Prescription Drug Use in the U.S.

Overmedication is a big issue in long-term care facilities, especially nursing homes. I was sent the following infographic on the state of prescription drug use in the U.S. by Emily Parker of Healthcare Management Degree Guide. The graphic showcases some interesting data pertaining to antibiotics, psychiatric drugs, stimulants and painkillers. While this information doesn’t focus specifically on the nursing home population, it does highlight a trend of increasing prescription drug use throughout the country. Be sure to check the blog over the next couple of weeks for a follow-up post on overmedication in nursing homes.Over-Prescribed America
Source: Healthcare-Management-Degree.net/

Medicare Annouces Changes to Nursing Home Rating System

On October 6, 2014, the Centers for Medicare and Medicaid Services (CMS) announced changes to the rating system used for nursing homes. These changes, which will start to be implemented in 2015, include focused survey inspections for a nationwide sample of nursing homes, quarterly electronic reporting of staffing data, the use of additional quality measures, improved requirements for nursing home inspections, and an improved scoring methodology.

CMS hopes that the changes will improve the rating system, leading to better care. The agency writes that the survey inspections, which will start in January, 2015, will “enable better verification of both the staffing and quality measure information that is part of the Five-Star Quality Rating System.”

The press release states the new system for the electronic reporting of staffing data “will increase accuracy and timeliness of data, and allow for the calculation of quality measures for staff turnover, retention, types of staffing, and levels of different types of staffing.” My past post on staffing levels mentioned that the number of staff and the hours of care they provide are important to the quality of care a resident receives. In a New York Times article, Katie Thomas quotes Brian Lee, executive director of Families for Better Care, who said, “If we are able to get better information on staffing levels, the higher the quality is going to be in the long run.”

CMS is not only looking to improve current quality measures, but also adding additional measures to the rating system. Beginning in January, 2015, the rating system with take into account the use of antipsychotic medications by residents. According to Thomas’ article, 20.3 percent of long-term residents of nursing homes are given antipsychotic medications. With the changes, instead of merely being reported, the percentage of residents given these drugs will play a role in each nursing home’s rating. In the future, ratings will also take into account other measures, including claims-based data on re-hospitalization and community discharge rates. These new inclusions, along with a revision of the scoring methodology of the rating system, could produce noticeable changes in nursing home ratings.

I have blogged about issues with the five star rating system in the past. When researching ratings, self-reporting and the manipulation of data have made it difficult to decipher the actual quality of care provided by a nursing home. It seems that CMS has proposed these changes with the goal of addressing these issues in mind. Only time will tell if the new rating system will be effective. However, these changes seem to be a step in the right direction. In addition, CMS demonstrates that they are aware of the issues and are responding to calls for change.

While writing this post, I was wondering why CMS does not have a section of their website dedicated to consumer reviews and ratings. Today, almost everything (movies, restaurants, hotels, etc.) is rated by consumers. Anyone who has access to the internet can rate and review a product in just a few minutes. While residents and family members can file complaints with the New York State Department of Health, if they have issues with a nursing home, to my knowledge, there is no option to rate or comment on the quality of a nursing home on Nursing Home Compare. A cursory Google search revealed some websites that allow individuals to rate and comment on nursing homes, including http://www.aplaceformom.com/, https://www.senioradvisor.com/, and https://www.ourparents.com/. Consumer reviews should always be taken with a grain of salt, but reviews from individuals with firsthand knowledge of nursing homes can provide a valuable insight into their quality.

Attorney General’s Hidden Camera Investigation Leads to Arrests

Two days ago, Attorney General Eric Schneiderman announced that another hidden camera investigation has resulted in the arrests of nursing home employees. Two certified nurses’ aides, who worked at Erie County Medical Center Skilled Nursing Facility (also known as Terrace View Long Term Care Facility), were arrested and charged with “Falsifying Business Records in the First Degree (class E felony), Endangering the Welfare of an Incompetent or Physically Disabled Person (class A misdemeanor) and Willful Violation of Public Health Laws (unclassified misdemeanor).”

According to video footage, the CNAs, Donna Laury and Nakeia Green, allegedly neglected to follow a 79-year-old resident’s personal care plan, “failing to use two people when performing incontinence care and failing to use a mechanical lift to transfer the resident.” The employees are accused of falsifying documents to cover up their alleged neglect.

Due to Alzheimer’s disease, dementia and the inability to get around on her own, the 79-year-old resident relies on nursing staff to assist with daily activities. Many nursing home residents are in similar situations, where their well-being depends on the care of others. While many residents do receive the care they need, there are many instances, including this one, where caretakers are neglectful or abusive, and do not provide proper care. What is it about the culture of a facility that lends itself to this type of behavior?  And is it evidence of a systemic problem?

Magician, Mat Franco, Wins America’s Got Talent

I am very pleased to learn that a magician, Mat Franco, won America’s Got Talent (a variety talent competition) on September 17, 2014. Magic is something that is best seen live, which makes his win all the more impressive. You may be wondering why I am blogging about a magician on a blog devoted to advocating for the elderly in long-term care facilities. Magic, both performing and watching, is a passion of mine. I have often thought about donating my time to perform in nursing homes. I intend to do that this winter with my wife, Christine, who is a balloon twister. I am curious to find out how those with cognitive deficits react to magic. We could all use a little mystery and wonder in our lives, regardless of age.

When selecting a nursing home, it is important to make sure there are many activities for residents, especially for those with dementia. You want to ensure that your loved one has access to activities in which they can participate and enjoy. A social worker can assist you in determining what activities are best.

What Does a Five-Star Rating Really Mean?

The New York Times placed Medicare’s nursing home rating system front and center in a recent, in depth article, by Katie Thomas, and a recent editorial . In the past, I have written about Medicare’s rating system, pertaining to New York State nursing homes. While The Times article mentions nursing homes in New York, it focuses on nursing homes in California, specifically Rosewood Post-Acute Rehab, which has a five-star rating despite having over 100 consumer complaints and around a dozen lawsuits filed against it.

Nursing home ratings, like Rosewood’s, cannot be taken at face value because much of the data behind them is self-reported and can be changed or misreported by facilities’ employees. The ratings are determined by three criteria, staff levels, quality statistics and health inspections. The Times editorial acknowledges that staff levels and quality statistics “are reported by the nursing homes and accepted at face value by Medicare without verification.” If this data is not authenticated by Medicare, facilities can easily get away with manipulating it for their benefit.

The data from annual health inspections, while not self-reported, can be manipulated, as well. Nursing homes often know when inspections will occur, and increase staff hours during the inspection, only to decrease them once the inspection was complete. The administrator of Medford Multicare Center for Living, a facility in New York, described the inspection period as “our Super Bowl.” The current rating system seems to shift the focus and effort of nursing home staff and administrators to obtaining high ratings, and away from providing consistent, quality care.

In an attempt to rectify part of the problem, the Affordable Care Act “requires Medicare to use payroll data to verify the accuracy of staff levels.” However, the agency, “still working on the verification system,” has not yet put this requirement into effect.

Even though the rating system is imperfect, Katie Thomas writes that, starting this year, Medicare plans to use a comparable system for hospitals, dialysis centers and home-health-care agencies. While the five-star rating system makes it easy for families and loved ones to compare facilities, these recent stories show that the data behind the ratings are not always accurate. When deciding on a nursing home, be sure to look beyond the ratings. They do not always represent the true quality of care.

Doolan Platt & Setareh, LLP Obtain $1.5 Million Dollar Verdict in Overmedication Case

Last Thursday, a jury in Clinton County, New York awarded $1.5 million dollars to the estate of one of our clients, John Solari, who died on August 1, 2011 after being given another patient’s medication. At the time, Mr. Solari was a patient at Champlain Valley Physicians Hospital (CVPH), in Plattsburgh, New York.

On July 29, 2011, a nurse at CVPH, who was filling in for a co-worker who was out sick, gave Mr. Solari controlled-release morphine in his applesauce. This medication was supposed to be given to another patient, but the nurse misidentified Mr. Solari, and gave it to him instead. Mr. Solari died three days later.

My associate Benjamin Decker, Esq. and I brought this case to trial on behalf of Mr. Solari’s daughter, who told the Press Republican, “The issue for me was accountability…Nobody would admit accountability  for my father’s death.” At Doolan Platt & Setareh, we strongly believe in holding those who commit negligence and abuse accountable. As I told Felicia Krieg, the Press Republican reporter, I hope this verdict brings about change.

Highpointe Employees Charged Following Hidden Camera Investigation

Continuing to make use of hidden cameras during investigations, Attorney General Eric T. Schneiderman announced charges against 17 employees of Highpointe on Michigan Health Care Facility in Buffalo, NY. The charges are based on video footage recorded by the Attorney General’s Office that allegedly reveals the neglect of a 56-year-old resident. According to the press release, “nurses failed to dispense pain medication and check on the resident,” and “aides neglected to check on the resident, failed to give him liquids and failed to perform incontinent care.” In addition, the video footage also revealed that the nurses and aides falsified documents to cover up their alleged neglect.

The resident of Highpointe, who had Huntington’s disease and was bedridden and unable to walk, was fully dependent on the facility’s staff. The Attorney General announced that his office “will use every tool in our arsenal…to ensure that nursing home residents receive the care they need and the respect they deserve.” Many residents of nursing homes, like the 56-year-old resident of Highpointe, do need someone to provide a watchful eye over their care. While the owners of nursing homes should be the ones to provide this oversight, many times, their lack of oversight adds to or causes neglect and abuse.

The Attorney General’s Office continues to demonstrate that it will be a watchful eye in nursing homes. In a previous blog post, I wrote about surveillance in nursing homes, and the Attorney General’s Office’s use of hidden cameras back in 2010. With advancements in technology, it is arguably becoming easier to oversee the care provided in long-term care settings. I am hopeful that the Attorney General’s commitment to oversight, coupled with his office’s willingness to use technology, will set an example for nursing home owners and the public throughout New York State.

State Rankings Paint Inaccurate Picture of Quality of Care in Nursing Homes

Previously, I blogged about the ongoing saga of Medford Multicare Center for Living, located on Long Island. A lawsuit, the highlight of which is the death and alleged cover up of an elderly woman at Medford, was filed by New York State Attorney General Eric T. Schneiderman. The Attorney General claims there is a history of neglect and mistreatment at Medford. These accusations are surprising because recent state rankings of the nursing home don’t reflect these claims of poor treatment.

According to two Newsday articles (one by Ridgely Ochs and Chau Lam and the other by Joye Brown), Medford Multicare Center for Living received an overall ranking of 3 out of 5 stars on a federal website, Medicare’s Nursing Home Compare, that provides detailed information about Medicare and Medicaid-certified nursing homes. Last year, the nursing home received a ranking of 4 out of 5 stars for health inspections and quality of care. If the Attorney General’s allegations are true, this average ranking in no way reflects the quality of care at Medford.

New York State’s Department of Health conducts inspections, collecting data used to rank nursing homes throughout the state. However, nursing homes themselves gather and report the statistics used for ranking. This data is not required to be reviewed, so the is no way to determine its accuracy. This self-reporting creates a conflict of interest that can lead nursing homes to inflate or even completely falsify the data they report.

In her Newsday article, Joye Brown quotes Charlene Harrington, a professor of nursing at the University of California, San Francisco. Harrington explains, “The rating system is based on three things: First, deficiencies: If those aren’t issued properly, then you can’t rely on that. Second, staffing: Nursing homes can gin up those numbers when they suspect surveyors are coming. Third, they can falsify quality measures.”

According to a paper by the Kaiser Commission on Medicaid and the Uninsured from 2013, the Affordable Care Act requires nursing homes to increase their transparency. The Centers for Medicaid and Medicare Services (CMS) has already implemented a number of new requirements, including improving the collection of data on owners and managers and providing links to health inspection reports. However, other important provisions have not yet gone into effect.

With the Attorney General’s surprising allegations, it may be time to rethink the way we assess and present the quality of care and safety at nursing homes. The public relies on these ratings to make difficult decisions for themselves and their loved ones. Verifiable data needs to be easily accessible and used in the ranking process, so ratings represent the truth about nursing homes throughout New York State.