THOSE ARE OUR PARENTS YOU ARE IGNORING

From The Elder Abuse Reform Now's "The Silver Standard News"
The Systematic understaffing of America's nursing homes.

By Joan Hunt

Most Nursing Homes Have Overstated Staffing for Years
 
A recent analysis by the New York Times and Kaiser Health News confirms what many families of nursing home residents have long suspected—staffing is often inadequate to provide proper care for their loved ones. Records show the number of nursing aides fluctuates significantly from day to day, with particularly large deficits occurring on weekends. In fact, on the lowest-staffed days, personnel take care of twice as many residents as they do on the highest-staffed days.

The analysis is based on a newly implemented system of documenting staff numbers in nursing homes, which has been designed to provide greater accuracy. Thus, records for the first time reveal the extent and magnitude of personnel deficiencies in facilities across America. Approximately 70 percent of 14,000 nursing homes have lower staff numbers than the previous system reported. The average staffing decrease is 12 percent. Records also show that on weekends, 11 percent fewer nurses and 8 percent fewer aides are on duty.

Federal law doesn’t mandate a minimum staff-to-patient ratio. The only requirement is that a registered nurse be on site eight hours a day and that a licensed nurse be on site at all times in certified nursing homes. Data from the last quarter of 2017 disclose that one fourth of the facilities had no registered nurse at work.

Previous Nursing Home Rating System Misled Consumers

Since 2009, Medicare had used a nursing home rating system that assigned from one to five stars to each facility based largely on three criteria. Two of the criteria were derived from unverified self-reported data. Because no procedure was in place to validate the data, it could paint an inaccurate picture of staffing levels.

While the remaining criterion came from annual health inspections conducted by independent reviewers, this assessment could be manipulated. It was possible for nursing homes to anticipate the inspection and temporarily schedule more staff during that time, thus enabling them to inflate their staffing numbers. After the inspection was finished, the staffing would return to its inadequate level. Consequently, the ratings failed to reflect reality, and consumers were misled.

New Nursing Home Rating System Has Greater Accuracy

Now, due to the Affordable Care Act of 2010, which has only recently been implemented, data on nursing home staffing is more accurate. Instead of coming from self-reports, it’s based on daily payroll records. The discrepancies between earlier staffing records and the new records provide evidence that staffing levels reported over the last ten years have been exaggerated. The data shows that even facilities with good Medicare ratings for staffing have shortages in nurses and aides on some days.

Despite the more reliable method of determining staff numbers, the new rating system still has some drawbacks. Medicare assigns stars to facilities by comparing one nursing home to another, which is, in effect, grading on a curve. Therefore, many facilities have kept their ratings, even though payroll records show they have lower staffing levels than previously reported. Although the ratings can be found on Medicare’s Nursing Home Compare website, they aren’t dependable indicators that a facility has enough staff to provide quality care.

Patient Advocacy Group Calls for Congressional Hearings

After the recent report in the New York Times, an advocacy group known as the Elder Justice Coalition (EJC) called for immediate congressional hearings on chronic nursing home staff shortages. Group members are specifically concerned that the shortages have gone unnoticed up until now.

“We’re asking Congress to take a good hard look at staff shortages,” said the coalition’s national coordinator, Bob Blancato, in an interview with the Silver Standard News. “The new system may not be living up to expectations. Perhaps after clarification there could be legislation that would come forward.

“Several things need to be considered: number, quality, and training of staff. If part of the problem in attracting and keeping staff is due to wages that aren’t competitive with other types of medical facilities, this needs to be addressed. There has to be an incentive for people to want to go to work. The lack of workforce required to care for the aging population is a crisis that will be in front of us for years.”

Consequences of Understaffing

Understaffing is one of the causes that underlie elder abuse and neglect in nursing homes: reports NursingHomeAbuseGuide.org. Research shows that when staff are overworked and stressed, patients have a higher risk of bedsores, dehydration, malnutrition, weight loss, pneumonia, and infections. The exhaustion that accompanies working in short-staffed conditions can result in mistakes and failures to notice adverse changes in patients’ health. Moreover, frustration that comes from overwork can lead to intentional or unintentional mistreatment.

