Wednesday, March 12, 2014
The Oldest Living Things in the World is an epic journey through time and space. Over the past decade, artist Rachel Sussman has researched, worked with biologists, and traveled the world to photograph continuously living organisms that are 2,000 years old and older. Spanning from Antarctica to Greenland, the Mojave Desert to the Australian Outback, the result is a stunning and unique visual collection of ancient organisms unlike anything that has been created in the arts or sciences before, insightfully and accessibly narrated by Sussman along the way.
Charlotte Cotton, author of The Photograph as Contemporary Art“Something astounding happens when Rachel Sussman photographs the most ancient organisms to be found across our planet. A fraction of a second of time in her photographic exposures animates forms that have evolved across nature's deep time to create a profound experience of being alive. Sussman's ten-year investigation of the symbols of the earth's ecology is rigorous and exploratory, realized with such generosity to the reader and her ambitions make an impossibly vast subject both felt and understood.”Jerry Saltz, New York Magazine“The Oldest Living Things in the World serves us the humbling profundity and pathos of things that live almost forever. We see our abstract selves and feel the terrible bludgeon of that which we cannot have and are fated only to behold. Rachel Sussman brings you to the place where science, beauty, and eternity meet.”
Edward O. Wilson, Harvard University
“The Oldest Living Things in the World adds in dramatic manner a fascinating new perspective—literally, dinosaurs—of the living world around us.”
Gallup has been doing an ongoing series on the Baby Boomers; Baby Boomers: The Largest Generation is "an ongoing series analyzing how baby boomers -- those born from 1946-1964 in the U.S. -- behave differently from other generations as consumers and in the workplace. The series also explores how the aging of the baby boomer generation will affect politics and well-being."
One of the series concerns Boomer trust levels in financial institutions. Baby Boomers Put More Money Than Trust in Banks: Nearly One in Four Boomer Customers are Dissatisfied With Industry by Daniela Yu and Julie Ray note that Boomers are the greatest group "of banking customers in the U.S. ... [with] [n]early nine in 10 baby boomers [with] ... at least one checking, savings, or money market account at a bank or another financial institution... [b]ut ... just 12% of baby boomers with active bank accounts trust banks a "great deal," with the majority placing only "some" or "very little" trust in these institutions."
What are the take aways from this Gallup poll?
While millennials are a hot topic in all kinds of banking strategy meetings, ... boomers, ... are still the largest and arguably the most influential generation because of its strongest purchasing power with regard to various banking businesses, such as retail, wealth management, and even business banking.
Given boomers' significant purchasing power, banks' failure to earn this large demographic's trust and satisfaction may be costing them money. ..
Banks need to design and sell financial products and services for baby boomers that are based on their life cycle needs and economic situations....
[B]aby boomers deeply appreciate individualized, customized service. Because baby boomers are such a large, diverse group, their banking needs can vary significantly....
On a few ocassions, we have blogged about the graying of the prisons, and most recently, we had a post in December on Medicaid expansion under the ACA and prison populations. Now, Governing has a new article about using private facilities to provide health care for the sickest of prisoners. Chris Kardish wrote the February 27, 2014 article States Look to Nursing Homes to Lower Prison Health Care Costs
While many states have special programs within their correctional systems for prisoners with severe health needs, few have partnered with outside facilities, which allows a state to save money through Medicaid and Medicare. States can apply for reimbursements through those health programs for inmates who need health services in facilities outside the prison system, effectively shifting significant costs to the federal government.
The article acknowledges the issues prisons face, caused by rising health care costs, longevity and the "strict sentencing laws". Further, statistics show that older inmates' health care costs are higher than younger, well inmates.
The article references the "Connecticut model" (nursing home with private contractor). Although the state had been looking into using nursing homes for prisoners close to or eligible for parole, the facilities themselves weren't as interested. The legislature gave the Department of Corrections the power "to release certain prisoners with severe medical problems who pose no danger to society" with them remaining under DOC oversight with interim medical status checks. Connecticut then issued an RFP and hired a company to run the 95 bed facility, currently with 12 residents and more than double that in referrals from the Department of Mental Health and Addiction Services.
