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

MSN had a story about U.S. News & World Report's issue on the Best Nursing Homes.

3.3 million Americans move into a nursing home each year.  One in seven Americans age 65 and older will spend time in one of the nation’s 16,000 nursing homes this year and for those 85 and older, the chances are more than one in five. Finding one that provides quality care is a challenge. Best Nursing Homes highlights meaningful data, like what proportion of residents have bedsores or are in pain.  Be leery of nursing homes that the government has labeled Special Focus Facilities. In Best Nursing Homes, facilities in this category are flagged with an icon that indicates they’ve been singled out by the state where they operate and by CMS as nursing homes with long histories of subpar or inconsistent health inspections.

The U.S. News rankings are built on data from Nursing Home Compare, a consumer web site run by the federal Centers for Medicare and Medicaid Services. CMS sets and enforces standards for all nursing homes enrolled in Medicare or Medicaid.  The data for Nursing Home Compare come from regular health inspections carried out by state agencies and from the homes themselves. Based onthat information, CMS assigns an overall ratings of one to five stars to all nursing homes other than a few too new for meaningful data to be available. Homes are also given one to five stars in how well they do in the health inspections, in providing enough nurses, and providing a high level of quality of care.

At Nursing Home Compare, you can search for a specific home or for all homes in a particular state or within a certain distance of your city or ZIP code.

Here are more details about the CMS standards that determine a home’s rating:

Health inspections

Because almost all nursing homes accept Medicare or Medicaid residents, they are regulated by the federal government as well as by the states in which they operate. State survey teams conduct health inspections on behalf of CMS about every 12 to 15 months.  Besides such matters as safety of food preparation and adequacy of infection control, the list covers such issues as medication management, residents’ rights and quality of life, and proper skin care. A home’s rating is based on the number of deficiencies, their seriousness, and their scope, meaning the relative number of residents who were or could have been affected. Deficiencies are counted that were identified during the three most recent health inspections and in investigations of public complaints in that time frame.

Nurse staffing

Even first-rate nursing care falls short if there isn’t enough of it because of too few nurses who can spend time with residents, so CMS determines average nursing time per patient per day. Homes report the average number of registered nurses, licensed practical nurses, licensed vocational nurses, and certified nurse aides who were on the payroll during the two weeks prior to the most recent health inspection and their number of hours worked. The information is compared with the average number of residents during the same period and crunched to determine the average number of minutes of nursing time residents got per day. To receive five stars in the latest CMS ratings, nurses and aides had to provide slightly more than four hours of care a day to each resident, including 33 minutes from registered nurses. The time provided by each home is shown in the rankings.

Quality measures

CMS requires nursing homes have to submit clinical data for the most recent three quarters detailing the status of each individual Medicare and Medicaid resident in 19 indicators, such as the percentage of residents who had urinary tract infections or who were physically restrained to keep from falling from a bed or a chair.

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Helping You Care is a great website with some great resources.  Recently they discussed the changes to CMS' Nursing Home Compare website. 

"The current nursing home quality measures of the Compare tool will be replaced with new quality measures based upon a new version of nursing home resident assessments, starting in 2012.  The new measure will include input from the residents.  As part of the transition to new quality measures, the 5 Star Quality Rating that the tool has provided will not include the new measurement until April 2012. Starting in April 2012, findings of the new assessment measures will be part of the 5 Star Quality Ratings."

Some of the other measures of nursing home quality that have been included in the Nursing Home Compare tool include staffing data and data from health inspections.   As explained in a recent article, “Navigating the Health Care System,” by Dr. Carolyn Clancy, Director of the Agency for Healthcare Research and Quality (AHRQ), also part of HHS:

“Staffing and health inspection data add important information and will continue to be a factor in each nursing home’s overall rating. The staffing measure tells you the average staffing levels—such as the number of registered nurses, licensed practical nurses, and certified nursing assistants—for each resident each day. This is a good benchmark, but it has limits. It does not show the number of nursing staff present at any given time or describe the amount of care give to any one resident. The health inspection measure looks at many major aspects of care in a nursing home. This includes how medicines are managed, whether food is prepared safely, and whether residents are protected from inadequate care. Inspections take place about once a year, but they may be done more often if the nursing home has several problems to correct. ”
 

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Erinn Stam is a community site manager at NursingScholarships.org (a non-profit that features financial aid resources for nursing students).   She sent us the following guest post article to share with our readers.

