Friday, June 26, 2015
Relying on the 14th Amendment, in a 5-4 ruling, the U.S. Supreme Court ruled that states must license marriages -- and recognize them as valid marriages -- for same sex couples. Justice Kennedy wrote the opinion for the majority; Chief Justice Roberts authored a dissent.
UPDATE: in watching the evening news tonight, I was struck by the numbers of couples with grey hair celebrating the Supreme Court's decision. For the moving story of Jim Obergefell, the lead plaintiff, see this People profile. For commentary on how the most recent Supreme Court ruling, on top of the Windsor case, affects "older" same sex couples, see this blog entry from Justice in Aging.
Tuesday, June 23, 2015
There are four overarching themes for topics deemed critical to elders' well-being to be discussed at the White House Conference on Aging in July 2015. The planned themes are: healthy aging, retirement security, long-term supports and services, and elder justice. Here is an overview, pointing to articles used to create an agenda, from Robert Hudson, Editor-in-Chief of the Public Policy & Aging Report for 2015.
June 23, 2015 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Programs/CLEs | Permalink | Comments (0)
Thursday, June 18, 2015
Earlier this week I recommended Atul Gawande's book, Being Mortal: Medicine and What Matters in the End, and I offered an excerpt from his discussion of how doctors are impacted by practical limits on their goals as solvers of problems. But the book is about more than just medicine. Another compelling chapter traces attempts to avoid "nursing homes" and the once cutting edge trend of "assisted living" as an alternative:
The idea spread astoundingly quickly. Around 1990, based on [Keren Brown] Wilson's successes, Oregon launched an initiative to encourage the building of more homes like hers. Wilson worked with her husband to replicate their model and to help others do the same. They found a ready market. People proved willing to pay considerable sums to avoid ending up in a nursing home, and several states agreed to cover the costs for poor elders.
Not long after that, Wilson went to Wall Street for capital, to build more places. Her company, Assisted Living Concepts, went public. Others sparing up with names like Sunrise, Atria, Sterling, and Karrington, and assisted living became the fastest growing form of senior housing in the country. By 2000, Wilson had expanded her company from fewer than a hundred employees to more than three thousand. It operated 184 residents in eighteen states. By 2010, the number of people in assisted living was approaching the number in nursing homes.
But a distressing thing happened along the way. The concept of assisted living became so popular that developers began slapping the name on just about anything. The idea mutated from a radical alternative to nursing homes into a menagerie of watered-down versions with fewer services. Wilson testified before Congress and spoke across the country about her increasing alarm at the way the ideas was evolving....
For more, see Chapter 4 of Being Mortal, titled "Assistance." The other intriguingly-named chapters are "The Independent Self," Things Fall Apart," "Dependence," "A Better Life," "A Better Life," "Letting Go," "Hard Conversations," and "Courage."
June 18, 2015 in Consumer Information, Current Affairs, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Property Management, Retirement, State Statutes/Regulations | Permalink | Comments (0)
Monday, June 8, 2015
In Eades v. Kennedy PC Law Offices, decided June 4, 2015, the Second Circuit ruled that a federal court in New York has personal jurisdiction to address alleged unfair debt collection practices of a Pennsylvania law firm in seeking to collect unpaid nursing home fees totaling $8,000. The plaintiffs, New York residents -- the husband and adult daughter of a woman in a Pennsylvania nursing home -- challenged statements in correspondence and phone communications allegedly made by the Pennsylvania law firm. The claims against the daughter were based on Pennsylvania's filial support law.
As reported on this Blog in December 2013, the United States District Court for the Western District of New York dismissed the suit, finding no personal jurisdiction and further rejecting application of the federal Fair Debt Collection Practices Act (FDCPA). The Second Circuit's ruling concludes, however, that the law firm's "three purposeful contacts with New York," of mailing a debt collection notice to the New York family members, engaging in a debt collection phone call with the daughter, and mailing a summons and complaint to both the daughter and the nursing home resident's husband, are enough to establish personal jurisdiction under New York's long-arm statute. Further, the defendant law firm had not shown that exercise of such jurisdiction was unreasonable.
