NORC Gazette

September 12, 2003

National Long Term Care Ombudsman Resource Center

National Citizens’ Coalition for Nursing Home Reform

 


Table of Contents

    Ombudsman Program Updates
1.
    MI Ombudsman Program to move to Office of Services to the Aging

 2.    AoA national summit scholarships awarded to ombudsmen

 3.    FL Ombudsman Program co-sponsors Residents’ Rights month activities

  Ombudsman Calendar of Events

    Home and Community-Based Care/Olmstead    
 4.
    LA preserves in-home care for Medicaid beneficiaries      
 
5.    VT moves toward increases in community-based services

 6.    MO Governor seeks changes in new laws affecting home care workers 

  Nursing Home News

 7.    Panel urges nursing homes to screen for depression in residents

 8.    AAHSA nursing home plan links quality of care to Medicare payments

 9.    Trans Healthcare, Inc. assumes operations of IHS facilities

    Nursing Home Quality Initiative

 10.    NHQI work helps reduce restraint use in TX nursing homes 

    Assisted Living  

 11.    NY residents recoup money from Atria assisted living facilities    

 12.    CO assisted living facility accused in death

    Staffing

 13.    NY facility trains welfare recipients as nurses

  Medicare

 14.    Administration fails to notify consumers of therapy cap

    Medicaid

 15.    Medicaid reform efforts not likely to pass this year

    Medicaid Cuts

 16.   MI eliminates non-emergency dental coverage for adults
           Research

  17.  Study shows need to protect unbefriended elderly patients

      DC Doins'
  18.  Life safety code changes go into effect     
  19.  AHCA and NCAL support funding for nursing initiatives

  20.  CMS organizes “Building Caregiver Coalitions” satellite broadcast

 

Ombudsman Program Updates
1. MI Ombudsman Program to move to Office of Services to the Aging

Michigan Director of Services to the Aging, Sharon Gire, announced that the services provided by the Michigan Office of the State Long Term Care Ombudsman would be handled internally by the state Office on Services to the Aging for a 2-year period as opposed to an external contract.  Under the internal structure, the State Long Term Care Ombudsman will report directly to Director Gire.  Michigan has historically been one of the few states that outsource the program through a competitive bid process; most states operate the program within state government.  Gire said that the state “will work with the agencies currently providing ombudsman services, aging advocates and department staff to build the best program to advocate for long term care residents now and in the future.”  Service to long-term care residents will continue without disruption over the next few months as the operation is transitioned to the Office of Services to the Aging from Elder Law of Michigan, Inc.  Source: MI Long Term Care Ombudsman Services Press Release; September 8, 2003

 

2. AoA national summit scholarships awarded to ombudsmen

Seven ombudsmen, two state and five local, were awarded scholarships to attend the Administration on Aging (AoA) Summit in September.  The Summit, entitled “National Summit on Creating Caring & Healthy Communities,” is designed for healthcare professionals and advocates at the state and local levels.  The summit will address topics such as creating a more balanced system of long-term care, building effective prevention and health promotion strategies into community care, and supporting family caregivers.  The following individuals have been awarded a $150 AoA scholarship to attend the national summit: Debi Myers, State Ombudsman, Iowa; Beverly Laubert, State Ombudsman, Ohio; Uvaldo Perez, Local Ombudsman, Texas; Eileen Bennett, Local Ombudsman, Maryland; Renee Sanders, Local Ombudsman, Georgia; Sam McCoy, Local Ombudsman, Ohio; Rhonda Monroe, Local Ombudsman, South Carolina.  The summit will be held September 21-23, 2003 in Orlando Florida.  Ombudsman Resource Center staff will convene a breakfast meeting for the ombudsmen who attend the summit.  For additional information, please visit: http://www.aoa.gov.  Source: AoA E-mail; September 8, 2003

 

