When a change in ownership within some of the largest players in the nursing home industry is described in the news as a “blockbuster move”; and when an earnings call to investors raises the specter of “even further upside potential” without any mention of superior care, quality of life, increased standards, greater accountability and better medicine, it is not nursing care. It is a different animal altogether, the savage world of publicly traded horse-trading.
It is worth noting here, that some of the parties cited in the article below are owners and operators of some of the worst rated nursing and rehabilitation facilities throughout the United States. Thus, shareholders to whom this article was addressed, are to some extent investing in substandard care. That’s just one part of the human tragedy. Another part of the human tragedy, cited in an earlier article below, tacitly admits that one methodology for adding shareholder value is manipulating the more lucrative sides of benefits from acute care patients “who also come with more lucrative Medicare and private insurance coverage than the typical long-term nursing home resident on Medicaid.” Statements like that should upend the comfort of Medicare and private insurance carriers.
The number of nursing home residents who died in the pandemic has been a particularly sensitive question for the Cuomo administration. Credit…Pool photo by Shannon Stapleton
Published 5.4.21 9:28am
Dear Reader:
Perhaps the punishment for cruelty to the elderly in nursing care should be lying in the same nursing home bed forced to wallow in excrement and urine. Were we to be a legislators, this would be the top of our bucket list. Alas, should the punishment not fit the crime? And yet, those with the courage to speak out are inevitably doomed.
Most of New York’s nursing homes or those owned throughout the United States by New York nursing home conglomerates, are a special brand of hell to the elderly living in them; and their owners and managers deserve accountability. Many are understaffed or staffed by undertrained employees. In most care is substandard, if there is care at all. In many the food is unpalatable or barely edible, but it is inexpensive. In all but a select few, elderly patients can spend hours sitting in their own excrement, thirsty for a drink, exposed to Covid-19 and other pathogens. There is no accountability. Where laws exist there is no oversight. It is a vicious cycle.
In some, the owners use the open spaces for parties and celebrations – a show of wealth and so-called hospitality. After all, a nursing home is a hospitality business. Even during Covid-19, at the worst of the outbreaks, we received reports of massive gatherings in the halls of some of these homes, catered by top kosher caterers, but not open to the patients and their families.
In all but a select few, money flows like water; and the only beneficiaries are the owners and operators, their investors and the politicians who benefit from political contributions. Name the horror and you will likely find it in New York’s nursing homes. Sadly, so many of the nursing homes are owned by different combinations of the same uber-wealthy individuals who have already sold their souls for money. Their attorneys shut their eyes, look the other way. It is really not an attorney’s job to judge. And the billing is glorious to those attorneys for whom these are their top clients. If one is without a conscience, a sense of morality, and is already adept at skirting laws, falsifying records and documents, paying off or discrediting those who get in their way – will new laws do anything but pay lipservice?
Factor in the guardians, many of whom are complete savages, and we have a lethal mix. Many of the patients are sent to nursing home hell by self-serving guardians who likely get hefty kickbacks – a “quid pro quo” of sorts. Most of New York’s nursing homes are for profit. Their ownership structure can be a moving target, crafted to avoid accountability. Many are financed by hedge funds, hedge fund owners and investment managers; or are publicly traded in various portfolios in the stock exchanges of the United States, Israel, the Canadian Stock Exchange and so many others. It is business, after all. Are we talking about human life? Irrelevant really. We are talking about money.
Guardianship is an extraordinary racket, a well-oiled machine which includes (but is not limited to) social workers, judges, politicians, guardians, medical staff, nursing staff, attorneys, the judiciary and the list goes on and on and on. It is a vicious cycle with little hope of breaking. We have been told it is an “open secret” in government and those who attack the system inevitably doom themselves to a loss of livelihood, reputation, financial well-being and even family safety. The people involved in this racket are like a close-knit family “the Gansa Mishpucha” for whom money leads, whatever conscious there is or may have been was set aside long ago.
The multitude of people involved are not morally bankrupt, as that implies there was something there to bankrupt in the first instance. That is a stretch. The elderly in many of the nations nursing homes are nothing more than financially lucrative chattel; lives of meaningless vulnerable people whose daily existence generates cash. It is a godless business.
