NOT YOUR GRANDMA’S NURSING HOME
TRENDS SHOW CHANGES IN RULES, RESIDENTS
Sunday, November 1, 2009
FAYETTEVILLE — Benton County will have 186 more nursing home beds opening up by the end of this year - a 9 percent increase for the county.
Benton County had suffered a shortage of beds for years because the state restricts the number to a percentage of the population. However, Benton County is a popular retirement community with a disproportionate number of older residents. It also has the longest life expectancy of any county in the state, recent state Health Department figures show.
“You can open a new nursing home to replace an existing one in the same county at any time,” said David Norsworthy, chief operating officer for Providence Health Care.
“You can still do that, butthe state figured out that they were paying for new homes to replace old ones in counties that no longer had the population tosupport the number of licensed beds.”’
The permit commission proposed a change to allow nursing home owners to transfer licenses they hold in counties with low (less than 70 percent) occupancy in nursing homes to ones with high rates of more than 80 percent. The Legislative Council, a committee that reviews state government actions between legislative sessions, approved the change.
John B. Montgomery of Rogers, the developer and owner of the new facility, moved almost immediately to transfer beds out of a Howard County nursing home into Benton County and even bought a nursing home in Jefferson County so it could move the beds, Norsworthy said. Providence Healthcare manages homes Montgomery owns.
This made the construction of a 140-bed facility in Rogers possible, plus expansion of existing homes by 46 beds.
Medicaid will pay up to $44,600 per licensed bed for new nursing homes. Cost of construction is ranging above $70,000 per bed, Norsworthy said.
The new center, called Jamestown, shows many of the trends and changes in regulations in the nursing home industry in Arkansas.
Shorter Care
The nursing home business has shifte d from long-term care to shortto medium-term physical therapy and rehabilitation. Many state nursing homes have rehabilitation centers within their walls to help stroke victims and others suffering from crippling e◊ects recover and go home. Jamestown has a separate entrance for its built-in center. The chief operating officer for Providence Health Care, which will run Jamestown, is a former physical therapist.
“Nursing homes have physical therapy departments. It goes on all the time,” said former state Rep. Mike Hathorn, D-Huntsville. Hathorn won a distinguished lawmaker’s award from the Arkansas Advocates for Nursing Home Residents, a nonprofi t group that supports nursing home resident rights and safety, in 2001. Hathorn later became chief executive for a nursing home firm, Pinnacle Health Care of Rogers.
“We figured out over the last 10 years that we can do that (therapy) for people who need it for a few weeks and are then ready to go home, and that Medicare reimbursement rates are a lot higher than Medicaid reimbursement.”
Each state sets its own Medicaid rates, and Arkansas’ has some of the lowest Medicaid reimbursement rates in the United States, federal fi gures show.
“Most of our patients are Medicaid, but Medicare’s where we make our money,” Hathorn saidFlexible Care
Residents are increasingly unwilling to stay in places with strict schedules and limited activities. Jamestown is on New Hope Road in Rogers, one intersection away from the Pinnacle Hills Promenade mall. Like many nursing homes, space is built in for activities and schedules of events such as meals, menus for those meals and other routines will be flexible.
“If you want to sleep in until 9 o’clock in the morning, we’ll let you,” Hathorn said. “Now, that may mean you get a continental breakfast instead of something fixed just the way you want it, but you should have the choice.”
Traditional nursing home patients, the ones who live at a facility, are demanding more control over their daily lives and are getting it, Hathorn said, along with nursing home resident Dale Winkler, 77, who lives at Heritage Park Nursing Home in Rogers.
“A lot of the people here will go to people’s homes and take care of the kids of young couples and single mothers so they can have a night out,” Winkler said of the residents. “That’s good for everybody. A lot of those moms never get to go anywhere unless they find and pay for a baby sitter. For us, who gets older and hasn’t had kids? It’s a good time for everybody, including the kids.”
“We had a Halloween party last night with a haunted house and a costume contest,” Winkler said Friday. “A lady dressed up like a gorilla won the contest, and she was good.
