Private equity firms do not affect nursing home quality of care, Harvard study finds

from McKnight's:

A year after a news report uncovered resident care and ownership problems at privately held nursing homes, a new report from Harvard Medical School finds the opposite: Quality at nursing homes does not suffer, and, in certain cases, may even improve under private-equity ownership.

Norman DeLisle, MDRC
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Staffing Cuts and Mounting Patient Care Problems at Manor Care's Pennsylvnia Facilities under Carlyle's Ownership

A new analysis of federal government data reveals staffing cuts and a surge in violations at ManorCare’s Pennsylvania nursing homes while under Carlyle’s ownership. Average nurse and CNA staffing has actually decreased to just 3.29 hours per resident per day (HPPD) at the 20 Pennsylvania Manor Care nursing homes that have undergone annual surveys since Carlyle acquired the company on December 21, 2007. (1) Nurse staffing was cut by 21.4% to just 3.05 HPPD at Manor Care Health Services – Lansdale, a 170 bed facility in Montgomeryville. (2) In addition, none of the 20 facilities provided the 4.07 hours of care identified by experts in a 2001 study as the threshold below which quality of care is compromised. (3) This staffing data may help to explain a surge in violations of federal health and fire safety standards at these facilities, which increased 31% overall to 202 violations in their post-buyout surveys. (4)

Government survey records describe the tragic stories behind these violations:

ManorCare Health Services - York South was cited in January 2008 and again in May for two separate incidents involving a failure to timely notify a physician of a resident’s change in condition. The residents involved in both incidents died. In January, a resident with a history of fainting and at a known risk for falls fell and died several days later as a result of blunt force head trauma sustained in the fall. Incomplete information was faxed to a physician’s closed office, but a physician was not actually called for more than 17 hours after the fall occurred, during which time the resident exhibited symptoms of increased confusion and vomiting. (5) In May, the facility again failed to timely notify a physician after a resident, whose medication carried a known risk of side effects including heart attacks, complained of head and chest pain and had elevated blood pressure. The resident went into fatal cardiac arrest late that night. (6)

ManorCare Health Services at Mercy Fitzgerald was cited by government inspectors for failing to provide timely assistance to a resident who had amputations of both legs, whose repeated requests for assistance in using the bathroom went unanswered over the course of half an hour. (7)

Donahoe Manor was cited for failure to follow state law and its own policies requiring an FBI criminal background check for an employee who had been hired more than 9 months earlier, and for hiring a dietary aide who worked on the tray line and delivering carts before his tuberculosis skin test was completed. (8)

(1) This average is weighted to reflect different homes census level. The staffing data is based on information from “About the Nursing Home–Inspection Results,” Centers for Medicare and Medicaid Services Nursing Home Compare data, downloaded 7/22/2008 and 11/09/2007. Under federal law, nursing homes must be inspected every nine to 15 months.

(2) Ibid.

(3) Ibid.

(4) Ibid.

(5) MANORCARE HEALTH SERVICES-YORK SOUTH, Incident investigation and a State monitoring visit, 01/09/2008, F-0309.

(6) MANORCARE HEALTH SERVICES-YORK SOUTH, Medicare/Medicaid Recertification,

State Licensure, Civil Rights Compliance and Incident investigation survey, 05/22/2008, F-0309.

(7) MANORCARE HEALTH SERVICES AT MERCY FITZGERALD, M edicare/Medicaid Recertification, State Licensure and Civil Rights Compliance Survey, 01/08/2008, F-0309.

(8) DONAHOE MANOR, Medicare/Medicaid Recertification Survey and State Licensure Survey, 01/07/08, F-0226, F-0630.
— Greg Pawelski
Staffing Cuts and Mounting Patient Care Problems at Manor Care's Pennsylvnia Facilities under Carlyle's Ownership

A new analysis of federal government data reveals staffing cuts and a surge in violations at ManorCare’s Pennsylvania nursing homes while under Carlyle’s ownership. Average nurse and CNA staffing has actually decreased to just 3.29 hours per resident per day (HPPD) at the 20 Pennsylvania Manor Care nursing homes that have undergone annual surveys since Carlyle acquired the company on December 21, 2007. (1) Nurse staffing was cut by 21.4% to just 3.05 HPPD at Manor Care Health Services – Lansdale, a 170 bed facility in Montgomeryville. (2) In addition, none of the 20 facilities provided the 4.07 hours of care identified by experts in a 2001 study as the threshold below which quality of care is compromised. (3) This staffing data may help to explain a surge in violations of federal health and fire safety standards at these facilities, which increased 31% overall to 202 violations in their post-buyout surveys. (4)

Government survey records describe the tragic stories behind these violations:

ManorCare Health Services - York South was cited in January 2008 and again in May for two separate incidents involving a failure to timely notify a physician of a resident’s change in condition. The residents involved in both incidents died. In January, a resident with a history of fainting and at a known risk for falls fell and died several days later as a result of blunt force head trauma sustained in the fall. Incomplete information was faxed to a physician’s closed office, but a physician was not actually called for more than 17 hours after the fall occurred, during which time the resident exhibited symptoms of increased confusion and vomiting. (5) In May, the facility again failed to timely notify a physician after a resident, whose medication carried a known risk of side effects including heart attacks, complained of head and chest pain and had elevated blood pressure. The resident went into fatal cardiac arrest late that night. (6)

ManorCare Health Services at Mercy Fitzgerald was cited by government inspectors for failing to provide timely assistance to a resident who had amputations of both legs, whose repeated requests for assistance in using the bathroom went unanswered over the course of half an hour. (7)

Donahoe Manor was cited for failure to follow state law and its own policies requiring an FBI criminal background check for an employee who had been hired more than 9 months earlier, and for hiring a dietary aide who worked on the tray line and delivering carts before his tuberculosis skin test was completed. (8)

(1) This average is weighted to reflect different homes census level. The staffing data is based on information from “About the Nursing Home–Inspection Results,” Centers for Medicare and Medicaid Services Nursing Home Compare data, downloaded 7/22/2008 and 11/09/2007. Under federal law, nursing homes must be inspected every nine to 15 months.

(2) Ibid.

(3) Ibid.

(4) Ibid.

(5) MANORCARE HEALTH SERVICES-YORK SOUTH, Incident investigation and a State monitoring visit, 01/09/2008, F-0309.

(6) MANORCARE HEALTH SERVICES-YORK SOUTH, Medicare/Medicaid Recertification,

State Licensure, Civil Rights Compliance and Incident investigation survey, 05/22/2008, F-0309.

(7) MANORCARE HEALTH SERVICES AT MERCY FITZGERALD, M edicare/Medicaid Recertification, State Licensure and Civil Rights Compliance Survey, 01/08/2008, F-0309.

(8) DONAHOE MANOR, Medicare/Medicaid Recertification Survey and State Licensure Survey, 01/07/08, F-0226, F-0630.
— Greg Pawelski
What do sewer sludge and Manor Care nursing homes have in common?

Washington, DC-based Carlyle Group owns Synagro Technologies, the company that processes municipal waste products, transports the resulting "sewer sludge" and distributes it for land application. Residents from around Pennsylvania have been calling for the expanded testing of Synagro sewer sludge and public reporting on its toxicity and disposal. Communities don't know everything that is in the sludge dumped on nearby lands. Without more information, there are possible health effects and diminished quality-of-life issues.

Concerns about the safety of Synagro sludge have intensified since the company's April 2007 buyout by The Carlyle Group. By taking Synagro private in a leveraged buyout, Carlyle is able to avoid requirements that Synagro provide federal agencies with certain information about its business practices and avoid publicly disclosing the existence of regulatory inquiries or legal complaints against the company resulting from health hazards caused by Synagro products and product distribution.

This has been happening with The Carlyle Group's take-over of Manor Care nursing homes. Manor Care's restructure could obscure ownership and make it more difficult to regulate care. You can't see how they are wasting money, short-staffing, under-paying workers, or understand all the intricate inter-relations they have with supposedly outsourced services such as therapy.

All 46 Manor Care nursing homes in Pennsylvania staff below a standard recommend in a Centers for Medicare and Medicaid Services (CMS) study as putting residents at risk (Schnelle, et all. Appropriatness of Minimum Nurse Staffing Ratios in Nursing Homes: Phase II final report, December 2001).

The steady cash flows nursing home operators produce is a big attraction for private-equity firms that need the cash to pay down borrowed debt. Beverly, Extendicare, Genesis and Vencor/Kindred went private, and now Manor Care. Private firms keep all their dirty deeds from the public, especially consumers.

Ownership structures with multiple stakeholders have been used by other private-equity firms to minimize liabilities and shield them from regulator inquiries. They use these kinds of structures to avoid taking responsibility when taking control of businesses. Private-equity buyout firms such as the Carlyle Group are not required to publicly disclose information about the business practices of the companies they own.

The Carlyle Group, one of the world's largest private-equity funds with more than $75 billion under management, owns Manor Care, the largest nursing home chain, and Synagro, the largest sludge company in the United States. Perhaps they'll process all their municipal waste products, and distribute it to the lawns and gardens of all their nursing homes and add to the significant health complaints at the homes?
— Greg Pawelski