May 5, 2006

NORC Gazette
May 5, 2006

National Long Term Care Ombudsman Resource Center
National Citizens’ Coalition for Nursing Home Reform

Table of Contents

    Ombudsman Program Updates   
1.    State Ombudsmen gather in Salem, MA for annual conference
2.    NC local ombudsmen teach aging sensitivity workshop to teens
3.    Legacy of extraordinary GA ombudsman continues
4.    Gianopoulos, other volunteers honored in new SC volunteer program
5.    Nominate an exceptional advocate for a NCCNHR leadership award!

  Ombudsman Calendar of Events

    Home and Community-Based Care/Olmstead    
6.    DRA provides tools for expanding services
7.    New reports analyze effect of DRA on home/community services  

     Nursing Home News
8.    NCCNHR releases report documenting stories of abuse and neglect
9.    KS advocacy group provides consumers with facility information
10.  Disaster planning guide for facilities published by AHCA
11.  Residents on ventilators must leave Virginia nursing home

     Culture Change
12.  Texas to get first Green Houses

    Assisted Living
13.  WI assisted living resident’s advocacy leads to change

  Staffing
14.  AARP paper looks at CNA training
15.  MI commission will include focus on improving direct-care jobs

  Medicare
16.  New policy protects beneficiaries against formulary changes
17.  Kaiser suggests steps to get nursing home residents’ drugs covered 

     Medicaid
18.  NY Governor vetoes spousal impoverishment protections

    Research
19.  Data show 63% increase in pressure sores in a decade

   DC Doins'         
20.  Grassley calls on CMS to correct problems in survey process
21.  Senate tort reform legislation would cap non-economic damages 
22.  Waxman urges colleagues to read NCCNHR report, cosponsor staffing bill

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Ombudsman Program Updates
1. State Ombudsmen gather in Salem, MA for annual conference
The Annual Training Conference for State Ombudsmen was held April 22-25th in Salem, MA.  State Ombudsmen representing 44 states and US territories attended the conference titled "Good Care: It's Not Magic."  Session topics included the Changing Long-Term Care Population, Systems Advocacy: "How To's," Ombudsman Program Outcome Measures, and Person Directed Care or Culture Change.  A special session offered by Sara Hunt, NORC Consultant, offered participants a chance to see the newly completed ombudsman curriculum module titled "The Problem Solving Process: Complaint Investigation."  The module will be available through the NORC in hard copy and on the website later this month.

Source: Julia Meashey, NORC, Ombudsman Specialist

2. NC local ombudsmen teach aging sensitivity workshop to teens
Ombudsmen in the Centralina Area Agency on Aging Ombudsman Program in North Carolina are working to combat ageism by giving high school students insight into what it is like to be elderly.  The goal of these ombudsmen - lead ombudsman Debi Lee, ombudsman Linda Miller and their colleagues – is to acquaint students with elderly stereotypes, make them rethink what it means to grow old, and help them empathize with older people.  Their efforts follow a new study by the International Longevity Center-USA that describes ageism as one of society’s most pervasive prejudices.  The ombudsmen use “instant aging kits” with the teens; the kits consist of bulky work gloves, a pill bottle with tiny candies, a sewing kit and five pairs of cardboard glasses.  The contents of the kit help students experience what it is like to be elderly.  After the teens have worked with the kits, the ombudsmen and students discuss separating the disability from the person.  “Aging is not a disease,” says Debi Lee.  “Illness and disease get in the way of normal aging.”  “And if you make sweeping statements about older people, you’re likely to over-generalize.”  Lee says that her long-term goal is to train local teachers to teach aging sensitivity workshops regularly.

