Legislature(1999 - 2000)
03/11/1999 03:35 PM Senate STA
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SENATE STATE AFFAIRS COMMITTEE
March 11, 1999
3:35 p.m.
MEMBERS PRESENT
Senator Jerry Ward, Chairman
Senator Lyda Green
Senator Randy Phillips
Senator Kim Elton
MEMBERS ABSENT
Senator Gary Wilken
COMMITTEE CALENDAR
PIONEER HOME REVIEW
WITNESS REGISTER
Lisa Caress-Beu
2420 Chinook Ave.
Anchorage, AK 99516
POSITION STATEMENT: Discussed her personal experiences with the
Anchorage Pioneers Home.
Kathy Emmons
16617 Davis St.
Eagle River, AK 99577
POSITION STATEMENT: Discussed her personal experiences with the
Anchorage Pioneers Home.
Marty Margeson
Anchorage, AK
POSITION STATEMENT: Discussed her personal experiences with the
Anchorage Pioneers Home.
E. H. "Bud" Caress
6808 Spruce Rd.
Anchorage, AK 99507
POSITION STATEMENT: Discussed his personal experiences with the
Anchorage Pioneers Home.
Francis Purdy
Office of the Ombudsman
PO Box 102636
Anchorage, AK 99510
POSITION STATEMENT: Answered questions regarding the Ombudsman's
investigation of the Anchorage Pioneers Home.
Patricia Senner
4021 Woronzof Dr.
Anchorage, AK 99517
POSITION STATEMENT: Commented on her interaction with the Pioneers
Home pharmacy and assisted living home regulations.
ACTION NARRATIVE
TAPE 99-5, SIDE A
Number 001
CHAIRMAN WARD called the Senate State Affairs Committee to order at
3:35 p.m. Present were Senators Green, Phillips, Elton, and Ward,
Chair. CHAIRMAN WARD announced today's review of Pioneer Homes was
scheduled at the request of Senator Green and others, and because
he, too, had concerns about how Alaskan elders are being treated in
Pioneer Homes. CHAIRMAN WARD described concerns expressed by
families of Pioneer Home residents as: harassment for bringing
forth legitimate concerns; lack of access to medical records; and
distribution and administration of pharmaceutical products to
residents. He emphasized our elders are our greatest asset and
should be honored. He added the people of the State of Alaska own
state programs; if those programs are not working, the proper
course of action is to notify the Legislature.
SENATOR GREEN informed committee members she requested this hearing
because of her growing concern about residents of the Palmer
Pioneer Home. A third party brought some Pioneer Home residents to
her office to express their concerns. Those residents prefer to
remain anonymous out of fear of retaliation. She then met and
spoke with employees of the Pioneer Home who were very concerned
about the implementation of new procedures. She also heard from
family members of residents, as well as physicians, who expressed
concerns about the pharmacy and prescriptions. After hearing
similar concerns from many groups, she requested a hearing to
unlayer the problems that are occurring.
SENATOR PHILLIPS and SENATOR ELTON both notified committee members
they had to leave at 4:00 to attend other meetings.
Number 112
CHAIRMAN WARD took teleconference testimony from Anchorage.
LISA CARESS BEU read the following written testimony into the
record.
For the Record, Mr. Chairman, I am Lisa Caress-Beu. My
mother has been a resident of the Anchorage Pioneer Home
since 1994.
I would like to thank you, Senator Ward, for calling for
this hearing. I have provided your office with documents
from the record files of the Anchorage Pioneer Home that
show that my mother has suffered 52 falls in the last 2
years. I have documents showing a dozen medication
errors that occurred in my mother's care in the last
year. Fortunately none of these medication errors have
resulted in permanent damage to my mother, as far as we
know. I was never notified when these errors occurred
and neither was her physician. Since, I have repeatedly
voiced concerns about both CNAs administering medications
and staffing shortages. I'd like to read the information
from one of these documents - This report references a
day that my mother did not receive her 2 o'clock heart
medication.
'The report asks - "What contributed most to this
situation? The response reads: Neither days' or
evenings' shifts gave med - maybe because hall was
short-staffed - there was staff on duty at this
time. Communication failure among those working
day shift."'
I have 4 medication error reports for 1998 that show that
my mother did not receive her afternoon heart medication
until the night shift came on and caught the error. I
have reports from three different days that show that she
did not receive any of her morning medications at all.
