South Carolina Nursing Home Blog

Ranking nursing homes

Ray Mullman — Mon, 08 Feb 2010 08:46:54 -0500

U.S. News & World Report issues the best and worst nursing homes every year based on federal and state inspections, surveys, and required data on staffing. Here is the most recent article. The rankings are only as good as the investigators which in most cases is poor. On a given day, 1.5 million people are living in the nation's 16,000-plus nursing homes, and in a typical year more than 3.2 million Americans will spend at least some time in one.

The U.S. News rankings rely on Nursing Home Compare, a program run by the federal Centers for Medicare and Medicaid Services. CMS analyzes information on all homes enrolled in Medicare or Medicaid. The homes also receive ratings of one to five stars in each of three areas: health inspections, nurse staffing, and measures of care.

At Nursing Home Compare, you can search for a specific home or for all homes in a particular state or within a certain distance of your city or ZIP code. But you can't assume that all five-star homes, or those with three or four stars, are of the same quality. There are so many homes in each rating—1,855 in the five-star and 3,661 in the four-star categories alone—that the range of performance is bound to be very wide. Nor can search terms be combined if, say, you want only five-star homes within 50 miles of a specific city.

America's Best Nursing Homes addresses these and other issues. Homes are presented in tiers within each star category, based on their total stars in all three of the major areas. The topmost tier, for example, consists only of five-star homes that got 15 stars. The next tier down is five-star homes with 14 total stars, and so on.

Here are more details about the measures that go into the CMS ratings.

Health inspections. Because almost all nursing homes accept Medicare or Medicaid residents, they are regulated by the federal government as well as by the states in which they operate. State survey teams conduct health inspections on behalf of CMS about every 12 to 15 months. They also investigate health-related complaints from residents, their families, and other members of the public. "Health" is broadly defined, as is evident in the 180-some items on the checklist. Besides such matters as safety of food preparation and adequacy of infection control, the list covers such issues as medication management, residents' rights and quality of life, and proper skin care. A home's rating is based on the number of deficiencies, their seriousness, and their scope, meaning the relative number of residents who were or could have been affected. Deficiencies are counted that were identified during the three most recent health inspections and in investigations of public complaints in that time frame. State inspectors also check for compliance with fire safety rules, although their findings do not factor into the CMS ratings.

Nurse staffing. Even the best nursing care is not enough if there are too few nurses to spend much time with residents, so CMS determines average nursing time per patient per day. Homes report the average number of registered nurses, licensed practical nurses, licensed vocational nurses, and certified nurse aides who were on the payroll during the two weeks prior to the most recent health inspection and their number of hours worked. The information is compared with the average number of residents during the same period and crunched to determine the average number of minutes of nursing time residents got per day.

Quality measures. Nursing homes have to furnish the latest three quarters of clinical data showing the status of each individual Medicare and Medicaid resident in 19 indicators, such as the percentage of residents who had urinary tract infections or who were physically restrained to keep from falling from a bed or a chair. The Best Nursing Homes rankings and Nursing Home Compare display data for each home on all 19. The ratings, however, are based on 10 that are considered the most valid and reliable, such as the two above and measures related to pain, bedsores, and mobility.

Use of Antipsychotics

Ray Mullman — Sun, 07 Feb 2010 13:56:02 -0500

McKnight's also ran an article about the recent studies that prove the off label use and over use of dangerous antipsychotics to elderly and vulnerable patients. Antipsychotic medication use is still widespread in nursing homes, even after the federal government issued a “black box” warning on the drugs in 2005 according to two new studies.

The drugs in question include clozapine, risperidone, olanzapine and paliperidone. Doctors prescribe these drugs, which are designed to treat bipolar disorder and schizophrenia, off-label for residents with dementia. Both studies appeared in Monday's issue of the Archives of Internal Medicine.

Overuse of antipsychotic

Ray Mullman — Sun, 07 Feb 2010 08:32:28 -0500

As a follow up to yesterday's blog entry, here is another article about the overuse of antipsychotic medications in nursing homes by Business Week. The practice can threaten physical health. Since the U.S. Food and Drug Administration instituted a "black box" warning in 2005, one study found a 19 percent decrease in the prescription of atypical antipsychotics in elderly people with dementia. But the researchers found that in 2008, antipsychotics still represented 9 percent of all prescriptions in this group.

"The [2005] safety warning pertained to an increased risk of death among individuals using these drugs, so the public health ramifications of use of these drugs in elderly people with dementia, often in nursing homes, which we consider a vulnerable population, is concerning," said Dr. E. Ray Dorsey, an assistant professor of neurology at the University of Rochester Medical Center and lead author of one of the studies in the Jan. 11 issue of the Archives of Internal Medicine.

Antipsychotics are widely used "off label" to control difficult behavior in elderly people with dementia. Indeed, Dorsey said he suspects that the vast majority of the use documented in his research is "off label." In the United States, no antipsychotics are approved to calm behavior.

The second study found that almost one-third of residents in nursing homes were prescribed antipsychotics and that one-third of that number did not have dementia or psychosis. Newly arrived residents were more likely to receive this type of drug if they were in a nursing home that routinely prescribed such drugs, suggesting that organizational culture and not patients are driving the trend.

