And here is another interesting finding – the most poorly performing homes are distributed UNEVENLY across the states, with eight states having no such homes and ten others have from 21 to 52 such homes. Where do you find the 52 worst nursing homes? According to the GAO, that’s in Indiana. Florida has 16 that make the list, a relatively low number considering there are 664 nursing homes in my Florida Senior Living Advisor database. But we don’t do as well as another popular retirement location – Arizona has just 4 homes on the list.

According to GAO’s estimate, of the 16,000 nursing homes in the US, four percent – or 580 – could be considered the most poorly performing. If you want to understand more about the GAO’s research and conclusions, you can read the summary and recommendations, or even review the entire report. But be patient – it is 57 pages long! (The map showing numbers of poorly performing homes in each state is on page 15.)

The sad reality is that falls are one of the most common causes of accidental death in the elderly. A series this week in the Minneapolis Star-Tribune aims to raise awareness of the prevalence of falls in Minnesota nursing homes; I have to believe this is a similar problem nationwide, and not just in nursing homes but in assisted living facilities, independent living communities and private homes. In her commentary on the series, Star-Tribune editor and senior vice-president Nancy Barnes writes, “I urge our readers not to look away, despite the distressing nature of these stories. Nothing is more certain in life than death; we can only hope that we will be allowed the gift of dignity. In many of these stories, that is simply not the case.”

The investigative article is long and, at times, difficult to read. But it is important. Worth sharing. As one doctor quoted in the  article states, “”I think if you asked a person on the street, not one of them would know that if you take the frequency of falling and the consequences of falling, it’s as big a problem as heart attacks and strokes.” My father was one of the lucky ones. For many elderly people, a single fall can trigger a rapid decline in health. I hope you will take a few minutes to read this article. And I hope you’ll share your thoughts by leaving a comment.

Thus far, my father has not had any issues, and (knock on wood) I don’t foresee any in his future. But when I came across this article from The Washington Post about contracts at continuing care retirement communities, I figured it was worth sharing. It makes reference to a specific CCRC in Northern Virginia, but the concepts are universal.

Scrutinize any contract to avoid nasty surprises at continuing care community

By David S. Hilzenrath

If you are considering moving to a continuing care retirement community, you would do well to consult a lawyer and read the fine print of any contract to determine whether the potential benefits outweigh the risks. A “Residence and Care Agreement” for Ashby Ponds, an Erickson community in Ashburn, illustrates some of the trade-offs the decision could entail.

You might be drawn to Ashby Ponds by the potential to avoid another disruptive move when you are least able to cope with it, but there is no guarantee you would be able to move to an assisted-living or nursing facility on the same campus — even when those facilities are completed. If the assisted-living and nursing home beds at Ashby Ponds are full, management could arrange for you to go elsewhere.

Some delay in building those facilities is routine at Erickson developments, said Ronald E. Walker, chairman of a nonprofit group associated with Erickson campuses. Though Ashby Ponds opened in September 2008, the assisted-living and skilled-nursing portions were not expected to open until the end of 2011 or the beginning of 2012, according to a May report from the community’s management.)

The deposit you post to move in does not limit the amount you could be required to pay on a monthly basis; management can raise the monthly fees. In addition, the fees can go up as you move from one level of care to the next. At Erickson communities, the average monthly fees range from $1,750 for singles in independent living to $5,178 in assisted living and $307 per day — as much as $9,517 per month — in the nursing homes, Erickson spokesman Mel Tansill said.

Management can decide to transfer you to a higher level of care. If you refuse to go, management can kick you out and hold on to your deposit until 60 days after it finds a new tenant. To gain admission to the community, you have to pass financial and medical reviews. If you marry a nonresident, your new spouse would have to pass such a review before being allowed to move in.

To reassure management that you have the ability to pay expenses, you must agree not to give away any assets that would bring your net worth below a minimum requirement. Evan H. Farr, a Fairfax lawyer who specializes in issues facing the elderly, recommends putting any extra assets in an asset protection trust before you move in.

Unlike a real estate investment, the deposit you post to enter the community does not grow as property values rise. But it can shrink as property values fall. If it takes management a long time to replace you, you may be offered the option of accepting a smaller payout so that management can in effect cut the price of admission for the next tenant to occupy your apartment.

And now FTRI has added a cordless amplified phone to its mix of available equipment. The Clarity W425 Pro amplifies incoming sounds up to 45 db.

