ACCORDING TO A PRESS RELEASE TODAY, H.R.5166, QUALITY CARE FOR NURSING HOME PATIENTS ACT, WAS INTRODUCED, TO GUARANTEE ADEQUATE STAFFING RATIOS AT NURSING HOMES RECEIVING MEDICARE OR MEDICAID FUNDING.  KUDOS TO THESE FOLKS !!!

   SEVERAL WEEKS AGO, CONGRESS RELEASED A REPORT THT FOUND THAT INADEQUATE STAFFING WAS A MAJOR CONTRIBUTOR TO THE VIOLATIONS THAT TAKE PLACE IN NURSING HOMES (WE ALREADY KNEW THAT BUT NOW CONGRESS APPEARS TO BE BELIEVING IT!).  NUMEROUS HORROR STORIES WERE INCLUDED IN THAT REPORT.  THE END RESULT OF SHORT STAFFING, ACCORDING TO THE REPORT, WAS BEDSORES, MALNUTRITION, AND A HOST OF OTHER DISTURBING AND PREVENTABLE AILMENTS.

WHILE MANY STEPS MUST BE TAKEN TO IMPROVE THE SITUATION, WE BELIEVE THAT PROVIDING AN ADEQUATE NUMBER OF WELL TRAINED STAFF IS THE KEY COMPONENT.  THE PRESENT SUBJECTIVE STAFF REQUIREMENT JUST WON’T CUT IT!

THE MAJOR PROVISIONS OF THE PROPOSED ACT INCLUDE:

MINIMUM LEVEL OF DIRECT CARE STAFF:

DAY SHIFT    1 FTE FOR EACH 5 RESIDENTS
EVENING SHIFT 1 FTE FOR EACH 10 RESIDENTS
NIGHT SHIFT 1 FTE FOR EACH 15 RESIDENTS
MINIMUM LEVEL OF LICENSED NURSES:

DAY SHIFT  1 FTE FOR EACH 15 RESIDENTS
EVENING SHIFT 1 FTE FOR EACH 20 RESIDENTS
NIGHT SHIFT 1 FTE FOR EACH 30 RESIDENTS

THESE RATIOS ARE MINIMUMS ONLY.  HCFA MAY ISSUE REGULATIONS PROVIDING UPWARD ADJUSTMENTS FOR RESIDENTS WITH HIGHER NURSING CARE NEEDS 
(AND WE DEARLY HOPE THAT THEY DO!).

 HOW WILL THESE RATIOS BE MET AND PAID?   HCFA MUST MODIFY REIMBURSEMENT LEVELS TO REFLECT THE ADDITIONAL COSTS OF MEETING DIRECT CARE STAFF RATIOS, AND MUST  MAKE RECOMMENDATIONS TO CONGRESS ON WAYS TO INCREASE THE NUMBER OF ADEQUATELY TRAINED STAFF WHO ARE AVAILABLE TO MEET DIRECT CARE STAFFING RATIOS, AND HOW TO RETAIN EXISTING STAFF.

 UNDER THE PROPOSAL, FACILITIES MUST ALSO PROVIDE A FULL TIME DIRECTOR OF NURSES WHO IS A REGISTERED NURSE, A PART TIME ASSISTANT DIRECTOR OF NURSING (FULL TIME IF 100 OR MORE BEDS, A PART TIME DIRECTOR OF IN-SERVICE EDUCATION (FULL TIME IF 100 OR MORE BEDS) AND A NURSING FACILITY SUPRVISOR ON DULY AT ALL TIMES, 24/7/365!!!

 OTHER PROVISIONS INCLUDE DISCLOSURE OF STAFFING LEVELS, AND POSTING OF INFORMATION IN A MANNER VISIBLE AND ACCESSIBLE TO ALL RESIDENTS, FAMILIES, AND CAREGIVERS.

CLEARLY, THIS PROPOSAL WOULD BE A MAJOR STEP IN THE RIGHT DIRECTION, AND WE ALL NEED TO LET THAT BE HEARD IN WASHINGTON.  IN THE HUMBLE OPINION OF THE WRITER (AND A LOT OF OTHERS) THE NUMBERS COULD STILL BE BETTER AND WE WANT TO LET THAT BE KNOWN TOO.   ( HALF A LOAF IS GOOD, BUT THE WHOLE LOAF WOULD BE BETTER!).

