NORC Gazette
January 21, 2002
National
Long Term Care Ombudsman Resource Center
National Citizens’ Coalition
for Nursing Home Reform
Table
of Contents
Ombudsman Program Updates
1. Iowa ombudsman program
can’t advocate for assisted living residents
2. Cleveland, Ohio ombudsman warns new staff rules may be a challenge
3. Ombudsman guide to OBRA ’87 being revised
4. AARP shifts volunteer ombudsman recruitment to state programs
Ombudsman Calendar of Events
Home and Community Based Care/Olmstead
5. “Smart House” designed to monitor
seniors
6. Information available to
assist in reviewing state Medicaid waivers
Nursing Home News
7. Missouri legislation would speed up
nursing home abuse investigations
8. Nursing home residents included in Iowa prescription drug discounts
9. Iowa state regulators miss some appeal
hearings
10. Canadian grant money to encourage family
participation in LTC
Assisted Living
11. New Jersey, Virginia introduce assisted living legislation
12. Federal assisted living tax credit
bill introduced to Congress
13. Iowa oversight of assisted living
facilities under fire
Staffing
14. Initiative to address shortage of long term care paraprofessionals
15. Beverly Enterprises, OSHA settle ergonomics case
16. Long term care employment rises as national employment declines
17. Facility settles overtime case
Research
18. Ethnicity linked to genetic dementia risk
DC
Doins'
19. HHS appoints representative for
Chicago region
20. Up to 3 consumer representatives to be added to regulatory group
22. Public benefits booklet now available
Ombudsman Program Updates
1. Iowa ombudsman program can’t advocate for assisted living residents
An article in the Des Moines Register reveals that Iowa’s ombudsman program can go to bat for nursing home residents, but not for assisted living residents. Part of the reason is that assisted living centers aren’t subject to the same type of standards that apply to nursing homes, so an ombudsman can’t make the same sort of demands on those facilities when residents have complaints. “We just don’t have that regulatory base to draw on,” said Debi Meyers, the Iowa State Ombudsman. “That’s the core issue for us.” Other reasons cited in the article included lack of sufficient resources and conflict of interest provisions since the State Ombudsman is housed in Elder Affairs, the state agency that oversees assisted living centers. Source: Des Moines Register, 1/14/02. See additional articles under “Assisted Living” for more stories on Iowa assisted living issues.
2. Cleveland, Ohio ombudsman warns new
staff rules may be a challenge
New staffing requirements that went into effect almost 11 weeks ago require that nurse aides must provide a daily average of two hours of resident care, and registered nurses must provided a minimum daily average of 12 minutes of care. To determine compliance with the rules, Ohio Department of Health officials will be relying on a computer program designed to analyze staffing. Advocates for residents and their families had said that the regulations weren’t tough enough, but had supported them reluctantly. Debby Allen, regional ombudsman for the Cleveland ombudsman program, commented that “These places are called nursing homes - where are the nurses?” Allen noted that it will be difficult for residents and families to know if the facility is complying with the requirements. “What can you do? Go up to someone and say, “did you get your 0.2 hours (12 minutes) of nursing care today?” Source: Plain Dealer, 1/8/02.
3. Ombudsman guide to OBRA ’87 being revised
The Resource Center
is revising An Ombudsman’s Guide to the Nursing Home Reform Amendments of
OBRA ’87. The book was last updated
in September, 1993. Sarah Greene Burger
is spearheading the project, and it is anticipated that the guide will be
available in late spring. If anyone
knows of an expert in PASARR who could provide some assistance relative to that
topic, please e-mail Sarah Greene Burger at sburger@nccnhr.org
4. AARP shifts volunteer
ombudsman recruitment to state programs
AARP is in the process of shifting its recruitment of ombudsman
volunteers to the state level. As a
result, ombudsman programs will need to work with their state AARP program.
According to Elinor Ginzler of AARP, all state programs will receive a letter
from the AARP in the next few weeks with instructions on how to implement the
program. State Ombudsmen will be sent a letter once the AARP state chapters
have been notified. The recruitment notice from AARP will no longer have a tear
off card, but will
have a letter about whom to contact in the ombudsman program for
information. Last year, programs in 22
states used AARP's recruitment. For
more information, contact Alice Hedt at 202-332-2275.
Ombudsman Calendar of Events
January 22: "New"
State Ombudsmen Orientation phone call. For more information contact Julie
Meashey at 202-332-2275 or jmeashey@nccnhr.org
January 24: Conference call on national long term care issues, including prohibition on nurse aide training, CMS’ news initiatives, proposed federal staffing legislation and other topics. To participate, call John Kafka at 202-332-2275.
