A Shift From Nursing Homes to Managed Care at Home

Faced with soaring health care costs and shrinking Medicare andMedicaid financing, nursing home operators are closing some facilities and embracing an emerging model of care that allows many elderly patients to remain in their homes and still receive the medical and social services available in institutions.

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Todd Heisler/The New York Times

Dr. Fredrick Sherman at Harlem PACE with Edna Blandon. “My spirits would drop if I went to a nursing home,” she said.

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The rapid expansion of this new type of care comes at a time when health care experts argue that for many aged patients, the nursing home model is no longer financially viable or medically justified.

In the newer model, a team of doctors, social workers, physical and occupational therapists and other specialists provides managed care for individual patients at home, at adult day-care centers and in visits to specialists. Studies suggest that it can be less expensive than traditional nursing homes while providing better medical outcomes.

The number of such programs has expanded rapidly, growing from 42 programs in 22 states in 2007 to 84 in 29 states today. In New York City, a program run by a division of CenterLight Health System, formerly known as the Beth Abraham Family of Health Services, has over 2,500 participants at 12 sites in the metropolitan area.

“It used to be that if you needed some kind of long-term care, the only way you could get that service was in a nursing home, with 24-hour nursing care,” said Jason A. Helgerson, the Medicaid director for New York State. “That meant we were institutionalizing service for people, many of whom didn’t need 24-hour nursing care. If a person can get a service like home health care or Meals on Wheels, they can stay in an apartment and thrive in that environment, and it’s a lower cost to taxpayers.”

The recent influx of adult day-care centers and other managed care plans for the frail elderly is being driven by financial constraints as President Obama and Congressional leaders seek hundreds of billions of dollars in savings in Medicare and Medicaid. Nursing homes, which tend to rely heavily on Medicare and Medicaid dollars, are facing enormous financial pressure — Mr. Obama’s proposed budget includes a $56 billion Medicare cut over 10 years achieved by restricting payments to nursing homes and other long-term care providers.

Nationally, the number of nursing homes has declined by nearly 350 in the past six years, according to the American Health Care Association. In New York, the number of nursing homes declined to 634 this January from 649 in October 2007, and the number of beds to 116,514 from 119,691.

Over the next three years, New York State plans to shift 70,000 to 80,000 people who need more than 120 days of Medicaid-reimbursed long-term care services and are not in nursing homes into managed care models, Mr. Helgerson said.

The move away from nursing homes was highlighted on Thursday when Cardinal Timothy M. Dolan announced that the Archdiocese of New York, one of the state’s largest providers of nursing home care, is selling two of its seven nursing homes and opening or planning to open seven new adult day-care centers over the next three years.

“Seniors and others who have chronic health needs should not have to give up their homes and independence just to get the medical care and other attention they need to live safely and comfortably,” Cardinal Dolan said in a statement before he opened a 250-patient program at Saint Vincent de Paul Catholic Healthcare Center in the South Bronx.

These new adult day-care centers, known around the nation by the acronym PACE — Program of All-Inclusive Care for the Elderly — provide almost all the services a nursing home might, including periodic examinations by doctors and nurses, daytime social activities like sing-alongs and lectures, physical and occupational therapy and two or three daily meals. All the participants are considered eligible for nursing homes because they cannot perform two or more essential activities on their own like bathing, dressing and going to the toilet. But they get to sleep in their own beds at night, often with a home health care aide or relative nearby.

The nonprofit groups that operate them receive a fixed monthly fee for each participant and manage their entire care, including visits to specialists, hospitalizations, home care and even placement in a nursing home. Because Medicare and Medicaid pay set fees instead of paying for specific procedures, center operators are motivated to provide preventive care to avoid costly hospitalizations or nursing home care.

Some elderly people, however, spurn PACE programs because under managed care, they would have to switch their physicians to those at the PACE center or in its network. Most elderly people want to live out their lives at home, a desire evident in interviews in the PACE center the archdiocese opened in 2009 in Harlem, which has a staff of three doctors and is visited regularly by a dentist, a podiatrist and a psychiatrist.

Todd Heisler/The New York Times

Rick Leeds, who teaches yoga and other wellness programs at the ArchCare PACE Center in Harlem, gives a massage to Edna Blandon, who goes to the center three times a week.

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Edna Blandon, 74, a diabetic weakened on her left side by a stroke who relies on a wheelchair, is transported by specialized van to the Harlem PACE center three days a week and appreciates that it provides not only a home care attendant but sends a nurse every two weeks to change pills in her pillbox and load a 14-day supply of insulin into syringes that she will inject.

“My spirits would drop if I went to a nursing home,” she said. “I love the fact that I can go home at night. There’s no place like home. I can sit down, look at the TV and go to bed when I want.”

