Business Week had an article about National Healthcare Corp. (NHC).   Nursing home and assisted-living center operator National Healthcare Corp. said Tuesday that its fourth-quarter profit rose 80 percent on a boost in patient revenue.

The company earned $5 million, or 37 cents per share, compared with profit of $2.8 million, or 21 cents per share, in the same quarter a year before. Revenue rose 4 percent to $168.5 million from $161.8 million. For the full year, the company earned $31.4 million, or $2.31 per share, up from $27.7 million, or $2.11 per share, in 2008. Revenue rose to $668.2 million from $633.2 million.

National Healthcare and its affiliates operate 76 long-term health care centers, along with 33 home care programs, 7 independent living centers and 15 assisted living communities. Other services include Alzheimer’s units, long-term care pharmacies, hospice, a rehabilitation services company, and management and accounting services to third parties.

National Healthcare shares rose 19 cents to $37.64 in morning trading.  See NHC’s press release here.

 

Mary Fridley at Gero-Resources wrote the following for The Capital. 

DEAR MARY: I just lost my dear husband of 65 years to Alzheimer’s disease. Mary, you would hardly believe the many times I thought about you during his stay in the hospital and nursing home. I am so glad we had the experiences of the wealth of knowledge you shared through the many workshops and seminars we attended together.

During this difficult period there were many times I thought how much the staff would benefit from your depth and detail of knowledge of dementia care. I was horrified by how they handled him; like he was a piece of meat. One time two aides were moving him up in the bed and slammed his head into the headboard. No one talked to him like he had any sense at all. Even the doctor dismissed him as if he should just die.

He was capable of following directions if they took the time to tell him what to do. Instead, they just did things without warning, which frightened him. I think they could learn a lot by being in bed for a day and having someone tend to all their needs. They would discover how humiliating and degrading an experience it is.

My husband was a person and the love of my life, and I would do anything to have him with me today – even in his Alzheimer’s state. He was a gentle, loving soul who would never hurt anyone. I am heartbroken over this experience.

DEAR READER: Please accept my sincere condolences on the loss of your husband. And I am sorry your final days together were so dreadful. No matter how often I hear this story (and I’ve heard it many times), it never fails to outrage me. The staff broke the most basic rule of care: to see the person, not just the disease.

It should be required that people take a sensitivity course before they work with the elderly. They should be put through the rigors of daily care, such as you suggested, experiencing first hand what it’s like to be on the receiving end. I hope your letter sparks discussion among staff to do better.

I know you are grieving, but I encourage you to write a letter to the administrators of the offending facilities. They need to know about your experience. Peace be with you.

___________

I like that.  See the person, not just the disease.  Nursing home employees especially unqualified CNAs do not get enough training on how to take care of demented residents.  It is a shame and a disgrace.

Auburn Pub had a great article on the increase of family caregivers, and the problem of burn out, frustration, and exhaustion that naturally arises.  The article is based on information from New York but the results and demographics apply nationwide.

2.2 million New York residents are the caretakers of a parent, spouse, grandparent or friend. Their work is worth about $25 billion, which reduces state and federal health care costs, according data from the AARP, and allows the sick to remain at home.  T he emotional cost for caregivers is immeasurable. Many caregivers have only a few hours to themselves a week, become secluded from their community because those they care for cannot leave home or be left alone, and neglect their own health from being so focused on the health of someone who will not get better.

More than half of caregivers live with the person they care for, and spend with that person anywhere from 10 hours a week to 24 hours day, according to a study by the state Office for the Aging that surveyed 1,109 caregivers between May and June 2008. The study, which aimed to identify New York’s caregivers and their needs, found that the average caregiver is a white female caring for a parent or a husband.

The study, “Sustaining Informal Caregivers,” shows that a majority of caregivers, 75 percent, care for someone who has been diagnosed with Alzheimer’s disease or another form of dementia. About half say the person they care for cannot be left alone. They reported an average of 10.3 hours a day spent providing care – more than a full-time job.

Guilt, isolation and physical exhaustion are only a few of the side effects of full-time care giving. The job can have serious health consequences, said Dr. David Strickland, director of the Center for Behavioral Health at Auburn Memorial Hospital.

