South Carolina Nursing Home Blog : South Carolina Nursing Home Lawyer & Attorney : Poliakoff & Associates Law Firm : Elderly Care, Senior Care

The Boston Globe had an article about how new technological advancements have helped people with disabilities regain independence and maintain a quality of life.  The author discusses the plight of Steve Saling who suffers from ALS, also known as Lou Gehrig’s disease, a progressive nerve disorder that slowly paralyzes patients while leaving their mind intact. They eventually lose the ability to even breathe.

Through a chance encounter shortly after his diagnosis, he teamed up with Barry Berman, chief executive of the Chelsea Jewish Foundation, and helped to design the nation’s first residence for ALS patients needing nursing care. The Leonard Florence Center for Living’s Steve Saling Residence officially opened recently in Chelsea.  Using customized infrared technology, patients have far more independence than in a typical nursing home.  Saling uses a computer to communicate and activate assistance. His “voice’’ is the monotone of a computer, activated by an infrared beam he moves with almost imperceptible twitches of his head.  Tiny infrared transmitters in the ceilings connect to a master computer in the basement. This allows its residents to use small computers on their wheelchairs to summon an elevator, open and close doors, turn lights, televisions, and DVDs on and off, control the heat and air conditioning, even order meals from the cafe downstairs.

Using a teeny dot on his glasses that reflects an invisible infrared beam from a small sensor/transmitter on his wheelchair, he can control the “mouse’’ on his computer. He guides that mouse with subtle shakes of his head, and suddenly the shades come down in his bedroom, the lights go off, music comes on, and the door closes.

“I even have a remote-controlled bidet to wash and dry my bum, so that I maintain that independence,’’ he said, using the infrared beam to tap letters on the screen, telling his computer voice what to say.

The Chelsea project “will show everyone that a vented life can be a quality life,’’ Saling said. “It is the honor of a lifetime to be involved with this paradigm-shifting venture.’’

“There is promising technology that will allow the computer to be controlled by thought alone,’’ he said. “I am considering participating in a trial that hopes to make that a reality.’’

“Until medicine proves otherwise, technology is the cure,’’ Saling said. “Thanks, and remember, life is good.’’

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There have been numerous news articles discussing how different states are proposing alternatives to nursing homes.  The number of Americans 65 and older is expected to more than double to 89 million by 2050.  The oldest of 79 million Baby Boomers turn 65 next year, a turning point that will begin to put pressure on social services, retirement homes and assisted-living facilities.  The percentage of people 65 and older is projected to climb from 13% today to 19% by 2050, while the share of adults age 20 to 64 is expected to drop from 60% to 55%, the Census Bureau says.  Everyone agrees that we must do something to keep its exploding elderly population out of nursing homes for as long as possible to curtail the crushing costs of extended institutional care.

USA Today's article referenced grass roots "Villages" sprouting up in neighborhoods across the country to help people age in their own homes.  More than 50 villages in a neighbor-helping-neighbor system have emerged. They are run by volunteers and funded by grants and membership fees to provide services from transportation and grocery delivery to home repairs and dog walking.

How villages operate:

•Residents pay a membership fee that varies from $25 to $600 or more a year, depending on the types of services members want. Some villages have paid staff members; others are run completely by volunteers.

•Most villages are opening in more upscale neighborhoods in cities and suburbs, but they all provide discount dues for lower-income elderly.

Capitol Hill Village, which began operating three years ago and is the oldest of six such villages in the nation's capital send folks to clean gardens, install railings, fix windows, bring groceries and run other errands.

Beacon Hill Village in Boston was the first in the movement, created by residents in 2001. It charges annual dues and delivers paid and volunteer help. The village movement is "consumer-driven and consumer-run," says Judith Willett, Beacon Hill's executive director. Beacon Hill partnered with NCB Capital Impact, a non-profit community development group, to launch the national Village-to-Village Network to help other areas. It is backed by funders such as the MetLife Foundation.

The Minnesota Star-Tribune had an article about Minnesota's Living at Home Network which includes 43 local programs and thousands of volunteers to assist the elderly in simple household tasks.  The Living at Home Network, once called the Block Nurse Program and the Elderberry Institute, dates to 1981.  Recently renamed, the loosely organized network just changed its budgeting and management to reaffirm its original mission, which allows localities to develop unique programs that all push the common goal of keeping the elderly out of nursing homes.

The network kept 1,222 elderly Minnesotans out of nursing homes in 2008-09.  Keeping people out of nursing homes also costs less. Caring for those same clients in nursing
homes would have cost an additional $20 million from taxpayers.  Multiply that by the thousands of other frail, elderly Minnesotans and the sums grow large.

Tax dollars spent on seniors' long-term care are projected to grow from roughly $1 billion in 2010 to $5 billion in 2035. In fiscal 2010, Minnesota spent $720 million on nursing home care for the elderly, compared with $333 million on non-institutional care. By 2035, the state hopes to reverse the ratio, spending $3.5 billion on non-institutional care and $1.5 billion on nursing homes.

Living at home is almost always cheaper and more comfortable than living in an institutional setting, said Kristen Whittenbaugh. She directs Nokomis Healthy Seniors, which serves 502 senior citizens on an annual budget of $165,000.

By comparison, in 2009 the average cost of a private room in a Minnesota nursing home was $54,750 a year, according to MetLife insurance company. In the Twin Cities, the annual average was $62,780.

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The Hartford Courant had an article about the use of a robotic seal to help dementia patients. Sea Sea, a white-furred robotic baby harp seal, was introduced to the residents and staff at McLean, a state-of-the-art care facility in Simsbury, Ct.. The seal is used primarily to calm patients with dementia in nursing homes and long-term care facilities. There are only 40 in the country today, according to Freddi Hoffmann, vice president of marketing at McLean.  Using animals to calm patients in a nursing-home setting is not a new idea. But only recently have advances in technology made it possible to replace living animals with their robotic counterparts.  Hopefully, these will become standard in most nursing homes.

The seal purrs and paddles its flippers when petted and opens its eyes and moves its head toward you when you talk. It has significant weight to it and when held against your chest you can feel it vibrate, simulating a heartbeat.

One of the most dramatic effects of Sea Sea's therapy was seen in Eileen, a non-verbal patient who often doesn't respond to verbal stimulation or acknowledge those around her. "She was lying in bed for about half an hour talking to her and stroking Sea Sea," Cookson said. "Eileen seemed calmed by the noise Sea Sea was making, she sat there laughing and talking with her the entire time."

It is through two microprocessors underneath her fur that Sea Sea is able to interpret and react to her environment. Cookson said that over time Sea Sea will learn to respond to her name and other phrases.

McLean was able to purchase Sea Sea through funds from the Sorenson Technology Center.  McLean is already looking to purchase more of the robotic seals.

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McKnight's reported the news that an Illinois judge ordered Illinois-based for-profit nursing home operators to stop using scare tactics on mentally ill residents including issuing misleading “information sheets” to mentally ill residents.  U.S. District Judge William Hart ordered the facilities to stop distributing the sheets immediately. Hart referred to some passages as inaccurate and incendiary, and ordered the operators to cease communication with the mentally ill patients without the consent of the ACLU or other patient representatives.

The American Civil Liberties Union filed the lawsuit against nursing home operators alleging that mentally ill residents were being misled about their options. A recent Illinois Nursing Home Task force recommended that they be allowed to seek community-based support services. “Information sheets” being distributed to the residents were purposefully lacking in details, and implied that those residents would be left homeless and without care if they left the nursing home, the ACLU charged.

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NY Times had an article about cuts in home-care services for elderly and disabled because of budget shortfalls despite the fact that programs have been shown to save states money in the long run because they keep people out of nursing homes.

Since the start of the recession, at least 25 states and the District of Columbia have curtailed programs that include meal deliveries, housekeeping aid and assistance for family caregivers, according to the Center on Budget and Policy Priorities, a research organization. That threatens to reverse a long-term trend of enabling people to stay in their homes longer.

States that have made cuts:

Oregon, facing a $577 million deficit, was cutting home aides to more than 4,500 low-income residents.  State legislators say home care is a service the state can no longer afford. Cuts affecting an additional 10,500 people are scheduled for Oct. 1.

¶Florida placed 69,000 people on waiting lists for home or community services last year, and more than 5,700 of them ended up in Medicaid nursing homes.

¶Alabama cut housekeeping services — useful for people who can no longer do some cleaning tasks — for more than 1,000 elderly residents.

¶Arizona sliced independent living supports and respite programs for family caregivers.

¶Kansas, with a $131 million shortfall, will cut independent-living services for 2,800 people with disabilities in the next year.

In Illinois, providers of Meals on Wheels have stopped adding clients because the state was not reimbursing them.

Colorado, Mississippi, Missouri, Nevada, New Jersey, New York and Texas have all made cuts or frozen spending at a time when the elderly population — and the need for services — is growing.

In California, which faces a budget shortfall of $19.1 billion for the 2010-11 fiscal year, Gov. Arnold Schwarzenegger’s office proposed eliminating adult day health care centers that serve 45,000 people and in-home supportive services that help more than 400,000 elderly, disabled or blind residents.

Because Medicaid regulations require states to provide nursing home care to receive federal Medicaid money, legislators often have more leeway to cut from home services. Advocates for the elderly and the disabled worry that these cuts are just the beginning, because state ledgers tend to recover more slowly than the national economy.

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Chicago Tribune had an article about the transformation of the culture at nursing homes.  The article discusses Bethesda Home and Retirement Center. Traditionally, the world of nursing homes have been run like highly regimented mini-hospitals. Bethesda made a change two years ago taking its first step to join a movement that hopes to transform the nation's nursing homes.

The "culture change" movement seeks to get these facilities to alter their physical layout and their caregiving practices to create homelike environments where residents are seen not as passive recipients of care but as individuals with control over their lives. Nursing homes that embrace the new philosophy are letting residents decide when to bathe, eat and sleep; allowing them to organize their own activities; and redesigning nursing units into small "households."

Advocates say residents in such homes are happier and healthier; the employees have more job satisfaction; and giving care this way even costs less. The idea is not new. The Pioneer Network, a national umbrella group of nursing home providers and consumer advocates, has been promoting it since it was formed in 1997.

Yet only 25 percent of the nation's nursing homes say they have "for the most part" embraced culture change, according to a 2007 survey by the Commonwealth Fund, and only 5 percent say they have done so "completely."

Nursing home operators, who are under tremendous pressure to cut costs, are often afraid that culture change would cut into their profits.  However, flexibility is more cost-efficient.

The experience of the Bethesda Home illustrates the challenges. Janet Meyer, the home's director of nursing, had proposed a single change: letting residents sleep late. But "that's a bigger deal at a nursing home than you might think," she said.

Mealtime practices had to be changed to accommodate late risers. Housekeeping had to be done more flexibly to avoid waking residents for vacuuming.

Most challenging, the morning medication system had to be changed. Nursing homes traditionally give out medications during a two-hour period. But if residents were allowed to sleep late, Bethesda could no longer give morning medications only between 8 and 10.

So the home made another change: Residents could get their morning medications any time between 6 and noon, by individual request.

Other practices were loosened too. At staff meetings, administrators told employees that they needed to be flexible and perform caregiving tasks like bathing when residents wanted them.

The Health Reform Act passed in March calls for conducting demonstration projects at nursing homes to establish the best ways to effect culture change. So many organizations and government agencies are now working toward culture change that "everything is in place for widespread dissemination," said Bonnie Kantor, executive director of the Pioneer Network.

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This is a good follow up to this morning entry about the failure of nursing homes to report incidents and the failure of regulatory authorities to investigate and prosecute most incidents.  McKnight's had an article about a new proposal that would cut penalties by 50%.  Ridiculous.

The newly proposed rule from the Centers for Medicare & Medicaid Services would reduce civil monetary penalties (CMP) issued against nursing homes by as much as 50%. To qualify for the reduced CMP under the rule, a nursing home would have to report a deficiency before it is discovered by either CMS or a state agency, and correct the deficiency within 10 days.

The penalty reduction would not apply in cases of immediate jeopardy, or in cases that are part of a recurring pattern of harm, according to the proposal. The new rule also would establish an escrow account where CMP would be held during any appeals process. In the event of a successful appeal, CMS would return the money with interest.

Currently, CMPs range from $50 to $10,000 per day of noncompliance, according to background information in the proposed rule. The rule was created in accordance with section 6111 of the Patient Protection and Affordable Care Act. CMS is asking for feedback on the rule, which was published Monday in the Federal Register. Comments are due by August 11.

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McKnight's Long Term Care News had an article reporting a study on how well nursing homes follow Do Not Resuscitate (DNR) orders. Nursing home residents who fill out forms through a certain end-of-life care documentation program are more likely to receive the care they request than those with only a Do Not Resuscitate (DNR) order, according to a new study.   The study, which looked at the medical records of 1,711 nursing home residents in three states, found that patients who requested pain management care were 59% less likely to receive unwanted treatments than patients with simple DNR forms.
Originally developed in Oregon in 1990, the Physician Orders for Life-Sustaining Treatment (POLST) program is now in nursing home and long-term care facilities in roughly 32 states. Both physicians and patients sign a medical order form detailing the patient's end-of-life treatment preferences, including CPR, hospitalization, feeding tubes and other interventions.PLOST patients requesting fewer interventions also received identical treatments for pain and other symptoms compared with other patients.

The main point of PLOST is to increase communication between physicians, patients and providers about end-of-life care wishes, according to the Coalition for Compassionate Care of California. The study also found that 98% of PLOST patients had specific end-of-life directions, compared with 16% of DNR patients. The report appears in the July edition of the Journal of the American Geriatrics Association
 

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SouthTown Star had an article written by Donna Vickroy about the benefits of pet therapy at nursing homes including maintaining memory. Restoring memories is just one of the benefits animal therapy can bring to nursing home residents, said Jackie Sinwelski, memory support coordinator at Providence Healthcare.   According to the Centers for Disease Control, pets can have multiple health benefits, especially for seniors. Animals can decrease blood pressure, cholesterol levels and feelings of loneliness.

The visits also lift moods, create excitement and provide comfort for many of the residents, she said.  "It's such a thrill for many of them to see the cats and dogs," Sinwelski said. "They can't keep a pet here, so it's nice that someone brings the animals to visit."

Four times each year, volunteers from Peoples Animal Welfare Society in Tinley Park bring shelter cats and dogs into the facility, allowing residents to pet and snuggle with the animals.   Now in its fifth year, the PAWS program benefits eight homes in the Chicago area. The animals visit four times a year, staying for about an hour and a half at a time.

"We're the only shelter in the Chicago area that has an animal therapy program," said John Greenan, PAWS animal therapy program coordinator.

Some members of the staff also seem to perk up at the sight of a smiling dog or inquisitive cat.

The outings are also good for the animals, all of which have managed to retain their gentle nature despite their own stories of hardship and abandonment.

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The Providence Journal had a great article on a government program ––called Shared Living––  which is part of Rhode Island's effort to save nursing-home costs while allowing people to stay in their homes.  States have been offering the Shared Living program for people with developmental disabilities and now is expanding the concept to frail elderly people and adults with disabilities who are eligible for Medicaid. The first participants are expected to be paired up in about four weeks.

Through two agencies selected by the state, the program provides caregivers with money ($13,000 to $18,000 a year, nontaxable), nurses, caseworkers, training and respite. The caregiver lives with the elderly or disabled client and helps with such tasks as bathing and dressing. Typically the caregiver and patient know each other, may be related and may already be living together.

Shared Living bolsters efforts to care for people at home so they are less likely to need a nursing home. “It’s not just the money, but the support behind it,” said Jane E. Korb, program director for the Homestead Group, one of the two companies that will run the program. The other is Caregiver Homes of Rhode Island.

In Rhode Island, the Shared Living program sprang from the state’s “global waiver” to its Medicaid program, which frees the state from Medicaid rules to allow innovative programs.

The state has focused its efforts on reducing nursing-home use in favor of community-based programs. Long-term care accounts for nearly a third of Medicaid spending, and more than half of that long-term care money pays for nursing homes, according to 2007 data from the Kaiser Family Foundation.

The agencies that will run the program are not licensed. The Health Department has no oversight, even though it regulates nursing homes, assisted living and home care. The state Department of Human Services plans to monitor client and caregiver satisfaction, length of stay in the program, caregiver retention rates and complaints. 

The Homestead Group has been running the state’s Shared Living program for developmentally disabled people for years. Caregiver Homes is among the agencies that have been providing a similar service in Massachusetts. Its Rhode Island program director, David E. Bell, was formerly director of elder services at Child and Family Services of Newport County.

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