JustCare

Tag: Nursing homes

  • Coronavirus: More home and community-based services needed

    Coronavirus: More home and community-based services needed

    For all the tragedy that Covid-19 has wreaked on this nation, there are a few silver linings. COVID-19 has cast a spotlight on the failings of nursing homes and the need for more home and community-based services and more affordable services so that older and disabled adults can age in place. The New York Times reports that many people today do not have the option to remain in their homes as they age because it can be so costly.

    People living in nursing homes and other adult care facilities during this pandemic have suffered mightily. As of now, about 181,000 have died. They represent one in three of all COVID-19 deaths, according to the Kaiser Family Foundation.

    What can communities do to help people and keep them from having to be institutionalized? Fewer and fewer people would choose institutionalization if they could remain in their homes. In the last three months of 2020, one in four nursing home beds were unfilled.

    Age-friendly communities offer a range of services to older people who need help caring for themselves. They might provide affordable age-friendly housing, good transportation and care services. Age-friendly housing generally provides living space on one floor without steps, walk-in showers, and hallways and doors that can accommodate wheelchairs.

    In some cases, apartment buildings can offer an array of services beyond shelter, such as grocery stores and pharmacies. In that way, older adults can have several community essentials at their fingertips, without having to leave the building. This set-up could benefit a lot of older adults.

    But, as people move into their 80’s and 90’s, they often need long-term care services as well. Medicare does not cover long-term care. At most, it covers 100 days in a skilled nursing facility, and that’s only if you’ve been hospitalized for at least three days prior to admission and need daily skilled services.

    Medicaid covers long-term nursing home care. But, it often does not cover home and community-based care. A little more than half of its spending for long-term services and supports covers home and community-based care. More than 40 percent goes to nursing-home care.

    What’s worse, even people who qualify for Medicaid might not get it. In many states, there’s a long Medicaid waitlist. Forty-one states limit Medicaid enrollment. Right now, 820,000 Americans are on a waiting list. On average, they wait more than three years. Fortunately, the American Rescue Act gives more money to states to expand Medicaid services. And, Biden’s new infrastructure proposal includes $400 billion more for home and community-based care.

    Here’s more from Just Care:

  • Don’t trust Medicare nursing home star ratings

    Don’t trust Medicare nursing home star ratings

    Two and a half years ago, I warned people not to be misled by Medicare five-star nursing home ratings. Unfortunately, you still can’t trust these nursing home star ratings. If Medicare can’t ensure that all nursing homes deliver high quality care, at the very least it needs to rate them appropriately.

    The New York Times reports that the nursing home gaming of Medicare star ratings continues. The star-rating system is broken. More than two-thirds of the 3,500 nursing homes with five-star ratings have been cited for problems with infection control and patient abuse.

    Five-star nursing home ratings continue to be misleading. Of the 130,000 nursing home residents who have died of COVID-19, those in five-star nursing homes were as likely to die as those in one-star nursing homes. Five-star nursing homes often fail in-person inspections.

    The New York Times reports that California is suing Brookdale Senior Living, the nation’s largest nursing home chain, for filing false information about its services to Medicare, with the goal of getting a high star-rating. Part of the problem is that Medicare relies mostly on unaudited and self-reported data to determine the number of stars it gives a nursing home.

    Naturally, nursing homes have an incentive to game the system. A five-star rating can lure more people to them and boost profits. Brookdale is alleged to have cooked its payroll books so that CMS would see high staffing levels at its nursing homes, Brookdale also allegedly asked its staff to misrepresent the amount of care their patients receive.

    Here’s more from Just Care:

  • Coronavirus: Senator Casey proposes legislation to protect nursing home residents and workers

    Coronavirus: Senator Casey proposes legislation to protect nursing home residents and workers

    As of now, more than 170,000 older Americans living in long-term care facilities and their caregivers have died from COVID-19. That works out to more than one in three people in the US who have died from COVID-19. Senators Casey, Whitehouse, Warnock, Booker and Blumenthal have introduced legislation to bring down the number of nursing home deaths. 

