Laura Siano, former director of nursing at Kirkwood House Nursing Home, allegedly stole $16,000 from a 75 yr old resident’s account. In addition, Siano made numerous personal purchases for decorative items, cat supplies and a laptop using the resident’s credit card. The investigation occurred as the result of a complaint to the Department of Public Health. She has been charged with larceny over $250.  See article at Wicked Local Wakefield.

DHEC has had a string of trouble lately, with allegations of impropriety in the tuberculosis outbreak, growing concern over the state of SC’s landfills, and now, a lawsuit that lists DHEC’s lack of enforcement as something that “threatens imminent harm” to the public, The State reports.

DHEC stopped enforcing the certificate-of-need law after Gov. Nikki Haley vetoed funds for the agency which enforces the law. The House of Representatives supported Haley’s veto, saying that money for the program’s enforcement should come from elsewhere in DHEC’s budget.
Under the law, hospitals and nursing homes must get a certificate of need from DHEC to purchase new equipment and to open their doors. Though this is still the law, if DHEC continues to not enforce it, nursing homes and hospitals can begin opening across the state without any enforcement.

As a result of DHEC’s lack of enforcement, 12 hospitals and nursing homes have gathered together to file suit against the health agency. They say that DHEC has other budgetary measures which enable them to pay for the enforcement, and that it’s illegal for them not to do so. They maintain that the veto eliminated state funding for other programs, which are still being enforced. To combat the confusion, DHEC has filed their own suit.

Everyone at some point has heard about mercy killings or angels of death, where medical professionals euthanize someone in an attempt to “ease their pain and suffering”. The most well known example is probably Dr. Jack Kevorkian, who assisted in the suicide of multiple patients, which eventually earned him a jail sentence.

In the Spanish town of Olot, near the border of France, Joan Vila, admitted to killing 11 residents in 2009 and 2010 at the nursing home where he worked, The Washington Post reports. He claimed that it was to ease their pain and suffering. How did he ease their pain and suffering? By forcing them to drink bleach, and other toxic liquids. His lawyers say that he is mentally ill and are asking for 20 years probation. The prosecutors are seeking a 194 year sentence, arguing that the man’s crimes were not committed with the intent of giving mercy at all.

CBS New York reported that two nursing home aides, David Rover and Thomas Mocera, have been accused of taking graphic photographs of approximately eleven nursing home residents in three Suffolk County nursing homes. New York Attorney General Eric Schneiderman asserts that among the photographs taken by the two were images of bed sores, patients’ private areas covered in feces, and an overflowing colostomy bag. These images were reportedly taken without the patients’ consent, violating both their privacy and dignity.

The incidents reportedly occurred at Woodhaven nursing home in Port Jefferson Station, Long Island State Veterans Home in Stony Brook, and Jefferson’s Ferry in South Setauket. Representatives from Woodhaven declined to comment to CBS New York, and representatives from Jefferson’s Ferry denied that there was any evidence that such an incident occurred. Fred Snanga, the director of Long Island State Veterans Home was “completely outraged” by the actions of the two men.

Rover and Mocera are both pleading not guilty to the charges. Family members of the victims are calling for better screening processes for nursing home employees.

Hundreds of Pennsylvania nursing home workers recently gathered in the State Capital to support three proposed bills that would increase standards.  Pennsylvania Senate bills 624, 625 and 626 would require nursing homes to meet a minimum level of nurse aide staffing, report turnover and staffing levels to the Department of Health, and spend a minimum amount of their Medicaid resident care per diem rate.

An analysis by the workers show nearly 30 percent of Pennsylvania facilities did not spend at least 95 percent of their resident care Medicaid component amount on resident care costs in fiscal year 2011 while nursing homes generated more than $500 million in profits in 2011, with a total margin near the national level of 4.7 percent.  The report also said that 54 percent of survey workers said their facility is only sometimes adequately staffed, and 27 percent say their facility is never adequately staffed.  A 2012 survey of nursing home workers across the state showed that 12 percent of employees work more than one job and 11 percent receive public assistance. 

 

The Consumer Voice released the testimony of Mitzi E. McFatrich, Executive Director of Kansas Advocates for Better Care on HB 2348 to increase nursing staffing minimums in nursing facilities.

"My name is Mitzi McFatrich and I am here today to speak up for increasing the hours of nursing care received by older adults living in nursing facilities. KABC is a not for profit, whose 850 members and volunteers are dedicated to improving the quality of care for older adults needing long-term care.

Correlation between Nursing Care and Elders Outcomes
There is one reason that adults go to Kansas nursing homes–Nursing Care. There are approximately 19,000 adults living in Kansas nursing homes.  There is an indisputable correlation between the number of nurses (registered and licensed practical) who provide direct care to residents on a daily basis (“nurse staffing” levels) and the quality of care and outcomes, along with the quality of life older adults experience. Numerous reports and studies confirm that nursing facilities provide better care to their residents, and residents have better outcomes, when facilities are adequately staffed.  No report finds better quality with fewer staff.1

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The Medicare drug benefit is provided by private insurance companies, competing with one another and operating under contracts with the federal government. Each insurer has one or more committees that decide which drugs will be covered. The decisions are supposed to be based on scientific evidence.

