Staff Turnover

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The Advocate had a letter explaining why staff turnover is so high in nursing homes.

“As with all nursing homes, there is a poor retention rate for the certified nursing assistants who keep the doors open; no one who owns a nursing home would do what they do. This is a backbreaking job that requires lifting, tugging and pulling to provide the care the residents need. They contend with medical equipment that includes a tracheostomy, feeding tube, ventilator, colostomy bag, Foley catheter, IV’s, oxygen mask/line, etc. They deal with bed sores and bathe, dress and groom the residents. All of this at a starting salary of $8 or less per hour depending on your experience.”

The average unit at a nursing home has at least 30 residents, and most of the time, there are 3 CNAs assigned. If you are assigned 10 residents, and five of them are to be spoon-fed or are incontinent, someone is going to get cold food, be hungry or lay in soiled clothing for some time because the CNA only attended to one resident at a time.

EarlySense

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Forbes had an article on a company called EarlySense.

“One company, EarlySense, is bringing skilled nursing facilities into the digital age through a practical and inexpensive approach. For several years, its contact-free patient monitoring systems have been used by hospitals to continuously track respiratory rate, heart rate and movement. The technology is a direct response to the challenges hospitals face in monitoring non-critical (non-ICU) patients—tracking their care status and preventing costly falls and pressure ulcers. With monitor bells ringing frequently, over time, nurses can develop alarm fatigue. Standard bedside equipment becomes the “machine that cried wolf”—making nurses less likely to respond to alarms they hear all day. This is exactly where continuous monitoring steps in.”

“Real-time alerts show 43% fewer patient falls, 64% fewer pressure ulcers and 86% fewer code blue events. A statistical analysis estimated that institutions using EarlySense leveraged the data and far-less-frequent alerts to save more than 550 lives, 800 falls and more than 45,000 hospitalization days in 2016.”

The key takeaway: improved care and reduced costs.

EarlySense technology is also user-friendly. Nurses can view the data at the bedside, nursing station or on a tablet, and receive alerts in real time.

ObamaCare Stabilizes in Ohio

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CNN Money reported the great news for Ohio residents.  Health insurers in Ohio have agreed to sell Obamacare policies in 19 of the 20 counties that had no options for 2018, the state Department of Insurance said.  Roughly 11,000 Ohio residents in these counties currently purchase coverage on the exchange.

“The exchange markets are proving to be more resilient than many would have expected,” said Cynthia Cox, an associate director at the Kaiser Family Foundation. “Premium subsidies protect consumers from paying higher prices and may also make it possible for insurers to stay in counties that are otherwise unattractive.”

Trump is threatening to end insurance subsidies for low income people which will destabilize the market and prompt insurers to exit.  Hopefully, Trump will not intentionally sabotage the market.

Insurers have until late September to commit to participating on the exchanges for next year. That’s when they sign contracts with the federal government.

Settlement in Choking Case

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National Law Review reported the settlement in a choking case where the staff ignored the doctor’s diet restriction order.  The elderly man who died was provided food that was not permitted in his diet program and was allowed to eat unsupervised, even though he was at high risk of choking. Antonio Mares died on November 9, 2012 when a nursing assistant was unable to properly perform the Heimlich maneuver while he was choking.

Center for Hispanic Elderly in Wicker Park has agreed to a settlement of $875,000 after nurses failed to follow doctors’ orders and a patient died.  Antonio Mares was prescribed a diet of mechanical-soft food by his doctor due to medical complications which increased his risk of choking. As he was at an elevated risk, he was also to only be fed while under the supervision of a nurse or nursing assistant. On November 9, 2012, both of these directives were ignored when a certified nursing assistant provided him with a tray of food that did not meet his dietary specifications and then proceeded to leave him to eat unsupervised.

Mares fought for his life after he began to choke, using the call button to desperately gain the attention of nursing staff members. Nobody responded to the calls and it wasn’t until the nursing assistant returned to the room that anyone was aware of the issue. The CNA proceeded to attempt the Heimlich maneuver, but did not perform it properly.