January 24: NCCNHR Virtual Annual Meeting session, "The High Cost of Poor Care" 2-3:30 pm EST. Contact John Kafka at 202-332-2275 to register ($90 charge).
January 31 – February 2: NASOP Conference: “Long Term Care Ombudsman Program: Rethinking and Retooling For the Future.” For more information contact Brian Lindberg at (202)789-3606.
February 14: NCCNHR Virtual Annual Meeting session, "Quality and Allocation of Resources in Survey and Enforcement" 2-3:30 pm EST. Contact John Kafka at 202-332-2275 to register ($90 charge).
March 5: NCCNHR Virtual Annual Meeting session, "Complaint Investigations by Regulatory Agencies" 2-3:30 pm EST. Contact John Kafka at 202-332-2275 to register ($90 charge).
March 14: Hotel
reservation due for State Ombudsman spring conference. Call Holiday Inn at
(614) 885-3334 in Columbus, Ohio and indicate your reservation in connection
with the "National Ombudsman Training Conference." Contact Mark
Miller at mmiller@nasua.org
April
13 - 16: State Ombudsman spring conference, Columbus, Ohio. Contact
Mark Miller at mmiller@nasua.org
Home
and Community Based Care/Olmstead
5. “Smart House” designed to monitor seniors
Soon it may be possible to electronically oversee an elderly person
at home through the use of sensors that track the person’s movements. Researchers have developed a prototype
system that records a person’s daily routine and monitors that routine for
deviations that might signal a problem.
The future plans for the system call for off-site computer monitoring,
which could analyze the data and report back to either the resident or a family
member. Designed to help seniors remain independent, the system may eventually
include capabilities such as blood pressure and medication monitors, toilet
sensors, and a kitchen console to chart a person’s dietary intake. The system would cost approximately $300 to
install, plus a monthly fee to the monitoring service.
Source: SNALF.com , 1/15/02
6. Information available to assist in
reviewing state Medicaid waivers
The National Health Law Program (NHeLP) has excellent information on its website about Medicaid waivers, including an outline of what Medicaid provisions can and cannot be waived. Advocates in states where waivers are being proposed may want to consult these materials when reviewing their state’s waiver. NHeLP is concerned that waivers in some states go far beyond the original purpose of a waiver and, in effect, do away with the concept of Medicaid as we now know it. To access this information, go to:
http://www.healthlaw.org/waiver.shtml
Nursing Home News
7. Missouri legislation would speed up nursing home abuse investigations
State Representative Craig Hosmer has proposed an Elderly Protection bill that calls for quicker notification of the state Attorney General’s office or local prosecutors when complaints against a home are lodged with the state Department of Health and Senior Services. Currently the Department handles its own investigations and then forwards the results to the police - sometimes months after an allegation of abuse has been made. Rep. Hosmer has stated that “If a crime happens anywhere, whether it’s in a nursing home or out on the street, it needs to be investigated immediately.” The legislation would also restrict advance knowledge of nursing home inspections and would issue more fines to violators. Rep Hosmer has sponsored this legislation for three years. Source: Springfield News-Leader, 1/16/02
8. Nursing home residents
included in Iowa prescription drug discounts
The "Iowa Priority" prescription drug savings
program, implemented earlier this month, will be developing a special contract
to accurately provide for the needs of residents of long-term care facilities.
The American Society of Consultant Pharmacists (ASCP) is working with the Iowa
Priority Program to develop this contract that will potentially be
used as a model for other long-term care discount card programs. The drug discount cards that are currently
available in the country are primarily targeted at the ambulatory,
community-dwelling senior population.
Using these cards in long term care facilities raised concerns for ASCP
members because the cards do not seek to cover the costs of special packaging
and other services provided in a long-term care facility. In addition,
long-term care pharmacies do not have a mechanism for point-of-sale purchases,
a key component of the discount card programs. The ACSP is working to address
these issues in the Iowa Program. Source: ASCP Senior Care Advocate, 1/17/02
9.
