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Hospice care in the U.S. has steadily grown over the past 12 years. This end of life care, in which beneficiaries opt out of curative treatment to instead receive palliative care in the final stages of a terminal illness, costs Medicare billions. In fact, Medicare spending went up from $9.2 billion in 2006 to $16.7 billion in 2016 to accommodate the 1.4 million beneficiaries that hospice care serves.

Despite the increased spending to aid terminally ill patients, a report conducted by the Office of Inspector General (OIG) found that oftentimes, a poor level of care is provided, and necessary services are neglected. Additionally, the OIG uncovered fraudulent charges, including instances where hospices charged Medicare for services they never actually provided.

In particular, the report cited poor quality care, lack of information to beneficiaries and their families, inappropriate billing and insufficient services as four main areas in which hospices can improve.

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Pressure sores, also referred to as bedsores, pressure ulcers or decubitus ulcers, are perhaps one of the most common evidences we see of nursing home abuse and neglect. Unfortunately, most elderly people are already predisposed to pressure sores due to lack of mobility and thin, fine skin.

When placed in a short-staffed long-term care facility that doesn’t have the proper resources to reposition an individual at least every two hours, bedsores are bound to develop. In fact, pressure sores can begin to form after a mere few hours of non-movement. In certain cases, if the wounds are left untreated, they may be lethal.

Bedsores most often develop in areas where the skin faces continuous pressure from being in contact with a bed or wheelchair. When an area on someone’s body is pressed against a bed without movement for an extended period of time, oxygen and blood flow to that part of the body are reduced. As cells lose oxygen, they begin to die, and as a result, the surrounding skin begins to die as well.

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Nursing home evictions are all too common, and oftentimes, they have traumatic effects on residents and their family members. According to the Department of Health and Human Services, in 2015 alone, 9,192 complaints out of 140,145 total complaints were regarding discharges and evictions.

Some believe the problem is much larger than what the 9,192 complaints suggest, as many residents face eviction or early discharge without putting up a fight. Ombudsman agencies told The New York Times that out of everything, eviction-related complaints are the most voluminous category of criticisms received by state long-term care ombudsman programs.

If evictions tend to potentially magnify health problems a resident is already facing by creating additional stress and trauma, why such a high rate of discharge?

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A new study in the Journal of the American Medical Directors Association, and later reported by the New York Times, indicates that some nursing homes may have found a lucrative new way to make money, through collecting extra funds from Medicare by providing excessive rehabilitation services to patients in their final weeks and days of life.

If this is the case, at least two major concerns are raised: Patients who need hospice and palliative care in their final days are not receiving it, but are rather receiving physical, occupational or speech therapy, and patients in need of rehabilitation services are potentially not receiving the appropriate level of care either, as the influx of rehabilitation patients crowds out therapists’ availability to help those in true need of their services.

The study, which was led by several professors at the University of Rochester Medical Center, found the trend to be more widespread in for-profit, rather than nonprofit, nursing homes.

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If you or someone you know is faced with the challenging task of finding a long-term care facility for a loved one, at times it can be difficult to know where to begin. Several websites have been designed so consumers can assess how individual facilities stack up.

Nursing Home Compare

Nursing Home Compare, run by the Centers for Medicare & Medicaid Services, is perhaps one of the most well-known resources that rates care facilities by providing a star-ranking system. Through the website, up to three nursing homes can be compared side-by-side regarding overall rating, general information, health inspections, fire safety inspections, staffing, quality of resident care and penalties.

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Under the Affordable Care Act of 2010, over 14,000 nursing homes were recently required to start providing payroll records to the government, which serve as indicators of staffing levels. Kaiser Health News analyzed the records and found that most nursing homes are operating at consistently understaffed levels, and some facilities even falsely reported having more staff on hand than they actually did.

Apart from across the board understaffing, the study discovered that on weekends, nursing homes see an even larger deficit in adequate staffing than during the week. At worst, a nurse or aide may be required to care for twice as many patients as he or she would on a day with more personnel.

Throughout the week, when staffing levels are typically at their highest, most aides were found to be responsible for anywhere from nine to 14 residents. On the weekend, that number goes up, as nursing staff drops roughly 11 percent on average, and aide staff drops roughly 8 percent.

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Anyone, including employees, residents or loved ones, has the right to file a complaint against a licensed long-term care facility in the state of Tennessee if any concerns in proper elder care arise. Unfortunately, many people do not know that this is an option, and the abuse or neglect suffered by a loved one goes unreported.

If you or someone you know has experienced substandard care in a nursing home, filing a complaint with the Tennessee Department of Health can be a proactive step that will prompt an investigation.

What Situations Can Be Reported?

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In recent months, The Boston Globe and USA Today have released a series of articles related to VA nursing home care. From hidden statistics to an in-depth view of one Bedford, Mass. VA nursing home ranked at one star, the facts from the investigation paint a grim picture for veterans in search of elder care.

A star-ranking system, which rates the nation’s 133 VA facilities by providing an overview of the general quality of care rather than detailed, long-term care reports, was just released in June of this year after years of being kept hidden.

Though, on average, private nursing homes rate better than the government-funded VA homes, many of the problems outlined in the investigative articles are all too common in private and public facilities alike.

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In 2012, the Centers for Medicare and Medicaid Services implemented new regulations in order to cut back the number of antipsychotic drugs prescribed in nursing homes. Despite their efforts, a recently released study conducted by the Human Rights Watch, and reported in The Washington Post, revealed that antipsychotics are still often misused as chemical restraints to keep patients docile and free from inconvenient behavioral disturbances. Perhaps more shockingly, they are sometimes administered without patient or familial consent.

Though some cutbacks in the drugs’ use have been made, it is estimated that nearly 179,000 nursing home residents are still being improperly prescribed the medications on a regular basis.

Antipsychotics, when used appropriately, can have profound effects for those suffering from schizophrenia, bipolar disorder or psychotic depression. However, the Food and Drug Administration never declared these drugs safe for the elderly suffering from dementia. In fact, they did the opposite.

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A 2016 Harvard University study found that nursing homes across America have been changing ownership at an alarming rate. On average, 1,500 nursing facilities were sold to a different corporation per year between 1993 and 2010. While change of ownership is not believed to directly cause turmoil and poor care, the study concluded that many nursing homes that already have a history of deficiencies and violations are more likely to be sold and rebranded.

David Grabowski, lead researcher and health care policy professor at Harvard Medical School, pointed out that nursing homes with a history of consistent, uniform ownership typically have fewer citations from inspectors, unlike their lower-quality counterparts, which more often have mergers, acquisitions or changes of ownership on their record.

More often than not, corporate chains are involved in the acquisition of failing health care facilities.