Grim way to increase nursing home profit: Toss out frail seniors and disabled

investigationnursinghomesnbc2019-300x262Profit-hungry nursing home operators persist in throwing out vulnerable seniors and disabled patients from needed care, too often because the facilities find they can get higher-paying patients to fill their already costly beds.

Thousands of complaints about potentially improper discharges or transfers from nursing homes and assisted living facilities dominate the work of ombudsmen, whose work is federally required, and state supported, an NBC News investigation found.

The broadcast journalists reported:

“Nationally, long-term care ombudsmen, who advocate for elderly and disabled residents of nursing homes and assisted living facilities, received 10,610 complaints about discharges and transfers in 2017, up from 9,192 in 2015. The ombudsmen … receive more complaints about discharges and transfers than any other grievance. The complaints likely expose just a small fraction of the problem, said Kelly Bagby, vice president at the AARP Foundation, a nonprofit that serves … people over 50.”

NBC found that facility operators target poor patients with significant debilitation and try to shove them out for higher-paying individuals:

“Advocates, experts and the federal government say that nursing homes tend to evict low-income, longer-term residents who receive Medicaid, to make room for shorter-term rehabilitation patients who are covered by Medicare. Medicare reimburses nursing homes at a higher rate than Medicaid, so it’s more lucrative for facilities to house Medicare patients who stay for short stints before recovering and moving elsewhere. In California, for example, the average state Medicaid reimbursement for a nursing home is $219 per day, according to the California Association of Health Facilities, while Medicare may reimburse more than $1,000 per day, but only for up to 20 days, when patients must begin paying part of the fees. (Medicare coverage ends completely after 100 days.) Advocates say that eviction notices are often handed out around the 20-day mark.”

The news organization said that not only have discharge and transfer complaints ticked up, despite federal officials’ efforts to both crack down on them and to assist both facilities and patients in fairer, more humane handling of such situations, cases have grown more egregious. NBC cited incidents in Los Angeles and Baltimore where homes “dumped” patients on the street, leaving them in Skid Rows in hospital gowns, without medications and clutching a bag with a few of their possessions.

Such treatment is not only inhumane and unacceptable, it does not comply with federal law and can subject nursing home operators to prosecution, NBC reported, adding:

“Nursing homes are legally permitted to evict residents under several conditions: if a resident’s health improves sufficiently; if his presence in a facility puts others in danger; if the resident’s needs cannot be met by the facility; if he stops paying and has not applied for Medicare or Medicaid; or if the facility closes. Facilities are obligated under federal law to give 30 days’ notice, in writing, and also to work with the resident on a transition plan.”

The investigation found that the common complaint by facility operators of patient nonpayment can be dubious, at best, as poor or indigent patients, with assistance, can be helped to qualify for federal and state assistance programs. Those may not pay as well. But facilities already are pleading about their finances at a time when the average cost of a single private room in a nursing home exceeds $100,000 annually.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them and their loved ones by nursing home abuse and neglect. Ours is a rapidly graying nation and many more us than expected will spend time in a nursing home or assisted living facility. Too many baby boomers, alas, have failed to save sums to protect themselves optimally in their retirement.

These are just a few reasons — along with too frequent, plentiful, and unacceptable reports of abuses —  why politicians and regulators must step up in significant fashion to improve oversight of nursing homes. NBC reported that:

“In 2016, the Centers for Medicare & Medicaid Services strengthened regulatory requirements around nursing home discharges and transfers, specifying that residents cannot be evicted for nonpayment while they are in the process of applying for Medicaid or appealing a Medicaid denial. A year later, the agency announced an initiative to prevent illegal nursing home discharges, acknowledging that “some discharges are driven by payment concerns, such as when Medicare or private pay residents shift to Medicaid as the payment source. Advocates for nursing home patients said more is needed. They want both federal and state agencies to do more to enforce existing rules on evictions …But the federal government has made changes that reduced fines against nursing homes that harm or endanger residents. Nursing homes used to receive fines for each day a violation was observed, but after a change the Trump administration implemented in July 2017, nursing homes are now usually fined just once per retroactive violation.”

We’ve got a lot of work to do to ensure that frail elderly patients and the disabled aren’t savaged by those who run nursing homes and assisted living facilities not to care for the debilitated but to line their pockets to the max.

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