Six
weeks after Deborah Zwaschka-Blansfield had the lower half of her left
leg amputated, she received some news from the nursing home where she
was recovering: Her insurance would no longer pay, and it was time to
move on.
The home wanted to release her to a homeless shelter or pay for a week in a motel.
“That
is not safe for me,” said Ms. Zwaschka-Blansfield, 59, who cannot walk
and had hoped to stay in the home, north of Sacramento, until she could
do more things for herself — like getting up if she fell.
Her experience is becoming increasingly common among the 1.4 million
nursing home residents across the country. Discharges and evictions
have been the top-ranking category of grievances brought to state
long-term care ombudsman programs, the ombudsman agencies say.
While nursing homes can discharge residents for a limited set of reasons,
legal advocates say that home operators sometimes interpret those
reasons in unjustified ways. Often, it’s because the residents’ more
lucrative Medicare coverage is ending, which is what Ms.
Zwaschka-Blansfield said happened in her case.
Many of the residents, unaware of their rights, leave without a challenge.
“The
nursing homes, they know the system and they really game it to where
they maximize their advantage,” said Tony Chicotel, a lawyer at California Advocates for Nursing Home Reform, a nonprofit group.
Complaints
about evictions have caught the attention of federal regulators, who
are now seeking ways to step up enforcement of the federal laws that
protect residents of the nation’s 15,000 nursing homes.
In
December, regulators sent a memo to state officials across the country
who inspect nursing homes for compliance with federal standards, saying
they would begin examining discharges that appeared to violate the
rules.
David
R. Wright of the federal Centers for Medicare and Medicaid Services
said in the memo that wrongful evictions were “of great concern” because
they could be unsafe or traumatic for patients, uprooting them “from
familiar settings” and moving them far from family and friends.
The
number of complaints about the discharge and evictions of residents was
rising through 2015, the most recent year for which data is available.
That year, there were 9,192 complaints about the discharge and eviction
of nursing home residents, out of a total of 140,145 complaints,
according to the Department of Health and Human Services. But some legal
advocates said they believed these figures understated the problem,
since many residents do not contest their discharge.
Even as the Trump administration has said it is looking for ways to address improper evictions, it has scaled back the use of fines against nursing homes that harm individuals, in keeping with the administration’s broader deregulation push.
Mr.
Chicotel, the advocacy group lawyer, said that the federal regulations
governing nursing homes were already strong but that enforcement was
weak. Even when nursing homes are cited for violations, he said, they
frequently “get a modest fine, and it’s often a cost of doing business.”
Dr.
David R. Gifford, a senior vice president of the American Health Care
Association, a trade group for nursing homes, said the perception that
residents were being moved against their will for financial reasons was
wrong.
“There’s
a tension in the regulations,” Dr. Gifford said. “They clearly state
that if someone can harm themselves or others, either through infections
or their behavior or whatever, the individual can be discharged. But
the regulations also clearly say that the goal is to not discharge
people, and they have a right to stay there and receive care.”
Bill
Wilson, a lawyer representing the nursing home where Ms.
Zwaschka-Blansfield was a resident, said he could not comment on the
specifics of her discharge because of privacy laws. But he said that
patients could not be discharged without a doctor’s order and that the
facility complied with all regulations. He also said the home
“unequivocally” denies that it wrongfully discharged the patient.
Federal
law stipulates that a nursing home must follow the same policies and
practices for the discharge and transfer of residents, “regardless of
source of payment.” But, legal advocates say, nursing homes often begin
to pressure residents to leave when their Medicare coverage — which pays nursing homes at a higher rate but for a limited period
— is close to ending and may be replaced by Medicaid. This happens to
patients who have been sent to homes for rehabilitation or therapy,
which is often covered by Medicare. Elderly residents who are deemed
difficult or require extra assistance — and who may cost more over all —
are more frequently discharged as well, advocates said.
Reimbursement
rates for Medicare and Medicaid differ substantially, according to the
National Investment Center for Seniors Housing and Care, a nonprofit
group that collects data on the industry. Nursing homes receive about
$200 a day for a Medicaid patient on average, compared with about $500
for a patient in the traditional Medicare program and $430 for a
Medicare patient in a managed care plan.
Alan
Schoen, a 58-year-old resident with multiple sclerosis at a nursing
home in Stockton, Calif., said he believed the facility was trying to
discharge him because his Medicare coverage was ending.
While
his wife was at work in late December, Mr. Schoen fell out of his bed.
An ambulance took him to a hospital, which released him to the nursing
home for physical therapy.
But
then in early January, the nurses could not wake him. They sent him
back to the hospital, which found that he had a bladder infection and
pancreatitis, and he had to start using a catheter.
After
he returned to the nursing home, it told him that his insurance would
soon stop paying — and that he should move to an assisted living
facility, where, he said, he would receive a lower level of care. But
Mr. Schoen, who can no longer stand or walk, said he needed the kind of
help he is receiving now.
“They are running a business,” Mr. Schoen said. “I get that, but it seems they forget the patient element in all of this.”
Mr.
Schoen is appealing his discharge. A spokeswoman for his nursing home,
citing privacy laws, said she could not comment on specific patients.
But she also said the decision to involuntarily discharge any resident
“would only be done in compliance with all applicable rules and
regulations.”
Patty
Ducayet, the long-term care ombudsman in Texas, said that disputes over
whether a particular nursing home can meet a patient’s needs were
common. That, she said, is often “a gray area.”
A
nursing home may be justified in saying it cannot care for patients who
cannot breathe on their own. But, Ms. Ducayet said, it would not be
justified in discharging patients because they refused to take
medications or because they filed complaints with state officials.
Even
when residents win an appeal of an eviction, they have no guarantee
they will be welcomed back. That was the case with Gloria Single, an
82-year-old with Alzheimer’s who often became agitated, according to her
legal complaint.
After
being discharged from the California nursing home where she lived with
her husband, Ms. Single won an appeal. But the nursing home would not
accept her. “They don’t take you back and there are no consequences,”
said Kelly Bagby, a lawyer at the AARP Foundation who is representing
Ms. Single.
Susan
Rogers, the ombudsman who assisted Ms. Zwaschka-Blansfield, said she
was incredulous when she learned Ms. Zwaschka-Blansfield’s nursing home
suggested discharging her to a homeless shelter, which she said was not
open during the day.
“Where is she going to get home health” services? Ms. Rogers asked. “In a park?”
That
crisis has been averted. After Ms. Rogers petitioned on Ms.
Zwaschka-Blansfield’s behalf, she said the nursing home found her an
independent living arrangement nearby.
If
she had not intervened, Ms. Rogers said, Ms. Zwaschka-Blansfield, who
lives on roughly $800 a month, might have been homeless.
Complaints About Nursing Home Evictions Rise, and Regulators Take Note
