Long-term care hospitals also had a higher incidence of bedsores and infections than regular hospitals in 2006, the most recent year for which federal data is available.
Fewer than 10 hospitals dedicated to long-term care existed in the early 1980s, according to Medicare officials. But many such hospitals have sprouted since then, driven by Medicare rules that offer high payments for hospitals that treat patients for an average of 25 days or more. Long-term care hospitals now treat about 200,000 patients a year, including 130,000 Medicare patients — at a projected cost of $4.8 billion to the government this year, up from $400 million in 1993.
Unlike other specialized hospitals, like psychiatric or children’s hospitals, long-term care hospitals do not treat specific types of patients or offer services unavailable in regular hospitals. They are defined solely by the fact that they keep patients longer than other hospitals. They are also smaller than a typical hospital, averaging about 60 beds.
Many patients at hospitals that specialize in long-term care are very sick. While usually in stable condition, they may be on dialysis, need a ventilator or have wounds that will not heal. If patients need surgery or suffer serious medical emergencies, they are usually transferred back to general hospitals.
Nontraditional Hospitals
Despite the rapid expansion of long-term care hospitals and the serious illnesses they treat, Medicare has never closely examined their care. Unlike traditional hospitals, Medicare does not penalize them financially if they fail to submit quality data.
Supporters of long-term hospitals say that even without staff physicians, they provide high-quality care and play an important role by treating patients who are too sick for nursing homes but are not improving at traditional hospitals. Hospital intensive care units help patients survive acute illnesses, heart attacks and trauma, but they are not intended to treat patients for weeks or months.
Of course, traditional hospitals can move those patients to regular medical wards for treatment. But under Medicare payment rules, traditional hospitals often lose money on patients who stay for long periods. So they have a financial incentive to discharge patients to long-term hospitals, which then receive new Medicare payments for admitting the patients. Both hospitals benefit financially.
That dynamic, rather than evidence that long-term hospitals benefit patients, has driven their expansion, said Dr. Jeremy M. Kahn of the University of Pennsylvania, who has received a federal grant to study the hospitals. The industry’s growth is an example of how health care companies can exploit the $450 billion Medicare program, he added.
“The U.S. health care system allows unintentional financial incentives to drive sweeping changes,” Dr. Kahn said.
The questions about long-term care hospitals center on the for-profit side of the industry, led by Select and Kindred Healthcare, another publicly traded company.
For-profit long-term hospitals generally spend less on patients and have higher margins than comparable nonprofits, according to data from the Medicare Payment Advisory Commission, a Congressional research agency.
In 2007, for-profit long-term care hospitals had margins of 6 percent on Medicare patients, while regular hospitals lost an average of 6 percent on Medicare patients, according to the commission.
In a presentation to investors last month, Select Medical reported that it improved its margins by monitoring staffing levels and lowering supply costs.
Medicare inspection reports, however, describe preventable patient injuries and deaths, and they portray Select’s hospitals as understaffed and with high turnover.
In the last three years, inspectors have found 22 violations of care standards at 12 Select hospitals so serious that, if uncorrected, could lead Medicare to ban those hospitals from admitting Medicare patients.
Howard McGowan
MaldenSenior
Saturday, December 17, 2011
Tuesday, December 13, 2011
Major For-Profit Nursing Home Chains Skimp on Care Quality,
Study Shows
Alyssa Gerace | December 12, 2011 | Comments (0)
The top ten for-profit nursing home chains in the United States provide a lesser quality of care to their patients, partially due to fewer nursing staffing hours, according to a recent study published in Health Services Research.
Nurse “staffing hours” in the largest for-profit chains were 30% lower than those in non-profit and government nursing homes between 2003 and 2008. At the same time, the for-profits had the sickest residents, and maintained total nursing staff levels significantly lower than 2008′s national average of 3.77.
“Nurse staffing levels have been documented to have a positive impact on both the process and the outcomes of nursing home care,” report the study’s authors.
