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‘Critical Conditions’ radio program looks at state of Ohio’s nursing homes

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Hello and welcome to “Critical Conditions.” I’m Chris Davidson

And I’m Christopher Kochera. For the next half hour, we’ll be talking about growing old in Northeast Ohio. Well take a look at nursing homes – and the spiraling costs of aging.

Growing old is one thing most of want to do. As the saying goes, what’s the alternative? But growing old brings countless problems for many of us. What can we do when we can’t take care of ourselves, when our independence begins to wane, when our health begins to fail. We’ll be addressing some of those issues today. (Davidson)

For some, the decision to place a loved one in a nursing home can be agonizing. (Kochera)

That’s right Chris. I talked with one woman who helped take care of her grandmother and mother at home but could not do the same for her father.

It was the most difficult decision that I probably had to make in regard to my parents.

For Dottie Cerimele, putting her dad in a nursing home was contrary to everything she believed.

I never thought I would put a parent in a nursing home because it was always against my values.

Her dad, Bill Nespeca, an Italian immigrant, a World War II vet and retired contractor remained active well into his 80s. He played bocce several times a week.

My father was very physically active, he was healthy and his illness came about so quickly.

Nespeca suffered a fall while gardening, which triggered a series of health problems.

My father was in rehab and after the allotted number of days I expected that he would return home.

But then …

He had a rare disease, pulmonary hypertension, and needed immediately to be on oxygen 24 hours a day and lost his ability to walk.

Cerimele felt she had no choice.

Because his needs became greater and he was on oxygen and couldn’t walk, and I couldn’t lift him, that there was no way that he could return home, even with caregivers.

As her father’s health declined, nursing costs sky rocketed. They paid for everything out of pocket.

He was on a medication that wasn’t covered and it – for this rare disease – was over $2,000 a month. Assisted living was over $3,500 a month and nursing care was over $6,000 a month.

At first, Cerimele chose a facility based on location.

I had to consider nursing homes, in the beginning, that were close to my work and not far from my home. But later, as he became worse, and I moved him, that could not be a consideration anymore.

Nespeca ended up spending the last three years of his life at three facilities.

He was in three different homes. He started with rehabilitation, then assisted living and then nursing care.

Cerimele’s dad died four years ago and her decision still haunts her.

It’s very difficult. It was so emotional and there were decisions I never thought I would have to make.

Cerimele says she still reproaches herself for the decisions she made.

You know, for so many people, those decisions are heart-breaking. (Kochera)

In our next story, a Southside couple decides on a different path. (Davidson)

When Chuck Horkey’s mother Helen fell down a staircase in 2009, the Horkeys had a decision to make – put Helen in a nursing home or take care of her themselves. Linda quit her job at Mill Creek MetroParks and became her mother–in-law’s full-time personal care assistant. It’s a busy job. (Kochera)

My life right now is circled around feeding her, keeping her clean and making sure she takes her medication. So it’s an everyday thing.

Although physically healthy, 82-year-old Helen suffers from Alzheimer’s. (Kochera)

She’s healthy as a horse, but her brain is just not there. It’s so sad.

Being a caregiver isn’t easy. Over the past three years, Linda and Chuck sacrificed much to take care of Helen. They rarely have time to themselves as their lives revolve around Helen’s wellbeing. (Kochera)

We don’t get to do much like we used to. We can’t at the drop of a hat just go somewhere and take a day and just go like on a day trip or even on a weekend.

The Horkeys agree that placing Helen in a nursing home isn’t the best option. (Kochera)

Nursing homes are crap. The idea of a nursing home is to help elderly people. But the people that they hire are there just to get a job.

Linda says they’ll only send Helen to a nursing home if her condition deteriorates and will put off the decision as long as they can. (Kochera)

Now, if she gets worse in the next couple years, then we will think about that. But we are hoping that’s not the case.

