- Email: [email protected]
California and federal government negotiate cease fire
NEWS
WATCH
California and Federal Government Negotiate Cease Fire SACRAMENTO, CA-A showdown between the Health Care Financing Administration (HCFA) and the State of California ended up in a March 11 agreement that the state and HCFA will work together to possibly revise the Interpretive Guidelines for the Omnibus Budget Reconciliation Act (OBRA) 87 Nursing Home Reform Amendments. California's lawsuit against the U.S. Secretary of Health and Human Services, Kitzer v. Sullivan, will be on hold until April 11 , and the state will begin surveying nursing facilities' compliance with OBRA87. Battle lines were drawn when California filed suit against the federal government, charging that the federal government had unlawfully withheld Medicaid funds needed to implement provisions of the 19'i57 Nursing Home Reform Act, which took effect October 1. Of $5 billion Medicaid dollars slated for California, the federal government had already held $24 million. In the lawsuit, California charged that HCFA had illegally mandated costly and unnecesary standards in its Interpretive Guidelines and asserted that "California refuses to comply with these illegal pronouncementc;." The often cited example of the state's dispute with the Interpretive Guidelines but not the reform amendments is room furnishings. The requirement, says state officials, is that each room have a chest of drawers, a night stand, and a chair. "What if the person is comatose?" asks a California spokesperson. Such unnecessary requirements drive up the expense of complying with the nursing home reform amendments, which the state estimates will cost $500 million a year. California Gov. Pete Wilson maintains that the suit reflects the problems of such other states as Kentucky, Ohio, Pennsylvania, and West Virginia,
108
GerintricNursing MnylJunc 19')1
which reportedly also are unable to comply with mandates the federal government has not provided funds to carry out. In early March, the HCFA sent more than 100 investigators to California in response to the state's refusal to survey its 1500 facilities according to the Interpretive Guidelines. Wilson, however, has argued that the rights of nursing home residents in California were already adequately protected by state regulations, a point the HFCA questions. HCFA chief Gail Wilensky, defending the Interpretive Guidelines, pointed out that they were meant to be only suggestions for inspectors. They "do not establish requirementsthatmustbe HCFA chief Wilensky met," she noted. Following Wilensky's explanation, plantiffs in Valdivia v. Department of Health Services, a suit filed last fall to force California to comply with OBRA 'i57, filed a motion for the Interpretive Guidelines to be designated rules, which would force nursing home facilities to comply with them fully.
States Reeling under Medicaid Mandates WASHINGTON, DC-Faced with new nursing home requirements and other federal health mandates, recession-weary states appear on the verge of slashing their Medicaid programs. Governors in about 30 states are proposing cutbacks in state programs such as Medicaid, says the American
Association of Homes for the Aging (A AHA). These states also are shelling out few new dollars for the nursing home reforms in the Omnibus Budget Reconciliation Act (OBRA) of 1987. While OBRA may cost as much as $9 more a day per patient, some states actually are cutting their Medicaid funding for nursing homes, noted Diana Elani, health-payment analyst for AAHA. Maryland and New York, for example, reserved a small amount of funds for the OBRA changes. Yet they also cut the basic reimbursement rates by a larger margin, leaving nursing homes with a net loss, Elani said. Given the current economic climate, "We're finding a wave [of Medicaid cuts] across the country," Elani remarked, with other states such as Connecticut and Massachusetts considering similar moves. Earlier this year, the nation's governors asked Congress to refrain from setting new health care mandates unless they included additional funding. "It appears to us that what is really happening is a 'back-door approach' to universal health care, using Medicaid as the vehicle and the states' credit cards as the financing mechanism," Arkansas Gov. Bill Clinton told a House subcommittee recently. Aside from the OBRA changes, Clinton said states are grappling with many new initiatives to expand Medicaid coverage to low-income women and children. But with much of the nation in recession, states have become the "pressure point" for government assistance, he continued. AAHA also blames the Medicaid squeeze on case-mix payment systems, which base reimbursements on resident characteristics and a nursing home's mix of patients. About 15 states currently use a case-mix system, and the Health Care Financing Ad-
ministration (HCFA) is directing a demonstration program affecting five other states. AAHA says many stales use case-mix systems to cap costs. Last year, Congress tried to deal with the funding issue by passing legislation that called on states to provide sufficient funding to help nursing home residents meet their highest functioning level. But even that has not assuaged arguments over cost. "Most states feel they haven't got a lot of money for OBRA," Elani commented. Federal and state governments "still haven't figured out how much the OBRAchanges will cost."
