Nursing homes oust unwanted patients with claims of psychosis
In a New York nursing home, a resident hurled a bingo chip. At a home in Georgia, a 46- year- old woman, paralyzed from the waist down, repeatedly complained that no one had changed her diaper. In a California facility, a patient threw tableware.
In all three cases, the nursing homes cited the incidents as a reason to send the residents to hospitals for psychiatric evaluations — and to bar them from returning.
Across the United States, nursing homes are looking to get rid of unprofitable patients — primarily those who are poor and require extra care — and pouncing on minor outbursts to justify evicting them to emergency rooms or psychiatric hospitals. After the hospitals discharge the patients, often in a matter of hours, the nursing homes refuse them re- entry, according to court filings, government- funded watchdogs in 16 states, and more than 60 lawyers, nursing home employees and doctors.
The practice at times violates federal laws that restrict nursing homes from abruptly evicting patients.
“Even before the pandemic, there was tremendous pressure to get rid of Medicaid patients, especially those that need high levels of staffing,” said Mike Wasserman, a former chief executive of Rockport Healthcare Services, which manages California’s largest chain of for- profit nursing homes. “The pandemic has basically supercharged that.” He said homes often take advantage of fits of anger to oust patients, claiming they need psychiatric care.
About 70% of U. S. nursing homes are for profit. The most lucrative patients are those on short- term rehabilitation stints paid for by private insurers or Medicare, the federal program that insures seniors and people with disabilities. Poor people on longer- term stays are covered by Medicaid, which reimburses nursing homes at a much lower rate than Medicare.
The financial incentive to have more Medicare or privately insured patients and fewer on Medicaid becomes more pronounced when the Medicaid patients have illnesses, such as dementia, that require extra care from staff members.
Nursing homes have faced acute staff shortages as the coronavirus has left employees sick or afraid to go in to work. Workers said they faced increased pressure from their employers during the pandemic to get rid of the most expensive, least lucrative patients.
Invoking psychiatric problems is a popular tool. Nursing homes routinely admit patients with dementia, Alzheimer’s or similar illnesses, and angry outbursts are common.
In March, the Rehabilitation Center of Santa Monica, Calif., sent Joan Rivers, who suffered from dementia and was on Medicaid, to the emergency room at USC Verdugo Hills Hospital. The nursing home’s staff said Rivers, 87, had tossed aside her chair, scaring other residents, according to her daughter, Evon Smith, and a governmentfunded watchdog. Within 24 hours, the hospital cleared her for discharge.
Smith said that she repeatedly asked the Rehabilitation Center to take her mother back but that it had refused. A social worker at Verdugo Hills said she, too, had tried unsuccessfully to get the nursing home to readmit Rivers.
Linda Taetz, chief compliance officer at Mariner Health Care, which operates the Rehabilitation Center and 19 other nursing homes in California, said the center hadn’t known that Rivers wanted to return.
Rivers eventually was admitted to the Colonial Care Center nursing home in Long Beach, Calif. There, she contracted COVID- 19. She died July 20.
Federal law requires nursing homes to follow strict guidelines when they intend to evict someone: They must give 30 days’ notice and come up with a plan to transfer the
resident to a facility that can meet his or her needs. If a resident goes to a hospital, the facility must hold the bed for a week.
But nursing homes frequently flout these rules, according to employees and state- funded ombudsmen who help oversee the industry. The New York Times reported in July that nursing homes were evicting an increasing number of low- income — and therefore low- profitability — residents into homeless shelters and run- down motels, apparently in violation of federal law.
There is no national data on nursing home evictions. The Times contacted ombudsmen in all 50 states. Some said they had not seen nursing homes dumping patients in hospitals during the pandemic. But in 16 states, including California, Texas and New York, ombudsmen said the problem was continuing. Some said they believed it was getting worse.
“We have been seeing these kinds of illegal discharges all the time because nursing homes seem to have figured out that they will rarely, if ever, be penalized,” said Alison Hirschel, senior legal counsel to the Michigan ombudsman program. “It’s devastating for residents and their families all the time but especially horrible and dangerous during a pandemic.”
Medicaid patients who require lots of staff attention “have a target on their back,” she said.
Charles Borden, a stroke victim with dementia, had been staying at the skilled nursing facility at Tahoe Forest Hospital in Truckee, Calif. Medicaid was covering his long- term stay. But in April, after Borden elbowed a nursing assistant and cursed at her, the nursing home sent him to the hospital’s emergency room for a psychiatric evaluation.
Within hours, the emergency room cleared Borden to return to the nursing home. But it wouldn’t take him back, according to court records. ( Although the nursing home and the main Tahoe Forest hospital share a campus and are owned by the same organization, the nursing home is financially independent from the hospital.)
Later that day, the nursing home dropped off all of Borden’s possessions at the ER and moved another resident into the room that Borden
had shared with wife, Beverly.
Two days later, on April 22, Borden’s son appealed the decision to California’s health care agency. It determined the nursing home was legally required to take his
Borden back. The nursing home refused.
The state agency said it had no authority to force the nursing home to let Borden return, aside from fining it $ 50 for every day it refused.