Full-time caregivers commonly experience clinical depression, sleep deprivation and inadequate nutrition. The frustration that builds while caring for another person day in and day out can turn into anger, and anger can lead to depression or thoughts of harming the person receiving care, Strickland said. He said the guilt of feeling negatively toward someone whom they still love often leads caregivers to ignore mental health problems, such as suicidal feelings.

“Accept these things do occur and are not to be ashamed of,” Strickland said, rather than ignoring – and exacerbating – the problem.

Caregivers should contact a doctor with any serious health problems, but interaction with others, especially other caregivers, can help manage the daily stress, Strickland said.

Cayuga County’s Office for the Aging networks caregivers, educates them about the diseases they deal with and helps them find ways to cope, by connecting them to aids, recommending day programs or just lending an open ear. The decision to make the move to a nursing home is among the hardest decisions caregivers make.  But it is a move Strickland advises caregivers to see as an opportunity. Nursing homes can manage the daily hygiene and medication that are among the most stressful tasks of caring for someone, making time spent together enjoyable again, he said.

“You don’t have to be a caregiver,” Strickland said. “You can be a sibling, a child, a relative.”

The fear that nursing home staff will not be able to provide adequate personalized care available at home is a major reservation for people considering the move.

Coping strategies

Tips for stressed caregivers from Dr. David Strickland, director of the Center for Behavioral Health at Auburn Memorial Hospital:

Recognize you are not alone – join a support group. Resources such as the county Office for the Aging and the Alzheimer’s disease Web site can direct you to groups for caregivers that meet regularly.

Take time for yourself – write it in your schedule. Even if you can spare only an hour, spend a little time every week doing something you enjoyed doing before you became a full-time caregiver.

Build a relief system. Keep in touch with friends and family who can lend a hand in caretaking or lend an ear to listen when you need to talk.

Look into respite care. Many facilities offer overnight stays for both you and the person you care for that allow you to take a break without being far away.

Do not ignore your mental health. Know the signs of depression – sleeplessness, guilt, hopelessness, and suicidal thoughts – and consult a doctor if you recognize them in yourself.

Palm Beach Post had an article about the incredible compensation given to an absent CEO of a  group of nursing homes. Most of the money comes from taxpayers.  Chief Executive Officer Maxcine Darville, a former dress shop owner with a nursing license, has taken home $404,000 in annual compensation from the Okeechobee Council on Aging Inc. and the Council on Aging of Florida Inc.. That’s more than double the state and U.S. averages for CEO pay at nursing-home nonprofits of comparable revenue, according to survey data.  Various nursing homes in Pahokee, Gainesville and Bradenton are funneling more than $1 million a year through a maze of nonprofit corporations that benefit a CEO, along with her daughter and son, a Palm Beach Post investigation shows.

Among The Post’s findings:
Darville’s daughter, Assistant CEO Joanne "Jody" Watson, was paid more than $200,000 plus $23,000 in expenses from the two councils. She received $160,000 a year later. Darville’s son, Gary Watson, the director of maintenance, was paid nearly $118,000. Darville has spent more than $30,000 on annual expenses. She took out a $50,000 loan from the parent council. She gets $1,200 a month to board an unnamed "visiting executive" in a residence she owns.

One member of the board of directors that the Okeechobee Council on Aging lists in 2009 state corporate records, Martha Stoner, died two years ago. Another, Johnie Blevins, said she was "forbidden" to talk to The Post.

Other allegations include nonprofit funds have paid for cars – including a BMW 325ci with a base price of $32,300 and a Cadillac Escalade with a base price of $57,465 – or a $1,708 whirlpool tub with Roman Tub Faucet ordered from a Home Depot in Johnson City, Tenn., and delivered to a Newland, N.C., address where Jody Watson is a part-time resident.

Receipts show the daughter writing checks to herself and other family members on an account for the Okeechobee Council on Aging Inc., doing business as Big Lake Housing – an apartment complex the nonprofit owns next to Glades Health Care Center in Pahokee. On the same day in March 2005, for example, Jody Watson signed checks of $1,000 to herself and her mother and one for $1,200 to her brother without a notation for the purpose, receipts show.

Checks on that account also have paid for tens of thousands of dollars in credit card charges over several years at businesses such as Kahootz Draft House in Okeechobee, Cloud 9 Spa Salon in Gainesville, Burdines, Dillard’s and hotels in North Carolina and Tennessee, receipts show.

