Monthly Archives for November 2003

Home Care Quality Data Not Always Easy to Interpret

Published in Pawtucket Times on November 10, 2003

A 70-year-old widow was recently discharged from a local hospital after surgery for cancer. Her daughter has agreed to take on caregiving duties, but because of her demanding job, there will be frequent periods of time that the elderly woman will be left home alone.

To keep this elderly woman at home after her hospital stay, her physician has referred her to a home health agency that will provide skilled nursing services for wound care and medication management.

Additionally, physical therapy has been ordered for rehabilitation. By being eligible for skilled nursing care, Medicare will also pay for a certified nursing assistant for five weekly visits to provide personal care services.

Although fictional, this situation is very typical of the care provided by 21 Medicare-certified home care agencies to 12,000 older Rhode Islanders who have a medical need for skilled care.

These agencies offer an array of health care (i.e. skilled nursing care, physical, occupational, respiratory and speech therapies, social services, psychiatric nursing and palliative care) and personal care services to patients in their own homes.

Federal and state officials, home care agency providers and Rhode Island Partnership for Home Care recently gathered at the Quality Partners of Rhode Island offices to unveil the Centers for Medicare & Medicaid Service’s (CMS) new quality improvement initiative.

CMS’s quality data will allow consumers to evaluate Medicare certified home care agencies on 11 quality measures. They include four measures related to improvements in getting around, four measures related  to improvement in meeting basic daily needs, two measures related to medical emergencies and one measure related to mental health improvements.

Quality Partners has been involved in the state’s public reporting program, which is designed to facilitate consumer choice and promote quality improvement in health care. The Providence-based independent quality improvement organization, under contract with CMS, is working with local home health agencies to improve the quality of care and inform consumers about the availability of the federal agency’s recently released quality performance data.

CMS’s new initiative is a “key step toward improving quality in getting consumers the information they need to make informed health care choices,” said CMS Administrator Tom Scully in a written statement. “By generating and publishing quality data, we are helping consumers make decisions that best meet their needs and are creating incentives for home health agencies to further improve quality.

“These quality measures should be used as an additional resource when making decisions about a home health agency or addressing the quality of care that a loved one is receiving,” said Scully. “Use these measures as an opportunity to discuss the care provided by the home health agency and address not only the areas of care covered by the quality measures, but all services as well.”

Lt. Gov. Charles j. Fogarty, who chairs the state’s Long-Term Care Coordinating Council, added, {CMS’] rating system for home health agencies fits in nicely with what we are doing here in Rhode Island. Having this information will help foster quality among the rated agencies. It will create an environment for home health care agencies to continue to improve on their quality of care.”

“Most home care agency providers embrace this quality initiative as an opportunity for agencies to focus more resources on quality for all agencies to achieve the highest standards of care which will result in an informed pubic,” noted Paula Parker, executive di rector of the Rhode Island Partnership for Home Care.

“Consumers can e confident that their home care provider has practices and policies in place to measure quality indicators. This will empower consumers to discuss quality with their providers,” she says.

While recognizing the merits to this initiative, Maria Barros, clinical director of the Pawtucket-based Nursing Placement and Saranna Home Care, is concerned that consumers may have difficulty in interpreting the quality data.

“The Home Health Quality Initiative does not really measure the agencies’ performances (in some situations),” says Barros, especially when agencies take care of patients who have chronic disabling or terminal conditions. “The patients do not improve and the quality measurers reflect this, ultimately giving a false impression that quality care is not being provided,” she says.

“Not all of our patients with diseases get better or are cured,” Barros adds. “We help them to manage their disease processes, keep them at home and enhance their quality of life until they are ready to enter into hospice care.”

Moreover, Barros said some agencies that take care of younger patients with acute medical conditions that only require short-term home health services will have better outcome data when compared to agencies that care for sicker patients’

“The intensity of the medical care is not always reflected in these 11 quality indicators,” she said.

Parker agreed, stressing that it is important for consumer to interpret the numbers released by the CMS in the context in which home care is provided.

For Medicare certified home health agencies, CMS has published advertisements in local newspapers that will include three of the quality indicators. The complete listing of quality data along with  other consumer information on home health care agencies in Rhode Island, is available at Home Health Compare located on Medicare website, www.medicare.gov and throughout Medicare’s 24-hour help line at 1-800-MEDICARE (1-800-633-4227).

For those 5,000 Rhode Islanders who receive home care through programs other than Medicare quality of care is measured by the R.I. Department of Health through their performance measurement and reporting program, mandated by legislation introduced by then-state Senator Charles Fogarty and passed by the General Assembly in 1998. Signed by the governor, this law is designed to provide consumers with published reports of quality measures for every segment of Rhode Island’s health care system.

Real Heroes Need to Be Recognized   

Published in Pawtucket Times on November 3, 2003

Sometimes the actions of real heroes are not reported by newspapers, radio or television newscasts. While stories of poor care and abuse in the state’s nursing facilities quickly make headline news in local media outlets, the good deeds oftentimes go unreported.

Here’s a story about a fire in an East-Providence independent living facility that made the local news one evening in October, but the real story was left untold.

Although the Rhode Island Chapter of the Red Cross ultimately go the ink for being on the scene, there were others – nursing facility administrators, firefighters, police officers and the Alliance for Better Long-Term Care – who also came to the assistance of the elderly tenants that fall night.

On Friday, Oct. 3, a boiler fire at Taunton Plaza forced 117 elderly and handicapped residents from their heated apartments into the chilly night. The elderly tenants residing in this independent living facility  were ultimately not allowed to return until Monday, because of a power outage, smoke damage and concerns regarding environmental contamination by polychlorinated biphenyls (PCBs).

Although the Santa Maria Club, on Broadway, offered a brief respite from the cool fall weather that evening, these residents needed overnight accommodations because they could not immediately return to their apartments. For that weekend, the majority of the elderly tenants went to the homes of family and friends, while others slept on cots at a temporary shelter site.

Roberta Hawkins, state ombudsman and executive director of the Alliance for Better Long-Term Care, remembered getting a phone call while watching a local television newscast about the fire.

“We really could use your help,” the Red Cross official said, asking her to immediately come to East Providence.

Ultimately, Hawkins and Kathy Heren, her agency’s staff nurse, quickly arrived at the Portuguese club and got down to the business of interviewing residents to learn about their medications, special needs and current health status. Some of the displaced elderly tenants were diabetic on insulin, while others were taking high blood pressure and heart medications.

Nursing home administrators, along with their directors of nursing, were also summoned to the fire site after receiving phone calls from Hawkins and Heren. These facilities would ultimately provide free accommodations for 18 elderly tenants whose health status required medical care  monitoring until they could return to their apartments.

Meanwhile, with information provided by Hawkins and Heren, East Providence firefighters and police officials entered smoke-filled apartments to retrieve prescription drugs. “Some of these seniors need to take their medications at the time of the fire,” said Hawkins.

Responding to a visibly shaken woman, an East Providence policeman even went into a smoke-filled apartment to rescue her cockatoo, a pet that might have died from smoke inhalation.

“The sobbing woman was so grateful that one would have thought the policeman had just rescued her child,” Hawkins said.

Administrator Orlando Bisbano Jr., of Orchard View Manor, came to Taunton Plaza that night of the fire with his director of nursing. He ultimately would take seven elderly tenants  back to his East Providence-based facility.

“We were willing to help in any way we could,” said Bisbano, noting the uncompensated care his facility provided totaled $ 2,300.

According to Bisbano, nursing assistants with wheelchairs were positioned outside Orchard  View Manor for more than a half an hour in the chilly night after the fire, waiting for the arrival of the traumatized elderly tenants.

“We called staff back to the facility who would later help to get them settled down and ready for bed,” he said. Management staff even came back to the facility to process the necessary paperwork that included a list of the new admission’s medications.

Ultimately, administrator Donna Amaral, of Eastgate Nursing and Recovery Center, along with administrators from Waterview Villa Nursing and Rehabilitation Center and Hattie Ide Chaffee Home, responded to Hawkins pleas for help for facilities to temporarily admit the displaced elder tenants.

“This was the first time in my 22 years as an administrator that I opened up my facility to help out in a crisis,” Amaral told All About Seniors, estimating  her East Providence-based facility provided at least $ 2,500 in free care, food and lodging, to six elderly residents.

Besides getting the residents fed and ready for bed, Amaral stressed how her staff had to locate medications for one of her unanticipated guests. One of her newly admitted tenants came without his insulin, and she quickly made arrangements with a local pharmacy for replacement insulin.

Hawkins recounted one elderly man was ultimately too confused to return to his apartment at Taunton Plaza and was late admitted to Amaral’s facility, Eastgate Nursing and Recovery Center.

Upon arriving with no shoes or jacket, Jack Heren, the facility’s food manager, took off his brand-new  sports jacket and gave it to a shivering man. “He sept wearing his new jacket that first night,” said Hawkins, who noted the man treasures the gifted jacket and has not taken it off since his admission to the facility.

Although the R.I. Red Cross and Picerne Management Group, the owners of Taunton Plaza, along with some of the elderly tenants and their families thanked the Alliance and nursing facilities for their assistance, local media did not report the acts of kindness.


It is disappointment the local press did not recognize the local nursing facilities were there and ready to take all of the residents, if necessary,” said Bisbano. “While it ultimately does not matter that we weren’t recognized, nursing facilities are here to serve the community and are prepared to deal with disasters like that fire.”

Hugh Hall, president of the R.I. Health Care Association, a trade group representing a majority of the state’s nursing facilities, added, “I don’t think that there is much positive news in general as we would like to see including positive articles about nursing facilities.

“When this type of crisis [fire] happens, the long-term care community rises to the occasion, to assist, and always will,” says Hall.

Hawkins weighted in on the issue of positive news coverage of nursing facilities, too.

“While local television stations covered this fire, they never really identified the real heroes, that is the nursing facilities, the police and firefighters, who in times of disaster help people they don’t even know,” she said.

“Couples fall in love and even get married in facilities with the assistance of staff. Nursing assistants oftentimes become family to residents, comforting them when they are sad, frightened or dying. We hardly read about these good deeds either,” said Hawkins.

For this columnist, hats off to the East Providence police and firefighters, the nursing facilities and their dedicated staff who briefly provided quality of care for the displaced traumatized elderly tenants and to the Alliance for Better Long-Term Care. Positive news and acts of kindness will be reported and real heroes recognized in this column.