Testimony before the U.S. Senate Special Committee on Aging by Kerry Weems. Figure 1 uses an ownership type field available in the OMT data to indicate whether facilities are owned by a for-profit corporation, not-for-profit corporation, LLC, GP, LP, LLP, or other (e.g., government owned) structure. In the context of this uncertainty, a possible use of detailed ownership data in facility oversight is to monitor involvement of investors (whether of property, management, or operating companies) in the nursing home business and to use this information at the point of licensure application. Indeed, a hierarchical, relational database--which Texas uses--seems necessary to capture this information sufficiently. Seeking greater understanding of the ownership structures of nursing homes, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) contracted with Harvard Medical School to study the trends in organizational structures of nursing homes and their impact on quality of care. Journal of Health Law. 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In fact, given the questionable usefulness of these data to consumer decision making (e.g., in discerning a reliable signal related to quality of care), policymakers should be cautious in adding complex ownership data to the wide range of inputs already available to consumers about nursing home care. Sava Senior Care has even seen one of its Sava facilities terminated from the Medicare program.SavaSeniorCare homes receive continuous low ratings on Medicare quality surveys. document.write(new Date().getFullYear()); Your use of this website constitutes acceptance of Haymarket MediasPrivacy PolicyandTerms & Conditions. Stevenson DG, Grabowski DC. Washington, DC: Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services; 2006. Since it entered the Texas nursing home market in 2000, Nexion Health also used a facility-specific entity structure. Great place to work. The goal is that current staff will remain in place and resident care will not be affected by the transition, Genesis said. From 2000-2007 the percent of Texas facilities using either a LLC or partnership structure increased from around one-quarter of all facilities to almost two-thirds of all facilities. Like all other lawsuits against the chains homes, this lawsuit alleges that the failure to adequately and properly staff the nursing home placed the residents in danger. Second, we sought to understand the relationship between corporate structure and a range of facility characteristics, including quality of care and staffing. Ownership and Management Change. Nursing homes across the country, not just in Colorado, are struggling financially, mainly due to empty beds, said Doug Farmer, president and CEO of Colorado Health Care Association, a trade group for nursing homes. Nursing home chains such as SavaSeniorCare have high-priced lawyers on their payroll to protect the companys interests, even when the nursing home engages in egregious and shocking conduct. In Colorado, the company has multiple centers in Denver, Colorado Springs and Fort Collins, but also several homes in rural towns including Brush, Yuma, Montrose and Sterling. This classification is based on the presence of any entity with a 20 percent or greater stake in both the pre and post-change periods, which would indicate that the name and ID of the top entity changed while the core ownership did not. Most obviously, detailed ownership data are not yet available nationally. Termination from Medicare in Alabama Medicare took the drastic step of terminating a SavaSeniorCare Healthcare home from the program for drastic and repeated violations of federal nursing home regulations. This table was used extensively for merging files. Based on our assessment, the State of Texas and a few other states (e.g., New Jersey, Illinois, and California) seemed to be ahead of the curve in its nursing home tracking systems, potentially offering a useful example for federal policymakers and other states to consider. SavaSeniorCare Administrative . Information in Table 2 is from OSCAR and is based on facility self-reported information on the multi-facility organization affiliation provided during the annual survey. November 15, 2007. The qui tam cases are captioned United States ex rel. This process is explored in the Methods section. Duhigg C. At many homes, more profit and less nursing. Such occurrences are indicative of the desire to change ownership structure based on various legal and economic considerations. At ASC, Shane will develop and oversee the strategic direction for ASCs operations across nearly 100 communities, Indianas largest nursing home provider said. Colorado knows there are operators who want to get out of running nursing homes, said Bonnie Silva, HCPFs director of the Office of Community Living. In addition, individual real estate owners may own facilities operated by multiple operators. The highest rate of both real and nominal changes occurred in 2003. There was near complete merge success for these two datasets since both came from the OMT office. The contact form sends information by non-encrypted email, which is not secure. J Health Politics, Policy and Law. Washington Post. Type: Company - Private. Nursing homes typically need to have 70% of beds full to break even, but most Colorado nursing homes