NORC Gazette
September 23, 2002
National Long Term Care
Ombudsman Resource Center
National Citizens’ Coalition
for Nursing Home Reform
Table
of Contents
Ombudsman Program Updates
1. Lori
Smetanka rejoins Ombudsman Center as Information Specialist
2. SC state representative to
propose volunteer ombudsman program
3. NCCNHR annual meeting to be held October 26-29!
Ombudsman Calendar of Events
Home and Community-Based Care/Olmstead
4. Report presents state long term
care developments
5. Expansion of adult day services proposed
7. MA wage pass-through program a success!
8. U.S. News conducts an examination of the nursing home industry's
finances
9. Nursing home crimestoppers programs appear in Florida and Arkansas
10. Federal investigation of PA nursing home launched
11. SD panel endorses federal
measure on reservation nursing homes
12. NC editorial supports use
of temporary management
Assisted Living
13.
2002 occupancy rates begin to plateau
14. MO assisted living facility must
obtain nursing home license
Staffing
15. WV interim legislative committee looks at staffing issue
16. Judge splits decision in CT nursing home suit
17. Five million Americans under 65 qualify for
Medicare
Research
18. Hospitals, nursing homes experience
40+ medication errors each day
DC Doins'
19. Elder Justice Act gains sponsors
20. Tort reform bill moves to full House
21. OSHA begins nursing home inspections
Other News
22. Partnerships in Law and Aging grants available
Ombudsman Program Updates
1. Lori Smetanka rejoins Ombudsman Center as Information Specialist
A hearty welcome to Lori Smetanka, Esquire, who rejoins the Ombudsman Center staff as the Center Information Specialist. Lori worked for NCCNHR from 1994 - 1999, and then took some time out to be a full-time mom. A graduate of the University of Dayton Law School, Lori started her work at NCCNHR as a Duke University intern. She has expertise in OBRA, Medicaid and Medicare, public policy and preparing consumer information documents. Lori will be working in the office three days a week. We ask that ombudsmen continue to send their requests for assistance to Ombudsman Specialist Julie Meashey, who will distribute the requests to the staff with expertise in that particular area.
2. SC state representative to propose volunteer
ombudsman program
South Carolina state representative Joel Lourie told the South Carolina Silver-Haired Legislature that he will propose a volunteer ombudsman program to send trained volunteers to monitor care in nursing homes on a weekly basis. Roy Mathis, speaker of the Silver-Haired legislature, said the volunteer ombudsman program was “a very efficient way to improve safety and security of the most vulnerable South Carolinians from abuse and neglect.” He said it would cost taxpayers $300,000 - $400,000. At the close of its 3-day session, the Silver-Haired Legislature identified the volunteer ombudsman program as one of its top 4 priorities. However, the president of the South Carolina Health Care Association has criticized the proposal, saying that adding professional ombudsmen would be better than volunteers since reports written by people without proper training could add to the growing number of lawsuits against homes. Source: The State, 9/13/02
3. NCCNHR annual meeting
October 26-29 offers several opportunities for Ombudsman learning!
The NCCNHR Annual Meeting is going to be an exciting opportunity for ombudsmen and others to learn about research, legislation, and initiatives related to long term care. What better time to equip ourselves to improve care than the 15th anniversary of OBRA! October 8th is the deadline for the reduced registration fee. October 2nd is the deadline for hotel reservations. Highlights include Bridge Day, Saturday, October 26th when participants in the NALC conference can add a luncheon with David Marks, Esq. speaking on “Nursing Home Law 15 years After OBRA - Why Aren’t We There Yet?” and afternoon sessions on Data in Neglect and Abuse Cases; Labor Law Violations; Tort Reform; Survey and Certification Challenges; and the Legal Basis of Using A Medical Chart. (NCCNHR conference participants can also add on the NALC morning sessions.)
