Carrie Teegardin, exposes many interesting aspects of the nursing home industry that should disturb anyone living within this State. She confirms that not only does Georgia not care if you get good or bad care in a nursing home, but it has set up an incentives program which actually encourages neglected care. The in depth analysis exposes clearly that major nursing home players care only about expense and profit, not about the quality of care for residents, or the fact that their cost cutting measures create the environment for the many violations they receive every year for harming residents. Her recent work allows us to take a comprehensive look into what is really going on in this State.

"Four of the nation's largest nursing home chains run many of the worst homes in Georgia. Their homes also appear to have the largest operating margins - an average of $784,000 per home, compared with about $93,000 for other smaller for-profit-mom-and-pop-facilities." In Georgia it does not matter whether you provide quality care or harmful care to residents, reimbursement rates are the same. For instance, a Jonesboro home run by Beverly enterprises reports one of the highest operating margins in 2001, but in the same year, the home is cited many times, owning one of the worst records in the State for harming its own residents.

Sunbridge Healthcare, where the Carr brothers were murdered, operated 6 nursing homes in GA with daily staffing levels below minimal standards required by Medicaid. When Carol Carr shot her son's there 2 months ago, Sunbridge was found to be understaffed more often than any other home in the state, but instead of being fined, "the state paid tens of thousands of dollars as reward for keeping costs down." 5 of their 6 homes grossed $300,000 the same year. Ansley Pavilion, one of Georgia's worst homes until it closed in December 2000, received incentive payments for keeping staff and other costs low, even while inspectors cited the Midtown Atlanta home for insufficient staff, patient abuse and neglect.

"3 of every 4 nursing homes in GA are run by national chains. Georgia and other sunbelt states have some of the highest concentrations of for-profit-homes in the country." The AJC analysis found after analyzing data that the system rewards nursing homes that keep their patient care expenses down. Trying to save tax dollars, Georgia's Medicaid program each year doles out hundreds of thousands of dollars in bonus payments as an incentive for homes that spend the least. Those bonuses are paid even where government inspectors have found residents in danger. The current system offers no bonuses to homes with the best record of quality care.

Staff at Savannah Home Kindred Care neglected to call a doctor more than 36 hours after a resident began vomiting violently. The man died in September, a day after going to the emergency room for a broken hip, bowel obstruction, and high white cell count. State inspection records cited Kindred Homes 80 times for actual harm in the past 4 years. A Jonesboro home run by Beverly Enterprises, was cited when an inspector found a woman with numerous bedsores lying in linens soaked with urine and feces that had contaminated her wound dressings. Staff did not even immediately address the problem even after being pointed out the problem. Beverly Homes was cited 78 times for harming residents in the past four years. A Rome home run by Sunbridge Healthcare was cited after a resident reports being sexually molested twice, by a staff member who drew curtains around her bed at night, to kiss and fondle her. Sunbridge's homes have been cited 68 times in past 4 years.
"Staffing was so thin at 33 homes on average that they violated minimal daily staffing levels every day last year, and never had to pay any retribution because state regulators never enforce the requirement. Medicaid officials promised in December to demand accountability, but have yet to enforce the minimums." In Georgia, we have some of the lowest-trained, paid, and educated people, doing bedside care. Most don't stick to their jobs because of the overwhelming workload and low hourly wages. No two people anywhere can properly attend decently, the needs of 15 to 24 people a night, day in and day out. Only four other states have average staffing levels of nurses and nurse's aides that are lower than Georgia's. Nurse's aides here earn an average wage of $7.40 an hour, among the lowest in the nation. Fast-food cooks make nearly as much -- $6.56 on average.

"In Georgia, where for-profit-homes dominate the industry, nursing homes have the goal of making money." The analysis shows that facilities operated by four national chains earn much higher operating margins and poorer inspection records than the other nursing homes. State inspectors wrote up the five national chains' homes for substandard care 65 percent more often than the cited other for-profit- homes over the last 4 years. When Governor Barnes took office, he increased state payments to nursing homes operators, who so happen to have been a major contributor in his past campaigns, donating $1.1 million dollars to both his 1998 and 2002 campaigns.

Back in 1997, Bob Kafka of ADAPT, did a similar insightful comparative study, but instead of nursing homes he compared states, expenses for community and institutional placement. He then released the information in a "10 Worst in the Nation list." Georgia ranked 7th on that list allowing 85% of the Medicaid Long Term Care dollar to be used in nursing facilities. 7 of the 10 worst states were in the southeastern sunbelt region, with Tennessee topping off the list as being the absolute worst in the nation using 93% of its Medicaid long term care funds to support institutional placement.

