JustCare

Tag: Nursing home care

  • Medicare Advantage enrollees denied post-acute care get better protections

    Medicare Advantage enrollees denied post-acute care get better protections

    The Centers for Medicare and Medicaid Services (CMS), which oversees Medicare, just issued a final rule designed to protect Medicare Advantage enrollees whose Medicare Advantage plans deny them needed care and help ensure providers are paid for the care they deliver. Josh Henreckson reports for McKnight’s on how the rule improves the process for appealing Medicare Advantage denials for rehab and skilled nursing services after hospitalization.

    So that you’re up to speed: Insurers selling Medicare Advantage plans have repeatedly been found to inappropriately delay and deny necessary skilled nursing and rehabilitation care post-hospitalization. People in traditional Medicare get this care. Medicare covers up to 100 days of skilled nursing and rehab services for people who need daily skilled services and have been hospitalized for at least three days in the 30 days prior to admission to a facility.

    People enrolled in Medicare Advantage plans struggle to get the rehab and skilled nursing care they need, not only because their plans deny them coverage but because they are on the hook for the cost of care that their Medicare Advantage plans won’t cover even when they appeal the decision. The CMS final rule ensures that these patients will not be liable for the cost of their treatment if they fail to appeal a denial of coverage while they are in the skilled nursing facility or rehab facility or if  they do not win their appeal. Beginning in June, people in MA plans whose post-acute care is terminated will no longer be liable for the full cost of services after termination.

    People who appeal these Medicare Advantage plan denials of skilled nursing or rehab care win more than eight in ten times. But the vast majority of people do not appeal. Often they do not know they can appeal. Or, they fear having to pay privately for the cost of their care if they do not win on appeal.

    As important, the new CMS rule requires that an independent organization decide fast appeals for people in skilled nursing and rehab facilities. The Quality Improvement Organization and not the Medicare Advantage plans will decide these appeals

    And, if people continue their care after their Medicare Advantage plan terminates their post-acute coverage and do not appeal at that time, they will now have the right to appeal after they leave the skilled nursing or rehab facility.

    The final rule also helps skilled nursing and rehab facilities. They have been struggling because Medicare Advantage plans fail to pay them even when these plans’ have inappropriately denied their patients needed care. Without an independent review agency, there’s no reason for providers to believe that care denials will be overturned; the insurers have no incentive to reverse their original decision.

    Here’s more from Just Care:

  • Need skilled nursing care? Medicare Advantage insurers often won’t cover it

    Need skilled nursing care? Medicare Advantage insurers often won’t cover it

    Insurers offering Medicare Advantage plans are causing nursing homes to lose money at a rapid pace, reports Amy Stulick for Skilled Nursing News. These insurers are not only paying Medicare-nursing homes less than the traditional Medicare rate, they are too often not covering enrollees’ care in nursing homes, even when they are required to do so. If our government does not step in to insist that insurers pay nursing homes the Medicare rate, there may be no skilled nursing facility care available to Medicare patients.

    Today, Medicare covers care in skilled nursing facilities in limited situations. To qualify for Medicare skilled nursing care, patients must need daily skilled nursing or therapy services and receive these services in a Medicare-certified skilled nurse facility. Moreover, they must be hospitalized for at least three days in the 30 days prior to admission to a skilled nursing facility. So long as they qualify, Medicare covers up to 100 days of care per benefit period.

    But, insurers offering Medicare Advantage plans don’t like to spend the money they receive to cover Medicare services. Every service they do not cover is money in their pockets. So, people in Medicare Advantage plans often do not get nursing home care or get very limited nursing home care or get poor quality nursing home care.

    Marc Zimmet, the president of Zimmet Healthcare says that nursing homes are losing $274.9 million for every one percent increase in Medicare Advantage enrollment. Traditional Medicare pays about 87 percent more ($841) for nursing home care than insurers offering Medicare Advantage ($448). Not surprisingly, Medicare Advantage enrollees not only get less nursing home care than traditional Medicare enrollees, they are forced to use lower quality nursing homes.

