Table of Content
- Federal Spending Bill Calls for Long-Term Care Strategy for Vets, Telehealth Extensions
- Get the latest on healthcare leadership in your inbox.
- More Senior Care
- Watch live: White House monkeypox response team holds briefing
- Medicaid Waiver Program for Assisted Living and In-Home Care
- “We're strengthening our enforcement policies to hold nursing homes accountable for the care they provide.”
- California nursing homes in high-risk wildfire zones are ill-prepared for emergencies: study
California nursing homes were most likely to be deficient in their use of emergency and standby power systems, the researchers observed. Among the 1,182 facilities identified, the authors then determined that 495 sites were considered “exposed” and 687 were “unexposed.” They defined exposed as those homes with “moderate” to “very high” wildfire risk, using designations from the California Office of the State Fire Marshal. A study conducted by the Commonwealth Fund last month found that if vaccination continued at its current pace, the country faced a potential winter surge of Covid infections that could result in 16,000 hospitalizations and 1,200 deaths per day by March 2023. Another patient who was there for five months after a stroke said she only received three showers in that time. A man who was badly injured in a car crash lost 30 pounds as a result of the care at the rehab center, according to the attorney general, and his condition worsened during his time there. He would later be admitted to the hospital for severe malnutrition, dehydration, a worsening pressure injury and a bone infection in his right foot.
These audits help reduce waste, abuse, and mismanagement and promote economy and efficiency throughout HHS. We help leaders and future leaders in the health care industry work smarter and faster by providing provocative insights, actionable strategies, and practical tools to support execution. In addition, the Times gained access to ratings information typically not made public from academics who, via research agreements with CMS, had access to such data. Verma pledges to improve transparency, quality and compliance without undue paperwork burdens on nursing homes. CMS is developing quality measures that score providers based on patient outcomes, not adherence to processes, Verma said. "I have directed my team at CMS to undertake a comprehensive review of our regulations, guidelines, internal structure, and processes related to safety and quality in nursing homes," she said.
Federal Spending Bill Calls for Long-Term Care Strategy for Vets, Telehealth Extensions
The U.S. Department of Health and Human Services Assistant Secretary for Preparedness and Response back in March allowed long-term care pharmacies to direct order Covid antivirals to facilitate increased access for long-term care residents. There was also testimony from staff and family members of residents that described the bleak conditions at the center, which was said to be unclean and had critical care equipment like wheelchairs, beds, shower chairs and A/C units that were broken, the lawsuit stated. Some residents were said to be left sitting in soiled clothing, while others had wounds that got infected due to a lack of care. Through a variety of different alleged schemes and frauds, those who were named in the lawsuit transferred more than $42 million to the owners of the Woodbury facility and other related parties from 2016 to 2021 according to the investigation by attorney general's office. Letitia James is taking legal action against Cold Spring Hills Center for Nursing and Rehabilitation, claiming there was financial fraud and rampant resident neglect in part due to severe understaffing.
When it comes to vaccines, while more than 86% of nursing home residents had completed their initial series of Covid shots, only 43.8% of residents are considered up to date on their vaccines. The proposed rule comes as skilled nursing facility admissions have dwindled, while home health admissions have surged. According to the Times, better predictors of how nursing homes would fare amid the pandemic were the infection rate of the surrounding community and the race of a nursing homes' residents.
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In a statement, James said that "Cold Spring Hill's owners put profits over patient care and left vulnerable New Yorkers to live in heartbreaking and inhumane conditions," and encouraged anyone who witnessed some of the alleged abuse and neglect to contact her office. In 2020, OIG quickly pivoted to new work to help protect nursing home residents during the pandemic. These individuals are particularly vulnerable to infectious diseases, such as COVID-19, due to their age and underlying medical conditions. In the lawsuit, filed in California's Superior Court, prosecutors claimed that the organization misrepresented its staffing levels, particularly the hours worked by RNs, and incorrectly discharged and transferred residents to make room for residents who would generate a greater profit. According to the Times, the lawsuit seeks civil penalties—which under California law, in this case, could total $5,000 per violation since seniors and individuals with disabilities are involved—and an injunction against future instances of illegal conduct. Another issue the Times citing in its investigation was imprecisely reported staffing levels, which could mislead consumers about how much time staff is able to spend with each patient or resident.
For instance, the Times reports that the rating system requires facilities to report the prescription medication they administer to residents and penalizes nursing homes that overuse certain medications. However—based on court documents and interviews with administrators, nurses, and federal officials—nursing homes "for years have underreported the number of residents" using opioid and antipsychotic medication. CMS has also increased public awareness of nursing homes failing to meet our minimum health and safety standards. "Now, instead of publishing notices in local newspapers, we're publicizing instances in which CMS terminates our agreements with nursing homes due to poor quality on our website," Verma said. "While we support and promote the private sector's critical role in our healthcare system, CMS' duty to monitor the safety of the nation's hospitals, nursing homes, and other providers, is a unique governmental task which lies at the core of government's role in healthcare," Verma said in a media release. The poorer emergency preparedness at high-risk nursing homes suggests, however, that staff members may be either unaware of or not adequately incentivized to respond to wildfire risk, the authors explained.
More Senior Care
“The medical complexity and functional needs of nursing home residents render them susceptible to disproportionate harm from exposure to environmental hazards,” the authors concluded. SEAL team commander found dead in California residenceAmtrak suspending some service due to massive winter stormSuch a response could be governed by emerging health care coalitions — regional partnerships that integrate emergency planning, health care and public health organizations, the researchers explained. Despite being located in fire-prone regions, these nursing homes demonstrate poorer compliance with Medicare’s emergency readiness standards, according to the study, published on Wednesday in the Journal of the American Geriatrics Society. When Jordyn's not covering the latest skilled nursing news, she's likely catching a Cubs game at Wrigley Field, cheering on the Iowa Hawkeyes or watching Gilmore Girls all the way through for the millionth time.
