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This is my blog and i want to talk about nursing homes, I'm a nurse and I'm currently working on this area.
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The Centers for Medicare & Medicaid Services announced it will soon
launch a ground-breaking ranking system of America's nursing homes,
giving each a "star" rating. CMS is requesting comments on the system
designed to provide patients and their families an easy to understand
assessment of nursing home quality, making meaningful distinctions
between high performing and low performing homes.
The ratings
will be posted on the agency's Nursing Home Compare Web site by the end
of this year. A sample screen shot of the proposed star ratings is
available here. Medicare Compare can be found at http://www.medicare.gov.
"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," said
Kerry Weems, CMS acting administrator.
Through its consumer information Web sites, CMS has begun to offer more
and better information on the quality, patient satisfaction, and cost
of care. Today's announcement, for example, closely follows the
agency's first nationwide identification of chronically underperforming
nursing homes. Facilities enrolled in the Special Focus Facility (SFF)
initiative are placed under special scrutiny and undergo twice as many
inspections as other homes. The "SFF" designation was recently added to
the Nursing Home Compare Web site at http://www.medicare.gov/NHCompare.
Last year, CMS also initiated a star rating system for health and
prescription drug plans that are available to Medicare beneficiaries.
This will be the first time that CMS will offer such a rating system
for the fee-for-service, or traditional Medicare program. Currently,
through the Compare Web site, CMS assists beneficiaries and their
families in making nursing home choices by providing information on
individual measures of quality of care, staffing, and survey inspection
information.
"Nursing Home Compare's new rating system will also provide an
incentive for nursing homes to strive toward earning a five-star rating
by providing an environment of better quality care," Weems said.
This new rating system is rooted in the tradition of the OBRA'87
nursing home reform law and quality improvement campaigns such as the Advancing Excellence in America's Nursing Homes,
a collaborative coalition of consumers, health care providers, labor,
and nursing home professionals. CMS plans to work with other health
care providers and consumers to make similar rating systems available
for hospitals, home health agencies, and end-stage renal disease
facilities in the future.
The agency is also considering
adding new information to that already available on Nursing Home
Compare such as whether a nursing home specializes in caring for
patients with dementia, on ventilators, or in need of specialized
rehabilitation services. Information on patient and family satisfaction
with services at a facility may also be added to Nursing Home Compare.
A "Guide to Choosing a Nursing Home," a publication that includes
information about the types of long-term care, local nursing home
comparisons, and how to pay for nursing home care, can also be found on
the site.
The five-star rating system will begin to be
published in December 2008. During June and July 2008 the agency is
soliciting ideas, comments, and suggestions from the public, consumer
groups, nursing homes, and many others. Comments may be sent to
BetterCare@cms.hhs.gov.
Descriptive information about the quality rating system and its
progress may be obtained after June 22, 2008 on the CMS "Hot Topics"
webpage here.
This webpage will also provide details about a national conference call
(called an "open door forum") that the agency will have about the
proposed five-star system on June 24, 2008.
"While Nursing
Home Compare is very informative, it is important to note that this
should be just one of the tools that family members and caregivers use
in the selection of a nursing home," Weems said. "There is no
substitute for visiting a nursing home in person and meeting with
staff, residents, and other families."
Centers for Medicare & Medicaid Services
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The Robert Wood Johnson Foundation
and Bill Thomas, a former nursing home physician, have been working to
overhaul the nation's nursing home system by promoting "smaller,
home-like facilities," the Wall Street Journal reports.
RWJF has invested $15 million over five years to encourage the
construction of "Green Houses" -- a concept developed by Thomas in
which facilities house 10 to 12 residents. There are currently 41 Green
Houses in 10 states, and the foundation has set the goal of building
Green Houses in all 50 states.
Jane Isaacs Lowe, head of RWJF's Vulnerable Populations portfolio, said, "We want to transform a broken system of care." According to the Journal,
"The foundation's undertaking represents the most ambitious effort to
date to turn a nice idea into a serious challenger to the nation's
system of 16,000 nursing homes."
The Journal
reports that to supporters of the Green House model, it is "nothing
less than a revolution that could overthrow what they see as the rigid,
impersonal, at times degrading life the elderly can experience at large
institutions." However, despite funding from RWJF to build more houses,
"obstacles remain," according to the Journal. Barriers to
constructing more Green Houses include "a thicket of elder-care
regulations," the need for "enormous capital" to build new homes,
"stiff resistance from many parts of the existing nursing home system"
and lower overhead at larger facilities.