    Large numbers of nursing homes and other long-term care facilities were unprepared for the novel coronavirus. They did not have the personal protective equipment and other resources they needed to ensure the safety of their staff and residents.

    If passed, the COVID-19 Nursing Home Protection Act would provide additional money to states to ensure that residents and workers had necessary resources for their safety. Money would be available for infection control help and for organizing local workers to assist with both patient care and managing COVID-19 outbreaks. Money could also go towards ensuring everyone in these facilities got vaccinated.

    Significantly, the COVID-19 Nursing Home Protection Act would also mandate that the Department of Health and Human Services collect and publicly report demographic data regarding the number of cases of the virus and virus deaths in nursing homes. Among other things, information on age, race and ethnicity would be required.

    The pandemic’s toll has been greatest on older people of color. Nursing homes with high proportions of Black and hispanic patients had disproportionately high case and death rates. Three times more people of color died from COVID-19 in these facilities than in facilities that had mainly white patients.

    Nursing home residents are among the most vulnerable Americans. The COVID-19 Nursing Home Protection Act is designed to protect them. The Democrats have majorities in the House and the Senate. The question is will some of the more moderate members of this Democratic Congress support this legislation or will they put the kibosh on it?

    Here’s more from Just Care:

  • Coronavirus: It will be challenging for many older adults to vote

    Coronavirus: It will be challenging for many older adults to vote

    It seems inconceivable in the year 2020 that everyone in this country eligible to vote should not be able to do so easily. With technology as sophisticated as it is, voting should be a simple protected click of a button. Instead, barriers to voting for large portions of the population remain huge; Kaiser Health News reports that many older adults living in nursing and other living facilities may not be able to vote this November. 

    The novel coronavirus is keeping family members from visiting with their loved ones in nursing homes and other group home settings. That will make it harder for older adults to vote. Family members are often responsible for helping their older loved ones complete voting ballots. Moreover, COVID-19 will also keep group homes from establishing on-site voting precincts.

    In some group homes, volunteers are assisting residents with voting by mail. But, this is not standard. And, it is generally not required. So, it seems more than likely that a smaller portion of older adults will vote in the upcoming election.

    States can step in to require facilities to help older residents with voting. California’s Department of Public Health is telling facilities housing older adults that they must help their residents with voting. But, a lot of these facilities are short-staffed. And, even when there are staff, the staff might worry about being seen as influencing residents’ votes. Moreover, some states only permit bipartisan assistance teams to help people to vote.

    Typically, more than 70 percent of older adults vote, as compared with less than half of young people between 18 and 29 years. old. Usually, there also are lots of voluntary organizations that assist older people with voting. In addition, candidates typically campaign at nursing homes and assisted living facilities. But, not during this pandemic.

    In the past, congregate living facilities would either have voting booths on site or bus their members to a voting site. This time round, older adults might need to request an absentee ballot in order to vote.

    If you or someone you love is not getting needed assistance to vote, contact the state’s long-term care ombudsman. Every state has one. The ombudsman provides free help and can work with the state’s Department of Public Health to see what help is available.

    Here’s more from Just Care:

  • Coronavirus: Lack of timely data jeopardizes public health

    Coronavirus: Lack of timely data jeopardizes public health

    In a new report, Sins of Omission: How Government Failures to Track Covid-19 Data Have Led to More Than 1,700 Health Care Worker Deaths and Jeopardize Public Health, National Nurses United (NNU) underscores the need to reform our health care system. Federal and state governments do not have systems in place to protect  the health and well-being of Americans, much less our nation’s nurses and other health care workers.

    NNU reports that more than 1,700 health care workers have tested positive for COVID-19. Of those, at least 213 registered nurses have died unnecessarily. The federal government does not have the systems in place to keep health care workers safe in a pandemic. Hospitals and other health care companies are not reporting infection rates or deaths accurately or in real time. Workplaces have not been safe.

    Without reliable and timely information, there is no way to respond effectively to the novel coronavirus pandemic. We need to know where the virus is, we need the resources to protect people in those areas, and we need to know what is working to contain the spread of the virus. The NNU report explains that rather than tracking this data, federal and state governments are hiding it or ignoring it. They are also playing with available data to mislead the public.

