Lauren Weiler for CheatSheets wrote about the dark secrets nursing homes do not want the public to know.

1. Some contracts don’t allow you to sue if something goes wrong:

Knapp & Roberts notes you should review all of the print in your paperwork, and keep a watchful eye out for anything noting “binding arbitration agreements.” Essentially, this agreement means you must settle your differences outside of court, removing your right to sue. If anything serious happens, you certainly don’t want to be bound by this clause.

2. Residents don’t always have as much freedom as they want:

One study found out of 65 nursing home residents interviewed, about half felt depressed due to a lack of independence and freedom, as well as loneliness. The interviewees also seemed to prefer homes that had programs designed to reduce their sense of isolation from others.

3. Residents don’t always get enough to eat:

 A 2015 overview from Nursing Older People found nursing home residents are among those who have higher rates of “anorexia of aging,” and over 50% of residents studied also complained of constipation. Your home of choice should have a plan in place to combat these issues.

4. Some of the ‘nurses’ aren’t nurses at all:

Every nursing home has some number of permanent nurses — but not everyone working is a staff member you’ll see again. Bottom Line Inc. explains “agency nurses” are often employed when a home is low on permanent staff. These temporary nurses work for staffing agencies and rarely form bonds with residents because of their position. For your comfort, it’s wise to choose a home with a staff that’s at least 80% permanent nurses.

5. Residents often have to leave the doctors they’re used to behind:

Knapp & Roberts explains most nursing homes have assigned physicians, which makes it difficult for residents to keep the doctors they’re used to seeing. If you’re really attached to your current doctor, it’s best to ask a potential home about their rules regarding this. You should also ask the home how often the physicians see their residents and what the health care plans may look like before committing.

6. Low staffing levels are a huge issue:

Up to 95% of American nursing homes may be understaffed.

Some homes have a difficult time finding enough staff, but other homes purposely understaff to cut costs. Having a bad patient to staff ratio is stressful for the staff and bad for your care. It may also leave you vulnerable to neglect and abuse. Be sure to ask what the patient to staff ratio is in your chosen home so you can ensure you’re getting the care you’re promised.  There should be at least 4.1 hours per person per day of direct nursing care.

7. Nursing homes may send a bill to relatives for the resident’s care:

According to Mass Mutual, the average amount paid for assisted living in 2017 was $3,750 per month. While you may have multiple ways of taking care of these costs, you should ensure none of the expenses accidentally get sent out to relatives. This happened in 2012 to a man who was forced to pay nearly $100,000 of his mother’s care without realizing it. Know what your state laws are regarding billing, and as always, have both you and your family members read the fine print.

8. The staff isn’t always clean:

Nursing home staff are careful with washing their hands, right? While this may seem like an obvious practice of personal hygiene and to prevent the spread of infections and communicable diseases, not all staff members participate. The New York Times reports many nursing homes are being cited for “hand hygiene” deficiencies.  Unsurprisingly, the nursing homes that were understaffed found the most hand-washing issues. Finding a well-staffed home may be key to your overall health.

9. Nursing assistants don’t need as much training as you think:

They may seem official, but many nursing assistants have no formal training at all to take care of you. NursingAssistantGuides.com explains some clinics will hire untrained workers and train them to be nursing assistants at the facility. Even for those who have a degree as a CNA, that can be acquired online with no hands-on experience. And many CNAs start at nursing homes and then move on to jobs with better pay, making the turnover rate incredibly high.  CNAs are not licensed health care providers.

10. Neglect is a common issue in the homes:

Next Avenue explains out of all the cases of nursing home abuse, neglect is the most common. While there are times when neglect is intentional, it isn’t always this malicious. Inadequate staffing and high turnover rates can also lead to this issue.  When choosing a nursing home, take a look at the other residents. Do they seem clean and well taken care of? The living quarters should also be clean and safe, with little wear and tear.

11. Some nursing homes may tell you to get extra aid outside of their care:

Staff in your chosen home are required to provide you with the care you need. If you’re ever told you need an outside aid to assist you for additional costs, Knapp & Roberts says to take note. This is negligence on the part of the nursing home.

12. The physical therapy units aren’t always up to snuff:

While you may be more concerned with what the rooms and eating areas look like, don’t forget to tour the physical therapy unit. Bottom Line Inc. explains if you require rehab of any kind, this is particularly important. Take a look at the machinery and ask if physical therapists are on the staff itself or just doing contractual work. If your nursing home is staffed with physical therapists, it’s likely to give you better service.

13. The ‘activities schedule’ might be a total bust:

U.S. News & World Report reminds us many nursing homes are still lacking in the activities department. While birthday parties and Bingo are commonplace, you’ll need more than that when choosing a place for your future. And the best homes will ask each resident about their interests to try and accommodate as many people as possible. Certain homes offer gardening clubs, cooking classes, and art therapy, so make sure you ask what’s available.

14. Most residents will have a lack of privacy:

While many folks in nursing homes like having company, there’s also another issue you may not have thought of: a lack of privacy. Bottom Line Inc. explains most homes offer a wide range of shared rooms, with private rooms costing serious cash. Not all shared rooms are bad, however. You’ll just want to make sure what’s dividing your bed from someone else’s is sturdier than a thin curtain.

15. More serious forms of abuse take place, too:

The National Council on Aging report about one out of every 10 Americans over 60 experience abuse — and it can even occur in nursing homes, Spangenberg Shibley & Liber LLP says. Neglect aside, the publication notes sexual assault and abuse has also been cited in certain homes. And many other instances of abuse go unreported. Do your research to see if any abuse allegations have been filed against your home of choice.

Kathryn Price’s blog had an article on the use of anti-psychotics in nursing homes despite the FDA’s black box warnings.  Human Rights Watch, a nonprofit, nongovernmental human rights organization, released a report this year that shows nursing homes are overprescribing antipsychotic drugs to manage the behavior of dementia patients even though anti-psychotic drugs are not FDA approved as treatment for dementia.

The FDA mandates that a black box warning appear on anti-psychotic medications, which cautions that they may lead to an increased risk of death for dementia patients. Additionally, research exists supporting the idea that anti-psychotics can be harmful when used for behavioral reasons alone on dementia patients, including an increased risk of deathfalls, and reduced cognitive functioning.

The federal government does have regulations aimed at preventing this. One such regulation appears in a 2016 revision to the Centers for Medicare & Medicaid Services’ (CMS) regulations for Medicare and Medicaid certified nursing facilities. The regulations state that “Residents who have not used psychotropic drugs are not given these drugs unless the medication is necessary to treat a specific condition as diagnosed and documented in the clinical record.”

According to federal regulations, patients and/or their guardians have a right to understand the purpose of their prescribed medical treatment prior to administering, which is vital to preventing the prescription of unnecessary anti-psychotic drugs.

Despite these regulations, the report maintains that anti-psychotic drugs are still used to treat behavioral concerns in dementia patients due to a lack of enforcement. A 2014 NPR report indicates the penalties that exist for unnecessary prescriptions are rarely used and of the infractions reported only 2 percent were severe enough to warrant a fine.

CMS launched a program in 2012 to combat the improper usage of antipsychotic drugs in nursing homes and by late 2016, CMS announced that it met its goal of reducing the national prevalence of antipsychotic use in long-stay nursing home residents by 30 percent.

 

 

The New York Times had an interesting article about the lack of primary care doctors.  Long hours and low pay have transformed pediatric or family practices into unattractive options for many aspiring physicians. The days of Marcus Welby are long gone.

“People are flocking to retail clinics and urgent care centers in strip malls or shopping centers, where simple health needs can usually be tended to by health professionals like nurse practitioners or physician assistants much more cheaply than in a doctor’s office. Some 12,000 are already scattered across the country, according to Merchant Medicine, a consulting firm.”

Giant corporations like CVS Health, the drugstore chain, and most recently Walmart, are eyeing deals with Aetna and Humana, respectively, to use their stores to deliver medical care.  The new deals involving major corporations increase pressure on small practices and push them closer to extinction.  In California, Apple recently decided to open up its own clinics to treat employees. Other companies are offering their workers the option of seeking medical care via their cellphones.

Investors are also pouring money into businesses aiming to create new ways of providing primary care by relying more heavily on technology.  By using sophisticated computer systems, One Medical, which employs 400 doctors and health staff members in eight major cities, allows its physicians to spend a half-hour with every patient.

“Big hospital groups are also eroding primary care practices: They employed 43 percent of the nation’s primary care doctors in 2016, up from 23 percent in 2010. They are also aggressively opening up their own urgent care centers, in part to try to ensure a steady flow of patients to their facilities.”

Cleveland’s The Plain Dealer reported that certified nursing assistant jobs have one of the highest reported rates of injury in Ohio and across the nation, according to researchers and government reports. Nursing assistants are injured three times more often than the average worker, data show.  The rate of injury among nursing assistants is similar to the rate among construction workers, police and firefighters, according to 2016 data from the U.S. Bureau of Labor Statistics.

For the more than 75,000 residents of Ohio’s 960 nursing homes, nursing assistants provide nearly all of the hands-on care. It is a job that requires dedication, passion and empathy.  State and federal officials have issued reports on injuries at nursing homes, dating back to 1999. The studies found that the lifting and moving of residents and the nonstop pace necessary to meet residents’ needs have caused thousands of Ohio nurses and nursing assistants to suffer injuries from overexertion and falls.

The pay in Ohio has trended downward for more than a decade, according to the Paraprofessional Healthcare Institute, a New York watchdog group that advocates for nursing assistants and home health-care workers. In 2006, their average wage was $12.80 an hour. In 2016, it was $11.96.  (It is about $10.50 in South Carolina).

“It’s appalling,” said Toby Edelman, the senior policy attorney for the Center for Medicare Advocacy in Washington, D.C. “That’s not a living wage for anyone.”

The low pay and the physical demands of the job result in an unusually high turnover rate. In Ohio, that rate was 54 percent for nursing assistants at nursing homes in 2015, the most recent data available, said John Bowblis of the Scripps Gerontology Center at Miami University in Oxford.

To offer quality care, staffs at nursing homes should provide an average of 4.1 hours of care for a resident each day, researchers said.

“A large proportion of people in nursing homes need two [assistants] to help them move, and many nursing homes just don’t have enough staff to offer that,” said Charlene Harrington, a professor emeritus of nursing at the University of California at San Francisco and an expert on nursing home staffing. “The better the staffing in nursing homes, the better the care and the less likely workers will get injured.”

This is a gargantuan problem in nursing homes,” said Brian Lee, who leads a Texas-based national advocacy group for nursing home residents called Families for Better Care. “[Nurses and nursing assistants] are overworked, short-staffed and underappreciated. The burnout, the frustration, the injuries. They can all be prevented if employers just hire more people.”

 

McKnight’s had an article about the new in-depth analysis published by the Henry J. Kaiser Family Foundation.  According to the data, occupancy rates at nursing homes fell between 2009 and 2016, however, the needs of nursing home residents have grown considerably — placing more demands on unprepared and under-staffed nursing employees.  Average total nursing hours increased to 4.1 per resident day for 2016, up from 3.9 in 2009.

In 2016, nearly half of nursing home residents had a dementia diagnosis, and just under one-third had other psychiatric conditions such as schizophrenia, mood disorders or other diagnoses. In addition, the report found nearly two-thirds of residents received psychoactive medications, including anti-depressants, anti-anxiety drugs, sedatives, hypnotics and antipsychotics.

Over the past 25 years, numerous research studies have documented a significant relationship between higher nurse staffing levels, particularly RN staffing, and the better outcomes of care,” wrote lead researcher and staffing expert Charlene Harrington, RN, Ph.D., FAAN, professor emeritus at the University of California-San Francisco School of Nursing. “Nursing assistants who provide most of the care to these individuals often have limited training in working with this [behavioral health] population. … Regulations could implement ACA requirements to improve the quality of care for residents with cognitive impairments and further restrict the use of psychotropic agents.”

The report is based on the federal Online Survey, Certification, and Reporting system (OSCAR) and Certification and Survey Provider Enhanced Reports (CASPER) system and also examines staffing levels, payment, and compliance.  The most common deficiencies in 2016 were given for failures in infection control, accident environment, food sanitation, quality of care, and pharmacy consultation.

“In 2016, more than one in five facilities received a deficiency for actual harm or jeopardy,” Harrington wrote. “As with other outcomes, there was wide variation across states in these outcomes; however, some states had high rates across all top ten deficiencies.”

Other key findings of the report include:

  • Between 2009 and 2013, the average number of deficiencies per facility declined from 9.33 to 7.28, though there was a slight increase between 2013 and 2016.
  • The proportion of for-profit facilities increased from 67% in 2009 to 69% in 2016.
  • Medicaid is the primary payer source for most certified nursing facility residents, with 62% of residents — about 832,000 people — having Medicaid as their primary payer in 2016. States in the East have higher Medicaid population shares.

The Anderson Independent Mail had an article about Orianna’s bankruptcy due to corporate mismanagement and how that affects pending lawsuits and victims.  Lawsuits incuding thos einvolving wrongful death of residents at Orianna’s nursing homes have been halted since the company’s bankruptcy filing last month in Texas.  Lawyers handling pending suits against Orianna have hired bankruptcy attorneys in Texas as part of an effort to have their clients heard in the company’s bankruptcy proceedings. Victims of abuse and neglect are classified as unsecured creditors, and may not be able to get any compensation for their injuries and wrongful death.

Orianna, which is the Upstate’s top nursing home operator, currently runs 42 nursing homes with more than 4,000 beds in seven states. It has about 5,000 employees.

The company intends to sell its Upstate nursing homes and several other facilities throughout South Carolina and Georgia under terms of a restructuring agreement with its landlord, Omega Healthcare Investors Inc. Plans call for Orianna’s 23 other nursing homes to be transferred to a new operator.

However, the U.S. government has objected to a plan by the bankrupt operator of the Orianna Health Systems nursing home chain to protect companies that would acquire facilities through its restructuring from successor liability. The nursing home operator, 4 West Holding Inc, has facilities in seven states. It is seeking a court order that would allow the transfer of assets free of any liability, which the government said is not allowed by Medicare provider agreements.

Besides seeking to halt all litigation in pending cases as a result of its bankruptcy filing, the company has stopped making payments related to some previously settled suits.

Freelance Contribution by Jessica Walter

 

Medicaid is the poor man’s insurance in the US and if Medicaid cuts will be implemented, seniors are part of vulnerable groups that will be hit the hardest. South Carolina has been identified as the state that will experience tough times. The recent Kaiser Analysis revealed that the state, along with 10 others will be in trouble should a $834 funding be slashed in the next decade. Most of the resources of Medicaid is spent on elderly care and people with disabilities.  At present, seniors 65 years and above comprise 16.7% of the state’s population.

 

Over 50 Million Americans Rely on Medicaid

 

Millions of Americans rely on Medicaid as an accessible form of health insurance. It covers low-income groups as well as vulnerable groups such as handicapped people, the elderly, children and pregnant women. Funded jointly by the federal states and the government, the Federal Medical Assistance Percentage differs from state to state according to factors such as income levels. Its eligibility is determined by using the supplemental security income (SSI) for individuals 65 years and older, or who have a disability or blindness. Nearly 1 in 5 Americans are covered by Medicaid. It covers 2/3 of the nation’s nursing homes. As such, it is the biggest expense to Medicaid.

 

Dental coverage can be included in Medicaid but each state is governed by different rules.  15 states will cover dental insurance when it is an emergency dental service and necessary dental procedures. It is up to the state to determine what is necessary and an emergency.  Dental benefits for SC residents were available on December 1, 2014 to pay for cleaning, fillings and extractions with a $750 per annum cap and $3.4 co-pay. This move benefited seniors with disabilities or who are on low incomes.

 

Impact of Repealing the Affordable Care Act

 

President Trump and Congress are trying to scrap the Affordable Care Act. After the elections, efforts were directed at cutting funding to Medicaid by a fifth. The Trump administration also mandated states to impose work requirements as a condition for eligibility to receive Medicaid assistance. The Center for Medicare & Medicaid Services (CMS) has already approved work requirements in Indiana and Kentucky and 8 states are going to follow. Proponents of the work requirements as conditions for Medicaid assistance say that this move will only target those who are not working, actively seeking work or unable to work because of an illness/disability. With work requirements, access to healthcare by low-income families and disadvantaged groups is reduced.

 

Medicaid cuts to South Carolina will affect its beneficiaries including seniors since it has the fourth highest federal match rate. That means for every $1 the state spends, the federal government gives $2.5. Budget cuts will affect everyone because there is no money to spare. It will limit access to healthcare and reduce further the number of people who can see doctors. The elderly will find it difficult to maintain mental, physical and emotional health. Overall wellbeing will diminish.

Managing the health care systems properly is important to provide access to services for the poor and senior groups. Without Medicaid, there are very little options available for mature adults especially those who need long term care or for those with no families to take care of them. Even towards the end of life, this means that the elderly are denied a dignified life without medical and health care.

Many people suffer in nursing homes either from abuse or neglect. Nationally, more than 1 in 5 Medicare recipients do, according to a 2014 study from the federal Department of Health and Human Services. Almost 60 percent of those abuse or neglect cases could have been prevented. The harm came from “substandard treatment, inadequate resident monitoring, and failure or delay of necessary care,” according to the study.

Under a measure advancing in the Louisiana statehouse, families would be able to install video cameras in loved ones’ nursing home rooms.  Under the legislation, nursing homes would be prohibited from denying entrance or retaliating against residents who opt for monitoring devices.  The cameras would be voluntary. Costs would have to be paid by the nursing home patient or family member. Any roommate would have to agree to the installation.

Rep. Helena Moreno (D-New Orleans) said her proposal would offer peace of mind to family members monitoring a parent or grandparent while also ensuring residents’ safety.  “What’s wrong with just having an extra set of eyes, with having a loved one being able to check up on you?” Moreno said.

Missouri is also considering allowing video cameras in nursing home rooms.  See article here.  Two bills have been introduced in the Missouri House this year allowing cameras in nursing home rooms, which advocates say could help prevent elder abuse. One would give families the ability to install cameras and mandate that nursing homes couldn’t prevent the installation. The other, which has already been handed over to the Senate, would give nursing homes the final say.

AARP, the Missouri Coalition for Quality Care and VOYCE, a St. Louis-based organization that sends volunteers to inspect nursing homes, supported the version giving families more power. That version received a public hearing last week but, so far, isn’t scheduled to be debated on the floor. Less than two months remain in the legislative session.

In-room cameras would go a long way toward giving residents and their family members a greater sense of security and could deter potential abuse or neglect, said Mary Lynn Faunda Donovan, VOYCE’s executive director.

“Surveillance cameras are not a suitable replacement for the personal involvement of the staff and family members,” she said. However, “video can provide compelling evidence” of abuse or neglect.  “A camera in the room could exonerate a staff member from any accusations of wrongdoing,” she said. “It works for both sides.”

As of 2017, five other states had nursing home camera laws, with additional rules for assisted living in two.  Andrew Muhl, advocacy director for AARP Louisiana, called it “a very common-sense approach.”

WFAA reported on the investigation into over-medication at Duncanville Healthcare and Rehabilitation Center.  Parkland Hospital investigators are conducting a review for possible over-drugging of patients in an alleged practice known as taking patients “to China.”  The reviews follow the WFAA series, “Drugged and Dying,” that investigated the unnecessary use of alleged powerful antipsychotic drugs to sedate or control patients.

In an effort to cut costs on staffing, many nursing homes drug the elderly rather than hire needed staff, patient advocates warn. They have dubbed the practice “chemical restraints.”  WFAA found in its “Drugged and Dying” series that about 70 percent of a typical nursing home expense goes to staffing.

Several witnesses have come forward stating that residents at Duncanville Healthcare and Rehabilitation were being sedated unnecessarily and inappropriately.   “They said: ‘Take this lady to China,’” the former employee told WFAA.  “It just can be any medication that will put a person to sleep,” the worker said.  “They took that lady to China, and she went to the hospital,” the worker said. “The lady never did come back from the hospital.”

The former employee claims the patient was given the antipsychotic drugs Risperdal and Seroquel. However, the patient, who had been awake and talkative – after receiving the drugs – was placed in bed and became nonresponsive, and within six hours was picked up in an ambulance – and later died, the worker said.  Advocates say the medications – particularly antipsychotics – may become another form of abuse when inappropriately and unnecessarily given. In fact, antipsychotic drugs may be potentially fatal for elderly patients.

Other patients at the Duncanville facility also may have been unnecessarily medicated, according to several workers.

 

 

 

Kansas is taking over 15 nursing homes with 854 residents across the state because of the owner’s mismanagement and diverting funds away from the facility operations. Now the owners can’t make payroll.  All of the care homes are operated under a variant of the name Care and Rehabilitation Center and are owned by a company called Skyline Health Care. Skyline is based in Wood Ridge, N.J. The company was founded in 2016 and took over a number of nursing homes and assisted living facilities that had been previously operated by Golden Living.

The Kansas Department for Aging and Disability Services is moving to contract with another operator to try to ensure the quality of care doesn’t continue to suffer for residents who live in the facilities.  Mission Health Care, which operates 14 nursing homes in Kansas and four other states, will operate the facilities until a permanent solution is found.

Recently, Nebraska had to take over 21 Skyline-owned facilities when the company informed that state it couldn’t pay its employees.

After taking Micardis for a while, I suddenly started to cough. When I discontinued https://fdlist.com/ medication, there was a gradual recovery, i. the irritating cough disappeared. But what am I doing now with my hypertension?