Hos­pital dis­charge law con­cerns advoc­ates

by Sarah Volpen­hein

A bill passed by the Wis­con­sin Legis­lature will make it easier for hos­pit­als to dis­charge cer­tain patients deemed inca­pa­cit­ated to nurs­ing homes, free­ing up hos­pital beds that might oth­er­wise be tied up for weeks.

The bill, which Gov. Tony Evers signed into law on March 20, has the sup­port of hos­pital sys­tems that com­plain of long, costly delays in dis­char­ging patients who can no longer make med­ical decisions for them­selves and haven’t des­ig­nated someone to act on their behalf. At present, they remain in the hos­pital while await­ing court pro­ceed­ings to appoint a guard­ian.

“This legis­la­tion will help ensure patients can move more quickly to the most appro­pri­ate set­ting for their recov­ery, while also improv­ing hos­pital capa­city for those who need hos­pital care,” said Kyle O’Brien, pres­id­ent and chief exec­ut­ive of the Wis­con­sin Hos­pital Asso­ci­ation, a trade group rep­res­ent­ing hos­pit­als.

The legis­la­tion was opposed by dis­ab­il­ity and aging rights advoc­ates, who say it cir­cum­vents the guard­i­an­ship pro­cess, designed to pro­tect the rights of vul­ner­able indi­vidu­als, and could res­ult in patients becom­ing con­fined to insti­tu­tions against their will.

“The guard­i­an­ship pro­cess is com­plex for a reason,” Lisa Has­sen­stab, pub­lic policy man­ager at Dis­ab­il­ity Rights Wis­con­sin, said dur­ing a Novem­ber hear­ing on the bill. “That reason is due pro­cess.”

The Sen­ate voted 28-5 in favor of the legis­la­tion on March 17 dur­ing what could be the body’s last floor ses­sion for the year.

The bill passed the Assembly in Feb­ru­ary with bipar­tisan sup­port, fol­low­ing an amend­ment adding price trans­par­ency require­ments for hos­pit­als.

Health sys­tems engaged in heavy lob­by­ing for bill

The legis­la­tion received a major push from Wis­con­sin health sys­tems, hos­pit­als and industry trade groups, which col­lect­ively spent more than 400 hours lob­by­ing in favor of the bill, accord­ing to reports made to the Wis­con­sin Eth­ics Com­mis­sion.

Wis­con­sin hos­pit­als spend hun­dreds of mil­lions of dol­lars every year hous­ing patients who no longer need hos­pital care and are await­ing dis­charge or trans­fer to nurs­ing homes or other facil­it­ies. While the reas­ons behind

dis­charge delays are many, the bill addresses only the guard­i­an­ship issue.

It does not address other under­ly­ing causes, such as lim­ited bed avail­ab­il­ity at nurs­ing homes or the lack of med­ical facil­it­ies accept­ing com­plex patients.

Up until now, if phys­i­cians deemed a patient no longer able to make med­ical decisions for them­selves and they did not have a power of attor­ney, the hos­pital could not dis­charge the patient to a nurs­ing home until a guard­i­an­ship peti­tion was filed with a court, even when fam­ily mem­bers agreed to the trans­fer. Those pro­ceed­ings could take weeks or months, hos­pital offi­cials said.

The patient may be someone who had a stroke, suffered a trau­matic brain injury, or has demen­tia or another agere­lated dis­ease and lacks the abil­ity to man­age their own health care, whether tem­por­ar­ily or per­man­ently.

The new law removes the require­ment to file for guard­i­an­ship and allows a fam­ily mem­ber, called a patient rep­res­ent­at­ive, to agree to the patient’s admis­sion to a nurs­ing home, make health care decisions for them and approve health-related spend­ing.

Dis­ab­il­ity advoc­ates argue the legis­la­tion removes pro­tec­tions like court over­sight that come with the guard­i­an­ship pro­cess while also grant­ing a lot of the same author­ity as a guard­ian. They say the legis­la­tion does not require that the patient be noti­fied of the rep­res­ent­at­ive’s appoint­ment or of their rights to ask for a ree­valu­ation of their men­tal capa­city. Nor does it require the rep­res­ent­at­ive to con­sider the wishes of the patient, they say.

The legis­la­tion, they said, also lacks pro­tec­tions against an abuser or estranged rel­at­ive assum­ing the role.

“Often­times the per­son who is an abuser is the per­son who is really keep­ing an eye on the per­son in the hos­pital,” said Tami Jack­son, pub­lic policy ana­lyst and legis­lat­ive liaison with the Wis­conVon sin Board for People with Devel­op­mental Dis­ab­il­it­ies. “Some­body who gets picked under this bill ends up with a whole lot of author­ity.”

Under the new law, the patient or another fam­ily mem­ber may object to the nurs­ing home place­ment, if aware.

Any­one may ask a court to review the patient rep­res­ent­at­ive’s actions or may request a ree­valu­ation of the patient’s capa­city.

Exten­ded hos­pital stays can con­trib­ute to over­crowding

While pro­mot­ing the bill, health sys­tems argued that patients may miss out on cru­cial rehab­il­it­a­tion or other health care while wait­ing in the hos­pital for dis­charge. By remain­ing in the hos­pital, they also are at increased risk of hos­pital-acquired infec­tions or falls espe­cially dan­ger­ous for eld­erly patients.

From Janu­ary to Octo­ber 2025, Mayo Clinic Health Sys­tem coun­ted about 35 patients with exten­ded stays at its north­w­est Wis­con­sin hos­pit­als, Gina

Ruden, a Mayo senior nurse admin­is­trator, said at a Novem­ber hear­ing on the bill. At Mayo’s Eau Claire hos­pital, that added up to patients spend­ing a col­lect­ive 1,200 days in the hos­pital because of guard­i­an­ship delays, she said.

