Next Avenue had an interesting article on how 4 states have lowered nursing home admissions. Nursing home care is the most expensive form of long-term care. According to the 2017 Genworth Cost of Care report, a private room in a nursing home now costs an average of $97,455 per year. A semi-private room runs more than $85,000.

“If you are hospitalized at age 65 or older, there is a one in five chance you will be discharged to a nursing home.   Certain states — like Minnesota, Maine, Oregon and Connecticut — have implemented policies that lower the chances of getting “stuck” in a nursing home, said Wendy Fox-Grage, a senior strategic policy advisory with the AARP Policy Institute and co-author of “State Strategies to Reduce the Risk of Long-Term Nursing Home Care After Hospitalization.”  The new report, released Oct. 6, highlights some of those innovative policies.

Minnesota: ‘Return to Community’

Minnesota uses “community living specialists” to work with older adults to get them back to their communities. The community living specialists, who are nurses or social workers, assist the nursing home to identify new residents who may want to return home. Then, after the residents return home, the community living specialists follow up with them to make sure they are getting the services and support they need over the following months.

Another Minnesota initiative lauded in the report is its Performance-Based Incentive Payment Program. This program rewards nursing homes with incentive payments for designing projects to lower their numbers of long-term residents.

Oregon: Downsizing Nursing Homes

Oregon does a better-than-average job of keeping people out of nursing homes by providing services in the community: just 3.3 percent of state residents age 85 and older live in nursing homes. (The national average is 9.5 percent, according to the AARP report.)

A 2013 law provided a financial incentive for nursing homes to buy another facility and then take the excess capacity out of use — a process known as “buy and close.” Some providers have diversified into hospice care, assisted living, home health and independent living, the report said.

Connecticut: Home Care for Older Adults

Connecticut’s Home Care Program for Elders provides financial assistance for home care services so older adults can delay or avoid going to a nursing home. There are varying levels of service depending on a person’s financial resources, but unlike other programs, those who don’t qualify for Medicaid are not automatically excluded.

The services may include housekeeping, companion services, home-delivered meals, a personal emergency response system, adult day care, assisted living, mental health counseling and minor home modifications. Family caregivers can receive payments of between $42.58 and $107.06 per day.

The program “represents a significant state investment in the delivery of home care services to people who, despite being at risk for nursing home admission, do not qualify for Medicaid,” the report said.

Maine: Getting to People Early

Maine has been working since the 1990s to limit nursing home admissions to the people who most need them, according to the report. It does that, in part, by mandating medical assessments before admission. Maine also provides prospective residents and their families with a “community plan of care,” which gives information about services they may be able to use instead of going to a nursing home.

The program also provides individuals with a service plan that has estimates of how much the home care services will cost. The service plan doubles as an authorization for payment by Medicaid, if the person qualifies, or the state-funded home- and community-based care services program.

 

 

 

Go Upstate reported that Cherokee County will be the home of a state-run veterans nursing home but state funding has not been confirmed.  Because the facility will be owned by the state, the $41 million needed for construction will come from the state budget.

Cherokee County County Council purchased a 60-acre parcel of land from the Batts family for $463,000.  The county is now in the final stages of transferring the land to the state so that the development process can begin.

“The commitment from the state was that this would be one of the sites they would build on as soon as they were funded,” he said. “We have an eight-year reversal of the land, which means the state has eight years to construct the facility. If they don’t, the land will come back to the county.”

Currently, South Carolina has three state veterans nursing home facilities — E. Roy Stone Veterans Pavilion in Columbia, Veterans’ Victory House in Walterboro and Richard Michael Campbell Veterans Nursing Home in Anderson.

Humphries said with the number of veterans in South Carolina closing in on one million, three facilities are simply not enough. Humphries said veterans and their families are driving 100 miles or more to access existing facilities.

“The bed wait for a state veteran’s nursing home in this state, today, is about six months,” he said. “That’s a big red flag when we have a population of more than 800,000 veterans.”

 In addition to the Cherokee County facility, others are planned in Florence County and Columbia, Humphries said.

Each nursing home will have 108 beds, and Humpries said having one in Cherokee County will provide better access for veterans within the county and those in surrounding counties like Spartanburg, York and Chester.

 

The Rand Corporation issued a press release about their new study showing that the average American’s lifetime risk of using a nursing home is substantially greater than previous research has suggested.  Among persons age 57 to 61, 56 percent will stay in a nursing home at least one night during their lifetime, according findings published online by the journal Proceedings of the National Academy of Sciences.

