Feds Fail to Unlock Nursing Home “SLUSH FUND” to Fight COVID19

A Gray Media investigation has blown the lid off of one the nursing home industry’s most guarded secrets—it’s called the Civil Monetary Penalty Reinvestment Fund.

Nearly half a billion dollars of federally collected nursing home fines have flowed into the fund and now these monies are reportedly languishing in state coffers, accruing interest instead of being used to battle the coronavirus pandemic.  

Families for Better Care’s executive director Brian Lee calls the fund nothing more than a “slush fund” for nursing homes.

He says owners tap into the fund so they can offset operational costs and pad profits all in the name of so-called improvement.  He recalled one instance when “a nursing home that had been fined hundreds of thousands of dollars received a $27,000 grant to buy a bread-making machine, to build a snack stand and to train staff on how to stock the shelves.”  Lee visited the facility and was surprised by what he discovered.  “I expected the aroma of fresh-baked break to greet me when I walked in the door. I got the exact opposite,” he said. “I was immediately bowled over by the smell of urine and feces.”

Lee argues that the fund should be unlocked immediately by the Trump administration so nursing homes can acquire molecular rapid testing machines to prevent COVID19 spread, not so they can be held in reserve for some unhatched profit scheme.  

And the industry largely agrees. 

Mark Parkinson, the American Health Care Association’s president and chief executive officer, told Gray Media that the funds “should be utilized to improve patient care.”  

Nursing home fines should become part of the pandemic solution by “curbing infection-related problems, residents' falls and accidents, and abuse and neglect” rather than, as Parkinson describes, “frivolous” improvement projects that “should have been paid for through the nursing homes’ annual budget.”

But, there is this: CMS last year approved grants to nursing homes to buy an antique popcorn machine, create song playlists for residents and build gardens.  Awesome.

Good Idea: Rhode Island Lifespan Respite Project Work Initiative Increases Access to Respite Care While Training Nursing Students

The Rhode Island Lifespan Respite Project at the Rhode Island Office of Healthy Aging implemented a workforce development initiative, CareBreaks, to match student nurses with low to moderate income families who have no access to subsidized respite care. This model provides free respite care with an increased supply of volunteer respite providers and offers important hands-on experience for nursing students approaching career field entry. The Project developed a Support Family Caregivers Toolkit to assist interested nursing programs and other organizations replicate a similar respite clinical experience program. Marketing materials include a flyer and a video. 

The project recently received national attention from recognition ARCH National Respite Network and Resource Center. Hopefully this type of program will soon be a common solution across the country. 

Music and Memory Program Means Fewer Meds, Better Behaviors

Photo 174795833 © Ljupco | Dreamstime.com

Researchers from the University of California, Davis documented in the August issue of JAMDA the impact of Music and MemorySM (M&M), a non-pharmacological intervention, on nursing home residents with dementia.

The Impact of Music and Memory on Resident Level Outcomes in California Nursing Homes studied 4,107 residents in 265 nursing homes over a three-year period. Debra Bakerjian, PhD, APRN, RN, and her team found that M&M was associated with reductions in psychotropic medications, reduced behaviors, improved mood, less pain, and fewer falls. It is the largest study of M&M to date.

The odds of antipsychotic use declined by about 11%, of antianxiety medications by 17%, and antidepressants by 9% per quarter. In addition, the odds of residents exhibiting aggressive behaviors declined by 20% per quarter, depressive symptoms by 16%, reported pain by 17%, and falls by 8%.

The authors found the reduction in antipsychotics to be “particularly noteworthy, given the documented significant reduction in the use of antipsychotics statewide before the start of this study.”

The M&M program advocates the use of personalized music for older adults with dementia and other cognitive or behavioral symptoms with the goal of improving their quality of life. According to the authors, “While there are a few proven non-pharmacological interventions, activities and music therapy have been shown to decrease overall agitation in nursing home residents.” They cited a 2018 systematic review and meta-analysis that found receptive music therapy, including listening to the participant’s favorite music, was more effective at decreasing agitation and behavioral problems than interactive music therapy.

The authors found that M&M was frequently housed within in the activities department “with limited involvement from other departments.” However, they noted, “Encouraging other departments, especially nursing, to use M&M with residents could increase the frequency and duration of use and overall successful sustainment of the program.”

The project was supported by the Centers for Medicaid & Medicare Services Civil Money Penalty funds as well as the National Institutes of Health’s National Center for Advancing Translational Sciences. It was sponsored by the California Association of Health Facilities.

Click here for more information on the findings above and more details about the study.

Judge Can Not Impose an ‘Unusual’ Condition on a Reversal of a Default Judgment in a Nursing Home Breach of Contract Lawsuit

Nursing homes are proficient in protecting themselves from risk of loss where Medicaid is concerned.  Spouses and children of the Medicaid applicants often find themselves being sued to recover for delays in seeking and obtaining Medicaid.