To Keep Your GNPs, Don't Change! NEW YORK, NY-A change of ownership or organizational structure can make geriatric nurse practitioners start looking for a new job. David Radosevich of the University of Minnesota tracked 97 nursing home nurses, prepared as GNPs, who were primarily employed in rural settings [Aging Research and Training News Vol. 13, No. 10]. The average length of employment in their first GNP job was more than 4.5 years. As many as 58 of the 97 GNPs were still in their first job when the study was done. For the rest, organizational change was the most frequently stated reason for leaving.
Bush Hurls Budget Axe At Medicare WASHINGTON, DC-The Bush administration's plans to raise Medicare premiums for high-income beneficiaries have drawn fire from advocates, who are appealing to Congress. In his FY '92 budget, Bush proposed new Medicare rate hikt:s for high-income elders earning more than $125,000 a year and couples earning $150,000 a year. They would pay 75 percent of the cost of the Medicare Part B program, while other elders would pay premiums to cover only 25 percent of program costs. While the plan would hit only the
In the intergenerational programs, residents of the Joseph L. Morse Geriatric Center in West Palm Beach, Fl., visit with preschoolers at an inner-dty day school.
Elders and Children Caring for Each Other WASHINGTON, DC-If your long-term care facility is tapping the talents of elders with an intergenerational child-care program, Generations United wants to know about it. And if you don't have an intergenerational program, but think you'd like to start one, this coalition of 100 organizations-cochaired by the National Council on Aging (NCOA) and the Child Welfare League of America (CWLA)-would like to help. Using a grant recently awarded by the Administration on Aging, Generations United will serve as a clearinghouse and guide to intergenerational child-care resources and programs, plus provide technical assistance to organizations that wish to start a program. The coalition is now trying to gather information on existing programs in order to prepare a compendium of programs that will be available to the public on a computerized database. Those with information about intergenerational child-care programs in their community can contact Paul Kerschner (NCOA, 202-479-6604) or Kim Helfgott (CWLA, 202-638-2952). wealthy, some argue it goes against the framework of Medicare, which is to provide services to seniors regardless of income. Other advocates say the income cutoff could be lowered to hit the middle class·Within a few years. "The administration's attempt to disable the Medicare program and erode its popular support without attempting to address the real issues of rapidly rising health care costs and the need for comprehensive health care reform is unconscionable," remarked Rep. Edward Roybal (D-CA). Roybal says the elderly have been paying more out-of-pocket health care costs for several years, with no end in sight. He commented that "to date, this administration has shown no willingness to ease this burden but is showing great enthusiasm for increasing it." About 500,000 elders would be af-
fected if Bush's plan for Part B gets approval from Congress, and it would save the government about $40 million. Bush also has proposed that elders pay a 20-percent co-insurance on lab tests, for a savings of $450 million. Overall, the Bush budget would raise Medicare budget by 9.2 percent, to $124 billion. But advocates, citing an anticipated growth of 12 percent, say it is not enough to cover costs. "As unfair as these cuts are, a greater tragedy is that this budget is clear evidence of the president's failed domestic leadership," observed Gary Christopherson, executive director of the Gray Panthers, a Washington, D.C., advocacy group for elders. Christopherson charged that the president "broke faith" with last year's budget agreement by seeking deeper cuts in Medicare.
Geriatric Nursing Mlly/June 199\
109
NEWS WATCH
UB nursing faculty (center, left to right) Patrida Burns, Ann Seid~ and Mary Anne Neary yisit Japanese meOKol colleagues in Kyoto, Japan, to discuss educational exchanges in geriatrics.
