1.   SEQ CHAPTER \h \r 1Please join us at our next statewide meeting on Saturday, November 14, 2009 from 10:30-2:30 at the Library of Michigan Lake Superior Room, 717 West Allegan, Lansing.  Please also mark your calendars for our next meeting on January 23 at the same time and place.  We love to welcome new members and see old friends!  If you plan to attend the November  meeting,  please RSVP to Alison Hirschel hirschel@lsscm.org or 517-394-2985, x 231 (please note: the Campaign has a new e-mail address and a new phone number!) by Nov. 11.  We will be discussing how to move long term care reform forward despite the state’s budget crisis, the impact of recent cuts on long term care consumers, how to honor deserving direct care staff, the long term care provisions in the federal health care reform bills, and many other important issues. We need you now more than ever to be part of our plans and exciting discussions!  Join us!

2.  Campaign Board Member John Weir elected President-Elect of NCCNHR—

    the National Consumer Voice for Quality Long Term Care!—                                                                           

Congratulations to John Weir on his election as President-elect of NCCNHR, the national advocacy organization for long term care consumers. John will begin serving a two year term as President in October, 2010.  John has been a dedicated and effective local ombudsman in the Kalamazoo area for more than 20 years and one of the Campaign’s most loyal and vital members.  John serves on the Campaign board, helped start the Kalamazoo chapter, and never misses a statewide meeting where he shares his sharp insights, creative ideas, and passion for long term care consumers.  John also serves on the Board of the National Association of Local Long Term Care Ombudsman and works with the State Ombudsman program helping to train and support other local ombudsman staff.   The photos depict John with current NCCNHR president, Norma Atteberry (left), and making presentations at the recent NCCNHR conference in Washington, D.C.     

3. Campaign members and other Michigan advocates participate in 34^th Annual NCCNHR conference—Numerous Campaign members, Michigan ombudsman staff, and other Michiganians once again attended the fabulous annual NCCNHR conference in Washington, D.C.  where participants attended sessions on diverse subjects ranging from nursing home residents’ rights and racial disparities in nursing home quality of care to assisted living and home and community based care.  Participants also attended a session on Capitol Hill at which Reps. Jan Schakowski and Linda Sanchez, as well as several Congressional staffers, shared information on pending legislation affecting long term care consumers including the various proposals for health care reform.  Many Campaign members and others then visited their Senators and Representatives to press them to support bills that benefit long term care consumers (see below for a description of these bills).  NCCNHR participants also had many opportunities for networking, sight-seeing, and sharing victories and concerns.  Next year’s NCCNHR conference will be held October 19 – 22, 2010 at the Caribe Royale All-Suite Hotel and Convention Center in Orlando, Florida.  We hope you can join us there! For more information on NCCNHR, go to www.nccnhr.org and see NCCNHR’s newly designed and user-friendly webpage.

4. Federal legislative proposals concern both nursing homes and home and community based care provisions—Although long term care has received little attention in the federal health care reform debate, several provisions have been included in the proposals now being considered by Congress. They include:

1.  The Nursing Home Transparency and Improvement Act would improve access to information about how well nursing home providers staff their facilities; make other quality-related information available to the public; make it easier for family members to file complaints about poor care and protect them from retaliation; develop a model for independent government monitoring of nursing home chains; and ensure better care of the 70 percent of nursing home residents with Alzheimer’s and other dementia by requiring pre-employment training in dementia management and abuse prevention. 

2.  The Patient Safety and Abuse Prevention Act would help states develop programs to conduct national screening and criminal background checks on employees who work in long-term care facilities (or for other types of long-term care providers, including home health agencies), and who have direct access to residents or patients.

3.  The CLASS (Community Living Assistance Services and Supports) Act – This provision, originally introduced by Senator Ted Kennedy, would create a national insurance program to finance non-medical services and supports for people with disabilities who want to remain at home.  The program would be financed by voluntary payroll deductions and would pay a benefit to individuals who had contributed to the program and subsequently needed assistance with activities of daily living such as bathing or dressing.  This provision is designed to permit more people to remain at home and to reduce the burden on state and federal Medicaid programs that now pay billions of dollars of home and community based and nursing home care.

4.  The Community First Choice Act – This proposal would create incentives for states to provide home and community based care to people who would otherwise need to enter a nursing home by providing additional federal Medicaid reimbursement for these services for five years.  The Act would also require states to collect data regarding how they currently provide home and community based care, how much they spend on that care, and whether consumers have access to non-institutional options when they require long term care.

5.  The Elder Justice Act – Portions of this act mandate reporting of crimes against residents in long-term care facilities; provide for adequate notice and relocation planning for residents when nursing homes close; and improve training of long-term care ombudsmen who investigate resident complaints as well as addressing numerous other issues related to abuse of the elderly.

In addition, Congress is continuing to consider the Fairness in Nursing Home Arbitration Act which would prohibit nursing homes, assisted living facilities, and other long term care providers from including provisions in their admissions contracts that require consumers to agree to mandatory, binding arbitration instead of litigation if a problem arises. 

 ADVOCACY ALERT! TAKE ACTION NOW: Please contact Senators Levin and Stabenow and your Representative in the U.S. House of Representatives to tell them you support these important provisions!

5. State budget includes very significant cuts to nursing home reimbursement and other services; home and community based care funding is increased – After a long and torturous process, Governor Granholm signed the state budget for the current fiscal year (October, 2009-September, 2010) almost a month after the fiscal year began. Despite the state’s dramatically reduced revenues, the legislature did not approve any new taxes or sources of revenue and instead slashed state programs, made what many — including the Governor -- consider to be unrealistic assumptions about expected savings in various programs, and plugged holes with one-time federal stimulus funds.  Miraculously, in a year when everything was on the chopping block, the MiChoice Home and Community Based Care program (which provides nursing home level of care to people who prefer to live in their own homes or assisted living) received a $17 million increase in funding and Home Help workers will receive a 50¢ increase in hourly wages, raising most workers from $7.50 to $8/hour.  Other programs were not so lucky.  Medicaid providers including nursing homes face an 8% reduction in reimbursement which will likely result in reduced staffing in many facilities.  Services offered by area agencies on aging and community mental health agencies will be significantly reduced.   And many state programs that promote health or welfare were eliminated altogether. 

          State officials are already looking ahead to the FY 2011 budget (which will go into effect on October 1, 2010) and the Governor has asked Department heads to consider how they can reduce spending by an additional 20 percent.  These reductions will be necessary because of the continuing absence of sufficient revenues in the state, the unwillingness of the Legislature to raise revenues, and the absence next year of the federal stimulus money that filled in some of the gaps in this year’s budget.   Campaign members have joined other advocates in supporting efforts to raise revenues in the state since the current budget is simply insufficient to meet the needs of Michigan citizens.

          ADVOCACY ALERT! CONTACT YOUR STATE REPRESENTATIVE AND SENATOR TODAY to thank them for preserving funding for home and community based care and urge them to continue to protect this funding in the next fiscal year.  But also tell them you are concerned that cuts to nursing homes means fewer staff to care for very vulnerable citizens and demand that they ensure nursing homes provide adequate staffing to care for this vulnerable population!

6. State Medicaid Director Paul Reinhart Dies; Long Term Care Consumers and Advocates Lose True Friend—State Medicaid Director Paul Reinhart (pictured below) lost his courageous battle with cancer on October 29.  Paul was one of our first Courage and Heart Award winners in 2006.  At that time, we said:

State Medicaid Director Paul Reinhart... became the Medicaid Director in 2003 after 28 years in various finance and administrative positions in state government.  Paul has a national reputation for his ability to leverage federal dollars for the state's Medicaid program and an extraordinary ability to stretch Medicaid dollars to meet the needs of the state's most vulnerable health care consumers. But Paul is much more than a numbers guy.  He has a profound concern for the well-being of Medicaid consumers and an eagerness to learn about their needs.   He asked Sarah Slocum, the State Long Term Care Ombudsman, to take him on tours of nursing homes so he could see first hand what Medicaid dollars were paying for in those settings.  He was so impressed with the work of the ombudsman staff that he figured out a way to provide substantial Medicaid dollars to supplement the ombudsman's chronically under-funded program. He negotiated the settlement to the Eager litigation which resulted in the reopening of the Home and Community Based waiver program, the creation of the Governor's Long Term Care Task Force, and a host of other changes.  Paul also made a commitment to pay for nursing home transitions for residents like our chairperson, Bill Mania, who were eager to reclaim their lives in the community….Paul is self-effacing, funny, straightforward and really smart.  But most of all, the Campaign recognizes him today because he holds in his heart a   true  anguish about the plight of long term care consumers who are not receiving the services and quality they deserve and a real passion and ability to make  their lives better.

          In recent years, Paul has provided unflinching support for increased funding for home and community based care and for helping people transition out of nursing homes and back to the community as well as preserving funding and benefits for the state’s 1.7 million Medicaid beneficiaries.  The Campaign and advocacy community will miss Paul dearly and extend our sincere condolences to his wife and daughter. 

7.  Research and investigative reports demonstrate racial disparities in quality of nursing home care – Research supported by the Commonwealth Fund has revealed extremely disturbing facts about the quality of care many African American residents in nursing homes receive:

• African Americans tend to reside in lower-quality nursing homes compared with whites, who have increasingly turned toward private-pay, assisted-living facilities.
• In 2000, African Americans were more likely than whites to be in nursing homes cited for deficiencies, including those causing harm or immediate jeopardy, and in homes terminated from Medicare and Medicaid.
• African Americans were less likely to be in nursing homes with the highest staffing level of direct-care providers and the highest ratio of registered nurses to all nursing staff. They were more likely to be in understaffed facilities and in facilities housing predominantly Medicaid residents.
• The five states with the highest racial disparities in quality of care were Maryland, Michigan, Missouri, Indiana, and Minnesota.
• Nursing home segregation was highest in the Midwest, where the minority population is concentrated in urban centers, and lowest in the South, where it is more evenly distributed across urban and rural areas.

For more information on the Commonwealth Fund study, go to www.commonwealthfund.org.

A recent in-depth investigation of Chicago nursing homes by the Chicago Reporter also revealed that homes that served primarily African American residents tended to have the lowest federal quality rating, less staff and fewer highly qualified staff members, more violations of state and federal standards, and were more often the subject of civil lawsuits and administrative complaints even compared to homes that served primarily white residents of similar economic status.  Staff of the Chicago Reporter and a Chicago community activist presented the data and their agenda for reform at the NCCNHR conference in Washington last month.  For more information on the Reporter’s fine and distressing findings, go to http://www.chicagoreporter.com/search/index.php?tag=16.

8. The Campaign wishes to thank its recent generous donors: Alison Hirschel, Joan A. Rolick, Lois Stegman, Sue Fabian, Esq., State Bar of Michigan, and Beth Ferguson.   SEQ CHAPTER . 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.

The Campaign wishes all our members a happy holiday season!!