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Lawsuit targets nursing home management, state regulators

State regulators allow nursing home companies to siphon money away from patient care to pad corporate profits, alleges a lawsuit filed by a longtime foe of the industry.

Glendale attorney Russ Balisok, who has made a career of suing nursing homes, brought the suit seeking to invalidate parts of state law that allow nursing facilities to contract out their own management. The suit, filed last month, targets Country Villa Health Services, which runs a chain of 50 skilled nursing and assisted-living facilities throughout California.

Balisok's strategy is to attack the industry's business model. At issue are state-approved agreements in which Country Villa homes contract out their operations to another Country Villa entity. The management company gets a percentage of revenues from the homes it operates. Balisok contends that the management company doesn't actually run the facilities and instead consumes money needed to care adequately for patients.

"It’s just their way of taking 5 percent off the top and leaving the nursing home with insufficient resources so that nursing homes limp along with poor care for patients," he said. "I want the 5 percent back."

Country Villa provided a statement that it is in full compliance with state authorities and federal law. 


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Advocates fear patient care will suffer under state budget cuts

Gov. Jerry Brown announced a state budget yesterday that relies on hospitals and nursing homes to achieve nearly $400 million in savings – a week after a far smaller proposal prompted concerns about patient care.

The governor's revised budget is the starting point to closing a $15.7 billion deficit. He proposed making further cuts to human services, paring down hours of care provided to In-Home Supportive Services recipients, and limiting child care support provided by the CalWORKs program.

The revised budget poses a new set of challenges to care providers and patient advocates. Last week, groups representing doctors, nurses and nursing home residents decried a comparatively minor budget change that would have cut the mandate for hospital and nursing home inspectors to perform unannounced inspections to monitor compliance with state laws.

The budget proposal by the state Health and Human Services Agency would have eliminated 25 nurse-inspector positions and slashed fees paid by hospitals and nursing homes that go toward enforcing patient safety laws.

Health and Human Services Agency Director Diana Dooley said that the proposal to change facility inspections was unrelated to yesterday's budget cuts. Rather, it was meant to streamline state operations “where we believed we could assure quality and safety in care,” Dooley said.


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Oversight of California nursing homes lacking, report finds

California nursing home inspectors fall short in following up on their own investigative findings, possibly enabling sustained neglect or lax practices that can injure residents, according to a new federal report.

The Department of Health and Human Services' Office of Inspector General, which oversees Medicare and Medicaid, identified shortcomings by the California Department of Public Health, which inspects the state's 1,150 nursing homes.

The report, issued last week, is the second in a series of federal examinations of California nursing home oversight. One review examines a case that limited federal overseers’ ability to take action after inspectors discovered that maggots were coming out of a resident's ear.


The Department of Public Health is charged with enforcing both state and federal regulations that govern nursing homes. Both state and federal overseers have different sets of rules, fines and sanctions they can levy on nursing homes with violations. The inspector general's reports examine how well state inspectors enforce federal regulations.

In response to the first report, which was released in September, the Department of Public Health said it receives about 19,000 complaints and facility-reported issues each year. It said the department instructs inspectors to first examine problems in light of state laws that allow them to levy fines of $1,000 to $100,000.

Filed under: Health & Welfare, Daily Report, Nursing Homes


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Minority nursing home residents increase, whites decline

As the nation’s elderly population increases, nursing homes across the country have seen a demographic shift in their residents. More Hispanic, black and Asian seniors are moving into nursing homes, while white seniors choose other options.

A study by Brown University researchers published in the journal Health Affairs found that this nationwide trend is driven in part by changing demographics, such as the rapid growth of elderly minority populations.

But the study also found that the increase in the proportion of minority nursing home residents indicates a lack of access to home- and community-based alternatives, which generally are preferred for long-term care. Whites seniors, who have greater economic resources on average, are finding better housing alternatives as they reach old age.

“We know those alternatives are not equally available, accessible or affordable to everybody, certainly not to many minority elders,” said Zhanlian Feng, an assistant professor at Brown University's Center for Gerontology and Health Care Research and the study’s lead author. “Most elders would rather stay in their homes or some place like home, but not a nursing home unless they have to.”


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Nursing homes reach last-minute deal on Medi-Cal cut

California nursing homes dodged the 10 percent rate cut hitting doctors and most other Medi-Cal providers approved by the Senate on Friday, angering advocates who hoped to see funding aligned to reward top-notch care.

Nursing homes carved out a deal carried by Assemblyman Bob Blumenfield, D-Van Nuys, that requires them to take a 7.6 percent cut this fiscal year. But those funds – an estimated $400 million – will be given back to them [PDF] by the end of 2012.

The 10 percent rate cut has been proposed this year and in years past for a number of Medi-Cal providers, including hospitals, which are taking a case to the Supreme Court, and doctors, who recently made a high-profile lobbying trip to Washington, D.C., seeking to thwart the cut.

Despite the relative ease with which nursing homes avoided the sharp edge of the budget ax, the trade association representing nursing homes said it still is bracing for possible Medicare cuts to nursing homes or payment delays if the budget is late.

Nancy Reagan, general counsel for the California Association of Health Facilities, said the temporary cuts could mean that a 99-bed nursing home would go without $600,000 before the money is refunded.

Audit: Common psychiatric meds can be deadly for elderly

A federal audit found widespread and costly prescribing of antipsychotic drugs to seniors in nursing homes, often in "off-label" uses that can be deadly for elderly patients with dementia.

