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Most nursing homes giving full value for tax dollars

As a nursing home administrator and long-term care services professional I am compelled to respond to Mary Johnson's column Nursing homes are abusing our tax dollars, June 4. While I'm in agreement with the need to "shift" the rules governing the tax dollars used for the long term care needs of elderly Americans, I believe Ms. Johnson and I may differ on how that shift should occur. If she feels that this cause is a worthwhile one, and I agree that it is, she should pursue it without defaming the nursing home industry as she did, nor should she verbally assault those of us who have chosen careers of service to the elderly.

Charges in nursing homes range quite a bit, as charges for many products and services do. Ms. Johnson discusses "up to $60,000 a year" which I know to be at the very high end. Being vastly familiar with charges in the industry, a typical charge for a stay in a nursing home is between $25,000 and $35,000 annually. Automobiles, too, may cost up to, and well over $60,000. However, typically, the average consumer shops around and makes a fair purchase of a quality vehicle at a more reasonable and affordable cost.

Now, what does that cost buy you? Unlike Ms. Johnson's inference to "less than three hours of care a day," let's be realistic. The type of care which I'm sure is being referenced here is "direct nursing care," _ actual, hands-on, one-to-one care specific to that particular resident.

In addition to that type of care, the nursing home resident receives most, if not all of the following included in the facility's charge: Three meals daily, dietician-supervised and physician-prescribed diets, afternoon and bedtime snacks, room and bath cleaning on a daily basis, fresh bed linens and towels around-the-clock, activities and programs including arts and crafts, socialization, religious and community events along with access to a full array of health care professionals including physicians, therapists and social workers. My list could go on and on.

From the business side of operating a nursing home let me also inform your readers of the "other" costs which are paid out of the revenues generated from our residents: utilities, taxes, insurances, supplies, equipment, furnishings, licensing and certification fees (imposed by local, state and federal authorities), along with salaries and wages and more governmentally imposed taxes and fees associated with the operation of any business.

I cannot speak to the last time Ms. Johnson went shopping, however, the list of services she quotes as those "you should expect" for $200 a day would be quite a bargain. "Non-stop entertainment," at the lowest legal minimum wage would cost over $100 per day. "Catering from the Four Seasons," three of the least expensive items on their menu would cost another easy $50. A sauna, massage and a personal trainer? Well, the personal trainer alone would top the list and let's face it, the $200 would be gone well before mid-day!

Agreed, there are substandard conditions at some facilities which must be corrected. I, too, am appalled at some of the reports of abuse and neglect. However, this is not the typical nursing home, and believe me I've been through dozens of facilities over the last 12 years all across the East Coast.

Residents who are incontinent are toileted and changed between five and 10 times per day. Residents are assisted with dressing and grooming daily, and are prepared to face the rest of the day as much like a well and functional adult as their medical condition(s) allow. No residents are "tied" to wheelchairs and "pumped full of drugs to keep them quiet." These practices are not only immoral and unethical, they are violations of state and federal laws.

Our staff is composed of caring and dedicated individuals who devote their entire work day to caring for those infirm elderly who are confined to nursing homes. On behalf of all of our residents and staff members, I openly invite Ms. Johnson, the St. Petersburg Times staff and the community at large to visit with us and our residents at anytime. Come and see for yourself, don't accept Ms. Johnson's word, we are proud of our work and will gladly show you why.

We appreciate and share the same very simple policy of your newspaper _ we too, "merely tell the truth."

Kenneth T. Montgomery, NHA, Administrator,

Orchard Ridge Nursing Center, New Port Richey

Re: Nursing homes are abusing our tax dollars.

There are certain items that were not mentioned. First of all, over 50 percent of Florida's nursing homes are not reimbursed for their costs by government programs. Anybody who reads the newspaper realizes that there is a shortage of nurses, and health insurance and workmen's compensation insurance have seen significant increases in recent years and governments are cutting back on reimbursement to nursing homes. Also, the article failed to mention the economic impact nursing homes have on the local communities, the number of homeless people taken care of, and the number of families that cannot or will not take care of their loved ones anymore. As a professional in the long-term care industry for a number of years, I have encountered numerous residents who are very happy, content and enjoying their golden years. To make a statement that the majority of residents are abused and mistreated is totally absurd. Before Ms. Johnson writes her next article, she should research the topic more carefully.

Andrew R. Webber, CPA, President,

Progressive Healthcare Services Inc., Tampa

I must take issue with Mary Johnson's comments about home vs. nursing home care. I know for a fact that a bedridden patient who needs 24-hour care pays much higher rates than the local nursing homes charge if he or she attempts to obtain such care in the home.

An elderly aunt tried all the available agencies in 1988-89 before being forced to sell her home, as every one of them charged more than the nursing homes did, and the rates were higher on weekends and holidays. Furthermore, the money from the sale of her home paid for the nursing home for more than two years before it ran out.

Granted, the care in institutions is sometimes lax, but there is the option of trying another _ my aunt was in four different places before we found one that best suited her. Also, I found out that if one's relatives visit frequently, the staff seems to take better care of the patient; an antagonistic attitude gets you nowhere.

Priscilla M. Hoon, St. Petersburg

Re: Nursing homes are abusing our tax dollars.

I am appalled that the St. Petersburg Times would even consider printing such an article, written by someone who obviously does not have the vaguest idea of what nursing homes are all about. She makes quotes that are not only outright lies, but assumes your readers are gullible enough to believe them.

Does Ms. Johnson believe that the only care given to nursing home residents is helping them wash, eat and change their clothes? If she does, I personally extend an invitation to her to spend one day with one of my nursing aides (who, by the way, earns less than a counter person at McDonald's because of limited state funding), and watch the care that is given to a resident on a 24-hour basis.

The residents we get from the hospitals today require more critical care than in past years. With the passing of the DRG rules, the hospitals release patients _ who should remain in the hospital _ to our care, at a fraction of the cost the hospital gets for the same care.

Ms. Johnson believes medical care in a nursing home to be "washing, eating and dressing" and claims that we charge $30,000 to $60,000 per year for this service. Well, Ms. Johnson, I've got some red hot news for you: We charge less than $30,000 per year, giving the same skilled care that a hospital charges approximately $130,000 per year for.

This misinformed columnist also states that an elderly person can be cared for at home at a cost of approximately $15,000 per year. Ms. Johnson, your $15,000 per year would not cover the cost of one caretaker eight hours per day, five days a week. Who would care for the person the other 16 hours per day? Who would pay for the food, shelter, medication, utilities and overall security they get from knowing we are there for them?

It is unbelievable to think that individuals can write about subjects they have not researched and make statements such as "being tied to a wheelchair and pumped full of drugs to keep them quiet." Nursing homes are surveyed annually by the Office of Licensure and Certification and are stringently monitored, particularly to restraining both physically and with drugs. We work very hard to attain a superior rating, and it goes without saying the abuses mentioned in the article are non-existent in regulated nursing homes.

Please, Ms. Johnson, before you attack another subject for what is blatant sensationalism, do your homework. The last paragraph states, "Isn't it time somebody called nursing homes on the carpet _ not just for poor care but for abusing public funds?" My response to this is, "Isn't it time we were recognized for the outstanding work we do?" Families do not just decide to throw a wife, husband, mother, father or other loved one into a nursing facility; it is a heartbreaking and big decision to have to make, and this type of article completely distorts the nursing home picture.

Thomas J. Scudiero, Administrator,

Bon Secours Maria Manor, St. Petersburg

I am quite dismayed at you for publishing, Nursing homes are abusing our tax dollars.

As a former consultant for a national nursing home chain for five years and presently a licensed administrator, I can unequivocably state that Mary Johnson's knowledge of long-term care facilities is totally non-existent. Is she familiar with Chapter 400 F.S., 10-D-29, 10-D-13, OBRA '87, the long-term Ombudsman Council, Aging and Adult Services of HRS, Department of Professional Regulation, Office of Licensure and Certification, Abuse Registry, Human Rights Advocacy Committee, Hospital Cost Containment Board, County Public Health Unit and other regulatory agencies?

Perhaps the Times should examine more closely the credentials of those making editorial statements. Being the editor of the dubiously famous Disability Rag hardly qualifies Mary Johnson as a person of expertise on matters concerning long-term care. Her vivid scenario on patient care is an affront to every member of the nursing home profession and is nothing less than slanderous.

Bob Delimon, NHA administrator

Oak Bluffs Nursing Center, Clearwater

Mary Johnson's column was terribly slanted and unfair to the nursing home services.

My aunt, in a nursing home in Prince Edward Island, was tied in a wheelchair when I visited her in November. What was the nursing home to do? Allow this frail, brittle, dear old lady to move around and fall? Could they assign each patient a nurse to "sit" them? Of course not. Rather than keep her in bed, they showed interest and love and had her sitting up. I applaud them.

My dear mother-in-law was in a nursing home here in St. Petersburg for nearly three years. Ms. Johnson, speaking of her typical situation, says that she only needed "home care." That is ridiculous. When I saw the way those helpless old people were being given such happy, friendly care, my reaction every time I visited was: These are God's angels here on Earth.

Harry V. Benjamin, Madeira Beach

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