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NURSING HOME REFORM NEWSLETTER
July 8, 2005
WHO WILL BE THE NEXT STATE OMBUDSMAN?
On the heels of state long-term care ombudsman John Sammons announcing
his retirement on Aug. 1, has come a whole bunch of other ombudsman
officials trying to bail out of the program. It is no secret that many
of them do not approve of the way the current administration is treating
the program. It all started when the long-term care part of the
ombudsman program in the Cabinet for Health and Family Services was put
way down in the cabinet organizational chart. Rumors are flying fast and
hard in Frankfort as to who will be Sammons’ successor. One name
prominently mentioned is Kathy Gannoe of Lexington who is the head
ombudsman of the Bluegrass district. Mrs. Gannoe would be a wonderful
choice if she accepts the job. But other rumors have it that the job
will be taken out of the state Merit System and left to a political
appointment. Mrs. Gannoe’s son is an aide to Gov. Ernie Fletcher which
might be a factor in her appointment. We don’t think this able and
talented lady needs any political help, however, if indeed she wants to
take the job. Maintaining full disclosure, we should said that we serve
on Mrs. Gannoe’s ombudsman agency board. We have therefore worked with
her, and would say unequivocally that if she could get this job on the
right terms, which would mean no political appointment and giving her
freedom to reorganize the long-term care program and where it reports,
then we would have a real champion of quality nursing home care in state
government. This could be a real feather in the Fletcher
administration’s hat. We would like to see the program report to the
governor directly, but we doubt that will happen. In any case, the
long-term care ombudsman should report directly to the secretary for the
cabinet. We shall see.
SPEAKING OF OMBUDSMEN
Someone contacted us recently about the education level of nursing home
ombudsmen in Kentucky. This person said she knows of one ombudsman in
the state who has only a high-school level education. We looked into
that and found that the preponderance of district ombudsmen in Kentucky
have a good education – with Master’s, law and associate college
degrees. State ombudsman John Sammons instituted minimum qualifications
for ombudsmen. Future hires for district ombudsman must have a four-year
degree from a college or university or equivalent years of experience.
WHAT’S NEXT FOR STAFFING
REFORM?
As the summer drags on, legislators are considering their key issues in
the 2006 session of the Kentucky General Assembly. Will improvement in
front-line staffing of nursing homes be in the new mix? The answer is
"probably," if two key lawmakers, Rep. Tom Burch, D-Louisville, and Rep.
Jimmie Lee, D-Elizabethtown, have anything to do with it. They have
promised hearings on staffing proposals and a "summit" meeting to figure
out answers. We will keep you informed of what’s happening and let you
know about any meetings this summer so that you can call your legislator
and attend the meetings yourself.
BE WATCHING….
When asked by an advocate for nursing home reform from Kentucky whether
he favored federal legislation to mandate quality staffing standards in
nursing homes, former Gov. Mark Warner, D-Va, said: "We've looked at
this just recently in Virginia, especially on assisted living and adult
homes. I think there might be some best practices... but whether there
ought to be a federal mandate, I have some concern there." What does
this mean to Kentuckians? This guy may run for President, so be watching
and listening.
WHAT ABOUT MEDICAID?
Medicaid could be the tail that wags the dog in the 2006 legislative
session with a looming $675 million shortfall that could get even worse
by the time the lawmakers meet in January. At a meeting of people
interested in Medicaid cuts last week, state officials discussed the
"savings" they are making by establishing co-pays for poor people on
prescription drugs. That, coupled with some other actions the state is
taking, so far saves a whopping $39 million. Rep. Lee, the acknowledged
expert on Medicaid among the legislators, says that is not near enough
and that the real problem is the attitude of state and national
lawmakers toward poor people, especially the elderly. "Society has never
made a determination as to whether we take care of people who cannot
take care of themselves. We are only kidding ourselves if we think these
little decisions (referring to so-called savings so far of only $39
million) make a difference." One top state official, Mark Birdwhistell,
said, "We are running out of easy decisions…. We are looking for
creative options." He left the meeting quickly before we could ask him
what those "creative options" might be. More than 70 percent of the
people in nursing homes are supported by the Medicaid program. The
Patton administration tried to kick people out of nursing homes to save
Medicaid dollars. But Birdwhistell said, "Removing people from the
Medicaid rolls is a last resort." This is something to keep your eye on
in the months ahead and we will try to keep you informed of how the
crisis will affect nursing home care.
PUBLIC FORUMS ON MEDICAID
ANNOUNCED
The state Cabinet for Health and Family Services will conduct two public
forums next week to hear Kentuckians' suggested solutions to address the
$675 million shortfall facing the Medicaid program in fiscal year 2006.
The first forum will be held from 10 a.m.-noon CST on Wed. July 13, in
Meeting Room 2 of the Holiday Inn University Plaza in Bowling Green
(1021 Wilkinson Trace). The second forum will be held from 10 a.m.-noon
EST on Thurs. July 14, in the Clubhouse at Levi Jackson State Park in
London (Jackson Mill Road). Cabinet Undersecretary for Health Mark
Birdwhistell and Medicaid Commissioner Shannon Turner will be at the
meetings to answer questions and take suggestions. We would urge readers
with family or friends in nursing homes to attend these forums.
PREDICTION
We don’t ordinarily make predictions here, but we will go out on the
limb this month and make one about Medicaid. The shortfall will not go
away, and the ideas to solve it will be too little and too slow in
coming. With their backs against an immovable wall of a $675 million
shortfall, we think legislators will look to additional revenue to solve
the problem, and that leads us to legalized gambling in Kentucky at
casinos and racetracks. We think the racetracks have the inside edge and
will win by a nose. Part of the sanctimonious rhetoric on the subject
will be saving Medicaid "for the poor people." We do like former Gov.
Brereton Jones’ idea to pass a constitutional amendment on gambling and
make part of the proceeds go to supporting and improving nursing home
care. He wants a constitutional amendment because these are harder to
change than simple legislation. Rep. Burch introduced the idea of tying
gambling to raising revenue for health care in the last session. The
gambling forces are powerful lobbyists so don’t underestimate their
making Medicaid one of their "causes."
QUOTE OF THE MONTH
Rep. Steve Nunn, R-Glasgow, attending a Medicaid informational meeting
last week was asked him to say something about the Medicaid shortfall
problem. "Lord help us," he said.
UK COLDSTREAM PROJECT
MOVING ALONG
The project to build a continuing care retirement community on the
University of Kentucky Coldstream Research Campus is moving along, but
not without a few bumps along the way. The UK board of trustees voted to
give The Praxeis Group of Jacksonville, Fl., the right to conduct a
feasibility study on the project that would include independent living,
assisted living and a nursing home. Praxeis developed a similar facility
at the University of Florida. Like any big project, questions emerge. UK
trustee Billy Wilcoxson questioned whether the Coldstream land is too
valuable to use for such facilities. Mr. Wilcoxson knows valuable
property when he sees it apparently because he is the business agent for
NBA basketball star Tayshaun Prince and other NBA standouts. Mr.
Wilcoxson told us, however, that he is still in support of the project,
in fact he made the initial motion to move it along at a trustees’
meeting last year. Another trustee – this one retired -- has made a lot
of noise objecting to the project on the grounds that Coldstream should
be used for research. Apparently he does not realize that the retirement
complex – especially the assisted living and nursing home -- on
Coldstream can be used as a living laboratory to study quality long-term
care. Research on long-term care will become very important as
Kentucky’s population ages quickly as it is expected to do. Trustee
Alice Sparks said the project could eventually have 400 residents and
100 employees and a budget of some $15 million. She is the sister of
Lexington Urban Councilman David Sparks who also is pushing the idea.
Mrs. Sparks said that if all goes well, UK – which furnishes only the
land, nothing else – is hoping for an August 2009 move-in date.
SHORT STUFF….
Niel Gulsvig, the guy whom we reported last month gave Kentucky
legislators glowing reports on nursing home care as a result of surveys
his firm did for the nursing home industry, is himself a former Beverly
Enterprises, Inc. nursing home executive who was in charge of operating
200-250 nursing homes. Beverly is the biggest nursing home chain in the
nation. He reported to legislators at a meeting last month in Northern
Kentucky…. The Kentucky Special Advisory Commission of Senior Citizens
passed a resolution supporting quality staffing standards for front-line
caregivers in all nursing homes in Kentucky. Veteran activist Abby
Marlatt of Lexington and others pushed the resolution. The statewide
group will lobby the legislature on behalf of all their resolutions…. A
127-bed nursing home, Woodcrest Manor Care Center in Kenton County, has
been sold to Extendicare Health Services of Milwaukee. Extendicare, you
remember, also owns the nursing home in Henderson – Medco Center -- that
was accused of allegedly having too few staff. The state investigation
of the Henderson facility, concerning the charges, is still on-going.
Medco has denied it has a staffing shortage…. An employee of Britthaven
Nursing Home in Bowling Green has been accused of allegedly abusing a
family member and also charged with three counts of incest….Gov. Ernie
Fletcher said he will extend the moratorium on opening any new nursing
homes in Kentucky. That move by the governor, in effect, bars any new
competitors for the existing nursing homes in Kentucky…. A federal
Government Accounting Office report says that the feds ability to
investigate fraud and abuse in the individual states has been cut back
so far that a state’s Medicaid program will get federal oversight no
more than once every seven years…. A study sponsored by the Kaiser
Family Foundation says that 84 percent of the elderly most likely to
need nursing home care would exhaust their assets within one year in a
nursing home…. The Wall Street Journal reports that 6 million U.S.
residents have long-term care insurance, but the number buying such
policies last year decreased 38 percent from five years ago…. A possible
preview of things to come: CMS administrator Mark McClellan has called
on Congress to remove what he called a Medicaid "institutional bias"
under which the program pays for nursing home care but not
community-based care. We will probably hear about doing this in Kentucky
during the next session, which is fine, as long as funding of it doesn’t
come from the funding that is being used to take care of people in
nursing homes.
YOU’RE THE BOSS
A legislator I ran into, who totally disagrees with nursing home reform,
said he would not meet with me to give me the opportunity for sharing
our case for nursing home reform. He said, "I don’t care to meet." I
smiled and said, "But after all, I’m your boss." He flew off the handle
at that and said someone he knew thought I was a "nut." I dropped the
conversation at that because it was going no where constructive. But I
got to thinking: We really are the boss of these lawmakers in the
legislature. They work for us, the taxpayers. They are supposed to
represent us and our views in the General Assembly. And it was strange
that this one legislator apparently took offense at my suggesting that.
I find that a number of people are afraid of legislators and other
governmental officials. That is too bad, because these people need to
know what we think. So don’t be timid in explaining nursing home reform
to your legislator. Be courteous, but be firm in your convictions and
explaining them. Don’t let your legislator tell you that he is too busy
to listen. After all, you really are the boss.
P.S.
Just came across this exercise suggested for seniors, to build muscle
strength in the arms and shoulders. It seems so easy, so I thought I'd
pass it on some of my younger friends. The article suggested doing it
three days a week.
Begin by standing on a comfortable surface, where you have plenty of
room at each side. With a 5-lb. potato sack in each hand, extend your
arms straight out from your sides, and hold them there as long as you
can. Try to reach a full minute, then relax.
Each day, you'll find that you can hold this position for just a bit
longer. After a couple of weeks, move up to 10-lb. potato sack.
Then 50-lb. potato sacks, and eventually try to get to where you can
lift a 100-lb. potato sack in each hand and hold your arms straight for
more than a full minute.
After you feel confident at that level, put a potato in each of the
sacks.
Thanks to Bob Pfeifer, Louisville
DON’T FORGET….
MORE THAN 30,000 PEOPLE IN NURSING HOMES IN KENTUCKY NEED US. THEY ARE
KENTUCKY’S FORGOTTEN PEOPLE.
Bernie Vonderheide
KENTUCKIANS FOR NURSING HOME REFORM
Tel: (859) 312-5617
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