NORC Gazette
April 29, 2002
National Long Term Care
Ombudsman Resource Center
National Citizens’ Coalition
for Nursing Home Reform
Table
of Contents
Ombudsman Program Updates
1. Older Americans Report
looks at problems in ombudsman program
2. Northern California Ombudsman Program recognized for excellence
3. Article criticizes possible WI ombudsman program cuts
4. HHS news release brings
attention to ombudsmen/Center Response
Ombudsman Calendar of Events
Nursing Home News
7. New York Times series to highlight problems in adult homes
8. Beverly reveals salaries
9. Studies find
increasingly high cost of nursing home care
10. Facilities in West Virginia face
insurance problems
14. NCCNHR will utilize press
conference to present staffing petitions to Congress -
May 9, 2002
15. LTC career website launched
16. Program on stemming nursing shortage to be offered
17. Nursing ads coming soon to a
theatre near you!!
18. Medicare payments to
nursing homes will continue
Medicaid
19. Oregon Emergency Board
refuses to cut Medicaid payments
Research
20. Effective intervention can delay LTC
placement
DC Doins'
21.
CMS’ Nursing Home Quality pilot goes live
22. Nursing home complaint data to be posted on
website
23. Ergonomics bill introduced
24. Quarterly provider updates to be published
25. VA not providing required
long term care services
26. ASA to hold Summer Series on Aging
Ombudsman Program Updates
1. Older Americans Report looks at problems in ombudsman program
The April 26, 2002 edition of the Older Americans Report includes a special 4-page section on the Long Term Care Ombudsman Program. The report examines problems with the ombudsman program, especially “the rapid increase in firing and resignations in recent years.” Ombudsmen say key issues they face include a lack of independence and effectiveness, and the inability to do systems advocacy. They also face a lack of funding, low pay, heavy reliance on volunteers, difficult work and lack of training. In addition, the April 19th Older Americans Report also included a brief article on the ombudsman program. The Resource Center has permission to distribute a limited number of copies of both articles. Contact John Kafka at jkafka@nccnhr.org to obtain a copy.
2. Northern California Ombudsman Program recognized for
excellence
Ombudsman Services of Northern California (OSNC) has been named as a winner of the California Awards for performance excellence. The award promotes quality awareness and provides organization assessment and feedback by independent examiners. The Northern California program demonstrated excellent performance in the following areas: leadership, strategic planning, customer and market focus (primarily long term care residents), information and analysis, human resource focus, process management and results. OSNC is the only long term care ombudsman program to receive this award in the nation. Joan Park and Clift Wilson, Program Managers, received the award on behalf of the ombudsman program at the awards ceremony on April 19, 2002. Go to http://www.ltcombudsman.org/ombpublic/49_468_3279.CFM to read more about OSNC’s award.
3. Article criticizes
possible WI ombudsman program cuts
An editorial in The Daily Telegram states that making budget cuts to the Wisconsin long term care ombudsman program, proposed by Governor McCallum and the Republican-controlled state Assembly, would be a “big mistake.” According to the editorial, the proposal would mean cutting $78,000 from the budget of the Board on Aging and Long Term Care which houses the ombudsman program and the loss of one ombudsman. The program’s caseload jumped 13% from 2000 to 2001 and there is only one ombudsman for every 4,100 beds. The program currently has 14 ombudsmen to handle 1600 cases. The article states that “The elderly residents of nursing homes and their families deserve better than to see arbitrary cuts in the small ombudsmen program … no one should face a delayed investigation whether it concerns daily care or assistance with financial aid.” Source: The Daily Telegram, 4/23/02
4. HHS news release brings attention to ombudsmen/Center
response
A Department of Health and Human Services (HHS) press release about the availability of quality data for homes in 6 pilot states also mentions the long term care ombudsman program. The release issued April 24 states that “state and local long-term care ombudsmen will use the new data, along with other information and personal visits, to assist families in making informed decisions about placement in nursing homes. The ombudsmen are primarily volunteers who help nursing-home residents and their families on a daily basis and are trained and funded through the HHS’ Administration on Aging.” Source: HHS News, 4/24/02
In response to the CMS Quality Initiative, the Center is updating its website regularly so advocates can have "one stop shopping" to link them to the latest information available on the Quality Initiative. To access this information go to www.ltcombudsman.org and look under the section labeled "what's new." NCCNHR has also revised its consumer information guide to choosing a nursing home to include information on using QI data. To view the guide visit the NCCNHR website at http://nursinghomeaction.org and look under the "what's new" section.
