Community-Acquired Pneumonia In The Elderly: Every Tenth Patient Dies In Western Countries

Community-acquired pneumonia (CAP) represents a public health problem of substantial magnitude, and remains the leading cause of death due to infectious diseases, with an incidence ranging from 1.6 to 10.6 per 1,000 adults per year in Europe.

Owing to demographic changes, elderly patients now represent about 50% of CAP patients in western countries. 

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081

Lawmakers hear testimony on nursing home arbitration clauses

WASHINGTON (Legal Newsline)-Federal lawmakers heard Tuesday that binding arbitration clauses in nursing home contracts provide a fair and timely resolution of patient disputes.

Arbitration agreements are "a viable option" for long term care providers and their residents to resolve legal disputes, said attorney Gavin Gadberry, representing the American Health Care Association and the National Center for Assisted Living.

"Arbitration is less adversarial than traditional litigation, produces quicker results and has been determined to be both fair and appropriate by our courts," he told members of the House Judiciary's Subcommittee on Commercial and Administrative Law.

The 12-member panel is considering legislation introduced by committee chair Rep. Linda Sánchez, D-Calif., who said she recently placed her father in a nursing home.

"Unfortunately, this debate is colored by anecdotes and misinformation perpetuated by high-profile trial attorneys who traditionally oppose any effort to bring balance to the personal injury playing field, and who give too little consideration to the harmful consequences on the long term care industry that follow from the high transaction costs of traditional litigation and the resulting financial drain on the system," Gadberry said.

The legislation, outlined in H.R. 6126, would render invalid pre-dispute arbitration agreements between a long-term care facility and a resident or anyone acting on the resident's behalf.

"When legal concerns arise, we believe that fair and timely resolution -the kind that is often the product of arbitration - is in the best interest of both the consumers and their care providers," Gadberry said.

The bill-the Nursing Home Arbitration Act of 2008-is supported by AARP, which represents older Americans.

Dr. William Hall, a member of AARP's board of directors, told the committee that pre-dispute arbitration clauses in nursing home contracts are "harmful" to residents and their families.

"These arbitration clauses force a Hobson's choice --waive the right to seek redress in the courts or get care in another facility, assuming there is one in their area without an arbitration clause," the Rochester, N.Y., geriatrician said.

While the quality of care in nursing homes and other residential care centers has improved since the enactment of federal nursing home quality standards in the Omnibus Budget Reconciliation Act of 1987, he said "much more" needs to be done to improve patient care.

"Many facilities do provide high quality care, but there are also too many facilities that show significant quality deficiencies that can cause harm to residents on their annual inspections," Hall said.

Arbitration clauses, he said, unfairly take away residents' and families' legal options. What's more is that many nursing home admissions are made unexpectedly, after a crisis.

"Clearly, most people seeking nursing home admission are focusing on the quality and range of services available, and are not thinking about possible future disputes," Hall said.

"When they are presented with admissions contracts, they often do not know that an arbitration requirement is buried in the fine print of the multi-page document," he added.


Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

Researchers: Nursing home residents attacking each other more often than expected

Nursing home residents are lashing out at each other verbally, physically and in other ways more often than previously believed, according to Cornell University-based researchers.

"Because of the nature of nursing home life, it is impossible to eliminate these abusive behaviors entirely, but we need better scientific evidence about what works to prevent this problem," said Karl Pillemer, director of the Cornell Institute for Translational Research on Aging at the College of Human Ecology.

Studies led by Pillemer and professor of medicine Mark S. Lachs, MD, at a large, city-based nursing home discovered 35 different types of physical and verbal abuse between residents. Screaming was the most common form, followed by pushing, punching and fighting.

Researchers also found in another two-week study period that 2.4% of residents said their were on the receiving end of physical aggression, while 7.3% said they had been verbally assaulted.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

House Committee Holds Hearing On Concerns About Nursing Home Ownership, Inspections

The House Energy and Commerce Oversight and Investigations Subcommittee on Thursday held a hearing to examine the effects that the "increasingly veiled nature" of nursing home ownership and problems with inspections have had on the quality of care for elderly and disabled residents, CQ HealthBeat reports (Reichard, CQ HealthBeat, 5/15). According to CongressDaily, more than 50% of nursing homes are part of chains, with many of those owned by private equity firms that establish "layered entities" to operate the facilities, "making it difficult" for CMS, states and consumers to determine their owners and operators (Cox, CongressDaily, 5/16).

At the hearing, Lewis Morris, chief counsel to the Inspector General for HHS, said that CMS operates a database called "Pecos" that includes some nursing home ownership information but added that the system does not address the issue adequately. The database includes ownership information on 70% of the nursing homes that participate in Medicare, according to acting CMS Administrator Kerry Weems. He said that CMS seeks to "populate Pecos 100%" and link ownership information to quality data on the Nursing Home Compare Web site but added that the agency must have "usable" ownership information (CQ HealthBeat, 5/15).

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

Center For Medicare Advocacy Issues New Report On Nursing Home Decisions

Nursing home decisions issued by the Department of Health and Human Services' Departmental Appeals Board (DAB) in 2007 highlight serious failures in care that cause residents to suffer unnecessary pain, injury, trauma, and death. "Despite the serious deficiencies reflected by these cases, the federal enforcement response is usually modest, at best," said Toby S. Edelman, Senior Policy Attorney with the Center for Medicare Advocacy and author of the just-released report,, an analysis of nursing home enforcement decisions issued by the DAB. "The federal government imposes only minor fines for these deficiencies," she continued, citing a case where a trivial $4050 fine was imposed when a resident strangled to death on her bedrail, after having fallen out of bed numerous times and been found caught by the bedrail in the same way a week before.

The Center for Medicare Advocacy's study of the 85 decisions is the first study ever made of the administrative appeals filed by nursing homes when federal remedies are actually imposed against them for poor care. "The study shows not only that the problems in care are serious and that penalties are modest, but also that facilities choose to appeal these enforcement actions through the administrative appeals process. Almost always, the facilities lose their cases," Edelman said. The government won 66 of the 71 cases that reached the merits of the appeals - a 93% success rate.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

Serious Deficiencies in Nursing Homes Are Often Missed, Report Says

Image via WikipediaNursing home inspectors routinely overlook or minimize problems that pose a serious, immediate threat to patients, Congressional investigators say in a new report.

In the report, to be issued on Thursday, the investigators, from the Government Accountability Office, say they have found widespread “understatement of deficiencies,” including malnutrition, severe bedsores, overuse of prescription medications and abuse of nursing home residents.

Nursing homes are typically inspected once a year by state employees working under contract with the federal government, which sets stringent standards. Federal officials try to validate the work of state inspectors by accompanying them or doing follow-up surveys within a few weeks.

The accountability office found that state employees had missed at least one serious deficiency in 15 percent of the inspections checked by federal officials. In nine states, inspectors missed serious problems in more than 25 percent of the surveys analyzed from 2002 to 2007.

The nine states most likely to miss serious deficiencies were Alabama, Arizona, Missouri, New Mexico, Oklahoma, South Carolina, South Dakota, Tennessee and Wyoming, the report said.

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

Elder Justice Act

To amend the Social Security Act to enhance the social security of the Nation by ensuring adequate public-private infrastructure and to resolve to prevent, detect, treat, intervene in, and prosecute elder abuse, neglect, and exploitation, and for other purposes.

  • Other Bill Titles


  • Official: To amend the Social Security Act to enhance the social security of the Nation by ensuring adequate public-private infrastructure and to resolve to prevent, detect, treat, intervene in, and prosecute elder abuse, neglect, and exploitation, and for other purposes. as introduced.
  • Short: Elder Justice Act as introduced.
3/29/2007--Introduced.
Elder Justice Act - Amends the Social Security Act (SSA) to establish an Elder Justice program under title XX (Block Grants to States for Social Services). Establishes within the Office of the Secretary of Health and Human Services (HHS) an Elder Justice Coordina more...

Norman DeLisle, MDRC
"With Liberty and Access for All!"
GrandCentral: 517-589-4081
MDRC Website: http://www.copower.org/
LTC Blog: http://ltcreform.blogspot.com/
Recovery: http://therecoveringlife.blogspot.com/
Change: http://prosynergypsc.blogspot.com/

Advocates laud Elder Justice Act

The Elder Justice Act (HR 1783) received a heap of accolades from senior care advocates and industry representatives at a hearing on Capitol Hill Thursday.

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Testimony from AARP and Robert Blancato, national coordinator of the Elder Justice Coalition, highlighted the care community's support of the bill, which was introduced last year by Representative Rahm Emanuel (D-IL).

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Among the more than 556,000 confirmed cases of elder abuse recorded in 2004, 20,000 of those occurred in a nursing home or long-term care facility, said Blancato, speaking to the House Judiciary Subcommittee on Crime, Terrorism and Homeland Security. In its submitted testimony, AARP echoed Blancato's sentiments of concern and praised the legislation.

Senator Grassley Introduces Nursing Home Transparency and Improvement Act of 2008

On February 14, 2008, Senator Charles Grassley and Senator Herb Kohl introduced the Nursing Home Transparency and Improvement Act of 2008 (S.2641). According to a related Press Release, S.2641 aims to bring more transparency to consumers regarding nursing home quality, improve enforcement, and strengthen nursing home staff training requirements.

Among other things, S.2641 would reportedly require that "special focus facility" designations be placed on the Nursing Home Compare website. S.2641 would also require that CMS develop a standardized complaint form and require more uniform reporting of nursing staff levels so that comparisons can be made across nursing homes. S.2641 would also strengthen the available penalties. For instance, S.2641 would reportedly allow the Secretary to impose civil monetary penalties of up to $100,000 for a deficiency resulting in death, $3,000-$25,000 for deficiencies at the level of actual harm or immediate jeopardy, and not more than $3,000 for other deficiencies. Finally, S.2641 would attempt to improve staff training by including dementia management and abuse prevention training as part of pre-employment training.