US Nurses Initiate Exchange withlapanese Colleagues BUFFALO, NY-Faculty at the State University of New York at Buffalo (UB) School of Nursing are working with Japanese schools, hospitals, and nursing officials to set up geriatric nurse education programs there. Japan has the fastest growing elderly population in the world, observed Patricia Burns, associate professor of nursing and director of the nursing school's Adult Nurse Practitioner Program. But Japan does not have an adequate number of nursing homes and health-related facilities to care for its ill elderly. Instead, hospitals or family members at home take care of them, without many of the support services offered in the US by home health-care agencies and related programs. Several exchanges have already taken place. Under discussion is a proposal to establish a program in which at least two Japanese nurses a year would study geriatric care at the UB Nursing School.
Guardianship Plan Tops New Bills in Congress WASHINGTON, DC- Lawmakers are beginning to turn their attention to health ""'r,..."...~=,.....,. care and other domestic issues. One of the new bills that Congress may I address comes from Rep. Edward Roybal (D-CA). Heis seeking to protect the rights Rep. Edward Roybal of elders who, for health reasons, may be placed under guardianship arrangements. The National Guardianship Rights
110 GeriatricNursing May/June 1991
Act would require that all elders facing guardianship receive ample notice of any proceeding and be represented by trained attorneys. The bill also says that an independent professional should examine elders and that elders have a right to a jury trial and appeal in any guardianship case. "Once under guardianship, a typical ward can no longer receive money or pay bills, marry or divorce, choose where to live or what medical care to receive," Roybal noted. He cited the plight of a 91-year-old Michigan man, a retired General Motors executive, who lost all rights and possessions without a hearing on the basis of testimony from one person-a speech therapist. A psychiatrist later pronounced the man of "fine and active
mind," but he died before he could successfully contest the guardianship. "Given the fact that Americans under guardianships are routinely denied due process of law, our current system of guardianship is nothing short of a national disgrace," Roybal continued. Roybal's bill would require that guardians receive extensive training. They would be mandated to provide annual reports to the court on the financial and physical health of the incapacitated individual. The U. S. Attorney General would have the right to withhold federal money from states that do not comply. In addition to the Roybal plan, lawmakers during the first two months of the 102nd Congress proposed legislation dealing with a variety of issues affecting nurses, health care delivery, and Medicare. Here is an overview of the major proposals: Advanced nurse education. Sens. Daniel Inouye and Daniel Akaka, both Democrats from Hawaii, introduced legislation to subsidize tuition for nurses seeking advanced degrees in exchange for the nurses' commitment to work in a facility designated by the Secretary of Health and Human Services (HHS). Students would receive a year of tuition aid for every year of commitment, and they would receive a $400 monthly stipend while in the scholarship program. LPN education. Rep. Frank Horton (R-NY) proposed legislation to give licensed practical nurses a tax deduction for tuition related to courses that will help them gain RN status. Nurse practitioner (NP) coverage. Sen. Inouye proposed another bill that would provide reimbursement for NP and clinical nurse specialist services under Part B of Medicare. The bill would make their services a mandatory benefit under Medicaid. Medicare co-insurance. Sen. Lloyd Bentsen (D-TX) introduced legislation that would lower the Medicare nursing home co-insurance rate to $65 for patients with stays between 21 and 100 days. Beneficiaries currently pay $78.50 a day during this period. News Watch continued on page 152
NEWS WATCH
