor nursing home staffers to ensure that they do not neglect patients, and that they do not abuse them in any way.

The case also underscores how vulnerable patients can be in large part because so many tend to be elderly (the victim here is 77 years old while the accused abuser is 51 years old). Many states not only have your typical criminal laws against abuse, but also specifically employ laws that deal harshly with those who would abuse or take advantage of an elderly person. This case further underscores how vulnerable patients with mental infirmities, like dementia and Alzheimer’s, can be since those infirmities leave them confused and forgetful, and they may not comprehend what is happening to them, or may not be able to adequately tell someone because of problems communicating coherently.

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March 28, 2015

Bankruptcy Sometimes an Option for Homes Facing Mounting Lawsuits

by Levin & Perconti

When a nursing home has been accused of derogating its duty to properly care for a resident or residents, or suffers allegations of not just neglect but abuse, it can be subject to all types of legal action. This includes regulatory sanctions by the state or federal government (if the home accepts Medicare or Medicaid federal dollars), criminal prosecution against a staffer for abuse, a civil lawsuit by a state attorney general, or a civil lawsuit by a victim of neglect or abuse or that victim’s family or guardian. Some nursing homes or holding companies that own chains of nursing homes have seen multiple claims against them, and jury awards or settlement figures that can truly rack up. Yet many can survive because they are financial juggernauts – particularly the bigger, more corporate-owned facilities. This is not always the case, however. If faced with a burgeoning of lawsuits, a nursing home’s owners and administrators may decide it needs protection under bankruptcy law.

California Nursing Home Entity Goes Bankrupt

In recent news, it was reported that a nursing home owner in California filed for bankruptcy because it could be on the hook for millions of dollars if lawsuits against it go against them if there are jury awards or expensive settlements. North American Healthcare owns over thirty nursing homes in the western United States, and one of its facilities in California just faced fines levied by California for providing poor care to its residents on top of numerous lawsuits against them by residents or their families. That particular facility was reportedly fined $100,000 back in 2013 when a patient died from an overdose of a blood thinner, and has been the subject of numerous complaints to the state – one of its current lawsuits stems from a patient’s fall and subsequent death at the facility.

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March 26, 2015

GAO Finds Major Overuse of Antipsychotic Drugs by the Elderly

by Levin & Perconti

In late 2014 we blogged about the accusations levied against Dr. Michael J. Reinstein about his improper use of antipsychotic drugs prescribed to patients in abundance, as well as taking kickbacks from the drug maker to prescribe it, and making 140,000 or more false billing claims submitted to Medicare and Medicaid for those treatments. This activity landed him in both civil and criminal hot water, and in more recent news he pled guilty to criminal charges as well as settled civil claims with the Illinois and federal governments.

The companies accused of providing those kickbacks and receiving Medicare and Medicaid dollars from the business Reinstein generated by prescribing their antipsychotic drugs. Reinstein exemplifies a holdover of a slowly diminishing practice of using antipsychotic medications, which now is viewed more as the easy way out and a method of chemical restraint when there are other methods that could more humanely calm and care for a patient, particularly dementia and Alzheimer’s patients who have historically been the recipients of antipsychotic medications. Nursing homes historically used these especially when they kept low staffing levels and did not have the manpower to aid patients. Yet antipsychotic drugs can create a cycle of drug dependency, and can even lead to death.

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March 24, 2015

Revamped Rating System Downgrades Nearly One-Third of Homes

by Levin & Perconti

How do the Feds rate nursing homes?

In a follow-up to a recent post, reports have come out indicating that the federal government’s rating of nursing homes saw an overall reduction in scores for almost one-third of the more than 15,000 nursing homes and long-term care facilities across the nation. These ratings are compiled and reported by the federal government through the Centers for Medicare and Medicaid Services (CMS) on a website called “Nursing Home Compare” in what is called its “five-star” quality rating system.

According to USA Today, about 1.5 million people use the website to look up ratings for nursing homes. Given the unfortunate history of many facilities when it comes to resident abuse and neglect, and the absolute importance of finding a place where an individual or a loved one needs proper treatment and attentive care, this is obviously a very important resource for those consumers. The website has been in need of a massive overhaul, however, because much of the quality data and staffing levels, which are two key criteria, were self-reported by facilities which of course could lead to bias or disingenuous reporting.

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