The Exception or the Standard?

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Listed as one of America’s poorest nursing facilities, Wentworth Rehab in Chicago has a reputation for miserably insufficient maintenance and patient care, as reported in the Chicago Tribune. It’s known for events like the death of Letasha Mims, whose family finds Wentworth to blame for her passing after she became desperately ill during her time there.

Even more recently, a 79 year old man was allowed to smoke while using an oxygen machine at Wentworth, which eventually caused a fire that killed him and caused massive damage in the nursing home. It was reported that the man had a history of destructive behavior and should have been more carefully surveyed for such danger, and also that the staff had acted in a dangerously negligent manner, with one nurse looking on carelessly as the man was burning to death and another nurse attempted to save him.

To those familiar, these kinds of events would not be surprising. None of this even mentions the seeming inescapability of insects and rodents in Wentworth Rehab. Inspectors have reported unidentifiable food being served to patients. Residents can be seen plainly in areas of the nursing home with unimaginably poor personal hygiene. When asked about any of this, Wentworth’s parent company, Alden Management Services, will either deny its facility’s negligence or decline to comment altogether.

There are plenty of bad nursing homes in the United States, many on the same lists as Wentworth. There are even plenty of other bad nursing homes in Chicago, where it’s not hard to imagine a need for affordable or accessible nursing homes. But with its history of lying, neglecting, and ignoring, Wentworth Rehab stands out as a hallmark of bad behavior in nursing homes and a way of looking at any facility’s character.

Questions to Ask

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LoHud.com had an article about the ten questions to ask before admitting a loved one to a nursing home.

What follows are questions to get answered before picking a nursing home.

1. How long has the nursing director worked there? High staff turnover can be a sign of problems while staff retention and longevity is a good sign.

2. How many registered nurses work there, and what is the ratio of licensed nurses to certified nursing assistants? Studies show strong positive relationships between registered nurse staffing levels and quality in nursing homes.

3. Is the staff friendly? Get a sense of how long they’ve worked there and if they like it by talking to them.

4. How good is the food? Visit on a Saturday or Sunday around lunch or dinnertime to see if you would eat what is served and maybe have a meal yourself.

6. Do you see good activities listed on the home’s calendar and are they really going on? Determine how staff works to engage residents.

7. How do residents look? If residents don’t appear clean, comfortable and neat, this could be a red flag.

8. What do state inspectors say? Ask to see the most recent inspection report and research other reports on your state regulatory agency’s website; in New York, it’s the New York Department of Health.

 9. What do federal regulators say about the home? Go to the Medicare.gov Nursing Home Compare website to review the nursing home’s star rating and other information.

10. Is the home a member of a reputable trade association in your state such as Greater New York Health Care Facilities Association? Membership requires meeting certain standards, and members are kept up-to-date on best practices and regulations.

For more, go to Medicare.gov.

Sources: USA TODAY Network, AARP, Medicare.gov, National Institute on Aging, New York Department of Health, Aging Life Care Association, Agency for Health Care Administration

Dark Secrets

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Lauren Weiler for CheatSheets wrote about the dark secrets nursing homes do not want the public to know.

1. Some contracts don’t allow you to sue if something goes wrong:

Knapp & Roberts notes you should review all of the print in your paperwork, and keep a watchful eye out for anything noting “binding arbitration agreements.” Essentially, this agreement means you must settle your differences outside of court, removing your right to sue. If anything serious happens, you certainly don’t want to be bound by this clause.

2. Residents don’t always have as much freedom as they want:

One study found out of 65 nursing home residents interviewed, about half felt depressed due to a lack of independence and freedom, as well as loneliness. The interviewees also seemed to prefer homes that had programs designed to reduce their sense of isolation from others.

3. Residents don’t always get enough to eat:

 A 2015 overview from Nursing Older People found nursing home residents are among those who have higher rates of “anorexia of aging,” and over 50% of residents studied also complained of constipation. Your home of choice should have a plan in place to combat these issues.4. Some of the ‘nurses’ aren’t nurses at all:

Every nursing home has some number of permanent nurses — but not everyone working is a staff member you’ll see again. Bottom Line Inc. explains “agency nurses” are often employed when a home is low on permanent staff. These temporary nurses work for staffing agencies and rarely form bonds with residents because of their position. For your comfort, it’s wise to choose a home with a staff that’s at least 80% permanent nurses.

