NORC Gazette
June 10, 2002
National Long Term Care
Ombudsman Resource Center
National Citizens’ Coalition
for Nursing Home Reform
Table
of Contents
Ombudsman Program Updates
1. CT regional ombudsman
helps residents in troubled facility
2. UT Ombudsman comments on assisted living
Ombudsman Calendar of Events
Home and Community-Based Care/Olmstead
3. Ohio legislature restores funding
to home health program
4. Final rule expands veterans’
community long term care services
5. Missouri in-home services program facing cuts
Nursing Home News
6. CA uniform LTC
admission form law never implemented
7. NV “exports” residents with
dementia and behavioral problems
8. Summary of Elder Justice proposal
available online
9. CANHR launches new consumer website
10. Sun cuts workforce
11. New book on American nursing homes published
Assisted Living
12. NY adult care home residents
moved to other “troubled” homes
13. Alterra’s listing on the American Stock Exchange threatened
14. Nursing assistants honored
during National Nursing Assistants’ week
15. HHS awards grants to ease nursing shortage
16. Series of articles on staffing crisis published
17. Medicare increasingly funding nursing home
care
18. Expert says that Medicare should pay for all nursing home costs
19. Home care co-payment proposed
20. Bill would increase Medicaid matching funds
21. SC governor vetoes bill creating Medicaid committee
Research
22. Study finds new risk factors for pneumonia
DC Doins'
23. HHS starts initiative for organ
donation
24. “PRO” is out, “QIO” is in
25.
Senators
introduce bill to protect patient safety
26. Council on Foundations to support legal
challenge to LSC restrictions
Ombudsman Program Updates
1. CT regional ombudsman helps residents in troubled facility
Theresa Walsh, a Connecticut regional ombudsman, has been working to assist residents at Strawberry Hill Care Center in Norwalk. On May 22, 2002, the facility filed for bankruptcy. Following the filing, both the state Department of Public Health and the attorney general began an investigation into patient care issues. Workers at Strawberry Hill have said that the facility has been mismanaged, resulting in their receiving paychecks without funds to cover them and the loss of health and pension benefits. There have also been allegations that the owner is illegally discharging residents. At the time of the bankruptcy filing, the facility had 107 residents. By June 5 it had only 88. At an emergency meeting to discuss the situation in the facility, Walsh said that area nursing homes have been calling Strawberry Hill residents and offering spaces at their facilities. A union member who represents the nurses at the facility said that other nursing homes were given access to confidential resident files by Strawberry Hill administrators. In light of the exodus of residents from the facility and the allegations of impropriety, the mayor of Norwalk has asked the state to oust the current owners from control of the facility and to have a bankruptcy trustee oversee the health care center. Walsh has worked with the facility’s resident council president, Florence Savoca, to hold a meeting with residents to inform them of their rights. Savoca stated that she will appeal to the state to step in and take over the facility until a new owner can be found. “We’re going to fight,” she said. “I gave up my home to come here and now I have nowhere to go to.” Source: The [Stamford] Advocate, 6/5/02; 6/6/02
2. UT
Ombudsman comments on assisted living
An article in The Salt Lake Tribune reports that as
more assisted living facilities are built in Utah, advocates for the elderly
are urging consumers to make sure they are choosing good facilities with a
solid track record. Chad McNiven, State
Ombudsman, told the Tribune that
providers of assisted living services often operate according to a business
model that requires their facilities to have 75 percent to 80 percent occupancy
at all times - a standard many facilities struggle to meet. He noted that “A lot of people who want to
get into the industry don’t do the market research.” As a means of addressing this problem, the Utah Department of
Health is increasing its scrutiny of assisted living by requiring facilities to
complete a feasibility study that details services, identifies ownership and
discusses financing before facilities are able to obtain licensing. Source: The Salt Lake Tribune, 6/5/02
Ombudsman Calendar of Events
July 24 – 24: American Health Quality Association national
meeting: Partnerships for Success: The Federal Initiative on Quality
Improvement & Public reporting in Nursing Facilities. Wyndham Baltimore
Inner Harbor, Baltimore, MD. Contact Virginia
Paganelli at Vpaganelli@AHQA.org for more information.
October 6 - 12: Residents’ Rights Week 2002. Start thinking about how your program will celebrate this week.
