+
TheConsumerVoice2016AnnualConference
Engaging&EducatingNursingHomeFamilies&OmbudsmentoImproveDementiaCare
RichardMollot,LongTermCareCommunityCoalition
www.nursinghome411.org
+ WhatistheLongTermCareCommunityCoalition?
n LTCCC:Anonprofitorganizationdedicatedtoimprovingcareandqualityoflifefortheelderlyandadultdisabledwhoareinlongtermcare(LTC).
n Ourfocus:Principally,residentsinnursinghomesandassistedliving.
n Whatwedo:SystemicResearch,Analysis&Advocacy.n Researchandanalysisonfederalandstatelawsandregulationsaffecting
nursinghomeandassistedlivingcare;n Educationandengagementofstateandfederalpolicymakers®ulators;n Educationandtrainingofconsumers,families,LTCOmbudsmen,providersand
otherstakeholders.
n CoalitionmembersinNYincludeLTCOmbudsmanPrograms,AARPNY,theAllianceofNYFamilyCouncils,severalAlzheimer’sAssociationChapters,othersenioranddisabledorganizations.
n RichardMollot:JoinedLTCCCin2002.Executivedirectorsince2005.
2
+ Today’sProgram
nDescriptionofLTCCC’sproject:Engaging&EducatingNursingHomeFamilies&OmbudsmentoImproveDementiaCare.
nReviewofsomeoftherelevantstandardsthatfamiliesandombudsmenshouldbeawareof,andthetoolswehavedevelopedthatYOU canusetosupportresident-centeredadvocacy.
nTimefordiscussion,questionsandanswers.
3
+ AbouttheProjectn Poordementiacareisapersistent,widespreadproblem.
n Toomanynursinghomescontinuetousepowerfulanddangerousantipsychoticdrugs:n Closeto20%ofUSnursinghomeresidentsaregivenantipsychotics,thoughlessthan
2%willeverhaveadiagnosiswhichCMSconsidersappropriateforthesedrugs.
n AntipsychoticshaveanFDA“black-boxwarning”againstuseonelderlypeoplewithdementiaduetohighriskofParkinsonism,falls,strokes,heartattackanddeath.
n Antipsychoticsarenotindicatedforso-calleddementiarelatedpsychosis.
n Antipsychoticsarenoteffectiveformorethanaveryshortperiodoftimeonso-called“Behavioral&PsychologicalSymptomsofDementia.”
n Despitefederallaw,toomanynursinghomesuseantipsychoticsasachemicalrestraint,tosedateresidents(inplaceofprovidingthecareandservicesresidentsneed).
n Toomanynursinghomestreatdementia“behaviors”asadisease,ratherthanascommunication.
n InspeakingwithLTCOmbudsmen,Residents&Families,wefrequentlyfindthattheyknowwhensomethingiswrong,butoftendon’tknowaboutthelawsandstandardsthatcansupportthemingettingtheirproblemfixed.
Attheendofthepresentationwewillprovidelinkstoresourcesondementiacare&antipsychoticdruggingratesforallUSnursinghomes.
4
+ AbouttheProjectn In2013,weheldasuccessfulfull-dayconferenceondementiacare
andreducingantipsychoticdrugging,bringingtogethernursinghomestaff,familymembers,ombudsmenandotherswhoworkwithresidents.
n Tofollow-uponthiswork,LTCCCreceivedfundingfromtheSamuelsFoundationtoconductfocusedtrainingsfortwoyearswithtwonursinghomefamilycouncilsandwiththeAllianceofNYFamilyCouncils(www.anyfc.org).
n Everymonth,wepresentashorttrainingatthefamilycouncilmeetingonarelevantnursinghomestandard,providingahandoutthatresidents,familiesandombudsmencanuseinthefuturetosupporttheiradvocacy.
n Becauseotherfamilycouncilswereinterestedinthetrainings,webeganconductingwebinarseveryothermonth,opentoallresidents,familycouncilsandombudsmeninNYC.
n Theprojectwillculminateinafreetoolkitforresident-centeredadvocacytoimprovedementiacareandreduceantipsychoticdrugging.
Thefreetoolkitwillbeavailableonourwebsite,www.nursinghome411.org,inSpring2017.
