Posted on July 3, 2009 by Ray Mullman
The NY Times had a great article about an alternative way to treat residents with dementia who are at risk for wandering at night. The article discusses the success of a night-care group that takes care of demented residents at night including supervised strolls around the facility.
The article specifically discusses seven women with Alzheimer’s disease or dementia, and are part of the Hebrew Home’s ElderServe at Night, a dusk-to-dawn drop-off program intended to strengthen their decaying minds while sating their thirst to be active after dark. Alzheimer’s is an irreversible brain disease that destroys memory, and it is one form of dementia, a disorder marked by the loss of mental functions. Nighttime can be treacherous for people with dementia, who are often struck by sleeplessness or night terrors and prone to wandering about. This agitation and disorientation, called “sundowning,” is especially vexing for relatives trying to care for them at home, and often hastens their placement in nursing homes.
ElderServe at Night began a decade ago, and is the only one of its kind in the country. It should be the standard. Participants spend 7 p.m. to 7 a.m. painting, potting plants, dancing and talking — or, for those immobilized by their disease, relaxing amid music, massage and twinkling lights. The patients rest as they need, for a few minutes or a few hours.
The program was born in 1998, after Daniel A. Reingold, now president and chief executive of the Hebrew Home, began hearing horror stories from people who jury-rigged alarm systems or slept on mattresses pulled across thresholds to stop their sleepless parents from wandering at night. Sleep deprivation, he learned, was causing many guardians to put relatively high-functioning patients into nursing homes rather than day care programs.
The activities mirror those done during the day: arts, crafts, exercise, and holistic remedies like meditation and pet therapy. Rather than give agitated patients mood-altering drugs, ElderServe aides might lead them by the hand into a softly lighted room, slip off their shoes and socks and massage their feet with a warm washcloth.
The staff indulges the urges that dementia and Alzheimer’s induce, walking with patients who crave a 2 a.m. adventure or taking evening trips to the circus or restaurants. Mr. Reingold has made presentations to professional associations, hoping others might copy the program. But a spokeswoman for the Alzheimer’s Association, a nonprofit research and education group based in Chicago, said she knew of no other nighttime drop-off program like it. Though it has not been independently evaluated, organizers say the program has helped patients maintain a discernible alertness even as their minds erode. It has also given their relatives desperately needed breaks.
I wish all long term facilities could have this type of program.
Posted on July 2, 2009 by Ray Mullman
Chico enterprise Record had a tragic story about a nursing home preventing a mother from seeing her disabled daughter. This is clearly in violation of the Resident's rights and should not be tolerated. Gladys McManaman says she's miserable because a nursing home has limited the time she can visit her disabled daughter. Gladys said the nursing home's administration will only let her visit Patricia between 9 a.m. and noon and only on weekdays.
There are no exceptions, she said. She couldn't visit on Mother's Day, Easter or her daughter's birthday. And if she stays a bit longer than the three hours she's allowed, a staff member will tell her sharply, "It's four minutes past noon — you have to go!" she said. "It's hateful."
The facility's administration is retaliating against McManaman for filing complaints about the place. McManaman said she's lodged complaints with the state Department of Public Health about Patricia's care. She said Patricia has had many falls and has often been neglected by the staff. Also, the facility has not responded when her daughter has needed urgent medical care, she said. McManaman said Patricia was born with severe disabilities.
She admits she's gotten mad at times when Patricia was neglected or given improper care at the nursing home but what mother wouldn't get mad when the facility is neglecting your child.
"She knows me, she responds to me," McManaman said. "I would think more than anyone, they would welcome my being there so I could alert them to what her needs are." The nursing home prohibits her from doing just about anything for her daughter. She can't even comb Patricia's hair without worrying a staff member might come in and reprimand her.
The only thing she's allowed to do is her daughter's laundry — something the facility is happy to have her do. McManaman recently filed a lawsuit against Riverside, hoping to win more visiting time, but she said she is frustrated at how long that is taking.
What Riverside is doing is clearly illegal, but it's done by nursing homes quite often, said Pat McGinnis, director of the San Francisco-based California Advocates for Nursing Home Reform.
McGinnis said patients' families have the right to visit whenever they want, although they don't always realize this.
McManaman said she's not in good health and, at her age, wonders how long she'll live and what will become of her daughter if she should die.
"In the last years of my life, I sure didn't expect this," she said.
Posted on June 27, 2009 by Ray Mullman
McKnight's had an article discussing the recent National Nursing Home Survey: 2004 Overview is the seventh in a series of periodic nursing home surveys conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics, Division of Healthcare Statistics. The full study is available at here.
The number of both nursing home beds and nursing home residents in the United States declined between 1999 and 2004. The number of nursing home beds dropped by more than 10% from 1.9 million in 1999 to 1.7 million in 2004. Meanwhile, the number of nursing home residents fell by 6% from 1.6 million to 1.5 million according to the study.
Here are other study findings:
More facilities were both Medicare and Medicaid certified in 2004 (87.6%) than in 1999 (81.8%).
Of the 936,000 persons providing nursing home care in 2004, the vast majority (roughly 600,800) were certified nursing assistants (CNAs).
Slightly more than 88% of the residents of the nation's 16,100 skilled nursing facilities are over the age of 65, 45.2% are over the age of 85, and 71.2% are female.
Only 1.6% of the entire nursing home population received no assistance with activities of daily living (ADLs) while a slight majority—51.1%—required assistance in all five ADL categories.
Posted on June 25, 2009 by Ray Mullman
There is a bill that was introduced in Ohio that would require nursing homes to notify residents and their families when a sex offender moves into the facility. This seems like a no-brainer.
Under current law, not only is notification not required, but nursing homes are not allowed to turn away applicants for being sex offenders.
Senate Bill 130 would require licensed nursing care facilities to notify residents and their families that a Tier 3 sex offender is living there. Notification would also be required if a person was imprisoned for a felony any time during the 12-month period of their application for admission.
Nursing home operators worry that notification will put them in a difficult legal position.
"What is the answer when (family members) come to the facility and say, 'Well, we don't want this person living next door to our loved one? What are you going to do about it?' " said Peter Van Runkle of the Ohio Health Care Association, which represents nursing home. "We are not legally allowed to refuse to admit someone that we have the ability to take care of because of their past offenses."
Here is the link to the story.
Posted on June 24, 2009 by Ray Mullman
I ran across the Nursing Home Complaint Center website which seems to be an advocacy group to prevent neglect, abuse, and Medicaid/Medicare fraud. Their website states that Americas Watchdog created the National Nursing Home Complaint Center because there really is no government or private organization that will act as advocates for senior citizens and their families with one simple phone call.
If a loved one has concerns about the treatment a family member is receiving in a nursing home in any state, they can call the Nursing Home Complaint Center anytime at 866-714-6466.
Aside from patient advocacy, the Nursing Home Complaint Center is also an advocate for the taxpayers, dedicated to the idea that the patient only has to pay for the treatment they receive. The group estimates on an annual basis US nursing homes over bill US taxpayers billions for services billed to Medicare & Medicaid, that were never performed. The Nursing home Complaint Center thus has a dual purpose; patient advocacy, and taxpayer protection.
Hopefully, this group will do a good job advocating for nursing home residents since we know regulatory agencies and politicians are certainly not doing a very good job.
Posted on June 23, 2009 by Ray Mullman
Tulsa World had an article about a nursing home employee who reported neglect and abuse at a nursing home, and was subsequently fired from her job despite her affirmative duty to report such incidents. This is outrageous. This employee did exactly what she was supposed to do and the nursing home fired her for it. She is now suing Cimarron Pointe Care Center and one of its contractors for wrongful termination. Is it any wonder why many nurses look the other way when residents are abused and neglected?
In the lawsuit, Harris said she worked as a housekeeper at the facility. She was paid by Health Care Services Group, a Tulsa company contracted by the home to provide cleaning services, and supervised by nursing home staff. During her employment, she observed numerous instances of improper care of the home's residents.
"Mrs. Harris observed a male resident who had been left in his own waste for so many hours that he had feces caked on to his leg from his hip to below his knee, and had wet himself at least one time." She saw the man sitting in his waste and reported it to her supervisor, the head nurse and two nurse's aides. Her supervisor sprayed deodorant in the man's room to cover the smell. The aides said they would leave him for the next shift.
"Two and a half hours later, he was still sitting in his own waste," Harris said. "He couldn't say nothing. I would always talk to him. He would just light up when I went to clean his room. It's heartbreaking when you see a resident not being taken care of."
Also, an elderly woman paralyzed from the waist down was left in her own waste, Harris said. She rolled out of the bed and into the hallway to get someone to change her soiled garments and the nurses "just laughed at her," Harris said.
"On another occasion, Ms. Harris brought the needs of another female resident to the attention of the nursing staff. The resident's needs were ignored, prompting the resident to write a letter to her family saying goodbye, in anticipation of death from neglect," the petition states.
Another female resident, who was unable to sit up alone, was left on a bench in the shower. She fell and hurt herself, the petition said.
Harris reported each instance of neglect or abuse to the facility's staff. The home's administrator and a supervisor from Health Care Services Group of Tulsa, the contractor that paid Harris, fired her. Of course, Cimarron Pointe Care Center denies any improper care of its residents. It also states that Harris was employed by Health Care Services Group, so the nursing home isn't responsible for her termination. However, Ms. Harris was told that the only basis for her termination was her reporting of the abuse. Ms. Harris had not done anything else to merit termination, and no other basis for termination were discussed or even suggested."
Posted on June 19, 2009 by Ray Mullman
The West Virginia Gazette had an interesting article on a nursing home's attempt to evict a mentally ill resident from the facility. The judge has ruled that 77-year-old Helen Shank gets to stay at Golden Living Center in Morgantown...for now. Medicaid must continue providing nursing home care for Shank, who is mentally ill and also a "brittle diabetic".
West Virginia Department of Health and Human Services tried to take federal Medicaid benefits away from Shank, despite recommendations by several of her physicians and psychiatrists.
Shank has lived in the Golden Living Center since October 2004. But last year, a DHHR evaluator said she no longer qualified for nursing home care.
Dr. Ward Paine, a physician who treated Shank at the Golden Living Center, said she would be at a "very high risk of hospitalization" if she were released from the home. Others agreed, including: Dr. Pamela Sullivan, another physician who saw Shank, and Dr. Janis Boury, a psychologist and case manager who gave Shank a mental-health evaluation in June 2008. Dr. Logan Graddy, a psychiatrist at West Virginia University Hospital, diagnosed Shank as suffering from developing dementia, "a severe, persistent and progressive psychiatric illness."
In his ruling, Judge Kaufman wrote, "The U.S. Congress defined a nursing facility as an institution which is primarily engaged in providing ... health-related care and services to individuals who because of their mental or physical conditions require care and services which can be made available to them only though institutional facilities." Shank's failure to meet "the minimum five daily living deficits," which do not include any psychological problems, does not make her ineligible to receive Medicaid benefits under federal guidelines, Kaufman ruled.
Once again, the nursing home industry proves that they are more concerned about making money than providing the care thier residents need.
Posted on June 13, 2009 by Ray Mullman
Below is an editorial from Syracuse.com about geriatrician Dr. Bill Thomas, a proponent of Green House Project and The Eden Alternative.
Ready for a new idea? Nobody has to live in a nursing home anymore.
"Every person in a nursing home has an exact clinical double living at home," says Dr. Bill Thomas, of Ithaca.
A geriatrician and evangelist for sensible new kinds of "elder care," Thomas created The Eden Alternative to raise awareness and change the culture around aging; and the Green House Project, which seeks to replace big, institutional nursing homes with scattered-site housing.
Thomas was in town earlier this month as keynote speaker at Loretto's Legacy Awards luncheon. Loretto has 17 facilities housing elderly residents in a variety of settings, and also runs PACE, a program that provides home-based care. Loretto CEO Michael Sullivan says PACE already keeps as many as 370 elderly clients out of nursing homes.
Although the numbers of the elderly in nursing homes has dropped in the last several years, beds are still filled in large facilities like Cunningham-Fahey, James Square, Rosewood and Van Duyn. Why are so many still living there, if home-like settings are feasible in every case, as Thomas argues?
"Because their daily needs are greater than family and friends can provide," Thomas explains. Back in the 1960s and 1970s, Syracuse made a major investment in what was then state-of-the-art elder care. "It was far-seeing -- then," says Thomas. But it created what Thomas calls "legacy overhang." He says cities like Seattle, Wash., and Lincoln, Neb., now are ahead of Syracuse, moving to scattered-site elder housing.
"Use economies of scale for billing, records," says Thomas. "Get to the small scale for care." Smaller can be economical, he adds. "It's a costly ballet to deliver 500 meals simultaneously," he says. "In Green Houses, food costs are way down. They cook what they want, when they want it."
Years ago, people with mental and developmental disabilities moved from institutions to community housing. Likewise today, there are alternatives to prison for nonviolent inmates.
In the case of the elderly, the transition to scattered sites could be easier, because community resistance -- "not in my backyard" -- is less of a factor. Thomas says there are 100 Green Houses in 12 states and more on the way.
He found a willing audience among Loretto's leaders. CEO Sullivan said Loretto has two scattered sites, on Highland Street and Fayette Street, and he wants more. "We would like to do away with nursing homes, floor by floor, house by house," he said.
Getting there won't be easy -- particularly with state government cutting back aid. Thomas hopes to amplify his message of "culture change" via the Oprah Winfrey show. "The media still treat old people like a plague of locusts," he says. "I think aging is a good thing, though bad may come with it. It's a kind of human development. What's missing in the media is how age makes you better."
Posted on June 4, 2009 by Ray Mullman
Kansa City Infozine had an article about a new study from a University of Missouri researcher which found that long-term care facilities in Missouri saved more than $6 million in the past three years after implementing a quality care improvement program. Savings for the facilities were more than 10 times the program costs. Of course, the nursing home industry should be improving care because it is the right thing to do instead of doing it to save money but that is another story.
Marilyn Rantz, professor in the MU Sinclair School of Nursing completed a three-year analysis of the Quality Improvement Program of Missouri (QIPMO) and found significant improvements in overall care quality of residents in participating facilities. Last year, a total of 990 residents avoided developing clinical problems, including pressure ulcers, depression symptoms and weight loss, resulting in a total savings of $3.7 million statewide for facilities and health care providers in the state.
The primary goal of quality improvement plans is to improve nursing home care practices. In Missouri, QIPMO is a cooperative service of the Sinclair School of Nursing and the Missouri Department of Health and Senior Services; it was created to pair facilities with gerontological nurse experts. The nurses perform on-site visits to offer technical assistance, care-planning help and clinical consultations. One of the nurses' primary functions is to identify "best practices" for care procedures and make such information available throughout the state.
"Quality improvement is cost effective for everyone involved," Rantz said. "Focusing efforts to improve quality of care not only helps to improve that care and the positive outcomes for people, but it also saves the industry and facilities money."
In the study, Rantz found that the cost savings for each year exceeded the total program cost by more than $1 million. Statewide trends among residents included improvements in pain, fall reduction and pressure ulcer reduction, and fewer tube feedings and restraint reduction.
QIPMO is funded through Missouri's Nursing Facility Quality of Care Fund, which is generated from care facilities paying taxes according to the number of beds in their facilities. The cost per facility to use the program was less than $3 per bed.
"The impact on improving the quality of care by expert gerontological nurses consulting in nursing homes is significant in addition to the cost savings for the facilities and health care system in general," Rantz said. "The role of these nurses should be embraced by state agencies, nursing home providers and consumers as an ongoing strategy to continuously improve the quality of nursing home care."
Throughout 2007-08, QIPMO nurses made 855 contacts with 246 different facilities in the state, and they made 417 site visits in 227 nursing facilities. Results showed that facilities who participated did improve, and costs of care problems were reduced.
The study, "Helping Nursing Homes ‘At risk' for Quality Problems: A Statewide Evaluation," was co-authored by several MU researchers and will be published in the July/August 2009 issue of Geriatric Nursing. For more information about QIPMO statistics, visit: www.nursinghomehelp.org/stats.html
Posted on May 28, 2009 by Ray Mullman
I am a big proponent of using surveillance cameras in nursing homes especially when privacy concerns are protected. There are numerous benefits to placing cameras in certain areas of the facility. Medication room, nursing station, and hallways and exits would deter theft, neglect, and elopements. They would also protect seniors in hospices, nursing homes and other group home settings from abuse, and would comfort guardians of such patients who might live far away.
The San Francisco Chronicle had an article about a proposal to let patients in care facilities or their families or guardians install surveillance devices in the patients' rooms. "The capabilities of monitoring from a remote location provide a sense of security to both the facility and the residents," said Cegavske, the bill's primary sponsor.
Cegavske said she introduced SB290 in large part because of an unexplained hand injury her mother sustained while in a Minnesota nursing home last year. Cegavske's mother has Alzheimer's disease and can no longer play the piano as a result of the injury.
Also backing the bill was Lillian Mandel, who said her mother was abused twice last year in a nursing home. She said one of the incidents involved a diaper shoved in her mother's mouth.
"I realized I needed some kind of evidence in my mother's room to protect her and any senior around because this is totally unacceptable," Mandel said, adding that the cases involving those responsible for abusing her mother were eventually resolved.
Changes to the bill made in the Senate specify that the monitoring devices use video without sound. Why is that necessary? What if someone is yelling out for help--shouldn't the camera record that?
Another change would release the facility from liability arising from any issues involving the monitoring device.
Posted on May 25, 2009 by Ray Mullman
On this Memorial Day, I was going to mention and celebrate all the veterans now living in nursing homes. Here is a link to information about veteran services and nursing home care. I hope and pray that these brave men and women receive the best care, treatment, and services America offers. Unfortunately, there are stories every day about how veterans are treated poorly in nursing homes and don't get the care necessary to live with dignity.
The Denver Post had an article about the administrator of the State Veterans Nursing Home in Rifle, Colorado, who was finally fired after an audit discovered he stole resident's money. He has been indicted for paying an employee $7,290 in state funds for veteran care to an employee who helped him restore a 1951 Cadillac.
The indictment alleges that Robert Leslie Shaw asked Rifle nursing home maintenance worker Michael Walker to help him restore the car at Shaw's residence. The work on the car began in October 2007, and Walker spent numerous weekdays and weekends working on the car at Shaw's home. In addition, Shaw asked Walker to travel out of state to pick up parts for the car, and Shaw paid Walker for the transportation costs and expenses. Shaw later paid Walker for 3,645 hours of on-call service, even though his job status did not entitle him to on-call pay. Nursing home employees who remain on-call — willing to come in to work in case of emergencies — are compensated $2 per hour for their time.
The Denver grand jury returned the indictment charging Shaw with two counts of felony theft and one count of first-degree official misconduct, which is a misdemeanor.
I hope this guy rots under the jail.
Posted on May 17, 2009 by Ray Mullman
The Charlotte News & Observer had a great article on how the culture of nursing homes are changing. Hopefully, for the better. This culture change is long over due and is desperately needed in most nursing homes. Instead of a hospital-style nurses' station, staff members talk with residents in an area that looks like a comfortable office, den and kitchen in someone's home. The physical and organizational structure of facilities is made less institutional. Large, hospital-like units with long, wide corridors are transformed into smaller facilities where small groups of residents are cared for by a consistent team. All this means that the center has adopted the long-term care approach known as culture change.
What does culture change mean? In the culture change model, seniors enjoy much of the privacy and choice they would experience if they were still living in their own homes. Residents' needs and preferences come first; facilities operations' are shaped by this awareness. To this end, nursing home residents are given greater control over their daily lives -- for instance, in terms of meal times or bed times, and frontline workers -- the nursing aides responsible for day-to-day care -- are given greater autonomy to care for residents.
A symposium in Raleigh on Tuesday will examine facets of the movement's main tenet: that residents' preferences should guide the way nursing homes are run, not what's most expedient for owners and staff. The label "culture change," or "resident-centered care," may give the approach a touchy-feely sound, but it's serious business to the several facilities in central North Carolina already adopting the changes. Some are even spending millions in building renovations to make it all work.
Changes at Hillcrest include:
Allowing residents more choice in schedules and dining choices, a move away from the structured regimes of many facilities.
Creating "neighborhood" halls with an approachable nurse's work station, small kitchen and den to service 16 or so residents. Carpeting, wall sconces and light wells that bring in sunshine create a homier appearance.
Having frontline workers such as certified nursing assistants take on some housekeeping and food-preparation duties so that residents get consistent care from fewer staff members.
Taking soiled laundry outside -- out of living areas -- as soon as it's gathered, avoiding waste smells not usually evident in homes.
Getting medicine and housecleaning carts off the halls when not in use, making for easier walking and less of a hospital-corridor feel.
Advocates for older people have pressed for better conditions in nursing homes for decades, but the specific improvements grouped as culture change have gained momentum during the past 10 years. A survey in 2007 by the Commonwealth Group, a national nonprofit, showed that about 30 percent of homes have adopted the approach, with an additional 25 percent striving toward it. Hopefully, this kind of change will become madatory throughout the country.
Posted on May 13, 2009 by Ray Mullman
The Telegraph had a bizarre story about a nursing home allowing mice to eat residents at an Austrlian facility. Two elderly residents of a nursing home in the Australian state of Queensland have been "severely chewed" by mice after the facility became infested with the rodents.
The first victim was an 89-year-old bedridden war veteran who was found with blood on his ears, face and neck after being gnawed on by mice at the state-run Dalby Hospital. The man's daughter discovered him bleeding from the bites last week. Ray Hopper, an opposition MP, told the Brisbane Times: "The top of his ears were severely chewed and he had bites to his head and neck. "His hands were covered in blood because he was trying to get the mice off him. "We are talking about a health facility overrun by vermin. It's atrocious." Mr Hopper said the man was so distressed that doctors had put him on morphine to calm him down.
Queensland Health, which runs the home, has since been accused of being slow to respond to a mouse plague at the facility. Following the attacks, Queensland Health has rostered on extra staff and pest control agents to kill mice. Residents have since been given the option of moving out and a "major" investigation into the incidents has been opened.
Posted on May 10, 2009 by Ray Mullman
A recent report from the House Committee on Oversight cites 8 states--New York, Michigan, Virginia, West Virginia, Kansas, Indiana, Florida, and Nevada--that are likely to use medicaid stimulus funding to fill budget gaps rather than to care for seniors. See the full report here.
This is ridiculous. The Federal government in an effort to help States care for the elderly and vulnerable against rising health care costs did not include a provision to make the intended use of the funds manadatory. $87 billion was set aside to help with Medicaid. By exploiting a loophole in the stimulus legislation, states are effectively able to use federal funds intended for healthcare spending for whatever projects they choose and without obligation to adhere to federal transparency and accountability rules attached to stimulus funds.
I hope the voters get upset by this cost-shifting.
Posted on May 1, 2009 by Ray Mullman
NJ.com had an interesting article discussing how nursing homes are dumping Medicaid residents after the residents spend their life savings on care and treatment. The article mentions May Hunish whose family decided to move her to the Maurice House, an assisted living facility in Millville, because after spending her $150,000 in savings on rent and care, they could ultimately switch to Medicaid to continue paying for her stay. But in the spring of 2007, after spending nearly all of her savings and applying for Medicaid, things changed. Officials at the Maurice House told the former Bridgeton resident that she would have to move to a smaller space or leave. While in the hospital for a fracture after a preventable fall caused by the home's neglect, she got an eviction notice the company operating the Maurice House said it would not accept Medicaid and she was being discharged for non-payment. Four days later, Hunish died.
