Right-to-work law is seen as effort to offset unions

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Indiana Gov. Mitch Daniels (R)
Indiana Gov. Mitch Daniels (R)
INDIANA — Gov. Mitch Daniels (R) signed anti-union legislation early in February that will turn Indiana into a right-to-work state.

Right-to-work legislation bans unions from requiring members to pay union dues, a move that pro-labor critics of the legislation characterize as “union-busting.” Indiana is the 23rd state to pass right-to-work legislation but the first to do it since Oklahoma passed similar legislation 10 years ago. Opponents of the law fear Daniels' move will inspire other states to do the same.

The right-to-work legislation is good news for long-term care providers that have been hit by a series of pro-union appointments and decisions at the federal level recent months. The most recent was President Obama's appointment of two pro-labor commissioners to the National Labor Relations board. Long-term care has increasingly been a target for unionization in recent years.

PLAINS/MOUNTAINS

Mandatory flu vaccines
COLORADO — Officials from Colorado's state health department have proposed mandatory flu vaccinations for all nursing home employees, regardless of religious or personal exceptions.

The state's board of health, which was expected to vote on the bill in February, considers hospitals and nursing homes to be “high-risk” medical facilities, the Denver Post reported. The bill would require high-risk facilities to meet targeted rates of employee vaccinations every year, with a goal of having 90% of employees vaccinated in the 2014-2015 flu season.

Individuals working in home health and assisted living facilities would have more wiggle room for personal and religious exemptions than those in nursing homes and hospitals, the Post reported. Exempt employees working in high-risk facilities would be required to wear facemasks during flu season. The flu causes more than 600 deaths each year in Colorado, according to state officials.

WEST

LTC pharmacies raided
WASHINGTON — Federal investigators raided two Seattle-area pharmacies upon reports that employees were collecting and reselling medications stolen from nursing homes. Scrips LTC Pharmacy operates both pharmacies.

According to documents filed to obtain a search warrant, Scrips regularly sent drivers to area nursing homes to collect unused prescription medications, including controlled substances, from residents. They then would bring the medications back to the pharmacy, where they sorted and repackaged them to sell at retail value.

Investigators said pharmacy employees had no way of knowing whether the drugs they were dispensing had expired.

MIDWEST

Home for sex offenders
IOWA — A small group of Iowa lawmakers says the state needs a nursing home that serves registered elderly sex offenders.

State legislators proposed the idea at a local forum held to discuss state budget issues.

The proposal follows an announcement by Gov. Terry Branstad (R) that asked the state legislature to require notification when sex offenders are admitted to long-term care facilities. Branstad cited a report showing that 55 sex offenders live in various care facilities throughout the state. The issue has been a hot topic since an 83-year-old registered sex offender assaulted a fellow resident at Pomeroy nursing home last August. Legislators in Kansas also are considering a bill that would tell nursing home residents if a sex offender moves in.

Iowa Rep. Tom Shaw (R) said the state should consider buying a nursing home that could be staffed with people trained to handle sex offenders.

Bed tax approved
ILLINOIS — Illinois nursing homes, which had been waiting as long as six months to be reimbursed by the state's Medicaid program due to state budget shortfalls, will get some relief from a newly approved bed tax. It is expected to generate an additional $145 million.

Gov. Pat Quinn announced in late January that state nursing homes, which were represented by the trade group Health Care Council of Illinois, have agreed to pay a bed tax of $6.07 each day for every non-Medicare patient they serve. $20 million will be used to hire an additional 160 inspectors while the rest will be funneled to the Medicaid program, where it will be matched by federal funds.

Critics of the agreement — which include many providers — describe it as “a bad plan for good homes and a good plan for bad homes.” They say the majority of the funds will go to nursing homes serving indigent residents, bypassing nursing homes with more Medicare and private pay populations.

NORTHEAST

Havoc predicted for pay
RHODE ISLAND —Nursing home groups are concerned that Gov. Lincoln Chafee's (I) plan to restructure nursing home reimbursement formulas will lead to “devastating” layoffs and service interruptions.

State LeadingAge officials say the plan would result in some nursing homes receiving a disproportionate share of state funding, with over 40 facilities losing a total of $12 million in state reimbursements.

Rhode Island health and human services officials, however, say the changes will be phased in over three years to soften the blow.

“There's no question that if this reimbursement structure is implemented, it will threaten the existence of some nursing homes in Rhode Island, including our not-for-profit homes with rich histories of providing quality and compassionate care,” James P. Nyberg, director of LeadingAge RI, told the Providence Journal. “At the very least, it will result in significant staff layoffs and cutbacks in care and services at many homes.”

Memory care mandate
MASSACHUSETTS — Dementia advocates in Massachusetts are hoping to fix a loophole that allows nursing homes to advertise dementia units without requiring special training for workers.

The proposed legislation would require all licensed nursing homes with dementia patients to offer specific training for employees who interact with the residents. The law also would require nursing homes to provide activities and programs that decrease troublesome dementia behaviors such as wandering and agitation, the Boston Globe reported.

Advocates have tried unsuccessfully to pass similar legislation in the past, including calls for higher staffing levels in dementia units. Forty-four states require specialized training for nursing home dementia unit workers, according to a 2005 federal report.

Advocates of the legislation include Scott Plumb, the senior vice president of the Massachusetts Senior Care Association. He believes the law “empowers [the state] to develop reasonable requirements in areas such as activities, physical plant, and training, and stays away from more controversial and potentially expensive issues such as minimum staffing requirements,” according to a Boston Globe report.

SOUTHWEST

J & J settles fraud suit
TEXAS — Johnson & Johnson has agreed to a $158 million payment to settle a Medicaid fraud lawsuit.

The lawsuit accused J & J subsidiary Janssen Pharmaceuticals of giving state officials kickbacks in exchange for putting the antipsychotic Risperdal on an approved list for Medicaid recipients. It also claimed that Janssen marketed the drug as being safe and cost-effective, despite the fact that it was linked to an increased risk of stroke and death in elderly dementia patients. Risperdal is approved to treat only adult schizophrenia.

Lawyers representing the state originally asked that Janssen repay $579 million to the state's Medicaid program, plus up to $500 million in penalties.

“Janssen ran amok,” Allen Jones, one of the plaintiffs, told the Associated Press. “They trashed the Johnson & Johnson credo, and they misused Texas and, I believe, well-meaning officials to further their marketing.”

Johnson & Johnson was recently ordered to pay $327 million in South Carolina and $258 million in Louisiana in similar Risperdal lawsuits.

SOUTHEAST

Inspection reports posted
TENNESSEE — In accordance with the Affordable Care Act, state health officials in Tennessee have begun posting nursing home inspection reports on the state health department's website.

The healthcare law requires states to post inspection reports going back four years, but thus far only one year's worth of inspections have been uploaded on the site, The Tennessean reported.

Inspection reports always have been available to the general public but were only obtainable by special request.
While aging advocates such as AARP and the Tennessee Health Care Association applaud the state's efforts, worries remain that users will fail to “see both sides of the story.” They contend that even though “corrective action” plans are posted with the reports, the facilities should have a place to air their own rebuttals to the findings.

“There is so much misinformation out there that we are pleased to see the state inspection reports posted online. Anyone faced with a decision about placing a loved one in a nursing home needs access to every resource possible,” Jane Fabian,  a member of AARP's Tennessee  Executive Council of volunteers, told The Tennessean.

Medicaid waivers requested
LOUISIANA — Louisiana health officials will ask the federal government for 200 waivers that would allow disabled Medicaid recipients to receive long-term personal care services, according to the terms of a settlement.

In 2010, Louisiana's Department of Health and Hospitals put a 32-hour per week cap on the number of hours that disabled individuals could receive personal care services. A class action lawsuit brought by Medicaid beneficiaries argued that the limit violated the Americans with Disabilities Act and could force elderly and disabled people into nursing homes.

Under terms of a settlement, the state agency said it would ask the government to sign off on 200 additional waiver slots that would be available for those who have not yet received one. Disability advocates called the settlement a “win-win.”

Nursing schools flooded
MISSISSIPPI — Community colleges and four-year universities are being forced to turn down nursing school applicants because they lack the faculty to keep up with demand. 

One local community college nursing program received applications from 485 qualified candidates but could accept only 72 of the candidates. Schools offering bachelor's degrees in nursing have had to turn down more than half of their applicant pool, according to a report in the Clarion Ledger.

Nursing program directors say the problem stems from a shortage of funding for recruiting qualified faculty. To fill the gap, experts say nurses with associate's degrees need to continue their education.

“In Mississippi, we have about twice as many graduates from associate-degree nursing as from baccalaureate- or higher-degree programs, and only about 15% continue with their education to earn the bachelor's degree,” Pat Waltman, associate dean for academic affairs and accreditation at the University of Mississippi's School of Nursing, told the newspaper. “Only about 5% of those go on to earn a master's or doctorage degree,” Waltman explained.

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