Friday, August 26, 2016
The long-term care industry depends hugely on the services of "nursing assistants," also known as NAs, who provide basic but important care for residents or patients under the direction of nursing staff (who, in turn, are usually Licensed Practical Nurses or Registered Nurses). As the U.S.Department of Labor describes, NAs typically perform duties such as changing linens, feeding, bathing, dressing, and grooming of individuals. They may also transfer or transport residents and patients. Employers may use other job titles for NAs, such as nursing care attendants, nursing aides, and nursing attendants. However, the Department of Labor makes a distinction between NAs and other key players in long-term care, including "home health aides," "orderlies," "personal care aides" and "psychiatric aides."
According to DOL statistics, the top employers of NAs include skilled nursing facilities (37% of NAs), continuing care retirement communities and assisted living facilities (together employing some 18% of NAs), and hospitals and home care agencies, which each employ about 6% of the NA workforce.
For many years, states have offered licensing for nursing assistants. The designation of CNA or "certified nursing assistant" meant that the nursing assistant had satisfied a minimum educational standard and had successfully passed a state exam. As another key protection for vulnerable consumers, CNAs had to pass background checks, involving fingerprints and criminal history searches.
In Arizona, however, now I'm hearing a new label: LNAs or Licensed Nursing Assistants. The Arizona Board of Nursing continues to license CNAs, but now it is offers the designation of Licensed Nursing Assistants. What's the difference? Frankly, not much, at least in terms of skill levels. Then why the change?
In Arizona, CNAs and LNAs have the same educational requirements, and must pass the same test and satisfy the same work credits. But, as of July 1, 2016, individuals seeking the LNA designation will be required to pay the state a fee to cover their mandatory background checks, including fingerprinting. CNAs, however, will no longer be required to undergo background checks or fingerprinting.
What is this about? Arizona is trying to save money. It seems that state and federal laws prohibit state authorities from mandating that CNA candidates cover the cost for their own background checks. In other words, if the candidate showed financial need in the application process, the state was required to pick up the costs for any background checks. Let's remember that the average wages of CNAs are relatively low -- the national mean is less than $30,000 per year. Presumably that is the reason behind the older laws limiting how much states can charge CNA applicants for their own background checks. By creating a new designation, LNA, Arizona takes the position it avoids the federal restriction.
But, what about the public? Will the public understand that CNAs licensed after July 1, 2016 will not be subject to fingerprinting and background checks? Responsible employers would, presumably, require such checks or limit their hires to LNAs. At least, let's hope so.
I also learned that apparently Arizona does not require "continuing" education for either CNAs or LNAs. (Again, you would hope that responsible employers would either provide or require such education.) Arizona used to require a minimum of 120 hours every 2 years of what are, in essence, "job credits" -- i.e., proof of employment in an NA position -- to maintain the CNA license. Recently, however, Arizona diluted that requirement to just 8 hours every two years for both CNAs and LNAs.
Arizona does have a useful website where current or prospective employers, including families, can check the licensing status of CNAs or LNAs. The website is searchable by name or license number, and shows whether an applicant has failed the entrance exam, or has withdrawn an application or lost the license.
Are other states creating this LNA designation as a "workaround" (loophole?) for financing background checks for CNAs? Let us know!
August 26, 2016 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)
Thursday, August 25, 2016
I was happy to see Nike's latest commercial for its Unlimited campaign featuring the triathlete dubbed the Iron Nun. According to an article in the Huffington Post, "Buder said that she manages to fit her training for these races in with her daily life. The sister, who is part of a nontraditional religious order called the Sisters for Christian Community, runs to her church in Spokane, Washington. She also runs to the local jail, where she volunteers to chat with inmates." I suspect the narration for the commercial is intended as amusing since it relies on aging stereotypes, but the Sister's accomplishments blow those stereotypes out of the water. Ad of the Day: Nike Celebrates the 'Iron Nun', an 86-Year-Old Triathlete With God on Her Side features the ad, as well as the behind the scenes interview with the sister without the narration. The quote I liked from Sister Buder: "the only failure is not to try". Huffington Post quotes from an article on her in Cosmo, "Don’t pay attention to how old you are, only focus on how old you feel ... And be patient — one of my worst enemies is patience, I’m still trying to fine-tune it so that I’m able to stop and smell the roses.”
