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Tuesday, October 14, 2008 12:01 AM CDT
Nursing home officials say they're over-regulated
MASON CITY — An employee at an Iowa nursing home was helping a patient get to the bathroom when a buzzer went off in another room, signaling that someone needed help.

If the aide left one patient to tend to the other and the first patient fell, her name could be placed on a registry that would prevent her from ever getting another job in her chosen profession.

That’s the dilemma that nursing home administrators and staffers face every day because of overzealous regulations of the Department of Inspections and Appeals, according to Steve Ackerson, executive director of the Iowa Health Care Association.

“It’s almost like a Salem witch hunt, like the department is trying to show everyone it is doing its job,” he said.

Ackerson was among health care professionals who conducted a forum for state legislators and legislative candidates Monday at the Kentucky Ridge assisted living center.

Over-regulating of care centers, low Medicaid reimbursement and closings of facilities dominated talk at the two-hour session.

Care center administrators from throughout North Iowa attended. Some told horror stories of trying to defend competent employees who the state tried to reprimand for minor infractions.

“We were cited for having too many crumbs in our toaster one morning,” said one administrator.

“We spent thousands of dollars in legal fees defending a great employee who the state wanted to put on the registry,” said another.

State Rep. Linda Upmeyer, R-Garner, who is also a nurse, said, “I wouldn’t put my license on the line the way things are now. If people have crazy little infractions, fix them. That’s what Iowans want.

“You can look for the bad guys and help the good guys at the same time. They are not mutually exclusive,” she said.

Upmeyer said the over-regulating of care facilities is not only going to drive people out of the profession but prevent others from entering it.

“We’ve regulated it to death. Access is going to be a huge, huge issue,” she said.

Ackerson said access is also going to be an issue because of Iowa’s poor Medicaid reimbursement rate, now 48th in the nation.

Iowa’s rate of reimbursement is $120.13 per patient per day. Only Illinois and Texas have lower rates. By comparison, Delaware has the highest rate, $225.23.

Three nursing homes have closed in the last month and others are on the brink, said Ackerson. Ottumwa Manor in Ottumwa, Nelson Nursing Home in Fairfield and Paullina Care Center in Paullina have all closed because their Medicaid census was too high, he said.

“When places like this close, there aren’t a whole lot of other places saying ‘we’ll take ’em,’ because everyone has the same problem,” said Ackerson.

The presentation was an eye-opener to the legislative candidates on hand.

Scott Tornquist, Republican candidate for the Iowa House 13 seat said, “This is the most depressing presentation I’ve ever been to,” and pledged his help if elected.

Sharon Steckman, Democratic candidate for the same seat, said, “We should be hearing about new homes opening. Instead we’re hearing about closings.”

Steckman, a retired teacher, said the regulations reminded her of the No Child Left Behind regulations in education.

“You have to do this and this and this — when you should be helping,” she said.

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Showing The Last 7 comment(s) Comments On This Story

sunshine wrote on Oct 14, 2008 3:41 PM:

" Hiring more help isn't that easy, people are not going into the healthcare field for numerous reasons so if there is nobody out there entering the field then there is nobody to hire. I have worked in long term care for 25 years as a CNA and as a nurse. It is a job that is very rewarding and I wouldn't do anything else. I do agree it is very over-regulated. Like the ADM. said we are inspected and yes they do watch you wash your hands, give meds, eye drops, inhalers, shots, treatments, do blood sugars and go through paperwork. They watch the kitchen cook, clean, serve the food, check the temp of the food and anything else you can think of. The CNA's are watched toileting people, turning people and yes they even watch them having their personal cares done! They do environmental checks as well, check for paint chips, scratches, room and water temps. Staff is also interviewed on policies and procedures. This list could go on and on and when the inspection is taking place the residents are also interviewed and asked how they like it where they live. It is a very intense and thorough inspection. It is frustrating when we here families or residents that complain about things that happened in the stay at the hospital: I never got out of bed, they didn't help walk me or help me eat, my bottom hurts now because I couldn't get to the bathroom, I have sores on my heels because my feet were rubbing on the bed. They will then say they are glad to be "home". If those things happened at the care center we would be cited. Regulations are of course needed but the current regulations need looked at by those that work in the field of healthcare. The care center is supposed to be as close to home for the folks as possible so lets try to keep it that way! Thank you "

2080 wrote on Oct 14, 2008 3:02 PM:

" Mike, I enjoyed reading your article and this problem is not unique to Iowa. I am the administrator of a 60 bed skilled nursing facility in northwest MO. Last week I received word that our Medicaid reimbursment rate was increased from $98.00 per day to $114.00 per day. I personally would love to have the $120.00 per day Iowa facilities are receiving. I'm not sure where you got your numbers and I'm not sure it really matters. The fact is Medicaid reimbursement dosen't cover operating costs regardless of which state you are in. I am also a former State surveyor for the MO Dept. of Health and Senior Services. I personally had issues with the unfairness of the survey process then and even more so now that I am an Administrator on the receiving end of things. It is the easiest job in the world to find fault with everyone else. In 2007 my facility spent over $3,000.00 dollors to make changes to the sprinkler system after a federal inspection. In 2008, the state surveyors gave me a citation or for the changes the federal surveyor forced me to make and now I'm out approximently $5,000 to undo what the feds made me just the year before. When facilities are being forced to spend thousands of dollars on unnecessary expenses such as this, what little money you do get from Medicaid is quickly eaten up. Money facilities would love to spend on resident care staff and equipment is being spend on incidentals that has nothing to do with care. Long Term care is completely over regulated. The only industry in the U.S. that has more regulation than Long Term Care is Neuclear Power. I Worked in the Hospital setting for 22 years and never once did I have a health care inspector monitor the way I washed my hand, pass the pills and pick apart my charting. In Long Term Care we have 2 inspections a year by the state regulator and are subject to inspections by Centers for Medicare/ Medicaid Servies (CMS), OSHA, and Wage and Hour. In a 9 month period of time my little facility with an excellent record had 4 surveys, 2 with the MO Dept. of Health, 1 by CMS and 1 with OSHA. We were so busy taking care of the regulators and their unreasonable demands, the very residents the regulator claim to be protecting did not get the time and attention they deserve. In the past 5 years my facility has been given citations for a 1/4 of an inch of rust on the lid of my ice machine, wheel chair scuffs on 9 of 30 doors,failure to maintain a full 1/2 inch air clearence under the pots and pans air drying in the kitchen and missing backflow valve on the garden hose in the front yard. Surveyors are paid to find fault with facilities. I attended the Federal Training CMS conducts with surveyors and Their opinion is 'There is no such thing as a good nursing Home" Well I'm here to tell you there is. As a surveyor and as an administrator I see dedicated care givers, live, laugh, cry and die with residents they care for. The system lumps the good with the bad. I wonder what the state and federal goverments plan will be when all the nursing homes, good and bad are shut down?

Thanks for listening.

Lisa McGhee
Administrator "

Matt wrote on Oct 14, 2008 12:12 PM:

" Mike, what are you going to pay the staff with? Their reimbursement is among the lowest in the nation (two states are worse). If nursing homes are actually forced to CLOSE, don't you think they'd try hiring as much staff as they could before they did that? They would. (It would be the difference between making money and losing it.)
The facility can't afford to staff the place, because there's no money to do it with. In those homes where a majority of residents pay for their care with Medicaid, it's unfortunately the case that the profit from higher-paying, privately-insured residents has to go toward paying for the care of Medicaid residents -- NOT just all in the pockets of owners, as some people wrongly suspect.
It is not uncommon for a facility to actually lose money by accepting a Medicaid resident. That's one reason no one wants to accept them. The problem would go away if Medicaid reimbursement rose at the same level as healthcare inflation. Sadly, it's not even close. Many states are considering Medicaid cuts next year. "

grannieatthelake wrote on Oct 14, 2008 8:48 AM:

" I am sure the nursing homes are hurt by the amount paid by Medicaid, but I know from the cash-paying family member, he does not get that amount of care in a month. The nursing homes are short staffed. If they weren't, the above scenario would not be an issue of leaving a patient unattended to help another. "

Flipflop wrote on Oct 14, 2008 7:39 AM:

" Mike, as you read in the article, the nursing homes can't make ends meet because of the high number of residents who are on title 19. Iowa has a poor Title 19 reimbursment rate. If the home isn't making money, they can't hire more employees. It's a no-win situation. "

US Citizen wrote on Oct 14, 2008 6:42 AM:

" Back in September when the Democratic controlled congress got back from their "VACATION" Nancy Pelosi wanted the House Judiciary Committee to pass out of committee three (3) immigration bills of which one of them was H.R. 5924, which would add 20,000 additional foreign nurses per year for three years (plus their families).

As for H.R. 5924 this effort to increase the number of employer-sponsored visas to address a supposed nursing shortage ignores the facts on the ground. My understanding is that nursing schools have giant backlogs of students who want to go into the field. One estimate suggests that as many as 10,000 nursing applicants are turned away each year. Why? The fact is, medical schools don’t have enough faculty to teach students how to become nurses.

Bringing in 60,000 nurses will do nothing to resolve the underlying problem in medical schools, and it may prevent Americans from entering the field, particularly if Congress brings in even more foreign nurses three years from now.

Now this is the Democrtic party that is suppose to be for the MIDDLE WORKING CLASS people. One of the other pieces of legislation was H.R. 5882, a bill that would add an additional 550,000 permanent green cards annually.

Barack Hussein Obama keeps talking about how he (and the Democrats) want to keep jobs here in America, but with the Democrats wanting to pass laws like this how does he think he is gong to keep the present jobs.

So I say to the AMERICAN VOTER take off your blinders before voting and see what the democrats are doing to the working class people.

Now just for clarification I don't think too much of the Republican party either. As far as I am concern the American voter needs to clean house and do it now.

There is more than just the two (2) parties (Republicans/Democrats). There is the Constitution Party - Chuck Baldwin for President and other parties that you can vote for. Maybe it is about time to vote for one of these other parties and maybe (just maybe) this might wake up the other two (2) parties when they see the votes. "

Mike wrote on Oct 14, 2008 12:19 AM:

" Yeah. Less regulation is the answer. Last time I heard that was when they were talking about Wall Street and mortgages.

How about adequately staffing the nursing homes so people are cared for properly? "

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