The Birmingham News had a great article discussing a new type of nursing home that makes the residents feel like they are at home instead of a hospital.  Residents are called "elders," not patients. Nurses are invited guests, not managers. Home is the emphasis, not medicine, although skilled care is available.

After years of planning and then construction, the retirement community has just completed the "Cottages at St. Martin’s, a Green House Community." St. Martin’s cottages are designed after a patented Green House concept that seeks to deinstitutionalize treatment of the elderly and create a family-like environment for their long-term care.

The $11 million project involves replacing 60 of St. Martin’s 138 nursing home beds in 6 separate homes where 10 residents live with the help of certified nursing assistants. The Green House concept was developed by Dr. William Thomas, a geriatrician fed up with the sadness, loneliness and boredom in his nursing home patients.  Today there are 15 Green House communities open and another 19 in development in 23 states.

St. Martin’s is the first nursing home in Alabama to embrace the idea and the first in the country to open multi-story houses. Because of limited space, St. Vincent’s has built two, three-story structures with a separate "cottage" or "Green House" on each floor. The cottages on the ground floor have an outside courtyard, and the upstairs cottages all have large, screened-in porches.

Each home has a separate entrance, and doorbells must be rung and the door answered before a nurse or other visitor enters.

The cost of care will be the same at the cottages as in the traditional nursing home. The ratio of nursing assistant to residents is better in the cottages, but the nursing assistants are also doing the cooking, light housework and other chores. Nurses make rounds on the cottages to give medicine and check vitals, but they are not the ones in charge.

Turnover of nursing assistants is expected to be less for those working in the cottages because they have more varied roles and fewer residents to look after.  Nursing assistants are getting culinary training this week. A central part of each cottage is the open kitchen, from which nursing assistants can monitor the residents and residents can smell the food cooking. Weight loss is a common problem in nursing homes, but Green Houses across the country have shown that to be less of an issue when the food is prepared near the residents.

There is a special place in hell for people who have the audacity and malice to steal from vulnerable elderly people residing in nursing homes.  I do not understand how someone can betray the trust of these residents in such a way.  Recently, I saw an article in the Staten Island Advance that discussed a case where a husband-and-wife team working at a Stapleton nursing home stole a credit card from a patient’s bedside drawer and used it at two locations on Staten Island.

Denard Brown, 44, and his wife, Benedicta Charles, 44, allegedly swiped the card from a patient.  Ms. Charles was responsible for providing care as a nurse’s aide at St. Elizabeth Ann’s Health Care and Rehabilitation Center, Stapleton.

The victim reported the card missing, which prompted investigators to monitor the card’s account for activity. Detectives got a hit last week at Waldbaum’s store.  Waldbaum’s turned over video surveillance tape that captured the couple using the card on Sept. 7. Armed with the tape, and bank records that implicated them in the crime, police arrested the couple at St. Elizabeth Ann’s when they reported to work.  Under questioning, Brown admitted he also used the card Sept. 4 to buy gas at a Hess station.

Ms. Charles and Brown have been "suspended pending an investigation," Fagan said.  Both are charged with grand larceny, criminal possession of stolen property and endangering the welfare of an "incompetent person."

 

 

Emmy Pei works for a technology provider in the medical  industry called Direct Alert (www.directalert.ca).  She was kind enough to share an article with us and we are pleased to include it on our blog. 

Elderly Care with Technology

There exists a looming problem in the healthcare system for our baby boomer population, and that is the shortage of people available to provide hands-on care for the elderly and the aging. Enter…the robots. Or to be more specific, a robot named Pearl.

Developed by a research team at Carnegie Mellon University, Pearl is undergoing a trial run in a Pittsburgh nursing home, guiding residents around the building, helping them get from their rooms to the dining hall, or from the library to their physical therapy session. Pearl is also able to give verbal alerts to remind residents to eat or to take their medications.

Advancements in assistive technology will not only improve the care for elderly people in institutions like nursing homes and hospitals, but they will also help to keep them out of said institutions. Fall detectors, pressure mats, door monitors, and bed alerts and medical alerts all serve to improve home safety, increasing people’s ability to live in the comfort of their homes for much longer.