However, the NY Times reported that a new report by Daniel R. Levinson, the inspector general at the Department of Health and Human Services, which admitted that the federal Medicare agency had not clearly defined “conflict of interest” and did not enforce standards meant to prevent such conflicts from influencing drug coverage decisions by the panels, known as pharmacy and therapeutics committees.

“The Centers for Medicare and Medicaid Services does not monitor conflicts of interest on pharmacy and therapeutics committees,” Mr. Levinson said. In many cases, he said, the government cannot identify potential conflicts because committee membership lists are unusable — incomplete, inaccurate and full of discrepancies. The panels are appointed by insurers or pharmaceutical benefit managers hired by insurance companies.

A separate study by university researchers found similar problems in many state Medicaid programs. The study, published this month in the journal JAMA Internal Medicine, described “inadequate management of conflicts of interest” among the panels that recommend drugs for coverage under Medicaid.

Since Medicare officials do not monitor conflicts of interest, Mr. Levinson said, they cannot be sure that prescription drug plans are complying with federal requirements that at least two committee members — one practicing physician and one pharmacist — be “independent and free of conflict.”

 

 

MSN Healthy Living had an article on the 9 warning signs of bad care.  Below is a summary.

1. Marked emotional or physical changes. Look first to your loved one. You should be concerned if she is less able to function as usual, has stopped taking part in activities, or has become withdrawn and uncommunicative. If Mom is experiencing emotional abuse—such as being ignored or talked down to—she may be agitated and withdrawn, fearful, or experience loss of weight or appetite and sudden changes in mood or sleep pattern. Physical abuse or neglect may be a concern if Dad has unexplained bruises, pressure ulcers, or skin tears, particularly in areas that are not regularly visible, like the upper back, hips, and thighs.

2. Unanswered or deflected questions. “I don’t know, but I will find out” is an acceptable response—but not regularly, and you shouldn’t get the feeling there’s something to hide. “If staff are evasive with your questions, unable to answer your questions, or refuse to discuss your loved one’s care with you, this is a big red flag that care may be suboptimal,” says Amy Jo Haavisto Kind, an assistant professor in geriatrics at the University of Wisconsin School of Medicine and Public Health.

Some questions, such as, “My mom is losing weight, what is the plan?” should always have a ready answer. “If all a person gets is blank stares or a dismissal—’Old people just do this, don’t worry about it’—then that is concerning,” says Uy.

What’s the ultimate wrong answer? “I get more concerned when someone says, ‘This is how we do things here,’ and has no desire to help,” says Jatin Dave, a physician at the Brigham and Women’s Hospital’s Center for Older Adult Health.

3. Frantic, discordant, or inadequate staff. A busy, thin-stretched staff may be unavoidable at times, experts say. But does it always feel chaotic when you visit? Are staff working well together, or do they seem to have bad attitudes? At meals, do they talk only among themselves or do they mingle with residents? Does important information get lost between shift changes?

Don’t overlook the leadership. Is the director nowhere to be found and unknown to residents? “I have never seen a place with strong, involved leadership that had bad care,” says Barbara Bowers, associate dean for research at the University of Wisconsin-Madison’s School of Nursing, who researches long-term care delivery.

4. High staff turnover. “Some regular staff turnover is an unfortunate reality at most nursing homes,” says Kind. “However, if you notice that your loved one’s nursing home constantly is training new staff to the point that no one on the staff knows your loved one—well, it is time to look for a new nursing home.” Consistent staff-resident pairing is important in the quality of care Mom gets.

5. “I don’t want so-and-so to care for me.” Your loved one should never feel distressed or uncomfortable around any staff member, experts say. Even if Dad suffers from cognitive problems, “take these statements seriously and investigate them thoroughly with the nursing home leadership,” says Kind. “They may be signs of mistreatment or neglect.”

And even if Dad doesn’t say anything, observe him when staff enters the room. Does he seem happy? Or is he anxious, fearful, or uncomfortable?

6. Constantly ringing phones and unanswered call lights. It should raise an alarm if the nursing staff doesn’t have the time to pick up the phone, says Elisa Gil-Pires, section chief of geriatric medicine and palliative care at Saint Francis Hospital and Medical Center in Hartford, Conn.

And if Mom says she’s waiting a long time after pushing the call button, “find out for yourself,” says Erin Hilligan, a licensed nursing home administrator at Ebenezer Ridges, a long-term care facility in Burnsville, Minn. “Put the light on. Note if the delay is during a specific time of day—shift change or a meal time, maybe. Then bring up your concern to a staff person and note how it is handled.” Of particular concern, adds Sewell, is if Mom says something like, ” ‘I waited as long as I could for someone to help me to the bathroom and then I just could not wait any longer, and so I got up on my own.’ ”

7. Dehydration and malnourishment. “One of the most frequent and insidious signs of neglectful nursing home care is dehydration,” says Kind. “If a nursing home does not have the adequate number of high-quality staff, residents in that home may not receive all of the food or fluids they need to remain hydrated and nutritionally sound. Meals may even be completely missed.” Act immediately if you suspect this is occurring, Kind says.

