State Offers Medicaid Funding to Nursing Homes for Private Rooms

By Amy Stulick

Nursing homes in Ohio will soon receive financial incentives for each additional private room they offer, thanks to a proposal recently greenlit by the Centers for Medicare & Medicaid Services (CMS).

The initiative, set to launch in the coming months, was developed by the Ohio Department of Medicaid and revises the reimbursement structure for Medicaid-funded nursing home rooms, according to a report from the Scioto Valley Guardian. It’s a significant step toward the state’s goal of offering a private room option to every nursing home resident.

Operators that decide to convert multi-resident rooms into private spaces, or add private rooms through new construction projects will receive additional Medicaid funding. If facilities offer private rooms with private bathrooms, they’ll receive $30 more per day while those with shared bathrooms will receive $20 more per day.

There has been movement toward private rooms at the national level as well, with the Biden Administration’s reform initiatives including a call for reduced room crowding in nursing homes. But, there hasn’t been much discussion around this aspect of the reform since it was unveiled in 2022.

Other states like Massachusetts already have mandated initiatives to de-densify nursing home rooms, offering bed buyback programs to help supplement the cost, but it wasn’t significant enough to offset financial losses. Thirty-one providers in Massachusetts last year ended up filing a lawsuit against the mandate, halting its enforcement, according to a report from Becker’s Healthcare.

The private room initiative is the latest in efforts to make significant investments and implement policy reform to improve care standards and quality of life, the Scioto Valley report found, supported by the Ohio Nursing Home Quality & Accountability Task Force.

Prior to the private room funding, the state launched Ohio Nursing Home Quality Navigator, an online tool offering detailed information about its nursing homes. The site aims to strengthen resident advocacy and facility inspections. 

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State Offers Medicaid Funding to Nursing Homes for Private Rooms

Dayton nursing home where woman went missing had been fined more than $140K by Medicare

by: Carlos Mathis

DAYTON, Ohio (WDTN) — The nursing home where the late Penny Boddie lived had been fined and cited by the government numerous times prior to her going missing.

2 NEWS received a statement from the Ohio Department of Health (ODH), that said the case of Boddie, the woman with dementia who went missing from CareCore at Mary Scott, is currently under investigation. She was last seen at the facility on Sunday, May 14, at 9:30 p.m. Just days later, on Wednesday, May 17, the Dayton Police Department said Boddie had been found dead.

DPD says they believe no foul play is suspected.

“Any loss of life is always tragic,” ODH said. “The incident is being thoroughly investigated by the Ohio Department of Health (ODH) and pending the outcome of the investigation, the Centers for Medicare and Medicaid Services (CMS) will issue their decision and may impose penalties.”

The nursing facility was given two out of five stars for an overall rating on medicare.gov.  

Inspections conducted by the state of Ohio show the overall health rating for the nursing home is one star, which is described as ‘Much Below Average.’ Staffing at the facility received a one-star rating as well.

On July 21, 2022, the facility received its latest noted health inspection, according to the full report. During the inspection, a total of 20 citations were given, well above both the state and national average. In Ohio, the average is 10.2 health citations, while the national average is 8.7.

Medicare also reports nine complaints over the past three years that resulted in a citation for the location. One citation came from an infection control inspection, which took place sometime in the past 3 years, Medicare said.

The facility also was subject to 5 federal fines totaling $141,806 over the past 3 years, including one for $110,885 in July 2022, Medicare reports.

The quality measures rating at Mary Scott is ranked five stars, which is considered as ‘Much Above Average.’ There is limited data for short-term stays at the facility as recorded by the government. Medicare gives out the rankings based on data from chosen clinical data measures. For quality measures, Medicare says the more stars a facility has means the performance is better.

“The quality measures star rating measures parts of nursing home performance in certain areas of care, like if residents have gotten their flu shots, are in pain, or are losing weight,” according to Medicare.

2 NEWS looked through the Ohio Department of Health and complaint surveys that have been completed by the state. Three survey results are shown to have been completed in 2023, with the most recent being from March 10.

We reached out to CareCore at Mary Scott on Tuesday, May 16 for comment. The facility told 2 NEWS they had no comment and would not answer any questions at that time.

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Dayton nursing home where woman went missing had been fined more than $140K by Medicare

OIG signals new focus on nursing homes

by Neville M. Bilimoria

The federal Office of Inspector General recently published  its “OIG’s Top Unimplemented Recommendations: Solutions To Reduce Fraud, Waste, and Abuse in HHS Programs.” 

In the 94-page document, the agency focuses on the top 25 unimplemented recommendations it believes would most positively affect U.S. Department of Health and Human Services programs by way of either cost savings, public health, and program effectiveness and efficiency.

I’ll give you one guess at what type of healthcare provider the first two recommendations dealt with… yes, nursing homes.  

The previous year’s OIG top 25 recommendations also dealt with nursing homes as the first listed recommendation. That focused on ensuring that nursing homes are implementing actions to prevent COVID-19 and protecting residents, placing a higher priority on infection control surveys.  Probably not surprising given the pandemic and the Centers for Medicare & Medicaid Services’ view of nursing homes during the pandemic. (Check out this.)

Significantly, OIG explicitly states in each of its top recommendations that the order of listings in its top 25 recommendations does not necessarily indicate the agency’s priorities. But certainly being at the top of the list perhaps signals something about OIG’s focus these days, and that focus seems to be nursing homes.

This year, not only were nursing homes listed as part of the top recommendations, but they were listed in both numbers 1 and 2 of OIG’s top 25 recommendations to reduce fraud, waste and abuse. Specifically, OIG listed the below recommendation measures that it also believes would assist in protecting patients:

1. CMS should take actions to ensure that incidents of potential abuse or neglect of Medicare and Medicaid beneficiaries, including those in nursing homes and hospice care as well as children enrolled in Medicaid, are identified and reported. 

2. CMS should address inappropriate nursing home discharges through training, by implementing deferred initiatives, and by assessing the effectiveness of its enforcement against inappropriate facility-initiated discharges. (This is the first time this particular recommendation is appearing).

These two (again, listed as the first two) top unimplemented recommendations are telling for a few reasons.  First, with regard to No. 1, clearly OIG sees that CMS enforcement is somehow lax, because by making it a top recommendation, the watchdog is signaling that this is an “easy” way, in its eyes, to help eliminate this noted problem for waste, fraud and abuse. Namely abuse and neglect in nursing homes. 