New York’s nursing homes and their owners are some of the worst. And then there’s the governor, Andrew Cuomo and his aides who were complicit in setting in motion further devastation as Covid-19 ravaged the elderly. So what did they do? They created immunity – and another loophole to escape accountability. We have coined that immunity the “Granny Killer Immunity Provisions”. Cuomo’s political existence has depended, in large part, upon a significant donor pool that exists within the nursing home industry. He is the quintessential beneficiary of political largesse.
Creating laws that would protect our morally challenged nursing home owners was all part of the movement of money. Until Covid-19 put the brakes on that, at least temporarily it just kept going. The Granny Killer Immunity Provisions immunized nursing home owners, operators and managers and hospitals. Those provisions have been overturned but their creation should be a warning to anyone in this fight. If the power of the nursing home industry can have sway over Governor Cuomo, it will happen again.
There is an effort (see below) to place restrictions on nursing homes. We again pose this: restrictions mean nothing if there is no one there to enforce. Our government is a part of the problem. Enforcement will not happen and the crimes against humanity – our elderly and most vulnerable – will continue. Do we not owe them more lest we all be savages?
While Gov. Andrew Cuomo was securing a reported $4 million deal to write a book on his pandemic “leadership,” he and his staff were busy suppressing the truth about New York’s nursing-home deaths in the wake of the March 25 order that forced homes to admit COVID-contagious patients. And it now turns out the coverup was even worse than we’d thought.
On top of blocking health officials from telling the truth, senior staffers also quashed a scientific paper that reported the true fatality total, The New York Times reported.
A June 18 e-mail from top aide Melissa DeRosa to health officials shows Team Cuomo was “anxious” about a pending Department of Health report on nursing-home coronavirus fatalities and out to downplay the idea that the March 25 mandate had proved deadly.
The Cuomoites were publicly citing a nursing-home death toll of about 6,000 by ignoring home residents who’d died while hospitalized. The draft report shared the full count of over 9,700, noting that the homes accounted for “approximately 35 percent” of all NY coronavirus deaths. But DeRosa — who at the same time was intimately involved in the gov’s book-deal negotiations — and other staff got all that edited out. The final report said the homes only yielded 21 percent of the state’s virus death total, making it seem below, rather than above, the US average.
The feud between Ron Kim and Andrew Cuomo is not over yet.
Assemblyman Ron Kim and Governor Andrew Cuomo had a very raw, very public falling out this past February that essentially catapulted the nursing home scandal—in which Cuomo is accused of hiding the number of fatalities from COVID-19 within New York State nursing homes—into the media spotlight. Kim became a household name overnight after the local politician alleged Cuomo threatened to ruin his career. Now, Kim is calling upon the Attorney General to join the fight.
Kim gathered with Voices for Seniors members in Foley Square on Monday afternoon. In the shadow of the Thurgood Marshall United States Courthouse, the assemblyman stood ahead of those who had lost elderly loved ones to the deadly virus calling out the Governor for what he says are “Some of the worst and deadly policies that this country has ever witnessed.”
“For ten months Andrew Cuomo only listened to the worst operators, the lobbyists, to put forward policies that were not only deadly but were irresponsible and criminal. So, we are here once again calling for full accountability for Andrew Cuomo’s unilateral decision-making around nursing homes, in particular, we are asking for the Attorney General and every other investigator who has now opened up investigations into Andrew Cuomo to look into him and his allies, and his administration committing fraud,” Kim said.
While Attorney General Letitia James is reportedly already conducting an investigation into the slew of sexual misconduct allegations levied at the head of state, this demand for action asks James to look into a cover-up of deaths within nursing homes. Kim also cited the importance of this proposed investigation to the families of the deceased who formed Voices for Seniors, a group that looks to improve the lives of the elderly through advocacy. Members of the organization clutched photographs of perished family members and signs dubbing the Governor a “super spreader,” blaming Cuomo for the deaths of their loved ones.