    People enrolled in Medicare Advantage need to recognize that they are taking a big risk with their health. They can’t count on getting high quality physician and hospital care; they can’t count on continuity of care; they can’t count on getting needed care. Yes, it is true that some people do perfectly well in Medicare Advantage; it’s also true that hundreds of thousands, if not millions, experience serious deterioration of their health and tens of thousands die needlessly. With Medicare Advantage, you are always playing the odds; you could end up in a killer plan.

    Here’s more from Just Care:

  • Medicare Advantage plans use AI to deny care

    Medicare Advantage plans use AI to deny care

    Bob Herman and Casey Ross report for StatNews on Medicare Advantage plans’ use of Artificial Intelligence (AI) to deny life-saving and quality-improving services to their enrollees needing costly care. Without appropriately taking account of patients’ individual health status, Medicare Advantage plans restrict needed nursing home care and physical therapy, as well as delay critical cancer care and more. The more they do, the more they profit.

    In one case, Security Health, a Medicare Advantage plan refused to cover more than 17 days of nursing home care for an 85 year-old woman with a fractured shoulder and uncontrolled severe pain. The Medicare Advantage plan said she could go home, even though it was clearly unsafe for her to do so. She could not perform any activities of daily living without assistance, and she lived alone.

    More than a year later, a federal judge found that Security Health was liable for the additional three weeks of nursing home care the woman had to pay for out of pocket. She had precious little means to do so and was forced to spend her limited savings down to the point where she qualified for Medicaid. Given how relatively few people appeal Medicare Advantage denials, Security Health and other Medicare Advantage plans make out like bandits restricting care.

    STAT’s investigation found that these inappropriate denials are growing as a result of AI. That should be expected. Medicare Advantage plans face no penalty for these types of egregiously inappropriate denials. Instead, enrollees face serious penalties, forced to pay for life-sustaining care out of pocket or to go without.

    The federal government is not overseeing the algorithms the AI uses to deny and delay care inappropriately, particularly for people who are very sick. The patients can appeal the denials, but that can take years. Often, by that time, the patients have died or suffered gravely.

    You can only imagine who is programming the algorithms and what these programmers are directed to do when they do the programming. The MA plans want as many denials and delays as possible to maximize their profits. They seem to treat enrollees like widgets, rather than as individuals with unique needs.

    We do not know how many MA plans use AI to make medical necessity determinations, but we do know that most of the largest ones do, including UnitedHealth Group, Elevance, Cigna, and Aetna/CVS Health. The biggest company offering AI services to MA plans is NaviHealth, which UnitedHealth now owns.

    NaviHealth, for its part, claims its AI algorithms do not make coverage determinations, but simply are used to let physicians and other health care providers know about their patients’ care needs. And, yes, the sky is green.

    The Stat reporters point out that the FDA must approve AI products that are designed to detect cancer or recommend treatments. But, the Medicare Advantage plans can use whatever AI tools they please to decide whether care is warranted and to pay for a procedure. Not surprisingly, MA plans deny care that is covered in traditional Medicare–which they are required to cover–often without speaking with the patient’s treating physicians.

    In one instance, a Medicare Advantage plan denied a stroke patient rehabilitation care. Yet, the patient couldn’t feed himself. He had signed up for a Medicare Advantage plan, wrongly assuming it would cover the care he needed.

    Several years ago, when the government decided to pay a fixed upfront fee for post-acute services, such as nursing home care, it  gave the providers an incentive not to overtreat, saving the government money. But, it also gave these providers an incentive to undertreat. The less care they offered, the more of the upfront money they could keep for themselves.

    NaviHealth works with many Medicare Advantage plans. It promises to “manage” enrollees’ care post hospital discharge. If it saves the Medicare Advantage plans money, it shares in the savings. Talk about an incentive for NaviHealth to focus on cost-savings and not quality improvement or good health outcomes.

