Nursing home residents risk losing bed holds

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Mass. Gov. Deval Patrick
Mass. Gov. Deval Patrick
MASSACHUSETTS — Ongoing Medicaid program cuts have now led to a game of musical chairs in the state's nursing homes, which no longer can hold the room of a resident who is temporarily hospitalized or leaves to visit friends or family.
The change, effective Nov. 1, eliminates a hard-fought state program that saves temporarily vacated rooms for up to 10 days. Nursing homes are still required by federal law to readmit a resident after a temporary leave to the first available bed in a shared room. But it does not guarantee the same room or bed as before, according to published reports.
The Massachusetts office of AARP and Massachusetts Advocates for Nursing Home Reform sharply criticize the measure, claiming it could be especially disruptive for patients with Alzheimer's or dementia. As many as 5,000 nursing home beds in the state are empty on any given day.

MIDWEST

Whistleblower wins suit
MICHIGAN – She cooperated in a state investigation of resident deaths and was later fired from her job as a respiratory therapist at Omni Continuing Care in Detroit.

A circuit court now agrees with Elizabeth Williamson, 52, that the two were related. As a result, the court has awarded the woman $705,000 in damages.

The Michigan Department of Community Health cited the facility for several incidents involving negligence, as well as “immediate jeopardy” violations related to hypoglycemia and tracheostomy monitoring failures that led to two patient deaths. The facility allegedly covered up one of the incidents.

The nursing home's lawyer told the Associated Press an appeal was planned.

NORTHEAST

Case managers targeted
NEW HAMPSHIRE – Case management in non-skilled licensed community homes is the latest thing to end up on the cutting room floor as officials seek ways to trim the state's Medicaid budget shortfall.

The move, which will affect nearly 500 people across the state and save $1 million, has some long-term care advocates criticizing the state for abdicating its responsibility to ensure proper care. Only those who qualify for more expensive nursing home care but choose alternative settings are affected.

The 30 affected community homes will take over the case manager duties in 90 days while the state seeks approval of the plan from the Centers for Medicare & Medicaid Services. Critics say most homes lack the expertise to perform case management and many will be forced to hire additional staff. The state currently pays $8.52 per day per client for five days each week.

Overturned sex offender law
MASSACHUSETTS – Attorneys for a 65-year-old registered sex offender who was forced out of a state-regulated rest home successfully argued his case before the state Supreme Court, which recently ruled the home's action was unconstitutional.

At issue is a 2006 state law that banned the most serious (“level 3”) sex offenders from nursing homes, infirmaries, rest homes and charitable homes for the elderly or developmentally disabled. But the court ruled that the law violated the man's 14th amendment rights to due process, as sex offenders are given when their names are posted on public websites.

Owners of a Texas nursing home recently found themselves having to defend their policy of accepting residents with criminal backgrounds after a news article reported 27 of them were registered sex offenders.

Retroactive pay sent
NEW YORK – After a lawsuit revealed the state was reimbursing nursing homes based on 27-year-old figures on the cost of care, hundreds of nursing homes across the state are now getting retroactive reimbursement checks totaling more than $480 million.

About 100 upstate nursing homes filed the suit last March, claiming the Department of Health had failed to update its rate schedule in 2009. That led to a discovery that the state's “rebasing” method (which adjusts reimbursements based on prior-year costs) had run afoul years ago, basing its figures on 1983 costs, allowing somewhat for inflation. The ordeal led the Ithaca Journal newspaper to declare the department acted in a “time warp.”

The Reimbursement Reform Act of 2006 requires the state to use more recent and relevant operating costs as the basis for Medicaid reimbursement. The payments are retroactive to April 1, 2009.

Telemental health for rurals

PENNSYLVANIA – Residents at the Falling Spring Nursing and Rehabilitation Center now have the ability to consult with psychiatrists by video chat, a move being lauded as much for its efficiency as its effectiveness in providing much needed care in otherwise underserved rural areas of the country.

Pennsylvania is one of 24 states whose Medicaid programs provide some coverage for “telemental health.” The Franklin County facility stumbled upon the plan after its former behavioral health provider pulled out while it was in the process of investigating a video teleconferencing program. California-based Age Serve Telecommunication provides the equipment, arranges the sessions and bills for the service.

SOUTHEAST

Federal grants decline
FLORIDA – The state succeeded in having a federal judge rule the Affordable Health Care Act unconstitutional. As a result, tens of millions of dollars in grants under that law are being turned away by the governor and Republican-controlled legislature, a New York Times article reported.

While the state hosts the nation's fourth-highest unemployment rate and second-highest rate of uninsured, Florida has declined to seek federal grants that help eligible recipients sign up for Medicare; educate teens on preventing pregnancy; incentivize less costlier home care, in-home counseling for child abuse; and strengthen state regulation of health premiums, the newspaper reported. The Legislature also failed to authorize an $8.3 million federal grant won by a county health department that would expand community health centers.

Even as Florida stares at a $3.7 billion budget deficit in 2011, Gov. Rick Scott told the Times he doesn't want to “waste” federal money for a law that has been declared unconstitutional.

Tornadoes spur prep plans
ALABAMA – Long-term care groups and the state's department of health are working to improve standards on emergency evacuation procedures at nursing homes in the wake of powerful tornadoes that cut a swath of destruction across the Southeast last spring.

Seven people died in a tornado that struck the Shoal Creek Valley Assisted Living facility. Another facility, La Rocca Nursing Home in Tuscaloosa, has since shut down after suffering catastrophic damage.

Current standards do not require nursing homes to have bottled water and non-perishable food on hand. La Rocca residents would have benefitted from both. The storm knocked out the facility's water supply and residents were moved to the least damaged part of the home in the 24 hours after the April storm. A roof collapse and burst natural gas lines in the area exposed the occupants to air contaminants. The residents were evacuated the next day, but three died in May and June. Their names were added to the tornado fatality list in August.

Officials want first responders to consider giving higher priority to fragile populations during a catastrophe. They are considering measures such as requiring homes to have face masks on hand for residents.

New construction rolls
TENNESSEE – The TennCare Medicaid program implemented nursing home rate cuts of 4.5% beginning July 1, but that's not stopping new facility construction in the southeast portion of the state.

All irony aside, two new nursing homes in Hamilton County — an 89-bed facility now under construction in Dayton and a planned Ooltewah facility recently receiving its certificate of need approval — will rise under the auspices of Life Care Centers of America. State regulators also approved funding for Memorial Hospital to upgrade its North Park Hospital in Hixson. Over in Jackson, Tennessee Health Management is building a SNF that is also slated to open in 2012.

The $16.8 million Ooltewah facility will help replace the shuttered Life Care Center in Orchard Knob, which now serves as county offices. The facility, which will open in 2012, will include 80 private and 20 semiprivate rooms and employ nearly 150 workers. A 100-bed assisted living center is planned nearby.

WEST

Day care becomes managed
CALIFORNIA – California is looking like a relative oasis for long-term care providers in the midst of a budget crisis. The state is promising to refund huge rate cuts in 2012 for nursing homes, and, more recently, has been working on a plan to stop the bleeding on funds serving adult day care.

Medi-Cal plans to eliminate those benefits in December, but now the state has a plan to keep more than 35,000 elderly and disabled residents ineligible for Medicare out of institutionalized settings. How? The same way it's planning to save the Medicaid program: managed care. As envisioned, the program's managed care plans would seek such alternatives as higher benefits for in-home support services, therapy and social services.

Critics say the plan could lead to adult day care center closures and force people into costlier nursing home care. The majority of day care program recipients suffer from serious debilitating ailments such as brain injury and dementia.

SOUTHWEST

Fed grant eases home care
NEVADA – It joins a growing list of states enacting laws encouraging care in less costly, non-skilled settings, but Nevada is getting additional incentives from a $10 million federal grant.

More than half of the money in the six-year grant from the Centers for Medicare & Medicaid Services will be used to support current Medicaid home and community services. Nearly $2 million will go toward setup of community living arrangements, such as help for rent and utilities, and another $2.3 will go toward quality-control measures such as a system to monitor participants and 24-hour backups for critical care services.

More than 500 people are expected to be shifted out of long-term care settings and into home-based care as a result of the program. Home-based transition began as a pilot program in northern Nevada in 2002.
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