PANAFIL'" Ointment [pan 'all./IIJ PANAFtLOil-WHITE Ointment Brief Summary. Please see package insert lor full prescribing information. DESCRIPTION PANAFIL'" Ointment Is an enzymatic debriding-healing ointment which contains standardized papain 10',1,. urea USP 10% and chiorophyilin copper complex 0.5%·In a hydrophilic base. Inactive ingredients are: While Petrolatum, USP; Propylene Glycol. USP; Slearyl Alcohol. NF; Sorbitan Monostearate, NF; Polyoxyl 40 Stearate, NF; Boric Acid, NF: Sodium Borate. NF; Chlorobutanol (Anhydrous). NF as a preservative. PANAFIL-WHITE is Identical except that the chlorophyllin copper complex Is omitted. INDICATIONS AND USES Ointment Is suggested for treatment 01 acute and chronic lesions such as varicose, diabetic and decubitus ulcers, burns, postoperative wounds, pilonidal cyst wounds, carbuncles and miscellaneous traumatic or Infected wounds. Oinlment is applied continuously throughout treatment of these conditions (1) for enzymatic debridement of necrotic tissue and liquefaction of fibrinous, purulenl debris, (2) to keep lhe wound clean. and simultaneously (3) to promote normal healing. CONTRAINDICATIONS Nona known. PRECAUTIONS See Dosage and Administration. Not to be used in eyes. ADVERSE REACTIONS Ointment Is generally well tolerated and nonirritating. A small percentage of patients may experience a transient "burning" sensation on application of the ointment. Occasionally, the profusa exudate resulting from enzymatic digestion may caUSe irritation. In such cases. more Irequent changes 01 dressings unlll eXUdate diminIshes will alleviate discomfort. DOSAGE AND ADMINISTRATION Apply Ointment direclfy to lesion and cover with gauze or linen dressing. When practicable, daily or twice dally changes of dressings are preferred. Longer Intervals between redresslngs (two or three days) have proved satlstactory. and Ointment may be applied under pressure dressings. At each redressing. the lesion should be Irrlgsted with Isotonfc saline solution or other mild cleansing solution (except hydrogen perOXide solution. whIch may Inaclivale lhe papain) to remove eny accumulation of IIquafled necrotic material. NOTE Papain may also be inactivated by Ihe salls or heavy metals (lead, sliver, mercury. elc.). Conlact with medications containing these metals should be avoided. HOW SUPPLIED PANAFIL-1 oZ. lubes. (NDC 0263-5145-01 j. lIb. jars, (NDC 0263-5145-16). PANAFIL-WHITE-l oz. tubes, (NDC-Q263-5148-01). CAUTION Federal law prohibits dispensing without prescription.
continued from page 110
Nurses on the Move in Long-Tem1. Care SEATTLE, WA-Janice L. Wynne-McGuire, RN, MA, has been appointed direc, tor of nursing and clinical services of the Ida Culver House Broadview. She is in charge of services at the Nursing Care Center, a skilled nursing facility in the new retirement community, and oversees a staff of 60 professionals. WEYMOUTH, MA-Kathryn Louise Keaney, RN, has been promoted to director of nursing at Bay Path at Duxbury Nursing & Rehabilitation Center. She will direct a staff of 110 nursing professionals in the 120-bed facility. BALTIMORE, MD-Jacqueline J. Birmingham, RN, BSN, was elected president of the American Association for Continuity of Care, the n ational association for health care professionals specializing in posthospitalization planning and care. She is director of home care planning, Hartford Hospital, Hartford, cr.
Sullivan Names Elder Abuse Task Force
c&stt® Company, Inc.
47 Center Avenue, P.O. Box 214 Little Falls, NJ 07424-0214 (201) 256-3737
©1990 Rystan, Inc.
1/91
WASHINGTON, DC-Health and Human Services (RHS) Secretary Louis Sullivan announced the formation of a special task force that will examine elder abuse in home and institutional settings.
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CLASSIFIED ADS Advertisements are accepted for publication from nurses seeking positions or from institutions and agencies regarding special programs and staff positions to fill. All advertising copy is subject to Geriatric Nursing editor's approval. However, publication of an advertisement does not constitute endorsement. Classified advertising is charged at $17.00 per printed line. Display advertising rates on request. Ad copy or cancellation must be received in our office NO LATER than the 25th of the second month preceding date of issue. For example, copy for the JulyAugust issue must be received no later than May 25. $85 minimum per ad_ Mail your order /0: Classified Advertising Department Geria/ric NlJrsi/lg 555 W. 57 St.
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WATCH
California and Federal Government Negotiate Cease Fire SACRAMENTO, CA-A showdown between the Health Care Financing Administration (HCFA) and the State of California ended up in a March 11 agreement that the state and HCFA will work together to possibly revise the Interpretive Guidelines for the Omnibus Budget Reconciliation Act (OBRA) 87 Nursing Home Reform Amendments. California's lawsuit against the U.S. Secretary of Health and Human Services, Kitzer v. Sullivan, will be on hold until April 11 , and the state will begin surveying nursing facilities' compliance with OBRA87. Battle lines were drawn when California filed suit against the federal government, charging that the federal government had unlawfully withheld Medicaid funds needed to implement provisions of the 19'i57 Nursing Home Reform Act, which took effect October 1. Of $5 billion Medicaid dollars slated for California, the federal government had already held $24 million. In the lawsuit, California charged that HCFA had illegally mandated costly and unnecesary standards in its Interpretive Guidelines and asserted that "California refuses to comply with these illegal pronouncementc;." The often cited example of the state's dispute with the Interpretive Guidelines but not the reform amendments is room furnishings. The requirement, says state officials, is that each room have a chest of drawers, a night stand, and a chair. "What if the person is comatose?" asks a California spokesperson. Such unnecessary requirements drive up the expense of complying with the nursing home reform amendments, which the state estimates will cost $500 million a year. California Gov. Pete Wilson maintains that the suit reflects the problems of such other states as Kentucky, Ohio, Pennsylvania, and West Virginia,
108
GerintricNursing MnylJunc 19')1
which reportedly also are unable to comply with mandates the federal government has not provided funds to carry out. In early March, the HCFA sent more than 100 investigators to California in response to the state's refusal to survey its 1500 facilities according to the Interpretive Guidelines. Wilson, however, has argued that the rights of nursing home residents in California were already adequately protected by state regulations, a point the HFCA questions. HCFA chief Gail Wilensky, defending the Interpretive Guidelines, pointed out that they were meant to be only suggestions for inspectors. They "do not establish requirementsthatmustbe HCFA chief Wilensky met," she noted. Following Wilensky's explanation, plantiffs in Valdivia v. Department of Health Services, a suit filed last fall to force California to comply with OBRA 'i57, filed a motion for the Interpretive Guidelines to be designated rules, which would force nursing home facilities to comply with them fully.
States Reeling under Medicaid Mandates WASHINGTON, DC-Faced with new nursing home requirements and other federal health mandates, recession-weary states appear on the verge of slashing their Medicaid programs. Governors in about 30 states are proposing cutbacks in state programs such as Medicaid, says the American
Association of Homes for the Aging (A AHA). These states also are shelling out few new dollars for the nursing home reforms in the Omnibus Budget Reconciliation Act (OBRA) of 1987. While OBRA may cost as much as $9 more a day per patient, some states actually are cutting their Medicaid funding for nursing homes, noted Diana Elani, health-payment analyst for AAHA. Maryland and New York, for example, reserved a small amount of funds for the OBRA changes. Yet they also cut the basic reimbursement rates by a larger margin, leaving nursing homes with a net loss, Elani said. Given the current economic climate, "We're finding a wave [of Medicaid cuts] across the country," Elani remarked, with other states such as Connecticut and Massachusetts considering similar moves. Earlier this year, the nation's governors asked Congress to refrain from setting new health care mandates unless they included additional funding. "It appears to us that what is really happening is a 'back-door approach' to universal health care, using Medicaid as the vehicle and the states' credit cards as the financing mechanism," Arkansas Gov. Bill Clinton told a House subcommittee recently. Aside from the OBRA changes, Clinton said states are grappling with many new initiatives to expand Medicaid coverage to low-income women and children. But with much of the nation in recession, states have become the "pressure point" for government assistance, he continued. AAHA also blames the Medicaid squeeze on case-mix payment systems, which base reimbursements on resident characteristics and a nursing home's mix of patients. About 15 states currently use a case-mix system, and the Health Care Financing Ad-
ministration (HCFA) is directing a demonstration program affecting five other states. AAHA says many stales use case-mix systems to cap costs. Last year, Congress tried to deal with the funding issue by passing legislation that called on states to provide sufficient funding to help nursing home residents meet their highest functioning level. But even that has not assuaged arguments over cost. "Most states feel they haven't got a lot of money for OBRA," Elani commented. Federal and state governments "still haven't figured out how much the OBRAchanges will cost."
