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Nursing Home Aide Setenced for sexual abuse

Dan Flanzig — Mon, 21 Nov 2011 17:36:00 GMT

A nursing home aide in New York was sentenced to seven years for sexually abusing a 61-year-old patient at Amsterdam Nursing Home in Morningside Heights. The woman was partially paralyzed, unable to speak and was considered "completely dependent" after suffering a stroke prior to her admission to the home.

Jose Ramos was convicted of one count of Sex Abuse in the First Degree, one count of Endangering the Welfare of a Vulnerable Elderly Person in the Second Degree and one count of Endangering the Welfare of a Physically Disabled Person. In addition to incarceration, when he finishes his sentence, Ramos will be under supervised release for ten years and will have to register as a sex offender. The victim's family may also choose to bring a New York nursing home abuse claim against the offender to recover financial compensation.

Ramos was assigned to assist the victim for the midnight shift, and was supposed to be helping her with personal hygiene. A duty nurse, however, noticed the victim's call button lighting up three different times and went to the victim's room, where she found Ramos in the process of sexually abusing the victim.

Alternative Delivery of Medicaid Home Care

Dan Flanzig — Wed, 16 Nov 2011 18:28:00 GMT

Consumer Directed: Alternative Delivery of Medicaid Home Care

By: Daniel G. Fish, for the New York Law Journal

November 15, 2011

Many seniors have extracted a promise from their children that can be summed up in the phrase "never a nursing home." However, when faced with the presence of a stranger in their home to provide care, they realize that their wish has come at a very high psychological cost. The loss of independence can undermine the benefit of avoiding nursing home placement. These individuals should be aware of a Medicaid option called the Consumer Directed Personal Assistance Program ( CDPAP) ¹ that can permit them to exercise greater autonomy. It is available to individuals (called "consumers") who are disabled, medically stable, self-directing and eligible for Medicaid long-term care services. It allows the consumer freedom of choice in selecting her own home care worker (called the "personal assistant").

In a typical home care case, Medicaid selects the agency that will provide the care, and the consumer has no input into the identity of the worker. The consumer directed program provides an alternative system by allowing the consumer to control the hiring and supervision of the worker. It is appropriate for those who want control over the selection of the aide and those who already have a home care worker whom they have been paying privately.

Nurse Practice Act

It also is appropriate for those who need services that an aide from an agency is prohibited from providing. Education Law §6901 et seq. (the Nurse Practice Act) defines the practice of nursing. Generally, only a registered nurse or a licensed practical nurse is allowed to perform a skilled service such as wound care, handing medication to a patient, giving an insulin injection, catheterization, or applying eye drops. A home health aide from an agency is limited to custodial care services such as helping a patient get out of bed, getting dressed, toileting and bathing. Family members, household members and friends are exempt from this restriction and are permitted to perform the skilled services.

Education Law §6908(1)(a)(iii) creates a specific exemption for those working under the consumer directed program. They enjoy the same exemption as a family member, household member or friend, and are permitted to perform skilled nursing tasks that otherwise may only be performed by a registered professional nurse or a licensed practical nurse. A personal assistant under the consumer directed program is permitted to provide care that a home care worker from a selected Medicaid agency would be prohibited from providing.

Medicaid can require an assessment by a registered nurse to verify that the consumer is capable of instructing the personal assistant properly in the provision of the skilled service. The consumer can be asked to demonstrate the skilled task and/or may be required to provide a written narrative of the steps in the skilled task.

This aspect of the consumer directed program has been shown to produce savings to the Medicaid program since the payment to the personal assistant is lower than the amount Medicaid would pay to a registered nurse or licensed practical nurse.

Transportation

At one point, Medicaid would not permit a personal assistant to drive a consumer to a non-medical appointment. That policy has been formally reversed. A Medicaid administrative regulation ² has established that a personal assistant may accompany the consumer to non-medical activities outside of the home (such as shopping, work, school, social activities). The consumer and personal assistant must assume complete responsibility for any liability related to the transportation, such as a motor vehicle accident. In addition, the consumer's physician must certify that the consumer's health is not at risk (i.e., driving would not take the personal assistant away from attention the consumer requires for medical safety). The personal assistant is still prohibited from driving the consumer to medically related activities. Such medically related transportation must be arranged through Medicaid.

Self-Directing

The CDPAP benefit is available to consumers who are capable of self-directing their own aide. The consumer must be able and willing to make informed choices about his or her care, understand the implications of these choices, and assume responsibility for the outcome of those choices. Specifically, the consumer would be expected to recruit, hire, train, supervise and fire, if necessary, a personal assistant. Some elderly consumers may not be self-directing. This requirement can be delegated to a legal guardian of the consumer, a relative or another adult.

The Process

A physician's order recommending that the consumer be enrolled in the consumer directed program must be submitted to Medicaid. A social assessment and nursing assessment by Medicaid must follow. When Medicaid approves the participation of the consumer in the program, the consumer may interview, select and hire his or her own personal assistant. The class of individuals qualified to be a personal assistant is limited. Payment cannot be made to a consumer's spouse, parent or designated representative. Payment can be made to any other person, including those who are related to the consumer. However, such relative may not reside in the consumer's home. There is an exception to this rule if the number of hours of care is so high that the relative must reside in the home.

In addition, since the personal assistant will be paid on the books, he or she must be a U.S. citizen or legally authorized to work in this country. Medicaid does not give funds to the consumer to pay the personal assistant. A fiscal intermediary selected by Medicaid will handle the payroll functions for the personal assistant. The fiscal intermediary will be responsible for withholding taxes, Worker's Compensation, unemployment insurance, sick time and vacation time.

According to the Consumer Directed Personal Assistant Association of New York State, in 2008 there were 9,105 consumers in the CDPAP program statewide, and 2,310 in New York City. It is important to keep in mind that the consumer directed program makes independence available but also puts a great deal of responsibility on the consumer. He or she is responsible for finding a personal assistant, for training that person and for supervising their care. He or she is responsible for having a back-up available in the event the personal assistant is absent. These are tasks that otherwise would be performed by a home care agency selected by Medicaid. In specific cases, the program can be a valuable alternative to home care provided by an agency of Medicaid's choice.

Daniel G. Fish is a principal in Daniel G. Fish LLC.

Test for Hospital Budgets: Are the Patients Pleased?

Dan Flanzig — Thu, 10 Nov 2011 20:17:00 GMT

Brian Ach

MATERNITY WARD Karen Goodman, a nursing manager, said NYU Langone Medical Center was working on more patient perks.

