Nursing homes push for lawsuit protection with fast-moving bill and broadcast ads; newspaper editorials excoriate sponsor, industry

A state Senate committee has approved a bill that would require lawsuits against nursing homes to clear a review panel before going to court, a move that has drawn very sharp criticism from the editorial pages of the state's two largest newspapers. Meanwhile, the nursing-home industry is running television and radio ads urging calls to legislators in favor of the measure, which the Senate Health and Welfare Committee approved 7-4 last Wednesday without hearing from its opponents.

"Slimy action on questionable bill" read the headline over Tuesday's Lexington Herald-Leader's editorial, which began, "Good ideas can withstand criticism. So, when lawmakers move a piece of legislation without hearing from any of its opponents, you have to wonder whether they're sneaking through a stinker."

The chairman of the committee and the bill's sponsor, Sen. Julie Denton, R-Louisville, said some members had to leave for other meetings. "But somehow they had time to listen to industry spokesmen before voting," the Herald-Leader noted. "The nursing home industry claims that it is under siege from frivolous lawsuits drummed up by attorneys advertising for clients and that this legal threat pushes up nursing homes' insurance and legal costs, taking money that otherwise could go into patient care." (Read more)

The Courier-Journal editorial, which first reported the committee's action, accused Denton of "a brazen abuse of her power as committee chairman" and said sarcastically that she was "humane" to spare members of he committee "the ugly details of nursing home neglect and abuse. . . . Why should members, before lunch, have to consider graphic testimony about bedsores, near-starvation, dehydration and bowel obstructions suffered by elderly, helpless people? But for members of the General Assembly who are interested in the facts, here are some:

• Kentucky currently has about 23,000, mostly frail, elderly people who are residents in about 280 nursing homes. About half the homes have been cited by federal inspectors for a serious deficiency since 2009.
• 40 percent of the homes are rated at below average by the U.S. Center for Medicare and Medicaid Services when it comes to basic health and safety.
• In 2012, Kentucky ranked first in overall federal fines for violations and one Kentucky nursing home racked up the nation’s highest fines for the year.
• Kentucky ranks first in serious nursing home deficiencies that threaten the safety of residents. (Read more)

Sen. Ray Jones, D-Pikeville, who called Denton's move "blatantly wrong." has filed several floor amendments to the bill, which remained in the Senate Rules Committee Monday.

The Kentucky Association of Health Care Facilities is pushing the bill with TV and radio commercials urging calls to legislators. It placed $9,464 worth of ads on Lexington TV stations through Feb. 14.

A state Senate committee has approved a bill that would require lawsuits against nursing homes to clear a review panel before going to court, a move that has drawn very sharp criticism from the editorial pages of the state's two largest newspapers. Meanwhile, the nursing-home industry is running television and radio ads urging calls to legislators in favor of the measure, which the Senate Health and Welfare Committee approved 7-4 last Wednesday without hearing from its opponents.

"Slimy action on questionable bill" read the headline over Tuesday's Lexington Herald-Leader's editorial, which began, "Good ideas can withstand criticism. So, when lawmakers move a piece of legislation without hearing from any of its opponents, you have to wonder whether they're sneaking through a stinker."

The chairman of the committee and the bill's sponsor, Sen. Julie Denton, R-Louisville, said some members had to leave for other meetings. "But somehow they had time to listen to industry spokesmen before voting," the Herald-Leader noted. "The nursing home industry claims that it is under siege from frivolous lawsuits drummed up by attorneys advertising for clients and that this legal threat pushes up nursing homes' insurance and legal costs, taking money that otherwise could go into patient care." (Read more)

The Courier-Journal editorial, which first reported the committee's action, accused Denton of "a brazen abuse of her power as committee chairman" and said sarcastically that she was "humane" to spare members of he committee "the ugly details of nursing home neglect and abuse. . . . Why should members, before lunch, have to consider graphic testimony about bedsores, near-starvation, dehydration and bowel obstructions suffered by elderly, helpless people? But for members of the General Assembly who are interested in the facts, here are some:

• Kentucky currently has about 23,000, mostly frail, elderly people who are residents in about 280 nursing homes. About half the homes have been cited by federal inspectors for a serious deficiency since 2009.
• 40 percent of the homes are rated at below average by the U.S. Center for Medicare and Medicaid Services when it comes to basic health and safety.
• In 2012, Kentucky ranked first in overall federal fines for violations and one Kentucky nursing home racked up the nation’s highest fines for the year.
• Kentucky ranks first in serious nursing home deficiencies that threaten the safety of residents. (Read more)

Sen. Ray Jones, D-Pikeville, who called Denton's move "blatantly wrong." has filed several floor amendments to the bill, which remained in the Senate Rules Committee Monday.