5
+ NursingHomeStandards:Residents’Rights
n Dignity:Everyresident,includingthosewithdementia,hastherighttobetreatedwithdignityand respect andtoliveinacomfortableenvironment.
n NecessaryCare&Services:Everyresident,nomatterwhopaysforhercare,hastherighttoreceivethecareandservicesnecessarytoattainandmaintainhighestpossiblewell-beingandfunctioning.
n InformedDecision-Making:Residentshavetherighttobeinformedabouttherisksandbenefitsofanymedicationortreatmentinlanguageheorshecanunderstand.
n RighttoRefuse:Residentshavetherighttorefuseamedicationortreatment.
n FreedomfromChemicalRestraints:Itisagainstthelawtogivemedicationsthatdonotbenefittheresident,suchasforconvenienceofstaff.
6
+ SelectedNursingHomeStandards:AntipsychoticDrugging
CONSUMERFACTSHEET#6:ANTIPSYCHOTICDRUGGING
Thisfactsheetdiscussestwooftheprincipalantipsychoticdruggingstandardsandhowyoucanusethemtoadvocateforyourresident.Followingarethestandardswithdescriptionsexcerptedfromthefederalregulations.[Thebracketsprovidethenumberfortherelevantfederalregulation(CFR).]
STANDARD1:PHARMACYSERVICES1[42CFR§483.45]- Residentswhohavenotusedpsychotropicdrugsarenotgiventhesedrugsunlessthe
medicationisnecessarytotreataspecificconditionasdiagnosedanddocumentedintheclinicalrecord;
- Residentswhousepsychotropicdrugsreceivegradualdosereductions,andbehavioralinterventions,unlessclinicallycontraindicated,inanefforttodiscontinuethesedrugs;
- ResidentsdonotreceivepsychotropicdrugspursuanttoaPRN[dispenseasneeded]orderunlessthatmedicationisnecessarytotreatadiagnosedspecificconditionthatisdocumentedintheclinicalrecord;and
- PRNordersforpsychotropicdrugsarelimitedto14days.
STANDARD2:BEHAVIORALHEALTHSERVICES2[42CFR§483.40]- Eachresidentmustreceiveandthefacilitymustprovidethenecessarybehavioralhealthcare
andservicestoattainormaintainthehighestpracticablephysical,mental,andpsychosocialwell-being,inaccordancewiththecomprehensiveassessmentandplanofcare.Behavioralhealthencompassesaresident’swholeemotionalandmentalwell-being….
- Thefacilitymusthavesufficientstaffwhoprovidedirectservicestoresidentswiththeappropriatecompetenciesandskillssetstoprovidenursingandrelatedservicestoassureresidentsafetyandattainormaintainthehighestpracticablephysical,mentalandpsychosocialwellbeingofeachresident,asdeterminedbyresidentassessmentsandindividualplansofcare….Thesecompetenciesandskillssetsinclude,butarenotlimitedto,knowledgeofandappropriatetrainingandsupervisionfor:(1)Caringforresidentswithmentalandpsychosocialdisorders…and(2)Implementingnon-pharmacologicalinterventions.
- Basedonthecomprehensiveassessmentofaresident,thefacilitymustensurethat….Aresidentwhodisplaysorisdiagnosedwithdementia,receivestheappropriatetreatmentandservicestoattainormaintainhisorherhighestpracticablephysical,mental,andpsychosocialwell-being.
1FormerlyFreeFromUnnecessaryDrugs[F-329-42CFR483.25(l)(2)(i,ii)].TheregulationprovidesexceptionstothePRN14daylimitationbasedonevaluationbyphysicianorprescribingpractitioner.2FormerlyNecessaryCareforHighestPracticableWell-being[F-309-42CFR483.25].
AdvancingQuality,Dignity&Justice
THINGSTODO
• Reviewmedications.Periodicallyrequestacompletelistofcurrentmedicationsfromthenursinghomeand/orreviewtheresident’smedicationadministrationrecordskeptbythefacility(especiallyifunauthorizeddruggingissuspected).
• Careplanmeeting.Askforacareplanmeetingtodiscusstheneedforproposedantipsychoticdrugs.Usethecareplanmeetingtodetermineifthedrugisreallyneededandwhetherthehomehascarefullyconsideredallalternatives.Seebox,above,forQuestionstoAsk.
• Knowaboutfederalstandards&guidelines.Theyareanimportantresourceforknowingthestandardsofcareandlegalexpectationsforthetreatmentofresidents.Remember:Itshardtoadvocateforyourresident’srightsifyoudon’tknowwhattheyare!
• Fileacomplaint.Ifyoudiscoverthatpsychotropicdrugsarebeingusedwithoutconsent,andyouarenotabletomakeheadwaywithfacilitystaff,youcannotifyyourlocalLTCOmbudsman[www.ltcombudsman.org]and/orfileacomplaintwithyourstatesurveyagency[https://www.medicare.gov/nursinghomecompare/resources/state-websites.html]and/oryourstateMedicaidFraudControlUnit[http://www.namfcu.net/medicaid-fraud-control-unit1.php].
RESOURCES
• WWW.NURSINGHOME411.ORG.LTCCC’swebsiteincludesmaterialsontherelevantstandardsfornursinghomecare,alistingofantipsychoticdrugnames,druggingratesandotherdataforallUSnursinghomesandmore.
• WWW.THECONSUMERVOICE.ORG.TheConsumerVoicehasnumerousmaterialsandresourcesforresidents,familymembersandLTCOmbudsmen.
• WWW.MEDICARE.GOV/NURSINGHOMECOMPARE.Thefederalwebsiteprovidesinformationonindividualnursinghomesnationwide.
QUESTIONSTOASKWHENANTIPSYCHOTICDRUGSAREGIVENORPROPOSED
1. Whatspecific,documentedsymptomsorbehaviorsprompteduseofthedrug(s)?
2. Haveallpossiblemedical,emotionalandenvironmentalcausesbeenruledout(suchasfear,
boredom,constipation,anunderlyinginfectionorchangeincaregivingroutine)?
3. Whatalternativetreatmentshavebeentried?Whatotheralternativesarethere?
4. Whatarethepotentialbenefitsandrisksofthedrug?
5. Isthisthelowestpossibledosageofthedrug?
6. Howwillthedrugeffecttheresidentmedicallyandmentally?
7. Whatistheplannedtimeframefortreatmentwiththedrug?
8. Whatistheplanforemployingnon-pharmacologicalapproaches?
9. Whatistheplanforgradualdose-reduction?
10. Whenandhowoftenwilltheneedforthedrugbereassessed?
11. Howwillsideeffectsbemonitored?
Remembertotakenotes.Includedatesofdiscussionsandwithwhomyouspoke.
7
+ SelectedNursingHomeStandards:ResidentAssessment&CarePlanning
CONSUMERFACTSHEET#9:RESIDENTASSESSMENT&CAREPLANNINGTherearemanystandardswhichnursinghomesarerequiredtofollowinordertoensurethatresidentsreceiveappropriatecare,haveagoodqualityoflifeandaretreatedwithdignity.Intheabsenceofeffectivegovernmentenforcement,YOUcanusethesestandardsasabasisforadvocatinginyournursinghome.FollowingaretwoimportantSTANDARDSFORRESIDENTASSESSMENT&CAREPLANNINGwithinformationthatcanhelpyouunderstandandusethemtoadvocateforyourresident.[Note:Thebracketsprovidetherelevantfederalregulation(CFR).Thisinformationisincludedasareferenceforyouinthefuture.]
STANDARD1:RESIDENTASSESSMENT1[42CFR483.20]- Thefacilitymustconductinitiallyandperiodicallyacomprehensive,accurate,standardized
reproducibleassessmentofeachresident’sfunctionalcapacity.- Afacilitymustmakeacomprehensiveassessmentofaresident'sneeds,strengths,goals,life
historyandpreferences,usingtheresidentassessmentinstrument(RAI)specifiedbyCMS.Theassessmentmustincludeatleastthefollowing:o Identificationanddemographicinformation.o Customaryroutine.o Cognitivepatterns.o Communication.o Vision.o Moodandbehaviorpatterns.o Psychosocialwell-being.o Physicalfunctioningandstructuralproblems.o Continence.o Diseasediagnosesandhealthconditions.o Dentalandnutritionalstatus.o Skincondition.o Activitypursuit.o Medications.o Specialtreatmentsandprocedures.o Dischargepotential.o Documentationofsummaryinformationregardingtheadditionalassessmentperformed
throughtheresidentassessmentprotocols.- Documentationofparticipationinassessment.Theassessmentprocessmustincludedirect
observationandcommunicationwiththeresident,aswellascommunicationwithlicensedandnonlicenseddirectcarestaffmembersonallshifts.
