Nursing Homes Summary: 2008

Thursday, October 9, 2008

Assisted living care

A nursing home, skilled nursing facility (SNF), or skilled nursing unit (SNU), also known as a rest home, is a type of 1. care of residents: it is a place of residence for people who require constant nursing care and have significant deficiencies with activities of daily living. Residents include the elderly and younger adults with physical disabilities. Adults 18 or older can stay in a skilled nursing facility to receive physical, occupational, and other rehabilitative therapies following an accident or illness.
Assisted living
1. From Wikipedia, the free encyclopedia
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Assisted living residences or assisted living facilities (ALFs) provide supervision or assistance with activities of daily living (ADLs); coordination of services by outside health care providers; and monitoring of resident activities to help to ensure their health, safety, and well-being. Assistance may include the administration or supervision of medication, or personal care services provided by a trained staff person. Assisted living as it exists today emerged in the 1990's as an alternative on the continuum of care for people who cannot live independently in a private residence, but who do not need the 24-hour medical care provided by a nursing home. Assisted living is a philosophy of care and services promoting independence and dignity.
There is no nationally recognized definition of assisted living. Assisted Living facilities are regulated and licensed at the state level. More than two-thirds of the states use the licensure term "assisted living." Other licensure terms used for this philosophy of care include Residential Care Home, Assisted Care Living Facilities, and Personal Care Homes. Each state licensing agency has its own definition of the term it uses to describe assisted living.
TYPE=PICT;ALT=seniortransitionandretirmentlivingspacer"Independent Living is an residential living setting for elderly or senior adults that may or may not provide hospitality or supportive services. Under this living arrangement, the senior adult leads an independent lifestyle that requires minimal or no extra assistance. Generally referred to as elderly housing in the government-subsidized environment, independent living also includes rental assisted or market rate apartments or cottages where residents usually have complete choice in whether to participate in a facility's services or programs.

What is Independent Living?
1. "TYPE=PICT;ALT=seniortransitionandretirmentlivingspacer"Independent Living is an residential living setting for elderly or senior adults that may or may not provide hospitality or supportive services. Under this living arrangement, the senior adult leads an independent lifestyle that requires minimal or no extra assistance. Generally referred to as elderly housing in the government-subsidized environment, independent living also includes rental assisted or market rate apartments or cottages where residents usually have complete choice in whether to participate in a facility's services or programs.

What is IndependentLiving?acer"Independent Living is an residential living setting for elderly or senior adults that may or may not provide hospitality or supportive services. Under this living arrangement, the senior adult leads an independent lifestyle that requires minimal or no extra assistance. Generally referred to as elderly housing in the government-subsidized environment, independent living also includes rental assisted or market rate apartments or cottages where residents usually have complete choice in whether to participate in a facility's services or programs.

Wednesday, October 1, 2008

HHS Inspector General Releases Report on Nursing Homes

September 30, 2008

A report by the HHS Inspector General’s Office has gotten a great deal of press attention, and we wanted to provide you access to the report in case you get questions from the media or others. The report uses OSCAR data to show trends in deficiencies from 2005 – 2007 and is contained in a memorandum from Inspector General Daniel Levinson to Kerry Weems, the Acting Administrator at CMS. You can access it on the OIG website, Trends in Nursing Home Deficiencies and Complaints (OEI-02-08-00140) http://intranet/oiginternet/oei/reports/oei-02-08-00140.pdf.

Among the highlights of the findings:

The percentage of nursing homes with deficiencies increased from 91.1% in 2005 to 91.9% in 2007.
The average number of deficiencies per nursing home increased from 6.4% to 7.0%. 74% of deficiencies in 2007 were for quality of care violations.
94% of for-profit facilities were cited in 2007, compared with 88% of nonprofits and 91 percent of government-owned nursing homes. For-profit nursing homes also had a higher average number of deficiencies.
7.3% of chain-operated facilities were cited in 2007, compared with 6.7% of single-owned facilities.
There was a slight increase in the scope and severity of deficiencies cited, with a higher percentage of for-profit nursing homes cited for immediate jeopardy or actual harm (17% versus 15% for nonprofit and government facilities).
Facilities with substandard quality of care deficiencies increased from 3.0% of nursing homes in 2005 to 3.6% in 2007. Again, for-profit nursing homes had higher citations—4.2% compared to 2.3% for nonprofits and 3.0 for government facilities.
The number of substantiated complaints fell from 14,781 in 2005 to 14,394 in 2007. Only about 39% of complaints were substantiated. About 20% of substantiated complaints involved abuse or neglect.

The report does not address an issue raised in a previous OIG report and in repeated Government Accountability Office (GAO) studies: undetected care problems and the under-citing of deficiencies. A GAO report published last spring found that when federal surveyors did comparative (look-behind) surveys, about 15% of the federal surveys “identified state surveys that failed to cite at least one deficiency at the most serious levels of noncompliance—actual harm and immediate jeopardy.” (See Nursing Homes: Federal Monitoring Surveys Demonstrate Continued Understatement of Serious Care Problems and CMS Oversight Weaknesses GAO-08-517, May 9, 2008.) The GAO attributes understatement of deficiencies to surveyors’ weak investigative and analytical skills.

In spite of shortcomings in the study, it provides an opportunity for advocates to make a case to the press and policymakers for the Nursing Home Transparency and Improvement Act (S. 2641), sponsored by Senators Chuck Grassley (R-IA) and Herb Kohl (D-WI), and its House companion bill, the Nursing Home Transparency and Quality of Care Improvement Act (HR 7128), introduced last week by Representatives Pete Stark (D-CA) and Jan Schakowsky (D-IL). The bills will provide the public better information about nursing homes’ owners and operators, expenditures, staffing levels, and sanctions, and will provide better tools for the government to monitor and sanction chains. It also lends support to passage of the Fairness in Nursing Home Arbitration Act, S. 2838 and HR 6126, which would invalidate providers’ efforts to force residents and their families into arbitration when a resident was neglected or abused.

Watch for a NCCNHR Bulletin providing more information about HR 7128 and other legislation advocates have been following this year.

A more comprehensive report using the same data, by Dr. Charlene Harrington of the University of California/San Francisco, is on the NCCNHR website:

Nursing Facilities, Staffing, Residents and Facility Deficiencies, 2001 Through 2007 by Charlene Harrington, Ph.D., et al. - The September 2008 edition of this book shows trends in U.S. nursing homes by state for 2001 through 2007. The data are from the federal On-Line Survey and Certification System (OSCAR) reports that are completed at the time of the annual nursing home surveys by state Licensing and Certification programs for the U.S. Centers for Medicare and Medicaid Services. Book sections include: Introduction; Facility Characteristics; Resident Characteristics and Services Provided; Staffing Levels; Facility Deficiencies from State Survey Evaluations; Summary; References; and Technical Notes. Read the Press Release. View the book.

