NORC Gazette
March 18, 2002
National Long Term Care
Ombudsman Resource Center
National Citizens’ Coalition
for Nursing Home Reform
Table
of Contents
Ombudsman Program Updates
1. Article on crackdown on
CA elder abuse cases cites local ombudsman
2. Changes proposed to the
National Ombudsman Reporting System
3. AoA listening sessions continue
Ombudsman Calendar of Events
Home and Community-Based Care/Olmstead
4. NYC Medicaid recipients not receiving full range of home
services
5. Arkansas to
toughen Medicaid personal care guidelines
Nursing Home News
6. PASRR guide now available
7. Study finds one
in five Florida nursing homes has no insurance
8. Mattresses: a cure for liability
woes?
9. Beverly teams with “A Place for
Mom, Inc.”
10. NY bill protects whistleblowers
11. Nursing home chain to pay $750,000
in MA resident’s death
12. SC legislature revisits
nursing home tax
13. “Good Morning, America” to
discuss use of video cameras
14. CARIE conference focuses on changing the long term care culture
Assisted Living
15. Assisted living resources
available from NHCC of New York State
16. KS assisted living residents protest
“terrorism” tariff
Staffing
17. House Committee on Government Reform posts
entire staffing report on-line
18. NCCNHR
needs 5,000 additional signatures to meet petition drive goal
19. AHCA offers pre-hire cna test
20. Staffing problems imperil NJ nursing home
residents
21. U.S. Senate bill provides
nursing staff training
22. Hurting at work in Buffalo, NY
23. AAHSA claims Medicaid is not paying its fair share
Research
24. Cholesterol-lowering drug may cut
dementia risk
DC Doins'
25. CMS issues sprinkler recall
26. Nursing home spending accelerating
27. CMS supports SPEAK UP campaign
Ombudsman Program Updates
1. Article on crackdown on CA elder abuse cases cites local ombudsman
In a recent article by the Sacramento Bee, Joan Parks, long term care ombudsman for 8 Northern California counties, said she believes that more abuse is happening and that more is being reported because of a growing awareness. Parks said about 44 percent of her current caseload of 1,246 care complaints involve elder abuse. Parks’ trained volunteers go into 400 facilities, including 75 nursing homes, once a week. The executive director of the CA Bureau of Medi-Cal Fraud and Elder Abuse has said that homes’ owners and operators will face criminal prosecution if they don’t report suspected abuse to law enforcement or the ombudsman’s office. California is currently working on new enforcement and educational programs to expose abuse and punish offenders including: 1) a curriculum for teaching doctors how to deal with elder abuse; 2) a forensic exam to help doctors document abuse; and 3) a training video for long term care facility employees. Employees will be required to watch this video which tells them that state law requires them to report any suspected abuse to the proper authorities, not merely to the home’s administrator. Source: Sacramento Bee, 3/14/02
2. Changes proposed to the National Ombudsman Reporting
System
The Administration on Aging (AoA)
is proposing form and instruction changes for the National Ombudsman Reporting
System (NORS) which would be implemented by October 2002. One of the changes
AoA proposes is the addition of a form certifying state annual expenditures on
statewide ombudsman programs that every state will have to submit for each
fiscal year. The new certification form will provide accurate information for
the NORS report and certify that the state is complying with Older Americans
Act provisions. The proposed changes, the result of a state and local ombudsman
task force, grew out of state ombudsmen's recommendations and have been reviewed
by all state ombudsmen. A federal register notice calls for a 60-day comment
period, followed by a submission of the proposals to the Office of Budget and
Management. To read the proposed
changes, the letter to state agencies on aging regarding the changes, the
federal register notice and for other information, go to http://www.aoa.gov/notices/2002/LTCO-01.html
3. AoA
listening sessions continue
The Administration on Aging (AoA) will hold its fifth listening session on the development of new regulations to implement the Older Americans Act which Congress reauthorized last November. The session will take place on April 2, 2002, from 9:00 a.m. to 12:00 noon, at the Double Tree Hotel, 2900 Chinden Blvd., Boise, ID 83714, (208) 343-1871. Those wishing to speak are asked to pre-register so that they may be given a time slot for their input. The pre-registration number is (816) 426-3511. The contact person is Ms. Irene Griffith.
Ombudsman Calendar of Events
April 13 - 16: State
Ombudsman spring conference, “So Much More to Discover: State Ombudsmen Explore
the Changing World of Advocacy.”
Columbus, Ohio. Contact Mark Miller at mmiller@nasua.org
June 5 - 7: Mid-Atlantic
Regional Ombudsman Conference, Winchester, VA. For more information contact
Jeni Coyne at 202-332-2275.
