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
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Elderly In Long-term Care Setting Suffer Depression More Than Those Cared For At Home

t some point after they were admitted, compared to only a quarter of the home-cared elders.

Jodi Shapuras and Lindsay Egan, undergraduate students in the social work program at ISU, conducted the research at their internships as part of a senior-level field practicum class.

“We are both interested in working with the elderly population in our careers, so we conducted this research to get a better feel for the prevalence of depression in those who need some level of outside care,” said Shapuras of Mitchell, Ind. “As social workers, it is important to understand the mental health issues, such as depression, within the different care settings.”

Shapuras and Egan said they weren’t surprised by their findings.

“We actually hypothesized that the long-term care patients would utilize antidepressants more and would self-report depression more,” said Egan of Terre Haute, Ind. “When an individual moves to a long-term care facility, they undergo a tremendous amount of changes. They are no longer able to live independently and are relying on others for care, and this greatly affects how they feel about themselves and the world around them.”

Shapuras added that in the home-care setting, elders are still residing within a familiar environment.

Statehealthfacts.org Posts Updated, New Information On Medicare, Medicaid

New and updated data, Statehealthfacts.org: Statehealthfacts.org has added new and updated data on Medicare and Medicaid. New data from the CMS Office of the Actuary on Medicare on Medicare spending estimates by state of residence for 1995 through 2004 are available for all states. These estimates are based on where individuals reside and include total Medicare spending; spending on hospital care, physician services, dental services, home health care, drugs and nursing home care; total per enrollee spending; per enrollee spending by service type; and the average annual percent growth in Medicare spending from 1995 to 2004. New data on total Medicaid spending estimates by state of residence for 1995 through 2004 also are available for all states (Kaiser Family Foundation release, 5/1).

State cash to boost city nursing care

The Michigan Department of Community Health plans to announce today a $1.7 million investment into Detroit nursing homes to improve the quality and skills of the staff serving a population of low-income, minority residents with chronic and mental health issues.

The state funding will be disbursed over two years to the Detroit Area Agency on Aging, which has identified numerous problems with the city's nursing homes, such as substandard care, financial difficulties and likelihood of closures.

Of the $1.7 million, $350,000 will be used for enhanced training of certified nursing assistants to care for patients with complex needs through a partnership with SEIU Healthcare Michigan, said James McCurtis Jr., a spokesman for the Michigan Department of Community Health.

Costs for long term care continue to rise

NEW YORK (AP) - The costs for long-term care have gone up for a fifth straight year.

Genworth Financial has found that charges for nursing homes, assisted living facilities and some in-home care services are up anywhere from 7 to 25% in the last five years.

The national average annual cost of a nursing home is more than $76,000, a 17% jump since 2004. The cost of assisted living facilities went up by 25%, from just under $29,000 to more than $36,000.

The study predicts that those fees will continue to rise because of a shortage of long-term care workers at a time when more baby boomers are reaching retirement.

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.

Nursing Homes Increasingly Use Arbitration To Avoid Lawsuits, Reduce Costs

Nursing home residents and their families increasingly are "giving up their right to sue over disputes about care, including those involving death, as the homes write binding arbitration into their standard contracts," the Wall Street Journal reports. Under arbitration agreements, nursing home residents and their families agree to settle disputes through a third-party arbiter. According to the Journal, "Nursing homes have been among the biggest converts to the practice since a wave of big jury awards in the late 1990s."

The practice has "profound implications" on the nursing home industry, according to the Journal. An industry study released last year found that the average cost of settling cases has declined for nursing homes. At the same time, claims of poor treatment have been increasing, the Journal reports.

Consumer advocates and plaintiffs' lawyers have criticized the arbitration systems for nursing homes, saying that people too often do not understand whether the arbitration clauses are mandatory or that they are waiving their right to sue. Critics say courts should handle such claims. Sens. Mel Martinez (R-Fla.) and Herb Kohl (D-Wis.) on Wednesday introduced legislation that would prohibit nursing homes from requiring patients to sign an arbitration agreement as a term of service. Martinez said, "It is an unfair practice given the unequal bargaining position between someone desperate to find a place for their loved ones and a large corporate entity like a nursing home."

The American Arbitration Association, which is the largest arbitration provider in the nation, generally refuses to handle cases of nursing home arbitration and opposes arbitration requirements in nursing home claims. The American Health Lawyers Association has a similar stance, and other arbitration groups said they only accept the cases when the agreements are in compliance with law. Eric Tuchmann, general counsel for the American Arbitration Association, said that some patients "really are not in an appropriate state of mind to evaluate an agreement like an arbitration clause."

The nursing home industry says arbitration is relatively inexpensive for plaintiffs and defendants, and allows nursing home staff to focus on patient care, instead of litigation (Koppel, Wall Street Journal, 4/11).

Nursing home residents sue for at-home care

ST. PETERSBURG, Fla. — Since a stroke four years ago, 66-year-old Bud Lee can't lift himself out of bed or take himself to the bathroom. He would like to regain a bit of his old independence.

John Boyd, 50, has been paralyzed since 14. He would like an apartment of his own and a job, like when he answered customer service phones for Red Lobster a few years back.

Instead, both men live in nursing homes, a frequent situation when Florida Medicaid pays the bills.

That may change.

Lee, Boyd and five other nursing home residents backed by the AARP Foundation have filed a class-action lawsuit against the state of Florida under the Americans with Disabilities Act, citing a 1999 court ruling that helped spring mentally ill people from big, impersonal hospitals.