California Nursing Home Residents Told To Find New Homes

Yves here. Yet another case study in neoliberal cruelty. At least in California, nursing home regulations appear to prevent dumping these older people onto the street. But you can imagine their care being degraded so as to force any relatives still left in the picture to haul them out.

By Jocelyn Wiener: @jocelynwiener. Published byCalifornia Healthline, a service of the California Health Care Foundation

Some of California’s most vulnerable nursing home residents, many of whom have nowhere else to go, are receiving letters from their health care plans saying they are no longer eligible for long-term care.

In one notable example, three dozen nursing home residents in San Luis Obispo County were informed on the same day that their Medi-Cal managed care plan was cutting off payment for nursing home care, said Karen Jones, the county’s long-term care ombudsman.

The residents included a 68-year-old amputee with diabetes, memory loss and kidney disease who required dialysis three times a week, and an 82-year-old man with congestive heart failure and diabetes who wasn’t strong enough to transfer himself from his bed to a wheelchair, Jones said.

“It just felt like we were tossing our seniors and disabled adults,” Jones said of the letters, which arrived in September 2018 and sparked a year-long dispute. “‘Sorry, we’re going to save some money here.’ That’s exactly what it felt like.”

The California Department of Health Care Services, which administers Medi-Cal, the state’s Medicaid program for low-income people, said the terminations by the managed care plan, CenCal Health, were isolated, a perspective some long-term care advocates share. CenCal said it was just following protocol, examining the books to make sure members still met the qualifications for long-term care under Medi-Cal.

But California Healthline interviewed multiple long-term care advocates and legal aid attorneys on the Central Coast and other parts of the state who said they have witnessed an increase in coverage denials for nursing home residents covered by Medi-Cal managed care plans. They worry such denials may soon become more commonplace: Medi-Cal nursing home care in all 58 counties will be placed under managed care beginning in January 2021, the state announced recently — up from 29 counties currently.

Under managed care, the state pays plans a monthly rate for each recipient to provide all of the medically necessary services that person needs. By comparison, under traditional “fee-for-service” Medi-Cal, the state compensates medical providers directly for each service they render.

California and other states increasingly are moving their Medicaid patients into managed care, arguing that the model saves money and also improves members’ health by coordinating care. More than 80% of the 12.8 million Californians on Medi-Cal are covered by managed care.

Long-term care advocates fear that the trend means more frail people will be forced out of nursing homes as managed care plans look to their bottom lines.

“We’re looking at multiplying this problem across the state,” said Leza Coleman, executive director of the California Long-Term Care Ombudsman Association.

The typical nursing home population in California is about two-thirds Medi-Cal, and many have given up everything — their apartments or mobile homes, their furniture, their burial insurance — to qualify, said Lonnie Golick, ombudsman for Shasta, Trinity, Siskiyou, Modoc and Lassen Counties in Northern California. Golick said she’s received a number of complaints against Partnership HealthPlan of California about coverage terminations. “They gave up their whole life,” she said. “And then they’re told, ‘It’s time to go.’”

Exacerbating the problem, Coleman added, is a shortage of assisted living facilities willing to serve Medi-Cal patients who no longer qualify for nursing home care.

To be eligible for nursing home coverage under Medi-Cal, individuals must have medical needs that require continual, around-the-clock care to prevent significant illness or disability, or alleviate severe pain.

CenCal sent the termination letters to the San Luis Obispo County nursing home residents as part of the process of reviewing their eligibility, said Bob Freeman, CenCal’s CEO. Normally that process is spread out over the year, he said, but the plan got “backed up” on evaluations, which is why so many patients were notified at once.

“We don’t like to do this,” he said. “It’s destabilizing; we don’t want to disrupt people’s lives. We do have state regulations that we have to follow.”

Last month, the Department of Health Care Services sent Medi-Cal managed care plans a notice clarifying that federal law allows residents to stay in nursing homes to receive “intermediate care”; in essence, plans should pay for lower levels of care rather than terminating coverage.

