NORC Gazette
September
21, 2001
National Long Term Care Ombudsman Resource Center
National Citizens' Coalition for Nursing Home Reform
Table of Contents
September 11, 2001 news Related to Long Term Care
Calendar of events: Note NCCNHR Annual Meeting Cancelled
Olmstead/Care Options
1. National conference call on new Medicaid waiver
2. Long waiting lists in Texas
State Nursing Home news
3. Veterans Administration oversight of nursing home lacking
4. CA passes nursing home bill; advocates withdraw support
Staffing
5. More workers seek training to work in FL nursing homes
6. Ohio has new staffing standards
7. Study: 750,000+ more nursing aides will be needed by 2008
Abuse/Neglect
8. Diversified pays $1.2 million for criminal neglect
Assisted Living
9. Granny Cam records gross indignity
10. State regulators meet with AL owners
Research
11. PA University develops nursebot.
DC Doins'
12. Fewer inspections rejected "out of hand"
13. New CMS regional administrators named
September 11, 2001 News and Responses
The National Ombudsman Resource Center joins the world in mourning for all
victims of the attacks on NY, PA, and DC. Our thoughts and prayers are
with the families, friends, communities, and the rescue and supportive services
in NY, PA, DC and all across the globe. See the ombudsman website for updated
information and to share information with colleagues: http://www.ltcombudsman.org.
Long term care related news
from the situations follow:
The Department of Health and Human Services announced that help is available
for senior citizens living in Lower Manhattan who are having trouble getting
their medication. The department established a toll free 24-hour hotline to
help seniors receive personal services, therapies, and transportation to health
facilities. Translators are available. The hotline number is
800/331-7767.
HHS Secretary Tommy Thompson today announced the immediate release of grants to
New York to help provide residents with child care, elderly assistance and
other community services to assist the community's recovery effort following
Tuesday's attacks. Thompson made the announcement during a tour of New York
health and emergency facilities. One grant will provide immediate services to
New Yorkers, including temporary shelter, food and clothing, and childcare
services. Another grant will help senior centers provide services, such as
transportation to health care, meals and counseling. Another funds supportive
mental health services and planning for long-term support for the victims,
their families, and professional and volunteer workers.
HHS waived the three-day hospital stay requirement for Medicare to cover skilled
nursing facility care. The SNF program requires a stay of three consecutive
days before Medicare will cover SNF services. HHS officials waived the
requirements because hospitals in the New York and Washington disaster areas
may need to discharge less critically ill beneficiaries to a SNF sooner than
usual due to overcrowding. Medicare contractors have been informed that HHS has
waived the three-day stay requirement for only the disaster area and only for
the duration of the disaster.
The American Association for Marriage and Family Therapy has posted
consumer-oriented material on its Web site to help individuals with terrorism
recovery, including coping with loss and bereavement and post-traumatic stress.
The site, www.therapistlocator.net, also
provides a database to help locate therapists throughout the country.
The American Bar
Association opened a toll-free hotline and website to help survivors and
victims' families address critical legal questions. The toll free hotline
number is 866-606-0626. More than 1000 lawyers have volunteered in this effort.
The website which is designed for victims, military personnel and lawyers is http://www.abanet.org/legalservices/disater.html
Calendar of events
September 28: Center Training
of New State Ombudsmen cancelled. The information that would have been covered will be mailed
and a conference call will be set up in early October.
September 29 - October
3: NCCNHR Annual Meeting cancelled. Be sure to cancel room reservations at the hotel. NCCNHR
will send out further information as soon as the necessary decisions have been
made.
October 7- 13: National Residents Rights Week. Theme: visitation
rights. This theme is even more important as residents cope with the current
national tragedy. (The Resident Rights packet was sent to all state ombudsmen
for distribution in their state in early August. Copies may be ordered from
NCCNHR, 202-332-2275.) This is a good resource for facility staff as well as
for advocates.
October 18, 3:00 pm EST:
Center Conference
Call on Training issues.
March 14, 2001:
Hotel reservation due for State Ombudsman spring conference. Holiday Inn
at (614) 885-3334 and indicate your reservation in connection with the
"National Ombudsman Training Conference." Contact Mark Miller
at mmiller@nasua.org
April 13 - 16, 2002: State Ombudsman spring conference, Columbus, Ohio.
Contact Mark Miller at mmiller@nasua.org
Olmstead/Care Options
2. Long waiting lists in Texas
As Texas struggles with Medicaid funds, many low-income assisted living
residents are waiting for promised services. More than 36,000 people in the
state are on waiting lists for Texas' largest home health care program, according
to the Fort Worth Star-Telegram. The Medicaid program, called Community-Based
Alternatives, is designed to help keep people out of nursing homes. It would
help some assisted living residents with rent and services that they may not be
able to get any other way. The state is under extra pressure to correct the
problem since the recent Olmstead ruling, which mandates that states provide
care in nonrestrictive settings, according to the paper. Though Texas agreed to
fund 2,400 new slots in the program over the next two years, advocates told the
paper that's hardly enough. There is a waiting list every year after funds run
out, experts told the paper. One state representative blamed state priorities.
An advocacy group may file a lawsuit to see whether there "is a legal way
to get the state to better implement Olmstead," a representative from the
group told the paper. Officials from one ALF in Texas told the paper that if
some residents are not accepted into the Medicaid program, they "may have
to charge families more or put two patients in one apartment." FROM:
BAL_Weekly
State Nursing Home news
3. Veterans Administration oversight of nursing home lacking
The Department of Veteran Affairs (VA) is coming under increasing government
scrutiny for its oversight of nursing homes that house United States veterans.
In July, the General Accounting Office (GAO) answered a call from Congress to
review the VA's current system of nursing home oversight, which includes annual
inspections of the nursing homes it uses. The VA had been considering scaling
back its nursing home inspections and relying on state inspection information
instead. The GAO report, GAO-01-768, concluded that this was acceptable only if
the VA could develop "a structured, comprehensive, and uniformly applied
policy for overseeing all community nursing homes under contract to VA."
Authors of the report also expressed their skepticism about the quality and
consistency of some state inspection data. Heightening Congress' concern was
the news of two deaths of residents in the VA nursing home program, which may
have resulted from poor care, according to U.S. Newswire. Both residents died
from infections they had allegedly developed while living in VA-associated
nursing homes. VA officials assured Congress that they were working on
implementing the recommendations in the GAO report. To read the full report, go
to: http://www.gao.gov/new.items/d01768.pdf
http://www.gao.gov/cgi-bin/getrpt?gao-01-768
4. CA passes nursing home bill; advocates withdraw support
A nursing home bill (AB 1075) that would "radically change the way
California pays for long-term care through Medi-Cal," the state's Medicaid
program, and that passed the state Legislature last week, has received
criticism from various senior groups and nursing home advocates, the Contra
Costa Times reports. The original bill, sponsored by state Assembly Majority
Leader Kevin Shelley (D), would have changed the way the state requires nursing
homes to account for staff hours and called for a five-to-one patient-to-staff
member ratio during the day. But late last week, legislators approved
amendments that would require California by Aug. 1, 2004, to "revamp its
reimbursement system" by determining an individual rate for each of the
state's 1,200 nursing homes. Currently, Medi-Cal reimburses nursing homes an
average of $125 per patient per day. The amendments also would put a
yet-to-be-determined staff-patient ratio in place by Aug. 1, 2003. Lisa
Hubbard, a spokesperson for the Service Employees International Union, the
leading proponent of the revised bill, said, "even an unspecific ratio
represents an improvement." She added, "We wanted ratios and we got
them." But Eric Carlson, a National Senior Citizen Law Center staff
attorney, said, "This is not the kind of thing you do with two days left
in the Legislature." Pat McGinnes, executive director of California
Advocates for Nursing Home Reform, added, "This isn't the bill that we
supported. I am concerned very much about the lack of specifics" in the
reimbursement provisions. Both McGinnes' group and the law center have
withdrawn their support of the bill in letters to Gov. Gray Davis (D). The
revised measure now awaits action from Davis, who "has no position on the
bill" and has until Oct. 14 to act on it (Peele, Contra Costa Times,
9/18).
Staffing
5. More workers seek training to work in FL nursing homes
Training programs for Certified Nursing Assistants are picking up the pace to
answer the state-mandated call for more CNAs in Florida's nursing homes. The
need for more CNAs accelerated in May when the Florida Legislature passed a law
requiring increased nursing staffing at long-term care facilities. Nursing home
administrators say they are unable to meet the new requirements because of a
lack of qualified nurses. "We have been absolutely overwhelmed with people
calling to get in our classes," said Judy Thom, who heads the Health
Industry Services department at Learey Technical Center.
