Who is “ Assisting” at Assisted Living Facilities and…… Is It Enough?




Assisting living facilities are a popular alternative to the traditional nursing home and the number of facilities  opening here in Ohio and around the country are growing fast. But is this tread good for our seniors?  The biggest danger is, are they staffed with enough well-trained personnel? A recent article highlighted this concern.

Hina Shah of the Coalition for a Fair and Equitable Caregiving Industry released a new report that shows the changes needed including

  • mandated staffing ratios,
  • inspections and enforcement, and
  • licensing, including mandatory wage and hour compliance training.

All of this would improve the quality of care for residents and the working conditions of the caregivers.

According to Shah’s report, 53% of the state’s (California) Residential Care Facilities for the Elderly, residents are aged 85 or more years, 40% have Alzheimer’s disease or dementia and 39% have cardiovascular disease.  Nationally, those numbers indicate 40% have Alzheimer’s disease or dementia, and 46% have cardiovascular disease.  I have no doubt Ohio’s numbers are comparable. So these residents need well trained caregivers and enough caregivers to keep the residents safe and cared for.

What working conditions need changed for caregivers?  Ms. Shah’s report highlights some their challenges:

  • Caregivers are understaffed and overworked. Live-in caregivers do not get sufficient sleep because many work in 24-hour shifts;
  • There is a lack of dignity and care. The work is physically demanding and many caregivers succumb to chronic stress, anxiety, loneliness and/or other mental health problems.  Grief counseling when dealing with the death of the resident is rarely provided, if at all;
  • Wage theft. When caregivers are required to work around the clock for a flat rate, many times the hours worked calculates to less than minimum wage; and
  • Miscalculation as independent contractors.

What About Ohio?

The challenge, and in some cultures the privilege, of caring for seniors is something most everyone will face in their lifetime.  So how safe are Ohio’s assisted living and skilled care centers?  Take a look at the Ohio Attorney General’s 2016 Ohio Medicaid Fraud Control Unit report covering the period between July 1, 2015 and June 30, 2016.  As of June 30, 2016, there were a total of 1,333 open investigations.  The highest number of investigations were opened in the categories of Nursing Facilities with 104 open investigations and 97 completed; Personal Care Services Attendant with 153 open investigations and 173 completed; and Home Health Agency with 116 open investigations and 85 completed compared to Assisted Living Facilities with 12 open investigations and 22 completed.  It has been my experience that most cases of neglect happen as a result of not enough staff or inadequately trained staff, so these proposed changes can only improve care for our seniors. The real issue will be can these necessary changes be enacted in the face of a resistant long-term care industry?

Reports like these are scary, for seniors and their  families trying to make difficult placement decisions. But being aware of the fact that good , safe care in assisted living facilities is dependent on well-trained  and sufficient numbers of staff, will give you questions to ask when investigating assisted living facilities

Falls Can Kill — Stay STEADI

Falls can kill — keep seniors STEADIFalling can be deadly for any of us, but especially for people over 65 years of age. The CDC (Centers for Disease Control and Prevention) just issued a report outlining the danger and prevalence of falls in nursing homes and at home.

The numbers are scary: In 2014, falls caused 27,000 deaths and 7 million injuries. About 25 percent of older adults reported falling at least once in the last year.

So, falls are happening to many elderly. But are they just an inevitable part of aging? Not according to this report and a new program the CDC has recently launched.

The new program is called STEADI: Stopping Elderly Accidents, Deaths and Injuries. The program identifies fall risks and interventions to lower the risk of falls for both individuals and practitioners. It also offers education, practice guidelines and materials for practitioners.

For example, the CDC suggests three questions for health practitioners to ask their patients:

  • Have you fallen in the past year?
  • Do you feel unsteady when standing or walking?
  • Do you worry about falling?

People who answer yes to any of these questions face an increased risk for falling, and the CDC recommends further assessment.

Some of the interventions include a review of all the medications a person is taking. Practitioners should eliminate unneeded medications and reduce those that affect balance and cognition. If a vitamin D deficiency exists, adding this vitamin will improve bone, muscle and nerve health.

Falls can be the beginning of the loss of independence — especially for our seniors. So I appreciate these simple efforts to reduce the risk of falls.




Have You Had That Dreaded Conversation With Your Parents?

Discussing senior living is the hardest conversation of allWe’re all grown-ups, right? So why is it still so hard to talk to our aging parents about leaving their homes and moving to senior living?

A recent poll found that 35 percent of respondents most feared speaking to their parents about the need for long-term care or a move to assisted living. This topic even beat out conversations about dying!

Watching our parents age, develop medical problems, lose their mobility, and begin to forget names and conversations is incredibly sad. After all, for so much of our lives, these were our protectors, teachers, and supporters.

But that’s why it’s important to remember our parents are relying on us now. Today is the right time to begin talking about aging and long-term care. And even better, talk about it often — because it isn’t just one conversation.