Previous studies have generally corroborated the U.S. Department of Health and Human Services’ estimate that only 35 percent of older Americans are likely to use a nursing home in their later years.

The average nursing home stay was 272 nights and for 10 percent of the study group, the stay was much longer—more than 1,000 nights. Out-of-pocket spending was similarly skewed, with 5 percent of older Americans needing long stays costing $47,000 or more over their lifetime.

“It is important to provide individuals and families a reliable assessment of the likelihood of entering a nursing home in retirement,” said Michael Hurd, lead author of the study and a senior principal researcher at RAND, a nonprofit research organization. “This information could help people make better decisions about how they or their loved ones will pay for the care they are likely to need.”

 

 

The graying of the U.S. population and growing numbers of Americans needing expensive, long-term care for dementia could cause the rate of nursing home use to keep rising and increase pressure on Medicaid to cover the costs.

“People think of Medicaid as being for the indigent, which is true at younger ages,” he said. “But Medicaid is the most important payer for nursing homes, covering a greater proportion of costs than individuals and families pay out-of-pocket. At older ages, Medicaid is an insurance program that many of us may need to use.”

 

Having children, the study notes, does not lessen the chances of needing a nursing home in old age, but can reduce the length of the stay and cut the associated costs by as much as 38 percent. Having daughters able to provide in-home care was correlated with even larger savings.

Funding for the study was provided by the National Institute on Aging. Other authors of the study are Pierre-Carl Michaud and Susann Rohwedder.

The RAND Labor and Population program examines issues involving U.S. labor markets, the demographics of families and children, policies to improve socio-economic well being, the social and economic functioning of the elderly, and economic and social change in developing countries.

SC Now reported on the progress for a new Veterans Affairs nursing home in Florence.  U.S. Sen. Lindsey Graham says Florence will get the major Veteran Affairs facility that’s been talked about locally for months.

Graham was in Florence last month for the grand opening ceremony of the county’s new VA Administration Building.  He reassured everyone that a new VA nursing home is in the works with support in Washington, D.C.

“There will be one coming to Florence,” he said. “There’s a real big demand and a short supply, and a VA nursing facility is a lot less expensive for our veterans. Of all the things lacking in the VA, quality nursing homes are at the top. Many of them, like the one in my hometown, have a waiting list a mile long.”

Officials close to the project have said the Florence facility is expected to take up approximately 20 acres, contain more than 100 beds, bring roughly 110 new VA staff members and come with a price tag of $35 million to $40 million.

State Senate President Pro Tempore Hugh K. Leatherman Sr. of Florence first spoke of the project last November, saying he was working to get one facility in Florence and another in the Upstate, as opposed to a larger facility in Columbia.

Though details were not provided, Leatherman said that land acquisition in Florence is being finalized on National Cemetery Road near the Florence Stockade. “There are a lot of veterans in the Pee Dee, and many of them don’t have the means to drive across the state, and neither do many of their families. It’s more beneficial to the people of this state to have multiple facilities.”

Graham said spending more money on veteran’s care will pay off in the long run with veterans of Vietnam aging and veterans of wars in the Middle East not far behind.

“The VA and the defense department is just a small percentage of overall spending,” Graham said. “About 74 percent of government spending is Medicare, Medicaid and other entitlement programs. The VA isn’t what’s putting us in debt; it’s the unlimited growth of entitlements.”

The Casper Star Tribune reported the settlement between SavaSeniorCare d/b/a Poplar Living Center and resident Gilbert Arellano.  The lawsuit involved a facility employee driving a van into the blind resident standing near the curb waiting for a ride in March 2014. Arellano was knocked to the ground, and injured.  The nursing home did not have someone stand with Arellano while he waited for his ride on the handicap ramp and the man was unable to avoid the danger himself because he is legally blind, the suit says. The suit alleges the facility failed to meet the legal standard of care because it is understaffed, did not accompany Arellano to the curb and allowed an employee to “negligently operate” a company van.

Since the incident, Arellano has had pain and numbness in his right arm.  The amount of the settlement reached on Nov. 1 could not be disclosed because of a confidentiality agreement.

The suit also alleges that SavaSeniorCare, the company that owns the Casper nursing home, kept staff numbers low and didn’t adequately train employees to save money, thus endangering the residents. That allegation is repeated across many of the other lawsuits. The Centers for Medicare and Medicaid Services also cited Poplar Living Center for understaffing the facility.

