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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March 19, 2015

Understaffing, Painkiller Overdose, & Death at Holland Home Nursing Home

by Levin & Perconti

Local nursing home resident advocates remain saddened, shocked, and disgusted by the latest news out of a nursing home in South Holland, Illinois. As reported by several news outlets last week (and discussed on this blog), the death of a 98-year old resident, Dorothy Byrd, at Holland Home was ruled a homicide with the cause of death attributed to an overdose of two separate painkillers--morphine and hydrocodone.

Making matters even more disturbing is that Dorothy Byrd is not the only resident whose life may have been lost by the suspected actions of Holland Home employees. In fact, at least five other residents were hospitalized last month due to unknown causes, with two of those residents passing away.

Chronic Painkiller Overdoses in Nursing Homes

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March 18, 2015

Mysterious Death in Chicago Suburb Prompts Investigations

by Levin & Perconti

In recent local news, there was a report of the death of a nursing home resident in the south suburbs of Chicago. This death is particularly mysterious because the medical examiner was unable to conclude a cause of death, though a toxicology report is apparently still pending. Those tests were performed on the victim, as well as done on five other residents at the nursing home who, like the deceased, all became sick with blood pressure problems and respiratory problems. While those five survived, the sixth died a day later. Fire officials indicated that carbon monoxide nor any other gas appeared to be the cause of the illnesses and the death. Without a clear explanation or reason for the death, especially for a patient whose daughter claimed her to be in good health at her age (she was 98 years old), authorities have proceeded to open investigations into the death.

State and Local Investigations

The federal government and state government share responsibilities for overseeing nursing homes and long-term care facilities. While state departments of health and/or aging, as well as state offices of attorneys general also may get involved on either a criminal, civil or regulatory angle, the federal government may also get involved where federal money is spent on insurance for patients through programs like Medicare and Medicaid. Such oversight includes investigations, collecting data for rankings, and placing homes on publicly listed “poor performance” lists or even sanctioning those homes. The federal government will often rely in particular on state data and state investigations.

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March 17, 2015

Painkiller Overdose Caused Holland Home Nursing Home Resident’s Death

by Levin & Perconti

The Chicago Tribune and other local media outlets are reporting that 98-year-old nursing home resident Dorothy Byrd died last month as a result of an overdose of two powerful painkillers. The Cook County Medical Examiner’s office has ruled her death a homicide. Byrd was a resident at Holland Home, an assisted living facility located at 16300 Louis Ave in South Holland, Ill.

Reports indicate that in addition to Byrd's death, five other residents of Holland Home were hospitalized on February 3 due to unknown causes. Two of these residents also died, but the Medical Examiner is still awaiting toxicology results and has not yet released the causes of their deaths. According to the Chicago Sun-Times coverage, Byrd’s death was the result of a morphine and hydrocodone overdose.

Holland House is an assisted living facility operated by Villa Healthcare, a healthcare management company headquartered in Skokie that, according to the company’s website, operates 12 nursing homes and four assisted living facilities in Illinois, Wisconsin and Michigan. According to the Holland Home’s website, the facility offers independent living, assisted living and memory care services.

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March 17, 2015

Nursing Home Camera Bill Introduced

by Levin & Perconti

The subject of keeping cameras in nursing home residents’ rooms has been the source of growing debate recently, and states have progressively moved toward passing and enacting laws that permit residents to keep cameras in their rooms. This is different than keeping cameras in common spaces and hallways, and does implicate certain privacy concerns. Yet the advantages of using a camera allows residents and their family members to observe just exactly what goes on in their rooms, including any type of abuse or neglect at the hands of nursing home staffers.

If nursing home staffers are aware that cameras are permitted in rooms, it could very well make them think twice about hurting a patient, or will keep them honest about providing adequate care, treatment and attention knowing that their visits will be monitored. It is also important to note that in no state has the use of a camera been mandated – only permitted. There is also a question of privacy for the nursing home staffers themselves, though the footage is intended to document visits and interactions while those staffers are on the job, so one might presume that they give up a certain level of privacy in the interest of transparency and safety for a facility’s residents. And privacy concerns for the residents can be alleviated on the simple idea that the patient or their family members make the choice to use the camera, as well as to bear the cost.

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March 16, 2015

Governor Rauner Seeks to Cut Medicaid by $1.5 Billion

by Levin & Perconti

While programs like Medicare and Medicaid are largely funded through federal dollars from the Centers for Medicare and Medicaid Services at the United States Department of Health and Human Services, Medicare and Medicaid are actually administered through states. This is why states take a great interest in the expenditure of those funds, and states attorneys general have fraud units dedicated to investigating medical providers and individuals who fraudulently submit reimbursement claims for false treatments or unnecessary treatments or procedures. Thus state legislatures and governors have substantial authority over how these funds are spent, and how much of these funds are spent. Medicaid tends to be a substantial part of many states’ respective budgets, and Illinois is no different. This program specifically is meant to help the poor with health care (while Medicare traditionally helps the elderly).

