One of the rules they created after years of discussion looked especially prescient in light of the tragic deaths on Wednesday of eight nursing home residents in Florida’s post-hurricane heat. But the rule, regarding power supplies and temperature control, does not take effect until November, and even then, some patient advocates are concerned that it does not go far enough.
The debate shows how challenging it has been to overhaul health care rules even after repeated instances of power failures and flooding, from Katrina to Hurricane Sandy in 2012, to Hurricane Harvey last month and now Hurricane Irma. Hospitals and nursing homes have pushed back against some requirements, arguing that they are costly and unnecessary.
The new federal rule will require that nursing homes have “alternate sources of energy to maintain temperatures to protect resident health and safety.”
But the rule does not specifically require backup generators for air-conditioning systems — the nursing home in Florida, Rehabilitation Center at Hollywood Hills, did not have such a generator — and now some are questioning whether the rule should.
Tuesday, September 26, 2017
Check out this updated policy brief, Policy Brief: Requirements for Reporting to Law Enforcement When There is a Suspicion of a Crime Against a Nursing Home Resident. The Long Term Care Community Coalition (as an aside, take a look at their cool url) released this updated brief with information about changes and 2017 updates
1. The potential fines for violations of the law are subject to adjustment for inflation. The fines indicated below are current as of September 2017.
2. New CMS guidelines for these (and other) requirements are in effect as of November 28,
2017. A summary of the guidelines for reporting can be found at the end of this brief. The
full federal Guidance can be found on the CMS website:
The overview explains that
The law broadens and strengthens the requirements for crime reporting in all long term care
facilities (including Nursing Facilities, Skilled Nursing Facilities, LTC Hospices, and Intermediate Care Facilities ...) that receive $10,000 or more in federal funds per year. The facility must inform the individuals covered under the law - its employees, owners,
operators, managers, agents, and contractors - of their duty to report any "reasonable
suspicion" of a crime (as defined by local law) committed against a resident of the facility. After forming the suspicion, covered individuals have twenty-four hours to report the crime to both the State Survey Agency and to a local law enforcement agency. If the suspected crime resulted in physical harm to the resident, the report must be made within two hours.
The brief explains the policy requirements and offers recommendations for consumers, state agency folks and long term care facilities. There is also a summary of the regs as well as definitions of commonly used words.
The brief can be downloaded as a pdf here.
September 26, 2017 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare, State Cases | Permalink | Comments (0)
Tuesday, September 19, 2017
Elder homicides often go undetected, and investigating them requires a multi-pronged approach. In this webinar, learn about the victims, the offenders, and the crime scenes. How does the medical examiner’s information contribute to solving these high-profile, difficult cases? Join the webinar to discover how research has advanced the successful investigations of these crimes.
To register for the webinar, click here
Thursday, September 14, 2017
In the developing story (see here and here) about a reported 8 deaths at a nursing home in Florida following Hurricane Irma, there is a growing debate about what a "new" federal regulation mandating Emergency Preparedness plans in Long-Term Care facilities actually requires. Is it enough to "have a plan" or must the facility actually have back-up generators or other means to "maintain" safe temperatures following an emergency? As New York Times writers Neil Reisner and Sheri Fink report on September 14, 2017:
“It’s vague, but this event is going to highlight the need,” said Dr. David Marcozzi, an associate professor at the University of Maryland School of Medicine and former director of a federal health care preparedness program. “Let me put it this way, if you were in Alaska and what was required to maintain safe temperatures was a heater, you wouldn’t say you don’t need the heater.”
For the full discussion of the Emergency Preparedness regulation, that took 11 years to get into place after the post-Katrina nursing home tragedies, but still gave another year to become mandatory, read Nursing Home Deaths in Florida Heighten Scrutiny of Disaster Planning.
