Here it is, March 5th, and I'm almost done updating for the 2014 edition.  It's not an easy process - I've done a lot of research to ensure that the information is correct.  There have been a few changes to both Medicare & Medicaid this past year.

     There have also been some huge changes to hospice and other programs.  I will explain these changes as best I can so that people can understand how to maneuver through the system.

     The updated copy of my book will be uploaded to on Sunday March 9, 2014.  I appreciate your patience. 

     As I mentioned on the Home page, I'll be updating this site to include articles about nursing homes and other healthcare issues.  I won't be discussing "Obamacare," because the Affordable Healthcare Act has affected the nursing home industry very little. 

      There's so much talk about changing the "culture" of the nursing home industry and how nursing homes are becoming more patient-oriented.  I've seen very little of that happening.  Administrators continue to cut costs while finding inventive ways to boost their revenue.  Patients are discharged without their families being informed about the patient's rights to remain there while a safe discharge plan can be found, patients are encouraged to accept treatments that will increase the nursing home's bottom line, and it's rare that staff members are willing to report any wrongdoing. 

     A social worker that I know recently walked off her job after her administrator (allegedly) attempted to force her to place an incontinent patient on a 12-hour bus ride to stay with relatives who had no idea he would be coming.  Did she report the incident?  Probably not.  The man was under the age of reporting for elderly abuse, and the only thing that would have happened would have been for her to be blackballed in the local nursing home industry. 

     So, I'm changing the site.  I'll be linking to stories about nursing home issues and associated problems.  I'm also updating the book for 2014.  It's going to be a busy year - but it will be worth my time if just one person learns enough to advocate for a family member in a nursing home.  I look forward to the new changes.  - l.e. green

     Sorry about how long it's taken to get back to ya'll.  Had a lot going on.  So, today I'll tell you the story about the nursing home administrator who is trying to force his staff to put a patient onto a bus and send him to live with his family in another state, about a 12 hour bus ride.  The patient is incontinent of both bowel and bladder and wears a brief - he has stage 4 decubitus ulcers (bedsores) on his buttocks and is a paraplegic.  So - to recap, the patient can't walk, shouldn't be in a seated position, shouldn't remain in a dirty brief, and has no ability to get off the bus during stops.  
     The reason that the administrator wants the patient discharged so badly is because he doesn't have the money to pay for his room & board in a nursing home and probably won't qualify for Medicaid.  The administrator doesn't want to wait and see about the Medicaid, so he tried to force his staff to send the patient away on a bus.  This is illegal on so many levels, as well as a human rights violation.
       Of course, the staff members who he's bullying have nothing in writing and it's a given that, if anyone reports his actions to the State, no one will back them up.  One worker took a stand this week and told him "NO."  The administrator responded by rescinding his permission for a scheduled vacation until she complied with his demands.  She walked off the job (and reported him to the state).  There will be an investigation, but the only way this administrator can be stopped is for someone to tape the administrator and submit it as evidence to the state.  I'm not sure of the legalities of taping someone without their knowledge...
     This happens more often than one can imagine.  Do your homework, people.  If the nursing home is poorly rated, don't go there.  If your Medicare HMO/PPO only contracts with these facilities (this is often the case), revert to Medicare A&B with a supplement.  
     I'll tell you about another nightmare discharge next week. 
     Medicare pays nursing homes to provide skilled services (therapy, wound care, etc) to patients, and trusts nursing homes to accurately report each patient's healthcare status.  The only time that Medicare audits a patient's chart is when a problem has been identified.  With over 16,000 nursing homes and thousands of assisted livings and group care homes in the US, many things are overlooked when it comes to auditing patient care.  But there are many ways th
     The more complicated a patient's needs, the higher the amount that Medicare will pay a nursing home.  Nursing homes are able to increase their billings by listing every possible diagnosis for the patient.  For example, if a doctor lists "Confusion possibly due to Alzheimer's Dementia" on the hospital History & Physical, a nursing home can list 1) Alzheimer's Disease, 2) Dementia, and 3) Altered Level of Consciousness.  Since they are only able to bill for conditions for which the patient is being actively treated, nursing homes can ask their physician to order low doses of medications commonly used to treat those diagnoses.  The physicians are usually willing to do so, and are able to increase their billed amounts accordingly.  They'll tell the patients/families that they're concerned about the patient, but it can be very difficult for patients to have all of their medications changed in order for the nursing home to increase its revenue.
     Those medications have certain side effects, which can mean additional diagnoses of agitation and difficulty sleeping.  The patient will also require speech therapy, physical therapy, and occupational therapy.  If the reason that the patient was sent to the hospital in the first place was a fall, there are additional potential diagnoses of pain management, constipation (due to the pain medications), dizziness ... and of course, the patient's usual home medications (such as high blood pressure, etc). 
     It's possible for a patient with virtually nothing wrong with him when he left home to return with 15-20 new diagnoses.  When he arrives at home, his primary doctor can discontinue all of the new medications - the patient might go through hell with all of the changes to his system, but the nursing home would have been able to bill at the maximum rates that Medicare will pay.  For more information about how nursing homes operate, order The Nursing Home Survival Guide on this site.  
     Have a nice week!  More next weekend!
   It's a two-for weekend - this story is about a hospice and a care home that are both out of business due to these, and other, practices:
     A patient lived in a group home, which is a home that is licensed by the
state to care for seniors.  The group home referred “Mr. Jones” for hospice so that they wouldn’t have to pay for all of the supplies and provide all of the personal care that he required.  Mr. Jones’ family lived out-of-state, so my general manager decided to allow the group home worker to  sign the Consent to Treat – but this is illegal.   Only the patient or his legal representative can give permission for a patient to receive medical
   Everything was fine until the unthinkable happened: Medicare asked for a
copy of the patient's chart.  The general manager called the Jones family in a panic, and faxed them the consents.  He told them just to sign and ignore the fact that he had back-dated the form.  To make things even worse, the family missed a signature and the general manager signed their name for them in his best imitation of their signature.  The new consent forms were faxed to Medicare and the general manager thought that he had resolved the issue.
    The manager wasn’t detail-oriented; the forms he sent to Medicare not
only had the actual date the family signed stamped at the top of the page, but his assistant also sent the fax cover sheet that instructed the family to sign and ignore the “back-dating,” along with the original form that the facility worker had signed on the patient’s behalf.  
    The Medicare program was not amused and asked for all of its money
back.  The state visited the care home as well.  Both the hospice and the group home were out of business within a couple of years.

