The Chattanooga Free Times Press had a great article discussing the need to make long term care a priority since baby boomers will begin entering facilities soon.  I think it should have been a priority for the last 20 years since elderly people who need health care are the most vulnerable members of the citizenry.

The article emphasizes the need for more efficient and less costly long-term care services because as baby boomers age and require more specialized care, there will be greater need for quality services.  10 million Americans need long-term care and that number will grow in the coming years.  Health care providers, educators, advocates for the elderly and lawmakers gathered at Blood Assurance in Chattanooga for a discussion focused on long-term care reform.

The number of U.S. geriatricians is far too small to handle the coming flood of people who will require geriatric care, said Dr. John Standridge, director of the geriatric fellowship program at the University of Tennessee College of Medicine in Chattanooga. “At a time when we are adding 75 million more children of the World War II generation to our geriatrics population, the (number of) people that are adequately trained in geriatric syndromes is falling by leaps and bounds,” he said.

Legislators should create incentives for students to go into geriatrics.  Elder care issues also affect acute care hospitals.  Hospitals often house many elderly patients who can’t be discharged because there are no community-based support services that can take care of them.

 

The New york Times recently how an article about the draconian changes to Medicaid rules.  The article explains how in the past federal law protected married couples from having to choose between divorcing or becoming impoverished when one spouse needs expensive nursing home care, allowing the healthier spouse to retain assets and income while the sicker one’s care is covered by Medicaid.   However, the Bush Administration changed those rules for those who are sick but still able to live at home. The federal government has ruled that New York has been too generous in applying the income protections to people at home, forcing several thousand couples to make a stark choice by March of this year.

“They’re saying if you put your spouse in a nursing home, you’re going to get to keep more income than if you keep your spouse out of a nursing home,” said Mark L. Kissinger, deputy commissioner of long-term care for the state Health Department. “That’s completely opposite to public policy and research of the last 10 years.”

Congress in 1988 passed a law intended to protect healthy spouses with lower incomes and fewer independent assets from being reduced to poverty by their better-off spouses’ need for long-term care.  For 2009, federal guidelines allow the couple to keep up to $2,739 a month in combined income and $109,560 in assets not including a home or car and still have Medicaid take care of the nursing home costs.

The federal Centers for Medicare and Medicaid Services sent a letter to state health officials in the fall of 2008 outlining a legal ruling that declares that couples in which both partners live at home are not entitled to the same protection.  The state Health Department estimates that 3,000 couples — out of 30,000 people in the long-term home-care program — are affected by the change, because the healthy spouse depends on the sick spouse’s income to survive; advocates for the elderly say the number is closer to 4,000.

Claudia Hutton, a spokeswoman for the state Health Department, said that New York wanted to keep the home health care program the way it was, and that any talk of changing income criteria was a “smokescreen” to gut the program.

“The Bush administration is trying to pull the rug out from under thousands of seniors in New York who depend on this critical program year in and year out just to survive,” Senator Charles E. Schumer, a New York Democrat, said in an e-mailed statement before this week’s transition.

Advocates say that the federal interpretation makes little sense. “The root of their interpretation is that Congress wanted to give states the option of extending these protections, but only to those whose incomes are so low that they would have no income to share with their spouse,” Ms. Bogart said. “It would be so absurd that no one would ever qualify.”

 

McKnight’s had an article discussing salaries and wages of employees of assisted living facilities.
Directors of nursing at assisted living facilities saw a pay increase in the last year. Their national average salaries rose to $60,000 in 2008 from $59,627 in 2007, according to the eleventh annual 2008-2009 Assisted Living Salary & Benefits Report.

RNs and CNAs in assisted living fared better, receiving a 3.34% and 3.17% pay raise, respectively. Meanwhile, the turnover rate among assisted living RNs fell from 42.33% last year to 35.5% this year, though the turnover rate for CNAs held steady at just more than 42%. This number is very high and explains the lack of consistency in care at most assisted living facilities.

The annual salary and benefits report, which was published by Hospital & Healthcare Compensation Service (HCS) in cooperation with the American Association of Homes and Services for the Aging, tracks compensation for 16 management and 24 non-management positions in all types of Assisted Living facilities across the country. 

If salaries and wages were increased (as profits have increased), turn over rates would go down.  If facilities were truly interested in quality of care, they would use their resources to adequately pay the people proving the care instead of funneling money to the corporate owners of the facilities.

 

I wanted to follow up on an entry from a few weeks ago discussing the benefits and merits of allowing residents pets after I read this article from the Daily Record.  The article reiterates what I had thought and written about how pets can alleviate depression and give companioship to lonely residents.  The article mentions how happy and positive the animals make the residents.

