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The many extracts on this page are from copyright material. They are reproduced here for educational purposes and to stimulate public debate about the provision of health and aged care. I consider this to be "fair use" in the common interest. They should not be reproduced for commercial purposes. The material is selective and I have not included denials and explanations. I am not claiming that all of the allegations are true. The intention is to show the general thrust of corporate practices as well as the nature and extent of the allegations made.


Care BEFORE the Mariner mergers


This page contains material about nursing home care in the companies which were acquired to form Mariner Post-Acute Network.

Recent Government investigations have shown poor standards of care and understaffing in corporate owned nursing homes across the USA. Even not for profit homes are struggling to obtain staff. The corporations blame a nursing shortage resulting from an economic boom and full employment. This is only partly true.

While low unemployment contributes to the staffing problems they started long before this in the late 1980's and early 1990's.

The large chains in their vast wisdom decided that nursing homes were overstaffed and inefficient. There were too many highly trained staff. They would operate more efficiently if staffing levels were cut. They set about downsizing and deskilling. Sun Healthcare's Andrew Turner was the most outspoken about this policy but it was an industry wide belief.

Not only did this strategy generate vast profits, it was music to political ears. No one questioned the logic, nor did they ask for evidence. In a market where payments for the majority of patients were relatively fixed success was built on cutting costs. Sun was the best example of this. Others followed.

Staffing is the major cost of nursing home care and reducing staff was enormously profitable. Working conditions became intolerable. Morale plummeted. Nurses deprived of gratitude and acknowledgment, their prime reward for caring moved into a more welcoming wider marketplace. Critics and whistleblowers pointed out that these changes compromised care and did not improve it as the companies claimed. They were discredited and if they persisted victimised. The nurses unionised and a bitter war between nursing unions and corporate chains followed.

In a competitive marketplace not for profit groups were forced to adopt corporate business practices and become competitive. Humanitarian institutions became business corporations. Not surprisingly they developed similar problems, but they have never been as severe.

As a consequence the problems, which now exist in nursing homes have as much if not more to do with past policies and practices than with the low unemployment rate in the USA.

Grancare, Paragon, and Mariner Health Group Inc. all had very poor records for care before they merged into Mariner Post-Acute Network, the second largest nursing home chain in the USA. The extracts on this page address care during this earlier period.


Money or mercy?
The Tampa Tribune November 15, 1998

A six-month Tampa Tribune investigation has found that residents of for-profit homes had higher than average rates of reported neglect and abuse. Homes owned by four large chains - Beverly Enterprises Inc., Integrated Health Services Inc., Vencor Inc. and Mariner Health Group Inc. - were more likely to fall below state standards than other homes.

COMMENT:- Mariner Post-Acute Care was created by a junk bond trader. One wonders what he knew about aged care or Medicare.

Profits can come at high costs
The Tampa Tribune November 15, 1998

About one-quarter of Florida's nursing homes fell below state standards during annual inspections between January 1997 and March 1998. Among four of the state's six major chains - Beverly Enterprises Inc., Integrated Health Services Inc., Vencor Inc. and Mariner Health Group Inc. - the substandard rate was 32 percent to 40 percent.

But it seems the only constant in today's nursing home environment is change. There have been dozens of corporate mergers and takeovers in the last two years.

One of the largest was orchestrated by Leon Black, a former junk bond trader: Paragon was created from the merger of two companies last year, and this year it merged with Mariner Health Group to create the second-largest chain in the country, Mariner Post-Acute Network.

Before the summer merger, Mariner owned or leased 26 Florida homes, many of which had substandard ratings last year.
A Tampa Tribune analysis of the latest inspections, up to April 1998, showed five of the six largest nursing home companies in Florida had a higher than average number of deficiencies when compared with all nursing homes in the state. Total deficiencies for every 10 homes Vencor 118 * Mariner Health Group 111 Integrated Health Services 110 Beverly Enterprises 106 Genesis 95 All other homes 89
Homes owned by five of the six largest companies, which are all publicly traded, had a higher than average number of deficiencies that caused "actual harm" to residents. - - - - deficiencies for every deficiencies for every 10 homes - - - - - - Integrated Health Services 12 Vencor 11 * Mariner Health Group 9 Beverly Enterprises 8 Genesis 7 All other homes 7

COMMENT:- It is now well established that care in corporate owned hospitals and nursing homes compares unfavourably with that in not for profit homes

The Palm Beach Post November 25, 1998

How does ownership affect care? About 25 percent of Florida's homes fell below state standards during annual inspections between January 1997 and March 1998, the Tampa Tribune reported last week. Among four major chains - Beverly, Integrated, Vencor and Mariner Health Group Inc. - the failure rate was higher.

COMMENT:- The next article is about Grancare

Getting Sued by Seniors: Verdicts growing in suits citing poor nursing home care
ABA Journal December, 1998

Joyce Lang didn't know a lot about nursing homes when she had to choose one for her 83-year-old mother in 1994. She picked Cedars Health Care Center in Lakewood, Colo., hoping its new Alzheimer's ward would provide the right care.

Lang got a quick education, and she didn't enjoy the lessons. She claims the home was thinly staffed and ill-maintained. Puddles of urine stayed on the floor for days. Her mother fell frequently, didn't eat regular meals and was not taken to the bathroom regularly.

In 1997, when her mother got severe diarrhea, her health deteriorated rapidly, says Lang, a real estate broker in Pine Junction, Colo., near Denver. "She just went down-hill ... [and] I couldn't convince them there was a problem."

Old Plaintiffs, New Tactic

Lang's mother -- Lydia Dill, now 88 -- is one of four plaintiffs who hope to represent 600 or more past and present Cedars residents in the first class action lawsuit against a nursing home. Salas v. GranCare Inc., No. 96-CV-4449.
Dill's innovative lawsuit is just one skirmish in an escalating battle between seniors and nursing homes. Experts say an aging American population is spurring more suits against the homes and, recently, bigger verdicts.

COMMENT:- Poor homes passed from Grancare to Paragon to Mariner. Only the names change. We have seen this before. National Medical Enterprises (NME) became Tenet. Columbia/HCA became HCA. Most recently Vencor became Kindred Healthcare. The market dictates what will happen in the homes. Names, personalities and good intentions are ultimately irrelevant.

Wide gulfs exist among facilities here
The Post and Courier (Charleston, SC) April 13, 1999
Third in a series

Perfect nursing homes don't exist - not in the Low country, not anywhere.

But state health inspectors find a gaping disparity in quality among tri-county homes, according to a Post and Courier review of 1997 and 1998 survey reports for the area's 16 facilities.
Chronic problems

Among facilities where inspectors found the most deficiencies: The three tri-county nursing homes owned by the multibillion-dollar chain Mariner Post-Acute Network.

But Mariner only recently took over the homes. It was formed in August when two companies - Paragon Health Network and Mariner Health Group - merged into the nation's second-largest long-term care provider.

That followed Paragon's creation in 1997 by uniting Living Centers of America and GranCare of Atlanta.

GranCare, which bought these nursing homes in 1994 and 1995, received Consumer Reports' worst rating on 21 percent of its nursing homes. None of its homes landed in the best category when the report was published in 1995.

Even after that, their inspection reports pointed to chronic problems.

Take Hallmark, whose August 1997 survey spanned 73 pages.

By the end of the report, inspectors chastised everyone from the Summerville home's administrator to the medical director.

"The medical director failed to ensure the facility implemented resident care policies, including abuse, resident assessments, care planning and overseeing the overall clinical care for residents in the facility," a DHEC inspector wrote.

The administrator was cited for failing to correct seven deficiencies, including quality of care issues, even after two follow-up surveys. And that survey found 20 new deficiencies.

For instance, three residents sat in the home's day room for long periods without meaningful activities. One banged a tray on a chair and shouted, "Get me out of here!"

Four of eight residents interviewed complained about a lack of staff.

"When I have to wet, I just go on and wet because they don't come," one told an inspector.

On one shift, inspectors found three nursing assistants caring for 88 residents.

In a complaint investigation earlier that year, inspectors found more staff shortages. On one, a single nursing assistant was working when four were required.

A Mariner company spokeswoman declined to comment on specific deficiencies.

"We don't discuss allegations related to specific patients because of our duty to protect the confidentiality of our patients' medical information," spokeswoman Kym Spell said.

"Instead, our nurses work closely with residents and families to make sure they feel comfortable with how we handle incidents in our homes," she added.
At Mariner's second tri-county nursing home, Oakbrook Healthcare Center, inspectors cited 58 pages of deficiencies in July.

A third of residents interviewed complained the facility was short-staffed. One woman said she used her diapers instead of the toilet because staff didn't respond promptly.

The nursing director told the inspector that "limitations were placed on running ads and staffing has been an issue. ... I know this was not right for the residents."

And at St. George Health Care Center, inspectors in 1997 cited the care of a resident who had lost 10 pounds in four months.

He had "received approximately half of the nutritional needs his condition required and had developed pressure sores," an inspector wrote.

Six of eight residents interviewed complained of a lack of staff. One tearfully told an inspector that "sometimes you have an accident, and then you are cussed out for being wet."

Inspectors also found an offensive urine odor and several rooms with floors and curtains stained with dark brown matter.

In a room housing a resident suffering end-stage HIV, dark brown matter with red specks was found on the floor. The room was cleaned by a housekeeper who said she hadn't been trained in basic sanitary precautions, the report says.

Back then, St. George contracted out its housekeeping and laundry services. Since a new administrator took the helm, he has hired in-house employees to do the jobs.

In its most recent survey last June, St. George wasn't cited for sanitary problems. Inspectors did, however, describe deficiencies over 60 pages.

But those were minor problems compared to past reports, said Leonard M. Cyrlin, the facility's new administrator.

He also noted that the inspectors, who came just several months after he arrived, found no repeat violations unlike in past surveys - a major goal of his.

Cyrlin concedes that the facilities now under Mariner had problems in the past.

"Our relationship with the community had gotten off track. But we've gotten that back tenfold," said Cyrlin, who had been administrator at St. George eight years ago.

He left St. George back then to open Hallmark but left because he was unhappy with the new management company.

"Everything was managed from way out there," he said, referring to the company's headquarters in California and then Atlanta. "Things just didn't go well."

Past inspection reports at the facilities reflect that, he said.

But since the Mariner merger, the company has installed new administrators and directors of nursing at each of its three tri-county facilities, in part because it recognized there were problems, Cyrlin said.

"This facility has undergone an incredible metamorphosis," Cyrlin said. "I'm not one for big corporations. But we're really happy under the new management."

For one, Mariner leaves more decision-making in the hands of each facility's administrator. Cyrlin was allowed to raise employee pay. And the company has invested more than $ 100,000 renovating the 18-year-old building.

Mariner also operates an Office of Ethics and Compliance in Washington, D.C., manned by registered nurses and headed by a former senior U.S. Senate investigator. The goal: Provide an independent review of concerns raised by people calling a hotline.

Mariner also performs criminal background checks on all employees, which isn't required in South Carolina.

Spell called the checks the "most comprehensive in the industry," searching criminal records and checking licenses and certification for health care workers.

It also runs Mariner University, which trains workers on issues such as the company's values and a new Medicare payment system.

"Our nurses and caregivers are professionals who work with families to ensure our residents receive quality care," Spell said. "The needs of our residents and concerns of family members take top priority."

Common concerns

Mariner's nursing homes received some of the lengthiest of recent inspection reports, but their problems were far from unique.

Common problems inspectors found at local facilities: Homes operating chronically short-staffed, providing few meaningful activities for residents and failing to prevent infections.

One inspector wrote, "After discussing with staff and observations, it became apparent that the care needs of residents may be compromised at times" due to staff shortages that left residents without basic care such as baths.

Several facilities were cited for failing to monitor patients adequately as they died.

5 nursing home chains: A briefing
The Des Moines Register December 13, 1999, Monday

Grancare Inc.

This Atlanta-based chain owns seven homes in Iowa and has a history of spending less than the state median (67 percent) on patient care. The chain generally spent 60 percent or less on patient care while its administrative costs ranged from 17 percent to 23 percent.

State inspectors found 54 violations in the most recent inspections and fined the chain $ 47,495 in the last fiscal year. Two Grancare homes were placed on probation and two were labeled as having substandard quality care.

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This page created Mar 2001 by Michael Wynne