Esther's Law Protects Ohio Seniors in Nursing and Rehabilitation Institutions by Permitting Cameras and Monitoring

Residents of Ohio’s nursing homes are permitted to place electronic monitoring devices in their rooms. “Esther’s Law” went into effect on March 23, 2022, after passing unanimously through the Ohio House and Senate and being signed by Governor Mike DeWine on December 22, 2021. This bipartisan legislation demonstrates that ridding Ohio is committed to reducing elder abuse generally, and particularly in institutions charged with caring for Ohio's vulnerable elderly residents. 

The genesis of Esther’s Law (Ohio Revised Code § 3721.60, et seq.), was a shocking video depicting the abuse of the bill’s namesake, Esther Piskor, at the hands of her nursing home care providers. Esther’s son Steve Piskor suspected his mother was the victim of abuse in an Ohio nursing home. In September 2011, Steve placed a hidden camera in his mother’s room which caught and documented six weeks of abuse. Nurses and aides threw Esther around the room, sprayed her in the face with unknown substances, and yelled at and neglected her. Mr. Piskor has since worked to ensure Elder Abuse will be driven out of Ohio’s nursing homes.

The law allows a nursing home resident, the resident’s guardian, or the resident's agent under a power of attorney, to authorize the installation of an electronic monitoring device in the resident's room under the following conditions: (1) the resident or the resident’s representative completes and submits a form to the facility, if the facility prescribes a form for the device and (2) the resident pays for the cost of the device and its upkeep. A resident may withdraw authorization at any time.

If the resident has a roommate, the consent of the other resident is required before any monitoring device may be installed. The roommate may consent based on certain conditions, such as agreed upon angling of the device, or limitations as to the use of the device. Devices must be installed and used in accordance with the consent of all residents residing in the room.

Nursing home operators and their staff should also be aware that the law requires reasonable attempts to accommodate residents to be made where a resident wishes to install an electronic monitoring device, but a roommate refuses to consent. Reasonable accommodation expressly includes moving the resident to another room where installation would be permitted if available.

The scope of Esther’s Law is currently limited to “long-term care” facilities defined as nursing homes and skilled nursing facilities and currently does not extend to assisted-living accommodations that do not meet the “long-term care facility” classification.  State legislators have indicated, however, that the scope of Esther’s Law may expand to other types of facilities in the near future.

Steve Piskor and the State Senators sponsoring Esther’s Law state that the goal of the law is to prevent abuse in the first instance, and not to be a reactive tool after abuse has occurred. This goal is made clear and is served by the law permitting long-term care facilities to place notices outside of the resident’s room to notify others that electronic monitoring is taking place.  In other words, the law is not intended to encourage secretive monitoring merely to encourage or facilitate litigation.

The law also prohibits any denial of admission, discharge, discrimination, or retaliation based on a resident’s decision to exercise the right to install an electronic monitoring device.  

Obviously, seniors and family members should seriously consider the use of such devices.  Keep in mind that even inexpensive and relatively unreliable devices will result in the placing of a notice that a device is electronic monitoring is taking place. Many home residents and merchants purchase signs advising that security systems and electronic surveillance exists, even where no such systems or devices are employed; deterrence is the first goal of any security or safety system or plan. 

SNF COVID Crisis Over? SNF COVID Deaths Fell 66% in Wake of Vaccine Clinics as Overall U.S. Fatalities Rose 61%

After a year of remarkable tragedy in nursing homes, a new analysis of federal COVID-19 data shows a significant drop in resident deaths in the weeks after vaccine clinics began, a trend made even more striking given the simultaneous spike in U.S. coronavirus deaths over the same period. The detailed analysis, courtesy of the Kaiser Family Foundation (KFF), paints a much-needed portrait of the COVID-19 pandemic as it has impacted, and continues to impact long-term term care facilities (LTCFs).  According to KFF, the final months of 2020 were the deadliest months of the pandemic for many LTCFs across the country, with over 26,000 COVID-19 deaths in LTCFs reported between Thanksgiving weekend and December 31, 2020. 