While rules regarding pet visits or ownership vary according to facility, a daily dose of wagging tails, purrs or even squawks has proven an overall boon to residents and staff alike. "Having a pet around is soothing," said Valerie Dalia, marketing director of Victoria Mews in Boonton. "Their presence is relaxing."    Upon providing documentation that shows animals are up to date on vaccinations and shots, family members are then permitted to bring pets in for frequent visits.

Meanwhile, the Beverwyck House of Merry Heart in Parsippany boasts a cat, while birds of a feather flock at the nursing home in Succasunna, right alongside a fully stocked fish tank. "It’s always helpful to have an animal around," said Blanche Banifacio, owner of Merry Heart. "There’s something in the animal that can sense pain."

"Animals are all-accepting. They don’t care about whatever issues a person might have," said Noralyn Snow, administrator at the Silverado Senior Living Aspen Park Community in Salt Lake City, home to 100 memory-impaired residents, seven dogs, six cats, 40 birds and a baby kangaroo named Marlee who can coax a smile out of even the most recalcitrant senior. "And having pets around adds excitement and spontaneity."

"People grow up with animals, have had them all their lives, and this is their home now, so why wouldn’t they have pets here?" said Helene King, communication coordinator for Levindale Hebrew Geriatric Center and Hospital in Baltimore, one of 300 facilities worldwide operating under the "Eden Alternative" philosophy, which integrates animals, plants and contact with children into daily routines to keep the elderly engaged. "It makes such a big difference in their lives."

Until recent years, most administrators took a dim view of the notion of animals living in such facilities. There were concerns about allergies or people tripping over animals; worries about bites and scratches; and much consternation about the insurance implications. Turns out that if well-managed, there’s nary a problem.

 

The CantonRep.com had an article about an unsupervised visitor to a ManorCare nursing home who was accused of fondling a physically disabled female patient at Cincinnati facility. Alvin Meyer was charged with gross sexual imposition by force. The allegation was made by the patient at the Heartland of Mount Airy facility in Springfield Township, which has about 105 patients.   Nursing home spokeswoman Julie Beckert said the alleged fondling happened in the patient’s room and that the patient was able to immediately tell staff what happened.

ManorCare Health Services of Toledo owns the facility. ManorCare has policies and procedures in place that should have protected the resident, including training and in-service of staff.

Meyer’s address is listed on the same street as the home, about a mile-and-a-half away.

 

Carl Hessler Jr wrote an article in Delaware County Daily Times about the woman accused of assaulting a resident skipping another court date.   For the second time in a month, Henrietta Sprual was a no-show in court, where she was supposed to be sentenced for using a belt to repeatedly beat an elderly Alzheimer’s patient while she worked at an Upper Merion assisted-living facility.

Defense lawyer Robert Datner couldn’t explain Sprual’s absence to President Judge Richard J. Hodgson, who was prepared to sentence Sprual.

"It appears to me that Miss Sprual is running 90 miles an hour down a dead-end street, and at the end of the day, she’s going to hit the brick wall and she’s going to have to face Judge Hodgson," said Assistant District Attorney Bradford Richman.

Hodgson issued a bench warrant for Sprual’s arrest, the second warrant in less than a month. Hodgson initially issued an arrest warrant for Sprual Jan. 7 after she neglected to show up for a sentencing hearing.

The judge had rescheduled the hearing for Thursday.

Richman said Sprual’s nonappearance for sentencing "is incomprehensible" and another example of her lack of remorse for her crime of striking an 87-year-old man who was in the advanced stages of Alzheimer’s disease with a belt some six to eight times while she worked as a patient-care worker at Arden Court in December 2007.

Relatives of the victim were in court hoping to observe the conclusion of the case. They had to leave the courthouse without their justice.

"They were very distraught. It really inflames the wounds suffered by this family," said Richman, describing the reactions of the victim’s relatives. "They want to put this behind them and they want this part of (the victim’s) life to be put to rest so they can celebrate the good aspects of his life."

 

The Minneapolis Star Tribune had a tragic story about cancer survivor Shirley Mae Almer. The 72-year-old woman from Perham, Minn., had survived lung cancer surgery and radiation therapy on a brain tumor. Her family planned to bring her home from a Brainerd nursing home for Christmas.
Instead, she died Dec. 21, and her children and grandchildren spent the holidays in grief.

They soon got a second shock. Minnesota health investigators discovered that the nursing home’s peanut butter was tainted by a strain of salmonella that has been making people sick across the country. Almer’s daughter Ginger Lorentz said she served her mother peanut butter toast a week before she died. She said she prepared it in the nursing home, using the facility’s peanut butter.

