Friday, May 29, 2015

Looking to Cuba for Comparative Law, Aging and Health Studies

Light blogging ahead for me, as I will be leaving in a couple of days for my first visit to Cuba, as part of a small Penn State University faculty group.  I'm confident I will have plenty of things to do with my time other than searching for an elusive internet café!

Seriously, I'm excited, on a number of levels.  First, I lived for several years in a Cuban-immigrant neighborhood in Miami at the end of law school, and many of my fellow judicial clerks and friends were the first generation sons and daughters of Cuban refugees.  Second, I've been educated by my Irish friend, Dr. Una Lynch, to appreciate the world-wide significance of the Cuban health care system, and I'm eager to see how they accomplish much with comparatively few resources.  Third, my Elder Law colleague, Amos Goodall Esq., State College, PA, has shared great suggestions for art and food. Plus, Attorney Karen Miller (NY and Florida) has shared her contacts with me from her travels and studies about law in Cuba. ¡Gracias a todos!

Here are a couple of items from some of my background reading on Cuba, including health care and aging statistics:

Turning to Cuba, let us examine the possible consequences of the tendency towards population aging that we have described. In the economic field, the consequences include an accelerated demand for the funds to cover social security expenditures. In fact, since 1970 funds budgeted for old-age, disability and death benefits have quintupled.  National budget expenditures for social security are higher than those of any other sector (e.g. education, health, defense, etc.) (Cuban National Statistics Office, 1999 "c"). 

   

At the same time, as the average age of Cuba's workforce increases over the coming years, we will see a deficit of workers for labor requiring greater physical effort, especially for agriculture, construction and industry, among others.  Consequently, the main economic difficulty Cuba faces today-as it did during the colonial period and at the beginning of the 20th century-is an insufficient workforce.

From Aging in Cuba, Realities and Challenges, byAlberta Duran Gondar and Ernesto Chavez Negrin.

During her recent visit to Havana in July of 2014, Margaret Chan, Director-General of the World Health Organization (WHO), impressed by the country's achievements in this field, praised the Cuban health care system: "Cuba is the only country that has a health care system closely linked to research and development. This is the way to go, because human health can only improve through innovation," She also praised "the efforts of the country's leadership for having made health an essential pillar of development." 

From Opera Mundi, translated into English for the Huffington Post.

May 29, 2015 in Current Affairs, Ethical Issues, Health Care/Long Term Care, International, Social Security, Statistics, Travel | Permalink | Comments (0) | TrackBack (0)

Thursday, May 28, 2015

Join "Conversations Live" at WPSU-TV to Discuss "Caring for Mom & Dad"

You can join us via telephone or email this evening, May 28, starting at 9 p.m. (ET) to discuss the new PBS documentary, Caring for Mom & Dad that airs at 8 p.m. on WPSU-TV.  Our conversation begins at 9 p.m..  Details available here. 

A recording of today's "Conversations Live," hosted by Patti  Satalia, will be available about 48 hours after the original show for viewing on-line at WPSU.psu,edu.

May 28, 2015 in Current Affairs, Ethical Issues, Health Care/Long Term Care, Programs/CLEs | Permalink | Comments (0)

Ohio Successfully Uses Local Property Tax Levies to Supplement Senior Services

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)

Wednesday, May 27, 2015

Book Recommendation: Ai-Jen Poo's "The Age of Dignity"

Ai-jen Poo's The Age of DignityIn my preparation for an upcoming talk show on WPSU on "Caring for Mom & Dad," I had the incentive to get to my stack of "must read" books to focus on The Aging of Dignity: Preparing for the Elder Boom in a Changing America, by Ai-Jen Poo (New Press 2015).  What I very much like about this book is the broad lens it brings to aging demographics, focusing not on "burdens" but on "opportunities" to be a more productive, healthy society by dealing realistically with the need for both professional caregivers and family caregivers.  Ai-Jen Poo writes:

Aging at home necessitates home care workers.  Yet the 3 million people currently in the home care workforce cannot meet even the current need, let alone the demand for care that will accompany the elder boom. We will need at least 1.8 million additional home care workers in the next decade. As a result, care giving, specifically home care, is the fastest growing of all occupations in the nation....

