Dave Abels, Author at Abels & Annes, P.C.

Report Claims It’s Tough to Determine Whether Community-Based Long-Term Care is Superior to Entering a Nursing Home in Illinois and Throughout the Nation

A report recently published by the Agency for Healthcare Research and Quality (AHRQ) found that there is no evidence to support the often accepted idea that home or community-based long-term care is less expensive than or provides superior care over institutions such as skilled nursing facilities. Instead, study authors argue that community-based elder care solutions reportedly benefit consumers who prefer to avoid entering a long-term care facility. The AHRQ report defines long-term care as daily living, housing, and medical care over an extended time frame.

According to the AHRQ, the question of how to provide the best, most economical long-term care solutions for the nation’s aging population has become increasingly important as states continue to experience revenue shortfalls. Currently, about 1.4 million U.S. residents reportedly reside in a skilled nursing facility. Approximately 40 percent of all long-term care provided throughout the country is paid for by federal Medicaid insurance. In addition, an estimated 64 percent of the money spent on long-term care for Medicaid beneficiaries is paid to nursing homes. At this time, at least 11 million Americans require some type of long-term care to assist them in their daily lives and about 55 percent of those individuals are reportedly age 65 or over. In addition, the AHRQ estimates that at least two-thirds of individuals who are over age 65 will require long-term care assistance for at least two years before the end of their lifetime.

The costs associated with receiving institutional care allegedly often exceed those for community-based elder care solutions. Because of this, many states have prioritized community-based solutions. Between 1995 and 2009, Medicaid spending on community-based long-term care solutions reportedly doubled. The AHRQ report argues, however, that there is no evidence that community-based solutions provide superior care. Still, skilled nursing facility residents allegedly exhibit more physical and cognitive impairment than individuals who utilize assisted living or community-based solutions. Because of this, the study authors reportedly believe more research should be performed to determine the exact cause of the disparity.

Families in Illinois often turn to skilled nursing facilities when they are no longer able to care for their elderly or disabled loved ones. Although nursing homes can be the best option for some patients, many need therapies that nursing homes are unable or unwilling to provide. Unfortunately, abuse and neglect can result when patients enter nursing facilities that are not equipped to properly care for them.

The Illinois Nursing Home Care Act was established to protect the rights of senior citizens and other individuals who live in long-term care facilities throughout the state. Those rights include the right to be free from abuse or neglect, the right to privacy, and the right to various levels of self-determination. If you believe the rights of your elderly or disabled friend or family member were violated by a long-term care facility, you should discuss your concerns with a skilled nursing home abuse and neglect attorney.
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Late Medicaid Payments Allegedly Place Illinois Nursing Home Residents at Risk

by Dave Abels

There is reportedly a Medicaid payment backlog of approximately six months for nursing homes and other long-term care facilities operating in Illinois. The State of Illinois has purportedly opted to delay payments to facilities that care for the state’s elderly and disabled Medicaid recipients in an effort to manage budgetary concerns. Reimbursements from the federal Medicaid insurance program reportedly fund the care of about two-thirds of all nursing home patients and approximately 60 percent of all assisted living facility residents in the state. According to some, the practice not only shifts the financial burden for Medicaid recipients in Illinois to the facilities that care for them, but also serves to decrease a company’s incentive to employ an adequate number of direct care staff.

According to Wayne Smallwood, Executive Director for the Affordable Assisted Living Coalition, small facilities are hit hardest by the backlog due to less flexibility in their budgets. He said many such nursing homes are currently experiencing difficulty with meeting payroll as funds become depleted. Jerry Finis, CEO of Pathway Senior Living, stated larger companies also feel the crunch when Medicaid payments are not received. A lack of information from state officials reportedly makes it hard for skilled nursing facilities to plan for unexpected shortfalls. Judy Baar Topinka, Comptroller for the State of Illinois, said the backlog has grown by at least $2 billion over the course of the past year. In addition, Baar Topinka stated the late Medicaid reimbursements are likely to get worse in the coming months.

In some cases, late Medicaid payments allegedly mean long-term care facilities are forced to delay payments for essential services such as utilities. According to Pat Comstock, Executive Director at Health Care Council of Illinois, a number of skilled nursing facilities have responded to delayed payments and the current 2.7 percent Illinois payment cut by declining to accept new residents who utilize Medicaid. Although Illinois reportedly pays a one percent interest penalty for late federal payments, the financial stress of the practice coupled with the need to increase direct care staff levels in order to comply with state law has reportedly placed many nursing homes at risk of closing.