James Harper, 70, a retired bank employee who spent 10 months at the archdiocese’s Kateri Residence, a nursing home on the Upper West Side, after a stroke paralyzed his right side, enjoys yoga breathing classes and discussions about black history. Yet he gets to spend nights and weekends with his wife, Albertene, and daughter, Traci, both of whom work during the day and are not around to care for him.

“This way I’m around people,” he said.

Dr. Fredrick T. Sherman, the Harlem PACE medical director, said that a 2009 study showed that PACE programs reduce lengths of stays in hospitals and delay assignments to nursing homes.

The archdiocese, whose new centers will serve a total of 1,500 people, receives an average of $4,000 a month from Medicaid for each participant and $3,300 from Medicare. By comparison, said Scott LaRue, the chief executive of ArchCare, the archdiocesan health care network, a month of nursing home care can cost the government $9,000.

Ultimately, the archdiocese hopes that half of its elderly clients will be served in community settings rather than in nursing homes, which currently serve about 90 percent of the archdiocese’s clients. For-profit companies have not yet moved into the managed care market, in part because of uncertainties about reimbursement formulas and the risks of taking on a nursing home population.

The PACE population tends to be younger than that at nursing homes, which raises the question of whether many PACE clients would really need nursing homes without PACE. Dr. Sherman replies to such skepticism by saying that his clients “need that level of service — the question is where they’re going to get it.”

Without PACE, he said, “they’re going to end up in nursing homes.”

Robert Pear and Christopher Reeve contributed reporting.

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The Snow is Melting. Are You Prepared for Spring Break and Holiday Coverage?

Its hard to believe as another 2 snowstorms are headed towards the Tri-State area, but the snow is melting, and spring is about 30 days away. That gives HR professionals and managers approximately one month to plan for spring break and holiday coverage.

 

Most schools take a week off in the spring, coinciding with the Easter holiday. Many schools also take off time in late February for President’s Day, whether it is a long weekend or a full week. Moms and Dads will be eager to take this week off from work to be with their children, whether they go visit family, go to a fun theme park or simply enjoy a staycation at home together. But is your hospital prepared to cover these shifts?

 

It is important to let employees have time off if they are due this time whenever it is possible. Taking a vacation or time off is often needed for stress release and is especially good for staff morale. One thing that concerns many employees is having a healthy work/life balance – being unable to take a vacation when they would like to have one may cause some employees to question if this is an environment they want to remain in. Though most employees do understand at times it is simply impractical or impossible for an employer to let everyone or too many employees have the exact same shifts off, hospitals can be proactive and work to arrange coverage to allow for some to have this time off.

 

Now is the time to put a plan in place to prepare for President’s Day weekend/week, Spring Break and all of the spring holidays. Contact Meridian Nurse Recruiters at 718-255-5830 to talk about your spring vacation and holiday needs, we’ll create a successful plan to cover EVERY shift without hassle or stress! http://www.meridiannurse.com/

 

Nurse-led Primary Care

Did you know that nurse-led primary care is critical to the success of Obamacare? Read one critic’s opinion of the plan, and just how important nurses are to today’s healthcare: http://www.philly.com/philly/blogs/fieldclinic/Nurse-Led-Primary-Care-is-the-Real-Key-to-Obamacares-Success.html

The Festival of Light – Diwali

To all our friends that celebrate the Festival of light – Diwali – May you enjoy this day and continue to bring light to the world!!!

To those that served to make this country what it is today…We Say Thank You!!!

To those that served to make this country what it is today...We Say Thank You!!!

Your Sacrifice is what made us United States of America

Multiple Positions to be filled

We are currently accepting applicants for multiple positions in Westchester
– Food Service Manager
– Director of Social Service & Marketing
– MDS Coordinator
– Finance Controller
– Admissions Coordinator

Click to apply http://meridiannurse.com/online.php

 

We Will Offer Whatever little we can…

Hurricane Sandy turned out to be more devastating than anyone had expected, leaving millions without power, destroying homes, causing flooding, and crippling transit throughout the tri-state area. Even though the storm is over, we at Meridian Nurse Recruiters hope that you are all safe, and we are inviting anyone to our office in Elmhurst, who may need a cup of hot coffee, a warm place to catch your breath, or a place to re-charge your electronic devices. Our door is open to you!

 

Hurricane Sandy – True Nursing At It’s Best!

NY have battled many in its history, but none were prepared for this. Hurricane Sandy on 10/29/12 unleashed a fury that ignited fears and courage all over New York. I have witnessed personally the devastation brought upon NY by this natural phenomenon and I have seen the true nature of dedication Nurses have to their community.

Our clients are wide and vast and I must commend the RNs, LPNs and CNAs for banding together in this great time of need. I’ve heard so many stories that I lost count. Stories of nurses abandoning their vehicle in waist-high water to make it to work, nurses working four plus shifts and not willing to leave until the danger is adverted. I’ve even heard about nurses opening their homes (those that weren’t affected much) to comrades for shelter just to make it to work the next day.

