Revisiting How to Select a Nursing Home
To keep updated on the number of deaths in each of the nursing homes, because of the coronavirus, in New York State please go to https://www.health.ny.gov/statistics/diseases/covid-19/fatalities_nursing_home_acf.pdf (4/20/20)
(5/27/20)-In her May 25 article in the NY Times entitles “Outbreaks Force a
Harder Look at Nursing Homes by Paula Span writes: “A New York Times analysis as of last Thursday showed that more than
34,000 deaths-37 percent of the nation’s fatalities from Covid
19-occurred among residents and staff members in long-term care facilities. In
15 states, long-term care accounted for more than half of all Covid-19 deaths.”
(4/23/20) In their article in the April 22 edition of the New York Times “Crisis Pushes Elder Homes to the Brink” written by Matthew Goldstein, Robert Gebeloff and Jessica Silver-Greenberg, the journalists point out several of the items we discussed in this article.
Many of the nation’s nursing homes and assisted living facilities were in deep financial trouble even before the COVID-19 pandemic, and now because of it, are over the edge into bankruptcy.
“Nursing homes for about 1.5 million people in the United States and 70 percent of the 15,400 are run for profit. While the financial picture of the industry, which also includes homes run by government agencies and nonprofits, was hardly rosy before the virus struck, it was especially precarious for many for-profit nursing homes.”…
“The industry is increasingly relying on the government for another form of support. The Department of Housing and Urban Development guarantees $20 billion in mortgages to more than 2,300 nursing homes-about 15 percent of the country’s total, up from about 5 percent a quarter century ago.”
(4/16/20)- There is an article in the April 15th edition of the New York Times entitled “Nursing Homes Deaths Top 3,800, with 45 at One Virginia Site” by Danielle Ivory, Nicholas Bogel-Burroughs and Mitch Smith in which it is stated:
“The Times has identified more than 2,500 nursing homes and long-term care facilities across the United States with cases. More than 21,000 residents and staff members at those facilities have contracted the virus, and more than 3,800 have died.”
(4/1/20)- More than 1,000 nursing home residents in New York state have tested positive for the coronavirus and nearly 15% of the state’s recorded deaths, according to a spokesman for the New York State Department of Health.
There were 1,050 confirmed cases of the virus in licensed nursing homes at 155 distinct homes, according to the department. There are more than 600 nursing homes licensed in New York State.
About 700 of these cases are in New York City nursing homes, and this number will surely continue to grow.The state Department of Health has instructed nursing homes that they must axccept patients who have been treated and discharged for COVID-19 in hospitals.
(3/26/27)-The Centers for Medicare and Medicaid Services announced that it temporarily intends to halt routine inspections of nursing homes to focus on the most dangerous situations, as COVID-19 continues to spread in nursing homes throughout the country.
“Right now, the biggest threat to our nursing home residents is the coronavirus,” said Seema Verma, the CMS Administrator. The regular inspections will be paused for 3 weeks.
(3/6/20)- Statistics from China show that nearly 15 percent of those 80 or older who have been infected with the Covid-19 virus die from it, while about 8 percent of those infected with the disease will die from it. This age grouping constitutes a little over half the patients in the 15,700 nursing homes in this country covered by the Centers for Medicare and Medicaid Services (CMS).
The CMS issued new guidelines that updated procedures to deal with the outbreak of the Covid-19 outbreak. Included in the new guidelines are limitation on visitors to patients in the home who come from, or have visited certain countries
Infection control procedures are updated and staff training instructions are reinforced. The Centers for Disease Control and Prevention (CDC) also issued new guidelines calling on the homes to restrict visitors who have respiratory illnesses or who are running a fever.
For updated information on the Covid-19 virus infection please go to:
https://www.cdc.gov/coronavirus/2019-ncov/summary.html
(5/20/18) In a recent article in the NY Times, it was highlighted that using the federal Nursing Home Compare website could not be used as the sole determinant in selecting a home for a loved one or friend. The Centers for Medicare and Medicaid Services (CMS) estimates that this tool will be used about 2.4 million times in 2018.
The ratings are updated every 12 to 15 months by on-site inspections, but 2 of the 5 categories in the rating evaluation, namely staffing and quality measures, are reported by the homes themselves.
The major shortfall in the star-rating system is that they do not take into account how the residents and their families feel about the home they are living in.
The most important item to be used in evaluating a home is the fact that you must visit the facility, talk to the staff and residents so that you can find out first-hand how good the home is. Check out the food in the cafeteria of the home.
Nursing Home Compare will be requiring homes to submit timecards quarterly. Use Yelp and other consumer reviews to check out the facility
(9/15/17)- In the article “Families Fear for Elderly Relatives in Path of Tempest” by Melanie Evans and Ann Jean Whalen in the Wall Street Journal “One in five Florida residents is age 65 or older, according to the July 2016 Census Bureau, estimates, compared with about 15% nationwide. The nine southern counties of Florida include 1.3 million residents over 65, of whom 320,000 live alone according to the Census estimate.
Thirty Florida hospitals and nearly 400 nursing homes, assisted living and other health care facilities had announced evacuations as early as Sunday evening, according to the state’s Emergency Operations Center”.
(2/24/15)- As we noted in our item dated 2/15/15 below, the Centers for Medicare and Medicaid Services (CMS) has readjusted the methodology it uses to award stars on its NursingHomeCompare.gov website that is the gold standard used by most consumers in evaluating nursing homes.
As a result of this readjustment only about 50% of the 15,000 nursing homes being evaluated received 4 or 5 stars, as opposed to the approximately 80% that attained this level before the change. The number of homes receiving one star in the quality area increased from 8.5% to 13%. The website gets about 1.3 million viewers a year.
The changes that took effect were mainly aimed at two of the 3 major criteria used to rate the homes on the site. Two of the three major criteria used to rate operations at homes, namely staffing levels and quality measure statistics, had been reported by the homes themselves, and these figures were not audited by the government.
A change was made last October when the federal government required nursing homes to report their staffing levels quarterly, using an electronic system that could be verified by payroll data. An auditing system was also installed that could double check the quality statistics that the homes were reporting.
The changes led to a decline in the quality measure for 63% of the homes. The staffing levels fell by about 13% under the new system
(2/15/15)- Thomas Hamilton, the director of the survey and certification group at the Centers for Medicare & Medicaid Services announced that it would be changing the way it measures nursing homes, making it more difficult for them to earn 4 or 5-star ratings.
Nursing homes are scored on a scale of one to five stars on Nursing Home Compare, the federal website that has become the gold standard for evaluating more than 15,000 nursing homes in the Medicare-Medicaid system.
In October, the federal government required nursing homes to report their staffing levels quarterly, via an electronic system that can be certified with payroll data. It also began a nationwide auditing program to check on the accuracy of a home’s quality statistic.
Eleven percent of the nursing homes rated 5-stars in 2013, the latest year this information was available.
The federal government is making it harder
for nursing homes to get top grades on a public report card, in part by
increasing, for the first time, scrutiny of their use of anti-psychotic drugs
and raising the bar on an array of other quality measures.
(8/27/14)- Kate Thomas, in an article that appeared in the August 25 edition of the N.Y. Times, entitled “Ratings Allow Nursing Homes To Game System” points out that just because Medicare rates a nursing home “five stars” doesn’t mean you can forgo an onsite visit to a prospective nursing home yourself. We reiterate that the most important item in the selection process is your own visit to the institution.
The problem in relying on the federal rating system is that many of the criteria used to determine the rating come from the home itself. She wrote: “in 2009, when the (rating) program began, 37 percent 37% of them received four-or-five-star ratings. By 2013, nearly half of them did.”
The article goes on to state that more than 95% of the homes on the list received one or two stars for the health inspection, which is conducted by state workers. The government does not verify the data reported by the nursing home
Medicare plans to introduce the rating system for hospitals, dialysis centers and home-health-care agencies.
Three criteria are used to determine the homes rating, two of which are reported to Medicare by the homes, those being staffing levels and quality statistics. The third criteria is the health inspection done by state inspectors.
(4/25/14)- Democratic Governor Andrew Cuomo of New York created a Medicaid Redesign Team in 2011 aimed at reining in the state’s escalating costs for Medicaid residents of nursing homes. One of the results of this effort was a plan to provide long-term care for as long as possible that is less expensive than nursing homes.
Starting June 1, everyone in a nursing home in New York State will need a contract with a managed long-term care plan. Medicaid does not pay the same daily rate for its beneficiaries as does private paying residents. Many of the non-profit nursing homes have a higher cost structure than the for-profit companies, which may result in them losing residents to the other type facilities.
To meet this challenge, many nursing homes have added home-care services, day-and-night care aides, assisted living facilities and independent middle-and- low income housing operations to their portfolios. They no longer are just “nursing home” operations.
The Hebrew Home at Riverdale has expanded its operation to include these added choices and will be changing its name to reflect this fact to the River-Spring Health.
(3/3/09)- We recently received this e-mail, and included Harold's response to it:
----- Original Message -----
From:
To: hrubin12@nyc.rr.com
Sent: Sunday, February 15, 2009 9:32 AM
Subject: H E L P
I found a piece of paper in an old laptop case with your e-maIL
address. How fortunate for me. I am presently faced with a difficult situation.
My mom lives alone in Manhattan, she is 92 and needs some assistance when going
food shopping and doctors
appointments. Her only income is social security. I live upstate. Any suggestions
would be greatly appreciated. Thank you.
Here's Harold's response:
There are services available in NYC for older individuals who need
assistance in independent activities of daily living (IADL). Have you tried
contacting Dorot on West 85th St in Manhattan
(212-769-2850), the Burden Center on the East Side (212- 535-5235)?. Also call the Office of Aging in NYC (212-442-3086). She
may be eligible for CityMeals on Wheels program
(212-687-1234). Explain the situation to them and ask for resources to help your
mother. If this doesn't work, let me know and I will suggest other sites.
Harold Rubin
Coeditor
(2/17/09)- We recently received this email and have added it to this article
along with Harold's response:
Subject: Questions about medicaid
|
Dear
Harold, |
Here's
Harold's response:
Hi ( ):
Your dilemma is
one faced by many other children in our society. There are no absolute right
answers. One has to deal with ones own intrapsychic
as well as interactive feelings. We faced it with our mother a number of years
ago, although Alzheimer's was not an issue. We would suggest you consult the
many free services available to individuals in their community. For example, in
NYC, there is the Dept. of Aging staffed by experts in the area of long term
care (see : http://www.nyc.gov/html/dfta/html/caregiver/long_term.shtml)
for more information. I am sure there are State Offices of Aging in your
parents area, which I am assuming is somewhere out on the Island. Another helpful
source of info is the non profit agency FRIA (see: http://www.fria.org/fria/). Is there an
adult day care center in your parents area. Why not
arrange a visit with them to discuss your parent's needs and see what turns
out.
I am not
clear what service you are getting for the $5000. Are they guaranteeing he will
get on Medicaid? Are they providing geriatric social service? etc. I read the information on the web site. I do not find
any statement as to Mr. (edited) credentials. His agency does offer a wide
range of services and he states he knows a lot of people in the
Medicare/Medicaid system which is always good and quotes a high success rate.
Some of the statements sound overblown. There is no "news bulletin"
after 11/06. Why not? As far as costs are concerned, Geriatric Social workers
do perform this kind of service on an hourly basis. Assuming $100 per hour,
this means 50 hours of work. Seems an awful long time for what?. Again, the question what are they actually doing beyond
putting the application into the system. NO ONE CAN GUARANTEE RESULTS despite
past performance. That is always a red flag for us.
The real
answer however is how much work are you ready to put into this project yourself
or is your time worth the money to have others do it for you. Only you can
answer that question. We felt the time we put in going around to different
sites, reading what others had to say and then using the available community
resources for information was all we needed to make an optimal decision on
where to place our mother. No place met all our needs, but when we prioritized
them, we found the place that most likely fit. Importantly, we made sure that
the site we ultimately picked knew us and knew that we would act as an advocate
for our mother.
I am sorry,
but we have a policy of not recommending a specific service provider because
each situation is individualized and the needs are not like the dating services
that exist.
Please feel
free to contact us with any of your questions.
Harold Rubin
Coeditor
(2/07)- 3. A
report issued by the Lewin Group (accessed January 26, 2007 at http://www.lewin.com/NewsEvents/Publications/) indicated,
in a study released in November 2006, that the
use of nursing homes by the oldest seniors, aged 85 and older, has sharply
declined. The use rate among this group fell from 21.1% in 1985 to 13.9% in
2004. At the same time, alternatives such as assisted-living facilities
continued to develop. Approximately 1 million residents with an average age
over 80 live in these facilities.
(1/3/07)-
According to a report from the office of Scott M. Stringer, the Manhattan
borough president, the New York State Health Department does not sufficiently
monitor the evacuation plans that nursing homes are required to maintain.
The report
found that the evacuation plans are not accessible to residents and family
members; that there are no guidelines for how to evacuate a nursing home if
transportation routes are blocked; and that there was no clear authority to
decide whether a given home should be evacuated.
Mr.
Stringer's office reviewed plans provided by 40 of the 180 nursing homes in the
city and interviewed 28 nursing home administrators.
The
evacuation plans of the homes that participated in the study varied from 2
pages to more than 200 pages. Marc E. Carey, a Health Department spokesman,
said the agency had not seen Mr. Stringer's report.
(1/10/06)-
The Nanking East Road Neighborhood Committee in Shanghai has taken to publicly
shaming people who neglect their elderly parents, The Shanghai Daily reported.
The council gives two warnings to children who fail to visit their parents at
least once every two weeks. After that, their names are posted on a public
bulletin board. In another part of the city, a government home for the elderly
is fining children for missing weekend visits, the paper said. (AP)
(1/8/06)-
Congress recently enacted changes in Medicaid coverage for nursing home care so
that a nursing home resident whose home equity exceeds $500,000 would not be
eligible for Medicaid coverage. A provision in the rules would allow individual
states to increase this limit to $750,000
The changes
enacted allow states to charge higher premiums and higher co-payments for a
wide range of Medicaid benefits, including prescription drugs, doctors'
services and hospital care. Medicaid recipients can be charged 10% of the cost
of any item or service if their family incomes were 100% to 150% of the federal
poverty level, $12,830 to $19,245 for a family of two. Recipients above that
can be required to pay 20% of the cost of any item or service.
Total
co-payments for all people in a family cannot exceed 5% of family income.
States would not have to provide a Medicaid recipient with all the services now
required by federal low, but can off a more modest package of benefits
resembling commercial insurance. States will be allowed to end Medicaid
coverage for people who fail to pay premiums for 60 days or more. Pharmacists
can refuse to fill prescriptions and doctors and hospitals can deny services
for recipients who do not make required co-payments.
(12/29/05)-
With the new Medicare prescription drug coverage plan due to go into effect on
January 1, 2006 many nursing homes are desperately trying to find out who will
pay for the medications being taken by its residents. About two-thirds of the
1.5 million residents of nursing homes are participants dual eligible in both
Medicare and Medicaid. Under the new law dual eligible beneficiaries have been
assigned randomly to one of the drug plans. Finding out which plan they have
been assigned to has become difficult to ascertain.
Each plan has
its own formulary, unlike the previous system where most nursing home residents
were covered under Medicaid. Medicaid paid for all the drugs used by residents
who were eligible for this type coverage. The Bush administration has sent
letters to people who were entitled to the dual coverage, announcing that
Medicaid coverage of their prescription drugs would end on January 1.
The nursing
homes were promised that online queries to a federal Web site or faxes
containing lists of beneficiaries could be submitted to the Center for Medicare
and Medicaid Services, and they would receive responses within 3 days. Now the
agency said that the responses would be received back in 10 days but even this
is not happening.
A federal
contractor, NDCHealth, is loading information onto
the Web site of the CMS, but the company said that it does not have the full
data needed for the system to work as originally planned. A spokesman for the
CMS said all information would be available very shortly.
In New York
the dual eligible have been assigned to one of a possible 15 plans, according
to the State Department of Health.
(9/26/05)-
Hurricane Katrina brought into the limelight the failure of many nursing homes
in the New Orleans area to properly execute the evacuation plans they had in
place during the emergency. St. Rita's, the nursing home in
New Orleans where the owners have been charged with the deaths of 34 of its
residents, had an evacuation plan, but failed to execute that plan.
A hurricane
and flood is a more unusual occurrence… an evacuation caused by a fire for example
is not that unusual an event. Every nursing home that receives payments from
Medicare or Medicaid must have an evacuation plan in connection with any
emergency that may arise within the home. Section 483.75 of the federal manual
for state operators, requires that all nursing homes have a "detailed
written plan" in case of emergency.
Every nursing
home covered by Medicare and Medicaid must train all employees what to do in
case of emergency and also hold periodic drills to practice its procedures.
Title 10, Section 415.26 of New York State's health code provides for just
about the same requirements on a state basis. As we go on to state in this
article, length of service at the particular home of the staff is one of the
most important criteria that you should consider when comparing different
nursing homes that you may be considering for a beloved family member or
friend.
In 2004, 1%
of the nation's slightly over17,000 nursing homes were
cited for inadequate emergency preparedness. If you want to check on the
deficiencies cited by inspectors of the nursing homes you can either get this
information from the home itself or by going to www.medicare.gov/nhcompare/home.asp
The National
Citizens' Coalition for Nursing Home Reform has a Web site that can be quite
helpful to you in evaluating a nursing home. This site has links to ombudsmen
and regulatory agencies in each state. You can find this site at www.nursinghomeaction.org .
According to
a survey done by MetLife Inc. the average cost of a private room in a nursing
home increased by 6.1% for the period of July 2003 through June 2004 to $192 a
day. The state with
the highest monthly stay rate is Alaska, where it costs on average $561 per
day. In New York City the average cost is $312 per day.
The average
length of stay in a nursing home according to the study is 2.4 years. Figures from
the U.S. Bureau of Labor Statistics showed that the Consumer Price Index (CPI),
which is the most commonly used inflation figure rose by 2.7% for the period of
July 2003 through August 2004.
This same
study concluded that the cost of a home health-care aide remained the same as
it was in 2003 at an average of $18 an hour. The MetLife Mature Market
Institute, a research unit of Met Life started tracking long-term care rates on
a local level several years ago.
One of the
biggest complaints about nursing homes in general is that living in a home is
like living in an institution. In a pilot project to try and move away from
this system, 30 homes are participating in a pilot project to change the
cultural atmosphere in nursing homes. The pilot project involves personalizing
the living conditions in the home to the individual requirement of each
resident.
Under the
pilot project the resident is allowed to get up in the morning whenever he/she
wants to rise. The individual can eat his/her meal whenever he/she wants to eat
it. Each floor in the home has its own residential committee to deal with the
problems of that particular floor. Meals are not served on trays. The
individual is allowed to go to rehabilitation within his/her own time frame
(within limitations). As we learn more about the pilot project we will pass the
information on to our viewers.
It should be
noted that presently, 5% of the older population in the United States resides
in a nursing home. The probability of nursing home placement increases with age
and affects 22% of the population aged 85 years old. The over 85 age group
represented 1.3% of the population in 1990 and it is estimated will increase to
5.1% in 2050.
(8/14/05)- We
at therubins received another request for us
to recommend a nursing home. We are not begging the question when we say we can
give you suggestions as to what to look for when you look for a nursing home
for a beloved relative or friend, but only you can do the leg work to determine
what is best suited for that individual.
The following
is an answer that we sent a viewer in connection with this type of question:
Dear…
Seeing our
parents aging and beset with various conditions which seem to multiply by the
day is certainly not what we expected. We are left with hard decisions. In the
case of your mother, it would seem that someone should be making some attempt
to treat the depression you describe. The hospital that she is in may begin
this treatment. The treatment may enhance the quality of her life especially in
light of the information you provided in your email i.e..
you do not mention any physical illness.
Your question about "suggesting a nursing home" is one we avoid
answering because we think it involves gathering information about the home in
relation to your mother's personality and temperament as well as your sense of
commitment to visit her. Only you can have this information. No one can answer
that one for you.
Visit sites you are interested in. Check out the information available about
these sites on the web etc. It stands to reason that as a commuter to NY, you
would
seem more likely to visit "mom" at a sight closer to your home, than
your work, because visiting includes Saturday and Sunday, traditional days that
we do not work. We doubt you would want to come back to the city on your days
off.
We think the home we chose "worked" for our mother not only because
of the quality of care she got there, but also because we provided her a
personal source of pleasure by having almost daily contact with her: weekdays I
would spend my lunch time with her and my brother would visit after work;
weekends we would share time with her. This did not mean we didn't take
vacations or missed days, for we also spoke to her on the phone and had
standing orders to interrupt whatever we were doing during the day when she
called. We also arranged for relatives and the few remaining friends she had to
visit
her. We also made sure we didn't stay in her room. We took her out in the
neighborhood to the various stores. It gave her a sense of a community outside
the home, just as she might have in her own home.
We hope this email points you down a road to explore. Feel free to contact us
for more information. We would like to hear from you as to how you finally make
your decision.
Harold Rubin
Co-editor
www.therubins.com
(4/25/05)- As
Americans are aging so are our nursing homes. The majority of the 16,800
nursing homes in this country that house 1.6 million people were built in the
1960s. The industry's occupancy rate has fallen to 85%, from nearly 100% 15
years ago, according to Joseph Angelelli, an assistant
professor of health policy and administration at Pennsylvania State University.
The most
frequently asked question that we get at therubins in connection with nursing homes
is: "Can you suggest a nursing home to us for our loved one in the
area?" There is no answer to this question since the selection of a
nursing home is such an individualized decision. We are reprinting a recent
answer to such a query that Harold sent so that you can see what we are talking
about:
Dear:
Seeing our parents aging and beset with various conditions which seem to
multiply by the day is certainly not what we expected. We are left with hard
decisions. In the case of your mother, it would seem that someone should be
making some attempt to treat the depression you describe. The hospital that she
is in may begin this treatment. The treatment may enhance the quality of her
life especially in light of the information you provided in your email i.e.. you do not mention any physical
illness.
Your question about "suggesting a nursing home" is one we avoid
answering because we think it involves gathering information about the home in
relation to your mother's personality and temperament as well as your sense of
commitment to visit her. Only you can have this information. No one can answer
that one for you.
Visit sites you are interested in. Check out the information available about
these sites on the web etc. It stands to reason that as a commuter to NY,
you would seem more likely to visit "mom" at a sight closer to your
home, than your work, because visiting includes Saturday and Sunday,
traditional days that we do not work. We doubt you would want to come back to
the city on your days off.
We think the home we chose "worked" for our mother not only because
of the quality of care she got there, but also because we provided her a
personal source of pleasure by having almost daily contact with her i.e.
weekdays I would spend my lunch time with her and my brother would visit after
work; weekends we would share time with her.
This did not
mean we didn't take vacations or missed days, for we also spoke to her on the
phone and had standing orders to interrupt whatever we were doing during the
day when she called. We also arranged for relatives and the few remaining friends
she had to visit her. We also made sure we didn't stay in her room. We took her
out in the neighborhood to the various stores. It gave her a sense of a
community outside the home, just as she might have in her own home.
Harold Rubin
(3/13/05)- Do
private pay patients pay too much because Medicaid is shortchanging nursing
home operators? This is a very interesting question that is wending its way
through the New York court system. The state is being sued by the operators of
58 nursing homes around Rochester, and the southern tier of the state, alleging
that they are forced to charge private-pay residents exorbitant amounts to make
up for inadequate Medicaid reimbursement made rate by the state to the nursing
home operators.
The lawsuit
was filed in state Supreme Court in Rochester, seeking to have the state
recalculate rates based on current economic standards. The method for
calculating the rate has not changed since 1983. This in turn has put the
burden on the private-pay residents who have to be "overcharged" in
order for the nursing homes to stay solvent.
Medicaid
covers about 70% of nursing home residents. One of the private-pay plaintiffs
in the lawsuit is a 100-year old woman by the name of Anna C. Malone of St.
Ann's Home in Irondequoit, near Rochester. Whereas a Medicaid resident pays
about $56,940 at that home, Anna pays about $114,610.
Sixty-two
Buffalo, N.Y. area nursing homes lost a similar suit last year in that city's
Supreme Court, but the plaintiffs are appealing that decision.
(1/5/03)- The
nursing home industry, along with many other industrial organizations are quite
upset at the proposed new guidelines issued by the Occupational Safety and
Health Administration for controlling repetitive-motion injuries. These
guidelines were first proposed during the Clinton administration, but Congress
killed the rules shortly after he left office.
At issue are
proposed guidelines to control so called musculoskeletal disorders, or
MSDs-muscle, nerve and joint-related injuries.
According to the latest figures from the Bureau of Labor Statistics nonfatal
workplace ergonomic injury and illness rates (includes sprains, strains, carpal
tunnel syndrome, tendinitis, back and other pain and soreness) are about three
times as great in the personal-care industry as is the case for the private industry
average.
While it was
lobbying Congress to kill the guidelines set up by the Clinton administration,
the Bush administration promised the labor movement that it would establish a
new and better set of ergonomic and MSD rules and guidelines. Elaine Chao,
Secretary of Labor has stated: "We cannot do nothing."
The proposed
guidelines for the nursing home industry urge nursing homes to minimize or
eliminate the manual lifting of residents, using two or even three staff
members, and also utilizing a full body-sling when such usage would be
appropriate. The guidelines would also have the employees trained to identify
and mitigate tasks that exceed their physical capacities.
Employer
groups say the guidelines are too vague and too broad. They fear that subsequent
administrations will use these voluntary guidelines to justify violation
citations under the Occupational Safety and Health Act's "general-duty
clause". This clause requires employers to ensure safe and healthy
workplaces even in the absence of specific rules.
During a
session with nursing-home operators, OSHA officials discussed its recent
settlement with Beverly Enterprises Inc., Ft Smith, Ark.
Beverly agreed to adopt a worker-training program for lifting patients, and
other rules involving the lifting of the residents by the staff members.
Assistant Labor Secretary John Henshaw stated; "Our message is very clear
to our compliance officers that we will not use the guidelines in any way,
shape or form for any kind of enforcement."
Medicare
covers the cost of about 12 % of nursing home residents, since it pays for at
least a part of the cost for the first 100 days that a resident spends in a
nursing home. Medicaid covers about 70% of the cost for nursing home residents,
which according to the latest figures means it pays an average of $105 per day.
Medicare pays an average of slightly more than $300 a day for each Medicare
beneficiary in a nursing home during the period of coverage.
We have often
been asked if there is any site that is available to consumers where you can
compare the different nursing homes for different criteria of importance for a
prospective resident. One of the best sites that we know of to get this
information is the Medicare site that you can view at http://www.medicare.gov.
HHS Secretary
Tommy G. Thompson announced a new proposal to improve the quality of care for
nursing home residents by allowing for trained assistants to help residents eat
and drink. We think this is quite an interesting idea because of the fact that
the nurse's-aides and the nurses who are on duty during the meal hours need
help to ensure that all the residents are properly fed.
To show you
how difficult the meal period can be on the staff, let us say that each
nurse's-aide is responsible for the direct care of 10 residents. During the
meal hour the nurses on duty have the job of administering medications to the
residents so that they can be of very little assistance to the staff in helping
to feed the residents.
Suppose, as
is often the case, one or two of the nurse's-aides residents is
too ill or infirm to come to the meal. Usually one staff member handles the
feeding of all the residents who can not come to the
dining area. If too many residents can't come to the meal,
that may mean that the aide must take care of the feeding of those in
the dining area and also feed the resident who is too ill or infirm to come to
the dining hall. Some residents require a lot more of attention and help in
eating the meal.
Under the
Centers for Medicare and Medicaid Services (CMS) proposal, the trained feeding
assistants would be required to complete a state-approved course in order to
qualify as a trained assistant. CMS will publish the proposed rule on feeding assistants
in the March 29 Federal Register, with a 60-day comment period open to all to
comment on. The CMS will then review all comments and make any needed changes
before issuing a final rule.
It has now
been over 4 years since our mom has passed away, and we continue to visit the
home where she resided for 4 1/2 years. I have become a volunteer for NY Cares
and I work as a volunteer transporter one night a month at that home. Some of
the residents who were there when our mom was there continue to reside at the
home.
I do also get
a chance on the evening when I am there to visit with the nurses and
nurses-aides, guards, porters and kitchen help who I came to know so well when
our mom resided there. Most of the old staff is still there, and it is a pleasure
to be with them again even if it is only for a short while. Please remember
that one of the keys in checking up on a nursing home is to see whether or not
the staff has been there for a long period of time.
Although the
floor where she resided had been converted to a sub-acute care unit, a smaller
wing had been given over to the long-term residents to reside in. Incidentally
we were pleased to find out that New York Cares had established a regular
program over at the home, and that is quite helpful to the residents since it
expands their ability to socialize.
One of the
few negatives that we point out is the fact that the nurse's-aides must tend to
12 residents on the night shift as opposed to the 8 residents that they
attended to when our mom was there. Otherwise most of the conditions continued
to be as good as we discussed in the original article "Selecting a Nursing
Home".
A report
ordered by Congress and prepared by the Department of Health and Human Services
concluded that more than 90% of the nation's homes have too few workers to take
proper care of the residents. Instead of imposing new rules regarding staffing
the administration hopes that by publishing the data, "nurse staffing
levels may simply increase due to the market demand created by an informed
public." The report concluded that it would take $7.6 billion a year,
which is an 8% increase over current spending to reach adequate staffing
levels. The report and the administration's recommendations will be presented
to Congress shortly.
The report
stated that a resident needs an average of 4.1 hours of care each day. The
nurse's aide should provide 2.8 hours of that care, with the other 1.3 hours
coming from a registered nurse or a practical nurse. It would require the home
to have one nurse's aide for every 5 to 6 residents from 7 a.m. to 11 p.m.
According to Dr. John F. Schnelle, a co-author of the
report, over 91 % of the nursing homes do not have this level of staffing. On
average the homes would need to increase their staffing by 50% or more.
To reach the
recommended levels according to the report, nursing homes would have to hire
77,000 to 137,000 registered nurses, 22,000 to 27,000 licensed practical nurses
and 181,000 to 310,000 nurses' aides. Anyone familiar with nursing homes can
tell you it is difficult enough right now to get competent staffing in most
communities right now. But we must also look at the fact that proper staffing
levels will mean that conditions will improve and the residents will certainly
be better off as a result thereof. In addition simply setting numbers does not
take into account the condition of the individual resident or patient. Some
require much more individualized time than do others.
For an
interesting interview on the subject of nursing home staffing please see our
interview with Dianne Menio, Pres. National
Citizens Coalition for Nursing Homes. Donna R. Lenhoff,
Esq. is presently the Executive Director of the organization.To
see their excellent site which deals with the staffing at nursing homes please
go to http://www.nccnhr.org
In addition
to the increased expense that the homes would face, we also have to look at the
expense this would mean to Medicare and Medicaid. These 2 programs pay for
about 75% of the cost for the residents and patients in nursing homes today.
One of the most pressing issues facing Medicare right now is the matter of lack
of prescription drug coverage for Medicare beneficiaries. It is estimated that
it would cost about $1.4 trillion over a 10-year period of time to cover the
cost of an adequate prescription drug coverage plan for Medicare beneficiaries.
An article
appeared in the June 22, 2001 edition of the Wall Street Journal, which told,
of the efforts by Dr. David Morris to cut back on the number of medications
being taken by his patients at the Riverdale unit of the Hebrew Home for the
Aged. The doctor felt that many elderly people were being overmedicated unnecessarily.
We do not have enough knowledge on this issue to give an informed viewpoint but
one of the areas that needs improvement in nursing homes in general is the
adequacy of their medical treatment. Many qualified doctors do not want to work
in the "depressing atmosphere" that exists in a nursing home. If you
do have a relative or loved one in a nursing home, you should take an active
involved approach in dealing with the medical treatment being received by the
resident.
Recently we
have learned about the attempt by some nursing homes to cut back, if not even
eliminate outside members of the medical profession from being able to come
into the home to check up on their "healthy" patients. In both our
articles on nursing homes we failed to mention the fact that you should check
with the administration of the home to see whether or not your loved one's
doctor or other medical professional could make a professional call to visit a
"healthy" resident.
The
resident's family physician may know the resident's medical condition better
than a member of the medical staff of the home may know it. We are not
questioning the competency of the medical staff at the nursing home, but we
feel that you should make sure that the family physician or other medical
professional will be allowed to make periodic visits to check up on the
condition of a "healthy" resident.
Periodically
we like to go back to visit the nursing home where our mom resided for 4 1/2
years. We like to do this for several reasons. The main reason is to visit with
the many members of the staff who we admired and respected so much, and who we
became proud to call friends. It also gives us a chance to see some of the
changes that occur in a home as time elapses. We are proud to say that some of
the finest people we have met in our lifetimes came as a result of our mom's
stay in the nursing home.
First of all
we will reiterate that visiting a nursing home can be a tough, depressing place
to visit. When you choose a home you may wonder whether or not it was the
"best place" you could have chosen for your loved one. We believe
that our article "How To
Select a Nursing Home" will give you many helpful hints on this
subject. A visit to a nursing home may affect your perspective and values on
life.
Most of what
we wrote about in the article is still true today. Before selecting a home you
should be prepared to visit the site and see for yourself the future home of a
beloved friend or relative. We are not talking about the visit that you take
when the administrative individual takes you on the "guided tour".
Please take
the time to visit the facility on your own time. Visit the cafeteria or coffee
shop. Taste the food that will be served to the residents. Speak to some
visitors and some of the staff people and ask them what they like and dislike
about the home. Go into the common social areas and see for yourself what is
going on at various times of the day. Reading the material given to you by the
administration only gives you a superficial knowledge about the establishment.
Believe it or not, you can ask the local shopkeepers in the area what they
think of the facility and its staff.
When we went
back to visit we found that most of the staff was still working in the same
facility. They might have been moved to different floors, but the old-timers
were still there. We believe that one of the most critical items in evaluating
a home is to determine how long the staff has been there. If you find that the
staff has been there for a long period of time it usually means that they are
happy with the place that they work in. If they are happy it certainly means
that the working conditions are good. You can observe how clean the
establishment is kept. Again we reiterate that all homes will have a certain
amount of bad aromas, but is that the exception or the rule?
Most nursing
homes today are expanding more into sub-acute care and trying to cut back
somewhat on long term care. The
Medicare-Medicaid payment system is realistically forcing them into this
changeover. Find out by asking the administration if they are proposing any
cutbacks in this area.
The ratio of
residents to nurses-aides and nurses is climbing in most homes. Cost cutting
measures are constantly being undertaken by all nursing facilities. Once again
we reiterate that you must ask about these ratios and about any possible
changes that may be done within the next few years.
Visit the
various therapy areas that the home provides and ask about the religious
facilities that may or may not be available. Check on the elevators and the
waiting times for an elevator to reach you. Are the elevators manned by
operators or are they automatic elevators? Are transporters available to take
the residents to the different events or therapy sessions?
Even though 4
years have now elapsed since our mom passed away the criteria we set up in the
article on selecting a nursing home are still operative today.
The
Administration on Aging has an excellent database to help the consumer in his/her
search for a nursing home for a friend or relative. To find - Consumer
Information about nursing homes go to: http://www.aoa.gov There are
approximately 17,000 nursing homes in the United States caring for over 1.5
million older adults. This well-researched Administration on Aging web page
provides information for the consumer including facility directories,
statistics and research articles that are accessible on-line.
Please also
see our article " Additional
Information to Selecting a Nursing Home".
FOR AN
INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A
NURSING HOME SEE OUR ARTICLE "How to Select a Nursing Home"
By Allan
Rubin and Harold Rubin
updated April 23, 2020
http://therubins.com
to e-mail: harold.rubin@gmail.com
or allanrubin4@gmail.com