State news: Joplin nursing homes mourn losses, sort through fallout weeks later

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State news: Joplin nursing homes mourn losses, sort through fallout weeks later
State news: Joplin nursing homes mourn losses, sort through fallout weeks later
MISSOURI – Six skilled nursing facilities are still sorting through the debris and fallout of lives and jobs uprooted from a tornado that nearly leveled the entire city of Joplin, MO, in late April.

One of the those facilities – Greenbriar Nursing Home – exists no more after being almost entirely wiped off the map by the category F5 tornado. One staff member and 10 residents among Greenbriar's 89 were killed. Only one 10-foot section of an interior wall of Greenbriar's structure was left standing, according to the facility's operator. 

As staffers tried to huddle the residents in a hallway, several were sucked through the roof, according to one Missouri facility worker. Spring River Christian Village, a Joplin-based continuing care retirement community, was miraculously unscathed and took in some Joplin nursing home residents while also providing laundry services. The remaining residents were transferred to facilities throughout Missouri, Arkansas, Oklahoma and Kansas. In total, the storm killed 151 people.

Only days before, vicious twisters ripped through Alabama, killing the owner and four residents of an assisted living facility in Shoal Creek Valley, about 45 miles outside Birmingham.

$81 million budget cut
LOUISIANA – Supporters of an approved House measure cutting the state's healthcare budget by $81 million claim only a proposed new Medicaid managed care program would be impacted. But healthcare officials are predicting dire consequences for the state's elderly, disabled and mentally ill.

In the $25 billion budget passed on Memorial Day, administration sources said the approved cuts would ultimately lower much-needed payments to any providers treating the elderly and poor, including skilled nursing facilities.

The officials also claimed the $81 million cut would save $22 million only by delaying the managed care program launch by a year. Up to $192 million in federal matching funds also are stake. The Senate was debating the measure at press time.

Meanwhile, the Obama administration was proposing a federal rule that would pressure some states to actually increase Medicaid payment rates.

Funding shortfall worries
INDIANA – Proponents of a state-funded home care assistance program are worried a budget shortfall could force thousands of frail elderly to seek more costly long-term care, or do without care altogether.

Gov. Mitch Daniels' representatives insist the legislature's recent decision to partially fund the CHOICE home healthcare program is fiscally responsible, and plans are to fully fund it later in the year as taxes are collected. The CHOICE program was recently allocated 70% of its previous budget, or approximately $20 million. The program offers such services as home-delivered meals, attendant care, skilled nursing visits and transportation.

AARP officials said the shortfall could lead to layoffs of as many as 2,500 people statewide. The program services 11,400 residents; another 7,000 are on a waiting list.

Months before, Daniels reportedly proposed a cut in the program's funding. His spending plan would have allowed CHOICE funding to be completely diverted into a Medicaid-funded program for home health care.

Bill seeks care transparency
ILLINOIS – A new law providing sweeping protections for the developmentally disabled is being lauded.

The law, spurred by a lengthy Chicago Tribune investigation, requires facilities providing such services to report residents' deaths to state regulators, coroners and medical examiners. It also calls for heavy fines for substandard care, restricted admissions in “troubled homes” and use of psychotropic medications. It would be easier to close homes with a chronic history of poor care, according to the Tribune. Facilities for the disabled also are required to disclose any medication errors or unusual incidents that occur within 30 days of resident deaths, the newspaper added.

The series documented a decade-long history of alleged abuse at a Chicago nursing facility where 13 children and young adults died.

Some have criticized the law for failing to provide funding for a greater number of inspectors.

Bed tax to prevent closures
WASHINGTON – A controversial bed tax designed to shore up the state's sagging Medicaid program has some nursing home operators breathing a sigh of relief, while others fear the tax's revenue may eventually be used for something else.

In a state reeling from deep cuts in public health programs (nearly $5 billion), the new “safety-net fee” could divert as much as $20 million in future annual Medicaid cuts, according to State Sen. Karen Keiser (D-Kent), who sponsored the bill enacting the tax. The measure was to go into effect July 1.

Proponents hope the tax now in place in 37 other states and approved already for the state's hospitals, will trigger federal matching funds for the state's Medicaid program. The fees will be as high as $11 per bed per day for some homes.

Some operators say the fee could help them stay solvent. Others, such as Providence Health & Services, argue that the fee will place an unfair burden on private-pay residents and could shift as much as $15 million in federal funds to non-nursing home programs.

Managed care mandated
CALIFORNIA – The state's efforts to rein in Medicaid costs using a managed care model is leaving a bad taste in the mouths of more than one million elderly and disabled recipients, who in June were told they had no choice but to sign up for the controversial program.

Plan advocates say the managed care Medicaid plan offered in various flavors by both public and private, for-profit health plans, is more efficient and will allow more people to be eligible for Medicaid. They also contend it will save $180 million a year — money that can be used to shore up the state's sagging Medi-Cal program, which offers traditional non-managed care Medicaid services.

Eldercare advocates worry the frail elderly could lose the continuity of care if their physicians don't participate in managed care. Until now, Medicaid-eligible seniors and disabled people were spared from having to join the managed care plan because of the complexity and severity of their health issues. Advocates say managed care plans, which receive lump sums to cover their members' health costs, have evolved to the point of being able to efficiently handle the needs of older, sicker people.

Resident list challenged
TEXAS – Owners of the Lake Worth Nursing Home found themselves having to defend their policy of accepting residents with criminal backgrounds after a Fort Worth Star-Telegram article reported nearly half of the facility's 65 residents are parolees, including 27 listed registered sex offenders. Nursing home officials said some of the offenders had died, leaving the true number under 20.

Statewide, 275 former prisoners under supervision live in 149 nursing facilities, a Department of Criminal Justice spokesman told the newspaper. A facility spokesperson also told the newspaper that parolees meet all of the qualifications for Medicaid and are referred there by the state because they usually have nowhere else to go.

Some in the neighborhood surrounding the facility said they worry about the presence of residents with sexual offense convictions. Nursing home advocates called for a state law requiring the homes to disclose such information to other residents and their families.

People who live near the facility receive postcards when a sex offender moves in, and new residents' families are told the home may have residents with non-specific criminal backgrounds, according to a spokesman, who added that the facility has a five-star quality-of-care Medicare rating.

Concern over Medicaid caps
RHODE ISLAND – On one hand, advocates of a novel funding approach that provides Medicaid funding for home care like that it keeps elderly out of nursing homes. On the other, they fear the program is so effective that federal Medicaid funding for nursing homes could keep spiraling downward.

Rhode Island is the first and only state with a spending cap for its entire Medicaid program, which has many of the same characteristics of a block grant. However, federal matching funds continue to apply to about half of the program's costs. The Rhode Island cap has helped the state cut Medicaid spending by more than $100 million since 2008.

Nearly 1,300 elderly and disabled adults have benefitted from the Rhode Island program, according to the Miami Herald. The program also has caught the eye of some conservatives in Congress seeking to take the government out of the Medicaid business. They are urging their own states to consider similarly funded approaches, the news-
paper reported.

Skeptics fear the frail elderly could be imperiled when they most need care if Medicaid funding is capped.

NLRB ends 13-month strike
CONNECTICUT – The National Labor Relations Board ended a 13-month strike among Spectrum nursing home employees in May, ordering the company to reinstate approximately 400 union nurses, nursing assistants and support staff who had since lost their jobs after walking out in April 2010.

The Spectrum employees reportedly earned new three-year contracts.The workers were to be reinstated to their pre-strike positions, shifts and hours. Spectrum was ordered to pay the workers $395,000 to cover their losses during the strike and expunge their personnel records of any reference to their termination or suspension. A separate monetary settlement of $150,000 was ordered for illegally fired workers.

Defibrillators low priority

PENNSYLVANIA – They're ubiquitous in schools, airports, churches and virtually every government building. But automatic external defibrillators are rarely found in a place where cardiac arrest often occurs: nursing homes.

One man is trying to change that after discovering the Lancaster County nursing home where his father-in-law resided had no AED, according to an article in the Intelligencer Journal/Lancaster New Era newspaper. His public campaign has sparked a statewide debate.

Medical experts say nursing home residents in their 60s and 70s could easily be saved. Many nursing home operators, meanwhile, say the elderly are more likely to die from an arrhythmia before a defibrillator is even activated. Others argue that some residents' advanced directives discourage life-saving measures. Defibrillators cost between $1,500 and $2,500.

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