How to Choose the Right Nursing Home
Choosing a nursing home is an important decision that will impact the continued health and happiness of your loved one, as well as have long-term financial ramifications. While referrals are a good way to start your search, they aren’t always the best way to select what could be a final home. What works great for one individual might be terrible for another. Conducting your own search with your family’s individual needs and circumstances in mind will lead to finding the right nursing home. Here are a few tips to keep in mind:

Analyze Your Finances
As much as we might wish that financial considerations didn’t matter in a decision like this, they do. Finances can actually play a significant role in this decision as the cost of nursing home care is quite expensive – as much as $200 per day or $6,000 per month. This cost may not even include services for special needs such as dementia or Alzheimer’s. Though financial assistance is available in the form of government programs such as Medicare or Medicaid, there are limitations on how much these programs will pay and for what services. A significant family contribution could still be required.
Determine what sources of financial aid are available to your family, then determine what amount you can afford to pay from your own sources, including income, pensions, retirement accounts, and savings.

Location
Start your search by looking for homes close to the majority of family and close friends. Studies have shown that those who receive many visitors in nursing homes experience an overall higher quality of life, better health, and faster recovery. If family members are able to visit frequently, they can also monitor the quality of care being provided.

Schedule Visits
The best indicator of the quality of a nursing home is your own first-hand experience with it. While there are many things you may not discover until you have entered into business with the home, you can learn a great deal about the quality of the facility and the level of care provided simply by touring the facility and interviewing the staff. Trust your instincts when you visit. Ask yourself the following: Are the staff friendly and inviting? Do the facilities seem clean and welcoming? Do you notice any odd smells or facilities that are in disrepair? Do the residents seem happy? Let your senses guide you, and take notes.

Consider Special Needs
Even if a nursing home seems great, it may not offer the type of care that your loved one needs. If your loved one has a special health condition, make sure the home provides the kind of treatment needed. Are there trained specialists on staff? Will you have access to the recommended treatments? Can you get the medication needed?
Also consider the personal needs and personality of your loved one. Some homes provide “person-centered care,” which gives patients the autonomy to determine their own schedules, including wake times and eating. Many nursing homes operate under a schedule, which could be a jolt to a sense of independence formerly enjoyed. “Consistent assignment” means that each patient is seen by the same staff members so that they can learn the patient’s needs and develop a closer relationship over time. Such care can make a significant impact on the overall experience enjoyed in a nursing home.

Research History
Finally, make sure you check up on the home’s history of complaints and citations. The Centers for Medicare and Medicaid Services collect data on more than 15,000 nursing homes throughout the country each year, and rankings are compiled based on health inspections, staffing, and other measures. You can find this information at Medicare.gov .
You can also talk to state officials to get a history of any complaints filed against the home, and talk to other residents to get a sense of how they feel about the level of care provided.
Overall, it can take a great deal of research and patience to determine the best nursing home for your family. Carefully consider all of these options before making your decision: It will have a long-lasting impact for your family and your loved one who is receiving care.

Bio:
Erinn Stam is the Managing Editor for nursing grants and scholarships. She attends Wake Technical Community College and is learning about government nursing scholarships. She lives in Durham, NC with her lovely 4-year-old daughter and exuberant husband.

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Cai Xingliang of Caregiverlist, Inc. contacted us to request that we mention Caregiver List which provides daily nursing home prices and assist in explaining senior care options and costs. Here is a link to the Widget page where you can grab and post the nursing home costs and ratings widget.  They contacted 18,000 nursing homes nationwide to secure this information and are the only resource providing actual costs of nursing homes nationwide.

