“Since nurse staffing is directly related to the quality of care that residents experience, CMS is very concerned about the risk to resident health and safety that these situations may present.”
-11/18/18 CMS memo to state nursing home surveyors
The Centers for Medicare & Medicaid Services (CMS), the federal agency tasked with regulating nursing homes, has updated rules for nursing home staffing levels and how they report employee hours.
Sen. Ron Wyden (D-OR) is the ranking member of the U.S. Senate Committee on Finance. He has been outspoken on many occasions regarding the outcome of nursing home preparedness in the event of an emergency such as a natural disaster. And with President Trump’s Administration’s recent announcement to ease a home’s necessary preparedness for emergencies, his concern came with outrage expressed in an official letter to the Centers for Medicare & Medicaid Services.
“It is troubling to see CMS decide to further roll back its already inadequate safeguards with this proposed rule, which does more to cut corners than cut costs,” Wyden wrote. “The Trump administration’s proposal not only strips patients of commonsense protections in order to pad the pockets of medical providers, but goes against the recommendations of well-respected national organizations charged with developing best practices for workplace and consumer safety.”
1 in 10 Americans, older than 65, will be diagnosed with Alzheimer’s disease, the most common type of dementia. These individuals will experience a drastic decline in mental abilities that make it difficult to complete daily activities most take for granted such as eating, bathing, socializing, or even the ability to remember their own name or address. A majority of dementia victims will require an intense amount of supervised care and physical assistance to go about these routines. More often than not, families will put their trust in a nursing home center to manage the progressive, non-curable disease that will continue to worsen their loved ones until death. For individuals with who live in nursing homes or long-term care facilities with dementia and have no family to check-in or watch out for them, receiving the best care can be difficult due to the staff responsible for the growing number of abuse and neglect cases impacting nursing home residents today.
Wandering represents one of many behavioral problems occurring in people with the dementia. In fact, six out of 10 people with dementia will wander and aimlessly move about within the facility or grounds without regard of their personal safety. For a better understanding of this phenomena, The National Council of Certified Dementia Practitioners (NCCDP) has identified several different reasons for wandering in nursing homes as well as the different types of wandering.
Although not surprised, the entire legal team at Levin & Perconti has been cringing over the recent ProPublica Illinois investigation into Chicago Lakeshore Hospital, a private psychiatric facility located in the northside of the city. The initial ProPublica findings involve both claims of sexual abuse and related disruptions grown from the ongoing neglect of young patients in the hospital’s Child and Adolescent Behavioral Health Program. The allegations are horrific to say the least. Even so, dozens of children have bravely stepped forward and shared their personal stories of being raped and sexually abused by staff and patients, while others have been physically assaulted. Many of the hospital’s hotline complaints in just the last few months were triggered from laxed staff who created scenes of abusive sexual activity (most forced), and inappropriate or violent altercations between children and teenage patients.
Federal inspection reports in 2018, show the Illinois Department of Children and Family Services (DCFS) has investigated 16 allegations of abuse and neglect, many sexual in nature, at the hospital between staff and child patients, and other hospital residents just this year. As the Chicago Tribune recently reported, some pending investigations include these sickening allegations:
While there has been a general slowing of individuals dependent on nursing home care from nearly 86 percent in 2012 to less than 82 percent in 2017, as life expectancy continues to increase in the U.S. and seniors account for a higher proportion of the population, demand for the services provided by nursing facilities will increase and no doubtingly, costs will follow suit. But supported and efficient services have failed to align and it’s our nation’s most vulnerable people and their families, as well as care staff, who pay the real price. So, who is to blame?
Third-party payors and private entities who haphazardly increase the costs of healthcare services without providing quality care of professional and skilled nurses and staff look guilty. Employing staff and pushing up labor costs only leads to widespread budget increases and less fattening of private facility pockets, but shortages can ironically do the same. Meanwhile, nursing home administrators blame behind the market reimbursement rates of patients on ‘traditional” Fee-for-Service (FFS) Medicare patients to Medicare Advantage (MA) patients to cause the industry to suffer and negatively profit, demanding them to raise general daily costs to residents and families or cut short in areas such as infrastructure and staffing quality workers.
With more than 1,200 long-term care facilities serving over 100,000 residents with all types of medical issues, Illinois facilities licensed, regulated and inspected by the Illinois Department of Public Health are open for review and often subject to complaints. Rightful complaints are evaluated under the state’s Nursing Home Care Act. The Department’s 24-hour a day Nursing Home Hotline receives nearly 19,000 calls a year.
IDPH investigates quality of care issues, such as allegations of actual or potential harm to patients, patient rights, infection control, and medication errors. The Department also investigates allegations or harm or potential harm due to an unsafe physical (building) environment. Here is a list of the most common complaints.
According to a state report filed by the Illinois Department of Public Health, Aperion Care Capitol, a 251-bed skilled-care facility and nursing home located at 555 W. Carpenter St. was fined for “failing to ensure there were appropriately trained staff to reinsert a feeding tube” that fell out while two nursing assistants were haphazardly removing the patient’s T-shirt.
According to the March 2018 report:
The latest quarterly report on Illinois nursing home violations is in and the number of Type AA and Type A violations has increased since the first quarter of 2018.
The Illinois Department of Public Health’s (IDPH) Second Quarterly Report of Nursing Home Violators includes some repeat offenders from quarter 1, as well as one facility that received a $50,000 fine for a Type AA violation for the second time this year.
According to IDPH, Type AA violations are given when a nursing home has a “condition or occurrence at the facility that proximately caused a resident’s death.” Type A violations are situations “in which there is a substantial probability that death or serious mental or physical harm will result, or has resulted.” IDPH defines Type B Violations as those that would likely cause mental or physical harm to a resident.
The Elder Justice Coalition is reacting to a July 7th New York Times article that outlined just how extensively nursing homes have hidden low staffing numbers. The advocacy group is calling for an immediate congressional review of staffing practices within nursing homes.
Actual Payroll Data Reveals Staffing Crisis
The article, investigated and published in collaboration with Kaiser Health News, was based off a review of payroll hours submitted to the Centers for Medicare and Medicaid Services (CMS). The actual hours made news not only because they show a serious crisis in terms of resident to staff ratios, but also because up until recently, nursing homes had supplied their own staffing data to CMS. With the new payroll-based submission process, nursing homes have no ability to fudge numbers.
The Illinois Department of Health produces quarterly reports on nursing home violators. The most recent report, dating January 2018 thru March 2018, highlights more than 50 Illinois facilities determined to be lacking in patient care abilities related to the Nursing Home Care Act, a statute that provides nursing home residents and their families with the assurance that proper and safe care will be received.
Some violations heightened with a serious high-risk designation, and all homes received fines of no less than $1,000 while others reached more than $50,000 fines for issues that caused actual harm or immediate jeopardy to residents. Several problems were related to infected bedsores, medication mix-ups, poor nutrition, and abuse and neglect of patients caused by lack of support or inexperienced, overburdened staff. These violations may result in an official recommendation for decertification to the Department of Healthcare and Family Service, or the Secretary of the United States Department of Health and Human Services. Facilities included in this report are:
Illinois Nursing Home Abuse Blog