By All Means, Fix the Veterans’ Home, and Fix Every Other Delaware Nursing Home
While the News-Journal’s recent series chronicling chronic patient care problems at the Delaware Veterans’ Home is invaluable, it misses the most vital point:
The same conditions found at the Delaware Veterans’ Home are prevalent at nursing facilities throughout the State of Delaware.
Under the willfully-negligent leadership of Vince “The Bulldog” Meconi and Carol “It’s the Nursing Home Industry That’s the Real Victim” Ellis, ‘long-term care residents’ protection’ was an oxymoron. Millions of dollars of State and Federal Medicaid reimbursements were paid out to facilities for care that they did not provide. Surprise inspections of facilities were virtually non-existent. Despite strong nursing home statutes, penalties were rarely imposed for even the most egregious violations. Carol Ellis publicly stated that she believed that Delaware nursing homes were overregulated, which would have made her an ideal ‘watchdog’ in the Bush Administration, but made her derelict in her duties as Division Director.
Jack Markell has installed a first-rate team in Sara Allshouse and Judge Susan Del Pesco to rectify this situation. A cursory reading of annual and complaint-driven surveys of Delaware nursing homes will confirm what ‘bulo is saying here. He is one of the few people to have read years and years worth of these reports in Delaware, and he could cite you chapter and verse on the abuses.
‘Bulo also cautions the new team about one of the industry’s biggest tricks. There are hundreds of people in Delaware ‘assisted living’ facilities, including Alzheimer’s patients, for bleep’s sake, that, by definition, belong in long-term care facilities. Which means that these residents receive less care than LTC residents even though they need at least as much. Overnight staffing in assisted living facilities is minimal, even though Alzheimer’s patients are awake and wandering at all hours of the night.
The Beast Who Slumbers agrees with Gov. Markell that expanding options to remain in the least-restrictive environment is ideal. However, as long as there are nursing facilities, as long as the State and Feds are paying roughly $150 million annually to Delaware nursing facilities, and as long as these residents, veterans and everyone else, are dependent on the state to protect them, they must be protected.
I am very familiar with nursing homes and their limits. They are indeed Adult day care at their core. Every facility including the Veterans Hone should be expected to provide adequate care.
In one instance after three weeks of blood pressure over 170/110 being documented but never referred to a Doctor I had to rely on 911 to have my Mother admitted.
There is a wave of technology available to have a physician designed and nurse monitored in home health care which would lower costs and improve quality of life experiences.
Both of my parents are veterans but I stayed clear of the Vets Home because I had no faith in the State of Delaware Government.
Mike Protack
The irony is that the Governor Bacon facility has long been one of the better nursing homes in Delaware, public or private.
The conditions are no better and, in some cases, far worse, in some of the ‘for-profit’ facilities.
Anyone considering a nursing home placement would ideally seek out the survey and complaint reports from the Division of Long-Term Care Residents’ Protection on the facilities you are considering.
Even though Meconi/Ellis kept the lid on some outrageous information, the surveyors in the Division of Long-Term Care Residents’ Protection continued to function as true professionals, lest anyone feel in the mood to diss state employees today. Their reports, by and large, accurately reflect conditions at nursing facilities.
Adequate staffing will cost a fortune. You could liken medical facilities in general to fire stations. Nothing going on? Lots of workers standing around doing nothing. All that can change in a moment. No facility has staff waiting around in the closets to be activated at a moments notice.
Link to E.S’s Division of Long-Term Care Residents’ Protection info.
Interesting stuff. I hope that I am still years and years away from having to deal with this.
Don’t worry 330 I’ll visit you and bring candy bars (and beer). Enjoy what’s left of your present freedom 😉
I meant my parents. My dementia is still manageable.
The U.S. is going to have to come to grips with its aging population and find good quality care for the millions that need it. Yes, it will be expensive. But is it cheaper than letting problems build up until they are very expensive?
No shit. Priorities will have to shift, but many people’s biggest complaint is how expensive their health care premiums are now. Healthcare workers, both professional and para, cost money for a reason. The job sucks for the most part.
When I worked in a nursing home, I likened it to my active military service in Grenada. Nothing was ever planned, constantly changing situations and priorities, and although threat of loss of (my) life or limb was rare, there always existed the potential for law suits, criminal suits, and permanent loss of employment in the field no matter how well trained and caring you were.
