The Chicago Tribune recently had an article about how politicians are bought off by the nursing home lobbyists and their substantial campaign contributions.  This is one of the reasons why health care should not be a for profit business.  Lawmakers receive thousands of dollars in contributions every year from the nursing home industry.  In return, the industry makes sure that staffing is kept low, no insurance is necessary, and no oversight  by the State is effective.

Among the contributors is Tim Boyle, the owner of Grinnell’s Friendship Manor, who serves as the president of the board of the Iowa Healthcare Association, a lobbying organization that represents nursing homes.  There were 12 legislative fundraisers during one week last year that were held by the Iowa Healthcare Association.  11 of the fundraisers were held at Iowa nursing homes.   The other was held at Boyle’s South Dakota home, and was for Rep. Christopher Rants, R-Sioux City, then the minority leader of the Iowa House. Rants collected 15 checks totaling $3,090, according to state records.

Boyle, whose Friendship Manor is facing a $112,650 federal fine for alleged neglect of an elderly woman, has complained to lawmakers that the Iowa Department of Inspections and Appeals is "overly aggressive" in policing the state’s nursing home industry.

The newspaper reported that the Iowa Healthcare Association in March provided Iowa’s care facility administrators with a fill-in-the-blank letter that could be given to residents forward to lawmakers.

It read, in part:

“(NAME OF FACILITY) is dedicated to providing the best care. … Increasing fines by the Iowa Department of Inspections and Appeals (DIA) are cutting into the funds that nursing homes have to put toward providing care. … (NAME OF FACILITY) will either be forced to close or increase my rates. I do not want to be forced to move into another nursing home. …”

Of course, this letter is an outright lie. The nursing home industry makes plenty of money. Just look at their stock prices.  Demand is high and supply is low.  Nursing homes are certainly making enough profit to waste thousands of dollars on lobbying politicians every year.

Andrea Pitzer wrote a great article about PACE for USA TODAY.  Program of All-Inclusive Care for the Elderly (PACE) tries to keep people who are eligible for nursing home care living independently in the community.  PACE patients at the center — almost all of whom qualify for both Medicare and Medicaid–are supported by a coordinated medical team that the federal government hopes will cut costs and improve life for the elderly.

According to the National PACE Association, there are 16,000 patients in PACE nationwide. The average client is 80 and takes eight prescription medications. Participants have to be 55 or older, certified by their state to need nursing home care and be able to live safely in the community.

Each program receives a fixed amount per person from a patient’s state Medicaid program — usually 85% to 90% of estimated nursing home costs. Medicare funds come through a risk-adjusted formula in which the program receives more for sicker enrollees.

PACE becomes both the patient’s insurer and care provider and is obliged to pay for all of the patient’s medical care from the point of enrollment forward.

PACE’s dual role allows for flexibility in using the money from the federal government.  Part of the idea is that thorough preventive care can prevent more serious conditions and reduce hospitalizations.

Started in the 1970s as a community project to keep elders in their homes, today PACE provides a ride back and forth to its centers for day-care activities and medical appointments. Along with the nutritionist, social worker, psychologist, activity director, nurses’ aides, nurse practitioner, doctor and others, the driver is a part of the health care team that meets daily. The clinical staff members also hold group meetings at least twice a year with each patient.

Because the amount received for an individual is fixed, says Shawn Bloom of the National PACE Association, the program has every incentive to keep patients as healthy as possible. "If we provide good care," Bloom says, "we control costs."

 

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The Morning Call had a story about another nursing home employee stealing narcotics from the residents.  State police in Pennsylvania have arrested a Bethlehem woman named Heather L. wolters for stealing drugs from a nursing home where she worked. She was employed as a nurse at the Lehigh Center nursing home in Lower Macungie Township when police say she stole 10 vials of injectible Hydromorphone from a computerized medication dispensing system.

A derivative of morphine, Hydromorphone is used as an alternative to morphine in cases of analgesia, and as a cough suppressant. Wolters was charged with numerous counts of possession of a controlled substance, theft by unlawful taking or disposition, theft by deception and receiving stolen property.

 

How could this happen?  Doesn’t the nursing home conduct a narcotics count after every shift?  If so, one or more of the residents are not getting their medication.  If not, they are negligent in dispensing medications.

The Denver Post had an interesting article about new developments in elder care.  Facilities are trying to move away from institutional settings and make resident’s stay feel more like home.

The article states that "a generation of retirees resists the fate of nursing homes they’ve grown to dread, supporters of a cultural revolution say they are reforming an industry long tainted by images of neglected patients languishing on soiled sheets".