Although the staffing levels were low in comparison to non-profit and government facilities, they were still higher than other for-profit chains and for-profit nonchains, the study found.
However, when compared to top-rated nursing homes, the top-ten chains were cited for 41% more serious deficiencies and 36% more deficiencies overall. The average number of total and serious deficiencies was “significantly higher than in any other ownership group,” although other for-profit chains and nonchains also had higher deficiencies than government facilities.
“Facility size and the percent Medicaid residents were positively associated with total deficiencies and serious deficiencies,” said the study.
This is the first study that looks at staffing in conjunction with quality of care in the largest for-profit chains, and the results show that there’s a relationship between ownership, low staffing and higher deficiencies, the study’s authors concluded.
“The study does provide evidence of the need for more study of quality of care in the largest for-profit chains and in chains purchased by private equity firms, because they are under pressure to improve shareholder and investor values, with little oversight by regulators,” they said.
The full article, “Nurse Staffing and Deficiencies in the Largest For-Profit Nursing Home Chains and Chains Owned by Private Equity Companies,” can be accessed here.
Written by Alyssa Gerace
Alyssa Gerace | December 12, 2011 | Comments (0)
The top ten for-profit nursing home chains in the United States provide a lesser quality of care to their patients, partially due to fewer nursing staffing hours, according to a recent study published in Health Services Research.
Nurse “staffing hours” in the largest for-profit chains were 30% lower than those in non-profit and government nursing homes between 2003 and 2008. At the same time, the for-profits had the sickest residents, and maintained total nursing staff levels significantly lower than 2008′s national average of 3.77.
“Nurse staffing levels have been documented to have a positive impact on both the process and the outcomes of nursing home care,” report the study’s authors.
Although the staffing levels were low in comparison to non-profit and government facilities, they were still higher than other for-profit chains and for-profit nonchains, the study found.
However, when compared to top-rated nursing homes, the top-ten chains were cited for 41% more serious deficiencies and 36% more deficiencies overall. The average number of total and serious deficiencies was “significantly higher than in any other ownership group,” although other for-profit chains and nonchains also had higher deficiencies than government facilities.
“Facility size and the percent Medicaid residents were positively associated with total deficiencies and serious deficiencies,” said the study.
This is the first study that looks at staffing in conjunction with quality of care in the largest for-profit chains, and the results show that there’s a relationship between ownership, low staffing and higher deficiencies, the study’s authors concluded.
“The study does provide evidence of the need for more study of quality of care in the largest for-profit chains and in chains purchased by private equity firms, because they are under pressure to improve shareholder and investor values, with little oversight by regulators,” they said.
The full article, “Nurse Staffing and Deficiencies in the Largest For-Profit Nursing Home Chains and Chains Owned by Private Equity Companies,” can be accessed here.
Written by Alyssa Gerace
Monday, December 12, 2011
Nursing homes are on a track toward negative profit
Alyssa Gerace | December 11, 2011 | Comments (0)
if Congress passes certain end-of-the-year legislation, and it could affect the level of services that are offered, according to analysis by The Moran Company on behalf of the American Health Care Association (AHCA).
The analysts considered the impact of policy changes that include a “clawback” of 2011 revenues from RUG IV implentation, a two-year suspension of market basket adjustments, limiting bad debt payments to 25%, imposing a 5% coinsurance on the first 20 days of skilled nursing care, and capping Medicaid provider taxes at 3.5% of total payments.
Evaluating these policy changes “would turn nursing facility net margins from mildly positive to consistently negative over the forecast period,” the research shows.
If implemented, resultant industry margin revenue would be at 0.1% in 2012, which would dip to negative 2.9% the following year and still further in 2015 to -3.1%. By 2021, revenue margins would remain negative at -0.8%, according to The Moran Company’s data.
