The Miami Herald reports on Florida Senator Chris Smith's unannounced visits to various South Florida assisted living facilities after reading the newspaper's investigative report:





Posted on Fri, Jun. 3, 2011
Top lawmaker stunned by conditions at assisted-living facility

BY MICHAEL SALLAH, ROB BARRYmsallah@MiamiHerald.com
 

In place of a sink, state inspectors found a bucket capturing water dripping from a leaking pipe in a bathroom at Briarwood ALF during an unannounced visit on May 20.

Just minutes after entering the troubled assisted-living facility, Florida Sen. Chris Smith took out his cellphone camera and began capturing the images: dirty hypodermic needles in a dresser drawer. Feces smeared on a bathroom floor. Electrical wires jutting from a hole in a wall. No sink in a bathroom, with an exposed pipe dripping water into a bucket.

In another room, rat droppings littered the floor.

After finishing a surprise inspection of Briarwood Manor in Lauderhill with state agents two weeks ago, the Democratic lawmaker said he placed an urgent call to one of the senate’s leading Republicans, Ronda Storms.

“I told her what I saw and how disgusted I was,’’ said Smith. “Ronda and I don’t always see eye to eye on a lot of issues,’’ but he said he told her, “We need to do something about this.’”

Shaken by his visit to the facility in the heart of his district, Smith said he will join Storms and other lawmakers to overhaul the troubled regulatory system that oversees Florida’s assisted-living facilities, saying the state needs to do more to protect “these vulnerable people.”

“We’re talking about human beings. I am amazed we are paying people to house human beings in such conditions. They’re mistreating those who don’t even know any better.’’

Smith’s visit capped two days of sweeps through the neighborhood by more than a half-dozen agencies that held unannounced inspections at four ALFs clustered in a small area known as Cannon Point.

Among the findings the agencies released Friday:

• A 55-year-old man with a festering, swollen leg wound that had gone untreated until state agents ordered the home to get medical help.

• Rodent infestations in two of the homes.

• Roaches and broken furniture in two of the facilities.

During the sweep, inspectors went to one of the homes, Shalom Manor, where caretakers just days earlier had found a 46-year-old resident in a chair, not breathing.

Instead of performing CPR or calling paramedics, one caregiver draped a sheet over his head while the other went to the kitchen to make breakfast, police reports state. Thirty-seven minutes later, caretakers called paramedics, who pronounced James Hazel dead. The state Department of Children & Families is investigating.

The inspections on May 19 and 20 by the Florida attorney general’s office, DCF, the Agency for Health Care Administration and others took place after a Miami Herald series, Neglected to Death, showed that state regulators were allowing dozens of homes to stay open despite dangerous and decrepit conditions.

The visit to Briarwood Manor turned up enough problems — including rodent droppings, nine structural violations and an interior described in a state report as “absolutely filthy from floor to ceiling” — to prompt Smith to fire off a letter to his Senate colleagues.

“I wouldn’t put my enemies in that place,’’ said Smith, adding that he will work with the senate’s Children, Families and Elder Affairs Committee to overhaul the state’s oversight of ALFs, now surpassing nursing homes as the primary facilities for the elderly and mentally ill in Florida.

Reached in her district on Florida’s west coast Friday, Storm said she was heartened by Smith’s call after his visit to Cannon Point — home to the highest concentration of ALFs in the state.

“It was important to me that we have his interest and his experience on the ground,’’ said Storms, who is leading the initiative to reform Florida’s ALF law.

For Smith, the incoming Senate minority leader, the cluster of assisted-living facilities in his district was always a curiosity, but he said he never knew the dangers the homes posed to residents until The Herald’s series.

The newspaper found a 74-year-old resident was bound for more than six hours, the restraints pulled so tightly they ripped into her skin and killed her, a 71-year-old man with schizophrenia died from burns after he was left in a bathtub filled with scalding water and a 75-year-old Alzheimer’s patient was torn apart by an alligator after wandering from his ALF for the fourth time.

One of the places profiled in the stories was Briarwood — the most heavily fined facility in Florida — which has left dozens of residents with mental illness to fend for themselves in dangerous conditions. Twice, regulators could have moved to shutter the facility since 2007, but even after the home failed to pay thousands of dollars in fines for years, it was allowed to stay open.

Smith said he was riled after learning the 34-bed home gets hundreds of thousands in taxpayer dollars every year to house residents. “These are state-licensed facilities, and more than that, facilities the state is paying for,” said Smith. “And that’s just astonishing.”

In addition, The Herald obtained records that show some of the tax dollars provided to the home meant for residents — a $54-per-month stipend — weren’t ending up in their hands, forcing the Department of Elder Affairs to step in two years ago.

The home’s owner, Andy Subachan, did not return calls seeking comment.

Several state agencies are expected to continue investigating conditions at the homes in Cannon Point, including the suspicious death at Shalom Manor on May 12.

Not only did caretakers fail to call 911 for 37 minutes after discovering James Hazel’s lifeless body, but police are now investigating why medical records describing the care he received during his past two months have disappeared, reports state. Hazel suffered from diabetes and other serious health problems, but no autopsy was performed to determine how he died, police said.

Shalom Manor administrator Emmins Henry told The Herald she doesn’t know what happened to the records, but suggested that officers may have taken them on the morning Hazel died. However, a spokesperson for the Lauderhill Police Department said that wasn’t the case. “There would be no reason for them to do that,” said Capt. Constance Stanley.

Stanley was among a group of law enforcement officers and inspectors who returned to the neighborhood early Friday morning for another round of unannounced visits.

At Briarwood, inspectors once again turned up many of the same problems, including a cache of used hypodermic needles stashed in an open filing drawer and a 51-year-old man forced to sleep on a living room sofa because his sheets were infested with bedbugs.