Janet C. Wells

Director of Public Policy

NCCNHR: The National Consumer Voice for Quality Long-Term Care

1828 L St., NW, Suite 801

Washington, DC 20036

202-332-2275

Fax 202-332-2949

Pam Edwards, Community Organizer
Mass Senior Action Council
topamedwards@hotmail.com
781-864-2596

Sunday, September 28, 2008

Nursing Home Discussion Why we need home care

Nursing Homes: Perceptions and Realities
By Aprill Jones
Why is there so much misinformation and so many misconceptions when it comes to nursing homes?

Admitting a loved one into a long-term, skilled nursing facility is a difficult and extremely emotional decision for all involved.

Here we will address common misconceptions and cultural perceptions that may or may not be true, but nevertheless influence our decisions and thought processes when a loved one may need the 24/7 care of a skilled nursing facility.

When faced with the daunting task of choosing the best facility for the needs of the patient and the family, the process becomes overwhelming, frustrating and even frightening. It’s hard to know what to believe and what to dismiss. Research is imperative and will go a long way in making you and your aging parent feel good about your choice.

Many of us believe nursing homes are where people go to die.

From her 25 years of experience, Barbara Fordyce, R.N., Case Manager in Senior Resource Management, considers the belief that nursing homes are the last stop before the funeral home to be today’s biggest misconception about nursing homes. She finds this is especially true for those who were in adulthood in the 1930’s and 40’s.

That particular generation is living a lot longer than they expected, and really have no cultural cues in how to handle getting older than anyone else they ever knew. They’ve watched friends grow feeble, forgetful and die. It’s a frightening time for them, and the prospect of going into a nursing home may be an indication to them that their time is drawing to an end.

The fact is, even though many senior adults may require the 24/7 care of a nursing home after surgery, an injury, accident or health event such as stroke or heart attack, once sufficiently recovered, they may be able to return to their previous living arrangement or released to a caregiver for the remainder of their lives.

With people in the United States living longer than ever before, it is estimated that anyone over 65 years of age will have a 43% chance of spending some time in a nursing home. About 24% of these individuals will spend less than a year in residence at a nursing home. (www.therubins.com/homes/stathome.htm)

Even when returning home permanently is not an option, most Medicaid-certified nursing facilities will hold beds for patients during a short visit with family or friends. Each state has rules that vary, so check on how out-of-home visits are treated at any nursing facility your are considering.

I can’t help but think that if my loved one is in a nursing home, they will be miserable and I will feel guilty.

Our culture harbors the belief that when we have a loved one who needs the care of a nursing home, the result is guilt and sadness for the family, and the end of any enjoyment of life for the patient. However, that does not have to be true.

Doing your homework before a relative is admitted into the home is the first step to making you both feel good about your decision. The fact is, some ailing seniors are happy to go to a skilled nursing facility so that they no longer feel guilty about the burden they feel they have been to the caregiver.

Your loved one also may be relieved to receive the medical, rehabilitative and nursing care provided in the nursing home by health care professionals.

And while most nursing home residents may miss day-to-day interaction with old friends, family and even pets, most facilities are upbeat, positive places. Patients often enjoy eating in dining rooms rather than in their rooms, and activities and outings offered each day to stimulate and entertain patients mentally, physically and socially.

Also keep in mind that a nursing home is not like a hospital. There are usually no restrictive visiting hours and your relative may be able to go with you for visits, family events and holidays. Expect nursing facilities to try to be home-like – where people can feel comfortable, make friends, visit with family and continue life's activities appropriate to their age and capabilities.

Your research before admission and frequent visits with your loved one once moved into the facility will ensure that their time in a nursing home is beneficial and pleasant without any misery or guilt.

It seems all the residents lose their privacy.

Fordyce reports that many residents, in their first weeks in a nursing home may experience a shock at their loss of privacy if assigned to a semi-private room. While they are usually allowed some personal items and clothing that help keep their sense of identity and individualism, there is a certain loss of control that many people struggle with for varying periods of time.

You should expect staff to be considerate of the need for privacy and knock on closed doors before entering the room, respect clothing choices and personal preferences when appropriate.

If you have a mother and father who would like to live together at the nursing home, you should expect to find a facility where this is allowed and their privacy is respected.

We’ve come to believe all nursing homes smell bad.

It’s true that incontinence is a fact of life in most nursing homes, but today’s cleaning methods and prompt attention to any sanitary issue is standard in most homes. If you encounter bad odors, the situation should be reported immediately. But in today’s skilled nursing world, stale, lingering, unpleasant odors are no longer an issue that cannot be resolved.

We perceive that when in a nursing home, people lose their dignity.

Because in the past, we may have observed nursing home patients sitting in wheelchairs waiting to be taken to where they are going next, or people wandering the halls seemingly having discussions with themselves, many of us perceive that residents in a nursing home lose all dignity. But Fordyce reports that residents, on average, receive 2.5 hours of skilled nursing care every day. You can expect the staff to be constantly aware of resident whereabouts and needs, and if you feel this is not the case, you should report what you see.

It is true that a large number of nursing facility residents have Alzheimer's. However, in most homes, Alzheimer's patients live in distinct units where they can be among people having the same limitations and receive the specialized care they require in a secure setting.

In your loved one’s nursing home, you should not encounter lingering odors or signs of neglect or disrespect resulting in loss of dignity. If you do, exercise you option to report the conditions. You have every right to have your concerns addressed and a plan of action shared with you.

It only seems logical that private pay surely results in better quality of care than when paid through Medicare or Medicaid.
According to Hillary Kaylor, Regional Long-term Care Ombudsman in Charlotte, NC, there should be no difference in quality of care between Medicare/Medicaid payment vs. private pay vs. long term care or Worker’s Compensation insurance payments. Quality is not based on payor source, but rather from influences such as the administrator, the size and number of beds in the home, and how closely the services offered at the home match the needs of the residents.

Kaylor says that nursing home operations are usually run by private corporations, hospital systems, or, more and more rarely, a “mom and pop” type organization.

All nursing homes in the United States that receive Medicare and/or Medicaid funding are subject to federal regulations. (American Association of Homes and Services for the Aging). The nursing home industry is one of the most heavily regulated operations in the United States. Each and every nursing facility is expected to meet minimum government quality standards, and undergo regular inspections by state surveyors.

Kaylor states that as an employed ombudsman, it is part of her job to urge facilities to do better than the minimum. If a problem is found, a prompt correction plan is required. Most areas have an active, government-supervised Ombudsman program that advocates for patients and families in the case of oversight.

It IS true that nursing homes have changed!

Nursing homes haves changed a good deal over the past decade, according to Kaylor. They are no longer a place where grandma sits and waits for someone to change the television to her afternoon soaps and for her once a week visit from the family. With more and more focus on rehab and recovery, nursing homes often have a diverse population, which includes both younger and elderly people.

A good place to start making nursing home comparisons for your particular area, according to Fordyce, is through the Centers for Medicare and Medicaid Services, which provides a nursing home compare tool. Go to www.medicare.gov, go to “Search Tools” and click on “Compare Nursing Homes in Your Area”, or call 1-800-633-4227.

