Your Estate … with James Ward: Department of Public Health warns nursing homes on discrimination

Why would a nursing home lie to a client just to get an additional $1,000 a month from the family?

By James Ward

James Ward

I’ve long told clients nursing homes frequently misrepresent the truth to gain a profit advantage, and now the situation has gotten so bad the state has issued a formal warning to all licensed nursing homes.

In late December of 2023, the California Department of Public Health issued a formal letter reminding of the admission, transfer, and discharge laws that are often disregarded in the pursuit of higher profits. Yes! This happens regularly and the illegally obtained charges cost families millions of dollars annually. Are the illegal profits necessary to sustain the industry? No! A recent study showed nursing homes make about $11 billion in profits annually.

Although nursing homes are required to provide long term care and their employees are prohibited from telling residents and their families they only provide short term care, the facilities illegally tell residents they don’t provide long term care and only provide “short term” or “rehab” stays. The facilities frequently, and illegally, tell residents they have to leave when their short term Medicare coverage is ending. The formal warning stated:

“(Nursing homes) may not seek to transfer or discharge residents solely due to a change in their source of payment, e.g., Medicare to Medi-Cal, or to open a bed for residents with insurance coverage that provides a higher rate of reimbursement.”

Why would the nursing homes willingly, purposely, intentionally, and repeatedly misrepresent the truth to their residents? In blunt terms, why do these supposedly nice and caring people lie? Well, it’s all about profits. When consumers are unaware of the law, the nursing homes take advantage of them to misrepresent the truth and increase the facility profits at the expense of families. This frequently allows the nursing home to collect an additional $1,000 a month from private pay as compared to Medi-Cal pay.

Why would a nursing home lie to a client just to get an additional $1,000 a month from the family? Well, if the nursing home has 100 residents, that could be an additional $100,000 per month for the owners, and if the owners have several nursing homes, it could amount to more than $1 million a month. Yes, that adds up to real money and real profits by hoodwinking the residents and their families.

When a resident’s Medicare coverage is close to ending, the nursing homes frequently put on a hustle to get the resident moved home or to an assisted living facility even if the discharge is premature and unsafe. The facility simply wants the person out.

One of my clients was told his wife had improved significantly, so he could take her home in the morning. She died in the nursing home that same night. Was she really “fine” to go home, or was it a hustle?

Nursing homes frequently flaunt the law to increase their profits. They can get away with it through the combination of lax enforcement of the rules and lack of consumer awareness.

Don’t let this happen in your family. If you’re informed, you can fight back. But that only works if you’re informed. When most people are confronted with a nursing home situation in their family, it’s the first time they’ve had to deal with the rules, so they get pushed around because they don’t know the rights of the resident. Don’t let this happen to you or your loved ones. Be informed!