patrick.net

Stop dumping your old folks off in convalescent homes so that they can be fed and watered at taxpayers expense, and you won't have anything to gripe about. Take responsibility for your elderly folks instead of leaving them in the care of strangers. What do you expect?

APOCALYPSEFUCK is Comptroller says

Any Medicare fraud involved?

AF:
I've got anecdotal stories of billing fraud, forcing patients to discharge to home health providers they didn't want, neglect, abuse... etc. The reason that they are anecdotal is because I wasn't able to remove the proof from the nursing home - that would be violating the law myself.

The billing fraud? Backdating consents in order to bill for patients, nursing homes billing at the highest rate for nearly every patient, patients being forced to participate in therapy, not being allowed to discharge (so that the nursing home could bill additional days), nurses sitting on top of patients forcing them to take medications against their will (and administrator didn't report the behavior to the board), brand new licensed practical nurses practicing without supervision (a patient died), a patient's arm being broken when the nursing home asked a family member to help lift her - then blaming it on the family member, a patient exploited and the nursing home administrator not reporting it to the state, patients being discharged according to how many days Medicare will pay versus how much therapy the patient needs... and more.

That doesn't include patients in nursing homes who aren't able to feed themselves having food trays left by their bedside, no staff to feed them... a patient moaning in intractable pain calling the nursing station on the phone and a staff member hanging up - and the administrator denying it was abuse... an administrator who said that she decided who was done with therapy (based on how many days Medicare would pay), not the professional therapists...

And more. I've been doing this awhile.

I did report much of this to the company and to the state. much of it couldn't be proven on paper. I've been fired from two jobs and "suspended without pay" from another for reporting.

The stories are short, so I'm blogging them. And hoping I don't lose my job over it, still working in healthcare.

By the way, AF - are you running for comptroller against Elliot Spitzer or are you actually the comptroller? Just curious.

This one is legal, even though it's hell on a patient (copied from my site):

Medicare pays nursing homes to provide skilled services (therapy, wound care, etc) to patients, and trusts nursing homes to accurately report each patient's healthcare status. The only time that Medicare audits a patient's chart is when a problem has been identified. With over 16,000 nursing homes and thousands of assisted livings and group care homes in the US, many things are overlooked when it comes to auditing patient care. But there are many ways th
The more complicated a patient's needs, the higher the amount that Medicare will pay a nursing home. Nursing homes are able to increase their billings by listing every possible diagnosis for the patient. For example, if a doctor lists "Confusion possibly due to Alzheimer's Dementia" on the hospital History & Physical, a nursing home can list 1) Alzheimer's Disease, 2) Dementia, and 3) Altered Level of Consciousness. Since they are only able to bill for conditions for which the patient is being actively treated, nursing homes can ask their physician to order low doses of medications commonly used to treat those diagnoses. The physicians are usually willing to do so, and are able to increase their billed amounts accordingly. They'll tell the patients/families that they're concerned about the patient, but it can be very difficult for patients to have all of their medications changed in order for the nursing home to increase its revenue.
Those medications have certain side effects, which can mean additional diagnoses of agitation and difficulty sleeping. The patient will also require speech therapy, physical therapy, and occupational therapy. If the reason that the patient was sent to the hospital in the first place was a fall, there are additional potential diagnoses of pain management, constipation (due to the pain medications), dizziness ... and of course, the patient's usual home medications (such as high blood pressure, etc).
It's possible for a patient with virtually nothing wrong with him when he left home to return with 15-20 new diagnoses. When he arrives at home, his primary doctor can discontinue all of the new medications - the patient might go through hell with all of the changes to his system, but the nursing home would have been able to bill at the maximum rates that Medicare will pay.
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If a patient enters a nursing home and receives minimal care, the nursing home will receive about $250/day. In the above example, the nursing home will receive $800+ per day.

Welfare cheats get a bad rap, but these are the job creators so we'll keep shoveling them money. I love this country!

Hmm, serious stuff.

I, too, was beguiled by the OP title, thinking it was some kind of nursing home spring break.

I don't know if getting hit with the sopping wet panties of an 85 year old nursing home patient is a survivable event, however.

elliemae says

Those medications have certain side effects....

"107-year-old man killed in police shootout"

(To be fair, the press haven't reported yet what medications the 107yo may have been on. I'm especially curious to know what meds the police were on, but that will probably never be reported.)

i'm not into cougars but never know...lets see some "gone wild" videos!

APOCALYPSEFUCK is Comptroller says

People have no idea about this stuff. Except you.

I assume you mean the press and you & I, who are writing checks to the govt to pay for this shit.

There are businesses dedicated to finding the loopholes in Medicare & Medicaid. And there are sooooooo many loopholes.

elliemae says

There are businesses dedicated to finding the loopholes in Medicare & Medicaid.

"The Romney Family Recipe for Crony Capitalism"

I can't help suspecting some of those politically connected businesses - including the NAR - have a role in the regulatory pressure to institutionalize elderly people as expensively as possible instead of allowing them to remain in their homes.

Yep. The incentive is to warehouse patients under the Medicare benefit at the highest level of reimbursement possible, often removing the patient's hope of returning home. People give up.

For physicians, it's a sweet gig to have patients in a nursing home. You see them once a month at the minimum, which involves a fly-by past them and 5 minutes charting and another 10 dictating. That's if the patient has any changes worth documenting. So if the patient is seen once a month (every other month it can be by a nurse practitioner or a Physician's Assistant) and there are 30-50 patients assigned to that MD, it's a friggin' gold mine.

Physicians usually take the word of the nurse who is calling, and will order any medication requested. That's where all the extra medications come into play. If a patient has elevated blood pressure, the nursing home can usually convince the md to order a mild dose of BP meds, a cardiac med, and often an anti-depressant. Voila! The patient now has a diagnosis of high blood pressure, cardiac disease and depression.

BTW, AF. My book is chock full of this info. And it's a real book, even if I don't have a publisher. If I did have a publisher, it would be possible that it would languish in the discount racks because it's not about bondage. that's the flavor of the month.

I'm selling a few, and I keep a majority of the royalties.

You need a catchier title: "Fifty Shades of Nursing Home Grey"

Ceffer says

You need a catchier title: "Fifty Shades of Nursing Home Grey"

Lol.

I actually had a patient who fell in love with another, and they wanted to move in together. Her family was dead-set against it and did everything possible to keep them apart. It was sad - they shunned her up until the end, and she spent Christmas with him and his children's house rather than hers. Her kids hated me because I advocated for her and tried to get me fired.

My boss was passive and didn't stick up for me. The whole thing sucked. This 85 yo man and his 93 yo girlfriend just wanted a little loving. (the family's reason for opposing the relationship was that she'd had plenty of men in her lifetime and didn't need another. Both were on Medicaid & had nothing to do with money).