Clarity W425 Pro cordless amplified phone

Permanent Florida residents who are certified as having a hearing loss can easily obtain the W425 Pro by completing an application and visiting one of FTRI’s 22 conveniently located distribution centers throughout the state.  For more information, call FTRI at 1-800-222-3448 or visit www.ftri.org. 

“FTRI aims to provide individuals with hearing loss a telephone solution like the Clarity W425 Pro,” said James Forstall, FTRI’s executive director.  “The majority of the people we serve are senior citizens and the Clarity W425 Pro is a device that may assist them with communicating with others on the telephone.”

 FTRI estimates that nearly three million Floridians experience some degree of hearing loss. Along with amplification technology, the W425 Pro contains large backlit numbers, a bright visual ringer, and is hearing aid compatible. 

 “FTRI is an outstanding program which helps so many people throughout Florida,” said Carsten Trads, president of Clarity.  “Hearing loss is a serious, yet often overlooked issue.  Many people are not aware that solutions like amplified telephones even exist.  Thanks to FTRI, hopefully more people in Florida will take the necessary steps to address their hearing loss and consider using amplified telephones.” 

FTRI also offers equipment for Florida residents who are deaf,  blind or speech impaired. Many other states have similar free programs.  Visit the Telecommunications Equipment Distribution Program  Association to learn more.

Christopher Williams, Senior Solutions

The words “long term care” usually bring to mind images of nursing homes and elderly people living in them who can no longer care for themselves. In truth, long-term care (LTC) comes in many different forms, is provided in many different settings, and can refer to people of all ages.

In 2008, the average annual cost of a stay in a private room in a nursing home was more than $76,000. A stay in an assisted living facility was $35,628. Yet the majority of long-term care services aren’t paid for at all. They are provided by 52 million unpaid caregivers – primarily family members and friends of those needing the care.

According to the Alliance for Health Reform, two-thirds of Americans age 65 will need some type of long term care in their lifetimes. For those who do not have family members to provide it, or those who do not want to be a burden financially (or emotionally) on their relatives, the out-of-pocket cost can be substantial. These costs vary widely from region to region, ranging from $25 per day to $500 per day, with the highest rates in the Northeast, Texas, and Florida. The average cost of a nursing home here in Florida is near $140 per day.  With the average stay in a LTC facility being two and a half years, that adds up to $127,700.

The question that needs to be addressed is whether someone has enough income or assets to handle these costs over time.  Typically, a senior’s income will not cover the costs, but their savings may be enough to handle the expenses. Unfortunately, however, there is no way for anyone to estimate the total of their future LTC expenses.

In making these decisions, one should consider all of the options. Many elderly people who do not have the assets to sustain the high costs of LTC may eventually qualify for Medicaid assistance. In order to qualify, though, they will have to spend down their own assets first before Medicaid steps in. Medicaid accounts for 49% of the total spending towards LTC in America. Another option is to purchase a Long Term Care insurance policy. These policies can be expensive, with costs varying greatly depending on the age and medical history of the insured. But the cost of these polices pale in comparison to the out-of-pocket potential of using one’s own assets. Before making any decision, it is a good idea to sit with a state licensed insurance agent to estimate the cost of a policy. This may be the agent who sold you your life or auto policy, or you may need to find a specialist. Either way, be sure the person fully understands your needs and is active enough to be selling at least a dozen policies a year.

In 1987, the Robert Wood Johnson Foundation initiated the Program to Promote Long-Term Care Insurance for the Elderly. This program is available in eighteen states, including Florida. The program involves a partnership between Medicaid and private LTC insurance.  It allows nursing home patients with state-approved long-term care insurance policies to be eligible for Medicaid with substantially higher levels of assets than are normally allowed. This would permit them to receive nursing care but still have enough to live on and to bequeath to their children.

Whatever decision you make, you may want to make it sooner rather than waiting. The cost of an insurance policy is partly based on age, but you will also want to make arrangements with friends or family members should you choose to “self-insure” or to receive care from a relative. It’s never easy to discuss or think about, but definitely needs to be addressed before it’s too late.

Tower apartments at The Palms at Sebring

The Palms of Sebring is Highlands County’s only retirement community offering three levels of living – independent living, assisted living and a nursing home. This senior living facility has approximately 70 units each in independent and assisted living, and 120 beds in the nursing home.

