Whatever happened to the American work ethic?  Whatever happened to common decency?  Recently one of the nurses at a nursing home was arrested for leaving several elderly residents alone and without proper care and supervision.   One of the residents got injured after the nurse left and put another resident in charge! 60-year-old Epifania V. Fitzgerald returned 2 1/2 hours later.  The authorities were there waiting on her.

One of the facility’s residents, a woman, had slipped and fallen in the bathroom. Another resident had called 911.   Fitzgerald was supposed to have been watching out for 21 elderly patients.

Authorities would not identify the facility.   Why do they protect these homes?  This is outrageous. if this was a day care center, the "authorities" would have shut down the place.

U.S News and World Report had an article about the difficulties of caring for an elderly loved one.  Journalist Gail Sheehy writes about navigating through the U.S. health care system during her struggle to care for her gravely ill husband. 

More than a year ago, her husband, publisher Clay Felker, was being discharged from a New York City rehabilitation facility after spending several months there in his long battle with throat cancer. "So, he has to come home now, and we’ve run out of benefits," Sheehy recalled at a recent media briefing in New York City. "We’re coming out, and there’s also nobody telling me what I have to do. He has a feeding tube, he has a tracheotomy, he has medications. I don’t know where to start."

Desperate, she sought out and hired a "geriatric care manager" — at $125 an hour — to advise them. Their insurance might still pay for an at-home nurse, she found out, but only if it’s a Medicare-approved nurse — and there aren’t any available in the city.

There are home health-care aides, of course, "but they cannot do medical services like giving a shot, taking care of a trach, changing a feeding tube," Sheehy said.

Once private insurance benefits end, the only option for most Americans is Medicaid, which requires that recipients have less than $5,000 in assets.

Her geriatric care manager spelled it out to Sheehy: If the couple first exhausts all their remaining assets, then Medicaid will cover Felker’s nursing care.

And if Sheehy, in her late 60s, wasn’t willing to give up all her assets and income?

"Then, you need to divorce him," the geriatric care manager told her.

In Sheehy’s case, it never came to that. She and Felker scraped together enough money to hire qualified, in-home caregivers and Felker’s last months were spent at home, relatively serene. He died in July at age 82.

Sheehy called her 15-year journey with Felker through the U.S. health care system a "nightmare," and she wonders how less affluent and well-connected Americans are faring.

U.S. Census figures project that the number of Americans 65 or over will double by 2030, and that two-thirds of today’s 65-year-olds will require some period of long-term care later in their lives. 
At the same time, the number of geriatricians has actually declined in recent years, to about 7,750: that translates to one for every 4,254 older Americans.   In addition, it’s projected that the country will face a shortage of more than 800,000 nurses by 2020.

Wage issues are keeping the number of geriatricians at an all-time low, as well. Geriatricians are crucial, the experts said, because they look not at a particular disease or body site, but at the older person as a whole. However, a recent U.S. Institute of Medicine report found that geriatricians remain the lowest paid medical specialty of all.


Newsday had an article about a 90-year-old Roman Catholic nun who died after an unbolted closet fell on her head at a nursing home. Rockland County, which runs the Westchester County home, was fined more than $17,000 by the federal Centers for Medicare and Medicaid.  The Summit Park Hospital and Nursing Care Center faces additional state penalties in the Aug. 31 incident.

The nun was found conscious but bleeding profusely from her forehead, face and left eye after the free-standing wardrobe fell on her.  She was taken first to a nearby hospital and later transferred to Westchester Medical Center in Valhalla, where she died. Her name was not released.

How could this happen?  Who was supposed to be watching her?  Why would they have a wardrobe closet unbolted or free-standing? 

The Advancing Excellence in America’s Nursing Homes campaign–a nationwide, voluntary quality improvement initiative-celebrated its second birthday last month.

More than 7,100 nursing homes in the U.S. have signed on with the initiative.  This is roughly 45% of the nation’s total number of nursing homes.   Also, 28 national organizations and 49 smaller local organizations have a hand in the unprecedented initiative, which originally was supposed to last just two years. Success, however, has granted it extra life, officials say.

"In two years, the Advancing Excellence campaign has seen progress in reducing pressure ulcers, reducing the use of physical restraints, and controlling or relieving pain for long-term and short-stay residents," said Mary Jane Koren, M.D., M.P.H., chair of the Advancing Excellence campaign.

For more information about the Advancing Excellence campaign, visit http://www.nhqualitycampaign.org.