Any skilled nursing facility in Illinois that receives federal Medicaid or Medicare funds is considered a certified nursing home. The majority of certified nursing homes that operate in Illinois are held to a high standard of care under both state and federal law. Despite that most nursing homes located in the state are certified, the Illinois Nursing Home Care Act does not require it. In addition, the Illinois Department of Public Health regulates the quality of care provided in all Illinois long-term care facilities regardless of the facility’s certified status.

The Illinois Nursing Home Care Act directed all skilled nursing facilities operating within the state to increase the number of direct care employees in order to sufficiently meet the needs of facility residents. Still, inadequate or poorly trained staff is a frequent cause of nursing home abuse or neglect. If your loved one suffered neglect or abuse as a result of inadequate staff levels, you are advised to speak with a quality lawyer to discuss your concerns.
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Study Suggests Nursing Homes that Successfully Coordinate With Other Medical Providers Reduce Hospitalization Rates

by Dave Abels

Medical care facility transitions for nursing home residents can often lead to a number of health complications. In fact, up to 20 percent of Medicare beneficiaries who enter a hospital are readmitted within 30 days. A study recently published in the Journal of the American Medical Association claims nursing homes and other long-term care facilities that collaborate with a patient’s other healthcare providers may have the ability to reduce repeat hospitalization rates. In a report entitled “Association Between Quality Improvement for Care Transitions in Communities and Rehospitalizations Among Medicare Beneficiaries,” researchers led by the non-profit corporation Colorado Foundation for Medical Care found that partnering between medical providers reduced rehospitalization rates by an average of almost six percent in the first 30 days following discharge. That number was reportedly almost three times the rate found when long-term care facilities attempted to reduce rehospitalization rates but failed to coordinate with community health care providers.

As part of the study, researchers analyzed data collected by 14 Centers for Medicare and Medicaid Services Quality Improvement Organizations (QIO) over a three-year-period. The QIOs purportedly focused on quality improvement efforts such as community organizing, coordinating evidence-based hospital discharges, providing technical assistance with regard to the implementation of best care practices, and monitoring. In 10 of the 14 communities that participated in the study, skilled nursing facilities also implemented the Interventions to Reduce Acute Care Transfers model for sharing relevant medical information. In addition to reducing rehospitalization rates, researchers found that collaboration saved each QIO community about $3 million in Medicare funds.

According to Dr. Jane Brock, lead study author and Chief Medical Officer at the Colorado Foundation for Medical Care, the research project successfully engaged entire communities in improving nursing home resident care. This was reportedly the first time researchers focused on successful health care intervention and monitoring. Dr. Brock stated the research demonstrates that community partnerships have the ability to improve medical care for nursing home residents.

Most nursing home and other long-term care facilities located in Illinois are under contract to receive Medicare and Medicaid funds. As a result, caregivers and administrators who are employed at such skilled nursing facilities must adhere to both state and federal laws. Although most nursing homes in Illinois provide satisfactory patient care, some cut costs and fail to employ a sufficient number of qualified staff. This research study suggests that providing quality resident care may actually reduce a facility’s expenses. If you believe a friend or loved one was abused or neglected while in the care of an Illinois long-term care facility, you should speak with a skilled attorney.
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Former Orland Park Nursing Home Employee Claims She Was Fired for Reporting Alleged Sexual Abuse of a Resident

by Dave Abels

A former Orland Park skilled nursing facility employee has reportedly filed a whistle blower lawsuit in Cook County Circuit Court. In her lawsuit, the former overnight nursing supervisor claims she was fired in 2011 in retaliation for reporting the alleged sexual assault of a 93-year-old resident to local police. The former nursing home supervisor claims she was required to take action after a fellow nurse reported the alleged incident to her. According to her complaint, a fellow nurse allegedly witnessed a male co-worker sexually abuse an elderly female resident at the Lexington Healthcare Center. The former supervising nurse stated she verified that the incident actually occurred prior to notifying local authorities.