The end of 2020 saw the approval of the first coronavirus vaccines and the launch of vaccine administrations in LTCFs through the Pharmacy Partnership for Long-Term Care on December 21st, 2020 (Pfizer-BioNTech) and December 28th, 2020 (Moderna). As of February 22, 2021, about 4.5 million residents and staff have received one or more dose through the Partnership; over 2 million residents and staff have received both doses. In addition, some states and some LTCFs have vaccinated residents or staff outside the Partnership. Vaccinations have increased outside of LTCFs as well, though at a significantly lower rate. 

Weekly deaths in nursing homes fell 66% between the last week of December, when the federal government’s long-term care vaccination partnership with CVS and Walgreens ground into gear, and the first week of February, according to the Foundation.  That decline nonetheless represents more than 2,000 fatalities, but it came as nationwide deaths, excluding nursing homes, spiked 61% to nearly 20,000 during the week ended February 7, prompting the Foundation to ponder whether the end of the crisis in LTCFs has finally come into view.

KFF stopped short of definitively concluding that the vaccine clinics were the direct cause of the drop, noting that not every facility started the inoculation process on the same day, but the general association is obvious.

“According to the CDC, there has been strong evidence that the vaccines prevent severe illness and death, and the sharp divergence in deaths inside and outside of LTCFs is consistent with that evidence,” KFF observed. “In addition, given the emerging research around the vaccines’ ability to prevent transmission of the virus, there is reason to believe that the vaccine may be playing a part in reducing virus transmission within nursing homes, contributing to the more rapid decline in new cases in nursing facility residents than in the overall population.”

Total case numbers in nursing homes dropped 83% in the post-clinic period, far outpacing the 45% dip among the general, non-LTC population. “While cases have dropped both within and outside nursing facilities, new nursing facility resident cases peaked earlier (week ending December 20, 2020) as compared to in the general non-nursing facility resident population (week ending January 10, 2021) and declined at a faster rate in nursing facilities than outside nursing facilities,” KFF noted.

The most recent data marks a swift turnaround from record-high death counts seen in LTCFs at the beginning of 2021.  One in every 51 residents of LTCFs died during the four weeks bookending New Year’s Day, for a grim total of nearly 20,000, according to an AARP analysis.

“While the record high death rate in the four weeks ending Jan. 17 represents only a slight increase from the previous month, when 1 in every 53 residents died from COVID-19, it is more than a quadrupling of the resident death rate at the end of the summer,” AARP noted.

The gains also came amid continued concerns about relatively low uptake of vaccines among nursing home staff. Only 37.5% of workers accepted vaccinations during the first month of clinics, according to the Centers for Disease Control & Prevention (CDC), as compared to 77.8% of residents.  Meanwhile the debate regarding mandating vaccines roils. 

Sources:

"Nursing Home COVID Deaths Fell 66% in Wake of Vaccine Clinics — Even as Overall U.S. Fatalities Rose 61%," Skilled Nursing News, February 25, 2021.

Is the End of the Long-Term Care Crisis Within Sight? New COVID-19 Cases and Deaths in Long-Term Care Facilities Are Dropping, KFF, February 24, 2021.  

Heartbreaking Study Finds that Contact with Nursing Home Residents Fell by More than Half

Nursing home operators took limiting in-person contact with residents very seriously after the onset of the coronavirus pandemic. Visits of all kinds fell by 53% between March and April, new findings by SeniorLiving.org research revealed.

According to McKnight's Long-term Care News,The Centers for Medicare & Medicaid Services (CMS) issued guidance in mid-March restricting access for all visitor and non-essential healthcare personnel from facilities in an effort to combat and limit the spread of COVID-19.

The findings also showed that between April and June visits rebounded but were still down overall 33% when compared to March. The analysis used de-identified visitor data to nursing homes from 26 states. Researchers noted that because the data is de-identified, total traffic to nursing homes is inclusive of staff, vendors and visitors. 

