Erinn Stam is a community site manager at NursingScholarships.org (a non-profit that features financial aid resources for nursing students).   She sent us the following guest post article to share with our readers.

How to Choose the Right Nursing Home
Choosing a nursing home is an important decision that will impact the continued health and happiness of your loved one, as well as have long-term financial ramifications. While referrals are a good way to start your search, they aren’t always the best way to select what could be a final home. What works great for one individual might be terrible for another. Conducting your own search with your family’s individual needs and circumstances in mind will lead to finding the right nursing home. Here are a few tips to keep in mind:

Analyze Your Finances
As much as we might wish that financial considerations didn’t matter in a decision like this, they do. Finances can actually play a significant role in this decision as the cost of nursing home care is quite expensive – as much as $200 per day or $6,000 per month. This cost may not even include services for special needs such as dementia or Alzheimer’s. Though financial assistance is available in the form of government programs such as Medicare or Medicaid, there are limitations on how much these programs will pay and for what services. A significant family contribution could still be required.
Determine what sources of financial aid are available to your family, then determine what amount you can afford to pay from your own sources, including income, pensions, retirement accounts, and savings.

Location
Start your search by looking for homes close to the majority of family and close friends. Studies have shown that those who receive many visitors in nursing homes experience an overall higher quality of life, better health, and faster recovery. If family members are able to visit frequently, they can also monitor the quality of care being provided.

Schedule Visits
The best indicator of the quality of a nursing home is your own first-hand experience with it. While there are many things you may not discover until you have entered into business with the home, you can learn a great deal about the quality of the facility and the level of care provided simply by touring the facility and interviewing the staff. Trust your instincts when you visit. Ask yourself the following: Are the staff friendly and inviting? Do the facilities seem clean and welcoming? Do you notice any odd smells or facilities that are in disrepair? Do the residents seem happy? Let your senses guide you, and take notes.

Consider Special Needs
Even if a nursing home seems great, it may not offer the type of care that your loved one needs. If your loved one has a special health condition, make sure the home provides the kind of treatment needed. Are there trained specialists on staff? Will you have access to the recommended treatments? Can you get the medication needed?
Also consider the personal needs and personality of your loved one. Some homes provide “person-centered care,” which gives patients the autonomy to determine their own schedules, including wake times and eating. Many nursing homes operate under a schedule, which could be a jolt to a sense of independence formerly enjoyed. “Consistent assignment” means that each patient is seen by the same staff members so that they can learn the patient’s needs and develop a closer relationship over time. Such care can make a significant impact on the overall experience enjoyed in a nursing home.

Research History
Finally, make sure you check up on the home’s history of complaints and citations. The Centers for Medicare and Medicaid Services collect data on more than 15,000 nursing homes throughout the country each year, and rankings are compiled based on health inspections, staffing, and other measures. You can find this information at Medicare.gov .
You can also talk to state officials to get a history of any complaints filed against the home, and talk to other residents to get a sense of how they feel about the level of care provided.
Overall, it can take a great deal of research and patience to determine the best nursing home for your family. Carefully consider all of these options before making your decision: It will have a long-lasting impact for your family and your loved one who is receiving care.

Bio:
Erinn Stam is the Managing Editor for nursing grants and scholarships. She attends Wake Technical Community College and is learning about government nursing scholarships. She lives in Durham, NC with her lovely 4-year-old daughter and exuberant husband.

 

A wrongful death lawsuit has been filed against Jefferson County and its former nursing home claiming staff failed to provide the treatment and care that could have prevented a patient’s death in 2009.  On Oct. 4, 2009, Mary Elizabeth Yancey died after the nursing home staff failed to detect a severe abdominal infection that ruptured when Yancey fell at the facility.

She was not sent to a hospital for three days, even though signs of the infection were apparent and Yancey was complaining of abdominal pain. She remained hospitalized until she died a month later of septic shock related to the infection.

The nursing home has been at the center of a political storm amid calls to close the chronically underutilized facility that required annual taxpayer subsidies to break even financially. The home posted a $28 million deficit over the 2003-2008 budget years, and has continued to lose more than $4 million per year.

The lawyers who filed the wrongful death suit, Perry Shuttlesworth Jr. and Alan Lasseter, wrote that efforts to make the nursing home profitable led officials to take on patients the facility was not able to properly treat and monitor.

"The defendants actively sought admission of patients with similar medical and nursing needs to Ms. Yancey in order to fill empty beds and to increase their rate of occupancy and overall revenues," the suit said.

See article at The Birmingham News.

McKnight’s Long Term Care News had an interesting article about a shady group of Pittsburgh nursing home owner/operators’ lack of oversight for their now-defunct nonprofit facility. The U.S. Court of Appeals ruled that the owner/operators may be liable under the law for siphoning money for care into their own pockets.  In calling for a trial, the U.S. Court of Appeals said a federal trial court should not have given summary judgment in favor of officers and board members at Lemington Home for the Aged, which filed for bankruptcy in April 2005.

The appeals court said evidence shows that the Lemington owners allowed the organization’s finances to go into deeper insolvency while under their control. The court reinstated claims pushed by an unsecured creditors committee against individual officers and board members. 
Due to duties of loyalty and healthcare, the ruling indicates leaders of such organizations might not be able to use a best-business-judgment defense when it comes to breach of fiduciary duty claims.

The appeals court said that the administrators pursued their own interests rather than making the nursing home a priority. Among the problems: resident deaths, a dearth of financial records and board minutes, no treasurer, commingling of home assets with those of related entities, and a lack of an administrator for prolonged periods of time.

 

Long-term care facilities often move advanced dementia patients to hospitals when problems with swallowing, pneumonia or infections arise.  The rate of questionable transfers of end-stage dementia patients from nursing homes to hospitals has raised red flags, according to researchers.  After analyzing Medicare records of nearly 475,000 patients, researchers, led by Brown University’s Joan Teno found almost 20% were questionable.  The investigators suspect money and reimbursements are playing a role since Medicaid pays $175 per day for care, in one example, Medicare pays three times that when a resident is transferred back to a nursing home after a hospitalization lasting three days or more.

"I think that’s unfortunately a factor in what’s happening here," said Dr. Joan Teno, a palliative care physician and health policy professor at Brown University. "A lot of this care just feels like in and out, in and out. You really have to question, is the health care system doing a good job or not."

She is a co-author of the study, published in New England Journal of Medicine and done with researchers from Harvard University and Dartmouth Medical School.

Rates of such transfers varied from 2 percent in Alaska to more than 37 percent in Louisiana. In McAllen, Texas, 26 percent of study participants had multiple hospitalizations for urinary infections, pneumonia or dehydration – conditions that usually can be treated in a nursing home. That compares to just 1 percent of patients in Grand Junction, Colo.

Read more at San Francisco Chronicle.

 

 

The Des Moines Register reported the tragic story of a mentally handicapped woman who was repeatedly raped over a five day period in a care facility. One suspect admitted to the rapes.  She was allegedly raped several times between June 11 and June 15 at the Fairview Care Facility. According to the Iowa Department of Inspections and Appeals, the woman’s account of what happened is supported by the records of the facility and the recollections of the nursing staff.

The three men charged in the case, each with a past history of violent crime, had been ordered by the court to live at the Fairview facility.   The facility’s head-count records show the woman and the three suspects could not be located during the time some of the alleged attacks occurred. The workers at the home told the state inspectors that they failed to search the basement of the facility after it was determined the four were missing.

The Department of Inspections and Appeals has cited the facility for failing to protect residents from harm and imposed a $5,000 fine — half the maximum allowable penalty.

 

A recent audit of Medicaid payments in New York showed overpayments are a major fiscal issue.  Nursing homes in NY received at least $42 million in overpayments because of flaws in how patient income is recorded.  New York pays $6.8 billion a year for an estimated 121,000 Medicaid patients in 700 nursing homes. New York auditors say the state Health Department has overpaid nursing homes about $42 million in Medicaid over a 44-month period.

 

 

"The system is not efficiently tracking the money that we are allocating to care for our most vulnerable citizens — that’s upsetting," said Richard Mollot, executive director of the Long-Term Care Community Coalition, a patient-advocacy group.

Upsetting?  It is criminal.

LincolnShire News reported the lickback charge against Jay Canastra, the director of admissions at The Wealshire.  He has been charged with accepting a kickback in exchange for referring nursing home Medicare patients to a specific home health care agency.  Jay Canastra was charged with one count of violating the anti-kickback statute which makes it illegal to exchange kickbacks in return for Medicare referrals. It is unclear how many other kickbacks may have occurred.

"The case is part of a nationwide take-down by the Medicare Fraud Strike Force, the U.S. departments of Justice, and Health and Human Services. The total investigation led to charges against 91 defendants for schemes to collectively submit more than $295 million in fraudulent claims to Medicare."

Others in the Chicago cases are:

Dr. John Natalie, a vascular surgeon who had privileges at Northwest Community Hospital. Natale was charged with two counts of health care fraud, two counts of making false statements involving a health care benefit program and one count of mail fraud.

Keennan R. Ferrell, a licensed psychologist in Illinois and at least a half-dozen other states, and Bryce Woods, who was not in a medical profession and owned and operated Take Action and Innert Arts, which claimed to provide psychotherapy services to Medicare beneficiaries residing in skilled nursing homes. Ferrell and Woods were charged with nine counts each of health care fraud.

Three chiropractors, Bradley Mattson, Steven Paul and Neelesh Patel, who own suburban clinics that provided chiropractic, medical and physical therapy services, were charged in a 23-count indictment with defrauding three private health insurance companies for more than a decade, beginning in 1999. Mattson was charged with 19 counts of health care fraud; Paul was charged with four counts of health care fraud; and Patel was charged with 15 counts of health care fraud.

Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team, a joint initiative announced in 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,140 defendants who collectively have falsely billed the Medicare program for more than $2.9 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

 

Roxanne McAnn works with Medicalbillingandcoding.org where they published an interesting article entitled, “8 Most Common Mistakes Americans Make With Their Meds”.  Considering the overlap in subject matter with our blog, she thought we would be interested in sharing the article with our readers.  Many of these common mistakes happen in nursing homes to tragic consequences.  Below are excerpts from the article:

Improperly storing medications
Medications should be kept at room temperature, in a dry place away from direct light.  Failing to properly store medications can make them less effective and less likely to keep you healthy.

Not taking medications on time
For those taking more than one medication, it can be tough to keep track of when to take each and every pill. Yet ingesting them on time is an essential part of helping them act at peak efficiency. Failing to do so could reduce the effectiveness of a medication or cause some unpleasant side effects.

Taking two or more medications that might interact with one another
One of the most common and dangerous mistakes people is taking multiple medications without first seeing whether or not the drugs negatively interact with one another.  These interactions can change how medications act in your body, cause them to become less effective or result in some very dangerous (and potentially deadly) side effects.

Taking reduced doses of pills
While times are tough and prescription medication costs remain high, cutting back on medication to save money may not be the right choice. In fact, for some types of medication, it could be downright dangerous.

Unintentionally overdosing on drugs with similar properties
The worst offenders for prescription drugs are narcotic painkillers, sleeping pills and anxiety medications.

Taking the wrong dosage
Unfortunately, stories about Americans taking the wrong dosage are all too common, whether the result of pharmacy error or simple mistakes made by those taking the medication. These kinds of oversights are very serious, and could lead to dangerous complications, side effects and (in some cases) death.

Cai Xingliang of Caregiverlist, Inc. contacted us to request that we mention Caregiver List which provides daily nursing home prices and assist in explaining senior care options and costs. Here is a link to the Widget page where you can grab and post the nursing home costs and ratings widget.  They contacted 18,000 nursing homes nationwide to secure this information and are the only resource providing actual costs of nursing homes nationwide.