Georgia was thrust into national limelight again when the following year, the U.S. Supreme Court decided to hear the case, Olmstead vs. L.C./E.W. challenging State's rights to decide institutional placement and whether it was fair according to Title II of the Americans with Disabilities Act calling for "most integrated setting." Independent living advocates favored community based services wanting the case to hopingly establish a written agenda for alternatives to institutional placement. The fact that things were so biased here actually helped the U.S. Supreme Court side with people's rights.

This decision set new precedence in long term care policy, forcing State's to create and have a plan for community based care as well as initiative to transition people out of institutional placement into community services, however though the decision gave us a strong foundation to sue States for violating people's civil rights, the enforcement of such litigation is still being pursued. And that's where we're at and why MiCASSA is not yet passed and Georgia can continue its long history of violating citizen's rights.

As long as long-term care policy is directed for the profit of a few, many will continue to suffer. Some advocates like myself don't want to shut down all of the nursing homes in the country. We just want to guarantee quality service and choices. Smaller scale nursing homes like Presbyteran Village mentioned in the AJC report, do honor their residents who enjoy assembly with others of similar circumstance. People find comfort with those experiencing like situation. Even for me, back when first injured , the idea of living amongst a group of young people with disabilities seemed very appealing, therapeutic. Group settings for some, means they are not alone against the world. It's the scariest thing, to be a freak among the masses, always looked at and made fun of.

There is no reason why the nursing home industry, cannot be a inclusive part of the healthy holistic world of long term care serving the elderly, disabled populations in a inspiringly beneficial way. That and the inclusion of community based services nation wide, and enforcement of accountability should force for-profit-harmful-to-resident nursing homes to shut down. They will no longer serve as dumping grounds for people who have nowhere else to go. Community services and facilities providing beautiful space, where individuals can face disease, age, and disability with a clear knowing that their last years will be of comfort and resignation, worry free of neglect, abuse, and enduring pain, will be the ones to survive the weeding out process. Besides wasn't that the promise, wok hard until your 65 so that you can finally settle to pleasurable living

Sources of information referenced by the Sunday articles include:

www.medicare.gov/ inspection data for every nursing home in the nation

http://www.accessatlanta.com/ajc/metro/nursinghomes/index.html
inspection data for Georgia and financial data nowhere else available
 
Based on several articles written by Carrie Teegrardin, a Journal-Constitution Staff Writer

Many soldiers joined the military as a result of how they felt when the Twin Towers fell on that fateful day in lower Manhattan, September 11th, 2001. They had determined to take a patriotic stance in defense of our nation, to do something that might protect their families and the lives of their children. Some had joined the military as a way to escape mediocre jobs, a desperate economy, and lives of restlessness with friends, who like them, had no sense of optimism for what the future hold. Many lean on the military to discipline themselves, access adventure while at the same time invest in later education as follow-up to a military career. Some joined as military reserves thinking limited service a great way of supplementing income without necessarily having to devote all of oneself to full time service. And so they joined at a time when they knew our nation was to go to war. This would be their way of honoring those who had in other times stood up in defense of our nation. 300,000 had so far served tours of duty in Iraq, many returned lives intact able to go on to other things. Others though would find themselves critically injured, facing futures with life long disabilities.

21 year old, Jay Briseno from Manassas Park, Va., was in Baghdad on a sweltering afternoon in June 2003 when out of nowhere a bullet pierced the back of his neck. The army rushed Briseno to one hospital after another, saving him from multiple heart attacks and strokes until finally he stabilized enough to be shipped back stateside. Briseno is a high level quadriplegic tethered to a respirator forgotten by the war that rages on without him, chewing up other young men and women, leaving them equally destroyed families left to help out where they can.

His care was left to his parents and sisters initially as all struggled to adjust. His father, Joe quit his job to be with his son. "From the beginning all we got from the VA was lip service. They questioned every piece of equipment we asked for. They told us Jay should be in an institution. They told us to give up on him. We were desperate when these people from the Army called and said, Do you have what you need? Is there any way we can help?" Thousand's like the Briseno family will be forced to navigate the difficult and often frustrating course of learning about the benefits and services of disabled veterans. With ongoing cuts to the VA and benefits for veterans, the fight to maintain services for those returning from the Iraq war is an uphill battle.

A few weeks after the Iraq war started and just 3 days before President Bush spent the Memorial Day weekend thanking the nation's veterans for their service, he proposed slashing Veteran's health care by $1 billion next year. An administration memo proposed a 3.4 percent cut in the Veterans Administration budget for 2005, from $29.7 billion to $28.7 billion, this follows other cutbacks since George W. became president. It is not that there is a lack of funding for the military, in fact this year we will spend $16.9 billion more on military increasing funding to $399.1 billion dollars. America spends more on military spending than the combined annual spending of the next 18 nation's combined.
You would think that the President and our congress would find it a priority to take care of those who give of themselves to defend our freedoms. Rep. Jan Schakowsky, a Democrat from Illinois' 9th Congressional District said, "I find it incomprehensible that a plan to reduce benefits for veterans in Illinois and across the country would even be contemplated at a time when hundreds of thousands of active-duty soldiers are risking their lives in Iraq. I join the Disabled American Veterans in asking, Is there is no honor left in the hallowed halls of our government that you choose to dishonor the sacrifices of our nation's heroes and rob our programs--health care and disability compensation--to pay for tax cuts for the wealthy.''

For decades, the Veterans Administration has struggled to keep up with providing health care to the 7.5 million veterans enrolled. At any one time, more than 3,000 vets await their first visit to the doctor. Those whose injuries from battle qualify them for disability compensation wait six months to two years to receive it. Veterans of the Iraq and Afghanistan wars, have waited 54 days on average to get their first veteran disability compensation checks. With VA's costs increasing by 10% to 15% a year, and newly disabled veterans draining resources the system is under a serious strain. According to David Uchic, spokesman for Paralyzed Veterans of America. "It doesn't just end with them going to Walter Reed [Army Medical Center in Washington] and being treated. This is a lifelong situation for them for the next 60 to 80 years. So is the system going to be ready to serve them for all those years? That is the question."

The next question is how many have been hurt from this war? The Pentagon defines both combat related and non-combat related injury and death. Their official tally shows only deaths and wounded in action. It doesn't include "non-combat" injured, those whose injuries were not the result of enemy fire. The 'official' count of injured in Iraq according to a UPI press release dated November 14th, 2004 has just now surpassed 9,200. However, if you study the number of soldiers flown to Landstuhl Regional Medical Center, the U.S. military hospital in Germany that receives all injured soldiers evacuated from Iraq and Afghanistan and the number of soldiers back in the States trying to get Veterans benefits, actual numbers swell to over 42,000 and this does not include the number of soldiers who will return and then go through post traumatic stress disorder as many soldiers did upon return from Viet Nam.

Bullets, RPG's, and mortar rounds discriminate less about casualty and being killed than our government's definition of being wounded in action. The Pentagon will only recognize a soldier's sacrifice for our country under the strictest mandate and interpretations of what it means to acquire a combat related injury. Take the case of Joel Gomez for instance, Gomez, was riding in the back of a Bradley fighting vehicle hunting insurgents on a dirt road when the ground gave way and they ended up rolling down the mountain. They landed upside-down in the Tigris River. Both of his buddies were killed and Gomez became a quadriplegic unable to move. Though he was in a military situation, doing a mission that was combat related the Pentagon defined him as "non-combat injured."

Another example: Chris Schneider, a young Kansas father, part of a Reserve unit providing security for a supply convoy traveling 100 miles through hostile territory, was injured when another convoy of heavy equipment transporters slammed into his truck throwing him 50 feet through the air until he landed on the road. The second transport in that convoy locked up brakes, sliding 50 feet until it came to rest on his pelvis wedging his lower leg into the axle. Schneider now uses an artificial leg and walks with a limp. According to 60 minutes which did this interview, he too is not counted on the Pentagon's casualty count.

Though it doesn't make sense to the soldiers that have returned from Iraq, 62 year old civilian Gene Bolles has a good idea. Dr. Bolles has spent two years at the hospital in Landstuhl, Germany, where he specializes in brain and spinal injuries. As a neurosurgeon with 32 years of practice, he admits he has never seen trauma to this degree. He says, "What you see on TV and what you see in reality, is like night and day. The embedding of the journalists made the war out to be like a football game. The true effects of war are not reported at all. In fact, the Bush administration has forbidden journalists from taking pictures of wounded or dead soldiers or even the hundreds of caskets that have been flown in from war. Many have said that the administration does not want what happened during Vietnam to happen today, that being loss of popular support for the war. Especially in wake of no weapons of mass destruction, no connection to Al-Qaeda, no imminent threat, and the UN stance of the war against Iraq being an illegal war."

60 Minutes asked the Department of Defense for an interview on non-combatant injury- totals. The DOD declined but sent a letter alleging "More than 15,000 troops with so-called 'non-battle' injuries and diseases have been evacuated from Iraq." However, Dr. Bolles says, "I've seen figures that are now upwards of 30,000. I know that at least 20,000 have been air-evacuated into the Landstuhl system." According to some veteran groups, 33,000 have sought VA care, 26,000 have filed VA disability claims, and 10,000 have sought VA counseling. With the Pentagon's official casualty number exceeding 9,200 and unofficial 'non-combative' injury number exceeding 33,000, America better get ready for a whole population of soldiers that will need her support. I ask you for the sake of those soldiers who fight because they believe in America and the democracy we represent to the world, call your Representatives and your Senators and tell them to support Veteran's benefits as many, many will need them. Our government owes responsibility to those people sent off to fight wars we insist necessary. Should they become injured during the process of any engagement, we should absolutely and without question, honor their service by providing all the things which will aide in their return from war and reintegration back into American society.