Since this facility has been operational less than a year, it's too soon to see if this model is going to save the state money by shifting the costs from the state budget to the federal one. The biggest issue evidently has been a variation of NIMBY-neighbors objecting to the facility in their backyard for concerns of rising crime, but because the inmates are so ill or frail, the neighbors' concerns have not materialized.
The article also mentions other proposals being considered elsewhere.
Tuesday, March 11, 2014
HHS OIG says that Less Than Half of Part D Sponsors Voluntarily Reported Data on Potential Fraud and Abuse
U.S. Department of Health and Human Services, Office of the Inspector General
Report (OEI-03-13-00030) 03-03-2014
Less Than Half of Part D Sponsors Voluntarily Reported Data on Potential Fraud and Abuse
Summary: In 2011, total expenditures for the Medicare Part D prescription drug program were $67.1 billion. CMS contracts with plan sponsors to provide Part D coverage to beneficiaries. The Office of Inspector General has recommended that CMS require sponsors to report data on potential fraud and abuse related to Part D to CMS. Rather than requiring these data, CMS encouraged sponsors to voluntarily report them beginning in 2010. This study provides information on the fraud and abuse data reported by sponsors and on whether CMS used these data to monitor or oversee the Part D program.
OIG accessed CMS's Healthcare Plan Management System to download data on potential fraud and abuse reported by Part D plan sponsors from 2010 through 2012. It also accessed CMS's public files of Part D enrollment to determine the number of beneficiaries enrolled in Part D plans from 2010 through 2012. OIG reviewed the sponsors' aggregate data to determine the number and percentage of sponsors that reported data on potential fraud and abuse each year. In addition, it surveyed CMS about its review and use of these reported data.
More than half of Part D plan sponsors did not report data on potential fraud and abuse between 2010 and 2012. Of those sponsors that did report data, more than one-third did not identify any incidents for at least one of their reporting years. In total, sponsors reported identifying 64,135 incidents of potential fraud and abuse between 2010 and 2012. Sponsors' identification of such incidents varied significantly, from 0 to almost 14,000 incidents a year. CMS requires sponsors to conduct inquiries and implement corrective actions in response to incidents of potential fraud and abuse; however, 28 percent of Part D plan sponsors reported performing none of these actions between 2010 and 2012. Although CMS reported that it conducted basic summary analyses of the data on potential fraud and abuse, it did not perform quality assurance checks on the data or use them to monitor or oversee the Part D program.
OIG recommends that CMS (1) amend regulations to require sponsors to report to CMS their identification of and response to potential fraud and abuse; (2) provide sponsors with specific guidelines on how to define and count incidents, related inquiries, and corrective actions; (3) review data to determine why certain sponsors treported especially high or low numbers of incidents, related inquiries, and corrective actions; and (4) share sponsors' data on potential fraud and abuse with all sponsors and law enforcement. CMS did not concur with the first recommendation, partially concurred with the second and fourth recommendations, and concurred with the third recommendation.
Download the complete report.
National Healthcare Decisions Day (NHDD) is April 16th, the date set aside each year to encourage everybody over age 18 to discuss and plan ahead of a serious illness. Five Wishes makes it easy because it is written in everyday language and deals with the things people care about most: their comfort, maintaining their dignity and other personal, spiritual and family matters.
Interested in $25 worth of free resources?
If you send us a photo and short account of your NHDD event or family gathering we'll give you a $25 credit for Five Wishes resources. Use this credit for a free DVD or to get copies of the 26 language translations of Five Wishes, pediatric documents, discussion guides, presenters guides, or access to Five Wishes Online. Get more information and tell us about your event here. Submit before May 15 to receive your credit.
NHDD buttons and stickers = more visibility for your good efforts:
If you're thinking about doing a community event, we want to help ensure it is a success, so we're again offering you a limited number of free "Five Wishes - Have You Signed Yours?" buttons and stickers. Just send us a message here, and we'll get the buttons and stickers to you.
NHDD Five Wishes
Five Wishes can deliver your message. Don't miss the chance to customize the back cover of Five Wishes with your organization's logo and message. To receive your customized documents in time for NHDD, please complete your request by March 14 (that's the end of next week!).