According to its website, SavaSeniorCare operates more than 230 nursing homes across the country, including two more in Wyoming: Cheyenne Healthcare Center and the Sheridan Manor.

“The nursing home’s settlement was the most recent conclusion to six wrongful death or personal injury lawsuits filed against it in the last six years. Repeated inspections by the Centers for Medicare and Medicaid Services also detail a pattern of understaffing, improper care and unsafe building conditions.”
The facility is on the Special Focus Facility list that needs close monitoring because of a “history of persistent poor quality of care.”   Inspection records show a pattern of the for-profit Sava nursing home failing to employ enough staff to keep residents safe, take care of residents who showed signs of depression and investigate complaints of neglect.
Improper wound care is repeatedly cited in the reports. The presence of pressure ulcers is an indicator of neglect and short-staffing.  One resident arrived at the facility in January 2015 without any wounds but developed open sores on her buttocks and legs in March.  The nursing home administrator told inspectors in January, “I’m nowhere near where I want to be in terms of staffing,” according to the agency’s Jan. 15 report.  According to a March 2015 report, there were many nights where only one nurse and one nurse’s assistant were in the building to care for more than 100 residents — many of whom require assistance to use the bathroom and navigate other simple tasks.

The reports repeatedly note that the nursing home fails to adequately record, investigate and resolve complaints about living conditions.  Residents who needed help using the bathroom reported they often waited long periods of time — sometimes up to eight hours — before they were taken to the restroom. One resident wandered the halls of the facility just after 8 p.m. March 29, 2015, with urine-soaked pants for at least 25 minutes before being helped.

Residents also told inspectors that the food served was inedible. A district manager who sampled a meal of steak and noodles also said the food was “not palatable,” according to the reports.

Families of previous residents have sued Poplar Living Center at least six times in the past six years alleging that negligence led to the death and serious injury of their loved ones. The nursing home settled four of those suits for undisclosed amounts and one is still ongoing.

NPR reported on what hospitals can and do tell patients looking for information on long term care alternatives.  “For years, many hospitals simply have given patients a list of all the skilled nursing facilities near where they live and told them which ones have room for a new patient. Patients have rarely been told which homes have poor quality ratings from Medicare or a history of public health violations, according to researchers and patient advocates.”

This is how some residents get admitted to bad facilities without the family knowing. Now, new rules will allow and require information to be shared.

Hospitals must provide patients with all nearby options, but the new rule says hospitals “must assist the patients, their families, or the patient’s representative in selecting a post-acute care provider by using and sharing data” about quality that is relevant to a particular patient’s needs for recovery.  The rule was drafted in October 2015.

Kindred Healthcare is exiting the skilled-nursing home business to focus on its better-performing home health, rehabilitation and long-term acute-care hospital units.  Kindred once operated 300 facilities and has been pruning the number over the years.  Kindred, ranks as the tenth largest nursing facility company in terms of skilled bed capacity. As of the end of last year it operated 90 facilities in 18 states, with a total of 11,535 beds.

The decision to leave the skilled nursing sector is the “final step in a process that began years ago,” Benjamin Breier, president and CEO of the Louisville-based long-term care provider said.

“We are taking proactive strategic steps to position Kindred for long-term success against the backdrop of dynamic changes in the healthcare services industry,” Breier said. “Our plan to exit the skilled nursing facility business, together with the significant cost realignment initiative we are undertaking in connection with the exit, are substantial steps forward in our continuing effort to transform Kindred’s strategy and growth profile to enhance shareholder value.”

The company forecasts annual revenues of $7.2 billion for 2016, a number slightly lower than initial estimates due to “significant headwinds facing the skilled nursing facility business,” Breier added.

Kindred Healthcare and Ventas Inc., a healthcare real estate investment trust, have reached a deal that will hasten its exit from the skilled nursing home business. Kindred has agreed to pay Ventas $700 million for 36 nursing homes Ventas owns and leases to Kindred. Kindred contractually needed consent from Ventas to sell or transfer the homes to another operator.

Kindred remains “optimistic” about the potential growth for its home health, hospice, community care, long-term acute care and inpatient rehabilitation facility businesses, he said. When the reorganization is complete, approximately 50% of revenues will come from the home health division, the company announcement said.

 

WSPA reported on the new $41 million 108-bed facility to house honorably discharged vets, paying about $34 per day.  County leaders decided on a location, but aren’t revealing where the 35 acre property is going to be.  The state is building three new veterans nursing homes, including one in Cherokee County.  According to the United States Department of Veterans Affairs, a 2014 survey found more than 100,000 Vietnam War veterans in South Carolina.