There are also several new options to address problems such as failing to take medications on time or remembering to take them at all. Smartmeds offers a wireless service that delivers notifications to take medications via cell phone calls. The On-Time-Rx software for Palm pilots provides a similar service, sounding an alarm and displaying a set of instructions at the appropriate time. More 21st century style options include wristwatches with preset alarms as medication reminders, or automatic dispensers which sound an alarm and dispense the pills at the right times. Also featured is the medical alert bracelets which carry the direct alert receiver. These two pieces can be worn with comfort and confidence.

One obstacle to overcome is the intimidation factor. Something as simple as cell phone buttons being too small, or wheel-mouse devices that are too sensitive can prevent some folk from adopting new technologies. Recognizing this potential pitfall, Jeffrey Pepper founded ElderVision in 1999, a company devoted to helping technophobic seniors get online. The Touchtone system replaces the mouse and keyboard with voice and touch-sensitive activation, making computers more accessible to a generation who grew up without them. To send an e-mail, for example, you can simply touch an onscreen photo of the intended recipient, instead of having to worry about typing it out.

Technological developments like these allow older generations to stay more connected, while enhancing their independence. With their health and well being in the hands of people who care and with the proper technological tools, senior citizens can live more relaxed and comfortable lives. And while the age of robots still remains on the horizon, residents of the Pittsburgh nursing home told the Carnegie Mellon team that Pearl is fine, as long as it’s not seen as a replacement for human contact
 

Lancaster online had an interesting article on Goods Run, one of the Mennonite Home’s new skilled "households."   These homes were designed to create a more homelike and less institutional environment for residents.

The change has helped many residents become more social.  Mennonite Home’s conversion to households incorporates a person-centered approach.  This approach is and should gain in popularity across the country.   It’s a key component of a $13 million physical renovation and "culture change" at the 105-year-old continuing-care community.

While the skilled-nursing area is being turned into nine households with up to 28 people each, the exterior of the brick building along Harrisburg Pike in Manheim Township is being transformed as well.   Other recent improvements include an all-season room, a café serving Starbucks coffee, a library, a country store and a new elevator tower.

In total, the households will consist of 190 beds, six fewer skilled-nursing beds than Mennonite Home had before.  Though Goods Run, which opened in March, has room for 28 residents, the rest of the households will accommodate 16 to 22 people.

Each household has a front door, which opens to reveal a living room with fireplace and flat-screen TV; a parlor; a dining room and residential-style kitchen; a washer and dryer; and even a spa with whirlpool. The traditional nurses station also has been eliminated, Sauder said, and replaced with charting and medication rooms tucked away from the main living area.

Resident rooms are configured and furnished differently, too, he said. Before, most skilled-nursing rooms were semiprivate, Sauder said. Now there are more private rooms, along with "modified" private rooms, where two people each have their own space (separated by a wall) but share a bath.

According to her Web site, culturechangenow.com, "Action Pact Inc. is a company of trainers, consultants and educators who assist nursing homes and other elder-care organizations in becoming resident-directed.

 

The May 4 death of a local nursing home patient has been ruled a homicide.  However, no criminal charges will be filed in the case.   Elsie Powell is suspected of pushing Edna Shaw to the floor at Encore Senior Village on University Parkway. Shaw hit her head on the floor.  Both were residents at a nursing home.   The Medical Examiners Office ruled that the blunt impact to Shaw’s head contributed to her death and ruled the death a homicide, the report said.

Powell’s condition has continued to deteriorate, Assistant State Attorney David Rimmer wrote in the report.   “It is doubtful that she was even mentally competent when the incident occurred,” Rimmer wrote. “Therefore, in my opinion, no criminal charge should be filed against her for the unfortunate death of Miss Edna Shaw.”
 

