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

McKnight's had an article discussing the recent National Nursing Home Survey: 2004 Overview is the seventh in a series of periodic nursing home surveys conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics, Division of Healthcare Statistics. The full study is available at here.

The number of both nursing home beds and nursing home residents in the United States declined between 1999 and 2004.   The number of nursing home beds dropped by more than 10% from 1.9 million in 1999 to 1.7 million in 2004. Meanwhile, the number of nursing home residents fell by 6% from 1.6 million to 1.5 million according to the study.

Here are other study findings:

More facilities were both Medicare and Medicaid certified in 2004 (87.6%) than in 1999 (81.8%).

Of the 936,000 persons providing nursing home care in 2004, the vast majority (roughly 600,800) were certified nursing assistants (CNAs).

Slightly more than 88% of the residents of the nation's 16,100 skilled nursing facilities are over the age of 65, 45.2% are over the age of 85, and 71.2% are female.

Only 1.6% of the entire nursing home population received no assistance with activities of daily living (ADLs) while a slight majority—51.1%—required assistance in all five ADL categories.

• Email This
• Print
• Comments
• Trackbacks

We have many people call us asking for advice on how to choose a nursing home. Many of the people seeking advice want to rely on Medicare's star ratings.  We are not convinced that these star ratings give an accurate assessment of a nursing home's ability to provide good care.  The ratings are primarily based on surveys and investigations done by the Department of Health and Environmental Control (DHEC).  Well, the problem with that is DHEC tells the facilities when they are going to investigate or conduct a survey giving the facilities time to get their best nurses in the facility, to staff more than typical, and make sure all the documentation is revisited and changed if lacking.  

When abuse or neglect is reported, the state's investigations procedurally favor the facilities. Violations must be actually found in the facilities' own documentation, which are very self-serving. We cannot rely on the state for enforcement of regulations that are designed to protect residents and ensure proper care.

The key to quality of care is competent, compassionate, and well-trained staff.  They are less likely to get burnt-out and more likely to stay in the job thus lowering turnover rates which are detrimental to residents especially those with dementia.  The reality often is that staff who complain about resident neglect don't remain employed.  Fortunately there are laws to protect workers from retaliatory firing, but many employees still fear losing their jobs by speaking up.  Regulations exist to protect residents from neglect, but residents and employees fear retaliation. Many times families aren't aware neglect is occurring. Facilities lie and cover up to protect themselves from liability.

There are no "good" facilities here.  Unfortunately the best that one can hope for is "average" — with most "below average."  It is tragic that our area does not have "above average" facilities available. We should be outraged. Our tax payer money is going to these facilities. instead of providing quality care and adequate staffing, the facilities send the money to "management" companies that are owned by the same people who own the nursing home and don't actually provide any services.

Our community needs to make it less profitable for nursing homes to neglect our elderly. A society is ultimately judged by how it treats its most vulnerable members. At this time civil actions are the only effective solution. The state won't do it.
 

• Email This
• Print
• Comments
• Trackbacks

The American Association of Homes and Services for the Aging (AAHSA) developed a Task Force on Survey, Certification and Enforcement.  In June 2008, they issued a report titled Broken and Beyond Repair: Recommendations to Reform The Survey and Certification System.

The AAHSA Task Force on Survey, Certification and Enforcement believes strongly that
despite some measurable, specific successes, the nursing home oversight system has,
overall, failed to fulfill its 20-year-old goals to ensure a nursing facility’s “sustained
compliance” with regulations and to enhance quality of care and quality of life for
residents living in those facilities. The Task Force’s year-long examination has convinced
each of its members not only that the system is not working today – but also that the
system will not work in the future, when a growing number of older Americans with
increasingly complex care needs will seek care in nursing homes. Now is the time – not
tomorrow or next year or five years from now – to take bold steps to design a new system
for ensuring quality of care and quality of life in this country’s nursing homes.

The National Commission for Quality Long-Term Care, a bipartisan study group,
suggested in its December 2007, report that the long-term care system can no longer
depend on “the old ways of doing things.”19 In this report, the Task Force on Survey,
Certification and Enforcement urges AAHSA to take the lead in advocating for steps that
will introduce “new ways of doing things” into the survey and certification system. We
urge the association to consider our recommendations carefully and to act on them
boldly.

• Email This
• Print
• Comments
• Trackbacks

 I have read several articles recently about how some cities like Cincinnati may stop conducting nursing home inspections.  That is fine with me since most inspectors in South Carolina are so overworked and underfunded that the inspectors don't have the time and resources to properly insure that the nursing home is properly caring for the residents. 

Typically, the nursing homes know when they are coming and improve conditions before the inspectors get there.  We hear countless stories from ex-employees of nursing homes in the area that all repeat the same chorus.  "They increase staff and clean everything when they know the survey team will be coming in". 

I have not seen any complaints substantiated or any fines incurred against any of the for profit nursing homes. The inspectors in South Carolina seem to ignore violations, and the concerns of residents and family members. Instead, they criticize the county run nursing homes or the charitable organizations that run the mom and pop nursing homes.  I can't tell if it is corruption or incompetence but certainly the inspection program in South Carolina isn't doing anything to provide better care or oversight for the residents.

Below is a summary of a story by Dan Horn about Cincinnati dropping nursing home inspections

The Cincinnati Health Department is considering whether to drop its inspection program for nursing homes and residential care facilities. Budget cuts and retirements could soon leave the department unable to keep up with annual inspections. Cincinnati is the only city in the state that does its own nursing home inspections, a policy that city officials have said allows the city to react more quickly and aggressively to problems.   He said the program once operated with six inspectors and supervisors, but that number fell to four by the start of this year. Another retirement will drop the total to three employees by this fall.

• Email This
• Print
• Comments
• Trackbacks

An independent, broad-based national expert panel should be convened to re-examine the oversight process for nursing homes, a task force from the American Association of Homes and Services for the Aging (AAHSA) concluded in its final report, "Broken and Beyond Repair: Recommendations to Reform the Survey and Certification System."

The report's 31 recommendations include improved communication to surveyors and providers about new requirements and changes to the survey process, standardized job descriptions for surveyors, more efficient use of survey resources, and flexibility to adapt to culture change. The task force's overarching recommendation is that an independent commission, such as the Institute of Medicine, reexamine the survey and certification process to "create a common vision for how our nation should care for its frailest citizens and to recommend a new oversight model for ensuring that this vision becomes reality in every nursing home today."

Bonnie Gauthier acknowledged that "our short-term suggestions alone won't bring the system back to the intent of OBRA 87 -- achieving optimal, quality-based, resident-centered care -- but they will tide the system over until broad systemic change can occur." Immediate changes needed, according to the report, include better public reporting of survey results, joint education of providers and surveyors, and greater overall consistency in the process."

To inform its conclusions, the report includes a digest of interviews with survey agency representatives from seven states and a catalog of surveyor job descriptions from numerous states.
Larry Minnix, AAHSA's president and CEO, said  "This system is angry, broken and can't be fixed. A system based on consistency, fairness and accuracy will help us move toward the day when there are two types of nursing homes: the excellent and the non-existent."

Get copies of the report . 

About AAHSA
The members of the American Association of Homes and Services for the Aging ( www.aahsa.org) help millions of individuals and their families every day through mission-driven, not-for-profit organizations dedicated to providing the services that people need, when they need them, in the place they call home. Our 5,800 member organizations, many of which have served their communities for generations, offer the continuum of aging services: adult day services, home health, community services, senior housing, assisted living residences, continuing care retirement communities and nursing homes. AAHSA's commitment is to create the future of aging services through quality people can trust.
SOURCE American Association of Homes and Services for the Aging
 

• Email This
• Print
• Comments
• Trackbacks