AGING IN PENNSYLVANIA

When the Centers for Medicare and Medicaid Services (CMS) unveiled its five-star quality rating system for nursing homes in December 2008, it had the best of intentions: to give consumers an easy-to-understand five-star rating system, not unlike the one used by the National Highway Traffic Safety Administration (NHTSA) to evaluate crash test results for the vehicles Americans drive.

But unlike the NHTSA’s rating system, in which all vehicles have the ability to score five stars if they earn five stars, the CMS rating system requires that 20 percent of all nursing homes in each state rank as the poorest (one star) and only 10 percent rank as the best (five stars). Such a forced curve hardly lends itself to accuracy.

So it is encouraging to see U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius acknowledge “inherent flaws” in the rating system and pledge to work to ensure consumers receive accurate, objective and useful information when seeking a nursing home for oneself or a family member. Secretary Sebelius expressed her concerns this week while speaking to the National Council on Aging and the American Society on Aging.

To read a story about her comments, click here.

Each year, thousands of patients receive care in one of the more than 17,000-plus skilled nursing and rehabilitation centers in the United States.  Each of these nursing homes is licensed and undergoes intense surveys where regulators ensure that they are meeting both federal and state standards of care. Every nursing home’s first commitment is to provide quality care and quality of life to residents in a safe and secure environment, and that is the purpose of the federal and state standards.

This is not unlike the standards of the NHTSA. All cars strive for five stars results. Some achieve that status, but all meet basic safety standards or they would not be on the road. Similarly, all nursing homes strive to be five-star facilities. Some achieve that. Some, while still providing quality care that meets all standards, do not achieve five star status.

Critically lost in the current CMS system is the fact that all licensed nursing homes meet the federal and state standards or they would not be allowed to operate.
It is essential that consumers have access to accurate and easy-to-understand information about the quality of care provided in any nursing home in America. We support CMS’s efforts to achieve that. But the current national nursing home rating system, while well-intended, needs more work before it can truly benefit consumers and give them accurate information. That much is clear to HHS now, too.

Secretary Sebelius’ acknowledgement of its flaws and her pledge to make it better is a step in the right direction. Let’s thank Secretary Sebelius for her willingness to fix what needs fixing.

The Pennsylvania Health Care Association and Center for Assisted Living Management recently had the  honor to recognize an extraordinary professional in long-term care with the prestigious Clarence Baumgard Award. A symbol of outstanding leadership within the profession and a testament to the commitment to enhancing the quality of care and quality of life for the residents in our facilities, this award is reserved for the best of the best in long-term care.

That’s a fitting description of this year’s winner: Sue Morey, Vice President and General Manager of the Eastern Division for HCR ManorCare. A member of the PHCA/CALM board of directors, Sue brings energy, motivation and passion to everything she does. For ManorCare’s residents and those throughout the state’s long-term care network, she helped to spearhead PHCA’s quality program, helping us set and achieve new goals in how we work with residents and families the areas of pain management and other needs.

Sue began her long-term care career as a physical therapist and has moved through the ranks at ManorCare, serving as a physical therapy director, rehab director, and eventually as the divisional director of physical, occupational and speech therapy, overseeing 60 nursing homes in seven states. In 1999, she was named regional director of operations and in 2005, she was promoted to her current position.

Sue remains actively involved in and spends much of her time advocating for the quality improvement of and increased funding for senior care, and testified on behalf of the PHCA regarding the passage of legislation that expanded the role of physical therapy assistants in long-term

Most recently, working with her staff, her residents and their families, Sue coordinated hundreds of letters to legislators and media to ensure those in need had their voices heard. And they were, and the final state budget showed.

A leader in service and long-term care advocacy, Sue Morey is a shining star for those who need long-term care and a fitting role model who work to help those in need.

Click here to see Sue receive her award. 

Long-term care advocates have something to cheer about — and push for — as congressional leaders prepare to sit down and hammer out a final health-care reform plan. Both the House and Senate included in their bills the Community Living Assistance Services and Supports (CLASS) Act, the first real step toward meaningful long-term care reform at the federal level in recent years. Addressing the nation’s long-term care needs is absolutely critical to the overall health-care debate.

America is aging rapidly, with 10 million elderly and disabled residents already in need some sort of long-term care or daily living assistance. That number will grow as baby boomers continue their march toward retirement and related elder-care services. With the CLASS Act, individuals would be able to take some control of planning for their long-term care needs. At the same time, the program would relieve pressure on an already overburdened Medicaid program, which ends up funding long-term care needs after individuals spend down all of their personal assets. That’s a flawed system.

The CLASS Act offers real reform. Here’s how it works: The federal government would establish a voluntary insurance program. Individuals must be employed to pay into the program. Employers could choose to have workers automatically enrolled unless they opt out, and premiums would be deducted from their paychecks. Even individuals with pre-existing conditions would be eligible. After paying in for five years, participants could acquire a cash benefit of at least $50 a day to pay for the non-medical services if they become disabled or frail. It may not sound like much, but it could be a vital resource to ensure our elderly age with dignity.

That the CLASS Act ends up as part of the final health-care reform package is no guarantee. The House passed its health-care reform plan in November. The Senate followed with its own version just before Christmas, although a number of senators tried unsuccessfully to remove the CLASS Act from the final legislation. 

The two bills still must be reconciled into one document and voted on again. Not only is inclusion of the CLASS Act in the final health-care reform package a must; it is also an important memorial to the late U.S. Sen. Edward Kennedy, who introduced the CLASS Act in the Senate and has long pushed for the plan. It is time to make the effort a reality.

Click here to read a recent Post-Gazette article about the CLASS Act.

Fulfilling the role of a nursing home administrator is no easy task. With the job come long hours and many unseen acts of selfless service. Oftentimes, added compensation for all the extra hours is just the simple satisfaction of knowing residents are receiving the attention and care they deserve.

Park Pleasant Nursing Home administrator Nancy Kleinberg is the perfect example of a dedicated professional — someone who serves as an advocate not only for those in her facility, but also for the state’s entire long-term care community. A few days before Christmas, Nancy welcomed U.S. Rep. Joe Sestak into her facility for a tour. Before he left, Rep. Sestak agreed to send a letter to U.S. House Speaker Nancy Pelosi, asking her to work with the Senate to extend the enhanced Medicaid funding that was part of the federal stimulus package earlier this year. Without action, the stimulus funds will expire at the end of 2010 and skilled nursing facilities will be hard pressed to make ends meet.

That Congressman Sestak agreed to sign the letter is a testament to Nancy’s will. And it is a fitting example of why the Pennsylvania Health Care Association and Center for Assisted Living Management honored her with the 2009 Distinguished Service Award. Nancy demonstrates a true calling to serve seniors — largely because the business of caring is in her blood. Nancy is the daughter of Edward Brody, founder Park Pleasant Nursing Home, where she has worked since 1981. She became administrator in 1991.

Nancy has a tremendous impact on her staff and plays a significant role in the lives of residents and their families at the facility. She strives daily to provide each resident with the personal care they would receive from their own family members. Congratulations deservedly go to Nancy Kleinberg, our 2009 Distinguished Service Award winner. She is a shining example of the constant commitment needed to improve both quality of life and quality of care for those who need help the most.

To view a video of Nancy receiving her award, click here. 

Today the Pennsylvania Health Care Association and the Center for Assisted Living Management recognized nine deserving legislative staffers with the Better Life Award for their contributions to the frail and elderly in long-term care facilities.

Those who work for legislators have very, very difficult jobs.  But despite all the conflicting pressures, they do what’s right and they do it because they care about Pennsylvania’s elderly. 

This Better Life Award gives us the opportunity to credit those outside of the long-term care profession with the recognition they deserve.

These awards are and always will be nonpartisan.  They are simply to thank those who go above and beyond the call of duty to benefit the Greatest Generation, who comprise much of the population in today’s long-term care facilities.

