The sale of Manor Care to Carlyle may be in jeopardy, in Ohio at least.

THREE WEEKS after the sale of Toledo’s Manor Care Inc. was to have closed, the deal has been stalled by state regulators nationwide, and Wall Street is getting jittery.

In a sign that investors are worried that the $6.3 billion deal might not be completed, shares of the nation’s largest nursing home operator were trading last week nearly 9 percent below the $67 price at which they will be redeemed if the sale goes through.

“It’s worrisome,” said one analyst who spoke on the condition of anonymity. “The longer this thing takes to close, the more bad news may pop up.”

Good. The more time, the more truthful information can be brought to light.

Things might get a bit whacky here over the next few days, up to a couple weeks. We’re upgrading our version of WordPress- the blogging platform used for this site. Also a brand new design is in the works which will enhance everyone’s visits and locating content will be much easier!

Stay tuned!

About that nursing home where maggots were found in a man’s eye:

DELAND — Before a World War II veteran came to the hospital with reports of maggots in his eye, the nursing home where he lived was ordered to correct a long list of problems that included serving residents spoiled milk and moldy bread.

“The milk was curdled and had a pungent odor,” an official from the state Agency for Health Administration wrote in a March 20 report of an inspection at the University Center West at 545 W. Euclid Ave

The inspector who discovered the open carton of milk with a straw in it alerted a staff member, who then discovered three more outdated cartons of spoiled milk in the center’s kitchen and two in the dining room. On the same day, officials found a loaf of wheat bread with a “green fuzzy substance” and “flying gnats” on a shelf near a bed, the report states.

On Nov. 7, Anthony Digiannurio, 82, a Purple Heart recipient, was taken to Florida Hospital DeLand at 3 a.m. from University Center West with respiratory problems. The hospital staff discovered the elderly man had maggots in one of his eyes, an infected breathing tube, a partly inserted catheter and bed sores on his left elbow, according to a DeLand police report.

This week, Sandi Copes, spokeswoman for the Florida Attorney General’s Office, confirmed her office is conducting a criminal investigation into the man’s care.

Uugh! So the reports were not sensational as some suggested. It makes me ill to know such places exist.

The facility has been under scrutiny for the past two years for a host of problems, according to a 77-page report by the Agency for Health Care Administration obtained by The Daytona Beach News-Journal in response to a public records request. The nursing home is owned by the nonprofit Hearthstone Senior Communities Inc., also known as AGE Institute of Florida Inc., based in St. Petersburg.

Inspectors found many certified nursing assistants had no training to deal with Alzheimer’s disease patients, and poor hygiene when treating patients with staph infections.

In February, an inspector reported the facility failed to investigate or report seven abuse and neglect allegations, including one by a resident who said staff members saw the resident vomit but did not clean off the resident on July 20, 2006.

“I slept in throw-up all night,” the resident told the inspector.

All the deficiencies noted in the report had been corrected as of April 2007, agency spokesman Fernando Senra said. Reached by telephone Wednesday, Jo-Ann Grasso, University Center West administrator, refused to comment or remain on the phone long enough to learn the subject of this story. Previously, she said the facility was cooperating with authorities and conducting its own investigation into the Digiannurio case.

The inspection report described residents unable to receive help when they couldn’t feed themselves. On Feb. 7, an inspector watched a resident in a wheelchair with stiff fingers who could not use utensils eventually stick the stiff fingers in the food and “suck (the) fingers for nutrition,” the inspector wrote. Unable to hold the glass of milk, the person had nothing to drink, the report said.

For two years this place was red flagged…and yet it’s still open, free to neglect residents. I think our inspection system works just fine; I think the fine system stinks and this bulloney about “working with the facility” to make improvements is just that: Bulloney. Close these places down for good. Send the management team to jail for a couple years too- and perhaps some of the nursing staff as well. There are never good excuses for MAGGOTS being in the eye of a resident. God only knows where else they’re living!

Here’s a reason why we don’t want to see private equity ownership of nursing homes: Using nursing home funds to start up other ventures.

HARTFORD, Conn. (AP) _ The state has begun investigating the finances of a nursing home chain owned by a Nashville recording studio executive.

Haven Healthcare, which provides about 1,800 beds in the state, has been sued by at least 12 creditors since 2005, the Hartford Courant reported Sunday.

That is about the time that Raymond Termini, Haven’s chief executive, launched Category 5 Records, which has signed artists including Travis Tritt.

Should we write letters to Mr. Tritt informing him that his career comes at a high cost?

Termini has acknowledged that he used assets from Haven to finance the record label and buy a house, but said none of that money had come from government Medicaid or Medicare payments.

Haven Healthcare received about $130 million in such funding last year.

It also was not improper to use cash from refinancing Haven homes in other New England states to invest in “non-health care companies,” which he hoped would someday generate a return to the nursing-home chain, he told the Courant.

It’s not illegal or against laws to use “profits” and other incomes from nursing homes- to buy and finance other companies. But we have to question the ethics of it. The fall out is bad and sadly not to many people seem to care. The neglect of nursing home residents on the back of these so called investment opportunities needs to be re-examined. Health care and profits do not mix.