Iowa state regulators miss some appeal hearings
State regulators do not attend some of the federal hearings that can result in fines begin reduced or dismissed. The Iowa Department of Inspections and Appeals has been using private consultants since October 2001 to rule on some of the appeals filed by nursing homes that have been fined or cited by the department. According to the department it can choose whether it attends the hearings and views the hearings as opportunity for homes – not the state - to argue their case. Iowa is one of three states chosen to participate in a federally financed project to test the use of independent case reviewers to handle appeals. The department feels that the review process saves the department money and gives state workers more time to spend on enforcement. Advocates, however, have concerns. After one independent reviewer rescinded a fine resulting from the death of a resident, Nicola Gould of the Advocacy Network for Aging Iowans said the process leaves too many questions unanswered. Source: Des Moine Register 1/10/02
10. Canadian grant money to encourage family participation in ltc
A three-year, $463,500 Ontario
Trillium Foundation grant has been awarded to the Concerned Friends of Ontario
Citizens in Care Facilities and The Self-Help Resource Centre to focus on
family council work. The “Family
Councils Project” will seek to encourage greater family involvement in the
lives of long term care residents. The
Project will promote the development, maintenance, and evaluation of family
councils and work in partnership with facility staff and residents’ councils to
improve the quality of life of Ontario’s residents in long term care
facilities. To read the press release,
go to
http://library.northernlight.com/FB20020116060000098.html?cb=0&dx=1006&sc=0#doc
Assisted Living
11. New Jersey, Virginia
introduce assisted living legislation
In New Jersey, 2 bills have been introduced concerning assisted living. The first would increase Medicaid reimbursement to assisted living providers, while the second would require assisted living administrators to undergo certain background checks. Two pieces of legislation introduced in Virginia would: require ALFs to post the rights and responsibilities of residents where they can be accessed, and allow facilities to conduct evaluations of a resident's cognitive function by a licensed clinical psychologist before the resident was admitted to the ALF. Source: BAL Weekly, 1/16/02
12.
Federal assisted living tax credit bill introduced in Congress
A bill to allow a tax credit for supported elderly housing was
introduced in the U.S. Congress last month.
Senate Bill 1886, also known as the “Assisted Living Tax Credit,” seeks
to amend the Internal Revenue Code of 1986 by giving a tax credit for qualified
elderly housing units. The bill contains a formula to calculate the amount of
the benefit, plus information on the applicable time period and what qualifies
as an assisted living residence for the credit. To read the bill go to http://thomas.loc.gov/cgi-bin/query
13. Iowa oversight of
assisted living facilities under fire
Iowa’s system for inspections of assisted living facilities has come under fire in the Des Moines Register. Elder Affairs, the department charged with overseeing these facilities, does not conduct surprise inspections to determine compliance with regulation. Instead, it mails written surveys to residents and family member to assess their satisfaction with the facility and judge the facility’s performance. The Des Moines Register notes that residents and family members are selected by the facility. “Monitors” are then sent in to review records and speak to residents, family members, and employees. The director of the Elder Affairs department called Iowa’s method of policing assisted living facilities a “model for the nation.” However, advocates for the elderly worry that seniors in assisted living facilities are in no position to pass judgment on such issues as medical services or the facility’s security systems. The Des Moines Register also found that no penalties of any kind have been imposed on any assisted living facility in Iowa, and that although Iowa law requires an on-site visit before a center’s license is renewed, Elder Affairs has been unable to keep up with the workload. The Department’s response to this problem has been to send out copies of old licenses with new expiration dates. Source: Des Moines Register, 1/14/02. To read the complete article, go to:
http: //www.desmoinesregister.com/news/stories/c4788996/17022675.html
14. Initiative to address shortage of long term care paraprofessionals
The
severe shortage of nursing assistants and home care aides is the focus of a
joint initiative between the Paraprofessional Healthcare Institute and the
Institute for the Future of Aging Services, the research arm of the American
Association of Homes and Services for the Aging. The partnership will develop a comprehensive national plan to
address the shortage of high-quality, committed workers in long-term care. The
groups hope to heighten public awareness of the crucial part these workers
play, promote innovative programs to recruit and retain good workers, develop a
searchable clearinghouse database on the long-term care workforce and explore
the causes of the current shortage. The initiative is funded by the Office of
Disability, Aging and Long Term Care Policy of the U.S. Department of Health
and Human Services and will conclude in December of this year. To read the press release, go to:
http://www.aahsa.org/public/press_release/PR212.htm
15. Beverly Enterprises, OSHA
settle ergonomics case
Beverly Enterprises Inc., will adopt specific measures to
reduce back injuries for employees involved in lifting nursing home
residents. As part of a settlement
agreement, the company has also agreed to establish a training program and
purchase mechanical lift equipment. The settlement applies to all Beverly
Enterprises facilities within federal OSHA jurisdiction. The agreement settles
citations issued by OSHA to five Pennsylvania nursing homes. The agency found
that the company's injury and illness records revealed numerous musculoskeletal
injuries sustained by nursing assistants that resulted in extensive lost work
time and restricted work duty.
