Geography's role in cost of care

McKnight's had an article discussing how geography dictates the quality of care provided to residents of nursing homes.  Geography plays an important role in the cost of nursing home and other long-term care services, according to a recently released report.

Nationally, the average nursing home cost was $210 per day for a private room in the markets surveyed.   But costs vary greatly depending on where you live.   If you reside in a facility in Homer, AK, you could be paying up to $538 per day in nursing home costs, according to the report.   But a nursing home in Lafayette, LA, costs a fraction of that-$118 per day. Meanwhile Hawaii is the most expensive on average for care in an assisted living facility at $4,406 a month-more than twice what assisted living residents in North Dakota pay. Many of the nation's Northeastern states have assisted living costs that top $4,000 per month.

The survey, which was conducted by the Long Term Care Group on behalf of Northwestern Mutual, sampled more than 7,000 long-term care facilities nationwide. For more information on the report, or the companies that commissioned it, visit www.nmfn.com.
 

Trans Healthcare, Inc. enters receivership

On Jan. 9, 2009, Trans Healthcare, Inc. filed for bankruptcy and entered into a receivership.  It seems to apply only to facilities located in Ohio and Maryland.  Trans Healthcare, Inc. is a subsidiary to THI Holdings, L.L.C. and a "sister" company to THI of Baltimore, Inc.   I would imagine the next step will be bankruptcy for THI of Baltimore, Inc. 

 

Bankruptcy of Trans Healthcare, Inc.

On Jan. 9, 2009, Trans Healthcare, Inc. filed for bankruptcy and entered into a recievership.  It seems to apply only to facilities located in Ohio and Maryland.  Trans Healthcare, Inc. is a subsidiary to THI Holdings, L.L.C. and a "sister" company to THI of Baltimore, Inc.   I would imagine the next step will be bankruptcy for THI of Baltimore, Inc. 

 

How to choose a nursing home

Elise Degrass has written a guest post for our blog.   We appreciate her contribution and look forward to many other posts in the future.

How to Make Sure Your Parents Are Being Treated Right at Their Nursing Home

It can be difficult to accept that one's parents need assisted living care in order to properly get through the day. While enrolling a parent in a nursing home may be a necessary step in the process, it's also important to ensure that he or she is receiving proper care.
Selecting the proper care institution and setting up the right structure for care will ensure that the best possible living conditions for one's parent(s) in a nursing home.

The first step to ensure proper Nursing Home treatment is to choose the right health care provider in the first place. By taking time to do background research on the Nursing Homes in your area, you can save a lot of time in the future. Services such as Consumer Reports provide information about what to expect from various nursing home providers. Unlike hospitals, nursing homes vary widely in terms of their ability to provide basic services, so always inquire whether a given care center can provide the services that your parents need. For many people, Nursing Home costs can be prohibitively expensive, so look for an institution that is covered by Medicare
Services
to help alleviate the cost burden. You should always visit a care center and request the latest state inspection (Form 2567) to see an objective review of the care center.

After taking time to select what seems to be the best possible institution, there are several steps you can take to ensure that quality of care is up to standards. The most direct way of checking in
on care standards is through regular visits at non-standard times –that way you can review the care standards at various times during the day, and you can keep an eye out for any necessary improvements (in terms of care, cleanliness or scheduling.) Always ask you parent(s) directly about the nature of the care, and discuss any possible issues with management in case any issues arise; in fact, scheduling regular meetings with supervisors can provide a constant feedback look to ensure proper care.

Selecting a Nursing Home close to your work or home will make it easier to visit more regularly. In addition to your direct visits, have various members of your family regularly check up on your
parent(s), as well as asking important questions in case issues arise. Always have a contingency plan in case the care falls below standards, so that you can move to an alternative care center. If your parent has serious medical conditions, it is important to take them to regular visits with their family physician so that they can be monitored for progress; if they are not getting their medications regularly or their diet is not sufficient to provide the nutrients they need, a doctor
should be able to provide you with feedback that you can relay to the Nursing Home. By selecting a nursing home that is professionally management with attentive, registered nurses and medical staff, you can provide the best possible environment for long-term care.

This post was submitted by Elise Degrass, a freelance writer primarily
writing about cell phones .

Medicaid Myths

Matthew M. Wallace is an attorney and CPA with the law firm of Matthew M. Wallace, PC, in Port Huron. Mr. Wallace wrote a great article about the myths of medicaid in the Times Herald.  He can be reached (810) 985-4320.  Below is a summary of the article.

Planning Matters: Busting myths about Medicaid

There are many misconceptions about Medicaid and Medicaid eligibility.  Medicaid laws are complex and confusing. I do not recommend that you try to plan for Medicaid by yourself. One mistake may cost you thousands of dollars and may result in months of Medicaid ineligibility. It is important to get good legal counsel from a knowledgeable legal specialist.

Misconception 1:
"I don't need Medicaid; I have Medicare."

The truth: Medicare is a federal catastrophic major medical insurance program primarily for hospitalization. Medicare does not pay for long-term custodial care.

Medicaid is a state and federal funded and state-run assistance program.

For seniors, Medicaid is primarily for long-term care in Medicaid qualifying nursing homes, and in certain circumstances, long-term care outside of a nursing home.

Misconception 2:
"If I or my spouse go into a nursing home, the state will take my home away."

The truth: Your home is an exempt asset if it is owned by you or you and your spouse and can stay an exempt asset during your entire nursing home stay.

The home must be used and titled properly. A home that is not titled or used properly is not exempt and is available for nursing home expenses. There are other exempt assets in addition to the home and include one automobile, certain pre-paid funeral arrangements and certain life insurance policies.