are no longer at that threshold. Another distinctive feature of the Texas nursing home market that has likely played a central role in spurring changes in nursing home ownership in recent years is the rise of nursing home litigation in the state. This includes directly interviewing sources and research / analysis of primary source documents. Perhaps reflecting the reality that for-profit investment, both privately and publicly held, will likely play a continued role in the nursing home sector, policymakers have focused increasingly on broader issues of ownership transparency and accountability. The LP model limits the liability of investors up to their level of investment, and they receive a dividend-like payment instead of a percentage of the profits. The resident was suffocating for 15 minutes by the time the paramedics dislodged the meatball, causing brain death. Of the states 230 nursing homes, 26 are below 50% occupancy. Get Contact Info for All Departments. Residents are great and there is a diverse population. Nursing homes across the country, not just in Colorado, are struggling financially, mainly due to empty beds, said Doug Farmer, president and CEO of Colorado Health Care Association, a trade group for nursing homes. SavaSeniorCare plans to step away from all 25 of the senior care centers it operates in Colorado, while Genesis HealthCare is working to unload operation of four of its 10 facilities across the state. In 2015, the government filed a consolidated False Claims Act complaint against Sava, alleging that between October 2008 and September 2012, Sava knowingly submitted false claims for rehabilitation therapy services as a result of a systematic effort to increase its Medicare billings. At this time, however, the most viable option to pursue these types of questions is to seek ownership data from state licensure agencies, which play an important regulatory role in nursing home oversight. The top 20 multi-facility organizations are listed for each year from 2000 to 2007. Please consult the disclaimer page for further information concerning NHLC. Three classifications were possible: Self-Managed, meaning that no managing company was hired to run the facility; Separate Owner, implying the ownership and management entities were separate; or Same Owner, meaning the owner and manager could reasonably be thought of as the same or connected parties. The number of Coloradans living in nursing homes who are covered by Medicaid government insurance fell to about 9,300 last month, down from 11,000 before the pandemic. In addition, having detailed ownership data could be a useful point of leverage if facilities in operation are unable to meet their regulatory obligations (e.g., hiring a temporary management company or paying financial sanctions). Because our master database required only the top-level and final-level entities, all connecting steps were removed for simplicity. Jonathan did a great job helping my family navigate through a lengthy lawsuit involving my grandmother's death in a nursing home. Hes watching closely, though, in the hopes that the transition doesnt result in closures, particularly in some rural areas where Colorado has already seen nursing homes shut down in the past several years. Nursing homes in Texas also have increasingly used management companies to deliver care. Shane comes to Indianapolis-based ASC from Sava Senior Care, where he served as division president. 2023 SavaSeniorCare Administrative Services LLC | All Rights Reserved Site Map Notice of Privacy Practices In addition, its homes have received numerous fines resulting from federal inspections of the facilities. Real Estate Data. SavaSeniorCare has a diverse payor mix that includes Medicare and Medicaid, commercial insurance, and private pay. The state added $14.6 million of its own fundingand is in the process of releasing an additional $13.3 million. the staff work hard. Before sharing sensitive information, make sure youre on a federal government site. Scott v. SavaSeniorCare Administrative Services, LLC, 3:15-cv-0404 (M.D. If certain conditions are met, including that new operators are found for the 51 centers across the country, Genesis could receive up to $170 million more in debt reduction from Welltower. SavaSeniorCare LLC and related entities (Sava), based in Georgia, have agreed to pay $11.2 million, plus additional amounts if certain financial contingencies occur, to resolve allegations that Sava violated the False Claims Act by causing its skilled nursing facilities (SNFs) to bill the Medicare program for rehabilitation therapy services that The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act against Sava by Relators Rita Hayward, Trammel Kukoyi, Terrence Scott, James Thornton and Barbara Roberts. For more information on the OSCAR database, see http://www.longtermcareinfo.com/about_oscar.html. Farmer was confident in the industrys future, however, and that the homes losing their operators would find new ones. Facility Provider Numbers -- Connects the OMT facility identifiers, which are specific to this database, to the Medicare provider IDs which are used in systems like the OSCAR. Ownership and Management Structuring. In other executive-level changes, ASC also assigned a new chief nursing officer (CNO). As can be seen in the figure, the percent of