NORC Gazette
February 19, 2003
National Long Term Care
Ombudsman Resource Center
National Citizens’ Coalition
for Nursing Home Reform
Table
of Contents
Ombudsman Program Updates
1. 2001 NORS data reveal increase in ombudsman complaints
3. Proposed bills would strengthen IL Ombudsman Program
Ombudsman Calendar of Events
Grant Possibilities
4. Older Driver Safe Mobility grants
available
Home and Community-Based Care/Olmstead
5. AL Medicaid Waiver extends
coverage to disabled over age 21
6. Florida to expand consumer-directed care program
Nursing Home News
7. LTC executive gets prison in MO abuse case
8. Profits
up for Manor Care in 4th quarter
9. Arkansas advocates work to defeat tort reform
Assisted Living
10. Americans need more affordable
assisted living services
11. New IA regulations give
seniors a voice in state-initiated transfers
12. NSCLS study finds holes in wage
“pass-through” programs
13. Correction regarding name
of DCA director
14. Therapy cap starts July 1, 2003
15. AARP says CO eligibility
changes could force residents into shelters
Research
16. Study finds widespread racism
against aides in nursing homes
DC Doins'
17. Elder Justice Act
reintroduced
18. Hearing on guardianships held
19. Joint hearing focuses on tort reform
Other News
20. NCOA adds
prescription drugs to benefits check-up service
Ombudsman Program
Updates
1. 2001 NORS data reveal increase in ombudsman complaints
NORS data from 2001 are now final and show an increase in complaints from 231,889 in 2000 to 264,269. The 2001 data shows the following as the most frequent complaints handled by long-term care ombudsmen. Nursing home complaints (top categories in order of frequency): 1-call lights (requests for assistance); 2-dignity, respect-staff attitudes; 3-care plans/resident assessment; 4-accidents, improper handling; 5-personal hygiene; 6-discharge/eviction; 7-shortage of staff; 8-menu-quantity, quality, etc.; 9-medications-administration, organization; and 10-symptoms unattended, no notice to change of condition. There were over 5,000 complaints in each of these categories. Board and care facility complaints (top categories in order of frequency): 1-menu-quantity, quality, etc.;2-medications administration, organization; 3-dignity, respect-staff attitudes; 4-discharge/eviction;5-equipment/building-disrepair, etc; 6-cleanliness, pests; 7-personal hygiene;8- shortage of staff; 9-care plan/resident assessment; 10-personal property lost or stolen; and 11-billing/charges notice, etc. There were over 1,000 complaints in each of these categories. NORS data also indicate an increase of 35,000 beds in 2001, an increase of 59 paid ombudsmen (from 970 to 1029), and an increase of 50 certified volunteers (from 8393 to 8442). In addition to handling complaints, the ombudsmen nationwide also provided assistance to over 283,000 individuals in 2001! There are now six years of nationwide NORS data available. For a hard copy of the data contact John Kafka at jkafka@nccnhr.org; this new NORS data is now on the AoA website www.aoa.gov
The Administration on Aging (AoA) has released an Information Memorandum on the effect on the long-term care ombudsman program of the Privacy Rule under the Health Insurance Portability and Accountability Act (HIPAA). The memo states that under the Privacy Rule, the LTCOP is a “health oversight agency.” This means that the Privacy Rule does not preclude release of residents’ clinical records to the LTCOP, with or without authorization of the resident or resident’s legal representative. In addition, nursing homes and other “covered entities” may, in response to appropriate ombudsman inquiries, share other information without fear of violating the Privacy Rule. The AoA memo provides additional information for state units, area agencies on aging and ombudsmen about the Privacy Rule. The entire AoA memo can be accessed on the Ombudsman Resource Center website at http://www.ltcombudsman.org/ombpublic/49_369_4128.CFM. Source: NORC memo, 2/11/03. Contact John Kafka for a hard copy, 202-332-2275.
3. Proposed
bills would strengthen IL Ombudsman Program
Three bills concerning the
Illinois Ombudsman Program have been introduced in this year’s legislative
session. Two bills, HB 1240 and HB
1484, were initiated by the Illinois Association of Long Term Care Ombudsmen
and Citizen Action/Illinois. HB 1240 creates a Long Term Care Council to
address broad issues of residents who need long-term care and to establish a
process that is without conflict in selecting the state ombudsman. HB 1484 adds technical amendments to the
Illinois Act on Aging that would bring the state law into compliance with the
Older Americans Act. The third bill, HB
1207, transfers the location and support of the Office of State Ombudsman from
the Department on Aging to the Office of Attorney General. Go to http://www.legis.state.il.us/
for the synopsis, full text and status of these bills. The Illinois Association
of Long Term Care Ombudsmen and Citizen Action/Illinois will be working with
legislators on all three of these bills.
For more information, contact Margaret Niederer at (217)523-8488 or mniederer@icare.ws Source:
Email from Margaret Niederer, Illinois Retired Teachers Association
Foundation, 2/11/03
Ombudsman Calendar of Events
February 21, 2003: Conference
call sponsored by the Citizens' Advocacy Center and NORC on Pain Management for
local and state ombudsmen., 3:00 p.m. EST.
Contact John Kafka for details, jkafka@nccnhr.org Limited to 75 participants.
February 26-28, 2003: Region IV Ombudsman Conference, Louisville, KY. Open to long-term care ombudsmen in Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee. Registration ends Jan. 30th. For more information contact Julie Meashey at jmeashey@nccnhr.org or 202-332-2275.
March 13 - 16, 2003: Joint Conference sponsored by American Society on Aging and National Council on Aging, Chicago, Illinois; Sheraton Hotel and Towers. http://www.agingconference.org/jc03/index.cfm
March 30, 2003: NORS reports due to AoA.
April 12, 2003 (morning): New State Ombudsman Training, Chicago, IL. Contact Alice Hedt for details, ahedt@nccnhr.org
April 12 - 15, 2003: State Ombudsman Spring Conference, Chicago, Illinois. Note: dates are tentative. For details contact Mark Miller at mmiller@nasua.org
Theme: What We Do Makes a Difference!
October 5 - 11, 2003: Residents' Rights Week - Start planning now. Send your ideas to Julie Meashey at jmeashey@nccnhr.org
October 15-18, 2003: NALC Conference, Arlington, VA; details forthcoming.
October 18, 2003:
NCCNHR/NALC
Bridge Day
October 18 - 21, 2003: NCCNHR Annual Meeting, Arlington, VA; Have ideas for sessions that would be useful for ombudsmen? Contact Alice Hedt at ahedt@nccnhr.org
4. Older Driver Safe Mobility grants available
The Academy for Educational Development (AED), in partnership with the American Society on Aging (ASA) and the National Highway Traffic Safety Administration (NHTSA) will be issuing grants to 3 community-based organizations to participate in a 1-year pilot program to make it easier and safer for older adults to get around and make appropriate driving choices that maximize their personal and community safety. Each grantee will receive $8,000, marketing materials and technical assistance from AED and ASA. The application form can be downloaded at http://olderdriver.aed.org/. For more information contact Mike Salamone at msalamon@aed.org.
Home and Community-Based Care/Olmstead
5. AL Medicaid Waiver extends coverage to disabled over age 21
The U.S. Department of Health and
Human Services has approved a waiver that will allow Alabama to continue to
cover Medicaid services to beneficiaries over age 21 who have “substantial
disabilities.” The waiver means that
beneficiaries who normally would lose benefits when they turn 21 will be able
to continue to receive coverage for private duty nursing care, medical
supplies/appliances, and assistive technology services, thereby avoiding
nursing home placement. The change came
about in large part due to the efforts of Nick Dupree, an Alabama man who is
quadriplegic and who will turn 21 on Feb. 23.
Both Dupree and his 18-year-old brother each require 16 hours of at-home
nursing care per day. Without the waiver, Nick Dupree might have had to receive
care in a nursing home. Nick Dupree developed a website to encourage members of
the public to write to state and federal lawmakers about the issue. He also
filed a lawsuit alleging that the policy of discontinuing in-home services for
Medicaid beneficiaries over age 21 discriminates against people with
disabilities. Source: Kaiser Daily Health Report, 2/11/03
6. Florida to expand consumer-directed care program
Florida has received federal approval of a waiver that will allow the state to expand its existing consumer-directed care program through the Department of Health and Human Services’ (HHS) Independence Plus initiative. The initiative is designed to help states fulfill the goals of President Bush’s New Freedom Initiative, an effort to ensure that Americans with disabilities have the opportunity to live more independently. The Florida program already includes 2000 state residents; the waiver will permit 150 more individuals to be assisted. Under the program, consumers and their families will be involved in all aspects of service delivery, including hiring, firing and training service providers. Source: Kaiser Daily Health Report, 2/14/03; SNALF.com, 2/13/03
Nursing Home News
7. LTC executive gets prison in MO abuse case
The president of a company that operated nursing homes across the St. Louis, Missouri region received the maximum penalty in a case that involved the beating death of a nursing home resident. Charles Kaiser III was sentenced to a year in jail and fined $1,000 for failing to report elder abuse. The misdemeanor charge resulted from the August 1999 beating death of a 78-year-old resident of St. Charles Claywest, operated by Kaiser’s company, American Healthcare Management. A nurse’s aide pleaded no contest to abuse in the incident and is serving 15 years in prison. During the trial, prosecutors presented a copy of an e-mail the facility administrator sent Kaiser, saying the injury should be reported to the state. Kaiser answered that he had also spoken with a state official and “this is NOT going to be hotlined.” American Healthcare Management and Claywest nursing home were also convicted of failing to report the abuse to the state. They were each ordered to pay the maximum fine of $5,000. The case is believed to be the first in the state where a nursing home executive has been sentenced to jail in a resident abuse case and was hailed by nursing home resident advocates as a milestone in the fight for better care. Violette King, executive director of Nursing Home Monitors, an advocacy group based in Godfrey, said she knows of only one other similar case in the country. Kaiser is expected to remain free on a $10,000 bond and appeal his conviction. Source: Post-Dispatch, 2/6/03; SNALF.com, 2/10/03
8. Profits up for Manor Care in
4th quarter
Manor Care Inc. announced that it had turned a profit for the fourth quarter, surpassing analyst estimates. Net income was $23 million, or 24 cents a share, compared with a loss of $17.9 million, or 18 cents a share, in the same period a year ago. Revenue rose to $728.1 million in the latest quarter, up from $704.9 million a year ago. Manor Care executives attributed the gains to improved occupancy rates, lower agency costs and shrinking wage increases. Source: SNALF.com, 2/3/03
9. Arkansas
advocates work to defeat tort reform
Advocates for Nursing Home Residents (ANHR), an Arkansas citizen advocacy group, is working hard to defeat HB 1213, a bill that would significantly alter nursing home residents’ rights to purse civil litigation. Nancy Allison, ANHR president, said her organization opposes the bill because it caps financial awards in civil lawsuits, allows the health care industry to appoint the insurance administration board created by the bill, and mandates arbitration before a lawsuit can be filed. Allison stated that an inmate who is assaulted in prison would have more rights than nursing home residents under this bill because an inmate can go directly to court and file suit. Under HB 1213, a nursing home resident would have to appear before an arbitrator before filing a lawsuit. Source: Fort Smith, Arkansas Times Record, 2/11/03
Assisted Living
10. Americans need more affordable assisted living
services
A recent report prepared for Volunteers of America by the Joint Center for Housing Studies at Harvard University concluded that more and more Americans need assisted living services but can’t afford to pay for them. “While assisted living has become an increasingly popular option with upper- and middle-income seniors, the high costs of the product put it out of reach of low- to moderate-income groups,” the study states. The report reviews the senior population, focusing on factors that are relevant to the potential market for assisted living; examines lessons from the private-pay industry; presents the various funding mechanisms that can be used to develop and operate affordable assisted living; profiles several projects; and offers some possible policy options and strategies. Titled, “Affordable Assisted Living: Surveying the Possibilities,” the report can be accessed by going to http://www.jchs.harvard.edu/publications/seniors/03-1_schuetz.pdf. Source: “Affordable Assisted Living: Surveying the Possibilities,” January 2003; SNALF.com, 2/12/03
11. New IA regulations give seniors a voice in state-initiated transfers
New assisted living regulations in Iowa give seniors a
way to voice to the state their wish to remain in an assisted living facility
(ALF) rather than going to a nursing home.
The regulations were revised
after the state attempted to force more than a dozen residents from the
assisted living facilities managed by the Olathe, a Kansas-based Eby Realty
Group. The state claimed that the
residents’ conditions were too acute for the facilities to properly care for
them. Eby Realty followed with a
lawsuit against the state, alleging
that by forcing the disabled into nursing homes, the state was guilty of
discrimination. In July 2002, the state
better defined what level of care ALFs were allowed to give. The regulations say that if the state feels
an ALF is caring for a resident in need of nursing home placement, a physician,
the resident, and his or her family will be called in to discuss the matter.
Their recommendations concerning a course of action for the resident will then
be conveyed to the state. Although under no obligation to follow the
recommendations, the state will consider residents under the new “standards and
discharge procedures.” Source: BAL Weekly, 2/5/03
Staffing
12. NSCLS study finds holes in wage “pass-through”
programs
An investigation of California’s “pass-through” system by the National Senior Citizens Law Center (NSCLC) reveals that money intended for nursing home workers has not in fact been “passed-through” to them. Wage “Pass-Through” programs have been implemented in California and a few other states as one way to address the problem of low wages paid to nurses and nursing assistants. The idea is that the state increases its Medicaid nursing facility rate by a certain amount and, in return, nursing facilities must “pass-through” that increase to nursing staff. However, NSCLC found that 128 of 372 nursing homes it looked at withheld from their direct-care workers a total of over $2.9 million in Medi-Cal increases. The report states that millions of dollars “fall though the crack” and that even the recovered money does nothing to benefit the poorly paid employees who are the intended beneficiaries. According to the study, the basic flaw is that nursing homes receive the money without having to explain how the money will be spent. The report recommends that the system be changed so that a facility must account for its use of the funds early in the process. To read the report, go to www.nscls.org. Source: NSCLC Washington Weekly, 2/7/03
13. Correction regarding name of DCA director
The most recent newsletter from the National Clearinghouse on the Direct Care Workforce stated that it had incorrectly identified the new executive director for the Direct Care Alliance (DCA) in an earlier issue. This incorrect information was included in the February 7 Gazette. The correct name is Patsy R. Harris. Source: National Clearinghouse on the Direct Care Workforce, 2/12/03
Medicare
14.
Therapy cap starts July 1, 2003
Claims for Part B therapies
received on or after July 1, 2003 will be subject to a $1500
therapy cap, according to a Centers for Medicare & Medicaid Services (CMS)
Program Memorandum released last week.
The agency applied an economic index to the original $1,500 cap limit,
which boosted the cap up to $1,590 per beneficiary. The cap had originally been
set to go into effect on January 1, 2003. The cap applies to all residents not
in a Part A stay, as well as non-resident outpatients receiving services at a
skilled nursing facility (SNF). It does
not matter whether a SNF furnishes the therapies itself or has outside
therapists perform the services. Consolidated billing requires SNFs to bill
Part B for therapies delivered to those residents who exhaust their Part A
benefits. To read the Program Memorandum, (PM AB-03-018), go to: http://www.snfinfo.com/content/AB03018.pdf. Source:
SNFinfo Connection, 2/10/03
Medicaid Cuts
15. AARP says CO eligibility changes could force residents into shelters
AARP in Colorado is working to stop new Medicaid eligibility requirements from being implemented. A new eligibility instrument, called the ULTC-100, is being proposed to reassess residents currently in nursing homes and adult care facilities (ACF) who receive Medicaid benefits, as well as those seeking to enter these types of residences. According to an AARP press release, this means that a resident of an adult care facility who met the state’s requirements yesterday may no longer meet the requirements as set forth by the new eligibility instrument. Once a resident is no longer a Medicaid beneficiary, the nursing home or ACF will not receive compensation for the resident’s housing, and thus the resident will be released. For many of these residents, their only recourse will be a homeless shelter. The press release notes that the Colorado Department of Health Care Policy and Financing actually admits that some residents will likely be discharged to homeless shelters and is advising discharge planners how to contact the Colorado Coalition for the Homeless. The final vote of the Medical Services Board on the new eligibility tool was to occur on February 14. Source: AARP Press Release, 2/12/03
Research
16.
Study finds widespread racism against aides in nursing homes
A study conducted by the Buehler Center on Aging at Northwestern University found that nearly 75 % of nurse aides working in nursing homes experience racism on the job. Researchers determined that nursing home residents as well as residents’ families and co-workers express racism. In addition, foreign-born aides were more likely to experience on-the-job racism. “Remedial attention is called for, and strategies for dealing with diversity in nursing homes are needed,” says study author Celia Berdes, assistant professor of medicine at the Feinberg School of Medicine and associate director of the Buehler Center. Source: SNALF.com, 2/11/03
17. Elder
Justice Act reintroduced
Senators John Breaux (D-LA) and Orrin Hatch (R-UT) reintroduced the Elder Justice Act on February 10. The bill requires reporting of crimes in long-term care settings and federal criminal background checks for those employed by long-term care providers. It includes measures to increase and retain staff in long-term care facilities and to better educate and train law enforcement and prosecutors about elder abuse. It also establishes offices within the Departments of Justice and Health and Human Services to deal with elder abuse issues. Senator Breaux stated that, “Without more attention and more resources, far too many of these cases of abuse, neglect and exploitation will go unaddressed and far too many older Americans will suffer.” Representatives of more than 50 advocacy groups used the introduction of the bill to announce the formation of the Elder Justice Coalition to push for passage of the bill. NCCNHR, NASOP, NASUA, AARP, are some of the many organizations that are part of the Elder Justice Coalition that supports this legislation. For more information including how to join the coalition, look under “Elder Abuse” on the “Current Issues” button of http://www.ltcombudsman.org/ Source: Associated Press, 2/10/03; SNAFL.com, 2/11/03
18. Hearing on
guardianships held
The
U.S. Senate Special Committee on Aging heard a series of “horror stories” at a
hearing on guardianships held last week.
At the hearing, Senator Craig (R-ID), the committee chair, announced
that he will request that the General Accounting Office (GAO) issue a report on
abuses of the guardianship system. The first case presented at the hearing was
that of Mollie Orshandsky. Although Ms.
Orshandsky had made legal plans for her own future, a local court in Washington
D.C. appointed a non-family member to act as her guardian and an attorney to
represent her, and placed her in a D.C. hospital. Ms. Orshandsky’s niece, Jane Pollack, described the legal battle
that ensued to rescue her aunt. Ms. Pollack’s attorney also testified and
called for guardianship reforms. A
number of other witnesses testified as well:
Frank Johns, representing the National Academy of Elder Law Attorneys,
emphasized the need for procedural due process protections; Penny Hommel of the
Center for Social Gerontology discussed mediation in the area of guardianship;
3) Diane Armstrong, author of the book called “The Retirement Nightmare,” spoke
of the motives that can drive family members to seek guardianship; 4) Robin
Warjone, who was the subject of a guardianship petition by her three children
in Seattle, described how she was forced to spend her retirement savings of
$300,000 to successfully defend against the guardianship; and Robert Aldridge,
an attorney from Idaho, spoke of the recent reform efforts in his state, and
the safeguards that have been put in place.
The testimony will be available soon at http://aging.senate.gov/hearings.htm. Source:
ABA Elderbar Listserve, Notes by Erica Wood, 2/13/03
19. Joint
hearing focuses on tort reform
Doctors, patients and insurance experts testified before a February 11 joint hearing of the Senate Judiciary and Health, Education, Labor and Pensions committees on the subject of sharply rising medical malpractice insurance premiums. Witnesses appeared to agree that the rising premiums are responsible for the “health care crisis” facing 12 states and threatening 30 others, but disagreed on the source of the increase or how to slow it. Some witnesses attributed the rise in premiums to high jury awards for pain and suffering in malpractice cases, while others said insurance companies have raised premiums to recover money lost in the stock market. For complete testimony from the hearing, go to http://judiciary.senate.gov/hearing.cfm?id=600. Source: Kaiser Daily Health Report, 2/11/03
Other
News
20. NCOA adds prescription drugs to
benefits check-up service
The National Council on the Aging (NCOA) has launched a
comprehensive, web-based service, BenefitsCheckUpRx,
to connect older adults with over 240 public and private prescription savings
programs covering nearly 800 prescription drugs. The service allows older Americans, their families and
caregivers to quickly determine what prescription savings programs a senior
qualifies for and how to claim them. Once users complete a brief questionnaire,
the service displays a personalized report specifying all the programs they are
eligible for and detailed instructions on how to enroll. BenefitsCheckUpRX is
available at: http://www.benefitscheckup.org/. Source: NCOA press
release, 1/22/03
This publication of the National Ombudsman
Resource Center (NORC), at the National Citizens' Coalition for Nursing Home
Reform, updates State and Local LTC Ombudsmen on the latest information,
resources, ideas, and practices in the full range of long-term health care.
The Gazette is organized for your easy reading. Information is grouped by
topics (Ombudsman Program Updates, Nursing Home News, Assisted Living,
Staffing, etc) and numbered. You can quickly see if any articles are of
interest and immediately go to those articles.
In order to get this info to you ASAP, there is little to no additional
verification work or search of resources.
The information comes from a number of sources including the Washington Post,
the New York Times, and two daily listservices. (one from the Kaiser Family
Foundation and the American Hospital Association) and other sources happened
upon by NORC staff and consultants. To start a subscription to AHA News
Now, send a message from your subscribing e-mail address listserv@ahals.aha.org
and write in the message area: subscribe ahanewsnow. Please submit suggestions
for improvement or information to Robyn Grant, NORC consultant, at robyngrant@comcast.net.
The National Long Term Care Ombudsman Resource
Center provides technical assistance and support to state and local long-term
care ombudsman programs. This summary was supported, in part, by a grant,
No. 90AM2139, from the Administration on Aging, Department of Health and Human
Services. Grantees undertaking projects under government sponsorship are
encouraged to express freely their findings and conclusions. Points of
view or opinions do not, therefore, necessarily represent official
Administration on Aging policy.
For more information contact the National Long Term Care Ombudsman Resource Center, at (202) 332-2275 or ombudcenter@nccnhr.org