Report from Santa Fe; Michelle Lujan Grisham

We're here. Hello. Hello. Hello. Hello. Hello. Hello. Hello. . . .

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. . . . . . . . . . . . . . . . . . . . . . . . . . . And so, although they always vote, that's what one of the things we love about the older population. They know the importance of politics and voting, but in terms of fighting for themselves in this bureaucratic nightmare of modern life, they don't really have a voice, and that's how you have served so many people so well. I'd like to start today with a little of your past undercover work. This is how I first, one of the first shows we did with you when you told us how you

would actually impersonate an older person and check yourself into some nursing homes and what happened. Tell us a few of those stories. Well, I'd be delighted to. You know, the reality is, one of the programs that this agency or now department is responsible for is something called the long-term care ombudsman, and it's a required program, and it is. It's literally the messenger. That's what the Swedish term ombudsman means, carrier of the message. And so we represent people who don't have a voice and can't speak for themselves, and the reality is, between four and 8,000 complaints from 15,000 residents and their families of nursing homes and assisted living in board and care statewide, some of the most atrocious care issues I've ever heard, and frankly, we were having trouble getting the right folks in both the federal government and the state government to enforce, and to hold accountable those bad actors. And I thought maybe the way to really raise and elevate the importance of this issue about taking care of people who are vulnerable and can't take care of themselves, people who

protected us and the entire country are now being locked away and not treated fairly. We thought the way to highlight those issues was actually to go in undercover and to do that, one story I don't know that I've ever told is there was a Santa Fe facility that was kind enough to let me pose as a certified nurse a trainee. So the first thing that I did was actually get on the job training as a certified nurse aide, and nobody had any idea who I was, and the important thing about that nursing home is they let me see some pretty interesting things, like the other certified nurse aides did some interesting hazing, where they put me alone in a shower room with a gentleman who didn't want to be showered. Well the rules are, if you don't want to take a shower, they can't force you, they can't rip your clothes off and the instructions that they gave me was to take this very dick and a five very independent man who's 97, and force him to turn around so that his back was facing me, almost as if he was being arrested, that kind of a posture and stance, and

to take all of his clothes off, to force him in and strap him into a chair and then shower him, and I refused, and they made it clear that you could be fired, well, actually it would be the reverse, you should be fired if you handled this way, and we were able to get this guy to agree to have folks support him, and to also give him some mail, nurse aides. He didn't want me. Oh, of course. Oh, of course. Especially for someone of that age. A gentleman. Absolutely. And they knew that, and so I did that, I learned about transfers, I saw people, this was the most, this was one of the things I learned that still bothers me today, and then I'll go quickly into an undercover story, but what they do, so that the certified nurse aides get a sense about all the residents and, you know, four floors of a nursing facility, is they rotate them. Problem with that is, is that you don't develop a relationship. This is where a person lives, sometimes for 10, 12 years, they need somebody that they that cares about them every day, and you don't know about some of the special issues,

and I would watch certified nurse aides, including myself, have no idea about a particular resident, and they would put their trays of food out of their reach, and they would put a saran wrap that you couldn't see on juice, and the blind person would pick that up and drop juice and be embarrassed, and it's the little things, and it's just about not caring enough about these folks. I also saw bad things, call lights not being answered, people left in their own ways for hours at a time, laundry not being done, dirty soiled laundry being reused, assistance with medications done inappropriately, you're in left on a floor in other ways, and public and common areas, cold food, enchiladas put in a blender, and then served in kind of a gray, hunky mess. This is a nightmare scenario, and this is what you found going on. This is what you found going on. This is just the training phase. After the training phase, I actually checked myself in and posed as a young disabled adult who was paralyzed on the left side of phasic, which meant I really couldn't communicate

or speak well, I couldn't feed myself, toilet myself, dress myself, and I spent three days in a boarding care home in Albuquerque, and another staff member spent the same number of days in another boarding care home in Albuquerque, and he was at a place called Sandia Ranch, which has since been closed for violating safety and fire code issues for the residents who were there, and the facility that I was at I don't think made it either was a place called Desert Heights, and their biggest problem is they just didn't know how to provide care, and they promised people that they could do things that they weren't licensed to do. And the most important horrible thing that they did to me is they left me unclothed in a public area. I was the most popular resident in the burden care at the time for several years. But you were younger than everyone by 30 or four years. Right, but imagine yourself. Imagine your sister, imagine your mother being bathed inappropriately, and then not dried, and then put in an open gap with no clothes on in the common public area waiting for dinner.

For three or four hours with no clothes on. How did you not rise up from your chair and lower your cover and just say, I will not be treated like this? You know, because I knew it was important for people to know that we got to do better. We must do better. And since that time, we've done about four others. We did several nursing homes around the state and found lots of poor and improper care, and it's not to say that some facilities don't do a terrific job. They do. But we still have too many facilities that have not enough workers who don't train them sufficiently to support the residents that they're caring for. Sometimes I think cut corners and don't provide the best quality food, the best medical attention, the best medication management, and we can and should do better for this population. And one of the things that Governor Richardson really cares about is he wants a zero-time tolerance atmosphere. And so, in fact, the Department of Health has been very aggressive and we've got several facilities who have been cited and are being sanctioned and are being told that got a quick

turnaround time to improve the quality of care, you know, we'll do it for them. And that's just exactly what we want, because once a couple of them do it, everybody will start to provide care in that fashion. Now just for the people who are horrified to hear these stories and have an older family member that they need to find a place for, does your agency provide a rating system or does a health department, is there a rating system available for how you can find the best place? You know, there's not really a rating system because it's a lot of the information, believe it or not, is still fairly subjective. But this is what we do do for any consumer at no cost. So as soon as I make the statement, I'm going to give you my toll-free number. But we will tell you whether there's been substantiated complaints, we can give you the staff to resident ratios, and we can also teach you what to look for. If it smells bad, that's a problem. If the staff don't know the names of the residents and don't have relationships, that's a bad sign.

If it doesn't seem warm and friendly and there are people freely moving around, if people seem restrained or over-medicated, bad signs, and we can tell you what to look for and tell you all the facilities that have complaints and the last thing. Within a week, we're publishing about a two-year report about the conditions of care, and we'll give you the top 10 nursing homes in terms of their ability to provide care, and the worst 10 in terms of the number of substantiated complaints. And so we use that as sort of a gauge, and that'll be available to the general public in about a week. Great. Yeah, 1-800-432-2080, 1-800-432-2080, and ask for the ombudsman, and we represent you. Oh, wonderful. I know that you'll get a lot of calls after this show, Ayers. One of the reasons we're doing this show now is that you're about to embark upon the 25th annual Conference on Aging, August 19th through 21st in Glorietta, and every year Ernie would do a show with you.

This was his favorite conference. He'd love to go there. You have so much new information. I think one of the topics this year is conscious aging. I'd like to know more about that. I guess we'll all find out. But tell us about the conference, where it is, when it is, and who was invited. Ah, well, it's the 25th anniversary, so we're very excited. And it's really a conference that's designed, and I don't think there's one like it in the country. It's designed equally for senior citizens, consumers, and families, and providers, and it's a wonderful mix of substantive learning, all about social security, all about Medicare, all about healthcare reform. Here's something that everybody needs to pay attention to. What's going on locally and what's going on nationally with prescription drug coverage and the changes to Medicare. We're going to spend a whole lot of time about that. There's also phenomenal entertainment. There's also direct service delivery. There's long-term care delivery. We even have respite care available for folks who are caring for their spouse, their loved ones.

It's kind of a retreat atmosphere. You can go for day-only registration. You can spend the night. We'll help you get registered. I'll tell you to call that same one, 800 number, if you're a local. I'd have you call 827-640, and so this whole gamut. We usually have about between 1,500, say, and 1,800 people. We have three plenary sessions. The governor is going to be there on Wednesday, which is the 20th. Barbara Richardson is going to be launching some phenomenal immunization, grandparenting, outreach campaigns on Tuesday the 19th for the opening, and so I really encourage people to come in. It's also just a wonderful place to get to meet new people and get a sense about what's the latest and the newest in terms of available information and services for you and your family. There's also, as you say, a retreat or camp-like atmosphere, a pluriot is beautiful, and I just saw some of the impromptu meetings and conversations.

Last year it was the political campaign. You had all the candidates, and they actually addressed senior issues. Absolutely. It won't be as political this year, but I'm delighted to know you're still pushing the Medicare reform and the prescription drug reform. Is there anything tangible that you can tell us what's happening in terms of seniors and prescription drugs? I can. I want folks to know that I'm going to plug for Governor Richardson and for the legislature. It was a really good partnership. They've passed a legislation that will enable us to create a Medicaid, which is a health insurance program for the poor, make that more like a health insurance program for just prescription drug coverage for more of the middle class. We are writing that waiver. It does require federal approval to let us change the dynamics, but it will make prescription drugs affordable and available to a great number of seniors who have no other access currently. The other big thing that's coming is Medicare is being reformed.

The Senate and the House and Congress passed two different measures. They'll be information about that at the conference on aging to put a prescription drug benefit into Medicare starting 2006. You know that old anage that when it sounds too good to be true. It is. I have a lot of concerns about these proposals, and they're hammering out right now in Congress. They're just about done with their recess, they're going to go back on to the Hill shortly, and I would really encourage seniors to either contact us. Come to the, I'll give you a couple of issues. Come to the conference, and we're asked for information from their congressional representative and see how they're voting, because benefit doesn't start till 2006. It's voluntary, which in many ways is wonderful, except that. It's not a standard benefit, which means private insurance companies are going to figure out how to market to you a formulary with drugs. Most people have drugs from several different companies, which means one plan will give you one drug, another plan will give you another drug.

They're going to have a considerable now new premium on a new part, Medicare part C, and then in addition to that, there's means testing to figure out what your deductibles and copays are. It's very complicated to figure it out. You still have significant out-of-pocket costs. There are gaps. That means that you have to enroll and pay a premium, but until you meet this maximum, which is as high as $4,500 into some of those proposals, you must keep paying your premium, and then spend out-of-pocket $6,000 before you're covered again. We call that the doughnut hole, which means you're paying without getting a benefit, but you can't disenroll, and we believe a couple of things, one. It changes Medicare, so that instead of being an entitlement comprehensive health insurance program, it's now a means tested only for a few kind of a program, and I think that's a very slippery slope. I think that we're asking states to trade in a very useful, very productive, very meaningful health insurance program for the hope that we might get prescription drug coverage to

your private insurance plans, which many retirees have. The reason they have prescription drugs is because you can't get it in Medicare. If you can get it in Medicare, they may elect to drop it from your current benefit package, and I think that's a viable scare. I think retirees ought to be very, very cautious about that, and your description of the changes that are coming in from Congress, the word Kafka-esque, comes to mind, this is not simple. People need something simple, and you need to really know that someone is here is helping you out here with those high deductibles, and that doughnut that you describe doesn't sound like anybody's really receiving much benefit. You literally have to be an accountant and a lawyer to figure out this bill. It's more complicated than the tax code, and I'll tell you something else that I'm really that's telling Congress specifically voted to exempt themselves from this kind of a prescription drug benefit or this Medicare proposal.

I think that that should tell the American people something, and I think the issue is, and seniors need to decide from the selves, is something better than nothing? Where do we want Congress to really pay attention to solving health and long-term care issues for this population? In my sense is, we want Congress to solve it. It's not free. I mean, that's the real issue here, right, is that it's expensive, and we have to decide as a country where we want to make those investments, and I believe investing in this population, and its prescription drug coverage is the cheapest treatment. So I may be a little bit too aggressive about this issue, but I really want folks to pay attention, make up your own mind, but definitely be heard on this issue. Speaking of aggressive, are the gray panthers still active nationally? I don't see much of them locally, but do they still exist, are they? They do, and they also have a local statewide organization.

I don't know that they're as aggressive, but there's still a group to be reckoned with. And so is that ARP, and so is the National Association of Federal Retirees and Leadership Council on Aging. There are a lot of groups, and I think that it's not that we don't have national advocacy organizations at Congress's level, it's whether America is ready to deal with the fact that we're changing the dynamics. We are, it's the graying of America is occurring. New Mexico is going to double its senior population by 2025, and then do that effectively. We need to make sure that we've got a good health and long-term care program in place, which is part of the design of elevating this agency to a department. This has to be mainstay policy. It's as important as education, it's as important as economic development, it's as important as corrections, in fact, it affects all of those efforts, this alone.

And so I want all those national organizations to reach back out of the grassroots level and get folks involved again, I think it's time. I want to come back to where you're going with your new cabinet level agency, but one little last political question, who are the lawmakers, both statewide, you know, state lawmakers and also the federal, who are the lawmakers that are particularly elder-friendly, who is fighting for the elders? You know, that's a tricky question, because I would say that at the state level that there's not a legislator who doesn't stand tall and say, I really care about this constituent group, and in fact, New Mexico has been very supportive, but there's a couple of folks that come to mind. And in fact, I'd like to announce that we have an annual award that we provide that's called the Representative Nick Salazar Advocacy Award, and of course Representative Salazar has led the effort to get funding for services to bring new life to long-term care, so people

have choices, don't have to just go to nursing homes, how about if we serve you in your home, how about if you had access to the dollars yourself so that you could make the decisions about what services you want to purchase and not purchase? I mean, he's really led that effort. He's giving the award this year to Representative Paul Taylor, J.P. Taylor, Paul Taylor, and a county. And he's, I mean, he and I know the Ernie used to talk about this with a great deal of compassion, which is the skinny cats. Yes. The ghattos, fuck that. That's right. And Paul Taylor is well known for that, that someone, he would be that voice, he would agree about the person with Alzheimer's, who was living alone somewhere, who was struggling with those day-to-day activities, and in fact, you know, Paul, every year, no matter how bad the purse dreams are at the state level, he's managed to make sure that he's got support for, you know, at least $50,000, so we could start a new Alzheimer's program somewhere he never failed.