    Federal and state governments are not requiring health care facilities to turn over mortality or infection rate data. Of course, these facilities have no interest in so doing. It could tarnish their images.

    Fewer than one in three states are providing infection data for health care workers. Without good data, there is no way to understand the breadth of the pandemic. There is no way to respond to it as warranted.

    The Centers for Medicare and Medicaid Services (CMS) has only required nursing homes to provide mortality and infection rate data for health care workers. That data is publicly available on its web site. Hospitals are not required to collect this data.

    The Trump administration has kept a lot of the COVID-19 data hidden at the department of Health and Human Services (HHS). It has traditionally been kept by the CDC, but the administration transferred it to HHS. The Trump administration is interfering in scientific work and failing to release accurate public health information. To be sure, it is not coming up with a strong national plan to keep the novel coronavirus from spreading.

    The CDC must be charged with tracking this data and given the resources and tools to do the job that is needed. Data should be independent and not played with for political or business reasons.

    Specifically, NNU calls for:

    • Daily reporting of data (as well as cumulative totals) on diagnostic testing and case counts at national, state, and county/local levels.
    • Daily reporting and cumulative totals of data on health care worker infections and deaths at an establishment level, such as the specific hospital or business.
    • Data on symptomatic cases must be reported at national, state, and county/local levels (influenza-like illness and Covid-like illness).
    • Daily reporting of data on hospitalizations and deaths must be reported at national, state, and county/local levels.
    • Hospital capacity data must be reported at national, state, and county/local levels; must be updated in real time; and must include total and available hospital beds by type (e.g., ICU, medical/surgical, telemetry, etc.), staffing, health care worker exposures and infections, and nosocomial (hospital-acquired) patient infections.
    • Data on the stock and supply chain of essential personal protective equipment (PPE) and other supplies must be reported at national, state, and county/local levels.

    Here’s more from Just Care:

  • Coronavirus: Where to live as you age?

    Coronavirus: Where to live as you age?

    The novel coronavirus has in no small way taken over all of our lives. It is also leading us to reconsider where to live as we age. Judith Graham reports for Kaiser Health News on new thinking among older adults about housing.

    Given the inability of so many nursing homes to contain the virus, many more people now recognize the dangers of ending up in a nursing home. As of now, the latest data show that 70,000 nursing home and assisted living residents and staff have died of COVID-19. Indeed, all group housing options need a rethink. Independent living is seeming far more attractive than ever before.

    At least in the confines of your home, you can control your environment. Other people are not in charge of your day-to-day activities, who you see and who can visit. You can protect yourself.

    Graham reports that some older adults are thinking ahead about a living environment where they can get assistance when they need it. Others are thinking about how best to age in a way that minimizes social isolation. In both cases that could mean owning or renting a bigger home, where there is adequate space for multiple people.

    Some older adults are waiting the pandemic out before they make a decision. At this point, no one has a good sense how long the pandemic will last or whether it will ever fully go away. But, they think they are more likely to avoid exposure to COVID-19 if they are in their own homes.

    Of course, getting care if needed is the challenge for anyone choosing to remain in their homes as they age. It can be expensive. And, good care can be difficult to find.

    Living on your own presents other challenges. Being able to engage with others might not be easy. In a group environment, it’s far easier to be around other people. And, then there’s the question of getting supplies, including masks and other protective equipment.

    All of these decisions turn in part on what’s affordable. For a growing number of older adults, eight million, living in a group facility, be it independently or with assistance, is not affordable. That’s in addition to the more than seven million older adults who live in poverty, with annual incomes under $12,000.

    If you or some you love is considering moving, here are some questions to consider:

    • What is the facility saying to its residents and their families about COVID-19?
    • Has there been a COVID-19 outbreak at the facility and, if so, is it letting people know about infections and death rates
    • How is the facility keeping its residents safe?
    • What is the facility’s plan and supplies in the case of a hurricane or other natural disaster?
    • How does the facility provide social engagement for its residents?
    • What is the financial situation of the facility? Can it withstand a drop in occupancy?

