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Questionable Treatment of Patients at Long-Term Care Facilities

In late February, the New York Times revealed startling patterns of patient neglect at many of the nation’s long-term care facilities. Since that time, the Senate Finance committee has initiated an investigation into allegations of inferior care and deaths in long-term care facilities, with a special focus on Select Medical Corporation. Additionally, the Government Accountability Office is further examining federal and state oversight of long-term care facilities in general. Evidence suggests that long-term care facilities regularly put profit before patient care, are not held adequately accountable for ethics and practice violations and provide substandard care in comparison with general hospitals.

Long-Term Care Facilities

The more than 400 long-term care facilities in the United States typically treat chronically ill patients. Patients often are too ill to be treated in nursing homes, but are not in critical enough condition to require the emergency services provided by hospitals. These facilities treat approximately 200,000 patients a year nationwide and are funded primarily through the Medicare system. In fact, because the facilities are so inextricably tied to Medicare funding, the Senate Finance Committee, which oversees Medicare, also oversees the accountability enforcement of long-term care facilities.

Medicare provides approximately 60 percent of long-term care facilities’ total revenue, which amounts to roughly $5 billion a year. The Medicare reimbursement system has driven the growth of the long-term care facility industry. Traditional hospitals tend to lose profits on long-term patients, and lose an average of six percent on Medicare patients in general. Long-term care facilities however, which are designed to accommodate chronically ill patients, spend less on patient care and are not required to have high-priced physicians on staff, tend to make a six percent profit margin on long-term Medicare patients.

While profitable and convenient, long-term care facilities may be reaping financial rewards at the expense of patient care. The Senate Finance Committee is now questioning whether these facilities are exposing their patients to “an unreasonable risk of harm.”

Select Medical Corporation

Select Medical Corporation operates 89 long-term for-profit care facilities in the United States. It is the nation’s largest long-term care facility provider and in 2007 and 2008, Select’s facilities were cited for serious violations of Medicare rules at a rate four times higher than that of traditional hospitals. All in all, Select was cited for 22 serious Medicare violations in the last three years.

Select is now under fire for violations including understaffing and inadequate patient monitoring. Perhaps most disturbing however, are Select’s discharge practices. Under Medicare reimbursement policies, a long-term care facility reaps the greatest amount of profit if a patient is treated for 25 days. If a patient is discharged earlier or later than 25 days, the margin of profit on the patient decreases. Select has allegedly tailored patient treatment to conform to discharge on the 25th day, even if the patient needs additional care or wishes to be discharged before 25 days have passed. In some Select facilities, the 25th day following patient admission is called “the magic day.”


The Senate Finance Committee has demanded that Select provide information to the Committee relating to allegations of:

  • Poor quality of patient care and inadequate patient monitoring
  • Inadequate staffing and high turnover rates
  • High rates of serious Medicare violations
  • Questionable discharge practices
  • Response to emergency situations

However, according to the New York Times, Medicare cannot fine long-term care facilities if it determines that the facilities provide poor patient care. Nor can Medicare force facilities to institute staff changes. Though it can bar facilities from treating Medicare patients if violations remain uncorrected, this option is rarely exercised. In fact, when Medicare attempted to force a St. Louis Select facility out of receiving Medicare funding in 2009, a federal judge found the action unjustified and forbade Medicare from remedying Select’s violations. It is thus unclear what action the Senate Finance Committee will be able to take in holding Select accountable for its allegedly egregious violations.

For Further Reference

If you have questions or concerns about the treatment a loved one has received or is receiving at a long-term care facility, please seek the counsel of an experienced personal injury attorney.