Nursing Homes Try to Get Exemptions from Covering Their Workers

The recent federal health care legislation requires that all employers with more than 50 employees provide affordable health care insurance for their workers.  Unfortunately, as it stands now, many nursing home staff simply cannot afford the health care coverage that their employers provide, and go without coverage entirely. 

As this article in the New York Times points out, it is especially important for health care workers, like nursing home employees, to be healthy, to receive regular preventative care, and to be able to obtain medical care whenever needed.  All too easily, a sick worker can spread her illness to a very vulnerable population. 

However, according to the Times article, at Lakeview Christian Home in Carlsbad, New Mexico, less than half of the employees have health coverage, because many cannot afford the $25/month they would have to pay.  In fact, over a quarter of front-line nursing home employees are not insured, according to the article. 

As the Times reports, though, rather than try to ensure that the nation's nursing home workers have access to affordable health insurance, the nursing home lobby is instead working to create loopholes for nursing homes. 

Nurse Aide Turnover at Nursing Homes

We've talked a lot here about things you can look at when trying to choose a nursing home or assisted living facility for a loved one. 

This article in today's New York Times highlights an important factor to examine when you are looking at the quality of care in any given nursing home:  nursing aide turnover.  According to the article, more than 70% of nurse aides  change jobs within a given year. 

The work that nurse aides do is invaluable.  They provide the majority of hands-on care to nursing home residents, assisting them with eating, bathing, hygiene, and getting around.  Given the difficult nature of this work, it is important that the aides are well-trained, working in a supportive environment, and being paid adequately for the work they do. 

Unfortunately, as the article points out, this is very often not the case.  Most troubling, high nursing aide turnover usually results in poorer care for the residents. 

More Strategies for Choosing a Nursing Home

This week's New York Times' Health section offers suggestions for families choosing a nursing home for a loved one.  

The article recognizes that, unfortunately, the majority of nursing home placements come after a person has been hospitalized, and that families often have very little time to fully explore their options.  However, many of these suggestions are useful even if you do not have much time before you have to decide upon a particular nursing home. 

The article suggests that you visit medicare.gov, and use their Nursing Home Compare tool to help get a picture of the facilities in your area.  We covered this topic in more detail here

The article also emphasizes the importance of visiting potential nursing homes, preferably at different times of the day, and using this checklist to review basic aspects of the nursing home. 

Also important in choosing the right home for your loved one is the nursing home's guiding philosophy.  The article suggests that you ask about "person-centered care" and "consistent assignment," burgeoning trends in the nursing home industry that can increase the quality of resident care.  While person-centered care focuses on allowing the residents to make their own schedules and maintain a degree of autonomy, consistent assignment focuses on the staff of the nursing home.  In a nursing home which practices consistent assignment, the same caregivers, nurses, and doctors attend to the same person as regularly as possible--allowing them to create lasting relationships, which positively affects the resident's care.  High staff turnover, on the other hand, can mean that resident care suffers--which is why the article suggests that you avoid nursing homes with over 50% annual turnover. 

Finally, it recommends you call your local Ombudsman's program to learn more about facilities you may be considering.  In New Mexico, the Ombudsman's bureau is a division of the state Aging and Long-Term Services Department.  Information on this program can be found at its website.  In New Mexico, there are five local and regional ombudsmen, in addition to the State Ombudsman. 

Using Surveys to Learn More About a Nursing Home, Part II

As I mentioned in my last post, looking at state nursing home surveys can be a very helpful tool in your quest to learn more about a particular nursing home. 

Now I will walk you through the information you can find at the New Mexico Division of Health Improvement website

In Step 1, you choose your provider type from the drop-down menu.  "Nursing Homes" is the third entry from the bottom. 

For Step 2, you can search by city, county, or provider name.  If you are trying to look at all nursing homes in Albuquerque or Bernalillo County, the result list may be too long; if you have difficulties, you can narrow it to just one particular nursing home. 

Once you have the information screen for a particular nursing home, it will show you the facility's name, address and phone number.  It tells you its Medicaid, Medicare, License number, and License expiration date.  It also tells you the name of the nursing home's current administrator, who owns the nursing home, and how many beds it has.   

There are three icons directly below this information:  View Map, View Reports, and View Statistics.  For our purposes, we are going to focus on "View Reports."

Once you've followed that link, you will have a listing of surveys conducted at this facility.  Usually, the most recent survey appears first.  It will tell you the type of survey--"health" or "life safety code"; the event ID; the dates the surveyors were at the facility; and the highest citation code.  It will also let you look at the survey itself, via a link at the bottom of that section. 

For your purposes, the most important information is likely contained within the "highest citation code" section, and the most recent surveys themselves.

Next to the "highest citation code," if there is a code, you will see a link for the "Scope/Severity Grid" next to it.  (If there is no code, that means that no violations were found in that survey.)   

This grid is very helpful in understanding the severity of the problems that the surveyors noted at the nursing home. The letter that appears in front of the "highest citation code" will correspond to a letter on the grid.  An "A" code shows that the problem was isolated and did not actually cause harm to anyone, but has some chance of causing minimal actual harm to the residents.  At the other end of the spectrum, an "L" code violation means that there was widespread conduct that caused immediate jeopardy to the residents' health or safety. 

Once you've gotten a sense of the severity of the problems, you can view the survey itself.  "Health" surveys typically discuss resident treatment and resident rights.  "Life Safety Code" surveys typically discuss the physical condition of the facility, and whether it is in compliance with fire and other safety codes. 

The top of the survey  has administrative information.  What interests us, though, is the narrative in the left-hand column:  "Summary Statement of Deficiencies." 

Here, assuming violations were found in the survey, you will see a description of the violation.  First, the surveyor states the language from the regulation that they are using to guide them.  This is followed by what the facility did that was not in compliance with the regulation.  It will typically say that "this REQUIREMENT is not evidenced by...", and then describes the problem(s) the surveyors observed at the facility. 

On the right-hand side, the facility writes its "Plan of Correction," which includes a response to the survey's criticism, and a plan of action to remedy the deficiencies the surveyors cited. 

These surveys are often fairly dense and can be hard to read, but hopefully, they will help provide you with another tool when you have the difficult task of  choosing a nursing home for a loved one.