    Here’s more from Just Care:

  • Coronavirus: What happened at a nursing home in Washington

    Coronavirus: What happened at a nursing home in Washington

    Katie Engelhart reports for California Sunday on what happened at Life Care Center of Kirkland, the first COVID-19 hot spot in America and, more generally, the role of the nursing home industry in spreading the novel coronavirus. Was Life Care Centers of America, a large nursing home chain, to blame for the many deaths in this facility?

    In a matter of a few weeks, 74 of the 121 residents at the Life Care Center of Kirkland nursing home–more than 60 percent of the residents–were no longer living there. Twenty-six had died. Another 26 had COVID-19. And, 66 staff members showed symptoms, but more than eight in ten of them had not been tested. The county could not provide the necessary testing. Over time, 81 residents tested positive for COVID-19,  along with 50 staff and visitors, and 46 people died.

    By mid-February, staff at the Life Care facility were aware of the growing number of people with respiratory infections. They thought it was the flu. But, they did not report the outbreak immediately as required by law. County health officials should have been notified within 24 hours; instead staff at Life Care waited 15 days.

    Staff did not even discuss the respiratory outbreak when they first noticed it at their quality assurance meeting. The medical director was not at the meeting. Rather, staff went ahead and held a Mardi Gras party. It was 17 days before the facility went into lockdown.

    During the second half of February, Life Care Center of Kirkland did not have the personal protective equipment it needed to protect staff and residents and control the spread of the virus. It was losing staff. It had an emergency response protocol required by law, but the protocol applied to hurricanes, not to pandemics and other medical emergencies. And, Washington state health officials would not allow Life Care to bring in staff from out of state without first going through a lengthy application process.

    Life Care appealed to nurses in its Washington State facilities to help out. It asked the county health department for COVID-19 tests, but it said it had no tests. Life Care’s medical director, the only doctor on staff, had come down with COVID-19 symptoms and was in quarantine. Life Care had no back up plan for another doctor. Since he was the doctor for 90 percent of the residents, they were without a physician to care for them.

    A week after the facility was in lockdown, the state provided just 40 COVID tests for the 90 residents. There were none available for staff. Through the US Department of Health and Human Services, a federal “strike team” of military doctors and nurses arrived eight days after lockdown. They had no long-term care experience and no experience caring for older adults. They also were not interested in learning from staff about what they were seeing in terms of how the virus was spreading.

    The daughter of one resident who died filed a wrongful-death suit against Life Care. By that time Life Care had been fined $611,325 dollars based on evidence of “serious deficiencies” in its response to the pandemic. Federal regulators said that Life Care had placed residents in “immediate jeopardy.” Under pressure from the nursing home industry, many states have given nursing homes immunity protection from lawsuits. Washington has not yet decided whether it will.

    Life Care, the largest private long-term care corporation in the country, is steadfastly unapologetic for the tragedies at Kirkland. It believes it has no responsibility for the death of so many of its residents and staff. (Note that Life Care Center of Kirkland had a five-star rating from Medicare. But Medicare’s star-rating system for nursing homes is a farce. A lot of the data factored into the ratings is self-reported. It should not be trusted.)

    County health officials also take no responsibility. They appear to believe that the county had no responsibility for helping a private nursing home. For its part, the CDC came to the facility simply to assess the situation and provide technical guidance. It said its role was not to provide assistance. The state’s disaster response team did not step in until five days after lockdown.

    The nursing home industry is now a $100 billion business. About seven in ten are for-profit. They have not managed the pandemic well. Nearly 46,000 residents have died, representing more than one in four COVID-deaths. And, 177,129 nursing-home residents have tested positive for COVID-19. They have actively fought regulatory protections locally and in Washington DC.

    There is a history of serious issues with the for-profit nursing homes, including fraud, understaffing and poor infection control. Life Care, along with the other four largest nursing-home chains have been charged with major wrongdoing in the past. In 2016, Life Care settled charges of Medicare fraud–billing for rehab services patients should not have been getting, among other things. The other largest nursing-home chains have also been charged with Medicare fraud. Two settled false claims charges. Those that settled paid tens of millions of dollars.

    Meanwhile, the Trump Administration, relaxed infection-prevention measures and other regulations on nursing homes in 2019, saying they were “unnecessary, obsolete, or excessively burdensome.”

    Here’s more from Just Care:

  • Coronavirus: Strike teams step in to help nursing home residents and staff

    Coronavirus: Strike teams step in to help nursing home residents and staff

    Nursing homes and other residential facilities have been hard hit by the novel coronavirus, with residents and staff easily representing 40 percent of lives lost in the US. What do you do when there’s a natural disaster of this sort? The New York Times reports that  some counties are sending in strike teams–medical workers and other emergency responders–to  help nursing homes and other residential care centers and provide aid to residents.

    Strike teams are usually made up of eight to 10 people from local health departments, private businesses, nonprofits and emergency response agencies. They bring their expertise and assistance to the nursing home disaster at the request of a facility. For example, county nurses and doctors may be called upon to step in for nursing home staff who become sick. They might test staff and residents for COVID-19 and provide care to residents. By so doing, they can help keep these residents from needing to be hospitalized.

    In Henderson County, NC, a rescue squad of volunteer paramedics set up tents where staff could take off their personal protective equipment. They taught staff important safety protocols. Residents’ families and staff received emotional support from chaplains and mental health therapists. And, someone with PR expertise was charged with helping family members understand the plight of residents in the facility.

    The goal is to slow the spread of the virus through better coordination of care. A strike team response is often used when there is a hurricane or other natural disaster. The inability of many nursing homes to contain the spread of the novel coronavirus within their facilities is just that, a natural disaster. It’s far simpler to help people on site with a team that knows how to manage the emergency than to remove people from the site.

    States, including Texas, Massachusetts and New Jersey, have taken on some emergency response work at nursing homes and other long-term care facilities. A bi-partisan bill in Congress would appropriate money for these states to continue this work. Though, it’s not clear whether it will be enacted into law.

    Now, more local agencies are taking emergency response measures to help the thousands of understaffed and under-resourced nursing homes and assisted living facilities in small communities across the country.

    While there is no data yet available on the benefits of the strike team approach, experts say it makes sense and, anecdotally, people say it is working.

    Here’s more from Just Care:

  • Can you protect nursing home residents in a profit-driven system?

    Can you protect nursing home residents in a profit-driven system?

    A story in The Guardian about corporate entities that buy up nursing homes, with the goal of squeezing as much profit out of them as possible and no regard for their residents, speaks volumes about the horrific nature of our profit-driven health care system. Because nursing homes can operate as for-profit facilities–even when Medicare and Medicaid are paying their bills–many of them have become storage units for frail and vulnerable Americans rather than care centers.

    Storage units? That might be too kind a description. Many nursing facilities have become places that do not provide staff to care properly for their frail and vulnerable residents. Instead, our taxpayer dollars flow to their owners, through Medicare and Medicaid, who buy and sell them like used cars, after pocketing as much money from them as possible. These nursing homes then engage a skeletal staff at a low wage to care for the residents. Here’s one example:

    Multi-millionaire Joseph Schwartz owns Skyline Healthcare LLC, which receives millions of Medicare and Medicaid dollars to provide care to patients in its 100-plus nursing facilities. But, Schwartz abandons these facilities without bothering to let the staff or residents’ families know he’s sold off his properties.

    Schwartz leaves staff unpaid, without benefits or recourse, and residents sitting in their feces, unfed, without electricity or care. He left one pharmacy without paying it the $200,000 it was owed for prescription drugs. And, since the novel coronavirus pandemic, police went to one Skyline facility and found 17 people dead and lying atop one another in a four-person morgue.

    According to the Guardian, over the last 20 years or so, it has become extremely common for corporate entities to buy nursing facilities, realize as much profit as possible, and then sell them. Massive fraud is also common. Patient neglect is often the norm. And, eviction of residents is not uncommon. Sometimes, state governments come to the rescue, but not always.

    For-profit nursing homes need to be better regulated. But, what would that mean? How would regulation protect against owners who have no interest in anything other than taking the Medicare and Medicaid revenue and running.

    One man who owned many nursing homes in a number of states received a 20-year prison sentence for pocketing Medicare and Medicaid dollars to care for residents and never spending a dollar on their care. But, he was not stopped until after he had amassed $1.3 billion. It took authorities several years to stop him after his fraud was exposed by reporters at the Chicago Tribune. How many others like him are still pretending to operate nursing homes and simply pocketing the federal and state dollars intended to go to residents’ care?

    Private equity firms are also buying up nursing homes, draining them of their value, and abandoning them. The Carlyle Group bought HCR ManorCare, a chain of nursing facilities. It sold off their real estate for $6.1 billion and then filed for Chapter 11 bankruptcy when the monthly rent cost too much.

    In case this isn’t all bad enough, many states are providing nursing homes immunity from COVID-19 litigation. And, Senate Majority Leaders Mitch McConnell has said that any new stimulus bill must include provisions that would make it extremely hard for residents and staff to sue nursing home owners. Advocates have organized to urge state legislators to permit residents to sue these facilities and hold them to account for not providing appropriate care. Otherwise, nursing homes will continue with these bone-chilling practices.

    Here’s more from Just Care:

  • It’s time to rethink nursing home care

    It’s time to rethink nursing home care

    For decades now, nursing homes in the US have failed to provide older residents with a dignified and humane life. Their horrifying response to the COVID-19 pandemic and inability to provide residents safe shelter or quality care only underscore the need to rethink nursing home care. We need to replace large institutional nursing homes with smaller facilities that feel more like home.

    For a long time now, most institutional nursing homes have had persisting deficiencies. Of late, more than 54,000 nursing home residents and staff have died as a result of the novel coronavirus. COVID-19 provides an opportunity to see the grave vulnerabilities of institutionalized nursing home care today.

    The Green House model of nursing home, small and focused first on the needs and desires of residents, is a great model. Green Houses offer a dignified way and patient-centered way to provide long-term care.

    Dr. Joanne Lynne, an analyst at the Program to Improve Eldercare at Altarum, explains why we should defund today’s nursing homes, shut them down and provide care to people in need of long-term care in the community.

    Dr. Lynne argues that different types of nursing care are best suited to older adults, depending upon their conditions. Small nursing homes are appropriate for people in need of a lot of assistance and of sound mind who need care over a long-stretch of time. Dr. Lynne sees five categories of people who need nursing care.

    1. People discharged from the hospital who need short-term care so that they can return home or to another place in the community.
    2. People with brain damage, including dementia and stroke, who do not know where they are and do not have family or friends to provide them assistance.
    3. People who need a lot of assistance and don’t mind moving out of their homes and having someone take care of them in a home-like setting.
    4. People who need a lot of care because of significant disabilities and favor congregate care, and can either afford it or who have coverage to pay for it.
    5. People at the end of life who need hospice care for a short period of time.

    People who have been discharged from the hospital and need short-term care and people who have dementia or otherwise do not know where they are could manage in a less-homelike setting. A small nursing home might not be best for them.

    But, people with serious disabilities need a comfortable living space, where they can socialize, build relationships with others, and their personal needs can be tended to. A small nursing home could be appropriate for them. No more than a small group of people should live together to ensure good outcomes.

    People in hospice also need a home-like and comfortable setting, but they do not need an environment conducive to establishing long-term relationships.

    Nursing homes in the age of COVID-19 are more like prisons for their 1.3 million residents. No visitors. No family or friends with whom to socialize. Often, residents are isolated in a single room. They have had no choice in this arrangement for four months now. They have been disenfranchised and their well-being jeopardized. Smaller nursing homes would make it much easier to contain the spread of a deadly virus.

    Medicaid must be able to pay for smaller nursing homes, as it does in many cases with Green Houses. And, in order to help ensure patients needs are met, these homes must be required to spend at least 85 percent of their revenue from insurers on direct patient care.

    Here’s more from Just Care: