Conference News & Views

An Open Letter to Commissioner Susan Cooper, Tennessee Department of Health

A society ... in particular its leaders ... will be judged by how well it cares for its most vulnerable members. How will our society be judged? How will you be judged?

As you know, last week McKendree Village was informed that its Medicare/Medicaid certification would be terminated on December 29, 2007. As a result, those of us who have family members on Medicaid have been told that we need to be prepared to move them to another facility. At the present time, there are simply no beds available in the Nashville area. Even if there were, in my opinion, the emotional and physical trauma of transfer to a new facility would be harmful to the current residents many of whom are very fragile.

My mother has been at McKendree since August of 2006. I chose McKendree because I believed it to be the best nursing home (which accepts Medicaid patients) in the Nashville area. I still believe it is the best for her to be. Before Mom went to McKendree, she was in a vicious cycle of spending 3 or 4 days in the hospital for severe urinary tract infections, pulmonary emboli, dehydration, and mental confusion ... going to rehab for 2 or 3 weeks ... then coming home only to repeat the cycle of hospitalization and rehab a month or so later. From November of 2005 to July of 2006 (the eight months prior to her admission to McKendree), my mother had 4 hospital admissions and 3 rounds of rehab. Since she has been at McKendree (the last 16 months), she has had no hospital admissions and no need for rehab. I attribute her stability and improved physical condition to the quality of nursing care that she has received at McKendree.

I realize that the Tennessee Department of Health has been charged with surveying facilities like McKendree for the Center for Medicare/Medicaid Services. And I understand that such inspections are intended to promote the welfare of a facility's residents. What I don't understand is ...

• how can McKendree suddenly have 19 deficiencies ... when it has had an excellent record of caring for sick and elderly for 40 years and has received certifications from two national organizations?
• why was the certification terminated when McKendree was obviously working to address the issues raised? At the re-inspection, all but 3 points had been resolved.
• why is the final report (with the documentation about those 3 remaining violations) not going to be available until December 13th ... thus allowing only 9-10 business days to make any further corrections (when you deduct weekends and the Christmas holiday)?
• why is the sanction so severe? ... given that remaining deficiencies are related to procedural issues regarding incident reports and given the fact that no patient was harmed.
• it is my understanding that one of the members of the survey team was a former employee of McKendree who had been fired ... why was such a person allowed to participate in McKendree's survey? Can a person who has been dismissed be fair? Is it reasonable (or ethical) to put a possibly disgruntled former employee in the position of evaluating McKendree's performance?
• why at Christmas? The holidays are particularly difficult for older people. They are lonely. They feel isolated. They are grieving the absence of spouses, family members, and friends who have preceded them in death. How do I tell my mother that she will have to leave the place which she now calls "home?"
• given the holiday and the long delay in receiving the final report ... why can't the deadline for correcting the remaining 3 points be extended?
• are you willing to assume responsibility for the consequences of this action? The trauma of transfer will undoubtedly cause suffering to those least able to bear it. Can you, in good conscience, stand by a decision that may result in a worsening of their physical condition or death?
• in the end ... the residents effected remain Medicaid patients. If moving them to another facility results in a deterioration of their condition and the need for hospitalization, is the state prepared to assume that additional financial burden?

It is my belief that the decision to terminate Medicare/Medicaid payments to McKendree is NOT in the best interest of anyone ... the elderly, sick, and poor at the health care facility, their families, the staff and administration of McKendree, or the state of Tennessee.

I am asking you to step forward and stand with some of the most vulnerable members of our society. I am asking you to use your influence and do all that you can to make it possible for those with Medicaid benefits to remain at McKendree through the appeals process. I trust that, given time and the opportunity, McKendree will address the concerns of the Department of Health.

Can I trust you? How will you be judged?

May God grant you wisdom and a compassionate heart. And may the least of God's children have a "room in the inn" throughout this holiday season and in the weeks and months to come.

Sincerely,

Paula C. Hoos
221 Vantage Way
Franklin, TN 37067