5. Residents often have to leave the doctors they’re used to behind:

Knapp & Roberts explains most nursing homes have assigned physicians, which makes it difficult for residents to keep the doctors they’re used to seeing. If you’re really attached to your current doctor, it’s best to ask a potential home about their rules regarding this. You should also ask the home how often the physicians see their residents and what the health care plans may look like before committing.

6. Low staffing levels are a huge issue:

Up to 95% of American nursing homes may be understaffed.

Some homes have a difficult time finding enough staff, but other homes purposely understaff to cut costs. Having a bad patient to staff ratio is stressful for the staff and bad for your care. It may also leave you vulnerable to neglect and abuse. Be sure to ask what the patient to staff ratio is in your chosen home so you can ensure you’re getting the care you’re promised.  There should be at least 4.1 hours per person per day of direct nursing care.

7. Nursing homes may send a bill to relatives for the resident’s care:

According to Mass Mutual, the average amount paid for assisted living in 2017 was $3,750 per month. While you may have multiple ways of taking care of these costs, you should ensure none of the expenses accidentally get sent out to relatives. This happened in 2012 to a man who was forced to pay nearly $100,000 of his mother’s care without realizing it. Know what your state laws are regarding billing, and as always, have both you and your family members read the fine print.

8. The staff isn’t always clean:

Nursing home staff are careful with washing their hands, right? While this may seem like an obvious practice of personal hygiene and to prevent the spread of infections and communicable diseases, not all staff members participate. The New York Times reports many nursing homes are being cited for “hand hygiene” deficiencies.  Unsurprisingly, the nursing homes that were understaffed found the most hand-washing issues. Finding a well-staffed home may be key to your overall health.

9. Nursing assistants don’t need as much training as you think:

They may seem official, but many nursing assistants have no formal training at all to take care of you. NursingAssistantGuides.com explains some clinics will hire untrained workers and train them to be nursing assistants at the facility. Even for those who have a degree as a CNA, that can be acquired online with no hands-on experience. And many CNAs start at nursing homes and then move on to jobs with better pay, making the turnover rate incredibly high.  CNAs are not licensed health care providers.

10. Neglect is a common issue in the homes:

Next Avenue explains out of all the cases of nursing home abuse, neglect is the most common. While there are times when neglect is intentional, it isn’t always this malicious. Inadequate staffing and high turnover rates can also lead to this issue.  When choosing a nursing home, take a look at the other residents. Do they seem clean and well taken care of? The living quarters should also be clean and safe, with little wear and tear.

11. Some nursing homes may tell you to get extra aid outside of their care:

Staff in your chosen home are required to provide you with the care you need. If you’re ever told you need an outside aid to assist you for additional costs, Knapp & Roberts says to take note. This is negligence on the part of the nursing home.

12. The physical therapy units aren’t always up to snuff:

While you may be more concerned with what the rooms and eating areas look like, don’t forget to tour the physical therapy unit. Bottom Line Inc. explains if you require rehab of any kind, this is particularly important. Take a look at the machinery and ask if physical therapists are on the staff itself or just doing contractual work. If your nursing home is staffed with physical therapists, it’s likely to give you better service.

13. The ‘activities schedule’ might be a total bust:

U.S. News & World Report reminds us many nursing homes are still lacking in the activities department. While birthday parties and Bingo are commonplace, you’ll need more than that when choosing a place for your future. And the best homes will ask each resident about their interests to try and accommodate as many people as possible. Certain homes offer gardening clubs, cooking classes, and art therapy, so make sure you ask what’s available.

14. Most residents will have a lack of privacy:

While many folks in nursing homes like having company, there’s also another issue you may not have thought of: a lack of privacy. Bottom Line Inc. explains most homes offer a wide range of shared rooms, with private rooms costing serious cash. Not all shared rooms are bad, however. You’ll just want to make sure what’s dividing your bed from someone else’s is sturdier than a thin curtain.