Freeman said the plan is reconsidering some residents’ eligibility, given the clarification. And Jones, the San Luis Obispo ombudsman, said CenCal recently hired a new nurse who has begun restoring eligibility for some residents in certain homes.

But residents of other homes — and in other regions — are still facing denials.

David Green, 60, a registered nurse in Santa Barbara County, said his 90-year-old mother received a letter last year telling her CenCal would no longer pay for her care at Marian Extended Care Center in Santa Maria.

She’d landed in a nursing home in 2016 after a bout of sepsis, he said. At first, she was so weak, she couldn’t walk. By the time she got the letter, her strength had improved, but she still had diabetes, kidney disease, hypertension, atrial fibrillation, breast cancer, memory loss and pain in her artificial knees, Green said.

Green sought out the Santa Barbara County ombudsman and, later, a lawyer. Eventually, he prevailed — but he’s always on alert for another letter.

“It’s very nerve-racking,” he said.

Tessa Hammer, the attorney from Legal Services of Northern California who helped Green, said she has worked on seven such cases out of Santa Barbara County, as well as a handful in the state’s rural northern counties. She’s concerned about residents who don’t have family advocating for them.

“I’m not sure where those folks might end up,” she said.

Golick, the ombudsman for several northern counties, said a man in his 80s in Trinity County received a notice from Partnership HealthPlan earlier this year that he was no longer covered for nursing care he’d depended on for a decade. Like many elderly residents, she said, he felt he had no choice but to comply. He told her he might sleep on someone’s couch, or in his brother’s car.

“Rural areas are really scary,” she said. “Where the hell do you go?”

Dustin Lyda, a spokesman for Partnership, said the plan doesn’t track data on these kind of coverage denials, but anecdotally hasn’t noticed an upsurge. Lyda said the plan works with facilities, doctors and family members to determine a patient’s needs. If Partnership determines skilled nursing is no longer medically necessary, it works for 60 days to find an alternative solution, he said.

In the meantime, nursing homes find themselves in a difficult situation. They cannot legally discharge residents who don’t have a safe place to go, but they are no longer paid to keep them. In some cases, including in San Luis Obispo, nursing homes have kept residents without pay.

“We’re all watching this closely,” said Craig Cornett, CEO of the California Association of Health Facilities.

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  1. JBird4049

    “We don’t like to do this,” he said. “It’s destabilizing; we don’t want to disrupt people’s lives. We do have state regulations that we have to follow.”

    Ah, the “I was just following orders” defense. How apropos. I guess one’s soul is really is less important than money. /s

    I am getting to just purely hate my state’s government and a system that consumes lives for the mere possibility of having more money.

  2. notabanktoadie

    May we note that the Progressive recipe for progress, which is apparently this:

    1) Welfare for the banks* and the rich** – to promote economic growth

    2) Welfare for the victims of the banks and the rich – so that all may profit from the economic growth produced by 1)

    is now a proven failure as far as promoting the general welfare?

    So much then for mere pragmatism over principles and ethics.

    *e.g. government guarantees for private liabilities.
    ** e.g. positive yields/interest on the inherently risk-free debt of the monetary sovereign.

    1. EricT

      You don’t understand what progressive policy is. What you are describing are neo-liberal policies.

      1. Mel

        Yeah. It disturbs me that we let our language slip like this. When the enemy has grabbed one of our words, “progressive” in this case, we just let them keep it. Some day we won’t be able to describe ourselves at all. At the very least, please use the “™” mark, i.e. “Progressive™”, to indicate that the use in the present case is commercial.

    2. Kathryn

      And Sanders & Warren’s M4A is exactly this model – all institutional providers (hospitals, cancer centers, dialysis, rehab, skilled nursing, etc) get a hard capped budget decided in DC by Sec? HHS. AND, Regional Directors monitor spending to ensure no over authorizing before dispensing quarterly Allotments of capped budget.

      And US House proponent of M4A Rep Jayapal’s bill specifically excludes state governments from any role in setting the budget or allocating. Sec HHS allocates each institutional provider at state level their share of the capped budget.