In fact, a nursing home may only add stress. (Kochera)

I would be there every day. Every day I’d be up there seeing if she is being taken care of. So that would be the thing. I would probably be more involved.

Linda says Helen is aware of the care she is receiving and is very thankful. (Kochera)

She is very grateful for us. Every night – ‘I love you guys.’ You know, she always tells us she loves us, even though she makes us so angry.

Linda hopes her children will be able to take care of her when she gets older. As she says, the circle will be completed.

You are listening to Critical Conditions on 88.5 WYSU. I’m Chris Davidson.

One local woman has no plans to place her father in a nursing home. But unlike the Horkey family, she hired caregivers to help. She travels back and forth daily from her Boardman home to her childhood home. And when you walk in to the Sest side ranch-style home it feels like summer.

It’s 79 (degrees) and not only just in November. Usually an older person is cold a lot so that’s why I’m kind of like dressed for June.

Mary Smith (she asked us not to use her real name) greets me in a tank top and capris. She keeps the thermostat high for her 87-year-old father.

He’s just older and he can’t walk very well, you know with the walker, and I mean he can’t drive and he can’t do for himself. So really, to put someone like that in a nursing home, I think, that would be cruel and wrong.

Her father had a series of knee replacements over the years, but the last one, completed in 2007, never healed.

The rehab is like the nursing home. He hated it. He couldn’t wait to get out and, I mean, I could never do that.

Her dad’s TV and reading room is outfitted with a wheel chair and a lift chair. (Davidson)

It’s like a big Lazy Boy, but then it sort of almost like dumps you and helps him get up better.

Smith and her family cared for both her grandmother and mother in this home. They both died here. To help with her mother and father’s care, Smith hired a care-giving agency. One worker has been with her dad since his knee surgery. (Davidson)

She’s been here five years with him and, I mean, she’s like a member of the family. She’s wonderful.

But they have gone through a series of other workers.

If the patient doesn’t care for the caregiver, it doesn’t work out.

She says the last few years have been tough on her and her dad.

It’s hard some days. We butt heads a lot, too. I have to say, ‘You know, I’m family we only have each other.’ (There’s) no siblings for me. My mom is gone…so that’s the way it is. So yeah, it’s not easy.

Three people, in total, assist her father from 8:30 a.m. to 8 p.m., seven days a week. Smith handles her dad’s paperwork, pays the bills, picks up his prescriptions and takes him to doctor’s appointments. She and her husband tend to her dad overnights.  She says she couldn’t do all this if she and her husband weren’t retired, but she firmly believes in home care.

If someone’s questioning between a nursing care and home care, the cost is probably similar or a nursing home might even be more. I’d say (choose) home care if you can do it.

Home health care is a growing business. Locally, many agencies as well as nursing homes and hospitals provide in-home health care. You can schedule home health care for several hours a day to up to 24 hours a day.

One thing that becomes very clear here is taking care of elderly or sick individuals requires time and patience. (Kochera)

Choosing a nursing home also requires time and patience. Rachel Lundberg gives us some tips that may help. (Davidson)

Pay attention to the details when you walk through the doors. You can note the fancy entrance with marble-like tiles and grand piano in the corner, but don’t just go by sight.

The first test is the smell test. If you walk into the facility and smells, it’s not being properly cleaned

That’s Dr. Daniel Van Dussen, coordinator of gerontology at Youngstown State University. He urges multiple visits.

Visit them at different times of a day, if you can – because, sometimes, different shifts are better or worse than others with workers. Look around, make sure things are well-maintained. 

Also look for interaction between staff and patients.

Look at the employees. Do they seem happy? Or do they seem really, really rushed and stressed out, because that will affect the level of care.

Nursing homes with a Residents’ Council tend to provide better services. (Lundberg)

Because the residents feel like they have a real say in how the facility is run. The good facilities have them. They listen to their ideas because then people are happier.

Location is another big consideration. Choose a facility within 5 miles from home. Family and friends can visit more often and keep a close eye on their loved one.