The Kentucky Association of Health Care Facilities is pushing the bill with TV and radio commercials urging calls to legislators. It placed $9,464 worth of ads on Lexington TV stations through Feb. 14.

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Lame-duck Congress could cut funding for critical access hospitals; more than two dozen in Kentucky

Critical access hospitals, which in most states are rural facilities with fewer than 25 beds, may be under attack in the lame-duck session of Congress, former national rural-health director Wayne Myers writes for the Daily Yonder. President Obama's "budget proposes to revoke CAH status and special payments for any such hospital within 10 miles of another hospital, and to cut the extra 1 percent payment for all of the critical access hospitals," Myers writes. (Census Bureau map of CAH locations)

This would "have enormous consequences," Myers writes. "Of the hospitals that lose CAH designation probably most will close or merge with another hospital. I've seen no estimates of numbers. There are more than a few congressional budget hawks in both parties who would like to eliminate the special payments to Critical Access Hospitals entirely. If these small hospitals dodge the bullet during the lame duck session, they'll continue to be targets in the next Congress. If they are successful in reducing payments to CAHs, the net effect will be to move health care capacity and jobs from smaller to larger towns."

The issue is complex. Rural areas have less political clout than ever, because of declining population, and many rural people use urban hospitals over CAHs, even for ordinary care. "Those who do use CAHs say their experience there is just as good as that in urban hospitals, even if the quality of care isn't as good as in larger facilities," Myers writes. "Elderly patients stay at CAHs because they know the nurses and doctors and their families live close by."

Issues for CAHs arise out of how Medicare payments are made to them, Myers writes. "A long list of arcane, special funding arrangements has accumulated to try to fit small rural hospitals into a Medicare payment system designed for large city hospitals." The largest program is the "Disproportionate Share Program," or DISH, which gives $15 billion a year to states to hand out to CAHs. The program is being phased out between 2014 and 2020, along with several other programs, as part of the Patient Protection and Affordable Care Act. (Read more)

Critical access hospitals, which in most states are rural facilities with fewer than 25 beds, may be under attack in the lame-duck session of Congress, former national rural-health director Wayne Myers writes for the Daily Yonder. President Obama's "budget proposes to revoke CAH status and special payments for any such hospital within 10 miles of another hospital, and to cut the extra 1 percent payment for all of the critical access hospitals," Myers writes. (Census Bureau map of CAH locations)

This would "have enormous consequences," Myers writes. "Of the hospitals that lose CAH designation probably most will close or merge with another hospital. I've seen no estimates of numbers. There are more than a few congressional budget hawks in both parties who would like to eliminate the special payments to Critical Access Hospitals entirely. If these small hospitals dodge the bullet during the lame duck session, they'll continue to be targets in the next Congress. If they are successful in reducing payments to CAHs, the net effect will be to move health care capacity and jobs from smaller to larger towns."

The issue is complex. Rural areas have less political clout than ever, because of declining population, and many rural people use urban hospitals over CAHs, even for ordinary care. "Those who do use CAHs say their experience there is just as good as that in urban hospitals, even if the quality of care isn't as good as in larger facilities," Myers writes. "Elderly patients stay at CAHs because they know the nurses and doctors and their families live close by."

Issues for CAHs arise out of how Medicare payments are made to them, Myers writes. "A long list of arcane, special funding arrangements has accumulated to try to fit small rural hospitals into a Medicare payment system designed for large city hospitals." The largest program is the "Disproportionate Share Program," or DISH, which gives $15 billion a year to states to hand out to CAHs. The program is being phased out between 2014 and 2020, along with several other programs, as part of the Patient Protection and Affordable Care Act. (Read more)

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Some strategies for seniors as Kentucky observes Fall Prevention Awareness Day Saturday, Sept. 22

Kentucky has joined 45 other states in proclaiming Saturday, Sept. 22 as Fall Prevention Awareness Day. In 2011, fall-related injuries among the elderly in the Bluegrass were associated with $266 million in hospital charges, according to Julie Lasslo, Kentucky Safe Aging Coalition coordinator at the Kentucky Injury Prevention and Research Center.

