NORC Gazette
June 18, 2002
National Long Term Care
Ombudsman Resource Center
National Citizens’ Coalition
for Nursing Home Reform
Table
of Contents
4. Local and State Ombudsman trained in West Virginia
Home and Community-Based Care/Olmstead
5. MI advocates seek alternatives to
nursing homes
6. TN “no tax” budget
proposal would force more elderly into facilities
Nursing Home News
7. MO bill prohibiting sex with residents goes to governor
8. AR advocates support use of video cameras in nursing homes
9. Mom kills sons in GA nursing home
10. Legionnaires’ hits PA nursing home in Philadelphia area
11. No nursing home ventilator beds in Houston, TX
12. Conference on nursing home and community
sexual abuse to be held
Assisted Living
13. Assisted living bills abound in NY
14. Washington Post Magazine looks at assisted living facilities
15. NY Democratic
legislators call for investigation of adult homes
17. Stricter AR staffing standards put on hold
18. CNA proposes roles for injured/aging nursing assistants
Medicare
19. Medicare to pay for group
therapy under certain conditions
20. U.S. Senators promote bill
to stop Medicare nursing home cuts
21. NIRT is here!
22. West VA
considers freezing Medicaid payments to nursing homes
Research
23. Study finds osteoporosis costs
California billions
24. Urine test may detect Alzheimer’s Disease
DC Doins'
25. Finance Committee to hold hearing on elder
justice
26. Committee on Aging will
look at solutions to long term care crisis
27. Senate considers ways to address elderly falls
28. IA Elder Affairs director
resigns
A reporter writing an article for the Atlanta Journal-Constitution about SunBridge Care and Rehabilitation in Griffin, Georgia interviewed Becky Kurtz, State Ombudsman, about the ombudsman program experience with the facility. SunBridge is the nursing home where Carol Carr allegedly killed her two terminally ill sons who resided in the facility (see item 7 in “Nursing Home News”). The Atlanta Journal-Constitution stated that its review of state survey records found a long history of understaffing, poor care and dangerous conditions, including “immediate jeopardy” violations at SunBridge. When the newspaper contacted the Long Term Care Section of Georgia’s Office of Regulatory Services, an official noted that there had been some improvements since last summer. From the ombudsman perspective, Kurtz reported that ombudsman representatives were still getting complaints about the home, although she said that the current administrator had been responsive to complaints and had tried to improve staffing at the home. Source: The Atlanta Journal-Constitution, 6/11/02
2.
Ombudsman best practices from 2002 state conference now online
Best Practices shared by state ombudsmen at the Ohio national
ombudsman training are now available on the Ombudsman Resource Center
website. You can find them under
“Ombudsman Support” at:
Program Management,http://www.ltcombudsman.org/ombpublic/49_507_1796.CFM;
Systemic Advocacy, http://www.ltcombudsman.org/ombpublic/49_352_1015.CFM;
and Training, http://www.ltcombudsman.org/ombpublic/49_506_1786.CFM.
If your state’s best practice is
not on the site in one of these categories, send it by e-mail to dokrent@nccnhr.org.
3. Maryland recognizes volunteer ombudsmen
Volunteer and paid ombudsmen from each Maryland regional ombudsman program were recognized in a special event sponsored by the Maryland Department of Aging. Speakers included Director Sue Ward and Kenton Williams from the Administration on Aging. The highlight of the luncheon included the traditional birthday cake and a new video about the ombudsman program. The video was designed so that other states can easily adapt it for their own use. Contact Maryland State Ombudsman Pat Bayliss for details: 410-767-1100.
4. Local/State Ombudsmen trained in Virginia
80+ ombudsmen attended the Center sponsored Mid-Atlantic training conference for PA, VA, WV, DC, MD and DE. Highlights included presentations from Wayne Nelson on Ombudspower, Bill Benson on "ombudsman basics", and Eric Carlson on investigation and advocacy in nursing homes. Debi Lee (NALLTCO) and Tim Hoyle (NASOP) discussed their associations’ current activities. The Center will sponsor training for the eight southern states in Region 9 in early 2003. Thanks Kentucky for agreeing to host this event! Julie Meashey will be organizing this conference with a planning committee made up of ombudsmen from each state.
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. Residents' Rights packets will be available in August.