The exten­ded stays con­trib­ute to hos­pital over­crowding. Mayo Clinic has seen an influx of patients, Von Ruden said, ever since the abrupt clos­ure in 2024 of two area hos­pit­als by Hos­pital Sis­ters Health Sys­tem, a com­pet­ing health sys­tem.

When over­crowded, the Mayo hos­pital in Eau Claire has to board patients in the emer­gency depart­ment, Von Ruden said, where they may spend the rest of their hos­pital visit if no bed becomes avail­able on an inpa­tient floor.

“They might be in a hall­way in the emer­gency depart­ment or even in the ambu­lance bay when things get real tight,” Von Ruden said.

The bill has a three-year sun­set pro­vi­sion, which allows legis­lat­ors to check if the bill is work­ing as inten­ded before renew­ing it. 

Full Article & Source:
Hos­pital dis­charge law con­cerns advoc­ates 

Michigan nursing homes have few staff, little training. Misery can follow

by Robin Erb

 

• Most poor care in nursing homes can be traced to low staffing, advocates, attorneys and others say
• Michigan has not updated its law since 1978 even as other states have boosted requirements
• An industry official calls such standards unnecessary ‘feel good’ measures and says the real issue is a worker shortage

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Residents of the Mission Point of Beverly Hills awoke hungry on Sept. 6, 2023. No meals were served. Nor did aides come to help immobile residents out of bed to avoid bed sores or make it to the bathroom.

The residents, many of whom had limited or no mobility, had been left on their own for an entire shift, according to a state inspection report. The reason: a lack of staff.

Across Michigan, the state’s most vulnerable residents are living out their last days in what inspection reports characterize as sometimes squalid conditions, because many nursing homes are critically understaffed. Positions are tough to fill because nursing aides are paid less than $40,000 for work that is so physically demanding they have a higher rate of workplace back injuries than construction workers. 

So far, the state and federal government have not stepped up to help.

Michigan has about 420 nursing homes that provide care to 34,000 residents. A Bridge Michigan review found that at least 167 facilities were cited at least 362 times total for lack of “sufficient” or “competent” staff in the past four years. 

That is a certain undercount, since inspectors are on site sometimes just once a year. Six of those homes were cited more than six times each.

“A basic minimum level of staffing is so important to the quality of life and the dignity of people’s lives,” said Megan O’Reilly, vice president of government affairs at the national AARP office, which has advocated for more staffing. 

“It almost feels like you’re being set up to fail. There’s no way to meet the need and the demand that’s in front of you,” she said.

Michigan’s minimum staffing requirements have remained unchanged since 1978 and require each resident to receive just 2.25 hours of care a day, or 2.31 hours if including time from the director of nursing, according to the National Consumer Voice for Quality Long-Term Care, a longtime national advocacy organization for residents of long-term care facilities.

That’s below the 4.1 hours a day recommended by the U.S. Centers for Medicare & Medicaid Services a quarter century ago.

Across the US, staffing minimums vary widely. Some states have no standard; at least six and the District of Columbia require at least 3.5 hours a day: DC (4.16 hours a day), Rhode Island (3.87) Illinois (3.83), Florida (3.66), Massachusetts (3.64) and California and New York (3.56)

When Michigan’s law passed, people in what many then called “retirement homes” often were more able-bodied. Today, those same people live in independent- or assisted-living facilities, leaving nursing homes to care for those with more complicated medical needs, said Sarah Slocum, a longtime consumer advocate and former head of the Michigan Long-Term Care Ombudsman office.

“There’s nobody in a nursing home who doesn’t need a bunch of help. That’s why they’re there,” she said. 

Bridge found that for-profit homes were cited more than nonprofit ones.

Roughly a fifth of the state’s 66 nonprofit nursing homes have been cited at least once for staffing shortages or inadequately licensed workers over the past four years. 

In contrast, more than one third of the state’s 319 for-profit homes were cited.

In all, Bridge Michigan documented about two dozen deaths at nursing homes in the past four years that were either cited by inspectors for wrongdoing or the subject of lawsuits alleging poor treatment.

To be clear, residents are frail and prone to injuries, and many of Michigan’s nursing cares provide exceptional care.

But a Bridge review reveals that others have far more persistent problems.

At the now-closed Mission Point Nursing and Physical Rehabilitation of Ishpeming, Richard Bellmore, 61, died in 2022 after he hadn’t been checked for hours, according to a lawsuit filed in his death and a 179-page report filed with the state.

At the facility, an inspector described residents who sat in their own waste, went without medical care, and were fed barely edible food. 

One resident’s pillow was soaked in urine that seeped up to the resident’s hairline, a visitor told the inspector. Residents who couldn’t walk on their own were left in their beds for days, according to the reports.

State reports claim the facility’s director of nursing was frequently absent and would even climb out of the office window to avoid staff members who had questions.

Confronted by a staff member as she was climbing through the window, the director of nursing explained she didn’t want to be “bombarded,” the staff member recalled to the inspector in a Jan. 18, 2023, report.

It was “hard to get down the hallway because too many people stop her and ask her questions,” the staff member said the nursing director told her.

‘Feel good’ measures?

Over the years, lawmakers have made efforts to boost Michigan’s minimum staffing requirements. A quarter-century ago, some lawmakers suggested boosting standards to 2.75 hours a day, defraying costs with money from a 1998 settlement with tobacco companies for $6.2 billion.

Many nursing homes typically exceed those standards, with about a third, 142, providing more than four hours a day of care per resident, according to data from  NursingHome411, a project by a New York nonprofit called the Long Term Care Coalition.

In all, 13 homes provided less than three hours, according to the report.

Last year, the Biden administration announced staffing requirements that would have pushed daily care requirements generally to 3.48 hours a day. 

Under these first-ever federal staffing levels,  more than a half hour of that care each day would be provided by a registered nurse — changes that would have saved about US 13,000 lives a year, according to research by the University of Pennsylvania.

In Michigan alone, the change could save 251 to 500 lives, according to estimates.