That is troubling, as we have certainly seen increased enforcement by CMS over the last two years in nursing home surveys and penalties. But OIG is basically saying that abuse and neglect must be focused on even more through CMS’ survey process.

Second, with regard to No. 2 above, OIG believes that nursing homes are inappropriately discharging residents, and that they are being cited for not complying with involuntary discharge notice requirements. OIG noted that CMS is attempting to fix this problem, and it remains a top focus for both agencies:

CMS stated that it plans to provide training, including clarification of guidance around facility-initiated discharges and/or transfers. CMS will also incorporate an assessment of the effectiveness of enforcement actions in response to inappropriate facility-initiated discharges.  Top Recommendations, p. 7.

If that weren’t enough, OIG also provided an update on last year’s infection control recommendations for nursing homes. In the Top Recommendations, OIG stated that it is aggressively focusing on staffing as a way to improve infection control, suggesting OIG’s belief or assumption that staffing shortages are causing infection control problems:

“Regarding nursing home staffing data, in January 2022 CMS began posting weekend staffing and staff turnover measures on the Care Compare website. CMS also shares Payroll Based Journal staffing data, including lists of facilities that potentially have insufficient weekend staffing, with state survey agencies.”  Top Recommendations, p. 10.

OIG goes on to highlight its heightened focus on nursing homes in this regard:

“This progress is part of larger nursing home reforms that the administration and CMS are pursuing. OIG continues to invest substantially in oversight of nursing home quality and safety and will continue to monitor CMS’s progress on related reforms.”  Top Recommendations, p. 10 (emphasis added).

So clearly, OIG and CMS are working together to “reform” nursing home care, and OIG is fixing its gaze on nursing homes. But their idea of reforming nursing homes is not to physically or monetarily help facilities per se with staffing shortages or by providing money for more staff.  

Their idea of reform is further enforcement, more aggressive enforcement, and a focus on monitoring and enforcing against facilities with staffing shortages. Ignoring the exorbitant CMS fines and penalties in the survey process currently, and the difficulties that facilities are having with recruiting and maintaining adequate staff, the OIG recommends that increased oversight and enforcement will force facilities to improve staffing as a means to affect change (… that “reform” they are focused on) in nursing homes for years to come. 

Neville M. Bilimoria is a partner in the Chicago office of the Health Law Practice Group and member of the Post-Acute Care And Senior Services Subgroup at Duane Morris LLP; nmbilimoria@duanemorris.com.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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OIG signals new focus on nursing homes

CMS Proposes Rule Requiring More Nursing Home Ownership Transparency, Including REIT and Private Equity Disclosures

By Zahida Siddiqi

The Centers for Medicare & Medicaid Services (CMS) announced Monday a proposed rule to require nursing homes to disclose more information regarding their ownership and management, including information related to assets held by real estate investment trusts (REITs) and private equity firms.

Nursing homes will be expected to disclose this information as part of the Medicare and Medicaid enrollment process,enabling government agencies and the public to more easily determine whether nursing home owners are private equity investors or real estate investment trusts.

In addition to these disclosures, CMS shared that the proposed rule would provide definitions of “private equity company” and “real estate investment trust” to assist nursing homes when reporting this data. 

The move garnered mixed reactions from industry professionals. They generally applauded the effort to increase transparency, but some also expressed concerns about the approach being taken. American Health Care Association/National Center for Assisted Living (AHCA/NCAL) CEO Mark Parkinson said that the focus on REIT and private equity ownership is a “red herring.”

This proposed rule is just the latest step that CMS has taken to increase transparency of nursing home ownership, which was identified as a key priority of the comprehensive slate of reforms floated about one year ago by the Biden Administration.

In the wake of the Biden proposals last year, nursing home industry leaders pushed back against the way various types of ownership groups were being described and classified. 

For example, private equity firms, private capital firms and REITs were being referred to all but interchangeably, even though they are distinct types of companies with very different structures and ability to influence operations, Rick Matros, CEO of Sabra Health Care REIT (Nasdaq: SBRA), said at the SNN RETHINK conference last year.

Defining REITs, private equity

However, Matros is in support of greater ownership transparency and is glad to see that CMS intends to define private equity and REITs as part of this latest move.

“It’s about accuracy,” he told SNN in an email. “Hopefully their work will lead them to distinguishing between private equity and private capital.”

The definitions of private equity and REITs contained in the proposed rule are broad. For instance, this is the language regarding private equity:

“A private equity company would be defined as a publicly traded or non-publicly traded company that collects capital investments from individuals or entities (that is, investors) and purchases an ownership share of a provider (for example, SNF, home health agency, etc.).”

CMS is soliciting feedback on these definitions and in particular requested input on whether publicly-traded private equity companies should be included in the definition.

“These key definitions will lead to the disclosure of whether direct and indirect nursing home owners are private equity companies or real estate investment trusts via an updated nursing home enrollment application expected to be ready for public use in the summer of 2023,” CMS said in a press release, citing research that private equity investment has been associated with decline in quality of care as well as an increase in Medicare costs.

“By making facility ownership and oversight more transparent, nursing home residents and their families will be more empowered to make informed decisions about care,” CMS said of the new proposal.

The proposed rule would require nursing homes enrolled in Medicare or Medicaid to disclose additional information regarding owners, operators, and management. This could help shed light on how “related parties” benefit from shared ownership interests in a nursing home or chain of nursing homes.

If the proposal is cleared, nursing homes would be required to share information such as that on providers of administrative services or clinical consulting services to their nursing homes in addition to names of lessors, who may be working under a different corporate name, CMS noted.

‘Distraction from the real issues’

Mark Parkinson, President and CEO of The American Health Care Association and National Center for Assisted (AHCA/NCAL) also applauded the move for transparency but targeting ownership and private equity is misleading, he said in an emailed statement to SNN.

“We support transparency and appreciate the Administration’s efforts to assist families in making more informed decisions. However, focusing on ownership and private equity is a red herring. Less than 5% of nursing homes are owned by private equity firms and roughly 12% are owned by a REIT, an entity that typically has no influence on daily operations,” Parksinson said. “This has become a distraction from the real issues that impact the majority of providers, like Medicaid underfunding and workforce shortages. If we truly want to improve America’s nursing homes, we need policymakers to prioritize investing in our caregivers and this chronically underfunded health care sector. Together, we should focus on meaningful solutions that can strengthen delivering the quality of care and services that our nation’s seniors deserve.”