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Aprill Jones holds a B.A. in English from the State University of New York. A writer for over 15 years, she has experience with a variety of clients in the healthcare field, including neuro rehab, optometry, radiology, dentistry and pharmacy as well as work in health insurance. She lives in North Carolina.

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Resources

Nursing Home Fact verus Ficton
For a nursing home fact vs. fiction quick reference chart, go to www.commonwealthfund.org, from E. Carlson, "Twenty Common Nursing Home Problems and the Laws to Resolve Them," Clearinghouse Review Journal of Poverty Law and Policy, Jan./Feb. 2006.

Comments (1 to 20 of 20)
alzheimersideas

Sep 10, 2008
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Very good article. People must understand nursing homes have changed and must adhere to certain standards as mandated by the department of public health
Susan Berg, author and dementia healthcare professional

PersonCareDotNet

Sep 10, 2008
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This article about nursing homes is very accurate and timely. Similar to when you may have looked for a day care center for a child, the child day care center's director is the key. In a nursing home, the administrator/management is the most important part of a caring nursing home.

Bob, experienced professional in the healthcare industry for equipment/supplies

alzheimersideas

Sep 10, 2008
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I think the director of nurses is also extremely important
Susan Berg
author and dementia healthcare professional

Cat

Sep 10, 2008
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Sorry to burst your bubble, but this article is lovely, but not realistic - unless you have money and are a relative of the administrator. I notice that the only people commenting on this article are in the industry. Speaking from "both sides of the fence" the truth is that in a recent poll in LTC Magazine 90% of the vote on the question: I wouldn't want to be a resident in my own nursing home - be it SNF, LTC, Assisted Living, etc.

Where are these lovely nursing homes where everyone visits - eats in the dining room and plays games? In a movie? I haven't seen any in Los Angeles County that were not high-end private pay. Sorry - aren't out there.

As far as Medi-Cal versus private pay goes - it is very nice to say that there is no difference - and you are right, it is mandated that there be no difference in care - but there is. Regardless of where the blame lies, the industry is run as FOR PROFIT and with Medicare, HMO and Medi-programs cutting reimbursable amounts it is a perfect storm of problems, an aging infrastructure, low paying jobs and a patient population that is many times in no position to object. Yes there is an Ombudsman, but abuses do occur and it is impossible to regulate things like "not caring" -

I invite everyone to spend 7 days as a patient - in fact that is the only thing that will change the system.

momsdaughter

Sep 11, 2008
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If at all possible, try to hire a live in before placing into a nursing home. My mom has been in 2 nursing homes

momsdaughter

Sep 11, 2008
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My comment got cut off. Anyway, Mom has been to 2 different nursing homes and while there are caring CNA's & RN/LPN's, who do their job, most facilities are short staffed and residents receive minimal care & are ignored for the most part. Mom has lost 12 lbs in less than 2 months and her care has not been anything like what we were told it would be. I've had CNA's ask me if I knew how to transfer mom into bed because they weren't sure! Yes, it's been reported. After 2 failed attempts & her health in jeopardy, we are now hiring a live in and will have more peace of mind knowing she is at home where we can take care of her better than the nursing homes we've had experience with. Hiring a live in is actually saving us money - you have to do alot of reference checking & CORI checks, but we've had good luck in finding a few great, experienced people eager to help just by placing an ad in the local newspaper.

Mgrady1

Sep 11, 2008
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I agree with Cat and momsdaughter- there is no such thing as a good nursing home. this article is very inaccurate and misleading.
there is alot of work that needs to be done about the lack of care and lack of humanity in nursing homes.
i do not have time at the moment to fully comment on this article, but i will at a later date.

alzheimersideas

Sep 11, 2008
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That is really too bad. The nursng home I work for while not perfect is much better than you describe. The majority of our staff are kind caring people who work extremely hard to make things as comfortable as possible
There are some over demanding unrealistic family members out there that take up a lot of time. This is time away from the other residents.
I work for a non profit home. But we do have to meet expenses and upkeep.
I think the key is having an administrator who is kind and allows certain expenses
Also important is a top notch on the ball director of nurses and assistant director who keeps the nurses and CNAs in line. You need ones that know the residents, are not afraid to get their hands dirty and will work more than the 40 hours they get paid for
by Susan Berg

Cat

Sep 11, 2008
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Dear Susan,

Thank you very much for your thoughts - I am wondering what city/state and non-profit your nursing home is - it sounds very nice. Does it take Medi/Medi? Are you also caring for someone directly yourself? I do ask that question kindly as you didn't identify yourself as such. I do ask the question kindly - it is not adversarial.

To reiterate what I said, yes, there are some caring people - and it is technically up to the DON, Administrator, Activity Director, SW, Facilities, Kitchen, Maintenance, Laundry, CNAs, Per Diem nurses and all of them. BUT this is a caregiver site and I believe that sometimes, it would be good to embrace the idea that we deserve *respect* and a safe place to talk about our opinions - including the good, bad and ugly of nursing homes.

I orignally had written more, but was cut off by the time before I had to log in again - so rather than start over - in a nutshell - if you are a caregiver, great. If not, perhaps you will learn more from our complaints and you can take those comments as honest feedback. My mother would have lasted about 3 months in a nursing home - but gong on seven years she is fine. Because caregivers do more than any staff would and they do it because.

Once again - rather than praising an outdated system of care - the SNF - LTC facililty - please recognize that we as family caregivers are not subsidized, paid, recognized or supported but we each do all of the work that it takes a facilty to do - on top of our regular daily lives. Perhaps if you want to be cutting edge at your facility, you will build some programs for low cost - or free subsidized respite for caregivers on a day program. we need it.

alzheimersideas

Sep 11, 2008
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I hear what you are saying. We do offer respite care. Occasionally we even have contests so one family can have a weekend of respite care at no cost. I do recog nize what caregivers do. We welcome family members to come in as often as they like with certain guidelines. I think the ideal if your mother needs SNF care, is too be extremely involved in her day to day care. However, you do have the option to take a break every now and then to regroup and refuel.
No one said taking care of an elderly parent is easy.You know your loved one the best. I even wrote an editorial in USA Today last year about the positives of nursing homes
I think adult day care is great also if a loved one can tolerate it

Cat

Sep 12, 2008
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Hello again - guess you did not "hear" what I was saying - or reply to my questions - but you did go straight some very self serving information about admitting for respite and what your nursing home does. I really don't care if you wrote a self-serving article about nursing home and are looking to develop "street cred" as an expert in all things geriatric - - to be blunt.....this is a caregiver support site - not a site for people to promote their businesses, or themselves.