Patients that are considered high-risk for choking should also never be left to eat without supervision or assistance. Mares was not only provided the wrong food for his special needs, but he was then left to fend for himself until he began to choke.

Safety and Security

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The Seattle Times reported the sexual assault of a resident at SeaTac assisted-living facility.  Police are investigating the attack.  The assailant used an open window to get into her room.  According to the Fire Department, the woman suffered serious head injuries and showed signs of having been sexually assaulted, the release said. She was taken to the hospital.

 The woman told police she was alone in her room, watching TV with the window open, when she heard a noise and saw a man remove the window screen and climb inside, the Sheriff’s Office said.

He went to where the woman was sitting, hit her several times on the side of the head, wrapped his hands around her throat and choked her before sexually assaulting her, according to the Sheriff’s Office.

The man left through the window, the release said. Out of fear, the woman waited several minutes before screaming for help, the Sheriff’s Office said.

Deputies responded and a police dog used to help search for the assailant.  The man was described as black, 5 feet 8 inches tall, with a slender but strong build, wearing a black-and-white shirt, black pants and a black skull cap.

Republicans and Arbitration

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Dean Clancy at U.S. News wrote an article on the Republican’s decision to force mandatory arbitration on consumers including nursing home residents. Forced arbitration clauses waive a customer’s right to sue a company in case of a dispute. The clauses are imposed on consumers without informed consent, and are increasingly being used to shield corporate wrongdoing.

By “overturning the anti-forced arbitration regulation issued this week by Consumer Financial Protection Bureau, as congressional Republican leaders are reportedly rushing to do, would be a political and policy mistake.”

1. Unconscionable. Here are some examples of the kind of behavior CFPB’s reg is trying to prevent.

· Wells Fargo Bank admitted its employees systematically created millions of sham bank accounts in its customers’ names, and then in many cases fraudulently billed those same customers for fees and services they never agreed to. Executives of the megabank knew this was happening but did nothing. Then, they decided to blame 5,300 “rogue” employees, who were summarily fired. Now, to ward off thousands of lawsuits, the company is hiding behind binding arbitration clauses in its victims’ contracts.

· Roger Ailes, the now-deceased executive of Fox News, was accused, before his death, by multiple female employees of sexual harassment. To keep the women’s allegations out of court, and to forestall a long line of past accusers from taking the witness stand, he invoked clauses in his employees’ hiring contracts requiring any disputes be handled through a private, highly secretive arbitration process.

· Military readiness has been negatively affected by unscrupulous payday lenders who prey on military servicemembers and veterans. The victims become overly indebted thanks to exorbitant interest rates and hidden fees they don’t understand, and then find themselves unable to obtain relief thanks to forced-arbitration clauses. Because of this, the Military Coalition, which represents nearly 6 million uniformed service members, veterans and their families, has formally petitioned Congress to ban the clauses.

 2. Unconstitutional. Question: If binding arbitration clauses are so bad, why are they so common? Because a series of Supreme Court rulings (the most recent one in May) have effectively overturned the traditional common-law understanding of arbitration. In past centuries, arbitration was understood as a voluntary option that is fair only when both parties are of roughly equal bargaining power or else have agreed to it freely after a dispute has arisen.

In lieu of that reasonable understanding, the Court has substituted a doctrinaire “right of contract” that allows a powerful party to effectively force a weaker party to waive his or her constitutional right to sue, before a dispute has arisen and often without informed consent. This transformation defies common sense and severely weakens Americans’ Seventh Amendment right to a jury trial.

 Today, arbitration has devolved into a private star-chamber that’s stacked in favor of the accused corporation – which, unsurprisingly, usually wins.

Is the CFPB itself unconstitutional? Yes, in my opinion. But so is forced arbitration. And Congress has a duty to protect our right to a jury trial.

Instead of lashing out at the agency by overturning this regulation, Congress should do the right thing and amend the Federal Arbitration Act to make binding arbitration agreements truly voluntary for all Americans, as the Constitution requires. Having done so, it could then, at its leisure, reform (or, as I would prefer, abolish) the controversial agency.

3. A Political Loser. Those who vote to overturn the CFPB regulation will be placing themselves on the side of accused sexual harassers, corporate wrongdoers and unscrupulous payday lenders who exploit our troops.

If Republicans are politically sensible – or just have an ounce of self-respect – they’ll take the high road and let this reasonable rule stand.

Theft of Pain Meds

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A nursing home employee at Bethany Lutheran Home has been accused of scamming nursing home residents out of more than 9,700 painkiller pills while working there.  Laurine Wilhite is charged with theft, tampering with records and two counts of dependent adult abuse.

Authorities say Wilhite ordered medications for residents of Bethany Lutheran Home while working there as a nurse and then stole 9,727 narcotic hydrocodone pills from 44 different residents at Bethany Home.

Police estimated the worth of the pills at $6,562. Reports stated Wilhite ordered the medications for residents and then allegedly stole them when they were delivered by the pharmacy, but before they were logged in as received by the facility.

Right to Video?

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The Advocate had an excellent article on the legal struggle to place a video camera in a resident’s room after the nursing home denied the family’s request. After Ann Graff, a nursing home resident at Heritage Manor of Slidell, ended up with a black eye and no one could explain how she got it, her daughter asked permission to place a video camera in Graff’s room.  An MRI taken determined that Graff had a fractured vertebra, which required surgery.

“The fact that the facility cannot tell me how she was injured leaves me guessing about what she experiences each day,” her daughter said.  Now, the family is asking a federal court to require the nursing home to allow the camera.  The family agreed to bear the cost of operating the camera and monitoring its footage. The camera does not record audio, and would record video only of Graff’s bed. The family received permission from Graff’s roommate and would have put up signs notifying visitors to the room of the camera.

A civil rights lawsuit claims Heritage Manor and its owner, Medico LLC, are discriminating against Graff on the basis of her disability and violating her rights as a Louisiana nursing home resident.  Medico is affiliated with nursing home magnate Elton Beebe, a major donor in Louisiana political campaigns.

The Advocacy Center of Louisiana and the AARP Foundation are representing the women in the lawsuit, which says it seeks to enforce Graff’s rights under the Americans with Disabilities Act, the Rehabilitation Act, the Fair Housing Act and the Louisiana Nursing Home Residents’ Bill of Rights.

In the 2015 Louisiana governor’s race, Beebe’s family and associated businesses donated at least $67,500 to John Bel Edwards and his top opponent, David Vitter. That same year, Beebe and his family also donated $25,000 to former Gov. Bobby Jindal’s failed presidential campaign.

 

 

 

Campaign Contributions in Louisiana

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The Economist had an interesting article about how campaign contributions from the nursing home industry influence policy in Louisiana.  ” No interest group showers more money on the Bayou State’s politicians than nursing homes and their owners. Indeed, the last two governors together collected over $1m in donations from nursing homes; Louisiana legislators and other state officials have raked in many millions more.”

“For nursing home owners, the investment in politicians has paid off handsomely. Every year, the fees the state pays them to house elderly and physically disabled people rise at rates that substantially outpace inflation. Meanwhile, their main competitors—home- and community-based health providers, which provide part-time care for the disabled in their own homes—have seen their rates cut repeatedly.”

In 2015, the governor considered an overhaul of Louisiana’s policies, one that would have shifted more money to home-based providers and away from nursing homes. The needed reform was dropped when the nursing home industry complained—an episode recounted in a recent report by the Advocate newspaper.

“Surveys have shown that given the choice and some help with basic tasks, most older folks would rather stay in their own homes than be institutionalised. That option also tends to be cheaper. Most states have been going in this direction: in a typical state, about 60% of the Medicaid budget for long-term care goes to nursing homes; the other 40% goes to home- and community-based care. The ratio has been getting closer to par every year. But in Louisiana, 77% of that pie goes to nursing homes, a share that has grown in each of the last four years.”

Sex Offenses Investigated

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Beavercreek police are investigating a sex offense at a nursing home.  On July 17, a case of gross sexual imposition and pandering obscenity involving a minor was reported to Beavercreek police.

WHIO reported that Pristine Senior Living in Beavercreek said they are conducting an internal investigation, and are cooperating with police in their investigation of sex offenses involving an employee.