Kudos Sister for your accomplishments!
Last week we blogged about those elders who have no kids to be their caregivers. The Washington Post featured an article on the topic of "aging solo". Aging Solo: Okay, I don’t have a child to help me, but I do have a plan, told from the perspective of the author, is an attention-grabber from the beginning
“The trouble is: You think you have time.” That Buddhist-sounding quote from a fortune cookie rattled around the back of my head for decades, seemingly for no reason. Now that I find myself living with my 94-year-old mother in a Florida city where preacher Billy Graham got his start and being a never-wed 60-something has made me a tourist attraction of sorts, I finally understand why I thought the repercussions of growing old without a child or two would not apply to me: I was just plain delusional.
As a New Yorker flush with friends, freelance work, Broadway tickets and great Botox, I had apparently existed in some sort of fun, singles bubble. It was a lifestyle so rewarding that I never read even one article about the stresses of the “sandwich generation.” (Hey, the writers all seemed to be married women with children, so even on a boomer-to-boomer level, I could not relate.)
Of course she's not alone. The article provides statistics--almost 33% of the Boomers have no kids. "That doesn’t count boomer parents who have lost a child or have one who is severely impaired. The Aging Solo pool also includes countless members of families plagued by addiction, disease, cults, rapacious children, even married progeny who much prefer their in-laws. While millions of Aging Soloists have siblings and other kin, many of us can’t imagine (or abide) having them shepherd us to our final rest."
The author calls for an aging plan with friends rather than kids, and using her parents' story as educational, she offers this advice "When you’re past 50 and single, location is 75 percent of the enchilada. Subways matter. Proximity to friends matters. Suburban seniors communities felt to me like slow death. I found senior centers and assisted-living facilities profoundly lonely because, it seems, the art of making friends does not grow as we age, and not everyone likes endless bingo and dominoes on Tuesdays, followed by a prayer service."
She goes on to offer further tips
It’s better to plan a more personal assisted-living future with your own friends while in your 50s or 60s. That will give you time to choose a location with diverse people and culture, with neighborhoods that have sidewalks and public transit....
Sharing resources can spawn all sorts of possibilities. Maybe my posse grabs several apartments in rental, condo or co-op buildings, or we share a group house in D.C., Manhattan or L.A. Heck, maybe we can find a way to lease a floor in one of the many overbuilt office buildings around the country. Perhaps (if yours is an anti-urban posse) you can hire an architect to design space-age yurts in Arizona. Each madly hip structure would be self-contained, but the colony would have a common dining hall, gym and tech-support center, or whatever your future selves desire.
New to the finances of aging, I had no idea how much control I gained by holding my mother’s durable power of attorney. Had I been less ethical, I could have taken her money and run. Therefore, I’ll never give that power to any one person; it will be held by at least three younger and devoted friends because elder fraud is one of the most horrifying aspects of aging solo. Trust me: That charming new friend who offers to manage your money so you don’t have to deal with “all those bills” is probably well known to the local police.
So what is the author doing to prepare for her aging without kids? She explains
What am I doing? Well, I’ve started small, using Skype dialogues with my pals to research and download the legal papers — from wills to end-of-life instructions — that we will need, sooner or later. Now we’re aiming higher. Should we learn what to look for in a nurse’s résumé so we can find the right person to help us in our collective dotage? Should we hire a visionary architect to create a high-tech trailer park or a cluster of tiny homes built around communal buildings? Our ideas are still all over the map.
We hope we have time to execute our most appealing visions. Mostly, however, we pledge to be our own Best Friends. United. Forever....
Wednesday, August 24, 2016
The Kaiser Health Network (KHN) and U.S. News ran a story in July about elders' admission to hospitals. They may be sicker on admission and when discharged, may not be able to care for themselves, needing help with ADLs. Elderly Hospital Patients Arrive Sick, Often Leave Disabled focuses on how hospitals care for elders, and a "trend" to create a special unit just for patients who are elderly.
How hospitals handle the old — and very old — is a pressing problem. Elderly patients are a growing clientele for hospitals, a trend that will only accelerate as baby boomers age. Patients over 65 already make up more than one-third of all discharges, according to the federal government, and nearly 13 million seniors are hospitalized each year. And they stay longer than younger patients.