    Christina Zitting, a hospital case management director in Texas, reports that “NaviHealth will not approve [skilled nursing] if you ambulate at least 50 feet. Nevermind that you may live alon(e) or have poor balance,” “MA plans are a disgrace to the Medicare program, and I encourage anyone signing up..to avoid these plans because they do NOT have the patients best interest in mind. They are here to make a profit. Period.”

    The Medicare Advantage plan nursing home denials appear to be largely inappropriate, with most denials that are appealed, overturned. Even when Medicare Advantage plans approve nursing home stays, Medicare Advantage plans usually only cover care for 14 days, even though Medicare covers up to 100 days.

    The Centers for Medicare and Medicaid Services, which oversees Medicare, proposed new rules which would prevent Medicare Advantage plans from denying coverage “based on internal, proprietary, or external clinical criteria not found in traditional Medicare coverage policies.” If those rules are finalized, it’s not clear that the Medicare Advantage plans could use NaviHealth or any other AI tool to deny care.

    But, again, the Medicare Advantage plans claim they are not using NaviHealth to deny care, only to guide coverage decisions. And, the CMS rule if finalized would still permit the Medicare Advantage plans to have internal coverage criteria if based on generally accepted treatment guidelines that are public. The insurers’ opposition to the proposed rule made the case that the government needed to give them “flexibility to manage post-acute care.”

    One relative of a Medicare Advantage enrollee who was denied needed nursing home care reports: “I’ve still got friends who say, ‘Oh, I’ve got UnitedHealthcare Advantage, and it’s wonderful.’” “Well, it is,” she said. “Until you need the big stuff.’”

    Here’s more from Just Care:

  • Medicare Advantage: Beware of inappropriate nursing home stay denials

    Medicare Advantage: Beware of inappropriate nursing home stay denials

    Susan Jaffe writes for Kaiser Health News about the risk that your Medicare Advantage plan will inappropriately deny you the nursing home care you need. Because the government pays Medicare Advantage plans a flat upfront fee, they have a powerful financial incentive to keep you from getting the costly care you need. They profit more the less they spend on your care.

    No one is monitoring in real time when and how Medicare Advantage plans delay and deny nursing home care, or any other care for that matter. The government pays Medicare Advantage plans to cover the same amount of medically necessary care as traditional Medicare covers. And, though the Medicare nursing home benefit is limited, it should cover as much as 100 days in a nursing home for people who have been hospitalized as an inpatient for at least three days in the 30 days prior to nursing home admission and who need daily skilled nursing or therapy services.

    The Office of the Inspector General (OIG) reports that Medicare Advantage plans can and do stint on costly care, including nursing home care, even when your treating physician says it is medically necessary. And, the Centers for Medicare and Medicaid Services (CMS), the agency charged with overseeing Medicare, does not publicly identify the bad Medicare Advantage actors, let alone cancel contracts with those that engage in widespread inappropriate delays and denials of coverage, as some do.

    In her story, Jaffe reports on a 97-year old woman in a nursing home whose Medicare Advantage plan told her it was ending nursing home coverage after only an 11-day stay. Her medical team disagreed with the decision, saying that she was not in good enough health to return home. She had taken a bad fall. Experts report that it has become increasingly common for Medicare Advantage plans to overrule the treatment preferences of patients and their doctors and deny care, without even seeing the patient.

    The American Health Care Association has “significant concerns” about the behavior of Medicare Advantage plans. No question that people are better off in their homes when they are healthy and able to take care of themselves, as the Medicare Advantage plans argue. But, it’s unsafe to push vulnerable older adults out of a nursing home before they are in good enough shape to manage at home.