“While this data does show the significant drop in visitors, it does not quite fully convey that there was almost a 100% decrease in [non-essential] visits that bring great joy to our residents — visits from their family and friends,” Erin Shvetzoff Hennessey, CEO of Health Dimensions Group, told McKnight’s Long-Term Care News. Hennessey explained that non-essential visitors that many facilities stopped included visits from family, beauticians, clergy, entertainment and all non-essential health visits. She noted that “most providers took the guidance very seriously and had even put in place restrictions prior to CMS requirements.”  

“The isolation our residents have felt is heartbreaking, but necessary to keep them safe from a virus that has been so unkind to our residents,” she added. 

Christopher Laxton, executive director of AMDA — The Society of Post-Acute and Long-Term Care Medicine, explained to McKnight's that better visitor insight might have been provided if the data was stratified by type of visitor.  But based on the findings, Laxton said, 

“It appears that the decline in visits in March and April validate nursing homes’ understanding that their patient and resident populations are at extreme and disproportional risk of illness and death from COVID-19 and need to be protected.  The subsequent increase in visits through June is likely multifactorial, including the need to mitigate the devastating effects of long-term social isolation on the nursing home population, among other reasons.” 

McKnight's headline called the findings "Heartbreaking."

The New Year Finds Nursing Homes Opposing New Minimum Staffing Requirements and Training Requirements for Dementia Care Workers

Nursing home providers are opposing proposed national legislation that would require skilled nursing facilities to meet minimum staffing requirements, and in New Hampshire  are looking to amend a newly effective state law that sets minimum training requirements for facility staff members who care for people with dementia, including Alzheimer’s. The industry is, instead, calling on lawmakers to find solutions to address what they characterize as a "workforce crisis" throughout the industry.

Sen. Richard Blumenthal (D-CT)  recently introduced The Quality Care for Nursing Home Residents Act (S.2943), which would revise minimum staffing requirements for skilled nursing facilities that participate in the Medicare and Medicaid programs.  The legislation has been referred to the Committee on Finance.  Rep. Jan Schakowsky (D-IL) also introduced the proposal (H.R. 5216) in the House. That legislation has since been referred to the House Ways and Means and Energy and Commerce committees.

Mark Parkinson, president and CEO of the American Health Care Association, said in a statement, that the legislation, without additional funding, would make it “impossible for facilities to implement new mandates” without risking additional closures.

“The skilled nursing profession has serious concerns about the practical implementation of the proposals in this bill. Today, our profession suffers from a critical workforce shortage and setting minimum staffing levels will not solve that issue. We need solutions like loan forgiveness that will help attract more workers to the long term care profession.”

He said that while the organization appreciates the interest in quality of care, more discussions are needed about “real solutions like the proposals that will allow reinstatement of CNA training programs. “These types of bipartisan solutions can help make meaningful progress and ensure access to care for seniors and individuals with disabilities across the country,” he said.

LeadingAge CEO and President Katie Smith Sloan said, though the proposed bill is “laudable,” it doesn’t address the true issue facing providers:

“There are simply more jobs open than can be filled across the U.S. In the words of one of our members: ‘We don’t even have people to interview, much less hire. Last year [2017], we had 9,000 RN, LPN, and CNA jobs in our state and only 2,500 applicants.” 

Smith Sloan added that the bill does not address the reason for the staffing shortages, which include demographics (America’s aging population) and money. She also urged lawmakers to support the Nursing Home Workforce Quality Act (H.R. 4468), which she said would “provide an opportunity to build a crucial talent pipeline.  According to Smith Sloan:

“Without mechanisms that address two significant issues, the availability of people to provide the care as well as the growing challenges of financing (Medicaid, which is the primary public source of funding for the majority of nursing homes, is inadequately funded, so providers are not reimbursed for the costs of care), this effort has small chances of achieving its desired end” 

The proposed legislation was commended by the National Consumer Voice for Quality Long-Term Care.