By JORDAN RAU

Published: November 7, 2011

"I'm a great kvetcher," said Pearl Schwartz, sitting in her hospital bed at NYU Langone Medical Center.

Indeed, during her brief stay to receive a pacemaker, Ms. Schwartz, an 88-year-old retired state worker, had a litany of complaints. Sure, the nurses were "splendid, warm and kind" and sang in her room - and her operation went off without a hitch. But her sink was too small, she had to wait eight hours in the radiology unit for an X-ray, and no one brought her anything to read as she had requested.

"If people are down here, wouldn't it be nice if they could look at a cheerful magazine?" she asked.

Winning praise from patients has become a pressing - and often elusive - obsession for NYU and for hospitals nationwide. In the coming months, Medicare will start taking patient satisfaction into account when reimbursing hospitals. Disgruntled patients will mean reduced revenue, a frightening prospect for hospitals already facing empty beds because of the recession and pressure from insurers to hold down costs.

Medicare's new rule, mandated in the Affordable Care Act, pits hospitals against one another in a competition to best satisfy patients; those with the best scores will receive more money.

But some hospitals are worried that assessments from patients like Ms. Schwartz can be influenced not just by the quality of their care, but also by amenities like single rooms, renovated units and tasty food. And hospitals in cities and certain regions, like the Northeast and California, tend to get lower ratings, raising concerns that their revenues will be reduced simply because patients in those places are more disposed to grumble about things that a polite Midwesterner or Southerner would forgive.

"Hospitals are going be punished financially by the federal government for things they can't control," said Dr. James Merlino, chief experience officer at the Cleveland Clinic.

Surprisingly, some of the nation's most prestigious hospitals, including Cedars-Sinai Medical Center in Los Angeles and the University of Chicago Medical Center, get lower marks from patients on most areas of patient experiences, according to the government's Hospital Compare Web site.

So do many of New York City's elite institutions, including NewYork-Presbyterian Hospital, the Mount Sinai Medical Center and Beth Israel Medical Center. Some hospitals, like NYU, get bad patient reviews even as they score average or superior in measures of clinical care from the government and accreditation groups.

"People in New York have very high expectations about what it means to be taken care of," said Dr. Katherine Hochman, an NYU physician. "When they don't get their food on time and have to spend eight hours in the emergency department, well, that's just not their image of what a world-class institution is."

The ratings are based on Medicare-approved surveys, which hospitals hire companies to give to a random selection of patients after they are discharged. Some surveys are given by phone, others by mail. All ask the same questions: Did the doctors and nurses communicate well? Was pain well controlled? Was the room clean and the hospital quiet at night? The surveys go to younger patients as well as Medicare beneficiaries.

In setting payment, the federal Centers for Medicare and Medicaid Services plans to be a tough grader. It is going to give hospitals credit only for patients who say their experiences were always good. The surveys also ask patients to rank their stays on a 10-point scale, and Medicare will credit only hospitals that receive a 9 or 10.

That is likely to be a tough threshold for hospitals. Interviewed weeks after her stay, Ms. Schwartz was much more positive about her experience, saying she had "a wonderful time," but still she was not sure whether NYU deserved more than eight points.

Hospitals' initial scores will be based on reviews by patients discharged since last July. Starting next October, the federal agency will withhold 1 percent of Medicare's regular reimbursements to most hospitals and redistribute that money based on how they performed compared with other institutions and how much they improved from the previous year. The bonus amount will rise to 2 percent in 2016.

The agency has decided that patient experience ratings will determine 30 percent of the total bonus payments, more than the hospital lobby favored. The other 70 percent will be based on how hospitals follow clinical guidelines for care, like giving the right medications to avert blood clots and infections.

The agency hopes that commercial insurers will also incorporate patient experience scores into their payments. One major insurer, Wellpoint, already has.

Hospitals have long catered to patients in an effort to draw more customers and beat out competitors. It is one of the reasons so many renovate and rebuild. Many are finding that small changes, like having nurses visit rooms hourly, often improve patients' responses to the surveys more effectively than do new hotel-like amenities.

Jefferson Regional Medical Center in Pittsburgh expects all employees, from maintenance workers to doctors, to respond to a patient's call light or find someone to offer assistance. In Los Angeles, Cedars-Sinai is testing new patient call buttons that ring directly to nurses' cellphones. If the nurse's line is busy, the call automatically rolls over to another worker's phone.

Many hospitals have devised detailed scripts that doctors and nurses follow when interacting with patients, telling them what to expect and often extolling the care they are getting. This fall, the University of Toledo Medical Center launched an internal "iCARE University" dedicated to training employees on improving patients' experiences.

In Connecticut, Bridgeport Hospital improved some of its lowest scores in its maternity unit after delivery nurses began telling patients how great the postpartum nurses are, said Eileen Callahan, the nurse manager for the maternity unit.

When the mothers and their babies are brought out of the delivery room, "the postpartum nurse greets them at the desk and starts the 'oohs' and 'ahhs,' and how lucky they were to have the nurse in the delivery," Ms. Callahan said. She said initially there was "some hard swallowing going on" during exchanges for nurses who did not like each other. Ms. Callahan said she bases a portion of her nurses' annual reviews on how well they followed these patient transfer practices.

Other hospitals are trying to game the system, said Paul Alexander Clark, a consultant to health system executives. He said some seek to influence patients' memories by instructing the staff to repeat phrases used in the post-discharge surveys. "The problem of teaching the test is caregivers are more focused on the right words rather than the right care," he said.

Another concern is that the ratings system may hurt hospitals that handle many complex cases. Mr. Merlino said the Cleveland Clinic's own research shows the longer a patient remains hospitalized, the less the patient thinks he is getting adequate attention and the lower ratings he gives the hospitals.

Depressed patients also tend to give more negative assessments, Mr. Merlino said. The hospital gets below-average reviews on several questions, even though patients in the same surveys overwhelmingly say they would recommend the clinic to friends.

Medicare says that the surveys adequately take patient medical conditions into account by asking patients about their health.

Jean Moody-Williams, director of the quality improvement group at the Centers for Medicare and Medicaid Services, said the topics covered by the surveys, like whether patients received proper instructions on what to do after they left the hospital, relate directly to important quality-of-care matters and will force hospitals to focus on them. "It's not just a feel-good kind of a thing," she said.

Hospitals with lower scores fear that the new payments could widen the gap between those that have money to invest in improvements and those that do not. In particular, hospitals with older facilities believe they will have a harder time getting good reviews than hospitals with newer buildings.