Several months after she reported the alleged sexual abuse, the 63-year-old supervising nurse was purportedly fired. According to her complaint, the nurse believes she was fired after nine years of service for bringing bad publicity upon the nursing home. The nurse’s lawsuit seeks $30,000 in damages pursuant to the State of Illinois’ whistle blower protection law. She is also reportedly seeking compensation for lost wages and benefits.

As this sad case demonstrates, nursing home abuse can take many forms, including sexual assault. Skilled nursing facilities in Illinois are required to immediately report any suspected instances of sexual abuse of a resident. The Illinois Department of Public Health is tasked with investigating and responding to all reports regarding senior citizen neglect or abuse at a skilled nursing facility. In addition, law enforcement, healthcare, and social service professionals must notify the Health Department anytime they suspect an elderly Illinois resident who is unable to report his or her abuse was victimized by a caregiver.

Too often, seniors in Illinois and elsewhere suffer egregious abuse at the hands of their caregivers. The sexual assault of an elderly or disabled nursing home resident can never be tolerated. Fortunately, the Illinois Elder Abuse and Neglect Act was established to respond to senior citizen abuse throughout our state. If you suspect a skilled nursing facility resident is being abused, you should discuss your concerns with a skilled nursing home abuse and neglect lawyer.
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Evergreen Park Nursing Home Settles Cook County Lawsuit Over Bedsores

by Dave Abels

A former nursing home patient’s family has reportedly settled a bedsore lawsuit that was filed against an Evergreen Park skilled nursing facility following her death. The 77-year-old stroke victim purportedly resided at the Evergreen Health Care Center for four months during the first half of 2007. When the woman died, she was allegedly immobile and covered in bedsores. The woman also reportedly suffered from dehydration, sepsis, and pneumonia at the time of her death.

According to the nursing home resident’s granddaughter, her bedsores resulted from neglect on the part of the care facility. In her lawsuit, the woman’s granddaughter accused the Evergreen Health Care Center of failing to prevent, treat, or monitor the stroke victim’s bedsores. She also claims such failures contributed to her grandmother’s death. The woman’s family claims that she was likely never turned, they often found her soiled, and on at least one occasion her feeding tube was dislodged. In addition, the stroke victim’s granddaughter stated that facility employees failed to discover or treat any of her bedsores.

25 lawsuits were reportedly filed against the Evergreen Health Care Center between 2001 and 2012. The for-profit nursing home also nearly lost its state license in 2010 after Illinois officials purportedly cited the facility for resident falls and other injuries, medication errors, and severe patient neglect. The nursing home was later allegedly placed on a nursing home watch list after at least 15 complaints were filed regarding the quality of care provided to residents during a two-year-period.

Although ownership did not change, the Evergreen Park facility was reportedly placed under new management in 2011. According to Evergreen Health Care Center spokesperson Liana Allison, the facility has since increased the number of registered nurses employed by the nursing home, provided more than 5,000 hours of staff training and development, and earned the Joint Commission on Accreditation of Healthcare Facilities Gold Seal of Approval. Allison also said that the facility has not received a single substantiated complaint regarding resident care in more than one year.

All nursing homes in Illinois must be licensed by the state and are subject to Illinois regulations. In addition, Illinois nursing homes that receive funds from the federal Medicaid and Medicare insurance programs are considered certified facilities. Certified facilities are governed by both state and federal laws. Although the Illinois Nursing Home Care Act does not require nursing homes to be certified, most skilled nursing facilities located throughout Illinois are in fact certified.

Federal regulations require skilled nursing facilities to ensure that all residents maintain the same level of health that was enjoyed upon entering the facility. If a resident’s condition worsens, the facility must work to restore the resident to his or her original condition. A common sign of nursing home neglect in Illinois and throughout the country is the presence of bedsores on a patient who has mobility issues. Bedsores are pressure ulcers that are generally caused by remaining in the same position for too long. With proper care, no skilled facility resident should suffer from bedsores.
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Influenza Epidemic Places Nursing Home Residents in Illinois and Nationwide at Risk

by Dave Abels

The current influenza outbreak is reportedly the worst the nation has seen in more than a decade. Earlier this month, the nation’s Centers for Disease Control and Prevention (CDC) declared that influenza has officially spread to epidemic levels. CDC data claims that 41 states are currently experiencing widespread influenza activity. During the first half of January, an estimated 128 million flu vaccines were reportedly administered to individuals throughout the country. That number purportedly accounts for about 95 percent of the influenza vaccines that were expected to be produced fot the U.S. over the course of the entire year. The CDC currently recommends that all health care personnel obtain a flu vaccine in an effort to prevent the spread of the virus.