Now, 503 people in 43 states have been infected by salmonella linked by DNA fingerprinting to peanut butter produced in a Georgia plant. Eight people have died, including two other Minnesota nursing home residents. About 200 products containing suspect peanut butter have been recalled. Among the first recalled were 5-gallon peanut butter containers like those sold to nursing homes.

The family on Monday sued the manufacturer, Peanut Corp. of America, of Lynchburg, Va., and the distributor, King Nut Co. of Solon, Ohio., alleging negligence, said Fred Pritzker, a Minneapolis attorney representing the family.

Salmonella typically causes abdominal pain, nausea — symptoms they say their mother suffered — diarrhea and fever. The infection can be fatal in young, elderly or frail people.

Shirley Almer was a mother of five and businesswoman. She retired five years ago and was found to have lung cancer in 2007. Yet her surgery at the University of Minnesota Medical Center was pronounced a success. In June she took a Florida vacation with her two sons, two daughters and four grandchildren. When she returned from the trip, she suffered a seizure that sent her back to the U, where doctors treated a brain tumor with radiation. She spent two months in the hospital. 

By October, she moved in with her daughter in Brainerd and spent weekends at her home in Perham. Then came another setback, a urinary tract infection that sent her to a transitional unit in Good Samaritan just after Thanksgiving. It was meant to be temporary, to regain strength, her family said. "So we would bring her snacks and cookies and things like that," said Lorentz. "They had a little kitchenette in her wing and she liked peanut butter toast. So I made her peanut butter toast for two days in a row."

The family had planned to take her home Dec. 22. Yet the day before that, she became gravely ill.

By then, the state Health Department was searching for clues to a salmonella outbreak that had struck elsewhere in the country and turned up in Minnesota in late November. During such outbreaks, state investigators routinely perform specialized tests on stool samples from sick people and interview victims or relatives about what they’ve been eating.

Nine days after her mother died, Lorentz said she got a call from a state epidemiologist. It was the first time that she had heard that her mother had been tested for salmonella and found to be infected with the strain afflicting people around the country. "She asked about chicken, and she asked about peanut butter," said Lorentz. "I said, ‘Yes, I used to make her peanut butter toast.’"

Dr. Kirk Smith, who heads the department’s foodborne disease investigative unit, said identifying victims at a long-term care facility — as a policy, the department doesn’t identify institutions or victims by name — and testing its peanut butter were the keys to identifying the source of the outbreak. A series of recalls soon began, first of the bulk peanut butter and then of products made from it, including cookies, crackers, cereal, candy, ice cream and pet food.

Federal officials say the contamination was traced back to the Peanut Corp. of America processing plant in Blakely, Ga., which was shut down.

None of this happened in time to help Clifford Tousignant, 78, who died Jan. 12 in another Brainerd nursing home operated the Good Samaritan Society, a nonprofit based in Sioux Falls, S.D. His son, Marshall Tousignant, said he also served his father peanut butter at night. His father, already weakened by diabetes, suffered continuous diarrhea for more than two weeks before he died, and tests linked his infection to the salmonella outbreak, his son said.

 

Nutrition is the most important aspect of a nursing home resident’s case.  Any weight loss makes a patient more susceptible to illness, infection, and death.  I have read a couple of articles about a nursing home patient who lost 87 pounds in 19 days and I still do not understand how it could happen and why it is not considered criminal neglect.  

State and federal agencies have filed numerous sanctions against the Winchester Centre for Health and Rehabilitation since August, when a patient lost more than 87 pounds in 19 days and the nursing home failed to call a doctor.  At the end of the 19 days, the patient was found unresponsive and was taken to the hospital.  The unnamed medical director at the Clark County nursing home is quoted (with the understatement of the year) as telling an investigator that the patient did not receive good care: "It was not a good experience during his three-week stay, and I think he suffered for it."

The lack of response is amazing.  The Federal Centers for Medicare and Medicaid Services is threatening to pull the facility’s funding in February and has warned that the facility could be fined up to $6,050 a day if conditions don’t improve, according to correspondence between the nursing home and the federal agency.  I can’t believe they didn’t shut this place down immediately and determine where the money went that was supposed to go to the residents.

Officials with Kindred Healthcare in Louisville, which owns the Winchester nursing home, say the facility has no plans to close. If the funding is cut off, the patients who receive Medicaid and Medicare will be sent to other facilities.  There are 166 patients at the facility.

The nursing home did not contact a physician or monitor a patient being treated for swelling and other problems. The patient lost more than 87 pounds, dropping from 197 pounds to 109.4 pounds, in 19 days When the patient was admitted to a hospital, a physician there told state investigators, "I would never want anyone to lose weight that fast. That is too fast."

