File this under “If you’re not outraged, you’re not paying attention.”

Remember a law California passed in 2004, designed to provide California nursing homes with additional MediCal money? This law -- The Nursing Home Quality Care Act -- was passed to address nursing homes’ complaint that the homes are understaffed because they simply cannot afford to hire more staff or to pay more wages. Under this law, the state’s 1,100 nursing homes received an additional $880 million in funding during 2004-2008, to hire more staff and pay better wages. Reporter Christina Jewett (pictured at the right) of California Watch has done a study, Nursing Homes Received Millions While Cutting Staff, Wages to see whether the additional funding to nursing homes has resulted in better staffing and salary levels. Jewett reports that 232 of 645 nursing homes receiving the extra funding either cut staffing, reduced wages, or violated state law minimum staffing level laws. These same nursing homes had fatter profit margins than other California nursing homes.

Jewett was also able to show a further correlation – the nursing homes receiving the extra funds that made the steepest staffing cuts also had about 30% more “deficiencies” (violations of State Title 22 licensing regulations) than the average California nursing home.

One other interesting fact in the article, “Nursing homes are allowed to bill the state for legal fees spent fighting abuse and neglect citations and lawsuits. They can bill for legal fees spent fighting audit findings they disagree with.” In other words, your tax dollars are going to help nursing homes hire lawyers to defeat elder abuse lawsuits and to challenge state officials who find the nursing home to be breaking the law.

The California Watch articles are mandatory reading for anyone with a family member in a California nursing home or anyone with a lawsuit against a California nursing home. The California Watch website contains data for each of the 232 nursing homes on the list (organized by county and by facility name). Check to see if your nursing home is on the list -- if it is, it should be a red flag to you that the nursing home is compromising staffing or wages for the sake of corporate profits. If you are prosecuting a lawsuit against a nursing home who has fattened its profit margin while cutting its staff, the data will help you build your case that the nursing home was reckless, willful or malicious under the California Elder Abuse and Dependent Adult Civil Protection Act.

Felicia Curran
www.ElderAdvocacyLaw.com

The advocacy group California Advocates for Nursing Home Reform (CANHR) has announced that California governor Arnold Schwarznegger has signed the following CANHR-sponsored bills into law:


"SB 781 (Leno): The RCFE Eviction Protection Act This law will add requirements to eviction notices that will require the facility to inform residents of their rights when faced with an eviction and will require the facility to provide a list of resources available to identify alternative housing and care options.

AB 392 (Feuer/Jones): Restoring Long Term Care Ombudsman Funding_

AB 392 appropriates $1.6 million from the federal citation penalty account to the local ombudsman programs on a one-time basis. It helps replace part of the $3.8 million in funds for these programs cut by Governor Schwarzenegger in 2008. Co-sponsored by numerous other groups. AB 392 was signed by the Governor on August 6, 2009 and took effect immediately.

AB 407 (Beall): CCRC Closure Protections This law will impose requirements on a Continuing Care Retirement Community (CCRC) provider faced with a permanent closure to ensure residents have adequate time to find new housing and to ensure that residents receive adequate compensation should they be required to move. Co-sponsor: California Continuing Care Residents Association (CALCRA).

AB 329 (Feuer): The Reverse Mortgage Elder Protection Act of 2009 This law will prohibit any person who participates in the origination of the mortgage from referring the borrower to anyone for the purchase of other financial products. The bill would require the lender to provide the prospective borrower with a list of not fewer than 10 nonprofit counseling and would require the borrower receive a suitability checklist specifying issues the borrower should discuss with a counselor before the loan application is approved.

AB 1169 (Ruskin): CCRCs. Co-sponsored with CALCRA, this law will increase transparency in financial reporting and establish limits on the transfer of CCRC funds.

AB 76 (Yamada): Life and Annuity Consumer Protection Fund
Will eliminate the sunset provision and extend the $1 fee imposed against insurers for sales of annuities and life insurance policies sold in California. Fees from the Fund are distributed to the Department of Insurance and to the District Attorney offices to provide protections for consumers of life insurance and annuity products.

AB 215 (Feuer/Smyth): Posting Nursing Home Ratings
This law would require nursing homes to post ratings issued by the federal Centers for Medicare and Medicaid Services (CMS) in a visible, public location.

AB 1457 (Davis): Nursing Home Admission Contracts - Ownership Disclosure
This law would require nursing home admission contracts to contain an attachment that discloses the name of the owner and the name and contact information of a single entity that is fully accountable for all aspects of patient care and operation at the facility and would also require written notice to residents and their representatives containing the name and contact information for a new owner when a change of ownership takes place."

Another great job by CANHR getting laws passed that protect the elderly.

CANHR says it will post a more detailed list of bills signed or vetoed on its website www.canhr.org by the end of the week.

Felicia Curran
www.ElderAdvocacyLaw.com

The New York Times ran an article on Monday describing an innovative type of training for medical students thinking of specializing in geriatric medicine – spend a week or two in a nursing home. The article profiles how a medical student, Kristin Murphy, pictured here, spent two weeks at a nursing home in New York. She was given the mock diagnosis of “mild stroke that affected her right side, difficulty swallowing and chronic lung disease,“ and had to act the part. She said that the experience gave her an even greater desire to practice geriatrics.

The idea is to sensitize the medical students to the experiences of their elderly patients who are sick enough to be in a nursing home, and to make prospective geriatric doctors familiar with the types of places that their sickest patients may find themselves living. The attention that the training program is drawing to need for geriatric doctors is great, but most medical students who will agree to live in a nursing home in the first place are probably already highly sensitive, and the medical students who need sensitization the most probably won’t participate in this program to begin with.

A cardiologist doesn't need to have had a heart attack herself in order to know how to diagnose and treat heart problems. So why should a geriatrician need to know about the quality of life issues that confront residents of nursing homes?

A recent article by Jane Brody on what is special about geriatric doctors sheds some light on this issue. Jane Brody interviewed, R. Sean Morrison M.D., pictured here,
a geriatric specialist at Mount Sinai Medical Center in New York. Jane Brody asked Dr. Morrison how he would approach a new patient who is 85 years of age. Dr. Morrison said he would start with a series of questions: ''Tell me about yourself. What do you like to do? What are the things you would like to do that you cannot do anymore? What is your medical history? What medications do you currently take? What brings you here today?''

If you are elderly, Dr. Morrison explained, “You want a doctor who asks more than just about your medical conditions. . . . The doctor should ask about the effect of medical conditions on quality of life, and then should explore what improvements are possible. ‘The focus of care should be on quality of life. . . .Too often, doctors lose sight of this goal when the focus is on treating specific diseases.'’ Dr. Morrison gives the example of “ if a patient has serious arthritis and hypertension and cannot go to places without a readily accessible bathroom on the first floor because she takes a diuretic for high blood pressure, perhaps the blood pressure medication should be changed. The patient may prefer a different drug that carries a slightly greater risk of stroke if it means a better quality of life.“

So if quality of life is part of what the geriatrician needs to address, they need to educate themselves on the diminishments of quality of life that can come with old age, and nursing homes, unfortunately, will present many instances of diminished quality of life for the medical student to draw on.

The Brody article also has an excellent discussion of what questions you should make sure your parents’ doctor is asking at their doctors' appointment.

To read Jane Brody’s article, click here.

To read about Kristen Murphy's experience in the nursing home, click here.

Kudos again to Kristen Murphy and others for their efforts to walk a mile in another person's shoes.

Felicia Curran
www.ElderAdvocacyLaw.com

If gay men and lesbian women face discrimination when they are young, active, and able to take care of themselves, what happens as they age, lose their independence, and need to enter nursing homes and assisted living facilities? Check out an article in yesterday’s New York Times ( "Aging and Gay, and Facing Prejudice and Uncertainty in the Twilight Years" by Jane Gross) to get a taste of what homophobia is like in the nursing home setting. The picture isn’t pretty.

The article quotes experts as saying that most gay elderly do not declare their identity when they enter the nursing home. Instead, for fear of prejudice and isolation, they retreat back to the invisibility that was necessary for most of their lives. They introduce their partner as “their brother” to nursing home staff and to other residents to avoid being shunned. They avoid having their openly gay friends come to visit, and they hide any memorabilia that may disclose that they are gay.

77-year-old lesbian Jalna Perry (pictured here), says that her guard was up all the time when she was in a nursing home or assisted living facility, for fear that she would be shunned by care givers and other residents.

Living in the nursing home's closet takes its toll. The article describes how gay elderly often fall into depression more quickly, and have a higher incidence of premature death than heterosexual elders.

On the other hand, stepping out of the closet may also cut short the gay elder’s life. When one openly gay man entered a nursing home on the East Coast, he was moved off the regular patient floor, in response to the homophobia of other residents and families, and housed with patients with severe disabilities or dementia. He hung himself in despair before the nursing home could be persuaded to treat him decently.

When Gloria Donadello (pictured here), entered a nursing home, her new roommate greeted her with the words, “Get that man out of my room.” That was enough for Gloria. She moved into an adult-assisted living center that specializes in gay and lesbian residents.

What if your community doesn’t have a care facility that promotes itself as friendly to gay seniors? Bruce Steiner, 76, pictured at the top, with his partner Jim Anthony, 71, said that his approach is to essentially to come as he is – “visit several nursing homes” and give “them the opportunity to encourage or discourage [you].”