October 26 - 30: NCCNHR Annual Meeting. Oct. 26th will be a “Bridge Day” with the NALC that is being held at the same location. More details to follow shortly, please mark your calendars and plan to attend. Theme: “No More Excuses: We Demand Quality Long-Term Care”
Home and Community-Based Care/Olmstead
3. Ohio legislature restores funding to home health program
The Ohio state legislature approved a budget last week that restores
$7.8 million to a program that provides home health care assistance to needy
seniors, according to the Plain Dealer.
The program, known as Passport, allows seniors eligible for nursing home care
to stay in their own homes by providing help with personal care, meals, and
chores. The governor is expected to sign the budget bill. The director of the
state department of aging said that the additional money means that the program
will aid another 3,500 people, eliminating a waiting list of about 1,500
applicants statewide. Source: Home Care Connection, 6/5/02
4. Final rule expands veterans’ community long term care services
The Department of Veterans
Affairs issued final regulations that add the following extended care services
to the medical benefits package: non-institutional adult day health care,
non-institutional geriatric evaluation, and non-institutional respite care.
This rule also amends VA medical regulations to establish provisions regarding
co-payments for extended care services. These actions implement provisions of
the Veterans Millennium Health Care and Benefits Act. To read the final rule, go to:
http://www.access.gpo.gov/su_docs/fedreg/a020517c.html and scroll down to the Veterans Affairs
Department heading. Source: Elder Law eBulletin, 6/4/02
5. Missouri in-home services program facing cuts
State officials in this year’s legislative session slashed $6.5 million from a Medicaid program that allows many disabled residents to receive care in their homes. The proposed cut would come from a change in the spend-down aspect of the Medicaid program. The spend-down plan reimburses people for the amount they spend on medical care to reach the Medicaid eligibility and then covers the rest of their medical expenses. The cuts would wipe out the reimbursement of initial medical expenses. Critics say it is ironic that while the program will definitely cause hardship for thousands of families, it won’t save the state any money. Instead, the measure will simply shift costs and may cost the state more in the long run because people will resort to nursing homes, emergency rooms and other government programs for care. Several Missouri legislators say they will urge the governor to veto the bill, and disability groups are trying to meet with the governor to discuss the spend-down program. Source: Post-Dispatch, 6/2/02
Nursing Home News
6. CA uniform LTC admission form law never implemented
Five years ago, then-Governor Pete Wilson signed a law directing the
California Department of Health Services to design an admissions form that would
be used by nursing homes statewide, the Contra
Costa Times reports. The bill requires “every skilled nursing facility,
intermediate care facility, and nursing facility to use a standard admission
agreement developed and adopted by the department.” According to Eric Carlson, attorney for the National Senior
Citizens Law Center and other advocates, a uniform admissions form, spelling
out resident care, rights and billing practices would give residents and their
families a better understanding of how to deal with nursing homes and
protections provided by state law. Pat McGinnis, Executive Director of
California Advocates for Nursing Home Reform and board member of the National
Citizens’ Coalition for Nursing Home Reform, stated that nursing homes “have been
able to get away with a lot without having a standardized agreement.” The deadline for completion of the form
passed almost two and a half years ago. A spokesperson for the department
blamed staff turnover and conflict within the design group for the delay. Nursing home reform advocates say the health
department’s failure to produce the form serves as another example of how it
bows to industry pressure and fails to protect the welfare of patients. “They
put it on a back shelf and hoped it would go away,” Carlson said. Source:
Contra Costa Times, 5/30/02
7. NV “exports” residents
with dementia and behavioral problems
In a hearing before a state legislative panel, legislators learned
that no Nevada long term care facilities handle residents who have a
combination of Alzheimer’s or some other form of dementia and behavioral
problems, in spite of being offered extra reimbursement to do so, according to
the Las Vegas Sun. As a result, those residents are being
placed in facilities in neighboring states. The panel heard testimony that
Medicaid nursing home residents, transferred to out-of-state facilities from
Nevada, received inadequate care and, in some cases, may have died as a
result. In addition, lack of beds led
to the transfer of a number of non-Medicaid residents out of state. Nursing homes fear the potential for
additional fines by state and federal regulators if they accept residents with
behavioral problems, says Nevada’s Medicaid head Charles Duarte. Duarte told
the panel he is exploring ways to attract a company to the state that would
offer a specialized treatment facility or find a private contractor to handle
such cases. Source: Las Vegas Sun, 6/5/02; SNALF.com, 6/7/02
8. Summary of Elder Justice proposal available online
A summary of U.S. Senator John Breaux’s announcement of the Elder Justice legislative proposal is now available on the Ombudsman Resource Center’s website. To access the summary, prepared by NCCNHR summer intern Emma Jones, go to:
http://www.ltcombudsman.org/ombpublic/49_369_3459.CFM
9. CANHR launches new consumer website
Detailed profiles on every nursing home in California are now available via the internet to consumers through the California Advocates for Nursing Home Reform’s (CANHR) new website: http://www.nursinghomeguide.org. The online guide provides consumers with a wealth of information about the state’s nursing facilities and includes data about state and federal enforcement actions, consumer complaints, financial matters, ownership and facility services.
10. Sun cuts workforce
In order to reduce overhead costs, Sun Healthcare Group
has laid off 10 employees from its headquarters, cut three out-of-state jobs
and eliminated four unfilled positions. The company hopes to save about $1
million a year as a result. According
to a Sun spokesperson, Sun may also cut a few more jobs this year. The company, which recently emerged from
bankruptcy, reported a $12.2 million loss for the first quarter of 2002 and has
predicted that its financial stability could be jeopardized if the scheduled
Medicare cuts go into effect in October.
Source: SNALF.com, 6/6/02
11. New book on American nursing homes published
A new book on nursing homes entitled, “The crisis in American’s Nursing Homes - What Are We Doing Wrong?” by Guy Seaton discusses the situation in America’s nursing homes and provides insight into improving the present healthcare systems. Charlene Harrington, Professor in the Department of Social and Behavioral Sciences at the University of California, San Francisco commented that the book is “An important contribution to the debate about healthcare today,” while Susan C Eaton, Ph.D., Assistant Professor of Public Policy at Harvard University, notes that the book is, “A very interesting and useful addition to the literature. Family members should read this book in detail to learn more about the challenges - and the possibilities - in providing quality care for their loved ones.” The book is published by Adverbage, Ltd. and is available in print and ebook versions. Source: Yahoo News, 6/4/02
Assisted Living
12. NY adult care home
residents moved to other “troubled” homes
New York state
officials have moved a number of the 300 residents of Seaport Manor, one of the
“most notoriously troubled” adult homes for the mentally ill in the New York
City area, to other adult homes that also have “histories of neglect,”
according to the New York Times. After years of “extensive” violations at
Seaport, the state decided to close the facility in March, 2002. State officials said that they have moved
more than 115 Seaport residents to “appropriate” facilities and that the
residents had consented to the transfers. However, the New York Times reports that state officials “did not say how the
residents had been able to provide meaningful consent” nor whether the state
“involved the close relatives of residents.”
In addition, the Times reports
that the state moved two Seaport residents to an unlicensed adult home and one
resident to a homeless shelter. According to the Times, the New York Department of Health could have appointed a
“temporary receiver” to manage Seaport to avoid relocating residents. Source:
Kaiser Daily Health Report, 6/3/02
13. Alterra’s listing on the American Stock
Exchange threatened
Alterra head Patrick Kennedy has announced that the American Stock Exchange will continue to list Alterra for now, but the company must produce plans charting its return to profitability in order to retain its standing on the exchange for the long term. At Alterra’s annual stockholders’ meeting, Kennedy assured investors that the company is working to avoid being delisted and continues its restructuring efforts. Kennedy said that the company is negotiating with creditors and selling off unprofitable holdings to avoid bankruptcy. He promised stockholders that Alterra will survive in some form. Source: SNALF.com, 6/4/02
Staffing
14. Nursing assistants honored during National Nursing
Assistants’ week
National Nursing Assistants’ Week
is being celebrated nationwide from June 6 - June 13. This special week was created by the National Network of Career
Nursing Assistants as a recognition program for nursing assistants. Jeni Gipson, founder of the CNA Network,
notes that “Career Nursing Assistants bring wisdom, patience, humor and a
general attitude of caring” to the daily lives of residents and clients in long
term care facilities. She encourages
facilities to honor experienced nursing assistants as the “wisdom keepers” and
“historians of what works” in long-term care.
“These ‘stayers’ provide predictability and stability to care, which in
turn enhances the feeling of security for our aging, frail, or chronically
challenged citizens,” she says. The CNA Network will hold its 2002 Convention,
“Celebrating the Great American Caregiver,” in Cuyahoga Falls, Ohio, June 13
and 14. Source: SNALF.com
15. HHS awards grants to ease nursing shortage
On June 4, Department of Health and Human Services (HHS) Secretary Tommy Thompson announced a series of grants totaling more than $33 million that are designed to ease the nation’s nursing shortage and improve the “quality of nursing services” nationwide. HHS’ Health Resources and Services Administration will award more than $22 million to universities, colleges and other organizations to boost the number of nurses with advanced degrees and “improve the quality of care for elderly patients.” The grants also include $8 million to repay educational loans of clinical care nurses who agree to work for two or three years in “designated public or not-for-profit health facilities facing a critical shortage of nurses.” Source: Kaiser Daily Health Report, 6/5/02
16. Series of articles on
staffing crisis published
In its March/April 2002 issue, the North Carolina Medical Journal published a series of articles focusing on the staffing crisis in long term care facilities. The series includes a lead article and photo essay, as well as 6 commentaries written from a variety of different perspectives. To access the series, go to: http://www.ncmedicaljournal.com/mar-apr-02/toc0302.htm
Medicare
17. Medicare increasingly funding nursing home care
According to a May 27 article in U.S. News, Medicare is increasingly subsidizing Medicaid’s share of long-term care reimbursement. The article points out that although only about 15% of nursing home residents are Medicare patients, the program provides 25% of nursing home revenues. Entitled “Long-term Blues,” the article discusses the “high stakes” at play over current federal budget deliberations, as well as other financial aspects. In the article, one industry lobbyist calls Medicare “the only game in town” because of pressure on state budgets that is affecting Medicaid spending. Source: Elder Law eBulletin, 6/4/02
18. Expert says that Medicare should pay
for all nursing home costs Richard
Kaplan, a health care expert at the University of Illinois at Champaign-Urbana,
has proposed a novel comprehensive approach to long term care funding. Under his plan, all nursing home costs would
be covered by Medicare, while care in non-nursing home settings would remain a private
responsibility. To help families pay
for care outside of nursing homes, such as assisted living facilities, Kaplan
proposes that private long term care insurance be improved to make it more
appealing. He believes that since
nursing homes’ costs need not be covered under the plan, long term care
insurance could become cheaper, less confusing and more reliable. Kaplan focuses his criticism on various
Medicare restrictions that “no longer make sense” in today’s world. For example, he notes, “Medicare pays for
physical conditions that might have been prevented (such as emphysema), but
does not pay for conditions (such as Alzheimer’s) over which patients have no
control.” Source: Ascribe News via Comtex, 5/30/02
19. Home care co-payment proposed
A co-payment of $40 per episode of Medicare home health care services is currently being considered by Republicans in the U.S. House of Representatives. In an analysis of the proposed co-payment, the Consortium of Citizens with Disabilities (CCD) found that such a co-payment would be a barrier to care and would affect the most frail beneficiaries, many of whom are low-income. According to the CCD, the $40 per episode co-payment would hit the disability community the hardest because: 1) a co-payment with no improvement in the benefit is simply a cost shift onto the beneficiary; 2) beneficiaries with disabilities are most likely to have multiple episodes lasting perhaps all year long (thus the co-payment would be $240 annually); and 3) home health beneficiaries with disabilities must be “homebound” and therefore would likely have no income or be on fixed incomes. Beneficiaries with disabilities are also most likely to be using durable medical equipment – which already has a 20% co-payment. Source: ABA Elderbar listserve, 6/5/02
20. Bill would increase Medicaid matching funds
A bill has been introduced in the U.S. Senate to provide short term relief to states facing rapidly rising Medicaid costs. The legislation, S2570, would provide a temporary one-percentage point increase in the federal medical assistance percentage (FMAP) for 18 months, and would include a “hold-harmless” provision for states in which FMAPs would otherwise decline in 2002 and 2003. The bill would also add $4.4 billion to the Title XX Social Service Block Grant. No such bill has been introduced in the House, and “prospects do not appear bright in either chamber,” according to a June 5th Washington Post article. Source: Kaiser Daily Health Report, 6/5/02; AHA News, 6/6/02
21. SC governor vetoes bill creating Medicaid committee
South Carolina Governor Jim Hodges (D) has vetoed a measure that would have established a joint legislative committee to study the state’s Medicaid program. Hodges said he vetoed the bill because the committee would have “encroached on the executive branch’s power and could [have] violate[d] federal regulations.” The state’s Medicaid program has had budget problems for years, leading lawmakers this year to tap $100 million in tobacco settlement funds and prompting cuts in most state agencies to keep the program fully funded. House Majority Leader Rick Quinn (R) said he was “disappointed” about Hodges’ veto, adding that “most experts agreed the health program needs a serious overhaul.” Source: Kaiser Daily Health Report, 6/3/02
Research
22. Study finds new risk factors for pneumonia
The Family Practice News reports four new risk factors that help spread
pneumonia among nursing home residents.
In addition to dysphagia and bed confinement, researchers found the
following factors increased residents’ susceptibility to the illness: use of
major tranquilizers; use of steroids; use of gastric or nasogastric tubes; and
a history of chronic obstructive pulmonary disease. Nursing-home acquired pneumonia is the most common infection
among long term care facilities, according to the physicians’ newspaper. Source:
SNFinfo Connection, 6/4/02
DC Doins’
23. HHS starts initiative for organ donation
Department of Health and Human Services (HHS) Secretary Tommy Thompson is encouraging employers to support organ donation through an initiative called “Workplace Partnership for Life.” The need for organ donation is urgent - more than 79,000 Americans are waiting for organs at this moment. To join this campaign, you can sign up at http://.www.hrsa.gov/donorinit/WorkPlaceIdeas.cfm. This site includes a description of ways in which the workforce can be educated about donation. The federal government has also created a new site where people can share ideas, stay in touch and keep up to date about organ donation. The website is www.organdonor.gov Source: Campaign for Quality Care listserve, 6/3/02
24. “PRO” is out, “QIO” is in
As part of its new “user
friendly” image, the U. S. Centers for Medicare & Medicaid Services (CMS)
has changed the name from “peer review organization” (PRO) to “quality
improvement organization,” (QIO) “to better reflect their responsibilities.” The definition and function of these
organizations will remain the same,” CMS says in the final rule published in
the May 24 Federal Register. To access
the regulations, go to:
http://www.access.gpo.gov/su_docs/fedreg/a020524c.html and scroll down to Centers for Medicare
& Medicaid Services. From Elder Law
eBulletin, 6/4/02
25. Senators introduce bill to protect patient safety
Senators John Breaux (D-LA.), Bill Frist (R-TN), Judd Gregg (R-NH) and James Jeffords (I-VT) have introduced the Patient Safety and Quality Improvement Act, which would implement many recommendations suggested by the Institute of Medicine (IOM) for the reporting of medical errors. In 1999, the IOM released a report stating that up to 98,000 Americans die each year from preventable medical mistakes, prompting members of Congress to consider legislation that would create systems to monitor, analyze and prevent such errors. The Breaux-Frist-Gregg-Jeffords bill would establish patient safety organizations to allow health workers to voluntarily and confidentially report medical mistakes. The organizations would analyze medical error data and make recommendations on medical mistake prevention. Previous efforts to pass medical error measures have “foundered,” particularly because of disagreement on whether medical error reporting information should be available for use in lawsuits. Under Breaux-Frist-Gregg-Jeffords, medical error information reported to the patient safety organizations would not be subject to criminal, civil or administrative subpoenas, nor would it be available through the Freedom of Information Act or legal discovery proceedings. Source: Kaiser Daily Health Report, 6/6/02
Other News
26. Council on Foundations to support legal challenge to
LSC restrictions
The Council on Foundations has stated that it will soon file a court brief in favor of overturning regulations that limit the lobbying and advocacy efforts of Legal Services Corporation (LSC) local programs. At issue is whether the government can force groups it supports to abide by limits on how they use private aid. The Council’s president and other advocates worry that the restrictions might apply to other groups and how they use money from private sources. The general counsel to the Council of Foundations has stated that the restrictions “are so onerous and expensive that the government is, in effect, restricting free speech.” To access an analysis done by The Center for Social Gerontology of how the LSC restrictions affect legal programs for the elderly and elder rights advocacy, go to: http://www.tcsg.org/bpnotes/march98/advocacy.htm Source: The Chronicle of Philanthropy, 5/30/02; ABA Elderbar listserve, 6/2/02
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@att.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