Trump Administration Relaxes Financial Penalties Against Nursing Homes
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Nursing Homes Worry Proposed Medicaid Cuts Will Force Cuts, Closures
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FM","link":"/"}},"stateofhealth_362314":{"type":"posts","id":"stateofhealth_362314","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"362314","score":null,"sort":[1514922063000]},"guestAuthors":[],"slug":"trump-administration-relaxes-financial-penalties-against-nursing-homes","title":"Trump Administration Relaxes Financial Penalties Against Nursing Homes","publishDate":1514922063,"format":"standard","headTitle":"Kaiser Health News | State of Health | KQED News","labelTerm":{"term":3007,"site":"stateofhealth"},"content":"\u003cp>The Trump administration — reversing guidelines put in place under President Barack Obama — is scaling back the use of fines against nursing homes that harm residents or place them in grave risk of injury.\u003c/p>\n\u003cp>The shift in the Medicare program’s penalty protocols was requested by the nursing home industry. The American Health Care Association, the industry’s main trade group, has complained that under Obama, federal inspectors focused excessively on catching wrongdoing rather than helping nursing homes improve.\u003c/p>\n\u003cp>“It is critical that we have relief,” Mark Parkinson, the group’s president, wrote in a letter to then-President-elect Donald Trump in December 2016.\u003c/p>\n\u003cp>Since 2013, nearly 6,500 nursing homes — 4 of every 10 — have been cited at least once for a serious violation, federal records show. Medicare has fined two-thirds of those homes. Common citations include failing to protect residents from avoidable accidents, neglect, mistreatment and bedsores.\u003c/p>\n\u003cp>The new guidelines discourage regulators from levying fines in some situations, even when they have resulted in a resident’s death. The guidelines will also probably result in lower fines for many facilities.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The change in policy aligns with Trump’s promise to reduce bureaucracy, regulation and government intervention in business.\u003c/p>\n\u003cp>Dr. Kate Goodrich, director of clinical standards and quality at the Centers for Medicare & Medicaid Services (CMS), said in a statement that unnecessary regulation was the main concern that health care providers raised with officials.\u003c/p>\n\u003cp>“Rather than spending quality time with their patients, the providers are spending time complying with regulations that get in the way of caring for their patients and doesn’t increase the quality of care they provide,” Goodrich said.\u003c/p>\n\u003cp>But advocates for nursing-home residents say the revised penalties are weakening a valuable patient-safety tool.\u003c/p>\n\u003cp>“They’ve pretty much emasculated enforcement, which was already weak,” said Toby Edelman, a senior attorney at the Center for Medicare Advocacy.\u003c/p>\n\u003cp>Medicare has different ways of applying penalties. It can impose a specific fine for a particular violation. It can assess a fine for each day that a nursing home was in violation. Or it can deny payments for new admissions.\u003c/p>\n\u003cp>The average fine in recent years has been $33,453, but 531 nursing homes amassed combined federal fines above $100,000, records show. In 2016, Congress \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Civil-Monetary-Penalties-Annual-Adjustments.html\" target=\"_blank\" rel=\"noopener\">increased the fines\u003c/a> to factor in several years of inflation that had not been accounted for previously.\u003c/p>\n\u003cp>The new rules have been instituted gradually throughout the year.\u003c/p>\n\u003cp>In October, \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-18-01.pdf\" target=\"_blank\" rel=\"noopener\">CMS discouraged\u003c/a> its regional offices from levying fines, even in the most serious health violations, if the error was a “one-time mistake.” The centers said that intentional disregard for residents’ health and safety or systemic errors should still merit fines.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-17-37.pdf\" target=\"_blank\" rel=\"noopener\">July memo\u003c/a> from CMS discouraged the directors of state agencies that survey nursing homes from issuing daily fines for violations that began before an inspection, favoring one-time fines instead. Daily fines remain the recommended approach for major violations discovered during an inspection.\u003c/p>\n\u003cp>Dr. David Gifford, the American Health Care Association’s senior vice president for quality, said daily fines were intended to prompt quick remedies but were pointless when applied to past errors that had already been fixed by the time inspectors discovered them.\u003c/p>\n\u003cp>“What was happening is you were seeing massive fines accumulating because they were applying them on a per-day basis retrospectively,” Gifford said.\u003c/p>\n\u003cp>But the change means that some nursing homes could be sheltered from fines above the maximum per-instance fine of $20,965, even for egregious mistakes.\u003c/p>\n\u003cp>In September 2016, for instance, health inspectors \u003ca href=\"https://www.medicare.gov/nursinghomecompare/InspectionReportDetail.aspx?ID=146064&SURVEYDATE=09/21/2016&INSPTYPE=CMPL&Inspn=HEALTH&profTab=1&loc=DECATUR%2C%20IL&lat=39.8403147&lng=-88.9548001&name=LINCOLN%20MANOR&Distn=2.7\" target=\"_blank\" rel=\"noopener\">faulted Lincoln Manor\u003c/a>, a nursing home in Decatur, Ill., for failing to monitor and treat the wound of a patient whose implanted pain-medication pump gradually slipped over eight days through a ruptured suture and protruded from her abdomen. The patient died.\u003c/p>\n\u003cp>CMS fined Lincoln Manor $282,954, including $10,091 a day for 28 days, from the time the nursing home noticed the problem with the wound until supervisors had retrained nurses to avoid similar errors. An administrative law judge called the penalties “quite modest” given the “appalling” care.\u003c/p>\n\u003cp>The fines were issued before the new guidelines took effect; if the agency had issued a one-time fine, the maximum would have been less than $21,000.\u003c/p>\n\u003cp>Lincoln Manor closed in September. Its owner could not be reached for comment, and his lawyer did not respond to an interview request.\u003c/p>\n\u003cp>Advocates for nursing home residents say that relaxing penalties threatens to undo progress at deterring wrongdoing. Janet Wells, a consultant for California Advocates for Nursing Home Reform, said the changes come as “some egregious violations and injuries to residents are being penalized — finally — at a level that gets the industry’s attention and isn’t just the cost of doing business.”\u003c/p>\n\u003cp>In November, the Trump administration exempted nursing homes that violate \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-18-04.pdf\" target=\"_blank\" rel=\"noopener\">eight new safety rules\u003c/a> from penalties for 18 months. Homes must still follow the rules, which are intended, among other things, to reduce the overuse of psychotropic drugs and to ensure that every home has adequate resources to assist residents with major psychological problems.\u003c/p>\n\u003cp>Rodney Whitlock, a health policy consultant and former Republican Senate staffer, said health inspectors “are out there looking for opportunities to show that the nursing homes are not living up to some extremely tight standards.” He said while the motivation for tough regulation was understandable, “the fines don’t make it easier to hire people and doesn’t make it easier to stay in business.”\u003c/p>\n\u003cp>In June, CMS rescinded another Obama administration action that banned nursing homes from pre-emptively requiring residents to submit to arbitration to settle disputes rather than going to court.\u003c/p>\n\u003cp>“We publish nearly 11,000 pages of regulation every year,” the agency’s administrator, Seema Verma, said in \u003ca href=\"https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-10-30.html\" target=\"_blank\" rel=\"noopener\">a speech in October\u003c/a>. That paperwork is “taking doctors away from what matters most: patients.”\u003c/p>\n\u003cp>Janine Finck-Boyle, director of health regulations and policy at LeadingAge, a group of nonprofit nursing homes and other entities that care for older people, said the group’s members had been struggling to cope with regulations.\u003c/p>\n\u003cp>“If you’re a 50-bed rural facility out West or in the Dakotas,” she said, “you don’t have the resources to get everything done from A to Z.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Henry J. Kaiser Family Foundation\u003c/a> which is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Medicare is discouraging regional offices from fining nursing homes for “one-time mistakes.\"","status":"publish","parent":0,"modified":1514922063,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":32,"wordCount":1129},"headData":{"title":"Trump Administration Relaxes Financial Penalties Against Nursing Homes | KQED","description":"Medicare is discouraging regional offices from fining nursing homes for “one-time mistakes."","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"362314 https://ww2.kqed.org/stateofhealth/?p=362314","disqusUrl":"https://ww2.kqed.org/stateofhealth/2018/01/02/trump-administration-relaxes-financial-penalties-against-nursing-homes/","disqusTitle":"Trump Administration Relaxes Financial Penalties Against Nursing Homes","nprByline":"\u003ca href=\"https://californiahealthline.org/news/author/jordan-rau/\" target=\"_blank\" rel=\"noopener\">Jordan Rau\u003c/a>","path":"/stateofhealth/362314/trump-administration-relaxes-financial-penalties-against-nursing-homes","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Trump administration — reversing guidelines put in place under President Barack Obama — is scaling back the use of fines against nursing homes that harm residents or place them in grave risk of injury.\u003c/p>\n\u003cp>The shift in the Medicare program’s penalty protocols was requested by the nursing home industry. The American Health Care Association, the industry’s main trade group, has complained that under Obama, federal inspectors focused excessively on catching wrongdoing rather than helping nursing homes improve.\u003c/p>\n\u003cp>“It is critical that we have relief,” Mark Parkinson, the group’s president, wrote in a letter to then-President-elect Donald Trump in December 2016.\u003c/p>\n\u003cp>Since 2013, nearly 6,500 nursing homes — 4 of every 10 — have been cited at least once for a serious violation, federal records show. Medicare has fined two-thirds of those homes. Common citations include failing to protect residents from avoidable accidents, neglect, mistreatment and bedsores.\u003c/p>\n\u003cp>The new guidelines discourage regulators from levying fines in some situations, even when they have resulted in a resident’s death. The guidelines will also probably result in lower fines for many facilities.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The change in policy aligns with Trump’s promise to reduce bureaucracy, regulation and government intervention in business.\u003c/p>\n\u003cp>Dr. Kate Goodrich, director of clinical standards and quality at the Centers for Medicare & Medicaid Services (CMS), said in a statement that unnecessary regulation was the main concern that health care providers raised with officials.\u003c/p>\n\u003cp>“Rather than spending quality time with their patients, the providers are spending time complying with regulations that get in the way of caring for their patients and doesn’t increase the quality of care they provide,” Goodrich said.\u003c/p>\n\u003cp>But advocates for nursing-home residents say the revised penalties are weakening a valuable patient-safety tool.\u003c/p>\n\u003cp>“They’ve pretty much emasculated enforcement, which was already weak,” said Toby Edelman, a senior attorney at the Center for Medicare Advocacy.\u003c/p>\n\u003cp>Medicare has different ways of applying penalties. It can impose a specific fine for a particular violation. It can assess a fine for each day that a nursing home was in violation. Or it can deny payments for new admissions.\u003c/p>\n\u003cp>The average fine in recent years has been $33,453, but 531 nursing homes amassed combined federal fines above $100,000, records show. In 2016, Congress \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Civil-Monetary-Penalties-Annual-Adjustments.html\" target=\"_blank\" rel=\"noopener\">increased the fines\u003c/a> to factor in several years of inflation that had not been accounted for previously.\u003c/p>\n\u003cp>The new rules have been instituted gradually throughout the year.\u003c/p>\n\u003cp>In October, \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-18-01.pdf\" target=\"_blank\" rel=\"noopener\">CMS discouraged\u003c/a> its regional offices from levying fines, even in the most serious health violations, if the error was a “one-time mistake.” The centers said that intentional disregard for residents’ health and safety or systemic errors should still merit fines.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-17-37.pdf\" target=\"_blank\" rel=\"noopener\">July memo\u003c/a> from CMS discouraged the directors of state agencies that survey nursing homes from issuing daily fines for violations that began before an inspection, favoring one-time fines instead. Daily fines remain the recommended approach for major violations discovered during an inspection.\u003c/p>\n\u003cp>Dr. David Gifford, the American Health Care Association’s senior vice president for quality, said daily fines were intended to prompt quick remedies but were pointless when applied to past errors that had already been fixed by the time inspectors discovered them.\u003c/p>\n\u003cp>“What was happening is you were seeing massive fines accumulating because they were applying them on a per-day basis retrospectively,” Gifford said.\u003c/p>\n\u003cp>But the change means that some nursing homes could be sheltered from fines above the maximum per-instance fine of $20,965, even for egregious mistakes.\u003c/p>\n\u003cp>In September 2016, for instance, health inspectors \u003ca href=\"https://www.medicare.gov/nursinghomecompare/InspectionReportDetail.aspx?ID=146064&SURVEYDATE=09/21/2016&INSPTYPE=CMPL&Inspn=HEALTH&profTab=1&loc=DECATUR%2C%20IL&lat=39.8403147&lng=-88.9548001&name=LINCOLN%20MANOR&Distn=2.7\" target=\"_blank\" rel=\"noopener\">faulted Lincoln Manor\u003c/a>, a nursing home in Decatur, Ill., for failing to monitor and treat the wound of a patient whose implanted pain-medication pump gradually slipped over eight days through a ruptured suture and protruded from her abdomen. The patient died.\u003c/p>\n\u003cp>CMS fined Lincoln Manor $282,954, including $10,091 a day for 28 days, from the time the nursing home noticed the problem with the wound until supervisors had retrained nurses to avoid similar errors. An administrative law judge called the penalties “quite modest” given the “appalling” care.\u003c/p>\n\u003cp>The fines were issued before the new guidelines took effect; if the agency had issued a one-time fine, the maximum would have been less than $21,000.\u003c/p>\n\u003cp>Lincoln Manor closed in September. Its owner could not be reached for comment, and his lawyer did not respond to an interview request.\u003c/p>\n\u003cp>Advocates for nursing home residents say that relaxing penalties threatens to undo progress at deterring wrongdoing. Janet Wells, a consultant for California Advocates for Nursing Home Reform, said the changes come as “some egregious violations and injuries to residents are being penalized — finally — at a level that gets the industry’s attention and isn’t just the cost of doing business.”\u003c/p>\n\u003cp>In November, the Trump administration exempted nursing homes that violate \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-18-04.pdf\" target=\"_blank\" rel=\"noopener\">eight new safety rules\u003c/a> from penalties for 18 months. Homes must still follow the rules, which are intended, among other things, to reduce the overuse of psychotropic drugs and to ensure that every home has adequate resources to assist residents with major psychological problems.\u003c/p>\n\u003cp>Rodney Whitlock, a health policy consultant and former Republican Senate staffer, said health inspectors “are out there looking for opportunities to show that the nursing homes are not living up to some extremely tight standards.” He said while the motivation for tough regulation was understandable, “the fines don’t make it easier to hire people and doesn’t make it easier to stay in business.”