Courts and the law are often sympathetic to the cause of the nursing home, particularly when admission agreements include provisions making family responsible.  In a recent case, the "sympathy" crossed a line towards activism on behalf of the institution.  Fortunately, on appeal, the ship of equity was righted.

George Brown entered a nursing home and signed an admission agreement, agreeing to apply for Medicaid benefits to pay for his care. Mr. Brown did not submit the necessary information to complete his Medicaid application, so his application was denied. The nursing home sued Mr. Brown and his wife, Gloria Brown, for breach of contract and her for lack of spousal support. Ms. Brown appeared at the initial hearing and argued that Mr. Brown had dementia and did not knowingly sign the agreement. In addition, she claimed he was mistreated at the nursing home.

The judge informed Ms. Brown that she needed to file an answer to the nursing home’s complaint. Ms. Brown never filed an answer, and the judge entered a default judgment against her. Six months later, Ms. Brown filed a request to remove the default judgment because she had been in the hospital and therefore unable to answer the Complaint. The judge granted her request to vacate the default judgment on the condition that she waive any claims against the nursing home to the extent the monetary recovery amount exceeded the amount Mr. Brown owed to the nursing home. The court, in effect, protected the nursing home from any risk of losing more than it was owed! Ms. Brown refused the condition and appealed.

The Massachusetts Appeals Court reversed, holding that the condition imposed by the judge was inappropriate.   Care One Management, LLC v. Brown (Mass. Ct. App., No. 19-P-1165, Oct. 7, 2020). Because the judge did not find that the nursing home suffered any prejudice from the default or the delays, there existed no authority for the court to , in essence, protect the nursing home. According to the court, although the judge made passing reference to Ms. Brown’s delay in fighting the default judgment, the judge “did not explain how or why such factors impacted [the nursing home’s] claim, and did not evaluate and explain whether and to what extent [the nursing home] suffered any prejudice, before imposing the unusual condition on the removal of the default judgment.”

The legal system worked to restore balance in this case.  The wife, though, has attendant cost and expense for which she will never be compensated.  This is just one unavoidable cost of institutional care, dutifully protected by the legal system. 

Survey Suggests 64% of Residents Don't Leave Rooms to Socialize; More Report Profound Loneliness

Nearly two-thirds of nursing home residents do not leave their rooms to socialize anymore since the onset of the coronavirus pandemic, a new survey by healthcare research group Altarum has revealed.

In addition, more than 75% of residents said they have felt lonelier following the ban on visitors implemented by the Centers for Medicare & Medicaid Services (CMS) in mid-March. In September, the agency issued new guidance that laid a framework for providers to resume in-home visitation. The agency cited the emotional and physical toll that the bans had on residents as a reason for the move. 

The survey featured responses from more than 360 residents in 36 states. Findings also showed how much social interactions, both inside and outside nursing homes, have declined during the pandemic. 

Fifty-four (54%) percent of residents said they aren’t participating in any in-home organized activities, while just 13% said they’re eating their meals in the dining room. Prior to the pandemic, 86% of residents said they were participating in activities and nearly 70% were eating in the dining room. 

Additionally, it found that 93% of residents did not leave their nursing home in a given week for routine activities, like shopping or visiting family, since the public health crisis. That number was 42% before the pandemic. 

“Hearing an elder say they feel like they are in prison is heartbreaking. We need to change this,” said Sarah Slocum, co-director of Altarum’s Program to Improve Eldercare.

Strategies to reduce loneliness 

Many facilities have offered more video chats and phone calls for residents and families since the onset of the pandemic, which is a great strategy, but there’s more they can to reduce feelings of loneliness, according to aging expert psychologist Eleanor Feldman Barbera, Ph.D. 

She suggested providers increase their number of recreation staff, if possible, and offer more safely spaced activities for residents. Examples of those types of activities include mobile fishing carts and doorway bingo.

“Engaging the community with a letter writing campaign, photos of pets, etc., is another way to promote connection with people who might not otherwise be involved with the nursing home. It’s also a way of promoting the home to those in the community,” Barbera told McKnight’s Long-Term Care News. 

She also suggested that facilities “make good use of psychologists on the team.”

“They are one of the few staff members whose job it is to actually sit down and talk with the residents for an extended amount of time on a consistent basis. Multiple residents have commented to me during this period about how I’m the only one who visits them,” she said. 

“The psychologist can monitor their moods to be sure their depression isn’t worsening, increase the frequency of sessions, refer them to the psychiatrist for antidepressants if needed, request a compassionate care visit,” she added. 

Barbera noted that providers will likely be dealing with this current situation for “far too long,” which means facilities will have to be creative about how they facilitate visits. 

“Think heated outdoor areas or plexiglass partitions in a corner of the lobby,” she explained.

Source: Mcknight's Long-Term Care News.