A few weeks ago, I posted a story about felons working in Florida nursing homes.  Thanks to that series of articles in the South Florida Sun-Sentinel, Florida’s attorney general is getting involved.

Here’s the latest article from the Sun Sentinel’s Sally Kestin:

Florida’s attorney general has ordered a review of a state system that allows convicted felons to work in day care and nursing homes, after a Sun Sentinel investigative series.

In a letter to legislators this week, Bill McCollum said the series highlighted the “disastrous results” of Florida’s exemption process that has cleared more than 8,700 people with criminal pasts to work as caregivers of children, seniors and the disabled.

A Central Florida woman with a record for aggravated assault won an exemption from the state to work in a nursing home, where she stole $36,000 from patients, the newspaper reported.

“With her violent criminal background, she should have never been given the opportunity to work in a position of trust,” McCollum wrote. The Republican official directed his staff to review existing laws and policies and make recommendations before the Legislature convenes in March.

Legislators are already working on changes to state law to restrict who can receive an exemption and for what crimes. One proposed bill would ban people with records for violence and fraud from ever getting clearance to work as a caregiver.

The Legislature created exemptions two decades ago as a second chance for people with long-ago or minor offenses in their past.

But the Sun Sentinel’s “Trust Betrayed” series found the state also granted exemptions to career criminals and people convicted of rape, kidnapping and murder. A dozen registered sex offenders were cleared to work along with 200 people charged with harming children.

Research in Florida has found that as many as half of convicted felons commit more crimes within five years of their release, said Joe Jacquot, the attorney general’s chief of staff.

“The state shouldn’t give people the opportunity to do so,” he said.

Lawmakers have also pledged to fix other problems identified by the Sun Sentinel series. Caregivers would have to pass a nationwide background check before they could begin working with children, the elderly or disabled, under proposed legislation.

Now, many caregivers undergo a criminal history search in Florida only, and can be on the job several months before the results come back.

The reforms have the support of George Sheldon, secretary of Florida’s Department of Children & Families. Sheldon has written a four-page letter to lawmakers outlining his plan to tighten screening requirements and exemptions, and met with legislative leaders this week.

The newspaper series “really made a tremendous difference in people’s resolve to address these issues,” said state Sen. Nan Rich, D-Weston. “I think this is just going to be a no-brainer.”

Sally Kestin can be reached at skestin@SunSentinel.com or 954-356-4510.

Funny how life gets in the way. It’s been several days since I posted on this Florida Senior Living Advisor blog. There are two reasons: first, I was busy helping my elderly father address some issues he is having with his eyes. Looks like cataract surgery is in his future. First he has to see a retina specialist, to make sure there are no underlying issues with his retina. I don’t mind taking him back and forth to doctors, but the fact is it is very time-consuming.

In addition to those obligations, I was busy on Friday and Saturday attending an amazing conferenced about social media and blogging. It was called “Izeafest” – a reference to the company that organized it, Orlando’s Izea, Inc. I learned so much and met so many wonderful people. I’m still going through all of my notes, mapping out next steps for this blog and for the Florida Senior Living Advisor website. But I know one my priorities needs to be to find other websites and blogs to link to me. So this is my first shout-out: if you know of a useful blog that focuses on issues such as senior care, senior living facilities, nursing homes, assisted living facilities, Alzheimer’s disease, Medicare, really ANYTHING of interest to seniors, please tell me about the site in a comment below. I also want to know about these sites so I can add them to my “Helpful Links” section of Florida Senior Living Advisor.

I’ve heard from many people lately who are just beginning their efforts to help a loved one select a Florida senior living facility. They tell me they feel overwhelmed and are so afraid of making a wrong decision. While every situation is unique, there are some standard ideas and steps that I suggest, including:

• Determine what type of facility the person needs. You can read my definitions to learn the differences between nursing homes, skilled nursing units, assisted living facilities, continuing care retirement communities and adult day care centers. In general, most people hope to retain as much independence as possible. (An increasingly popular option is in-home care. I’ll write more about a great home care company located in Central Florida in one of my next blogs.)
• Decide what part of the state of Florida your loved one is interested or willing to live. I’ve divided my database into the following regions: Panhandle, North Florida, Central Florida, Central Gulf Coast, Southeast Coast, Southwest Gulf Coast, South Central Florida. You can also look at my map to understand where those regions are.
• Conduct a search of the Florida Senior Living Advisor database, based on your answers to the above two questions. If a facility has a website, I provide a direct link to it from the database. So look at the facility’s website to get more information. Of course, keep in mind that some of these Florida senior living facilities provide very detailed information on their websites, others do not. If a facility you are interested in does not have a website, you will need to call to get more information.
• Look at Florida Senior Living Advisor’s “Evaluating Facilities” page for a list of the questions that I asked – and some I wish I had asked – as I was researching facilities for my elderly father. The answers you receive can help you start to narrow down your list of options.
• Of course a big deciding factor is cost. This will vary greatly from facility to facility.

