Bill Set to Require Nursing Homes to Post Quality Ratings

A bill introduced into the legislature this year could lead to quality improvements at the state's nursing homes and other long-term care facilities. At the very least, consumers would have another tool to assist them in the nursing home decision-making process.

Assembly Bill 215, by Feuer and Smyth, would require long-term health care facilities to post the overall facility rating given by the federal Centers for Medicare and Medicaid Services (CMS). If enacted, the CMS rating must be posted in an area accessible and visible to members of the public, employee break rooms, and dining halls, activity halls or other communal areas for the residents.

CMS initiated its five-star rating for nursing homes in December 2008. A five star rating equates to above average quality compared to other nursing homes in the state, while a one-star rating means the facility is operating below average yet still meeting Medicare's minimum requirements. Factors considered in determining the star rating are:

• The results of health inspections
• Quality measures, such severe pain and mobility of residents
• Staffing levels of nurses and nursing assistants

The main purpose of this bill is to provide information on facility quality to consumers making the initial decision to place a loved one into a nursing home. If enacted, this bill could also have the effect of urging nursing homes to improve in order to achieve a higher star rating, since the rating will be prominent and reported to the state regularly.

Not surprisingly, the nursing home and hospital lobbies are opposed to this bill, arguing that the CMS rating is arbitrary, inaccurate and erroneous. Even if AB 215 does not pass, nursing home residents and families still have many other resources for information on nursing home quality, including the Health Facility Consumer Information System of the Department of Public Health, California Advocates for Nursing Home Reform, the California Health Care Foundation's California Nursing Home Search, and Healthgrades.com.

Originally introduced on February 3, 2009, AB 215 passed the Assembly Health and Appropriations committees and moved to the Senate, where it passed out of the Senate Health committee and was referred to Senate Appropriations. While not an appropriations measure, the bill will have a fiscal impact due to posting and reporting costs and a provision that subjects failure to post to a penalty, with the fines going into the Health Facilities Citation Penalties Account. The last action on this bill was on June 30, when it was placed for its third reading in the Senate.

Selection of a nursing home for a family member is an emotional decision with critical consequences for the patient and loved ones. Unfortunately, hardly any nursing homes in the state are in full compliance with federal standards of care, with one-third having been cited for serious or potentially life-threatening problems. If you believe that you or a loved one has suffered abuse or neglect in a nursing home, contact The Law Offices of James R. Gillen for a confidential consultation.

Budget Cuts May Endanger California Ombudsman Program

California Nursing Home Ombudsman Program
California’s long-term care ombudsman program investigates and settles complaints regarding elder care abuse in nursing homes and other long-term care facilities. Thirty-five county and nonprofit agencies throughout the state carry out the ombudsman work. State-certified volunteers do much of the work by visiting nursing homes and attempting to resolve the thousands of complaints.

The California ombudsman program began in 1978 with a federal law that requires each state to have such a program. The ombudsman program is especially necessary, considering that nursing home and elder care abuse is on the rise and the fact that as many as 60 percent of elderly in nursing homes and other long-term care facilities have no family or friends to visit them and make sure they are being treated well. The program is so widely-used that between July 1, 2007 and June 30, 2008, the Riverside County office alone received almost 2,400 complaints about suspected nursing home abuse or neglect.

2008-2009 California Budget Cut Impacts Ombudsman Program
When the 2008-2009 California budget was signed on September 23, 2008, many people in the elder care industry were shocked to see that $3.8 million – or about half its annual budget – was cut from the ombudsman program. This will ensure that at least one of the offices will close and will put many, if not most, others in grave danger of closure or severely stress the resources of the remaining offices. Even the California Association of Health Facilities, the professional organization for nursing home and residential care facilities owners, was surprised by this budget cut.

Only days before this cut was passed, a September 18, 2008 report by the Inspector General of the Department of Health and Human Services singled out California as being one of the worst nursing home offenders in the country. No less than 99 percent of California’s nursing homes were found to be violating federal standards in some way.

Moreover, the cut only affects the ombudsman program, whose sole purpose is to assist nursing home and long-term care patients and their families where there have been incidents of neglect or abuse. Other nursing home funding, such as that through the Medi-Cal program, actually increased under this budget cut. However, funding from Medi-Cal is not required to be spent on staffing or patient care and is therefore unlikely to go toward ensuring patients are treated properly.

Possible Effects of the Budget Cut on Nursing Home Residents
In addition to the potential closing of at least one, and possibly more, of the regional ombudsman program offices, the greatest concern is what will happen to already vulnerable nursing home patients around the state. California Advocates for Nursing Home Reform (CANHR) , the statewide advocacy group for nursing home patients, believes this budget cut could result in an increase in the number of unreported and unresolved nursing home incidents.

Governor Schwarzenegger’s office believes that California’s Department of Public Health inspectors, who are in charge of monitoring and inspecting nursing homes, will sufficiently attend to patients’ needs. However, considering the amount of complaints the ombudsman offices currently receive, and the fact that the budget cut has already forced many offices to cut their staff significantly, it remains to be seen whether the state inspectors will be able to adequately address the needs of nursing home patients.

Thanks for reading my blog. If you have a comment or question, please feel free to reply to this posting, or send me an e-mail. If you suspect that a loved one has been the victim of elder abuse, contact me to schedule a confidential consultation and for immediate assistance.

Too Many Patients, Not Enough Staff

A $2 million settlement on a class-action lawsuit filed against the corporate owner of nursing homes in Southern California was announced this week. The lawsuit was filed on behalf of residents at one of the facilities owned by Brea-based Sun Mar Healthcare, Inc., which owns 17 nursing homes. The lawsuit alleged that Sun Mar defrauded residents and violated health and safety codes. Sun Mar officials allegedly promised residents a level of care they knew they couldn’t provide, given their level of staffing. A spokesman from the California Advocates for Nursing Home Reform stated that nursing homes are not precluded from taking on more patients than they can adequately provide for, a practice the organization deems tantamount to fraud.

Inspection and investigation records obtained during the course of the lawsuit indicated that one of Sun Mar’s homes had 77 health and safety violations from 2004-2008. Nursing home advocates strongly recommend that you thoroughly research a home’s history of health and safety violations with the California Department of Public Health. They also suggest that you ask about the staff to resident ratio. Spend some time observing the staff interaction with residents. Does it appear that call bells and resident requests are responded to in a timely manner? Does there appear to be adequate staffing for the number of residents?

Other observations you should make regarding the staff during your visit include the following:

• Do staff members treat the residents with dignity and respect?
• Do staff members speak directly to the residents, or do they treat them as if they were not present?
• Do staff members respect the privacy of residents? Do they knock before entering?
  Do the nurses and administrators know the residents?
• Is everyone friendly and receptive to questions?
• What languages does the staff speak in addition to English?
• Does the facility conduct background checks on staff prior to hiring?
• Are there therapists on staff or does the facility contract out for therapists?
• Is there a social worker on staff? Full or part-time?
• Are there permanent full-time nurses and nurse assistants (CAN’s) on staff? Or registry nurses and aides?

Keep in mind these are simply some of the observations you will want to note during your visit. Inadequate staffing has a direct impact on the quality of care received. Nursing homes promise to provide a high standard of care, but often fail to do so. Understaffed facilities have higher incidences of pressure sores, falls and other injuries.

Thanks for reading. If you have a question or comment, feel free to reply to this posting, or send me an e-mail. If you suspect a loved one has been harmed by negligence, neglect or abuse in a nursing home, contact me for immediate assistance.