New York Governor Andrew Cuomo (D)

NEW YORK – That the state health department cut nursing home Medicaid funding this year was enough of a sting, but having to recoup payouts from years before was the proverbial straw for nearly 36 facilities, which are now suing the state Health Department.

Those homes are asking the state Supreme Court to reverse a Medicaid funding formula change enacted in early 2011 that made the now-controversial change to the reimbursement formula. Health Department officials insist Gov. Andrew Cuomo’s office was asked by the state’s nursing home industry to make those changes to ensure a more equitable system of funding.

Some facilities took special exception to those changes being retroactive to April 2009 and claim the department is now inequitably doling out funds in a special relief fund established years ago to assist financially ailing homes.

Post-Irene power under fire
MARYLAND – East coast storms spawned by Hurricane Irene left many nursing homes powerless for five days or more in late August, and now citizens are demanding more accountability from the state’s major electricity supplier.
The Public Service Commission, which regulates utilities, is investigating how well Baltimore Gas and Electric (BGE) Co. performed during the storm, which caused billions of dollars in damage. The storm reportedly left more than a quarter of a million private residences in the state without power for as many as eight days, forcing businesses and schools to close.

The utility has said it may be forced to recoup the $81 million it spent on power restoration efforts through higher rates down the road — something that doesn’t sit well with anyone, much less cash-strapped providers.

Health Facilities Association of Maryland, which advocates for nursing homes and assisted living facilities, also asked the commission to ensure BGE gives facilities the same high priority as hospitals during power outages.

Bill minimizes awards?
TENNESSEE – A recently passed bill ratchets up ongoing tort reforms in a state already gaining notoriety for minimizing awards for negligent nursing home care.

Officials also are planning even lighter oversight measures, trimming the number of investigations and proposing laws that make it even more difficult for plaintiffs to earn large injury awards, according to an investigation by The Tennessean.

Current tort reform rules cap pain and suffering claims at $750,000. Growing numbers of facilities also are reportedly requiring residents and families to waive their rights to a trial before admission.

Tort reform advocates claim such changes were needed to help reverse a financial crisis and improve the state’s business climate by attracting more facilities and jobs. Critics say current tort reform measures now dissuade families of neglected residents from seeking justice, and fly in the face of reason in a state whose nursing homes receive among the lowest quality care ratings in the nation. According to the U.S. Government Accountability Office, no state under-reports poorly performing nursing homes more than Tennessee.

‘No lunch’ saves jobs
OHIO – Workers in a county-owned nursing home will split increased revenues gained from filing better care reports, and it will cost them only a free lunch.

For the 85 union workers at the Butler County Care facility in Hamilton, the concession was easy to swallow. By giving up a paid lunch hour, the state saves nearly $250,000 a year; by agreeing to provide more detailed documentation on resident care, workers will avoid potential layoffs (because of a $609,000 Medicaid shortfall) and divvy up 50% of all newly gained revenue that is expected to flow because of state aid requirements that provide such incentives. A portion of state funding is based on a point system, measured by how difficult a person’s care is for the facility, according to the Oxford Press newspaper.

The self-sustaining facility has taken other cost-cutting measures, including trimming the night shift nursing staff, reorganizing the restorative nursing program and joining a new county purchasing program.

Asbestos removal probed
ILLINOIS – Busy nursing home administrators are beset with a host of everyday clinical and administrative concerns and responsibilities, but are they also supposed to know the composition of their facility’s construction materials during renovations?

When decades-old, asbestos-laden floor tile was discovered during a Pekin facility laundry room project, the state health department was notified. At issue in a state Department of Health investigation is the administrator’s failure to report that the 50-year-old tiles were a hazard before having them removed, according to a report in the Pekin Times.

Hallmark House Nursing Center Administrator Lynn Brady admitted to not following state requirements to check the composition of the tiles before ordering their removal. She said she was unable to find the facility’s construction records when asked by the contractor whether asbestos was present.

Health department officials ordered the removal postponed while workers checked facility air quality. Brady said appropriate pre-cautions were taken during the final removal process to prevent air contamination to residents and staff. She said she also had the rest of the facility inspected for any other potentially hazardous construction materials.

‘Granny cams’ debated
MINNESOTA – Borrowing on the success so-called “nanny cams” have had in prosecuting abusive babysitters, a few nursing homes, police departments and some residents’ families are installing hidden “granny cams” in efforts to expose suspected offenders, according to the Minneapolis Star-Tribune.

Abusers have been exposed in states including Ohio, where a tiny camera placed in a desk fan by the son of a 78-year-old Ohio resident led to battery accusations; in New Jersey, where videotaped abuse led to a wrongful death lawsuit; and New York, where 22 workers were arrested after hidden cameras exposed a series of resident abuses.

Some observers say facilities should be cautious because of potential legal and privacy pitfalls. Only Texas, New Mexico and Maryland allow video surveillance in nursing homes.

The LTC industry has long opposed video surveillance on privacy grounds, and because it could dissuade new hires. Surveillance proponents say residents should be allowed to install their own cameras.

Vet homes stressed
COLORADO – Disproportionately high labor costs and questionable administrative decisions have plagued the state’s veterans nursing homes, an independent state audit said.

More than $1.5 million has been lost by the publicly operated facilities run by the Colorado Department of Human Services over the past five years, in spite of those facilities posting gains the past two, the Denver Post reported. The same facilities today have a staff-to-resident ratio of 546 to 434.

The audit claims the homes’ employee salaries are in many cases higher than those in privately operated facilities.
Auditors said unclear or inconsistent guidelines for setting limits on resident populations are partially to blame for the problem. The Department of Human Services acknowledged that outsourcing some administrative services and excessive salaries could have contributed to the posted losses.

Charting lies a ‘regularity’
CALIFORNIA – A newspaper investigation has uncovered over 150 alleged incidences of patient record falsification at the state’s nursing homes.

The Fresno Bee detailed a litany of cases involving phantom nurses, “fill-in-the-blank charting,” suspicious entries and “phony paperwork hurriedly produced after an injury or death.” The report also found:
• A nursing home supervisor who admitted to being ordered to alter the medical records of a resident who died after developing massive bedsores.
• A chart claiming a resident was given physical therapy five days a week, in spite of 28 of those sessions being documented by employees who were never there.
• Falsifying a cancer patient’s records to mask incorrect dispensing of medications.
Echoing some of California’s most experienced elder abuse attorneys, a representative for the state attorney general’s Bureau of Medi-Cal Fraud and Elder Abuse told the newspaper such actions are occurring “with regularity.”