Medicare Quality Improvement Organization Initiative may provide the magic balm of Gilead that nursing homes have been looking for. Pressure ulcers are a major problem in nursing homes, hospitals, and assisted living facilities. By using the Medicare Quality Improvement Organization Initiative, over 780 nursing homes achieved a 38% reduction in pressure ulcers and a 76% reduction in restraint use in three years. The protocol uses risk assessments and evidence-based training to help reduce pressure ulcers and restraint use. For more information, and a fact sheet on the project, read the full article here.
Maxcine Darville and daughter JoAnne Carter may not be names you’ve ever heard of. But these innocuous sounding names bely the business acumen that led these two to operate a nursing home and the criminal enterprise which led them to defraud the government of $3 million. The two pled no contest to grand theft charges, according to a pending settlement. The mother-daughter pair drew attention when they used Medicaid funds to buy personal items including ‘luxury cars, mortgage payments, maid service and utility bills.’ The executives clearly pay more attention to their own lifestyles than those who reside in the nursing homes they manage; two of the homes received the lowest possible rating and one was put on a ‘watch list with a conditional license.’
WLKY reported that Green Meadows Health Care Nursing Home hired Laura Morrow, a drug addict and allowed her access to medications including narcotics. After one week of suspicious behavior and discrepancies in medication records, her supervisors and authorities could no longer ignore what was going on. Morrow became very angry and combative when it was suggested that somebody accompany her while she distributed medication to the elderly residents. She claimed that she did it before and knew what she was doing, displaying clear signs of paranoia and anxiety, making remarks to make it clear that she did not want anyone to follow her around.
Morrow has been charged with stealing 26 doses of narcotics in 5 days by fraudulently forging the names of nine different nurses on the medication chart. The medications she stole were of the same family of drugs that she went doctor shopping for in February of 2013. The most alarming potential situation that is prone to occur is that this situation is likely be repeated if Morrow does not have to forfeit her nursing license. Many nursing homes have provisions in their contracts where they actively hire ex-convicts and ex-felons. Without proper rehabilitation for the crimes they have committed, be it drug or sexual abuse, a deja-vu situation is bound to reoccur.
Sarah Kliff is impressed by the above chart:
This simple, four-line chart is amazing news for the federal budget. It shows that the government is expected to spend about $50 billion less paying for the Medicare program this year than it had expected to just four years ago. What this chart shows is how much the Congressional Budget Office expects we’ll need to pay for each and every Medicare beneficiary. And over the past four years, the forecasting agency has consistently downgraded the price of covering one senior’s health care costs.
Saving $1,000 per patient adds up quickly in a program that covers about 50 million people. More precisely, it adds up to about $50 billion in savings this year. The reduction in expected costs grows to $2,369 in 2019. With an expected 60 million seniors enrolled in Medicare that year, it would work out to more than $120 billion shaved off the total cost of the program.
Tricia Neuman and Juliette Cubanskigo go into more detail on the factors at play:
In addition to scheduled reductions in Medicare’s more formulaic payment rates, providers may be tightening their belts and looking to deliver care more efficiently in response to financial incentives included in the ACA, and it is possible that these changes are having a bigger effect than expected. For example, CMS recently reported that hospital readmission rates dropped by 130,000 between January 2012 and August 2013. It is also possible that hospitals and other providers are using data and other analytic tools more successfully to track utilization and spending and to reduce excess costs. Another more straightforward factor is that several expensive and popular brand-name drugs have gone off patent in recent years, which has helped to keep Medicare drug spending in check.
Whatever the causes may be, the slowdown in spending is good news for Medicare, the federal budget and for beneficiaries—at least for now, and as long as it does not adversely affect access to or quality of care.
The Mini Nutritional Assessment, a short questionnaire which is used to determine a resident’s nourishment, relies on body mass index to assess residents. However, for the elderly and those with underlying conditions such as dementia, it can be incredibly difficult to measure BMI, or height and weights of bedridden patients. A new study shows that calf circumference may be a suitable alternative to BMI and height/weight measurements. The study was conducted with ~240 residents in seven Turkish nursing homes. Calves were measured at the widest point. Measurements of more than 31 cm received three points. A score of 12 or higher means someone is well nourished. In a situation like a nursing home, which is full of bedridden, frail, and sometimes impaired residents, using calf circumference can be a useful alternative to taking BMIs.
Fox11 reported that 41 residents of the Golden Living Center facility got an unwelcome surprise when a lightning strike caused a fire in the eastern ward. The home instituted emergency protocol and evacuated all of the residents. But the place the residents were placed wasn’t a community center or a hospital, but a school gym! The local elementary school gym was an ideal place to temporarily house 31 of the residents, while 10 stayed with family members. The Red Cross provided blankets, cots, and other assistance. The Florence community also played a large role in providing assistance to the home and its residents. Their stay in the gym will be a short one, but the easy transition, the outreach, and support demonstrate how the community can be just as important in helping in emergency situations as the corporate management companies which organize protocols.
Older people who undertake at least 25 minutes of moderate or vigorous exercise everyday–such as walking quickly, cycling or swimming– need fewer prescriptions and are less likely to be admitted to hospital in an emergency, new research has revealed. Such physical activity leads to a higher metabolism and better circulation, reducing the risk of conditions and diseases common in older age such as high blood pressure, type 2 diabetes, coronary heart disease and strokes. Exercise should be targeted and tailored to those in their 70s and 80s, aiming to increase muscle strength, balance, coordination and aerobic fitness to prevent falls. In the first study of its kind looking at this age group, researchers from the Universities of Bath, Bristol and UWE-Bristol looked at data from 213 people whose average age was 78. The findings, published in the journal PLoS ONE, reinforce the need for exercise programms to help older people stay active. It could also reduce reliance on health care services and potentially lead to cost savings.
Professor Ken Fox, from Bristol University’s Centre for Exercise, Nutrition and Health Studies who led the study said: “Until now, very little has been known about the value of physical activity in later life, particularly when people are in their 70s and 80s. This research underlines that keeping older people active brings a whole range of health benefits, as well as reducing reliance on the NHS and potentially leading to major cost savings.”
To access the latest research papers see http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0097676.
The Wall Street Journal had an article about Medicare Lab Billing. Medicare allowed $1.7 billion in 2010 payments to clinical laboratories for claims that raised red flags, according to a report to be released, the latest example of how the federal insurance program for the elderly and disabled is susceptible to fraud and abuse. The report, by the Department of Health and Human Services’ Office of Inspector General, found that more than 1,000 laboratories showed five or more measures of questionable billing during that year, the latest available when the office began compiling the data. That includes various metrics signifying higher-than-average billing, using ineligible physician identification numbers and administering duplicate tests, among other things.
Malnutrition, deprivation, inanition. These words may not sound that familiar, but they all mean the same thing: starvation. So why are we writing about starvation? Because it’s a problem that still persists in nursing homes today. A whistleblower in the UK came forward in an article with The Mirror after the paper ran a story on seven people who died of hunger. In hospitals.
Unfortunately, the epidemic doesn’t end there. It is all too easy to get caught up in the ideal of helping people which naturally leads to the question of how nursing homes can get so bad that a resident could drop from a size 16 to a size 12 in two to three weeks, as in the case the whistleblower details. But nursing homes are businesses, and too often, it seems, those in charge care less about the personal and more about profits.
The whistleblower says that much of the problem arises from the food schedule, lack of options, and lack of assistance necessary from staff. At the facility where she works, the portions are small, and the schedule has residents eating a small meal for dinner at 4:45 pm. Their next meal isn’t until 9:00 am the next morning, and the only snack they can have is a piece of toast and a cup of tea. She has 40-50 residents which are being fed at once, and about ten of them need to be fed, and many more need assistance with feeding. There’s no way one person can assist all those who require it during a timely manner.
She says, ‘By the time you help three or four, the food is cold for everyone else.’ Another issue is that there are no options for residents. If they don’t like what’s being served, they can only have a piece of toast as a substitute. Additionally, the workers have to deal with a climate that seems hostile to those who raise complaints or threaten to blow whistles. See article at The Daily Mirror.
My Fox Tampa Bay reported that Rachel Mobley, administrator of Grace Manor at Lake Morton allegedly refused to allow a staffer at the facility to call 911 for an elderly resident suffering severe eye pain. She is charged with neglect of an elderly person, which is a second degree felony.
Kristal Stowell, a worker at the home, wanted to call emergency services when Charles Burrows told her he was suffering from eye pain. Due to an ‘unwritten rule’ at the facility, no one can call 911 without getting a supervisor’s approval. When Stowell called Mobley to ask if she could call 911, Mobley allegedly told her she couldn’t, and to give the man a prescription Tylenol. Stowell called repeatedly, as Burrows’ pain became more severe, but each time, Mobley said she couldn’t call 911. Stowell eventually called 911 even though Mobley never approved it. Unfortunately, Burrows died ‘after having a stroke’. The nursing home released a statement supporting Mobley and denying the claim of neglect. The family declined to comment other than the loss ‘is painful.’