NORC Gazette
June 3, 2002
National Long Term Care Ombudsman Resource Center
National Citizens’ Coalition
for Nursing Home Reform
Table
of Contents
Ombudsman Program Updates
1. KY regional ombudsman
develops residents’ rights presentation
Ombudsman Calendar of Events
Home and Community-Based Care/Olmstead
2. NY home care workers push for
better wages, threaten strike
3. Virginia home care program
impacted by shortage of aides
Nursing Home News
4. NCCNHR and other advocates oppose proposed feeding assistant rules
5. OH Senate agrees to compromise on nursing home malpractice bill
6. Aides on West Virginia abuse registry continue to work
7. PA background check loophole raises concern
8. Wall Street Journal examines IHS
collapse
Nursing Home Quality Initiative
9. National conference on QI initiative to be
held
Assisted Living
10.
Assisted living costs average nearly $26,000 per year
11. JCAHO changing emergency standards for
assisted living facilities
12. Man convicted of manslaughter to serve
sentence in FL facility
Staffing
13. Study finds link between RNs and quality of hospital care
14. FL governor
signs legislation to address nurse shortage
Medicare
15. Use of Medicare preventive
services varies widely
Medicaid
16. Recent court rulings on
Medicaid uphold beneficiaries’ right to sue
Research
17.
AARP report finds seniors healthier, but many at risk
18. MRI may help
detect Alzheimer’s Disease
DC Doins'
19. Medicare paperwork to be
“streamlined”
20. CMS seeks stronger federal survey team
Ombudsman Program Updates
1. KY regional ombudsman develops residents’ rights presentation
Kentucky regional ombudsman, Ruth Morgan, has prepared a power point training on residents’ rights that includes a summary of both federal and Kentucky state rights and review questions. According to Morgan, the presentation - which will have a voice over capacity - can be loaded on a PC and utilized for self-directed training of nursing facility staff and ombudsmen or used in a large group setting. Morgan anticipates that the presentation will be available for purchase in July and will cost $50. The presentation can be modified by Morgan’s ombudsman program to accommodate differences in state laws. For more information, contact Ruth Morgan at: 800-355-7580.
Ombudsman Calendar of Events
June 5 - 7: Mid-Atlantic
Regional Ombudsman Conference, Winchester, VA. For more information contact
Julie Meashey at 202-332-2275.
July 24 – 24: American Health Quality Association national meeting: “Partnerships for Success: The Federal Initiative on Quality Improvement & Public Reporting in Nursing Facilities.” Wyndham Baltimore Inner Harbor, Baltimore, MD. Contact Virginia Paganelli at Vpaganelli@AHQA.org for more information.
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
2. NY home care workers push for better wages, threaten strike
The 120,000 home care workers in the state of New York may go on
strike if the state’s political leaders do not meet their demands for better
wages, according to the New York Times.
In January, Governor George Pataki and the state legislature approved $900
million in raises over four years for the state’s home care workers. Last
month, Pataki approved another $50 million to further boost their pay. The
state would use the money to boost the state’s minimum wage to $6.75 an hour, a
$1.60 increase over the current state and federal minimum wage. However, the New York Times reports that the money would go to personal care
workers and not to home health aides, despite the fact that personal care
workers in New York often earn more than home health aides. If wages do not improve, the state’s health
care union of 215,000 members is threatening to begin a strike against Premier
Home Health Care, which employs 3,500 home health aides. Source:
Home Care Connection, 5/29/02
3. Virginia home care program impacted
by shortage of aides
A recent article in the Richmond Times-Dispatch profiled how a shortage of aides in rural Virginia is impacting home care services under the state’s Medicaid program. Although Medicaid beneficiaries who qualify for nursing home care are eligible for personal home care, rural areas are faced with a declining number of aides. The problem, the Times-Dispatch reports, is related to low reimbursements that the private agencies that manage the home care workers receive from Medicaid. The state Department of Medical Assistance Services, which administers Virginia’s Medicaid program, pays agencies in rural Virginia $11.25 per hour for home care. Because many home health workers are seeking higher paying jobs elsewhere, some providers have turned to retired nurses to cover the shortage. A registered nurse supervisor in one of the state’s area agencies on aging said, “If the state doesn’t do something to increase the amount aides can earn, I don’t know how the personal care program is going to go on.” Source: Kaiser Daily Health Report, 5/20/02
Nursing Home News
4. NCCNHR and other advocates oppose proposed feeding assistant rules
The National Citizens’ Coalition for Nursing Home Reform (NCCNHR) and almost 30 organizations and individuals, including many state and local ombudsman programs, submitted a joint letter to the Centers for Medicare & Medicaid Services (CMS) commenting on proposed rules that would establish feeding assistants in nursing facilities. The letter urged CMS to withdraw the regulations and voiced objections to authorizing workers who do not meet the minimum professional licensing or nurse training, competency evaluation and registry requirements to provide care to individuals so frail that they cannot eat without assistance. NCCNHR and the organizations and individuals who signed onto the letter stated that CMS could better address understaffing in nursing homes by using its rulemaking authority to implement findings of the recently released staffing report and to institute the minimum nurse staffing hours identified as the threshold for quality care. For a copy of the letter, contact Janet Wells, Director of Public Policy, NCCNHR, 202-332-2275.. Source: Letter to Tom Scully, 5/28/02
5. OH Senate agrees to compromise on nursing home
malpractice bill
The Ohio Senate has agreed to a compromise on the statute of limitations for malpractice suits against nursing homes, leaving the House to approve the provisions in a bill that limits the evidence that could be used in lawsuits related to patient neglect. The bill, which was supported by the nursing home industry, says the only people who can sue a nursing home or an assisted living center on behalf of a resident are the resident, a legal representative or the resident’s spouse, parent or other relative. It also blocks people who file such suits from using inspection reports by the Ohio Department of Health or other agencies as evidence in a civil case. Opponents of the bill say it limits the options for nursing home residents who want to pursue abuse or neglect accusations. The bill had placed a two-year statute of limitations on lawsuits that accuse nursing homes of medical malpractice. The conference committee recommended a change to a one-year limit, which is how long patients have to sue hospitals for malpractice. Source: Associated Press, 5/29/02
6. Aides on West
Virginia abuse registry continue to work
Legislative auditors found that
five nursing aides whose names appear in the West Virginia Nurse Aide Abuse
Registry continued to work in nursing homes months, and even years, after their
names were placed in the registry, according to a report in the Charleston Daily Mail. The auditors noted that 52 additional aides
listed in the registry continued to work in other health care sectors,
including assisted living facilities. Source:
SNALF.com, 5/24/02
7. PA background check loophole raises concern
Elder advocates are questioning the effectiveness of Pennsylvania’s
background check laws. The state law requiring that all those applying for work
in nursing homes submit to criminal background checks only calls for a search
of in-state records. As a result, someone convicted of a violent crime in another
state could move to Pennsylvania and produce a clean background check. Janet Wells, Public Policy Director of the
National Citizens’ Coalition for Nursing Home Reform (NCCNHR) told the Philadelphia Inquirer that, “We’ve seen
what the problems are in nursing homes when you have incomplete criminal
background checks – assaults, abuse – these are things we want to avoid.” Elder advocates and some lawmakers are
calling for national as well as local checks. University of Maryland
criminology professor Charles Wellford notes that national background checks
are particularly important in metropolitan areas that span several states, such
as the Philadelphia-Camden area, where it’s easy to move from one state to
another. According to a spokesperson for Search, a criminal information group
run by a consortium of the 50 states, about 75 percent of the states have some
type of “double-checking mechanism” whereby they run a national criminal
background check if a statewide check turns up a clean record. Source:
SNALF.com, 5/28/02; The Philadelphia Inquirer, 5/24/02
8. Wall Street Journal examines IHS collapse
In a front page article, the Wall Street Journal has chronicled the “collapse” of the Integrated Health Services (IHS) “empire.” The article recounts how the “empire” was built almost solely on subacute care Medicare reimbursements after its founding in the late 1980s, only to face collapse when the federal government changed reimbursement methods in 1998. By using the “reasonable cost” reimbursement system much like hospitals did, IHS nearly doubled its normal average Medicare reimbursement rate. Former Centers for Medicare & Medicaid Services Administrator Bruce Vladeck stated that IHS had “found a hole in Medicare policy through which one could drive a truck.” After the “reasonable cost” method of reimbursement was jettisoned, the average payout to nursing homes fell 25%. Consequently, IHS suffered great financial losses and filed for bankruptcy in 2000. Many experts believe that IHS will not survive its bankruptcy reorganization proceedings and will eventually be dismantled.
Source: www.mcknightsonline.com, 5/29/02
9.
National conference on QI initiative to be held
The American Health Quality
Association (AHQA) will hold a national long term care conference,
“Partnerships for Success: The Federal Initiative on Quality Improvement &
Public Reporting in Nursing Facilities” in Maryland July 24-25, 2002. The target audience includes Quality
Improvement Organizations (QIOs), state and national association staff
representing medical directors, nursing directors, administrators, surveyors,
consumers and consultant pharmacists.