 

With some course corrections in our culture and in our institutions, we can have the care infrastructure that will enable us to live our full potential. . . . The moral of this story is that a caring America is entirely within reach.

Not surprisingly, given her inspiring call for action, Ai-Jen Poo was a MacArthur "genius" grant recipient in 2014.  She is one of the commentators on Caring for Mom & Dad, and in Pennsylvania,  she will be part of our panel for WPSU's Conversations Live following the airing of the documentary on Thursday, May 28.  The documentary is at 8 p.m., and the audience can "call-in, e-mail or text-in"beginning at 9 p.m.  More details and links available here about the documentary and schedules here. 

May 27, 2015 in Consumer Information, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Grant Deadlines/Awards, Health Care/Long Term Care, Medicaid, Medicare, Statistics, Television | Permalink | Comments (0) | TrackBack (0)

Tuesday, May 26, 2015

The Effect of Rising Levels of Acuity in Rehab and Nursing Homes on M&A Activity

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.  

May 26, 2015 in Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare, Statistics | Permalink | Comments (1) | TrackBack (0)

Monday, May 25, 2015

The Affordable Care Act & Medicaid Expansion

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.

May 25, 2015 in Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid | Permalink | Comments (0) | TrackBack (0)

Modern Day Coverture? Medicaid Eligibility Rules' Harsh Effect on Married Women

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 21, 2015

$10+ Billion Dollar Deal: CVS Health to Buy Pharma Giant Omnicare

 Anyone who's noticed the upsurge in M&A activity in the senior care industries will want to take special notice of today's news, with the announcement that CVS Health will spend $10.4 billion to buy Omnicare, thus giving CVS an even stronger pipeline for prescription drug distribution to the elderly.  (In 2006, CVS acquired Caremark Rx Inc. for a reported $21 billion.)

The Los Angeles Times reports:

The deal announced Thursday will give one of the nation's biggest pharmacy benefits managers national reach in dispensing prescription drugs to assisted living and skilled nursing homes, long-term care facilities, hospitals and other health care providers. Omnicare's long-term care business operates in 47 states and the District of Columbia. With more people entering assisted-living residences as the U.S. population ages, CVS Health says there is a "substantial growth opportunity" for companies serving those patients.

 

Cincinnati's Omnicare also provides pharmacy consulting and runs another segment that provides specialty pharmacy services. Specialty drugs are complex medications that treat certain forms of cancer or hepatitis C, among other conditions. They often represent treatment breakthroughs but can cost considerably more than other prescriptions. Use of these drugs is climbing, and insurers and employers are looking for help containing that cost.

This deal should keep a lot of lawyers busy! From The American Lawyer, news of four major law firms involved in the latest CVS acquisition.

UPDATE:  Here's an interesting editorial observation from an industry observer, describing Omnicare as the giant "lion of the jungle" who is now being gobbled up by giant CVS as the T-Rex.  Amusing, but apt, metaphors and observations about the potential implications for the public.

May 21, 2015 in Consumer Information, Current Affairs, Health Care/Long Term Care, Medicare | Permalink | Comments (0) | TrackBack (0)

Documentary on "Moving with Grace"

St. Louis Elder Law Attorney Martha Brown recently recommended a 2013 documentary, writing:  "It is called 'Moving with Grace.'  It is played a lot in St. Louis on the local PBS station as reporter Stone Phillips and his parents lived in St. Louis.  It is a wonderful documentary about the trials and  tribulations of aging parents without the drama of a dysfunctional family."  That is an important message, right?  The challenges associated with "growing older" can hit everyone, even the "best" of families.

American Public Television, that distributes the program, previews it and offers a link to scheduling in your area here, explaining:

Like many baby boomers, former NBC anchor Stone Phillips and his siblings found  themselves caring for their aging parents. Ninety-two-year-old Vic, a World War  II veteran, copes with chronic heart issues, although his mind and memory  remain "as reliable as a Bob Gibson fastball." Grace, his wife of 66 years,  suffers from dementia, which robs the once-gregarious former teacher of her  short-term memory. MOVING WITH GRACE, an intimate documentary Phillips produced  and shot, follows this charming couple as they move out of the family home in  Missouri and adapt to life first in a retirement community and later in an  assisted-living facility. This honest and, at times, poignant story highlights  the common struggles associated with elder care and its consequences.