"If you enter a nursing home that has a higher proportion of people on antipsychotics, you are also likely to be put on antipsychotics," Briesacher said.

Overmedication in nursing homes

Ray Mullman — Sat, 06 Feb 2010 08:06:03 -0500

NY Times had a great article on the too common practice of overmedicating residents in nursing homes. Nursing homes often chemically restrain residents because it is easier: No complaints, no call bells, no requests. Management can then staff less people on certain shifts especially at night. Paula Spann wrote a great article.

Within three months of admission, a team of University of South Florida researchers determined, 71 percent of Medicaid residents in Florida nursing homes were receiving a psychoactive medication — an antidepressant or anti-psychotic, or dementia drugs — even though most were not taking such drugs in the months before they moved in and didn’t have psychiatric diagnoses. 15 percent of residents were taking four or more such medications. Only 12 percent were getting nondrug treatments like behavioral therapy.

The article mentions Victor Molinari, a professor of aging at the University of South Florida and lead author of the study. He wasn’t startled by those statistics. “They confirmed what I suspected,” he told me in an interview. “And people who work in nursing homes wouldn’t be surprised. It seems the use of psychoactive medication is trumping the use of nondrug treatments,” Dr. Molinari said. And given the possible interactions with the many other drugs most residents take, an average 10 or more prescriptions, “it could well be that we’re causing problems like falls, confusion and delirium, and hospitalizations,” he cautioned.

Nursing homes’ reliance on psychoactive drugs has troubled professionals in geriatrics for years. In many states, residents being admitted directly from hospitals are exempt from screening. As a result, federal data show, fewer than half of residents with major mental illnesses receive the mandated assessment. Only half of nursing homes provide weekly patient consultations with psychiatrists, psychologists or other mental health experts; even fewer provide consultations with those who specialize in working with seniors. In addition, staffs are stretched thin and inadequately trained in mental health care. With a pill a quicker and simpler intervention than the alternatives, intentional overuse is the result. If the aide had fewer patients to care for or if management increased staffing numbers, and more time to soothe one who was agitated, if she’d had better training in responding to behavioral problems, she might be able to handle behavioral issues.

The Justice Department brought criminal charges against Eli Lilly, accusing the big pharmaceutical firm of illegally marketing its anti-psychotic Zyprexa to doctors who work in nursing homes and assisted living facilities, and encouraging them to prescribe it for sleep disorders and dementia. Its approved use is to treat schizophrenia and bipolar disorder. Lilly agreed to pay $1.4 billion in a related civil settlement.

“For years, I’ve had calls from family members saying, ‘Mom was completely lucid when she went into the nursing home, and a week later she no longer recognized us,’” said Janet Wells, public policy director of NCCNHR, formerly the National Citizens’ Coalition for Nursing Home Reform. “Families should question why drugs are prescribed, do some research. A lot of drugs are being used as restraints.”

Paula Span is the author of the recently published “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

Spending on nursing home care rose

Ray Mullman — Fri, 05 Feb 2010 08:56:25 -0500

Life and Time Health Insurance reported that spending on nursing home care climbed to more than $138 billion in 2008, up 4.6% from the 2007 total, according to federal analysts. The "good" news is that the rate of increase decelerated from 5.8% in 2007. Analysts from the Centers for Medicare and Medicaid Services have reported those figures in the latest issue of Health Affairs, an academic journal that covers health care finance and delivery systems.

The slowdown in the LTC spending growth rate was due partly to reduced growth in private spending on nursing homes. Private payers account for 38% of total spending on nursing home services. Increases in nursing home care prices fell to 4% in 2008, from 4.7% in 2007, and that also contributed to the deceleration, the researchers report.

Meanwhile, public spending for nursing home services grew slightly faster than the year before because of increased growth in Medicaid nursing home spending. Medicaid, which accounted for 41% of total nursing home spending in 2008, saw spending on that item grow 2.6% in 2008, after growing just 2.6% in 2007 and 1.5% in 2006.

Guilty plea in health care fraud case

Ray Mullman — Thu, 04 Feb 2010 08:59:12 -0500

St. Louis Today had an article about a criminal enterprise masquerading as a nursing home. Luckily they got caught and the company pleaded guilty to fraud and will pay $1.6 million in fines and restitution.

When the Texas-based Cathedral Rock Corp. bought 11 Missouri and Illinois nursing homes in 2001, owner and CEO C. Kent Harrington told employees that residents were the first priority and would get "extra-special treatment."

The real priority was packing elderly and disabled clients into those homes — including five in the St. Louis area that were understaffed and provided substandard care, according to court documents and federal prosecutors. Until 2005, the services "were grossly inadequate" and represented "a complete failure of care," Assistant U.S. Attorney Dorothy McMurtry said in court.

It also settled a whistle-blower civil lawsuit filed by nurses in 2003 that triggered what officials said was a relatively rare criminal prosecution of a nursing home over poor care.

Five Cathedral Rock-owned companies that ran those homes agreed to pay $1 million in criminal fines and penalties, and $628,000 in the civil settlement. The companies will be formally sentenced in April, likely to some term of probation in addition to the fines and penalties. So no one is going to jail for defrauding the government, stealing from medicare and medicaid, and directly causing the deaths of dozens of residents!