      Think about that Power in the hands if a Trump Sec., or a future Bush43 or Reagan.

      Read Title VI of these bills.

      1. ChiGal in Carolina

        There is plenty of waste and fraud or at least artificially inflated salaries for those at the top in medical institutions. They will adjust to global budgets just fine because they will have to: there will be a single payer.

  3. Henry Moon Pie

    We’ve created a society where it’s necessary for all able-bodied adults in a nuclear family to work long hours to maintain a “middle class lifestyle.” There’s no time left for looking after children or the elderly as humans were once wont to do.

    Human productivity has reached a point where life could be rather easy and pleasant for everybody in our society, but we’re organized to make life as full of drudgery, anxiety and empty materialism as possible. “Experts” decide that the elderly must first divest themselves of everything but their toothbrush in order to receive otherwise unaffordable nursing home care, then another “expert” comes along and advises the state to save money by requiring some of those penniless patients to depend on in-home care when they’ve already been stripped of a home. What would we ever do without these brilliant “experts?”

    If you’ve ever spent much time in a nursing home, you know what an awful solution it is for the problems of aging and infirmity. It’s also very expensive even when the highly stressed workers are paid a pittance. If our entire society weren’t organized around making a few people bizarrely rich, maybe we could go back to caring for children and the aged within families and small community groups.

    1. David B Harrison

      My mom was in a nursing home for app.3.5 years. I visited her there over 1000 times.The staffing was horrible, many times two CNAs would have to take care of 90+ patients.This all about greed(66,000 dollars a year for substandard care).

    2. Prairie Bear

      If our entire society weren’t organized around making a few people bizarrely rich …

      Yes, that, and also what we make them rich doing, which is global militaristic “full spectrum dominance” and surveillance, to the tune of $1 TRILLION per year or more.

      1. Henry Moon Pie

        It’s great when you can have an entire nation of taxpayers take care of the security line in your budget. Sometimes, they’ll even handle the acquisition of new resources.

  4. Steve H.

    > many have given up everything — their apartments or mobile homes, their furniture, their burial insurance — to qualify

    This is a real thing, my mother (not in Cali) gave up her ‘wealth’ – Section 8 qualification, for example – to get placement in a non-care facility. The residents cover for people who *need* care, because you can get moved out of the facility without having a place to go.

    IIRC, the facility gets over $1600 per one-bedroom apartment, in a town where you can get a house for $1000 a month. Sweet deal if you can get it.

  5. Lee

    Infirm elders could be a cost saving export product. We could stamp “Made in U.S.A.” on their butts, send them to a low wage, lower medical cost country, pay the rates there, and save money.

    1. The Rev Kev

      Something like that was the subject for a popular film called “The Best Exotic Marigold Hotel”-

      I guess that the elderly are now to be pursued as a commodity that is to be monetized with all value extracted and then the elderly themselves dumped on the streets. It took people with college educations and MBAs to come up with an idea like that. May their twilight years be the same.

      1. Whoamolly

        I loved Best Marigold Hotel when it came out. Now, however, after seeing a couple friends get old and move into nursing homes, I see it as a nasty fairy-tale.

        The elders in the film were exceptional people. (Hey, it’s entertainment.) They were all healthy, mobile, mentally alert and flexible enough to move to a foreign country. They also had the wealth to travel to India.

        A couple years ago, a close friend moved to a local nursing home. When I visit her I hear the gossip about her roommates and neighbors and see who else lives there. People who end up in a nursing home have very few of the characteristics of the Best Marigold Hotel residents. They are, instead, ordinary people who had the misfortune to get old and sick in America.

        I’ve decided that the best hope most of us have is to stay healthy as long as we can, and pray we die quickly.

        PS: After a few years of regular visits to my friend, I remain amazed at the number of husbands, wives and friends who trek daily and weekly to the nursing home to visit their loved ones. The staff is generally competent and caring. Even when overworked.

    2. Danny

      In addition to older legal immigrants and their parents, that we IMPORT, 6% of California’s population are illegal aliens. Now the state even pays for much of their medical care.
      “About half of California’s undocumented immigrants have incomes low enough to qualify for Medi-Cal should coverage be offered to them. Their highest concentrations are in Los Angeles, Orange, and Santa Clara Counties, the Inland Empire, and the San Joaquin Valley.”

      It’s a big world and we have to share, according to the people in power. Of course, these immigrants, legal or illegal, have not been paying taxes for half a century, nor did their relatives fight and die in wars and build the country going back generations.

      The old people from the Greatest Generation and the Boomers will just have to sacrifice for the greater hemispheric good and to maintain markets, cheap labor and the state Democratic Party.

      Bernie Sanders is our only hope to reform the steaming pile of greed that is our so called health care system. Even he is against the national suicide of open borders.
      “”If you open the borders, my God, there’s a lot of poverty in this world, and you’re going to have people from all over the world. And I don’t think that’s something that we can do at this point. Can’t do it. So that is not my position.”

      1. CarlH

        You seem to be really, really obsessed with immigrants, legal or not. How can they be the source of all of your anger? Why aren’t you ever going on and on about the employers that hire these people, thus giving them a reason to come here in the first place? Learn to punch up and quit punching down. It is not the poorest and most vulnerable among us who are the source of our problems. It is our elites who profit off of them.

        1. Felix_47

          He was talking about the parents or elderly relatives of immigrants. You would be amazed at the amount of elective care these patients consume all elective……total joints, spine surgery, stomach bypass and on and on. All paid by MediCal. They have total joints in the Punjab at very low cost but they get them here. Of course I would like to think we have a lower complication rate but one cannot dispute that they have not paid into the system for coverage. An American could not go to Germany or France and get elective total joints at 50 to 100K per pop or stents or whatever. An American cannot emigrate to Germany unless they have health insurance in force. An American cannot stay in Germany on more than a three month tourist visa without proof of income and health insurance. Is it really punching down to say that these are reasonable requirements? And I am talking about legal migrants, parents of legal immigrants in the US. Don’t even think about the illegals. Like what do you think a course of HEP B treatment costs or untreated diabetes or said total joints or spine surgery etc. on and on.

        2. Danny

          Gee Carl, You seem to be really obsessed with me.
          Discuss issues.
          Of course employers, Republican and Democrat are part of the issue. Educated people don’t need to have finger painting pictures drawn for them between issues.

          I’ll punch any enemy I perceive, up down, sideways, forwards and backwards.

          So sorry that people ignore America’s poor, who are shafted by cheap labor immigration which is a symptom of the elites. Of course, I’m sure you have a screaming goat nostrum to explain to an older lady who can’t find an affordable place to live why she shouldn’t be concerned with the competition willing to live 10 to an apartment.

          Tell her to focus on the elites. That’ll make her feel better as she enters another winter living in her car.

          1. Yves Smith Post author

            Your tone is out of line, and bringing your pet issue of immigration into unrelated posts is thread-jacking, a violation of our written site Policies. CalH was correct to call you out. However, you did make comments that were on topic later on….

            Commenting here is privilege, not a right, and I suggest you read our Policies before commenting again.

      2. notabanktoadie

        In ancient Israel, the assets (primarily agricultural), were roughly equally owned by all Hebrews with laws to keep it that way (e.g. Leviticus 25) so wage labor was something no Hebrew would normally have to do.

        As a result (and per Old Testament commandments, e.g. Leviticus 19:34) foreigners were welcome as a source of wage labor.

        Contrast that with present day USA where most citizens have been reduced to wage slavery themselves and thus resent foreign competition for wages they should not normally have to work for anyway, that is if US churches had not ignored or distorted the Old Testament wrt economic justice.

  6. Judith

    There is even a term for it. Senicide: the abandonment to death, suicide, or killing of the elderly.