I have one that shows that she did not receive an anti-
seizure medication at all for 4 continuous days. I have another
that shows that she was double-dosed on her heart medication. All
these errors were the result of CNAs administering my mother's
medications. All of the errors were caught by a licensed or
registered nurse. I have asked that my mother's medications only
be administered by a licensed or registered nurse and have been
given reassurances that the CNAs have been properly trained in this
task. I now know that my concerns are well justified.
Deputy Director Alison Elgee references the medication
administration concerns of families in her March 8, 1999
letter to the Long Term Task Force Chairs about the
Public Forum held at the Pioneer Home in January. She
says the family concerns are about whether the pharmacy
is filling expired prescriptions or whether physicians
are prescribing new medications without discontinuing
present medication. I assure you that is not the cause
for my concern. Perhaps Ms. Elgee needs to do more
research with families to find out the real causes for
their anxiety. I have provided Commissioner Poe the
documents that outline these medication errors and falls.
He certainly has my permission to make them available to
her.
The Pioneer Homes say they are no longer a medical model
- they are focusing on the psychosocial aspect of care -
If the medical needs of these residents are not profound,
why do they require an in-house pharmacy? These people
are frail and many are ill and it is time that the
Pioneer Homes systems wake up to that reality. Provide
them with beautiful surroundings if you can afford - but
not at the expense of their very real medical needs.
Currently the Dept. of Administration is requesting funds
to add at least 60 CNA positions statewide to the
Pioneers Homes. I strongly recommend that some of these
funds be dedicated to hire more registered nurses rather
than exclusively CNAs. As the documents that I have
provided to Senator Ward show, CNAs cannot consistently
administer medication safely. These employees should not
be put in the position to do things that they are not
properly trained for and residents should not be put at
risk because the Pioneers Homes do not allocate funds
properly to ensure the residents' needs are being met
competently. It is unfair to residents to make promises
of appropriate care and then not provide it.
I have provided you, Senator Ward, with documents that
make reference to the fact that my mother used the call
cord, received no response and attempted to move by
herself and experienced a fall. She was then reminded
that she should WAIT until the staff got there to help
her. The document reports:
Resident stated she wanted to get out of bed and
was tired of waiting for staff to assist her. No
one came, she said. The nurse explained that the
shift was short-staffed and she should wait for
help. Resident has been weak and unsteady lately.
How long can a resident wait when they have incontinence
problems? How long have residents having chest pains
waited for help to come? How many residents have died
because "help" did not arrive on time? After a CNA
responds to a call cord in an emergency, how long does it
take to locate one RN on duty at night in a home for 228
residents?
This cannot be allowed to continue. Any problems will
give [indisc.] here today. One solution towards
resolving these problems would be addressing SB 20 that
asks that the license of the Pioneer Home be transferred
to the Department of Health and Social Services. I would
also ask that the Department of Administration no longer
be allowed to run the Homes or nursing units for those
residents that need it. Thank you.
CHAIRMAN WARD asked Ms. Caress-Beu to review her initial
conversation with him. He asked her to elaborate on her statement
that her mother was elderly and would sometimes "soil" herself and
that the Pioneer Home policy only provided her one bath per week.
MS. CARESS-BEU said she called for a "care conference" on February
5 and asked at that conference that her mother receive more than
one bath per week because she had become incontinent. She was told
that was against Pioneer Home policy. The Pioneer Home staff
thought the hygiene methods they employed were adequate. She then
told them she disagreed, and that her mother had an odor problem
that needed to be alleviated. The outcome of the conference was
that she would be allowed to come midweek and give her mother an
additional bath.
CHAIRMAN WARD asked if she was told the Pioneer Home rules allow
only one bath per week. MS. CARESS-BEU said yes, but a Pioneer
Home employee was concerned and told her that had never been a
previous policy.
CHAIRMAN WARD asked Ms. Caress-Beu to recount the process she had
to go through to get her mother's medical error reports. MS.
CARESS-BEU explained she first requested the medical error reports
in a telephone conversation with a nurse. She then e-mailed Mr.
John Vowell asking him for the reports, but her request was
refused. She was refused again after writing a formal request.
Finally, the Department of Law became involved, and because she is
her mother's legal guardian with power of attorney, she was
provided with copies of the reports.
SENATOR GREEN referred to a letter Ms. Caress-Beu received from an
Anchorage attorney asking her about her association with a certain
organization, and asked how that letter impacted her. MS. CARESS-
BEU stated she received a letter from Wayne Anthony Ross that was
intimidating because it implied legal action against her. It asked
her 21 to 22 very detailed questions.
CHAIRMAN WARD asked when she requested the medical error reports.
MS. CARESS-BEU answered she first requested the unusual occurrence
reports, which she believed was in late January or early February.