8. Status quo reigns. Ask staff what improvements the nursing home has recently put in place, especially since your loved one moved in. In particular, ask about anything they told you would be updated by now. “It is easy to identify nursing homes that are trying to improve and ones that are trying not to get shut down,” says Uy.

9. A bad feeling. Ultimately, your gut knows. “Most of these warning signs will be the family member’s concern that something is not right, or a feeling of uneasiness when they visit,” says Gil-Pires.

Kaiser Health News reported on the debate on staffing levels in a bill modeled on a California law that would require health care providers to maintain a minimum nurse-to-patient ratio at all times.  Nurses, consumer advocates, and health care experts agree that the Patient Protection Act codifies into law minimum staffing levels that are needed to maintain patient safety and meet patient needs.  Citing positive outcomes of the California law, the labor union National Nurses United is strongly pushing for the staffing ratio bill in D.C.  Studies have shown that the law has led to an increase in nurse hiring in California and a decrease in nurse turnover due to burnout.

 

CMS Issues Sunshine Rule
By Joyce Frieden, News Editor, MedPage Today
Published: February 01, 2013

The Centers for Medicare and Medicaid Services issued a long-awaited rule Friday finalizing the details for a database that will list payments made to physicians by pharmaceutical and device manufacturers.

You should know when your doctor has a financial relationship with the companies that manufacture or supply the medicines or medical devices you may need,” Peter Budetti, MD, the agency’s deputy administrator for program integrity, said in a statement. “Disclosure of these relationships allows patients to have more informed discussions with their doctors.”

The rule, a provision of the Affordable Care Act known as the Physician Payments Sunshine Act, “finalizes the provisions that require manufacturers of drugs, devices, biologicals, and medical supplies covered by Medicare, Medicaid, or the Children’s Health Insurance Program to report payments or other transfers of value they make to physicians and teaching hospitals to CMS,” the statement explained. “CMS will post that data to a public website. The final rule also requires manufacturers and group purchasing organizations (GPOs) to disclose to CMS physician ownership or investment interests.”

Data collection will start on Aug. 1, CMS said, noting that “Applicable manufacturers and applicable GPOs will report the data for August through December of 2013 to CMS by March 31, 2014 and CMS will release the data on a public website by Sept. 30, 2014. CMS is developing an electronic system to facilitate the reporting process.”

The rule “is intended to help reduce the potential for conflicts of interest that physicians or teaching hospitals could face as a result of their relationships with manufacturers,” the statement continued.

1.The event meets the accreditation or certification requirements and standards of the Accreditation Council for Continuing Medical Education, the American Dental Association’s Continuing Education Recognition Program, the American Academy of Family Physicians, the American Medical Association, or the American Osteopathic Association

2.The drug or device company doesn’t directly pay the speaker

3.The drug or device company doesn’t select speakers for the event or “provide the third party (such as a continuing education vendor) with a distinct, identifiable set of individuals to be considered as speakers for the continuing education program”

“We believe this reporting strategy appropriately separates accredited and certified continuing education from unaccredited and noncertified continuing education, so that consumers can better understand the nature of the payment received by a covered recipient,” the agency noted in the rule. “We also believe that educational speaking engagements should be separated from all other speaking engagements, promotional or otherwise.”

The American Medical Association responded cautiously to the release of the final rule. “The AMA will carefully review the new Physician Payment Sunshine Act rule,” AMA President Jeremy Lazarus, MD, said in a statement. “Physicians’ relationships with the pharmaceutical industry should be transparent and focused on benefits to patients … As the rule is implemented, we will work to make sure physicians have up-to-date information about the new reporting process.”

Others were more effusive. “This rule allows a long-delayed transparency measure to take effect,” Allan Coukell, director of medical programs at The Pew Charitable Trusts, said in a statement. “Public reporting of the financial relationships between doctors and drug or medical device companies will protect patients and help restore trust in our healthcare system. We applaud the Centers for Medicare and Medicaid Services for issuing the Sunshine regulation, which will now allow manufacturers to comply with their reporting obligations under the law.”

The CMS action comes after complaints by physicians and others that the agency was taking too long to issue the rule.

“We applauded its passage but, nearly 3 years later, we are disappointed that the [Sunshine Act] has yet to be implemented — especially in light of reports that the final rules are being held up at the White House Office of Management and Budget,” a group of prominent physicians, including former New England Journal of Medicine editors Marcia Angell, MD, and Jerome Kassirer, MD, wrote in a January letter to outgoing White House Chief of Staff Jack Lew.

“Financial relationships between physicians and drug and medical device companies can create conflicts of interest that threaten the quality of patient care and drive up healthcare costs,” the letter continued. “As our nation struggles with these problems, it is imperative that the administration implement the [Sunshine Act] without any further delay.”

The rule is scheduled for publication in the Federal Register on Feb. 8.