Once the “Red Sox hospital,” now a nursing home, Sancta Maria in Cambridge to close.

The Cambridge Chronicle has a nice story on the hospital’s history, along with some photos of the nuns who worked there.

CaptureShortly after its founding in 1948, Sancta Maria Hospital earned the nickname “the Red Sox hospital” because of the number of players who received care there. Initially located on Memorial Drive in Cambridge, a little more than a mile across the river from Fenway Park, the hospital provided a convenient place for treating players’ injuries and ailments.

The nuns on staff, members of the Daughters of Mary of the Immaculate Conception, would receive a call from a team doctor or trainer asking, “Is our room empty?”, according to a 1949 Boston Globe article. The nuns would start preparing “the Red Sox room,” described as a “pleasant, blue room with large open fireplace and cheery floral hangings.”

Advertisements

Is there anything worse than making money off old or disabled people in need of care? KHN reports on the #nursinghome shell game.

It links to a Harvard study that make the same connection. This story also ran below the fold in the Sunday NYTimes business section.

Care Suffers As More Nursing Homes Feed Money Into Corporate Webs

Publish by permission. 

khn_logo_facebookMEMPHIS, Tenn. — When one of Martha Jane Pierce’s sons peeled back the white sock that had been covering his 82-year-old mother’s right foot for a month, he discovered rotting flesh.

“It looked like a piece of black charcoal” and smelled “like death,” her daughter Cindy Hatfield later testified. After Pierce, a patient at a Memphis nursing home, was transferred to a hospital, a surgeon had to amputate much of her leg.

One explanation for Pierce’s lackluster care, according to financial records and testimony in a lawsuit brought by the Pierce family, is that her nursing home, Allenbrooke Nursing and Rehabilitation Center, appeared to be severely underfunded at the time, with a $2 million deficit on its books in 2009 and a scarcity of nurses and aides. “Sometimes we’d be short of diapers, sheets, linens,” one nurse testified.

That same year, $2.8 million of the facility’s $12 million in operating expenses went to a constellation of corporations controlled by two Long Island accountants who, court records show, owned Allenbrooke and 32 other nursing homes. The homes paid the men’s other companies to provide physical therapy, management, drugs and other services, from which the owners reaped profits, according to court records.

In what has become an increasingly common business arrangement, owners of nursing homes outsource a wide variety of goods and services to companies in which they have a financial interest or that they control. Nearly three-quarters of nursing homes in the United States — more than 11,000 — have such business dealings, known as related party transactions, according to an analysis of nursing home financial records by Kaiser Health News. Some homes even contract out basic functions like management or rent their own building from a sister corporation, saying it is simply an efficient way of running their businesses and can help minimize taxes.

But these arrangements offer another advantage: Owners can establish highly favorable contracts in which their nursing homes pay more than they might in a competitive market. Owners then siphon off higher profits, which are not recorded on the nursing home’s accounts.

The two Long Island men, Donald Denz and Norbert Bennett, and their families’ trusts collected distributions totaling $40 million from their chain’s $145 million in revenue over eight years — a 28 percent margin, according to the judge’s findings of fact. In 2014 alone, Denz earned $13 million and Bennett made $12 million, principally from their nursing home companies, according to personal income tax filings presented in court.

Typical nursing home profits are “in the 3 to 4 percent range,” said Bill Ulrich, a nursing home financial consultant.

In 2015, nursing homes paid related companies $11 billion, a tenth of their spending, according to financial disclosures the homes submitted to Medicare.

In California, the state auditor is examining related party transactions at another nursing home chain, Brius Healthcare Services. Rental prices to the chain’s real estate entities were a third higher than rates paid by other for-profit nursing homes in the same counties, according to an analysis by the National Union of Healthcare Workers.

Such corporate webs bring owners a legal benefit, too: When a nursing home is sued, injured residents and their families have a much harder time collecting money from the related companies — the ones with the full coffers.

After the Pierce family won an initial verdict against the nursing home, Denz and Bennett appealed, and their lawyer, Craig Conley, said they would not discuss details of the case or their business while the appeal was pending.

“For more than a decade, Allenbrooke’s caregivers have promoted the health, safety and welfare of their residents,” Conley wrote in an email.

Dr. Michael Wasserman, the head of the management company for the Brius nursing homes, called corporate structures a “nonissue” and said, “What matters at the end of the day is what the care being delivered is about.”

Networks of jointly owned limited liability corporations are fully legal and used widely by other businesses, such as restaurants and retailers. Nonprofit nursing homes sometimes use them as well. Owners can have more control over operations — and better allocate resources — if they own all the companies. In many cases, industry consultants say, a commonly owned company will charge a nursing home lower fees than an independent contractor might, leaving the chain with more resources.

“You don’t want to pay for someone else to make money off of you,” Ulrich said. “You want to retain that within your organization.”

But a Kaiser Health News analysis of federal inspection and quality records reveals that nursing homes that outsource to related organizations tend to have significant shortcomings: They have fewer nurses and aides per patient, they have higher rates of patient injuries and unsafe practices, and they are the subject of complaints almost twice as often as independent homes.

“Almost every single one of these chains is doing the same thing,” said Charlene Harrington, a professor emeritus of the School of Nursing at the University of California-San Francisco. “They’re just pulling money away from staffing.”

Early Signs Of Trouble

Martha Jane Pierce moved to Allenbrooke in 2008 in the early stages of dementia. According to testimony in the family’s lawsuit, her children often discovered her unwashed when they visited, with an uneaten, cold meal sitting beside her bed. Hatfield said in court that she had frequently found her mother’s bed soaked in urine. The front desk was sometimes vacant, her brother Glenn Pierce testified.

“If you went in on the weekend, you’d be lucky to find one nurse there,” he said in an interview.

After a stroke, Pierce became partly paralyzed and nonverbal, but the nursing home did not increase the attention she received, said Carey Acerra, one of Pierce’s lawyers. When Pierce’s children visited, they rarely saw aides reposition her in bed every two hours, the standard practice to prevent bedsores.

“Not having enough staffing, we can’t — we weren’t actually able to go and do that,” one nurse, Cheryl Gatlin-Andrews, testified in a deposition.

KHN’s analysis of federal inspection, staffing and financial records nationwide found shortcomings at other homes with similar corporate structures:

Homes that did business with sister companies employed, on average, 8 percent fewer nurses and aides.
As a group, these homes were 9 percent more likely to have hurt residents or put them in immediate jeopardy of harm, and amassed 53 validated complaints for every 1,000 beds, compared with the 32 per 1,000 that inspectors found credible at independent homes.
Homes with related companies were fined 22 percent more often for serious health violations than were independent homes, and penalties averaged $24,441 — 7 percent higher.

(Story continues below.)

For-profit nursing homes employ these related corporations more frequently than nonprofits do, and have fared worse than independent for-profit homes in fines, complaints and staffing, the analysis found. Their fines averaged $25,345, which was 10 percent higher than fines for independent for-profits, and the homes received 24 percent more substantiated complaints from residents. Overall staffing was 4 percent lower than at independent for-profits.

Ernest Tosh, a plaintiffs’ lawyer in Texas who helps other lawyers untangle nursing company finances, said owners often exerted control by setting tight budgets that restricted the number of nurses the homes could employ. Meanwhile, “money is siphoned out to these related parties,” he said. “The cash flow gets really obscured through the related party transactions.”

The American Health Care Association, which represents nursing homes, disputed any link between related businesses and poor care. “Our members strive to provide quality care at an affordable cost to every resident,” the group said in a statement. “There will always be examples of exceptions, but those few do not represent the majority of our profession.”

‘Piercing The Corporate Veil’

The model of placing nursing homes and related businesses in separate limited liability corporations and partnerships has gained popularity as the industry has consolidated through purchases by publicly traded companies, private investors and private equity firms. A 2003 article in the Journal of Health Law encouraged owners to separate their nursing home business into detached entities to protect themselves if the government tried to recoup overpayments or if juries levied large negligence judgments.

“Holding the real estate in a separate real-property entity that leases the nursing home to the operating entity protects the assets by making the real estate unavailable for collection by judgment creditors of the operating entity,” the authors wrote. Such restructuring, they added, was probably not worth it just for “administrative simplicity.”

In 2009, Harvard Medical School researchers found the practice had flourished among nursing homes in Texas, which they studied because of the availability of state data. Owners had also inserted additional corporations between them and their nursing homes, with many separated by three layers.

To bring related companies into a lawsuit, attorneys must persuade judges that all the companies were essentially acting as one entity and that the nursing home could not make its own decisions. Often that requires getting access to internal company documents and emails. Even harder is holding owners personally responsible for the actions of a corporation — known as “piercing the corporate veil.”

At a 2012 Nashville conference for executives in the long-term health care industry, a presentation slide from nursing home attorneys titled “Pros of Complex Corporate Structure” stated: “Many plaintiffs’ attorneys will never conduct corporate structure discovery because it’s too expensive and time consuming.” The presentation noted another advantage: “Financial statement in punitive damages phase shows less income and assets.”

A lawyer in Alabama, Barry Walker, is still fighting an 11-year-old case against another nursing home then owned by Denz and Bennett, according to court records. Walker traced the ownership of Fairfield Nursing and Rehabilitation Center back to the men, but he said the judge had allowed him to introduce the ownership information only after the Alabama Supreme Court ordered him. That trial ended with a hung jury, and Walker said a subsequent judge had not let him present all the information to two other juries, and he dropped the men from the lawsuit. The home closed a few years ago but the case is still ongoing despite two mistrials.

“The former trial judge and the current trial judge quite frankly don’t seem to understand piercing the corporate veil,” he said. “My firm invested more in the case than we can ever hope to recover. Sometimes it’s a matter of principle.”

The complexity of the ownership in Pierce’s case was a major reason it took six years to get to a trial, said Ken Connor, one of the lawyers for her family. “It requires a lot of digging to unearth what’s really going on,” he said. “Most lawyers can’t afford to do that.”

The research paid off in a rare result: In 2016, the jury issued a $30 million verdict for negligence, of which Denz and Bennett were personally liable for $20 million. The men’s own tax returns bolstered the case against them. They claimed during trial they delegated daily responsibilities for residents to the home’s administrators, but they reported on their tax returns that they “actively” participated in the management. The jury did not find the nursing home responsible for Pierce’s death later in 2009.

The fight is not over. Denz and Bennett are appealing the verdict, the damages, their inclusion and the trial judge’s decisions. They argue that Tennessee courts should not have jurisdiction over them since they spent little time in the state and neither was involved in the daily operations of the home or in setting staffing levels. Their lawyers said jurors should never have heard from nurses who hadn’t cared directly for Pierce.

“No way did I oversee resident care issues,” Bennett testified in a deposition.

Deficient In The End

Whoever was responsible for Pierce’s care, her family had no doubt it was inadequate. Her son Bill Pierce was so horrified when he finally saw the wound on his mother’s foot, he immediately insisted that she go to the hospital.

“The surgeon said he had never seen anything like it,” Hatfield said in an interview. “He amputated 60 percent of the leg, above the knee.”

After her amputation, Pierce returned to the nursing home because her family did not want to separate her from her husband, who was also there.

At the trial, the nursing home’s lawyers argued that Pierce’s leg had deteriorated not because of the infection but because her blood vessels had become damaged from a decline in circulation. The jury was unpersuaded after nurses and aides testified about how Allenbrooke would add staffing for state inspections while the rest of the time their pleas for more support went unheeded.

Workers also testified that supervisors had told them to fill in blanks in medical records regardless of accuracy. One example: Allenbrooke’s records indicated that Pierce had eaten a full meal the day after she died.

Data journalist Elizabeth Lucas contributed to this report.

“Life and Death in Assisted Living”: A Frontline/ProPublica investigation

downloadDealing with the housing and care issues that come with aging and disability is, at best, discouraging. When assisted living came along, those who could afford a spot found a comfortable, dignified place to age. These homes look more like hotels than hospitals and offer care for those who need help, but don’t need a nursing home.

But, long-term care is a challenge for both residents and owners. And when the owner is an off-site corporation, efforts to contain costs can lead to poor care for residents.

That’s what the  investigative reporters at Frontline and ProPublica found when they started digging. The FRONTLINE series — starts tonight, Tuesday, and the ProPublica series is running this week on the group’s website. Here’s what they found:

imagesWith America’s population of seniors growing faster and living longer than ever before, more and more families are turning to assisted living facilities to help their loved ones age in comfort and safety.

But are some in the loosely regulated, multibillion-dollar assisted living industry putting the lives of those loved ones at risk?

From the Texas assisted living resident who froze to death on Christmas morning to the Hall of Fame football player who drank unsecured toxic dishwashing liquid and died 11 days later, this major investigation raises questions about fatal lapses in care and a quest for profits at one of America’s best known assisted living companies.

Here in Massachusetts, assisted living facilities have to be certified by the state Office of Elder Affairs. State law requires the homes to have:

  • One or two bedroom units with entry doors that lock
  • Private bathrooms for each unit in newly constructed ALRs
  • Private kitchenettes or access to cooking facilities
  • At least one meal a day
  • For all residents who need it, assistance with bathing, dressing, ambulation and supervision of or reminders to take prescribed medications.
  • 24 hour a day on-site staff
  • Emergency response systems to signal on-site staff
  • Individualized service plans
  • Residency agreements (lease/contract) which detail what the home will provide to the resident, including the rights and responsibilities of both the home and the resident.

The home staff members are not allowed to deliver medical care and the homes are barred from accepting residents who need “skilled nursing care” unless that care is provided by an “employee of a Certified Provider of Ancillary Health Services.  Those caregivers can include physician, pharmacist, restorative therapist, podiatrist  hospice and home health aides.

In other words, assisted living is housing, not health care. This series did not look at homes here. But a former aide at a Massachusetts assisted living program makes some serious charges in the comment section of the ProPublica story.

Mandatory overtime, lack of experience linked to #nursinghome worker injuries #longtermcare

Frank W. Porell, Professor of gerontology, at UMass Boston contributed to this study of injuries to nursing home aides.  It might be interesting to see what kind of sick time or insurance these employees have.

This from Medscape:

May 9, 2012 — Nursing home aides who work less mandatory overtime and receive better training were less likely to be injured on the job, according to a new study based on data from the US Centers for Disease Control and Prevention.

Injury rates were highest among new certified nursing assistants (CNAs), workers who changed jobs frequently, and those who received lower wages, according to an analysis of 2004 data by the Research Triangle Institute in Durham, North Carolina. The rates were also high for those who worked mandatory overtime or felt they did not have enough time to take care of home residents.

Retirement Research Foundation in Chicago helped pay for the study.

Abstract

Work-Related Injuries Among Certified Nursing Assistants Working in US Nursing Homes. RTI Press.

Certified nursing assistants (CNAs) working in nursing homes are at significant risk for work-related injuries, but little is known about the frequency and types of such injuries and how assistive equipment such as patient lifts affect injury rates. This study uses 2004 data from the National Nursing Assistant Survey and the National Nursing Home Survey to analyze the prevalence, nature, and predictors of these injuries among CNAs working in US nursing homes. The study found that 60.2 percent of all CNAs nationally reported a work-related injury in the year prior to the survey; among injured CNAs, 65.8 percent reported being injured more than once in the past year, 16 percent required a transfer to light duty work, and 24 percent were unable to work because of their injury. The reported injuries varied in nature and included scratches, open wounds, back injuries, black eyes and other bruising, human bites, and strained or pulled muscles. In examining predictors of injury, the study found that although assistive equipment was readily available and often used, it was not associated with lower rates of workforce injuries. New workers, workers who change jobs more frequently, those reporting poor job preparation, workers who received lower wages, workers who felt that they had inadequate time to provide personal care, and those working mandatory overtime were more likely to have a workplace injury. CNAs who worked in facilities where they felt respected and rewarded for their work and where the organization valued their work were less likely to report an injury.

How to check out a nursing home

The reform debate has shrouded the other healthcare crisis – How to pay for and deliver long- term care. In the meantime, buyer beware. Here’s some help.

Medicare has a new searchable database on Nursing Home Quality.

USA Today has a story on it and their own version of the database.

One in five of the nation’s 15,700 nursing homes have consistently received poor ratings for overall quality, a USA TODAY analysis of new government data finds.

Massachusetts already has a database but the two above are easier to read.

Elder abuse: Over her not-quite-dead body

Most of the workers I met when my father was shuffled around the nursing homes of Boston were hard working, underpaid and often very caring. Some of the residents were  very difficult to deal with, at times abusive and racist. Still, the aides who take those jobs need to be trained to deal with abuse. I hope the guy in the first story below behaves a bit better at work. 

Caretaker links to the left.

FREEPORT, N.Y. – A nursing home worker let his ailing mother lie on the floor of their home for two days, stepping over her when he had to and not calling 911 until she was malnourished and dehydrated, police said yesterday.

 Closer to home…

 Nursing home aide charged with assault

Allegedly struck elderly resident

By Brian Ballou, Globe Staff  |  August 15, 2009

A nurse’s aide, accused of punching and threatening an 83-year-old nursing home resident who has Alzheimer’s disease, was arraigned in Malden District Court this week on assault and battery charges, authorities said.

The state attorney general’s office said that Marie Michel, 54, of Medford, punched the woman twice in the chest and stomach about 4 a.m. on Sept. 17, 2008, pushed her down onto her bed, and ordered her not to get up again. according to the state attorney general’s office. The elderly woman had gotten out of bed at the Epoch Senior Healthcare center in Melrose and was apparently wandering around her room when Michel allegedly entered and starting hitting her.

Investigators say that the victim’s roommate witnessed the attack and that an investigation was launched last October.

Some resources:

The Mass Family Caregiver Handbook

Mass Elder Abuse Hotline (1-800-922-2275)

SEIU 1199 — union for nursing home workers