NY State has a new web site that posts all pertinent information about each nursing home in the state. Survey results, staffing patterns and other info is readily available for anyone who wants to know.

More problems in NY State. This is about Home Health Service contracts.

New York State Attorney General Andrew Cuomo last week sued and obtained a restraining order against a Pennsylvania based company and its owners for preying on New York’s elderly by selling expensive home health services agreements and not delivering on the promises. Homeward Bound Services of North America and its owners, Marc Orth and Thomas Muldoon, are accused in the lawsuit of using deceptive and fraudulent practices to sell agreements to more than 600 New York seniors. They would promise services meant to help keep the seniors out of nursing homes and in home-based care settings and then didn’t deliver on their agreements.

Upon request of the attorney general’s office, a temporary restraining order barring Homeward Bound from selling or renewing agreements across the state was signed on August 14 by state Supreme Court Justice Joseph D. Mintz in Buffalo.

“This company misled and fleeced hundreds of New York state’s elderly citizens with a fraud that won’t be tolerated under my watch,” Cuomo said. “They exploited the fears of elderly consumers of being placed in nursing homes. Too often, disreputable businesses and individuals look to the most vulnerable in our society to line their own pockets, and I am committed to using the full force of my office to come down hard on anybody who tries to get away with it.”

Trouble with some NY State Home Health Aide Training schools:

ALBANY, Aug. 23 — Attorney General Andrew M. Cuomo announced guilty pleas on Thursday from the former operators of two schools for home health aides who sold state certifications to hundreds of people who never received proper training.

The pleas, which were agreed to in May and July, stemmed from an investigation by the attorney general’s office into the rapidly growing — but relatively lightly regulated — field of home health care.

In a statement, Mr. Cuomo’s office described the two schools as “certification mills” linked to what he called a widespread and elaborate scheme to defraud Medicaid of millions of dollars in billings for federally subsidized home health care. Both schools were licensed by the state.

Earlier this week, Mr. Cuomo announced the convictions of 10 people who had illegally billed Medicaid for work as home health aides using the tainted certificates, some of them obtained from the schools involved in Thursday’s announcement, and in some cases claiming to have worked for more than 24 hours a day.

He has issued subpoenas to dozens of the state-certified agencies that hire aides and bill Medicaid for their services, to determine whether any of them have been involved in such fraud.

The (non) aides involved with these cases are not innocent. They have been convicted as well:

Under state law, home health aides, who may administer medication, dress wounds and perform some other procedures, must go through 75 hours of training at a school and 16 hours of practical training with a registered nurse.

Schools must be licensed by the Department of Health or the Department of Education to administer certification tests for their students.

Because there is no central registry of those certifications, state officials do not know how many people are working as home health aides in New York.

Several of the home health aides convicted earlier this week received their documents from On Time Home Care Agency or Smalls Training and Counseling School.

This could be much bigger than it appears right now. What caliber of person would pay for a certificate and go to work as a Home Health Aide, with ZERO training?

If these allegations, as they stand now, are true, I hope these aides get the full book of punishments thrown at them.

GIRARD — Nurse’s aides, described as bullies in a state investigator’s report, allegedly spent months tormenting nursing-home residents with Alzheimer’s disease and other mental impairments.

The incidents at Pleasant Hill Village, described in a Feb. 21 report by investigators from the Illinois Department of Public Health, have resulted in a $25,000 fine, Public Health spokeswoman Kimberly Parker said Tuesday. The nursing home is challenging the fine.

Girard police also are investigating the accusations and will forward information in a few months to the Macoupin County state’s attorney for possible criminal charges, Girard police Sgt. Harold Gist said.

Police are focusing on the actions of two nurse’s aides, both of whom have been fired. A third aide also has been fired, apparently because she is believed to have witnessed the incidents but didn’t immediately report the conduct to her supervisors.

What are the allegations?

Among allegations outlined by the state report:

# Nurse’s aides held an alarm next to a resident’s ear to discourage her from getting up when they didn’t want her to get up.

# Aides poked a resident with a safety pin because the resident would constantly try to get out of her wheelchair to go to the bathroom or to bed. To avoid that treatment, the resident started to avoid activities and began to stay in bed all day.

# One of the aides grabbed a resident’s injured arm and asked “Does this hurt?” and the resident responded, “Don’t do that.”

# Aides took personal belongings as a way of punishing one resident.

# Aides made residents take showers against their will.

# Aides restrained one man by holding his arms behind his back and bending back his fingers.

Sickening, if true.

The government, CMS, is going to be taking a hard look at the relatively new position of Feeding Assistants.

