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Tag: Nursing homes

  • When looking into nursing home care, ask about staffing levels

    When looking into nursing home care, ask about staffing levels

    The vast majority of Americans would prefer to age in place–live out their lives in their homes. But, 1.3 million older Americans do not have the supports they need to age in place and end up living in a nursing home. In an opinion piece for the New York Times, Norma B. Coe and Rachel M. Werner explain why rules regarding adequate nursing home staffing literally saves lives.

    Today, under federal law, nursing homes must have a minimum staff level that ensure that around 13,000 nursing home staff do not endure a premature death and thousands more do not end up with bed sores and urinary tract infections. Even though these rules increase the costs of care in a nursing home, the Trump administration should stand behind them.

    Robert F. Kennedy Jr. is likely to be the next head of the US Department of Health and Human Services. In his confirmation hearings, he made clear his opposition to these nursing home staffing rules. Contrary to his claim, rural hospitals can get exemptions from these requirements if they cannot find staff to meet them. RFK Jr.’s misplaced views aside, Republican attorneys general have brought a lawsuit to end these rules.

    The federal nursing home rules ensure nursing-home owners are able to provide residents with adequate care. A registered nurse must always be at the nursing home and nursing aides must be available for a few hours of care daily for each patient. In more than 80 percent of nursing homes, that was not the case in early 2023, before the staffing rules took effect.

    If you’re looking into nursing home care for yourself or others, always ask about nurse and nurse aide staffing levels. With more nurses and nurse aides, residents tend to get better care and live longer. They get fewer bedsores and urinary tract infections.

    For-profit chain nursing homes tend to have poor staff levels. Ninety percent of them did not comply with the minimum standards. About 60 percent of non-profit nursing homes also did not meet standards.

    Only about one in five nursing homes in the United States meet basic minimums. The for-profit ones claim low profits, but that is extremely misleading. The owners too often hide their profits through subsidiary companies they overpay to provide nursing home services or to rent the facility.

    The US is an aging society. Americans over 65 currently represent 17 percent of the population and will represent 22 percent by 2040. If we care about our elders, we should ensure they are being properly care for.

    Here’s more from Just Care:

  • New nursing home staffing requirements are a step forward

    New nursing home staffing requirements are a step forward

    It has become increasingly clear that our federal government is not willing or able to enact laws and rules that go as far as necessary to protect consumers. Recently, the Centers for Medicare and Medicaid Services (CMS) issued final rules with regard to nursing home staffing requirements that are a huge step forward and yet not nearly enough, Jordan Rau reports for KFF Health News. Patient safety and adequacy of care remain a concern, even with these rules. 

    Under the new rules, most of the 15,000 nursing homes in the US will have to hire more nurses and aides, beginning in 2026. The nursing homes will, on average, need to offer 3.48 hours of care each day to each resident. Today, some four in ten nursing homes do not do so. But, many advocates do not believe that these rules will ensure that nursing homes deliver high quality care.

    Without a higher ratio of nurses and aides to nursing home residents, it is challenging for nursing homes to care for their patients, as we saw during the Covid epidemic. Instead, residents end up with bedsores, fall needlessly, are not properly diagnosed for their conditions or take more trips to the emergency room.

    At the moment, it’s not clear whether there are enough nurses and aides available for nursing homes to hire. Nursing homes tend to pay less for nurses than hospitals. And, aides can often earn more working in restaurants. If the worker shortage remains, the nursing homes will likely not comply with the new rule.

    CMS projects that its rules will cost nursing homes $6 million more a year. CMS does not plan to increase Medicare and Medicaid payments to cover these additional costs. The nursing home industry calls it an “unfunded mandate” and intends to see if it can persuade Congress (or likely the next Administration) to undo it.

    And, still, CMS is calling for nursing-home staffing levels that are less than excellent, according to the head of the Long Term Care Community Coalition. The rule is a step forward because the previous rule was not specific as to what constituted a “sufficient” staffing level, only that the staffing level be “sufficient.”

    To date, the Office of the Inspector General has found that many nursing homes do not meet many basic staffing requirements.