Meanwhile, providers in New Hampshire are looking to amend a newly effective state law that sets minimum training requirements for facility staff members who care for people with dementia, including Alzheimer’s. The law, which went into effect January 1st, was part of the state budget passed by the state lawmakers in September. The minimum training requirements apply to staff members working in residential homes or community-based programs with people who have forms of dementia, according to an Associated Press report. Direct-care workforce staff members, including staff at nursing homes and assisted living facilities, must also complete the training requirements, the Union Leader reported.

“We are committed to culturally competent dementia care. We are already providing it. We will comply with any legal mandate, but do want it to be practicable,” Brendan Williams, president and CEO of the New Hampshire Health Care Association, told McKnight’s. 

Williams said the organization wants the law to be more “practicable and prospective” for providers. One change providers are pushing for would allow for the use of a variety of training resources for staff members and not just rely on the Alzheimer’s Association curricula, as the current law requires. 

He argued that “no additional funding accompanied this new mandate for its Medicaid share-of-cost.”

“So we are wary of new unfunded mandates that may make it harder to recruit and retain staff.  An early state implementation draft would apply the new law even to volunteers,” Williams said. 

Williams added that the law is redundant, noting that federal regulations already require facilities and staff members to undergo training and provide “proper dementia care” to residents. 

He also noted that New Hampshire state law requires licensed nursing assistants to undertake 100 hours of training, which includes training in emotional support for how to respond to residents with dementia or cognitive impairments. 

“Hopefully, we can get to a result here that works for everybody,” Williams said. 

The foregoing demonstrates that the year 2020 is likely to be a year in which nursing home providers, legislators, regulators, and senior advocacy groups jockey for position in an effort to reform nursing home care to improve quality and accountability.  

__________________________________________________________________

The foregoing article draw from several articles, the most important being a pair of articles published in McKnight's Long-term Care News: 

• New bills call for nursing home minimum staffing requirements;
• Providers want to change new state law that sets minimum training requirements for dementia care staff.

Missouri Receives a Near Failing "D" on Nursing Home Report Card

Families for Better Care ("FBC"), recently  published its state-by-state nursing home report card. Missouri received  a near failing "D" grade, ranking thirty-ninth (39th) among the fifty states. The only bright news is that current ranking represents an increase in Missouri's relative ranking, up from  fortieth last year, and an improvement to Missouri's near failing "D" grade this year from a failing "F" last year. 

FBC scores, ranks, and grades states on eight different federal quality measures ranging from the number of caregiver hours residents received on a given day to the percentage of nursing homes cited severe deficiencies. The Report Cards include information from the newly revamped Nursing Home Compare reporting, requiring nursing homes to prove staffing levels, a sharp departure from previous administrations that accepted, without proof, representations from nursing homes regarding sufficiency of staffing.  More than one-third of nursing homes saw CMS ratings drop under the new, more deliberate, and more reliable system.

Regarding the Missouri's ranking, the Report Card noted:

• Missouri’s nursing home care climbed eight spots and moved up one full letter grade; ranking No. 39 overall and posting the state’s first non-failing grade in report card history.
• Missouri scored failing or below average grades in 5 of 8 nursing home quality measures.
• Less than 40 percent of Missouri’s nursing homes provide above average direct care staffing, resulting in a high percentage of understaffed homes.
• Missouri nursing home’s professional nursing services are among the most depleted in the nation as facilities provide fewer than 81 minutes of licensed nursing care per resident daily.
• Severe deficiencies in Missouri’s nursing homes climbed higher following the previous reporting period’s decline.
• Despite Missouri’s glaringly high percentage of facilities with deficiencies, the state’s ombudsmen verified 55 percent fewer registered complaints—pushing the state’s ranking into this year’s Top 10 states for this category.
• Missouri’s nursing home care ranks at the bottom of the Central Plains Region

Families for Better Care, Inc., is a Texas-based nursing home resident advocacy group dedicated to creating public awareness of the conditions in our nation’s nursing homes and other long-term care settings and developing effective solutions for improving quality of life and care.

