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NURSING HOME REFORM
NEWSLETTER
January 18, 2006
FIRST, A PERSONAL NOTE...
It is our practice not to
inject personal information into this newsletter, mainly because I am an
old journalist who was brought up that way, and mostly because you don’t
have time to read about me. But I am going to break that rule this one
time because what happened on Jan. 4 affects my activities in working on
nursing home reform. In short, I suffered a mild heart attack. Was
rushed to the hospital and received two stents. I feel fine now and have
my energy back, but the warning is not to go at it too hard. So if there
is something you think I have missed or should be on top of, you will
know why not. I might not be able to be in Frankfort as much, but I can
still do these newsletters and keep you informed... so that you can
help.
AN UPDATE ON LEGISLATION...
Kentuckians For Nursing
Home Reform is tracking bills in this 2006 legislative session. Here
is the ones that have been introduced so far, and what we think about
them:
HOUSE BILL 303. This bill strengthens the state penalties on
nursing homes for violations. When the violation has to do with
insufficient staffing, the fines are tripled. Each year, the Cabinet for
Health and Family Services will have to report to the legislature the
number and types of citations issued to nursing homes the previous year
and point out the ones pertaining to shortages of insufficient staff.
This is a bill that will definitely get the attention of nursing homes
on the staffing problem and one we should support. Rep. Tom Burch,
D-Louisville, and chair of the House health and welfare committee,
introduced this bill.
HOUSE BILL 362. This is a bill that sets minimum staffing
standards for nursing homes. It is being introduced again by Rep. Kathy
Stein, D-Lexington. If we could get this bill, or a version of it,
passed, many of the problems in nursing homes would be solved.
Therefore, we support this bill. The nursing home industry will lobby
heavily against this bill.
HOUSE BILL 360. This is a bill that penalizes anyone who would
intentionally tip off a nursing home that it is going to be inspected by
the state. This bill passed the House last year but did not make it out
of the Senate judiciary committee. It is introduced again by Rep. Kathy
Stein, D-Lexington.
HOUSE BILL 121. There are still nursing homes in the state that
have no fire-prevention sprinkler systems. And there are more only
partially sprinkled. Until a federal law mandating sprinklers in all
nursing homes passes, this bill, introduced by Rep. Susan Westrom,
D-Lexington, is a good back-up. It says that nursing homes must let
people know before they are admitted whether they have a sprinkler
system. With all the terrible fires that have occurred in nursing homes
in recent years, a person would be crazy to live in one without
sprinkler protection. This bill was filed last year and did not come out
of committee. We support this bill.
HOUSE BILL 300. This bill would make it possible to report to the
district court misuse of a person’s assets by a durable power of
attorney. The court could require an accounting and thereby stop the
misuse before an entire estate is gone. This legislation would also
clarify that the appointment of a guardian or conservator revokes or
limits a durable power of attorney. Former state Supreme Court Justice
Jim Keller is pushing this one and Rep. Robin Webb, R-Grayson, is the
sponsor. We recommend it for your support, too.
HOUSE BILL 177. This bill says that someone with a criminal
record can stay with a resident of a nursing home or assisted living
facility for up to two hours a day. That would be like a volunteer or
paid caregiver. But residents do not want a criminal staying with them
any time. This bill was introduced by Rep. John Vincent, R-Ashland.
Hopefully, this bill will not come out of the health and welfare
committee, and we oppose its passage.
HOUSE BILL 93. This bill, introduced by Rep. Rob Wilkey,
D-Scottsville, would let people convicted of a Class D felony have their
record expunged. Some of these people could end up working in nursing
homes. We don’t like that and so we oppose this measure.
NOTE: For any of these bills, you can read a brief description
and the bill itself by going to
www.lrc.ky.gov/record/06RS/record.htm
We will keep you updated as changes occur in the status of legislation
on nursing home reform. Of course, we will alert you immediately when a
bill is going to be voted on.
FROM THE NEW YORK TIMES...
Apparently people are
beginning to catch on to the poor care in many nursing homes. Following
is an article from The New York Times which we are reproducing in its
entirety because it is related to several of the bills discussed above.
Here it is, and hope you have time to read it all:
http://www.nytimes.com/2006/01/16/politics/16nurses.html?th&emc=th
January 16, 2006
NURSING HOME INSPECTIONS MISS VIOLATIONS, REPORT SAYS
By ROBERT PEAR
WASHINGTON, Jan. 15 - State
inspectors often overlook serious deficiencies, including
life-threatening conditions, in the nation's nursing homes,
Congressional investigators say in a new report.
In the report, the investigators, from the Government Accountability
Office, questioned data used by the Bush administration in arguing that
its policies have fostered "significant improvements" in the nation's
nursing homes.
Nursing homes must meet federal standards to participate in Medicaid and
Medicare. Homes are inspected by state employees working under contract
to the federal government.
Much of the apparent improvement has resulted from the fact that those
state inspectors "missed serious deficiencies" or understated their
severity, the accountability office said.
The Congressional investigators found pervasive understatement of
"serious deficiencies that cause actual harm or immediate jeopardy to
patients." The harm includes severe weight loss, "multiple falls
resulting in broken bones and other injuries, and serious, avoidable
pressure sores," the report said. The deficiencies included fire safety
violations.
The top Medicare official, Dr. Mark B. McClellan, said that he too was
"concerned about possible understatement or omission of serious
deficiencies" by state inspectors.
Over all, Dr. McClellan said, the quality of nursing home care has
improved in the last five years. But, he said, these gains are in
jeopardy because Congress has not provided enough money and state
budgets for this purpose are "very limited."
Dr. McClellan said the Bush administration wanted to link payment of
nursing homes to the quality of care they provide. He said he expected
to test such a "pay for performance" system this year.
Medicaid, the federal-state program for low-income people, covers
two-thirds of the nation's 1.6 million nursing home residents. Together,
Medicaid and Medicare spend more than $67 billion a year on nursing home
care.
The study was requested by Senators
Charles E. Grassley,
Republican of Iowa, and Herb Kohl, Democrat of Wisconsin. "If state
surveyors are missing serious deficiencies in the quality of care, then
the federal government has not yet achieved the necessary level of
improvement in oversight of the inspection process," said Mr. Grassley,
who is chairman of the Finance Committee.
In its report, the Government Accountability Office made these points:
States often take weeks or months to start investigating reports of harm
to nursing home residents. These reports come from patients and their
relatives and from nursing home employees.
Some useful information on nursing home quality is available at a
federal Web site, but much of the data is inaccurate or unreliable.
The timing of inspections is highly predictable. This "allows homes to
conceal problems if they so desire."
Concerns about cost have delayed the installation of automatic sprinkler
systems in older nursing homes. More than 20 percent of homes lack such
fire protection devices. The industry wants the government to help pay
the installation costs, estimated at $1 billion.
Dr. McClellan said the proportion of nursing homes cited for serious
deficiencies had declined sharply, to 16 percent last year from 29
percent in 1999.
The Government Accountability Office found great variation from state to
state, and it suggested that inspectors were more rigorous in some
states.
From 2003 to 2005, the report said, California cited 6 percent of its
nursing homes for serious violations, while Connecticut cited 54 percent
of its homes.
Senator Kohl said, "There are too many inconsistencies in what is deemed
a deficiency from state to state."
The accountability office said that some inspectors were confused about
the meaning of "actual harm." As a result, it said, the same conditions
are sometimes viewed as a violation of federal rules in one state but
not in others.
Texas reported a big decline in serious deficiencies over the last five
years. But one reason, the report said, is that Texas had "a significant
number of inexperienced surveyors" who were hesitant to cite nursing
homes for major violations.
The Bush administration said that, by some measures, the regulation of
nursing homes had improved. For example, it said, inspectors
investigated 47,124 complaints in 2004, reflecting an increase of 45
percent over the number investigated in 1999.
Moreover, Dr. McClellan said, inspectors have paid more attention to
fire safety since 31 people died in nursing home fires in Connecticut
and Tennessee in 2003. Inspectors identified 47,456 fire-safety
violations in 2004, an increase of 20 percent over the previous year.
Federal employees visit about 5 percent of the nation's 17,000 nursing
homes each year to validate the findings of state inspectors. In 28
percent of these visits from 2002 to 2004, the federal agents found
serious problems not detected by state inspectors. This proportion has
increased in recent years, from 22 percent in 2000 to 2001.
STILL MORE EVIDENCE OF STAFFING SHORTAGES
An upcoming report from
something called the International Longevity Center-USA, a non-profit
research affiliate of New York’s Mount Sinai School of Medicine, will
report that its research shows that nine out of 10 nursing homes fall
below minimum staff standards. Same as that federal study a couple years
ago we keep telling state legislators about.
CAUTION. ‘STATE AT WORK’
The new Medicaid program for
Kentucky is expected to be approved soon. How will it affect nursing
home care? Probably not at all at first. But in “phase two,” look out.
There are some signs that the state has been at work to reduce costs in
Medicaid by letting only certain people into nursing homes, if they are
on Medicaid. This comes out in a study of the new program done by Health
Management Associates of Chicago. It’s no secret that the state wants
everyone to stay at home for their long-term care and out of nursing
homes. That’s because Kentucky officials believe that in-home care is
cheaper than nursing homes. (Not necessarily true, according to some
research we have seen.) Kentucky AARP with Laurel True leading the way
has been pushing what they call “person-centered” funding. Sound
gimmicky? It is. Our answer is that while no one wants to go to a
nursing home, sometimes it is a necessity. What happens then? Well, we
will just have to wait and see, but the fear here is that a new state
employee called a “support broker” could easily become the most hated
person in the state. He will decide if you can go in a nursing home. If
you want to read this study, go to www.healthyky.org/PDFs/KY%20Health%20-%20Long%20Term%20Care.pdf
And thanks to Sheila Schuster for alerting us to the study.
FEEDBACK FROM A NURSE ASSISTANT...
Here is a letter we
received from a certified nursing assistant in a nursing home in
Kentucky:
“…. I have been a CNA for nearly 20 years and try to bring up issues
about the care given by "non-qualified" CNA's (Certified Nursing
Assistants) and/or nurses.
“The nursing personnel hired to ‘take care of’ all of the residents and
patients at a nursing facility or hospital are often underpaid and
under-staffed. Under-qualified personnel with little knowledge can harm
residents. There is nothing that can be done except to bring this to the
attention of the director of nursing, the assistant director of nursing
and the administrator, and sometimes to Adult Protective Services in
your area.
“Sadly, there are many aged Americans who are neglected and abused by
their own "legal caregivers" such as family members or POA's. Those such
as myself have little chance to say much about this matter when you
barely have the time to care for 15-18 people on 2nd shift or 27-30 on
3rd shift.
“My feedback to this situation would be:
1. “Don't lose track of those most important to you, no matter their
health, emotional or mental well-being. They are as special as anyone.
2. “Don't expect the nursing personnel to inform you of any abuse or
neglect. That is your responsibility to follow up on ANY suspicious
activity at the nursing facility. The nursing personnel are already
overworked, underpaid and undervalued enough, without having to put
their careers on the line for a resident who has already been given up
on by their own family members.
3. “Nurses and CNA's should respectfully ask for someone, such as family
members or POA's, to lobby Congress to enact a NATIONWIDE
resident-to-caregiver ratio (something more like 1:8 instead of 1:15-30
for CNA's).
4. “Lobby Congress to enact a better pay scale and/or working conditions
for qualified/compassionate/well-educated CNA's so they may be able to
give the well-deserved care they are seeking to give. Many times CNA's
are forced to give only minutes of care instead of the needed emotional,
physical and compassionate care the residents require.
5. “Instead of having five minutes of "in-service" training on making
sure you answer call lights immediately, have a better-rounded
in-service to include the proper care, compassion and understanding that
we are supposedly there to provide.
“My love goes out to anyone with a family member in a nursing facility
that has been known to inflict injury or persecution. I could only ask
that you never forget about them, never give up on them, and by all
means SHOW them that you care.”
--
NAME WITHHELD
SHORT
STUFF
• Residents of nursing and
assisted living facilities in Bardstown and Campbellsville can save as
much as 60 percent on the cost to live there if they are a qualifying
veteran of the armed services. The help comes from a federal assistance
program. Rep. David Floyd, R-Bardstown, owns the facilities...
• Northern Kentucky advocates for the elderly got a boost recently in
the form of a federal grant of $2,600 that will help establish a
safe-haven for elderly people trying to escape abuse. District nursing
home ombudsman Pam Pangburn has been one of the leaders in getting the
project started...
• You think these nursing homes aren’t making money? Beverly Enterprises
in Little Rock is the second biggest nursing home operator in the
nation, and they have eight nursing homes in Kentucky. They are in the
process of being sold to an outfit in San Francisco for $2.29 BILLION.
Their chief executive officer just negotiated a severance package valued
at $40.2 million, according to an SEC filing...
• The seniors housing and care sector outperformed the rest of the stock
market in 2005 by leaps and bounds. And so far this year? Almost all of
them are up again, with Kindred Healthcare, headquartered in Louisville,
leading the pack of skilled nursing companies with big stock market
gains...
• Just a warning in case you are thinking of writing someone in the
federal government to complain or make a suggestion about nursing home
care. Don’t count on a reply. Jim Vonderhaar, a Virginia man who has a
sister in a Kentucky nursing home, wrote Mark McClellan, chief
administrator for the Centers for Medicare and Medicaid Services in
Washington, a letter on May 24, 2005, supporting efforts to improve fire
safety in nursing homes. He still has received no reply. Those big shots
are busy up there...
• They had something called the White House Conference on Aging which is
one of the bigger jokes in the nation’s Capitol. Hundreds of delegates
attended and they came up with such hard-hitting resolutions as,
“Reauthorize the Older Americans Act,” “Develop a Coordinated,
Comprehensive Long-term Care Strategy,” and our favorite, “Insure That
Older Americans Have Transportation Options.” Thousands of your tax
dollars are spent on this boon-doggle….
• Showing just how cost-driven many nursing homes are, the PEG has
become widely used by them. The PEG is a feeding-tube. Its scientific
name is percutaneous endoscopic gastrostomy nozzle. And it’s easy for
the nursing home to use. Lots easier than feeding people by spoon
individually. The Wall Street Journal recently reported that “It’s often
easier for overworked nursing homes to use tubes to feed frail, demented
patients who can’t feed themselves.” And the author of a JAMA study on
the device says, “If you’re in a nursing home where a lot of people are
PEG fed, that’s a poor nursing home,” implying that the motivation is
the bottom line, not the patient...
• A national advisory commission called the Medicare Payment Advisory
Commission has predicted that profit margins for skilled nursing
facilities will be lower in 2006, and on top of that has recommended
that the feds give zero inflation adjustment to them. While MedPAC’s
recommendations are often ignored by the feds, the nursing home industry
is already hollering and wailing those all-too-familiar howls of how
badly they will be hurt. No problem, as we see it. The industry just
digs a little deeper in the “donations” to lawmakers’ bottomless bags,
and official Washington will come though with money for them again...
P.S.
It was entertainment night
at the senior center and the Amazing Claude was topping the bill. People
came from miles around to see the famed hypnotist do his stuff. As
Claude went to the front of the meeting room, he announced, "Unlike most
hypnotists who invite two or three people up here to be put into a
trance, I intend to hypnotize each and every member of the audience."
The excitement was almost electric as Claude withdrew a beautiful
antique pocket watch from his coat. "I want you each to keep your eye on
this antique watch. It's a very special watch. It's been in my family
for six generations.”
He began to swing the watch gently back and forth while quietly
chanting, "Watch the watch, watch the watch, watch the watch..." The
crowd became mesmerized as the watch swayed back and forth, light
gleaming off its polished surface. Hundreds of pairs of eyes followed
the swaying watch, until, suddenly ----- it slipped from the hypnotist's
fingers and fell to the floor, breaking into a hundred pieces.
Shit!" said the hypnotist...
It took three weeks to clean up the senior center.
-- Another one passed on by Bob
Pfeifer of Louisville.
DON’T FORGET….
MORE THAN 23,000 PEOPLE IN NURSING HOMES IN KENTUCKY NEED US. THEY ARE
KENTUCKY’S FORGOTTEN PEOPLE.
Sincerely,
BERNIE VONDERHEIDE
KENTUCKIANS FOR NURSING HOME REFORM
E-mail: KyNursingHomeReform@yahoo.com
Telephone: (859) 312-5617
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