The report released Monday by the Health and Human Services Inspector General's Office shows that 88 percent of the second-generation antipsychotic drugs prescribed at U.S. nursing homes are for patients with dementia, despite a government warning that such patients face an increased risk of death on such drugs.

The report, accompanied with a strongly worded column by the Health and Human Services inspector general, also comes down clearly on one side of an ongoing debate in California over the use and safety of antipsychotic medications.

Such medications are prescribed daily to 24,000, or about a fourth, of the 99,000 nursing home residents in the Golden State, federal data shows.

Inspector General Daniel Levinson called the findings about prescriptions to dementia patients “alarming.” The Food and Drug Administration in 2005 issued its strongest “black box warning,” saying that prescribing atypical antipsychotic drugs to seniors can increase their risk of death. Those drugs were developed to meet the needs of patients with rare and severe mental conditions, such as bipolar disorder and schizophrenia.


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Elder-care ombudsmen seek independence from state

A group of local elder-care ombudsmen have found an ally in the Legislature in their quest to give the state’s top ombudsman more autonomy by creating an independent nonprofit.

The local groups, which investigate abuse allegations involving seniors in care facilities, grew disillusioned with the statewide leader when he stood by as program funding was eliminated in 2008.

Sen. Lois Wolk, D-Davis, supports them in a move to create an independent nonprofit “giving the new ombudsman’s office the complete autonomy needed to speak out effectively on behalf of resident concerns.”

Now the current statewide ombudsman, Joseph Rodrigues, plans to fight to keep the position where it is, saying that his proximity to state leaders and the governor’s office is good for seniors.

“Frankly, I feel like we already have an independent state office,” Rodrigues said in an interview. “I don’t feel any restrictions on my ability to act and speak.”

Last summer, lawmakers held a hearing about the issue of whether the state needs to separate the state ombudsman’s office from the Health and Human Services Agency.

During the hearing, Rodrigues announced that he secured newfound autonomy to speak out on bills and advocate more strenuously for the office and for seniors.


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Lawmakers push for elder abuse reforms

Citing the difficulty in prosecuting elder abuse, state and local officials are proposing reforms that will streamline the reporting of cases and make it easier to obtain convictions.

Assemblywoman Mariko Yamada, D-Davis, recently introduced AB 40, which would require mandated reporters to inform both an ombudsman and local law enforcement when they suspect abuse. Currently, mandated reporters – which include employees at nursing homes and social, health, and law enforcement workers – are only required to report cases to one of the two agencies.

Another bill, SB 558, introduced in February by Sen. Joe Simitian, D-Palo Alto, would change the burden of proof in elder abuse cases, which are often prosecuted as civil cases, not criminal ones. The bill lowers the burden of proof from "clear and convincing evidence" to a "preponderance of evidence."

The bills introduced this year indicate many state officials believe current laws aren't aggressive enough. According to California Advocates for Nursing Home Reform, 96 percent of physical, sexual and mental abuse cases involving seniors result in a citation of $1,000 or less and many cases are reported to prosecutors years after the fact.

The elder abuse issue gained momentum last month, when law enforcement, state agencies, elder advocates and nursing home operators testified at an assembly hearing in Sacramento. Led by Yamada and Tom Ammiano, D-San Francisco, the hearing was meant to shed light on California's shortcomings in dealing with elder abuse and make the case for bills such as AB 40.


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Nearly all nursing homes employ convicted criminals

More than 90 percent of nursing homes employ at least one person with at least one criminal conviction, and nearly half of facilities have five people on staff with a criminal conviction, according to a report by the federal Health and Human Services Inspector General.

Among those convicted, about 44 percent of employees were found guilty of property crimes such as burglary, shoplifting or writing bad checks. The workers most likely to have convictions were housekeeping, nursing assistant and dietary workers, according to the report [PDF], which was released last week.

The report also found:

  • Among convicted workers, 20 percent had driven under the influence, 16 percent were convicted of drug-related crimes and 13 percent committed crimes against people.
  • Eighty-four percent of convicted employees had their most recent conviction before the start of their current employment.
  • In 15 percent of nursing homes, 10 percent or more of the staff had a criminal conviction.

Report authors say the federal health reform law aims to address the problem of unfit caregivers by creating a national criminal background check database.

Still, the fitness of care workers in homes, nursing homes and small residential facilities has been a hot topic in California.

Lawsuits allege nursing home neglect

In the months since a Humboldt County jury leveled a $671 million verdict against a nursing home chain, five similar lawsuits have been filed throughout California. Each case alleges that nursing homes are providing too few staff to meet resident needs.

Last July, the Humboldt County jury found Skilled Healthcare had failed to meet the state staffing standard and imposed the maximum fine of $500 per patient for each day that the chain was in violation. Attorneys for both sides have since agreed that the chain should pay $50 million to settle the claims and avert bankruptcy. The company admitted no wrongdoing.

Attorneys for the plaintiffs hailed the class-action case as one of the largest jury verdicts in nursing home litigation history.

Eureka Times Standard reporter Matt Drange wrote a detailed three-part series about the case, which you can read here. I also wrote about some of the “smoking gun” internal e-mails that jurors saw during the trial.

Several of the attorneys who prevailed in Humboldt County are bringing the new wave of complaints, which closely resemble the Skilled Healthcare lawsuit.


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