Wednesday, November 4, 2020

Penalties at Play: Millions of dollars flow to nursing homes from fines they have paid for poor care

(InvestigateTV) - States are sitting on millions of dollars that could provide testing, PPE, and staff to nursing homes battling the aggressive coronavirus pandemic.

But the federal government has been unwilling to unlock most of the $400 million stockpiled in states' Civil Money Penalty funds.

Advocates, families of residents and the national association that represents nursing homes say now is the time for the Centers for Medicare and Medicaid Services to direct those funds to combatting a once-in-a-lifetime pandemic.

The money dispensed as grants “to support activities that benefit nursing home residents and that protect or improve their quality of care or quality of life,” according to CMS.

But an InvestigateTV analysis of grants awarded in 2019 show that some of the funded projects do not address the most serious issues facing nursing homes: curbing infection-related problems, residents' falls and accidents, and abuse and neglect.

Rather, CMS last year approved grants to nursing homes to buy an antique popcorn machine, create song playlists for residents and build gardens.

“It’s ridiculous,” said Brian Lee, executive director of Families for Better Care, which advocates for nursing home residents. “This is the time these funds should be unlocked.”

The American Health Care Association, which represents nearly every nursing home in the country, agrees.

The group said it plans on using InvestigateTV’s analysis to persuade CMS to change course.

“In our view, the funds should be utilized to improve patient care,” said Mark Parkinson, ACHA’s president and chief executive officer. “We could make a big difference with this.”

Every year millions of dollars flow to nursing homes from the fund that is built from fines collected from long-term care facilities that have put the health and safety of residents in jeopardy.

The federal government collects the fines then allocates them to states to use as grants to nonprofit groups, universities and the nursing homes.

In 2019, CMS approved more than $89.5 million in funding to nearly 300 entities, according to an InvestigateTV analysis of its 2019 State CMP Reinvestment Projects report. Some of the projects have been receiving grant funds for two, three or four years.

Nearly three dozen of the 2019 grants were awarded to individual nursing homes that themselves had paid into the CMP fund in the past three years because of serious violations that put residents in harm’s way.

Today, in the midst of a pandemic, nursing homes are struggling to keep the coronavirus at bay. COVID-19 has claimed nearly 60,00 nursing home residents.

Thousands of nursing homes report that they have staff shortages. Hundreds say they don’t have enough personal protective equipment such as masks and gowns or the ability to test residents.

The estimated $400 million of CMP money in state coffers could help shore up problems exposed by COVID-19 – lack testing and PPE, advocates for nursing home resident say. CMS policy does not allow the fund to be used to pay for staffing.

But CMS is allowing nursing homes to tap into their state fund for a maximum of $6,000 to buy iPads and to purchase materials to make protective visitation barriers.

In January, the state of South Carolina had enough money in its fund to award nearly $87,000 to every nursing home in the state. West Virginia could have doled out more than $81,000. Even Texas, which has the most nursing homes in the country, had enough to give more than $20,000 to each facility.

“There’s no better use and no better time to use CMP funds,” said Cissy Sanders whose mother resides in an Austin, Texas nursing home that has been ravaged by COVID-19.

Civil Money Penalty Funds

InvestigateTV requested the 2020 Civil Money Penalty State Plan from every state. 22 declined to share their plans with us. Of the 28 that did, we have looked at their funding totals and potential funding a long-term care facility could apply for. States that supplied their records are noted in green.

 

Source: U.S. Census Bureau’s cartographic boundary shapefiles, 2016 edition • Illustration: Emma Ruby, InvestigateTV

Grants don’t address the biggest problems facing nursing homes

Brian Lee became a critic of the CMP program about 15 years ago during his tenure as Florida’s state ombudsman, which serves as a government watchdog over nursing homes and advocates for residents.

He noticed that a nursing home that had been fined hundreds of thousands of dollars received a $27,000 grant to buy a bread-making machine, to build a snack stand and to train staff on how to stock the shelves.

He visited the nursing home to see exactly how the money was spent.

“I expected the aroma of fresh-baked break to greet me when I walked in the door. I got the exact opposite,” he said. “I was immediately bowled over by the smell of urine and feces.”

He has since regarded the CMP fund as nothing more than a “slush fund” for nursing homes.

“This is money that was collected because people suffered, (were) abused, neglected and even died,” he said. “This is kind of blood money.”

Of the 294 projects given the green light last year, more than a third were aimed at “training,” according to InvestigateTV’s analysis of the grants.

The federal government approved nearly $35 million in CMP spending for these initiatives. Some of the projects were designed to help nursing homes come into compliance with CMS requirements such as a $2 million grant in Kentucky where all nursing homes in the state were to learn new emergency preparedness procedures.

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