Mcknight’s had an article discussing the annual report by Hospital & Healthcare compensation Service which surveys the compensation and raises of various healthcare providers.   Even though most nursing home Administrators are not healthcare providers, Administrators ar epart of the survey.   Nursing home administrators’ salaries rose this year at their highest rate in four years despite an economic recession and slower compensation gains for nurses and nurse managers who actually provide health care to residents, and despite the nursing home industry complaining that they need tort reform to make a profit.

Administrator salaries jumped by an average of 4.8%, according to the 2009-2010 Nursing Home Salary & Benefits.   This is the largest one-year increase since the 2006-2007 survey found a 4.6% pay rise that put administrators over the $80,000 mark.   Last year, the national average salary for facilities of all bed sizes, both for-profit and nonprofit, was $85,464. This year, it is $89,606.

Maybe the for profit corporation should hire more staff to take care of the needs of the residents instead of raising the salaries of bean counters.

The annual HCS report samples information from tens of thousands of nursing home employees at thousands of facilities across the country to determine the industry standards for compensation and benefits.

 

Here is a link to The Frederick News-Post which had a terrific op-ed by Katherine Heerbrandt about accountability and the nursing home industry.  The editorial is below:

Nursing homes are places where residents go about the business of wrapping up their lives or recuperating from illness, so it’s not surprising that many of us have an aversion to them. Perhaps we see a future we don’t want to contemplate.  But as baby boomers age, living out our golden years in a long-term care facility is a real possibility. The size of the disabled older population who will need assisted or nursing home care will grow by more than 50 percent between 2000 and 2040, according to the Urban Institute.

Entrepreneurs are looking at long-term care facilities as good investments. But as private equity investors flood into the nursing home business, "it’s become harder and harder for families, regulators or prosecutors to identify the right individual or business entity to hold accountable for bad care," Janet Wells, public policy director of National Citizens’ for Nursing Care Reform, said in an interview.

"The Office of Inspector General says it has found as many as 17 limited liability companies in the ownership and operations of a single facility," Wells said. "Most of these companies are making profits from the business, but they can’t be held accountable by anyone for what happens to an individual resident."

This trend, she said, triggered a transparency bill this year and is part of the controversial health care reform legislation currently before Congress. A similar bill failed last year, and compromises were made. The bill currently before the House requires Nursing Home Compare (Medicare.gov/NHCompare/home/asp) to report the number of adjudicated criminal violations by facilities or crimes committed by their employees. States will also have to post survey reports online so consumers can read the inspectors’ findings.

It’s an uphill battle for advocacy groups. Nursing home lobbyists have much deeper pockets. "The nursing home industry is extremely powerful," Wells said. "And although it claims it can’t make a profit from operating nursing homes, spends hundreds of thousands of dollars on campaign contributions and lobbying."

Lobbying, it seems, is a recession-proof profession. In the past decade, nursing home lobbyists’ spending has risen from $25 million to $100 million, according to opensecrets.org, maintained by the Center for Responsible Politics.

Tyonja Bathgate became an unwilling advocate for nursing home residents’ rights when her husband, Colin, moved to a local long-term care facility two years ago, and she worked with Delegate Sue Hecht on a bill to allow cameras in nursing homes. That bill failed this year.

Based on her experiences, Bathgate supports any legislation that will make nursing home operators more accountable and their operations more transparent.

Even if you or a loved one is not in a nursing home, she said, you are still affected by this legislation.

"Where do you think Medicare/Medicaid comes from? Those are tax dollars and nursing homes shouldn’t be able to hide behind LLCs, or to spend millions on lobbyists. That’s ridiculous," she said.

She’s right. Why shouldn’t the facilities entrusted with caring for our nation’s chronically ill and elderly be held accountable for how they run their businesses?

For sample letters to your representatives and more information on the details of the nursing home transparency legislation, visit nccnhr.org.
 

Edna Mae Sides’ body was found in front of the Hillside Plaza Nursing Home by staff around 6 a.m.   Hillside Plaza Nursing Home staff found the body of Edna Mae Sides at 6 a.m. but for some reason did not call police for four hours at 10:15 a.m.   The time gap between when Sides’ body was found by nursing home staff, and the time it took staff to call police, triggered an "intense investigation".

"The question always arises, cops are suspicious people, why did it take you four hours to call the police?" said Barry Starnes, Wells Chief of Police.   "The time difference and then finding a body outside one of the residence and bringing it back inside and cleaning it up and all this, to police is very suspicious," said Starnes. "To people who run nursing homes, that’s standard practice."

Evidence suggests that the nursing home failed to supervise the demented resident and she wandered outside and apparently fell outside the nursing home.  Hopefully, the police will ask the right questions:  What was the staffing ratio?  Was the door alarm on?  Was it working? Did anyone respond to it?  Was a bed check done?  When was the last time she was seen?

Starnes said there are still several unanswered questions in this case. "Now, how she got out there, what procedures were not followed or what other things may be wrong, that’s all still under investigation," he said.   "She fell on her face," said Starnes. He said she was unable to get up after the fall.

With the recent discussion on how to best reform America’s health care system, insurance companies and nursing home lobbyists, are once again blaming the lawyers.   Numerous studies have debunked the need for tort "reform".   For example, Health Affairs published a study assessing the cost of malpractice premiums, litigation, and payments, in addition to potential expenditures from so-called "defensive medicine".

U.S. citizens spent $5,267 per capita for health care in 2002—53 percent more than any other country. The cost of defending U.S. malpractice claims is estimated at $6.5 billion in 2001, only 0.46 percent of total health spending. The two most important reasons for higher U.S. spending appear to be higher incomes and higher medical care prices.

Malpractice Claims Filed in the US.   The authors compared domestic suits with those in Canada, Australia and Britain (all countries with a similar, British-based legal system), and it turns out Americans sue 50% more than Britain or Australia, and 350% more than Canada. The most likely explanation is our private system makes more mistakes.  While approximately 98,000 people die each year from negligent treatment, a mere 2 percent sue their physicians. Between 1990 and 2002, “5.2 percent of doctors were responsible for 55 percent” of all malpractice pay outs.  Of our high rate of suits, 2/3rds are dropped, dismissed, or found for the defendant. Only 1/3rd of plaintiffs make anything. In Britain, however, 60% of suits are settled, while only 36% are dropped or found for the defense. So while we have more malpractice, we have much fewer victims being compensated.

• Claim Payments Lower in the US     Our average payout is much less than Canada or the UK: we give $265,103 vs. their $309,417 and $411,171 respectively, putting us 14% below Canada and 26% behind the UK.   Media attention and conservative rhetoric focus on the large rewards, but they are rare .

• Cost of Malpractice     Legal costs are $27,000 per claim, settlements and judgments are $4.4 billion, and insurance is $700 million. The total cost of malpractice is thus 6.5 billion –.46% of health care costs, or less than one half of one percent. They’re just not a significant factor in rising health prices, and those who say different are lying.

Defensive Medicine    The Congressional Budget Office did a study and concluded that the savings from less defensive medicine post-tort reform, if there were any, would be very small.

• Claim Payments Have Not Been Growing More Rapidly in the US    Payments stateside have been growing at a steady 5% over inflation. In other countries, however, they’ve been growing at 10-28%. If malpractice insurance is growing rapidly in America, it is the fault of our insurance companies and system, not consumers.   British and Canadian physicians are protected from malpractice litigation risks by a single national organization with government subsidized premiums and no incentive to jack up prices on doctors. Australia has a private system more like ours, but the government subsidizes malpractice premiums and reinsures high-cost claims.

The way to protect doctors from malpractice costs is to remove the profit incentive for insurers to hike premiums on them. Canada, Britain and Australia have all done so by bringing the government in and promising protection to doctors. Under their solutions, consumers and physicians were protected, insurance companies were the ones who ended up hurt.

 

Atlanticville.com had an article about a piece of crap nursing home owner/operator who pleaded guilty to stealing $39,000 from one of his elderly residents.   Michael D. Berg pleaded guilty to one count of third-degree theft by deception.  The charge is the result of an investigation, conducted by the Prosecutor’s Office following a referral from the New Jersey Office of the Ombudsman for the Institutionalized Elderly.

Berg was the owner and operator of Wayside Retirement Center Inc., a nursing home located in the Wayside section of the township. From Jan. 1, 2005, through March 31, 2008, Berg received funds that belonged to a resident of the retirement center.  The funds came from the resident’s pension and from other benefits. 

Berg ended up retaining more than $39,000 from the resident’s funds that he wasn’t entitled to for his own personal purposes.  Pursuant to the terms of the plea agreement, the Monmouth County Prosecutor’s Office will recommend Berg get probation.  Incredible.  The guy steals from one of his residents and only he gets is probation.  That isn’t much of a deterrent.

 

New Hampshire’s Union Leader had an article recently about the investigation into the death and possible elder abuse of a nursing home resident.  Detectives were called to the Southern New Hampshire Medical Center on June 28 to investigate concerns raised by staff at the hospital about the condition of the man’s wounds.  The man was a resident at The Elms, a nursing home on Elm Street run by SunBridge Healthcare Corp., based in Rochester, N.Y.

Investigators and hospital staff found that the man had serious sores on his legs, which had been wrapped in Ace bandages. When hospital staff removed the bandages, he said, they found that the sores had been neglected. "The skin had grown over the bandages on his leg," said Douglas. "I’ve never seen anything like this."

In addition to the sores, the man’s catheter was blocked with blood, his genitals were extremely swollen, and he had unexplained cuts and abrasions elsewhere on his body. The man was unresponsive to hospital personnel.  The man’s catheter tube had been wrapped so tightly around his leg that significant swelling had occurred.

 

 13Wham.com had a story about a nursing home employee charged with rape of a mentally disabled resident.   The man was a nurse in charge of caring for residents at a local nursing home. Kipper Allen Stevens, an LPN (licensed practical nurse) at Shore Winds Nursing Home, was arrested for rape and endangering the welfare of an incompetent or physically disabled person after a six-month investigation by Rochester, N.Y police.

In his statement to police, Stevens gave a different account of what happened; he claims he had a "relationship" with the woman.   “Our relationship started out as friends, but…I know that I should not have been involved romantically with a patient, but it just happened. We were two consenting adults having a relationship, and at no time was it forcible." Stevens goes on to say, “I want people to know although this was improper, it was nothing malicious.”

Prosecutors said another worker witnessed the alleged abuse and reported it to management. Shore Winds president, Robert Hurlbut, Jr., said they began an internal investigation immediately, and suspended two workers, including Stevens.

The story does not mention how long the "relationship" lasted or if her family was aware of it.

 

HeraldNet.com out of Washington had an article about the recent investigation into falls at a Life Care Center of America nursing home.  The state Department of Social and Health Services is investigating the case of a nursing home patient who slipped and fell last month as she was getting out of bed, taken to a hospital and later died.  The nursing home patient was treated at the hospital for a cut to her head and a skin tear to her arm, said Roberta Crawford, a field manager for the state agency.   DSHS is investigating whether there was neglect of the patient and if the nursing home failed to provide adequate supervision.

The woman was a resident at the Life Care Center of Bothell. An employee at the nursing home declined to comment on the case, saying any statement would have to come from its corporate headquarters in Tennessee.

Four reports were filed with a DSHS hot line about the patient’s care, triggering the investigation, Crawford said. Reports were made by he nursing home’s director of nursing, the hospital, a relative of the patient and the state’s department of Adult Protective Services, part of DSHS, Crawford said.

 

Link to Modernmedicine.com of tables summarizing data from RN Magazine’s Salary Survey of nurses’ salaries. See results.  Nursing is one of the most difficult but rewarding careers to have, and the future looks good.

The past two years have seen stagnant wages, eroding benefits, and feared or actual layoffs as recession swamped the economy.  However, the vast majority of nurses enjoy rising fortunes. Their average wages have echoed the double-digit percentage increases of the mid-2000s—with even sharper raises for select nursing specialties and settings.

The average annual base pay of salaried nurses (who typically hold management or administrative positions) grew 10%, or $6,746, to $75,180. Nurses paid by the hour fared even better; their average base earnings rose 13% ($7,460), to $64,018. Combined, hourly and salaried nurses received $7,270 more on average, for a 12% raise to an overall base pay of $65,653.

The article concludes that nursing salaries will remain lucrative:

The American Recovery and Reinvestment Act, passed in February 2009, allocated $500 million toward the National Health Service Corps and Nursing Workforce Development Programs, to boost funding for nurse education and create nursing jobs in underserved areas.

With a Democratic president and Congress, and a recent alliance among three nursing associations with the AFL-CIO to address healthcare, union, and nursing-workplace issues, nurses’ union membership may rise, which past RN surveys have linked to higher salaries.

Demand for nurses will only increase. The Bureau of Labor Statistics anticipated in 2006 that 587,000 new nursing positions would open over the next 10 years.   As older nurses reduce their hours or retire, gaps in existing positions could raise that demand to 1.1 million.   And nursing schools are having trouble hiring sufficient faculty to accept all qualified applicants.   If the faculty chokepoint isn’t resolved, new nurses could bid their starting wages higher.
 

The Philadelphia Inquirer had an interesting article about the increased use of anti-psychotics in nursing home residents. Sales of atypicals rose to $14.36 billion in 2008 from $8.4 billion in 2003, according to data provider IMS Health. Elderly patients have been a major source of that growth. Studies suggest that 20 percent to 30 percent of nursing-home residents take an atypical, despite not having a psychosis diagnosis.

This is a dangerous treatment since these medications have terrible side effects such as constipation, loss of appetite, lethargy, and increased risk of falls.  I always worry that their use is more to make thing easy for the staff then to help the residents. Nursing homes provide these medications because they may calm people and help them sleep.  Families of residents need to worry staff using these medications as a chemical restraint to subdue residents who complain about the poor care they are receiving.  The article discusses two specific residents and how one benefited and the other did not.

 Risperdal, Seroquel, Zyprexa, Abilify, and Geodon are atypical antipsychotics, a category of psychotropic drugs. These drugs are approved to treat schizophrenia and bipolar disorder despite mixed evidence that they help and ample evidence that they hurt. The drugs have life-threatening side effects, especially in the elderly. Several studies report they increase the risk of heart attacks, stroke, and premature death in this group. The atypicals now carry a so-called black box warning – the most serious required by the U.S. Food and Drug Administration – saying patients with dementia who take them are "at increased risk of death."

In February, California’s attorney general charged three nursing home employees with using Risperdal and Zyprexa to sedate patients and make them easier to manage. In a separate case in January, Lilly agreed to pay the federal government $1.4 billion to settle charges that it illegally marketed Zyprexa for use by the elderly.  As evidence surfaced that some elderly patients were being medicated into submission, Congress passed laws making overuse of psychiatric drugs, or "chemical restraint," illegal.

Laws trying to ensure proper use of psychiatric drugs require that nursing homes carefully monitor them, checking to see how patients respond and trying to reduce the dose or wean patients off them.  However, this is hardly ever done by well-trained or qualifed nurses.

Elaine Leventhal, director of the Gerontological Institute at the University of Medicine and Dentistry of New Jersey, said caregivers should try to manage behavior before turning to medications. She recommends that the family stay for dinner the day a relative is admitted to a nursing facility and visit as often as possible to ease the transition.