This newsletter is being sent directly to local ombudsmen as well as state ombudsmen who are in our Ombudsman Center database.  Contact John Kafka at jkafka@nccnhr.org to have your name added.

 

NORC Gazette

August 15, 2003

National Long Term Care Ombudsman Resource Center

National Citizens’ Coalition for Nursing Home Reform

 


Table of Contents

    Ombudsman Program Updates
1.    Important legislation affecting the ombudsman program passes in IL!

2.    Colorado ombudsmen honor nursing assistants and aides

3.    East TN District Ombudsman Program celebrates 25 years

  Ombudsman Calendar of Events

    Home and Community-Based Care/Olmstead    
4.    Report says greater coordination needed for long-term care changes 

5.    Training about home modification, assistive devices available online

    Nursing Home News

6.    Cost of nursing home care continues to rise

7.    Paramedics, nursing home team up to improve emergency care in MD

8.    AARP wants convicts out of IL nursing homes

9.    AHCA offers tips for nursing home visitors

10.  Business Week Online features story on Choosing a Nursing Home
     Assisted Living
11.  Assisted living facility occupancy down

12.  NY ALF fined $75K for sexual abuse cover-up

13.  Aide from Breaux’s office joins ALFA 
     Staffing

14.  VT report calls for better wages and benefits

   Medicare

15.  Governors want Medicare to cover Medicaid prescription drug costs

    Medicaid

16.  GAO finds flaws in Medicaid funding formula

    DC Doins'
17.  Federal policy requiring segregated Medicaid areas becomes rule

18.  Upcoming Town Hall Listening Session in North Carolina

19.  CMS to issue new guidance for citing scope/severity

20.  GAO says Scully retaliated against contractor

    Other News

21.  NCSL issues report on long-term care

 

Ombudsman Program Updates
1. Important legislation affecting the ombudsman program passes in IL!

After much hard work in Illinois, two important bills have been signed into law by the governor.  The first piece of legislation amends the Illinois Act on Aging so that the ombudsman program provisions more closely conform with the Older Americans Act. The Illinois Act now authorizes the State Ombudsman, instead of the Department on Aging, to designate all ombudsmen, including the regional ombudsmen.  It also inserts the federal language of the Older Americans Act regarding the confidentiality of records into Illinois law and mandates that the Director of Aging consult with the State Ombudsman when reporting violations of law to a State’s Attorney or the Attorney General regarding interference with an ombudsman or retaliation against any resident or employee of a facility for contacting or providing information to an ombudsman.  The second bill signed into law creates the Illinois Long Term Care Council.  This law gives the state a public oversight body to ensure that the Illinois Long Term Care Ombudsman Program has the independence to truly represent residents in long-term care facilities.  In addition, the new law requires that the Council provide an opportunity for public testimony at each meeting and gives the Council the responsibility to comment on issues pertaining to the continuum of long-term care and residents’ rights.  Source: Email from Margaret Niederer, 7/25/03, 8/13/03          

2. Colorado ombudsmen honor nursing assistants and aides

On May 5, 2003 Dene Carter, Marlene Miller and Bonnie Smith-Moore presented a program to over 60 ombudsmen from the state of Colorado at the program’s annual conference.  The topic was “The Kindness of the Hands that Touch Us!”  The topic came from the National Citizens’ Coalition for Nursing Home Reform 2002 Annual Meeting that the 3 attended in Washington, D.C.  The speaker who presented the program that inspired this session was Wendy Lustbader.  The hands that touch the residents in long-term care facilities most often are those of the certified nursing aides and nursing assistants.  The ones who perform this work from Northeast Colorado were honored during the presentation.  Each nursing assistant and aide was asked to trace their right hand, put their first name on it, and indicate how long they had been caring for residents.  Some added comments about how much the residents meant to them and how working with residents enriched their lives.  These hands were then displayed during the presentation and throughout the conference.  Many positive comments were made regarding the dedication and hard work of these staff members.  Source: Email from Pat Tunnel, 6/13/03           

3. East TN District Ombudsman Program celebrates 25 years

The East Tennessee Ombudsman Program was developed in 1978 in response to the Older Americans Act mandate requiring the establishment of ombudsman services.  From its inception, the program recognized that the utilization of lay volunteer ombudsmen provided a method for better serving residents of long-term care facilities.  The East Tennessee program pioneered the use of volunteers in the state and was the first district program to train and utilize volunteer ombudsmen.  The first class of volunteers “graduated” in 1983 and 3 of those volunteers - Imogene Newton, Rachel Carson and Frances Maxwell - are still active today!  (Imogene is also a board member of the National Citizens’ Coalition for Nursing Home Reform.)  East Tennessee’s Ombudsman Program staff note that, “Over the years, the creativity and enthusiasm of the volunteer ombudsmen has caused staff to view this mandate as an opportunity rather than an obligation.”  Source: Dispatches from the Front, July 2003

 

 

Ombudsman Calendar of Events     
September 21-23, 2003: AoA National Summit on “Creating Caring Communities” in Orlando, Florida.  For registration and other information, go to: http://www.hsrnet.net/AoASummit/.

October 5 - 11, 2003: Residents' Rights Week - Start planning now.  Residents’ Rights Tool Kits are available for purchase through the NCCNHR Clearinghouse.  The Tool Kit is actually a ready to carry Kit containing many items to take with you to presentations including sample agendas, training strategies, activities, posters and power point presentations.  Includes a 31/2” disk.  Contact the NCCNHR Clearing house for further details or place your order by calling 202-332-2275.

October 15-18, 2003: NALC Conference, Arlington, VA; details forthcoming.

October 17, 2003: New State Ombudsman Orientation, 10:00 - 5:00, Arlington, VA

October 18, 2003: NCCNHR/NALC Bridge Day

October 18 - 21, 2003: Elder Justice: Shaping Policy, Saving Lives. NCCNHR Annual Meeting, Arlington, VA.  Register now.  Plenary speakers include Bill Thomas from the Eden Alternative; Dr. Susan Wehry - expert on residents with mental illness; Dr. Charlene Harrington - nursing home statistics and staffing expert.  Breakout session topics include: HIPAA, End of Life, Pain Management, Community Involvement to address Neglect and Abuse, MDS Changes, Arbitration Clauses in Nursing Homes, Medicaid Reform, Criminal Prosecution, Enforcing OBRA, etc.  There will be a special two part session to explore Citizen Advocacy Group and Ombudsman relationships, barriers and advocacy successes that will be facilitated by Karen Gravenstine from the AARP.  Like last year, there will be a luncheon sponsored by the NORC for ombudsman volunteer coordinators.  Pre-registration is required for both the CAG/Ombudsman Session and the Coordinators luncheon.  The NCCNHR conference begins at 1:30 on Saturday and ends at 5:15 on Tuesday.  For an additional $50, you can attend Saturday morning Bridge Day sessions with the NALC Conference and the Bridge Day Luncheon.  The final NCCNHR flyer will be mailed next week.

 

 

Home and Community-Based Care/Olmstead      
4. Report says greater coordination needed for long-term care changes 

In its newly released annual report, the National Council on Disability (NCD), an independent federal advisory group on disability issues, describes the “unprecedented and sometimes baffling complexity” of changes necessary to reorient the nation’s long-term care system from an institutional to community-based model.  The report describes a variety of cross-programmatic, multi-agency and intergovernmental coordination issues that must be confronted if the goal of minimizing unnecessary and costly institutionalization is to be achieved.  These issues include funding for personal assistance services in the home, as well as transportation, housing, assistive technology and others. NCD found that mechanisms for achieving the requisite coordination do not now exist, or if they exist are not widely in use.  It stated that a high-level planning mechanism is needed for coordinating and for ensuring accountability in the Olmstead-related activities of a number of federal agencies and programs.  To read the report go to: http://www.ncd.gov/newsroom/publications/progressreport_final.html.  Source: National Disability Policy: A Progress Report, December 2001 – December 2002; SNALF.com, 7/29/03

 

5. Training about home modification, assistive devices available online

Caring for an older person often includes tasks that add physical strain and compound existing health problems.  The National Resource Center on Supportive Housing and Home Modification will be offering online training and technical assistance for the aging network to address this need.  Courses will be available October 14 - December 23.  Through a grant from the Administration on Aging, training is free to Area Agency on Aging staff members and their National Family Caregiver Support Program affiliates.  The National Resource Center on Supportive Housing and Home Modification at the University of Southern California is a non-profit organization dedicated to promoting aging in place and independent living for persons of all ages and abilities.  To register, go to www.homemods.org, and then click on the link for “Online Courses,” followed by “Promoting C.A.R.E.S.”  Source: AoA eNewsletter, August 2003

 

 

Nursing Home News    
6. Cost of nursing home care continues to rise

A survey conducted by the MetLife Mature Market Institute found that the average cost of a private room in a nursing home increased by 8% to $181.24 per day since MetLife’s last survey in 2002.  This increase is nearly four times the rate of inflation over a 15-month period.  The survey, which was conducted in June, includes prices from 476 nursing homes in all 50 states and the District of Columbia.  According to the Bureau of Labor Statistics, the Consumer Price Index increased by 2.1% during the 12 months that ended in June.  Nursing home care costs were the highest in Alaska, at $420 per day, and the lowest in Shreveport, Louisiana, at $96 per day.  Source: Kaiser Daily Health Report, 8/5/03

 

7. Paramedics, nursing home team up to improve emergency care in MD

In response to the frustration felt by paramedics of the Baltimore County, Maryland Fire Department when they respond to emergency calls at nursing homes in the county, the fire department has entered into a partnership with Blakehurst retirement community and nursing home in Towson, Maryland.  Paramedics at the fire department report experiencing stress upon arriving at a long-term care facility only to encounter problems finding the patients they are there to help and accessing vital medical information which is buried in filing cabinets or “six inch folders.”  As part of the agreement, nursing staff at the facility will keep one sheet of medical information for each resident ready to give to paramedics.  The one page medical form will give paramedics the information they need right away.  In turn, paramedics will participate in regular training at the facility. Blakehurst was chosen because it has one of the best working relationships with county emergency staff.  Organizers hope that the model can be duplicated in the other 69 facilities in the county.  Source: www.sunspot.news, 8/8/03

 

8. AARP wants convicts out of IL nursing homes

AARP-Illinois wants the state to halt the practice of placing parolees in nursing homes.  For many years, the state Department of Corrections has located convicts recently released from prison who are ill and unable to care for themselves into ordinary long-term care facilities.  According to corrections officials, there are 33 parolees currently living in Illinois nursing homes.  AARP officials say they will work to put an end to the practice during the next legislative session.  Source: SNALF.com, 8/7/03

 

9. AHCA offers tips for nursing home visitors  
The American Health Care Association (AHCA) is offering a free booklet called “Tips on Visiting Friends and Relatives.”  It addresses who should visit, planning for visits, ways to make visits more interesting, the proper way to conduct visits and how to hold visits outside of the facility.  The guide is available free of charge (one per customer) by calling AHCA’s toll-free consumer line at 1-800-628-8140 or by going to: http://www.longtermcareliving.com/family_guide/visit/visit1.htm.  Source: SNALF.com, 8/7/03

 

10. Business Week Online features story on Choosing a Nursing Home
A story featured in the August 14th edition of Business Week Online focuses on choosing a nursing home.  The article encourages readers to make sure to do an on-site visit.  NCCNHR Public Policy Director, Janet Well's gives several tips regarding what to look for and the ombudsman is listed as a key resource person.  To read the full article go to:

http://www.businessweek.com/bwdaily/dnflash/aug2003/nf20030814_2024_db026.htm

 

 

Assisted Living

11. Assisted living facility occupancy down

According to the National Investment Center for the Seniors Housing & Care Industries (NIC), the assisted living sector saw a sizeable drop in occupancy rates during the first quarter of 2003, with the median declining three percentage points from 86 to 83% and the mean dropping from 85 to 83.5%.  NIC analysts suggest the drop might be seasonal, as there have been first-quarter declines in the past.  They also speculate that the poor economy and war could be causing people to delay moving into assisted living facilities (ALFs) or even causing them to move out.  Source: SNALF.com, 7/23/03

 

12. NY ALF fined $75K for sexual abuse cover-up

An assisted living facility (ALF) in New York State has agreed to pay a $75,000 fine for covering up possible sexual abuse by one of its workers.  Alterra Health Care Corp. admitted that it failed to notify the state that nursing assistant Jesus Gonzalez attempted to sexually abuse a resident at Alterra Clare Bridge last year.  The company settled the charges before a hearing that was scheduled to begin this week.  The allegations against Gonzalez surfaced when officers arrested him last April for a different incident in which he attempted to sexually abuse an Alzheimer’s patient.  He was then fired, and administrator Charlene Englerth and case manager Geri Thurston lost their state licenses.  Gonzalez faces felony charges of sex abuse.  Source: SNAFL.com, 8/8/03

 

13. Aide from Breaux’s office joins ALFA       
Janet Heald Forlini, an aide to U.S. Senator John Breaux (D-LA), has been hired by the Assisted Living Federation of America (ALFA) to serve as its senior vice president and director of public policy.  In her work with Senator Breaux, Forlini put together Committee hearings and advised him on legislation and policy directives encompassing issues such as Medicaid, long-term care, and end-of-life care.  Recently Forlini helped convene, spearhead, and direct the activities of the Assisted Living Workgroup, a collection of nearly 50 organizations established by the Committee to recommend improvements in the industry.  ALFA has stated that government relations are a top priority for the organization.  Forlini will start her new position sometime in mid-August.  ALFA press release, 7/15/03

 

 

Staffing

14. VT report calls for better wages and benefits

Improving wages and benefits for direct-care workers is one of ten recommendations in a recent report on how to lay the groundwork for a successful long-term care system in Vermont.  The report, “Shaping the Future of Long Term Care, 2000-2010,” notes that the state faces a growing shortage of direct-care workers, whom the report calls personal caregivers.  To counter that problem, the report recommends that the state “continue to increase the wages and benefits for personal caregivers in all settings until caregivers receive a starting wage of at least $10/hour, along with basic benefits such as health insurance, sick time and vacation leave.”  It also recommends that wages in all settings be adjusted annually to keep up with inflation.  The report provides detailed projections of the state’s needs for long-term care services in the near future and advocates the development of more home- and community-based services to take the place of nursing home care.  To download the report, go to:

http://directcare.c.tclk.net/maabhwUaaZmC1bbWbsCb/

Source: National Clearinghouse on the Direct Care Workforce newsletter, 7/22/03

 

 

Medicare

15. Governors want Medicare to cover Medicaid prescription drug costs

In a letter signed by 51 governors and sent to U.S. House and Senate conferees last week, the governors called on Congress to ensure that the final version of Medicare reform legislation provides prescription drug coverage to elderly and disabled Medicaid beneficiaries.  The governors said that including the provision is their highest priority for the legislation.  While the House-passed bill includes a provision for Medicare to be the primary payor and to gradually assume a significant share of prescription drug costs for those individuals dually eligible for Medicare and Medicaid, the Senate version does not.  Source: SNAFL.com, 8/5/03

 

Medicaid
16. GAO finds flaws in Medicaid funding formula

A new report from the General Accounting Office (GAO) concludes that the formula used to determine how much states receive in federal Medicaid matching funds is based on an “incomplete measurement” of states’ resources and low-income populations.  The report examines the formula, which compares states’ per capita income to the national average, giving states with a lower per capita income more matching funds and states with a higher per capita income less funds.  The receipt of federal funds under the current formula enabled 30 states’ Medicaid per beneficiary spending to be closer to the national average, but moves 21 states farther away from the average.  Three of the 21 states - California, Florida and New York - are among those with the largest numbers of people living in poverty.  “Because of the formula’s structure, in many instances, two states devoting similar proportions of their own resources to Medicaid can spend very different amounts per person in poverty,” the GAO says.  For a copy of the report, entitled “Medicaid Formula: Differences in Funding Ability Among States Often Are Widened,” (GAO-03-620), go to http://www.gao.gov/.  Source: SNALF.com 8/13/03

 

 

DC Doins’

17. Federal policy requiring segregated Medicaid areas becomes rule

CMS has issued final regulations mandating “distinct parts” for residents on Medicaid and Medicare.  The regulations apply only in facilities that are partially Medicaid and/or Medicare certified.  Advocates have long been concerned about the distinct part requirement because it subjects residents to transfer trauma when they are moved to another room or even discharged if there is no certified bed available, discriminates against residents solely on the basis of payment source, and violates several provisions of the Nursing Home Reform Act.  A recent case in Indiana (see Gazette, April 23 2003) highlighted the negative effect of this policy on residents when they are forced to give up their rooms and move to a distinct part and mobilized efforts in Indiana and around the country to change the distinct part requirement.  In May, when CMS published proposed rules to elevate its distinct part policy to the level of regulation, a coalition of organizations worked together to develop comments recommending a definition of distinct part that would not require segregation.  The groups included the Center for Medicare Advocacy, the National Citizens’ Coalition for Nursing Home Reform, the National Senior Citizens Law Center, the National Association of State Long Term Care Ombudsman Programs, The Senior Law Project of Legal Services of Indiana, United Senior Action, the Nursing Home Community Coalition of New York State, and the Michigan Campaign for Quality Care.  Advocates plan to continue to see what can be done to address this issue. For a copy of the regulations, which go into effect October 1, click on:

http://a257.g.akamaitech.net/7/257/2422/14mar20010800/edocket.access.gpo.gov/2003/03-19677.htm.

The rule also provides for a $6.9 billion increase in Medicare SNF funds over the next 10 years.  In a meeting July 31 that included NCCNHR, the Center for Medicare Advocacy, and providers, Senator Charles Grassley (R-IA) told CMS Administrator Tom Scully that he expects the new funds to be used for direct care.  Source: Robyn Grant

 

 

18. Upcoming Town Hall Listening Session in North Carolina

The fifth Administration on Aging (AoA) Town Hall Listening Session will be held on September 12, 2003, from 11:00 a.m. to 1:00 p.m. in Charlotte, North Carolina in conjunction with the North Carolina Conference on Aging.  The session is an opportunity for older people, their families and caregivers, and members of the National Aging Services Network to comment on critical issues.  Persons interested in testifying must pre-register and be assigned a time slot.  To register, contact: Jennifer McIntosh by telephone: 202-828-5100, ext. 151 or email: JMcintosh@hsrnet.com.  Source: AoA website: www.aoa.gov


19. CMS to issue new guidance for citing scope/severity

During the July 29 SNF/Long-Term Care Open Door Forum, Steve Pelovitz, director of the Center for Medicare & Medicaid Services’ (CMS) survey and certification group, said that the agency plans to issue new guidance on citing scope and severity in the very near future.  The guidance will change the ways that surveyors cite the scope and severity of deficiencies and provide more detailed protocols on pressure sores and incontinence.  CMS originally released a draft of proposed changes to the State Operations Manual (SOM) in late 2001.  That proposal proved controversial and was withdrawn.  Pelovitz stated that this time CMS hopes to provide “more specific guidance to surveyors on how to cite certain critical observations they see during the survey,” including when surveyors see actual harm, possible harm, or immediate jeopardy to residents.  Source: SNFinfo Connection, 8/5/03


20. GAO says Scully retaliated against contractor

A new report from the General Accounting Office (GAO) concluded that Centers for Medicare & Medicaid Services (CMS) Administrator Tom Scully “undermined the integrity” of Medicare’s contracting system by retaliating against a researcher who raised questions about the agency’s program comparing nursing homes.  The report found that Scully improperly canceled up to $1.6 million in new work for Wisconsin’s Center for Health Systems Research & Analysis after director David Zimmerman raised technical concerns about CMS’ nursing home comparison initiative.  Zimmerman angered top health officials by suggesting changes in the standards used to allow the public to compare nursing homes shortly before CMS expanded the program from a six-state pilot project to a nationwide initiative.  In a written response to the GAO’s findings, Jacquelyn White of the Department of Health and Human Services criticized Zimmerman’s center.  For a copy of the GAO’s report (GAO-03-842), go to http://www.gao.gov/.  Source: SNALF.com, 8/6/03

 

 

Other News

21. NCSL issues report on long-term care
The National Conference of State Legislatures (NCSL) has released “Budgeting for Long-Term Care: Spending Limited Dollars More Wisely.”  The report details how states are managing to do more with less and examines the challenges of rising costs for nursing home care, prescription drugs and other health services required by the elderly and persons with disabilities.  To order, contact NCSL’s Publications Department at 303-364-7700 or by e-mail at books@ncsl.org.  Source: Family Caregiver Alliance Caregiving Policy Digest Volume III, Number 13, 8/1/03

 

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 at least two daily listservices (one from the Kaiser Family Foundation and the American Hospital Association) and other sources happened upon by NORC staff and consultants.  Please submit suggestions for improvement or information to Robyn Grant, NORC consultant, at robyngrant@comcast.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. 90AM269001, 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