On the questions raised by the FDCPA claims, the Second Circuit rejected several key arguments by the plaintiffs, concluding that Pennsylvania's filial support law is not preempted by the Nursing Home Reform Act's prohibition on nursing homes requiring third party guarantees of payment:
June 8, 2015 in Consumer Information, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Legal Practice/Practice Management, State Cases, State Statutes/Regulations | Permalink | Comments (0)
Sunday, May 31, 2015
The GAO has issued a new report on how Home & Community Based Services & Supports are delivered. Older Adults Federal Strategy Needed to Help Ensure Efficient and Effective Delivery of Home and Community-Based Services and Supports is a 60 page report that "addresses (1) federal programs that fund these services and supports for older adults, (2) how these services and supports are planned and delivered in selected localities, and (3) agencies’ efforts to promote a coordinated federal system of these services and supports." The GAO recommends in the report "that HHS facilitate development of a cross agency federal strategy to ensure efficient and effective use of federal resources for HCBS. HHS concurred and HUD, DOT, and USDA did not comment." A number of topics are covered, including transportation, aging in place, information and referral, housing, in-home services, and food assistance. The report discusses the importance of cross-agency collaboration. The GAO concludes that
As the older population continues to grow, communities will find it increasingly difficult to meet the demand for the HCBS and supports many older adults will need to age in their own homes and communities. Based on recent trends, federal funding at AoA, HUD, and DOT for HCBS and supports is not likely to keep pace with demand for these services and supports, making it important to ensure that the federal resources available for this purpose are used effectively and efficiently. Development of a cross-agency federal strategy could better position the federal agencies to assist area agencies on aging and community-based organizations with providing HCBS and supports in the most efficient and effective manner. Under the Older Americans Act, AoA is responsible for facilitating the provision of home and community-based services and supports for older adults in this country, in coordination with CMS and other federal agencies. As a result, AoA is well-positioned to lead collaboration among the five federal agencies covered in our review. However, because of increases in Medicaid spending and emphasis on the role of HCBS in supporting health care patients, CMS has become an even more important partner to AoA in meeting older adults’ expected demand for HCBS. Thus, it may be most appropriate for the HHS Secretary to take the initiative in developing such a cross-agency federal strategy.
Thursday, May 28, 2015
In the PBS documentary airing in May and June, Caring for Mom & Dad, the second half of the program focuses on policy initiatives to support services for older adults. One interesting highlight is Ohio's use of local property tax levies that directly supplement senior services. Begun in the early 1980s as a referendum initiative in just one county, similar programs have been adopted by voters in counties or municipalities in more than 70 of Ohio's 88 counties. That is an amazing history, especially given the usual hostilities about "new" taxes. Voters appear to recognize that the levies permit unique flexibility to design programs that meet the needs of their community's seniors, whether in rural or urban areas, such as transportation services or home care subsidies. The revenue now generated in Ohio, more than $125 million per year, exceeds federal grant funding under the Older Americans Act nationally.
Ohio's inspiring "Lady of the Levy," Lois Dale Brown, is mentioned in the PBS documentary, and she's profiled, along with additional details about the senior service levies, on the Ohio Department of Aging's website.
As a reminder, WPSU-TV is airing Caring for Mom & Dad at 8 p.m. this evening in Pennsylvania, followed by a one hour "Conversations Live" open to incoming calls, texts and emails. Details available here.
May 28, 2015 in Current Affairs, Estates and Trusts, Ethical Issues, Federal Statutes/Regulations, Film, Health Care/Long Term Care, Housing, State Statutes/Regulations, Statistics | Permalink | Comments (0) | TrackBack (0)
Tuesday, May 26, 2015
Here is an interesting item from a recent Senior Care Investor News, published by Irving Levin & Associates:
"The rise in acuity in post-acute care is certainly having its impact in the skilled nursing M&A market. Historically, the range in price per bed for skilled nursing facilities has been approximately $100,00 to $125,000 per bed, according to the 2015 Senior Care Acquisition Report. Every year, there are always sales between $10,000 and $20,000 per bed, with the occasional sale below $10,000 per bed. And there have always been sales above $100,000. But in 2014, while the low price was a typical $9,000 per bed, the high was an astounding $268,500 per bed, resulting in a spread of $259,500. There was also a record number of deals valued over $100,000 per bed, with 19 transactions, which just goes to show the rise in acuity is pushing up prices across the board."