Many seniors are already suspended precariously between independent living and reliance on others. They are weakened by multiple chronic diseases and medications.
One bad hospitalization can tip them over the edge, and they may never recover, said Melissa Mattison, chief of the hospital medicine unit at Massachusetts General Hospital. “It is like putting Humpty Dumpty back together again,” said Mattison, who wrote a 2013 report detailing the risks elderly patients face in the hospital.
If one considers the special circumstances for elder patients, it makes sense that hospitals may want to be prepared for these patients. But, the way the medical system works currently, "the unique needs of older patients are not a priority for most hospitals... Doctors and other hospital staff focus so intensely on treating injuries or acute illnesses — like pneumonia or an exacerbation of heart disease — that they can overlook nearly all other aspects of caring for the patients" according to one expert quoted for the article.
Some hospitals have special units for these patients, referred to as Acute Care for Elders (ACE) units. "ACE units have been shown to reduce hospital-inflicted disabilities in older patients, decrease lengths of stay and reduce the number of patients discharged to nursing homes. In one 2012 Health Affairs study, ... researchers found that hospital units for the elderly saved about $1,000 per patient visit." Not only do these units save money, according to the article, patients in these units seem to be better when discharged.
If you discuss this in class, have your students find out whether any of the local hospitals have a similar unit. It makes a difference.
Monday, August 22, 2016
The New York Times on Sunday had an exceptionally well written and important article about the latest trend in senior care. For-profit companies are now allowed to participate in PACE, the Program of All-Inclusive Care for the Elderly, a Medicare- and Medicaid-approved program designed to permit innovation in care that doesn't require residence in high-priced settings such as traditional nursing homes. Sarah Varney writes:
Inside a senior center here [in Denver], nestled along a bustling commercial strip, Vivian Malveaux scans her bingo card for a wining number. Her 81-year-old eyes are warm, lively and occasionally set adrift by the dementia plundering her mind.
Dozens of elderly men and women -- some in wheelchairs, others whose hands tremble involuntarily -- gather excitedly around the game tables. After bingo, there is more entertainment and activities: Yahtzee, tile-painting, beading.
But this is no linoleum-floored community center reeking of bleach. Instead, it's one of eight vanguard centers owned by InnovAge, a company based in Denver with ambitious plans. With the support of private equity money, InnovAge aims to aggressively expand a little-known Medicare program that will pay to keep oldr and disabled Americans out of nursing homes.
The feature-length article details how "private equity firms, venture capitalizes and Silicon Valley entrepreneurs have jumped" onto the PACE niche. For more on this important development, read Private Equity's Stake in Keeping the Elderly at Home.
My thanks to Laurel Terry and Karen Miller for sharing this article with us.
Wednesday, August 17, 2016
Earlier this week, I wrote about a new publication drawing attention to "six" specific areas of need that can helped by a health/law partnership to provide more comprehensive services for the older client or patient. That post inspired one of our regular readers to write about her experiences with an important Consortium effort between the law school at UC Hastings and the medical program at UC San Francisco. Their Medical-Legal Partnership for Seniors Clinic (MLPS Clinic) sounds terrific and, not surprisingly, it attracted the attention of the New York Times from its inception:
Consider the geriatricians working at the Lakeside Senior Medical Center, an outpatient clinic at the University of California, San Francisco. Many of their patients, despite multiple chronic diseases and advanced age, have never filled out power-of-attorney documents or appointed someone to make health care decisions if they are unable to.
Sometimes, the doctors suspect their patients might qualify for public benefits they are not getting, like food stamps or MediCal, the state’s version of Medicaid. Perhaps they face problems with landlords or appear to be victims of financial abuse, or they ought to have a simple will.
In other words, they need lawyers. But trying to get frail, low-income seniors to consult an elder attorney can seem an insurmountable problem. How will they travel to a law office? Or pay a fee that can reach $300 an hour? Even if the doctors can refer them to a legal aid office, will their elderly patients actually make an appointment? Then remember to go?
At Lakeside there is a simpler solution, said Sarah Hooper, who teaches at the University of California Hastings College of the Law. “The physicians do the initial screenings, hear what their patients’ problems are, take the history — and they essentially write a prescription: ‘Go down the hall and see my friends at U.C. Hastings for help with this housing issue,’ ” she said.
