Wednesday, September 13, 2017

The Critical Importance of A.C. for Emergency Preparedness

A couple of years ago, I was present when my father's dementia care facility -- a licensed assisted living community -- was doing a test of part of their emergency preparedness plan.  The staged "emergency" for that particular test was "loss of air-conditioning," which for most of the year in Arizona and other locations in the south and southwest is a serious concern.  With climate change, heat and air-conditioning systems are going to be even more critical in the future.

I was impressed that even without back-up generators, the facility had both a short-term and long-range plan. The long-term plan required staged evacuation to other locations.  Of course, to be effective, any evacuation would depend on the "other" locations having working power systems, something that can't be certain in a large scale weather or similar emergency.  

Sadly, as reported in the New York Times on September 13, following the damage caused by Hurricane Irma, there were several deaths at a long-term care facility near the coast in southeastern Florida.  The rapidly developing story suggests that as many as eight deaths were tied to loss of air-conditioning, although not a complete loss of power to the facility. It is too early to know all of the relevant facts.  But, what about the law?  The NYT article notes that:  

Florida requires nursing homes to have procedures to ensure emergency power in a disaster as well as food, water, staffing and 72 hours of supplies. A new federal rule, which comes into effect in November, adds that whatever the alternative source of energy is, it must be capable of maintaining temperatures that protect residents’ health and safety.

Does the federal regulation mandate emergency sources of air-conditioning? Although the highlighted language in the NYT article suggests the new federal rule "comes into effect" in November of this year, my read of the regulation says the effective date was November 15, 2016 -- in other words, last year.

***

9/14/17 Correction to above paragraph:  It was bothering me that I saw more than one news article describing the Emergency Preparedness rule as not taking effect until November of this year.  The "effective date" of the Rule is clearly November 15, 2016 -- but, the New York Times is correct -- Long Term Care facilities have "until" November 15, 2017 to "implement" their preparedness plans, including any plan for maintaining safe temperatures.   The implementation deadline was in a previous version of the rule, not the version of the rule actually made "effective" on November 15, 2016.  Another lesson for me in the need for careful reading of regulations!

***

Perhaps more importantly, here's the language of the federal regulation, at 42 C.F.R Section 483.73, governing emergency preparedness at LTC facilities:

The LTC facility must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least annually. At a minimum, the policies and procedures must address the following:
 
(1) The provision of subsistence needs for staff and residents, whether they evacuate or shelter in place, include, but are not limited to the following:
    (i) Food, water, medical, and pharmaceutical supplies.
    (ii) Alternate sources of energy to maintain
        (A) Temperatures to protect resident health and safety and for the safe and sanitary storage of provisions;     
        (B) Emergency lighting;
        (C) Fire detection, extinguishing, and alarm systems; and
        (D) Sewage and waste disposal.
Does this regulation require alternative sources of air-conditioning or heat -- as necessary to "protect resident health and safety" -- or does it merely require a "policy and procedure"?  I suspect this language might be a legal issue in any post-Irma proceedings.  
 
This is still a developing story, with state authorities conducting investigations.  For more, see this NPR story

September 13, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, State Statutes/Regulations | Permalink | Comments (0)

Tuesday, September 12, 2017

Disaster Planning and Services on Our Minds

With Irma in Florida's rear view mirror (and not a moment too soon), many are focused on what, if anything, should be done differently  next time.

For us as attorneys, we should be sure to tell our clients about the importance of having a disaster plan. For clients living elsewhere, whether a long-term care facility or housing specifically for elders, they should be advised to ask a lot of questions. Does the facility have a disaster plan? Get a copy of it.  What services does the facility provide to help residents evacuate? In what evacuation zone is the facility located? Does the facility have a back-up generator in the event of a power outage? How does the facility balance having adequate staff on site before, during and after the disaster while simultaneously allowing staff to prepare for the disaster?  Does the facility's insurance policy cover property of residents? What services does the facility provide to help residents return after the disaster? What happens if the facility is now uninhabitable?  Does the admissions contract provide for any return of the resident's money (this may be more applicable to a CCRC than a SNF or apartment). Will the facility help residents find other suitable housing? What other items would you add to the list?