CHAIRMAN WARD asked Ms. Caress-Beu if she was familiar with the
March 5, 1999 letter of instructions for the medical error reports
from Leslie Brundage to Donna Burrall (ph) concerning this subject.
MS. CARESS-BEU was not. CHAIRMAN WARD read the following section
of the letter.
Lately team members have expressed increasing concern
about your lack of assistance. You have written up
medication errors while there was still time to fix the
problem, seeming to be more in a "gotcha mode" than a
supportive and helpful mode. This shows a tremendous
lack of trust with your co-workers, particularly when
routine medication errors could be corrected and are not.
MS. CARESS-BEU said she was familiar with that letter and thought
it was outrageous. She stated, "I think it addresses a registered
nurse doing what a registered nurse should do and she's being
reprimanded for that very thing. And I don't understand how the
Pioneer Home can properly track medication errors if they aren't
recorded. How can they find out which employees need more
training?"
CHAIRMAN WARD recalled a time, 45 years ago, when Ms. Caress-Beu's
mother took care of him after he was injured. He apologized for
her mother's treatment.
Number 292
KATHY EMMONS, a registered nurse from Eagle River, stated she was
employed at the Pioneer Home from 1990 to 1996. She read her
letter of resignation into the record:
As you know I do not approve of the Assisted Living
changes. I do not want to be held legally responsible
for CNA medication administration, nor do I want to be
the only RN in the building for 240 residents. My
concern is for the welfare of residents. I have accepted
a position at Providence Medical Center, so it is with
deep regret that I am submitting my resignation to you.
It will be effective April 6, 1996, at 2300 hours.
MS. EMMONS then read the following testimony into the record.
I am a registered nurse in the State of Alaska. I also
am certified through the American credential center in
Gerontology. I have worked at the Anchorage Pioneer's
Home for 6 years from 1989 to 1996. Contrary to popular
belief, I was not, nor have I ever been, a disgruntled
employee. As far as I know, I have always had excellent
evaluations. I resigned because I did not agree with the
direction the home was going in and I would not
participate in a program where certified nurses aides
were giving medications. I did not believe it would be
a safe environment for residents of Pioneer Homes.
Registered nurses work within a scope of practice. Our
first and foremost duty is to be an advocate and protect
the people in our care, no matter what the setting. Be
it skilled nursing facilities, assisted living homes,
clinics, hospitals, doctors' offices, schools, or
anywhere there is a person requiring our skills, the
scope of practice is followed.
Licensed practical nurses also have a scope of practice
they must adhere to. It is recognized when the licensed
practical nurse works in a team relationship with the
registered nurse, the licensed practical nurse
contributes significantly to each aspect of a process.
However, the final responsibility for the process and its
application remains with the registered nurse.
Certified nursing assistants are unlicensed assistive
personnel (UAP). These are individuals who are not
authorized to perform nursing acts or tasks that are
regulated by the Board of Nursing except pursuant to
legal delegation by a nurse. The registered nurse is
responsible for the management and provision of all care
that a resident receives under the RN's supervision or
direction. The scope of nursing practice permits an RN
to assign tasks to UAPs. "UAP" refers to health care
workers who are NOT licensed to perform nursing tasks
though they may be certified or trained.
Certified Nursing Assistants are continually placed in
precarious positions by the administration of the
Anchorage Pioneers Home. They are forced to administer
medications with only 8 hours of training. Many
certified nurse aides do not want this responsibility.
Certified nursing assistants are illegally giving
medications at the Anchorage Pioneer Home. Registered
nurses at the home are not delegating this duty, the
administration is. Three licensed practical nurses have
just been promoted with raises to assisted living
coordinator position. These positions were pervasively
held by registered nurses. Licensed practical nurses
have been placed in positions of authority over
registered nurses. A license dictates authority, not a
position or a promotion.
Registered nurses have been subject to harassment and
degradation when they have spoken out on issues related
to the safety of persons trusted in their care. When
medication error reports are made out by registered
nurses, they are counseled by the administration. The
Pioneer Home administration does not have the right to
dictate to a registered nurse not to follow the
guidelines of the Board of Nursing.
Registered nurses were given letters of instruction by
Leslie Brundage and they were also presented with two
licensed practical nurses who were at the meeting also.
Registered nurses were told they make too many medication
errors. It is beyond my comprehension why registered
nurses are continually treated with disrespect and
pressured not to follow their scope of practice.
Number 375
SENATOR ELTON asked Ms. Emmons if she has taken any of her concerns
to the Board of Nursing, and if so, whether the Board addressed any
of those concerns. MS. EMMONS said she did when members of the
Board met in Anchorage. She believes the Board is working on the
problem through its process.
SENATOR GREEN asked if a registered nurse can choose to allow a CNA
to administer medications. MS. EMMONS replied a registered nurse
may delegate that task if the CNA is competent to do so.
SENATOR GREEN asked whose license would be in jeopardy if a CNA
administered the wrong medication. MS. EMMONS stated the
responsibility ultimately belongs to the registered nurse.
SENATOR GREEN asked if all Pioneer Homes require CNAs to administer
medications, or if some Pioneer Homes allow only registered nurses
to administer medications. MS. EMMONS answered to the best of her
knowledge, all of the Pioneer Homes require CNAs to administer
medications.
SENATOR GREEN asked Ms. Emmons to comment on the Pioneers Homes'
policies on the use of restraints, exercise, and activity therapy
for residents. MS. EMMONS read the following letter she wrote
about that topic.
January 11, 1999
Wilma died Saturday night. She and my mother-in-law,
Margaret, had known each other for over 50 years. They
met when they both had civil service jobs at Elmendorf
sometime in the 40's. I first met Wilma in 1975. She
lived in a small house by the airport. To say that Wilma
never threw anything away would be an understatement. I
looked around her house and knew that somewhere in one of
the many stacks of newspapers was probably the first one
ever delivered to her doorstep. She was going to read
them all when she got the chance. What a good-hearted
person she always was. When you met her you knew she was
a true Alaskan and the first one to come to anyone's aid.
Wilma never had any reason to fear anyone until she was
70 years old and she tried to help someone who wanted to
hurt her. She was brutally attacked and had to be
hospitalized. A lot of things changed for Wilma that
night. She lost trust. The police officer who worked
the case was so disgusted he quit the force after the man
was sent to prison. Wilma moved into the Anchorage
Pioneers Home in 1997. It was to be a safe haven where
she could live out the remainder of her life secure.
In April, my mother-in-law moved to Chugiak. I went to
get Wilma from the Pioneer Home to surprise Margaret. I
was the one who got the surprise. I was told Wilma now
had a public guardian and I had to have her permission to
take her out of the home. I called the public guardian
and she said I could not take Wilma out of the home.
Wilma had paid companions to take her where ever she
wanted to go. I felt like Wilma had become state
property, so I started taking my mother-in-law to
Anchorage to see her friend of 50 years.
On the first visit, Wilma was up walking around. The two
of them held hands and strolled around. The second time
I took her to see Wilma, she was tied to a chair and a
man was walking around in her room. I escorted the man
out of the room. I left the two old friends alone to
talk about whatever an 80 year old and 83 year old talk
about when one is almost blind and both have their own
varying degree of dementia.
When I returned Margaret said, "Kathy you know I can't
see. Wilma was uncomfortable so I put pillows all around
her. Will you see if I did it right?" I viewed the
loving care one old friend had given the other. Wilma
was surrounded with small plastic diapers. Margaret
thought they were pillows. "Did I do it right?," she
asked apprehensively. Both of them were looking at me
for a reply. "Yes Margaret, you did a wonderful job."
-
I went to see Wilma on Thanksgiving Day. Behind the
closed doors of Gardenview she sat tied to a reclining
chair in her room. She had a wanderguard attached to her
ankle, a small device designed to sound an alarm should
she get near an exit. For a brief moment it flashed
through my mind, "Are prisoners under house arrest
treated in this manner?" NO! I think not.
Christmas Day's visit found Wilma still tied to the
recliner in her room. New Year's Day - still tied to the
recliner but sitting staring at me like a zombie. This
frail little old lady was also given tranquilizers.
The holidays were causing a staff shortage even greater
than normal. Wilma had been found in her room tied to
her recliner with a man lying on top of her. The man was
a patient transferred from Harborview. No one knew how
many hours he had been there because the door was closed.
There would only be one more episode. The same man I had
escorted out of her room again was found sitting in her
room with the door closed. I know in my heart she had to
have felt terror.
I am asking for this 21st legislative session to pass a
"Wilma's Law." Legislation that protects all of our
senior citizens in assisted living homes from physical
and chemical restraints. Legislation that does not allow
frail elderly persons to be victimized. Intact licensing
regulations that are equal to skilled nursing home
licensing.
It will only be then that Wilma will truly be free from
the ties that bound her.
CHAIRMAN WARD asked Ms. Emmons if she was saying state employees
tie people down to make their job easier. MS. EMMONS replied they
also give them tranquilizers to make their jobs easier.
CHAIRMAN WARD asked if Ms. Emmons brought this to anyone's
attention when it happened. MS. EMMONS replied the nurses who work
at the Pioneers Home bring these things to the attention of the
administration but she did not know what action, if any, was taken.
Number 375
SENATOR ELTON asked whether the nurses or administration offered
any explanation of why the restraints were used. MS. EMMONS stated
she was told they had a physician's order, however physicians'
orders for restraint are only used if a patient is in imminent
danger, and patients are only to be restrained for a brief period
of time. She added nursing homes are "restraint-free," yet
assisted living homes have no regulations regarding restraints.
MS. EMMONS concluded by saying she hopes her testimony emphasized
how dangerous it is for elderly people to be in this situation.
Number 482
MARTY MARGESON gave the following testimony via teleconference from
Anchorage. Her father is a resident of the Anchorage Pioneer Home.
He suffers from Alzheimer's Disease and, because he can no longer
speak coherently, she is his health care advocate. He is a private
pay patient who pays over $2800 per month for a semi-private room.
He shares a bath with women in the adjoining room. With numerous
falls and assaults this past year, he has back and knee pain, and
because the doctors ordered a weekly jacuzzi to ease his pains, he
must now forfeit his weekly bath. Unlike other assisted living and
nursing homes, the Pioneer Home will not administer the MD-
prescribed nutritional supplements recommended for corrective care
and preventative holistic medicine, so he pays an additional $300
per month for someone to give him supplements. Prior to admission,
the staff nurse approved the administration of these supplements
but a new pharmacist was hired who has criticized nutritional
supplements. Families must now pay extra to have them
administered. No other Anchorage assisted living home refuses to
administer nutritional supplements ordered by an MD.
MS. MARGESON continued.
My dad's physical and mental handicaps make him totally
dependent on the Pioneer Home for safety. On August 29
another resident entered my dad's room, pummeling his
face, so I had to take my dad to ER for X-rays for his
eye sockets, nose and chin, and stitches above his eye.
The administration suggested my father must have done
something to cause the assault. He was sitting alone on his
bed watching TV and the police found no evidence that he had
been able to defend himself from the attack. Less than a week
later, the same individual again attacked my dad and injured
his hand. The same individual attacked at least two other
women, injuring a wheel-chair bound lady before beating
another lady's face and breaking her fingers as she lay in
bed.
These attacks on vulnerable adults in the Alzheimers-Dementia
Unit are examples of insufficient staffing and an insufficient
plan to protect the safety of all residents. My dad has been
assaulted six times and had six falls this year. There were
no staff witnesses in seven of the 12 incidents, again,
indicative of a staff shortage. Although the Pioneer Home
advertises 24 hour RN coverage, there was no RN available to
medically assess my dad's injuries in seven of the 12
incidents. In fact, when I requested an [indisc.] injury, I
had to wait until after midnight for staff to locate an RN to
come in for work. There may have been more assaults. I was
only called by the staff half of the time. I discovered most
of the assaults. The Pioneer Home is not required to notify
families of falls, assaults, medication errors, or [indisc.]
incidents.
The emotional damage my father had suffered from this violence
has left him emotionally battered and wanting privacy. His
physicians recommend a private room. Most of the Pioneer Home
residents have private rooms, however the AD/RD Unit has few
private rooms. My dad has been passed over for at least five
private rooms. They say he is not critical enough. I believe
this is because I openly advocate for his care and safety.
The Pioneer Home needs to recognize and compensate its victims
of assault, abuse and neglect by creating therapeutic
activities in a therapeutic environment so these residents can
heal. With a population of over 80 mentally and physically
handicapped residents, the Anchorage home needs to hire a
geriatric certified activities specialist to design day care
and weekend activities, comparable to our adult day care.
Currently AD/RD residents sit in a circle of boredom, despair
and loneliness.
Last week, the same female resident who previously assaulted
my dad on three previous occasions, and who is involved in
five previous assaults I witnessed, pushed an 87 year old
women who broke her hip. She may never walk again. I worry
for my dad and others. No extra staff has been assigned to
watch this assaultive woman. Staff attempts to control her
[indisc.] have obviously failed. There are frequent staff
shortages because of a multitude of staff meetings. My
attempts to talk with the director have been ignored. The
assisted living coordinator has no answers. This woman has
caused more injury than my dad's first assailant, who was sent
to API. This resident needs to be removed immediately. I
believe she is a former Harborview resident. The Pioneer Home
cannot accommodate psychiatric residents.
Thankfully, the Attorney General ruled that I can have my
dad's med-error reports. My personal log shows over 75 med
errors in eight months. The Pioneer Home med-error report
shows only 11 errors in 11 months. I believe CNAs are not
filling out the med-error reports in the AD/RD Unit. The
physician cannot provide good care if medications are not
given. I find pills on the floor. I worry when I see aides
giving shots. I worry when my six-year old finds a hypodermic
needle on the floor.
The Pioneer Home has such a longstanding excellent reputation
that most families trust the care of their loved ones without
question. Dropping the nursing license and concentrating on
admitting high-needs without increasing staff was a mistake.
My dad needs the same level of care as a low-level nursing
home. Bring back the nursing license and our RNs. The
Anchorage Home needs at least the staffing ratio for the
mentally-physically handicapped as the Juneau Home. Often
there is one RN for two hundred residents. We need more RNs.
The Juneau Home has a one RN for 47 residents staff ratio. We
need more CNAs. Juneau has a one to six staff resident ratio;
Anchorage has a one to 11. The AD/RD residents need skilled
staff. They can't talk to describe pain. The RN has to read
body language.
It is clear from the news coverage, the assaults and falls at
the Anchorage Pioneer Home, it is not staffed or managed as
well as the smaller homes. Alzheimer's is a dreadful disease.
It takes away our memory, our ability to dress and feed
ourselves, walk and control body functions. These, our most
vulnerable seniors, need 24 hour line-sight protection that we
give our children in day care. No assault is acceptable.
Assaults should be minimal. Medication errors must cease.
Threatening families who seek decent care and safety with
Wayne Ross letters is unacceptable. Writing letters telling
residents they can move out [indisc.] is unacceptable. In my
dad's case this is a threat because with his advanced
Alzheimer's and battered personality, we have no place to
move. Both Mr. Poe and Mr. Bot (ph) [indisc.] I move my
father out. We know how to treat our seniors better - let's
do it now.
I offer the following 12 suggestions.
1. Restore the nursing home license to AD/RD and Comprehens
ive. Bring a doctor back on staff and abolish the residency
requiremen
t so we can fund these changes and qualify for federal funds and
Medicaid.
2. Stop promoting administrators and instead hire direct
patient care RNs and more CNAs. Install time clocks. The
self-directed team approach is not working and residents are
being left alone.
3. Promptly investigate and report to families all assaults,
medication errors, abuse, and abandonment of duty. We need
safe staffing. Sick staff must be replaced immediately.
Weekends and holidays are dangerously understaffed. Today at
lunch were only 3 CNAs to feed and assist over 20 AD/RD
residents.
4. Postpone "Edenizing." This is a luxury program for the
cognitive resident who is already happy. Moving in dogs,
cats, bunnies and birds brings [indisc.], pet food, allergies
and potential injury.
5. Support HB 16, SB 20.
6. Start supporting the Ombudsman, Fran Purdy. Her office is
understaffed. She is the only one who had the courage to
promptly intervene, without her intervention my dad's assault
could have been an untimely wrongful death.
7. Close the pharmacy which is a source of danger and
antagonism to families and residents, and is, according to Mr.
[ndisc.], "run on a break-even basis. There are no profits."
8. Stop using the capital budget for plump, plush leather
furniture, expensive oak tables and chairs, and carpeting,
which causes pain to handicapped individuals like my father
who has worn a hole in his shoe in just a few months and
endured a constant pain from shuffling on carpet at a
heightened risk of falling on carpet nap. Remove the carpet
to provide safe walking areas for residents. Use the capital
budget for safety. Repair the numerous code violations.
Paint for dementia so residents can find their rooms and
bathrooms. Create an institution with painted floors with
bathroom symbols, arrows directing mentally challenged and
create individualized room colors so residents can find their
own rooms. A safe, understandable, affordable environment
reduces aggression. Return the big screen TV to AD/RD.
Crowding 20 residents who, according to Mr. Collins, bite and
pop each other, around a 20 inch TV, is setting the stage for
aggression. Provide safe night lighting. Two of my dad's
roommates have fallen and broken their hips at night.
9. Hire male staff. One-third of the Anchorage AD/RD
residents are men, many of whom are old fashioned, modest
folks, agitated by the female caregivers. Provide male
activities. The Pioneer Home provides few male activities,
but does cater a Super Bowl Party and Monday Night Football,
but AD/RD residents are excluded because there is no staff to
accompany them.
10. Make AD/RD safe so other Pioneer Home residents and
volunteers will visit and help.
11. Physical therapy is overcrowded and understaffed.
Bathing is minimal because there's not enough staff to provide
more than one bath per week. Hire staff.
12. Hire a geriatric certified activities specialist to
design and maintain a day care activity program for AD/RD
residents. The Pioneer Home is a great place for cognitive
residents. We have misrepresented and shortchanged our
mentally challenged and physically handicapped residents. Now
is the time to change that. Thank you Senator Ward for this
opportunity.
TAPE 99-5
SIDE B
CHAIRMAN WARD asked if Ms. Margeson believes her father has been
retaliated against because of the suggestions she gave to the
committee. MS. MARGESON said that is absolutely true. A senior
citizen who has been assaulted six times and has fallen six times
is in a critical situation that merits a private room. The
previous resident who received a private room was only assaulted
once, and the other resident who just received a private room got
one because she is a smoker.
Number 562
SENATOR ELTON asked Ms. Margeson whether she believes 60 new staff,
budgeted for in the supplemental budget, will alleviate the
problems for Pioneer Home residents. MS. MARGESON said if the
ratios of staff to patients in the Pioneers' Homes are equalized,
60 will help.
SENATOR ELTON stated that applying the goal of the national
standard of 3.2 hours of personal care every 24 hours would help to
equalize the ratio. MS. MARGESON said we forget that the Anchorage
Pioneer Home is taking in the Alzheimer/Dementia residents who
cannot be safely accommodated in a "mom and pop" home. Those
residents would be in nursing homes in other states but they are
not accepted into Alaska nursing homes unless they have medical
needs.
CHAIRMAN WARD pointed out the committee will be looking at the
entire allocation process for all of the Pioneer Homes as well as
whether additional appropriations can be made, and the mission of
the Pioneer Homes.
Number 534
W.H. "BUD" CARESS testified via teleconference from Anchorage and
addressed three points: the Eden Alternative Plan used at the
Anchorage Pioneers Home; Leslie Brundage's performance appraisal to
an RN; and his work with a national news program.
MR. CARESS stated the Eden Alternative Plan was sold to the State
of Alaska to be implemented in the Pioneers Homes as a means to
assist and contain costs for care of Pioneer Homes residents. The
needs of the Pioneers Home residents vary, and the assessment and
implementation of these needs must come from trained and dedicated
people. These professionals need back-up staff who are caring and
compassionate, and are those who work on the front line. The Eden
Plan emphasizes an environment with gardens, pets and children, yet
Pioneers Home residents are more in need of staff who can properly
administer medication and closely monitor patients. The Eden Plan
de-emphasizes program activities, the role of prescription drugs,
and a top-down bureaucracy in favor of a team approach. That
approach undercuts the expertise of the registered nurses.
Pioneers Home registered nurses are being disciplined for writing
up medical error reports and are being counseled into fixing the
problem instead. He read an excerpt from a disciplinary memo
written by Leslie Brundage, an administrator, to a registered
nurse. He felt error reports should be looked at as an opportunity
to correct problems, not something to be covered up. The status
quo of any kind of business would spell doom, and striving for
excellence should be a must.
MR. CARESS informed committee members he worked with a national
news program. The news program monitored his mother's room via a
camera it installed. Cameras were installed in other residents'
rooms also. The news program has the film but has not determined
whether to use it. He cautioned that televising the film on a
national news station could embarrass the State of Alaska.
Number 436
CHAIRMAN WARD stated whether privatization or realignment of the
Department or another solution is necessary, the State of Alaska
owes its senior citizens assurance that they will not feel
intimidated by public employees.
Number 426
FRAN PURDY, Long Term Care Ombudsman, Department of Administration,
stated her office issued an investigative report regarding the
Pioneer Home pharmacy. Many of the recommendations put forth in
the report have not been implemented. Regarding staffing levels,
she recommends that the Pioneer Home follow the recommendations of
the National Citizens' Coalition for Nursing Home Reform which
suggests having one full-time equivalent staff per five residents
during the day, per 10 residents during the evening, and per 15
residents at night. In addition, a ratio of one full-time direct
on-care nurses should be available for each 15 residents during the
day, 20 residents in the evening, and 30 residents at night. These
recommendations apply to nursing homes that do not have high-
intensity medical issues, such as residents on respirators. The
Pioneers' Home fiscal request for FY 2000 comes close to that goal.
Number 386
SENATOR GREEN asked what the rule of thumb is for the ratio of
nurses to CNAs in similar types of homes. MS. PURDY replied Alaska
has no regulation governing a ratio. The statutes require that
each home develop a care plan that addresses all of the health,
safety, welfare, and mental health needs of the residents. Each
home must provide adequate staff, both in numbers and quality, to
implement its care plan. If the care plan is not fulfilled, the
licensing unit could hold the home in violation. Nursing homes are
held accountable for providing individual activities and necessary
care by the nursing home licensing agency.
SENATOR GREEN stated the reason she asked Ms. Purdy is because she
is trying to develop language for the supplemental budget to
address the ratio of RNs to CNAs. She asked if one RN to 15 CNAs
is a reasonable ratio.
MS. PURDY repeated the National Citizens Coalition recommendations.
She added that the day and night shift numbers differ because the
majority of contacts between RNs and physicians about the health
needs of the residents occur during the day shift.
SENATOR ELTON asked Ms. Purdy to rate the Pioneer Home system
compared to other facilities that she has been in, and whether some
Pioneer Homes are doing better than others.
MS. PURDY replied the Pioneers Homes differ and most, other than
Anchorage, have an adequate RN to CNA ratio. Those homes do not
have the same high number of high needs residents living at the
Anchorage Pioneer Home. Juneau's Pioneer Home is one of the better
homes because it has a team staff approach that works smoothly.
The CNAs and recreational people actually work as a team,
communication with families is good, the Home is open at all times,
and volunteers and families flow in comfortably. Juneau's Home is
also smaller, and its staff has been working as a team for a long
period of time. The Anchorage Pioneer Home has problems with its
size and the high needs of residents. It has almost a full nursing
home wing that it tries to operate as an assisted living home.
Number 294
SENATOR ELTON asked Ms. Purdy to rate the Anchorage Pioneer Home
with private facilities and private non-profit homes. MS. PURDY
stated the Anchorage Pioneer Home is almost like two different
homes. In the part of the Home in which the residents are semi-
dependent on staff, the Home is comparable to the other homes in
Anchorage. In terms of the other enhanced assistance, AD/RD and
comprehensive clients, the Anchorage Pioneer Home must be compared
to nursing homes, which have different standards and staffing
ratios. The Anchorage Pioneer Home does not have all of the
amenities and activities that one would expect for residents at
that level of need. It has two staff for every 16 people which is
inadequate.
SENATOR ELTON asked Ms. Purdy if she believes the problem at the
Anchorage Pioneers Home is caused by a lack of finances or a lack
of professionalism. MS. PURDY stated the Anchorage Pioneers Home
has some very big financial problems; the lack of adequate staff
levels prevents accurate checking of medications. No quality
assurance check has been done by an outside agency. Nursing homes
have the benefit of a nursing home licensing agency that gives
guidance and has the ability to enforce changes. The licensing
agency has the ability to stop the use of restraints and to
minimize medication errors. She added the Ombudsman's Office has
repeatedly brought complaints on behalf of families to the
Anchorage Pioneer Home and most of those complaints have not been
resolved. She said she hopes SB 20 will be calendared quickly so
that licensing and enforcement can begin to turn around many
attitude problems. The other half of the equation will be funding
for more staff.
Number 203
PAT SENNER, a registered nurse, testified via teleconference and
described her previous work with the elderly. She stated through
the years, on the federal level, a lot of legislation was enacted
to protect the elderly from abuse. That legislation was
incorporated into skilled nursing facility regulations. When
facilities changed from skilled nursing facilities to assisted
living facilities, all regulatory control over quality of care was
essentially lost. At the same time, facilities were no longer
required to have registered nurses, who implemented internal
regulatory controls. New quality control protections are needed.
She discussed the staffing ratio at the Mary Conrad Center and a
feedback mechanism to physicians regarding medications. That
feedback mechanism at the Pioneer Home was totally lacking. She
discussed a situation in which one resident's medication was
substituted by the Anchorage Pioneer Home pharmacist and the
resident had an adverse reaction. The pharmacist again changed the
medication and never once contacted the resident's physician.
Recently the pharmacist alerted the same physician that he did not
have a medication prescribed by the physician. In a skilled
facility, a physician would send an order for a medication change
to the nursing staff who would pass the order on the pharmacy. At
the Pioneer Home, the pharmacist acts as the caregiver which is a
strange arrangement which is not working. She suggested
eliminating the in-house pharmacy and raising the RN to CNA ratio.
CHAIRMAN WARD announced that Commissioner Poe was present during
the meeting and that he would be before the Committee again to
respond to today's comments. He assured teleconference
participants that no one who testified would be retaliated against.
CHAIRMAN WARD then adjourned the meeting at 5:05 p.m.
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