I am unclear why people who are not actual caregivers participating for themselves, feel that offering their self-declared "expertise" is appropritate . It is not and is unwelcome - there are enough SW's and discharge planners and marketing reps in our areas - all of whom are in an INDUSTRY and are paid to promote their service. With due respect - please go peddle your services somewhere else - or troll senior centers for business. Or conversely, you could be honest and pay for advertising space on this site and tell us the name and location of your nursing home.

alzheimersideas

Sep 13, 2008
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Dear Cat I am very sorry you feel that way. I am not trying to promote any business, but just give things from my perspective.You are lucky. You are able to keep your loved one at home and can give her all the support and attention she needs. Some people are not so lucky.Some loved ones require more than any family could possibly provide. Some people try to cheat the system which makes it harder for others to get the services they need. I think we can both agree that more financial support is needed for caregivers. Did you know that if you are the primary caregiver, you can get a stipend formcaring for your loved one at home. Granted it really only scratches the surface, but you may as well take advantage of everything out there.
Again I am indeed sorry if I offended you or anyone else.
Susan

Cat

Sep 13, 2008
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Dear Susan,

Thank you for explaining yourself. I am very aware of how lucky I am. To put my comments into perspective this is my background: I had to fight to pull my mother out of a SNF after a younger sibling put her into the hospital / SNF with a DNR order. Long story short - I lived at the SNF, and did the 85% of work that was not done by staff. They billed for services not performed and when I saw enough there to turn me into an activist.

when I got her discharged to my care with the help of the Ombudsman and a very wearing fight with authorities, she was 84 lbs, incontinent, stage 3 bedsore and unable to communicate/verbalize. The administrator and DON basically told me I was wasting my time because she was going to die - they justified her state and refused to take responsiblity for her condition. Her doctor told me I was crazy to bring her home because it would "be too hard to handle" - I am a single woman - no help.

Six years and alot of work later, she is walking, communicating, continent and enjoying life. This is why I generally try to encourage people that their expectations about their loved one's care are generally self fulfilling prophecys.

I would like to find out about the stipend you mentioned - perhaps you can do a full article on that and how to access it.

Take care and I hope that you will encourage families not to default to a SNF simply because it is the easy way out. Our parents took alot of time out of their lives to raise us and change our diapers - time to return the favour.

alzheimersideas

Sep 13, 2008
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Dear Cat,
Wow what a story. I am not happy about that nursing home. You must be an amazing woman. I cannot put my blog on with html so you will have to be diligent finding it dementiatips But you sound like one tough cooke. I also wrote an article about honoring caregivers on labor day also. I know how hard you all work.
I would like to tell your story
If that is ok, leave a comment
I will have to find the aticle about the stipend. You are obviously most deserving of it
Susan

Mgrady1

Sep 20, 2008
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Dear Susan-
if you would look and you wouldn't have to look very far, you will find thousands/millions of stories like Cat's. I have a very similar story to hers. I had to remove my mother from "one the better" nursing homes. When i brought her home, all she could do was drool and her hands were in tight fists- she could not talk, walk or feed herself. My sister and I took care of her in my home and after a couple of months and alot of pain, she was finally detoxed and drug free. she could stand, walk and do crossword puzzles. my story is a long one and I will not go into details at the moment- my point is, nursing homes have not changed THAT much and 2 something hours per CNA per patient is NOTHING! In order for those hours to work properly, that means that a CNA cannot have more than 4 patients- please tell me of any nursing home where a CNA does not have more than 4 patients!
i am adding a link to a story that came out today. it is about a patient still trapped in a nursing home. Please read it and let me know what you think.
http://www.embarqmail.com/news/read.php?id=16397097

195Austin

7 days ago
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Cat
I am very glad you are telling it like it is we are lucky in our area there are a lot of N,H.'s to chooes from and some hosp. are starting there own 20 day units for people who are not ready to go home when discharged so N.H's are looking for pt.s to fill there beds. I have noticed that the ones who hire locally are better then the ones who train and buss in staff. Keep up your commets about NH's people need to know what really goes on in these places more often then not. Also we need to report what we see going on at the time. Cat keep up talking about it.

alzheimersideas

7 days ago
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Dear mgrady
That link did not work.
It is bad that you both have had such bad experiences. The home I work for is nonprofit and has a top notch staff. Maybe we are in the minority?
That is a shame because there are some people who have to be there
Susan

Mgrady1

7 days ago
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Dear Susan-
yes, you are VERY much in the minority. the people in your nursing home are truly lucky. too bad it is not like that everywhere.
the link works when i click on it- maybe you can copy and paste it in your browswer?
Molly

GinaConte

7 days ago
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I got paid to take care of my mother at home but I had to be a certified caregiver (in Arizona). Her insurance was through the state (she was low income) and she was qualified to get help 3 days a week. The pay was only $9.00 an hour but it helped! I also worked full time and went to college at the same time. She was in a nursing home for a few weeks and the care was horrible until I had a talk to the administrator about specific things the CNA's were and were not doing. They treated her better after that. I wish I had the resources to open up a comforting and stimulating
Day Care Home that would give caregivers peace of mind to work or play while their loved ones were being cared for!
By the way, CNA's and caregivers do NOT get paid enough. Thus, the turnover rates and lousy care, that's my opinion!

Cat

4 days ago
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I truly wish that there were programs for day care at home here in California, the only way to qualify for that is if your parent/ loved one is on Medi-Cal (Medi-caid) and has a very small SS check. The way it has been explained to me they pay based on time per task - and at the minimum wage of 6.50 or so... Recently California has been in a budget stalemate with Legislature so no one in healthcare whether it be SNFs or HHA's have been paid.

Imagine the uproar if they did not pay police or firemen!

Thursday, September 11, 2008

Nursing Home Report and comments

Tuesday, July 22, 2008

Concerns about Nursing Home Reform Act

The Nursing Home Reform Act, passed in 1987, established quality standards for nursing homes nationwide, emphasized the importance of quality of life, and preserved residents’ rights. However, despite enactment of this law, serious concerns remain about the quality of care provided to residents in the nation's 16,000 nursing homes. To improve the quality of care and the quality of life for nursing home residents, a growing movement, known as "culture change," is working to deinstitutionalize long-term care and radically transform the nursing home environment.

In the culture change model, which has gained momentum over the past decade, seniors enjoy much of the privacy and choice they would experience if they were still living in their own homes. Residents' needs and preferences come first; facilities operations' are shaped by this awareness. To this end, nursing home residents are given greater control over their daily lives—for instance, in terms of meal times or bed times—and frontline workers—the nursing aides responsible for day-to-day care—are given greater autonomy to care for residents. In addition, the physical and organizational structure of facilities is made less institutional. Large, hospital-like units with long, wide corridors are transformed into smaller facilities where small groups of residents are cared for by a consistent team.

Tuesday, July 15, 2008

Nursing Home care Vs Home Care Medicaid

A Balancing Act: State Long-Term Care Reform, is the first to examine Medicaid spending on long-term care for older people and adults with physical disabilities, separate from other LTC users such as people with mental retardation/developmental disabilities (MR/DD).

Nationally, 75 percent of Medicaid LTC spending for older people and adults with physical disabilities pays for institutional care in nursing homes. In contrast, states have done a much better job balancing Medicaid LTC for people with MR/DD, spending just 39 percent on institutional care. The majority of funds now supports people in home and community-based settings.

"We recognize the success state Medicaid programs are having providing home and community based services to people with mental retardation/developmental disabilities," said AARP Pennsylvania State Director Dick Chevrefils. "It proves that balancing long-term care is doable and should be used as a model to help states provide home and community based services for older adults."

As part of its Commonwealth Long-Term Living Project, Pennsylvania set a goal of 50 percent home-based care to 50 percent institutional care for all long-term care populations by FY 2011-12. Unfortunately, the recently passed 2008-09 state budget included no new spending to reduce existing HCBS waiting lists for Pennsylvania's lottery-funded OPTIONS program.

The report examines Medicaid LTC funding because it is the primary payer for LTC in the country. "This underscores the need for better government and private sector financing options for long-term care. Americans have few options to plan and pay for their long-term care. Balancing Medicaid LTC options will require a commitment from our state officials and cooperation from federal authorities. HCBS can be both cost-effective and responsive to the preferences of older people and adults with disabilities," said Chevrefils.

The new report includes state rankings and can be found at: http://www.aarp.org/research/longtermcare/programfunding/2008_10_ltc.html.

Monday, July 7, 2008

Nursing Home Reform

NCCNHR The national consumer voice for quality long-term care
1828 L Street, NW, Suite 801 Alison Hirschel, President
Washington, DC 20036 Alice H. Hedt, Executive Director
202 332-2275 Fax 202 332-2949
www.nccnhr.org
NCCNHR (formerly the National Citizens’ Coalition for Nursing Home Reform) is a nonprofit membership organization
founded in 1975 by Elma L. Holder to protect the rights, safety, and dignity of America’s long-term care residents.
Support the Nursing Home Transparency and Improvement Act!
Congress is considering the most important nursing home legislation in 20 years. Two of Congress’s leading supporters of nursing home reform, Senator Chuck Grassley of Iowa, Ranking Republican on the Finance Committee, and Senator Herb Kohl of Wisconsin, Chairman of the Special Committee on Aging, have introduced S. 2641, the Nursing Home Transparency and Improvement Act. A companion bill is expected soon in the House of Representatives.
NCCNHR worked with congressional staff to develop the legislation, which would increase transparency of nursing home ownership, operations, staffing, and expenditures; improve the consumer complaint process; increase civil monetary penalties; and expand public information about nursing home quality, including penalties and staffing levels. Please inform your members, colleagues, friends, and nursing home residents and their families about the bill:
• Check the NCCNHR website (www.nccnhr.org) for information and updates.
• Download S. 2641 by clicking on [S.2641.IS].
Summary of major provisions in S. 2641
Transparency and accountability in the ownership and operations of nursing homes
Corporations would be required to disclose their owners, operators, financers, and other related parties. Facilities that were part of chains would be required to submit annual audits. Purchasers would have to demonstrate that they were financially able to run facilities.
Disclosure of how Medicare and Medicaid funds are spent
Providers would have to report wage and benefit expenditures for nursing staff on cost reports. Cost reports would be revised to categorize spending for direct care, such as nursing and therapies; indirect care, such as housekeeping and dietary services; capital costs, including buildings and land; and administrative costs, which often include the company’s profits.
Independent monitoring of chains
The federal government would develop a protocol for an independent monitor of chains to analyze their financial performance, management, expenditures, and nurse staffing levels. It would provide for corrective action and collection of civil monetary penalties.
Accurate information about nurse staffing
The government would collect data electronically from nursing homes on the number of RNs, LPNs, and nursing assistants, using payroll records and contracts with temporary agencies as the source. Data would include turnover and retention rates and hours of care per resident provided by each category of worker.
Better

Sunday, May 4, 2008

Nursing Homes Assisting Living Costs

Study finds increases in nursing home, assisted living costs

Costs for nursing homes, assisted living facilities and some in-home care services have increased for a fifth consecutive year, and could rise further if a shortage of long-term care workers isn't resolved, a new study indicates.

The survey by Genworth Financial Inc., released Tuesday, comes as baby boomers are approaching retirement amid worries that they haven't saved enough to cover day-to-day expenses as well as long-term medical care costs.

The study found that the average annual cost for a private room in a nursing home rose to $76,460, or $209 per day, this year, a 17 percent increase over the $65,185 cost in 2004. Nursing home costs this year ranged from $515 per day in Alaska to $125 per day in Louisiana, the study found.

The cost for assisted living facilities, meanwhile, averaged $36,090 nationally, up 25 percent from $28,763 in 2004. Costs ranged from $4,921 per month in New Jersey to $1,981 per month in Arkansas, the study said.

The study by Genworth Financial, which is based in Richmond, Va., looked at data from more than 10,000 nursing homes, assisted living facilities, and home care providers nationwide. The company sells insurance, including long-term care products.

Buck Stinson, president of Genworth Financial's long-term care insurance business, said the results indicate that "the expense of just a few years of long-term care in a facility or at home can very quickly wipe out a lifetime of savings."

He noted, for example, that an elderly person typically spends 2- 1/2 years in a nursing home, or more than $190,000 on average at today's costs.

He said that individuals, especially the baby boomers born between 1946 and 1964, "need to do more thinking about their own retirement plan and how they're going to age."

Stinson also said there was a need to find ways to "recruit close to 200,000 people a year to keep pace with the aging demographic." A companion Genworth Financial study found that low wages and benefits as well as a lack of training and career-advancement potential have made it difficult to attract workers to the elder care industry and retain them.

The study for the first time also looked at adult day health care and found an average daily cost of $59. That would work out to about $15,000 a year for participation five days a week.

Adult day health care, sometimes at a community-based center, can monitor medication, provide therapy and ensure that people with cognitive problems are watched and don't wander off.

Stinson said these centers were proving popular with families who have elderly parents living in their homes and need daytime support so they can continue jobs, take care of children or just get a break from caregiving.

"It's a convenient outlet ... and obviously less expensive than a full-time facility, so it makes economic sense," Stinson said.

Consumers can compare the costs of various care options on a state-by state basis at Genworth Financial's Web site, http://www.genworth.com/costofcare.

Saturday, April 26, 2008

AMENDMENT 601 LONG TERM CARE

Notwithstanding any general or special laws to the contrary, there shall be a special commission established to examine the Commonwealth’s institutional long term care system, which shall recommend a plan to provide a seamless transition to a continuum of long term care services for elders and persons with disabilities that recognizes the central place of consumer choice and consumer control in any long term care setting; evaluate options and prepare policy recommendations regarding potential savings to the commonwealth achieved by reducing the number of MassHealth licensed nursing home beds; develop recommendations as to the criteria to be used to determine which beds are de-licensed, provided that said criteria shall include at a minimum established Quality Indicators and other quality measures, such as staffing levels, turnover rate and training options for direct care staff; and to consider any programmatic or financial incentives to reduce the number of nursing home beds, convert said beds to subacute beds or other uses, or otherwise more efficiently use the institutional long term care facilities in the Commonwealth. The commission shall examine the eligibility requirements, services, and costs for each state-funded long term care program, including but not limited to nursing homes, assisted living, group adult foster care, rest homes, home care programs, and managed care dual eligible programs; and to make recommendations for organizing the continuum of long term care in a cost-effective way.

The commission shall consist of 18 members, 1 of whom shall be the secretary of health and human services or his designee, 1 of whom shall be the secretary of elder affairs or her designee, 1 of whom shall be the director of the office of Medicaid or her designee, 1 of whom shall be the Attorney General or her designee, 1 of whom shall be the Auditor or his designee, 1 of whom shall be the house chair of the joint committee on elder affairs, 1 of whom shall be the senate chair of the joint committee on elder affairs, 1 of whom shall be the senate chair of the joint committee on health care financing, 1 of whom shall be the house chair of the joint committee on health care financing, 1 of whom shall be a consumers or consumer surrogates member of the PCA quality home care workforce council approved by a majority of the Council, and 8 persons to be appointed by the governor, 1 of whom shall be a health care economist, 1 of whom shall be a representative of 1199SEIU, 1 of whom shall be a representative of the Statewide Independent Living Council, 1 of whom shall be a representative of the Massachusetts Extended Care Federation, 1 of whom shall be a representative of Mass Home Care, 1 of whom shall be a representative of the Mass Alzheimers Association, 1 of whom shall be a representative of MassAging and 1 of whom shall be a representative of AARP. The commission shall be co-chaired by the senate and house chairs of the joint committee on elder affairs.

The commission shall meet within 30 days of passage, and not less than quarterly thereafter, and shall release its first recommendations to the house and senate committees on ways and means no later than December 31, 2008.

Tuesday, April 22, 2008

Traditional Nursing homes VS Green House

Resident Outcomes in Small-House Nursing Homes: A Longitudinal Evaluation of the Initial Green House Program
August 16, 2007
Authors:Rosalie A. Kane, Ph.D., Terry Y. Lum, Ph.D., Lois J. Cutler, Ph.D., et al.
Contact:kanex002@umn.edu
Summary Writer(s):Laura Buchholz and Deborah Lorber view citation e-mail this page
In the Literature
Reforms enacted in the late 1980s helped to improve the health care received by many nursing home residents, but for the most part these changes did not address the larger problem of quality of life. Since then, what is known as the "culture change" movement has gathered force. Its adherents advocate transforming the large, institutional nursing facility into smaller-scale housing with private rooms and baths; empowering frontline workers to be centrally involved in decisions about day-to-day resident care; and implementing the principles of individualized care.

One of the most innovative projects in the culture change field is the Green House®—a radical vision of deinstitutionalized nursing homes. In Green Houses, seniors enjoy privacy, community, and, perhaps most important, an environment designed to look and feel like a real home. In a study comparing health outcomes and quality of life for Green House residents with residents at two traditional nursing homes, Green House residents were found to experience better quality of life, with the same or better quality of care than those in the comparison homes.

The study, "Resident Outcomes in Small-House Nursing Homes: A Longitudinal Evaluation of the Initial Green House Program," (Journal of the American Geriatrics Society, June 2007), was led by researcher Rosalie A. Kane, Ph.D., of the University of Minnesota School of Public Health, and supported by The Commonwealth Fund and the Robert Wood Johnson Foundation.

About Green Houses
Green Houses are self-contained dwellings for seven to 10 residents requiring nursing home levels of care. They incorporate physical design changes such as private rooms and bathrooms, a residential-style kitchen, a communal dining area, and accessible outdoor space. Institutional elements, like medication carts, public address systems, and nurses' stations, are avoided. The model also transforms the hierarchy of the institutional staff, giving wider responsibilities to certified nursing assistants who are supervised by an administrator, or "guide." A visiting clinical team comprises all other professional staff members, such as nurses, doctors, physical therapists, social workers, and others.

For the study, Kane and colleagues interviewed residents, family members, and staff from the Green House in Tupelo, Miss., and two traditional nursing homes nearby (the remaining residents of Cedars Health Care Center, where the Green House was implemented, and Trinity Care). The research team also accessed records from the Minimum Data Set (MDS), which provides clinical data about nursing home residents. The study was conducted between 2003 and 2005.

Quality of Life
Interviewers gathered data on 11 aspects pertaining to quality of life: physical comfort, privacy, dignity, autonomy, ability to enjoy food, spiritual well-being, security, individuality, functional competence, relationships, and ability to engage in meaningful activities. The Green House residents reported better quality of life than Cedars residents on seven measures, and on four measures compared with Trinity residents. Green House residents did not report lower quality-of-life scores than either the Cedars or Trinity residents on any of the 11 measures.

Health, Satisfaction, and Functioning
There was no statistically significant difference in self-reported health, ability to perform activities of daily living (e.g., bathing, dressing, eating, using the toilet) or ability to perform instrumental activities of daily living (e.g., taking medicine, using the telephone, managing money) across the three facilities. However, Green House residents did report significantly higher scores on emotional well-being—indicators such as happiness, contentedness, and looking forward to the future—than did residents at Cedars.

Green House residents, furthermore, expressed greater satisfaction with their institution as a "place to live" than did residents at either of the other two facilities, and as a "place to get care" than did residents of Cedars. They were also more likely to recommend the facility to others. In terms of quality indicators measured by the MDS, Green House residents experienced lower rates of depression, bed rest, reduced activity, and decline in functional abilities than both the Cedars and Trinity groups. The Green House residents did fare worse than one of the comparison settings in terms of rate of incontinence.

Social Activity
With the increased emphasis on individuality and autonomy at Green House facilities, it is perhaps not surprising that residents there were less likely to participate in organized activities than were residents at Cedars and Trinity. Green House residents, however, were more likely to participate in social outings off the grounds. In addition, they were equally as likely to receive phone calls and visits, engage in solo activities, take privately arranged trips, or have overnight guests. "The findings that Green House residents equaled the comparison groups in seven areas of social activity allays concerns that the Green House model offers insufficient resident stimulation," say the authors.

Moving Forward
"The results strongly favor the Green House and suggest that it achieved its stated goals," say the authors. As the Green House model proliferates, more research will be needed to examine the processes of implementation and management for sustaining the innovation. There will likely be no shortage of opportunity for follow-up. Based on its positive experience with the first four Green Houses, the nursing home operator has added six more facilities. In addition, in 2005, the Robert Wood Johnson Foundation began a replication project to open 50 Green Houses within five years.

Facts and Figures

Green House residents reported significantly higher satisfaction with their facility as a place to live than did residents of the other two traditional nursing homes, and better scores on many dimensions of self-reported quality of life.
In terms of care and health outcomes, Green House residents experienced lower rates of depression, bed rest, reduced activity, and decline in functional abilities, but did have higher rates of incontinence than did one of the comparison settings.
Green House residents reported significantly higher scores on emotional well-being indicators.

Citation
R. A. Kane, T. Y. Lum, L. J. Cutler et al., Resident Outcomes in Small-House Nursing Homes: A Longitudinal Evaluation of the Initial Green House Program, Journal of the American Geriatrics Society, June 2007 55(6):832–39

Monday, April 21, 2008

NURSING HOME BUILDINGS

These buildings give those within their walls little reason to suspect that elderhood can be a rich, rewarding phase of human development. Long corridors disable frail people, forcing them into wheelchairs. Massive dining rooms are impersonal and intimidating and promote anxiety. There is limited access to outdoor space. Double rooms (laughably called "semiprivate" rooms) and shared bathrooms invade privacy. Furniture, floor coverings, and drapery are matched consistently throughout, as if the place were a chain hotel rather than the home it is meant to simulate. The grim institutional appearance damages the well-being of staff and residents alike

Tuesday, March 11, 2008

McFadden Manor (exception to rule) Keep Open

AS A MEMBER OF MASS SENIOR ACTION I HAVE BEEN INVOLVED IN MANY SENIOR ISSUES.
RIGHT NOW MASS SENIOR ACTION IS INVOLVED IN FINDING THE BEST ALTERNATIVE FOR CARING FOR OUR AGING POPULATION
ONE OF THE MAIN ISSUES IS DEALING WITH THE "HOUSE OF HORRORS" KNOWN AS NURSING HOMES AND GETTING MORE HUMANE WAYS OF DELIVERING HEALTH CARE THAT THE MAJORITY OF ELDERLY THE FAMILIES AND CARE GIVERS VOTE FOR HOME CARE IN FAMILIAR NEIGHBORHOODS
IN MALDEN WE HAVE FOUND AN "OASIS" TO THE NURSING HOME PROBLEM FOR SATISFACTORY HUMANE AND ADEQUATE
CARE IN A CITY OWNED FACILITY FOR CRITICALLY ILL CLIENTS WHERE A HOME CARE ENVIRONMENT IS PRACTICED
KEEP MCFADDEN MANOR OPEN

Monday, March 10, 2008

Nursing Home Problems

If Nursing Home Problems Occur
Understanding how the nursing home system works, how to solve problems, where to go for help, and the residents' rights are important in getting good care in a nursing home.
Communication Is Key
There are many reasons why nursing home care is not always good. At the first sign of a problem, it is best to discuss it with the nursing home staff. Friendly, open communication and relationships with nursing assistants, charge nurses, the director of nursing, the social workers, the administrator and other staff help keep small problems from becoming big. When a problem comes up or is ongoing, chances are that other families (and residents) are also concerned.
Communication among the families of residents is so important that Medicare and Medicaid nursing homes are required to allow families to form family councils. These councils can meet privately in the facility. Ideally, the council is a place for families to talk freely among themselves. They can present concerns or complaints to staff. Find out if there is an established family council already meeting. If not, start one. Communication is always the best step to avoiding or solving problems.
Periodically, nursing homes must hold care planning meetings. During these, residents' needs and any changes the nursing home should make in their care are discussed. It's important that residents and their families participate in these meetings. The meeting should involve a team of staff members, not just nurses. Ask about the next care planning conference. Ask who will be attending and feel free to request that other staff attend as well (including nursing assistants). The long-term care ombudsman, a member of the clergy or a close friend could also come to the meeting to provide support.
How to Solve Problems
Often families fear that if they complain, someone will take it out on their loved one. Sometimes, out of fear, residents ask family members not to speak up. This is the primary reason families hesitate to complain about poor nursing home care. Nursing home workers themselves say that families who call attention to problems get results. Try the following suggestions to confront problems:
Use the care planning conference to discuss problems with staff. This meeting creates a natural setting to address concerns without raising them to the level of a complaint.
When making a complaint about a staff member to a supervisor, share any concerns about retaliation.
Work with the family council to address problems in the nursing home.
Solving problems can be more affective when working in a group.
If the nursing home is poorly staffed or poorly managed, it may not give good care until residents or their families take the concern to a higher level. If working with the nursing home is not getting the problem solved, never hesitate to take a complaint outside the facility The purpose of your complaint should be to get better care for a loved one and the other residents. It should not be to hurt the facility or its employees. A written record can be very helpful when filing a complaint. Keep track of when the problems(s) occurred and who was involved. These are some places to go for advice or investigation of complaints dealing with nursing homes:
Long-term care ombudsman
Citizen advocacy groups
Legal services
State licensing and certification agency
When the Nursing Home System Fails
If nothing you try improves the care a loved one is receiving, join a citizen advocacy group. If none exists, form one. Ask the family council group for help, and check with the local AAA or ombudsman program about how to get an advocacy group started in your area.
Protecting Rights and Dignity
Too often people lose even the simplest rights when they become nursing home residents:
Privacy when they sleep, bathe, and dress
Freedom to go wherever and whenever they want to visit with friends and relatives
Choice of what they eat or wear
Control of their money
The right to choose their own doctor or make decisions about medical treatment
The Nursing Home Residents' Bill of Rights helps people can keep their privacy and dignity. It protects rights as basic as whether or not staff knock on the door before entering a resident's room. These rights apply to all residents who live in Medicare or Medicaid certified nursing homes.
Neglect and Abuse
Good care is everyone's basic right in a nursing home. Poor care is usually from the nursing homes' failure to have enough qualified licensed nurses and nursing assistants. It is understandable to sympathize with overworked nursing staff, but expectations for good care should not be lowered. Nursing homes must keep an adequate number of qualified staff.
Providing poor quality food, not keeping residents clean and dry, and ignoring a change in a resident's condition are all signs of neglect. Sometimes poor care and neglect may result in dangerous medical conditions. Some signs to watch for are:
Dehydration
Malnutrition
Bedsores (or pressure sores)
Physical restraints
Chemical restraints (Drugs used to control a resident's behavior)
Contractures (Muscles that are becoming too stiff to move easily)
Abuse sometimes happens in nursing homes. Sometimes residents are hurt physically or psychologically. Do not accept behavior toward a loved one that is abusive, including rough treatment or unkind words during or in between care. If supervisory staff do not act immediately to fix a problem, contact one or more of the following authorities:
The long-term care ombudsman
The local adult protective services agency
The police
Nursing homes should be a place where loved ones get the care they need. Working together, families can make nursing homes better.
AARP Resources

United States Nursing Homes

In the United States, nursing homes are required to have a licensed nurse on duty 24 hours a day, and during at least one shift each day, one of those nurses must be a Registered Nurse. In April, 2005 there were a total of 16,094 nursing homes in the United States, down from 16,516 in December, 2002. Some states have nursing homes that are called nursing facilities (NF), which do not have beds certified for Medicare patients, but can only treat patients whose payments source is Private Payment, Private Insurance or Medicaid.

[edit] Services
Services provided in nursing homes include services of nurses, nursing aides and assistants; physical, occupational and speech therapists; social workers and recreational assistants; and room and board. Most care in nursing facilities is provided by certified nursing assistants, not by skilled personnel. In 2004, there were, on average, 40 certified nursing assistants per 100 resident beds. The number of registered nurses and licensed practical nurses were significantly lower at 7 per 100 resident beds and 13 per 100 resident beds, respectively.
Nursing facilities that participate in the Medicare and Medicaid programs are subject to federal requirements regarding staffing and quality of care for residents.[1] In 2004, 98.5% of the 16,100 nursing facilities nationwide were certified to participate in Medicare, Medicaid, or both.
Medicare covers nursing home services for beneficiaries who require skilled nursing care or rehabilitation services following a hospitalization of at least three consecutive days. The program does not cover nursing care if only custodial care is needed — for example, when a person needs assistance with bathing, walking, or transferring from a bed to a chair. To be eligible for Medicare-covered skilled nursing facility (SNF) care, a physician must certify that the beneficiary needs daily skilled nursing care or other skilled rehabilitation services that are related to the hospitalization, and that these services, as a practical matter, can be provided only on an inpatient basis. For example, a beneficiary released from the hospital after a stroke and in need of physical therapy, or a beneficiary in need of skilled nursing care for wound treatment following a surgical procedure, might be eligible for Medicare-covered SNF care.
SNF services may be offered in a free-standing or hospital-based facility. A freestanding facility is generally part of a nursing home that covers Medicare SNF services as well as long-term care services for people who pay out-of-pocket, through Medicaid, or through a long-term care insurance policy. Generally, Medicare SNF patients make up just a small portion of the total resident population of a free-standing nursing home.
Medicaid also covers nursing home care for certain persons who require custodial care, meet a state's means-tested income and asset tests, and require the level-of-care offered in a nursing home. Nursing home residents have physical or cognitive impairments and require 24-hour care.
Almost no one can afford to pay for nursing home care "out of pocket." They cost $5,000 per month or more. Some deplete their resources on the often high cost of care. If eligible, Medicaid will cover continued stays in nursing home for these individuals. However, they require that the patient be "spent down" to poverty levels first, thus depleting their life savings.

[edit] Government regulations and oversight
All nursing homes in the United States that receive Medicare and/or Medicaid funding are subject to federal regulations. People who inspect nursing homes are called surveyors or, most commonly, state surveyors.
The Minimum Data Set (MDS) is part of the U.S. federally mandated process for clinical assessment of all residents in Medicare or Medicaid certified nursing homes. This process provides a comprehensive assessment of each resident's functional capabilities and helps nursing home staff identify health problems.
For United States homes, the Centers for Medicare and Medicaid Services has a website which allows users to see how well facilities perform in certain metrics (see "Nursing Home Compare Tool" in the external link section below).
Care homes for adults in England are regulated by the Commission for Social Care Inspection.
Nursing homes are subject to federal regulations and also strict state regulations. The nursing home industry is considered one of the two most heavily regulated industries in the United States (the other being the nuclear power industry).[2]

[edit] Consumer choices
Current trends are to provide people with significant needs for long term supports and services with a variety of living arrangements. Indeed, research in the U.S as a result of the Real Choice Systems Change Grants, shows that many people are able to return to their own homes in the community. Private nursing agencies may be able to provide live-in nurses to stay and work with patients in their own homes.
When considering living arrangements for those who are unable to live by themselves, it is important to carefully look at many nursing homes and assisted living facilities as well as retirement homes, keeping in mind the person's abilities to take care of themselves independently. While certainly not a residential option, many families choose to have their elderly loved one spend several hours per day at an adult daycare center.
Beginning in 2002, Medicare began hosting an online resource known as Nursing Home Compare (see the "External Links" section at the bottom of the page). The program is intended to foster quality improving competition between nursing homes. Informed consumer choice has long been missing from decisions regarding the placement of the elderly in need.
The website My Patient Guide provides a directory of New Jersey nursing homes and assisted living communities, along with a question-and-answer section.

[edit] Trends
Nursing homes are beginning to change the way they are managed and organized to create a more resident-centered environment, so they are more "home-like" and less "hospital-like." In these homes, nursing home units are replaced with a small set of rooms surrounding a common kitchen and living room. The staff giving care is assigned to one of these "households." Residents have far more choices about when they awake, when they eat and what they want to do during the day. They also have access to more companionship such as pets. Some organizations working toward these goals are the Greenhouse nursing home, the Pioneer Network, and the Eden Alternative. Many of the facilities utilizing these models refer to such changes as the "Culture Shift" or "Culture Change" occurring in the LTC industry.

[edit] Quality of life

This article does not cite any references or sources. (February 2007)Please help improve this article by adding citations to reliable sources. Unverifiable material may be challenged and removed.

[edit] Resident-oriented care
Resident oriented care is where nurses are assigned to particular patients and have the ability to develop relationships with individual patients. Patients are treated more as family, as opposed to random patients. Using resident-oriented care, nurses are able to become familiar with each patient and cater more to their specific needs, whether they be emotional or medical.

[edit] Scientific findings
According to various findings residents who receive resident-oriented care experience a higher quality of life, in respect to attention and time spent with patients and the number of fault reports after the introduction of Primary Nursing. Although resident-oriented nursing does not lengthen life, nursing home residents are able to connect with someone, which allows them to dispel many feelings of loneliness and discontent.
"Resident assignment" refers to the extent to which residents are allocated to the same nurse. With this particular system one person is responsible for the entire admission period of the resident. However, this system can cause difficulties for the nurse or care-giver should one of the residents they are assigned to pass away or move to a different facility, as the nurse/caregiver may become attached to the resident(s) they are caring for.
In coming to this conclusion three guidelines must be assessed: structure, process and outcome. Structure is the assessment of the instrumentalities of care and their organization; Process being the quality of the way in which care is given; Outcome being usually specified in terms of health, well being, patient satisfaction, etc. Using these three criteria find that are strengthened when residents experience resident oriented care.
Communication is also heightened when residents feel comfortable discussing various issues with someone who is experienced with their particular case. In this particular situation nurses are also better able to do longitudinal follow up, which insures the implementation of more lasting results.
Various findings suggest that task-oriented care produces less satisfied residents. In many cases, residents are disoriented and unsure of who to disclose information to and as a result decide not to share information at all.
Patients usually complain of loneliness and feelings of displacement.
"Resident assignment" is allocated to numerous nurses as opposed to one person carrying the responsibility of one resident. Because the load on one nurse can become so great, various nurses are unable to identify with gradual emotional and physical changes experienced by one particular resident. Resident information has the ability to get misplaced or undocumented because of the numerous amounts of nurses that deal with one resident.[citation needed]

[edit] Task-oriented care
Task oriented care is where nurses are assigned specific tasks to perform for numerous residents on a specific ward. Residents in this particular situation are exposed to multiple nurses at any given time. Because of the random disbursement of tasks, nurses are declined the ability to develop more in depth relations with any particular resident.

[edit] United Kingdom

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