Here is more from the NH Abuse site:

There are a myriad of remedies for you if you have an abuse or neglect situation that includes complaints made to various government agencies. Some remedies are more effective than others and the remedy you use will often depend on the severity of the abuse and neglect. In pursing any remedy, be prepared to be frustrated but you must remain persistent.

Ombudsman - Most states have a long term care ombudsman program. Their success rate and true commitment to quality care depend on each ombudsman program. In general, ombudsmen can help you get a new mattress for your family member, make the nursing home pay for lost or stolen items, and other types of simple problems but they may not be able to tackle serious problems involving lack of care. There are some aggressive ombudsman offices, but they are at the mercy of the state health department bureaucracy. It is best to use this office for non life threatening situations.

State Department of Health - The Division in a State Department of Health that deals with the oversight of nursing homes and enforcement of nursing home regulations is, in most states, called the Division of Licensing and Certification. This bureaucracy licenses the nursing home facility for the state and is also responsible for certifying the facility for participation in the federal Medicare and Medicaid programs each year. The state conducts yearly inspections, called surveys, of each nursing home and also investigates complaints. Some of the state surveyors are quite good, but there is enormous pressure on the state bureaucracy and legislature by the powerful nursing home lobby to keep remedies and fines to a minimum.

You can file a complaint with Licensing and Certification and they must investigate the complaint. Licensing and Certification can either substantiate or unsubstantiate your complaint. If the complaint is substantiated, this agency can issue a citation and impose a fine and require corrective action. The nursing home as a right to appeal a substantiation finding by the state and you have the right to an informal hearing on a unsubstantiated finding. Unfortunately, the nursing home often gets a fine reduced and often only temporarily corrects the problem. The surveyors often rely on the nursing home records in their investigation and these records can be falsified or “cleaned up”. The nursing home, through deduction or leaks usually finds out who made the complaint.

Surfing around the web, I came back to this site that has some good stuff about nursing home abuse. The site is for consumers, and I think it is always a good idea to read what info they are getting.

The Certification Survey

Under federal law, nursing homes that are participating in the Medicaid and Medicare programs, are to undergo an annual survey and certification process. The purpose of the survey process is to assess whether the quality of care, as intended by the law and regulations, and as needed by the resident, is actually being provided in nursing homes. Nursing homes must be in substantial compliance with Medicaid and Medicare care requirements as well as state law. If a nursing home is found to be out of compliance, federal law sets forth enforcement options such as denial of payment for new admissions, civil money penalties, revocation of Medicaid and Medicare certifications, transfer of residents and the imposition of temporary management. In implementing the survey and certification process, several expectations of nursing homes were established. These expectations were:

Nursing homes participating in the Medicaid and Medicare programs remain in substantial compliance with the Medicaid/Medicare care requirements.
All deficiencies will be addressed promptly.
Residents will receive the care and services they need to meet their highest practicable level of functioning.

Surveys are supposed to emphasize resident outcomes through observations, interviews and review of medical records. Surveyors are to ascertain whether a nursing home is actually providing the required and needed care and services, rather than whether the facility is capable of providing the care and services.

Certification surveys are conducted on an annual basis by a state or local survey agency that has entered into an agreement with the Health Care Financing Administration (HCFA). In California, the survey agency is the Department of Health Services, Licensing and Certification. Surveys, by law, are supposed to be unannounced.

Listed below are the survey tasks conducted by the survey agency for each survey:

Task 1. Entrance Conference

Task 2. Obtain Resident Sample

Task 3. Tour of the Facility. Resident Needs. Physical Environment. Meeting with Resident Council Representatives. Tour Summation and Focus of Remaining Survey Activity.

Task 4. Observation/Interview/Medical Record. Review of Each Individual in the Resident Sample (including drug regimen review).

Task 5. Drug Pass Observation.

Task 6. Dining Area and Eating Assistance Observation.

Task 7. Forming the Deficiency Statement.

Task 8. Exit Conference.

The New Food Pyramids are available. Check them out.

The U.S. Department of Agriculture released a new food pyramid, which breaks food categories into a spectrum to emphasize variety. Exercise was introduced as a component of the food pyramid, and 12 individualized intake profiles were added.

Last week we discussed different types of special diets and the diseases and conditions that may necessitate them. This week, we’ll explore the most common special diets in nursing homes.

Fiber-restricted diets
Fiber-restricted and residue-restricted diets are ordered for people who have digestive problems. There are several illnesses that affect the digestive system, such as cancer, colitis, and diverticulitis.

Fiber passes through the digestive tract undigested with a consistency similar to sandpaper, causing pain and discomfort when it rubs against cancers or open sores. Corn, whole grain breads and cereals, raw vegetables, seed, and nuts are often excluded in a fiber-restricted diet.

GERD (anti-reflux) diets
Gastroesophageal Reflux Disease (GERD) causes the contents of the stomach to back up into the esophagus. There are some foods that have a tendency to cause this reflux which should be excluded. These include chocolate, fatty foods, coffee, and alcoholic beverages.

Certain foods can actually cause damage to the esophagus if they do reflux. These should be avoided completely and include citrus juices, tomato products, and pepper.

Fat-controlled diets
Fat-controlled diets are either low-fat, fat-free, or “50-gram” fat diets. The difference between the diets is the amount of fat allowed in each. The foods a resident should avoid or eat in measured amounts in a fat-controlled diet include fried foods, ice cream, whole milk, butter, egg yolks, mayonnaise, some baked goods, and fatty meats, such as bacon. When serving a restricted fat diet, make sure there is no butter, margarine, or regular salad dressing on the resident’s food tray.

Sodium-restricted diet
A sodium-restricted diet is often ordered for patients with heart disease or high blood pressure. Although most of our sodium comes from salt, there are a number of foods which naturally contain high levels of sodium.

Residents on sodium-restricted diets should not have luncheon meats, canned soups or vegetables, chips, pickles, soy sauce, ham or bacon, or frozen prepared dinners.

Diabetic diets
Diabetic diets control the amount of sugar and carbohydrates a resident consumes. Carbohydrates are controlled because they break down into starch and sugar in the body.

The goal of a diabetic diet is to balance the amount and type of food with the amount of insulin available. It is important for meals and snacks to be served on time to diabetic residents for the insulin to be most effective.

Source:
from LTC Nursing Assistant Trainer. Property of HcPro, Inc.

LTC Nursing Assistant Trainer is a FREE e-mail newsletter for nursing assistant trainers. We’re pleased to offer training tips on nursing measures, best practices, and other crucial aspects of job training for CNAs.

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A book worth reading:

Product Description:
“At present nursing homes are designed . . . like outmoded zoos. Residents are kept in small rooms, emotionally isolated. Occasionally they are visited by family members who reach through the bars and offer them treats. Aides keep their bodies clean and presentable. . . . America invests huge amounts of money to maintain the body while leaving the person to languish, cut off from all they love.”—From Nobody’s Home
After caring for his mother at the end of her life, Thomas Edward Gass felt drawn to serve the elderly. He took a job as a nursing home aide, but was not prepared for the reality that he found at his new place of employment, a for-profit long-term care facility. In a book that is by turns chilling and graphic, poignant and funny, Gass describes America’s system of warehousing its oldest citizens.

Gass brings the reader into his sterile building with its flat metal roof and concrete block walls. Like an industrial park complex, it is clean, efficient, and functional. He is blunt about the institution’s goal: as long as the staff keeps those faint hearts pumping, the life savings and Medicaid dollars keep rolling in. With 130 beds in the nursing home, the owner grossed about three million dollars annually. As a relatively well-paid aide, Gass made $6.90 an hour.

Seventeen of the twenty-six residents on Gass’s hall were incontinent, and much of his initiation to his work was learning to care for them in the most intimate ways. One of the many challenges was the limited time that he had available for each of his charges—17.3 minutes per day by his calculation. Even as he learned to ignore all but the most pressing demands of the residents, he discovered the remarkable lengths to which aides and their patients will go to relieve the constant ache of loneliness at the nursing home.

With Americans living longer than ever before, the position of health care aide is among the fastest growing occupations. This book makes clear that there is a systemic conflict between profit and extent of care. What if elder care was not about controlling costs and maximizing profits? What if it was about our basic need to lead meaningful and connected lives until our deaths? What if staff members dropped the feigned hope of forestalling the inevitable, and concentrated on making their charges comfortable and respected? These and other questions raised by this powerful book will cause Americans to rethink how nursing homes are run, staffed, and financed—as well as the circumstances under which we hope to meet our end.

What is going on down at this place? Smells fishy to me. Patti and I want to know if anyone reading this has heard of this place or, better yet, works here…Email us.

Meet state Sen. Joe McPherson. He holds the reins of the committee that regulates nursing homes. He also happens to own Maison de Lafayette, which has been fined more than all but two homes in the state.
Tuesday, April 19, 2005
By Jan Moller
and Steve Ritea
BATON ROUGE — One of the most penalized nursing homes in Louisiana is co-owned by the state lawmaker who is chairman of the Senate committee that regulates the industry and is vice chairman of the panel that has a big say in how much the homes get paid.

Sen. Joe McPherson, D-Woodworth, won the legislative leadership posts last year with the support of Gov. Kathleen Blanco.

McPherson strongly backed Blanco in her 2003 gubernatorial campaign, but has quickly emerged as a leading critic of her proposal to overhaul the way Louisiana cares for the elderly and disabled, a plan that includes shifting money and resources from nursing homes to alternative programs.

As chairman of the Senate Health and Welfare Committee and in the No. 2 slot on Senate Finance, McPherson is powerfully positioned to influence how far Blanco gets in those efforts and what the landscape will look like for Louisiana nursing homes for years to come.

As a businessman, McPherson is majority owner of Maison de Lafayette, which state records show has been cited for more serious violations than all but two other homes in the state since 1999, the earliest year for which comprehensive records are available.

At least 21 residents suffered actual harm during that time, according to state inspection reports, causing the home to draw more fines than all but four other nursing homes in Louisiana. The state records show Maison de Lafayette was fined $26,650 during the six-year period. However, just $4,250 of that came from state regulators. After the home failed to fix its problems within 90 days, federal authorities imposed fines of $600 a day for more than a month in 1999 and later levied an additional $5,000 for the home’s failure to diagnose and treat a diabetic resident’s pressure sores, records show.

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