Among the claims was that the homes' staff doctored patient charts, falsified drug records and failed to give necessary medications. Some residents suffered from bed sores. Others wandered away. One ended up on a roof. One was found days later. One died after falling from a window. The homes were repeatedly cited by regulators, fined and penalized. Officials said the homes filed corrective plans but then failed to comply or "misrepresented" their efforts to comply.

"FTB (fill the beds) is everything," read a 2004 e-mail from a Cathedral Rock regional vice president to another executive. "Whereas compliance is important and cost control is as well, CENSUS is to be your primary focus," the e-mail read.

In 2004, Cathedral Rock had 2,600 beds in 25 nursing homes and assisted-living facilities in Missouri, Illinois, Texas, Ohio and South Carolina, Harrington said at the time.

Its website currently lists 1,308 beds in 15 homes in Texas and New Mexico. A spokesman said it no longer operates facilities in Missouri or Illinois.

Greedy CEO pleads guilty

Ray Mullman — Wed, 03 Feb 2010 08:43:40 -0500

The Hartford Courant had an article about another greedy nursing home CEO. The former chief executive of a now defunct nursing home chain pleaded guilty to federal charges that he improperly used money intended for the homes to buy real estate. Raymond Termini pleaded guilty to conspiracy to commit wire fraud and engaging in unlawful monetary transaction.

Termini stole a $6 million loan for private business transactions, and up to $2 million for sprinklers at the nursing homes instead to buy real estate and other purposes. Termini was CEO of Middletown-based Haven Healthcare, one of the state's largest nursing home chains before it filed for bankruptcy protection in 2007, operating 27 facilities in five states, including 15 in Connecticut. Termini agreed to forfeit $500,000. So he steals millions but he "agreed" to pay a measly half a million.

"Mr. Termini admitted he made some errors," Keefe said. "Otherwise he did a lot of good for a lot of people in that industry."

Arrests in chemical restraint death cases

Ray Mullman — Tue, 02 Feb 2010 08:28:49 -0500

ABC News reported a story about the deaths of residents caused by over medication and chemical restraint. When residents at the Kern Valley Nursing Home complained or annoyed nursing director Gwen Hughes, prosecutors say she chemically restrained them with powerful anti-psychotic drugs. Her methods were so severe, three residents died.

California Attorney General Jerry Brown says that Hughes ordered one patient drugged just for glaring at her, and another for throwing a carton of milk. Some residents were left drooling, dehydrated, and dangerously thin. According to Brown, "In a couple cases, elderly people were actually held down, restrained against their will, and given excessive amounts of medicine to keep them quiet."

Even more shocking -- Hughes had been fired for over-drugging once before, from a nursing home in nearby Fresno, Calif. The administrator of that nursing home said they told her next employer only the dates she worked there.

Three nursing home officials appeared at a hearing on charges of elder abuse at the Kern Valley facility from 2003 to 2007 -- Gwen Hughes, as well as administrator Pamela Ott and staff physician, Dr. Hoshang Pormir. The three defendants each face up to 11 years in prison, and all have pleaded not guilty. A preliminary hearing is set for March 9, 2010.

Additionally, a former pharmacist at the facility, Debbi Gayle Hayes, accepted a plea bargain on the condition that she testifies for the prosecution.

Experts say over-drugging is common nationwide, and the number of nursing home residents who are given these drugs is rising. It has been estimated that nursing homes give anti-psychotics to one in every four patients. Some suggest that the drugs are replacing physical restraints, which are now illegal except as a last resort.

Toby Edelman, from the watchdog Center for Medicare Advocacy, says, "They're hiding the restraints. A physical restraint is visible, but a chemical restraint is not."

Using a chemical purely as a restraint is also illegal, but they are so widely used that the lawyer for Pormir, the doctor in the California case, plans to cite the drugs' widespread use as part of his defense.

His attorney, Dennis Thelen, says, "To suggest that using psychotropic medication is contrary to a patient's best interest is just flatly contradicted by what happens every day in the United States, yesterday, right now, and tomorrow."

A Food and Drug Administration official estimates that unnecessary anti-psychotics kill 15,000 nursing home patients each year, including Fannie Mae Brinkley.

There are steps you can take to make sure your loved one isn't at risk. Click the links below for more information.

Elder Justice Coalition http://www.elderjusticecoalition.gov

National Committee for the Prevention of Elder Abuse http://www.preventelderabuse.org

National Adult Protective Services Association http://www.apsnetwork.org/

National Center on Elder Abuse http://www.ncea.aoa.gov

National Association of State Units on Aging www.nasua.org

National Academy of Elder Law Attorneys www.naela.org

National Association of State Long-Term Care Ombudsman Programs http://www.nasop.org/

Nursing Home Comparison Tool from Medicare http://www.medicare.gov/NHCompare

Center for Medicare Advocacy www.medicareadvocacy.org

Directory of State Resources from the National Center on Elder Abuse http://www.ncea.aoa.gov/NCEAroot/Main_Site/Find_Help/State_Resources.aspx

Disparate treatment based on race/ethnicity?

Ray Mullman — Mon, 01 Feb 2010 08:19:56 -0500

I saw this press release from Brown University. Interesting conclusions based on data.

Hispanic senior citizens are living in nursing homes in ever-increasing numbers, but they face a gap in their quality of care compared to white residents, according to new research from Brown University.