Monday, September 4, 2017
A recent article focuses on what is sometimes called "granny dumping," and the author urges states to examine carefully whether "abandonment" of a care-dependent person is addressed by the state's elder protection laws. Author Stephanie Rzeszut, a recent graduate of Hofstra Law, writes (footnotes omitted):
The only states that currently include elder abandonment as a form of elder abuse in their statutes are Alaska, California, Connecticut, Illinois, New Jersey, Oregon, Pennsylvania, Utah, Washington, and Wyoming. Although each of these states includes elder abandonment in their statutes, each statute varies as to how they define elder abandonment.[For example, the] state of California lists elder abandonment as a form of elder abuse without defining or describing what elder abandonment actually is. Conversely, the state of Oregon defines what elder abandonment is under their statute as the “desertion or willful forsaking of an elderly person or a person with a disability or the withdrawal or neglect of duties and obligations owed to an elderly person or a person with a disability by a caregiver or other person.”***Not only do a majority of the states not include elder abandonment in their statutes, but there is currently no uniformity among each state's statutes for what constitutes elder abuse in general. This is problematic because in some states a caregiver may not be prosecuted for elder abuse or not prosecuted for committing elder abandonment when it has in fact occurred.
Sunday, September 3, 2017
Here's something to give you pause. The HHS Office of Inspector General has released an early alert. The Centers for Medicare & Medicaid Services Has Inadequate Procedures To Ensure That Incidents of Potential Abuse or Neglect at Skilled Nursing Facilities Are Identified and Reported in Accordance With Applicable Requirements (A-01-17-00504) dated August 24, 2017,
alert[s] [the CMS administrator about] ... the preliminary results of our ongoing review of potential abuse or neglect of Medicare beneficiaries in skilled nursing facilities (SNFs). This audit is part of the ongoing efforts of the Office of Inspector General (OIG) to detect and combat elder abuse. The objectives of our audit are to (1) identify incidents of potential1 abuse or neglect of Medicare beneficiaries residing in SNFs and (2) determine whether these incidents were reported and investigated in accordance with applicable requirements.
The 14 page letter provides a lot of detail about the situation and offers a number of recommendations, including immediate action: "implement procedures to compare Medicare claims for [ER] treatment with claims for SNF services to identify incidents of potential abuse or neglect of Medicare beneficiaries residing in SNFs and periodically provide the details of this analysis to the Survey Agencies for further review and ... continue to work with ... HHS ... to receive the delegation of authority to impose the civil monetary penalties and exclusion provisions of section 1150B." Longer term the alert suggests new regulations among other ideas.
September 3, 2017 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)
Wednesday, August 30, 2017
Kaiser Health News ran this story, Elder Abuse: ERs Learn How To Protect A Vulnerable Population, a few days ago.
Because visits to the emergency room may be the only time an older adult leaves the house, staff in the ER can be a first line of defense, said Tony Rosen, founder and lead investigator of the Vulnerable Elder Protection Team (VEPT), a program launched in April at the New York-Presbyterian Hospital/Weill Cornell Medical Center ER.
The most common kinds of elder abuse are emotional and financial, Rosen said, and usually when one form of abuse exists, so do others. According to a New York study, as few as 1 in 24 cases of abuse against residents age 60 and older were reported to authorities.
The project consists of a team of doctors and social workers who rotate being on call, with backup from other professionals when the case so requires. The team trains the entire ER staff about identifying elder abuse. "A doctor interviews the patient and conducts a head-to-toe physical exam looking for bruises, lacerations, abrasions, areas of pain and tenderness. Additional testing is ordered if the doctor suspects abuse."
The team looks for specific injuries. For example, radiographic images show old and new fractures, which suggest a pattern of multiple traumatic events. Specific types of fractures may indicate abuse, such as midshaft fractures in the ulna, a forearm bone that can break when an older adult holds his arm in front of his face to protect himself.
When signs of abuse are found but the elder is not interested in cooperating with finding a safe place or getting help, a psychiatrist is asked to determine if that elder has decision-making capacity. The team offers resources but can do little more if the patient isn’t interested. They would have to allow the patient to return to the potentially unsafe situation.
Patients who are in immediate danger and want help or are found not to have capacity may be admitted to the hospital and placed in the care of a geriatrician until a solution can be found. Unlike with children and Child Protective Services, Adult Protective Services won’t become involved until a patient has been discharged, so hospitalization can play an important role in keeping older adults safe.
