WE’VE FINALLY HEARD SOME  POSITIVE RECOMMENDATIONS FOR IMPROVING NURSING HOME QUALITY OF CARE.  THESE WERE PROVIDED AT A RECENT LEGISLATIVE COMMITTEE MEETING BY MS. VICTORIA FIERRO.  MS. FIERRO HAD BEEN APPOINTED TO THE GOVERNOR’S TASK FORCE ON LONG TERM CARE, AS A CONSUMER REPRESENTATIVE.  DURING THE TASK FORCE MEETINGS  SHE  ASKED SOME QUITE SERIOUS AND VERY PROBING QUESTIONS OF THE VARIOUS WITNESSES WHO PRESENTED INFORMATION TO THE TASK FORCE.  ALTHOUGH THE TASK FORCE DID NOT MAKE RECOMMENDATIONS AS A GROUP, MS. FIERRO DID HAVE NUMEROUS RECOMMENDATIONS WHICH SHE ASKED TO BE INCLUDED AS A PART OF THE STAFF REPORT.

  MS. FIERRO BELIEVES THESE RECOMMENDATIONS REQUIRE LITTLE OR NO GENERAL REVENUE, OR ARE REVENUE NEUTRAL (COST EQUALS SAVINGS).  WE FEEL THEY  ARE WORTHY OF CONSIDERATION, AND PRESENT THEM HERE:

 (1) EITHER REINSTATE THE REGULATIONS PREVIOUSLY STRIPPED FROM 59A 4.108, OR INCLUDE THOSE ELEMENTS IN STATUTE (UPDATED FOR CURRENT PRACTICE STANDARDS).

 (2) RAISE THE STATE MINIMUM STAFFING STANDARDS CONTAINED IN 59A 4.108 FOR NURSING HOMES TO THE HIGHEST LEVELS POSSIBLE CONSIDERING THE $90 MILLION OF PREVIOUSLY APPROPRIATED FUNDS FOR PATIENT CARE, CASE MIX AND DIRECT CARE STAFFING ADJUSTMENTS.  (THE RULE IS CURRENTLY IN RULE DEVELOPMENT BASED ON hb 1971).

 (3) REQUIRE NURSING HOMES AND ASSISTED LIVING FACILITIES WHICH ARE OPERATING BELOW STATE MINIMUM STANDARDS TO NOTIFY AHCA.  IMPROSE FINES FOR FAILURE TO NOTIFY THE STATE.

 (4) THERE SHOULD BE CLEAR PROHIBITION IN LAW AGAINST FALSE CHARTING IN RESIENT CHARTS OR MINIMUM DATA SET INFORMATION BY EITHER LICENSED OR UNLICENSED STAFF, AND PENALTIES SHOULD BE PRESCRIBED.  PROVIDE SPECIFIC PENALTIES AGAINST ANYONE WHO INDUCES ANOTHER TO FALSELY CHART OR RECORD MINIMUM DATA SET INFORMATION.

 (5) NURSING HOMES AND ASSISTED LIVING FACILITIES SHOULD NOT HAVE THEIR LICENSES RENEWED IF THERE ARE ANY OUTSTANDING ACCOUNTS RECEIVABLE DUE TO THE STATE, INCLUDING IMPOSED FINES AND PENALTIES.  ADDITIONALLY, ALL REQUIRED COSTS REPORTS (INCLUDING HOME OFFICE COST REPORTS) MUST BE CURRENT AS OF THE DATE OF RENEWAL.

 (6) REQUIRE THAT NURSING HOMES AND ASSISTED LIVING FACILITIES MUST CHART ACTIVITIES OF DAILY LIVING SERVICES PROVIDED TO RESIDENTS IN THE RESIDENT’S MEDICAL/CARE RECORD.

 (7) INCREASE THE NUMBER OF STATE SURVEYORS FOR LONG TERM CARE FACILITIES AND REQUIRE ASSISTED LIVING FACILITIES TO HAVE ANNUAL INSPECTIONS.  THE COSTS CAN BE RECOUPED BY:

CHARGING FOR FACILITY INSPECTIONS BEYOND THE ANNUAL SURVEY (AND ONE FOLLOW UP IF NEEDED) WHERE THE FACILITY IS FOUND TO NOT BE IN  COMPLIANCE WITH STATE OR FEDERAL REGULATIONS OR WHERE A COMPLAINT IS SUBSTANTIATED.