    If your Medicare Advantage plan denies you skilled nursing facility or rehab care that your medical team says you need, you have the right to appeal. With a letter from the medical team explaining why care is medically reasonable and necessary and why you meet the eligibility requirements for skilled nursing facility or rehab benefits, there is a very high likelihood the Medicare Advantage plan will reverse its decision. And, if it does not do so, you can appeal to a higher level authority, where you are likely to succeed on appeal.

    There is no cost to appealing a Medicare Advantage denial of coverage, and it’s easy. You will likely face bills from the nursing facility while your appeal is being decided. But, you can ignore the bills if you win your appeal, and you have a high likelihood of winning. The Medicare Advantage plan will have to pay. Unfortunately, your Medicare Advantage plan faces no penalty for inappropriate denials. So, it can continue to deny care inappropriately without any likely consequence.

    Here’s more from Just Care:

  • Our nursing home crisis is only worsening; who cares?

    Our nursing home crisis is only worsening; who cares?

    Jay Caspian King writes for the New York Times about our worsening nursing home crisis. For decades now, big corporations and private equity firms have been buying up nursing homes, collecting money from Medicare and Medicaid to provide care, and failing their residents. Will Congress act to protect vulnerable older Americans and people with disabilities?

    Early on in the pandemic, the media did a good job of highlighting the nursing home crisis. Thousands of nursing home residents died needlessly. The facilities were understaffed and doing a poor job of caring for their residents. But, the attention did nothing to address the problem.

    Instead of fixing the nursing home crisis, many politicians tried to bury it. The National Academy of Sciences issued a report recommending major industry reforms, such as smaller nursing homes, better pay and training for workers. Right now, some nursing homes have 100 percent turnover, staff are so underpaid.

    The Biden administration also drew up a plan to improve nursing home conditions and made note of private equity’s mounting investment in nursing homes–up to $100 billion in 2018.

    But reports and plans recommending specific reforms to the industry have been issued for the last several decades and little has been done to improve conditions. It costs money to ensure nursing homes have more and better paid staff. It costs money to oversee nursing homes and ensure that when they violate the law, they are penalized appropriately.

    There are a lot of regulations in place. But, even when major violations are identified, nursing home are allowed to continue to operate. Change is not possible without an overhaul of chain nursing homes and other for-profit nursing homes.

    We need more transparency as to where government money is going, how nursing homes are spending the money they receive from government. People need to know how much of that money is being put towards patient care. We cannot continue to let nursing home owners profit without being held to account for the care they provide residents.

    Here’s more from Just Care:

  • PACE helps older adults stay in their community

    PACE helps older adults stay in their community

    The Program of All-inclusive Care for the Elderly (PACE) is a home and community-based program designed to keep older adults who are at risk for nursing home placement living in their community.  PACE is a partnership between a local sponsoring organization, and Medicare and Medicaid health insurance programs. To become a PACE “participant,” a person must be nursing home eligible. While a person can pay privately for services, most participants have Medicare, Medicaid, or both insurance programs.

    The PACE philosophy: PACE members are called “participants” because they are encouraged to participate in their care–decision making and active care–whenever possible.  The overarching goal of the PACE Model of Care is to keep people living in the community and out of institutional care.  While an individual does not need to visit the PACE Center, which offers adult day programs with wrap around health services, it promotes socialization and addresses common problems of isolation, loneliness, and boredom.

    Who can get PACE? Programs of All-Inclusive Care for the Elderly (PACE®) serve individuals who are age 55 or older, certified by their state to need nursing home care, able to live safely in the community at the time of enrollment and live in a PACE service area.

    How does PACE work? PACE works by providing care and services in the home, the community, and at the PACE center. It is team-based care that provides everything covered by Medicare and Medicaid if authorized by your health care team.  If your health care team decided you need care and services that Medicare and Medicaid doesn’t cover, PACE may still cover them.  The team provides comprehensive coordinated care and includes the PACE participant, physician, nurse, social worker, recreational specialist, rehabilitation specialists, and transportation specialists.