15. More serious forms of abuse take place, too:

The National Council on Aging report about one out of every 10 Americans over 60 experience abuse — and it can even occur in nursing homes, Spangenberg Shibley & Liber LLP says. Neglect aside, the publication notes sexual assault and abuse has also been cited in certain homes. And many other instances of abuse go unreported. Do your research to see if any abuse allegations have been filed against your home of choice.

Orianna in Trouble

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The Anderson Independent Mail had two articles on national for-profit nursing home chain Orianna.  See articles here and here.  Orianna Health Systems is a Tennessee-based company that runs 13 Upstate nursing homes, more than any other provider.

One article discussed the quality of care issues at Orianna’s facilities in Greenville where residents complained that staff members were slow to respond to call lights; some reported waiting 50 minutes for requested pain medication without receiving it, according to the inspection report. A resident interviewed that afternoon said “call lights often yield no response and sometimes the resident must yell or shout for assistance.”

Another resident complained that staff members “seem upset that you rang your bell and they tell you to wheel yourself around,” according to the report, which also listed nine grievances that had been filed between March and August about slow responses to call lights.  Citing the failure to respond to call lights in a timely manner, the inspection report found that the nursing home had not provided care “that keeps or builds each resident’s dignity and respect of individuality.”

Linville Court at Cascades Verdae was one of three Upstate nursing homes where inspectors found a number deficiencies that exceeded state and national averages between April 5 and Aug. 25, according to the most recent records from the Centers for Medicare & Medicaid Services.

A total of 12 deficiencies were found at Greenville Rehabilitation and Healthcare Center, according to a July 19 inspection report. Eight deficiencies were found at The Arboretum at the Woodlands nursing home in Greenville, according to a May 4 inspection report.

One of the deficiencies at Greenville Rehabilitation and Healthcare Center involved a January incident in which a certified nursing assistant verbally abused a resident. The nursing assistant later resigned, according to the inspection report.

Another deficiency listed in the inspection report involved the nursing home’s failure to adequately address a 22-pound weight loss by a resident during a six-week period. The nursing home was also cited for a medication error rate of 11.1 percent, which is more than twice the acceptable rate.

The inspection report cited numerous environmental problems at the nursing home, including the presence of flies in the kitchen and other areas. The report said a resident was seen swatting files with a wash cloth in an activity/dining room.

Other deficiencies included a failure to provide proper treatment to prevent bed sores or heal existing bed sores and a failure to store, cook and serve food in a safe and clean way, according to the inspection report.

A state inspector also visited The Arboretum at the Woodlands in June in response to a complaint. According to the inspection report, a staff member was found asleep in the nursing home’s living room during an 11 p.m. to 7 a.m. shift on May 25.

Mikki Meer, chief operating officer for Orianna Health Systems, said in an email that her company “is proud of the continued improvement demonstrated in the recent survey results of its South Carolina facilities.”

Meanwhile the second article explains why the quality of care at Orianna’s nursing homes has gone down.  Orianna has serious financial problems as a result of mismanagement and the siphoning of funds to the corporate owner’s pockets.  Orianna has now fallen behind on lease payments for its facilities to Omega Health Investors, a Maryland-based healthcare real estate investment trust.

Taylor Pickett, Omega’s CEO, reported that since 2014, the occupancy rate at Orianna’s facilities has declined from 92 percent to 89 percent and expenses have grown by 6 percent while revenues increased only 2 percent.

As recently as July, Orianna was operating 48 skilled nursing facilities with 5,000 total beds in 11 states, according to the company’s website. The latest version of the website says the company is now managing 43 skilled nursing facilities with a total of 4,500 beds in seven states.

