California Law Aims to Aid Appeals Process for Nursing Home Discharges

A new California law effective Wednesday will require nursing homes to offer residents copies of any information on their eviction, helping make appeals against the discharge easier to file. Evictions are one of the most common complaints reported to California’s Long Term Care Ombudsman programs, noted a report produced by CalMatters. In the past five […]

Top Trends That Will Shape the Skilled Nursing Sector in 2024

Margins squeezed by interest rates and inflation, staffing shortages amid a draconian staffing mandate proposal, an invasion of Medicare Advantage and mixed efforts at adapting to Minimum Data Set (MDS) changes are among a litany of the challenges facing the skilled nursing sector at the start of 2024. However, all is not doom and gloom […]

The Quotes That Defined 2023 in Skilled Nursing — and Hint at What’s Ahead

As the Covid-19 public health emergency officially ended in 2023, the nursing home sector continued to face lingering troubles across many facets of the business even if spread of disease – and death resulting from it – diminished as a concern. Chief among troubles that continued to plague nursing homes included workforce shortages and expansion […]

Humana Is Latest To Face Lawsuit for AI-Based Denials of Medicare Advantage Claims in Nursing Homes

In facing a class-action lawsuit for its use of artificial intelligence in denying claims for services to residents in post-acute care, Humana (NYSE: HUM) joins the ranks of other health insurance behemoths such United Healthcare and Cigna. The complaint, filed late Tuesday, in a federal court in Kentucky, accuses Humana of using AI tools – […]

US Supreme Court Denies Medicare Fraudster Philip Esformes Appeal Hearing To Throw Out Conviction, Penalties

Nursing home operator Philip Esformes – convicted of one of the biggest Medicare frauds in history and whose 20-year sentence was commuted by President Donald Trump – was denied an appeal hearing by the U.S. Supreme Court on Monday to throw out his conviction altogether. While Trump commuted Esformes’ prison sentence in December 2020, he […]

MedPAC Advises Cutting Skilled Nursing Medicare Payment Rate by 3%

The Medicare Payment Advisory Commission (MedPAC) is recommending that for fiscal year 2025, Congress should reduce the 2024 Medicare-based payment rates for skilled nursing facilities (SNFs) by 3%, citing strong margin projections, occupancy growth and access to capital for the sector. “We project the SNF margins in 2024 to remain high even with the downward […]

OIG’s Audit of Nursing Home Workers in Louisiana Finds Flaws in Background Check Process

A federally commissioned report released Wednesday found that nursing homes in Louisiana failed to complete background checks on a portion of their non-licensed employees. In conducting the audit to examine whether Louisiana nursing homes complied with federal requirements for backgrounds checks, the Office of Inspector General (OIG) chose a sample of 9 Louisiana nursing homes […]

‘Operating Pressures Are Very Intense’: Ohio Living CEO on Skilled Nursing Strategy and Mega-Trends

Operational pressures continue to shape the landscape of the skilled nursing sector as many organizations with assets across the care continuum are divesting nursing homes in favor of other service lines. Responding to pressures from staffing and low reimbursements, Ohio Living decided to act “proactively” and downsize its skilling nursing segment while growing its services […]

The Clinical Dashboard: Bridget Grover, Vice President, TruHealth

As a physician assistant and current vice president of TruHealth, which serves as the clinical team for national I-SNP and Medicare Advantage operator American Health Plans, Bridget Grover’s day-to-day experience is driven by clinical needs among the aging population. In this Clinical Dashboard interview, Grover shares her insights based on being a partner to hundreds […]

Fighting the Market Not a Winning Strategy: United Church Homes CEO on the Future of Managed Care

United Church Homes (UCH) is continuing to make progress on a recently announced value-based care play with health plan provider CareSource, while responding to the ongoing market and regulatory pressures in the nursing home space. In June, UCH — with a portfolio of about 1,600 senior housing and care units, including 600 nursing home units […]

UnitedHealth Faces Lawsuit, Media Scrutiny Over AI’s Role in Medicare Advantage Denials of Nursing Home Care

UnitedHealthcare, a unit of UnitedHealth Group (NYSE: UNH), is facing a federal lawsuit over its use of an artificial intelligence tool in making Medicare Advantage claims denials for patients in extended care facilities. That same issue was at the center of a recently published piece in STAT, a health-oriented news outlet. Aaron Albright, a spokesperson […]

‘Deeply Flawed’: LPNs Speak Out On Their Exclusion from Nursing Home Staffing Proposal

As advocacy efforts to oppose the federal government’s proposed staffing mandate continue, the National Association for Licensed Practical Nurses (NALPN) is lending its voice towards the withdrawal of the mandate by sharing a joint letter it sent to the federal agency. The role of licensed practical nurses (LPNs) has been chopped off from the proposal, […]

DOJ Reopening Medicare Fraud Case Against Philip Esformes – Nursing Home Mogul Pardoned by Trump

The Department of Justice (DOJ) is attempting to reopen the case of nursing home mogul Philip Esformes – convicted of one of the biggest Medicare frauds in history – and whose 20-year sentence was commuted by President Donald Trump, and an article in Mother Jones magazine provides a deeper look into the case. Together with […]

AG Rhodes CEO: Bad Policies Driven by Politics Hurt Person-Centered Care in Nursing Homes

As CEO of Atlanta-based nonprofit A.G. Rhodes and LeadingAge board member, Deke Cateau knows that well-intentioned policies sometimes simply don’t work in the real world – and can even wreak havoc for nursing homes. “If we have individuals … making critical changes to an industry that they do not understand, it’s dangerous. It would be […]

Hope Isn’t a Strategy: Inside the Fight for Survival of One Rural Nursing Home

Earlier this year, the Boundary Waters Care Center was in danger of closing. Through a concerted push for funds, the center raised $60,000 in community donations and is still operating — but Executive Director Adam Masloski is fighting every day to overcome operational and financial challenges, and he is deeply concerned about the potential devastating […]

The Clinical Dashboard: Brian Buys, Vice President, Product Management – Senior Care, PointClickCare

The Clinical Dashboard: Brian Buys, Vice President, Product Management – Senior Care, PointClickCare As VP, Product Management — Senior Care for international health care technology provider PointClickCare, Brian Buys is intimately familiar with the need for — and potential of — information dashboards serving clinicians in the long-term care and post-acute care industries. In this […]

Skilled Nursing Operators Put ‘Pedal to the Metal’ to Increase RN Staffing in Light of Federal Mandate

The recently proposed federal nursing home staffing mandate includes the requirement that all facilities have a registered nurse on staff around the clock, every day of the week. Operators are taking some early steps to prepare for this requirement even as they rally against this aspect of the mandate, arguing that 24/7 RN staffing will […]

CarDon CEO: Automation Has Saved Us $2M, Leadership Hire from Outside Industry Key to Staffing Success

Kent Rodgers, president and CEO for CarDon & Associates, has seen some great challenges in his 17-year career at one of Indiana’s largest nursing home providers, but he’s also excited about being at the forefront of many transformations, some spurred by the Covid-19 pandemic. In fact, the pandemic was raging when he became the company’s […]

Health System LECOM Continues to Expand in Senior Care, Reaches 10 Long-Term Care Facilities

LECOM Health, the nation’s only osteopathic academic health center, announced its acquisition of another long-term care facility, bringing the total of senior living communities owned by the Pennsylvania-based health and education system to 10. The health system has been expanding its senior living and care arm, and provides primary care and consultative clinical services to […]