Many hospitals were evacuated due to various unforeseen circumstances, but no matter the challenges, the Nursing bond could not be broken. Not one report of failed nursing attempts while evacuating during the torrential down pour, vast flooding and many other constraints thrown at them.

When we say Nurses, the titles are long and wide. From the head – Director of Nursing Services down the ladder to CNAs were all hands on deck.

Today We Salute You…The Nurses Of NYC!!!

Let’s Celebrate Hard Work!

Happy Labor Day, America!

Featuring ‘Lunch Atop a Skyscraper’ by Sergio Furnari; edited and additions by webmaster

Happy Labor Day, America!

Non-Immigrant Visa Options for Nurses – guerreroyee.com

In this post, other avenues for sponsorship are explored.

NIV Options for Nurses — Atty. Rio Guerrero

Since the H-1C nonimmigrant visa program sunset on December 20, 2009, visas for hundreds of nurses have expired or will soon expire, leaving H-1C-authorized healthcare employers struggling to provide much-needed professional nursing care with a dwindling nursing staff. Although H.R. 1933, which is currently pending before the U.S. Senate Judiciary Committee, would reauthorize the H-1C nonimmigrant visa program, the sunset of this program casts light upon the dearth of nonimmigrant visa options available for foreign nurses and its negative impact upon nurse staffing nationwide. What are the alternatives for healthcare facilities in the United States?

Currently Available Nonimmigrant Visa Options for Nurses

TN Status—NAFTA
Registered nurses are included in the list of professions eligible for TN status pursuant to Appendix 1603.D.1 to Annex 1603 of NAFTA.
It is difficult to accurately measure the precise number of Canadian and Mexican citizens currently employed as professional nurses in TN status, however, TN status is generally believed to be the most frequently utilized nonimmigrant option among foreign nurses employed in the United States. The primary advantage of TN status is the ease of entry. Registered nurses applying for admission in TN status may be employed in positions covering a wide scope of expertise – from entry-level RN placements to more senior administrative positions. However, the stark disadvantage of TN status is that the pool of potential foreign nurses is restricted to Canadian and Mexican citizens.

H-1B Specialty Occupation Workers
It is well-settled that certain specialty occupations in the nursing industry may qualify for H-1B  nonimmigrant status. Specifically, a narrow group of nurses holding a baccalaureate or higher degree (or equivalency) in nursing that includes advanced practice nurses (such as Clinical Nurse Specialists (CNS), Nurse Practitioners (NP), Certified Registered Nurse Anesthetists (CRNA), and Certified Nurse-Midwives (CNM)), nurse managers, and nursing administrators, may qualify for H-1B status. According to USCIS data, the issuance of H-1B visas for specialty occupation nurses varies greatly from year to year. In recent history, the greatest number of H-1B nurse visas issued in any given fiscal year was only 136. Unlike TN status, the H-1B visa for specialty occupation nurses is available to qualified nurses from all foreign countries. However, the limited scope of eligible specialty occupations greatly narrows the potential use of the H-1B to fill U.S. nursing job vacancies. For instance, many RNs may not qualify for an H-1B because employers and state licensing boards do not usually require a BSN to perform services as a registered nurse.

Return of the H-1C?
The H-1C nonimmigrant classification enables foreign nurses to perform services as a registered
nurse in a U.S. health professional shortage area as determined by the U.S. Department of Labor
(DOL). To qualify for an H-1C visa, both the employer and employee must meet certain
eligibility criteria. The U.S. employer must:
-Be a “subsection (d)” hospital under the Social Security Act;
-Be located in a “Health Professional Shortage Area;”
– Have at least 190 acute care beds;
-Have a Medicare population of no less than 35%;
– Have a Medicaid population of no less than 28%; and
-Be certified by DOL.

The employee must:
-Hold a full and unrestricted nursing license in the country where their nursing education was obtained, or have received a nursing education in the U.S.;
-Have passed the examination administered by the Commission on Graduates for Foreign Nursing Schools (CGFNS), or have a full and unrestricted license to practice as a registered nurse in the state where the employee will work, or have a full and unrestricted registered nurse’s license in any state and have received temporary authorization to practice as a registered nurse in the state where the employee will work; and
-Have been fully qualified and eligible under the laws of the state of intended employment to practice as a registered nurse immediately upon admission to the U.S.

According to recent information provided by the U.S. Senate Judiciary Committee, H.R. 1933 remains on the Committee’s agenda, but is not yet scheduled for a Senate vote. As drafted, this legislation reauthorizes the availability of 300 H-1C visas (a departure from the 500 originally authorized under NRDAA) for an initial validity period of three years, with the opportunity to renew H-1C status for an additional three years. New aspects of H.R. 1933 include the three-year extension and H-1C portability between any of the eligible hospitals under INA §214(n). Whether H.R. 1933 becomes law remains to be determined, but it would no doubt assist authorized healthcare facilities to meet their nursing staff needs given that most H-1C visas have already expired.

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