Remember when they said to the elderly: You won’t lose any benefits?

They lied.

By a vote of 53 to 41, the Senate on Saturday rejected a Republican effort to block cutbacks in payments to home health agencies that provide nursing care and therapy to homebound Medicare beneficiaries.

Republicans voted against the cuts, saying they would hurt some of the nation’s most vulnerable citizens. Most Democrats supported the cutbacks, saying they would eliminate waste and inefficiency in home care.

Who is the elderly’s friend now in Congress? Instead of holding the few bad actors accountable in this waste and inefficiency game, let’s punish EVERYONE by taking away benefits. How many nurses and aides will lose their jobs when these cuts go into effect?

Not to worry though, for there will be jobs, once they move all the former beneficiaries, into nursing homes.

All this, for what?

The Democrats’ health care bill would reduce projected Medicare spending on home care by $43 billion, or 13 percent, over the next 10 years. The savings would help offset the cost of subsidizing coverage for the uninsured.

I sure hope CNA’s get something out of this. I hope they get affordable health insurance. It seems like a very painful trade.

And some every day average people are extremely upset about this:

I am shocked that the Senate slipped such major Home Health Care cuts in on a snowy Saturday night in Washington, when everyone was sitting cozily at home with their family, watching a DVD or reading in front of the fire.

And I am disappointed, hurt, worried, and depressed that the Democrats were the ones who got the cuts passed. I feel sure they wouldn’t have done so if Teddy Kennedy had been there. And Obama, what do you have to say for yourself? Were you sitting cozily in front of the fireplace too, watching a Walt Disney movie with your adorable daughters?

I smell a fox, in fact several. We are in a democracy; I accept that we don’t all agree. But I worked hard to get Obama elected. I have fought hard to encourage others to support health care reform, and to support Obama’s plan, and now I feel betrayed.

And this comment:

I work as a hospice chaplain and every day see how home care keeps people out of hospitals and nursing homes. Curring the services of home health aides who are often paid at or below minimum wage, and often without health insurance themselves seems a particularly nasty and dysfunctional way to cut medicare costs.

One thing to keep in mind: The herd mentality is at work here. It’s cheaper to warehouse people into nursing homes, cut the doctor pay, regulate the cost of medications, supplies, food, CNA pay, nurse pay and the like, than it is to be human about all this.

High tech health care doesn’t always mean better lives for our elderly. But we should be careful with the language we use when discussing other “options”. Futile care is an example I would hesitate to speak right now.

LOS ANGELES — A surprising number of frail, elderly Americans in nursing homes are suffering from futile care at the end of their lives, two new federally funded studies reveal.

One found that putting nursing home residents with failing kidneys on dialysis didn’t improve their quality of life and may even push them into further decline. The other showed many with advanced dementia will die within six months and perhaps should have hospice care instead of aggressive treatment.

Most LTC nurses and aides I know do not support aggressive treatment. We see the frail, dehydrated, malnourished bodies of the very old and know these treatments will not help.

Medical experts say the new research emphasizes the need for doctors, caregivers and families to consider making the feeble elderly who are near death comfortable rather than treating them as if a cure were possible — more like the palliative care given to terminally ill cancer patients.

“We probably need to be offering a palliative care option to many more patients to make the last days of their lives as comfortable as possible,” said Dr. Mark Zeidel of the Beth Israel Deaconess Medical Center in Boston, who was not involved in the studies.

Palliative care focuses on managing symptoms of a disease and a main goal is to relieve pain at the end of life.

Isn’t this what we do with our nursing home residents? Don’t we go out of our way to keep them comfortable and clean? Calling this all “palliative” and using phrases like- “last days of their lives” really isn’t good right now during the fight for health care reform. All this discussion brings many people to believe there really might be “Death Panels” and that turns folks away, especially older people. Who can blame them?

As with all stories, there are two sides. I’m not sure what to make of this.

LOS ANGELES — Amelia Mendoza’s last words to her husband were that she was afraid she would be fired for reporting that she had been assaulted at her hospital nursing job.

Moments later, she had a massive hemorrhagic stroke that has left her in a vegetative state and in a health care limbo because of a dispute over her coverage.

What happened?

Amelia Mendoza, 52, was struck in the face, head and neck by a violent patient while working as a certified nurse assistant at Huntington Memorial Hospital in Pasadena, attorney Russell Glauber said. She is not expected to recover from her April 20 collapse.

Claims for her care have been denied by her insurer, Blue Cross, and by workers’ compensation, Glauber said. He is appealing Mendoza’s workers compensation denial and calling on the state board to expedite its response.

At issue here is whether the assault caused the stroke.

