nursing homes | Distance Learning Systems (DLSI)

Care Lapses in Nursing Homes

Eight Connecticut nursing homes have been penalized by the state Department of Public Health for lapses in proper care. On Nov. 7, Beacon Brook Health Center in Naugatuck was penalized $2,180 in relation to a citizen who passed away May 23 of cardiopulmonary arrest and a bowel impediment, DPH records show. DPH discovered that the house’s healthcare record did not indicate that an abdominal evaluation was done on May 23 after the citizen reported of feeling sick and a stomachache on May 22. Also, healthcare records did not indicate that a doctor had seen the citizen after May 21 and the home did not have a policy about stomach tests. On May 23, the citizen was discovered without a pulse and CPR was started. The citizen passed away after paramedics came and took over the CPR.

In a similar case, a Beacon Brook citizen with congestive heart failure incorrectly was not given drugs for fluid retention and no excess weight factors were mentioned in the resident’s history that would have activated a doctor’s notice. The citizen gained nine pounds between July 10 and July 21 and was put in the medical center for difficulty breathing and liquid excess. DPH discovered that the drug was mentioned in a doctor’s purchase but not in the drugs history, so the elderly care facility ceased providing it to the citizen on July 9. The citizen spent five days in the medical center.

Beacon Brook’s manager, Betty Garcia, said that the occurrences happened before she took over, so she could not comment. On Nov. 6, Manchester Manor Health Care Center was penalized $2,250 in connection with two occurrences, including one on May 29, when a nurse’s assistance had left a citizen in a bathroom, heard a thump and then discovered the citizen on his or her legs with a deep cut on the temple. The cut required five stitches to close and personnel discovered that the assistance had breached a safety rule at the nursing home by leaving the citizen alone.

A health professional was observed on Oct. 30 providing a citizen with Alzheimer’s disease coffee without a lid in breach of a doctor’s order that the citizen be given a lid on all hot drinks. State records show the citizen had been burnt off on the hip and legs Aug. 2 and on the stomach on Oct. 2, after dropping hot coffee that was provided without a lid. Administrator Jane Ellen Gaudette said the staff has been retrained since the occurrences and the property is in full conformity with state guidelines. These lapses in care, although minor can have very relevant effects in nursing homes.

Nursing Homes and Assisted Living Dilemma

For family members across Kansas and Missouri, struggling to choose the right service to take care of an aging beloved with Alzheimer’s disease or dementia, an important aspect of the decision is understanding the differences between nursing homes and assisted living. It is a dilemma Mitzi McFatrich deals with every day as the executive director of Kansas Advocates for Better Care, a non-profit advocacy organization assisting elderly care service residents and or their family members. “There are so many of us that are aging and a large number of those individuals are going to have Alzheimer’s disease and dementia,” she said. “How are we going to fulfill their care needs?”

People often mix up nursing homes and assisted living facilities, but the two are not exactly the same. A nursing home provides health care to Alzheimer’s disease and dementia patients, with RNs on-site eight hours a day. In Missouri and Kansas, assisted living facilities employ RNs on a limited basis. Because assisted living facilities receive health insurance funding, there are strict state and government regulations on staff training, the number of employees required per shift and the level of cleanliness. There is zero government oversight for assisted living centers; very few state rules. Medicare often pays most of a patient’s elderly care service bill. In assisted living facilities, a resident’s family must shoulder the whole cost.

While a nursing home service agrees to become a permanent residence for individuals no matter their disease, a person who’s Alzheimer’s disease or dementia worsens can be discharged from an assisted living service. The director of education, programs and public policy for the Alzheimer’s Association, Heart of America chapter, Michelle Niedens says these care facilities can evict a resident in as little as 30 days. “There’s often an over promising; ‘We can handle your mom and dad, through the whole disease course,’ that is, until some major bump occurs and then the game gets changed,” Niedens said. According to McFatrich, facilities will say, “We can no longer fulfill this person’s needs. And that’s what they use in order to release someone.” That release or eviction can affect a family’s ability to find their loved one a new house.

Neglect in Nursing Homes

Many of today’s nursing homes are managed by thoughtless and selfish business people whose main objective is pleasing their investors. They are compensated with nice incomes and rewards for team cutting and other cost-cutting methods. Profits are spent in powerful lobbying groups that enjoy effective influence over law makers and authorities. These organizations respond to medical negligence legal cases, not with training learned and corporate mandate to improve care, but with tort change, introduced and passed into law by greedy and recompensed congress. Eighty percent of the sector’s payments come from community funds, Medical health insurance and State health programs and we are not getting our entire worth.

Health and Human Services revealed that medical health insurance paid $5.1 billion dollars for poor elderly care facility care in 2009. Harmless repercussions of poor care have taught this market that it’s more profitable to offer poor care and pay an occasional fine than it is to hire and train staff to offer proper care. Sequestration cuts are further weakening the bite of regulating agencies that view themselves as in “partnership” with the very market they’re charged with watching. Charges are meager, inconsistently gathered and do not act as preventives.

Silence and inaction are daily pointers that our community doesn’t want to think about old individuals suffering neglect and abuse in nursing. Even organizations with “aging” and “health care” in their titles don’t want to cross the nursing-home limit. The realities of life and death in nursing homes are too dark and our man’s instinct surrenders to more enjoyable matters. Accounts of abuse are as ignored as the sufferers themselves and reform supporters are continuously advised they can’t force individuals to good care. There are no children or pet dogs or cats to save in these experiences. They are old individuals who can no longer protect and defend themselves. Unfortunately, the number of individuals willing to rebel against this highly effective profit-motivated industry continues to be low. This is why true change and proper care remain out of our reach. We simply need more individuals to care and to be counted.

Nursing Homes Quality

Ohio tax payers are paying large numbers to nursing homes that don’t succeed to fulfill minimum state specifications for looking after their citizens, falling short of a bar many say is too low. Even three nursing homes on a government watch list for high numbers of inadequacies over long periods, two in Cincinnati and one in Youngstown, met Ohio’s quality measures, which give a passing quality even if a service flunks 75% of state specifications. In all, $12.7 million was invested to take good care of sufferers living in nursing homes that did not achieve at least five of 20 measures for great quality care, according to research for the financial year that ended June 30 from the Ohio Department of Medicaid. Still, less than 1% fell short of that standard, only nine of the 926 nursing homes. One has since closed. None is in central Ohio.

“We’ve got some good signs, but the floor is so low everybody can fulfill those,” said Robert Applebaum, home of the Ohio Long-term Care Research Project at Miami University. He also served on the advisory board that released suggestions to congress for enhancing care. “We need to do a better job of getting rid of bad-quality homes, but we also need to do a better job of reimbursing the high-quality homes.”

Medicaid, which provides coverage of health to poor and impaired Ohioans, will pay for approximately 70% of nursing-home care in the state. On average, the federal-state program includes about 58,200 long-term-care citizens. Last year, in an effort to improve institutional care, the state started demanding features to fulfill at least five of 20 high quality measures to earn a full State Medicaid programs payment, which earnings $165 a day per person. The measures include giving citizens meal options, enabling them to choose when they get up and go to bed and the opportunity to customize their bedrooms. The nine nursing homes unable to fulfill the mark lost 10% of the payment, or nearly $16.50 of the per-resident daily subsidy. Those funds are to be allocated to the more than 900 facilities meeting the standard.

Owning Nursing Homes

92% of county-owned nursing homes outside New York City lost money in 2010 and are struggling to survive, a report uncovered. Counties have been looking to leave the nursing-home business as expenses rise and as they face fiscal demands from flat tax earnings to pay for government operations. The report from the Rochester-based Center for Governmental Research said 33 areas own nursing homes, down from 40 in 1997. Eight, including Rockland County, are in the process of selling their features and five plan to put them on the block.

The New York State Health Foundation, a private Albany-based group, requested the research. “In the past few years, six areas have marketed or closed their houses, with mixed results ranging from improvements in proper care expressing closing of one poorly performing house,” said Donald Pryor, the study’s author, said in a statement. “Other areas have kept their houses but are dealing with an increasingly rugged landscape.” Counties traditionally considered running an elderly care service as a way to take care of its elderly, particularly those who are poor. Yet at a time of cost constraints, counties are finding the mission affected as more private houses are built.

Westchester County marketed its elderly care service to the Westchester County Nursing Center and the service was closed in 2009. Dutchess County sold its elderly care service in 1998. Monroe County has struggled with growing expenses of its nursing home and in Albany County; there has been a delivered debate about whether to sell its service. Broome and Chemung counties also own nursing homes. The troubles are expected to grow as the population ages, the research discovered. In the upstate areas with assisted living features, there will be 180,000 more residents older than 75 by 2030. The research said wages grew at all assisted living features 37 % since 2001 and were up 45 % at county houses.

While county houses are about 8 % of all assisted living features in the state, they represent about 11 % of all the beds in the state because they are among the state’s largest facilities. Many of the patients rely on State Medicaid programs, yet the payments haven’t kept up with the expenses by as much as $100 a day, the review said. State Medicaid programs represented 71 % of county-owned homes’ revenue in 20130, in comparison to 55 % for other houses. County assisted living features reported a lack of $201 million in 2010, double the decrease in comparison to 2005, the review said.

Nursing Homes Vacancy

At the House Rehabilitation & Nursing Center in Simsbury, 17 of the nursing home’s 73 beds sat vacant last spring, a 23% opening rate that would have been unlikely five years ago. The home’s occupancy has decreased despite its above-average medical care quality ratings in the government national rating system. “There are a lot of aspects, a lot of projects out there now to keep people out of nursing homes,” said Keith Brown, the home’s manager. “And with the increase in home care, we’re seeing a weaker citizen population. So we have fewer citizens with greater skill.” The Simsbury home is not unique: Nearly one-third of Connecticut’s nursing homes are less than 90 % filled.

Of the 68 homes with higher-than-average opening prices, 20 were only 60-80% filled, leaving hundreds of beds unused. State-wide, even though 15 nursing homes have closed since 2008, at least 2,450 beds were vacant as of May. The state information show that occupancy prices decreased in all but two areas since 2004, falling from 96% to 88% in Tolland; 95 to 88% in Litchfield; 95 to 91% in New Haven; 93 to 90% in Hartford; 95 to 92% in Middlesex; and 97 to 93% in Windham. The exclusions were Fairfield County, where the occupancy rate stayed at about 92% and New London, where it increased from 88% to 92%.

Overall, Connecticut’s nursing home occupancy rate has tumbled in the past years, from 93.3% in 2003, the third maximum in the nation, to 89.8%, the Tenth maximum, according to March government information. The latest state Department of Social Services nursing home demographics put the statewide occupancy amount at just above 90%. Only 11 of the 230 certified nursing homes in the state were full to capacity as of last spring. Nursing home directors say the opening rate has been motivated by a number of aspects, including state projects to keep more seniors and impaired citizens in home and community configurations, as well as the ballooning assisted-living industry, generally controlled in Connecticut.

Cause of Hospitalization from Nursing Homes

A primary cause of hospitalizations from nursing homes, discussed in industry literature for more than 20 years, is the inadequate health professional employment levels in nursing homes. Last fall, the Kaiser Family Foundation released two studies about the hospital stay of elderly care facility citizens. Their findings about why elderly care facility citizens are hospitalized confirm earlier research in this field and point to the need to increase health professional employment in nursing homes as a way to improve quality of care in assisted living features and reduce hospital stay and re-hospitalization of patients.

The Kaiser study, “Financial Incentives in the Long-Term Care Context: A First Look at Relevant Information” determined the economical incentives that encourage hospital stay of elderly care facility citizens.[6] These incentives include Medicare payment policies for doctors, skilled assisted living features, and hospice services as well as the dual roles of healthcare director and attending physician frequently being held by the same individual.

A companion study, based on interviews with doctors, nurses, social workers, and close relatives of residents, determined 10 factors that encourage hospital stay of elderly care facility residents: the limited capacity of assisted living features to address healthcare issues; physicians’ preference for inpatient settings; concerns with liability for not hospitalizing; economical incentives for doctors and facilities; inability of assisted living features to address residents’ healthcare needs; lack of relationship between facility staff, doctor, and family; lack of advance care planning; family preference; and behavioral health problems. Although several factors impact a decision to hospitalize an elderly care facility resident, a key factor determined in the Kaiser reviews and other studies mentioned is the lack of sufficient professional and paraprofessional medical staff in nursing homes. The insufficient employment in assisted living features has been recognized for a long period.

Today’s Nursing Homes

These days, you can hear more and more people talk about searching for a good nursing homes for their aging parents. Nursing homes, as a phrase is becoming phased out of use, in favor of more modern and accurate descriptions takes its place. Retirement Homes is the phrase that is quickly becoming the accepted, because the quality of care a senior receives has been so widely scrutinized, that often facilities are going far beyond what they did in the past, to accommodate the needs of their residents.

In modern retirement homes, there are a lot of facilities and solutions there for residents. Many retirement homes are built with seniors’ needs in mind from the outset. In some top quality luxury pension homes, residents are allowed to do indoor sports activities, exercise sessions, hot tubs, keep pets, and a whole lot more. All of these are being done by caring nursing staff, ready in hand, should any support or care be required.

Of course, the quality of retirement home medical care is not a subject put to rest. There are many individuals who require support or daily care with specific things like showering or cooking. In exchange, modern nursing homes provide many solutions that are focused on senior citizens who have such needs. Today’s model of care available in most long-term care houses (the nearest in the pension market as to what might be called “Nursing Homes”) goes aside from a one-size-fits-all to an individual care model. Today’s nursing homes wisely provide citizens with various care choices and many homes include gender specific medical teams, or support to long-term care and Alzheimer’s disease care.

Hospitalization and Nursing Homes

Nursing home residents are regularly put in the hospital. Residents who have recently been admitted from the medical center are regularly rehospitalized. Many of these hospitalizations, which “can cause pain for residents, anxiety for their loved ones, morbidity due to iatrogenic events and excess medical care expenses,” are considered preventable. The National Healthcare Quality Report found that residents’ hospital stay rates for possibly preventable conditions improved between 2000 and 2007.

The expenses of preventable hospitalizations are enormous. In April 2010, the Medicare Payment Advisory Commission (MedPAC) revealed that in 2005, “potentially preventable readmissions cost the [Medicare] program more than $12 billion” and that “In 2007, more than 18 percent of SNF stays led to a possibly preventable readmission to a medical center.” Residents’ use of medical centers is expensive for the Medicare program, may create additional medical care problems for sufferers and is often seen as showing poor health care quality, both in the medical center (which may release sufferers too soon, often without adequate release planning) and in the nursing facility (which may have been unable to provide needed care). Reducing hospitalizations and rehospitalizations could save Medicare insurance dollars while improving high quality of care for recipients.

The Patient Protection and Affordable Care Act, the health care reform law details these issues through a variety of payment systems. Section 3025, the Hospital Readmissions Reduction Program, reduces a hospital’s compensation if the patient is rehospitalized within a time frame specified by the Assistant, such as 30 days of release. Unfortunately, supporters, including the Center for Medicare Advocacy, are concerned that section 3025 may result in improved use of observation status, a status that recognizes the hospital sufferers as “outpatients.” In addition to the changes in Section 3025, Section 3023 of the ACA allows a pilot program that provides a single payment for an episode of both serious and post-acute care. While payment systems may help decrease unsuitable unexpected hospitalizations, they do not address the factors why nursing homes hospitalize their residents. Understanding the factors behind unsuitable hospitalizations of nursing home residents should help policymakers as they work to implement the ACA and to decrease hospitalizations.

Nursing Homes Cost

The cost of living at nursing homes has soared to a new high of more than $80,000 per year. Over the past five years, the average yearly price of private nursing homes has jumped 24% from $67,527 to $83,950, according to Genworth’s 2013 Cost of Care Survey, based on data from nearly 15,000 long-term health care providers. From 2012 to 2013 alone, the price climbed 4%. A combination of factors is pushing expenses greater, said Bob Bua, V. P. of Genworth. Expenses like insurance, food, building maintenance and labor expenses are all going up and being passed along to customers as a result. “Nursing home employees hardly ever get pay decreases, food hardly ever costs less, rent hardly ever goes down, it’s an ever-increasing cycle,” Bua said.

It’s not much cheaper for a semi-private room at a nursing home, where space is shared with at least one other person. This brings up at an average $75,405 per year, up 23% from five years ago. A less expensive alternative to nursing homes are assisted living facilities because they don’t offer the same level of care, but these are also seeing significant price increases from year-to-year. The average yearly price of care in an assisted living service is $41,400, up nearly 5% from last year and 23% greater than five years ago, Genworth discovered.

The price of at-home care, such as home health aides or homemakers, is rising at a much slower pace. Hiring a homemaker, who typically assists elderly people with cleaning, cooking and transportation, currently costs an average $41,756 per year, up just 1% from last year and a mere 4% increase from five years ago. Home health aides, who provide more hands-on care like bathing and grooming, cost $44,479 per year, up 5% from five years ago. At-home care is also the most attractive option for many elderly people. A separate Genworth study discovered that 78% of respondents would prefer to receive care in their own houses rather than go to a nursing home or assisted living service.