1. In 2007, the average number of registered nurses hours per resident was 0.6 hours - a little more than a half an hour per resident. This represents a 14% decline between 2001 and 2007.
What does this mean? Either most people in nursing homes do not require registered nursing care or, if they require it, they're not getting it. How much money does your state pay nursing homes for registered nursing services?
2. There was a 7% increase of residents with dementia (to 45.6% of the total residents) and a 33% increase of residents with other psychiatric diagnoses (21.4% of total residents).
What ever happened to the PASSAR requirements? Why are so many people in a nursing facility with mental health disabilities? Why aren't the mental health advocates screaming about this?
Given the huge percentage of nursing home residents with a mental health diagnosis, have nursing homes become an extraordinarily expensive version of personal care boarding homes and state mental hospitals? Have the beds on the Titanic merely been rearranged so that states could receive reimbursements under the Medicaid nursing home provisions?
We know that residents are not receiving RN services (see #1 above),but are they receiving psychological and behavior management services?It's really inconceivable that nursing homes are providing such services.Are the nursing homes in your state required to have trained staff to provide such services?
3. The good news is that fewer people were either in bed or physical restraints. The bad news is that the form of restraints has shifted to"chair bound." 56% of all residents were chair bound.
Has your state asked why so many people are "chair bound?" Is there a correlation between those people who have been diagnosed with either dementia or other psychiatric illnesses and being "chair bound"restrained?
4. More than 94,000 residents (nearly 7% of the entire nursing home population) have pressure sores.
How many of these people were "chair bound?" OK, so there are very few RN s, but aren't the nursing assistants supposed to be turning people on a regular basis just to prevent these dangerous sores. Aren't most of them preventable with adequate and appropriate services? If nursing facilities cannot prevent even pressure sores, is there really anything they can do?
5. More than 114,600 "deficiencies" were issued for violations of federal regulations and requirements. There was an average of 7.5 deficiency violations per nursing facility in 2007. UCSF noted that there was a wide range in the average number of deficiencies, suggesting that state enforcement varies widely.
Should we be at all upset with so many deficiency violations? Only if we are in the institutions. If someone else is in them, oh well.
6. The percentage of nursing homes cited for the following specific violations include:
- 37% of the 15,281 nursing facilities were cited for failing to ensure a safe environment;
- 35.3% cited for food sanitation (is it really that hard to keep kitchens clean?);
- 28.9% cited for failing to meet quality standards;
- 27.6% for failure to meet professional standards (which professionals?
Not RN s, because there are so few, not MD s because they are virtually never seen, then who? The administrators?);
- 22.4% for failure to provide comprehensive care plans;
- 19.2% for inadequate incontinence care;
- 19% for administering unnecessary drugs; and
- 18.1% for poor infections control.
There are many other violations, but you get the point. Nursing homes are really dangerous places. No wonder more than 90% of elderly people do not want to go into a nursing facility.
Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. To contact Steve Gold directly, write to stevegoldada@cs.com
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