|
|
|
Solving Problems in Long Term Care |
March
2009 1.
Please
join us at our next statewide meeting on Saturday, March 21, 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 as
well pursuing several other advocacy issues.
Please also mark your calendars to join us at our next meetings:
May 9 (note date change) at the same time and place. We love to welcome new members and see old friends!
If you plan to attend, please RSVP to Alison Hirschel at hirschel@umich.edu
or 517-324-5754 by March 18, 2009. We
need you to be part of our plans and discussions! 2.
Governor’s Proposed Budget for FY ‘10
significantly increases funding for MiChoice Home and Community Based waiver
program but
includes other worrisome cuts–-
In February, the Governor issued her budget proposal for Fiscal Year 2010.
This article discussed the Governor’s proposal, but the final
budget will have to be approved by the Legislature and may look
substantially different from the proposed budget.
Your advocacy is important to make sure the state Legislature gets
the budget right!! The Legislature has already begun holding hearings on
the budget (see next article); consumer advocacy will be crucial to assure
continued and increased funding for long term care services and supports. Despite
Michigan’s extremely challenging budget environment, Governor Jennifer
Granholm has proposed a substantial increase
in funding for MiChoice Home and Community Based Waiver Services, the
program that provides nursing home level of care services to people in their
own homes. The additional
funding should ensure services are provided more promptly to many of the
approximately 4200 people across the state who are on the waiting list for
MiChoice. In
addition, the Governor has proposed continued funding for Nursing Home
Transitions, the program that assists nursing home residents in returning to
the community with the supports and services they need.
A federal grant also supports this effort. The Governor’s proposed budget also includes some worrisome cuts.
The Governor has eliminated the Office of Long Term Care Supports and
Services, effective October 1, 2009, and Administration officials have said
the functions of the office will be integrated into the Department of
Community Health. This office was created three years ago by the Governor to
coordinate long term care services and ensure that the recommendations of
the Governor’s Medicaid Long Term Care Task Force were implemented.
Advocates viewed the creation of the Office as a huge step forward to
addressing our fragmented and outdated long term care system.
Although the Administration has repeatedly stated that it remains
committed to long term care reform and to implementation of the Task Force
recommendations, advocates believe it is essential that the office retain
strong leadership, accountability, significant consumer involvement, and
that the majority of the functions of the office remain housed in the same
unit in the Department. The Governor’s budget also includes $2.2 million in proposed cuts to the Office of Services to the Aging with specific reductions in in-home services, care management, congregate meals, home delivered meals, and other programs. Among the most difficult proposed cuts were those made to mental health programs including a $7.6 million reduction in funding for mental health services for individuals who do not qualify for Medicaid. In addition, the Governor proposes eliminating $6.8 million in mental health including eliminating mental health initiatives for older persons and mental health respite services. 3.
Advocates turn out in force to testify in support of continued
funding for long term care supports and services and strong enforcement in
nursing homes–The legislature is now in the
process of reviewing all aspects of the Governor’s proposed budget for FY
2010 (which begins October 1, 2009).
The House Appropriations Subcommittee on the Department of Community
Health has already held several hearings at which Administration officials
have explained the budget proposals for Medicaid, long term care, and other
programs the Department oversees and consumers and other stakeholders have
had an opportunity to provide short testimony.
In late February, State Long Term Care Ombudsman, Sarah Slocum, and
Campaign members John Weir and Alison Hirschel presented testimony about the
urgency of increasing the number of nursing home surveyors so that serious
complaint investigations can be handled more promptly (see article below).
On March 2, many long term care consumers as well as advocates from
around the state came to urge the Committee to: §
Support the Governor’s proposed increase in funding for MiChoice
home and community based waiver program; §
Continued funding for the Long Term Care Connection demonstration
programs in Detroit, Southwest Michigan, Western Michigan, and the Upper
Peninsula (these agencies provide one stop shopping for long term care
consumers who need unbiased information about their options, available
programs, eligibility requirements for supports and services, etc.),; §
Oppose cuts to the Office of Services to the Aging programs for
seniors; §
Support additional funding for Department of Human Services
caseworkers so they can process Medicaid applications more promptly and
serve Home Help and Adult Community Placement clients more appropriately;
and § Support maintaining a unified Office of Long Term Care Supports and Services with strong leadership, accountability, and consumer involvement.