Reforms will likely quicken in the next year as Colorado begins sending higher Medicaid payments to homes that make changes ranging from reducing bed sores to giving residents a peanut-butter sandwich on demand.   Critics of traditional nursing- home care are not ready to declare lasting success. Reforms at a given home too often depend on the energy and dedication of a few key staff members, and those changes are difficult to replicate in more than 16,000 nursing homes nationwide.

"In general, the quality of nursing-home care is really bad," said Charlene Harrington, a professor of sociology and nursing at the University of California at San Francisco who has studied national reforms. Truly improving care almost always requires increasing staff, she said.

"There’s some basic merits to the idea of the culture-change movement," Harrington said. But "the nursing-home industry is trying to promote the idea you don’t need the staff; you just change the culture. That’s why I’m skeptical of the whole effort."

"The heart of it is just treating people the way you want to be treated," said Barbara Moore, administrator of Bruce McCandless Colorado State Veterans Nursing Home in Florence. Once entrenched in a notorious state nursing system, McCandless has won kudos for trying everything from consistently matching staff with the same patients to parking a Patton tank outside for grandkids to climb on.

Promotion of culture change or comparable reforms is vital for baby boomers who want to avoid mass warehousing in the coming decades. The U.S. population 65 and older will jump from 40 million in 2010 to 55 million in 2020, according to the federal Administration on Aging.

The vulnerable population 85 and older, meanwhile, will need many new care beds, with the population in that oldest group rising from 6.1 million to 7.3 million that same decade.
By all accounts, they want to avoid the nursing homes of their parents’ day.

Another Medicare and Medicaid report in September said that more than 90 percent of U.S. nursing homes were cited for violating federal standards in the past three years, but those transgressions can range from improper food storage to acute medical problems.
Caring for the elderly, meanwhile, consumes a good share of the state budget.

In Colorado and across the country, nursing-home occupancy rates are flat or dropping even as the population ages. More families are keeping aging relatives at home, hiring home-health aides, or choosing newer and smaller assisted-living sites for patients who don’t need extensive medical care.

Culture change can be as varied as adopting a cow for a pet or building a $1 million adapted home from the ground up to house only six residents — but the basic tenets across the country are consistent:

• Breaking from institutional schedules and rules in which residents must eat at common times or take showers at a rigid hour set by the staff.

• Training staff in resident-centered care and reassigning employees to more-consistent jobs.

• Some attempt to alter the physical monotony of nursing-home settings dominated by institutional 1960s and ’70s architecture. Larger homes may parcel themselves into "neighborhoods;" others renovate with resident input on colors and materials; still more add gardens, meditation rooms or restaurant-style dining areas.

A national survey of the transformation of nursing-home culture found that 31 percent of homes had adopted significant portions of the movement. The results "indicate a hopeful picture about the potential for deep, systemic change within the industry," according to the Commonwealth Fund.

Proponents believe the new state reimbursement system for Medicaid will eliminate any reason not to participate in the changes being made.  Culture change is not more expensive in the long run — it can save on staff turnover, food costs and expensive acute care. But for managers concerned about immediate costs, the state program to come on line next summer offers immediate financial rewards.

Nursing homes will earn points for quality of medical care, satisfaction of patients and their families, and culture-change tenets like consistent staffing and resident-controlled decisions. A home that scores 100 points will receive $4 more per Medicaid patient per day (on top of the current Medicaid rate of about $178 a day).

Medicaid pays for about 63 percent of nursing-home residents; the new payment system will mean, for example, that a high-scoring home with 70 Medicaid patients could earn an extra $8,400 a month. The first year of the program will cost $4 million, half coming from the federal government and half from a new fee charged to all nursing homes.

 

McKnight’s had an article about the increased use of advance directives.  Many of our clients feel pressured into signing these directives.  I believe it is a way for the nursing homes to avoid liability.  When the nursing home neglects a resident or fails to deliver timely care and the delay in treatment causes a wrongful death, the nursing home points to the advance directives as a way of explaining their negligence. most CNAs and LPNs do not understand the purpose of advance directives. They believe that advance directives allows them to ignore the condition of the residents and permits letting the resident suffer and die in cases where simple treatment could have avoided the death.

The article states that advance directive documentation is on the rise in the nation’s nursing homes, according to a recent report from the Institute for the Future of Aging Services, a research arm of the American Association of Homes and Services for the Aging.

