Articles Tagged with Elder

Under new laws signed by Gov. Rick Scott on March 26, 2018, Nursing homes and assisted living facilities in Florida will now be required to have generators to provide backup power during an outage.

This legislation was passed in response to the deaths of 12 residents at the Rehabilitation Center at Hollywood Hills in Hollywood, FL during power outages in the days after Hurricane Irma devastated South Florida.  The residents died as a result of overheating because of the lack of power to operate the air conditioning system in the facility.Hurricane_Fran_sept_1996

Under the new laws, larger nursing homes and assisted living facilities are required to have enough fuel to run generators for at least 72 hours. Facilities with fewer than 17 beds are required to only have 48 hours’ worth of fuel. Nursing homes will be required to have equipment that maintains a temperature of no more than 81 degrees Fahrenheit (27 degrees Celsius) for at least 96 hours after an outage.

According to new study published in the February American Journal of Infection Control, researchers found that implementing simple hand-washing protocols in nursing homes help prevent the spread of deadly infections.

The study showed that if nursing home employees exercise the hand washing techniques that are already in practice in hospitals, the spread of deadly infections can be lowered dramatically.  Lowering the spread of these infections significantly lowers death rates for nursing home residents and also lowers the amount of antibiotics that need to be prescribed to those residents.

United States nursing homes experience around 3 million infections yearly and those infections are one of the leading causes of death in nursing facilities. Infections also add around $1 billion in extra healthcare costs, according to the Association for Professionals in Infection Control and Epidemiology.

A new study released this week by the Human Rights Watch found that many nursing home residents are needlessly being given antipsychotic drugs.  The 157 page report titled “They Want Docile’: How Nursing Homes in the United States Overmedicate People with Dementia,” found that approximately 179,000 people, mostly those suffering from dementia, are being given antipsychotic drugs every week in US nursing homes in an attempt to control their behavior. Facilities administer these drugs without the proper diagnosis and in many cases without obtaining informed consent from residents or their families.  This is also being done in the face of an FDA warning that these drugs can almost double the risk of death for elderly dementia patients.

The drugs are being predominately used for their sedative effect, rather than any medical benefits.  Nursing homes are using these drugs as a cost-effective and simple way for understaffed and overwhelmed facilities to control its residents.  Many nursing homes have an inadequate amount of staff to properly care for the amount of residents in their facilities.  This leads to the staff cutting corners and finding shortcuts to deal with the stress of caring for elderly dementia residents.  However, it is the residents that suffer when the staff cut these corners.

Federal law requires that nursing facilities fully inform their residents about their treatment and the resident has the right to refuse that treatment. There are also some state laws that require informed consent in order for these antipsychotic medications to be given to nursing home residents. The study found that many nursing home staff members admitted to often failing to obtain consent or even to attempting to do so.

Quality rating systems and report cards for healthcare facilities are intended to give consumers more information about choosing the best quality hospital or nursing home.  A study performed by Marcelo Perraillon, a Health economist of the Colorado School of Public Health at CU Anschutz, sought to determine whether the form in which that information is conveyed to consumers mattered.  Perraillon assessed whether a simplified rating system used by the Nursing Home Compare website encouraged consumers to choose higher rated nursing homes.

Perraillon used a statistical method called regression continuity to illustrate that consumers do respond to public reporting of nursing homes quality information and are actually using the data to make better decisions about care.  He published his findings on December 28 in the American Journal of Health Economics under the title “Consumer Response to Composite Ratings of Nursing Home Quality.”

The main finding was that nursing homes that attained an additional star, in the 1 to 5 star system, gained more admissions. However, this consumer response to this system change was not universal.  Low-rated nursing homes in poorer areas which take mostly Medicaid patients still saw high admissions.  Residents of those areas don’t have a lot of options when it comes to selecting a nursing home facility so they can’t benefit from the rating system in the same way.  Those facilities in the poorer areas do not have the same incentive to improve their rating because admissions are already high due to the lack of choice.

According to a report by the Associated Press, an investigation into the death of a 76 year old woman at an Ohio nursing home revealed she spent roughly 8 hours outside while temperatures fell below zero.  Phyllis Campbell was found dead from hypothermia on January 7 outside Hilty Memorial Home in Pandora, OH.  She reportedly suffered from dementia and had a history of wandering off.  “She had a history of exit seeking behaviors” and “the facility failed to ensure adequate supervision was provided,” according to a report released by the Ohio Department of Health.

That report from the Ohio Department of Health says two nursing home aides told investigators they didn’t do scheduled checks that night even though they were marked as completed.  She left the building around 12:35 am and Putnam County Coroner Dr. Anne Horstman determined that she died between 1 and 2 am.  She was able to exit through a door into a courtyard even though she was wearing a monitor that should have set off alarms but “at times would not sound.”  She was found in the courtyard about 30 feet from its doors in the morning.  The Investigations findings note that Campbell had wandered into the courtyard 2 other times during the week before she died and that she got out of her room several times that day.

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.

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.

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.

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.

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.”

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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