“This year’s nursing home report card exposed an alarming trend that should serve as a wake-up call for us all,” said Brian Lee, Families for Better Care’s executive director. “Nursing home inspection ratings have soured.”

According to survey data collected by federal and state governments, fewer than 30 percent of nursing homes were capable of scoring an above average inspection rating, that’s nearly a 15 percent decline since the last reporting period.

“America’s nursing home care is worsening,” Lee exclaimed. “Erratic inspection performance is, by and large, traceable to a singular reason, the failure by so many nursing home operators to hire enough staff to safely care for residents.”

While Families for Better Care has repeatedly warned that nursing home staffing shortfalls are a grievous problem, the organization is calling for a new solution, one that the nursing home industry should welcome and would be embraced by residents and their families.

“The best way to heal America’s nursing homes is to appropriate additional funding to be used solely for hiring more staff,” Lee stated. “No more excuses, no more threats, no more scare tactics from lobbyists, politicians, operators—or anyone else for that matter—it’s time to do what’s right and stop the infliction of our loved ones with unnecessary injury or harm because of negligent policy making.”

According to the report’s findings, the majority of nursing homes (54 percent) were incapable of scoring an above average staffing rating. Residents received just 2 hours and 33 minutes of direct care daily—an average that’s unchanged from the previous report card. Nearly every state—with the exception of Alaska, the District of Columbia, and New Mexico—suffered a net loss in the percentage of nursing homes with above average staffing levels over the past three report cards.

“Before any checks are written to nursing homes, a rock solid staffing standard must accompany any new funding; otherwise, taxpayer monies could end up being diverted to subsidize the lifestyles of the rich and not-so-famous instead of getting back to the residents and their care,” Lee stated. “Too many nursing homes have demonstrated an unfaithfulness in self-governing their staffing levels to safely care for residents, so it’s time we help them out a little, as a nation, by federally mandating the most stringent staffing requirement that leaves no loopholes through which violators could squeeze.”

 As for the state’s nursing home rankings, the states highly rated in past report cards, once again, dominated the top spots while the chronic underachievers continued to disappoint.

This year’s top nursing home states were Hawaii, Delaware and Alaska while Texas, North Carolina, and Illinois scraped the bottom of the barrel. States with the biggest gains in overall ranking were New York (↑20), Mississippi (↑17), and Nevada (↑14) while Vermont (↓27), Massachusetts (↓24), and Arkansas suffered the biggest losses.

Three of the last report card’s best nursing home states slid out of the top ten, including Vermont, which plunged from No. 3 to No. 31 overall. The remaining states were New Hampshire (down from No. 2 to No. 11) and Florida (falling seven spots from No. 6 to No. 13).

Other key findings included:

• 500,000 elderly living in dangerous conditions—Nearly half-a-million elderly nursing home residents are living in facilities that tolerate below average staffing scores.
• Abuse and neglect vexes nursing home quality—1 in 5 nursing homes abused, neglected, or mistreated residents in almost half of all states for the second consecutive report card.
• States that are downright awful—Texas, Illinois, New Mexico, Michigan, Oklahoma, Louisiana, and Indiana consistently linger at, or near, the bottom in state nursing home care, scoring failing grades in every nursing home report card.

Families for Better Care argues that America desperately needs a nursing home cultural transformation, and the best way for that to happen is for nursing homes to saturate facility hallways with a brigade of well-trained frontline caregivers.

“Nursing home staffing levels must be ratcheted up if care is ever going to improve,” said Lee. “Since nursing homes rely so heavily on federal and state reimbursements, it’s incumbent upon us to pull up our bootstraps and find a way to inject much needed staffing currency as soon as possible.”


Readers of this blog should not be, and probably are not, shocked by either the report card grades, or the news that nursing home quality is generally worsening. These are compelling, but hardly new, reasons for implementing an Aging in Place plan.  If you haven't already, ask to attend an Aging in Place workshop.  

