Nursing homes receive public funding from states in many ways. They are reimbursed for the care they give to Medicaid residents through the Medicaid nursing home reimbursement systems. These systems sometimes include add-ons to the reimbursement rate for hard to place residents or for residents with special needs. In addition, some states have grant programs that give additional Medicaid funds for special projects; some give facilities additional Medicaid funds for performing well (“pay-for-performance” and other incentives to promote quality). Some of these states have begun to move their reimbursement system from one based only on facility costs to one more focused on quality.

Given the fiscal crisis that New York State and other states find themselves in and the many care problems still existing in nursing homes, it is crucial that the state undertake a comprehensive assessment of these funding streams. How are funds being granted? Is the state getting quality care for its money? Can the system be modified in a way that all public funds going into nursing homes encourage and ensure access, quality and efficiency? Can the Medicaid reimbursement system be modified to focus on positive resident outcomes rather than simply on facilities’ reported costs?

See report, supported by a grant from the New York Community Trust, for recommendations for modifying the system to better encourage quality, access and efficiency.

CMS Issued Proposed Rules for a New Version of Medicare Reimbursement - RUGs IV.

On May 12, 2009, CMS issued proposed changes to the present RUGs III Medicare reimbursement system for nursing homes. LTCCC is making comments which are due at the end of June. The new system will use a new assessment tool: MDS 3.0.

Free Toolkit: Speak Out to Advocate for Safe Nursing Home Staffing Standards

Study after study has indicated that sufficient staffing is key to quality of life and quality of care. Yet while we give nursing homes millions of dollars a year, and trust them with our most vulnerable loved ones, we do not require that they maintain adequate staffing to provide decent care.

It is time that our elected officials, who sign off on payments to nursing homes, sign on to hold them responsible for having safe staffing levels.  But they wont do that unless they hear from us – a lot of us – that this is an important issue. 

LTCCC Report Examines Nursing Home Oversight Across New York: Major Problems Still Exist - Many Regional Differences Found

Vulnerable nursing home residents depend on the state to hold nursing home providers accountable for the care they receive by identifying problems during regular inspections and through investigations of complaints.

This report, supported with a grant from the New York Community Trust, examines the effectiveness of each regional office in ensuring resident safety and quality of life.  

It is a follow up to a study LTCCC issued last year (see link below to that report) which compared New York’s oversight performance to that of other states and the federal government. The motivation for the new study was to identify strengths and weaknesses among the regional offices overseeing nursing homes in New York and develop recommendations for the NY Department of Health to protect residents no matter where they live.

 The full report (see link on the right), examples of surveyor ratings that were too low, examples of superior surveying, region by region differences, possible reasons for these differences and recommendations for improvement.

CLICK HERE TO READ PRESS RELEASE

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Legislation for Safe Nursing Home Staffing in NY State:

Numerous studies have indicated that nursing home staffing levels are the most critical indicators of good care and resident safety.

LTCCC supports NY State legislation to encourage better staffing in nursing homes. Introduced in the Assembly by Assemblyman Richard Gottfried (with many other sponsors), A01718 would mandate ratios of nurse aides, RNs and LPNs. We also support federal legislation to mandate minimum safe staffing levels, such as that introduced in 2005 by Representative Waxman of California.

Another bill that is very important, especially if A 01718 does qnot pass, is A01721, the Nursing Home Diversion Act (NHDA).  This bill, introduced by Assemblyman Richard Gottfried, would not permit nursing homes to accept any new residents if their staffing levels drop below a dangerous point.

CLICK HERE to read about the NHDA and what it would do.

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LTCCC Fights Allowing Poorly Trained Feeding Assistants in Nursing Homes:

The federal government has announced a relaxation in standards for nursing home workers who provide care to residents.  Until now, one had to be at least a certified nurse aide (CNA) to give resident care. CNAs must have at least 75 hours of training under federal law (100 hours in New York) and meet other requirements. Under the new interpretation, states are permitted to allow nursing homes to use "feeding assistants" with less than 10 hours training, no certification and little oversight to feed vulnerable residents. 

This is a vital function, and there are serious risks for the person being fed.  In addition, it is dehumanizing to the resident to be treated as the subject of tasks rather than to be cared for as an individual and treated with dignity. LTCCC is working to prevent the use of feeding assistants by joining in an amicus brief to support a lawsuit to stop feeding assistants.

See button on right side of page, LTCCC Position on Poorly Trained Feeding Assistants, for more information and a copy of the brief.

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LTCCC Testifies at Assembly Hearing on DOH Oversight:

"The findings of this study indicate that NYS is failing in this job a significant amount of time and is putting nursing home residents at risk."  Cynthia Rudder and Martin Sobel, LTCCC.

CLICK HERE to read testimony.

"There is no adequate and effective DOH oversight. The major obstacle ...appears to be its (DOH's) willingness to cooperate with the administration."  Shirley Genn, family member and retired Executive Director of Brooklyn-wide Interagency Council on Aging.