    Critics of the new CMS rule argue that it will lead to many nursing home closures as nursing homes will not be able to hire more workers. Both the cost of hiring them and the scarcity of workers present obstacles. But, a recent study found that, overall, nursing homes are doing extremely well financially. Owners are able to secure substantial profits through all kinds of shenanigans. A while back, the Kaiser Family Foundation explained how owners profit and advised avoiding chain nursing homes.

    Here’s more from Just Care:

  • Medicare Advantage plans get $16 billion increase in 2025

    Medicare Advantage plans get $16 billion increase in 2025

    The battle over how much more the administration will pay insurers offering Medicare Advantage plans in 2025 is over. According to the Centers for Medicare and Medicaid Services (CMS), insurers will get a $16 billion increase. The insurers are playing with the numbers to suggest they are getting a cut, when, as it is, they are receiving $83 billion more this year than they should be.

    The insurers were hoping that the CMS final rate notice, issued last week, would give them an increase over the CMS proposed rate. Social Security Works, People’s Action, Be a Hero, Public Citizen and many other advocates and experts called for Medicare Advantage rate cuts, given the massive overpayments to the insurers. Even with the massive overpayments, some insurers are denying and delaying care inappropriately and they are failing to pay money due hospitals, physicians, home health agencies, rehab facilities and nursing homes for services provided with their approval.

    It’s not clear when or how Congress will step in to address the insurer overpayments, inappropriate care denials, and failure to pay providers in Medicare Advantage. A recent story in Newsweek focuses on the fact that insurers are not paying nursing homes appropriately. The American Medical Association has not spoken out against the insurers offering Medicare Advantage for not paying physicians appropriately, though it has highlighted the sometimes deadly consequences of prior authorization, a tool the Medicare Advantage plans use to inappropriately delay and deny care.

    Meanwhile, the American Hospital Association continues to speak out about the failings of Medicare Advantage plans. And, many hospitals have cancelled their Medicare Advantage contracts.

    Will the insurers cut extra benefits in Medicare Advantage plans? Time will tell. It’s hard to believe they will. Many enrollees do not take advantage of them. They are a valuable marketing hook. Insurers are still making a fortune off of Medicare Advantage.

    Here’s more from Just Care: 

  • Medicare Advantage poses grave risk to rehab facilities and nursing homes

    Medicare Advantage poses grave risk to rehab facilities and nursing homes

    Brendan Williams, president and CEO of the New Hampshire Health Care Association and a former state insurance regulator, writes for McKnight’s about Medicare Advantage’s existential threat to nursing home and rehabilitation care.  Our policymakers need to focus on the risks Medicare Advantage plans pose to critical health care providers and patients because of their low payments and high denial rates.

    Medicare Advantage threatens the nursing home and rehab industries. These Medicare Advantage threats are on top of  the threats we are all aware of: nursing and other health care worker shortages, little Medicaid support, and a low unemployment rate coupled with restraints on immigration.

    Because the federal government is overpaying Medicare Advantage plans considerably, the Medicare Advantage plans have been able to offer enrollees additional benefits that are unavailable in Traditional Medicare. And, while those benefits are of questionable value–it’s unclear how many people get them and the data show widespread and persistent inappropriate delays and denials of care and coverage in Medicare Advantage–the Medicare Advantage plans can use the additional benefits to attract members away from Traditional Medicare.

    People with Medicare do not appreciate the challenges they face getting costly and complex care when they are diagnosed with a serious cancer or heart problem and desperately need good care. The New York Times reported last spring, “every year, tens of thousands of people enrolled in private Medicare Advantage plans are denied necessary care that should be covered under the program, federal investigators concluded in a report…”

    People needing rehabilitation services post hospitalization are also at serious risk in some Medicare Advantage plans. They are often denied critical services. According to the American Medical Rehabilitation Providers Association, Medicare Advantage plans refused to cover more than half of people admitted to rehabilitation facilities.

    Williams finds it unsurprising that the Centers for Medicare and Medicaid Services, which oversees Medicare Advantage, is not going after the Medicare Advantage plans. The people working there, he says, will be looking for industry jobs when they leave. Williams suggests that people in Medicare Advantage are left unprotected.

