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My thanks to a CNA from Arkansas who shared following about the overwhelming burden of nursing home work. We applaud her courage for speaking out and sharing her story! Out of a sense of social justice, changes must come to the nursing home industry. The voices of persons who, like this CNA, know from the inside about the problems within the nursing home industry, can help lead to significant changes when their story is shared. We are glad to share her story, as painful as it is (on many levels)…

“I’m a Certified Nursing Assistant (CNA) with 10 years of experience. I love helping people and that is why I picked this career.

I’ve only worked in nursing homes and have to say everyone of them had staffing problems. I’m always exhausted by the end of my shift and yet I’m not even 30 years old. Many days I feel like I’m one of the older people I take care of. This job has worn me down: I have chronic lower back pain along with arthritis in my back.

I’m a struggling single mom with hopefully many years ahead of me. But when anyone tells me they are thinking of being a CAN, I tell them don’t do it! The nursing homes don’t care about how they work the CNAs and the nurses seem to only know how to put more work on you. This is a bad business to get into if you value your back and knees, not to mention the employment benefits are almost non-existent. After a decade of working as a CNA in Arkansas I only make $9.00 a hour!

Arkansas desperately needs to change state regulations regarding nursing home staffing levels! If things don’t change in a big way and soon there will be no CNAs to take care of anyone because most of us are injured or just plain worn out! The past generations of CNAs just took the crap, while this generation knows change has to be made. I can’t keep quiet and do my job anymore it is literally killing me from the inside out.”

A CNA (most of them are females) in Arkansas who has a decade of experience is making $9.00 per hour, while the CEO’s of many for-profit nursing home corporations (many of which are men) are easily earning over $1 million per year! This is criminal, not to mention obscene. Oh yeah, and more than a little bit sexist!

If you are a resident of Kentucky, this urgent request is for you! Nursing homes in the Commonwealth are again attempting to obtain special protections from being sued. They will do anything to protect their billion-dollar industry from being held accountable, and Kentucky Senate Bill 6 is this year’s attempt to shield themselves from being held financially accountable for abuse and neglect of the residents entrusted to their care! SHAME on these greedy corporations and the Corporate Whores who protect them by their lobbying efforts!

UPDATE: Senate Bill 6 PASSED last week (early February) in the Kentucky Senate Health & Welfare Committee. Thankfully it looks to be headed for defeat AGAIN in the Kentucky House! But to assure it’s defeat in the House (so it can’t be signed into law by the Governor), your helps is STILL NEEDED: Please contact your Kentucky State Representative! They NEED to know your thoughts NOW on the proposed legislation dealing with this important matter! Ask your legislator today to vote NO on Senate Bill 6. You can follow this link to find your senator if you don’t know who your senator and representative are: http://www.lrc.ky.gov/whoswho/county.htm Once you know their names, call the Capital Annex and leave a message for him/her at 502-564-8100. Again: VOTE NO ON SENATE BILL 6 — because nursing homes are not entitled to special rights!

What you dear readers write offers some of the most compelling reasons to not trust the nursing home industry. I thought my late mother had it bad, but your loved ones (and you as a family member of a nursing home resident) have also truly suffered! What follows is the heart-wrenching account involving a lady who passed away while a nursing home resident in Texas. A grieving daughter shares…

R.I.P. Dear Texas Lady

R.I.P. Dear Texas Lady

“I went to visit my mother on Sunday February 16, 2014. I was stopped by a nursing home employee who worked on the hallway where my lived. She told me that my mother was no longer there. At first I thought she meant they moved her to a different room. Then I was getting upset because I thought she had been sent to the hospital without myself or any of my siblings being notified. The employee informed me that my mother had passed away!

I am so hurt and angry! My brother (who had arrived by this time) asked a supervisor why we hadn’t been notified of our mother being sent to the hospital or even of her passing? His excuse was they did not have the correct contact information. This was not true at all since just one month before (in mid-January) my family had a meeting with the nursing home administrator and my mother’s doctor. During this meeting my phone number and the phone numbers of all of my brothers had been shared and verified. If nursing home staff would have looked through my mother’s chart they would have found my number (and the numbers of all of her other children)!

When we asked nursing home staff where our mother’s body had been taken and where we could find her belongings, we were told they could not tell us. They said her chart and belongings were locked up and we would have to wait until the next morning to even find out what hospital they sent my mother to!