Thank you, Martha, for sharing this resource!

May 21, 2015 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care, Housing, Television | Permalink | Comments (0) | TrackBack (0)

Wednesday, May 20, 2015

Massachusetts Case Demonstrates Significance of Contracts in Senior Living Options

This week I attended the 16th Annual Meeting of the Massachusetts Life Care Residents Association (MLCRA) near Boston.  Having last met with the group in 2011, I was impressed with the residents' on-going commitment to staying abreast of legal and practical developments affecting life care and continuing care (CCRC) models for senior living.  Their organization has some 800 individual members, representing a majority of the communities in the state. 

MILCRA Annual Meeting 2015In 2012, MLCRA was successful in advocating for passage of amendments that substituted "shall" for "may" in the laws governing key disclosures to be made to prospective and current residents. 

My preparation for the meeting gave me the opportunity to read one of those troubling "unpublished" -- but still significant -- opinions that shed light on attempts to make consumer protections stick.  Here the "contract" trumped the statute. 

In a February 2014 decision in Krens, v. 1611 Cold Spring Road Operating Company, a son who sought refund of his deceased mother's $282,579 partially "refundable" Entrance Fee was denied relief by a Massachusetts appellate court, despite the fact that Massachusetts law expressly mandated that a continuing care contract "shall provide" for a refund to be paid "when the resident leaves the facility or dies." The reasoning? The actual contract provided merely that the refund could be paid "within 30 days of actual occupancy of the vacated unit by a new resident." More than three years had elapsed since the mother's passing, apparently without the unit being "resold" or rented, and therefore the CCRC operating company took the position that no refund obligation had been triggered.

Continue reading

May 20, 2015 in Consumer Information, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Housing, Property Management, Retirement, State Cases, State Statutes/Regulations | Permalink | Comments (1) | TrackBack (0)

Tuesday, May 19, 2015

Blueprint for Advocacy? Changing the Culture of Care

Recently I had the opportunity to read a report of Northern Ireland's independent Commissioner of Older People advocating for "a change of culture" to better protect older people in care settings. The thirteen primary proposals strike me as concise, reasonable, and extraordinarily important, for any (make that every) country, including the U.S..  See what you think:

1. The rights, quality of life, dignity and care needs of vulnerable older people should be at the heart of planning, delivering, regulating and inspecting care services; it is their needs that must matter the most.

2. Standards for the care of vulnerable older people should be clearly displayed and available to all service users and their families and relatives of all nursing, residential and domiciliary care services as well as for any prospective users.

3. Inspection processes should be rigorous, with decisive and timely enforcement action taken when failings are detected.

4. The regulation and inspection service should include a rating system for care homes and domiciliary services. In addition to an overall rating, it should clearly identify if there are any breaches of regulations or failures to comply with improvements required.

5. There should be clear and rigorously applied sanctions taken against care providers for non-compliance with the minimum standards.

Continue reading

May 19, 2015 in Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care, Housing, International | Permalink | Comments (0) | TrackBack (0)

Monday, May 18, 2015

Drops in Occupancy Mark Challenges to Financial Health for Senior Living Industries

Publically-traded Brookdale Senior Living, founded in 1978, has grown to become the largest owner and operator of "senior living" communities in the U.S., including for-profit continuing care retirement communities (CCRCs). Thus, it is good to keep an eye on the finances of Brookdale for those of us interested in the long-term financial health of CCRCs and other senior housing options.

Steve Monroe at Irving Levin Associates notes that Brookdale "was no different than the rest of the market, posting sharp drops in first quarter occupancy" for 2015:

"The legacy Emeritus [a component of Brookdale, following a 2014 merger] properties posted a 110 basis point decline from the fourth quarter of 2014, and a whopping 200 basis point decline from a year ago. The legacy Brookdale properties dropped 80 basis points sequentially and 110 basis points from a year ago. This was not good news, but not unexpected. Oddly enough, the legacy Brookdale properties had a 250 basis point increase in community operating margin to 35.2% despite the occupancy declines. The Emeritus properties had a 90 basis point sequential drop in margin, which makes more sense."