"Falls come at an immeasurable impact on the quality of life for many seniors," Lasslo writes in the Lexington Herald-Leader, noting that the Centers for Disease Control and Prevention estimate that one-third of Americans are hospitalized due to falls. She says such falls are not an inherent part of the aging process and some simple strategies can prevent them:

# Engage in a physical activity regime that includes balance, strength training, and flexibility.
# Consult with a health professional about getting a falls risk assessment.
# Have medications periodically reviewed.
# Get an annual eye exam.
# Store frequently used items at waist level.
# Remove clutter from stairwells, hallways and walking paths.
# Install and use handrails in stairwells and bathrooms.
# Remove throw rugs.
# Place double-sided tape under area rugs and loose carpet.
# Keep your home well-lit and consider using a night light.

For more information, go to Nofalls.org.

Kentucky has joined 45 other states in proclaiming Saturday, Sept. 22 as Fall Prevention Awareness Day. In 2011, fall-related injuries among the elderly in the Bluegrass were associated with $266 million in hospital charges, according to Julie Lasslo, Kentucky Safe Aging Coalition coordinator at the Kentucky Injury Prevention and Research Center.

"Falls come at an immeasurable impact on the quality of life for many seniors," Lasslo writes in the Lexington Herald-Leader, noting that the Centers for Disease Control and Prevention estimate that one-third of Americans are hospitalized due to falls. She says such falls are not an inherent part of the aging process and some simple strategies can prevent them:

# Engage in a physical activity regime that includes balance, strength training, and flexibility.
# Consult with a health professional about getting a falls risk assessment.
# Have medications periodically reviewed.
# Get an annual eye exam.
# Store frequently used items at waist level.
# Remove clutter from stairwells, hallways and walking paths.
# Install and use handrails in stairwells and bathrooms.
# Remove throw rugs.
# Place double-sided tape under area rugs and loose carpet.
# Keep your home well-lit and consider using a night light.

For more information, go to Nofalls.org.

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New tool allows analysis of nursing-home deficiencies across the country; Kentucky seems to rank high in serious problems

Reporters now have a tool at their fingertips that will allow them to find nursing home problems in facilities across Kentucky, which appears to ranks high in serious problems.(iStock photo)

The tool was launched this week by ProPublica, a nonprofit, investigative news group, and allows "anyone to easily search and analyze the details of recent nursing home inspections, most completed since January 2011," report Charles Ornstein and Lena Groeger.

The tool has features that the federal government's Nursing Home Compare doesn't have, including the ability to search using any keyword. Results can also be sorted according to the severity of the violation and by state.

About 1.5 million people still live in nursing homes nationwide, though more seniors are living at home or in assisted-living facilities. The reports show there were almost 118,000 deficiencies cited against 14,565 homes. According to the Centers for Medicare and Medicaid Services, the average number of deficiencies for a nursing home inspected in the U.S. is eight and the average in Kentucky is seven.

ProPublica's analysis shows Kentucky ranked fourth nationwide for the most "K" and "L" deficiencies, considered the most serious kind. The state had 45 in the analysis, as did South Carolina. Texas had the most in the country by far, however, with 183. 

While ProPublica does rank the states, nursing home industry officials say "inspectors in different regions of the country have different thresholds for issuing a citation, and that could unfairly make one state's homes appear worse than another's," Ornstein and Groeger report. (Read more)

Reporters now have a tool at their fingertips that will allow them to find nursing home problems in facilities across Kentucky, which appears to ranks high in serious problems.(iStock photo)

The tool was launched this week by ProPublica, a nonprofit, investigative news group, and allows "anyone to easily search and analyze the details of recent nursing home inspections, most completed since January 2011," report Charles Ornstein and Lena Groeger.

The tool has features that the federal government's Nursing Home Compare doesn't have, including the ability to search using any keyword. Results can also be sorted according to the severity of the violation and by state.

About 1.5 million people still live in nursing homes nationwide, though more seniors are living at home or in assisted-living facilities. The reports show there were almost 118,000 deficiencies cited against 14,565 homes. According to the Centers for Medicare and Medicaid Services, the average number of deficiencies for a nursing home inspected in the U.S. is eight and the average in Kentucky is seven.

