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.

Alliance for Better Long-Term Care Celebrates 25th Anniversary

Published in Pawtucket Times on October 20, 2003

Next Friday, nursing home advocates, state officials, residents and their families and friends along with long-term care providers are invited to North Kingston to celebrate the 25th anniversary of the Alliance for Better Long-Term Care.

With its emergence on the advocacy scene in 1988, the Alliance for Better Home Care (later renamed the Alliance for Better Long-Term Care) has effectively defended the rights o those who can no longer speak for themselves – the elderly who receive care in the state’s nursing homes. Later in the late 1990s, the nonprofit group expanded its advocacy role into the assisted living, home care and hospice sectors. (This would result in the above-mentioned organizational name change).

Back in 1986, a thirty-something Roberta Hawkins had just raised her two daughters, Robin and Cindy. The former facility worker with 15 years’ experience under the belt working at Warwick-based Levitons Manufacturing Co., sought out a new career in human services.  Hawkins enrolled at Rhode Island College to become a  social worker.

At this time, she joined the federally funded program, Volunteers in Service to America (VISTA) “to make a difference.”

Hawkins would later be assigned to assist low-income Rhode Islanders in applying for eligible federal and state benefits. However, poor nursing home care provided at the Rhode Island Nursing Home in Providence would later lead to refocusing of the nonprofit group’s mission, one that would aim to protect the health and dignity of the Ocean State’s growing nursing home resident population.

With VISTA funds and small grants drying up at the beginning of the Reagan years, around 1888, Hawkins’ nonprofit group received funding from the Department of Elderly Affairs to refocus her group’s new advocacy role in the state. The Alliance for Better Nursing Home Care was born.

Hawkins, along with six fellow VISTA volunteers, would later form the staff of the newly created statewide, advocacy group.  Three years later, Hawkins would take over the helm of the group.  Three years later, Hawkins would take over the helm of the group. Ultimately, she would become the sole staffer, with an organizational budget of $ 8,000.  Volunteer staff, consisting mostly of family members of nursing home residents, would help Hawkins formulate advocacy strategy, recruit new members, write and disseminate a newsletter and organize fundraisers.

Twenty-five years later, Hawkins Alliance for Long-Term Care has an operating budget of $ 770,000 with a staff of 14 people and a core group of 40 volunteers.  Several years ago, the Department of Elderly Affairs (DEA) out-sourced ombudsman duties to this non-profit group.

Since its inception, the Alliance for Better Long-Term Care has assisted families in both understanding and choosing the most appropriate care setting to place their loved ones, said Hawkins, in a multiple of care settings – from assisted-living nursing homes or to their own homes, through the provision of home care services.

As the state’s official ombudsman agency, Hawkins and her staff work to educate family members and residents of their state and federal rights.  Care complaints are investigated a resolution mediated between residents and the long-term care providers.

As an advocate, Hawkins testifies on behalf of nursing home residents at legislative and regulatory hearings.

Where does Hawkins go from here?

Hawkins said she looks forward to making  bigger changes in the Ocean State’s long-term care delivery system.

“When delivering services, state agencies sometimes cut people off from the services when they reach a certain age,” like rehabilitation and mental health services, she said.  “That’s totally inappropriate,” she adds.

Hawkins also told All About Seniors she will continue to work toward “putting the home back into nursing homes.” The facility must truly become are a resident’s home, she urged.

Rhode Island’s most visible nursing home advocate also wants to see facility staff adequately paid for the valuable work they perform.

“We must get rid of the staff that do not care about providing good care to the elderly and keep those who really do, by paying them livable wages and providing a good working atmosphere,” she said.

Hawkins has gained the respect of a wide variety of state officials, aging advocates and providers in her 25 years of advocacy.

Lt. Gov. Charles Fogarty, who worked with Hawkins when he was a state senator and as chair of the state’s Long Term Care Coordinating Council (LTCCC), said Rhode Island is fortunate to have such a dedicated and committed advocate.

“We all sleep better at night knowing that she is there for us to advocate on behalf of the thousands of frail and vulnerable elderly in long-term care settings,” he said.

Lucille Massemino, administrator of Charlesgate Nursing Center, a Providence-based 160-bed skilled nursing facility and a former m ember of its board of directors, said she sees Hawkins as a passionate advocate pushing for the quality of life of nursing home residents.

“She is very assertive with administrators, knowing the needs of residents and prodding facilities towards fulfilling those needs,” she said.

Meanwhile, Hugh Hall, president of the Rhode Island Health Care Association has seen Hawkins in action over the past 18 years, working tirelessly for the improvement of Rhode Island’s long-term care services.

“She has lobbied the state legislature for better care in nursing homes [urging lawmakers to pay facilities an adequate reimbursement rate and calling for the state to address a nurse staffing shortage],” he said.

Hawkins said she plans to stay around as long as she is effective and as long as her passion to fight for nursing home residents remains. For the sake of the tens of thousands of Ocean State seniors and young disabled people who need long-term care services, hopefully we’ll see her around advocating on their behalf for a long time to come.