San Francisco District
Attorney’s Office launched its Senior Pedestrian Safety Campaign by posting these “Drive Slow” and “Seniors Crossing” banners on streetlight poles
near senior communities, in honor of Elder Abuse Awareness Month in June.
Beware of seniors …
especially if loaded guns are in the home! While checking my email
account on July 4, I was distracted by this Yahoo! News headline: “'You Took My Life, So I'm Taking Yours.' Woman, 92, Allegedly Kills Son Who Tried to Put Her in Assisted Living.” I wanted to go beyond the sensational
headlines to understand what happened. Was
92-year-old Anna Mae Blessing a victim of elder abuse? Did she shoot her
72-year-old son in self-defense because he threatened to put her in assisted
living? Was her desperate act to avoid
assisted living preventable?
As I read reports from
other sources, I noticed the media often confused assisted living with nursing home:
·
Biz
Pac Review: “Anna Mae Blessing, 92, charged with murdering son because he was going to put her in a nursing home”
·
CBS
News: “13 guns found in home of
woman, 92, who allegedly killed son over nursing home dispute”
Then I read
readers’ comments that ran along the lines of:
·
If
she did all this without assistance (after shooting her son, “she bent down to
check his pulse,” and “before police arrived, Blessing walked back to her room
and sat in her recliner, intending to kill herself”),
she definitely is not a candidate for assisted living.
·
She’ll
get the shortest life sentence in history.
·
Now
she’s really in assisted living supported by the state.
·
Assisted
living is luxury prison.
·
Caveat
– “note to self: don’t send mom to assisted living,” or “I forwarded this story
to my son, and said remember this in the years to come.”
While the
investigation of Anna Mae Blessing’s case continues, the related issue of
long-term care (LTC) planning affects us all. More than half of Americans age 65+ will develop
a disability serious enough to require LTC. Like Anna Mae Blessing,
most people want to age in their homes and communities, and avoid institutional care.
LTC is
labor-intensive, consisting of informal care by family/friends (often unpaid)
and formal care through paid caregivers, adult day care centers, home healthcare,
assisted living, memory care, or (often spending down resources to qualify for
Medicaid payments which pay for) nursing home.
Effective July 1, 2018, San Francisco’s hourly minimum wage increased to $15, the highest in the nation. This pay rate boost is expected to benefit minimum-wage workers such as domestic workers, janitors and food preparation help – typical positions in LTC work – and lead to reduced employment (giving employers incentives to produce what they can with fewer unskilled workers, through slower hiring).
Effective July 1, 2018, San Francisco’s hourly minimum wage increased to $15, the highest in the nation. This pay rate boost is expected to benefit minimum-wage workers such as domestic workers, janitors and food preparation help – typical positions in LTC work – and lead to reduced employment (giving employers incentives to produce what they can with fewer unskilled workers, through slower hiring).
“…underpaid women who
clean our homes…, prepare and serve our meals, and care for our elderly—earning
wages that do not provide enough to live on—are the true philanthropists of our
society.”
—Barbara Ehrenreich,
“It is Expensive to be Poor,” The
Atlantic (Jan. 13, 2014)
According
to AARP, private nursing home costs in 2012 averaged 252% of the median household income for those ages 65+, while the cost of home health services (30
hours per week) averaged 88% of median income.
The Aging Services
Network has developed home- and community-based services (HCBS) as less
expensive alternatives to reduce dependency on nursing home care and to address
quality of life issues for older adults who wish to remain as integrated within
their communities.
Gray Panthers’ meeting, Looking at the Many Forms of Long-Term Care, featured panelists: Teresa Palmer, MD, geriatrician; Katie Owens, Advanced Approach to Senior Care Director who connects clients to LTC providers; Benson Nadell, LTC Ombudsman; and Michael Lyon, Gray Panther advocate of
universal LTC who shared Health Affairs article, “Long-Term Care: Who Gets It, Who Provides It, Who Pays, and How Much?”
Dr. Palmer, who
practiced geriatrics for over 35 years, including 15 years at Laguna Honda and
10 years at On Lok, presented on Basics
of LTC with data provided by San Francisco Department of Public Health:
·
LTC
provides services to meet medical and non-medical needs of people with a
chronic illness or disability who cannot care for themselves. Medical
services include skilled nursing (e.g., wound care, IV injections),
rehabilitation (speech, occupational, and physical therapy), medication
management, durable medical equipment, health promotion/disease prevention,
hospice care. Non-medical services include assistance with activities of daily
living (ADLs, such as dressing, bathing, toileting, eating, transferring),
home-delivered meals, transportation, home repairs and modifications, financial
and/or legal services.
·
Optimally,
post-acute care (medical services that support recovery from illness after a
hospitalization) is provided in home- and community-based settings whenever
possible, and the majority (64% + 15% with home health) of patients are
discharged home after a hospital
stay.
·
Some
(9%) patients who cannot be safely discharged home rely on skilled nursing facilities (SNFs) to receive post-acute care, 24/7
medical care, which can be paid from Medi-Cal or Medicare (short-term only);
average cost is $11,700 to $14,200 per month.
·
Residential Care Facilities for the
Elderly (RCFEs, such
as “assisted living” and “board and care”) provide 24/7 supervision and are paid out-of-pocket. Since RCFEs are non-medical, no insurance
covers this level of care; average cost is $4,300 per month, and few to no
facilities accept Social Security.
·
While
our aging population with LTC needs continues to grow, the supply of beds in SNFs
(especially closure of CPMC’s 79 SNF beds at St. Luke’s , plus shutdown of 25-bed Swindell’s
Alzheimer’s Residential Care Program)
and RCFEs continues to decline.
Benson, who has been San
Francisco’s LTC Ombudsman since
1986 (or 32 years), presented, “What does a Gray Panther need to know?”
·
LTC
Ombudsman investigates complaints or allegations of abuse/neglect in LTC
facilities, and often refers to licensing agency for enforcement (California
Department of Public Health for SNF,
California Department of Social Services for RCFE).
·
Common
complaints for RCFEs include poor coordination of care with professionals in
the community; yelling and verbal abuse of residents; failure to take persons
to appointments; sub-standard food choices; evictions for running out of money
(e.g., Benson mentioned 98-year-old resident with $2,500 monthly income paying
$7,000 monthly to Assisted Living); taking person back from hospital without
screening; labeling complainers as difficult rather than looking at content of
complaint; and staffing numbers not adequate, poorly supervised and trained.
·
LTC
Ombudsman also monitors closure/ownership transfer of LTC facilities.
Panelists discussed the
sad state of memory care, which are mostly locked facilities to “redirect” “wandering”
or “elopement,” often lacking true person-centered care for residents with different
stages of memory loss. Some families pay
over $10,000 per month for Memory Care, and their visits are needed to monitor
proper care of residents by staff. For
example (true incident from my very brief stint in Memory Care), after a
resident’s daughter asked why her father was served water and deprived of juice,
it was discovered that the Food Restrictions Cheat Sheet which identified
residents by their room numbers (instead of personal names) mixed up her
father’s diet of NO NUTS with another resident’s diet of DIABETIC/NO SUGAR …
and the diabetic resident who was served juice and other sweets later died of a
stroke!
During the
Aging in America conference in San Francisco, Benson asked why call a place Memory Care when it includes residents without
memory problems? While I don’t agree with this practice, Assisted Living
residents who have higher care needs (such as recovering from a stroke or
adhering to strict diet, yet no memory issues) are transferred to Memory Care,
which has higher cost due to staffing levels to assist with ADLs and locked
facility to prevent residents from accessing forbidden foods; this practice then frees up space to accommodate wait list for Assisted Living.
This state of formal LTC—bed shortages, high costs, inappropriate care, etc.—sounds like doom and gloom. But each time I see someone looking refreshed from a stay at Jewish Home & Rehab Center, I think I need to check myself in there to look and feel so good! No one mentioned the expansion of Jewish Home to San Francisco Campus for Jewish Living, based on proposed Robin Hood model to use new high-end independent and assisted living units to subsidize SNF which has been dependent on dwindling Medicare/Medicaid. Competition that offers more choices is a partial response to the wait lists. Age and Disability Friendly San Francisco included this recommendation: Identify the challenges faced by residential care facilities and develop recommendations that will support and expand their capacity.
Assisted
living residents tell me they're not living at home because they are at the mercy of staff to get through ADL
and must adjust to community living, including waiting turns to get on
elevators and avoiding potential injuries as others using wheelchairs and
walkers navigate common areas. Unlike
home care, where one can replace hired help, assisted living
residents tolerate their situation because where else can they go when there
are wait lists?
Enforcement of existing regulations at SNF and RCFE may not improve care because regulators do not want to discourage business of LTC facilities with penalties.
Enforcement of existing regulations at SNF and RCFE may not improve care because regulators do not want to discourage business of LTC facilities with penalties.
Flower Piano at San
Francisco Botanical Garden. For myself, home
should include easy access to nature: fresh outdoor air and plants. I wonder whether Anna Mae Blessing had an
opportunity to tour assisted living facilities? The internet offers many
evaluation checklists from
·
CANHR
In Journal of Aging Research article, “The Factors Influencing the Sense of Home in Nursing Homes: A Systematic Review from the Perspective of
Residents,” a study of 17 articles identified three main factors:
·
Psychological
(behavioral, cognitive and emotional): sense of acknowledgement, preservation
of one’s habits and values (personal routines, moments of privacy), autonomy and control (perceptions of
freedom and mobility, voluntary move to LTC, shared decision-making), coping
(emphasizing advantages of living in nursing home, such as safety and receiving
prompt emergency help)
·
Social
(home as place of connection and socialization): interaction and relationship with staff (attentive, individualized
care; available, reliable, flexible, physically and emotionally accessible,
reciprocity), residents, family and friends, and pets; activities (engage with community to preserve continuity with past
and society)
·
Built
environment (layout, interior design, surroundings): private space and (quasi-)public space (smaller residential density
increase perceptions of belonging, place to walk), personal belongings (help create attachment to place in nesting and
being in charge), technology (improve ease of life and being in charge, TV link
to outside world and distraction), look and feel (architecture, interior
design, maintenance), and outdoors and location (connection with nature,
balconies and views from room)
One researcher identified
two situations that support the process of feeling at home: “haven” (place that
is secure, comfortable and predictable) and “heaven” (place where you can be
who you are and feel connected with like-minded people).
Elderly should be housed in luxury developments with spas to keep them out of care homes
ReplyDeleteLaura Donnelly, HEALTH EDITOR
14 AUGUST 2018
Traditional care homes will be increasingly replaced by luxury developments with spas, hairdressers and beauty salons in a bid to keep pensioners independent for longer, ministers say today.
The Government plans will see £76 million invested annually for the next three years in new homes specially designed for those who are frail, elderly or suffering from disabilities.
Health officials said the plans aim to keep people independent for longer - with their own front door, but more support on hand, with use of sensors and video monitoring to track the most vulnerable.
Housing developers will be able to bid for funds, from the programme which has already seen £315 million allocated to projects which design such homes.
One scheme in Manchester is using the funds to develop 135 flats for the elderly which have onsite facilities including a spa, beauty salon and a bistro. The plans also include dementia-friendly design, landscaped sensory gardens and communal function rooms.
Caroline Dinenage, care minister, said the schemes aimed to ensure that elderly people were able to live in suitable housing, which helped them to maintain independence.
“Far too often, older people who could have stayed at home for longer are ending up in hospital or residential care. We must do much more to ensure the quality of our housing keeps up with ever-evolving health needs,” she said.
Calling for more investment in supported living schemes, she said the Manchester project, developed by Wythenshawe Community Housing Group - which offers flats for sale, rent or shared ownership - is a prime example of the kind of housing which should be rolled out more widely.
“We need to encourage far more of these types of developments. Communities likes these can improve quality of life, help more people live in the community for longer and keep the pressure off our health and social care system – something we all want to see,” she said.
So far, 3,300 specially designed new homes have been built following previous bidding rounds.
Developments include bungalows tailored to the needs of those with high level autism, with curved walls without sharp edges, with bedrooms built a little below ground level to diffuse outside noise, in one scheme in Bicester.
Other projects include homes in London for adults with learning disabilities, with garden areas, substantial communal areas, and staff available around-the-clock.
Ms Dinenage said: “There are still far far too many people living in substandard accommodation, faced with stairs they can no longer climb or cupboards beyond their reach. This is not the quality of life we would want for our own mums or dads – or indeed ourselves.”
It comes alongside NHS plans to embed smart technology into homes.
The Healthy Towns project is working with developers to allow remote monitoring of those with health conditions, with results sent directly to GPs and hospitals.
New-build homes will contain movement sensors and other smart technology linked to a tablet computer, meaning health tips can be flashed up on screens if activity levels fall.
https://www.telegraph.co.uk/news/2018/08/13/elderly-should-housed-luxury-developments-spas-keep-care-homes/
Facilities’ staff fled, abandoned seniors during Tubbs Fire, state says
ReplyDeleteBy Peter Fimrite
Thursday, September 6, 2018
State regulators moved to revoke the licenses of two Santa Rosa senior housing facilities Thursday after finding that employees abandoned dozens of elderly and disabled residents during a confused and frantic evacuation amid the deadly Tubbs Fire last year.
Investigators with the California Department of Social Services concluded that the staffers at the Varenna and Villa Capri apartments were untrained and ill-equipped to handle evacuations, and that supervisors in both facilities left residents alone at the peak of the crisis.
Two dozen residents of Villa Capri would have died in the fire if not for the actions of family members and emergency personnel to get them out before the building went up in flames, according to a complaint filed by the department. It cites the licensed operator of the facilities, Oakmont Senior Living, as well as its management group and the executive directors of the centers, Deborah Smith and Nathan Condie.
The licenses will be revoked in 15 days unless an appeal is filed requesting a hearing before an administrative law judge.
…None of the residents of the two high-end assisted-living facilities died in the fire, but the complaint describes confusion, inattention and breakdowns in communication among the managers as the fire crackled toward the building the night of Oct. 8 and early morning Oct. 9.
Smith, administrator of Villa Capri, failed to train the four staffers on duty that night in emergency and evacuation procedures…They were responsible for 62 residents, 25 of whom were in the memory care unit and unable to exit the building unassisted…
The employees did not know where flashlights, batteries or keys to the facility’s vehicles were, and two of them were incapable of moving or assisting residents because they could not lift more than 10 pounds or use both hands,…One staffer searched for an hour that night,…but could not find keys to any vehicles…Outside was a large bus that could have been used to evacuate all the residents, but nobody knew where to find the keys…
Smith knew about the emergency at 11:30 p.m., but never made it to the facility and eventually arrived at an evacuation center at 6 a.m. the next day. The residents were saved by family members, who flagged down a police cruiser and helped their stranded relatives down from the second floor and out from behind a locked door in the lobby…
…The situation at Varenna, where 228 residents were living, was equally chaotic, … Condie, the administrator, had failed to train the two health care workers and two maintenance staffers on duty that night in emergency procedures…he was unable to articulate an evacuation plan and instead directed the staff to return the residents to their rooms,…He left the facility in his car with a small number of residents at about 3:30 a.m. and did not tell the staffers where keys to a large bus owned by Varenna were located.
All the other staffers later departed, leaving the residents asleep in their rooms as the fire raged toward the facility. They were eventually evacuated by their families and friends, who reported spending hours pounding on doors, waking up and assisting residents, many using walkers and wheelchairs, to the lobby,…When emergency responders finally arrived at 4:15 a.m., no staffers were available to identify residents or provide a list of those who were evacuated...
“We’re very pleased that the state of California has held Oakmont accountable and sent a very strong message that it needs to spend money on residents and not just pretty buildings,” said Kathryn Stebner, the attorney for former Villa Capri and Varenna residents, who settled a lawsuit filed on behalf of the residents Aug. 17 for an undisclosed sum…
https://www.sfgate.com/california-wildfires/article/State-says-employees-abandoned-seniors-at-Santa-13210949.php
San Francisco General Hospital cuts social workers, and trouble follows
ReplyDeleteBy Charlotte Silver | Aug 9, 2018
…In May…the hospital abruptly laid off seven to nine social workers for the Medical Surgical unit, an abrupt reduction of around 33 percent of those positions.
…As a result, social workers have gone from handling 10 to 19 patients a day to sometimes seeing more than 40, …
“We are the dumping ground for everything the doctors and nurses don’t do or don’t have time to do,” the social worker said, stressing that the entire department is working long hours to try to keep up.
Nearly every day for the last two years, San Francisco General Hospital — the region’s only trauma center — has been operating past capacity. As a safety-net hospital, SFGH serves the city’s poorest residents. The reasons for the hospital’s overcrowding are complex, including explosive growth in the volume of patients coming to the hospital’s emergency department, a remarkable trend administrators are still grappling to explain.
…biggest barrier to moving patients smoothly through the hospital system is an inability to discharge them from the Medical Surgical unit when they no longer have acute needs.
…The hospital’s target is to operate at 85 percent capacity. This goal has not been met for years.
Patients across the hospital system — from the emergency room, critical care, surgery or clinics — converge on the Medical Surgical unit, which recently had to open up 15 more beds to address the overwhelming need. The unit now has 179 beds.
But, like the patient who wanted to transfer to hospice, a significant portion of these patients no longer need to be here.
After patients have been treated for their acute needs, these patients are re-categorized as needing “lower levels of care,” which means their stay at the hospital is no longer covered by MediCal or other insurance providers. It costs the hospital $2,800 a day — out of its own funds — to keep a lower-level patient. So, for the woman who stayed around for 10 days while waiting for a hospice bed, the hospital may have had to pay up to $28,000.That’s on top of losing outside revenue from a covered patient — a patient who actually needed the higher level of care.
…Lower-level-of-care patients are usually the most vulnerable patients, and frequently homeless. The city has tried to move such patients through the system smoothly — but, by removing social workers in May, the hospital constricted the exitway for them. And, while they did so due to budget constraints, it may have contributed to a costly source of revenue loss.
Social workers are responsible for coordinating the safe discharge of all patients. Some patients simply go home, but a social worker can spend a considerable amount of time trying to find a bed for a patient who needs follow-up care. A homeless patient in need of continued care, for example, cannot be discharged to the street, and an elderly patient in need of follow-up treatment may need an intermediary care facility.
Without a social worker making these determinations and getting the patient placed, they are not discharged and remain at San Francisco General. And, in a cascading effect, other patients who need more acute care end up stuck in inappropriate locations.
SFGH’s emergency department has seen a 20 percent uptick in service every year for the last three years, according to May.
At the same time, the city has struggled to add discharge beds to its stock to keep up with the precipitous decline in beds in private facilities. The city’s board-and-care facilities, which provide residential treatment, have halved over the last five years, dropping from 70 to 38 facilities — providing beds to just 355 people, according to Department of Public Health figures.
… the city has lost five skilled nursing facilities since 2010, a total loss of about 500 beds....But as San Francisco’s population ages, May says, there is increased demand…
https://missionlocal.org/2018/08/san-francisco-general-hospital-cuts-social-workers-and-trouble-follows/
The high cost -- and stress -- of caring for the elderly
ReplyDeleteBy WALECIA KONRAD MONEYWATCH September 27, 2018, 7:25 AM
More than half of recently surveyed affluent Americans age 50-plus said they would rather die than spend time in a nursing home.
Instead, 71 percent of respondents to a recent study from Nationwide Retirement Institute said they hope a loved one will take care of them and that they can compensate that person financially for their efforts…
But the reality is caregiving is often stressful, both emotionally and financially. The Nationwide study, released Wednesday, also surveyed adults 50 and older who had been or are caregivers. "We found that only 20 percent of caregivers received some kind of financial support, and more than half of them spend their own money -- on average about $4,000."
A separate study by the National Alliance for Caregiving and AARP found that 16 percent of women caregivers and 6 percent of men take a less demanding job to care for a loved one. Twelve percent of women and 3 percent of men quit work altogether. That can lead to a loss of $304,000 in wages and benefits on average over a lifetime, according to AARP research.
Insurance doesn't offer much relief. Steep premium increases and troubles in the industry have put long-term care insurance, which covers the cost of nursing homes, assisted-living facilities and home health care, out of reach for many people. Only 27 percent of Nationwide's survey respondents have such coverage for themselves or someone else.
In addition, Medicare doesn't cover most long-term care costs, which often comes as a surprise to people when they enroll. That said, some limited relief may be on the horizon for people covered by Medicare Advantage policies. Private insurers sell Medicare Advantage plans as an alternative to traditional Medicare, often with extras such as vision and dental coverage.
The list of extras Medicare Advantage insurers can offer starting in 2019 has significantly increased, thanks to an April ruling from the Centers for Medicare and Medicaid Services that expands the definition of health-related benefits.
The new rule opens the door to coverage of adult day-care services, home-based palliative care, in-home support services, caregiver support, non-opioid pain management, memory fitness services, home and bathroom safety devices and modifications, transportation to and from doctor visits, and over-the-counter health items, according to a list provided in a CMS memo.
Great as the new coverage sounds, it isn't required. Insurers will offer these extras only if they choose to. Firms are just now filing their 2019 plans with regulators, so it remains to be seen how many Medicare Advantage policies will expand benefits.
And even for those that do, it's important to remember that not all policyholders will necessarily be eligible for all of the benefits,
Other relief may come from your state. Caregivers may want to check with their Area Agency on Aging to determine if their state has passed one of the many new laws that offer a range of breaks, including tax credits for elder care and allowing sick leave to be used to care for an elderly person, according to AARP. More such laws are in the pipeline.
Hawaii, for instance, provides $70 a day for services such as respite care or adult day care for some working people who care for an elderly loved one. And several states have passed laws requiring employers to allow paid family leave to be used for caring for an elderly relative.
No matter what kind of insurance you have or what state you live in, there's one thing everyone can do right now, said Snyder. Start talking.
She was surprised to find from the Nationwide survey that 39 percent of people have not discussed long-term care planning with anyone, including a spouse, partner, children or financial adviser. "I hope that changes," Snyder said. "The solution starts around these conversations."
https://www.cbsnews.com/news/the-high-cost-and-stress-of-caring-for-the-elderly/
Home Health-Care Costs Are Hurting All of Us. Here’s How States Could Fix the Problem
ReplyDeleteBy Reshma Kapadia
Nov. 9, 2018
A state initiative in Maine…failed to pass—but it reflects the growing imperative that state governments feel to address an aging population, and the increasingly high cost of caring for it.
…The grayest state—a fifth of Maine’s population is over the age of 65—offered voters a referendum to provide universal home care for seniors and people with disabilities. The initiative highlights the growing recognition of the challenges faced by the 40 million Americans who are caregivers to aging parents, partners, or other adults.
About 63% of voters in Maine said no to a first-of-its-kind referendum that would have created a fund to provide universal home care, such as home health care or nursing aides, for those who need help with at least one activity of daily living, like bathing or getting out of bed. To fund the benefit, the proposal called for a 3.8% tax on those with individual incomes of $128,400 or more. It also tried to address the shortage of home-care workers by raising wages, improving the quality of care by boosting the training of home-care aides, and allowing the benefit to be paid to family caregivers.