 INTERESTING, THAT THE INITIAL PROPONENTS OF THIS BILL ARE FROM ILLINOIS (HOME STATE OF SENATOR CHUCK GRASSLEY, CHAIRMAN OF THE SENATE SPECIAL COMMITTEE ON AGING).  WE NEED TO LET THEM KNOW WE APPRECIATE THESE EFFORTS.  CO-SPONSORS OF THE BILL ARE REPRESENTATIVES HENRY WAXMAN (CA), AND CAROLYN McCARTHY AND MARTIN FROST (TX).

 PLEASE KEEP TRACK OF THIS BILL, AND I’LL TRY TO DO THE SAME.

 AT A SPECIAL HEARING HELD THE FIRST WEEK IN SEPTEMBER, THE COMMITTEE HEARD TESTIMONY FROM THE INDUSTRY, THE GOVERNMENT (GAO , HCFA, AND HHS), AS WELL AS THE RESEARCH DIRECTOR FOR RAYMOND JAMES (A FLORIDA GENTLEMAN). 

 THE BIGGEST QUESTION, OF COURSE, WAS, IN LIGHT OF THE ALMOST LIMITLESS MEDICARE PAYMENTS MADE TO THE INDUSTRY FROM 1990 TO 1998, WHEN THE PAYMENTS FOR NURSING HOME CARE GREW AT AN AVERAGE RATE OF 30% A YEAR, FROM $578M TO $14B, WHY ARE SEVERAL OF THE LARGEST NURSING HOME CHAINS NOW CRYING “BANKRUPTCY” , IMPACTING ABOUT 10%  (OR 17,000) OF THE COUNTRY’S NURSING HOMES.

JAMES RANSOM (FOR RAYMOND JAMES) TOOK THE COMMITTEE THROUGH THE NURSING HOME SAGA.  HE INDICATED THE INDUSTRY NOTED WITH INTEREST THAT THE GOVERNMENT HAD CUT BACK ON THERAPY TO HOSPITALS, EVEN FOR PATIENTS WHO NEEDED IT, RESULTING IN MANY MORE PATIENTS GOING FROM THE HOSPITAL TO NURSING HOMES BECAUSE THEY WERE NOT WELL ENOUGH TO BE AT HOME.

SOME OF THE INDUSTRY LEADERS BEGAN THINKING ALONG THE SAME LINES (COULD THIS HAVE BEEN  SOME KIND OF COLLUSION AMONG  THEM?) AND  COMMENCED DEVELOPMENT OF THEIR OWN THERAPY  PROGRAMS TO MEET THE NEEDS NO LONGER MET BY THE HOSPITALS.   THESE SERVICES COULD BE PROVIDED TO PATIENTS WHO HAD STROKES, SERIOUS SURGERIES, OR OTHER LONG RECOVERY CONDITIONS, WHICH MEDICARE WOULD STILL PAY FOR.  MEDICAID WAS ALREADY PAYING FOR THESE ITEMS, BUT AT MUCH LOWER RATES THAN MEDICARE WOULD RROVIDE.

COMPANIES SUCH AS GENESIS, HIS, VENCOR AND SUN WENT FULL SPEED AHEAD, BUYING REHAB AND HOME HEALTH COMPANIES PRIMARILY WITH BORROWED FUNDS, TO INCREASE EVEN FURTHER THEIR ACCESS TO THE RIVER OF GOLD FLOWING FROM WASHINGTON.

 AND SO THE INDUSTRY AND ITS  SHAREHOLDERS WERE HAPPY, DELIRIOUSLY HAPPY, FOR A TIME.

 BUT THE GAO PRESSED HARDER AND HARDER WITH ITS CASE FOR DRAWING THE LINE ON THESE PAYMENTS  (THANK YOU, GAO!)  EVEN SO, THE INDUSTRY WAS STILL CONFIDENT THE MONEY WOULD CONTINUE TO FLOW BECAUSE IT (THE INDUSTRY) WAS  SERIOUSLY INVOLVED IN ALL THE NEGOTIATIONS FOR A DIFFERENT PAYMENT SYSTEM.  UMMHH, MAYBE THE SYSTEM OF GIVING INDUSTRY TOO MUCH SAY SO IN WHAT IS WHAT AND CONSUMERS NOT ENOUGH SHOULD BE RECONSIDERED.