The $200 billion nursing home industry opposed the change, arguing that it would require finding another 102,000 workers nationwide in an industry already beset with worker shortages.

Staffing ratio levels are “feel-good” measures but arbitrary — failing to account for individual needs of residents — and put a “target on our back” for inspectors, said Melissa Samuel, president and CEO of the Healthcare Association of Michigan, an industry lobbying group.

Instead, the government should relax immigration standards and increase Medicaid reimbursements, she said.

“If you want to fix the problem of a workforce problem, then let’s fix the problem and get workers,” she told Bridge.

In the end, it didn’t matter.

The “One Big, Beautiful Bill,” signed by President Trump in July, listed such staffing requirements as “wasteful spending,” delaying the rules until 2034.

Less training than a barber

Providing the backbone of care in Michigan are more than 38,000 certified nurse aides who are paid less than $39,000 per year on average, according to the US Bureau of Labor Statistics.

Michigan requires 75 hours of training for them, with an additional two days of clinical training — less than most other states and far less than a 2008 recommendation by the National Academy of Medicine that called for at least 120 hours of training.

Michigan requires 400 hours to be a manicurist and 1,800 hours to be a barber.

Nursing aides is a tough job that requires is physically and emotionally draining — and aides can quickly get overwhelmed, said Clare Luz, a gerontologist whose work at Michigan State University 

“Have you ever tried to give an elderly disabled person a shower?” she said. “You and I — we jump in the shower, we spin around, and two minutes later we can get out.”

For a medically-frail person, she said, “it can take a full hour just to give somebody a shower.”

She said a few hours of care a day for residents isn’t enough.

‘My roommate hasn’t gotten up’

At Mission Point of Beverly Hills in 2022, an inspector entering the facility heard one resident yelling “I’ve been sitting in piss for five hours.” Others complained they’d gone weeks without showers. Medications were late. One resident reported waiting nine hours to get fed.

“My roommate hasn’t gotten up in over a week,” one resident told inspectors.

The facility — along with the closed home in Ishpeming that closed in 2024 — is part of the Mission Point Healthcare Service chain of Grand Rapids.

Its Beverly Hills facility has been cited so frequently that federal officials deemed it  a “special focus facility,” making it subject to more inspections. 

As recently as on Oct. 26, 2023, an inspector detailed at least six days of nursing shortages.

Darious Parks, administrator of the Beverly Hills facility, now part of the Certus Healthcare chain and called Harmony Village of Beverly Hills, told Bridge by phone that improvements have been made at that facility — both in staff, and in turn, for the residents.

He said he has been on the job only a few months, and he’d heard the allegations of a “terrible” record connected to Mission Point. A former nurse aide, Parks said staffing and care has improved during his tenure.

In all 15 different Mission Point locations in Michigan were cited by state inspectors over three years for having insufficient staff, either by not having enough workers “to meet the needs of every resident” or by failing to have, specifically, enough nursing staff, according to a Bridge analysis of three years of inspection reports.

Calls from Bridge to Mission Point corporate offices were not returned.

‘Impossible to meet the needs’

Mission Point of Grandville was cited in 2023 for short staffing, too, after an 85-year-old church elder died when her blood sugar slumped after missed medications. Staff noticed her struggling, but no one notified her doctor, according to state inspectors.

The day before she was scheduled to return home, a nurse found her unresponsive, and her blood sugar level “incredibly low.” 

The nurse, who later said he hadn’t been told of her low sugar the previous days, raced around the facility to find a dose of injectable or gel glucagon, used in a low-blood-sugar crisis.

There was none.  

He tried to get into a medicine cabinet. It was locked.

He called 911, crushing glucose tablets to put into Johnson’s mouth in an attempt to “save her life,” he later told an inspector. 

It was too late.

Inspection reports also indicate that residents went without showers because there wasn’t enough staff, doctor appointments were missed and wound care was neglected.

Falls — the leading and increasing cause of accidental death for older Americans — had surged.  In a two-week period, staff reported 14 separate falls in the facility. One fall left a 78-year-old resident on the floor in only his briefs, his pelvis broken, one nurse said.

“Help, help,” he called, the nurse later told the inspector.

A woman broke her arm in another fall. After that, she was left in her wheelchair instead of being put in bed after dinner “because there weren’t enough staff,” an aide reported.

Even as the inspector visited the facility on April 13, two aides were helping a resident who had fallen to the bathroom floor, unable to locate a nurse to help.

It was “impossible” to meet the needs of all the residents,” an aide told the inspector.

Angelic Thomas said her mother, Julia Williams, never complained about her care at the facility. 

Still, she said she never saw staff either.

“There never seemed to be anyone at the nurses’ station,” she said.

The facility also was cited for Williams’ death after staff failed to offer her CPR and other life-saving help when she apparently suffered from a heart attack in 2023.

At her Grand Rapids home this past summer, Thomas said she often thinks about her last visit with her mother. Julia Williams had been a housekeeper, working into her 70s. She’d been independent and strong, but in those final weeks, she seemed to be “tired, giving up,” Thomas said.

“The last conversation we had, she wanted out of the nursing home,” Thomas said of her mother.

Thomas dropped her head into her hands, rubbing her face and shaking her head.

She sighed at the memory: “I said ‘Mom, I’ll try.”  

Full Article & Source:
Michigan nursing homes have few staff, little training. Misery can follow 

Nursing homes receiving millions in extra taxpayer funds face allegations of poor patient care

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. 

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Nursing homes receiving millions in extra taxpayer funds face allegations of poor patient care 

New guidance strips nursing homes of ability to seek voluntary payments from resident reps, families

by  Kimberly Marselas

Federal regulators have taken a “big jump” in their latest interpretation of third-party financial guarantees, putting limits on contractual language used by nursing homes for decades, a pair of post-acute care attorneys warned Thursday.