When NYU moved its cardiology unit to a renovated floor in 2008, patient rankings shot up even though the procedures and employees were the same. NYU found that long waits at its elevators drove down its scores, so now it is building a new bank of elevators. Double rooms and cramped emergency rooms invariably lead to more noise and annoyances, but NYU said that it cannot fully solve that until it opens a new building in 2017.

"Those amenities are really important," said Dr. Robert I. Grossman, NYU's chief executive officer. Still, he said he believes that "institutions have total control over the medical quality, and that's what I think they should be judged on."

NYU is scrambling to find lots of little ways to please patients. Nurses in the emergency room are instructed to greet people at the door within 30 seconds. Several floors have started happy hours, providing chips and cookies for family members. The maternity ward has been experimenting with giving women cellphones so they can text their nurses. When new mothers leave, they are given cards signed by doctors and nurses.

"We have a lot of overachievers, and they want to overachieve with their babies," said Karen Goodman, the nursing manager for obstetrics. "Our patients are upper-middle-class, educated women, and we're telling them, 'You have a roommate, you have to share a bathroom.' We have to go over the top, because no one's going to recommend the environment."

Like many hospitals, NYU has patient advocates who handle nonmedical problems. On a cancer unit, one advocate, Jo-Ann Delgado, visited patient after satisfied patient. "The service is just wondrous," one told her.

But she got an earful from another, who complained that an elevator operator had turned away someone who tried to get on, saying that that the elevator took only freight.

"I was beginning to have stress pain in my chest; that's where my tumor is," the woman said. "Her haughtiness got to me."

Ms. Delgado responded, "I'm glad you told us that, because she has to know patients come first."

Some patients remain reluctant to give superlatives. Charles Doheny, a 60-year-old hip surgery patient from Bayside, Queens, said he would give NYU an eight, although he said his doctors and nurses always communicated well and helped moderate his pain.

"I can't say I've had a bad experience at all," he said.

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A Nursing Home Shrinks Until It Feels Like a Home

Dan Flanzig — Tue, 01 Nov 2011 19:27:00 GMT

A Nursing Home Shrinks Until It Feels Like a Home

Joshua Bright for The New York Times

By LAURIE TARKAN

Published: October 31, 2011

Toni Davis spent much of her childhood roaming the corridors of a nursing home in West Orange, N.J., where her mother was the director. Even now she recalls the pleas of the residents there: " 'Please help me, please take me home with you,' they'd beg," Ms. Davis said. "I remember asking my mom, 'Why can't we take them home for dinner for just one night?'"

Enlarge This Image

Joshua Bright for The New York Times

WARMTH Toni Davis, right, director of the Green Hill Retirement Community in West Orange, N.J., played bingo last week at one of the four Green Houses on the campus.

Following in her mother's footsteps, Ms. Davis is now director of Green Hill Retirement Community, a nursing home and assisted living facility, and she is determined to make it into a place where residents feel little reason to leave. She has added fish tanks and bird cages, hung pictures on the walls carpeted the corridors, and brought in dogs for pet therapy.

Still, the nursing home looks like... a nursing home. "No matter what you do, you can't get that homelike feeling in an institution because it's too big," she said.

So now Ms. Davis, along with two dozen other nursing home operators across the country, is trying something different. This year, behind two large institutional buildings on the Green Hill campus, she has opened four small Arts and Crafts-style houses for elderly residents.

Just 10 residents live in each so-called Green House, which looks nothing like a traditional nursing home. The front door opens onto a large living and dining area; on one side is a hearth surrounded by upholstered chairs, and on the other is a long communal dining table where meals are served. An open kitchen faces the table, so caregivers can chat with elderly residents while preparing meals.

Private bedrooms and baths surround the main living area. The house has a front porch and back deck with tables and chairs. There are no corridors, no nursing stations, no medicine carts (each room has a locked cabinet containing the resident's medications) and no trays of food delivered to the rooms.

There are 117 Green Houses across the United States now, part of a quiet but intriguing effort to de-institutionalize elder care. The movement has its roots in the 1987 Nursing Home Reform Act, which declared that residents of long-term care have the right to be free from abuse or neglect. Nursing homes across the country have tried a variety of strategies to become more "resident-centered."

"It's happening all over the country, in a lot of different models," said Sarah Wells, executive director of the National Consumer Voices for Quality Long-Term Care, an advocacy group based in Washington.

The Green House concept is the most comprehensive effort to reinvent the nursing home, experts say - including the way medical care is delivered. In traditional nursing homes, employees typically have narrowly defined jobs: Some give baths, some cook, some do laundry. It's a system based on efficiency that tends to ignore individuals' preferences and needs.

In a Green House, each home is staffed with two certified nursing assistants who perform all of these jobs, but for fewer residents. In addition, one registered nurse typically supports two or three houses.

"If you have one person doing everything, they can spend more time with the residents and get to know somebody as a real person," said Robert Jenkens, a director at NCB Capital Impact, a nonprofit community development finance institution that has partnered with the Robert Wood Johnson Foundation to provide consulting and loans for organizations developing many Green Houses.

"You're also less locked into a rigid 'wake, meal, bath' schedule, and you can reorganize someone's day based on her preferences," he said.

If nurses' aides aren't feeling rushed to dress and bathe residents, the thinking goes, they're more likely to let them perform more of these tasks themselves, fostering independence.

Erika Dickens, a certified nursing assistant, worked in the traditional nursing home at Green Hill for 20 years but recently was transferred to the new Green House.

"I used to feel like my hands were tied. I had to get the elders out of bed at a certain time, even if they didn't want to," she said. "Now if someone doesn't want to get out of bed for breakfast one day, I'll bring her a milkshake."

The notion that elder care should be de-institutionalized is a popular one. According to a poll released in September by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health, 82 percent of pre-retirees (adults over age 50 who have not retired but plan to) and 78 percent of retirees are somewhat or very concerned about being in an institutional environment that is not as comfortable as a home.

"Loneliness, helplessness and boredom are the three plagues of nursing homes," Mr. Jenkens said. "Arguably, much of the institutionalized practice induced this."

Still, it's not clear that the Green House model can be widely duplicated. Though the day-to-day costs are no greater than those of larger nursing homes, the homes are typically built in clusters of two or more and require comparatively large initial capital investments. "It would increase long-term costs if it were implemented to replace every nursing home in the country," said Dr. Catherine Hawes, director of the program on aging and long-term care policy at Texas A&M Health Science Center.