Ultimately, the Times' investigation found the Covid-19 fatality rate at five-star facilities was just half a percentage point lower than at facilities with lower ratings—and in fact, the fatality rate was slightly lower at two-star facilities than at four-star facilities, the Times reports. The Centers for Medicare & Medicaid Services has launched a review of regulations and processes governing safety and quality of care in the nation's nursing homes, Administrator Seema Verma said. It will still be subject to Medicaid estate recovery, but the net rental income would go to the nursing home, reducing Medicaid’s outlay and ultimate estate recovery claim.
Billing and PaymentsRecommendationRelevant ReportsCMS should analyze the potential impacts of counting time spent as an outpatient toward the 3-night requirement for skilled nursing facility services so that beneficiaries receiving similar hospital care have similar access to these services. During the COVID-19 pandemic, OIG has identified a spike in the number of reports alleging elder harm and neglect. Also, of great concern is the rise in the number of bad actors preying on Medicare and Medicaid beneficiaries during the public health crisis. In response, our Office of Investigations launched an initiative to raise awareness of fraud and abuse in elder care settings. According to the Times, the pandemic hit nursing homes harder than other part of the industry, with nearly one in every 10 nursing home residents dying from Covid-19—and it also suggested that the star-ratings system does little to spotlight which organizations excel at infection prevention and control. In fact, according to the Times, inspectors over a three-year period spotted at least one issue involving potential patient abuse—such as staff acting violently toward residents, or failure to look into injuries—among nearly 1,200 homes with overall five-star ratings.
OIG investigates potential violations to hold accountable those who victimize residents of nursing homes. Patient neglect and inadequate care by nursing facilities is a recurring challenge that OIG works with the Department of Justice to address in False Claims Act cases. According to the Times, despite the weight CMS allots in-person inspections in its overall star rating, "the exams do little to penalize homes with serious problems"—particularly among nursing homes with five stars for care quality, which are nearly as likely to fail these inspections as they are to ace them.
"We want to make sure providers spend time caring for residents instead of completing unnecessary paperwork." Power outages are directly linked with adverse outcomes among nursing home residents — many of whom are dependent on electric health care equipment and struggle to tolerate temperature fluctuations, according to the study. As a result of the alleged fraud financial abuse and unnecessary staffing cuts, residents at the rehab center suffered badly and needlessly during the COVID-19 pandemic, the lawsuit states. Just a month before the pandemic struck, the owner of the facility devised a plan to cut $1.6 million from the budget by reducing staff — even though the Department of Health said all nursing homes needed to prepare for the coming pandemic. An investigation by James' office found that the facility's owners diverted $22.6 million in Medicaid and Medicare funds from resident care through a network of 13 companies that were used to conceal profit-taking.
But this strategy makes more sense with high-value houses where the equity is likely to exceed any estate recovery claim. That’s not likely in your situation and, of course, you would no doubt have to invest more money to make the house suitable for rental. Although guidance from the Centers for Medicare & Medicaid Services encourages nursing homes to collaborate with municipal risk assessment and disaster planning initiatives, no clear standards exist to verify such partnerships, according to the study. The total number of emergency preparedness deficiencies also tended to be higher for exposed facilities than for unexposed sites, according to the study. To draw these conclusions, researchers from Yale University investigated California nursing homes that had received certification from the Centers for Medicare & Medicaid Services and were located within 5 kilometers (3.1 miles) of a wildfire risk area. Some states are further behind than others, according to an AARP analysis of federal data as of mid-October.
According to the Times, nursing home inspections—which form the basis of the overall star ratings—can, in theory, occur at any time, without any warning. However, the Times investigation found that in 2019, about 70% of nursing homes boosted their staffing levels by an average of 25 staff hours on inspection days, when compared with typical staffing levels for that day of the week. In fact, at more than 800 nursing homes, inspectors reviewed the facilities during what ended up being the facilities' best-staffed day of the year. Instead, skilled nursing facilities should share their clinical quality metrics directly with hospital partners, and hospitals should evaluate providers as holistically as possible. This means looking beyond any individual rating, using a scorecard to assess potential partners across clinical, efficiency, and partnership metrics.
The person looking after him was not told when the man died, or even was informed of his condition after going back to the facility. Top Management ChallengeOIG annually identifies top management and performance challenges HHS faces as it strives to fulfill its mission. In addition to fraud, the Brooklyn-based agency was also cited for cheating aides out of their wages. Engaged in a $2 million fraudulent promissory note scheme when purchasing the facility. New York Attorney General Letitia James sued Cold Spring Hills Center for Nursing Rehabilitation in Woodbury for allegedly diverting over $22.6 million in Medicaid and Medicare funds to the owners' pockets.
The Clinical Executive Conference will examine trends, challenges and opportunities facing clinical leaders in skilled nursing. CMS solicited comment on various related topics, including how MAOs preauthorize treatment in discrete increments; enrollee timelines to file appeals regarding termination of services; and how reinstatement of services is handled following quality improvement organization decisions. OIG examines risks to residents' well-being and recommends ways for CMS to better monitor and mitigate these risks. This work often includes assessments of how CMS is—or could be—leveraging data more effectively for oversight and to make risks more transparent to consumers.
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