Sarah Hooper, Executive Director for the clinic, provided an update, explaining, "We’ve done quite a bit of outreach within MLP and in the healthcare system, but are increasingly realizing that we need to get more elder law attorneys and legal aid advocates energized around this idea." Sarah reports that she'll be attending and presenting at the National Aging and Law Conference in D.C. in October, 2016 and hopes to inspire others to develop similar partnerships.
For more on the UC Hastings-San Francisco MLPS Clinic, read the full New York Times article (first published in 2013) by Paula Spahn, "The Doctor's New Prescription: A Lawyer." For more on the Medical-Legal Partnership concept, visit the website for the National Center for Medical Legal Partnerships.
Tuesday, August 16, 2016
Not everyone who needs caregiving has a family member to serve as caregiver. So what should a Boomer do when planning ahead? What resources might an elder law attorney recommend? Last October, U.S. News Wellness ran a story on this topic, No Spouse, No Kids, No Caregiver: How to Prepare to Age Alone. Referring to this group of our population as "elder orphans", the article paints the serious implications for those aging without a family support system. One expert is quoted that "[t]he risk of potentially finding yourself without a support system – because the majority of care provided as we get older is provided by family – may be increasing...." Factor in loneliness and the impact becomes even more serious "older adults who consider themselves lonely are more likely to have trouble completing daily tasks, experience cognitive decline, develop coronary heart disease and even die. Those who are socially isolated are also at risk for medical complications, mental illness, mobility issues and health care access problems." The article contains 5 tips for planning to live independently, including speaking up about one's situation, planning ahead now (here's where the elder law attorney can be quite helpful), maintaining friendships while establishing new ones, name a health care agent (and do a DPOA, too)-the article gives a shout-out to elder law attorneys, moving to a more livable community and live life well.
The points in the article are still relevant today. Thanks to Julie Kitzmiller for sending me the article!
Monday, August 15, 2016
The introduction explains: "The purpose of this article is to estimate the prevalence and identify risk factors of engaging in resident aggression and abuse in assisted living facilities. Measuring the prevalence of resident aggression and abuse in assisted living facilities is needed to better understand the scope of the problem. Identifying strategies to mitigate and prevent resident aggression and abuse can help to improve social well-being and progress toward achieving public health objectives." The authors conclude that
Prior studies have found evidence of resident abuse in nursing homes (Pillemer et al., 2011; Pillemer & Finkelhor, 1988; Pillemer & Moore, 1989). Our findings build on this knowledge base with nationally representative estimates of resident aggression and abuse in assisted living settings. In conclusion, this study provides evidence of the prevalence of resident aggression and abuse in assisted living facilities. Given the rising prevalence of dementia and aging population in the United States, resident aggression and abuse is a growing problem that warrants more attention from policy makers, researchers, and long-term care providers. Furthermore, dementia and SMI were significant risk factors for physical, verbal, and sexual abuse in residential care settings. Future research is needed to develop better methods for identifying residents at greater risk of engaging in abuse as well as supporting ongoing training and prevention efforts to mitigate this risk.
Thursday, August 11, 2016
Bear with me-this is going to take a bit for me to connect the dots to my point. We have posted on several occasions about the need for caregivers as the Boomers continue their aging trek. We've also blogged about the shortage of caregivers and the impact caregiving has on family members. With me so far? So, it would seem logical that we want to make it as easy as possible for caregivers to provide care. In many instances for the family caregivers do this, the family lives together, whether the parent moves in with the adult kids or vice versa. In other instances, the home may be remodeled to make it appropriate for multi-generational families. In others, the caregivers add to their property with an auxiliary dwelling unit or ADU (popularly known as a granny flat), a medical-cottage, or even converts their garage into a "mother-in-law" apartment.
Still with me? So, when remodeling, we may need a permit. When we are adding a building, renovating or bringing in an ADU or med-cottage, we may run afoul of zoning ordinances, when zoning is for single families. Hopefully local governments, understanding the need for caregiving, would be willing to grant variances for this, although there are cases where the contrary has occurred.
So this is all a lead up to a recent story in the Washington Post. The Next big Fight Over Housing Could Happen, Literally, In Your Back Yard opens with the story of a couple who had built their home in their daughter's back yard. Here's what happened:
They were just finishing the place when a lawsuit earlier this year against the city of Los Angeles brought permits for homes like theirs — second units on single-family lots — to a halt. As a result, city officials who gave them permission to build now haven’t given them a certificate of occupancy, and the utility won’t connect them to the power grid.