This flu season, a record number of cases were allegedly reported in nursing homes and other long-term care facilities located in Illinois and throughout the nation. Because the flu is more likely to prove fatal to the elderly and individuals with underlying health conditions, it is especially important for skilled nursing facility workers to remain vigilant with regard to preventing the spread of illness. Nursing homes are encouraged to provide disease prevention education materials to anyone who lives in, works at, or visits their facility. In addition, signs should be posted at each entrance to warn others regarding any potential flu or other outbreaks. Whenever possible, masks should be worn by anyone with a cough, facility employees should be encouraged to stay home when feeling ill, and the Illinois Health Department should be notified regarding any suspected cases of the flu. As always, frequent hand washing is vital.

According to Michelle Stober, a registered nurse with Pathway Health Services, it is important for skilled nursing facilities to properly prepare, prevent, and respond to any influenza or other outbreak. Stober said all nursing homes should develop a comprehensive communication plan with not only state authorities, but also direct care and other employees, and facility visitors such as volunteers and the family members of residents. Stober reportedly believes such a plan may help everyone work together to keep the elderly and disabled safe from the flu virus.

Because long-term care facility residents generally live in close proximity to one another, communicable diseases like the flu are often spread easily. Appropriate sanitation measures are necessary to ensure the health of nursing home patients. Despite that skilled nursing facility workers in Illinois are required to take simple precautionary measures designed to control the spread of disease, many reportedly fail to do so. Regrettably, this can have a disastrous impact on facility residents. If your friend or loved one died after he or she contracted a preventable disease at an Illinois nursing home, you should speak to a skilled nursing home abuse and neglect lawyer.
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Federal Nursing Home Deficiency Reports Available Without Redactions for the First Time in Illinois and Nationwide

by Dave Abels

For the first time, the United States government has released reports regarding issues uncovered by nursing home investigators across the nation without redactions. The non-profit organization ProPublica reportedly obtained the U.S. Centers for Medicare and Medicaid Services reports through a Freedom of Information Act request. In order to protect the privacy of nursing home residents, patient and employee names are not included in the reports.

Previously, much of the information included in the unredacted Medicare and Medicaid reports was made available on ProPublica’s Nursing Home Inspect website. The tool reportedly allows website visitors to browse the more than 267,000 nursing home deficiencies documented across the nation over the last three years by keyword. Although the searchable Nursing Home Inspect tool currently only includes redacted care facility inspection reports, the complete and unredacted reports are now also available online. The unedited Medicare and Medicaid Services reports are grouped by region and may be downloaded from ProPublica’s website.

The additional information will reportedly make the reports more useful to those who seek to learn more about the quality of care provided at a particular skilled nursing facility. For example, the unredacted reports now include any diagnosed medical conditions, all pharmaceutical drugs administered to residents, and patient ages. Such information is useful because it allows consumers to see whether residents receive appropriate prescription medications based on their medical diagnosis. For example, patients who suffer from a dementia disorder should not be administered an anti-psychotic medication because the drugs reportedly do little to manage their behavior. The nation’s Food and Drug Administration also issued a warning about prescribing anti-psychotics to such patients because their use is purportedly associated with an increased mortality rate.

Most skilled nursing facilities in Illinois are certified to receive funds from Medicaid and Medicare programs. A certified nursing home is required to adhere to both state and federal regulations. Although the Illinois Nursing Home Care Act does not require long-term care facilities operating in the state to be certified, it requires all nursing homes to be licensed. The Illinois Department of Public Health regulates standards of care for all licensed nursing homes.
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Los mayores en Illinois y por todo el país Reciben el Cuidado Inadecuado de Proveedores Médicos Privados.

by Dave Abels

Cada vez más, los pacientes en los Estados Unidos dependen de proveedores privados de atención médica. Durante las últimas décadas, más y más hogares de ancianos, hospitales y otras instituciones de servicios de salud supuestamente han privatizado. Desafortunadamente, el estatus de la ganancia de una facilidad de asistencia médica a menudo afecta el cuidado proporcionado a pacientes. Por ejemplo, los hospitales de para-ganancia son supuestamente menos probables de ofrecer los servicios médicos necesarios que no crean ganancias grandes. Aunque esto es generalmente una buena noticia para los accionistas, puede significar un desastre para los pacientes. Según un estudio, las muertes de pacientes aumentan considerablemente cuando los hospitales sin fines lucrativos llegan a ser privatizados. La dotación de personal también supuestamente tienden a disminuir.