“In a couple of months, it will be Christmas,” said Winkler, a widower twice over. “You can really be lonesome that time of year. There’s going to be people sitting at home alone because they’re so afraid to go to the nursing home. People just don’t want to do it. They’re just against it. What right do you have to make a decision like that if you’ve never even come here and taken a look?” Socialization
There’s more at stake in having fl exibility and activities, such as cooking and aerobics classes, than pleasing the residents, said Bill Wickizer, administrator for Butterfield Trail Village.
The village is not a nursing home, but a retirement community where residents must be fully independent when they move in. The community o◊ers a range of care and is the only certifi ed Continuing Care Retirement Community in the state, state records show. It provides a full range of care from independent apartment living to a skilled care nursing home that is one of the best in the state, according to inspectors’ reports.
“There’s value and benefi t in socialization,” Wickizer said. People of any age who do not interact and get lonely can face serious health and attitude consequences, he said
There’s also sound business reasons for pleasing your residents, Norsworthy said. People would rather live somewhere where they are in charge, at least of themselves. Tight schedules simply do not work in today’s market, he said.
Unlike the past, people move when they cannot fi nd what they want locally.
“If they want a glass of wine with dinner and there’s no medical reason for them not to have it, they should have it,” he said.
Another service is as vital as nursing care, Hathorn said: food.
“When you get down to it, the biggest question in quality of care is, ‘Who is going to take care of me?’” Hathorn said. “The next one is, ‘What am I going to eat?’”
“When you’re looking for a nursing home for a loved one, spend time looking and asking questions, but be sure and have lunch or dinner there too,” Hathorn said. “That tells you something you need to know.”
All other factors, however, are pale compared to whether the residents in your care are and believe themselves to be safe, all interviewees agreed.
“In this business, you’re only as good as your worst employee at 2 a.m. on a weekend shift,” Norsworthy said.
Direct Caregivers
More money in Arkansas has been put into direct care, particularly for hiring the nursing staff who have the most direct contact with residents.
Arkansas nursing homes began paying a bed tax in 2001. Although homes paid the fee per licensed bed, they got almost three times as much because the federal government matches state contributions at an almost four-to-one ratio of taxpayers’ money.
Long-term residents of nursing homes are usually Medicaid patients. Medicaid is a program for the poor that is largely paid for by federal taxpayers but administered by the state. The state also bears about a 25 percent share of the cost. Medicare is a fully federally funded and administered program.
A less-publicized part of the so-called “bed tax” was related legislation that changed the formula for how Medicaid money is distributed. Now more money is tied to direct care, particularly pay for certified nursing assistants - the ground troops of long term care.
Nursing homes have also received some unexpected help from a busted economy, said Debbie Fort of Van Buren, Hathorn’s director of operations. “We can fi nd the people we need.”
Wickizer agreed.
“We had a secretary’s position open up. We had 150 applicants including a Ph.D.” However, there is a serious shortage of nurses that cuts across all health care, he said.
A state audit of nursing homes found self-reported sta◊levels in nursing homesare inflated, nursing home resident advocate Martha Deaver points out. Deaver is the president of Arkansas Advocates for Nursing Home Residents.
Quality Of Care
State inspections have consistently cited at least 3,500 violations a year since 2005 in Arkansas nursing homes, Deaver said. Of those, 158 showed physical harm done to at least one patient, state records show.
Most Arkansas nursing homes receive far more violation citations from state inspectors than the national average. One nursing home watchdog group, MemberoftheFamily.net, claims that all but 73 out of 230 nursing homes in Arkansas are far below average by national standards, based on the number of violations cited. A federal General Accounting Office report also states that under-reporting of violations is a national problem.
“It’s the only business I know of where the state pays your liability insurance,” Deaver said. “If you have a medical error and judgment against you and your liability insurance goes up, you’re allowed to use state Medicaid to pay for it.”
That is true in most states, Deaver said.
A major change for the better in Arkansas, Deaver said, was approval of a state ombudsman beginning in 2003 - a full-time, state-paid advocate for nursing home residents. Arkansas ombudsman Kathie J. Gately won the 2009 National Coalition of Citizens for Nursing Home Reform advocacy award. Deaver and her group nominated Gately for it.
News, Pages 1 on 11/01/2009
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