As part of the news coverage surrounding Irma, the Washington Post ran a story about the risks of evacuating elders. Moving Florida’s many seniors out of Irma’s path has unique risks discusses the research that has been done on the stress of evacuations on elders, noting that some evacuees will die from the stress of evacuation.  Whether to go or stay is akin to rolling the dice. On the one hand, those in the path have plenty of advance notice of the approaching storm, but as seen with Irma, the track can (and does) change, so no one knows where it will hit. 

If you stay you have risks. If you go, you have risks.  As one person quoted in the Washington Post article noted, "[t]his is one of those classic cases of damned if you do, damned if you don’t. It’s a very difficult decision: When you evacuate, there is an inherent body count for frail, older adults...”   Because these folks are frail, they need to be evacuated earlier than others might, and based on lessons learned from Andrew and Katrina, there may be more pressure from officials for facilities to evacuate their residents rather than to stay put to weather the storm.  Speaking from personal experience, the wait is stressful. It seems to take a long time for the storm to pass over once the go-no go time has passed. Then afterwards, there's the issue of utilities, clean up, services and supplies.

The media aren't the only ones focused on the issues of elders in the path of disasters. The Senate Committee on Aging has scheduled a hearing for September 20, 2017 at 9:00 a.m. on "Disaster Preparedness and Response: The Special Needs of Older Americans"  

Stay tuned.

September 12, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Other | Permalink | Comments (0)

CMS Issues ABLE letter to State Medicaid Directors

CMS released State Medicaid Director Letter #17-002, Implications of the ABLE Act for State Medicaid Programs. The letter is designed to give guidance to state Medicaid programs on implementing ABLE. The letter includes background on the ABLE Act, explains who is eligible to have an ABLE account (including an explanation about the use of the word "qualified" in the statute)), how funds in the ABLE account are treated, contributions by the beneficiary or a 3rd party, distributions, post-Medicaid eligibility treatment of income  and transfers of ABLE money to a state and estate recovery.

September 12, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid | Permalink | Comments (0)

Thursday, September 7, 2017

Jimmo v. Sebelius-Is the End in Sight?

CMS has released a new webpage as part of its settlement of the Jimmo case. The Center for Medicare Advocacy press release explains that "[t]he Jimmo webpage is the final step in a court-ordered Corrective Action Plan, designed to reinforce the fact that Medicare does cover skilled nursing and skilled therapy services needed to maintain a patient’s function or to prevent or slow decline. Improvement or progress is not necessary as long as skilled care is required. The Jimmo standards apply to home health care, nursing home care, outpatient therapies, and, to a certain extent, for care in Inpatient Rehabilitation Facilities/Hospitals."

The CMS Jimmo website

 reminds the Medicare community of the Jimmo Settlement Agreement (January 2013), which clarified that the Medicare program covers skilled nursing care and skilled therapy services under Medicare’s skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline or deterioration (provided all other coverage criteria are met).  Specifically, the Jimmo Settlement Agreement required manual revisions to restate a “maintenance coverage standard” for both skilled nursing and therapy services under these benefits:

Skilled nursing services would be covered where such skilled nursing services are necessary to maintain the patient's current condition or prevent or slow further deterioration so long as the beneficiary requires skilled care for the services to be safely and effectively provided.

Skilled therapy services are covered when an individualized assessment of the patient's clinical condition demonstrates that the specialized judgment, knowledge, and skills of a qualified therapist (“skilled care”) are necessary for the performance of a safe and effective maintenance program.  Such a maintenance program to maintain the patient's current condition or to prevent or slow further deterioration is covered so long as the beneficiary requires skilled care for the safe and effective performance of the program. 

