State News July 2014

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IL State Sen. Jacqueline Collins (D-16)
IL State Sen. Jacqueline Collins (D-16)

PLAINS/MOUNTAINS

Mixed palliative care levels

SOUTH DAKOTA — Nursing homes appear to have the best palliative care resources in a state that's otherwise plagued by geographical disparities that play a significant role in access to hospice care. Those findings from a recent study pointed researchers to identify a need for a healthcare and allied healthcare workforce with specialized training in palliative and end-of-life care.

More than half of the 668 healthcare facilities studied had no specific contact person for palliative care, hospice services and advance directives, authors reported in South Dakota Medicine, the journal of the state medical association. Nursing homes reported the highest percentage of contacts for palliative care, hospice services and advance directives.

Researchers found advanced directives processes in place at most (75%) facilities in the state, while fewer (about 50%) had actual planning resources available. About 80% of the facilities reported having no staff specifically trained in palliative care. Trained staff were most likely to be found in hospice and home health facilities.

Despite such findings, South Dakota is ranked among the better states in the country for access to palliative care. In its recent “state-by-state” report card, the Center to Advance Palliative Care and the National Palliative Care Research Center gave South Dakota a “B” grade for its prevalence of hospital palliative care teams, putting the state in the top 10 nationwide, behind only New Jersey, Ohio and Virginia.

MIDWEST

Fingerprints, photos required

MINNESOTA — Beginning in October, all new hires in care settings for the elderly, disabled and other “vulnerable” populations in the state could be required to be fingerprinted and photographed before reporting to work.

The plan stems from a bill now awaiting the governor's signature.

The state Department of Human Services says the plan is designed to fix what it calls a seriously flawed program for criminal background checks for healthcare workers. Under the current system that bases searches on names and birth dates that can easily be forged or changed, caregivers are investigated only when they are hired or switch jobs. About 2,500 criminal records of healthcare workers fall through the cracks each year, according to a Minneapolis Star-Tribune report.

Supporters say the system will obviate duplicative multiple background checks and speed up hiring for state-licensed programs. The new, mostly automated program, made possible through a $3 million grant from the Centers for Medicare & Medicaid Services, also will allow DHS to cross-check its own caregiver database against the Minnesota Court Information System. This will allow it to determine instantly if a caregiver has been convicted of a disqualifying offense.

Similar laws are in place in other states, including Pennsylvania and Kentucky. 

Task force would address racial disparities in long-term care

ILLINOIS — Democratic Gov. Patrick Quinn was expected to sign legislation designed to reverse decades of race-based disparities in the care provided in all types of long-term care settings.

Illinois lawmakers in both houses of the General Assembly unanimously approved Senate Bill 2773 and forwarded it to Quinn on June 6. The governor had 60 days to sign it into law, and was urged by AARP to do so.

AARP officials said they hoped the bill would go far in correcting the state's well-documented history of racial and ethnic disparities in quality services. The measure will establish a Long Term Care Services and Supports Disparities Task Force to identify and document the number and type of long-term care providers and clients in the state and compare multi-year data to identify trends in the delivery of long-term care for various racial and ethnic groups, according to an AARP statement.

The panel also will provide recommendations to address disparities in use and quality of care.

Long-term care disparities linked to race and minority status have long been indentified across the country, according to an article in Medical Care Research and Review. Market-based incentives designed to improve quality may actually be exacerbating the disparities because of racial and socioeconomic segregation of long-term care facilities.

Condom found in stomach 

ILLINOIS — A Chicago-area nursing home resident allegedly suffered from a condom lodged in his stomach, leading to a lawsuit filed in Cook County Circuit Court. 

The resident experienced gastrointestinal symptoms and was taken from Westchester Health and Rehabilitation Center to Adventist La Grange Memorial Hospital in June 2012, the Chicago Sun-Times reported. There, doctors discovered the condom in his stomach.

The man reportedly was bedridden, non-verbal and being tube-fed. The plaintiff alleges the condom is evidence of sexual abuse. The resident died in February 2012, about eight months after gastrointestinal surgery that uncovered the condom, the Sun-Times reported.

The hospital and nursing home both are named defendants in the suit, which is seeking $50,000 in damages.

Facilities try to reduce OT

OHIO — To recover from the global recession amid declining reimbursements, a wide majority of the state's nursing homes have aggressively sought to add more Medicare residents while decreasing overtime for full-time care staff.

According to an April 2014 report from the Scripps Gerontology Center, nursing homes and residential care facilities across the state have also employed a variety of other strategies to control expenses and boost revenues, including reducing the proportion of Medicaid patient days, eliminating or reducing planned wage increases, increasing job responsibilities and offering less expensive menu items.