…The referendum may have also taken on too much at once by tackling ways to fund caregiving, as well as trying to boost wages for caregivers, says John Schall, head of Caregiver Action Network, a nonprofit …
A handful of more targeted initiatives are making their way through state legislatures, including an initiative in Washington state for a payroll tax on all employees that would fund a trust to help offer a monthly benefit (up to a certain amount) for long-term care costs, modeled on funds created in states like New York and California that finance paid leave. California’s legislature has convened a roundtable to explore a similar initiative that would use a payroll tax for a home-care stipend, while Arizona’s legislature is mulling a caregiving tax credit, says Elaine Ryan, vice president of advocacy and strategy at AARP.
On the federal front, AARP has supported a bill that would establish a family caregiver credit of up to $3,000 a year that can help offset out-of-pocket costs caregivers often spend—$7,000 a year, on average…bill has bipartisan support and is still working its way through Congress.
So far, only Hawaii has passed caregiving legislation, with the Kapuna Caregivers Act passed in late 2017 offering up to a $70 a day stipend for respite care, which allows caregivers to take a break; transportation; and other assistance for family caregivers who work 30 hours a week elsewhere. (The fine print, though, is that the benefit is available until the $600,000 allocated to it runs out; at that point, the legislature needs to come up with more cash.)
Other retirement experts have proposed a Social Security credit for unpaid caregiving, to address the financial hit that caregivers—often women—take. Not only do caregivers give up their wages and disrupt their career trajectories, often in the midst of their peak earnings period, but they also earn fewer credits for Social Security, which means a smaller check when they retire, says Catherine Collinson, chief executive of the Transamerica Institute, a private foundation focused on retirement and health-related issues…
Paid home-care workers are in short supply—…typically earn an average wage of $11 an hour, or less than $23,000 a year, for a stressful job that can be both mentally and physically grueling…
…Helping care for people at home keeps them out of hospitals and nursing homes, lowering the cost of long-term care. That ultimately reduces costs incurred by Medicare, which pays for hospital visits, and Medicaid, which covers nursing-home care for those eligible. As the country grapples with a $1 trillion deficit, anything that can help lower the cost of entitlements should attract attention.
https://www.barrons.com/articles/home-health-care-costs-are-hurting-all-of-us-heres-how-states-could-fix-the-problem-1541785937
Dementia Patients Fuel Assisted Living’s Growth. Safety May Be Lagging.
ReplyDeleteBy Jordan Rau
Dec. 13, 2018
They found Bonnie Walker in a pond behind her assisted living facility in South Carolina. There were puncture wounds on her ear, her temple, her jaw and her cheeks.
Her pacemaker was inside one of the alligators that lived in the pond.
Like four in 10 residents in assisted living facilities, Ms. Walker, 90, suffered from dementia…no one noticed her missing for seven hours…
Assisted living facilities were originally designed for people who were largely independent but required help bathing, eating or other daily tasks. Unlike nursing homes, the facilities generally do not provide skilled medical care or therapy, and stays are not paid for by Medicare or Medicaid.
Dementia care is the fastest-growing segment of assisted living...
In California, 45 percent of assisted living facilities have violated one or more state dementia regulations during the last five years. Three of the 12 most common California citations in 2017 were related to dementia care.
…These concerns, though particularly acute for people with dementia, apply to all assisted living residents. They are older and frailer than assisted living residents were a generation ago. Within a year, one in five has a fall, one in eight has an emergency room visit and one in 12 has an overnight hospital stay, according to the Centers for Disease Control and Prevention. Half are over 85.
“Assisted living was created to be an alternative to nursing homes, but if you walk into some of the big assisted living facilities, they sure feel like a nursing home,” said Doug Pace, director for mission partnerships with the Alzheimer’s Association.
Yet the rules for assisted living remain looser than for nursing homes. The federal government does not license or oversee assisted living facilities, and states set minimal rules.
The government does not publish quality measures as it does for nursing homes. Inspections usually are less frequent, and fines are generally far lower than what a nursing home might incur for a similar mistake.
Lindsay Schwartz, an associate vice president at the National Center for Assisted Living, an industry group, said facilities must balance safety with allowing people with dementia to move about as freely as possible and to socialize.
…But residents’ families, their lawyers and advocates say the violent behavior of agitated residents and escapes could be avoided with better training and more staff. Eliza Cantwell, a Charleston plaintiffs’ lawyer, said too many facilities were accepting residents they weren’t prepared to adequately care for because they wanted to maximize their income.
…Nearly a quarter of the nation’s 30,000 assisted living facilities either house only people with dementia or have special areas known as memory care units. These wings have locked doors and other safeguards to prevent residents from leaving. The facilities often train staff members in techniques to manage behavior related to these diseases and provide activities to keep the residents engaged and stimulated.
These units usually are more expensive, with monthly costs averaging $6,472, compared with $4,835 for regular assisted living, according to a survey by the National Investment Center for Seniors Housing & Care, a group that analyzes elder care market trends. Senior housing investors earned nearly 15 percent annual returns over the last five years, higher than for apartment, hotel, office and retail properties, …memory care unit construction was outpacing all other types of senior housing.
Aggressive behavior, a hallmark of dementia, is a major problem in assisted living facilities. One national study, published in 2016, found that 8 percent of assisted living residents were physically aggressive or abusive toward residents or staff…
https://www.nytimes.com/2018/12/13/business/assisted-living-violations-dementia-alzheimers.html
Helping seniors is rewarding
ReplyDeleteCommentary by Richard Corriea
JANUARY 5, 2019
Last summer there was an advertisement in the Richmond Review seeking volunteers to become long-term care ombudsmen (L.T.C.O.). In response, I called on Benson Nadell at the San Francisco L.T.C.O. program office, which started me on a poignant educational and experiential odyssey of a magnitude that I hadn’t anticipated, and to one of the most personally rewarding endeavors of my adult life.
So, what exactly is an L.T.C.O.? They are advocates for residents of nursing homes, board and care homes and assisted living facilities. They endeavor to improve the quality of life and quality of care of people living in these facilities.
Ombudsmen investigate and resolve complaints made by, or on behalf of, individual residents in long-term care facilities. And they encourage resident empowerment and self-advocacy through informing residents of their rights and options for long term care.
Issues that ombudsman confront include quality of care, financial, emotional and physical neglect and abuse of residents. But in a less technical sense, ombudsmen help people.
…as the former captain of the Richmond Police Station, I was all too often disheartened by the reports of fraud and theft perpetrated against the elderly…With my background and experience I thought I’d be a good fit for the ombudsman program. In the past year, I have come to believe that any empathetic person who enjoys helping people would make a fine ombudsman.
My experiences as an ombudsman have been interesting, delightful, rewarding and, sometimes, troubling. However, there are no words that convey the great honor and pleasure it has been to help folks living in long term care facilities. Being an ombudsman fits with the notion that, “it is in giving that we receive.”
One of my fist encounters as an ombudsman involved a decorated WWII veteran during what turned out to be the last weeks of his life. He was content with his life and satisfied with the care he was receiving. When I asked if I could assist him in any way he said it would be nice if he could have “two fingers of scotch whisky.”
Other folks sought guidance with the handling of their financial concerns or eviction threats, while others needed help with the activities of daily living.
I have learned a great deal about provisions in our culture for elder care and have discerned common patterns about how folks arrive in long-term care. Often a fall or lingering illness results in a stay in an acute care hospital and upon release a person is not well enough to return home to independent living. This can result in a brief stay in a skilled nursing facility, and after that it’s often a hurried, and sometimes unsettling, transition to long-term care.
Experience informs me that older folks can alter this pattern. Specifically, getting a bit of in-home help while still living independently can reduce the risk of illness or injury, and thus avoid a trip to the hospital. The key is to add support in a timely manner as it’s needed.
The safety net for seniors is much more limited than I ever thought. It’s mostly the very wealthy and very poor who have options; long-term care insurance can give folks more options.
Old is not sick; it just means that someone may need a bit of help from time to time. Without advanced planning, or an incremental approach to in-home assistance, a person can move very quickly from independence to an institutional setting that they might find unsatisfactory. The resulting loss of autonomy and control over the events in their lives can be devastating to some.
Finally, it is so important for a person’s health and longevity to have network of social contacts, and within this network to have one or more folks who can be called upon to help with both the urgent and the mundane puzzles that life presents…
Richard Corriea is a retired commander in the SF Police Department and a former president of the Planning Association for the Richmond.
https://sfrichmondreview.com/2019/01/05/commentary-richard-corriea-4/
My turn: California has a broken system of long-term care. Here’s what’s needed
ReplyDeleteJan. 29, 2019
By Nancy McPherson and April Verrett
In his inauguration speech, Gov. Gavin Newsom pledged that “every senior should be able to retire with security.” That’s a significant commitment to address challenges facing older adults, families and caregivers who struggle in a dysfunctional system.
California has an insufficient system of long-term services and supports for older people and people with disabilities, as detailed in a 2015 report by the California Senate’s Select Committee on Aging and Long-Term Care.
The report painted an alarming picture of the shortcomings of the current system, but offered real solutions: California can build a better system to serve all who have long-term care needs.
Since the Senate issued its report, the problem is only becoming more critical. By 2030, the California Department of Finance projects 24 percent of the population will be at least 65. And, in the next 20 years, the number of adults with disabilities could grow by 20 percent.
This added pressure on the system is creating a crisis for the middle class and generational poverty as each generation spends more of its savings caring for family members.
According to an AARP study, the annual cost of nursing homes is more than double the $50,000 median income of older households in California. Although Medi-Cal is a major public payer for the system of long-term services and supports, the high cost of nursing homes and long-term services is causing an increase in the number of unpaid family caregivers. The study also showed that in 2013, 4.5 million family caregivers provided care valued at roughly $58 billion.
Fortunately, there are innovative ways to address the long-term care crisis to achieve the intended results without putting additional pressure on the state’s general fund.
While some people can afford private long-term care insurance, the market for those policies is disappearing. As premiums rise, insurance companies are dropping coverage for long-term care.
And, as most people find out when it is too late, Medicare does not adequately cover long-term care services, which are far too expensive for most to pay out of pocket.
What is desperately needed is a solution that fits the diverse long-term care needs of the Golden State. We need an affordable and accessible system of long-term care for all Californians, regardless of their income or ZIP code.
To come up with that solution 20 organizations representing long-term care stakeholders have come together to form the California Aging and Disability Alliance. This alliance is working on an innovative and cost-effective approach to the long-term services and supports challenges we face.
We believe the public would embrace funding a limited but meaningful range of services for those with long-term services and supports needs. This would have many positive effects, including providing some relief to the state in its Medi-Cal long-term services and supports costs.
In the next few months, California Aging and Disability Alliance will develop our proposal based on that principle and seek the active involvement of the Legislature. At the same time, we look forward to working closely with Gov. Newsom to support his ideas and plans on this issue.
As Gov. Newsom said: “I have never been a fan of pretense or procrastination. After all, our state is defined by its independent, outspoken spirit.”
We agree. California can do this, but only if we work together.
Nancy McPherson is state director for AARP California, nmcpherson@aarp.org. April Verrett, aprilv@seiu2015.org, is President of SEIU Local 2015, both are CADA members.
https://calmatters.org/articles/commentary/my-turn-california-has-a-broken-system-of-long-term-care-heres-whats-needed/
Governor Gavin Newsom
ReplyDeleteState of the State Address
February 12, 2019
SACRAMENTO — Governor Gavin Newsom delivered his first State of the State address before a joint session of the California Legislature today.
Mayors, county supervisors, and city councils around the state are working hard to reduce homelessness and its underlying causes. We’ve got to have their backs.