Perhaps more important, whether the Green House model improves care for the elderly, compared with institutional settings, is not known. Several small studies, none particularly rigorous, have found that Green Houses deliver similar care for no more money than traditional nursing homes. The homes do this largely through reducing supervisory positions and training certified nurse assistants to take on more responsibility.

Green Houses also have a lower vacancy rates than conventional nursing homes, and they accept patients on Medicare and Medicaid, making them an option for low-income elderly. On average, about 54 percent of Green House residents are on Medicaid, while the rest pay for the care privately.

Residents of Green Houses experience fewer bed sores than those in conventional nursing homes, according to one survey, and each day they get 24 minutes more of direct and personalized care and 1.5 hours more of nursing staff time than those living in traditional nursing homes. Residents say they feel like they have deeper relationships with the staff, and family members report higher satisfaction with the physical environment, privacy, their own autonomy, health care and meals. Employees, too, report less stress. The turnover rate is significantly lower than in a traditional nursing home. Green House certified nursing assistants are paid on average about 5 percent more than those in institutional settings.

Even if this model of elder care turns out to be impractical on a large scale, Ms. Wells said, "we can learn a lot from what the Green House is doing and can translate these methods into things that existing nursing homes can use."

Many residents and their families find the Green House to be a substantial improvement over standard nursing home care. Diane LoCicero moved her 88-year-old mother, Evelyn, from the traditional nursing home into one of Green Hill's Green Houses this year. Her mother is far more relaxed now, said Ms. LoCicero, and she actually enjoys visiting the place.

"Before, it was like a hospital and I hated to visit," Ms. LoCicero said. "Now, I'll stay here for hours."

On a recent day in September at Green Hill, Jane Larkin, 82, a retired home economics teacher who suffered a stroke in 2007, sat in her wheelchair at the long dining table and marveled at the differences between this residence and the traditional nursing home in which she'd once lived.

"There's more opportunity to be social here. We can get outdoors easily, and people like to visit more," she said. "Sometimes, I give the girls advice when they're cooking, like I'm their teacher. There was no opportunity to do that in the other place, because we were isolated in our rooms."

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City to Pay $70 Million in Medicaid Suit

Dan Flanzig — Tue, 01 Nov 2011 19:17:00 GMT

City to Pay $70 Million in Medicaid Suit

By ANEMONA HARTOCOLLIS

Published: October 31, 2011

New York City will pay the federal government $70 million to settle a lawsuit that accused the city of overbilling Medicaid by improperly approving home care for frail and elderly clients, both parties said on Monday.

Follow @NYTMetro for New York breaking news and headlines.

In the settlement, the city acknowledged that for a decade, from 2000 to 2010, it had re-authorized personal care for certain patients without having physically obtained the required assessments from doctors, nurses or social workers. The city also admitted that it sometimes did not get "independent medical reviews," as required when there was a dispute over the amount of care needed.

The city presented the case as a dispute over what Michael Cardozo, the city's corporation counsel, called "technical record-keeping deficiencies and nothing more." Federal officials, however, said that the requirements were important because they determined the payment of huge amounts of money.

Mr. Cardozo said the city had acted in the good-faith belief that the services being provided were appropriate.

"These services allowed poor and infirm New Yorkers - among our most vulnerable population - to remain in their homes and live independently," Mr. Cardozo said.

Preet Bharara, the United States attorney for Manhattan, reacted angrily to Mr. Cardozo's contentions that the settlement reflected a mere technical problem, and that it accounted for "less than half of 1 percent" of the $18 billion cost of the program in the city over 11 years. He noted that the Justice Department's original complaint, filed in January, had alleged tens of millions of dollars in improper billing, and that the settlement was within that range.

"It is unfortunate that Mayor Bloomberg's counsel would contradict the stipulations that he personally signed and submitted to the court, in which he acknowledged that the settlement was fair and reasonable," Mr. Bharara said. "The city's argument that this case was about 'paperwork' was specifically rejected by Federal District Court Judge Jed Rakoff when he denied the city's motion to dismiss this case."

In its statement on Monday, the Justice Department did not explicitly contest whether patients needed the care they were getting, which could include housecleaning, dressing, bathing and shopping and could cost $75,000 to $150,000 a year.

But Mr. Bharara said the settlement took "an important step toward restoring the integrity of this program and ensuring that all beneficiaries get the level of care and service they require and to which they are entitled."

The case was brought as the result of a complaint by a whistle-blower, Dr. Gabriel Feldman, an independent medical reviewer in a private agency under contract to the city. Dr. Feldman will receive $14.7 million of the $70 million settlement.

The False Claims Act, under which the case was brought, is typically used to prosecute doctors who, for example, bill Medicaid for tests they did not really conduct.

City officials said they were distressed by the use of the law in this case because the city had received no financial benefit from the payments that were being challenged. Mr. Cardozo said the law was being used to "resolve funding disputes among governmental entities."

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Medicare tests Monthly Incentives for inovative Primary Care

Dan Flanzig — Wed, 19 Oct 2011 21:00:00 GMT

Medicare tests monthly incentives for innovative primary care

Participating practices will receive an average of about $20 per patient per month to coordinate quality care for Medicare and private patients.

Washington -- Medicare will partner with private insurers to offer physicians patient management fees and the opportunity to share savings under a primary care payment initiative led by the Centers for Medicare & Medicaid Services.

The Comprehensive Primary Care Initiative is a new collaboration between public and private payers to strengthen primary care, CMS officials said during a Sept. 28 news conference. The Center for Medicare & Medicaid Innovation is inviting insurers to join government health plans in trying a new approach to paying for primary care starting in 2012.

"We believe that if we can give primary care clinicians the time and resources to take care of their patients and coordinate their care across the spectrum, in the end we'll get happier and healthier patients," said Richard Gilfillan, MD, acting director of the innovation center. "We know we'll get providers who feel more fulfilled. And we know over time we'll improve overall costs of the system and make the system more sustainable."

The initiative is designed to enhance the work being done by payers who have developed innovative models to pay for coordinated care and higher quality services, such as the patient-centered medical home. The Medicare agency wants to pay more for outpatient services that keep patients healthier and prevent costlier inpatient care. For instance, care coordination in the Community Care of North Carolina program, which initially launched as a Medicaid medical home project, has been able to lower preventable hospitalizations significantly for patients with chronic conditions, according to CMS.