    Services: Delivering all needed medical and supportive services, a PACE program is able to provide the entire continuum of care and services to older adults with chronic care needs while maintaining their independence in their home for as long as possible. Services include the following:

    • adult day health care that offers nursing; physical, occupational and speech/language therapies; recreational therapies; meals; nutritional counseling; social work and personal care;
    • medical care provided by a PACE physician familiar with the history, needs and preferences of each participant;
    • home health care and personal care;
    • all necessary prescription and over-the-counter medications;
    • medical specialties, such as audiology, dentistry, optometry, and podiatry and speech therapy;
    • respite care; and
    • hospital and nursing home care when necessary.

    See more at: http://www.npaonline.org/policy-advocacy/value-pace#services

    Find a PACE program near you: Currently, there are 144 PACE organizations in 30 states serving 58,000 people. To find out if you or a loved one is eligible, and if there is a PACE program near you, visit www.pace4you.org or www.Medicaid.gov, or call your Medicaid office.

    Beware of for-profit PACE programs: Government audits find for-profit PACE program neglects patients, delays needed care and cancels critical care.

    Learn what to do to ensure safety at home for people aging in their communities. And, see how one new program is helping older adults remain at home with assistance from a handyman, occupational therapist and nurse. For those who like technology solutions, check out how sensors can offer peace of mind to caregivers.

    _________________________

    This post was originally published on March 2, 2016

    Here’s more from Just Care:

  • More hospitalized Medicare patients will qualify for nursing home care

    More hospitalized Medicare patients will qualify for nursing home care

    For many years now, Medicare has not always covered nursing home care for patients post-hospitalization. Hospitals that treated patients as outpatient–even when the patients stayed overnight–had no right to Medicare coverage of their nursing home or rehab care upon discharge. Susan Jaffe reports for Kaiser Health News that this might finally be changing, in some cases.

    More than ten years after a class-action suit was brought challenging Medicare nursing home coverage policies, a federal appeals court in Connecticut has ruled that patients should be able to challenge a Medicare coverage denial of their nursing home care if they were admitted to the hospital as an inpatient and the hospital switched their status to outpatient or observation, which is covered under Part B of Medicare. Complicated? Yep.

    For reasons that are surely financial, hospitals sometimes admit patients as inpatients, which is covered under Medicare Part A, and then switch them to outpatient or observation status. What’s most insane is that a hospital can change a patient’s status even when the patient has stayed overnight for three nights and even after the patient has been discharged. The decision is completely unrelated to the care the patient received in hospital.

    From the patients’ perspective, so long as they have Medicare Parts A and Part B and supplemental coverage, there is generally no difference how Medicare pays for their hospital care. But, if patients need rehab or nursing home care post hospitalization, there’s a big difference. Medicare generally only covers nursing home and rehab care for people who have been hospitalized as inpatients for at least three days.

    Patients who receive outpatient care in hospital never qualify for skilled nursing or rehab coverage. It doesn’t matter if they received exactly the same care as an outpatient as they would have as an inpatient.

    Consequently, tens of thousands patients who would have qualified for Medicare nursing home care had their hospital treated them as inpatients are denied Medicare nursing home or rehab coverage. If they need to be in a nursing home or rehab facility after discharge, they have to pay the full cost out of pocket.

    If you are admitted to hospital, you want to speak with your doctor and make sure that the hospital admits you as an inpatient. Hospitals did not have to disclose this information until recently, when a federal law was enacted in 2017. Since then, they must give you written notice, but, until this latest ruling, you weren’t able to appeal the hospital’s decision to treat you as an outpatient.

    The government has not said whether it will appeal this latest ruling. For now, patients who are admitted to the hospital as inpatients have the right to appeal a hospital decision to switch them to outpatient status. And, the tens of thousands of patients who have had to pay for their nursing home care because their hospitals switched their status can file a claim seeking reimbursement. For more information, visit the Center for Medicare Advocacy site.