More:

State's [Pennsylvania] Failing Grade for Nursing Home Care is Unconscionable
Nursing Home Care Declines in Florida
Illinois Nursing Homes Rank Third Worst in the Country
Texas Ranked Last on 2019 Nursing Home Report Card
Delaware Ranked No. 2 on Nursing Home Report Card
Hawaii Grabs Nursing Home Report Card's Top Spot
Strong Staffing Boosts Alaska To No. 3 On 2019 Nursing Home Report Card
Rhode Island Slips to No. 4 On 2019 Nursing Home Report Card
Utah Ranks No. 5 On 2019 Nursing Home Report Card
Idaho Ranks No. 6 in 2019 Nursing Home Report Card
Arizona Ranked No. 7 on 2019 Nursing Home Report Card
Washington D.C. Surges To No. 8 On 2019 Nursing Home Report Card
Maine Drops to No. 9 on 2019 Nursing Home Report Card
North Carolina Drops to Second Worst in Nursing Home Quality

Ohio Receives Near Failing Grade on Nursing Home Report Card

Families for Better Care ("FBC"), recently  published its state-by-state nursing home report card. Ohio received  a near failing "D" grade, ranking fortieth among the fifty states. The current ranking represents a decrease in Ohio's relative ranking, down from 34th last year, but no change in Ohio's near failing "D" grade from last year. 

FBC scores, ranks, and grades states on eight different federal quality measures ranging from the number of caregiver hours residents received on a given day to the percentage of nursing homes cited severe deficiencies. The Report Cards include information from the newly revamped Nursing Home Compare reporting, requiring nursing homes to prove staffing levels, a sharp departure from previous administrations that accepted, without proof, representations from nursing homes regarding sufficiency of staffing.  More than one-third of nursing homes saw CMS ratings drop under the new, more deliberate, and more reliable system.

Regarding the Ohio ranking, the Report Card noted:

• "Ohio’s nursing home care continued its ratings slump, falling to No. 40 after dropping six spots.
• Ohio is a testament to nursing home mediocrity as the state failed to muster a Top Ten ranking or above average grade in any quality measure.
• Severe deficiencies in Ohio’s nursing homes swelled six percent, pushing the number of potentially dangerous nursing homes to nearly 1 in 5 statewide.
• Seventy-five percent of Ohio nursing homes failed to score an above average health inspection.
• Nearly 90 percent of Ohio’s nursing homes cited a regulatory deficiency—the state’s highest percentage thus far.
• Ohio’s nursing home residents received little more than 2 hours and 18 minutes of direct care each day.
  

Families for Better Care, Inc., is a Texas-based nursing home resident advocacy group dedicated to creating public awareness of the conditions in our nation’s nursing homes and other long-term care settings and developing effective solutions for improving quality of life and care.

“This year’s nursing home report card exposed an alarming trend that should serve as a wake-up call for us all,” said Brian Lee, Families for Better Care’s executive director. “Nursing home inspection ratings have soured.”

According to survey data collected by federal and state governments, fewer than 30 percent of nursing homes were capable of scoring an above average inspection rating, that’s nearly a 15 percent decline since the last reporting period.

“America’s nursing home care is worsening,” Lee exclaimed. “Erratic inspection performance is, by and large, traceable to a singular reason, the failure by so many nursing home operators to hire enough staff to safely care for residents.”

While Families for Better Care has repeatedly warned that nursing home staffing shortfalls are a grievous problem, the organization is calling for a new solution, one that the nursing home industry should welcome and would be embraced by residents and their families.

“The best way to heal America’s nursing homes is to appropriate additional funding to be used solely for hiring more staff,” Lee stated. “No more excuses, no more threats, no more scare tactics from lobbyists, politicians, operators—or anyone else for that matter—it’s time to do what’s right and stop the infliction of our loved ones with unnecessary injury or harm because of negligent policy making.”