Those two were incredible, you know, Senator Feldman and Representative Dennis Pickrow have long been those prescription drug health care reform advocates, you know, I also think about Senator Linda Lopez, who is very interested in quality of care issues. We have some amazing partners. Senator Michael Sanchez has been after nursing home issues, Representative Condi Cordiva. She's been really wanting to increase staffing. They passed a brand new AQE staffing bill. Here's some really dynamic fighters, Representative Ken Martinez, trying to get through a private right-of-action, which is, again, you know, putting the control in the hands of the consumers for nursing homes. There's some incredible legislators in the Mexican. I know I'm going to be in trouble for forgetting some folks who have done incredible work on our behalf. Well, I did kind of spring the question on you, but I'm so pleased. I think that J. Paul Taylor is the cream of the crop, the most humanitarian, the greatest kind of lawmaker. I'm just so happy that you're going to honor him, so I think. You know, he addresses lawmaking like a practical, caring person.

How does this make a difference in the life of someone who's struggling? When that's your threshold test, how can you go wrong? Yeah. Well, he never has. Now, all right. Well, we've got a little bit of time left, and I'm dying to know what it means to you to finally have this agency that you've labored so long to make visible, suddenly to be almost a cabinet-level position, and you, the cabinet secretary, designate as soon as you're confirmed, maybe it'll happen. You're one of the special sessions that you're confirmed by the Senate Rules Committee, and then you're a real cabinet secretary, and you're a real deal. You're the real deal. So how does this alter what you've been doing, and how does it help what you've been doing? Because you know, you really will get a lot more recognition and a lot more support. Right. Well, in fact, you've just answered the question for me. It means that you're at the same policy-making level as everybody else, which takes senior issues and puts them at the same level of importance as education issues, and the same level of importance as healthcare reform issues, so that instead of having to go up the wrong and

then convince those other policy makers, I don't have to do it anymore. What it means is that this executive branch, Governor Richardson, has said, we're going to address consumer protection, we're going to get people to stay at home and to live in their own communities independently. That's what they want. That's what they want. We're going to deal with these transportation issues. We know that folks, there's lots of folks who are struggling with adequate income, we're going to get prescription drug coverage. That means that those issues will be addressed in this administration, and I don't have to fight to get them on somebody's radar screen. In the legislators now have a partner to move forward these agendas, and the last but the most important is, I have real partners, children, youth, and families department, my partner, human services department, my allied health, my allied, in fact, they are negotiating with us right now, and very soon in about a week or so, we'll have a final announcement, but reality is, we have adult services and senior services all over stick government, and so you can't navigate it, and you got inconsistent policies, and it's really a nightmare, not only

for consumers, but for me, we're going to consolidate everything we can into one place, leverage that money, be cost effective, do a single straight forward, concentrated effort, and I think that this is really going to move it forward faster, because people are tired of waiting. Me too. I don't want anybody else to have to go to a nursing home, because they don't choose that. I don't want anybody else to be on a waiting list for somebody to come in their home and help them. I just left Clayton yesterday, and I don't want to have to leave Clayton or Des Moines or any of those small communities with people wondering how they're going to get to the doctor, and how they're going to find a doctor to provide the right kind of care for them. Now, how are you going to let people know what's available on the changes that are happening, which is, of course, when you show like this, thank you. But, you know, do you do mailings, do you keep a list of the people who call in for help, are you going to do town halls, Lord have mercy?

The four agencies, children, youth and family, health, human services, and you did all these town halls, 17 town halls around the state. I know. I know. I know. So, your schedule, and it was even hard to even book a show with you, because you were always doing it. But, what have you learned from these? What ideas are bubbling up from the grassroots? What have people brought? Well, we need to do 10 more shows, tons of ideas, how we can pool insurance, how we can recoup Medicaid money from providers and others who were not providing the services that they're supposed to, how we can increase prescription drug coverage, how we can take all these different exceptions to Medicaid that make that a very complicated program to provide, maybe collapse it into one waiver that's self-directed, so that you, the family, the consumer is making the decisions not government. We get all kinds of, those will save money, they put power control back to you, we're working on transportation, we're working on changing eligibility requirements, I mean, basically

we're redesigning the entire system. And we are going to have to do 10 more shows, because this one is over. We have disease prevention, health, emotional, and I'm ready, I'm ready. All right. Well, first of all, I want to remind everyone that August 19 through 21st in Gloria Santa, is the 25th annual conference on aging. And I'd like to thank you, Michelle, Luha, and Grisham, the Cabinet Secretary, designate for the new State Department of Aging and Long-Term Care. Thank you for being with us today. We hope you'll come back. It's a pleasure. I'd love to come back. Great. Thank you. And I'm Larry Mills. I'd like to thank you our viewers for being with us on report from Santa Fe. Report from Santa Fe is made possible in part by a grant from the members of the National Education Association of New Mexico, an organization of professionals who believe that investing in public education is an investment in our state's economic future. Thank you.

Thank you.