In honor of Memorial Day and all our veterans, I thought I would share Anne Hart’s column from the Sacramento Organizing Examiner which discussed assistance for veterans such as such as "a sizable cash benefits check each month– if you or a spouse of a veteran are frail and need in-home help. 

The article emphasizes that you don’t have to pay anyone or invest money to get your long-term care veterans benefits. Unfortunately there’s typically a waiting list to get into nursing homes for veterans.  Did you know that if you’re a veteran, help is available–?

Bob Scrivano is an independent senior care planning consultant quoted in the article. Also see the site, Veterans America: Improving Pension Benefits and Assets & Aging. The basic message is that you have to organize now what you want to have happen to your home or any other assets you have, and you have to act on any plan of what to do if you or any family member becomes in need of in-home or nursing home care.

What you need to know is what you’re entitled to, how not to lose your home when the state tries to take it away to pay for nursing home or medical bills, or what to watch out for as you act on your plan. 

"If you’re married to a veteran or are a veteran and are looking for veteran’s benefits for long-term care or in-home care for an older person who needs assisted living, such as someone coming into the home to care for the older person, watch out for scams and schemes. There’s too many people being mailed information about VA benefits for long-term care that requires you to invest in something or pay for something. You don’t have to buy anything."

Visit the Department of Veterans Affairs to download a Veterans Benefits fact sheet or call the VA at 1-800-827-1000 to obtain information about available services in your area. And check out the Veterans Health Administration to view available programs and services.

 

The Herald Online ran an article on the guilty plea and sentencing of Melissa Rice Kelly for misusing the residents’ money.  Kelly was the business office manager at Magnolia Manor in Rock Hill, S.C; this facility is one of the many facilities owned and operated by Murray Forman’s Fundamental family of companies.  

Kelly only recieved probation instead of the 70 years she could have faced on the 13 felonies she admitted to in court. Kelly pleaded guilty to 12 counts of exploitation of a vulnerable adult and one count of breach of trust with fraud intent.

 

 

WQAD had a story about the cover up of sexual abuse at Windmill Manor nursing home. State and federal authorities have levied more than $92,000 in fines where staff are accused of covering up the sexual abuse of an elderly resident.  State records say a male resident of Windmill Manor was found in bed with a female resident in November, and both were undressed. And then, on Christmas Day, staff saw the two having sex. Staff did nothing to prevent the two from engaging in sexual activity.

In addition to the fines against Windmill Manor nursing home, criminal charges were filed recently against its former director of nursing, Karen Etter.  Regulators also allege that Etter warned staff members not to tell anyone of the incident if they wanted to keep their jobs. Regulators say the woman, who has Alzheimer’s disease, could not have given informed consent to sex.

 

WCBSTV.com had an incredible story with a video showing a nursing home employee willfully neglecting a resident.  The video shows a nurse dumping an elderly woman in a wheelchair on the floor.   Nursing homes are supposed to be a safe place for the most vulnerable — the elderly too sick and frail to care for themselves. But CBS 2 HD got an exclusive look at what happens when a nurse, instead of taking care of a patient, causes incredible harm. This is all too typical of the type of care provided at most nursing homes.

Criminal charges against nurse Jessie Joiner are based on the video recorded by a camera placed to protect patients and staff, by the William Benenson Rehabilitation Pavilion in Queens, N.Y.   Joiner is seen on video pushing a medication cart but suddenly abandons the cart and heads to the patient in the wheelchair. Joiner appears to jerk the chair sharply to the left and the woman, who is 85 years old and suffers from dementia, goes flying to the ground, a fall that breaks her hip.   No other staff intervened or assisted the resident.   The woman is seen lying alone on the floor for more than two minutes before another employee arrives on the scene. It appears he will help her, but with the patient still writhing on the floor, for over a minute he does nothing.

Nurse Joiner is seen walking right by the patient, who is now flailing on the ground with a broken hip. She does this not once but twice and then leaves the area.

According to the attorney general’s complaint, Joiner admitted knocking the woman out of the wheelchair and not helping her. The complaint also alleges that she didn’t report the incident until another staff member noticed the patient and later lied about it to the nursing home staff.

Joiner’s attorney, Michaelangelo Matera, told a different story, saying that the patient herself caused her own fall.  Incredible.  Blame the victim.

Among the charges against Joiner are endangering the welfare of a vulnerable elderly person and willful violation of health laws. She has pleaded not guilty.

 

The News-Gazette had an article about the state investigation of an incident in which a female patient at Champaign County Nursing Home suffered an injury that went undetected (or covered up) and died several days later.  The incident has led to a chain reaction of investigations, reports and findings that have resulted in $50,000 in fines against the nursing home, the loss of some Medicare and Medicaid funding and the potential loss of all Medicare and Medicaid funding.

Two other visits to the nursing home by public health inspectors – one on April 2 and another on April 29 – found more problems at the facility. In the April 2 inspection, it was determined that the nursing home did not follow its own policy in handling an allegation lodged against an employee.

Also that day, the inspector determined that the nursing home staff "failed to provide appropriate treatment and services to maintain or improve abilities in toileting and transfers" for four residents.

The April 29 inspection found that nursing home staff failed to use proper equipment when transferring three patients. In the most serious case a 91-year-old patient suffering from dementia broke her hip after she stood up from her wheelchair and fell. The woman was supposed to have had a personal safety alarm on her wheelchair.

In the incident which set off the series of investigations, a patient identified only as R7 slipped out of a chair while in a lounge area, but apparently was caught by a certified nurse aide.

"CNA slid under (R7) and pulled her onto her lap … (R7) denied pain .. did not hit head … did not hit w/c (wheelchair) or w/c pedals. (R7) talking and laughing with staff … able to move arms and legs without a problem or pain … Body check done with no areas of redness noted," said a report identified as a "late entry," and dated Jan. 25. It is not clear whether the incident occurred that day or earlier. There was no other documentation of the fall before Jan. 25.

By Jan. 29, however, nurses noticed bruising on the woman’s right leg and right hand. A physician ordered the woman be taken to an unidentified hospital. There, an emergency department attendant said the woman’s "right leg has progressively increased in size with diffuse ecchymosis (bruising) … It does appear (R7) struck her head." There was an "incredible amount of blood lost in the leg," an emergency department physician said. It "took a lot of fluid and blood to fix (R7’s) anemia/shock which resulted in CHF (congestive heart failure)."

The woman died on Feb. 4. The Public Health investigation of the incident, dated Feb. 25, found the nursing home neglected to properly care for the patient in at least four ways:

– "By failing to implement existing policies on Falls, Lab and Diagnostic Test Results, Laboratory Testing, Orders for Anticoagulants, Anticoagulants and Change in Resident’s Condition or Status;"

– "By failing to notify the physician in a timely manner of high laboratory values, neglected to identify a fall, to notify the Physician/Nursing staff of the fall and implement post fall monitoring;"

– "By failing to assess and monitor significant bruising as a side effect of anticoagulant therapy and a fall;" and

– Neglecting "to notify the Physician of the significant bruising in a timely manner, but continued to administer anticoagulants to R7."

The nursing home has allegedly instituted changes in response to the public health findings. For example, training will include special attention to reporting falls. "An episode where a resident lost his or her balance and would have fallen were it not for staff intervention, is a fall. In other words, an intercepted fall is still a fall," said a memo.

And when employees are accused of mistreatment of residents, a memo says they "will be removed from resident contact immediately until the results of the investigation have been reviewed by the administrator or designee. Employees accused of possible mistreatment shall not complete the shift."

 

Joanna Weiss of the Boston Globe wrote a great article on Medicare and waste. Below is excerpts of the article which is based on her experience with a relative on Medicare.  One axiom of our Medicare system: It’s hard to understand how maddening it is until something happens to your family.

Take, for example, my own elderly relative, who recently spent time in the hospital. Everyone wanted him to recover at home, but we knew that would require nursing care. And his care coordinator in the hospital had strange, bad news: If he went to a residential nursing home, Medicare would foot the bill. But if he wanted an at-home nurse, at substantially less cost, Medicare would only cover a few hours of care, a few days a week.

To anyone with a smidge of common sense, that sounds absurd. But when I relayed the story to Dr. Brent James, he wasn’t surprised. As chief quality officer at Intermountain Healthcare, a network of hospitals and providers in Utah, he’s an expert in Medicare’s one-size-fits-all solutions and perverse incentives. More than a decade ago, his hospitals put a reform in place, involving the timing of antibiotics, that helped patients recover more quickly and completely. But the hospitals were losing millions of dollars, and the billing records solved the mystery. If a patient got pneumonia and went on a ventilator, the reimbursement from Medicare was $800 more than the treatment itself. If that same patient didn’t get pneumonia, the billing codes changed, and the payment for his briefer, simpler hospital stay was $800 less than the cost.

James has implemented many solutions at Intermountain. Among them are “global payments,’’ which opponents have managed to demonize as rationing of care. As James explained it to me, it’s a far-less-nefarious way to create the the right incentives in a system that now often has the wrong ones.

In the case of my elderly relative, Medicare would give his hospital a set amount of money to coordinate and spend. Any money left over would be profit. If the payment fell short of the cost of his care, the hospital would eat the loss.

In theory, that could give doctors and nurses a reason to provide him with less care. Careful monitoring of quality would have to go hand in hand with global payments. But this change could also encourage steps known to reduce the length and cost of illnesses. Washing hands more often to reduce the spread of infection. Coordinating better among hospital divisions. Offering better access to the home-based nursing care that would cost a lot less.

“Over 50 percent of expenditures on a patient on health care are technically waste,’’ James told me. But “one person’s waste is another person’s income is a major political contribution.’’

According to some health care and economics experts — including Roger Feldman and Bryan Dowd at the University of Minnesota and Bob Coulam at Simmons College, who wrote a recent paper on the subject — competitive pricing would shave 8 percent off the annual Medicare budget. That amounts to $50 billion to $60 billion every year. And yet, every time that reform has been proposed, providers have revolted, and Congress has blocked it in a very bipartisan way.

Now we have a looming crisis, a foreseeable future when the Medicare Part A trust fund will go bankrupt, or when Medicare costs will start to overwhelm the federal budget. There will come a point when ignoring the problem won’t be feasible anymore. Maybe it will happen too late to help some of my own relatives. But when it does happen, there’s some small comfort in knowing that solutions are out there — just waiting for action, a little bit of courage, and a will to change.
 

Karen Mason was the chief executive officer of Havenwood Nursing and Rehabilitation Center who has been sentenced to two years in prison for tax evasion. Federal prosecutors say 57-year-old Karen Mason, previously known as Karen Mueller, admitted taking more than $1 million from the Havenwood Nursing and Rehabilitation Center from 2002 through 2005 and not reporting the money as income.

The U.S. attorney’s office says she used the money for jewelry, home furnishings, cars, entertainment, travel and other expenses, including more than $30,000 for a wedding and honeymoon for one of her children. It says she underpaid her federal income taxes by more than $360,000.

The Supreme Judicial Court of Massachusetts made a horrible decision by rejecting the Attorney General’s attempt to prosecute Life Care Centers of America for the death of a resident.  See article from The Boston Globe here.  In 2007, Coakley’s prosecutors convinced a Middlesex grand jury to return a manslaughter charge against Life Care, a Tennessee-based operator of nursing homes nationwide.

Life Care Centers of America was charged with manslaughter because numerous employees willfully violated the standard of care by failing to safeguard a resident who died when she fell down steps after her wheelchair overturned.  McCauley was unsupervised in her wheelchair at 7 a.m. without an alert device on her wrist that closes the facility’s doors.  The Globe reported in 2007 that McCauley had a habit of wandering away. Doctors ordered her to have a device put on her wrist that sets off an alarm and closes the center’s doors when patients get near them. She apparently wheeled herself through the double doors and fell down eight steps.

The Attorney General attempted to hold Life Care Centers of America criminally liable for the “aggregate actions’’ of all the employees she said played a role in the failed care of Julia McCauley.  “A corporation may be criminally liable for the crimes alleged here only where at least one of its employees could be found individually liable for the crime,’’ Justice Judith Cowin wrote for the court.

The SJC ruling does not end the criminal case because Coakley may be able to pursue a manslaughter prosecution on a different legal theory — that the actions of a single supervisor caused the woman’s death.

 

 

The Providence Journal had an interesting article about the neglect and poor care provided at Summit Commons nursing home.  Rhode Island’s Department of Health has found that Summit Commons provided neglectful and substandard care to a patient.  DOH ordered the nursing home to install electronic-medical records to prevent future such problems.

The order against the Summit Commons Skilled Nursing and Rehabilitation Center marks the first time the Health Department has imposed such a mandate on a nursing home.  Through a series of negligent mistakes, Summit Commons failed to check the blood sugar of a diabetic patient for three weeks, even after prescribing a drug that can cause blood sugar to go up. The nursing home also continued to give the patient stool softeners after he developed diarrhea.

The patient was admitted to Summit Commons on March 16 with doctor’s orders to check his blood sugar twice a day and give him insulin as necessary. But the nurses failed to transcribe those instructions onto the patient’s medical chart, and failed to catch the error when checking later, Gifford said. Electronic-medical records would automatically generate such orders and nurses would not have to transcribe them, Gifford said.  Later, the patient was prescribed prednisone to treat arthritis. Prednisone can elevate blood sugar, and that prescription should have triggered tests of blood sugar, Gifford said.

The patient was eventually admitted to Memorial Hospital of Rhode Island with shortness of breath, congestive heart failure, low blood pressure and dangerously high blood sugar.  The patient was sent home with hospice care and died soon after.

The patient was hospitalized, the nursing home failed to notify the Health Department as required. The Health Department conducted an inspection on April 20 after relatives of the man reported the incident and requested an investigation.  It’s the second time in less than a year that Summit Commons has run afoul of health inspectors. In August, the state declared that patients were in “immediate jeopardy” because of the nursing home’s failure to treat bedsores.