In 1987, Congress passed landmark legislation aimed at improving nursing home care for the nation's vulnerable elderly population. However, a recent investigation by Consumer Reports found poor care in nursing homes is still extremely common, especially in the for-profit chains that have become the dominant force in the industry.
The Nursing Home Reform Act requires nursing homes to comply with federal regulations for quality of care and specifically states that "a nursing facility must care for its residents in such a manner and in such an environment as will promote maintenance or enhancement of the quality of life of each resident."
However, Consumer conducted an analysis of state inspections for some 16,000 homes nationwide and reported that "two decades after the passage of a federal law to clean up the nation's nursing homes, bad care persists and good homes are still hard to find," in a September 2006 report.
When nursing home facilities are found to be out of compliance or have deficiencies that put residents in immediate jeopardy, states are required to refer case information to Centers for Medicare & Medicaid Services (CMS) for enforcement action.
Once the state refers a case, CMS determines what enforcement actions are warranted. Mandatory remedies are actions that CMS is statutorily required to take to address egregious or extended cases of noncompliance and include termination of the facility's Medicare contract and the denial of payment for new admissions (DPNA).
In enforcement actions, CMS is required to apply the denial of payment remedy for facilities that fail to return to substantial compliance within 3 months and is required to terminate Medicare contracts with facilities that fail to return to substantial compliance within 6 months, or have unabated immediate jeopardy deficiencies for 23 days.
CMS is required to terminate the Medicare contract when the facility still has not reached compliance after application of the required DPNA at 3 months.
For all facilities found to have provided substandard care on three consecutive surveys, CMS must apply the remedies of DPNA, state monitoring of the facility, and the state must notify the attending physician of each affected resident and the state licensing board.
As part of the Office of Inspector General's (OIG) evaluation of the quality of care in nursing homes, an analysis was recently conducted to determine the extent to which the CMS applied the "mandatory remedies" for nursing homes not in compliance.
The OIG released a report in May 2006, that found that in 55 cases requiring the termination of the Medicare contract during 2000-2002, the CMS did not apply the remedy as required in 30 cases or 55%.
The review found that 23 cases that required termination because they were noncompliant for 6 months were not terminated and through reviews of surveys following the study period, the OIG found that all of the facilities not terminated had new cases of noncompliance, serious enough to again require referral to CMS for enforcement action.
Of the 706 cases in 2002, requiring DPNA remedies, the report said 28% were never applied and 14 percent were applied late.
No doubt tired of waiting for the Federal government to act, state law enforcement agencies are cracking down on abuse and neglect of patients in the nursing homes. On January 6, 2006, New York Attorney General, Eliot Spitzer, announced the arrest of 19 employees at two separate nursing homes where hidden cameras produced evidence of serious patient neglect.
In addition to the prosecution of criminal charges, the Attorney General's office also filed a civil lawsuit against the corporations that control one of the nursing homes, including the primary owner and operator of the facility, Anthony Salerno, and a consulting company he owns known as Healthcare Associates.
"The residents of our state's nursing homes are among our most vulnerable citizens," Mr Spitzer stated in the press release. "My office is committed to doing all it can to protect these individuals, who are sometimes without friends and family to protect their interests."
"With these cases," he said, "we are trying to send a message that law enforcement is watching to ensure that appropriate standards of care are met."
The ONLY way to monitor for abuse,
is to go and see for yourself.
Many of the folks in nursing homes are there because they have nobody to care for them at home.
Many families do visit and monitor.
But many others do not.
I am a retired RN and a volunteer in the local Alzheimers Unit, married to a Geriatrician and Medical Director of a Skillled Nursing Center in another town.
The care in both is most usually exemplary, but mistakes are made and not everyone is the most ethical who seek a job that demands TLC and physical stamina.
Much energy is also spent by the most highly trained of staff on paperwork to satisfy the beauracracy that has nothing to do with the quality the resident actually receives.
Nursing homes in neighborhood communities are excellent opportunities for those who call themselves Christians to do one of The Beatitudes:
visit, care and comfort the widow and orphan, the ill, the afflicted and outcast.
e
http://www.wearewideawake.org/
by
Eileen Fleming (172 articles, 101 quicklinks, 274 diaries, 650 comments [16 recommended, 0 rejected]) on Sunday, Sep 17, 2006 at 10:57:21 AM
Executives have been extravagantly rewarded for unethical, greedy, and negligently irresponsible business practices for their own benefit. Until we restrict their salaries and redistribute the revenues back into the facilities (primarily labor) that care for our elders and eventually ourselves, we will not see improvement.
In addition to salarly restriction, all assets belonging to these executives and all assets transferred to a 'secured' trust during their tenure should also be immediately frozen/confiscated. Too many times these greedy corporate aristocrats hide their assets so that the victims are never duly compensated.
Last, but not least, welcome to the HealthCare Crisis. Many of these same practices are occurring in our hospitals as well. Ironically enough, private run hospitals appear to be providing far better care than our non-profit brothers. Again, executives and physicians are being over-compensated for making poor decisions that puts patients in danger rather than improving care.
As a registered nurse, I think what would also help is that every professional who has RN behind his/her name should be required to perform at least 24 hours of direct bedside patient care to maintain licensure. There has been an abyss open between those of us who valiantly attempt to perform our duties to the best of our ability and management who seem determined to thwart our best efforts by making decisions that directly and negatively impact our performance.
Healthcare in crisis is simply another aspect of our loss of basic moral standards in relation to the treatment of our fellow citizens. Those who know it won't happen to them can easily afford private (including in-home) care, while the majority of Americans who have worked all their lives just to make ends meet lose everything for their hospital/nursing home bill. We haven't even begun to discuss the magnitude of billing mistakes made that many unsuspecting (and suspecting) people have incurred but are unable to adequately track what, how, when, and why they were charged for various services and supplies.
So many of us want smaller government, but who else is going to be the playground monitor? Private citizens don't have the capacity fill the vaccuum. We have seen that whistle blowers are treated unfairly and know they are likely to lose their financial means of survival if they do.
When we look at many industries that support our wellbeing and economy we see rampant mismanagement with little to no accountability. I'm beginning to think that this has become the new "American Way".
by
Lisa W. (1 articles, 0 quicklinks, 2 diaries, 60 comments) on Sunday, Sep 17, 2006 at 11:30:55 AM
I am currently an RN supervisor in a Non-pofit, hospital attached facility. Here is the reality:
1. Micromanagement by Bean counters who want nurses to be Med Monkeys not nurses.
2. Chronic staff shortage because facilities pay peanuts to direct care staff and operate from union minimum staff/resident ratios
3. Staffing by mandate, which means regular unwanted 16 hour days, back to back! Try it for yourself and see how good you are at being civil, never mind helpful or caring!
4. A system that "rewards" facilities for taking on complex health problems (eg multiply problems, high maintenance nursing) which consumes all resources for a shift. Leaving "regular" care patients short. Staff are faced with issues like choosing between suctioning a trach, tube feeding, running IV's, complex wound care and frantic relatives with 1 resident, or hand feeding another resident and dealing with their sundowning issues. With 1 nurse and 3 aides for 40 residents you do the math!!
Etc etc etc. Nurses run screaming from the profession as fast as they can! Want to know more??
by
Pam Ladds (0 articles, 0 quicklinks, 0 diaries, 12 comments) on Wednesday, Sep 20, 2006 at 1:48:11 PM
(0+)
Want to post your own comment on this Article?
How would you rate this?
You must be logged in (if signed up) to do ratings.
It's free to signup! And easy. And takes just a minute or two....
Contact Author
View Authors' Articles
(0+)
Must Read (0) 
Well Said (0) 
News (0) 
Touching (0) 
Funny (0) 
Supported (0) 
Interesting (0) 
Inspiring (0) 
Valuable (0) 