The Jimmo Settlement Agreement may reflect a change in practice for those providers, adjudicators, and contractors who may have erroneously believed that the Medicare program covers nursing and therapy services under these benefits only when a beneficiary is expected to improve.  The Jimmo Settlement Agreement is consistent with the Medicare program’s regulations governing maintenance nursing and therapy in skilled nursing facilities, home health services, and outpatient therapy (physical, occupational, and speech) and nursing and therapy in inpatient rehabilitation hospitals for beneficiaries who need the level of care that such hospitals provide.

The website provides links to added resources, FAQs and pdfs of resources. 

September 7, 2017 in Consumer Information, Current Affairs, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Wednesday, September 6, 2017

Medicaid 101 Webinar

The National Center on Law & Elder Rights  has announced an upcoming free webinar on Medicaid 101.

Here is the info about the webinar

Understanding Medicaid is a key to understanding the health and long-term care delivery system for older adults. Every year, over 6 million older Americans rely on Medicaid every year to pay for necessary health services. Over two-thirds of all older adults who receive long-term care at home or in a nursing facility, participate in the Medicaid program.

This free webinar, Legal Basics: Medicaid 101, will provide participants with a basic primer on the Medicaid program. It will explain the formation of Medicaid, Medicaid funding, key Medicaid protections, and Medicaid’s role in paying for health and long-term care for older adults.

The webinar is set for September 12, 2017 at 2:00 p.m. edt. To register, click here.

September 6, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Programs/CLEs, Webinars | Permalink | Comments (0)

Debt Collectors, Caregivers' Debt and Employers' Dementia

Recently I heard an account of an especially disturbing fact pattern, and I suspect it is all too common.  A loan company called the "employer" of a borrower, superficially to ask to speak to the employee. When the employer said "this isn't [the employee's] shift time," the caller said, "Well, then I'll talk to you. Your employee is X dollars in debt to our company and hasn't paid.  Would you like to make a payment on his account today by phone to help him out?"

The "employer" in this case is the care-needing client.  Apparently the client has dementia and has enough understanding to be frightened by the call --"if I don't pay, I could lose my helper" --  but not enough to truly understand what happened.  

Let's be clear.  Such a communication appears to be a violation of the federal Fair Debt Collection Practices Act on several levels.  State debt collection laws may be even more relevant to the improper conduct involved here.  For example, as a starting place federal law governing "communication in connection with debt collection" provides at 15 U.S.C. Section 1692(c):

(b) Communication with third parties
Except as provided in section 1692b of this title, without the prior consent of the consumer given directly to the debt collector, or the express permission of a court of competent jurisdiction, or as reasonably necessary to effectuate a postjudgment judicial remedy, a debt collector may not communicate, in connection with the collection of any debt, with any person other than the consumer, his attorney, a consumer reporting agency if otherwise permitted by law, the creditor, the attorney of the creditor, or the attorney of the debt collector.

The employee in this situation can and should immediately instruct any debt collector not to call his or her employer or client. (The employee also has the right to demand all calls cease, even to the employee's own home numbers and to direct that any further communications be in writing only.)  Further, by releasing personal details about the employee's debt to the employer, the debt collector would appear to have triggered substantial financial penalties for the loan company, with sanctions of up to $1,000 per violation, as explained here and here and  here.  In the context of a caregiver's workplace, this entire scenario seems uniquely abusive to both employer and employee. A home telephone is often a key lifeline for older adults and disabled persons. They do not need another reason to fear calls from manipulative people.  

September 6, 2017 in Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Federal Statutes/Regulations | Permalink | Comments (0)

Sunday, September 3, 2017

Early Alert from CMS-SNF Abuse

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)

Monday, August 28, 2017

Reverse Mortgage Resources

The Consumer Financial Protection Bureau has released three resources on reverse mortgages:

1.  https://s3.amazonaws.com/files.consumerfinance.gov/f/documents/201708_cfpb_costs-and-risks-of-using-reverse-mortgage-to-delay-collecting-ss.pdf on using a reverse mortgage to delay taking SSA retirement. The issue brief, The costs and risks of using a reverse mortgage to delay collecting Social Security runs 27 pages and is downloadable as a pdf. As the conclusion explains

 

We find that borrowing a reverse mortgage loan to get an increased Social Security benefit carries significant costs that generally exceed the additional lifetime amount gained from delaying Social Security. In addition, the amount that a consumer will need to borrow from a reverse mortgage loan to delay claiming Social Security benefits could negatively affect the consumer’s ability to move or use their home equity to meet a large expense later in life.

