November 14

NORC Gazette
November 14, 2005
National Long Term Care Ombudsman Resource Center
National Citizens’ Coalition for Nursing Home Reform

Table of Contents
    Ombudsman Program Updates
1.    Welcome to new State Ombudsmen in KY and NV
2.    Local KY program website stresses resident focus in complaint work
3.    MI Ombudsman voices concerns about Medicare Part D
4.    HHS town hall meetings open to ombudsmen, others
    Ombudsman Calendar of Events
    Home and Community-Based Care/Olmstead    
5.    Home health care performance standards released
6.    Report looks at strategies to keep consumers at home
        Nursing Home News
7.    Two drunken moose invade Swedish home
8.    Nursing homes as domestic violence shelters
9.    NY nursing homes unprepared for disaster
10.  FL facilities help each other out
    Culture Change
11.  Attend the “Celebrate Direct-Care Workers” conference!
    Assisted Living
12.  Assisted living costs rise 15% since 2004
13.  PA provider group sues to stop new personal care home rules
      Staffing
14.  Regulations on posting nurse staffing information published
15.  Some MI nursing homes trying to help staff with grief
   Medicare and Medicaid
16.  US House of Representatives unable to line up enough votes to pass Budget Reconciliation Bill
17.  McClellan speaks to Medicaid directors about dual eligibles
18.  New paper on Medicare Part D issues released
     Research
19.  Researchers call for observational protocols to evaluate quality care 
   DC Doins'         
20.  Calling Ombudsman Delegates to White House Conference on Aging
21.  CMS revises guidance about citations of past noncompliance
     Other News  
22.  Elder abuse fatality review teams to be subject of webcast 

Ombudsman Program Updates
1. Welcome to new State Ombudsmen in KY and NV
Kentucky and Nevada both have new state Ombudsmen!  In Kentucky, Charles (Larry) Smith has been appointed to the State Ombudsman position.  Larry worked with the KIPDA Long-Term Care Ombudsman Program prior to coming on board as State Ombudsman.   Kay Panelli is the new NV State Ombudsman.  Kay is a registered nurse and a certified case manager.  In the past, she had been a nursing assistant, a state surveyor, a case manager for worker’s compensation and a nursing facility specialist for the Medicaid agency. Please join us in welcoming Larry and Kay!
Source: Email from Julie Meashey, November 8, 2005

2. Local KY program website stresses resident focus in complaint work
The KIPDA District Long Term Care Ombudsman Program in Louisville, Kentucky has launched a new website that includes a section on “Submitting a Complaint to An Ombudsman.”  This section provides a complainant with a good understanding of the resident-focused nature of ombudsman work by outlining core principles that guide the program.  As presented on the website, these principles are: 1) Complaints are resident driven.  They begin with the resident, focus on the resident, and end with the resident.  When someone else refers a complaint, the Ombudsman determines, to the extent possible, what the resident wants before intervening; 2) Complaints are confidential.  Ombudsmen do not reveal the identity of a resident without permission; 3) Complaints call for empowerment.  Ombudsmen provide information and encouragement to residents or complainants to act on their own behalf with minimal involvement from the Ombudsman; and 4) Though there are many persons involved in a resident’s care, the primary focus of the Ombudsman is the resident her/himself.  To check out the website, go to: www.nursinghomeconcerns.com.  To access the page about complaints, go to:
http://www.nursinghomeconcerns.com/?PageID=88&
Page=Submitting%20a%20Complaint%20to%20an%20Ombudsman.
Source: www.nursinghomeconcerns.com

3. MI Ombudsman voices concerns about Medicare Part D
Sarah Slocum, MI State Ombudsman, recently expressed her concern about how nursing home and assisted living residents are going to fare with the new Medicare Part D prescription drug plan.  Since residents of long term care facilities are isolated from public service ads and sometimes don’t even have family or friends to help them, they may have difficulty choosing a plan and getting the right drugs at an affordable price.  Slocum stated, “For nursing home or assisted living residents, they have some obvious barriers in making the decision.”  “They’re less able to go out to community events and learn about their choices.  Some of them have cognitive impairments that will make it harder to decide.”  Slocum recommended that families and residents look for plans that have a long-term care component and offer the resident’s specific medications.
Source: mlive.com, November 2, 2005

