As expected, critics lit into nursing home owners and their management practices Thursday at a pair of congressional hearings. Providers attempted to blunt the criticism by defending their practices and, in some cases, offering to work with reformers.

At a Senate Special Committee on Aging hearing, Chairman Herb Kohl (D-WI) announced that he and Sen. Charles Grassley (R-IA) intend to introduce a bill that would guarantee public disclosure of nursing homes' inspection results, staffing levels and ownership status.

Also at the hearing, Acting Centers for Medicare & Medicaid Services Administrator Kerry Weems discussed his agency's plans to start disclosing the names of facilities taking part in the Special Focus Facility Program - the "worst of the worst" when it comes to nursing home inspection results, according to Kohl.

"It is in everybody's best interest to let consumers know which nursing homes repeatedly demonstrate deficiencies and violate government standards. Those homes are obviously not doing their jobs," Kohl said. "Often, the only way to ensure the improvement of any entity is to bring its failings to light. I honestly believe that more nursing homes will come back into compliance for good if they have the court of public opinion and the power of market forces as encouragement."

Seniors Fear Moving Into A Nursing Home

Senior citizens fear moving into a nursing home and losing their independence more than they fear death, according to a study, “Aging in Place in America,” commissioned by Clarity and The EAR Foundation, which also found that the Baby Boomer children of seniors also fear for their parents.

When asked what they fear most, seniors rated loss of independence (26%) and moving out of home into a nursing home (13%) as their greatest fears. Death was cited as the greatest fear for just 3% of seniors.

Some key findings of the study:
89% of seniors want to age in place - or grow older without having to move from their homes - and more than half (53%) are concerned about their ability to do so.
82% of Baby Boomers fear their parents will be mistreated in a nursing home and 89% fear their parents will be saddened by the loss of their independence.
79% say they are worried that their parents would not like living in a nursing home, and 70% are concerned their parents will be scared to move out of their homes."

[Click here to read]
 

UK AND DEVELOPER ANNOUNCE SITE AND PLANS
FOR NEW CONTINUING CARE COMMUNITY
By Bernie Vonderheide

The University of Kentucky announced today that its new continuing care community will be located on the Fayette-Jessamine county line on 89.1 acres of land on Brannon Road near the new Brannon Crossing shopping center, just off Nicholasville Road.

When developed, the project will include facilities for independent living with 200 apartments and free-standing homes, an assisted living facility, and a skilled care nursing home with private rooms and a “memory support” unit for residents with some kind of dementia.

Officials of the Praxeis Group of Florida, the developer, said they are accepting $1,000 refundable deposits now from people who want to get their name on the list to live at the new community named Limestone Crossing.

The exact cost to live there, however, is yet to be determined. Officials of Praexis, however, would say that there will be a buy-in cost up front in a “life-lease contract,” and then a monthly rent that presumably will include such things as meals and maintenance.

Praexis is hoping to sell around 300 units before they start construction. In addition to the 89.1-acre parcel of land for Phase 1, Praexis also has an option to buy another 25 acres if interest from the public is high.

You don’t have to have an official connection with the university to live at Limestone Crossing. However, you must be at least 65 years of age when you move in.

Will the new community also be a part of UK research on the aging? UK President Lee Todd said he hoped there would be some, “but right now I just cannot be specific.”

Advocates for the new development had hoped that it would be tied in to UK research on long-term care along with the establishment at UK of a new Research Institute on the Aging. Initial suggestions to the university also included using the UK Cooperative Extension Service to distribute results of such research throughout the state.

Praexis has earned high marks for its development of similar continuing care communities at other universities including Florida, Duke, Alabama and Penn State.

To learn more about Limestone Crossing, Praexis is opening a Lexington office at 200 West Vine Street, in the PNC Bank Building. It also has a toll free telephone number: 1-877-210-2100.

Behind those nursing-home ads
By Joel Englehardt
Palm Beach Post editorial writer
August 07, 2007

During its first decade, the Alliance for Quality Nursing Home Care has been quick to protect Medicare payments to nursing homes. What could be better for America's elderly than an industry watchdog fighting for their rights?

