Nursing Home Care in the Spotlight

Published in the Woonsocket Call on August 4, 2019

Following on the heels of its March 6 hearing, “Not Forgotten: Protecting Americans from Abuse and Neglect in Nursing Homes,” the Senate Finance Committee held its second nursing home hearing this year, “Promoting Elder Justice: A Call for Reform,” on July 23, in 215 Dirksen, to study proposed reforms to reduce neglect and abuse in the nation’s nursing homes and to put a spotlight on the need to reauthorize key provisions of the Elder Justice Act.

During the two hour and twenty-minute morning hearing, Chairman Chuck Grassley (R-Iowa) and Ranking Member Ron Wyden (D-Oregon) along 11 members of the Senate committee listened to the testimony of five panel witnesses.

In his opening statement, Grassley acknowledged that the work isn’t done yet to improving the care in the nation’s nursing homes and Congress must protect nursing home and assisted living residents and those in group living arrangements from harm. The Iowa Senator noted in the recently released U.S. Government Accountability Office (GAO) report the federal agency that provides auditing, evaluation, and investigative services for Congress, noted that while one-third of nursing home residents may experience harm while under the care of these facilities, in more than half of these cases, the harm was preventable.

Calls for Bipartisan Efforts to Improve Nursing Home Care

Grassley called on Congress to reauthorize programs, such as the Elder Justice Act, to put the brakes on the growing trend of elder an abuse fueled by social media.

Adds, Wyden, in his opening statement, there is now an opportunity for Congress to come together to hammer out bipartisan legislative reforms to fix the nation’s nursing home oversight efforts. He urged his fellow Senate committee members to work to reduce the instances of physical, sexual, mental and emotion abuse in nursing homes, that appears to be increasing. He also called for a redo to the federal nursing home rating system because it does not reflect the increased prevalence of abuse.

During the first panel, Megan H. Tucker, Senior Advisor for Legal Review, of the HHS Office of Inspector General (OIG), stated that abuse and neglect oftentimes are not properly identified, reported or even addressed. While most providers are delivering good care, Tucker warned that Health and Human Service safeguards are lacking.

Tucker testified that the Centers for Medicare and Medicaid Services (CMS) should use data more effectively and close the gaps in their reporting process to ensure that abuse and neglect are identified and the deficiencies corrected.

Concluding the first panel, John E. Dicken, Director, Health Care, of the U.S. Government Accounting Office (GAO), discussed a newly released GAO report, released at the hearing, that detailed a growing trend of abuse and neglect of residents. According to one GAO report findings, abuse deficiencies more than doubled between 2013 (430) and 2017 (875), with the greatest increase in actual harm and immediate jeopardy deficiencies, and that abuse is still under-reported, he said. The GAO report also expressed concern over “significant gaps” with CMS’s oversight.

Leading the second panel, Robert Blancato, Coordinator of the Elder Justice Coalition, called on Congress to reauthorize, the Elder Justice Act. With elder abuse becoming a “national emergency,” he urged lawmakers to dedicate funding for Adult Protective Services at the local and state levels. Blancato also stressed the importance of strengthening the long-term care ombudsman program, continuing the Elder Justice Coordinating Council, authorizing an Advisory Board on Elder Abuse, Neglect, and Exploitation, and finally funding for elder abuse forensic centers.

President and CEO, Mark Parkinson, of the Washington, DC-based American Health Care Association (AHCA), representing nearly 10,000 of the 15,000 plus nursing homes in the country who provide care to nearly four million individuals each year, stated he was not at the hearing to defend poor care but to provide solutions to Congress to prevent such incidents from happening again.

Fixing the Problem

Parkinson testified that over the past seven years, facilities participating in AHCA’s quality initiative, have shown improvement in 18 of 24 quality measures. Specifically, there are less hospital readmissions, fewer antipsychotic medications being prescribed, staff are spending more time than ever before with residents and today’s nursing homes are more person-centered care today than ever before.

Parkinson called on lawmakers to improve employee background check systems, add patient satisfaction data to CMS’s nursing home rating system, address the severe staffing shortage and to adequate fund Medicaid.

Finally, Lori Smetanka, Executive Director of the National Consumer Voice for Quality Long-Term Care, ended the second panel discussions, by warning that more must be done to protect nursing home residents from abuse.

Smetanka urged Congress to take steps to enforce minimum requirements for sufficient staffing, establish standards and oversight for nursing home ownership and operations, prevent rollback of nursing home regulatory standards, increase the transparency of information and to strengthen and adequately fund elder justice provisions.

Now, with the Congress putting poor nursing home care on its policy radar screen, both Democratic and Republic congressional leadership must work closely together to come up with bipartisan solutions. Fix this problem once and for all.

Senate Finance Committee members — Senators Lankford, Stabenow, Daines, Menendez, Carper, Cardin, Warner, Casey, Brown, Cortez Masto, and Hassan – attended the July 23 hearing

To listen to this Senate Finance Committee hearing, go to http://www.c-span.org/video/?462733-1/finance.

For a copy of the GAO report, http://www.gao.gov/assets/710/700418.pdf.

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Survey: Older Americans Puzzled About LTC Programs and Services

Published in Woonsocket Call on July 19, 2015

Planning for your golden years is key to aging gracefully.  But, according to a new national survey looking at experiences and attitudes, most Aging Boomers and seniors do not feel prepared for planning or financing their long-term care for themselves or even their loved ones.

This Associated Press (AP)-NORC (NORC) Center for Public Affairs Research study, funded by The SCAN Foundation, explores a myriad of aging issues, including person-centered care experiences and the special challenges faced by the sandwich generation.  These middle-aged adults juggle their time and stretching their dollars by providing care to their parents, even grandparents while also financially assisting their adult children and grandchildren.

Older American’s Understanding of LTC

This 21 page survey report, released on July 9th, is the third in an annual series of studies of Americans age 40 and older, examines older Americans understanding of long-term care, their perceptions and misperceptions regarding the cost and likelihood of requiring long-term care services, and their attitudes and behaviors regarding planning for possible future care needs.

The survey’s findings say that 12 percent of Americans age 40 to 54 provide both financial support for their children and ongoing living assistance to other loved ones.   Federal programs are often times confusing to these individuals, too.   More than 25 percent are unsure whether Medicare pays for ongoing living assistance services like nursing homes and home health aides. About 1 in 4 older Americans also overestimate private health insurance coverage of nursing home care.

Researchers noted that about half of the respondents believe that a family member or close friend will need ongoing living assistance within the next five years. Of those who anticipate this need, 7 out of 10 reports they do not feel very prepared to provide care, they note.

More than three-quarters of those surveyed age 40 or older who are either receiving or providing ongoing living assistance indicate that their care includes at least one component of “person-centered care.”  This approach allows individuals to take control of their own care by specifying preferences and outlining goals that will approve their quality of life.

The survey also finds that most of those reporting believe that features of “person-centered care” have improved the quality of care

Paying for Costly LTC Services

The 2015 survey findings are consistent with AP-NORC survey findings from previous years, that is older Americans continue to lack confidence in their ability to pay the costs of ongoing living assistance.  Medium annual costs for nursing homes are $91,260; the cost for at-home health is about half that amount, $45,760, says the report.

Finally, only a third of the survey respondents say that they have set aside money for their care. More than half report doing little or no planning at all for their own ongoing living assistance needs in their later years.

“The three surveys on long-term care [by AP-NORC] are helping us create a comprehensive picture of what Americans 40 and older understand about the potential need for these critically important services,” said Director Trevor Tompson, at the AP-NORC Center in a statement. “Experts estimate that 7 in 10 Americans who reach the age of 65 will need some form of long-term care, and our findings show that many Americans are unprepared for this reality,” he says.

Dr. Bruce Chernof, President and CEO of The SCAN Foundation, says that the 2015 study takes a look at public perception regarding long-term care and most importantly, how people can plan for future long-term care needs.  “The insight provided by this research is critical because it will help us promote affordable health care and support for daily living, which are essential to aging with dignity and independence.” he says.

AP-NORC’s 2015 study results are validated by other national research studies, says AARP Rhode Island State Director Kathleen Connell.    “AARP’s research, both nationally and state by state, reveals that people in the 50+ population are concerned about the cost of retirement and especially long-term care,” she says, observing that “very few people seem worry free on this question and rightfully so.”

 Beginning the Planning Process

Connell adds, “I would say our response to this survey is that it adds to the awareness that people need to start thinking about this at an earlier age. And that means not only focusing on saving but also getting serious about health and fitness.”

What can a person do to better prepare for paying for costly long-term care and community based services?   “AARP.org has an abundance of information on long-term care. There’s advice on long-term care insurance, a long-term care cost calculator and many other resources. We also need to remain strong as advocates for programs that support seniors. Social Security, Medicare and Medicaid need to remain strong in order to support Americans entering the most vulnerable chapters of their lives,” she says.

Amy Mendoza, spokesperson for the American Health Care Association (AHCA), a Washington, DC-based trade association that represents over 12,000 non-profit and proprietary skilled nursing centers, assisted living communities, sub-acute centers and homes for individuals with intellectual and development disabilities, calls for increased conversations to help planning for potential future need.  “Given that the need for long-term or post-acute care is a life changing event, it demands some considerable thought, discussion and research,” says Mendoza.

“AHCA’s “Care Conversations” program helps individuals have the honest and productive discussions needed to plan and prepare for the future long-term care needs,” adds Mendoza.  Care Conversations has a Planning Tools page on its website which provides information on advance directives. Learn more at: http://careconversations.org/planning-tools.

Todd Whatley, a certified elder law attorney, notes that some of his best clients are middle age adults who after taking care of their parents want to avoid costly nursing home or community based care services.  “They are then suddenly very interested in some type of [insurance] coverage for the extraordinary expense of long term care when a year earlier, they had no interest whatsoever,” he says.

Whatley, President-Elect of the Tuscan, Arizona-based National Elder Law Foundation, suggests contacting a financial planner or Certified Elder Law Attorney when purchasing long term care insurance, “Get early advice from someone with their best interest at heart.  There are many times that a person simply doesn’t need this product financially, but most people do.

To locate a Certified Elder Law Attorney, contact Lori Barbee, Executive Director, National Elder Law Foundation.  She can be reached at 520-881-1076 or by email: Lori@nelf.org.

For a copy of the study, go to http://www.longtermcarepoll.org/Pages/Polls/long-term-care-2015.aspx.

Herb Weiss, LRI ’12 is a Pawtucket-based writer covering aging, health care and medical issues.  He can be reached at hweissri@aol.com.

 

 

The Best of…Little Things Count When Deciding on a Nursing Home

            Published April 23, 2001, Pawtucket Times          

           It isn’t easy operating a nursing facility these days.

           The high turn over rate of certified nursing assistants has drastically impacted the quality of care provided in facilities.  And this direct care staffing shortage is also financially hurting facilities too, reducing their financial stability, even pushing many towards bankruptcy.

          According to the Rhode Island Health Care Association, eight out of the state’s 105 nursing homes have filed for Chapter 11 Bankruptcy, two are currently in state receivership and two more were recently ordered closed by the Department of Health.

         In these difficult financial times for nursing facilities, especially with a state-wide shortage of certified nursing assistants, youmusts become a better shopper when seeking the most appropriate nursing facility to place your loved one.

       “Until there is a health crisis, families don’t often think about nursing facility care until it’s too late,” states Roberta Hawkins, executive director of the Alliance for Better Long Term Care who serves as the state’s ombudsman on the behalf of 10,000 Rhode Island nursing home residents.  “If  it’s possibly, just plan ahead,” Hawkins recommends.

      “Your state health department provides a comprehensive list of nursing homes and their survey results to help you determine if the facility is reputable,” states Hawkins.

       According to Hawkins, word of mouth or personal recommendations from family, friends, neighbors, hospital discharge planners, and her nonprofit advocacy group about a nursing home’s care are key bits of information to determine if the facility is well managed.

        “The Alliance also offers a free phone help line to assist matching the particular needs of a person with a specific facility,”  Hawkins adds.

       With more than 20 years of experience under her belt in assisting families find the right nursing facility for the loved ones, Hawkins gives simple tips on selecting a facility.

        Hawkins suggested that a need for upgraded services for residents requiring intensive medical care, special rehabilitation therapies and dietary requirements, along with religious and cultural needs should also be taken into account before selecting a facility.

       Location should not always be a deciding factor in selecting a nursing facility.  Carefully choose a facility that meets your loved ones medical, personality and social needs.

       In many cases, this critical decision is made only for convenience of family members or visitors.  If an elderly spouse can not drive, make sure that the selected facility is on a bus line.  Keeping a married couple close together is very important for their psychological well-being.

       Always have the older person in need of skilled nursing care, actively participate in choosing a facility even if they can’t physically visit the site.  Family members can also provide this person with brochures and admission materials.

      Don’t choose a facility on the basis of a beautiful physical exterior, fancy rugs, or glittering chandeliers, Hawkins says.  When visiting a nursing facility, always observe how staff members interact with residents and each other — look for laughter, a pleasant environment, and a strong activity program.

       For those frail residents who are bed bound, look for a stable nursing staff.

       Ask yourself, is the facility’s environment cheerful in appearance and clean?

        Are the bedrooms warm looking and do they reflect the residents individuality?  Or do they all look the same, like hotel rooms.

        Find out if residents are allowed to bring in personal belongings such as chairs, tables, lamps or even a television set into their rooms.

        For those persons who always loved nature and being outdoors, find out if the nursing facility has an outside area for sitting or walking.  Determine if this area is accessible to a wheelchair bound person who might want to roll outside to listen to the birds.  This simple amenity is very important.

        When touring a facility determine if a dining room is available for eating meals and space to allow residents to socialize with each other and participate in activities.

         Is there a real working activities room?  A resident who has always been involved in crafts and enjoys participating in group activities will want to select a facility with a well-run activities program.

         Also, be aware of how the nursing facility smells.  Sometimes you may smell strong odors of deodorants.  This might be covering up unpleasant odors.

        Listen for sounds of buzzers, rung by residents in need of help, and observe how quickly staff responds.

         When walking the halls, say “hello” to the staff you meet.  Do the staff pleasantly respond to you?  IF not, consider that they may not respond           well to your loved one.

         Walk in and talk with residents gathered in a community room.  In conversation, find out how long they have lived at the facility.  Ask if they like the facility and are they respected as individuals by staff.

         If you see residents in restraints lying or sleeping in a chair or wheelchair, this may be a red flag for poor care.  The facility may not have enough staff to allow the residents to lay down in bed for a nap in the afternoon.

         After you locate your facility, “put your name on the waiting list,” Hawkins recommends, even if the nursing facility admissions will occur months later.

         For those afflicted with Alzheimer’s and related dementia, it is wise for these individuals to be admitted earlier in the disease process to get them acclimated to the facility and for the staff to learn more about the resident’s habits, likes and dislikes.

        Herb Weiss is a Pawtucket-based freelance writer covering aging, health care and medical issues.  This Column appeared in the Pawtucket Times on April 23, 2001.