    1. Henry Moon Pie

      And that’s a horrifying thing to contemplate. From the older end of things, we elderly have to come to terms with our mortality. Clinging to life when we become a heavy and permanent burden on others seems to me to more pathology than love of life. I’m lucky enough to not be in that position now, and maybe when I am infirm, that need to cling will grab me as well. But I have watched some die who were not plagued by that desperation. Death can be met with acceptance. Lao-Tzu had useful advice:

      To find peace is to fulfill one’s destiny.

      1. drumlin woodchuckles

        If antiboomerites try to make boomercide a thing, those boomers who are physically able to defend themselves and each other will defend themselves and each other.

        Ok antiboomerite

        ” Come over any time. We’ll keep a round in the chamber for you.” – Bitter Boomer

      2. The Rev Kev

        And of course while one generation is getting antagonistic to one or more of the other generations & while the talk of reparations is trying to divide America by colour and how much you have by blood, the real fight gets ignored – the 99% versus the 1%.
        Occupy Wall Street got it. Remember their slogan “We are the 99%”? That is why they were a ray of hope. And that is why they were destroyed in a coordinated attack across seventeen cities. That idea had to be stopped by the 1%.

        1. notabanktoadie

          For our struggle is not against flesh and blood, but against the rulers, against the powers, against the world forces of this darkness, against the spiritual forces of wickedness in the heavenly places. Ephesians 6:12 [bold added]

  7. Tyronius

    Those poor, helpless bizarrely rich! How will they ever manage? /s

    The French Revolution is looking more and more like the only viable solution;

    ‘When all avenues of peaceful protest are cut off, the only remaining option is violence’.

    I don’t like the idea of revolt. I don’t want to see a revolt. Revolts happen when people see them as a better option than continuing to suffer. This is a direct admonition to the rich and powerful: ‘the Hamptons are a low lying and indefensible position’ -Mark Blyth

  8. Danny

    On the other hand, living in your car or on your kid’s couch might a better alternative than this kind of California licensed “nursing home.”

    “Brius has repeatedly been fined, sued, and sanctioned by local, state, and federal agencies for providing substandard care to nursing home residents. According to the Sacramento Bee, Brius-owned nursing homes were “tagged with nearly triple as many serious deficiencies per 1,000 beds as the statewide average in 2014.” Families and residents have filed multiple lawsuits against Rechnitz and Brius for allegations including wrongful death and elder abuse. According to allegations in one lawsuit Brius chronically understaffs and under-resources its nursing homes in order to maximize profits.”

    “In addition to violating resident-care standards, Brius has also faced criminal investigations. In 2012 and 2015, the FBI raided two separate Brius nursing homes, with agents seizing records related to criminal investigations at both facilities” (Sacramento Bee, 2015).

  9. coboarts

    Water, Power, Agriculture, Healthcare, Elections… there is nothing in California that isn’t a scam, America too. So, into the misery abandoned by the “state” come the nonprofits doing everything they can to fill in the gaps and retain some humanity (let’s not have the nonprofits discussion here – it’s quite many sided). Do small things, do real things, and show you mean it. The “state” belongs to its citizens, but if its citizens are only awakened long enough for a drunken binge of power, everything proceeds according to someone’s plan. How do we break that plan, little by little, every day, until it no longer functions. Don’t rush, don’t get caught up in hype (any hype) and realize that Everything you are being fed is fake news, fake food. Little by little, shut it down. Permanent change comes from within, but “they” have gotten us so confused and made us so angry that’s impossible – right? You can’t fight a rip tide, but you can swim with the flow and angle out of it. That really does work, as my fellow coastal Californians may well know.

    1. Danny

      “(let’s not have the nonprofits discussion here – it’s quite many sided)”
      It’s not complex if you focus on just one “issue.” San Francisco is a malignant tumor of non-profits, but it also applies statewide:

      1: Politician applies for State and Federal grants to help the homeless.

      2: Politician gets grant and encourages activists to start a non profit to supposedly help homeless.

      3: Activists starts non profit and politician transfers them the funds.

      4: Activists pay self often huge salary and donate heavily to politician’s campaign.

      5. Activists register homeless to vote at non profit site and handle their completed ballots for local politicians through “Ballot Harvesting.”

      In the city of San Francisco, there are almost a thousand non-profits having to do with housing. Some are small cooperatives that run apartments, but most are steps One to Four above.

    2. Jack Parsons

      We are a 1-party state, and like all 1-party states we have devolved into corruption because the opposition is not strong enough to cause real pain. But since it’s blue 1-party, we have Medicaid.

  10. Kradek

    This is a problem with how capitalism functions not progressive politics. Just another reason to go to single payer.

    This is all caused by the increasing costs of senior care in the US. A simple solution is to make Medicare portable overseas where housing, care and medical services are less expensive.

  11. sharonsj

    Some billionaire just sent Elizabeth Warren a five-page nasty letter because she has the temerity to want to tax him once he earns more than $50 million. And the tax is only on the 51st million and thereafter. Bernie Sanders wants to tax the rich if they earn over $30 million in the same way. This is making the wealthy howl like banshees. That’s why the French Revolution has a lot of appeal for me.

    By the way, cutting the military budget and ending the endless wars on terror and drugs would also pay for all our social programs.

  12. Stan Sexton

    The CALPERS and CALSTRS deficits are getting so big now that many services are being cut. Some of those CALPERS pensions are over 300k per year. Over 31,000 pensions are over 100k per year. I have clients who make over 14k per month – Retired professors and firemen. Many citizens will be denied benefits so govt employees get these extravagant pensions. They take no economic risk – recession-proof. Newsom gets elected by this voting block who own the state.

    1. Yves Smith Post author

      You’ve got the issue wrong. The super high pensions are largely if not entirely the doing of local governments. CalPERS runs over 2200 pension plans. They don’t design them. You need to blame the employers, not CalPERS.

  13. smoker

    Thanks so much for highlighting this issue, Yves!

    I’ve just had my second traumatizing months long (in less than a decade) go round on someone I love’s behalf in a Northern California Skilled Nursing Facility (most or all of which are physically attached to Nursing Homes) with one of California’s numerous, horrid, for-profit Skilled Rehab/Nursing Homes (the vast predominance of which are for-profit, in California). The first one was sued for Elder Abuse by the Federal Government, and I wouldn’t at all be shocked if at some point soon that last one is.

    The timing of my most recent, countless Skilled Rehab/ Nursing home complaints were such that I actually suspect that the parent entity (which owns 50 other such facilities in three states) has possibly even trashed my so called reputation score™ on one of the criminally venal, US reputation score™ websites – somehow insanely allowed to legally operate – which criminally charges people to correct an utterly erroneous record while further criminally attempting to suck up the victim’s phone number and/or email address to make their libel appear even more validated. My local Blue™ Rep, was not at all interested in addressing that, they’re a millionaire and can’t be bothered with such minor issues as savaging someone calling out criminal abuse of the most vulnerable.

    Further, not only is the nursing home system in California rampant with abuse, but all related systems geared to: discharge patients to said facilities (that would be Hospitals); and provide housing support for the most vulnerable, are utterly broken as a consequence of: lack of Regulation and insane Policy 1; underfunding, negligence, and corruption. I’d speak to it in more detail, but I don’t at all have the resources to fight vengeful entities which might take vengeance on the person I love.

    I increasingly have been witnessing – firsthand – a disaster for impoverished elders, and the disabled who have no well to do family members able to help care for them. I’ve never felt so traumatized in my life by what I’ve witnessed firsthand in the Golden State [Empire]™, in the last 7 months. Most hideous, the local press and major news stations appear to have been told not to cover the disaster which is already here, and will only get far worse, RAPIDLY. And Government Representatives are not interested in the least (that was another [Blue State™] PTSD experience which near broke me).

    1. Policies deliberately (?) destined for disaster. The vulnerable cannot afford attorneys who predominately will not represent someone anyway, unless that person has a business, or is working. And the vulnerables’ countless miseries generally receive no press outside of – when utter disaster hits and it can’t be obscured any longer – MSN CLICK BAIT; which CLICK BAIT is never followed up on to see if things have at all gotten better.

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