I saw a great article discussing the process of choosing and entering a nursing home.  The article tells the story of a woman who scouted nursing homes with a home-like setting where the staff-to-resident ratio was low.

More than 5 million people in the United States receive some form of daily care, according to Joseph L. Matthews, a California attorney who specializes in elder law and is the author of "Long-Term Care: How to Plan and Pay for It."

More than 2 million people older than 65 are in some type of nursing facility or other residential care facility at a cost of between $30,000 and $150,000 each per year, according to Matthews.

One out of four of those nursing-home residents stay in a facility for longer than a year, and 10 percent stay for more than three years.

Medicare covers the first 20 days of care at 100 percent. After that, a 20 percent co-pay is required for the next 80 days.  Some supplemental Medicare insurance will pick up the co-pay, but patients without that coverage could find themselves paying $130 or more per night for the remaining 80 days, Honig said.

While Medicaid will cover the cost of nursing home, residents have to spend down their assets to qualify, she said. But the spouse still living at home can keep residential property, a car and a limited number of other assets. 

The Center for Medicare & Medicaid (CMS) is the component of the Federal Government’s Department of Health and Human Services that oversees the Medicare and Medicaid programs. 

Medicaid and Medicare dollars are used to cover nursing home care and services for the elderly and disabled. State governments oversee the licensing of nursing homes. In addition, State have a contract with CMS to monitor those nursing homes that want to be eligible to provider care to Medicare and Medicaid beneficiaries. Congress established minimum requirements for nursing homes that want to provide services under Medicare and Medicaid. These requirements are broadly outlined in the Social Security Act (the Act). The Act also entrusts the Secretary of Health and Human Services (DHHS) with CMS, a DHHS Agency, is also charged with the responsibility of working out details of the law and how it will be implemented, which it does by writing regulations and manuals.

CMS contracts with each State to conduct onsite inspections that determine whether its nursing homes meet the minimum Medicare and Medicaid quality and performance standards. The State conducts inspections of each nursing home that participates in Medicare and/or Medicaid about once a year.  The State also investigates complaints about nursing home care.

During the nursing home inspection, the State looks at many aspects of quality. The inspection team observes resident care processes, staff/resident interaction, and environment. Using an established protocol of residential rights, the team interview a sample of residents and family members bout their life within the nursing home, and interview caregivers and administrative staff. 

Depending on the nature of the problem, the law permits CMS to take a variety of actions; for example, CMS may fine the nursing home, deny payment to the nursing home, assign a temporary manager, or install a State monitor. CMS considers the extent of harm caused by the failure to meet requirements when it taken an enforcement action. If the nursing home does not correct its problems, CMS terminates its agreement with the nursing home. As a result, the nursing home is no longer certified to provide care to Medicare and Medicaid beneficiaries. Any beneficiary residing in the home at the time of the termination are transferred to certified facilities.

I saw this story in a Pittsburgh paper.  I can’t believe they gave probation to a nurse who lied, changed medical documents, and covered up the circumstances of neglect that caused the death of a nursing home resident. 

What kind of deterrent is this?

Kathleen Galati who was a nursing home supervisor was sentenced to only five years’ probation.
She pleaded guilty in March to perjury, false swearing, criminal conspiracy, and tampering with evidence in connection with the October 2001 death of Mabel Taylor, 88, at Ronald Reagan Atrium I Nursing and Rehabilitation Center.

Allegheny County Common Pleas Judge David R. Cashman also banned Galati from working in health care during her probation.  So in five years she can go back to covering up neglect in nursing homes!

Atrium head Martha Bell helped cover up the death of Taylor, who died after wandering outside on a cold night.  Bell was convicted of involuntary manslaughter and health care fraud and sentenced to at least seven years in prison.

There is a new product called QuietCare which is a home monitoring system that tracks a resident’s health, and alerts designated neighbors by e-mail or phone when something is wrong. 

The QuietCare monitoring system can keep up with meals and medications, and to alert others if he has had a fall or other emergency.