4. HHS town hall meetings open to ombudsmen, others
The U.S. Department of Health and Human Services (HHS) is holding a series of four town hall meetings to solicit public comment on the economic impact of major health care regulations on the health care industry, including nursing homes.  HHS wants to hear directly from health care administrators, institutional providers, physicians, practitioners, patients and others about quantifying the economic impact of federal health care regulations.  At the first meeting, which was held in Washington D.C. on November 3, the National Citizens’ Coalition for Nursing Home Reform made a statement saying that although the panel was interested in reducing regulation to save costs, understaffing and weak enforcement of the Nursing Home Reform Act contribute to high health care costs to treat pressure sores and other avoidable conditions.  (A copy of NCCNHR's statement is on the NCCNHR website.)  The other meetings are scheduled to be held in Chicago on December 8; Oklahoma City on January 12 and San Francisco on February 2.  Written comments may also be submitted regardless of attendance at the public meeting.  For more details and information on how to register for the meetings, contact Marty McGeein or Adelle Simmons at 202-690-6443 or go to:  http://aspe.hhs.gov/arrb/index.shtml.
Source: Email from Janet Wells, November 1, 2005

Ombudsman Calendar of Events     
November 17 - Teleconference Training on Workforce Issues. 2 pm - 3:15 pm (eastern time) Learn from David Farrell, NHA, MSW, Quality Partners of Rhode Island, about key staffing issues that impact residents.  This session will include a review of the major studies on workforce retention, turnover, supervision, and staffing ratios, as well as recent data about successful workforce outcomes achieved by the Quality Improvement Organizations (QIOs).  Please register by emailing John Kafka, jkafka@nccnhr.org, with your name, email address, and telephone number. 

November 30 – December 2, 2005 Celebrate Direct-Care Workers, Orlando FL.  This conference is sponsored jointly by the Pioneer Network and the Direct Care Alliance. Celebrate Direct-Care Workers, the only national conference scheduled by either organization this year, will convene workers, consumers, and providers from the full spectrum of long-term care and aging services.  Participants will honor and celebrate the work of direct-care workers, enhance leadership skills and organizational effectiveness, and renew their energy for their work as champions of change. For more information about the conference, go to: www.celebratedirectcareworkers.org.

December 8, 2005, January 12, 2006, February 2, 2006: HHS town hall meeting on economic impact of major healthcare regulations on the health care industry. For more information, call Marty McGeein or Adelle Simmons at 202-690-6443 or go to: http://aspe.hhs.gov/arrb/index.shtml

December 11 – 14, 2005: 2005 White House Conference on Aging.  Washington, D.C. 

April 19 - 23 2006: NAELA 2006 Symposium Washington DC

April 20 - 23 2006: 2006 National Aging and Law Conference, Elder Rights: Building on the Past, Strengthening the Future. Co-sponsored by AARP Foundation, ABA Commission on Law and Aging, National Senior Citizens Law Center, The Center for Social Gerontology, Center for Medicare Advocacy, Inc., National Academy of Elder Law Attorneys, National Consumer Law Center and National Association of State Units on Aging the conference will be held at the Doubletree Hotel, Crystal City, Virginia.

April 22 – 25 2006: Annual State Ombudsman Training to be held in Salem, MA.

Home and Community-Based Care/Olmstead      
5. Home health care performance standards released

The National Quality Forum (NQF) has published a new set of national consensus standards for home care.  These standards provide a set of standardized performance measures to facilitate comparison of the quality of home health care providers.  The set of standards consists of 15 measures, such as improvement in areas such as ambulation/locomotion, bathing, and management of oral medications.  Data from these measures will be reported by the Centers for Medicare and Medicaid Services (CMS) on its Home Health Compare website.  The executive summary of the report, with a list of endorsed performance measures, can be found on the NQF website at http://www.medicare.gov/HHCompare/home.asp.
Source: National Quality Forum press release, October 26, 2005

6. Report looks at strategies to keep consumers at home
A report from the Kaiser Commission on Medicaid and the Uninsured discusses tactics used to shift resources from institutional to home- and community-based long term care services.  States have created policies to transition individuals from institutional settings to alternative community settings, or to divert consumers who are at risk of nursing home placement to other community-based options, including programs supporting informal caregivers.  The report examines “transition” and “diversion” policies and practices in eight states, and provides information about how states can promote diversion policies. For more information, visit: http://www.kff.org/medicaid/7402.cfm.
Source: Family Caregiver Alliance Caregiving Policy Digest, Volume V, Number 14, November 8, 2005

Nursing Home News    
7. Two drunken moose invade Swedish home
Residents of a home for the elderly in southern Sweden were taken by surprise when their facility was invaded by two intoxicated moose.  According to a staff person at the home, the moose – a cow and her calf – had become drunk by eating fermented apples they found outside the home in Sibbhult, Sweden.  Police managed to scare them off once, but the large animals returned to get more of the fruit.  The second time the moose were aggressive, as well as drunk, forcing the police to send for a hunter with a dog to make them leave.  Police did not pursue the culprits, but made sure that all the apples in the area were picked up.  No one – human or animal – was hurt.
Source: Associated Press, November 8, 2005