Make sure that you spend the same amount of effort and time finding the nursing home as you would finding a new apartment. 

Last but not least, it’s always helpful to look up Medicare ratings and health inspection reports. States also conduct regular family and resident surveys on every nursing home and they post the results on a consumer guide web page. If needed, long-term care ombudsman will give help and advice for families and patients.

For TheNewsOutlet.org, I’m Rachel Lundberg.

Right now in Mahoning County, one in four of us are over the age of 65. By the year 2030, one in five Americans will be in their mid-60s or older. And as the Baby Boomers, those people born between 1946 and ’64, age – housing choices change. Lee Murray fills us in on some options. (Davidson)

The Ohio State University Extension lists several alternatives to nursing facilities that you may want to look into for your older family members.

They include:

Age-restricted retirement communities. Some comunities require an age limit of 55, others start at 60 or 65.

Board and care facilities. These are similar to nursing care facilties, but on a smaller scale. They can house 2 to 20 and are many times located in residential areas.

Elder Cottage Housing Opportunities. An ECHO cottage, often called a “granny flat,” is a temporary, manufactured home that is located on the same property, with a separate entrance, to a single-family home.

Shared housing. Those people who don’t want to live by themselves may be happy sharing their homes with other seniors.

For additional information, you can visit the Ohio Department of Aging web site at http://www.goldenbuckeye.com

For TheNewsOutlet.org, I’m Lee Murray.

You are listening to “Critical Conditions” on 88.5 WYSU. I’m Chris Davidson.

Whatever you choose, know that any of these options are not cheap.

And if you are paying for long-term care, it’s going to cost a lot. (Kochera)

Long-term care is expensive. According to an online report by AARP, the annual cost of a semi-private or shared nursing home room in the state of Ohio is $69,350. In Pennsylvania, the average cost is $89,425.

A 2011 study by Genworth Financial found the average monthly cost of a private room to be $6,387.50.

Assisted living facilities offer residents an alternative. According to the Ohio Department of Aging, assisted living costs range from $2,000 to $4,000 a month.

According to a calculator on AARP’s website, 10 years of care in a private nursing home room in the Youngstown-Warren area costs more than $1 million.

Linda Horkey of Youngstown knows that when it comes to nursing homes, you get what you pay for.

The ones that are real nice, it’s $6,000 a month just to keep them in a nice place. That’s a lot of money!

Horkey fears that if mother-in-law, Helen, needs nursing home care, the family will be unable to pay.

She barely brings in a little over a thousand. You know, how’s she gonna afford that?

Medicaid, Medicare and private long-term care insurance plans can help alleviate the cost. According to Medicare.gov, about half of all nursing home residents pay nursing home coasts out of pocket. (Kochera)

Those dollar figures are astounding. (Davidson)

Those don’t even count specialized care. And in the case of one local facility, the rising cost of respiratory care forced the closing of the program. (Kochera)

Fourteen residents received 30-day notices to vacate Valley Renaissance HealthCare Center in Boardman in mid-November. Doug Livingston reports. (Davidson)

While the administrator for Valley Renaissance Healthcare Center has provided a written statement expressing the tough decision to discontinue the respiratory care program after 11 years, the facility hasn’t specified why the unit must be closed. And Valley Renaissance patients aren’t the only ones facing eviction. They’re just the latest that we know of.

It’s not something that we’re informed of unless the families or the residents approach us.

That’s John Saulitis, an advocate for nursing home patients with the 11th district Agency on Aging.

But there have been a number of them in the local area over the years that have closed.

Saulitis and the Ohio Agency on Aging advocate for patients and residents in Ohio’s 958 nursing homes.

Joe Rossi, chief executive officer of the Agency on Aging for Ashtabula, Mahoning, Trumbull and Columbiana counties, says the distance between facilities that offer respiratory care pushes families further from their loved ones.