“I don’t want to get bit no more,” Lewis Hill, lying on a cramped, black sofa with his feet dangling over the side, told The Herald.

Two weeks after his visit to the facility, Sen. Smith said he wasn’t surprised at the newest findings. “From the total lack of decency that I observed from my visit, I’m sad to say that I’m not shocked that there were still major violations,’’ he said.

WLRN-Miami Herald reporter Kenny Malone contributed to this report.



© 2011 Miami Herald Media Company. All Rights Reserved.
http://www.miamiherald.com



Read more: http://www.miamiherald.com/2011/06/03/v-print/2250227/surprise-inspection-finds-grisly.html#ixzz1OLKzGCUu



For more information about Miami-Dade, Broward and Palm Beach County home health care for seniors and other family members, contact Brian Gauthier at A Family Member Home Care (954) 986-5090 or www.afamilymemberhomecare.com. Serving Coconut Creek Cooper City Coral Springs Dania Beach Davie Deerfield Beach Fort Lauderdale Hallandale Beach, Hillsboro Beach Hollywood Lauderdale Lakes Lauderdale-by-the-Sea Lauderhill Lazy Lake Lighthouse Point Margate Miramar North Lauderdale Oakland Park Parkland Pembroke Park Pembroke Pines Plantation Pompano Beach Sea Ranch Lakes Southwest Ranches Sunrise Tamarac Weston Wilton Manors Aventura Sunny Isles Beach Hialeah Miami Lakes Boca Raton Delray Beach

The following is a letter to The Miami Herald from Krone Weidler, President of the Florida Assisted Living Association in response to the newspaper's scathing investigative report on abhorrent conditions of abuse and neglect in many Florida assisted living facilities:


May 26, 2011

To the Editors of the Miami Herald:

Recently, Floridians read tragic stories of how vulnerable seniors and adults with mental illnesses in a few of Florida’s assisted living residences were neglected or abused. The Miami Herald also reported that some residences went unpunished and some were allowed to remain open. What the Herald neglected to report was that, of the twenty two residences named, some have closed or have changed ownership, or are in compliance with regulations.

Fortunately, Florida has a strong regulatory framework; indeed, a model for other states. It was created explicitly for the purpose of protecting seniors and others from neglect and abuse and to offer a better quality of life than institutions for adults diagnosed with mental illnesses.

Unfortunately, the resources necessary to enforce these strong regulations have eroded over time as the State, with its considerable financial challenges, has re-directed its resources from the agencies responsible for enforcement. That is, Florida has a resource problem—not a regulation problem.

At any one time, close to 83,000 seniors and adults diagnosed with mental illnesses reside in almost 3,000 licensed assisted living residences in Florida where residents live with optimal independence, are treated with dignity and respect, and receive quality and loving care from hard-working and dedicated caregivers.

When we look over the 10 year span of the incidents reported on by The Miami Herald, it should be noted that close to one million Floridians were cared for in assisted living residences during that time. Though we consider even one episode to be one too many, residents, their families and the public should recognize that these are isolated incidents and do not represent the loving and high quality care that is provided every day to more than 83,000 residents in assisted living communities statewide.

The reaction to the Miami Herald series by some may be to impose new regulation on top of existing regulation on all assisted living residences as if they are all guilty of, or even tolerant of, neglect and abuse.

The vulnerable citizens of Florida would be better served by a collaborative effort by all stakeholders to identify the systemic problems that may have contributed to the failure of the system to protect these residents and work together to find the solutions.

Sincerely,

Krone Weidler, President
Florida Assisted Living Association

cc: Damon Thomas, FALA Vice President
Mary Sue Patchett, FALA Treasurer
Luis Collazo, FALA Secretary
Jamie Glavich, FALA Immediate Past President

Florida Assisted Living Association
2447 Millcreek Court, Suite 3   Tallahassee, FL 32308
Telephone:  850.383.1159    850.224.0448 Faxwww.falausa.com


The Florida Assisted Living Association (FALA) is the largest state association in Florida representing assisted care communities. It provides legislative and regulatory oversight to its members and is the leading provider of assisted living education and training in Florida.

The U.S. Department of Health and Human Services issued the following announcement of proposed regulation changes that would would give people the right to get a report on who has electronically accessed their protected health information.  Below, find information about how to make sure your comments are submitted through the Federal Register.  Below that is information on how to file a HIPAA complaint.


HHS announces proposed changes to HIPAA Privacy Rule

HITECH lets people know who has accessed their health information

A Notice of Proposed Rulemaking concerning the accounting of disclosures requirement under the Health Insurance Portability and Accountability (HIPAA) Act Privacy Rule, is available for public comment. The proposed rule would give people the right to get a report on who has electronically accessed their protected health information.

The U.S. Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) is proposing changes to Privacy Rule, pursuant to the Health Information Technology for Economic and Clinical Health (HITECH) Act. HITECH is part of the American Recovery and Reinvestment Act of 2009.

“This proposed rule represents an important step in our continued efforts to promote accountability across the health care system, ensuring that providers properly safeguard private health information,” said OCR Director Georgina Verdugo. “We need to protect peoples’ rights so that they know how their health information has been used or disclosed.”

People would obtain this information by requesting an access report, which would document the particular persons who electronically accessed and viewed their protected health information. Although covered entities are currently required by the HIPAA Security Rule to track access to electronic protected health information, they are not required to share this information with people.

The proposed rule requires an accounting of more detailed information for certain disclosures that are most likely to affect a person’s rights or interests. The proposed changes to the accounting requirements provide information of value to individuals while placing a reasonable burden on covered entities and business associates.