Central Florida News 13 had a disturbing article about thieves pretending to be nursing home employees preying on the sick and elderly.  Why didn’t the staff realize that these people did not work there?  Is the turnover rate so high that the nurses don’t know all the employees?

Police in Central Florida said the women take credit cards, cash and checks and go on shopping sprees.  Surveillance video shows two women trying to cash a falsified check.  Video also shows three women who used a stolen credit card inside the Altamonte Springs Mall and may have also used it in Sanford.

The women dress in hospital scrubs, go into nursing homes acting like workers and steal credit cards, checks and cash.  Once inside the patient’s room, police said, the woman wearing the scrubs asked the patient if that patient was physically able to walk to the bathroom by themselves. Police said that is when the patient demonstrated that they could and that was when the crime was committed.

Matthew M. Wallace is an attorney and CPA with the law firm of Matthew M. Wallace, PC, in Port Huron. Mr. Wallace wrote a great article about the myths of medicaid in the Times Herald.  He can be reached (810) 985-4320.  Below is a summary of the article.

Planning Matters: Busting myths about Medicaid

There are many misconceptions about Medicaid and Medicaid eligibility.  Medicaid laws are complex and confusing. I do not recommend that you try to plan for Medicaid by yourself. One mistake may cost you thousands of dollars and may result in months of Medicaid ineligibility. It is important to get good legal counsel from a knowledgeable legal specialist.

Misconception 1:
"I don’t need Medicaid; I have Medicare."

The truth: Medicare is a federal catastrophic major medical insurance program primarily for hospitalization. Medicare does not pay for long-term custodial care.

Medicaid is a state and federal funded and state-run assistance program.

For seniors, Medicaid is primarily for long-term care in Medicaid qualifying nursing homes, and in certain circumstances, long-term care outside of a nursing home.

Misconception 2:
"If I or my spouse go into a nursing home, the state will take my home away."

The truth: Your home is an exempt asset if it is owned by you or you and your spouse and can stay an exempt asset during your entire nursing home stay.

The home must be used and titled properly. A home that is not titled or used properly is not exempt and is available for nursing home expenses. There are other exempt assets in addition to the home and include one automobile, certain pre-paid funeral arrangements and certain life insurance policies.

Misconception 3: "If I give assets away, I have to wait 60 months to qualify for Medicaid."

The truth: The Department of Human Services looks back 60 months for transfers that are "divestments." If your transfer is not a divestment, it is ignored, even if it is made the day before you apply for Medicaid, and even if it is thousands of dollars.

To determine the number of months your divestment disqualifies you for Medicaid benefits after your Medicaid application is approved, you divide the amount of the divestment by the penalty divisor, which is $6,191 in 2008.

For example, a $20,000 divestment will disqualify you from receiving benefits for about 3.2 months after your application is approved.


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A Perfect Cause is an advocacy group that pushes for reform of nursing home laws, regulations, and requirements.  Recently, they got the Oklahoma attorney general and the Oklahoma County district attorney’s office to support a push to make crimes against nursing home patients immediately reportable to police.

Jack Crow, who says he believes his wife was abused at a nursing home, is pushing to change the statutes.  Crow’s wife, who suffers from Alzheimer’s disease, was badly bruised in July. An investigation found that she suffered the injuries in a fall.

Crow disputes the findings and is working with A Perfect Cause to change the reporting procedures.

Current Oklahoma statutes call for someone with reasonable cause to believe abuse or neglect is occurring at a care center in the state, it should be reported to the Department of Human Services or the Sheriff’s department.  However, reasonable cause is subjective and no guidance is given to nursing homes as to what constitutes neglect and abuse.

The district attorney and attorney general’s offices believe police should be called first.

"When you have a crime scene, there is evidence," said Scott Rowland, of the Oklahoma County district attorney’s office. "There is witness testimony in these crime scenes."

A Perfect Cause wants to make sure facilities follow that procedure by requiring them to report suspected abuse to police first, before anyone else.

North Dakota’s NBC affiliate KFYR had an article and video discussing the shortage of nursing home beds available in North Dakota.  The authors discovered that there are far more seniors than there are beds available in certain areas of North Dakota.  However, The Good Samaritan Society has senior care facilities throughout rural North Dakota, many with plenty of room for our aging population. The urban areas are where beds are needed, so that`s where the society is relocating all its open space.

The good news is are plenty of skilled nursing beds for senior citizens throughout the state. The bad news, many are in rural areas, not in the growing cities, where the need for them is growing.