What we found on our own, without the help of the nursing home staff, was that instead of sending out my mother to a hospital just a 15 minutes drive from the nursing home, they sent her to a hospital that was nearly a 40 minute drive. It turned out that our mother had been admitted to a hospital two weeks prior to discovering she had passed away! Two weeks and NO word from the nursing home about her need to be hospitalized! She passed away five hours after she was transferred from the nursing home to the hospital.

I will never get closure from this. I will never get to tell my mother goodbye. My mother died alone. My mother had family and children that loved and adored her. We need answers and justice.”

I’m sitting at my desk sobbing while I read what I just posted. If this doesn’t make you angry at the outrageous injustice that nursing homes in this country get away with regularly I don’t know what will! Texas, where this lady passed away, has a state law making it almost impossible to sue nursing homes. Several state legislatures are currently considering such heinous laws. Nursing homes mush be held accountable for their evil and laws to protect them from accountability should never see the light of day.

agendaNearly every state’s legislature begins their 2014 session this month. So January is the appropriate month to offer my five point agenda for nursing home reform. I believe that these five points can, at a reasonable cost to taxpayers and to nursing homes, help improve the quality of the care provided to residents.

Suggestion #1: Have each state mandate an INCREASE in the percentage of inspections (commonly referred to as “surveys’) that MUST take place outside of regular business hours on weekdays. This standard should apply to both annual inspections (inspections the state conducts approximately once each year at all licensed nursing homes) as well as to surprise inspections (these are inspections that take place in response to complaints the state receives about a particular nursing home.

In most states a minimum of 10% of nursing home annual inspections must begin at night or on the weekend. That means that 90% of inspections are likely done during 23% of time that accounts for regular weekday business hours. I believe that if state law would mandate a minimum of 25% – 33% of inspections begin on weekends and during hours when administrators are not normally at work the inspectors would get a more accurate view of the low quality of care that goes on in nursing homes on weekends, 2nd and 3rd shift and on holidays — the times when administrators are rarely on the job.

As a family member of a nursing home resident, it was “after hours” that my mother experienced the worst neglect by her caregivers. These are the hours when staffing levels are usually at their lowest and when management isn’t present to see for themselves what’s going on.

Suggestion #2: Require management personnel to work staggered shits ALL THE TIME, not just when state inspectors are in their building. In large facilities that have an Assistant Administrator (or equivalent position), the state should mandate that the Administrator and their assistant must not be allowed to work identical shifts. I believe the state should require that the shifts for management can not overlap more than four hours per day (Example: Administrator works 8:00am – 4:30pm, while the Assistant Administrator is scheduled to work 12:30pm – 9:00pm).

The majority of nursing homes are too small to be able to afford an Assistant Administrator. Yet even these facilities MUST have a full-time Director of Nursing on staff. In these nursing homes the same “staggered shifts” rule should be in place for the Administrator and Director of Nursing.

Why suggest this legislative mandate? For much of the same reason that I made my first suggestion: after management is out of the building the quality of care given often suffers. As the cliche goes, “When the cat is away, the mouse will play!” And “play” they often do (e.g., taking excessive smoke breaks, ignoring call lights, talking on their personal cell phone instead of checking on or responding to their residents). One third shift nursing staff member at an Indiana facility where my mother lived admitted to me that she “preferred” to work overnight so “the big shots” couldn’t get in her way of doing her job the way she wanted to do it. Scary! One of CNAs who worked with this individual on third shift shared with me that this nurse took an average of seven (7) smoke breaks — OFF THE UNIT — PER HOUR! This clearly would not be allowed by either the state inspectors or sane nursing home management — but how could the state or management know this was problem existed if they aren’t in the building at at times other than when management is in the building? Residents with dementia are likely incapable of reporting such problems. Family members can’t stay with their loved one 24’7 non-stop to monitor the situations. Placement of a “Granny Cam” inside the room is incapable of documenting problems that take place outside of the resident’s rooms (example: documenting a lack of staffing at the nurse’s station caused by staff taking an excessive number of smoke breaks).

If it is impossible to have management in the building 24/7, then the state should mandate their presence a minimum of 12 hours per day on non-holiday weekdays and 4 hours (or more) per day on holidays and weekends.

Suggestion #3: When the state shows up for an any type of inspection (annual or in response to a complaint) the inspectors (a/k/a “surveyors”) should IMMEDIATELY seize payroll data (before it can be altered) to verify staffing levels for the 14 continuous days immediately prior to the inspection. With this information in hand, inspectors should have the legal authority to insist that while they are in the building that the staffing level can NOT exceed the average staffing level for the previous 14 days.

Why do I believe this issue requires a legislative intervention? Because calling in off-duty nursing staff during an inspection or even bringing in temporary employees is one of the biggest (and most deceptive) things nursing home management does to make it appear that resident needs are being taken care of in a timely and appropriate manner — when the reality is that they aren’t being responded to in either a timely and/or appropriate manner when the state inspectors are not around. “Putting on a show” for state inspectors should be against the law! Inspectors should see and judge the quality of care based on the REALITY of ACTUAL staffing levels.

Suggestion #4: Pass legislation that prohibits nursing homes from either outright banning or limiting visits of residents by their family and friends. Once  nursing home staff identify a resident’s family member(s) or friend(s) as a “trouble maker” (e.g., that we really have the courage to report their facility to the state, as is our LEGAL RIGHT AND MORAL RESPONSIBILITY TO DO) then you can count on the facility to begin devising schemes to make it look appear that we are the bad guy, thus justifying prohibiting (or at least limiting) our visits. Some facilities have even limited visits from family and friends from taking place on the unit where the resident resides — allowing, for instance, visits to only take place in the lobby. This way family and friends can’t observe the substandard care the resident is receiving, thus preventing them from being able to observe (and thus report to the state) problems with care.

Attempts to prevent family and friends from visiting nursing home residents (when no harm is being caused to the resident as the result of the visit and when the resident wants to receive visits from such individuals) is clearly a violation of nursing home resident’s civil rights! We activists must get through to these corrupt nursing home owners and managers that their facility is the HOME of the resident and therefore the SAME rights of visitation residents had at their house, apartment on condo apply inside the nursing home facilityStrongly worded legislation is clearly the only hope we have to prevent nursing homes from taking their residents hostage!

Suggestion #5: We need legislation that will mandate increased fines against nursing homes that are found guilty of abusing resident’s rights, especially with regard to forcing residents to move to another facility. Many nursing home residents find themselves being forced out of their facility as retaliation against the resident or their family for sticking up for their rights. This type of abuse of resident’s rights must stop! It is truly a twisted, dysfunctional way of thinking when a nursing home’s only way of handling it’s problems is to punish their residents (or the resident’s family) by forcing the resident to leave their facility. How many residents must suffer “eviction” before a facility is finally forced to look inside itself and make the changes needed to resolve their real problems?

How can you help to make these five changes happen within the state where you reside? Contacting your state legislators would be a good start. Also request the support of your local or state Long-Term Care Ombudsman to help promote this reform agenda. If your area or state doesn’t have a nursing home reform organization then start one! I’ll be glad to help you start and promote such an organization.

I believe that together we CAN make meaningful, important and positive changes take place within the nursing home industry. While the industry clearly has the big bucks to spend on maintaining the status quo, we have more than enough individuals on our side to make change HAPPEN!

Many of us family members of nursing home residents have been told one (or many) lies by nursing home administrators and/or other staff members. What ever became of honesty? Whatever became of ethical behavior? Whatever became of honest chart notes? Whatever became of telling the truth at all costs? These virtues have long disappeared from most nursing homes when it comes to employee behavior.

Some of the lies we’ve heard are fairly subtle, like when you call your loved one’s nurses station and the first thing out of the mouth of the nurse who answers the phone is a line like, “I just came from your mother’s room and she is doing really well!” Did the nurse really just leave your parent’s room just before you called to check on them? Probably not. If they did that would be great. But if they didn’t? That would be a lie.

I can’t tell you how many times nursing home Administrators, Directors of Nursing and Nurses — even one nursing home owner — promised to fix a problem I had pointed out. Only to NOT have fixed the problem or to have only managed to fix the concern for a few days or a few weeks before the problem returned. Wow. These folks know how to tell us what they believe we want to hear, but what about the follow through? Nothing like the line I’ve heard many times from Administrators that goes, “Well I can’t fix a problem if I don’t know it exists.” Really. OK, I told you. The problem either didn’t get fixed or didn’t stay fixed. Yeah, I can really trust you. Not!

womantakingwrittennotesSo what can be done to confront the nursing home employees who lie? Probably the best thing we can do is DOCUMENT, DOCUMENT, DOCUMENT! Yes, it will take work and a little money to accomplish proper documentation (the cost of one or more notebooks and the cost of an ink pen), but these investments are well worth it if/when the time comes to call in the state to deal with a problem that doesn’t get fixed (a problem they promised — or promised repeatedly — to fix). When you call the state you’ll need to refer to your notes to establish that the problem was called to the attention of nursing home staff. You’ll need to verify how long the problem has been going on and the times and dates you informed nursing home staff about the problem.

Summary: Good nursing home documentation regarding care concerns should always include 1) a description of the problem, 2) the name/position of who you spoke to about the problem (You don’t know their name? Ask them for their name! Many states require that all caregivers wear a name tag at all times they are on duty. If they aren’t wearing a name tag, report that as well!), 3) when (day and time) you spoke to nursing home staff about the situation (EACH time you speak to staff about your concern) and 4) a summary of the response from nursing home staff to the information you shared.

Suggestion: While you may want to save your documentation on a digital device (e.g., a computer, tablet or a digital voice recorder), remember that data stored on any device can be lost! So if you use any sort of digital device to make a record of your documentation, be sure to PRINT OUT EVERY BIT OF YOUR DOCUMENTATION and KEEP IT IN A SAFE PLACE in case you lose your digital data!

Another important reason to DOCUMENT, DOCUMENT, DOCUMENT your conversations with nursing home management and staff goes back to the subject line of this journal entry: these people don’t tend to be oozing with honesty! So covering your tracks (and your conversations) when dealing with nursing home staff is in your best interest.

I know personally of occasions when a nursing home Administrator and a Director of Nursing LIED in their notes about what either I had told them and/or what they told me! I had a decent memory to be able to defend myself, but I really wish I would’ve had good written notes to better be able to defend myself. I know nursing home management constantly document their conversations with family members, friends and their own staff. With our own documentation available we can rest assured that one honest record of what happened will exist!

Are all nursing home staff members (or owners) pathological liars? Of course not. Many are honest individuals. Some lie only because they know that their bosses expect them to lie in order to protect the facility from lawsuits, state inspections, fines imposed by the state and other sanctions. Kudos to the brave nursing home staff members who have told the truth and paid the consequences for being honest — often times losing their job. An industry that rewards liars and persecutes honest people is in serious need for major reform!

As a resident of Kentucky committed to nursing home reform, I was thrilled when our 2013 legislative session ended a few weeks ago without passing Senate Bill 9. The bill’s intention was to make it much more difficult to sue nursing homes by mandating that a panel of three physicians would have to, by majority vote, approve of the merits of a lawsuit against a nursing home before it could tried in court.

Most nursing homes in Kentucky are owned by for-profit corporations. Most hospitals in Kentucky and owned by non-profit corporations. Kentucky’s hospitals have never sought such protection. So it’s obvious what this dysfunctional bill was all about: protecting nursing home profits. With a smaller profit margin nursing home bosses like Kindred President & CEO Paul Diaz might not be able to make an obscenely huge salary of over $6.4 MILLION like he did during 2012. This is all the more an obscene situation when you consider how cheaply Kindred and other nursing home giants run their facilities — meaning they don’t provide adequate staffing to care for their residents and the front-line caregivers are woefully underpaid, many not even having health insurance as part of their compensation.

While Senate Bill 9 passed in the Kentucky Senate, thankfully it never received a hearing in the House Health & Welfare Committee, so it couldn’t up for a vote by the House. While the fact that this bill was able to pass in the Senate is disturbing, yet it points out a reality that the nursing home industry needs to face: No matter how much money they spend to buy legislator’s votes to support such a bill and to run deceptive commercials to promote their agenda to the public, they do NOT have the truth or decency on their side. Thankfully, so far at least when it comes to Senate Bill 9, all of their money and lies could not force their hideous agenda on nursing home residents. Truth won. Greed lost. Amen.

I want to offer a few reminders about this blog…

– As I’ve mentioned before, I’m very familiar with how nursing homes operate in Kentucky and Indiana, due to my late mother’s experiences in facilities located in both of these states. But I never claimed to be knowledgeable about nursing home rules and regulations in any other states.

— Since I’m not an attorney, nor am I employed by any government agency that regulates nursing homes I ask that you do not contact me for help resolving a problem with any nursing home, especially if they aren’t located in either Kentucky or Indiana. Instead, I urge you to focus on contacting either your local long-term care ombudsman and/or the agency that regulates nursing home in your state (the agency name varies from state to state, but this is information you can find at your local library or from your state legislators). These are the people you need to contact. With access to Google and other Internet search engines, you can likely find their contact information quite easily. If you can’t find the information online, then (as mentioned previously) contact your local library and/or state legislator for this information. In both Kentucky and Indiana all nursing homes MUST (as a matter of law and/or regulation) provide anyone who asks (resident, family member or friend) for their

– While I do publish from time to time comments readers leave on this blog having to do with nursing home problems they’ve experienced, please remember that I reserve the right to edit your comments. I edit these comments to protect the identity of the nursing home resident, the author of the comment and I never include the name of the facility involved. Given the tendency for nursing homes to retaliate against residents and their friends and families, it should be obvious why this information is omitted. I also don’t feel comfortable naming a nursing home accused of neglect or abuse of their residents unless this is a matter of public record (e.g., it involves a situation that has been the subject of a lawsuit).

Please DO keep share your story with me and with our readers! I believe it is therapeutic to share the horror of one’s stories with others and it is helpful for others to be reminded they are not alone and that others have faced the same nursing home crap they have!

Remember: Truth Won. Greed Lost. If it can happen in Kentucky (and it did during our 2013 legislative session) it can also happen in your corner of the world!

A visitor to this blog shared the following comment a few days ago. I think her comment speaks directly to the issue of corporate greed and that leads to both the neglect of nursing home residents as well as mistreatment of nursing staff. A nurse wrote:

“At one time I worked in a nursing home that was so understaffed that I dreaded work every day. I provided care to 24 residents at one time (on a unit with a total of 48 residents). On my shift there were just two CNAs and two nurses for 48 residents.

One time I was forced to work while having the flu and a 102 degree fever. Management told me that I would be fired if I didn’t report to work and they would demand the state revoke my licence for abandonment. It is really sad what happens in these nursing homes.”

Many important issues are touched on here.

  1. Clearly nursing home management had NO regard for the residents by insisting that a staff member with a fever of 102 and a diagnosis of the flu report to work — or else! True, most all nursing home residents are given a flu vaccine shot each year, but that is NO guarantee of protection from every strain of the flu. Given the severe health problems most nursing home residents have in the first place, the last thing that needs to happen is for them to be exposed to the flu! The flu can be deadly for elderly persons and others who suffer from serious health problems.
  2. Clearly nursing home management had NO respect for their staff member in this case. Someone sick with the flu, without question, should be allowed to stay home from work. Nurses and all caregivers have a RIGHT to take care of themselves and their health!
  3. Clearly nursing home management ignored their option to bring out one (or more, if needed) temporary employee(s) to cover the shift(s) of the nurse sick with the flu — assuming no other qualified staff members were available to cover her shift(s). Oh wait, temporary employment agencies charge for providing staff. Which means that would be a threat to the bottom line for the nursing home involved in this situation! We certainly have greed taking priority over respecting the health of residents and treating their nursing staff with dignity! Indeed GREED MUST ALWAYS rule the day with the nursing home industry! Sad. Truly sad.
  4. One nurse and one CNA per shift for 24 nursing home residents. Do the math: how many minutes PER RESIDENT can the nursing staff provide EACH resident over the course of an 8 hour shift? When I do the math it comes out to 20 minutes per resident/per staff member. Generous? Hardly! Especially considering how much time is spent by both nurses and CNAs to do things like clean up messes caused by sick residents (including helping a resident change out of soiled clothing and changing  bed clothing), taking infirm residents to and from the bathroom, giving showers, serving food and feeding infirm residents, preparing medications, etc. — on top of doing all of the paperwork required to document resident care!
  5. One nurse and CNA per 12 residents would be able to provide a lot better quality of care than one each per 48 residents, don’t you think? Remember most CNAs barely earn above minimum wage and many don’t work enough hours to qualify for health insurance or other company benefits! So nursing homes can’t afford to hire more CNAs yet the owners, administrators and other management people (who never — or hardly ever — provide direct resident care make five, six-or-more-figure annual salaries! It isn’t fair. It isn’t just. The priorities regarding financial compensation for staff are all wrong!

Some people who read this blog assume that I am against nurses and CNAs who care for nursing home residents. I have no respect or use for staff who abuse and/or neglect the residents charged to their care. At the same time, I would never assume that most or all nurses abuse of neglect their residents. No, the real evil here clearly goes back to ownership and management. The fault for corporate greed begins and ends with them.

We know that abuse and neglect of nursing home residents is all too common. Make no mistake that nursing home management and ownership routinely psychologically abuse both the residents and family members of residents who confront abuse, neglect and other problems (including fraudulent billing) that takes place!

One such family member of a nursing home resident who has visited this blog wrote the following earlier today, “I just got a copy of a bill submitted to Medicare for $8,000 worth of therapies never done for my father by nursing home staff. Their fraudulent billing was so bold as to list therapies done on CHRISTMAS, a day when he was asleep 95% of the day!” When confronted by the family member, what did the nursing home’s administrator do? The family member continues, When I disputed the bill, the administrator told me perhaps it was time to move my father!”

THIS TYPE OF PSYCHOLOGICAL RETALIATION MUST STOP!!! It is NOT a crime or a bad thing to confront fraudulent nursing home billing! It is NOT fair to retaliate against a nursing home resident because their family member points out a legitimate problem! It is NEVER wrong to point out possible insurance fraud!

How is suggesting moving a family member to another nursing home a type of “psychological retaliation”? Because it is NOT in any way, shape or form an appropriate suggestion. Claims of possible fraudulent billing by a family member (or resident) isn’t something that should cause a nursing home administrator to even suggest a resident should be moved. The problem is the FRAUD committed by the facility and NOT reporting the possible fraud! The “sub-text” of this type of “suggestion” is actually a THREAT to involuntarily FORCE a resident to be moved as a way to punish the person concerned about fraudulent billing. Involuntary discharge from a nursing home because a resident or their family member reports possible fraud is ILLEGAL. Nursing homes are masterful in how they can cook up FALSE reasons (through lies and false charting of resident information) to make it appear that involuntary discharge is for legal reasons. Think of the stress inflicted upon the resident and/or family member to have to defend themselves against false claims. Think of the stress caused a family member when a nursing home resident, for no good reason, is forced to move to a different facility — some residents end up being moved literally hundreds of miles from their family member in order to find a facility that takes Medicare payment that will accept the resident. It isn’t easy to place a resident when the discharging facility has falsely documented problems about the resident in order to justify kicking them out.

If possible insurance fraud involves Medicare, as in the case of this reader, the official Medicare website (www.medicare.gov) offers the following information about how to report fraud

First, if you even suspect that Medicare is being charged for a service or supply that wasn’t provided your loved one (or a friend, or yourself), call toll-free 1-800-MEDICARE.

It will help to have the following information handy at the time you report fraud:

  • The provider’s name and any identifying number you may have.
  • The service or item you’re questioning.
  • The date the service or item was supposedly given or delivered.
  • The payment amount approved and paid by Medicare.
  • The name and Medicare number of the person the service or supplies were alegedly provided to.
  • The reason you think Medicare shouldn’t have paid.
  • Any other information you have showing why Medicare shouldn’t have paid for a service or item

Under certain circumstances fighting Medicare fraud can pay up to $1,000! You may be eligible for a reward of up to $1,000 if all of these 5 conditions are met:

  1. You report the suspected Medicare fraud. The allegation must be specific, not general.
  2. The suspected Medicare fraud you report must be confirmed as potential fraud by the Program Safeguard Contractor, the Zone Program Integrity Contractor, or the Medicare Drug Integrity Contractor (the Medicare contractors responsible for investigating potential fraud and abuse) and formally referred as part of a case by one of the contractors to the Office of Inspector General for further investigation.
  3. You aren’t an “excluded individual.” (Example: You didn’t participate in the fraud offense being reported. Or, there isn’t another reward that you qualify for under another government program).
  4. The person or organization you’re reporting isn’t already under investigation by law enforcement.
  5. Your report leads directly to the recovery of at least $100 of Medicare money. The incentive reward can’t exceed 10% of the overpayments recovered in the case or $1,000, whichever is less. If multiple individuals qualify for a reward, the reward is shared among them.

If you want to know more about Medicare’s Incentive Reward Program, call toll-free 1-800-MEDICARE.

My prayer is that nursing home residents and their family members may never again be subjected to psychological abuse in retaliation for telling the truth.

Nearly every state’s legislature will begin their 2013 session this month. So January is the appropriate month to offer my five point agenda for nursing home reform. My hope is that state nursing home reform groups and individuals concerned with nursing home problems will lobby their legislators about these matters. My belief is that these five points can, at a reasonable cost to taxpayers and to nursing homes, help improve the quality of the care provided to residents.

Suggestion #1: Have each state mandate an INCREASE in the percentage of inspections (more frequently known as “surveys’) that MUST take place outside of regular business hours on weekdays. This standard should apply to both annual inspections (inspections the state conducts approximately once each year at all licensed nursing homes) as well as to surprise inspections (these are inspections that take place in response to complaints the state receives about a particular nursing home.

In many states at least 10% of nursing home inspections must begin at night or on the weekend. That means that 90% of inspections are likely done during 23% of time that accounts for regular weekday business hours. I believe that if state law would mandate a minimum of 25% – 33% of inspections begin on weekends and during hours when administrators are not normally at work the inspectors would get a more accurate view of the low quality of care that goes on in nursing homes on weekends, 2nd and 3rd shift and on holidays — the times when administrators are rarely on the job. As a family member of a nursing home resident, it was “after hours” that my mother experienced the worst neglect by her caregivers. These are the hours when the staffing levels are usually at their lowest and when management isn’t present to see for themselves what’s going on.

Inspections that take place during weekday first shift hours get a skewed picture of the care being offered. When nursing home owners and management get the message that the state CAN and WILL be showing up UNexpectedly more often, then I believe we’ll see improved staffing levels on second and third shift and on weekends and holidays.

Suggestion #2: Require management personnel to work staggered shits ALL THE TIME, not just when state inspectors are in their building. In large facilities that have an Assistant Administrator (or equivalent position), the state should mandate that the Administrator and their assistant must not be allowed to work identical shifts. In fact, I believe the state should require that the shifts for management can not overlap more than four hours per day (Example: Administrator works 8:00am – 4:30pm, while the Assistant Administrator is scheduled to work 12:30pm – 9:00pm).

The majority of nursing homes are too small to be able to afford an Assistant Administrator. Yet even these facilities MUST have a full-time Director of Nursing on staff. In these nursing homes the same “staggered shifts” rule should be in place for the Administrator and Director of Nursing.

Why suggest this legislative mandate? For much of the same reason that I made my first suggestion: after management is out of the building the quality of care given often suffers. As the cliche goes, “When the cat is away, the mouse will play!” And “play” they often do (e.g., taking excessive smoke breaks, ignoring call lights, talking on their personal cell phone instead of checking on or responding to their residents). One third shift nursing staff member at an Indiana facility where my mother lived admitted to me that she “preferred” to work overnight so “the big shots” couldn’t get in her way of doing her job the way she wanted to do it. Scary! One of CNAs who worked with this individual on third shift shared with me that this nurse took an average of seven (7) smoke breaks, OFF THE UNIT, per hour! This clearly wouldn’t be allowed by either the state or sane nursing home management — but how could the state or management know this was problem existed if they aren’t in the building at night? Residents with dementia likely aren’t capable of reporting such problems. Family members can’t stay with their loved one 24’7 non-stop to monitor this. Placement of a “Granny Cam” inside the room is incapable of documenting problems that take place outside of the resident’s rooms (as in documenting a lack of staffing at the nurse’s station caused by staff taking an excessive number of smoke breaks).

If it is impossible to have management in the building 24/7, then the state should mandate their presence a minimum of 12 hours per day on non-holiday weekdays and 4 hours (or more) per day on holidays and weekends.

Suggestion #3: When the state shows up for an any type of inspection (annual or in response to a complaint) the inspectors (a/k/a “surveyors”) should IMMEDIATELY seize payroll data to (before it can be altered) to verify staffing levels for the 14 continuous days immediately prior to the inspection. With this information in hand, inspectors should have the legal authority to insist that while they are in the building that the staffing level can NOT exceed the average staffing level for the previous 14 days.

Why would I suggest this issue requires a legislative intervention? Because calling in off-duty nursing staff during an inspection or even bring in temporary employees is one of the biggest (and most deceptive) things nursing home management does to make it appear that resident needs are being taken care of in a timely and appropriate manner — when the reality is that they aren’t being responded to in either a timely and/or appropriate manner when the state inspectors are not around. “Putting on a show” for state inspectors should be against the law! Inspectors should see and judge the quality of care based on the REALITY of ACTUAL staffing levels.

Suggestion #4: Pass legislation that prohibits nursing homes from either outright banning or limiting visits of residents by their family and friends. Once  nursing home staff identify a resident’s family member(s) or friend(s) as a “trouble maker” (e.g., that we really have the courage to report their facility to the state, as is our LEGAL RIGHT AND MORAL RESPONSIBILITY TO DO) then you can count on the facility to begin setting traps (coming up with schemes) to make it look like we are the bad guy), thus justifying prohibiting (or at least limiting) visits. Some facilities have even limited visits from family and friends from taking place on the unit where the resident resides — allowing, for instance, visits to only take place in the lobby. This way family and friends can’t observe the substandard care the resident is receiving, thus preventing them from being able to observe (and thus report to the state) problems with care.

Attempts to prevent family and friends from visiting nursing home residents (when no harm is being caused to the resident as the result of the visit and when the resident wants to receive visits from such individuals) is clearly a violation of nursing home resident’s civil rights! We activists must get through to these corrupt nursing home owners and managers that their facility is the HOME of the resident and therefore the SAME rights of visitation residents had at their house, apartment on condo apply inside the nursing home facility! Strongly worded legislation is clearly the only hope we have to prevent nursing homes from taking their residents hostage!

Suggestion #5: We need legislation that will mandate increased fines against nursing homes that are found guilty of abusing resident’s rights, especially with regard to forcing residents to move to another facility. Many nursing home residents find themselves being forced out of their facility as retaliation against the resident or their family for sticking up for their rights. This type of abuse of resident’s rights must stop! It is truly a twisted, dysfunctional way of thinking when a nursing home’s only way of handling it’s problems is to punish their residents (or the resident’s family) by forcing the resident to leave their facility. How many residents must suffer “eviction” before a facility is finally forced to look inside itself and make the changes needed to resolve their real problems?

How can you help to make these five changes happen within the state where you reside? Contacting your state legislators would be a good start. Also request the support of your local or state Long-Term Care Ombudsman to help promote this reform agenda. If your area or state doesn’t have a nursing home reform organization then start one! I’ll be glad to help you start and promote such an organization.

I believe that together we CAN make meaningful, important and positive changes take place within the nursing home industry. While the industry clearly has the big bucks to spend on maintaining the status quo, we have more than enough individuals on our side to make change HAPPEN!

I’ve had it with folks who defend the nursing home industry and it’s employees as if some really serious problems don’t exist that threaten the well-being of residents. REAL problems — including some very serious ones — DO exist and I’m not going to be silenced about these issues by the toxic apologists of the nursing home industry! Yes, some very wonderful individuals have (and are) working in the industry, but some very evil people have (and still are) causing real harm to nursing home residents and SILENCE ABOUT THOSE INDIVIDUALS IS NOT ACCEPTABLE!!!

You don’t believe what I just wrote? Really. How can you deny the abuse of an Oklahoma nursing home resident that is featured in the news video below? The video does NOT lie! This video shows the resident shown being abused by two of her certified nurses aides — in her nursing home room!  Make no mistake: this once incident is just the tip of the iceberg!

Please click on the follow link to view a video clip, courtesy of News9 in Oklahoma City, that shows the horrible abuse of a 95 year old nursing home resident:

http://www.news9.com/story/20232384/caught-on-tape-elderly-woman-tortured-in-okc-nursing-home#.ULu46VJiwDA.twitter .

Please note that near the end of the video clip it was mentioned that it is estimated between 24,000 to 63.000 acts of physical abuse of nursing home residents by nursing home staff take place every year! This estimate refers JUST in OKLAHOMA! Multiply that shocking estimate by 50 states and the District of Columbia! This situation is a national tragedy and truly a source of shame!

May God help our nation and world when both this kind of abuse goes on and when non-abusers are silent about the abuse!

Nursing Home News Watch

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