The meeting will include presentations on the development and selection
of the nursing facility quality measures and the relationship of the initiative
to the survey and certification system, as well as facilitated state-based
group discussion designed to elicit lessons learned and recommendations for CMS
and QIOs derived from the pilot state
experience. For more information,
contact Virginia Paganelli at Vpaganelli@AHQA.org.
Assisted Living
10. Assisted living costs average nearly $26,000 per year
The average cost of an assisted living facility in the U.S. is
$2,159 per month, or $25,908 per year, according to the Metlife Assisted Living
Market Survey 2002. The study, the
first of its kind, found that the highest monthly average was New York City at $3,696,
while the lowest was Jackson, Mississippi at $592. For a breakdown of costs for the various regions in the 50
states and the District of Columbia, contact Christina Tso of MetLife at
212-578-4946. Source: Press release from Metlife, and Matz, Blancato
& Associates, 5/29/02
11. JCAHO
changing emergency standards for assisted living facilities
Proposed revisions to Joint Commission on Accreditation for Healthcare Organizations (JCAHO) standards for assisted living facilities would more clearly define what is expected of assisted living communities in medical emergencies. The revisions would require facilities to: 1) define the number of staff who will be certified based on the needs of the facility’s population and availability of back-up personnel; 2) provide for the management of medical emergencies; and 3) notify residents and families of medical emergency management policies. The modified standards are expected to be included in the 2003 Accreditation Manual for Assisted Living (AMAL). Source: BAL Weekly, 5/29/02
12. Man convicted of
manslaughter to serve sentence in FL facility
Seventy-four-year-old Edward Kula, accused of stabbing a woman to
death in his kitchen with a butcher knife, will serve his sentence at The
Courtyards of Vero Beach, a Florida assisted living facility, according to the
[Vero Beach, FL] Press Journal.
Though a grand jury charged him with first-degree murder, the State Attorney’s
Office reduced the charge to manslaughter as part of a plea agreement accepted
last week by the circuit court judge. Kula continues to deny that he killed the
woman. His sentence includes two years of community control and 13 years of
probation. He and his family will have
to pay for his care. Kula has had a stroke and two heart attacks, and would
have been placed in a
medical facility even if he were convicted of murder, prosecutors told the
paper. He will also wear an electronic ankle bracelet so that police can track
him, and he will only be able to leave the facility for doctor appointments. Source:
BAL Weekly, 5/29/02
Staffing
13. Study finds link between RNs and quality of hospital
care
Patients in hospitals with low
numbers of registered nurses are more likely to have complications, stay in the
hospital longer and die from treatable conditions than patients in hospitals
with more registered nurses, according to a study released May 30, the
New York Times reports. Researchers
from the Harvard School of Public Health and the Vanderbilt School of Nursing
analyzed the discharge records of more than six million patients at 799
hospitals in 11 states during 1997.
Peter Buerhaus, one of the study’s lead researchers, said, “This
research clearly shows that we need more and better-educated nurses to ensure
that hospital patients don’t suffer needlessly from complications.” American Hospital Association Senior Vice
President for Policy Carmela Coyle agreed that the study suggested that
registered nurses are critical to good patient care, but expressed concern that
the study could lead some people to conclude that mandated nurse-staffing
ratios - which are opposed by hospitals - would solve the problem. Buerhaus
called for more research to “understand the factors influencing nurse staffing
levels and the mix of different types of nurses” in hospitals. Source: Kaiser Daily Health Report, 5/30/02
14.
FL Governor signs legislation to address nurse shortage
Florida Governor Jeb
Bush has signed legislation (HB 519) aimed at recruiting nurses to fill the
state’s 9,000 nursing vacancies. Under
the legislation, nurses relocating to Florida from other states and
territories, including Puerto Rico, that have comparable training standards
will be permitted to obtain a Florida nursing license after completing a
background check. The legislation also allows the Florida Department of Health
to repay nursing students’ loans - up to $4,000 per year for up to four years -
for those who did not receive other financial aid and work in Florida health
care facilities. Bush also signed a bill (SB 1808) that provides funding for
the Florida Center for Nursing to establish a “state strategy to deal with the
nursing shortage.” Source: Kaiser Daily
Health Report; 5/29/02
15. Use of Medicare preventive services varies widely
Use of Medicare preventive services has increased over time, but
varies widely by service and state, according to a report by the General
Accounting Office (GAO). It also varies
by ethnic group, income and education.
From 1995 through 1999, the proportion of Medicare beneficiaries
immunized against flu and pneumonia and the proportion of women screened for
cervical and breast cancer increased steadily, the GAO says. However, usage
rates for the various Medicare preventive services vary markedly. For example,
the 75% usage rate for breast cancer screening in 1999 was considerably higher
than the 55% rate for pneumonia immunizations. Among ethnic groups, differences
were greatest for immunizations, with about 70% of whites receiving flu shots
within the past year compared with 49% of African Americans. Disparities
between income and educational groups were greatest for cancer screening. You
can access the report at http://www.gao.gov/cgi-bin/getrpt?GAO-02-422. Source:
AHA News, 5/24/02
16. Recent court rulings on Medicaid uphold
beneficiaries’ right to sue
Two federal appeals court rulings issued in May found that low-income individuals may sue state officials to force them to provide federally mandated Medicaid benefits. According to the New York Times, these rulings could have a “significant” effect on the Medicaid program. In one case, the 6th U.S. Circuit Court of Appeals ruled in favor of parents who sued Michigan to provide early and periodic screening, diagnostic and treatment services for their seven-year old child. Federal Medicaid law requires states to provide this service to children younger than age 21. The appeals court rejected Michigan officials’ claim that federal Medicaid law “is not enforceable” by individual Medicaid beneficiaries. Judge Gilbert Merritt said that “doctrines of sovereign immunity” provide “no shield” for state officials accused of “depriving citizens of a federal right.” In the second case, attorneys filed suit against the state of North Carolina on behalf of children who did not receive dental care and other services that states must provide under federal Medicaid law. Judge Paul Niemeyer of the 4th U.S. Circuit Court of Appeals, in a ruling similar to that of Judge Merritt, also found that state officials could not use the “sovereign immunity shield” to avoid the lawsuit. Source: Kaiser Daily Health Report, 5/28/02
Research
17. AARP report finds seniors
healthier, but many at risk
Research conducted by AARP and presented in its report, “Beyond 50: A
Report to the Nation on Trends in Health
Security,” sheds light on the health and health care of America’s midlife and
older populations. The report indicates
that while Americans are living an average of almost nine years longer than
they did in 1900, obesity threatens to cancel out gains made from decreased
smoking and increased exercise. Health care is more expensive and harder to
get, the report says, and more people are relying on expensive prescription
drugs and other innovative technologies. The AARP report calls for solutions to
health security risks that address racial and ethnic minorities; long term care
systems designed to enhance the quality of life rather than merely to prolong
it; a stronger public health system; and improvements in health care,
prescription drug and long term care coverage. To read the full report, go to: http://www.aarp.org/beyond50
Source: SNALF.com, 5/31/02; Elder Law
eBulletin, 5/28/02
18. MRI may help detect
Alzheimer’s Disease
Researchers found that volumetric measurements of the hippocampal
area of the brain, obtained using magnetic resonance imaging, may help to
identify victims of Alzheimer’s Disease many years, even decades, before
initial clinical expression, according to a study published in the current
issue of Neurology. The study of
post-mortem MRI scans from 56 Catholic nuns revealed that shrinkage of the
hippocampus was an accurate predictor for eventual development of the
neuropathological criteria for diagnosis of Alzheimer’s. To read the abstract,
go to http://www.neurology.org/cgi/content/abstract/58/10/1476 Source:
SNALF.com 5/30/02
DC Doins’
19. Medicare
paperwork to be “streamlined”
Starting July 1, 2002, skilled nursing facilities will be allowed, in most cases, to use a shorter form instead of the Minimum Data Set required for Medicare reimbursement, according to a Centers for Medicare & Medicaid Services (CMS) press release. Used in place of the eight-page MDS, the three and a half page Medicare Payment Assessment Form is expected to take 45 minutes to complete, instead of the estimated 90 minutes to fill out the MDS. The new shorter form can be used to update a resident’s condition on days 5, 14, 30, 60 and 90 of their stay in the nursing home. CMS states that the purpose of the change is to allow nurses and other caregivers to spend more time with residents. CMS will still require a full MDS for a nursing home resident within 14 days of admission, annually, and whenever there is a significant change in condition. A notice of the changes can be found in the May 31 Federal Register. To read the full CMS press release, go to http://www.cms.gov/media/press/release.asp?Counter=462
Source: SNALF.com, 5/29/02
20. CMS seeks stronger federal survey team
The Centers for Medicare & Medicaid Services (CMS) has put out a call for contractors to provide a solid team of surveyors to conduct more comparative surveys of nursing homes and to go into facilities immediately if CMS determines there is a problem with the state survey agency. Currently, CMS is required to perform federal oversight surveys in 5% of all nursing homes. CMS’ Director of the Survey and Certification Group, Steven Pelovitz, stated that the move came about because the General Accounting Office recommended that CMS conduct more comparative surveys of nursing homes. Source: SNFinfo Connection, 5/28/02
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