But they can’t do it alone. To help lead this discussion, I’m appointing a new Commission on Homelessness & Supportive Housing, led by Sacramento Mayor Darrell Steinberg.
With your support, let’s put half a billion dollars into immediate funding for navigation centers — emergency shelters with services on site, and another hundred million for Whole Person Care to replace a fragmented approach to services with one that’s more integrated and comprehensive.
And while cities and counties are on the front lines, this challenge will only be solved regionally. We need to work together as a state to focus on prevention, rapid rehousing, mental health, and more permanent supportive housing — because while shelter solves sleep, only permanent supportive housing solves homelessness.
Now, let’s talk about something too often overlooked:
The Golden State is getting grayer. We need to get ready for the major demographic challenge headed our way.
For the first time in our history, older Californians will outnumber young children. Over the next decade, our statewide senior population will increase by 4 million. In 25 years, it will double. And more than half will require some form of long-term care.
Growing old knows no boundaries – aging doesn’t care what race you are, your economic status, or if you’re single with no other family support.
I’ve had some personal – and painful – experience with this recently. I lost my father over the holidays, after years of declining physical health and dementia. He was determined to live out his days with dignity. He also happened to be a retired public official with a pension and a support circle of family and friends.
Even with all those advantages, it was a daily challenge to meet his needs so he could live in place and maintain a good quality of life. Millions of Californians share a similar story, and the numbers will only grow.
It’s time for a new Master Plan on Aging. It must address: person-centered care, the patchwork of public services, social isolation, bed-locked seniors in need of transportation, the nursing shortage, and demand for In-Home Supportive Services that far outpaces its capacity.
And we can’t talk about aging without focusing on Alzheimer’s.
Too many of us have seen the crushing grip this disease has on our loved ones – and especially on our wives and mothers – two-thirds of new Alzheimer’s cases are women.
Today, I am launching the Alzheimer’s Prevention and Preparedness Task Force, bringing the most renowned scientists and thinkers together to develop first-of-its-kind research in this area. It will be headed by a leading advocate for families dealing with Alzheimer’s, our former first lady, Maria Shriver. She is here today and we are grateful for her continued service.
https://www.gov.ca.gov/2019/02/12/state-of-the-state-address/
Are Older Americans Getting the Long-Term Services and Supports They Need?
ReplyDeleteJanuary 24, 2019
Amber Willink, Judith Kasper, Maureen E. Skehan, Jennifer L. Wolff, John Mulcahy, and Karen Davis
ABSTRACT
• Issue: Older adults’ needs have evolved and are no longer met by the Medicare program. With the recent passage of the Bipartisan Budget Act of 2018 (BBA), Medicare Advantage (MA) plans can now provide beneficiaries with nonmedical benefits, such as long-term services and supports (LTSS), which Medicare does not cover.
• Goal: To examine the use of LTSS among Medicare beneficiaries age 65 and older living in the community and explore differences by age, income, and other variables.
• Methods: Descriptive analyses of the National Health and Aging Trends Study (NHATS), 2015.
• Key Findings and Conclusions: Two-thirds of older adults living in the community use some degree of LTSS. Reliance on assistive devices and environmental modifications is high; however many adults, particularly dual-eligible beneficiaries, experience adverse consequences of not receiving care. Although the recent policy change allowing MA plans to offer LTSS benefits is an important step toward meeting the medical and nonmedical needs of Medicare beneficiaries, only the one-third of Medicare beneficiaries enrolled in MA plans stand to benefit. Accountable care organizations operating in traditional Medicare also should have the increased flexibility to provide nonmedical services.
Background
…needs of older Americans have evolved since Medicare’s enactment in 1965. Average life expectancy at age 65 has grown by approximately five years since 1960, an increase in longevity that has been accompanied by a rise in multiple chronic conditions and functional and cognitive impairment in the later years of life.
Because traditional Medicare does not cover most long-term services and supports (LTSS), individuals and their families bear most of the costs for this assistance. Medicare may only cover walkers, canes, wheelchairs, and commodes if the beneficiary requires such durable medical equipment for medical needs and purchases it through an approved provider. Meanwhile, Medicaid covers only a portion of LTSS costs once dual-eligible beneficiaries meet “nursing home level of care” criteria.
Policy Implication
... Although expanding Medicare coverage in tight budget times is controversial among policymakers, adding LTSS benefits could help older Medicare beneficiaries with LTSS needs while achieving greater efficiencies and value of spending for this population. In 2015, average annual Medicare spending for beneficiaries with functional or cognitive impairment was twice as high as for those without functional or cognitive impairment.…
Beyond the BBA, other proposals could provide more flexibility (as well as broader accountability) in the traditional Medicare program to ensure the health and well-being of most Medicare beneficiaries. One such proposal would promote the development of integrated care organizations that would operate much like accountable care organizations but cover a broad range of LTSS needs. This would open the door for innovative models of care that better support more older Medicare beneficiaries with LTSS needs.
One example is the Community Aging in Place–Advancing Better Living for Elders (CAPABLE) program, in which a nurse, occupational therapist, and maintenance person work as a team to ensure the safety and independence of low-income older adults living at home. In a demonstration project funded by the Centers for Medicare and Medicaid Services (CMS), Medicare saved $2,765 per quarter per participant, while beneficiaries’ number of ADL limitations decreased from 3.9 to 2.0 after five months in the program. Achieving such savings on a larger scale requires policymakers to rethink what Medicare should cover to promote better health among older Americans.
https://www.commonwealthfund.org/publications/issue-briefs/2019/jan/are-older-americans-getting-LTSS-they-need
Where There’s Rarely a Doctor in the House: Assisted Living
ReplyDeleteBy Paula Span
March 29, 2019
The patient moved into a large assisted living facility in Raleigh, N.C., in 2003. She was younger than most residents, just 73, but her daughter thought it a safer option than remaining in her own home.
The woman had been falling so frequently that “she was ending up in the emergency room almost every month,” said Dr. Shohreh Taavoni, the internist who became her primary care physician.
…As the falls continued, two more in her first three months in assisted living, administrators followed the policy most such communities use: The staff called an ambulance to take the resident to the emergency room.
There, “they would do a CT scan and some blood work,” Dr. Taavoni said. “Everything was O.K., so they’d send her back.”
Such ping-ponging occurs commonly in the nation’s nearly 30,000 assisted living facilities…
It’s an expensive, disruptive response to problems that often could be handled in the building, if health care professionals were more available to assess residents and provide treatment when needed.
But most assisted living facilities have no doctors on site or on call; only about half have nurses on staff or on call. Thus, many symptoms trigger a trip to an outside doctor or, in too many cases, an ambulance ride, perhaps followed by a hospital stay.
Twenty years after the initial boom in assisted living — which now houses more than 800,000 people — that approach may be shifting.
Early on, assisted living companies planned to serve fairly healthy retirees, offering meals, social activities and freedom from home maintenance and housekeeping — the so-called hospitality model.
But from the start, the assisted living population was older and sicker than expected. Now, most residents are over age 85, according to government data. About two-thirds need help with bathing, half with dressing, 20 percent with eating.
Like most older Americans, they also generally contend with chronic illnesses and take long lists of prescription drugs — and more than 80 percent need help taking them correctly.
Moreover, “these places became the primary residential setting for people with dementia,” said Sheryl Zimmerman, an expert on assisted living at the University of North Carolina at Chapel Hill.
About 70 percent of residents have some degree of cognitive impairment, her studies have found. So residents can find it difficult to coordinate medical appointments and tests, and to travel to offices and labs, even when facilities provide a van.
“The assisted living industry has to recognize that the model of residents going out to see their own doctors hasn’t worked for a long time,” said Christopher Laxton, executive director of AMDA, a society that represents health care professionals in nursing homes and assisted living.
His recent editorial in McKnight’s Senior Living, an industry publication, was pointedly headlined: “It’s time we integrate medical care into assisted living.” AMDA is considering developing model agreements.
“There has to be more attention to medical and mental health care in assisted living,” Dr. Zimmerman agreed. “Does everyone who falls really need to go to an emergency department?”
…But persuading most operators to provide medical care likely won’t happen without a fight. They’ve built their marketing strategies on looking and feeling different from the dreaded nursing home, and they object to “medicalizing” their communities.
…Spending time in emergency rooms and hospitals often takes a toll on residents, even if their ailments can be treated. They get exposed to infections and develop delirium; they lose strength from days spent in bed.
Perhaps that contributes to short stays in assisted living. Adult children often see these facilities as their parents’ final homes, but residents stay just 27 months on average, after which many move on to nursing homes…
https://www.nytimes.com/2019/03/29/health/assisted-living-doctors-house-calls.html
Suicide In Long-Term Care
ReplyDeleteBy Melissa Bailey and JoNel Aleccia
APRIL 9, 2019
…In a nation where suicide continues to climb, claiming more than 47,000 lives in 2017, such deaths among older adults — including the 2.2 million who live in long-term care settings — are often overlooked. A six-month investigation by Kaiser Health News and PBS NewsHour finds that older Americans are quietly killing themselves in nursing homes, assisted living centers and adult care homes.
…KHN analysis of new data from the University of Michigan suggests that hundreds of suicides by older adults each year — nearly one per day — are related to long-term care. Thousands more people may be at risk in those settings, where up to a third of residents report suicidal thoughts, research shows.
…frail older Americans are managing to kill themselves in what are supposed to be safe, supervised havens raises questions about whether these facilities pay enough attention to risk factors like mental health, physical decline and disconnectedness — and events such as losing a spouse or leaving one’s home. More controversial is whether older adults in those settings should be able to take their lives through what some fiercely defend as “rational suicide.”
…Even in supervised settings, records show, older people find ways to end their own lives. Many used guns, sometimes in places where firearms weren’t allowed or should have been securely stored. Others hanged themselves, jumped from windows, overdosed on pills or suffocated themselves with plastic bags. (The analysis did not examine medical aid-in-dying…)
Descriptions KHN unearthed in public records shed light on residents’ despair: Some told nursing home staff they were depressed or lonely; some felt that their families had abandoned them or that they had nothing to live for. Others said they had just lived long enough…
By 2030, all baby boomers will be older than 65 and 1 in 5 U.S. residents will be of retirement age, according to census data. Of those who reach 65, two-thirds can expect to need some type of long-term care. And, for poorly understood reasons, that generation has had higher rates of suicide at every stage, said Dr. Yeates Conwell, director of the Office for Aging Research and Health Services at the University of Rochester.
…Long-term care settings could be a critical place to intervene to avert suicide — and to help people find meaning, purpose and quality of life, Mezuk argued: “There’s so much more that can be done. It would be hard for us to be doing less.”
…The main risk factors for senior suicide are what he calls “the four D’s”: depression, debility, access to deadly means and disconnectedness.
…Most seniors who choose to end their lives don’t talk about it in advance, and they often die on the first attempt, he said.
…Conwell, a leading geriatric psychiatrist, finds the idea of rational suicide by older Americans “really troublesome.” “We have this ageist society, and it’s awfully easy to hand over the message that they’re all doing us a favor,” he said.
Know what’s normal. Depression and thoughts of suicide are not an inevitable part of aging or of living in long-term care. Consider treatment for depression if the person experiences trouble sleeping, muscle aches, headache, changes in appetite or weight, restlessness or agitation.
Don’t be afraid to ask about it. ... Ask what would help them look forward to waking up or want to be alive.
If you have concerns, speak up.
Ask about suicide protocols. chemicals, cords and plastic bags. Ensure that windows, stairwells and exits are secure.
Even when there are clear indications of risk, there’s no consensus on the most effective way to respond. The most common responses — checking patients every 15 minutes, close observation, referring patients to psychiatric hospitals — may not be effective and may even be harmful, research shows.
https://khn.org/news/suicide-seniors-long-term-care-nursing-homes/
Many Americans Will Need Long-Term Care. Most Won’t be Able to Afford It.
ReplyDeleteA decade from now, most middle-income seniors will not be able to pay the rising costs of independent or assisted living.
By Paula Span
May 10, 2019
Gretchen Harris likes the small brick house she bought in Norman, Okla., 36 years ago…
But Ms. Harris, 72, a retired attorney, has grappled with assorted health problems…Divorced, childless and without family nearby, “I am going to need some long-term support, independent or assisted living, rather than just living by myself.”
But will she be able to afford it on her income, $4,600 a month from a state pension and Social Security?... “It’s the middle-class bind,” she said. Too much money to qualify for Medicaid or subsidized housing, but not enough to pay for long-term care, an industry that has primarily pursued the well-off.
A recent analysis in Health Affairs, pointedly titled “The Forgotten Middle,” investigated how many middle-income seniors will be caught in that bind…researchers defined the middle-income cohort as Americans from the 41st to the 80th percentile in terms of financial resources.
In 2029, for people 75 to 84 (ages when they’re likely to need long-term care), that would mean access to about $25,000 to $74,000 a year in current dollars. Over age 85, the middle-income category extends to $95,000.
About 14.4 million people will fall into the middle-income category, almost double the current number. Sixty percent will need canes, walkers or wheelchairs to remain mobile, the analysis estimated, and 20 percent will need extensive help with the so-called activities of daily living, such as bathing and dressing.
They’re a better educated and more diverse group of older adults than in the past, less likely to experience poverty…
A decade hence, 80 percent of middle-income seniors will have less than $60,000 a year in income and assets, not including equity in their homes. Yet the estimated cost of assisted living plus out-of-pocket medical expenses will hit $62,000, by the team’s conservative estimate.
“This group gets ignored and underserved in today’s long-term care market, and it’s a problem that’s going to explode over the next 20 years,” said Caroline Pearson, a health researcher at Norc (formerly the National Opinion Research Center) at the University of Chicago and lead author of the study…
Depending on how one defines the need, half to two-thirds of older Americans will eventually require long-term care…(The analysis includes assisted and independent living but omits nursing homes, where Medicaid becomes a major payer.)
Even among middle-income seniors with housing equity, though, more than half will be unable to pay assisted living fees and medical costs in 2029…
“Though a very large percentage of older adults own homes, the amount of equity they have isn’t as much as they think,” said Howard Gleckman, a senior fellow at the Urban Institute. “They’ve used home equity for other things, including health care.”
Mr. Gleckman looked into housing equity as a member of the Long-Term Care Financing Collaborative,…
among 65- to 74-year-olds, the median household had about $100,000 in home equity and an equal amount in other assets…
While the Genworth survey puts the current national average for a one-bedroom apartment in assisted living at $4,120 monthly, geographic variations can be extreme, from about $3,700 in New Orleans to over $6,000 in Boston.
Moreover, today’s middle-income older adults have more debt and less savings than earlier cohorts. They’re less likely to receive pensions and have smaller families to turn to for unpaid care.
…Next year, Social Security’s costs will start exceeding its income; the program is projected to deplete its reserves in 16 years. Medicare will deplete its hospital fund in just seven years.
.…The United States, unlike many Western democracies, has never created a broad public program covering long-term care.
https://www.nytimes.com/2019/05/10/health/assisted-living-costs-elderly.html
Anna Mae Blessing update: New footage reveals why 92-year-old Valley woman killed her son
ReplyDeleteBy Zach Crenshaw
May 30, 2019
PHOENIX, AZ — Newly released body camera footage, detective interviews, and 911 calls shed light on a murder that shocked the Valley.
Anna Mae Blessing was arrested on July 2, 2018, for the shooting death of her 72-year-old son Thomas Blessing at their home in Fountain Hills.
Blessing told detectives she was upset about her son’s plans to put her in an assisted living facility. Blessing also said she was angry with how her son and his girlfriend, who also lived at the home, were treating her. She claims they were mean and did not care for her.
When the couple got home from a vacation and ignored Blessing, she told Maricopa County Sheriff’s Office deputies she walked into their bedroom with two concealed pistols in her robe pockets.
The grandmother said she got in an argument with her son and pulled out a revolver. “I can’t remember the caliber, it was a good size one,” she told a detective after being arrested.
Blessing said she did not remember why she removed the gun, but she said as Thomas lunged, she fired multiple rounds, killing her only son.
“I backed up and I pulled the trigger, and it broke the mirror and I don’t know what I did,” she said. “Then Tom was going to come at me again so I pulled the trigger…I’m sure the second round hit him.”
“Where did it hit him?” asked the MCSO detective.
“I have no idea, but I do know I killed him,” explained Blessing. “I bent over and took his pulse, and there was no pulse. So I knew I killed him.”
After she shot Thomas, she then admitted to pointing the gun at her son’s girlfriend. The two struggled over the weapon before the girlfriend knocked the revolver away.
The girlfriend, Julie, can be heard screaming at the dispatcher for help in newly released 911 calls.
… “She got in her pocket and she pulled out another gun … I grabbed onto her and I was yelling, ‘Stop Ann! Stop.’ She’s strong for 92, let me tell you. And when I knocked her down, she took the gun and she put it in my side. Then she pulled it up again.”
Blessing had a second pistol but never used it.
“Then I went to my bed and sat in the chair and waited for police to come,” said Blessing.
During a roughly 11-hour holding period, with hours of interrogation, coughing, and naps, Blessing confessed multiple times.
“I killed my own son,” she said. “He was coming at me, so I fired the gun.”
She also explained her motive. “I didn’t want to go to a nursing home and he would promise me I never would have to.”
The 92-year-old was of sharp mind, correcting the detective at some points, but she was also clearly elderly.
“Right now I’m so damn tired, I don’t know,” said Blessing, who also had a Life Alert necklace and hearing aids on at the time of her arrest.
“When you reached down and felt that he didn’t have a pulse, how did you feel?” asked the detective.
“I didn’t have much of a feel I guess,” she replied.
“How do you feel right now about what happened?”
“I wish I had stayed in Florida,” said Blessing
Blessing did not appear remorseful throughout the lengthy interview.
When asked if she felt bad about pointing the gun at Julie — who she said she was close friends with weeks prior — she responded, “Yeah kind of. But she’s part of the trying to get me put in a nursing home too … so I don’t know that I do feel that bad.”
Blessing ultimately told the detective, “I probably ought to be put to sleep.”
“What can I do for society?” she asked out loud, “I killed my son. The person I brought into this world.”
Blessing died in jail hospice on January 25, 2019. She was set to stand trial for the murder weeks later in March.
Her only granddaughter told ABC15 after the arrest that she thought Blessing should be released from jail where she could have her dignity back.
https://www.abc15.com/news/region-northeast-valley/fountain-hills/anna-mae-blessing-update-new-footage-reveals-why-92-year-old-valley-woman-killed-her-son
The Future Looks Terrible For U.S. Nursing Home Costs
ReplyDeleteJUNE 25, 2019 • LUKE MCGRATH
The results of a six-year study by Georgetown University Medical Center revealed just how fast U.S. nursing home prices have been increasing all across America. And the future looks just as grim.
Dr. Sean Huang, the study’s lead author, said the brutal dynamic governing long-term care in America—where many nursing home residents must spend down the bulk of their life savings before qualifying for federal assistance—is intensifying. California, Florida, New York and Texas all saw increases that far outstripped the 11.65% rise in inflation between 2005 and 2010, the period reviewed by Georgetown’s analysis of eight states. Additional data show the upward trend has continued in the years since.
And it’s not just baby boomers who need to worry—Generation X, millennials and Generation Z might face an even darker old age. Rising wage pressure on a sector in need of workers is driving up costs, and unless Washington comes up with a fix, be it a version of Medicare-for-All or something less ambitious, the funding for some programs is projected to start running out in the next decade.
“We’re talking about long stays—people who have disabilities, dementia, Parkinson’s disease,” Huang explained about the growing nursing home population. “Medicare does not cover that. They will pay out-of-pocket until they use all of their wealth.”
“It’s unlikely that you’re going to see any improvement in these trends, and if anything, things will probably get worse.”
Many Americans have no idea how Medicare works, including those approaching retirement. A sort-of government health insurance policy largely for older Americans, eligibility generally begins at age 65, covering some of the costs of routine and emergency medical care. What it doesn’t cover is most aspects of long-term “custodial” care—as in nursing homes, where a large portion of Americans can expect to spend the last years of their lives.
That’s where Medicaid—state-administered coverage for Americans whose assets fall below a certain level—comes in. For those who qualify for nursing home admission, Medicaid generally requires they exhaust most of those assets before qualifying for coverage. Without expensive long-term care insurance, which most people don’t have, an increasing number of older Americans are falling into this financial trap, Huang said.
And their nest eggs are being depleted more quickly than ever. Huang’s study found nursing home price rises over the period measured generally outpaced increases in overall medical care (20.2%) and general consumer prices (11.7%). For example, in California between 2002 and 2011, the median out-of-pocket cost for nursing home care increased by 56.7%.
Huang and three co-authors began looking into the matter in 2013. With no central database, they had to collect information from each state and individual nursing homes. Some states only had data through 2010, he said. In the end, they managed to crunch data from an average of 3,900 nursing homes for each of the years measured, representing approximately 27% of freestanding U.S. facilities.
Nursing homes in New York during the period reviewed had the highest average daily price of $302.30, while Texas had the lowest average daily price of $121.90. Additional information has shown that nursing home costs have continued to increase at a much higher rate than inflation, albeit slight slower than the study period.
https://www.fa-mag.com/news/the-future-looks-terrible-for-u-s--nursing-home-costs-45608.html
Patient abuse scandal rocks San Francisco’s Laguna Honda hospital
ReplyDeleteDominic Fracassa June 28, 2019
Twenty-three patients at San Francisco's Laguna Honda Hospital and Rehabilitation Center endured systemic abuse at the hands of six of the hospital employees, the Department of Public Health alleged Friday.
The victims live in two wards at the public hospital that primarily serves dementia patients and were subjected to alleged physical and verbal abuse between 2016 and January 2019, according to the health department. An investigation by DPH and the city attorney’s office that started in February also found that some patients were regularly given both prescription and nonprescription drugs intended to sedate them. The patients ranged in age from 30 to around 100.
The public, city-run facility serves as a live-in hospital, nursing home and rehabilitation center for 780 patients.
Health officials said Friday that the six alleged abusers took photos and videos of themselves engaging in the abuse — including having sexualized conversations with patients. The alleged abusers then exchanged those photos and videos over text messages…
The patients and their families and caretakers all have been notified of the abuse.
None of the six alleged abusers work for Laguna Honda today…The hospital’s chief executive, Mivic Hirose, has resigned. The hospital’s chief of quality management — who oversees Laguna Honda’s compliance with patient-care standards — has been placed on administrative leave and will not return to the position…The city has brought in administrators from Zuckerberg San Francisco General Hospital to manage Laguna Honda’s quality management temporarily.
Maggie Rykowski, the health department’s chief integrity officer and director of the Office of Compliance and Privacy Affairs, will serve as the hospital’s acting CEO until a full-time replacement is found.
The California Department of Public Health is also conducting an ongoing investigation. Back in 2017, that agency fined Laguna Honda $100,000 for safety violations that led to a patient’s death…
The San Francisco Police Department’s Special Victims Unit began its own criminal investigation into the abuse in February after being contacted by the city attorney’s office, SFPD spokesman David Stevenson said Friday.