For consumers who have the option, working past age 62 is usually a less costly way to increase their monthly Social Security benefit than borrowing from a reverse mortgage.40 The extra years of work often provide people more time to save for retirement and pay off debts. The extra years of work may also result in an increase in Social Security benefits—separate from the increase that arises from deferring the start of benefits—by replacing years with low or no earnings from the person’s earnings record.41 Consumers may also consider other options to increase their Social Security benefit, such as coordinating their claiming decision with their spouses.

As consumers consider borrowing a reverse mortgage loan in order to delay claiming Social Security benefits or defer withdrawing funds from retirement savings, it is important for them to be aware of the risks and costs associated with this strategy. This is especially true for consumers whose primary source of income is Social Security and whose main asset is their home. For those consumers, the costs of a reverse mortgage loan will likely exceed the lifetime amount of money gained from an increased Social Security benefit, which in turn may threaten their financial security later in life.

The second resource is a discussion guide on reverse mortgages a twenty-four page pdf that provides "an overview of many key concepts of reverse mortgages." The guide is organized by the requirements for a reverse mortgage and includes illustrations and graphics for each. This is a very helpful tool!

The final resource is a 2:06 video on YouTube that gives a cursory overview of the ins and outs of reverse mortgages.

The agency's blog also discusses this new resources. Add these to your collection of resources!

 

August 28, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Housing, Retirement, Social Security | Permalink | Comments (0)

Monday, August 21, 2017

Affordable & Accessible Community-Based Housing for Vulnerable Adults

A new publication is available from the National Academies Press. Developing Affordable and  Accessible Community-Based  Housing for Vulnerable Adults: PROCEEDINGS OF A WORKSHOP is available for download as a pdf or for purchase as a print copy.   Here is an excerpt from the introduction

Accessible and affordable housing can enable community living,2 maximize independence, and promote health for vulnerable populations. However, the United States faces a shortage of affordable and accessible housing for vulnerable low-income older adults and individuals living with disabilities. This shortage is expected to grow over the coming years given the population shifts leading to greater numbers of older adults and of individuals living with disabilities.

Housing is a social determinant of health and has direct effects on health outcomes, but this relationship has not been thoroughly investigated. To better understand the importance of affordable and accessible housing for older adults and people with disabilities, the barriers to providing this housing, the design principles for making housing accessible for these individuals, and the features of programs and policies that successfully provide affordable and accessible housing that supports community living for older adults and people with disabilities ....

The forum meets to discuss how to support independence and community living for people with disabilities and older adults. The roundtable promotes health equity and the elimination of health disparities by advancing the visibility and understanding of the inequities in health and health care among racial and ethnic populations; by amplifying research, policy, and community-centered programs; and by catalyzing the emergence of new leaders, partners, and stakeholders.

The book runs 108 pages and the pdf is a free download.

August 21, 2017 in Books, Consumer Information, Current Affairs, Federal Statutes/Regulations, Housing | Permalink | Comments (0)

Sunday, August 20, 2017

Hospice Compare

CMS has announced the release of the Hospice Compare website.  Here's the information from the Medicare website:

The Centers for Medicare & Medicaid Services (CMS) is working diligently to make healthcare quality information more transparent and understandable for consumers in all stages of life to empower them to take ownership of their healthcare choices. This includes decisions about end-of-life care, when consumers in a time of vulnerability need transparent, digestible information to make the best choice for their care or the care of their loved ones.

