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The National Consumer Voice for Quality Long-Term Care

March 5, 2013

Consumer Voice Calls Medicare Payments for Poor Care "Shameful" and Urges CMS to Take Action

“Shameful” is how the National Consumer Voice for Quality Long-Term Care (Consumer Voice) described the findings of a new Office of Inspector General (OIG) report that skilled nursing facilities (SNFs) received $5.1 billion in Medicare funding for stays in which they did not meet or follow significant care requirements and failed to provide quality care to Medicare beneficiaries. Responding to this report, the Consumer Voice calls upon the Centers for Medicare and Medicaid Services (CMS) to implement a threefold plan: ensure that Medicare beneficiaries and other residents in SNFs receive the quality of care to which they are entitled; make information about how SNFs spend their money publicly available this year; and require nursing homes to allot a specific portion of their Medicare revenue to direct care services.

In this report, entitled Skilled Nursing Facilities Often Fail to Meet Care Planning and Discharge Planning Requirements, OIG found that 37% of SNFs did not develop care plans for beneficiaries that met care planning requirements or did not provide services in accordance with beneficiaries’ existing care plans. Thirty-one percent (31%) of SNFs also did not meet discharge planning requirements. Furthermore, investigators found “egregious examples” of poor care related to wound care, medication management and therapy.

Medicare is the most profitable source of payment for SNF care. In 2011, the Medicare Payment Advisory Commission (MedPAC) reported that Medicare margins exceeded 10% for the ninth consecutive year, illustrating that Medicare payments to SNFs far exceed facilities’ costs of providing care to beneficiaries. In March 2009, MedPAC reported that one-quarter of SNFs showed profit margins of at least 24.8%. Nursing homes continue to remain profitable despite alarms raised by the industry. In fact, FY2012 nursing home earning reports reflect strong economic growth, and owners increased CEO salaries by an average of 76% last year, pushing the average annual salary to $2,591,361.

While stockholders and nursing home executives are benefiting, nursing home residents are not. Profits have not resulted in increased care or services for residents. Instead, the OIG report indicates that far too many residents are not even getting care that meets basic minimum requirements. 

According to Robyn Grant, Director of Public Policy and Advocacy for the Consumer Voice, “Our country cannot continue to pay SNFs billions of dollars to provide inadequate care at a tremendous human cost to residents and financial cost to the taxpayers. Enough is enough. CMS must hold these SNFs accountable for the quality of their care and how they spend their money.”

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Consumer Voice Commends Efforts in Georgia to Fight Mandatory Pre-Dispute Arbitration Agreements

The Consumer Voice commends the efforts of leading long-term care advocates in Georgia, who were victorious in postponing the consideration of legislation that would make it easier for long-term care facilities to bind consumers to mandatory pre-dispute arbitration agreements. These agreements are increasingly included in nursing home and other long-term care facility admission contracts that consumers or their families sign upon admission. Once signed, pre-dispute arbitration agreements bar consumers from seeking legal action in court should they suffer harm or injury while residing in the facility; disputes are instead settled using a process in which one or more arbitrators (often selected by the facility itself) decide the outcome. 

Georgia Senate Bill 202 would have made it easier to bind consumers to arbitration agreements by allowing almost any family member admitting a resident into a long-term care facility to enter into an arbitration agreement on the resident’s behalf, even if that family member was not the agent under a health care power of attorney or guardian. Furthermore, it would have limited the number of fact and expert dispositions that could have been presented on behalf of the consumer during the arbitration process. This bill was heard in committee last week, where advocates made a strong case against the legislation and provided testimony on the disadvantages arbitration agreements pose to long-term care consumers.

The Consumer Voice strongly opposes pre-dispute arbitration agreements and continues to advocate for federal legislation that would bar the use of such agreements in nursing home and other long-term care facility admission contracts. For further information on this topic, please go to www.theconsumervoice.org/advocate/arbitration. In addition, if you or a family member has experience with an arbitration agreement, please contact Marybeth Williams at mwilliams@theconsumervoice.org or 202-332-2275 ext.225.

Source: The Atlanta Journal-Constitution

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Consumer Voice Meets with OMB Regarding Minimum Wage and Overtime Protections for Home Care Workers

Last Friday, March 1st, the Consumer Voice participated in a meeting with the Office of Management and Budget (OMB) regarding the Department of Labor’s proposed rule to end the exclusion of home care workers from minimum wage and overtime protections. Consumer Voice, along with stakeholder organizations advocating on behalf of the direct care workforce as well as consumers, workers and employers themselves, met with OMB staff to urge their office to complete the final step in the review process of this proposed rule so that it may ultimately take effect. It has been fourteen months since the rule was first put forward by the Department of Labor.

 In the meeting, Consumer Voice shared the perspectives of home care consumers, collected in last year’s Consumer Perspectives Report, on the importance of providing these workers with minimum wage and overtime protections. Sarah Wells, Executive Director, expressed that home care consumers feel it is essential for direct care workers to receive better pay and benefits and believe increased compensation would lead to better care. Ms. Wells also shared that many home care consumers express a desire for additional hours of care, which are often limited due to the lack of overtime compensation and low pay for direct care workers, and believe that providing minimum wage and overtime pay to their home care workers (who consumers often develop close bonds to) is the least that could be done. Our organization will monitor the actions of the OMB regarding this proposed rule closely as the agency continues its review and continue to advocate for better care through better wages.

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Financial Services Round Table Releases Curriculum for Training Financial Institutions on Fraud and Financial Exploitation

The Financial Services Round Table recently released a model curriculum for training financial institution staff on fraud and financial exploitation of adults at risk. If you believe financial institutions in your area would benefit from staff receiving this kind of training talk to them or talk to your state or regional bankers association about why this training is important and how it will make a difference in your community.

For more information, click here.

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U.S. News Holding Twitter Chat on 2013 "Best Nursing Homes" Ratings

U.S. News is holding a live Twitter chat about the 2013 “Best Nursing Homes” ratings. If you have topics or questions you want to address, email Kimberly Leonard at KLeonard@usnews.com and she will bring them up during the chat.

Thursday, March 7, 2013
2:00pm EST
Hashtag: #BestNursingHomes

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Consumer Voice's Robyn Grant Quoted in Article on a Facility's No-CPR Policy

Consumer Voice Director of Public Policy and Advocacy Robyn Grant was quoted in an article published in news outlets across the country regarding a facility’s no-CPR policy following a resident’s death. A nurse at a retirement home in Bakersfield, CA refused to give a woman CPR after she collapsed in the dining room and was barely breathing. The nurse called 911, but refused to give CPR, saying it was against the facility’s policy. Robyn commented on the situation: “This speaks to the fact that consumers have to be extremely vigilant when selecting independent living and assisted living care. It’s really hard when you’re looking for care and reading these contracts to understand every word. We suggest people take them to an attorney to understand the responsibilities of the facilities.

For more information, read the article in USA Today.
Other news outlets featuring Robyn's quotes:

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Free Staff Training In-services and Tool Kit Available from National Council of Certified Dementia Practitioners Available for Download Until March 15th

The National Council of Certified Dementia Practitioners and International Council of Certified Dementia Practitioners are offering The National Council of Certified Dementia Practitioners Alzheimer’s and Dementia Staff Education Week February 14th to the 21st Free Staff Training In-services and Tool Kit. The Tool Kit and In-services are free and available at www.nccdp.org. The tool kit and in-services include many free Power Point in-services to use for training staff, family members, and volunteers. The tool kit and in-services can be downloaded until March 15th. Each in-service is designed to be taught in 30 minutes. Each year new in-services and topics are added to the archives.

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Protect the Elderly from Dangerous Bed Rails

THANK YOU to those individuals and groups who have signed our petition which calls for safety standards for adult bed rails. Haven’t signed yet? Please take the time to do so today by clicking here. We have a goal of 1,000 signatures and we need your help to reach that goal!

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About The Gazette

The Gazette is a weekly e-newsletter, published by the National Consumer Voice for Quality Long-Term Care and the National Long-Term Care Ombudsman Resource Center. If you do not wish to continue receiving this publication, please unsubscribe. Your contributions and comments are welcome and should be sent to swells@theconsumervoice.org. Copyright © 2013.

The Consumer Voice is the leading national voice representing consumers in issues related to long-term care, helping to ensure that consumers are empowered to advocate for themselves. We are a primary source of information and tools for consumers, families, caregivers, advocates and ombudsmen to help ensure quality care for the individual. The Consumer Voice's mission is to represent consumers at the national level for quality long-term care, services and supports.

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