facilities that use the for-profit corporate structure decreases over the study period (from 51 percent in 2000 to 28 percent in 2007), while the percent owned by an LLC and a partnership of some kind (the vast majority use the LP structure in particular) goes up substantially--from 12 percent in 2000 to 23 percent in 2007 for LLCs, and from 13 percent to 33 percent for partnerships. For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/_/office_specific/daltcp.cfm or contact the ASPE Project Officer, Susan Polniaszek, at HHS/ASPE/DALTCP, Room 424E, H.H. NHLC LLC has a network of recognized attorneys located across the country who have experience representing clients in all types of nursing home injury cases. Nursing home profit status and quality of care: Is there any evidence of an association? The site is secure. The key lynchpin in researching and enforcing policy directives around nursing home ownership is having timely, detailed data about ownership structures and management arrangements. The chain has also faced multiple class-action suits and is a continuous recipient of negative publicity for shocking incidents at its nursing homes and violations of federal law. and the potential influence of entities beyond the operator/facility itself (e.g., the real property owner) on care delivery. When a nursing home in Colorado had a confirmed case of the virus among residents or staff, the home was not allowed to admit new residents. The design and roles of these data sources are discussed below. - Director of Nursing, Sunset Manor / Brush, CO. Three patients are left to move from Estes Park, Hall said. This table also categorizes the facilities based on type (Nursing, Assisted Living, Intermediate Care Facility for the Mentally Retarded, or Unlicensed), though our analyses were limited to nursing homes. The company that owns four of those Colorado buildings, Welltower, recently announced that it was terminating leases with Genesis at 51 properties around the country. The former is managed by the Texas Department of Health, while the latter falls under federal jurisdiction in the Centers for Medicare and Medicaid Services (CMS). This final designation was given if at least one entity had a 10 percent or greater stake in both aspects of the nursing home. As mentioned earlier, OSCAR data were the core of the master data file. The answer seems to depend on the extent to which these other entities directly or indirectly influence resident care processes, something that remains unclear. Protecting nursing home companies: Limiting liability through corporate restructuring. More by Michael Booth, Jen is a co-founder and reporter at The Sun, where she writes about mental health, child welfare and social justice issues. 2hr 5min. Please see the individual center pages or contact the center directly to inquire about the specific . The latter category includes changes at the top level of ownership or management that do not substantially change the core owners of the facilities. Colorado agencies and advocates have long been working to help patients leave nursing homes or stay out of them altogether if they want, and the pandemic fallout provides an opening to redouble that work, Bimestefer said. The latter, merged through the entity IDs, gave provider names and basic information about all the top-level and final-level entities contained within. Based on detailed ownership data from the State of Texas, nursing home ownership and corporate structures changed substantially in the state during the 2000-2007 time period. February 1, 2005; 45(1):48-67. An important example of this approach is the Corporate Integrity Agreement model used by the HHS Office of the Inspector General over the past several years with 15 corporate nursing home providers.16. Partnerships and not-for-profit/other facilities have also seen growth in the use of management companies, but not to the same extent; their current levels are roughly equal now, at 9.7 percent for partnerships and 11.8 percent for not-for-profit/other in 2007. Meanwhile, the percent of individuals with ownership at 1-2 levels deep went down from 90 percent in 2000 to 70 percent in 2007. Unfortunately, end-of-year 2007 facility numbers from OSCAR are not available to us, as we only have the first two quarters of data from that year; however, the trends from earlier in the decade were consistent over time. The LLP model is used rarely in the Texas data. Farmer was confident in the industrys future, however, and that the homes losing their operators would find new ones. The chain has approximately 25,000 beds in its facilities. One outstanding question in the collection and maintenance of nursing home ownership data is whether it has relevance for consumer decision making. Armed with these data, licensure agencies could identify bad actors and introduce potential safeguards to lessen the potential for future problems. Stevenson DG, Studdert DM. The companyalso the parent entity of the Ensign group of skilled nursing, assisted living, rehabilitative care, home health care, hospice and urgent care companiessaid today it has agreed. At the same time, driven in part by liability trends, the larger for-profit nursing home chains exited the Texas market, selling their facilities to private investment companies and others. Some real estate owners (e.g., Sava and ManorCare) are clearly connected to facility operations, at least in name; for other entities (e.g., NH Texas Properties and SHG Resources LP), the relationship between the operator of record and the real estate owner is not as clear. 