If there isn’t a unit in the Valley here, they’re going to have to go to Akron or Cleveland or some place like that, and the transportation issues to get there. So you know, that’s a loved one. That’s going to have an adverse effect on them.

It’s happening across the country, says Gene Gantt a respiratory therapist and chairman of the long-term care section of the American Association for Respiratory Care.

Gantt doesn’t expect the number of patients who will need respiratory care to decrease any time soon.

We are seeing a steady increase in the number of ventilator patients, and a smaller increase, perhaps, in the number of beds. So there are not enough facilities for these patients to be taken care.

The cause, Gantt says, is that the costs associated with respiratory care exceed Medicaid reimbursement rates in some states. And each state is different.

Ohio’s Medicaid reimbursement rate is less than $170 per nursing home patient per day. Gantt says that if reimbursement rates dip below $500 a day, then … (Livingston)

the cost of care for this patient population that is ventilator dependent will exceed that reimbursement rate. (Gantt)

The 2011 biennial budget cut Ohio’s Medicaid program by 5.8 percent. While the Governor’s Office of Health Transformation touts $360 million in savings for taxpayers over a two-year period, gerontologists and advocates have started to witness ventilator units closing across the state.

Saulitis says Ohio and the nation should reprioritize the care provided through Medicaid.

Should we be increasing the reimbursement for people on ventilator units to make sure that there’s enough revenue coming into a facility to maintain these units in geographic areas to serve the population?

It’s a population that requires additional staffing and monitoring. As a respiratory therapist, Gantt says the delicate nature of these patients also burdens the bottom line.

It is a very high-risk population, a lot of litigation surrounding that type of patient.

Even though some facilities are discontinuing respiratory care, the number of ventilator beds in Ohio has increased by more than 10 percent, according to statistics from the American Health Care Association.

But those beds are found in fewer and fewer nursing homes, limiting options for patients who, Saulitis says, frankly require this service to stay alive.

It’s a difficult situation that they’re already in. Anything that makes that individual’s life, the quality of their life, harder is something that we as a community should be concerned about.

Reporting for The News Outlet, I’m Doug Livingston.

When any health care programs end, it’s tough on the residents. (Davidson)

That’s right and as you know, Chris, trouble spots in nursing homes are usually identified by state inspections. Every year, 130 surveyors travel from nursing home to nursing home to check on resident health and safety standards. Here’s Karen Bell.  (Kochera)

The state health department inspectors, all of whom are registered nurses, had to undergo a year of training and testing to learn what to look for on these visits.

They inspect 956 nursing homes annually.

When surveyors arrive at each home they use state–supplied tablet computers to verify that each home is up to state standards. They check on nursing care, sanitary and safety procedures and the quality of food.

They also interview nursing home residents.

Surveyors follow strict guidelines, with nothing weighing as heavily as a complaint from a resident.

Dustin Ellinger, who heads the Ohio Bureau for Long Term Care, says even if just one resident says he’s been treated poorly, a surveyor will turn the focus of the inspection to resident abuse.

All observations and records are then sent to the state.

Inspectors’ rate problems on a scale of one to three, with one being the least life threatening and three being immediate jeopardy. Immediate jeopardy means the nursing home has 30 days to address the problems cited.

Also, surveyors rate the nursing homes on an overall scale of A-L. When a home receives a D or below it has to correct problems within 30 days.

If nursing homes don’t comply within the 30 days, the Department of Health can withdraw funding and cut Medicare programs.

All nursing home citations can be found at www.ltcohio.org. Soon, the nursing homes’ responses will be available online as well.

For TheNewsOutlet.org, I’m Karen Bell.

You’re listening to “Critical Conditions” on 88.5 WYSU. I’m Chris Davidson.