How do you achieve a significant increase in "operating margin" despite "occupancy declines?" A good question to ponder.  Steve Monroe continues: "The reasons for the legacy Brookdale improvement were a combination of cost controls and more pricing flexibility. Move-ins have been increasing, which is great, but 'cost controls' always make me nervous, especially with the current acuity creep. Stay tuned."

The reference to "acuity creep" is to the increase in average age and frailty of new residents, compared with past years (especially before the financial crisis of 2008-10). This trend impacts CCRCs in several ways, both in terms of market appeal to healthier potential residents, and operating costs tied to an earlier need for higher levels of care.  An additional question may be whether low interest rates have supported a bubble in certain segments of senior housing despite the softer occupancy rates, and whether an eventual return to higher capitalization rates will result in lower values and additional consequences.

Along that same line, the Philadelphia Inquirer published a recent article in their "retirement" news edition, noting "Continuing-Care Retirement Community Choice Requires Diligence," by Harold Brubaker, with tips on what to ask if you are a consumer considering a CCRC option.

May 18, 2015 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Property Management, Retirement, Statistics | Permalink | Comments (0) | TrackBack (0)

UK Conference on Intersections of Aging, Gender & Sexualities

The University of Surrey in the UK is hosting an international conference on July 6-7 on "Intersections of Ageing, Gender and Sexualities," with speakers from Israel, Iran, Taiwan, Hong Kong, Spain, Italy, Australia, South Africa, New Zealand, the U.S., and, of course, the U.K. 

Sociology Professor Toni Calasanti from Virginia Tech is giving the opening keynote address.  The half day sessions are separated into "themes," including Embodiment, Temporal (Dis)location, Queer Kinship, Representations, Intersections, and Age, Gender, Sexuality and Care.  Several of the sessions explore relationships between sexuality and menopause. 

For more on the program, see here.    

May 18, 2015 in Current Affairs, Discrimination, Ethical Issues, Health Care/Long Term Care, International, Programs/CLEs | Permalink | Comments (0) | TrackBack (0)

Friday, May 15, 2015

Justice Dep't & CCRC Agree to Consent Order in Disabilities Discrimination Claim

On May 12, the U.S. Department of Justice announced resolution of a disabilities discrimination complaint initiated by residents of a Continuing Care Retirement Community (CCRC) in Virginia. 

The resolution includes filing of a complaint and consent order that resolves allegations that Fort Norfolk Retirement Community Inc. (Fort Norfolk) violated the Fair Housing Act by instituting policies that discriminated against residents with disabilities at Harbor’s Edge, a CCRC in Norfolk, Virginia:

The consent order, which still needs to be approved by the court . . . along with a complaint, in the U.S. District Court of the Eastern District of Virginia.  The complaint alleges that beginning in May 2011, Fort Norfolk instituted a series of policies that prohibited, and then limited, residents in the assisted living, nursing and memory support units at Harbor’s Edge from dining in dining rooms or attending community events with independent living residents.  The complaint also alleges that when residents and family members complained about these policies, Fort Norfolk retaliated against them.  In addition, the complaint alleges that Fort Norfolk had polices that discriminated against residents who used motorized wheelchairs by requiring those residents to pay a non-refundable fee, obtain liability insurance and obtain Fort Norfolk’s permission.

 

Under the consent order, Fort Norfolk will pay $350,000 into a settlement fund to compensate residents and family members who were harmed by these policies.  Fort Norfolk will also pay a $40,000 civil penalty to the United States.  In addition, Fort Norfolk will appoint a Fair Housing Act compliance officer and will implement a new dining and events policy, a new reasonable accommodation policy and a new motorized wheelchair policy.

