Michigan Campaign For Quality Care

Newsletter

January, 2005

1. Please join us at our next statewide meeting on January 15, 2005– We will meet from 10:30 - 2:30 at the Library of Michigan, 717 West Allegan, Lansing. If you plan to attend, please call Alison Hirschel at 517-324-5754 or email her at hirschel@umich.edu by January 12 so we know how much food to order for lunch! Hope everyone had safe, happy holidays and is ready for another energetic year of seeking better care, better quality of life, and better options for Michigan’s long term care consumers!!

2. Campaign members make poignant and effective presentations at the Governor’s Task Force on Long Term Care meetings– Campaign members Nadene Mitcham, Carole Newburry, and John Weir each gave excellent and compelling testimony to the Governor’s Task Force on Long Term Care at the Task Force’s November and December meetings. Both Nadene and Carole talked about their distressing personal experiences with long term care when their mothers required institutional care. Nadene focused on the importance of nursing homes providing rehabilitative care and adequate discharge planning and suggested improvements in the way the state handles nursing home closures. Carole talked about homes that were cited for the same deficiencies year after year and suggested ways to improve the state survey and enforcement process. John Weir, who is also a local ombudsman from Kalamazoo, drew on his many years of experience to educate the Task Force about current problems in nursing homes and expressed concern about discrimination in nursing home admissions .

The Task Force will continue to meet every month through April, 2005. If you would like to share your story and your suggestions, please plan to attend the Task Force meetings on January10, or those tentatively scheduled for February 14, March 14, and April 11. Testimony should be only about 5-10 minutes long and can focus on any area of long term care including assisted living, nursing homes, home health care, home and community based services, and other issues. Meetings generally last from 9:30 - 3:30 and public comment is scheduled at 1 p.m. Meeting locations change, but information is available at the Task Force web site http://www.ihcs.msu.edu/LTC/default.htm. The January 10 meeting will be held in the Lake Ontario Room of the Library of Michigan, 717 West Allegan, Lansing.

The January 10 Task Force meeting should have a special focus on nursing home quality and on the state’s licensing, survey, and enforcement system for nursing homes. The Task Force has invited Sarah Slocum, State Long Term Care Ombudsman, and Walt Wheeler of the Michigan Department of Community Health to testify about these issues.

3. Legislature fails to pass nursing home temperature control bill – The Michigan Senate failed to consider H.B. 5537, the nursing home temperature control bill, before the end of the legislative session. The bill, which was intended to ensure that nursing homes maintained comfortable temperatures between 71 and 81 degrees, had been substantially weakened when it passed in the Michigan House of Representatives earlier this year. Since it was not voted out of the Senate before the end of the legislative session, it will have to be reintroduced in 2005 if it is to be considered by the new legislature. The Campaign has long supported efforts to make sure nursing home residents do not suffer from heat in the summer or cold temperatures in the winter and we hope a new, strong bill will be introduced and pass both houses in 2005.

4. Detroit News runs two day investigative report of malnutrition and dehydration in nursing homes – On November 28 and 29, the Detroit News published a special report, "Starving for Care" about the plight of nursing home residents in Michigan and across the country who suffer from preventable malnutrition and dehydration. The report is based on an analysis of 9.7 million death records from the U.S. Centers for Disease Control and Prevention, 7.5 million hospital discharge reports, and government databases regarding violations and staffing levels at nursing homes across the country. According to the study, more than 800 residents in Michigan and almost 14,000 residents nationwide died from malnutrition and dehydration between 1999 and 2002 and those conditions contributed to the deaths of 68,000 other residents. The report suggests that many of these deaths could have been prevented and that the problem is so widespread that nearly a quarter of the residents admitted to hospitals from nursing homes are suffering from malnutrition and dehydration. The report blames insufficient staff and poorly trained staff for the failures in care. The series of articles also includes information on understaffing in facilities, the feeding assistant issue, the failure of regulators to investigate cases of malnutrition and dehydration because they are often unaware of them, the availability of on-line report cards of nursing homes (www.medicare.gov; click on "Compare Nursing Homes in your area" under "Search Tools"), and ways families can help protect residents.