    Mrs. Smith was an elderly woman with dementia whose husband was her
caregiver.  Both of them were admitted to a nursing home after her husband broke his hip.  They shared a room, with Medicare paying $700 + per
day for his care while their family paid about $200 per day for her room &
board.  This way, they could stay together.  
    The nursing home administrator had another idea; she directed me to
complete the paperwork that would send Mrs. Smith to the hospital against her will on a 72-hour hold because she was a danger to herself due to her Dementia.  If Mrs. Smith remained there for three days, she could return to the nursing home and they could bill Medicare for all sorts of treatments she didn’t need.  
   This was a blatant manipulation in order to game the system. 
Mrs. Smith wasn’t experiencing a mental breakdown and it wasn’t appropriate to send her to a psych ward; the hospital never should have accepted her.  I should mention that the nursing home administrator had bragged on several occasions that the local psychiatric ward would accept any patient she sent and hold them for at least three days – the magic number that allows the nursing home to bill Medicare when patients return.  
    After I refused to complete the forms that certified Mrs. Smith was a
danger to herself and to society, the administrator screamed at me for a few
minutes and then found a nurse who agreed to complete the paperwork (She later fired me).
  Mrs. Smith returned 3 days later and the nursing home billed Medicare at
the $700+ rate for the maximum amount of therapy for several months. 
Under the administrator’s direction, the nursing home then billed Medicare for three hours of therapy each day, even though she was so confused she wasn’t able to remember and benefit from the treatments.  
    The only benefit was to the nursing home and to the nursing home
administrator who received bonuses for behaviors such as this.

I've decided that, instead of writing a full book about my experiences (good & bad) in nursing homes, I will start to blog about the bad ones.  I welcome your comments. 

First one will be posted this weekend.  Please note that I'm going to try my hardest to stick to the truth, although I will have to change identifying info in order to ensure I don't get the crap sued out of me.  Unfortunately, we are talking about huge corporations with deep pockets. If only they'd spend more time and money caring for their patients instead of trying to protect themselves, the world would be a better place.  Until this weekend! 
You have every right to discharge from a nursing home when you are ready to leave.  The doctor can't make you stay, your insurance can't make you stay - no one can make you stay there if you don't want to.  It doesn't matter if you have just arrived there or if you've been a resident of the nursing home for months - you have the right to leave.  Ask the social worker to call the Local Contact Agency for assistance.  This is an agency that the nursing home is federally mandated to call if you or your family member asks.

If you or your family member has difficulty becoming discharged, call the Ombudsman, the State Regulatory agency (a full listing is located in the Nursing Home Survival Guide, and the number of the agency is posted in a public area of the nursing home), or even feel free to call an attorney.  The nursing home can't legally block you from leaving nor can they threaten or attempt to intimidate you.

The worst thing that can happen is that the doctor will refuse to help you leave, and you'll have to go to your primary physician for prescriptions or in-home care.  If the nursing home refuses to allow you to leave, call the doctor in charge of your care on your own.  He might not even know you want to leave - and once you explain the situation to him, he'll probably help you with the discharge. 
I've received feedback for my book, which I am currently updating to reflect the Medicare deductibles and co-payments for 2013.  While the feedback has been positive, one review stated that my book "has a very cautionary, somewhat negative tone regarding nursing homes."  The reason that I wrote this book was to provide information as to how nursing homes operate, and what the consumer can do to ensure that their family member receives the best care possible.  Nursing homes operate under the assumption that the patient and family will accept anything they might be told, and that they don't know that they are able to appeal most decisions made on the patient's behalf.  This includes everything from which nursing home the patient will be sent, to when he'll be discharged.  

This book is cautionary, and I'm pleased that it reads that way.  There are many great facilities out there - but there are also those that use intimidation to increase their profits.  People have the right to make decisions about their healthcare, and this book takes the mystery out of nursing home placement. 
I spoke with a woman who told me that the hospital was going to place her mother in a certain nursing home, but after reading my book she did a bit of research and chose another facility that was not only closer to her house, but better rated as well.  She said that, until she had read my book, she wasn't aware that she had a voice in the matter.  Man, it makes me feel good to know that my book made a difference in someone's life.