• Resident Choice of Health Professionals

DADS reminded Assisted Living Facilities (ALFs) and Home and Community Support Services Agencies of a resident’s right to choose and contract with his or her own health care professionals. According to DADS, ALFs must specify in the facility resident admission agreement any requirements the facility imposes on non-facility staff entering the facility and delivering services to residents. See the two-page letter for details.

• Critical Incident Reporting

DADS informed Home and Community-based Service (HCS), Texas Home Living (TxHmL), and Intermediate Care Facilities for Persons with Mental Retardation (ICFs/MR) providers about critical incident reporting requirements changes, which are designed to allow DADS to annually report aggregate data required by the Health and Human Services Commission. The changes are effective September 1, 2009. Providers must begin collecting data on August 1, 2009, and data entry must occur no later than September 30, 2009. Download each letter with attachments for more information:

• HCS (14 pages)
• TxHmL (14 pages)
• ICFs/MR (13 pages)

Congress is considering the Fairness in Nursing Home Arbitration Act of 2008, which make pre-admission arbitration agreements invalid and unenforceable. The House Judiciary Subcommittee on Commercial Law and Administrative Law just approved the bill and refused amendments which would prevent it from being applied retroactively, among other things.

Specifically, the bill:

…requires that agreements to arbitrate nursing home disputes be made after the dispute has arisen and not at the time of admittance into the home. While the new Act does not prohibit arbitration in nursing home disputes, it does prevent a nursing home corporation—which typically has greater bargaining power–from forcing residents and their families into arbitration via a non-negotiable contract that was forced on the resident prior to the dispute. The Act also ensures arbitration occurs on a voluntary basis and is not forced.

The bill now moves to the Senate Judiciary Committee and will be heard on Thursday, July 31st beginning at 10 A.M. E.T..

According to a memo to Regulatory Service Regional Directors and State Office Managers, surveyors must accept and display in a conspicuous location a preprinted resident rights poster issued to Skilled Nursing Facilities and Nursing Facilities through the Long-Term Care Ombudsmans Program and DADS’ Regulatory Services.

Facilities also must give residents and their families a copy of the rights statement upon admission. For more information, download the memo.

ABC News has released footage of a health care worker beating a resident whom, it appears, was not cooperating with attempts to care for him. The beating appears quite vicious. The family had, unknown to facility staff, installed a hidden camera in the room of the resident, who resides in a Baltimore, Maryland nursing home.

As you know, here in Texas, the law addresses covert monitoring–but lays out no real and affirmative sanctions against residents and family members who do it. So, beware and actively verify that your staff is not abusing residents, or you may find that your facility is subject to an ABC news story complete with video.

Amendment 747 revises the methodology used by the State to estimate the Medicaid Upper Payment Limit (UPL) for hospital inpatient services. The UPL is the federal limit on Medicaid payments to a group of hospitals and is determined under Federal regulations as a reasonable estimate of the amount that would be paid for the Medicaid services or similar services using Medicare payment principles.

On behalf of the Texas Department of Aging and Disability Services, HHSC proposes a new subchapter to the Texas Administrative Code, Rights Of Individuals With Mental Retardation.

The new subchapter will “clarify the requirements” for a state mental retardation facility (MR) and a mental retardation authority (MRA) concerning their responsibilities for telling individuals with mental retardation about their rights and educating staff about those rights. MRs and MRAs must also hire a rights protection officer, whose job will be to protect individuals’ rights.

For more information, see the relevant section of the September 8 Texas Register.

KidneyNotes.com posts about the new CPR guidelines. As the post notes, the highlights are:

*The ratio of compressions-to-ventilations has been changed to 30:2
*Rescuers now deliver 1 shock (360J monophasic) followed by CPR, not 3 shocks
*Lay rescuers no longer check for circulation
*Many other algorithms have been simplified

These are published in the Nov 29, 2005 issue of Circulation.

KidneyNotes has formatted some easy links to the above for you to read. Click here to see what I mean. (HT Grand Rounds at Corante)

Back last November, I wrote about rumblings in Florida to require criminal background checks on prospective resident. In Illinois, they’ve apparently passed such a law and are now about to suffer the consequences:

Emergency rules implementing the recently signed legislation require all 100,000 current nursing home residents to undergo a criminal background check and be checked against sex offender databases maintained by the Illinois State Police and the Illinois Department of Corrections. The same requirements apply to new admissions.

–snip–

A spokeswoman for a statewide nursing home association said the new rules are going to turn a delicate family decision into a gut-wrenching experience.
“It’s difficult enough to decide to put an elderly relative in a nursing home,” said Pat Comstock of the Illinois Health Care Association. “But then to have your elderly grandmother or grandfather subjected to a criminal background check is even more difficult.”

And then there is this:

Although the State Police and DOC databases can be easily checked from any computer equipped with Internet access, requests for criminal background checks submitted electronically to the State Police can take up to three days and cost $10. If submitted manually on paper, they can take up to a few weeks and cost $16, according to State Police spokesman Rick Hector.

More than 50 percent of new admissions to nursing homes come directly from hospitals, Comstock said. (emphasis added)

Do you think those hospitals will keep the patients for the days (or weeks) it will take to do this check?

The New York Times published a piece about a study raising questions about its safety:

Patients taking Plavix, a popular and expensive antistroke drug, experience more than 12 times as many ulcers as patients who take aspirin plus a heartburn pill, a study to be published today in The New England Journal of Medicine found.

Up to half of those now taking Plavix do so because their doctors assume that Plavix is safer on the stomach than aspirin, said Dr. Francis K. L. Chan, the study’s lead author. Both the American College of Cardiology and the American Heart Association recommend that heart and stroke patients at risk of developing ulcers be given Plavix instead of aspirin.

Here is a description of how Dr. Chan conducted his study:

Dr. Chan said he was surprised to find that almost no studies had been done to confirm whether this assumption was true. He found 320 patients whose ulcers had healed and gave half of them Plavix and half of them aspirin plus Nexium, a heartburn pill. He followed them for a year.

However, the physician blogger over at DB’s Medical Rants puts this study in perspective:

Reports like this make the news, especially the financial news. The challenge that clinicians and clinician scientists must understand involves putting each new data piece into perspective. Several questions come to mind immediately, prior to reading the remainder of the article:

• Would PPIs (proton pump inhibitors) also decrease ulcer rates in Plavix treated patients?
  
• Which patients really benefit from Plavix?
  
• What duration of therapy should we use?
  
• How important were the ulcers (did they bleed, cause pain, or were they “incidental” findings)?
  
• Thirteen of the patients taking Plavix, or 8.6 percent, experienced renewed ulcer bleeding during the year while just one, or 0.7 percent, of those taking aspirin and Nexium had an ulcer bleed.

  –Snip–

This is the wrong study. The results make Plavix look bad, but it does not answer the key questions:

• Given a patient with NO ulcer history – does Plavix induce ulcers?
• How would a combination of Plavix + a PPI compare with ASA + a PPI in patients with previous ulcer?

We clearly should understand the risks of Plavix, but this article does not really help. Most patients who receive Plavix, do so for clear indications. We need to understand side effects in patients who resemble our patient populations.

On November 15, 2004, CBS news reported on an incident involving alleged resident-on- resident sexual abuse in a Florida nursing home. The resident-suspect, a man in his 80′s, had been found wandering the streets by Florida law enforcement. A Florida court declared him a “vulnerable adult … in need of protective services.” Thus, the officials caused him to be admitted to the nursing home–where he allegedly sexually abused another resident.

Buried further down in the story, it is noted that Florida officials did not know of the resident’s criminal background–and those officials emphasized that criminal background checks of residents is not required.

The story also talks about a nursing facility in Minnesota that was shut down as a result of the actions of geriatric prisoners transferred to those homes:

Minnesota’s Atttorney General Mike Hatch just shut down one nursing home after sex offenders transferred from prisons were caught fondling, beating and sexually assaulting other residents.

“What the hell is going on here? How could you put sex offenders in with vulnerable adults?” says Hatch. “You put them in a locked ward with the women locked in?”

When you read this story, notice that the other side of the stories–those of the nursing homes–is not told. In the case of the Florida incident, that is because the family is suing the nursing home. CBS is, therefore, carrying water for the plaintiff’s personal injury lawyer. Would it be too much for a competent journalist to ask why those in the best position to get criminal information–like the Court and law enforcement didn’t do that before placing the man? Do you wonder what those official’s reactions would have been had the facility requested such information before agreeing to admit?

As for the Minnesota situation–wouldn’t a competent journalist interested in adhering to the Code of Ethics for Professional Journalists have seen fit to discuss exactly how those facilities got those prisoners and what information was given regarding the backgrounds of the prisoners? Doesn’t the situation suggest to a reasonable person that the Minnesota Prison System had a problem dealing with geriatric prisoners and looked outside the system for help–and shouldn’t that be discussed in the story? Naah…it’s much more gratifying to blame nursing homes and attribute outcomes like this to reasons such as:

The answer may be money. When prisoners of all ages fill empty nursing home beds, Medicaid or Medicare pays the bill.

So, the next time a governmental entity or probate court seeks to do you a favor by providing you admissions–remember this story and take precautions to protect yourself and your facility. (like insisting on full information)