Misconception 3: "If I give assets away, I have to wait 60 months to qualify for Medicaid."

The truth: The Department of Human Services looks back 60 months for transfers that are "divestments." If your transfer is not a divestment, it is ignored, even if it is made the day before you apply for Medicaid, and even if it is thousands of dollars.

To determine the number of months your divestment disqualifies you for Medicaid benefits after your Medicaid application is approved, you divide the amount of the divestment by the penalty divisor, which is $6,191 in 2008.

For example, a $20,000 divestment will disqualify you from receiving benefits for about 3.2 months after your application is approved.

 

Continue Reading...

New website helps families find good nursing homes

Barbara O'Connell responded to a recent post about finding a good nursing home:

I just read your post below and thought you might like to know about www.WhereToFindCare.com. It’s easier to use and has more information than the site you referenced, including quality data and more types of providers. This should help your readers a little more. Learn more here http://wheretofindcare.com/mediaroom.aspx.

National for profit chains provide less staff and deficient care

Newsday ran a story from the Hartford Courant about how states relying on nursing home chains raise concerns about quality of care provided to the residents.

The article states that large, for-profit chains nursing home chains dominate Connecticut's market, according to an analysis of federal data released Sunday by the Hartford Courant. Such facilities have lower staffing levels and higher rates of serious patient-care violations than small chains and independently owned homes, according to the newspaper's review.

"Ownership is certainly a factor in quality of care," Toby Edelman, senior policy attorney with the nonprofit Center for Medicare Advocacy, told the Courant.

 

He said many of the larger chains have complex organizational structures with multiple layers of management. "They send a lot of money to their corporate offices," he said. "There can be a lot of distance between the owners and the facilities themselves. They're not on the ground."

The Courant looked at two years of inspection and ownership data from the federal Centers for Medicare and Medicaid Services for the more than 240 licensed nursing homes in Connecticut.  Adjusted for size, homes owned by large chains provided, on average, 16 percent fewer registered and licensed nurses than small-chain and independent nursing facilities, according to the data.

The state's large-chain homes had a 30 percent higher rate of causing patients harm or putting them in immediate jeopardy, the Courant determined. For the five large chains in Connecticut, which control about one third of the state's nursing home beds, such serious deficiencies occurred at a 42 percent higher rate than at homes not controlled by large chains.

Information from: The Hartford Courant, http://www.courant.com
 

Sunrise Senior Living promises better care....again.

The Dealmakers Forum has an article about Sunrise charting a new course and discussion of how much money they are allegedly losing. 

Sunrise Senior Living was founded 27 years ago by Paul and Terry Klaassen when they opened a small nursing home in Virginia they purchased for just $325,000.   Now, 27 years later, the company manages more than 440 nursing homes in four countries, has revenues under management of more than $2.4 billion, boasts an average same-community occupancy rate that has been at 90% or better for four consecutive quarters and is perhaps the only company in the industry with a national brand name known to the consumer.

Mr. Klaassen will be relinquishing his chief executive officer duties and will become the non-executive chairman of the board. Mark Ordan, who was brought in earlier this year as the chief administrative and investment officer, will take over as CEO. And with this change, an era in our industry will come to a close

The company finally filed its 2007 10-K on July 31—the promised date—and the accounting mess that started two years ago is close to coming to an end.  The 2007 financial statements stated that total operating revenues last year were basically flat with 2006, and the importance of "buyout fees" to the company’s overall financial performance in both 2005 and 2006. In addition, hospice and ancillary service revenues inceased by 64%, but the associated expenses increased by 80%, causing this business category to go from a small profit to an $8.8 million operating loss.

For 2007, Sunrise posted a net loss of $70.3 million, which was after $214.0 million of gains from real estate sales and the company’s share of earnings in unconsolidated communities. These gains and earnings more than offset the combined $166.5 million in unusual cost items such as loss on financial guarantees ($22.2 million), impairment of goodwill and intangible assets ($56.7 million), write-off of abandoned development projects ($28.4 million), impairment of owned communities ($7.6 million) and the accounting and legal cost of the accounting restatement ($51.7 million).

This means that operating EBITDA was a negative $73.4 million, compared with a positive $110.2 million in 2006. That is a downward swing of $183.6 million, caused mostly by the disappearance of the previously mentioned "buyout fees," which were $134.7 million in 2006 and next to nothing in 2007, and represent, we assume, the fees paid by Five Star Quality Care to Sunrise to buy out Sunrise’s management agreements for properties leased by FVE but operated by SRZ.

The other large item was G&A expense, which increased by a whopping 42.5% year-over-year to $187.3 million but should not include all those costs associated with the accounting restatement. If you do the math, this means that without those buyout fees in 2006, operating EBITDA would have been negative in that year as well, although not as large as 2007. We still have trouble understanding how the management model that Sunrise has adopted can work in this industry if a company can’t make money managing more than 440 properties around the world.

The end result is that the entire increase in cash during 2007 came from a net $56.7 million increase in borrowed funds. In addition, the company had a negative working capital of $116.3 million at the end of 2007 due to $222.5 million of short-term debt and the current portion of long-term debt. Although we usually don’t get worked up about working capital for Sunrise, when the bank line-of-credit is reduced (which it was in July) because of breeches in loan covenants, it does make one pay closer attention to some of the details.

So what has happened over the past several years to this giant in the industry? In an effort to make more money and exclude from themselves from liability or accountability, Sunrise entered into tricky financial loans and buyouts to prevent any judgments for neglect to be collected.

In looking back over the past five years or so, it seems that the biggest problem was that Sunrise got a little ahead of itself, believing that it was so good that it could take risks that others might not take, with some competitors accusing the company of a certain degree of arrogance.  In addition,  Sunrise decided to get quite aggressive with accounting interpretations several years ago, and it came back to bite them in a big way. 

But enough of the past and on to the future. As management transitions from Mr. Klaassen to Mr. Ordan, there will be increased attention on cost control, and after the unprecedented increase in overhead expense last year, the company has announced a program to cut between $15.0 million and $20.0 million on an annualized basis beginning in 2009, which will include some "voluntary" employee reductions.

Second, while Mr. Ordan are concentrating on cutting overhead costs, the other complaint we hear is that management is not paying attention to operations at the local level. Quality of care is crucial, especially for the industry leader, and you don’t want what happened in Pennsylvania last year to happen again, anywhere. With less focus on development over the next 12 months, there should be renewed focus on operations. While it is great that Sunrise has grown to 440 properties under management, that itself may be part of the problem. This industry has some great leaders, but when you scratch beneath that, all we hear is that there is a huge management void, and we hear this from operators themselves.


 

NHC's Press Release re: aquisition of more SC nursing homes

NHC Acquires Charleston, SC Facilities

National HealthCare Corporation (AMEX:NHC)(AMEX:NHC.PR.A), one of the nation’s leading operators of senior care services, announced today that it has added Trinity Mission Health and Rehabilitation of Charleston and Trinity Mission Assisted Living of Charleston in Charleston, South Carolina as affiliates effective August 1. NHC purchased the 132-bed skilled nursing and rehabilitation facility and the 60-bed assisted living facility for $13.25 million.

This acquisition increases NHC’s operations that are owned and managed in the South Carolina region to over 2,000 beds in 13 locations. The administrator for the new facilities, now renamed NHC HealthCare-Charleston and NHC Place-Charleston, is Angela Atkinson. Ms. Atkinson, previously with Trinity Mission of Charleston, joins NHC with 15 years of experience in healthcare administration, including licensure as both an assisted living and nursing home administrator.

“The superior quality of NHC’s services to the senior care community in the state of South Carolina is well known,” Steve Flatt NHC’s Senior Vice President of Development said. “While we have been a strong provider in the Upstate and Midland region for over 30 years, this additional location allows us to better serve the Low Country area as well. We are grateful for the help and cooperation of the staff of the center in making this a smooth transition.”

NHC has plans for more growth in the Low Country of South Carolina as construction is expected to start next month on a 120-bed skilled healthcare and rehabilitation center in Bluffton near Hilton Head Island.

NHC operates for itself and third parties 76 long-term health care centers with 9,772 beds. NHC also operates 32 homecare programs, seven independent living centers and 23 assisted living communities. NHC’s other services include managed care specialty medical units, Alzheimer’s units, hospice and a rehabilitation services company. Additional information about NHC, including the company’s Form 10-K, Form 10-Q, annual report and press releases, is available on our website at www.NHCcare.com.

Statements in this press release that are not historical facts are forward-looking statements. NHC cautions investors that any forward-looking statements made involve risks and uncertainties and are not guarantees of future performance. All forward-looking statements represent NHC’s best judgment as of the date of this release.


Contacts
National HealthCare Corporation
Gerald Coggin, Sr. V.P. Investor Relations, 615-890-2020

 

Green Homes

I was surfing some of the blogs this morning, and ended up at Legal Medicine where Lauren Ellerman had posted this video from YouTube.  I admit I had not heard about this concept, at least not in this form.  I have heard of the Eden Alternative, but this is the Eden Alternative at its best.  This is what the nursing home industry should strive for - this is the sort of care that all elderly should have access to.  Its certainly the sort of care I'd like to have if necessary, and that I'd want my parents to have, if necessary. 

And you know what the greatest part is?  The way that the hands-on caregivers - the people who are usually on the bottom of the totem pole in a regular nursing home - they become the most valuable, and they love their jobs!  Under their care, the residents are thriving. 

If you're at all interesting in the future of long term care, this video is a must watch.  If you've been in a typical nursing home, and see how it usually works, the video will bring tears to your eyes.  If not, you still cannot mistake the vast improvement between the nursing home and the Green home.

And if you want to know more, just google it, Green Homes - I did - And found this NPR story - among other things.  I haven't listened to it yet, but I will before the day is out.

I hope that this is the future.

Not a bad thing to have to look forward to.  Certainly not as bad as the alternatives . . .

New website to help families pick a nursing home

Online Nursing Home Resource Provided by IQ Nursing Homes.  IQ Nursing Homes announces the launch of their new website, a comprehensive online research tool for nursing home residents and concerned family members.

(EMAILWIRE.COM, July 17, 2008 ) New York - IQ Nursing Homes announces the launch of their new website, a comprehensive online research tool for nursing home residents and concerned family members. A national nursing home directory, up-to-date nursing home news, nursing home deficiency reports, and legal resources for victims of nursing home abuse and elder neglect cases are now just a click away on one easy to navigate site.

With increased life expectancies in today’s society leading to higher numbers of nursing home residents, IQ Nursing Homes recognized the need to create a free, complete online nursing home resource. Careful research is imperative to ensure that the nursing home to which you entrust your loved one’s care is reputable and safe. When you visit IQ Nursing Home’s national directory to locate elder care facilities in your area, you can also check nursing home deficiency reports to make sure the facility you choose provides the best care possible to its residents.

In addition to directories and information, IQ Nursing Homes provides a way for nursing home employees, residents, and their families to combat elder abuse and neglect. These are serious, prevalent problems that can result in physical and emotional suffering. Painful bed sores, broken hips, and even death are among the afflictions the nursing home residents face at the hands of negligent or abusive caregivers. Resources to help individuals recognize and report these problems are available on the IQ Nursing Homes website, including signs and symptoms of abuse and neglect and an anonymous abuse report form.

If abuse is suspected, a free nursing home abuse case evaluation is also available on the site. IQ Nursing Homes has partnered with expert nursing home lawyers and law firms throughout the country with the goal of putting a stop to the victimization of the elderly. By holding negligent and abusive staff members accountable for their actions and making it financially devastating for nursing homes to allow abuse and neglect to occur, this epidemic can be put to an end.

Be IQ Smart. Visit http://www.iqnursinghomes.com/ to learn more.

This press release was issued through GroupWeb EmailWire.Com. For more information on unlimited press release distribution service, go to http://www.emailwire.com

Things to think about

I know I'm about a week behind on this one, but I think it's important.  Jane Gross wrote a piece for one of the New York Times blogs about all the decisions that needed to be made for her mother towards the end of her life.  In the piece titled What I Wish I'd Done Differently, Ms. Gross talks about everything from having a geriatrician to selling her mother's house, and all the uncertainties in between.

She points out, quite correctly that there's no way to be without uncertainties in situations like this, but that she would have liked to known prior to making some decisions that ultimately limited the choices they had later in regards to her mother's care.

Something to think about this afternoon . . .

How to pick a Nursing Home for an Alzheimer's Patient

Heather Johnson was kind enough to write a guest post for the blog.  We thank her for her contribution, and appreciate her expert advice.

How to Pick a Nursing Home for an Alzheimer’s Patient

Any family that’s been afflicted by having a member stricken by Alzheimer’s disease knows how immensely difficult and trying it can be. Many times it’s so hard because the person with Alzheimer’s disease is in perfect physical health. This makes the family so much more hesitant to put the relative in a nursing home because it seems like nothing is wrong and we want to believe that. However, we also know that as the disease progresses they can’t perform the daily activities safely and responsibly. It puts such a strain on the family that eventually the only choice is to look for a nursing home. This brings up the major issue of finding a place that can provide the care we demand. It can be an arduous search and here a few tips to help you as you look for that special place:

1. Staff ratios are of the utmost importance. Alzheimer’s disease patients need more direct care than your standard nursing home. Given the unpredictability of the disease and the actions of the afflicted it’s dire that they receive as much dedicated care as possible. Make sure the facility can guarantee at least a ratio of five patients to one caregiver.


2. Pay attention to the building’s architecture. Many Alzheimer’s disease patients have trouble making sharp corners. They do better with rounded hallways that don’t require sharp turns. All hallways should have hand railings to further assist patients with walking.


3. Group activities are important. Check to see that the facility offers small group activities instead of large ones. Alzheimer’s disease patients react much more favorably to working in groups under four than they do in larger groups.


4. Talk to relatives with family members already in the facility. This is sometimes the best way you can determine if the facility is the right place for your loved one. They will shoot you straight and answer your questions directly and honestly instead of a coordinator who needs to toe the company line and always put a positive spin on the facility’s deficiencies.


5. Discover what kind of experiences the patients can expect. There are many new techniques that some nursing homes offer their patients that help alleviate some of the accompanying discomforts that go hand-in-hand with those who suffer from Alzheimer’s disease. Aromatherapy and experimenting with dimmer lighting are a couple examples of ways nursing home deal with the anxiety that many suffer from on a daily basis.

By-line:

This post was contributed by Heather Johnson, who writes on the subject of Cruise Ship Nursing. She invites your feedback at heatherjohnson2323@gmail.com.

Article discussing how to choose a nursing home

RN Karen Mowers has an article in The Daily Star newspaper which discusses how a family should choose a nursing home.  However, many times a person goes into a nursing home from the hospital. In those situations, often the family does not have time and relies on the social services person at the hospital to decide. This is a mistake.  The consumer should have the final say. 

Ms. Mowers has some good tips to assist you in choosing the right nursing home for your loved one.
Begin by researching the nursing homes in your area by reviewing The Centers for Medicare and Medicaid Services' website, www.medicare.gov, that provides a section titled "Nursing Home Compare."   Comparisons can be made in relation to quality, staffing ratios, survey reports and fire safety deficiencies.   (This information can be unreliable depending on the enforcement of your state's regulatory agency)

Contact other resources such as hospital discharge planners, social workers, physicians and your local Office for the Aging or ombudsman (volunteer resident advocate) who can be contacted through the local Office for the Aging as well. 

Formal visits or tours can be scheduled through the Department of Social Services, or you could just stop by and take a look around. Visit with residents, families and staff as you look around, and observe the activities.

Other things to be considered when selecting a nursing home:  Bed availability, staffing, activities, policies, services and fees, preventative care programs, nutritional services, and treatment options.

Karen Mowers, a registered nurse with a Bachelor of Science degree, is director of nursing services in the Fox Nursing Home.
.

New website helps families choose a nursing home

There is a new website called Seniordecision that can help families research and decide on placing a loved one in a nursing home.  Any information you can get on the home is helpful in making the right decision.

Study critical of nursing home admissions paperwork

The Columbia Tribune of Missouri has an article about a new study that shows nursing home admission paperwork to be confusing and takes away a resident's fundamanetal rights without explanation to the residents.

Nursing home admission agreements are confusing, can run 10 pages or more with unfamiliar language, are often signed in moments of distress, and force residents to sign away fundamental rights.

"It’s a situation where they’re worried about health, they’re worried about their family, and often they’ll just sign anything," said Richard Royer, CEO of Primaris, a Medicare quality improvement organization.

A study released today by the not-for-profit National Senior Citizens Law Center evaluated 175 legal agreements signed by residents who entered Missouri nursing homes. The study found many agreements allow facilities to evict residents for almost any reason, limit their rights to be visited by family members and require family or friends to assume personal financial liability for care. All such provisions are in violation of the federal Nursing Home Reform Act of 1987.

The study found that 17 percent of surveyed nursing homes reserved the right to evict someone for any reason even though federal law lists only six valid reasons for eviction. Consequently, patients with Alzheimer’s disease and dementia or residents who complain about the care received are being evicted for being "difficult."

The survey also found that 19 percent of nursing homes required a guarantee asking a family member or sponsor to take financial responsibility for the cost of care. The study argues it’s illegal to require fiscal responsibility and that Medicaid is required to cover expenses when a resident is unable to pay.

The study found 5 percent of agreements instituted visiting hours for residents, also in violation of the federal law.

One of the things not mentioned in the study but is very disconcerting to many residents is the inclusion of an arbitration clause hidden in the admissions paperwork that waives the resident's right to a jury trial if the resident gets abused or neglected.

The study and a consumer guide outlining the rights of residents are available online at nsclc.org.

Elderly in need of care moving to Mexico

USA Today has an interesting but sad article about how some families choose to move their loved ones into Mexican nursing homes because of the poor care from the for profit chains in America.

For $1,300 a month — a quarter of what an average nursing home costs in Oregon — residents get a studio apartment, three meals a day, laundry and cleaning service, and 24-hour care from an attentive staff, many of whom speak English.

As millions of baby boomers reach retirement age and U.S. nursing home costs soar, Mexican nursing home managers expect more American seniors to head south in coming years. Mexico's proximity to the USA, low labor costs and warm climate make it attractive.

An estimated 40,000 to 80,000 American retirees already live in Mexico, many of them in enclaves like San Miguel de Allende or the Chapala area, says David Warner, a University of Texas public affairs professor who has studied the phenomenon. There are no reliable data on how many are living in nursing homes, but at least five such facilities are on Lake Chapala alone.

"You can barely afford to live in the United States anymore," said Harry Kislevitz, 78, of New York City. A stroke victim, he moved to a convalescent home on the lake's shore two years ago and credits the staff with helping him recover his speech and ability to walk.

Continue Reading...

Tips for Selecting A Nursing Home

Choosing a nursing home for a loved one is one of the most emotional and stressful decisions a family will ever face.  With so many nursing homes out there and all of the stories we have heard about under-staffing, sub-standard care and neglect, how does one make an informed decision?  I recently came across an article that offers some really good advice on selecting a nursing home that I hope will help make this decision a little easier.  

First, visit the facilities you are considering.  Go often and unannounced.  Visit at different times during the day such as mealtimes and activities.  This will allow you to get a good idea of how the needs of the residents are addressed in different situations. 

The article also suggests to pay close attention to what your sense of sight and smell are telling you when you visit.  Is the facility clean?  Are the hallways clear and safe or crowded?  Does it smell clean?  If you notice foul odors from feces or urine, chances are residents are not being tended to quickly enough and it could be a sign of neglect. 

Check for resident call bells that go unanswered; that is a major red flag.  Also, talk to the staff.  Do they seem friendly and helpful?  Are they willing to answer your questions?  Are they attentive to the residents?

Hopefully, these tips will assist you in making a more informed decision about a nursing home.  If you are interested in seeing the complete article, visit this link: news.enquirer.com/apps/pbcs.dll/article

Budget cuts for home health

Former NY Mayor Ed Koch wrote a great article on the budget cuts to home health that have forced many older citizens into nursing homes.  Below are excerpts of the article:

In the last seven years, while the Medicare budget for nursing home stays has dramatically increased from $13.6 billion to $15.7 billion, home health care has been cut by 25 percent, from $14 billion to $10.5 billion. It is cut further in the Bush administration's proposed fiscal year 2008 budget, which calls for an "inflation freeze" that would slash $410 million in fiscal 2008 and $9.68 billion over five years.

None of this makes common sense. Home care allows the elderly who have become frail to maintain their dignity and independence, sleep in their own beds, use their own kitchens and stay in the house they have long enjoyed (or in the house of a child or relative) - unless their condition deteriorates to the point where moving into an institution is absolutely necessary.

Besides offering a higher quality of life, home care is far cheaper than the alternatives - averaging one-fifth the price of nursing homes and a tiny fraction (3 percent) of the cost of hospitalization. It costs roughly $109 per visit, compared to $499 per day in a skilled nursing facility and $3,838 for hospitalization, according to Medicare statistics.

Starting in 1997, under the Balanced Budget Act, Medicare home health spending was cut by half. This forced the closing of nearly 25 percent of all home health agencies in the United States.

According to the Center for Responsive Politics, "hospitals / nursing homes" gave more than $30 million to candidates in the 2004- 2006 federal election cycles, based on Federal Election Commission data, and they are among the top third of 80 "industries" ranked. Home health does not even rate a mention on the chart.

There are some 1.6 million people in nursing homes today. Sometimes, senior citizens are able to live normal lives and care for themselves, but as people age, many have problems compounded by poor health and need caretakers. They should not be forced into nursing homes for lack of alternatives.

Family learns valuable lesson about reading admission contract.

I saw this article written by a family member who failed to read the contract when admitting his mother to the nursing home.  When she was neglected and he wanted to remove her, the nursing home charged him extra money because the family did not provide one week's notice!! Incredible.  Make sure you read every clause in the contract especially to see if there is an arbitration clause in the contract. If you see one, strike it out of the contract; you do not want to waive your right to a jury trial.  Below are excerpts from the article.

I sent my mother, Sarah, to ManorCare in Easton for physical therapy after she suffered a fractured right hip. On my interview to sign her contract, everything seemed in order. My mother did not receive the care I had hoped for and what ManorCare said would be performed. I informed the nursing home that I wanted to remove her.

They told me she needed a release from her doctor, which I obtained. As I was wheeling her out, an official from ManorCare stopped and told me I hadn't given them a week's notice and would be charged for an extra week, which was $1,757. They said it was stated in the contract.

Neither my wife nor I remember being told about the week's notice at the time of signing the contract. We paid the bill but are not happy about it. My mother, who lives on a limited income, should get her money back.

 

Good article about picking a nursing home

I saw a great article discussing the process of choosing and entering a nursing home.  The article tells the story of a woman who scouted nursing homes with a home-like setting where the staff-to-resident ratio was low.

More than 5 million people in the United States receive some form of daily care, according to Joseph L. Matthews, a California attorney who specializes in elder law and is the author of "Long-Term Care: How to Plan and Pay for It."

More than 2 million people older than 65 are in some type of nursing facility or other residential care facility at a cost of between $30,000 and $150,000 each per year, according to Matthews.

One out of four of those nursing-home residents stay in a facility for longer than a year, and 10 percent stay for more than three years.

Medicare covers the first 20 days of care at 100 percent. After that, a 20 percent co-pay is required for the next 80 days.  Some supplemental Medicare insurance will pick up the co-pay, but patients without that coverage could find themselves paying $130 or more per night for the remaining 80 days, Honig said.

While Medicaid will cover the cost of nursing home, residents have to spend down their assets to qualify, she said. But the spouse still living at home can keep residential property, a car and a limited number of other assets. 

New product QuietCare helps elderly avoid nursing homes

There is a new product called QuietCare which is a home monitoring system that tracks a resident's health, and alerts designated neighbors by e-mail or phone when something is wrong. 

The QuietCare monitoring system can keep up with meals and medications, and to alert others if he has had a fall or other emergency.

In an industry that is becoming proactive, QuietCare focuses on keeping aging or disabled people at home longer. Everything from computerized medication dispensers to concierge health-care managers aim to give the elderly and disabled the assistance they need to stay independent and safe.

With the cost of nursing home care skyrocketing and baby boomers reaching retirement, the country is facing an expensive health-care bill. Nursing homes are already crowded, and at a cost of $6,000 to $6,500 per month in Central Florida, providing round- the-clock nursing home care to an increasing number of seniors could be back-breaking for the nation's health-care system.

There certainly is no shortage of products designed to help seniors and caregivers.

AT&T offers home video monitoring, or so-called nanny cams, that some people are using to keep a watch on elderly relatives.

LifeAlert -- known for its marketing slogan "I've fallen and I can't get up!" -- markets emergency-button systems. Other companies offer similar personal emergency-response systems as well, with prices ranging from $200 to more than $1,500, plus monthly monitoring fees.

If taking medication is an issue, Guardian Medical offers a pill dispenser that can be programmed to dispense medication at certain times, and provide alerts by phone if pills are missed.

Nursing home placement worsens Alzheimers

People with Alzheimer's disease experience an acceleration in the rate of cognitive decline after being placed in a nursing home according to a new study by the Rush Alzheimer's Disease Center. The observational study involved 432 older persons with Alzheimer's disease.  

On average, cognition declined at a gradually increasing rate for all participants. During the study period, 155 persons were placed in a nursing home, and placement was associated with a lower level of cognition and more rapid cognitive decline.

"The findings suggest that experience in day care may help individuals with Alzheimer's disease make the transition from the community to institutional residence," said study author Robert S. Wilson, PhD, a neuropsychologist at the Rush Alzheimer's Disease Center.

The authors considered the possibility that nursing home placement is simply a sign of increased severity of Alzheimer's disease. Yet, the nursing-home-related increase in cognitive decline was observed even after simultaneous control for cognitive and noncognitive indicators of dementia severity at the time of nursing home entry.

"The findings suggest that the transition from the community to a nursing home is particularly difficult for people with Alzheimer's disease and that those planning for their care should consider the possibility that experience in adult day care programs may help prepare affected persons for institutional living," said Wilson.

See article here

New government program helps elderly get care at home

North Carolina officials say a federal grant will help about 550 older and disabled North Carolinians stay home instead of being placed in nursing homes and hospitals.

The nearly $$17 million grant is part of a larger 5-year federal project that will pay for caregivers to provide services in homes. Officials say one goal is to save money -- for example, a nursing home can easily cost $$50,000 a year.

The other goal is to allow people to live at home as they age, which is a growing desire among older people. The program is being designed now. The benefit is expected to be available to people next year.

Hopefully, South Carolina will be able to get funds to help citizens of this State avoid nursing homes.

New study reveals need for more funding for alternatives to nursing home care

 Senior citizens who do not have children to help care for them are less likely to have to go into a nursing home if they live in a state that spends more on home- and community- based services found.   Researchers at the University of Illinois at Chicago report the finding in the May 11 issue of the Journals of Gerontology: Social Sciences. 

Naoko Muramatsu, associate professor of community health sciences at the UIC School of Public Health and lead author of the study stated  "There has been little evidence, prior to this study, to show that spending more money on these services helps seniors avoid or delay placement in a nursing home."

Some states spend as little as $35 per person each year on home- and community-based services for seniors, while other states spend more than $1,300 per person annually, according to previous research.

Regardless of how much was spent on home- and community-based services, the researchers found that doubling states' spending on services would reduce the risk of nursing home admission among childless seniors by 35 percent. 

The study was funded by the National Institute on Aging, one of the National Institutes of Health.


See journal article here

Regulatory enforcement is lacking

I ran across a sad but interesting article discussing the difficulties in choosing the right nursing home for a loved one.

The author was looking for the right place for his wife who suffered from Alzheimer’s Disease. He used the federal database (the Nursing Home Compare Database) that is supposed to help in choosing a nursing home for our loved one. This can be found at: www.medicare.gov/NHCompare.

He visited dozen facilities, making a careful inspection of each, before finally deciding on one that seemed just right.  Afterwards he realized, after reading an editorial in the Boston Globe, that he could easily have made a really bad choice.

The Boston Globe April 27 piece entitled, “Enforce Quality Care for Elders,” the Globe points out that the Department of Health and Human Services (DHHS) is failing in its duty to make sure that nursing homes correct their shortcomings and then continue to meet quality standards. That is the conclusion of an April 23 report Congress mandated from the Government Accountability Office (GAO). Here’s a quote from that report, referring to the Centers for Medicare and Medicaid Services (CMS):

In general, the effectiveness of CMS's management of nursing home enforcement is hampered by the overall complexity of its immediate sanctions policy, intended to deter repeated noncompliance, and by its fragmented data systems and incomplete national reporting capabilities.”

You’ll find this report at: www.gao.gov/htext/d07241.html.

According to the Globe, the U.S. has more than 16,000 nursing homes, caring on an average day for about 1.5 million patients. Another report that Congress mandated dated Feb. 21, 2002 — more than five years ago — begins: “HHS Nursing Home Compare Website Has Major Flaws.”

This report said: “The report finds that ‘Nursing Home Compare’ has major flaws that can mislead families seeking to find a safe nursing home.”

Here’s what they’re hiding from consumers: the data on ‘Nursing Home Compare’ does not include tens of thousands of recent violations of federal health standards, including nearly 60 percent of the violations involving death or serious injury. 

Tthe Nursing Home Compare Web site is being used by millions of familiest. The Web site receives approximately 100,000 visits a month and is one of the most popular destinations for individuals who view the Medicare homepage. HHS says, “the most important information on this site is the searchable database that allows the public to determine the compliance status of virtually any nursing home in the United States.”

Despite this talk of compliance, the report shows that the HHS Web site in fact excludes information on many documented health violations in these nursing homes. Information is missing because Nursing Home Compare does not include the results of complaint investigations conducted by state inspectors.

You can read the whole thing. Just search on: “Nursing Home Compare Website Has Major Flaws.”

Cost of a nursing home

The cost of nursing home care in N.C. is less than the national average.

The average cost of a private room in a nursing home now tops $61,217 per year in North Carolina, according to Genworth Financial's annual Cost of Care Survey;  the Genworth survey polls more than 10,000 nursing homes, assisted living facilities and home care providers to gauge care prices.

Private nursing home rooms cost, on average, $167.72 per day, with a minimum daily rate of $120. By comparison, the national average for a private nursing home room in 2007 is $204.95 per day, or more than $74,800 per year.

Semi-private nursing home rooms run slightly less, costing, on average, about $154.55 per day in North Carolina, or about $56,400 per year. Nationally, semi-private rooms carry an average price tag of $180.78 per day, or nearly $66,000 a year.

A private bedroom in a North Carolina assisted living facility cost more than $30,000 per year on average, or more than $2,500 per month. The national average for a private room in an assisted living facility is $32,572.61 per year, or more than $2,714 per month.

Genworth Financial is a financial services provider based in Richmond, Va.

Choosing a Nursing Home

How to Choose a Nursing Home

© 2007 ElderLawNet, Inc.

Last Updated: 4/10/2007


Few things are more stressful than finding a nursing home for a loved one. Everyone has heard nursing home horror stories and no one wants that to happen to their loved ones. While there is no way to guarantee that nothing will go wrong, some careful research and planning can help reassure you. Following are some criteria to consider when looking for a nursing home.

Location. No single factor is more important to quality of care and quality of life of a nursing home resident than visits by family members. Care is often better if the facility knows someone's watching and cares. Visits can be the high point of the day or week for the nursing home resident. So, make it as easy as possible for family members and friends to visit.

Special Needs. Make sure the facility can meet any special needs the resident may have, including a ventilator, psychiatric care, or extra supervision. If the resident has dementia, the facility will need to be one that handles dementia patients. Make sure the staff is properly trained for dementia patients; there is enough staff, especially at night; and staff members are assigned to a particular resident.

Personal Needs. Can the facility meet personal needs, such as religious or ethnic needs? Also, if the resident speaks a language other than English, are there staff who speak the same language?

References. Ask the facility to provide the names of family members of residents so you can ask them about the care provided in the facility and the staff's responsiveness when the resident or relatives raise concerns.

Do research. CareScout is an unbiased source for ratings and reviews of eldercare providers nationwide. Detailed, 7-10 page Nursing Home reports are available for a fee, and include more than 100 pieces of information on quality, resident population profiles, and health violations. Medicare.gov allows you to get three years worth of inspection reports on the nursing homes you are considering. Find out who owns the facility and if they own any other nursing homes, and see if you can get reports for those nursing homes as well. In addition, talk to the long-term care ombudsman in your state to find out if there have been complaints against the nursing homes you are considering.

Interview the administration and staff. Talk to the nursing home administrator or nursing staff about how care plans are developed for residents and how they respond to concerns expressed by family members. Make sure you are comfortable with the response. It is better that you meet with and ask questions of the people responsible for care and not just the person marketing the facility.

Tour the nursing home. Try not to be impressed by a fancy lobby or depressed by an older, more rundown facility. What matters most is the quality of care and the interactions between staff and residents. See what you pick up about how the staff interacts with the patients, how well residents are attended to and whether they are treated with respect. Also, investigate the quality of the food service. Eating is both a necessity and a pleasure that continues even when we're unable to enjoy much else.

© 2007 ElderLawNet, Inc.

Transition to nursing home

There are ways to make transition to a nursing home less stressful
By Meredith Moss 

The difficult decision has been made: Mom will be moving to a nursing home. But how do we make the transition easier for everyone?   And how do we deal with the guilt?

"It's one of the most difficult decisions anyone ever has to make because you may have promised mom or dad that you'll always take care of them and you'll never place them in a nursing home," said Thelma Sens, a social worker at Kettering Medical Center, who's been in the field for more than 20 years.

"But circumstances change. And you'll have to explain to your loved one that you are simply unable to handle the care that's required to keep them safe."

Continue Reading...

Nursing Homes: A Tough Decision

Entering nursing home is a tough decision

By MISTY MAYARD

Monday, April 2, 2007 6:00 PM EDT

EDITOR'S NOTE: At the turn of the 20th century, Americans could expect to live to the ripe old age of 47. Today, according to the Centers for Disease Control National Center for Health Statistics, the average American can expect to live 77.9 years.

As the percentage of the population which reaches "old age" continues to increase, we are faced with how to best prepare for it. Over the next few days in a series of stories we will examine the process of aging in our area and the unique problems it presents, not only for those who are aging but also for those who are charged with the care of those who cannot care for themselves in their golden years.

Three years ago Bob Biddle made the decision to place his parents in the Maysville Nursing & Rehabilitation Facility.

Biddle's father was developing dementia, and his mother was unable to care for herself any longer, Biddle said.

While his father died last August, Biddle's mother, May Biddle, remains a resident at the facility.

The decision to place a family member in a nursing home can be difficult for many, but Biddle said it was the best option to guarantee the care needed for his parents was provided, and their quality of life did not suffer.

"The nursing home has been wonderful," Biddle said of the Maysville facility. "I can leave there and know she's under good care."

At 98 years old, May Biddle has more of a social life now than she ever did at her home, Biddle said.



"My mother goes to bingo ... and church," he said. She exercises, and has a number of friends in the facility. Bob Biddle said she also receives more visitors than she ever did at her home.

"It's been good for her," he said.

Continue Reading...

10 Tips For Finding A Nursing Home

10 Tips: Finding a nursing home

Take wise steps when choosing a nursing home

LAURA T. COFFEY, Times Correspondent
Published February 18, 2007

Who knew that so many people have to make decisions about nursing homes while under severe time constraints? These tips can help:

1 Know your rights. If a hospital tells you your loved one must be discharged within 24 hours, you have appeal rights under Medicare that can extend your relative's stay by two days and give you time to research nursing homes. Ask the hospital for a copy of "An Important Message from Medicare," or call toll-free 1-800-633-4227.

2 Use the Eldercare Locator. It will connect you with your local agency on aging, which can give you names and locations of nursing homes. Call toll-free 1-800-677-1116

3 Do lots of clicking. Consumer Reports recently completed an investigation of nursing homes. Go to www.consumerreports.org/cro/health-fitness/nursing-home-guide/0608_nursing-home-guide.htm, and click on the map. This will lead you to Florida nursing homes to consider and avoid.

4 Tap into other resources. You can check less complete surveys of nursing homes through the Nursing Home Compare database on the Web site of the Center for Medicare and Medicaid Services: www.medicare.gov/nhcompare/home.asp. The Florida Agency for Health Care Administration has a site www.floridahealthstat. com that tracks nursing homes within the state.

Continue Reading...

Raw data on nursing homes

(Data are for U.S. for year indicated)

Number of nursing homes: 18,000

Number of beds: 1.9 million

Number of current residents: 1.6 million

Average length of stay (current resident): 892 days

Number of discharged residents: 2.5 million

Average length of stay (discharged resident): 272 days

Occupancy rate: 87 percent

Source: The National Nursing Home Survey: 1999 Summary, tables 1, 11, 39




National Citizen's Coalition for Nursing Home Reform

The National Citizen's Coalition for Nursing Home Reform is a grass roots organization of people who want to protect the elderly who reside in nursing homes. Their website is a great resource for family members and lawyers who handle nursing home cases.

www.nursinghomeaction.org/default.cfm

Medicare website comparing different nursing homes

Medicare has begun to gather information including fines, investigations, past surveys, and other information on all nursing homes that receive medicare from their residents. This information is very helpful and family members should check the website before choosing a facility for a loved one.

www.medicare.gov/NHCompare/Include/DataSection/Questions/SearchCriteria.asp

Research on different nursing homes

This website is a great way to investigate if a nursing home has a history of problems or survey violations.  carepathways.com/

Always find out as much as possible about the nursing home you choose for your loved ones.

Website to check on a specific nursing home

The below website is very helpful in researching South Carolina nursing home facilities. Family members should gather as much evidence as possible before determining which nursing home to place a loved one.

www.memberofthefamily.net/sc.htm

Website to research specific nursing homes

Before choosing a nursing home to place a loved one in, family members should investigate the facility as much as possible. The below website is helpful in assisiting families choose the right nursing home.

Click here: MemberoftheFamily.net U.S. Nursing Home Information Registry Ratings Complaints Surveys Quality & Staffing

Poliakoff & Associates, P.A., is one of South Carolina’s most respected and distinguished law firms. The Poliakoff firm began nearlyMore...