“While our analysis demonstrates the possibility that the industry might be able to weather reductions of this magnitude, it makes clear the substantial degree of uncertainty surrounding the industry’s ability to actually do so,” the analysis concluded.
Taking into account the expected 2% cuts to Medicare payments, as a result of deficit reduction activity, The Moran Company estimates that baseline overall margins will range from 0.64% of revenue in 2012 to 2.11% in 2021.
If these reimbursement reductions are implemented, the analysts said, the level of services now provided in nursing facilities could also be affected.
“Many may not want to mention margins when it relates to healthcare providers, but the fact of the matter is without a margin, it’s just not possible to keep operating,” said AHCA President and CEO Mark Parkinson in a statement.
The Moran Company’s findings, “Assessing the Financial Implications of Alternative Reimbursement Policies for Nursing Facilities,” can be viewed here.
Written by Alyssa Gerace
if Congress passes certain end-of-the-year legislation, and it could affect the level of services that are offered, according to analysis by The Moran Company on behalf of the American Health Care Association (AHCA).
The analysts considered the impact of policy changes that include a “clawback” of 2011 revenues from RUG IV implentation, a two-year suspension of market basket adjustments, limiting bad debt payments to 25%, imposing a 5% coinsurance on the first 20 days of skilled nursing care, and capping Medicaid provider taxes at 3.5% of total payments.
Evaluating these policy changes “would turn nursing facility net margins from mildly positive to consistently negative over the forecast period,” the research shows.
If implemented, resultant industry margin revenue would be at 0.1% in 2012, which would dip to negative 2.9% the following year and still further in 2015 to -3.1%. By 2021, revenue margins would remain negative at -0.8%, according to The Moran Company’s data.
“While our analysis demonstrates the possibility that the industry might be able to weather reductions of this magnitude, it makes clear the substantial degree of uncertainty surrounding the industry’s ability to actually do so,” the analysis concluded.
Taking into account the expected 2% cuts to Medicare payments, as a result of deficit reduction activity, The Moran Company estimates that baseline overall margins will range from 0.64% of revenue in 2012 to 2.11% in 2021.
If these reimbursement reductions are implemented, the analysts said, the level of services now provided in nursing facilities could also be affected.
“Many may not want to mention margins when it relates to healthcare providers, but the fact of the matter is without a margin, it’s just not possible to keep operating,” said AHCA President and CEO Mark Parkinson in a statement.
The Moran Company’s findings, “Assessing the Financial Implications of Alternative Reimbursement Policies for Nursing Facilities,” can be viewed here.
Written by Alyssa Gerace
Monday, November 28, 2011
Category: Nursing Homes
The population of 90+ Americans is projected to more than quadruple over the course of the next four decades, Census data released this week states. That population nearly tripled over the past 30 years to reach 1.9 million in 2010, comprising 4.7% of the overall population. The growing demographic has strong implications for senior housing providers and skilled nursing in particular, the Census report indicates.
“Traditionally, the cutoff age for what is considered the ‘oldest old’ has been age 85,” said Census Bureau demographer Wan He, “but increasingly people are living longer and the older population itself is getting older. Given its rapid growth, the 90-and-older population merits a closer look.”
The proportion of those in the 90+ demographic who live in skilled nursing facilities is roughly 20% for those in their lower 90s and upwards of 30% for those in their upper 90s, the report states. “An older person’s likelihood of living in a nursing home increases sharply with age,” it says. The proportion is nearly 40% for centenarians. Additionally, those who are 90 or older are almost universally covered by health insurance, at 99.5% of the population.
Aside from a need for skilled nursing care, Census statistics gathered on the 90+ population those in the age group who live in households are also very likely to need assistance with everyday activities.
View the Census report: 90+ in the United States 2006-2008.
Written by Elizabeth Ecker
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“Traditionally, the cutoff age for what is considered the ‘oldest old’ has been age 85,” said Census Bureau demographer Wan He, “but increasingly people are living longer and the older population itself is getting older. Given its rapid growth, the 90-and-older population merits a closer look.”
