Many nursing homes have young residents for short term rehab

The Fort Mill Times had an interesting article discussing how nursing homes are no longer for those who are elderly.  Many young people live in them when they become disabled.  The article talks about  Lori Hagedorn.  She had worked at nursing homes before she started living in one at age 45.

She suffers with chronic medical problems.  She is part of a growing population of younger people who need the long-term care, skilled nursing and structure offered in a nursing home.

Two decades ago, about 1 percent of nursing home residents were under the age of 65.  Now it's closer to 10 percent, according to statistics from the Department of Social and Health Services in Washington state.

"It used to be a place where the aged went," Vande Merwe says. "Now 80 percent of new admissions are coming for short-term rehabilitation." Some eventually return home or go to an assisted living setting.  "It's not that uncommon because we have a gap in the health care system between the hospital and the nursing home. People like Lori are younger, but they need the medical care. The structure and support of the staff helps people to remain as independent as possible."

Vande Merwe expects the upswing in younger patients to continue.  Some children are in nursing homes because of severe birth defects and disabilities. Other young people have diseases with no cure, such as multiple sclerosis, and may reside in nursing homes for many years.

Activity directors say keeping younger residents active and stimulated can be a challenge. For years, most programs were geared to a different generation. The new clientele would rather surf on the Internet, send e-mails or play video games.

 

Eviction of resident stayed

WBALTV.com had a story about a nursing home patient who was threatened with eviction from her facility because she couldn't pay her bill has been allowed to stay.  The WBAL TV 11 News I-Team detailed the story of Melanie Conaway, a multiple sclerosis patient. A nursing home called Future Care Northpoint in Dundalk was about to discharge her against her wishes because of an alleged outstanding bill.

Conaway said she wondered about her future, where she would live and who would handle her health care needs. "There is nothing I can do," Melanie Conaway told I-Team reporter Barry Simms on Thursday. "All they did was come in and say they haven't received the full payment, so I can't stay here any longer."  But under a last-minute settlement, Conaway will remain at the nursing home.

The whole dispute focused on a $300 a month payment -- alimony Conaway is supposed to receive from a divorce settlement. The funds are considered income and must be used for her nursing home stay, Simms reported.

By law, Future Care may have the legal (but not the moral) right to evict Conaway because the unpaid debt had grown to $2,500, but the nursing home finally agreed (after the story went public) to give Legal Aid time to pursue a claim against her ex-husband and possibly garnish his wages.

Growth of health care spending

McKnight's had an article about health care spending.  The article states that Federal spending on nursing home and home health accelerated in 2007, even as overall healthcare spending grew at the slowest rate since 1998, according to a new spending report issued by the Centers for Medicare & Medicaid Services.

Freestanding nursing home spending expanded by 4.8% that year, compared with 4.0% in 2006. Meanwhile, spending for freestanding home healthcare services increased to 11.3%.   Overall healthcare spending climbed by 6.1% in 2007 to $2.2 trillion, or $7,421 per person. Total healthcare spending by public programs, such as Medicare and Medicaid, grew 6.4% in 2007, a deceleration from 8.2% 2006.

One of the factors contributing to the overall slower growth in federal healthcare spending was a deceleration in prescription drug spending due to an increased use of generic medication. Retail prescription drug spending grew by 4.9% in 2007, compared with 8.6% growth in 2006, according to the report.

 

Technology may solve the nursing home crisis

Science Daily had an interesting article about how technology can assist in caring for residents at home instead of placing them in nursing homes. Many older adults want to remain active and independent and to live in their own homes and avoid moving to nursing homes. University of Missouri researchers are using sensors, computers and communication systems, along with supportive health care services to monitor the health of older adults who are living at home.

According to the article, motion sensor networks installed in seniors’ homes can detect changes in behavior and physical activity, including walking and sleeping patterns. Early identification of these changes can prompt health care interventions that can delay or prevent serious health events.