As part of its recent budget, New York State has enacted a new law that significantly impacts nursing home operators in New York. Effective January 1, 2022, the new Section 2828 of the Public Health Law requires, among other things, that:
Not less than 70% of nursing home revenues shall be spent on direct resident care costs;
40% of the nursing home revenues must be spent on staff who work directly with patients (so-called resident-facing staff, as that term is defined in Section 2828), which is included in amounts spent on direct resident care costs; and
Nursing home profits are limited to not more than 5%, and profits in excess of this threshold shall be turned over to the [sic]
Pursuant to the legislation, the Department of Health shall promulgate regulations in accordance with the new [sic]
Direct resident care is defined to include non-revenue support services (e.g., maintenance and patient food service), ancillary services (e.g., laboratory and pharmacy services), and program services directly serving patients.
Direct resident care is defined to include non-revenue support services (e.g., maintenance and patient food service), ancillary services (e.g., laboratory and pharmacy services), and program services directly serving patients. Expenses that are specifically excluded as not related to patient care include, without limitation, administrative costs (other than nurse administration), capital costs, debt service, taxes (other than sales taxes or payroll taxes), capital depreciation, rent and leases, and fiscal services. Specifically excepted from the new law are nursing homes that provide certain specialized services, including, for example, behavioral intervention and neurodegenerative services.
Aides to the New York governor, Andrew M. Cuomo, repeatedly prevented state health officials from releasing the number of nursing home deaths in the pandemic.
Mr. Cuomo’s most senior aides engaged in a sustained effort to prevent the state’s own health officials, including the commissioner, Howard Zucker, from releasing the true death toll to the public or sharing it with state lawmakers, these interviews and documents showed.
A scientific paper, which incorporated the data, was never published. An audit of the numbers by a top Cuomo aide was finished months before it became publicly known. Two letters, drafted by the Health Department and meant for state legislators, were never sent.
And they came as the governor’s approach to nursing homes was receiving intensifying scrutiny from critics and Republicans, including former President Donald J. Trump, whose administration made a public show of requesting nursing home death data from four states with Democratic governors, including New York.
The number of nursing home residents who died in the pandemic has been a particularly sensitive question for the Cuomo administration.
The number of nursing home residents who died in the pandemic has been a particularly sensitive question for the Cuomo administration.
Gov Cuomo signs bill repealing legal immunity granted to New York nursing homes during pandemic as he faces probe into hundreds of excess deaths at care facilities
Effective immediately, nursing homes and other healthcare facilities can be held civilly and criminally liable for treatment of individuals with COVID-19
The bill was sponsored and championed by Cuomo critics including Sen. Alessandra Biaggi
However, Cuomo himself has faced calls to resign amid probes into whether the state mishandled nursing home deaths related to the pandemic
The Cuomo administration has faced accusations that the state miscounted hundreds of nursing home deaths as hospital deaths
Lawmakers had already rolled back some of the protections that had been granted to healthcare workers last year
Queens assemblyman and advocates rally for nursing homes investigation and immunity repeal
“Every time we get close to the truth, it seems like the governor is untouchable. How many more scandals? How many more women? How many more nursing home-related lies and frauds need to be exposed before we can hold him accountable?” Kim said during a virtual rally with advocates on Thursday, April 1.
This week, Arizona legislators will vote on bill 1377, which would shield nursing homes from civil liability for negligence while providing services during the Covid-19 pandemic.
At least 32 states have already passed laws or issued executive orders during the pandemic making it harder for nursing home residents or their families to take the companies that run these facilities to court. The new Arizona bill would protect any health care institution assumed to be acting in “good faith” except in cases of “willful misconduct” or “gross negligence.”
The provision of such broad immunity is particularly problematic for nursing homes in light of growing evidence indicating that during the pandemic, nursing home residents have suffered considerable harms from neglect and prolonged isolation, in addition to the risk of Covid-19 itself.
In a report published last week, Human Rights Watch documented serious concerns over possible neglect in nursing homes across the United States during the pandemic’s first year, when staffing was low and family members were often not allowed in facilities. Residents, family members, and staff reported extreme weight loss, dehydration, and infected bedsores, which in some cases may have contributed to death. In many cases, residents’ hygiene appeared to have been neglected as well, with family members reporting residents were left in soiled incontinence pads for hours at a time and their hair and fingernails grew long and dirty. Many nursing home residents, deprived of daily social contact because of restrictions on visitors and activities, declined physically and emotionally.
