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

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

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

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

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

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

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

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

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The Tennessean had an interesting article about Silvercare, a company that has found a niche in the nursing home industry that improves the quality of care provided and the resident's quality of life.   Silvercare Solutions was started in February to capitalize on Medicare rules that required nursing homes to do more to ensure that residents are properly assessed for incontinence and provided with comprehensive care services.

Silvercare brings nurse practitioners to nursing homes to treat residents, relieving the homes of the need to hire specialized staff, find urologists to see the elderly residents in their clinics or transport residents there.   About a third of nursing home residents are incontinent, he said.

Silvercare got off to a fast start by acquiring the private practice of a geriatric nurse practitioner that delivered incontinence services to nursing homes in Philadelphia.  It is using the model of that practice to expand in Tennessee, Pennsylvania and New Jersey, where it operates in 48 homes.

Nina Monroe, director of nursing at client Bethany Healthcare Center here, said the nursing home already is seeing improvements in some residents since signing up with SilverCare about a month ago.  Previously, a gerontologist examined residents with incontinence, she said, adding that having specialized care helps to get to the source of conditions that cause the residents’ discomfort.

One of the founders of Silvercare, Frazer Buntin said he was motivated to launch Silvercare by personal experience; he lost his grandmother four months after she broke her hip hurrying to the
restroom at a Nashville nursing home.   This is a common problem in nursing homes.  Residents need to go to the bathroom; they hit the call bell for assistance. No one responds.  They risk falling by trying to get to the bathroom or they wet themselves and lose all dignity.  Many of the fall cases we handle resulted from the staff's failure to respond to call bells in a timely manner.

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The Des Moines Register has an interesting story about Congress considering legislation that would eliminate taxpayer funded bonuses to nursing homes. Nursing homes around the country are getting hundreds of millions of dollars in taxpayer funded bonuses despite history of violations.

The legislation is an amendment to the budget bill that has been debated by Congress. The amendment was accepted by unanimous consent of the Senate on Thursday, but the bill itself has yet to be approved. The Des Moines Register reported last November that nursing homes throughout the country are earning hundreds of millions of dollars in taxpayer-funded bonuses despite violations of basic health-and-safety standards.

Nationally, the total cost of the bonuses is unknown. The Centers for Medicare and Medicaid Services, which approves and helps fund each of the bonus programs, does not track the payments. Currently, there are 81 bonus-payment programs in 36 states.  How and why do not they not track these bonuses?  Why would we give bonuses to profit-driven companies that short change residents on care and essential activities of daily living such as eating, bathing, and hygiene?  What a waste of taxpayer money!

The Register examined eight programs in the seven states where recent regulatory violations don't disqualify a nursing home from receiving a bonus that is touted as being directly related to quality care. Those eight programs cost taxpayers $312 million per year. Some of the largest bonuses to poor-performing homes have been in Oklahoma, the home of Republican Sen. Tom Coburn, a medical doctor. Coburn authored Thursday's amendment, telling his Senate colleagues that taxpayers shouldn't be billed for bonuses paid to inferior care facilities.

"We paid out in excess of $300 million in bonuses to nursing homes that had significant problems in terms of giving the care and meeting Medicare standards," he said. "Why? Why wouldn't we fix that?"

Coburn's amendment would prohibit federally funded bonuses to nursing homes and any other government contractors that "fail to meet basic performance requirements." Coburn has likened the bonuses to those paid to executives at American International Group, or AIG, the insurer that has received $182 billion in federal bailout money.

In Iowa, the Register found that 16 of 23 homes hit with major fines in 2007 qualified for 2008 bonuses. Two homes that earned bonuses were on a federal list of the worst nursing homes in the nation, and a third faced the threat of having its license pulled because of substandard care.

In New Hampshire, the bonus program was dubbed the Medicaid Quality Incentive Payment to ensure legislative approval, although state officials there acknowledge the program includes no incentives or benchmarks for quality care. In other states, homes have been given bonuses to pay for legally mandated requirements, such as the installation of fire sprinklers or the payment of minimum wage.

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MedPageToday.com had a short summary of a new Centers for Medicare & Medicaid Services (CMS) plans to test a pay-for-performance program to improve the quality of care in nursing homes.  All Medicare-certified nursing homes in Arizona, Mississippi, New York, and Wisconsin will be invited to join the Nursing Home Value-Based Purchasing demonstration project, which will run for three years starting in July.  CMS expects to enroll at least 100 homes from each state.

Under the program, participating institutions will be awarded points on the basis of staffing measures, avoidable hospitalizations, resident outcomes, and deficiencies identified during inspections.   Homes that score the highest and that show the greatest improvements over time will receive payments.  CMS expects to pay for the program with the money saved by reducing avoidable hospitalizations through improved performance. The funds will be placed into state pools from which incentive payments will be drawn.

I think this is a good idea but shouldn't nursing homes provide quality care and adequate staffing anyway for the billions of tax payer dollars they get every year?
 

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