IMPROSE FINES ON NURSING HOMES AND ASSITED LIVING FACILITIES WHO FAIL TO REPORT INCIDENTS OF STAFFING BELOW THE STATE MINIMUM STANDARDS AND DEDICATE THE FINES TO SURVEYOR COSTS.

 (8) REQUIRE THAT CASES WHERE JURIES IMPOSE PUNITIVE DAMAGES ON NURSING HOMS AND/OR ASSISTED LIVING FACILITIES THAT THERE BE AN IMMEDIATE REFERRAL TO THE APPROPRIATE LAW ENFORCEMENT AGENCY FOR INVESTIGATION AND POSSIBLE PROSECUTION.

 (9) ADOPT A UNIFORM CHART OF ACCOUNTS FOR MEDICAID COST REPORTING SO THE STATE WILL BE ABLE TO COMPARE COSTS OF CARE IN AN “APPLES TO APPLES: MANNER.

(10) TRANSFER THE QUALITY MONITORS CURRENTLY IN AHCA TO EITHER THE OMBUDSMAN PROGRAM OR AN OBJECTIVE PROGRAM UNRELATED TO THE REGULATORY FUNCTION.

(11) REQUIRE ALL NURSING HOME AND ASSISTED LIVING FACILITIES ADMISSION CONTRACT FORMS TO BE REVIEWED AND APPROVED BY THE STATE BEFORE ADOPTION OR USE BY A LONG TERM CARE FACILITY.

(12) ENCOURAGE AHCA TO AGGRESSIVELY PURSUE THE COLLECTIONS OF ALL FINES, PENALTIES AND OVERPAYMENTS DUE TO THE STTE AND TO REPORT TO THE LEGISLATURE ANNUALLY ON THE AMOUNTS RECOMMENDED, IMPOSED AND COLLECTED.

(13)   INCLUDE IN THE RESIDENT’S RIGHTS THE RIGHT FOR RESIDENTS IN LONG TERM CARE FACILITIES TO INSTALL AND USE VIDEO CAMERAS OR OTHER ELECTRONIC DEVICES SUCH AS VIDEOPHONES, COMPUTER WEBCAME, ETC. AT THE RESIDENT’S OR FAMILIES’ EXPENSE.

(14)  REQUIRE THE INCLUSION OF VERDICTS, FINES, AND SETTLEMENT INFORMATION (UNLESS CONFIDENTIAL) TO BE PART OF THE STATE’S GUIDE TO NURSING HOMES AND OTHER PUBLIC INFORMATION VEHICLES CONCERNING LONG TERM CARE FACILTIES AS IMPORTANT CONSUMER INFORMATION.  IF THE STATE PROVIDES FUNDING FOR INCREASES IN LIABILITY INSURANCE FOR LONG TERM CARE FACILITIES, NO SECRET SETTLEMENT SHOULD BE PERMITTED.

(15)   IF LIMITS ON PLAINTIFF ATTORNEYS’ FEES ARE ENACTED RELATING TO CHAPTER 400 CASES, PLACE ON EQUAL LIMITATION ON THE AMOUNT OF DEFNSE ATTORNEYS’ FEES.

(16) REQUIRE SPECIFIC DEMENTIA SCREENING PROTOCOLS FOR INDIVIDUALS AT RISK OF INSTITUTIONALIZATION WHO ARE PRESENTING WITH SYMPTOMS OF DEMENTIA.  (THIS WILL REQUIRE SOME SEED CAPITAL BUT COSTS SHOULD BE ABLE TO BE RECOUPED WITHIN A YEAR’S TIME FROM COST SAVINGS FROM DIVERTING INDIVIDUALS WHO WOULD OTHERWISE HAVE BEEN INSTITUTIONALIZED.  (REFER TO LOS ANGELES COUNTY GENESIS PROJECT).

(17) PROVIDE AHCA THE AUTHORITY TO DEDUCT ANY STATE FINES IMPOSED DIRECTLY FROM MEDICAID PAYMENTS MADE TO PROVIDERS.