An elderly gentleman had serious hearing problems for a number of years. He went to the doctor who was able to fit for a set of hearing aids that allowed the gentleman to hear 100%.
The elderly gentleman went back in a month to the doctor and the doctor said, "Your hearing is perfect. Your family must be really pleased that you can hear again."
The gentleman replied, "Oh, I haven't told my family yet. I just sit around and listen to the conversations. I've changed my will three times!"
Remember the holiday song, "over the river and through the woods, to grandmother's house we go"... Imagine those lyrics when grandmother is homeless. An article by Rachel Belle published on February 27, 2014 in mynorthwest.com focuses on this issue, referencing a national housing crisis for low-income elders. Homeless Grandma? There’s a National Senior Housing Crisis uses the story of a 75 year old looking for housing to drive home the depth of the issue. The elder isn't homeless, but is looking for a place that provides her better access to services. She "has contacted dozens of senior living facilities and they all tell her the same thing: we're full and the waiting list is full, so try again next year... [she] lives in a nice apartment in Sammamish, but the only place she can walk to, with her bad foot and ankles, is the strip mall across the street."
One staffer from Seattle's Aging & Disability Services notes how many elders are being priced out of rental housing in which they have resided for years. The elder in this story has a section 8 voucher but so far has been unsuccessful in securing another place to live, despite even trying to find a place in California. Her goal for a new home: activities, transportation, and of course, a place to call home. The article is accompanied by an audio version.
Seattle's Aging & Disability Services conducted a collaborative study among six agencies about the upcoming "need for affordable senior housing." The 2009 report, A Quiet Crisis: Age Wave Maxes Out Affordable Housing, is availabe on the website. Takeaways from the study include:
By 2025, the number of seniors in King County will double, representing 23 percent of King County's total population. The number of seniors living in poverty will more than double.
Currently, the need for affordable housing greatly surpasses the supply. ..
The future needs of seniors will differ in some respects from today's ...
Working together, local governments, non-profit agencies and housing authorities can lead community-wide efforts to avert the crisis...
Kelsey Campbell-Dollaghan has written a story about an interesting town in Holland, An Amazing Village Designed Just for People with Dementia where, according to the author "in the small town of Weesp, in Holland—that bastion of social progressivism—at a dementia-focused living center called De Hogeweyk, aka Dementiavillage, the relationship between patients and their care is serving as a model for the rest of the world."
The website for the village offers the following (you need to translate it into English if you don't read Dutch) and makes it clear that we are not talking about a structure but instead "a self-contained village":
One section of the website describes the concept, "[l]iving in life spheres. A reflection of recognizable lifestyles in today's society" as:
Hogeweyk (Hogewey's nursing home) is a specially designed residential area with 23 homes where 152 demented elderly with a nursing home-indication, in lifestyle living. There are 7 lifestyles: City, Goois, domestic, Christian, traditional, Indian and cultural. Together with a permanent team of employees perform the residents their own household. This is how it's cooked daily in every home, crops, etc. Daily shopping in the supermarket of the Hogeweyk done. Hogeweyk offers its dementia maximum privacy and independence. In the district are streets, squares, courtyards and a small park where residents can safely walk in freedom. As in each district has Hogeweyk several amenities including a restaurant, a café and a theatre. These features are there for the residents of the Hogeweyk and for the residents of the area: everyone is welcome!
Another section Architecture for Protected Living explains:
The public spaces and area surrounding the houses are important for the Hogeweyk design. These spaces have qualities found in historical villages and cities. A variety of blocks has been designed to build the plan. Squares, streets, gardens, buildings, water and objects were designed create a recognizable atmosphere. The architecture of the houses corresponds with the interior spaces as well as the public spaces, making the architecture serve as an intermediary between the different scales.
It is important to look at the village website to see photos and floor plans of the village to get a better sense of how it works. According to the article, the village opened in 2009 and was covered in a story published in the NY Times in 2012. FYI, both of the above quotes from the Village website were translated into English by software.
