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One of the most difficult decisions families have to face is deciding to put a loved one in a nursing home. They want to make sure they are placing their family member in a safe environment where they will receive the proper care they need.

Many of those families rely on a government rating system to determine which facilities are the best.  The Five-Star Quality Rating System employed by Centers for Medicare & Medicaid Services (CMS) is a source of information to help consumers make an informed decision when choosing a nursing home.  The Medicare Nursing Home Compare website features a quality rating system that gives each nursing home a rating of between 1 (much below average) and 5 stars (much above average). The nursing home is given a star rating in three areas, self-reported staffing, self-reported quality measures, and health inspections.  The facility is also given an overall star rating.

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A new study of California nursing homes (the nation’s largest system of nursing homes) discovered that some nursing homes have inflated their self-reporting to improve their score in the rating system.  The study was done by faculty at Florida Atlantic University and the University of Connecticut and published in the Production and Operations Management journal under the title “Winning at All Costs: Analysis of Inflation in Nursing Homes’ Rating System”The rating system was implemented in 2008 and this study used data from 2009 to 2013.

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Pennsylvania Governor Tom Wolf’s administration is putting out a new Medicaid feature that’s aimed to decrease the number of enrollees in nursing homes in the future.  It is also intended to lessen a large expense for the state, which has a rapidly growing elderly population.  This plan has been in place in many other states for years and provides the road map for how it can be administered in Pennsylvania.

This new feature will have a financial incentive to get enrollees the medical care and services they need in their home instead of in the nursing home, where it can be twice as expensive.

The savings under this plan will be substantial. It is around $62,000 per year for nursing home care and about half that for the care at home.  There are over 50,000 Pennsylvania nursing home residents that are covered under Medicaid.

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Over the last few decades there has been a movement to reduce bed rails and other variations of restraints that are used on nursing home residents.  This movement has been growing ever since Congress enacted the Nursing Home Reform Act in 1987.  This law included a prohibition on restraints being used for the purpose of discipline or staff convenience and not for medical purposes.

The goals of the restraints were to improve resident safety in nursing homes.   However they often have the opposite result and lead to more injuries, deaths, and deprive the residents of their dignity and freedom.

Rails can be especially hazardous for residents suffering from dementia. They can fall from greater heights if they attempt to climb over them and sustain more serious injuries (especially head injuries).  There are also issues with entrapment.

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A 9th nursing home patient has died as a result of power outages caused by Hurricane Irma in Florida.  The power outages caused the air conditioning to stop working and as a result the facilities reach dangerously hot temperatures.

Nursing home residents at the Rehabilitation Center at Hollywood Hills in Hollywood, FL were evacuated from the nursing home last Wednesday morning after the medical staff from the nearby Memorial Regional Hospital began to see nursing home patients in the emergency room with “extraordinarily high temperatures.”  Some of the patients who were admitted to the hospital had temperatures of up to 106 degrees. Once hospital staff realized something was wrong at the nursing home, they began evacuating patients from the nursing home to the hospital on stretchers.  A lack of backup power is being investigated as a main factor that contributed to the deaths

Around the country, facilities have been caught unprepared for emergencies that don’t come close to the severity of a hurricane like Irma that hit Florida earlier this month.  Nursing home inspectors issued 2,300 violations of emergency-planning rules during the past four years.  536 of those citations were for failure to maintain comfortable and safe temperature levels for residents. In addition, a third of U.S. nursing homes have been cited for failing to inspect their generators each week or to test them monthly.

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More than 1 in 4 cases of possible sexual and physical abuse against nursing home patients went unreported to police, according to a government audit. These unreported cases violate a federal law requiring immediate notification of nursing home abuse.

The Health and Human Services inspector general’s office issued an “early alert” on preliminary findings from a large sampling of cases in 33 states.

Auditors identified 134 cases in which emergency room records indicated possible sexual or physical abuse, or neglect. The incidents spanned a two-year period from 2015-2016.

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Pennsylvania Attorney General Josh Shapiro is part of a coalition of 16 State Attorneys General and the Attorney General from the District of Columbia who sent a letter to the Centers for Medicare & Medicaid Services (CMS) hoping to protect nursing home patients.