Source: AHA News, 1/16/02
16. Long term care employment rises as national
employment declines
While the United States Department of Labor Bureau of Labor Statistics (BLS) reported on January 4, 2002 that overall employment decreased in December 2001, health care employment was on the rise with the addition of 31,000 jobs in December. Of those additions, 29 percent were in long-term care employment: 3,000 jobs were added in nursing and personal care facilities, and 6,000 jobs were added in home health care services. Many recruiters see this lull in overall economic growth as an opportunity to recruit health care workers. The U.S. Department of Labor, together with the American Association of Homes and Services for the Aging (AAHSA) and the American Healthcare Association (AHCA), has created the Caregiver Job Clearinghouse, a free website for posting long term care job openings. HotJobs.com, in expectation of an intense period of growth in health care employment, is working to help health care companies recruit talent online. For more details about the BLS report and other related reports go to http://www.directcareclearinghouse.org/
17.
Facility settles overtime case
Mercy Health and Rehabilitation Center reached an agreement with
members of the Service Employees International Union Local 1199 Upstate just
days before going to trial before an administrative law judge of the National
Labor Relations Board. The union filed
charges with the NLRB in early 2001, accusing Mercy of failing to implement
agreed-upon limitations on mandatory overtime and firing or suspending
certified nursing assistants who insisted on working to the terms of the
agreement. As part of the settlement, Mercy agreed to reinstate three fired
employees, pay approximately $26,450 in back wages and change its mandatory
overtime policy.
Source: SNALF.com, 1/11/02
Research
18. Ethnicity linked to genetic dementia risk
The latest news about Alzheimer’s
suggests that race may be a risk factor.
African-Americans with one or more relatives suffering from Alzheimer’s disease
may be at greater risk of developing dementia than whites in the same
circumstances, according to a study published in the latest issue of the Journal of the American Medical Association.
Researchers found that the cumulative risk of dementia in first-degree
biological relatives of African-American Alzheimer’s victims was almost twice
as great as the risk to first-degree biological relatives of white Alzheimer’s
sufferers. The study also found that, in both races, female first-degree
biological relatives were more likely to develop dementia than similarly
related males. To read the full
article, go to:
http://jama.ama-assn.org/issues/v287n3/abs/joc11033.html
DC
Doins’
19. HHS
appoints representative for Chicago region
Department of Health and Human Services (HHS) Secretary Tommy
Thompson has appointed Corey Hoze as regional representative for Region 5,
based in Chicago. Hoze will be responsible for guidance and coordination of HHS
policies in Illinois, Indiana, Michigan, Minnesota, Ohio and Wisconsin. Prior
to joining HHS, Hoze worked for Miller Brewer Co. in Milwaukee as manager of
corporate affairs. He has also served
as the administrator of the division of economic development at the Wisconsin
Department of Commerce. Source: AHA
NEWS 1/17/02
20.
Up to 3 consumer representatives to be added to regulatory group
Responding to criticism that the regulatory reform task force was too heavily weighted toward business interests, HHS Secretary Tommy Thompson has said that he will add consumer groups to the reform task force. Consumers had argued that providers, insurers and representatives of the industry sector unfairly dominated the group because only two of its 27 members were from beneficiary groups. Secretary Thompson has stated he would add up to three patient representatives, but did not set a timetable for naming these new members. While consumer advocates cautiously supported Secretary Thompson’s pledge, they want him to appoint people who have fought for consumer protections in the past. One advocate noted that without the proper background, consumer representatives might easily yield to provider or other industry interests. To read the full article, go to:
http://www.modernhealthcare.com/currentissue/topten.php3?refid=8254&db=mh99up&published=20020114
The Center for Social Gerontology (TSCG) will present its Sixth Annual Adult Guardianship Mediation Training June 2-4, 2002 in Ann Arbor, Michigan. This training will be presented jointly by TCSG and PeaceTalks. It is targeted to trained mediators who would like to expand their practice to include mediation of disputes that arise when guardianship over an adult is being considered, and to persons interested in establishing such service programs. More detailed information on logistics, registration, and the curriculum will be available soon from the Center. TSCG’s website is http://www.tscg.org/
22.
Public benefits booklet now available
The AARP
Foundation's National Legal Training Project is pleased to announce that its
2002 Annual Update of Public Benefit Figures is now available. This nine-page
booklet contains benefit amounts and income limits for 13 benefit programs,
including Social Security, Supplemental Security Income (SSI), Medicare,
Medicaid, Spousal Impoverishment, and Food Stamps. To request a free copy,
please send an email to Mary Wall at mwall@aarp.org. Specify Spanish or English, hard copy or
electronic (Word) version.
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