October 26 - 29: NCCNHR Annual Meeting. Oct. 26th will be a “Bridge Day” with the NALC that is being held at the same location. Registration forms were mailed this week. NASOP and NALLTCO will hold meetings during the conference. Theme: “No More Excuses: We Demand Quality Long-Term Care”
Home and Community-Based Care/Olmstead
5. MI advocates seek alternatives to nursing homes
A coalition of 14 advocacy groups is lobbying for an approach to long term care that would offer an alternative to nursing homes for elderly and disabled people. According to the executive director of the Michigan Association of Centers for Independent Living, “What we would like is for the money to follow the person.” The state spends $1.3 billion a year on nursing homes, compared to $127 million a year for the MIChoice waiver programs – programs which allow Medicaid clients to use long term care funds for at-home care. A state spokesperson commented that comparing the two budgets is misleading since nursing homes provide a completely different level of care and the waivers do not cover items such as rent. The executive vice present of the Health Care Association of Michigan also stated that the nursing home population is significantly older and sicker than at-home care clients and these individuals are often without family or friends capable of caring for them. The battle over Medicaid dollars is becoming increasingly contentious as the state struggles with budget shortfalls. Source: Detroit Free Press, 6/9/02
6. TN “no tax” budget proposal would force more elderly into facilities
When the Tennessee legislature returns to session on June 19 it must pass a balanced budget by July 1. Two different options being considered are an income tax and a “no-tax” budget. The latter would involve a 12.5% cut across all state departments. The director for the Commission on Aging and Disability estimated his department would lose $1.8 million under a no-tax budget. As a result, at least 1,100 clients would get no or significantly reduced services, and many would be transferred to nursing homes. In addition, the loss of the commission’s improvement budget for the third year in a row would prevent it from taking advantage of more than $6 million in matching federal funds for a family caregiver support program. Source: Knoxville News Sentinel, 6/11/02
Nursing Home News
7. MO bill prohibiting sex with residents goes to governor
State lawmakers have passed a bill that includes an amendment penalizing nursing home owners or employees for engaging in sexual acts with residents, even with their consent, according to the St. Louis Dispatch. The proposal failed to pass the Senate twice in recent years, but finally succeeded as an amendment to a larger bill. The bill’s sponsor contends that the power structure of a nursing home makes consent by a resident to a sexual act an unacceptable defense. Under the new legislation, an owner or employee of a nursing home would be guilty of a Class B misdemeanor if they engage in sexual contact with a resident and a Class A misdemeanor in cases of sexual intercourse. Consent is excluded as a possible defense. If the governor signs the legislation, it will go into effect Aug. 28. Source: SNALF.com, 6/11/02
8. AR advocates support use of video cameras in nursing
homes
Nancy Allison, president of the
Arkansas Advocates for Nursing Home Residents, a citizens’ advocacy group and
National Citizens’ Coalition for Nursing Home Reform group member, spoke out in
favor of “granny-cams” at a meeting last week.
Use of the cameras would make families feel more at ease, slow staff
turnover, improve resident care and cut liability insurance rates, she
said. But Randy Wyatt, Executive
Director of the Arkansas Health Care Association, commented that surveillance
cameras may violate patient privacy rights and could lead to employee
resignations. Allison argued that any
nursing home employee who isn’t comfortable being recorded shouldn’t be working
with elderly residents. In March a
proposed bill allowing video cameras died in a House committee. The bill’s sponsor, Representative Sam
Ledbetter, (D-Little Rock) plans to reintroduce the legislation in the next
session. Source: The Log Cabin Democrat, 6/11/02
9. Mom kills sons in GA nursing home
Over the weekend of June 8-9, Carol Carr walked into the Georgia nursing home room where her two sons lived and shot them both to death. The sons, ages 41 and 42, were in the advanced stages of Huntington’s Disease. The men had lived at the SunBridge Care and Rehabilitation home since January 2002, and Carr had visited several times a week. It’s unclear what prompted the shootings, but a third brother, who is in the early stages of the disease, said the men were not getting the care they needed at the home. The brothers were bedridden, he said, and the facility left them lying on bedsheets soaked in their own urine despite the family's complaints. A hearing is set for June 27. Source: AP wire, 6/11/02; Atlanta Journal- Constitution, 6/11/02
10. Legionnaires’ hits PA nursing home in Philadelphia
area
Nine residents of a new nursing home in Montgomery County, Pennsylvania are gravely ill, five of them with Legionnaire’s disease. The other four are being tested for the disease. All nine had lived in their own rooms on the “D Wing” of the Madlyn and Leonard Abramson Center for Jewish Life in Horsham. More than 70 other residents on that wing were moved to other rooms of the facility as a precaution while authorities searched for a possible source of the bacterial illness. The facility has stopped any new admissions. The disease is an airborne respiratory infection whose bacteria breed in air-conditioning cooling towers, hot water tanks, whirlpool spas, humidifiers, faucets, showerheads and moist soil. The elderly and those with weakened immune systems have the greatest risk of contracting the disease. Source: The Philadelphia Inquirer, 6/12/02