We at CMS understand that there are many difficult decisions that come with a terminal illness—including deciding if hospice is right for you and which hospice to choose—which is why we have launched Hospice Compare. This new website will help empower you by allowing you to easily and quickly compare hospice providers on various aspects of care and assess the quality of care that potential hospices provide.

Hospice Compare provides information on hospices across the nation and allows patients, family members, caregivers, and healthcare providers to compare hospice providers based on some key quality metrics, like what percentage of a hospice provider’s patients were screened for pain or difficult or uncomfortable breathing and if their patients’ preferences are being met. Specifically, the quality measures look at the percentages of patients who received recommended treatment, for example:

  • Patients or caregivers who were invited to discuss treatment preferences, like hospitalization and resuscitation, at the beginning of hospice care;
  • Patients or caregivers who were invited to discuss beliefs and values at the beginning of hospice care;
  • Patients who were checked for pain at the beginning of hospice care;
  • Patients who received a timely and thorough pain assessment when pain was identified as a problem;
  • Patients who were checked for shortness of breath at the beginning of hospice care;
  • Patients who got timely treatment for shortness of breath; and
  • Patients taking opioid pain medication who were offered care for constipation.

The information on Hospice Compare can be used along with other information you gather about hospice providers in your area. In addition to reviewing the information on Hospice Compare, you’re encouraged to talk to your doctor, social worker, other healthcare providers, and other community resources when choosing the best hospice for care for you or your loved one.

In addition to Hospice Compare, Medicare also offers a number of other websites that can help you select providers and facilities to meet a wide range of care needs, including Inpatient Rehabilitation Facility Compare; Long-Term Care Hospital Compare; Hospital Compare; Physician Compare; Nursing Home Compare; Medicare Plan Finder; Dialysis Compare; and Home Health Compare.

Hospice Compare is available here

August 20, 2017 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Thursday, August 17, 2017

House Hearing on Right to Try Bill

The federal right to try law's next stop is the House of Representatives. The article in Kaiser Health News, House Expected To Hold Hearings On ‘Right-To-Try’ Bill That Senator Tied To FDA Funding  provides this background

The Senate quickly passed the bill that would allow dying patients access to experimental drugs after Sen. Ron Johnson (R-Wis.) had threatened to slow down consideration of a separate bill to renew the FDA’s fee-collection authority. In other drug industry news, the FDA is implementing new rules about hiring foreign scientists, industry tightens controls to keep out counterfeit drugs, cancer trials are low on patients and costs of old drugs rising quickly for Medicaid.

Although given priority by the Senate, the bill isn't expected to get the same treatment by the House. According to an article in Roll Call,  ‘Right to Try’ Bill Could Face Slower Action in House if the House committee changes the bill from the Senate version, things will slow down.  Here's a bit of an overview from the article:

Currently, when a patient seeks access to an experimental drug, his or her physician must work with the drug company, the FDA and an institutional review board that signs off on drug testing to approve the treatment’s use. When originally introduced in January, Johnson’s bill would have taken the FDA and other government entities out of that process. It would have let the states define “terminal illness,” potentially leading to dozens of different standards across the country about who would qualify for access. It also would have prevented the FDA from using outcomes associated with the experimental use when considering the drug’s application.

The new bill, instead of leaving the definition of terminal illness to the states, says that eligible patients should have a “life-threatening disease or condition” as defined by current federal law. It also gives the FDA the right to use outcome data if the administration determines that it is critical to assessing the drug’s safety — or if the drug company wants the outcomes used.

The drug companies would also have to provide the FDA with information about the experimental uses. Like the original bill, the new version shields companies against liability, but extends that protection to manufacturers who chose not to grant access to treatments. The bill would also limit the drugs that can be provided to those that have already completed the first phase of formal clinical trials, which are conducted to assess drug safety.

