Medicare paid billions in taxpayer dollars to nursing homes nationwide that were not meeting basic requirements to look after their residents, government investigators have found. The report, released Thursday by the Department of Health and Human Services' inspector general, said Medicare paid about $5.1 billion for patients to stay in skilled nursing facilities that failed to meet federal quality of care rules in 2009, in some cases resulting in dangerous and neglectful conditions. One out of every three times patients wound up in nursing homes that year, they landed in facilities that failed to follow basic care requirements laid out by the federal agency that administers Medicare, investigators estimated. By law, nursing homes need to write up care plans specially tailored for each resident, so doctors, nurses, therapists and all other caregivers are on the same page about how to help residents reach the highest possible levels of physical, mental and psychological well-being. Not only are residents often going without the crucial help they need, but the government could be spending taxpayer money on facilities that could endanger people's health, the report concluded. The findings come as concerns about health care quality and cost are garnering heightened attention as the Obama administration implements the nation's sweeping health care overhaul. "These findings raise concerns about what Medicare is paying for," the report said. Investigators estimate that in one out of five stays, patients' health problems weren't addressed in the care plans, falling far short of government directives. For example, one home made no plans to monitor a patient's use of two anti-psychotic drugs and one depression medication, even though the drugs could have serious side effects. In other cases, residents got therapy they didn't need, which the report said was in the nursing homes' financial interest because they would be reimbursed at a higher rate by Medicare. In one example, a patient kept getting physical and occupational therapy even though the care plan said all the health goals had been met, the report said. The Office of Inspector General's report was based on medical records from 190 patient visits to nursing homes in 42 states that lasted at least three weeks, which investigators said gave them a statistically valid sample of Medicare beneficiaries' experiences in skilled nursing facilities. That sample represents about 1.1 million patient visits to nursing homes nationwide in 2009, the most recent year for which data was available, according to the review. Overall, the review raises questions about whether the system is allowing homes to get paid for poor quality services that may be harming residents, investigators said, and recommended that the Centers for Medicare & Medicaid Services tie payments to homes' abilities to meet basic care requirements. The report also recommended that the agency strengthen its regulations and ramp up its oversight. The review did not name individual homes, nor did it estimate the number of patients who had been mistreated, but instead looked at the overall number of stays in which problems arose. In response, the agency agreed that it should consider tying Medicare reimbursements to homes' provision of good care. CMS also said in written comments that it is reviewing its own regulations to improve enforcement at the homes. "Medicare has made significant changes to the way we pay providers thanks to the health care law, to reward better quality care," Medicare spokesman Brian Cook said in a statement to AP. "We are taking steps to make sure these facilities have the resources to improve the quality of their care, and make sure Medicare is paying for the quality of care that beneficiaries are entitled to." CMS hires state-level agencies to survey the homes and make sure they are complying with federal law, and can require correction plans, deny payment or end a contract with a home if major deficiencies come to light. The agency also said it would follow up on potential enforcement at the homes featured in the report. Greg Crist, a Washington-based spokeswoman for the American Health Care Association, which represents the largest share of skilled nursing facilities nationwide, said overall nursing home operators are well regulated and follow federal guidelines but added that he could not fully comment on the report's conclusions without having had the chance to read it. "Our members begin every treatment with the individual's personal health needs at the forefront. This is a hands-on process, involving doctors and even family members in an effort to enhance the health outcome of the patient," Crist said. Virginia Fichera, who has relatives in two nursing homes in New York, said she would welcome a greater push for accountability at skilled nursing facilities. "Once you're in a nursing home, if things don't go right, you're really a prisoner," said Fichera, a retired professor in Sterling, NY. "As a concerned relative, you just want to know the care is good, and if there are problems, why they are happening and when they'll be fixed." Once residents are ready to go back home or transfer to another facility, federal law also requires that the homes write special plans to make sure patients are safely discharged. Investigators found the homes didn't always do what was needed to ensure a smooth transition. In nearly one-third of cases, facilities also did not provide enough information when the patient moved to another setting, the report found.
Wednesday, February 27, 2013
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Wednesday, February 20, 2013
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The first of three people killed in a gunman's rampage was identified Wednesday as a 20-year-old woman but police did not know why she was in the home of the shooter, who lived with his parents and was described by authorities as a video game-playing loner. Courtney Aoki, 20, of Buena Park was shot multiple times early Tuesday in the home where gunman Ali Syed, 20, lived, said Orange County sheriff's spokesman Jim Amormino. Authorities don't know her occupation, how she might have known Syed, how she got in the house — or what drove Syed to kill her with a shotgun and then leave a trail of dead and wounded as he stole a series of cars and eventually committed suicide at an intersection. "There is no evidence, no notes that would explain his very bizarre and violent behavior," Amormino said, adding there was no evidence of a sexual assault and the woman was found fully clothed. The shootings and carjackings lasted about an hour and created chaos and terror for early morning commuters who were shot at, had their car stolen or saw someone get shot. In one 911 call, a panicked construction worker reported that the foreman at his business had been shot and one of the company's trucks stolen. The man then followed Syed in another truck as he fled on the freeway, telling a dispatcher his location. "The guy has a shotgun and I need an ambulance too," the caller said. "There is someone who has been shot. Hurry up! I need an ambulance. Right away. Fast. There's someone with a shotgun. There's someone down! There's someone down!" Syed was a loner and a "gamer" who spent hours holed up in his room, authorities said. "He took one class at college and he did not work, so that gives him most of the day and evening and most of the time in his free time he was playing video games," Amormino said. A 12-gauge shotgun used in the killings belonged to Syed and was purchased by his father about a year ago, he said. Attorney Vincent John LaBarbera Jr. made a statement for Syed's family Wednesday night. "No words can express their heartbreak and sorrow," La Barbera said. "Their thoughts and prayers go out to the families of all the victims. They will continue to assist authorities in the investigation as they themselves try to make sense of this tragedy." The rampage began before dawn Tuesday at the home in Ladera Ranch, a wealthy Orange County suburb about 50 miles south of Los Angeles, and ended 25 miles to the north during the early morning rush hour. Syed killed two more people during carjackings, injured at least three more, and shot up cars zooming down a busy freeway interchange before he ended it by putting the shotgun to his own head as police closed in. The shooter forced one commuter out of his BMW, marched him to a curb and shot him three times from behind as shocked witnesses looked on, Tustin police Chief Scott Jordan said. Syed had no criminal history and no history of mental illness or mental disability, said Lt. Paul Garaven, a Tustin police spokesman. An autopsy will determine whether Syed had any drugs in his system, but Amormino said no illegal drugs were found in the house and there were no signs he was using illegal substances. His parents did not recognize the woman who was shot to death in the Ladera Ranch home, he said. Syed's parents called police at 4:45 a.m. Tuesday after hearing the gunshots, but Syed had already sped off in their black SUV. Officials released the 911 call Syed's parents made as a dispatcher tried to elicit information from the shooter's panicked, sobbing mother as a house alarm blared in the background. "I think somebody was shot," the mother said in her first comprehensible statement. "I heard a gunshot." The dispatcher then asked questions to sort out what happened including whether there was an intruder or if the mother had been shot. "Yes, there is somebody in our house," the mother said. After several minutes, Syed's father took the phone and said he believed his son may have gotten in a fight with a friend. The father said Syed left the home and took their car but he and his wife had not entered his son's room to see what happened. "We were asleep, we heard something, it sounded like a gunshot," he said. From Ladera Ranch, the gunman headed north and pulled off Interstate 5 in Tustin, about 20 miles away, with a flat tire, police said. There he fired at and wounded a man in a car, then carjacked a vehicle from a man at a gas station and got back on the freeway, where he fired at commuters, authorities said. The shooter then exited the freeway in nearby Santa Ana and carjacked a BMW, killing driver Melvin Lee Edwards, 69, of Laguna Hills. Edwards served as a U.S. Army combat infantry officer in Vietnam and graduated from the University of Southern California, according to a biography on his company's website. He and his wife, Cheryl, had celebrated their 42nd anniversary on Feb. 12 and have two adult children, his brother-in-law, Jeff Osborn, told the AP in a phone interview. "He was an extremely remarkable person. I know it's an old cliche, but he really did love life," he said. "The world's a lot smaller today for not having him here." One 911 caller told a dispatcher she watched through her rear-view mirror as a man later identified as Edwards got shot and another caller reports that he's can see him lying near the off-ramp. Syed took Edwards' BMW and next popped up at a Tustin business, where he shot and killed construction worker Jeremy Lewis, 26, of Fullerton. Lewis' co-worker rushed to intervene and was shot in the arm, Jordan said.
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This morning's papers make dismal reading for Arsenal fans after their Champions League humiliation against Bayern Munich.
Out of the FA Cup - Out of the League Cup - Out of title race - Almost out of CL - Should Wenger be OUT OF A JOB? Oliver Holt: The righteous anger of Arsene Wenger gave way to something more poignant at the Emirates. Outraged by newspaper headlines on Monday, he was humbled in front of the fans who once adored him. Sure, the supporters grew angry now and again at the impotence of their team against the might of Bayern Munich. But they have been angry for so long here that it is almost as if they are burned out with it. This is becoming a place of constant sorrow and the mood towards Wenger at times during this 3-1 mauling felt dangerously like pity. The Sun - Kiss good Bayern to another season Steven Howard: The loyalists still preach the Wenger mantra, that Arsene still knows best. But the once great man looks to have run out of both ideas and inspiration. It happens to them all — even the mighty Brian Clough. Even the best have a shelf life. So in many ways this was the result Arsenal Football Club probably needed. To show them exactly where they stand in the grand scheme of things. The Times - Arsenal left with no way back Matt Dickinson: We came to the Emirates Stadium wondering if this might be a watershed evening in the decline, and fall, of the Arsene Wenger empire. But that would load the occasion with historic significance when this, depressingly, was just more of the same. Terrible defending, an absence of leadership (the admirable Jack Wilshere aside), a team without a striker. So far so predictable. When the supporters have seen it all against Bradford City and Blackburn Rovers, it was hardly a surprise that Bayern Munich should brutally expose all the same fragilities. Daily Telegraph - Down and out Paul Hayward: Bayern are a pretty good approximation of how Wenger would probably like Arsenal to look, but in the same domestic league there would be 15-20 points between them. Jack Wilshere was one of the very few who carried the battle to Bayern in a way that Tony Adams or Vieira might have recognised. There was no turning point, no relief for Wenger and very little hope of Arsenal overturning this deficit in Bavaria, unless they can summon the spirit of Chelsea in last season’s Champions League final and somehow treble it. As Wenger himself said: “Let’s not hide the truth." The Guardian - Wenger concedes trophy hopes David Hytner: Jack Wilshere stuck to his task impressively, never hiding and always seeking to push his team. There was the creation of a couple of half-chances before the interval and he inspired a little more in the second-half. Even to the last, he gritted his teeth, burst into the area and forced Neuer into a rare safe. This, however, was Bayern's evening. They were too good for Arsenal. The worry is that Wilshere might be, as well. Independent - Don't blame Wenger James Lawton: (The possibility of a recovery) was put to the sword when Bayern’s marvellously fecund striker Mario Mandzukic ran beautifully to deliver a third goal. On the touch-line, Wenger sagged again. He had talked of the mental strength of his team and their deep-seated ability before this trial and no doubt he will walk again to create something from the debris of defeat. It is a forlorn task for a great football man for whom the weight of pressure had reached still another level.. Daily Mail - Hurtling towards oblivion Martin Samuel: Only seven clubs have overturned a first-leg home deficit in the Champions League, and a two-goal margin gapes like a chasm. Arsenal require a backs-to-the-wall performance as great as anything Chelsea pulled off last season; greater, really, considering Wenger’s team need to reverse not just form, but recent history.
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The early morning commute was just getting under way on suburban Orange County's network of freeways when Melvin Lee Edwards pulled up to a stop sign near a busy off-ramp. It was just after 5 a.m. and Edwards, 69, was on his way to work when, police say, a fleeing murder suspect forced him out of his BMW at gunpoint, marched him across the street and shot him three times from behind as horrified commuters watched. The shooting was the second of three murders in a trail of carnage early Tuesday that spanned 25 miles — but lasted just an hour. The shooter, 20-year-old Ali Syed, killed a woman in the home he shared with his parents, killed two drivers during carjackings, injured two others and shot up cars on a busy freeway interchange before committing suicide as police closed in, authorities said. Syed, an unemployed part-time community college student, had no known motive and acted alone, said Tustin police Chief Scott Jordan. The first victim, a woman in her twenties, has not been identified and was not related to Syed, he said. The violence began at 4:45 a.m., when deputies responded to a call from Ladera Ranch, a sleepy inland town about 55 miles southeast of Los Angeles. They found the woman shot multiple times. Syed's parents were in the house at the time, fled the residence when shots were fired, and reported it, Jordan said. From Ladera Ranch, the gunman headed north and pulled off Interstate 5 in Tustin, about 20 miles away, with a flat tire, police said. A man who was waiting in a shopping center parking lot to carpool with his son saw Syed had a gun and tried to escape in his Cadillac, Jordan said. Syed ran after the car as it drove away and fired his shotgun through the back window, striking the driver in head but not killing him. The driver "noticed that he was loading his shotgun, so he simply gets back in his car and tries to escape," Jordan said. "He's driving through the parking lot trying to get away and the suspect is actually chasing him on foot, taking shots at him." Syed then crossed the street to a Mobil gas station, where he approached the driver of a pick-up who was filling his tank and asked for his keys, Jordan said. "He says something to the effect of, 'I've killed somebody. Today's my last day. I don't want to hurt you. Give me your keys,'" the police chief said. "He hands over the keys and he gets in the truck and leaves." Syed got back on the freeway, where he pulled to the side of the road at the busy I-5 and State Route 55 interchange and began firing at commuters, Jordan said. One driver was struck in the mouth and hand. He didn't have a cellphone, but was able to drive home and call police. Two other cars were hit but their drivers weren't injured, Jordan said. "All of this is happening so quickly," he said, estimating that Syed shot at drivers from the side of the freeway transition for about a minute. The shooter then exited the freeway in nearby Santa Ana but ran the curb and got his car stuck, authorities said. He approached Edwards, of Laguna Hills, who was on his way to his Santa Ana business. Syed shot Edwards three times, including in the back of the head and the back, Jordan said. Onlookers "tried to get away. They saw what was going on, they tried to get away and they called police," he said. Syed took Edwards' BMW and next popped up at the Micro Center, a Tustin business, where he shot and killed construction worker Jeremy Lewis, 26, of Fullerton. Lewis' co-worker rushed to intervene and was shot in the arm, Jordan said. Syed took the second construction worker's utility truck and fled to Orange, this time with California Highway Patrol officers in pursuit. He jumped from the moving utility truck at an intersection in Orange, about five miles away, and shot himself in the head, Jordan said.
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