Topic: Cancer Patients in Nursing Homes

Summary of Major Provisions of the Act

Improve transparency and accountability in the ownership and operations of nursing homes

Corporations would be required to disclose their owners, operators, financers, and other related parties. Facilities that were part of chains would be required to submit annual audits. Purchasers would have to demonstrate that they were financially able to run facilities.

Require disclosure of how Medicare and Medicaid funds are spent

Providers would have to report wage and benefit expenditures for nursing staff on cost reports. Cost reports would be revised to categorize spending for direct care, such as nursing and therapies; indirect care, such as housekeeping and dietary services; capital costs, including buildings and land; and administrative costs, which often include the company's profits.

Establish independent monitoring of chains

The federal government would develop a protocol for an independent monitor of chains to analyze their financial performance, management, expenditures, and nurse staffing levels. It would provide for corrective action and collection of civil monetary penalties.

Collect accurate information about nurse staffing

The government would collect data electronically from nursing homes on the number of RNs, LPNs, and nursing assistants, using payroll records and contracts with temporary agencies as the source. Data would include turnover and retention rates and hours of care per resident provided by each category of worker.

Provide better public information about nursing homes

Nursing Home Compare would be updated with more timely reporting of surveys; ownership information; accurate nurse staffing data, including turnover and retention rates; links to survey reports (Form 2567) when states put them online; enforcement actions; and all Special Focus Facilities identified for three years. The government would undertake a study on how to improve the website to make it more useful and understandable.

Implement new consumer complaint processes

The government would develop a standardized form consumers could use in filing complaints with the state regulatory agency or ombudsman. States would be required to establish a complaint resolution process for residents' representatives who were retaliated against, including denied access to residents, if they complained about quality of care or other issues.

Provide for higher civil monetary penalties and other CMP reforms

Federal civil monetary penalties would be increased for the first time since the 1987 Nursing Home Reform Act - up to $100,000 in the case of a resident's death. Fines would be held in escrow during appeals of deficiencies, no longer delayed until appeals were resolved. Federal CMP funds, which are now returned to the U.S. Treasury, are encouraged to be used for the benefit of residents.

Provide for reporting of closures and continuation of federal payments

Nursing homes would be required to give 60 days notice of closure, including a relocation plan and assurances that residents would be transferred to the most appropriate facility or other setting. No new residents could be admitted after the notice was given, and the federal government could continue Medicare and Medicaid funding for residents until relocation was completed.

Authorize studies of temporary management; special focus facilities; culture change; and nurse aide training

The bill provides for studies of temporary management; the characteristics of Special Focus Facilities, including ownership; best practices in culture change; and training of nurse aides and supervisors. Dementia management would be added to the initial 75-hour nurse aide.

The one provision that is utmost important is "Mandatory Staffing Levels." That provision was taken out of the bill, probably thinking that it had a better chance of being approved without it. It needs to be put back in!

Many states fought twenty world-wars to get mandatory staffing levels, even then, it was constantly being attacked. In one state, when there was a possibility of cutting Medicaid funding, the industry jumped at the chance to use that funding cut as an excuse to abandon the staffing level requirements.

Federal law only requires nursing homes to provide sufficient staff and services to attain or maintain the highest possible level of physical, mental, and psychosocial well-being of each resident, and we know this is insufficient.

There have been numerous federal bills requiring various mandatory staffing levels, only to be defeated or die on the vine. Now is the time for those mandatory staffing levels!

The for-profits are taking over hospices the same way they have taken over nursing homes. The Kaiser Network noted that hospice care was designed to be delivered mainly by not-for-profit groups with affiliations to religious and community groups, but the June 2008 MedPAC report found that since 2000 mostly for-profit companies and hospices have been providing such care.

Manor Care operates hospice under their for-profit nursing homes as Heartland Hospice Care. On top of receiving an additional $130 a day for hospice service, above the daily payment they receive providing nursing home care, they take donations to their Heartland Hospice Fund.

For-profit hospices, like for-profit nursing homes are run by corporations the are coldly efficient, according to a leading palliative care specialist. If there is a way to play the system to make a higher profit, they will. Nursing home residents are already receiving 24/7 care. The hospice service is an additional $130 a day the home receives.