\u003c/p>\n\u003cp>In June, CMS rescinded another Obama administration action that banned nursing homes from pre-emptively requiring residents to submit to arbitration to settle disputes rather than going to court.\u003c/p>\n\u003cp>“We publish nearly 11,000 pages of regulation every year,” the agency’s administrator, Seema Verma, said in \u003ca href=\"https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-10-30.html\" target=\"_blank\" rel=\"noopener\">a speech in October\u003c/a>. That paperwork is “taking doctors away from what matters most: patients.”\u003c/p>\n\u003cp>Janine Finck-Boyle, director of health regulations and policy at LeadingAge, a group of nonprofit nursing homes and other entities that care for older people, said the group’s members had been struggling to cope with regulations.\u003c/p>\n\u003cp>“If you’re a 50-bed rural facility out West or in the Dakotas,” she said, “you don’t have the resources to get everything done from A to Z.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Henry J. Kaiser Family Foundation\u003c/a> which is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/362314/trump-administration-relaxes-financial-penalties-against-nursing-homes","authors":["byline_stateofhealth_362314"],"categories":["stateofhealth_14"],"tags":["stateofhealth_2808","stateofhealth_2519","stateofhealth_2829","stateofhealth_3209"],"affiliates":["stateofhealth_3036","stateofhealth_3007"],"featImg":"stateofhealth_362315","label":"stateofhealth_3007"},"stateofhealth_362214":{"type":"posts","id":"stateofhealth_362214","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"362214","score":null,"sort":[1513692052000]},"guestAuthors":[],"slug":"complaints-rise-in-california-as-nursing-homes-evict-poor-patients","title":"Complaints Rise in California as Nursing Homes Evict Poor Patients","publishDate":1513692052,"format":"audio","headTitle":"California Healthline | State of Health | KQED News","labelTerm":{"term":3036,"site":"stateofhealth"},"content":"\u003cp>Anita Willis says the social worker offered her a painful choice: She could either leave the San Jose, Calif., nursing home where she’d spent a month recovering from a stroke — or come up with $336 a day to stay on.\u003c/p>\n\u003cp>She had until midnight to decide.\u003c/p>\n\u003cp>Willis’ Medicaid managed-care plan had told the home that it was cutting off payment because she no longer qualified for such a high level of care. If Willis, 58, stayed and paid the daily rate, her Social Security disability money would run out in three days. But if she left, she had nowhere to go. She’d recently become homeless after a breakup and said she couldn’t even afford a room-and-board setting.\u003c/p>\n\u003cp>In tears, she said, she agreed to leave. Thus began a months-long odyssey from budget motels to acquaintances’ couches to hospital ERs — at least five emergency visits in all, she said. Sometimes, her 25-year-old daughter drove down from Sacramento, and Willis slept in her daughter’s car.\u003c/p>\n\u003cp>“They kicked me out in the cold,” said Willis, a former Head Start teacher.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Complaints about allegedly improper evictions and discharges from nursing homes are on the rise in California, Illinois and other states, according to government data. These concerns are echoed in lawsuits and by ombudsmen and consumer advocates.\u003c/p>\n\u003cp>In California alone, such complaints have jumped 70 percent in five years, reaching 1,504 last year, said Joseph Rodrigues, the state-employed Long-Term Care Ombudsman, who for 15 years has overseen local ombudsman programs, which are responsible for resolving consumer complaints.\u003c/p>\n\u003cp>Around the country, ombudsmen say many patients like Willis end up with no permanent housing or regular medical care after being discharged. Even when the discharges are deemed legal, these ombudsmen say, they often are unethical.\u003c/p>\n\u003cp>“It’s a growing problem,” said Leza Coleman, executive director of the California Long-Term Care Ombudsman Association. Coleman says the practice stems from skilled nursing facilities’ desire for better compensation for their services and from the shortage of other affordable long-term care options that might absorb less severe cases.\u003c/p>\n\u003cp>In Willis’ case, she ultimately lost her appeal to return to the nursing home, Courtyard Care Center. A state hearing judge determined that she had left the home voluntarily because she refused the opportunity to pay to remain there.\u003c/p>\n\u003cp>Top administrators at Sava Senior Care, which owns Courtyard, did not return repeated calls for comment.\u003c/p>\n\u003cp>Among other recent cases of allegedly improper discharges:\u003c/p>\n\u003cul>\n\u003cli>In October, California’s attorney general moved to prevent a Bakersfield nursing home administrator from working with elderly and disabled people, while he awaits trial on charges of elder abuse and wrongful discharge. State prosecutors said one patient was falsely informed that she owed the home money, then sent to an independent living center even though she could not “walk or toilet on her own.” The administrator did not return messages left at the nursing home.\u003c/li>\n\u003cli>A \u003ca href=\"http://www.marylandattorneygeneral.gov/News%20Documents/State_v_NMS_Complaint.pdf\" target=\"_blank\" rel=\"noopener\">pending lawsuit\u003c/a> by Maryland’s attorney general alleges a nursing home chain, Neiswanger Management Services (NMS), illegally evicted residents, sending them to homeless shelters or other inadequate facilities to free up bed space for higher-paying patients. NMS countersued state regulators, alleging they are trying to drive the chain out of business.\u003c/li>\n\u003cli>Last month, a 73-year-old woman with diabetes and heart failure \u003ca href=\"http://canhr.org/newsroom/newdev_archive/2017/PDFs/Complaint-JohnsonMoore-Dumping.pdf\" target=\"_blank\" rel=\"noopener\">sued a Fresno, Calif., nursing home\u003c/a> for allegedly \u003ca href=\"http://www.fresnobee.com/news/local/article182618836.html\" target=\"_blank\" rel=\"noopener\">leaving her with an open wound on a sidewalk\u003c/a> in front of a relative’s home. The suit said conditions in the residence were unsafe and a family member refused to allow her inside. The state cited the home in July and issued a $20,000 fine.\u003c/li>\n\u003c/ul>\n\u003cp>Of course, not all complaints or lawsuits are well-founded. Federal law allows a nursing home to discharge or evict a patient when it cannot meet the resident’s needs or the person no longer requires services; if the resident endangers the health and safety of other individuals; or if the patient has failed, after reasonable and appropriate notice, to pay.\u003c/p>\n\u003cp>The law also generally requires a home to provide 30 days’ notice before discharging a patient involuntarily and requires all discharges be safe and orderly.\u003c/p>\n\u003cp>Deborah Pacyna, spokeswoman for the California Association of Health Facilities, a trade organization that represents nursing homes, questions why nursing homes should be responsible for providing a safety net for the indigent and homeless.\u003c/p>\n\u003cp>“Nursing home residents reflect society,” she said in a written statement. “Some nursing home residents live in homeless shelters or hotels. They may request that they go back ‘home,’ or to their local shelter or hotel upon discharge. We must honor their choices as long as their needs are met.”\u003c/p>\n\u003cp>Pacyna also noted that eviction and discharge complaints represent a tiny fraction of the hundreds of thousands of residents released from the state’s nursing homes each year.\u003c/p>\n\u003cp>Nationally, discharge and eviction complaints have remained more or less steady in recent years after rising significantly between 2000 and 2007, according to data collected by the federal government. Still, these complaints remain the top grievance reported to nursing home ombudsmen as the number of overall complaints about everything from abuse to access to information has dropped in the past decade.\u003c/p>\n\u003cp>The rate of complaints can vary considerably by state. Jamie Freschi, the Illinois state ombudsman, says discharge and eviction complaints have more than doubled in her state since 2011.\u003c/p>\n\u003cp>She recalled one wheelchair-bound nursing resident who was in severe pain from osteoarthritis, scoliosis and fibromyalgia when she was discharged from a nursing home and sent to a homeless shelter. After the shelter rejected her because it could not accommodate her wheelchair, the resident went to a motel, which kicked her out when she ran out of money. She has since cycled between the emergency room and the streets, Freschi said.\u003c/p>\n\u003cp>“It’s an example of a really, really broken system, all the way around,” Freschi said.\u003c/p>\n\u003cp>Advocates say such decisions are often money-driven: Medicare covers patients for just a short time after they are released from hospitals. After that, these critics say, many nursing homes don’t want to accept the lower rates paid by Medicaid, the public insurance program for low-income residents.\u003c/p>\n\u003cp>Even when they appeal and win, advocates say, it doesn’t always help the patient. The Centers for Medicare & Medicaid Services has advised California on two occasions — including this past summer — that it must enforce decisions from appeals hearings. (The state contends that it uses a variety of strategies to enforce the law.)\u003c/p>\n\u003cp>Last month, the California Long-Term Care Ombudsman Association joined with the legal wing of the AARP Foundation to \u003ca href=\"https://www.documentcloud.org/documents/4199718-2017-10-02-Complaint.html\" target=\"_blank\" rel=\"noopener\">sue a Sacramento nursing home\u003c/a>, alleging it had improperly discharged an 83-year-old woman with Alzheimer’s — requiring the nursing home to readmit her.\u003c/p>\n\u003cp>“The facilities are getting the message that they don’t have to follow the rules here, so they’re emboldened,” said Matt Borden, a San Francisco attorney helping with the lawsuit.\u003c/p>\n\u003cp>Willis and her advocates were convinced that Courtyard Care Center broke the rules in her case.\u003c/p>\n\u003cp>Willis “did not leave Courtyard ‘voluntarily’ in just about any sense of the word,” said Tony Chicotel, a staff attorney with California Advocates for Nursing Home Reform.\u003c/p>\n\u003cp>At a hearing in April, held at the nursing home and attended by a reporter, Chicotel and an ombudsman argued that Willis’ discharge violated legal requirements, including lack of written notice. They asked that she be immediately readmitted.\u003c/p>\n\u003cp>According to hearing documents, Willis’ documented medical problems were many: an aneurysm, an ulcer, difficulty walking, muscle weakness, gastritis, anemia and heart and kidney disease. During her stay at the nursing home, she said, she’d fallen and hit her head while visiting the doctor, resulting in a severe concussion.\u003c/p>\n\u003cp>For their part, Courtyard staffers explained that Medicaid wouldn’t cover Willis anymore based on their assessment of her condition. They said she had “almost returned to her prior level of functioning.”\u003c/p>\n\u003cp>During the hearing, Willis repeatedly told those in attendance that she felt dizzy and nauseated. Her head pounded. “I’m not good,” she said. Afterward, she begged for a ride to the emergency room, where she was admitted with a torn aorta and bleeding ulcer.\u003c/p>\n\u003cp>She was still in the hospital when the hearing officer issued her decision a few days later. Eventually, she was released to another nursing home, which also discharged her after a month, she said. Then she resumed sleeping on friends’ couches. She chose not to file another appeal.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“This time in my life,” Willis said, “it’s very discouraging.”\u003c/p>\n\n","blocks":[],"excerpt":"Complaints about allegedly improper evictions and discharges from nursing homes in California have risen 70 percent in the last five years. ","status":"publish","parent":0,"modified":1517982528,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":35,"wordCount":1499},"headData":{"title":"Complaints Rise in California as Nursing Homes Evict Poor Patients | KQED","description":"Complaints about allegedly improper evictions and discharges from nursing homes in California have risen 70 percent in the last five years. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"362214 https://ww2.kqed.org/stateofhealth/?p=362214","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/12/19/complaints-rise-in-california-as-nursing-homes-evict-poor-patients/","disqusTitle":"Complaints Rise in California as Nursing Homes Evict Poor Patients","audioUrl":"https://www.kqed.org/.stream/anon/radio/tcr/2018/02/NursingHomeEvictionsFeibel.mp3","nprByline":"\u003cb>Jocelyn Wiener\u003c/b>\u003c/br>California Healthline","path":"/stateofhealth/362214/complaints-rise-in-california-as-nursing-homes-evict-poor-patients","audioDuration":null,"audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Anita Willis says the social worker offered her a painful choice: She could either leave the San Jose, Calif., nursing home where she’d spent a month recovering from a stroke — or come up with $336 a day to stay on.\u003c/p>\n\u003cp>She had until midnight to decide.\u003c/p>\n\u003cp>Willis’ Medicaid managed-care plan had told the home that it was cutting off payment because she no longer qualified for such a high level of care. If Willis, 58, stayed and paid the daily rate, her Social Security disability money would run out in three days. But if she left, she had nowhere to go. She’d recently become homeless after a breakup and said she couldn’t even afford a room-and-board setting.\u003c/p>\n\u003cp>In tears, she said, she agreed to leave. Thus began a months-long odyssey from budget motels to acquaintances’ couches to hospital ERs — at least five emergency visits in all, she said. Sometimes, her 25-year-old daughter drove down from Sacramento, and Willis slept in her daughter’s car.\u003c/p>\n\u003cp>“They kicked me out in the cold,” said Willis, a former Head Start teacher.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Complaints about allegedly improper evictions and discharges from nursing homes are on the rise in California, Illinois and other states, according to government data. These concerns are echoed in lawsuits and by ombudsmen and consumer advocates.\u003c/p>\n\u003cp>In California alone, such complaints have jumped 70 percent in five years, reaching 1,504 last year, said Joseph Rodrigues, the state-employed Long-Term Care Ombudsman, who for 15 years has overseen local ombudsman programs, which are responsible for resolving consumer complaints.\u003c/p>\n\u003cp>Around the country, ombudsmen say many patients like Willis end up with no permanent housing or regular medical care after being discharged. Even when the discharges are deemed legal, these ombudsmen say, they often are unethical.\u003c/p>\n\u003cp>“It’s a growing problem,” said Leza Coleman, executive director of the California Long-Term Care Ombudsman Association. Coleman says the practice stems from skilled nursing facilities’ desire for better compensation for their services and from the shortage of other affordable long-term care options that might absorb less severe cases.\u003c/p>\n\u003cp>In Willis’ case, she ultimately lost her appeal to return to the nursing home, Courtyard Care Center. A state hearing judge determined that she had left the home voluntarily because she refused the opportunity to pay to remain there.\u003c/p>\n\u003cp>Top administrators at Sava Senior Care, which owns Courtyard, did not return repeated calls for comment.\u003c/p>\n\u003cp>Among other recent cases of allegedly improper discharges:\u003c/p>\n\u003cul>\n\u003cli>In October, California’s attorney general moved to prevent a Bakersfield nursing home administrator from working with elderly and disabled people, while he awaits trial on charges of elder abuse and wrongful discharge. State prosecutors said one patient was falsely informed that she owed the home money, then sent to an independent living center even though she could not “walk or toilet on her own.” The administrator did not return messages left at the nursing home.\u003c/li>\n\u003cli>A \u003ca href=\"http://www.marylandattorneygeneral.gov/News%20Documents/State_v_NMS_Complaint.pdf\" target=\"_blank\" rel=\"noopener\">pending lawsuit\u003c/a> by Maryland’s attorney general alleges a nursing home chain, Neiswanger Management Services (NMS), illegally evicted residents, sending them to homeless shelters or other inadequate facilities to free up bed space for higher-paying patients. NMS countersued state regulators, alleging they are trying to drive the chain out of business.\u003c/li>\n\u003cli>Last month, a 73-year-old woman with diabetes and heart failure \u003ca href=\"http://canhr.org/newsroom/newdev_archive/2017/PDFs/Complaint-JohnsonMoore-Dumping.pdf\" target=\"_blank\" rel=\"noopener\">sued a Fresno, Calif., nursing home\u003c/a> for allegedly \u003ca href=\"http://www.fresnobee.com/news/local/article182618836.html\" target=\"_blank\" rel=\"noopener\">leaving her with an open wound on a sidewalk\u003c/a> in front of a relative’s home. The suit said conditions in the residence were unsafe and a family member refused to allow her inside. The state cited the home in July and issued a $20,000 fine.\u003c/li>\n\u003c/ul>\n\u003cp>Of course, not all complaints or lawsuits are well-founded. Federal law allows a nursing home to discharge or evict a patient when it cannot meet the resident’s needs or the person no longer requires services; if the resident endangers the health and safety of other individuals; or if the patient has failed, after reasonable and appropriate notice, to pay.\u003c/p>\n\u003cp>The law also generally requires a home to provide 30 days’ notice before discharging a patient involuntarily and requires all discharges be safe and orderly.\u003c/p>\n\u003cp>Deborah Pacyna, spokeswoman for the California Association of Health Facilities, a trade organization that represents nursing homes, questions why nursing homes should be responsible for providing a safety net for the indigent and homeless.\u003c/p>\n\u003cp>“Nursing home residents reflect society,” she said in a written statement. “Some nursing home residents live in homeless shelters or hotels. They may request that they go back ‘home,’ or to their local shelter or hotel upon discharge. We must honor their choices as long as their needs are met.”\u003c/p>\n\u003cp>Pacyna also noted that eviction and discharge complaints represent a tiny fraction of the hundreds of thousands of residents released from the state’s nursing homes each year.\u003c/p>\n\u003cp>Nationally, discharge and eviction complaints have remained more or less steady in recent years after rising significantly between 2000 and 2007, according to data collected by the federal government. Still, these complaints remain the top grievance reported to nursing home ombudsmen as the number of overall complaints about everything from abuse to access to information has dropped in the past decade.\u003c/p>\n\u003cp>The rate of complaints can vary considerably by state. Jamie Freschi, the Illinois state ombudsman, says discharge and eviction complaints have more than doubled in her state since 2011.\u003c/p>\n\u003cp>She recalled one wheelchair-bound nursing resident who was in severe pain from osteoarthritis, scoliosis and fibromyalgia when she was discharged from a nursing home and sent to a homeless shelter. After the shelter rejected her because it could not accommodate her wheelchair, the resident went to a motel, which kicked her out when she ran out of money. She has since cycled between the emergency room and the streets, Freschi said.\u003c/p>\n\u003cp>“It’s an example of a really, really broken system, all the way around,” Freschi said.\u003c/p>\n\u003cp>Advocates say such decisions are often money-driven: Medicare covers patients for just a short time after they are released from hospitals. After that, these critics say, many nursing homes don’t want to accept the lower rates paid by Medicaid, the public insurance program for low-income residents.\u003c/p>\n\u003cp>Even when they appeal and win, advocates say, it doesn’t always help the patient. The Centers for Medicare & Medicaid Services has advised California on two occasions — including this past summer — that it must enforce decisions from appeals hearings. (The state contends that it uses a variety of strategies to enforce the law.)\u003c/p>\n\u003cp>Last month, the California Long-Term Care Ombudsman Association joined with the legal wing of the AARP Foundation to \u003ca href=\"https://www.documentcloud.org/documents/4199718-2017-10-02-Complaint.html\" target=\"_blank\" rel=\"noopener\">sue a Sacramento nursing home\u003c/a>, alleging it had improperly discharged an 83-year-old woman with Alzheimer’s — requiring the nursing home to readmit her.\u003c/p>\n\u003cp>“The facilities are getting the message that they don’t have to follow the rules here, so they’re emboldened,” said Matt Borden, a San Francisco attorney helping with the lawsuit.\u003c/p>\n\u003cp>Willis and her advocates were convinced that Courtyard Care Center broke the rules in her case.\u003c/p>\n\u003cp>Willis “did not leave Courtyard ‘voluntarily’ in just about any sense of the word,” said Tony Chicotel, a staff attorney with California Advocates for Nursing Home Reform.\u003c/p>\n\u003cp>At a hearing in April, held at the nursing home and attended by a reporter, Chicotel and an ombudsman argued that Willis’ discharge violated legal requirements, including lack of written notice. They asked that she be immediately readmitted.\u003c/p>\n\u003cp>According to hearing documents, Willis’ documented medical problems were many: an aneurysm, an ulcer, difficulty walking, muscle weakness, gastritis, anemia and heart and kidney disease. During her stay at the nursing home, she said, she’d fallen and hit her head while visiting the doctor, resulting in a severe concussion.\u003c/p>\n\u003cp>For their part, Courtyard staffers explained that Medicaid wouldn’t cover Willis anymore based on their assessment of her condition. They said she had “almost returned to her prior level of functioning.”\u003c/p>\n\u003cp>During the hearing, Willis repeatedly told those in attendance that she felt dizzy and nauseated. Her head pounded. “I’m not good,” she said. Afterward, she begged for a ride to the emergency room, where she was admitted with a torn aorta and bleeding ulcer.\u003c/p>\n\u003cp>She was still in the hospital when the hearing officer issued her decision a few days later. Eventually, she was released to another nursing home, which also discharged her after a month, she said. Then she resumed sleeping on friends’ couches. She chose not to file another appeal.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“This time in my life,” Willis said, “it’s very discouraging.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/362214/complaints-rise-in-california-as-nursing-homes-evict-poor-patients","authors":["byline_stateofhealth_362214"],"categories":["stateofhealth_11","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_3207","stateofhealth_3208","stateofhealth_2808","stateofhealth_99","stateofhealth_2519","stateofhealth_2829"],"affiliates":["stateofhealth_3036"],"featImg":"stateofhealth_362215","label":"stateofhealth_3036"},"stateofhealth_351133":{"type":"posts","id":"stateofhealth_351133","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"351133","score":null,"sort":[1499378023000]},"guestAuthors":[],"slug":"half-of-nursing-homes-scrutinized-on-safety-still-treacherous","title":"Half of Nursing Homes Scrutinized on Safety Still Treacherous","publishDate":1499378023,"format":"standard","headTitle":"Kaiser Health News | State of Health | KQED News","labelTerm":{"term":3007,"site":"stateofhealth"},"content":"\u003cp>In 2012, Parkview Healthcare Center’s history of safety violations led California regulators to issue an ultimatum reserved for the most dangerous nursing homes.\u003c/p>\n\u003cp>The state’s public health department designated Parkview, a Bakersfield, Calif., nursing home, a “special focus facility,” requiring it to either fix lapses in care while under increased inspections or be stripped of federal funding by Medicare and Medicaid — a financial deprivation few homes can survive. After 15 months of scrutiny, the regulators deemed Parkview improved and released it from extra oversight.\u003c/p>\n\u003cp>But a few months later, Elaine Fisher, a 74-year-old who had lost the use of her legs after a stroke, slid out of her wheelchair at Parkview. Afterward, the nursing home promised to place a nonskid pad on her chair but did not, inspectors later found. Twice more, Fisher slipped from her wheelchair, fracturing her hip the final time.\u003c/p>\n\u003cp>The violation drew a $10,000 penalty for Parkview, one of 10 fines totaling $126,300 incurred by the nursing home since the special focus status was lifted in 2014.\u003c/p>\n\u003cp>While special focus status is one of the federal government’s strictest forms of oversight, nursing homes that were forced to undergo such scrutiny often slide back into providing dangerous care, according to a Kaiser Health News analysis of federal health inspection data. Of 528 nursing homes that graduated from special focus status before 2014 and are still operating, slightly more than half — 52 percent — have since harmed patients or put patients in serious jeopardy within the past three years.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>These nursing homes are in 46 states. Some gave patients the wrong medications, failed to protect them from violent or bullying residents and staff members, or neglected to tell families or physicians about injuries, inspection records show. Years after regulators conferred clean bills of health, levels of registered nurses tend to remain lower than at other facilities.\u003c/p>\n\u003cp>Yet, despite recurrences of patient harm, nursing homes are rarely denied Medicare and Medicaid reimbursement. Consequences can be dire for patients like Fisher.\u003c/p>\n\u003cp>“She used to go to bingo every day and she was very involved in the nursing home,” said her son-in-law, Eric Powers. He said that although Fisher moved to a different nursing home for better care, “after this whole thing, she has to be on painkillers. She’s mainly in her room all the time. It’s the saddest thing in the world.”\u003c/p>\n\u003cp>Parkview’s owner at the time of the violations, LifeHouse Health Services, did not respond to requests for comment. Dr. David Silver, who purchased Parkview last fall, said he had replaced top management and staff members who resisted a new approach.\u003c/p>\n\u003cp>“We were not happy with the level of patient care,” he said.\u003c/p>\n\u003cp>Regulators rarely return homes to the watch list, instead issuing fines for subsequent lapses. Some homes continue operating despite multiple penalties.\u003c/p>\n\u003cp>“When you’re looking at these large corporations, that’s just the cost of doing business,” said Neil Gehlawat, who is representing Fisher in her pending lawsuit against Parkview. “It doesn’t have the effect of changing behavior.”\u003c/p>\n\u003cp>\u003cstrong>‘Worst Of The Worst’\u003c/strong>\u003c/p>\n\u003cp>The Centers for Medicare & Medicaid Services, or CMS, sets the federal standards for nursing homes and determines whether they are in compliance, based on inspections performed primarily by state health departments. States license facilities and have the authority to revoke the licenses.\u003c/p>\n\u003cp>Special focus facility status is reserved for the poorest-performing facilities out of more than 15,000 skilled nursing homes. The federal government assigns each state a set number of slots, roughly based on the number of nursing homes. Then state health regulators pick which nursing homes to include.\u003c/p>\n\u003cp>More than 900 facilities have been placed on the watch list since 2005. But the number of nursing homes under special focus at any given time has dropped by nearly half since 2012, because of federal budget cuts negotiated by President Barack Obama and Congress. This year, the $2.6 million budget allows only 88 nursing homes to \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-17-20.pdf\">receive the designation\u003c/a>, though regulators identified 435 as warranting scrutiny. California and Texas each has six slots, the most of any state. Twenty-nine states have just one.\u003c/p>\n\u003cp>Especially troubling is that more than a third of operating nursing facilities that graduated from the watch list before 2014 still hold the lowest possible Medicare rating for health and safety: one star of five, KHN’s analysis found.\u003c/p>\n\u003cp>“You have this recidivism of nursing homes that are special focus facilities,” said Richard Mollot, executive director of the Long Term Care Community Coalition, an advocacy group in Manhattan. “These are the worst of the worst and they’re back?”\u003c/p>\n\u003cp>CMS defended the program, saying that nursing homes on the watch list showed more improvement than did comparably struggling facilities not selected for enhanced supervision. “CMS continues to work to improve oversight to prevent any facility from regressing in performance,” the statement said.\u003c/p>\n\u003cfigure id=\"attachment_351140\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-351140\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-800x533.jpg\" alt=\"Andrew Edwards is among the patients who were harmed by nursing homes that had earlier been given a clean bill of health by Medicare and health regulators.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-1180x786.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-520x346.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo.jpg 1540w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Andrew Edwards is among the patients who were harmed by nursing homes that had earlier been given a clean bill of health by Medicare and health regulators. \u003ccite>(Doug Kapustin/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Short-Term Oversight\u003c/strong>\u003c/p>\n\u003cp>Special scrutiny was lifted for about one-fourth of the nursing homes in less than a year. Facilities need to pass only two consecutive inspections without major violations or substantiated complaints.\u003c/p>\n\u003cp>“The period of time is just not long enough for them to show that they can sustain improvement,” said Robyn Grant, director for public policy at the National Consumer Voice for Quality Long-Term Care in Washington. “There needs to be some significant changes in the program.”\u003c/p>\n\u003cp>In 2010, NMS Healthcare of Hagerstown, Md., left the watch list after 10 months.\u003c/p>\n\u003cp>Last year, Maryland’s attorney general \u003ca href=\"http://www.marylandattorneygeneral.gov/News%20Documents/State_v_NMS_Complaint.pdf\">sued the facility and its owner,\u003c/a> Neiswanger Management Services, \u003ca href=\"http://www.marylandattorneygeneral.gov/Press/2016/122116.pdf\">alleging that they evicted\u003c/a> frail, infirm and mentally disabled residents “with brutal indifference” when their health coverage ran out or the facility had the opportunity to get someone with better insurance.\u003c/p>\n\u003cp>Among those was Andrew Edwards, who was told by NMS that he was being discharged to an assisted-living center, according to the lawsuit. Instead, in January 2016, the staff sent him to a crowded, unlicensed Baltimore City row house where the owner confiscated his bank card and withdrew $966 over his objections, the lawsuit said. Although NMS said it had arranged for his outpatient kidney dialysis, “that was false,” Edwards said in an interview. He ended up in an emergency room after he missed his treatment.\u003c/p>\n\u003cp>NMS maintains it stopped referring patients to that owner when told of the conditions. This month, CMS expelled the Hagerstown nursing home from Medicare and Medicaid after citing it for more violations. The company is closing the facility. NMS, which still runs other homes in Maryland, has sued state regulators, claiming they are vindictively trying to drive the chain out of business.\u003c/p>\n\u003cp>\u003cstrong>Few Terminations\u003c/strong>\u003c/p>\n\u003cp>Some nursing homes on the watch list do maintain improvements. After Evergreen Nursing Home in southern Alabama was designated a special focus facility in 2005, the owners brought in new managers and added nursing supervisors, said Kimberly Bush, the facility’s administrator.\u003c/p>\n\u003cp>Medicare now rates Evergreen a five-star facility. “I’d like to say there’s some kind of magic recipe to this, but it’s just doing the job and holding people accountable,” Bush said.