To Keep Your GNPs, Don't Change! NEW YORK, NY-A change of ownership or organizational structure can make geriatric nurse practitioners start looking for a new job. David Radosevich of the University of Minnesota tracked 97 nursing home nurses, prepared as GNPs, who were primarily employed in rural settings [Aging Research and Training News Vol. 13, No. 10]. The average length of employment in their first GNP job was more than 4.5 years. As many as 58 of the 97 GNPs were still in their first job when the study was done. For the rest, organizational change was the most frequently stated reason for leaving.
Bush Hurls Budget Axe At Medicare WASHINGTON, DC-The Bush administration's plans to raise Medicare premiums for high-income beneficiaries have drawn fire from advocates, who are appealing to Congress. In his FY '92 budget, Bush proposed new Medicare rate hikt:s for high-income elders earning more than $125,000 a year and couples earning $150,000 a year. They would pay 75 percent of the cost of the Medicare Part B program, while other elders would pay premiums to cover only 25 percent of program costs. While the plan would hit only the
In the intergenerational programs, residents of the Joseph L. Morse Geriatric Center in West Palm Beach, Fl., visit with preschoolers at an inner-dty day school.
Elders and Children Caring for Each Other WASHINGTON, DC-If your long-term care facility is tapping the talents of elders with an intergenerational child-care program, Generations United wants to know about it. And if you don't have an intergenerational program, but think you'd like to start one, this coalition of 100 organizations-cochaired by the National Council on Aging (NCOA) and the Child Welfare League of America (CWLA)-would like to help. Using a grant recently awarded by the Administration on Aging, Generations United will serve as a clearinghouse and guide to intergenerational child-care resources and programs, plus provide technical assistance to organizations that wish to start a program. The coalition is now trying to gather information on existing programs in order to prepare a compendium of programs that will be available to the public on a computerized database. Those with information about intergenerational child-care programs in their community can contact Paul Kerschner (NCOA, 202-479-6604) or Kim Helfgott (CWLA, 202-638-2952). wealthy, some argue it goes against the framework of Medicare, which is to provide services to seniors regardless of income. Other advocates say the income cutoff could be lowered to hit the middle class·Within a few years. "The administration's attempt to disable the Medicare program and erode its popular support without attempting to address the real issues of rapidly rising health care costs and the need for comprehensive health care reform is unconscionable," remarked Rep. Edward Roybal (D-CA). Roybal says the elderly have been paying more out-of-pocket health care costs for several years, with no end in sight. He commented that "to date, this administration has shown no willingness to ease this burden but is showing great enthusiasm for increasing it." About 500,000 elders would be af-
fected if Bush's plan for Part B gets approval from Congress, and it would save the government about $40 million. Bush also has proposed that elders pay a 20-percent co-insurance on lab tests, for a savings of $450 million. Overall, the Bush budget would raise Medicare budget by 9.2 percent, to $124 billion. But advocates, citing an anticipated growth of 12 percent, say it is not enough to cover costs. "As unfair as these cuts are, a greater tragedy is that this budget is clear evidence of the president's failed domestic leadership," observed Gary Christopherson, executive director of the Gray Panthers, a Washington, D.C., advocacy group for elders. Christopherson charged that the president "broke faith" with last year's budget agreement by seeking deeper cuts in Medicare.
Geriatric Nursing Mlly/June 199\
109
NEWS WATCH
UB nursing faculty (center, left to right) Patrida Burns, Ann Seid~ and Mary Anne Neary yisit Japanese meOKol colleagues in Kyoto, Japan, to discuss educational exchanges in geriatrics.
US Nurses Initiate Exchange withlapanese Colleagues BUFFALO, NY-Faculty at the State University of New York at Buffalo (UB) School of Nursing are working with Japanese schools, hospitals, and nursing officials to set up geriatric nurse education programs there. Japan has the fastest growing elderly population in the world, observed Patricia Burns, associate professor of nursing and director of the nursing school's Adult Nurse Practitioner Program. But Japan does not have an adequate number of nursing homes and health-related facilities to care for its ill elderly. Instead, hospitals or family members at home take care of them, without many of the support services offered in the US by home health-care agencies and related programs. Several exchanges have already taken place. Under discussion is a proposal to establish a program in which at least two Japanese nurses a year would study geriatric care at the UB Nursing School.
Guardianship Plan Tops New Bills in Congress WASHINGTON, DC- Lawmakers are beginning to turn their attention to health ""'r,..."...~=,.....,. care and other domestic issues. One of the new bills that Congress may I address comes from Rep. Edward Roybal (D-CA). Heis seeking to protect the rights Rep. Edward Roybal of elders who, for health reasons, may be placed under guardianship arrangements. The National Guardianship Rights
110 GeriatricNursing May/June 1991
Act would require that all elders facing guardianship receive ample notice of any proceeding and be represented by trained attorneys. The bill also says that an independent professional should examine elders and that elders have a right to a jury trial and appeal in any guardianship case. "Once under guardianship, a typical ward can no longer receive money or pay bills, marry or divorce, choose where to live or what medical care to receive," Roybal noted. He cited the plight of a 91-year-old Michigan man, a retired General Motors executive, who lost all rights and possessions without a hearing on the basis of testimony from one person-a speech therapist. A psychiatrist later pronounced the man of "fine and active
mind," but he died before he could successfully contest the guardianship. "Given the fact that Americans under guardianships are routinely denied due process of law, our current system of guardianship is nothing short of a national disgrace," Roybal continued. Roybal's bill would require that guardians receive extensive training. They would be mandated to provide annual reports to the court on the financial and physical health of the incapacitated individual. The U. S. Attorney General would have the right to withhold federal money from states that do not comply. In addition to the Roybal plan, lawmakers during the first two months of the 102nd Congress proposed legislation dealing with a variety of issues affecting nurses, health care delivery, and Medicare. Here is an overview of the major proposals: Advanced nurse education. Sens. Daniel Inouye and Daniel Akaka, both Democrats from Hawaii, introduced legislation to subsidize tuition for nurses seeking advanced degrees in exchange for the nurses' commitment to work in a facility designated by the Secretary of Health and Human Services (HHS). Students would receive a year of tuition aid for every year of commitment, and they would receive a $400 monthly stipend while in the scholarship program. LPN education. Rep. Frank Horton (R-NY) proposed legislation to give licensed practical nurses a tax deduction for tuition related to courses that will help them gain RN status. Nurse practitioner (NP) coverage. Sen. Inouye proposed another bill that would provide reimbursement for NP and clinical nurse specialist services under Part B of Medicare. The bill would make their services a mandatory benefit under Medicaid. Medicare co-insurance. Sen. Lloyd Bentsen (D-TX) introduced legislation that would lower the Medicare nursing home co-insurance rate to $65 for patients with stays between 21 and 100 days. Beneficiaries currently pay $78.50 a day during this period. News Watch continued on page 152
NEWS WATCH
PANAFIL'" Ointment [pan 'all./IIJ PANAFtLOil-WHITE Ointment Brief Summary. Please see package insert lor full prescribing information. DESCRIPTION PANAFIL'" Ointment Is an enzymatic debriding-healing ointment which contains standardized papain 10',1,. urea USP 10% and chiorophyilin copper complex 0.5%·In a hydrophilic base. Inactive ingredients are: While Petrolatum, USP; Propylene Glycol. USP; Slearyl Alcohol. NF; Sorbitan Monostearate, NF; Polyoxyl 40 Stearate, NF; Boric Acid, NF: Sodium Borate. NF; Chlorobutanol (Anhydrous). NF as a preservative. PANAFIL-WHITE is Identical except that the chlorophyllin copper complex Is omitted. INDICATIONS AND USES Ointment Is suggested for treatment 01 acute and chronic lesions such as varicose, diabetic and decubitus ulcers, burns, postoperative wounds, pilonidal cyst wounds, carbuncles and miscellaneous traumatic or Infected wounds. Oinlment is applied continuously throughout treatment of these conditions (1) for enzymatic debridement of necrotic tissue and liquefaction of fibrinous, purulenl debris, (2) to keep lhe wound clean. and simultaneously (3) to promote normal healing. CONTRAINDICATIONS Nona known. PRECAUTIONS See Dosage and Administration. Not to be used in eyes. ADVERSE REACTIONS Ointment Is generally well tolerated and nonirritating. A small percentage of patients may experience a transient "burning" sensation on application of the ointment. Occasionally, the profusa exudate resulting from enzymatic digestion may caUSe irritation. In such cases. more Irequent changes 01 dressings unlll eXUdate diminIshes will alleviate discomfort. DOSAGE AND ADMINISTRATION Apply Ointment direclfy to lesion and cover with gauze or linen dressing. When practicable, daily or twice dally changes of dressings are preferred. Longer Intervals between redresslngs (two or three days) have proved satlstactory. and Ointment may be applied under pressure dressings. At each redressing. the lesion should be Irrlgsted with Isotonfc saline solution or other mild cleansing solution (except hydrogen perOXide solution. whIch may Inaclivale lhe papain) to remove eny accumulation of IIquafled necrotic material. NOTE Papain may also be inactivated by Ihe salls or heavy metals (lead, sliver, mercury. elc.). Conlact with medications containing these metals should be avoided. HOW SUPPLIED PANAFIL-1 oZ. lubes. (NDC 0263-5145-01 j. lIb. jars, (NDC 0263-5145-16). PANAFIL-WHITE-l oz. tubes, (NDC-Q263-5148-01). CAUTION Federal law prohibits dispensing without prescription.
continued from page 110
Nurses on the Move in Long-Tem1. Care SEATTLE, WA-Janice L. Wynne-McGuire, RN, MA, has been appointed direc, tor of nursing and clinical services of the Ida Culver House Broadview. She is in charge of services at the Nursing Care Center, a skilled nursing facility in the new retirement community, and oversees a staff of 60 professionals. WEYMOUTH, MA-Kathryn Louise Keaney, RN, has been promoted to director of nursing at Bay Path at Duxbury Nursing & Rehabilitation Center. She will direct a staff of 110 nursing professionals in the 120-bed facility. BALTIMORE, MD-Jacqueline J. Birmingham, RN, BSN, was elected president of the American Association for Continuity of Care, the n ational association for health care professionals specializing in posthospitalization planning and care. She is director of home care planning, Hartford Hospital, Hartford, cr.
Sullivan Names Elder Abuse Task Force
c&stt® Company, Inc.
47 Center Avenue, P.O. Box 214 Little Falls, NJ 07424-0214 (201) 256-3737
©1990 Rystan, Inc.
1/91
WASHINGTON, DC-Health and Human Services (RHS) Secretary Louis Sullivan announced the formation of a special task force that will examine elder abuse in home and institutional settings.
ALTERNATIVE PRODUCTS FOR RESTRAINT-FREE ENVIRONMENTS
V AMBULARM™
V EXIT ALARM
v
WALK ALERT SLIPPERS
Call for further infonnation: 800-826-7444 415-381-9009
ALERTCARE 591 Redwood Hwy. Suite 2125 Mill Valley, CA 94941 Circle No. 18 on Reader Inquiry Card
CLASSIFIED ADS Advertisements are accepted for publication from nurses seeking positions or from institutions and agencies regarding special programs and staff positions to fill. All advertising copy is subject to Geriatric Nursing editor's approval. However, publication of an advertisement does not constitute endorsement. Classified advertising is charged at $17.00 per printed line. Display advertising rates on request. Ad copy or cancellation must be received in our office NO LATER than the 25th of the second month preceding date of issue. For example, copy for the JulyAugust issue must be received no later than May 25. $85 minimum per ad_ Mail your order /0: Classified Advertising Department Geria/ric NlJrsi/lg 555 W. 57 St.
152 GerinlricNul1!ing Mny/Junel991
New York, New York 10019-2961