These states are recommending that CMS keep in place its current pro-patient rule.  The existing rule protects patients’ rights by prohibiting pre-dispute arbitration clauses in nursing home and other long-term care contracts.  The current regulation was adopted on October 4, 2016, by CMS and a proposed rule would reverse the prohibition on binding pre-dispute arbitration clauses in Long-Term Care facility contracts.  Pre-dispute arbitration clauses require seniors to waive their rights to go to court to resolve any disputes with a nursing home.

In the August 7th letter, the Attorneys General stated in their comments “Pre-dispute binding arbitration agreements in general can be procedurally unfair to consumers, and can jeopardize one of the fundamental rights of Americans; the right to be heard and seek judicial redress for our claims. This is especially true when consumers are making the difficult decisions regarding the long-term care of loved ones. These contractual provisions may be neither voluntary nor readily understandable for most consumers. Often consumers do not recognize the significance of these provisions, if they are aware of them at all, especially in the context of requiring care in a nursing home.”

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The Pennsylvania Department of Health has levied $816,000 in fines against nursing home providers already in the first half of 2017. That is more than double the $407,450 in fines handed out in 2016.  The department also handed out fines of $170,050 in 2015 and $62,000 in 2014.

In 2014, there were 7 cases where the department found a citation that had caused a resident actual harm. So far in 2017, there have been 88 cases.  This vast increase in fines is due mostly to regulators using a more rigorous penalty system.  The rigorousness is coming after receiving criticism for being too lenient on insufficient care.  “When the auditor general looked at our oversight of nursing homes, one of the key recommendations was to be more aggressive in our oversight, and we are,” the department said earlier this year in a statement.  In October 2016, Secretary of Health Karen Murphy announced that the department would be using more discretion in determining how much it would fine facilities.  The department will be taking into account the level of harm, how long it takes for a problem to be fixed, the facility’s track record of compliance, and other factors.

April Hutcheson, a department spokeswoman, said the department has resumed using federally mandated anonymous reporting, which had been discontinued previously. State surveyors also received federal training last year for how to identify the scope and severity of the situation “and, as a result, we have seen an increase in citations of deficiencies at the actual harm and immediate jeopardy level,” said Lorraine Ryan, a CMS spokeswoman.

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In our last blog post we talked a bit about signs that it might be time to consider assisted living for an aging loved one. In this post, we will talk a bit about Nursing Home Abuse and Elder Abuse. How often abuse occurs, what to be on the lookout for, and what to do if you think an aging loved one has been abused or is being abused.

Unfortunately, nursing home abuse and elder abuse are common and take many forms. According to the Office for Victims of Crime, roughly 5 million people over the age of 65 are victims of elder abuse or nursing home abuse each year. Abuse can be physical, psychological or sexual. Abuse can also take the form of neglect and financial exploitation. Abuse can come from anywhere, even friends and family members. Even more frightening is that only 1 in 24 cases of elder abuse or nursing home abuse is reported to authorities.

Continue reading →

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Whether to move a loved one into an assisted living home or hire an in-home caregiver is a difficult decision. Families can feel pressure to continue providing care for an aging adult despite signs that it might be time to explore other options. Other times families may find themselves unsure as to whether a loved one may need around the clock care.

While there is rarely a clear sign that it is time to move an aging family member to an assisted living home or hire an in-home caregiver, Caring.com recently published a list of eleven signs that family members and caregivers can look for to help in making that decision. Here are some highlights from that article: Continue reading →

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When moving a family member into a nursing home you are doing so with the hope that they will be given the utmost care and protection.  Unfortunately, understaffing in nursing homes leads to neglect of its elderly residents.  When there is a shortage of staff members compared to the amount of residents, the staff becomes overworked and stressed and it is the residents that suffer. This leads to increases in malnutrition, unhealthy weight loss, dehydration, infections and bedsores among the nursing home residents.

PennLive analyzed Medicare and Medicaid reimbursement data to compile a list of the 18 most understaffed nursing homes in Pennsylvania based on hours spent caring for each resident. PennLive also compiled how much of that care came from registered nurses (RN), licensed practical nurses (LPN), and certified nurse assistants (CNA).  It is recommended that at least 4.1 staff hours a day be spent on each resident’s care.  The average hours per day spent on each resident is 2.84.  The most understaffed home on the list was Manor Care in Pottsville (2.77 hours of care per day). Manor Care, which is one of the biggest nursing home chains in the United States, occupied 10 of the 18 spots on this list.

The full list can be seen here.