NURSING HOME & MEDICARE DOLLARS

A shift in focus has occurred by nursing homes to attract short term care. Rehabilitation facilities are attracting many Medicare patients who are forced to leave hospital as soon as their Medicare for in patient care runs out. After a hip replacement or knee replacement, the patient is pushed out of the hospital where they had their surgery and yet those patients cannot take care of themselves when pushed out of the hospital. As a result of this trend, nursing homes/rehabilitation facilities are going after these patients who are on Medicare for short term care after their hospital stay. The concept is that Medicare pays far more than Medicaid. Most long term care at these nursing homes is paid for by Medicaid at a much lower rate then Medicare. The nursing homes have a very small margin of profit from Medicaid patients so they are going after short term patients on Medicare.

In an article written in The New York Times by Katie Thomas on April 14, 2015, entitled “As Nursing Homes Chase Lucrative Patients, Quality of Care is Said to Lag”. She points out that promises of decadent hot baths on demand, putting greens for golf putting and gurgling waterfalls to calm the mind. The cutthroat race for Medicare dollars leads nursing homes to turn to amenities to lure patients leaving a hospital and in need of short term rehabilitation after an injury or illness. As these nursing homes are investing in luxurious living quarters, the quality of care is strikingly uneven. These nursing homes are not up to the challenge of providing intense medical care. Many are often short on nurses and aides and do not have doctors on staff.

The article points out that the Department of Health & Human Services Office of the Inspector General found that 22% of Medicare patients who stayed in a nursing facility for 35 days or less experienced harm as a result of their medical care. An additional 11% suffered temporary injury. The report estimated Medicare spent $2.8 billion on hospital treatment in 2011 because of harm done to these patients in nursing facilities. Dr. Arif Nazir, an associate professor of clinical medicine who studies at Indiana University studies geriatrics and said many patients leave hospitals with acute medical needs before infections have been fully treated. “These patients are leaving the hospital half-cooked”. Competition for these patients has become intense because Medicare pays 84% more for short term patients than nursing homes get from Medicaid for long term care.

The combination of hospitals pushing patients out early who are not ready to go home and need for continuing care on a short term basis has created a bull market in a once struggling industry. As investors buy up these nursing homes who have the best chance of bringing in short term patients. Sales prices of nursing homes averaged $76,500 per bed in 2014, a record of breaking prices. This is created a shift for nursing homes to care for short terms care patients. Some nursing homes decided to no longer take lower paying long term care Medicaid patients. This shifting landscape marginalizes poor long term residents with extensive medical needs.

Dr. Johnson -Hamerman researched short term rehabilitation facilities for an injured foot in 2012. She picked Watermark whose website promised “top notch health care” with amenities including a staff to administer a “decadent hot bath at any hour”. The reality was that the doctor ended up in the emergency room with severe bed sores that had become dangerously infected. Far from the services she had been promised. She said workers at the home never gave her a full bath or shower, were slow to respond to her requests to have a diaper change and did not turn her every few hours which caused the bed sore. She ended up back in the hospital according to the article. This disconnect is called the “chandelier effect”; attractive lobbies and enticing amenities do not always mean that the nursing home provides good medical care. In recent years that focus on Medicare, patients has intensified as many long term residents have moved to assisted living facilities. In 2000, on a typical day, about 9% of residents in an average nursing home were covered by Medicare. By 2014, that number had raised to 15%. Even homes with a history of poor care are marketing their high end amenities. The Medford Multicare Center for Living on Long Island recently opened a wing intended for short term care known as “the Lux at Medford”. Patients have access to a putting green, a model apartment and a parked PT Cruiser to teach them how to resume their day to day activities.

The New York State Attorney General sued the facility in 2014 over care and seven employees were indicted on a range of charges related to the death of a patient in the facility ventilator unit. The article points out deaths attributed to lapses in care are not uncommon. In 2010, Mary Dwyer was a patient in Harborview Healthcare Center in Jersey City, New Jersey to recuperate after dislocating her shoulder in a fall. Ms. Dwyer who was 87, planned to return home but her condition deteriorated rapidly. Staff workers were so overworked that Ms. Dywer was not feed properly and not repositioned frequently in her bed and she died. Ms. Dywer lost 20 pounds and developed a bed sore so severe that it exposed her bone. She was rushed to a hospital and died a month later. Her family sued the Harborview Healthcare Center and a jury awarded her family more than $13 million. The amount was reduced to $4.75 million.

If you or a love one has sustained injuries (bedsore, fractures from falls or death) as a result of lack of care from a nursing home, call the Office of Dominick J. Robustelli & Associates at (914) 288-0800.