美国国家公共电台 NPR As Nursing Homes Evict Patients, States Question Motives（在线收听）

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People complain about nursing homes a lot - the staffing, the food. The list goes on. But this story is about the top complaint, involuntary discharge - people getting kicked out. NPR's Ina Jaffe covers aging. She brings us this look at two states working to hold nursing homes accountable.

INA JAFFE, BYLINE: Maryland Attorney General Brian Frosh says that in his state, more than half of all involuntary discharges have come from just one small chain of nursing homes run by NMS Healthcare.

BRIAN FROSH: Your odds of getting evicted from an NMS nursing home are about a hundred times what they are of any other nursing home in the state.

JAFFE: So Maryland is suing NMS for Medicaid fraud, alleging the company charged the state for services it didn't deliver, specifically discharge planning. Nursing homes are supposed to make sure a resident has a safe place to go. But according to the complaint, NMS sent residents with complex medical needs to a homeless shelter or to unlicensed board-and-care facilities. Frosh says a woman with severe dementia was dropped off in front of her son's home.

FROSH: Her son found her wandering around several hours later when he came home from work.

JAFFE: According to Frosh, the company's motivation was purely financial. To understand this, you just need to know two things. First, Medicare pays nursing homes a lot more than Medicaid does. But second, Medicare only lasts a hundred days. Frosh claims that NMS evicted hundreds of residents just as they were transitioning from Medicare to the lower-paying Medicaid.

FROSH: We cite emails in the complaint that offer a bounty for getting patients out quickly. A hundred bucks is offered for somebody who can make a bed vacant within two hours.

JAFFE: Attorneys for NMS did not make anyone available for an interview. But in court documents, they call the state's charges false, reckless and inflammatory. Now, nationwide complaints about involuntary discharges have risen just slightly, but in Illinois, those complaints have more than doubled over five years, says State Senator Daniel Biss. He sponsored legislation to crack down on nursing homes that improperly discharge residents.

DANIEL BISS: We're seeing nursing homes that have made a financial decision that they would like a certain type of resident.

JAFFE: One that is compliant and doesn't require too much staff time. Biss says when a nursing home has a resident who doesn't fit the mold...

BISS: They're able to essentially drop them in the hospital and walk away.

JAFFE: That's what happened to a 57-year-old Chicago man named Vincent Galvan. He thinks he was evicted because he complained too much, starting with the nursing home administration.

VINCENT GALVAN: They didn't pay no attention. So I learned that they had a hotline to call the corporation they belonged to. I called them also, and nothing really happened.

JAFFE: Galvan first went to the nursing home in 2012 after his right leg was amputated. His left side was already messed up from an earlier accident. As he tells it, one day, without warning, the paramedics showed up and took him to a hospital psychiatric unit.

GALVAN: They were actually accusing me of being aggressive and that I was a schizophrenic, that I had manic depression. And none of that was true.

JAFFE: His hospital progress notes confirmed that he did not have a serious mental illness, but the nursing home wouldn't take him back. It took the hospital 102 days to find another nursing home for Galvan. All that time, he remained in the psych ward.

GALVAN: It was crazy. It was really crazy. It was one of the worst experiences of my life.

JAFFE: Now, there are legal reasons to evict someone - for example, if a resident is a danger to other people. But in Illinois, even if the nursing home is found to have wrongly discharged someone, the Department of Public Health can't force the nursing home to take the resident back. That's what State Senator Daniel Biss' legislation would change.

BISS: It gives the department the power to order a resident readmitted.

JAFFE: And failure to do that would result in a fine of $250 a day. That could add up quickly, which is why Matt Hartman says it goes too far. He's vice president for public policy at the Illinois Health Care Association which represents nursing homes. He says that nursing home problems shouldn't be measured by complaints but by verified wrongdoing. And Hartman says raising fines on nursing homes won't help the residents.

MATT HARTMAN: Anything that takes that much money away from resident care and away from staffing and medical equipment is just not the correct approach.

JAFFE: Hartman has been making that argument in negotiations with Illinois lawmakers who could vote on the bill before the end of the year. Ina Jaffe, NPR News.