The Homeplace at Midway opens, with cottages for nursing, assisted living, memory care; first 'Green House' facility in Ky.

By Kacie Kelly and Al Cross
University of Kentucky School of Journalism and Telecommunications

The Homeplace at Midway was formally opened Thursday, June 25, bringing to fruition a 16-year campaign for a nursing home in the Woodford County town of 1,700. For photos from its June 28 open house, click here.

Construction this spring (Christian Care Communities photo)

The Homeplace, which has four residential buildings that look like single-family homes, is more than a nursing home. Two of the buildings are for skilled nursing, but one is for assisted living and the other is for "memory care" or personal care of patients with dementia and other cognitive impairments.

“The Homeplace at Midway represents a new beginning for older adults in Kentucky and for communities across the commonwealth to embrace them as living treasures, not a burden or a challenge,” Dr. Keith Knapp, president and chief executive officer of Christian Care Communities, which built the Homeplace and will operate it, said at the ribbon-cutting ceremony.

Assisted living cottage (Photo by Kacie Kelly)

“We are extremely grateful to the City of Midway, the Midway Nursing Home Task Force, Midway College, state and local government agencies, our capital campaign’s Leadership Council and all our friends and supporters who championed this new direction and envisioned with us a new day when older adults would receive the highest quality care and support, without feeling their lives are being disrupted or overtaken,” Knapp said. “We trust that it will inspire other senior living providers to move in a similar direction.”

The Homeplace is the first facility in Kentucky built with The Green House model, which includes home-like environments and strong relationships with caregivers, with the goal of meaningful lives for residents. Dr. William Thomas, creator of the model, told the crowd at the event, “The Homeplace, with its emphasis on home, shows how care can be made more loving, community centered and effective.”

One of the two skilled-care cottages (Photo by Kacie Kelly)

Patients have been moving in all month. The staff at The Homeplace is trained to use the “best friend approach,” Laurie Dorough, the facility's community-relations manager, said in an interview. Staff and volunteers are to treat residents as they would treat a best friend.

Knapp said at the ribbon-cutting, “Each resident will have a private bedroom and bath and share, just as people do in any home, the kitchen, living room, den and porch areas. It’s all designed to give residents the freedom to set their own daily routines and to live life to its fullest, while receiving the individual care they need – within each cottage.

The assisted-living cottage is larger than the others, to provide room for more activities and “the potential for spouses to live there,” said Laurie Dorough. “It’s kind of the first step out of independent living,” she said. The cottage has an open kitchen where residents can get involved with meal preparation or “come out and see what’s cooking.”

Skilled-care cottage bathroom lift system (Photo by Kacie Kelly)

The skilled-nursing cottages have bedrooms with medicine cupboards rather than medical carts, and a bathroom lift system (photo at right) that takes the resident straight to their own bathroom. The bedrooms are relatively small, an incentive for residents to spend more time in the communal living space.

The Homeplace campus, across Weisenberger Mill Road from Midway College, also includes an administrative cottage and the Lucy Simms Lloyd Gathering House for special gatherings, worship services and activities.

Between the cottages is the courtyard, with lighted walking paths from building to building, a gazebo, and space for outdoor activities. “Our hope is to maybe start a community garden,” said Dorough.

The long campaign for a nursing home, led by the Midway Nursing Home Task Force, began to see success in 2010 when Louisville-based Christian Care agreed to be the developer. Christian Care has facilities in 11 Kentucky cities, and a church-outreach program with more than 230 churches as partners.

The Homeplace will have a partnership with Midway College, which becomes Midway University July 1. “We are excited to work with Midway College to not only provide learning opportunities for students but also for the residents of The Homeplace,” said Tonya Cox, the facility's executive director.

The Homeplace will be offering internships and other learning opportunities for students. This partnership will also benefit residents, Cox said: “Our residents will also have the opportunity to attend events and classes to foster their lifelong learning.”

Cox said The Homeplace aims to provide “unique long-term care in a way that honors their preferences and desires to be home.” More information is on the facility's website. It will host an open house from 1 to 3 p.m. Sunday, June 28.