16-CV-0840 (E.D. I immediately felt at ease and was glad to have him on my side. Mariner Health Care owned 62 nursing homes in 2002; Mariner went through a bankruptcy and was purchased in 2004 by a private equity firm, North America Senior Care. The federal and state infusions werent enough to rescue the facilities from financial distress, however. The table also categorizes each entity based on whether it is a person or business, as well as by its function, as in Table 7. This study furthers the knowledge base from the previous two studies by describing specific corporate structures and the relationship between ownership trends and indicators of nursing home quality. Figure 4 shows a trend toward the use of other companies in the management of facility operations. Talk to a local advisor for free. Correspondingly, given that the total number of Texas facilities has been fairly constant, the number of other types of facilities has decreased over the study period. SavaSeniorCare is one of the countrys largest privately held operators of skilled nursing facilities. Great company, great co-workers. About 40% of the 6,000 Coloradans who have died from COVID-19 were in nursing homes when they got the virus. Instead, the nurses aide who should have performed the maneuver on the spot wheeled the resident 40 feet to another nursing station where the maneuver was attempted. Then the wheelchair pitched forward and the resident hit his face and head on the ground. the call out rate is high. Washington, DC: OIG; April 2009. We will focus below on the potential use of detailed ownership data in regulatory oversight activities. 3:15-cv-1102 (M.D. At the same time, policy attention to the issue played out in multiple state legislatures, as advocates and labor organizations raised concerns about the purchase of the nations largest nursing home chain, HCR Manor Care, by the private equity firm the Carlyle Group.3 Importantly, the empirical evidence of the quality impact of private equity investment in the nursing home industry has been mixed to date. Each center's skilled nursing professionals provide around-the-clock care that helps you make the move from the hospital to your home. These included occupancy levels, a count of the number of g-level deficiencies, a sum of the total number of facilities owned by a particular chain in any given year, and nurse staffing based on full-time equivalents (FTE) per resident. If all goes according to plan, residents shouldnt notice a difference as new operators take over the Colorado facilities, Farmer said. The great majority have been able to move to the same single facility on the Front Range, and many of them were very happy to be able to stay with their fellow residents, Hall said. Sava currently owns and operates SNFs across the country. Layout of the Master Database. The regressions include all management/ownership types in the same model, thus identifying the marginal effects of these features in the context of the others. Analyses of this dataset focus on two types of entries: facilities, which refer to the brick-and-mortar buildings in which nursing home services are provided, and entities, which are the businesses and people with controlling stakes in either the ownership of the facilitys license or in the management of these facilities. A later file provided by the OMT office gave some additional help, but ultimately we had to attempt an unreliable text-field merge based on address information. Thornton, et al. Along with Florida, Texas nursing homes were hit especially hard by the rise in malpractice litigation that occurred in the late 1990s and early 2000s,12 possibly leading to increased use of corporate structures to help shield parent companies from potentially costly lawsuits. Holt Senior Care and Rehabilitation Center in Holt, MI has a short-term rehabilitation rating of Average and a long-term care rating of High Performing. To facilitate the analysis, these ownership stakes (and the start and end dates of their incidence) are included in the table. The information provides context for where to focus analyses of the OMT data. The quality of care investigation was supported by the Justice Departments Elder Justice Initiative, which helps to coordinate the departments law enforcement and programmatic efforts to combat elder abuse, neglect, and financial exploitation. We are truly fortunate to include him in the ASC family, and we look forward to his leadership, Kelsey said in a press release. 2006; 25(1):155-181. Sava allegedly set these aggressive, prospective corporate targets for the highest Medicare reimbursement rates without regard for its patients actual clinical needs and then pressured its staff to meet those targets. Even the very straightforward task of identifying facilities with the same chain owner can be difficult with OSCAR data, as this field in the database is an open-ended text-field subject to slight variations and errors in data entry. COVID has just made that all the more challenging, he said. 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