Abolish Nursing Homes

New program aims to provide seniors with home-based alternative to nursing facility care

By Abolish Nursing HomesNo Comments

In an effort to help Illinois seniors stay in their homes for longer, officials announced Monday the state will be participating in a new federal program that could provide them with an alternative to nursing facility care.

In a statement, Gov. J.B. Pritzker said the Program of All-Inclusive Care for the Elderly (PACE) would expand seniors’ options for community-based services.

“Here in Illinois, we recognize that our elders thrive when they remain in our communities as they age,” Pritzker said. “The PACE program is an innovative model that delivers a much-needed alternative to traditional nursing facility care.”

The program will be available to qualifying seniors eligible for Medicare and Medicaid, who are 55 and older, live within a PACE service area and meet the state’s standard of qualifying for nursing home care, while also being able to live safely at home.

State officials identified five health care organizations in Chicago as PACE partners.

Esperanza Health Centers and Annie’s Place PACE will provide services for residents living on the South Side, and Kinship PACE of Illinois, Lawndale Christian Health Center and PACE of Southwest Chicago will serve residents on the West Side.

All still need to pass a “stringent” federal application process, which the state’s Department of Healthcare and Family Services said they would be supporting the organizations through.

For that reason, “It will yet be a while before we actually start enrolling participants and delivering service,” Ricardo Cifuentes, a spokesman for Esperanza Health Centers, said Tuesday. “But still, the announcement is a major win and will help create more options for seniors on the South and West sides of Chicago.”

State officials said they anticipate the program will start providing services in 2024.

More than 30 states already participate in PACE, according to Cifuentes.

Services available through the program include adult day care, occupational therapy programs, dental care, meals and access to prescription drugs, according to Cifuentes.

“It’s also a big benefit for caretaker families who must often sacrifice work hours and other responsibilities to tend to the needs of frail and elderly parents,” Cifuentes said.

If a senior enrolled in the program eventually needs nursing home care, “PACE will fund that and continue to coordinate the patient’s care,” the family services department said.

Heidi Ortolaza-Alvear, vice president of strategy and business development for Esperanza, said the PACE model has shown it can prevent or delay nursing home placement and reduce emergency room visits “because you’re catching things early.”

“The end goal really is to help people age in place,” Ortolaza-Alvear said.

The program also helps seniors find opportunities to socialize, including through arts and crafts programing, as isolation can contribute to declines in health.

“That’s another element of this model and why there’s this whole socialization component to it is really to get people to have time to spend engaged with folks in their community,” Ortolaza-Alvear said.

Michael Loria is a staff reporter at the Chicago Sun-Times via Report for America, a not-for-profit journalism program that aims to bolster the paper’s coverage of communities on the South and West sides.

Biden’s unlikely to get his full funding ask for home health care

By Abolish Nursing HomesNo Comments

President Biden called for a $400 billion investment in home-care for the elderly and the disabled. But signs point to Congress missing the mark — and by a lot.

Last week, a key House committee pitched spending less than half of what Biden wanted. Privately, some lawmakers and advocates are pushing Congress for more funding, asks that range from $250 billion to $400 billion.

Democrats are wrestling with how to stuff all of their health-care priorities into a massive social spending bill. And the home-care dynamic is yet another example of how funding for a key policy, even one Biden himself pitched, could be scaled back significantly. As one Democratic aide put it, “tough choices have to be made.”

Yet, now is a critical moment for changing how the country cares for older adults and the disabled, supporters of robust funding argue. The coronavirus pandemic swept through nursing homes, killing nearly 135,000 residents and sparking fresh demands for the government to put more dollars into helping people stay out of institutional settings.

Competing priorities

Lawmakers are learning it’s easier said than done. 

Here’s the state of play: 

  • Earlier this summer, the thinking in the Senate was that the in-home care policy may dip as low as $150 billion to fit within the $3.5 trillion budget agreement, according to four sources familiar with the negotiations. But there’s a push to increase that number.
  • The House Energy and Commerce panel, which will mark up its plan today, put $190 billion toward Medicaid’s home and community-based services. That came as a pleasant surprise to some advocates, and even Hill aides, who were anticipating a number closer to $150 billion, according to multiple sources.
  • The Senate is still hashing out its plan. Negotiations are still very much in flux on a wide range of key health-care policies in the upper chamber. The White House declined to comment.
Moving home

States have historically used their Medicaid dollars to pay for nursing homes, rather than care inside the home — which can include everything from help eating and dressing, to physical therapy and nursing care. Waitlists for these services are often long, and finding care can be a complex process.

Lawmakers see a need for a shift. Sen. Bob Casey (D-Pa.), who chairs Congress’ aging committee, is the leading champion of the call for change in the Senate. He authored a bicameral bill with Rep. Debbie Dingell (D-Mich.), who’s a vocal advocate for expanding in-home care after her husband, a longtime congressman, was able to receive care at home.

  • Casey is pushing for Democrats’ $3.5 trillion package to put roughly $250 billion toward Medicaid’s in-home services, according to a Senate aide. He believes that amount of cash could be enough to implement the changes to the system his bill envisions.

But some advocacy groups contend more money is needed to be able to clear waitlist backlogs and pass on wage increases to underpaid staff.

The issue is top of mind for the Service Employees International Union, a labor giant whose membership includes home-care workers and is fighting for the full $400 billion. Mary Kay Henry, SEIU’s international president, said those members “are the most politically active part of our membership” and give the most to the union’s political action fund.

SEIU President Mary Kay Henry speaks at a 2019 Democratic presidential debate. (Scott Olson/Getty Images)
  • SEIU is piling on the pressure in a new $3.5 million TV and digital ad buy, shared first with The Health 202. The campaign will go to the end of the month and run TV ads in places like Arizona, West Virginia and Washington, D.C.
  • In an interview, Henry threatened to withhold funding from politicians who don’t back a robust infusion of cash. “We don’t intend to give one penny, one phone call, one door knock, any mobilization of our members to support anybody’s re-election that doesn’t back a strong investment on care,” she said.


Departing FDA officials argue boosters aren’t yet necessary

An international group of scientists came out against booster shots in a review published Monday in The Lancet.

Among the co-authors of the paper are two outgoing Food and Drug Administration vaccine regulators: Marion Gruber, who leads the Office of Vaccines Research and Review, and Philip Krause, her deputy, The Post’s Ben Guarino and Laurie McGinley report.

The authors argue there is not yet enough evidence that vaccines are showing a substantial decline in their ability to protect against severe disease. They point out that boosters could increase the risks of side effects, which could strengthen resistance to the shots among the unvaccinated. But they acknowledged booster shots may be needed, should future evidence support that.

Yet, there are people who need the shots more, said study author Ana-Maria Henao-Restrepo, a World Health Organization epidemiologist.

“Even if some gain can ultimately be obtained from boosting,” Henao-Restrepo said, “it will not outweigh the benefits of providing initial protection to the unvaccinated.”

The delta variant is scrambling the start of the school year
Biden talks to students at Brookland Middle School in the District. (Manuel Balce Ceneta/AP)
Biden promised to get kids back in the classroom, but the highly transmissible delta variant has put that promise to the test, The Post’s Yasmeen Abutaleb, Laura Meckler and Valerie Strauss report.
  • Schools have undergone 1,700 temporary closures, according to Burbio, a data firm that tracks school reopenings.

Health officials say it’s possible for kids to return to in-person schooling safely as long as precautions are in place. But it’s not clear that schools are adhering to public health recommendations.

  • A Washington Post survey of the nation’s 20 largest school districts found that few are offering robust coronavirus screening. Meanwhile, a quarter of the nation’s largest 200 school districts are ignoring the Centers for Disease Control and Prevention’s recommendation to mandate masks.
Rapid coronavirus tests are way more expensive in the U.S.

Biden has promised to make it easier to get at-home, rapid coronavirus tests, and a deal with major retailers could knock 35 percent off the price of tests. But even after the discount, Abbott’s popular BinaxNOW two-pack will sell for more than $15.

Those prices put frequent, at-home testing out of reach for many consumers, Kaiser Health News’s Hannah Norman reports.

In Germany, grocery stores sell tests for $1 per test. The United Kingdom provides 14 free tests per person, and Canada is giving out free rapid tests to businesses.

Regulators in the U.S. have approved far fewer tests than their European counterparts, which may make it harder for new companies to enter the market and drive prices down.

How N.Y.’s Biggest For-Profit Nursing Home Group Flourishes Despite a Record of Patient Harm

By Abolish Nursing HomesNo Comments

Charlie Stewart was looking forward to getting out of the nursing home in time for his 60th birthday. On his planned release day, in late 2012, the Long Island facility instead called Stewart’s wife to say he was being sent to the hospital with a fever.

When his wife, Jeanne, met him there, the stench of rotting flesh made it difficult to sit near her husband. The small wounds on his right foot that had been healing when Stewart entered the nursing home now blackened his entire shin.

“When I saw it at the hospital … I almost threw up,” Jeanne Stewart said. “It was disgusting. I said, ‘It looks like somebody took a match to it.’ ”

Doctors told Stewart the infection in his leg was poisoning his body. To save his life, they would have to amputate above the knee.

Stewart had spent about six weeks recovering from a diabetic emergency at Avalon Gardens Rehabilitation & Health Care Center on Long Island. The nursing home is one of several in a group of for-profit homes affiliated with SentosaCare, LLC, that have a record of repeat fines, violations and complaints for deficient care in recent years.

Despite that record, SentosaCare founder Benjamin Landa, partner Bent Philipson and family members have been able to expand their nursing home ownerships in New York, easily clearing regulatory reviews meant to be a check on repeat offenders. SentosaCare is now the state’s largest nursing home network, with at least 25 facilities and nearly 5,400 beds.

That unhindered expansion highlights the continued weakness of nursing home oversight in New York, an investigation by ProPublica found, and exposes gaps in the state’s system for vetting parties who apply to buy shares in homes.

State law requires a “character-and-competence” review of buyers before a change in ownership can go through. To pass muster, other health care facilities associated with the buyers must have a record of high-quality care.

The decision maker in these deals is the state’s Public Health and Health Planning Council, a body of appointed officials, many from inside the health care industry. The council has substantial leverage to press nursing home applicants to improve quality, but an examination of dozens of transactions in recent years show that power is seldom used.

Moreover, records show that the council hasn’t always had complete information about all the violations and fines at nursing homes owned by or affiliated with applicants it reviewed. That’s because the Department of Health, which prepares character-and-competence recommendations for the council, doesn’t report them all.

The department’s assessments of Landa and other owners of SentosaCare homes have routinely found that the facilities provided a “substantially consistent high level of care” – the standard owners must meet to receive council approval.

Yet the agency’s assessments in 15 separate ownership applications since 2013 did not mention at least 20 federal fines paid by the group’s homes, records show. In more than a dozen cases, the department reported “no repeat violations,” even when a SentosaCare home had been cited multiple times for the same serious deficiency.

Many of the nursing home deals ProPublica reviewed received a go-ahead despite rules saying they “shall not be” approved when facilities have repeat violations that put residents at risk. Under a narrow interpretation of the rules, however, the department still recommends approval if violations aren’t strictly identical or were promptly addressed.

SentosaCare’s owners or associates weren’t the only applicants to get incomplete vetting, but the council has had repeated opportunities to scrutinize their records. Landa, Philipson or relatives bought shares in a dozen homes in 2013 and 2014, records show.

Advocates for nursing home patients say that instead of a backstop, New York’s approval process has become a rubber stamp.

“The law establishes mechanisms for at least a moderate review of an applicant’s character and competence,” said Richard Mollot, director of the Long Term Care Community Coalition in New York. “The failure to provide complete information on a provider’s past performance fundamentally undermines the review process.”

Mollot’s group published a recent report saying the Health Department has one of the nation’s lowest rates of citing nursing home operators for deficiencies in care. New York is also among a minority of states that don’t mandate minimum staffing ratios, even though research shows a strong link between nursing staff and residents’ well-being.

Thirteen of SentosaCare’s homes (though not Avalon Gardens) have Medicare’s bottom score for nurse staffing. Inspection reports also show that at least seven residents have wandered away from the SentosaCare affiliated facilities in recent years — including one who froze to death in 2011. Inspectors and prosecutors have found that staff falsified records in some cases. Dozens of patients at SentosaCare homes have experienced long delays before receiving necessary care; some ended up in hospitals.

The Stewarts said the staff at Avalon Gardens showed “no sense of urgency” when they complained about missed meals, soiled sheets and unanswered call bells. Even though nurses dressed the wound on Charlie’s leg daily, and a doctor checked it each week, no one warned them about its worsening condition, the Stewarts said.

Dr. Kris Alman, a retired endocrinologist who reviewed Stewart’s medical records and photographs at ProPublica’s request, said that the two quarter-sized lesions on his foot when he was admitted to Avalon Gardens could not have “become what it did overnight.” That the condition “progressed as far as it did, with him coming in septic and needing an above-the-knee amputation, was inexcusable,” Alman said.

Landa’s attorney and business partner, Howard Fensterman, declined to comment on Stewart’s case for reasons of patient privacy. Fensterman defended Avalon Gardens and other SentosaCare facilities, however, saying that when inspectors have found problems, the homes quickly addressed them and secured state approval of correction plans.

Fensterman also said that SentosaCare does not have “ownership or control” over the facilities in its network and only contracts with them to provide administrative and rehabilitation consulting, regulatory advice and purchasing services. Records show, however, that Landa and Philipson, or family members, have ownership stakes or directorships in nearly all of SentosaCare’s facilities. Fensterman also co-owns 14 nursing homes with Landa in several states, including one SentosaCare home.

Fensterman is a former member of the state health council, as is Landa, who entered the nursing home business in the late 1980s and emerged as one of the sector’s biggest players over the next decade. Landa, Philipson or family members now hold stakes in at least 33 nursing homes in New York and an equal number in nine other states.

In 2013, the latest year for which state data is available, homes under the SentosaCare umbrella paid the company more than $11.5 million for financial, staffing and other services, and spent nearly $630,000 with Fensterman’s law firm.

The nation’s $137 billion nursing home industry has made major improvements since the landmark 1987 federal Nursing Home Reform Act imposed mandates to combat abuse and neglect. But the industry, which draws heavily on taxpayer funding via Medicare and Medicaid, still struggles to provide safe care for many.

One-third of Medicare patients suffered preventable harm within a month of being admitted to nursing homes for short-term rehabilitation, according to a 2014 study by the Department of Health and Human Services’ inspector general. The harm cost Medicare $2.8 billion for hospitalizations alone in 2011, the study estimated.

New York spends about $13 billion each year on the state’s 627 nursing homes, which collectively care for more than 100,000 residents. The Department of Health is charged with day-to-day oversight of safety, but patient advocates say the agency lacks the staff and expertise to do the job adequately.

SentosaCare homes, which took in nearly $538 million from Medicare and Medicaid in 2013, aren’t the only facilities in the state with repeat violations and low staffing, and several of the company’s homes have above-average ratings on Medicare’s Nursing Home Compare web site, which rates them with one to five stars. (State-by-state inspection reports can be searched on ProPublica’s Nursing Home Inspect, which also lists deficiencies by severity level.)

But federal data through August shows that 11 of SentosaCare’s homes exceeded the state average of 24 violations over the past three years, and three had double that number.