There have been a number of cases of suspected abuse identified by the team with a fair percentage of those confirmed as abuse cases. Ultimately, the team wants "to optimize acute care for these vulnerable victims and ensure their safety. They plan to work at continually tweaking VEPT to improve the program and to connect to emergency medical, law enforcement and criminal justice services. Eventually, they hope to help other emergency departments set up similar programs."
Tuesday, August 22, 2017
Mark your calendars for September 6, 2017 at 2:00 p.m. edt. DOJ's Elder Justice Initiative will be hosting another in its series of webinars on elder abuse. More information and registration for Financial Exploitation in the Context of Guardianships and Other Legal Arrangements will be available soon.
Update 8/28/2017: registration is now open!
August 22, 2017 in Cognitive Impairment, Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Programs/CLEs, State Statutes/Regulations, Webinars | Permalink | Comments (0)
Tuesday, August 8, 2017
Recently the U.S. Senate passed S 178, the Elder Abuse Prevention and Prosecution Act which is "[t]o prevent elder abuse and exploitation and improve the justice system’s response to victims in elder abuse and exploitation cases."
Title I is "Supporting Federal Cases Involving Elder Justice", Title II is "Improved Data Collection & Federal Coordination", Title III covers enhanced services to victims of elder abuse, Title IV, the "Robert Matava Elder Abuse Prosecution Act of 2017", includes enhanced penalities for those email & telemarketing schemes targeting elders, as well as interstate initiaties and state training & technical assistance.
In Title V, Miscellaneous, there are sections that deal with GAO reports, "[c]ourt-appointed guardianship oversight activities under the Elder Justice Act...," outreach to both state and local law enforcement and a requirement that the AG "publish model power of attorney legislation for the purpose of preventing elder abuse" (section 504) and "publish best practices for improving guardianship proceedings and model legislation relating to guardianship proceedings for the purpose of preventing elder abuse."
Friday, August 4, 2017
The Uniform Law Commissioners recently approved the new guardianship act. The prior act, the Uniform Guardianship & Protective Proceedings Act was approved in 1997. The new act, the Uniform Guardian, Conservatorship & Other Protective Arrangements Act was approved in mid-July at the ULC's 126th annual meeting. Terminology has changed with this new act, with the use of incapacitated person falling by the wayside. Instead, the act refers to "adult subject to guardianship" or adult subject to conservatorship" both of which are defined in Section 102. Less restrictive alternative now includes supported decision-making, along with other alternatives such as a health care or financial power of attorney or representative payee. More emphasis is put on protective arrangements (Article 5 of the Act) as an alternative to guardianship. Another version of the new act with a prefatory note and commentary will be available on the ULC website soon.
Wednesday, August 2, 2017
Clark County, Nevada has been at the center of serious allegations of abuse by court-appointed guardians, including "public" guardians, as we have reported here in the past. Most recently, the county was the site of a conviction and sentencing of a woman who was charged with theft from her "long-time companion," the incapacitated person she was appointed to protect.
Helen Natko was found guilty by a Las Vegas jury in April of theft and exploitation of a vulnerable person:
Natko raised suspicions when she transferred nearly $200,000 out of a joint account. Natko returned the money but that's when Del's daughter, Terri Black, tried to protect her father leading to a guardianship case.
"That began our 4 year odyssey of pain and sorrow that continues to this day for my family," says Terri. She says the most painful part was not having quality time with her father in his final days.
Although the prosecutor (and the protected person's family members) sought "prison time" following the conviction, ultimately the state court judge sentenced Natko to 5 years probation, a $10,000 fine and a bar on "gambling." Further, according to Las Vegas Contact 13 KTNV news reports, "she's disqualified to be a guardian under new laws passed" since the channel's investigation and news series exposed problems in the county's guardianship system.
For more see Contact 13: Guardian Sentenced to Probation. My thanks for the update from Rick Black, the son-in-law of the victim in this case. It's been a long haul for the family. Mr. Black commented, "We are satisfied with the [July 31, 2017] sentence. Although we wanted prison time, it wasn't in the statutes. Thanks to the many victim family members and advocates who came to support Terri [Rick's wife]."
Mr. Black is a volunteer with Americans Against Abusive Probate Guardianship (AAAPG), which was founded in Florida in 2013 by Sam J Sugar, M.D., in response to his own experiences in the Miami-Dade probate court.
My thanks to those who wrote to correct my earlier mistake in describing the history of AAAPG.
August 2, 2017 in Cognitive Impairment, Crimes, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (1)
Wednesday, July 26, 2017
The National Adult Protective Services Association (NAPSA) and the National Council on Crime and Delinquency announce a free upcoming webinar, The Abuse Intervention Model: A Pragmatic Approach to Intervention for Elder Mistreatment. Set for August 9, 2017 at 2 p.m. edt, the "webinar will present the Abuse Intervention Model (AIM), which is a simple, coherent framework of known risk factors of the victim, perpetrator, and environment that applies to all types of abuse. Dr. Laura Mosqueda will discuss the details of the AIM, and present case studies on how the AIM can be applied to APS work." Click here to register. To read more about the intervention model, click here.
Wednesday, July 19, 2017
Justice in Aging has announced a free webinar on Juhttp://www.justiceinaging.org/webinar-elder-abuse-insight-victims-crimes-act-voca/ly 31, 2017 at 2:00 p.m. edt, Elder Abuse-Insight into Victims of Crimes Act (VOCA). Here is a description of the webiniar
The Victims of Crimes Act (VOCA) supports crime victims programs that assist victims of sexual assault, spousal abuse, child abuse, or other previously underserved victims of crimes. In recent years, VOCA has supported elder abuse programs, including certain specified legal assistance expenses that help crime victims.
Legal aid programs play a crucial role in accessing justice for elder abuse victims. In this webinar, Elder Abuse-Insight into Victims of Crimes Act (VOCA) and Legal Aid Support, Steve Derene, Executive Director of the National Association of VOCA Assistance Administrators (NAVAA), will explain VOCA and its potential for supporting elder justice initiatives in legal services programs. Kathy Buckley, Manager of the Victim’s Services Program at the Pennsylvania Commission on Crime and Delinquency will provide insight into the programs the Commission supports through VOCA.
The webinar will emphasize key details legal aid programs should understand when applying for VOCA funding to support elder justice work.
And did I mention, it's free? To register, click here.
Monday, July 10, 2017
The ABA Commission on Law & Aging and the Virginia Tech Center for Gerontology have released a report, Restoration of Rights in Adult Guardianship: Research & Recommendations. The report is divided into four parts: (1) introduction & background, (2) research on restoration of rights, (3) discussion & recommendations on key issues to restoration, and (4) conclusion. The report runs 69 pages and is available for download as a pdf. Section 3 covers a number of topics, including lack of knowledge of the availability of restoration, review by courts re: continuing need for guardianship, court access, attorney representation (and the attorney's role), the guardian's role, supports available to the person, evidence and evidentiary standards, and data and research. Here is the conclusion
The time is ripe for restoration of rights to be become a viable option for people subject to guardianship. In the context of the emergent paradigm of supported decision-making, restoration can be a path to self-determination and choice. For courts, attention to restoration can weed out unnecessary cases from dockets, allowing a stronger focus on problems needing judicial intervention, and saving administrative costs of carrying unnecessary cases.
To make restoration work:
• State legislation must ensure sufficient notice that the option exists, provide for regular court review of the continuing need for guardianship, afford the right to counsel, and set workable evidentiary standards.
• Courts must assess cases for possible restoration, find ways to make individuals and families more aware of the option, make the process more accessible, take into account available supports in making determinations, and track data on restoration.
• Guardians must perceive their role as enhancing self-determination and working toward termination of guardianship with sufficient support – more as "supporters" guided by the person’s expressed wishes if possible. There must be sufficient legal decision-making tools, family supports, technological supports, and community supports readily available to bolster functional abilities.
• Lawyers must recognize and act on the potential of restoration in guardianship cases.
This study has set the stage for such actions, bringing to life the possibility that guardianship is not automatically an end but can be "a way station and not a final destination."