The Good Samaritan Society is able to construct the $16 million project on Versailles Avenue, by lumping together all the open skilled nursing and basic care beds it has in its rural facilities.

"In our rural communities, we`ve had some vacancies due to declining populations and movement of people from rural communities to the four major cities in North Dakota where the health care services are more dominant," says John Droppers, of the Good Samaritan Society.

The GSS expects the facility to be full of seniors by the spring of 2010, seniors who otherwise may have had to travel to outlying areas to find a home. The Long Term Care Association says in the next three years another 180 skilled nursing beds are expected to be transferred from rural areas to the Bismarck-Mandan area.

The Birmingham News had a great article discussing a new type of nursing home that makes the residents feel like they are at home instead of a hospital.  Residents are called "elders," not patients. Nurses are invited guests, not managers. Home is the emphasis, not medicine, although skilled care is available.

After years of planning and then construction, the retirement community has just completed the "Cottages at St. Martin’s, a Green House Community." St. Martin’s cottages are designed after a patented Green House concept that seeks to deinstitutionalize treatment of the elderly and create a family-like environment for their long-term care.

The $11 million project involves replacing 60 of St. Martin’s 138 nursing home beds in 6 separate homes where 10 residents live with the help of certified nursing assistants. The Green House concept was developed by Dr. William Thomas, a geriatrician fed up with the sadness, loneliness and boredom in his nursing home patients.  Today there are 15 Green House communities open and another 19 in development in 23 states.

St. Martin’s is the first nursing home in Alabama to embrace the idea and the first in the country to open multi-story houses. Because of limited space, St. Vincent’s has built two, three-story structures with a separate "cottage" or "Green House" on each floor. The cottages on the ground floor have an outside courtyard, and the upstairs cottages all have large, screened-in porches.

Each home has a separate entrance, and doorbells must be rung and the door answered before a nurse or other visitor enters.

The cost of care will be the same at the cottages as in the traditional nursing home. The ratio of nursing assistant to residents is better in the cottages, but the nursing assistants are also doing the cooking, light housework and other chores. Nurses make rounds on the cottages to give medicine and check vitals, but they are not the ones in charge.

Turnover of nursing assistants is expected to be less for those working in the cottages because they have more varied roles and fewer residents to look after.  Nursing assistants are getting culinary training this week. A central part of each cottage is the open kitchen, from which nursing assistants can monitor the residents and residents can smell the food cooking. Weight loss is a common problem in nursing homes, but Green Houses across the country have shown that to be less of an issue when the food is prepared near the residents.

The Roanoke News recently had an article about the numerous deficiences and violations found by infrequent inspections of nursing homes. 

At Avante at Roanoke, an unannounced health and fire inspection turned up 34 deficiencies in 2007 — more than four times the national average for for-profit nursing homes. During visits to the facility, inspectors found patients not being bathed because of staff shortages, problems with cleanliness and at least two instances where residents faced immediate harm.

A new national study finds that such problems are not uncommon. Inspectors cited 94 percent of nursing homes last year for federal health and safety standards, the Department of Health and Human Services reported this week.  Nationwide, about 17 percent of nursing homes had deficiencies that caused "actual harm" or put patients in "immediate jeopardy," the report noted, and for-profit homes were more likely to have citations than government-sponsored and nonprofit nursing homes.

Take bed sores, for instance. Last year, Virginia was ranked among the 10 worst states in the nation for high-risk pressure ulcers, she said, noting 2,260 instances.

Virginia’s Medicaid reimbursement rate is so low that facilities lose an average of $7 per day per Medicaid resident, he said. "And yet we have to meet the same 150 federal standards as nursing homes in other states, some of which get close to double the reimbursement."

Avante at Roanoke, a 130-bed facility, had the most violations, with 28 health-inspection infractions and six fire and safety deficiencies. Average daily certified nursing assistant time per patient at Avante was one hour, 40 minutes — less than the region’s top performer by 70 minutes.  Clearly this proves that inadequate staffing impairs the quality of care provided.

The 180-bed Virginia Veterans Care Center had 26 health and three fire and safety violations. "The year before we had three or four total," said Bill Van Thiel, administrator of the Salem facility. "It’s important to remember that any survey is pretty much a one-time snapshot, and there’s a huge range in severity." The existence of bed sores is a much more telling gauge of facility excellence, he added. "Normally we run about three acquired bed sores for 180 patients; that’s way under the national average [of 12.7 percent]. Today, I have none."