Nursing homes evicting residents with less insurance coverage, Medicaid

From the Seattle Post-Intelligencer:

For two years, Irene Henderer lived at the West Woods boarding home in Olympia, where she was known for her lively stories and sharp wit. But in November 2007, the home gave Henderer an eviction notice, along with 20 other Medicaid residents.

Henderer, 89, grew depressed and refused to leave her room for meals. As her move approached, she quietly asked her guardian: "Why can't I just die here?"

Three days after moving out, Henderer's congestive heart failure worsened. A month later, she died.

"That was her home," said Pam Privette, Henderer's legal guardian. "If she could have stayed there, we would not have gone through any of this -- the depression, the giving up on life. This pre-empted a natural death, in my opinion."

As health care costs rise and Medicaid rates lag behind, nursing and boarding homes are forcing out sick, elderly and frail residents in what advocates say is a growing trend. No official data exist on eviction counts, but discharge complaints have climbed to record highs.

The Washington Long-Term Care Ombudsman program handled more than 700 such complaints last year, nearly a 50 percent increase over the year before.
Nationally, discharge-related complaints have more than doubled in a decade --
to 12,000 in 2007, according to the U.S. Administration on Aging.

"The system is getting frayed around the edges," said Louise Ryan, the state's long-term care ombudsman, or chief resident advocate.

"People are getting harder to take care of," she said. "When (homes) can find an opportunity to discharge the person, they will. The problem is especially hard with nursing homes, because where else are they going to go? It's the end of the line."

The results are often tragic.

Another woman evicted from West Woods wandered outside one night before her move, barefoot and in a nightgown, saying she wanted "to fall down and die in the cold," Ryan said.

In Grays Harbor County last year, an evicted mentally ill man left his boarding home a week after moving in, and was found dead near some railroad tracks. In other areas, evicted residents have ended up in homes nearly a hundred miles away from loved ones.

In 2007, Seattle University forced out 115 residents when it decided to convert its nursing home into office and class space. Three months later, 14 of the residents had died.

Social workers have a name for such a swift decline after a move: "transfer trauma."

"When you get older, just transferring from one room to another can be very traumatic," said Paul Tosch, the regional long-term care ombudsman serving Thurston, Mason and Lewis counties. "The windows, the ceilings, the front door, the bathroom are all different. In a worst-case scenario, confusion sets in. It can start dementia or increase dementia. Depression sets in. They shut themselves off and say, 'I'm not going to live.' "

Homes can legally evict a resident who fails to pay, becomes dangerous or has needs a home can't meet. Boarding homes can evict Medicaid residents by slashing public-assistance beds, but federal law bars nursing homes from kicking out residents solely because of Medicaid.

But advocates say many homes find ways to bend the laws. They say homes mislead families to lure in residents, and use the broad "can't meet needs" reason to force out difficult or expensive residents.

One of the most common types of eviction is when homes send a resident to the hospital and refuse to take him back, in a practice that resident advocates call "dumping."

"We have a lot of experiences with nursing homes who load somebody up in an ambulance on a Friday night. ... They do it on a Friday, I think, because advocates go home," said Vicki Elting, the regional ombudsman in King County. By Monday morning, hospitals are struggling with a discharged patient with nowhere to go.

Industry representatives deny that "dumping" occurs and say homes are diligent in taking only residents they can care for. They attribute the rise in discharge complaints to a younger, more vocal generation now living in homes.

"This urban myth that people are getting kicked out all the time -- there's no evidence of that," said Gary Weeks, executive director of the Washington Health Care Association, a group of 400 nursing and boarding homes.

Advocates counter that dumping rarely occurs to private-pay people, but to Medicaid residents such as Florence Wade, who had lived at the Regency at Tacoma Rehabilitation Center for roughly three years.

In January, Wade, 85, went to the hospital for pneumonia and a urinary tract infection. The nursing home refused to take her back, saying she had been uncooperative with caregivers in using a hydraulic lift to move her, according to Wade's daughter, Barbara Arnold.

Arnold argued that her mother, who is obese and wheelchair-bound, simply needed coaxing and had used the lift in the hospital. The home then accused her of not doing a "bed hold" -- which she never had to do in the past -- and said the room was gone anyway. Someone else had moved in.

"They had already packed my mother's room up," said Arnold, who owns a computer-training business. "They had no intention of taking her back."

The eviction left Arnold with one stressful option: a nursing home 45 minutes away -- too far for regular visits from friends and family.

"It is very, very hard," said Arnold, who believes her previous complaints about the home prompted the eviction. "My feeling is that by isolating her like that, she isn't going to last long."

Dell Workman, vice president of operations for Regency Pacific, which owns the Tacoma facility, said the home had assessed Wade's condition and determined it couldn't meet her needs. He said federal law barred him from commenting further on Wade's condition.

Other families have felt deceived by boarding homes that promised Medicaid beds and later reneged. Or by nursing homes that discharged residents with advanced Alzheimer's disease, after touting expert dementia care.

"It's unfair, unethical and greedy," said Nancy Dapper, executive director of the local Alzheimer's Association chapter. "You go to these places as a family and they say, 'Oh yes, we have an Alzheimer's care unit.' Unless the family is extraordinarily knowledgeable, they're not going to say, 'Can my mom die here?' "

Doug Campbell recalled asking the administrator of his mother's Port Townsend boarding home what would happen when his mother's money ran out. "(The administrator) said, 'As long as I'm here, your mother will not have to move,' " said Campbell, a retired teacher.

But the administrator soon left, and the home -- Victoria House -- evicted his deaf, blind, 97-year-old mother soon after she converted to Medicaid.

Victoria House and West Woods are owned by Assisted Living Concepts, a Wisconsin-based company with 200 homes nationwide and a market value of $290 million. The company did not return calls for comment.

Elting, the King County ombudsman, said some homes, desperate to fill beds, take in difficult residents with severe mental illnesses, addictions or complex medical needs. Unequipped to deal with them, the homes often end up forcing them out, creating a cycle of needing to fill beds.

"Unfortunately, there are people who have care needs who are discharged to a shelter, or the street," Elting said. "That's the most disgraceful end result of all this."

Weeks, of the state Health Care Association, disputed that practice.

"Why would (homes) admit somebody they know they're going to let go?" he said. "From a business perspective, our buildings are trying to stay as full as possible."

He said the more pressing problem is the growing gap between care costs and Medicaid payouts. Medicaid caseloads have also grown, because people are
living longer and baby boomers are aging into long-term care.

With assisted living costing residents $3,000 to $6,000 a month, and nursing homes costing up to $10,000 a month, homes lose money daily on each Medicaid resident, Weeks said. On average the state pays out about $5,000 a month for a nursing home resident, and $2,000 for a boarding home resident.

To survive, nursing homes are seeking out residents with better coverage, he said.