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September 07, 2005

Nursing home hubris in Louisiana

Reporter Gardiner Harris's story in today's New York Times tells of 32 residents killed by rising water in St. Rita's 60-resident nursing home 20 miles southeast of downtown New Orleans:

There are signs in the home that the water rose to the roof. Three inches of muck still cover the floors. Tadpoles wriggle in doorways. The stench is nauseating. ... The flood victims still lie where they died - draped over a wheelchair, wrapped in a shower curtain, lying on a floor in several inches of muck... (from In Nursing Home, a Fight Lost to Rising Waters)

This report floats to the top of the swampy stew of stories of dead bodies, but beneath it lies an even nastier story.

The nursing home industry in Louisiana is among the most corrupt in the nation, and frankly, what is coming to light now in the falling waters doesn't surprise me one bit.

Earlier this year reporters at the New Orleans Times-Picayune did a series of stories, "State of Neglect," on the horrendous state of nursing home regulation in Louisiana, drawing a picture of an industry virtually impervious to reform.
In her April 19 story, Money = Clout, reporter Jan Moller wrote:

More than 100 elderly and disabled people crowded into a basement hearing room in the state Capitol in May, hoping the Legislature would take a small step toward reducing Louisiana's heavy dependence on nursing homes.
A bill by Rep. Sharon Weston Broome, D-Baton Rouge, was before the House Committee on Health and Welfare to let 500 volunteers move from nursing homes and other institutions into less restrictive programs that would let them get their care at home. Medicaid dollars that had been going to nursing homes would be redirected to pay for the alternatives.
The bill had been a longtime goal of activists who say the state's costly reliance on institutional care deprives people of choice in how they're cared for and independence in how they live.
By the time testimony began, the crowd of supporters had grown too large for the meeting room and had spilled into the hallway. But it quickly became clear that Broome's proposal was dead on arrival.
One after another, committee members spoke against Broome's bill and in support of the status quo. Some cited the two-year, $5 million price tag. Others raised the fear that patients would be forced to leave institutions against their will, something the bill did not contemplate. Louisiana Nursing Home Association lobbyist Joseph Donchess warned of "chaos and confusion" if state officials "were to come into nursing homes and suggest to people who need 24-hour care that they could leave."
After more than 90 minutes of testimony, Broome withdrew the bill.

I'm quoting this long piece because I thought this wasn't available online. A reader did find a link to this story, which I've now provided, above. But it seems that most of these Times-Picayune stories are no longer online. If readers find links, please add a comment. If you don't find them online and if you want to read the series, email me.

The story about the hearing came in the middle of the series that ran in the paper in April.

"When nursing homes suffer a legal or political setback," wrote Moller, "the Legislature also serves as a friendly 'court of appeal.' Three times in recent years, the Legislature has moved to undo or mitigate actions by state and federal courts that the industry didn't like." The legislature overturned a 1999 appeals court ruling that said malpractice suits against nursing homes could not have damage awards caps. They also got the legislature to overturn the state Supreme Court ruling that residents could sue for damages.

On April 17, reporters Jeffrey Meitrodt and Steve Ritea chronicled the many deaths that had occurring in nursing homes due to negligence, adding that all the "home" ever received was "a slap on the wrist." Deaths by drowning, by poisoning ... one case of a woman found in bed with over 500 ants crawling in and out of her body orifices.

And this cautionary paragraph:

In September 1998, during the massive evacuation for Hurricane Georges, two nursing home residents died after they were moved out of the New Orleans area. An 86-year-old woman had a heart attack after being stuck on a bus without air conditioning, where she was given nothing to eat or drink for 10 hours, according to Hood and a lawsuit filed on the woman's behalf by her family. Another lawsuit alleges that a diabetic resident died after he was accidentally given orange juice and went into a coma.
Hood said he ordered an immediate investigation of the homes, both owned by Bob Dean Jr., a Baton Rouge businessman. [LA Dept. of Health and Hospitals head David] Hood said he was flummoxed by the results.
"The word I got from our investigators was, 'We investigated this, and we didn't see any problem. The lady was going to die anyway,' " said Hood, referring to the bus incident.

In a companion story, Meitrodt wrote that "At nearly every level, the inspection process is flawed. ... Surprise visits that aren't. Inspectors ...have no real experience. Surveys ... focus on paperwork." Only one nursing home had ever been closed, he wrote in another story.

Meitrodt and Ritea told readers that the state "relies heavily on nursing homes reporting their own errors and coming up with solutions for the problems," going on to note that some nursing home owners were multi-millionaires. The next day, Ritea reported that plaintiffs' lawyers who practice in multiple states say that Louisiana is one of the most favorable in the country for nursing homes. In their April 19 story, Ritea and Jan Moller reported that "One of the most penalized nursing homes in Louisiana is co-owned by" state Sen. Joe McPherson "who is chairman of the Senate committee that regulates the industry and is vice chairman of the panel that has a big say in how much the homes get paid."

