By JW Law
Moving a loved one or even broaching the conversation about moving to a nursing home or assisted living is an emotionally challenging process. But when nursing homes abuse or improperly evict residents, it is devastating both for residents and their families.
A recent story from National Public Radio (NPR) sheds light on the growing practice of involuntary discharge of Medicaid residents to accommodate Medicare and private pay patients to maximize reimbursements.
“This story offers an exquisite example of how the nursing home industry puts profits over people while committing fraud along the way,” said Javerbaum Wurgaft Attorney Francisco Rodriguez.
According to the available figures, in 2014 about 1.4 million people occupied 15,600 nursing homes across the country, of which 45,185 were in New Jersey and a staggering 105,390 in New York State.
While both federal Medicare and Medicaid programs pay for most of the nation’s nursing home care, roughly $75 billion in 2014, Medicare reimburses at a much higher rate for rehabilitation services than Medicaid for long-term care.
“Medicare pays for short-term rehabilitation after hospitalizations, whereas Medicaid pays for long-term care when a resident does not have assets to pay for a nursing home themselves,” explained Rodriguez.
In the article, NPR reported how a particular nursing home chain in Maryland and Illinois discharged Medicaid residents without proper discharge planning and charged Medicaid for planning services that it never provided.
“Nursing homes are required to discuss plans of an eviction with a resident and/or their loved ones, as well as prepare detailed records for the resident to give to their next facility or care provider,” he added.
However in this case, Instead of discharging the resident into an appropriate facility they were sent to homeless shelters. Some were left unattended on the sidewalk in front of their family member’s homes, even though they had dementia.
Those residents, who did not “fit the mold” or complained about the services, were inappropriately transferred to hospitals or in psychiatric wards. “…and of course, the government ends up paying more taxpayer money to take care of that resident’s unnecessary hospitalization,” said Rodriguez about this disturbing trend. “More importantly, residents end up with their health and safety in jeopardy, and family members and hospitals, end up with having to clean up the mess.”
Sadly the issue of wrongful eviction goes far beyond Maryland and Illinois. In a race for Medicare dollars, most nursing homes across the country wrongfully evict their long-term care residents.
An Associated Press analysis of federal data from the Long-Term Care Ombudsman Program finds complaints about discharges and evictions are up about 57 percent since 2000. It was the top-reported grievance in 2014, with 11,331 such issues logged by ombudsmen, who work to resolve problems faced by residents of nursing homes, assisted living facilities and other adult care settings.
The Federal Nursing Home Residents’ Rights Act protects occupants against unreasonable transfer or removal by specifying only six grounds for discharge:
-The facility cannot meet the resident’s needs
-The resident no longer needs nursing facility services
-The resident’s presence endangers the safety of others in the facility
-The resident’s presence endangers the health of others in the facility
-The resident has failed to pay
-The facility is closing
Even if one of the above conditions legitimizes the nursing home’s decision, there is a protocol that they must follow to ensure the patient’s safety. According to the federal law, the nursing home must fulfill proper discharge planning requirements. These include: providing a written notice 30 days before the removal/transfer unless there is emergency justification for removal on short notice. In addition to the notice, the discharge planning procedure requires the facility to prepare a report of the resident’s mental and physical health status and a post-discharge plan of care for the resident.
Sometimes these facilities toss out residents who are “undesirable” or complaint a lot. They often use the threat of discharge as a method of retaliation or obtain compliance from family and residents who may be complaining about dangerous conditions, inadequate care, or violations of state and federal regulations.
“Residents and their families need to understand that these threats of discharge and other forms of retaliation by facilities are just that, threats,” said Rodriguez. “In reality, it is the residents and family members who do not complain on behalf of their loved one to the authorities, like the state Ombudsman for the Institutionalized Elderly, who end up putting residents at risk. If they do not complain to the state when the illegal and dangerous conduct occurs, those residents are at the greatest risk. They will be run over by the thirst for profits of the owners of these nursing homes.”
If you or your loved one resides in a nursing home, rest assured that you have protection under the law. If you know of anyone who is unfairly discharged or threatened with eviction, contact Javerbaum Wurgaft’s nursing home Lawyers. Our highly experienced lawyers will intercede to enforce the law and fight for their rights.