Are You Really Better Off in a Nursing Home than at Home? SNF Residents with Pre-existing Healthcare Associated Infections Less Likely to be Readmitted to Hospital

According to McKnight's Long-term Care News, "skilled nursing operators have a new tool in their marketing kits to portray themselves as worthy providers of good clinical care."  According to McKnight's: 

Residents with pre-existing healthcare-associated infections (HAIs) are less likely to be readmitted to a hospital when discharged to a skilled nursing facility as opposed to a home-health setting, according to University of Michigan researchers.

The study found that SNF residents with HAIs were 38% less likely of being readmitted when compared to patients who returned home or received home health care services. The most common reasons for all readmissions included Clostridioides difficile and urinary tract infections.  

Investigators used national hospital discharge data from more than 702,000 Medicare beneficiaries age 65 and older. About 353,000 of those seniors, or 50%, were discharged to a SNF. About 179,400 (26%) were discharged to home health care and about 169,800 (24%) were sent home. 

The study was published  in the Journal of the American Geriatrics Society. 

So, if you contract a "healthcare-associated infection," an infection you would not have contracted at home, this study suggests you are more likely to have a positive health outcome if you go to another healthcare institution, a skilled nursing home, rather than to your home. 

The study based positive health outcome upon hospitals readmissions, but there does not appear to be in the study a control to determine whether readmissions did not occur because they are penalized by Medicare regulations.  Bottom line, though, is that there is now a study which stands squarely for the proposition that you should accept referral to a SNF from a healthcare institution/hospital from which you may have contracted an infection rather than transfer to your home. 

Hopefully the industry wields responsibly the shiny new tool in their marketing kits to portray themselves as worthy providers of good clinical care.  One would hope that would include full disclosure of the risks of institutional care:

• One-Third of Nursing Home Residents Injured or Killed In Treatment;
• New Cont
• Institutional Care: America's Most Vulnerable Seniors Raped and Sexually Abused;
• COPD Patients Discharged to a Skilled Nursing Have Two Times the Risk of Death Within Year Compared to Those Who Go Home;
• Hapatitis Infection Risk in Nursing Homes Up 50%; Infection Risk Across the Board Increases;
• Resident's Death Caused By Nursing Home Failing to Follow Advanced Directives Requesting CPR;
• Nursing Home Involvement in Patient's Death Object Lesson on Aging-in-Place Planning;
• Nursing Home Worker Faces Homicide Charges in Violent Death of Resident;
• Paramedics Often Obstructed, Provided Insufficient Information On Nursing Home Calls;
• Non-Profit Long-Term Care Safer than For-Profit;
• Habits Are Hard to Break: Nursing Homes Habitually Violate Federal Standards Year After Year;
• CDC Reports That SNF Workers Most Likely Among Health Care Workers to Forego Recommended Vaccinations;
• Don't Let Institutions Plan for You: Medicaid-Eligible Nursing Home Resident Stuck With Costs of Private-Pay Room;
• Many Skilled Care Providers Still Unaware of New Medicare Rules Permitting Chronic Condition Care;
• Ohio Ranks Poorly on Long-Term Care Services Scorecard;
• Hospice Costs Medicare Less Notwithstanding that Hospice Patients Live Longer.

    

Taking Advantage of Medicare Open Enrollment

Medicare Open Enrollment Period, October 15th through December 7th, can pay off in significant savings and/or significant additional benefits. Medicare Fall Open Enrollment Period is the time you can join, switch, or make other changes to Medicare drug and health plans.

In Medicare, individuals must choose one of two paths: original fee-for-service Medicare, or a federally subsidized Medicare Advantage plan, which typically operates like a health-maintenance or preferred-provider organization. Many who opt for traditional Medicare also purchase a private "Medigap" policy, as well as a separate prescription-drug policy, to patch holes in their coverage.

In recent years, Medicare Advantage plans have gained in popularity, in part because, when compared with a Medigap policy, they generally cover a wider array of benefits, often including prescription drugs and dental care. Many also charge lower premiums, but require members to use the plan's network of providers.  As previously reported on this Blog, Medicare Advantage premiums are estimated to decline to their lowest in 13 Years. 

How, then, should Medicare beneficiaries prepare for Open Enrollment? Here’s a checklist from The Senior Citizens League:

1. Review: By now, people covered by Medicare Part D or Medicare Advantage plans should have received an Annual Notice of Changes for 2020 from their current plan. In addition to changes to the premiums, the notice will explain increases, if any, in the deductible, copayments and coinsurance. The notice will tell you where to find information about the pharmacies in the drug plan’s network, and it will refer to “the drug list” or plan formulary of covered drugs which usually can be found online or requested from the plan. What the notice does not include is a list of the drugs you currently take, the tiers that your drugs will be on in 2020, whether coverage has been dropped for any of your drugs in 2020, or what those drugs will cost if co-insurance is charged.  Plans will provide most of that information, but it requires either calling your plan directly and speaking to someone who can estimate the cost of your drugs in 2020, or obtaining the advice and counsel of a professional, such as the professionals at Harding Harding & Associates, Inc., who will help evaluate your plan changes.  Once you have this information, it’s very important to compare all your health and drug plan options to find your lowest-costing coverage.
2. Gather and write legibly: Gather all of the drugs you currently take and carefully make a list, printing the name of the drug, dosage, quantity taken per day, and quantity required per month. Do this for each drug taken. Make sure your writing is legible. Type and print it out if possible. Keep this list on file where you can find it easily. Not only will you need it to compare drug plans, it’s handy to take with you on each visit to your doctor.
3. Get free, unbiased assistance from a Medicare counselor: You can get great help from a local Medicare benefit counselor who provides free one-on-one counseling through State Health Insurance Programs (SHIPs). Local contact information can be found at: https://www.shiptacenter.org. Call and make appointment now, because Open Enrollment will take more time than usual this year. The Medicare Drug Plan Finder comparison tool which counselors use to compare drug plans and estimate costs has recently been re-designed. “It’s likely to take longer than usual to sort through plans and determine the best choice for clients while all of us are learning how to use the new system,” Johnson says.
4. Narrow your choices and contact the prospective drug plans directly to confirm details: Once you have picked out three or so plans that look like your best bets, contact the plans directly to confirm the details. This includes coverage of all your drugs, estimated co-pays and co-insurance, which pharmacies participate and other questions you may have.
5. Switch plans by going through the Medicare website: It’s better to switch plans through the Medicare website than trying to do so directly with the insurer. This way Medicare will make sure your previous plan unenrolls you by the end of the year and your new coverage begins on January 1, 2020 with the new plan. Your SHIP Medicare benefits counselor can help you do this.

If you need help call 1-800-Medicare (1-800-633-4227) or contact your local area agency on aging to get free one-on-one counseling.

For more information: 

• Visit the Medicare website at www.medicare.gov, or call toll free at 1-800-MEDICARE (1-800-633-4227).
• Medicare Advantage Premiums Decline to Lowest in 13 Years With Open Enrollment Approaching.
• Preparing for Medicare Open Enrollment

Veterans Service and Non-Service Connected Benefits

The  Senior Veterans Service Alliance is kind to publish the following summary of benefits available to senior veterans through the Veterans Administration:

Non-Service Connected Disability Benefits

Veterans who served during a period of war or their surviving spouses may be eligible for additional income from the Department of Veterans Affairs to help pay for their long term care, out-of-pocket costs.  These benefits are called Pension and Survivors Pension.  They are also misnamed the “Aid and Attendance Benefit.”

Pension benefits are subject to income and asset restriction tests which VA scrutinizes closely during application and even years after veterans or their survivors are on claim.  Pension and Survivors Pension represent only about 9% of all individuals who are on claim for all disability income categories.  

Potential incomes up to the following upper limits are possible:

• Disabled veteran with spouse – $2,230 a month;
• Single disabled veteran –  $1,881 a month;
• Single disabled surviving spouse – $1,209 a month;
• Healthy veteran with a disabled spouse – $1,477 a month

 Service-Connected Disability Benefits

Service-connected disability benefits are available to any veteran or surviving spouse with no income or asset restriction tests.  For these benefits, the Department of Veterans Affairs does not care how much money these veterans or their survivors make or what their assets are.  The benefits listed below represent the other 91% of veterans or survivors who are on claim for disability income. 

