Tuesday, March 1, 2016

NPR Story on Nursing Home Evictions

Previously I wrote about a story in Kaiser Health News about nursing home residents stuck in hospital "limbo" and the ensuing litigation.  NPR also did a story about this. Nursing Home Evictions Strand The Disabled In Costly Hospitals was released on February 25 and features an audio of the story as well as the print version.  Although the suit is filed in California, this is not a California-specific issue.  As the story notes

This is not just a California issue. Nationwide, between 8,000 and 9,000 people complain to the government about nursing home evictions every year. It's the leading category of all nursing home complaints, according to the federal Administration for Community Living.

Robyn Grant thinks the problem is even larger than reported. Grant would know: She's the public policy director for the nonprofit National Consumer Voice for Quality Long-Term Care, so she hears about many nursing home evictions around the country like the ones in California.

March 1, 2016 in Consumer Information, Current Affairs, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (1)

Monday, February 29, 2016

Five Star Rating System: Clarity or Confusion?

You recall Medicare's 5 Star Rating System to aid consumers in making choices regarding services and facilities. Kaiser Health News (KHN) ran a story on February 23, 2016 about the difference between how consumers rate facilities vs. how Medicare rates facilities.  Dueling Star Ratings May Confuse Some Home Health Patients explains that Medicare assigns stars "primarily based on Medicare’s assessment of how often patients got better. But [looking] further ... may lead to confusion. Medicare also posts stars to convey how patients rate agencies after their care is over."

KHN did a survey on the frequency of these disparities  and found that "[s]uch contradictory results between how patients view home health agencies and how the government rates them are hardly unusual."  

In a statement, the Centers for Medicare & Medicaid Service said the different star ratings should not be confusing. “CMS stresses that website users should look at all of the different types of measures available for a given provider type, including for home health care agencies,” the statement said. “By providing both clinically based and survey-based measures, CMS hopes to make available to the public a range of perspectives and information that consumers can evaluate to help inform their decision about an agency.”

The disparity at least in part is explained: "[s]ome of the differences between home health care patient experience and clinical quality stars can be chalked up to the fact that the two domains focus on different facets of home health care." The article goes on to quote elder care experts on their views about the reasons for the differences in the rankings.  The article wraps up noting it is unknown how many Medicare beneficiaries use the 5-star rating system, and understand them.

February 29, 2016 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Sunday, February 28, 2016

Abandoned Nursing Home Residents?

Kaiser Health News (KHN) ran a story titled The Agonizing Limbo Of Abandoned Nursing Home Residents. The story focuses on the refusal of some California nursing homes to readmit residents after a hospital stay.  The story opens with a story of one resident who "had been living[in a nursing home] for four years... [and] the home refused to readmit him, even after being ordered to do so by the state. Nearly nine months later, [the resident] is still in the hospital."  It seems that these residents are trapped in a sort of limbo.

Nursing home residents are entitled to hearings under federal law to determine whether they should be readmitted after hospitalization. The state Department of Health Care Services holds the administrative hearings, but has said it is not responsible for enforcing the rulings.

But the state Department of Public Health, which oversees nursing homes, neglects to enforce the rulings and sometimes disagrees with them, according to advocates and court documents.

That leaves residents .... [even those] who won ... [the]  hearing .... with little recourse — and not many places to go. And since many nursing home residents have publicly-funded insurance, it means taxpayers are on the hook for hospital stays long after the patients are ready for discharge.

California Advocates for Nursing Home Reform (CANHR) in November, 2015 filed suit against California Health & Human Services on behalf of some of these residents with an upcoming hearing in March of 2016. The suit seeks "to require California to establish a hearing process that complies with federal law and to enforce the rulings." The defendant has filed a motion to dismiss.

February 28, 2016 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid | Permalink | Comments (0)

Tuesday, February 23, 2016

Only Limited Authority as Health Care Agents? The Latest Grounds to Challenge Dreaded Arbitration Clauses in NH Cases

The New York Times offers another window into concerns about pre-dispute binding arbitration provisions that are routinely found in nursing home agreements.  This is a long-simmering war, with many battlefronts and tactical arguments, as documented in the article.  However, the article also focuses on a narrow group of cases where courts have rejected a binding effect for arbitration clauses signed by someone serving "merely" as a health care agent for the incapacitated resident. (I hope my Contracts course students this semester are reading this article!)  