ProPublica's analysis shows Kentucky ranked fourth nationwide for the most "K" and "L" deficiencies, considered the most serious kind. The state had 45 in the analysis, as did South Carolina. Texas had the most in the country by far, however, with 183. 

While ProPublica does rank the states, nursing home industry officials say "inspectors in different regions of the country have different thresholds for issuing a citation, and that could unfairly make one state's homes appear worse than another's," Ornstein and Groeger report. (Read more)

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CDC: Ten swine flu cases reported last week were linked to Ohio's Butler County Fair; warns nation's fairgoers to be cautious

Centers for Disease Control officials in Atlanta say 29 human cases of the new strain of the H3N2 swine flu have been confirmed in the last year, including 12 last week. Ten of the new cases were linked to the Butler County Fair in southwest Ohio. Butler County is just north of Cincinnati's Hamilton County. The fair ended last weekend. None of the cases have been tied to human-to-human transmission and all 12 of the new patients had close contact with swine prior to getting sick. The two other new cases occurred in Hawaii and Indiana. (CBS News photo)

Health official told CBS News that because county and state fair season in full swing, attendees should avoid taking food and drinks into barns and to wash their hands after they have been near animals. Pregnant women, young children, the elderly and people with weakened immune systems are especially at risk for developing the flu strain. So far, the strain hasn't spread easily, and recent cases have been mild. (Read more)

Centers for Disease Control officials in Atlanta say 29 human cases of the new strain of the H3N2 swine flu have been confirmed in the last year, including 12 last week. Ten of the new cases were linked to the Butler County Fair in southwest Ohio. Butler County is just north of Cincinnati's Hamilton County. The fair ended last weekend. None of the cases have been tied to human-to-human transmission and all 12 of the new patients had close contact with swine prior to getting sick. The two other new cases occurred in Hawaii and Indiana. (CBS News photo)

Health official told CBS News that because county and state fair season in full swing, attendees should avoid taking food and drinks into barns and to wash their hands after they have been near animals. Pregnant women, young children, the elderly and people with weakened immune systems are especially at risk for developing the flu strain. So far, the strain hasn't spread easily, and recent cases have been mild. (Read more)

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Most Ky. nursing homes give more antipsychotic drugs to non-psychotic patients than U.S. median, but get little attention so far

Most Kentucky nursing homes exceeded the national average of the share of residents without psychosis or a related condition who nevertheless received antipsychotic drugs, according to federal data gathered by The Boston Globe and distributed by Kentuckians for Nursing Home Reform.

The data from the Centers for Medicare and Medicaid Services showed that 16.7 percent of patients fell into that category, and that 161 of the 280 Kentucky nursing facilities for which data were available exceeded the national average. Twenty had percentages more than double the national average, and three were more than triple: the Glasgow State Nursing Facility, at 62 percent; Arbor Place of Clinton, 61 percent; and the nursing home at Western State Hospital in Hopkinsville, 60 percent.

The data are for 2010. Nursing homes were not included if there were no data on antipsychotic drug use. Some data were taken from 2009 because no 2010 data were available. The Globe put the data into an easily reviewable database, available here, the Kentucky reform group issued a press release about it on June 14, and Kentucky Health News reported it on June 22.

However, only two Kentucky newspapers have reported on the survey and a local facility that exceeded the national average, according to our limited subscriptions and the news-clipping service subscribed to by the Foundation for a Healthy Kentucky and shared with Kentucky Health News. Those were the Kentucky New Era in Hopkinsville, which mentioned several facilities in its area (Western State's director said state policy prevented him from commenting), and The Anderson News of Lawrenceburg. Its June 20 edition had a story focusing on Heritage Hall in Lawrenceburg, where 20 percent of non-psychotic patients received antipsychotic drugs.

A spokesman for Heritage Hall's operator, Elmcroft Senior Living and Memory Care of Louisville, told Anderson News Editor Ben Carlson that physicians "may choose to prescribe a medication such as antipsychotics without a diagnosis of psychosis or related condition such as controlling a patient's anxiety over a specific disease process."

Bernie Vonderheide, spokesman for the reform group, told Carlson that it suspects that many nursing homes use the drugs to keep patients under control and to avoid hiring more staff. "That is the single biggest problem in nursing homes, the lack of caregivers." (Read more; the New Era's story is behind a pay wall.)

Besides the Glasgow, Clinton and Hopkinsville facilities, the following had a percentage of non-psychotic patients receiving antipsychotic drugs that was more than double the national average:

Dawson Pointe, Dawson Springs 49%
Dover Manor, Georgetown, 49%
Edgemont Health Care, Cythiana, 46%
Pineville Community Hospital, Pineville, 44%
Edgewood Estates, Frenchburg, 42%
Wesley Manor Nursing Center, Louisville, 42%
Wellington Parc of Owensboro, 42%
Stanton Nursing Center, Stanton, 41%
Shady Lawn Nursing Home, Cadiz, 41%
Charleston Health Care Center, Danville, 37.5%
Breckinridge Memorial Nursing Facility, Hardinsburg, 37%
Cedar Ridge Health Campus, Cynthiana, 37%
Brighton Cornerstone Health Care, Madisonville, 36%
Carmel Home, Owensboro, 36%
Ridgeway Nursing and Rehabilitation Facility, Owingsville, 36%
J.J. Jordan Geriatric Center, Louisa, 35%
Medco Center of Henderson, 35%
Wolfe County Health and Rehabilitation Center, Campton, 34%
(Figures are rounded to the nearest percentage unless .5)

Most Kentucky nursing homes exceeded the national average of the share of residents without psychosis or a related condition who nevertheless received antipsychotic drugs, according to federal data gathered by The Boston Globe and distributed by Kentuckians for Nursing Home Reform.

The data from the Centers for Medicare and Medicaid Services showed that 16.7 percent of patients fell into that category, and that 161 of the 280 Kentucky nursing facilities for which data were available exceeded the national average. Twenty had percentages more than double the national average, and three were more than triple: the Glasgow State Nursing Facility, at 62 percent; Arbor Place of Clinton, 61 percent; and the nursing home at Western State Hospital in Hopkinsville, 60 percent.

The data are for 2010. Nursing homes were not included if there were no data on antipsychotic drug use. Some data were taken from 2009 because no 2010 data were available. The Globe put the data into an easily reviewable database, available here, the Kentucky reform group issued a press release about it on June 14, and Kentucky Health News reported it on June 22.

However, only two Kentucky newspapers have reported on the survey and a local facility that exceeded the national average, according to our limited subscriptions and the news-clipping service subscribed to by the Foundation for a Healthy Kentucky and shared with Kentucky Health News. Those were the Kentucky New Era in Hopkinsville, which mentioned several facilities in its area (Western State's director said state policy prevented him from commenting), and The Anderson News of Lawrenceburg. Its June 20 edition had a story focusing on Heritage Hall in Lawrenceburg, where 20 percent of non-psychotic patients received antipsychotic drugs.

A spokesman for Heritage Hall's operator, Elmcroft Senior Living and Memory Care of Louisville, told Anderson News Editor Ben Carlson that physicians "may choose to prescribe a medication such as antipsychotics without a diagnosis of psychosis or related condition such as controlling a patient's anxiety over a specific disease process."

Bernie Vonderheide, spokesman for the reform group, told Carlson that it suspects that many nursing homes use the drugs to keep patients under control and to avoid hiring more staff. "That is the single biggest problem in nursing homes, the lack of caregivers." (Read more; the New Era's story is behind a pay wall.)

Besides the Glasgow, Clinton and Hopkinsville facilities, the following had a percentage of non-psychotic patients receiving antipsychotic drugs that was more than double the national average:

Dawson Pointe, Dawson Springs 49%
Dover Manor, Georgetown, 49%
Edgemont Health Care, Cythiana, 46%
Pineville Community Hospital, Pineville, 44%
Edgewood Estates, Frenchburg, 42%
Wesley Manor Nursing Center, Louisville, 42%
Wellington Parc of Owensboro, 42%
Stanton Nursing Center, Stanton, 41%
Shady Lawn Nursing Home, Cadiz, 41%
Charleston Health Care Center, Danville, 37.5%
Breckinridge Memorial Nursing Facility, Hardinsburg, 37%
Cedar Ridge Health Campus, Cynthiana, 37%
Brighton Cornerstone Health Care, Madisonville, 36%
Carmel Home, Owensboro, 36%
Ridgeway Nursing and Rehabilitation Facility, Owingsville, 36%
J.J. Jordan Geriatric Center, Louisa, 35%
Medco Center of Henderson, 35%
Wolfe County Health and Rehabilitation Center, Campton, 34%
(Figures are rounded to the nearest percentage unless .5)