A team led by Mary Fennell, professor of sociology and community health, found that Hispanic elderly are more likely than whites to live in nursing homes of poor quality. These residences are often faced with structural problems, staffing issues and financial trouble.

Details will be featured in the January 2010 edition of Health Affairs. The research follows up and expands upon a landmark 2007 study, also published in Health Affairs, suggesting that blacks are more likely than whites to live in poor-quality nursing homes. Vincent Mor, chair of the Department of Community Health, was a lead author in that study and is a co-author in the new work looking at nursing home care for Hispanics. Temple University was also a partner in the previous research.

Fennell said the paper is the first full-scale analysis of its kind to attempt to look broadly at Hispanics in nursing homes — what kind of nursing homes they live in and how care at those facilities compares to nursing homes which care mostly for white elderly people. She said the data revealed a sharp disparity in care.

"The most shocking finding is the pervasiveness of disparities in nursing home care that are primarily white, compared to nursing homes that are a mix of whites and Hispanic residences," Fennell said.

Fennell said the findings, in part, reflect a departure from prior patterns of elder care among Hispanic families in the United States. Traditionally, the group has used formal long-term care services less frequently than any other U.S. ethnic group. They had also been less likely than white or black residents to live in nursing homes. In Hispanic households, elder care has traditionally been handled by adult daughters at home, but acculturation and financial issues have forced a growing number of young Hispanic women into work outside the home.

As a result, Fennell said, the loss of home caregivers is occurring even as the growth of the elderly Hispanic population rises dramatically. The authors estimate that more than 5 percent of the current Hispanic population is elderly, a number that is expected to quadruple during the next 10 years. That number should rise to 4.5 million by 2010, according to Fennell and her team.

Fennell and her colleagues found that the overall use of nursing homes has declined since 1985, but the racial/ethnic mix of the national population of nursing home residents has shifted. From 2000 to 2005 — the period of data used in the study — the percent of Hispanic residents increased from 5 percent to 6.4 percent, but the percentage of non-Hispanic white residents dipped from just under 83 percent to 79.4 percent.

Nursing home residents are coming increasingly from the lower end of the socio-economic scale, Fennell said, lacking resources for better quality care in assisted living facilities or elsewhere.

Fennell argues that the impact of substandard nursing home care is a complex issue. Residents admitted to nursing homes have often already endured hospitalizations or a health issue that required expensive, high-level care. Once admitted, the individual is then often caught in a spiral of long-term lower quality of life, multiple episodes of poor health and ongoing chronic conditions without a way out.

"People with resources can get into very good places or alternatives for nursing home care," Fennell said. "Everyone else is left with not-very-good facilities that are not performing well."

Fennell is hoping that both federal and state policy-makers pay attention to the data as they shape health care reform policy.

Fennell and Mor, with Zhanlian Feng, assistant professor (research) of community health and Melissa Clark, associate professor of community health, looked at a number of federal sources for their research, including the federal Minimum Data Set on nursing home care, the Online Survey Certification and Reporting Database (OSCAR), and U.S. Census Bureau data. Their nursing home sample included 5,179 nursing homes in operation across the country from 2000 to 2005. About 80 percent of all Hispanic nursing home residents are counted in the analysis.

Fennell's research is part of the program project funded by the National Institute on Aging, on Shaping Long-Term Care in America, based at the Center for Gerontology and Health Care Research at Brown. The datasets used by Fennell and colleagues can be accessed through the program project's web site, LTCFocUS.org, which was launched in early November.

Editors: Contact: Mark Hollmer
Mark_Hollmer@brown.edu
401-863-1862
Brown University

Brown University has a fiber link television studio available for domestic and international live and taped interviews, and maintains an ISDN line for radio interviews. For more information, call (401) 863-2476.

Lack of end of life programs in nursing homes

Ray Mullman — Sun, 31 Jan 2010 09:00:20 -0500

McKnight's had an article about end of life programs in nursing homes. Fewer than one in five nursing homes provide end-of-life care services, according to new research from the American Association of Homes and Services for the Aging. However, any expansion would have to deal with the "death panel" demagoguery. These programs are necessary to assist residents and their families regarding their rights to end of life decisions.

As many as 25% of all deaths occur in the U.S. occur in a nursing home, according to the report from AAHSA's Institute for the Future of Aging Services. Despite this, less than 20% of nursing homes offer end-of-life programs. Nursing homes were more likely to participate in end-of-life programs if they also offered specialty programs for hospice, pain management or dementia care, according to the report.

There is also a link between staff training in end-of-life care services and a facility's participation in end-of life-programs, the report showed. Providing appropriate staff training may be the key to expanding program participation, according to Helaine Resnick, director of research at IFAS. The research was published in the online version of the American Journal of Hospice and Palliative Care Medicine.

Investigation into Ohio nursing homes

Ray Mullman — Sat, 30 Jan 2010 08:48:56 -0500

Ohio's Newsnet5.com had an article about their investigation into Ohio nursing homes. Working with their partners at Scripps Howard News Service, NewsChannel5 spent three months researching care homes. NewsChannel5 found poor ratings for a number of Cleveland-area nursing homes. In fact, a quarter of the facilities in Cuyahoga County rated just one star on Medicare's five-star scale. Five other ManorCare properties in the area garnered just one star.

"There should be two kinds of nursing homes the excellent and non existent," said Larry Minnix, chief executive officer of the American Association of Homes and Services for the Aging.

Long-term care ombudsman, Gerald Kasunic, said, "If you smell urine or feces, or what I call the chemical hidden smell, something that may be a serious chemical odor, those are kind of bad signs."

According the SHNS and WEWS study of death records maintained by the Centers for Disease Control and Prevention, nearly 19,000 people died in area nursing homes in 2005 and 2006. Of those deaths, 651 people died of accidents, skin infections or other potentially avoidable causes.

Resident wanders away from facility

Ray Mullman — Fri, 29 Jan 2010 08:12:28 -0500

NewJersey.com ran an editorial about the resident who was allowed to wander away from Preakness Healthcare Center in Wayne. A resident with dementia wandered out of the nursing home and was found more than two hours later, roaming in the snow and ice and subfreezing weather. 68-year-old Vidal Mojica, was rescued by members of the Passaic County Sheriff's Department. Mojica, who uses a walker to get around, was found behind the nursing home on Oldham Road wearing just a golf shirt, pants and shoes. Mojica was transported to St. Joseph's Wayne Hospital, where he was being treated for exposure to the cold.

One Preakness employee said Mojica would have to have climbed unsupervised down three flights of stairs with his walker to leave the building. The employee also said Mojica is the second resident to wander away from the nursing home since it opened in October.

While we understand the need to protect the confidentiality of a patient, we are disturbed by the county's stonewalling about the circumstances of his escape from the facility. This is an issue that concerns not just one Preakness resident and his family; it is an issue of deep concern to every county resident.

Numerous questions need to be answered:

How could a patient using a walker have escaped so easily? How could he have gotten so far so fast and remained unseen for more than two hours?

Is there some design flaw in the new building that makes it susceptible to such "escapes"? If so, what steps are being taken to correct them?

Finally, has this happened before, and how can we be assured it won't happen again?

Such a lack of information about what appears to be a severe breach in security in a brand-new, $90 million facility that has already taken on the scorn of taxpayers is not something the county or facility administrators can afford to just slough off.

Perhaps there is a perfectly reasonable explanation of how a 68-year-old man using a walker was able to elude authorities for more than two hours. If so, we'd love to hear it.

Verdict in NY includes punitives for cover up

Ray Mullman — Thu, 28 Jan 2010 08:54:59 -0500

Fox News ran a NY Post article on the verdict against a Brooklyn nursing home. Brooklyn Queens Nursing Home will have to compensate the family of a 76-year-old patient neglected so badly that he left with more than 20 bedsores. The verdict of nearly $19 million, handed down by a jury, is the first in the state against a nursing home that includes punitive damages.

"It was horrible," said Margaret Whitehurst, who pulled her father, John Danzy, from the home after just nine months. "He walked in on two legs and a cane. He was 237 pounds. When we got him back, he was 148 pounds and he had holes all over his body." She and her siblings moved Danzy, a retired truck driver and butcher, to another nursing home. He died as a result to an infection caused by the bedsores.

A Brooklyn jury deliberated two full days following the four-week trial before finding the Cypress Hills facility delivered substandard care. The panel awarded $3.75 million for Danzy's pain and suffering, but tacked on $15 million in punitive damages, based in part that the home had doctored records to try to cover up the neglect.

An FBI expert testified that about 100 different skin-check notes showing "G" for "good" had been penned over to show "B" for "broken" — an effort by the home to claim it hadn't missed the horrific sores. "Someone went back and wrote B's over the G's to cover their tracks, so they falsified the records, he said. "We believe that once they found out they were being sued, they went back and said, 'How could we have G's here when they guy has 20 sores?' "

The nursing home restrained the Alzheimer's-stricken Danzy to keep him from wandering off, but left him alone for long periods. Medical standards require that bedridden or restrained patients be moved every two hours to prevent such sores, but that Brooklyn-Queens only moved Danzy every four hours — if at all.

Dog therapy helps residents

Ray Mullman — Wed, 27 Jan 2010 08:17:52 -0500

The Intelligencer had an article about dog therapy in nursing homes. Therapy dogs walk the halls and sit at the feet of residents of nursing homes and hospital patients, putting smiles on faces. In addition, they visit assisted living facilities, children's reading programs and libraries, assist with stress relief, do home visits, visit hospices, schools and shelters throughout the year.

At Mound View Health Care in Moundsville, in addition to resident facility bulldog Betsy, therapy dogs have been visiting for several years. Connie Smith of Moundsville and her dog, Shadow Dancer, have been visiting the facility for more than four years. Shadow Dancer, a Shetland sheepdog is now semi-retired after making about 150 regular visits, but the dog still makes an occasional return. Smith said she now has a younger dog that is making the visits.

Randy Moore of St. Clairsville and his boxer mix, Sierra, have made more than 200 visits at different facilities around the Ohio Valley.

"There are not enough therapy dogs," he noted. "I think every place needs therapy dogs. It's amazing what they can do. They can actually help bring someone's blood pressure down and reduce stress."

Therapy Dogs International is an organization that provides therapy dogs for hospitals and other facilities. "The dogs need to be trained," he noted. They have to be able to pass a 16-part test. Most hospitals require dogs to have TDI certification before they are allowed to visit. It ensures the dogs have the right temperament and meet insurance requirements.

Smith said anyone who might want to get involved with TDI and bring a dog for training can call her at 304-845-7829. Moore suggested looking at the TDI Web site www.TDI-dog.org.

Does licensing nurses work?

Ray Mullman — Tue, 26 Jan 2010 08:55:31 -0500

I read an interesting article from the Oakland Tribune about how nurses move to avoid the consequences of misconduct. There is a dangerous gap in the way states regulate, license, supervise, and sanction nurses: They fail to effectively tell each other what they know. As a result, caregivers with troubled records can cross state lines and work without restriction, an investigation by the nonprofit news organization ProPublica and The Los Angeles Times found.

Using public databases and state disciplinary reports, reporters found hundreds of cases in which registered nurses held clear licenses in some states after they'd been sanctioned in others, often for serious misdeeds. In California alone, a months-long review of its 350,000 active nurses found at least 177 whose licenses had been revoked, surrendered, suspended or denied elsewhere.

State regulators aren't using their powers to seek out this information, or act on what they find, the investigation found.

By simply typing a nurse's name into a national database, state officials can often find out within seconds whether the nurse has been sanctioned anywhere in the country and why. But some states don't check regularly or at all. The failure to act quickly in such cases has grave implications: Hospitals and other health care employers depend on state nursing boards to vouch for nurses' fitness to practice.

Because there is no federal licensing of nurses, each state sets its own standards on punishable behavior. In general, states can discipline a nurse based solely on the actions taken by another state. But they vary widely in how quickly — or harshly — they act on this information, according to interviews with regulators in 14 states.

Delays in several states left Craig Smart free to practice. In 2000, he surrendered his license in Florida after testing positive for cocaine and flunking a treatment program. It took eight years for five other states in which he was licensed to respond to Florida's action. California was the last to revoke his license, in 2008, after he had practiced here for several years.

Even when states share borders, they sometimes fail to heed each other's disciplinary actions. At least 10 nurses, for example, hold clear licenses in Massachusetts despite being disciplined next door in Rhode Island, including suspensions for drug thefts and violence.

There is ample information available for states to identify nurses disciplined by other jurisdictions. Two separate databases attempt to track disciplinary actions from every state. States are required to report to one, run by the federal government, within 30 days of taking an action. Reporting to the other, operated by the National Council of State Boards of Nursing, is voluntary.

Each database can be programmed to alert a state whenever a nurse it has licensed runs into trouble in another state. When checking a nurse's record, nursing officials say they almost uniformly use the council's database; it's free and the government's is not. In fact, federal statistics show that nursing boards accessed the government database fewer than 300 times total in 2007 and 2008.

In addition, ProPublica and The Los Angeles Times found that the federal database is incomplete, despite the requirement that all states report discipline to it. Many actions appeared to be missing when reporters tried to match known cases by date of discipline to a version of the database in which confidential information had been removed.

The council cannot force states to submit names, and states have a financial incentive not to: They make money by charging nurses to verify their licenses, test scores and training to authorities in other states. For example, a nurse licensed in California who wants credentials to practice in Arizona must pay California $60 to confirm her background. Those sorts of checks netted California nearly $1 million in fiscal 2009. New York, which charges $20 a check, earns more than $250,000 a year.

When states turn over their lists of licensed nurses to the national council, that group earns such verification fees. "The decision to join is a revenue loss for them," said Kathy Apple, the council's chief executive officer. "That's difficult for some states."

Reporters went further, checking the full roster of 350,000 licensed nurses against a public version of the council database. They found that at least 643 California nurses had sanctions elsewhere, including the 177 whose licenses had been revoked, suspended, denied or surrendered.

Jose Martinez, who surrendered his license in Texas in July 2008 after being accused of performing a rectal exam on an 11-year-old girl without a doctor's order or a witness present. In a letter to the Texas board, Martinez acknowledged his misconduct. "Yes, I made a mistake and, yes, I am guilty. After 4 years as a tech and 12 years as a nurse I slip and fall. "... I guess I deserve what is coming to me." His California license is active, without restrictions, and does not expire until July 2010.

Randy Hopp, who was convicted in 2004 of assaulting a nursing home resident in Minnesota. It was the fourth facility since 1998 at which he had been accused of mistreating a resident, records show. The nursing boards in Minnesota and Missouri placed him on probation, and Kansas imposed restrictions on his practice. Hopp surrendered his license in Texas. In California, his license remains clear.

In the past the board took a median of 13 months to file public accusations against nurses after their licenses were first revoked, surrendered, denied or suspended by another state, according to a review of 258 such cases since 2002.

Three of these nurses got work and stole drugs from California hospitals after they had surrendered their licenses across the border in Nevada for previous wrongdoing there.

New Study on Life Expectancy

Ray Mullman — Mon, 25 Jan 2010 08:48:26 -0500

Ashley Julian of the marketing firm Trent & Company sent me an email.
"According to a recent report released by the MacArthur Research Network on an Aging Society, Americans living in the next 40 years will be much older than the government currently predicts.

The study contends that the U.S. Society Security Administration and Census Bureau have misjudged the average American lifespan by three to eight years. "The significance of this study is that it not only brings up the topic but length of life, but quality of life. People living longer want to
live healthier for longer," said Dr. Steven Joyal, Vice President of Science and Medical Affairs for the Life Extension Foundation, the largest non-profit organization dedicated to research on extending the healthy human life span."

Here is a link to the study.

Access to medical records

Ray Mullman — Sun, 24 Jan 2010 11:21:23 -0500

Many times, a family member of a nursing home resident will call us with concerns about bruises, unexplained injuries, falls, and pressure ulcers. We suggest that they look at the medical records. Numerous nursing homes will refuse to allow family members access to the medical records despite 42 CFR 483.10(j)(1)(vii) - which clearly states:

(1) The resident has the right and the facility must provide immediate access to any resident by the following:

(vii) Subject to the resident's right to deny or withdraw consent at any time, immediate family or other relatives of the resident.

Nursing homes are either ignorant of their responsibilities or intentionally concealing material and medical information to residents and their family members. Why would a nursing home refuse to allow a family member of the resident access to the chart? Many times, after a family requests the chart, nursing homes send the chart to outside legal and clinical consultants to "clean up" the information in the chart. The above federal regulation needs to be enforced. The best way is to complain to your local ombudsman, state health agency, and your local politician.

New GAO Report on Underreporting of Violations

Ray Mullman — Fri, 22 Jan 2010 09:56:08 -0500

The Government Accountability Office issued a new report titled Addressing the Factors Underlying Understatement of Serious Care Problems Requires Sustained CMS and State Commitment. Not surprisingly South Carolina is one of the worst offenders. Reducing understatement is critical to protecting the health and safety of vulnerable nursing home residents and ensuring the credibility of the survey process. Federal and state efforts will require a sustained, long-term commitment because understatement arises from weaknesses in several interrelated areas—including CMS’s survey process, surveyor workforce and training, supervisory review processes, and state agency practices and external pressure.

The conclusions reached include as follows:
Concerns about CMS’s Survey Process. Survey methodology and guidance are integral to reliable and consistent state nursing home surveys, and we found that weaknesses in these areas were linked to understatement by both surveyors and state agency directors. Both groups reported struggling to interpret existing guidance, and differences in interpretation were linked to understatement, especially in determining what constitutes actual harm. Surveyors noted that the current survey guidance was too lengthy, complex, and subjective. Additionally, they had fewer concerns about care areas for which CMS has issued revised interpretive protocols.

Ongoing Workforce and Surveyor Training Challenges. Workforce shortages in state survey agencies increase the need for high-quality initial and ongoing training for surveyors. Currently, high vacancy rates can place pressure on state surveyors to complete surveys under difficult circumstances, including compressed time frames, inadequately staffed survey teams, and too many inexperienced surveyors. States are responsible for hiring and retaining surveyors and have grappled with pervasive and intractable workforce shortages. State agency directors struggling with these workforce issues reported the need for more readily accessible training for both their new and experienced surveyors that did not involve travel to a central location. Nearly 30 percent of surveyors in high-understatement states stated that initial surveyor training, which is primarily a state activity that incorporates two CMS on-line computer courses and a 1-week federal basic training course culminating in the SMQT, was not adequate to identify deficiencies and cite them at the appropriate scope and severity level. State agency directors reported that workforce shortages also impede states’ ability to provide ongoing training opportunities for experienced staff and that additional CMS online training and electronic training media would help states maintain an experienced, well-informed workforce.

Supervisory Review Limitations. Currently, CMS provides little guidance on how states should structure supervisory review processes, leaving the scope of this important quality-assurance tool exclusively to the states and resulting in considerable variation throughout the nation in how these processes are structured. We believe that state quality assurance processes are a more effective preventive measure against understatement because they have the potential to be more immediate and cover more surveys than the limited number of federal comparative surveys conducted in each state. However, compared to reviews of serious deficiencies, states conducted relatively fewer reviews of deficiencies at the D through F level, those that were most frequently understated throughout the nation, to assess whether or not such deficiencies were cited at too low a scope and severity level. In addition, we found that frequent changes to survey results made during supervisory review were symptomatic of workforce shortages and survey methodology weaknesses.

State Agency Practices and External Pressure. In a few states, noncitation practices, challenging relationships with the industry or legislators, or unbalanced IDR processes—those that surveyors regard as favoring nursing home operators over resident welfare—may have had a negative effect on survey quality and resulted in the citation of fewer nursing home deficiencies than was warranted. In one state, both the state agency director and over 40 percent of surveyors acknowledged the existence of a noncitation practice such as allowing a home to correct a deficiency without receiving a citation. Forty percent of surveyors in four other states also responded on our questionnaire that noncitation practices existed. Twelve state agency directors reported on our questionnaire experiencing some kind of external pressure. For example, in one state a legislator attended a survey and questioned surveyors as to whether state agency executives were coercing them to find deficiencies. Under such circumstances, it is difficult to know if the affected surveyors are consistently enforcing federal standards and reporting all deficiencies at the appropriate scope and severity levels. States’ differing experiences regarding the enforcement of federal standards and collaboration with their CMS regional offices in the face of significant external pressure also may confuse or undermine a thorough and independent survey process. If surveyors believe that CMS does not fully or consistently support the enforcement of federal standards, these surveyors may choose to avoid citing deficiencies that they perceive may trigger a reaction from external stakeholders. In addition, deficiency determinations may be influenced when IDR processes are perceived to favor nursing home operators over resident welfare.

Recommended Action includes:

Make sure that action is taken to address concerns identified with the new QIS methodology, such as ensuring that it accurately identifies potential quality problems; and clarify and revise existing CMS written guidance to make it more concise, simplify its application in the field, and reduce confusion, particularly on the definition of actual harm.

To address surveyor workforce shortages and insufficient training, we recommend that the Administrator of CMS take the following two actions: (1) consider establishing a pool of additional national surveyors that could augment state survey teams or identify other approaches to help states experiencing workforce shortages; and (2) evaluate the current training programs and division of responsibility between federal and state components to determine the most cost-effective approach to: (1) providing initial surveyor training to new surveyors, and (2) supporting the continuing education of experienced surveyors.

To address inconsistencies in state supervisory reviews, we recommend that the Administrator of CMS take the following action:
Set an expectation through guidance that states have a supervisory review program as a part of their quality-assurance processes that includes routine reviews of deficiencies at the level of potential for more than minimal harm (D-F) and that provides feedback to surveyors regarding changes made to citations.

To address state agency practices and external pressure that may compromise survey accuracy, we recommend that the Administrator of CMS take the following two actions: (1) reestablish expectations through guidance to state survey agencies that noncitation practices—official or unofficial—are inappropriate, and systematically monitor trends in states’ citations; and (2) establish expectations through guidance to state survey agencies to communicate and collaborate with their CMS regional offices when they experience significant pressure from legislators or the nursing home industry that may affect the survey process or surveyors’ perceptions

Making nursing homes places to house mentally ill felons

Ray Mullman — Thu, 21 Jan 2010 08:16:56 -0500

Chicago Tribune had a scary article about Federal, state and county officials finding dozens of resdients with outstanding arrest warrants and wanted on charges ranging from disorderly conduct to burglary to assault. The raids involved about 20 federal marshals and Cook County sheriff's police. Illinois Attorney General Lisa Madigan initiated the sweep in response to Tribune investigative reports about Illinois nursing facilities that house high numbers of felons and sex offenders.

Five people were arrested, including a sex offender wanted in another state for failing to register. In three cases, the residents were too sick to be taken into custody, and the other warrants were not immediately enforceable because they were issued in other jurisdictions. The team found nine people with outstanding warrants when it swept Columbus Park Nursing & Rehabilitation Center on Chicago's West Side and another nine at Heather Health Center in Harvey.

Authorities also examined records for Somerset Place on the North Side and discovered three residents with outstanding warrants, but jurisdictional limits prevented immediate arrests.

The number of felons known to be living in Illinois nursing homes has grown as the state increasingly relied on the facilities to house younger psychiatric patients, thousands of whom have criminal records. The Tribune reported that Illinois State Police once ran similar sweeps of nursing homes for felons with outstanding warrants and unregistered sex offenders. From January 2005 through June 2006, when 20 northern Illinois nursing homes were swept and roughly 80 fugitives and sex offenders removed, state police in that region recorded a nearly 67 percent decrease in nursing home abuse and neglect complaints, according to a department citation issued to the sweeps unit. But the program was halted after five years in 2006 because federal regulators questioned whether the sweeps were an appropriate use of Medicaid anti-fraud funds. State police were not part of Tuesday's sweeps.

The Tribune has reported that the criminal background checks and risk assessments carried out for new residents of the state's nursing homes were riddled with errors and omissions.

Medication error leads to rectal bleeding

Ray Mullman — Wed, 20 Jan 2010 08:34:05 -0500

The Madison and St. Clair Record had an article about a lawsuit filed against a nursing home for giving a resident a blood thinner that caused rectal bleeding. Ron Matikitis filed a lawsuit in Madison County Circuit Court on behalf of Ann Matikitis against Bravo Care of Edwardsville. Ron Matikitis claims nurses at Rosewood Care Center in Edwardsville - a nursing home licensed by Bravo Care - administered 4 milligrams of Coumadin to Ann Matikitis on Sept. 24, 2008, despite the fact that her physician had ordered her prescription to be held because of an elevated PT/INR lab result. The drug, usually used to prevent blood clots, ended up causing Ann Matikitis to experience massive rectal bleeding and to be hospitalized.

In addition to her injuries, Ann Matikitis suffered a marked deterioration of her prior physical condition, incurred substantial medical bills and suffered great pain and anguish. In addition she suffered a severe and permanent disability.

Ron Matikitis blames Bravo and its employees for failing to properly consult with Ann Matikitis' physician and her family members about her deteriorating condition, for failing to timely report the medication error, for failing to provide appropriate general nursing, for failing to record the medication error and for failing to comply with a physician's orders. In addition, employees negligently failed to record the care provided and Ann Matikitis' reaction to the prescription and violated resident care policies, according to the complaint.

Ron Matikitis seeks a judgment of more than $50,000, plus costs and other relief the court deems just.

Robert H. Gregory of the Law Office of Robert H. Gregory in East Alton will be representing him.