\u003c/p>\n\u003cp>But even prolonged supervision does not guarantee progress. Poplar Point Health and Rehabilitation in Memphis stayed on the watch list for 2½ years until 2009. A \u003ca href=\"https://www.justice.gov/opa/pr/united-states-files-false-claims-act-complaint-against-six-vanguard-nursing-facilities-and\">federal lawsuit brought last year\u003c/a> claims that Poplar and its owner, Vanguard Healthcare, regularly provided “nonexistent, grossly substandard, worthless care” as far back as 2010. Vanguard, now in bankruptcy court, declined to comment.\u003c/p>\n\u003cp>\u003cem>(Story continues below.)\u003c/em>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"//datawrapper.dwcdn.net/Sfw8o/12/\" scrolling=\"yes\" frameborder=\"0\" allowtransparency=\"true\" allowfullscreen=\"allowfullscreen\" webkitallowfullscreen=\"webkitallowfullscreen\" mozallowfullscreen=\"mozallowfullscreen\" oallowfullscreen=\"oallowfullscreen\" msallowfullscreen=\"msallowfullscreen\" width=\"600\" height=\"600\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>The ultimate enforcement threats are termination from Medicare and Medicaid or closure by state or federal authorities. But only 17 percent of former special focus facilities are no longer operating, and that can include ones that went out of business for unrelated reasons, KHN found.\u003c/p>\n\u003cp>State regulators are reluctant to close nursing homes because of the upheaval it causes patients and families. In some areas, there are no alternative facilities nearby, making termination even less appealing.\u003c/p>\n\u003cp>“At the end of the day, there are those centers that cannot be corrected, can’t fix themselves, and the best thing for the patients and the residents might be for them to move to another location,” said Lyn Bentley, an executive at the American Health Care Association, a nursing facility trade group. But, she said, “it’s always difficult to close someone’s home.”\u003c/p>\n\u003cp>\u003cstrong>Lack Of Nurses\u003c/strong>\u003c/p>\n\u003cp>Too few nurses, particularly registered nurses, provide care at some of the most troubled homes, KHN’s analysis shows. Registered nurse staffing was still 12 percent lower than at other facilities, even three years after the homes were released from the watch list.\u003c/p>\n\u003cp>In 2009, Pennsylvania health regulators released Golden LivingCenter-West Shore in Camp Hill after 17 months of supervision. The company said in a recent statement that when a home was put on that list, “we mobilize the resources necessary to help get that LivingCenter back into compliance.”\u003c/p>\n\u003cp>But data from Medicare’s Nursing Home Compare website show the facility has among the worst nurse-to-patient staffing ratios in the nation, with registered nurses devoting an average of 12 minutes for each patient daily. The state average is 58 minutes daily per patient.\u003c/p>\n\u003cp>Golden LivingCenter-West Shore was fined $59,150 in 2015 after being cited for, among other violations, allowing a resident’s feeding tube to become infested with maggots, records show. Also, Golden Living agreed to pay $750,000 to settle three cases involving patient injuries from falls that occurred after extra oversight ended, court records show.\u003c/p>\n\u003cp>Last year, Golden Living sold its Pennsylvania homes to Priority Healthcare Group.\u003c/p>\n\u003cp>Priority is following a common strategy for shedding an unwanted reputation: changing the facility’s name. In California, Parkview — where Fisher slipped out of her wheelchair — is being rebranded too, as Kingston Healthcare Center.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n","blocks":[],"excerpt":"Nursing homes that have graduated from an unsafe status by Medicare and are still operating have harmed patients.","status":"publish","parent":0,"modified":1499378023,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":true,"iframeSrcs":["//datawrapper.dwcdn.net/Sfw8o/12/"],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":45,"wordCount":1762},"headData":{"title":"Half of Nursing Homes Scrutinized on Safety Still Treacherous | KQED","description":"Nursing homes that have graduated from an unsafe status by Medicare and are still operating have harmed patients.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"351133 https://ww2.kqed.org/stateofhealth/?p=351133","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/07/06/half-of-nursing-homes-scrutinized-on-safety-still-treacherous/","disqusTitle":"Half of Nursing Homes Scrutinized on Safety Still Treacherous","nprByline":"\u003ca href=\"http://khn.org/news/author/jordan-rau/\" target=\"_blank\">Jordan Rau\u003c/a>","path":"/stateofhealth/351133/half-of-nursing-homes-scrutinized-on-safety-still-treacherous","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>In 2012, Parkview Healthcare Center’s history of safety violations led California regulators to issue an ultimatum reserved for the most dangerous nursing homes.\u003c/p>\n\u003cp>The state’s public health department designated Parkview, a Bakersfield, Calif., nursing home, a “special focus facility,” requiring it to either fix lapses in care while under increased inspections or be stripped of federal funding by Medicare and Medicaid — a financial deprivation few homes can survive. After 15 months of scrutiny, the regulators deemed Parkview improved and released it from extra oversight.\u003c/p>\n\u003cp>But a few months later, Elaine Fisher, a 74-year-old who had lost the use of her legs after a stroke, slid out of her wheelchair at Parkview. Afterward, the nursing home promised to place a nonskid pad on her chair but did not, inspectors later found. Twice more, Fisher slipped from her wheelchair, fracturing her hip the final time.\u003c/p>\n\u003cp>The violation drew a $10,000 penalty for Parkview, one of 10 fines totaling $126,300 incurred by the nursing home since the special focus status was lifted in 2014.\u003c/p>\n\u003cp>While special focus status is one of the federal government’s strictest forms of oversight, nursing homes that were forced to undergo such scrutiny often slide back into providing dangerous care, according to a Kaiser Health News analysis of federal health inspection data. Of 528 nursing homes that graduated from special focus status before 2014 and are still operating, slightly more than half — 52 percent — have since harmed patients or put patients in serious jeopardy within the past three years.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>These nursing homes are in 46 states. Some gave patients the wrong medications, failed to protect them from violent or bullying residents and staff members, or neglected to tell families or physicians about injuries, inspection records show. Years after regulators conferred clean bills of health, levels of registered nurses tend to remain lower than at other facilities.\u003c/p>\n\u003cp>Yet, despite recurrences of patient harm, nursing homes are rarely denied Medicare and Medicaid reimbursement. Consequences can be dire for patients like Fisher.\u003c/p>\n\u003cp>“She used to go to bingo every day and she was very involved in the nursing home,” said her son-in-law, Eric Powers. He said that although Fisher moved to a different nursing home for better care, “after this whole thing, she has to be on painkillers. She’s mainly in her room all the time. It’s the saddest thing in the world.”\u003c/p>\n\u003cp>Parkview’s owner at the time of the violations, LifeHouse Health Services, did not respond to requests for comment. Dr. David Silver, who purchased Parkview last fall, said he had replaced top management and staff members who resisted a new approach.\u003c/p>\n\u003cp>“We were not happy with the level of patient care,” he said.\u003c/p>\n\u003cp>Regulators rarely return homes to the watch list, instead issuing fines for subsequent lapses. Some homes continue operating despite multiple penalties.\u003c/p>\n\u003cp>“When you’re looking at these large corporations, that’s just the cost of doing business,” said Neil Gehlawat, who is representing Fisher in her pending lawsuit against Parkview. “It doesn’t have the effect of changing behavior.”\u003c/p>\n\u003cp>\u003cstrong>‘Worst Of The Worst’\u003c/strong>\u003c/p>\n\u003cp>The Centers for Medicare & Medicaid Services, or CMS, sets the federal standards for nursing homes and determines whether they are in compliance, based on inspections performed primarily by state health departments. States license facilities and have the authority to revoke the licenses.\u003c/p>\n\u003cp>Special focus facility status is reserved for the poorest-performing facilities out of more than 15,000 skilled nursing homes. The federal government assigns each state a set number of slots, roughly based on the number of nursing homes. Then state health regulators pick which nursing homes to include.\u003c/p>\n\u003cp>More than 900 facilities have been placed on the watch list since 2005. But the number of nursing homes under special focus at any given time has dropped by nearly half since 2012, because of federal budget cuts negotiated by President Barack Obama and Congress. This year, the $2.6 million budget allows only 88 nursing homes to \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-17-20.pdf\">receive the designation\u003c/a>, though regulators identified 435 as warranting scrutiny. California and Texas each has six slots, the most of any state. Twenty-nine states have just one.\u003c/p>\n\u003cp>Especially troubling is that more than a third of operating nursing facilities that graduated from the watch list before 2014 still hold the lowest possible Medicare rating for health and safety: one star of five, KHN’s analysis found.\u003c/p>\n\u003cp>“You have this recidivism of nursing homes that are special focus facilities,” said Richard Mollot, executive director of the Long Term Care Community Coalition, an advocacy group in Manhattan. “These are the worst of the worst and they’re back?”\u003c/p>\n\u003cp>CMS defended the program, saying that nursing homes on the watch list showed more improvement than did comparably struggling facilities not selected for enhanced supervision. “CMS continues to work to improve oversight to prevent any facility from regressing in performance,” the statement said.\u003c/p>\n\u003cfigure id=\"attachment_351140\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-351140\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-800x533.jpg\" alt=\"Andrew Edwards is among the patients who were harmed by nursing homes that had earlier been given a clean bill of health by Medicare and health regulators.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-1180x786.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-520x346.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo.jpg 1540w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Andrew Edwards is among the patients who were harmed by nursing homes that had earlier been given a clean bill of health by Medicare and health regulators. \u003ccite>(Doug Kapustin/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Short-Term Oversight\u003c/strong>\u003c/p>\n\u003cp>Special scrutiny was lifted for about one-fourth of the nursing homes in less than a year. Facilities need to pass only two consecutive inspections without major violations or substantiated complaints.\u003c/p>\n\u003cp>“The period of time is just not long enough for them to show that they can sustain improvement,” said Robyn Grant, director for public policy at the National Consumer Voice for Quality Long-Term Care in Washington. “There needs to be some significant changes in the program.”\u003c/p>\n\u003cp>In 2010, NMS Healthcare of Hagerstown, Md., left the watch list after 10 months.\u003c/p>\n\u003cp>Last year, Maryland’s attorney general \u003ca href=\"http://www.marylandattorneygeneral.gov/News%20Documents/State_v_NMS_Complaint.pdf\">sued the facility and its owner,\u003c/a> Neiswanger Management Services, \u003ca href=\"http://www.marylandattorneygeneral.gov/Press/2016/122116.pdf\">alleging that they evicted\u003c/a> frail, infirm and mentally disabled residents “with brutal indifference” when their health coverage ran out or the facility had the opportunity to get someone with better insurance.\u003c/p>\n\u003cp>Among those was Andrew Edwards, who was told by NMS that he was being discharged to an assisted-living center, according to the lawsuit. Instead, in January 2016, the staff sent him to a crowded, unlicensed Baltimore City row house where the owner confiscated his bank card and withdrew $966 over his objections, the lawsuit said. Although NMS said it had arranged for his outpatient kidney dialysis, “that was false,” Edwards said in an interview. He ended up in an emergency room after he missed his treatment.\u003c/p>\n\u003cp>NMS maintains it stopped referring patients to that owner when told of the conditions. This month, CMS expelled the Hagerstown nursing home from Medicare and Medicaid after citing it for more violations. The company is closing the facility. NMS, which still runs other homes in Maryland, has sued state regulators, claiming they are vindictively trying to drive the chain out of business.\u003c/p>\n\u003cp>\u003cstrong>Few Terminations\u003c/strong>\u003c/p>\n\u003cp>Some nursing homes on the watch list do maintain improvements. After Evergreen Nursing Home in southern Alabama was designated a special focus facility in 2005, the owners brought in new managers and added nursing supervisors, said Kimberly Bush, the facility’s administrator.\u003c/p>\n\u003cp>Medicare now rates Evergreen a five-star facility. “I’d like to say there’s some kind of magic recipe to this, but it’s just doing the job and holding people accountable,” Bush said.\u003c/p>\n\u003cp>But even prolonged supervision does not guarantee progress. Poplar Point Health and Rehabilitation in Memphis stayed on the watch list for 2½ years until 2009. A \u003ca href=\"https://www.justice.gov/opa/pr/united-states-files-false-claims-act-complaint-against-six-vanguard-nursing-facilities-and\">federal lawsuit brought last year\u003c/a> claims that Poplar and its owner, Vanguard Healthcare, regularly provided “nonexistent, grossly substandard, worthless care” as far back as 2010. Vanguard, now in bankruptcy court, declined to comment.\u003c/p>\n\u003cp>\u003cem>(Story continues below.)\u003c/em>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"//datawrapper.dwcdn.net/Sfw8o/12/\" scrolling=\"yes\" frameborder=\"0\" allowtransparency=\"true\" allowfullscreen=\"allowfullscreen\" webkitallowfullscreen=\"webkitallowfullscreen\" mozallowfullscreen=\"mozallowfullscreen\" oallowfullscreen=\"oallowfullscreen\" msallowfullscreen=\"msallowfullscreen\" width=\"600\" height=\"600\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>The ultimate enforcement threats are termination from Medicare and Medicaid or closure by state or federal authorities. But only 17 percent of former special focus facilities are no longer operating, and that can include ones that went out of business for unrelated reasons, KHN found.\u003c/p>\n\u003cp>State regulators are reluctant to close nursing homes because of the upheaval it causes patients and families. In some areas, there are no alternative facilities nearby, making termination even less appealing.\u003c/p>\n\u003cp>“At the end of the day, there are those centers that cannot be corrected, can’t fix themselves, and the best thing for the patients and the residents might be for them to move to another location,” said Lyn Bentley, an executive at the American Health Care Association, a nursing facility trade group. But, she said, “it’s always difficult to close someone’s home.”\u003c/p>\n\u003cp>\u003cstrong>Lack Of Nurses\u003c/strong>\u003c/p>\n\u003cp>Too few nurses, particularly registered nurses, provide care at some of the most troubled homes, KHN’s analysis shows. Registered nurse staffing was still 12 percent lower than at other facilities, even three years after the homes were released from the watch list.\u003c/p>\n\u003cp>In 2009, Pennsylvania health regulators released Golden LivingCenter-West Shore in Camp Hill after 17 months of supervision. The company said in a recent statement that when a home was put on that list, “we mobilize the resources necessary to help get that LivingCenter back into compliance.”\u003c/p>\n\u003cp>But data from Medicare’s Nursing Home Compare website show the facility has among the worst nurse-to-patient staffing ratios in the nation, with registered nurses devoting an average of 12 minutes for each patient daily. The state average is 58 minutes daily per patient.\u003c/p>\n\u003cp>Golden LivingCenter-West Shore was fined $59,150 in 2015 after being cited for, among other violations, allowing a resident’s feeding tube to become infested with maggots, records show. Also, Golden Living agreed to pay $750,000 to settle three cases involving patient injuries from falls that occurred after extra oversight ended, court records show.