Updates to surveyor guidance that went into effect in late April don’t just prohibit family member or guardian guarantees as a condition of admission; they now prohibit providers from enforcing other voluntary language that has traditionally helped ensure responsible parties use a resident’s assets to pay for care or help apply for Medicaid when those assets run out.

“This is not a change to the Nursing Home Reform Act, it is not a change to the statute, so it did not go through the regulatory, standard processes of rulemaking,” said Erin Saylor, senior partner and director of compliance for the Stotler Hayes Group. “This was sort of something CMS just issued and sort of slid under the radar a little bit.”

Saylor and Emily M. Solum, partner at Husch Blackwell, detailed the new Centers for Medicare & Medicaid Services guidance about guarantees during a webinar hosted by the American Health Law Association Thursday.

The attorneys said providers should expect to see surveyors putting admission agreements under the microscope in coming months, much as they did with arbitration agreements when those were prohibited from admission conditions in new Rules of Participation.

The problem, Solum and Saylor said, is that what’s prohibited for financial guarantees seems to have taken a sudden turn for the worse for providers whose patients’ bills are going unpaid. Examples provided in the updated guidance appear to forbid clauses that nursing homes have used in voluntary payment provisions, with similar terms upheld by courts for decades in keeping with terms in the  Nursing Home Reform Act of 1987.

“Some of the language — payment guarantees, express or implied — obviously, that is clearly not allowed under the statute, or language holding a third party jointly responsible for the resident’s care,” Solum said.

Toothless contracts

But from there, new stipulations strip providers of their right to collect payment. Those include prohibition of language that holds third-party individuals personally liable for breach of an obligation in an agreement, such as failing to apply for Medicaid in a timely manner, and failure to provide accurate financial information.

“These are all things that the statute allows you to hold a third party responsible for,” Solum said. “And now what CMS’ guidance is saying is that you cannot seek to hold that third party personally liable for failing to do the things that they had actually agreed, potentially, to do.”

Saylor explained that nursing homes could still ask residents’ family members with legal access to that resident’s assets to sign a voluntary payment contract but that the guidance prohibits enforcement of most provisions.

“You can have them enter into an agreement, but you can’t hold them responsible financially for breaching it,” she said.

The attorneys said judges have often upheld such agreements in the past, holding third parties responsible for assistance they did not provide, such as supplying banking information, other verification or appealing negative Medicaid decisions.

“It really just continues to shift the burden onto nursing facilities, who are not in a position to access the residents’ income and assets directly, are not in a position to access the resident’s financial and personal information,” Saylor said. “This is all solely within the purview of the resident or their family, or their responsible party. Essentially, CMS, with this guidance, is trying to take off the table, at least in terms of language in the admission agreement, your ability to… hold a responsible party financially responsible for failing to uphold their duties that they’ve agreed to.”

More scrutiny, penalties?

What’s worse, providers might now be dinged for agreements that contain language requesting responsible parties’ contributions, even though the statute doesn’t disallow that. As surveyors become better attuned to the new guidance, nursing homes should expect more scrutiny and potential penalties ranging from citations to denial of admissions, the attorneys said.

Everyone should be reviewing their admissions packets to make sure they comply with the guidance, as well as looking for alternatives o now to handle cases in which residents and their families are not paying. Both attorneys emphasized family extensive and documented communication in the case of patients whose bills go unpaid while assets exist, as well as referrals to outside agencies in the case of those whose representatives won’t help with Medicaid applications after agreeing to do so.

Saylor said facilities could set a dollar amount that triggers review by an attorney, who could pursue a breach of contract claim that gets family members to perform specific obligations, such as application completion, even if that doesn’t mean payment. Or providers could try to compel payment for services under state statutes or common law, including spousal impoverishment or filial care laws meant to protect impoverished seniors.

As provider associations look for relief from the new guidance from a regulation-lite administration, there may be reason to hope for eventual relief from the courts too — especially if CMS is seen as having skirted expected rule-making requirements.

“This is an expansion of what a third-party guarantee actually means from a legal perspective, but it’s also inconsistent with three decades of case law that have discussed this very issue,” Solum concluded. “There is an argument that the guidance is contrary to statute. … We’ll see how that plays out over the coming years.” 

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New guidance strips nursing homes of ability to seek voluntary payments from resident reps, families 

Opinion: Nursing homes may start sedating your elderly parents — and, eventually, you — because they don’t have enough workers

Staffing levels ‘significantly impact’ the use of antipsychotic medication, new research has found

By Brett Arends

About 24,000 additional nursing-home residents will be sedated just to keep them under control as a result of the defeat of the Biden administration’s staffing mandate, new research says.

The chances of your parent or grandparent being subject to so-called “chemical restraint” by nursing-home staff is about 10% higher than it would have been if the staffing mandate had survived, according to the analysis just published by the Pension Research Council at the University of Pennsylvania’s Wharton School of Business. 

This was based on a detailed analysis of staffing levels and sedative use across America’s 16,000 nursing homes between 2012 and 2021. Researchers Jong Meong Lim, Ken Moon and Minje Park obtained regulatory data on antipsychotic use, staffing levels and other information about nursing homes from the federal government’s Centers for Medicare and Medicaid Services through Freedom of Information Act requests.

“Our analyses consistently find that staffing levels significantly impact nursing homes’ antipsychotic medication use,” they report. “We find that increasing a nursing home’s nurse staff hours per resident day (HPRD) decreases its usage of antipsychotics by 6.039 residents on average, even after controlling for resident, zip code, and nursing home characteristics.”

As they explain, “patients placed under chemical restraints require less work. By reducing workloads rather than fulfilling them, nursing homes can hire fewer nurse staff while utilizing antipsychotic medications to still manage their patient load.”

They find that nursing homes run for profit are most likely to resort to such “chemical restraints” to control residents.

Co-author Ken Moon, a professor at Cornell’s SC Johnson College of Business, says the true figure may end up being even higher than 24,000. That’s because of the Trump administration’s nationwide purge of immigrants without legal status, which is making it even harder for nursing homes to find staff. (The nursing-home industry has also complained about this.)