As part of the "aging in place" research at MU, integrated sensor networks were installed in apartments of residents at TigerPlace, a retirement community that helps senior residents stay healthy and active to avoid hospitalization and relocation. MU researchers collected data from motion and bed sensors that continuously logged information for more than two years. The researchers identified patterns in the sensor data that can provide clues to predict adverse health events, including falls, emergency room visits and hospitalizations.

"The ‘aging in place’ concept allows older adults to remain in the environment of their choice and receive supportive health services as needed. "Monitoring sensor patterns is an effective and discreet way to ensure the health and privacy of older adults."

In recent evaluations, the sensor networks detected changes in residents’ conditions that were not recognized by traditional health care assessments. MU researchers are perfecting the technology infrastructure so these technologies and supportive health care services can be made available to seniors throughout the country.

"Our goal is to generate automatic alerts that notify caregivers of changes in residents’ conditions that would allow them to intervene and prevent adverse health events," Rantz said. "Additional work is underway to establish these health alerts, improve the reliability and accuracy of the sensor network, implement a video sensor network, and refine a Web-based interface to make it even more user friendly and meaningful to health care providers."

The study, "Using Technology to Enhance Aging in Place," was presented at the 2008 International Conference on Smart homes and health Telematics. It was funded by a grant from the U.S. Administration on Aging and the National Science Foundation ITR grant.
 

Diabetic care in nursing homes

Washington Post had an article recently about the epidemic of diabetes in nursing homes.  The article states that more and more people with diabetes are living to older ages but nursing homes are not ready for the additional challenges that come with treating patients with diabetes.

"We need to spend appropriate time to think of a way to successfully provide care for people with diabetes as they enter their elder years, and we're just beginning to understand how to do that," said Dr. Paul Strumph, vice president and chief medical officer for the Juvenile Diabetes Research Foundation.   Although about one in four nursing home residents has diabetes, not all are getting care that meets the American Diabetes Association's goals for community-dwelling adults, according to a recent study.

The study, published in Diabetes Care, found that while 98 percent of nursing home residents with diabetes had their blood glucose levels monitored, only 38 percent met short-term glucose goals.

"One of the key differences in managing diabetes in a nursing home is that it's often not the condition of primary importance," said Helaine Resnick, director of research at the Institute for the Future of Aging Services for the American Association of Homes and Services for the Aging.

Resnick said one of the concerns she had with the study findings was that no one has yet to come up with specific guidelines for caring for elderly people with diabetes. Glucose control goals for someone who's 40 and living at home may well be different than for someone who's 85, cognitively impaired, and living in a long-term care facility, she said.

"Someone in a nursing home could pull out a pump site and not know. In that case, you may want to be on a longer-acting insulin instead. We haven't yet defined what the ideal insulin [regimen] is for someone in a facility with a fairly predictable schedule," Strumph said.

"Families need to become more actively involved in working with care teams, and that's true for diabetes and for other conditions. Ensure that the facility understands the family's and the resident's preferences. Is your mother more interested in keeping her blood glucose control tight and risk [low blood sugar]? Or is it better for her to ease up on glucose control and work more on quality-of-life issues? Resnick said.

SOURCES: Paul Strumph, M.D., vice president, chief medical officer, Juvenile Diabetes Research Foundation, New York City; Helaine Resnick, Ph.D., M.P.H., director of research, Institute for the Future of Aging Services, American Association of Homes and Services for the Aging, Washington D.C.; June 2007, Diabetes Care

 

Nursing Home of the Future

Providence Business News at PBN.com had an inspirational article about a group called Nursing Home of the Future.  They are a team of professionals who are trying to understand the difficulties of living in a nursing home and recommending changes to how we care for our vulnerable adults.

The members of the Nursing Home of the Future team spent whole days with residents of the Tockwotton Home, hearing their stories, watching them in their rooms, in the dining area, in exercise class, at the card table.  They saw how hard it is for seniors on walkers to use the bathroom. Realized how they might just stay in their wheelchairs for hours just because moving is too difficult. Noticed that even with all the activities on the calendar, there’s really very little to do all day.  They saw how institutional, rigid and unhomelike life can sometimes be.

This project aims to change the situation.  Armed with reams of information gathered through site visits, interviews and research, and helped by partners from health care and academia to industrial design, the team hopes to reinvent long-term care for a generation of baby boomers.

“The Nursing Home of the Future is exactly the reason we created the Business Innovation Factory,” BIF founder, Chairman and “Chief Catalyst” Saul Kaplan said in a recent interview. “To bring a community of innovators together to come up with solutions to an issue we all face.”

The goal is to ensure older Americans get “the kind of experience as they age that they deserve.” “We want to create a series of laboratories where we can roll up our sleeves and come up with solutions,” said Kaplan.  “We want to work in health care, education, in the consumer space, in the citizen space, looking at public safety solutions.”

The nursing home project began in the spring, as a collaboration between BIF, Tockwotton and a diverse group of experts, including the MIT AgeLab, Brown University and Rhode Island School of Design faculty, Quality Partners of Rhode Island and the design firm Tellart. 

For Phase I, which started in early summer and cost about $160,000, Kaplan, project director Melissa Withers and 14 others set out to document every aspect of life at Tockwotton, a 30-bed assisted living center and 42-bed skilled nursing facility in Providence’s Fox Point neighborhood.

They had group discussions and one-on-one interviews with the Tockwotton staff, residents and family members. They learned how everything is done – how meals are served, medications dispensed and transportation arranged. They watched the staff give manicures, style hair and do makeup; they sat in on exercise sessions, games and TV time.

And they learned about life as a frail elder, watching seniors struggle on walkers and in wheelchairs, and nurses’ aides feeding residents when they couldn’t feed themselves, carrying them in and out of bed and escorting them to the toilet and the shower.

Team member Allan Tear analyzed every part of the bathrooms, quickly identifying design flaws such as the toilet paper’s placement behind the seat, where it would be hard to reach, and the sink so far and inconvenient that many seniors on walkers don’t even try to use it.

“I sat in the shower chair, where the PVC piping of the structure, the medical green synthetic backing fibers and the jammed wheels it rested on, along with the toilet seat for a chair, did nothing to make me relax,” she wrote. “I tried to imagine sitting there naked as someone washed me … I felt ill at ease and exposed.”

Speaking with the seniors was especially instructive, the team found.

How do you take all this knowledge and translate it into better nursing homes?  That is the challenge for Phase II.  That’s when active experimentation will begin, guided by an “opportunity map” the team used to set priorities in different areas.

To better care for seniors’ bodies and minds, they want to create stimulating games and activities; design special furniture and technologies to maximize comfort and reduce pain; and come up with innovative low-risk physical activities, among other ideas.  They want to re-design bathrooms – toilets, sinks, shower areas – to make them easier to use, more welcoming and much safer, not just in the nursing home, but in assisted-living homes and for seniors’ own homes, so accidents that lead to institutionalization are prevented.

They want to use assistive technologies for a wide range of purposes, from remote monitoring of bathroom visits and wireless biometric monitoring, to communications devices and medication reminders for seniors who might forget their pills.

Indeed, the cost and logistics of caring for the baby boomers as they age is a big incentive to make big, dramatic changes in elder care, the team members stressed. Already, there are more than 15,000 nursing homes in America, and $125 billion was spent in nursing home care in 2006. But with the boomers, the elderly population will more than double.

Nursing home “culture change,” a movement within the industry that aims to make facilities more homelike, is making a difference, but not enough, team members said. Seniors can stay up late if they want, for example, but Tockwotton feels eerily quiet and dark at night.

 

New federal rules make it more difficult to get information

The Capital-Journal Editorial Board had a recent editorial about a change in federal rules on nursing home inspections that restricts access to information about care facilities. The changes were adopted by the Bush administration and went into effect in October.

"It's an extremely troubling development — it puts a lot of information related to nursing-home inspections off-limits," said the director of a nonprofit organization funded in part by the federal Administration on Aging. "I think it's certainly bad for consumers and the folks who represent them."

The change barred nursing home inspectors from releasing privileged information to the public without approval from the director of the Centers for Medicare and Medicaid Services. State employees who performed inspections for the federal government have been reclassified as federal employees as part of the revision.

The editorial was based on an Associated Press story which focused on an 81-year-old woman who was transported from a North Carolina nursing home to a hospital in 2006 with pain in her hip.  The woman's family later discovered her hip had been fractured, but no one at the nursing home had told the family anything about an accident.  Her daughter was able to find out what happened, but only by reviewing follow-up reports by state inspectors.

Under the new rules, those documents wouldn't be available except with approval by the head of the sprawling Medicare and Medicaid Services agency. In the North Carolina case, the family learned from state regulators that a nurse's aide had allowed her mother to fall. The aide then got colleagues to prop up the woman in a chair and agree not to report the incident to a supervisor, as required.  This kind of cover up is typical of many nursing homes.

It took more than two weeks for the woman to obtain treatment for the bone fracture. Now, she can't walk.

 

Editorial from Aiken Standard

The Aiken Standard had an interesting editorial about the deficient care of nursing homes in Aiken, South Carolina and the new 5 star rating system.  The editorial states that nursing homes are increasingly becoming an integral part of the health care network in our country. As people live longer, the chances that they will spend some time in a nursing facility increases. That is why the federal government's five-star grading system is so important for patients and their families.

The five-star comparison allows people to compare nursing homes in their areas and to determine which might be the best for themselves or their loved ones.

Medicare recently came out with its latest report on nursing home quality, grading all six of the nursing home facilities in Aiken County. Only one of the six scored at the five-star level which means "much above average" according to the Medicare guide. Carriage Hills Living Center scored at the five-star level.

Only one of the other five, NRC Healthcare - North Augusta, was at the three-star, or average, level.

Pepper Hill Nursing and Rehabilitation Center score two stars out of five, below average.

The other three, Anne Maria Rehab and Nursing Center of North Augusta, Azalea Woods Nursing Home in Aiken, and Heritage Healthcare at Mattie C. Hall in Aiken, all scored one star out of five, much below average.

It would be hoped that all of the local facilities would have scored at least average. Further it is hoped that patients and their families will insist that improvements be made in the future.

Complete information about the nursing home comparisons can be found online at www.medicare.gov/NHCompare.

 

Florida nursing homes given immunity from new disclosure law

Florida's "right to know" constitutional amendment that allows patients to check records of medical mistakes by health care providers doesn't apply to nursing homes according to the Florida Supreme Court.

The decision in Benjamin v. Tandem Healthcare, Inc. came in a lawsuit over the death of Marlene Gagnon, a nursing home resident who choked to death on food specifically served to her against her doctor's orders.

The decision allows the nursing home to hide relevant and material information from her estate.  This includes the nursing homes nondisclosure of an incident report on Gagnon's death.  The amendment itself says it covers "health care facilities" and "providers" as defined in general law.

The high court arbitrarily decided that state law doesn't include nursing homes among health care facilities.  "They basically said nursing homes do not provide health care," said Jeffrey Fenster, a lawyer for Gagnon's five children. "This strips constitutional rights from the elderly. ... This is just an invitation to more elder abuse."

The amendment never was intended to apply to nursing homes because it refers to "patients" and people in nursing are considered "residents" under state law, said Tony Marshall , association senior vice president.

The amendment was put on the ballot through a petition drive sponsored by consumer advocates. It was one of three initiatives dealing with medical malpractice adopted in 2004, including one that bars doctors with three malpractice judgments from practicing. The third, promoted by the Florida Medical Association, limits how much lawyers can collect in fees.