    Williams quotes the late Senator Ted Kennedy, who was reported arguing in the context of the advent of Medicare Advantage that “Congress would provide lavish subsidies to private health plans, giving them an unfair advantage in competition with the government-run Medicare program.” AARP is of no help to Medicare Advantage enrollees either, he says. It has cut a deal with UnitedHealthcare, that generates tens of millions of dollars in annual revenue for AARP.

    One report by the Medicare Payment Advisory Commission or MedPAC, which oversees Medicare, quotes a survey that “Medicare’s FFS per day payments were 25% higher than MA rates.”  MedPAC sums up: “[t]he payment differential between MA and FFS SNF rates indicates that facilities accept lower payments to treat MA enrollees who are not much different from FFS beneficiaries.”

    Williams suggests that as Medicare Advantage takes over the Medicare market, the lower rate to nursing homes and rehabilitation facilities will mean their demise.

    Here’s more from Just Care:

  • Avoid a lawsuit, don’t sign nursing home admissions form

    Avoid a lawsuit, don’t sign nursing home admissions form

    Noam Levey reports for Kaiser Health News on nursing homes that sue the friends or family of residents to collect debt. And, it appears not to matter whether the friend or family has power of attorney or control of the patient’s assets. What usually matters is that a friend or family member signed the nursing home admissions form for the patient.

    Searching through Rochester, New York court records, Levey found 238 instances in which 24 nursing homes sued patients, relatives or neighbors in order to try to collect on a patient’s debt, in a three-year period. More than 70 of those cases were targeted at someone other than the patient or the spouse, who often did not have power of attorney over the patient. In one case, the sister of a nursing home resident was sued for $8,000 by the nursing home, even though she had no control over his health or finances and no legal responsibility for his debts.

    Levey found 60 cases in which the local government sued to collect nursing home debt over that same three-year period.

    Federal law should protect people from these lawsuits. Nursing homes are not allowed to force patients’ friends and families to guarantee their bills. But, the fine print in the nursing homes’ admission agreements often include something that a relative or friend signs, unwittingly, giving the nursing home debt collection rights.

    In many lawsuits, the nursing home has no evidence that the person being sued should be responsible for the bill. But, the nursing homes win many of these cases via default judgments because the person they are suing ignores the suit or does not have the means to hire a lawyer to defend them.

    New York is not the only state where this is going on. Levey reports that lawyers in Kentucky, Massachusetts, Illinois and California suggest that it is not uncommon for a nursing home patient’s family or friends to be sued to collect debt in their states.

    A recent Kaiser Family Foundation poll found that around 14 percent of adults with medical debt report being threatened with arrest or a legal action. Five percent report being sued.

    Tip: If you help a family member or friend get admitted to a nursing home, do not sign any papers. Make sure that, if anyone signs, it is the patient who signs.

    Here’s more from Just Care:

  • Nursing shortage? Robots can help

    Nursing shortage? Robots can help

    John Leland reports for the New York Times on robots designed to help meet the needs of nursing home residents. With a nursing shortage, nursing homes are often understaffed. Robots can help provide physical and emotional support, “virtual assisted living.”

    The robots are designed to meet a whole range of needs and look like a miniature person, standing four feet tall. They have eyes and mouths, hands and legs. They also have an Ipad affixed to their chests.

    One key role a robot plays in a nursing home is companionship. The pandemic has brought with it massive nursing shortages. Reports indicate that more than 400,000 people who had worked at long-term care facilities no longer do. Among other things, this mass worker exodus has left many nursing home residents feeling completely isolated.

    What can robots do in addition to keeping people company? They can offer reminders to take medicines, call for help if someone needs it, teach yoga and tai chi. New technologies are enabling robots to tell jokes, sing songs, play games, and kill germs in a room using ultraviolet lights.

    Technical glitches remain. As of now, they might fall while demonstrating a yoga or tai chi pose and might not be able to pick themselves up. Before too long, robots will be able to help people recall good memories, be it their wedding or the birth of a child.

    What if robots are not your thing or otherwise not available to you? The number of low-cost devices that can monitor just about everything you do and help you in all kinds of ways is soaring.