Previous studies have also shown a correlation between higher staffing levels, better care and less abuse of sedatives or “chemical restraints” in nursing homes. However, this is the first to look specifically at the possible impact of the staffing mandates pushed by the Biden administration.

The staffing mandates, which were proposed by the Biden administration in 2024, would have set minimum levels of nursing staff per resident. They were defeated earlier this year as a result of a concerted campaign by the nursing-home industry and its political allies. The rules were blocked by the courts in April and seemingly killed for good by the Trump administration’s One Big Beautiful Bill, which was passed by Republican majorities in both houses of Congress and which the president signed into law earlier this month. The law imposed a moratorium on the rules until 2034.

There are inevitable caveats. Nursing homes are still subject to various regulations at the federal and state levels. (How well facilities are monitored and regulations enforced is a subject for debate.) The Biden staffing mandate couldn’t wave a magic wand: Nursing-home operators complained that they already couldn’t find enough staff at prevailing wages and that many of them couldn’t afford the extra workers required, and they warned that some nursing homes would simply close down instead. The 24,000 figure comes from applying the theoretical staffing levels to nursing homes’ 2019 occupancy levels. Obviously, this involves projections and estimates.

In an emailed statement, Holly Harmon of the nursing-home industry’s trade association, AHCA/NCAL, said “our providers are committed to strengthening the long term care workforce, but they need meaningful support.” The industry, she added, urges policymakers to support its “Better Way” policy priorities.

Alas, one of those includes protecting Medicaid — the main financial support for America’s nursing homes — from cuts. (The Republican megabill signed into law by President Donald Trump earlier this month, includes deep cuts to federal Medicaid spending — more than $1 trillion over 10 years, according to the Congressional Budget Office).

It’s long been known that some or many understaffed nursing homes have resorted to the use of antipsychotic medications, typically meaning sedatives and tranquilizers, to make up for a shortage of staff. A U.S. Senate subcommittee reported as long ago as 1975 on this abuse of medications as a way to keep residents docile and easy to manage. A recent study suggested that nearly one resident in four is being medicated in this way. 

Some nursing-home operators have responded to increased oversight by exploiting regulatory loopholes, critics also argue. This includes diagnosing more residents with conditions such as schizophrenia, where the use of antipsychotics draws less scrutiny, they say.

But look on the bright side. Based on the evidence of recent decades, including during the pandemic, hardly anybody outside of a nursing home really cares what happens to the people inside. 

They figure it won’t happen to them, anyway. It will only happen to other people. Of course it will. 

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Opinion: Nursing homes may start sedating your elderly parents — and, eventually, you — because they don’t have enough workers 

Texas is illegally keeping people with disabilities in nursing homes, federal judge rules

By Stephen Simpson 

Texas has been violating federal law for decades by sequestering individuals with severe disabilities in poorly run nursing homes without offering them alternative living options and services in the community, a federal judge has ruled.

U.S. District Court Judge Orlando Garcia from the Western District Court of Texas ruled on Tuesday that the state has caused irreparable injury to people with intellectual and developmental disabilities by denying them specialized services, including federally-required services within the community.

“Although community programs are the most integrated setting appropriate to meet their needs, they remain unnecessarily institutionalized in nursing facilities, or at serious risk of such institutionalization. They are harmed by such institutionalization and deprived of living in a community setting and participating in integrated community programs,” Garcia said in his 475-page ruling.

The decision stems from a class action lawsuit, filed in 2010 by disability rights advocates and six institutionalized plaintiffs between the ages of 26 and 46, that alleges that state social services officials have violated the Americans with Disabilities Act by failing to provide appropriate treatment to some 4,500 Texans living in nursing homes.

Advocates say the state has consistently sent individuals who were receiving care for their disabilities at home or in the community to nursing homes by mistake after being hospitalized for an illness. Once there, they don’t receive the services they need because they haven’t been adequately screened, and they are effectively trapped, since many can’t argue for their transfer.

Garth Corbett, senior attorney for Disability Rights Texas, praised the court decision, noting it entrenches the rights of individuals to leave a nursing facility and transition to the community.

“It underscores the right of persons admitted to nursing facilities with IDD to be provided the necessary supports and services required by federal Medicaid law, so that those who want to live at home or in another community-based setting are able to do so safely,” he said.

The state coordinates services for the severely disabled through Medicaid waiver programs. Funded by the state and federally, the programs help pay for various services, including residential support, skill development, job coaching, home modifications and specialized therapies.

Most individuals with intellectual or developmental disabilities are placed on a waitlist for one of these Medicaid waiver programs at an early age. By the time they become adults, the state funds most of their care, making them reliant on the decisions made by state agencies.

Jennifer Ruffcorn, a spokesperson for Texas Health and Human Services Commission, said in an email this week that the agency is reviewing the judge’s decision.

In 1987, the U.S. Congress passed the Nursing Home Reform Act after a study found that many nursing home residents were not receiving adequate care and that neglect and abuse were common. This also mandates nursing homes to screen all applicants for evidence of severe mental illness and IDD before admitting them. The goal was to ensure individuals with severe disabilities were not inappropriately placed in nursing homes, which degraded their overall health more quickly than if they received services in the community, according to the study.

Garcia stated in his opinion that the state’s failure to provide these services constitutes a longstanding violation of several federal laws, including the Nursing Home Reform Act, the Americans with Disabilities Act, and the Medicaid Act.

The opinion included a multitude of stories about individuals with severe disabilities. Reports of broken wheelchairs, individuals trapped in facilities unable to see their families, and families who were advocating for more services for their loved ones but were ignored were all examples Garcia listed as ways Texas was violating federal law.

“Even if the State has made some changes since the trial of this case, past conduct has shown a likelihood of future repetition,” he said.