While many Florida continuing care retirement communities such as this require a large, up-front community fee, The Palms of Sebring only charges new residents a one-time fee of $750. After that, independent living residents choose whether to live in the full-service Tower apartments, where monthly rent starts at $1689 and includes utilities, all meals, housekeeping, and transportation; or the Poinsettia apartments, where monthly rents starts at just $901 and does not include meals or housekeeping. Recreational activities and wellness programs are included for residents in both buildings. Another unique feature of The Palms is that they do allow residents to have pets – cats and dogs in the Poinsettia Apartments and cats only in the Tower Apartments.

In addition, the dining room is open continually from 7am – 6pm. “So if you want a steak dinner at two in the afternoon, you can have it,” explains marketing director Janice Roberts. “Our executive chef is wonderful.”

Roberts also told me The Palms has a home health agency that provides services to residents in their Palms apartments, and also to individuals who do not live on property.

To learn about this Florida senior living facility, visit The Palms at Sebring. To search for other senior living facilities around Florida, visit Florida Senior Living Advisor.

This headline in Sunday’s South Florida Sun-Sentinel caught my attention. Halfway through reading the  article, I was speechless. Thanks to reporter Sally Kestin and the Sun-Sentinel for allowing me to re-publish the article here on the Florida Senior Living Advisor blog.

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By Sally Kestin, Peter Franceschina and John Maines South Florida Sun Sentinel

Florida seniors and disabled adults too frail to live on their own have been beaten, neglected and robbed by caregivers with criminal records.

A cancer patient at a Pompano Beach assisted living facility watched helplessly from bed as a nurse’s aide with a record for theft rifled through her handbag and stole $165.

“What are you doing with my bag?” a police report quoted her as saying. “You have no right. Put it down.”

A video camera caught an aide at a North Miami Beach group home for the disabled shoving a cerebral palsy patient face-first to the floor, busting her lip. The aide had previously pleaded guilty to aggravated assault and never should have been working there.

More than 3,500 people with criminal records — including rape, robbery and murder — have been allowed to work with the elderly, disabled and infirm through exemptions granted by the state the past two decades, a Sun Sentinel investigation found. Hundreds more slipped through because employers failed to check their backgrounds or kept them on the job despite their criminal past.

In Palm Beach County, a woman with pending forgery charges got a job at a nursing home, where she assaulted a patient.

Glades Health Care Center in Pahokee did a background check on Phillina Anderson in 2004, but it did not turn up the charges, said Francine Hennessy, chief operating officer of the Council on Aging of Florida, Inc., which owns the facility. If it had, the nursing home would not have hired her, Hennessy said.

Anderson was still on probation in that case when she was arrested for abusing patient Cora Edwards.

Near the end of her shift on July 13, 2007, Anderson became upset with Edwards, a stroke victim with Alzheimer’s disease, according to an arrest report.

Anderson told Edwards to “shut up” and slapped her “extremely hard” across the face.

“Why did you hit me?” the elderly victim cried out, according to the report. “I never did anything to you.”

Anderson was convicted of abuse on an elderly person and served three months in jail. Hennessy said the nursing home learned after her arrest that she had been accused of abusing a resident at another facility that did not report it.

“We were very surprised,” she said. “Her background check was clear.”

Screening gaps

Florida has a patchwork of controls for checking caregivers of the elderly that seems to put more emphasis on protecting against embezzlement than safeguarding patients.

Inconsistencies in state law are glaring — facility owners, administrators and people who handle money require a nationwide FBI check, but not employees caring for patients. With some exceptions, they are checked only for crimes in Florida.

For nursing homes, a background check must be complete before anyone can work. But for assisted living facilities and home health aides and companions, employees can begin work before screening results come back.

“It ought to be consistent,” said Bob Blancato of the Elder Justice Coalition, an advocacy group based in Washington, D.C., that supports nationwide background checks for all employees.

Holly Benson, head of the Florida agency that regulates health care facilities, said the discrepancies are a result of different laws passed over more than a decade. “A lot of the way that this policy evolved is just kind of hit or miss,” said Benson, secretary of the Agency for Health Care Administration.

Of more than 100,000 people screened through AHCA over the past 3 1/2 years, more than 3,420, or 3 percent, were rejected because of a criminal history for offenses that included murder, exploiting the elderly and elder neglect, a Sun Sentinel analysis shows. The jobs include positions at clinics and treatment centers as well as nursing homes and agencies caring for the elderly.

Under Florida law, certain crimes disqualify someone from working with seniors or the disabled unless they obtain an exemption by showing evidence of rehabilitation.