And don’t forget good, old-fashioned word-of-mouth. Talk to friends and neighbors. This is what lead me to help my father find the perfect facility – a casual conversation at a social event with an acquaintance I had not seen in several months. When she asked, “What’s new?” I proceeded to explain how I was immersed  in helping my father select a Florida senior living facility. She responded by telling me about a facility she had just visited with her elderly mother. And the rest, as they say, is history.

One more idea: if you feel like you need more help, someone to walk you through the process, consider hiring a senior care management company. I  recently met a wonderful woman named Patrice Antony who owns and operates Elder Advocates, Inc. in the Orlando area. Patrice is a Physical Therapist and Geriatric Clinical Specialist with more than 27 years of experience in working with the handicapped and the elderly. Patrice and her staff will do as much or as little as you need – from helping you research and select a senior facility, to consulting with medical staff on a client’s behalf, and negotiating with insurance companies. For more information, visit the Elder Advocates website.

I’d love to hear back from anyone currently going through this search process for an elderly family member. Comment on this blog or send  me an email at mitra@flseniorlivingadvisor.com.

Today’s featured senior living facility is Pinebrook Rehabilitation and Nursing Center in Venice, FL. Pinebrook is a 120-bed facility that offers a wide range of post-acute care, short-term rehabilitation, long-term care, and other specialty medical services. They also have a special Alzheimer’s care unit called the Avalon Wing, and they provide hospice-related services (in partnership with a licensed hospice organization) and respite-care services (for elderly people whose primary, at-home caregiver is temporarily unavailable).

Pinebrook has been part of the Venice, Florida, community for more than 17 years. Last year the facility received the Excellence in Action Award from the Florida Health Care Association, in recognition of outstanding customer service.
One of the facility’s unique features is an outdoor therapy garden. This functional therapy garden provides real-life activities where elderly residents can regain balance, strength, mobility-and confidence. For example, instead of using parallel bars indoors, patients can cross a bridge with parallel railings that spans a man-made koi pond.

Other therapeutic areas include:

• A beach-like area to practice walking in sand
• A gravel walkway similar to many home driveways
• An uneven pavement area

Pinebrook also offers:

• On-site beauty/barber shop
• Common room
• Several dining rooms
• Family lounge
• Well-equipped therapy gym
• Koi pond
• Picnic areas
• Assistance with scheduling transportation to medical appointments and nearby shops

To learn more about Pinebrook Rehabilitation and Nursing Center, visit www.pinebrookrnc.com. For a searchable database of senior living facilities in Florida, visit Florida Senior Living Advisor.

This made me smile. I just heard about a wonderful exhibit at the Museum of Florida History in Tallahassee. “Art from the Heart” is a display of artwork from 35 nursing home and assisted living residents from throughout Florida. The elderly residents created the artwork as entries for the Florida Health Care Association’s “Art from the Heart” 2009 calendar competition. According to a news release from the FHCA, some of the artists have been creating art their entire lives, while others have recently discovered their talent. Some of the individuals who submitted pieces for this year’s calendar include:

• 82-year old Helene Kereluk’s passion is painting, as demonstrated by her “St. John’s River” artwork featured on the 2009 calendar cover. She studied art in Chicago and continued her studies after moving to DeLand, Florida, where today she resides at The Cloisters independent and assisted living facility (ALF) and teaches a monthly class for her fellow residents.
• 84-year old Sally Darcangelo never realized her natural talent for painting, ceramics and crafts until entering Palm Garden of Pinellas in Largo, where she has lived for over a year. Her “Starry Night” painting is the featured artwork for May.
• 56-year old Bruce Landers is a C5, 6, 7 quadriplegic who is paralyzed from the chest down and has no hand or finger function. He used a hand adaptation to create his “Lighthouse Keepers Home” painted jigsaw puzzle that is the featured artwork for September. Bruce resides at Park Meadows Health and Rehabilitation Center in Gainesville.

The artwork will be on display in the Museum’s Heritage Gallery through September 7. The 2009 Art from the Heart calendars sold for $7 each, with proceeds used toward FHCA’s Quality Credentialing Foundation. The Foundation focuses on improving services and quality care for those living in Florida’s nursing homes by offering long term care providers mentoring, information and resource sharing and advocacy. The Foundation also promotes increased customer satisfaction and employee retention in long term care facilities and offers continuing education and scholarships for long term care nurses, nursing assistants (CNAs) and other professional staff.

For a comprehensive searchable database of senior living facilities in Florida, visit Florida Senior Living Advisor.

I just learned that a nursing home in West Palm Beach has been fined $16,000 after a patient was found on the floor with maggots crawling out of his leg cast. An August 2008 report by state regulators determined that Azalea Court Nursing Home failed to provide necessary care to the resident, who had a cast on his lower leg, leading to the infestation of maggots. The patient’s broken leg was supposed to be treated every three days, but the facility could only document weekly treatment.

