July 21, 2009
NEWSLETTER
A non-profit organization dedicated to the welfare of the “Forgotten Kentuckians”
WATCH ON WASHINGTON
A new national group, called the Coalition for Quality Care, an organization of citizen advocacy groups working for quality long-term care, is hard at work to have included in the current health care reform bills now being hotly debated in the Congress provisions contained in the Nursing Home Transparency and Improvement Act, a sweeping measure on nursing home reform recently introduced in the Congress
In effect, what advocates for nursing home reform have been able to do is fold the Nursing Home Transparency and Improvement Act into the health reform bills. The challenge now is to keep it there.
The nursing home reform provisions would ensure much-needed transparency of exactly who owns the corporate structures like these big nursing home chains. It would force all nursing homes to disclose their owners and operators. This would help not only residents and their families (like, if you want to complain, whom do you complain to?) but also help the states and the federal government provide better oversight for multi-state nursing home chains. All this has come up because in recent years several large chains have been bought out by global private equity investors. Furthermore, a majority of nursing homes are now owned by for-profit corporations. Most of them are looking out for their bottom line; providing good service comes secondary. The way these companies structure themselves, even our state health regulators often cannot determine who owns them, especially when the owners are out of state. This can create a dangerous situation for the residents, because no one can be found to be truly accountable for what happens.
Another important part of the proposed legislation would pull back the veil of secrecy and uncertainty that surrounds staffing numbers and ratios in nursing homes. Once and for all, you would be able to fine out exactly how nursing homes are staffed so that everyone can know whether they really do have adequate staffing as many of them claim they do.
Our ever-growing elderly population and their families deserve nursing homes that are transparent and accountable and have adequate staffing. Surely it is not too much to expect of our lawmakers to mandate laws that will ensure our getting at least information on exactly who the owners and operators are and exactly how they are staffed.
Nursing home residents and their families badly need this information to help them make good choices when they choose a nursing home. But watch out. The nursing home industry is hard at work to stop these reforms —and they are a big and wealthy industry. That’s where you come in. Read on.....
WHAT YOU CAN DO
Now is not the time to stand by and permit the rich nursing home industry to have its way. Let your lawmakers in Washington know that you want them to support the reform issues in the new health care reform legislation. It’s in there now, but only your voices will keep it there. Our national advocates with NCCNHR in Washington and many citizen advocates in the states (see previous item) are working hard to get this. Important reform measure included in whatever health care legislation comes out of the Congress, but we have to do our part from the grassroots. If you have not done so already, please go to our Web site, http://www.KyNursingHomeReform.org and on the front page it will tell you exactly what to do.
FIVE-STAR SYSTEM UNDER ATTACK
The feds new rating system for nursing homes is predictably under attack by the nursing home industry. You can see why. Just imagine owning one of those big for-profit facilities, making money hand over fist and all of a sudden you pick up the paper and you are rated only one star. Now that hurts..... the bottom line that is. Even though there were facilities that actually received a Five-Star rating, the new system was a call to arms for the "don’t mess with us" nursing home industry. High-paid lobbyists in black suits and red ties have begun storming Washington calling the new system "unfair." Poor, rich things..... they might soon have to clean up their act. Except that money often talks louder than words and nursing home residents are always very quiet and their advocates are terribly underfunded and most do not even own a red tie, much less a black suit. The industry has prepared two lengthy papers on the system, one of which is being used in an undercover campaign aimed at federal lawmakers. The papers simply say the current nursing home inspection system should be scrapped. Replace it with a kinder, gentler system where inspectors and nursing home owners work “cooperatively and collaboratively” to achieve improvements. That would certainly change the Five-Star System. Every nursing home in America would have five stars. All this is not to say the system is perfect, and there always can be adjustments and improvements to it, some of them very important. The ratings on staffing, for example, need to be based on actual work hours of staff from facility time sheets, not “reports” —many of them highly questionable— by facilities as it is now. A recent Washington Post story said, "As CMS weighs changes to the system, the first priority will probably be staffing information." So there is important work to be done. In short, make adjustments, but do not scrap the system.
By the way, if you want to see how nursing homes in your area are rated, just go to http://www.medicare.gov/NHCompare.
