The U.S. government’s 5-Star ratings of the nations nursing homes are in!

While these results are not as glamorous as the Oscars or the Grammys… okay, they are not glamorous at all, but they are significantly more meaningful than entertainment awards, and they affect more of us much more directly. Currently, about 7.5% of Americans currently live in nursing homes. With the current trends in costs of care, health concerns, and the number of aging Baby Boomers, it has been estimated that about 11 million people will be likely to require assistance in old age within the next 10 to 20 years. That makes it essential that we understand what makes a “good” nursing home or a “bad” nursing home, and how to find the good ones.

Every year the Centers for Medicare and Medicaid Services (CMS) publish the results of their 5-Star Quality Ratings of nursing homes. The Five-Star Quality Rating System was created to help consumers, their families, and caregivers compare nursing homes more easily, and help identify areas about which you may want to ask questions. Nursing home ratings are taken from three sources of data:

• Health Inspections. Onsite visits by a team of trained inspectors who check on the quality of care, inspect medical records, and talk with residents about their care. Inspectors also make sure that the nursing home meets federal quality processes.
• Staffing. This rating looks at the overall number of staff compared to the number of residents…as well as how many of the staff are trained nurses.
• Quality Measures. This measure rates how well a nursing home performs on 10 important aspects of care, such as how well the nursing home prevents and treats skin ulcers, and how well residents are helped in eating and dressing. While this sounds like a valuable measure, the data for Quality Measures are self-reported by the nursing home staff. This makes it the least objective measure, and the most likely to be inappropriately high.

Each of these areas is individually rated, and then these three ratings are combined to calculate an Overall Rating.

The lowest overall rating is awarded to homes “much below average” compared with others in their state, according to CMS. Among problems that can drop a rating: consistently dirty equipment and linens, mistreatment and unlicensed caregivers or specialists.

How to Choose a Good Nursing Home

USA TODAY Analyzes Ratings

The CMS Nursing Home Compare data only list the most recent star ratings, but it doesn’t provide a history for consumers. Now, USA TODAY prices an analysis of the ratings for more than 15,000 nursing homes over the past 3 years. Among their findings:

• Quality improved. There was a 5% decrease in the number of nursing homes with 1- or 2-star ratings; and there was a 5% increase in the number of 4- and 5-star rated facilities.
• Some of the worst stay bad. 564 nursing homes received 1-star ratings in each of the rating periods during the past three years.
• Two-thirds of these low-performing facilities are for-profit organizations.

Here’s how to see specific nursing home ratings from the past three years:

• Go to the USA TODAY ratings page here:  USA TODAY Nursing Home Ratings
• On the upper right corner of the chart at the top of the page, enter the state you would like to search.
• On the lower right side of the chart, you can narrow your search by entering a specific term, which can include a city name, part of the name of the nursing home, a street name, etc.
• To see a comparison of all three years’ ratings, click the “+” sign to the left of the nursing home name and address.

ADDITIONAL RESOURCES

USA TODAY article: Fewer seniors live in nursing homes

To see the full reports AND to search for specific nursing homes by name or location, see the Nursing Home Compare page here: Nursing Home Compare

To see the HensonFuerst video about how to choose a good nursing home, click here: How to Choose a Good Nursing Home (and Avoid the Bad Ones)

Good news for disabled and elderly people who require personal care services:  A federal judge has stopped North Carolina from ending services for some Medicaid recipients who receive in-home care.

According to an article in the News & Observer, the state Department of Health and Human Services (DHHS) had recently increased eligibility requirement for personal care services so that recipients would need to demonstrate that they need help with three, instead of two, activities of daily living, such as eating, bathing, or dressing. The requirement was challenged because it only pertained to recipients who receive in-home care; recipients who live in nursing homes still need to demonstrate needing help with only two activities of daily living.

“This is good news,” said Vicki Smith, executive director of Disability Rights North Carolina, one of the groups representing in-home care recipients. “This is a minimum level of service that will make a concrete difference for these individuals and their families.”

The DHHS says that this requirement is part of its efforts to reduce Medicaid fraud and misuse. Still, it seems that it might be easier and more humane to check into individual suspicions of fraud than to eliminate services for thousands of elderly and disabled people. And according to Ms. Smith:

…offering personal care will save money over time. It’s less expensive for the government to pay for personal care for people living in their own homes than it is for 24-hour supervision in adult care homes, she said.

To read the full article in the News & Observer, click here: http://www.newsobserver.com/2011/12/09/1699117/judge-halts-change-to-medicaid.html#ixzz1gLRMvHX5

The New York Times published an eye-opening article about how some antipsychotic drugs given to the elderly are dangerous, and even potentially lethal.

Nearly one in seven elderly nursing home residents, nearly all of them with dementia, are given powerful atypical antipsychotic drugs even though the medicines increase the risks of death and are not approved for such treatments, a government audit found.

More than half of the antipsychotics paid for by the federal Medicare program in the first half of 2007 were “erroneous,” the audit found, costing the program $116 million for those six months.

So…the nursing home residents are being given toxic medications, families and caregivers are duped into believing the pharmaceuticals are of more benefit than they are, and taxpayers are being fleeced to the tune of more than $225 million per year. It’s unconscionable. For some pharmaceutical companies, though, it seems to be business as usual.

Many of the toxic medications are specifically and, according to the article, illegally marketed for use by the elderly. Television commercials for the drug Abilify, for example, show a middle-aged woman taking care of her elderly mother, and talking about how she wants to do everything possible to help her mother from losing more of her memory to dementia, including giving her Abilify. Other common drugs that are potentially lethal to the elderly are Risperdal, Zyprexa, Seroquel, and Geodon.

Why would doctors continue to prescribe these medications? According to The New York Times:

While the Food and Drug Administration has warned doctors that using antipsychotic drugs in elderly patients with dementia increases their risks of death, doctors continue the practice because they have few other good choices, said Dr. Daniel J. Carlat, editor in chief of The Carlat Psychiatry Report, a medical education newsletter for psychiatrists.

“Doctors want to maximize quality of life by treating the patient’s agitation even if that means the patient will die a bit sooner,” Dr. Carlat said.

Until regulators take action based on this report, the families of nursing home residents will have to be extra vigilant about which medications their loved ones are taking. Ask for a full list of all medications, and find out why they were prescribed. If you see any of the antipsychotics on the list, ask to speak with a doctor to see if the medications are necessary, helpful, and not likely to cause harm.

At HensonFuerst Attorneys, we take our role as advocates for nursing home residents very seriously, and we will continue to protect their rights, to speak for people who have no voice. If you believe someone you know has been harmed by harmful medication, please feel free to call us at 1-800-4-LAWMED. Someone is always available—24 hours a day, 365 days a year. You can also learn more on our website at http://www.lawmed.com/.

If you have questions, HensonFuerst has answers.

Given the choice of long-term care at home or in a nursing facility, most people would choose to stay in their own home. Now, there is a program that helps people make the transition back home after living in an inpatient facility.

The program is called “Money Follows the Person” (MFP), and that’s a good description of how it works. Medicaid-eligible individuals get to apply their Medicaid dollars to their choice of long-term care—the money follows the individual, instead of staying with a particular type of institution or care facility.

Although anyone can apply for the program, Doris Hire’s son worked with an attorney to give them the best chance of being approved.

This is good news for everybody. The nursing home resident gets a chance to choose how to spend his or her last years, and the rest of us get the added benefit of tax dollar savings—experts estimate that for each person who takes advantage of MFP, care costs could be reduced by about 60%. On average, a year of nursing home care costs more than $75,000 per person.  Medicaid picks up two-thirds of that cost for people who are disabled or poor, or about $58,000 per person per year. On the other hand, people who receive intermediate-level care in the home spend about $32,000 per year, which includes meal delivery, daily health aide visits, and cleaning services. Higher-level skilled care can run to about $42,000–still about 25% less than Medicaid dollars spent for an inpatient facility.

An article in today’s Winston-Salem Journal tells the story of Doris Hire, the first person in Forsyth County to take advantage of this new program. According to the article:

After two years in a nursing home, she [Doris Hire] is once again living with her husband, Ray Hire, 83, in their home off Peacehaven Road in Clemmons.

“I never intended to stay (in the nursing home) that long,” she said. “I am grateful to the program for bringing me home.”

A home-health worker comes to her home every day from 8 a.m. to 1 p.m. Her helper, Karen Hanchock, who works for Tender Care of Winston-Salem, assists the wheelchair-using woman, helping her bathe, groom and exercise. Hanchock also cooks for her and does light housekeeping.

Without the flexibility offered by Money Follows the Person, the Hires would still be loving each other, but living apart.

Who Is Eligible?

Not everyone who wants to live at home can live at home. Some people have medical or personal care needs that require round-the-clock care. Additional eligibility requirements include:

• The person must have lived in an inpatient nursing facility for at least three months.
• The person must be receiving Medicaid services.
• The person must have a “qualified residence” to move into. Qualified residences can include a person’s own home or apartment, the home of a family member, or a group home with four or fewer people.
• The person must live in a part of the state that has an active MFP program.

Every year as part of their annual assessment, nursing homes are now required to ask residents: “Where do you want to live?”  For those who want to and can live at home, MFP offers a cost-effective helpline.

To learn more about the Money Follows the Person program, click here:  NC Division of Medical Assistance

To read the full article in the Winston-Salem Journal, click here: Helping Seniors Return to the Comforts of Home

And if you have legal questions about nursing homes or nursing home abuse, please feel free to visit our website at http://www.lawmed.com/. Or, you can call HensonFuerst Attorneys at 1-800-4LAW-MED. If you have questions, HensonFuerst has answers.

According to an article on WRAL.com, the North Carolina Department of Health and Human Services (DHHS) has recommended that the Centers for Medicare and Medicaid Services fine Britthaven of Chapel Hill nursing home for violations that led to the hospitalization of six patients in February. One patient, 84-year-old Rachel Holliday, died.

Ms. Holliday and eight other patients tested positive for opiates, powerful and controlled pain medications–and many of them had not been prescribed opiates at all.

Angela Almore, 44, of 724 Berwick Valley Lane in Cary, was indicted in June on one count of second-degree murder and six counts of felony patient abuse. Almore worked as a registered nurse at Britthaven. Prosecutors allege that Almore drugged the patients to make them more manageable. [from WRAL.com]

After an extensive investigation, the DHHS Nursing Home Licensure Section found that Britthaven of Chapel Hill “didn’t ensure patients were protected from abuse, its services didn’t meet professional standards, unnecessary drugs were prescribed and significant medication errors occurred.”

The requested fines were $2,500.00 for each violation, for a total of $20,000.00.

HensonFuerst’s Nursing Home Abuse team continues to conduct an independent investigation into these and other episodes of nursing home abuse and neglect. If you have questions about potential abuse, we’re here to provide answers. Call us anytime, day or night, at 1-800-4LAW-MED.

Assisted Living Concepts, a Wisconsin-based company that, according to its Web site, operates 216 assisted-living residences with capacity for more than 9,000 residents in 20 states is being criticized for its decision to cut down on Medicaid recipients, even ones who first entered their facilities with the ability to pay from private funds.  ALC was harshly scolded in a 48-page state Public Advocate’s Office report that said when the chain began evicting tenants once they spent their money and moved to Medicaid “it caused the company’s New Jersey residents to suffer significant harm.”  The report said the Office of Ombudsman, which investigates abuse, neglect and exploitation in long-term centers, noticed a significant uptick in a variety of complaints against Assisted Living Concepts during the spring and summer of 2007.

Click to read the entire article from The Press of Atlantic City.

The Bush administration shut off a source of information last fall about abuse and neglect in long- term care facilities that people suing nursing homes consider crucial to their cases. A new Rule designates state inspectors and Medicare and Medicaid contractors as federal employees, a group usually shielded from providing evidence for either side in private litigation.

Click to read the entire article from Bloomberg News

A new federal rule gives states sweeping authority to charge premiums and higher co-payments for doctors’ services, hospital care and prescription drugs provided to low-income people under Medicaid. The rule is expected to save money for the federal government and the states.

But public health experts and even some federal officials predicted that many low-income people would delay or forgo care because of the higher charges. Under the rule, states can deny care or coverage to Medicaid beneficiaries who do not pay their premiums or their share of the cost for a particular item or service.

Many Medicaid recipients have chronic illnesses, use numerous prescription drugs and frequently visit doctors, so the burden of even modest co-payments can become substantial.  David P. Sloane, senior vice president of AARP, said, “Denying necessary care to people who are unable to pay is unconscionable,” as well as fiscally unwise.

The Congressional Budget Office has estimated that 13 million low-income people, about a fifth of Medicaid recipients, will face new or higher co-payments. Most of the savings result from “decreased use of services,” it said.  Under the rule, states can use co-payments to promote the use of preferred brand-name drugs and to discourage the use of hospital emergency rooms for routine care. 

 Click HERE for the for the full New York Times Article.