8. Nursing homes serve as domestic violence shelters
The Hebrew Home for the Aged in Riverdale, the Bronx, has opened its doors to elderly victims of domestic violence. According to the National Clearinghouse on Abuse in Later Life, the Hebrew Home’s new program for abused elders is one of about eight such programs in the United States.  Residents of the Hebrew Home said that before finding their new residence, they had no choice but to join social systems that were intended for young women or children.  These systems were unable to provide the residents with the kind of care and help that they needed.  In 1981, a House committee on aging called for the creation of emergency shelters for older victims.  Since then, reports of elder abuse have increased to 472,813 cases in 2000, but the number of shelters for abused elderly has not changed.  Joanne Otto, Executive Director of the National Adult Protective Services Association, cited a lack of federal funds and legislation as a reason.  “There’s a reluctance to acknowledge the enormity of the problem of elder abuse,” Otto said.  “It’s like where domestic violence was 20 years ago.”
Source: New York Times, November 8, 2005;  www.myziva.info, November 9, 2005

9. NY nursing homes unprepared for disaster
A survey conducted by the New York State Department of Health found that more than half of New York’s nursing homes have no plan to evacuate sick and vulnerable residents in the face of a hurricane or other disaster.  The survey also determined that only 26% of the homes had disaster plans and only 4% were prepared to summon extra staff in an emergency.  The health department has long required facilities to have plans for evacuating buildings, but not for moving residents to safety elsewhere.  According to Assemblyman Richard Brodsky, “They’re going to be able to get people to the sidewalks, but they’re not going to be able to get them any farther.”  The problem is most acute for the 17 nursing homes located in the Rockaways, where 3,500 residents – including 1,000 who can’t walk – live on a hurricane–vulnerable peninsula with few ways in or out.
Source: Daily News, November 1, 2005; www.myziva.info, November 2, 2005

10. FL facilities help each other out
South Florida nursing homes have banded together to try to get the supplies they need to operate their homes.  Every day, the Florida Health Care Association hosts a statewide conference call in which 200 or so nursing home operators, industry officials and state regulators grapple with the day’s crises.  People share everything from information to washing machines.  In addition, the Florida Association of Homes for the Aging has set up shop at the Palm Beach Emergency Operations Center and has been instrumental in getting gas to nursing home doctors, nurses and aides, while the Agency for Health Care Administration has created gas distribution sites to fill cars of health care workers.
Source: St. Petersburg Times, October 29, 2005

Culture Change
11. Attend the “Celebrate Direct-Care Workers” conference!
The Pioneer Network and the Direct Care Alliance are co-hosting “Celebrate Direct-Care Workers,” a national conference that will focus on culture change.  The conference will explore ways of improving quality of care by improving the quality of direct-care jobs.  Sessions include: Embracing Person-Directed Care: Improving Relationships between Direct-Care Workers and Nurses; Nurses and Nursing Assistants: United We Can; Innovative Roles for Direct-Care Workers in Culture Change; Creating a Supportive Environment: It’s All About Relationship; and Building Relationship Among Nurses and Direct Care Workers.  The conference will be held November 30-December 2 in Orlando, Florida.  For additional information, go to: www.CelebrateDirectCareWorkers.org.
Source: Email from Rose Marie Fagan, November 5, 2005 

Assisted Living
12. Assisted living costs rise 15% since 2004
Assisted living costs in the U.S. increased 15% in the past year, according to the 2005 MetLife Market Survey of Assisted Living Costs.  The average monthly base price rose from $2,524 in 2004 to $2,905 this year, or $34,860 annually.  The highest cost was reported in Boston at $4,629 per month, while the lowest was Jackson, Mississippi at $1,642.  Monthly private pay base rates were defined as room and board that includes at least two meals, housekeeping and personal care assistance for private rooms or one-room apartments with a private bath.
Source: MetLife Market Survey of Assisted Living Costs, October 2005

13. PA provider group sues to stop new personal care home rules
The Northern Area Personal Care Home Administrators Association in Pennsylvania is seeking an injunction to block new state Department of Welfare regulations for personal care homes that went into effect on October 24.  The association claims that the rules are cumbersome, expensive and unnecessary.  The state says the rules are needed to safeguard the 53,000 residents of Pennsylvania’s 1,700 personal care homes.  The decision to promulgate new rules stemmed from incidents of abuse or neglect and from agreement that the field had changed dramatically with current residents in frailer condition than in the past.  Some of the changes are being phased in gradually, some contain ‘grandfather” provisions, and some apply only to homes with more than eight beds.  Among the new provisions are rules that require increased staff training, enhanced qualifications for administrators, training for employees who assist residents with their medications, and detailed assessments and care plans upon admission and when there are changes in the resident’s condition.  A decision on the request for a preliminary injunction is expected within weeks.
Source: Pittsburgh Post-Gazette, October 28, 2005 and October 30, 2005 

Staffing
14. Regulations on posting nurse staffing information published
The final regulations on posting nurse staffing information in nursing homes were published in the October 28 Federal Register.  The final regulations have changed in some respects from the proposed regulations issued in February 2004, but they still require certain core information supported by NCCNHR and some 100 local, state and national groups who signed on to NCCNHR’s comments in April 2004.  To download the regulations and CMS’s explanation of them, go to http://www.gpoaccess.gov/fr/.  Click on “Browse” and then “Back Issue.”  The regulations are under the Centers for Medicare and Medicaid Services.  Facilities are required to post at the beginning of each shift and “in a prominent place readily accessible to residents and visitors” the actual hours worked (as opposed to scheduled to be worked) by direct care workers by category – RN, LPN/LVN, and CNA, and the resident census.  Facilities are not required to use a standardized reporting form, although CMS provides an example that would meet the requirements.  The postings must be retained for 18 months, and copies of the postings must be available upon request.
Source: NCCNHR email, October 28, 2005

15. Some MI nursing homes trying to help staff with grief
An article in the Jackson Citizen Patriot describes the suffering felt by direct-care workers when the people they care for die.  The article quotes national experts as well as local providers on the need to support grieving workers and describes steps some area nursing homes are taking to help staff members cope with the loss of residents they were close to.  “Others in the health-care industry see death, of course, but their encounters with patients are usually short-term,” points out author Monetta L. Harr.  “Nursing home staffers, on the other hand, have invested time - often years - to building relationships with their patients and their patients’ families.  They, in fact, become almost like family.”  To read the article, go to:
http://www.mlive.com/entertainment/jacitpat
/index.ssf?/base/features-0/112826732092590.xml&coll=3#continue
Source: Quality Jobs/Quality Care, October 7, 2005 

Medicare and Medicaid
16. US House of Representatives unable to line up enough votes to pass Budget Reconciliation Bill
Republican leaders in the House of Representatives were unable to line up enough votes last Thursday to bring their budget reconciliation bill to the floor for a vote.  They will try again this week to secure enough Republican support to pass the legislation, which includes $11 billion in Medicaid cuts and would delay Medicaid coverage for nursing home residents who could not show that they had not given any assets away during the five years before they applied for benefits.  All House Democrats are expected to vote against the bill, but Republicans have split on such issues as the Medicaid cuts and drilling for oil in the Arctic National Wildlife Refuge.  The Senate has already passed a budget reconciliation bill with $4.6 billion in Medicaid cuts and asset transfer provisions that prohibit questionable estate planning practices but do not penalize any gift a resident may have made or be unable to account for.
Source: E-mail from Janet Wells, NCCNHR Public Policy Director, 11/14/05

17. McClellan speaks to Medicaid directors about dual eligibles
The Administrator of the Centers for Medicare and Medicaid Services (CMS), Mark McClellan, recently spoke to state Medicaid directors about concerns that dual eligibles - individuals who qualify for both Medicare and Medicaid - will “fall between the cracks” when their prescription drug coverage switches from Medicaid to Medicare.  McClellan said that CMS is automatically enrolling dual eligibles in a Medicare drug plan to prevent beneficiaries from being denied medications because they have not selected a plan.  To-date, CMS has identified 6,130,120 dual eligibles and has assigned 5,498,604 of them to randomly chosen Medicare prescription drug plans.  Beneficiaries randomly assigned to plans were mailed letters informing them of their new coverage.  In addition, CMS said pharmacists can file eligibility inquiries to determine a beneficiary’s coverage if dual eligibles do not know their drug plan.  CMS also has developed a “point of sale mechanism” to ensure coverage if there is a lag time when a beneficiary is first assigned to a plan or “switches in and out of dual eligibility.”  Under the mechanism, CMS contractors immediately can confirm if beneficiaries are eligible and arrange to enroll them in a plan.
Source: Kaiser Daily Health Policy Report, November 9, 2005

18. New paper on Medicare Part D issues released
The American Society of Consultant pharmacists has written a new issue paper entitled, "Access to Medications Under Medicare Part D."  The paper addresses cost management tools, such as prior authorization and step therapy, that could complicate beneficiaries' ability to get some drugs even when the Prescription Drug Plans they are considering appear to have comprehensive formularies.  The paper is available at: http://www.ascp.com/MedicareRx
/docs/ASCPPartDMedAccess.pdf.
Source: Email from NCCNHR, November 1, 2005

Research
19. Researchers call for observational protocols to evaluate quality care 
In an article in the latest issue of The Gerontologist, Dr. Sandra Simmons, Dr. John Schnelle and Dr. Dan Osterweil, researchers at the Borun Center of Gerontological Research, write that federal surveyors should adopt standardized direct observations of care delivery in many care areas, including feeding assistance, as a means of evaluating nursing home care quality.  The three researchers believe that observational data “provide one of the few sources of information about care that is independent of staff self-reports,” which other studies have shown are often riddled with inaccuracies.  The Borun Center team argues that the methods currently used by surveyors to observe lack specificity and yield unreliable results.  The article presents guidelines for crafting an observation protocol that is both scientifically defensible and feasible to use by nursing home staff and surveyors alike.  For more information, contact project director Anna Rahman at rahmananna@yahoo.com.  In addition, the Borun Center’s website offers free access to six training modules on improving daily care in nursing homes.  Some of the modules include standardized observational protocols that can by used by nursing home staff in daily practice.  You can access the modules at: http://www.borun.medsch.ucla.edu/.
Source: Press release from Anna Rahman, October 10, 2005

DC Doins’
20. Calling Ombudsman Delegates to White House Conference on Aging
A conference call was held on November 9th for Ombudsman delegates to the White House Conference on Aging (WHCoA).  The guest speaker was Bob Blancato, member of the WHCoA Policy Committee and former Executive Director of the 1995 WHCoA.  The subject encompassed strategizing to maximize effectiveness.  The discussion touched on issues such as:
    Strategies for forming alliances
    How best to articulate resident issues
    Status of the NCCNHR WHCoA resolutions
    Ground rules of the Conference
A follow-up conference call is planned for December 5th 3:00 p.m. ET.  A caucus lunch is planned for December 11th.  Time and details to follow.
As of this writing, the identified ombudsman delegates and alternates to the WHCoA are Becky Kurtz (GA SLTCO), George Potaracke (WI SLTCO), Patricia Bayliss (MD SLTCO), Nancy Flowers (IL LTCOP), Kathy Greenlee (KS SLTCO), and Jacquie Woodruff (VA LTCOP).  If you know of an ombudsman who is a delegate and is not on this list, please have them contact or send their name(s) to Deanna Okrent, dokrent@nccnhr.org.
For a list of all delegates and other information about the Conference, visit www.whcoa.gov.
Source: E-mail from Deanna Okrent, NORC Consultant, 11/14/05

21. CMS revises guidance about citations of past noncompliance
The Centers for Medicare and Medicaid Services (CMS) has issued revised guidance clarifying survey and certification actions related to citations of past noncompliance.  In a letter to state survey agency directors dated October 20, 2005, CMS says that past noncompliance may be cited if all three of the following criteria are met: 1) the facility was not in compliance with the specific regulatory requirement(s) at the time the situation occurred; 2) the noncompliance occurred after the exit date of the last standard recertification survey and before the survey currently being conducted; and 3) there is sufficient evidence that the facility corrected the noncompliance and is in substantial compliance at the time of the current survey.  Surveyors are instructed to no longer use F698 to cite past noncompliance, but to use the specific regulatory tag instead.
Source: CMS Letter to State Survey Agency Directors, October 20, 2005     

Other News
22. Elder abuse fatality review teams to be subject of webcast
A webcast on elder abuse fatality review teams will be held on December 6, 2005 at 3:00 p.m. Eastern Standard Time.  Elder abuse fatality review teams examine deaths resulting from or related to elder abuse to learn about and improve the responses of adult protective services, health care providers, law enforcement officers, prosecutors, victim assistance providers, and others to living elder abuse victims.  This webcast will focus on issues and challenges involved in the creation of elder abuse fatality review teams. Content will include advice on how to get started and anticipated challenges and benefits. To register, go to: http://www.visualwebcaster.com/event.asp?id=31371. Voice Over Internet Protocol (VOIP) will be used.  You will need sound capability and Windows Real Player software (available for free download as part of registration) to participate.  The archived webcast will be available within 24 hours after its completion.  In addition, a manual on elder abuse fatality review teams is available online at no cost at the following link: http://www.abanet.org/aging.
Source: Elder Abuse list serve, November 9, 2005

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.  
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. 90AM2690, 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.