The executive compensation saddens and baffles the family of Doris Bullock, a patient at Glades Health Care Center who died last year at age 88 from internal bleeding after an unexplained blow to the head.  The family is still seeking answers about how a frail woman who needed help getting into a wheelchair could sustain a traumatic head injury, and wind up back in her bed with no one the wiser.

"It’s frustrating," Bullock’s granddaughter Felisha Whitehurst said. "That’s taxpayers’ money, and it’s not being spent sufficiently where it should be."

Darville’s $30,385 expense allowance works out to $14.60 per hour in a standard work year – more than the $11.43 median hourly salary of a nursing aide, orderly or attendant in the state, according to research by Florida International University.

In a separate investigation, a Glades Health Care worker was convicted of elder abuse in 2007 for slapping an 89-year-old patient in the face and saying "I can’t stand you," according to state records. A year earlier, the nursing home had rehired the certified nursing assistant months after she got out of jail on charges related to forgery, investigators found.

Riverfront Nursing and Rehabilitation Center in Bradenton was placed on a watch list with a conditional license from the state last year. AHCA inspectors cited 31 violations since July 2007, faulting management for, among other things, its handling of a suspected abuse case. In records filed in January of this year, Darville signed a settlement as CEO of the Bradenton Council on Aging LLC agreeing to pay $13,500 in fines and fees. The facility has been removed from the watch list but maintains a one-star rating, as does a sister facility, the Gainesville Health Care Center.

Meanwhile, patient advocate Anna Spinella of Tampa has a word for hefty executive pay and perks at nursing homes with troubled records: "Obscene. The purpose of a nursing home is to care for residents."

 

Somebody sent me this article from Cityfile.com.  It is about The Carlyle Group having to sell their corporate jets.  The Carlyle Group owns and operates the ManorCare nursing homes throughout the country.  They are notorious for under-staffing and neglect.  Below is part of the article although the Cityfile website has additional information.

You can add The Carlyle Group to the long, long list of financial firms looking to cut back on their private jet budgets. The Washington-based private equity giant that counts members of the Bush family as investors is now looking to unload its 2004 Gulfstream G450. Like its rivals, it’s been a challenging few months for Carlyle, which was ranked the largest private equity firm last year by Private Equity International. In December, the firm announced plans to slash 10 percent of its staff—the first layoffs in Carlyle’s 20-year history—and it also said it planned to close down its Silicon Valley office. The jet broker responsible for selling the G4 didn’t indicate how much Carlyle is hoping to get for the plane. (Similar models run about $30 million.) But if you’re in the market for a jet that’s made its fair share of trips to Kennebunkport and Crawford, you may want to set aside a little extra to replace all the gaudy gold plating in the bathroom and kitchen. Photos and detailed specs after the jump.
 

 Richard Wagamese had a revealing story for the Calgary Herald about accountability and the preventable death of a friend’s loved one at a nursing home.  Below are excerpts and a summary of that tragic story.  The mother of one of his friends was found frozen to death outside the nursing home the day after Christmas. She was 84 year-old and had suffered from Alzheimer’s disease.   Her name was Juliette (Julie) Bombardier and she was a great-grandmother, grandmother, wife, friend, confidante and valued member of her community.

Mr. Wagamese mentions that Julie inexplicably managed to get out of doors that were ostensibly locked, but are often propped open by staff who pop outside for a smoke. In the early morning hours, dressed in a nightgown, she froze to death in a snowdrift, a few yards from that door. She died there, alone and unprotected. Nearly three hours after the search for her was initiated, my friends were there when she was discovered.

The real tragedy according to Mr. Wagamese in Julie’s death is not the loss itself.  It’s the refusal of the company that runs the nursing home to take responsibility. Instead of saying, "there was a failure in our system that resulted in a death and we’re taking immediate steps to prevent it happening again" and honouring the loss of Juliette Bombardier, they rely on the standard "we’re conducting our own internal investigation". There doesn’t need to be an investigation. The system failed. Period.

The obfuscation and shrugging off of direct responsibility is a dishonouring of Julie’s death and a dishonouring of her family’s grief.

