Lead Story:
Oregon
Nurse ratios to drop
Gov. Ted Kulongoski (D) issued a mandate last month to lower the ratio of nurses to residents in nursing homes.
The move could set a model for the country, as numerous other states also are considering such a measure. The nursing home community has generally opposed the ratios, arguing they would place unnecessary restrictions on facilities.
Under the new rules in Oregon, the ratio of day-shift certified nursing assistants to residents must fall from 1:10 to 1:8. Ratios will be phased in over three years to allow facilities time to train the new hires, according to the state Department of Human Services. In April 2009, the ratio is expected to decrease to 1:7. Projections indicate that 500 to 700 more nurses will need to be hired statewide by 2010.
The mandate also reduces the ratio of evening-shift CNAs to residents. The amount of time nursing assistants spend helping residents with daily activities also must increase under the rules, and facilities are required to monitor and post their daily staffing ratios.
More State News:
Northeast
Proposal cuts funding for 700
Rhode Island – The long-term care industry expressed concern over the governor’s proposal to cut the nursing home population by approximately 700 by July 1.
The goal of the plan is to shift more residents from nursing homes to home- and community-based settings. Restructuring the long-term care system would save the state $34 million, according to Gov. Don Carcieri (R), who introduced his budget proposal in January. It includes eliminating residential placements for disabled children and adults.
Carcieri’s fiscal 2008-09 budget would eliminate financing for 690 Medicaid-eligible nursing home residents. Meanwhile, the state plans to invest $7 million in rate increases for assisted-living and adult day care programs.
State senators are leery about the reduction and have introduced two bills that would lessen the severity of the governor’s plan. One would slowly begin transferring Medicaid funds from nursing homes to increase the capacity of home-based alternatives.
Plan would reduce SNF funding
Massachusetts – Nursing home advocates expressed disappointment with the governor’s plan to reduce an annual Medicaid rate increase for skilled nursing.
Instead of a regular 4% rate increase provided to nursing homes on July 1, Gov. Patrick Deval (D) seeks to provide
2.5% at that time and 1.5% in July 2009.
His goal is to direct money away from nursing homes and into home care. His budget for the fiscal year starting on July 1 includes $45.8 million for a home- and community-based care initiative for elderly and disabled people.
The plan “smacks of robbing Peter to pay Paul,” said W. Scott Plumb, a senior vice president of the Newton-based Massachusetts Extended Care Federation.
Short-stay residents on the rise
New York – Residents are staying for shorter periods in nursing homes. They also increasingly are sicker or cognitively impaired, according to a recent study released by the United Hospital fund.
While the majority of residents are long-stay, the number of them staying less than two months tripled from 1996 to 2005, according to the report.
During that 10-year period, both long-term residents and short-term residents have become more disabled, and more of them are cognitively impaired. In 2005, there were also more mental health
diagnoses among them than
in earlier years.
Occupancy rates stayed the same across the state while the number of nursing home admissions more than doubled, the study found.
West
Tort reform legislation collapses
Hawaii – A controversial state tort reform bill died due to inaction in late February. The bill struck a chord in the healthcare community because it touched on a state dilemma: how to keep doctors from leaving Hawaii and attract new ones to the state.
The bill would have capped non-economic damages at $500,000 for high-risk specialties, and put a limit on catastrophic damages at $3 million. The legislation fell apart after Tommy Waters, chair of the Judiciary Committee, failed to hear it before a deadline.
Proponents for medical liability reform say they would continue to fight for legislation. Opponents argue that they are trying to protect patients’ rights.
Exploding toilets cause havoc
Washington – A boiler malfunction at an Auburn nursing home caused toilets to explode.
No one was hurt, but 72 occupants of Regency Auburn Rehabilitation Center were temporarily evacuated to five other rehabilitation facilities, the Valley Regional Fire Authority reported.
The highly unusual explosion set off the sprinkler system and flooded the three-story building.
Southwest
Governor wants hold on new rules
Arizona – Gov. Janet Napolitano (D) has called on Congress to place a moratorium on proposed Medicaid regulations that would increase costs for states.
The regulations would shift an estimated $13 billion in costs for Medicaid to states, a harsh move during a time of declining state revenues, she said.
The six new regulations, issued by the Centers for Medicare
& Medicaid Services, are scheduled to take effect over the next few months. They would limit Medicaid payments to hospitals and nursing homes run by state governments, ban the use of federal Medicaid money to
pay for doctor training and eliminate some funds for disability programs.
Legislation would isolate offenders
Oklahoma – A state House committee has approved legislation that would place registered sex offenders in special long-term care facilities.
The House was expected to vote on the measure, as of press time. The purpose of the legislation is to prevent criminal offenders from harming elderly or disabled residents at nursing homes, proponents said.
Advocate Wes Bledsoe said he had found 57 registered sex offenders in Oklahoma nursing homes and other long-term care facilities since beginning research in April 2004, according to an Associated Press report.
Midwest
House passes immigration bill
Indiana – The Indiana House took historic action, passing legislation that would crack down on illegal immigration.
Its passage marks the first time a bill on this issue has managed to succeed. Unlike past proposals, however, the legislation focuses on business owners who profit from hiring illegal workers rather than depriving individuals of social services.
Under the bill, the state can revoke an employer’s business license for repeatedly hiring illegal immigrants. It also requires the Indiana State Police to enter into an agreement with federal officials to seek training and begin enforcing federal immigration laws. The attorney general also would be asked to investigate written complaints made against employers.
The bill could affect nursing homes, which often hire immigrants for low-skilled caregiving positions.
The Senate also passed an immigration bill. As of press time, a House-Senate conference committee was set to hammer out differences between the bills. Gov. Mitch Daniels (R) said he was not committing his support until he saw the final bill.
Poor conditions spur concerns
Ohio – The recent discovery of deplorable conditions at a Cincinnati nursing home has prompted calls for more frequent inspections of facilities in the city and state.
A raid at an East Price Hill home and adjoining assisted living center uncovered more than 100 safety, fire, health and building code violations.
These infractions stemmed from loose handrails, holes in the walls, and ceiling tiles falling as well as dirty floors and walls in the nursing home.
Inspectors found toilets leaking, air conditioning and heating problems, broken floor tiles and leaky faucets in the assisted living facility.
The state and city health departments inspect facilities every year. The Cincinnati Health Department reportedly detected only a few
violations at the facility in January. Dr. Noble Maseru, Cincinnati health commissioner, suggested more frequent inspections may be necessary.
Southeast
Electronic health network planned
Tennessee – The state is developing the country’s first statewide health information exchange, according to communications company AT&T, which is partnering with the state on the initiative.
The Tennessee Information Infrastructure eHealth Exchange Zone is expected to transform how the caregiving community accesses and delivers health information, AT&T said. The goal is to increase patient safety, reduce spending and improve quality of care.
The network will feature a private online network, which will allow for e-prescribing; electronic health records with patient profiles, medical history and other information; and access to the Tennessee Department of Health applications.
Senate slashes facility funding
Florida – The state Senate last month agreed to cut $316 million to nursing homes, hospitals and other healthcare providers in its 2008-2009 budget.
Providers receive the annual payment increases for treating low-income residents and patients.
Lawmakers noted that nursing homes may not be able to maintain staffing levels as a result of the cut. The reduction could compel facilities to reduce services and recreational programs and possibly cause them to turn away residents, others noted.
Operator cops tax fraud plea
Texas – Nursing home operator Gary R. Trebert pleaded guilty recently to conspiracy to defraud the government, tax evasion and other charges.
The case against Trebert and two other defendants is one of the largest payroll tax fraud cases ever prosecuted in the U.S., said U.S. Attorney Richard B. Roper of the Northern District of Texas.
Trebert, along with Larry Gordon and Stephen Michael Ewing, allegedly created more than 150 sham staffing/payroll entities to prevent the IRS from collecting more than $34 million in payroll taxes.
The false entities allowed them to obtain control of 70 licensed nursing facilities and create the appearance that the entities employed more than 4,500 nursing facilities employees.
Trebert said that he conspired with the two others from August 1999 through mid-May 2004.
Funding for brain-injured adults
Kentucky – Federal authorities approved a plan to expand Medicaid services to help keep adults with brain injuries out of nursing homes.
The plan, which would be phased in starting this year, would pay for care for as many as 65 people to live in settings such as apartments or group homes with staff or nursing assistance. It also would pay for services, such as adult day care, home health and housekeeping, for an additional 135 people at home.
Spending on home health and private duty nursing exploded to $234 million in 2007 from $18 million in 2000.
Gov. Steve Beshear (D) proposes funding the program with $6.5 million in the fiscal year that begins July 1, and $18.7 million in the following fiscal year. Federal matching funds would total nearly $60 million.
Plains/Mountain
Bill would increase lawsuit caps
Colorado – A state senator is proposing tort reform – but not in its usual form.
Senate President Peter Groff has proposed a bill that would increase the upper payout limits for malpractice lawsuits. It would adjust a definition used in lawsuits and increase the cap to $300,000 in cases involving awards for pain and suffering.
Most people associate tort reform with a decrease in the amount of money plaintiffs can receive in malpractice cases.
The legislation’s intent, according to the bill, is to align caps for injury in a malpractice case with the caps in other civil cases involving injury.
Many believe that high limits in malpractice cases force up doctors’ medical malpractice costs.
From the April 01, 2008 Issue of McKnight's Long-Term Care News
