Long read. And yikes.

https://www.newyorker.com/news...-over-a-nursing-home

Ugh, I want to read this but am not in a "yikes" kind of mood...

Private equity firms are buying up assisted living facilities (where the residents pay 4k- 5k a month).

They are sending residents to short term care facilities or to hospitals under false pretenses, evicting them under false pretenses, and not letting them in the front door again.

This behavior is nefarious, if not evil, IMO.

BTW, states' enforcement against this practice ranges from outright corruption to a slap on the wrist.

quote:

Originally posted by Daniel:
Private equity firms are buying up assisted living facilities (where the residents pay 4k- 5k a month).

They are sending residents to short term care facilities or to hospitals under false pretenses, evicting them under false pretenses, and not letting them in the front door again.

This behavior is nefarious, if not evil, IMO.

BTW, states' enforcement against this practice ranges from outright corruption to a slap on the wrist.

Not clear about the situation you're describing.

Are you saying a privately run assisted-living facility (costing $3 - 4K/mo) won't let former residents return from a different kind of care facility (hospital, rehab - don't know what short-term facility is)?

Not addressing the part of the issue (which I understand is where most corruption is going on) but I'd really like to understand the basics of patient charges.

Do you mean if they are paying full freight, they are still not allowed back?

My mother was in Assisted Living for many years (a rather posh place where she had a nice apartment, starting with two bathrooms and bedroom + LR).

Since then she's been transferred (under supervision of SIL who's assigned herself her POA, + Medical Directives) to other care levels.
(They are SO sticky about the "ADLs" they count and how).

I think Mom is now in Memory Care/combo Hospice (Hospice amounts to having visitors to Memory Care), punctuated by short hospital stays after her incessant falls some of which lead to fractures. (Legally, they aren't allowed to strap her in wheelchairs or even put bars on the sides of her bed. Crazy! Something about "freedom"*)

Since she's left to get herself to her bathroom, naturally, she is continually falling. I think they are allowing her to remain there as a kind of favor so she doesn't "graduate" to a more intensive level of care (with a much higher cost.)

I'm sure there are vast differences in qualities of care at variously run, variously named care facilities so my question may be irrelevant to your indignation, but perhaps you can at least address my question even if it doesn't apply.

(To compare notes to see if I understood your complaint...Are you upset that when facilities are privately owned they are - for some reason - able to kick out patients who have previously been there paid for by Medicaid? By somehow getting them temporarily housed elsewhere. (?)

I'm sure they cut corners in quality of care - to say the least - once they aren't answerable to government standards (to the extent the facilities are really supervised by the government.) I've read about such (privately owned) franchises. Ones, which when "caught" in serious negligence and even abuse, shut down after paying a low fine, only to open again under a new name.

Likewise - don't know under whose stewardship - I've even read about nightmare situations in which numerous patients succumbed to Covid, only to be kept in refrigerated morgue trucks until - whenever. (Read of this in an interview with a whistleblower, who was one of the young men, given the job of carrying out the bodies day in day out.)

Added the specifics above, only to say I am familiar with Florida abuses in such facilities - private or public. (I also knew of other abuses, like drugging Alzheimer's patients with anti-psychotics for manageability, and illegally changing their diagnosis post hoc to fit the new treatment. Also, abuse and just plain neglect.)

But I am particularly interested in clarification of an aspect of your description for personal reasons.

Thank you.

* If you hadn't read elsewhere in a different post of mine, my 99 year old mother is both blind and deaf, and suffers from pretty advanced Alzheimer's.



Daniel, in spite of your carefully elaborated post, I find I am even more confused about the issue you wrote about.

You say that although you don't know why (except that the motive must have been greed) these facilities you refer to, send patients on a medical pretext to a facility providing a different level of care.

Then when they would ordinarily be discharged and returned to their original facility, they are refused readmission - also on a pretext. (And it sounds like they are also doctoring medical records to justify this refusal).

I remain confused about how this would benefit the owners financially, if the patient has been paying the facility's full charge up to then (and would be continuing with same).

I will recount what's going on with my mother to the extent it may shed some light on this. As I said, she is continually falling attempting to go the bathroom at night (recalling she is blind, deaf and suffering from Alzheimer's). How could she NOT fall, really, however well she knows the layout of her room?