\u003c/p>\n\u003cp>Last year, Golden Living sold its Pennsylvania homes to Priority Healthcare Group.\u003c/p>\n\u003cp>Priority is following a common strategy for shedding an unwanted reputation: changing the facility’s name. In California, Parkview — where Fisher slipped out of her wheelchair — is being rebranded too, as Kingston Healthcare Center.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/351133/half-of-nursing-homes-scrutinized-on-safety-still-treacherous","authors":["byline_stateofhealth_351133"],"categories":["stateofhealth_11","stateofhealth_1"],"tags":["stateofhealth_2808","stateofhealth_2972","stateofhealth_2519","stateofhealth_2829"],"affiliates":["stateofhealth_3007"],"featImg":"stateofhealth_20482","label":"stateofhealth_3007"},"stateofhealth_348688":{"type":"posts","id":"stateofhealth_348688","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"348688","score":null,"sort":[1498775776000]},"guestAuthors":[],"slug":"nursing-homes-worry-proposed-medicaid-cuts-will-force-cuts-closures","title":"Nursing Homes Worry Proposed Medicaid Cuts Will Force Cuts, Closures","publishDate":1498775776,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>The Senate vote on the health care bill has been pushed back, but it still has a lot of people in the nursing home industry worried. About two-thirds of nursing home residents are paid for by Medicaid. And the Congressional Budget Office \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\">found\u003c/a> that the Senate health care bill would cut Medicaid by more than $770 billion over the next decade.\u003c/p>\n\u003cp>That could mean trouble for people like 88-year-old Betty Redlin. She's lived at the \u003ca href=\"http://victoriacarecenter.com/\">Victoria Care Center\u003c/a> in Ventura, Calif. for about 2 1/2 years.\u003c/p>\n\u003cp>She explains that she fell and broke her hip and never regained her ability to walk. \"I was living with my granddaughter,\" she says, \"and my doctor won't [allow] going back to her place.\"\u003c/p>\n\u003cp>Betty had a career as a bookkeeper. She also raised three children. Now she's spent everything she had. There's no way she could afford the roughly $80,000 a year this nursing home costs. (That fee is pretty standard for nursing homes.) So it's Medicaid that enables her to stay here.\u003c/p>\n\u003cp>\"There's nothing I can do about it,\" she says. \"It's gotta be [Medicaid] or [I'm] out on the street. One or the other.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/534764940/534764941\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>John Gardner, executive director of the Victoria Care Center, says that most of the long-term care residents like Redlin are on Medicaid or, as it's called in California, Medi-Cal.\u003c/p>\n\u003cp>\"If you look at what it costs to provide that service and what we get from Medi-Cal, we're actually losing a little bit of money every day on that.\" He says they make up the difference with short-term residents who have Medicare, which pays more than Medicaid does. Private pay patients also pay more than Medicaid.\u003c/p>\n\u003cp>Gardner says he's an optimist. Whatever Congress does, he doesn't think that Victoria Care Center would close down, though there might have to be cuts in staff and in the costs of food and supplies. Also, Gardner says that Victoria Care Center is part of a chain of 200 facilities, which could cushion the blow.\u003c/p>\n\u003cp>But not everyone is as optimistic as he is. According to the \u003ca href=\"https://www.ahcancal.org/Pages/Default.aspx\">American Health Care Association\u003c/a> (AHCA), a national trade group for nursing homes, the current Senate bill's cuts to Medicaid could mean that a typical nursing home would eventually run deficits of hundreds of thousands of dollars a year. James Gomez is the CEO of The \u003ca href=\"http://www.cahf.org/\">California Association of Health Facilities\u003c/a>, the AHCA's California chapter.\u003c/p>\n\u003cp>[contextly_sidebar id=\"mrVakER0R6f0AToNbkAK83dprja2VTaO\"]\u003c/p>\n\u003cp>\"If you can't break even or make a few dollars, you're not going to keep running your business,\" says Gomez. And that could lead to closures. \"So access [to nursing home beds] will become a huge issue.\"\u003c/p>\n\u003cp>The repercussions of cuts and closures would be felt across the nation's health care system, says Katie Smith Sloan, the president of \u003ca href=\"http://www.leadingage.org/\">Leading Age\u003c/a>, which represents non-profit nursing homes and other services for older adults.\u003c/p>\n\u003cp>\"People who are in nursing homes are there because they need the kind of services that a nursing home provides\" says Sloan. \"Without those services, they'll be forced to get that kind of care in a hospital, which will simply increase costs to Medicare.\"\u003c/p>\n\u003cp>Reining in Medicaid has been on conservatives' to-do list for a long time. House Speaker Paul Ryan has said he's \u003ca href=\"http://www.cnbc.com/2017/03/20/paul-ryan-has-wanted-to-reform-medicaid-since-his-frat-days.html\">dreamed of it\u003c/a> since his college days. Robert Moffit, a senior fellow in health policy studies at the conservative \u003ca href=\"http://www.heritage.org/\">Heritage Foundation\u003c/a>, argues that the program isn't being used as intended.\u003c/p>\n\u003cp>\"Do we want Medicaid, which was a program designed for the poor and the indigent, to become a kind of backdoor mechanism to establish a middle class entitlement for long-term care? Medicaid was never really intended to do that,\" says Moffit.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Senate bill is likely to change. But leader Mitch McConnell has indicated that Medicaid cuts will still be part of it.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Nursing+Homes+Worry+Proposed+Medicaid+Cuts+Will+Force+Cuts%2C+Closures&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"Two-thirds of nursing home residents are paid for by Medicaid.","status":"publish","parent":0,"modified":1498776331,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":true,"iframeSrcs":["https://www.npr.org/player/embed/534764940/534764941"],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":19,"wordCount":676},"headData":{"title":"Nursing Homes Worry Proposed Medicaid Cuts Will Force Cuts, Closures | KQED","description":"Two-thirds of nursing home residents are paid for by Medicaid.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"348688 https://ww2.kqed.org/stateofhealth/?p=348688","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/06/29/nursing-homes-worry-proposed-medicaid-cuts-will-force-cuts-closures/","disqusTitle":"Nursing Homes Worry Proposed Medicaid Cuts Will Force Cuts, Closures","nprByline":"\u003ca href=\"http://www.npr.org/people/2100677/ina-jaffe\" target=\"_blank\">Ina Jaffe\u003c/a>","nprImageAgency":"Ina Jaffe/NPR","nprStoryId":"534764940","nprApiLink":"http://api.npr.org/query?id=534764940&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2017/06/28/534764940/proposed-medicaid-cuts-likely-to-put-pressure-on-nursing-homes?ft=nprml&f=534764940","nprRetrievedStory":"1","nprPubDate":"Thu, 29 Jun 2017 13:53:00 -0400","nprStoryDate":"Wed, 28 Jun 2017 17:15:00 -0400","nprLastModifiedDate":"Thu, 29 Jun 2017 13:53:00 -0400","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2017/06/20170628_atc_proposed_medicaid_cuts_likely_to_put_pressure_on_nursing_homes.mp3?orgId=1&topicId=1128&d=213&p=2&story=534764940&t=progseg&e=534685874&seg=2&ft=nprml&f=534764940","nprAudioM3u":"http://api.npr.org/m3u/1534764941-043df7.m3u?orgId=1&topicId=1128&d=213&p=2&story=534764940&t=progseg&e=534685874&seg=2&ft=nprml&f=534764940","path":"/stateofhealth/348688/nursing-homes-worry-proposed-medicaid-cuts-will-force-cuts-closures","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2017/06/20170628_atc_proposed_medicaid_cuts_likely_to_put_pressure_on_nursing_homes.mp3?orgId=1&topicId=1128&d=213&p=2&story=534764940&t=progseg&e=534685874&seg=2&ft=nprml&f=534764940","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Senate vote on the health care bill has been pushed back, but it still has a lot of people in the nursing home industry worried. About two-thirds of nursing home residents are paid for by Medicaid. And the Congressional Budget Office \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\">found\u003c/a> that the Senate health care bill would cut Medicaid by more than $770 billion over the next decade.\u003c/p>\n\u003cp>That could mean trouble for people like 88-year-old Betty Redlin. She's lived at the \u003ca href=\"http://victoriacarecenter.com/\">Victoria Care Center\u003c/a> in Ventura, Calif. for about 2 1/2 years.\u003c/p>\n\u003cp>She explains that she fell and broke her hip and never regained her ability to walk. \"I was living with my granddaughter,\" she says, \"and my doctor won't [allow] going back to her place.\"\u003c/p>\n\u003cp>Betty had a career as a bookkeeper. She also raised three children. Now she's spent everything she had. There's no way she could afford the roughly $80,000 a year this nursing home costs. (That fee is pretty standard for nursing homes.) So it's Medicaid that enables her to stay here.\u003c/p>\n\u003cp>\"There's nothing I can do about it,\" she says. \"It's gotta be [Medicaid] or [I'm] out on the street. One or the other.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/534764940/534764941\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>John Gardner, executive director of the Victoria Care Center, says that most of the long-term care residents like Redlin are on Medicaid or, as it's called in California, Medi-Cal.\u003c/p>\n\u003cp>\"If you look at what it costs to provide that service and what we get from Medi-Cal, we're actually losing a little bit of money every day on that.\" He says they make up the difference with short-term residents who have Medicare, which pays more than Medicaid does. Private pay patients also pay more than Medicaid.\u003c/p>\n\u003cp>Gardner says he's an optimist. Whatever Congress does, he doesn't think that Victoria Care Center would close down, though there might have to be cuts in staff and in the costs of food and supplies. Also, Gardner says that Victoria Care Center is part of a chain of 200 facilities, which could cushion the blow.\u003c/p>\n\u003cp>But not everyone is as optimistic as he is. According to the \u003ca href=\"https://www.ahcancal.org/Pages/Default.aspx\">American Health Care Association\u003c/a> (AHCA), a national trade group for nursing homes, the current Senate bill's cuts to Medicaid could mean that a typical nursing home would eventually run deficits of hundreds of thousands of dollars a year. James Gomez is the CEO of The \u003ca href=\"http://www.cahf.org/\">California Association of Health Facilities\u003c/a>, the AHCA's California chapter.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"If you can't break even or make a few dollars, you're not going to keep running your business,\" says Gomez. And that could lead to closures. \"So access [to nursing home beds] will become a huge issue.\"\u003c/p>\n\u003cp>The repercussions of cuts and closures would be felt across the nation's health care system, says Katie Smith Sloan, the president of \u003ca href=\"http://www.leadingage.org/\">Leading Age\u003c/a>, which represents non-profit nursing homes and other services for older adults.\u003c/p>\n\u003cp>\"People who are in nursing homes are there because they need the kind of services that a nursing home provides\" says Sloan. \"Without those services, they'll be forced to get that kind of care in a hospital, which will simply increase costs to Medicare.\"\u003c/p>\n\u003cp>Reining in Medicaid has been on conservatives' to-do list for a long time. House Speaker Paul Ryan has said he's \u003ca href=\"http://www.cnbc.com/2017/03/20/paul-ryan-has-wanted-to-reform-medicaid-since-his-frat-days.html\">dreamed of it\u003c/a> since his college days. Robert Moffit, a senior fellow in health policy studies at the conservative \u003ca href=\"http://www.heritage.org/\">Heritage Foundation\u003c/a>, argues that the program isn't being used as intended.\u003c/p>\n\u003cp>\"Do we want Medicaid, which was a program designed for the poor and the indigent, to become a kind of backdoor mechanism to establish a middle class entitlement for long-term care? Medicaid was never really intended to do that,\" says Moffit.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Senate bill is likely to change. But leader Mitch McConnell has indicated that Medicaid cuts will still be part of it.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Nursing+Homes+Worry+Proposed+Medicaid+Cuts+Will+Force+Cuts%2C+Closures&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/348688/nursing-homes-worry-proposed-medicaid-cuts-will-force-cuts-closures","authors":["byline_stateofhealth_348688"],"categories":["stateofhealth_2442","stateofhealth_15","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_2808","stateofhealth_99","stateofhealth_218","stateofhealth_2519","stateofhealth_2829"],"featImg":"stateofhealth_348689","label":"stateofhealth"},"stateofhealth_215784":{"type":"posts","id":"stateofhealth_215784","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"215784","score":null,"sort":[1469214894000]},"guestAuthors":[],"slug":"rehab-hospitals-may-harm-a-third-of-patients-report-finds","title":"Rehab Hospitals May Harm A Third Of Patients, Report Finds","publishDate":1469214894,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Patients may go to rehabilitation hospitals to recover from a stroke, injury or recent surgery. But sometimes the care makes things worse.\u003c/p>\n\u003cp>In a government report \u003ca href=\"https://www.documentcloud.org/documents/2995032-HHS-OIG-Adverse-Events-RFs.html\" target=\"_blank\">published\u003c/a> Thursday, 29 percent of patients in rehab facilities suffered a medication error, bedsore, infection or some other type of harm as a result of the care they received.\u003c/p>\n\u003cp>Doctors who reviewed Medicare cases from a broad sampling of rehab facilities say that almost half of the 158 incidents they spotted among 417 patients were clearly or likely preventable.\u003c/p>\n\u003cp>\"This is the latest study over a long time period now that says we still have high rates of harm,\" says \u003ca href=\"https://www.amia.org/about-amia/leadership/acmi-fellow/david-c-classen-md-ms-facmi\" target=\"_blank\">Dr. David Classen\u003c/a>, an infectious disease specialist at the University of Utah School of Medicine who developed the analytic tool used in the report to identify the harm to patients.\u003c/p>\n\u003cp>\"We're fooling ourselves if we say we have made improvement,\" Classen says. \"If the first rule of health care is 'Do no harm,' then we're failing.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The oversight study, from the \u003ca href=\"https://oig.hhs.gov/\" target=\"_blank\">office of the inspector general\u003c/a> of the U.S. Department of Health and Human Services, focused on rehabilitation facilities that were not associated with hospitals. Rehab facilities generally require that patients be able to undergo at least three hours of physical and occupational therapy per day, five days a week. Patients at these facilities are presumed to be healthier than patients in a more typical hospital or a nursing home.\u003c/p>\n\u003cp>Still, the findings echoed those of previous studies that found that more than a quarter of patients in \u003ca href=\"https://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf\" target=\"_blank\">hospitals\u003c/a> and a third in \u003ca href=\"https://www.propublica.org/article/one-third-of-skilled-nursing-patients-harmed-in-treatment\" target=\"_blank\">skilled nursing facilities\u003c/a> suffered harm related to their care.\u003c/p>\n\u003cp>\"It's important to acknowledge that harm can occur in any type of inpatient setting,\" says Amy Ashcraft, a team leader for the rehabilitation hospital study. \"This is one of the settings that's most likely to be underestimated in terms of what type of harm can occur.\"\u003c/p>\n\u003cp>For the purposes of the study, doctors and nurses identified harm by reviewing the medical records of 417 randomly selected Medicare patients who stayed in U.S. rehabilitation facilities in March 2012. The events they identified varied in severity, ranging from a temporary injury to something that required a longer stay at the facility or that led to permanent disability or death.