    Here’s more from Just Care:

  • Coronavirus: More home and community-based services needed

    Coronavirus: More home and community-based services needed

    For all the tragedy that Covid-19 has wreaked on this nation, there are a few silver linings. COVID-19 has cast a spotlight on the failings of nursing homes and the need for more home and community-based services and more affordable services so that older and disabled adults can age in place. The New York Times reports that many people today do not have the option to remain in their homes as they age because it can be so costly.

    People living in nursing homes and other adult care facilities during this pandemic have suffered mightily. As of now, about 181,000 have died. They represent one in three of all COVID-19 deaths, according to the Kaiser Family Foundation.

    What can communities do to help people and keep them from having to be institutionalized? Fewer and fewer people would choose institutionalization if they could remain in their homes. In the last three months of 2020, one in four nursing home beds were unfilled.

    Age-friendly communities offer a range of services to older people who need help caring for themselves. They might provide affordable age-friendly housing, good transportation and care services. Age-friendly housing generally provides living space on one floor without steps, walk-in showers, and hallways and doors that can accommodate wheelchairs.

    In some cases, apartment buildings can offer an array of services beyond shelter, such as grocery stores and pharmacies. In that way, older adults can have several community essentials at their fingertips, without having to leave the building. This set-up could benefit a lot of older adults.

    But, as people move into their 80’s and 90’s, they often need long-term care services as well. Medicare does not cover long-term care. At most, it covers 100 days in a skilled nursing facility, and that’s only if you’ve been hospitalized for at least three days prior to admission and need daily skilled services.

    Medicaid covers long-term nursing home care. But, it often does not cover home and community-based care. A little more than half of its spending for long-term services and supports covers home and community-based care. More than 40 percent goes to nursing-home care.

    What’s worse, even people who qualify for Medicaid might not get it. In many states, there’s a long Medicaid waitlist. Forty-one states limit Medicaid enrollment. Right now, 820,000 Americans are on a waiting list. On average, they wait more than three years. Fortunately, the American Rescue Act gives more money to states to expand Medicaid services. And, Biden’s new infrastructure proposal includes $400 billion more for home and community-based care.

    Here’s more from Just Care:

  • Government-administered long-term care insurance is long overdue

    Government-administered long-term care insurance is long overdue

    Since the start of the novel coronavirus pandemic, more than 46,000 people have died in nursing homes.  The private health care market is failing, and government-administered long-term care insurance, ensuring government oversight, is long overdue.

    Alexander Sammon makes the case in the American Prospect that the private long-term care insurance market has failed Americans more than any other piece of the health insurance market. Long-term care is the term used to describe an array services and assistance provided to older adults and people with disabilities. It includes help with activities of daily living such as bathing, feeding and toiletting, as well as nursing and therapy services.

    For sure, the number of deaths of older adults in long-term care facilities are easy to track and horrifying. Though, without good data and knowing that out-of-pocket costs keep people with complex conditions from getting medical and hospital care, it is not at all clear that the number of deaths of working people with serious illnesses and injuries stemming from their private health insurance is not equally chilling.

    What the long-term care story reveals is how a for-profit health care market endangers people’s lives by putting profits first and cannot be relied upon to guarantee our health. More than one in ten long-term care residents are no longer with us, in large part because long-term care facilities were not prepared to care for them.

    At some point in your life, there is a good chance that you will need long-term care. Seven in ten people 65 and older require long-term care. Most people rely on family and friends or Medicaid for long-term care. Only about three percent of Americans have long-term care insurance; it is expensive, often not available to people with pre-existing conditions, and generally not worth the cost, delivering little bang for your buck.

    Because the cost of long-term care is so high, private insurers are hard-pressed to profit from selling coverage and the market has shrunk considerably.

    When it was being drafted, the Affordable Care Act included government coverage for long-term care. But, it was designed as a voluntary program with high costs. And, it would not have paid for itself. So, it was dropped from the law before enactment.