1The2016federalregulationkeepsthepreviousCFRnumber.ThepreviousF-tagforthisstandardwasF-272.
AdvancingQuality,Dignity&Justice
UsethischecklisttoidentifywhatisimportanttoYOUwhenyouhavearesidentassessment!
LTCCCConsumerFactsheet#9:StandardsforResidentAssessment&CarePlanning
STANDARD2:COMPREHENSIVECAREPLANS2[42CFR483.20(k)]
- Thefacilitymustdevelopacomprehensivecareplanforeachresidentthatincludesmeasurableobjectivesandtimetablestomeetaresident'smedical,nursing,andmentalandpsychosocialneedsthatareidentifiedinthecomprehensiveassessment.
- Thecareplanmustdescribethefollowing—o Theservicesthataretobefurnishedtoattainormaintaintheresident'shighest
practicablephysical,mental,andpsychosocialwell-being…;ando Anyservicesthatwouldotherwiseberequired…butarenotprovidedduetotheresident's
exerciseofrights…[suchas]therighttorefusetreatment…. - Acomprehensivecareplanmustbe—
o Developedwithin7daysaftercompletionofthecomprehensiveassessment;o Preparedbyaninterdisciplinaryteam,thatincludestheattendingphysician,aregistered
nursewithresponsibilityfortheresident,andotherappropriatestaffindisciplinesasdeterminedbytheresident'sneeds,and,totheextentpracticable,theparticipationoftheresident,theresident'sfamilyortheresident'slegalrepresentative;and
o Periodicallyreviewedandrevisedbyateamofqualifiedpersonsaftereachassessment.- Theservicesprovidedorarrangedbythefacilitymust—
o Meetprofessionalstandardsofquality;ando Beprovidedbyqualifiedpersonsinaccordancewitheachresident'swrittenplanofcare.
RESOURCES
• WWW.NURSINGHOME411.ORG.LTCCC’swebsiteincludesmaterialsontherelevantstandardsfornursinghomecareandnumerousresourcesforconsumers,LTCombudsmen&caregivers.
• WWW.THECONSUMERVOICE.ORG.TheConsumerVoice’swebsitehasavarietyofmaterialsandresourcesforresidents,familymembersandLTCOmbudsmen.
2The2016federalregulationkeepsthepreviousCFRnumber.ThepreviousF-tagforthisstandardwasF-279.
RelevantPointsFromtheFederalGuidelines
• Afacilitymustmakeanassessmentoftheresident’scapacity,needsandpreferences.• Theassessmentmustincludeawiderangeofresidentneedsandabilities,including
customaryroutine,cognitivepatterns,mood,abilitytoandmethodsofcommunication,physical,dentalandnutritionalstatus.
• Afacilityisexpectedtoprimarilyrelyondirectobservationandcommunicationwiththeresidentinordertoassesshisorherfunctionalcapacity.
• Inadditiontodirectobservationandcommunicationwiththeresident,thefacilitymustuseavarietyofothersources,includingcommunicationwithcarestaffonallshifts.
• Aresident’scareplan“mustdescribe…theservicestobefurnishedtoattainormaintaintheresident’shighestpracticablephysical,mentalandpsychosocialwell-being….”
• Thecareplanmustbebasedontheassessment.Inotherwords,itmustcomefromtheresident’sneedsandabilities,nottheserviceswhichthenursinghomedecidestoprovidebasedonitsfinancial(orother)priorities.
8
+ 9
WHY areAssessment&CarePlanningImportant?BECAUSE thisiswhenyourresident’sneedsaredeterminedandwherethefacilitysetsforthhowitisgoingtomeetthoseneeds.
+ SelectedNursingHomeStandards:ExpectedPracticesforDementiaCare
BasicStandardsofPracticeforGoodDementiaCare&AvoidingInappropriateAntipsychoticDrugging
Earlierhandoutsinthistoolkitdiscussedtheimportantregulationsthatlayoutwhatnursinghomesarerequiredtodotoprotectresidents,includingthosewithdementia,frominappropriateantipsychoticdruggingandprovideeachofthemwithgoodandappropriateservicestomeettheirneedsasindividuals.Thishandoutfocusesonthe“Behavioral&PsychologicalSymptomsofDementia”(BPSD):whattheyareandwhatthenursinghomeshouldbedoingtoaddressthem.
ExamplesofBehaviorsThataResidentMightExhibitWhichResultsinAntipsychoticDrugging
• Aggressivebehaviortowardscarestaff,otherresidentsorlovedones
• Abnormal/repetitivevocalizations• Sleepdisturbances• Wandering
• Agitation,and/orrestlessness• Screamingorcrying• Repetitivemotoractivity• Anxietyand/orDepression• Delusionsandhallucinations
Someimportantthingstoknowabout“Behavioral&PsychologicalSymptomsofDementia(BPSD)
• TheonlyBPSDthatmayberesponsivetoorappropriateforantipsychotictreatmentareaggression,agitation,orpsychoticsymptomsthatposeanimmediateriskforharm.
• AntipsychoticmedicationsareonlymoderatelyeffectiveformostBPSDandshouldbetrialedasthelastresortforalimitedperiodoftimewhenthereisanimmediateriskofharm.
• Notallpsychoticsymptomsnecessarilyrequirepharmacologictreatmentofanykind(i.e.,hallucinationsthatdonotdistressthepersonwithdementia).
• Itisimportanttoconsiderothersocial,psychologicalandphysicalneedsthatapersonmighthavethatmayresultinBPSD,especiallypain,whichishighlyprevalentamongolderpersons.
• MostBPSDareresponsivetonon-pharmacologicalapproaches.Theapproachshouldbebasedonanassessmentofpossiblecausesandindividualizedtotheperson’sabilitiesandphysical/emotional/socialneeds.
2
WhatStepsShouldBeTakentoAddressBPSD?
•• Obtaindetailsabouttheperson’sbehaviors(nature,frequency,severityandduration)andrisksofthosebehaviors,anddiscusspotentialunderlyingcauseswiththecareteamand(totheextentpossible)resident,familyorrepresentative;
•• Identifypotentiallyremediablecausesofbehaviors(suchasmedical,medication-related,physical,functional,psychosocial,emotional,environmental);
•• Implementnon-pharmacologicalapproachestocaretounderstandandaddressbehaviorasaformofcommunicationandmodifytheenvironmentanddailyroutinestomeettheperson’sneeds;
•• Implementthecareplanconsistentlyandcommunicateacrossshiftsandamongcaregiversandwiththeresidentorfamily/representative(totheextentpossible);and
•• Assesstheeffectsoftheapproaches,identifybenefitsandcomplicationsinatimelyfashion,involvetheattendingphysicianandmedicaldirectorasappropriate,andadjusttreatmentaccordingly.
Non-PharmacologicApproaches
Nursinghomesarerequiredtomakechangestothecare,treatmentandenvironmentofaresidenttoappropriatelyaddressandalleviateBPSD.Followingaresomeexamplesofapproachesthatmightbetaken,dependingonthespecificneedsoftheresident:
•• Clinical.Identifyingifaresidentisinpainoruncomfortableandtakingstepstoaddressandproviderelief.
•• Environmental.Identifyingenvironmentalcausesandtakingstepstoaddressthem,suchasreducingnoiseorvisualstimulation,providinganareaforsafewanderingorcreatingahome-likeatmospheretoreducearesident’sstress.
•• StaffTraining.Educatingcarestaffon:o Communicationskills;o Person-centeredbathing;o Minimizingandavoidingcare-resistantbehaviorsduringoralhygieneandwhen
assistanceisprovidedwithdressingorotheractivitiesofdailyliving;ando Strategiesforunderstandingwhataresidentiscommunicatingandhowtorespondto
hisorherneedsappropriately.•• Activities.Justlikepeoplewholiveoutsideofnursinghomes,residentsneedtobeinvolved
inactivitiesthatareengaging,nomatterwhattheirphysicalormentalabilitiesmaybe.Musicandarttherapy,structuredexerciseandrecreationprogramsandanimaltherapy(realorstuffedanimals)aresomeoftheactivitieswhichhavebeenfoundtobebeneficial.
Behavioriscommunication.Behaviorisnotadisease.
Formore information and resources to help you improvedementia care in your facilityplease visit www.nursinghome411.org. This website has a section dedicated toAntipsychotic Drugs & Dementia Care with links to resources that we and otherorganizationshavedevelopedtoimprovecareandsupportyouradvocacy.
10
+ IndividualAPDruggingInfo
TheSASSystem
FacilityName County ZIPCode NoAPDrugs GivenAPDrugsBALLENGERCREEKCENTER Frederick 21701 89.13% 10.87%BAYRIDGEHEALTHCARECENTER AnneArundel 21403 70.93% 29.07%WICOMICONURSINGHOME Wicomico 21802 92.59% 7.41%THEPINESGENESISELDERCARE Talbot 21601 89.15% 10.85%ST.MARY'SNURSINGCENTERINC St.Mary's 20650 88.49% 11.51%ARCOLAHEALTHANDREHABILITATIONCENTER Montgomery 20902 82.93% 17.07%FAIRLANDCENTER Montgomery 20904 79.07% 20.93%LONGVIEWHEALTHCARECENTER,LLC Carroll 21102 84.85% 15.15%FORESTVILLEHEALTH&REHABILITATIONCENTER PrinceGeorge's 20747 86.88% 13.12%MILFORDMANORNURSINGHOME Baltimore 21208 69.51% 30.49%MANORCAREHEALTHSERVICES-HYATTSVILLE PrinceGeorge's 20783 89.26% 10.74%NMSHEALTHCAREOFSILVERSPRING Montgomery 20902 83.93% 16.07%POTOMACVALLEYNSG&WELLNESS Montgomery 20850 54.48% 45.52%MANORCAREHEALTHSERVICES-CHEVYCHASE Montgomery 20815 91.73% 8.27%LONGGREENCENTER BaltimoreCity 21212 79.51% 20.49%LEVINDALEHEBREWGERCTR&HSP BaltimoreCity 21215 84.42% 15.58%KESWICKMULTI-CARECENTER BaltimoreCity 21211 93.81% 6.19%CITIZENSCARECENTER Harford 21078 83.85% 16.15%KENSINGTONNURSING&REHABILITATIONCENTER Montgomery 20895 63.28% 36.72%ST.ELIZABETHREHAB.&NSG.CE BaltimoreCity 21227 88.39% 11.61%MANORCAREHEALTHSERVICES-WHEATON Montgomery 20902 92.05% 7.95%NMSHEALTHCAREOFSPRINGBROOK,LLC Montgomery 20904 83.33% 16.67%MANORCAREHEALTHSERVICES-TOWSON Baltimore 21286 86.32% 13.68%GOLDENLIVINGCENTER-CUMBERLAND Allegany 21502 82.57% 17.43%ALICEBYRDTAWESNURSINGHOME Somerset 21817 92.19% 7.81%WOODSIDECENTER Montgomery 20910 93.90% 6.10%MANORCAREHEALTHSYSTEM-ADELPHI PrinceGeorge's 20783 87.88% 12.12%BELPREHEALTH&REHABILITATIONCENTER Montgomery 20906 65.43% 34.57%SALISBURYCENTER Wicomico 21804 80.50% 19.50%MANORCAREHEALTHSERVICES-DULANEY Baltimore 21204 85.59% 14.41%
11
Onwww.nursinghome411.org wepost,approx.everysixmonthsdatafromCMSonallAPdrugging– non-risk-adjusted.
