Medicare Nursing Home Five Star Quality Rating System

The Centers for Medicare and Medicaid Services created a system for comparing nursing homes throughout the United States. The ratings are accessible through a Nursing Home Compare search tool on the Centers for Medicare and Medicaid Services website. The ratings are determined by three categories:

• Health Inspections
• Staffing
• Quality
  

These areas of data are then ranked with a star rating, which is then combined for the overall rating for a particular nursing home.

Health inspections involve an analysis of the major aspects of care offered by a nursing home. The rating is also based on visits by objective state surveyors, which are checked by federal surveyors. One limitation of this rating is that each state has a different inspection process and different licensing requirements, so a comparison of ratings between nursing homes from different states may not be accurate.

Staffing ratings look at the number of residents compared to the total staff and the number of nurses that are members of the staff. The data used to form this rating is self reported and only reflects nursing home staffing from a two week period of time during the year.

Quality measures how a nursing home rates on ten aspects of care, including how the facility helps residents dress and eat, efforts to prevent and treat skin ulcers, or steps taken to deal with the flu. The data used to form this rating is based on self reported information.

Overall, not-for-profit nursing homes received higher ratings than for-profit nursing homes, according to USA Today.

How to Use the Rating System
The rating system provides some preliminary information on a nursing home, but the ratings may not provide an entirely accurate picture of a particular facility. As a result, while going through the process of selecting a nursing home, it is highly recommended that you visit each nursing home that you are considering.

In many cases, selecting a nursing home in close proximity to family and friends has a large affect on a resident’s quality of life in the nursing home. The rating system may provide a starting point to determine which nursing homes in your area meet your basic criteria for a nursing home facility.

The Importance of Researching a Nursing Home
Complaints against California nursing homes to the California Department of Public Health rose from 5,742 in 2004 to 6,950 in 2008. This increase in complaints shows that nursing home residents and their loved ones are not entirely satisfied with the level of care provided by nursing homes state-wide. This increase in complaints indicates the importance of carefully selecting a nursing home, and the new rating system serves as a tool to help in this process.

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 nursing home abuse or theft, contact me to schedule a confidential consultation and for immediate assistance.

New Law to Help Elders against Theft and Abuse in Nursing Homes

Theft in nursing homes is more common than one might think. In the past year, the California Department of Public Health received over 250 reports of theft or loss of resident property. Unfortunately, many other items, most notably heirloom jewelry, cash, checkbooks, and other valuables are lost or stolen, and these thefts rarely get reported to the authorities. Neither the state nor any counties keep statistics on stolen items in nursing homes.

Additionally, because of the age and poor health of many nursing home residents, they are unaware that their valuables are missing until a relative visits and notices. Patients with Alzheimer’s disease do not even notice that rings are missing from their hands. Adding to the problem is that as many as 60 percent of nursing home residents have no family or friends to visit them to make sure their belongings are not being stolen. Also, nursing homes prefer to address reports of theft internally without reporting them to the authorities because if it leaks that their staff is stealing from residents, their business could suffer. These thefts can also affect private caretakers; it is even legal for felons to get jobs taking care of elders.

However, on January 1, 2009, a new California law will take effect with the hopes that it will encourage people to report such thefts. The state law will require local ombudsmen and police to report cases of known or suspected theft and abuse immediately to the District Attorney’s office. However, the law does not require nursing homes themselves to report the thefts.

Whether this law will be effective is unclear. As discussed in my previous blog entry, the state’s ombudsman program has been cut drastically in the 2008-2009 California budget. This may mean that the ombudsman offices will not have the resources or staff they need to carefully address complaints resulting from the new reporting law.

Elders’ families can do several things to try to prevent their valuables from being stolen:

• Store valuables for elders at your home or in your safe deposit box
• Visit often and watch your relatives’ possessions closely
• Limit how much cash the elder has at any time
• If you notice your relative is missing something, report it to the nursing home immediately; if the property is not found within 24 hours, report it to the police.