Nearly 70% of all nursing home residents over the age of 65 have at least one advance directive document in their records. That is up from 53% in 1996, according to the report. The documents were more common for married, white and female residents.

Advance directives provide written documentation of a patient or resident’s end-of-life choices. "Both residents and families must continue to engage in the discussions needed to accurately document end-of-life choices," said Helaine Resnick, Ph.D., director of research at IFAS, adding that providers, as well, must continue to stress the importance of advance directives.
 

Wisconsin State Journal had an article about a nursing home employee charged and arrested for abusing residents.  Eric Larrabee slapped an 85-year-old hospice patient only 10 days before she died at a Stoughton nursing home.  The resident suffered from Alzheimer’s disease. He had only worked there for about two months before he was fired on Feb. 12. The woman died on Feb. 20.

The complaint states that another worker at the home heard Larrabee yell at the woman telling her to be quiet before seeing him slap her with an open hand. The woman appeared to be stunned by the blow, the complaint states.

State Department of Health Services Investigator Michelle Dutkiewicz said Larrabee admitted that he struck the woman out of frustration but said he only "tapped" her face.

 

The SCDHEC website has an interesting question and answer session where they discuss nursing homes.  SCDHEC is responsible for licensing and enforcing the standards at nursing homes.  They are woefully understaffed and underfunded.  Below is an excerpt from "conversations with the Commissioner.

How many licensing people in DHEC’s whole health licensing side? How many are assigned only to Community Residential Care Facilities?

DHEC’s Division of Health Licensing has 45 positions; three are vacant. The division has 29 inspectors. The community care oversight program has 13 positions. An additional inspector position is proposed, but has not been hired. One administrative person from the division’s operation support program is assigned responsibilities of processing CRCF applications for licensure.

How many investigators in DHEC’s whole health licensing side? How many are assigned only to CRCFs?

We have 30 investigator positions. Of these, 11 are specifically assigned to CRCF in the Community Care Oversight Program.

Does DHEC need more inspectors and investigators for the CRCF program? How many?

Currently, the DHEC’s Division of Health Licensing licenses 489 CRCF’s with a total of 16,637 beds. We are assessing the CRCF program to determine how best to achieve the goals and responsibilities of the program. We’ll be happy to share the results once the study is completed.

Does this program have annual reports? (DHEC’s solid waste division, for example, produces annually a nice comprehensive report.)

No.

How many natural deaths occur each year in CRCFs?

We do not collect that information as it is not required to be reported to DHEC by the facilities. We are to be notified by the facility of a death where there is an unusual circumstance that involves an investigation by the coroner or local law enforcement. We would investigate to determine whether there would be any violations of DHEC regulations that occurred. The investigation into the cause of the death and any criminal charges brought in the matter would be left to the coroner and local law enforcement agencies under their authority.

How many deaths due to staff negligence or inadequate staffing occur each year in CRCFs? (This question includes residents like the wheelchair death of a Peachtree Manor man, who was a resident but he was being pushed down the road.)

We are to be notified by the facilities when there is a death that is investigated by the coroner or local law enforcement. Criminal charges that may be brought would be done by those local authorities.

How many injuries occur each year in CRCFs? What is the nature of the injuries?

The facilities are required to notify DHEC of serious injuries that require hospitalization due to incidents involving fractures, burns, lacerations, hematomas, etc. While that information is reported to DHEC, we do not have the specific numbers compiled.

How many complaints do you get each year about CRCFs? How many are justified? What are the categories of complaints?

For the fiscal year July 1, 2007 to June 30, 2008, we received 569 CRCF complaints alleging 2,592 various issues which resulted in 579 citations.

For the current fiscal year from July 1, 2008, we have received 186 complaints alleging 886 issues for which 14 citations have been cited. Some findings for this period are inconclusive at this time as most of the complaints are still open.

Often the citations noted were not associated with the original complaint. Many times we are unable to determine if the complaint was justified.

The complaints are typically taken under the following headings:

Abuse
Accessibility
Activities
Administrative
Animals
Background Checks
Care Plans
Charting/Records
Dietary/Food
Dirty Needles
Dumping
Finances
Fire Code
Housekeeping
Incident Reports
Level of Care
Maintenance
Misappropriations
Oxygen
Patient Rights
Pharmacology
Quality Program
Recreation Staff Unlicensed
Safety
Staff
Staff Training
TB Requirements
How many CRCFs has DHEC closed in recent years?

Within the most recent years DHEC has actively been involved in the forced closure of one facility; Peachtree Manor.