What would be driving the market for "skilled" beds to a higher figure, especially given the continued dependence on Medicaid as the primary payer for skilled care, combined with the fact that Medicaid pays below (and arguably significantly below) actual costs of skilled care? This market data seems illogical to me, and I'm sure I'm missing something.
Monday, May 25, 2015
A new report from the AARP Public Policy Institute/Urban Institute highlights the positive impact of Medicaid expansion for the 50-64 age group. Monitoring the Impact of Health Reform on Americans Ages 50–64 notes that "[t]he Uninsured Rate for 50- to 64-Year-Olds Dropped 31 Percent since December 2013."
The abstract for the report offers that
New data from the December 2014 Health Reform Monitoring Survey show that the share of Americans ages 50 to 64 without health insurance fell by nearly a third, from 11.6 percent to 8.0 percent, between December 2013 and December 2014. States that chose to expand eligibility for their Medicaid programs saw a larger drop in uninsured rates among 50- to 64-year-olds than states that did not. Overall, the number of 50- to 64-year olds with health coverage increased by approximately 2.2 million between December 2013 and December 2014.
The report determines that "Medicaid expansion was a clear driver of the reduction of the uninsured rate among 50- to 64-year olds."
The full report is available here.
University of South Dakota Assistant Professor of Law Thomas E. Simmons has an intriguing article in the summer 2015 issue of Hastings Women's Law Journal. From his article, "Medicaid as Coverture," here are some excerpts (minus detailed footnotes) to whet your appetite:
Not long ago, married women possessed limited rights to own separate property or contract independently of their husbands. Beginning in the nineteenth century, most of the most serious legal impediments to women enjoying ownership rights in property and freedom of contract were removed....
Three twenty-first century developments, however, diminish some of this progress. First, later-in-life (typically second) marriages have become more common.... These types of couples were not the spouses that reformers had in mind in designing inheritance rights or other property rights arising out of the marital relationship....
Second, perhaps as a product of advocacy for women's property rights, and perhaps out of a larger social remodeling, women's holdings of wealth have made significant advances.... [But] women of some wealth (in later-in-life marriages, especially) may in fact find themselves penalized by the very gender-neutral reforms that were designed to help them; especially, as will be unpacked and amplified below, when those reforms interface with Medicaid rules.
Third, beginning in the late twentieth century, the possibility of ongoing custodial care costs became the single greatest threat to financial security for older Americans.
As practicing elder law attorneys experience on a daily basis, Medicaid eligibility rules, despite the so-called "Spousal Impoverishment" protections, can impact especially harshly on married women as the community spouses. They are often younger and thus will have their own financial needs, frequently have been caregivers before being widowed, but their personal assets may still be included in the Medicaid estate for purposes of determining their husbands' eligibility. This article takes a critical, interesting approach to that problem.
May 25, 2015 in Discrimination, Estates and Trusts, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare, Social Security | Permalink | Comments (1) | TrackBack (0)
Thursday, May 14, 2015
PBS is premiering a powerful documentary special, Caring for Mom & Dad, during the month of May, with Meryl Streep as the narrator. A sample? Many of us might find resonance with one adult's "bad daughter" (or "bad son") feelings of guilt, candidly admitted here.
Even more important than the video itself will be the conversations that follow viewing. Check your local public t.v. schedule to see when the program will air in your area. (You can check here, to see if the documentary is scheduled yet in your viewing area -- go to the drop down menu for "Schedule.") Plus, in some markets, the documentary will be combined with a live call-in opportunity for individuals and families to explore health care, social care, financial topics and legal issues with a panel of experts.
My own university, Penn State, is hosting the special on Thursday, May 28, 2015 at 8:00 p.m. (Eastern time), followed by Conversations Live at 9:00 p.m. That is two weeks from today on WPSU-TV, a station that reaches a viewing area of 29 counties in central Pennsylvania. In addition, the Conversations Live program will be broadcast on WPSU-FM radio and can be viewed "on-line" at WPSU.org.