HORSES OF DIFFERENT 'COLORS'
It strikes us that there is a similarity in the frustration of the horse industry in Kentucky and the efforts of advocates to get reform measures passed. Recently, in a special session of the Kentucky General Assembly, it was the horse industry that was abruptly pulled up when the bill to put slots at racetracks got killed in the state Senate. In recent years, advocates for nursing home reform have also found frustration when they were told by legislative leaders that "your bills don’t stand a chance in the Senate." At least the horsemen did get a committee hearing in the Senate, albeit a failed effort, but nursing home bills don’t even get that. Frustrating indeed.
Now we read where the powerful and rich horse industry may take to the hinterlands for some old fashioned grassroots politicking to unseat Senators who voted against "racinos." (Headline in The Courier-Journal —"Racing industry to target slots foes"). The C-J went on to say that there will be 19 Senate seats up for re-election next year, a dozen of them by Republicans who have mostly opposed the slots. Might be a possibility for the horsemen to win in 2010, but a long shot for nursing home advocates whose organizations are neither powerful nor rich. There is nothing wrong, however, in advocates for reform going to the lengths of making sure candidates support nursing home reform. Or as one of our supporters, Aubrey P. Maffett of Richmond recently wrote, "It would certainly be difficult to support any candidate who would not vote for and support a reform in nursing home legislation." If we had more people like Mr. Maffett who speaks out publicly and lets his legislators know, we could see progress. In the meantime, we will do our best to determine who is for us, and try to let you know before you go to the polls, and keep our fingers crossed that the horse industry and us will meet at the finish line victoriously.
WATCH OUT FOR THIS ONE.....
Rumors are that the Obama administration is getting ready to push for shifting control over Medicare rate adjustments for nursing homes to a new, independent five-member commission called IMAC, which stands for Independent Medicare Advisory Council. The White House proposal is that they would have the final word on rates unless their actions were vetoed by the Congress or the President. Right now there is MedPAC, which stands for Medicare Payment Advisory Commission whose recommendations on rates are not binding. Just recently MedPAC recommended freezing Medicare rates for skilled nursing facilities and cutting reimbursements to home health agencies by 5.5 percent. This move has scared the industry to death, and even some consumer advocates. But imagine the same thing happening when it takes only a veto to stop them.
IS OUR 'EXCELLENCE' ADVANCING?
There is something called the Advancing Excellence Campaign for nursing homes nationwide. Nationally it has been a bust. After almost three years, only 47.2 percent of the nursing homes in the U.S. are participating. In Kentucky, there is 64 percent participation. The campaign puts out eight measurable goals for nursing homes —things for them to try to improve upon. Participating Kentucky nursing homes are supposedly working on half of them —pressure ulcers, physical restraints, pain management for long-term residents, and pain management for short-stay residents. Is the campaign working? It’s hard to tell in Kentucky where only 9.8 percent of the participating nursing homes have released their performance results to the public. And no one tells the names of the nursing homes participating. Could this be industry public relation shills at work? Announce a quality improvement campaign and brag on that, but don’t tell anyone who is participating and the results?
SURPRISE, SURPRISE? WHAT A JOKE!
An employee of one of the largest nursing homes in the state —afraid to speak out publicly for fear of losing her job— wrote us to complain about the insufficient staffing she sees every day. She blamed it on weak enforcement and wrote: "...I am yet to see a state (inspector) or ombudsman visit where the facility didn't know in advance. Oh, but it is on these days that we have proper staff, until the visit is over, then it is back to the same staffing shortage, and minimal care." That brings up again the question of whether these state inspections of nursing homes are indeed a surprise. The short answer is "no, usually not." Everybody knows that and there are indeed cases of where inspections are innocently predictable. The situation is so bad that even the feds are worried about it. They just recently reissued an order that inspections must be a surprise, and sent the notice to state officials. And the feds can penalize a nursing home $2,000 a day if they find someone tipping the nursing home off. Kentuckians for Nursing Home Reform got into this important issue several years ago when it worked with Sen. Tom Buford, R-Nicholasville, in getting a Kentucky law passed that would come down hard on anyone who would tip off a nursing home. The bill did indeed pass, but it was a watered-down version which ended up saying only that any state employee caught tipping off the nursing home will be fired. That hasn’t happened, to our knowledge, yet, although there has been a case in the Office of Inspector General that came close, in our opinion.
FOLLOW LEXINGTON
Communities around the state would do well to follow what Lexington is trying to do for its senior citizens. Already, aging officials of the area development district, headquartered in Lexington, have put together the Bluegrass Aging Consortium which brings a diverse group of professionals interested in aging programs together on a monthly basis. Janice Austin of the University of Kentucky Elder Care program heads up the consortium. At City Hall, Dr. Marlene Helm, director of social services, is putting together a program on aging services with special emphasis on independent living. "It’s modeled a little bit after the state Department of Aging and Independent Living," Dr. Helm said. Heading up the new citywide program will be Kristy Stambaugh who for the past eight years has been with the Lexington Division of Parks and Recreation. Besides her certification in therapeutic recreation and rehabilitation counseling, she has spent 20 years working with the disabled and providing programs for senior adults. One of her top priorities in the new job will be to oversee the Lexington Senior Center and push planning for a second center in the city.
QUOTE OF THE MONTH
"I believe Congress must act swiftly to combat the shortage of health professionals specializing in long-term care and geriatrics. Nurses are the backbone of our nation’s health care system, and we must do more to make nursing an attractive profession for students. I support policies that will lower the nurse-to-patient ratio and reduce the arduous work schedule nurses are asked to maintain."
—Kentucky Congressman John Yarmuth in response to a letter sent to him by Kentuckians for Nursing Home Reform.
SHORT STUFF
- Sadiqa Reynolds has left her post of Inspector General in the state Cabinet for Health and Family Services to become a district judge in Louisville, an appointment that was made by Gov. Steve Beshear. No word yet on who her successor will be.
- What Iowa officials have called an "end run around state regulations," a big assisted living facility in Dubuque has turned down its state license and made itself an apartment complex for 116 senior residents. No more state regulations, and the owners say the residents love it. Why? Because instead of being ordered out of the facility and into a nursing home because of health problems, they can stay in their apartment as long as they want. If they want 24-hour health care they have to pay for it, but state health inspectors won‘t visit the home to check on the quality of the care. Are they missing something here....?
- It’s not for sure, of course, but one thing that might make some of you like the proposed health care reform legislation now before the Congress is a provision in the House bill that would force pharmaceutical companies to provide drugs for dual-eligible seniors, which are those eligible for both Medicare and Medicaid, at a 34 percent discount. Currently it’s 14 percent.
- Nursing home giant Kindred Healthcare, headquartered in Louisville, has been hit with a $1.3 million judgment to settle claims that it violated federal laws by overbilling residents for drugs at its Knoxville nursing facility. A Kindred employee blew the whistle.
- There’s something called the Civil Monetary Penalty Fund in Kentucky that receives all monies from federal penalties on nursing homes. The fund can contain at any one time upwards of $6 million. Now comes along the feds issuing guidance on how these funds must be used. Like right now it is seemingly okay that Kentucky uses part of them to fund full-time nursing home ombudsmen. The feds spell out the accepted uses. Kentuckians for Nursing Home Reform believes that Gov. Beshear should have a watchdog advisory committee for this fund to be sure the funds are always used in the right way. The governor has promised to do this, but so far no action.
- The head of the Kentucky Chamber of Commerce, Dave Adkisson, made headlines recently when he warned that state lawmakers were letting too much of precious state dollars go to Medicaid, public employee healthcare, and corrections. He said more money should be channeled to education. He has a point, but does he realize that Medicaid is the precious resource that keeps the frail and elderly, many of them living in poverty, in nursing homes across the state? The average nursing home will have upwards of 70 percent of its residents supported by Medicaid. But there are abuses, and Mr. Adkisson is right that lawmakers should be more vigilant in watching how Medicaid dollars are spent.
- Hopeful sign: The new Assistant Secretary on Aging in the U.S. Department of Health and Human Services is Kathy Greenlee of Kansas. She once served as Kansas state long-term care ombudsman.
- In its latest update of the best nursing homes in the U.S., the magazine U.S. News & World Report includes in its "honor roll" a facility in Kentucky —the Home of the Innocents in Louisville. This is a long-term care facility for children. No nursing home serving adults in Kentucky was on the list.
- Newspaper story: "The former bookkeeper of a Kutztown (PA) nursing home was sentenced to nine months of house arrest for stealing the identity of a resident, opening a credit card account and stealing $37,500 from the home to pay the credit card and other bills, officials said Monday." Could happen in Kentucky because right now the only background checks required on nursing home employees are on direct care givers.