A second Type A citation was issued Jan. 12, after a patient received the wrong dosage of an anti-seizure medication for 40 days in November and December, an error that wasn’t discovered until the patient suffered a seizure. The patient was supposed to have received a daily dose of 450 milligrams of extended-release capsules by mouth, but the nursing home staff gave 400 milligrams through a feeding tube, which altered the medication’s effectiveness. The facility didn’t have a system to make sure that medications were administered properly, according to the Jan. 12 citation.

Records of state inspections and investigations show that physicians were not notified when patients’ conditions deteriorated and doctors’ orders weren’t followed for patients with serious medical conditions. Inspections since 2007 also have turned up problems with cleanliness, disrepair and the temperature of food served to patients. 
In one case in September, the nursing home did not notify a physician when a patent’s pressure ulcer worsened and the patient had to be hospitalized as a result. The physician told state investigators that the problem should have been detected sooner and that the patient did not receive "the best of care" at the facility.

 

The American jury is at the heart of the justice system.  The right to a jury trial is a constitutional right.  But the GOP in Tennesse want to limit the amount a jury may award in cases involving the abuse and neglect of America’s most vulnerable citizens.  Arbitrary caps on damages do not work.  If they want to prevent lawsuits, they should require better care including increasing staffing and training.  Advocates for the elderly told a special committee studying the effects of litigation on the nursing home industry that better care would prevent lawsuits.

The main discussion at the committe meeting was on whether caps should be placed on damages in lawsuits against nursing homes. Senate Speaker Ron Ramsey has made malpractice caps for nursing homes part of his legislative agenda for the year. The Republican said limiting damages is necessary because he believes the industry is being targeted by lawyers.

But Daniel Clayton, president of the Tennessee Association of Justice, told the committee that the focus should be on improvement of care rather than capping damages. "If care is good, lawsuits will go down," Clayton said. "If care is bad, lawsuits will go up." Last month, the Centers for Medicare and Medicaid Services released a report that ranked Tennessee’s nursing homes worst in the nation and gave 30 percent of them the worst rating possible.  Why would you provide immunity to an industry that is hurting your voters and constituents?

The ratings are based on state inspections, staffing levels and quality measures, such as the percentage of residents with pressure sores, urinary tract infections and declining mobility. Each nursing home was given an overall score of one to five stars, with five stars being the best. The ratings are based on as much as three years of data, ending in November 2008.

Only Louisiana and Georgia ranked lower than Tennessee in the report, which evaluated 16,000 nursing homes nationwide.

Patrick Willard, AARP Tennessee’s advocacy director, said his group is studying litigation of nursing homes and preliminary results show the state ranks below the national level when it comes to staffing at nursing homes. "If your staffing level is below the national level, you’re more than likely to be sued," he said.

Committee member Charles Curtiss agreed. The Sparta Democrat said his mother has been in two nursing homes, and he noticed their staffing was not up to standard. "I’m not for saying we’re going to cap liability, and then let the service be exactly as it is today," Curtiss said. "If they’re going to give the operators a break, then certainly we’ve got to get something for those people who are in the nursing homes, and that would have to be better care."

Rep. Henry Fincher said he’s against capping damages, and shows his disdain for the idea in calling it "the kill old people act." "I don’t think that limiting liability is the way to make sure that people are treated better," said the Cookeville Democrat.

"If you take away people’s chance to recover damages for wrong things done to them, you’re protecting the wrongdoer. It turns the whole idea of responsibility on its head."

 There is an article about The Justice Department’s settlement with the state of Tennessee regarding civil rights violations at the Tennessee State Veterans Homes (TSVHs) in Humboldt and Murfreesboro. The TSVHs are state-owned nursing homes, each serving approximately 140 residents, most of whom are veterans. It sounds eerily similar to the Bush Administration’s last minute settlement with South Carolina recently.

The agreement, filed in U.S. District Court, is designed to (hopefully) ensure that the nursing home residents will (finally) be provided adequate medical and nursing care and protected from harm. During its investigation of the TSVHs, the Justice Department discovered numerous violations, including medical and nursing care that violated generally accepted professional standards, and psychiatric medication practices so deficient that they contributed to the deaths of some residents. Further, staff at the veterans homes did not adequately protect residents from injuries associated with falling.

The Justice Department conducted its investigation pursuant to the Civil Rights of Institutionalized Persons Act (CRIPA), which authorizes the Attorney General to investigate and root out systemic deficiencies in care such as those found at the TSVHs, rather than focus on individual civil rights violations.  The Department of Justice’s CRIPA enforcement effort reaches beyond nursing homes, and includes psychiatric hospitals, facilities for persons with developmental disabilities, juvenile justice facilities, prisons and jails.