Category Archives: Choosing A Nursing Home

Design for Better Infection Control

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The coronavirus has shown that nursing homes were not prepared either with proper training and supplies or sufficient numbers of qualified and competent staff.  Shortages of safety gear and staff. Workers who may inadvertently be carriers.  These are some of the reasons the coronavirus has hit nursing homes hard. But some experts and advocates claim the design of the buildings should be included.

Many of the nursing homes across the country are laid out like hospitals, and some house hundreds of residents. Most rooms are double occupancy, but some have three or even four residents. With shared resident rooms off long narrow corridors and large cavernous dining rooms where everyone interacts, nursing homes have been designed to be cost effective not safe.

Before the pandemic, a movement under the banner of “culture change” was challenging this institutional model, calling for dividing up large nursing home populations into small, self-sufficient units with kitchens, private rooms and a dedicated staff.  This type has been set up in multistory buildings with a couple of households per floor and in single-story purpose-built structures with homelike interiors. This smaller-is-better approach arose out of a concern for residents’ privacy and dignity, but evidence is emerging that it may also be helping with infection control.

A private room or even an entire household can be closed off more easily, keeping out or confining viruses. Staff members who are focused on a small number of residents may be more likely to pick up on warning signs, such as a lack of appetite, that someone is sick. The preparation of food and laundry in a household — rather than in central facilities and then distributed — also eliminates a few of the ways diseases can infiltrate.
Administrators of nursing homes large and small, as well as the architects who renovate and design their facilities, expect to zero in on disease control in the future as a result of the pandemic. Air circulation and filtration will be scrutinized when heating, ventilation and air conditioning systems are planned, they said.  Nursing home providers and their architects are also talking about easy-to-clean, nonporous surfaces; antimicrobial materials, like copper, for “high touch” features such as hand railings; and voice- or sensor-activated controls for doors, lighting, curtains, faucets and toilets.
The Department of Veterans Affairs began embracing a small-house model in 2011; now, 13 of its 134 nursing homes are organized around communities of 10 to 14 residents. In these settings, only a single veteran has tested positive for Covid-19.
“If we don’t see change in the nursing home market now,” said Jane Rohde, principal at JSR Associates, a design and health care consultancy in Catonsville, Md., “I don’t know when we will.”

 

“Scrubbed and Cleaned?”

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CMS issued an interim final rule at the start of May, requiring operators to submit weekly information about COVID-19 infections and deaths to the agency and the Centers for Disease Control & Prevention (CDC). The goal, according to CMS and the CDC, is to help officials track coronavirus hotspots while also providing full transparency to the public.

Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma recently confirmed that mandatory COVID-19 data will eventually appear on Nursing Home Compare, with the first public information expected to be released by the end of May.  I would not hold your breath.

In addition to building-by-building information on the consumer-facing website, the COVID-19 data will also be presented in a separate trend analysis from CMS, the administrator indicated.

“Ultimately, it will go on Nursing Home Compare, so that people can look up the specific nursing home and have the report on what happened,” Verma said to reporters.

“Obviously, we want to make sure it’s scrubbed and it’s cleaned,” Verma said. “We have to get the data from CDC. We want to do our own analysis, as well, to sort of put out some broad parameters of what we’re seeing, so that that’s easy and digestible.”

A lack of specific public data around coronavirus infections and deaths in nursing homes has been a major source of frustration for lawmakers, resident advocates, and families.

 

 

PACE: A Better Alternative

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PACE has five locations that help more than 1,200 seniors who are no longer able to be completely independent because of health or age. PACE has over a hundred buses that allow seniors to live at their home but then be picked up and brought to one of the centers where they’re greeted by care takers who help with prescriptions and medical attention.

PACE has been around since 1994 in our area with centers in Southfield, Dearborn, Detroit, Sterling Heights and Eastpointe. It is soon to be opening in Pontiac at end of this year.   You have to be eligible for Medicare and Medicaid to qualify.

“The Bible says we should honor our mother and our father. So, seeing them, they are my family,” said Nike Adewale.

“I think it’s the most wonderful place that I’ve ever been in my life,” said a woman who is 103.

She’s 103 years old and is thrilled she’s not in a nursing home and instead here with friends.  It’s care for the whole day. Then they go home where they sleep.

“Our goal is to keep chronically ill seniors independent in their homes, hopefully until the end of their lives,” said Mary Naber.