\u003c/p>\n\u003cp>Almost a quarter of the harmed patients had to be admitted to an acute care hospital, at a cost of about $7.7 million for the month analyzed, the study shows.\u003c/p>\n\u003cp>The physicians who reviewed the cases for the OIG say substandard treatment, inadequate monitoring, and failure to provide needed care caused most of the harm. Almost half the cases, 46 percent, were related to medication errors and included bleeding from gastric ulcers due to blood thinners and a loss of consciousness linked to narcotic painkillers.\u003c/p>\n\u003cp>That high number indicates there's lots of room for improvement, says Dr. Eric Thomas, director of the UT Houston-Memorial Hermann Center for Healthcare Quality and Safety.\u003c/p>\n\u003cp>\"We know a lot about preventing medication errors,\" Thomas says.\u003c/p>\n\u003cp>An additional 40 percent of the cases in which patients were harmed were traced to lapses in routine monitoring that led to bedsores, constipation or falls. These problems almost never contributed to a patient's death but could mean extra days or weeks of recovery, a loss of independence or permanent disability, says Lisa McGiffert, director of the Consumers Union Safe Patient Project.\u003c/p>\n\u003cp>\"It is a domino effect for any person who has had an adverse event,\" says McGiffert, who was not involved in the study.\u003c/p>\n\u003cp>The inspector general is recommending that Medicare and the Agency for Healthcare Research and Quality work together to reduce harm to patients by creating a list of adverse events that occur in rehab hospitals. In their responses to the report, the agencies have pledged to follow that suggestion.\u003c/p>\n\u003cp>Officials from the American Medical Rehabilitation Providers Association, the trade group that represents rehab facilities, say they have not yet seen the report and decline to comment for now.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>ProPublica is interested in hearing from patients who have been harmed while undergoing medical care, through its\u003c/em> \u003ca href=\"https://www.propublica.org/getinvolved/item/have-you-been-harmed-in-a-medical-facility-share-your-story\" target=\"_blank\">Patient Harm Questionnaire\u003c/a> \u003cem>and\u003c/em> \u003ca href=\"https://www.facebook.com/groups/patientharm/\" target=\"_blank\">Patient Safety Facebook Group\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 ProPublica. To see more, visit \u003ca>ProPublica\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Rehab+Hospitals+May+Harm+A+Third+Of+Patients%2C+Report+Finds&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"Patients are sent to rehab facilities to recover from a medical crisis or surgery, but too often suffer additional harm once they get there.","status":"publish","parent":0,"modified":1469214953,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":20,"wordCount":703},"headData":{"title":"Rehab Hospitals May Harm A Third Of Patients, Report Finds | KQED","description":"Patients are sent to rehab facilities to recover from a medical crisis or surgery, but too often suffer additional harm once they get there.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"215784 http://ww2.kqed.org/stateofhealth/?p=215784","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/07/22/rehab-hospitals-may-harm-a-third-of-patients-report-finds/","disqusTitle":"Rehab Hospitals May Harm A Third Of Patients, Report Finds","nprImageCredit":"Andersen Ross","nprByline":"Marshall Allen\u003cbr />\u003ca href=\"https://www.propublica.org/article/new-report-problem-care-harms-almost-one-third-of-rehab-hospital-patients\">ProPublica\u003c/a> and \u003ca href=\"http://www.npr.org/sections/health-shots/\">NPR Shots\u003c/a>","nprImageAgency":"Blend Images/Getty Images","nprStoryId":"486756178","nprApiLink":"http://api.npr.org/query?id=486756178&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2016/07/21/486756178/rehab-hospitals-may-harm-a-third-of-patients-report-finds?ft=nprml&f=486756178","nprRetrievedStory":"1","nprPubDate":"Thu, 21 Jul 2016 11:35:00 -0400","nprStoryDate":"Thu, 21 Jul 2016 00:02:00 -0400","nprLastModifiedDate":"Thu, 21 Jul 2016 12:25:33 -0400","path":"/stateofhealth/215784/rehab-hospitals-may-harm-a-third-of-patients-report-finds","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Patients may go to rehabilitation hospitals to recover from a stroke, injury or recent surgery. But sometimes the care makes things worse.\u003c/p>\n\u003cp>In a government report \u003ca href=\"https://www.documentcloud.org/documents/2995032-HHS-OIG-Adverse-Events-RFs.html\" target=\"_blank\">published\u003c/a> Thursday, 29 percent of patients in rehab facilities suffered a medication error, bedsore, infection or some other type of harm as a result of the care they received.\u003c/p>\n\u003cp>Doctors who reviewed Medicare cases from a broad sampling of rehab facilities say that almost half of the 158 incidents they spotted among 417 patients were clearly or likely preventable.\u003c/p>\n\u003cp>\"This is the latest study over a long time period now that says we still have high rates of harm,\" says \u003ca href=\"https://www.amia.org/about-amia/leadership/acmi-fellow/david-c-classen-md-ms-facmi\" target=\"_blank\">Dr. David Classen\u003c/a>, an infectious disease specialist at the University of Utah School of Medicine who developed the analytic tool used in the report to identify the harm to patients.\u003c/p>\n\u003cp>\"We're fooling ourselves if we say we have made improvement,\" Classen says. \"If the first rule of health care is 'Do no harm,' then we're failing.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The oversight study, from the \u003ca href=\"https://oig.hhs.gov/\" target=\"_blank\">office of the inspector general\u003c/a> of the U.S. Department of Health and Human Services, focused on rehabilitation facilities that were not associated with hospitals. Rehab facilities generally require that patients be able to undergo at least three hours of physical and occupational therapy per day, five days a week. Patients at these facilities are presumed to be healthier than patients in a more typical hospital or a nursing home.\u003c/p>\n\u003cp>Still, the findings echoed those of previous studies that found that more than a quarter of patients in \u003ca href=\"https://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf\" target=\"_blank\">hospitals\u003c/a> and a third in \u003ca href=\"https://www.propublica.org/article/one-third-of-skilled-nursing-patients-harmed-in-treatment\" target=\"_blank\">skilled nursing facilities\u003c/a> suffered harm related to their care.\u003c/p>\n\u003cp>\"It's important to acknowledge that harm can occur in any type of inpatient setting,\" says Amy Ashcraft, a team leader for the rehabilitation hospital study. \"This is one of the settings that's most likely to be underestimated in terms of what type of harm can occur.\"\u003c/p>\n\u003cp>For the purposes of the study, doctors and nurses identified harm by reviewing the medical records of 417 randomly selected Medicare patients who stayed in U.S. rehabilitation facilities in March 2012. The events they identified varied in severity, ranging from a temporary injury to something that required a longer stay at the facility or that led to permanent disability or death.\u003c/p>\n\u003cp>Almost a quarter of the harmed patients had to be admitted to an acute care hospital, at a cost of about $7.7 million for the month analyzed, the study shows.\u003c/p>\n\u003cp>The physicians who reviewed the cases for the OIG say substandard treatment, inadequate monitoring, and failure to provide needed care caused most of the harm. Almost half the cases, 46 percent, were related to medication errors and included bleeding from gastric ulcers due to blood thinners and a loss of consciousness linked to narcotic painkillers.\u003c/p>\n\u003cp>That high number indicates there's lots of room for improvement, says Dr. Eric Thomas, director of the UT Houston-Memorial Hermann Center for Healthcare Quality and Safety.\u003c/p>\n\u003cp>\"We know a lot about preventing medication errors,\" Thomas says.\u003c/p>\n\u003cp>An additional 40 percent of the cases in which patients were harmed were traced to lapses in routine monitoring that led to bedsores, constipation or falls. These problems almost never contributed to a patient's death but could mean extra days or weeks of recovery, a loss of independence or permanent disability, says Lisa McGiffert, director of the Consumers Union Safe Patient Project.\u003c/p>\n\u003cp>\"It is a domino effect for any person who has had an adverse event,\" says McGiffert, who was not involved in the study.\u003c/p>\n\u003cp>The inspector general is recommending that Medicare and the Agency for Healthcare Research and Quality work together to reduce harm to patients by creating a list of adverse events that occur in rehab hospitals. In their responses to the report, the agencies have pledged to follow that suggestion.\u003c/p>\n\u003cp>Officials from the American Medical Rehabilitation Providers Association, the trade group that represents rehab facilities, say they have not yet seen the report and decline to comment for now.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>ProPublica is interested in hearing from patients who have been harmed while undergoing medical care, through its\u003c/em> \u003ca href=\"https://www.propublica.org/getinvolved/item/have-you-been-harmed-in-a-medical-facility-share-your-story\" target=\"_blank\">Patient Harm Questionnaire\u003c/a> \u003cem>and\u003c/em> \u003ca href=\"https://www.facebook.com/groups/patientharm/\" target=\"_blank\">Patient Safety Facebook Group\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 ProPublica. To see more, visit \u003ca>ProPublica\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Rehab+Hospitals+May+Harm+A+Third+Of+Patients%2C+Report+Finds&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/215784/rehab-hospitals-may-harm-a-third-of-patients-report-finds","authors":["byline_stateofhealth_215784"],"categories":["stateofhealth_11"],"tags":["stateofhealth_2828","stateofhealth_2829","stateofhealth_2827"],"featImg":"stateofhealth_215785","label":"stateofhealth"},"stateofhealth_20825":{"type":"posts","id":"stateofhealth_20825","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"20825","score":null,"sort":[1408382135000]},"guestAuthors":[],"slug":"the-assisted-living-reform-bills-that-died","title":"The Assisted Living Reform Bills That Died","publishDate":1408382135,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cstrong>By Polly Stryker\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_20831\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11379_photo-scr.jpg\">\u003cimg class=\"size-large wp-image-20831\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11379_photo-scr-640x480.jpg\" alt=\"Taking some fresh air in the courtyard at Westchester Villa, an assisted facility in Inglewood. (Rachael Myrow/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Taking some fresh air in the courtyard at Westchester Villa, an assisted facility in Inglewood. (Rachael Myrow/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Last Thursday, August 14, was the day that bills still in the state Senate Appropriations Committee sank or swam. The Senate Appropriations Committee is where bills costing $150,000 or more go for consideration. If bills make it out of this committee, then bills are still in play and could make it to the governor’s desk, albeit with potential amendments along the way. If not, they die.\u003c/p>\n\u003cp>Going into the home stretch of this legislative session, 16 bills were on the table that, altogether, constituted the first major overhaul of the assisted living industry in nearly 30 years.\u003c/p>\n\u003cp>Two have already made it to the governor’s desk. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1523\" target=\"_blank\" rel=\"noopener\">AB1523\u003c/a> mandates liability insurance for all assisted living facilities. Advocates say liability insurance is one of the best ways to improve conditions in the industry. Operators whose violations make buying insurance too expensive will be simply forced out of business. The industry group \u003ca href=\"http://caassistedliving.org/\" target=\"_blank\" rel=\"noopener\">California Assisted Living Association\u003c/a> supported AB1523. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1572\" target=\"_blank\" rel=\"noopener\">AB1572\u003c/a> mandates facility operators allow and support resident and family councils at assisted living facilities. CALA supported that one as well.\u003c/p>\n\u003cp>Most of the rest of the bills are still swimming. But what about the bills that died?\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!--more-->\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1571\" target=\"_blank\" rel=\"noopener\">AB1571\u003c/a> (Eggman D-Stockton) would have created a more robust online consumer information system than \u003ca href=\"https://secure.dss.ca.gov/CareFacilitySearch/home/selecttype/\" target=\"_blank\" rel=\"noopener\">the one currently offered\u003c/a> by the Department of Social Services.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related:\u003c/strong> \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/05/online-information-about-assisted-living-facilities-hard-to-come-by/\" target=\"_blank\" rel=\"noopener\">Online Information About Assisted Living Facilities Hard to Come By\u003c/a>]\u003c/p>\n\u003cp>“It is very disappointing,\" says Pat McGinnis, executive director of \u003ca href=\"http://www.canhr.org/\" target=\"_blank\" rel=\"noopener\">California Advocates for Nursing Home Reform\u003c/a>, one of the key advocacy organizations sponsoring legislation this year. McGinnis says that there are more than 7,500 licensed facilities in California, \"and absolutely no way for consumers to compare one facility with another. It will be impossible for consumers to try to look up 348 [facilities] in Alameda County, for example, to try to see what violations, deficiencies, et cetera, they might have.”\u003c/p>\n\u003cp>\"I am not at all finished with this issue,” says the bill’s author, Assemblywoman Susan Eggman (D-Stockton). Though she says the DSS has already made changes to its website in response to AB1571, Eggman says she is considering reintroducing similar legislation in the next session. The DSS declined to comment.\u003c/p>\n\u003cp>\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1454\" target=\"_blank\" rel=\"noopener\">AB1454\u003c/a> (Calderon D-Industry) would have required every facility licensed by the Department of Social Services to be subject to annual, unannounced inspections. DSS licenses many different types of facilities, not just assisted living facilities. Currently, state law requires DSS to visit a facility every five years, barring a complaint which generates a separate visit. The agency says in practice it has an investigator visit about every 2 and a half years.\u003c/p>\n\u003cp>Bill watchers say two concerns appear to have spiked this bill. For one thing, AB1454 would have changed the inspection frequency for \u003cem>every\u003c/em> type of facility DSS visits. For another, that would cost a pretty penny: $20 million, by one state estimate.\u003c/p>\n\u003cp>In a written response, Assemblyman Ian Calderon said, “Although the Legislature provided an increase in funding to the Department of Social Services in the 2014-2015 Budget to protect our children and elderly, annual inspections continue to be urgently needed as part of the oversight process. Without increasing the frequency of unannounced visits, our state will continue to put our most vulnerable populations – children and elderly – at risk.”\u003c/p>\n\u003cp>But there's another bill that addresses this issue, in part. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB895\" target=\"_blank\" rel=\"noopener\">SB895\u003c/a> (Corbett D-Alameda) would phase in unannounced annual visits for assisted living facilities only, by July 1, 2018. That passed out of the Senate Appropriations Committee with amendments.\u003c/p>\n\u003cp>Finally,\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1554\" target=\"_blank\" rel=\"noopener\"> AB1554\u003c/a> (Skinner D-East Bay) would have required the DSS to investigate complaints that alleged physical or sexual abuse, or imminent physical danger, at assisted living facilities within one working day, instead of 10 -- and report to the complainant promptly.