They tell us that all the doors were locked until staff had finished their search of the building.  What they are asking all of us to believe is that an 84-year-old dementia patient managed to negotiate her way through a secure facility, passed trained supervisory staff, out a locked door and then somehow managed to lock it behind herself again and froze to death.

To suggest we believe that is a dishonouring of everyone.  There are a lot of seniors in care in such facilities all across the country. They are not just Alzheimer’s patients, stroke victims, addled, debilitated, frail, helpless or needy. They’re somebody’s grandmother, somebody’s mother and somebody’s friend. They are not numbers in a ledger, not a part of somebody’s financial bottom line — they are a part of our collective history and they are valuable.

Richard Wagamese, a former Calgary Herald columnist, is the 2007 recipient of the Canadian Authors Association Award for fiction and a former National Newspaper Award-winning columnist.

 

Studies show a significant decline in quality of nursing home care for blacks compared to whites.
Elderly black Americans in nursing homes get worse care than that enjoyed by their white counterparts.  "If you’re black, you’re much more likely to get your care in a nursing home that’s not so good, relative to nursing homes that are serving predominantly white patients," Dr Vincent Mor, head of the department of community health at Rhode Island-based Brown University’s school of medicine, told AFP on Tuesday.

Mor was a lead author of the study which looked at "racial segregation in US nursing homes and its relationship to racial disparities in the quality of care."  The study cited race data from nursing homes found US nursing homes remain relatively segregated by race.

"Blacks are much more likely than whites to be located in nursing homes that have serious deficiencies, lower staffing ratios, and greater financial vulnerability," the study showed.

Another study led by Brown University researchers and due to be published in June in the Health Services Research medical journal, looked at the rate of hospitalization of nursing home residents.
That study showed that 24.1 percent of black nursing home residents required hospitalization  compared with 18.5 percent white residents.   It found that nursing homes "with high concentrations of blacks had 20 percent higher odds … of hospitalization than residents in nursing homes with no blacks", and linked the quality of care to the reimbursement policies of Medicaid, the US program for those unable to pay for healthcare.

The rate of hospitalization was an indicator of performance, as were "a whole variety of different measures of quality in terms of regulatory compliance, staffing levels, and so on," Mor explained.

"Both studies clearly suggest that nursing homes which have a predominance or much higher proportion of African-American residents perform more poorly," Mor said.

Extending Life, Waiting for Death at Nursing Home in Florida

Review by Dave Shiflett

Jan. 14 (Bloomberg) — Growing old isn’t for sissies. Anyone who doubts that should tune into “Andrew Jenks, Room 335,” which airs on Cinemax tomorrow at 7 p.m. New York time.

The 90-minute film about life and death at a Florida assisted-living facility is depressing and inspiring. It provides a peek into the likely futures of millions of baby boomers, who may want to ditch all those life-stretching diets and exercise regimens when they see what awaits them.

Jenks was 19 when he spent a month at the posh Harbor Place near Port St. Lucie. From the outside, it looks like a fancy hotel. Inside, time has stripped many residents to the bone.

The opening shots show faces familiar to anyone who has ever visited a nursing home: residents snoozing in wing chairs, heads tilted back, eyes closed tight and mouths wide open. The smartest fashion accessory may be a drool bib.

“All your friends die on you,” a resident says. “You miss the people you had so much fun with all your life. They go one by one.”

“My bones are like lace,” says another.

Yet many residents still have some fire in their bellies, even if their eyes, ears and bladders aren’t fully dependable.

Bill, a gruff 80-year-old Army vet, is fond of Hawaiian shirts, twisting arms and playing the tough guy. Yet he walks over a mile each day to buy chocolate bars that he shares with his less-mobile companions.

Pig Latin

Then there’s Tammy, a spry and chirpy 95-year-old who is scared of elevators and wields a sharp tongue. “I can’t understand that pig Latin you use,” she tells one pal. Tammy keeps her spirits up even after a bum heart lands her in the hospital.

A sense of resignation seems to prevail, though Jenks does find an undercurrent of resentment. When he asks Tammy why there are no blacks or Hispanics at the facility, she insists those ethnic groups take care of their elderly members at home.

“Years ago, nobody ever got sent to a place like this,” she says. “This generation can’t be bothered.”

The long days are punctuated by bingo games and watching “Jeopardy.” One resident tries to play “Edelweiss” on the piano, but her efforts are doomed by all the sour notes.