Michael Martin --
vice president of Riverside Health System, which owns several
traditional nursing homes -- said that Green Houses "will absolutely
provide a quality of life unsurpassed," but "they don't work
financially."
RWJF "officials acknowledge they don't know
whether Green Houses are a viable economic model," but "they've decided
not to wait for an answer" and could provide more funding in the
future, the Journal reports. Thomas Hamilton, who oversees nursing home quality and regulatory issues for CMS,
said, "Robert Wood Johnson is making an important investment to try to
make sure there is a sufficient cadre of early adopters of the Green
House model -- and research to make sure the model is actually
working," adding that CMS is trying to encourage nursing homes to
create more "patient-centered" models (Lagnado, Wall Street Journal, 6/24).
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All but 18 of the 81 affected hospitals and nursing homes in New York state have met the June 30 deadline to close, merge or downsize in accordance with the recommendations made in 2006 by the Commission on Health Care Facilities in the 21st Century, state Health Commissioner Richard Daines announced Wednesday, the Rochester Democrat and Chronicle reports. The recommendations became law on Jan. 1, 2007, after the state Legislature did not vote to reject them. The New York Health Department amended the operating certificates of the 18 facilities that were not in compliance with the mandates or had not made significant progress as of June 27.
The commission projects that have been or are in the process of being completed include the closure of nine hospitals by the end of 2008, which will eliminate nearly 1,700 beds; the elimination of an additional 1,700 hospital beds by the end of 2010 through mergers, downsizing and affiliations between health care facilities; the closure of seven nursing homes by the end of 2008, which will eliminate about 1,100 beds; and the elimination of an additional 1,600 nursing home beds by the end of 2011 (Matthews, Rochester Democrat and Chronicle, 7/3).
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Nursing home decisions issued by the Department of Health and Human
Services' Departmental Appeals Board (DAB) in 2007 highlight serious
failures in care that cause residents to suffer unnecessary pain,
injury, trauma, and death. "Despite the serious deficiencies reflected
by these cases, the federal enforcement response is usually modest, at
best," said Toby S. Edelman, Senior Policy Attorney with the Center for
Medicare Advocacy and author of the just-released report,,
an analysis of nursing home enforcement decisions issued by the DAB.
"The federal government imposes only minor fines for these
deficiencies," she continued, citing a case where a trivial $4050 fine
was imposed when a resident strangled to death on her bedrail, after
having fallen out of bed numerous times and been found caught by the
bedrail in the same way a week before.
The Center for Medicare Advocacy's study of the 85 decisions is the
first study ever made of the administrative appeals filed by nursing
homes when federal remedies are actually imposed against them for poor
care. "The study shows not only that the problems in care are serious
and that penalties are modest, but also that facilities choose to
appeal these enforcement actions through the administrative appeals
process. Almost always, the facilities lose their cases," Edelman said.
The government won 66 of the 71 cases that reached the merits of the
appeals - a 93% success rate.
The Center for Medicare Advocacy recommends that the regulatory system,
unchanged for more than a decade, be updated. The Center calls for a
stronger and faster enforcement response to the serious noncompliance
that these cases reflect. The federal enforcement system should impose
larger fines for facilities' failure to provide residents with the care
they need, not just for failing to correct problems, and it should
include a broader array of federal remedies to impose against
facilities that harm residents.
In addition, said Edelman, "more public information is needed about the
survey and enforcement systems and about the appeals process."
Medicare's informational website, Nursing Home Compare,
does not describe the facts supporting deficiencies and contains no
information about enforcement actions. "Consumers need information
about surveys and enforcement to help them choose facilities and to
monitor the care their loved ones receive."
The full report is available here.
The Center for Medicare Advocacy, Inc.
is a national non-profit, non-partisan organization that provides
education, advocacy, and legal assistance to help elders and people
with disabilities obtain Medicare and necessary health care. The Center
was established in 1986. We focus on the needs of Medicare
beneficiaries, people with chronic conditions, and those in need of
long-term care. The organization is involved in writing, education, and
advocacy activities of importance to Medicare beneficiaries nationwide.
