Table of Content
- The Quotes That Defined Skilled Nursing in 2022 — and Hint at What’s Ahead
- Promote Emergency Preparedness and Response Efforts
- ‘They Tried to Kill Me': Neglect, Abuse and $22M Fraud at NY Nursing Home, AG Finds
- HHS Office of Inspector General
- Federal Spending Bill Calls for Long-Term Care Strategy for Vets, Telehealth Extensions
- Protect Residents from Fraud, Abuse, and Neglect and Promote Quality of Care
As an example, the Times cites the experience of one nursing home resident, Eunice Hill, at a five-star facility in South Carolina, where medical records indicate that Hill was given a strong antipsychotic on her first day, as well as anti-anxiety medication each day for a week. However, the organization in the data it filed with CMS indicated that it didn't give Hill any antipsychotic medication, and only administered anti-anxiety medication once. Ultimately, Hill died in January 2018, after being rushed to the hospital with kidney failure and severe dehydration in late December 2017. According to the Times, the system when rolled out drew praise from senior-care groups, who said it provided an easily comprehensible snapshot of nursing homes. However, within months of the system's launch, members of a Medicare advisory board warned federal officials that—in an industry with razor-thin margins—the system incentivized nursing homes to misreport their metrics. SSAs are conducting a portion of their unannounced after-hours and weekend inspections to focus on staffing problems during those times.
In April 2018, we incorporated data on nursing home staffing based from a new payroll-based journal system into Nursing Home Compare and the Nursing Home Five-Star Quality Rating System. The new PBJ data allows CMS to more accurately track staffing levels in nursing homes. CMS Administrator Seema Verma details a five-point plan to improve quality of care and regulatory enforcement at the nation's nursing homes. The remaining proceeds of the sale will go to your mother and may render her ineligible for Medicaid until they’ve been spent down.
The Quotes That Defined Skilled Nursing in 2022 — and Hint at What’s Ahead
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.
New York also offers seniors who are eligible for long-term Medicaid nursing home care options to stay in Assisted Living facilities through its Assisted Living Program . To be eligible, both Medicaid recipients and private payers must be medically eligible for, and would otherwise require, placement in a nursing home due to the lack of a home or suitable home environment. However, eligible ALP residents must not require continual nursing care, be chronically bedfast, or be impaired to the degree that they endanger the safety of other ALP residents. The ALP program is limited to 4,200 residents, and approximately 85% are Medicaid recipients. Medicaid recipients must have their ALP services approved in advance by the Local Social Services District. More than 1.4 million individuals live in over 15,500 Medicare- and Medicaid-certified nursing homes across the nation.
Promote Emergency Preparedness and Response Efforts
Arizona, for example, has only 15.2% of staff and 22% of residents considered up to date on their vaccinations. North Dakota, on the other hand, has 60.9% of residents but only 18.5% of staff that are up to date, according to the analysis. Skilled Nursing News is the leading source for news and information covering the skilled nursing industry. The Office of Evaluation and Inspections conducts national evaluations of HHS programs from a broad, issue-based perspective. The evaluations incorporate practical recommendations and focus on preventing fraud, waste or abuse and encourage efficiency and effectiveness in HHS programs. According to the Times, the odds of such circumstances happening by chance are "virtually zero," indicating that some nursing homes can anticipate when their inspections will occur.
The Texas health system is using a diabetes care management program that tracks engagement and pushes targeted resources and interactions to address care gaps and costs. Nursing homes in California located in higher-risk wildfire exposure zones tend to be less prepared for emergencies than facilities without such risk, a new study has found. “We look forward to working with the administration, and we will continue our tireless efforts to protect the health of our residents,” they added. AHCA/NCAL President and CEO Mark Parkinson and LeadingAge President and CEO Katie Smith Sloan issued a joint statement following CMS’s memo, pointing to the fact that resident vaccination rates are nearly four times higher than the “dismal” 11% rate among the general public.
‘They Tried to Kill Me': Neglect, Abuse and $22M Fraud at NY Nursing Home, AG Finds
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.
OIG annually publishes the top unimplemented recommendations that, in our agency's view, would most positively affect HHS programs in terms of cost savings, program effectiveness and efficiency, and public health and safety if implemented. Recommendations concerning nursing homes that were unimplemented as of October 2021 appear in the table below. Decades of OIG work on nursing homes has uncovered widespread challenges in providing safe, high-quality care. Our audits, evaluations, and investigations have raised concerns regarding staffing levels, background checks for employees, reporting of adverse events experienced by residents, and other issues. "We are developing our regulatory strategy in a way that puts patient quality and safety first while removing unnecessary burdens on providers that create staffing challenges and increase cost without increasing quality," she said.
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.
According to the Times, this analysis depended in large part on nursing homes' self-reported data from January 2020, which was submitted before the novel coronavirus pandemic temporarily altered how data is submitted, as well as payroll and cost report data from 2019. To assess how star ratings changed over time, the Times examined quarterly ratings and metrics through 2015. As an example of how this system can affect overall star ratings, the Times cited a nursing home in Florida, which in early 2019 had a two-star rating for its staffing. However, in the second half of 2019, the facility reported a dramatic increase in nursing hours—supplied entirely by the addition of administrative nursing staff—and by January 2020, the facility had a five-star rating, the Times reports. CMS fines nursing homes that don’t comply and the agency recently launched an initiative to invest these Civil Money Penalty dollars in efforts to reduce adverse events, improve staffing quality and improve quality of care for residents with dementia.
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.
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.
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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