In newspaper and television ads targeting U.S. Reps. Ron Klein, D-Delray Beach, and Tim Mahoney, D-Palm Beach Gardens, the alliance points out that Congress doesn't have to cut Medicare spending for the elderly to help uninsured children receive subsidized health insurance through the SCHIP program. Congress can do both.

No matter how powerful an advocate, that's a strange position for a group that not so long ago had then-lobbyist Haley Barbour as its chief spokesman. Mr. Barbour, now the governor of Mississippi, is a champion of Republican tax cutting. The alliance's position on the children's health-insurance bill that Congress passed, however, makes the group seem more like the "tax-and-spend" Democrats Mr. Barbour used to vilify as national GOP chairman.

So who is behind this champion of the elderly poor? The alliance is no industry watchdog. It is the industry. The Alliance for Quality Nursing Home Care is 16 of the largest chains. It gave $100,000 to Tom Delay's political action committee that redrew districts for the Texas Legislature, a contribution that figured prominently in criminal charges against the former House speaker. When the alliance needed a lobbyist, it hired Thomas Scully, the Medicare administrator who squelched the true cost of the federal prescription drug plan.

Support for Medicare from the Alliance for Quality Nursing Home Care is like support for Barry Bonds from steroid makers. But just how does the alliance define "quality"?

The alliance claims to have led in adopting quality assurance programs. It boasts that stabilized Medicare spending, due partly to its powerful lobbying, has resulted in continued improvement in nursing home care. And it argues that the one-year, $700 million freeze in Medicare nursing home spending in the children's insurance bill would cost the industry $2.7 billion over five years. Spread over the industry, said alliance President Alan Rosenbloom, that would be the equivalent of two lost staff positions per nursing home.

It's hard to believe, but the industry's arguments amount to a claim of poverty. At 3 percent, profit margins are too slim, Mr. Rosenbloom said, to absorb even a one-year freeze.

Tell that to patients of the nation's largest nursing home owner, HCR Manor Care, an alliance member. Manor Care's chief executive, Paul Ormond, received an $18 million pay package this year. Mr. Ormond is overseeing the public company's $6.3 billion sale to the private Carlyle Group, owner of Dunkin' Donuts, Water Pik and Hertz. If the financials are so dismal, why is Carlyle buying Manor Care?

If the sale goes through, Mr. Ormond stands to make even more. He can cash in stock options valued at between $118 million and $186 million, TheToledo (Ohio) Blade reported last month. Options for other top executives would reach $68 million. That's a third of the proposed Medicare freeze for all nursing homes.

In Palm Beach County and the Treasure Coast, nine Manor Care facilities under the Manor Care, Heartland and Arden Courts labels received low rankings in 26 of 81 inspection categories from the state Agency for Health Care Administration. That means they rated in the bottom 40 percent in areas such as quality of care and rate of patient decline. All but two of those nine, however, ranked near the top in not using restraints on patients and preventing abuse.
Rather than reap multi-million-dollar rewards, these executives should have to live for a week in their lowest-ranking nursing homes. To enhance the experience, they would be fitted with diapers and allowed no visitors or phone calls, as so many of our elderly have been in their final days.

Would violations cease? Would standards of care increase? Would the industry's "slim" profit margin drop as nursing pay increased?
Quality? The alliance isn't about quality. It's about assuring nursing home operators their payday.

Joel Engelhardt is an editorial writer for The Palm Beach Post. His e-mail address is joel_engelhardt@pbpost.

LET'S DO THE NUMBERS - 1 CEO or 2000 NURSES
by Toby S. Edelman

There is a great NPR show, Market Place, where the host always says "Let's do the numbers." Well, someone has done the numbers for us in the big business corporate nursing home industry. What if you took the money a CEO would make (or shareholder dividends) and put it toward staffing and resident care.

"Reports that Manor Care’s CEO Paul Ormond would personally realize between $118 and $186 million when his company, the largest nursing home chain in the United States, is acquired later this year by a private equity group got us thinking about staffing in nursing homes. Knowing that the federal government has reported that more than 90% of nursing homes do not have enough staff to take care of their residents, we wondered how many nurses and nurse aides could be hired for a year at Manor Care’s nursing facilities with that same money.