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related: \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/11/crime-in-assisted-living-what-happens-after/\" target=\"_blank\" rel=\"noopener\">Crime in Assisted Living: What Happens After\u003c/a>\u003c/strong>]\u003c/p>\n\u003cp>Assemblywoman Skinner remarks the bills that made it out of the Senate Appropriations Committee put the onus on the industry itself, as opposed to the DSS.\u003c/p>\n\u003cp>“My frustration is, if we have higher expectations on the facilities, if we don’t have responsibility of the agency to enforce, then how are we going to feel assured that these facilities are complying?” Skinner is termed out, so she won’t introduce a similar bill next legislative session. But she adds, note how many legislators were involved in trying to reform assisted living facilities. This issue, Skinner says, isn’t going to go away.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Rachael Myrow contributed to this report.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Bills that made it out of the Senate Appropriations Committee put the onus on assisted living industry.","status":"publish","parent":0,"modified":1525451712,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":18,"wordCount":783},"headData":{"title":"The Assisted Living Reform Bills That Died | KQED","description":"Bills that made it out of the Senate Appropriations Committee put the onus on assisted living industry.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"20825 http://blogs.kqed.org/stateofhealth/?p=20825","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/08/18/the-assisted-living-reform-bills-that-died/","disqusTitle":"The Assisted Living Reform Bills That Died","path":"/stateofhealth/20825/the-assisted-living-reform-bills-that-died","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By Polly Stryker\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_20831\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11379_photo-scr.jpg\">\u003cimg class=\"size-large wp-image-20831\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11379_photo-scr-640x480.jpg\" alt=\"Taking some fresh air in the courtyard at Westchester Villa, an assisted facility in Inglewood. (Rachael Myrow/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Taking some fresh air in the courtyard at Westchester Villa, an assisted facility in Inglewood. (Rachael Myrow/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Last Thursday, August 14, was the day that bills still in the state Senate Appropriations Committee sank or swam. The Senate Appropriations Committee is where bills costing $150,000 or more go for consideration. If bills make it out of this committee, then bills are still in play and could make it to the governor’s desk, albeit with potential amendments along the way. If not, they die.\u003c/p>\n\u003cp>Going into the home stretch of this legislative session, 16 bills were on the table that, altogether, constituted the first major overhaul of the assisted living industry in nearly 30 years.\u003c/p>\n\u003cp>Two have already made it to the governor’s desk. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1523\" target=\"_blank\" rel=\"noopener\">AB1523\u003c/a> mandates liability insurance for all assisted living facilities. Advocates say liability insurance is one of the best ways to improve conditions in the industry. Operators whose violations make buying insurance too expensive will be simply forced out of business. The industry group \u003ca href=\"http://caassistedliving.org/\" target=\"_blank\" rel=\"noopener\">California Assisted Living Association\u003c/a> supported AB1523. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1572\" target=\"_blank\" rel=\"noopener\">AB1572\u003c/a> mandates facility operators allow and support resident and family councils at assisted living facilities. CALA supported that one as well.\u003c/p>\n\u003cp>Most of the rest of the bills are still swimming. But what about the bills that died?\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!--more-->\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1571\" target=\"_blank\" rel=\"noopener\">AB1571\u003c/a> (Eggman D-Stockton) would have created a more robust online consumer information system than \u003ca href=\"https://secure.dss.ca.gov/CareFacilitySearch/home/selecttype/\" target=\"_blank\" rel=\"noopener\">the one currently offered\u003c/a> by the Department of Social Services.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related:\u003c/strong> \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/05/online-information-about-assisted-living-facilities-hard-to-come-by/\" target=\"_blank\" rel=\"noopener\">Online Information About Assisted Living Facilities Hard to Come By\u003c/a>]\u003c/p>\n\u003cp>“It is very disappointing,\" says Pat McGinnis, executive director of \u003ca href=\"http://www.canhr.org/\" target=\"_blank\" rel=\"noopener\">California Advocates for Nursing Home Reform\u003c/a>, one of the key advocacy organizations sponsoring legislation this year. McGinnis says that there are more than 7,500 licensed facilities in California, \"and absolutely no way for consumers to compare one facility with another. It will be impossible for consumers to try to look up 348 [facilities] in Alameda County, for example, to try to see what violations, deficiencies, et cetera, they might have.”\u003c/p>\n\u003cp>\"I am not at all finished with this issue,” says the bill’s author, Assemblywoman Susan Eggman (D-Stockton). Though she says the DSS has already made changes to its website in response to AB1571, Eggman says she is considering reintroducing similar legislation in the next session. The DSS declined to comment.\u003c/p>\n\u003cp>\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1454\" target=\"_blank\" rel=\"noopener\">AB1454\u003c/a> (Calderon D-Industry) would have required every facility licensed by the Department of Social Services to be subject to annual, unannounced inspections. DSS licenses many different types of facilities, not just assisted living facilities. Currently, state law requires DSS to visit a facility every five years, barring a complaint which generates a separate visit. The agency says in practice it has an investigator visit about every 2 and a half years.\u003c/p>\n\u003cp>Bill watchers say two concerns appear to have spiked this bill. For one thing, AB1454 would have changed the inspection frequency for \u003cem>every\u003c/em> type of facility DSS visits. For another, that would cost a pretty penny: $20 million, by one state estimate.\u003c/p>\n\u003cp>In a written response, Assemblyman Ian Calderon said, “Although the Legislature provided an increase in funding to the Department of Social Services in the 2014-2015 Budget to protect our children and elderly, annual inspections continue to be urgently needed as part of the oversight process. Without increasing the frequency of unannounced visits, our state will continue to put our most vulnerable populations – children and elderly – at risk.”\u003c/p>\n\u003cp>But there's another bill that addresses this issue, in part. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB895\" target=\"_blank\" rel=\"noopener\">SB895\u003c/a> (Corbett D-Alameda) would phase in unannounced annual visits for assisted living facilities only, by July 1, 2018. That passed out of the Senate Appropriations Committee with amendments.\u003c/p>\n\u003cp>Finally,\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1554\" target=\"_blank\" rel=\"noopener\"> AB1554\u003c/a> (Skinner D-East Bay) would have required the DSS to investigate complaints that alleged physical or sexual abuse, or imminent physical danger, at assisted living facilities within one working day, instead of 10 -- and report to the complainant promptly.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related: \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/11/crime-in-assisted-living-what-happens-after/\" target=\"_blank\" rel=\"noopener\">Crime in Assisted Living: What Happens After\u003c/a>\u003c/strong>]\u003c/p>\n\u003cp>Assemblywoman Skinner remarks the bills that made it out of the Senate Appropriations Committee put the onus on the industry itself, as opposed to the DSS.\u003c/p>\n\u003cp>“My frustration is, if we have higher expectations on the facilities, if we don’t have responsibility of the agency to enforce, then how are we going to feel assured that these facilities are complying?” Skinner is termed out, so she won’t introduce a similar bill next legislative session. But she adds, note how many legislators were involved in trying to reform assisted living facilities. This issue, Skinner says, isn’t going to go away.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Rachael Myrow contributed to this report.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/20825/the-assisted-living-reform-bills-that-died","authors":["8344"],"categories":["stateofhealth_11","stateofhealth_14"],"tags":["stateofhealth_186","stateofhealth_825","stateofhealth_2829","stateofhealth_3245","stateofhealth_591"],"featImg":"stateofhealth_20831","label":"stateofhealth"},"stateofhealth_20618":{"type":"posts","id":"stateofhealth_20618","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"20618","score":null,"sort":[1407847856000]},"guestAuthors":[],"slug":"are-the-proposed-assisted-living-reforms-in-california-enough","title":"Are The Proposed Assisted Living Reforms in California Enough?","publishDate":1407847856,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_20634\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11410_photo-hpf.jpg\">\u003cimg class=\"size-full wp-image-20634\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11410_photo-hpf.jpg\" alt=\"CAPTION COMING (Rachael Myrow/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11410_photo-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11410_photo-hpf-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11410_photo-hpf-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A \"crime book\" maintained by the San Diego advocacy group Consumer Advocates for RCFE Reform. (RCFE is short for Residential Care Facility for the Elderly.) This book contains cases of what CARR calls \"egregious neglect\" at San Diego assisted living facilities. (Rachael Myrow/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Over the last 25 years, the number of assisted living facilities in California has nearly doubled. The homes are intended to care for relatively independent, healthy seniors, but that doesn’t describe a lot of the people living in them today.\u003c/p>\n\u003cp>\"There’s been a seismic shift in the population they serve,\" says Deborah Schoch of the California HealthCare Foundation\u003ca href=\"http://centerforhealthreporting.org/project/medical-errors-weaker-rules-signal-safety-problems-ca-assisted-living-homes\" target=\"_blank\" rel=\"noopener\"> Center for Health Reporting\u003c/a>. Schoch says the system was set up to meet the needs of people who could use some extra help with the tasks of daily living –- and it does. But many of those people need a lot of help.\u003c/p>\n\u003cp>The system, she says, is caring for people \"who are frail, who may have dementia, who may be wheelchair bound, who may not be able to turn on their own in bed.\"\u003c/p>\n\u003cp>\u003c!--more-->Assisted living facilities are not designed to deliver skilled nursing care, and they do not typically have people with those qualifications on staff. There are no staff-to-resident ratios or many of the other rules that govern nursing homes. While many assisted living facilities do a fine job of delivering care, others are overwhelmed –- or worse. Schoch was the lead reporter for \u003cspan style=\"color: #20497d\">a \u003c/span>series called “\u003ca href=\"http://centerforhealthreporting.org/project/medical-errors-weaker-rules-signal-safety-problems-ca-assisted-living-homes\" target=\"_blank\" rel=\"noopener\">Deadly Neglect\u003c/a>” that detailed 27 deaths in San Diego County assisted living facilities from abuse and neglect.\u003c/p>\n\u003cp>\"I worked with \u003ca href=\"http://www.utsandiego.com\" target=\"_blank\" rel=\"noopener\">UT San Diego\u003c/a>, and we were able to get access to a lot of inspection reports: deaths, injuries, elder abuse, people left on the floor for 48 hours in assisted living facilities in San Diego County.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>She's since come out with more stories detailing more troubling incidents, but that first series had a politically explosive effect. In San Diego, Supervisors voted to fund a special unit in the District Attorney’s office to target crime in the facilities.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related: \u003c/strong>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/11/crime-in-assisted-living-what-happens-after/\">Crime in Assisted Living: What Happens After\u003c/a>]\u003c/p>\n\u003cp>In Sacramento, where regulations haven’t changed much in close to 30 years, lawmakers held hearings featuring reform advocates like Aaron Byzak, who started a group called “\u003ca href=\"https://www.facebook.com/HazelsArmy\" target=\"_blank\" rel=\"noopener\">Hazel’s Army\u003c/a>” after his grandmother Hazel died in assisted living. \"If somebody parked in my grandmother’s disabled parking lot illegally, they’d be fined $450,\" he told reporters in the state capitol. \"But they kill her, and it’s $150.\"\u003c/p>\n\u003cp style=\"color: #20497d\">\u003cspan style=\"color: #333333\">Lawmakers were also keenly aware of recent headlines from Castro Valley, where 14 bed-ridden residents were \u003ca href=\"http://www.sfgate.com/bayarea/article/Castro-Valley-care-home-patients-abandoned-4929583.php\" target=\"_blank\" rel=\"noopener\">discovered abandoned\u003c/a> after the state ordered the facility closed. It turned out the operators had a long list of violations.\u003c/span>\u003c/p>\n\u003cp>You’ll get no argument from the agency charged with oversight of these facilities that it’s time for a revamp. A number of recommendations made in its last annual budget proposal mirror reform bills now pending in the legislature, such as raising the $150 maximum fine to $15,000, and upgrading the online database available to the public. That’s not all. Pat Leary is the Chief Deputy Director of the California Department of Social Services.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/162846042\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>\"They’re going to create a medical expertise unit, with a nurse,\" Leary said. \"We’re establishing a corporate accountability unit. There are a number of these facilities that are owned by corporations that are making decisions on a statewide basis. But the way that we track facilities is on a one-facility-at-a-time basis -- we’ve been missing trends.\"\u003c/p>\n\u003cp>Two women in San Diego were so frustrated with the lack of data and analysis, they created their own non-profit, and their own database for roughly 700 assisted living facilities in San Diego and Imperial Counties, as well as rural Northern California. CARR, the \u003ca href=\"http://www.rcfereform.org\" target=\"_blank\" rel=\"noopener\">Consumer Advocates for RCFE Reform\u003c/a>, (RCFE stands for residential care facility for the elderly) has managed to do what the state hasn’t yet - build a publicly accessible online database with 30,000 documents\u003ci>, \u003c/i>including inspection, complaint, and civil penalty reports. Their documents formed the basis of \"Deadly Neglect.\"\u003c/p>\n\u003cp>CARR co-founder Christina Selder echoes a sentiment heard commonly among consumer advocates. \"We find that they’re more of a facility protection agency than a consumer protection agency.\"\u003c/p>\n\u003cp>\"There are a number of cases where facilities will have repeat noncompliance meetings for atrocious activities,\" Selder said.\u003c/p>\n\u003cp>Without providing its name, she mentions a facility CARR uses as an example.\u003c/p>\n\u003cp>\"This particular facility had one resident who was left on the floor in their apartment for more than 24 hours and bled to death,\" she said. \"Same facility, a dementia resident who was unable to consent to have sexual relations with another resident but that repeatedly went on. There was a culture of fear among the staff, and so they weren’t cooperating during the investigation with Department of Social Services. That was the third one for this facility. Now, this facility remains open today. There’s no caution tape on the door.\"\u003c/p>\n\u003cp>Her partner in CARR, Chris Murphy, chimes in. \"I mean it’s almost like 'what do you have to do to get closed?'