•  A surviving spouse could be receiving DIC at $1,319.04 a month or $1,599.13 a month based on the particulars of the veteran’s death.  For a surviving spouse receiving DIC and receiving long term care services, VA will pay an additional $326.77 a month – bringing the total to $1,645.81 or $1,925.90 a month.  Some surviving spouses should be receiving a monthly income from DIC but they are not.  The Senior Veterans Service Alliance can help certain surviving spouses with applications for entitlement to DIC.
• A retired veteran on Disability Compensation at 60% or more for one rating or 70% or more combined rating – with at least one of the underlying ratings at 40% – can be paid at 100% for individual unemployability.  Disability Compensation for a veteran at 60% pays $1,113.86 a month.  A veteran receiving Compensation income for individual unemployability and paid at 100% will receive $3,057.13 a month.  A senior veteran who is housebound and being paid at a 100% rating, due to individual unemployability, could apply for an additional income allowance for being housebound – bringing the total income to $3,421.90 a month.
• An older veteran receiving Disability Compensation at a 100% rating receives $3,057.13 a month.  This 100% rated veteran who is receiving long term care services could qualify for additional income allowance for long-term care bringing total income to $3,804.04 a month.

Vietnam Era Veterans, Who with Aging, Have Developed Conditions Such As Diabetes, Heart Disease, Certain Forms of Cancer and Parkinson's Disease

A veteran, who is one of 2.2 million living veterans who served in-country in Vietnam, can get additional income.  By showing evidence of one or more of the conditions above, a Vietnam veteran can receive additional income starting at $140.05 a month and going up to the possibility of $3,057 a month.

Older Single Veterans with Worsening Hearing Loss or Tinnitus

Service-connected hearing loss or tinnitus starts at $140.05 a month and goes up to the possibility of $3,057.13 a month for an older senior veteran who qualifies.  A rating for hearing loss/tinnitus of 10% or more will entitle the veteran to Veterans Health Care which is entirely free except for inexpensive prescription drug costs.  This person can then receive free hearing aids, free hearing aid batteries, free eyeglasses and substantial discounts on prescription drugs.

A Decade of Innovation: AARP Research Highlights Changes in Technology Adoption

A single decade means transformative change in the world of technology, particularly as regards health and aging in place.  In 2008 AARP examined technology use of the 65+ population.  The iPhone had just been released in June of 2007, so this survey did not consider smartphone use – there was no Digital Health “(a check engine light for your body!”); the Longevity Economy hadn’t been invented; Fitbit was a 2007 new clip-on tracker, and Facebook was still a campus toy. The survey was fielded in December of 2007 with a population of 907 adults aged 65-98 (mean age was 74) – rarely surveyed today, despite increasing lifespans.

The survey was conducted by showing responders  still pictures of products from a Leading Age video. Only one third of the 65+ had broadband in the home (the rest used dial-up) or had gone online at the time of this survey. The older responders were less likely to search for health information online or to trust online sources. Responders were also, generally, less willing to use a computer to interact with people at a distance (Skype had just surfaced in 2003).  Perhaps seeing the future, 6 in 10 thought that “personal computers will cost too much to install (62%), maintain (59%) and may not be something I need (58%).”  The 65+ population thought favorably about home safety devices, including mitigating losses from impairment (vision, mobility) – but only for others, not for themselves.

By 2011, according to the report Healthy@Home 2.0, in-home PC was commonplace; 71% of the 65+ population were using PCs to communicate with family and friends. Caregivers were increasingly using technology to help them manage care (although they still objected to being called caregivers). By 2018, tech attitude differences between the 70+ and younger population were obvious: while 90% of all adults owned a computer or laptop, those aged 70+ were more likely to use them, along with feature phones, and smartphone adoption had reached just 55% in the older group.  Among those under the age of 70, text messaging had taken over as the primary tool to stay connected, replacing email and telephone conversation, the latter of which was rarely used by younger individuals after 2015.

Telemedicine was positively perceived in 2008, but more than half of older adults said they would like to be able to monitor their health status at home, sending information to their doctor via telephone and email. By 2008, the VA had completed a study about the efficacy of home telehealth for veterans, in particular, aside from the claims of cost effectiveness, those that had the devices in-home felt more connected to their care providers. That was the good news. By 2019, the so-called tipping point in utilization by doctors has not been reached, though, perhaps it is just around the corner – the VA being the first to allow doctors to ‘practice’ across state lines.  But even though adoption is improving, only one-third of hospitals and 45% of doctors actually offer telehealth services. However, an October poll showed that older adults would still prefer in-person visits and anyway, have generally not encountered telehealth offerings. Their expressed concerns were nearly identical to those noted in 2008  -- more than half did not know if their doctor offered and nearly half worried whether the technology would work.

Technology is providing solutions precisely when they are most needed.  Aging in Place planning should consider and employ technological solutions where possible. 

https://www.ageinplacetech.com/blog/considering-technology-adoption-aarp-s-2008-healthyhome

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