    Here’s more from Just Care:

  • Biden administration overlooks importance of informal caregivers for nursing home residents

    Biden administration overlooks importance of informal caregivers for nursing home residents

    Back in February, the Biden administration proposed a series of nursing home reforms, many of which could help significantly to improve nursing home quality. But, shockingly, the administration does not address the need for nursing home residents to have informal caregivers by their side. Judith Graham reports for Kaiser Health News on the often critical role that informal caregivers play for nursing home residents and why nursing homes should not be able to keep informal caregivers away, even in a pandemic.

    In theory, better staffing at nursing homes, better oversight of nursing homes, and better information about particular nursing homes could be a huge step forward in ensuring nursing home residents are safe and well cared for. But, the rights of residents to be with family members are as important, yet most family members were prevented from spending time with loved ones in nursing homes during the pandemic. The consequent isolation many residents felt took a toll on their mental and emotional health.

    Without the support of family and friends, nursing home residents suffer. Many of them rely on these informal caregivers to help them with personal care, cleaning and other basic activities. Sometimes these informal caregivers are their principal ongoing contact with the outside world.

    But, support from informal caregivers vanished for many of them during Covid. Most nursing homes ended visitation privileges, even from close family and friends. And, the fear is that, now, nursing homes will cut those privileges whenever they deem appropriate, without regard to residents’ essential needs.

    Keep in mind that not all nursing homes are alike. Some are far better than others at caring for patients. Do your homework before choosing a nursing home and don’t trust Medicare star-ratings of nursing homes. Stay away from chain nursing homes. Look into Green Houses, smaller nursing homes that are not-for-profit. And, also look into non-profit PACE programs, which allow you to remain in your home and community as you age.

    Advocates are now calling for additional protections for nursing home residents, including the right to designate two people who will always have access to them in their nursing homes so long as they comply with the same safety policies that staffers must comply with.

    Caregivers are not staff, but they should participate in the care planning process. They should be supported. They can offer love that staff generally never offer, as well as ongoing attention to their loved ones’ care needs.

    Here’s more from Just Care:

  • Private equity-owned hospice and home health agencies drive up Medicare spending, jeopardize quality of care

    Private equity-owned hospice and home health agencies drive up Medicare spending, jeopardize quality of care

    Jake Johnson writes for Common Dreams about a new report from the Private Equity Stakeholder Project that focuses on private equity’s “disastrous” hold on home health care and hospice care. Vulnerable older adults and people with disabilities are paying a high price, as is the Medicare program. Congress is sitting back and watching.

    Non-profit agencies once provided most home health and hospice services. Today, for-profit companies have taken over the majority of these two industries. Two in three hospices are for-profit and two in five home health care agencies are for-profit. Private equity has invested heavily in the corporations that own these agencies.

    Medicare home health care and hospice care can be good money for corporations, so long as care is limited and low-cost. So, they are likely working to get more people to take advantage of these benefits. More Medicare investment in this care would be wonderful–many people who would benefit from this coverage are unaware they are eligible for it–if the money is being spent wisely and being directed towards more people with Medicare who want and need these benefits.

    But, if private equity investment in nursing homes and PACE programs is any indication, people are getting far lower quality hospice and home health care from companies with private equity backing, and Medicare is spending more than it should for their care. Private equity ownership of nursing homes is associated with poorer care and more deaths. The home health and hospice industries are even less regulated than nursing homes.

    With private equity, profits come first. The cost to vulnerable older adults and people with disabilities receiving care from private-equity backed companies is likely high but hard to measure. In a 2021 Congressional hearing on private-equity owned nursing homes, Congressman Bill Pascrell of New Jersey asked, “How many grandmothers and grandfathers died because profits were prized above lives, with our taxpayer dollars funding this?”

    So, are any private-equity owned hospice agencies delivering quality care and not driving up Medicare spending needlessly? As with Medicare Advantage plans, we do not have good agency-specific information. The Private Equity Stakeholder Project report concludes, more generally: “Unfortunately, for-profit home healthcare and hospice companies have been linked to lower standards of care compared to their non-profit counterparts, including, but not limited to, a lower number of visits to patients by healthcare professionals (registered nurses, physicians, or nurse practitioners) in their final days in hospice, higher rates of hospitalization in home healthcare, and poorly paid—yet highly stressed—employees in both sectors.” “This is additionally troubling, because such for-profit entities serve higher percentages of people of color and those with low incomes.”