The exact percentage of nursing homes owned by private equity firms is a subject of debate. The CMS proposed rule issued Monday stated that about 70% of nursing homes were for-profit facilities with about 11% owned by private equity in 2021, although the agency noted that “estimates vary.”

LeadingAge, which represents 5,000 nonprofit aging services providers, cheered on the proposal, with CEO and President Katie Smith Sloan calling it a step toward ensuring that “owners or associated businesses” do not put profits over care quality.

She also emphasized the rules and frameworks that nonprofit organizations in the sector already must adhere to.

“Nonprofit providers have always disclosed ownership information as required by federal tax law on Form 990s that are open to public inspection,” Smith Sloan said. “The corporate structures of LeadingAge members promote longevity of ownership through governance by community boards of directors, and are financially sustained through public bond offerings and donations from philanthropists and foundations—though government support is often needed to cover the rising costs of caring for older adults.”

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CMS Proposes Rule Requiring More Nursing Home Ownership Transparency, Including REIT and Private Equity Disclosures

CMS Reinstitutes Tougher Penalties for Past Nursing Home Deficiencies

July 28, 2021

Earlier this year, the National Consumer Voice for Quality Long-Term Care (Consumer Voice) and California Advocates for Nursing Home Reform (CANHR) filed with the assistance of counsel AARP Foundation and Constantine Cannon LLP a lawsuit challenging a Centers for Medicare and Medicaid Services (CMS) 2017 directive that weakened the enforcement standards of the Nursing Home Reform Act and put residents at risk of harm.  Last week, CMS reversed course, rescinding the directive and reinstituting stronger penalties for nursing home violations.

The guidance at the center of the lawsuit restricted the use of civil money penalties for past non-compliance to a “per instance” maximum fine rather than allowing fines for each day of noncompliance.  This policy significantly reduced the penalties imposed for violations that placed residents at risk of harm and removed incentives for nursing homes to detect and fix serious problems quickly.  

“This action by CMS will provide incentive for nursing homes to identify and correct problems in a timely manner, as required by the Nursing Home Reform Act,” said Lori Smetanka, Executive Director of the Consumer Voice. “A strong enforcement system is necessary to protect residents from harm. The Consumer Voice commends CMS for this important action.”

In rescinding the guidance, CMS stated “upon further consideration … the agency should retain the discretion at this time to impose a per-day penalty where appropriate to address specific circumstances of prior noncompliance.”

For more information, contact Lori Smetanka, lsmetanka@theconsumervoice.org.

Read the article on the topic in the New York Times.

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CMS Reinstitutes Tougher Penalties for Past Nursing Home Deficiencies

Tennessee lifting nursing home visitation restrictions Sunday

By Brandon Richard

MEMPHIS, Tenn. (WMC) - On Sunday, the State of Tennessee will lift its visitation restrictions at nursing homes and long-term care facilities.

Tennessee Gov. Bill Lee says the state is taking this step because 100% of the state’s nursing homes and other long-term care facilities have completed both doses of the COVID-19 vaccinations.

“There has been a lot of isolation, a lot of separation for the elderly in our state, so we’re really glad to be in this spot,” said Lee.

Tennessee Health Commissioner Dr. Lisa Piercey says anyone planning to visit a nursing home in Tennessee needs to keep in mind that there are still federal guidelines in place, and individual long-term care facilities can also implement their own visitation rules.

“That does not mean that every nursing home or long-term care facility will be open season and when their doors open on Sunday or Monday anybody can come in,” said Piercey. “Individual facilities will still have their own policies, particularly those not under the purview of CMS (Center for Medicare and Medicaid Services). They will have their own facility guidance.”

Under federal guidelines, nursing homes may allow indoor visitation if there have not been any COVID-19 cases reported in the last two weeks and if there’s no outbreak testing going on, according to the Tennessee Department of Health.

According to state data, more than 2,600 long-term care facility residents in Tennessee have died from COVID-19 since the pandemic began.

The death rate significantly decreased over the last month as more vaccinations were administered.

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Tennessee lifting nursing home visitation restrictions Sunday

AHCA Says Permission for Holiday Visits Still Stands, Despite Recommendation From CMS

Click to Watch Video

By Cait McVey

The Centers for Medicare and Medicaid Services put out new guidance for nursing home residents, recommending they don’t leave their facilities for outside visits.

This recommendation is in direct conflict with the latest guidance from the Agency for Health Care Administration (AHCA), which oversees long-term care facilities (LTCs) in Florida.

Just a few weeks ago, AHCA released clarification for Gov. Ron DeSantis’ most recent LTC visitation order, saying residents must be permitted to leave facilities, including for holiday visits.

Spectrum News reached out to AHCA and was told the agency’s guidance regarding visits still stands, despite the CMS recommendations.

AHCA also provided the following statement:

“While the CMS recommendations encourage nursing home residents to not leave their facility, it acknowledges this will occur and provides guidance for those leaving including social distancing, remaining in small groups, mask use, and other precautions. These recommendations are consistent with information in the AHCA FAQ. The AHCA FAQ also directed facilities to monitor for additional updates. The Agency shared the CMS ​memo with all long-term care facilities as newly released guidance.”  

For more insight, we reached out to family advocate Mary Daniel, who is not only on the Governor’s long-term care task force, but also helped AHCA with its latest guidance.

Cait McVey: “We’re hearing from CMS the exact opposite of what the sate has put out.”

Mary Daniel: “See, I don’t necessarily see it that way.  All of these are recommendations. It’s what they’re saying they would like for us to do. I don’t think that has any bearing on changing anything in the state order.”

Cait McVey: “How important is the word recommend in this case?”

Mary Daniel: “It’s hugely important. This is telling me this is what they’re recommending but it doesn’t tell me this is what I have to do. If we really dig into this and see what it’s saying, it’s telling us the risk, it’s telling us you can do it, but you need to be extremely careful.”

Cait McVey: “What do you have to say to people who are watching the numbers climb here in Florida and feel because this is a vulnerable population, it’s not wise to take them home for the Holidays?”

Mary Daniel: “Why do we believe that staying in a facility with people coming and going, and I’m speaking particularly of the staff, why is that safer than being in my own home with just me? That’s an assumption that I don’t by into that. This can be done safely.  It really can.”

Daniel advises families to already be looking ahead to December and reaching out to facilities now, rather than waiting until the last minute.  She also recommends contacting AHCA directly, should a facility indicate it won’t be following the state order.