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This guest post is contributed by Jill Thompson, who is a volunteer contributor who writes about various topics including consumer issues such as rent to own houses . Jill welcomes your comments at her email thompson.jill82@gmail.com.

When you first learn that a loved one is going to need nursing home care, the costs can seem daunting. But you may not have to shoulder the entire burden. There are a number of potential sources of payment that can assist in reducing the out of pocket cost burden.

If your loved one has been in the hospital for three or more days and is in need of nursing or rehabilitation services, Medicare may be the initial payor for services. Medicare will pay a portion of the costs for a nursing home for those eligible beneficiaries who require skilled nursing or rehabilitation services. However, to be covered, the resident must have been admitted to the skilled nursing facility following a qualifying hospital stay of at least three days. For more information about Medicare's payment of skilled nursing care, the Medicare Fiscal Intermediary for South Carolina can be reached at (800) 633-4227.

For eligible residents who do not have the financial resources to pay for nursing home care, Medicaid will pay for the majority of the costs. The eligibility requirements for Medicaid vary by state. In South Carolina, the Medicaid program is run by the South Carolina Department of Health & Human Services.

The South Carolina Medicaid Program will pay for nursing home care and special services for those who need nursing home care but choose to stay at home. There are a number of eligibility requirements that can become quite complicated. Generally, an individual must be 65 or older, blind, or totally and permanently disabled pursuant to the Supplemental Security Income guidelines. Additionally, the individual must be a citizen of the United States or a lawful alien, a resident of South Carolina, be able to present a social security number or apply for one, and assign the rights to medical benefits or support.

In addition to these basic requirements, there is a somewhat complicated formula to meet the financial requirements for Medicaid eligibility. After exclusions, the individual cannot have more than $2000 of resources. The exclusions are the following:

• The value of the home (up to a maximum of $500,000 unless there is a spouse, minor child, or disabled child lawfully residing in the home);
• The value of one automobile;
• The value of a life estate interest in real property;
• The value of household goods and personal effects;
• The value of undivided interest in heirs property;
• Up to $1500 that is set aside of the individual's burial ($3000 if the spouse is still living); and,
• The case value of life insurance policies owned by the individuals when the total face value of all policies is $10,000 or less.
If the resident meets these requirements and needs nursing facility care as certified by the Community Long Term Care Program, Medicaid will pay for the covered services.

If the potential resident is not covered by Medicare or Medicaid, the costs for the nursing home will generally need to be paid out of personal resources or private insurance. If you have questions about eligibility or need assistance, the South Carolina Department of Health and Human Services may be able to assist you. You can reach them at (888)549-0820.

Paying for nursing home services can be difficult, but under many circumstances, there is government assistance available to share the burden.
 

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Beatrice Owen writes articles for http://bachelorofscienceinnursing.org/, a website dedicated to providing students with the information and tools needed in order to pursue their Bachelor of Science in Nursing.

Her latest article is called 25 Q & A Sites About Nursing Home Care.  The article and site are very informative.

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K. Gabriel Heiser, J.D., has focused exclusively on estate planning and Medicaid eligibility planning, including trusts, estates, gifts, and related tax issues, since graduating from Boston University School of Law in 1983.   Gabriel Heiser is an attorney with more than 25 years of experience in nursing home law, and believes that people should start planning now for long term care.

The fact is that in 2010, more than 7,000 people turned 65 years old or older every single day, a figure that is predicted to rise in 2011. Further, an AARP survey revealed that only 4 in 10 of those people feel they will be financially secure for their golden years.  For many, that lack of financial stability will transform from being a worry to becoming a crisis if they discover they’ll need any kind of assisted living.

The mistake a lot of people make is thinking that they can’t qualify for Medicaid, according to Heiser.

“Many feel that because they own a home or have some assets that they can’t qualify for Medicaid help with their nursing home and doctor’s bills,” he said. “The truth is there are a variety of assets people can own and still qualify. It’s just a matter of knowing the rules, and making a plan to meet those requirements.”

Heiser listed the asset limits for those applying for Medicaid. They include:

· Cash – You can possess $2,000 cash that will not be counted as an asset in determining your Medicaid eligibility.

· Home – There is a $500,000 exclusion toward your home, meaning that if your home is valued at $500,000 or less at the time of your application, it is excluded as an asset. Some states use the higher permitted exemption of $750,000.

· Car – Up until recently, you could exclude only one car at a value of $4,500 or less, however that law has been changed. Now, one automobile of ANY current market value is excluded on your application.

· Funeral and Burial Funds – If you have a pre-planned funeral or memorial arrangement, the entire value of that plan is excluded. If you do not, a separate bank account that contains $1,500 toward funeral expenses can be excluded. If you have pre-purchased burial plots, you can exclude not only the costs of the plot for the applicant, but for the entire family, and still be eligible for Medicaid.

· Property – According to federal law, any real or personal property that is essential to self-support, regardless of value or rate of return, is excluded. That could include farms, rental properties and other real estate investments that generate income necessary for self-support. For rental income, however, the property must generate at least 6 percent of its value annually in order to qualify for the exclusion.

· Life Insurance – Only the cash value of a life insurance policy owned by the applicant is counted, thus, all term policies are ignored.

If you would like to interview Gabriel Heiser or request a review copy of How to Protect Your Family's Assets from Devastating Nursing Home Costs contact Ginny Grimsley at ginny@newsandexperts.com.

Ginny Grimsley
National Print Campaign Manager
News and Experts
1127 Grove Street · Clearwater, Florida 33755
Phone: 727-443-7115 EXT 207
www.newsandexperts.com

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Roxanne McAnn at NursingSchools.net sent me an interesting article "15 Interesting Facts About For-Profit Hospitals".  See below:

If you haven't spent much time in the hospital, you've probably never thought about the difference between non-profit and for-profit facilities. Yet for those in the health care industry, and who have medical conditions that need constant care and the larger community, the difference between the two can be substantial. As a nurse or health care professional, these are issues that may affect how you practice, where you want to work and what kind of facilities are available where you live – so it's important to know as much as you can. As many communities are divided between those who support and those who oppose for-profit health care, you'll need to know the facts to make an informed decision. Here are some to get you started, letting you know the pros, cons and stats of for-profit hospitals.

Over 17 percent of hospitals are for-profit. In 2002, that number was only around 10%, demonstrating a marked growth in the for-profit health care industry over the past decade, growth that's expected to continue over the next five years.
For-profit hospitals often focus on high-end, high-revenue treatments. Visit a for-profit hospital and you're likely to see a gleaming cardiac wing, top-notch brain surgeons and fancy CT scanners. What you are less likely to see are family planning services, emergency rooms and psychiatric care. These services have a low rate of return on investment and may actually cost rather than bring in money, so many private institutions opt out of providing them. Of course, there are some for-profit hospitals that provide the bulk of these services (and others) to their local communities.
More for-profit hospitals engage in morally questionable practices like patient dumping. A study found that for-profits were twice as likely to dump emergency room patients onto other facilities as not-for-profits. Patients who do not have insurance or whose plans will not cover emergency care were more likely to be transferred, often in a manner that violates the Emergency Medical Treatment and Labor Act. Not-for-profits certainly aren't in the clear here, but the difference between the two is striking.
For-profit hospitals are buying out may non-profits. In communities around the nation, many not-for-profit hospitals are struggling to stay afloat. Rising costs, a heavy patient load and outdated equipment make some simply not economically viable. For-profit medical groups are often stepping in and buying these hospitals. While some community leaders are relieved that the hospitals are being saved, others worry that it will be at a cost to the economically disadvantaged in the community. With more hospitals on the auction block every day, the effect of this change is likely to become clear in the coming months and years.
It'll cost you more to go to a for-profit hospital. Not necessarily because they just want to charge you more, though profit margins certainly are an issue. For-profit hospitals don't get the tax breaks that not-for-profits do, meaning they have to charge more to make up for it. How much? Expect to pay around 19% more for a visit to a for-profit than a not-for-profit.
For-profit hospitals have a higher death rate, on average. While the results of the study have been hotly contested, a group of Canadian researchers found that for-profit hospitals have a slightly higher death rate — around 2% higher. While the study found a difference, researchers were unable to pinpoint just what was causing the disparity, but some think it might have to do with for-profits cutting corners in order to generate more revenue. Of course, that number doesn't mean every for-profit has a higher death rate — it is an average– some may have a much lower chance, while others are much higher.
A woman is 17 percent more likely to have a C-section at a for-profit hospital. While the number of C-sections performed nationwide at all hospitals has skyrocketed in the past decade, a fact many see as a direct threat to the safety of both women and their children, a California study found that women are even more likely to get a C-section at a for-profit hospital. The reason isn't hard to figure out. A surgical birth costs twice as much as a vaginal one, and more C-sections means more profit. Additionally, once that baby is born, it's more likely to end up in a pediatric ICU, whether it needs it or not, at a for-profit.
You're more likely to get diagnosed with costly conditions at a for-profit. And that would be fine, provided that was really what was ailing you. A study in a German medical journal found that many for-profits may be guilty of up charging. They compared admissions of patients with respiratory infections and pneumonia, two conditions that can be pretty hard to tell apart from a medical standpoint, but with one usually paying about $2000 more to the hospital. Over the past decade, for-profits diagnosed the more expensive condition at rates much higher than that of not-for-profits. Lawsuits have since reduced this phenomena, but more recent data shows that for-profits still routinely cost Medicare more than their non-profit counterparts.
For-profit hospitals may have an advantage when it comes to efficiency. There is one area in which for-profits often excel. Because they're watching the bottom line, for profits are better at reducing waste, streamlining their processes and running a more efficient, tightly managed facility. Of course, there are exceptions, and studies have found that it depends more heavily on ownership than on profit status whether or not a hospital will be efficient.
For-profit hospitals may stretch staff more thinly. Because they're focused more operating efficiency, for-profits often have lower staffing ratios. This may not mean much for patients, as these staff members are usually compensate by being more productive (most patients often rate than standard of care similarly.) Yet it can make a difference in terms of stress and job satisfaction for those who are working in a for-profit institution. A study found that hospital workers are more likely to feel valued as a person, receive praise and feel their job is important at not-for-profits than at for-profits.
Dementia patients are more likely to be over treated at a for-profit. The practice of tube-feeding patients with advanced dementia has been widely criticized by the top medical journals and isn't medically necessary in most cases, yet doctors are still using it as a treatment for dementia patients. While it occurs in for-profits and not-for-profits alike, patients at the former are 33% more likely to be given a feeding tube. It is even more common at large hospitals in either category, with a whopping 50% greater chance of feeding tube insertion in hospitals with over 300 beds.
Patients rate higher loyalty and satisfaction in for-profit ERs. While some for-profits might shy away from these low-return facilities, those who do have them tend to have higher rates of patient satisfaction than their not-for-profit counterparts. Some suggest that the reason for this may be due to for-profits having access to greater capital, meaning they can more easily invest in updated equipment and services. Additionally, not-for-profits are often chronically overburdened with patient volume and suffer from short staffing, factors that could reduce overall satisfaction
For-profit hospitals rate consistently lower when delivering care for these common conditions: congestive heart failure, heart attack and pneumonia. If you've got any of these conditions, or suspect you might, you may be better off heading to a not-for-profit if you have a choice. A 2006 study by the Harvard Medical School determined that patients with these conditions were more likely to get high-quality care diagnosis and treatment for these conditions as not-for-profits– a fact they suggest is due to increased staffing and more technology.
For-profit hospitals have lower costs per patient. Whether this is for better or worse for patients is up to you to decide, but Census data in 2008 recorded that the average total cost per patient per stay is about $7,985 at a for-profit hospital compared to $10,081 at a not-for-profit. This could be due to greater cost-cutting measures, efficiency or differences in staffing at for-profits versus their counterparts.
The impact of for-profit hospital conversion on the community is varied. Some may see for-profit hospitals taking over not-for-profits as a blessing, others as a curse, but the facts don't have much to lend either side. Studies conducted by the Boston University School of Public Health found that some for-profits dramatically increased care to the poor while others decreased it, sometimes as much as 40%. The study found that, on average, there were no long-lasting changes in care between the two types of hospitals, meaning a lot of worries communities have about for-profit health care could be unfounded.

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The National Consumer Voice for Quality Long-Term Care (formerly NCCNHR), announced the launch of its new guide Piecing Together Quality Long-Term Care: A Consumer's Guide to Choices and Advocacy, which is intended to educate people with disabilities and older adults about their options for long-term services and supports and empower them to be self-advocates for quality long-term care. The guide also provides information and resources to assist people currently living in nursing homes to move back into the community.

The Consumer Voice has developed a website (http://www.theconsumervoice.org/piecing-together-quality-long-term-care) for the guide, which features Piecing Together Quality Long-Term Care in different formats, including an HTML version, a PDF version and audio portions of the guide. The website also includes three state-specific guides funded by the Consumer Voice and written by citizen advocacy groups in Kansas, North Carolina and Virginia. These state guides are designed to assist older adults and persons with disabilities in making informed decisions when choosing long-term care services. A hardcopy of the 80-page, professional bound guide is available for $20 and can be purchased online.

 "While older adults and individuals with disabilities may have different needs, they all deserve a choice of quality long-term care services," said Consumer Voice Executive Director Sarah F. Wells. "Many consumers face the daunting and overwhelming task of trying to navigate a long-term care system that is fragmented and complicated. This project aims to build a bridge between the aging and the disability communities and create a strong, unified long-term care consumer voice.

 "We are launching the guide at this time because the Affordable Care Act is increasing opportunities for the elderly and persons with disabilities to receive care in their own homes."

 The publication of this new resource coincides with the one-year anniversary of the signing of the ACA, which created some of the most significant improvements and changes in long-term care in a generation. Through the ACA, consumers will see increased transparency of nursing home operations and quality; improved safety for people receiving care in long-term care facilities and their homes; strengthening of agencies that investigate neglect and abuse of the elderly, including the long-term care ombudsman program, state survey agencies and Adult Protective Services; and new programs that provide incentives to states to provide more Medicaid home and community-based services.

 This guide was funded by the Milbank Foundation for Rehabilitation. For more information on this project and on health care reform, visit www.theconsumervoice.org.

The National Consumer Voice for Quality Long-Term Care is a 501(c)(3) nonprofit organization founded as the National Citizens' Coalition for Nursing Home Reform (NCCNHR) in 1975 by Elma Holder. The organization represents the consumer voice at the national level for quality long-term care, services and supports by advocating for public policies that support quality care and quality of life responsive to consumers' needs in all long-term-care settings; empowering and educating consumers and families with the knowledge and tools they need to advocate for themselves; training and supporting individuals and groups that empower and advocate for consumers of long-term care; and promoting the critical role of direct-care workers and best practices in quality-care delivery.
 

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Celina Jacobson at Mastersinhealthcare.com recently shared an article with us titled  “20 Incredibly Educational Alternative Medicine Blogs”.  We thought it was informative and wanted to share it.

Many nursing homes do not offer any options on treatment including alternative treatments that are effective in other countries.  When you choose a nursing home, ask them if they offer alternative medical treatments.

 

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