Nursing Home Magazine does it again: AN excellent article about dysphagia and swallowing problems, some of which is aimed at CNA’s:

Dysphagia is not unusual among older adults living in long-term care facilities. One study recorded the presence of mealtime difficulties in nursing home residents and found that nearly 90% had impairments that included dysphagia, poor oral intake, positioning problems, or challenging behaviors. Furthermore, 68% of the residents experienced dysphagia, compromising their ability to enjoy meals, let alone consume the necessary calories to meet nutritional requirements. Dysphagia can lead to aspiration, choking, dehydration, malnutrition, and pneumonia. In fact, aspiration pneumonia is the fifth leading cause of death in people over 60 years of age and the third leading cause of death in people over 80. Clearly, food intake is crucial to many residents’ health and quality of life.

Residents with dysphagia often require modified diet consistencies, such as thickened liquids or pureed foods. In addition, nursing assistants must often comply with specialized feeding techniques, such as placing food in the non-impaired side of the mouth, limiting the use of straws, or facilitating the use of adaptive feeding equipment. In the dining room, nursing assistants who provide help to, monitor, or feed residents must follow the techniques for the residents’ safety and nutritional health. Failure to successfully comply with swallowing and feeding recommendations can cause inadequate hydration and nutrition and unsafe feeding.

More:

Through therapy, a speech-language pathologist can help many residents with dysphagia learn compensatory swallowing techniques. Researchers have found that poor staff training and a lack of understanding about feeding recommendations can cause malnutrition and dehydration in long-term care. McGillivray and Marland conducted a review of the literature on assisting people with dementia during meals. Their review found that mealtime assistance is often stressful for residents and staff because feeding becomes task centered and staff have not been sufficiently educated or trained.

I think ALL staff could use more training.

Did you know?

Signs and Symptoms of Dysphagia
Some signs and symptoms of dysphagia are not commonly known. For example, did you know that a persistent low-grade fever might be a sign of dysphagia? Did you know that if a resident is spitting food at meals, he or she might have oral phase dysphagia and might be unable to chew properly? Review the list below with your staff. Residents displaying the following signs and symptoms of dysphagia should be seen by a speech-language pathologist:

* Having trouble recognizing food
* Difficulty placing food in mouth
* Drooling or spitting
* Food falling out of mouth
* Pocketing of food in mouth
* Rocking tongue back and forth while chewing
* Food left in mouth after the swallow
* Chewing for a long time
* Coughing before, during, or after the swallow
* Delayed or absent rise of the larynx during the swallow
* Requiring 3–4 swallows after each bite
* Continuous throat clearing during or after the meal
* Wet or hoarse voice
* Complaining of something caught in throat
* Refusing to eat or very slow eater
* Lasting low-grade fever
* Unplanned weight loss or unexplained loss of appetite
* Pneumonia
* Malnutrition or dehydration

This article provides an excellent review of swallowing problems for nursing home residents and would be a timely and good resource for an in service.

You should read this. And be thankful for how some people handle such things with grace and composure.

Former Justice Sandra Day O’Connor’s husband, suffering from Alzheimer’s disease, has a romance with another woman, and the former justice is thrilled — even visits with the new couple while they hold hands on the porch swing — because it is a relief to see her husband of 55 years so content.

The article is much longer and goes into depth about how older people value love and relationships. This is a very positive story.

This past Thursday hearings were held at Capitol Hill regarding ownership transparency and nursing homes.

At two Capitol Hill hearings yesterday, legislators highlighted the need for greater transparency in nursing-home operations and called for a government probe into the quality of care given at facilities owned by private-equity firms.

Experts presented studies that showed more incidents at private-equity-owned chains and lower staffing ratios compared to nonprofit and publicly owned facilities.

The hearings come as the Carlyle Group winds up its $6.3 billion takeover this month of Manor Care, the nation’s largest nursing home chain. The takeover has been challenged by some long-term-care advocates and a labor union trying to organize the Toledo company’s 60,000 employees.

Rep. Pete Stark (D-Calif.), chairman of the House Ways and Means subcommittee on health, called for the Government Accountability Office to look into the ownership structures of nursing homes and how they affect transparency, staffing levels and quality of care.

“I am concerned about quality issues and lack of accountability, particularly as more and more beneficiaries are now living in private-equity-owned homes. While we must not prejudge anything, these changes provide ample reason for us to reinitiate closer oversight of this industry to make sure that interests of beneficiaries are protected,” Stark said at the hearing.

Aren’t we all concerned?

The other hearing:

Kerry N. Weems, the acting administrator of the Centers for Medicare and Medicaid Services, which regulates nursing homes, offered several initiatives to improve oversight. His suggestions included releasing the so-called special focus facility list, which identifies homes that regulators consider among the nation’s worst. That list, which will be released Dec. 1, has not been public.

Mr. Weems also announced that his agency was developing a system to identify any person or company that owned more than 5 percent of a nursing home. But similar systems in some state have been easily sidestepped by investment companies hoping to obscure ownership through complicated corporate structures.
[...]
Lawmakers also discussed requiring nursing homes to have insurance or bonds to pay fines or court verdicts. Some owners have escaped such payments by leaving homes undercapitalized or by removing profit through complex transactions.

In defending the industry, a nursing home executive said that some information should remain confidential and that companies were committed to providing quality care.

“Nursing home providers are transparent in the disclosure of quality data, but there are those who take the information and use it against us,” said Steve Biondi, speaking on behalf of the American Health Care Association, a nursing home trade group. “We concur with all here today that there is far more to accomplish. But we must do so together.”

Mr. Biondi said the company he works for, Extendicare, has about five sites on the “special focus facility” list.

The hearings also provided a forum for competing studies that evaluate nursing homes owned by private investment groups.

It’s sad that they even call this the “nursing home industry” when one thinks about it. It should not be an industrious business; it should be humane.