(18)   PROVIDE AHCA AUTHORITY TO RECOUP MEDICAID PAYMENTS (OR PARTIAL RECOUPMENT) FROM PROVIDERS WHO FAILED TO PROVIDE SERVICES IN COMPLIANCE WITH THE REGULATIONS.

(19) ESTABLISH SPECIFIC PENALTIES IF NURSING HOMES ALLOW UNLICENSED OR UNCERTIFIED STAFF TO PROVIDE DIRECT PATIENT CARE.

 MS. FIERRO PRESENTED THE FOLLOWING ADDITIONAL QUALITY ENHANCEMENT RECOMMENDATIONS THAT DO HAVE A GENERAL REVENUE IMPACT (REQUIRE COMMITMENTS OF MONEY):

 (1)   PROVIDE ADDITIONAL FUNDING TO NURSING HOMES DIRECTED SPECIFICALLY TO PROVIDING MORE DIRECT CARE STAFF (BEYOND THE RECOMMENDATION CONTAINED ABOVE).  TIE ANY INCREASES TO A MEASURABLE OUCOME AND REQUIRE A SIMULTANEOUS INCREASE IN THE MINIMUM STAFFING STANDARDS.

 (2) PROVIDE ADDITIONAL FUNDING TO SUPPORT THE EXPANSION OF THE STATE LONG TERM CARE OMBUDSMAN PROGRAM.

 (3) PROVIDE ADDITIONAL FUNDING FOR THE STATE’S PUBLIC GUARDIANSHIP PROGRAM.

 (4)  REQUIRE THAT ALL NURSING HOME AND ASSISTED FACILITY DEATHS BE REFERRED TO THE COUNTY MEDICAL EXAMINER, WHO WOULD THEN BE REQUIRED TO REVIEW THE DEATH AND REFER ANY CASE OF SUSPECTED ABUSE OR NEGLECT TO HE STATE ATTORNEY’S OFFICE FOR INVESTIGATION AND POTENTIAL CRIMINAL PROSECUTION.

 (5) REQUIRE THAT CERTIFIED NURSING ASSISTANTS (CNAs) MUST BE RECERTIFIED EVERY TWO YEARS.

So when you are asked what you suggest or recommend be done to improve the situation, you might pick some ideas from this list.

 THE FOLLOWING PEOPLE HAVE SUBSTANTIAL CONTROL OVER THESE ISSUES.  WRITE, CALL, E MAIL, OR MEET THEM AND LET YOUR VOICE BE HEARD.  THE COMMUNICATION CAN BE SHORT – JUST SAY YOU SUPPORT MORE STAFF, BETTER TRAINING OF STAFF, AND KEEPING ENFORCEMENT OF RESIDENTS’ RIGHTS THE WAY IT IS NOW.

 REPRESENTATIVE NANCY ARGENZIANO IS CHAIRMAN OF THE COUNCIL FOR HEALTHY COMMUNITIES.  THIS COUNCIL OVERSEES THE ELDER AND LONG TERM CARE COMMITTEE. SHE HAS VOICED STRONG SUPPORT FOR IMPROVEMENT OF QUALITY OF CARE BY INCREASED STAFFING, AND AGAINST THE DRASTIC CHANGES TO THE MANNER  OF ENFORCEMENT OF RESIDENTS’ RIGHTS.  THE NURSING HOME INDUSTRY HAS FORMED GROUPS TO PICKET HER OFFICE AND TAKEN OUT FULL PAGE (EXPENSIVE) ADS IN NEWSPAPERS ATTACKING HER.   THE PREFERRED METHOD OF CONTACT WITH HER IS BY FAX TO HER CRYSTAL RIVER OFFICE:  FAX TO  352-860-5177.  ALTERNATES ARE:  E MAIL TO [email protected], OR WRITE TO 6216 WEST CORPORATE OAKS DRIVE, CRYSTAL RIVER, FL 34429.

 REPRESENTATIVE TOM FEENEY IS SPEAKER OF THE HOUSE, WHO HAS STEPPED FORWARD TO SUPPORT REPRESENTATIVE ARGENZIANO IN THIS SITUATION.  WE NEED TO LET HIM KNOW WE AGREE WITH REP. ARGENZIANO, AND WILL ALSO APPRECIATE HIS EFFORTS ON BEHALF OF RESIDENTS.  YOU CAN COMMUNICATE WITH HIM VIA ONE OF THESE METHODS:  E MAIL:  [email protected], FAX TO 850-410-5369, TELEPHONE TO TALLAHASSEE 850-488-0468, OR  TELEPHONE TO OVIEDO OFFICE 407-977-6504, OR WRITE HIM AT BOX 622109, OVIEDO, FL 32762-1300. 

SENATOR GINNY BROWN-WAITE IS PRESIDENT PRO TEM OF THE SENATE, AND IS THE SENATOR WHO HAS INDICATED SHE WILL SPONSOR THE NURSING HOME INDUSTRY’S PROPOSED BILL (COMMONLY CALLED “TORT REFORM” BUT WHICH IN REALITY IS A LESSENING OF THE ENFORCEMENT OF RESIDENTS’ RIGHTS). YOU CAN COMMUNICATE WITH HER  VIA ONE OF THESE METHODS:  E MAIL TO  [email protected], TELEPHONE TO BROOKSVILLE OFFICE 352-544-2344, OR WRITE HER AT HERNANDO GOVERNMENT COMPLEX, ROOM 200 – 20 N. MAIN STREET, BROOKSVILLE, FL 34601.

 SENATOR JOHN McKAY WAS A MEMBER OF THE TASK FORCE, WHO APPARENTLY DID NOT THINK IT WAS AN IMPORTANT ENOUGH ISSUE TO ATTEND MORE THAN ONE MEETING.  NEVERTHELESS, HE IS THE CURRENT PRESIDENT OF THE SENATE, AND NEEDS TO BE HELD ACCOUNTABLE FOR THESE ISSUES.  HE SEEMS TO HAVE REMAINED DETACHED FROM THE WHOLE THING, BUT IF THE NURSING HOME INDUSTRY THINKS IT IS IMPORTANT ENOUGH TO PICKET NANCY ARGENZIANO’S OFFICE WHEN SHE TRIES TO HOLD THEM ACCOUNTABLE, WE CERTAINLY NEED TO LET SENATOR McKAY HEAR OUR VOICES.  YOU CAN COMMUNICATE WITH HIM VIA ONE OF THESE ADDRESSES – E MAIL [email protected], OR TELEPHONE TO TALLAHASSEE 850-487-5229, OR TELEPHONE TO BRADENTON 941-727-6349, OR MAIL TO WILDEWOOD PROFESSIONAL PARK, SUITE 90, 353 CORTEZ ROAD WEST, BRADENTON, FL 34210.

FINALLY, IF YOU ARE A MEMBER OF AARP, YOU SHOULD LET THEIR LEGISLATIVE OFFICE KNOW YOU SUPPORT THE AARP POSITION.  FLORIDA’S AARP PRESIDENT, BENTLEY LIPSCOMB, FOLLOWING THE NATIONAL AARP POLICY, HAS COME OUT STRONGLY IN FAVOR OF INCREASING QUALITY OF CARE BY MORE STAFFING AND BETTER TRAINING, AND AGAINST THE DRASTIC REDUCTION OF THE ABILITY OF A NURSING HOME RESIDENT TO HOLD THE NURSING HOME ACCOUNTABLE FOR ITS ACTIONS AND FAILURE OF ACTIONS.  IF HE REPRESENTS YOUR POSITION, YOU NEED TO SEND A SHORT COMMENT TO THAT EFFECT.  YOU CAN COMMUNICATE THAT BY E MAIL TO [email protected] ,OR FAX TO 850-222-8968, OR MAIL TO AARP, 200 WEST COLLEGE AVENUE, SUITE 304, TALLAHASSEE, FLORIDA 32301.

HAS DONE WHAT THEY DESCRIBE AS A “COMPREHENSIVE EMPIRACAL STUDY”  OF THE IMPACT OF TORT REFORM ON INSURANCE COSTS AND RATES SINCE 1985.

 THE STUDY IS CALLED “PREMIUM DECEIT   THE FAILURE OF ‘TORT REFORM’ TO CUT INSURANCE PRICES”.  THE REPORT CONCLUDES “THAT LEGISLATIVE ATTEMPTS TO REDUCE INSURANCE  RATES BY TAKING AWAY THE RIGHTS OF THE MOST SERIOUSLY INJURED IN OUR SOCIETY, HAS BEEN AND CONTINUES TO BE A FAILED PUBLIC POLICY”.

 WHY THEN DOES THE NURSING HOME INDUSTRY CLAIM THAT THE ANSWER TO THE PRESENT INSURANCE PREMIUM CRISIS IS TO REDUCE THE ABILITY OF RESIDENTS TO ENFORCE THEIR RIGHTS?????? 

 IN MY DAILY CONVERSATIONS WITH PEOPLE ON THESE ISSUES I HAVE FOUND THAT MANY PEOPLE ARE VERY MUCH UNAWARE OF THE HISTORY OF THE RESIDENTS’ RIGHTS ISSUE IN FLORIDA AND GENERALLY DON’T KNOW WHAT RIGHTS ARE INVOLVED, SO HERE IS A BRIEF SUMMARY.

 IN THE EARLY 1970’S REPORTS OF ABUSE AND NEGLECT IN NURSING HOMES IN FLORIDA RIVALLED THE EARLIER  DAYS WHEN  ABUSE AND NEGLECT IN AMERICA’S MENTAL INSTITUTIONS WAS PREVALENT.  AFTER A SERIES OF GRAND JURY INVESTIGATIONS IN SOUTH FLORIDA, WHERE EGREGIOUS ABUSES WERE UNVEILED, THE NURSING HOME RESIDENTS’ BILL OF RIGHTS WAS ENACTED IN 1976. AND IS SET FORTH IN SECTION 400.022 OF THE FLORIDA STATUTES.

 THE BILL WAS SPONSORED BY SENATOR BOB GRAHAM, AND REPRESENTATIVE GEORGE SHELDON, TO PROTECT THE RIGHTS, HEALTH AND SAFETY OF FLORIDA’S NURSING HOME RESIDENTS, BECAUSE OF THE MULTITUDE OF INDIGNITIES AND ABUSE REPORTED TO THE GRAND JURIES.  APPARENTLY IT WAS THOUGHT THAT IF YOU SPELLED OUT THE FACT THAT THESE RESIDENTS WERE STILL CITIZENS, AND HAD CERTAIN INHERENT RIGHTS, RIGHTS WE HAVE ALL COME TO TAKE FOR GRANTED FOR OURSELVES, THAT THE SPECIFIC SPELLING OUT OF THESE RIGHTS WOULD HALT THE EGREGIOUS ABUSE AND NEGLECT.

 N O T !!!

 AT LEAST NOT IN THE SEVERAL YEARS AFTER THE RIGHTS WERE ENACTED INTO LAW.  THE ABUSE AND NEGLECT CONTINUED UNCHECKED UNTIL THE LEGISLATURE PUT SOME TEETH INTO THE LAW BY ENACTING SPECIAL ENFORCEMENT PROVISIONS  -- SET FORTH IN SECTION 400.023 OF THE FLORIDA STATUTES.

 TO REVERSE THAT LAW AND REDUCE THOSE ENFORCEMENT PROVISIONS  NOW WOULD THROW FLORIDA BACK 25 YEARS – TO A TIME WHICH NO ONE WANTS TO REMEMBER OR THINK ABOUT AND --  SIMPLY PUT – WOULD ALLOW THE NURSING HOMES TO DO ANYTHING (OR NOT DO THE RIGHT THING) AND NOT BE HELD ACCOUNTABLE !!

 JUST FOR KICKS, LET’S LOOK AT SOME OF THE RIGHTS THE LEGISLATURE FOUND IT NECESSARY TO SPELL OUT --  WOULD YOU WANT TO GIVE UP THESE RIGHTS?

 THE RIGHT TO QUALITY OF LIFE – REQUIRES RESIDENTS TO BE CARED FOR IN A MANNER  WHICH WILL PROMOTE MAINTAINING OR ENHANCING QUALITY OF LIFE, WITH EMPHASIS ON DIGNITY, CHOICE, AND SELF-DETERMINATION.

 THE RIGHT TO SERVICES AND ACTIVITIES – REQUIRED RESIDENTS TO BE PROVIDED WITH SERVICES AND ACTIVITIES TO HELP THEM ATTAIN OR MAINTAIN THE HIGHEST PRACTICAL PHYSICAL, MENTAL, AND PSYCHOSOCIAL WELL BEING, BASED ON A WRITTEN PLAN OF CARE, PREPARED WITH PARTICIPATION TO THE EXTENT PRACTICABLE OF THE RESIDENT OR THE RESIDENT’S FAMILY OR LEGAL REPRESENTATIVE.

 THE RIGHT:

TO CHOOSE A PERSONAL PHYSICIAN,
TO VOICE GRIEVANCES ABOUT CARE OR TREATMENT WITHOUT DISCRIMINATION OR REPRISAL;
TO OBTAIN FULL INFORMATION IN ADVANCE REGARDING CHANGES IN CARE AND TREATMENT;
TO REASONABLE ACCOMMOCATION BY THE NURSING HOME FOR INDIVIDUAL NEEDS AND PREFERENCES;
TO ORGANIZE AND PARTICIPATE IN RESIDENT GROUPS (WITH THEIR FAMILIES HAVING THE RIGHT TO ORGANIZE FAMILY GROUPS) IN THE FACILITY;
TO PARTICIPATE IN SOCIAL, RELIGIOUS AND COMMUNITY ACTIVITIES OF THEIR CHOICE;
TO PRIVACY IN MEDICAL TREATMENT, VISITS, TELEPHONE COMMUNICATIONS, AND MEETINGS OF RESIDENT
 AND FAMILY GROUPS;
TO CONFIDENTIALITY OF PERSONAL AND CLINICAL RECORDS;
TO BE FREE FROM PHYSICAL OR MENTAL ABUSE, CORPORATE PUNISHMENT, INVOLUNTARY SECLUSION, OR 
 DISCIPLINARY USE OF RESTRAINTS;
TO RECEIVE MEDICATION AS ORDERED BY A PHYSICIAN, FOR A SPECIFIC MEDICAL SYMPTOM, WITH PERIOD 
 REVIEW;
TO RECEIVE INFORMATION ESSENTIAL TO THEIR DAILY LIFE;
TO RECEIVE IMMEDIATE VISITS FROM HIS OR HER PERSONAL PHYSICAN, REPRESENTATIVES OF THE HEALTH 
DEPARTMENT AND OMBUDSMAN, AND, WITH THE RESIDENT’S CONSENT, TO RECEIVE  IMMEDIATE VISITS FROM RELATIVES;  TO RECEIVE VISITS FROM OTHERS (SUBJECT TO REASONABLE RESTRICTION),  AND FROM ORGANIZATIONS OR INDIVIDUALS WHO PROVIDE HEALTH, SOCIAL, LEGAL OR OTHER SERVICES;
TO HAVE OMBUDSMEN REVIEW THE RESIDENT’S CLINICAL RECORDS WITH THE RESIDENT’S PERMISSION;
TO HAVE TRANSFER AND DISCHARGE RIGHTS, INCLUDING NOTICE PROVISIONS, BED HOLD PROVISIONS AND 
 ORIENTATION;
TO HAVE THEIR PERSONAL FUNDS PROTECTED; AND 
NOT TO BE DISCRIMINATED AGAINST DUE TO BEING ON MEDICAID.

 AGAIN, THIS IS THE TIME TO SPEAK UP OR FOREVER HOLD YOUR TONGUE !

THERE ARE ADVOCATES HERE IN FLORIDA, AND ELSEWHERE THROUGHOUT THE COUNTRY, WHO ARE WORKING CONSTANTLY TO IMPROVE THE LOT OF OUR LOVED ONES IN NURSING HOMES.  EACH HAS A DIFFERENT APPROACH, BUT ALL HAVE THE SAME HEART.  THIS IS A PARTIAL LIST FOR YOUR INFORMATION:

NATIONAL CITIZENS COALITION FOR NURSING HOME REFORM (NCCNHR) www.nccnhr.org (202-332-2275)
COALITION TO PROTECT AMERICA’S ELDERS www.protectelders.org (1-877-262-5484)
FLORIDA ADVOCATES FOR NURSING HOME PROVEMENT (FANHI) WWW.FANHI.ORG (1-888-645-3367)
FIGHTING ELDER ABUSE TOGETHER, INC. (FEAT) [email protected]  (1-321-984-8883 or 321-725-5386)
THE NIGHT WATCHMAN, P. O. BOX 13553, TAMPA, FL 33681-3553  [email protected]