The report identifies the following possible signs of malnutrition :

h clothes that fit more loosely than usual;

h cracked lips or a mouth that looks pale;

h false teeth that no longer fit:

h recent loss of teeth or mouth sores:

h hair thinning or growing sparse;

h wounds that take longer to heal;

h confusion (not related to a disease such as Alzheimer’s or other dementias)

h skin breaking down or loose skin;

h unusually dry skin:

h eyes that appear sunken;

h unexpected weight loss;

h residents who eat less than half of food served.

The article also notes that residents with dry mouths, cracked lips, sunken eyes or dark urine and those who are easily confused and tired may be suffering from dehydration.

The report also suggests families take the following steps to help prevent dehydration and malnutrition:

h Assist with meals when possible;

h Bring food the resident likes to the nursing home (you may wish to check with staff if there are dietary or medical issues of concern although the resident --or his or her legal representative if the resident lacks capacity– has the right to choose what he or she wishes to eat);

h Be involved in care planning;

h Ask the staff to evaluate other issues that could compromise nutritional status such as depression, difficulty swallowing or dental problems;

h Monitor the resident carefully for physical changes and share your observations with the staff;

h Be assertive about getting good care. You can take concerns to the floor staff, the staff person responsible for responding to complaints, the administrator, the facility owner, the family or resident council if they exist in the facility, or the state. Complaints to the can be filed with the Michigan Dept. of Community Health by calling (800) 882-6006 or going to www.michigan.gov/mdch. You can also file complaints with the state attorney general by calling (800) 242-2873 or going to www.michigan.gov/ag.

The special report is available at: www.detnews.com/2004/specialreport/0411/28/index.htm.

5. Federal Government’s Nursing Home Compare website now contains information on residents’ wieght loss– The federal government has added a quality measure for the percentage of "residents who lose too much weight" to the information that is available on-line about nursing homes across the country. According to the Nursing Home Compare website (www.medicare.gov; click on "Compare Nursing Homes in your area" under "Search Tools"), Michigan homes and homes across the nation have an average of 9 percent of residents who loose too much weight. Some facilities report higher or lower percentages of residents with significant weight loss. However, consumers should be cautious about relying too heavily on this or the other 14 quality measures reported on the website. The information is self-reported by facilities and not monitored, so a facility may not provide accurate information. Moreover, even good facilities may have higher percentages of residents with significant weight loss if, for example, they have a higher percentage of residents whose conditions cause unavoidable weight loss. The website does not provide sufficient information to explain the circumstances surrounding the statistics.

6. State finalizing plan for dining assistant pilot project– The Michigan Dept. of Community Health is finalizing a plan to test a dining assistant pilot project in a limited number of for profit, non-profit, and county homes in urban and rural or suburban areas across the state. The six month pilot will be studied by highly respected researchers Drs. Clare Luz and Maureen Mickus from Michigan State University in an effort to determine whether dining assistants–who have less training than a nursing assistant but receive limited training in feeding residents-- benefit residents. The Campaign was instrumental in helping to design a pilot project that protects residents and in recruiting Drs. Luz and Mickus for this important study which will be the first formal study of feeding assistants anywhere in the country. Residents who live in the facilities participating in the pilot project will have the right to refuse assistance from a dining assistant.

7. Flu shots should now be available to all nursing home residents – The Campaign reported in our last newsletter that many nursing home residents had been unable to obtain a flu vaccine due to a shortage of the vaccine. Since then, additional doses of the vaccine have become available. Michigan Department of Community Health Director Janet Olszewski asserted in December that her department has contacted virtually all nursing homes throughout the state to assess vaccine supply status and that the vast majority of homes assured the department that senior citizens residing in their facilities have had the opportunity to be vaccinated. If you know of residents who want to receive the vaccine but have not yet been able to do so, you should speak to the nursing staff or administrator of the resident’s facility immediately. Additional information is available from the Michigan Department of Community Health website, http://www.michigan.gov/mdch/0,1607,7-132--82930--,00.html and your local county health department.

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The Campaign thanks donors Pamela Balfour and Dennis and Carol Cavanaugh!