At least part of the problem is that nursing homes and assisted living facilities don’t usually make an effort to ask about sexual orientation, or to prepare staff members and residents for the possibility that some residents may be gay. In California, we have made a start to address the issue of sensitivity to gay elders with the “Older Californians Equality and Protection Act,” passed in 2006. The law requires state aging agencies to provide sensitivity training and support for senior services for gay elders. For example, nursing home admissions staff may receive training in how to interview prospective residents in a way that respects each person's sexual orientation. Or nursing home residents may receive support to help familiarize themselves with issues relating to sexual orientation differences.

What can you do to help gay elders? For starters, don’t make assumptions that each elder you meet has the same sexual orientation as you do, and respect their differences. Correct your family and friends if they make homophobic remarks. Put yourself in the gay elder's shoes. And support laws in your community to prohibit discrimination in nursing homes and assisted living facilities based on sexual orientation sexual identity. In California, we have the Civil Rights Housing Act of 2006, which prohibits discrimination in housing based on sexual orientation and sexual identity, and we also prohibit state contractors from such discrimination, which covers nursing homes receiving state Medical funds.

The Times' website has a terrific multimedia file containing DVD interviews with the elders interviewed in the article. Listen and hear them describe their experiences in their own words. The website will also refer you to resources relating to gay elderly - click here. It's a great resource.

Felicia Curran
www.ElderAdvocacyLaw.com

When Arnold Schwarzenegger played Los Angeles narcotics detective John Kimble in Kindergarten Cop, he was said to be “the toughest undercover cop in LA. If you're bad, he'll know it. If you're hiding something, he'll find out. If you cheat, he can tell.”

Some of Arnold’s funniest lines in the movie were when Arnold, as Detective Kimble, took charge and demanded action. Remember such lines as:

“You lack discipline!”

“Well I've got news for you! You are mine now! You belong to me!”

“Who is your daddy, and what does he do?“

"You tell him you didn't do your homework"

“I'm going to ask you a bunch of questions, and I want them answered immediately.”

“Stop whining!”

Arnold is now governor of our state. Unlike Detective John Kimble, Governor Schwarzenegger seems ready to accept excuses for inept and incompetent performance by government agencies that operate under his command. There is a bill sitting on Arnold’s desk, Assembly Bill 399 (Feuer), passed by the California legislature, that only requires the governor’s signature to become law. The bill would require the California Department of Health Services to complete investigations of complaints against nursing homes within 40 business days. The governor’s spokesperson says that he “hasn’t yet taken a position on whether he will sign the bill.”

What is he waiting for? All I can say is it’s time for the Governor to sign that bill and to tell the Department of Health Services to “stop whining.”

The Los Angeles Times did an article describing the types of delays that have prompted the bill.

In July 2006, 81-year-old Octavio “Nito” Jimenez (pictured here) was rushed from an Oxnard nursing home, Maywood Acres, by ambulance to an acute care hospital, where doctors found advanced, infected wounds on his heel and buttocks. The nursing home had told Octavio’s family only that he had “a little sore” on his foot.

His granddaughter Josie Valdez (pictured here) asked the county Ombudsman to investigate. The Ombudsman referred the matter to the state Department of Health Services, stating, “the family is very concerned that they will lose their father from neglect.”

Unfortunately, they were right. A few days later, Octavio passed away from an apparent heart attack. In the 15 months since the complaint was filed, the Department of Health Services still hasn’t investigated the complaint. “To this day, nobody has been able to tell me what the findings were.” Josie Valdez is quoted as saying. “It hurts families and it hurts the person unable to care for themselves.”

The Department of Health Services has proved time and time again that they will not complete investigations on their own accord. They need the fixed deadines provided by 399 to force them to complete investigations on time.

Consider these other delays documented by The Los Angeles Times:

“* One year to investigate and impose a $100,000 fine against Westgate Gardens Care Center after an unattended 77-year-old resident choked on a grape and later died. Instructions in the resident's records indicated she was not to be served whole fruits or left alone when she ate.

* Eleven months to investigate and fine Beverly Healthcare Center in Stockton $80,000 after its air conditioner failed during a heat wave in July 2006. One resident died from hyperthermia caused by the high temperatures, and another resident was taken to the hospital with the same condition, the state said. The home has since changed its name to Golden Living Center-Stockton.

* Fourteen months to cite Manorcare Health Services in Hemet after an 83-year-old dementia patient fell out of his wheelchair, suffered a brain hemorrhage and died. He was supposed to be placed in chair with a lap cushion to prevent falls. The home was fined $75,000.

As Assemblyman Feuer says, the bill is needed to quickly flag problems at nursing homes and ensure they are corrected.”

"A timely investigation with timely results can make the difference literally between life and death sometimes," Feuer said. "Forty days is plenty of time to conduct a meaningful, finely grained, detailed investigation."

Arnold, residents of nursing homes need your help. Tell Department of Health Services, “Don’t procrastinate,” “I own you. You are mine now.” Give them some deadlines.

Let the Governator know what you think - send him an email – click here.

Felicia Curran
www.ElderAdvocacyLaw.com