Robert Abrams: “I Want to Create the Nursing Home Community”

Robert Abrams: ‘I Want to Create the Nursing Home Community’


The late 1980s were an auspicious time for multitalented Robert Abrams. After several years of working in special education for the developmentally disabled, Abrams-in the space of one week-got a nursing home administrator’s license and took the New York State Bar exam, preparatory to becoming a healthcare lawyer. That was in 1987. That same year saw Congress pass the now-famous (or infamous) OBRA ’87, as well as the creation of a new legal field called elder law. Abrams soon became the first chair of the New York State Bar Association’s Elder Law Section and proprietor of his own law practice devoted to nursing home compliance with federal and state law.
Over the years the practice grew to represent more than 100 nursing homes. In 2000, when he merged the practice with the New York law firm of Fensterman & Fensterman, Abrams served a second New York Bar chairmanship-the Health Law Section-and had authored professional and consumer-market books on guardianship practices and basic health system knowledge for baby boomers. He decided that year to put it all together-the social concern, the legal expertise, the media experience-to develop an information technology platform he called MyZiva (“ziva” being the symbol from Slavic mythology for a long and healthy life). Under the mantra that long-term care providers and consumers are not adversaries, but collaborators in promoting quality care, Abrams has since committed more than $5 million and all of his time to spreading the word about the MyZiva platform, which he believes will create a true nursing home community. Recently he fielded several questions on his long-term care observations, philosophies, and hopes for the future in an interview with Nursing Homes/Long Term Care Management Editor-in-Chief Richard L. Peck.

Peck: First, can you provide a brief description of MyZiva?

Abrams: It is a comprehensive Internet-based platform that provides valuable resources and applications for the entire nursing home community. Our consumer application,, provides consumers with a wealth of information about searching for, evaluating and paying for nursing home care, along with a section that allows providers to tell their own stories. Our provider platform,, is a suite of management, financial, clinical, and regulatory information that enables providers to manage their facilities better with more up-to-date knowledge of their own operations, their competitors’ operations, and regulatory changes, and to engage in continuing education. The site is aimed at helping them to address their end of the quality-of-care equation in long-term care.

Peck: What led you to conclude that so much information was required and demanded in this field?

Abrams: There seemed to be a growing disjunction between consumers and nursing homes, and between nursing homes and government. Consumers were perceiving most nursing homes as cold, uncaring institutions interested primarily in money. On that basis, nursing homes were an easy target for news media and politicians seeking to score points with consumers; moreover, government regulators and, more recently, plaintiff’s attorneys seemed more than willing to take that same tack. Meanwhile, nursing homes felt beleaguered, ostracized, and misunderstood. None of these perceptions are wholly accurate or necessary-not if people have the information they need. The impact that such an adversarial and destructive environment has on resident care is of greatest concern.

Peck: Recently your organization published a study of the nursing home field that some might take as somewhat unflattering-finding, for example, that nursing homes nationwide had been hit with survey deficiencies 44% of which could have produced “possible harm.” The study also found that there was no absolute linkage between quality and reimbursement or staffing. Would you elaborate?

Abrams: First, all of this indicates the objective stance we take with the industry. Although it is clear that some providers are not providing the quality of care that we want, that 44% also indicates problems with the survey process itself-for example, that “harm” is not clearly defined, nor are the surveys conducted consistently from state to state, or even within states. It shows that people have to look past the numbers to truly evaluate nursing homes.

While we found that some states clearly and dangerously underfunded their Medicaid programs and that there was some correlation between reimbursement in those states with the lowest Medicaid rates and quality of care, we also found that there was not an absolute correlation between Medicaid reimbursement and survey performance; some higher-Medicaid-rate states had relatively poorer performance on surveys, and vice versa. One thing we do know is that long-term care reimbursement, in general, is a charade, applying different rates for Medicare, Medicaid, private-pay, and private insurance for the same service. We’d love to see a more consistent approach to cost reporting and determining rates across the board nationally. In fact, MyZiva users have access to our Comprehensive Management Tool (CMT), which analyzes Medicaid data in New York State and will be available to other states in the near future, as well as the Performance Evaluation Tool (PET) that compares national Medicare data. Through applications such as these, facilities can evaluate their financial and program performance and identify and address industry trends. Collection, analysis, and distribution of such data should facilitate efficient management, delivery of quality care, and a rational explanation of nursing home reimbursement rates set by third parties.

Our study also found that nursing homes were generally employing higher staff-to-resident ratios than many people thought was the case but, by the same token, there was no absolute correlation between staff ratios and survey performance. Again, this might be an artifact of the inconsistent survey enforcement system we have in this country. It is clear, though, that one cannot apply a fixed “ideal” staffing ratio to the nursing home field because acuity from facility to facility simply varies too much.

Peck: Do you find the field, as a whole, interested in improving the quality of care?

Abrams: Most definitely, on an individual basis. In my opinion, though, the long-term care organizations in some states are showing a void of leadership on this issue. We should make no mistake: Poor performers with a history of neglect and indifference ought to be identified and shut down, without question. By the same token, society must-but doesn’t always-recognize and support those providers who are making an honest effort to improve quality of care.

Peck: Creating a nursing home “community” bespeaks creating some level of trust between consumers and providers. How is your approach addressing that?

Abrams: Our consumer platform,, is helping consumers learn how to evaluate a nursing home, what questions to ask, how to compare apples with apples, etc. It also allows providers to tell their own stories. In short, it sets up a dialogue-and it’s pretty hard for providers to lie about what they’re doing because the site is monitored by consumers, government and, perhaps most importantly, their competitors. MyZiva also includes a hotline,, which allows staff, residents, and family members to communicate their grievances directly and anonymously to nursing home management, allowing nursing homes to respond accordingly and expeditiously. These solutions are all structured based on our belief that open communication among all parties involved leads to improved trust among them.

Peck: What are the prospects for “spreading the word” in 2004?

Abrams: is available nationally and is being promoted to consumers and nursing homes in various ways. Hundreds of thousands of consumers and healthcare professionals visited the site in 2003 to evaluate and select nursing homes, and we anticipate more than a million visitors this year. The provider platform,, with all its options for facility management information, regulatory and corporate compliance, and continuing education, had its trial run in New York State, and now we are moving state by state with a more focused version to keep prices reasonable. Nursing home organizations in Arizona, Ohio, Maryland, Michigan, Idaho, Florida, Texas, and Washington, D.C., for example, have expressed interest in becoming users. That platform is also available to individual providers who express an interest, no matter where they’re located.

Peck: On a personal note, among all your professional activities-educator, administrator, lawyer, author, entrepreneur-which have you found to be the most satisfying, and why?

Abrams: I’m living it right now. Through MyZiva I get to work with some of the most talented and dedicated professionals in long-term care, and I’m proud to contribute in this way to the nursing home community. NH

For more information, write MyZiva at 1111 Marcus Ave., Suite 105, Lake Success, NY 11042, phone (516) 616-9600, fax (516) 616-9683 or e-mail To comment on this article, please send e-mail to

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