As for what’s coming next, poll respondents suggested some emerging technology that might help them remain independent as they aged. Their suggestions included smart homes, mobile patient monitoring, artificial intelligence, and even robots! Now that sounds interesting for the future — but don’t put off that hard conversation.




Assisted Living Facilities’ Annual Report Card Will Surprise You

Preventing assisted living fraud and abuseAs healthcare consumers, we rely on the government to protect our loved ones from unscrupulous caregivers. Each year the US Department of Health and Human Services compiles evidence from assisted living facilities across the country. The HHS has recently released its Medicaid Fraud Control Units Fiscal Year 2015 Annual Report. Think of it as an annual report card for assisted living fraud and abuse.

How assisted living facilities across the country fared

The report revealed an increase in criminal convictions. In fact, 2015 saw the highest number of convictions. There were 1,553 criminal convictions reported by all types of facilities studied.

Breaking down convictions according to caregivers

Nearly one third of convictions involved personal care service attendants, who provide most of the hands-on care. The remainder of the convictions were for assisted living fraud. An example of fraud is when caregivers bill for care not given, such as when an assisted living resident temporarily stays in a hospital but continues to receive bills for assisted living services. Almost half of the fraud convictions involved unlicensed providers. The report also highlighted that civil settlements and judgments are slightly down, which was due to a decrease nationally.

How Ohio facilities fared

In 2015 Ohio had 986 open fraud investigations, which resulted in 16 civil settlements or judgement. Of the 432 cases open to investigate abuse or neglect, there were only 27 criminal convictions.

Is it enough?

Based on these numbers, investigations into abuse and neglect are resulting in only a very small fraction of convictions. That is troubling because our seniors can be such a vulnerable population. It makes you wonder if we’re devoting enough resources to investigating claims of abuse in assisting living.

Certainly, requiring assisting living facilities to operate in compliance with federal regulations (like nursing homes must do) would make a good first step. But as I have discussed before, strong and sustained lobbying efforts have so far prevented that much-needed oversight.







Feds Crack Down on Social Media Nursing Home Abuse

cellphoneYour elderly mom probably doesn’t use social media, but what about her caregivers? How do nursing home resident rights come into play online?

As we work to prevent elder abuse in nursing homes, physical harm is the first thing on our minds. But virtual abuse and exploitation can also be devastating. Advocates have been calling for federal regulation updates since last year, when ProPublica and the Washington Post revealed dozens of incidents in which nursing home and assisted living workers shared “embarrassing and dehumanizing” photos and videos of residents.

In response, the U.S. Centers for Medicare & Medicaid Services (CMS) has announced it will begin reviewing nursing homes’ social media policies for their employees. A memo last month (August 2016) informed providers that CMS surveyors will want to see policies that prevent staff from sharing photos or videos that “demean or humiliate a resident” on social media platforms such as Snapchat and Facebook.

“Each nursing home must establish and enforce an environment that encourages individuals to report allegations of abuse without fear of recrimination or intimidation,” the CMS memo reads.

The memo also touches on what can be considered violations of a resident’s rights. Examples include sharing images of nudity and bathing, publishing derogatory statements about residents, or agitating residents to elicit a response.

I look forward to nursing homes establishing more formal procedures for sanctioning employees who make degrading posts about residents on social media platforms. It’s critical for staff to consider the CMS guidance before posting sensitive information, even with the best of intentions.




How Would the Democratic Party Platform Affect Seniors in Nursing Homes?

DNC 2016 - Hillary ClintonLast month, while the Republican National Convention was held right here in Cleveland, I reviewed what the GOP platform had to say about elder care and nursing home laws.

Since then, the Democratic party has released its 2016 platform during its convention in Philadelphia. So I wanted to be sure to take a look at their healthcare priorities as well.

The majority of relevant text was on page 38:

“Our country faces a long-term care crisis that prevents too many seniors and people with disabilities from being able to live with dignity at home or in their communities. The vast majority of people who are aging or living with a disability want to do so at home, but face challenges finding and affording the support they need to do so. Programs that emphasize independence rather than institutionalization must be better structured to support them. Democrats will take steps to strengthen and expand the home care workforce, give seniors and people with disabilities access to quality, affordable long-term care, services, and supports, and ensure that all of these resources are readily available at home or in the community.”

As for taking action on elder abuse and nursing home negligence, the platform stated a commitment to “fighting the immense problem of elder abuse, neglect, and exploitation.” But it gave no further details.

The Democratic platform reaffirmed its commitment to the Affordable Care Act (Obamacare). It also called for pushing back on any Congressional attempt to “privatize, voucherize, or ‘phase out’” Medicare.

I am relieved that both parties are at least discussing long-term care and seniors’ issues in their platforms. These issues hit so close to home for millions of us. So I hope you’ll take a closer look at both documents as you consider how you’ll vote this November.

Image credit: DNC 2016 – Hillary Clinton by JefParker via Wikimedia Commons




Another Call for a Ban on Forced Arbitration

arbitration signatureYet another voice has joined the chorus of consumer advocates, lawyers, and journalists calling for a ban on forced arbitration in nursing home contracts. The editorial board of the New York Times has published a piece titled “Nursing Home Residents Still Vulnerable to Abuse.” In the article, the well-respected paper calls for an all-out ban on pre-dispute nursing home arbitration clauses in admission contracts.

A recent rule update by the Centers for Medicare and Medicaid Services (CMS) prompted the article. The authors believed the CMS didn’t go far enough in banning such unfair agreements. Instead, the rule requires nursing homes only to disclose such clauses (they usually bury arbitration clauses deep in multipage admission contracts). It also prohibits nursing homes from making these clauses a condition of admission.

I agree with the NYT that this rule update does not go far enough. Nursing home residents and their families are particularly vulnerable when a loved one faces admission to a nursing home. The editorial board called on the White House to invoke an all-out ban if the rule passes.

The NYT makes a powerful argument that such clauses amount to abuse. And that’s why a ban is necessary to protect families. It is my hope that with enough pressure from the media, consumer groups, lawyers, and families, these clauses will be banned for good.





How Would the GOP Platform Affect Seniors in Nursing Homes?

Cleveland Convention Center

This year’s Republican National Convention has drawn quite the spotlight to Cleveland, and it has been very exciting… so far! My office is just a few blocks away from the downtown convention center, and it’s rare to step outside without encountering visitors dressed in red, white, and blue; or local, national, or international press; not to mention all the street closures.

Now this is suppose to be about politics and policy — right? Policy news has started to emerge from the convention. The GOP released its 2016 platform on Monday. The 66-page document discusses healthcare priorities from several angles. This includes a paragraph on page 37 about senior care and nursing home laws:

“Our aging population must have access to safe and affordable care. Because most seniors desire to age at home, we will make homecare a priority in public policy and will implement programs to protect against elder abuse.”

Now that sounds good, but how to make that happen for seniors will be the real news. The 2016 platform also includes plans to stop advancement of the Affordable Care Act, as well as a call to preserve Medicare and Medicaid while reining in spending “before they consume most of the federal budget.” I will be particularly interested to see details about meaningful action on elder abuse and nursing negligence both in homes and in facilities.

Soon we’ll have a chance to see what the Democratic platform says about nursing home laws and the ACA (Obamacare). Until then, please keep Cleveland and Ohio in your thoughts during the RNC.


Image credit: Cleveland Convention Center by Michael Barera (CC BY-SA 4.0), via Wikimedia Commons




Hotel Room Rates at Your Local Nursing Home!

HotelI am taking a detour from one of our regular topics of nursing negligence in long-term care to comment on an interesting news item about nursing home costs.

It probably is no surprise that the cost of long-term care is on the rise, but the numbers might surprise you. It might be cheaper to check into a hotel and order room service than to check into a nursing home.

Hold on to your seat, or your wallet — the average cost of a private nursing home room was $92,376 per year or $7,698 per month. Meanwhile a semi-private room was $82,128 per year or $6844 per month. These rates increased by 2.27% and 1.24% respectively, according to Genworth’s 13th annual Cost of Care Study, released this week.

Ohioans, are you interested in what that means here in the land of Buckeyes? The study has a neat calculator which breaks down nursing home costs per state and region within our state. Northeastern Ohio costs are $250 per day for a private room in a nursing home or $230 per day for semi-private (annually that is $91,250 and $83,950).

Both interesting and alarming is the increase in assisted living costs, which saw a 4% increase to $47,700 annually. So how does that compare to the costs of keeping our seniors in their homes? This approach costs about half of what a nursing home charges: a home health aide costs $46,332 annually. And certainly keeping seniors in their homes is what most would prefer. The study found that costs in the Northeast were higher than the Southeast.

If only these rising rates came with improved care, maybe the higher price tags would yield a better value.


Nursing Home Residents May Be Both Victims and Perpetrators of Elder Abuse

2016-06 man hallwayTraditional efforts to prevent nursing home abuse have focused on the nursing staff. Lawmakers have considered reforming all kinds of staffing practices, from background checks and training to data collection. But a new study finds that we should be just as concerned about elder abuse by roommates and neighbors. At least one in five seniors living in nursing homes has experienced some sort of abuse at the hands of another resident.

The most common resident-on-resident abusive events included verbal mistreatment, menacing gestures, and physical violence. More than 20 percent of the 2,011 residents in the study said they’d experienced at least one abusive event in just the past month.

What’s worse, the risk of abuse was greater in residents with cognitive or memory impairments — the very people least able to defend themselves or report their concerns. Higher incidents of abuse were also correlated with higher nurse aide caseload.

The authors advocate for better protection for residents. They suggest healthcare providers should avoid convenient but harsh interventions like sedation or restraint. Instead, they should look into ways that technology like cameras and data collection can help measure and prevent abuse.

The study was released last week (June 14) in Annals of Internal Medicine. To learn more about elder abuse by roommates and peers, read the editorial article that accompanied the study. Or find out how you can take action on elder abuse in Ohio.


Page 1 of 3123