The article offers an additional opportunity to consider the tensions between public policies on either side of the debate over "fairness" of arbitration as a forum for consumer claims:

Arbitration clauses have proliferated over the last 10 years as companies have added them to tens of millions of contracts for things as diverse as cellphone service, credit cards and student loans.. Nursing homes in particular have embraced the clauses, which are often buried in complex contracts that are difficult to navigate, especially for elderly people with dwindling mental acuity or their relatives, who can be emotionally vulnerable when admitting a parent to a home.

 

State regulators are concerned because the secretive nature of arbitration can obscure patterns of wrongdoing from prospective residents and their families. Recently, officials in 16 states and the District of Columbia urged the federal government to deny Medicaid and Medicare money to nursing homes that use the clauses. Between 2010 and 2014, hundreds of cases of elder abuse, neglect and wrongful death ended up in arbitration, according to an examination by The New York Times of 25,000 arbitration records and interviews with arbitrators, judges and plaintiffs.

 

Judges have consistently upheld the clauses, The Times found, regardless of whether the people signing them understood what they were forfeiting. It is the most basic principle of contract law: Once a contract is signed, judges have ruled, it is legally binding.

 

Mr. Barrow’s case [set for trial in Massachusetts] is pivotal because, with the help of his lawyers, he has overcome an arbitration clause by using the fundamentals of contract law to fight back. As is often the case when elderly people are admitted to nursing homes, Mr. Barrow signed the admissions paperwork containing the arbitration clause on his mother’s behalf.

 

Although his mother had designated Mr. Barrow as her health care proxy — someone who was authorized to make decisions about her medical treatment — his lawyers argued that he did not have the authority to bind his mother to arbitration.

For more, read Pivotal Nursing Home Suit Raises a Simple Question: Who Signed the Contract?

Our thanks to attorneys Karen Miller in Florida and Morris Klein in Maryland, plus Dickinson Law students Joe Carroll, Corey Kysor and Kadeem Morris in Pennsylvania for sending us the link to the NYT coverage.

February 23, 2016 in Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare, Statistics | Permalink | Comments (0)

Monday, February 22, 2016

The Gerontologist Special Issue on Veterans

The February 2016 issue of The Gerontologist is devoted to Veterans issues.  The issue contains a number of articles on a variety of interesting topics. Check it out!

February 22, 2016 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care, Veterans | Permalink | Comments (0)

Monday, February 1, 2016

How Well Do Families Understand Updated Wage & Hour Rules for "Home Care"?

Over the last 20 years, I've definitely noticed a change when, during a meeting with a new person, I'm asked "what do you teach?"  For many years, I would get a blank stare or, perhaps, "what exactly is elder law?"  Now, more frequently the response is "do you have time for a quick question?"  (Unfortunately, quick questions rarely have quick answers, even when I begin "Let me suggest you see an experienced attorney in your area....") 

I'm hearing more questions about home care workers.  One frequent question is about overtime pay, and the type of employment definitely matters.  The U.S. Department of Labor (DOL) website has helpful materials, and the site reports on the effect of recent litigation affecting home care workers.  

Recently someone asked me if it was "safe" to assume they don't have to keep track of "overtime" hours, because the individual they have hired has irregular, mutually adjustable hours and is permitted to sleep when they stay overnight.  Family members will tell me "we just want someone there in case something happens."  That scenario is definitely affected by whether or not the employee's duties are correctly described as "companionship" services.  There is a limited exemption from minimum wage and overtime pay requirement for "companionship" employees.  

In late 2014, the DOL issued a detailed "Home Care Final Rule" that became effective only after litigation in the federal Court of Appeals rejected a challenge by third-party employers (home care agencies) to implementation.  See Home Care Association of America v. Weil.  Thus, as of January 1, 2016, the Department of Labor takes the position the Home Care Final Rule is now fully enforceable.  

As the DOL explains, its Final Rule defines "companionship services" as the provision of "fellowship and protection."   "Companionship services" may also include the provision of care if the care is attendant to and in conjunction with fellowship and protection services, so long as the "care" does not exceed 20 percent of the total hours worked per person and per workweek. Driving "usually" constitutes assistance with instrumental activities of daily living (IADLs) and if the employee is working for less than 24 hours per shift, any permitted sleep time must still be compensated. (State rules may also have tighter rules affecting payments.)  

DOL provides this example:

Sue, a direct care worker employed solely by Ms. Jones, regularly works 35 hours per week in Ms. Jones' home. Sue primarily provides fellowship and protection to Ms. Jones. If she also spends no more than 7 hours per week (20% of her work time for Ms. Jones) providing assistance to Ms. Jones with ADLs and IADLs, she is providing care within the scope of the definition of companionship services, and Ms. Jones is not required to pay her minimum wage and overtime compensation.

For more, see FAQs about Home Care on the DOL website -- or, better yet, talk to an experienced attorney in your city! 

February 1, 2016 in Consumer Information, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (0)

Sunday, January 31, 2016

Don't Fall for this (or any other) Scam

The Social Security Administration posted on its blog about a Social Security scam involving phishing.  According to the post, the scam focuses on "protecting" yourself from identity theft and financial fraud.  "The subject line says “Get Protected,” and the email talks about new features from the Social Security Administration (SSA) that can help taxpayers monitor their credit reports, and know about unauthorized use of their Social Security number. It even cites the IRS and the official-sounding “S.A.F.E Act 2015.” It sounds real, but it’s all made up." The post offers a couple of tips to suss out a scam. If the email ended up in your junk folder, it could be a scam. Also, mouse over the URL and see if it is really from SSA, or from a .com site instead.

Always remember-if in doubt, don't click on the link and don't provide personal information.

January 31, 2016 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Retirement, Social Security | Permalink | Comments (0)

Monday, January 11, 2016

Another Must Read from Professor Kaplan

Our good friend and elder law guru, Professor Dick Kaplan from Illinois has released a new article, Reflections on Medicare at 50: Breaking the Chains of Path Dependency for a New Era.  (In my opinion, anything Dick Kaplan writes is a must-read).  The article is available for download on SSRN here.  The abstract explains more:

On the occasion of Medicare’s 50th anniversary, this Article examines the evolution of this essential program from its enactment in 1965 through implementation of the Affordable Care Act. Persons who are, or soon will be, newly enrolled in Medicare may be especially interested in the first part of this Article, which addresses the coverages, exclusions, and costs of Medicare’s constituent parts and concludes (on pp. 20-21) with seven critical questions that every new beneficiary must consider before enrolling. The Article then proffers policy recommendations to better align Medicare with current models of health insurance and provide more appropriate coverage of long-term care expenses.

January 11, 2016 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Wednesday, January 6, 2016

SSA releases ABLE POMS

SI 01130.740 Achieving a Better Life Experience (ABLE) Accounts was released December 18, 2015. The POMS has six sections, including an explanation of ABLE accounts, definitions, what is excluded, what is countable, and verification/documentation of the account balances and of the distributions. Check it out! Oh and by the way, it's a good time to explain the POMS to your students. Check out SSA's explanation of the POMS on the POMS home page here.

January 6, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Other, Social Security | Permalink | Comments (0)

Thursday, December 31, 2015

Are Financial Institutions Part of the Problem When it Comes to Enabling Financial Exploitation?

The Wall Street Journal has a good article, Officials Seek Clampdown on Elder Fraud, reporting on attempts by federal and state agencies to increase accountability for financial exploitation, especially of older persons, by financial institutions handling the transactions: 

Grappling with growing financial exploitation of the elderly, state officials are pressing for laws that require financial advisers to report suspected “elder fraud” to authorities. But the mandate faces pushback from the financial industry, which says it could result in a massive number of reports that turn out to be false....

 

To help curb the problem, a coalition of state securities regulators in September proposed a model state law that would require financial advisers, including brokers at large investment houses and independent advisers, as well as their supervisors, to report suspected elder financial fraud to both a state securities regulator and an adult protective-services agency.