 

 

August 17, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (0)

Monday, August 14, 2017

Medicare Observation Status Disproportionate Impact on Poor Elders

According to recent stories about Medicare observation status, poor elders may be harder hit by this than those with more affluence. Medicare’s Observation Care Policy More Likely To Affect Low-Income Seniors makes note of "[a] new study finds that low-income patients are more likely to be kept in the hospital under observation, and the higher out-of-pocket spending that accompanies not being officially admitted is a bigger burden for them."  The study referenced is published in the American Journal of Medicine. The article's abstract explains:

Medicare beneficiaries hospitalized under observation status are subject to cost-sharing with no spending limit under Medicare Part B. Since low-income status is associated with increased hospital utilization, there is concern that such beneficiaries may be at increased risk for high utilization and out-of-pocket costs related to observation care. Our objective was to determine whether low-income Medicare beneficiaries are at risk for high utilization and high financial liability for observation care compared to higher-income beneficiaries.

A subscription is required to access the full article.

August 14, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink

Frances Perkins, Advocate for America's Social Safety Net

The ABA Journal this month has a short piece especially relevant today, August 14, 2017.  Today is the 82nd anniversary of the signing of the Social Security Act in 1935.  Frances Perkins is highlighted in the article as "The Woman Behind America's Social Safety Net."  

By late 1934, Roosevelt was facing conservative resistance to his New Deal programs in Congress and the courts. Moreover, it would take years before those who had immediate needs would see any benefit from the social security [Secretary of Labor Frances] Perkins favored. Roosevelt confided to others that the timing might not be right for old-age insurance.

 

Perkins was furious and confronted him, arguing that the nation’s dire condition might provide the political opportunity for a bold initiative. When Roosevelt gave her a Christmas deadline, Perkins invited the committee to her home, placed a bottle of scotch on a parlor table, and told them they were not to leave until they had framed a legislative proposal....

Okay -- admit it -- how many of us first came to know the name of Frances Perkins in the movie Dirty Dancing?  

August 14, 2017 in Current Affairs, Federal Statutes/Regulations, Social Security | Permalink | Comments (0)

Medicare End of LIfe Consults

Kaiser Health News recently ran a story about the end of life consultations now covered by Medicare. End-Of-Life Advice: More Than 500,000 Chat On Medicare’s Dime  offers some interesting statistics on the number of consults.  "In 2016, the first year health care providers were allowed to bill for the service, nearly 575,000 Medicare beneficiaries took part in the conversations, new federal data obtained by Kaiser Health News show." In fact, that number is almost double of what the AMA projected for 2016.  Although those numbers are good news for the proponents of the law, when compared to the numbers of Medicare beneficiaries overall, the percentage is quite low.

[O]nly a fraction of eligible Medicare providers — and patients — have used the benefit, which pays about $86 for the first 30-minute office visit and about $75 for additional sessions.... Nationwide, slightly more than 1 percent of the more than 56 million Medicare beneficiaries enrolled at the end of 2016 received advance-care planning talks, according to calculations by health policy analysts at Duke University....

The article explores some explanations for these numbers, including lack of knowledge of the benefit by doctors and lingering concerns over the "death panels" controversy.

August 14, 2017 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Thursday, August 10, 2017

GAO Report on Federal Low-Income Programs

The GAO has issued a report that examines various federal programs for low-income individuals. Federal Low-Income Programs: Eligibility and Benefits Differ for Selected Programs Due to Complex and Varied Rules  offers the following findings

