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September 1, 2006 September 1, 2006
NORC Gazette
September 1, 2006
National Long Term Care Ombudsman Resource Center
National Citizens’ Coalition for Nursing Home Reform
Table of Contents
Ombudsman Program Updates
1. HI Ombudsman Program helps pass criminal background check law
2. Local OH ombudsman receives Excellent Advocate Award
3. MO local ombudsman recommends aging game for certification training
4. CA local program marks 25th anniversary with special event
5. IL ombudsmen recognized for outstanding work
Ombudsman Calendar of Events
Home and Community-Based Care/Olmstead
6. MA workforce council, worker registry created
7. UT group protests nursing home stay requirement
Nursing Home News
8. VA newspaper says nursing homes use arbitration as shield
9. Beverly name becomes golden
10. MO seeks nursing home voters who need photo ID
11. Nursing home administrator training enhanced in Oklahoma
Culture Change
12. KS honors facilities promoting culture change
Assisted Living
13. Newspapers expose problems in NC adult care home system
Staffing
15. MI home care workers get raise
Medicare
16. CMS error creates confusion, potential problems for Medicare beneficiaries
Medicaid
17. GA estate recovery law nixed
DC Doins'
18. OIG report calls for changes in nursing home evacuation rules
19. Study finds QIO efforts effective
Other News
20. Patient advocates services growing ___________________________________________________________________
Ombudsman Program Updates
1. HI Ombudsman Program helps pass criminal background check law
Thanks to the work of the Hawaii Ombudsman Program and other advocates, residents of healthcare facilities, including nursing homes, assisted living facilities, and adult residential care homes, are now better protected. Bob Masuda, a member of the legislative committee of the Policy Advisory Board for Elder Affairs in Hawaii writes, “After countless hours of testimonies at the legislature, after many hours of conferences with key legislators, and many, many years of frustration, a law protecting senior citizens, many of whom are disabled or vulnerable due to advanced age was finally passed this year. This law requires criminal history record checks on persons providing care or having access to senior residents of healthcare facilities. The irony of this issue is that Hawaii has always had in place laws protecting children and minors but never seniors until this year. Many thanks to John McDermott, our long term care ombudsman for his invaluable assistance in providing critical data in support of this legislation.” Individuals for whom a criminal history record check is conducted must consent to be fingerprinted. For more information about the legislation, contact State Ombudsman John McDermott.
Source: Bob Masuda, July 24, 2006; Email from John McDermott, June 20, 2006
2. Local OH ombudsman receives Excellent Advocate Award
Francine Chuchanis, an ombudsman with the Akron/Uniontown regional ombudsman program, has been recognized by Beverly Laubert, Ohio State Long-Term Care Ombudsman, as an Excellent Advocate! Chuchanis received the “Excellent Advocate Award” which is given bi-annually to recognize excellence on behalf of long term care consumers. The award was presented on July 26, 2006. Chuchanis was hired in April 2002 and specializes in Medicare managed care advocacy. Sam McCoy, the regional ombudsman program director who nominated her, said that Chuchanis has three qualities - compassion for others, a strong but courteous approach, and a high level of competency invested in all she does. Specifically, Chuchanis was instrumental in preparing advocates for the implementation of the Medicare prescription drug coverage plan. McCoy stated, “I can’t imagine how enrollees would have fared without Francine’s help as they confronted the most significant systemic change in the Medicare program in four decades.” Highlights of Chuchanis’ efforts in 2005 included presenting at more than 105 community education events, assisting hundreds of callers, preparing training materials for pharmacists, and training staff to respond to approximately 1200 callers at a Medicare hotline event. Many consumers have commented on her good work, including one individual who noted, “Francine has a gift of true caring and compassion for others and in her position she can share it with others who are in desperate need of her assistance.”