Glauber said Mendoza was attacked on April 14 and 16 but was told to make an appointment at an in-house workers compensation clinic at Huntington hospital on April 20.

Why did she wait so many days before seeking medical help?

An April 20 note in Mendoza’s medical records says she was “in her usual state of health until about a week ago when she was bitten at work and had increased anxiety about her work injury.”

The records also note that Mendoza had developed high blood pressure since the incidents.

Dr. Arthur E. Lipper, who was hired by Glauber, has examined Mendoza’s medical records and said he believes the stroke was a result of Mendoza’s workplace injury.

“Whatever conspired to cause her to have her stroke, clearly at least in part transpired after and because she was bitten, hit in the head and neck,” Lipper said. “She was agitated because of it, and then she stroked.

Not quite true, but it makes for a good headline. I feel terrible for her, but her family, lawyers and others need to be honest and realistic with this. Strokes happen all the time without any “warnings”- and “stress” is not a factor. Read the facts about stroke, HERE, and keep them in mind when forming an opinion on this article.

The main point to this article is the denial of medical care payment- the worker comp people are saying the assault did not cause the stroke; the health insurance people are probably waiting for the worker comp report and will take over the case once it’s released.

As reported:

WILMINGTON– An 82-year-old patient at Governor Bacon Health Center suffered a cut on her forehead and a skull fracture when she was left unattended and fell out of bed, officials said.
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The incident occurred when a certified nursing assistant left the resident to take a personal phone call Monday morning without taking steps to assure the woman’s safety, according to a news release from the state Department of Health and Social Services. The woman’s bed was elevated about two feet above the floor.

Lesson? Don’t accept phone calls while tending to your resident! I suspect the phone involved was a cell phone, and if it was, perhaps we really need to evaluate there use at work. I have seen dozens of co workers texting and talking while working, and sooner than later we will read more stories like this.

Why I haven’t seen links to this article at other nursing home blogs is beyond me.

HARTFORD, Conn. (AP) – The nation’s nursing homes are perilously close to laying off workers, cutting services – possibly even closing – because of a perfect storm wallop from the recession and deep federal and state government spending cuts, industry experts say.

The spending cuts are only just beginning. Wait until this health care reform really gets going. It’s all in the details, which hopefully we will all have a chance to read and comment on. It appears that some of our elected officials are not even reading the devilish details.

A Medicare rate adjustment that cuts an estimated $16 billion in nursing home funding over the next 10 years was enacted at week’s end by the federal Centers for Medicare and Medicaid Services – on top of state-level cuts or flat-funding that already had the industry reeling.

And Congress is debating slashing billions more in Medicare funding as part of health care reform.

Add it all up, and the nursing home industry is headed for a crisis, industry officials say.

“We can foresee the possibility of nursing homes having to close their doors,” said David Hebert, a senior vice president at the American Health Care Association. “I certainly foresee that we’ll have to let staff go.”

So in order to fix one part of health care, we have to sacrifice another part? Seems so. A saving grace here might be that home care would be the most cost effective “choice”- which is far better for the elderly person than a nursing home admission.

Now this is real different! A nursing home that offers 24 hour meal service. Culture change at it’s best.

Highlight:

The staff says 24-hour dining and all the changes it produced have had a huge impact on quality of life for every elder. They now may choose exactly what and when they want to eat. They can sleep in if they wish and are able to maintain the same daily routine as they had at home. Physical health has improved. The number of elders eating a puréed diet was reduced from 30 people to seven because of the selection of food available and because there is time for one-on-one interaction while dining. Pressure ulcers have also decreased due to increased food intake and ability to choose the food they like. Residents are gaining weight, pain and behavioral issues are improving, and elder satisfaction with the entire home has improved. “Our care plan meetings and elder council meetings no longer revolve around food issues,” Godfrey says. “In fact, at our annual state survey in May, there were no elder complaints about food.” The surveyors who stayed for lunch even complimented the food!

There has been such a demand for meals that sales to staff and family have gone from $2,000 per month to $6,400 per month. There has been such a demand for families to eat with their elder, Rolling Fields has hired a hostess to seat and take reservations. Some family members were even coming without their elder to eat. “This was happening so often we had to put up some parameters to limit family members to only eating when accompanied by their elder,” Moody says.

I wonder what will eventually happen to this program, if this insightful administrator ever resigns from this facility, er, home?

The New York Times posted an article about the benefits of moving nursing home residents back into their homes, and how this truly benefits them…and how it’s a real threat to the industry.

“It was like being in jail,” Mr. Brown said on a recent afternoon. “In the nursing home you’ve got to do what they say when they say it, go to bed when they tell you, eat what they want you to eat. The food was terrible.”

But recently state workers helped Mr. Brown find a two-bedroom apartment in public housing here, which he shares with his daughter. “It just makes me more relaxed, more confident in myself,” he said, speaking with some difficulty, but with a broad smile. “More confident in the future.”

A growing number of states are reaching out to people like Mr. Brown, who have been in nursing homes for more than six months, aiming to disprove the notion that once people have settled into a nursing home, they will be there forever. Since 2007, Medicaid has teamed up with 29 states to finance such programs, enabling the low-income elderly and people with disabilities to receive many services in their own homes.

The nursing home industry is fighting these ideas, in order to keep their doors open. By empowering residents to go back into their communities these states are finding out that people come first and it’s not nearly as expensive as some like us to think.

“Medicaid has had an institutional bias in favor of nursing homes,” even for people who do not need them, said Gene Coffey, a staff lawyer at the nonprofit National Senior Citizens Law Center. “Federal law requires states to provide nursing home services. They don’t have to provide home or community-based services.”

I think this bias lives on due to the herd belief: It’s cheaper, easier and more managable to keep lots of people together in one building (institution). They use safety as an excuse, often…but does that really justify taking away a person’s independence? I don’t think so- not for those who can think for themselves and who can get by with a little help.

Sorry for the summer long hiatus here! We’ve been quite busy with moving, attending summer camps with kids and other activities. We’re back now.

Provider Magazine has an article about the traits of successful CNA’s.

Traits of A Successful CNA (PDF file)

The five most important foundational skills that a successful nursing assistant needs are:
Reading for information
Locating and using information
Observation skills
Applied mathematics
Writing

I agree. We do have a problem here, though. A lot of CNA’s cannot read and comprehend English very well, therefore they cannot report (verbally and in writing) the things they observe. I think more education is needed in order to carry out observations- I see problems every day with this. Math is a no brainer, but it goes with the language problem.

The characteristics of successful CNA’s:

cooperation, goodwill, optimism, order, savvy, and determination/striving

Good start. We have some articles that go into detail on these issues:

Observation Skills for CNA’s

Legal Issues for CNA’s

Professional Boundaries

Being Professional

CNA’s & Respect

Why Being Negative Can Really Hurt You

7 Habits of Highly Effective CNA’s

7 Habits of Highly INeffective CNA’s

This sounds promising.

State of the art technology is changing the way nursing homes operate.

Inside one Louisiana Alzheimer’s facility, each room is equipped with a fall prevention system.

“We have a ’smart’ system, which is a computer system that will learn, actually learn patient movement and activity,” said Neal Rider, Guardian House CEO.

Each resident has an individual profile that determines their risk for potential falls. If they are categorized as a “fall risk,” the computer and motion sensor devices will monitor their every move in bed and alert the staff if anything is abnormal.

“The unauthorized bed exit is coming in and you can see an individual getting out of the bed. It identifies where the person is in the building and where other individuals and staff members are located throughout the building,” said Rider.

Does anyone have experience with these types of systems?

Advancing Excellence has announced updates to to their GOALS and several of these give voice to the direct care workforce. AE is now in it’s second year of operation.

Advancing Excellence in America’s Nursing Homes is a coalition-based campaign concerned with how we care for the elderly, chronically ill and disabled, as well as those recuperating in a nursing home environment.

There are over 7300 nursing homes participating on a voluntary basis.

Originally the group listed 8 goals member nursing homes should work on. Those goals are located HERE.

Newly revised and updated, three are of interest to CNA’s- this is a PDF file.

GOAL 6 — STAFF SATISFACTION
NEW
Participants in this goal will have to assess staff satisfaction at least annually and upon separation; plus incorporate results into quality improvement efforts. AE has not yet decided on a target objective for this goal but it will probably be twofold: A) Increasing the number of staff surveyed and B) Raising satisfaction scores by a yet undetermined amount.

GOAL 7 — STAFF TURNOVER
REVISED
AE will ask nursing homes to reduce current levels of staff turnover for each of the following categories of employees: RN, LPN, CNA, DON, and NHA. Turnover will be measured separately for each of those categories. Participants will have to regularly measure and report staff turnover and develop plans to reduce the rate of turnover for each of the staff categories.

GOAL 8 — CONSISTENT ASSIGNMENT
REVISED
AE will increase its efforts to encourage and help nursing homes to adopt “consistent assignment” of front line staff – that is 85% of long stay residents in a nursing home have a maximum of seven (7) CNA caregivers each month AND 85% of short stay residents have a maximum of seven (7) CNA caregivers over two (2) weeks. Participants will be asked to set targets to increase the number of residents being served by a consistent assignment model by a yet undetermined amount.

In another post we will examine, more closely, what some of the AE member nursing homes are doing to promote the goals.