CLICK HERE to read U.S. Government Accountability Office Report on Nursing Home Oversight

The Government Accountability Office (GAO) has issued a new report which assesses problems with nursing home oversight from 1998 to the present.  The report, Nursing Homes: Despite Increased Oversight, Challenges Remain in Ensuring High-Quality Care and Resident Safety (GAO-06-117), presents the findings of GAO's investigation in which they reviewed trends in nursing home quality from 1999 to January 2005, evaluated the extent to which CMS (Centers for Medicare and Medicaid Services) has addressed nursing home survey and oversight problems and identified the key challenges to greater progress in ensuring resident health and safety.  The investigation found widespread, serious issues, from understatement of serious deficiencies to inconsistency in state surveys.   The GAO's findings corroborate many of the findings in LTCCC's recent report, Nursing Home Residents at Risk! NYS' Failure to Oversee Nursing Homes, which compared nursing home oversight in NY State vs. other states and found that New York had serious underperformance issues in a number of areas critical for nursing home resident protection and safety.

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Using Civil Money Penalties to Improve Care

Federal Civil Monetary Penalties (CMPs) and State CMPs/fines are imposed by the regulatory agencies that license nursing homes if a nursing home does not comply with regulatory standards. We believe that CMPs and state CMPs/fines present an additional valuable resource for fiscally constrained states to improve the quality of nursing home life and care. In 2006 we released a report on a project funded by the Commonwealth Fund that examined how states re currently use these funds, provided recommendations for ways to make concrete improvements for resident quality of life and care, and provided tools for all stakeholders - families, residents, advocates, ombudsmen and providers - to help realize the potential of CMPs. In 2007 we pulled together a group of consumer stakeholders to work with New York State as it distributed these funds to improve nursing home care and quality of life. This led to the state opening the funds to consumer and community groups and encouraging more creative projects.  In 2009 we met with staff in the central office of the Centers for Medicare and Medicaid (CMS) to urge them to encourage all states to do the same.  Attached is a memo sent to all states in June, 2009, urging states to do this.

What Lies in the Future for NY’s Nursing Homes and Those Who Will Need Them?

LTCCC Hosts Two Unprecedented Meetings of NY State Political Leaders, Charitable Foundation Reps and Major Stakeholders

The future for nursing homes and those who will need them is looking bleak.  Problems in nursing homes are widespread and well known. Too many of our loved ones suffer because of neglect and abuse.  As a result, there is a strong and growing movement in New York and nationwide to enable people who need long term care to receive that care outside of nursing homes. These developments are wonderful for people who are able to get care in their home or in a more community-like setting, such as assisted living. But what will happen to those who need or want care in a place that offers 24 hour skilled nursing? With money and public attention turning away from nursing homes – while the numbers of frail elderly continue to rise dramatically - how will we ensure that people have access to good and safe nursing home care?

To address these critical questions, LTCCC convened two invitation-only roundtable meetings of state policy makers, leading consumer and provider representatives, and representatives of several of the state’s foremost foundations to begin the dialogue necessary to guide New York’s planning and policy development in the future.

Click on the link above to read more or download our report listing recommendations from the participants.

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New York State Office of the Attorney General - Medicaid Fraud Control Unit - Publishes Brochure Outlining How it Can Help You

The brochure, "Protecting Patients From Abuse and Neglect," discusses the types of investigations the office undertakes in nursing homes, the types of crimes providers can be charged with, how to contact the office and ways you can be helped if you have suffered abuse or neglect. Click on the link above to download the brochure.

Read testimony on Medicaid fraud by LTCCC's Director of Special Projects, Cynthia Rudder, at the NY Assembly hearing on Medicaid fraud on September 9, 2005.

Joint meeting of LTCCC committees to discuss federal and state issues.

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Final Nursing Home Staff Posting Requirements Issued:

In 2001, the Centers for Medicare and Medicaid Services (CMS) mandated that every nursing home in the country post in a prominent, public place the numbers of licensed and unlicensed direct care staff on duty for every shift. LTCCC, with funding from the Robert Sterling Clark Foundation, conducted a study to determine if this requirement was adequate to give consumers the information they need to determine staffing levels in their nursing home. Based on this study, LTCCC made recommendations to CMS for improvements to the initial regulations. The final regulations on posting nurse staffing information in nursing homes were published by CMS in late October 2005.

The final regulations have much of the core information as in the proposed regulation issued in 2004. However, they do not include some of the important comments which LTCCC and other groups had urged the federal government to require, such as requiring a standardized form that would be readily identifiable to residents and family or posting information for more than one shift (to give people a better understanding of the home's staffing levels).

CLICK HERE for final nursing home staff posting requirements.

CLICK HERE to read LTCCC's report, Is the CMS nursing home staff posting requirement serving consumers?

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CLICK HERE to read LTCCC's Report: Results of LTCCC's Survey of NYS Ombudsmen

"Poor care, accidents leading to hospitalization and several deaths,.... I also find that care plans are not always followed because staff is in a hurry, accidents occur because toileting residents is delayed so residents attempt to toilet themselves."

Additional LTCCC Reports:

Building upon its Certified Nurse Aide Training "Model" Program (2002), in 2004, the Coalition released a number of reports and studies demonstrating the need for more staff and better screened and trained staff: (1) Certified Nurse Aide Screening and Continuing Education: A National Survey of State Requirements with Recommendations for Improvement, (2) LTCCC Urges New York State Leaders to Consider Costs of Poor Care (discusses the cost of poor care related to low staffing) and (3) Are the Federal Nursing Home Staff Posting Requirements Serving Consumers? a report on a year long campaign of consumer experience with postings in their nursing home(s), with recommendations for regulatory improvement.

With support from the New York Community Trust, LTCCC published a report on improving working conditions: Improving Working Conditions for Nursing Home Direct Care Staff: A description of a project in two nursing homes in New York City and A Ten-Step Guide to Improving Working Conditions.