November 2007

1. Please join us at our next statewide meeting on Saturday, November 17, 2007 from 10:30-2:30 at the Library of Michigan Lake Superior Room, 717 West Allegan, Lansing. We love to welcome new members and see old friends! If you plan to attend the November meeting, please RSVP to Alison Hirschel at hirschel@umich.edu or 517-324-5754 by November 14, 2007. We will be discussing important issues including how we can assist in advocacy efforts to prevent declining care at Manor Care facilities (see # 4 below), support a proposal that the state considers a nursing home chain’s history of quality care when it decides whether to permit the chain to expand, on-going advocacy efforts to expand home and community based care as an alternative to nursing home care, and much, much more. We need you to be part of these important plans and discussions! Join us!

2. It’s official! The Campaign receives approval as a public charity from the I.R.S.. All contributions will now be tax deductible! Thanks to the efforts of Campaign treasurer Paul VanWestrienen and members John Weir and Linda Phillips, the Campaign has now been recognized by the Internal Revenue Service as a public charity and a tax exempt organization. Paul has also registered the Campaign with the Office of the Attorney General. So...now we are asking you to do your part to support the Campaign. Unlike most organizations, we charge no membership fee or annual dues. But we are in urgent need of funds to continue to print and mail our newsletters, produce informational brochures and materials on a variety of topics, pay for mailings to legislators and other policymakers, support Campaign members’ attendance at important conferences, pay membership dues in other organizations with which we partner on advocacy efforts, maintain our website, etc. We need your help!!  Please send today as generous a donation as you are able to: the Michigan Campaign for Quality Care, c/o Paul VanWestrienen, Treasurer, 359 Park Ave., Parchment, MI 49004. 

3. Another way to help the Campaign–receive our newsletter electronically and help us save printing and postage! –Many of our members receive our newsletter electronically, thus saving us printing and postage costs. If you have access to email and are willing to receive newsletters electronically instead of by mail, please contact our secretary, Carole Newburry, at cjnewb@mei.net. Thanks!! 

4. Campaign joins effort to stop private equity firm from purchasing 27 Michigan HCR Manor Care nursing homes–-Advocates across the country are joining forces with SEIU Healthcare (a union representing direct care workers) to fight the proposed purchase of HCR Manor Care by the Carlyle Group, one of the world’s largest private investment firms. Advocates’ concerns arise because the buy-outs are designed to create greater profits, not improved care or quality of life for Manor Care residents. In fact, the experience of other nursing home chains that have been purchased in recent years by private investment companies sounds a deeply troubling warning. On September 23, 2007, the New York Times ran a front page article entitled, "At Many Homes, More Profits and Less Nursing." According to this meticulously researched report:

• Private equity firms over the last six years have acquired nursing homes and then routinely cut costs by reducing staffing and budgets for supplies and resident activities; 

• Residents at homes acquired by large private investors generally suffer more often from depression, loss of mobility, and loss of ability to engage in activities of daily living than residents of other nursing homes;

• Many homes that performed above the national average on issues like skin breakdown, preventable infections, and restraint usage before their acquisition by private investors scored below the national average after their acquisition; 

• At 60 percent of the homes acquired by private equity firms between 2000 and 2006, clinical registered nurses were cut and, on average, homes owned by private investors offered residents 35% fewer hours of care by registered nurses than the national average;

• Serious quality of care deficiencies rose at every large nursing home chain after it was acquired by a private investment group from 2000-2006. The typical number of serious health deficiencies at homes owned by large investment companies was almost 20 percent higher than at other nursing homes.

Moreover, the Carlyle Group’s own experience in healthcare raises concerns. Carlyle owns LifeCare Hospital group, the defendant in a class action lawsuit that alleges a LifeCare hospital was understaffed and poorly prepared during Hurricane Katrina, resulting in the deaths of 24 patients who were awaiting evacuation.

But the bad news does not end there. When private investment firms buy nursing home chains, the corporate structure becomes increasingly complex and hard to track, shielding those firms from liability in lawsuits concerning abuse and neglect of residents and making regulation of the chains more difficult. In addition, according to research by SEIU Healthcare, the buy-out will make HCR Manor Care more fragile financially and load it down with huge debt. And the buy-out is likely to result in extraordinary windfalls for Manor Care’s executives and advisors. For more information on the Carlyle Group buy-out effort, go to http://carlylefixmanorcarenow.org/. 

Before the Carlyle Group can assume responsibility for Michigan’s 27 Manor Care homes, the state must approve both certificates of need and a change of ownership. Advocates have urged Janet Olszewski, the Director of the Michigan Department of Community Health, to deny these requests and urged policy makers to hold hearings on this issue. If the state does approve the requests, the Campaign has asked Ms. Olszewski to assure that no Manor Care facility reduces staffing after the change of ownership; that the facilities staff at the level of 4.1 hours/resident/day which is recommended by a federal study as the minimum required to meet residents’ needs; that facilities do not reduce any training or orientation for staff; that facilities engage in sincere and significant efforts at culture change to create more homelike and progressive environments; and that all beds in Manor Care facilities become and remain dually certified for Medicare and Medicaid. 

Advocacy has already been effective at the federal level, since the buy-out affects Manor Care facilities in a number of states. Rep. John Dingell, D-(Dearborn) MI, chairman of the House Energy and Commerce Committee, and Rep. Barney Frank, D-Mass., chairman of the House Financial Services Committee, announced they will hold hearings in their respective committees to examine the proposed buy-out. In addition, U.S. Senate Finance Committee Chairman Max Baucus (D-Mont.) and the committee’s ranking Republican member, Sen. Charles E. Grassley (R-IA), sent letters to Carlyle and four other private-equity firms asking for information related to their ownership and management of nursing homes. The committee will likely hold hearings on the issue and may introduce legislation. Senators Baucus and Grassley also sent a letter to the Centers for Medicare and Medicaid Services, the federal agency responsible for overseeing nursing home inspections, asking it to account for a report of higher health and safety violations in nursing homes that have been bought by private-equity investors.

As a result of all the pressure and attention, the Carlyle Group has issued a pledge to provide quality care to residents and to provide adequate training for staff but many health care experts do not have much faith in the Carlyle promise. In Michigan, SEIU Healthcare, the Campaign, State Ombudsman Sarah Slocum and a number of other groups including the Michigan Disability Rights Coalition; the ARC Michigan; the Michigan Association for Justice; the Area Agencies on Aging Association of Michigan; and numerous Michigan lawmakers will continue their advocacy to assure the safety of residents of Manor Care facilities.

What you can do to stop the Carlyle Group takeover of Manor Care facilities and fight declines in care and staffing: Contact Michigan Department of Community Health Director Janet Olszewski (olszewskiJD@michigan.gov or write to her at: Capitol View Building, 201 Townsend Street Lansing, Michigan 48913) and Governor Granholm (go to www.michigan.gov/gov and click on "contact the Governor" or write to: Governor Jennifer M. Granholm, P.O. Box 30013, Lansing, Michigan 48909 or call (517) 373-3400) as well as your state and federal legislators to express your concern over the Carlyle Group’s proposed purchase of HCR Manor Care. 

5. New law requires estate recovery; state will seek to recover funds spent to provide Medicaid funded nursing home and MiChoice services from the estates of some individuals–-Under federal law, states are required to attempt to recoup some of the Medicaid funds spent to provide care and services to nursing home residents and home and community based care participants after their deaths. Although Michigan had long avoided this federal mandate–and was the only state not to enact estate recovery–a new law, Public Act 74, was enacted on September 30, 2007 that creates a limited estate recovery program for the state. Due to the advocacy of elder law attorneys and others, the law is far less aggressive than we previously feared although a number of questions remain regarding how it will be implemented. The new law will not apply to individuals who received Medicaid funded nursing home care or MiChoice services before October 1, 2007 and may not apply to individuals who begin receiving services for some period after that date. It applies only to assets that remain in the individual’s probate estate although many individuals have assets that do not pass through probate. In addition, the law appears to exempt 50 percent of the average value of a home in the county in which the recipient’s home was located, family farms and businesses, and homes in which certain relatives reside. The Department of Community Health is required to provide written information to individuals who will be affected by this new law. Recipients and their families may wish to seek guidance from attorneys with expertise in this area to determine whether and how the new law will affect the estates of Medicaid recipients in nursing homes or MiChoice.

6. Campaign awards Second Annual Courage and Heart Awards–On October 11, the Campaign was proud to present this year’s Courage and Heart awards during the annual conference of the Elder Law and Disability Rights section of the State Bar. The recipients were: elder law attorney Doug Chalgian for his on-going support of the Campaign and his outstanding service on the Ombudsman Advisory Group, the Nursing Home Standards Advisory Committee of the Certificate of Needs Commission, and the Alzheimer’s Association board; Assistant State Long Term Care Ombudsman Brad Geller for his lifelong commitment to and expertise in championing the rights of individuals in the guardianship system and other vulnerable individuals; and RoAnne Chaney for her outstanding leadership on the Governor’s Medicaid Long Term Care Task Force, her ability to bring advocates for the elderly and advocates for people with disabilities together, and her brilliant and effective advocacy for long term care consumers.

7. Campaign members go to Washington–Campaign officers Bill Mania, Carole Newburry, and Paul VanWestrienen and members Toni Wilson, John Weir, Jean Schultz and Alison Hirschel all attended the 32^nd Annual Meeting of NCCNHR –the National Consumer Voice for Quality Long Term Care on October 20-24 in Arlington, Virginia. Other Michigan advocates present included State Long Term Care Ombudsman Sarah Slocum, local ombudsman Dawn Jacobs, Ombudsman consultant Sara Hunt, and PHI State Director Hollis Turnham. The conference draws ombudsman, citizen advocacy groups like the Campaign, and national experts on long term care for three intense days of training on diverse topics concerning long term care, sharing advocacy successes and challenges, and meeting with national policymakers. On the last day, participants attended a session on Capitol Hill with members of Congress to celebrate the 20^th anniversary of the landmark federal Nursing Home Reform Law and to talk about new goals for federal legislation on long term care.

      For information on NCCNHR and to tap its many resources for consumers, go to www.nccnhr.org.