There is a history of similar issues arising in other CCRCs.  For example, in 2008, in California, CCRC resident Lillian Hyatt initiated, and eventually resolved to her satisfaction, a discrimination claim based on a ban on "walkers" in the dining rooms of her community.  

As the average age of residents in CCRCs has increased in recent years, the "appearance" issues are sometimes raised as a marketing or image concern, contrasting sharply with the expectations of individual residents as they age and seek continued access to the full range of services in their community. 

Our thanks to Karen Miller, Esq., of Florida, for bringing the recent Virginia case to our attention.

May 15, 2015 in Consumer Information, Current Affairs, Discrimination, Ethical Issues, Federal Cases, Health Care/Long Term Care, Housing | Permalink | Comments (0) | TrackBack (0)

Thursday, May 14, 2015

During Month of May on PBS: "Caring for Mom & Dad"

Caring for Mom & DadPBS 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)

Tuesday, May 12, 2015

Pharma Company Fights Back on Off-Label Drug Use Prosecutions

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

May 12, 2015 in Consumer Information, Crimes, Current Affairs, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

Monday, May 11, 2015

A Juror's Perspective from the Iowa Sexual Assault-Dementia Trial

I'm catching up on news items after being away for a few days.  There are additional insights about the sad trial of Henry Rayhons in Iowa, that ultimately resulted in his acquittal, from one of the jurors, who also happened to be a reporter.  Too often it is easy to focus about what is wrong with the court system, but here is a reminder of just how seriously most jurors take their duties. 

Read, "The Rayhons Trial: A Juror's Perspective," by Angela Nelson.  And my thanks to Bryan Gruley who made sure we did not miss this powerful coda to the trial. 

May 11, 2015 in Cognitive Impairment, Crimes, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (1) | TrackBack (0)

Tuesday, May 5, 2015

GAO Reports to "Congressional Requesters" on Advance Directives

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)

Friday, May 1, 2015

Criminal Record? Is Life-Time Ban from Care Industry Employment Necessary to Protect Older, Vulnerable Persons?

In 2003, in Nixon v. Commonwealth, Pennsylvania's Supreme Court struck down a provision of the state's Older Adult Protective Services Act that imposed an absolute bar on designated care "facilities," including nursing homes, personal care homes, and home health agencies, prohibiting them from hiring  "new" employees who had been convicted of certain crimes. The Court concluded that the prohibition, which affected only "new" employees, or those working at a covered facility for less than one year, did not bear a real and substantial relationship to the Commonwealth's interest in protecting the elderly, disabled, and infirm from victimization, and therefore unconstitutionally infringe[d] on the Employees' right to pursue an occupation." 

Twelve years later, the Pennsylvania legislature, despite consideration of many proposals to "fix" the "Nixon case problem," still had not amended the statute. (This is the second time in a week that Pennsylvania's speed -- or lack thereof -- in enacting important reforms has attracted media attention.) As explained by NPR in a feature story by Carrie Johnson, a new lawsuit again challenges Pennsylvania's employment ban:

In 1981, when he was just 18, [Tyrone] Peake was arrested with a friend for trying to steal a car to take a girl home after a long weekend. "No, we never got the car," Peake said. "We broke the ignition column and then the cops came."

 

Peake couldn't even drive back then. He says he was just along for the ride. He never went to prison. Instead, he got probation. But that single charge years ago still haunts him, sometimes even after he's gotten work....

 

"I've been fired from three jobs," Peake said, "because [of] having a criminal record. And my record is like 32 years old, and I haven't been in trouble since then." A lot's happened since the 1980s for Peake. He went back to school, and he's been working part time as a counselor for men addicted to drugs and alcohol. But the law prevents him from being hired full time to work in a nursing home or long-term-care facility because of that single criminal conviction.

Peake's history of attempting to get on the right side of the law presents a dramatic contrast between the law's laudable purpose of protection of vulnerable adults and its sometimes harsh effect.  For more, see NPR's Can't Get A Job Because Of A Criminal Record? A Lawsuit Is Trying To Change That. 

May 1, 2015 in Crimes, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0) | TrackBack (0)

Thursday, April 30, 2015

New Report on Nursing Homes

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.

 

April 30, 2015 in Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)