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Large percentage of patients with dementia given drugs they don't need; see how your nursing home is doing

Kentucky reporters can now see how the nursing homes in their area are treating patients with dementia. The Boston Globe has published a list of all the nursing homes in the country that shows the percentage of residents without psychosis or a related condition but who are being given antipsychotic drugs. The data came from the federal Centers for Medicare & Medicaid Services.

Almost 40 percent of nursing home residents with dementia are on powerful antipsychotic drugs though they don't have psychosis or a related condition, federal regulators announced at the end of May. Their aim is to cut the use of these drugs on these patients by 15 percent by the end of this year.

The median use nationwide for patients being given antipsychotic drugs but who don't have psychosis is 16.7 percent. In Kentucky, 161 of 280 nursing homes surveyed were over the median number, according to the nonprofit advocacy group Kentuckians for Nursing Home Reform.

To see how your nursing home is doing, click here. (Read more)

Kentucky reporters can now see how the nursing homes in their area are treating patients with dementia. The Boston Globe has published a list of all the nursing homes in the country that shows the percentage of residents without psychosis or a related condition but who are being given antipsychotic drugs. The data came from the federal Centers for Medicare & Medicaid Services.

Almost 40 percent of nursing home residents with dementia are on powerful antipsychotic drugs though they don't have psychosis or a related condition, federal regulators announced at the end of May. Their aim is to cut the use of these drugs on these patients by 15 percent by the end of this year.

The median use nationwide for patients being given antipsychotic drugs but who don't have psychosis is 16.7 percent. In Kentucky, 161 of 280 nursing homes surveyed were over the median number, according to the nonprofit advocacy group Kentuckians for Nursing Home Reform.

To see how your nursing home is doing, click here. (Read more)

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Health-care system not ready to deal with baby boomers as they get old, expert says at seminar on aging

When it comes to dealing with aging baby boomers, the nation's health-care system isn't ready to deal with them, Dr. Gregg Warshaw, left, said at the University of Kentucky's Summer Series on Aging in Lexington yesterday. "We've made progress," he said, but "We have a lot more to do, and we are running out of time." (Photo by Jonathan Palmer)

Warshaw's figures show "patients with five or more chronic conditions account for about 68 percent of spending on Medicare," Mike Wynn reports for The Courier-Journal. "Around 141 million people suffered with chronic conditions in 2010, and that number is expected to jump by 30 million in the next two decades."

The shift from primary-care doctors to specialists is another big, expensive problem that is hurting the quality of health care for seniors, Warshaw argued. Ageism and frustrations over health networks are also challenges. "Like a lot of things in American medicine right now, we know the answers to those questions," he said. "We just don't know how to get from here to there."

Warshaw, who is the director of the Geriatric Medicine Program at the University of Cincinnati College of Medicine, was one of more than 350 professionals who attended the seminar, hosted by the UK College of Public Health. (Read more)

When it comes to dealing with aging baby boomers, the nation's health-care system isn't ready to deal with them, Dr. Gregg Warshaw, left, said at the University of Kentucky's Summer Series on Aging in Lexington yesterday. "We've made progress," he said, but "We have a lot more to do, and we are running out of time." (Photo by Jonathan Palmer)

Warshaw's figures show "patients with five or more chronic conditions account for about 68 percent of spending on Medicare," Mike Wynn reports for The Courier-Journal. "Around 141 million people suffered with chronic conditions in 2010, and that number is expected to jump by 30 million in the next two decades."

The shift from primary-care doctors to specialists is another big, expensive problem that is hurting the quality of health care for seniors, Warshaw argued. Ageism and frustrations over health networks are also challenges. "Like a lot of things in American medicine right now, we know the answers to those questions," he said. "We just don't know how to get from here to there."

Warshaw, who is the director of the Geriatric Medicine Program at the University of Cincinnati College of Medicine, was one of more than 350 professionals who attended the seminar, hosted by the UK College of Public Health. (Read more)

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