As Karen just reported nursing homes come under fire for code violations. One nursing home in Struthers received a remarkably high number of code violations last year. Lee Murray reports on why the figures don’t tell the whole story and how these state reports affect the level of care at the facility. (Davidson)

Maplecrest Nursing Home in Struthers received 22 health code violations in its May (2012) inspection report. The national average is 7.5; in Ohio, it’s just six. Teri Sebastiano, Maplecrest’s director of nursing, says there is more to the story.

The industry, she says, is one of the most heavily regulated in the nation and not all of the citations in the report are serious.

The two most serious deficiencies cited at Maplecrest were failing to report a patient’s deteriorating condition to a physician and failing to investigate a resident’s allegation of abuse.

The first patient, bleeding and lethargic, waited days to see a doctor. The second patient claims he was forced to bed early and was, allegedly, treated roughly by nurse’s aides.

Nursing home officials responded with a pledge to handle similar situations in the future better.

Sebastiano says the inspection process leads to better living and care conditions for the elderly.

She did say, however, she wishes the state would give the home credit for the good things that they do.

The state plans to do just that by year’s end (2012) when it installs a new web-based system. This will allow nursing home responses to be listed along with the citations on the same website.

For TheNewsOutlet.org, I’m Lee Murray.

As Lee just told us, problems are identified and hopefully corrected at area nursing homes. But we have heard horror stories about patients receiving poor or abusive treatment. (Kochera)

This next story is disturbing. A Kent, Ohio, couple believed their mother was safe and comfortable in Stow Glen Health Care Center. They never dreamed that one event could keep them asking questions a year later. Ashley Morris brings us the details of one family’s turmoil. (Davidson)

Greg and Joan Shreve chose Stow Glen Health Care Center as the facility for their mother and father, Donald and Ruth Nelson. At the time, it seemed like the ideal place for them. Here’s Greg Shreve.

We knew that Stow Glen was employee owned – that was important. It’s only a few minutes down the road from us.

Joan Shreve says that when her father died in 2005, her mother continued to live in an assisted living apartment.

 She would never have to be moved. She could always be were she knew people. That was important to me.

For two years, Ruth Nelson was in good shape, able to manage her day-to-day needs. She began a rapid decline after her eldest son died of cancer in January 2011.

It was the hospital visit, but I think it was also her son’s death – that she couldn’t quite deal with it. He was just (two years) older than Joan …

Joan Shreve says her mother’s behavior became unpredictable.

She had her nights and days mixed up quite often. She’d be up and night, and she’d go down to the nurse’s station and just chat away and telling people things. The nurse said she would be talking about – like “I’m going go to Norway soon.

Joan says Stow Glen was a welcoming and friendly place. She never imagined anyone being hurt or mistreated there.

I had just never noticed anything where someone had shown any disrespect to a resident.

Greg agrees.

 We knew nurses. We knew maintenance people, nurse’s aides, the housekeeper – we knew them by name.

Because of their close relationship with Stow Glen, they were surprised by what transpired next.

She had obviously been beaten. There was this whole issue of the bruising, the scalp wound. They came in and they said, ‘Yes, but this is not her main problem. Her main problem is she’s at the end of life.’

Nelson’s roommate told state inspectors a State Tested Nursing Assistant attacked Nelson Jan. 30 (2012) without reason.

The results of the attack are gory. Reports say Nelson was swollen and bleeding around her scalp. Several washcloths drenched in blood were found nearby. Afterward, Nelson was taken to the hospital where she had a CAT scan and the Shreves were told the horrifying news. Joan recalls a doctor’s assessment of her mother’s bruising.

He said, you know, that this could be the life threatening or … this subdural hematoma, but even if she makes it she’s still within 90s days of dying.

Nelson died less than a month after the attack. Joan and Greg don’t blame Stow Glen for their mother’s death.

 Putting all of this together, it seemed to say that this was an anomaly at Stow Glen. Like they say, even at the best places bad things happen.

Almost a year later, the police have not identified the perpetrator and the Shreves are still asking questions.

 So did we the right things? I think we did – and it still didn’t prevent her from being beaten. So what do you do? What would we have done differently?