11. No nursing home ventilator beds in Houston, TX
Despite the fact that Houston, Texas prides itself on its cutting-edge medical care, there is not a single nursing home in the city that will accept residents who need ventilators to help them breathe. Houstonians who are ventilator-dependent and who need long term care must move one to four hours away from their loved ones in order to live in one of only 8 nursing homes statewide. While some nursing home spokespeople say that the problem is due to low government reimbursement, others disagree. Beth Ferris, a lobbyist with Texas Advocates for Nursing Home Reform, which is a National Citizens’ Coalition for Nursing Home Reform group member, said she believes reimbursement is adequate for ventilator patients and that the nursing homes have an obligation to accept them. In addition, reimbursement is clearly sufficient for the 8 nursing homes that currently take ventilator residents. Administrators of these facilities say their methods are not out of the ordinary and involve comparison shopping for equipment, aggressive negotiating with medical supply vendors and doing the necessary paperwork. Source: Houston Chronicle, 6/10/02
12. Conference on nursing home and community sexual abuse to be held
United
Senior Advocates 2K will be holding its conference, “The Silent Crime - Sexual
Assault on Women in Nursing Homes and the Community,” on September 23-24, 2002
at the Hotel Sofitel in Houston, Texas.
The keynote speaker will be psychologist, Beth Rom-Rymer, Ph.D. For more information, go to: www.usa2k.org.
Assisted Living
13. Assisted living bills abound in NY
Numerous bills regarding assisted living have recently been introduced in the New York legislature. The bills include legislation that would: define assisted living residences for adults, provide for the licensing and registration of assisted living residences, establish standards for assisted living agreements, including disclosure, and provide for the regulation and inspection of assisted living facilities by the Department of Health. To read the different bills, go to: http://assembly.state.ny.us/leg and type “assisted living” in the search box. Source: BAL Weekly, 6/12/02
14. Washington Post Magazine looks at assisted living
facilities
The Washington Post Magazine recently profiled assisted living, describing it as an option “defined largely by what it isn’t: It’s not a nursing home.” The article noted that unlike nursing homes, which face stringent federal regulations, assisted living facilities are regulated by states, which “may take a keen interest or very little” in overseeing such facilities. According to the Post, the industry is likely to undergo significant change in the coming years, particularly with “the first” of 80 million baby boomers now entering their eighties. The increased demand for assisted living services will strain a “patchwork system” made up of federal funding, private savings, long-term care insurance and “various state and local and charitable institutions,” the Post reports. Robert Kramer, Executive Director of the National Investment Center for the Seniors Housing and Care Industries, said, “We have to think through the whole question in some rational, coherent way. Is this an individual’s responsibility? A government’s responsibility? An entitlement, a right? This really needs national debate.” Source: Kaiser Daily Health Report, 6/10/02
15. NY Democratic legislators call for investigation of
adult homes
New York state Democrats on June 12 called for an independent prosecutor to investigate “criminal misconduct and hazards” in the state’s adult homes and “alleged neglect” by the administration of Governor George Pataki (R) in “protecting residents,” the Albany Times Union reports. The newspaper also stated that four committee chairs in the state Assembly accused the administration of “accepting fines at a fraction of what the violations called for, and for being unduly influenced by lobbyists and its own unidentified officials with relatives who own or operate” adult homes. However, according to a spokesperson for the state Health Department, “The claim is complete and utter nonsense and typical of the Assembly’s partisan attacks.” The spokesperson pointed out that the administration has increased the number of inspectors, launched more than 500 investigations and taken 74 “enforcement actions” in the past year. In addition, the administration has announced plans to establish a new office to address “serious threats” to residents in the state’s adult homes and build criminal cases against the facilities. Source: Kaiser Daily Health Report, 6/14/02
Staffing
16. PHI
seeks innovative programs
The Paraprofessional Healthcare Institute (PHI) is seeking innovative
programs that improve the recruitment, training or retention of direct care
workers in facility-based or home and community-based services, including
consumer-directed care. The search is
part of two federally funded studies on the long term care workforce that PHI
is conducting. Nominations are welcome
from all regions of the United States.
Program descriptions will be available free of charge through a database
on the National Clearinghouse on the Direct Care Workforce website. To obtain a nominating form, go to: http://directcareclearinghouse.org/Documents/Provider_Practice_Form.htm
17. Stricter AR staffing standards put on hold
Stricter staffing requirements at Arkansas nursing homes are on hold because of state budget cuts. Under the new law, Arkansas nursing homes were supposed to have one staff member that provides direct patient care for every seven residents during the day, for every nine during the evening and for every 14 during late-night shifts. Within that, there was to be one licensed nurse for every 40 patients. Current levels require one patient-care staff member for every seven residents during the day, for every 10 during the evening and for every 16 during late-night shifts. Within that, there must be one licensed nurse for every 80 patients. In a memo dated June 5, the director of the state Department of Human Services’ (DHS) Office of Long-Term Care told nursing homes that the state won’t require homes to comply with higher standards effective July 1, as the law intended. A provision in the bill passed last year prohibited the implementation of the law if the state lacked money to cover the changes. A DHS spokesman said the current levels will remain until state revenue improves enough to make funding available for the higher levels. Source: Arkansas Democrat Gazette, 6/11/02
18. CNA proposes roles for injured/aging
nursing assistants
John Booker, a veteran certified nursing assistant, has written an article in which he explores what happens to career nursing assistants who have had their careers end because injuries or age leave them unable to handle the physical challenges of the job. In his article, Booker proposes that many nursing assistants who leave the field due to injuries or chronic conditions could make valuable contributions in a variety of ways. His article can be read at: http://click.topica.com/maaaoOLaaSrTja9Yx9Fb Source: National Clearinghouse on the Direct Care Workforce, 6/8/02
Medicare
19. Medicare to pay for group therapy under certain
conditions
The Centers for Medicare &
Medicaid Services (CMS) recently announced that
Medicare Part B will cover therapy provided in a group setting, as long as
the therapy is conducted appropriately.
Transmittal 1753 instructs carriers to pay
for outpatient physical, occupational, or speech-language therapy provided
to two or more patients at the same time if: patients can, but don’t need to,
perform the same activity, therapists oversee patients continuously, and
therapists have one-on-one contact with each patient. Go to http://www.snfinfo.com/ppsrc/#Therapy
to see Transmittal 1753. Source:
SNFinfo Connection, 6/10/02
20. U.S. Senators promote bill to stop Medicare nursing
home cuts
U.S. Senators Robert Torricelli (D-NJ)
and Gordon Smith (R-OR) are urging colleagues to support their new legislation,
the Medicare Skilled Nursing Beneficiary Protection Act of 2002 (S. 2490), that
stops 10% of Medicare cuts from being implemented on October 1, 2002. Torricelli and Smith wrote a “Dear
Colleague” letter that states the following: “It is vital that we do two
things: first, assure that Medicare funding for skilled nursing care is not
cut, as scheduled, on October 1st of this fiscal year. Secondly, it is imperative that we put
skilled nursing providers on a path toward long-term stability so that we can
assure that Medicare beneficiaries have access to quality care. Our legislation accomplishes both of these
objectives by maintaining Medicare funding for skilled nursing care at 2002
levels, plus appropriate inflationary adjustments, and by ensuring adequate
funding well into the future.” To read
the legislation, go to: http://www.senate.gov
and enter S 2490 into the “by Number” box under the section entitled “Bill
Search.” Source: SNALF.com, 6/17/02
Medicaid
21.
NIRT is here!
To help bring greater consistency to state Medicaid policies relative to long term care and other institutions, The Centers for Medicare & Medicaid Services (CMS) has announced that it has formed the Medicaid National Institutional Reimbursement Team (NIRT). Beginning July 1, a NIRT review will replace the current Medicaid institutional reimbursement state plan amendment review and decision process. The NIRT will provide technical assistance on institutional reimbursement issues to states and develop institutional reimbursement regulations and policies. CMS intends for the new program to assure the uniform application of institutional Medicaid reimbursement policy nationwide, pinpoint and quickly respond to emerging issues, identify and promote best practices relative to Medicaid institutional reimbursement, and conduct the review and decision process in a way that is both timely and consistent from state to state. CMS notified state Medicaid directors of the new policy in a May 29 letter. To read the letter, go to: http://www.cms.gov/states/letters/smd52902.pdf Source: SNALF.com, 6/10/02
22. West VA considers
freezing Medicaid payments to nursing homes
To offset a projected $187 million deficit in West Virginia’s
Medicaid budget for the fiscal year beginning July 1, the AP/Charleston Gazette
reports that a state official announced that the program could save $8 million
to $10 million by freezing reimbursement rates to nursing homes. The Medicaid rates are reevaluated
semi-annually in April and October. The
state official said that while freezing the rates will cause “pain” for nursing
homes, “it won’t be something that forces facilities either to shut down or
impact the quality of care to any degree.”
But nursing homes, which are coping with increasing liability insurance
premiums, said a rate freeze could “push them into bankruptcy.” Source: Kaiser Daily Health Report, 6/14/02
Research
23. Study finds osteoporosis costs California billions
According to a study conducted by the University of California at San Francisco, osteoporosis cost the state of California more than $2.4 billion in 1998. Study results found that the disease most commonly affects women and 80 percent of those hospitalized for the disease are white. The study, published in the current issue of Osteoporosis International, also revealed that fifty-nine percent of the dollars spent on the disease go to nursing homes because osteoporotic fractures often lead to institutionalization. Other costs include physician services, medications, emergency room visits and home health care. Source: SNALF.com, 6/12/02
24. Urine test may detect
Alzheimer’s Disease
University of Pennsylvania researchers have found that people suffering from mild cognitive impairment (MCI), a known precursor of Alzheimer’s, had elevated urine levels of a particular fatty acid that is a biomarker for free radical damage to the brain, according to a study published in the current issue of Archives of Neurology. The study’s authors conclude that accelerated oxidative damage to the brain may be occurring in individuals with MCI before the onset of symptomatic dementia and that the process is detectable through a urine test. Source: SNALF.com, 6/17/02
DC Doins’
25. Finance Committee to hold hearing on elder justice
The U.S. Senate Committee on Finance, chaired by Senator Max Baucus, held a hearing entitled, “Elder Justice: Protecting Seniors from Abuse and Neglect” on June 18. Witnesses include Catherine Hawes, Ph.D., Professor, Department of Health Policy and Management, Texas A&M University. Contact John Kafka, Center Administrative Assistant for hard copies of the testimony. Source: News Release, 6/12/02
26. Committee on Aging will look at solutions to long
term care crisis
On June 20, the Senate Special Committee on Aging will hear from expert witnesses on at least five solutions to confront the issues raised throughout the committee’s series of 13 long term care hearings on the need for comprehensive federal reform. The committee will also release findings summarizing the analysis of the governors, state and local officials and other experts who have testified before the committee about the crisis. The hearing entitled, “Long Term Care: Blueprints for Reform,” will be held at 9:30 a.m. and will be webcast live and available for viewing later at http://aging.senate.gov Source: Press release, 6/14/02
27. Senate considers ways to address elderly falls
Some 12 million elderly Americans
fall down each year, resulting in “billions of dollars” in medical bills,
elderly advocates and caregivers said during a U.S. Senate Health, Education,
Labor and Pensions - Aging Subcommittee hearing held on June 11. More than 10,000 seniors died in 1999 as a
result of fall-related injuries, David Fleming, acting Director of the Centers for
Disease Control and Prevention Center, said in written testimony, adding that
treatment of elderly falls accounts for about $20 billion in medical costs each
year. Bobby Jackson, Vice President of
the National Safety Council, said that 25% of the elderly who fracture a hip
during a fall - “among the most common injuries”- die within one year, and 75%
“never regain the quality of life they had before the fall. Senators Tim Hutchinson (R-AR) and Barbara
Mikulski (D-MD) have proposed a bill (S 1922) that would provide $38 million
each year for three years to establish an education campaign to reduce elderly
falls, subsidize research on preventing falls and improving treatment and
examine expanding Medicare and Medicaid coverage of treatment after falls. To read the bill, go to: http://thomas.loc.gov/cgi-bin/query
and enter “S 1922” into the “by Number” box under the section entitled “Bill
Search.” Source: Kaiser Daily Health Report, 6/12/02
28. IA Elder Affairs director resigns
The director of the Iowa Department of Elder Affairs, Judith Conlin, resigned in early June, saying that her departure was “in the best interest of the department.” Conlin leaves an agency buffeted by criticism of its regulatory scheme to oversee assisted living facilities, its keeping dual sets of inspection records and its alleged failure to protect elderly residents. Under Conlin, the Elder Affairs department used what it called a “collaborative” approach to the regulation of the assisted living industry. Inspections were announced in advance, and no penalties were imposed when problems were found. Conlin had called the system a “model for the nation.” Mark Haverland, a former state representative, has been appointed as the interim director of the department. Haverland is expected to work with a special task force to make recommendations to the governor regarding ways to strengthen the Department of Elder Affairs. Source: Des Moines Register, 6/4/02
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