The federal government is investing another $3 million into palliative care services over the next three years, Health Minister Rona Ambrose announced Thursday. The funding goes to the Pallium Foundation of Canada and was promised in the 2013 federal budget. The foundation provides educational tools to agencies that deliver hospice, or end-of-life, care. Ambrose said the money will help train frontline healthcare workers and is "critical to ease the strain on families." She said the government has put $43 million into palliative care research in the past eight years.
Only 16 to 30 per cent of Canadians who die have access to or received hospice palliative and end-of-life care services, depending on where they live in Canada, according to a 2007 report by the Canadian Institute for Health Information.
Monday, March 10, 2014
National Study of Long-Term Care Providers Report
This report presents descriptive results from the first wave of the National Study of Long-Term Care Providers, (NSLTCP) which was conducted by CDC’s National Center for Health Statistics (NCHS). Data presented in this report are drawn from five sources: NCHS surveys of adult day services centers and residential care communities, and administrative records obtained from the Centers for Medicare & Medicaid Services on home health agencies, hospices, and nursing homes.
The report provides information on the supply, organizational characteristics, staffing, and services offered by providers of long-term care services; and the demographic, health, and functional composition of users of these services. Service users include residents of nursing homes and residential care communities, patients of home health agencies and hospices, and participants of adult day services centers. NSLTCP will be conducted every other year starting in 2012. Key
- In 2012, about 58,500 paid, regulated long-term care services providers served about 8 million people in the United States.
- Provider sectors differed in ownership, and average size and supply varied by region. Rates of use of long-term care services varied by sector and state.
- Users of long-term care services varied by sector in their demographic and health characteristics and functional status.
Depending on your age, you may remember when doctors made house calls, and your milk was left on your doorstep by the "milkman". It's not unusual for elder law attorneys to make house calls, but do doctors still do this? The Commonwealth Fund February/March 2014 newsletter, Quality Matters, ran a story about an in-progress study on the impact of house calls by doctors on certain patients.
The summary for the article, In Focus: Making House Calls to Improve Care of Patients with Advanced Illnesses
A Centers for Medicare and Medicaid Services demonstration is testing whether treating frail, elderly patients with multiple chronic conditions in their homes improves outcomes and reduces health care spending. While the three-year demonstration is only halfway through, some participants have reduced hospitalizations and readmissions dramatically by providing more intensive services to this population of patients.
The focus of the study is the Independence at Home Initiative through the ACA which "targets Medicare patients with functional impairments and multiple chronic conditions such as heart failure and chronic obstructive pulmonary disease... [because this group] is increasingly worrisome to policymakers [since] ... they comprise about a quarter of beneficiaries but account for roughly two-thirds of the program's expenditures. And their numbers are expected to increase dramatically with the aging of the population."
The article reviews interim results of some of the projects, offers some graphs, discusses advantages of house calls and reviews issues with replication. FAQs about the demonstration project, including beneficiary eligibility to participate is available here.
The newsletter also includes an article on House Calls for the Homebound and a Q&A [on] Closing Gaps in Care with At-Home Visits. To subscribe to the newsletter, click here.
Article: The Vicious Cycle of Parental Caregiving and Financial Well-being: A Longitudinal Study of Women
Authors: Yeonjung Lee1, Fengyan Tang2, Kevin H. Kim3 and Steven M. Albert4
Abstract: This study examines the relationship between caring for older parents and the financial well-being of caregivers by investigating whether a reciprocal association, or vicious cycle, exists between female caregiver’s lower household incomes and caring for elderly parents. Data for women aged 51 or older with at least 1 living parent or parent-in-law were drawn from the Health and Retirement Survey 2006, 2008, and 2010 (N = 2,093). A cross-lagged panel design was applied with structural equation modeling. The authors found support for the reciprocal relationship between parental caregiving and lower household income. Female caregivers were more likely than noncaregivers to be in lower household income at later observation points. Also, women with lower household income were more likely than women with higher household income to assume caregiving at later observation points.
This study suggests that there exists a vicious cycle of parental care and lower household income among women. A key concern for policy is female caregivers’ financial status when care of older parents is assumed and care burden when women’s financial status declines.
