By: Taylor Stevens
BEAVER, Utah —
Through a little-known federal funding stream,
Utah nursing homes owned by cities or counties are eligible for
additional taxpayer dollars meant to improve the quality of care for the
elderly and disabled residents who live or stay there.
It all adds up to big money. Over the last decade, state records show
nursing homes participating in the Upper Payment Limit program have
received $1 billion in federal funds they wouldn’t have otherwise had
access to.
But despite all that extra money, a new analysis of publicly
available federal data — commissioned by a local law firm — found that,
since 2017, the quality of care at these facilities has been worse than
at nursing homes that aren’t getting all that extra money – with lower
overall ratings and staffing scores and worse deficiency scores in
inspections.
“When you look at really every available metric to
determine, ‘are these facilities doing better with the money that
they’ve been given?’ They’re not. They’re just not,” said Barry Toone,
an attorney working with the Elder Care Injury Group, of the data. “The
program does not appear to be working the way that it was supposed to
work.”
The Elder Care Injury Group — which is pursuing multiple
medical malpractice complaints against facilities that are part of the
program — provided FOX 13 News with its underlying analysis, which the
station reviewed and spot checked against public data.
Both
the nursing home industry and the Utah Department of Health and Human
Services (DHHS) have pushed back on the analysis, which they say is not
based on an “apples-to-apples comparison.”
The law firm’s findings
come as some patients have complained about poor quality care at
facilities that are part of the program, and as federal inspection
reports continue to highlight problems within them.
“There are
real people in here who are suffering,” said Doni Hunt Webb, a resident
at a southern Utah nursing home that receives Upper Payment Limit funds.
One nursing home that’s received $26 million through the program since 2016 has been named as the state’s Special Focus Facility, meaning it has been identified as having a pattern of persistent and pervasive care issues.
Twelve other government-owned facilities that receive extra money currently have a special alert on the Centers for Medicare and Medicaid’s Care Compare website,
warning consumers that each one has been “cited for potential issues
related to abuse.” Four of those nursing homes are on the list of
candidates to receive additional oversight from federal regulators.
A
FOX 13 News review of court records also found nearly 20 Utah families
are currently suing facilities in the program, alleging in many cases
that poor quality care led to the death of their loved ones.
“When
we look at these facilities, a lot of these Upper Payment ones are not
the ones getting the highest reviews,” noted Nate Crippes, an attorney
with the nonprofit Disability Law Center, which is concerned about
conditions in these facilities (but is not party to any of the lawsuits
against them). “And we’re seeing a lot of problems in them.”
The
nursing homes in the program, he added, stand out because they are
receiving “much larger reimbursement rates than non-UPL facilities yet
continue to demonstrate serious quality concerns,” including high
turnover and insufficient staffing in some.
While still behind non-Upper Payment Limit facilities, data
does show quality ratings and inspection scores have improved slightly
among nursing homes in the program since 2017, while staffing metrics
have declined overall since that time.
A ‘long game’
If you ask Utah’s nursing home industry about these analyses, they’ll tell you critics have the program all wrong.
Before
the Upper Payment Limit, they say, Utah’s long-term care system for
seniors “was in crisis.” Nursing homes with Medicaid patients were
receiving almost $100 less per patient per day than it cost to provide
services to them. Some were losing “millions of dollars each year.” A
few were on the verge of closure.
After the program was created in
2013 and began allowing nursing homes to receive the substantially
higher Medicare reimbursement for Medicaid patients, they say facilities
have been able to offset those losses and increase staff wages, upgrade
aging facilities and make other improvements.
"The changes have been just amazing in these 10 years,” said Beaver Valley Hospital CEO Scott Langford in a video about the Upper Payment Limit.
“Not only has it improved the facilities for the elderly in the state
of Utah, virtually every part of the state has been touched by this
program.”
The city-owned hospital Langford represents is itself
owned by the city of Beaver in central Utah. It currently owns the
licenses for more than 40 of the state’s nursing homes, from Logan to
St. George.
Both Beaver Valley and Gunnison Valley — another
city-owned hospital that is a major participant in the Upper Payment
Limit — declined on-camera interviews for this story. So did the Utah
Department of Health and Human Services and the Utah Health Care
Association, which represents the state’s long-term care industry.
But
in written statements, all pushed back on the Elder Care Injury Group’s
analysis, arguing that it isn’t fair to compare Utah’s Upper Payment
Limit facilities to nursing homes that don’t accept Medicaid, in part
due to the more complex health needs of those patients.
Facilities
that aren’t part of the program, Beaver Valley said, “serve different
populations and are often supported by private-pay and insurance
resources using more diversified operating models. They provide a
different service to a different type of patient.”
DHHS pointed to
the most recently released quarter of federal data, which it said shows
facilities part of the program have similar overall scores as national
facilities, including non-Medicaid ones and “substantially higher”
quality scores.
The Utah Health Care Association also noted in an
email to FOX 13 News that almost every nursing home that qualifies for
the program is part of it, and that equating "roughly 80 facilities to
20 facilities that aren’t on the program isn’t a level comparison.”
Toone,
on the other hand, argues that it is a level comparison. He notes that
the Upper Payment Limit ensures Medicaid facilities receive the same
reimbursements as Medicare ones, meaning quality “should be at least
equal to the non-UPL facilities.”
He also added that the firm’s
analysis of federal data shows Utah facilities that aren’t in the
program have higher patient acuity than Upper Payment Limit facilities
but still “significantly outperformed” them.
In a fact sheet
provided to FOX 13 News, Beaver Valley said federal data reflects
“snapshots of challenges” and national pressures that affect both its
nursing homes and others across the country.
“When issues are
identified with facilities licensed by Beaver Valley Hospital,” it
added, "these are addressed, and steps are taken to improve care.”
Ultimately, the hospital argues, the Upper Payment Limit "is a long
game, with the goal of sustained improvements that continue to
strengthen the quality of eldercare in Utah over time.”
Langford,
Beaver Valley’s CEO, also pushed back on accusations that federal funds
haven't been properly spent for the benefit of nursing home patients,
noting that the hospital has followed “all state and federal regulatory
requirements of the UPL program since its inception in 2013.”
“All
funds from this program, which is one of the most rigorously regulated
of its kind in the country and provides more than $100 million annually
at no additional cost to Utah taxpayers, have been used strictly for
their intended purpose of providing care to Utah’s most vulnerable
seniors,” he continued in an email.
“Unfortunately,” Langford
added, “malpractice attorneys who focus on suing nursing homes continue
to misrepresent and exploit the complexities of this program for their
own self-interest.”
DHHS, which exercises oversight of the
administration of the Upper Payment Limit program, told FOX 13 News that
it does “not track specific spending related to how UPL monies are
being used.” Beaver Valley and Gunnison Valley also did not provide
specific breakdowns of how money has been spent overall at the
facilities they own.
“The funds are used to run the facility
including staffing, training, wages, facility improvements, capital
etc.,” Gunnison Valley said in response to the request from FOX 13 News.
“We trust our managers to use the funds as needed for each individual
facility as each facility is unique.”
Oversight and operations
This isn't the first time the Upper Payment Limit has come under scrutiny.
In 2017, a legislative audit
raised concerns about Beaver Valley’s administration of the program and
called for additional oversight and transparency of spending.
Among
their findings, auditors noted that nursing homes were using a little
less than half of the federal dollars flowing through the program, while
Beaver Valley collected the remaining 51% for seed funding and
administration fees.
Of the funds that went to the nursing
facilities, auditors found the majority were used for “renovations and
other expenses.” They also said they saw “little oversight” of the $6
million Beaver Valley had received at that time in “administrative
overhead.”
Those were among the most concerning parts of the audit for Hunt Webb, a resident at St. George Rehabilitation.
“There's
not that many people in Beaver,” she said in an interview with FOX 13
News. “I don't understand why they're allowed to take the money from
nursing homes.”
Hunt Webb is a 55-year-old former social worker
who sought long-term care at the southern Utah nursing home about seven
years ago, after the severe nausea and vomiting she developed during her
first pregnancy led to chronic and debilitating health issues that
required full-time care.
As she grew more frustrated by the
quality of that care, a series of internet searches she made last year
led Hunt Webb to discover that the facility she lives in is owned by
Beaver Valley Hospital.
At first, she was surprised. But after she found and read the legislative audit, she started to get angry.
Hunt
Webb eventually took those frustrations to Beaver Valley Hospital’s
Facebook page, where she posted that the facility and her care were
“beyond disgusting” but that there were “no other options,” since the
hospital also owns other nursing homes in her area.
She and the
other disabled and elderly patients in Beaver Valley facilities, she
alleged, were “enduring abuse and neglect” while the hospital benefited
from the funds in the program.
Beaver Valley said in a fact sheet
that the "vast majority of UPL funds are used by nursing facilities to
provide patient care,” while the “remaining, much smaller portion is
used by the hospital to improve access to care and health services
provided by the hospital.”
A she looks around her nursing home,
Hunt Webb said she doesn’t understand how St. George Rehabilitation has
spent the $20.9 million state records show it's received through the
Upper Payment Limit since 2017. But she doesn’t feel the funds have done
much to improve her care.
"It was supposed to provide for more
staffing,” she said of Upper Payment Limit dollars. "It's CNAs; it's
extra staff that we don't get."
While federal data shows St.
George Rehabilitation’s health inspection rating and overall staffing
have improved slightly over the years, the facility currently has a “below average” staffing rating from the Centers for Medicare and Medicaid Services.
St.
George Rehabilitation declined an on-camera interview for this story.
An administrator told FOX 13 News in an email that the facility prefers
to “personally connect with our residents” rather than involve the
media.
Like other nursing homes that are part of the program, St.
George Rehabilitation isn’t actually operated by Beaver Valley. Though
the hospital and other government entities that participate in the
program hold the licenses for the facilities, day-to-day operations are
largely overseen by private management companies.
Hunt Webb’s nursing home, for example, is operated by the Ensign Group, a private equity chain with about 300 facilities across the country.
"They’re
really only owners in name,” Crippes said of Beaver Valley and the
other government entities involved in the program. “They’re not
operating the facilities. They’re not there.”
For Toone, it all
raises questions about whether the funds in the program are being
siphoned away from patient care and "into private-equity coffers and
large for-profit chains.”
“As much as the industry likes to talk
about how they can barely meet their budgets,” he argues, “the reality
is those kinds of corporations aren’t drawn to industries like this if
they’re not going to make good money.”
Beaver Valley told FOX 13
News that its role in the program is to “oversee compliance,” while
“seasoned elder care facility managers” provide day-to-day patient
care.Under the Upper Payment Limit, it added, “Beaver Valley oversees
and empowers these experts to do what they do best,” ensuring residents
receive care “from professionals with the right skills, training and
compassion.”
'A program that was designed to do good’
After the legislative audit, the Department of Health and Human Services implemented a Quality Improvement Program in 2018, in an effort to address concerns about the need for greater state oversight.
To
qualify for continued funding, facilities are now required to either
improve from the previous year or score better than the national average
on at least six of nine metrics.
In a recent training for nursing
facilities, DHHS Quality Improvement Director Trent Brown said the
program helps demonstrate “that the additional resources that come in
from those UPL payments are being used to improve quality of care as
well as quality of life for nursing facility residents.”
He added
that it can also be a “very strong defense mechanism for the facilities
who participate when being questioned about the supplemental payments.”
Eleven
facilities in the program were put on probation for not meeting quality
requirements in 2024, according to documents obtained through an open
records request. DHHS told FOX 13 that the program seems “to be
effective” when comparing the metrics it tracks for Upper Payment Limit
facilities against national ones.
But Toone — noting other metrics
comparing these facilities to the ones here in Utah that aren’t
receiving extra money — argues the Quality Improvement Program doesn't
“appear to be working” and wants to see additional requirements for
facilities.
“I would like to see UPL dollars tied directly to
staffing ratios that are considered acceptable and wages that are
considered acceptable so we could see the stabilization of staffs within
these facilities,” he said. “If we could tie those dollars to those
kinds of things, that’s when you’re going to see the results that you
were supposed to see.”
The number of nursing staff hours per resident per day is one of several metrics that facilities are currently judged on.
Crippes,
with the Disability Law Center, agrees that staffing should be a more
significant metric and urged the state to consider additional payment
methods for the program that would enhance quality, “such as
incentivizing spending on direct care staff.”
“We would also
encourage the state to redirect its investments away from a costly UPL
model and instead focus on home and community-based services which would
allow people who are aging and people with disabilities to remain at
home — services that cost much less and have better outcomes,” he added.
For
his part, Toone said he believes the Upper Payment Limit could be a
positive for Utah’s nursing homes. But he said it's important that
policymakers ensure the money actually improves patient care for “the
most vulnerable members of our population.”
“Utahns should care
that good taxpayer dollars — and we’re talking about a lot of money here
— are used the way they are supposed to be used,” he said. “Especially
when you have a program that was designed to do good.”
You can view the full Beaver Valley Hospital audit HERE.
Full Article & Source:
Nursing homes receiving millions in extra taxpayer funds face allegations of poor patient care
