Court rules nursing home illegally removed cook with HIV

The Appellate Court of Illinois, First District, has upheld the reinstatement of a cook who lost his job after his employer learned of his HIV-positive diagnosis. James W. Davis was placed on unpaid leave by Burton Behr, the administrator of the Raintree Health Care Center in Evanston. Behr did not respond when Davis' doctor sent a requested letter stating HIV could not be transmitted through food preparation. Davis, believing he was fired, filed a discrimination complaint. An administrative law judge and the Human Rights Commission both ruled in Davis' favor. On appeal, Raintree claimed it had made a good faith effort to comply with the State Administrative Code, which lists AIDS as one of the diseases requiring that a nursing home employee be placed on leave until a doctor declares the disease is no longer contagious or infectious. The appeals court ruled that the regulation clearly distinguished between AIDS and HIV. Justice Morton Zwick, writing for the majority, stated that eligibility for employment must be individually determined on the basis of ability to perform a specific job. Although Raintree contended Davis had not been fired, the Court said Davis was constructively discharged when his working conditions were altered so that he could not perform his duties. Dissenting, Justice Thomas R. Rakowski called the doctor's note ambiguous, and said the issue should be judged by what was known about HIV at the time.     

Rationing home care resources: how discharged seniors cope

Rationing home care services has become a common strategy used by state/provincial governments to control escalating health care costs, particularly at a time when very little new funding has been re-directed to the home care sector. Across British Columbia, Regional Health Authorities had implemented service reforms that call for the discharge of higher functioning clients from home support service. This paper describes the coping strategies of 137 senior clients who were discharged from home support services and from the Continuing Care Program in the Simon Fraser Health Region located in British Columbia, Canada. Personal interviews were conducted by experienced case managers to gain an understanding of how seniors were coping 19 to 21 months after their discharge. Of the 137 clients, 34.3% are characterized as being "home alone and suffering in silence," 29.2% reported receiving assistance from informal sources or reported paying out-of-pocket for private care, and 28.4% reported that they can do the work better themselves. The remaining 8.0% of participants reported mixed feelings about the impact of their discharge from home support service. The effectiveness of discharge targeted to a senior population is discussed and it is suggested that functional status together with age are important criteria when rationing home care services.     

The new rules of home health

Home care is an ever more important component of a system's arsenal of care, but most hospital-based programs were set up for reasons that no longer apply in today's marketplace. The author offers a framework for thinking through a hospital home care program for the next decade.     

Nursing home queues and home health users

Home health market growth suggests the need for models explaining home health utilization. We have previously explained state-level Medicare home health visits with reference to nursing home markets. Here we introduce a model whereby state-level Medicare home health use is a function of nursing home queues and other demand and supply factors. Medicare home health users per state population is negatively related to nursing home bed stock, positively to Medicaid eligibility levels and to Medicaid nursing home recipients per population, as well as to various other demand and supply measures. This explanation of home health users explains previously-reported findings for home health visits. The findings support the argument that home health use is explained by factors affecting lengths of nursing home queues.     

Nursing assistance by a home care team after the death of the patient

This is report about an experience of continuation of home assistance to families after the patient's death who had determined the beginning of assistance. The present article shows the criteria used to provide a family with an "Assistance service and support to families of chronical patients of HUM" as well as discussions emerged and feelings experienced by the team when subjected to the possibility/proposal of the continuation of assistance. Furthermore the article considers the visitor's reaction at first visit made after death and finally it also presents the importance of continuation of assistance based on reports of verbal manifestation of the family and on evaluation of team members. The authors believe that due to the fact that the assistance to the family is still regarded as a topic which has been very little explored, discussions that might contribute somehow to the consolidation of its practicability must be made possible and stimulated.     

