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Trust Index: Are nursing homes making more money for COVID-19 residents?

HOUSTON – Are nursing homes denying critical, potentially life-saving hospital care to their COVID-19 residents to make more money? This is something several KPRC2 viewers asked us to look into.

In Texas nursing homes, there are about 10,721 residents and employees that have contracted COVID-19, and 2,793 have died. The mortality rate for cases in Texas nursing homes is a whopping 26%.

It gets scarier when you hear the owner of one nursing home put it plainly.

“There’s no nursing home or any other facility that can stop COVID from coming in,” said Vickie Moreau, owner of Windsong Retirement in Pearland.

Nursing home residents are older and sicker and therefore can skew the numbers, but our viewers are rightfully concerned and skeptical.

“Is it true nursing homes have an incentive to not send COVID patients to the hospital i.e. they make more money(?),” one viewer asked.

“Sure I think it’s a reasonable suspicion,” said Greg Shelley, program manager of the Harris County Long-term Ombudsman Program at Cizik School of Nursing at UTHealth.

Shelley is a county ombudsman, basically a patient/resident advocate. He says Medicare does pay more to nursing homes who treat COVID patients, but that doesn’t mean there’s rampant abuse.

“The CDC has pretty well-established guidelines for when someone should go to the hospital,” said Shelley.

“We sent 33 patients to the hospital... which is a fairly significant amount of people to send to the hospital,” said Moreau.

She has owned the Pearland nursing home for decades. Doctors who are contracted with her facility decide who goes to the hospital, she said. Besides it being immoral and perhaps illegal to not send them, the extra money is not a windfall, Moreau said.

“When you deduct all the things that you have to pay for, including the COVID test, then the nursing homes don’t make a huge amount of money off of the COVID patient,” Moreau said.

What shouldn’t be lost in any of this, is that patients have rights, including second opinions and demanding hospital care.

“They have a right to insist on going to an emergency room just like you or (me),” Shelley said.

On the KPRC 2 Trust Index scale, we rate this a yellow, “be careful” about this claim.

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Resources

If you need to reach an ombudsman:

Phone number: 877-787-8999

Online form: https://hhsportal.hhs.state.tx.us/heartwebextr/public/assignment_hhsc_omd?methodToCall=loadExternalAssignmentHome

Fax: 888-780-8099

Write a letter: HHS Office of the Ombudsman, P.O. Box 13247, Austin, Texas 78711-3247

READ: Here are the Centers for Medicare & Medicaid Services guidelines for long-term care facilities