October 6 - 12: Residents' Rights Week 2002. Start thinking about how your program will celebrate this week.
October 25 - 30: NCCNHR Annual Meeting. Oct. 25th will be a "Bridge Day" with the NALC that is being held at the same location. More details to follow shortly, please mark your calendars and plan to attend.
Home and Community-Based
Care/Olmstead
4. NYC Medicaid recipients not receiving full range of home services
New
York City Medicaid beneficiaries who are cared for in their homes “may not be
receiving the full range of care services that they need,” even though they
have health needs similar to those of beneficiaries cared for in nursing homes,
according to a new study from the United Hospital Fund (Hokenstad et al., “Medicaid Long-Term Care
in New York City: Comparing Needs and Personal Care Services in the Medicaid
Home Attendant Program and in Nursing Homes,” February 2002). The report says
that nursing home residents were “generally frailer and sicker” than
individuals being cared for at home, but two-thirds of Home Attendant
recipients also had “high levels of need,” and might not have received the
“complement of services that are best suited to their needs.” The report found
that the costs of care for individuals with extensive needs was “remarkably
similar” between the programs and that family caregivers save the Medicaid
program nearly $10,000 per home care recipient. Based on its findings, the report recommends that the state test
and expand community-based care services; better train, supervise and
compensate home attendants; and ensure that family care givers are fully consulted,
informed and assisted in providing care.
A free copy of the report is available by calling (888) 291-8161. Source: Kaiser Daily Health Report, 3/8/02
5. Arkansas to toughen Medicaid personal
care guidelines
According to an Associated Press
report, some legislators fear that the Arkansas Department of Human Services’
(DHS) planned changes to the Medicaid personal care program will drive more
seniors into nursing homes. The DHS has announced that it will reduce the
maximum number of hours of personal care a Medicaid recipient may receive
without prior approval from 64 hours a month to 32. The change will affect
about 20,000 older Arkansans. Recipients can still receive the additional hours
of care if they can prove that the extra time is medically necessary. The state will contract with a private firm
to determine if recipients qualify for the additional hours. Some legislators
expressed concern that providers may not make the effort to qualify those
patients they think are marginal and also questioned who would check the work
of the private firm.
Source: SNALF.com, 3/11/02
Nursing Home News
6. PASRR guide now available
A new guide to understanding federal requirements in screening for mental illness in nursing home applicants has been released by the Substance Abuse and Mental Health Services Administration (SAMHSA). Federal PASRR regulation provides some leeway in interpretation of policy to the States, thus resulting in some variation in implementation. This report of PASRR policy is based on a review and comparison of current law, regulation, and State Guidance. It is intended to help state and local authorities and nursing facilities understand their responsibilities for ensuring appropriate admission and treatment of individuals with mental illness applying to and residing in nursing facilities. The report is entitled, “Screening for Mental Illness in Nursing Facility Applicants: Understanding Federal Requirements” and can be downloaded by going to:
http://www.mentalhealth.org/cmhs/ManagedCare/pubs.asp.
7. Study finds one in five
Florida nursing homes has no insurance
A report released by the Florida Policy Exchange Center on Aging
reveals that nearly 20% of Florida's nursing homes don’t carry liability
insurance. In addition, the study
revealed that more than three out of five nursing homes were subject to
lawsuits from January through September 2001. According to the researchers,
region and for - or nonprofit status were not related to the total number of
lawsuits filed against a nursing
home. Researchers also concluded that facilities in the Sunshine State could
face as many as 1,268 lawsuits for the first nine months of 2002. For more information, go to
http://www.fpeca.usf.edu/Publications/LTC.htm
and click on “Lawsuits and
Liability Insurance Experience of Florida Nursing Facilities.” Source:
SNFinfo Connection; 3/12/02
8. Mattresses: a cure for
liability woes?
A new campaign claims that a highly touted new mattress and
treatment system can help heal many nursing home woes. Because of its
beneficial effect on bedsores, use of a specially designed mattress, coupled
with a treatment program of special salves and ointments, can reduce the cost
of nursing home liability insurance, according to Bentley Lipscomb, director of
the Florida AARP. AARP is not receiving any financial gain from its advocacy of
the program, Lipscomb says. A pilot program at Marriott facilities and Delta
nursing homes found that the system dramatically reduced the number of
bedsores, according to Tempur-Med, manufacturer of the mattresses. Residents at
the Delta Healthcare Center of Tampa love the mattresses, according to the
director of nursing at the facility. Marriott will be using the system in all
of its long-term care facilities. Two insurance companies, Marsh USA and
Provider Alliance, will discount policies for nursing homes that use the
system. Source: SNALF.com; 3/11/02
9.