As a result of an invitation to be part of the WPSU studio panel, I've had the opportunity to watch the documentary -- several times (it's that interesting!) -- in preparation to help in responding to audience comments, emails and call-in questions. Additional Conversations Live guests include:
Ai-jen Poo, co-director of Caring Across Generations and director of National Domestic Workers Alliance, will be joining via satellite from D.C. Ai-jen Poo is featured in the documentary, and she also has a particular interest in enactment of a Domestic Workers' Bill of Rights, to deal realistically and fairly with the work force that will be necessary to meet the boomer generation's care needs.
Dr. Gwen McGhan, Hartford Center for Geriatric Nursing Excellence at Penn State, with a research background on informal family caregiving.
Jane McDowell, Hartford Center for Geriatric Nursing Excellence at Penn State, and a geriatric nurse practitioner.
The documentary was produced by WGBH-Boston, with funding assistance from AARP and Pfizer.
Please join us and share your stories and observations. The documentary starts with personal stories, but the public policy messages that emerge are ones that need to be heard at state and federal levels -- and heard clearly -- for there to be hope for realistic, necessary and timely solutions.
May 14, 2015 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, Film, Health Care/Long Term Care, Medicaid, Medicare, Social Security, State Statutes/Regulations | Permalink | Comments (0) | TrackBack (0)
Wednesday, May 13, 2015
The recent issue of Bifocal, the bi-monthly Journal of the ABA Commission on Law and Aging has a great line-up of articles, including a piece by Social Security Administration (SSA) specialist Janet Truhe on Social Security Seeks Pro Bono Lawyers to Meet Need for Representative Payees. She notes that many disabled individuals do not have family members or other trusted persons who can serve as their agents for receipt and management of Social Security benefits. Anticipating the need for "rep payees" will continue to grow as boomers age, SSA is recruiting attorneys to serve:
Recently, the agency announced the implementation of a pro bono pilot in the State of Maryland (where SSA is headquartered), which is aimed at expanding the pool of suitable representative payee candidates statewide. SSA believes that partnership with the legal community for this purpose is a natural fit....
One particular advantage of this pro bono opportunity is that any attorney, regardless of his or her specialty, can serve as a representative payee with SSA providing any needed assistance. SSA has created a web site for attorney volunteers with training and other information about the role of a representative payee. Any licensed attorney in Maryland, or in neighboring jurisdictions, who would like to volunteer as a representative payee for a beneficiary residing in Maryland can go to http://www.socialsecurity.gov/payee/probonopilot.htm and complete an online registration form. SSA will send the volunteer attorney’s contact information to the servicing local field office. When SSA needs a representative payee for a particular beneficiary, that field office will contact one of the volunteer attorneys and make an appointment for the attorney to come in for an interview and meet the beneficiary.
Hat tip to ElderLawGuy Jeff Marshall for pointing out this SSA recruitment effort.
One option for seniors needing more income late in life is using the equity in their homes, and "reverse mortgages" may make it possible for the older homeowner to stay in the home longer. The Washington Post recently explored the option of having family members serve as the source of reverse mortgage funding. When the Kids Provide a Reverse Mortgage for Mom and Dad outlines potential pros and cons of family-based financing, starting with the mechanics of the loan:
Here’s a simplified example: Say you and two siblings want to help Mom and Dad, who are in their late 70s. You and your siblings are all doing well enough that you have at least some cash to spare. Ultimately, you want to retain your parents’ house for the estate once your parents pass away, keep costs to a minimum and sell the property only when you, not a faraway bank, choose to do so.
So you sit down with Mom and Dad and determine that, at least for the foreseeable future, they will need about $1,500 in additional income a month. You and your siblings agree to apportion the payments among yourselves in some way, maybe a commitment of $500 a month each for a period of years. You also pick an interest rate that achieves a win-win result for you and your parents — say, 3 percent annually. That’s much lower than a commercial lender would charge but higher than what you’ve been earning on your bank deposits or money market funds. There are no required fees upfront — hey, it’s Mom and Dad.