 

The legislation would mandate prompt reporting by a financial adviser who “reasonably believes that financial exploitation” of an older person “may have occurred, may have been attempted, or is being attempted.” The bill gives brokers and advisers civil immunity from privacy violations for reporting suspected fraud, and allows them to put a temporary hold on suspicious account disbursements. Supporters say advisers and brokers are well-positioned to raise early warnings about exploitation that can leave elderly victims with scant money left for necessities and little time to rebuild savings.

In hearings where I've testified about the potential benefits of so-called "mandatory reporting" by financial institutions, representatives of banks offer a host of explanations for why mandatory reporting isn't necessary.  Sounds like the same arguments I have encountered were repeated for the Wall Street Journal reporters:

Currently, even when financial advisers suspect an aging client is being taken advantage of, many say they are hamstrung by strict rules governing the execution of trades and processing of withdrawals, and worry about violating privacy laws if they report concerns.

 

The current system, “kind of puts advisers and firms in between a sort of legal rock and hard place,” said Steve Kline, director of state government relations for the National Association of Insurance and Financial Advisors, a professional association. The proposed rules aim to provide clarity.

Certainly I understand industry hostility to more regulations.  At the same time, it seems to me that one option would be to offer immunity from tort or contractual liability for "negligent" failure to report suspected financial abuse, for any financial institution that can show it routinely monitors for abuse and that uses a reasonable system for reporting.  A "carrot" rather than a "stick" to encourage reporting. 

Our thanks to University of Illinois Professor Dick Kaplan for sharing this article. 

 

December 31, 2015 in Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, Property Management, State Statutes/Regulations | Permalink | Comments (0)

Tuesday, December 29, 2015

Nursing Home Residents-Privacy Violations

An article in the Washington Post shortly before Christmas had me shaking my head at the cluelessness of some employees of nursing homes regarding resident privacy.  Nursing home workers have been posting abusive photos of elderly on social media gave me one of those "you have got to be kidding me moments."  Maybe it's an age-gap thing, but I just can't fathom why it would be appropriate to post intimate photos of individuals with whose care one is entrusted.  The article indicates that this is not a geographically isolated problem:

Nursing home workers across the country are posting embarrassing and dehumanizing photos of elderly residents on social media networks such as Snapchat, violating their privacy, dignity and, sometimes, the law.

ProPublica has identified 35 instances since 2012 in which workers at nursing homes and assisted-living centers have surreptitiously shared photos or videos of residents, some of whom were partially or completely naked. At least 16 cases involved Snapchat, a social media service in which photos appear for a few seconds and then disappear with no lasting record.

The article offers some illustrations of these photos and the remedies available against the perpetrators.  The article also notes that not only are those photos invading resident privacy, they serve as evidence of the violations.

The incidents illustrate the emerging threat that social media poses to patient privacy and, at the same time, its powerful potential for capturing transgressions that previously might have gone unrecorded. Abusive treatment is not new at nursing homes. Workers have been accused of sexually assaulting residents, sedating them with antipsychotic drugs and failing to change urine-soaked bedsheets. But the posting of explicit photos is a new type of mistreatment — one that sometimes leaves its own digital trail.

How often is this violation of resident privacy occurring? The article notes that "ProPublica identified incidents by searching government inspection reports, court cases and media reports. [A district attorney in Massachusetts] said she suspects such incidents are underreported, in part because many of the victims have dementia and do not realize what has happened."  So far HHS' Office of Civil Rights hasn't sanctioned any nursing homes "for violations involving social media or issued any recommendations to health providers on the topic." The article notes that CMS, in the process of revising the regs dealing with nursing homes, plans to deal with the issue when revising the definitions of various types of elder abuse. Even one of the social media sites referenced in the article expressed concern about the actions of  those nursing home employees.

The article summarizes some cases where charges have been filed.  Read the story and assign it to your students. 

 

December 29, 2015 in Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Health Care/Long Term Care, Other | Permalink | Comments (0)

Sunday, December 20, 2015

Social Security: File and Suspend No More

Back in October, as part of the Bipartisan Budget Act, Congress eliminated a couple of Social Security claiming strategies (§ 831) that have been getting a lot of press (one is known as "file and suspend", the other, "restricted application").  The New York Times ran an article on December 4, 2015 discussing these strategies that are being eliminated and what options remain for individuals planning for their retirement.  The End of Social Security Loopholes: What Now? examines the role of life expectancy in deciding when to start collecting Social Security retirement benefits. But, "[f]iguring out the best strategy is difficult because few retirees know how long they will live." The article discusses the variables that go into deciding which strategy is best  and notes that these are not "one size fits all" decisions.

The Washington Post also ran an article about the elimination of these two claiming strategies and what that means for individuals planning for their retirement. As one Social Security strategy disappears, consider other smart options focuses on the elimination of the file and suspend strategy and offers 4 tips, including obtaining advice and preparing a budget.

December 20, 2015 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Retirement, Social Security | Permalink | Comments (1)

Tuesday, December 15, 2015

Is There a New "War on Drugs" -- or rather, on Drug Pricing?

The Senate Special Committee on Aging is taking up the important issue of drug pricing:

A Senate investigation of drug-price spikes at four companies kicked off Wednesday with specialists from all corners of the health-care system testifying that they're powerless to manage the out-of-control prescription costs.

 

The hearing launches the Special Committee on Aging's investigation into the soaring prices of old drugs, including the recent overnight price hike of Daraprim from $18 to $750.  Doctors and policy experts offered a slew of proposed policy solutions, such as expediting applications for generic drugs to increase competition and requiring companies to reveal how much drugs really cost.

 

But the testimony to the committee in advance of the hearing underlined a stark fact about the current system, too: Doctors, companies that manage prescription drug benefits, hospitals, and health care policy experts alike feel fairly powerless to control high drug prices -- because they are allowed.

 

For instance, a pediatrician from the University of Alabama at Birmingham testified that an infant needed a treatment that had increased from $54 a month to $3,000 a month, causing the pharmacist to scramble for a solution. A kidney transplant patient in Baltimore began experiencing hallucinations as her medical team tried to obtain a drug once easily available.

For more coverage, read the Washington Post's article, Doctors, Hospitals Condemn Out-of-control Drug Prices as Senate Investigation Begins.

December 15, 2015 in Consumer Information, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (1)

Monday, December 14, 2015

America's Love of the Automobile: A Trend the Boomers Keep on Driving

Ok, that title was supposed to be somewhat tongue in cheek, but there is some reality to it as well.  According to an article in the Wall Street Journal on December 8, 2015,  The Fastest-Growing Group of Licensed Drivers: Americans Age 85 and Up,  "[n]ew data from the Federal Highway Administration shows people age 60 and above represented almost 26% of all driver’s license holders in 2014, up from 20.6% in 2004. Those younger than 30, on the other hand, make up about 21% of drivers, down slightly from 22% in 2004." Discussing the trend that younger generations are moving away from driving, the article notes

[S]ince 2000, people of every age cohort under 60 have been slowly letting their driver’s licenses lapse or have not been getting them in the first place.

Those 60 and above, meanwhile, are now more likely than before to have a valid driver’s license in their wallet.

People age 85 and up represent the fastest-growing group of licensed drivers, the FHWA said.

The article explains this trend is slow moving and offers reasons for its occurrence, especially costs.  The article concludes with a comment that this changing demographic is also changing the highways: "[t]o help older drivers navigate the roads, the agency said it is working on new laminates to make highway signs brighter from further away."

Information about the Federal Highway Administration report is available here.  The Administration's Handbook for Designing Roadways for the Aging Population is available here. The 2014 Highway Statistics Report is available here.

December 14, 2015 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Other, Travel | Permalink | Comments (0)

Monday, December 7, 2015

The Costs of Dementia-Part Three

Money Magazine's final article in the series on the costs of dementia focuses on the costs in the final stages of the disease. Coping With the Costs of Dementia: The Final Stage discusses the costs and the options for caring for an individual in the final stage of this disease.

In the final stages of dementia, which typically last four to five years, the need for care intensifies. [One's] spouse eventually will require around-the-clock assistance with most activities of daily living. [One's] toughest decision: whether to try to continue caregiving at home or move [one's] loved one to an assisted-living facility or a nursing home. [One] may feel guilty at the prospect of putting someone [one] love[s] in “a home”—that’s common and understandable—but a setting where professionals are providing the intense level of care needed at this point is often the best path, especially if they’re trained in the needs of dementia patients. That said, it’s also the most expensive care option by far.

The article urges caregivers to take proactive action, suggests caregivers pick a nursing home with a memory care unit, get advice on the order in which to spend assets and start planning for the caregiver's own future.  "Caring for someone with dementia is emotionally exhausting and financially draining, but it comes with one particular satisfaction: knowing that you’ve done whatever you can to make the last years easier for someone you love."

December 7, 2015 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare | Permalink | Comments (1)

Sunday, December 6, 2015

The Costs of Dementia-Part Two

Money Magazine's second article on the costs of dementia focuses on the middle stage of dementia. Coping With the Costs of Dementia: The Middle Stage discusses a series of steps for the caregivers and family to take, not only for the present, but in positioning themselves for the final stage of the disease.  The article discusses a number of suggestions:

  • greater levels of care, including adult day care and respite care and recommends only hiring caregivers with experience in caring for individuals with dementia;
  • examine the terms of any long term care insurance policy, if the individual has one;
  • if the individual is a veteran, look into VA benefits;
  • examine the individual's and family member's investment portfolio; rearranging allocations to more conservative investments may be needed;
  • investigate a reverse mortgage;
  • caregivers should talk to employers about options; and
  • begin to research nursing homes.

December 6, 2015 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare | Permalink | Comments (0)

Thursday, December 3, 2015

The Costs of Dementia

Money Magazine ran a series on the costs of dealing with dementia.  Separating dementia into three stages, early, middle, and late, the series breaks down the costs for each of the stages.

Coping With the Costs of Dementia: The Early Stage looks at both the personal costs as well as the financial costs of copying with the disease in the beginning.

The financial toll can be nearly as large as the personal loss. Over the last five years of life, the average out-of-pocket cost of care for dementia patients totaled $61,500—81% more than for people without dementia—according to a new study in the Annals of Internal Medicine. Nearly half of the dementia patients ended up on Medicaid, the government health care program for impoverished Americans, compared to about 20% of patients suffering from heart disease or cancer.

If you were asked what is the reason for the costs of dementia early on, would you say drugs or treatments? According to the article, if you did, you'd be wrong.  "Driving the cost aren’t drugs or treatments, but the years of care necessary to get a person safely through life’s everyday activities. Medicare, the primary health insurance for people 65 and older, doesn’t cover that long-term nonmedical care." 

The article discusses the differences between "normal" aging and early signs of Alzheimer's.  As far as costs in the early stage of the disease, "which lasts an average of two years, [one's] out-of-pocket costs won’t be burdensome. But [one will] need to plan for more expensive care later on, and move quickly, since [one's] husband, wife, or parent has a limited window to participate in financial decisions and sign any necessary legal documents before cognitive abilities fade."

The article recommends a number of steps to take to prepare, including obtaining the needed documents, appointing agents, talking to a doctor, organizing finances and preparing for Medicaid.  Check out the graphic of expenses in the last 5 years of life.

December 3, 2015 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid | Permalink | Comments (0)

Wednesday, December 2, 2015

Nursing Home Quality: Another GAO Report

The GAO has released another report on Nursing Home Quality.  Dated October, 2015, Nursing Home Quality: CMS Should Continue to Improve Data and Oversight is a 52 page report issued by the GAO  that "examines (1) the extent to which reported nursing home quality has changed in recent years and the factors that may have affected any observed changes, and (2) how CMS oversight activities have changed in recent years."

The report notes some issues with the data collected as well as some efforts regarding oversight, and in the conclusion the GAO discusses the issues with the data and also

according to CMS officials, the agency faces the challenge of conducting effective oversight of nursing home quality with its limited resources, while meeting all of its oversight requirements. CMS has made modifications to some activities it considered essential to its oversight, without knowing whether the modifications have affected the agency’s ability to assess nursing home quality. Further, some modifications made by CMS regional offices and state survey agencies to their own nursing home oversight activities could adversely affect the CMS central office’s ability to oversee nursing home quality, while other modifications could be effective strategies that could be adopted more widely among regional offices and state survey agencies....

The GAO makes 3 recommendations: 

  • Establish specific timeframes, including milestones to track progress, for the development and implementation of a standardized survey methodology across all states.
  • Establish and implement a clear plan for ongoing auditing to ensure reliability of data self-reported by nursing homes, including payroll-based staffing
  • The Administrator of CMS should establish a process for monitoring modifications of essential oversight activities made at the CMS central office, CMS regional office, and state survey agency levels to better understand the effects on nursing home quality oversight.

A one page highlights sheet is available here and an accompanying podcast here.

 

 

 

December 2, 2015 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing | Permalink | Comments (0)

Monday, November 30, 2015

Medicaid-It's Complicated and Important

Huffington Post's Post50's blog on November 29 featured the post, 5 Common Misconceptions About Medicaid.  The author, Anne Tumlinson,opens the post

I have a confession. I've been avoiding writing about Medicaid. It's so complicated it scares me. But, Medicaid can be really important to daughterhood because someday you might have to decide if it's right for your parent. So you have to get smart about it.

She explains the importance of the Medicaid program as a "safety net for when everything falls apart" and after a brief description, moves into a discussion of the 5 misconceptions:

  1. "Medicaid is a lot like Medicare...
  2. Medicaid is available to everyone...
  3. Medicaid Will Take Your Parents' Home...
  4. Medicaid is a national program that's the same for everyone...
  5. Medicaid only covers nursing homes...."

With each she offers explanations as to what Medicaid really covers and concludes her post noting

When is Medicaid right for your parent? It depends on so many individual and family circumstances. And, it depends on your state. There are no hard and fast rules. But, if you've been walking down this caregiving road for a long time and you are looking at nursing home care, Medicaid may be necessary to pay for the care. OR, if your parent's money is running out because of expensive care --- even if he or she isn't in a nursing home --- then it could be helpful, especially if there's a good community program in your parent's local area... [a]nd, figuring this program out for your family is not easy. Just remember that it's a crazy complicated hard situation. Not that you are failing.

Note, you can also access her post on her blog here.

 

November 30, 2015 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare | Permalink | Comments (0)

Fighting Robocalls

Ever received a robocall? Of course you have. Even if you are on the do-not-call list, you still get robocalls. Want to do something about robocalls?  Then read the following 

Consumers Union issued a report, Dialing Back: How Phone Companies Can End Unwanted Robocalls.  Here is an excerpt from the executive summary:

The Do Not Call list, federal law enforcement efforts, and actions by the states have not been enough to protect Americans from the flood of unwanted robocalls that have become rampant in recent years. Hundreds of thousands of people complain each month to the Federal Trade Commission (FTC) about unwanted calls, and it’s estimated consumers lose $350 million a year to phone scams. Thanks to rapid advances in Internet technology, robocallers can make thousands of auto-dialed calls per minute for a relatively low cost. Robocall scammers easily escape detection and punishment by operating overseas or using software to disguise—or spoof—their name and number. The problem is so bad that federal agencies and Congress have been exploring solutions to the unwanted robocall problem.

Technological solutions are necessary to address this problem. A number of leading experts agree that phone companies have the power right now to implement technologies to dramatically reduce robocalls.

Consumers Union surveyed a variety of experts and innovators and found there are at least four proposed and existing robocall filtering technologies that phone companies could pursue to help protect their customers from unwanted robocalls. One solution, the Primus Telemarketing Guard, has been successfully implemented for traditional and broadband phone lines in Canada, which calls into question why similar technologies have not been offered in the United States.

The executive summary reviews call-blocking technologies that phone companies may provide and then offers the following recommendations:

Phone companies should immediately offer free robocall-filtering services to all of their customers based on latest available technology.

● Phone companies should immediately develop "Do Not Originate" techniques to reduce spoofing by fraudulent callers.

● Phone companies should continue to pursue call authentication strategies as a long-term solution to the spoofing problem

 

 (citations omitted).

To read more about Consumers Union's efforts to fight robocalls, click here.

November 30, 2015 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Other | Permalink | Comments (0)