Read the full article in The Journals of Gerontology: Series B
Sunday, March 9, 2014
The Office of the Inspector General for HHS has issued a new report, Adverse Events in Skilled Nursing Facilities: National Incidence Among Medicare Beneficiaries. (OEI-06-11-00370, Feb. 2014). The study is a follow up to the study the OIG did on hospital adverse events (defined on page 2 of the report as "harm to a patient or resident as a result of medical care" and which includes not only errors but "more general substandard care that results in ... harm" but aren't always limited to preventable acts or negligence (citations omitted)).
The report examines SNF post-acute care, which is "intended to help beneficiaries improve health and functioning following a hospitalization and is second only to hospital care among inpatient costs to Medicare." The executive summary describes the OIG findings: approximately 22% of Medicare beneficiaries had an adverse event while in the SNF with another 11% with temporary harm. Doctors who reviewed these concluded that 59% of both the adverse and temporary harm occurrences were either preventable (clearly) or likely could have been prevented. The doctors pointed to a number of factors, including "substandard treatment, inadequate resident monitoring, and failure or delay of necessary care." More than 50% of these SNF residents were rehospitalized for care.
The OIG report makes several recommendations, including that the Agency for Healthcare Research & Quality (AHRQ) and CMS both increase awareness of the need to improve SNF resident safety and also to adopt safety efforts such as those used by hospitals. The report suggests collaborations that lead to the compilation of a list of events in SNFs that would help SNF staff understand and identify harm. The report also recommended that CMS should also require state surveyors to look at SNF practices for preventing adverse events.
The report includes comments from AHRQ and CMS, which agreed with the recommendations. CMS also included information about what is currently being done and its plans to increase resident safety. CMS did conditionally agree with the OIG sub-recommendation about reporting incidents to patient safety organizations, because of concerns about preserving confidentiality and privileges. The comments are included in Appendix G.
In an effort to make young people aware of the tragedy of elder abuse, Attorney General Tom Horne and the Arizona Elder Abuse Coalition have partnered in the 2014 “Why Should I Care About Elder Abuse?” Junior High School Arts Competition. “This competition increases awareness of elder abuse to the younger generations,” said Horne. “While my office continues to prosecute perpetrators of elder abuse, only through awareness can we stop abuse before it begins.”
Submissions of poster art designs must be received by 5p.m. on May 2, 2014. Contest results will be announced in May. Statewide contest winners will receive a first, second and third place prize of $100, $75, $50, and five honorable mentions will receive $25. Winning artworks will be printed on a poster to be distributed as part of the statewide Elder Abuse Awareness campaign held to coincide with World Elder Abuse Awareness Day on June 15, 2014.
Friday, March 7, 2014
According to the March 3, 2014 story by Anna Gorman in the Kaiser Health News (in collaboration with the LA Daily News), L.A. County Officials Told Inspectors To Cut Short Nursing Home Probes, county inspectors were instructed to close certain cases without a complete investigation. The project was dubbed "Complaint Workload Clean Up Project" and involved the following:
According to the confidential documents, L.A. County public health supervisors ... told inspectors to administratively close complaints submitted anonymously as “No Action Necessary.”
They instructed inspectors to close other cases by examining previous reports about the facility instead of thoroughly investigating the complaint at hand. If two other inspections done around the same time did not reveal problems similar to the new allegation, the complaint was to be determined “unsubstantiated.”
The county also told inspectors to administratively close cases reported directly by a nursing home if the facility had been in compliance with an earlier routine inspection.
The internal documents said, however, that inspectors were to fully investigate complaints that were high-profile, were part of a lawsuit or involved alleged abuse or neglect.
According to the county's chief of the health facilities inspection division quoted in the story, this occurred because of the state's impetus to close cases. Although all investigations began, some were not finished or documented, and he noted an insufficient number of staff to deal with the cases.
The article looks at the number of open investigations statewide and references legislative hearings about the backlog. The state's department of public health has had issues before regarding the processing of complaints against nursing homes: "[a] 2005 lawsuit, a 2007 state audit, a 2011 report by the federal Office of the Inspector General and 2012 sanctions by [CMS] all have taken issue with the time it takes to resolve complaints." The article notes that the state's department doesn't condone the practice and has ordered the county to stop. There is a separate inquiry undertaken by CMS.
A follow up story on March 5, 2014 notes that the county board of supervisors ordered an audit regarding the public health department's oversight of nursing homes. The director of the Department of Public Health answered questions during the supervisors' meeting.
ASA's 2014 Aging in American Conference, a five day conference held this year in San Diego, kicks off on March 11, 2014. AiA14 celebrates ASA's 60th anniversary. I will be presenting on March 12 at 11:30 pst with two of my colleagues on how to be an effective witness. If you are attending the conference, stop by our session and say "elder law rocks!"
In MetLife Home Loans v. Vareen, decided in Kings County, New York on February 11, the mortgage company attempted to foreclose on a reverse mortgage, apparently because of unpaid water bills for the property. The case was "conferenced extensively with the defendant homeowner's family in the court's Foreclosure Settlement Conference Part," with no resolution of the dispute, but the homeowner did not file a formal answer in the lawsuit. Eventually the mortgage company sought an "ex parte" default ruling.
In denying the requested relief, the judge noted that the homeowner had a contractual obligation to stay current on all items which could become charges against the property. However, the mortgage company also had the contractual option to "make the payment for the mortgagor and charge the mortgagor's account. If a pattern of missed payments occurs, the [mortgage company] may establish procedures to pay the property charges from the mortgagor's funds as if the mortgagor elected to have the mortgagee pay the property charges under this section." It appears the homeowner was receiving monthly "reverse mortgage payments," rather than a single lump sum.
This history of the case is a reminder that reverse mortgages may not be the best solution for some older homeowners, especially if the cost to maintain the house is substantial, or if the elderly homeowner (or a volunteer in the family) is unable to handle payment of bills as they come due.
Here the court stepped in to prevent loss of the home, citing the lender's contract options. The court quoted the rosy language of a HUD-approved consumer guide, appearing to assure borrowers they can "continue to live at home as long as you want," and concluded:
"As such, plaintiff cannot foreclose on defendant's reverse mortgage because of her default in paying the NYC water bill. Furthermore, serving a senior citizen holding a reverse mortgage with a complaint that fails to specify what the default is can only be described as unconscionable."
Other court challenges to attempts to foreclose on reverse mortgages where there is a "surviving" spouse, but that individual is not an owner of record, are detailed here, with the potential class of plaintiffs represented by an AARP Foundation Litigation team. Thanks to ElderLawGuy Jeff Marshall for tweeting on AARP's efforts.
Thursday, March 6, 2014
New GAO Report on "Retirement Security: Trends in Marriage, Work, and Pensions May Increase Vulnerability for Some Retirees"
The decline in marriage, rise in women's labor force participation, and transition away from defined benefit (DB) plans to defined contribution (DC) plans have resulted in changes in the types of retirement benefits households receive and increased vulnerabilities for some. Since the 1960s, the percentage of unmarried and single-parent families has risen dramatically, especially among low-income, less-educated individuals, and some minorities. At the same time, the percentage of married women entering the labor force has increased. The decline in marriage and rise in women's labor force participation have affected the types of Social Security benefits households receive, with fewer women receiving spousal benefits today than in the past. In addition, the shift away from DB to DC plans has increased financial vulnerabilities for some due to the fact that DC plans typically offer fewer spousal protections. DC plans also place greater responsibility on households to make decisions and manage their pension and financial assets so they have income throughout retirement. As shown in the figure below, despite Social Security's role in reducing poverty among seniors, poverty remains high among certain groups of seniors, such as minorities and unmarried women. These vulnerable populations are more likely to be adversely affected by these trends and may need assistance in old age.
While updating my treatise (a section on older drivers) I came across this article from AAA on how older drivers can maximize their safety while driving through their choice of a vehicle. Here's an excerpt::
Smart Features for Older Drivers
A vehicle is one of the largest purchases a person makes, and it is critical to find the right one for you. To help older drivers know what to look for in a vehicle, AAA worked with the University of Florida Institute for Mobility, Activity, and Participation to help identify
smart features for older drivers (SFOD) to optimize their comfort and safety. Use the tool at the bottom of the page to explore these smart features.