Naber is the CEO and for her it’s a labor of love.  She knows this place is the best kept secret in town for elder care.

“They will have a continental breakfast, they will have lunch, they will do activities, they will go to the rehab gym and get full rehab services – physical therapy, occupational therapy if that is what they choose,” Naber said. “They may be seen in the clinic for an appointment, a dentist, an eye appointment – whatever it is, that day.”

The caretakers here, to the bus drivers they’re all trained to make sure that if someone’s having a bad day, they get the medical care they need.  It’s a holistic approach to elder care and it’s working well.

“With PACE they’ve allowed me to stay independent and stay in my home,” Lewis said.

For more information go to: http://www.pacesemi.org/

Informed Consent on Choice of Physician

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Physician coverage in nursing homes has been cited as a key area of potential improvement for the industry — both for resident outcomes and financial health. Doctors who specialize in nursing home residents tend to be few and far between in many markets, despite the fact that timely interventions from physicians and other advanced practitioners generally lead to better outcomes and fewer penalties under various value-based models.

A new law in New York will require nursing home operators to provide information about their relationship to physicians including  privileges to residents as a prerequisite for admission. Signed into law by Gov. Andrew Cuomo last month, the update to the state’s public health law means that skilled nursing facilities can’t accept residents until they receive a description of the policy regarding granting physician privileges. The issue is a matter of informed patient choice.

“Potential nursing home residents have a right to know which physicians will be available to provide care prior to signing a residency agreement,” Sanders said.  “Many individuals enter nursing homes having pre-existing relationships with doctors in their community,” Sanders said. “Whether or not those physicians already have or have the opportunity to be granted privileges may play an important role in choosing a nursing facility.”

As the Patient-Driven Payment Model (PDPM) was rolled out this year, SNF-specific physician groups marketed their services as a way to increase nursing homes’ ability to serve higher-acuity residents and handle the documentation necessary to receiving proper Medicare reimbursement under the new system.

 

 

Florence Veterans Affairs Nursing Home Under Construction

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WPDE reported that construction for the $55 million Florence VA nursing home started in July and is progressing well.  It’s being built on 33 acres off of National Cemetery Road just down the road from the Florence National Cemetery and the Florence County Veterans Affairs Office. Officials said the Florence facility will cost about $55 million. The nursing home will include 104 bedrooms, a dining area, and a recreational facility.

The S.C. Department of Mental Health operates all VA nursing homes in the state. The VA center will create 100 new permanent jobs and generate nearly $20 million in revenue for the Florence economy during the construction phase of the project, according to Florence County Senator Hugh Leatherman (R).

Many people in the community said they’re excited that veterans will have a resting place and the new jobs created at the nursing home.

 

CMS adds alerts to Nursing Home Compare

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CMS last month announced that it would add a new icon—which is a red circle with a white stop hand in the center—to the site to alert consumers when a nursing home has been cited for incidents of abuse, neglect, or exploitation. According to the data-analysis company StarPRO, CMS has affixed the icon to ratings for only 760, or roughly 5%, of the 15,262 facilities on the site.

CMS said the consumer alert icon would appear next to facilities that have been cited in inspection reports for abuse that caused a resident harm within the past year, as well as abuse that could have potentially caused residents harm in the past two years, and the move has been applauded by experts and consumer advocates in the nursing home industry.

CMS’ Nursing Home Compare website assigns a certain number of stars to nursing home facilities, similar to systems used to rate hotels. The best possible rating Medicare can give to a nursing home is five stars based on staffing, quality measures, and other factors. The ratings are designed for both consumers and providers. CMS added the icons to the site, and they appear directly next to the names of facilities that have received citations.

CMS said it will use the agency’s latest inspection data to update the icons each month, and it will remove the consumer alert icon when nursing homes have fixed the issues that caused the citations. According to the Wall Street Journal, CMS will remove the icon once a flagged facility goes without an abuse citation for one year.

Consumer advocates praised the icon’s introduction, but said the tool is imperfect and is based on an inspection system that often misses cases of abuse.

Richard Mollot, executive director at the Long Term Care Community Coalition, said, “We just hit the tip of the iceberg here. We are not finding the harm that’s out there. If we see a few occasions that are getting out, I think it’s an important alert for the public.”

 

Sumter Nursing Home for Veterans

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The next state-operated, federally funded nursing home for veterans is likely to land in Sumter. Thanks to Representative Murrell Smith.

