Federal Penalties Coming to Middle South Nursing Homes for Care Failures

New Orleans       There are few lobbies as powerful as the nursing home owners’ groups in Louisiana, Arkansas, and Mississippi.  All of which makes the intervention of federal rules extending some of the same accountability standards that hospitals now face, welcome news.  The fact that the penalties go right to their pocketbooks is even better news.

Here’s the deal on the new rules hitting nursing homes across the country now.  Penalties – or incentives for those doing better – will be meted out to nursing homes based on the frequency of readmission of elderly Medicare patients that are returned to hospitals within thirty days of leaving a skilled nursing home.  The financial penalty can reach up to 2% of the individual Medicare reimbursement rate per patient.  Hospitals already have to measure up to this standard and in recent months nursing homes came under the same regime.

Will this affect many homes?  Yes, indeed!

Kaiser Health News reported an analysis of homes in Louisiana and found that 85% of the 277 skilled nursing facilities in the state would be subject to a penalty based on data from 2015 through 2017.  Not that Louisiana was by itself since the figures for nursing homes in Arkansas and Mississippi was almost exactly the same.  Bottom line:  the vast majority of nursing homes in the three-state area are facing penalties.  The Advocate reports that in New Orleans for example, a dozen facilities will face a penalty and only two will receive small bonuses for doing right.  These are not just problems with for-profit providers.  The three homes overseen by the Catholic Archdiocese of New Orleans will each receive almost the maximum penalty for each new admission at 1.98% of the possible 2%.

The question of how nursing homes can provide better care to patients, often elderly, sick, and frail, is a constant concern for families and appropriately for public policy.  Reading the comments from administrators of homes that got the good grades under the new rule, they cite getting more thorough information from the hospitals about incoming and prospective patients is key as well as offering preventive care on site.

All of that sounds right, but given the long experience that Local 100, United Labor Unions, has had in representing nursing home workers and observing care conditions firsthand, it will be difficult to fundamentally improve care until staffing levels are adequate to the significant health demands of patients as a first priority.  Being able to retain professional caregivers also means compensating workers commensurate to the value of the service they provide to families and patients.  In the thirty or more years that we have been involved with nursing homes we still see a conflict faced by many home owners and operators between seeing the facilities as real estate developments with a sideline in healthcare as opposed to healthcare facilities that happen to be built on real estate.

We’ve got a long way to go still, but hopefully the application of this new rule will bring some change now that owners will feel the pain of nonperformance in dollars and cents.

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I’m Not Complaining, but What a Week

New Orleans  Returning exhausted from stops in Shreveport, Louisiana, Little Rock, Arkansas, and Greenville, Mississippi, somehow I can’t get these weird signposts of the times and odd ends out of my mind. Normally, I would let them go, but somehow this Chief Organizer Report is going to be a report on the chief organizer, so bear with me.

Bargaining four nursing home contracts in Shreveport, the company already wants to include language making the Affordable Care obligations moot, even while the whole operation continues forward in the stalemate of Congress and presidential politics.

A studio chair and some folding chairs for WAMF, the new low power FM radio station that we just got on the air in New Orleans, was donated to us in Bossier City across the river (thanks Butlers and Clarks!). In a pleasant middle income suburb between a mall and an expressway, I parked my big truck, doors wide open in the driveway of the unoccupied house waiting for Local 100 organizer, Toney Orr from Arkansas, to help me load it all in. Neighbors drove by and up and down the driveway next door. No questions asked, even as we hauled the furniture out. Is that weird?

In Little Rock, despite six months of work on the Home Savers Campaign and running PSAs on KABF referring calls to Arkansas Community Organizations, the former Arkansas ACORN, that yielded little, we finally broke through and within 48 hours found a trove of both Vision Property Management and Harbour Portfolio rent-to-own and contract to purchase houses throughout central Arkansas. We had boomed out to visit victims in Ohio, Michigan, and Pennsylvania and here they were right under our noses! The lesson, even when the spirit is willing, we have to shore up the capacity to account for how often the flesh of our operations need more underwire. Capacity matters, even a little can make a huge difference, and that’s worth remembering. Oh, and, a Home Savers organizer, Dine’ Butler, was the big finish of the well-regarded Reveal podcast, home visiting a victim in Detroit.

Capacity, capacity, capacity, it comes up again and again, and amazingly we stumble around trying to find it even when it is kicking us in the knees and pushing us to the ground. One kingdom after another lost for lack of a horse. Our biggest underwriting partner at KABF was being stymied on promoting its great work, because we had never pressed hard enough for the spots for them to realize if they gave us copy we could produce them quickly or allow hosts to do “reads.” Ouch!

Visiting radio station WDSV in Greenville for the 7th month, it was the same story with a different verse. Frustrated and stalled in achieving their mission after 5 years on-the-air as the voice of the people in the Delta, they were being held hostage by technology too large and complicated for them to easily access to master the ladder to the heaven they sought. The magic and miracle is not that we can fix that, but that it takes so long for us to marry problems to solutions, so that we can move forward in our work.

Sometimes I’m racing so fast that I miss how easily it is to stumble on the simplest steps. I wish it were just me!

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