Ombudsman Calendar of Events
May 9: NCCNHR press
conference to present staffing petitions. For more information contact Janet
Wells at 202-332-2275.
June 5 - 7: Mid-Atlantic Regional Ombudsman Conference, Winchester, VA. For more information contact Julie Meashey at 202-332-2275.
October 6 - 12: Residents' Rights Week 2002. Start thinking about how your program will celebrate this week.
October 26 - 30: NCCNHR Annual Meeting. Oct. 26th 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. Theme: "No More Excuses: We Demand Quality Long-Term Care"
Home and Community-Based
Care/Olmstead
5. CMS chief pushes PACE
“I love PACE,” declared Tom Scully, administrator of the Centers for
Medicare & Medicaid Services, at a forum on the program sponsored by the
National PACE Association last week. Programs
for All-Inclusive Care for the Elderly seamlessly integrate Medicare and
Medicaid funding to provide responsive care to seniors who wish to stay at
home, Scully told an audience of PACE providers and state officials at the
association’s Spring Policy Forum.
Pledging continued enthusiastic support for the program, Scully noted,
“We know when people have a choice they choose to stay at home and not move
into a nursing home.” Currently, 36
PACE programs serve about 8,500 people over age 55 who meet their state’s
criteria for needing nursing home care. Scully offered to assist in
establishing additional PACE programs and called for more such programs in
rural areas. “I am one of the PACE program’s biggest fans,” he added. Source:
SNALF.com, 4/22/02
More than 300 seniors marched at the state capitol in Arizona last week, protesting proposed budget cuts that would trim services to the state’s frail elders. The Arizona chapter of AARP organized the rally and bused in people from all over the state. Gov. Jane Hull’s proposed budget cuts would slash home and community-based adult services by $4 million and would result in about 2,300 people being dropped from services, and no new people would be added. Senator Ruth Solomon, D-Tucson, who heads the Arizona Senate appropriations committee, told the group that both she and another state representative were committed to preserving these elder services. Source: The Arizona Republic, 4/23/02
Nursing Home News
7. New York Times series to highlight problems in adult homes
From April 28-30, the New York Times is publishing a series entitled, “Broken Homes,” an investigative report into adult homes - for-profit residences that care for 15,000 mentally ill adults in New York State. These homes, overseen by the state, were envisioned as alternatives to state psychiatric institutions. However, the Times investigation reveals that these homes are often places of misery and neglect and little more than warehouses for the mentally ill.
8. Beverly reveals salaries
Beverly Enterprises Inc. chief executive William Floyd was paid $664,690 as a base salary in 2001 with an additional $600,000 bonus during his first year leading the Fort Smith-based company, according to Beverly’s proxy statement filed with the Securities and Exchange Commission. Floyd was hired in 2000 as the nursing home operator’s president, and promoted to the top position in February 2001 when chief executive David Banks stepped down. Serving as chairman of the board, David Banks received a base salary of $620,192 with no bonus. This amount is less than the $775,000 base salary with a $160,000 bonus he received in 2000. Other top executives earned salary increases between 2 and 46 percent and bonus increases between 233 and 500 percent. Source: Arkansas Democrat-Gazette, 4/16/02
9. Studies find increasingly
high cost of nursing home care
Two recent studies funded by insurance companies pointed out the
hefty price tags attached to a stay in some nursing homes, with some markets
costing more than $100,000 per year. However, the two studies report different
findings. The GE Long Term Care Insurance Nursing Home Survey, a study of 2,462
nursing homes, found that the average cost for a one-year stay in a U.S.
nursing home is $54,900. The other study, conducted by
MetLife Mature Market Institute, reported that the average cost was $168 per
day, or $61,320 per year. They also disagreed about which area of the country
is most expensive. GE found that a stay in an Alaskan nursing home is most
costly, at $163,400 per year, while MetLife gave that honor to Stamford, CT, at
$347 per day, or $126,665 per year. Both agreed that Louisiana was the cheapest
area, at between $32,120 and $36,000 per year. Go to http://www.snfinfo.com/ppsrc/#miscellaneous
and click on “Met Life Study” to read more results of the study. Source: SNFinfo connection, 4/16/02
10. Facilities in West Virginia face insurance problems
West Virginia nursing homes could face an insurance availability problem, according to Insurance Commissioner Jane Cline. Cline said that Cincinnati Insurance Co., one of the major insurers in the state, has asked for a “significant” increase in premiums. Along with rising litigation costs, insurance industry lobbyist Randy Cox cites Sept. 11, a sluggish stock market and higher health care costs as reasons for the rate increase. Currently, the West Virginia Care Home Association reports that 28 of the 66 nursing homes it represents are “going bare,” - opting not to carry liability insurance. The Association states that so far, only small facilities are not carrying insurance. A spokesperson for the West Virginia Health Care Association, which represents larger facilities, said none of its members are uninsured yet, but warned that larger facilities may be faced with that choice in the future. Source: Charleston Daily Mail, 4/17/02; SNALF.com, 4/23/02
A nursing home liability bill passed the Ohio Senate 20-11 and now goes back to the House where Senate changes will be considered. The bill prohibits residents and their relatives from using nursing home inspection reports in lawsuits unless the reports relate directly to the plaintiff. It also specifies that Ohio’s arbitration law does not apply to nursing homes and that juries must consider the nursing home’s ability to pay before deciding on a punitive award. The nursing home industry, including the Ohio Health Care Association, supported the bill. AARP Ohio opposed it. Source. Dayton Daily News, 4/26/02
Assisted Living
12. ASHA releases
coast-to-coast ALF regulatory guide
The American Seniors Housing Association (ASHA) released the 2002
Seniors Housing State Regulatory Handbook this month. The book contains a
matrix illustrating each state’s major licensure and regulatory requirements
for assisted living centers and continuing care retirement communities. ASHA
also came out with another updated edition this month - its Seniors Housing
Statistical Handbook. This book holds information on senior demographics,
housing characteristics, and the latest statistics from the 2000 Census, which
show the startling growth of the 85 and older population. Both books are
available for a fee by going to http://www.seniorshousing.org
or calling 202-237-0900. Source: BAL Weekly, 4/24/02
In response to revelations that the Iowa Department of Elder Affairs had released only sanitized versions of investigation records while keeping more detailed reports confidential, Gov. Tom Vilsack ordered the Department of Inspections and Appeals, the office that oversees nursing homes, to take over the regulation of assisted living facilities and the investigation of assisted living complaints. In a related matter, the Iowa Attorney General conducted its own investigation into record keeping by the Department of Elder Affairs and determined that the Department did indeed keep two sets of inspection records - but not to mislead the public. According to Iowa Attorney General Tom Miller, the Department was simply confused about what information it needed to keep private and what it needed to make public. Source: SNALF.com, 4/22/02, 4/26/02
Staffing
14. NCCNHR will utilize
press conference to present staffing petitions to Congress - May 9, 2002
The presentation of the NCCNHR staffing petitions is set for Thursday, May 9, from 10 - 11 a.m. at a press conference on Capitol Hill sponsored by Rep. Henry Waxman and others. The press conference will be followed at noon by a luncheon briefing for congressional staff on the Phase II staffing study. Both briefings are to provide information about and support for the research, which, as you know, was dismissed as “insufficient” by Secretary Thompson.
NCCNHR needs 5,000 more petition signatures to reach 100,000 and is asking advocates to activate their networks to make sure they reach their goal! All petitions NCCNHR receives by May 6 will be delivered to Congress on the 9th.
The press conference will be held on the House Triangle (an open space on the Capitol grounds) if the weather permits. The presentations will include remarks by members of Congress; presentation of the NCCNHR petitions; and presentations by a family member, nurse, and CNA describing the impact of understaffing.
Between 11:30 and 1:30 (approximately) there will be a luncheon briefing in room S-207 in the Capitol for House and Senate staff. It will be co-sponsored by Waxman and Senator Grassley. Presenters will be Jack Schnelle of UCLA, who did the research on nursing assistant hours; Charlene Harrington, who is a leader in nursing research; Donna Lenhoff; and a state representative who has sponsored staffing ratio legislation, Nancy Argenziano, a Republican state senator from Florida. For more information contact Janet Wells, NCCNHR Director of Public Policy at 202-332-2275.
15. LTC career website launched
U.S. Department of Labor Secretary Elaine Chao recently announced the activation of CareCareers.net, a new on-line job bank for long term care positions. The free 24-hour service is devoted exclusively to linking job seekers to long term care employers. Potential applicants can search local job listings and post their resumes for positions available anywhere in the country. Employers can post job listings and review resumes on-line. Both the American Health Care Association and the American Association of Homes and Services for the Aging worked with the Dept. of Labor to develop CareCareers.net. To access the new website, go to http://www.carecareers.net/ Source: SNALF.com, 4/24/02
16.
Program on stemming nursing shortage to be offered
PRIMEDIA Workplace Learning, in partnership with the American Nurses
Association, will deliver the program, “Nursing’s Agenda for the Future,” on
May 8th for free via satellite to any facility that has a steerable satellite
dish. The program addresses the need to find solutions to the nursing shortage,
given projections that the demand for nursing services will outstrip the supply
of registered nurses (RNs) by 2010. The target audience for this live 90-minute
program includes nurses, certified healthcare executives, nursing home
administrators and certified professionals in healthcare quality. This program
offers free continuing education to the disciplines previously mentioned. For
more information about the May 8th program, go to http://www.pwpl.com/healthcare.
To learn more about PRIMEDIA Workplace Learning, go to http://www.pwpl.com/healthcare/about.asp Source:
PRIMEDIA press release, 4/25/02
17.
Nursing ads coming soon to a theatre near you!!
“Nurses for a Healthier Tomorrow” is taking its advertising campaign to promote nursing careers to the big screen. An ad scheduled to play in movie theaters in May will showcase real-life nurses from the campaign's print ads and the campaign tagline: “Nursing. It's Real. It's Life.” The ad is set to appear throughout the month on 436 screens in 13 major markets, directing an estimated 2.5 million moviegoers to the “Nurses for a Healthier Tomorrow” website at http://www.nursesource.org. Source: AHA News, 4/26/02
Medicare
18. Medicare payments to nursing homes will continue
The Centers for Medicare and Medicaid Services (CMS) will continue making $1 billion in payments to nursing homes that were set to expire this year. Nursing homes had predicted dire consequences if they lost the payments from Medicare. CMS had planned to refine the current payment system and eliminate the $1 billion in payments. But in a recently released statement, the agency said that “the research is not sufficiently advanced at the present time to implement refinements this year.” The nursing home industry has lobbied to halt the payment cuts, which stem from legislation passed in 1999 and 2000. Two other payments totaling about $1.4 billion are still scheduled to expire Oct. 1 and require action by Congress to be changed. Source: Wall Street Journal, 4/24/02
Medicaid
19. Oregon Emergency Board refuses to cut Medicaid
payments
Oregon
lawmakers have refused to go along with cuts in Medicaid payments to nursing
homes and other long term care facilities.
Last month, Gov. John Kitzhaber vetoed parts of a budget passed at a
March special session and then made $81 million in spending cuts of his own. His cuts, to take effect in July, would
eliminate a planned 3.4% increase in payments to nursing homes and reduce
reimbursements to assisted living facilities. He made the cuts to help
rebalance the state budget, which had fallen short by $845 million. Legislators acted to restore $6.1 million in
Medicaid payments to nursing homes and assisted living facilities, with the
money to come from Oregon’s emergency fund.
At a recent meeting, the Legislative Emergency Board upheld the
legislature’s position and refused to cut Medicaid payments. However, the Emergency Board didn’t provide
any money to restore the payments.
Source: The Oregonian, 4/19/02;
The World, 4/20/02
Research
20. Effective intervention can delay LTC placement
The latest Journal of the American Medical Association features two studies that look at why people choose nursing home placement over home care. University of California at San Francisco researchers found that both caregiver and patient characteristics significantly influence the decision to place an elderly person with dementia in a nursing home. Cognitive impairment and behavior problems were two of the patient factors that made nursing home placement more likely. Older caretakers and those scoring high on the Zarit Burden Scale were more likely to opt for nursing home care. The study suggests that interventions designed to ease caregiver burden or reduce difficult patient behaviors could delay nursing home placement. In the other study, researchers at Yale University School of Medicine found that providing restorative care to elderly patients who had been ill or hospitalized resulted in a greater likelihood that the patient would remain at home. Those patients receiving restorative care also had higher scores on self-care, home management and mobility. To read the abstract on caregiver and patient characteristics, go to: http://jama.ama-assn.org/issues/current/abs/joc11467.html. To read the abstract on restorative care, go to:
http://jama.ama-assn.org/issues/current/abs/joc11694.html
Source: SNALF.com, 4/26/02
DC Doins’
21. CMS’ Nursing Home Quality pilot goes
live
On April 24 CMS released the
long awaited data on the quality of care at more than 2,500 nursing homes in
six states - Colorado, Florida, Maryland, Ohio, Rhode Island and Washington -
as part of a pilot program to allow consumers to compare the performance of the
facilities. The data rate nursing homes
in nine quality measures. Consumers can
use the information to compare facilities with each other, with state averages
and with the average for all facilities in the 6 pilot states. Consumer advocates and industry
representatives both expressed support of the initiative, although both AARP
and the National Citizens’ Coalition for Nursing Home Reform (NCCNHR) stated
that that the data should not replace government enforcement of quality
standards. In a NCCNHR press release,
Donna Lenhoff, Executive Director, stated that “The information released today
in the pilot states should help people evaluate nursing homes - both when they
are choosing a facility and when they are monitoring the care their loved ones
are getting.” However, she noted that
providing this information “must not supplant thorough annual inspections,
prompt complaint investigations, and strict enforcement of federal and state
standards.” In addition, consumer,
industry and government representatives emphasized that consumers should visit
nursing homes to determine the quality of care at the facilities and should not
select a nursing home solely on the quality measure data. To view the data
online go to: http://www.medicare.gov/NHCompare/home.asp. Information can also be obtained by calling
1-800- MEDICARE. You can access the ads
that appeared in the six pilot states at: http://www.cms.hhs.gov/providers/nursinghomes/nhi/printads/
Source: SNALF.com; 4/25/02;
NCCNHR press release, 4/24/02
22. Nursing home complaint data to be posted on website
U.S. Representative Henry Waxman and Senator Chuck Grassley congratulated the Centers for Medicare and Medicaid Services (CMS) for their decision to post nursing home complaint data on the internet. CMS Administrator Tom Scully sent a letter to Rep. Waxman and Sen. Grassley stating that the data would be posted on the CMS website in May. Rep. Waxman noted that “Families need to have access to the full compliance history of nursing homes so they can make good decisions for loved ones. The posting of this data is a significant step forward.” In February 2002, Rep. Waxman and Sen. Gralley released a report that found that the HHS website did not include information on violations found during complaint inspections of nursing homes. As a result, information on thousands of serious violations was not available to the public. Source: Press release from Rep. Waxman, Sen. Grassley, 4/22/02
23. Ergonomics bill
introduced
U.S. Senator John Breaux (D-LA) has introduced Senate bill S.2184 calling for
the Department of Labor to reissue mandatory regulations to address
work-related musculoskeletal disorders and workplace ergonomics hazards within
two years. Co-sponsored by Arlen Specter (R-PA) and 22 other senators, the bill
differs only in a few technical details from one Breaux introduced last year.
The proposed legislation would require that the new rule clearly define the
application of the standards, prohibit expanding state workers’ compensation
laws and provide for training assistance to help achieve compliance. Source:
SNALF.com, 4/24/02
24. Quarterly provider updates to be published
The Centers for Medicare & Medicaid Services (CMS) has launched a quarterly publication for providers entitled “CMS Quarterly Provider Update.” In addition to listing the latest changes in Medicare and Medicaid regulations occurring in the previous three months, the publication will list some that are scheduled for the coming quarter. The agency organizes the changes by provider type, including a section devoted to skilled nursing facility policies. In the future, CMS will publish the update on the first business day of every quarter. The update also will include all non-regulatory changes to Medicare or Medicaid that could affect providers. Changes generally go into effect 90 days after publication in the update. Whenever possible, CMS says it will publish regulations in the Federal Register on the fourth Friday of every month. To access the first quarterly update, go to: http://cms.hhs.gov/providerupdate/main.asp
25. VA not providing required long term care services
General Accounting Office (GAO) officials told members of the Senate Veterans Affairs Committee on April 25 that the Department of Veterans Affairs has violated provisions in the 1999 Veterans Millennium Health Care and Benefits Act requiring the department to provide long term care services for veterans. Under the law, the VA is required to offer several services in addition to nursing homes, including adult day care, geriatric health care and home respite care. However, the department has not met those requirements. The GAO found that the Department of Veterans Affairs has failed to publish a final rule to address this issue. The GAO also determined that not all VA hospitals are complying with a policy directive requiring them to provide a range of long term care services. An official in the VA has said that the department plans to publish a final regulation regarding this matter and has drafted a proposal to move the department into compliance with the law by 2004. Source: Kaiser Daily Health Report, 4/26/02
Other News
26. ASA to hold Summer Series on Aging
Once again, the American Society on Aging (ASA) will present
its annual Summer Series on Aging - a regional continuing education program for
professionals who work with older adults, their caregivers and their families. The sessions will be held on the West Coast
in San Franciso on June 17-20, and on the East Coast in Philadelphia from July
22-25. You can preview the intensive
offerings for the West Coast series by going to www.asaging.org/summer-series. Check the Summer Series website after May 6
for information on the East Coast intensives.
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