“There are a lot of retirees in Sumter, and they’re aging. They’re going to need these resources in these later years of life,” state Rep. Murrell Smith, R-Sumter, said. “It’s a perfect opportunity.”

Smith is chairman of the House Ways and Means Committee and is on the Joint Bond Review Committee; he claims it’s a win-win for both Sumter and the state.

“It’s a way to show appreciation for our members of the military who served, who were stationed here at Shaw [Air Force Base] and to incentivize them to retire here,” he said.

Members of the state General Assembly’s Joint Bond Review Committee agreed to a new project last month for what would be the sixth such facility in South Carolina. The homes are funded based on a cost-sharing formula between the Veterans Administration and state Department of Mental Health, with the VA providing 65%.

There are already three state veterans’ nursing homes in South Carolina: The E. Roy Stone Veterans Pavilion in Columbia, the Richard Michael Campbell Veterans Nursing Home in Anderson and the Veterans’ Victory House in Walterboro. Those are at capacity with a total of 530 veterans.

According to The Post and Courier, more than 1,000 veterans throughout the state want to live at a state nursing home, which are touted as high quality and low cost.

Three new homes received federal approval in April 2018, starting the design phase in Florence, Gaffney and Columbia, but construction costs increased since the state applied for the federal funds in 2015, Binkley said. When two facilities could be built, according to 2015 estimates, for about $82 million, the state is estimating only one for that much.

“We’re estimating high to not get caught short again,” Binkley said. “In 2015, we thought it would take about $40 million for one, but when we bid it in 2019, the low bids were in the $60 million range.”

Not having enough money allocated in the state budget to build three nursing homes, the Florence and Gaffney facilities were approved in June by the VA. The Columbia facility was nixed, the process starting over with an eye on Sumter.

Binkley is requesting $37 million in state appropriations in next year’s budget to put toward the Sumter facility and one more, if approved, at an undetermined location.

Using the $20 million leftover from not building the Columbia location, the $37 million includes $9.1 million that the General Assembly must appropriate in its spring 2020 session to meet an August 2020 deadline certifying the state has matched enough funds for the Sumter location. The rest is for what would be required in state matching funds for the seventh state nursing home.

The Florence and Gaffney homes began preliminary site work in May for an anticipated opening date of summer 2021, Binkley said. Sumter’s facility may be ready by 2023, but after the state funds are matched and certified, the VA still must appropriate its share. The state should know by June 2020 if the VA will match.

The 148,000-square-foot facility in Sumter would serve 104 residents and employ a 100-person staff. Binkley said the state is looking at modifications in design to lower construction costs for any future sites, such as semi-private rooms and eliminating in-home dining, that are permitted using state rather than federal guidelines.

State Sen. Thomas McElveen, D-Sumter, said while Sumter has always been at the forefront of prioritizing South Carolina’s veterans, he is seeing a “rapid change” across the rest of the state.

“Sumter is a natural fit for something like this. We’re very welcoming to our military and very friendly with our military out at the base,” he said. “Our delegation consistently advocates for issues that are important to veterans, and this was just the icing on the cake. Everything has lined up well for Sumter.”

New Warning from CMS

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Federal officials have started affixing a bright red “stop” hand icon next to facilities that have received recent abuse citations from the Centers for Medicare & Medicaid Services.

CMS unveiled the labeling plans as part of an unfolding five-pillar plan that includes improving transparency for consumers. Starting Oct. 23, the “Do not proceed” symbol will be placed next to facilities that have been cited for abuse, neglect or exploitation. Authorities call the open-palm display in a red circle “a consumer alert icon.”

It will appear next to facilities that have been given a citation for abuse that led to the harm of a resident within the past year or cited for abuse that could have potentially led to resident harm in each of the previous two years.

The icon will be updated on a monthly basis at the same time as inspection results. CMS said the monthly updating will come quicker than current quarterly updates and ensures that nursing facilities “will not be flagged for longer than necessary if their most recent inspections indicate they have remedied the issues that caused the citations for abuse or potential for abuse and no longer meet the criteria for the icon.”

“Through the ‘transparency’ pillar of our five-part strategy to ensure safety and quality in nursing homes, we are giving residents and families the ability to make informed choices,” CMS Administrator Seema Verma said.

While consumers can already learn about nursing home violations through health inspection reports available through the website, the CMS said they’re too difficult to access now and that the new icon will make it easier for consumers to find out about abuse citations.

She said the added information is meant for “incentivizing nursing homes to compete on cost and quality.

Another Blue Ridge Facility Added to List

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Blue Ridge in Georgetown nursing home and rehabilitation center was named to a list maintained by the federal government of poorly performing facilities.  Blue Ridge in Georgetown was already fined nearly $44,000 for health violations in 2018. The facility received 33 health citations during its last inspection in October 2018.

Blue Ridge joined four other nursing homes in the Palmetto State as candidates for a federal oversight program. Commander Nursing Center in Florence has been officially flagged for the government to focus on since July.  Blue Ridge of Sumter was added to the list of candidates for the SFF program in June. Magnolia Manor in Columbia and The Retreat at Brightwater in Myrtle Beach were added in July.

The Centers for Medicare and Medicaid Services, the federal office in charge of administering the programs, keeps a list of nursing homes that consistently don’t meet standards and agreed to publicly release a monthly update to that list in June.

The most severe offenders are then designated as Special Focus Facilities. This designation increases the frequency that a nursing home must be inspected and sets guidelines for where and how quickly a facility must improve. Around 400 facilities are designated as SFF candidates at one time.

Facilities that do not graduate from the SFF program within 18 months risk losing their ability to participate in the Medicare and Medicaid programs.

 

Illuminate HC in Michigan

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WoodTV had an interesting article about Illuminate HC which took over management of SKLD and 10 other Michigan nursing homes a year ago. Of SKLD’s 11 homes, four have one-star ratings (much below average), four have two-star ratings (below average), two have three-star ratings (average), and one has a four-star rating (above average).

Brandee Davis has been complaining about the care and treatment of her mother for months. Davis, whose mother lives at SKLD nursing home in Wyoming, has filed formal complaints with the state twice since May.

“It’s really hard to watch someone you love with all your heart suffer… beg for help, beg to leave,” Davis said in an interview.

SKLD has a one-star rating on the federal website medicare.gov, a score that’s described as “much below average.” Of the 25 licensed nursing homes in Kent County, SKLD is one of just three with a one-star rating.

Davis is going to court in September to try to get guardianship over her mom, Michele, so she can move her.

“I shouldn’t have to keep calling and reporting,” Davis said. “My mom shouldn’t have to call me, begging me to call the home because her call light has been on for two hours and nobody’s coming to her room.”

Among Davis’ complaints to the state is that SKLD workers failed to answer her mom’s call light or change her diaper for hours; ran out of appropriately-sized briefs, thus forcing her to wear too-small briefs which ripped her skin; left her in the same clothes for five days and placed an aggressive dementia patient into her room despite her inability to protect herself.

“They decided to place a known violent dementia patient… in a room with an incapacitated adult who can’t do anything for herself,” Davis said.

State investigators who inspect nursing homes on behalf of the Centers for Medicare and Medicaid Services substantiated several of Davis’ complaints, including the one about her mom’s new roommate, who was moved to another room after she “went through (Davis’ mom’s) things … smacked her legs” and attacked staff, bruising a nurse, according to a state report.

“Review of documentation and interviews, revealed (Davis’ mom) was vulnerable and unable to defend herself from (the dementia patient) who wanders, has physical behaviors and a history of blocking the doorway to the residents’ room so staff could not get into the room. Which placed (Davis’ mom) at higher risk of harm,” a state inspector wrote.

Inspectors issued statements of deficiencies and ordered the home to create plans of correction after their visits in late May and mid-July. Among the deficiencies cited were out-of-reach and unplugged call lights, residents left for hours in urine-soaked briefs and dirty rooms with “dried food and liquids stuck to the residents’ room floors, dirt and dust accumulating under the residents beds, tissues and papers accumulating on the floors.” One room had dust clumps “larger than golf balls” under the bed.

Davis said SKLD injured a helpless elderly person.

“It’s mind-blowing and traumatizing,” she said. “And when I was in there two days ago, they’re still using one person to change my mom and she can’t use her arms to stop, to protect herself. So if they roll her and she rolls to the other side, that’s going to be catastrophic.”

Davis’ biggest fear is that her mom will choke and be unable to call for help.

“She can’t really eat or swallow very well, so I always get worried she’s going to choke and she’s going to push her call light and no one’s going to get there in time,” she said.