 WHEN THE MEDICARE CUTBACKS OCCURRED, POP WENT THE CRADLE, AND THE BABY CAME TUMBLING DOWN.

 WHILE THE INDUSTRY PLACES HUGE AMOUNTS OF BLAME ON UNSCRUPULOUS LAWYERS FILING “FRIVOLOUS” LAWSUITS, IT SEEMS TO ME IF THE MONEY SPENT ON MILKING THE SYSTEM HAD BEEN SPENT ON STAFF AND CARE ISSUES,  RESIDENTS WOULD HAVE BEEN HEALTHIER, MANY PREVENTABLE INJURIES AND ILLNESSES WOULD NOT HAVE OCCURRED, FAMILIES WOULD NOT HAVE BEEN ANGERED BEYOND REPAIR, AND THE LAWSUITS WOULD HAVE GONE AWAY.

 AT THIS POINT IN TIME THE INDUSTRY NEEDS TO MEND ITS WAYS.  THEY ACCEPTED THE RIVER OF GOLD WITHOUT PUTTING IT INTO CARE;  NOW ITS PAYBACK TIME, AND WE ALL KNOW THAT PAYBACKS ARE HELL !!!

 AT THE RECENT LONG TERM CARE TASK FORCE MEETING IN TAMPA, WE HEARD NUMEROUS NURSE AIDES READ PREPARED STATEMENTS WHICH  SEEMED TO BE COPIED FROM A SCRIPT, USING THE SAME PHRASES OVER AND OVER.  SURELY, THEY DID NOT BELIEVE THE WORDS THEY READ.

 CLEARLY THERE ARE SOME FRIVOLOUS LAWSUITS IN EVERY ASPECT OF LAW.  JUST AS CLEARLY, THERE ARE MANY LAWSUITS BASED ON TERRIBLE INJUSTICES, SOME SO SERIOUS WE CANNOT EVEN CONCEIVE OF THEM.

  BUT THE UNDERLYING CAUSES ARE FIXABLE IF THE INDUSTRY WILL JUST GET DOWN AND DO IT, INSTEAD OF TRYING TO FIX BLAME ON  SOMEONE ELSE (IN THIS CASE ON LAWYERS) FOR ITS OWN FAILURE TO CLEAN UP ITS ACT.  WHILE THERE ARE STILL SOME GOOD (AND SOME AT LEAST ADEQUATE) NURSING HOMES, THE REPUTATION OF THE INDUSTRY AS A WHOLE IS HIGHLY TARNISHED BY REPEATED REPORTS OF WHOLESALE FRAUD, ABUSE AND NEGLECT.  THE INDUSTRY IS CLEARLY UNABLE TO MONITOR ITSELF, AND CONTINUES TO  TRY TO ESCAPE ACCOUNTABILITY BY REMOVING FROM NURSING HOME RESIDENTS THE RIGHT OF REDRESS FOR HORRENDOUS WRONGS COMMITTED AGAINST THEIR RIGHT TO LIFE, TO REASONABLE CARE IN NURSING HOMES, AND TO  PROTECTION AGAINST A VARIETY OF FORMS OF NEGLECT AND ABUSE.

 THE INDUSTRY’S PRESSURE DURING THE LAST LEGISLATIVE SESSION  FOCUSED ON A DEMAND FOR REMOVAL OF RESIDENT RIGHTS AS THEY EXIST UNDER THE PRESENT LAW, AND MOVEMENT OF ALL NURSING HOME LITIGATION TO THE SECTION OF THE LAW WHICH NOW GOVERNS MEDICAL MALPRACTICE, NEVER MINDING THAT MOST OF THE FACTUAL SITUATIONS DO NOT COME WITHIN THE MEANING OF MEDICAL MALPRACTICE AS WE PRESENTLY THINK OF IT.

 MAKING THIS CHANGE WOULD PRECLUDE NEARLY ALL RESIDENTS FROM THE RIGHT OF REDRESS.  THE ONLY PEOPLE WHO COULD PURSUE ACCOUNTABILITY WOULD BE A SURVIVING SPOUSE OR A CHILD UNDER AGE 25.  THIS WOULD ELIMINATE ALMOST ALL LAWSUITS BASED ON NURSING HOME ISSUES WHICH WE ARE ALL FAMILIAR WITH.

 WHILE THE INDUSTRY WOULD HAVE BENEFITTED GREATLY BY SUCH LEGISLATIVE CHANGES, WHAT BENEFIT WOULD THERE HAVE BEEN TO OUR LOVES ONES?  WOULD REMOVING THEIR RIGHT TO REDRESS MEAN BETTER CARE?  I THINK NOT!

 BUT, BE ALERT !!  IF AT FIRST THEY DON’T SUCCEED, THEY WILL  SURELY TRY, TRY AGAIN.  THEY MAY USE OTHER PLOYS, TRYING TO ERODE AROUND THE EDGES UNTIL THE WALL PROTECTING RESIDENTS’ RIGHTS COMES TUMBLING DOWN !!

  WE ARE RECEIVING REQUESTS FOR INFORMATION ON HOW TO START AN ACTIVE FAMILY COUNCIL.  AS YOU MAY KNOW, “ACTIVE” GROUPS ARE FEW AND FAR BETWEEN.  PRESENTLY, THEY ARE PRIMARILY DIRECTED INTO QUASI SOCIAL ACTIVITIES BY EITHER A SOCIAL SERVICES OR ACTIVITIES DIRECTOR  OF THE NURSING HOME.

 IN AN EARLIER ISSUE, WE NOTED THE IMPORTANCE TO OUR LOVED ONES OF HAVING AN ACTIVE FAMILY COUNCIL, WORKING WITH THE ADMINISTRATION TO IMPROVE CARE,  SO WE HAVE PUT TOGETHER SOME WRITTEN MATERIALS TO HELP FAMILIES CHANGE THE NATURE OF EXISTING FAMILY COUNCILS.

 FOR HELPFUL INFORMATION AND FREE MATERIALS, PLEASE CONTACT YOUR EDITOR.

 ALSO, THERE HAS BEEN A REQUEST TO FORM AN AREA FAMILY COUNCIL, PERHAPS SEVERAL AREA COUNCILS IN THE STATE.  WHAT DO YOU THINK ABOUT THAT?

CAREGIVER SUPPORT

 AT THIS WRITING CAREGIVER SUPPORT PROPOSALS ARE STILL ON THE TABLE IN WASHINGTON.  IF YOU SUPPORT CAREGIVER TAX CREDITS, RENEWAL OF THE OLDER AMERICANS ACT TO AUTHORIZE THE FAMILY CAREGIVER SUPPORT PROGRAM, AND APPROPRIATION OF $125 MILLION FOR FAMILY CAREGIVER SUPPORT PROGRAM, PLEASE LET YOUR CONGRESSIONAL DELEGATION KNOW. 

THERE ARE ADVOCATES IN FLORIDA AND ELSEWHERE WHO ARE WORKING TO IMPROVE THE LOT OF OUR LOVED ONES IN NURSING HOMES. EACH HAS A DIFFERENT APPROACH BUT THE SAME HEART.  THIS IS A PARTIAL LIST:

NATIONAL CITIZENS COALITION FOR NURSING HOME REFORM (NCCNHR),
          www.nccnhr.org (202-332-2275)
THE COALITION TO PROTECT AMERICA’S ELDERS,
          www.protectelders.org   (1-877-262-5484)
FLORIDA ADVOCATES FOR NURSING HOME IMPROVEMENT (FANHI)
          www.fanhi.org  (I-888-647-3367)
FIGHTING ELDER ABUSE TOGETHER, INC., (F.E.A.T.)
[email protected] NOTE:  THERE IS AN UNDERSCORE _ BETWEEN AHLER AND FRIDDLE)  (321) 984-8883 or  (321) 725-5386. (This group is newly organized in Palm Bay/Melbourne area

IF YOU WISH TO COMMENT TO THE EDITOR, YOU MAY E MAIL TO  [email protected]
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THE NIGHT WATCHMAN, P. O. BOX 13553, TAMPA, FL 33681-3553.