By Bonnie Miller Rubin, Chicago Tribune reporter

January 25, 2012

Sherry Wolf always indulged her husband’s love of Costa Rica — until he brought home a book about moving there.

“I told him, ‘Don’t even think about it, because I’m not going,’” she said.

While Scott Wolf, a 61-year-old Flossmoor radiologist, envisioned a retirement of surfing and mojitos, his wife carried a very different snapshot in her head of theater, restaurants and concerts. Also, she has obligations anchoring her to the Midwest, including a 90-year-old mother in Northbrook.

“If something happens, it takes two days to get home from Central America,” she said. “So, for now, we’re just not dealing with it.”

As the first wave of baby boomers hit 65, they are confronting one of the most fundamental questions of retirement: Where are we going to live?

After years of earning a paycheck and raising children, couples say the prospect of finally having time to pursue their own interests can be delicious — or daunting. And while there’s plenty of advice on how to navigate this chapter financially, landing on the same page emotionally as your spouse can be far more elusive.

The Wolfs, who have two grown daughters and have been married for 31 years, were surprised to reach this crossroads and discover that they had different road maps. For now, Sherry Wolf, 59, is content with working — which includes supervising student teachers for Governors State University and leading Weight Watchers meetings.

Her husband, though, had tired of medicine and retired two years ago. He longed to live near water, which doesn’t enter into her equation at all. “I can handle the beach for four or five days … but after that, I need something more.”

Instead, she is lobbying for Santa Fe, N.M., with its change of seasons and vibrant cultural scene, even though surfing isn’t an option in landlocked New Mexico. They considered buying a second home but decided against the responsibilities of owning two dwellings.

So, for the last three years, he has gone to Costa Rica solo for a month, while she keeps her daily routine here. They talk by Skype every day — about the kids, the dog, everything but living arrangements.

The Wolfs are hardly alone. In a 2011 study, the MetLife Mature Market Institute found that only 51 percent of respondents have even identified personal goals in retirement. Some 63 percent of those 55 and older say they plan to age in place, while 12 percent plan to move and 26 percent are undecided.

John Migliaccio, MetLife’s director of research and gerontology, gives couples paper and crayons to draw their post-work life. When it comes time to compare sketches, one spouse might have a remote mountain retreat while the other has an urban loft.

“They can be married 40 or 50 years and they’ll look at each other as if to say, ‘How could you not know that I was thinking about this?’ A lot of couples approach retirement in their head … but it never gets externalized to their partner,” Migliaccio said.

Baby boomers differ from their parents in several key ways, including longer life expectancy and being more accustomed to pulling up stakes, experts said. Also, unlike the World War II generation, women — who have their own careers and pensions — are less likely to leave all the decision-making up to their husbands.

Today’s retirees also can choose from far more options on how to spend these bonus years. The Peace Corps, for example, saw a 44 percent increase in applications from older Americans between 2007 and 2009. If one mate envisions this as a time for public service, while the other dreams of verdant fairways in a 55-and-over enclave, expect some sparks to fly.

“It’s one reason why you see more couples end their relationship at this stage,” Migliaccio said. “They’re both on different paths.”

Julia Valentine, author of “Joy Compass: How to Make Your Retirement the Treasure of Your Life,” agreed that this can be a tricky transition.

“Just having the right amount in the bank is not enough,” Valentine explained. “You need to ask yourself: What do I need to be fulfilled? Then find specific ways to ensure those needs can be met.”

Valentine was one of the speakers at the recent Ideal Living Resort and Retirement Expo in Schaumburg. The event brought together a dazzling array of Sun Belt communities, touting lush landscapes, championship golf and tennis, all enjoyed by smiling, sherbet-attired couples.

At every booth, balmy winter temperatures and low taxes beckoned — as did salespeople ready to swat away objections, including proximity to children and grandchildren.

“What happens when the kids choose to move for another job? Are you willing to sacrifice your own life for the sake of your children?” asked Carol Schulz, formerly of Barrington. She now works for The Villages of Citrus Hills in Hernando, Fla., about an hour’s drive north of Tampa.

Still, Schulz conceded that uprooting yourself late in life is a big step. When she and her husband first moved in 2004, she would return to Chicago about eight times a year. Now, she has whittled the trips down to three.

“We’re asking people to change everything they know. … It’s a process, and you have to baby them along the way.”

Ginger and Tom Waeghe of Algonquin — he’s in construction; she’s in banking — admitted to feeling overwhelmed by all the exhibitors, including 24 locales in Tennessee alone.

“It’s stressful,” said Ginger Waeghe, 55. “The only way we can talk about this is on our cellphones during our commutes. … It just seems to go better that way. By the time we’re done with our day, we’re too drained to have these conversations.”