Tips for Choosing a Nursing Home

Because the current rating system doesn’t guarantee a nursing home is adequately staffed, families of the elderly should investigate candidate facilities thoroughly when the need for placement of a loved one becomes apparent. Assistive Living Today provides the following tips in choosing a home:

⋅    Instead of scheduling a visit, make a surprise visit to get an idea of cleanliness and quality of care. If the facility looks promising, make at least two additional trips to observe meals and activity sessions.
⋅    Check the public record for violations of state code. Note the type of complaints to see if they are related to serious issues.
⋅    Conduct research to see what licenses are required in your state, and ask the facility to show you its credentials.
⋅    Observe the residents to see if they appear happy, well-groomed, and actively engaged.
⋅    Pick a facility that doesn’t have a strong odor. Don’t be fooled by a strong deodorizer scent that may be masking the smell of urine and excrement.
⋅    Ask the facility if it has dieticians and if they can accommodate special dietary needs.
⋅    Since activities are important, inquire whether an activities director is on staff, and find out whether outdoor activities are included.
⋅    If your loved one has a condition requiring special care, such as Alzheimer’s disease or diabetes, ask if the staff has experience in these areas.

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THOSE ARE OUR PARENTS YOU ARE IGNORING

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Bill to eliminate requirement for prospective wards' legal counsel in guardianship cases put on hold

Kris Fawson

SALT LAKE CITY — A legislative committee voted to hold a bill Wednesday that would eliminate the requirement that young adults with intellectual disabilities be represented by legal counsel when courts consider their parents' guardianship petitions.

The House Judiciary Committee voted unanimously to hold HB101 to give its sponsor, Rep. Fred Cox, R-West Valley City, more time to refine the proposal.

As drafted, the legislation would be limited to young adults who have intellectual disabilities, minimal assets and are able appear in court with the petitioner. Judges must be satisfied that counsel is unnecessary, the bill states.

Cox said he sponsored the legislation to assist families who have adopted or raised a child with disabilities from birth and have the young adult's best interests in mind by petitioning courts to become their guardians.

But paying their child's legal fees, on top of their own, is a financial burden for many families, he said. However, Cox acknowledged that some petitioners may not have the child's best interests at heart.

"I’m trying to balance the 98 percent of the time with the 2 percent of the time," he said.

But some committee members expressed concerns that young adults with intellectual disabilities, in particular, need to be represented by counsel.

"The trend in the law going forward is to give and recognize more rights to the person to be protected. In fact, you're going to see, and I predict in this state, the trend will be more toward limited guardianships and limited conservatorships rather than full," said Rep. Lowry Snow, R-Santa Clara, who is an attorney.

Laura Anderson, the mother of a son diagnosed with classical autism, told the committee she has been attempting to complete the guardianship process, which is complex.

"I don't want to pay for an attorney. I feel like I shouldn't have to, but it's part of the process. It's my son's legal right to have an attorney represent him," Anderson said.

"Just because he's disabled doesn't mean he doesn't have the rights each one of us are afforded."

Anderson said the Utah Legislature removed one impediment last year by lowering the court filing fees for guardianship petitions from $360 to $35 under legislation sponsored by Rep. Becky Edwards, R-North Salt Lake.

Andrew Riggle, public policy advocate for the Disability Law Center, cautioned that the proposed legislation could run afoul of the federal Americans with Disabilities Act and the equal protection clauses of the Utah and U.S. constitutions.

"We believe the right to counsel, especially in proceedings that have the potential of bridging a person's fundamental rights, are exactly where independent representation is most important," he said.

Parents seeking guardianships find the process to be "confusing and complex," Riggle said.

"How likely is it that a proposed ward who isn’t represented is going to be able to navigate through the process on their own?"

Kris Fawson, chairwoman of the Utah Coalition for People with Disabilities, said the coalition has no formal position on the legislation but noted guardianship "is a huge issue for families."

Fawson said she obtained guardianship of a young man with Down syndrome in the 1980s. No health care provider has asked her to present proof of the guardianship since.

Yet, she said she has concerns about eliminating a requirement that wards have legal counsel in guardianship proceedings.

"This is a population that’s been minimized in many, many ways. To have those rights not available to them, I think, is one more way we minimize that population," she said.

Cox said his constituents tell him that a growing number of health care providers are requiring proof of guardianships because of federal medical privacy laws.

"That’s the biggest culprit in most cases," he said.

Snow said HB101, as currently drafted, was intended to create a summary disposition intended to be easier on the petitioner and the potential ward.

However, if judges fear a potential ward's rights are not adequately protected, they may "require full proceedings in order to be safe." That's the opposite of what Rep. Cox was attempting to accomplish, he said.

Riggle said advocates need to do a better job of informing families of no-cost resources available in the community to assist them if the want to seek guardianships.

For instance, the Utah State Bar's Guardianship Signature Program provides to judges a group of attorneys who have volunteered to represent respondents in guardianship and conservatorship proceedings when the individual does not have counsel of his or her own choosing.

The state court system also has online resources for families.

"It's still a problem even with all the things we have," Cox told the committee.

"I appreciate your willingness to help."

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Bill to eliminate requirement for prospective wards' legal counsel in guardianship cases put on hold