Second homes, often called “granny flats,” have become a new front in the conflict that pits the need for more housing in the country’s most expensive cities against the wishes of neighbors who want to preserve their communities. The same battles flare over large developments that might loom over single-family neighborhoods. But even this modest idea for new housing — let homeowners build it in their own back yards — has run into not-in-my-back-yard resistance.
And the difficulty of implementing even such a small-scale solution shows why it will be hard to make room in crowded cities for the middle- and working-class households who increasingly struggle to afford to live there.
Not only do these "second homes" help caregivers live in proximity to the elder, these second homes could also alleviate housing shortages according to the article. So what's the objection? "Many neighbors, though, protest that a glut of back yard building would spoil the character of neighborhoods designed around the American ideal of one family on one lot surrounded by verdant lawn. They fear that more residents will mean less parking. And they question whether small homes, particularly in wealthier neighborhoods with the most room to build them, would really constitute affordable housing."
Do these concerns really apply if the purpose is to provide caregiving to a family member? I realize that it's difficult to separate out second housing units designed as rental income from second houses designed for caregiving. The article notes that several cities are considering revisions to their zoning ordinances, primarily to address the need for more affordable housing. But let's not forget about the caregivers and their parents. Let's make it as convenient as possible for them to provide care, even if it is just to allow the temporary installation of ADUs or medical cottages.
Tuesday, August 9, 2016
Disability Scoop ran an article recently focusing on aging issues faced by those with special needs. Aging Poses New Challenges For Those With Special Needs explains the issues that will occur as individuals with special needs age, and need different or additional services. "In 1983, the average life expectancy for a person with Down syndrome was 25. Today, it’s 65 to 70, fueled largely by the mastery of a surgical procedure that corrects a heart defect present in 1 out of 2 people with Down syndrome ...." Of course, there are challenges to be overcome, including increasing services and bringing health care providers up to speed. "As the first generation of individuals with disabilities reaches ages not seen before, the medical community is still catching up. Most skilled nursing facilities are still made up of residents without disabilities, so people with disabilities may be better suited to an environment where caregivers are accustomed to taking their special needs into account."
The article highlights the need to be forward-thinking and planning ahead. Not everyone ages the same way at the same speed. The article focuses on how a person with Downs syndrome might experience aging issues. The "interest in caring for people with disabilities who are aging has been of such concern that the [National Down Syndrome Society] compiled an “Aging and Down Syndrome” guide in 2013. Since then, the guide has been requested tens of thousands of times, in both English and Spanish ...."
Friday, August 5, 2016
Earlier in the week, I shared the feature news story on "avoidable deaths" in Pennsylvania long-term care, often shown to be linked to inadequate staffing (whether in numbers or training, or both). The article began with a fall of a man while apparently unattended, and also identified residents "choking" on food as another documented risk associated with staffing and supervision.
But other senior care communities in the country may have their own unique complications. South Carolina has reported its first apparent "alligator attack," sadly connected to the death of a 90-year-old woman, who was earlier reported missing from her assisted living community. For more, read the Post-Courier report from July 29, 2016.
Thursday, August 4, 2016
Legg Mason released a 142 page document on elder housing, Aging & Its Financial Implications: Planning for Housing. The report was created "in collaboration with The Center for Innovative Care in Aging at the Johns Hopkins University School of Nursing, to bring [the reader] perspective, research and practical insights to assist [the reader] with the challenges of aging. The document includes a discussion guide for determining one's housing needs, information about different types of housing, case studies, a check list, charts, graphs and data, resources and more. Why is thinking about housing important? Because, according to the report, "America is aging and everyone is affected by longer life expectancy. As advanced age approaches, people often need to shift the way they live and/or where they live to accommodate age-related discomforts and reduced capabilities. There are a number of trends that impact decisions related to housing during the years of retirement."
Wednesday, August 3, 2016
Pennsylvania attorney Douglas Roeder, who often served as a visiting attorney for my former Elder Protection Clinic, shared with us a detailed Penn Live news article on what the investigative team of writers term "avoidable deaths" in nursing homes and similar care settings. The article begins vividly, with an example from Doylestown in southeastern Pennsylvania:
Claudia Whittaker arrived to find her 92-year-old father still at the bottom of the nursing home's front steps. He was covered by a tarp and surrounded by police tape, but the sight of one of his slim ankles erased any hope it wasn't him. DeWitt Whittaker, a former World War II flight engineer, had dementia and was known to wander. As a result, his care plan required him to be belted into his wheelchair and watched at all times. Early on Sept. 16, 2015, Whittaker somehow got outside the Golden Living home in Doylestown and rolled down the steps to his death.
"It wasn't the steps that killed him. But the inattention of staff and their failure to keep him safe," his daughter said.
The article is especially critical of recent data coming from for-profit nursing homes in Pennsylvania, pointing to inadequate staffing as a key factor:
In general, according to PennLive's analysis, Pennsylvania's lowest-rated nursing homes are for-profit facilities. Half of the state's 371 for-profit homes have a one-star or two-star rating – twice the rate of its 299 non-profit nursing homes. The reason for that discrepancy, experts say, isn't complicated: Studies have found that for-profit nursing homes are more likely to cut corners on staffing to maximize profit.
Spokespeople from both the for-profit and nonprofit segments of the industry are quoted in the article and they push back against the investigators' conclusions.
I have to say from my own family experience that while adequate staffing in care settings is extraordinarily important, older residents, even with advanced dementia, often have very strong opinions about what they prefer. My father is in a no restraint dementia-care setting, with a small cottage ("greenhouse") concept and lots of programming and behavioral interventions employed in order to avoid even the mildest of restraints. It was a deliberate choice by the family and my dad walks a lot around the campus and has his favorite benches in sunny spots.
The trade-off for "no restraints" can be higher risk. Residents, including my father, are sometimes stunningly adept at escape from carefully designed "safety"plans, such as those necessary in the summer heat of Arizona. Family members often remain essential members of the care team. For example, this summer I plan my daily visits at the very hottest part of the day, in order to help try to lure my father, a late-in-life sunshine worshiper, back into the cool. I watch the staff members exhaust themselves intervening with other ambulatory and wheelchair residents who are constantly on the move.
None of this "care stuff" is easy, but certainly the Penn Live article paints a strong picture for why better staffing, better financial resources, and more reality-based plans are necessary. For more, read "Failing the Frail." Our thanks to Doug for sharing this good article.
August 3, 2016 in Cognitive Impairment, Consumer Information, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Housing, Medicaid, Medicare, Property Management | Permalink | Comments (0)
Tuesday, August 2, 2016
Health and Human Services (HHS) Office for Civil Rights issued guidance in late May, 2016 for long term care facilities. The guidance, Guidance & Resources for Long Term Care Facilities: Using the Minimum Data Set to Facilitate Opportunities to Live in the Most Integrated Setting " is on using the minimum data set (MDS) so "residents receive services in the most integrated setting appropriate to their needs."
There are 3 recommendation sections of the guidance (actually there are 4, but the 4th deals with further resources). Why did OCR issue this guidance?
OCR has found that many long term care facilities are misinterpreting the requirements of Section Q of the MDS. This misinterpretation can prevent residents from learning about opportunities to transition from the facility into the most integrated setting. We are therefore providing a series of recommendations for steps that facilities can take to ensure Section Q of the MDS is properly used to facilitate the state’s compliance with Section 504 and to avoid discrimination.
The recommendations include a discussion of the importance of knowing about local resources and community based services, ensuring compliance with applicable civil rights laws ("[b]ecause Section Q is designed to assist residents in returning to the community or another more integrated setting appropriate to their needs, proper administration of Section Q of the MDS can further a state’s compliance with civil rights laws.") and the importance of maintaining up-to-date policies and procedures, and training employees.
McKnight's News is a publication for insiders in the long-term care industry, reaching professionals who operate nursing homes, extended care sites, CCRCs and more. John O'Connor, who has been with McKnight's for more than 20 years, recently published a candid editorial about factors affecting health care fraud in the industry. He writes:
[G]iven how easy it is to cheat these days, we probably shouldn't be terribly surprised that so many operators give in to temptation. That's especially the case when it comes to invoice preparations.