Once the participating private payers are selected, interested physician practices will be asked to apply through CMS to participate. CMS will require practices to provide comprehensive primary care services to Medicare patients and to those with coverage from a participating payer. Preference will be given to practices that have achieved meaningful use of an electronic medical record system, according to the application materials.

Practices will receive patient management fees to pay for the new health care delivery methods, said Richard Baron, MD, director of the Seamless Care Models Group at the innovation center. This fee is expected to average about $20 per month for each patient covered by one of the participating payers. CMS also will provide practices with patient and resource use data so patients have more information on the quality of their care and their physicians' performance. Any savings that might be generated for the Medicare program would be shared with the practices.

Federal antitrust laws still will apply, so payers will be prevented from coordinating with one another on what they pay for management fees.

Trying to transform primary care

CMS plans to select up to seven areas of the U.S. to participate in the demonstration, which will launch in the summer of 2012. Each market will include about 75 practices caring for roughly 300,000 Medicare or Medicaid patients over four years. Those participating in the initiative can't participate in other shared savings initiatives, such as the forthcoming Medicare accountable care organization program.

The American Medical Association was pleased to see that the announcement includes a physician-led model of care, upfront financial resources and participation by private health insurers, said AMA President Peter W. Carmel, MD. He said the initiative represents an exciting opportunity for physicians that will transform care at the local level.

"Physicians want to deliver coordinated, cost-effective care that improves patient outcomes, but the current payment system often penalizes the valuable services that make these improvements possible," Dr. Carmel said. "By providing a monthly care management fee for Medicare patients, [the innovation center] is recognizing the full scope of work done by physician practices to improve the health of their patients."

Until recently, the Medicare program had been absent from patient-centered medical home payment models, said Yul Ejnes, MD, chair of the American College of Physicians Board of Regents. Dr. Ejnes has had only one payer support the medical home at his practice, Coastal Medical Inc., in Rhode Island.

Dr. Ejnes said if his area of the country is selected to participate in the Medicare-led demo, it would mean that more payers would start supporting medical homes and more practices would be encouraged to adopt the patient-centered model, he said.

Some physicians have been waiting for payers to fund high-value primary care models rather than take the risk of transforming their practices without support for different payment models, said Glen Stream, MD, president of the American Academy of Family Physicians. Dr. Stream sees the point of the new program as bringing the funding to the practice so it can make the enhancements necessary to become a patient-centered medical home.

"We're confident this initiative will further demonstrate that patient outcomes improve and costs are saved when the health care system values primary care by paying for all the services family physicians provide to their patients," he said.

ADDITIONAL INFORMATION:

5 elements of comprehensive primary care

Medicare has established five core primary care functions that payers will pledge to support under its new comprehensive primary care payment model. Physicians who apply and are chosen to participate in the demonstration would receive resources to perform these functions.

Risk-stratified care management: Assessing all patients to identify and predict which ones need interventions, and developing care plans in consultation with patients.

Access and continuity: Providing patients with 24-hour access to a designated health professional or care team.

Planned care for chronic conditions and prevention: Offering proactive primary care through Medicare's annual wellness visit.

Caregiver engagement: Establishing policies to ensure that patient preferences are determined and incorporated into treatment decisions.

Coordinated care: Communicating key information during care transitions or referrals to other physicians.

Finding a cure for Alzheimer's - a family working together

Dan Flanzig — Wed, 05 Oct 2011 17:29:00 GMT

Hoping to Crack Alzheimer's, Together as a Family

Joshua Lott for The New York Times

AWAY FROM HOME Natalia Agudelo, who traveled to Phoenix from Colombia, belongs to a family linked to an inherited form of Alzheimer's disease.

By PAM BELLUCK and SALVADOR RODRIGUEZ

For the Betancur family, it was a kind of pilgrimage, an act of faith in science.

The Vanishing Mind

War on Dementia

Articles in this series are examining the worldwide struggle to find answers about Alzheimer's disease.

Health Guide: Alzheimer's Disease

In September, four family members traveled from Medellin, Colombia, to the Banner Alzheimer's Institute in Phoenix, along with eight distant relatives. There are many more where they came from, about 5,000 - all members of the largest extended family linked to an inherited form of Alzheimer's disease.

"There's no words to describe seeing a loved one decay to the point where you no longer recognize them," said Blanca Nelly Betancur, 43, whose mother and, so far, three siblings have inherited the disease. "To see them as a cadaver."

Banner's researchers and a Colombian neurologist are studying the extended family, planning a clinical trial to determine whether Alzheimer's can be prevented by giving drug treatment years before dementia begins.

The Colombian relatives are considered ideal for testing preventive treatments, because scientists can tell which family members will develop Alzheimer's and approximately when. Those getting the disease carry a genetic mutation causing memory loss in their early to mid-40s and often loss of most cognitive functions by their early 50s.

The trial is not expected to begin until 2012 because researchers are applying for federal financing and have not yet decided which drug to test. Testing will occur in the region where most relatives live, Antioquia, which includes Medellin and many isolated mountain villages.

But last month, 12 relatives visited Phoenix so scientists could conduct PET scans that can show whether their brains have the characteristic amyloid plaques of Alzheimer's disease. Altogether, these scans will be performed on 50 family members this fall, some with Alzheimer's already, some with the mutation that will cause it, and some who have no mutation and will not get the disease.

The snapshots of amyloid in family members with and without the gene, and with and without symptoms, will help focus the drug-testing study so researchers can better understand whether the drug is staving off Alzheimer's, said Dr. Eric Reiman, the Banner Institute's executive director.

"We need to find out when these amyloid plaques accumulate, how advanced they are by the time they enter the prevention trial," Dr. Reiman said. "This information will provide a foundation for knowing how much these brain changes have occurred roughly at the time people at their age will enroll in the trial."

The drug trial will test a treatment that attacks amyloid, most likely a drug already tried unsuccessfully in people with Alzheimer's symptoms. Many scientists now believe it is possible that drugs have failed so far because once symptoms begin, the brain is already badly damaged.

Initially, the project plans to enroll 100 relatives with the mutation who will receive the drug, plus 100 mutation carriers and 100 noncarriers who will receive a placebo. Participants will not be told whether they have the mutation or are receiving the drug.

Ms. Betancur's family is in an especially difficult position because she married a distant cousin, Carlos Alberto Villegas, and the mutation runs in both sides of the extended family. Her mother, who was living with them, died last year of Alzheimer's; a sister with early symptoms now lives with them, too. Mr. Villegas, 54, once a vibrant livestock trader, has Alzheimer's that is progressing so rapidly that in just the last year he has lost all ability to speak and walk.