July 10, 2017 in Cognitive Impairment, Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)
Monday, June 19, 2017
The Denver Post reported recently that the Denver DA and the Denver Police are taking steps to combat elder and vulnerable adult abuse. Denver DA, police form units to protect elderly, developmentally disabled explains that the DA has created a division within the office on elder abuse. As well the Chief of Denver PD has established a special victims unit for elders and vulnerable adults who are victims of abuse. The DA's division "will focus on physical abuse and neglect crimes against at-risk adults aged 70 or older, as well as adults with intellectual or developmental disabilities ... [as well as] prosecute financial fraud cases that target at-risk adults." The PD unit will work together with DA investigators and social workers to investigate reports.
Colorado uses age 70 for victims of elder abuse, and the law includes mandatory reporting. The law seems to be having a positive effect, based on the statistics in the article: "the number of Denver police investigations related to at-risk adults climbed adults climbed 271 percent from 228 to 847 cases between 2013 and 2016, according to department statistics. Elder abuse cases make up the bulk of the cases. Police investigated 735 elder abuse cases in 2016, a 418 percent increase above the 142 cases investigated in 2013."
Monday, June 12, 2017
Perpetrators of financial exploitation and other forms of elder abuse may exert undue influence to control the decision-making of their victims. Learning to recognize signs of undue influence will help legal and aging network service providers prevent or redress elder abuse and enhance victims’ access to justice.
Lori Stiegel and Mary Joy Quinn, nationally recognized experts on elder abuse and undue influence, will present this advanced webinar, Elder Abuse: The Impact of Undue Influence, to help legal and aging network professionals understand the dynamics and indicators of undue influence, and the relationship of this psychological process to elder abuse and guardianship.
During this training, Lori will discuss the concept and its connection to capacity and consent, tactics and process, and legal remedies. Mary Joy will provide an example of how undue influence is defined in California law and share an undue influence screening tool for Adult Protective Services that lawyers and other professionals should be aware of and can use in their own practice.
To register for the webinar, scroll to the bottom of the page and click on the register now button. .
Thursday, June 8, 2017
World Elder Abuse Day is June 15, 2017. Here is the info from the Administration for Community Living
Each year, an estimated 5 million older adults are abused, neglected, or exploited. Older Americans lose an estimated $2.6 billion or more annually due to elder financial abuse and exploitation, funds that could be used to pay for basic needs such as housing, food, and medical care. Unfortunately, it occurs in every demographic and can happen to anyone—a family member, a neighbor, even you. It is estimated that only one in five of these crimes are discovered.
World Elder Abuse Awareness Day (WEAAD) was launched on June 15, 2006 by the International Network for the Prevention of Elder Abuse and the World Health Organization at the United Nations (UN). WEAAD aims to provide an opportunity for communities around the world to promote a better understanding of abuse and neglect of older persons by raising awareness of the cultural, social, economic, and demographic processes affecting elder abuse and neglect. In addition, WEAAD is held in support of the UN International Plan of Action acknowledging the significance of elder abuse as a public health and human rights issue. This observance serves as a call-to-action for individuals, organizations, and communities to raise awareness about elder abuse, neglect, and exploitation.
Access the latest World Elder Abuse Awareness Day campaign materials available from the USC Center on Elder Mistreatment . Logos, web banners, stationary templates, sample press releases, and more are available.
Tuesday, May 30, 2017
On June 12, 2017, the American Society on Aging, along with the USC Leonard Davis School of Gerontology is launching a 5 week course on elder mistreatment. Here is the course description for Elder Mistreatment: Prevention of Abuse and Neglect:
Elder mistreatment prevention is not restricted to just stopping abuse and neglect before they occur, but also encompasses bringing abuse to an end once it has begun, preventing abuse from recurring in older adults who have already been victimized, and minimizing the damage of abuse when the cycle of abuse can’t be prevented. In this five-week course, USC faculty members will introduce participants to what is known about primary, secondary, and tertiary prevention within the field of elder mistreatment, teaching some options and remedies for protecting existing victims of elder mistreatment and those who have not yet been mistreated.
The courses are open only to members of the American Society on Aging. To join or learn more, click here. The course is one in a series of gerontology courses offered by the partners. More information about the series is available here. (full disclosure, I'm on the ASA board).