The academic evidence echoes our findings: just last week, an article published in the Journal of the American Medical Directors Association (JAMDA) found that in Connecticut nursing homes, depression, substantial weight loss, and incontinence increased among residents in the four months after visitor restrictions went into place.
Human Rights Watch, to continue reading click here.
New York’s now infamous corporate immunity law for nursing home executives has been placed on the legislative docket for repeal. The law, slipped into last year’s budget by Gov. Andrew Cuomo, shielded nursing homes from liability as they were forced by the governor to accept patients presumed to have COVID into their facilities.
Last Spring, while the national media was celebrating Cuomo, The Daily Poster helped break open the story of Cuomo passing the law after receiving huge campaign donations from the corporate group pushing it. As The Daily Poster reported earlier this week, the law has shielded administrators and executives from liability for a wide range of negligence claims, even those that don’t appear to be directly related to COVID.
We have been railing about for-profit nursing and rehabilitation facilities for years: when an elder care facility, any version of elder care, is for-profit, there is utter lawlessness. Money flows like water through a sieve, unencumbered by laws or oversight.
A thorough review of the names of for-profit nursing homes and rehabilitation facilities in New York, cross-checked with PPP Loans reveals that many of them (and/or their attorneys) were some of the largest recipients of PPP Loans during the first round of Covid relief. The second round remains to be seen. They will likely be the first to get PPP Loan forgiveness even though many of them did little, or more accurately nothing to protect their employees or their patients. In fact, the word “nothing” here is quite forgiving. It would mean a passive omission, simple apathy.
To put the narrative in a more truthful perspective, many of the for-profit nursing homes fed their own pockets with the Covid-19 funding. That money should have guaranteed staffing but they were underpaying wages or not hiring. And, many of the country’s nursing homes are owned by the same or similar groups of owners, and they actively manipulated and continue to manipulate the system to profit from Covid-19. Yes! To profit!
Many nursing homes (though not all) take out life insurance on their patients with them as beneficiaries of the policy, when the patient signs in. If that patients makes it past 30-days to 60-days depending upon the policy, the death of the patient generates income to the homes. It is a win/win. Well, the insurers are out – but there is little oversight there either. These are small money policies that generally are unregulated by the insurance industry.
LeadingAge, the “elder care facility advocacy group” believes that the failure of many of these homes cannot be fixed by oversight it can only be fixed by adding money. The comments by LeadingAge imply that there is not enough money to help these facilities take appropriate care of their patients. That is a vile and utterly false interpretation of events. The business model is profit above all else. A view from 30,000 feet shows his analysis doesn’t match the math with respect to many, if not all, of the for-profit elder care facilities.
The problem, in this blogger’s humble opinion: YOU CANNOT BUY MORALITY. IF YOU ARE LACKING IN A MORAL COMPASS, THERE IS NO AMOUNT OF MONEY IN THE WORLD THAT WILL FIX THAT. ADDITIONAL MONEY SIMPLY FEEDS THE MONSTER!
The nursing and rehabilitation home industry is a well-played, well-gamed and manipulated system run by super savvy individuals or groups who know how to game every aspect of the operation. Many are partially owned by the attorneys who represent them and some of those attorneys, at least in NY, help decide who runs on political tickets. These “moblike” industry is a web of somewhat incestuous industry connections. The Elder Care Centers will contract out linen and food services to friends, family or even themselves (a rose by any other name…). They buy drugs from distribution or drug companies owned or operated by their friends, colleagues or even their own corporate enterprises who provide a scratch on their proverbial backs. Foodservice is provided by friends, family or interrelated entities. Mobile medicine is provided by interrelated companies.
These facilities use inexpensive sharps for things like insulin and other injectable drugs that often result in more pain to the patient but less pain to the bottom line. Many reuse insulin or other injectable drug vials but charge each patient for their own, sometimes stockpiling the extra meds and sidestepping laws that prevent the reuse of needles or vials. Instead of giving their patients the name-brand drugs they may have used before admission to their facilities, they give them the generics and file claims for name-brand. They often fail to provide necessary services: occupational, speech, physical and other therapies, they claim to provide those services and bill for them; but many of the patients will attest to what they are not getting and therapy is on the top of that list. They charge for doctor’s visits that don’t happen or are substituted by RN’s, NP’s or PA’s so the doctors are often paid multiple times for the same hour in a day – a reward for often misdiagnosing ailments or over-diagnosing meds.
Facilities that have specialized Dialysis centers associated with their services have little reason to protect a diabetic’s kidneys when a slow destruction of the kidneys yields greater profit. Dialysis is far more profitable then kidney treatment and insulin.
These numbers can be obtained for the asking by law enforcement or anyone reading this blog. Nursing homes and rehabilitations centers need strict oversight absent loopholes. For-profit nursing homes need to be de-licensed – all of them. The ownership of the homes is available on public links. The links between owners in different states can be found by cross checking ownership state-by-state. We have done this analysis with respect to about 30 of the largest of the and most mafia-like ownership groups, which, by the way, own some of the country’s worst nursing homes. We are not stating anything that is not otherwise publicly available and we have been making these claims for years.
No one should be listening to the lobbyists. They have an agenda and quality care for elderly and vulnerable individuals is a far too altruistic endeavor. The lobbyists also have skin-in-the-game and it amounts to a fortune!
The Democratic-led New York state Assembly released a package of nearly 20 nursing home accountability bills Friday, aimed at tightening restrictions on the hundreds of for-profit facilities.
Among the 19 bills is one sponsored by Assembly Health Chair Dick Gottfried (D-Manhattan) that would prohibit the creation of any new for-profit homes and impose a morratorium expanding the capacity of existing homes.
“Lots of people have been discovering that there are enormous problems in our nursing homes. COVID may have brought them to light and made them worse but a lot of us know those problems have been there for many, many, many years,” Gottfried said during Thursday’s remote Joint Legislative Budget Hearing on Health.
He railed against the for-profit industry in an interview later Thursday evening with NY1, arguing those nursing homes often have higher infection rates and instances of bed sores among patients.
“We’re not going to license any more for-profit nursing homes or for-profit beds,” he said. “We should stop the creation of for-profit beds…you should [operate a nursing home] to care for people not because you want to make money.”
Right now, there are 401 for-profit, privately owned nursing homes out of the roughly 619 in the Empire State, according to a January report from the office of state Attorney General Letitia James.
As our regular readers know, the lack of accountability of nursing home owners and operators is one of our central focuses. If this blog could solve just one problem on the “Bucket List” it would be improving the quality of care for our nation’s elderly and infirmed and ending the associated fraud scheme that makes neglect profitable.
As a single example, the pardon of Philip Esformes was a travesty of justice and a slap in the face of every elderly resident who suffered in his nursing homes, and a disregard for the taxpayers who fund Medicare and Medicaid. The lack of transparency and accountability fosters an environment fraud and neglect and likely President Trump and members of his party benefited from the pardon.
Owners and operators should not be able to deny accountability when their patients die of Covid-19. In many cases, the deaths were the result of lacking staff, rationing of PPP and profit. Many of the owners and operators of some of the worst homes had a “last clear chance” to add safety measures (though that is not generally the standard of care used).
The Covid-19 pandemic has brought years and years of neglect within nursing care to the surface. This is nothing new. These homes have been historically understaffed and many of them are not strangers to subpar care. Death is harder to hide than neglect, though many continue to hide their mortality rates.
Nursing home owners and operators should not be allowed hidden protections of LLC’s, foundations, trusts and other corporate structures, to either prevent a cross referencing of ownership for licensure purposes or to manipulate the math when homes go sideways. There must be complete transparency and personal accountability and liability.
The ownership of many of the most deplorable homes is difficult to decipher and cross reference. Many of the worst run homes have a joint group of owners some of which are comprised of attorneys and other professionals with different percentages throughout each of the cross-owned homes. First, owners and operators who are also licensed professionals should be held to higher standards of care or some form of specific registration should be in place that distinguishes these professional-owned homes from others. Second, their professional licenses should be at risk when they fail to provide adequate care. Third, professional firms that have partners who own and operate nursing homes should not be permitted to donate to political or judicial candidates or campaigns. Nursing home neglect should not be a lobbying cry. If owners and operators, particularly professional owners and operators can curry favors with politicians and judges, patients are simply not safe.
To the victor goes the spoils and for-profit nursing care is rarely an altruistic endeavor. Humanity should come before profit.
But, so too are most nursing homes and rehabilitation centers. Many of them represent the greatest constitutional violation of life, liberty, happiness and dignity for those most vulnerable who are confined to many of the nations homes.
There are very personal reasons why this blogger knows so much about them and their deplorable conditions. Setting aside visits to upwards of 45 different nursing homes and rehabilitation centers throughout New York, New Jersey and Pennsylvania and being asked to negotiate a bid on Personal Protective Equipment by an unsuspecting client, research on homes and their owners has made the entire industry stomach-turning. That client did not realize at the time that the equipment he was asked to broker had been taken from a nursing home (paid for by Medicare, Medicaid or private insurance) and warehoused in New Jersey. Someone else likely did the deal, the client walked away.
So, perhaps Covid-19 was necessary to open people’s eyes to the dangers of nursing homes and rehabilitation centers and to provide much needed incentive for the government to oversee them with vigor, zeal and a passion that reflects our need to protect the elderly and most vulnerable.
Well, this might just be wishful thinking.
Suffice it to say, most owners and operators are looking to the bottom line. It is about the money, the profit and loss, the quasi virtual auction of human life by social services, guardianship, social workers in hospitals and the individuals that make the wheels of the human life industry turn. Many are morally bankrupt and the more their pockets get lined the more soulless they become.
The pandemic is reshaping the way Americans care for their elderly, prompting family decisions to avoid nursing homes and keep loved ones in their own homes for rehabilitation and other care.
Americans have long relied on institutions to care for the frailest seniors. The U.S. has the largest number of nursing-home residents in the world. But families and some doctors have been reluctant to send patients to such facilities, fearing infection and isolation in places ravaged by Covid-19, which has caused more than 115,000 deaths linked to U.S. long-term-care institutions.
To continue reading in The Wall Street Journal, click here.
“We should be able to provide more services in the home setting that can enable somebody to be independent,” said Seema Verma, administrator of the Centers for Medicare and Medicaid Services. “Covid is going to force a national conversation about how we take care of our elderly, and clearly there are issues in nursing homes that go beyond infection control,” she said.
During his campaign, President-elect Joe Biden promised to spend $450 billion to make sure people who need long-term care can get support in the home and community.
They had survived so much already — war and dust storms, cancer and poverty, lost eyesight, lost spouses, lost memories — and still went on to find moments of grace inside the corridors of America’s nursing homes.
In Windsor, Conn., Johnny James ate chocolate bars with his visiting great-grandchildren. In Lewiston, Idaho, Edna McBride celebrated her 100th birthday. In Providence, R.I., Florence Tilles, who had two knee surgeries, liked to joke she would one day die at the 18th hole of her favorite golf course.
One day came on May 30, when 98-year-old Tilles fell victim to covid-19 amid a soaring death toll that included James and McBride and would soon grow to more than 80,000 residents in nursing homes across the country. They suffered alone, in homes locked down to visitors, peering at the masked faces of weary nurses and aides who risked their own lives to be there.
The industry and the government could have done far more, watchdog groups have said from the beginning, shoring up infection-control protocols and staffing, delivering stronger oversight of troubled homes and ensuring that coronavirus stimulus payments reached patients and caregivers rather than corporate owners.
Instead, 10 months later, thousands of families are learning to live without goodbyes.
The 51 residents whose stories are told here, one from every state and the District of Columbia, left behind at least 129 children, 230 grandchildren, 210 great-grandchildren and 41 great-great-grandchildren. Some blame the nursing homes for questionable care. Others say they are enormously grateful for the work of caregivers.
LOSTMESSIAH 