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.”

SavaSeniorCare Settlement

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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.

New Rule for Hospitals

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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: Good Riddance

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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.

 

Veterans Nursing Home in Cherokee

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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.

Diet is Important

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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.

Golden Living Chain

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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.

Changes to Nursing Home Compare

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The Centers for Medicare & Medicaid Services (CMS) launched its Nursing Home Compare website in 1998 for the 17,000 nursing homes that participate in Medicare or Medicaid, and began its 5-star rating system for nursing homes in 2008 (see Medicare Nursing Home Compare).  The core indicators for nursing home performance include information from health inspections, staffing ratios, and five short-stay measures (residents in an episode whose cumulative days in the facility is 100 days or less in the quality reporting period) and 13 long-stay measures (residents in an episode whose cumulative days in the facility is 101 days or more in the quality reporting period) (see Nursing Home Quality Initiative Quality Measures).  Examples of those measures include:

Short Stay Quality Measures:

  • Percent of residents who self-report moderate to severe pain (short stay)
  • Percent of residents with pressure ulcers that are new or worsened (short stay)
  • Percent of short-stay residents who newly received an antipsychotic medication

Long Stay Quality Measures:

  • Percent of residents who were physically restrained (long stay)
  • Percent of residents who have depressive symptoms (long stay)
  • Percent of long-stay residents who received an antipsychotic medication

In April 2016 (see Further Improvements to the Nursing Home Compare Five-Star Quality Rating System), CMS will begin posting data for six new quality measures (QMs) on Nursing Home Compare:

  1. Percentage of short-stay residents who were successfully discharged to the community
  2. Percentage of short-stay residents who have had an outpatient emergency department visit
  3. Percentage of short-stay residents who were re-hospitalized after a nursing home admission
  4. Percentage of short-stay residents who made improvements in function
  5. Percentage of long-stay residents whose ability to move independently worsened
  6. Percentage of long-stay residents who received an anti-anxiety or hypnotic medication

The evolution of the CMS nursing home rating system is just one tangible example of how performance measurement is driving competition in the health care market.

New Quality Measures

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McKnight’s reported the following:

New quality measures for skilled nursing facilities will be introduced in the coming months, Centers for Medicare & Medicaid Services officials said during an Open Door Forum call for providers.

Data for six new quality measures — some based on Medicare claims, others on MDS data — will be added to Nursing Home Compare beginning in April. The new measures, bound to make providers’ jobs more complicated, are:

  • Percentage of short-stay (stays of less than or equal to 100 days) residents who have had an outpatient emergency room visit (Medicare claims-based)

  • Percentage of short-stay residents who were successfully discharged to the community, and did not die or were readmitted to a hospital or skilled nursing facility within 30 days of discharge (Medicare claims-based)

  • Percentage of short-stay residents who were re-hospitalized after SNF admission, including observation stays (Medicare claims-based)

  • Percentage of short-stay residents who made made improvement in physical function and locomotion (MDS data-based)

  • Percentage of long-stay (stays of greater than or equal to 101 days) residents whose ability to move independently worsened (MDS-based)

  • Percentage of long-stay residents who received an anti-anxiety or hypnotic medication(MDS-based)

“We believe that these measures will be useful to consumers and to nursing homes as they provide important information about quality of care outcomes that we really haven’t been able to cover previously on Nursing Home Compare,” said Ed Mortimore, technical director of survey and certification at CMS, during the call.

Five of the six new measures will be phased in to the Five-Star Quality Ratings systems over a nine-month period, beginning this July. The measure on anti-anxiety and hypnotic medication use will be left out of the Five-Star system due to concerns about specificity and appropriate thresholds for star ratings.

The information used for the new measures will use a year of data up to the beginning of July 2015. Providers will receive a preview of their data for the measures in April, Mortimore said.

Click here to read more about the new quality measures.

The Open Door Forum call also included a push for providers to voluntarily submit electronic staffing data ahead of the July 1 start of mandatory filing, as well as an update on the government’s research into alternative payment methods for SNFs. The ongoing research has been narrowed down to focus on resident characteristics, rather than service use, officials shared.

Granny Pods

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David Wolfe had a great idea for providing independence and security to elderly family members.  MedCottages or “Granny Pods” are an excellent solution for taking care of elderly family members. Wolfe wanted to take care of his aunt and was excited about having his loved ones close, but still in their own space. Reverend Ken Dupin invented these 12 feet by 24 feet pods that sit conveniently in any backyard and plug right up one’s existing plumbing and electrical. They allow both caregiver and senior to have their own space while remaining connected.  Here is his website with pictures.

These “Granny Pods” are specially built with the safety of a senior in mind. They include a small kitchen, bedroom, and bathroom all designed to house safely a senior. The bathrooms are handicap accessible with railing and safety features built in.

The kitchen includes a microwave, small refrigerator, and a pill dispenser. The microwave could be unplugged and used as an electromagnetically-insulated safe container for supplements. A BerryBreeze refrigerator purifier could be put in the small refrigerator. The pill dispenser could be filled with capsules of supplements, superfoods, and superherbs. Everything is conveniently located and safe to reach.

The safety features for these little homes are fantastic. They include webcams for monitoring by family members and a padded floor! Padded floor is great on joints. Also, they protect older relatives from a fall. One can be comfortable having their family member spending time in these homes.

These pods utilize small robotic features that can monitor vital signs. In addition, they can filter the air for contaminants while sending alerts reminding when to take supplements, superfoods, and superherbs. Communication is a breeze with high-tech video and text cell technology incorporated. If anything were to go wrong, these pods have alert systems to notify caregivers as well.