Steven Schwartz, special counsel from the Center for Public Representation, who represented the plaintiffs in this case, lauded the ruling as the most comprehensive and poignant opinion he has seen in his 50 years of practicing law.

“The opinion is sweeping in its scope and breathtaking in its impact for people with IDD,” said Schwartz. “He has made it clear that the rights Congress established through the Medicaid Act and the Nursing Home Reform Act are critically important rights, and Texas has systematically violated those rights.”

The state had previously reached an interim agreement with the plaintiffs in 2013 where they committed to expanding community living options for people with intellectual disabilities; to avoiding admitting individuals with severe disabilities to a nursing facility if those people can safely live in the community instead; and to devising educational activities to address community living options for affected individuals and their families.

However, when Gov. Greg Abbott took office in 2014, the state refused to sign the final settlement agreement, prompting the lawsuit that has been ongoing for the past decade.

“It would have clearly been a better resolution for everyone. It would have been more timely, safer, less expensive, and would not have required a federal judge to issue all these orders; instead, it could have been done by agreement,” Schwartz said.

Schwartz said the decision by the judge didn’t come with immediate requirements., Both the state and the plaintiffs must submit their proposals for changes by August 1. He said after that, he will impose requirements on the state.

“Texas knows how to serve people in the community with significant needs. Programs are in place that are effective, cost-effective, and clinically effective, serving the most challenged individuals,” Schwartz said. “Obviously, they don’t have enough, but this isn’t a new science or changing the fundamental way Texas operates; it just has to expand to do it.”

Full Article & Source:
Texas is illegally keeping people with disabilities in nursing homes, federal judge rules

AI-Powered Monitoring Gains Traction in Nursing Homes Amid Staffing Shortages and Higher Acuity

by Amy Stulick

Nursing homes are implementing clinical tech, especially AI, to support staffing.The trend could signal a broader shift as nursing homes pursue tech-enabled care coordination to remain competitive and meet increasing acuity demands.

Operators see the practice as a way to strengthen partnerships, especially with hospitals, in turn aiding in referrals. But, tight margins tied to subpar Medicaid and managed care reimbursement add financial barriers to unlocking cutting-edge tech systems that can help nursing homes level up.

All the while, more higher acuity patients are moving into nursing homes.

“If the technology is not affordable, I think the nursing homes are going to lag behind,” Matt Nieukirk, director of operations for SNF practice and home health at OSF Healthcare, told Skilled Nursing News. “The care that we give to these patients will continue to evolve, and the nursing homes are going to need to look for that extra technology, or that extra push that’s going to get them to the next level.”

OSF is an Illinois-based health care system with a network of 17 hospitals, partnering with nursing homes for operations rather than owning them outright.

But, the use of AI and other technologies should be done with purpose and strategy, said Aimee Middleton, COO for the South Dakota-based Evangelical Lutheran Good Samaritan Society. Notably, without replacing caregivers. If anything, staff roles should evolve with the use of technology, she said.

“I don’t think we have an option to not look at technology being part of our future,” said Middleton. “What are our residents looking for, and how can we get those frontline caregivers back to the actual caregiving?”

Construction with tech in mind, and rethinking staff roles

Good Samaritan this year has automated its revenue cycle task to save staff significant hours. The operator also is baking in another tech initiative – robot vacuuming and food service – at a new campus construction project in Sioux Falls, South Dakota.

“Our existing campuses will benefit from this as well – we’re going to trial some of these technologies in some of our existing campuses,” said Middleton. Housekeepers could socialize with residents more, and dietary aides can work on making sure all residents have warm food at the same time when they sit down for a meal.

In terms of revenue cycle automation, the organization can tweak certain positions to focus more on bedside care, positively impacting the quality of care, she said.

“I know it doesn’t sound very exciting, but we have five employees spending about 80 to 100 hours every single month, closing out our locations. Well, we automated that system,” said Middleton.

Virtual nurse wraparound services for night shifts have also been considered by Good Samaritan, she said. Right now, if a nurse has a question at 3 a.m., she has to call the director of nursing.

“Imagine a world where the DON doesn’t get the call. There’s a world where a virtual care RN answers the question, and the team member on the front line gets the support that they need,” said Middleton. “My DON’s job satisfaction goes up. Her work-life balance is better. That’s the world we’re dreaming of right now, and really trying to make sure that we have the network in place to be able to do it, and that we could carry this to many locations.”

Catching up with hospital tech advancements

AI is a critical step in bridging the tech gap between hospitals and nursing homes, Nieukirk said. A lot of nursing home operators lack real-time patient monitoring systems, a common pattern among acute care providers.

Such tech adoption is seen as a way to strengthen hospital-nursing home partnerships and in turn referrals. But, cost remains a major barrier to a broader rollout across the nursing home industry, he said, especially considering tight Medicaid margins across the country.

“Nursing homes for the past 25 years have been relying on human interactions. They don’t have the monitoring systems like the hospitals do. This is a great first line for nursing homes to start rolling into new technology and having AI involved,” said Nieukirk. “It puts the hospital’s mind at ease too, knowing that these facilities do have an extra layer of monitoring.”

OSF HealthCare has partnered with AI company Somato to pilot predictive monitoring technology in 25 nursing homes across Illinois, Nieukirk said, with plans to further expand the program. The tech works to improve early detection of clinical deterioration by using AI to scan electronic medical records, and flagging “out-of-range” vitals and pattern deviations.

The tech flags subtle signs of infection along with gradual temperature increases and elevated heart rates, he added. Somato case managers review alerts before notifying staff at the nursing home. The tech acts as a second pair of eyes on patients in an attempt to reduce hospital transfers.

“What we have found is, a lot of times people that are turning septic, or they’re starting to get an infection, it doesn’t start overnight,” said Nieukirk. “[Somato’s case managers are] looking back and they’re alerting the nursing homes, and the nursing homes are taking action, whether they’re calling the physician, getting an antibiotic started, maybe getting some labs done.”

The biggest goal is to keep the patient in bed, and not have an emergency transfer to the hospital.

“We’re actually catching patients prior to them, you know, turning septic, or needing to go back into the hospital,” said Nieukirk. “It’s like you have an extra nurse sitting at your nurse’s desk and doing nothing but monitoring for you.”

Nursing homes are coming around to AI

OSF Healthcare launched the initiative in October 2023, and it took eight to nine months to get nursing home operators on board. That means the program has only been in facilities for about seven months. It’s part of a larger trend to incorporate clinical AI into post-acute care settings, Nieukirk said, especially as staffing shortages continue to challenge operations.

OSF’s nursing home partners Allure Group and Arcadia Care have implemented the technology, and initial results show a “positive impact,” Nieukirk said. Data is still rolling in and will inform any sort of refining as expansion occurs.

“I’m introducing it to administrators all the time. When you have 100 to 150 facilities using it and you’re collecting data, it’s that much easier to prove how the technology works and how the systems can help the facilities,” said Nieukirk.

Actionable alerts are limited to 15-20 per facility per month, enhancing care without overwhelming staff, Nieukirk noted. Somato filters through quite a lot of notifications, receiving between 12 and 1,500 per month for all participating facilities. 

Full Article & Source:
AI-Powered Monitoring Gains Traction in Nursing Homes Amid Staffing Shortages and Higher Acuity 

Tech plus touch is goal for senior living industry

Artificial intelligence has the potential to transform the senior living industry. From helping to drive resident satisfaction and supporting staff member retention to enhancing efficiency and streamlining processes, industry experts are optimistic about how AI can help support their operations.

At the same time, senior living leaders are mindful of the importance of human interaction in the industry and the need to maintain the right balance of what Alex Prough, chief commercial officer at Medical Guardian, called “tech plus touch.”

In a private roundtable discussion, “Exploring AI-Driven SaaS in Senior Living Operations,” sponsored by Medical Guardian, leaders from the company came together with senior living and care industry professionals to gain insights into how AI can best be used in the industry’s daily operations.  

When asked to pinpoint their most pressing operational challenges, panelists overwhelmingly cited staffing and regulatory issues. “It’s all about staff,” said Chris Winkle, a consultant and former CEO of Sunrise Senior Living. He said he believes “there’s a lot of opportunity for tech and automation to ease that labor pressure.”

“There’s not enough staff in the industry to fill positions,” agreed Mark Mitchener, corporate vice president for Greystone Communities. He added that, too often, staff members abandon jobs in the senior living industry to pursue higher-paying jobs elsewhere, with caregivers going to agencies. In states with a high minimum wage, operators find themselves competing with fast food or retail employers, and even Amazon, for employees.

Regulatory compliance issues also loom large for operators. “In some states, [senior living communities] are treated like nursing facilities when it comes to staffing ratio,” said Heather Tussing, president of The Aspenwood Company.

Valuable tool for reducing workload

From a regulatory compliance standpoint, it’s a moving target in certain states,  according toDivinia Nunez, director of operations for Sinceri Senior Living.

“All the regulatory demands are difficult for administrators,” noted Carrie Lund, vice president of operations at Principle LTC. “That’s probably one of the biggest challenges.”

The paperwork associated with meeting regulations also is a huge burden for staff members, and the panelists acknowledged that they are desperate to find ways to streamline their workflows. “Electronic records were supposed to make our job easier,” observed Mitchener. “The key is to use AI to take some of the paperwork load off caregivers and nurses and allow them to be on the floor with the residents.”

April Young, chief operating officer at Sinceri Senior Living, bemoaned “too many software platforms for employees to get lost in” at the expense of “customer service and engaging with residents and families.”

As with many other senior living companies that are beginning to explore ways that AI can assist in care and service delivery, resident engagement, documentation and compliance, Young said that Sinceri Senior Living is experimenting with AI to “determine how we could be more efficient and run more smoothly.”

Varied applications for AI

“I’ve seen applications from the marketing side to the procurement side to the capital side,” Winkle said. He described an AI tool that links procurement to the menu to lock in food cost.

Jenni Bost, vice president of marketing for Radiant Senior Living, described how her company has been more successful gathering survey information using an AI-driven chatbot than when using a live person. “We use it in our sales, marketing and with our [customer relationship management platform]. I use it for distilling survey information, and we’re able to do that faster than before,” she said.

Michener noted that his company is using AI to distill tome-like referrals down to two pages so staff members can more easily digest information and make decisions quickly. 

The panelists agreed that AI has the potential to enhance rather than detract from the level of human touch that residents receive. For example, AI can help ensure that the needs of all residents are being met. Winkle noted that AI can be applied to electronic health records data to determine which care plan residents should be on and whether their actual care reflects that assessment.

“Typically, the sickest people need the most attention, but we want to make sure that people that are less sick don’t get neglected,” observed Jim Reilly, senior director of MGLiving for Medical Guardian. 

AI also can be used to boost customer satisfaction. Howard Teicher, senior vice president for MGLiving and channel partners for Medical Guardian, explained that the company has created a wellness check-in campaign through which residents rate how they feel physically and emotionally. If a resident says he or she isn’t feeling well, then staff members receive a prompt to call the resident’s caregiver to suggest a check-in. 

“AI can give you visibility. You can make that outreach greater,” explained Terri Williams, senior director of healthcare marketing for Medical Guardian.

Tussing said that The Aspenwood Company has uploaded information on individual residents’ specific interests and is using AI to create unique experiences for residents, such as “one-on-one experiences or LinkedIn Learning courses.”

Enhancing outreach is an ongoing focus for Medical Guardian, company representatives said, adding that the firm is working to create an outreach coordinator program for its clients that can supply Silver Sneakers-approved providers to run activities.

Powerful tool to enhance care 

AI also can provide valuable insights into fall risk assessment, according to panelists.

“We’re seeing real promise in leveraging AI to work upstream to help prevent falls,” Prough said. “We are now doing dynamic fall risk scoring and starting to move the needle on emergency department utilization and other things for some of the communities we help support. We feel like there’s a lot of promise there.”

“There’s also an opportunity on the independent living side for a bot to answer a lot of the questions that nurses or staff members field, so that they can spend more time with residents,” Michener said.

Giving staff members the right tools can enhance job performance and job satisfaction, panelists said. 

“If staff members have something to help guide them through issues and give them the right answers, we’re better operators and have less liability risk,” Reilly said. That automation is especially helpful at helping keep those employees with the least experience from feeling overburdened, he added.

The panelists agreed that AI can be a huge benefit to lessening the workload of an overburdened workforce plagued by high burnout and turnover rates.

“It certainly helped with my staff burnout,” Bost said. “I could do much more than I could ever do before.”

“There is more we can do to prevent that burnout with our teams by utilizing AI,” Michener said. “We’re just scratching the surface at our organization.”

The increased use of AI also will require additional staff training, so the panelists stressed the importance of communicating to staff members that the training will make their jobs easier in the long run.

Michener concluded that “AI is coming, whether we like it or not.”

“We need to learn how to use it in our industry to have the best impact on our residents’ and staffs’ lives,” he said. “We do need to put the brakes on a bit to make sure our systems are all in place.”

To get the greatest value from AI, the panelists said that data need to be integrated, and they stressed the importance of sharing data across platforms.

“There are even more opportunities to create a centralized hub of data to support residents in a more meaningful way,” Prough said.

Full Article & Source:
Tech plus touch is goal for senior living industry  

Investigation Uncovers Food Insecurity in Nursing Homes

Takeaways

• A recent investigation found many nursing homes spend less than $10 per day on food per resident, raising concerns about malnutrition and food quality.
• There has been an increase in food-related sanctions, dietary complaints, and disease outbreaks in nursing homes.
• Residents report unappetizing food and inadequate portion sizes, highlighting a lack of accommodation for dietary needs.

Nutrition plays an essential role in the healthy aging. The American Medical Association (AMA) reports that healthy eating reduces mortality by 20 percent. Adequate nutrition is of particular importance for older adults with complex medical needs who reside in long-term care facilities.

Yet, a recent journalistic investigation has identified problems with food in nursing homes across the United States. The report raises concerns that many long-term care residents are at risk of malnutrition, foodborne illness, and neglect that manifests as limited access to quality food options.

Many nursing homes — acquired by private equity firms in the wake of the pandemic — cut food costs, with more than a quarter of nursing home operators spending less than $10 per day on food per resident and some spending as low as $4 a day, according to the report published by NewJersey.com.

Long-term care facility operators may be cutting food costs because there is no federal minimum standard for food spending per resident. Operators may see food as a less-regulated area to reduce spending.

Nursing Homes

Many people rely on nursing homes for 24-hour care, as these facilities provide housing, medical assistance, and meals. The Kaiser Family Foundation (KKF) reports that over 1.2 million individuals reside in nursing homes in the United States. According to the Centers for Disease Control and Prevention (CDC), of the 15,300 nursing homes in the U.S., 70 percent were for-profit in 2020.

Nursing homes are expensive, with costs representing a significant financial responsibility for individuals and their families. In 2024, the national median cost of a private room in a nursing home ranged from $9,733 ($320 a day) to $10,645 per month. While Medicaid covers the cost of a Medicaid-certified nursing home care for individuals who qualify based on need, these individuals often reside in lower-quality nursing homes, per research published by the National Library of Medicine.

People residing in nursing homes constitute a vulnerable population with complex medical needs that make independent living more challenging. According to the Alzheimer’s Association, almost half — 48 percent — of nursing home residents have Alzheimer’s or related dementias.

Given the vulnerability of those in nursing homes and the high cost of long-term care, it is surprising and heartbreaking that food insecurity is a real concern in nursing homes across the country.

Highlights From the Investigation

Reporters reviewed thousands of federal cost reports filed with the Centers for Medicare and Medicaid Services. They worked with Rutgers University academics and data experts to identify several troubling findings in addition to low food-spending in nursing homes:

• Writeups for food-related sanctions tripled from 2021 to 2024.
• Dietary complaints to ombudsman offices increased by more than 50 percent from 2020 to 2023.
• Disease outbreaks, such as E. coli, listeria, and salmonella, are on the rise in nursing homes nationwide. This is worrisome as foodborne illnesses can be especially harmful to older adults
• Residents interviewed commonly complained that the food was unappetizing — even when it met nutritional standards. One resident commented that the food in prison tasted better. Another resident stocked up on canned goods in his room.

Food access was another concern the investigation highlighted, with facilities offering small portions — such as a single ravioli or a rationed cup of milk. This is particularly troubling as individuals who live in nursing homes already face a greater risk of malnutrition and dehydration.

The investigation also found a pattern of facilities not accommodating residents’ needs, such as failing to provide soft food for those without teeth and not providing bananas to a woman who needed more potassium per her doctor’s orders.

The report suggests that many nursing homes have significant room to improve in how they feed residents. For those navigating long-term care options, these findings are concerning. Older adults considering long-term care and their families may wish to consider how much a nursing home spends per resident on food, whether fresh fruits and vegetables are available, and how the facility accommodates dietary needs and restrictions.

Work With an Elder Law Attorney

If you have concerns about a loved one in a nursing facility, be sure to reach out to a local elder law attorney or the long-term care ombudsman in your state.

An elder law attorney can assist long-term care residents by advocating for their rights and helping to ensure they receive quality care. They can address issues such as substandard treatment, lack of access to food, and financial exploitation. Attorneys also can help navigate complex regulations, resolve disputes with the facility, and ensure compliance with care plans. If abuse or neglect is suspected, they can file complaints and pursue legal action to protect the resident.

Full Article & Source:
Investigation Uncovers Food Insecurity in Nursing Homes