Six key federally funded programs for low-income people vary significantly with regard to who is eligible, how income is counted and the maximum income applicants may have to be eligible, and the benefits provided. In fiscal year 2015, the most current data available, the federal government spent nearly $540 billion on benefits for these six programs—the Earned Income Tax Credit (EITC), Medicaid, the Housing Choice Voucher program, Supplemental Nutrition Assistance Program (SNAP), Supplemental Security Income (SSI), and Temporary Assistance for Needy Families (TANF). The target population for each of these programs differs, for example, people who are elderly or disabled or who have dependent children. Further, some programs have conditions for continued eligibility, such as participation in work activities under TANF. The six programs also vary in what income is and is not counted when determining an applicant's eligibility. For example, certain programs, such as SNAP, disregard a portion of earned income, while others do not. The maximum amount of income an applicant may have and still be eligible for benefits, which is determined for some programs at the federal level and for others at the state or local level, also differs significantly. As of December 2016, this amount ranged from $5,359 per month for one state's Medicaid program to $0 per month in one state for TANF cash assistance, for a single parent with two children. Benefit levels also differed across the six selected programs, with average monthly benefits for these programs ranging in fiscal year 2015 from $258 for SNAP to $626 for Housing Choice Vouchers, and four of the six programs adjust benefits annually.Legal, administrative, and financial constraints pose challenges to efforts to streamline varying eligibility rules for federal low-income programs, according to GAO's current and previous work. A key challenge is that the programs are authorized by different federal statutes enacted at different times in response to differing circumstances. Other laws, such as appropriations laws, can also have an impact on federal programs and their rules. As a result, streamlining eligibility rules would require changing many laws and coordination among a broad set of lawmakers and congressional committees. A further challenge is that a different federal agency or office administers each program GAO reviewed. For some of these programs, such as TANF, state governments also establish some program rules, making it more difficult to streamline rules at the federal level within or across these programs. Finally, financial constraints may also affect efforts to streamline program rules. For example, if rule changes raise the income eligibility limit in a program, more people may become eligible and that program's costs may increase. Despite these challenges, Congress, federal agencies, and states have taken some steps to streamline program administration and rules, such as by making greater use of data-sharing where permitted by federal law and aligning programs' applications and eligibility determination processes. For example, SSI recipients in most states are automatically eligible for Medicaid, and GAO previously reported that some states have integrated the SNAP eligibility process with other low-income programs, such as through combined applications and common eligibility workers.

The 56 page report is downloadable here as a pdf.  The one page highlights is available here.

August 10, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Food and Drink, Housing, Medicaid | Permalink | Comments (0)

Tuesday, August 8, 2017

Senate Passes Elder Abuse Prevention and Prosecution Act

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."

 

 

August 8, 2017 in Consumer Information, Crimes, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations | Permalink | Comments (0)

Sunday, August 6, 2017

Free Webinar: In-kind Support & Maintenance

Mark your calendars for August 16, 2017 at 2:00 p.m. edt for a free webinar from Justice in Aging on In-Kind Support & Maintenance (ISM).  Here's a description of the webinar:

Why do many clients receiving Supplemental Security Income (SSI) benefits only receive $490 each month instead of $735, and what can we do about it?  In many cases, the reason is “in-kind support and maintenance” (ISM). A person who receives shelter and food from a friend or family member they live with is receiving in-kind support and maintenance. The Social Security Administration (SSA) counts that support as income and lowers their benefit. The ISM rule is unique to the SSI program, and causes a lot of confusion for recipients, advocates, and SSA. This free webinar, In-Kind Support and Maintenance, will explore the ins and outs of ISM, provide examples of how the rule works, and offer strategies for dealing with the rule. As SSI is a means-tested program, applicants and recipients must meet several financial eligibility criteria on an ongoing basis. The income and resources rules, including “in-kind support and maintenance,” are particularly complicated. These rules can cause significant hardship for low-income people trying to survive on SSI. Giving advocates the tools to successfully navigate the rules on behalf of their clients can make a big difference. The recipient in the example above could have an additional $245 per month for necessities like health care expenses, household expenses, transportation, and other basic needs.

To register for this webinar, click here.

August 6, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Programs/CLEs, Social Security, Webinars | Permalink | Comments (0)

Saturday, August 5, 2017

Free Webinar: Bankruptcy & Elders

Justice in Aging is offering a free webinar on Tuesday August 8, 2017 at 2:00 p.m. edt on Bankruptcy Protections for Older Consumers. Here's the description of the webinar:

An increasing number of older consumers are struggling with unmanageable debt. Debt collectors are using aggressive tactics to pursue older adults with limited resources, making it critically important for legal services attorneys to understand protections that may help their clients. Bankruptcy may help older consumers eliminate debt and preserve income needed to pay rent, buy food, and keep the lights on.   This free webinar, Bankruptcy Protections for Older Consumers, outlines the issues facing older consumers and offers strategies to address the challenges. This session will highlight the various protections available and alternatives to filing for bankruptcy.

