Nbc News Investigation: Nursing Home Chain Collapses Amid Allegations Of Unpaid Bills Poor Care
A month after the death, the Centers for Medicare and Medicaid Services, the federal agency that oversees the nursing home industry, terminated Medicare certification for the facility and another Skyline property in Tennessee. It terminated a third in the state in 2018.
During the investigation, the company’s medical director told inspectors, “I have no support, no direction.”
In the deposition from September, which was in relation to a wrongful death suit filed last year in Arkansas on behalf of a resident named Lois Rack, Schwartz insisted that Skyline delivered high-caliber long-term care. An attorney for the plaintiffs, Blake Fromang, asked him, “Did you monitor the quality of care your facilities were providing?” He responded, “I did not monitor but I did make aware that that is what I want.”
Fromang also asked, “Did you have a system in place to make sure were getting quality care?” Schwartz responded, “I’m sure.” Fromang followed up, “Do you remember what it was?” Schwartz answered, “No.”
Former employees alleged in an ongoing lawsuit that they discovered that the company had stopped paying health care premiums, leaving them to discover that they were uninsured, and they sued Skyline. Schwartz denied the allegations in court.
The Massachusetts attorney general cited Schwartz for failing to pay hundreds of employees their wages.
Is A Nursing Home Your Only Choice
Make sure to read through the other residential care housing options included on this page. There may be other alternatives for care in a more residential environment including getting the care and services the person needs at home. Learn more about in-home services.
Adults receiving state-funds to pay for long term care services may also be eligible for the Nurse Delegation Program. With Nurse Delegation, a caregiver may be trained to help with certain nursing type care tasks in your home, Assisted Living Facility, or adult family home. Learn more about Nurse Delegation.
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Expansion Under The Affordable Care Act
The Affordable Care Act provided for the expansion of Medicaid to cover childless adults whose income is 138 percent of the federal poverty level or below. The provision for expanding Medicaid went into effect nationwide in 2014. As of November 2018, a total of 36 states and Washington, D.C., had expanded or voted to expand Medicaid.
Arkansas expanded its Medicaid program in 2013 via an alternative systemthe state used federal Medicaid funds to purchase private insurance on the state’s exchange. While GovernorAsa Hutchinson, elected in 2014, supported the state’s expansion, he also called for an exploration of other options in January 2015. On May 4, 2017, Hutchinson signed legislation into law lowering the threshold for Medicaid eligibility for childless adults in the state from 138 percent of the poverty level to 100 percent of the poverty level..
Support
Arguing in support of the expansion of Medicaid eligibility in an April 2013 article, the Center for American Progress states that the expansion helps increase the number of people with health insurance and benefits states economically. The organization argues that by providing health insurance to those who would otherwise be uninsured, Medicaid expansion allows low-income families to spend more money on food and housing:
Opposition
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More Ways To Pay For In
While the above programs help many people finance in-home care, they will not cover all costs for everyone. There are other ways to pay for in-home care, including annuities, reverse mortgages, private insurance and out-of-pocket arrangements with siblings. Read Caring.coms Guide to In-Home Care Costs to learn more about these alternative payment options.
Assisted Living Scope Of Care
In Arkansas, ALFs may be classified as Level I or Level II. The level of care that a facility is equipped to provide will determine eligibility for residence based on applicants physical and intellectual capabilities. ALFs can provide personal care services through the Medicaid State Plan, and in Level II ALFs, more medically trained staff will be on hand.
The main differences between a Level I and Level II facility are:
- A Level I facility cannot serve residents who are nursing home-eligible, while a Level II facility may.
- A Level II facility must employ a consulting pharmacist.
- A Level I facility cannot provide significant medication assistance, while a Level II facility can provide direct care to help residents take their medicines.
Both Level I facilities and Level II facilities do provide:
- 24-hour staff availability
- Limited assistance with all Activities of Daily Living
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Concordia Nursing And Rehab
When looking for dementia care facilities in Bella Vista, Arkansas, you will find Concordia Nursing And Rehab as an excellent luxury memory care option that is located at 7 Professional Drive in the 72714 zip code area. It has a total capacity of 102 Alzheimers and dementia units and provides amenities that include secure campus to prevent wandering, special dementia and Alzheimers programs to increase feelings of comfort and emergency pullcords in bedrooms and bathrooms. Concordia Nursing And Rehab provides dementia and Alzheimers care not only to Bella Vista residents, but also to all Benton county residents as well.
Arkansas Memory Care Facilities Vs Assisted Living Facilities
In an assisted-living home, people with special needs can continue to live independently, with immediate access to healthcare and support services. Aside from boarding and lodging, assisted-living centers may also provide physical, mental and emotional support and allow for social interactions with other community members.
However, given that they are mostly unregulated by the central government there are chances for significant discrepancies in the care quality, facilities development, amenities acquisition, building maintenance, and overall community management. Although nursing homes and Arkansas assisted living homes can have a special memory care unit separate from the rest of the institution, with qualified staff to provide the specialized care that patients with dementia require, not every facility may have it.
On the other hand, memory care communities are equipped and trained to provide care to people diagnosed with Alzheimers and other types of dementia.
In addition to providing meals, rooms and other support services, they also offer behavioral health services, assisting in the administration of memory care-specific treatments, and supervising individual and group therapies together with any additional services as required.
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Asset Protection Strategies For Long
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The U.S. Department of Health and Human Services has predicted that a person turning 65 today faces a close to 70% chance of needing some form of long-term care service in their remaining years.
Many people think they can avoid needing such care or simply dont want to face the idea and deal with the details. Long-term care can be extremely expensive the average cost of a semi-private room in an Arkansas nursing home is $5,353 a month and often people dont understand their rights and options.
Long-term care insurance, a persons individual finances and Medicaid are the primary sources of money for long-term care.
Forethought in the form of a savings plan or paying insurance premiums over time are ways for a person to prepare for such a major life change. But many dont go to the trouble or dont want to spend the money on such advance planning, and frequently Medicaid becomes the go-to payment method for long-term care.
But Medicaid is means tested, requiring applicants to have low incomes and limited assets.
For married or single applicants to nursing home care in Arkansas, the Medicaid income limit is $2,382 a month per individual with assets of no more than $2,000 for single applicants and $3,000 for married applicants. The numbers are the same to qualify for waivers for home- and community-based services.
For married applicants with only one spouse applying, the asset limit is $2,000 for the applicant and $130,380 for the non-applicant.
Benefits And Drawbacks Of Assisted Living In Maumelle
- Property taxes in Maumelle are very low, but the states sales tax rate is high. Social Security income is not subject to state income tax, and other types of retirement income are only partially taxed.
- The air quality in Maumelle is very good with low levels of ozone and particle pollution. This may be beneficial for seniors, particularly those with respiratory or cardiovascular conditions.
- The Maumelle area has no facilities from which to choose in the event of a medical emergency or illness, with the nearest major hospital located in North Little Rock.
- The overall cost of living in Maumelle is only about 2% higher than the U.S. average but roughly 18% higher than the state average, which may be a consideration for Arkansas natives living on a tight retirement budget. The cost of housing is about 11% higher than the national average, which may drive up assisted living costs.
- As is typical of Arkansas, Maumelle has a warm climate with hot summers and relatively mild winters, which may suit seniors who are sensitive to cold weather. The hottest months of the year are July and August when highs are in the 90s, and the coolest month of the year is January when highs are around 50 degrees.
- The combined property and violent crime rates in Maumelle are lower than the national average, with a majority of the citys crime being property-related. This may appeal to seniors seeking a safe community for their retirement years.
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Minimum Staffing For Long Term Care Facilities
Minimum staffing requirements are included in the regulations that pertain to each type of facility. To view them, please go to Regulations, view or download the regulations document for the type of facility that interests you, and navigate to the staffing section.
The Office of Long Term Care has created a Minimum Staffing Calculator for nursing facilities that you can download and install on your computer. To learn more, click the link below.
The Office of Long Term Care has gone live with an online portal for the collection of the monthly minimum staffing requirement data. The online portal is powered through a technology called QuickBase and is part of a larger effort to provide an online portal for providers to submit information to OLTC. Users can access the portal by going directly to and selecting the OLTC Minimum Staffing icon.
Arkansas Charges Former Nursing Home Chain Owner With Medicaid And Tax Fraud
The former owner of a national nursing home chain that collapsed amid widespread allegations of neglect and financial mismanagement detailed in a previous NBC News investigation has been charged by the Arkansas attorney general with eight counts of Medicaid fraud and two tax fraud counts.
The man, Joseph Schwartz, who lives in Brooklyn, New York, is expected to turn himself in to Arkansas authorities in early January, said his Arkansas attorney, Bill James.
All 10 of the counts are felonies.
Arkansas is working with a group of other state attorneys general who are also considering possible civil action against Schwartz, said a person familiar with their discussions.
At one time, Schwartz oversaw the care of more than 7,000 older Americans through his company, Skyline Healthcare, which at its peak owned or ran more than 100 facilities in 11 states. With a handful of staff members, Schwartz managed them from a tiny office over a New Jersey pizzeria.
From 2017 to 2019, the chain crumbled, and more than a dozen Skyline-operated nursing homes shut their doors, throwing residents, vendors, employees and state regulators into chaos, according to court filings, state officials and former employees.
Arkansas Attorney General Leslie Rutledge alleges that as it declined, the company did not just fail to pay bills but that it also committed fraud.
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Medicaid Benefits And Services
The services covered by Medicaid vary from program to program and from state to state. What follows are general Medicaid benefits which are typically available in most states.
The Affordable Care Act does not significantly impact Medicaid long term care benefits for the elderly. Therefore, repeal by the Trump administration will have limited impact.
Background Checks For Assisted Living
In the assisted living communities of Arkansas, all employees including any non-employees working on ALF grounds must pass a criminal background check. The background check itself is specifically designed in accordance with Arkansas Rules and Regulations for Conducting Criminal Record Checks for Employees of Long-Term Care Facilities.
- It must be verified that any would-be employee has never been convicted of, and does not have any substantiated reports of neglect or abuse of residents, or misuse of resident property.
- Before making any new hires or allowing workers onto the grounds, the facility must check names against the Employment Clearance Registry of the Office of Long-Term Care, and also the Adult Abuse Registry maintained by DHS/DAAST.
- Re-checks must be done every five years.
- The Office of Long-Term care will conduct an investigation into the character of prospective administrators as part of their criminal background check.
- Administrators must have no prior convictions relating to the operation of a long-term care facility.
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Heres An Introduction To Medicaids Complicated Rules On Eligibility For Nursing Homes And Home Health Care
If you have limited assets and a low income and you need help paying for nursing home or assisted living care, Medicaid might help you pay for your care. Medicaid is a joint federal and state program, and the states have some flexibility in setting the benefits they will offer and the eligibility criteria for those benefits.
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Does Arkansas Help With My Medicare Premiums
Medicare Savings Programs can help Medicare beneficiaries who struggle to afford the cost of Medicare coverage MSPs pay for Medicare Part B premiums and in some cases Part A premiums and well as Medicare cost sharing.
- Qualified Medicare Beneficiary : The income limit for this category is $1,064 a month if single and $1,437 a month if married. QMB pays for Part A and B cost sharing, Part B premiums, and if a beneficiary owes them it also pays their Part A premiums.
- Specified Low-income Medicare Beneficiary : SLMB pays for Part B premiums for beneficiaries who meet income limits of up to $1,276 a month if single and $1,723 a month if married.
- Qualifying Individuals : The income limit is from SLMB levels up to $1,436 a month if single and $1,940 a month if married. QI pays for Part B premiums.
MSP asset limits:
Income and asset limits for QMB, SLMB and QI vary based on an applicants marital status. However, eligibility rules for other Medicaid programs usually vary based on the number of household members.
Income limits for MSPs and Medicaid benefits are significantly higher for applicants who still are working, because only a little less than half of employment income is counted.
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Reverse Mortgages In Arkansas
Reverse mortgages are available in Arkansas. A reverse mortgage is a home equity loan where the borrower does not have to make payments.
This type of mortgage can increase monthly income, eliminate mortgage payments, and even fund Long-Term Care Insurance. However, Arkansas has many rules on these mortgage products, and you should seek the help of a qualified and licensed mortgage broker.
If you have significant equity in your home and you and your spouse are at least 62 years old, you can get a reverse mortgage to turn your equity into funding long-term health care, pay for an LTC Insurance policy, pay bills and add to your retirement lifestyle.
The home must be the principal residence without any tax liens.
Learn more about reverse mortgages by .
*The federal government sets a new minimum and maximum amounts each year, but states can set their own minimum requirements at any level between the federal limits. This information is based on the best available sources.
Assisted Living Laws And Regulations In Arkansas
Assisted living communities in Arkansas have state-enforced rules and regulations to ensure that the facilities are clean and well-maintained and the residents receive proper care. The Arkansas Department of Human Services, the Division of Medical Services and the Office of Long-Term Care license and regulate the states assisted living communities to ensure compliance.
Assisted Living Service Plan Requirements
When residents are admitted, the assisted living community is required to conduct a thorough assessment to determine their care needs. This assessment must be conducted on an annual basis, ensuring that as residents needs change, their care plan changes to accommodate.
Assisted Living Admission Requirements
In Arkansas, an assisted living community cannot admit or retain someone who is not independently mobile. Every resident must have the physical and mental ability to leave the building within three minutes. Communities also cannot admit a senior who has a feeding or intravenous tube, is completely incontinent or needs nursing services beyond what the community provides on a day-to-day basis.
Residents cannot pose a danger to themselves or to others, and they cannot be admitted if they have a mental illness or substance addiction. Finally, a community can turn away a prospective resident if that persons religious, cultural or dietary regimens cannot be reasonably met.
A resident may only be discharged if the community can no longer meet medical needs.
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Assisted Living Choices Waiver
People who are nursing home-eligible and wish to reside in an assisted living facility may qualify for the Assisted Living Choices program. Assisted Living Choices is a Medicaid waiver which allows for 24-hour personal care services to be covered for a limited number of people, helping nursing home-eligible recipients avoid being institutionalized. Other forms of assistance are available through this program, including:
- Extended prescription drug coverage for non-Medicare residents
- Periodic nursing evaluations and services
- Medication oversight and administration
- Therapeutic, social, and recreational activities
Who is Eligible?
Those who require intermediate-level nursing home care are eligible, but individuals requiring skilled care are not. Adults who have no physical disabilities must be 65 or older to qualify.
- There is a $2,000 asset cap for individuals, and the assets of married couples are considered individually.
- Only countable assets are considered, including bank accounts, cash, and mutual funds.
- There is a $2,250 income cap for individuals, with no separately designated amount for couples.
How to Apply
Applications can be filed at your local Department of Human Services office, or the process can be initiated over the phone by calling the Choices in Living Resource Center at 801-3435.
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