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AHCA Says Permission for Holiday Visits Still Stands, Despite Recommendation From CMS

Nursing homes face threats of citations, penalties if they restrict visitor access without good cause

by Danielle Brown

CMS Administrator Seema Verma speaks Thursday in Washington D.C.

Providers who fail to facilitate in-person visitations “without a reasonable clinical or safety cause” could be cited and face other penalties under new guidance issued Thursday by the Centers for Medicare & Medicaid Services.

The agency updated its guidance on nursing home visitation during the COVID-19 pandemic, which creates a framework for providers to facilitate in-home visitation, and resume communal activities and dining. 

The agency stated in a memo that it believes the guidance represents reasonable ways a nursing home can facility in-person visitation and failure to do so “without adequate reason related to clinical necessity or resident safety” would constitute a potential violation. It could also lead to a citation and enforcement actions.

“No one should be forced to weather this pandemic alone — especially the most vulnerable among us — so we’re using every lever at our disposal to ensure America’s seniors in nursing homes can continue seeing loved ones in a safe way,” CMS Administrator Seema Verma wrote in an op-ed Thursday. 

Core principles 

The guidance explains that outdoor visits are preferred because it poses a lower risk of transmission due to increased space and airflow. Facilities should accommodate and support indoor visits, beyond compassionate care situations, if there have been no new cases in the last 14 days and visitors adhere to core principles. 

Providers must adhere to the “Core Principles of COVID-19 Infection Prevention” in order to conduct visits. Those principals include screening everyone who enters the facility, cleaning and disinfecting frequently touched areas often and conducting resident and staff testing. Nursing homes can restrict access to visitors who don’t adhere to the core principles. 

Nursing homes also should limit the number of visitors per resident and the number of visitors in the facility at a single moment, and limit movement within the facility. The guidance also recommends that visits can occur at facilities in areas with low or medium COVID-19 county positivity rates; while visits at facilities in areas with high rates should only occur for compassion care situations.  

The moves come a half year after the agency suspended visitor access, communal dining and all group activities in mid-March. CMS stated though the initial guidance was focused on protecting residents from COVID-19 it has since recognized that “physical separation from family and other loved ones has taken a physical and emotional toll on residents.

“CMS understands that nursing home residents derive value from the physical, emotional, and spiritual support they receive through visitation from family and friends. In light of this, CMS is revising the guidance regarding visitation in nursing homes during the COVID-19 [public health emergency,]” the agency wrote in the memo. 

Praise for nursing home commission

Vice President Mike Pence said the release of an extensive report by a national nursing home commission laid the framework for resuming in-person visits at nursing homes.

“The recommendations’ today that will lay a framework for communities to begin opening up once again — open up for in-person visitation in our nursing homes. I know it’s going to be a blessing for families across the country,” he said during a routable discussion Thursday with several commission members. 

“Setting up this commission was a great idea. It really helped guide our efforts and essentially after looking at the results of the report it validated all of the work that we’ve done,” Verma added. 

Pence also assured that the federal government “will continue to do our part to make sure that we scale testing and provide testing supplies, including point-of-care testing that makes it possible to be able to visit.”

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Nursing homes face threats of citations, penalties if they restrict visitor access without good cause

CMS Implements Stricter COVID-19 Testing Requirements, Fines for Nursing Homes

By Alex Spanko

The federal government on Tuesday issued stricter requirements for COVID-19 testing in nursing homes, making routine staff testing a requirement for participation in Medicare and Medicaid and rolling out fines as high as $8,000 per instance of non-compliance.

The Centers for Medicare & Medicaid Services (CMS) established the new rules as part of a larger package of data reporting requirements for hospitals and laboratories.

“These new rules represent a dramatic acceleration of our efforts to track and control the spread of COVID-19,” CMS administrator Seema Verma said in a statement announcing the requirements. “Reporting of test results and other data are vitally important tools for controlling the spread of the virus and give providers on the front lines what they need to fight it.”

The exact frequency of the required employee testing will depend on the level of COVID-19 infections in a facility’s surrounding community, according to CMS.

“CMS recommendations for the frequency of staff testing will be based on the degree of community spread, to be announced shortly through guidance, that indicate the facility may be at increased risk for COVID-19 transmission,” the agency noted.

Nursing homes must now also provide tests to residents during all outbreaks, as well as when residents show any symptoms of the viral infection.

CMS has directed state surveyors to perform inspections ensuring that providers comply with the new regulations, with fines exceeding $400 per day or $8,000 per individual infraction.

Finally, all nursing facilities that receive a point-of-care testing unit from the Department of Health and Human Services (HHS) will be required to report diagnostic results as mandated under the CARES Act, CMS announced.

The rule, which will also apply to hospital labs and other sites that perform COVID-19 tests, will be enforced with fines of $1,000 per day for the initial infraction, with $500-per-day fines thereafter.

Nursing homes and other lab sites will be given a one-time grace period, lasting three weeks, to begin reporting the data.

“This requirement complements existing HHS guidance requiring laboratories to report test results and additional information, such as demographic data,” CMS noted. “This change allows CMS to take enforcement action against laboratories that fail to provide the required data, which is needed by federal, state, and local officials to conduct effective surveillance of the COVID-19 pandemic.”

CMS explicitly framed the rulemaking decision as a directive from President Trump.

“The provisions in today’s rule on nursing homes represent his expectation that CMS pull every available regulatory lever to maximize nursing home residents’ safety and quality of life,” Verma said in the statement. “These Americans and their families, who have already gone through so much, deserve nothing less.”

The move to beef up rules and enforcement around testing was largely expected in the wake of the HHS program, under which most of the nation’s 15,000 nursing facilities are slated to receive a point-of-care antigen testing unit by the end of September.

The antigen testing units are generally less sensitive than the gold-standard polymerase chain reaction (PCR) tests, with a higher chance of false negatives, though industry leaders and health care experts have largely welcomed the ability for quicker test results in a landscape marked by overwhelmed third-party labs and long turnaround times.

The federal government will provide an initial shipment of testing assays as part of those device deliveries, but facilities will be on their own to cover the costs of subsequent tests — as well as any follow-up PCR tests, which are typically recommended to confirm negative antigen results.

CMS pointed to the most recent round of $5 billion in federal CARES Act relief set aside for nursing homes — on top of billions in other aid available to post-acute and long-term care providers — as a key source of funding to cover testing expenses under the new rules.