Beverly teams with “A Place for Mom, Inc.”
“A Place for Mom,” the nation’s largest eldercare referral service, recently announced a national marketing services agreement with Beverly Healthcare. Families will be able to find information about Beverly Enterprises’ facilities in their area by calling “A Place for Mom” or submitting an online assessment form. “A Place for Mom's” web site will have a page dedicated to information about Beverly’s health and wellness services, and will also include Beverly homes in its database of information. In partnering with “A Place for Mom” Beverly is joining Alterra Corp., Sunrise Assisted Living, Atria Retirement and Assisted Living and Hearthstone Assisted Living, among others. Source: www.longtermcareprovider.com
10. NY bill protects
whistleblowers
The state legislature passed a bill, which Gov. George Pataki is
expected to sign, strengthening whistleblower protection for employees in
nursing homes and other health care facilities. Under current state law, health
care workers are protected from employer retaliation only if a patient has
suffered actual harm. The new law would extend that protection to workers who
report potentially harmful situations, make reporting dangerous situations easier
for employees and increase possible court fines for employer retaliation to
$10,000. Source: SNALF.com; 3/13/02
11. SunBridge Healthcare
Corp. to pay $750,000 in MA resident’s death
SunBridge Healthcare Corp., a major
national nursing home chain, has agreed to pay $750,000 to settle a lawsuit
involving an elderly resident who was hit over the head and killed by a 35 year
old resident at a now-closed Quincy, MA long term care facility. The 1997 incident that took the life of Mary
Keenan, is being seen as an egregious example of abuse of nursing home
residents, an issue has gained increasing attention after a GAO report and
Senate hearing spotlighted the problem.
The home, Robbin House Nursing and Rehabilitation Center, which was
owned and operated by SunBridge Healthcare Corp., closed in 2000. Mary Keenan
was hit in the head and knocked to the floor by her roommate, Wanda Perryman, a
35 year old woman who was in the home as a result of a drug induced
stroke. Keenan died three days
later. The victim’s family questioned
why their loved one was put in the same room with Perryman. A Department of Health investigation found
that a prescreening assessment showed that Perryman had hit residents and staff
while hospitalized and had slapped other residents in the nursing home. Source:
Boston Herald, 3/14/02
12. SC legislature revisits nursing home tax
South Carolina legislators are rethinking a law hurriedly passed in the current session that charges a $3 per day tax on nursing home residents. The tax was intended to help balance the state Medicaid budget depleted by the recession. The fee is expected to raise about $5.2 million this year, which can be used to obtain $15.6 million in federal funds. Nursing home residents and their families have protested the tax and urged its repeal, saying a “sick tax is hardly a fair, nondiscriminatory way to go.” Approximately 30 percent of all nursing home residents in the state are private pay and would have to pay the bed tax without receiving any benefit from it. House Ways and Means Committee members have created a budget proposal to rescind the tax altogether. The proposal was to be up by the full House. Source: The State, 3/8/02
13. “Good Morning, America” to discuss use of video
cameras
“Good Morning, America” will air a segment on the use of video cameras in nursing homes on March 19, 2002, sometime between 7:00 am and 9:00 am.
14. CARIE conference focuses
on changing the long term care culture
The Center for Advocacy For the Rights and Interests of the Elderly (CARIE) will hold its 25th annual conference on May 16, 2002. The conference, “Changing the Culture of Long Term Care,” will explore what consumers want, how the long term care system can evolve to reflect their needs, and how quality of life and quality of care can be obtained across all long term care settings. For more information, contact CARIE at (215) 545-5728 or cubit@carie.org
Assisted Living
15. Assisted living resources
available from NHCC of New York State
The Nursing Home Community Coalition (NHCC) of New York State has completed 2 major projects related to assisted living that may be helpful to advocates nationwide. The first is the publication of a final report on assisted living in New York State which is an action paper summarizing findings of a 3 year study conducted with the Coalition of Institutionalized Aged and Disabled and Temple University. To access the report go to:
http://www.nhccnys.org/papers/assisted_living_project.htm Information about the baseline survey and the case studies upon which the report is based is available on the NHCC website (http://www.nhccnys.org ). The second project completed by NNCC is draft language for assisted living legislation that would require licensure for all assisted living residences and protect assisted living consumers. The draft legislation can be downloaded from the NHCC website.
16. KS assisted living
residents protest “terrorism” tariff
A Kansas assisted living provider has earned some unwelcome attention
for a rent hike it attributed to the Sept. 11 terrorist attacks. Rosemary
Standiferd, director of Elm Grove Estates in Hutchinson, KS, sent a letter to
residents Feb. 19 notifying them that they would have to shell out an
additional $425 in March as a one-time payment to offset the increase in
liability insurance premiums arising from circumstances linked to the terrorist
attacks. Residents are protesting the fee. Tony Evans, with the Kansas
Insurance Commission, said insurance companies still have not determined losses
related to the attacks. A spokesperson for Elm Grove Estate's parent company,
Emeritus Assisted Living, admitted that statements in the letter to the
residents connecting rising insurance rates to the events of Sept. 11 might
have been misleading. Source: SNALF.com, 3/15/02
17. House Committee on Government Reform posts entire staffing report on
website
Rep. Henry A. Waxman has
obtained a copy of a draft federal study that shows “strong and compelling”
evidence that nine out of ten U.S. nursing homes are understaffed. The report
titled "Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes"
is posted in its entirety on the House Committee on Government Reform website.
To read the report visit the Committee website at: http://www.house.gov/reform/min/inves_nursing/nursing_cms_rep.htm
18. NCCNHR needs 5,000 additional signatures to meet petition
drive goal
The NCCNHR petition drive to support mandatory nurse staffing standards in nursing homes is coming to a close. To date, 95,000 Americans from 49 states and the District of Columbia have signed the petition. NCCNHR is in need of an additional 5,000 signatures to reach its goal. An event to present the petition to Congress is currently being planned to take place in the next few weeks. NCCNHR is urging its membership and all those working with the petition drive to have their petitions in by April 1st!
19. AHCA offers pre-hire cna test
The American Health Care Association
(AHCA) and the National Center for Assisted Living have developed a CNA
Pre-Employment Test, designed to help identify the strongest applicants and
those most likely to stick around. The test, administered and scored using
PC-based software, takes less than 30 minutes to complete and examines skill
levels, knowledge, performance and potential for longevity. According to an AHCA press release, the test
“exceeds the requirements of all federal guidelines governing employee
selection,” including the Americans with Disabilities Act, the Equal Employment
Opportunity Commission and the Civil Rights Acts. To read the full press
release to: http://www.ahca.org/brief/nr020311.htm
20. Staffing
problems imperil NJ nursing home residents
Chronic understaffing and poor
pay for caregivers at area nursing homes are jeopardizing the safety and
well-being of elderly residents in three South Jersey counties, according to a
study commissioned by the Service Employees International Union. The study reported widespread violations of
state and federal rules in Camden, Gloucester and Burlington Counties. According to an analysis of inspections by
the state Department of Health and Senior Services, 75 percent of nursing homes
in the three counties were cited in 2000 for violations that harmed residents
or had the potential to cause harm. Paul Langevian, president of the Health
Care Association of New Jersey, agreed that the industry was struggling with
staffing issues, but said money to expand services did not exist. Gail MacInnes
of the National Citizens’ Coalition for Nursing Home Reform in Washington, D.C.
said having too few nurses to care for too many patients was creating a
“shameful national crisis from which New Jersey is not exempt.” The report calls for a task force to be
formed to address the funding system and raise wages, for the state to adopt a
minimum staff-to-resident ratio rule that is easier to enforce than current
standards, and for staffing levels at nursing homes to be publicly
disclosed. Source: Philadelphia Inquirer, 3/14/02
21. U.S. Senate bill provides nursing staff training
The Nurse Reinvestment Act, S.1864, passed by the U.S. Senate this year, includes scholarships and stipends for certified nursing assistants and home health aides who enroll in entry-level nursing programs, grants for training of workers who provide long-term care for the elderly, and a 90% Medicaid match for nurse aide competency and evaluation programs. The version of the act passed by the house, H.R. 3487, does not include these provisions. The bills have not yet gone to a conference committee to resolve the differences. In testimony before the Senate Special Committee on Aging on February 27, 2002, Claudia J. Beverly, Ph.D., R.N., of the Reynolds Center on Aging spoke of the link between high CNA turnover and the poor quality of nursing home care, and called for nursing home staff training in geriatrics, care assessment, and management skills to address these issues. The text of the bills can be found at http://thomas.loc.gov/ The webcast and text of the Senate Special Committee on Aging testimony can be seen at http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=478
22. Hurting at work in Buffalo, NY
The federal Occupational Safety and Health Administration recently sent letters to 13,000 companies nationwide, telling them that their rates of worker injury and illness are dramatically higher than the national average. In the Buffalo Niagara region, 32 of the 110 businesses receiving the letters were nursing homes; statewide 25 % of the companies listed were nursing homes. The second most dangerous industry - food manufacturing - accounted for 7.6% of the listings. One worker interviewed said that heavy lifting contributed to the high injury rate, while union officials and physical therapist added that understaffing and cost-cutting are also responsible. The president of the New York State Health Facilities Association had a different perspective, saying that often nurses bring the injuries on themselves by trying to do too much on their own. One Niagara Falls nursing home installed lifting equipment and reduced workdays lost to injury from 364 in 2000 to 52 last year. Source: Buffalo News, 3/12/02
Medicaid
23. AAHSA claims Medicaid is
not paying its fair share
According to a press release by the American Association of Homes
and Services for the Aging (AAHSA), “State governments are balancing their
budgets on the backs of the frail elderly.” AAHSA estimates that Medicaid
reimburses the average non-profit facility $300,000 less each year than it
takes to provide quality services. Nationally, Medicaid covers more than 68
percent of all nursing facility patients but accounts for less than 60 percent
of revenues, the association says.