The Philadelphia Inquirer wrote an article about how many errors in health care settings do not get reported.  These errors or mistakes, whatever you want to call them, need to be disclosed so we can figure out how to prevent them in the future.  These health care businesses are more worried about getting caught then preventing them.

The article describes several incidents where patients were not given proper care but the hospitals failed to report the problems such as two patients at Fox Chase Cancer Center in Philadelphia required additional surgery after objects were negligently left inside their bodies or three patients at Mercy Fitzgerald Hospital had to be sent back to the OR last year to stop excessive postoperative bleeding or  At Abington Memorial Hospital, an elderly woman recovering from surgery for a broken hip in 2005 was left on a bedpan for at least 41/2 hours. She developed two open bedsores as a result.

For several years now, hospitals in Pennsylvania and New Jersey have been required to report medical mistakes and serious complications to state agencies charged with reducing medical errors. But most hospitals aren’t complying, undermining efforts to improve patient safety.  In New Jersey, five of the state’s 80 hospitals failed to report a single preventable mistake last year. In Pennsylvania, some facilities didn’t report any serious events or even the near misses that might have harmed patients.

James Bagian, head of the Department of Veterans Affairs’ National Center for Patient Safety, said: "Anybody that is supposed to report close calls and has zero reports is clueless; Management is asleep at the switch and just waiting until they kill someone."  The public can only learn that a hospital isn’t reporting mistakes in those rare instances when the health department cites it for failing to comply with the law.

"There is still some underreporting, and we are working directly with the hospitals to understand why," said Eliot Fishman, policy director of the New Jersey Department of Health and Senior Services.  Consumer advocates want more transparency so patients can make better health-care decisions.

The numbers suggest underreporting is more than just a passing problem.   Calvin Johnson, the Pennsylvania secretary of health, said only people with their "head in the sand" would fail to see the problem of uneven reporting by hospitals. But he noted that with about 200 hospitals and millions of patient visits each year, it is impossible for the state to check every chart.

While it’s important to study each of those reports, it is at least as crucial to identify hospitals that are not participating at all, said Conway, of the health-care improvement institute.   "We cannot improve care unless we understand the problems," Conway said. "There can’t be safety without transparency."
 

AOL had an article equating nursing homes with prison.  This may sound harsh but the people I speak to at nursing home typically feel that way.  The residents do not feel like the nursing homes want them to get better because they will lose money if the residents return home.  The most interesting aspects of the article are the comments under the story.

The article talks about Charles Todd Lee, a 67-year-old photographer who has been confined to a nursing home for five years, the victim of a stroke that paralyzed his left side.

"Most of the people come here to die, so you want to die," he said. "It is a prison. I can’t escape it."

Lee is a Medicaid recipient challenging the nightmare of the old and disabled: to be forced from comfort and familiarity into a nursing home.  Residents say the state is illegally forcing them to live in nursing homes when they should be able to live where they choose. Advocates charge that nursing homes, afraid of losing money, have successfully pressured politicians to make qualifying for community care more difficult. They have filed a federal lawsuit seeking class-action status on behalf of nearly 8,500 institutionalized Floridians.

Whether the litigation gets Lee and others moved out of nursing homes remains to be seen. But at the very least, it has illuminated the frustration experienced by older people or those with disabilities who say they’re shuttled into nursing homes when they are healthy enough to live at home, with relatives, or in other less institutional settings.

Americans who qualify for Medicaid and get sick or disabled enough to require substantial care typically have little problem gaining admission to a nursing home. But obtaining Medicaid-supported services at home, such as visits from an aide, is substantially harder and often involves a long waiting list, even though it may cost the government less.

Advocates for the elderly and disabled had hoped a 1999 Supreme Court case would change that. The Olmstead decision, as it is known, involved two Georgia women, both Medicaid beneficiaries with mental retardation who wanted community-based services, but were refused and were treated in institutions.   The high court ruled unjustified isolation of the disabled in institutions amounted to discrimination under the Americans with Disabilities Act.   It said states must provide community services if patients want them, if they can be accommodated and if it’s appropriate.