Source: Charlotte Observer, April 18, 2006

3. Legacy of extraordinary GA ombudsman continues
Although Barbara Fraser, who served for more than 15 years in the Georgia Ombudsman Program, died on March 23, 2002, her legacy continues through a fund established by the Georgia Office of the State Long Term Care Ombudsman at the request of Barbara’s family.  Barbara’s tireless advocacy for residents’ rights made her a role model and a mentor for scores of advocates.  The monies in the Barbara Fraser Legacy of Learning Fund have been used to promote professional development and public education on long term care and aging.  The Fund has brought national experts to Georgia, including Robyn Stone of the Institute for the Future of Aging Services; Dr. William Thomas, president and founder of the Eden Alternative; Paul Nussbaum, clinical neuropsychologist and author of Brain Health and Wellness; and John Banja, clinical ethicist.  For more information about the fund or to make a contribution, contact Andrew Hales at jahales@dhr.state.ga.us.

Source: Email from Andrew Hales, April 20, 2006

4. Gianopoulos, other volunteers honored in new SC volunteer program
A recent article in the South Carolina Spartanburg Herald-Journal reported that a Spartanburg citizen, Janette Gianopoulos, was honored at the state capital for completing the training to become a certified volunteer ombudsman.  The Volunteer Ombudsman Program is new in South Carolina.  To mark the successful completion of their training, Gianopoulos and other volunteers received a plaque from Lt. Governor Andre Bauer and were recognized from the floor of both chambers of the General Assembly.

Source: Spartanburg Herald-Journal, April 22, 2006

5. Nominate an exceptional advocate for a NCCNHR leadership award!
Do you know an advocate who has demonstrated an exceptional commitment to improving the lives of long term care facility residents?  If so, nominate him or her for a 2006 NCCNHR Leadership Award!  This is a meaningful way to recognize the work of dedicated and committed advocates.  Information about the 6 different awards and criteria can be found at: http://www.nccnhr.org/uploads/2006CallforNominations.pdf.  Award nominations may be made by individual or group members of NCCNHR and must be submitted no later than July 7, 2006.  Award recipients each receive a beautiful plaque, awarded at NCCNHR’s 2006 Annual Conference and Meeting which will be held October 22-25 at the Hilton Crystal City Hotel in Arlington, VA.   

Source: http://www.nccnhr.org/uploads/2006CallforNominations.pdf

Ombudsman Calendar of Events     

July 17-19, 2006: OmbudsManager Users Conference, Burlington, VT.  Join state and local ombudsmen from around the country at Synergy's National Users Group Meeting.  For information on the two-day OmbudsManager track, contact Tim Riley at triley@synergysw.com or 800-294-8515, Ext. 60.  Cost $260 (hotel room rate is $139 per night).

August 2-4, 2006: Pioneer Network National Conference, “Let Freedom Ring.”  Philadelphia, PA. For more information, go to www.PioneerNetwork.net.

October 22 – 25, 2006: NCCNHR Annual Meeting. Hilton Crystal City, Arlington, VA. 

Home and Community-Based Care/Olmstead      
6. DRA provides tools for expanding services
According to the Centers for Medicare & Medicaid Services (CMS), states can use the Deficit Reduction Act (DRA) to expand their home and community-based services.  In its document entitled, “Roadmap to Medicaid Reform,” CMS indicates that the DRA gives states additional tools for assisting individuals with long term care needs.  One new tool will be the ability to offer home and community-based services without waivers.  Beginning January 1, 2007, states can amend their State plans to offer home and community-based services as a State plan optional benefit.  This option breaks the eligibility requirement that an individual can receive community services only if he or she needs an institutional level of care.  Instead, services can be offered based on a person’s functional need.  States will be able to establish the number of individuals served under this new State plan option, and thus will have control over the development and growth of their systems.  In addition, states will be able to: apply for grants to rebalance their long-term support system under the Money Follows the Person Rebalancing Demonstration program; apply for Real Choice System Change grants to design and construct infrastructure that will improve community long-term support systems; and offer a State plan benefit for self-directed personal care services without a waiver.  To read the “Roadmap,” go to: http://www.cms.hhs.gov/NewFreedomInitiative
/02_WhatsNew.asp#TopOfPage  and click on Long-Term Care Roadmap to Medicaid Reform.

Source: Long-Term Care Roadmap to Medicaid Reform; Family Caregiver Alliance Caregiving Policy Digest, Volume 6, Number 7

7. New reports analyze effect of DRA on home/community services
The Kaiser Family Foundation’s Commission on Medicaid and the Uninsured has released four new reports that look at how home and community-based policies are affected by the Deficit Reduction Act (DRA).  The reports are:  “Medicaid Long-Term Services Reforms in the Deficit Reduction Act;”  “Beyond Cash and Counseling: An Inventory of Individual Budget-based Community Long-Term Care Programs;”  “Nursing Home Transition Programs: Perspectives of State Medicaid Officials;” and “Nursing Home Transition Programs: Perspectives of Medicaid Care Planners.”  To read the reports, go to:http://www.kff.org/medicaid/kcmu041706pkg.cfm.

Source: http://www.kff.org/medicaid/kcmu041706pkg.cfm

Nursing Home News    
8. NCCNHR releases report documenting stories of abuse and neglect
The National Citizens’ Coalition for Nursing Home Reform (NCCNHR) has released a major report, titled Faces of Neglect: Behind the Closed Doors of Nursing Homes.  This document tells the stories of 36 ordinary residents in 12 states who were neglected to the point of abuse.  These tragic situations occurred in for profit and non profit facilities, assisted living and nursing homes, to those who were private pay and those who were using Medicaid to supplement their own resources.  The document puts a human face on the gaping failure of public policy to adequately protect the elderly and disabled who are neglected or abused in long term care facilities.  It also highlights how high turnover, poor supervision, understaffing and lax enforcement put residents at risk and how proposed federal medical malpractice legislation would effectively eliminate residents’ ability to hold facilities accountable for harm in the civil justice system.  The report was released at a Congressional briefing held on April 28.  NCCNHR Executive Director Alice Hedt, family members of two residents featured in “Faces of Neglect,” and William Scanlon, former Director of Health Care Issues at the U.S. General Accounting Office, spoke at the briefing.  You can view excerpts from the report at: http://www.nccnhr.org/action_center/366_1994_12825.cfm.

Source: http://www.nccnhr.org/action_center/366_1994_12825.cfm; Congressional Staff Briefing advisory

9. KS advocacy group provides consumers with facility information
An article in The Leavenworth Times describes information that Kansas Advocates for Better Care, a citizen advocacy group, compiles in order to help consumers research the state’s licensed long term care facilities.  The organization prepares two different reports: the Consumer Information Report and a County Comparison Report.  The Consumer Information Report includes such data as the facility’s current and past administrators, history of facility name changes and ownership, number of deficiencies for the three most recent surveys, awards, enforcement, certain quality indicators, and availability of special care units for residents with Alzheimer’s Disease or dementia.  The County Comparison Report contains summarized information about facilities in any Kansas county.

Source: The Leavenworth Times, April 26, 2006

10. Disaster planning guide for facilities published by AHCA
The American Health Care Association (AHCA) and the National Center For Assisted Living have published a new manual to help long term care providers plan for both natural and man-made disasters.  The manual is in large part a response to the 2005 hurricanes that devastated the Gulf Coast, including many nursing homes.  “Disaster Planning Guide: A Resource Manual for Developing a Comprehensive Preparedness Plan,” suggests that nursing home facilities establish plans for evacuation and non-evacuation.  The guide also advises facilities to prepare for transportation, housing, finance, insurance, and legislative and legal issues in the event of fires, tornados, bomb scares, hazardous accidents in the community, bio-terrorism, hypo- and hyperpyrexia and hurricanes.  The manual, which was developed by the Florida Disaster Preparedness Committee and the Florida Health Care Association, is meant to be a reference tool to assist in the implementation of a disaster operation plan.  For more information, visit www.ahca.org.

Source: McKnight’s Long Term Care News & Assisted Living, April 25, 2006

11. Residents on ventilators must leave Virginia nursing home
Seven residents who receive ventilator care at a Virginia nursing home have been informed that the facility is closing its ventilator unit and they must find a new home.  The unit at Avante At Lynchburg is the only one of its kind in that part of Virginia, and one of only three in the entire state.  A spokesman for Avante said that the decision was for economic reasons; “Medicaid reimbursement is substantially lower than Avante’s cost of providing these services,” he said.  The spokesman went on to state that the corporation would try to maintain ventilator services at its Roanoke facility, but would not “continue indefinitely to absorb large losses in the course of providing respiratory therapy services to Medicaid patients.”  The projected closing of the unit is June 1, and residents and their families are scrambling to find options.  One resident’s daughter said, "It’s almost like an eviction- and you haven’t done anything wrong."

Source: The News & Advance, April 18, 2006

Culture Change

12. Texas to get first Green Houses
Buckner Westminster Place, a retirement community in Longview, Texas, has announced its plans to build two Green Houses.  Currently, residents at Buckner have an option of assisted living or independent living, but must relocate to a nursing home if they need 24-hour nursing care.  In considering how to provide this higher level of care, Buckner officials said that the Green House model “grabbed our heart” and that when you go to a Green House, “you see life.”  The Green House model was created by Dr. William Thomas, with the first home established in Tupelo, Mississippi in 2003.  Each Green House is a self-contained dwelling for seven to 10 people.  Residents have private bedrooms and bathrooms, and the house has a central hearth, open kitchen and common living area and eating area where residents share meals around a table.  Ground breaking for the estimated $3 million project will be June 3, with construction scheduled to wrap up about nine or ten months later.  Last November the Robert Wood Johnson Foundation donated $10 million to the nonprofit NCB Development Corporation to help spread the Green House model nationwide.  Westminster will be the first site in Texas to feature Green Houses.

Source: The News-Journal, April 17 & 19, 2006

Assisted Living

13. WI assisted living resident’s advocacy leads to change
Wisconsin Governor Jim Doyle recently signed into law a bill that will allow 150 people currently in assisted living facilities to stay there rather than move to nursing homes when they become eligible for Medicaid.  The bill is named the “Clara Heath bill” in recognition of Ms. Heath, who was a resident at Pioneer Court Assisted Living.  In May 2005, Heath’s personal savings ran out, and she had to move to a nursing home, even though she did not need the level of care provided in a nursing home.  Faced with having to relocate, Heath, joined by her friend, a retired circuit judge, advocated for reform by singing from the lobby of Health’s assisted living home and writing letters.  State Senator Judy Robson took up Heath’s cause and sponsored the bill to permit assisted living residents to remain in the facility after exhausting their financial resources.  Although the bill wasn’t passed in time to help her, Heath said, “It’s kind of exciting.”  “I don’t think of it as being anything special, it was just something that needed to be done.” 

Source: Beloit Daily News, April 20, 2006 
 

Staffing

14. AARP paper looks at CNA training
A new issue paper from the AARP Public Policy Institute examines the adequacy of training for certified nursing assistants.  Esther Hernández-Medina of Brown University and colleagues studied programs in ten states and interviewed key informants, including CNAs and experts in CNA training and testing.  The authors find a link between high-quality training and high-quality care and identify a number of weaknesses in current training programs.  In the paper, titled “Training Programs for Certified Nursing Assistants,” the authors recommend that the federal government and the states increase training hours for CNAs to at least 100 hours; increase clinical skills training; establish more specific guidelines for CNA training programs; enforce federal regulations regarding reimbursement for training and testing expenses; and increase resources assigned to review CNA training programs.  To read the paper, go to:

http://assets.aarp.org/rgcenter/il/2006_08_cna.pdf.

Source: Quality Jobs/Quality Care, April 27, 2006; “Training Programs for Certified Nursing Assistants,” March 2006

15. MI commission will include focus on improving direct-care jobs
Michigan Governor Jennifer M. Granholm has created the Michigan Long-Term Care Supports and Services Advisory Commission to help the state upgrade its long term care system in several ways, one of which is improving the quality of direct-care jobs.  The commission was appointed to implement the recommendations of the Governor’s Medicaid Long-Term Care Task Force, and one of those recommendation calls for the state to “Build and sustain a competent, highly valued, competitively compensated and knowledgeable long-term care work force.”  According to Hollis Turnham, vice chair of the commission and the Michigan Policy Director for the Paraprofessional Healthcare Institute, the task force recommendations lay out the link between quality of care and the quality of training, leadership, and compensation associated with careers in long-term care.”  The commission will assist the Office of Long-Term Care Supports and Services, which is the sole developer of long term care policy within Michigan’s Department of Community Health.

Source: Quality Jobs/Quality Care, April 27, 2006

Medicare

16. New policy protects beneficiaries against formulary changes
The Bush administration has issued a new policy that prevents changes in formularies from denying Medicare Part D beneficiaries access to drugs they are already receiving.  Under the new policy, an insurer who removes a drug from a plan formulary or imposes new restrictions on the drug cannot apply these changes to current members of the plan until the new plan year.  As most Part D beneficiaries are locked into their chosen plans for the full benefit year, formulary changes by insurers can leave beneficiaries without access to needed prescriptions.  “In general, a plan cannot change your coverage for the drugs you are using during the year.  The stability of drug formularies is extremely important for many of our beneficiaries,” stated CMS administrator Mark McClellan.  Per the policy, “no beneficiaries will be subject to a discontinuation or reduction in coverage of the drugs they are currently using,” though there are a few limited exceptions.

Source: www.myziva.com, April 28, 2006

17. Kaiser suggests steps to get nursing home residents’ drugs covered 
A recent Kaiser Medicare Q & A Column, prepared by the Kaiser Family Foundation and distributed by Knight Ridder/Tribune, addresses what nursing home residents should do if their nursing home uses a pharmacy that is not covered by their Medicare prescription drug plan.  According to the column, many nursing homes have contracts with a single pharmacy for all of their residents’ medications, so it is a good idea for beneficiaries to enroll in a plan that includes the pharmacy used by their nursing home to avoid out-of-pocket costs.  The column suggests that nursing home residents or their families ask the nursing home for a list of drug plans that are accepted at the pharmacy the facility uses.  Beneficiaries and their families then should compare benefits to make sure most medications are covered and consider the plan’s premium, deductible and copayments.  The column notes that if nursing home residents have a problem with their drug plan, they can switch plans at any time during the year, unlike other beneficiaries who can only switch plans once per year.

Source: Kaiser Medicare Q&A column, April 20, 2006

Medicaid  

18. NY Governor vetoes spousal impoverishment protections
For years, spouses of nursing home residents and of those receiving care at home in New York have been protected from paying for their spouses’ care, and Medicaid has covered the cost.  Approximately 630 spouses of nursing home residents and 8,400 spouses of home care patients currently make use of what is referred to as the “spousal refusal option” annually.  Governor Pataki has attempted to end this practice in past years by removing the provision that allows for spousal refusal, but the state legislature has always reinstated it.  This year, however, the governor claims that the legislature violated the state constitution by changing the language of the Medicaid bill in order to keep spousal refusal.  The Governor contends that this blocks the legislature from overriding his veto.  Advocates for the elderly fear the damage such a decision may cause.  “You just can’t pull the rug out from people without alternatives.  What are people’s choices?  Get divorced before you send your spouse to a nursing home?  There has to be some middle ground,” stated William Ferris of the New York chapter of the AARP.

Source: www.myziva.com, April 18, 2006

Research
19. Data show 63% increase in pressure sores in a decade
A statistical brief released in April based on data from the Healthcare Cost and Utilization Project (HCUP) shows that 455,000 hospital stays in 2003 involved treatment of pressure ulcers.  This represents a 63% increase over the 280,000 stays involving pressure ulcer treatment noted in 1993.  Approximately 72.3% of patients with pressure ulcers were age 65 and older, and these individuals had average stays of 12.4 days.  Payer source was also examined, revealing that 65.9% of pressure-ulcer related stays in 2003 were covered by Medicare and another 23.4% were covered by Medicaid.  The mean charge for hospital stays principally for pressure sores was $37,800 in 2003, but charge varied by payer.  The average charge billed to Medicare was $37,100 and to Medicaid

was $39,100. To read the report, go to:

http://www.hcup-us.ahrq.gov/reports/statbriefs/sb3.jsp.

Source: Healthcare Cost and Utilization Project Statistical Brief #3:  Hospitalizations Related to Pressure Sores, 2003; www.myziva.com, April 24, 2006

DC Doins’

20. Grassley calls on CMS to correct problems in survey process
Senator Charles Grassley, Chairman of the U.S. Senate Committee on Finance, has written a letter to Centers of Medicare & Medicare Services (CMS) Administrator Mark McClellan asking that CMS report on how it intends to respond to findings of a December 2005 Government Accountability Office (GAO) report.  The GAO report discovered what Grassley called two “consistent and longstanding” problems: inconsistency in the results of state surveys and the continual understating of negative findings.  Grassley requested that CMS specifically address the following: 1) what the agency is doing to address the inconsistencies in survey results; 2) how CMS handles data or information discovered to be false or misleading on Nursing Home Compare; 3) what efforts CMS is taking to rectify the understating of negative findings by state survey agencies; and 4) what initiatives CMS is undertaking to resolve the problem of predictability of survey visits and any improvements resulting from those initiatives.  To read Grassley’s letter, go to: http://www.hcpro.com/content/57250.pdf.

Source: Letter from Senator Charles Grassley, April 12, 2006

21. Senate tort reform legislation would cap non-economic damages 
U.S. Senator John Ensign of Nevada has introduced a medical malpractice bill that would cap the amount of non-economic damages (compensation for pain and suffering) in nursing homes, assisted living facilities and other health care institutions at $250,000.  S. 22, the “Medical Care Access Protection Act of 2006,” would also limit punitive damages to the greater of twice the amount of economic damages or $250,000; plaintiffs could ask for punitive damages only if they could show malicious intent and a court found that there was a substantial probability that they would win.  In addition, the bill would cap attorney fees. There would be no limit on economic damages, which replace income. While the bill would not cap damages in states that already had caps (even if they were higher than the bill's caps), it would preempt most other provisions in state laws governing civil lawsuits against healthcare providers. A vote is expected next week.  S. 22 will be posted on the Library of Congress website, http://thomas.loc.gov.

Source: NCCNHR, Kaiser Daily Health Policy Report, April 28 & May 1, 2006; McKnight’s Long Term Care News & Assisted Living, April 28, 2008

22. Waxman urges colleagues to read NCCNHR report, cosponsor staffing bill
U.S. Representative Henry Waxman has sent a “Dear Colleague” letter to his fellow legislators in order to bring NCCNHR’s “Faces of Neglect” report to their attention.  In his letter, Waxman writes that the stories of the 36 abused or neglected residents are “a call to action to improve the quality of nursing home care.”  He states that many of the cases in the report were caused by inadequate staffing and points out that “one of the most effective ways to improve the quality of care is to ensure that nursing homes are adequately staffed.”  Waxman urges his colleagues to read the NCCNHR document and to cosponsor his legislation that would require nursing homes to comply with staffing levels identified in the 2001 CMS study.  To read the letter, go to: http://www.nccnhr.org/uploads/WaxmancolleagueLtr.pdf.

Source: Letter from Representative Henry Waxman, April 28, 2006

______________________________________________________

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, atrobynjgrant@sbcglobal.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