Mayor London Breed said at a news conference Friday that she and the health department were “committed to restoring trust” among the hospital’s patients and their caregivers…
Breed’s own grandmother, whom she said suffered from dementia, lived at Laguna Honda for years, until she died in 2016…
Board of Supervisors President Norman Yee said he was “super outraged with what has occurred,” and pledged to call a hearing to find ways “to prevent such abuse.” The hospital is located in District Seven, which Yee represents…
DPH Director Dr. Grant Colfax apologized to the patients and their families, and outlined several steps the department has already taken in response to the abuse allegations. In addition to the personnel changes, hospital staff have been retrained to prevent and report patient abuse. Colfax said he was concerned about “a culture of silence” at the hospital, where staff turn a blind eye to abuse. The department also plans to submit a “turnaround plan” for the hospital within 60 days to the mayor and the Health Commission, which governs the department.
“People with dementia get picked on because they’re easy targets and no one believes them,” said Pat McGinnis, executive director of California Advocates for Nursing Home Reform.
Reports of the abuse at Laguna Honda were distressingly similar to those her organization sifts through on a daily basis, she said. But what did stand out, she said, was “the extent of it — how long it went on and how many people were involved. It’s absolutely disgusting and horrible.”
https://www.sfchronicle.com/bayarea/article/Patient-abuse-scandal-rocks-San-Francisco-s-14059074.php
Many view assisted living as just housing, not health care. That’s dangerous
ReplyDeleteBY ED DUDENSING AND ANTHONY CHICOTEL
AUGUST 21, 2019
...Gov. Gavin Newsom’s Master Plan for Aging, scheduled to be unveiled next year, affirms the need for decisive and strategic action. Reforming the assisted living industry must be a part of this strategy.
The graying of California has been a boon for assisted living programs, as families look for alternatives to traditional nursing homes for loved ones who are living longer. Assisted living centers appear attractive because they more closely resemble homes than hospitals, with comfortable living spaces, social programs and other amenities.
But as the popularity of assisted living continues to grow – and with it the economic clout of corporate owners – oversight and sound health care standards and practices have lagged, imperiling vulnerable people. We can attest to this firsthand: Recently, one of us represented the family of a 77-year-old resident of the long-term care mega-provider Eskaton, who choked to death after she was given powerful sedatives to chemically restrain her.
The tragedy, which resulted in a record $42.5 million verdict against Eskaton by a Sacramento jury, raised questions that go to the heart of assisted living policy in California: Why was a powerful psychotropic drug, in this case Ativan, improperly administered? Why were staffing levels and training inadequate to ensure safe and effective care? Why was oversight lacking, both inside the facility and on the part of regulators?
The answer lies in our dangerous tendency to view assisted living as housing, rather than health care. The level of care required by some assisted living residents can be indistinguishable from the level of care required by some patients in skilled nursing facilities.
Yet staffing and training requirements are far lower for assisted living programs, which, for example, don’t require a physician or nurse on-site, and do not have any minimum staff-to-resident ratios. Rising demand has only intensified the workload for assisted living staff. And the drive for profits creates an incentive to keep staffing levels lean and training minimal.
Powerful psychotropic drugs of such as Ativan may in some cases have therapeutic benefits, but they also are potentially dangerous and must be used judiciously under a physician’s order and supervision. Even though assisted living programs are required to have a medical doctor sign off on a particular medication’s use, undertrained and overworked staff often are left to make real-time decisions, especially when a resident is expressing discomfort through unruly behavior or not following instructions. This has become an issue particularly in popular memory care units, where Alzheimer and other dementia patients reside.
Since the Residential Care Facilities for the Elderly Act was passed in 1985, there have been numerous efforts to bolster oversight. Unfortunately, most reforms have focused on industry issues such as licensing and liability, and less on quality of care. While there have been additions to the state Health and Safety Code to include tiered “levels of care,” implementation has not followed.
Assisted living has many advantages. But if we are to be successful in caring for our growing ranks of elderly citizens, California needs to reset how it regulates the industry, increasing training, staffing levels and physician and nursing involvement.
This may impact the bottom line, but business priorities can’t supersede delivering responsible long-term care. This is a challenge we all – the governor, Legislature, industry and individual citizens – must confront head-on.
Ed Dudensing is a former deputy district attorney for Sacramento County who represents victims of nursing home and assisted living facility neglect and abuse. Anthony Chicotel is a staff attorney for California Advocates for Nursing Home Reform.
https://www.sacbee.com/opinion/op-ed/article233305782.html
How Not to Grow Old in America
ReplyDeleteBy Geeta Anand
Aug. 29, 2019
Assisted living seems like the solution to everyone’s worries about old age. It’s built on the dream that we can grow old while being self-reliant and live that way until we die. That all you need is a tiny bit of help. That you would never want to be warehoused in a nursing home with round-the-clock caregivers. This is a powerful concept in a country built on independence and self-reliance.
The problem is that for most of us, it’s a lie. And we are all complicit in keeping it alive.
The assisted living industry, for one, has a financial interest in sustaining a belief in this old-age nirvana. Originally designed for people who were mostly independent, assisted living facilities have nearly tripled in number in the past 20 years to about 30,000 today. It’s a lucrative business: Investors in these facilities have enjoyed annual returns of nearly 15 percent over the past five years — higher than for hotels, office, retail and apartments, according to the National Investment Center for Seniors Housing and Care.
The children of seniors need to believe it, too. Many are working full time while also raising a family. Adding the care of elderly parents would be a crushing burden.
…The irony of assisted living is, it’s great if you don’t need too much assistance… But if you have trouble walking or using the bathroom, or have dementia and sometimes wander off, assisting living facilities aren’t the answer, no matter how desperately we wish they were.
“They put their money into the physical plant. It’s gorgeous,” said Cristina Flores, a former home health care nurse who has a Ph.D. in nursing health policy, lectures in the gerontology program at San Francisco State University and runs three small group homes for the elderly.
But when it comes to direct care, the facilities are often lacking. “The way they market everything is, it’s all about autonomy and independence…,” she said. Families and residents don’t realize that these facilities are not designed to provide more than minimal help and monitoring. Even those that advertise “24-hour” monitoring may have someone present round-the-clock on the premises, but may not have sufficient staff to actually monitor and assist the large number of residents.
…Most residents of assisted living need substantially more care than they are getting.
…Not surprisingly, complaints against assisted living facilities are mounting in courts around the country.
…More than 40 percent of people in assisted living have some form of dementia. Construction of memory care units in assisted living facilities is the fastest-growing segment of senior care. But assisted living, even memory care units, often aren’t the right place for people with dementia. In most states, there’s no requirement that these units be staffed with enough people or that they be properly trained.
Assisted living has a role to play for the fittest among the elderly, as was its original intent. But if it is to be a long-term solution for seniors who need substantial care, then it needs serious reform, including requirements for higher staffing levels and substantial training.
That will raise prices…
Perhaps the United States can learn from Japan, which…created a national long-term-care insurance system that is mandatory. It is partly funded by the government but also by payroll taxes and additional insurance premiums charged to people age 40 and older. It is a family-based, community-based system, where the most popular services are heavily subsidized home help and adult day care. …still use nursing homes and assisted living facilities, but the emphasis is on supporting the elder population at home.
…Americans need to allow the reality of ourselves as dependent in our old age to percolate into our psyches and our nation’s social policies.
Geeta Anand…is a professor at the University of California Berkeley Graduate School of Journalism…
https://www.nytimes.com/2019/08/29/opinion/sunday/dementia-assisted-living.html
Two SF homes for elderly and formerly homeless plan to close amid rising costs
ReplyDeleteBy Trisha Thadani
Tuesday, September 3, 2019
At least two residential care facilities in San Francisco that provide long-term care for 26 vulnerable people — some elderly, others formerly homeless — plan to shut their doors in the next few months, the latest in a spate of board-and-care closures around the city.
Officials with both facilities say they’ve been socked by the rising costs of doing business in San Francisco and a stagnant state reimbursement rate to run the homes. They also cited increasing difficulty in hiring and retaining staff. The two homes are Tiffany’s Care Home in Bernal Heights, which serves the elderly, and Parkview House #1 in Haight-Ashbury, which houses people who were formerly homeless and struggle with mental illness and substance abuse.
The two closures are part of an alarming trend that’s contributing to the city’s homeless and mental health crisis — the rapid disappearance of residential care beds for the elderly, mentally ill and those with substance abuse problems. San Francisco has lost more than a quarter of its board-and-care beds since 2012, according to the city’s working group on the problem. The operators say that many facilities are closing because the landlords are selling the properties in San Francisco’s hot real estate market, or because the costs to run the homes are outstripping revenue.
In the wake of the latest closures, Supervisors Rafael Mandelman and Norman Yee introduced a resolution at Tuesday’s Board of Supervisors meeting that they hope will discourage more board-and-cares from shuttering. The resolution would require a special permit if a landlord wants to change the board-and-care home to a different use, such as a single-family home. The new rule would last 18 months.
“Residential care facilities, or board-and-care homes, have for decades provided stable housing to our vulnerable population of seniors and people with disabilities,” Mandelman said at Tuesday’s meeting. “This is an urgently needed stopgap measure to preserve a crucial component of our city’s housing stock for our vulnerable, sick and elderly residents.”
The Department of Public Health said it will help find placement for the displaced tenants, six from Tiffany Home and 20 from Parkview House #1. But finding another long-term housing option for these people will likely be difficult in a city where such facilities are increasingly hard to come by.
…Board-and-care facilities are home-like environments for the low-income, mentally ill and elderly. Licensed board-and-cares receive monthly rent from the government, and tenants often help pay for their care through their Supplemental Security Income checks, which is a combination of federal and state funds for people with serious mental illness.
…The latest closures come despite a $1 million investment by Mayor London Breed last year to assist residential care facilities. That investment increased the local subsidy for most facilities from $19 a night to $21 a night.
The closures also come two weeks after the Department of Public Health came under fire after news surfaced that dozens of long-term beds have been sitting empty at San Francisco General Hospital’s Adult Residential Facility for more than a year — despite the demand for more long-term housing for the mentally ill and homeless.
Those beds were empty because the department said it could not hire enough staff to help run them. Instead of figuring out how to operate the existing beds, the city plans to turn them into temporary respite beds…
https://www.sfgate.com/politics/article/Two-SF-homes-for-elderly-and-formerly-homeless-14411412.php?t=c8cf9e7624
Elderly often face neglect in California care homes that exploit workers
ReplyDeleteby Jennifer Gollan
Wednesday, September 18, 2019
…An investigation by Reveal from The Center for Investigative Reporting found that some operators of senior board-and-care homes that violate labor laws and steal workers’ wages – previously exposed by Reveal – often also endanger or neglect their residents, sometimes with dire consequences.
Reveal analyzed thousands of licensing records and hundreds of U.S. Department of Labor cases in California and conducted two dozen interviews with workers, residents and their family members.
Reveal’s review provides the first comprehensive accounting of failures in care homes whose operators preyed on vulnerable caregivers, many of them poor immigrants, and elderly residents. In California, which has the most licensed senior care homes of any state, federal data shows that operators broke minimum wage, overtime or record-keeping laws in more than 500 cases over the last decade. In 1 in 5 of these cases, operators were cited for health and safety violations that endangered residents, Reveal found.
…Vicky Waters, a spokeswoman for California Gov. Gavin Newsom, said two state agencies are working on a new enforcement initiative to crack down on the mistreatment of workers and seniors…“The California Department of Social Services and the California Department of Industrial Relations are launching an effort under which the Departments will work closely together to ensure compliance with labor and licensing laws, including data sharing, joint meetings with licensees, and legal actions up to and including license revocation.”
…In May, Reveal reported widespread exploitation of caregivers in senior residential care homes, many of whom earn as little as $2 an hour to work around the clock with no days off, while some industry operators make millions. Caregivers routinely are harassed and fired if they complain.
Reveal also found that companies caught stealing from workers continue to operate illegally despite outstanding wage theft judgments, leaving scores of workers unpaid. California regulators had said they could not strip these companies of their licenses unless residents’ health and safety were threatened.
…at Walnut Creek Willows care home in the San Francisco Bay Area, investigators found residents sitting in soiled underwear and a resident wandering about with a bruised and bloody foot. The staff ignored both, records show. At Sonia’s Care Home in Stockton, a resident who fractured a hip in 2017 had to be hospitalized, but staff were cited for failing to notify licensing officials as required. That same year, Spring Hills Assisted Living in Redding lacked records stretching back four years that staff had received the care training required by the state…
In 2017, a year after Nora’s Home Care #2 in Fair Oaks, northeast of Sacramento, was caught violating federal labor laws, a man died not long after being admitted to the care home. Medical records show the man’s diet was supposed to be restricted to pureed food, but Eleonora Berci, the home’s administrator at the time, told state inspectors that she had been distracted and fed him solid food. She also forgot to tell the other caregiver about his restricted diet. He was fed stew, macaroni and applesauce.
After noticing that he was spitting out saliva, Berci sent him to the hospital, where he told doctors that something was stuck in his throat. He was treated for bronchitis and sent back to the care home, where caregivers gave him applesauce with his medications. He began throwing up and aspirating and was sent back to the hospital an hour after he was released. He died two weeks later of aspiration pneumonia and food in his esophagus...
A review of state licensing records supports the worker’s account of the rat infestation at the care home in Rancho Palos Verdes, an upscale community along the coast south of Los Angeles…
https://www.sfgate.com/news/article/Elderly-often-face-neglect-in-California-care-14451370.php
SF pays $780K fine in hospital abuse scandal affecting 130 patients
ReplyDeleteJOSHUA SABATINI
Oct. 23, 2019 4:00 p.m.
The City has paid a $780,000 fine in connection with a patient abuse scandal at Laguna Honda Hospital and the number of patients impacted has grown to 130 after a months long investigation, health department officials said Wednesday.
The six staff members directly involved in the abuse, which included life-threatening drugging, photos and sexualized conversations, have lost their jobs, but it remains unclear if the San Francisco Police Department will arrest them. A criminal investigation is ongoing.
The latest details in the patient abuse scandal at the Department of Public Health’s 780-bed skilled nursing facility came during Wednesday’s Board of Supervisors Government Audit and Oversight Committee meeting, the first hearing the board has held on the issue since Mayor London Breed revealed the abuse during a City Hall press conference in late June.
Evidence of abuse surfaced as a result of a hospital worker’s human resources complaint in February, prompting the City Attorney’s Office to investigate.
Since then, forensic analysis conducted on cell phones that former hospital workers used to take photos and videos of patients and text each other about the alleged abuse has uncovered more evidence.
The new evidence shows the rights of 130 patients were violated, far more than the 23 announced in June, according to Troy Williams, the chief quality officer for Zuckerberg San Francisco General Hospital, who was sent over to Laguna Honda to assist in the investigation.
Williams said that the additional evidence from the phones includes “some physical, sexual and psychological abuse, but the majority of the additional images” he said are privacy breaches of the patients. Examples of the privacy breaches, he said, included “residents being seen in the background” of photos.
Williams noted that the sexual abuse is photos of nudity, not sexual assault. He said that the additional evidence did not implicate any additional employees.
As a result of the abuse allegations, the California Department of Public Health, launched an investigation into Laguna Honda Hospital and found a number of deficiencies the hospital has since corrected. This has resulted in fines.
“We did receive a $780,000 fine, which we paid,” Williams said. He said the fine was paid about two weeks ago, but he anticipates additional penalties from the phone evidence, which they turned over to CDPH on a rolling-basis until mid-August. He said that privacy beaches “carry a pretty heavy fine.”
Patients or their decisionmakers who were impacted were notified by The City. Williams said that so far two legal claims, precursors to lawsuit, have been filed against The City. The City Attorney’s Office has yet to provide requested copies of the claims.
Williams confirmed a criminal investigation by the San Francisco Police Department is still underway. “In fact, we met with the San Francisco Police Department yesterday and are developing a plan to help facilitate interviews with residents,” Williams said.
“They should be in jail,” said Board President Norman Yee, who called for the hearing…
One of the problems at the hospital, Williams said, was a culture of silence, where staff members were afraid to report issues for fear of retaliation. Those in quality management positions lacked expertise to investigate issues as they came up, Williams said…
https://www.sfexaminer.com/news/sf-pays-780k-fine-in-hospital-abuse-scandal-affecting-130-patients/
'We Anticipate She Has the Coronavirus. We Do Not Anticipate Her Fighting.'
ReplyDeleteJack Healy, Karen Weise and Mike Baker
The New York Times
March 6, 2020
KIRKLAND, Wash. —
…As fatal infections spread through the Life Care Center in suburban Seattle, …
Moving into a nursing home can be a wrenching choice for aging parents and their adult children. But families said they never imagined facing a public health crisis in the quiet hallways where they once believed their loved ones would be safe.
In the week since the Kirkland nursing facility became the focal point of an unfolding coronavirus outbreak in the Pacific Northwest, daily life has stalled into a sleepless, slow-motion agony. With visits restricted, families now call and call for updates from the overworked nursing staff. The families wonder whether they should demand a visit, risking their own health and wider contamination. Some want their parents moved to the hospital or to a different facility but have no idea who else would care for fragile patients potentially exposed to a deadly disease.
…Nobody knows for sure how the coronavirus first entered the facility, which has become a grim warning of how the virus can spread particularly quickly inside nursing homes. At least eight of the 14 coronavirus deaths in the United States have been Life Care residents, and at least a half-dozen other people connected to the facility have been sickened by the virus.
Even amid intense scrutiny of the nursing center and its record of handling infections, families said they were struggling to get basic information from Life Care’s leaders and public health officials. They said they had spent untold hours on the phone, being shunted between county and state government offices and the Centers for Disease Control and Prevention.
…Many residents inside the 190-bed facility went days without being tested for coronavirus, families said, even as they and their roommates started coughing and feeling feverish. Families worry that the true number of infections may be higher than official totals.
Experts in infectious diseases say older people, many of whom have underlying health problems and respiratory problems, are particularly vulnerable to the virus and have a higher risk of death.
…At a news conference Wednesday, Dr. Jeff Duchin, officer for public health in Seattle and King County, said teams were now working to test every Life Care resident for the virus and apologized for a breakdown in communication. A federal disaster medical assistance team was expected to arrive at the center Thursday.
Ellie Basham, executive director of Life Care, said in a statement that it was assigning every resident a representative who could answer questions from family members.
Families welcomed the promised help and praised the nurses and caregivers who showed up to work even as the virus spread and as several employees tested positive…
https://www.yahoo.com/news/anticipate-she-coronavirus-not-anticipate-130556138.html
U.S. Health Experts Say Stricter Measures Are Required to Limit Coronavirus's Spread
ReplyDeleteDenise Grady
The New York Times
March 9, 2020
As the coronavirus spread to two-thirds of the states, Americans began to grasp the magnitude of the threat facing them. The weekend’s case tally ballooned, veering toward nearly 600 cases and close to 20 deaths.
In Washington state, with the epicenter in the Seattle area, Gov. Jay Inslee said on Sunday that he was considering mandatory measures to help keep people apart. Federal public health officials also signaled that the degree of community spread — new cases popping up with no known link to foreign travel — indicated that the virus was beyond so-called containment in some areas and that new, stricter measures should be considered.
It’s a concept in public health known as shifting from containment of an outbreak to “mitigation,” which means acknowledging that the tried-and-true public health measures of isolating the sick and quarantining their contacts are no longer enough. So steps must be taken to minimize deaths from the disease and to slow its spread so that hospitals are not overwhelmed.
…No one in the United States wants to use the word “lockdown,” in the manner of what Italy is doing in its northern regions to try to control the spread of the disease.
But the specter of isolation — of telling people in affected areas not to go out — is hovering in big cities where the infection has taken hold.
…If community spread is being detected now, that means it began, unseen, weeks ago. The greatest concern is for older people, particularly those who have underlying conditions like diabetes, heart disease, lung problems and weakened immunity.
…If community spread has already started, as in Seattle, he said, everyone should practice social distancing.
…One goal of mitigation is at least to slow down an epidemic, he said, adding, “If you can stretch things out long enough, you buy more time for the development of the vaccine and the research to be done for treatments.”
…In Washington state, the nursing home that has faced the brunt of the coronavirus outbreak thus far in the United States said on Sunday that it had seen some residents go from no symptoms to death in just a matter of a few hours.
Tim Killian, a spokesman for the nursing home, Life Care Center of Kirkland, said its medical staff had found the coronavirus to be troubling, volatile and unpredictable.
“It was surprising and shocking to us that we have seen that level of escalation from symptoms to death,” Killian said. He said the center was still in triage mode as it worked to get a handle on the issue for its remaining 55 residents.
On Sunday, health officials raised the death toll in Washington to 18, with 16 of those linked to Life Care, including 15 residents. Killian said other residents were in the process of getting test results, and six of them were ill.
Seventy of the center’s 180 staff members were out sick, but there weren’t enough test kits yet for them, he said. Three staff members have been hospitalized, one of whom has tested positive for the virus…
This article originally appeared in The New York Times.
https://www.yahoo.com/news/u-health-experts-stricter-measures-121112738.html
Nursing home at center of coronavirus deaths spurs precautions across U.S.
ReplyDeleteBy MARIA L. LA GANGA, RICHARD READ
MARCH 9, 2020
KIRKLAND, Wash. —
…“If the CDC’s doing such a bad response on a small little place like this,” he said, “imagine if this was happening in a large nursing home in downtown Los Angeles or in New York City.”
Nursing home operators and government officials have been imagining just that, and such nightmare scenarios have spurred new precautions at facilities across the country. There are cries for widespread testing, fears of protective gear shortages and staffing problems, and confusion about how best to balance the needs of frail elderly residents against the safety of the wider community.
Few places are more fraught with risk than a skilled nursing facility, where sick, elderly and vulnerable people live in close quarters. Since the outbreak at Life Care Center of Kirkland hit the headlines, at least three more Seattle-area nursing homes or senior-living centers have announced possible outbreaks.
…“This is a collision of two vulnerable groups — older people and those in healthcare facilities,” said Michael Dark, staff attorney at California Advocates for Nursing Home Reform. “The concern is people on the outside are bringing in the virus.
“We’re going to be facing a period, maybe months long, where many nursing home staff who are underpaid and overworked may be afraid to go to work,” Dark said. “Staffing levels, which are already low, may get much worse.”
Life Care Center of Kirkland had 180 employees before the outbreak hit. At weekend briefings, company spokesman Timothy Killian said that 70 employees have been quarantined in their homes because they have exhibited symptoms consistent with COVID-19. Three employees have been hospitalized, he said, and one has tested positive for the virus.
Killian said Sunday that Life Care would like to test all of its employees for the virus and has asked for the necessary test kits. “We don’t have test kits to do that,” he said. “It’s concerning to us.”
“Various government agencies” have helped Life Care Center beef up its depleted staff, the company said in a fact sheet, sending several nurses, two nurse practitioners and a doctor. That help, however, did not arrive until Saturday.
Staffing problems have bubbled up in sometimes dramatic fashion at the Kirkland nursing home since the outbreak began. Residents’ family members called the Thursday news conference to raise the alarm about conditions and take government officials to task for not stepping in sooner.
… “I think it’s tragic that they didn’t have the support here to do the work that needed to be done in a good way,” Herrick said. “How do we contain this? How do we deal with people that are ill? How do we protect ourselves?”
Those questions loom large in a country whose fastest-growing age group is people 85 and older. According to the National Center for Health Statistics, there were 15,600 long-term care facilities in the U.S. in 2016, and nursing homes had 1.3 million residents in 2015. Those are the agency’s most up-to-date numbers.
On Wednesday, the Centers for Medicare & Medicaid Services said nursing homes should screen visitors and staff for symptoms of respiratory infection, for international travel to restricted countries and for contact with anyone who has or is suspected to have COVID-19.
…Life Care Center of Kirkland has prohibited all visitors. Family members have resorted to knocking on windows and holding up messages for their loved ones inside. Those who can, call regularly…
https://www.latimes.com/california/story/2020-03-09/nursing-home-coronavirus-deaths-precautions
Coronavirus is nursing homes' 'greatest threat' in years. Here's what they must do.
ReplyDelete"This is the greatest threat to nursing home residents that we have seen in many years, if not ever," one expert said.
March 10, 2020
By Erika Edwards
…On Tuesday, the American Health Care Association and the National Center for Assisted Living released new guidelines meant to protect residents, who are the most vulnerable to complications from the disease.
The most worrisome example of what the virus can do in a nursing home has been at the Life Care Center. At least 18 residents there have died from the coronavirus in the past month, as well as one person who visited the facility.
Eleven other patients at the Life Care Center have passed away since the outbreak began, though it's unclear whether they, too, had been infected with the new virus. Dozens of other residents at the facility have tested positive for the illness.
Historically, fewer than seven residents pass away each month at the facility.
Several other facilities for older adults in the Seattle area have also reported cases.
The new guidance is part of an urgent push to keep the virus out of other elder care center across the country. They advise staff to ask visitors whether they've had respiratory symptoms, such as a fever, cough, sore throat or shortness of breath, and then wash their hands before having any contact with the residents.
"This is unprecedented action that we're taking," Mark Parkinson, president of the AHCA and the NCAL, said during a media briefing Tuesday. He added that visitors should also be asked about recent international travel and whether they've been in other facilities with confirmed cases of COVID-19, the illness caused by the coronavirus.
Within the past 24 hours, the Centers for Medicare and Medicaid Services released similar guidance to counter the spread of the coronavirus.
And, effectively immediately in the state of Washington, Gov. Jay Inslee announced Tuesday that children are temporarily banned from nursing homes, and any adult visitors must remain in resident rooms. The rules do not apply to end-of-life situations, however.
Visitors may also be required to wear protective equipment, such as gloves and gowns.
"Older folks don't have the reserve to handle illnesses," Dr. Richard Baron, a geriatrician and the president of the American Board of Internal Medicine, said. "They really are fragile, and their clinical status can change very quickly."
"If there is one single thing that matters most right now, it's that if someone has a fever or a cough or feels sick, do not visit a nursing home," Wasserman said. "There should be no exceptions."
But cutting off physical contact with friends and family, even temporarily, can be difficult. The recommendations suggest facilities develop alternative methods of communication for residents to engage with the outside world.
Debbie Meade, an AHCA member and the CEO of a Georgia assisted living facility called Health Management, said her staff has started offering residents cellphones so they can videoconference with family while visits are restricted.
"This is to protect the patients and the residents," Meade said during a call with reporters.
The Los Angeles Jewish Home, an assisted living system in California where Wasserman also serves as the medical director, recently implemented a policy that each person who walks through the door — employees included — must submit to a temperature check.
While the AHCA and the NCAL recommendations do not recommend checking visitors or staff for fever at this time, Wasserman said the extra precaution is necessary.
"If we sit idly by and wait to find out how bad it is," he said, "we could very well be sitting around asking ourselves why we didn't do more."
https://www.nbcnews.com/health/health-news/coronavirus-nursing-homes-greatest-threat-years-here-s-what-they-n1153181
Death at California senior home raises quarantine questions
ReplyDeleteCuneyt Dil and Olga R. Rodriguez, Associated Press
Wednesday, March 11, 2020
ELK GROVE, Calif. (AP) — Residents of a Northern California assisted living facility were under a two-week isolation order after a woman in her 90s died of the coronavirus.
Health officials on Wednesday defended their approach of not quarantining the Carlton Senior Living facility in Elk Grove even as a new dispute arose over whether Sacramento County officials were getting a sufficient number of kits to test residents and staff for the virus.
Elderly people with underlying health issues are particularly vulnerable to the illness. A nursing home in suburban Seattle has had the deadliest outbreak in the U.S., with 22 residents succumbing so far. Family members there criticized facility operators and local government for not moving more quickly when the virus first appeared.
Isolation is a less restrictive order that separates people with a contagious disease from people who are not sick. A quarantine restricts the movements of people who have come into contact with a contagious infection to see if they become sick, according to the federal Centers for Disease Control and Prevention.
…Sacramento County public health spokeswoman Brenda Bongiorno said under isolation orders precautions include limiting visitor access, freezing new admissions to the facility, closing common areas and enhanced cleaning measures. She would not release information on other residents in quarantine or whether any residents or employees were showing symptoms or tested positive, citing the need to protect health confidentiality.
The Elk Grove facility can house up to 180 residents and offers on-site nursing and a variety of care, including for people with memory loss. State inspection reports showed no significant health violations for the facility.
In the hours after the isolation was announced, it appeared business as usual. Delivery people and workers came and went, as did residents. One of them, 95-year-old Bob Sutherland, left on his bike.
He said what's happening inside is similar to what has occurred during flu outbreaks.
“We no longer have any meetings. And they even closed the exercise room where I go,” Sutherland said. “We just have to wait in rooms, and they bring the food up and everything. We’ve been through it before with the flu virus. Same protocol.”
No information about the woman who died has been released by Carlton or local health officials. Sutherland said she was 97, chair of the facility's food committee and “always very friendly."
She was taken to the hospital late last week, he said, but it was a couple days before residents learned why she was there.
On Tuesday, Sacramento County health director Peter Beilenson indicated frustration at the pace of testing for the disease. Under federal guidelines, the county is only allowed to process 20 tests per day.
…Bongiorno said Sacramento County's current turnaround time between collecting a sample and getting results ranges from 24 to 48 hours.
State and public health officials are isolating and testing Elk Grove care facility residents in their apartments if they have fevers or acute respiratory symptoms, Folmar said. The facility will keep doing so as new symptoms emerge for 14 days after the last day the woman who died was in the facility.
The facility identified all employees who potentially were exposed to the woman and told them to monitor themselves for fever or respiratory symptoms for 14 days after their last exposure. They were told not to come into work if they are ill or to wear face masks for 14 days even if they don't feel sick. The facility also isn't accepting new residents…
https://www.sfgate.com/news/article/Death-at-California-senior-home-raises-quarantine-15125089.php
SF restricts visitor access to 18 long-term care facilities to combat spread of coronavirus
ReplyDeleteJOSHUA SABATINI
Mar. 12, 2020
San Francisco announced Thursday a ban on non-essential visitors from entering long-term facilities to protect residents from the spread of the coronavirus.
The public health order, issued by The City’s Health Officer Tomas Aragon, builds on the order issued March 7 to ban non-essential visitors from entering city-owned and operated long-term care facilities at Laguna Honda and Zuckerberg San Francisco General hospitals.
The order applies to 18 private long-term care facilities where residents, because of their age and medical conditions, are at an elevated risk of getting seriously ill or dying if they are infected by COVID-19, the disease caused by the novel coronavirus.
“This order is supported by our best scientific evidence and follows best practices for limiting the spread of the novel coronavirus,” Mayor London Breed said in a statement. “We’re following the recommendations of public health officials to slow the spread of COVID-19 in our community and are taking steps to protect those who are most vulnerable to the virus.”
The concern is that since the virus is spreading in San Francisco, visitors with mild symptoms or who are asymptomatic could expose the residents to the disease.
The order was supported by Board of Supervisors President Norman Yee.
“We know the hardship that this temporary limit on visitors will have on seniors and on their families and loved ones,” Yee said. “We strongly encourage using other means of communication to stay in contact, such as phone calls, video calls, e-mail.”
The order also requires long-term care facilities to create a COVID-19 plan that details the screening of residents, staff and visitors for symptoms.
https://www.sfexaminer.com/news/sf-restricts-visitor-access-to-18-long-term-care-facilities-to-combat-spread-of-coronavirus/
Sick staff fueled outbreak in Seattle-area care centers
ReplyDeleteCarla K. Johnson and Mike Stobbe, Ap Medical Writers
Wednesday, March 18, 2020
SEATTLE (AP) — Staff members who worked while sick at multiple long-term care facilities contributed to the spread of COVID-19 among vulnerable elderly in the Seattle area, federal health officials said Wednesday.
At least 30 coronavirus deaths have been linked to Life Care Center in Kirkland. A report Wednesday from the U.S. Centers for Disease Control and Prevention provided the most detailed account to date of what drove the outbreak.
Public health authorities who surveyed long-term care facilities in the area found facilities didn't have enough personal protective equipment or other items such as alcohol-based hand sanitizer.
They also said nursing homes in the area are vulnerable because staff members worked with symptoms, worked in more than one facility, and sometimes didn't know about or follow recommendations about protecting their eyes or being careful while in close contact with ill patients.
Nursing home officials also were slow to think that symptoms might be caused by coronavirus, and faced problems from limited testing ability, according to the report.
Life Care officials did not immediately respond to a request for comment on the findings. Long into the outbreak, facility officials said they didn't have enough tests for residents and that staff had gone untested.
Several family members and friends who visited Life Care before the outbreak told The Associated Press that they didn’t notice any unusual precautions, and none said they were asked about their health or if they had visited China or any other countries struck by the virus.
They said visitors came in as they always did, sometimes without signing in. Staffers had only recently begun wearing face masks. And organized events went on as planned, including a Feb. 26 Mardi Gras party, when residents and visitors packed into a common room, passed plates of sausage, rice and king cake, and sang as a band played “When the Saints Go Marching In.”
“We were all eating, drinking, singing and clapping to the music,” Pat McCauley, who was there visiting a friend, told the AP. “In hindsight, it was a real germ-fest.”
About 57% of the patients at the nursing home were hospitalized after getting infected. Of those, more than 1 in 4 died. No staff members died.
“The findings in this report suggest that once COVID-19 has been introduced into a long-term care facility, it has the potential to result in high attack rates among residents, staff members, and visitors," the report says. "In the context of rapidly escalating COVID-19 outbreaks in much of the United States, it is critical that long-term care facilities implement active measures to prevent introduction of COVID-19.”
Infected staff members included those working in physical therapy, occupational therapy and nursing and nursing assistants.
Researchers who have studied nursing home workers say the jobs are low paying, with many earning minimum wage. Many employees don't get paid when they are out sick, they said.
"It is very common for them to work two jobs in order to make ends meet especially if they have a family,” said Charlene Harrington, of the University of California, San Francisco.
Harrington said her research shows that large for-profit nursing home chains such as Life Care have the lowest staffing levels of any ownership group.
David Grabowski, of the Harvard Medical School, said nursing home employees often leave for retail and restaurant jobs.
"We're going to see a lot of outbreaks like the one we saw in Kirkland," he said. “It's the front lines for containing the virus."
https://www.sfgate.com/news/medical/article/Sick-staff-fueled-outbreak-in-Seattle-area-care-15140492.php
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