  • Nine of Orianna’s homes agreed to pay $4.46 million to settle lawsuits involving the deaths of 20 residents. That total includes three settlements adding up to $752,500 that were approved after last year’s name changes.
  • Inspectors found at least 525 deficiencies at the company’s Upstate nursing homes, according to the Centers for Medicare & Medicaid Services. The deficiencies included instances of neglect, possible cases of abuse that were not investigated and medication errors, as well as failures to eliminate hazards, properly prepare meals and treat residents with dignity. The most dangerous deficiencies resulted in 26 fines totaling nearly $495,000.
  • The company’s nursing homes were responsible for 47 percent of the inspection-related deficiencies and 49 percent of fines at Upstate nursing homes. Orianna’s facilities account for 38 percent of the overall nursing home beds in the region.

Minka Homes

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STAT News reported on the pioneering geriatrician Dr. Bill Thomas and the 330-square-foot, plywood-boned home he calls a Minka.  The structure is warm, light, and surprisingly roomy, in a studio loft sort of way. Four oversize windows look out onto the lake, a shed-style roof rising to the view.  In the back corner, across from a big bathroom compliant with the Americans with Disabilities Act, sits a full-size bed. On the other side of a plumbing-filled wall from the bathroom is a kitchen and countertop, made from Ikea components. (The term “Minka” has Japanese origins, as a traditional house for rural dwellers, typically those of modest financial means.)

The idea sounds, in one sense, simple: create and market small, senior-friendly houses like this one and sell them for around $75,000, clustered like mushrooms in tight groups or tucked onto a homeowner’s existing property so caregivers or children can occupy the larger house and help when needed.  The initiative has turned Thomas into a rare breed: the physician homebuilder, and it pits him not only against the nursing home industry, but also the housing industry, with its proclivity for bigger and bigger spaces.

“I spent my career trying to change the nursing home industry,” he said. “But I’ve come to realize it’s not really going to change. So now what I’ve got to do is make it so people don’t need nursing homes in the first place. That what this is about.”

Thomas wants to help people grow older on their own turf and terms, while helping spare them the fiscal and physical stress of maintaining  homes.  In so doing, he hopes to shield them from the mouth of a funnel that too often summons elders to a grim march — from independent living, to assisted living, to nursing homes, to memory units, and to the grave.

Thomas said he’s less interested in growing wealthy from the idea than in changing the culture of senior housing.

Pest Control

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WALB reported the complaints about the horrific conditions at Pinewood Nursing Home.  Virginia Toombs said her brother was living in horrible conditions at the nursing home during the last year of his life.  “It was the most disgusting thing I’ve seen in my whole life,” said Toombs.  “I’m glad he’s in heaven. I prefer him to be in heaven than in that place any day,” said Toombs.

Roaches everywhere, a sight that will make will make your skin itch.  “Everywhere I tried to sit in the room with my brother who was dying. They were in the bed. My brother was on an oxygen machine and they were crawling on the oxygen machine,” said Toombs.

Toombs said she brought it to the attention of some of the staff there who said they were already aware of the issue.

“I said, ‘This is disgusting. How can you all even work here?'” said Toombs.

The facility has a 1-star overall rating.

In August of 2015, the Federal Department of Health and Human Services and Centers for Medicare and Medicaid Services listed on its inspection report that the pest control company revealed to the inspector that the bill was not paid from July 2015 to December 2015 with a total of $1,313.00 owed to the pest control company.

Live roaches were found in two rooms, and dead roaches were found in the conference room.

In the most recent inspection completed five months ago, it details a much bigger problem.

They found bugs on a variety of surfaces on the walls, bulletin boards, and behind toilets.

The pest problem also mentioned rats.

The inspection report details that ‘The administrator revealed that the pest control company comes to the facility on a monthly and as-needed basis. She stated to the inspector that she felt as if the pest control program was effective.’

“Your parents in their last days or your family members they need to be in the best of care in their last days and not in a facility where their health is already bad and being infested by roaches and rats just makes it worse,” said Toombs.

When we reached out to the facility, their administrator gave us a statement saying “We are not aware of a pest control problem. We have pest control come twice a month. Any issues in the inspections have been taken care of.”

 

Staying Out of Nursing Homes

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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.

 

 

 

Veterans Nursing Home

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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.

 

More than half of Americans will reside in a Nursing Home

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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.

New VA Nursing Home in Florence

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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.”