Using federal wage estimates for nursing home workers, we calculated that Manor Care’s 278 nursing homes could hire an additional 5,346 certified nurse aides or an additional 2,198 registered nurses if $118,000,000 were spent on staff (19.2 aides or 7.9 RNs at each Manor Care nursing home). If Mr. Ormond’s $186,000,000 windfall were spent on staff, Manor Care could hire an additional 8,427 certified nurse aides or an additional 3464 RNs (30.3 CNAs or 12.5 RNs at each Manor Care nursing home).

Like all nursing home chains, most of Manor Care’s revenues come from public programs, Medicare and Medicaid. How should our public health care dollars be spent? One man’s windfall or certified nurse assistants and registered nurses in nursing homes?

Elderly Organize to Meet Problems of Aging
By Jane Gross
August 13, 2007
The New York Times

WASHINGTON — On a bluff overlooking the Potomac River, George and Anne Allen, both 82, struggle to remain in their beloved three-story house and neighborhood, despite the frailty, danger and isolation of old age.

Mr. Allen has been hobbled since he fractured his spine in a fall down the stairs, and expects to lose his driver’s license when it comes up for renewal when he turns 85. Mrs. Allen recently broke four ribs getting out of bed. Neither can climb a ladder to change a light bulb, or crouch under the kitchen sink to fix a leak. Stores and public transportation are an uncomfortable hike.

So the Allens have banded together with their neighbors, who are equally determined to avoid being forced from their homes by dependence. Along with more than 100 communities nationwide — a dozen of them here in Washington and its suburbs — they are part of a movement to make neighborhoods comfortable places to grow old, both for elderly men and women in need of help but not ready for assisted living, and for baby boomers anticipating the future.

“We are totally dependent on ourselves,” Mr. Allen said. “But I want to live in a mixed community, not just with the elderly. And as long as we can do it here, that’s what we want.”

The Allens’ wish to live out their lives in familiar surroundings, shared by almost nine in 10 Americans over age 60, according to numerous polls, may soon become a reality. Their group has registered as a nonprofit association, developed a business plan based on membership dues and begun lining up providers of transportation, home repair, companionship, daily security check-ins and other services to meet their needs at home for as long as possible.

Urban planners and senior housing experts say that this movement, organized by residents rather than government agencies or social services providers, could make “aging in place” safe and affordable for the majority of elderly people. Many of these communities are calling themselves “villages,” playing on the notion that it takes a village to raise a child and also support the aged in their decline.They are expected to open this fall on Capitol Hill, in Cambridge, Mass., New Canaan, Conn., Palo Alto, Calif., and Bronxville, N.Y .

“Providers don’t always need to do things for the elderly,” said Philip McCallion, director of the Center for Excellence in Aging Services at the State University of New York at Albany. “There are plenty of ideas how to do this within the aging community.

Although not a panacea for those with complicated medical needs, the approach addresses what experts say can be a premature decision by older people to give up their homes in response to relatively minor problems: no way to get to the grocery store; tradesmen unwilling to take on small jobs; or the isolation of a snowy winter.

As these small problems mount, experts say, sometimes accompanied by pressure from adult children, the elderly homeowner is caught off-guard. Remaining at home without sufficient help is frightening. But moving to an assisted living center is often an overreaction that can be avoided or postponed.

“A few neighborhood-based, relatively inexpensive strategies can have an enormous effect,” Mr. McCallion said. “If people don’t feel so overwhelmed, they don’t feel pushed into precipitous decisions that can’t always be reversed.”

For inspiration, the nascent groups looked to Boston’s Beacon Hill Village, which pioneered the approach six years ago. Beacon Hill’s 400 members pay yearly dues — $580 for an individual and $780 for a couple, plus a la carte fees — in exchange for the security of knowing a screened carpenter, chef, personal trainer or home health aide is one phone call away.

Experts in aging say the self-help approach provides a sense of mastery, often lost with the move to an institution or even an adult child’s spare bedroom. That can-do spirit is attractive to baby boomers like Alisia Juarrero, 59, who is a board member of the Allens’ group, which spans the Palisades neighborhood, a leafy enclave of single family homes west of Georgetown, and Foxhall, an adjacent area of attached Tudors.

Ms. Juarrero is mindful of the future because of the struggles of her 89-year-old mother and 92-year-old aunt in Coral Gables, Fla. “This is where we’re all headed,” she said. “If I help set this up, it’ll be there when I need it.”

So far, most of the villages are in places where residents are well-connected and skilled in finance, law, medicine and philanthropy as a result of their own careers. That raises the question of whether the model is viable only in neighborhoods of privilege. But experts point out that most care for the elderly is already out of reach of all but the wealthy.

The amenities of an assisted living center are far more expensive than a village’s membership fee. Medicare does not pay for long-term care, and private-duty help is pricey. Only the destitute are protected in old age because Medicaid pays their nursing home fees.
A few villages are cropping up where low-income families live, such as San Francisco’s Richmond District, with its recent wave of Russian immigrants; Falmouth, Mass, where year-round residents struggle when the summer crowd is gone and pockets in Westchester County, like Yonkers, with diverse populations.

In such locations, social service organizations are likely to organize the project, instead of the older residents, and rely on bartered or volunteer services to keep fees down. One member fixes another’s faucet, banks the time and in exchange gets a ride to a medical appointment. Groups also share expertise at national and local conferences, including several this spring, and on a new group e-mail server. Some have access to regional resource centers that assist with matters like hiring an executive director or buying liability insurance.

In terms of government support, New York State is at the forefront, with a 20-year-old model known as a NORC (pronounced “nork”), short for naturally occurring retirement community. Since 1995, New York has paid for social services, including nurses and case managers, in many apartment buildings with a concentration of residents over 60. Last year, the state added a few suburban neighborhoods, so-called horizontal NORCs. On the federal level, Congress authorized experiments in aging in place in the 2006 Older American Act but did not finance them.

The sprawl of suburbia presents challenges to the elderly once they cannot drive. Amid the rolling Virginia hills of Fairfax County, one group is grappling with how to serve prospective members in a place with a single general store and five-acre zoning. Taxi vouchers may be too costly when running errands takes hours. Recruiting volunteer drivers from 118 home owners’ associations and 17 churches presents liability issues.

“The question is distance and time and the money that relates to that,” said William Cole, 77, the group’s secretary-treasurer. Mr. Cole anticipates yearly dues of $1,000 , which may be prohibitive for neighbors who are real estate rich and cash poor. One likely service, Mr. Cole said, will be advice about reverse mortgages.
Second only to transportation is a concern whether the villages can provide adequate support once the founding members, who tend to be vigorous, regardless of age, decline either physically or cognitively. In this regard, the New Canaan group, with annual dues of $360 and $480, may be better positioned than most. The community already has a home health care agency, assisted living center and nursing home, thanks to years of advocacy by a local doctor, now 87 and a board member.

Because of that, “we have the confidence to live without these problems getting the best of us,” said Tom Towers, 69, board president of Staying Put in New Canaan. “And if they do, we can take care of it right here.”

The first village in the Washington area is expected to be on Capitol Hill. When they open for business on Oct. 1, annual memberships will be $750 for a household and $500 for an individual.

Among the eager members are Marie Spiro, 74, and Georgine Reed, 78, who share a turn-of-the-century house that they insist they will only leave “feet first.” Between them, Ms. Spiro, a professor emeritus of art history and archeology, and Ms. Reed, a retired designer of museum exhibits, have already endured three knee replacements and an array of other ailments.

Ms. Spiro describes huffing and puffing while grocery shopping; Ms. Reed is increasingly reluctant to socialize with friends across town. Both women, who are childless, would already welcome help with meals, transportation and paperwork. If they need home care, Capitol Hill Village can organize that.

“I’ve never had to rely on other people, and I never wanted to,” Ms. Spiro said. “But I’d rather pay a fee than have to ask favors.”
Members of all these groups share an independent streak — and the willingness to plan for the future. Those characteristics were on view recently in a living room in Hollin Hills, a post World War II development in Alexandria, where neighbors once organized baby-sitting co-ops.

Now, in their 70s and 80s, they still drive, play tennis and travel the world. None has yet lost a spouse but fear what will happen to the one left behind.

“The vast majority of people don’t have the capacity to be realistic,” said Ruth Morduch, 71. “We don’t know what’s going to happen in X number of years, but we know we’re going to need help. In my own home, that’s less likely to be humiliating. And an organization like this gives me a sense that we’re all in this together, our last grand adventure.”
 

BEFORE YOU GET TAKEN IN BY ALL THOSE NURSING HOME INDUSTRY CLAIMS OF ‘QUALITY’, READ THIS:
By Joel Englehardt
Palm Beach Post editorial writer
Tuesday, August 07, 2007

During its first decade, the Alliance for Quality Nursing Home Care has been quick to protect Medicare payments to nursing homes. What could be better for America's elderly than an industry watchdog fighting for their rights?

In newspaper and television ads targeting U.S. Reps. Ron Klein, D-Delray Beach, and Tim Mahoney, D-Palm Beach Gardens, the alliance points out that Congress doesn't have to cut Medicare spending for the elderly to help uninsured children receive subsidized health insurance through the SCHIP program. Congress can do both.

No matter how powerful an advocate, that's a strange position for a group that not so long ago had then-lobbyist Haley Barbour as its chief spokesman. Mr. Barbour, now the governor of Mississippi, is a champion of Republican tax cutting. The alliance's position on the children's health-insurance bill that Congress passed, however, makes the group seem more like the "tax-and-spend" Democrats Mr. Barbour used to vilify as national GOP chairman.

So who is behind this champion of the elderly poor? The alliance is no industry watchdog. It is the industry. The Alliance for Quality Nursing Home Care is 16 of the largest chains. It gave $100,000 to Tom Delay's political action committee that redrew districts for the Texas Legislature, a contribution that figured prominently in criminal charges against the former House speaker. When the alliance needed a lobbyist, it hired Thomas Scully, the Medicare administrator who squelched the true cost of the federal prescription drug plan.

Support for Medicare from the Alliance for Quality Nursing Home Care is like support for Barry Bonds from steroid makers. But just how does the alliance define "quality"?

The alliance claims to have led in adopting quality assurance programs. It boasts that stabilized Medicare spending, due partly to its powerful lobbying, has resulted in continued improvement in nursing home care. And it argues that the one-year, $700 million freeze in Medicare nursing home spending in the children's insurance bill would cost the industry $2.7 billion over five years. Spread over the industry, said alliance President Alan Rosenbloom, that would be the equivalent of two lost staff positions per nursing home.

It's hard to believe, but the industry's arguments amount to a claim of poverty. At 3 percent, profit margins are too slim, Mr. Rosenbloom said, to absorb even a one-year freeze.

Tell that to patients of the nation's largest nursing home owner, HCR Manor Care, an alliance member. Manor Care's chief executive, Paul Ormond, received an $18 million pay package this year. Mr. Ormond is overseeing the public company's $6.3 billion sale to the private Carlyle Group, owner of Dunkin' Donuts, Water Pik and Hertz. If the financials are so dismal, why is Carlyle buying Manor Care?

If the sale goes through, Mr. Ormond stands to make even more. He can cash in stock options valued at between $118 million and $186 million, TheToledo (Ohio) Blade reported last month. Options for other top executives would reach $68 million. That's a third of the proposed Medicare freeze for all nursing homes.

In Palm Beach County and the Treasure Coast, nine Manor Care facilities under the Manor Care, Heartland and Arden Courts labels received low rankings in 26 of 81 inspection categories from the state Agency for Health Care Administration. That means they rated in the bottom 40 percent in areas such as quality of care and rate of patient decline. All but two of those nine, however, ranked near the top in not using restraints on patients and preventing abuse.

Rather than reap multi-million-dollar rewards, these executives should have to live for a week in their lowest-ranking nursing homes. To enhance the experience, they would be fitted with diapers and allowed no visitors or phone calls, as so many of our elderly have been in their final days.

Would violations cease? Would standards of care increase? Would the industry's "slim" profit margin drop as nursing pay increased?

Quality? The alliance isn't about quality. It's about assuring nursing home operators their payday.

Joel Engelhardt is an editorial writer for The Palm Beach Post. His e-mail address is joel_engelhardt@pbpost.com

Study: Hourly rate for nursing home RNs rises 4%
July 11 2007

The national median hourly rate for registered nurses in nursing homes increased by almost 4% in this year compared to last year, a new study finds.

The median RN nursing home rate is $25 per hour, according to the Hospital & Healthcare Compensation Service, which released its latest report this week. Last year, the median hourly rate was $24.07. Median represents the value below and above which there is an equal number of values.

By comparison, RNs in continuing care retirement communities earn a median wage of $24.27 per hour, a 2% increase from last year, the report found.

Once again, nursing turnover in nursing homes is highest among CNAs, according to annual study results. CNAs reported a turnover rate of 43.5%, much worse than LPNs (30.6%) and RNs (32.2%).

The Nursing Home Salary and Benefits Report is available for purchase from HHCS (www.hhcsinc.com), with discounts applicable to members of the major nursing home associations that supported the project.

California Health Care Advocates Launch Investigation of Long-Term Care Insurers' Claims-Handling Policies
May 29, 2007

The House Energy and Commerce Committee last week sent letters to long-term care insurers Conseco and Penn Treaty American to request documents as part of an investigation into the business practices of such companies, the San Francisco Chronicle reports. The committee launched the investigation in response to a March New York Times article that examined issues related to long-term insurance (Colliver, San Francisco Chronicle, 5/26).

In the article, the Times reviewed more than 400 complaints and lawsuits filed against long-term care insurers and found that some of the companies have developed practices to limit the ability of policyholders to receive claims payments (Kaiser Daily Health Policy Report, 3/26). Bonnie Burns, training and policy specialist for California Health Advocates, said, "Seven, eight, nine years later they are looking at claims and saying, 'gee whiz, is there anything on that application we can use to deny this claim,'" adding that the investigation "will shed light on practices that have been going on far too long without any regulatory response."

In a statement, Penn Treaty officials defended company business practices and said the company "sees this as an opportunity to highlight the value of long-term care insurance to America's seniors." Conseco officials in a statement said, "We agree that every long-term care policyholder deserves assurance that their claim will be handled timely and in accordance with the terms of their contract," adding that the company seeks a "thorough and fair" investigation (San Francisco Chronicle, 5/26).

Wall Street Journal Profiles New
Nursing Home in San Francisco
Kaiser Daily Health Policy Report

San Francisco plans to spend about $600 million to replace the Laguna Honda Hospital and Rehabilitation Center, an effort that "bucks a tenuous trend across the country" to provide care to seniors in their homes or in assisted living facilities, the Wall Street Journal reports. "A debate has long raged over whether it's cheaper to care for the elderly and frail in institutions or at home," and the federal government "now believes it can save Medicaid dollars and improve elderly people's lives by encouraging more home care," the Journal reports. However, nursing homes "still are favored by federal Medicaid payment rules, which in recent years have allowed the elderly and younger disabled to seek alternatives but require them to clear more hurdles to qualify," according to the Journal.

The Journal reports that Laguna Honda "benefits from unusually friendly treatment from Medicaid," under which reimbursements are doubled to $338 per patient daily because the facility is licensed as both a hospital and a nursing home, although the facility has only 20 hospital beds. With additional payments from the city, Laguna Honda receives an average of $431 per patient daily, and the new facility could receive as much as $500 per patient daily because of additional payments from Medicaid and the city related to construction costs.

"While San Francisco has its own roster of home and community programs for the elderly," critics maintain that the "new Laguna Honda's existence will push residents into it who otherwise could be in more homey settings" and that the cost of the new facility "will starve other alternatives of funds," according to the Journal. However, Sen. Dianne Feinstein (D-Calif.) and House Speaker Nancy Pelosi (D-Calif.) support the new facility. Pelosi said, "Sure, it would be nice if you could reinvent the wheel. But I am more interested in seeing that very sick people have skilled nursing care and access to a physician 24 hours a day" (Lagnado, Wall Street Journal, 5/7).