Source: Excellent Advocate Award Announcement; Email from Hilary Stai, August 1, 2006
3. MO local ombudsman recommends aging game for certification training
Beth Simpson, a local Missouri ombudsman, has discovered a new training tool to use in certification training sessions. The tool, called Into Aging, is a simulation game that is designed to help individuals develop a personal understanding of the aging process. Players encounter conditions associated with aging that may hinder the accomplishment of their goals and/or break down their self-images. Different “stages of life” are set up for the players to walk through as they imitate life and learn. Simpson explains that as players draw ‘life event cards” they find themselves out of control of their lives. Family members and doctors label them “senile,” hard of hearing and combative. Players take medications incorrectly and find themselves in the hospital and then in a nursing home. As nursing home residents, they are given undignified nicknames and labeled as problems. According to Simpson, the volunteers find that the game gives them insight into how the people they serve come to live in long term care. Simpson believes that the game builds empathy, which is an important part of certification training. She has used the game on two occasions when she has had sufficient numbers of trainees to play it, and looks forward to incorporating it into as may sessions as she can. Simpson also thinks that it would be a good in-service activity for seasoned ombudsmen. To learn more about the game or to order it, go to: http://www.slackbooks.com/view.asp?slackCode=30532.
Source: Email from Beth Simpson, August 16, 2006; Email from Julie Meashey, July 25, 2006
4. CA local program marks 25th anniversary with special event
Long Term Care Ombudsman Services of Ventura County, a local ombudsman program in California, is hosting a gala event to celebrate its 25th anniversary. According to an article in the Ventura County Star, the 25th Anniversary Celebration Gala will allow attendees to step back in time to the ’40s and ’50s and enjoy an evening of entertainment reminiscent of the USO and Hollywood Canteen. The evening will include dinner, silent and live auctions and dancing to big band music. The evening will also honor World War II veterans currently residing in long term care facilities in the county. The article notes that another way to support the ombudsman program is to serve as a volunteer ombudsman.
Source: Ventura County Star, August 21, 2006
5. IL ombudsmen recognized for outstanding work
Outstanding individuals in the Illinois Ombudsman Program were honored and recognized at the 20th Illinois Annual Elder Rights Conference held August 1-3, 2006 in Chicago. Brigit Dyer-Reynolds, the Illinois regional ombudsman for ICARE Project Advocate located in Springfield, was named “Outstanding Long Term Care Ombudsman of the Year.” According to the award announcement, Dyer-Reynolds has displayed the spirit of team work as vice president for the Illinois Association of Long Term Care Ombudsman and with her involvement in statewide advocacy. She has also taken charge of difficult cases where the ICARE program’s advocates were the only people listening to residents and responding to their concerns. She feels strongly about sex offenders and parolees being placed in long term care facilities and last year led a successful fight to remove a violent felon who had assaulted a woman in a local long term care facility. Brigit Dyer- Reynolds was awarded a scholarship to attend the upcoming 2006 NCCNHR Conference.
Bob and Phyllis Ervin, also from ICARE Project Advocate, were named “Outstanding Long Term Care Ombudsmen Volunteers of the Year.” They have been volunteering for 11 years and moved into a leadership role as Lead Advocates for Sangamon County two years ago. They monitor all the volunteers in the county, making sure monthly visits are conducted at all the long term care facilities. The Ervins can always be counted on to make a visit to a facility if the volunteer assigned to the facility is unable. They also plan and put on a volunteer appreciation luncheon for the volunteers in Sangamon County each Christmas.
Source: Award Announcement; Email from Sally Petrone, August 25, 2006
Ombudsman Calendar of Events
October 1-7, 2006 Residents’ Rights Week. Each year the first full week in October is designated by the National Citizens' Coalition for Nursing Home Reform as National Long-Term Care Residents' Rights Week. To access an informational flyer/order form for this year's packet go to: http://www.ltcombudsman.org/uploads/RROrderForm06.pdf
October 22 – 24, 2006: NCCNHR 31st National Conference and Annual Meeting, [Please note change in end date!] “CARE Matters.” Arlington, Virginia. Hilton Crystal City Hotel. For more information and a registration form, go to http://nursinghomeaction.org.
Home and Community-Based Care/Olmstead
6. MA workforce council, worker registry created
Massachusetts has passed legislation creating a council to help consumers who supervise their own personal care attendants (PCAs) to access good care by creating a more stable PCA workforce. The Personal Care Attendant Quality Workforce Council will be made up of seniors, people with disabilities and their family members, and PCA advocates. It will help set wages and benefits, establish a worker registry to help consumers find PCAs, and provide training. Consumers will still be in charge of choosing, hiring, and firing their PCAs, who will have the right to form a union. The legislation was backed by 1199 SEIU and endorsed by over a hundred organizations, including many senior and disability providers and advocacy groups.
Source: Quality Jobs, Quality Care, August 14, 2006
7. UT group protests nursing home stay requirement
The Disabled Rights Action Committee (DRAC) recently held a protest at the Utah State Department of Health urging a change in a rule that requires a nursing home stay of 90 days to qualify for in-home assistance. The goal of the protest was two-fold: to push for a change in state policy and to call on the state to grant a waiver to Renee Baturin, a 45-year old woman with cerebral palsy. Baturin has lived on her own for 23 years with the help of home care and recently moved to Utah with the expectation that she could continue receiving in–home services. However, once in Utah, she learned that in order to receive home care, she would have to spend 90 days in a nursing home. DRAC demonstrators say the current policy is a waste of money and strips disabled Utahns of their independence. The waiver they are seeking would allow Baturin to access state funds without a nursing home stay. Michael Hales, State Medicaid Director, said that under federal Medicaid rules states must pay for institutional care. He noted that people who prefer home care have to wait in line, but the waiting lists are very long. Hales stated that the 90-day nursing home stay was a “creative solution to try and fast-track people” off a 4,000-person waiting list.
Source: The Salt Lake Tribune, August 22, 2006; www.kcpw.org, August 16, 2006
Nursing Home News
8. VA newspaper says nursing homes use arbitration as shield
According to The Roanoke Times, an increasing number of nursing homes across the country are adding arbitration clauses to their admission agreements to protect themselves from lawsuits. One estimate claims that more than one half of homes in Virginia require incoming residents or their families to sign such an agreement. These clauses require that disputes be settled out of court, so a resident or their family cannot sue the home for neglect, abuse or inadequate care – even if it contributes to the resident’s death. Representatives of the nursing home industry claim that these agreements hold down the cost of litigation and, according to Steve Morrisette, director of the Virginia Health Care Association, “they provide an individual that has been damaged with the money they deserve as opposed to trial lawyers getting anywhere from a third to a half of the settlement.” Consumer advocates have labeled the practice as unfair because arbitration shields facilities from taking responsibility for abused or neglected patients. Eric Carlson, an attorney with the National Senior Citizens Law Center in Los Angeles, stated that factors controlled by the nursing home weaken the plaintiff’s ability to receive just compensation in an arbitration hearing. These factors include the arbitrator’s ability to limit the number of investigative interviews, to limit the exchange of documents and to place a cap on damages that can be awarded. Furthermore, arbitration gives the nursing home the ability to select the arbitration service that will decide on the matter rather than leaving it in the hands of an unknown jury.
Source: The Roanoke Times, August 24, 2006; www.myziva.info, August 28, 2006
9. Beverly name becomes golden
The company that bought the former Beverly Enterprises Inc. (BEI) has announced a name change that will affect 78% of its nursing homes and assisted living centers nationwide. A family of “Golden” names will be used for the different companies that came under the Beverly name. The new names are as follows: Golden Horizons (the parent company); Golden Living (the long term care company that operates the nursing homes and assisted living centers); Golden Living Centers (the nursing facilities); Golden Living Communities (the assisted living centers); Golden Innovations (the company that handles service businesses, such as rehab, home health, hospice, staffing, procurement, and construction services); and Golden Ventures (the administrative service company providing finance, human resources, marketing, and billing services). Golden Ventures is located in Fort Smith, Arkansas on the site of the former corporate headquarters. The new headquarters is in California. Ron Silva, Chairman of the Board of Golden Horizons, said that the new names are part of the “first statement of how we take the company forward.” The name change will cost approximately $2 million and includes new logos and graphics. Signs at 365 properties nationwide will be changed, along with employee badges, business cards, stationery and 40,000 soap dispensers that bear the Beverly logo. BEI will continue to operate 80 nursing homes, to be called Beverly Living Centers, and 3 assisted living centers, renamed Beverly Living Communities.
Source: Business Wire, August 17, 2006;
http://www.nwanews.com/adg/Business/163875/, August 18, 2006
10. MO seeks nursing home voters who need photo ID
As part of a new state law requiring voters to present a Missouri or federally-issued photo ID, the Missouri Department of Revenue will send mobile units to any nursing home where residents need their picture taken. This outreach effort is required by the new law. Earlier this summer, the Department sent 1,500 letters to nursing homes and other facilities serving the elderly and disabled, offering to bring a mobile unit to the facility. Only 53 have requested such visits so far, and 44 IDs have been issued. Officials say that 900 individuals are scheduled to receive photo IDs during the 53 visits scheduled through mid-October. The Department of Revenue is spending $2.9 million on its effort, including $19,450 for each mobile unit that consists of a camera, laptop computer, an electronic signature pad and a screen placed behind the photo subject. The Department also hired 16 hourly workers, who must rent a car for each of the visits. Missourians who lack proper identification can obtain a photo ID for free, but critics say that it is not free at all since a birth certificate, passport or some proof of identity is necessary to obtain the ID. At one Missouri nursing home, the activities director who was trying to determine which residents needed photo ID, reported that a number of residents who were interested backed down because of the cost of obtaining this documentation. The new law is being challenged in court by opponents who claim that it will disenfranchise the poor, minorities and the elderly.
Source: The Kansas City Star, August 25, 2006
11. Nursing home administrator training enhanced in Oklahoma
Individuals who want to become nursing home administrators in Oklahoma in the future will be required to attend an “administrators university.” The board overseeing long term care facilities in the state says future administrators need to learn the finer points of ethics, infection control, food safety and financial management of nursing homes. A four-year college degree is already required to be a nursing home administrator, but board members say more specific knowledge and training is needed to operate nursing homes. Source: http://www.kotv.com/news/?109885, August 24, 2006
Culture Change
12. KS honors facilities promoting culture change
The Kansas Department of Aging (KDOA) has recognized the work of several nursing homes that have made significant changes to improve the quality of residents’ lives in the past year. This recognition is part of a nursing home initiative called PEAK (Promoting Excellent Alternatives in Kansas) that promotes culture change in long term care. The awards go to homes that are among the best in the state at providing opportunities for resident control, staff empowerment, home environment and community involvement. Seven nursing homes have been named as the 2006 PEAK Award Recipients. Each year all nursing homes in Kansas are invited to submit an application describing the changes they have made during the previous year. A committee consisting of representatives from AARP, the Kansas Association of Area Agencies on Aging, Kansas Advocates for Better Care, the Kansas Foundation for Medical Care and the Kansas Silver-Haired Legislature reviews the applications and selects homes for site visits. The winners are chosen after this visit, which is conducted with officials from Myers and Stauffer, the Ombudsman Program and the Kansas Department on Aging.
As part of PEAK, educational materials to assist nursing homes have been developed, including a booklet, entitled “Pioneering Change in Kansas Nursing Homes,” and a number of training modules. Both the modules and the book can be accessed by going to: http://www.k-state.edu/peak/overview.htm.
Source: http://www.k-state.edu/peak/recognitions.htm; http://www.agingkansas.org/kdoa/programs/PEAK/peak.htm
Assisted Living
13. Newspapers expose problems in NC adult care home system
Three North Carolina newspapers recently published articles describing serious problems in the state’s adult care home system. One paper, The News & Observer, analyzed 53 cases of preventable deaths that had occurred in adult care homes since 2000. Even though the most serious level of violation had occurred in each of these cases, fines were lowered or dismissed in 38% of the cases, and the average fine paid was only $2,615. The paper notes that a legislative change made in 2005 increases some fines to as much as $20,000, but that meetings of the Penalty Review Committee, the group that sets the fines, have been cut from monthly to twice a year. Advocates believe this committee is a key means of opening the regulatory process to families and the public. A second paper, The Charlotte Observer, found problems in the licensure system for adult care homes. Its research revealed that homes are often able to escape a troubled past. The paper notes that despite the fact that state lawmakers have tried to tighten rules so that owners of such homes can’t close and reopen with a newly clean slate, family or new owners are able to take over and get an unblemished license, no matter how serious previous violations have been.
Finally, both The Charlotte Observer and The News & Record examined the failure of the system to properly care for the needs of the mentally ill in adult care homes and highlighted the danger this can create for older, frailer residents. According to both papers, more than 40% of residents in adult care homes and nursing homes are mentally ill, but state rules governing these homes are geared to the elderly. This leaves employees understaffed and untrained for the challenges of handling mentally ill residents, who often are younger individuals. A study group commissioned by the state legislature made several recommendations in a report that was presented to a legislative panel in February of this year. Recommendations included: 1) developing a screening process; 2) hiring mental health experts to train staff on dealing with mental health issues; and 3) upgrading staffing levels. The state’s Division of Aging and Adult Services has begun work on a screening process, but legislators failed to consider any of the proposed reforms. However, in response to questions from The Charlotte Observer, the chair of the legislative panel said that legislators need to revisit the report’s recommendations when the panel meets again.
Source: The Charlotte Observer, August 17, August 18, August 23, 2006; The News & Observer, August 13, 2006; The News & Record, August 20, 2006
Staffing
15. MI home care workers get raise
Michigan Governor Jennifer Granholm has signed a fiscal year 2007 budget for the Department of Community Health that includes an increase in salaries for the state’s more than 42,000 home care workers. Beginning in October, workers will earn $7/hour, an increase of $1. A broad statewide coalition, that included advocates for seniors and people with disabilities led by the Michigan Quality Home Care Campaign, worked hard to gain bipartisan support for the bill.
Source: Niles Daily Star, August 15, 2006
Medicare
16. CMS error creates confusion, potential problems for Medicare beneficiaries
After having erroneously sent checks to 230,000 Medicare beneficiaries to reimburse them for Medicare prescription drug benefit premiums, the Centers for Medicare & Medicaid Services (CMS) plans to send letters to the same individuals informing them of their options for repayment to the federal government. CMS Administrator Mark McClellan stated that a “glitch” prompted the agency to mistakenly send these refunds. To repay the government, beneficiaries can write “Void” on the check and mail it to a specific address; mail in a personal check or money order; or call a toll-free number to arrange an electronic transfer from their bank account. Beneficiaries can also arrange for a monthly installment plan over a period of up to 7 months. In addition to the refund, the beneficiaries also received letters from the Social Security Administration erroneously stating that the agency will no longer deduct their monthly prescription drug benefit premiums from their Social Security checks. According to Vicki Gottlich of the Center for Medicare Advocacy, there are a number of important points that beneficiaries and advocates need to know about these “snafus.” First, some of the refunds are not errors, but are reimbursements to which beneficiaries are entitled after months of having premiums withheld incorrectly. The CMS letter may lead these individuals to believe they must return the refund. Second, while Social Security will begin deducting monthly premiums again in October, beneficiaries have not been clearly told what is going to happen with or what to do about the September premium. Advocates who want to learn more about these and other potential problems and how to assist beneficiaries, should go to:
http://www.medicareadvocacy.org/PartD_06_08.24.PartDPremiumIssues.htm.
Source: Kaiser Daily Health Policy Report, August 29, 2006; http://www.medicareadvocacy.org/PartD_06_08.24.PartDPremiumIssues.htm
Medicaid
17. GA estate recovery law nixed
Federal officials rejected a new state law in Georgia that would have protected more recipients from a Medicaid estate recovery plan intended to recoup costs of nursing home care after residents die. The Centers for Medicare & Medicaid Services (CMS) notified state officials last month that it will not approve changes to the state’s plan to recover a portion of the money Medicaid spends on recipients in nursing homes, facilities for the mentally retarded or on adults 55 and older who get community and home-based services. Georgia lawmakers had raised the estate exemption from $25,000 to the first $100,000 of an estate and exempted people who were already receiving Medicaid-covered services. No decision has been made about whether to appeal the federal government’s ruling.
Source: Atlanta Constitution, August 17, 2006
DC Doins’
18. OIG report calls for changes in nursing home evacuation rules
A report released by the Office of the Inspector General (OIG) for the U.S. Department of Health and Human Services concludes that frail elderly residents evacuated from nursing homes as a result of hurricanes in 2005 fared worse than those who were not evacuated. The OIG found that the plans of the 20 nursing homes they reviewed met federal and state law, but were deficient with regard to ensuring the safe and comfortable evacuation of residents with complex needs. Facilities that evacuated before the storms experienced the most problems, which primarily centered on the availability of transportation. The OIG report recommends that regulations be changed to require certain core elements in every evacuation plan. Increased collaboration with state and local emergency officials is also recommended as many facility operators stated they were unable to get the help they needed from these officials. CMS Administrator Mark McClellan agreed with the report and said the agency will consider the recommendations. To read the full report, go to: http://www.oig.hhs.gov/oei/reports/oei-06-06-00020.pdf.
Source: www.myziva.info, August 21,2006; www.SeniorJournal.com, August 18, 2006
19. Study finds QIO efforts effective
According to a study published in the Annals of Internal Medicine, intensive efforts by the Quality Improvement Organizations (QIOs) likely led to nationwide improvements in the quality of health care provided to patients in a variety of settings, including nursing homes. The nursing home part of the study, conducted by federal researchers, assessed improvement in care using five nursing home quality measures: pain; pain for short-stay residents, pressure sores, restraints, and assistance with daily activities. Nursing homes that worked with QIOs improved on all five measures studied, and those working intensively with a QIO improved to the greatest degree. The QIOs and nursing homes that worked most closely together halved the number of nursing home residents in chronic pain from 13% to 6.2%, and halved the percentage of nursing home residents who were restrained from 16.5% to 8.4%.
Source: www.newswise.com, August 16, 2006
Other News
20. Patient advocates services growing
U.S. companies are increasingly including patient advocate services in the health plans they offer to their employees. An article in the Philadelphia Inquirer notes that these advocates “navigate the labyrinthine health care system, identifying specialists, translating doctorese and negotiating insurance claims” for patients. The patient advocates are often nurses and mostly counsel over the phone, although some might accompany patients on doctor visits. Advocates “attempt to find the best doctors for what ails employees, and employers pay for fewer wrong diagnoses and unnecessary procedures,” according to the Inquirer. Many physicians are willing to accept advocates’ participation in patient care. “This is a very, very nice way to avoid getting sued,” said Mehmet Oz, vice chairman of surgery at New York Presbyterian-Columbia University and co-author of “You: The Smart Patient,” noting that “an empowered patient does better.” Betty Long, founder of Guardian Nurses, which provides patient advocates, said, “You wouldn't think of going into the legal system without a lawyer. You wouldn’t want to go into the medical system without an advocate. It’s so overwhelming.”
Source: Kaiser Daily Health Policy Report, August 28, 2006; Philadelphia Inquirer, Augusts 27, 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, at robynjgrant@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
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