States have been putting more money into community services, but not nearly enough to meet the demand of people who would rather stay at home than go to a facility. Nationally, state Medicaid payments for long-term community care have skyrocketed since the Olmstead decision, from $17.4 billion in 1999 to $42.8 billion last year, though spending on nursing homes and other institutions is still substantially higher.   A total of $59.5 billion was spent last year on institutional care through Medicaid.

The article also mentions John Boyd, 50, who has been in a nursing home for the last nine years. He hates them. He became a quadriplegic 36 years ago when he fell off a wall and broke his neck.
"I can’t choose what meal I want, I can’t have a visitor after 8 o’clock — it’s just like a prison without bars," he said. "People are making decisions for and about me that don’t even know me or even care about me. All they care about is the money they’re getting for me."
 

Naples Daily News had an article about Medicare overpaying nursing homes.  Watchdog groups have warned about the overpayment months ago.  The already extremely profitable nursing home industry is getting an extra $1.5 billion from Medicare despite a call from an independent Medicare advisory panel that reimbursement has been inflated for the past three years and needs to be scaled back.

The windfall to skilled nursing facilities comes with no strings attached and there is no reason to believe this windfall will help improve the quality of care or quality of life for nursing home residents,” said Toby Edelman, a senior policy attorney with the Center for Medicare Advocacy Inc., in Washington, D.C.

The overpayment remains even though the Medicare Payment Advisory Commission, an independent advisory group to Congress, recommended in May that the rates be adjusted because nursing homes are being overpaid. The Bush Administration decided this past month to "study" the issue further.

The Center for Medicare has been overpaying nursing homes since January 2006 after expanding the list of categories used in determining patients’ medical status for purposes of reimbursement  .By not addressing the issue now, the nursing home industry will reap an extra $780 million next year, Edelman said.

An Office of Inspector General report in 2006 found that 22 percent of nursing home claims were overcoded for higher reimbursement, he said.

The system used to determine reimbursement to nursing homes is complex. One component alone involves a patient evaluation form with 509 questions, Hamilton said. The forms help determine the nursing home’s reimbursement rates.  This raises questions about how much time staff members have to do the evaluation, how trained they are and whether the patient’s medical record matches the care rendered, Hamilton said.

On a second front, the nursing home industry is receiving a 3.1 percent inflation adjustment that will mean getting an additional $710 million next year from Medicare.  MedPAC had reviewed nursing homes’ operating margins and recommended no cost adjustment to the federal government but the inflation increase is moving forward.

 

The Urban Institute did a study that showed Americans who go without health insurance.  They will spend $30 billion out of pocket for health care this year alone, and they will get $56 billion worth of free care, according to a report released on Monday.

Government programs pay for about three-quarters, or roughly $43 billion, of the bills for these uninsured people, Jack Hadley of George Mason University in Virginia and a team at the Urban Institute reported.

On average, an uninsured American pays $583 out of pocket toward average annual medical costs of $1,686 per person,  The annual medical costs of Americans with private insurance average far more — $3,915, with $681, or 17 percent, paid out of pocket, the report found.

"The uninsured receive a lot less care than the insured, and they pay a greater percentage of it out of pocket. Contrary to popular myth, they are not all free riders," Hadley said.

Current estimates show that 47 million Americans lack any health insurance, and 28 million have gone without for some part of the year.  

The purpose of the Long Term Care Ombudsman program in South Carolina is to provide advocates for the elderly and their families.  If you or a loved one is a resident of a nursing home or assisted living facility in South Carolina, the Ombudsman in your region should be able to answer your questions.  Most importantly, if you have a complaint against a facility contact your Ombudsman for help.  Click here for to find out more about the Long Term Care Ombudsman program and to get contact information.  Another resource to try is SCDHEC, or South Carolina Department of Healht and Environmental Control.  This is the agency that licenses and inspects nursing home and assisted living facilites in South Carolina.  Click here for more information.

When making a complaint, whether it is made to the Ombudsman, DHEC, or the facility itself, it is best to do it writing, not verbally, and make sure you keep a copy for your records.