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NURSING HOME REFORM NEWSLETTER
Oct. 5, 2005
UPDATE ON STAFFING LEGISLATION
We checked today with Rep. Jimmie Lee, D-Elizabethtown, and Tom Burch,
D-Louisville, about their so-called "summit" meetings on legislation to
improve staffing in nursing homes. Rep. Burch could not be reached, but
Rep. Lee said they are still meeting with small groups on the subject.
You will recall that Kentuckians For Nursing Home Reform met at the
"summit" with the two representatives and Sen. Ernesto Scorsone,
D-Lexington, on Sept. 2 and we had a wonderful turn-out of supporters.
We will keep you informed and we will tell you when and where we will
need your support again.
WOULDN’T IT BE NICE?
One of our favorite nursing home ombudsmen in the state, Kathy Gannoe of
Lexington, was talking to us one time about the kind of quality care she
wished for in nursing homes. It was this:
A sufficient number of staff always on duty so that residents get
interacted with often.
Staff who are full-time employees always on duty, seven days a week. No
temporary employees on weekends. They are called "agency" workers.
Adequate and competent social workers in each nursing home.
Good activity therapists.
WE ALREADY HAVE STAFFING
REGS….
A state legislator we talked to recently seemed surprised when we told
him there are already regulations on the books mandating quality
staffing in nursing homes. This could be the forgotten regulation when
it comes to long-term care in the state and how the state enforces good
care. A regulation, 902 KAR 20:026 Section 3, (9) (d) 2, says:
"The facility shall have adequate personnel to meet the needs of the
patients on a twenty-four (24) hour basis. The number and classification
of personnel required shall be based on the number of patients, and the
amount and kind of personal care, nursing care, supervision, and program
needed to meet the needs of the patients, as determined by medical
orders and by services required by this administrative regulation…. If
the staff to patient ratio does not meet the needs of the patients, the
Division of Licensing and Regulation (now the Office of Inspector
General) shall determine and inform the administrator in writing how
many additional personnel are to be added and of what job
classification, and shall give the basis for this determination." This
regulation is very clear. It indicates that the power already is there
for the state to mandate staffing ratios. To our knowledge, the state
pretty much ignores this regulation when it inspects nursing homes. And
well they might because the regulation is so subjective. Only
legislation, it would seem, can help the process by giving the
inspectors specific ratios on which to judge. This reg also makes the
job of the legislators easy. All they have to do is pass an amendment to
this regulation mandating minimum staffing ratios.
66 DAYS, AND COUNTING….
It’s been 66 days since the very important office of state long-term
care ombudsman has been vacant. At first it looked like it would be a
political appointment to which we objected strongly. Now it seems that
Secretary Jim Holsinger will do the right thing and keep it a
merit-system job. Stay tuned.
LETTERS, WE GET LETTERS….
-- I have worked at almost every nursing facility in my area. They are
all the same -- exactly the same.
Care is always secondary to profit. The first nursing home I worked in I
was green and stupid, but I did have compassion and a strong sense of
right and wrong. When it came time to feed supper, we passed out trays.
I asked the aides when we go back to feed the ones who can't feed
themselves and I was told, "We don't have time to feed. If they can feed
themselves, they eat. If they can't, they don't." I ALWAYS knew when we
were up for state inspections because we always had advance notice they
were coming. Extra staff was put on just for those days so everything
"looked" good. After the inspection, staff was cut back. More times than
I can count I have worked by myself and one other aide for 90 patients
-- many incontinent. Now, I am disabled and facing an unsure future. The
prospect of being placed in one of those "warehouses" scares the life
right out of me. Anything you can do to change this atrocious wrong will
mean gold stars in Heaven for you. May God Bless You.
ANONYMOUS (name on file)
SHORT STUFF
The Kentucky Special Advisory Commission of Senior Citizens meets again
Nov. 3-4 in Frankfort. These are the people from all over the state who
discuss all kinds of elder issues and each year affirm their support for
nursing home reform. At their last meeting in May they passed the
following resolution: "Create minimum quality staffing standards for
front-line caregivers in all nursing homes in Kentucky"….
A big nursing home corporation, Advocat Inc., sent out a news release
that said five of their nursing homes had won a quality award from the
American Healthcare Association. But sharp-eyed advocates for nursing
home reform noted that in the past three years the five nursing homes
honored had 124 violations, two showing possible actual harm. We checked
in Kentucky and found three nursing homes winning the same award and one
of them racked up 31 violations in the past three years….