Until this year, the disqualifying offenses did not include financial crimes that can lead to abuse and exploitation. An expanded list takes effect Thursday — eight years after a committee of prosecutors and state regulators recommended adding crimes such as burglary, fraud and forgery.

The patchwork screening system puts Florida’s most vulnerable adults at risk, the Sun Sentinel found.

Latoera O’Neal was able to care for seniors for two years in the Panhandle because she was screened only for offenses she might have committed in Florida.

In Ohio, O’Neal was an admitted cocaine dealer and served time in prison for a drug offense. Her out-of-state record only came to light when she switched jobs to work with the disabled.

Florida’s Department of Children & Families conducts nationwide criminal background checks of employees who work with the mentally and physically disabled. DCF first found O’Neal was disqualified as a caregiver, but gave her an exemption to work in 2004 after she said she had found God and being a caregiver brought joy to her heart.

While working at a group home in Fort Walton Beach in 2007, O’Neal dragged a mentally disabled man out of a van by his feet, slamming his head on the floorboard and the pavement, an arrest report said. She now faces a charge of abusing a disabled person.

Tierra Henry got a job in 2004 at a North Miami Beach group home operated by United Cerebral Palsy of South Florida.

Henry had served a year of probation for a 2001 charge of aggravated assault with a deadly weapon. Henry, then 19, hit a 15-year-old girl in the head with nunchuks, a martial arts weapon, a Miami-Dade Police report said.

“I told them straight up before they even hired me,” Henry said in an interview. “I told them I had a fight with a girl from high school … They gave me the job, no problem.”

DCF reviews the results of national FBI checks on caregivers of the disabled, while criminal history searches in Florida go directly to employers, who may miss disqualifying charges or fail to remove people as required.

United Cerebral Palsy thought Henry was clear after receiving a letter from DCF showing no record on her FBI check, said Leigh Kapps, an executive director. But Kapps’ agency should have checked her background in Florida and disqualified her based on the aggravated assault offense, a DCF spokeswoman said.

A year later, a video camera at the group home recorded Henry approaching a 22-year-old resident with cerebral palsy, grabbing her arm from behind and pushing her to the floor. Henry pleaded guilty to aggravated abuse of a disabled adult and is serving four years’ probation.

Rules ignored

Patients and their families have no way of checking employees’ criminal histories. Personnel files are confidential, as they are for any private business.

The Agency for Health Care Administration relies on employers to check the backgrounds of employees working with the elderly. State inspectors are supposed to ensure screening requirements are met but inspect nursing homes on average only once a year and assisted living facilities every other year.

Inspection data shows the system fails to weed out employees with disqualifying records and is slow to remove them once hired.

Screening problems are among the four most common violations in assisted living facilities, adult day cares and nursing agencies. Home health agencies and nursing homes are also cited, but less frequently.

At nursing homes, where a completed background check is required before starting, some employees had worked as long as seven years without any check.

A nurse in West Palm Beach was on the job despite several “misdemeanors and felonies” in the personnel file, and another worked more than a year without undergoing screening “due to lack of facility funds to pay for the background check,” a state inspector reported in April 2008. A background check costs about $25.

Supervisors at a Sunrise nursing home knew about a housekeeper’s record for cocaine trafficking and possession but kept him on because they felt he “deserved a break,” a June 2008 inspection found.

“The teeth aren’t long enough or sharp enough,” said Don Hering, head of Florida’s Long-term Care Ombudsman Council, which investigates elder facilities. “People who know how to game the system, they fine them, they give them 30 days to clean up their act, then it’s back to business as usual.”

‘Last thing on your mind’

Joan Loughman never thought about the pasts of the staff at the Lyford Cove assisted living facility in Fort Pierce when she admitted her ailing father in 2002, said her husband, Tom.

Loughman selected the facility after meeting its marketing director, Andrew Gosciminski, at the hospital treating her father. Gosciminski helped her move her father’s belongings and admired her 2-carat diamond ring and other jewelry worth $40,000, records show.

“That for me set off an alarm,” said Tom Loughman, who remained in the couple’s Danbury, Conn., home. “I called her and said that conversation really bothered me. I told her, ‘You have to be careful.’”

On Sept. 24, 2002, the day before she was scheduled to fly home, Loughman, a grandmother and Girl Scout volunteer, was found dead in her father’s Hutchinson Island home, her throat cut and her jewelry missing. That night, Gosciminski gave his girlfriend a diamond ring, according to court testimony.

