By Thomas Goldsmith
There are plenty of ways to help nursing home residents through projects that could be paid for by a nearly $29 million, mostly unused, fund accumulated by federal and state authorities, advocates for older people and a state legislator said.
Instead, the civil money penalties fund, comprised of fines levied against North Carolina nursing homes, has spent only about 1.4 percent of the current total during the past three years. Officials at NC DHHS are soliciting applications to the fund. Since an NCHN story ran Jan. 9, here are a few of the uses that have been suggested:
- Enhanced training and a lighter workload for the certified nursing assistants who handle much of frail elderly people’s care,
- High-tech means to monitor the conditions of nursing home residents minute to minute,
- Planning services to help long-term care centers attract, hire and keep qualified workers.
The little-known civil money penalties fund — the state AARP director hadn’t heard of it until last week — could go a long way toward easing conditions for nursing home residents, despite some strict limits on its use, said Mary Bethel, executive director of the North Carolina Coalition on Aging.
More than $25 million in the fund has gone unused at a time when the state’s 60-plus generation is projected to outnumber those younger than 18 this year. Advocates have argued without success to the General Assembly that people older than 60 require help — such as transportation and Meals on Wheels — that would add millions to the state’s budget.
“Twenty-eight-million-plus is a crazy amount of money,” Bethel said. “I know there are lots of restrictions on the use of the funds — only used for projects/initiatives to improve care in nursing homes, can’t supplant state or federal dollars, can’t be for long-term commitments, etc.
“I hope down the road that attention can be placed on focusing more big-picture and looking at some of the systemic problems or challenges that our system has.”
State Rep. Carla Cunningham, a Charlotte Democrat, speaks from experience when talking about needs in the long-term care arena. Cunningham is a registered nurse who worked in skilled nursing as recently as last year and serves as a member of the Joint Legislative Oversight Committee on Health and Human Services.[sponsor]
Conversations with the state Department of Health and Human Services on topics such as resident-staff ratio and worker training should take place during the legislative session that begins later this month, Cunningham said.
“I think that the supervision of those people that are working with the client really needs to be improved,” she said.
She pointed to efforts to prevent pressure ulcers, also known as bed sores, which require moving patients frequently.
“Like the turning of the clients is supposed to be done, if they are bedridden, every two hours,” she said. “But the CNA, the certified nursing assistant, may have 15 clients based on what their staffing is that day.”
Staff failure to turn a resident often enough to prevent the potentially deadly wounds is a recurring issue in skilled nursing settings. As noted, the civil monetary fund money is not supposed to be spent on efforts that the nursing home is already required to perform. However, a Massachusetts program funded by the same pot of money is dedicated to setting up family councils made up of friends or relatives who can report, in Cunningham’s example, problems caused by neglected skin care.
Potential technological fixes
Complaints often surface of unclean facilities, another problem on which family councils can make forceful reports.
“Years ago, if a client’s family member came in and they felt like the room hadn’t been cleaned, they would throw a piece of paper up under the bed, and if it was still there when they came back, they would know the room had not been cleaned,” Cunningham said.
Doug Dickerson, director of NC AARP, pointed to technology developed by the Raleigh-based company K4connect as one of the innovative means of improving residents’ lives. The technology incorporates elements of the “smart home” with electronic monitoring to make it possible for nursing home staff to keep track of residents in real time.
“We know them well, because they happen to be in our building,” Dickerson said of the company. “We’ve gone down and we’ve seen what they can do. So that’s an example of technology that could seriously help health care facilities.”
Bethel noted that the issue of recruiting and retaining staff in homes, particularly for direct care workers, is a major challenge for many homes now and will continue to grow as the older population increases. That effort and others would require business, government, academia and nonprofits to work together.
“Setting up a structure/process to address this, bringing together all the players that could have a stake in this, and actually working to implement steps to address would be a great use of the money in my opinion,” she said.