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

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.
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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.

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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.

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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.

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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

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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.

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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.

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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. 

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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.

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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

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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.

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 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

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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.”

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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.

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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.

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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."

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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.

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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.

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(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

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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

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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

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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.

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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

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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

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