Actual Proposals

During the last election cycle, Bruce Rauner, who is no stranger to owning entities related to nursing home businesses, won the governor’s seat over incumbent Pat Quinn. Governor Rauner, as part of his budget, has proposed to decrease Medicaid funding in Illinois by $1.5 billion. If the budget were instituted, it would reduce Medicaid spending to about $19 billion, covering about 3.6 million state residents. As Medicaid is a program that pays for all types of health care, this will affect Medicaid patients seeking care from doctors, hospitals, as well as nursing homes alike. This massive cut is actually a re-visit of cuts made temporarily in the state’s previous legislative session. Such budget cuts affected certain services like dental care and podiatry, as reported in the local news.

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March 14, 2015

Federal Government to Improve Faulty Rating System

by Levin & Perconti

In recent months, there were reports that the federal government’s methods of rating nursing homes and long-term care facilities were deficient and resulted in inaccurate ratings of the quality of care at certain facilities. The federal government’s role in nursing home and facilities exists largely where federal funds go toward paying for the insurance of residents through programs like Medicare of Medicaid. The Centers for Medicare and Medicaid Services (CMS), which falls under the umbrella of the United States Department of Health and Human Services (HHS), is responsible for tracking the performance of nursing homes that receive federal dollars through Medicare or Medicaid, as well as handing down sanctions and maintaining lists of underperforming facilities.

The “Nursing Home Compare” website is the main source for this type of information for nursing home consumers and their families. One of the core reasons for the deficient ratings was the fact that many facilities were permitted to self-report certain data regarding the quantity and quality of care they gave to their patient residents.

Naturally, this implies that facilities may be more than likely to overinflate their own reporting, including statistics like staff levels. A key problem with facilities, though, is the low staffing levels used by owners and administrators in an effort to increase revenue and profit at the expense of attention to patients. There was furthermore information that went unverified. According to some, far too many homes received four and five-star ratings (out of five) that they likely did not deserve, and homes with a history of poor quality of care received rather high marks. Also, the prior ratings did not take into account the use of antipsychotic drugs to hold down irritable or potentially violent patients. Notably, between 2009 and 2013, the number of five-star rated homes increased from 11% to 29% of facilities nationwide under the previous rating paradigm.

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March 12, 2015

With New CMS Ratings, Sauk Valley Takes a Hit

by Levin & Perconti

In recent weeks the Centers for Medicare and Medicaid Services, which oversees and monitors nursing homes, in conjunction with relevant state agencies, announced a significant reform of its “five star” rating system for about 15,000 nursing homes across the United States. These ratings, along with statistics as well as data on citations or sanctions, are available on CMS’s Nursing Home Compare website.

The old version of Nursing Home Compare relied largely on self-reported data by homes about the quality of care they offer to patients, as well as self-reported data on staffing levels. Much of this went unverified and led to certain homes being overrated due to the biased data. In order to remedy this problem, which was reported on at length in the latter months of 2014, CMS (which falls under the Department of Health and Human Services), worked to refine the data collection process by using payroll information to corroborate staffing level statistics and by stepping up investigations to verify the quality of care at facilities. It also adds a vital new piece of criteria that takes into account the use of antipsychotic medications, which is increasingly seen as a means of chemical restraint and an inappropriate way to medicate and sedate patients.

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March 10, 2015

High Court Holds ‘Bed Tax’ Constitutional

by Levin & Perconti

We previously covered the Illinois Supreme Court’s consideration of what has been termed the “bed tax.” This tax is an assessment of a $1.50 fee for each bed in a nursing home or long-term care facility in the state of Illinois. The fee is charged per bed per quarter, which for those who can already figure out with basic arithmetic, amounts to $6.00 a year per bed. The money collected from this tax is put directly into a Long-Term Care Provider Fund, which was established by statute, and is used to help fund long-term care and other health initiatives for the state.

This is, in general, a common use for taxes by states and even the federal government in the sense that the money is used for services and costs related to the industry or subject area of the tax in the first place. In spite of this as a function of the state’s taxing power, such taxes must also pass constitutional muster – be it federal or state – and nursing homes have vehemently challenged this tax as unconstitutional, which has resulted in a case path up to the state’s highest court. The state, on the other side, has argued that the tax is applied to all nursing homes across the state, and that it is hardly arbitrary, but instead goes to the long-term care fund which helps nursing homes and other health care programs and initiatives, including Medicaid.

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March 7, 2015

Investment Firm Takes Over Family-Run Nursing Home

by Levin & Perconti

When someone thinks of a “mom and pop,” they might think of a small town shop, solely owned and operated by a couple or by a family. The term evokes something not necessarily simpler, but more approachable, possibly family-oriented, and something that may count its role in the community as part of its identity. However, with an ever-growing corporate America, as well as globalization, mom-and-pop outfits are less common, especially in the more populated areas, and bigger companies swoop in and take over ownership, control and operation of stores, restaurants, and the like.

Unfortunately, nursing homes and long-term care facilities do not avoid this trend either. As time goes by and the demand for nursing health care increases with a baby boomer population that grows older and requires more support and care, there is more money to be made. Throw in the involvement of not just private insurance but of government programs like Medicare and Medicaid for the elderly, the poor and the infirmed, and there are even greater dollar signs on the horizon for nursing home owners and administrators.

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