According to the report’s findings, the majority of nursing homes (54 percent) were incapable of scoring an above average staffing rating. Residents received just 2 hours and 33 minutes of direct care daily—an average that’s unchanged from the previous report card. Nearly every state—with the exception of Alaska, the District of Columbia, and New Mexico—suffered a net loss in the percentage of nursing homes with above average staffing levels over the past three report cards.

“Before any checks are written to nursing homes, a rock solid staffing standard must accompany any new funding; otherwise, taxpayer monies could end up being diverted to subsidize the lifestyles of the rich and not-so-famous instead of getting back to the residents and their care,” Lee stated. “Too many nursing homes have demonstrated an unfaithfulness in self-governing their staffing levels to safely care for residents, so it’s time we help them out a little, as a nation, by federally mandating the most stringent staffing requirement that leaves no loopholes through which violators could squeeze.”

 As for the state’s nursing home rankings, the states highly rated in past report cards, once again, dominated the top spots while the chronic underachievers continued to disappoint.

 This year’s top nursing home states were Hawaii, Delaware and Alaska while Texas, North Carolina, and Illinois scraped the bottom of the barrel. States with the biggest gains in overall ranking were New York (↑20), Mississippi (↑17), and Nevada (↑14) while Vermont (↓27), Massachusetts (↓24), and Arkansas suffered the biggest losses.

Three of the last report card’s best nursing home states slid out of the top ten, including Vermont, which plunged from No. 3 to No. 31 overall. The remaining states were New Hampshire (down from No. 2 to No. 11) and Florida (falling seven spots from No. 6 to No. 13).

Other key findings included:

• 500,000 elderly living in dangerous conditions—Nearly half-a-million elderly nursing home residents are living in facilities that tolerate below average staffing scores.
• Abuse and neglect vexes nursing home quality—1 in 5 nursing homes abused, neglected, or mistreated residents in almost half of all states for the second consecutive report card.
• States that are downright awful—Texas, Illinois, New Mexico, Michigan, Oklahoma, Louisiana, and Indiana consistently linger at, or near, the bottom in state nursing home care, scoring failing grades in every nursing home report card.

Families for Better Care argues that America desperately needs a nursing home cultural transformation, and the best way for that to happen is for nursing homes to saturate facility hallways with a brigade of well-trained frontline caregivers.

“Nursing home staffing levels must be ratcheted up if care is ever going to improve,” said Lee. “Since nursing homes rely so heavily on federal and state reimbursements, it’s incumbent upon us to pull up our bootstraps and find a way to inject much needed staffing currency as soon as possible.”


Readers of this blog should not be, and probably are not, shocked by either the report card grades, or the news that nursing home quality is generally worsening. These are compelling, but hardly new, reasons for implementing an Aging in Place plan.  If you haven't already, ask to attend an Aging in Place workshop.  

More:

State's [Pennsylvania] Failing Grade for Nursing Home Care is Unconscionable
Nursing Home Care Declines in Florida
Illinois Nursing Homes Rank Third Worst in the Country
Texas Ranked Last on 2019 Nursing Home Report Card
Delaware Ranked No. 2 on Nursing Home Report Card
Hawaii Grabs Nursing Home Report Card's Top Spot
Strong Staffing Boosts Alaska To No. 3 On 2019 Nursing Home Report Card
Rhode Island Slips to No. 4 On 2019 Nursing Home Report Card
Utah Ranks No. 5 On 2019 Nursing Home Report Card
Idaho Ranks No. 6 in 2019 Nursing Home Report Card
Arizona Ranked No. 7 on 2019 Nursing Home Report Card
Washington D.C. Surges To No. 8 On 2019 Nursing Home Report Card
Maine Drops to No. 9 on 2019 Nursing Home Report Card
North Carolina Drops to Second Worst in Nursing Home Quality

Washington State May Be First Sate With Payroll-Funded Long Term Care Insurance Benefit.

ID 124552162 © Designer491 | Dreamstime.com

Numerous states are considering proposals to create a long-term care insurance programs, many funded by a payroll tax. Washington may be the first to actually enact a plan. Both the Washington State House and Senate have passed legislation, so all that’s required is a House re-vote on a Senate package that differs slightly from the House version. 