\"\u003c/p>\n\u003cp>They've developed some strong opinions after reviewing so many DSS reports. For instance, despite the claims of some that the worst abuses are likely to be more common in big facilities, especially those owned by corporate chains, Selder and Murphy say small homes are just as likely to fail their residents.\u003c/p>\n\u003cp>Both Murphy and Selder have degrees in gerontology. Both say they’re heartened by all the legislation in Sacramento, especially \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1523\" target=\"_blank\" rel=\"noopener\">the bill they sponsored\u003c/a>, AB 1523, requiring all facilities to carry liability insurance. [UPDATE: That bill passed, and Governor Jerry Brown signed it into law.] But Murphy worries about the fine print on all the legislation. \"If it’s not clearly stipulated within the bill, then it’s left to the regulators, then the regulators are going to come up with whatever they come up with. So I would hope that they get serious about having stakeholders meetings, using all of the expertise that’s available in this state.\"\u003c/p>\n\u003cp>Selder worries lawmakers are tweaking a system that is fundamentally dysfunctional. If a growing number of elderly need medical care, Selder says, maybe they shouldn’t be in assisted living. Or maybe assisted living should deliver tiered levels of care, with tiered levels of regulation. But that’s not the discussion on the table in Sacramento - at least, not this year.\u003c/p>\n\u003cp>\"We are behind the curve,\" Selder says. \"Other states have rating systems. Other states have assisted living regulated under the Department of Public Health. We’re not there. We’re not even talking about it in the right way yet.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Polly Stryker contributed to this report.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"\"We are behind the curve. Other states have rating systems. Other states have assisted living regulated under the Department of Public Health. We’re not there. We’re not even talking about it in the right way yet.\"","status":"publish","parent":0,"modified":1525451423,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":23,"wordCount":1216},"headData":{"title":"Are The Proposed Assisted Living Reforms in California Enough? | KQED","description":""We are behind the curve. Other states have rating systems. Other states have assisted living regulated under the Department of Public Health. We’re not there. We’re not even talking about it in the right way yet."","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"20618 http://blogs.kqed.org/stateofhealth/?p=20618","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/08/12/are-the-proposed-assisted-living-reforms-in-california-enough/","disqusTitle":"Are The Proposed Assisted Living Reforms in California Enough?","path":"/stateofhealth/20618/are-the-proposed-assisted-living-reforms-in-california-enough","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20634\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11410_photo-hpf.jpg\">\u003cimg class=\"size-full wp-image-20634\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11410_photo-hpf.jpg\" alt=\"CAPTION COMING (Rachael Myrow/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11410_photo-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11410_photo-hpf-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11410_photo-hpf-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A \"crime book\" maintained by the San Diego advocacy group Consumer Advocates for RCFE Reform. (RCFE is short for Residential Care Facility for the Elderly.) This book contains cases of what CARR calls \"egregious neglect\" at San Diego assisted living facilities. (Rachael Myrow/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Over the last 25 years, the number of assisted living facilities in California has nearly doubled. The homes are intended to care for relatively independent, healthy seniors, but that doesn’t describe a lot of the people living in them today.\u003c/p>\n\u003cp>\"There’s been a seismic shift in the population they serve,\" says Deborah Schoch of the California HealthCare Foundation\u003ca href=\"http://centerforhealthreporting.org/project/medical-errors-weaker-rules-signal-safety-problems-ca-assisted-living-homes\" target=\"_blank\" rel=\"noopener\"> Center for Health Reporting\u003c/a>. Schoch says the system was set up to meet the needs of people who could use some extra help with the tasks of daily living –- and it does. But many of those people need a lot of help.\u003c/p>\n\u003cp>The system, she says, is caring for people \"who are frail, who may have dementia, who may be wheelchair bound, who may not be able to turn on their own in bed.\"\u003c/p>\n\u003cp>\u003c!--more-->Assisted living facilities are not designed to deliver skilled nursing care, and they do not typically have people with those qualifications on staff. There are no staff-to-resident ratios or many of the other rules that govern nursing homes. While many assisted living facilities do a fine job of delivering care, others are overwhelmed –- or worse. Schoch was the lead reporter for \u003cspan style=\"color: #20497d\">a \u003c/span>series called “\u003ca href=\"http://centerforhealthreporting.org/project/medical-errors-weaker-rules-signal-safety-problems-ca-assisted-living-homes\" target=\"_blank\" rel=\"noopener\">Deadly Neglect\u003c/a>” that detailed 27 deaths in San Diego County assisted living facilities from abuse and neglect.\u003c/p>\n\u003cp>\"I worked with \u003ca href=\"http://www.utsandiego.com\" target=\"_blank\" rel=\"noopener\">UT San Diego\u003c/a>, and we were able to get access to a lot of inspection reports: deaths, injuries, elder abuse, people left on the floor for 48 hours in assisted living facilities in San Diego County.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>She's since come out with more stories detailing more troubling incidents, but that first series had a politically explosive effect. In San Diego, Supervisors voted to fund a special unit in the District Attorney’s office to target crime in the facilities.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related: \u003c/strong>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/11/crime-in-assisted-living-what-happens-after/\">Crime in Assisted Living: What Happens After\u003c/a>]\u003c/p>\n\u003cp>In Sacramento, where regulations haven’t changed much in close to 30 years, lawmakers held hearings featuring reform advocates like Aaron Byzak, who started a group called “\u003ca href=\"https://www.facebook.com/HazelsArmy\" target=\"_blank\" rel=\"noopener\">Hazel’s Army\u003c/a>” after his grandmother Hazel died in assisted living. \"If somebody parked in my grandmother’s disabled parking lot illegally, they’d be fined $450,\" he told reporters in the state capitol. \"But they kill her, and it’s $150.\"\u003c/p>\n\u003cp style=\"color: #20497d\">\u003cspan style=\"color: #333333\">Lawmakers were also keenly aware of recent headlines from Castro Valley, where 14 bed-ridden residents were \u003ca href=\"http://www.sfgate.com/bayarea/article/Castro-Valley-care-home-patients-abandoned-4929583.php\" target=\"_blank\" rel=\"noopener\">discovered abandoned\u003c/a> after the state ordered the facility closed. It turned out the operators had a long list of violations.\u003c/span>\u003c/p>\n\u003cp>You’ll get no argument from the agency charged with oversight of these facilities that it’s time for a revamp. A number of recommendations made in its last annual budget proposal mirror reform bills now pending in the legislature, such as raising the $150 maximum fine to $15,000, and upgrading the online database available to the public. That’s not all. Pat Leary is the Chief Deputy Director of the California Department of Social Services.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/162846042&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/162846042'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"They’re going to create a medical expertise unit, with a nurse,\" Leary said. \"We’re establishing a corporate accountability unit. There are a number of these facilities that are owned by corporations that are making decisions on a statewide basis. But the way that we track facilities is on a one-facility-at-a-time basis -- we’ve been missing trends.\"\u003c/p>\n\u003cp>Two women in San Diego were so frustrated with the lack of data and analysis, they created their own non-profit, and their own database for roughly 700 assisted living facilities in San Diego and Imperial Counties, as well as rural Northern California. CARR, the \u003ca href=\"http://www.rcfereform.org\" target=\"_blank\" rel=\"noopener\">Consumer Advocates for RCFE Reform\u003c/a>, (RCFE stands for residential care facility for the elderly) has managed to do what the state hasn’t yet - build a publicly accessible online database with 30,000 documents\u003ci>, \u003c/i>including inspection, complaint, and civil penalty reports. Their documents formed the basis of \"Deadly Neglect.\"\u003c/p>\n\u003cp>CARR co-founder Christina Selder echoes a sentiment heard commonly among consumer advocates. \"We find that they’re more of a facility protection agency than a consumer protection agency.\"\u003c/p>\n\u003cp>\"There are a number of cases where facilities will have repeat noncompliance meetings for atrocious activities,\" Selder said.\u003c/p>\n\u003cp>Without providing its name, she mentions a facility CARR uses as an example.\u003c/p>\n\u003cp>\"This particular facility had one resident who was left on the floor in their apartment for more than 24 hours and bled to death,\" she said. \"Same facility, a dementia resident who was unable to consent to have sexual relations with another resident but that repeatedly went on. There was a culture of fear among the staff, and so they weren’t cooperating during the investigation with Department of Social Services. That was the third one for this facility. Now, this facility remains open today. There’s no caution tape on the door.\"\u003c/p>\n\u003cp>Her partner in CARR, Chris Murphy, chimes in. \"I mean it’s almost like 'what do you have to do to get closed?'\"\u003c/p>\n\u003cp>They've developed some strong opinions after reviewing so many DSS reports. For instance, despite the claims of some that the worst abuses are likely to be more common in big facilities, especially those owned by corporate chains, Selder and Murphy say small homes are just as likely to fail their residents.\u003c/p>\n\u003cp>Both Murphy and Selder have degrees in gerontology. Both say they’re heartened by all the legislation in Sacramento, especially \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1523\" target=\"_blank\" rel=\"noopener\">the bill they sponsored\u003c/a>, AB 1523, requiring all facilities to carry liability insurance. [UPDATE: That bill passed, and Governor Jerry Brown signed it into law.] But Murphy worries about the fine print on all the legislation. \"If it’s not clearly stipulated within the bill, then it’s left to the regulators, then the regulators are going to come up with whatever they come up with. So I would hope that they get serious about having stakeholders meetings, using all of the expertise that’s available in this state.\"\u003c/p>\n\u003cp>Selder worries lawmakers are tweaking a system that is fundamentally dysfunctional. If a growing number of elderly need medical care, Selder says, maybe they shouldn’t be in assisted living. Or maybe assisted living should deliver tiered levels of care, with tiered levels of regulation. But that’s not the discussion on the table in Sacramento - at least, not this year.\u003c/p>\n\u003cp>\"We are behind the curve,\" Selder says. \"Other states have rating systems. Other states have assisted living regulated under the Department of Public Health. We’re not there. We’re not even talking about it in the right way yet.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Polly Stryker contributed to this report.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/20618/are-the-proposed-assisted-living-reforms-in-california-enough","authors":["251"],"categories":["stateofhealth_11","stateofhealth_14"],"tags":["stateofhealth_186","stateofhealth_825","stateofhealth_2829","stateofhealth_3245","stateofhealth_591"],"featImg":"stateofhealth_20634","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. Michel Martin hosts on the weekends.","airtime":"MON-FRI 1pm-2pm, 4:30pm-6:30pm\u003cbr />SAT-SUN 5pm-6pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/All-Things-Considered-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/all-things-considered/","meta":{"site":"news","source":"npr"},"link":"/radio/program/all-things-considered"},"american-suburb-podcast":{"id":"american-suburb-podcast","title":"American Suburb: The Podcast","tagline":"The flip side of gentrification, told through one town","info":"Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. But is this once sleepy suburb ready for them?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/American-Suburb-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/news/series/american-suburb-podcast","meta":{"site":"news","source":"kqed","order":"13"},"link":"/news/series/american-suburb-podcast/","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328","tuneIn":"https://tunein.com/radio/American-Suburb-p1086805/","rss":"https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"}},"baycurious":{"id":"baycurious","title":"Bay Curious","tagline":"Exploring the Bay Area, one question at a time","info":"KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.","airtime":"THU 10pm, FRI 1am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.commonwealthclub.org/podcasts","meta":{"site":"news","source":"Commonwealth Club of California"},"link":"/radio/program/commonwealth-club","subscribe":{"apple":"https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2","google":"https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw","tuneIn":"https://tunein.com/radio/Commonwealth-Club-of-California-p1060/"}},"considerthis":{"id":"considerthis","title":"Consider This","tagline":"Make sense of the day","info":"Make sense of the day. Every weekday afternoon, Consider This helps you consider the major stories of the day in less than 15 minutes, featuring the reporting and storytelling resources of NPR. Plus, KQED’s Bianca Taylor brings you the local KQED news you need to know.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Consider-This-Podcast-Tile-703x703-1.jpg","imageAlt":"Consider This from NPR and KQED","officialWebsiteLink":"/podcasts/considerthis","meta":{"site":"news","source":"kqed","order":"7"},"link":"/podcasts/considerthis","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1503226625?mt=2&at=11l79Y&ct=nprdirectory","npr":"https://rpb3r.app.goo.gl/coronavirusdaily","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM1NS9wb2RjYXN0LnhtbA","spotify":"https://open.spotify.com/show/3Z6JdCS2d0eFEpXHKI6WqH"}},"forum":{"id":"forum","title":"Forum","tagline":"The conversation starts here","info":"KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.","airtime":"MON-FRI 9am-11am, 10pm-11pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED Forum with Mina Kim and Alexis Madrigal","officialWebsiteLink":"/forum","meta":{"site":"news","source":"kqed","order":"8"},"link":"/forum","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/kqeds-forum/id73329719","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz","npr":"https://www.npr.org/podcasts/432307980/forum","stitcher":"https://www.stitcher.com/podcast/kqedfm-kqeds-forum-podcast","rss":"https://feeds.megaphone.fm/KQINC9557381633"}},"freakonomics-radio":{"id":"freakonomics-radio","title":"Freakonomics Radio","info":"Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. 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Updated Monday through Friday at about 3:30 p.m. PT.","airtime":"MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.marketplace.org/","meta":{"site":"news","source":"American Public Media"},"link":"/radio/program/marketplace","subscribe":{"apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=201853034&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/APM-Marketplace-p88/","rss":"https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"}},"mindshift":{"id":"mindshift","title":"MindShift","tagline":"A podcast about the future of learning and how we raise our kids","info":"The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. 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