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Medicare paid billions to sub-par nursing homes: HHS

SAN FRANCISCO 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 costs 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 The Associated Press. "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, N.Y. "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.

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Benedict XVI Begins Final Day as Pope

Pope Benedict XVI, the first pontiff to resign in 600 years, will step down today to lead a secluded life of prayer, far from the grueling demands of the papacy and the scandals that have recently plagued the church.

Benedict, 85, will spend a quiet final day as pope bidding farewell to his colleagues that have gathered in Vatican City to see him depart. His first order of business this morning is a meeting with the College of Cardinals in the Clementine Hall, a room in the Apostolic Palace, where Angelo Sodano, the dean of the College of Cardinals, is set to speak, but not Benedict.

Pope Benedict XVI Delivers Farewell Address

Despite the historical nature of Benedict's resignation, not all cardinals are expected to attend the event. With their first working meeting not until Monday, only around 100 cardinals are set to be in Vatican City Thursday, the Vatican press office said. Those who are there for Benedict's departure will be greeted by seniority.

In the evening, at 5:00 p.m. local time, Benedict will leave the Vatican palace for the last time to head to Castel Gandolfo, the papal summer residence outside of Rome. Before his departure the German-born theologian will say some goodbyes in the Courtyard of San Damaso, inside the Vatican, first to his Secretary of State Cardinal Tarcisio Bertone and then to the Swiss Guards who have protected him as pontiff.

9 Men Who Could Replace Pope Benedict XVI

Pope's Successor Needs to be 'Attuned to Modern Communication' Watch Video

From there it is a short drive to a heliport for the 15-minute flight via helicopter to Castel Gandolfo, just south of the city. Benedict will not be alone on his journey, accompanied by members of the Pontifical Household such as two private secretaries, the head of protocol, his personal physician and his butler.

Once Benedict lands in the gardens at Castel Gandolfo, a group of dignitaries, such as the governor of the Vatican City state Giovanni Bertello, two bishops, the director of the pontifical villas, and the mayor and parish priest. Off the helicopter and into a car, Benedict will head to the palace that he will call home for the coming months. From a window of the palace, Benedict will make one final wave to the crowd at the papal retreat.

It is there, at 8:00 p.m., that Benedict's resignation will take effect once and for all. Once the gates to the residence close, the Swiss Guards will leave Benedict's side for the last time, their time protecting the pontiff completed.

Pope Benedict's Last Sunday Prayer Service

For some American Catholics in Rome for the historic occasion, Benedict's departure is bittersweet. Christopher Kerzich, a Chicago resident studying at the Pontifical North American College of Rome, said Wednesday he is sad to see Benedict leave, but excited to see what comes next.

"Many Catholics have come to love this pontiff, this very humble man," Kerzich said. "He is a man who's really fought this and prayed this through and has peace in his heart. I take comfort in that and I think a lot of Catholics should take comfort in that."

In his final address to the faithful as leader of the Roman Catholic Church, Benedict on Wednesday said his decision to resign was "the fruit of a serene trust in God's will and a deep love of Christ's Church." Before a crowd of hundreds of thousands of people in St. Peter's Square, Benedict said he was "deeply grateful for the understanding, support, and prayers of so many of you, not only here in Rome, but also throughout the world."

The date of the conclave to determine Benedict's successor has yet to be determined. In one of his last moves as pope, Benedict issued a decree permitting the cardinals to convene the conclave before the March 15 date that would have been required under the old rules.

Benedict is eventually planning to move to a monastery inside Vatican City once work there is finished, but until then he will call home the palace at Castel Gandolfo. He will be known as "pope emeritus" and don brown shoes given to him on his trip to Mexico, rather than the red ones he wore as pontiff.

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We need a piece of Mars to continue search for life

THERE'S no need to cry over spilt chemicals. Thanks to an accident inside one of its instruments, NASA's Curiosity rover has detected the presence of a substance called perchlorate in Martian soil (see "Curiosity's spills add thrills to the Mars life hunt").

Not exactly earth-shattering, you might think. But it adds a new twist to the most controversial chapter in Martian history: did the Viking landers detect life?

This is a question that has divided the Viking missions' researchers for almost three decades. One group has resolutely stuck to its guns that the landers detected signs of life. Equally adamant is a second group who say they absolutely did not – a view that has always been the official version of events.

The unexpected discovery of perchlorate supplies a legitimate reason to reopen the debate. Perchlorate is an oxidising agent that destroys organic molecules. Its presence could finally explain the disputed results.

The episode highlights another important issue. Curiosity is a sophisticated machine, but there is only so much soil chemistry we can do from millions of kilometres away. A sample return mission must be a priority.

This article appeared in print under the headline "We need a piece of Mars"

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Hong Kong unveils budget, warns on global risks

HONG KONG: Hong Kong's finance chief on Wednesday unveiled a budget to kickstart growth in the city and temper property prices but warned the world economy could face headwinds from possible trade and currency battles.

During a speech interrupted by protests, Financial Secretary John Tsang also set out a series of measures to support the middle class and alleviate poverty in the first budget under an increasingly unpopular leader Leung Chun-ying.

The announcement came as data showed the southern Chinese financial hub saw growth of just 1.4 per cent in 2012 and was tipped to expand only 1.5-3.5 per cent this year.

In unveiling measures to boost the city's financial sector and private equity industry he warned: "The whole world will have to face wars on three fronts, namely 'currency', 'trade' and 'geopolitics'.

"As a highly open and small economy, Hong Kong will be impacted by the development of these wars to a certain extent."

His comment come after a sharp drop in the value of the yen sparked accusations of government meddling and concerns about a possible global war in which nations weaken their currencies to gains give a jolt to softening exports.

Tsang outlined plans to boost the city's financial sector, including extending profits tax exemption for offshore private equity funds, with an eye on regional rival Singapore.

He also unveiled a string of populist measures aimed at supporting the middle class and poor, while looking to address the city's chronically high property prices, which have doubled since 2009, squeezing average citizens.

Tsang vowed to increase land-supply to allow the building of more houses while quarterly rates amounting to HK$11.6 billion and covering 75 per cent of properties will be waived. That follows Friday's decision to double stamp duty on second homes to 8.5 per cent.

Also on Wednesday, Tsang said there will be a 75-per cent cut in salaries tax to a ceiling of HK$10,000.

However analysts said the budget would do little to improve the lot of the middle-class or poor or give a lift to the popularity of Leung, whose government has been rocked by a series of protests since he came to power in July.

Leung, who was chosen by a committee dominated by pro-Beijing elites, has seen his support rating drop after scandals involving illegal structures at his home, and last year came close to facing impeachment proceedings.

"For the middle class there is very minimal. If the middle class is renting property -- those rates are nothing to do with him," said Philip Hung, President of the The Taxation Institute of Hong Kong.

Hung added the level of some of one off measures, such as the salary-tax cut, was lower than last year.

Despite announcing a budget surplus of HK$64.9 billion ($8.4 billion) this year -- which swelled reserves to HK$734 billion -- the new measures totalled only HK$33 billion, down from the HK$80 billion-worth introduced last year.

In a sign of the dissatisfaction with the administration, dozens of people, some dressed as the Chinese "wealth god", waved banners and shouted slogans outside government headquarters demanding handouts of HK$10,000 and more welfare spending.

"The government should give money directly to the general public so that they can make ends meet," activist Tam Kwok-kiu told AFP, adding that the government is sitting on a fiscal surplus.

Two lawmakers including radical Leung Kwok-hung were escorted out of the chambers after interrupting Tsang's speech and calling him a "liar".

Tsang said he had had been listening to the concerns of the middle class, who are faced with rising bills for rent, medical care, and supporting their parents and children.

"I agree that middle-class families should be given some support. However, as one may appreciate, it is impracticable for the government to respond to each and every demand," he said.

- AFP/xq

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Peru: 'Missing' U.S. couple found, but family wants proof

STORY HIGHLIGHTS

• Peru's tourism minister say Jamie Neal and Garrett Hand were found in the Amazon


• Hand's mother says she won't believe the news until she hears directly from her son


• Family and friends have not been able to reach the couple since January


• Some areas they planned to visit are out of cell phone and Internet reach

(CNN) -- An American couple that went missing on a bike trek through Peru has been spotted "safe and sound," the South American country's top tourism official said Tuesday.

Jamie Neal and Garrett Hand are heading upstream in a small boat on a jungle river, said Jose Luis Silva, Peru's minister of tourism and commerce.

"They're currently in a remote, paradise-like region of the Peruvian Amazon, which is difficult to access," he told CNN.

But even as authorities trumpeted the news, Hand's mother said in a statement that she won't believe it until she hears directly from her son.

"We have not heard from them since January 25, nor have they accessed bank accounts since that time," mother Francine Fitzgerald said. "We have only the worst to consider as to why."

The couple, who hail from the San Francisco area, left last November and began a series of social media posts chronicling the trip of their dreams -- a four-month bike adventure through South America.

"Will be riding my bike in other countries and out of contact for 4 months!" Neal wrote in a November Facebook post before flying with Hand to Buenos Aires, Argentina.

But for weeks, the couple shared photos online from their trek through Argentina, Chile and Peru, showing themselves posing beside their bikes on remote mountain roads, camping out in tents and smiling at the beach.

In late January, however, their Internet postings stopped and calls to their cell phones went unanswered. Family members say no one has been able to get in touch with them since then.

Fitzgerald said both the U.S. Embassy in Peru and the country's interior ministry have called to say that Neal and Hand were spotted.

But that's not enough, she said.

"Let me reiterate, until we have PROOF OF LIFE, we cannot celebrate these rumors and sightings," she wrote on a Facebook page set up to facilitate a search for the couple. "Proof of life is my son's voice on the phone and a picture of him holding the missing poster."

Silva told CNN that the tourism ministry learned of the couple's location from police, who received a report from a clinic in the town of Angoteros after sending out a nationwide alert about the missing couple.

The ministry will send a hydroplane tomorrow to shoot video of the couple and provide proof they're doing OK, he said.

"They have no idea of the commotion they have caused in the media," he said, "because they simply can't communicate with family from where they currently are."

Neal and Hand, both 25, according to a family flyer, were last seen in Lima, the Peruvian capital. But some of the areas they planned to visit are out of cell phone and Internet reach.

The Peruvian National Police earlier told CNN that the manager of a hostel in Pucallpa, where the couple stayed, confirmed to a police investigator they reached the jungle city in early February.

The manager of Arco Iris Amazonica, a small hotel in the rain forest city of Iquitos, told police the couple stayed there on February 16 and told him they planned to travel to the town of Naplo, a 15-day trek.

Peru is known for the Inca ruins of Machu Picchu, located in the Cusco region, which attract hundreds of thousands of international travelers each year.

Two weeks ago, the U.S. Embassy in Lima issued a security message warning Americans of "a potential kidnapping threat in the Cusco area."

"The Embassy has received information that members of a criminal organization may be planning to kidnap U.S. citizen tourists in the Cusco and Machu Picchu area," the message said.

But it also clarified that "thousands of U.S. citizens routinely travel to the Cusco region without undue incident. The U.S. Embassy remains confident of the Peruvian government's efforts to ensure the safety of all tourists in the region."

Peru's tourism minister said Tuesday that he was "deeply concerned" about the negative impact of reports of the missing American couple.

The reason the couple has been out of touch for so long has nothing to do with any crime, he said.

"These two young people have fallen in love with Peru," Silva said. "They have visited off-the-beaten-path places and it seems like they're having a blast -- so much so that they have forgotten to communicate with their families."

CNN's Catherine E. Shoichet and Tom Watkins contributed to this report.

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Two cops, suspect dead in Calif. shootings

Updated 1:50 a.m. EST

SANTA CRUZ, Calif. Two police officers were shot and killed Tuesday while investigating a sexual assault, and a suspect was also fatally shot, authorities said.

Santa Cruz police Chief Kevin Vogel says Sgt. Loren Butch Baker and Detective Elizabeth Butler were gunned down in mid-afternoon Tuesday as they followed up on a sexual assault investigation. He says Baker was a 28-year veteran of the department and Butler had been with the department 10 years. Vogel says Baker was married and the father of two daughters, while Butler leaves behind two young sons.

A suspect, identified as 35-year-old Jeremy Goulet, was shot and killed a short time later while authorities were pursuing the gunman, the Santa Cruz County sheriff's office said.

Residents on the adjoining streets where the shootings occurred received an automatic police call warning them to stay locked inside. About half an hour later, more than a dozen semi-automatic shots echoed down the streets in a brief shootout that killed the suspect.

Witnesses described hearing a "multitude of gunfire" - with 20 or more shots fired during that gun battle between the suspect and law enforcement, reports CBS San Francisco station station KPIX-TV.

Police were going door-to-door in the neighborhood, searching homes, garages, even closets, although the sheriff said authorities didn't know if another suspect remained at large.

Police, sheriff's deputies and FBI agents filled intersections, some with guns drawn, in what is ordinarily a quiet, residential neighborhood in the community about 60 miles south of San Francisco.

A store clerk a few buildings away from the shooting said the barrage of gunfire was "terrifying."

"We ducked. We have big desks, so under the desks we went," said the clerk, who spoke on condition of anonymity and asked that her store not be identified because she feared for her safety.

She said she remained locked in her store hours after the shooting and was still scared.

Two schools were locked down during the shooting. The students were later evacuated by bus to the County Government Center about half a mile away.

As darkness fell, helicopters and light aircraft patrolled above the neighborhood, which is about a mile from downtown Santa Cruz and the Santa Cruz Beach Boardwalk. The campus of University of California, Santa Cruz, is about five miles away.

The city's mayor, Hilary Bryant, said in a statement that the city was shocked over the shootings.

"Tonight we are heartbroken at the loss of two of our finest police officers who were killed in the line of duty, protecting the community we love," the statement said. "This is an exceptionally shocking and sad day for Santa Cruz and our Police Department."

Santa Cruz has faced a recent spate of violence, and community leaders had scheduled a downtown rally Tuesday to speak out against shootings. That and a city council meeting were canceled after teary-eyed city leaders learned of the deaths.

Those shootings include the killing of Pauly Silva, a 32-year-old martial arts instructor who was shot outside a popular downtown bar and restaurant on Feb. 9.

Two days later, a UC Santa Cruz student waiting at a bus stop was shot in the head during a robbery. She is recovering from her injuries.

Then on Feb. 17, a 21-year-old woman was raped and beaten on the UC Santa Cruz campus. Four days later, a Santa Cruz couple fought off two men who came in their home before dawn and threatened them with a sword.

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What's Next for Pope Benedict XVI?

The party for the world's most prominent soon-to-be retiree began today when Pope Benedict XVI hosted his final audience as pontiff in St. Peter's Square.

More than 50,000 tickets were requested for the event, according to the Vatican, while the city of Rome planned for 250,000 people to flood the streets.

FULL COVERAGE: Pope Benedict XVI Resignation

With his belongings packed up, Pope Benedict XVI will spend the night, his final one as pope, in the Apostolic Palace.

The pontiff, 85, who is an avid writer, will be able to take his personal notes with him. However, all official documents relating to his papacy will be sent to the Vatican archives.

On Thursday, Pope Benedict XVI will take his last meeting as pontiff with various dignitaries and the cardinals, said the Rev. Federico Lombardi, director of the Vatican Press Office.

INTERACTIVE: Key Dates in the Life of Pope Benedict XVI

While not all of the cardinals are in Rome, it is possible that among the princes of the church saying farewell to the pope could be the man who will succeed him.

"I think the overall tone is going to be gratitude. From the cardinals' perspective, it'll be like the retirement party for your favorite professor," said Christopher Bellitto, a professor at Kean University in New Jersey who has written nine books on the history of the church.

AP Photo/Andrew Medichini

Papal Appearance: Faithful Flock to Saint Peter's Square Watch Video

RELATED: Cardinal Resigns Amid Sexual Misconduct Allegations

Pope Benedict XVI will depart the Vatican walls in the afternoon, taking a 15-minute helicopter ride to Castel Gandolfo, the papal retreat just outside of Rome, where he will live while his new Vatican quarters undergo a renovation.

Around sunset, the pontiff is expected to greet the public from his window in the palace, which overlooks the small town square, for the last time as pope.

At 8 p.m. local time, the papal throne will be vacated. The man known as Pope Benedict XVI for the past eight years will take on a new title: Pope Emeritus.

What Lies Ahead for the Pope Emeritus

The announcement that Benedict XVI would be the first pope to resign in 600 years shocked the world and left the Vatican with the task of creating new rules for an event that was unprecedented in the modern church.

"Even for the historical life of the church, some of this is brand new territory," said Matthew Bunson, general editor of the "Catholic Almanac" and author of "We Have a Pope! Benedict XVI."

"The Vatican took a great deal of care in sorting through this," he said. "This is establishing a precedent."

Along with Benedict's new title, he will still be allowed to wear white, a color traditionally reserved for the pope.

He'll still be called Your Holiness. However, the Swiss Guards, who are tasked with protecting the pope, will symbolically leave his side at 8 p.m. Thursday.

His Ring of the Fisherman, kissed by thousands of the faithful over the years, will be crushed, according to tradition.

Not much is known about the pope's health.

In his resignation statement, the pontiff said his physical strength has deteriorated in the past few months because of "an advanced age."

He also mentioned the "strength of mind and body" necessary to lead the more-than-1-billion Catholics worldwide.

If he is able to, Bellitto believes the pope will keep writing, perhaps on the Holy Trinity, a topic of great interest to him.

RELATED: Papal Conclave 2013 Not Politics as Usual

As the pope emeritus settles into the final chapter of his life, experts have said it is likely he will stay out of the public realm.

"[Pope Benedict XVI] has moved very deliberately in this process," Bunson said, "with an eye toward making the transition as smooth, as regal, as careful as possible for the election of his successor."

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Today on New Scientist: 25 February 2013

First fruits of a groundbreaking art-science tie-up

A pioneering collaboration between two of London's most prestigious cultural institutions shows that sci-art has come of age

The great illusion of the self

Your mind's greatest trick is convincing you of your own reality. Discover the elaborate illusions involved and what they mean in our special feature

Stunning seeds: a biological meteor wreathed in flames

Some seeds have a look that evokes all-consuming fire, says an artist who captures their portraits with a flatbed scanner

Armband adds a twitch to gesture control

The Myo band turns electrical activity in the muscles of a user's forearm into gestures for controlling computers and other devices

Treat malware as biology to know it better

Treating computer viruses as a biological puzzle could help computer scientists get a better handle on the wide world of malware

Take my taxi to the moon

Susmita Mohanty, the founder of India's first private space company, Earth2Orbit, wants India to claim bigger piece of the space-launch pie

How electrodes in the brain block obsessive behaviour

Why deep brain stimulation can help people with OCD was a mystery, but now it seems the treatment fixes brain signalling well beyond the stimulated area

Ancient continent hides beneath Indian Ocean

The sands on Mauritius's beaches are older than the island itself, suggesting a hidden continent is the source

New blood test finds elusive fetal gene problem

Take parents' DNA and make a computer model of their fetus's genome - comparison with the real thing will show up problems that other tests miss

Amazon to open market in second-hand MP3s and e-books

A new market for second-hand digital downloads could let us hold virtual yard sales of our ever-growing piles of intangible possessions

People in a vegetative state may feel pain

Scans have revealed activity in areas of the brain responsible for the emotional aspects of pain in people thought to have no subjective awareness

Sewage solutions: Six alternative toilet technologies

Two-and-a-half billion people don't have access to sanitary toilets, but standard designs aren't an option without a sewer network. See some alternatives here

Rusty rocks reveal ancient origin of photosynthesis

Iron oxide in the world's oldest sedimentary rocks suggest photosynthesis evolved 370 million years earlier than we thought, not long after life began

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GIC raises US$1.25b by selling shares in Global Logistic Properties

SINGAPORE: The Government of Singapore Investment Corp (GIC) has raised US$1.25 billion by selling about 596 million shares in warehouse operator Global Logistic Properties (GLP).

GIC sold the shares at S$2.60 each, which is a 4.8 per cent discount to Monday's closing price.

Following the share sale, it now holds a 37 per cent stake in GLP, down from 49 per cent.

GIC said the move is part of the fund's portfolio rebalancing and it will remain a substantial shareholder for the long run.

- CNA/ms

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