On a recent fall she hit her head and broke her hip which required surgery. After a stay in rehab was (finally) returned to her original Memory Care unit. There WAS a certain amount of confusion (and LOTS of paperwork and evaluations) governing whether she would be allowed to go back
to that Memory Care unit. The alternative was being sent to a Skilled Nursing facility because she would no longer qualify for the earlier level of care.

It was tense for my family because the Skilled Nursing Facility is much more expensive. The determination was made on the basis of her "ADL'" (Activities of Daily Life") and somehow - perhaps to a degree, as a favor - she finally qualified to be returned to Memory Care. I don't know how many ADL's she was considered able to manage alone (I see there are six on the list) but apparently she passed muster.

Perhaps in these privately owned facilities, patients who are deteriorating, are no longer returned to their former facility because their evaluations determine the patient would require more staff time to function. That would mean they are undesirable residents compared to patients with fewer needs. That WOULD mean the first facility is getting rid of such patients presumably on the basis of how many ADL's they now require.

As far as I know, however, they are pretty strict about how ADL's are assessed. I guess in the situation you're describing, the profit-motivated owners are falsifying the ADL's to get rid of patients who ought by rights to be allowed to remain in their previous housing. (Maybe being privately run, they don't have to be subjected to oversight about such assessments.)

One thing is sure, it sure is a helluva situation to be in when one is old and disabled. My SIL again spent most of the last days dealing with this paperwork and making calls about Mom's care. SIL stressed to me, she had no idea how patients without such a basically full-time case-manager (as she is acting) manage at all. (All of which sent a chill down my spine
wondering where I'll end up!).

One lesson to be drawn seems to be that whether it's a prison or a child care or elder care facility, one is certainly better off avoiding a for-profit, privately owned facility!

quote:

I think Mom is now in Memory Care/combo Hospice (Hospice amounts to having visitors to Memory Care), punctuated by short hospital stays after her incessant falls some of which lead to fractures. (Legally, they aren't allowed to strap her in wheelchairs or even put bars on the sides of her bed. Crazy! Something about "freedom"*)

The facilities cite Medicare Skilled Nursing Facility Rights :

quote:

Freedom from restraints

Physical restraints are any manual method or physical or mechanical device, material, or equipment attached to or near your body so that you can't remove the restraint easily. Physical restraints prevent freedom of movement or normal access to one's own body. A chemical restraint is a drug that's used for discipline or convenience and isn't needed to treat your medical symptoms.

It's against the law for a SNF to use physical or chemical restraints, unless it's necessary to treat your medical symptoms. Restraints may not be used to punish or for the convenience of the SNF staff. You have the right to refuse restraint use except if you're at risk of harming yourself or others.

In the memory care unit where my mom was they even had to stop using the seat alarms that would sound when someone tried to stand up from a wheelchair, or the bed alarms that did the same for people getting up at night. It was considered a restraint. They just had to keep an eye on everyone. Works reasonably well if you have adequate staffing. I ended up working with them and installing an inexpensive system that had a central console and pagers that sounded when the seat or bed alarm sounded. Worked great in my Mom's case.

The other strategy for residents who got out of bed at night, the staff would lower the bed down to the ground every night and put a foam pad next to it so that if someone tried to get out they couldn't possibly fall and they were much less likely to injure themselves.

I think hospice is not well understood. People who are on hospice aren't necessarily in immediate peril of dying. Care is focused on quality of life rather than extension. It might be medical and support people coming in to help, equipment, and other support services like pastoral care for the resident/patient and the family.

Medicare pays for hospice services, if the resident meets the requirements. Hospice helps the staff with residents who are requiring extra care and the facility may encourage family to sign up for it, especially if they're short-staffed, but no matter what, it's basically extra hands on deck. Mom got extra showers and there was another nurse who came in on a regular basis. A low air loss mattress is available under the program at no cost to the resident. Medications are covered, too, IIRC.

A lot of facilities relaxed COVID lockdown protocols to allow family to visit residents who were end-of-life. I'm not sure you had to be on hospice to qualify.

quote:

Originally posted by Amanda:

quote:

Originally posted by Daniel:
Private equity firms are buying up assisted living facilities (where the residents pay 4k- 5k a month).

They are sending residents to short term care facilities or to hospitals under false pretenses, evicting them under false pretenses, and not letting them in the front door again.

This behavior is nefarious, if not evil, IMO.

BTW, states' enforcement against this practice ranges from outright corruption to a slap on the wrist.

Not clear about the situation you're describing.

Are you saying a privately run assisted-living facility (costing $3 - 4K/mo) won't let former residents return from a different kind of care facility (hospital, rehab - don't know what short-term facility is)?

Not addressing the part of the issue (which I understand is where most corruption is going on) but I'd really like to understand the basics of patient charges.

Do you mean if they are paying full freight, they are still not allowed back?

My mother was in Assisted Living for many years (a rather posh place where she had a nice apartment, starting with two bathrooms and bedroom + LR).

Since then she's been transferred (under supervision of SIL who's assigned herself her POA, + Medical Directives) to other care levels.
(They are SO sticky about the "ADLs" they count and how).

I think Mom is now in Memory Care/combo Hospice (Hospice amounts to having visitors to Memory Care), punctuated by short hospital stays after her incessant falls some of which lead to fractures. (Legally, they aren't allowed to strap her in wheelchairs or even put bars on the sides of her bed. Crazy! Something about "freedom"*)

Since she's left to get herself to her bathroom, naturally, she is continually falling. I think they are allowing her to remain there as a kind of favor so she doesn't "graduate" to a more intensive level of care (with a much higher cost.)

I'm sure there are vast differences in qualities of care at variously run, variously named care facilities so my question may be irrelevant to your indignation, but perhaps you can at least address my question even if it doesn't apply.

(To compare notes to see if I understood your complaint...Are you upset that when facilities are privately owned they are - for some reason - able to kick out patients who have previously been there paid for by Medicaid? By somehow getting them temporarily housed elsewhere. (?)

I'm sure they cut corners in quality of care - to say the least - once they aren't answerable to government standards (to the extent the facilities are really supervised by the government.) I've read about such (privately owned) franchises. Ones, which when "caught" in serious negligence and even abuse, shut down after paying a low fine, only to open again under a new name.

Likewise - don't know under whose stewardship - I've even read about nightmare situations in which numerous patients succumbed to Covid, only to be kept in refrigerated morgue trucks until - whenever. (Read of this in an interview with a whistleblower, who was one of the young men, given the job of carrying out the bodies day in day out.)

Added the specifics above, only to say I am familiar with Florida abuses in such facilities - private or public. (I also knew of other abuses, like drugging Alzheimer's patients with anti-psychotics for manageability, and illegally changing their diagnosis post hoc to fit the new treatment. Also, abuse and just plain neglect.)

But I am particularly interested in clarification of an aspect of your description for personal reasons.

Thank you.

* If you hadn't read elsewhere in a different post of mine, my 99 year old mother is both blind and deaf, and suffers from pretty advanced Alzheimer's.

I'm sorry that your mother is in a situation where there is no option but to risk falling.

My indignation was after reading an excellent article written by a daughter about her mother basically being evicted under false pretenses. She wrote in detail about her attempts to have Missouri enforce its laws. The narration ended with the state doctoring its own paperwork to fit its excuses.

To be clear, the case had nothing to do with Medicaid.

The mother was paying in the range of 4k to 5k.

It's not clear to me exactly why the facility did this, but one can assume the motivation was related to greed, and also (this was revealed the author) not an isolated incident.

Likewise, one can reasonably assume that the industry was manipulating the political process.

I would link to the article for you if I could remember where I read it.

Yes, I meant rehab by short term facility.

Daniel, in spite of your carefully elaborated post, I find I am even more confused about the issue you wrote about.

You say that although you don't know why (except that the motive must have been greed) these facilities you refer to, send patients on a medical pretext to a facility providing a different level of care.

Then when they would ordinarily be discharged and returned to their original facility, they are refused readmission - also on a pretext. (And it sounds like they are also doctoring medical records to justify this refusal).

I remain confused about how this would benefit the owners financially, if the patient has been paying the facility's full charge up to then (and would be continuing with same).

I will recount what's going on with my mother to the extent it may shed some light on this. As I said, she is continually falling attempting to go the bathroom at night (recalling she is blind, deaf and suffering from Alzheimer's). How could she NOT fall, really, however well she knows the layout of her room?

On a recent fall she hit her head and broke her hip which required surgery. After a stay in rehab was (finally) returned to her original Memory Care unit. There WAS a certain amount of confusion (and LOTS of paperwork and evaluations) governing whether she would be allowed to go back
to that Memory Care unit. The alternative was being sent to a Skilled Nursing facility because she would no longer qualify for the earlier level of care.

It was tense for my family because the Skilled Nursing Facility is much more expensive. The determination was made on the basis of her "ADL'" (Activities of Daily Life") and somehow - perhaps to a degree, as a favor - she finally qualified to be returned to Memory Care. I don't know how many ADL's she was considered able to manage alone (I see there are six on the list) but apparently she passed muster.

Perhaps in these privately owned facilities, patients who are deteriorating, are no longer returned to their former facility because their evaluations determine the patient would require more staff time to function. That would mean they are undesirable residents compared to patients with fewer needs. That WOULD mean the first facility is getting rid of such patients presumably on the basis of how many ADL's they now require.

As far as I know, however, they are pretty strict about how ADL's are assessed. I guess in the situation you're describing, the profit-motivated owners are falsifying the ADL's to get rid of patients who ought by rights to be allowed to remain in their previous housing. (Maybe being privately run, they don't have to be subjected to oversight about such assessments.)

One thing is sure, it sure is a helluva situation to be in when one is old and disabled. My SIL again spent most of the last days dealing with this paperwork and making calls about Mom's care. SIL stressed to me, she had no idea how patients without such a basically full-time case-manager (as she is acting) manage at all. (All of which sent a chill down my spine
wondering where I'll end up!).

One lesson to be drawn seems to be that whether it's a prison or a child care or elder care facility, one is certainly better off avoiding a for-profit, privately owned facility!

But wait, upon rereading your posts, it sounds at first like you're referring to privately owned facilities (bought up from the state), while later it sounds like the State authorities are working together with these exploitative new owners.

Confused.
Don't bother to go into immense detail, though, as this woman (mother of the writer) is clearly in a very complex situation. I remain uncertain about how widespread this is, and - again - why they are engaging in this practice. My first reading was that they were expelling patients who weren't able to pay full fare.

Now I don't know.

I think your theory that the evicted residents in this daughter's narrative including of course her own mother had become unprofitable in the eyes of the private equity firm(s) is correct.

I apologize for letting my emotions get the better of me and posting about this without providing a link.

https://youtu.be/IWBmRHOucls

The federal government is not doing its job either.

While my Mom was in rehab this spring at "the best" place, we noticed odd things...All per diem staff, understaffed, then one day I was in the lobby and two men met the manager to inspect the facility..This jived with the gossip I heard some aides talking about "the sale".

It is not just the sale, it is leading up to the sale...families need to do what they do in Central America...you need to be there to care for your family member...We brought food, took her out of her room for fresh air, bathed, clothed her...the staff always had a reason why they were not availble.

Our saving grace was Mom was rushed to the ER with a fever..She was diagnosed with malnutrition and dehydration..huh...We had her discharged to home where she is thriving now..I took her for a big shopping trip all over Walmart yesterday then out to lunch!! Rehab had called hospice..

Mom lives in an Erickson Community that is wonderful for independent living...healthcare not so much.

But better than the years prior..The namesake, Erickson, used it as his cash cow. Erickson Sued

It is run as a nonprofit now, but has become a mega org.

No matter where you loved one is, you HAVE to be diligent and watch them like hawks. We were often complemented on how much time we spend with Mom...Many patients have no one.

Our trip to Walmart yesterday included the baby dept where Mom was very determined to choose something cute for her soon to be Great Grandchild!

Malnutrition and dehydration??

What th-?

And undoubtedly in a place which is charging a pretty penny too!

What could be more basic?

Not much else to miss out on except not protecting against infected, deep bed sores, abuse, and not changing adult diapers.

Terrifying to picture such neglect in a top ranked Massachusetts care facility. Massachusetts! It's one thing to make excuses for neglecting basic hygiene and care, but to fail at nourishment and hydration?!?

Yes, I have heard such tasks are also delegated in India too, including in hospitals. That families have to bring the patients, family members, food and clean laundry.

OMG, the article says the Erickson Facilities were found to have spent..."Among the approved expenses claimed in the suit were a $10 million yacht, a $4.6 million Erickson mansion in Baltimore, as well as a second smaller yacht and a $400,000 Baltimore condo."

Meanwhile, they are starving their residents? How is this possible?

quote:

Originally posted by wtg:

quote:

I think Mom is now in Memory Care/combo Hospice (Hospice amounts to having visitors to Memory Care), punctuated by short hospital stays after her incessant falls some of which lead to fractures. (Legally, they aren't allowed to strap her in wheelchairs or even put bars on the sides of her bed. Crazy! Something about "freedom"*)

The facilities cite Medicare Skilled Nursing Facility Rights :

quote:

Freedom from restraints

Physical restraints are any manual method or physical or mechanical device, material, or equipment attached to or near your body so that you can't remove the restraint easily. Physical restraints prevent freedom of movement or normal access to one's own body. A chemical restraint is a drug that's used for discipline or convenience and isn't needed to treat your medical symptoms.

It's against the law for a SNF to use physical or chemical restraints, unless it's necessary to treat your medical symptoms. Restraints may not be used to punish or for the convenience of the SNF staff. You have the right to refuse restraint use except if you're at risk of harming yourself or others.

In the memory care unit where my mom was they even had to stop using the seat alarms that would sound when someone tried to stand up from a wheelchair, or the bed alarms that did the same for people getting up at night...
The other strategy for residents who got out of bed at night, the staff would lower the bed down to the ground every night and put a foam pad next to it so that if someone tried to get out they couldn't possibly fall and they were much less likely to injure themselves.

I think hospice is not well understood...

Medicare pays for hospice services, if the resident meets the requirements. Hospice helps the staff with residents who are requiring extra care and the facility may encourage family to sign up for it, especially if they're short-staffed, but no matter what, it's basically extra hands on deck...

A lot of facilities relaxed COVID lockdown protocols to allow family to visit residents who were end-of-life. I'm not sure you had to be on hospice to qualify.

Yes, hospice is as you describe and it really helps. also, they've finally started lowering my mother's hospital bed til it's on or near the floor with pads next to her for the same reasons you describe your mom's caregivers' doing.

Can't help wondering why this isn't standard practice and why they only now caught on. Mom's broken her wrist and hip in separate falls and landed on her head too more than once. I think she's falling every other day at least. This isn't doing her dementia any good!

Don't know much about the staffing at her facilities except that in her Assisted Living place, NO ONE got Covid nor did any staff contract it.

This Memory Care place is rather different in that regard. I must say it seems the enforced isolation and separated visiting arrangements before, may have done more harm than less scrupulous enforcement of Covid regs, though.
My brother and SIL "visited" her occasionally outside a screened in porch, with all parties wearing masks. Mom already couldn't hear or see them even in the same room, so this was pretty much a lost cause in terms of communication.
She really deteriorated in that extra strict Covid lockdown period.

I read that New Yorker article and was utterly horrified. It sounds completely Dickensian. The children expressing alarm and shock - why didn't they try to intervene? Surely they could see the way the wind was blowing in terms of their parents' failing - and both painfully and without dignity.

I guess the incarcerated parents were paid for by Medicaid - otherwise, I can't believe the children couldn't arrange some kind of home care situation for $3-4K/month (if not in their own homes, then there are private homes taking in elders.)

Or they could hire companions too to come in handicapped apartments (adapted design). CNA's bathe them and prepare meals, probably toilet them too and occasional housekeepers could come in too for that residential fee. If they provided food and housing for live-ins, it might help the total reimbursement.

I think Medicare pays for some home care too especially after surgical procedures.

Those inhuman rip-off artists warehousing the disabled elderly ought to be in jail. I remember Biden promised to provide federal oversight of such facilities, including increasing staffing, but the lobby of nursing home owners successfully fought his reform efforts.