Even while many facilities have made efforts to improve care quality and resident and family satisfaction, the state's shift to home- and community-based services has exacted a toll, according to the report. The state's percentage of elders receiving Medicaid long-term care services in nursing homes has dropped to 55% from 62% in 2007. 

Since the recession, 82% of nursing homes and 67% of RCFs have reduced overtime while 71% of nursing homes have sought to increase Medicare residents, the report states. 

Adding Medicaid waiver beds is growing in popularity with private-pay intensive RCFs, and is also becoming popular among assisted living facilities.

NORTHEAST

County: Too much overtime

PENNSYLVANIA — Overtime wages at a 290-bed county-owned nursing home have hit nearly $1 million the past two years in a row, raising the eyebrows of local finance officials.

Claremont Nursing and Rehabilitation Center posted $1.1 million in overtime wages in 2012, followed by nearly $900,000 in 2013, according to published reports. The facility is on track to log more than $800,000 this year, leading
Claremont County's finance committee to scrutinize overtime bills that are twice as high as any other county department.

Claremont Administrator Karen DeWoody told officials the facility's union contract allowing 12-hour shifts, as well as a system that allows over-scheduling staff, are to blame. The current system also allows wrongly assigned staff members to keep their scheduled hours even if they aren't needed. DeWoody told officials she is looking at adding more part-time workers to fill shifts.

Privatization hits snag

NEW YORK — A state judge has said the transfer of a county nursing home to an independent board is invalid, putting on hold an attempt to privatize.

State Supreme Justice Elaine Slobod said the Orange County legislature's 12-9 vote in April to move the 360-bed Valley View Center for Nursing Care and Rehabilitation into private hands fell short because a 14-vote supermajority was needed, The Times-Herald Record reported. 

The decision forms an obstacle to those in the Legislature who want to sell the nursing home to a private operator. The board had solicited offers from buyers, with a minimum price of $18 million.

SOUTHEAST

Video scandal before runoff

MISSISSIPPI — After a lurid scandal involving a continuing care retirement community rocked the state's GOP senate primary, incumbent Thad Cochran and challenger Chris McDaniel were set to square off again in a runoff election on June 24.

The June 3 GOP primary ended in a virtual deadlock, with McDaniel ahead of Cochran by a margin of 0.7%, or about 1,000 votes. Some observers believed the scandal could have seriously hurt McDaniel's chances of winning the primary. Some individuals loosely allied to McDaniel were criminally charged in the unauthorized photographing of Cochran's wife in her nursing home room. 

Authorities said blogger Clayton Kelly illegally photographed Rose Cochran at St. Catherine's Village, a Madison CCRC, under false pretenses. The photos wound up in a campaign video that was quickly pulled from the Internet. The video used the photos in connection with assertions that Cochran was having an affair while his wife has resided in the facility's nursing unit with dementia. Cochran, a six-term incumbent, has denied those assertions.

In May, three additional individuals were charged as alleged conspirators in the case. One of them had a connection to the continuing care retirement community involved and might have helped the blogger gain access, Mississippi authorities added. 

Madison County District Attorney Michael Guest told a local newspaper that additional individuals could be charged, but he would not elaborate.

WEST

Family sues over sex abuse

CALIFORNIA — Family members of a nursing home resident say the 93-year-old grandmother died last year, weeks after suffering injuries and trauma from a sexual assault by a certified nursing assistant. The family is suing Evergreen Arvin Healthcare and owner EmpRes Healthcare Management for enabling the assault and covering up previous sexual assaults by the employee, according to published reports. 

The woman, who had been a resident of the skilled nursing facility since August 2001, reportedly suffered vaginal tearing and bleeding after the reported May 25, 2013, assault. She died 18 days later. The lawsuit alleges the assault ultimately led to the woman's death. The facility declined to comment.

Attorneys for the woman's family said the facility failed to immediately report the assaults to authorities and suspend the employee, both in violation of state law. 

Observation better after falls

WASHINGTON — Seniors who are admitted as hospital inpatients after a fall seem to have more serious conditions than those held in observation, according to a state Department of Health epidemiologist.

There was a 25% increase in the rate of fall victims being placed in observation during the 2010 to 2012 study period, reflecting a growing trend driven by reimbursement issues, Jennifer Sabel, Ph.D., found. But it does appear that inpatients were clinically worse off than those kept in observation, and seniors in observation with a primary diagnosis of “unintentional fall” should not be considered fall hospitalizations in “routine surveillance,” she stated.

Sabel studied 29,806 hospitalizations and 4,223 observation stays with an unintentional fall primary diagnosis. She presented her findings in late June at the Council of State and Territorial Epidemiologists annual convention in Nashville. 

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