In their quest for Medicare dollars, for-profit hospices don't provide all the care that they should in order to fulfill the hospice mission of maximizing patients' quality of life.

In fact, a 2004 Medical Care study of 2,080 patients enrolled in 422 hospices across the country found that terminally ill patients who receive end-of-life care from for-profit hospice providers receive a full range of services only half the time compared with patients treated by nonprofit hospice organizations.

That's because for-profit hospices like to keep costs low by skimping on services, particularly so-called "non-core" services like medications and personal care. For example, families of patients receiving care from a for-profit hospice received counseling services, including bereavement counseling, only (45% as often) as those in a nonprofit hospice.

When researchers controlled for differences across patients, sicknesses, and conditions, those at for-profit hospices were only half as likely to get the same support provided at nonprofit hospices. A 2005 follow-up study confirmed that for-profit patients receive a narrower range of services than nonprofit patients.

But it's not just "non-core" services that for-profit hospices are skimping on. For-profit hospices are only half as likely as nonprofits to provide palliative radiotherapy (RPT), a radiation therapy that has been shown to effectively reduce pain and other symptoms related to tumor growth.

The dearth of for-profit RPT probably has a lot to do with the fact that for-profit hospices take on a smaller share of patients with cancer than do nonprofits-in part because it costs a lot to care for cancer. In addition, it's much easier to predict how soon cancer patients will die. They rarely stay in a hospice for more than six months.

Indeed, for-profit hospices tend to "cream-skim" patients, both by taking on fewer cancer patients and having a greater share of patients who require a relatively long stay (In this regard, MedPAC's fears are warranted).

Worse still, according to research from the University of California, Irvine, patients who stay longer at for-profit hospices receive less high-skilled nursing care-such as tracheotomy care, wound care, and suctioning or feeding tubes-because skimping on these services keeps costs down. In sum, research shows that patients stay longer at for-profit hospices, yet receive less personal care, symptoms management and spiritual support during their stay.

This is a pretty good way to make money, and indeed, the largest for-profit hospices are doing very well: a 2005 studyin the Journal of Palliative Medicine found that large hospices owned by publicly traded companies generate profit margins nine times higher than those of large nonprofits and three times higher than privately owned for-profit hospices of similar size. In other words the "corporatization" of nursing homes seems to be a major part of the problem.

Among them are VITAS, the country's largest for-profit, publicly-owned hospice, which cares for more than 11,000 patients in 16 states; the publicly-owned Odyssey Healthcare and Vista care and the private Heartland Hospice, which is a division of HCR Manor Care.

Back in 2007, the major private equity firm The Carlyle Group bought up Manor Care for $6.3 billion. A New York Times story covering the privatization of elderly care noted that large nursing home chains owned by an investment company in 2005 earned $1,700 a resident and were, on average 41% more profitable than the average facility.

Like for-profit hospices, these nursing homes cut services in order to reduce costs, but the health care industry isn't like other industries. What may count as "efficiencies" in other fields - reduced labor costs, more streamlined services, etc - compromise the quality of health care to such an extent that patients die. There's just no way around it, health care is labor intensive.

What's so frightening about the case of for-profit hospices in particular is that cutting corners undermines the whole mission of hospice care. For-profit hospices risk losing sight of the fundamental principles of hospice because they are not doing all they can to support and comfort patients and families during the final stages of life.

There's really no way to do a half-way job with hospice care. You're either doing everything you can to make dying people and their families feel better, or you're not. This is not a calculus that comes down to dollars.

More and more, it looks like the business plan of for-profit hospices is to provide relatively minimal care to people who will take a long time to die. If ever there were a strategy antithetical to the principles of hospice, this is it.

Source: Health Beat

 I don't know about other places --- but the nursing home where my father is is wonderful and when a resident has cancer or any other terminal illness Hospice is called in and they get the same attention as if they were in their own homes.

JO

 It is run and owned by the Lutheran church, takes Medicaid, and highly rated.

JO

Nursing Homes, like deteriorating public schools, crumbling bridges and other pieces of our society's essential infrastructure have been neglected for a long time.

http://www.healthbeatblog.com/2009/03/the-111th-congress-at-work-.html