The new requirements will take effect under an interim final rule with comment period, published in the Federal Register for inspection.

Previous federal testing requirements have largely taken the form of recommendations, such as specific benchmarks included in CMS’s guidelines for reopening nursing homes to visitors; CMS in July also announced its intention to require weekly staff testing in states with an overall infection rate of 5% or higher.

The American Health Care Association, which represents primarily for-profit nursing facilities, expressed general support for wider mandatory testing rules, while also raising concerns about how third-party testing delays could potentially result in fines.

“When CMS clarifies the frequency of testing required, it must factor in the delays that continue to be a reality,” AHCA president and CEO Mark Parkinson said in a statement. “Otherwise facilities could face fines for circumstances beyond their control and be conducting tests that are so delayed that they have little clinical value. CMS can solve these concerns by being reasonable in its implementation of the rule.”

LeadingAge, a trade organization of non-profit senior care and housing providers, called for more direct assistance on top of the requirements, noting that some providers have serious questions about the logistics of using the point-of-care machines.

“The fight against this virus is far from over, and our members need continued support,” CEO Katie Smith Sloan said in a statement. “The antigen testing machines HHS is delivering to nursing homes will help, but members who already have the machines report that they are still waiting for instructions and test kits to make them usable. What’s more, this HHS program addresses just one segment of the care continuum, and even nursing homes still face high costs for testing supplies and staff resources.”

Full Article & Source:
CMS Implements Stricter COVID-19 Testing Requirements, Fines for Nursing Homes

Nursing home resident, advocate in Massachusetts experiences staffing shortage first-hand

by  Kathy Curran

Click to Watch Video

BRAINTREE, Mass. — Penny Shaw was in pain as she lay helpless in her bed at Braintree Manor Nursing Home amid the COVID-19 pandemic. She became so desperate she even called Braintree Police.

"I was screaming, get me out of here, get me out of here, I was in terrible pain," she said. "And they didn't come for me."

Shaw, 77, suffers from quadriparesis and needs total care. She is also a national advocate for nursing home residents who were named earlier this month to the White House's Coronavirus Commission for Safety and Quality in Nursing Homes.

"I can't lay in bed for hours and hours in pain like that," she said. "We need a quality, safe, respectful, individualized care, person centric care, all care."

Her complaints about the care at Braintree Manor filed with the Department of Public Health put the spotlight on several issues also playing out nationwide. She said in her complaints that:

• staffing shortages were impacting basic care, including that aides did not have enough time to give her a weekly shower
• one morning, there were only two certified nursing assistants for 39 residents
• She was stuck in bed for hours and had missed breakfast several times
• there was not always enough personal protective equipment
• on one day, a COVID-positive resident was wandering around without a mask and entering other people's rooms.

"We need to have adequate staff. We need to keep people separate the physical distancing," she said. "We need to have infection control procedures."

Braintree Manor Healthcare 

 

The staffing issues in Braintree Manor Healthcare were cited repeatedly in a 2019 inspection of the home that found actual harm-investigators discovered residents were being improperly restrained because there weren't enough staff to supervise them.

Toby Edelman with the Center for Medicare Advocacy says staffing shortages and improper infection control had a devastating impact in facilities across the country.

"Having not enough staff is the most serious problem. And it made the pandemic much worse," she said.

Toby Edelman, senior policy attorney with the Center for Medicare Advocacy, said low staffing and poor infection control has been an issue in nursing homes for years.

 

In Massachusetts, nursing homes were hit especially hard. Sixty-two percent of all COVID-19 deaths in the state were in long term care facilities, according to state data.

"Nursing homes were not prepared for this pandemic. They didn't have enough staff. They did not have proper infection control practices for a very, very long time. And so when this pandemic hit, they were they did not know what to do," Edelman said.

Next Step Healthcare, the company that owns Braintree Manor Healthcare, said in a statement that ample personal protective equipment has been secured and is available, and the home passed its most recent on-site audit with a perfect score.

"The safety of our residents and employees is of the utmost importance, and this is at the center of all decisions we make," the company statement said.

Shaw said she wants her speaking out and serving on the White House panel to be a wake-up call for nursing homes everywhere.

"I would say the hope with this project is to save lives today as soon as possible and in the future," she said.

Full Article & Source:
Nursing home resident, advocate in Massachusetts experiences staffing shortage first-hand

With Spotlight on Nursing Homes, CMS Announces New Chief Medical Officer, Promotions

by Maggie Flynn

The Centers for Medicare & Medicaid Services (CMS) announced several new appointments on Tuesday, including a new chief medical officer who will help with the agency’s efforts on nursing home safety and security. The appointment comes four months after the last person to hold the role departed the agency.

Dr. Lee Fleisher, who currently serves as a practicing anesthesiologist, was named CMS’ new chief medical officer and director of the Center for Clinical Standards and Quality (CCSQ). Fleisher also serves as a professor of medicine and chair of the Department of Anesthesiology and Critical Care at the Perelman School of Medicine at the University of Pennsylvania.

He succeeds Jean Moody-Williams, who will continue in her role as a CMS deputy director, according to the announcement from CMS administrator Seema Verma.

Dr. Kate Goodrich, who served as CMO at the agency until earlier this year, left CMS in February to take on a new role with the insurance giant Humana (NYSE: HUM).

“As Director of CCSQ, Dr. Fleisher will use his prior experience to provide overall leadership to CCSQ while focusing on CMS’s continued efforts to ensure the safety and security of America’s nursing homes, improving quality and safety in our nation’s healthcare facilities, and reducing burdensome regulations to give providers more time to care for their patients,” Verma wrote in the announcement.

In addition to Fleisher’s appointment, Dr. Michelle Schreiber was promoted to the deputy director for quality and value at CCSQ, where she will work to move the health care system to one focused on paying for results and outcomes over service and procedure volume, according to Verma. Schreiber joined CMS in 2018.

Karen Tritz, the current director of the CCSQ’s Quality Safety and Oversight Group Division of Continuing and Acute Care Providers, was promoted to the role of survey and operations group director, a role created by a reorganization and expansion of the CCSQ that occurred last year.

Tritz has also served as the director of the Division of Nursing Homes in CMS’ Quality and Safety Oversight Group, at least in 2018; in that role, she worked on issues related to surveys and nursing home reporting requirements.