    Sammon reports that Americans do not appreciate how likely it is that they will need long-term care. And, many also do not know that Medicare only covers a limited set of long-term care services: up to 100 days of care in a skilled nursing facility if certain qualifying criteria are met, some home care for people for whom leaving home is extraordinarily difficult and who need skilled nursing or therapy services, and durable medical equipment.

    The cost of long-term care keeps rising. It costs seven times more in 2015 ($225 billion) than it did in 2000 ($30 billion). The private market is not up to the task of providing good coverage.

    There are smart ways to provide everyone long-term care coverage through social insurance. Washington state enacted a social insurance program, imposing a small payroll tax on workers’ salaries. It will pay out $100 a day for up to a year of in-home care. Hawaii did something similar. It’s time that the federal government stepped in and offered similar or better coverage to everyone in the nation through social insurance.

    Here’s more from Just Care:

  • Can you protect nursing home residents in a profit-driven system?

    Can you protect nursing home residents in a profit-driven system?

    A story in The Guardian about corporate entities that buy up nursing homes, with the goal of squeezing as much profit out of them as possible and no regard for their residents, speaks volumes about the horrific nature of our profit-driven health care system. Because nursing homes can operate as for-profit facilities–even when Medicare and Medicaid are paying their bills–many of them have become storage units for frail and vulnerable Americans rather than care centers.

    Storage units? That might be too kind a description. Many nursing facilities have become places that do not provide staff to care properly for their frail and vulnerable residents. Instead, our taxpayer dollars flow to their owners, through Medicare and Medicaid, who buy and sell them like used cars, after pocketing as much money from them as possible. These nursing homes then engage a skeletal staff at a low wage to care for the residents. Here’s one example:

    Multi-millionaire Joseph Schwartz owns Skyline Healthcare LLC, which receives millions of Medicare and Medicaid dollars to provide care to patients in its 100-plus nursing facilities. But, Schwartz abandons these facilities without bothering to let the staff or residents’ families know he’s sold off his properties.

    Schwartz leaves staff unpaid, without benefits or recourse, and residents sitting in their feces, unfed, without electricity or care. He left one pharmacy without paying it the $200,000 it was owed for prescription drugs. And, since the novel coronavirus pandemic, police went to one Skyline facility and found 17 people dead and lying atop one another in a four-person morgue.

    According to the Guardian, over the last 20 years or so, it has become extremely common for corporate entities to buy nursing facilities, realize as much profit as possible, and then sell them. Massive fraud is also common. Patient neglect is often the norm. And, eviction of residents is not uncommon. Sometimes, state governments come to the rescue, but not always.

    For-profit nursing homes need to be better regulated. But, what would that mean? How would regulation protect against owners who have no interest in anything other than taking the Medicare and Medicaid revenue and running.

    One man who owned many nursing homes in a number of states received a 20-year prison sentence for pocketing Medicare and Medicaid dollars to care for residents and never spending a dollar on their care. But, he was not stopped until after he had amassed $1.3 billion. It took authorities several years to stop him after his fraud was exposed by reporters at the Chicago Tribune. How many others like him are still pretending to operate nursing homes and simply pocketing the federal and state dollars intended to go to residents’ care?

    Private equity firms are also buying up nursing homes, draining them of their value, and abandoning them. The Carlyle Group bought HCR ManorCare, a chain of nursing facilities. It sold off their real estate for $6.1 billion and then filed for Chapter 11 bankruptcy when the monthly rent cost too much.

    In case this isn’t all bad enough, many states are providing nursing homes immunity from COVID-19 litigation. And, Senate Majority Leaders Mitch McConnell has said that any new stimulus bill must include provisions that would make it extremely hard for residents and staff to sue nursing home owners. Advocates have organized to urge state legislators to permit residents to sue these facilities and hold them to account for not providing appropriate care. Otherwise, nursing homes will continue with these bone-chilling practices.

    Here’s more from Just Care: