A new report shows that Medicaid programs are failing to deliver adequate medical services to the low-income populations they were designed to serve including nursing home residents.  The non-profit consumer advocacy organization Public Citizen issued a report ranking Medicaid programs by how they met and surpassed federal mandates in four categories: eligibility, scope of services, quality of care and provider reimbursement.

Fifty-five million, mostly low-income Americans get their health care coverage through their state Medicaid program. The worst Medicaid programs in the country, according to Public Citizen, are those in Alabama, Colorado, Idaho, Indiana, Mississippi, Missouri, Oklahoma, South Carolina, South Dakota and Texas.

Public Citizen ranked states by the optional health care services that states provide beyond legally mandated services.
"Medicaid desperately needs nationwide uniform standards of quality of care and an effective means of monitoring and upholding those standards," said Ms. Ramirez de Arellano.

See story here

Georgetown police could not find any physical evidence to corroborate one of the recent complaints filed against Georgetown Healthcare and Rehab in Maryville. In March, police were called to the facility after a resident said he was choked by a nurse.

The incident happened in December but he waited to report it because he was “in fear of possible retribution.”  The nurse denied the charges but was placed on suspension during the investigation. 

The resident was shown pictures of 12 women who work at that facility and was asked to show the investigators the one who choked him. The photo selected was not the nurse he accused of the abuse. There was a inconsistency in part of his allegations.

“Based on this investigation, there is no physical evidence or witnesses to support this allegation,” Investigator Johnell Sparkman wrote in his report. “At this time this case is unfounded.”

Helluva an investigation.

No polygraph examination of the accused? Prior complaints? Interview other residents?

See story here

The nursing home industry and insurance lobbyists have fought (and continue to fight) to limit the duties of nursing homes in conducting background checks on employees.  It is ridiculous. Background checks are cheap and quick in the computer age even with the high turnover rate of employees.  Look at this story where a nursing home aide raped 90-year-old resident.. It could have been prevented if they did a background check.

William Morrison, a former aide at the Rome Memorial Hospital Residential Health Care Facility,  was convicted last month of raping and sexually assaulting a 90-year-old resident of the nursing home.

Morrison was an employee at Rome Memorial Hospital for several months before being transferred to the hospital’s affiliated 80-bed nursing home. Rome Memorial Hospital Residential Health Care Facility intended to perform a criminal background check when Morrison was hired, but it was not completed before he raped the elderly resident.

The background check would have revealed that Morrison was previously convicted for one felony and several misdemeanors in the 1990s. His last conviction was for a misdemeanor drug offense in 1999

See story here

This is an incredible story.  A nursing home employee was jailed for allegedly using a cigarette lighter to set fire to an elderly patient’s bed over the weekend.

Tina Louise Spencer was booked into the county jail on charges of first-degree arson and attempted murder. Spencer is accused of setting fire to the bed of Ann Hudson, 88, at Carlton Cove nursing home.  The resident sustained first- and second-degree burns on her scalp and forehead.

Investigators said Hudson wasn’t a regular patient of Spencer’s but that Spencer checked on her from time to time. Firefighters were called to Carlton Cove shortly after 7:30 a.m. Saturday. Firefighters determined the fire wasn’t accidental, which led to a probe by investigators with the police’s Arson Task Force and the fire marshal’s office.

Johns Hopkins has recently released a study that indicates that patients that resided in long term care facilities within the last six months are more likely to be infected with drug resistant superbugs.    There was no definitive explanation for the increased risk, but researchers believe that underlying illnesses and weakened immune systems in nursing home residents are a factor.  Those residents who are wheelchair or bed -bound have an even higher risk of superbug infection – 22 times higher than patients who hadn’t resided in long-term care facilities.  The problem with superbugs is that they can lead to dangerous bloodstream infections.

The result of this study, at least immediately for Johns Hopkins, is that all patients who have been in the long-term care stetting will be tested for superbugs, and will be treated as infected until the test results are in.  In terms of nursing homes, this study shows how wide spread drug resistant bacterial infection has become, and indicates the need for better infection control in long term care facilities.

To read more about this study, click here.

In past years, the bill came close to passing but failed because of lack of support in the House of Representatives. Therefore, it is extremely important to get members of the House to co-sponsor and support the bill this year.

Please contact your U.S. Representative’s office and ask for him or her to co-sponsor the Elder Justice Act, H.R. 1783. Ask them to support this bill because:

  • Abuse and neglect of the elderly in long-term care settings are serious problems. (If you can, give a local example that shows this.)
  • Abuse and neglect are under-reported; but even so, long-term care ombudsmen across the country receive over 16,000 complaints a year about abuse, gross neglect, and exploitation. (If you have one, substitute a statistic from your state or area that shows the amount of abuse or neglect in your local facilities.)
  • The Elder Justice Act will help public agencies combat abuse against all elderly. It is the strongest legislation introduced to protect nursing home residents in the past 20 years.
  • There are several ways to contact your Representative:
    Call the U.S. Congress switchboard at 202/224-3121. They will put you through to the Representative’s office, and you can give your message to the person who answers the phone.
  • The Elder Justice Act provides for a wide range of programs and grants to improve detection and handling of elder abuse. A number of provisions are directly related to protecting residents in nursing homes and/or other long-term care facilities. These would:
  • Improve forensic investigation of elder abuse.
  • Require the number of adjudicated criminal violations by facilities or their staffs to be published on Nursing Home Compare.
  • Provide for a consumer rights information page on Nursing Home Compare.
  • Authorize new funding to improve ombudsman capacity and training.
  • Authorize a national training insitute for long-term care surveyors.
  • Require operators and empoyees of any long-term care facility that receives federal funds to report "any reasonable suspicion of a crime" to law enforcement; establish fines for those who fail to report and protection from retaliation for those who do.
  • Require nursing homes that are voluntarily closing to give 60 days notice to the state survey agency and provide a plan to relocate residents.
  • Authorize a report to recommend legislation or administrative action to establish a national criminal background check system for nursing home workers.
  • Authorize a study on establishing a national nurse aide registry.

Woman fell nine times in 7 months, and didn’t get 22 doses of necessary medications but the State only fined the home $1500. 

A resident fell nine times in seven months before anyone at her nursing home acted to prevent further falls. Her chart also describes six weeks last fall when she was behaving wildly — yelling, pacing, threatening staff and taking off her clothes, among other things. But none of her caregivers connected that to the fact that they failed during those same weeks to give her 22 doses of a drug to treat her mental illness.

For failing to provide that necessary care, Santa Rosa Care Center paid a $1,500 fine last week to the Arizona Department of Health Services, which licenses nursing homes and other elder-care facilities.
Last week’s $1,500 fine was the second penalty Santa Rosa has paid since Oct. 31. The home paid $3,500 after a March 2006 complaint investigation documented that a male nurse and two other staffers were verbally, emotionally and physically abusive to seven residents.

One of the residents was kicked, another was restrained with a choke hold, another had his arm twisted behind his back, and several of the residents said staff members had yelled at them.

The purpose of a fine is "to create enough incentive to stay in compliance (with state licensing rules) but to not be so detrimental to the facility as to pull too many resources away from patient care," Wynn said.
Grabel said he thought the penalty was low, "considering what happened to the patient … If the individual had nine falls, there should have been a fall-prevention plan that was implemented for her. If there was a problem with her getting her meds appropriately, then that also should have been taken care of as part of a plan. We need to make sure that we have better care for our elderly."

See link for full story www.tdn.com/articles/2007/04/15/top_story/news01.prt

Two formers owner of two Bronx County nursing homes defrauded the Medicaid program of millions of dollars by overcharging for services at two facilities over a six-year period.

From 1997 to 2003, Zelmanowicz, through his nursing homes, submitted bills to Medicaid fraudulently claiming that the facilities were entitled to payments for reserving or “holding” residents’ rooms during periods when the residents were temporarily hospitalized, commonly referred to as “bed holds.”

See link www.midhudsonmostwanted.com/stories/20070413-03.htm

I saw an article about a NY family who settled a fall case for $300,000 after a jury found the nursing home negligent for failing to put up bed rails.

 Palisades resident Gertrude J. Shapiro was in the nursing home recovering from an operation after a fall that left her other hip broken when the accident occurred in October 2001, her lawyer said yesterday.

A Rockland County jury ruled earlier this month that Nyack Manor was negligent in not making sure the bed rails on her bed were used properly. Shapiro’s family and the nursing home reached a settlement this week before a second jury could rule on damages.

See link www.nynews.com/apps/pbcs.dll/article

The cost of nursing home care in N.C. is less than the national average.

The average cost of a private room in a nursing home now tops $61,217 per year in North Carolina, according to Genworth Financial’s annual Cost of Care Survey;  the Genworth survey polls more than 10,000 nursing homes, assisted living facilities and home care providers to gauge care prices.

Private nursing home rooms cost, on average, $167.72 per day, with a minimum daily rate of $120. By comparison, the national average for a private nursing home room in 2007 is $204.95 per day, or more than $74,800 per year.

Semi-private nursing home rooms run slightly less, costing, on average, about $154.55 per day in North Carolina, or about $56,400 per year. Nationally, semi-private rooms carry an average price tag of $180.78 per day, or nearly $66,000 a year.

A private bedroom in a North Carolina assisted living facility cost more than $30,000 per year on average, or more than $2,500 per month. The national average for a private room in an assisted living facility is $32,572.61 per year, or more than $2,714 per month.

Genworth Financial is a financial services provider based in Richmond, Va.