Plenary speakers include the popular and dynamic Wendy Lustbader, MSW, speaking on “No More Excuses: Good Care is Possible;” expert researcher Jeanie Kayser-Jones addressing “The Experience of Dying in Nursing Homes: Pain, Thirst and Indignity” and a serious discussion of the challenges of the Long-Term Care Ombudsman program featuring citizen advocate Barbara Hengstebeck, local ombudsman Debi Lee, state ombudsman Carol Scott, and Bill Benson, President-elect of NCCNHR. See the NCCNHR website for the newest details and registration form: http://nursinghomeaction.org
Ombudsman Calendar of Events
September 24: “Take a Loved
One to the Doctor Day.”
September 27, 1:00 – 3:30 p.m. EST. CMS live webcast on the Pioneer Network. To register, go to http://cms.internetstreaming.com.
October 6 - 12: Residents’ Rights Week 2002. This year’s theme is “Giving Voice to Quality: Affirming Residents' Rights in Long Term Care.” Residents’ Rights packets will are currently available. Remember, Monday, October 7th has been designated to focus on Resident Councils and Saturday, October 12th will focus on Family Councils. Now is the time to organize residents’ right celebrations in your community! To order your Residents' Rights Week Packet, contact Charles Booker, NCCNHR Clearinghouse Manager at 202-332-2275.
October 25, 11am to 5 pm: New State Ombudsmen Orientation, Arlington, Virginia.
October 26 - 29: NCCNHR Annual Meeting/Conference. Oct. 26th will be a “Bridge Day” with the NALC that is being held at the same location. Speakers include Social Worker Wendy Lustbader, researcher Jeanie Kayser Jones, and other experts in long term care. See the NCCNHR website for details. Theme: “No More Excuses: We Demand Quality Long-Term Care” NASOP and NALLTCO will be holding meetings during this conference.
Home and Community-Based Care/Olmstead
4. Report presents state long term care developments
A new report entitled, “State Long-Term Care: Recent Developments and Policy Directions” is now available online. This report provides a thumbnail sketch of long term care budgets, legislation and planning in the 50 states and the District of Columbia. The focus of this report is mainly on state legislation, expenditures and policy activity in FY 2001. It also previews FY 2002 (when the data were available and appropriate). Go to http://aspe.hhs.gov/daltcp/whatsnew.htm and click on “State Long-Term Care: Recent Developments and Policy Directions” to read the report.
Source: http://aspe.hhs.gov/daltcp/whatsnew.htm.
5.
Expansion of adult day services proposed
U.S. Senator John Rockefeller (D-WV) has introduced a bill, SB 2655 that would expand care and reimbursement options for people in need of adult day services. The legislation would allow adult day services to be funded as a stand-alone service and not through home health agencies. According to an issue brief developed by the National Adult Day Services Association (NASDA) which is advocating for the legislation, the amendment would permit Medicare beneficiaries who qualify for home health benefits to receive those services in the most appropriate setting - their home or in an adult day location. Source: www.nadsa.org; SNALF.com, 9/18/02
Columnist Bob Herber recently wrote in the New York Times that home health care workers do “important work” but are among the “most poorly paid and poorly treated” employees in the health care industry. Herbert noted that more than 15,000 home health care workers in New York City have voted to join the Service Employees International Union 1199 in order to address issues such as low pay and lack of health insurance. However, contract negotiations with the home health service agencies that employ the workers have proven “extremely difficult.” Most home health care workers “receive no health care, no sick pay, and get no vacations” as compensation for their work, Herbert writes, concluding that “now would be a good time to stop the[ir] utter exploitation.” Source: The New York Times, 9/12/02
Nursing Home News
7. MA wage pass-through program a success!
Barbara Frank, who is responsible for the Paraprofessional Healthcare Institute’s work in Massachusetts, has provided clarification regarding the wage pass-through initiative discussed in the September 17th issue of the Gazette (item #16). Although newspaper articles have claimed that nursing homes failed to allocate money for nursing assistant salaries, Frank reports that the wage pass-through program has actually been a phenomenal success, with 97% compliance on the handling of the pass-through money. She indicates that homes that had originally been determined to be out of compliance are now being found in compliance after having submitted additional information. Moreover, she also notes that the reason a number of facilities are still non-compliant is because they did not spend the money, not because they misspent it. Frank points out that as a result of the infusion of pass-through funds, wages have increased by 8.7%, after years of increases of only about 2%. In addition, the certified nursing assistant vacancy rates and turnover rates have gone down due to the wage pass-through and other workforce initiatives undertaken in the state. For more information, contact Barbara Frank at (617) 338-8478 or bfrank1020@aol.com
8. U.S. News conducts an
examination of the nursing home industry's finances
Do the nursing home industry's cries about cuts in
Medicaid funding contributing to their demise hold water? A study conducted by U.S. News suggests they
do not. The magazine analyzed hundreds of thousands of pages of
nursing home financial statements and shared the results with current and
former regulators, patient advocates, congressional staffers, and others
knowledgeable about the industry. For a
look at their findings go to: http://www.usnews.com/usnews/issue/020930/health/30homes.htm
Source: Health and Medicine 9/30/02.
9. Nursing home crimestoppers programs appear in Florida
and Arkansas
The Quapaw Quarter Nursing and Rehabilitation Center in Little Rock, Arkansas and seven Florida nursing homes are taking part in the Senior Crimestoppers Program. Terry Rooker of the Memphis-based Senior Housing Crime Prevention Foundation, which sponsors the program, said that Senior Crimestoppers has reduced crime by more than 80 percent in participating facilities. Each resident is given a lock box for valuables. Under the program, the facility adopts a zero-tolerance policy concerning theft, abuse, neglect, fraud and other crimes, and a toll-free number allows anyone witnessing such an incident to anonymously report. If their information checks out, they can be given a cash reward of up to $1,000. They collect the money off premises, and the reward offer never expires. A wrongdoer need not be arrested and convicted for Senior Crimestoppers to pay the reward. Source: www.kark.com 9/5/02; News Journal, 9/14/02
10. Federal investigation of PA nursing home launched
Federal
agencies have begun an investigation at Ronald Reagan Atrium I Nursing and
Rehabilitation Center, a Robinson, Pennsylvania nursing home, which has been
the subject of an Allegheny County police inquiry since the death of a resident
last year. The resident died October 26
after she was locked in one of the nursing home’s outdoor fenced courtyards on
a 40-degree night. Testimony during a
coroner’s inquest indicated that workers at Atrium carried Taylor’s cold body
back to bed, redressed her and turned up the heat to make it appear that she
had died in her sleep. Following the
inquest, the Allegheny County Coroner called on the district attorney to
prosecute Atrium administrator Martha F. Bell for “gross, reckless and
negligent misconduct” and to prosecute Bell and other employees for criminal
neglect of Taylor and “most of the other” residents, perjury and obstruction of
justice. Agents from the FBI and the
U.S. Department of Health and Human Services are questioning current and former
employees and relatives of residents, and have subpoenaed thousands of
documents. Source: Post-Gazette,
9/19/02
11. SD panel endorses federal measure on reservation
nursing homes
A
South Dakota legislative panel, the State-Tribal Relations Committee, has voted
to support a congressional measure introduced by South Dakota senators, Tom
Daschle and Tim Johnson, that would allow nursing homes to be built on Indian
reservations. Currently such
construction is not possible as a result of a moratorium that prevents
construction of new nursing homes or the addition of additional beds in
existing nursing homes. Nursing homes
are needed on the Pine Ridge Indian Reservation and several other reservations
because existing facilities are located too far away. However, because of the state moratorium, any nursing home built
on a reservation would not get a state license. Consequently, such a nursing home would be unable to get Medicaid
funding for its residents. Measures
seeking to loosen the state moratorium so nursing homes could be built on
reservations have repeatedly failed in the state legislature. The bill in Congress would allow
construction of nursing homes on South Dakota reservations by requiring that
the federal government pay 100 percent of the Medicaid cost for residents in
tribal nursing homes. Source: AP Newswire, 9/13/02
12. NC editorial supports use of temporary management
Following the recent closing of a rest home in North Carolina, an editorial in the Raleigh, North Carolina News and Observer advocates the use of a state temporary management law. The editorial states that this law, which has existed for 9 years but has never been invoked, could be an alternative to the “bitter pill of displacing frail elderly and mentally ill people.” According to the editorial, money is the reason the law has not been used. The law was designed to be paid for by licensing fees and fines collected by the divisions of the Department of Health and Human Services, but this fund has been empty since a court order in the mid-1990s sent all such money to school districts. The editorial suggests that the Health and Human Services Secretary should ask the General Assembly to “restock” the fund. Source: The News and Observer, 9/16/02
Assisted Living
13. 2002 occupancy rates
begin to plateau
Assisted living occupancy rates in both the median (83 percent) and
average (84 percent) stayed nearly the same as last quarter. Assisted living also had a slight increase
in average monthly net move-in rates for facilities open less than 24
months. To view results for both
occupancy and move-in rates, go to: www.nic.org and click on “Key Financial Indicators: First Quarter 2002 data.” Source: SNALF.com, 9/16/02
14. MO assisted living
facility must obtain nursing home license
Claiming that an assisted living facility in Chesterfield, Missouri
was providing too much oversight without a license to its Alzheimer’s
residents, the state is forcing the facility to get a nursing home license to
avoid being shut down. The St. Louis Post-Dispatch reported that
Sunrise Assisted Living agreed to the requirement, which came as a result of its
lawsuit against the state. Sunrise sued
for $21 million in damages last year because it claimed the state agreed to its
original plan for the assisted living facility, but demanded afterwards that
the facility acquire nursing home licensure for its locked Alzheimer’s
wing. In the final settlement, Sunrise
did not receive any damages and was required to pay $75,000 to the state’s
Merchandising Practices Revolving Fund to resolve the matter of what the state
called misleading advertising. Because
Missouri currently has a freeze on issuing licenses to nursing homes, the
assisted living facility provider will have to purchase one from another
nursing home company. Source: BAL
Weekly, 9/18/02
Staffing
15. WV interim legislative committee looks at staffing
issue
State
lawmakers in West Virginia are studying what to do about the need for more
nursing home workers amid a great deal of dispute between union officials and
industry representatives. Dr. Charlene
Harrington of the University of California San Francisco, an expert on nursing
home quality, told the legislators that though payments to the state’s nursing
homes increased by an average of 20 percent between 1999 and last year,
staffing levels and quality of care in the state dropped. A representative from Service International
Employees Union Local 1199 voiced concerns about increasing reimbursements to
nursing homes as a solution to the staffing problem because those facilities
have failed to use past increases to raise staffing levels and workers’
salaries. Responding to the issue of
quality, the chief executive officer of the West Virginia Health Care
Association said that a survey conducted by Marshall University showed more
than a 90% satisfaction rate with nursing home services in the state. Senator Preszioso, co-chairman of the Select
Committee on Nursing Homes, said he thought lawmakers would ask each group to
try to reach common ground on what the situation is and what should be done
about it. He said that lawmakers should
do something to make salaries for nursing home workers more attractive and to
make sure quality of care is kept up. Source:
Charleston Daily Mail, 9/18/02; Associated Press, 9/17/02
16. Judge splits decision in CT nursing home suit
A federal court judge issued a split decision in a civil lawsuit against Connecticut Governor John Rowland, who was sued by a union for using taxpayer-funded replacement workers during a nursing home strike last year. Workers at 39 private nursing homes went on strike in May 2001 seeking better pay and increased staffing levels. Rowland then spent state money to cover replacement workers at the facility, prompting the union to claim the governor was trying to break it. The judge agreed with the New England Healthcare Employees Union, District 1199 that the state’s hiring of replacement workers interfered with collective bargaining and the plaintiffs’ right to strike, which is protected by the National Labor Relations Act. However, the court sided with the Governor and the Department of Social Services Commissioner in ruling on other claims in the suit, including finding that Rowland did not violate the strikers’ First Amendment Rights. Source: www.ctnow.com, 9/13/02
Medicare
17. Five million Americans under 65 qualify for
Medicare
According to a new report
prepared for The Commonwealth Fund and The Henry J. Kaiser Family Foundation,
about 5 million Americans under age 65 qualify for Medicare coverage because
they are totally and permanently disabled, representing one of seven Medicare
beneficiaries. The report, “Medicare’s
Disabled Beneficiaries: The Forgotten
Population in the Debate Over Drug Benefits,” says the disabled are heavier
users of medications than are the elderly, filling more prescriptions on
average and spending more on drugs, $1,284 vs. $841 in 1998. Findings show the disabled are more likely
to be in poor health and to experience difficulties performing basic daily
tasks. The report’s authors conclude
that a Medicare drug benefit designed for the elderly will not suffice for the
disabled unless their particular needs are assessed and addressed. To read the report, go to http://www.kff.org/content/2002/6054. Source: AHA, 9/16/02
Research
18. Hospitals, nursing homes experience 40+ medication errors each day
Researchers who conducted a study of 36 hospitals and skilled
nursing facilities in Georgia and Colorado found that medication errors occur
more than 40 times per day in a typical 300-bed facility, although only about
7% of the errors were judged potential adverse drug events. The study, which appeared in the Archives of Internal Medicine, found
that 19%, or nearly one in five medication doses, was in error. The most frequent errors by category were
wrong time, omission, wrong dose, and unauthorized drug. The study notes that defects in medication
administration systems are widespread, and the study’s authors concluded that
the typical patient was subject to about 2 errors every day. Source: AHA News, 9/9/02
DC
Doins’
19. Elder Justice Act gains sponsors
The original sponsors of the Elder Justice Act, Senators John Breaux and Orrin Hatch, have been joined by 8 co-sponsors: Max Baucus (D-MT), chair of the Finance Committee; Jean Carnahan (D-MO); Ben Nelson (D-NE); Debbie Stabenow (D-MI); Kit Bond (R-MO); Susan Collins (R-ME); Blanche Lincoln (D-AR); Gordon Smith (R-OR); and Robert Torricelli (D-NJ). The bill, S 2933, can be accessed by going to: http://thomas.loc.gov and typing in S 2933 for Bill Number (note that the bill is 138 pages). Source: NCCNHR, 9/18/02
20. Tort reform bill moves to
full House
The U.S. House Energy and Commerce Committee has voted in favor of
H.R. 4600, a bill that would place limits on medical malpractice suits brought
against nursing homes and other health care providers. The House Judiciary Committee approved the
bill on Sept. 10. The bill now moves to
the full House. Source: Kaiser Daily Health Report, 9/19/02;
SNALF.com, 9/20/02
21. OSHA begins nursing home
inspections
Effective September 17, the U.S. Department of Labor’s
Occupational Safety and Health Administration (OSHA) started conducting
targeted inspections of nursing and personal care facilities that have 14 or
more injuries or illnesses resulting in lost work days or restricted activity
for every 100 full-time workers. The
enforcement effort follows a 60-day education initiative. OSHA Administrator John Henshaw says, “It’s
time to take the next step and begin our enforcement efforts on specific
facilities that have injury and illness rates almost five times the average for
general industry.” Source: SNALF.com,
9/18/02
22. Partnerships in Law and Aging grants
available
The Partnerships in Law and Aging
Program, with funding from the Borchard Foundation Center on Law and Aging and
the Marie Walsh Sharpe Endowment of the ABA Fund for Justice and Education,
will award up to ten (10) grants of $7,500 each to encourage development of new
and collaborative community-based projects that enhance the legal awareness of
older persons and improve their access to the legal system. Request for
Proposals and Application Cover Sheet are available at www.abanet.org/aging. Descriptions of previously funded projects
are also available at that location.
Applications must be postmarked or hand-delivered on or before December
2, 2002. For additional information,
contact Stephanie Edelstein at the ABA Commission, (202) 662-8694 or by e-mail
at sedelstein@staff.abanet.org.
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