The six articles you should read about the privatization of elderly care

Sunday, September 15th, at 7p ET, our new Fault Lines episode, "Elderly Incorporated", airs on Al Jazeera America. In this episode, correspondent Josh Rushing investigates the growing business of elderly care, and travels throughout the US to find out what happens when corporations put profits before people.

Here's some background reading for the episode, and we will have more from the episode in the next week with repeat airings and the Al Jazeera English premiere.

We will be livetweeting this episode Sunday from our main Twitter account, @ajfaultlines.   

"Medicare Paid $5.1 Billion for Inadequate Nursing Homes", Alex Wayne for Bloomberg.com, Feb 28, 2013

Medicare paid $5.1 billion to nursing homes in 2009 that failed to meet quality-of-care requirements, U.S. government investigators said.

Reviewers found examples of poor quality of care, including services related to wound and medication management, the Department of Health and Human Services’ inspector general said in a report today. The analysis builds on a separate report last year that showed Medicare paid $1.5 billion more to nursing homes than they were owed in 2009 because the facilities erroneously billed a quarter of their claims.

[...]

“These findings raise concerns about what Medicare is paying for,” Daniel Levinson, the inspector general, said in his report.

Medicare, the U.S. health program for the elderly and disabled, paid $32.2 billion to nursing homes in the 2012 fiscal year. The inspector general today recommended that the Centers for Medicare and Medicaid Services strengthen regulations on care planning, increase surveillance of underperforming nursing facilities and more directly link pay to performance.

"For-Profit Nursing Homes Lead in Overcharging While Care Suffers", Peter Waldman for Bloomberg.com, Dec 31, 2012

A report by federal health care inspectors in November said the U.S. nursing home industry overbills Medicare $1.5 billion a year for treatments patients don’t need or never receive.

Not disclosed was how much worse it is when providers have a profit motive. Thirty per cent of claims sampled from for- profit homes were deemed improper, compared to just 12 percent from non-profits[...]

At nursing homes, 78 percent of $105 billion in revenues went to for-profits in 2010, up from 72 percent in 2002[...]

The figures add to the case -- advanced by health care researchers and Medicare overseers in at least six government and academic studies in the last three years -- that the rise of for-profit providers is fueling waste, fraud and patient harm in the $2.8 trillion U.S health care sector.

"Low Staffing and Poor Quality of Care at Nation's For-Profit Nursing Homes", Elizabeth Fernandez for UCSF, November 29, 2011

The 10 largest for-profit chains in 2008 were HCR Manor Care, Golden Living, Life Care Centers of America, Kindred Healthcare, Genesis HealthCare Corporation, Sun Health Care Group, Inc., SavaSeniorCare LLC, Extendicare Health Services, Inc., National Health Care Corporation, and Skilled HealthCare, LLC.

From 2003 to 2008, these chains had fewer nurse “staffing hours” than non-profit and government nursing homes when controlling for other factors. Together, these companies had the sickest residents, but their total nursing hours were 30 percent lower than non-profit and government nursing homes. Moreover, the top chains were well below the national average for RN and total nurse staffing, and below the minimum nurse staffing recommended by experts.

The 10 largest for-profit chains were cited for 36 percent more deficiencies and 41 percent more serious deficiencies than the best facilities. Deficiencies include failure to prevent pressure sores, resident weight loss, falls, infections, resident mistreatment, poor sanitary conditions, and other problems that could seriously harm residents.

"The Worst-Performing Nursing Facilities Are Seldom Sanctioned; Self-Reporting is Not an Accurate Quality Measurement", The Center for Medicare Advocacy, January 24, 2013

According to an analysis by the Center for Medicare Advocacy (the Center) few sanctions are imposed for the poor care provided by nursing facilities identified by the Federal Government as among those providing the poorest quality of care and quality of life to residents – Special Focus Facilities (SFFs).  The Center's analysis documents an enforcement system that is weak and timid in dealing with even the poorest quality nursing facilities and debunks the industry's claim that the federal enforcement system is overly stringent, punitive, and unfair.  

"As nursing home care improves, some problems slow to mend", Paul Monies for USA TODAY, February 10, 2012

More than 560 of the nation's nursing homes have not budged for the past three years from a one-star federal government rating — the lowest on a five-star scale — even as most homes improved

"Nobody wants to see consistent one-stars; they give everybody a bad name," says Larry Minnix, president and CEO of LeadingAge, an association of non-profit nursing homes. "You'd like to think the marketplace would deal with it and residents wouldn't get placed there, but sometimes they don't have a choice."

"Second state official out after investigation", Margie Menzel for The News Service of Florida, FloridaToday.com, August 24, 2013 

After the departure of the state’s top watchdog for nursing homes and assisted-living facilities, a second former key official has confirmed that his resignation also was prompted by an internal investigation at the Florida Department of Elder Affairs.

Ruskin resident Don L. Hering, a retired Marine who oversaw field operations for the state’s long-term care ombudsman program, resigned from the department Aug. 12.

His departure followed the abrupt retirement of the former state ombudsman, Jim Crochet, in late July. Crochet also was under investigation by the agency.

Hering's departure came as the Department of Elder Affairs moves to fill its state ombudsman post for the second time in two years.

That position has been a bone of contention since Gov. Rick Scott took office and the previous state ombudsman, Brian Lee, was dismissed in early 2011. Lee's filed a lawsuit that remains pending.

Infographs and Factsheets:

Nursing Home Report Card, Families for Better Care, 2013

Fact sheet on elder abuse from the National Center on Elder Abuse, Administration on Aging

Nursing Home Ratings, 2009-2011, USA Today