Been there, done that, you couldn’t pay me enough to do it again. Wonder why there is a heathcare worker shortage?
Meatball: The state developed an effective program to recruit and train CNA’s, and there is no shortage of them now.
The nursing home laws have minimum staffing requirements and minimum staffing requirements by shift. Homes are reimbursed assuming that they meet those staffing levels.
In many instances, however, the homes are not in compliance, and the Division of Long-Term Care Residents’ Protection is not notifying the State Medicaid Office that homes are understaffed. So, homes are being reimbursed as if they were fully-staffed when, in fact, they are not.
If the homes were fully-staffed, it would significantly reduce the stress levels on hard-working and overworked staff. And that would lead to better patient care.
The U.S. is going to have to come to grips with its aging population and find good quality care for the millions that need it.
Logan’s Run
My point is that the state mandated staffing ratios are unsafe.
Are we looking to provide real quality of life care, or are we warehousing? You may have read the files, but I’ve lived it. I know that sounds condescending and perhaps angry, that is not my intention. But this is an age old argument in the world of healthcare, staffing ratios vs. acuity.
Here’s an example: The experienced guy on the assembly line says we can produce 3 cars a day, management wants 5 a day. Management says, “then we need to improve the process.” Right? The thing is we’re not talkin’ cars here.
Also, I question the statement “and there is no shortage of them [CNAs] now.”
Are the ratios too high or too low? The ratios that were put in place increased staffing in nursing facilities. They were based on evaluations by national gerontological experts as to what constituted at least minimal staffing. Additional funding was provided by the Joint Finance Committee to pay for the additional staffing. It may not be adequate, but it’s a significant improvement over what there was beforehand.
The legislation did not increase the number of residents a facility could care for, it established minimum staffing both in total and by shift.
The fact that there are sufficient CNA’s does not mean that facilities are hiring and retaining sufficient CNA’s. Meatball can probably tell everybody the extent to which these facilities use temp agencies, but, in many cases, they wouldn’t have to if they were sufficiently dedicated to retaining the staff they had.
“Logan’s Run”
Soylent Green.
Its a Shame that the previous administration caved all the way around to a few egomaniacs on the Commission on Veterans Affairs not only building the home in Milford but building it at all The money should have been spent upgrading existing facilities with sections of each of the 5 Facilities reserved for vets. What family in NCC wants to travel to Milford around 70 miles to visit a loved one this was done to satisfy a few egos that insisted that we needed the home because we were the only state with out one and that they were the only ones that could run it.
Go down to the home some time their names are platered on a pretty brass plaque at the main entrance
Andy’s point is well-taken. Put the ‘Veterans’ label on a nursing home, and it’s still a nursing home, all of which were close to unregulated during the Reign of Ruth Ann.
And locating it in Milford, which is south of Dover, when 5/7 of the state’s population lives in NCC, only made it less likely that it would truly be a boon to veterans. But, at least, Ruth Ann Mediocre can waddle on over to pat herself on the back and pose for pictures.
No doubt pay is higher in the nursing homes (this is why I dipped my toes in that putrid water to begin with). And no doubt, a quick scan of the “want ads” does show a high proportion of “temp agency” type recruitment efforts. Why do you think this is? (Hint: it’s a whole other topic)
[Staffing ratios]” were based on evaluations by national gerontological experts as to what constituted at least MINIMAL staffing.”
Hmmm….at least minimal. Again, we’re not talking about getting product off the line, we’re talking about people, right.
Hypothetical (but maybe it really happened): Fully staffed nursing home on a day shift with CNA ratio to residents 1:10. CNAs must above all protect their charges from harm. Also, they must bath, dress, get out of bed, transport to the dining area, feed, and measure vital signs of all the customers in their assigned area. Enter Mrs. So-n-So who has only one leg to stand on and still suffers from confusion related to the gangrene, sepsis, and drugs from the process that necessitated the limb amputation in the first place. She continuosly stands up on her leg and falls over. Over and over and over again she falls to the floor. She never injures herself when she falls and yet each time she falls, professional staff are required to submit the proper forms to the relevant state agency.
What do you do?
a. tie her into her chair.
b. send her to an acute care facility and let them deal with her.
c. dedicate one CNA to “guard” Mrs. So-n-So and have the remaining CNAs pick up the guards nine patients.
Acuity matters, it just doesn’t get paid for.
Full disclosure, Meatball has worked all levels of nursing care from volunteer, para-pro, professional, and management, but has not worked in the NH Industry for three years now. Today he is a simple chicken farmer and guider of lost sheep. And he apologises for such a long soapboxy post, but thanks for listening.
Meatball’s approach is much appreciated. And one of the insidious reasons that there are so many temp ads is that, in some cases, national nursing home providers, like Genesis Healthcare, for example, also operate temp services and often service…their own nursing homes. Then they cry to the Feds that they’re losing $$’s b/c they’re forced to use temp agencies when in fact it’s THEIR temp agency that is making money hand over fist. When dealing with criminals, you have to think like criminals.
‘Bulo agrees with Meatball about the ‘minimal’ issue. However, until the staffing ratios were mandated, most Delaware NH homes didn’t meet, and some did not approach, the minimal threshhold.
‘Bulo hopes Meatball keeps posting on this. He/she has a lot to add.
Thank you, meatball. Great post.
Thanks for the insight, Meatball.
Meatball is right on. UI is also on the game, that we better wake up to the needs of the aging population. But Mike Protack, what are you thinking? It’s that kind of denial that precludes great care in our last days.
REALITY CHECK: Why is a person in a nursing home? They or their family can no longer physically, emotionally, financially care for the heavy physical and emotional demands that come with aging. It is supposed to be a safe, comfortable stop on the journey to whatever your next dimension is. The DEMAND that you treat every abberancy in their general health by numbers is ridiculous. Yes, a person may have an elevated blood pressure, but do they have a headache with that? Let’s keep them comfortable from the headache. If you want every aging disease or any disease treated for cure, then don’t put them in a nursing home. YOU follow up their care, and YOU schlep around to doctors, and haul them out for bloodwork, and dress them to be ready, and drop out of your real life to oversee this. Nursing homes should be for comfort, compassion, cleanliness, and the reality that all the drama of illness has played out. You are there now to be safe, kept clean, fed,visited, comfortable, and given your routine medications that you have taken for years. To suggest, and expect top-level intervention is an unfair indictment of nursing homes, but one that more people want to shake a finger at. Put the money in staffing, so they can get the night aides to reorient them, and help them to the bathroom quickly. Put the money in human capital to keep up the backrubs, and powdering. Put the money in muscle to move them to a hairdresser’s chair for a great shampoo. But don’t expect a nursing home to be your acute care facility when the designation alone of being there, is more along the lines of declining with dignity. Make up your minds people of what you expect/want for dear ol’ Aunt Aggie–then get them to the right place. But for 200bucks/day for the average nursing home these days, what do you think is going to come with that round-the-clock care, bedroom, activities and meals? You sure would pony up more than that for an “all inclusive” vacation.
I wrote the following letter to the Editor of the News Journal over a week ago, but it appears the NJ has declined to print it.
Dear News Journal,
I read the article on Sunday, April 12th, about the horrible treatment of veterans at the State Veterans Center in Dover. I found the story disturbing, but unfortunately, I was not surprised, Last year you ran a story about a woman who was fired from the same Veterans Center after she blew the whistle on various problems. In 2007 and 2008, you reported the abuse of patients, massive theft from patient trust accounts, and the mistreatment of a whistleblower at the Delaware Psychiatric Center. Also, last year you ran a story about patient abuse at Emily P. Bissell Hospital, caught on hidden video, that the state declined to prosecute.
Many financial and abuse problems could be solved much sooner, but many state employees are afraid to come forward and risk the consequences. Whistle blowers need much better protection in Delaware. That is one reason why I am running for State Auditor in 2010. If elected Auditor I would be the best friend/advocate state whistle blowers ever had. I would back them up 100%, stand up to the Big Boys threatening them, and even publicly protest in front of the state agency where the whistle blower is being mistreated.
I know that is not the Delaware Way, but the Delaware Way is not solving these problems.
Sincerely,
Ken Matlusky, CPA
Democrat for State Auditor