On December 12, 2003, a federal court approved settlement of a class action law suit, Davis, et al. v. CHHSA, et al., (Case No. C00-2532-SBA) which alleged violations of the Americans with Disabilities Act. The settlement agreement between the Plaintifs (seven Laguna Hona Hospital residents and the Independent Living Resource CenterSan Francisco) and the City and County of San Francisco, created a Targeted Case Management program to assess whether residents of Laguna Honda Hospital could be served in community-based settings. One of the co-counsels who assisted with filing the Davis lawsuit is Protection & Advocacy, Inc. (PAI), a non-profit agency with responsibility for providing advocacy services.
The Davis settlement stipulated that by March 29, 2004 San Francisco would implement a Targeted Case Management Program within San Franciscos Department of Public Health to conduct screening, assessments, service/discharge planning, and ongoing case management. Using a tool that it had developed (but which is not validated for using in nursing homes), the Targeted Case Management program estimated that 80% of Laguna Hondas patients could live in the community. The TCMs claim found its way into other public documents in San Francisco, although some staff at Laguna Honda have asserted TCMs 80% estimate is wildly inaccurate.
In a separate lawsuit the so-called Chambers case filed by PAI as one of the co-counsels, PAI has asserted that According to TCM assessments, the vast majority of the over 1,000 Laguna Honda residents could live at home or in the community if housing and appropriate services were provided to them. One of the attachments to the Davis settlement agreement is not posted on PAIs web site. It is data from the Minimum Data Set Home Care (MDS-HC), which is based on another assessment tool that has also not been validated for use in nursing homes. PAI surely must be aware of the MDS data that disproves TCMs flawed data.
The MDS system reports clinical quality measures data to the federal Centers for Medicare and Medicaid Services (CMS) during a residents stay in a skilled nursing facility. The MDS data is also analyzed by researchers at the University of WisconsinMadison at the Center for Health Systems Research and Analysis, in reports known as CHSRA, named after the Center. CHSRA reports compare data for a given facility against state and national averages for a variety of data points, including such things as the prevalence of falls, high risk residents with pressure ulcers, and residents who are physically restrained, among other quality measures.
In response to a public records request, Laguna Honda Hospital has released a CHSRA data analysis for Fiscal Year July 1, 2006 through June 30, 2007 that shows fully 73% of Laguna Hondas residents have no potential for discharge to the community. As well, during a comparable period, CHSRA data for the comparison groups document that 54% of residents in other California nursing homes have no discharge potential, and the national average of those with no discharge potential is 63%, demonstrating that residents of Laguna Honda have a statistically-significant higher prevalence of no discharge potential. In contrast, while the state and national averages for those with discharge potential within either 30 days or 3090 days stood at approximately 20% and 18%, respectively, residents of Laguna Honda who had an identified discharge potential of less than 30 days or between 30 and 90 days fluctuated between 4.5% and 5.9% during FY 0607, roughly three to five times lower than state and national averages. (Residents with uncertain discharge potential at LHH ranged from 20.6% to 21.8%, while state and national averages for those with uncertain discharge potential were approximatly 25% and 18%, respectively.)
The CHSRA data is an antidote to the misinformation that 80% of Laguna Hondas resdients could be served in the community. The MDS and CHSRA data clearly illustrate that the TCMs assertion that 80% of Laguna Hondas residents, and PAIs allegation that the vast majority of Laguna Hondas residents, could live in the community, are wildly incorrect.
Both the federal Courts and San Franciscos public policy makers should ignore TCMs and PAIs exaggerated claims, and the Courts and San Francisco officials should pay closer attention to verifiable MDS and CHSRA data provided to CMS.
Mark Chambers, Woodrow Falls, Jr., M.H., Phillip K., Gerald Scott, Mary T. and the Independent Living Resource Center of San Francisco, et al., Plaintiffs, vs. City and County of San Francisco, Defendant, Case No. C06-06346 WHA.
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