Every year the Long Term Care Community Coalition (LTCCC), a nonprofit that monitors nursing homes and assisted living facilities, publishes a report card on the previous year’s performance of the various government entities charged with protecting New Yorkers who rely on long term care services.
LTCCC just released its report for 2010, with mixed findings. LTCCC was impressed with the aggressiveness of New York State Attorney General’s Office (A), Office for the Aging (A-) and Medicaid Inspector General (A) in combating nursing home neglect and abuse.
LTCCC found that both the State Senate (D-) and State Assembly (C) were essentially useless. The Department of Health (DOH) received a passable (B-) regarding its responsibilities for ensuring nursing home quality and safety. The CMS (Federal Medicare) received a C.
The report card is based on a number of factors, including assessments throughout the year of actions taken (or the failure to take action) by the government entities on consumer issues that fall within their purview, results from our meetings and direct communications with government officials, research on specific issues that we have identified as important to consumer care in the course of the year and input from LTCCC’s members.
NYS Attorney General MFCU: A The Medicaid Fraud Control Unit (MFCU) of the NY Attorney General’s office continued to work diligently and aggressively to investigate nursing home abuse and neglect. LTCCC examined six cases patient abuse cases, not substantiated by DOH, where MFCU convicted a number of CNAs, LPNs and an admission coordinator in a court of law of patient abuse, neglect or mistreatment.
One case involved a nursing home aide who pushed a resident from a chair to the floor, grabbed him by his shirt, pushed him up and down on the floor, while yelling at him and calling racial slurs at the resident. He then picked him up off the floor, threw him on the bed, put his right knee on the resident’s back, pulling his shoulder back while continuing to shout at him. The other cases were just as egregious.
In another case where the DOH failed to substantiate a case of alleged sexual abuse, MFCU obtained a conviction and the individual received ten years probation and was ordered to register as a level 2 sex offender.
NYS Office for the Aging: A- LTCCC applauded SOFA’s focus on empowering seniors. SOFA’s website now includes a new section on community empowerment. SOFA was one of 12 state agencies recently awarded a Lifespan Respite Program grant from the U.S. Administration on Aging. The federal grant will be used to develop and enhance coordinated, accessible, community-based respite care programs for caregivers (family, friends and neighbors) regardless of age.
In addition, SOFA won a number of federal grants to provide long term care options counseling, to help individuals at risk of being admitted to a nursing home to remain at home, to develop a consumer directed option for home-based services, and to participate in the Veteran’s Directed Home and Community-based Service Program.
A new law passed in 2010, introduced as an Office for Aging departmental bill, requires a public utility company or municipality that intends to discontinue services to a multiple dwelling to notify the State Ombudsman if the multiple dwelling is a residential health care facility, adult care facility or assisted living residence. But LTCCC was troubled that New York City still does not have a New York Connects program, helping people in the City identify and access the services they need whether in their homes, communities or a residential setting. Almost every other region has had a functioning NY Connects program for its residents, and this is the fifth program year for NY Connects.
NYS Medicaid Inspector General (OMIG): A New York has led – and continues to lead – the nation in identifying and recovering improper Medicaid payments. OMIG conducted 10 investigations this past year into allegations of both quality problems and financial improprieties at nursing homes.
One case will be referred to the OAG; and another found significant patient care deficiencies that resulted in an OMIG report and a requirement to develop a plan of correction. In this case, OMIG found immediate jeopardy: poor care for residents with major pressure ulcers; residents denied pain medication; and residents not receiving appropriate follow up care by their physicians.
Underway is an OMIG project that is crucial to New York’s nursing home residents, a review of the usage of atypical antipsychotics in New York State nursing homes. There have been no results to date.
NYS Department of Health (DOH): B- Inspection and Enforcement: The number of homes identified by the DOH as putting their residents in immediate jeopardy went down from 43 in 2009 to 33 in 2010. In addition, the number of state and federal fines dropped slightly from 103 to 99 (though the amount fined increased from $1,413,183 to 1,456,245).
The number of homes receiving other actions such as state monitoring, directed plans of correction, etc… was down again this year from 58 to 51. LTCCC does not believe that this means care is improving but rather that inspectors still have problems identifying deficiencies. Importantly, DOH applied, and was accepted to become one of the states to use the new Quality Indicator Survey (QIS). This new process uses 162 quality indicators and focuses on resident, family and staff interviews, past deficiencies and complaints.
Resident samples will be increased and every surveyor will use a Data Collection Tool (DCT) tablet PC to enter information. This new system began in August 2010. The substantiation rate of complaints has improved to 15.6 percent, up from 13 percent last year.
The DOH was supportive of an LTCCC initiative to amend the Patient Abuse Law that would permit DOH to analyze why they did not substantiate an abuse complaint and whether they should change how they determine whether a witness is credible.
Nursing Home Quality Improvement: DOH took the lead to develop a patient safety/quality improvement project, launched in 2010, to lower the number of pressure ulcers across the entire continuum of care: The Gold STAMP (Success Through Assessment, Management and Prevention) Program to Reduce Pressure Ulcers in New York State. The uniqueness of this project lies in its attempt to promote collaboration and communication within and throughout the continuum of care related to pressure ulcer assessment, management and prevention.
Nursing Home Reimbursement: LTCCC is pleased that DOH staff continued to be very supportive of the quality pools concept for nursing homes and very responsive to LTCCC’s suggestions about the nursing home reimbursement modifications, agreeing to work to require nursing homes to document expenditure of any add-ons to the rates for dementia and bariatric residents.
NYS Senate: D-; NYS Assembly: C LTCCC faulted the Legislature for not rewarding quality and setting more rigorous staffing standards at nursing homes. Â This year the Senate received an even lower grade than last year. They listened to the lobbying of the nursing home industry and killed the quality pool initiative for the year. Â The quality pool initiative would tie higher payment to better outcomes for $50 million of $6 billion of the state’s nursing home annual reimbursement. The group also faulted the Legislature for not supporting more rigorous nursing home staffing standards. Many nursing homes have one or two nurse’s aides for an entire floor or wing of a nursing home. The Assembly was also described as being moribund.
Both houses got credit for passing the Family Decision Making Law and the End of Life Counseling Bill. The End of Life Counseling bill requires physicians and nurse practitioners to inform terminally ill patients of options including hospice, aggressive pain management and palliative care.
CMS: C CMS is responsible for ensuring that the state conducts effective and comprehensive oversight. CMS drafted strong draft rules to implement the health care reform law in relation to civil monetary penalties.
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