Gosciminski was convicted of murder and sentenced to death, but the Florida Supreme Court overturned the verdict last fall based on insufficient physical evidence. Jury selection in his retrial began last week.

Gosciminski, who had felony theft and worthless check convictions in Broward County, did not even need a background check to work at Lyford Cove. He fell into a category of employees not required to undergo screening — administrators who do not provide “personal services” to residents.

“They claimed they were given the OK by the state to hire him because he wasn’t actually doing hands-on care of residents,” said Bennie Lazzara Jr., a Tampa attorney who represented Loughman’s family in a lawsuit against the facility.

Lyford Cove settled the lawsuit for undisclosed terms and is under different ownership.

Tom Loughman, an accountant, said family members assume employees caring for their loved ones have been thoroughly checked out.

“When you’re under the gun of trying to find a place for your relative and they’re in the hospital and they’re dying, it’s the last thing on your mind as to whether it’s a safe facility,” he said. “You assume with the state regulating them, that’s a given.”

Sally Kestin can be reached at skestin@SunSentinel.com or 954-356-4510.
Peter Franceschina can be reached at pfranceschina@SunSentinel.com or 954-459-2255. ]]> http://www.flseniorlivingadvisor.com/blog/2009/09/30/felons-working-in-florida-nursing-homes-newspaper-investigation-finds-yes/feed/ 1 http://www.flseniorlivingadvisor.com/blog/2009/09/25/the-veranda-of-pensacola-offers-range-of-care/ http://www.flseniorlivingadvisor.com/blog/2009/09/25/the-veranda-of-pensacola-offers-range-of-care/#comments Fri, 25 Sep 2009 19:20:12 +0000 Florida Senior Living Advisor http://blog.flseniorlivingadvisor.com/?p=226 Today’s “Friday’s Featured Facility” is The Veranda of Pensacola, a Florida continuing care retirement community. This means that The Veranda offers both independent living and assisted living options, which allows elderly residents to “age in place” – ie – transition from independent to assisted living as their needs increase.

According to their website, the apartments at The Veranda retirement community are spacious, modern and well-equipped one and two bedroom units with fully equipped kitchens.  Utilities and expanded cable TV are included. The amenities at The Veranda include common areas inside and out, an indoor heated pool, fitness center, and a own stadium seating movie theatre.

The Veranda provides housekeeping, linen and laundry service, scheduled transportation for independent residents and coordination of transportation for assisted living residents, a personal emergency response system and maintenance inside and out. The Veranda also has 24-hour camera surveillance.

The dining service provides a healthy breakfast, lunch (main meal of the day) and light meal in the evening. When it is time for community outings, shopping and personal appointments, the professional staff at The Veranda retirement community will schedule the necessary transportation.

The Veranda is just one of many Florida continuing care retirement communities. To see a complete list, searchable by region, visit Florida Senior Living Advisor. The database also includes assisted living facilities, nursing homes, adult day care centers, independent living communities, hospice and skilled nursing units.

The latest inspection report of Regents Park, conducted by the Florida Agency on Health Care Administration in August, gives the facility just one star out of five in most categories. According to the AHCA website, “The fewer stars a facility receives, the more the facility was found to be in noncompliance with the regulations governing nursing homes.” The Federal Centers for Medicare and Medicaid Services also publishes a Nursing Home Compare web site that provides additional information to compare nursing homes in Florida and the nation.

In this particular incident, a witness told police she heard something from one of the rooms, and when she went in she saw Njorge engaged in a sexual activity with a woman in the room. The woman is disabled.The witness told police she reached for her cell phone, but Njorge tried to stop her.She was able to make a call and someone else came into the room. That witness told police she saw Njorge cleaning up and then throw something in the disposal room.

DCF Spokesperson John Harrell says his agency has investigated eight allegations of abuse at Regents Park in the past year, though none have been verified.

“Of those eight reports, four showed no findings, but four had some findings, including inadequate supervision [of patients]. That happened a couple of times,” Harrell said.

Njorge also worked at Life Care Center, another Southside nursing home. DCF is now looking into whether the attack is an isolated incident.Police are withholding any further information due to the nature of the crime and the investigation. Njorge remains in jail on a $500,000 bond.

Florida Senior Living Advisor offers a complete searchable database of all senior living facilities in Florida, including nursing homes, assisted living facilities, adult day care centers, skilled nursing units, independent living, continuing care retirement communities and hospice. As part of your research on particular facilities, you can check their rating in the AHCA guide; of course, you should always visit and inspect a facility in person before making such an important decision.