Nearly four years after the Centers for Medicare & Medicaid Services first published a final rule allowing nursing homes to use paid feeding assistants, the agency is adding to it.

The new surveyor guidance on paid feeding assistants, F-Tag 373, highlights areas that inspectors should focus on during surveys, including whether assistants have completed state-approved training and whether the facility has record of it. Surveyors also are instructed to investigate whether feeding assistants are being properly supervised, and whether appropriate residents have been chosen to receive their help.

Where I work we don’t use PFA’s. At all. We have unit aides who make beds and clean up units and the like, but they don’t feed our clients because of the very different population we serve (Brain injured young adults). Most of them are fed via GTUbes anyway. Does your facility use PFA? If so are they a help? Do you think they’re trained properly and well supervised?

More than ever, medical errors and poor nursing care will become a very hot topic in the near future.

WASHINGTON, Aug. 18 — In a significant policy change, Bush administration officials say that Medicare will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals, a move they say could save lives and millions of dollars.

Private insurers are considering similar changes, which they said could multiply the savings and benefits for patients.

Under the new rules, to be published next week, Medicare will not pay hospitals for the costs of treating certain “conditions that could reasonably have been prevented.”

Among the conditions that will be affected are bedsores, or pressure ulcers; injuries caused by falls; and infections resulting from the prolonged use of catheters in blood vessels or the bladder.

In addition, Medicare says it will not pay for the treatment of “serious preventable events” like leaving a sponge or other object in a patient during surgery and providing a patient with incompatible blood or blood products.

“If a patient goes into the hospital with pneumonia, we don’t want them to leave with a broken arm,” said Herb B. Kuhn, acting deputy administrator of the Centers for Medicare and Medicaid Services.

The new policy — one of several federal initiatives to improve care purchased by Medicare, at a cost of more than $400 billion a year — is sending ripples through the health industry.

It also raises the possibility of changes in medical practice as doctors hew more closely to clinical guidelines and hospitals perform more tests to assess the condition of patients at the time of admission.
[…]
The Centers for Disease Control and Prevention estimates that patients develop 1.7 million infections in hospitals each year, and it says those infections cause or contribute to the death of 99,000 people a year — about 270 a day.
[…]
Consumer groups welcomed the change. And while hospital executives endorsed the goal of patient safety, they said the policy would require them to collect large amounts of data they did not now have.

Lisa A. McGiffert, a health policy analyst at Consumers Union, hailed the rules.

“Hundreds of thousands of people suffer needlessly from preventable hospital infections and medical errors every year,” Ms. McGiffert said. “Medicare is using its clout to improve care and keep patients safe. It’s forcing hospitals to face this problem in a way they never have before.”

Christine K. Cahill, a registered nurse who used to inspect hospitals for the California Department of Public Health, said: “This is a great start. Infection-control specialists have been screaming for 20 years that federal and state officials should pay more attention to this problem because hospital infections hurt patients and cost money.”
[…]
The rules, first reported in The Star-Ledger of Newark, carry out a directive from Congress included in a 2006 law. When they were proposed in May, consumer advocates said they feared that some hospitals might charge patients for costs that Medicare refused to pay.

But that is forbidden. “The hospital cannot bill the beneficiary for any charges associated with the hospital-acquired complication,” the final rules say.

Trust me. Someone WILL pay these bills. Hospitals are great at shifting costs; they will simply charge more for services and we will all pay for the errors of a few and the ensuing costs to care for the results. That pressure sore? Think about all the time, the dressing changes and wound care…the products…everyone will pay. But we won’t see any benefit from this. Less money coming into the system will mean even less money for wages and benefits. It’s strange how these rules are thought out. IF there were enough nurses and aides to begin with, pressure sores wouldn’t be prevalent now would they? If OR nurses weren’t so rushed, there wouldn’t be so many errors; same with medications and other things. AND if we all just washed our hands more often, and wore gloves with each contact with patients/residents, these infection rates would go down. It’s pretty elementary.

One of the reasons elderly people, who can (and can’t) afford it, are moving to Mexican nursing homes (as in the post below) as opposed to American nursing homes, is because the costs of running the American nursing home. One of the biggest costs is always staff: Pay, benefits, insurances. So when we see more Unions come to these places, we expect to see costs skyrocket. It’s simple economics and it’s very much bad for the industry in whole. The big chains can cough up some money for pay and other staff needs; it’s the small locally owned and managed facilities that suffer, and end up closing doors.

So when I read News Releases like this, I have to ask: HOW ARE UNIONS BETTER for RESIDENTS? If more and more of them are seeking alternatives, including moving to another country, how can the unions make the claims they do?

DETROIT, Aug. 17 /PRNewswire/ – SEIU Healthcare Michigan, the state’s largest local health care union, was formed this week, the union’s leaders announced.

The new union will represent more than 55,000 healthcare workers statewide, including Registered Nurses, home care workers, nursing home aides and hospital support staff.

“SEIU Healthcare Michigan will be a champion for quality healthcare in Michigan,” said SEIU President Rickman Jackson. “Our members are on the front lines of the healthcare crisis in our state, and we’ll work endlessly to make sure all Michiganders have access to the healthcare they need.”

Access is one thing; the cost of it is quite another. And what do CNA’s and nurses have to do with making sure ALL of a state’s citizens have access??

The move coincides with the formation of SEIU Healthcare, a national union which represents 1 million members nationwide. The union’s agenda includes advocating for improvements in the health care system, including putting patients first, providing affordable care to every man, woman and child in America, ensuring long term care for the nation’s elderly and disabled population, and higher standards for pay, benefits, training and staffing for health care workers.

“We have similar goals for Michigan,” Jackson said, “as we know that many of our workers don’t have insurance or adequate coverage to address their needs. That’s why we have high turnover in the home health care field and certainly, a nursing shortage in Michigan.”

Jackson’s goals include affordable and adequate healthcare for nursing home and other healthcare workers; the creation of the state’s largest training center and creating a stronger voice for the professions his union represents.

“A quality work force equals quality care,” Jackson said.

Remember who is paying for nursing home care. Each and every one of us who pays federal taxes.

The customers are looking for alternatives. Culture change is happening and Eden type nursing homes are becoming more and more popular. The nurses and aides who work for these places have consistently rejected unions- and they don’t make any more money than the rest of us. Now we see elderly people going to Mexico and India for nursing home care; what next? We already know a great many people hire non nursing aides to come in and take care of their older loved ones- these families train these aides to do things their way…not our way.

We’re not taking the hint here. It’s time we change. Or the people who we think need us won’t- they are revolting now and demanding something better and cheaper. Can we go with this wave of change or will be go with the old model and join the unions and destroy our own line of work? Something to think about.

Here’s a twist: American elderly are going to Mexican nursing homes and assisted living facilities because the costs are far less than anything in the US…

AJIJIC, Mexico — After Jean Douglas turned 70, she realized she couldn’t take care of herself anymore. Her knees were giving out, and winters in Bandon, Ore., were getting harder to bear alone.

Douglas was shocked by the high cost and impersonal care at assisted-living facilities near her home. After searching the Internet for other options, she joined a small but steadily growing number of Americans who are moving across the border to nursing homes in Mexico, where the sun is bright and the living is cheap.

For $1,300 a month — a quarter of what an average nursing home costs in Oregon — Douglas gets a studio apartment, three meals a day, laundry and cleaning service, and 24-hour care from an attentive staff, many of whom speak English. She wakes up every morning next to a glimmering mountain lake, and the average annual high temperature is a toasty 79 degrees.

“It is paradise,” says Douglas, 74. “If you need help living or coping, this is the place to be. I don’t know that there is such a thing back (in the USA), and certainly not for this amount of money.

She’s right. Absolutely right.

What are some of the benefits of moving to Mexico?

Many expatriates are Americans or Europeans who retired here years ago and are now becoming more frail. Others are not quite ready for a nursing home but are exploring options such as in-home health care services, which can provide Mexican nurses at a fraction of U.S. prices.

Correct.

And:

Retirement homes are relatively new in Mexico, where the aging usually live with family. There is little government regulation….
[…]
Residents such as Richard Slater say they are happy in Mexico. Slater came to Lake Chapala four years ago and now lives in his own cottage at the Casa de Ancianos, surrounded by purple bougainvillea and pomegranate trees.

He has plenty of room for his two dogs and has a little patio that he shares with three other American residents. He gets 24-hour nursing care and three meals a day, cooked in a homey kitchen and served in a sun-washed dining room. His cottage has a living room, bedroom, kitchenette, bathroom and a walk-in closet.

For this Slater pays $550 a month, less than one-tenth of the going rate back home in Las Vegas. For another $140 a year, he gets full medical coverage from the Mexican government, including all his medicine and insulin for diabetes.

“This would all cost me a fortune in the United States,” said Slater, a 65-year-old retired headwaiter.

More than a fortune.

But there are some problems:

The U.S. Embassy said it had no record of complaints against Mexican nursing homes, but some residents in the Lake Chapala area reported bad experiences at now-defunct homes.

The first home that Jean Douglas lived in after she moved from Oregon was staffed by “gossips and thieves,” she said. It went out of business.

Irene Chiara of Los Angeles also lived in a home that was shut down by Jalisco state authorities.

“It was filthy, and the food was very bad. It was all made in the microwave,” she said.

Some Mexican managers also underestimate the costs and difficulty of running a retirement home. Two hotels turned into assisted-living facilities, The Spa in San Miguel de Allende and The Melville in the Pacific Coast city of Mazatlán, recently abandoned the business, their managers said.

“It was very expensive to run it,” said Luis Terán, manager of The Melville.

Some managers said they were especially selective when admitting foreign residents, to make sure they’ll be able to pay. Medicare, Medicaid, the Department of Veterans Affairs and most U.S. insurance companies will not cover care or medicine as long as patients are outside the United States.

I wonder how many of these people are medically fragile? And how many will become so sooner than later, and what will come of their care needs? A lesson from this newer trend, for American nursing homes AND those who work for them: Keep an eye on costs. Unions which drive up wages and benefits might begin losing residents to Mexico. We’re already losing American aides with Mexican immigrants who take our jobs (at far less pay…) The free markets can fix all of this if we allow it. Too many regulations and third party players are ruining nursing homes.

Some older people are taking matters into their own hands. Setting up small communities that will provide services and care on as needed basis. They call this AGING IN PLACE…and it’s very different from those complexes where Assisted Living and Nursing Homes are on a campus.

WASHINGTON — On a bluff overlooking the Potomac River, George and Anne Allen, both 82, struggle to remain in their beloved three-story house and neighborhood, despite the frailty, danger and isolation of old age.

Mr. Allen has been hobbled since he fractured his spine in a fall down the stairs, and he expects to lose his driver’s license when it comes up for renewal. Mrs. Allen recently broke four ribs getting out of bed. Neither can climb a ladder to change a light bulb or crouch under the kitchen sink to fix a leak. Stores and public transportation are an uncomfortable hike.

So the Allens have banded together with their neighbors, who are equally determined to avoid being forced from their homes by dependence. Along with more than 100 communities nationwide — a dozen of them planned here in Washington and its suburbs — their group is part of a movement to make neighborhoods comfortable places to grow old, both for elderly men and women in need of help and for baby boomers anticipating the future.

“We are totally dependent on ourselves,” Mr. Allen said. “But I want to live in a mixed community, not just with the elderly. And as long as we can do it here, that’s what we want.”

Their group has registered as a nonprofit corporation, is setting membership dues, and is lining up providers of transportation, home repair, companionship, security and other services to meet their needs at home for as long as possible.

This is a good idea for those who don’t have a lot of medical needs. And given the spirit of these people of this generation, I fully expect them to overcome that issue as well.

Urban planners and senior housing experts say this movement, organized by residents rather than government agencies or social service providers, could make “aging in place” safe and affordable for a majority of elderly people. Almost 9 in 10 Americans over the age of 60, according to AARP polls, share the Allens’ wish to live out their lives in familiar surroundings.

Many of these self-help communities are calling themselves villages, playing on the notion that it takes a village to raise a child and also support the aged in their decline. Some are expected to open this fall on Capitol Hill; in Cambridge, Mass.; New Canaan, Conn.; Palo Alto, Calif.; and Bronxville, N.Y.

“Providers don’t always need to do things for the elderly,” said Philip McCallion, director of the Center for Excellence in Aging Services at the State University of New York at Albany. “There are plenty of ideas how to do this within the aging community.”

The rest of this article explains the ways and means of this idea; the costs and problems. While it’s a new idea, I bet it catches on all over the country. This is where Home Health Agencies could do a lot of good work as well.

This is cool, and I wish I could find her essay online.

Remona Pasley, a certified nurse’s assistant, won second place in a Florida Health Care essay contest with her entry “Treasure our Elders.”

“I was shocked,” Pasley said.

She has devoted her entire life to caring for other people.

“I never went to college, I had to help my mom take care of the rest of the family,” she said.

More than 35 years ago, Pasley was drawn to medical work, to caring for those who could not care for themselves. She took some classes to get her certification through the organization she was working for.

“I didn’t realize it was college-level work,” Pasley said.

It was, and through perseverance, Pasley completed the courses and became certified.
[…]
“The prize was $300,” Becker said. “She turned around and donated half of it to the facility.”

Pasley smiled and said she is going to keep her eye on the future, and go for first prize. If she ever wins the grand prize money, she said, she wouldn’t hesitate to donate half again.