This year’s award winners are ( in alphabetical order):

Amy Bolze, Executive Director, Senate Public Health and Welfare Committee

Fran Cleaver, Executive Director, Senate Consumer Protection and Professional Licensure Committee

Wayne Crawford, Executive Director, House Professional Licensure Committee (Minority)

Mary Hisrich, Budget Analyst, Senate Appropriations Committee

Greg Jordan, Executive Director, Senate Appropriations Committee

Art McNulty, Executive Director, House Insurance Committee

Chuck Quinnan, Executive Director, House Aging Committee (Majority)

Sharon Schwartz, Executive Director, Housing Aging Committee (Minority)

Marlene Tremmel, Executive Director, House Professional Licensure Committee (Majority)

My thanks to all of the winners for their tireless efforts on behalf of Pennsylvania’s elderly.  They are true champions!

Americans are healthier and living longer than ever before. That’s the good news. The bad news is that too few people are planning ahead to ensure their long-term care needs are covered as they age.

Clearly, how we provide and pay for the long-term care needs of our aging population is a serious fiscal and social challenge.

Fortunately, many of our leaders, including state Sen. Michael Stack, are taking notice. Sen. Stack recently penned a column in the York Daily Record urging residents to evaluate their needs and options, and touting a new state law that gives Pennsylvanians an opportunity to purchase long-term care insurance.

Planning for your future needs starts now. Learn more at www.phca.com.

This year, the Pennsylvania Health Care Association and the Center for Assisted Living Management recognized 10 caregivers with our prestigious “Excellence in Caregiving” award for the way they put their heart and soul into caring for the residents in their facilities.

For these caregivers, it’s not just about providing quality health care – although that is their number one mission.  It’s also about ensuring that those in long-term care facilities also experience quality of life.

On their own time and dime, these individuals go beyond the traditional role caregiving to do things that bring joy and meaning to residents’ lives.  Things like bringing residents meals from their favorite restaurants,  shopping  for holiday gifts for residents’ families, and overseeing  activities (like making apple butter and canning vegetables) that bring back fond memories for residents.  They also serve as mentors and heroes to their colleagues.

Without further ado, meet this year’s award winners.  (In alphabetical order)

Ernestine Cramer, a certified nurse assistant at ManorCare-Yeadon.  Ernestine has worked at her facility for 40 years, and she says that her one desire in life was always to care for the elderly and she’s been able to fulfill that desire at HCR Manorcare-Yeadon. 

Andrea Doerr, restorative coordinator at Country Meadows of Hershey.  Andrea really takes time to get to know her residents, and then finds ways to get them involved in activities that they will enjoy.

Isetta Hewlett, assistant activity director at ManorCare-Pottstown.  Isetta is known for always thinking of others, especially her residents.

Kathleen Kuskavage, LPN Supervisor at ManorCare-Lansdale.  Kathy is a favorite of both residents and their families because she always goes the extra mile for them – and does it with a smile.

Tina Litsch, restorative program manager at Country Meadows in Bethlehem.  Tina really keeps her residents moving and active so they stay healthy in her facility.

Frances Makowski, personal care attendant at The Willowbrook Assisted Living Facility in Clarks Summit. Frances is the one often called upon to help with the most difficult residents because her smile and kindness can overcome anything.

Robin Monroe, certified nurse assistant at Carleton Senior Care and Rehabilitation Center, a Guardian facility in Wellsboro. Robin commutes 45 minutes each way, each day, to a job she dearly loves, and to residents who dearly love her.

Denise Smith, LPN Assessment Coordinator at the Denver Nursing Home in Stevens. Denise does it all for her residents – she shops for them, she fixes their glasses, she provides spiritual guidance when called upon to do so.  When there’s a need, she fills it.

Frances Steinberger, a LPN at Laurel Ridge Center in Uniontown. Frances has worked at Laurel Ridge for 23 years and is the nurse that the younger ones look up to for a shining example of professionalism and excellence.  

Lori Strickler, dietary manager at Hanover Hall in Hanover.  Everything that comes from Lori’s kitchen is served with love.

 Click here to read more about these award winners. 

Congratulations to all!

Congratulations to PHCA/CALM’s 2009 award winners!

Over the next few weeks, we’ll be profiling each of our award winners in this blog.

Today, we’re celebrating Mollie Zydzik, Eve Calvano and Roy Goldwire, who work at Statesman Health and Rehabilitation Center, an Extendicare facility in Levittown in Bucks County.  Mollie, Eve and Roy won our first-ever Excellence in Service award.

No words can tell their story – and what they were willing to do to make a resident’s dream come true – as well as the video below, so please take a few minutes and watch it.  It will make your day.  Oh - and make sure you have a tissue nearby. 

• Trip of a Lifetime

State legislators have sent Senate Bill 850 to the Governor for his signature.  By all accounts, this ‘bridge’ budget does little more than assure badly-needed paychecks for hungry state workers. 

Our question is, what does this fake budget mean for health care and social service providers that rely on state funding to provide care to their patients and pay their staff? 

Nursing homes are perhaps the most vulnerable provider right now, as two out of three (65 percent) nursing home residents are on Medicaid.  You don’t have to be a mathematician to recognize that late reimbursement payments could leave nursing homes – and their staff – in dire straits. It’s difficult enough for nursing homes to provide the kind of quality care and quality of life their elderly and frail residents want and deserve when nursing homes are already under-reimbursed an average of $14 a day, or $5,000 a year, for each Medicaid resident.  

Here’s hoping that our elected officials realize that not having a state budget impacts far more than state workers.  It is vital that health care providers continue to receive their Medicaid reimbursements even during this budget impasse.

Interested in some summer beach reading? Then skip the federal health-care plan introduced earlier this week in the U.S. House of Representatives. At 1,018 pages, it’s a read more in line for a transatlantic voyage. While it may not be a blockbuster, it is a noble effort — designed to give Americans the basic health-care coverage they need to get healthy and stay healthy.  To this, I say, “Bravo.”

Click here to read our commentary in the Philadelphia Inquirer. 

As someone who has been dabbling in national health-care reform for the past 30 years, I am excited to see this progress and believe we’re closer than we’ve ever been to ensuring that all Americans have access to affordable health care. Of course, the challenge has never been the will to reform health care; no, the challenge has always been how to pay for it. The House proposal relies on a mix of higher taxes and budget cuts to provide health insurance to the nearly 50 million Americans who do not have it.

While it will take time to sort through the pages of ideas put forth in the House bill, one thing we do know is that the legislation includes almost $50 billion in Medicare cuts over the next 10 years.  This is potentially devastating news for nursing homes.  For years, Medicare payments have balanced out Medicaid shortfalls, allowing nursing homes that serve a high percentage of poor people to stay afloat.  Here in PA, where nursing homes have been shortchanged nearly $650 million over the past 3 ½ years for the care of Medicaid residents, Medicare no doubt has allowed many nursing homes to continue to accept Medicaid residents, and to provide them with quality care and programs, despite the fact that their care costs more than the reimbursement for that care.  Medicare cuts, coupled with continued Medicaid shortfalls, will destroy their ability to do that, making it difficult for our most frail and elderly Americans to obtain quality long-term care.

I’m also sure that once we start sifting through the proposal, based on what we’ve seen and heard even before the bill’s introduction, we’ll find that any meaningful long-term care reform is not included. All too often long-term care is left out of the health-care reform mix, and that’s a terrible mistake, especially now, with a rapidly aging population in Pennsylvania and across the country that soon will be seeking late-in-life medical services.

The national wave of baby boomers hasn’t even begun to hit long-term care providers. Yet, state governments, including Pennsylvania, already are having a hard time paying their Medicaid bills, leaving many long-term care facilities and nursing homes holding the bag. Imagine just a few years from now just how serious this balancing act of ensuring quality care for more people with fewer resources will be.

To care for the needs of today’s seniors and the baby boomers who will soon be of age to benefit from quality long-term care, we need to begin planning now. Whether that 1,018-page House bill is a start is still anyone’s guess. For all that’s being said in the health-care debate, it’s what’s not being talked about that is of most concern:  how we manage and pay for our country’s long-term care needs.