“We need to do everything we can to make sure our veterans are taken care of,” said Cherokee County Veterans Service officer Todd Humphries.

The facility will come from federal and state funding. Humphries says it would also bring almost 200 jobs to the area.

“There will be doctors, nurses, dieticians – all sorts of medical staff and non-medical staff,” he said.

Once the federal dollars start rolling in, county officials hope to break ground as early as 2019.

The Alternative Daily had a great article on the importance of food for providing our bodies with the energy and building blocks we need to heal and prevent harm. Eating a healthy diet supports healthy organ function, balanced hormones, strong immunity and resistance to illness and disease.  A bad diet can quickly send your health in an exponential downward spiral, opening the door to harmful pathogens, disease, hormonal imbalance, mental instability and general unhappiness.

Unfortunately, most nursing homes around the country provide cheap and bland unhealthy foods. Next time you schedule a visit to see your parent or relative in their nursing home, time it so that you’re around for one of the scheduled daily meals. Sit back and observe — you’ll probably be shocked by what you see.

For starters, you’ll probably notice a lot trans fats, artificial sweetners, and high fructose corn syrup, not to mention chemical preservatives and a myriad of other harmful additives.

“The “butter” being given to your loved ones actually has no resemblance to what it claims to be, and in fact, is composed of unhealthy, heat-treated vegetable oils, which damage the heart and clog arteries. The jam is loaded with (you guessed it) high fructose corn syrup, as well as a range of chemical preservatives, pesticide and herbicide residues from the non-organic source fruits, and almost no nutrients left from the original fruit.”

The only salt you’ll find in a nursing home spread is ultra-refined table salt, which has had all other minerals removed and a range of questionable anti-caking agents added to take their place. We’ve all heard about how we need to cut down on our salt intake, but that’s only when it’s not real sea salt or unrefined mineral salt, which still contain all the essential minerals your body needs to function as it should. The elderly aren’t getting these kinds of salts in their nursing homes, and it’s doing them damage.

A survey of over 100 nursing home residents and staff from 32 facilities across 10 counties in Kentucky found the biggest complaint coming out of these homes was the food.  One regional nursing home facility switched from serving respectable pieces of steak or chicken to only handing out chicken nuggets at mealtime. Another facility places three slices of thin deli meat on residents’ plates for their meals.

Make sure you find them a home that guarantees healthy, nourishing food — not chicken nuggets or deli meat.

If you’re interested in learning more about how real food can nurture the body, prevent disease and slow aging, check this out.

For the second time in just over a month, a Minnesota nursing home has been cited for neglect in the case of a patient who died after a medical transcription error according to a report by the Star-Tribune.

Nurses at a Golden Living nursing home last October mistakenly [read: negligently] entered a physician’s order for blood-thinning medication on the wrong person’s medical record. The error went unnoticed by multiple nurses for nine days, until the patient developed blood clots in the brain and died of a stroke, according to a state Department of Health investigative report.

Golden Living is the nation’s third-largest nursing home chain with facilities in 21 states.  After visiting the Golden Living home last November and interviewing staff, state investigators concluded that the facility “was not monitoring the performance of the nurses and had not conducted annual medication competencies of the nurses.”

The findings against Golden Living come weeks after another Minnesota nursing home neglected a patient who was mistakenly given 10 times his prescribed dose of morphine. Staff at the Mahnomen Health Center, a hospital with a 42-bed nursing home, had transcribed the wrong amount of morphine on the patient’s record, and did not detect the error until it was too late, state investigators found.

 In a case early last year, a patient at a Golden Living home in Moorhead fell out of a mechanical lift, suffering a skull fracture and brain bleeds; the resident was placed on hospice services and died three months after the fall, state investigators found.

In another case, a resident from a Golden Living home in Benson appeared at a hospital malnourished and dehydrated, with multiple open sores, after staff failed to notify a physician that the patient’s condition had worsened. Since 2013, health officials have substantiated maltreatment at five of the company’s homes in Minnesota.

The Pennsylvania Attorney General’s Office last year sued Golden Living for failing to provide basic services at more than two dozen nursing homes in Pennsylvania, alleging that facilities were understaffed and residents were left “thirsty, hungry, dirty, and unkempt.”

The company has repeatedly denied these allegations, asserting that the lawsuit stems from an inappropriate relationship between the attorney general and an outside law firm that is paid by contingency fees.