“These CMS staff changes build upon a leadership team at the agency that has made tremendous progress in advancing several quality initiatives, including by eliminating 79 measures across quality payment programs in the hospital setting, inpatient psychiatric facilities, ambulatory surgery, cancer hospitals, and hospital outpatient departments through the Meaningful Measures initiative,” Verma wrote. “This resulted in projected savings of $128 million and an anticipated reduction of 3.3 million burden hours.”

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With Spotlight on Nursing Homes, CMS Announces New Chief Medical Officer, Promotions

CMS warns nursing homes against seizing residents' stimulus checks

By Naomi Jagoda

The Centers for Medicare and Medicaid Services (CMS) said Thursday that nursing homes that confiscate residents' coronavirus stimulus payments could be subject to federal enforcement actions, including possible removal from participating in Medicaid and Medicare programs.

CMS said in a news release that it is aware of allegations that some nursing homes are demanding residents' payments, and that the practice is prohibited. The agency said that it has not received specific complaints about this practice but wants to inform nursing home residents of their rights while warning facilities of the potential consequences of seizing residents' checks.

CMS's message comes after state attorneys general have been reporting that they've had complaints of nursing homes and assisted-living facilities requiring residents on Medicaid to sign over their payments. Members of Congress on both sides of the aisle have been asking federal agencies to help protect residents, with House Ways and Means Committee Chairman Richard Neal (D-Mass.) and House Energy and Commerce Committee Chairman Frank Pallone Jr. (D-N.J.) urging CMS to issue guidance to nursing homes and residents.

CMS said that the confiscation of residents' checks could be considered misappropriation of resident property under federal regulations. Nursing homes that require residents to sign over their payments could also be in violation of rules that give residents the right to manage their own financial affairs, the agency added.

CMS encouraged nursing home residents and their family members who were directed to turn over their stimulus checks to file complaints with their state survey agency and to contact their state attorney general.

Under legislation enacted in March, most Americans are entitled to one-time payments of up to $1,200 per adult and $500 per dependent child. The checks are advance payments of refundable tax credits, which means that they cannot count as income for Medicaid eligibility purposes.

Neal and Pallone said in a statement late Thursday that they were "relieved" to see CMS tell nursing homes that they are barred from taking residents' payments.

“We’re relieved CMS heeded our concerns and issued clear guidance prohibiting this unlawful practice," the lawmakers said in a joint statement. "Predatory facilities are now on notice that there will be forceful repercussions if they attempt to seize their residents’ economic impact payments. Seniors and their families are struggling immensely during this crisis – we hope today’s news offers them some assurance.”

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CMS warns nursing homes against seizing residents' stimulus checks

More than 25,000 nursing home residents and 400 staff have died during pandemic, federal report shows

A patient is transported out of Brooklyn's Cobble Hill Health Center in late April. (John Minchillo/AP)

By Debbie Cenziper, Peter Whoriskey and Joel Jacobs

More than 25,000 residents died and 60,000 were infected as the coronavirus swept through U.S. nursing homes in recent months, particularly affecting facilities with a history of low marks for staffing and patient care, the federal government reported Monday.

The virus also infected 34,000 staff and took the lives of more than 400, according to the Centers for Medicare and Medicaid Services, the federal agency that oversees the nation’s nursing homes.

The numbers represent the first official national accounting of fatalities in the 15,000 nursing homes that receive Medicare and Medicaid funding. The tally, however, is incomplete. Only about 80 percent of the nation’s nursing homes reported data to the federal government, and they were required only to include cases since early May.

CMS officials nevertheless said they were confident the figures offer a reliable snapshot of the pandemic in the nation’s hard-hit nursing homes.

“This represents a good picture of where we’ve been,” CMS Administrator Seema Verma said in a call with reporters Monday afternoon.

A Washington Post accounting of cases and deaths in nursing homes shows a higher toll and that tally rounds up data from less than half of the states. Based on reports from 21 states since the beginning of the pandemic, The Post found that more than 28,000 residents have died.

Of the homes that reported data to CMS, 1 in 5 recorded at least one death from covid-19, the disease caused by the coronavirus, and 1 in 4 had at least one positive case. In the District of Columbia and three states — New Jersey, Connecticut and Massachusetts — more than 1 in 10 nursing home residents died, according to the data collected so far by CMS.

An early analysis by CMS showed that nursing homes that have received poor marks for nurse staffing and patient care were more likely to see higher case counts than those with stronger track records.

Statistical analyses touted by the industry, by contrast, suggest that the outbreaks have little to do with the quality of nursing homes. Instead, studies indicate that a home’s location and size are better predictors of an outbreak.

"Significant research from leading health experts, including analysis from Harvard Medical School and Brown University as well as testimony to Congress by the University of Chicago, has shown no correlation between covid-19 outbreak and [Medicare’s] star rating system,” said Beth Martino, American Health Care Association senior vice president of public affairs, referring to the government’s quality grades for nursing homes. “In fact, the first covid case was at a five-star rated facility. As this research shows, the amount of covid-19 cases in nursing homes has been directly linked to the level of the virus in the surrounding local community.”

On Monday, Verma focused heavily on infection control, saying the agency would strengthen enforcement, including civil penalties, of nursing homes with persistent violations of federal standards meant to prevent the spread of illness. The move, according to CMS, would “help prevent backsliding, improve accountability and ensure prompt compliance."

Nursing homes across the country have struggled with infection control both before and during the pandemic. In April, a Post analysis of about 650 homes with cases of the coronavirus found that 40 percent had been cited more than once for infection control deficiencies in recent years.

Verma said the agency will distribute $80 million to states to increase infection-control inspections of nursing homes during the pandemic. States that fail to inspect all Medicare-certified homes by July 31 will be required to submit a corrective plan to the federal government. Those still lagging by August will lose some of the money.

The new federal data, while limited, comes after months of criticism from watchdog groups and patients’ families, who argued that transparency is critical during a public health emergency. Since the first known outbreak at a nursing home, in Washington state in February, some states have repeatedly declined to name affected facilities or describe the scale of the problem, forcing families to plead for information from homes that were often reluctant to release details.

“I think people have a right to know what’s going on — and not all this hiding,” said Toby Edelman, a senior policy attorney at the nonprofit Center for Medicare Advocacy. “If the nursing homes would just tell the truth, people would respect them a lot more than this language about ‘We love our residents.’”

In April, CMS announced that all nursing homes would be required to report case information to the Centers for Disease Control and Prevention on a weekly basis. CMS requested data by May 17 but gave nursing homes a two-week grace period to report. The agency also announced a new rule requiring nursing homes to report cases to all residents and their families.