Thanks to Maryland elder law attorney Morris Klein for the pointer to this article.
Tuesday, May 12, 2015
We've written on this blog several times about successful prosecutions connected to so-called "off label" drug use, including the use of antipsychotics for agitation in dementia patients. See here and here, for example. Now, courtesy of a New York Times article, there is news of a pharmaceutical company's lawsuit to preempt such prosecutions, raising First Amendment free speech rights as grounds for off-label advocacy:
On Thursday, Amarin Pharma took the unusual step of suing the Food and Drug Administration, arguing that it has a constitutional right to share certain information about its product with doctors, even though the agency did not permit the company to do so. Lawyers for the company said that they believed their case was the first time a manufacturer had pre-emptively sued the agency over the free-speech issue, before it had been accused of any wrongdoing. Other companies have sued the agency only after they have gotten into trouble....
Lawyers for Amarin say the company is not proposing to market Vascepa to a wider population of patients, merely to share with doctors the results of a 2011 company-sponsored clinical trial that showed the drug lowered triglycerides in patients with “persistently high” levels....
More details about the suit available here.
Tuesday, May 5, 2015
Here we go again. Another hard look at why a significant percentage of the public has not signed some form of advanced directive. In April 2015, GAO issued Advance Directives: Information on Federal Oversight, Provider Implementation, and Prevalence, its response to requests made by Senators Bill Nelson (D-Fla), Johnny Isakson (R-Ga), and Mark Warner (D-Va) who were inquiring into the role of the Centers for Medicare and Medicaid Services (CMS) in overseeing providers, including hospitals and nursing homes, that are mandated by law to maintain written procedures and provide information about advance directives.
Perhaps it is just me, but whenever legislators raise this topic, it seems to me the not-so-subtle underlying message is "why aren't people agreeing in writing to forego aggressive health care as they near the end of life so that we can save more money on health care?"
In any event, the report:
- documents current practices for offering living wills, health care powers of attorney, and various alternatives such as DNR and POLST forms (including the potential for some confusion among staff members of health care providers about "who" should be handling the education and signing process),
- refers to a major Institute on Medicine study (Dying in America, 2015) on a similar topic, and
- concludes that there is no "single" point of entry for execution of advanced directives.
As the GAO team observes, "[t]herefore, a comprehensive approach to end-of-life care, rather than any one document, such as an advance directive, helps to ensure that medical treatment given at the end of life is consistent with an individual’s preferences."
Hat tip to Karen Miller, Esq., in Florida for the link to the latest study and report.
May 5, 2015 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Estates and Trusts, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare | Permalink | Comments (1) | TrackBack (0)
Thursday, April 30, 2015
The Long Term Care Community Coalition has released a new report, Safeguarding Nursing Home Residents and Program Integrity A National Review of State Survey Agency Performance. The 30 page report looks at several topics, including resident harm, inappropriate use of antipsychotic drugs , staffing and treatment of pressure ulcers. The report makes a series of recommendations for CMS and state survey agencies:
1. Re-commit to their mission as enforcement agencies. Residents and their loved ones depend on enforcement agencies to ensure that providers are meeting - or exceeding - standards of care. Tax payers depend on CMS and the SAs to assure financial integrity of the billions of dollars spent each year on nursing home care. However, too often (in our experience), CMS and the individual SAs treat the industry as their client, and its interests as paramount, rather than those of the residents, their families and tax payers.
2. Improve resource allocation. CMS and the SAs should be dedicating their limited resources to fostering vigorous oversight, not training, engaging or otherwise trying to encourage providers to attain the minimum standards of care for which they are already being paid to achieve...
3. Comply with federal Survey Agency requirements. CMS and the SAs should focus efforts on achieving both the letter and the spirit of the law, regulations and the State Operations Manual....
