Steve Gold - "Why are persons in Nursing Homes"

http://www.stevegoldada.com/stevegoldada/archive.php?mode=A&id=238
Why Are People In Nursing Facilities - Residents' 2007 Clinical Characteristics
From Steve Gold:

Why Are People In Nursing Facilities - Residents' 2007 Clinical Characteristics
Information Bulletin #238 (1/08)

CMS' 2007 Nursing Home Data Compendium was recently released. In this and in the next two succeeding Information Bulletins, we will break down some of the findings. To review your State , go to http://www.cms.hhs.gov/CertificationandComplianc/12_NHs.asp#TopOfPage and scroll down to Nursing Home Data Compendium 2007 - Parts 1 and 2 .

Why are people in these facilities?

Nursing facilities, especially those reimbursed with federal Medical Assistance reimbursements, require a "medical necessity" for such institutionalization. That is, legally, a person should not be admitted unless the person has a "medical necessity" for institutionalized nursing facility services.

The following are the two most frequently used indica of such "medical necessity" - (1) Need for help with Activities of Daily Living and/or (2) Cognitive Impairments.

1. Regarding whether a person's condition severely affects his/her "Activities of Daily Living," CMS evaluated ability to get in and out of bed, dressing, eating, transferring and toileting. A condition was noted only when the resident required "extensive assistance" with the activity.

2. Regarding whether a person had a cognitive impairment, CMS used the Cognitive Performance Scale.

States normally require a person to have a certain number of ADL or cognitive impairments to either be admitted into or stay in a nursing facility. In order to receive federal nursing facility Medicaid reimbursements, documentation of "medical necessity" is required.

Obviously, a person can have both, but CMS does not provide a cross tabulation for persons who have both ADLs and cognitive impairments.

Here's what CMS surveys found regarding these two conditions:

ADL Impairments:

Nearly 30.3% of persons in nursing facilities had NO impairment of ADL; that's more than one million persons institutionalized in nursing facilities at sometime during the year who had no ADL impairment. Another 8.3% had only one ADL impairment. More than 46% of the persons had two or fewer ADL impairments. (Table 3.3.(e)).

The following states have the largest percentage of persons with NO ADL impairments, far above the national average of 30.3%:

Oklahoma 44.6%
Missouri 41.4%
Illinois 40.7%
Arkansas 39.3%
Kansas 38.2%
Louisiana 37.8%

Why are any persons in nursing facilities with no or even only one or two ADL impairments? If they are in these facilities only due to ADLs, can't these people be provided Personal Attendant Services in the community?

Why are States, for those residents on Medical Assistance, permitting these people to be admitted into nursing facilities and then paying extremely large payments for them to be unnecessarily institutionalized?

Why aren't advocates making the States "Close the Front Door" and not admit or pay for these persons? Why aren't advocates demanding their states to offer persons with no or only one or two ADLs less expensive community-based services?

If people are in nursing facilities and do not have impairments of no or few ADLs, then presumably they are institutionalized because they have a cognitive disability. If that is correct, did these people receive PASSAR evaluations before they were admitted, and are they receiving appropriate services for their cognitive impairments? If they have only a cognitive impairment, how do they otherwise meet the "medical necessity" standard for nursing facilities?

Cognitive Impairments:

Nearly 31% of residents had NO cognitive impairment; that's nearly one million persons without any cognitive impairments. Another 12.2% had only a "very mild" and 14.5% have a "mild" cognitive impairment. Therefore, nearly 58% had either no or only a mild or less cognitive impairment.
(Table 3.5.(e))

The following states, in descending order, have the largest percentage of persons in nursing facilities with NO cognitive impairments, far above the national average of 30.9%:

Arizona 45.3%
New Jersey 42.0%
DC 41.2%
Florida 39.5%
Maryland 38.4%
Nevada 38.3%.

Interestingly, the national average was only 11.5% of the residents had a "severe" or "very severe" cognitive impairment, far lower than what is commonly believed.

The following states, in descending order, far exceeded the national average for the percentage of people in nursing facilities with a severe or very severe cognitive impairment:

Georgia 17.4%
Arkansas 15.5%
South Carolina 15.5%
Louisiana 13.9%
Kentucky 13.8%
Maryland 13%

Advocates should ask their MA officials for a breakdown of persons with a combined ADL and cognitive impairments.

Are people with severe or very severe cognitive impairments receiving specialized services, as Congress required in the Nursing Home Reform Act.

When one looks at both ADL and cognitive impairments, a frightening picture emerges. Have nursing facilities become the last refuge for many persons who are mentally ill, homeless, developmentally disabled? Are States permitting them to stay in nursing facilities because that's where states can receive federal reimbursements and funds?

Why is your State wasting Medical Assistance dollars on those persons who could easily be treated appropriately in the community? Think how many more persons could be served in the community with better use of these funds.

~ Steve Gold, The Disability Odyssey continues



Support the Community Choice act!!!! support ADAPT www.adapt.org

an elderly parent in a nursing home, just to get them out of the way, is because it would cut into the profits of the nursing home corporations that make a lot of money off of the elderly and suffering. There are also mentally challenged young people in nursing homes that must not be forgotten.
Excluding people from nursing homes that would do fine with government funded hospice care in their on homes or elderly apartments
would alleviate abuse problems and save the ordinary citizen a lot of money. But who in Washington, D.C. really gives a rats ass
about ordinary people. Nursing home lobbyists own us. :dem:

Statement of Senator Barack Obama on the Community Choice Act

Tuesday, January 15, 2008

For Immediate Release
Contact: Michael Ortiz

Washington, DC -- Senator Barack Obama (D-IL) released the following statement in advance of the House Energy and Commerce Committee, Health Subcommittee hearing on "Medicaid's Critical Role for Americans with
Disabilities." The hearing will be held on Wednesday, January 16, 2008.

"There remain severe shortcomings in our country's efforts to break down the barriers that exclude people with disabilities and deprive them of true equality of opportunity and independence.

The United States must lead the world in empowering people with disabilities to take full advantage of their talents and become independent, integrated members of society. We must build a world free of unnecessary barriers, stereotypes, and discrimination. Policies must be developed, attitudes must
be shaped, and buildings and organizations must be designed to ensure that everyone can live independently as full citizens in their communities.

For that reason, I support the passage of the Community Choice Act of 2007, which would allow Medicaid-eligible Americans with significant disabilities the choice of living in their community, rather than having to live in a nursing home or other institution. This legislation is vitally important to
the independence, community integration, and equality of hundreds of thousands of Americans with disabilities."

The Community Choice Act of 2007 was introduced by Senator Tom Harkin (D-IA) and Rep. Danny K. Davis (D-IL). Senator Obama is a cosponsor of the legislation.


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shades of ronald reagan. I remember a time when mentally ill people were in hospitals,
not wandering the streets alone and helpless.

where they can't be seen or heard and overmedicating them for convenience of staff is hardly progressive. Community Choice means just that - CHOICE

Sticking folks into prision like mental institutions when they haven't committed any crime is barbaric.

Think before you rant!

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http://www.cqpolitics.com/wmspage.cfm?docID=hbnews-000002656258

CQ HEALTHBEAT NEWS
Jan. 16, 2008 – 6:24 p.m.
Disabled People Want More Choice in Types of Care

By Emily P. Walker, CQ Staff

Dozens of people with disabilities packed a House Energy and Commerce hearing room on Wednesday to support legislation that aims to give people with disabilities more choice about their care.

“Individuals with disabilities deserve care when and where they decide,” said Jan Schakowsky , D-Ill., a member of the Health subcommittee, which held the hearing on Medicaid’s role in caring for people with disabilities.

On Monday, the Centers for Medicare and Medicaid Services (CMS) issued a proposed regulation that the agency said would allow more Medicaid beneficiaries to be in charge of their own personal assistance services rather than relying on an agency to deliver them. CMS has requested public comment on how states could allow Medicaid beneficiaries who need help with the activities of daily living to hire, direct, train or fire their own personal care workers. Beneficiaries could hire qualified family members to perform the personal assistance services, CMS said. (See related story, CQ HealthBeat, Jan. 14, 2008)

Medicaid only covers for community care for adults if the disabled person is transitioning into the community after being in a nursing home. For instance, Medicaid allows states to pay for case managers, but only to help transition Medicaid beneficiaries from a nursing home institution to the community. Medicaid is piloting another program that rewards states for transitioning people with disabilities into the community, but requires the person to have been in a nursing home for at least six months beforehand. “You should not have to go in to get out,” said Stephanie Thomas, an organizer with ADAPT, a grass-roots disability rights organization. “Sixty-seven percent of Medicaid long-term funds go toward institutions, and just 33 percent are left for community services,” she said. Shifting some funding away from nursing home institutions and toward community services could save money, Thomas said, because nursing home care cost is more expensive. “We could be serving three people for every two we are serving now, and doing it more humanely,” she said.

-more-

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totally w/o consent.

Out wondering the community for crumbs is what it sounds like to me. But neglected and fed slop in a nursing home is not my idea of quality of life either.

and shut the door and forget them. It doesn't do enough to fix the problem. The for profit nursing home care is bullshit and needs entirely revamping by people who care about people rather than the fucking dollar. Take the profit out of the equation and one ends up paying for NO care. The helpless are either warehoused or turned out into the street to wander. Without even looking at the thing you are pushing, it doesn't do enough.

Here's a short synopsis from the ADAPT website

"For decades, people with disabilities, both old and young, have wanted alternatives to nursing homes and other institutions when they need long term services. Our long term care system has a heavy institutional bias. Every state that receives Medicaid MUST provide nursing home services, but community based services are optional. Sixty five percent of Medicaid long term care dollars pay for institutional services, while the remaining 25% must cover all the community based waivers, optional programs, etc.
Families are in crisis. When support services are needed there are no real choices in the community. Whether a child is born with a disability, an adult has a traumatic injury or a person becomes disabled through the aging process, they overwhelmingly wan t their attendant services provided in their own homes, not nursing homes or other large institutions. People with disabilities and their families will no longer tolerate being forced into selecting institutions. It's time for Real Choice.

The Community Choice Act provides an alternative and will fundamentally change our long term care system and the institutional bias that now exists. Building on the Money Follows the Person concept, the two million Americans currently residing in nursing homes and other institutions would have a choice. In addition, people would not be forced into institutions in order to get out on community services; once they are deemed eligible for the institutional services, people with disabilities and their families will be able to choose where and how they receive services. Instead of making a new entitlement, the Community Choice Act, makes the existing entitlement more flexible.

The Community Choice Act establishes a national program of community-based attendant services and supports for people with disabilities, regardless of age or disability. This bill would allow the dollars to follow the person, and allow eligible individuals, or their representatives, to choose where they would receive services and supports. Any individual who is entitled to nursing home or other institutional services will now be able to choose where and how these services are provided."
Links to the senate and house bills

Senate S733
http://thomas.loc.gov/cgi-bin/query/D?c110:20:./temp/~c1102cuDZH::">House HR 1621
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The Community Choice Act will allow people to stay inn their homes instead of being shuffled off to institutions. What;s not to like?

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