For TheNewsOutlet.org, I’m Ashley Morris.

It’s clear that the Shreves did everything right. They researched the facility. They visited often. They were on top of their mother’s care. Yet, in just a few seconds – Ruth Nelson – suffered the unthinkable. (Kochera)

So, this horror story may be enough to convince some people to keep their loved ones at home. (Davidson)

I mentioned earlier that the private costs for nursing care are astounding. (Kochera)

Long–term care isn’t cheap for the state, either. As of 2012, ten percent of the state budget goes to nursing home care.

Nursing homes receive money from several sources.

According to the U.S. Centers for Medicare and Medicaid Services, nursing homes receive about 43 percent of their money from Medicaid, 20 percent from Medicare, 24 percent out of the patient’s pocket and the remaining from private health insurance and other private funds.

Many of these facilities are forced to do what they can with what they have.

In 2011, Medicaid and Medicare made funding cuts to Ohio’s more than 950 skilled nursing facilities.

These two major cuts proved challenging for nursing home administrators, who had to find ways to save money while providing the highest quality of care to residents. (Kochera)

With approximately 80,000 Ohioans currently in nursing home care, quality is of the utmost importance. (Davidson)

Suzi Starheim brings us the story of person-centered-care which some say will lead to a better life for nursing home residents. (Kochera)

Many residents entering nursing homes know they will never return to their homes. To ease this transition, Ohio has made a conscious effort to focus on person-centered care in its nursing homes throughout the last five or six years.

Person-centered care, which gives nursing home residents more individual choice in their daily care, is very important to the happiness of nursing home residents. Dr. Daniel Van Dussen, coordinator of gerontology at YSU, said person-centered care is, first and foremost, meant to retain individuals’ independence as they move into a new part of their lives.

Well the idea behind the independence is that you can make your own decisions and that the structure of the facility allows you to maximize your ability to maximize your talents to try to almost deinstitutionalize it the best way that you can.

Prior to person-centered care’s implementation in Ohio nursing homes, Van Dussen said nursing homes controlled nearly every aspect of residents’ lives.

It was a major issue, and it is always something you have to be vigilant on because what’s best for the institution isn’t always what’s best for the individuals in the institution. A lot of times, what is easiest for the institution can actually be detrimental to the people.

When selecting a nursing home that has person-centered care, Van Dussen says there are some important questions to ask the facilities.

Do you have person-centered care and how do you implement person-centered care? Another way to do it would be to say, ‘My mother, she really enjoys – whatever her hobby was – how can you accommodate that?

Van Dussen says nursing homes that work hard to implement person-centered care should be rewarded with state funding and increased number of individuals wanting to live there.

On the other hand, Van Dussen says that nursing homes that don’t make person-centered care a priority deserve no reward.

Those who are choosing not to do that are putting themselves at risk for going out of business. Now I almost hope that they would go out of business.

You are listening to “Critical Conditions” on 88.5 WYSU. I’m Chris Davidson.

Thanks to all of you for taking part in “Critical Conditions.” If you need additional information on nursing homes, please visit our website, TheNewsOutlet.org. (Davidson)

We’d like to thank all the people who contributed to this program. In addition to all the reporters you’ve heard there are others who deserve credit. They include: Drs. Alyssa Lenhoff and Tim Francisco, the directors of the News Outlet, who also helped to write and report. 
News Outlet coordinator, Mary Sweetwood;
editor and technical manager Andrew Bush. (Kochera)

We’d also like to include our thanks to some additional writers, reporters and editors. Here they are – Kevin Alquist, Rose Bonilla, Chris Cotelesse, Caitlin Cook, Jason Horkey,
Dustin Livesay … (Davidson)

… Joshua Medore,
Kathryn Mills,
Shannon Watson,
Shee Wai Wong, George Yanchick. (Kochera)

Thanks again. (Davidson)

Good night. (Kochera)