4. Improve performance assessment & integrity.
a. CMS and the SAs should improve training and direction of surveyors...
b. The SAs should collect and assess data on their survey teams’ identification of deficiencies and identification of harm and assess these data in relation to relevant measures (including, inter alia, antipsychotic drug use, staffing levels and pressure ulcer rates)...
c. CMS should conduct, on a regular basis, similar performance assessments of the SAs and the CMS Regional Offices to identify and address weaknesses in quality assurance and oversight. CMS should include in its assessment an analysis of SA complaint handling that includes review of a sampling of actual complaints to determine if they were appropriately investigated and resolved.
Tuesday, April 28, 2015
Another change from the Medicare Access and CHIP Reauthorization Act of 2015 is that Medicare will stop using beneficiary Social Security numbers on the Medicare cards. Section 501 of the new law provides that
The Secretary of Health and Human Services, in consultation with the Commissioner of Social Security, shall establish cost-effective procedures to ensure that a Social Security account number (or derivative thereof) is not displayed, coded, or embedded on the Medicare card issued to an individual who is entitled to benefits under part A of title XVIII or enrolled under part B of title XVIII and that any other identifier displayed on such card is not identifiable as a Social Security account number (or derivative thereof).
This will appear in 42 U.S.C. 405(c)(2)(C)(xiii). The changes won't necessarily occur immediately and "shall apply with respect to Medicare cards issued on and after an effective date specified by the Secretary of Health and Human Services, but in no case shall such effective date be later
than the date that is four years after the date of the enactment of this Act." The same holds true with reissuing cards; HHS has up to 4 years from the date the Secretary picks for the new cards.
This is a critically important step, what with the rise of identity theft. It has been a long time coming.
According to the Atlanta Journal-Constitution, the "long-time head of [Georgia's] powerful nursing home lobby has resigned after months of internal differences." The resignation appears to be about more than just internal politics, perhaps implicating state ethics. AJC explains:
"The resignation of Jon Howell, first reported by Georgia Health News, came only a few months after he told lawmakers that the industry didn’t need all of the money Gov. Nathan Deal recommended as part of a rate hike for select nursing homes. Several of those nursing homes are owned by one of Deal’s top contributors. But one state official said the 'civil war' within the organization began before this year’s General Assembly session.
The nursing home association is a major player at the statehouse, and owners have a big stake in what happens at the Capitol. The state pays more than $1 billion a year to nursing homes to care for Georgians. Owners have long been politically active, donating big money to state leaders and lawmakers who fund reimbursements. Earlier this year, Deal recommended that select nursing homes get a $27 million a year rate increase, a bump stalled by the Department of Community Health board last year...."
Separate articles in the AJC indicate that federal CMS authorities are now seeking millions of dollars of reimbursement for Medicaid payments made to 34 specific nursing facilities, although whether this claim correlates with the governor's recommended rate increase is not clear from the articles. State officials are reported as disagreeing with the federal CMS ruling that triggers the reimbursement claim.
Recent rate increases recommended by the Georgia governor were rejected by Georgia's General Assembly. Additional coverage on the Georgia nursing home industry's organization is provided by McKnight's Long-Term Care News.
I suspect the Georgia stories are part of a bigger picture. Compare, for example, Al Jazeera's America Tonight report from April 2014 on The Whopping Political Power of the Florida Nursing Home Lobby, describing the nursing homes advocating for placement of children into facility-based care.
Wednesday, April 22, 2015
LTCCC press release says new study assesses nursing home citation rates nationwide, finds little or no punishment when nursing homes fail to provide care that meets the standards they are paid to achieve, even when such failures result in significant suffering.
Widespread and persistent nursing home problems, including serious deficiencies in care, result in unnecessary harm to thousands of vulnerable residents every day. Deficient and worthless services also cost taxpayers hundreds of millions of dollars a year. The nursing home industry frequently complains that it is one of the most highly regulated in the country. But what does that mean when so many nursing homes are consistently paid to provide care that fails to meet those standards?
LTCCC’s new report, , presents a comparative overview of every state’s (50 states + DC) performance on several key criteria. LTCCC assessed overall state citation rates, number and amounts of fines that each state has imposed in the last three years for violations of minimum standards and the rates at which the states identified resident harm when they found deficiencies. In addition to reviewing state citations as a whole, the study focused on three criteria important to quality care – pressure ulcers, staffing and antipsychotic drugging.
“While no data are perfect, we felt that assessing overall citation and penalty rates, as well as citations for three critical quality criteria, would together provide valuable insights into State Survey Agency performance and the extent to which important problems are being addressed in each state” said Richard Mollot, LTCCC’s Executive Director and author of the report.
1. Resident Harm. States only find harm to residents 3.41% of the time that they cite a deficiency. California and Alabama tied for lowest in the country, finding harm only 1.14% of the time.
2. Inappropriate Antipsychotic Drugging. The nationwide average antipsychotic drugging rate is 18.95% while the average citation rate for inappropriate drugging is 0.31%. This indicates that there is a significant amount of inappropriate antipsychotic drugging that is not being cited by the states.
3. Pressure Ulcers. Pressure ulcers (bed sores) are a problem for over 86,000 nursing home residents. Though they are largely preventable, states cite nursing homes the equivalent of less than 3% of the time that a resident has a pressure ulcer. When states do cite a facility for inadequate pressure ulcer care or prevention, they only identify this as harmful to residents about 25% of the time.
4. Sufficient Care Staff. Insufficient care staff is one of the biggest complaints made by nursing home residents and their families. Studies have repeatedly identified it as a serious problem in a majority of US nursing homes. Nevertheless, insufficient staffing is rarely cited by the states. The annual rate of staffing deficiencies per resident is infinitesimal: 0.042%. Less than 5% of those deficiencies are identified as resulting in harm. Twenty one states never connect insufficient care staff to resident harm in their states.
The report is available on LTCCC’s dedicated nursing home website at http://www.nursinghome411.org/articles/?category=lawgovernment. The website includes interactive charts showing key rates for each state as well as national averages. They include state rankings on criteria identified as important to nursing home resident care and the protection of taxpayer funds that pay for the majority of nursing home care. These charts can be used to gain insights into the strengths and weaknesses of quality oversight in any state.
Tuesday, April 21, 2015
If you haven't had a chance yet to read the new law, you should take a look. Medicare Access and CHIP Reauthorization Act of 2015 was signed by the President on April 16, 2015. Among some of the provisions to note is section 211 which provides for a permanent extension of the QI program (which had expired effective April 1 and had been reauthorized a year at a time), a change to Medigap plans (section 401) and a change to the income-related premium increases for higher income beneficiaries for Part B and D (section 402). These last 2 are part of the offsets in the bill. For the Medigap plans, effective in 2020, those newly eligible for Medicare won't be able to buy a gap plan to cover the Part B deductible. The changes to the income-related premium adjustments take effect a little earlier (2018) and those beneficiaries affected by the change will be paying more for their Medicare coverage.
Monday, April 20, 2015
Whenever I look at national programs on "hot topics" in healthcare law, I'm seriously impressed by the number of offerings on regulatory compliance issues connected to Medicare and Medicaid payments. There are abundant reasons for this emphasis. Each year the Department of Justice touts its statistics on "recoveries" for False Claim Act cases. For the fiscal year ending September 30, 2014, the DOJ enthusiastically reported its "first annual recovery to exceed $5 billion" in a single year. No wonder health care law is a hot field. And remember, much of the money is connected to senior care in all of its guises.
A recent $1.3 million settlement on a Medicare-related False Claims Act case might seem like small potatoes at first glance. But, I was struck by the fact that it was a DOJ settlement with a (non-profit) Continuing Care Retirement Community. I don't usually think of CCRCs as being a major target of False Claim Act allegations. Details are a bit sparse, but the size of the payment seemed pretty hefty when you consider that Asbury Health Center near Pittsburgh, PA actually "self-disclosed" its violation of Medicare regulations. The DOJ press release on April 15 explains:
"For post-hospital skilled nursing care, Medicare regulations require that a facility obtain a physician certification at the time of admission or as soon thereafter as reasonable and practical. The facility must also obtain a physician recertification within 14 days of admission and every 30 days thereafter. Based on information provided by Asbury, the United States alleged that it had civil claims against Asbury resulting from Medicare payments for post-hospital skilled nursing services that were not supported by physician certifications and recertifications."