All other closures have been as a result of the voluntary surrender of the facility’s license or closure of the facility as a decision made by the licensee/owner. Our enforcement actions have contributed to many of the voluntary closures.

About how many CRCFs are like Still Hopes (a CRFC in West Columbia) where mostly upper income folks go.

We do not compile information whether a facility is strictly private or whether it accepts residents that receive the Optional State Supplement (OSS) or both. You can contact the S.C. Department of Health & Human Services to request information on those facilities residents who receive the OSS supplement.

The CRCF at Still Hopes is only one part of that overall facility. Still Hopes has apartments for independent living as well as a skilled-care nursing home.

Describe briefly DHEC’s main concerns with its CRCF program.

Compliance with the requirements of Regulation 61-84, Standards for Licensing Community Residential Care Facilities. Pam Dukes and Commissioner Hunter can elaborate on this question at your meeting this afternoon.

Describe briefly how DHEC wants to address those concerns.

The Division of Health Licensing is reviewing Regulation 61-84 for possible revision. We are studying possible changes in the programs. We expect to have that process completed within the next 30 days.

Can I attend the 1 p.m. Oct. 22 CRCF meeting at the Heritage Building in Columbia mentioned in Ken Moore’s Sept. 26 memo?

This meeting is for our staff and invited directly affected stakeholders to review the CRCF program and potential regulatory changes. As such, the session is not considered a “public” meeting based on input from the agency’s legal staff as the group does not constitute a public body. Allowing media participation may significantly limit our ability to engage stakeholders in a completely open and frank dialogue. We do encourage you to attend future public CRCF meetings that will be held as we continue this process.

(Question 1 response) You write, “The Community Care Oversight Program has 13 positions.” Q. My questions: How many of these positions are filled with full-time on-duty people?

All 13 are full-time on-duty staff.

How many of these positions with full-time on-duty people are devoted EXCLUSIVELY to CRCFs? (The 489 facilities you regulate).

None of the 13 are devoted exclusively to CRCF.

Of the positions EXCLUSIVELY devoted by CRCFs and filled now by full-time on-duty FTEs, how many are investigators? Inspectors? (This entire question may be most easily addressed on the phone with someone. I just want to be sure we are describing your staffpower accurately. For example, we have a lot more positions in our newsroom than actual workers. We have lost many through buyouts, attrition, etc. Saying you have a position doesn’t reveal much about actual staffing.)

The CRCF program staff that inspect facilities are inspectors. The program does not use the position title of investigator.

(Questions 2 response) Does the “Community Care Oversight Program” only concern the 489 CRCFs, or does it include other types of facilities?

The Community Care Oversight program includes 87 Intermediate Care Facilities for the Mentally Retarded (MR15 and MR16). There are a total of 1,864 ICFMR beds.

(Question 8 response) You say for FY 07-08 you received 569 CRCF complaints alleging 2,592 issues… etc. (my question: Does this include the complaints forwarded to you by the Ombudsman’s office and Gloria Prevost’s group, Protection and Advocacy, which does about 85 contract inspections of CRCF’s a year for Department of Mental Health and forwards complaints to DHEC?)

Yes, but not all information forwarded to the CRCF program from these groups requires a DHEC investigation. Often, either the findings provided from their complaint investigation or the complaint itself is not within our scope of authority.

(Question 9 response)… Any idea how many closures in the past 3-4 years have been attributable in part to DHEC enforcement actions besides Peachtree?

Approximately 16 since 2004

On a different but related note: How many patients in state nursing homes? How many nursing homes?

For clarification, are you asking how many nursing homes are owned by the State of South Carolina, and how many patients are served in those homes? Or, is your question more general?

The general answer is that in South Carolina, we license 195 nursing homes with 19,647 beds. Most nursing homes in the state operate at over 95 percent occupancy.

If you want to know how many are State of South Carolina owned and how many beds are in those homes, we will need a couple of days to get you that information.

 

The PostStar.com had an article about a registered nurse working at a nursing home despite being convicted and sent to prison for selling prescription drugs he stole from the hospital where he had worked.  How could he keep his license?  Why would a nursing home hire him for a job where he could steal drugs again?

Bradley Winslow is on parole until August 2009, and said Tuesday he did not lose his nursing license, and was not disciplined by the state, for the January 2007 conviction for third-degree criminal sale of a controlled substance.

He said he "fully disclosed" the conviction when applying for a job at the nursing home, and that the nursing home was aware of his conviction when they looked into his background.

Winslow was a nurse at Saratoga Hospital when he was arrested in July 2005 on charges he sold stolen morphine to an informant for the state Department of Health. He had taken the morphine while working at the hospital. The informant was a doctor who later died of a heroin overdose.

Winslow said he was not disciplined by the state, a comment that was corroborated by the Web site of the state Office of Professions, which lists disciplinary actions against licensed professionals in New York, including nurses. His name is not included among those subjected to disciplinary cases.

Jane Briggs, a spokeswoman for the state Education Department, which oversees the Office of Professions, said the agency could not discuss Winslow’s disciplinary history because it was "pending." She could not explain why the matter would still be "pending" 23 months after he was sent to prison, though.

 

RITE AID TO HOST LIVE, ONLINE CHATS FOR CAREGIVERS DECEMBER 3 AND 4

 

Chats Feature Expert Advice from Geriatric Experts and a Rite Aid Pharmacist, Provide Online Network of Support for Caregivers

 

Camp Hill, PA (December 2, 2008) – On December 3 and 4, Rite Aid will host two free, live online chats to help caregivers find solutions to everyday problems and answer common caregiver questions. To participate in the online chat, caregivers must register online at www.giving-care.riteaid.com. Questions also may be submitted by email prior to the event by sending an e-mail to expertevent@riteaid.com. Caregivers who are unable to participate in the event can view and print a transcript online after the event. Additional events will be available on the Web site as they are scheduled.

 

On Wednesday, December 3, from 12-1 p.m. EST, Attorney Vincent J. Russo, ESQ, will answer questions on elder law, special needs and estate planning. Elder Care Expert and Geriatric Care Manager Dr. Marion Somers, PhD, will discuss topics ranging from home safety to senior-friendly technology.

 

On Thursday, December 4, from 12-1 p.m. EST, Susan Strecker Richard, editor-in-chief of Caring Today, will offer advice on how to care for loved ones without sacrificing your own wellbeing and answer general questions on caregiving. Rite Aid pharmacist Natalie Teaff, R.Ph, will answer questions on medications, therapies and medication interactions.

 

The chats are part of Rite Aid’s “Giving Care for Parents” program that launched in September. The program includes a 20-page Caregivers Guide offering hints on financial planning and strategies for balancing careers and personal lives, especially when living with loved ones. It also has information on support groups, programs and resources such as medical facilities and businesses catering to seniors and caregivers.

 

At www.riteaid.com, caregivers can click on “Giving Care for Parents” and find a collection of helpful articles written by industry experts, frequently asked questions, drug information counseling and educational videos showing actual caregivers and elders as they deal with real situations such as dementia, long term care and nutrition.

 

Rite Aid Corporation is one of the nation’s leading drugstore chains with more than 4,900 stores in 31 states and the District of Columbia with fiscal 2008 annual sales of more than $24.3 billion. Information about Rite Aid, including corporate background and press releases, is available through the company’s website at http://www.riteaid.com.

 

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I found this cool website called Aboutlawsuits.com that had an article about a wrongful death lawsuit filed in Chicago alleging the nursing home’s neglect caused fatal pressure ulcers or bedsores. 

The lawsuit states that Stanley “Ted” Dancy, 77, was admitted to the nursing home. However, after one month in the nursing home for rehabilitation, he was transferred to Mount Sinai Hospital, where he was diagnosed with four advanced stage bed sores, as well as malnutrition and a urinary tract infection

As a result of the injuries sustained at the nursing home, Dancy’s health continued to deteriorate and the wrongful death lawsuit alleges that the bedsores and other injuries he sustained at Washington Heights Nursing Home were the contributing factors that lead to his death on December 12, 2007.

Nursing home bedsores, which are also commonly referred to as decubitus ulcers or pressure sores, are caused by prolonged pressure on one area of the body.  This is typically caused by the staff’s failure to move the residents.  This pressure results in a lack of blood flow to the skin in that area, which turn into an open would that progress to a serious and fatal infection.

When immobile residents are not repositioned for long periods of time, pressure can accumulate on one area of the skin, typically involving the thin layers of skin around the tailbone, shoulder blades, elbows or heels.  Many residents do not get moved or repositioned for days because of inadequate and incompetent staff.

Many nursing home lawsuits involve circumstances where the nursing home was not properly monitoring the resident for signs of the pressure ulcers and leaving the resident in one position for extended periods of time. Failure to properly clean the resident, change soiled adult diapers or bed sheets also increases the risk of bedsores developing and getting infected.

Injuries caused by malnutrition and dehydration are a result of a failure to provide adequate amounts of food or fluids to a resident and are linked to negligence and neglect.