+ IndividualSNFGeneralInfo
ProviderName ProviderAddress
ProviderCity
ProviderState
ProviderZipCode
ProviderCountyName
OwnershipType
NumberofCertifiedBeds
NumberofResidentsinCertifiedBeds
WRANGELLMEDICALCENTE P.O.BOX108WRANGELL AK 99929 Wrangell Government 15 14YUKONKUSKOKWIMELDER' 1100CHIEFE BETHEL AK 99559 Bethel Nonprofit-C 18 15PROVIDENCEKODIAKISLAND 1915EREZAN KODIAK AK 99615 KodiakIslandNonprofit-C 22 20PRESTIGECARE&REHABCE 9100CENTEN ANCHORAGE AK 99504 Anchorage Forprofit-Co 102 81UTUQQANAATINAAT 436MISSIONKOTZEBUE AK 99752 NorthwestAr Nonprofit-C 18 18PROVIDENCETRANSITIONAL 910COMPAS ANCHORAGE AK 99504 Anchorage Nonprofit-C 50 37PROVIDENCEVALDEZMEDIC 911MEALSAVALDEZ AK 99686 ValdezCordoGovernment 10 9CORDOVACOMMUNITYME P.O.BOX160CORDOVA AK 99574 ValdezCordoGovernment 10 10PETERSBURGMEDICALCENT P.O.BOX589PETERSBURG AK 99833 PetersburgC Government 15 14SOUTHPENINSULAHOSPITA 4300BARTLE HOMER AK 99603 KenaiPeninsuNonprofit-C 28 28PROVIDENCEEXTENDEDCAR920COMPAS ANCHORAGE AK 99504 Anchorage Nonprofit-C 96 96QUYANNACARECENTER 1100GREGK NOME AK 99762 Nome Nonprofit-C 18 18HERITAGEPLACE 232ROCKWE SOLDOTNA AK 99669 KenaiPeninsuForprofit-Co 60 48KETCHIKANMEDCTRNEWH 3100TONGA KETCHIKAN AK 99901 KetchikanGaNonprofit-C 29 20PROVIDENCESEWARDMED 2203OAKST SEWARD AK 99664 KenaiPeninsuGovernment 40 30SITKACOMMUNITYHOSPITA209MOLLERSITKA AK 99835 SitkaBoroughGovernment 15 10DENALICENTER 151019THAVFAIRBANKS AK 99701 FairbanksNo Nonprofit-C 90 72WILDFLOWERCOURT 2000SALMO JUNEAU AK 99801 Juneau Nonprofit-C 57 55MERRYWOODLODGECARE POBOX130 ELMORE AL 36025 Elmore Forprofit-Co 124 102MOUNDVILLEHEALTHANDR THIRDAVENU MOUNDVILLE AL 35474 Hale Forprofit-Co 68 62JACKSONHEALTHCAREFACI2616NORTH JACKSON AL 36545 Clarke Forprofit-Co 91 79CAMDENNURSINGFACILITY210PONDER CAMDEN AL 36726 Wilcox Forprofit-Co 95 74CYPRESSCOVECARECENTER200ALABAM MUSCLESHO AL 35661 Colbert Forprofit-Co 90 75MONTROSEBAYHEALTHAN HIGHWAY98 MONTROSE AL 36559 Baldwin Forprofit-Co 83 52WILLOWBROOKECOURTAT ONECROWNHUNTSVILLE AL 35802 Madison Nonprofit-C 59 51
12
Onwww.nursinghome411.org wepost,approx.everysixmonths,datafromCMSonallUSnursinghomes’ownership,quality,staffing,resident/familycouncil,penalties,deficiencies,substantiatedcomplaint.
+ Resourcesn www.nursinghome411.org - Informationonarangeof
nursinghomeissueswithasectiondedicatedtodementiacareandantipsychoticdrugs.ThewebsiteincludedLTCCC’sreports,consumerguides andinformationonquality,staffingandantipsychoticdruggingforallUSnursinghomes.
n www.medicare.gov/nursinghomecompare - Thefederalwebsiteprovidesinformationonindividualnursinghomesnationwide,includingtheirratesofantipsychoticmedicationuse.ItalsohascontactinformationonStateoversightagencies,LTCOmbudsmenandtheFederalNursingHomeComplaintForm.
n Sign-upforLTCCC’squarterlynewsletter,TheLTCJournal,[email protected].
n JoinusonFacebookatwww.facebook.com/ltccc.
13
Top Related