Death is never far away. We see a shriveled woman named Dotty, who has no immediate family, gasping for air in a hospital bed with a few friends and a priest hovering nearby.

At one point, Jenks tells Dotty he would like to say a prayer. Suddenly, she lifts her ancient hands and clasps them. Dotty died soon thereafter.

Jenks was clearly moved by his month at Harbor Place.

“We’re all going to grow old at some point,” he notes. “Does this mean we’re going to be neglected, too?”

Here’s the lesson I learned: Longevity, like most other things, should be taken in moderation.

(Dave Shiflett is a critic for Bloomberg News. The opinions expressed are his own.)

Spectrum News has an article discussing a study that shows elderly citizens to fear nursing homes and loss of independence more than death. 

89% of America’s seniors want to age-in-place and are willing to use adaptive technology allowing them to maintain their independence, according to a study commissioned by Clarity and the EAR Foundation. The same study found that their boomer children share the same concerns and are willing to support their parent’s efforts. 

In a recent survey, seniors rated loss of independence (26 percent) and moving out of their home into a nursing home (13 percent) as their greatest fears. Death was listed as a fear by only 3 percent of the respondents.

Seniors cited three main threats to their independence. Health problems were the main consideration followed closely by memory problems and the inability to drive.   Most seniors stated an openness to new technologies that help them avoid nursing homes.

The children of seniors, today’s boomers, were also interviewed and their answers echoed the parental desires and concerns over aging in place and living independently.   The vast majority (94 percent) feel that it’s important their senior parents are able to age-in-place. More than three-fourths (79 percent) are concerned about their parents’ ability to do so, and more than half (57 percent) are very concerned.

Despite the boomers’ parents’ belief that they receive no support from their children, 63 percent of the boomers surveyed stated that they are providing some kind of assistance to allow their parents to age-in-place. Much of the assistance reportedly provided by boomers was with household maintenance, transportation, medical issues, help with financial decisions and financial support.

Surprisingly, senior parents appeared to be more open to aging-in-place technology than their boomer children. Only 14 percent of the tech-savvy boomers have actually looked into technological solutions to help them ensure the health and safety of their parents.

 

I do not understand how nursing homes continue to say that they can’t make any money taking care of their residents.  The corporate executives of Manor Care will get more than $200 million for their sale to the Carlyle Group.  See the article here.

The head of America’s biggest nursing-home company is about to get intensive financial treatment. 

Chief Executive Paul Ormond will receive $118 million to $186 million from cashing in his company stock when the deal is completed this year.  Sixteen other top executives and recently retired officers at the firm to be purchased by the Carlyle Group, of Washington, can receive a total of $68 million for their stock.

In total, Manor Care officials stand to receive $200 million or more from their stock holdings.

The amount to be paid by Carlyle, a global private-equity firm that owns stakes in more than 500 companies and real-estate developments, may not be known for weeks.

The buyer said it will purchase Manor Care for $6.3 billion and hopes to complete the deal by the end of the year.

Mr. Ormond, CEO and chairman of the company that had $167 million in profits on $3.6 billion in revenue last year, is typically among the top-compensated corporate CEOs locally each year. Last year, he was compensated $18.8 million, an SEC filing shows.

The biggest chunk of looming stock payouts from Carlyle are to Mr. Ormond, whose 1.8 million company shares will be worth more than $118 million. They could be worth another $68 million if options on another 1.9 million shares he has are exercised for prices ranging from $20 to $53 each.

But the most recent regulatory filings show $55.5 million in stock payments could go to R. Jeffrey Bixler, former vice president and general counsel; Geoffrey Meyers, former executive vice president and chief financial officer; and M. Keith Weikel, former senior executive vice president and chief operating officer.

Company officers, directors, key employees, and some retirees stand to collect about $200 million for their existing stock, and possibly more than $250 million if unexercised stock options can be cashed in, the new SEC filings show.

Manor Care, No. 565 on the Fortune 1,000 list of the largest U.S. corporations, was once part of Owens-Illinois Inc. and started acquiring health-care facilities in the early 1980s. It spun off and became Health Care & Retirement Corp. and in 1998 merged with Manor Care Inc. of Gaithersburg, Md.