Please contact your State Representatives and State Senators to let
them know how you feel about these important budget issues.
In a tough budget year, we need to let our legislators know how much
we value long term care services and supports!
4.
State still lags far behind schedule in investigating serious complaints in
nursing homes– In October, 2008,
the Bureau of Health Systems–the agency responsible for regulating nursing
homes – reported to the
Legislature that it has been
able to investigate very promptly the small number of complaints and
facility reported incidents that it characterizes as placing residents in
“immediate jeopardy.” But according to the Report, BHS investigations of
complaints at the next of the three levels of urgency—those that alleged
harm but did not rise to the level of Immediate Jeopardy -- required an
average of 106 days to complete. Examples of this level of harm include
when: ·
A resident is intimidated or threatened; ·
A resident is physically abused by spitting, slapping, sticking with
a sharp object, pushing or pinching; ·
An unexplained or unexpected death with circumstances indicating
there was abuse or neglect; ·
Resident on resident sexual assault, harassment, or coercion; ·
Inappropriate use of restraints, resulting in injury; · Failure to obtain appropriate care or medical services. However,
federal policy requires that an on-site investigation of complaints at this
level be initiated within 10 working days of intake.
And a 2003 federal protocol required investigations at this level of
severity to be completed within 20 working days.
In addition, federal law require states to maintain adequate
procedures and sufficient staff to investigate and report on the nursing
facility complaints they receive. Unfortunately,
Michigan falls far short of this standard. As
residents and families know, the failure to investigate promptly can cause
residents on-going and preventable harm. Imagine a resident who is being
repeatedly physically abused by a staff person who is slapping or pinching
him continuing to endure that abuse for 106 days.
If a resident is not receiving appropriate care and medications to
monitor and treat her diabetes—after 106 days (or more, since the 106 days
is simply the average length of time it takes to complete a complaint
investigation), the resident may no longer be alive. When there is a
report of an unexpected death in circumstances indicating abuse or
neglect—how many other residents will be imperiled in the 106 days it
takes BHS, on average, to complete its investigation of that complaint? The
delays in investigations cause other harm as well.
When complaints are investigated weeks or months after alleged
incidents occur, it is increasingly difficult to substantiate the complaint
and take appropriate enforcement action.
Residents die, staff leave, records are lost or changed, and memories
blur. Thus, it is not
surprising that only 22 percent of consumer complaints are substantiated.
The
delays in complaint investigations are due to the shortage of nursing home
complaint investigation staff. Twenty-five
percent of the budgeted 28 complaint surveyor positions remain open.
However, even if all of the positions were filled, the completion of
complaint investigations would likely still exceed federal guidelines
because the complaint unit is faced with the overwhelming burden of
investigating all complaints and facility reported incidents. In FY ’08,
there were 1212 consumer complaints and 4274 facility reported incidents for
a total of 5486 required investigations.
Michael Dankert, the recently retired BHS Bureau Chief, has asserted
that a surveyor can be expected to investigate only 100 complaints and/or
facility reported incidents each year.
Thus, the state would have to employ almost twice as many surveyors
as are currently budgeted—and two and a half times as many as are
currently on staff -- to ensure timely investigations. There
are also vacancies in the standard surveyor positions who conduct the
federally mandated annual surveys. Of
72 budgeted positions, 8 remain vacant.
If all complaint unit and standard surveyor positions were filled,
the total survey staff would number 100; only a few years ago there were 120
surveyors. Unfortunately,
recruitment to fill the 15 vacant positions in the standard survey and
complaint units is difficult because the positions pay approximately half
what the industry offers, the job is viewed as fairly contentious, and
extensive travel is required. Many individuals who receive a job offer as a
surveyor do not accept. And
when new surveyors are hired, it takes approximately a year of training
before they can operate independently.
(Note: the information in this update was taken from the testimony
presented by Sarah Slocum and Alison Hirschel to the Michigan House
Appropriations Subcommittee on Community Health in February.)
Call
your legislators to demand funding for more nursing home surveyor positions
and to ask the Legislature to ensure that nursing home surveyor positions
are exempt from any hiring freezes or other state employment restrictions!
Or write to Janet Olszewski, Director, Department of Community
Health, Capitol View Building, 201 Townsend Street, Lansing, MI 48913 and
express your concern about the need for more surveyors.
|