People may now read the proposed rule at: http://www.federalregister.gov/ and submit comments to http://www.regulations.gov/ (search for Proposed Rule) through August 1, 2011.

 http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html.
__________________________________


People who believe a covered entity has violated their (or someone else’s) health information privacy rights or committed another violation of the HIPAA Privacy or Security Rule, may file a complaint with OCR at

How To File a HIPAA Complaint

If you believe that a covered entity violated your (or someone else’s) health information privacy rights or committed another violation of the Privacy or Security Rule, you may file a complaint with OCR. OCR can investigate complaints against covered entities.

COVERED ENTITIES - A covered entity is a health plan, health care clearinghouse, and any health care provider that conducts certain health care transactions electronically. For more information, please review our Understanding Health Information Privacy section or look at our responses to Frequently Asked Questions (FAQs) on our web site.

COMPLAINT REQUIREMENTS - Your complaint must:
Be filed in writing, either on paper or electronically, by mail, fax, or e-mail;
Name the covered entity involved and describe the acts or omissions you believe violated the requirements of the Privacy or Security Rule; and
Be filed within 180 days of when you knew that the act or omission complained of occurred. OCR may extend the 180-day period if you can show "good cause."

ANYONE CAN FILE! - Anyone can file a complaint alleging a violation of the Privacy or Security Rule. We recommend that you use the OCR Health Information Privacy Complaint Form Package. You can also request a copy of this form from an OCR regional office. If you need help filing a complaint or have a question about the complaint or consent forms, please e-mail OCR at OCRMail@hhs.gov.

HIPAA PROHIBITS RETALIATION - Under HIPAA an entity cannot retaliate against you for filing a complaint. You should notify OCR immediately in the event of any retaliatory action.

HOW TO SUBMIT YOUR COMPLAINT - To submit a complaint, please use one of the following methods.

If you mail or fax the complaint, be sure to send it to the appropriate OCR regional office based on where the alleged violation took place. OCR has ten regional offices, and each regional office covers specific states. Send your complaint to the attention of the OCR Regional Manager. You do not need to sign the complaint and consent forms when you submit them by e-mail because submission by e-mail represents your signature.File A Complaint Using Our Health Information Privacy Complaint Package


File A Complaint Using Our Health Information Privacy Complaint Package

Open and fill out the Health Information Privacy Complaint Form Package in PDF format. You will need Adobe Reader software to fill out the complaint and consent forms. You may either: print and mail or fax the completed complaint and consent forms to the appropriate OCR regional office; or
e-mail the completed complaint and consent forms to OCRComplaint@hhs.gov.(Please note that communication by unencrypted e-mail presents a risk that personally identifiable information contained in such an e-mail, may be intercepted by unauthorized third parties.)

• Your name
• Full address
• Telephone numbers
• E-mail address (if available)

• Do you need special accommodations for us to communicate with you about this complaint?
• Who else can we call if we cannot reach you?
• Have you filed your complaint somewhere else? If so, where?

Additional information about OCR’s enforcement activities can be found at http://www.hhs.gov/ocr.








For more information about Miami-Dade, Broward and Palm Beach County home health care for seniors and other family members, contact Brian Gauthier at A Family Member Home Care (954) 986-5090 or www.afamilymemberhomecare.com. Serving Coconut Creek Cooper City Coral Springs Dania Beach Davie Deerfield Beach Fort Lauderdale Hallandale Beach, Hillsboro Beach Hollywood Lauderdale Lakes Lauderdale-by-the-Sea Lauderhill Lazy Lake Lighthouse Point Margate Miramar North Lauderdale Oakland Park Parkland Pembroke Park Pembroke Pines Plantation Pompano Beach Sea Ranch Lakes Southwest Ranches Sunrise Tamarac Weston Wilton Manors Aventura Sunny Isles Beach Hialeah Miami Lakes Boca Raton Delray Beach

The Florida Office of Economic and Demographic Research ("EDR") recently published the following report on County Profiles:



Select a county on the map or in the listing to view that county's profile:





Below are a series of links to other websites which may be of interest to visitors to the EDR website.

indicates the link will open in new window.

Criminal Justice





Bureau of Economic and Business Research - University of Florida US Census Bureau - US Department of Commerce State Population Counts from 2000 Census
US Census Bureau - Gateway to Census 2000 2000 Census Data (100% items) U.S. Census Bureau--redistricting summary tables Florida Census Data Center--redistricting data for the state and county

Redistricting






For more information about Miami-Dade, Broward and Palm Beach County home health care for seniors and other family members, contact Brian Gauthier at A Family Member Home Care (954) 986-5090 or www.afamilymemberhomecare.com. Serving Coconut Creek Cooper City Coral Springs Dania Beach Davie Deerfield Beach Fort Lauderdale Hallandale Beach, Hillsboro Beach Hollywood Lauderdale Lakes Lauderdale-by-the-Sea Lauderhill Lazy Lake Lighthouse Point Margate Miramar North Lauderdale Oakland Park Parkland Pembroke Park Pembroke Pines Plantation Pompano Beach Sea Ranch Lakes Southwest Ranches Sunrise Tamarac Weston Wilton Manors Aventura Sunny Isles Beach Hialeah Miami Lakes Boca Raton Delray Beach Federal Reserve Bank Databank Bureau of Labor Statistics - US Department of Labor National Bureau of Economic Research US Census Bureau - US Department of Commerce Bureau of Economic Analysis - US Department of Commerce The White House Economic Statistics Briefing Room Regional Economic Data National Income and Products Accounts County and City Data Books CPI - Link to current CPILeague of Women Voters' Democracy Net Florida Division of Elections Federal Elections Commission U.S. Census Bureau Redistricting Data Program Census Bureau TIGER Web Site ESRI TIGER Translation Web Site

U.S. Economic, Financial and DemographicFlorida Legislature - Online Sunshine Florida House of Representatives Florida Senate
Local Government
Metropolitan Planning Organizations Regional Planning Councils Water Management Districts County Governments School Districts

Population, Demographic and 2000 CensusBureau of Economic and Business Research - University of Florida Legislative Committee on Intergovernmental Relations Labor Market and Employment Data Florida State Board of Administration Federal Reserve Bank - Atlanta

Florida LegislatureSUS Factbook - contains data about the State University System Florida Department of Education K-20 Budget Florida Bright Futures Scholarship Program Educational Facilities Budgeting Florida Community Colleges Fact Books

Florida Economic, Financial and DemographicFlorida State University Criminal Justice Links Florida Department of Law Enforcement Florida Corrections Commission Florida Department of Juvenile Justice Florida Court System Florida Department of Corrections U.S. Bureau of Justice Assistance

Education Financehttp://edr.state.fl.us/Content/area-profiles/county/index.cfm

These county profiles present information, by county, on population, housing, state infrastructure and employment.  They also includes data on the labor force, including the labor force as a percentage of population aged 18 and older and the unemployment rate.  In addition, the profiles provide information about financial health - such as personal income, per capita personal income, and poverty - as well as indicators of quality of life such as educational attainment and crime.

• Full supplemental report in PDF format
• Full report no.11-06 in PDF format

For more information about Miami-Dade, Broward and Palm Beach County home health care for seniors and other family members, contact Brian Gauthier at A Family Member Home Care (954) 986-5090 or www.afamilymemberhomecare.com. Serving Coconut Creek Cooper City Coral Springs Dania Beach Davie Deerfield Beach Fort Lauderdale Hallandale Beach, Hillsboro Beach Hollywood Lauderdale Lakes Lauderdale-by-the-Sea Lauderhill Lazy Lake Lighthouse Point Margate Miramar North Lauderdale Oakland Park Parkland Pembroke Park Pembroke Pines Plantation Pompano Beach Sea Ranch Lakes Southwest Ranches Sunrise Tamarac Weston Wilton Manors Aventura Sunny Isles Beach Hialeah Miami Lakes Boca Raton Delray Beach

The Associated Press published the following article on June 1, 2011:

New Fla. nursing home watchdog rejects criticisms
By MATT SEDENSKY
Associated Press

WEST PALM BEACH, Fla. (AP) -- The new top advocate for Florida's nursing home residents insisted Thursday he is committed to patients' wellbeing and rejected suggestions he is too friendly with the industry to effectively serve as watchdog.

Jim Crochet was named state long-term care ombudsman in April after his predecessor Brian Lee was ousted. Lee had a contentious relationship with the nursing home industry, but Crochet disputes characterizations that he is more of a friend.

"To say that I'm partial to the industry is not a correct statement," he said. "My job is to look out for the health, welfare, safety and rights of the residents."

Lee's dismissal in February led to a wave of complaints from volunteers in the program, a still-ongoing federal investigation, the firing of a volunteer who was an outspoken critic and two whistleblower complaints.

Crochet said the program is prevailing in its fight for residents' rights despite the turmoil.

"It's not about Brian, it's not about me, it's not about any one person in this program," he said. "This ship will move forward."

Chief among his goals for the program are to attract, retain and recognize volunteers. He said he'd like to see the ratio - currently about one volunteer for every 605 nursing home residents - cut in half.

Crochet said he expected to push for legislation on behalf of nursing home residents, but said he has not yet familiarized himself with measures that moved through the Legislature in the recently closed session.

State lawmakers proposed bills that, among other things, would have removed the requirement for ombudsmen to conduct on-site assessments of nursing homes; repealed a law requiring the collection and analysis of data related to complaints in long-term care facilities; removed a requirement to disseminate a list of facilities that have been fined; and made it more difficult to sue nursing homes and place a lower cap on damages that could be awarded.

All of those measures ultimately failed, though another legislative change, to lower the staff-to-resident ratio requirements for nursing homes, did pass, seen as a cost-cutting measure in the face of reductions to Medicaid reimbursements. It reduces the average amount of direct care provided residents by 18 minutes each day.

Lee, who is not seeking reinstatement, said he does not expect his successor to be a strong voice against efforts to weaken nursing home residents' rights. He said Crochet, who previously wrote rules governing nursing homes, consistently has sided with the industry.

"He was put there by the industry and I'm sure he owes them a debt of gratitude for his employment and I'm sure he'll placate who he has to," Lee said.





For more information about Miami-Dade, Broward and Palm Beach County home health care for seniors and other family members, contact Brian Gauthier at A Family Member Home Care (954) 986-5090 or www.afamilymemberhomecare.com. Serving Coconut Creek Cooper City Coral Springs Dania Beach Davie Deerfield Beach Fort Lauderdale Hallandale Beach, Hillsboro Beach Hollywood Lauderdale Lakes Lauderdale-by-the-Sea Lauderhill Lazy Lake Lighthouse Point Margate Miramar North Lauderdale Oakland Park Parkland Pembroke Park Pembroke Pines Plantation Pompano Beach Sea Ranch Lakes Southwest Ranches Sunrise Tamarac Weston Wilton Manors Aventura Sunny Isles Beach Hialeah Miami Lakes Boca Raton Delray Beach

The Florida Current follows up on its story about Florida hospitals have been given an additional 20 days to find $45 million or face reductions in their Medicaid rates:


Above:  Rep. Matt Hudson answers questions on the floor of the House.
(Photo Credit: Meredith Geddings, Florida House of Representatives)


Hospitals have been given an additional 20 days to find $45 million or face reductions in their rates.

Agency for Health Care Administration Secretary Liz Dudek sent a letter to hospitals on June 2 advising them of the extension to send money to Tallahassee to plug a shortfall or have their Medicaid rates reduced, possibly as early as July 1.

“The new deadline is close of business June 20, 2011,” Dudek wrote in a brief letter.

It’s the second letter AHCA Secretary Dudek has sent to hospitals in the last eight days advising hospitals of a $45 million shortfall in intergovernmental transfers, or IGTs. IGTs are collected by counties or taxing districts and are used to help finance Medicaid, including reimbursements for hospitals.

The $45 million shortfall is the result of higher than anticipated hospitalizations for Medicaid patients from July 1, 2010 through June 30, 2011.
The first letter was sent May 24 and advised the hospitals they had seven days -- including the weekend and Memorial Day -- to contribute $45 million or face rate reductions. An analysis conducted by the Safety Net Hospital Alliance of Florida showed that including federal dollars the cut would equal about $123 million.

After being advised of the shortfall by the Florida Tribune, Rep. Matt Hudson, R-Naples, blasted the agency for not advising the Legislature of the shortfall while it was in session.

Additionally Hudson -- who chairs the committee responsible of the agency’s budget -- criticized the agency for giving the facilities less than one week to find $45 million.

Hudson told the Florida Tribune that he had a “lengthy conversation” with Dudek to air his concerns about the “process.” Dudek called him back early morning Thursday, Hudson said, to say she “had talked to the plaza level” and would extend the deadline. "Plaza level" refers to the governor's office, which is located on the first floor of the Capitol.

Hudson said in his phone call with Dudek he made clear he was not pleased with the agency

“I was very ‘critical,' I guess that would that could be the politically correct word,” Hudson said, adding that had he known about the $45 million deficit he perhaps wouldn’t have agreed to cut hospitals’ reimbursement rates by 12 percent in the upcoming fiscal year, which begins June 1, 2011.

Hudson said he warned the agency against ever “blindsiding the Legislature again.”

AHCA did not respond to requests about the phone call between Hudson and Dudek.

If the $45 million cannot be collected, Jackson Memorial would see a $22 million reduction in rates, an analysis prepared by the Safety Net Hospital Alliance of Florida shows.

Shands Jacksonville and Shands Gainesville would see a $6.7 million and a $3.9 million reduction, respectively and Tampa General would have a $5.8 million reduction, the SNHAF review shows.

Additionally, Memorial Healthcare System (comprised of Memorial Hollywood, Memorial Miramar, Memorial Pembroke Pines and Memorial West) would see a $7.1 million hit. And Broward Health (comprised of Broward General, Coral Springs, Imperial Point and North Broward Medical Center) would see a $5.3 million hit.


For more information about Miami-Dade, Broward and Palm Beach County home health care for seniors and other family members, contact Brian Gauthier at A Family Member Home Care (954) 986-5090 or www.afamilymemberhomecare.com.

This informative and entertaining blog was posted by the "Lake County Fiscal Rangers," a government fiscal watchdog effort penned by CPA Vance Jochim.  Mr. Jochim also provides a hyperlink to the Florida Agency for Health Care Administration's new Web page for the Hospital District Tax Reform Commission:
http://ahca.myflorida.com/mchq/FCTFH/fctfh.shtml


The AHCA page contains audio files of the May 27, 2011 meeting, future meeting dates and information and a list of the Commission members.




We Visit the First Tallahassee Meeting of Governor Scott's Hospital District Tax Reform Commission


Published May 29, 2011



Tavares, FL - May 29, 2011 -


You might call it Vance and Stan and Marilyn's "Excellent Adventure" driving up to Tallahassee on Thursday for the first meeting on Friday, May 27th of the Florida State Commission to Review Taxpayer Funded Hospital Districts (FSCRTFHD ?). We will refer to it as the Commission or HDC (Hospital District Commission). The Commission was established by Gov. Scott in an Executive Order.


(Updated below on May 31 to add clarifying text and indicate audio recordings have been posted to the official website)


Most website links we found are listed below in the text, or a links section at the bottom.


Note: Due to the holiday weekend, only one news article has been published on this meeting as of Sunday. I will add updates to this page after more appear. They will be in the LINKS section at the bottom of this page.


Summary:


You can read a news article HERE about the Commission meeting, with quotes both from Lake County's Marilyn Bainter, a member of the North Lake Hospital District, and Vance Jochim, writer of this blog. Bainter and Jochim were the ONLY parties providing public input at the end of the meeting.


This Commission was created by Governor Scott to investigate Hospital Tax Districts in Florida and make recommendations. We first wrote about it HERE in an earlier post. Members of the Commission seem to be
independent, and no representatives of Hospitals are on the Commission.


Our interest is that our local North Lake County Hospital District (NLCHD) provides about $5-million to EACH of two local hospitals, Waterman and Leesburg, and we wanted to understand the objectives of the Commission and provide public input supporting improvements in Hospital District practices. We have written numerous articles on NLCHD, which are HERE.


No decisions were made at this first of many meetings, which was mostly focused on establishing guidelines, learning about Sunshine rules and providing a list of information they want from staff for the next meeting, to be held on June 20 (Monday).


The Commission is using staff and facilities from the Florida AHCA ( Agency for Health Care Administration). Two absent Commission members called in via phone. One was a Florida Representative who only listened for half the meeting, however, the official list of Commission members does NOT list the Representative, so that must be new. Another Commission vacancy will not be filled so as not to delay the Commission. The Commission members asked the AHCA staff to initiate some basic research, including more statistics on all the Hospital Districts so they can decide specifically which ones would be part of the review. Apparently, there are some Hospital Districts that exist, but are dormant, and may be excluded (or should be closed if recommended).


About 60 people were there, including lobbyists, press members (inlcuding the NY Times), MANY staff from AHCA, representatives of various affected hospitals including both Florida Hospital (parent of Lake County's Waterman Hospital) and a rep for Leesburg Regional Health Center.


Transparency of Commission Activities: At the request of FiscalRangers.com several weeks ago (and probably others), the Commission has already established a website HERE where agendas, supporting attachments, minutes, and audio recordings of meetings will be posted, as well as other documents. We also asked for a streaming video and online audio broadcast, which are being considered. A Commissioner pointed out the need for streaming video and had to tell them about the free service Ustream, which is used by our own Lake County Board for meetings. They also intend to provide a phone line for callers to listen to the discussion, but not provide feedback (again, technical issues), but may allow call in questions later. As of today, two days after the Friday meeting, the website has downloadable copies of the Agenda and all supporting documents provided to the Commission members. UPDATE: As of May 31, the audio recordings have been posted to the website. We expect the minutes to be posted fairly soon on that website, so we will not post those links here.


Details of the meeting


Basically, the members of the Commission were given a set of seven objectives listed in Governor Scott's Executive Order, with five of them focused on "government operated" hospital districts. There are only 10 of 67 Florida Counties that have Hospital Tax Districts. A number of them actually own one or more hospitals, which are considered "government operated".


This blog has never focused on the South Lake Hospital District, which DOES own half of South Lake Hospital, but it will certainly fall under the purview of this Commission. Our articles on this blog will only focus on how the Commission affects the North Lake County Hospital District.


Clarification: We have talked about the lack of specific spending rules, performance audits and low accountability for funds provided to the two local Hospitals by the North Lake County Hospital District. However, we should clarify for those that do not understand our definition of accountability or audit methods. The District DOES have financial audits by a CPA firm to warrant that they spent funds like described in their financial statements, which basically list a few large payments indirectly to the Hospitals. In addition, each Hospital has audited financial statements and also forwards data to AHCA for required reports. But, when we talk about accountability and auditing, we are talking about the complete lack of guidelines for how our own North lake County Hospital District Tax revenues are to be spent by the Hospitals (i.e. not for renovations or bonuses), a complete lack of audits to ensure compliance with those desired guidelines (which are non-existent at this point) and a lack of any performance audits to ensure that the funds received by the hospitals from NLCHD are efficiently spent. For instance, are they being used to pay for non-paying patients just because the Hospital doesn't have an aggressive or fair collections process?


I will write a future article on this issue to further clarify it. The hospitals or AHCA will say they have financial audits, and they do, but not the type to verify exact, efficient uses of Lake County tax funds. Additionally, they will say they spend the full $5-million on indigent care, but that is not what the law says - it uses a vague term "for continued hospital care" which can be defined in many ways. The indigent care question is up in the air, because the hospitals are both non-profits, they escape paying most all taxes, and when creating a non-profit, to get that status, they had to agree to absorb costs for all health care patients who could not pay, so why should they get another subsidy when they are already getting huge tax breaks, AND reporting profits in prior years. Finally, if the hospitals really needed subsidies from Lake County taxpayers, why didn't the Tax District Board establish pay caps on staff until the subsidies were no longer needed. Remember, the Federal government did that for the General Motors bailout, so why isn't that done for local hospitals receiving taxpayer bailout subsidies? In contrast, the regulations establishing the North Orange County Hospital District have NO cost reduction or cost control tradeoffs from the hospitals for receiving about $5-million in subsidies.


Conclusion:


Marilyn and I gave public input to focus on ensuring that the Commission also reviewed operations of Hospital Districts that were Tax Districts only, and did not run government owned hospitals. Thus, they will be sure to also review those Tax Districts, their need for sunset provisions, need for better accountability, need for spending guidelines, need for pay caps as long as subsidies are needed, etc.


We expect that there will be very good transparency on meeting proceedings and opportunities for public input. This committee, unlike the North Lake County Hospital District, is objective and is NOT controlled by Hospital representatives. I have corresponded with staff several times to ensure there was adequate transparency, and their website indicates a very good understanding of the need for transparency.


I will post updates on future issues and meetings of the Commission.



The Excellent Adventure:


I rode up to Tallahassee with Marilyn Bainter and her husband, Stan Bainter, former Florida State representative. A number of people came up to Stan at the meeting who knew him when he was in the Florida House. He and Marilyn even knew the chair of the Commission, Dominic Calabro, as well as some GOOD looking lobbyists and staff members of elected officials.


We got to the Commission meeting early, and met with some attendees. Later after the meeting and our public input, we were joined by several "like minded" people from other Counties that had similar problems with Hospital Districts or the Hospitals their District owned and ran.


Riding with Stan and Marilyn is one of those "you can't make this up" experiences. Marilyn has a new car and Stan was driving. It was raining after we stopped for food, and Stan went out to get the car. Then the rain came down in buckets. He pulled up to the door and Marilyn and I ran to the passenger doors, and were getting drenched as buckets of water came down. Stan didn't know how to work the door locks to unlock the passenger doors, and we got thoroughly soaked.


It was certainly a memorable adventure. It's the kind of stuff you would see in an I Love Lucy episode.


Lake County taxpayers are lucky to have the Bainter duo on their side.


Links:


FiscalRangers.com articles on this Committee will be posted under the category "North Lake County Hospital District" on this blog and all those articles can be seen HERE.


The official AHCA provided website for the Commission is HERE, which also has alink to Governor Scott's Executive Order number 11-63, which specifies the 7 major objectives of the Commission, and there is also alink for the Commission Members:


http://www.fdhc.state.fl.us/mchq/FCTFH/fctfh.shtml


Other articles on the Commission - before and after this May 27 meeting:

http://www.wctv.tv/news/headlines/Panel_Begins_Health_Safety_Review_122821444.html


This one, by Lloyd Dunkelberger, is apparently syndicated – I have found it in three different newspapers. This one is the Sarasota Herald-Tribune. They may have been edited or shortened from the original.


Sarasota Herald Tribune:


http://www.heraldtribune.com/article/20110527/ARTICLE/110529458/-1/sports?Title=Review-of-Florida-s-public-hospitals-begins


http://www.ocala.com/article/20110527/ARTICLES/110529733/1454?p=all&tc=pgall&tc=ar


http://fltrib.com/scotts-review-taxpayer-funded-hospitals-ready-gear


http://capitalsoup.com/2011/03/23/governor-scott-orders-review-of-government-run-hospitals/


This blog by John Degroot covers the North Broward County Hospital District (Florida)


http://john-degroot.com/2011/05/27/stay-tuned.aspx


This link is to an article about a controversy in a Seattle Hospital District because the head of the publicly funded and government owned hospital is paid over $1-million and is the highest paid govenment employee in Washington State.


http://www.king5.com/home/valley-medical-center-122473009.html


http://webworks.typepad.com/lakecountyfiscalrangers/2011/05/www.Fiscalrangers.com
http://www.typepad.com/services/trackback/6a00d834632be569e20154329fe320970c
You can also follow us by Liking our Facebook page "FiscalRangers" HERE.



For more information about Miami-Dade, Broward and Palm Beach County home health care for seniors and other family members, contact Brian Gauthier at A Family Member Home Care (954) 986-5090 or www.afamilymemberhomecare.com.  Serving Coconut Creek Cooper City Coral Springs Dania Beach Davie Deerfield Beach Fort Lauderdale Hallandale Beach, Hillsboro Beach Hollywood Lauderdale Lakes Lauderdale-by-the-Sea Lauderhill Lazy Lake Lighthouse Point Margate Miramar North Lauderdale Oakland Park Parkland Pembroke Park Pembroke Pines Plantation Pompano Beach Sea Ranch Lakes Southwest Ranches Sunrise Tamarac Weston Wilton Manors Aventura Sunny Isles Beach Hialeah Miami Lakes Boca Raton Delray Beach

Above:  State Representative Carlos Lopez Cantera shows his no vote to an amendment to the House appropriations bill during the 2011 Florida Legislative Session. ( Photo Credit:  AP/Coale)







Posted on Wed, Jun. 1, 2011
Lawmakers: Get tough on ALF watchdogs


By Carol Marbin Miller, Michael Sallah and Rob Barrycmarbin@MiamiHerald.com


One of the state’s most powerful lawmakers has proposed punishing agency heads and inspectors who fail to police assisted-living facilities that violate state law.


State Rep. Carlos Lopez-Cantera, House majority leader and head of the Miami-Dade legislative delegation, suggested Wednesday that lawmakers consider “putting teeth into penalties for agency heads that do not follow the law.” His comments were made during a visit by members of the delegation to The Miami Herald editorial board, where lawmakers discussed the successes and shortcomings of the recently concluded session.


“I think it’s appropriate, and we have to take this up as a Legislature,” the Miami Republican said of legislation designed to reform the operation and oversight of ALFs, which were the subject of a recent series of stories called “Neglected to Death” in The Herald. The lawmaker said ALFs had “exploded’’ in many South Florida neighborhoods in recent years, aided by laws that thwart the ability of local governments to restrict land-use and zoning.


Lopez-Cantera said lawmakers also should look at the role of inspectors with the state Agency for Health Care Administration, which regulates ALFs, “to see why they haven’t been doing their jobs.”


The Herald series reported that the state, once lauded for its passage of laws to protect frail elders, has failed to keep pace with the explosive growth of ALFs, slashing both the frequency and number of inspections while failing to punish operators who don’t live up to state standards. The Herald found the state could have sought to close at least 70 homes between 2008 and 2009 for severe violations, including incidents in which elders died at the hands of caregivers, but closed just seven.


The Herald also found that fines against bad homes were routinely decreased, delayed and, in some cases, dropped altogether.


Lopez-Cantera said he would speak with House social service leaders and ask them to review The Herald series and consider joining Senate colleagues in a summertime study of the state’s ALF program and oversight. Last month, Sen. Ronda Storms, a Valrico Republican who heads that chamber’s Children, Families and Elder Affairs Committee, said she will work with Weston Democratic Sen. Nan Rich, to initiate such an interim report.


Rich, the Senate minority leader who attended Wednesday’s editorial board meeting, agreed that lawmakers should consider putting greater pressure on AHCA to hold facilities accountable, saying state law already includes many protections for ALF residents. The greater problem, she said, was the failure of agency heads to enforce the laws.


“There actually are statutes and laws that protect people in ALFs,” Rich said, “but very weak enforcement.”


Lopez-Cantera said he expects lawmakers to iron out the details in the coming months, but he favors legislation that attaches penalties to the misconduct of agency heads and workers.


“When there has been a clear breakdown in the inspector’s job, and the agency’s job, to the extent that they were culpable or negligent, they should be held accountable,’’ Lopez-Cantera said. “If you have an inspector walk into a facility and witness something [wrong] and then turn the other cheek, I would think that would be grounds for prosecution.”


Rep. Jeanette Nunez, a Miami Republican and healthcare executive, said AHCA’s oversight of retirement homes reminded her of the state’s child welfare system, where the state has failed children for years — improving services and oversight only after scandals erupt in the local newspaper. “This is an ongoing problem we have, and it is a cycle,’’ Nunez said.


Rep. Richard Steinberg, a Miami Beach Democrat, criticized his colleagues for supporting legislation, which passed, that limited money damages ALF residents or their families may be awarded if they suffer from abuse or neglect at a retirement home. Steinberg suggested lawmakers were hypocrites for calling for reforms of the troubled homes while making it harder for lawyers to help families that have been harmed.


“We are calling for greater protections on the government side, while on the side of lawyers who protect people, you limit that,” he said.


© 2011 Miami Herald Media Company. All Rights Reserved.
http://www.miamiherald.com




Read more: http://www.miamiherald.com/2011/06/01/v-print/2246400/lawmakers-get-tough-on-alf-watchdogs.html#ixzz1O5CKyiIu

Left:  Florida State Representative Matt Hudson listens to debate on the House floor.  (Photo Credit: Ana Goni-Lessan)


Hospitals told to raise $45 million or face additional reductions to their rates

Christine Jordan Sexton, 5/31/2011 - 9:07 PM
www.thefloridacurrent.com

 Hospitals -- already facing a 12 percent reduction in their Medicaid rates in the next fiscal year -- could see deeper rate cuts in the coming months.

The state Agency for Health Care Administration on May 24 sent a letter to hospitals advising them that there is a $45 million shortfall in intergovernmental transfers -- so called IGTs used to help fund hospital Medicaid rates.

If the state cannot find “willing contributors” to shore up the deficit in seven days, the letter notes, the state will ”take actions to reduce the current hospital reimbursement rates" on June 1. Modified rates would be established for the first six months of the year according to the letter, and the “recoupment process will likely begin in the first payment cycle in July.”

Because Medicaid dollars are matched by federal funds the impact on Florida hospitals is $123 million, according to an analysis prepared by the Safety Net Hospital Alliance of Florida, an association that represents many of the large hospitals that provide indigent care.

Rep. Matt Hudson, R-Naples and chairman of the House Appropriation Health Care subcommittee, blasted AHCA for not advising the Legislature -- which adjourned earlier this month -- of the deficit in IGTs.

“It would have been nice to be told this when we were actually in session," Hudson said.

Additionally, he criticized the state for giving hospitals just seven days -- which included the weekend and Memorial Day when most people were off -- to come up with the $45 million.

“Giving people one week to come up with that amount of money is an unrealistic thing and it’s not fair to the public,” Hudson told the Florida Tribune.

Hudson said the Legislature handled the deficits in the Agency for Persons with Disabilities in a public way and they should have had a similar opportunity with the hospital rates. Additionally, Hudson said he doesn’t want to hear from the agency that it wasn’t aware of the shortfall.

“'I didn’t know' isn’t an excuse. 'I didn’t know' means I didn’t do my job well,” said Hudson.

The overall health care budget for fiscal year 2011-12 included in SB 2000 appropriates nearly $30 billion for health care and human services, or a 5 percent increase. But there are also plenty of cuts in the final budget. Hospitals will have their Medicaid reimbursement rates cut by 12 percent, county health departments’ rates will be cut 10 percent, nursing home rates will be cut by 6.5 percent and development disabled providers will receive a 3 percent rate cut. The budget also cuts money set aside for biomedical research.

SNHAF President Tony Carvalho said the reductions could be “devastating” given the fact Medicaid rates already are below hospital costs. Carvalho said his association “is working on options,” including “petitioning the Legislature and agency” to take more time before recouping any dollars from hospitals. Carvalho said there’s no requirement that the reductions be made by July 1 as AHCA has indicated.

Carvalho’s hospitals, which provide a large amount of Medicaid care, stand to lose the most money -- about $72.7 million.

Medicaid HMOs pay hospitals based on their Medicaid rates and if reductions to rates are made, arguably it could be a savings for Medicaid HMOs. But Florida Association of Health Plans President and Chief Executive Officer Michael Garner said the reductions would impact plans differently and an analysis would need to be done to see the impact. Additionally Garner stressed that not all hospital inpatient days are paid by managed care plans.

But he did note that hospitals are the “major driver” of health care costs.

“Absolutely, it will have a positive (fiscal) effect in the system,” he said.


In accordance with Senate Bill 1484 (Chapter 2010-144, Laws of Florida), Section 2, the Agency for Health Care Administration established a technical advisory panel to advise the Agency in the study and development of intergovernmental transfer distribution methods within the Medicaid program. The panel included representatives from contributing hospitals, medical schools, local governments and managed care plans.

• Click to see AHCA's IGT report from 2010-2011:  http://static-lobbytools.s3.amazonaws.com/press/20110110_florida_medicaid_intergovernmental_transfer_technical_advisory_panel_report.pdf

Below . . . Reported by South Florida Hospital News in March 2007

Proposed CMS Rule Will Cut Hospital Reimbursement by More Than $4 Billion - Some Hospitals Could Close

The Florida Hospital Association (FHA) has completed an analysis of the proposed Centers for Medicare & Medicaid Services (CMS) rule governing the use of intergovernmental transfer (IGT) funds and has determined it will cost Florida's hospitals more than $4 billion over the next five years. The proposed rule, which was published on January 18, 2007, negates the policies adopted and approved by the federal government for Florida's Low Income Pool (LIP) program, Medicaid, and the care afforded by these programs.

"This proposal will have a disastrous impact on Florida's hospital community'" said Wayne NeSmith, President of the Florida Hospital Association. "We are asking the Florida Congressional Delegation to protect our state's hospitals from these cuts and the communities we serve," said NeSmith.

The analysis developed by FHA shows the annual financial impact on hospitals in Florida exceeds $932 million per year. The rule drastically changes the way Florida funds its Medicaid LIP program. The LIP program provides special Medicaid payments to hospitals based on the amount and types of services provided including pediatric, trauma, rural, and graduate medical education. "If this rule is allowed to go into effect, hospitals across the state and the country will be forced to dramatically reduce services and in some cases, hospitals will close," according to NeSmith.

FHA will continue to meet with the Florida Congressional Delegation and work closely with the American Hospital Association (AHA), the National Association of Public Hospitals (NAPH), and the Safety Net Hospital Alliance of Florida on a Congressional solution.