In April 2008, just four months before the above-mentioned incident report, inspectors cited the 120-bed facility for a series of isolated events that it said “put the health or safety of residents in immediate jeopardy.” The nursing home was put on a “watch list” and given just one out of a possible five stars as its overall inspection grade, including just one star for quality of care and quality of life measurements, according to the Florida Agency for Health Care Administration. State regulators gave Azalea Court a “J” grade for protecting residents from mistreatment and having policies to prevent abuse. That grade means there was “immediate jeopardy” to resident’s health or safety for isolated violations. You can find Florida’s watch list and get other state ratings of nursing homes here. Azalea Court has appealed the penalty.
 
I can’t help but wonder if the resident in this case has any family members nearby who oversee his care. I know that when my father fell last fall while living in his continuing care retirement facility, I was there every day afterward to check on his care and rehabilitation at the on-site nursing home. This shouldn’t be necessary – a resident in a senior living facility should get quality care whether there is a relative or friend watching or not; but I can’t help but think that in reality – at least in some senior living facility – it does matter.

What is particularly appalling about this story is the paltry size of the fine – $16,000??!! I’d like to know how state regulators came up with that amount. And more importantly, when the appeals process is complete, will the facility face any fine??

The nationally renowned advocacy group, Americas Watchdog, has created the Nursing Home Complaint Center to draw attention to senior citizens suffering wrongful death, abuse and neglect. America’s Watchdog describes itself as a “National Advocacy Group for Consumer Protection and Corporate Fair Play.” It’s the same group that has been helping to lead the charge against allegedly toxic Chinese drywall. They have also received attention for their Mortgage Inspection Service, intended to keep consumers from being cheated or overcharged when they finance or refinance their home.

According to America’s Watchdog,”once our legal team is in place, the Nursing Home Complaint Center will focus weekly press releases on elder abuse, Medicare or Medicaid fraud, Class Actions, or Wage and Hour investigations.”

They are interested in the following issues:

• Nursing homes not providing patients with minimum time per day.
• Nursing homes over billing Medicare for testing that was never done.
• Nursing homes not changing patients for a 24 hour period of time. (the patient then gets septic infections and then they often die)
• Nursing-home care firms that, instead of sending an actual nurse, send a undocumented worker to spend the day with the patient.
• Nursing homes not paying overtime to their employees, or abiding by fair labor laws.
• Possible class issues related to standard of care, drug costs, testing schemes, etc.

I will be interested to see what develops from this group. Unfortunately, I suspect they won’t have any trouble finding complaints against nursing homes to try to splash all over the evening news. Certainly there are many wonderful nursing homes throughout Florida and the entire country that are providing quality care and service to patients. But I also think that in many of these facilities, employees are overworked, underpaid and not monitored closely enough. Maybe just the creation of this complaint center will be enough to get some nursing homes to pay closer attention to safety, quality and customer service.

We’ll see. I’ll report back as I learn of updates from America’s Watchdog.

If you are trying to select a Florida nursing home for yourself or a loved one, here is an information-packed website that you will want to check out – www.medicare.gov/NHcompare/Home.asp

This is the federal government’s Medicare website. One of the most useful tools they provide is their Nursing Home Compare database. This tool has a Five-Star Quality Rating System about every Medicare and Medicaid-certified nursing home in Florida and throughout the country. There are 677 Florida nursing homes in the database.

Here is a description of the rating system for nursing homes from the website:
The Five-Star Quality Rating System helps consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions.

The Nursing Home Compare Web site now features a quality rating system that gives each nursing home a rating of between 1 and 5 stars.  Nursing homes with 5 stars are considered to have much above average quality and nursing homes with 1 star are considered to have quality much below average.  There is one Overall 5-star rating for each nursing home, and a separate rating for each of the following three sources of information:

Health Inspections – The health inspection rating contains information from the last 3 years of onsite inspections, including both standard surveys and any complaint surveys.  This information is gathered by individuals who go onsite to the nursing home and follow a specific process to determine the extent to which a nursing home has met Medicare’s minimum quality requirements.  The most recent survey findings are weighted more than the prior two years.  More than 200,000 onsite reviews are used in the health inspection scoring nationally.

Staffing – The staffing rating has information about the number of hours of care on average provided to each resident each day by nursing staff.  This rating considers differences in the level of need of care of residents in different nursing homes.  For example, a nursing home with residents who had more severe needs would be expected to have more nursing staff than a nursing home where the resident needs were not as high.

Quality Measures (QMs) – The quality measure rating has information on 10 different physical and clinical measures for nursing home residents – for example, the prevalence of pressure sores or changes to resident’s mobility.  This information is collected by the nursing home for all residents.  The QMs offer information about how well nursing homes are caring for their residents’ physical and clinical needs.  More than 12 million assessments of the conditions of nursing home residents are used in the Five-Star rating system.

On the Web site people will be able to arrange the order of the nursing homes according to any of the three aspects above, as well as an overall quality rating based on those three sources of information.