Mentally ill people ages 22 to 64 make up 9 percent of the nation’s 1.4 million nursing home residents, a number that has climbed 6 percent since 2002. That increase is attributed to the closing of state mental institutions and a shortage of hospital psychiatric beds.

Allowing mentally ill patients, many with a history of aggression toward others, to live in nursing homes with the elderly has had tragic results. In 2003, a 23-year-old woman was accused of starting a fire in the nursing home where she lived, which killed 16 fellow residents. The woman was found incompetent to stand trial and was committed to a mental institution.

Earlier this year, a 21-year-old nursing home resident diagnosed with bipolar disorder with aggression was charged with raping a 69-year-old resident. Seventy-seven-year-old nursing home resident Ivory Jackson died a brutal death when his mentally ill roommate – 30 years his junior – bashed his face in with a clock radio.

“Sadly, we’re seeing the tragic results of the failure of federal and state governments to provide appropriate treatment and housing for those with mental illnesses and to provide a safe environment for the frail elderly,” said Janet Wells, director of public policy for the National Citizens’ Coalition for Nursing Home Reform, to the Associated Press.

SOURCE: Nursing Home Abuse › Mentally ill threaten safety of nursing home patients

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If Winchester Centre loses its contract, the home will stop receiving Medicare and Medicaid payments from the federal government and will no longer be certified to care for patients receiving those services. In that event, patients at the home would then be transferred to certified nursing homes, which may result in the closing of Winchester Centre. Officials say they are unsure what will happen to Winchester Centre and that other options besides closing are available, such as bringing in a new group of professionals to run the nursing home and incurring daily fines until specific citations are resolved.

Currently, 166 patients reside in the 183-bed facility. The home offers skilled nursing and rehabilitative care as well as a special unit for patients with dementia. Central Kentucky already has lost 400 Medicaid beds for nursing home patients, said Gannoe. “It’s a disaster for Central Kentucky,” she says.

SOURCE: Nursing Home Abuse › Kentucky nursing home facing most serious citation

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Measuring the quality of a nursing home is not always clear-cut. More that 1.5 million people live in 15,000 nursing homes throughout the country. Each facility is inspected annually and must meet federal standards in order to participate in Medicaid and Medicare. The Centers for Medicare & Medicaid Services has established the site to give the public a better understanding of how nursing homes compare to others.

The site rates three criteria – health inspection, nursing home staff and quality measures. Those three criteria make up the nursing home’s overall rating. The “health inspection” criteria is the data from the last three standard health inspections and all complaint inspections that have been conducted in the last three years. “Nursing home staffing” criteria is gathered from the most recent health inspection and ranks homes based on overall staffing hours and the type of staff employed. “Quality measures” criteria is reported by each nursing home and is based on 19 quality measures collected from residents.

Five stars indicate a nursing home that is “much above average,” and one star indicates a nursing home is “much below average.” An orange icon indicates homes that are considered Special Focus Facilities (SFF), or homes that have a history of persistent poor quality of care.

Those who visit the site can look up nursing home by name, zip code, state or county. Those listings can be further refined into subsets such as “nursing homes within a continuing care retirement community,” “nursing homes within a hospital,” and “nursing homes with resident and family councils.”

While the Nursing Home Compare site offers valuable information, the Centers for Medicare & Medicaid Services recommends that family members visit nursing homes they are considering; talk with doctors or other healthcare practitioners, family and friends about their choices; and contact the long-term care ombudsman or State Survey Agency before making a decision.

SOURCE: Nursing Home Abuse › Web site lists ratings of all nursing homes in country

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The Des Moines Register reviewed 81 bonus payment programs in 36 different states. Iowa, which began participating in the bonus program six years ago, was one of the first to establish a bonus program.

Of the 36 states that participate in the bonus program, eight do not disqualify a nursing home from receiving bonus money based on regulation violations. Fifteen of the bonus programs are based on quality of care. Points also are awarded for having a large percentage of patients on Medicaid and for offsetting expenses such as property taxes, fire sprinklers, or paying the minimum wage.

Nursing homes that receive the most bonus money do not necessarily have the best rating, the report points out. The bonus program may appear to be an incentive program or to reward quality care; however, its purpose in some cases is to reimburse or offset cost of bringing homes up to state or federal standards or encourage more homes to accept Medicare-dependent patients.

The bonus program first came to light in March after the Des Moines Register reported that some of the state’s most deficient homes were receiving money from the bonus program. Since then, Iowa has begun revising its program, reducing payments to homes that have recently been cited for causing “actual harm” to residents and eliminating payments to homes that put residents in “immediate jeopardy” of death or injury.

SOURCE: Nursing Home Abuse › Bonuses paid to nursing homes with no regard to quality care

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For one resident and her family, it was downright stressful.

Last June, a resident in the facility to receive physical therapy after having surgery on both knees, needed to get to her regular orthopedic doctor appointment. She was not ambulatory, needing a mechanical lift to be moved from the bed to the bathroom, and wheelchair to get around. She had to get to her doctor’s appointment in her hometown 32 miles away. The nursing home said its van was unavailable to transport her, leaving the resident and her family in a bind.

When administrator Pamm Dickey got word of the situation, she demanded the family pick up the resident by 5 p.m. that Thursday. The family scrambled, calling around and finally locating another nursing home. But that facility couldn’t accept her until Friday. Dickey was unwilling to budge. Using lewd language, Dickey demanded the family remove the resident from Pleasant Manor by the 5 p.m. Thursday deadline. Never mind that the other nursing home wasn’t ready for the resident. The woman’s family could just move her into their home in the interim, she was reported as saying.

However, moving the resident to the family’s home simply wasn’t an option. They were not equipped to lift and move her when she needed to use the bathroom, much less provide the skilled nursing care she needed. Even if it were for one night, the family just wasn’t able to do it.

Still, Dickey wouldn’t bend, becoming combative with the other nursing facility’s administrator over the phone. That administrator, who said she was “shocked” by Dickey’s unethical conduct, told Dickey she had no choice but to call Adult Protective Services. Dickey’s response, according to the administrator who reported her: “She proceeded to tell me to tell APS to bring a car to pick [the resident] up then because I will set her a– on the g—— curb!”

A 151-page report on the investigation into Pleasant Manor cited several incidents of emotional and verbal abuse by Dickey, including the incident mentioned above as well as berating residents for pushing their call buttons too often at night and arguing with one resident over a remote control. Dickey resigned Aug. 13, but dismissed the claims, saying “What is written (in the report) is not the truth by any means.”

Meanwhile, Pleasant Manor was found by surveyors as subjecting residents to immediate jeopardy and was fined, and the Centers for Medicare and Medicaid Services has denied payment for all new residents admitted there who require coverage by Medicare or Medicaid effective Oct. 14 until the home achieves compliance with federal and state regulators.

Dickey’s case will be heard before the Oklahoma State Board of Examiners for Nursing Home Administrators, who will then determine the status of her license.

SOURCE: Nursing Home Abuse › Nursing home administrator cited for verbal, emotional abuse

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According to a report in the Senior Journal, the Government Accountability Office estimated in a July 2004 report that automatic sprinkler systems can decrease the chance of fire-related deaths by 82 percent. In March 2005, CMS began requiring all long-term care facilities that did not have sprinklers to install battery-operated smoke alarms in all patient rooms and public areas, the publication reports.

By 2013, all nursing homes will have to have sprinkler coverage in areas including resident rooms, kitchen, dining and activity areas, corridors, attics, canopies, overhangs, offices, waiting areas, closets, storage areas for trash and linen, and maintenance areas.

SOURCE: Nursing Home Abuse › Lifesaving: not an option

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CMS is the federal agency that manages Medicare, the health insurance program for the elderly and disabled, and Medicaid, the health program for the poor.

On its web site, CMS says the new system is being designed as an easy way for the public to understand their assessment of nursing home quality, and will provide the public with a way to make meaningful distinctions between high-performing and low-performing homes. The rankings will be posted on the agency’s Nursing Home Compare Web Site, with plans to launch the program in December.

In June and July, the CMS is asking the public to visit its site and provide feedback about the new star rating system. A sample screen shot of the proposed star ratings also is available.

A press release on the agency web site quotes Kerry Weems, CMS acting administrator, as saying, “More than three million Americans rely on services provided by a nursing home at some point during the year. The new ‘five star’ rating system will provide a composite view of the quality and safety information currently on Nursing Home Compare to help beneficiaries, their families, and caregivers compare nursing homes more easily.”

According to CMS, this will be the first time the agency has offered a rating system for the fee-for-service, or traditional Medicare progra. Currently, the Compare web site assists beneficiaries and their families in making nursing home choices by providing information on individual measure of quality of care, staffing, and survey inspection information.

Medicare already lists troubled nursing homes in its online database, but that system can be hard for the general public to understand or to navigate. It is hoped that the new system will be easier to use, and therefore more effective for decision making.

Another hope is that by being listed as low performers with the easily identifiable star system, nursing homes that are below par will be motivated to improve, CMS officials say.

Descriptive information about the quality rating system and its progress may be obtained after June 22 on the CMS Hot Topics web page.

Comments and suggestions about the new nursing home rating system should be sent to BetterCare@cms.hhs.gov.

SOURCE: Nursing Home Abuse › Five-star care

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