So far, she and her 50-year-old husband agree that the next stage will probably include part-time jobs. She likes Florida, but he doesn’t. They’ve checked out Arizona, which they both rejected. They share a straightforward but contradictory idea of what they require from a retirement spot. “We want to live simply, but we do like nicer things.”

So, it’s back to the drawing board, to tweak — not abandon — their plans. Ginger Waeghe knows that time is precious, especially because both of her parents died in their 60s. “We’re not waiting.”

Added her husband, “We don’t want to be so busy making a living that we don’t make a life.”

brubin@tribune.com

The draft framework was created based on input from the Advisory Council on Alzheimer’s Research, Care, and Services, which is comprised of over 20 representatives from federal agencies and organizations outside the Federal Government. The framework seeks to address five goals:

■Prevent and Effectively Treat Alzheimer’s Disease by 2025.
■Optimize Care Quality and Efficiency.
■Expand Patient and Family Support.
■Enhance Public Awareness and Engagement.
■Track Progress and Drive Improvement.

The plan takes a multi-faceted approach to each goal. For example, in order to enhance care quality and efficiency, the agency outlines a plan to build a larger workforce of long term care providers and others who care for those with Alzheimer’s as well as implement policies that allow for easy transitions between hospitals and long term care settings. The plan asserts a commitment to advancing research but also to maintaining dignity, safety, and other rights for those with Alzheimer’s disease. Many other departments, agencies, and organizations will be collaborating with HHS in the coming years to implement the plan, when finalized.

Read the full document: “Draft Framework for the National Plan to Address Alzheimer’s Disease” and submit your comments about the plan to HHS at NAPA@hhs.gov

Marlton, NJ (PRWEB) January 07, 2012

Home Care Assistance, the leading provider of in-home care for seniors, is proud to announce the Hospital to Home Care program, a comprehensive set of educational resources for families managing the difficult transition home after hospitalization. The program helps families prepare for discharge, manage the unique needs of post-hospitalization patients and coordinate recovery at home.

“The hospitalization and discharge experience is a source of tremendous anxiety for patients and their families,” said Lily Sarafan, President of Home Care Assistance. “Individuals are placed in a stressful situation, often without the resources they need to make the best long-term decisions for their loved ones. As the leading experts in post-hospitalization care, we wanted to provide families everywhere with the information and guidance they need to manage every step of the discharge process and recovery at home.”

The program is supported by the book, From Hospital to Home Care, written by Home Care Assistance co-founders Dr. Kathy Johnson, Dr. James Johnson and Lily Sarafan. The book provides a comprehensive overview of the challenges and resources associated with each step in the transition from hospital to the home, explains the discharge process from an inpatient hospital stay, outlines common issues associated with specific medical conditions, discusses the unique needs of recently hospitalized patients and emphasizes the importance of home care in patient outcomes and quality of life. Home Care Assistance is also excited to unveil HospitaltoHomeCare.com, a free online resource for families seeking information about the discharge process and recovery at home.

“We hope to offer comfort and provide education to patients and families going through the hospital discharge process with these resources,” said Steve Malone, Owner of Home Care Assistance of Southern New Jersey. “Getting seniors back into their homes with the appropriate level of care is critical to the recovery process. We find that families are not always knowledgeable about this process or prepared for what to expect.”

Hospital to Home Care is part of a long-term initiative at Home Care Assistance to encourage recovery and rehabilitation at home while reducing avoidable hospital readmissions. Alongside the psychological and emotional benefits of recovery at home, patients also benefit from dedicated one-on-one support from a caregiver. In addition, patients avoid the infection risk associated with care facilities and enjoy greater freedom outside of an institutional setting.

“Our mission at Home Care Assistance is to change the way the world ages,” said Sarafan. “We have been able to help countless clients with their post-hospitalization recovery at home and now we’ve been able to transfer that expertise into informative resources for the public. By encouraging patients to recover at home and reducing avoidable hospital readmissions, we hope to re-shape how families and health professionals think about post-hospitalization care.”

From Hospital to Home Care: A Step by Step Guide to Providing Care to Patients Post Hospitalization is available for pre-order on Amazon.com for $17.95. A 16-page PDF guide to the discharge and recovery process is available for free at HospitaltoHomeCare.com.

For more information about Home Care Assistance or to learn more about the transition from hospital to home, please visit HomeCareAssistance.com or call 1-856-988-6495.

ABOUT HOME CARE ASSISTANCE
Home Care Assistance is the leading provider of home care for seniors across the United States and Canada. Our mission is to change the way the world ages. We provide older adults with quality care that enables them to live happier, healthier lives at home. Our services are distinguished by the caliber of our caregivers, the responsiveness of our staff and our expertise in Live-In care. We embrace a positive, balanced approach to aging centered on the evolving needs of older adults. A 2011 Franchise500® Company, Home Care Assistance has received numerous industry awards including Entrepreneur’s Fastest-Growing Franchises and Franchise Business Review’s Top 50. For more information about Home Care Assistance, our services and franchise opportunities, visit HomeCareAssistance.com or Franchise.HomeCareAssistance.com.

When choosing a provider for over 50 life insurance, please consider carefully the qualifying period as it does have an impact on the amount of coverage that you will be paid if you were to die unexpectedly soon after implementing the policy.

Unlike competitive plans, Aviva’s Guaranteed Lifelong Protection Plan will pay out the full sum if you die after the plan has been in force after 12 months. And, if you were to die as a result of an accident after the first 12 months, Aviva pays double the coverage amount.

If you die within the first 12 months of the plan, Aviva pays out an amount equal to the premiums that have been paid. However, if you die as a result of an accident in the first 12 months, Aviva pays the full sum assured.

Choose a name you can trust: Aviva is the largest provider of life, pensions, and long-term financial services in the UK, and serves around 44.5 million customers worldwide.

Aviva’s expert advisers will help you every step of the way. They’ll be able to answer your questions and help you to complete your application, as well as offer you advice on Aviva’s life insurance plans.

Visit Aviva’s Guaranteed Lifelong Protection Plan for more information.

A Gallup poll found those aged 65 and older report the highest level of enjoyment and happiness out of any age group. The survey indicated that seniors who spend much of their time socializing are more likely than their peers to report a high level of happiness.

Individuals aged 18 and up were asked if they experienced a lot of enjoyment and happiness without much stress and worry throughout the previous day. Overall, 64 percent, a percentage higher than any other age group, of seniors reported a high level of enjoyment and happiness. The next happiest age group was the 50-64 year olds, of which 47 percent reported a high level of enjoyment and happiness without a lot of stress and worry. Researchers found that the feeling of emotional wellbeing rises sharply after age 60, but this increase is not a result of retirement. Both those 60 and older working full time, at 61 percent, and those out of the workforce, at 63 percent, reported similar levels of happiness.

The perception of happiness was affected by the amount of social interaction. About 72 percent of participants aged 65 and older who reported engaging in social activity six hours a day described a high level of enjoyment and happiness. Only 44 percent of those 65 and older who reported zero hours of social time described the same emotional wellbeing.

Read more about the findings of the poll in the article U.S. Seniors Maintain Happiness Highs with Less Social Time.

The traditional eight-hour workday may soon be the exception rather than the rule. New evidence shows that we’re reaching a tipping point in terms of workplace flexibility, with businesses seeing the wisdom of allowing employees — young employees especially — to work odd hours, telecommute, and otherwise tweak the usual 9-to-5 grind.

One of the top 12 trends for 2012 as named by the communications firm Euro RSCG Worldwide is that employees in the Gen-Y or “millennial” demographic — those born between roughly 1982 and 1993 — are overturning the traditional workday.

The Business and Professional Women’s Foundation estimates that by 2025, 75% of the global workforce will be Gen-Y. As early as next year, this group of younger Americans will already comprise 60% of the employees at companies such as Ernst & Young. And increasingly, companies creating workplace flexibility programs because it makes good business sense, not in the least because that’s what their employees demand.

(MORE: 5 Most Surprising Findings from the 2010 Census)

Gen-Y is spearheading this change because they don’t want the same work environment their parents had. Between new technology and global workplace dynamics, companies are implementing flexible work arrangements for everyone, inclusive of Gen-Y. A recent Vodafone UK survey illustrates that 90 percent of employers enable work flexibility instead of sticking to traditional hours.

Leading the charge in the shift toward allowing employees to work anywhere around the world, at any time they want, are companies such as Ernst & Young, Aflac, and MITRE, which realize that they need to accommodate employees’ personal lives if they want to retain them. “This notion of an eight-hour day is rapidly disappearing simply because we work so virtually and globally,” says Maryella Gockel, Ernst & Young’s flexibility strategy leader. By understanding Gen-Y’s need for workplace flexibility, companies are better able to recruit and grow young talent for the future.

Aside from early adopters of workplace flexibility programs, many other companies are hesitant because of the traditional “command and control” approach laid out for older generations. The challenge these companies face is letting go and trusting their young employees — even when they are telecommuting or using Facebook regularly at work.

(MORE: A New Job for Christmas? Why the Holidays Can Be a Great Time to Look for Work)

Many companies fear that, without structure, employees will be distracted, not as engaged and less productive. In fact, the opposite is often true. A trusting work environment breeds more loyal employees and increases efficiency. Here are three reasons why successful companies will embrace workplace flexibility programs:

1. Gen-Y workers won’t accept jobs where they can’t access Facebook. Cisco’s “Connected World Technology Report” shows that more than half of Gen-Y employees prioritize social media freedom over a higher salary when evaluating a job offer. Furthermore, more than half of them say that the Internet is an integral part of their lives. Gen-Y wants to be connected to their friends and families, not just their co-workers, throughout the day. Although some companies ban social media at work, other companies have embraced it as long as employees are using it professionally. “We do want people to use social networks in order to keep in touch with their colleagues and contacts,” explains Gockel, whose company has no formal social media guidelines or policies.

2. Gen-Y values workplace flexibility over more money. More than one-third (37 percent) of Gen-Y workers would take a pay cut if it meant more flexibility on the job, reports a study by Mom Corps. Flexibility motivates Gen-Y workers to be more productive and loyal to their companies because they feel like they are respected. An employer that allows flexibility in the workplace also demonstrates that it understands the evolving modern-day work environment, which bodes well for the future.

3. Gen-Y workers are always connected to jobs through technology. Technology has made the traditional nine-to-five model blurry — for all workers, of all generations, really. No one is ever out of touch, or off the clock. When workers go home, they are still “working” because who they are personally and professionally are becoming one in the same and interconnected. Workers are always representing the company, and more and more, it seems, that work email doesn’t stop for anything or anyone. By no means does time away from the office equate to less work getting done.

>Dan Schawbel is the Managing Partner of Millennial Branding, LLC, a full-service personal branding agency. Dan is the author of Me 2.0: 4 Steps to Building Your Future, the founder of the Personal Branding Blog, and publisher of Personal Branding Magazine.

View this article on Time.com

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Seattle, WA (PRWEB) December 20, 2011

As leaders in hospice quality improvement for 20 years, OCS is proud to announce the release of a Hospice Quality Reporting Toolkit; an educational and instructional document designed to help hospices with the hospice public reporting mandates from the Centers of Medicare and Medicaid Services (CMS).

This document summarizes past and present guidelines of hospice quality reporting, along with providing significant insight into the future of quality reporting initiatives for hospices in 2012 and 2013. Hospice organizations can purchase the low-cost toolkit through the OCS website.

“As CMS takes initial steps toward the eventual standardization of hospice measures and public reporting, it is important that hospices have access to longitudinal support of quality reporting, including data submission templates, education, and integrated resource directories,” said Roger Herr, Strategic Advisor for OCS. “OCS has seen the evolving need and has set out to assist hospices in this transitional time.”

The Hospice Quality Reporting Toolkit is comprised of three sections, an educational overview Hospice Quality Data Submission Educational Overview, Hospice Quality Data Submission Instructions, and a template for Hospice Quality Submission.

The toolkit is an efficient way for hospice providers to learn the new hospice quality reporting mandate, quickly get up to speed on the impact of the mandate, and access guidelines and step-by-step instructions for 2012 and 2013 quality submission.

For questions about the Hospice Quality Reporting Toolkit, call 888.325.3396, write to info(at)ocsys(dot)com, or visit the OCS website.

About OCS and My InnerView
As a combined business unit of National Research Corporation, OCS and My InnerView empower clients and partners throughout the entire post-acute continuum of care, including hospice, home health, skilled nursing, assisted living, and more. The company offers market-leading survey solutions, predictive tools, data analytics, quality and outcomes reporting, financial insights, and the nation’s largest comparative databases. OCS and My InnerView partner with more than 12,000 post-acute providers.

For more information, please visit the OCS and My InnerView websites, write to info(at)ocsys(dot)com, or call 888.325.3396.

About National Research Corporation
National Research Corporation, headquartered in Lincoln, Nebraska, is a leading provider of performance measurement, quality improvement services, and governance education to the healthcare industry in the United States and Canada.

Detroit Free Press Medical Writer

Virginia Everett, 85, had something that many other nursing home residents don’t: a daughter and grandchildren who lived nearby and dropped in frequently. “I love ‘em,” she said of her visitors.

And that, experts say, is immeasurably more important than polished lobbies, state-of-the-art whirlpool tubs and, in some cases, even a near-spotless inspection report or high ratings by the U.S. Centers for Medicare & Medicaid Services.

In fact, the Whitehall Healthcare Center of Novi, where Everett was a longtime resident until her death in June, has had its share of citations from state inspectors. And Whitehall receives just two stars overall in a U.S. five-star rating system, with five serious violations in the last three years.

But the experience of Everett and her family underscores this advice from experts both inside and out of the nursing home industry: A home’s ranking and history on health and safety measures is important in choosing a nursing home, but so is the unspoken message that family visits send to staff: “Someone cares about this person. Someone may complain if care is unacceptable.”

“The best nursing home in the world is the one where you can stop by on a regular basis,” said Mt. Clemens attorney Patrick Simasko, who helps families prepare their finances for long-term care.

Patient advocates say the best sign of a good home is how actively the staff encourages involvement by loved ones. A good home includes residents and their families in developing care plans. Staff members encourage them to ask questions.

Cheryl Deep, 55, Everett’s daughter, checked out a handful of other homes several years ago when her mother first stepped into the revolving door of emergency rooms and long-term rehabilitation after health issues began setting in. Deep would size up each facility, knowing it might be the last stop for her mother, a retired construction company owner who began drifting in and out of reality this year.

“I saw some of the really pretty, newer ones and some of the older places, too,” she said.

Ultimately, Deep made her decision as many family members do — in crisis, after another hospital stay following heart problems.

“It was clear she couldn’t come home,” Deep said. “Honestly, she was fading very fast and we thought we only had a month or so left. Her lungs were filling with fluid. So we thought, it didn’t matter so much where as long as we can see her often.”

Four years later, her mom was still at Whitehall, and Deep was happy. Deep said she saw her mother several times a week before she died from an acute kidney infection. By then, Deep knew the staff well. They smiled and joked with Everett. When Deep asked about a scabbed-over scrape on her mother’s leg — staff said it came from a run-in with a door frame — her mom was certain it happened on a recent hike on a mountain.

Deep, who was interviewed by the Free Press before her mother died, chuckled at the thought of her mother mountain climbing. She knew the staff and trusted them.

“They’ll reference to something else in her day — maybe her breakfast or lunch or something she said earlier. So clearly they’ve been there and they’ve paid attention,” Deep said. “That means a lot.”

Contact Robin Erb: 313-222-2708 or rerb@freepress.com

Seniors in Connecticut, Indiana, Minnesota, New York and Ohio will benefit from the Department of Housing and Urban Development grants, which will enable them to age in place in apartments designed to meet their physical needs.

The funding has been provided through HUD’s Assisted Living Conversion Program, which converts eligible multifamily assisted housing projects into assisted living facilities.

“The funding will allow the elderly an opportunity to age in place in familiar surroundings as they become older and require supportive services,” said HUD Secretary Shaun Donovan. “These grants will provide an affordable option to nursing homes, helping seniors to live independently.”

The grants will be awarded on a competitive basis, and HUD will assess factors that include the extent to which the conversion is needed by the persons the project is intended to serve; the quality and effectiveness of the proposal in addressing the proposed conversion; the ability of the project owner to secure other community resources which can be combined with the grant; and the capacity of the project owner to carry out the conversion in a timely and effective manner.

New Haven Jewish Federation Housing Corporation, Laverna Terrace Housing, and NCR of Johnstown are among the groups that will be receiving the individual grants, which range from $1.3 million to $8.6 million.

Written by Alyssa Gerace

Janet Stubbs was grateful when the nursing home recommended hospice care for her aunt Midge. Although Stubbs knew her aunt wasn’t dying, the offer of free, Medicare-paid hospice visits from a nurse and chaplain, plus an extra weekly bath, was too good to pass up.

Stubbs didn’t know that her aunt, Doris Midge Appling, was admitted to Hospice Care of Kansas during the company’s “Summer Sizzle” promotion drive, which paid employees as much as $100 a head for referrals, according to the U.S. Department of Justice. Stubbs also said she had no clue that the nursing home doctor who referred her aunt for hospice moonlighted as medical director for the hospice company.

“It doesn’t seem right,” said Stubbs, who had Appling’s power of attorney to make medical decisions. “What incentive did the doctor have to put my aunt on hospice? How much was she being paid?”

Harden Healthcare LLC, the hospice’s current owner, said medical directors received no incentive pay. Appling’s doctor, Donna Ewy, didn’t return four calls seeking comment.

Hospice care, once chiefly a charitable cause, has become a growth industry, with $14 billion in revenues, 1,800 for-profit providers and a base of Medicare-covered patients that doubled to 1.1 million from 2000 to 2009.

Compensation based on enrollment numbers, pay to nursing- home doctors who double as hospice medical directors, and gifts to the nursing facilities have helped fuel the boom, according to an examination of 1,000 pages of court documents and interviews with more than 45 current and former hospice employees, patients and family members.

KKR Buys In

“They wanted us to admit, admit, admit,” said Joyce White, a former marketer for Vitas Healthcare, a Chemed Corp. (CHE) unit that is the nation’s largest hospice chain. “All of us competed against each other to make our numbers. You lived or died by your numbers.”

Publicly traded companies like Chemed and Gentiva Health Services Inc. (GTIV) have created hospice chains through serial takeovers in the last decade. Hospice buyouts and investments by private-equity firms have also led to boosted enrollments.

Funding from Kohlberg Kravis Roberts & Co. enabled closely- held Harden’s acquisition of Hospice Care of Kansas’s parent last year. The seller: private-equity investor Apax Partners, of London and New York.

“There was always pressure to get the patient census up, any way we could, to sell the company,” said Rae Ann Angelo, a Wichita salesperson for the Kansas hospice between 2003 and 2009, including most of the time when Apax owned it. “You can’t sell unless you show big growth.”

‘Make a Buck’

Other private equity concerns that have been active in the hospice trade include Denver-based KRG Capital Partners LLC. KRG sold Dallas-based Trinity Hospice for $75 million in 2006. The company was liquidated by the buyer, nursing-home operator Sunrise Senior Living Inc., (SRZ) two years later, after $67 million in writeoffs and government allegations of ineligible patient enrollments prior to the takeover.

“After KRG came in, it was clear their philosophy was, ‘Put everyone on hospice, don’t ask questions and build!” said Catherine Covington, who worked as a Trinity compliance officer from 2000 to 2004. “They were there to make a buck.”

KRG members on Trinity’s board ordered “immediate disciplinary action” when they learned of compliance violations, which led to terminations, according to KRG spokesman Topper Ray.

Diapers, Wheelchairs

Hospice Care of Kansas, or HCK, gave salespeople a budget of $500 a month to buy lunches and gifts for doctors and nursing-facility managers and staff, said Angelo, who now works for another hospice. Nursing homes have been offered diapers, wheelchairs, nutritional supplements and other supplies in return for patient referrals, other former hospice workers said.

Vitas paid salespeople bonuses based on patients’ length of stay, according to White, who worked for the company in Cathedral City, California, from 1998 to 2004. Medicare, which foots 90 percent of the national hospice bill, compensates providers on a per-diem basis, and lengthier stays increase profitability, federal data show.

Vitas “compensates some marketing and management representatives based on overall growth,” according to spokeswoman Kal Mistry. She said Vitas does not link compensation to length of stay or pay bonuses to employees involved in admissions decisions.

Pizza Parties

VistaCare Hospice, a unit of Atlanta-based Gentiva, paid enrollment bonuses to doctors, admissions directors and branch managers, according to Misty Wall, a former social worker for the company and now an assistant professor at Boise State University in Idaho. VistaCare also gave pizza parties, gift cards and other extras to its registered nurses and social workers for meeting admission targets, Wall said.

Wall has filed a lawsuit against VistaCare in U.S. District Court in Dallas under the U.S. False Claims Act, seeking repayment to the government for admissions of ineligible hospice patients. The law lets plaintiffs share in any recoveries. The Justice Department, which has not joined Wall’s suit, is opposing VistaCare’s motion to dismiss the claim.

The allegations predated Gentiva’s ownership of VistaCare, according to spokesman Scott Cianciulli, who said the company is committed to complying with all Medicare rules.

The inspector general of the U.S. Health and Human Services Department is probing hospice marketing practices and financial relationships with nursing facilities. The inquiry was spawned by a 2009 report by the Medpac commission, a congressional advisory body, that found hospices “aggressively marketed” to nursing-home patients, and paid incentives to medical directors for “inappropriate” referrals and enrollments.

Complicated Laws

Under various federal statutes, paying for patient referrals or compensating employees based on the number of Medicare patients recruited may be illegal. But the laws are “painfully complicated” and loaded with exceptions, said Ryan Stumphauzer, a former federal prosecutor in Miami who helped launch South Florida’s Medicare Fraud Strike Force.

Stumphauzer said he and other “cautious” lawyers believe the health care laws bar all employees and contractors from earning bonuses based on Medicare enrollment goals, including salesmen and managers.

Nursing-home physicians referring patients to hospices that also pay the doctors, especially in cases when the compensation includes enrollment bonuses, may violate a federal statute known as the Stark Law, according to Stumphauzer. The law is designed to ensure that doctors refer patients based on who provides the best care, not based on who is paying them.

Patient 11

Seven pending or settled lawsuits against hospice companies say that enrollment-based incentives led to admitting patients who didn’t qualify for hospice care. Appling, Stubbs’s aunt, is identified as “Patient 11” in one of these cases, a U.S. Justice Department civil fraud complaint against HCK and its owner, the Voyager HospiceCare unit of Harden. Prosecutors say the company bilked Medicare by paying bonuses to employees and doctors to sign up patients who weren’t dying.

HCK in court filings denied it billed Medicare for ineligible patients. Those the government identified were eligible because “a medical director and/or an attending physician certified” they were terminally ill, HCK said.

Appling was discharged after 20 months in HCK, and lived four more years before her death in April at age 106. Medicare paid nearly $80,000 for her hospice care.

Imminent Death

Harden’s purchase of HCK’s parent was part of a flurry of buyouts in the sector. A record 17 hospices were acquired in the first six months of 2011, according to Dexter Braff of the Braff Group, a Pittsburgh-based merger-advisory firm. Prices for mid- sized and larger hospice chains have risen “significantly” in the past two years, from about one times annual revenue to as much as 1.5-times, said investment banker Burk Lindsey of Raymond James & Associates in Nashville.

The rise of for-profit hospice care since 2000 has helped drive a 60 percent increase in the average time patients spend in hospice, to 86 days in 2009, according to Medpac. The average stay of the 10 percent of patients who remained in hospice the longest soared 71 percent to 240 days.

That means at least 110,000 patients weren’t facing imminent death when they were admitted — although doctors said they were. To qualify for Medicare hospice coverage, patients must have a prognosis of six months or less to live, certified by two doctors.

‘Christmas Cash Blitz’

Profit margins on healthier patients who survive for years with minimal care can exceed 20 percent, according to Medpac. Medicare patients can stay on hospice indefinitely, as long as a hospice physician recertifies that they are terminally ill every 60 days.

Besides the “Summer Sizzle” promotion, the push for patients at HCK included “Christmas Cash Blitz” and “Fall Frenzy” admission drives. Those eligible for cash incentives in these and other programs included managers and admissions and medical staff, according to a dozen former employees.

A former company nurse said employees were warned that disclosing the incentive arrangements outside the company was a fireable offense, according to summary of her interview with the Federal Bureau of Investigation.

The nurse, Yolanda Anderson, was dismissed for revealing the bonus program to a social worker at a nursing home, according to a Justice Department court filing. Harden couldn’t comment on the reason Anderson left because her departure pre- dated its acquisition, said spokeswoman Meg Meo.

Free Vacations

Hospice salespeople would vie with drug marketers to provide lunches for doctors, since free food was often the only way to buttonhole them, Angelo said. She’d let physicians’ offices order off the menu from Scotch & Sirloin, a Wichita steak house, and then pick up and deliver the order.

Doctors and nursing homes that Angelo looked to for referrals were given baskets of bread, candy and other goodies at holidays, plus pens, mouse pads, calendars and hand sanitizer emblazoned with the hospice logo, she said. Medical directors — many of whom also worked for nursing homes — took a company- paid annual “retreat” to locales including San Diego, and free family vacations at Great Wolf Lodge in Kansas City, Kansas, according to Angelo.

Angelo said her base salary was about $45,000 a year, plus $8,000 to $10,000 in bonuses that were hers to keep whether or not admitted patients turned out to be ineligible.

Rising Patient Stays

HCK was founded in 1998 by Wichita social worker Mark Rowe. Rowe sold the company in 2004 for $11.9 million to Voyager HospiceCare, a startup launched that year by a firm later acquired by Apax. Rowe stayed on as chief executive officer until 2006, garnering at least $2.1 million in additional pay from Voyager, according to HCK court filings.

Under Voyager’s control, HCK increased the average patient stay at its main Wichita branch 45 percent to 109 days, according to Healthcare Market Resources, a medical researcher in Thresher, Pennsylvania. During the same 2004 to 2009 period, the average length of stay at all Kansas hospices rose 30 percent to 86 days, the firm said.

Apax sold Voyager in 2010 to Harden for roughly $80 million, or about four times Apax’s investment, said Thomas Combs, Voyager’s co-founder. The purchase was funded with $90 million in loans and equity from Kohlberg Kravis, which now owns a minority stake in Harden, according to KKR spokeswoman Kristi Huller. She declined to comment on the government’s allegations and referred further questions to Harden.

‘Patients Aren’t Widgets’

Apax wasn’t named in the U.S. suit against Voyager and HCK, which is pending. Lew Little, Harden’s CEO, declined to answer questions about the federal allegations against Voyager and HCK.

“It is not an unusual practice” for doctors to be medical directors at nursing homes and hospices simultaneously, and some patients “take comfort” from continuing into hospice with the same doctor, Little said in an email. No HCK medical directors, including Ewy, received compensation based on referrals or enrollment size, Little said.

“The hospice industry is not about financial incentives but about providing quality of life and dignity to patients,” he said.

HCK taught salespeople to visit nursing facilities to identify hospice prospects, get to know their families and strike up “friendly games of dominoes,” said another former marketer, Vickie Hardiman. When Rowe pushed her to accept commissions for patient admits, Hardiman said she refused because “dying patients aren’t widgets.”

Admissions ‘Pressure’

Rowe, who now owns an HCK rival, Rivercross Hospice in Kansas and Oklahoma, said his hospices have always complied with federal rules and regulations and receive high marks from government overseers.

Admissions directors at the Kansas hospice were eligible to earn bonuses of up to 15 percent of their salary for meeting enrollment targets, and medical directors were eligible for “ad hoc ‘spiff’ bonuses” based, in part, on enrollment, according to the government complaint, filed last year in U.S. District Court in Kansas City, Kansas.

Nurses evaluating patients for hospice admissions reported to the marketing department, and felt “pressure” to admit patients whom the marketers identified, whether eligible for hospice or not, according to Pat Perkins, a former HCK nursing supervisor.

Hospice ‘Doorkeepers’

HCK paid nursing-home doctors up to $4,000 a month to consult for a day or so per week on patients’ conditions and to sign treatment orders, said Roger Megli, a former HCK chaplain and marketer. The nursing-home physicians served as the hospice’s “doorkeepers,” according to Megli.

“If I’m getting $3,000 or $4,000 a month from a hospice to work one day a week, I’m going to refer my patients to hospice, too,” said Megli.

The company used its network of nursing-home doctors to provide a ready supply of patients, according to family physician Larry Anderson of Wellington, Kansas, a former president of the Kansas Medical Society. Several times when he declined to approve his patients for hospice because they weren’t dying, one of the nursing-home doctors certified them instead, Anderson said. He called it ”a win-win for everybody but the taxpayer.”

More than half of Voyager’s patients resided in nursing homes, according to Combs, the company’s co-founder and former senior vice president. That compares to about one-third of Medicare hospice patients nationally.

Hershey’s Kisses

The government often pays twice for hospice patients in nursing homes — about $137 a day to the hospice provider from Medicare, and about $200 a day that goes to the nursing facility from Medicaid, which covers the indigent elderly.

“Hospice should not be in nursing homes at all,” said Anderson. “It’s redundant and it’s an expense we cannot afford and don’t need.” In July, the inspector general of HHS recommended reducing payments to hospices in nursing home.

Stubbs, Appling’s niece, said she got a call one day from the nursing home where her aunt lived offering extra care if she were enrolled in hospice. HCK admitted Appling with a terminal diagnosis of cardiovascular accident, or stroke. It was changed later to “general debility,” according to documents filed in the court case.

Ewy signed two separate hospice admission orders — one as Appling’s attending physician at the nursing home and another one as the Kansas hospice’s medical director, copies of the documents show.

Not that Appling was dying, Stubbs said. She and her husband continued visiting her aunt twice a month at the home, Wheat State Manor in Whitewater, Kansas. Stubbs’s son and his children often joined them. Aunt Midge in her wheelchair would eat Hershey’s Kisses and play ball with the children in the garden, or Uno indoors when it was cold.

‘Inappropriate For Hospice’

A year after Appling went on hospice, the medical staff noted in her chart that she’d gained weight, was “doing well” and was “inappropriate for hospice,” according to documents submitted as evidence in the federal fraud case. Yet Appling remained on hospice eight more months before the company discharged her, according to Stubbs.

Medicare paid HCK $3,980 a month to care for Appling, according to the government’s complaint. On top of that, Stubbs paid the nursing home $4,000 to $5,000 a month for room and board. “I feel really dumb,” Stubbs said.

Stubbs said she worries her aunt’s hospice stay may have deprived Appling of medical treatments that might have helped her. Patients who enroll in hospice agree to accept pain management instead of aggressive, or “curative,” treatment.

Resisting Discharges

Stubbs said no one explained that when she enrolled Appling. Stubbs wonders if her aunt, who had several strokes, might have benefited from drugs or rehabilitation unavailable to most hospice patients.

“Could we have made her remaining years more comfortable?” Stubbs asks.

In 2005, the year Appling went on hospice, about 25 percent of HCK’s patients did not meet eligibility requirements and an additional 25 percent were questionable and needed to be reviewed, according to Diana Alvarez, the company’s former director of program integrity.

When members of the medical staff wanted to discharge a patient for good health, hospice managers — whose pay was tied to enrollment — resisted, according to Brian Billings, a physician in McPherson, Kansas, who worked for HCK from 2003 until 2007. Billings said he quit because the hospice wouldn’t discharge patients who “obviously” didn’t qualify. “There was a definite shift toward the bottom line,” he said.

Gerald Stout spent about a year in HCK hospice care ending in 2006, and is still alive more than five years later, said his daughter, Brenda Chastain. No one “ever said anything about dying” when he was admitted, Chastain said.

Eight months after Stout was admitted by HCK for Parkinson’s disease, medical reviewers noted in his chart that he’d gained weight, got around well with a walker and “was not appropriate” for hospice. He was discharged three months later. Medicare paid more than $34,000 for his hospice care.

To contact the reporter responsible for this story: Peter Waldman in San Francisco at pwaldman@bloomberg.net

To contact the editor responsible for this story: Gary Putka at gputka@bloomberg.net