En los EE.UU., las empresas privadas supuestamente proporcionan servicios sociales más esenciales que en cualquier otra nación industrializada. Algunos creen que esto ha resultado en una atención de calidad inferior para nuestra nación, enfermos y ancianos. En lugar de bajar los gastos y la eliminación de residuos, hogares de ancianos privatizados y hospitales según se informa ahora les ofrecen a los médicos y otros miembros del personal de atención directa con los incentivos financieros para maximizar los beneficios sin incurrir en ningún gasto adicional.

Lamentablemente, esto puede tener un efecto sobre el cuidado del paciente. Según un estudio con respecto al gasto de Medicare, ningún dinero del contribuyente fue guardado cuando Organizaciones privadas de Mantenimiento de Salud (SEGURO MEDICO GLOBAL) fueron utilizados. Adicionalmente, otro estudio reclama que el costo de Medicaid aumentó por acerca del 12 por ciento sin ningún incremento en la calidad cuando los beneficiarios comenzaron a utilizar HMO.

Un estudio de Wisconsin encontró que hogares de ancianos sin fines lucrativos tienden a administrar menos sedantes que las empresas lucrativas. En algunas áreas, los residentes de hogares de ancianos con fines de lucro supuestamente reciben un promedio de tranquilizantes cuatro veces más que los que viven en una instalación gubernamental o una facilidad administrada sin fines de lucro. El economista Burton Weisbrod cree que esta disparidad ha surgido porque tales drogas son baratas y tienden a incapacitar pacientes que de otro modo podrían requerir atención adicional o estimulación. Él dijo que los programas diseñados para mantener a los residentes de centros de enfermería comprometidos cuesta dinero. Además, también el personal necesario para administrar los programas.

El exceso de medicación a los residentes de hogares de ancianos o el empleo de un número insuficiente de personal de atención directa en un esfuerzo por aumentar la línea final de una empresa no es acceptable. Un número inadecuado de empleados bien-entrenados en hogar de ancianos es una causa común de abuso y descuido en facilidades hábiles de enfermería a través de Illinois y el país. Afortunadamente, el Acto del Cuidado de Hogar de ancianos en Illinois fue establecido para aumentar la calidad del cuidado recibido por residentes en hogares de ancianos en nuestro estado. Según la ley, todas las facilidades hábiles de enfermería especializadas en Illinois deben proporcionar por lo menos 2.5 horas de cuidado directo por día para cada paciente. Adicionalmente, todos los hogares de ancianos que operan dentro del estado deben proporcionar 3.8 horas del cuidado directo para cada residente antes del 1 de enero de 2014.
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Seniors in Illinois and Nationwide May Receive Inadequate Care from Private Medical Providers

by Dave Abels

Increasingly, patients in the United States are relying on private medical care providers. Over the past several decades, more and more nursing homes, hospitals, and other health service institutions have purportedly privatized. Unfortunately, the profit status of a health care facility often affects the care provided to patients. For example, for-profit hospitals are reportedly less likely to offer necessary medical services that do not create large profits. Although this is generally good news for shareholders, it can spell disaster for patients. According to one study, patient deaths increase sharply when non-profit hospitals become privatized. Staffing levels also allegedly tend to decline.

In the U.S., private companies purportedly provide more essential social services than in any other industrialized nation. Some believe this has resulted in lower quality care for our nation’s sick and elderly. Instead of lowering costs and eliminating waste, privatized nursing homes and hospitals reportedly now provide physicians and other direct care staff with financial incentives to maximize profits without incurring any additional expense. Sadly, this can have an effect on patient care. According to a study regarding Medicare spending, no taxpayer money was saved when private Health Maintenance Organizations (HMOs) were used. Additionally, another study claims the cost of Medicaid increased by about 12 percent without any increase in quality when recipients began utilizing HMOs.

A Wisconsin study found that non-profit nursing homes tend to administer fewer sedatives than for-profit enterprises. In some areas, residents at for-profit nursing facilities allegedly receive an average of four times more tranquilizers than those living in a government or non-profit managed facility. Economist Burton Weisbrod believes this disparity has arisen because such drugs are cheap and tend to incapacitate patients who may otherwise require additional care or stimulation. He said programs designed to keep skilled nursing facility residents engaged cost money. In addition, so does the staff required to administer the programs.

Over-medicating nursing home residents or employing an inadequate number of direct care staff in an effort to increase a company’s bottom line is not acceptable. An inadequate number of well-trained nursing home employees is a common cause of abuse and neglect at skilled nursing facilities throughout Illinois and the country. Fortunately, the Illinois Nursing Home Care Act was established to increase the quality of care received by nursing home residents in our state. Pursuant to the law, all skilled nursing facilities in Illinois must provide at least 2.5 hours of direct care per day for each patient. Additionally, all nursing homes operating within the state must provide 3.8 hours of direct care staffing for every resident prior to January 1, 2014.
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Recent Study Suggests For-Profit Nursing Homes in Illinois and Nationwide are More Likely to Overcharge Medicare While Neglecting Seniors

by Dave Abels

A study recently published by the nation’s Department of Health and Human Services reportedly found that skilled nursing facilities throughout the nation overcharged the federal Medicare system about $1.5 billion in 2009. According to data compiled by Bloomberg News, approximately 30 percent of Medicare claims submitted by for-profit nursing homes were for patient treatments that were either unnecessary or never received. In contrast, only around 12 percent of such claims submitted by non-profit facilities were reportedly deemed improper. In 2010, a similar study found that for-profit nursing homes were twice as likely as non-profits to bill Medicare at the highest possible rate for residents with similar medical issues and needs.

A report released in 2012 by the Medicare Payment Advisory Commission (MEDPAC) claims that for-profit healthcare providers currently dominate the nation’s medical services industry. MEDPAC data suggests that about 33 percent of all nursing home revenues come from the federal Medicare program. An additional 50 percent is reportedly funded by Medicaid insurance for the poor. According to MEDPAC, for-profit skilled nursing facilities enjoy a 20 percent profit margin on all Medicare residents. In 2010, 78 percent of the approximately $105 billion in skilled nursing industry revenues were purportedly paid to for-profit homes.

The Alliance for Quality Nursing Home Care, a nursing home trade group, claims that nursing homes employ in excess of $1.6 million Americans. Still, the nation’s 10 biggest for-profit skilled nursing facility companies allegedly employed nearly 40 percent fewer registered nurses than non-profit facilities between 2003 and 2008. In addition, the same companies also purportedly received almost 60 percent more deficiency citations following federal inspections. A spokesperson for the American Health Care Association, Greg Crist, stated for-profit nursing homes have increased the number of registered nurses employed since 2009. Crist also claims a number of initiatives designed to increase quality were put into place at many facilities last year.

The pressure to reduce personnel expenses and increase federal insurance payments is reportedly quite high at many for-profit skilled nursing facilities. University of California, Los Angeles Law Professor Jill Horwitz stated for-profit nursing homes are also more likely to push legal boundaries in order to pursue higher revenues. As a result, civil and criminal cases filed by federal prosecutors against nursing homes throughout the nation reportedly increased by about 60 percent between 2008 and 2012.

The bulk of Illinois skilled nursing facilities receive Medicare and Medicaid funds. This means they are considered certified nursing homes. All certified nursing homes throughout the state are required to adhere to both Illinois and federal laws and regulations. The Illinois Nursing Home Care Act required skilled nursing facilities to increase staff numbers to 2.5 hours of direct care staffing for every skilled care resident by July 1, 2010. Additionally, the law mandates that all nursing home facilities in Illinois must provide 3.8 hours of direct care staffing for every patient by January 1, 2014.

Sadly, inadequate staffing levels are a common factor in nursing home abuse or neglect in Illinois and nationwide. Intentionally employing an insufficient number of healthcare workers in order to increase profits is a recipe for disaster. If you feel your friend or loved one was the victim of nursing home abuse or neglect, you are advised to discuss your concerns with a skilled lawyer.
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