The Senate tweaked a few aspects of a proposal passed earlier by the House, so approval appears all but assured. The governor, provider associations and many others have  supported the measure, which would cap the lifetime benefit maximum at $36,500 per person. The governor has promised to sign the bill when presented. 

MyNorthwest reported in an article the sponsor's statements supporting the legislation:

"Democratic State Rep. Laurie Jinkins has introduced the Long Term Care Trust Act, which she says would work similarly to unemployment.  'What we do is create, essentially an insurance program where folks pay a premium of 0.58 of a percent, so 58 cents of every hundred dollars they earn would go into the trust. In return, any time they needed long-term care they’d be able to draw on that,' Jinkins explained. 

Workers of all ages would pay into the program, at a cost of around $24 a month for someone earning $50,000 a year.

That creates a benefit of roughly $37,000 over a person’s lifetime they could take in units of $100.

“That amount of money, for example, would pay for 25 hours a week of in-home care over the course of a year, respite care for one of your family members who was getting care; it would pay for that for maybe five years. So, it’s a pretty significant benefit for people,” Jinkins said.

Providers could start collecting payment from the program beginning in January 2025. The measure covers traditional long-term care services for people needing help with at least three activities of daily living (ADLs), as well as things like in-home care and meal delivery, rides to the doctor, home modifications such as wheelchair ramps, and reimbursements to unpaid family caregivers.  Washington defines more broadly ADLs than does private insurance, which usually triggers benefits when someone requires help with two ADLs. The state would reimburse providers directly. Family caregivers could be paid, though they first would have to go through a training program. 

Premiums of 0.58% of wages would begin being withheld from employees’ checks starting in 2022. Someone earning $50,000 per year would pay a premium of about $24 per month, or $288 per year. Under the Senate version, individuals holding long-term care insurance policies would be exempt.

A participant must work and pay the premium/payroll tax for at least 10 years, with at least five uninterrupted, or three of the last six years. Thus, most current retirees would be ineligible for the program.  

Provider and consumer groups testified in favor of The Long Term Care Trust Act, and nobody testified against it, at a House Health & Wellness Committee hearing in January. Experts say 60 percent of us will need long-term care or support of some sort after we hit 65.

In a House committee hearing,  Dan Murphy, executive director of the Northwest Regional Council explained who the insurance would benefit:

“People need long-term care when they can no longer do basic things themselves. Things like bathing, dressing, getting out of a chair, a bed getting into a car, managing their medications or just even standing, walking around. That’s what we’re really talking about in the assistance lift, when folks can’t any longer do things for themselves.”

An outside study authorized by the Legislature back in 2015 found there is a significant need, with seven of 10 people over 65 years old expected to need this type of care.

Of course the program also benefits the State of Washington.  An outside study found the program would lead to big savings for Medicaid over time, close to $900 million in the 2051-53 biennium.

According to an article in Forbes, although Washington is the first state in the US to enact a public long-term care insurance program other states are considering similar legislation.  "Hawaii has provided a public cash benefit for family caregivers of frail older adults, though it is not really an insurance program. California is considering a ballot initiative on a public long-term care financing program, Michigan and Illinois are studying public programs for those not on Medicaid, and Minnesota has proposed two alternative private financing options for long-term care."  Forbes notes,  though, that the "idea is not universally popular, however. Last year, Maine voters rejected a public plan to help fund home care."

According to Forbes, Washington State is choosing a "front-end insurance model that could begin to cover benefits as soon as participants have a need. It would cover the most people, though its benefit would pay only a small fraction of the costs for someone who needs several years of care."  An alternative model, "called a catastrophic or back-end design, would require participants to pay for the first years of care, but provide lifetime coverage after that.  It would cover fewer people than a front-end plan but would focus on those with the greatest need."

The Forbes article concludes that "[t]he Washington State model would be an important experiment, and it could create momentum for other states to adopt long-term care insurance programs."