The proportion of those in the 90+ demographic who live in skilled nursing facilities is roughly 20% for those in their lower 90s and upwards of 30% for those in their upper 90s, the report states. “An older person’s likelihood of living in a nursing home increases sharply with age,” it says. The proportion is nearly 40% for centenarians. Additionally, those who are 90 or older are almost universally covered by health insurance, at 99.5% of the population.
Aside from a need for skilled nursing care, Census statistics gathered on the 90+ population those in the age group who live in households are also very likely to need assistance with everyday activities.
View the Census report: 90+ in the United States 2006-2008.
Written by Elizabeth Ecker
.
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« Ensign Acquires 88-Bed Idaho Skilled Nursing Facility
FHA’s Healthcare Programs Outshine Struggling Single Family in FY 2011 »
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Friday, November 18, 2011
trend away from nursing homes and to other, more home-like forms of long-term care for American seniors.
In the past 10-plus years, there has been a trend away from nursing homes and to other, more home-like forms of long-term care for American seniors. Most say the shift is due to nursing homes’ high costs, but also some of the traditional qualities that nursing homes have represented over the years and the rise of alternative options.
Between 1998 and 2008, the number of Americans living in nursing homes shrank 6.1% to slightly more than 1.2 million, says a Brown University study published in the July 2011 edition of Health Affairs. During this same time frame, there was 18.1% increase in the number of Americans aged 65-69, and 8.7% rise in those aged 70 and older, according to U.S. Census Bureau estimations. MetLife estimates that today’s nursing home care costs upwards of $83,000 per year for a private room, on average.
Jodie Spiegel, a lawyer for consumer advocacy organization Bet Tzedek, says in her experience from speaking with clients, the nursing home population is decreasing because there are so many other options available, like assisted living, which has experienced rapid growth. There are more than one million people living in assisted living facilities, according to the Assisted Living Federation of America, even though it’s a relatively new concept that was developed about 25 years ago.
“Previously, when someone required care outside of their home, their only choices were hospitals or nursing homes,” says Spiegel. “Now, there’s assisted living, continuing care, adult day healthcare, senior centers, receiving care at home—there are more choices, and choices are more home-like, which in general is more appealing to people.”
Something else that may be keeping seniors out of nursing homes is the multitude of stigmatized issues attached to those establishments. As a consumer advocate, Spiegel encounters many recurring complaints regarding nursing homes, many of which she says are due to staffing shortages.
“Nursing homes are businesses and they’re trying to make a profit,” says Spiegel. “In a perfect world, nursing homes would be hiring more staff to provide better care, but unless they’re required to do so, they’re unlikely to do so.”
Missouri-based Cheryl Parsons, who’s a registered nurse and a licensed nursing home administrator and consultant, admits staffing can be a major issue for some facilities.
“The problem is, the acuity level has gotten a lot higher in the long term care setting,” says Parson, referring to the level of severity of a resident’s illness. “Hospitals just are not keeping patients, so we’re seeing higher acuity levels,” which translates to higher levels of care and attention being needed. “Couple that with reimbursement issues, owners are having a hard time keeping the bills met, and the staff paid, in order to keep that staffing where it needs to be,” she says. “It is a concern, it’s a big issue.”
Now that nursing homes are facing an 11.1% cut to Medicare payments, the challenges abound. Although both Medicaid and Medicare programs apply to nursing home residents, reimbursement rates from the government-funded programs aren’t as high as what a nursing home could receive from a private pay resident, says Spiegel.
Since many nursing homes have a high population of Medicare- and Medicaid-eligible residents, these facilities could be especially affected by funding cuts, since it will affect their ability to subsidize lower Medicaid reimbursements with Medicare funds.
“You need to pay the bills to keep the doors open and let patients in,” Parsons says. “It weighs heavily on those of us who are committed to the industry and to our residents. Most facilities work very hard and diligently to do so, but it’s always a challenge because of the reimbursement issue.”
Greg Crist, the Head of Affairs for (AHCA) says the important thing to remember is that nursing homes want residents to be in the least-restrictive setting. They’re not trying to pull in large numbers of residents to give them lesser-quality care for a profit, if those residents are better off living at home or at an assisted living facility.
“There will always be a need for long term care,” he says.”We just want to make sure there’s a cost-effective, and least-restrictive method as well. We only want them in our facilities if that makes the most sense.”
Written by Alyssa Gerace
Between 1998 and 2008, the number of Americans living in nursing homes shrank 6.1% to slightly more than 1.2 million, says a Brown University study published in the July 2011 edition of Health Affairs. During this same time frame, there was 18.1% increase in the number of Americans aged 65-69, and 8.7% rise in those aged 70 and older, according to U.S. Census Bureau estimations. MetLife estimates that today’s nursing home care costs upwards of $83,000 per year for a private room, on average.
Jodie Spiegel, a lawyer for consumer advocacy organization Bet Tzedek, says in her experience from speaking with clients, the nursing home population is decreasing because there are so many other options available, like assisted living, which has experienced rapid growth. There are more than one million people living in assisted living facilities, according to the Assisted Living Federation of America, even though it’s a relatively new concept that was developed about 25 years ago.
“Previously, when someone required care outside of their home, their only choices were hospitals or nursing homes,” says Spiegel. “Now, there’s assisted living, continuing care, adult day healthcare, senior centers, receiving care at home—there are more choices, and choices are more home-like, which in general is more appealing to people.”
Something else that may be keeping seniors out of nursing homes is the multitude of stigmatized issues attached to those establishments. As a consumer advocate, Spiegel encounters many recurring complaints regarding nursing homes, many of which she says are due to staffing shortages.
“Nursing homes are businesses and they’re trying to make a profit,” says Spiegel. “In a perfect world, nursing homes would be hiring more staff to provide better care, but unless they’re required to do so, they’re unlikely to do so.”
Missouri-based Cheryl Parsons, who’s a registered nurse and a licensed nursing home administrator and consultant, admits staffing can be a major issue for some facilities.
“The problem is, the acuity level has gotten a lot higher in the long term care setting,” says Parson, referring to the level of severity of a resident’s illness. “Hospitals just are not keeping patients, so we’re seeing higher acuity levels,” which translates to higher levels of care and attention being needed. “Couple that with reimbursement issues, owners are having a hard time keeping the bills met, and the staff paid, in order to keep that staffing where it needs to be,” she says. “It is a concern, it’s a big issue.”
Now that nursing homes are facing an 11.1% cut to Medicare payments, the challenges abound. Although both Medicaid and Medicare programs apply to nursing home residents, reimbursement rates from the government-funded programs aren’t as high as what a nursing home could receive from a private pay resident, says Spiegel.
Since many nursing homes have a high population of Medicare- and Medicaid-eligible residents, these facilities could be especially affected by funding cuts, since it will affect their ability to subsidize lower Medicaid reimbursements with Medicare funds.
“You need to pay the bills to keep the doors open and let patients in,” Parsons says. “It weighs heavily on those of us who are committed to the industry and to our residents. Most facilities work very hard and diligently to do so, but it’s always a challenge because of the reimbursement issue.”
Greg Crist, the Head of Affairs for (AHCA) says the important thing to remember is that nursing homes want residents to be in the least-restrictive setting. They’re not trying to pull in large numbers of residents to give them lesser-quality care for a profit, if those residents are better off living at home or at an assisted living facility.
“There will always be a need for long term care,” he says.”We just want to make sure there’s a cost-effective, and least-restrictive method as well. We only want them in our facilities if that makes the most sense.”
Written by Alyssa Gerace
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