Lexington newspaper ACE Weekly said the best fund-raiser this year was
the Decorator Showcase for the benefit of the Nursing Home Ombudsman
Agency of the Bluegrass. Plaudits to Lexingtonian Paula DeBoor who has
run the event with aplomb for years….
And in the same issue of ACE Weekly they list Ernesto Scorsone, Kathy
Stein and Alice Forgy Kerr as best state legislators. All of them, as
you are big supporters of nursing home reform….
Kathy Gannoe, who runs the Ombudsman Agency of the Bluegrass, had this
thought on staffing: Directors of Nursing in nursing homes might welcome
minimum staffing ratios, she says, because the ratios could give them
leverage with their corporate offices to hire more staff. Kathy has a
good point. We ourselves have heard from DONs who confidentially wished
for more help and were frustrated at the lack of approval from on high
for it….
The average daily cost of a private room in a nursing home in Louisville
is $189 a day, and in Lexington $180 according to the annual MetLife
Mature Market Institute Survey. The average daily cost nationally is
$203. If you go out and hire a home health care aide from a licensed
agency, it will cost you $20 per hour on the average in Lexington and
$17 in Louisville, according to the survey. If you hire a homemaker from
a licensed agency, the average is $17/hr. in Lexington and $16 in
Louisville.
The median salary for nursing home directors of nursing rose 7.07
percent this year to $66,917.
Another bit of info says that nursing home administrators could be in
short supply soon because of a 40 percent decline in the rate of people
take the exam for certification for the job….
Only 35 percent of people surveyed by the highly respected Kaiser Family
Foundation said nursing homes are doing a good job, just above health
insurance companies and HMOs….
This fact and warning from a reader: In 1987, the state operations
manual for Skilled Nursing Facilities was developed as part of the
Nursing Home Reform Act. But it has never been updated on infection
control. Without effective data collection system the issue is flying
under the radar of health inspectors and our elderly are living in
peril, according to a reader who alerted us to this….
A candidate for lieutenant-governor in Virginia wants nursing home
residents or their guardians to be able to install camera’s in their
nursing home rooms to monitor the care they are getting. She calls them
"grannycams."….
In Philadelphia, a couple of Roman Catholic priests caught up in a grand
jury report on sexual abuse, were found working as chaplains in nursing
homes, according to a story by The Associated Press. The administrator
of one of the homes said he was "unaware" of the priest’s history….
A crisis looms within the nursing home lobbying industry as a rebel
group made up of big corporate nursing home interests challenges
long-established ones for control of the for-profit and not-for-profit
associations. Rich Miller and Tim Veno of the respective associations in
Kentucky are taking a wait-and-see attitude. Miller said he would not be
interested in assuming the helm of what comes out. "Washington’s too
busy a place," he told us.
As we reported last month, John Snyder of Louisville is out of the
nursing home business. He was CEO of EPI Corporation which owed more
than 20 nursing homes in and outside of Kentucky, including Tanbark in
Lexington. Now we find out that Mr. Snyder has left EPI. Probably took
his bag of money and went fishing in Florida. Kyle White, former CFO of
EPI has taken the big organization, sans nursing homes, over….
WHAT’S IN A NAME?
They made a big to-do in Frankfort last month over the name of a
legislative subcommittee – an interim (between sessions) one at that.
First thing that happened was that someone eliminated the subcommittee
on long-term care. After we found out about that we also discovered that
they wanted a new subcommittee in its place called Aging, Disabilities,
and Independent Living. Ah, we could see what was happening there. The
AARP is on this kick to get funding to help people stay in their homes
to live when they get old. Good stuff. But they tend to want to do this
at the expense, literally, of long-term care. So they rolled out a fancy
slide presentation for the legislators and a presentation by the state
president of AARP, Bill Harned of Owensboro. Oh, yes. By the time the
legislators got to this on their agenda, most of the committee was
leaving and thus a quorum was also being lost. While Mr. Harned made his
presentation, enter our heroines, Reps. Kathy Stein, Ruth Ann Palumbo,
Mary Lou Marzian, Joni Jenkins and Susan Westrom. They grabbed fleeing
committee members by the neck and asked them to stay for a vote, thus
retaining a quorum. Up then popped Rep. Jenkins from Shively with a
motion to change the name of the new committee to Aging, Disabilities,
Independent Living, and Long-Term Care. What was intentionally left out
was back in and the nursing home reform people and AARP won a victory.
So what’s in a name? Not much in this case, except we cannot let people
go on putting long-term care aside like it doesn’t exist. "Write that up
in your newsletter," said smiling interim committee co-chair Tom Burch
when the vote was unanimous to adopt the amended name. We just did, Tom,
and thanks.
TOO MANY TIMES
Too many times nursing homes and long-term care have been left out of
important discussions in Frankfort. One time, a new health cabinet
secretary promised us to always include the long-term care people…. but,
as typical, he never did. Which makes us wonder why the AARP people, in
their zeal to find state funding for independent living, would also
leave out long-term care. Here’s our point: We support the AARP in its
efforts because if you can keep people out of nursing homes you have
done them a favor. But we cannot afford to take funding away from
keeping quality care in nursing homes and that’s what will happen if
Medicaid money is diverted from long-term care to independent living.
So, let’s do both. Let’s work together. We hope Bill Harned will change
their message and talk about some the problems in long-term care. We
will keep you posted on what happens because the other side may not.
And, oh yes, we meet with the Ky. AARP steering committee a couple years
ago asking for their help and didn’t even get an answer. And so it
goes…..
QUOTE OF THE MONTH….
"The dated notion of ‘Medicaid millionaires’ giving away their money and
draining the system was debunked last month in a report by the Health
Policy Institute at Georgetown University. After an analysis of several
federal studies, the report, written by Ellen O’Brien, found that people
qualifying for Medicaid gave gifts of less than $5,000 on average, with
a minimal impact on the program." – From a story written by Jane Gross
in the June 27 issue of The New York Times.
AN OBSERVATION….
It seems to us that hurricanes Katrina and Rita have underlined one
thing many of us have always known about people in nursing homes. That
is that they are so very old, so fragile, so ill, so often overlooked.
Just take the 34 who were killed in Katrina and the 24 who were killed
in a bus disaster in Rita. These were the horrible, sensational stories
of life in nursing homes. But while we read these headlines, the story
of old, fragile neglected elderly right here in our own state is a story
that goes untold. We are trying to tell their story – the Forgotten
Kentuckians, but we need your help
. Write us, if you have not done so already, and tell us you will help
nursing home reform. Tell us your story. Then send us the names and
e-mail addresses of 10 of your friends who will help also.
P.S.
A middle-aged woman had a heart attack and was taken to the hospital.
While on the operating table, she had a near death experience. Seeing
God, she asked, "Is my time up?" God said, "No, you have another 43
years, two months and eight days to live." Upon recovery, the woman
decided to stay in the hospital and have a facelift, liposuction and
tummy tuck. Since she had so much more time to live, she figured she
might as well look good. Following her final cosmetic operation, she was
released from the hospital. While crossing the street on her way home,
she was struck and killed by an ambulance. Arriving in front of God, she
demanded, "I thought you said I had another 40 years? Why didn't you
pull me out of the path of that ambulance?"
God replied, "Girrrl, I didn't even recognize you!"
-- From Carol Pruette
P.S. 2
Only in Kentucky: A Magoffin County woman is accused of taking an older
nursing home patient, a 70-year-old gentleman, to her home and pulling a
gun on the nursing home staffer who tried to rescue him. "Why have you
got him locked up in there?" hollered the Sheriff. "I want to marry
him," said the alleged abductor. The nursing home staff said she had
tried to sneak him out of the facility several times.
HAPPY HOLIDAYS….
The Nursing Home Ombudsman Agency of the Bluegrass invites you to its
Holiday Showcase at Maxwell Place, the home of University of Kentucky
President and Mrs. Lee Todd. The beautiful and historic home is located
on the UK campus and at Christmastime can be a veritable wonderland.
Dates are Nov. 25-27 and Dec. 2-4 from 10 to 4 on Fridays and Saturdays
and 12-5 on Sundays. Tickets are $10 per person. We will see you there,
I hope…..
Bernie Vonderheide
KENTUCKIANS FOR NURSING HOME REFORM
Tel: (859) 312-5617
KyNursingHomeReform@yahoo.com
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