    Congress needs to start paying attention. Already a number of home health and hospice agencies have been charged with overbilling Medicare, underpaying their workers and neglecting patient care needs. For example, there are allegations that Kohlberg Kravis-owned BrightSpring, a home health care agency, put patients at risk, and other private-equity backed agencies have been charged with fraudulent billing of Medicare and Medicaid.

    In October of last year, Senator Elizabeth Warren reintroduced the Stop Wall Street Looting Act to stop private equity’s  “predatory” and “abusive” practices, but that bill is going nowhere at the moment.

    Here’s more from Just Care:

  • Covid-19 roundup: What you should know

    Covid-19 roundup: What you should know

    The novel coronavirus has taken an incalculably enormous toll on Americans of all ages, particularly older adults. That said, people with Medicare have better Covid-19 protections than most other people in terms of their coverage and out-of-pocket testing and treatment costs. Here’s what you should know.

    Test and treatment costs can be very high, but Medicare should cover them

    Why the vaccine and the booster are important preventive measures

    Symptoms with and without a vaccine and disability benefits:

    Treatments

    Here’s more from Just Care:

  • Coronavirus: The nursing home tragedy

    Coronavirus: The nursing home tragedy

    Jay Caspian Kang writes about Covid-19 and the nursing home tragedy in the US in an opinion piece for the New York Times. Nearly 200,000 nursing home and long-term care facility residents have died of Covid-19. After tapering off for a bit, Covid-19 deaths in long-term care facilities are increasing again.

    Nearly one in ten nursing home and long-term care facility residents have died of Covid-19. And, they continue to die. Congress and state lawmakers have taken precious little action to protect them. Indeed, former NYS governor Cuomo inexplicably required nursing homes to admit Covid-19 patients in stable condition post hospital discharge.

    All in, NYS nursing homes took in more than 9,000 residents with Covid. Rather than protecting residents, Governor Cuomo protected nursing home and hospital owners, through an order shielding them from liability for Covid-19 deaths in their facilities. Fortunately, that protection ended back in April 2021. The Cuomo administration also underreported the number of nursing home deaths.

    The nursing home industry is no longer about motherhood and apple pie. Most nursing homes are now owned by large corporations and are part of chains. Quality of care is a serious issue. Often, these nursing homes are understaffed.

    Kang says that nursing homes have always had the ability to contain the spread of the virus in their facilities. But, the for-profit nursing home owners fear losing money when they invest in containing the spread of Covid-19. Local governments, in sharp contrast, are not concerned with delivering profits to shareholders and can prioritize patient safety. Laguna Honda, run by the local government in California, had the staff necessary to keep people from dying and the willingness to respond to emerging issues swiftly, when necessary.

    Kang blames the for-profit nursing home industry “almost entirely” for all the needless nursing home Covid-19 deaths. They have not provided residents with the care they need. And lawmakers have sat quietly on the sidelines while this has happened.

    What’s beyond shocking is that, notwithstanding all these deaths–which some have called “murders”–nursing homes have raked in large profits. There does not appear to be the political will to keep nursing home owners from prioritizing profits, let alone to hold nursing home owners accountable for these deaths.

    It seems that it’s not worth it to lawmakers to act says Kang. The people running these nursing homes are powerful. And, we are an ageist society, with our representatives apparently willing to write off the death of the elderly as inconsequential.

    It’s time we passed laws that increased the rights of nursing home residents and made it costly for nursing home owners to behave negligently towards their residents. Moreover, state and local governments should be able to take control of for-profit nursing homes that are failing their residents, through eminent domain. Kang argues that there is no other solution that will lead nursing home owners to deliver the care people need.

    Currently, a large percentage of the money that Medicaid and Medicare allocate to nursing homes never gets allocated to the care and feeding of residents. Rather, it gets pocketed by the nursing home owners in one way or another. That’s why it is smart to avoid using for-profit chain nursing homes.

    One expert says that the nursing home industry is called the “Syndicate” because it is so corrupt. Whether we can overcome their money, their power, and their political ties is the question.

    Here’s more from Just Care: