December 2008
1. Please join us at our next statewide meeting on Saturday, January 31, 2009 from 10:30-2:30 at the Library of Michigan Lake Superior Room, 717 West Allegan, Lansing. We will be revising our legislative priorities for the new state legislature and planning our Campaign Day at the Capitol at our next meeting, as well pursuing several other advocacy issues. Please also mark your calendars to join us at our next two meetings: March 21 and May 23 at the same times and place. We love to welcome new members and see old friends! If you plan to attend, please RSVP to Alison Hirschel at hirschel@lsscm.org or 517-324-5754 by January 28, 2009. We need you to be part of our plans and discussions! Join us!
2. Federal Nursing Home Compare Site Set to Begin Rating Nursing Homes on a Five Star System On December 18, the Centers for Medicare & Medicaid Services (CMS) will add a new feature to its Nursing Home Compare website: it will assign a rating of between one and five stars to every nursing home in the country that receives Medicare or Medicaid funding. This rating system will be based on three measures: inspection ("survey") results for the past three years; staffing; and quality measures for long stay residents related to pressure sores, restraints, catheters, pain, urinary tract infections, and reductions in residents� functional abilities and mobility. Because inspectors might differ from state to state, CMS will compare nursing home survey results only to survey results of other homes in the same state. Initially, the data on staffing and quality measure will be based on information that facilities self-report and that is not monitored, but advocates hope that CMS will eventually obtain more reliable data.
A facility that earns a five star rating will not be the equivalent of a five star restaurant, however. Top marks mean only that the facility has done a better job than other facilities in meeting minimum standards and that it alleges it has higher staffing and better outcomes than other facilities, not that it has been independently determined to provide exceptional service.
Although advocates have had concerns that the five star rating could be misleading and inappropriately simplify the complex issue of assessing nursing home quality, consumers can count one major victory in this new development. No facility can earn five stars unless it offers at least 4.08 hours of staffing (Registered Nurse, Licensed Practical Nurse, and nursing assistant hours combined), on average, to each resident each day. Moreover, that total number of hours must include at least .55 hours of RN time. That 4.08 hour minimum standard was recommended after a 10 year long federally funded study of nursing home staffing in 2001. At the time, the federal government was unwilling to accept the recommendation but it will finally be utilized in the five star rating system. While advocates believe that 4.01 hours of care per resident per day is only a minimum standard, not the basis for a top rating, we appreciate that the federal government has finally officially recognized this important benchmark and hope it will encourage the 90 percent of facilities across the country that do not meet this standard to improve their staffing levels.
To find the Nursing Home Compare website, go to www.medicare.gov and scroll down the page. Click on "Compare Nursing Homes in Your Area" on the right hand side of the page. Follow the instructions to see information on the facilities in which you are interested. The website contains voluminous information on each facility including its past three inspection reports, quality measures, fire safety violations, how many beds the facility has, staffing, and other information.
3. Campaign dives into more advocacy on issues related to wheelchair use in nursing homes � The Campaign continues to work on the issue of Medicaid funding for custom made or modified wheelchairs for nursing home residents. These custom modifications are often necessary for residents to have proper posture and positioning in their chairs (to prevent them choking on their food, for example, or from developing pressure sores from sitting in one position for too long), for mobility, dignity and autonomy, safety, and other reasons. Although we persuaded the Department of Community Health not to issue a proposed policy earlier in the year that would have virtually ended funding for custom made or modified chairs for nursing home residents, the state has not yet issued a new policy. We now understand that a number of requests for approval of funding for these chairs continue to be denied and that the state is still using a different and more restrictive standards for approving requests for these expenses for nursing home residents than for residents of assisted living facilities or individuals who live at home. The Campaign, along with other advocates and the State Long Term Care Ombudsman program, is continuing to press for fair and appropriate policy on this issue. If you are aware of a Medicaid funded resident who needs a custom made or modified wheelchair but is not receiving it, please contact Alison Hirschel at 517-394-2985, ext. 231 or email her at hirschel@umich.edu.
On a related topic, we understand that a number of facilities are refusing to admit applicants who use power wheelchairs or barring individuals in nursing homes from using their power chairs. The facilities are apparently concerned about the possibility that residents using the power chairs will run into other people in the hallways or damage the facility by steering their chairs carelessly. The inability to use the power chair causes severe health and safety risks to individuals who need those chairs as well as needlessly and cruelly restricting their mobility and autonomy. In one recent case, a facility turned a resident�s chair to the manual mode and then, during a tornado watch, inadvertently left the resident alone in front of a plate glass window in a lounge for 45 minutes. Because the very alert resident could not move her chair by herself after the facility turned off her power, she was unable to move to a safer location. The Campaign is interested in hearing about other cases involving restrictions on the use of power chairs. We believe barring individuals from using their chairs violates the law. Please contact Alison (see above) if you know of cases in which individuals who want to use their power chairs are not permitted to do so.
4. Bureau of Health Systems Director, Mike Dankert, to retire Mike Dankert, the Director of the Bureau of Health Systems which is the state agency responsible for regulating nursing homes will be retiring at the end of the year. Mike has a very tough job and far too little staff to adequately oversee the state�s more than 400 nursing facilities. Nevertheless, Mike has been diligent in his efforts to protect residents, attempted various innovations to address his staffs overwhelming workload, and worked collaboratively with advocates. He has often faced fierce opposition from the nursing home industry as well as significant criticism from consumers and has not had sufficient support within state government. The Campaign wishes him well in his retirement and will urge Janet Olszewski, the Director of the Department of Community Health, to name a very strong and capable individual to replace Mike and to provide the Bureau of Health Systems with the staffing and support it needs to do its job well in the future.
5. Is your assisted living facility licensed? Consumers are often unaware if an assisted living facility is licensed and regulated by the state or how to file a complaint against a facility. In Michigan, assisted living facilities can be adult foster care homes or homes for the aged, which are licensed and regulated by the state, or they can be unlicensed assisted living facilities that are not regulated. The easiest way to determine a facility�s status is to check the Department of Human Services website, "Statewide Search for Adult Foster Care/Homes for the Aged Facilities," http://www.dleg.state.mi.us/brs_afc/sr_afc.asp. (Note: Although the Michigan Department of Community Health regulates nursing homes, the Department of Human Services (DHS) regulates licensed assisted living facilities.) You can also go to www.Michigan.gov and type in "Adult Foster Care licensing" in the search box. This will bring you to a web page that has a lot of information about adult foster care and homes for the aged, including information on residents� rights and placing a resident in a facility. If you scroll down to "License Lookups," you will be able to determine if a facility is licensed.
If an assisted living facility is licensed in the state, you can file a complaint with the Office of Children and Adult Licensing at DHS by calling a toll free number: 1-866-856-0126. You can also write to Bureau of Human Services, Office of Children and Adult Licensing, Complaint Intake Unit, 7109 W. Saginaw, 2nd Floor, P.O. Box 30650, Lansing, MI 48909. You can also file a complaint on-line at the Department of Human Services website. Finally, if a facility is licensed, you can seek help from the State Long Term Care Ombudsman Program: 1-866-485-9393.
6. The Campaign thanks its recent generous donors! Thanks so much to Lannette M. Nabb, Lois Stegman, John K. Dunn, Lottie M. Surmacz, Jean Schultz, and J. Herbert Cox for their generous support. We were particularly pleased to hear from Lannette who was one of the original members of the Campaign and whose support and determination helped launch our efforts. Lannette recalls that one of our first meetings was in her basement more than a decade ago! Please continue to send your tax deductible donations to: the Michigan Campaign for Quality Care, c/o Paul VanWestrienen, Treasurer, 359 Park Ave., Parchment, MI 49004.
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The Campaign wishes Happy Holidays to all and shares your commitment to ensuring 2009 brings better care, better quality of life, and better choices for Michigan�s long term care consumers!