Mark Parkinson, president of the American Health Care Association and National Center for Assisted Living, said the newly reported numbers validate the need for widespread testing and more support for nursing homes.

“Especially as we continue to expand testing for residents and staff in long term care centers in June, we should anticipate the number of cases to rise as asymptomatic residents and staff will be identified," he said. "While an increase in these reported numbers may be startling, it will improve our ability to confront this threat and protect our residents.”

The data released on Monday did not include case or death counts for individual homes. Those numbers are expected to be released on Thursday.

Jacobs is a graduate student in journalism at Northwestern University’s Medill Investigative Lab.

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More than 25,000 nursing home residents and 400 staff have died during pandemic, federal report shows

Crime Insider: State investigating deadly stabbing at Richmond nursing home

By: Mike Bergazzi , Jon Burkett

RICHMOND, Va. -- The Virginia Department of Health has launched an investigation into the brutal death of a patient at a Richmond nursing home and rehabilitation center.

Kim Beazley, deputy director of VDH’s Office of Licensure and Certification, said that her office is handling the probe.

The on-site investigation began January 21, six days after the fatal stabbing of Robert Massie Willoughby, who was found dead inside his room at ManorCare Health Services-Imperial on Bellevue Avenue.

Richmond police have arrested Lynwood Lee Main, 65, and charged him with the murder of the 86-year-old.

Main was Willoughby’s roommate.

“Reportedly, the residents were arguing and one resident fatally stabbed the other with a pocketknife,” a spokesperson for the Centers of Medicare and Medicaid Services in Philadelphia said. CMS officials are monitoring the situation and have been in contact with Virginia officials, they wrote in an email

A timeline for the state investigation is unknown. Within 10 days of its completion, VDH must submit a report to CMS, according to Washington

Willoughby’s death sent shock waves from Richmond to western Virginia, where he was born and raised.

“It’s been tough, that’s the best I can say,” said Randy Harris, Willoughby’s nephew. “It shouldn’t have happened the way it did.”

Family members say Willoughby – a veteran of the Korean War – was a man who always put his family first.

“Robert was there for me, supported me,” Harris said. “I’ll never forget him for it.”

Sources tell CBS 6 that Willoughby’s throat was slashed.

“No one ever wants to lose a loved one, but this was a particularly bad way to go,” he said.

According to court records, Main has a long history of criminal activity and mental illness. In the past, he has been hospitalized at Central State Hospital, which houses some of Virginia’s most violent psychiatric patients.

So how did he end up sharing a room with the elderly Willoughby?

“I’ve been taught all my life that you don’t make decisions until you have all the information, but I will say that it’s concerning,” Harris said.

When CBS 6 reached out to the company that runs ManorCare, a spokesperson wouldn't go into details, but said that they monitor patients for behavior issues, and address those with a "care plan."

But a nurse who works at the Imperial location tells CBS 6 that staff knew that there had been confrontations between Main and Willoughby, and that they should been moved to separate rooms. But the nurse claims that did not happen because the facility is "short staffed."

In mid-January, the official Medicare website showed that ManorCare Health Services-Imperial had just a one out of five stars overall rating, which is described as "much below average."

Last week, that rating was upgraded to two stars, or "below average."

Specifically regarding staffing, the facility currently has a "below average" rating. Per the Medicare site, the total number of licensed nurse staff hours per resident per day at ManorCare Imperial is 1 hour and 31 minutes, which is below the state and national average.

During the most recent health inspection, the facility received 24 citations, double the statewide average, and triple the national number.

Willoughby's family said they are glad that the state is investigating his death because they want to know how this tragedy occurred, and if it could have been prevented.

In the meantime, their thoughts are not just with their lost loved one, but also his accused killer.

"We’re gonna pray for him, and we hope that God will forgive him," Harris said.

"Hopefully one day we’ll find the strength to do the same."

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Crime Insider: State investigating deadly stabbing at Richmond nursing home

Dozens of For-Profit Hospices Fail to Visit Dying People in Their Final Days, GAO Says

Dozens of for-profit hospice providers failed to visit dying patients in their last few days, according to a recent report by the U.S. Government Accountability Office (GAO).

© Chip Somodevilla/Getty Images HIV-positive Shana Reynolds-Fairley, 34, leaves Joseph's House, a hospice that provides nursing and support services to homeless men and women dying of AIDS and cancer, to go to Georgetown University Hospital for treatment of edema on August 30, 2013.

The investigation focused on providers paid by the Centers for Medicare and Medicaid Services (CMS) in 2017. While for-profit and nonprofit hospices had similar scores on pain assessment and other quality measures, more than 450 private groups discharged patients before they died.

This is not the first troubling report on the Medicare-paid hospice system. Earlier this year, the Office of Inspector General (OIG) found that 18 percent of all hospices in a nationwide survey had serious deficiencies, like failing to vet staff.

In the recent report, eighty for-profits failed to send registered nurses, physicians or nurse practitioners to visit discharged patients even once in the last 72 hours of their lives, while only three nonprofits did the same.

Both for-profit and nonprofit hospices gave these end-of-care visits to most patients, but the dozens that didn't left at least 800 dying people and their families without guidance.

"According to researchers we interviewed and one of the studies we reviewed, provider visits near the end of a hospice beneficiary's life are critical to providing quality care, including for emotional support and for training the beneficiary's family members or other caregivers on the signs and process of dying," the GAO said.

A smaller number of for-profit hospice units (55) did not provide any visits from medical social workers, chaplains or spiritual counselors, licensed practical nurses or hospice aides in the entire week preceding more than 600 patients' deaths.

As baby boomers enter old age, there has been a substantial growth in Medicare payments for hospice services, as well as the number of Medicare beneficiaries using hospices, since 2000, according to the GAO.

Yet CMS doesn't instruct its surveyors to record information on providers' performance, the GAO said. That can impede oversight of providers doing a poor job. At the same time, the only penalty CMS can impose is kicking these hospices out of the reimbursement pool entirely, a punishment too severe for most offenses.

The GAO, together with the Department of Health and Human Services, called on Congress to give CMS more authority to create additional enforcement remedies for hospices not up to par.

"Americans at the end of life and their families expect the best care possible—it's unacceptable that too often hospice providers are falling short," Senator Ron Wyden, who requested the investigation, said in a Thursday statement.

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Dozens of For-Profit Hospices Fail to Visit Dying People in Their Final Days, GAO Says

CMS will crack down on nursing home inspectors

The CMS announced Thursday that it would bolster the system it uses to hold nursing home inspectors accountable.

The agency said in a statement that it will carry out a number of changes to the State Performance Standards System (SPSS) to address concerns about infrequent and ill-timed nursing home inspections. The SPSS will update how it evaluates the performance of state survey agencies who actually inspect nursing homes, as well as update the SPSS assessment tools.

The changes are aimed to ensure that inspections are done correctly and on time, the agency said. They will also ensure that enforcement actions, including civil monetary penalties, are consistently applied.

"By holding inspectors accountable for conducting timely and consistent inspections, we're holding nursing homes accountable for providing safe, high-quality care—helping ensure safe nursing home environments," CMS Administrator Seema Verma said in a statement.

Survey agencies will experience increased monitoring thanks to new metrics to make sure that states inspect nursing homes on time. The CMS will also review new state performance indicators each quarter to expose problems with nursing home inspections. Those reviews used to occur at the end of the fiscal year to evaluate how well states were inspecting nursing homes.

The agency will step up how it holds survey agencies accountable for their handling of "immediate jeopardy" situations, which are health and safety situations presenting a pressing danger.

The changes are one step in the agency's work to improve nursing home inspections. In the future, states may be allowed to determine how to address problems on their own and create specific plans to help the federal government identify low-performing survey agencies. The CMS also plans to increase states' access to centralized data so survey agencies can figure out how to meet federal mandates.

The Trump administration this month announced that it would make it easier for consumers to learn about nursing homes that have violated rules on abuse, neglect or exploitation through improvements to its Nursing Home Compare website. The website makes available detailed information about Medicare- and Medicaid-certified nursing homes in the U.S.

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CMS will crack down on nursing home inspectors

Hundreds of hospice centers in U.S. get failing grades

By Michael Kosnar

Hundreds of hospice care facilities across the country were found to have serious, life-threatening deficiencies, according to an investigation by the Department of Health and Human Services Office of Inspector General that was obtained by NBC News.

Severe complaints were lodged over unsanitary conditions at some facilities and over patient wounds that were badly treated or not treated at all at others.

More than 300 hospice facilities out of the 4,563 surveyed nationwide between 2012 and 2016 were considered poor performers, according to the IG’s report.

“Those numbers are surprising and, frankly, they’re unacceptable,” Erin Bliss, assistant inspector general at HHS, said.

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Almost every hospice center in the country that provided care to patients receiving Medicare benefits was part of the study, the most in-depth of its kind ever undertaken relating to hospice care.

According to HHS statistics, Medicare spent $17.8 billion for hospice care for almost 1.5 million beneficiaries in 2017. Hospice care is generally considered appropriate for terminally ill patients with a life expectancy of six months or less.

More than 80 percent of hospice facilities had at least one deficiency, most of those had multiple deficiencies, 1 in 5 had a serious deficiency.

“When we looked into some of the more extreme examples of how those deficiencies can impact patients, we found cases where patients were actually harmed by their hospice care,” Bliss said.

Investigators uncovered shocking examples of poor care or abuse that included the following:

• A patient’s wounds were not treated properly resulting in gangrene and the patient’s leg having to be amputated.
• Maggots were allowed to develop around a patient’s feeding tube.
• Hospice workers failed to recognize signs of a possible sexual assault of a patient.
• A patient went two years before anyone treated her for a wound.
• Poorly trained staff attempting to move a patient dropped her on the floor resulting in a broken leg.

In some cases, criminal charges have been filed against hospice facilities, owners and employees.

In one sweeping federal investigation in North Texas, 16 people were indicted in what was described by prosecutors as an elaborate $60 million Medicare fraud scheme. Nurses admitted to overmedicating patients to quicken their deaths and secure higher payments from Medicare, resulting in several overdose deaths. Seven defendants have already pleaded guilty in that case and nine others are slated for trial later this year.

In its report, the IG found numerous cases of fraud, including hospice centers that enrolled patients who were not terminally ill, altering patient records and billing for services that were never provided.

Some hospice facilities were also cited for inadequate training, failing to monitor medications, providing fewer services than were called for in a patient’s plan, and not conducting proper criminal background checks on employees.

According to the study, California, South Carolina and Texas had the worst performers.

The Centers for Medicare and Medicaid, known as CMS, is the HHS agency responsible for administering the Medicare program for the federal government. Bliss said the investigation found that CMS needs to improve its oversight of hospices through additional enforcement tools, better collection and analysis of deficiency data, and ensuring that data be made more available to the public.

“Hospice patients and their families are some of the most vulnerable,” Bliss said. “We’re talking about people that are dealing with a terminal illness for themselves or their loved ones. And so we think that Medicare should make it as easy as possible for them to get good information about their hospice options and the track records of those providers and how to make complaints in the event that they do run into a problem or are concerned about their hospice provider.”

In a statement provided to NBC News, a CMS spokesperson said, “CMS has zero tolerance for abuse and mistreatment of any patient, and CMS requires that every Medicare-certified hospice meet basic federal health and safety standards to keep patients safe."

“The OIG’s findings are based on cases that occurred between 2012 and 2016, a selective sample of the most serious cases of harm found during hospice surveys. In these cases, CMS cited the hospices for failing to meet certain requirements in the Medicare and/or Medicaid programs," the statement said.

CMS added that this year the agency issued new guidance to surveyors who inspect hospice facilities to help them more quickly identify and address the most grave patient safety situations. The agency said it is making hospice quality information easier for consumers to find and understand on its Hospice Compare website.

Mollie Gurian, the chief strategy Officer for The National Partnership for Hospice Innovation, an organization representing not-for-profit hospice providers across the country, told NBC News she agrees with the HHS OIG findings and recommendations.

"We are strongly in favor of increasing oversight on hospice programs that deliver poor-quality care," said Gurian. "Throughout our organization’s history, we have encouraged the Centers for Medicare and Medicaid Services to shift their focus from penalizing deficiency-free programs to the exact kinds of programs these reports address — those that cause serious harm to patients and their families."

The Office of Inspector General encourages anyone who has experienced or witnessed abuse, neglect, poor care or financial irregularities in a hospice to contact the hospice administrator, the state department of health, the Medicare hotline at 1-800-Medicare or the police if someone feels a potential crime has been committed.

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Hundreds of hospice centers in U.S. get failing grades