The Center's central office is in Connecticut, with offices in
Washington, DC and throughout the country.
Center for Medicare Advocacy, Inc
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AARP issued a statement following today's House Energy and Commerce
Oversight and Investigations Subcommittee hearing on nursing home
safeguards. The statement,
from AARP Legislative Policy Director David Certner, follows:
"We thank the subcommittee for its work to protect the 1.5 million older
Americans who rely on
nursing homes for their care. Hearings like the one held today are an
important part of ensuring
that quality and safety are the top priorities for nursing homes,
regardless of their ownership.
Families should never have to worry about the safety of their loved ones
who receive care in a
nursing home.
"We hope today's hearing will spur members of the subcommittee to consider
ways to improve
the quality, accountability and transparency of the country's nursing
homes. AARP has
suggested several steps to begin this process, including more thorough and
updated
documentation of facility ownership and better data on nursing home
staffing and public
reporting of this information.
"AARP has also endorsed the bipartisan Nursing Home Transparency and
Improvement Act
(S. 2641) introduced by Senators Charles Grassley (R-IA) and Herb Kohl
(D-WI). This bill
would improve the transparency and accountability of nursing homes and is
one of the most
significant nursing home reform initiatives since the 1980s. We look
forward to working with
members from both chambers to enact such legislation, which would help
improve America's
nursing homes for all who rely on them."
AARP is a nonprofit, nonpartisan membership organization that helps people
50+ have
independence, choice and control in ways that are beneficial and
affordable to them and society
as a whole. AARP does not endorse candidates for public office or make
contributions to either
political campaigns or candidates. We produce AARP The Magazine, the
definitive voice for
50+ Americans and the world's largest-circulation magazine with over 33
million readers; AARP
Bulletin, the go-to news source for AARP's 39 million members and
Americans 50+; AARP
Segunda Juventud, the only bilingual U.S. publication dedicated
exclusively to the 50+ Hispanic
community; and our website, AARP.org. AARP Foundation is an affiliated
charity that provides
security, protection, and empowerment to older persons in need with
support from thousands of
volunteers, donors, and sponsors. We have staffed offices in all 50
states, the District of
Columbia, Puerto Rico, and the U.S. Virgin Islands.
http://www.aarp.org
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Hospital superbugs that can break down antibiotics are so widespread throughout Europe that doctors increasingly have to use the few remaining drugs that they reserve for emergencies. Now these hospital superbug strains have spread to nursing homes and into the community in Ireland, raising fears of wider antibiotic resistance, scientists heard today (Wednesday 28 November 2007) at the Federation of Infection Societies Conference 2007 at the University of Cardiff, UK, which runs from 28-30 November 2007.
Doctors collected 732 samples from 22 Irish hospitals over the last ten years and found that 61% of them, 448 samples, tested positive for bacteria that can produce an enzyme that destroys a whole family of common antibiotics including penicillins and cephalosporins.
"The ability to make these enzymes - called extended spectrum beta-lactamases (ESBLs) - spreads very easily between different types of bacteria", says Dr Dearbhaile Morris from the National University of Ireland Galway, Ireland. "It lets them break down many different penicillins and cephalosporins. So the genetic ability to resist very important antibiotics often spreads with the ability to make ESBLs, and that means that doctors increasingly have to use antibiotics which in the past were held back for exceptional cases".
During the years 2003 and 2004 a severe outbreak of cystitis, an infection of the bladder, was caused in the UK by E. coli bacteria that could produce a particular type of extended spectrum beta-lactamase enzyme. The Irish research team were trying to find out how common similar strains of antibiotic resistant bacteria are in Ireland.
"Our results showed that ESBL producing bacteria, especially of the type which caused the bladder infections in the UK outbreak, are now common in Ireland as well as in other countries in Europe. We also showed that they are not just found in hospitals but also in nursing homes and in the community", says Dr Morris.
Although cystitis is not life threatening, it is the most common form of urinary tract infection, and the economic consequences of failing to treat an outbreak quickly and properly are considerable. The patients may get no benefit at all from treatment with common antibiotics, which means that they will feel sick for longer, miss more work or household duties, and will probably have to return to their doctor for more time consuming tests and different antibiotics, increasing the costs for the health care system. In severe infections patients may suffer serious complications if the first antibiotic given to them does not work.
"It is very important to track the spread of antibiotic resistant bacteria so that doctors have the information to make a good choice of antibiotic in the early stages of infection before the lab has had time to find out exactly which type of bacteria is causing the infection and which antibiotic they can depend on to work" says Dr Dearbhaile Morris. "ESBL producing bacteria can break down several of the most commonly used antibiotics in clinical practice today so it is important that we know how common they are".
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Article adapted by Medical News Today from original press release.
----------------------------
Source:
Lucy Goodchild
Society for General Microbiology |
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Most people, who cannot take care of their loved ones for one reason or another, generally place them in nursing homes or retirement centers. Another option is Adult Foster Care Homes. . I have worked with elderly in this kind of setting for a large portion of my life. If you are considering an Adult Foster Care Home for your loved one, I want to share with you how to go about finding the best match for your family member.
Adult Foster care homes are private homes that are generally run by an owner/operator and relief help or resident managers and relief help. They provide care that your loved one needs in a one on one family setting. These homes can have five residents at a time and some can also have day care clients too. The care is relaxed, private care in a homely-oriented, friendly atmosphere. Adult Foster Care Homes divide into three classes based on the level of care necessary. Class one takes people who don't require a lot of care. Normally their only need is medication management. Class two is the most popular because they can take people that class one can and also people requiring more care, such as shower assistance and assistance with daily activities like dressing and diet management. Class two homes can also take people in wheelchairs. Some even allow your loved one's pets to live there too. Class three homes take people needing more care, including those who need tube feeding and are bedridden. No matter what class the home is they are all licensed through the state. This means that anyone can call their local senior and disabled division to obtain a list of Adult Foster Care Homes in their area. Now that you have an understanding about how Adult Foster Care works, the following information will assist you to choose the right home for your loved one. First look at the list you obtained from your senior and disabled services and determine whether your loved one would be eligible for class one, two or three. Then write down some questions you might ask on your first call to those homes. I have given you a few ideas listed below. 1. Ask the cost and if the home accept Medicare clients. 2. Is the home owner operated or manager operated? 3. If your loved one has a pet ask if the pet can stay with your loved one. On the flip side if your loved one has allergies you may want to make sure the house has no pets. 4. If your loved one is a private person, you may want to ask if the home has a private room available. 5. If you live out of state or your schedule won't allow you to take your loved one to appointments you should inquire if the home could provide this service. 6. If your loved one is incontinent or maybe they have a tough time walking, a commode by the bedside may be needed ask if that is acceptable. 7. Is your loved one a wanderer? If so you need to know if the house has alarms on the doors. During your phone calls you should also ask any other questions you can think of. Make notes of the answers and put a check mark by the homes that fit your loved ones care needs. Then I suggest that you visit the homes that you have checked. Do this unannounced and take a look at the house, the caregiver, and the other residents. Make notes and put a star by the homes your loved one would feel at home in. For example, if your loved one is active you wouldn't want them in a home where the residents just sit and watch TV. Once you have done that and narrowed your list down, return two more times to the top three homes you have chosen from your list. Make sure these visits are unannounced and at different times of the day. I have you do this because a caregiver needs to be flexible. If he/she can't drop what they're doing and take time for you, then, tell me, how do you think they would handle an emergency situation? Once you have completed all the above, you will have decided which home will work for your loved one. So now it's time for your loved one to see the home. Call the home and ask if they do a day care program. If they say no suggest one. Tell them you would like your loved one to come and stay for an eight-hour period-covering two meals- before you place them in their home. Offer to pay for the day if that's what it takes. I believe this time will ensure that your loved one likes the food, and can get along with the other residents, but most important it will allow the caregiver a chance to make sure he or she can provide adequate care for your loved one. When you pick up your loved one ask the caregiver if they feel like they could provide the care your loved one needs on a long term basis. The last thing you want to do is move your loved one from home to home. If you find that this home will not work complete this step again with the top houses on your list until you find the one that will work. Then it will be time to call the home and let them know that you would like to move your loved one into their facility. The owner will then have you go over some paper work that they are required to do by law, and give you a move in-date for your loved one. I have done care-giving for 28-plus years in many situations. Out of those years the ones I loved the most were the seven years I owned and operated my Adult Foster Care Home. The End (c)Jewel Hughes http://writing-your-life-story.com I work from home: http://findingthegoodstuff.blogspot.com/
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