AAHSA condemns state plans to deal with the economic downturn by
reducing rates to Medicaid providers, tightening Medicaid eligibility
requirements, reducing services covered, increasing cost-sharing with patients
or imposing Medicaid provider taxes.
AAHSA recommends that the Social Security Act be modified to set federal
Medicaid payment standards, enhance federal matching funds and require states
to provide a full range of home and community-based services, including
assisted living, through Medicaid with federal assistance. To read the full press release, go to: http://www.aahsa.org/public/press_release?PR219.htm
Research
24.Cholesterol-lowering drug may cut dementia risk
Women with high cholesterol levels are at increased risk of developing memory problems and other signs of dementia as they age, while those who took cholesterol-lowering drugs appeared to reduce their risk. Women whose cholesterol levels fell in the lowest 25% were more likely to be taking a statin drug, a common type of cholesterol-lowering medication. Among all women, those who reported using a statin drug scored higher on tests of mental ability regardless of their cholesterol level. The finding supports previous studies suggesting a link between elevated cholesterol and impaired mental function, including the development of Alzheimer’s disease, among older women. However, researchers noted that more studies are needed before any definitive conclusions can be drawn. Source: Health-Reuters, 3/15/02
DC Doins’
25. CMS issues sprinkler
recall
The Centers for Medicare and Medicaid Services (CMS) has issued a
recall of millions
of sprinkler heads installed in many certified health facilities. Central
Sprinkler Co. has agreed to replace 35 million of their sprinklers, while Gem
Sprinkler Co. and Star Sprinkler Inc. have agreed to replace 167,000 of their
sprinklers. There will be no replacement charge to the consumer. The sprinkler
heads in question have the words “CENTRAL” or “STAR,” the letters “SCS,” the
letter “G” in a triangle, or a star-shaped symbol stamped on either the metal
sprinkler frame or on the deflector. The Consumer Product Safety Commission
found that most of the sprinkler heads would function
during a fire, but some may require higher water pressure to activate than
available in a particular building. For more information, go to http://www.sprinklerreplacement.com
or call (800) 871-3492. Source: AHA
News, 3/14/02
26.
Nursing home spending accelerating
Health care spending will reach $2.8 trillion by 2011, more than
double the amount spent in 2000, the Office of the Actuary at the Centers for
Medicare and Medicaid Services projected in a report appearing in the current
issue of Health Affairs. The report predicts that total nursing home spending
will be $166.4 billion by the year 2011, with Medicare and Medicaid spending
about $102 billion. The explosive
growth in 2001 nursing home spending was largely due to the impact of the
Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000,
according to the report. Source: “National
Health Expenditures: 2001-2011” at
http://www.hcfa.gov/stats/NHE-Proj/proj2001/default.htm
To read the article in Health Affairs, see the March/April 2002 issue on the Health Affairs web site at http://www.healthaffairs.org
27. CMS supports “SPEAK UP” campaign
The Centers for Medicare and Medicaid Services (CMS) has announced its support for the recently launched “Speak Up” campaign aimed at promoting patient safety. The campaign, sponsored by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), encourages patients to play a more active role in preventing medical errors and to become active, involved and informed participants on the health care team. According to a 1999 Institute of Medicine report, errors in health care may be killing up to 98,000 people each year. The campaign’s initiatives are based on research showing that patients who participate in the health care delivery process are more likely to have better outcomes. To access the consumer brochure, go to: http://www.jcaho.com/speakup_bro.html Source: AHA News, 3/14/02
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