According to state officials, Hunish wasn't the only person forced out of a facility by Wisconsin-based Assisted Living Concepts Inc. (ALC) while attempting to switch to Medicaid, even after the company promised that they could. The New Jersey Public Advocate issued a report that found that the company, which operates eight assisted living facilities in southern New Jersey, evicted, or threatened with eviction, dozens of residents who tried to switch to Medicaid after spending down their life savings all in an effort to boost shareholder profits.
From interviews with 111 current and former facility residents and their families, the department found that officials at the facilities routinely told tenants that they could switch to Medicaid and would not be evicted, including residents that would likely be ineligible for Medicaid, a government-administered program offered to residents with low-income or low-resources. The public advocate said the company was deceptive and its actions caused residents to suffer "financial, physical, and emotional harm as a result."
"The bottom line: the company pursued a policy of keeping elderly residents until they drained their life savings, and then washed their hands of them," said state Public Advocate Ronald K. Chen. According to state figures, a private pay resident would pay $3,390 a month at one of ALCs facilities; comparably, ALC would receive $2,780 for a Medicaid resident, under 2007 rates.
The Public Advocate's office was alerted to the company practice through resident complaints to the state's ombudsman. Officials there have been working with the state Department of Health and Senior Services, which determined that discharging residents violated the "certificates of need" for the eight facilities, part of the licensing process in which the company stated in writing that it would not ask residents to leave because of "spend-down situations," state officials said.
Posted on April 26, 2009 by Ray Mullman
MedPageToday.com had a short summary of a new Centers for Medicare & Medicaid Services (CMS) plans to test a pay-for-performance program to improve the quality of care in nursing homes. All Medicare-certified nursing homes in Arizona, Mississippi, New York, and Wisconsin will be invited to join the Nursing Home Value-Based Purchasing demonstration project, which will run for three years starting in July. CMS expects to enroll at least 100 homes from each state.
Under the program, participating institutions will be awarded points on the basis of staffing measures, avoidable hospitalizations, resident outcomes, and deficiencies identified during inspections. Homes that score the highest and that show the greatest improvements over time will receive payments. CMS expects to pay for the program with the money saved by reducing avoidable hospitalizations through improved performance. The funds will be placed into state pools from which incentive payments will be drawn.
I think this is a good idea but shouldn't nursing homes provide quality care and adequate staffing anyway for the billions of tax payer dollars they get every year?
Posted on April 23, 2009 by Ray Mullman
WSAZ.com out of Ohio had a story about the use and effectiveness of Wii therapy for residents of nursing homes. I have discussed Wii therapy other times on this blog and encourage all nursing homes to use this kind of therapy. It is interactive, fun, and effective in assisting residents with social interaction, mobility, and exercise. Doctors and therapists say the Nintendo Wii is a huge hit with senior citizens by helping with motor skills and mental acuteness.
The article talks about a tournament in Ironton, Ohio. The Wii was like a form of medicine. Bryant's Health Center in Ironton was hoping for a little home team advantage Monday. It played host to three other local nursing homes for a Wii bowling tournament.
"When they're having bad day or something, it helps them with the stress," says Norma Thomas, a senior activities director.
"We all just have fun doing it, that's all it is, having a good time," nursing home resident Willie Nelson said.
Many of the residents enjoyed the competition and chance for exercise.
"It has been very therapeutic for our patients; range of motion, socialization has been great, we've loved this," Natalie Adams said. "The elderly, a lot of them used to bowl years ago, and it's brought it back in their lives and it's been great."
Posted on April 15, 2009 by Ray Mullman
Senators Chuck Grassley (R-IA) and Herb Kohl (D-WI) reintroduced the Nursing Home Transparency and Improvement Act, a bill that would give consumers more information about individual nursing homes and their track record of care, give the government better tools for enforcing high quality standards, and encourage homes to improve on their own.
"Improving the quality of care in nursing homes is a constant challenge. More transparency, better enforcement and improved staff training are needed, and this legislation works to make changes in those areas and improve the quality of life of nursing home residents and to empower the family members and loved ones of those residents," Grassley said.
"Twenty-two years have passed since Congress last addressed the safety and quality of America's nursing homes in a comprehensive way," said Kohl. "As we prepare to debate reforms across our health care system, there has never been a better time to implement critical improvements to our nation's system of nursing homes. And as the GAO report demonstrates, many of these improvements are past due."
In addition to the bill introduced today, Grassley and Kohl released a U.S. Government Accountability Office (GAO) report entitled "Medicare and Medicaid Participating Facilities: CMS Needs to Reexamine Its Approach for Oversight of Health Care Facilities." This report suggests that the survey and certification system is significantly underfunded relative to the scope of its oversight responsibilities, which have greatly expanded in recent years. The report found that survey frequencies have greatly lengthened due to resource constraints, resulting in some facilities receiving inspections only once every ten years. The Nursing Home Transparency and Improvement Act seeks to bolster the federal government's survey and certification system.
Grassley is ranking member and former chairman of the Committee on Finance, with jurisdiction over the federal health care programs that cover nursing home care, and former chairman of the Special Committee on Aging. Kohl is chairman of the Special Committee on Aging, a standing committee that conducts oversight of issues related to the health, safety, and financial well-being of older Americans. The Grassley-Kohl bill is the product of their work together on nursing home quality, which has helped to generate some positive results in recent years, including the government's new five-star nursing home rating system and the release of the Special Focus Facility program participant list, consisting of the 135 worst nursing homes in the country.
Continue Reading...
Posted on April 2, 2009 by Ray Mullman
The Dallas Morning News had an article about the amount of money Texas provides to nursing home residents who are on Medicaid. The article emphasizes that the amount of money is directly related to the quality of care and shows how Texas treats its most vulnerable citizens.
Texas' Medicaid program only reimburses nursing homes an average of $112.79 per patient per day – less than 48 other states. Texas remains 30 percent below the national average of $163.27 per day. Patient advocates and industry experts say Texas' 49th-place ranking means that nursing homes can't pay employees competitive wages. That in turn leads to high staff turnover, which hurts residents' care. It is no surprise that 28 percent of Texas' 1,100 nursing homes received the worst rating and only 10 percent scored the best when Medicare announced its new nursing home ratings late last year.
The reimbursements now don't even cover nursing homes' actual costs and would need to increase to at least $125 a day for facilities to break even. Skilled nursing care costs tens of thousands of dollars a year, so many nursing home residents eventually exhaust their personal assets and qualify for Medicaid, the federal-state health care program for the poor.
Nursing homes have tried to hold the line on their labor costs, but that leads to high staff turnover. It's difficult to compete with hospitals, which pay better, so nursing homes routinely lose registered nurses, licensed vocational nurses and nurses' aides. "The average annual turnover rate is 87 percent for certified nurses' aides," said Pearl Merritt, who leads a center task force on long-term care. "It's a challenge to maintain high-quality care in a revolving-door environment."
Nurses' aides can work at a McDonald's for more than what Texas nursing homes are willing to pay them.
Posted on April 1, 2009 by Ray Mullman
The Edmond Sun had a recent article about a 131 page investigative report that supports complaints against a nursing home in Oklahoma. One of the complaints includes a lack of an effective system for investigating and reporting abuse and failure to consult with a resident’s physician when there was an injury. The investigation was triggered by a Sept. 16, 2008, incident at Grace Living Center. On that day, a resident, Lester Pendergraft, allegedly sexually assaulted a 67-year-old resident. Pendergraft has been charged with one count of rape by instrumentation.
A meager $10,000 penalty resulting from the investigation has been proposed by the Centers for Medicare and Medicaid Services.
Documentation showed the victim’s daughter was notified at 8:45 a.m., 1 hour and 35 minutes after the incident occurred at 7:10 a.m. Edmond Police arrived shortly after they were notified, at about 9 a.m. The victim’s doctor was called between 8:15-8:25 a.m., shortly after he arrived at his office.
On Sept. 25, the detective assigned to the case said, “The facility did a poor job of protecting the evidence.” He said facility staff threw away evidence and washed the victim’s bed linens and clothing and Pendergraft’s clothing. Why would the facility do that unless they were trying to cover up what happened?
According to the report, the facility’s staff should immediately notify the director of nurses and the doctor, get the resident out of harm’s way and assess the resident whenthere is an allegation of abuse or neglect. “The resident was not assessed timely after the incident,” the report stated.
The detective said someone in charge said to another officer that he felt “The situation was being blown out of proportion.”
Citizen advocate Wes Bledsoe, founder of A Perfect Cause, an advocacy organization for disability and elder rights, said when he read the report he was “deeply disturbed." Bledsoe said what was most shocking was that the incident happened in the first place, that evidence was destroyed with either intent or by incompetence and that a staff member voiced concern about police blowing the situation out of proportion. Furthermore, there were warning signs before the incident that Pendergraft posed a threat to residents. Pendergraft was entering rooms of residents without reason or explanation who could not call out for help.
According to the report, a certified nurse aide reported before the Sept. 16 incident that she observed Pendergraft touch another resident who was dependent on staff for assistance. The same day, Pendergraft was seen pulling up the shirt of still another resident who was dependent on staff for assistance.
Posted on March 30, 2009 by Ray Mullman
McKnight's had an article about President Obama's budget and how it will affect nursing homes. It may be too early to tell but it looks like nursing home reimbursements will increase under the new budget. Many nursing home operators are praising President Obama's proposed 2010 budget for provisions that would help educate and train nurses. The budget also proposes “bundling” of some Medicare funding for post-acute care. The goal of bundled payments is to lower hospital readmission rates and decrease the overall cost of health care.
Larry Minnix, the CEO of the American Association of Homes and Services for the Aging, highlighted another part of the budget: a proposal to allocate $1 billion “to capitalize and launch the Affordable Housing Trust Fund to develop, rehabilitate and preserve affordable housing and increased funding for the project-based rental assistance program to preserve 1.3 million affordable rental units will help moderate income elders find and keep a place to call home.
Posted on March 21, 2009 by Ray Mullman
Newstranscript.com had a recent article about an application filed by the Village for Health Care and Rehabilitation of Workman's Circle for a new and different type of long term care facility. Plans call for the construction of a twostory skilled care nursing facility containing 152 beds for long-term care and sub-acute care (short-term rehabilitation) on a 13-acre parcel.
Testifying on behalf of the applicant was engineer Robert J. Curly, of CMX Engineering, Manalapan. According to Curley, the building will have 152 private rooms and 80 parking spaces, primarily for staff members. The plan also calls for a large buffer of pine trees and an 8-foot tall berm to keep the facility private and so as not to become a disturbance to residents who live on Oakley Drive.
Marshall Goldberg will be the administrator of the Freehold Township facility. He said he takes pride in the home-like, non-institutional environment the skilled care nursing facility will offer. He said the idea is to have the private resident rooms clustered around a living room area, which he said is the center core of the design plan. Some living spaces will have 16 resident rooms around a core center, others will have 12 resident rooms around a core center.
Materials to be used for the exterior of the building will include stone and stucco. The front of the building will have a covered canopy. The first floor of the building will be comprised of 54,000 square feet with bedrooms, the kitchen and the living room areas. Also on the first floor will be resident amenities such as a library, beauty shop, gift shop and activity rooms The second floor will be comprised of 54,000 square feet to include bedrooms and administrative offices.
The structure appears to be more like a residential property with a Colonial design and unique architectural features, according to project architect Judith Mumma. Mumma explained that the model used to design The Village is called Greenhouse, a new concept in senior care which emphasizes home-like houses with between 10 and 16 residents, rather than institutional beds and corridors.
"This is loosely based on that model," she told the board. "Residents will eat in their own dining room with just those in their house, not everyone in the building. This provides a safer, cozier environment."
The model for the Greenhouse concept has the "homes" detached and completely separated. The homes for The Village give the appearance of standing alone as separate homes, but people can walk from one end of the building to the other inside.
There area no visible nursing stations, but rather a home-like center living room with a team room where nurses and aides will conference with patients in a safe environment. Medications and treatment carts are stored in those areas, but will be behind closed doors and not visible, according to the testimony provided to the board.
Posted on March 15, 2009 by Ray Mullman
Maryland allows nursing homes to prohibit families from monitoring their loved ones via video or webcam. NBC 25 had a story and article about local lawmakers trying to make it illegal for nursing homes to prevent people from installing cameras in patient's rooms. Cameras prevent neglect and abuse, and make sure that residents are getting the services they need.
The bill would require nursing homes to give people the choice of installing cameras that the patients or their families would pay for themselves. Cameras would not be allowed in bathrooms.
All rooms being monitored would be required to have a sign on the door.
For families, it's legislation that would bring them piece of mind. It would also help management determine the competency of the staff and the effectiveness of treatments. The nursing home industry does not want families to know what is going on at the facility when they are not there.
Many times, when demented residents suffer abuse, the nursing home cannot substantiate the abuse and rarely try. Imagine if there was a video--wouldn't that be a deterrent to any neglect or abuse?
Posted on March 12, 2009 by Ray Mullman
McKnight's had an article about a report discussing the possibility of moving at least 9 million nursing home residents onto Medicare instead of state Medicaid. Consolidating certain aspects of financing care for some of the poorest older and disabled Americans at the federal level could soften the blow significantly to state budgets according to the new report. It also would provide consistent standards and compensation for services throughout the country. Shifting long-term care coverage from Medicaid to Medicare is one of the report's recommendations.
Moving more of the cost of care for so-called dual-eligibles – the 9 million Americans eligible for both Medicaid and Medicare – from Medicaid to Medicare could save states as much as $47 billion annually, say study authors from the Kaiser Family Foundation's Commission on Medicaid and the Uninsured, and researchers at the Urban Institute. A majority of nursing home residents fit under the “dual eligible” label.
Although dual eligibles make up only 18% of the Medicaid population, they account for nearly 50% of all Medicaid medical spending. The analysis can be found at www.kff.org/medicaid/7862.cfm. This report examines coverage of the nearly 9 million "dual eligible" beneficiaries, the low-income elderly and persons with disabilities who are enrolled in both Medicare and Medicaid. It explores the national and state impacts of shifting the financing of selected services for dual eligibles from Medicaid to Medicare, including having the federal government pick up the full cost of Medicare premiums, cost-sharing and gaps in Medicare-covered services and long-term care services for this population.
Posted on February 24, 2009 by Ray Mullman
Ken Connor is a lawyer and co-author of "Sinful Silence: When Christians Neglect Their Civic Duty." He is also Chairman of the Center for a Just Society. For more articles and resources from Mr. Connor and the Center for a Just Society, go to www.centerforajustsociety.org Below is his article "Old age for Sissies" which I found on the Renew America website.
"Rise in the presence of the aged, show respect for the elderly and revere your God. I am the LORD."
-Leviticus 19:32 NIV
Old age ain't for sissies — especially if you happen to be living in one of America's 15,000 nursing homes.
While there are some fine facilities for the long term care of the elderly, many nursing homes have become dangerous places for the residents who live there. I know because I have seen their suffering up close and personal. As a trial lawyer, I represent many victims of abuse and neglect in nursing homes and assisted living facilities across the country.
But you don't have to take my word for it.
A recent Department of Health and Human Services report found that 94% of America's nursing homes have been cited for violating federal health and safety standards. Perhaps even more disturbing, however, is a study by Consumer Reports that found that state regulators fined only 50% of nursing homes whose misconduct warranted fines.
Pressure ulcers (bed sores) are all too common among the elderly in nursing homes. They develop as a result of leaving a resident in one position for too long without turning or repositioning them. Pressure from a mattress or chair on a bony prominence deprives the resident's tissue of blood flow and the skin breaks down. While "bed sores" sound benign, they are not. I have seen countless pressure ulcers that penetrate to the bone. They are gaping wounds that are often infected and foul smelling as a result of contamination with urine and feces. They develop because short-handed staff frequently don't have enough time to turn or reposition residents, or even to clean them up after they have soiled themselves. Malnutrition is estimated to plague up to 65% of nursing home residents and countless others suffer from avoidable dehydration — all because harried staff don't have time to assist with feeding or to provide fluids to thirsty residents. Still others suffer broken bones resulting from falls and the lack of supervision. Often this occurs when the resident's call light isn't responded to in a timely fashion and the resident attempts to get to the bathroom without assistance in order to avoid soiling themselves.
Make no mistake about it — pressure sores, malnutrition, dehydration, and falls in nursing homes are not the inevitable consequence of old age and ill health. They are, all too often, the result of understaffing of nursing homes and the resulting inability of the staff on hand to provide the care their residents need and deserve. Shockingly, government studies show that more than half of nursing homes fall below the "minimum" staffing standard proposed by the Health Care Financing Administration (n/k/a the Center for Medicare and Medicaid Services) of two hours of care each day from certified nursing assistants, and nine out of ten homes fall below the HCFA "optimal" standard of 2.9 hours of care each day from certified nursing assistants. Iowa Senator Chuck Grassley rightly observed, "More than half the nation's nursing homes don't meet a minimum benchmark for staffing. That means residents don't get fed enough. They don't get turned to prevent bedsores. They end up in the hospital much more often than they should."
But why wouldn't nursing homes provide adequate staffing to take care of their frail elderly residents? Two words: "corporate greed," the same two words that are at the root of our current economic meltdown. You see, the largest expense of a nursing home's budget is "labor." Nursing home executives have learned that one surefire way to increase the profitability of their homes is to reduce costs by "shorting" the staff. That pumps up the bottom line. In the process, however, residents who depend on the staff for their basic needs are shortchanged.
One example from the New York Times is informative: Habana Health Care Center was taken over by private investment firms in 2002. The firms immediately cut the staff, reducing the number of registered nurses (RNs) by 50%. Budgets for care were slashed. Fifteen residents died and their families sued the home for negligent care. Regulators warned the home time and again, but received no response. These procedures are commonplace. Sixty percent of homes which have been bought out by private investment firms in recent years have cut their number of RNs, sometimes to illegal levels.
The offending nursing homes often try to conceal their perfidy by falsifying patients' charts. In an attempt to deceive state inspectors about the level of care being delivered, nursing homes frequently host "charting parties" where staff will hastily fill in blanks in patients' charts. The result is that they often chart care as having been given on non-existent days (February 31), or after the resident is dead, or, perhaps, before the resident was even admitted to the facility. Sometimes, they will chart care as having been given despite the fact that the identified care giver wasn't at work (a review of the employee time cards reveals this fraud). Such actions no doubt account for John T. Bentivoglio's statement in the Washington Post on February 4, 2000 that, "A number of high flying nursing home chains appear to have incorporated defrauding Medicare as part of their business strategy." At the time he made that statement, Mr. Bentivoglio served as Special Counsel for Health Care Fraud at the Justice Department. His statement is no less true today than when he first uttered it.
Lamentably, there is little media coverage of elder abuse. Perhaps that's because much of it goes on behind the closed doors of nursing homes. Perhaps it's because our culture is obsessed with youth and no one wants to contemplate getting old. Or perhaps it's because we simply devalue the elderly — after all, many of them have substantially degraded mental and physical abilities. For whatever reason, no one seems to pay much attention to elder abuse these days.
The Ethics and Public Policy Center is a rare exception. It recently acknowledged that elder abuse is on the rise: "According to a National Center on Elder Abuse survey, more than 565,000 cases of suspected elder abuse were reported in 2003 — an increase of nearly 20 percent from 2000." But, mark it down: things are only going to get worse. The perfect storm is brewing. A massive age wave has begun. The over-65 population will more than double between 2010 to 2040. The leading edge of the Baby Boomers is approaching retirement age. Huge numbers of Boomers will need nursing home care. They will overwhelm existing capacity, and they will do so at a time when America's old age entitlement programs are on the verge of collapse. In 2017, Social Security's cash flow is projected to go negative, and in 2019 Medicare is slated to go broke. Meanwhile, our national consensus has shifted from a sanctity of life ethic to a quality of life ethic. The elderly suffering the ravages of time — strokes, dementia, disability — do not score well using quality of life calculus. It will become easier to view them as "disposable" when they cost more to maintain than they produce.
Americans need to wake up to the implications of what it means to become a mass geriatric society. Individuals need to prepare now for the years when they will live in decline. Families must prepare to assume a greater role in caring for their aging loved ones. The church must acknowledge that the elderly are part of the "least among us" and reach out to lend a helping hand. Government needs to get its head out of the sand and prepare for a crisis that will make Hurricane Katrina look like a walk in the park. And the nursing home industry must mend its ways and be held fully accountable whenever it abuses, neglects or exploits those it has agreed to care for.
We all have a stake in averting this crisis. Only the dead don't grow old.
© Ken Connor
Posted on February 23, 2009 by Ray Mullman
Seattle Post Intelligencer had an article about the recent increases in evictions in nursing homes.
Contact the Washington Long-Term Care Ombudsman program, call 800-562-6028, or visit ltcop.org/index.htm if you need help. The article reveals one example where a woman was evicting and died shortly after being evicted. Henderer grew depressed and refused to leave her room for meals. As her move approached, she quietly asked her guardian: "Why can't I just die here?" Three days after moving out, Henderer's congestive heart failure worsened. A month later, she died.
Health care costs rise (along with corporate profits) despite Medicaid rates not increasing. Quality of care gets compromised and nursing homes are forcing out sick, elderly and frail residents who cut into profits because they are too expensive to care for. No official data exist on eviction counts, but discharge complaints have climbed to record highs.
The Washington Long-Term Care Ombudsman program handled more than 700 such complaints last year, nearly a 50 percent increase over the year before. Nationally, discharge-related complaints have more than doubled in a decade -- to 12,000 in 2007, according to the U.S. Administration on Aging.
Another woman evicted from West Woods wandered outside one night before her move, barefoot and in a nightgown, saying she wanted "to fall down and die in the cold," Ryan said.
In Grays Harbor County last year, an evicted mentally ill man left his boarding home a week after moving in, and was found dead near some railroad tracks. In other areas, evicted residents have ended up in homes nearly a hundred miles away from loved ones.
In 2007, Seattle University forced out 115 residents when it decided to convert its nursing home into office and class space. Three months later, 14 of the residents had died.
Social workers have a name for such a swift decline after a move: "transfer trauma."
Homes can legally evict a resident who fails to pay, becomes dangerous or has needs a home can't meet. Federal law bars nursing homes from kicking out residents solely because of Medicaid so they often find some other excuse. Advocates say many homes find ways to bend the laws such as the broad "can't meet needs" reason to force out difficult or expensive residents.
One of the most common types of eviction is when homes send a resident to the hospital and refuse to take him back, in a practice that resident advocates call "dumping." Advocates say that dumping rarely occurs to private-pay people, but to Medicaid residents such as Florence Wade, who had lived at the Regency at Tacoma Rehabilitation Center for roughly three years.
In January, Wade, 85, went to the hospital for pneumonia and a urinary tract infection. The nursing home refused to take her back, saying she had been uncooperative with caregivers in using a hydraulic lift to move her. The home then accused her of not doing a "bed hold" -- which she never had to do in the past -- and said the room was gone anyway. Someone else had moved in. The eviction left Arnold with one stressful option: a nursing home 45 minutes away -- too far for regular visits from friends and family.
With assisted living costing residents $3,000 to $6,000 a month, and nursing homes costing up to $10,000 a month, homes still claim they lose money on each Medicaid resident. On average the state pays out about $5,000 a month for a nursing home resident,
Posted on February 21, 2009 by Ray Mullman
San Mateo County Times reported that a caregiver at a Menlo Park nursing home accused of stealing the checkbooks of two elderly residents in an embezzling scheme was sentenced in San Mateo County Superior Court to only six months in jail.
Ramil Panlaqui pleaded no contest to three felony counts of financial elder abuse in a deal with prosecutors that limited his punishment to two years in prison. He had been facing up to 10 years in prison on multiple felony counts, including residential burglary and elder abuse.
Panlaqui, who worked at Atherton Healthcare, stole the checkbooks of an 88-year-old resident and a 75-year-old resident and then wrote multiple checks from one victim's account to the other's before withdrawing the transferred money from the second account. After Panlaqui's arrest, authorities found a completed check from a third victim, according to prosecutors.
In addition to his six-month prison sentence, Panlaqui was ordered by a Superior Court judge to serve three years' probation. He must also reimburse Wells Fargo and the Bank of America to replace the money stolen from the checking accounts.
Posted on February 20, 2009 by Ray Mullman
The Chicago Tribune had a well written and tragic story on the living conditions in a one star nursing home. The articles discusses numerous and disgusting incidents of neglect that injured residents both physically and psychologically.
Dozens of health violations were documented last year on a single inspection of the Berwyn Rehabilitation Center, contributing to its dubious distinction as one of the area's worst nursing homes in the area. The federal government is now rating nursing facilities on a 1 to 5 star system. Although conditions at one-star homes are startling, what is perhaps more alarming is their prevalence: About a quarter of U.S. nursing homes, including 81 in the six-county Chicago area, received one star.
The Tribune obtained the most recent inspection reports for the area's lowest-rated homes through a Freedom of Information Act request. The conditions described are grim and, at times, deadly—as the Berwyn facility demonstrates.
Inspectors found workers were improperly using side railings on beds. Four months later, records show, a 53-year-old obese resident suffocated when he got stuck between the mattress and side rails. Illinois fined the facility only $50,000 for the death, one of the largest nursing home penalties in the state last year.
According to records, all major violations found during the annual inspection last March had been corrected as of June. But the man who suffocated did so in July—weeks after new management took over.
One-star nursing homes meet minimum standards but are considered "much below average," according to the federal rating system. Inspection reports of those facilities show the daily despair many residents face.
Residents in most nursing homes complain of cold or tasteless food, staff not answering calls for help, loud employees keeping them up at night, and workers not relaying phone messages from family members.
Residents say that when they voice concerns, staff respond at times by pointing to the cemetery across the street. State investigators cited the nursing home, concluding that residents could not speak up without fear of reprisal. Almost all the patients lay in their beds, sleeping or watching TV. The vast majority of the residents can't walk and are incontinent.
This is a great article for anyone who wants to know about the care provided in many nursing homes throughout this country using our tax money.
Posted on February 13, 2009 by Ray Mullman
The Dallas News had an article about the new "Green" nursing homes that have been built. The article explains how these new homes have changed the resident's attitudes about being placed in a nursing home. Residents and family members report other "miracles" at Holly House and its sister nursing home, Hawthorne House, which Dallas-based Buckner Retirement Services Inc. opened amid considerable public attention one year ago.
Holly House and Hawthorne House were Texas' first Green Houses – small homelike facilities where 10 residents, or elders, receive the full range of personal care and clinical services found in a conventional nursing home. The two Green Houses in Longview are at the vanguard of a national movement to reinvent the traditional nursing home so that it looks and feels less like a hospital and more like a home where the frail and elderly can live and thrive.
Fifty homes have opened in 12 states, and 130 are under development. Forty-two senior-care organizations are building the houses with technical assistance from NCB Capital Impact, a nonprofit group.
"Our Green Houses are the best thing we've ever done," said Pearl Merritt, president of Buckner Retirement Services, a nonprofit agency that traces its roots to the mid-19th century. "They have exceeded our expectations in every respect."
Merritt says Buckner plans to build similar homes elsewhere in Texas and is studying the feasibility of operating several Green Houses as part of a larger retirement development in North Dallas. Most of the elders at Buckner's two ranch-style homes in Longview had lived elsewhere on the agency's Westminster Place retirement campus there, and the rest had moved from their homes or other nursing facilities in the area.
Since settling in at the Holly House and Hawthorne House, the elders have slept in their own bedrooms, eaten home-cooked meals and enjoyed each other's company, much as the members of any family would.
At the same time, the Green Houses are licensed skilled-nursing care facilities. Residents remain under the watchful eye of a care team that includes a physician, registered nurse, licensed vocational nurse and nurses' aides.Many families say they've seen improvement in their parents' physical health and mental alertness over the last year.
The elders' improved health isn't so much a miracle as the result of a close-knit team of caregivers who know their seniors better than they could in a conventional nursing home, said Green House administrator Debby Burgett. I wonder why all nursing homes are not required to give this level of care.
Some nursing professionals have questioned whether the Green House movement, with its emphasis on a home atmosphere, compromises the quality of the residents' health care. Barbara Bowers, a nursing professor at the University of Wisconsin-Madison, visited Buckner's homes in Longview and concluded that, if anything, the nursing care is better than in a conventional nursing facility.
"Things don't get overlooked at a Green House, as they might be in a nursing home, where caregivers don't work so closely with each other. If an elder stumbles at a Green House, every caregiver knows it and starts watching that person," she said. Shouldn't this be the standard and not the exception?
Bowers' research has been underwritten by the Robert Wood Johnson Foundation, which is encouraging the development of Green Houses and studying their viability. Of all the challenges facing Green Houses, the toughest is to become financially viable, experts say. For the homes to become a practical alternative, they can't cost too much to build and operate and can't charge more than many older adults can afford. Otherwise, they'll occupy just a small niche of the nursing home industry. Buckner spent $3 million to construct its two Green Houses, about what it would have spent on a conventional nursing home with private rooms. During the first year, the Longview houses charged $165 per day, comparable with what most nursing homes with private rooms cost.
Posted on February 12, 2009 by Ray Mullman
The Chattanooga Free Times Press had a great article discussing the need to make long term care a priority since baby boomers will begin entering facilities soon. I think it should have been a priority for the last 20 years since elderly people who need health care are the most vulnerable members of the citizenry.
The article emphasizes the need for more efficient and less costly long-term care services because as baby boomers age and require more specialized care, there will be greater need for quality services. 10 million Americans need long-term care and that number will grow in the coming years. Health care providers, educators, advocates for the elderly and lawmakers gathered at Blood Assurance in Chattanooga for a discussion focused on long-term care reform.
The number of U.S. geriatricians is far too small to handle the coming flood of people who will require geriatric care, said Dr. John Standridge, director of the geriatric fellowship program at the University of Tennessee College of Medicine in Chattanooga. “At a time when we are adding 75 million more children of the World War II generation to our geriatrics population, the (number of) people that are adequately trained in geriatric syndromes is falling by leaps and bounds,” he said.
Legislators should create incentives for students to go into geriatrics. Elder care issues also affect acute care hospitals. Hospitals often house many elderly patients who can’t be discharged because there are no community-based support services that can take care of them.
Posted on February 11, 2009 by Ray Mullman
The New york Times recently how an article about the draconian changes to Medicaid rules. The article explains how in the past federal law protected married couples from having to choose between divorcing or becoming impoverished when one spouse needs expensive nursing home care, allowing the healthier spouse to retain assets and income while the sicker one’s care is covered by Medicaid. However, the Bush Administration changed those rules for those who are sick but still able to live at home. The federal government has ruled that New York has been too generous in applying the income protections to people at home, forcing several thousand couples to make a stark choice by March of this year.
“They’re saying if you put your spouse in a nursing home, you’re going to get to keep more income than if you keep your spouse out of a nursing home,” said Mark L. Kissinger, deputy commissioner of long-term care for the state Health Department. “That’s completely opposite to public policy and research of the last 10 years.”
Congress in 1988 passed a law intended to protect healthy spouses with lower incomes and fewer independent assets from being reduced to poverty by their better-off spouses’ need for long-term care. For 2009, federal guidelines allow the couple to keep up to $2,739 a month in combined income and $109,560 in assets not including a home or car and still have Medicaid take care of the nursing home costs.
The federal Centers for Medicare and Medicaid Services sent a letter to state health officials in the fall of 2008 outlining a legal ruling that declares that couples in which both partners live at home are not entitled to the same protection. The state Health Department estimates that 3,000 couples — out of 30,000 people in the long-term home-care program — are affected by the change, because the healthy spouse depends on the sick spouse’s income to survive; advocates for the elderly say the number is closer to 4,000.
Claudia Hutton, a spokeswoman for the state Health Department, said that New York wanted to keep the home health care program the way it was, and that any talk of changing income criteria was a “smokescreen” to gut the program.
“The Bush administration is trying to pull the rug out from under thousands of seniors in New York who depend on this critical program year in and year out just to survive,” Senator Charles E. Schumer, a New York Democrat, said in an e-mailed statement before this week’s transition.
Advocates say that the federal interpretation makes little sense. “The root of their interpretation is that Congress wanted to give states the option of extending these protections, but only to those whose incomes are so low that they would have no income to share with their spouse,” Ms. Bogart said. “It would be so absurd that no one would ever qualify.”
Posted on February 9, 2009 by Ray Mullman
I wanted to follow up on an entry from a few weeks ago discussing the benefits and merits of allowing residents pets after I read this article from the Daily Record. The article reiterates what I had thought and written about how pets can alleviate depression and give companioship to lonely residents. The article mentions how happy and positive the animals make the residents.
While rules regarding pet visits or ownership vary according to facility, a daily dose of wagging tails, purrs or even squawks has proven an overall boon to residents and staff alike. "Having a pet around is soothing," said Valerie Dalia, marketing director of Victoria Mews in Boonton. "Their presence is relaxing." Upon providing documentation that shows animals are up to date on vaccinations and shots, family members are then permitted to bring pets in for frequent visits.
Meanwhile, the Beverwyck House of Merry Heart in Parsippany boasts a cat, while birds of a feather flock at the nursing home in Succasunna, right alongside a fully stocked fish tank. "It's always helpful to have an animal around," said Blanche Banifacio, owner of Merry Heart. "There's something in the animal that can sense pain."
"Animals are all-accepting. They don't care about whatever issues a person might have," said Noralyn Snow, administrator at the Silverado Senior Living Aspen Park Community in Salt Lake City, home to 100 memory-impaired residents, seven dogs, six cats, 40 birds and a baby kangaroo named Marlee who can coax a smile out of even the most recalcitrant senior. "And having pets around adds excitement and spontaneity."
"People grow up with animals, have had them all their lives, and this is their home now, so why wouldn't they have pets here?" said Helene King, communication coordinator for Levindale Hebrew Geriatric Center and Hospital in Baltimore, one of 300 facilities worldwide operating under the "Eden Alternative" philosophy, which integrates animals, plants and contact with children into daily routines to keep the elderly engaged. "It makes such a big difference in their lives."
Until recent years, most administrators took a dim view of the notion of animals living in such facilities. There were concerns about allergies or people tripping over animals; worries about bites and scratches; and much consternation about the insurance implications. Turns out that if well-managed, there's nary a problem.
Posted on February 2, 2009 by Ray Mullman
I have been doing research lately on the effect of animals on relieving depression in the elderly. Many nursing homes have cats and dogs live with or visit the residents. I think it is a great idea. (As long as you know which residents are allergic.) I ran across this article recently. The story is about the River Chase Village nursing home in Mississippi, and the pets who share the nursing home. The idea stems from the Eden Alternative philosophy. Six four-legged, furry residents of River Chase Village have the run of the 60-bed nursing home as part of a plan to empower the two-legged residents, said Nate Payne, administrator.
"They have needs, one of them being caregiving," Payne said of the residents. The three dogs and three cats that live at the home provide that opportunity for caregiving, he said. Isbella Sharp, a resident who cares for cats Lance and Crisco, said the animals are wonderful. "They make you feel like you are at home." The animals also help residents take their minds off their personal troubles, she said. "They are thinking about petting a dog or cat."
The philosophy extends to other areas, and the residents are included in making decisions from menus to hiring employees, he said.
"With the animals here, loneliness is out the window," Payne said. Taking care of an animal can alleviate feelings of helplessness, he said.
"Boredom well, you know, if you can get over there and rough Flip up and make him have a dogfight with all the rest of the animals, and watch that for 10 minutes in the morning, what a way to start the day. You can't be bored when Flip is going to sit by you with that goofy look of his."
Payne said the conflicts between humans and animals are minimal. "Animals know who likes them and who doesn't. That's the common question: 'What about the people who don't like animals?' Animals won't go around you if you don't like them. They are quick to pick up on that."
Ocean Springs veterinarian Matthew Roth said, "There are a lot of well-known health benefits having animals around." Among those benefits can be lower blood pressure, less stress, and less depression, he said. "The health benefits are definitely enormous," he said. However, people with weakened immune systems have to be careful or avoid close contact with animals, he said.
The animals at River Chase Village are screened for their temperament, and each has a medical care plan, Payne said.
Posted on January 31, 2009 by Ray Mullman
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.
Posted on January 24, 2009 by Ray Mullman
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.
Posted on January 20, 2009 by Ray Mullman
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.
Posted on January 18, 2009 by Ray Mullman
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.
Posted on January 16, 2009 by Ray Mullman
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
Posted on January 14, 2009 by Ray Mullman
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.
Posted on January 8, 2009 by Ray Mullman
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.
Posted on January 6, 2009 by Ray Mullman
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.
Posted on January 4, 2009 by Ray Mullman
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.
Posted on December 29, 2008 by Ray Mullman
The NY Times had an article recently discussing how the nursing home industry is concerned about the new rating system for nursing home facilities. The industry is concerned because 22 percent of the nation's nearly 16,000 nursing homes received the federal government's lowest rating in a new five-star system, while only 12 percent received the highest ranking possible.
Under the new rating system, a facility could obtain up to five stars based on criteria such as staffing and how well they fared in state inspections. The lowest ranking possible was one star. Kerry Weems, acting administrator for the Centers for Medicare and Medicaid Services, said the agency was merely taking existing data already on the agency's Web site and making it easier for patients and families to evaluate a nursing home. ''This should help consumers in narrowing their choices, but nothing should substitute for visiting a nursing home when making a decision,'' Weems said.
Under the new system, five stars means a nursing home ranks ''much above average,'' four star indicates ''above average,'' three means ''about average,'' two is ''below average'' with a one indicating ''much below average.'' The rankings will be updated quarterly. Of course, these ratings are based on how well the State investigates complaints and conducts surprise inspections. In South Carolina, DHEC is so poorly funded, and investigators are so poorly trained, that many violations are not recognized or complaints investigated. DHEC hardly ever finds any nursing home complaint substaniated.
The ratings are based on three major criteria: state inspections, staffing levels and quality measures, such as the percentage of residents with bed sores. The nursing homes will receive stars for each of those categories as well as for their overall quality.
Consumer groups note potential problems with the data. For example, the staffing data is self-reported just before state surveys and is widely recognized as unreliable.
''From a consumer viewpoint, it's not stringent enough,'' said Alice H. Hedt, executive director of the National Citizens' Coalition for Nursing Home Reform. Hedt said consumers should consider the star ratings, but not solely rely on them when comparing facilities. Her organization also warned that nursing homes may appear in the ratings to give better care than they actually do.
CMS used three year's worth of inspections to rate nursing homes based on an annual survey designed to measure how well homes protect the health and safety of their residents. The measurement for staffing reports the number of hours of nursing and other staff dedicated per patient each day. The measurement for quality looks at 10 areas, including the percent of patients with bed sores after their first 90 days in the nursing home and the number of residents whose mobility worsened after admission.
Industry officials said surveys conducted in some states are stricter than others, so they cautioned against using the new ratings to conclude that one state's nursing homes were better than another's.
Posted on December 24, 2008 by Ray Mullman
The State Journal-Register of Illinois had an interesting article about how most nursing home deaths are not investigated. This comes as a surprise to many families and violates the state and Federal regulations stating that incidents should be investigated to determine cause. The nursing homes generally do not want deaths investigated because the investigation would show that neglect was a contributing cause of the resident's death.
Many county coroners believe Illinois should pass a law requiring nursing homes to notify coroners whenever one of their residents dies so the circumstances can be investigated for potential abuse or neglect. But even after a yearlong pilot study involving 10 Illinois counties, it doesn’t appear that such a mandate is any closer to reality.
Public Health, which doesn’t know how many Illinoisans die in nursing homes each year, this summer completed a yearlong pilot project in 10 Illinois counties — including Morgan — to determine whether such a policy should become the standard. State officials and the Illinois Coroners and Medical Examiners Association don’t plan to lobby for legislation to require that nursing home deaths be reported and investigated.
Only the states of Arkansas and Missouri require all nursing-home deaths to be reported to local coroners for potential investigation. The Arkansas law piqued the interest of the Illinois Department of Public Health. Public Health spokeswoman Melaney Arnold said state officials will leave the option of proposing legislation to the coroners association.
Lake County Coroner Dr. Richard Keller said they would like to see a law passed, regardless of financial concerns and statistics. Uncovering suspicious deaths in nursing homes is part of a coroner’s job, regardless of whether it’s specifically outlined in a new law, he said.
Brigit Dyer-Reynolds, a Springfield-based long-term-care ombudsman who advocates on behalf of nursing home residents, said people in nursing homes would benefit from a death-reporting law.
Even in the state’s largest counties, including Cook, coroners and medical examiners often look into nursing home deaths only after they receive complaints from family members or if criminal activity is suspected. McHenry County Coroner Marlene Lantz said she asks all nursing homes in her county to report deaths to her, but some facilities refuse. She said a state law that both requires nursing homes to report all deaths and also includes funding for investigations would be a big help.
Posted on December 17, 2008 by Ray Mullman
The Milwaukee-Wisconsin Journal Sentinel had an interesting article about Bruce Bowman. He was a resident at a nursing home facility who was given Risperdal, an anti-psychotic medication. Normally it is used to control agitation and aggression but many nursing homes use it and other medications as a chemical restraint to "quiet" the residents.
Mr. Bowman had adverse reactions to the Risperdal. These reactions were well known to his health care providers but the nursing home never warned the family of any possible side effects. Mr. Bowman's throat swelled up. His body went rigid. He got pneumonia from lack of mobility. The once strong former logger withered away. Two weeks before he died June 19, Bowman weighed only 112 pounds.
Six months before he died, Bowman was given Risperdal by the nursing home. his children insist they were never told by the nursing home staff that Risperdal has a black-box warning that reads: "Increased mortality in elderly patients with dementia-related psychosis." They didn't know that in clinical trials for Risperdal, most patient deaths occurred from cardiovascular or infectious complications, such as pneumonia. The drug's listed side effects also include vomiting, weight loss and muscle stiffness, among many others.
"I'd never give any kind of consent for any of that," said Martin Bowman, Bruce's son, who was the legal guardian of his father's care and needed to approve any changes in medication.
The black-box warning for Risperdal was issued by the Food and Drug Administration in 2005. The drug is only approved for use in people with schizophrenia, bipolar disorder and some irritability associated with autism. Martin Bowman never saw that warning because the nursing home was using 7-year-old medication consent forms, Public Investigator found.
The old forms didn't have the paragraphs of warnings about Risperdal because the warnings hadn't been issued in 2001, when the forms apparently were printed. The nursing home should have downloaded an updated form from the state Department of Health Services Web site.
Anti-psychotic drugs often are prescribed to elderly patients with dementia to control their agitation and outbursts. Many researches believe that anti-psychotic drugs are overprescribed to subdue nursing-home patients. The consequences can be deadly.
Many nursing homes use medications as a restraint so they can save money on staff. The less vocal a resident is or the more they are asleep, the less the staff has to do for them. Nurses are happy because of less work, and the corporation who owns and operates the facility gets more profit.
Posted on December 14, 2008 by Ray Mullman
Bamberg County Council has given approval to a contract for the purchase, sale or lease of the Bamberg County Nursing Center to UHS-Pruitt Corp., a Georgia company.
The council, in a meeting Monday with the Hospital and Nursing Center Board, approved first reading of the contract which outlines the "conveyance of nursing home property and assets" to Toccoa, Ga.-based UHS-Pruitt Corp.
The county council at a Nov. 3 meeting approved a letter of intent with UHS-Pruitt to continue negotiations on all of its options in paying for hospital renovations, including the use of funds from the potential sale of the nursing center. UHS-Pruitt has already applied for a certificate of need from the S.C. Department of Health and Environmental Control. CON applications provide details about the particular need for a project. UHS-Pruitt is estimating the total cost of the project at $5,076,000.
Sara Maret, health planner for UHS-Pruitt, said state law required the company apply for a certificate of need for the nursing home project. Public notice of the application is also a state DHEC requirement, she said.
"They (Bamberg County) put the Bamberg Nursing Home up for sale because they wanted it to be a separate entity from the hospital," said Maret, noting that the company put the details of its application out so that pricing suggestions could be made and to show why the company "would be the better company" to purchase the nursing center.
Dobson-Elliott said the county itself has not published an amount for which the nursing center could potentially sell.
"It's a moving target. We've pulled all sales of nursing homes and like facilities in the state. When you break it down comparing size and when it was built, the numbers we're talking about are very good," she said.
Posted on December 11, 2008 by Ray Mullman
The Chicago Tribune recently had an article about how politicians are bought off by the nursing home lobbyists and their substantial campaign contributions. This is one of the reasons why health care should not be a for profit business. Lawmakers receive thousands of dollars in contributions every year from the nursing home industry. In return, the industry makes sure that staffing is kept low, no insurance is necessary, and no oversight by the State is effective.
Among the contributors is Tim Boyle, the owner of Grinnell’s Friendship Manor, who serves as the president of the board of the Iowa Healthcare Association, a lobbying organization that represents nursing homes. There were 12 legislative fundraisers during one week last year that were held by the Iowa Healthcare Association. 11 of the fundraisers were held at Iowa nursing homes. The other was held at Boyle’s South Dakota home, and was for Rep. Christopher Rants, R-Sioux City, then the minority leader of the Iowa House. Rants collected 15 checks totaling $3,090, according to state records.
Boyle, whose Friendship Manor is facing a $112,650 federal fine for alleged neglect of an elderly woman, has complained to lawmakers that the Iowa Department of Inspections and Appeals is "overly aggressive" in policing the state’s nursing home industry.
The newspaper reported that the Iowa Healthcare Association in March provided Iowa’s care facility administrators with a fill-in-the-blank letter that could be given to residents forward to lawmakers.
It read, in part:
“(NAME OF FACILITY) is dedicated to providing the best care. … Increasing fines by the Iowa Department of Inspections and Appeals (DIA) are cutting into the funds that nursing homes have to put toward providing care. … (NAME OF FACILITY) will either be forced to close or increase my rates. I do not want to be forced to move into another nursing home. …”
Of course, this letter is an outright lie. The nursing home industry makes plenty of money. Just look at their stock prices. Demand is high and supply is low. Nursing homes are certainly making enough profit to waste thousands of dollars on lobbying politicians every year.
Posted on December 10, 2008 by Ray Mullman
Andrea Pitzer wrote a great article about PACE for USA TODAY. Program of All-Inclusive Care for the Elderly (PACE) tries to keep people who are eligible for nursing home care living independently in the community. PACE patients at the center — almost all of whom qualify for both Medicare and Medicaid--are supported by a coordinated medical team that the federal government hopes will cut costs and improve life for the elderly.
According to the National PACE Association, there are 16,000 patients in PACE nationwide. The average client is 80 and takes eight prescription medications. Participants have to be 55 or older, certified by their state to need nursing home care and be able to live safely in the community.
Each program receives a fixed amount per person from a patient's state Medicaid program — usually 85% to 90% of estimated nursing home costs. Medicare funds come through a risk-adjusted formula in which the program receives more for sicker enrollees.
PACE becomes both the patient's insurer and care provider and is obliged to pay for all of the patient's medical care from the point of enrollment forward.
PACE's dual role allows for flexibility in using the money from the federal government. Part of the idea is that thorough preventive care can prevent more serious conditions and reduce hospitalizations.
Started in the 1970s as a community project to keep elders in their homes, today PACE provides a ride back and forth to its centers for day-care activities and medical appointments. Along with the nutritionist, social worker, psychologist, activity director, nurses' aides, nurse practitioner, doctor and others, the driver is a part of the health care team that meets daily. The clinical staff members also hold group meetings at least twice a year with each patient.
Because the amount received for an individual is fixed, says Shawn Bloom of the National PACE Association, the program has every incentive to keep patients as healthy as possible. "If we provide good care," Bloom says, "we control costs."
Continue Reading...
Posted on December 8, 2008 by Ray Mullman
The Denver Post had an interesting article about new developments in elder care. Facilities are trying to move away from institutional settings and make resident's stay feel more like home.
The article states that "a generation of retirees resists the fate of nursing homes they've grown to dread, supporters of a cultural revolution say they are reforming an industry long tainted by images of neglected patients languishing on soiled sheets".
Reforms will likely quicken in the next year as Colorado begins sending higher Medicaid payments to homes that make changes ranging from reducing bed sores to giving residents a peanut-butter sandwich on demand. Critics of traditional nursing- home care are not ready to declare lasting success. Reforms at a given home too often depend on the energy and dedication of a few key staff members, and those changes are difficult to replicate in more than 16,000 nursing homes nationwide.
"In general, the quality of nursing-home care is really bad," said Charlene Harrington, a professor of sociology and nursing at the University of California at San Francisco who has studied national reforms. Truly improving care almost always requires increasing staff, she said.
"There's some basic merits to the idea of the culture-change movement," Harrington said. But "the nursing-home industry is trying to promote the idea you don't need the staff; you just change the culture. That's why I'm skeptical of the whole effort."
"The heart of it is just treating people the way you want to be treated," said Barbara Moore, administrator of Bruce McCandless Colorado State Veterans Nursing Home in Florence. Once entrenched in a notorious state nursing system, McCandless has won kudos for trying everything from consistently matching staff with the same patients to parking a Patton tank outside for grandkids to climb on.
Promotion of culture change or comparable reforms is vital for baby boomers who want to avoid mass warehousing in the coming decades. The U.S. population 65 and older will jump from 40 million in 2010 to 55 million in 2020, according to the federal Administration on Aging.
The vulnerable population 85 and older, meanwhile, will need many new care beds, with the population in that oldest group rising from 6.1 million to 7.3 million that same decade.
By all accounts, they want to avoid the nursing homes of their parents' day.
Another Medicare and Medicaid report in September said that more than 90 percent of U.S. nursing homes were cited for violating federal standards in the past three years, but those transgressions can range from improper food storage to acute medical problems.
Caring for the elderly, meanwhile, consumes a good share of the state budget.
In Colorado and across the country, nursing-home occupancy rates are flat or dropping even as the population ages. More families are keeping aging relatives at home, hiring home-health aides, or choosing newer and smaller assisted-living sites for patients who don't need extensive medical care.
Culture change can be as varied as adopting a cow for a pet or building a $1 million adapted home from the ground up to house only six residents — but the basic tenets across the country are consistent:
• Breaking from institutional schedules and rules in which residents must eat at common times or take showers at a rigid hour set by the staff.
• Training staff in resident-centered care and reassigning employees to more-consistent jobs.
• Some attempt to alter the physical monotony of nursing-home settings dominated by institutional 1960s and '70s architecture. Larger homes may parcel themselves into "neighborhoods;" others renovate with resident input on colors and materials; still more add gardens, meditation rooms or restaurant-style dining areas.
A national survey of the transformation of nursing-home culture found that 31 percent of homes had adopted significant portions of the movement. The results "indicate a hopeful picture about the potential for deep, systemic change within the industry," according to the Commonwealth Fund.
Proponents believe the new state reimbursement system for Medicaid will eliminate any reason not to participate in the changes being made. Culture change is not more expensive in the long run — it can save on staff turnover, food costs and expensive acute care. But for managers concerned about immediate costs, the state program to come on line next summer offers immediate financial rewards.
Nursing homes will earn points for quality of medical care, satisfaction of patients and their families, and culture-change tenets like consistent staffing and resident-controlled decisions. A home that scores 100 points will receive $4 more per Medicaid patient per day (on top of the current Medicaid rate of about $178 a day).
Medicaid pays for about 63 percent of nursing-home residents; the new payment system will mean, for example, that a high-scoring home with 70 Medicaid patients could earn an extra $8,400 a month. The first year of the program will cost $4 million, half coming from the federal government and half from a new fee charged to all nursing homes.
Posted on December 5, 2008 by Ray Mullman
McKnight's had an article about the increased use of advance directives. Many of our clients feel pressured into signing these directives. I believe it is a way for the nursing homes to avoid liability. When the nursing home neglects a resident or fails to deliver timely care and the delay in treatment causes a wrongful death, the nursing home points to the advance directives as a way of explaining their negligence. most CNAs and LPNs do not understand the purpose of advance directives. They believe that advance directives allows them to ignore the condition of the residents and permits letting the resident suffer and die in cases where simple treatment could have avoided the death.
The article states that advance directive documentation is on the rise in the nation's nursing homes, according to a recent report from the Institute for the Future of Aging Services, a research arm of the American Association of Homes and Services for the Aging.
Nearly 70% of all nursing home residents over the age of 65 have at least one advance directive document in their records. That is up from 53% in 1996, according to the report. The documents were more common for married, white and female residents.
Advance directives provide written documentation of a patient or resident's end-of-life choices. "Both residents and families must continue to engage in the discussions needed to accurately document end-of-life choices," said Helaine Resnick, Ph.D., director of research at IFAS, adding that providers, as well, must continue to stress the importance of advance directives.
Posted on December 2, 2008 by Ray Mullman
RITE AID TO HOST LIVE, ONLINE CHATS FOR CAREGIVERS DECEMBER 3 AND 4
Chats Feature Expert Advice from Geriatric Experts and a Rite Aid Pharmacist, Provide Online Network of Support for Caregivers
Camp Hill, PA (December 2, 2008) – On December 3 and 4, Rite Aid will host two free, live online chats to help caregivers find solutions to everyday problems and answer common caregiver questions. To participate in the online chat, caregivers must register online at www.giving-care.riteaid.com. Questions also may be submitted by email prior to the event by sending an e-mail to expertevent@riteaid.com. Caregivers who are unable to participate in the event can view and print a transcript online after the event. Additional events will be available on the Web site as they are scheduled.
On Wednesday, December 3, from 12-1 p.m. EST, Attorney Vincent J. Russo, ESQ, will answer questions on elder law, special needs and estate planning. Elder Care Expert and Geriatric Care Manager Dr. Marion Somers, PhD, will discuss topics ranging from home safety to senior-friendly technology.
On Thursday, December 4, from 12-1 p.m. EST, Susan Strecker Richard, editor-in-chief of Caring Today, will offer advice on how to care for loved ones without sacrificing your own wellbeing and answer general questions on caregiving. Rite Aid pharmacist Natalie Teaff, R.Ph, will answer questions on medications, therapies and medication interactions.
The chats are part of Rite Aid’s “Giving Care for Parents” program that launched in September. The program includes a 20-page Caregivers Guide offering hints on financial planning and strategies for balancing careers and personal lives, especially when living with loved ones. It also has information on support groups, programs and resources such as medical facilities and businesses catering to seniors and caregivers.
At www.riteaid.com, caregivers can click on “Giving Care for Parents” and find a collection of helpful articles written by industry experts, frequently asked questions, drug information counseling and educational videos showing actual caregivers and elders as they deal with real situations such as dementia, long term care and nutrition.
Rite Aid Corporation is one of the nation’s leading drugstore chains with more than 4,900 stores in 31 states and the District of Columbia with fiscal 2008 annual sales of more than $24.3 billion. Information about Rite Aid, including corporate background and press releases, is available through the company’s website at http://www.riteaid.com.
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Posted on November 17, 2008 by Ray Mullman
U.S News and World Report had an article about the difficulties of caring for an elderly loved one. Journalist Gail Sheehy writes about navigating through the U.S. health care system during her struggle to care for her gravely ill husband.
More than a year ago, her husband, publisher Clay Felker, was being discharged from a New York City rehabilitation facility after spending several months there in his long battle with throat cancer. "So, he has to come home now, and we've run out of benefits," Sheehy recalled at a recent media briefing in New York City. "We're coming out, and there's also nobody telling me what I have to do. He has a feeding tube, he has a tracheotomy, he has medications. I don't know where to start."
Desperate, she sought out and hired a "geriatric care manager" -- at $125 an hour -- to advise them. Their insurance might still pay for an at-home nurse, she found out, but only if it's a Medicare-approved nurse -- and there aren't any available in the city.
There are home health-care aides, of course, "but they cannot do medical services like giving a shot, taking care of a trach, changing a feeding tube," Sheehy said.
Once private insurance benefits end, the only option for most Americans is Medicaid, which requires that recipients have less than $5,000 in assets.
Her geriatric care manager spelled it out to Sheehy: If the couple first exhausts all their remaining assets, then Medicaid will cover Felker's nursing care.
And if Sheehy, in her late 60s, wasn't willing to give up all her assets and income?
"Then, you need to divorce him," the geriatric care manager told her.
In Sheehy's case, it never came to that. She and Felker scraped together enough money to hire qualified, in-home caregivers and Felker's last months were spent at home, relatively serene. He died in July at age 82.
Sheehy called her 15-year journey with Felker through the U.S. health care system a "nightmare," and she wonders how less affluent and well-connected Americans are faring.
U.S. Census figures project that the number of Americans 65 or over will double by 2030, and that two-thirds of today's 65-year-olds will require some period of long-term care later in their lives.
At the same time, the number of geriatricians has actually declined in recent years, to about 7,750: that translates to one for every 4,254 older Americans. In addition, it's projected that the country will face a shortage of more than 800,000 nurses by 2020.
Wage issues are keeping the number of geriatricians at an all-time low, as well. Geriatricians are crucial, the experts said, because they look not at a particular disease or body site, but at the older person as a whole. However, a recent U.S. Institute of Medicine report found that geriatricians remain the lowest paid medical specialty of all.
Posted on November 17, 2008 by Ray Mullman
Newsday had an article about a 90-year-old Roman Catholic nun who died after an unbolted closet fell on her head at a nursing home. Rockland County, which runs the Westchester County home, was fined more than $17,000 by the federal Centers for Medicare and Medicaid. The Summit Park Hospital and Nursing Care Center faces additional state penalties in the Aug. 31 incident.
The nun was found conscious but bleeding profusely from her forehead, face and left eye after the free-standing wardrobe fell on her. She was taken first to a nearby hospital and later transferred to Westchester Medical Center in Valhalla, where she died. Her name was not released.
How could this happen? Who was supposed to be watching her? Why would they have a wardrobe closet unbolted or free-standing?
Posted on November 14, 2008 by Ray Mullman
The Advancing Excellence in America's Nursing Homes campaign--a nationwide, voluntary quality improvement initiative-celebrated its second birthday last month.
More than 7,100 nursing homes in the U.S. have signed on with the initiative. This is roughly 45% of the nation's total number of nursing homes. Also, 28 national organizations and 49 smaller local organizations have a hand in the unprecedented initiative, which originally was supposed to last just two years. Success, however, has granted it extra life, officials say.
"In two years, the Advancing Excellence campaign has seen progress in reducing pressure ulcers, reducing the use of physical restraints, and controlling or relieving pain for long-term and short-stay residents," said Mary Jane Koren, M.D., M.P.H., chair of the Advancing Excellence campaign.
For more information about the Advancing Excellence campaign, visit http://www.nhqualitycampaign.org.
Posted on November 10, 2008 by Ray Mullman
A Perfect Cause is an advocacy group that pushes for reform of nursing home laws, regulations, and requirements. Recently, they got the Oklahoma attorney general and the Oklahoma County district attorney's office to support a push to make crimes against nursing home patients immediately reportable to police.
Jack Crow, who says he believes his wife was abused at a nursing home, is pushing to change the statutes. Crow's wife, who suffers from Alzheimer's disease, was badly bruised in July. An investigation found that she suffered the injuries in a fall.
Crow disputes the findings and is working with A Perfect Cause to change the reporting procedures.
Current Oklahoma statutes call for someone with reasonable cause to believe abuse or neglect is occurring at a care center in the state, it should be reported to the Department of Human Services or the Sheriff's department. However, reasonable cause is subjective and no guidance is given to nursing homes as to what constitutes neglect and abuse.
The district attorney and attorney general's offices believe police should be called first.
"When you have a crime scene, there is evidence," said Scott Rowland, of the Oklahoma County district attorney's office. "There is witness testimony in these crime scenes."
A Perfect Cause wants to make sure facilities follow that procedure by requiring them to report suspected abuse to police first, before anyone else.
Posted on November 10, 2008 by Ray Mullman
North Dakota's NBC affiliate KFYR had an article and video discussing the shortage of nursing home beds available in North Dakota. The authors discovered that there are far more seniors than there are beds available in certain areas of North Dakota. However, The Good Samaritan Society has senior care facilities throughout rural North Dakota, many with plenty of room for our aging population. The urban areas are where beds are needed, so that`s where the society is relocating all its open space.
The good news is are plenty of skilled nursing beds for senior citizens throughout the state. The bad news, many are in rural areas, not in the growing cities, where the need for them is growing.
The Good Samaritan Society is able to construct the $16 million project on Versailles Avenue, by lumping together all the open skilled nursing and basic care beds it has in its rural facilities.
"In our rural communities, we`ve had some vacancies due to declining populations and movement of people from rural communities to the four major cities in North Dakota where the health care services are more dominant," says John Droppers, of the Good Samaritan Society.
The GSS expects the facility to be full of seniors by the spring of 2010, seniors who otherwise may have had to travel to outlying areas to find a home. The Long Term Care Association says in the next three years another 180 skilled nursing beds are expected to be transferred from rural areas to the Bismarck-Mandan area.
Posted on November 6, 2008 by Ray Mullman
The Birmingham News had a great article discussing a new type of nursing home that makes the residents feel like they are at home instead of a hospital. Residents are called "elders," not patients. Nurses are invited guests, not managers. Home is the emphasis, not medicine, although skilled care is available.
After years of planning and then construction, the retirement community has just completed the "Cottages at St. Martin's, a Green House Community." St. Martin's cottages are designed after a patented Green House concept that seeks to deinstitutionalize treatment of the elderly and create a family-like environment for their long-term care.
The $11 million project involves replacing 60 of St. Martin's 138 nursing home beds in 6 separate homes where 10 residents live with the help of certified nursing assistants. The Green House concept was developed by Dr. William Thomas, a geriatrician fed up with the sadness, loneliness and boredom in his nursing home patients. Today there are 15 Green House communities open and another 19 in development in 23 states.
St. Martin's is the first nursing home in Alabama to embrace the idea and the first in the country to open multi-story houses. Because of limited space, St. Vincent's has built two, three-story structures with a separate "cottage" or "Green House" on each floor. The cottages on the ground floor have an outside courtyard, and the upstairs cottages all have large, screened-in porches.
Each home has a separate entrance, and doorbells must be rung and the door answered before a nurse or other visitor enters.
The cost of care will be the same at the cottages as in the traditional nursing home. The ratio of nursing assistant to residents is better in the cottages, but the nursing assistants are also doing the cooking, light housework and other chores. Nurses make rounds on the cottages to give medicine and check vitals, but they are not the ones in charge.
Turnover of nursing assistants is expected to be less for those working in the cottages because they have more varied roles and fewer residents to look after. Nursing assistants are getting culinary training this week. A central part of each cottage is the open kitchen, from which nursing assistants can monitor the residents and residents can smell the food cooking. Weight loss is a common problem in nursing homes, but Green Houses across the country have shown that to be less of an issue when the food is prepared near the residents.
Posted on October 31, 2008 by Ray Mullman
There is a special place in hell for people who have the audacity and malice to steal from vulnerable elderly people residing in nursing homes. I do not understand how someone can betray the trust of these residents in such a way. Recently, I saw an article in the Staten Island Advance that discussed a case where a husband-and-wife team working at a Stapleton nursing home stole a credit card from a patient's bedside drawer and used it at two locations on Staten Island.
Denard Brown, 44, and his wife, Benedicta Charles, 44, allegedly swiped the card from a patient. Ms. Charles was responsible for providing care as a nurse's aide at St. Elizabeth Ann's Health Care and Rehabilitation Center, Stapleton.
The victim reported the card missing, which prompted investigators to monitor the card's account for activity. Detectives got a hit last week at Waldbaum's store. Waldbaum's turned over video surveillance tape that captured the couple using the card on Sept. 7. Armed with the tape, and bank records that implicated them in the crime, police arrested the couple at St. Elizabeth Ann's when they reported to work. Under questioning, Brown admitted he also used the card Sept. 4 to buy gas at a Hess station.
Ms. Charles and Brown have been "suspended pending an investigation," Fagan said. Both are charged with grand larceny, criminal possession of stolen property and endangering the welfare of an "incompetent person."
Posted on October 30, 2008 by Ray Mullman
Emmy Pei works for a technology provider in the medical industry called Direct Alert (www.directalert.ca). She was kind enough to share an article with us and we are pleased to include it on our blog.
Elderly Care with Technology
There exists a looming problem in the healthcare system for our baby boomer population, and that is the shortage of people available to provide hands-on care for the elderly and the aging. Enter...the robots. Or to be more specific, a robot named Pearl.
Developed by a research team at Carnegie Mellon University, Pearl is undergoing a trial run in a Pittsburgh nursing home, guiding residents around the building, helping them get from their rooms to the dining hall, or from the library to their physical therapy session. Pearl is also able to give verbal alerts to remind residents to eat or to take their medications.
Advancements in assistive technology will not only improve the care for elderly people in institutions like nursing homes and hospitals, but they will also help to keep them out of said institutions. Fall detectors, pressure mats, door monitors, and bed alerts and medical alerts all serve to improve home safety, increasing people’s ability to live in the comfort of their homes for much longer.
There are also several new options to address problems such as failing to take medications on time or remembering to take them at all. Smartmeds offers a wireless service that delivers notifications to take medications via cell phone calls. The On-Time-Rx software for Palm pilots provides a similar service, sounding an alarm and displaying a set of instructions at the appropriate time. More 21st century style options include wristwatches with preset alarms as medication reminders, or automatic dispensers which sound an alarm and dispense the pills at the right times. Also featured is the medical alert bracelets which carry the direct alert receiver. These two pieces can be worn with comfort and confidence.
One obstacle to overcome is the intimidation factor. Something as simple as cell phone buttons being too small, or wheel-mouse devices that are too sensitive can prevent some folk from adopting new technologies. Recognizing this potential pitfall, Jeffrey Pepper founded ElderVision in 1999, a company devoted to helping technophobic seniors get online. The Touchtone system replaces the mouse and keyboard with voice and touch-sensitive activation, making computers more accessible to a generation who grew up without them. To send an e-mail, for example, you can simply touch an onscreen photo of the intended recipient, instead of having to worry about typing it out.
Technological developments like these allow older generations to stay more connected, while enhancing their independence. With their health and well being in the hands of people who care and with the proper technological tools, senior citizens can live more relaxed and comfortable lives. And while the age of robots still remains on the horizon, residents of the Pittsburgh nursing home told the Carnegie Mellon team that Pearl is fine, as long as it's not seen as a replacement for human contact
Posted on October 6, 2008 by Ray Mullman
Lancaster online had an interesting article on Goods Run, one of the Mennonite Home's new skilled "households." These homes were designed to create a more homelike and less institutional environment for residents.
The change has helped many residents become more social. Mennonite Home's conversion to households incorporates a person-centered approach. This approach is and should gain in popularity across the country. It's a key component of a $13 million physical renovation and "culture change" at the 105-year-old continuing-care community.
While the skilled-nursing area is being turned into nine households with up to 28 people each, the exterior of the brick building along Harrisburg Pike in Manheim Township is being transformed as well. Other recent improvements include an all-season room, a café serving Starbucks coffee, a library, a country store and a new elevator tower.
In total, the households will consist of 190 beds, six fewer skilled-nursing beds than Mennonite Home had before. Though Goods Run, which opened in March, has room for 28 residents, the rest of the households will accommodate 16 to 22 people.
Each household has a front door, which opens to reveal a living room with fireplace and flat-screen TV; a parlor; a dining room and residential-style kitchen; a washer and dryer; and even a spa with whirlpool. The traditional nurses station also has been eliminated, Sauder said, and replaced with charting and medication rooms tucked away from the main living area.
Resident rooms are configured and furnished differently, too, he said. Before, most skilled-nursing rooms were semiprivate, Sauder said. Now there are more private rooms, along with "modified" private rooms, where two people each have their own space (separated by a wall) but share a bath.
According to her Web site, culturechangenow.com, "Action Pact Inc. is a company of trainers, consultants and educators who assist nursing homes and other elder-care organizations in becoming resident-directed.
Posted on October 6, 2008 by Ray Mullman
The May 4 death of a local nursing home patient has been ruled a homicide. However, no criminal charges will be filed in the case. Elsie Powell is suspected of pushing Edna Shaw to the floor at Encore Senior Village on University Parkway. Shaw hit her head on the floor. Both were residents at a nursing home. The Medical Examiners Office ruled that the blunt impact to Shaw’s head contributed to her death and ruled the death a homicide, the report said.
Powell’s condition has continued to deteriorate, Assistant State Attorney David Rimmer wrote in the report. “It is doubtful that she was even mentally competent when the incident occurred,” Rimmer wrote. “Therefore, in my opinion, no criminal charge should be filed against her for the unfortunate death of Miss Edna Shaw.”
Posted on October 1, 2008 by Ray Mullman
The Philadelphia Inquirer wrote an article about how many errors in health care settings do not get reported. These errors or mistakes, whatever you want to call them, need to be disclosed so we can figure out how to prevent them in the future. These health care businesses are more worried about getting caught then preventing them.
The article describes several incidents where patients were not given proper care but the hospitals failed to report the problems such as two patients at Fox Chase Cancer Center in Philadelphia required additional surgery after objects were negligently left inside their bodies or three patients at Mercy Fitzgerald Hospital had to be sent back to the OR last year to stop excessive postoperative bleeding or At Abington Memorial Hospital, an elderly woman recovering from surgery for a broken hip in 2005 was left on a bedpan for at least 41/2 hours. She developed two open bedsores as a result.
For several years now, hospitals in Pennsylvania and New Jersey have been required to report medical mistakes and serious complications to state agencies charged with reducing medical errors. But most hospitals aren't complying, undermining efforts to improve patient safety. In New Jersey, five of the state's 80 hospitals failed to report a single preventable mistake last year. In Pennsylvania, some facilities didn't report any serious events or even the near misses that might have harmed patients.
James Bagian, head of the Department of Veterans Affairs' National Center for Patient Safety, said: "Anybody that is supposed to report close calls and has zero reports is clueless; Management is asleep at the switch and just waiting until they kill someone." The public can only learn that a hospital isn't reporting mistakes in those rare instances when the health department cites it for failing to comply with the law.
"There is still some underreporting, and we are working directly with the hospitals to understand why," said Eliot Fishman, policy director of the New Jersey Department of Health and Senior Services. Consumer advocates want more transparency so patients can make better health-care decisions.
The numbers suggest underreporting is more than just a passing problem. Calvin Johnson, the Pennsylvania secretary of health, said only people with their "head in the sand" would fail to see the problem of uneven reporting by hospitals. But he noted that with about 200 hospitals and millions of patient visits each year, it is impossible for the state to check every chart.
While it's important to study each of those reports, it is at least as crucial to identify hospitals that are not participating at all, said Conway, of the health-care improvement institute. "We cannot improve care unless we understand the problems," Conway said. "There can't be safety without transparency."
Posted on October 1, 2008 by Ray Mullman
The Philadelphia Inquirer wrote an article about how many errors in health care settings do not get reported. These errors or mistakes, whatever you want to call them, need to be disclosed so we can figure out how to prevent them in the future. These health care businesses are more worried about getting caught then preventing them.
The article describes several incidents where patients were not given proper care but the hospitals failed to report the problems such as two patients at Fox Chase Cancer Center in Philadelphia required additional surgery after objects were negligently left inside their bodies or three patients at Mercy Fitzgerald Hospital had to be sent back to the OR last year to stop excessive postoperative bleeding or At Abington Memorial Hospital, an elderly woman recovering from surgery for a broken hip in 2005 was left on a bedpan for at least 41/2 hours. She developed two open bedsores as a result.
For several years now, hospitals in Pennsylvania and New Jersey have been required to report medical mistakes and serious complications to state agencies charged with reducing medical errors. But most hospitals aren't complying, undermining efforts to improve patient safety. In New Jersey, five of the state's 80 hospitals failed to report a single preventable mistake last year. In Pennsylvania, some facilities didn't report any serious events or even the near misses that might have harmed patients.
James Bagian, head of the Department of Veterans Affairs' National Center for Patient Safety, said: "Anybody that is supposed to report close calls and has zero reports is clueless; Management is asleep at the switch and just waiting until they kill someone." The public can only learn that a hospital isn't reporting mistakes in those rare instances when the health department cites it for failing to comply with the law.
"There is still some underreporting, and we are working directly with the hospitals to understand why," said Eliot Fishman, policy director of the New Jersey Department of Health and Senior Services. Consumer advocates want more transparency so patients can make better health-care decisions.
The numbers suggest underreporting is more than just a passing problem. Calvin Johnson, the Pennsylvania secretary of health, said only people with their "head in the sand" would fail to see the problem of uneven reporting by hospitals. But he noted that with about 200 hospitals and millions of patient visits each year, it is impossible for the state to check every chart.
While it's important to study each of those reports, it is at least as crucial to identify hospitals that are not participating at all, said Conway, of the health-care improvement institute. "We cannot improve care unless we understand the problems," Conway said. "There can't be safety without transparency."
Posted on September 22, 2008 by Ray Mullman
AOL had an article equating nursing homes with prison. This may sound harsh but the people I speak to at nursing home typically feel that way. The residents do not feel like the nursing homes want them to get better because they will lose money if the residents return home. The most interesting aspects of the article are the comments under the story.
The article talks about Charles Todd Lee, a 67-year-old photographer who has been confined to a nursing home for five years, the victim of a stroke that paralyzed his left side.
"Most of the people come here to die, so you want to die," he said. "It is a prison. I can't escape it."
Lee is a Medicaid recipient challenging the nightmare of the old and disabled: to be forced from comfort and familiarity into a nursing home. Residents say the state is illegally forcing them to live in nursing homes when they should be able to live where they choose. Advocates charge that nursing homes, afraid of losing money, have successfully pressured politicians to make qualifying for community care more difficult. They have filed a federal lawsuit seeking class-action status on behalf of nearly 8,500 institutionalized Floridians.
Whether the litigation gets Lee and others moved out of nursing homes remains to be seen. But at the very least, it has illuminated the frustration experienced by older people or those with disabilities who say they're shuttled into nursing homes when they are healthy enough to live at home, with relatives, or in other less institutional settings.
Americans who qualify for Medicaid and get sick or disabled enough to require substantial care typically have little problem gaining admission to a nursing home. But obtaining Medicaid-supported services at home, such as visits from an aide, is substantially harder and often involves a long waiting list, even though it may cost the government less.
Advocates for the elderly and disabled had hoped a 1999 Supreme Court case would change that. The Olmstead decision, as it is known, involved two Georgia women, both Medicaid beneficiaries with mental retardation who wanted community-based services, but were refused and were treated in institutions. The high court ruled unjustified isolation of the disabled in institutions amounted to discrimination under the Americans with Disabilities Act. It said states must provide community services if patients want them, if they can be accommodated and if it's appropriate.
States have been putting more money into community services, but not nearly enough to meet the demand of people who would rather stay at home than go to a facility. Nationally, state Medicaid payments for long-term community care have skyrocketed since the Olmstead decision, from $17.4 billion in 1999 to $42.8 billion last year, though spending on nursing homes and other institutions is still substantially higher. A total of $59.5 billion was spent last year on institutional care through Medicaid.
The article also mentions John Boyd, 50, who has been in a nursing home for the last nine years. He hates them. He became a quadriplegic 36 years ago when he fell off a wall and broke his neck.
"I can't choose what meal I want, I can't have a visitor after 8 o'clock — it's just like a prison without bars," he said. "People are making decisions for and about me that don't even know me or even care about me. All they care about is the money they're getting for me."
Posted on September 9, 2008 by Ray Mullman
Naples Daily News had an article about Medicare overpaying nursing homes. Watchdog groups have warned about the overpayment months ago. The already extremely profitable nursing home industry is getting an extra $1.5 billion from Medicare despite a call from an independent Medicare advisory panel that reimbursement has been inflated for the past three years and needs to be scaled back.
“The windfall to skilled nursing facilities comes with no strings attached and there is no reason to believe this windfall will help improve the quality of care or quality of life for nursing home residents,” said Toby Edelman, a senior policy attorney with the Center for Medicare Advocacy Inc., in Washington, D.C.
The overpayment remains even though the Medicare Payment Advisory Commission, an independent advisory group to Congress, recommended in May that the rates be adjusted because nursing homes are being overpaid. The Bush Administration decided this past month to "study" the issue further.
The Center for Medicare has been overpaying nursing homes since January 2006 after expanding the list of categories used in determining patients’ medical status for purposes of reimbursement .By not addressing the issue now, the nursing home industry will reap an extra $780 million next year, Edelman said.
An Office of Inspector General report in 2006 found that 22 percent of nursing home claims were overcoded for higher reimbursement, he said.
The system used to determine reimbursement to nursing homes is complex. One component alone involves a patient evaluation form with 509 questions, Hamilton said. The forms help determine the nursing home’s reimbursement rates. This raises questions about how much time staff members have to do the evaluation, how trained they are and whether the patient’s medical record matches the care rendered, Hamilton said.
On a second front, the nursing home industry is receiving a 3.1 percent inflation adjustment that will mean getting an additional $710 million next year from Medicare. MedPAC had reviewed nursing homes’ operating margins and recommended no cost adjustment to the federal government but the inflation increase is moving forward.
Posted on September 9, 2008 by Ray Mullman
The Urban Institute did a study that showed Americans who go without health insurance. They will spend $30 billion out of pocket for health care this year alone, and they will get $56 billion worth of free care, according to a report released on Monday.
Government programs pay for about three-quarters, or roughly $43 billion, of the bills for these uninsured people, Jack Hadley of George Mason University in Virginia and a team at the Urban Institute reported.
On average, an uninsured American pays $583 out of pocket toward average annual medical costs of $1,686 per person, The annual medical costs of Americans with private insurance average far more -- $3,915, with $681, or 17 percent, paid out of pocket, the report found.
"The uninsured receive a lot less care than the insured, and they pay a greater percentage of it out of pocket. Contrary to popular myth, they are not all free riders," Hadley said.
Current estimates show that 47 million Americans lack any health insurance, and 28 million have gone without for some part of the year.
Posted on September 7, 2008 by Angela Lizer
The purpose of the Long Term Care Ombudsman program in South Carolina is to provide advocates for the elderly and their families. If you or a loved one is a resident of a nursing home or assisted living facility in South Carolina, the Ombudsman in your region should be able to answer your questions. Most importantly, if you have a complaint against a facility contact your Ombudsman for help. Click here for to find out more about the Long Term Care Ombudsman program and to get contact information. Another resource to try is SCDHEC, or South Carolina Department of Healht and Environmental Control. This is the agency that licenses and inspects nursing home and assisted living facilites in South Carolina. Click here for more information.
When making a complaint, whether it is made to the Ombudsman, DHEC, or the facility itself, it is best to do it writing, not verbally, and make sure you keep a copy for your records.
Posted on September 5, 2008 by Ray Mullman
The Toldeo Blade has a sad article about the effects of delays and denials caused by for profit insurance companies making health care decisions for residents instead of health care professionals. This should be criminal the way the health care industry denied this man's chances of survival.
The article discusses various specific cases. Randy Steele, 64, of Oak Harbor was transferred back and forth between health care facilities as physicians attempted to stay ahead of the hepatitis C virus that was slowly threatening his liver and kidneys.
He was finally referred to specialists at Cleveland Clinic to offer a second opinion on a potentially life-saving kidney-liver transplant. Cleveland Clinic fit Mr. Steele onto its schedule. But instead, his appointment was canceled and he waited weeks to learn if his insurer would pay for this life saving measure.
Mr. Steele, like many patients across the country, was the victim of a complex health-care bureaucracy and an insurance industry that repeatedly denies doctors’ orders — leaving patients bewildered and suffering.
Bill Hodnik, 41, endured the same shortcomings.He suffered months of avoidable pain while his insurer delayed and denied coverage for a necessary surgery ordered by his physician. Mr. Hodnik’s physician told him the optimal solution to his problems would be cutting-edge artificial disc replacement surgery.
The surgery was scheduled, but he never underwent the procedure. After months of repeated delays and denials from his insurer, and with his disability insurance running out, Mr. Hodnik needed to return to work, and so — against doctor’s orders — he settled on fusion surgery.
Doctors nationwide believe there is an emerging crisis in providing health care to their patients because insurers routinely challenge their orders.
Doctors said patients usually receive some of the therapy, testing, medication, or procedures needed and prescribed for them. But too often, physicians said, there’s a lapse in time between the office visit and when the care or test is delivered because of interference by insurers.
Posted on September 3, 2008 by Ray Mullman
The Wall St. Journal had an article recently that made me think about the future of helath care when the baby boomers enter the nursing home industry. Will there be a revolution in health care? Will for profit chains dictate how the old and frail among us will conclude their lives?
A nursing home in California wants to evict Jasmine Nguyen, a 32-year-old dependent on a ventilator to breathe and the facility's staff for her daily needs, and a dozen other residents in similar situations replacing them with short-term residents that bring more profit.
Across the country, nursing homes are forcing out frail and ill residents. While federal law permits nursing-home evictions in some circumstances, state officials and patient advocates say facilities often go too far, seeking to evict those who are merely inconvenient or too costly. Residents with dementia or demanding families are among the most vulnerable, particularly if -- like Ms. Nguyen and the other Lodi residents -- they depend on Medicaid to pay their bills, the officials and advocates say.
Assisted-living facilities have sprung up as alternatives for those who don't require nursing-home care but need assistance with things like taking medications or bathing and dressing. Each state regulates the industry differently, so eviction policies vary. But many states simply require facilities to give four- to six-weeks' notice, with no appeal guaranteed.
In Florida, for example, the state's 2,400 assisted-living facilities must give residents 45 days' notice before evicting them, but don't need to provide a reason or appeal process.
No national figures on assisted-living evictions exist, but discharge-related complaints recorded by the federal Administration on Aging more than doubled in the decade before 2006, rising 177% -- nearly twice the growth for complaints overall. Some attorneys are turning to federal fair-housing rules and the Americans with Disabilities Act to help assisted-living residents stay in their homes. They argue that those laws require all landlords, including assisted-living companies, to make reasonable accommodations for disabled residents, and prohibit them from evicting residents because their condition worsens.
And evictions may be even more widespread, since some eviction attempts are resolved without formal complaints. Residents may not know they can appeal or may be too ill to do so or fear retribution. Federal law -- enforced by the states -- says residents can be discharged involuntarily for just six reasons: if they are well enough to go home; need care only available elsewhere; endanger the health of others; endanger the safety of others; fail to pay their bills; or if a facility closes its doors. Even so, nursing homes must give residents at least 30 days' notice, explain their appeal rights, and put together a plan to make sure the move doesn't harm them.
Even an orderly eviction can carry grave risks for the old and ill. Studies suggest "transfer trauma," or relocation-stress syndrome, can spur depression and weight loss and increase the risk of falls.
For example, the nursing home trying to evict Jasmine Nguyen, Lodi Memorial Hospital, told her and a dozen others that they would have to move by June 30 because the nonprofit organization was closing the facility -- for renovations. All 13 residents were "sub-acute" patients, most of them dependent on ventilators or feeding tubes, or with other conditions requiring significant extra care.
Lodi Memorial told the state it planned to replace them with patients recently discharged from its hospital -- who typically require shorter-term care covered at a higher daily rate by private insurance or by Medicare. (Medicare pays for up to 100 days in a nursing home following a hospital stay of at least three days.)
In April, after Lodi Memorial sought state approval, administrators were told that they knew when accepting the sub-acute residents that they would need extensive care, probably for many years, and it couldn't simply stop. Moreover, the state said in a letter, "your facility is not ceasing to operate as you are not surrendering your license."
The nearest nursing home certified to care for patients like Ms. Nguyen is about two hours away with traffic, says Jasmine's 23-year-old sister, Mary. Their mother, Kim Nguyen, who runs the family nail salon in nearby Stockton, visits Jasmine twice a day.
Posted on August 28, 2008 by Ray Mullman
I have read several articles recently about how some cities like Cincinnati may stop conducting nursing home inspections. That is fine with me since most inspectors in South Carolina are so overworked and underfunded that the inspectors don't have the time and resources to properly insure that the nursing home is properly caring for the residents.
Typically, the nursing homes know when they are coming and improve conditions before the inspectors get there. We hear countless stories from ex-employees of nursing homes in the area that all repeat the same chorus. "They increase staff and clean everything when they know the survey team will be coming in".
I have not seen any complaints substantiated or any fines incurred against any of the for profit nursing homes. The inspectors in South Carolina seem to ignore violations, and the concerns of residents and family members. Instead, they criticize the county run nursing homes or the charitable organizations that run the mom and pop nursing homes. I can't tell if it is corruption or incompetence but certainly the inspection program in South Carolina isn't doing anything to provide better care or oversight for the residents.
Below is a summary of a story by Dan Horn about Cincinnati dropping nursing home inspections
The Cincinnati Health Department is considering whether to drop its inspection program for nursing homes and residential care facilities. Budget cuts and retirements could soon leave the department unable to keep up with annual inspections. Cincinnati is the only city in the state that does its own nursing home inspections, a policy that city officials have said allows the city to react more quickly and aggressively to problems. He said the program once operated with six inspectors and supervisors, but that number fell to four by the start of this year. Another retirement will drop the total to three employees by this fall.
Posted on August 25, 2008 by Ray Mullman
David Krough wrote, for Portland's kgw.com, an article stating that a nurse assistant at a nursing home was arrested for stealing narcotics from residents in other nursing homes. Nursing assistants provide about 85-90 percent of all the care to residents.
The article is informative but does not provide key information such as prior arrests, employment history, knowledge of the mangement of the nursing homes regarding the missing narcotics or her conduct. How could she get hired? Was she a user or a pusher? What safeguards do they hav ein place to make sure this doesn't happen? Below is a summary of the article.
Surveillance cameras caught a woman on camera, posing as a resident's granddaughter, then as an employee. Administrators there said the woman snuck in and spent at least three evenings with one of their residents.
Theresa Smith was a nursing assistant who worked at nursing homes in the Portland Metro area. Police listed Smith as a person of interest after a report of theft of Fentanyl patches at the Laurelhurst Village Nursing Home on SW Stark Street. She was accused of stealing Fentanyl pain patches from nursing home residents while the residents were wearing the patches. Detectives said she stole from several patients at area nursing homes.
Detectives arrested Smith Wednesday while she was working at the Care Center East Nursing Home on NE Wielder Street. Smith was charged with burglary, criminal mistreatment, possession of a controlled substance and theft. Police said she may face more charges.
Posted on August 20, 2008 by Lara Pettiss Harrill
What an interesting concept - training called Xtreme Aging, which is designed to simulate diminished abilities associated with old age. I just read this article about this program, which is apprently becoming a part of many nursing and medical school curriculums, and I think should be mandatory training for every nursing home employee, or for anyone who works with the elderly.
Here's the idea, they put on glasses to blur their vision; stuff cotton balls in their ears to reduce hearing and their noses to reduce sense of smell; and put on latex gloves with adhesive bands around the knuckles to impede dexterity. They even put corn kernels in thier shoes to approximate typical aches and pains. And after all that, the subjects are put through a series of typically routine tasks like buttoning a shirt, finding a phone number in the phone book, dialing a cellphone and folding and unfolding a map. Imagine - shirt buttons are so small, phone book print and cellphone numbers are so small, folding a map is a frustrating task for me in my thirties!
The idea behind Xtreme Aging, of course, is to foster sensitivity both inside and outside medical facilities. I generally don't quote directly from articles, but this is something to think about.
To approximate the state of people entering a nursing home, she asked each participant to write down five favorite possessions, five cherished freedoms and three loved ones on Post-it notes. Then one-by-one she asked members of the group to part with a possession, a freedom or a person: a car here, a husband there, freedom of travel next — until all that anyone had left were two possessions.
“You guys just aged to the point of going into a nursing home,” she said, as participants made the last hard choice, invariably giving up contact with their children. “What did you give up? All your loved ones. All your privileges. And at most nursing homes you only get to bring two possessions.”
She asked, “How did that make you feel?”
Hands went up.
“Lost.”
“Like I want to die.”
“Like I failed.”
“Now,” Dr. Rosebrook said, “how many of you look forward to living in a typical nursing home?” No hands went up. “But this is what we do to people. If we’ve taken everything away, what have we done to the elders in society?” Kim Hansen, 46, who works in the facility’s rehabilitation unit, said the hardest part of the exercise was giving up the people in her life. “I gave up my parents first,” she said. “Then it was between my husband and my kids. I gave up my husband. I got very emotional with that.”
There's something to think about - yes, its a simulation, but a powerful one, and one that just considering it makes me very sad. The participants get to go back to their lives, and their possessions, freedoms, and loved ones . . . but what happens when you're no longer a participant? Shouldn't we strive to make the reality as pleasant as possible?
Posted on August 20, 2008 by Ray Mullman
Prudential Study Sheds Light on the Increasing Costs of Long-Term Care. Prudential website has a great tool to determine the cost of long term care in each state.
According to the U.S. Census Bureau, by 2030 the number of Americans aged 65 and older will more than double to 71 million, comprising approximately 20 percent of the U.S. population. With an aging population boom, Prudential issued 2008 Long-Term Care Cost of Care research report. The study found an increase in the average cost of long-term care ranging from 5% to 13%, varying by type of service, in the past two years alone.
"Many Americans mistakenly believe that Medicare or private health insurance will pay for their long-term care needs. The reality is long-term care risk is substantial, and under current Medicare and Medicaid policy, much of it is the uninsured private responsibility of individuals who pay for care and of families who care for their relatives," said Andy Mako, Senior Vice President, Long-Term Care Insurance, Prudential.
Prudential's Cost of Care study sheds light on the State-specific average costs associated with nursing homes, assisted living facilities, and home health care services.
The study related significant issues:
-- Average costs for long-term care services increased over the past two years and are expected to continue to rise. The average daily cost for an assisted-living facility is now more than $100, or $3,241 per month. What's more, the average daily cost of a private room in a nursing home is now $217, or $79,205 annually.
-- Home health care experienced the smallest rate increase, rising just 5 percent over the past two years. The average hourly rate for a home health aide/certified nursing assistant increased by $1 in the past two years, to $21.
-- Costs for long-term care services continue to vary significantly by location, with Alaska, New York City, and Stamford, CT consistently being the most expensive areas for nursing home and assisted living facilities, and Oklahoma City, St. Louis, and South Dakota being the least expensive.
In addition to the report being available to consumers on www.prudential.com, Prudential is also launching an updated interactive consumer cost of care mapping tool on its website at www.prudential.com/insurance/longtermcare, designed to provide more in-depth State-specific cost detail - and in some cases City-specific - aimed at arming consumers with essential facts to help them make better financial decisions. "While consumers understand the importance of planning for their financial future, they continue to have misperceptions about the costs of long-term care services and the benefits of long-term care insurance. Our resources can help them dispel these myths and put them on the right path to securing their retirement," added Mako.
Posted on August 19, 2008 by Ray Mullman
Florida's FirstCoastNews wrote a story about a nursing home that took advantage of a resident by stealing her social security check. A resident by the name of Crews entered Harts Harbor Health Care Center for short term rehabilitation. Her son told the administrator he will pay for the stay.
Crews says, "I said if she stays over the 20 days that the government allows for free, I will pay every dime, it does, which is $128 per day." Crews said she stayed in the Nursing Home 27 days and he paid the facility a total of $1,528.
The problem is this month when he went to pay her bills there was no money in his mom's account. Her Social Security check of $665, which is a direct deposit, was re-directed to the Harts Harbor Health Care Center, instead of going into her account.
"They took it from Wachovia, how they did it I don't know, cause I did not sign any papers," says Crews. Crews says when he contacted Harts Harbor he was met by a cavalier attitude.
The Social Security Administration is investigating Crews' complaint. But the Crews would like an explanation from the nursing home. "I'm telling you, they should not have had it in the first place," says Crews. And he wants a full refund. I'd like for them to refund her check and the bank fees, that's the bottom line," says Crews.
The nursing home refuses to explain how they got their greedy little hands on this little old lady's social security check. I am so glad that her son figured out what happened. How many residents get money stolen from them when family members aren't around to check on their finances.
Posted on August 15, 2008 by Gary Poliakoff
McKnight's had an article about nursing homes getting their residents to ask for tax refunds.
The article discussed how a lot of nursing home residents haven't taken advantage of their opportunity to file for federal stimulus refund checks. That's up to $600 each for thousands of people. In other words, a lot of money.
So CEOs of the five of the nation's seven largest nursing home chains nudged residents into filing paperwork for their refunds. Then, the residents could turn around and give the money to some “humane” charity. Outrageous.
The nursing home industry shows audacity in asking for this from a population that is largely on Medicaid is almost unfathomable. To think that such people—who normally receive perhaps just $50 of personal money per month from Medicaid for everything they want—are being asked to start forking over the largest lump sum they're bound to see for a while boggles the mind.
So to the CEOs of HCR ManorCare, Kindred Healthcare, Genesis HealthCare, Golden Living and SavaSeniorCare, I say: Go ahead, urge your residents to file their paperwork and get what they have coming. Then leave them alone.
Posted on August 11, 2008 by Ray Mullman
Dan Frith wrote the following blog
article about improper evictions in nursing homes. The Wall Street Journal ran an interesting
article on August 7 about America's nursing homes wrongfully discharging residents. The article states that one in seven discharges from Washington, DC area nursing homes are improper.
Why are nursing homes wrongfully and illegally kicking out their residents? What else...money! You see most (approximately 70%) of nursing home residents are Medicaid beneficiaries and Medicaid sets the reimbursement rate for their stay. Medicare, which pays a higher rate, is usually only available for about 100 days of care in a nursing home. Nursing homes want the higher income provided by Medicare, long term care insurance, or private pay by the resident. They don't want the low rates paid by Medicaid.
Under federal law a resident can be discharged only for the following reasons:
1. The resident is well enough to go home.
2. The facility can no longer provide the care needed by the resident.
3. The resident is endangering the health or safety of others.
4. The facility closes its doors.
5. The resident (or Medicaid, Medicare, etc.) fails to pay the bills.
Know your rights. Don't let nursing homes kick out your loved ones just because they desire to make more money.
Posted on August 5, 2008 by Ray Mullman
The Buffalo News has an article about the difficulty of middle class families to afford nursing home care. The article talks about how elderly or infirm people seeking to spend down or transfer assets to qualify for Medicaid are finding it increasingly difficult because of changed rules, and a new law will make it even tougher. The changes, designed to minimize government spending by reducing the number of people eligible for aid, are hitting many middle-class families in the pocketbook.
To ensure they qualify, families of residents or future residents routinely try to legally manipulate their assets to evade the financial limits. To remain eligible, the maximum Medicaid-countable assets you can have are $104,400.
Of the 120,000 residents in nursing homes in New York, 75 to 78 percent are on Medicaid, said Richard Herrick, president and CEO of the New York State Health Facilities Association. As a result, nursing home care consumes about 14 percent of the approximately $49 billion New York State annual budget for Medicaid, or about $7 billion, he said.
To qualify for Medicaid, an individual must disclose all assets — from bank accounts to vacation homes — to the county Department of Social Services. A single individual can have up to $13,050 in assets.
If the individual is married to a “community spouse,” a person who is not in a facility, the spouse can keep between $74,824 and $104,400, depending on the total assets they had before going into a nursing home. The community spouse can also keep a house and a car.
To determine the length of the penalty period, the county looks at how much money a Medicaid candidate has gifted for less than fair market value within the look-back period. To calculate a penalty period, a person can divide the total amount of money they moved around during the look-back period by the average monthly cost of skilled nursing for their region, Beinhauer said. For Western New York, the average monthly cost is $7,066.
For example, if a person gave $100,000 to his children before applying for Medicaid, they would have a little longer than 14 months to wait before the government started paying.
That’s not to say all gifts will cause delays. Beinhauer said certain gifts can be justified.
“If you can establish a pattern of gift making and you were in good health when you made the gift, for example, you could argue that gift should not be considered a sanctionable transfer,” he said.
Prepaying burial costs and funeral expenses is an easy way to spend down money legitimately, Burial-related costs for a spouse, son, daughter or sibling are not counted as part of one’s assets.
A house can also be transferred in several ways so that the transaction is exempt. If a child is living with a parent for two or more years or a sibling for at least a year, the applicant can transfer the deed without the house counting as an asset.
Posted on July 31, 2008 by Angela Lizer
Nursing home residents may be at risk from rape and other sex crimes. Julie Appleby reports in USA Today that there are registered sex offenders living among the elderly and vulnerable in nursing homes. According to a 2006 report by a U.S. Government Accountability Office, at least 700 registered sex offenders live among the estimated 1.5 million people in long-term care facilities. And even more concerning is the fact that few residents and families are even aware of the danger. Very few states have regulations concerning the notification of facilities and residents that a sex offender lives among them.
Recently more states have begun to evaluate the issue and consider legislation to require notification, and a subcommittee of the U.S. House of Representatives held a hearing on the matter.
Ray McDaniel believes that all facilities should be required to notify residents and their families if any residents are on the sex offender registry. McDaniel's 18-year-old daughter was admitted to a nursing home in 2005. 10 days later another resident, who was a registered sex offender, raped her. McDaniel had no idea that a sex offender lived in the facility because no one was required to tell him.
As a result of McDaniel's daughter's rape, the state of Ohio is close to passing a bill that would require facilities to post notice that a resident was a sex offender.
Oklahoma, California, Illinois, Minnesota, Oklahoma, and some counties in Florida either have or are considering some form of legislation related to long-term care residents who are registered sex offenders.
Posted on July 15, 2008 by Ray Mullman
The New Jersey Courier Post online had an
article about how nursing homes' populations are getting younger. Below is an excerpt from the article:
At 45, John Eickmeyer is the youngest resident of the New Jersey Veterans Memorial Home on North West Boulevard. His roommate is 86 and has advanced Alzheimer's disease. That disparity isn't unique to the veterans home.
Eickmeyer is one of a growing number of younger residents in long-term care facilities traditionally viewed as places for the elderly. At the veterans home, the average age of residents is 81.
But, 24 of the home's 290 residents -- or roughly 7 percent -- are under age 65. In December 2003, 12.4 percent of New Jersey nursing-home residents were under age 65, according to the Centers for Medicare & Medicaid Services. In December, 14.3 percent were 65 or younger.
Across the country, 12.3 percent of nursing-home residents were under age 65 in December 2003. Last year, that number increased to 13.9 percent. In all instances, the vast majority of those residents were over age 30.
Health-care experts said the number of younger residents in nursing homes and assisted-living facilities will continue to grow, creating new challenges for administrators who must find ways to provide quality of life for residents who might be a half-century apart in age.
At first, Eickmeyer found it hard to adjust to being lumped in with an older crowd.
"It was culture shock," said Eickmeyer, who grew up in Waterford and lived in Hammonton before moving in to the veterans home. He and some of the older residents disagreed on things as simple as room temperature. But, Eickmeyer eventually saw an upside to living with people old enough to be his grandparents.
"Thrown into an environment like that, you listen first," he said. "I figured I could learn a multitude of information from older people, and I did."
"Within the next 10 to 15 years, there will be more of an influx of those who served in Vietnam, Desert Storm and more recent conflicts," he said.
Reach Tim Zatzariny Jr. at tzatzariny@thedailyjournal.com
Posted on July 10, 2008 by Ray Mullman
CLARK KAUFFMAN at DesMoinesregister.com wrote an
article about a nursing home employee who stole a resident's cat. Luckily, the cat found his way back! The article states that the Iowa nursing home has been cited by the state for numerous problems, including the theft of a resident's pet cat.
Granger Nursing and Rehabilitation Center, located in Granger in Dallas County, was fined $7,500. Recently, investigators with the Iowa Department of Inspections and Appeals looked into allegations that employees at the home were attempting to get rid of an unnamed elderly resident's cat.
The woman told inspectors someone had taken her cat and put it outside, although the cat did not run away. Later, the resident alleged, someone at the home took the cat and dumped it along a gravel road. The cat allegedly found its way back to the facility. According to state records, inspectors interviewed seven employees, all of whom expressed concern that someone at the home intended to put the cat in the facility's trash bin and kill it.
One worker allegedly told inspectors that the staff had been trying to dispose of the cat. The worker said that one night, while the resident was eating supper, she entered the resident's room, placed the cat in a box and took it home for safekeeping. The worker said she intended to keep the cat only until she felt it could be safely returned to the nursing home.
Based on that worker's statement, state officials cited the home for taking a resident's property.
The Granger home has been cited for numerous other problems in recent months. Inspectors have alleged that:
•
A worker stole a resident's pain medication for her own use. The worker allegedly took the resident's Imitrix, a costly drug that is prescribed for the treatment of migraine headaches. The resident's insurer had paid for the drug at a rate of $26 per tablet.
The worker told inspectors she took the pills at the suggestion of the director of nursing. The director of nursing told inspectors she knew of only one instance in which the worker used the resident's medication. She acknowledged that she did not report the theft to police or to state inspectors.
• As inspectors watched, a resident who was totally dependent on employees for assistance with eating was given little or no help with breakfast. At one point, the resident motioned to workers, pointing to a cereal bowl. One worker stopped and put milk and sugar on the cereal but then walked away. Twenty minutes later, the resident reached for a worker as she passed, but the worker only paused and walked away with the resident still pointing at his or her plate. A few minutes later, the resident was wheeled out of the dining room with most of the food untouched. At lunch, workers again failed to assist the resident with eating.
• One resident was mistakenly given double the amount of prescribed insulin for diabetes treatment.
• The home was cited for failing to ensure that residents had ready access to drinking water and for inadequate infection control.
• Inspectors watched workers walk through urine while providing care for one resident.
• One resident walked out of the home and was later seen by a passer-by crawling along the shoulder of a nearby highway. The passer-by alerted workers at the home, who picked up the resident and took him to a hospital for evaluation.
The Granger home has 61 residents. Federal records indicate residents of the home receive, on average, 18 minutes of daily care from a registered nurse, which is half the average of all Iowa nursing homes.
Posted on July 10, 2008 by Ray Mullman
A recent Cornell University study reports aggression is commonplace in nursing homes--between residents themselves and between residents and employees of the nursing home. Verbal and physical abuse is more common than the industry acknowledges. In an online report with McKnight’s Long Term Care News, the study documents many observations made at a city-based nursing home which found at least 35 different types of abuse, with screaming being the most popular. Physical violence included pushing, punching, and fighting.
The report also referenced another two-week study wherein researchers found that 2.4 percent of nursing home residents have been victims of physical aggression; 7.3 percent claimed they were verbally abused. A third report discussed an investigation in which 12 nurse observers found 30 incidents of aggression between residents in one eight-hour shift. Victims were most commonly male and often had “wandering cognitive processing problems.”
A report released earlier this year by the Congressional Government Accountability Office (GAO) revealed a widespread “understatement of deficiencies,” that included malnutrition, severe bedsores, overuse of prescription medications, and nursing home resident abuse in the nation’s nursing home inspection reports. The report stated that nursing home inspectors routinely ignore or minimize problems that pose serious, immediate patient threats.
Facilities are generally only inspected once a year by overworked and underpaid state employees. Federal officials sometimes attempt to validate state inspector work by joining them on visits or conducting follow-ups. It was in a follow-up that the GAO discovered the state missed at least one serious deficiency in 15 percent of all inspections. Worse, in nine states, inspectors missed serious problems in over 25 percent from 2002 to 2007.
There are 16,400 nursing homes with over 1.5 million residents nationwide; approximately one-fifth of the homes were cited for serious deficiencies last year. “Poor quality of care—worsening pressure sores or untreated weight loss—in a small, but unacceptably high number of nursing homes, continues to harm residents or place them in immediate jeopardy, that is, at risk of death or serious injury,” the report said. Taxpayers spend about $72.5 billion annually to subsidize nursing home care and facilities must meet federal standards to participate in Medicaid and Medicare, which covers over two-thirds of its residents, at a cost of over $75 billion annually.
Unfortunately, nursing home abuse tends to be underreported because individual homes do not take elder abuse seriously and residents fear embarrassment, injury, even incapacitation for speaking up.
Posted on July 1, 2008 by Ray Mullman
A new article, 'Torts Provide Best Relief for Nursing Home Residents,' is now available free from Clifford Law Offices web site at http://www.cliffordlaw.com. The Chicago law office is posting legal articles on their website in an effort to educate the public about legal matters.
Torts Provide Best Relief for Nursing Home Residents
Clifford's Notes, Chicago Lawyer, 08/01/2005
By Robert A. Clifford
A man in his 70s with a psychotic disorder, known as someone who smokes in prohibited areas, sneaks out of his room in a Niles nursing home when two of the three nurses on duty are on a break.
He leaves the dementia unit and wanders into an unused wing of the hospital, where he lights a cigarette that causes most of the room to be engulfed in flames. He is burned over 25 percent of his body, and both of his legs have to be amputated.
Another nursing home in suburban Niles fails to adequately supervise a 71-year-old woman who falls down the stairs in her wheelchair.
In Chicago, a nursing-home care worker is charged with involuntary manslaughter earlier this year after she allegedly attacked a 62-year-old resident, dragging him out of bed and causing him to fall and break his hip. He dies of a heart attack a week later, and the Cook County Medical Examiner’s Office rules it a result of the stress of the assault.
Reports of nursing-home abuse appear to be on the rise for a number of reasons: the growing aging population, a greater cognizance of neglect and abuse of the elderly and the increasing specialized care for the aged. Projections of 2000 census data indicate that the elderly population will rise to 71 million Americans by 2030, more than twice the number counted in the 2000 census. By 2050, the elderly population is expected to reach nearly 87 million, comprising about 20 percent of the U.S. population.
Who is going to take care of all of the aged people, given the number of small families, divorced couples and working people? Much of the care will be left to the 18,000 nursing homes operating in this country.
Nursing homes did not really begin to develop until after World War II, when the federal government began licensing and regulating them. With the passage of Medicare and medicaid legislation in 1965 that authorized federal reimbursements for these homes, the number of beds soared, and nursing homes became big business, from private sole-proprietorship facilities to corporate chain operations.
Such facilities deal with residents’ needs ranging from rehabilitation to custodial care. Although a host of federal regulations are in place and administered under the U.S. Department of Health and Human Services, state governments are responsible for enforcing compliance with federal and state regulations. Generally, the state’s public health department conducts inspections.
When abuse and neglect occur, it is possible to bring a breach of contract action when residents and their families sign an agreement specifying a certain quality of care. But it is generally under state tort law that nursing home residents and their families appear to find the greatest satisfaction and relief.
In Illinois, the Nursing Home Care Act, 210 ILCS 45/1-101 (2005), deals with such facilities. When it was originally passed in 1979, it was hailed as the most comprehensive legislation in the nation dealing with long-term care. The act explains the conditions necessary to provide adequate long-term care and penalties for failing to meet them, with the most drastic remedy being license revocation and closing the facility.
Although such laws are necessary to protect the elderly, they do little for those who personally suffer harm. It is generally left to negligence standards to compensate those who suffer at the hands of nursing home workers. The courts, though, have made a distinction between professional negligence and ordinary negligence, both of which can occur in a nursing home facility.
For example in Myers v. Heritage Enterprises Inc., 354 Ill.App.3d 241, 820 N.E.2d 604 (4th Dist.2004), a 78-year-old resident of a downstate nursing home fractured both legs when she fell while being transported in a special lift. She died two weeks later, apparently of unrelated causes.
The executor of her estate filed a lawsuit alleging negligent transfer and supervision of the patient under the NHCA, as well as a common law negligence. The trial court instructed the jury, though, that only expert testimony could be used to determine if negligence occurred. "You must not attempt to determine this question from any personal knowledge you have," was part of the court’s instruction under I.P.I. 105.01.
On appeal, however, the court reversed and remanded, holding that the plaintiff was prejudiced by such an instruction. The court found that operation of the lift did not require expert testimony necessitating a professional negligence instruction. Jurors should have been allowed to use their own experience to decide if the nurses’ aides negligently dropped the woman.
In Harris v. Manor Healthcare Corporation, 111 Ill.2d 350, 489 N.E.2d 1374 (1986), the Illinois Supreme Court held that the term "adequate care" was synonymous with "ordinary care" or "reasonable care," thus denoting the use of an ordinary care standard of negligence in proceedings against nursing home attendants.
Illinois defines institutional abuse as, "Any physical or mental injury or sexual assault inflicted on a resident other than by accidental means in a facility," Ill. Admin. Code, Title 77, 300, 330 (1983). Malnutrition, bedsores, improper restraints, scalding in bath water or thermal blanket burns, even food poisoning are some of the institutional abuse that has been witnessed by the residents and their loved ones.
Robert Browning, the 19th century poet, once wrote, "Grow old along with me!/The best is yet to be./The last of life, for which the first was made:/Our times are in His hand."
Life in Illinois’ nursing homes may not live up to Browning’s ideal. It is left to the legal community to at least ensure that a decent quality of life for the elderly is sustained, particularly for those who often cannot take care of themselves.
Posted on June 29, 2008 by Ray Mullman
Interesting
article from the Courant.com about a deal to sell the bankrupt Haven Healthcare nursing-home chain. Attorney General Richard Blumenthal said that Formation Capital, which owns Genesis HealthCare, notified the state that it was pulling out of an $85 million deal to take over 14 of Haven's homes in Connecticut and 10 in other New England states, without giving a reason.
Formation announced June 12 that it had signed a purchase agreement for the homes, but the company had two weeks to reconsider before the deal was to be finalized in bankruptcy court Thursday.
Many nursing homes across the country are owned by real-estate investment firms and managed by other entities — a form of ownership called a REIT, or a real-estate investment trust. By law, a REIT cannot operate a nursing home, but must hire a licensed provider to do so.
"The former management of Haven is history. We are all committed to a new day for these nursing homes, their residents and their dedicated employees," Blumenthal said.
Blumenthal and officials of the state Department of Social Services said they and the health department will be closely monitoring operations of the Haven homes while the future of the chain remains in limbo. Occupancy in some Haven homes has fallen off dramatically since the chain declared bankruptcy seven months ago.
Haven — one of the largest chains in the state, with more than 1,800 beds — declared bankruptcy last November in the wake of a series in The Courant detailing its financial troubles and repeated citations for patient-care deficiencies.
The company defaulted on millions of dollars in bills for supplies and utilities while its CEO used corporate assets to launch a Nashville recording company and make other personal purchases.
The Department of Social Services had offered Genesis sizable Medicaid rate increases and other incentives to take over the chain, but also had required that Genesis agree to provide detailed financial reports and meet certain staffing standards once it took over operations.
Blumenthal said Thursday that a wide-ranging investigation of Haven's financial dealings will continue, regardless of the outcome of the sale of the chain.
Posted on June 25, 2008 by Ray Mullman
Below are excerpts of an interesting article about "Green Houses". A new approach to taking care of the elderly. The article is called: "Rising challenger takes on elder-care system" (06/24/08 Wall Street Journal) By Lucette Lagnado
In the spring of 2001, Bill Thomas, dressed in his usual sweat shirt and Birkenstock sandals, entered the buttoned-down halls of the Robert Wood Johnson Foundation. His message: Nursing homes need to be taken out of business. "It's time to turn out the lights," he declared.
Cautious but intrigued, foundation executives handed Dr. Thomas a modest $300,000 grant several months later. Now the country's fourth-largest philanthropy is throwing its considerable weight behind the 48-year-old physician's vision of "Green Houses," an eight-year-old movement to replace large nursing homes with small, homelike facilities for 10 to 12 residents. "We want to transform a broken system of care," says Jane Isaacs Lowe, who oversees the foundation's "Vulnerable Populations portfolio." "I don't want to be in a wheelchair in a hallway when I am 85."
The foundation's undertaking represents the most ambitious effort to date to turn a nice idea into a serious challenger to the nation's system of 16,000 nursing homes. To its proponents, Green Houses are nothing less than a revolution that could overthrow what they see as the rigid, impersonal, at times degrading life the elderly can experience at large institutions.
Green Houses face a host of hurdles. Plus, experts say the concept faces stiff resistance from many parts of the existing nursing-home system. Traditional nursing homes, many of which care for 100 to 200 patients, are predicated on economies of scale -- the larger the home, the cheaper it is to care for each individual resident.
"Robert Wood Johnson is making an important investment to try to make sure there is a sufficient cadre of early adopters of the Green House model -- and research to make sure the model is actually working," says Thomas Hamilton, who oversees nursing-home quality and regulatory issues for the Centers for Medicare & Medicaid Services. He says his agency is trying to coax nursing homes into changing their cultures and adopting more humane, "patient-centered" models such as the Green House.
The $122 billion nursing-home industry arose from the 1965 birth of Medicare and Medicaid, the government health-insurance programs for the elderly and poor that provide billions in government reimbursements. Made up of both not-for-profit and for-profit companies, the industry still generates most of its revenue from Medicaid and Medicare.
Ms. Lowe and her foundation colleagues began to shift that stance after their meeting with Dr. Thomas. A native of upstate New York, Dr. Thomas headed to Massachusetts to get his degree at Harvard Medical School, then returned to work as a doctor in a local nursing home. He says he was troubled by the experience. "I was distressed by the amount of emotional suffering that people were encountering even when they had good medical care," he says.
But it was Dr. Thomas's electric delivery -- officials liken him to an evangelist -- that got the group's attention. "Our energy needs to be around how to replace nursing homes. Not replace the building but replace the idea that older people can be taken away and put into an institution," Dr. Thomas recalls saying. He described his vision of homelike places where elderly residents could gather, dine together and sit before a blazing fire.
In 2003, Ms. Lowe traveled to Tupelo, Miss., where the first Green House had just opened, and says she marveled at how different it was from a well-regarded nursing home she'd previously visited. "Instead of thinking, 'I don't want to be here,' it was, 'How can I move in?'" she recalls.
Rebecca Maust, chief of the Division of Quality Assurance at the Ohio Health Department, says in a statement that the agency "fully supports" person-centered care but that Green Houses have to be on the same lot as the main nursing home to "ensure proper care of residents."
Mr. Hamilton of the Centers for Medicare & Medicaid Services says his agency doesn't think existing rules "represent any serious barriers" to the Green House model. He added that he wants to "maintain open lines of communication" to any parties who believe that a regulation is a barrier.
"There are providers who don't want to change because of the capital investment they've made," adds Larry Minnix, CEO of the American Association of Homes and Services for the Aging, which represents not-for-profits. But he says they need to. "Forty years ago, the paradigm was the 'minihospital' and that is what became the modern American nursing home," Mr. Minnix says. "That is not what is needed now."
Robert Jenkens, who is spearheading the Green House project at NCB Capital for Robert Wood Johnson, says that some not-for-profits and at least one for-profit believe the model to be financially viable. St. John's Lutheran Ministries in Billings, Mont., operates both a nursing home and some Green Houses. In an internal review, officials found that it cost $192 a day to care for a resident in the traditional nursing home versus $150 a day in their Green Houses.
Based on this "first round" of Green Houses, they believe that it is financially doable, but they are rigorously testing the model and developing software that should help providers determine whether they can handle Green Houses financially. "Green House belongs to the tradition of finding the better product, of building the better mousetrap," he says.
Posted on June 18, 2008 by Ray Mullman
NEWS RELEASE
Ken Powers
Media Relations Manager
630-792-5175
kpowers@jointcommission.org
The Joint Commission Announces 2009 National Patient Safety Goals
for Long Term Care Organizations
(OAKBROOK TERRACE, Ill. – June 17, 2008) The Joint Commission today announced the 2009 National Patient Safety Goals and related requirements for accredited long term care organizations. The National Patient Safety Goals promote specific improvements in patient safety by providing health care organizations with proven solutions to persistent patient safety problems. These Goals apply to the more than 15,000 Joint Commission-accredited and -certified health care organizations and programs.
Major changes include a new requirement related to preventing deadly central line-associated bloodstream infections. This addition builds on an existing National Patient Safety Goal to reduce the risk of health care associated infections, and recognizes that patients continue to acquire preventable infections at an alarming rate while receiving health care. The new infection-related requirement has a one-year phase-in period that includes defined milestones, with full implementation expected by January 1, 2010.
“The 2009 National Patient Safety Goals represent ongoing opportunities for improvement that can immediately benefit patients,” says Mark R. Chassin, M.D., M.P.P., M.P.H., president, The Joint Commission. “By taking action to consistently meet the Goals, health care organizations can substantially improve patient safety in America.”
A revision of the requirements for the existing medication reconciliation Goal is based on feedback obtained from a Medication Reconciliation Summit convened in late 2007 and is included in the 2009 update.
The 2009 Long Term Care National Patient Safety Goals:
Improve the accuracy of resident identification.
· Use at least two resident identifiers when providing care, treatment, and services.
· Prior to the start of any surgical or invasive procedure, individuals involved in the procedure conduct a final verification process, such as a time-out, to confirm the correct resident, procedure and site, using active, not passive, communication techniques.
Improve the effectiveness of communication among caregivers.
· For verbal or telephone orders or for telephone reporting of critical test results, the individual giving the order verifies the complete order or test result by having the person receiving information record and “read-back” the complete order or test result.
· There is a standardized list of abbreviations, acronyms, symbols, and dose designations that are not to be used throughout the organization.
· The organization measures, assesses, and, if needed, takes action to improve the timeliness of reporting, and the timeliness of receipt of critical tests and critical results and values by the responsible licensed caregiver.
· The organization implements a standardized approach to hand-off communications, including an opportunity to ask and respond to questions.
Improve the safety of using medications.
· The organization identifies and, at a minimum, annually reviews a list of look-alike/sound-alike medications used in the organization, and takes action to prevent errors involving the interchange of these medications.
· Reduce the likelihood of resident harm associated with the use of anticoagulation therapy. (Note: This requirement applies only to organizations that provide anticoagulation therapy and/or long-term anticoagulation prophylaxis (for example, atrial fibrillation) where the clinical expectation is that the resident’s laboratory values for coagulation will remain outside normal values. This requirement does not apply to routine situations where short-term prophylactic anticoagulation is used for venous thrombo-embolism prevention (for example, related to procedures or hospitalization) and the clinical expectation is that the resident’s laboratory values for coagulation will remain within, or close to, normal values.
Reduce the risk of health care-associated infections.
· Comply with current World Health Organization (WHO) hand hygiene guidelines or Centers for Disease Control and Prevention (CDC) hand hygiene guidelines.
· Manage as sentinel events all identified cases of unanticipated death or major permanent loss of
function related to a health care associated infection.
· Implement best practices or evidence-based guidelines to prevent central line-associated bloodstream infections. Note: This requirement covers short and long term central venous catheters and PICC lines.
Accurately and completely reconcile medications across the continuum of care.
A process exists for comparing the resident’s current medications with those ordered for the resident while under the care of the organization.
When a resident is referred or transferred from one organization to another, the complete and reconciled list of medications is communicated to the next provider of service and the communication is documented. Alternatively, when a resident leaves the organization’s care directly to his or her home, the complete and reconciled list of medications is provided to the resident’s known primary care provider, or the original referring provider, or a known next provider of service. (Note: When the next provider of service is unknown or when no known formal relationship is planned with a next provider, giving the resident, and family as needed, the list of reconciled medications is sufficient.)
When a resident leaves the organization’s care, a complete and reconciled list of the resident’s medications is provided directly to the resident, and the resident’s family as needed, and the list is explained to the resident and/or family.
In settings where medications are used minimally, or prescribed for a short duration, modified medication reconciliation processes are performed. Note: This requirement does not apply to organizations that do not administer medications. However, it is important for health care organizations to know what types of medications their residents are taking because these medications could affect the care, treatment, and services provided.
Reduce the risk of resident harm resulting from falls.
· The organization implements a fall reduction program that includes an evaluation of the effectiveness of the program.
Reduce the risk of influenza and pneumococcal disease in institutionalized older adults.
· The organization develops and implements protocols for administration of the flu vaccine.
· The organization develops and implements protocols for administration of the pneumococcus vaccine.
· The organization develops and implements protocols to identify new cases of influenza and to manage outbreaks.
Encourage residents’ active involvement in their own care as a resident safety strategy.
· Identify the ways in which the resident and his or her family can report concerns about safety and encourage them to do so.
Prevent health care associated pressure ulcers (decubitus ulcers).
· Assess and periodically reassess each resident’s risk for developing a pressure ulcer (decubitus ulcer) and take action to address any identified risks.
The development, annual review and modification of the National Patient Safety Goals, first introduced in 2003, is overseen by the Sentinel Event Advisory Group, a panel that includes widely recognized patient safety experts, nurses, physicians, pharmacists, risk managers and other professionals who have hands-on experience in addressing patient safety issues in hospitals and other health care settings. Each year, this panel works with The Joint Commission to undertake a systematic review of the literature and available databases to identify potential new Goals and requirements. The Joint Commission also conducts an extensive field review of candidate new Goals and seeks input from practitioners, provider organizations, purchasers, and consumer groups among others. The Joint Commission’s Board of Commissioners approves the Goals and requirements each year. Compliance with the requirements is a condition of continuing accreditation or certification for Joint Commission-accredited and -certified organizations.
The full text of the 2009 National Patient Safety Goals and requirements for all accreditation programs, along with the elements of performance, can be found on The Joint Commission’s website. Compliance with the requirements is a condition of continuing accreditation or certification for Joint Commission-accredited and -certified organizations.
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Posted on June 16, 2008 by Ray Mullman
Mother Jones had an interesting article about Ken Connor, the conservative Christian Republican who testified in support of a bill that would ban the use of mandatory binding arbitration clauses in nursing home contracts. Most nursing homes today, as a condition of admission, force vulnerable elderly people to waive their right to a jury trial. Instead, they must take any complaints about neglect or abuse to a private arbitrator, chosen and paid by the nursing home, in secret proceedings where awards are much lower. The arbitration agreements are often buried in a stack of complicated paperwork, where in some cases, they have been signed by blind people and those suffering from Alzheimer's.
The nursing home arbitration bill should pass overwhelmingly. That's why Republicans really, really don't want to vote for the nursing home bill, and one reason Connor's advocacy is making them squirm. Connor sues nursing homes for a living. Just last month, Connor won a $2 million verdict against Sunrise Senior Living in California for failing to prevent and care for an elderly woman's fatal bedsores. . As such, Republicans would love to dismiss Connor as just another greedy trial lawyer. But Connor's religious-right bona fides simply make that impossible.
For three years, Connor served as the president of the Family Research Council, a leading social conservative outfit, and became a rock star among the GOP’s evangelical wing when he went to work in 2004 for then-Governor Jeb Bush to defend a Florida law that would have prevented doctors from removing Terri Schiavo's feeding tube. For Republican legislators, Connor has moral authority. He also gives money to many of them, so Republicans have to tolerate him, even as he forces them into a corner where they have to chose between devotion to industry and devotion to God and life.
While the GOP views trial lawyers as its mortal enemies, Connor doesn't see any contradiction between his profession and role as family values crusader. Instead, he sees his lawsuits against nursing homes as an extension of the work he did in the Schiavo case. "Removing the feeding tube, letting Teri Schiavo starve to death," he said in an interview, "I see this all the time with the elderly." Connor believes that the frail elderly are second only to the unborn in their suffering due to what he sees as a prevailing "quality of life" mindset, as opposed to one focused on the sanctity of life. He says he's witnessed bioethicists in Florida argue that if an elderly person suffers from dementia, there would be nothing wrong with hastening his or her demise. "If you call yourself a Christian, you have an obligation to fight for social justice," he says, noting that, "It's much easier to make the case for the elderly than for the unborn."
He testified about some of his experiences with nursing homes: "All too often, the story is the same: avoidable pressure ulcers (bed sores) penetrating to the bone; wounds with dirty bandages that are infected and foul smelling; patients languishing in urine and feces for hours on end; hollow-eyed residents suffering from avoidable malnutrition, unable to ask for help because their tongues are parched and swollen from preventable dehydration; dirty catheters clogged with crystalline sediment and yellow-green urine in the bag."
Continue Reading...
Posted on May 29, 2008 by Ray Mullman
Politico's Samuel Loewenberg wrote an article about how high priced lobbyists are attempting to get rid of necessary reforms for nursing home care to improve.
The profitable nursing home industry is mobilizing Washington’s most well-connected lobbyists to fight needed reforms, Recently state and federal investigators and outside experts have agreed to certain reforms as a gaggle of industry lobbyists plotted strategy.
Among the lobbysts was The Carlyle Group, the politically connected and powerful private equity firm that recently bought Manor Care, one of the nation’s largest nursing home chain, for $6.3 billion.
“In spite of existing oversight mechanisms, we continue to see examples of horrific treatment of nursing home residents,” testified Lewis Morris, general counsel for the Department of Health and Human Services’ Office of the Inspector General.
The lobbyists are carefully watching the Senate, where legislation could increase the oversight and enforcement of the industry. It is well documented how deficient the oversight and enforcement of the industry is as evidenced by the recent GAO Report. The senators are expected to try to attach the legislation to the upcoming Medicare payments package.
The industry lobbyists are fighting provisions to fully disclose ownership of nursing homes. Why? No one knows. Clearly, families of residents should be able to understand who owns and operates the facility where they place loved ones.
Additionally, penalties would be increased to as much as $100,000 if a patient is harmed or dies due to poor care. The penalties, which have not been changed in two decades, are now capped at $10,000.
To gird for the increased regulation, the industry is using a half-dozen of Washington’s most politically potent lobbying firms on both sides of the aisle. “It is going to be pretty much battening down the hatches, because we’re not going to have a fair shake with a Democratic majority,” said a nursing home industry lobbyist who spoke on the condition of anonymity.
Since Carlyle took over Manor Care, some homes have reported significant patient care problems, said SEIU spokeswoman Julie Eisenhardt. Meanwhile lobbyists for The Carlyle Group are stating that there is no evidence that private equity ownership negatively impacts care. Both the Government Accountability Office and the Senate Finance Committee are still investigating the negative effect of private equity ownership on nursing home quality.
The issue is at the heart of one of the most controversial parts of the Grassley-Kohl legislation: a requirement that the sometimes-twisted ownership structures of nursing homes be made more transparent. Congressional staff, experts, and advocates for the elderly say that private equity firms often establish layers in ownership structure as a way to dodge responsibility and legal liability.
And GAO reported how federal government regulators often miss signs of abuse and care deficiencies, ranging from failure to ensure “proper nutrition and hydration and [prevent] pressure sores” to serious deficiencies that could lead to “actual harm and immediate jeopardy.”
Posted on May 15, 2008 by Ray Mullman
Here is a link to the recent GAO Report that shows a lack of investigation into nursing home neglect and abuse. The NY Times ran a great article on this report. Below are some excerpts from that article.
Nursing home inspectors routinely overlook or minimize problems that pose a serious, immediate threat to patients, Congressional investigators say in a new report. In the report, the investigators from the Government Accountability Office, say they have found widespread “understatement of deficiencies,” including malnutrition, severe bedsores, overuse of prescription medications and abuse of nursing home residents.
The accountability office found that state employees had missed at least one serious deficiency in 15 percent of the inspections checked by federal officials. In nine states, inspectors missed serious problems in more than 25 percent of the surveys analyzed from 2002 to 2007.
The nine states most likely to miss serious deficiencies were Alabama, Arizona, Missouri, New Mexico, Oklahoma, South Carolina, South Dakota, Tennessee and Wyoming, the report said.
“Poor quality of care — worsening pressure sores or untreated weight loss — in a small but unacceptably high number of nursing homes continues to harm residents or place them in immediate jeopardy, that is, at risk of death or serious injury,” the report said. Nursing homes must meet federal standards as a condition of participating in Medicaid and Medicare.
Lewis Morris, chief counsel to the inspector general of the Department of Health and Human Services, said he had often been frustrated in trying to identify the owners of nursing homes that provided substandard care. “We have found nursing home residents who were grossly dehydrated or malnourished,” Mr. Morris said. “We’ve found patients with maggot infestations in wounds and dead flesh. We’ve found residents with broken bones that went unmended.”
Posted on April 17, 2008 by Ray Mullman
William C. Lhotka of the St. louis Post-dispatch wrote an article about a Judge preventing a nursing home from evicting a resident from a nursing home. Below is an excerpt of his article:
A judge has barred an Ellisville nursing home from discharging a resident in a billing dispute because of the possible traumatic effects of transferring her to another care facility. The judge found for the family of Barbara H. Lindsay and against Bethesda Long Term Care Inc. which operates Bethesda Meadow. The ruling means the nursing home cannot move Lindsay to another nursing home when Bethesda alleged Lindsay's family owed the company past due bills.
Lindsay's son Douglas contended that the bill was erroneous and that his mother was too fragile to move. Jacqueline Levey, attorney for the Lindsays, argued before Vincent that "any nursing facility wishing to expel an elderly or disabled resident can simply manufacture a series of grossly inaccurate billing statements."
Bethesda lawyer James W. Erwin had contended that some billing errors by Bethesda didn't negate the failure of the Lindsay family to make payments. On the day before the hearing in October, the Lindsay family paid its bill in full. Nonetheless, the nursing home proceeded with the discharge, said Levey, the family's lawyer.
Vincent cited medical testimony in his order that Barbara Lindsay "is very fragile and has very little strength." The judge said the nursing home provided no evidence that "a safe and orderly discharge could be accomplished."
Posted on April 17, 2008 by Ray Mullman
Below is an excerpt of an article I recently saw from The Choate News about how California nursing homes used an increase in reimbursements from the State for profit instead of providing adequate care.
Nursing Home Pocket Money Meant For Care
By Jordan Rau
SACRAMENTO, Calif. -- California’s nursing homes pocketed much of the $590 million that state lawmakers provided them to better tend to low-income people, while patient care declined by several key measures, according to a study to be released Tuesday.
A law boosting reimbursements from MediCal, the state’s health-care program for poor people, passed in 2004. By 2006, the first full year the higher rates were in place, average nursing-home revenues from MediCal had increased from $124 a day to $152 per day, according to the study by a team of researchers at the University of California, San Francisco -- but few of the promised improvements for patients or staff had come to pass.
Nursing attention for patients grew, on average, by 3 percent. But the study also found that 144 homes, or 16 percent, did not meet the state’s minimum staffing standard.
Average wages for nursing assistants increased from $10.61 an hour to $11.32, not quite enough to keep pace with inflation, the study said. Turnover among nurses grew slightly worse, with nearly 7 in 10 leaving their jobs that year.
The amount nursing homes spent on direct patient care actually decreased by 3.6 percent, according to the study. Substantiated complaints of patient mistreatment increased by 38 percent. State and federal regulators cited homes for 6 percent more violations.
“They got so much money, they should have been able to do something,” said the study’s lead author, Charlene Harrington, a UCSF professor and nationally recognized authority on nursing homes. “The fact that they let the nursing-assistant wages actually decline with inflation, I think there’s no excuse for that,” Harrington said. “They’re the bulk of the workers and they’re the lowest paid.”
The higher reimbursement rates were pushed through the Legislature in the final two weeks of its 2004 session by a powerful alliance between the nursing-home industry and Service Employees International Union, which represents many health-care workers.
At the time, several nursing-home advocates objected that the measure lacked sufficient safeguards to ensure that the money went to patient care.
Along with more money, the new law changed the way facilities were reimbursed from a flat fee for each patient to one based on how much the homes spent on workers, patients and the physical plant. Supporters pledged that the change would reward homes that hired more nurses and paid them better.
The average nursing home netted $248,047 in 2006, a 233 percent increase from 2004, the study said. The study found some areas where nursing-home spending did increase substantially.
For example, administrators’ wages rose by 13 percent, and the pay for licensed nurses -- who have more training than assistants -- grew by 9 percent.
Nonprofit nursing homes raised their wages more than for-profit homes. Still, said Michael Connors of California Advocates for Nursing Home Reform, a patient watchdog group, “to a great degree, no one knows where the money went and how it was used. What’s clear is it hasn’t been used for beneficial effects on residents, which is appalling.”
Posted on April 10, 2008 by Ray Mullman
Here is an article from Long Term Living online editor John Oberlin that indicates that the economic slowdown will not affect the profits by the nursing home industry. Cambridge Chairman Jeffrey A. Davis points out that all components of the senior housing sector appear to be in good shape, with nursing homes, assisted living, and independent living facilities all at their highest occupancy levels in years
Although the economy apparently is at a tipping point, the outlook for the senior housing/healthcare industry remains remarkably upbeat, one industry expert maintains.
"While no industry is completely recession-proof, owners and operators of senior housing/healthcare properties are better positioned to deal with an economic downturn than they've been at other periods in the past," believes Jeffrey A. Davis, chairman of Cambridge Realty Capital Companies, a senior/healthcare debt and equity financing firm.
"Historically, the pattern has been for the industry to go through debilitating boom/bust cycles. However, at this time, there's no over-building and occupancy levels for all product types are high," he observes.
Davis points out that all components of the senior housing sector appear to be in good shape, with nursing homes, assisted living, and independent living facilities all at their highest occupancy levels in years.
"This time around, there has been significant restraint regarding new construction. Generally speaking, management appears to be more enlightened in this regard and consumers more aware of the expanding range of products available to them. Even if the economy tanks, the industry will not be as vulnerable as some other segments of the commercial real estate market because there hasn't been an artificial demand component working against sound economic judgment," he said.
"Going forward, capital will continue to be available but more constrained in 2008. The crisis in confidence has impacted various lenders in different ways, and underwriting criteria has become more stringent across-the-board.
"But credit will be available from sources attracted to the industry by its long-term outlook. Investors and commercial lenders notice that demographics for the industry continue to move in a positive direction, and that the product that has emerged in the marketplace today has a much broader appeal to users than it did 25 years ago," he said.
HUD has emerged as the preeminent lender of choice for qualified borrowers in the skilled nursing home and assisted living segments and continues to solidify its role as a capital provider to under-served markets. But capital will also be coming from a variety of other sources, including Fannie Mae, Freddie Mac, commercial banks, insurance companies, private equity firms, and credit companies, he noted.
Posted on April 8, 2008 by Ray Mullman
Oklahoma Center for Consumer & Patient Safety
PO Box 4481, Tulsa, OK 74159-0481
FOR IMMEDIATE RELEASE:
Contact: Hugh M. Robert, Ex Dir 918-850-0293 hugh@okccps.org
April 7, 2008
HOUSE COMMITTEE KILLS NURSING HOME INSURANCE REQUIREMENT:
REPLACES BILL TO FAVOR COMMITTEE CHAIR
Tulsa, OK – The Public Health Committee in the Oklahoma House of Representatives considered the amended version of the bi-partisan approved Senate Bill 1549 this morning.
Just minutes before the committee meeting was scheduled to begin, Representative Cox, the owner of several nursing homes, submitted a committee substitute which stripped out the insurance requirement. The committee members voted 10-9 to consider the committee substitute, falling one vote short of being able to hear the bill in the form already approved by the Senate.
“It is sad that Dr. Cox put his personal financial interest in front of requiring nursing homes be financially responsible,” said Hugh M. Robert, Executive Director of the Oklahoma Center for Consumer and Patient Safety. Robert went on to say “the Oklahoma Senate had overwhelmingly supported the amended bill and
Dr. Cox, who purportedly operates his nursing homes without insurance, today showed his personal financial interest is more important to him than protecting his constituents or the citizens of the State of Oklahoma.”
The amended bill would have required nursing home operators to prove they have sufficient assets to cover claims of resident abuse or neglect. If the nursing home operator fails to keep sufficient assets and does not carry liability insurance the officers, directors and shareholders of the nursing home operator would be personally liable to a nursing home resident or their family when someone is abused or neglected.
One reason Dr. Cox as well as the nursing home lobby has cited for not carrying insurance is that the Medicaid reimbursement levels not being high enough to provide the owners with large profits and pay for insurance. However, this does not take into account the private pay residents and if the issue is with reimbursement rates, then Dr. Cox, in his capacity as a representative should work on reimbursement rates, not blocking a resident or family of a resident from holding responsible a nursing home who abuses or neglects a loved one.
If a nursing home resident is neglected or abused they should have a remedy. Robert comments “we require people who drive cars to carry mandatory insurance, why should nursing homes be any different.” “Forcing nursing home operators to show they are financially sound in order to have a license to take care of our elderly citizens just makes common sense, especially with the growing elderly population” Robert says. Most nursing home operators are for profit and carrying liability insurance is a legitimate cost of doing business. A nursing home does not have to choose between providing good care and being financially responsible, they should be required to do both.
About the Oklahoma Center for Consumer and Patient Safety- Please call 800-994-6025 or visit www.okccps.org.
Posted on March 25, 2008 by Ray Mullman
Below is an excerpt from a great article from Dallas News about family councils in Texas. The relatives of Texas nursing home residents have discovered there's strength in numbers. Emboldened by a new state law, they've begun to organize more "family councils" at their nursing homes to advocate for better care.
"My mother was the one who taught me how to stand up and speak out, so it's only fitting that I now step in for her," said Daisy Kincheloe, who knew she had to do something after her elderly mother fell at Doctors Healthcare Center in North Dallas. Her mother's accident was the last straw. Before that, she had discovered other problems that convinced her that some staff members weren't paying enough attention.
Ms. Kincheloe and other families at Doctors have just formed the group to give each other moral support, act as added sets of eyes and ears around the nursing home, and bring grievances to the administration's attention. By presenting a united front, family councils have persuaded nursing homes to respond more quickly to residents' call buttons, improve the meals and even hire more staff. Family councils are enjoying renewed attention nationwide because many of their newer leaders are baby boomers, whose generation is known for its activism.
Though administrators occasionally resist the councils at first, a growing number say they welcome the groups because they encourage family participation and accountability from staff.
Many families hesitate to bring up problems because they're afraid the nursing home staff will retaliate against their relatives. Others complain but find their grievances fall on deaf ears. A family council can add weight to a complaint, advocates say.
HOW TO ORGANIZE A FAMILY COUNCIL
1. Determine the need. As few as two or three families can organize a council.
2. Advise the administrator. By law, nursing homes must provide private meeting space for councils.
3. Notify other families. Meeting announcements can be posted on bulletin boards. Administrators may also offer to mail notices.
4. Ask advocacy groups and the local ombudsman for help. Advocates and the state ombudsman program's local representative can explain nursing home residents' rights.
5. Hold your first meeting. Discuss the council's purpose, ask the ombudsman to talk about the grievance process and invite the administrator to speak.
Posted on March 24, 2008 by Ray Mullman
There is a great article about the use of the game Wii to help residents with socialization and physical therapyin nursing homes. Wii-hab is the name of the game sweeping nursing homes across the region.
Morrell Nursing & Rehab Center in Hartsville and Bethea Baptist in Darlington are among the long-term care facilities taking part in the craze, much to the delight of their residents. The new Wii-hab program uses the Nintendo Wii to promote exercise at the facility.
The favorite game is Wii bowling, because it allows the residents to exercise upper body despite physical limitations. Residents and staff alike gather in the center’s sunny activities room to both play and watch others play such Wii games as bowling, tennis, baseball and boxing.
Mary Etheredge, activities director at Morrell, is the person responsible for bringing the program to all three of Wilson Senior Care’s facilities in the Pee Dee. She said so far, the program has been a great success. Etheredge said the biggest challenge so far has been getting the male residents to participate. The exercise from the Wii-hab is deceptively easy for many of the residents, Etheredge said, almost tricking them into doing rehab to make their daily lives easier.
“When they’re doing this, they really don’t realize how much they are moving,” she said. “It has them concentrating. They have to watch their eye and hand movement. It really works.”
While the tournament was going on, residents and employees gathered around Hopkins and Woodham to cheer them on with yells and clapping.
Etheredge said that sort of involvement has become almost commonplace since the Wii-hab program began at the facility. She said the Wii-hab program has made a difference in the quality of life for residents and it’s a change she plans on keeping around for a long time.
Hopefully this will become standard practice at other nursing homes.
Posted on March 19, 2008 by Ray Mullman
Randy Ellis staff writer for NewsOk.com has a sad story about a neglected resident who did not get questions or compensation because the nursing home had no assets and no liability insurance. Below are excerpts of the story:
The story refers to a family who received a telephone call that their mother had been injured at The Gardens nursing home in Sapulpa. Hospital X-rays revealed her mother had suffered spiral fractures to both legs. Since that type of injury often is caused by abuse or neglect, the family sued the nursing home to get answers about what happened. However, the nursing home had no medical liability insurance coverage.
The number of nursing homes that have dropped medical liability insurance coverage has skyrocketed in recent years. There are now at least 56 uninsured homes with 6,621 beds, according to the Tulsa-based Oklahoma Center for Consumer & Patient Safety.
"Based on information provided to the Center, over 20 percent of the beds in Oklahoma are in nursing homes that refuse to carry insurance,” said Hugh M. Robert, executive director of the nonprofit group. "A state study last year speculated the number may be as high as 65 percent.”
Legislation introduced by Sen. Richard Lerblance, D-Hartshorne, would require nursing homes either to carry medical liability insurance or prove they have sufficient assets to pay substantial damages if they are found responsible for injuries caused by abuse or neglect. It is difficult for consumers to discover that information on their own because nursing home owners often play a "corporate shell game."
One woman had maggots crawling out of her air cast because employees at her Oklahoma City nursing home had not cleaned beneath it and open pressure sores had developed. An Edmond nursing home patient was left on a bed pan so long her tail bone stuck to it, and a woman at a Frederick nursing home died after becoming so dehydrated that her tongue stuck to the roof of her mouth, attorneys said.
Posted on March 12, 2008 by Ray Mullman
McKnight's has an article about the average price paid per bed for skilled nursing facilities hitting a new record in 2007.
The average of $55,200 was 6% higher compared with the year before and 75% more than the notable low of 2003, according to analysis results from research firm Irving Levin Associates.
As more investment groups own long-term care properties, valuations and loan volume in the sector soared to record highs. The median SNF bed price leaped 15% in 2007 buoyed by billion-dollar deals involving major nursing home chains going private.
The average sales price for assisted living units also hit a new high $159,100 in 2007, 20% higher than the year before. Independent living unit prices also rose 20% in 2007, to $174,500 per unit, another record, according to the report.
Posted on March 10, 2008 by Ray Mullman
Connecticut Attorney General Richard Blumenthal wrote an editorial about the nursing home industry. We have included it below.
Recent revelations of shameless self-dealing, massive mismanagement and substandard care at one of the state's largest nursing home chains, Haven Healthcare, have rightly shocked the public. Haven, which operates 15 nursing homes in the state, received tens of millions in taxpayer dollars, but often failed to pay its medical and other suppliers, even at times its utility bills.
When it came to patient care, managers constantly cut corners, endangering residents' health and well-being. Adding insult to injury, Haven CEO Ray Termini improperly diverted money to fund his fantasy of becoming a country music mogul. Termini's name for his failed label — Category Five —proved prescient: His mismanagement devastated Haven like a Category 5 hurricane.
After The Courant broke this story, causing Haven to seek bankruptcy protection, my office successfully sought appointment of a chief restructuring officer who is currently supervising the chain's operations until a responsible buyer is found and a patient care officer has stabilized and improved care at the facilities. This remedy required a Herculean legal battle, which took tremendous time and determination from my office, as well as the court. In addition to wasting state tax dollars and endangering residents, this abysmal episode exposed severe deficiencies in state oversight of nursing homes.
Haven's secret self-serving diversion of scarce resources exemplifies the dark side of nursing home consolidation, leading to a fiscal debacle and endangering patient well-being. As nursing homes are swallowed by corporate chains and conglomerates such as Haven, state supervision becomes more difficult. Byzantine corporate constellations — like the 45 interlocking entities established by Haven's owners — conceal and confuse, frustrating accountability and oversight. Such improper practices must be prevented, not just punished.
The state must demand more financial disclosure and transparency to prevent plunder of nursing home assets. To forestall future bankruptcies or insolvencies — as happened to Haven — the state should impose expanded auditing and reporting requirements, prohibitions on bleeding or abuse of resources, accountability of landlords and other measures that safeguard public dollars and cents — the lifeblood of patient care.
Symptoms of fiscal crisis should immediately land nursing homes on a watch list with the same stringent monitoring and scrutiny as a patient in intensive care, and with prompt state intervention when necessary. I have proposed a package of reforms to guard against abuses, better protect patients and ensure that state tax dollars are properly spent.
My proposals include:
• Empower the state comptroller to monitor and review nursing home finances through regular forensic financial audits of nursing homes and their owners. The comptroller could subpoena records, compel testimony and review financial information of nursing home operators and their affiliates.
• Provide for a court-appointed receiver upon a finding of gross financial mismanagement. Currently, a receiver may only be appointed if financial mismanagement threatens patient care — a higher bar that hindered our ability to obtain a receiver for Haven sooner.
• Cap management fees and rental payments that nursing homes pay to related entities at the amount allowed under Medicaid reimbursement rates and prohibit use of nursing home assets as collateral for loans unrelated to operations. This step will prevent nursing home affiliates from soaking taxpayers through sweetheart contracts with related management or landlord companies.
• Require a minimum level of malpractice and liability insurance coverage for nursing home owners and management companies.
• Clarify and strengthen the state Department of Public Health's authority to regulate and approve nursing ownership structures and agreements. As happened with Haven, nursing home operators too often disperse ownership among numerous limited liability corporations, affiliates, subsidiaries and wholly owned partnerships — hindering efforts to identify, evaluate and hold accountable a home's real owner.
• Make landlords legally responsible for nursing home repairs and maintenance. The health department should also be authorized to seek appointment of a building monitor to do repairs and divert rent to pay for the work if the home's owner fails or refuses to do it.
Massive nursing home conglomerates like Haven Healthcare are leaving mountains of financial ruin after squandering massive public funding, imperiling patient care and safety. The regulatory landscape of nursing homes in Connecticut must be reformed to halt these abuses.
Posted on March 3, 2008 by Ray Mullman
A newly released poll from Zogby International shows that 63% of respondents oppose President Bush's proposed nursing home Medicare cuts.
Also, 61% of those surveyed would be less likely to vote to re-elect their representative in Congress if he or she voted for the president's plan containing Medicare reductions. Bush's proposed budget would slash $24 billion to the nursing home benefit over five years. Zogby conducted the poll for the American Health Care Association, a major lobbying group for the nursing home industry.
Other results of the poll: 50% of respondents say that any nursing home benefit cuts would have "a negative impact on the quality of care for seniors" and 73% say they would support a presidential candidate who will not reduce Medicare funding for nursing homes.
Posted on February 26, 2008 by Ray Mullman
Brandunson.com has an article about Extendicare REIT reporting fourth quarter profits of $10.5 million. Revenue in the quarter totalled $469.7 million, up from $453 million.
Extendicare REIT, through its owned subsidiaries, operates 269 nursing and assisted living facilities in North America as well as medical specialty services.
For the full year, Extendicare earned $70.4 million or $1 per diluted share on $1.8 billion in revenue. That compared with a loss of $35.7 million or 53 cents per diluted share on $1.73 billion in revenue in 2006. Shares in Extendicare, which released its results after the close of markets, were down 18 cents at $11.30 on the Toronto Stock Exchange.
This shows that nursing homes are very profitable even during bad economic times. It also shows there is no need for ridiculous caps on damages.
Posted on February 26, 2008 by Ray Mullman
KDBC in Texas ran a
story about a new study that suggests the overuse of antibiotics in dementia patients contributes to drug-resistant germs. In the study published in Archives of Internal Medicine, more than 200 people with advanced dementia were followed for 18 months. Almost half died before the study finished.
Researchers found 42% received antibiotics within two weeks of their deaths.
Antibiotic overuse spurs on the potentially fatal drug-resistant bugs like MRSA. Past studies have suggested that nursing homes are favored stomping grounds for the super germs. The study's co-author says doctors should discuss antibiotics with family, just as they would discuss placing a feeding tube.
Posted on February 26, 2008 by Ray Mullman
The Tennessean has a great
editorial about the legislation that will protect nursing homes who abuse and neglect residents. Below is a summary of the editorial.
Nursing home operators are begging the General Assembly to grant them special protections from lawsuits that might be filed by residents who are seriously wronged under their care. What the owners want is a law that would allow nursing homes to force residents to waive their constitutional right to a jury trial and sign arbitration agreements as a prerequisite for being admitted, and they want caps on how much money a jury could award to a resident in a case against the nursing home.
This effort by the nursing home industry takes a lot of nerve. The state suspended admissions at 22 nursing homes in 2007, which was twice as many as in the previous year and three times the amount in 2005. Hundreds of residents were displaced last year because of serious health and safety violations that caused those homes to lose federal funds. Yet in this environment, the nursing home industry wants special protection from lawsuits.
Posted on February 20, 2008 by Ray Mullman
McKnight's website has an article about Medicare overpayments (i.e. fraud) to nursing homes and estimate that the amount could be $130 million. Where did all the money go?
The federal investigation into these overpayments state that the Medicare program might have paid too much for hospital and laboratory services including double payments for services. As a result of its findings, OIG recommended (not ordered) that the Centers for Medicare & Medicaid Services instruct payment contractors to "re-examine" records for overpayments and then move to recover them where appropriate. It also suggested CMS test and refine payment system protocols designed to identify such overpayments.
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The full audit report is available at http://www.oig.hhs.gov/oas/reports/region1/10600503.pdf.
Posted on February 20, 2008 by Ray Mullman
KSPR News has an article about a nursing home in Kansas that has introduced the video game Nintendo Wii to the residents. This assists them in mobility, activity, and social interaction. The activities director says a group of nursing home residents stay young by playing a game meant for their grandkids. The activity room at the Ozark Nursing and Care Center is packed when it’s time for Wii. When they play Wii, a light weight controller allows them to play a game they normally couldn't. There are more than physical benefits. It gives the residents a sense of life outside the skilled nursing center.
The activities director says they're sticking with bowling for now because it’s the easiest. They'd like to slowly introduce boxing and Guitar Hero. I hope this becomes universal in all nursing homes.
Posted on February 12, 2008 by Ray Mullman
Washington Post has a great article by Marie-Therese Connolly about demographics and elderly abuse. Ms. Connolly worked at the DOJ and has years of experience with the nursing home industry. Below are some excerpts.
As though declining health, impending mortality and other challenges weren't hard enough, too often old age is also plagued by abuse, neglect and exploitation.
Science has extended our lives dramatically: In 1900, Americans' average life expectancy was 47. By 2000, it was 77, and it's still rising. Estimates of the prevalence of elder abuse vary wildly, but by some reports there could be up to 5 million cases a year, with 84 percent going unreported. All other factors being equal, victims of even relatively minor mistreatment are three times more likely to die prematurely than those who are not victimized.
Furthermore, our nation is in the midst of three seismic demographic shifts that will put seniors at even greater risk for mistreatment. Older people are living longer, until they're frailer and more vulnerable. They are increasingly alone in old age, given that families are smaller and more geographically and emotionally dispersed. And the pool of potential caregivers is aging and shrinking. We need 30,000 geriatricians: We have only 9,000.
Neglect may sound more benign than abuse, but it usually lasts longer, is harder to prove and prosecute, and can be just as lethal. Thirty percent of seriously ill elders surveyed have told researchers that they would rather die than go to a nursing home. But while neglect of one person is tragic, systemic neglect by a facility or chain housing numerous residents can be catastrophic.
Facility owners may extract millions in profits, leaving insufficient funds to care for residents. Insulated by corporate structure, casting blame on facility staff, they are rarely held accountable. But the news about staffing, the most critical factor in the quality of long-term care, is bleak: A government study in 2002 concluded that more than half of the nation's nursing homes are understaffed at levels that harm residents. Nursing homes receive $80 billion from Medicare and Medicaid annually to care for 1.5 million residents. Yet not a single federal employee works on elder abuse issues full-time.
Marie-Therese Connolly, a fellow at the Woodrow Wilson International Center for Scholars, is former coordinator of the Department of Justice's Elder Justice and Nursing Home Initiative.
Posted on February 4, 2008 by Ray Mullman
The Kansas City Star has an
article about a study from the National Senior Citizens Law Center discussing clauses in nursing home agreements that violate the law. Some admission agreements skirt state and federal laws, misleading consumers about the care they can expect and inducing them to sign away critical consumer protections. Advocates for the elderly said the study raised serious questions about how some nursing homes operate.
The National Senior Citizens Law Center, a Washington-based nonprofit legal advocacy group for seniors and elder-care lawyers, reviewed 175 admission agreements voluntarily provided by nursing homes. The study found agreements which improperly limited a nursing home’s obligations. Others allowed discharges for vague reasons, or stuck relatives with bills they legally didn’t owe.
Toby S. Edelman, a spokesman for the Center for Medicare Advocacy in Washington, said similar studies in other states also show “ongoing concerns” with nursing home agreements.
The Missouri study found that nursing homes protect themselves by persuading seniors to waive their right to a jury trial.
In 18 percent of the agreements, seniors were required to submit a dispute to arbitration, rather than sue in court. Trial lawyers contend they have successfully fought the provisions in court as unconstitutional and unenforceable in health-care cases.
The study contends the agreements also thwart federal law by inserting provisions making it easier to evict residents. Federal law sets out six conditions that justify evicting a resident.
Carlson, the study’s author, said that under the federal reform law nursing homes cannot require a relative or a friend to become financially liable for nursing home expenses. Yet, the study found that 19 percent of the admission agreements required a financial guarantee “in direct violation” of federal law. Such “co-guarantor clauses” are becoming more common.
Posted on February 4, 2008 by Ray Mullman
Foxbusines.com has a good article about the difficulty the government has in evaluating funding levels for Medicaid. The article insists that an expansive view of nursing homes industry is needed to determine funding needs.
The Bush Administration's FY 2009 budget will include no Medicare funding update to help care for the growing number of seniors who need high acuity nursing home care. The Alliance for Quality Nursing Home Care will work to demonstrate that Medicare funding decisions can be accurately determined only by taking a more expansive, complete view of the industry's operating environment.
This White House has often cited the work of the Medicare Payment Advisory Commission (MedPAC). Alan G. Rosenbloom, President of the Alliance, stated, "On behalf of nursing home patients and the hundreds of thousands of caregivers who serve them, we are disappointed that again, MedPAC's flawed funding policy guidance is being adopted, and superseding the economic realities experienced by providers in the long term care marketplace. By failing to consider the substantial Medicaid payment shortfalls to nursing homes in formulating its recommendations, MedPAC provides the Administration, Congress and the public a flawed basis upon which to assess the funding landscape, and to ultimately determine the best policy."
Medicare funding is important when states are cutting Mediciad to balance their budgets.
SOURCE The Alliance for Quality Nursing Home Care
Posted on January 29, 2008 by Lara Pettiss Harrill
So its time for another one of my little rants. There's money to be made in the nursing home business, just like there's money to be made in the assisted living business. However, do you suppose the people actually doing the work are making the money? If you said "no", you're right.
I ran across an article about Atria Senior Living, which is owned by a investment fund affiliated with Lazard, a large Wall Street firm. Reportedly, the CEO of Lazard earned nearly $23 million in 2006 and is worth more than $2 billion. Want to know how much the employees on the floor at Atria make? Try $8 - $10 an hour.
The employees of several Atria facilities decided to join together to unionize, but Atria and Lazard apparently began threatening and intimidating the workers not to unite. There are so many victims here - residents that probably don't get the quality of care they deserve, due to short staffing, or high turnover which leads to inconsistent care; and of course employees who are out there hands on caring for elderly residents and receiving "peanuts" in return.
What's wrong with this picture? When do we say 1) the elderly (our mothers, fathers, grandparents) are more important than million dollar salaries and 2) the people that choose to be their caregivers should be adequately compensated for it.
I'm not saying that CEO's don't work. I was raised by one, and he still works hard every day. I am saying that people deserve to be compensated for caring for our family members. I am saying that nursing homes and assisted living facilities cost thousands a month to reside there. A great deal of what you're paying for is someone to care for you. Those caregivers should be compensated accordingly.
For more information, visit www.improveassistedliving.org.
Posted on January 23, 2008 by Ray Mullman
The News & Observer of Raleigh has an interseting article about the "new philosophy" of limiting or preventing nursing home residents from being in a wheelchair as long as the resident wants.
The article argues that older people's health, mobility and self-image can suffer from too much time in wheelchairs. More than 24,000 North Carolina nursing home residents - about two-thirds of the total population - use wheelchairs as their main means of getting around.
Ways to limit unnecessary wheelchair use are part of a movement that gives priority to the well-being of residents and their caregivers, above the functions of the nursing home or convenience of the staff.
The Midwest-based group called GROW - Get Residents Out of Wheelchairs - has taken up the cause on a national level. The nonprofit urges nursing homes to help residents use regular chairs, couches, recliners when sitting "is considered the norm and socially accepted." That includes for meals, TV watching, socializing with family and friends, and resting when tired.
Advocates acknowledge that wheelchairs have their uses for certain residents at certain times.
Advocates and academics say the downsides to spending too much time in a wheelchair are varied, but specific. They include a greater chance of pressure sores, significant discomfort and physical strain from operating chairs.
In addition, people in wheelchairs can be perceived as less able and are even spoken to differently in what becomes a self-perpetuating cycle of helplessness. Perhaps most importantly, loss of mobility can begin within a few days if someone starts using a wheelchair instead of walking.
Solutions are readily available in concept, but harder in reality. The GROW Coalition wants a requirement that nursing homes carry out a resident assessment before placing anyone in a wheelchair. In addition, lowered staffing ratios would let a center's caregiver take more time with slow-moving residents.
Easier access to meals and other services should mean that more North Carolina nursing-home residents will be able to stay healthy and mobile.
Posted on December 19, 2007 by Ray Mullman
I realize that this post might be a bit off topic but it shows the arrogance of insurance companies and their contempt and disdain for the rule of law. Nursing home attorneys routinely see this when the insurance companies refuse to provide nursing home records or when they state an elderly resident's life is not worth much because "they were already going to die" or when they blame neglect on resident complaince.
Allstate Insurance Co. told a judge that they refuse to produce key records to the Court no matter how much the Court fines them. Judge Michael Manners has already fined them $25,000 a day since mid September — a total of $2.4 million and growing.
Last month the Missouri Supreme Court ordered the documents produced. At issue are the so-called McKinsey documents which show how Allstate set up a claims scheme in the 1990s that shortchanges clients while earning the insurance company huge profits.
Allstate still refuses to disclose the damaging documents.
The case stems from a car wreck seven years ago on Interstate 70. Allstate client Paul Aldridge of Hawaii ran into the back of a truck and severely injured the driver. He is suing Allstate for bad faith for refusing to pay the claim for years.
Posted on October 30, 2007 by Ray Mullman
Here is an interesting
article about attorney Ken Connor's appearance for an advocacy group for nursing home reform. The seminar was titled "Nursing Homes: A Failed Experiment,". Connor's appearance was sponsored by the advocacy group Kentuckians for Nursing Home Reform.
Connor said he classified nursing homes as "a failed experiment" because the current system puts the economics of the provider ahead of the life, health and safety of the residents.
"In other words, they put profit over people; they put revenue over residents," he said.
To increase profit, Connor said, staffing is cut. And some nursing homes are run by businessmen who have never been doctors or nurses and don't have any expertise in the medical field. They are, however, good at making money.
It's important for people to be educated about this issue -- to know what to do if they are confronted with a problem and know where to file a complaint. It's also good to know where to find support.
Connor urged the crowd to pay attention to signs such as pressure ulcers, infections, urine and feces-stained bed linen and foul odors. Also, the hollow eyes and parched tongues of loved ones display the lack of time devoted to them.
Connor said nursing home problems are pervasive throughout the country. "Corral your congressmen and senators and make them understand the breadth of the problem," he said.
Kentuckians for Nursing Home Reform work to change state law so criminal background checks and random drug tests are required for all nursing home employees. They are fighting to ensure there is a minimum staffing standard.
Kentucky has cited about one in four nursing homes for serious deficiencies that caused "actual harm" or "immediate jeopardy".
Posted on October 24, 2007 by Angela Lizer
The headquarters of The Carlyle Group, a Wall Street Investment corporation that made our blog a few weeks ago when we wrote about its involvement with Habana Health Care Center (see Wall Street and Nursing Homes? and Nursing Home Profits), was the site of a demonstration Monday, October 22nd by nursing home advocates. The Carlyle Group is in the process of taking over Manor Care Inc., a Toledo, Ohio-based nursing home chain with facilities across the country. Manor Care has several facilities in South Carolina.
The Washington Business Journal reports that the demonstration was organized by SEIU Healthcare, a health care workers union, and it's purpose was to express worries caregivers and advocates have about the quality of care residents will receive after the the takeover as well as the status of jobs within the facilities. As we blogged in previous articles mentioning The Carlyle Group, there is much data to support the fact that staffing numbers are cut and care quality goes down when Carlyle is involved.
On Monday, Carlyle made a pledge to quality care at Manor Care facilities saying that education, training, and staffing levels would ensue proper clinical care and all federal and state regulations would be met. A Carlyle higher-up stated that "Manor Care is poised to become an even stronger health care provider under Carlyle's ownership."
A statement released by Carlyle said the acquisition of Manor Care is expected to be completed by the end of November. I suppose only time will tell if Carlyle will uphold their promise to provide quality care to the residents of the former Manor Care facilities. A statement released by the executive vice-president of the union that organized Monday's event says advocates will continue to hold Carlyle Group "accountable for improving care and staffing at Manor Care."
The Washington Business Journal also reported that the demonstration was planned to continue on Tuesday at Capitol Hill to lobby Congress to "hold hearings on private equity ownership of nursing homes."
Posted on October 8, 2007 by Angela Lizer
October 7-13 is Residents' Rights Week. Check out the
National Citizen's Coalition for Nursing Home Reform website for more information.