Moller's April 21 story reported that state Medicaid officials had finally granted a "limited waiver" to let people get services in their homes. Moller wrote that "94 cents of every dollar the government spends on long-term care for the elderly goes to nursing homes -- compared with a national average of 70 cents," even though "studies show home care for the elderly typically costs far less than do nursing homes." A person receiving in-home services "costs the state $1,600 a month -- slightly more than half the approximately $3,000 per month Medicaid would pay ...in a nursing home. " "About 4,455 people are getting home-care services through the two programs, compared with about 30,000 people in nursing homes." Yet Louisiana Nursing Home Association director Joseph Donchess had the unbelievable hubris to tell Moller that one needed to "think of the safety and the welfare of the people you're going to be providing the services to first, before you start funding these programs."

On April 25 the newspaper editorialized that "Louisiana's nursing home operators have plenty enough power to protect their interests in the state Capitol. And too much power for anyone else's good." And a few weeks later it was clear that the industry had been little affected by the series or its attendant publicity. Another malpractice bill introduced in the wake of the series died in committee. In just two days -- May 24 and 25,

a House committee restored $47 million in nursing home financing that [the governor] had cut, while a Senate committee unanimously approved a bill to enshrine into state law a financing formula for nursing homes that has been sharply criticized in a pair of recent studies as wasting taxpayers' money by paying for empty beds. ... [And] lawmakers voted 62-28 to reject legislation that would have partially restored the right to sue for damages under the Nursing Home Patients Bill of Rights.

On June 21, Moller reported that McPherson's bill to give nursing homes a competitive edge in developing "assisted living" center passed the House unanimously. It was a reaction to a requirement that state Medicaid funds reduce its payments for "nursing home beds." Now the money can freely go to the "assisted living beds" owned by the same folks.

In August, reporters Meitrodt and Moller finally got data they'd had to request under the Freedom of Information Act:

Louisiana nursing homes are far less likely to be fined for violations than their counterparts in other Southern states, even though the state's homes often rank at or near the bottom on key national quality indicators.
Over the past four years, Louisiana's 309 nursing homes were issued a total of $1,168,719 in state and federal fines, according to state and federal records recently released in response to a Freedom of Information Act request. Altogether, federal regulators, who rely on state officials to recommend cases for sanctions, imposed $218,162 in fines on Louisiana operators.

Following the April series, there were letters to the editor -- some from nursing home industry shills warning that letting people live in their own homes might be "dangerous." And then there was this letter, from Ron Wemhoner: "I asked my kids to make sure that if I ever have to be institutionalized, it's not in Louisiana. It's just too scary here."

This morning, I tried and failed to find a credible source to the reports that nursing homes were the last facilities to be evacuated in Katrina's wake. There's a line to that effect on the SeniorJournal.com site, and the assertion appears again, oddly enough, in a story from the New Zealand Herald.

The New York Times story reports that

St. Rita's had an evacuation plan that depended on another nursing home. Acadian, by far the largest ambulance provider in the state, used helicopters to evacuate many of the parish's neediest medical cases after the storm hit. But [parish councilman] Mr. Kuiper said he never heard from St. Rita's.

Harris reports officials saying that the other 4 nursing homes in
St. Bernard's Parish, where St. Rita's is located, "were evacuated before the storm."
I wonder if that's true. No way to tell for sure. If the official was inventing a quote on the spot, I wouldn't be surprised. Because the nursing home industry in Louisiana has all the officials in their pockets.
COMMENT-BODY:Aaron Brown on Newsnight took a stab at this but it was lame---all about how long it took for the reporter to get there, to St Rita's and very little focus on the patients, and no backround at all on the nursing home problem as it predated the storm
COMMENT-BODY:The New Orleans newspaper's offices were destroyed. Most of the staff was evacuated when the flood water was several feet deep in newspaper delivery trucks. They have been publishing a PDF version of the paper from Baton Rouge, first only on the Internet. The T-P uses loaned space with a skeleton staff. At least one reporter sent to cover the hurricane went missing and hasn't been fournd. I doubt they have access to their archives servers.
COMMENT-BODY:Re June Gordon's comment, just above:
Actually, I'd searched for these articles on the Times-Picayune website about a month ago when someone forwarded me the "money=clout" article as a text file. At that time, I could not get to either that article or any others, and ultimately used a Nexis (paid) search to retrieve them. I checked again the day I posted my blog; and June Gordon is likely right that now is not the best time to expect things to work at the beleagured T-P. We're lucky they're publishing at all.

Posted by mjohnson at September 7, 2005 10:18 AM