Nursing home evacuation plans

Objectives. I examined evacuation plans from 2134 nursing homes and analyzed national data to determine the types of nursing homes cited for deficiencies in their evacuation plans.Methods. Evacuation plans were assessed according to criteria developed by an expert panel funded by the Office of the Inspector General. Deficiency citations came from the Online Survey, Certification, and Recording database, collected from 1997 to 2005. Four specific citations, for written emergency plans, staff training, written evacuation plans, and fire drills, were examined with multivariate logistic regression.Results. Most plans had water supply provisions (96%). Only 31% specified an evacuation route. The rate of citations was relatively stable throughout the study period: each year approximately 0.6% of facilities were found to be deficient in written emergency plans, 2.1% in staff training, 1.2% in written evacuation plans, and 7.9% in fire drills.Conclusions. Some nursing homes need more specific evacuation plans. Water supply was the most and evacuation routes were the least well-addressed areas.The US Department of Health and Human Services recently reported that administrators from 5 of 13 nursing homes evacuated as part of Hurricane Katrina described negative effects on residents’ health, such as dehydration, depression, and skin tears. The report further stated that “problems can be tied to a lack of effective emergency planning.”1^(pii)In nursing homes, an important tool used as part of emergency planning is the evacuation plan. Federal law requires that Medicare-and Medicaid-certified nursing homes have written plans for evacuation. Nursing homes are subject to deficiency citations (and fines) if the Medicare or Medicaid survey and certification process determines that they do not have adequate written evacuation plans.State Medicaid programs are responsible for approximately 50% of all nursing home expenditures, and Medicaid recipients consume 70% of all bed days. Because the federal government is such a dominant purchaser of nursing home care, it is also the dominant overseer of care quality. This oversight primarily occurs via the certification process. Titles XVIII and XIX of the Social Security Act require that all nursing homes accepting Medicare or Medicaid residents must be certified. Specific minimum standards were established for this certification, and surveyors inspect facilities for compliance.2 The standards require facilities to have “detailed written plans and procedures to meet all potential emergencies and disasters.”3^(p19) In addition, facilities must “train employees in emergency procedures when they begin work in the facility, periodically review procedures, and carry out unannounced staff drills.”3^(p19)The intent of the survey and certification process is to monitor and ensure quality of care. Several mechanisms are available to the government when facilities fail to meet certification minimum standards. These include varying levels of fines (≤ $10000/day) and termination from the Medicare and Medicaid programs. In all cases, however, when a facility does not meet government standards, a deficiency citation is issued. The deficiency citations (commonly called F-tags) for evacuation planning are F-517 and F-518. F-517 states, “The facility must have detailed written plans and procedures to meet all potential emergencies and disasters, such as fire, severe weather and missing residents.”4^(p32) F-518 states,

The facility must train all employees in emergency procedures when they begin to work in the facility, periodically review the procedures with existing staff, and carry out unannounced staff drills using those procedures.4^(p32)

In addition, incorporated into survey and certification regulations are Life Safety Code requirements (commonly called K-tags). These regulations focus mainly on fire safety but also include evacuation planning procedures, such as K-48 and K-50. K-48 states, “There is a written plan for the protection of all patients and for their evacuation in the event of an emergency.”5^(p42) K-50 states,

Fire drills are held at unexpected times under varying conditions, at least quarterly on each shift. Staff are familiar with procedures and aware that drills are an established routine. Responsibility for planning/conducting drills is assigned only to competent persons who are qualified to exercise leadership.5^(p42)

To my knowledge, the report from the Department of Health and Human Services is the only published document addressing evacuation plans used by nursing homes.1 The authors of the report interviewed 20 nursing home top managers involved with facility evacuation and examined deficiency citations given nationally in 2004 for having no plans or deficient plans for evacuation (codes F-517, F-518, K-48, and K-50). They found that nationwide, 94% of nursing homes met federal standards for emergency plans and 80% had sufficient emergency training. They also found substantial variation in the content of evaluation plans used by the 20 nursing homes examined.I examined evacuation plans from 2134 nursing homes and analyzed national data to determine the types of nursing homes (such as for-profit or nonprofit) that received deficiency citations for inadequate plans. My analysis extends the previous research by (1) examining evacuation plans from a large sample (n = 2134) of nursing homes and (2) analyzing longitudinal panel data (1997–2005) from nursing homes (n = 121 779) to determine the types of nursing homes that received deficiency citations for inadequate evacuation plans.