Click here to register for this webinar.

August 5, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Programs/CLEs, Webinars | Permalink | Comments (0)

Friday, July 28, 2017

FDA and the Right to Try

The GAO has issued a new report regarding the FDA's right to try approach to experimental drugs. Investigational New Drugs: FDA Has Taken Steps to Improve the Expanded Access Program but Should Further Clarify How Adverse Events Data Are Used reviews the FDA's increased access to experimental drugs.  Here's the findings from the report:

Under the Food and Drug Administration’s (FDA) expanded access program, patients with serious or life threatening ailments and no other comparable medical options can obtain access to investigational drugs outside of a clinical trial. Expanded access requests must be submitted to FDA but manufacturers must also grant permission for patients to access their investigational drugs. Of the nearly 5,800 expanded access requests that were submitted to FDA from fiscal year 2012 through 2015, FDA allowed 99 percent to proceed. Almost 96 percent of these requests were for single patients (either emergency or non-emergency). FDA’s review process for expanded access requests is designed such that all requests are either allowed or not allowed to proceed within 30 days of receiving each request. FDA typically responded to emergency single-patient requests within hours and other types of requests within the allotted 30 days.

FDA and other stakeholders, including a non-profit organization and a drug manufacturer, have taken steps to improve the expanded access process and patient access to drugs...  Some states have also enacted "Right-to-Try" laws to facilitate patient access to investigational drugs. These laws provide liability and licensing protections for manufacturers and providers under state law if an adverse event—such as an adverse reaction to the drug—occurs with patients who were allowed access to investigational drugs. However, some stakeholders GAO interviewed cited concerns that these laws may not help patients access drugs, in part because they do not compel a manufacturer to provide access.

Manufacturers sponsoring clinical trials must submit safety reports to FDA that include adverse events data resulting from clinical trials and any expanded access use, to be used in assessing the safety of a drug within the drug approval process... Further, some of the manufacturers told GAO the guidance was unclear. These manufacturers noted that the lack of clear information can influence their decision whether to give patients access to their drugs because of their concerns that an adverse event will result in FDA placing a clinical hold on their drug, which could delay its development. This could impact FDA’s goal of facilitating expanded access to drugs for treatment use by patients with serious or life-threatening diseases or conditions, when appropriate.

 

 

 

 

July 28, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (0)

Monday, July 24, 2017

Checking Yourself Out of the Hospital

Checking yourself out of the hospital, rather than being discharged, is known as DAMA (discharge against medical advice). The New York Times ran an article about the challenges in deciding to leave the hospital.  The Patient Wants to Leave. The Hospital Says ‘No Way.’ references a recent study that illustrates the issues that may occur for elders who want to leave the hospital. "Though A.M.A. discharges occur far more frequently in younger patients, a recent study in The Journal of the American Geriatrics Society analyzed a large national sample from 2013 and found that 50,650 hospitalizations of patients over age 65 ended with A.M.A. discharges." The article also discusses why folks choose to leave, for example, they feel better, they are worried about money, or they're afraid. The article also discusses the arguments against the DAMA and some confusion about the impact of DAMA on subsequent care.  The abstract of the article, Discharge Against Medical Advice of Elderly Inpatients in the United States, elaborates  "[d]ischarge against medical advice (DAMA) is associated with greater risk of hospital readmission and higher morbidity, mortality, and costs, but with a rapidly increasing elderly inpatient population, there is a lack of national data on DAMA in this subgroup...  Although DAMA rates in individuals aged 65 and older were one fourth of those found in individuals aged 18 to 64, an increasing trend was found in both groups..."  To order the article, click here.

 

July 24, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink