Engaging & Educating Nursing Home Families & Ombudsmen to ...€¦ · Engaging & Educating Nursing Home Families & Ombudsmen to Improve Dementia Care. nReview of some of the relevant

+

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&regulators;n Educationandtrainingofconsumers,families,LTCOmbudsmen,providersand

otherstakeholders.

n CoalitionmembersinNYincludeLTCOmbudsmanPrograms,AARPNY,theAllianceofNYFamilyCouncils,severalAlzheimer’sAssociationChapters,othersenioranddisabledorganizations.

n RichardMollot:JoinedLTCCCin2002.Executivedirectorsince2005.

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+ Today’sProgram

nDescriptionofLTCCC’sproject:Engaging&EducatingNursingHomeFamilies&OmbudsmentoImproveDementiaCare.

nReviewofsomeoftherelevantstandardsthatfamiliesandombudsmenshouldbeawareof,andthetoolswehavedevelopedthatYOU canusetosupportresident-centeredadvocacy.

nTimefordiscussion,questionsandanswers.

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+ 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.

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+ 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.

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+ 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.

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+ 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.

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+ 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.

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+ 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.

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+ 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%

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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

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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.

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