"Psychologically it's very tough," said their daughter Natalia Agudelo, 24, who also traveled to Phoenix.

"After they lose memory, what remains are their instincts like animals," she said, adding that her father can still chew and make other instinctive movements. "Until his last moment, we'll be there seeing what more we can do to help, what more we can do to love."

Natalia and her younger brother and sister may have inherited the mutation from their father or, if their mother is a carrier, from her as well. As a result, Natalia has decided not to have children.

"I love babies, and I'd be so happy with children, but having a child isn't just 'Oh, how cute,' " she said. "You have to be realistic and be clear that the disease is very tough. They say in Medellin, 'Don't go spreading the Alzheimer's around.' "

Joining them in Phoenix were the elder Ms. Betancur's brother, William, 50, and her sister Estela, 46, both with symptoms.

William, who quit his job as a bus driver because he could not remember the stops, knows he is losing his mind. He is so enthusiastic about the research that when asked into which arm he preferred the intravenous tube, he said, "Anywhere! With William, you guys have no problems at all!"

But Alzheimer's makes him frustrated, irritable and "sad that my kids might eventually get the disease," said William, who had a vasectomy after his third child because of that risk. "I would almost prefer that I not have grandchildren. Or at least only a few."

When the relatives picked up their passports for the Phoenix trip, William got lost for an hour in the government building. He has no memory of the huge celebration his family threw in May for his 50th birthday. Asked his age, he still thinks he is 49.

"What's the point of doing these things for him if he doesn't even remember?" asked his wife, Elida Castrillón.

"Because he feels the love," Natalia said.

Estela said she had not been told if she has Alzheimer's, but believes she does, "because I begin to forget things."

She cries often and is lonely because her husband is estranged, and her daughter is busy with work and school. She hopes researchers might find a cure in time to benefit her.

These days, she is halfway through a book called "A Pesar de Todo, Que Linda Es la Vida" - "Despite Everything, Life Is Beautiful."

www.nyelderabuse.com

Congressional Report Shows 1/3 of nursing homes have been cited for abuse.

Dan Flanzig — Wed, 28 Sep 2011 19:16:00 GMT

CBS reports:

Families turn to nursing homes to give the elderly the care and attention they need, but a congressional report out Monday says 1,600 U.S. nursing homes - nearly one-third - have been cited for abuse, reports CBS News Correspondent Bill Whitaker.

Some 5,283 nursing homes were cited for abuse violations, according to a review of state inspection records requested by Rep. Henry Waxman, D-Calif. These homes were cited for nearly 9,000 abuse violations from January 1999 to January 2001.

"We found examples of residents being punched, choked or kicked by staff members or other residents," Waxman said.

Complete Coverage

For more of CBS News Correspondent Vince Gonzales' investigation into the country's nursing homes:

A Culture Of Corruption

Tracking Abuse In Nursing Homes

The Hidden Danger: Neglect

Fighting Elder Abuse

Keeping An Eye On The Caregivers

It's a shocking reality for thousands of older Americans, a trend CBS News first reported last year with the story of Helen Love. She was attacked by a certified nurse's assistant at a Sacramento facility, who was angered she'd soiled herself.

"He choked me and went and broke my neck and broke my wrist," said Love.

Helen Love died two days after her interview. Her assailant got a year in county jail and a CBS News investigation found that three other employees at the same Sacramento facility had been convicted for abuse, which should have barred them from nursing home work.

The nursing home industry agrees on the need for stiffer background checks, but disagrees abuse is widespread.

"The congressman himself said the great majority of long-term care in our nation is excellent. There are people every day that are working very hard to provide that care," said Charles H. Roadman II, president of the American Health Care Association (AHCA), a nursing home trade group that represents 12,000 nonprofit and for-profit centers and homes for the elderly and disabled.

Waxman, the top Democrat on the House Government Reform Committee, which oversees spending and other operations, said Congress should re-estalish an abolished federal law that boosts nursing home spending. The Boren amendment would guarantee that the nation's nearly 17,000 homes do a better job of screening, training and counseling their staff. Roughly 1.5 million seniors live in nursing homes.

Waxman is also introducing a plan that would require criminal background checks on nursing home staff and impose tougher standards on homes with violations.

The AHCA supports a federal criminal background check system for potential employees.

"Recruiting, training and keeping frontline nursing staff are among the most important things we can do to ensure our patients continue to receive quality skilled nursing care," said Roadman.

But center operators said abuse is not the norm in nursing homes and many staff members deserve praise.

"Our patients are like family, and incidents like those described here today are extremely rare," said Sharon Sellers, vice president of operations at Washington Home, a nearly 200-bed center in the District of Columbia.

Bruce Rosenthal, spokesman for the American Association of Homes and Services for the Aging, said Congress should focus on the troubled centers, rather than create cumbersome standards for all.

"We strongly believe nursing homes that exhibit consistently poor performance should either clean up their act or be put out of business," said Rosenthal, whose group represents 5,600 not-for-profit homes and centers.

Read All About It

A congressional report has found that 5,283 - over 30 percent - of the nursing homes in the U.S. were cited for an abuse violation that had to cause harm between January 1999 and January 2001. Over 2,500 of the violations were serious enough to cause actual harm or to place residents in immediate jeopardy of death or serious injury.

Click here to read the entire report.

The reported abuses were physical, sexual and verbal. All abuse is on the rise, the report said. More than twice as many nursing homes were cited for abuse in 2000 than in 1996. In 1996, 5.9 percent of all nursing homes were cited for an abuse violation during their annual inspections; in 2000, 16 percent of nursing homes were cited.

"It would have been intolerable if we had found a hundred cases of abuse; it is unconscionable that we have foud thousands upon thousands," Waxman said.

The report found that in 1,601 nursing homes - about 1 in 10 - abuse citations were made in serious incidents that either put residents at great risk of harm, injured them or killed them.

For instance, a resident was killed when another resident with a history of abusive behavior picked her up and slammed her into a wall. In another case, a resident's nose was broken by an attendant who hit her. An attendant raped another resident in her room.

It was not clear how many people were abused. In some cases, the report said, an abuse citation referred to a single victim; in others a single case affected several residents.

Investigators said many violations are neither detected nor reported, leading officials to believe the problem is underestimated.

The report also found:

more than 40 percent, or 3,800 abuse violations, were only reported after formal complaints from residents, their families or community advocates.

1,327 homes were cited for more than one abuse violation in the two-year period; 305 homes were cited for three or more abuse violations, and 192 nursing homes were cited for five or more abuse violations.

To Save on Health Care, First Crack Down on Fraud

Dan Flanzig — Tue, 27 Sep 2011 19:35:00 GMT

By KATHLEEN SHARP

Published: September 26, 2011

Santa Barbara, Calif.

LAST week, the Obama administration announced a plan to cut $320 billion over 10 years from the projected growth of Medicare and Medicaid . The plan would raise premiums and deductibles, lower payments to hospitals and require elderly people who receive care at home to make co-payments.

But before charging consumers more and eliminating valuable services, we should be much more aggressive in recovering money stolen from these taxpayer-supported programs. According to some estimates, health care fraud is a $250 billion-a-year industry, and about$100 billion of that is stolen from Medicare, the health care program for the elderly, and Medicaid, the insurance program for the poor and disabled.

There are many ways to defraud taxpayers. For example, a hospital chain can buy drugs at a steep discount and then bill Medicare for high sticker prices. Doctors can bill for procedures that never happened, or for drugs that were supplied to them by pharmaceutical companies free of charge, or pharmaceutical companies can promote a drug for risky, unapproved uses.

Recovering billions of dollars from these ruses won't solve the problem of rising health care costs, but it'll go a long way in helping to reduce waste and protect services.

Many states already aggressively pursue health care fraud. In 2005, a whistle-blower accused Quest Diagnostics, the chain of medical laboratories worth over $7 billion, of deliberately overcharging California's insurance program for poor and disabled people, Medi-Cal, for more than 15 years. He alleged that Quest had paid kickbacks in the form of free tests and discounts to doctors and hospitals that referred patients to its labs. Recently, while denying wrongdoing, the company settledfor $241 million. According to California's attorney general, Kamala D. Harris, it was the largest fraud settlement in the history of the state's False Claims Act.

Quest isn't accused of defrauding only California, however. Andrew Baker, a health care executive who ran a company acquired by Quest, has accused it of overbilling our national Medicare plan by as much as a billion dollars. The case was dismissed for technical reasons that had nothing to do with its merits, and Mr. Baker is appealing the dismissal. Oddly, the Department of Justice has not joined him.

Why not?

It could be that the Justice Department prefers to let the state attorneys general do the heavy lifting. Once a state wins a case, the feds can piggyback onto it. This may be happening in the Quest case since the department said it reserved the right to join the case later. But why wait? According to a public statement made by Mr. Baker (who, thanks to the False Claims Act, which encourages individuals to expose wrongdoing by giving them a cut of the recovery, could earn about $1 million from the case), the inaction could be explained in another way. "Quest is too big to go after," he said. The department instead seems to focus on individual physicians, like the Miami-area doctor recently convicted ofbilling Medicare $23 million for phony injections.

Compare this to Pennsylvania, which just obtained $49 million from four companies accused of selling drugs to state agencies at inflated prices. South Carolina, Idaho and other states are settling similar suits, and still the Justice Department idles.

At the beginning of this year, the Justice Department had more than 1,300 whistle-blower cases under investigation, the bulk of them related to pharmaceuticals, hospital chains and health care companies. That's up from the 900 or so cases that were stalled during the end of the Bush administration. To be fair, the department has long been understaffed when it comes to health care investigations. But in 2009, the Justice Department and the Department of Health and Human Services were given an additional $198 million to combat health care fraud. Neither the money nor a new task force seem to have helped much.

Last year, the Justice Department recovered $3 billion in false claims, $2.5 billion of that from health care cases. But that's just a drop in the bucket. It's gotten so that even if a case is settled, many pharmaceutical companies simply write it off as the cost of doing business. After all, if you're selling tens of billions of dollars' worth of drugs in one year, a $2 billion settlement is a slap on the wrist.

The only way to tell if taxpayers are getting their money's worth of fraud-fighting is for the Department of Justice to routinely publish, among other statistics on corporate fraud, a breakdown of the number of cases it opens and the number originating from whistle-blowers.

This should be a priority. Health care costs are rising toward unsustainable levels. But before we start cutting important programs, let's go after the fraudsters.

Kathleen Sharp is the author of "Blood Feud: The Man Who Blew the Whistle on One of the Deadliest Prescription Drugs Ever."

Punitive Damages Claims Dismissed Against Nursing Home for Alleged Violations

Dan Flanzig — Tue, 27 Sep 2011 17:21:00 GMT

Haym Solomon Home for the Aged (HSHA) moved to dismiss administrator Butler's claim for punitive damages asserted against it under Public Health Law §2801-d(2). Butler alleged HSHA violated §2801-d, claiming it violated decedent's rights by failing to provide wound care resulting in sepsis and death. HSHA's expert opined the record did not evidence neglect of decedent or his conditions, claiming his medical condition and death were secondary to his multiple morbidities. Butler's expert alleged defendant failed to prevent deterioration of skin ulcers while decedent was a resident of HSHA, resulting in an infection that led to death. The court noted that while there was ample guidance on punitive damages awards in negligence and malpractice actions, there was little direction as to the burden under the Public Health Law. Thus, the statute must provide direction, and the court found the instant case did not manifest a willful deprivation of a right or benefit, or a reckless disregard of a lawful right to decedent to permit his estate to maintain a claim for punitive damages. It concluded the ulcers decedent had upon his admission to HSHA did not deteriorate during his stay, hence, Butler's claims for punitive damages was dismissed.

Punitive Damages Claims Dismissed Against Nursing Home for Alleged Violations

Dan Flanzig — Tue, 27 Sep 2011 17:21:00 GMT

A guide to Nursing Home Abuse and Neglect Cases in New York, By Daniel FLanzig, Esq.

Dan Flanzig — Tue, 20 Sep 2011 22:22:00 GMT

A Guide to Nursing home and Assisted Living Facility Abuse and Neglect in New York

Written by: Daniel Flanzig,

Attorney licensed in New York

This is a guide to help you better understand the Nursing Home, Assisted Living and Elder Abuse Cases. This guide can be used to help you identify abuse as well as how to properly document the evidence and correctly report your findings.

Types of Neglect:

A report issued by the Department of Health and Human Services (DHHS) has found that of the nation's 15,000 nursing homes, "nearly all" nursing homes in the United States have received citations for health and violations in 2007. In most cases violations cited by Federal Inspectors consisted of: - Infected bed sores by caused by immobilization or sustained pressure - Malnutrition - Medication mishaps - Patient abuse (psychological or physical) - Patient neglect - Falls - Dehydration If you notice a distinct change in the patients behavior, such as being a sudden introvert, signs of bruising or lack of appetite.

Places where neglect can occur:

In our practice, we have seen abuse occur in nursing homes, assisted living centers, in patient and out-patient rehab centers and hospitals. Outside of these places, we have seen abuse occur at the hands of home health care aides, companion services, in-home therapists and nurses. A common place for injury is during transportation. Falls from wheel chairs, beds or gurneys can occur at hospitals, rehab centers and other medical facilities while patients are being transported from department to department. Falls can also occur while being transported by ambulance or ambulette. In New York City Access-A-Ride falls and accidents are also common as well.

What to do in case you Suspect Neglect.

If you suspect that you or a family member is the victim of assisted living abuse, it is important to immediately document and report the problem. Your report should include: The victim's name, age, and address The name of the facility and the person (or people) responsible for the victim's care The name of the person(s) who abused or neglected the victim The nature and extent of the victim's injuries, or physical signs of abuse or neglect The time, date, and location of the incident. This report should be dated and include a description of any previous incidents. An attorney can help you make this report and file a claim on your behalf.

Additional Resources

For more information, visit our website at NYELDERABUSE.COM

Humane Housing for the Mentally Ill at Nursing Homes

Dan Flanzig — Fri, 16 Sep 2011 16:15:00 GMT

Humane Housing for the Mentally Ill

Published: September 15, 2011

Gov. Andrew Cuomo brought an end to a shameful chapter in New York's history last week when he agreed to settle a suit over the mistreatment of mentally ill people who have been unnecessarily confined in nursing homes.

Related in News

In Deal, Hundreds of Mentally Ill People Will Leave Confinement of Nursing Home (September 13, 2011)

During the 1990s the state began shunting people who left state psychiatric hospitals into prison-style nursing homes, where they were barred from going outside, had little contact with others and had almost no ability to object to confinement. Under the settlement, New York will move as many of them as possible into community housing, where they will receive the services they need to live independently.

Federal disability law forbids warehousing of the disabled and requires the states to house and care for them in the least restrictive setting. The aim is to integrate the mentally ill into the communities where they live.

Advocates for people with mental illness, led by Disability Advocates, filed suit in 2006. They charged that the state's practice violated federal law and did little to give people the psychiatric treatment or life skills training they needed to live independently.

Under the settlement, the state will adopt a new discharge policy under which only those who cannot be cared for in the community will be sent to nursing homes. Over the next three years, more than a thousand nursing home residents will be evaluated to determine whether they are suited for independent living. New York also agreed to develop 200 units of housing that would be appropriate for this population. It is long past time to move these people into more humane, integrated settings.

Argument on Lawyers' Access to Home Residents Begins Term

Dan Flanzig — Wed, 07 Sep 2011 20:37:00 GMT

Argument on Lawyers' Access to Home Residents Begins Term

Joel Stashenko Contact All Articles

New York Law Journal

September 07, 2011

ALBANY - The Court of Appeals began its 2011-12 session yesterday by hearing a challenge to the rules imposed by the New York Coalition for Quality Assisted Living regarding visitors to its 33 facilities that advocates claim restrict residents' access to legal representatives.

Jane Bello Burke of O'Connell & Aronowitz in Albany, who represents the coalition (NYCQAL), argued that its guidelines are not in violation of Department of Health Regulations under 18 NYCRR 485.14. Those regulations prohibit public or private health care facility operators from restricting clients' access to "legal representatives" or "legal counsels."

See appellant NYCQAL's brief and reply brief, respondents MFY Legal Service and Coalition of Institutionalized Aged and Disabled's brief, and briefs for amici curiae Disability Advocates and New York Lawyers for the Public Interest and The Center for Constitutional Rights, Goddard Riverside's SRO Law Project, Housing Conservation Coordinators, Legal Services NYC, Make the Road New York and the Urban Justice Center.

"Is the thrust of your guidelines to put yourself between the resident and the visitor?" Chief Judge Jonathan Lippman asked Ms. Burke yesterday.

"Absolutely not," she replied,

She said the rules merely provide for a "confidential and private" place for the facilities 5,000 residents and their visitors to meet.

John M. Aerni of Dewey & LeBouef, who represented MFY Legal Services and the Coalition of Institutionalized Aged and Disabled, countered that it should be irrelevant whether an attorney or a family member or friend is visiting someone in an assisted-living or adult home.

Some patients may have legitimate reasons for not identifying visitors as attorneys, Mr. Aerni argued.

The coalition is "trying to deny access and accountability," Mr Aerni argued in New York Coalition for Quality Assisted Living Inc. v. MFY Legal Services Inc., 148.

Advocates for patients argue that there is an inconsistency between state law and NYCQAL's guidelines prohibiting visitors from wandering through facilities "for the purpose of blanket solicitation" of patients as clients. The rules also allow the operators of facilities to confirm that visitors are attorneys and to deny them access.

Supreme Court Justice Martin Shulman (See Profile) found that the coalition's rules were legal and enforceable, and would not have a chilling effect on the rights of residents to meet with or retain legal counsel.

The Appellate Division, First Department, overruled that determination, holding that the guidelines violated Department of Health regulations. The appeals panel found that state health law requires that visitors "state only the purpose of their visit" and do not have to reveal more to the operators of a facility.

The access to adult home patients was the first matter to be heard of the 22 cases on the Court's schedule this week and next.

CBS News Investigates Increase in Nursing home abuse

Dan Flanzig — Fri, 24 Jun 2011 17:45:00 GMT

Nursing Home Abuse Increasing

(CBS) Families turn to nursing homes to give the elderly the care and attention they need, but a congressional report out Monday says 1,600 U.S. nursing homes - nearly one-third - have been cited for abuse, reports CBS News Correspondent Bill Whitaker.

Some 5,283 nursing homes were cited for abuse violations, according to a review of state inspection records requested by Rep. Henry Waxman, D-Calif. These homes were cited for nearly 9,000 abuse violations from January 1999 to January 2001.

"We found examples of residents being punched, choked or kicked by staff members or other residents," Waxman said.

Complete Coverage

For more of CBS News Correspondent Vince Gonzales' investigation into the country's nursing homes:

A Culture Of Corruption

Tracking Abuse In Nursing Homes

The Hidden Danger: Neglect

Fighting Elder Abuse

Keeping An Eye On The Caregivers

Read All About It

more than 40 percent, or 3,800 abuse violations, were only reported after formal complaints from residents, their families or community advocates.

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