In an industry that is becoming proactive, QuietCare focuses on keeping aging or disabled people at home longer. Everything from computerized medication dispensers to concierge health-care managers aim to give the elderly and disabled the assistance they need to stay independent and safe.

With the cost of nursing home care skyrocketing and baby boomers reaching retirement, the country is facing an expensive health-care bill. Nursing homes are already crowded, and at a cost of $6,000 to $6,500 per month in Central Florida, providing round- the-clock nursing home care to an increasing number of seniors could be back-breaking for the nation’s health-care system.

There certainly is no shortage of products designed to help seniors and caregivers.

AT&T offers home video monitoring, or so-called nanny cams, that some people are using to keep a watch on elderly relatives.

LifeAlert — known for its marketing slogan "I’ve fallen and I can’t get up!" — markets emergency-button systems. Other companies offer similar personal emergency-response systems as well, with prices ranging from $200 to more than $1,500, plus monthly monitoring fees.

If taking medication is an issue, Guardian Medical offers a pill dispenser that can be programmed to dispense medication at certain times, and provide alerts by phone if pills are missed.

Movie explores love, life and Alzheimer’s Disease in nursing home setting.

A new movie, “Away From Her,” is set in a nursing home and examines a couple’s struggle with Alzheimer’s Disease as well as love within the context of life and aging.   An Ontario couple who has been married for over 40 years decides to seek nursing home placement for the wife (played by Julie Christie) after she wanders away from home.

For the first time in the five decades of their relationship, they are forced to undergo a long separation since the nursing home has a “no-visitors” policy for the first 30 days of a resident’s stay so they can adjust to their new surroundings. When the husband visits after the adjustment period, he is devastated to find out that not only has his wife seemingly forgotten him, she has transferred her affections to another man. The other man, also a nursing home resident, is mute and wheelchair-bound. The husband then starts spending time with the male resident’s wife, played by Olympia Dukakis. Dukakis’ own mother had Alzheimer’s Disease.

Source: www.npr.org, May 16, 2007; http://www.imdb.com/title/tt0491747/

People with Alzheimer’s disease experience an acceleration in the rate of cognitive decline after being placed in a nursing home according to a new study by the Rush Alzheimer’s Disease Center. The observational study involved 432 older persons with Alzheimer’s disease.  

On average, cognition declined at a gradually increasing rate for all participants. During the study period, 155 persons were placed in a nursing home, and placement was associated with a lower level of cognition and more rapid cognitive decline.

"The findings suggest that experience in day care may help individuals with Alzheimer’s disease make the transition from the community to institutional residence," said study author Robert S. Wilson, PhD, a neuropsychologist at the Rush Alzheimer’s Disease Center.

The authors considered the possibility that nursing home placement is simply a sign of increased severity of Alzheimer’s disease. Yet, the nursing-home-related increase in cognitive decline was observed even after simultaneous control for cognitive and noncognitive indicators of dementia severity at the time of nursing home entry.

"The findings suggest that the transition from the community to a nursing home is particularly difficult for people with Alzheimer’s disease and that those planning for their care should consider the possibility that experience in adult day care programs may help prepare affected persons for institutional living," said Wilson.

See article here

A former nursing aide who admitted raping and impregnating a profoundly disabled and defenseless woman at a Bloomingdale nursing home three years ago was sentenced Wednesday to 25 years in prison.

Reynaldo Brucal Jr., 20, pleaded guilty in November to aggravated criminal sexual assault of the then-23-year-old woman, who has cerebral palsy, is brain-damaged and has the mental capacity of a 3-year-old. She was in his care at Alden Village Health Facility for Children and Young Adults when the attack occurred in 2004.

Brucal, who is not a U.S. citizen, has been in DuPage County Jail since his 2005 arrest. 
After serving his sentence, he will be deported to his native Philippines.

Staff at the nursing home, where the victim and her twin sister had lived for 13 years, discovered she was expecting in June 2005 when she was more than 28 weeks’ pregnant. A baby girl was delivered by Caesarean section in July 2005.

The twins, who cannot speak or function independently, have been moved to another area nursing facility, and their family has filed a civil lawsuit against Alden that is pending.

The facility also has been fined $10,000 by the Illinois Department of Public Health for lack of oversight and mishandling of the investigation.

According to the probation department’s pre-sentencing report, Brucal admitted assaulting the woman because he was "bored."

But Brucal, who began working at Alden in September 2004 and was 17 at the time of the attack, "didn’t believe he did anything wrong," Berlin said.

Initially, Brucal denied sexual contact but was arrested in November 2005 after admitting such contact, claiming a latex glove he used as a condom had failed.

See article here

States that set high staffing standards for elder care in nursing homes are the only ones that come close to having enough staff nurses to prevent serious safety violations, according to a new study by a professor in the UCSF School of Nursing.

The majority of the nation’s elderly and disabled in nursing homes remain in situations where staffing is well below national recommendations for safe care, the study found. While no states have ideal nursing levels, those states with higher Medicaid reimbursements or higher mandated nursing levels have come closer to meeting the recommendations, according to the analysis published in the June issue of the journal "Health Services Research."

The study’s initial objective was to examine the relationship between Medicaid reimbursement rates, which many states have cut under their cost-containment efforts, and nurse staffing levels in US nursing homes, according to Charlene Harrington, PhD, RN, UCSF professor of sociology and nursing and lead author of the report.

She said previous studies have shown a direct correlation between staffing levels and higher Medicaid reimbursement for nursing homes, but this is the first to show that states with higher mandated staffing standards had substantially higher staffing as well.

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 At a hearing this month concerning the state of the nursing home industry 20 years after the landmark Nursing Home Reform Act (better known as OBRA ‘87), Senate Special Committee on Aging Chairman Herb Kohl (D-WI) addressed the deficiencies of a system that has allowed some poorly performing nursing homes to escape penalties.

Testimony by the Government Accountability Office (GAO) presented at the hearing concludes that many nursing homes shown to be providing substandard care are still not being subjected to any sanctions, and are therefore not be motivated to make the lasting improvements necessary to protect the health and safety of residents.

According to the GAO, in 2006 nearly one in five nursing homes nationwide was cited for poor care or, more specifically, care that can cause actual harm to residents.

“Without question, the Nursing Home Reform Act improved nursing home care in this country. Today, many of the nation’s 16,000 nursing homes are providing adequate or excellent care. But shamefully, quite a few nursing homes are getting away with providing a lot less, putting a good number of the seniors living in long-term care facilities at risk. This is unacceptable, and raises questions about how and why our enforcement system is failing,” said Chairman Kohl. “This committee has a long history of closely scrutinizing the quality of nursing home care, and we intend to reaffirm that commitment.”

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The owner and manager of a Palmetto nursing home has been arrested on a charge of neglecting an elderly person in connection with a large lesion found on the face of a resident there.

According to reports, 85-year-old Ronald Larsen began living at the Palmetto Guest House in June, 2005. Jacqueline Dorelien took over the home in July of the following year.

The lesion was present when Dorelien took charge, but grew during the next few months, eventually rupturing into a large open wound.  The report says Dorelien failed to get medical help for the man, despite the advice of doctors.

The arrest came two days after the state agency that oversees nursing homes started action to revoke the Palmetto Guest House’s license for allegedly failing to provide adequate care.

The Florida Agency for Health Care Administration issued the complaint Wednesday.

In it, the agency accused the facility of:

• Failing to provide care and services appropriate to the residents’ needs.

• Failing to arrange for necessary physician appointments.

• Violating the Assisted Living Facility residents’ bill of rights by failing to provide "adequate and appropriate" health care.

"A facility’s first priority should be the safety and well-being of its residents," AHCA Secretary Andrew Agwunobi said in a statement issued with the complaint. "It is unacceptable when the management of a facility does not take this responsibility seriously. Our action in revoking their license is necessary to protect this most vulnerable population. The agency will continue to monitor this facility during the administrative complaint process to ensure the safety of its residents."