Louisville's PharMerica is still a defendant in federal cases in which big drug makers have paid billions in fines

Abbott Laboratories has paid billions, and Amgen Inc. has paid millions, in fines for offering "rebates" or "kickbacks" to get pharmacy companies to increase their prescriptions of drugs in nursing homes, and PharMerica Corp. of Louisville is the remaining defendant in both civil cases, according to a detailed report by James McNair at the Kentucky Center for Investigative Reporting.

PharMerica manages drug benefits for nursing homes, hospitals and assisted living facilities. McNair paints a dismal picture of nursing homes and says they are ripe for this type of abuse, writing that they house "people with age-weakened bodies, multiple ailments and, often, severe mental impairment. Many are over-medicated. Many have no visitors. A third of them will die within a year of admission." (Click on chart for larger version)

McNair notes that a whistleblower lawsuit first called attention to Abbott Labs, which pled guilty in 2012 to a criminal charge, settled civil kickback and fraud claims, and paid $1.5 billion in fines for its role in paying millions of dollars in "rebates" to get pharmacy companies to increase prescriptions for an anti-seizure drug, Depakote, for uses beyond its Food and Drug Administration approval. Medicaid payments for this drug "went on to top $7 billion," McNair reports.

Amgen also enlisted these same pharmacy companies to promote its anemia drug, Aranesp, for uses beyond its FDA approval, and after pleading guilty settled civil kickback and fraud charges and paid a total of $762 million in fines.

These two cases brought more government attention to such schemes, which are "standard practice in the pharmaceutical industry," and also on the pharmacy companies that are on the receiving end of the payoffs, McNair writes.

McNair describes PharMerica as the "second-biggest operator of nursing home pharmacies in the country" and writes that it had " $1.9 billion in revenue last year," making it the "10th-biggest publicly traded company in Kentucky, according to rankings by The Lane Report." Since 2007, the chief executive has been Gregory Weishar (pronounced WISH-er) .

Companies like PharMerica, and its larger competitor Cincinnati-based Omnicare Inc., act on behalf of the nursing homes, buying drugs from the pharmaceutical companies in bulk and then dispensing them under the supervision of "consultant pharmacisits," McNair reports.

The Abbott Labs and Amgen lawsuits assert that PharMerica gave "certain drugs to nursing home patients in return for drug company kickbacks, not because they were the "right medication."" McNair reports that the suits were filed by drug company insiders who have knowledge of these payoffs disguised as "rebates" or "discounts."

"PharMerica denies the claims," writes McNair. But the company has been in this type of case many times since 2005, McNair reports: It has agreed to pay $40 million in fines to settle federal complaints, five additional closed cases connected to this company.

McNair also reports that just last week, the Justice Department said PharMerica will pay $31.5 million for dispensing addictive painkillers to nursing home patients without prescriptions, then falsely billing Medicare. As part of this settlement, PharMerica also agreed to a five year "corporate integrity agreement," which McNair notes later in the article are rarely enforced.

McNair goes on to list the details of several other cases PharMerica has been involved in, one of them "deemed so flagrant that the inspector general sought to ban PharMerica from federal health-care programs for 10 years."

PharMerica declined to make its executives available for an interview with the Kentucky Center for Investigative Reporting but said in a statement: “PharMerica is committed to outstanding compliance and the highest standards of ethical conduct, and we are diligent in ensuring that we comply with all applicable law and regulation,”

Jan Scherrer, vice president of Kentuckians for Nursing Home Reform, a non-profit advocacy group based in Lexington, told McNair that the CEOs of companies involved in kickback schemes should be held personally accountable, "These are not victimless crimes," he said.

“It’s the same players -- PharMerica and Omnicare,” Scherrer continued. “They keep doing this over and over and over, and all they get is a fine. And for them that fine is nothing more than the cost of doing business.” (Read more of this detailed report by clicking here.)

Senate OKs bill for review panels in medical lawsuits after lively debate between doctors, lawyers, others

This story, which was published Thursday morning, has been updated with action in the full Senate.
By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- The Senate has approved a bill that advocates say will help weed out "frivolous" medical malpractice lawsuits and speed up litigation for legitimate suits.

Alvarado

"Right now, Kentucky has one of the nations most litigation-friendly environments, making our commonwealth a prime and profitable target for personal injury lawyers preying upon our health care providers," Sen. Ralph Alvarado, R-Winchester, a physician and sponsor of Senate Bill 6, told the Senate Health and Welfare Committee. Opponents disputed that claim.

The Senate passed the bill Thursday 24-12. It is not expected to pass the House.

The bill would establish panels of three medical experts, two chosen by each side and the third chosen by the other two, to review suits against health-care providers to determine if the case has merit before the lawsuit can proceed. Panel findings would be admissible in court but not legally binding.

The Republican-controlled Senate passed a very similar bill last year but it got nowhere in the Democrat-controlled House, and its prospects are similar this time. However, Wednesday's committee meeting provided a detailed and lively explication of the issue, lasing almost two hours.

Vanessa Cantley, a Louisville personal injury attorney, told the committee that most medical malpractice cases are legitimate. She cited a Harvard University study published in the New England Journal of Medicine that concluded "portraits of a malpractice system that is stricken with frivolous litigation are overblown" and reported that 97 percent of claims for medical injury evaluated over a decade were deemed to be meritorious.

However, Michael Sutton of Louisville, a civil defense attorney, said defendants win 80 per cent of medical malpractice suits.

Cantley said there are 2,700 deaths in Kentucky each year due to purely preventable medical error, but, according to the state Department of Insurance, fewer than 500 lawsuits a year are filed by abuse and neglect victims. She spoke for the Kentucky Justice Association, formerly the Kentucky Academy of Trial Attorneys.

Alvarado and other opponents argued that Kentucky has become a haven for such lawsuits and bills like his have helped deter them. "Medical review panels are a proven solution for limiting baseless claims brought by a personal injury lawyer to ensure a faster, more efficient path for patients with legitimate claims, " he said.

Alvarado said the state is 4,000 doctors short of its need and the legal climate in Kentucky makes it hard to recruit and retain doctors. Sen. Julie Raque Adams, R-Louisville, the committee chair, said the expansion of Medicaid in Kentucky makes it all the more important to make the state attractive to doctors. "Anytime there's a paradigm shift, there are other policies that  need to go along with that paradigm shift," she said.

Dave Adkisson, president and CEO of the Kentucky Chamber of Commerce, said review panels "will stabilize our medical malpractice system and make our state more attractive" and "protect the legitimate cases while weeding out the meritless claims," which increase costs to consumers and employers through higher premiums and defensive medicine in the form of extra medical tests.

Kentucky's constitution bans laws that would cap damages

in lawsuits. (Care First Kentucky graphic)

Every state surrounding Kentucky offers some level of protection against medical malpractice, while Kentucky offers no legal protections for healthcare providers, according to Care First Kentucky, a business coalition supporting the bill.

Sen. Reggie Thomas, D-Lexington, a lawyer, argued that Kentucky already has laws to punish attorneys for filing frivolous cases. Alvarado said the rule isn't used much because judges "allow a lot of latitude," and Sutton said it is reserved for "really egregious conduct."

Cantley argued, subtly, that courts are the refuge for patients who suffer from abuse, neglect and malpractice. She said the federal Centers for Medicare and Medicaid Services has ranked Kentucky No. 1 in nursing-home deficiencies, and argued that state boards that discipline doctors do a poor job.

The full Senate's debate on the bill was cut short because the committee adopted a substitute version, preventing Democratic Leader Ray Jones of Pikeville, a plaintiffs' lawyer, from offering any of his amendments, which had been drafted to the original bill. Under traditional procedures, a bill gets its required readings on days between the committee meeting and the floor vote, but in recent years Republicans have given important bills readings before committee action, allowing a vote on them the day after they pass a committee.

Medicare ratings for nursing homes rely heavily on self-reported data; recent inspection data are available elsewhere

Next time you look at Medicare's ratings for nursing homes, be aware that most of the information used to make the ranking is based on self-reported data and is not verified by the government.

Consumers and investors make critical decisions based on these misleading "gold standards" that are doled out by Medicare, Katie Thomas reports for The New York Times.

"Only one of the three criteria used to determine the star ratings - the results of the annual health inspections — relies on assessments from independent reviewers," Thomas writes. "The other measures — staff levels and quality statistics — are reported by the nursing homes and accepted by Medicare, with limited exceptions, at face value."

ProPublica, the nonprofit, investigative journalism enterprise, offers a program, Nursing Home Inspect, that allows consumers to search and analyze the details of recent nursing home inspections, featuring tools the federal government's Nursing Home Compare doesn't have, including the ability to search using any keywords and the ability to sort results based on the severity of the violation and by state. (Read more)

The Medicare ratings also do not account for fines and other enforcement actions by state, rather than federal, authorities,Thomas reports, or complaints filed by consumers with state agencies.

Starting this year, Medicare will use this same type of rating system not only in nursing homes, but also in hospitals, dialysis centers and home-health-care agencies, Thomas writes. And federal officials told Thomas that "while the rating system can be improved — and that they are working to make it better — it gives nursing homes incentives to get better." They cite the homes' reduced use of physical restraints, and fewer reports of bedsores, as examples of improvement.

But current and former nursing home employees, lawyers and advocacy groups say some nursing homes have "learned how to game the rating system," Thomas writes. Nursing home ratings have risen steadily since the program began, she notes. "In 2009, when the program began, 37 percent of them received four- or five-star ratings. By 2013, nearly half did."

The Times analysis also shows that even if a nursing home has a history of poor care, it self-reports better. "Of more than 50 nursing homes on a federal watch list for quality, nearly two-thirds hold four- or five-star ratings for their staff levels and quality statistics," Thomas writes. These same homes received one or two stars for the health inspection, which is conducted by state workers.

“These are among the very worst facilities, and yet they are self-reporting data that gives them very high staffing and very high quality measures,” Toby S. Edelman, a senior policy lawyer with the Center for Medicare Advocacy,told Thomas. “It seems implausible.”

Nursing-home industry cited as example of how campaign-funding lobbying interests get what they want from General Assembly

Lobbying groups' political action committees gave almost 40 percent of the money that the campaign committees of the legislature's party caucuses received in the last 18 months, Tom Loftus reports for The Courier-Journal.

"Much of the remaining 60 percent came in contributions from officers of corporations and associations representing highway contractors, nursing homes, coal companies, payday lenders and other interests with an active lobbying presence in the state capital," Loftus writes. "The Senate Republican Caucus got at least $26,000 from about 30 owners or employees of Kentucky nursing homes."

"It's a part of the equation where we can't compete," Bernie Vonderheide, president and founder of Kentuckians for Nursing Home Reform, told Loftus. "The only tool we have to compete with that is to try to make our case to the public and hope." For several sessions of the legislature, the group has lobbied for staffing requirements at nursing homes, to no avail.

The winner of that lobbying battle is the Kentucky Association of Health Care Facilities, which has a generic name but is in fact the main lobby for nursing-home owners. KAHCF President Betsy Johnson sent Loftus this statement: "We support candidates who have consistently supported Kentucky's excellent caregivers, and in particular some of our most pressing issues including medical liability reform."

Loftus reports, "The General Assembly's two top leaders, who have been leading fundraising drives for their caucuses for the past month, say there's no problem." He quotes Senate President Robert Stivers, R-Manchester: "Contributions do not influence policy. ... It's the policy that influences contributions."

House Speaker Greg Stumbo, D-Prestonsburg, told Loftus, "We tell them when we have our fundraisers that this doesn't guarantee anything except that we will promise we will listen to your problems and we'll try to be honest with you." (Read more)