Thursday, May 25, 2017
With World Elder Abuse Awareness Day next month, I was particularly interested in the Frameworks Institute Toolkit on talking elder abuse. Talking Elder Abuse is divided into 6 parts: introduction, big picture, anticipating public thinking, guides to key framing, sample communications and other resources.
This toolkit is designed to help experts and advocates who work in this field to increase public understanding of
- why elder abuse is a matter of public concern
- the causes of elder abuse, including the social determinants and environmental factors that can foster the occurrence of abuse, and
- what solutions can most effectively prevent elder abuse, address existing cases, and improve the conditions and wellbeing of those who have experienced abuse.
This toolkit, sponsored by Archstone Foundation, The John A. Hartford Foundation, and Grantmakers in Aging, and in partnership with the National Center on Elder Abuse at the Keck School of Medicine of the University of Southern California, models how to apply the FrameWorks Institute’s evidence-based recommendations to messages and conversations about elder abuse and related issues, in order to build public understanding and support. The kit’s materials include:
- sample communications, such as a “key points” guide and social media content, that can be adapted and repurposed for your organization’s needs
- communications examples that demonstrate the “do’s and don’ts” of the framing recommendations
- graphics that illustrate the key concepts of the recommendations
- annotations that explain the framing strategies being illustrated.
Users are encouraged to borrow toolkit language verbatim if desired—no citation or special permissions are needed—and also to adapt the examples to the immediate needs of a local communications context.
For nearly two decades, FrameWorks research has demonstrated that effective communications can help to engage the public in conversations about complex social issues—such as the causes and consequences of elder abuse and the social policies and programs that can prevent its occurrence and improve the lives of older people in the US. This toolkit is based on the findings of a two-year, multi-method study of elder abuse and aging that queried more than 10,400 Americans’ thinking on these issues. The research included expert interviews, on-the-street interviews, large-scale surveys, and persistence and usability trials. This extensive research included the development, empirical testing, and refinement of the tools and strategies offered in this toolkit.
Wednesday, May 17, 2017
Earlier this month Kaiser Health News (KHN) ran a story about Ombudsman volunteers. Volunteers Help Ombudsmen Give Nursing Home Residents ‘A Voice’ In Their Care discusses the local ombudsman volunteers and their importance regarding a resident's quality of care.
Ombudsman’s offices, which operate under federal law in all 50 states, Washington, D.C., Puerto Rico and Guam, investigated 200,000 complaints in 2015, according to the Administration on Aging, a part of the Department of Health and Human Services.
Of those, almost 117,000 were reported to have been resolved in a way that satisfied the person who made the complaint, and about 30,000 were partially resolved. At the top of the list were problems concerning care, residents’ rights, physical environment, admissions and discharges, and abuse and neglect.
Ombudsmen volunteers have a right to enter a long term care facility and talk to residents or anyone else. They investigate complaints and can find issues on their own, and maintain confidentiality. The article emphasizes the importance of volunteer ombudsmen to the success of the programs. There's more involved than putting your name on a list. Ombudsmen volunteers go through training, must pass background checks, are supervised on a few first visits and attend monthly meetings. The article notes the spectrum of experience held by the volunteers but identifies one commonality, "an abundance of compassion."
Tuesday, May 16, 2017
The Justice Clearing House has announced an upcoming webinar scheduled for June 20, 2017 at 3 p.m. edt. Paul Greenwood, Prosecutor from California will present How to Overcome Barriers to Successful Investigation and Prosecution of Elder Abuse Cases.
Drawing upon his 21 years experience of prosecuting both physical and financial elder abuse and neglect felony cases, Paul will highlight some common misconceptions that often hinder the pursuit of justice for elderly victims. He will provide examples of how such barriers can be avoided and will emphasize the importance of a multi-disciplinary approach that should be led by local prosecutors in every jurisdiction. He will confront likely “excuses” as to why certain cases cannot be prosecuted such as “It’s just a civil matter” or “She has dementia and therefore won’t make for an effective witness” or “he gave the money voluntarily so there is no crime.”
To register, click here.