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 nursing home abuse or theft, contact me to schedule a confidential consultation and for immediate assistance.

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.

Elder Abuse Occurs Even in Luxury Care Facilities

Overall, between 2005 and 2006, the California Office of the Attorney General reports that there were 108 criminal filings and 60 convictions for elder abuse, and 25 civil complaints filed and 22 civil judgments for elder abuse. For both criminal civil cases, $4,806,652 was awarded in between 2005 and 2006 in restitution and penalties.

The families of those in nursing homes must continually observe their loved ones to prevent abuse. The California Attorney General’s Crime and Violence Prevention Center provides some indicators for possible abuse:

• Physical indicators include unexplained bruises or welts, poor skin condition or poor skin hygiene, untreated medical conditions, the presence of cuts, pinch marks, skin tears, lacerations or puncture wounds, or the existence of bruises or welts in various stages of healing.


• Behavior indicators include confusion, withdrawal, fear, or anger.


• Social indicators interaction or activity within the family that is restricted or prohibited, or an elder not being given the opportunity to speak for him or herself or see others without the care-giver present.


• Financial indicators include a lack of amenities, such as TV, personal grooming items, or appropriate clothing.
  

More information on the warning signs for elder abuse can be found at http://www.safestate.org/, the California Attorney General’s Crime and Violence Prevention Center.

Elder abuse can occur even in luxury care facilities. When Elmore Kittower, an 80 year-old occupant of Silverado Senior Living in Calabasas, California, passed away, his death was not initially deemed suspicious. Mr. Kittower was paying $75,000 a year to reside at Silverado Senior Living. Shortly after his death, Mr. Kittower’s widow, Rita, was contacted by a woman that claimed to be a Silverado employee. The woman told Mrs. Kittower that her husband had been beaten and suffocated by another employee at the nursing home. This led to a Los Angeles County Sheriff’s Department investigation and a finding that the trauma to Mr. Kittower’s body was similar to that of an assault.

Since Mr. Kittower’s death, the investigation of possible elder abuse at Silverado expanded. Authorities examined the possible abuse of three other residents of the nursing home. In an autopsy on Mr. Kittower, it was revealed that he died due to a lung blood clot. The report also stated that “blunt force trauma” was a factor in his death. Mr. Kittower’s body also had multiple bruises and showed evidence of a partially healed rib fracture. Another resident alleged to have been harmed is the mother of Keith Stubbs. Stubbs learned from authorities that his mother’s chest was jumped on. Stubbs said he did not suspect that his mother had been abused. In retrospect, Stubbs noted that he started seeing bruises on his mother’s arms and neck, and that he recently noticed that his mother recoiled when she was touched by visiting loved ones, something she had not done previously. The other possible victims are Silverado residents, Richard McDonough and Robert Turner. Authorities have said that Turner was punched in the stomach.

A former Silverado caregiver, Cesar Ulloa, has been implicated in the investigation. Ulloa has been charged with four counts of elder abuse and one count of torture. Ulloa was arraigned this week in Los Angeles Superior Court. He entered a not guilty plea.

Silverado spokesman Mark Mostow said that the company screens its potential employees and conducts background checks. He also said that all employees undergo an elder-abuse reporting program conducted by the California Department of Justice. Mostow indicated that Ulloa, who Silverado fired last year, appeared to have a friendly and outgoing demeanor and that families of the residents of Silverado received him well.

The Silverado case illustrates that even expensive facilities are not immune from elderly abuse. If you have a loved one in a nursing home or care facility, visit frequently and be alert for signs of possible abuse.

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.

New Elder Abuse Laws Signed by Governor Schwarzenegger

California Governor Arnold Schwarzenegger signed into law this week several bills aimed at curbing elder abuse and providing greater protection for the elderly in the State of California. Here is a brief summary of the new laws:

AB 2100 requires ombudspersons at long-term care facilities to report cases of alleged or suspected physical abuse, including sexual abuse, and financial abuse to the local district attorney’s office. The purpose of this bill is to encourage the reporting of suspected cases of abuse.

SB 1140 extends the statute of limitations for a claim for damages due to financial elder abuse to four years from the plaintiff discovers, or should have discovered, the abuse. Presently, the statute of limitations on such a claim is three years. In addition, the definition of financial abuse of an elder is expanded to include the action of taking, appropriating, obtaining or retaining, real or personal property by undue influence.

SB 1136 makes it a misdemeanor to charge an “unconscionable fee” to qualify a person for a public social service benefit, including Medi-Cal.

AB 225 extends the protection of a restraining order to include named family members, household members and conservators of the elder abuse victim.

AB 2149 regulates the use of “expertise” designations and requires advisors to take training courses before holding themselves out as having specialized knowledge regarding the financial needs of seniors. The bill is designed to prevent the elderly from falling prey to unscrupulous financial advisors who claim to be experts on financial planning for the elderly.

Also signed into law were two bills targeting nursing home and residential care facilities. AB 2370 requires residential care facilities to post information regarding recent rate increases on an annual basis, and also requires the disclosure of rate increase information to new residents, and, upon request, to prospective residents. AB 749 requires residential care facilities to have a comprehensive emergency plan by March 1, 2009 that provides that the facility will be self-reliant if necessary for at least 72 hours. The plan must be available to residents and emergency personnel.

The new laws are designed to protect the elderly in the event of a disaster and protect them from financial elder abuse.

Thanks for reading my blog. 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.

Recent Developments in Elder Law

In my last blog entry I promised to keep readers apprised of any developments with the Fairness in Nursing Home Arbitration Act (the “Act”), which was approved by the House Judiciary Subcommittee on Commercial Law and Administrative Law earlier this week. The Act which would preclude nursing homes from forcing patients to sign an arbitration agreement prior to a dispute. The Act doesn’t preclude binding arbitration as an option in the event of a dispute, but instead requires the decision to be made by both parties after a dispute occurs. A resident cannot be forced to sign an arbitration agreement as a condition to admission to a nursing home or assisted living facility.

Republican members of the committee attempted to modify the bill, by trying to prevent the bill from being retroactive, or by attempting to exclude nursing home physicians. These modifications were rejected by voice voting. The committee’s approval of the Act makes it one step closer to becoming law. I’ll continue to keep you posted on further developments.

In other recent developments in the law regarding elders and nursing homes, the Centers for Medicare and Medicaid Services (CMS) announced last month the implementation of a new rating system for nursing homes. The new system will rate nursing homes on a 5-star scale, similar to the way hotels and restaurants are currently rated by critics, with one star being the lowest rating and five stars the highest possible rating. The purpose of the new system is designed to assist families in determining the best facilities in their area. CMS plans to implement the new system before the end of 2008; the new system will appear on Medicare’s “Nursing Home Compare” Web site.

The new system is a welcome improvement to the “Nursing Home Compare” Web site, which many have criticized as being too difficult to navigate. The Nursing Home Compare Web site has basic staffing information, general findings of inspection reports for the past three years, and a list of quality indicators. Quality indicators include the percentage of residents subject to some form of restraint; percentage of residents with pressure sores; and percentage of residents who have lost too much weight, among other factors. I will keep you updated on the implementation of the new “Nursing Home Compare” site.

Regardless of how a nursing home is rated, you should not allow a rating system to substitute for your own observations and best judgment. It is crucial to personally check out a nursing facility prior to making a decision on whether or not to entrust them with a loved one. Sadly, every day there is a story of nursing home abuse or neglect in the media. This week it was announced that a lawsuit has been filed against a Detroit-area assisted living facility over the death of Vunies High, sister of boxing legend Joe Louis. High died of hypothermia after wandering outside the facility in freezing weather. She was found with her face frozen to ice on the ground.

Thanks for reading my blog. If you have a question or comment, please feel free to post it here. If you have a question or need assistance with a potential claim against a nursing home or assisted living facility, contact me for a confidential consultation and immediate assistance.