Thom, who said her program is the largest in the state, attributed much of the
surge to the new legislation and media reports on the urgent need for CNAs. In
response, Learey hired an additional full-time instructor and added an evening
class to its schedule. "We're doing all we can here to fill the
need," Thom said. To read the full story, go to http://tampabay.bcentral.com/tampabay/stories/2001/09/17/focus2.html
6. Ohio has new staffing standards
Ohio Gov. Bob Taft (R) on Sept. 5 urged state lawmakers to approve new rules
that would boost staffing and care in state nursing homes, the Columbus
Dispatch reports. In a letter to state Rep. Jamie Callender (R), chair of the
state Joint Committee on Agency Rule Review, Taft asked the panel to pass a
proposal that would revise state nursing home rules for the first time in 27
years. Under the proposed rules, nursing homes would have to provide an average
of 2.75 hours of "direct care" to patients daily, up from an average
of 1.6 hours. State Health Director J. Nick Baird, who has met with eight of
the 10 members of the committee to discuss the proposal, said, "his
presentation was well-received." However, he said that the nursing home
industry has lobbied against the proposal. In his letter, Taft pointed out that
nursing homes will receive about $250 million in additional funding through the
state budget that took effect July 1, which "will more than cover any
costs generated by the proposed changes." About 100,000 Ohio residents reside
in 1,030 nursing homes statewide, and about 100 nursing homes in Ohio do not
provide 2.75 hours of daily direct care to patients, Baird said (Craig,
Columbus Dispatch, 9/6).
The state Joint Committee on Agency Rule Review let stand a state Department of
Health rule that would increase daily direct care requirements for nursing
homes from 1.6 hours per patient to 2.75 hours per patient (Leonard, Columbus
Dispatch, 9/11).
7. Study: 750,000+ more nursing aides will be needed by 2008
The U.S. will need more than 750,000 additional nursing aides and direct care
workers by 2008, particularly to provide long-term care, according to a panel
of experts that met 9/10/01 at Wake Forest University's School of Medicine. The
group concluded that a lack of funding, training and professional respect
hinder job growth in a service that only will grow as the Baby Boom generation
reaches retirement age. One report noted that in North Carolina, fewer than 300
people are enrolled in the state's community colleges to become certified nurse
assistants, but by 2008 the state will need about 31,000 additional nursing
aides and direct care workers. The group called for new resources and money to
attract, train and retain workers. FROM: AHA news now.
Abuse/Neglect
8. Diversified pays $1.2 million for criminal neglect
In a settlement marking the first time a corporation was held responsible for
resident abuse, Diversified Health Services agreed to pay $1.2 million to
answer criminal charges that it seriously neglected 24 residents. The charges
stemmed from complaints at Diversified's Pavilion Health Care Center, a skilled
nursing facility in Louisville, KY, reported the Louisville Courier-Journal.
The state shut down the facility in 1998 after investigators found evidence of
malnutrition, dehydration, severe bedsores, and injuries resulting from a resident's
escape from the nursing home. Diversified Health Services also pleaded guilty
on one count of Medicaid fraud for billing the agency for services not
provided. The case is unusual because the corporation, which has changed hands
since the neglect incidents occurred, is being held accountable for poor
patient care, instead of its employees. Because investigators found Pavilion to
be seriously understaffed, part of the settlement money will go to a state
nursing scholarship fund, in hopes of recruiting new nurses into the
profession. FROM: SNF connection
Assisted Living
9. Granny Cam records gross indignity
An elderly man who can't talk or get around on his own was restrained on a
portable toilet of the Anchorage Pioneers' Home this summer for long enough to
violate basic care standards, according to a state complaint.
The man, with advanced Alzheimer's disease, did not report the matter.
Instead, it was captured on a video camera that his family installed in
his room. The Pioneers' Home gave permission for the camera, and it's visible
to workers. It's the only one state officials know of at any Alaska nursing or
assisted-living home. Cameras have been used in the past, including hidden ones
installed briefly at the Anchorage Pioneers' Home several years ago by the
network news magazine Dateline NBC.
The Anchorage Daily News reports this incident marks the first time that state
inspectors used a video to make a case against a home for the elderly in
Alaska. It brings Alaska into a growing national movement in which families use
cameras to monitor what happens in rooms of residents who are too incapacitated
by age or disease to call for help if a worker hurts or neglects them.
10. State regulators meet with AL owners
State regulators are preparing to meet with ALFs to discuss good regulatory
approaches to assisted living within their states, Francine Moore, a
spokesperson from the Assisted Living Federation of America (ALFA) told BAL
Weekly yesterday. ALFA encouraged this action after assisted living regulators
from 37 states and ALFs met last week in Chicago to discuss assisted living
regulation at the federation's State Policy Summit on Assisted Living.
Regulators and providers from across the nation plan to reconvene in March, to
put together what they feel are "best regulatory approaches" for
assisted living, Moore said. These approaches will be compiled in a report and
presented to the Senate Special Committee on Aging at a forum scheduled for
next April. Major topics addressed at last week's summit include the following,
said Moore:
- Negotiated risk
- Medication management
- Staffing issues
- Move-in and move-out criteria
Attendees also talked about the possibility of "portable funding" in
Medicaid, in which funds are attached to an individual. They also discussed the
need to cross-train individual employees as the market flattens out. Go to http://www.fpeca.usf.edu to read the
presentation on the regulatory climate in assisted living from the summit's
keynote speaker, Larry Polivka, PhD, from the Florida Policy Exchange Center on
Aging at the University of South Florida. Results of the summit will also be
discussed at ALFA's fall conference in Washington, DC in October. FROM:
BAL_Weekly.
Research
11. PA University develops nursebot.
Two years ago, nurse Wendy Fello allowed some robotics experts to follow her
through her daily routine in the suburban Pittsburgh nursing home where she
works. She visited with patients, filled medicine containers and escorted
people to physical therapy appointments. Recently, the experts paid several
return trips, bringing with them a 4-foot-tall robot named Pearl.
Pearl, who has silver grab bars in lieu of arms, greeted people and dispensed
candy. She entered residents' rooms and told them they should follow her to
physical therapy. When they agreed, Pearl's screen and voice said, ''Lets go!
Chop chop!'' The ''nursebot'' is a marvel of robotics, and her creators hope
she represents the future of nursing.
When fully developed, Pearl and her progeny will be able to assist elderly
people in their homes, allowing them to live independently longer before they
need the round-the-clock care of a nursing home. Pearl can perform such routine
tasks as opening a jar, reminding people to take their medication or calling
for help if they fall. Trouble with basic tasks is the main reason elderly
people give up independent living. To read the whole story, go to www.boston.com/dailyglobe2/254/science/Introducing_Nursebot_+.shtml
DC Doins'
12. Fewer inspections rejected "out of hand"
As reported by the Associated Press on 9/10, White House officials said
yesterday that they had rejected proposals at the Department of Health and
Human Services to soften government regulation of certain nursing homes. The
idea was to lessen the frequency of inspections of nursing homes that have
consistently followed the law while increasing inspections at homes with a
history of problems. Inspecting all homes once a year, no matter what their
quality, was "nutty," a top HHS official said earlier this year.
Yesterday, White House spokesman Ari Fleischer said the idea had been
considered and rejected "out of hand." Fleischer said President Bush
planned to outline a nursing-home initiative this fall. For more
information, check out NCCNHR's action alert on its website and the story in
the Washington Post http://www.washingtonpost.com/wp-dyn/articles/A58983-2001Sep7.html
13. New CMS regional administrators named
HHS Secretary Tommy Thompson today announced the appointment of Josh Valdez as
representative to HHS Region XI, based in San Francisco, effective today. The
area includes California, Arizona, Hawaii, Nevada, and the Trust Territory of
the Pacific Islands, Guam and American Samoa. Valdez is now the vice president
for operations at AltaMed Health Services Corp. and served as a health services
administrator for the U.S. Air Force.
HHS Secretary Tommy Thompson on Sept. 6 announced the appointment of Massachusetts
GOP Party Chair and state Rep. Brian Cresta (R) as the "secretary's direct
representative" for Region 1, which covers Connecticut, Maine,
Massachusetts, New Hampshire, Rhode Island and Vermont. Cresta, who will assume
responsibility for "guidance and coordination of HHS policies in the
region" on Sept. 17, has served in the Massachusetts Legislature since
1994 and is a past ranking member of the Human Services and Elderly Affairs
Committee.
___________________________________________________________
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 (Program Development, Staffing, Olmstead/Care Options, Demographics,
Clinical Advancements 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, 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 to listserv@ahals.aha.org and write in the
message area: subscribe ahanewsnow.
Please submit suggestions for improvement or information to Hollis Turnham,
NORC consultant, at hturnham@aol.com
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