3. FL Ombudsman Program co-sponsors Residents’ Rights month activities

The Florida Long-Term Care Ombudsman Program, the Pioneer Network and the Winter Park Health Foundation are sponsoring several educational seminars throughout the month of October in celebration of Residents’ Rights month.  These seminars are open to residents, healthcare professionals, and anyone interested in improving the quality of life and quality of care for residents in long-term care facilities.  Sessions include: “Pioneer Culture Change: What you can do;” “Person-Centered Care in an Ideal Long-Term Care Setting;”and “Bathing without a Battle.”  Speakers include Rose Marie Fagan, Eric Haider and Joanne Rader.  Sessions will be held throughout Florida in Jacksonville, Tallahassee, Miami, Orlando, Gainesville and Tampa.  Source: Marty Daemy E-mail, September 5, 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 available for purchase through the NCCNHR Clearinghouse August 15th.  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 Julie Meashey - jmeashey@nccnhr.org 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. Register before September 26th to receive an early bird discount!! NCCNHR Annual Meeting, Arlington, VA. 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 sessions 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. Click Here to Register  

April 24-27, 2004: Spring Training for State Ombudsmen, St. Louis, MO.  Make your hotel reservations today by calling Embassy Suites Hotel, St. Louis Downtown at 314-241-4200.  Room rate is $102 (single) & $122 (double) plus local taxes and fees. All rooms are suites that include refrigerator, microwave, wet sink, and coffee maker.  Rate includes a full cook-to-order breakfast in the Garden Atrium and an evening manger's reception.  Be sure to mention you are with the Annual State Long Term Care Ombudsman Training Conference.  Plan to come and spend Friday getting to know your fellow State Ombudsmen and touring this great city.  More details about the training program to follow.

Home and Community-Based Care/Olmstead      
4. LA preserves in-home care for Medicaid beneficiaries    

Medicaid patients who face spending the rest of their lives in a nursing home will soon be entitled to receive in-home care after a federal judge declined to reopen a 6-month-old legal settlement.  The legal settlement requires the state to provide in-home care to any qualifying Medicaid beneficiaries.  The state sought to reopen the case so that they could provide care on a more limited basis instead of abiding by the original settlement agreement.  The New Orleans Advocacy Center filed a lawsuit against the state following the 1999 U.S. Supreme Court ruling that states must provide the elderly and people with disabilities a choice between community or institutional care.  Because the court denied the state's request to reopen the settlement, the state must now offer coverage for in-home services for Medicaid beneficiaries earning less than $547 per month.  The new program, which could be implemented as early as Oct. 1, will cover as much as 56 hours of in-home care each week.  Health department officials estimate that 1,700 people will be eligible for the program, not counting current nursing home residents who may opt for home care when it becomes available.  Source: New Orleans Times-Picayune, September 4, 2003; www.kaisernetwork.org, September 5, 2003.

 

5. VT moves toward increases in community-based services

Vermont wants to make it easier for sick and disabled citizens to stay in their homes. The state Aging and Disabilities Commissioner outlined a plan to seek a Medicare waiver from the federal government to increase monies for at home services.  If approved, the waiver would give the state more flexibility when paying for elder care.  The nursing home industry responded with concerns that in-home services are not regulated as heavily as nursing home services and therefore could compromise care quality.  Furthermore, the nursing home industry is not convinced that the waiver program would save the state money.  Despite industry concerns, the state is moving ahead, believing a mix of settings is best.  State officials hope to have an answer this spring about whether they will be getting the waiver.  Source: http://www.WCAXtv.com; September 9, 2003.

 

6. MO Governor seeks changes in new laws affecting home care workers 

Missouri Governor Bob Holden asked legislators to make “technical changes” to correct the unintended consequences of two bills signed into law earlier this year.  In June, Holden signed a bill strengthening state oversight of nursing homes suspected of providing poor care to their residents.  The bill also created hiring restrictions for employees of in-home health care providers.  In July, Holden signed another bill which requires background checks on child- and elder-care workers, to include criminal history records for all felonies and misdemeanors.  Holden said that the two laws could force many in-home care providers to be fired for long-ago, minor violations not affecting their present trustworthiness or competency.  It was estimated that as many as 1,000 in-home care workers could be affected by the laws.  The governor’s proposal would give the state Department of Health and Senior Services the authority to immediately create rules that would waive the hiring restriction for in-home service providers who do not pose a health or safety risk to patients.  Furthermore, the governor’s proposal would clarify that hiring restrictions only apply to employees actually providing in-home care, not to everyone who works for the organization providing the care.  Source: St. Louis Times, September 8, 2003.


Nursing Home News    
7. Panel urges nursing homes to screen for depression in residents

An expert panel has recommended that nursing homes regularly screen all residents for depression, with particular attention to residents who suffer from dementia.  The panel, led by the American Geriatrics Society and the American Association for Geriatric Psychiatry, called for significant revisions to the standards of care for nursing home residents with depression and behavioral symptoms associated with dementia.  Up to 40% of residents with dementia have both behavioral and psychiatric symptoms that staff could alleviate with proper care and treatment.  The panel calls for routine and regular screening for depression in every nursing home resident, improved screening instruments and first-line treatment of major depression with antidepressant medications in combination with non-pharmacological interventions.  The panel’s consensus statement also outlines ways that nursing home administrators and staff can improve the environment for residents, enhancing their quality of life.  Source: SNFinfo Connection, September 9, 2003; www.snalfnews.com, September 4, 2003.

8. AAHSA nursing home plan links quality of care to Medicare payments 
The American Association of Homes and Services for the Aging (AAHSA) presented a plan to lawmakers that would link quality of care to nursing homes’ Medicare payments.  In testimony before the U.S. Senate Finance Committee, AAHSA recommended a two-way commitment to foster improvement in quality of care and services provided at nursing homes.  The group charged that authorities responsible for paying Medicare and Medicaid have the right to align payments for nursing homes with proper and efficient care.  The association also recommended that lawmakers implement a demonstration project to explore ways of matching quality of care and services.  According to AAHSA, the initiative should include developing and testing a method for paying bonuses to facilities that achieve high performance ratings.  Source: HealthCare Alert E- newsletter, August 28, 2003.

 

9. Trans Healthcare, Inc. assumes operations of IHS facilities

Trans Healthcare, Inc., (THI) has officially assumed full operational control of the Long Term Care facilities ABE Briarwood Corporation purchased from Integrated Health Services, Inc. (IHS).  Trans Health is the largest privately held healthcare company in the U.S. and previously operated 100 skilled nursing facilities, specialty hospitals, and outpatient rehabilitation clinics in 12 states.  It now operates over 200 facilities across the U.S., representing over 20,000 beds with a workforce of approximately 30,000.  Source: Business Wire, September 4, 2003.

 

Nursing Home Quality Initiative

10. NHQI work helps reduce restraint use in TX nursing homes

The use of physical restraints in Texas nursing homes dropped after the Centers for Medicare & Medicaid Services (CMS) launched its Nursing Home Quality Initiative last November.  The statewide percentage of Texas nursing home residents in restraints dropped from 18 percent to 14 percent in the first quarter after the initiative began.  Prior to the initiative, the national average for percentage of residents in physical restraints was 10 percent, and Texas was at 18 percent, according to a Texas Medical Foundation (TMF) representative.  TMF contracts with CMS to provide quality improvement programs to Texas facilities.  The TMF chose the reduction of physical restraints as one of three priority areas for quality improvement training and technical assistance to Texas nursing homes.  Source: http://www.snalfnews.com, September 8, 2003.

 

 

Assisted Living

11. NY residents recoup money from Atria assisted living facilities

After signing an agreement with the New York State Attorney General’s Office, Atria Inc., which owns assisted living facilities in New York, will be required to refund former residents thousands of dollars for unjust fees it charged after 1999.  Since 1999, residents of Atria have been charged a “community fee” which was not described in the contract signed or the literature reviewed by the residents.  Furthermore, though all Atria residents were charged the community fee, not every resident used the services paid for by the additional charge.  Ruth Berger, Director of the Suffolk County Long Term Care Ombudservice, played an important role in the investigation which brought Atria’s misleading billing practices to light.  Ms. Berger noted, “If someone is paying for something the contract should specify exactly what they are paying for.  In this case of course, it didn’t.”  Source: The Observer, August 26, 2003.

 

12. CO assisted living facility accused in death 
The families of six residents of the Sunrise Assisted Living facility in Centennial, Colorado have filed a lawsuit charging that neglect and poor care killed one resident and jeopardized the lives of others.  Plaintiffs include state Senate President John Andrews, whose mother-in-law was a resident of Sunrise.  The suit claims that Sunrise touted its facilities as among the best in the nation, promising expert care of Alzheimer’s patients and a full activities schedule.  However, according to the suit, residents were left in wet diapers for hours, were not bathed for months, suffered falls and were deprived of adequate water and food at the facility, which was poorly staffed and often filthy.  The resident who is at the center of the lawsuit lost more than 40 pounds in her eight months at Sunrise and weighed only 87 pounds when she died in June.  The suit alleges that the resident died of starvation and dehydration.  Source: Rocky Mountain News; http://www.rockymountainnews.com. August 29, 2003.

 

 

Staffing

13. NY facility trains welfare recipients as nurses

The Van Duyn Home & Hospital in New York State is trying a different approach to address the nurse shortage.  The Onondaga County nursing home is sharing $6.6 million in welfare-to-work money with five other public nursing homes in the state to train nurse aides as registered nurses.  The grant allows people already employed by the facilities to work on their nursing degrees during their shifts without losing wages.  The nursing homes get extra money to hire replacement workers, keeping staff levels up during class times.  Nearly 200 people have signed up for the classes at the Van Duyn facility, which currently has a 28-percent vacancy rate among registered nurses. 

Source: www.snalfnews.com, August 28, 2003. 

 

 

Medicare

14. Administration fails to notify consumers of therapy cap

As reported in the September 5th Gazette, annual caps of $1,590 were applied to Medicare payments for outpatient speech and physical therapy (combined) and on occupational therapy services (singly), effective September 1.  However, the Medicare Rights Center (MRC) has filed a motion to delay implementation of the caps on grounds that the government failed to notify consumers about the cap.  In June, MRC, Easter Seals and the American Parkinson Disease Association sued the Bush Administration to stay the coverage caps, alleging that the Department of Health and Human Services failed to advise people with Medicare that it intended to implement the therapy caps on July 1.  To settle the case, the Bush Administration agreed to delay implementation of the coverage caps until September 1, and pledged to notify at least 90% of the 41 million people with Medicare that the caps were going into effect.  MRC recently learned that approximately 40% of people with Medicare were not advised of the caps.  Source: MRC Flash, Medicare Watch #18, Vol. 6, No. 18: September 5, 2003.

 

 

Medicaid  

15. Medicaid reform efforts not likely to pass this year

Because Congress is unlikely to pass a Medicaid reform bill this session, governors and federal legislators anticipate returning to Medicaid reform efforts next year.  Reform efforts “stalled” this year because of disagreement among governors about which Medicaid changes to endorse.  Members of a National Governors Association (NGA) Medicaid task force this year failed to agree on whether to endorse a Medicaid plan proposed by President Bush.  For beneficiaries covered at the state’s discretion, the Bush administration plan would give states’ Medicaid programs a fixed amount of funding, rather than matching funds, and would no longer require states to apply for federal waivers to deviate from federal eligibility and benefits standards.  In addition, states would only be required to maintain comprehensive Medicaid coverage for beneficiaries whose income levels are low enough that the federal government mandates that they be covered.  To read the full article please visit:

http://cme.kaisernetwork.org/Key=181.D40.F.D.FwvN2v. 

Source:  www.kaisernetwork.org, September 8, 2003.

 

Medicaid Cuts    
16. MI eliminates non-emergency dental coverage for adults       
Beginning October 1st, about 600,000 Michigan Medicaid beneficiaries ages 21 and older will no longer receive coverage for non-emergency dental services.  The Michigan Department of Community Health, which administers the Medicaid program, will also reduce coverage for hearing aids and chiropractic and podiatry services for adult beneficiaries.  The cuts are a result of budget reductions.  Opponents to the cuts point out that consumers will now be forced to use more expensive emergency services to receive treatment.  To address the problem, the Macomb Oakland Regional Center, which administers services for about 4,000 people with developmental disabilities, has launched a campaign called Adopt-A-Smile to encourage dentists to provide free care to people with disabilities.  For the full article please visit:          http://cme.kaisernetwork.org/Key=145.GYn.P.D.N67sh.

Source: Detroit Free Press, September 3, 2003; www.kaisernetwork.org, September 4, 2003.

 

Research
17.
Study shows need to protect unbefriended elderly patients

A new study by the American Bar Association Commission on Law and Aging found that only 13 states have enacted laws that specifically address the problems confronting isolated elderly patients who lack the capacity to make their own health care decisions.  A new report entitled, Incapacitated and Alone: Health Care Decision-Making for the Unbefriended Elderly, outlines these findings and presents 12 recommendations on improving the fate of these isolated patients.  The report found that in states that have adopted laws addressing the needs of unbefriended elderly patients, those laws have addressed: statutory authorization for consent, often by attending physicians; creation of volunteer committees to make decisions, usually for mentally retarded or mentally ill individuals; and court processes authorizing limited consent to treatment.  Some states also have public guardianship programs, but they are often overburdened and under-funded.  The report concludes that all of these mechanisms have drawbacks but move in the right direction.  All SLTCO will receive a complimentary copy of the report.  To order additional copies, email: abaaging@abanet.org or call (202) 662-8690.  For further information on the study, contact Naomi Karp, nkarp@staff.abanet.org or Erica Wood, ericawood@staff.abanet.org.  Source: Elderbar Listserve; September 9, 2003.

DC Doins

18. Life safety code changes go into effect    
As of September 11th the Centers for Medicare & Medicaid Services (CMS) began its enforcement of the 2000 Life Safety Code(r) (LSC), and nursing facilities must be in full compliance to avoid citations.  Much has changed since facilities were required to adopt the 1985 version of fire safety precautions.  Some of the highlights include new requirements for smoke detector placement in corridors containing resident rooms, sprinkler installation, quarterly fire drills on each shift, minimum width for doors in established exit routes, and smoke detectors in sleeping rooms if residents bring their own upholstered furniture.  Although the LSC allows roller latches on doors in some cases, CMS has called for their elimination.  Source: http://www.snfinfo.com, September 2, 2003.

 

19. AHCA and NCAL support funding for nursing initiatives

The American Health Care Association (AHCA) and the National Center for Assisted Living (NCAL) have urged the U.S. Senate to pass an amendment to the Labor-Health and Human Services (HHS) Appropriations bill that would increase by $63 million federal funding for nurse training, scholarship and other recruitment, education, and retention initiatives.  The nursing workforce development initiatives consist of a public education campaign promoting the benefits of nursing, the establishment of a faculty loan program to boost teaching programs, and the creation of a National Nurse Service Corps.  The service corps would provide financial assistance for education in return for two years of service in areas with a nurse shortage.  The amendment, known as the Mikulski-Collins amendment, comes on the heels of an announcement by the U.S. Department of Labor (DoL) that the ongoing health care worker shortage will be the focus of a new job training initiative.  For the full article, please visit:

http://www.ahca.org/news/nr030904.htm;

Source:www.snalfnews.com, September 5, 2003.


20. CMS organizes “Building Caregiver Coalitions” satellite broadcast     
The Centers for Medicare & Medicaid Services is holding a satellite broadcast on September 30 to explore ways to provide support to informal long-term caregivers.  The broadcast titled, “Building Caregiver Coalitions,” will bring together a 12-member panel representing caregiver organizations, coalition builders, businesses and potential partners to discuss strategies and share experiences in building state-focused coalitions to reach caregivers.  There will be a question-and-answer session after the discussion to allow viewers to talk with the panelists.  The objective is to motivate organizations to develop, join and sustain coalitions to help provide services and information to caregivers.  In order to view this broadcast through satellite, you must have access to a digital steerable dish that receives a K or C band signal.  For additional information, please visit: http://www.cms.hhs.gov/events/event.asp?id=54&type=0

Source: CMS website, September 10, 2003

 

 

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@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. 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.