Let's be honest: How hard is it to put a resident in a higher RUGs category than is probably accurate? Or to bill for therapy services that were not actually delivered? Or to have therapists working overtime doing services that never should have occurred in the first place? And that, my friends, is just the tip of the proverbial iceberg.
Throw in stiff competition, incentives that reward upcoding, a dearth of interested investigators and good old-fashioned human greed, and what we have here is a breeding ground for creative accounting.
For more, read "It's Time for 'The Talk' About Healthcare Fraud."
Sunday, July 31, 2016
Raymond James wealth management group has published a 5 page document for clients that explains special needs trusts. Special Needs Trusts Providing for a Family Member with a Disability or Special Needs provides an overview of SNTs, the types of SNTs, how they work, and how they are managed. (I know that there are many such documents out there, and many are designed for the organization's clients.) I thought the graphics in this one were useful, so I'm passing on the info to you, for what it's worth. (Full disclosure, one of our alums is the Chief Trust Officer for Raymond James).
If you have run across any similar documents that you think are useful, let us know. After all, it's August, which means it is time for us to begin thinking about the beginning of the fall semester...and reading assignments for students.
Friday, July 29, 2016
My good friend (and former New York Administrative Law Judge) Karen Miller recently had successful hip replacement surgery and I was happily amused when I realized she wasn't home two hours before she was already corresponding with me about the latest hot topics in "aging." Karen is a great example of an "active mind!"
Her latest communications focused on a topic I'd also been discussing recently with Stephen Maag, Esq., Director of Residential Communities for LeadingAge. Steve had mentioned that one of the challenges facing senior living across the board was attracting an appropriately trained and stable work force.
Karen pointed out to me that her CCRC (or, to use the latest label, Life Plan Community) in Florida was looking into partnering with a local high school and community college to provide financial support to students as well as site-based training in senior living. For example, Certified Nursing Assistants or CNAs may often think of hospitals or "nursing homes" as primary employers, but Karen pointed out that active senior living communities may offer far more attractive opportunities for employment, while still needing workers, such as CNAs, with specialized skills .
Karen pointed me to an article about a similar collaborative program in Maryland already under operation:
Thanks to a partnership with Ingleside at King Farm, a not-for-profit continuing care retirement community (CCRC) in Rockville, Maryland, students get first-hand experience in senior living and caregiving while residents enjoy participating in their education. And the partnership proves mutually beneficial, providing the CCRC access to a well-trained labor supply.
“Having a program like this exposes the younger generation to the health care field,” Adaeze Ikeotuonye, Ingleside at King Farm’s health care administrator, tells SHN. “Not many people in high school are necessarily thinking of working in the senior living industry, but bringing them in at such a young age and letting them see what the career possibilities are—that mixes up the dynamics.”
For more about creative partnerships to deal with caregiver shortages, read Senior Housing News' "CCRC Helps Forge High School-to-Senior Living Career Path."
Thanks to Karen for this link and best wishes for continued rapid recovery.
Thursday, July 28, 2016
Kaiser Family Foundation (KFF) published 10 Essential Facts About Medicare and Prescription Drug Spending on July 7, 2016. Here are some of the 10 facts, in no particular order.
- "Medicare accounts for a growing share of the nation’s prescription drug spending: 29% in 2014 compared to 18% in 2006, the first year of the Part D benefit."
- "Prescription drugs accounted for $97 billion in Medicare spending in 2014, nearly 16% of all Medicare spending that year."
- "Medicare Part D prescription drug spending – both total and per capita – is projected to grow more rapidly in the next decade than it did in the previous decade."
- "As a result of the Affordable Care Act (ACA), Medicare beneficiaries are now paying less than the full cost of their drugs when they reach the coverage gap (aka, the “doughnut hole”) and will pay only 25% by 2020 for both brand-name and generic drugs."
- "High and rising drug costs are a concern for the public, and many leading proposals to reduce costs for all patients – including Medicare beneficiaries – enjoy broad support."
To read all 10 facts and review the corresponding charts and explanations, click here.
Wednesday, July 27, 2016
If your answer is no, you don't know a doctor who specializes in geriatric medicine, then take heart, you aren't alone. One would think, with the sheer number of baby boomers aging away, that there would be a number of doctors specializing in geriatric medicine. Kaiser Health Network (KHN) and West Virginia Public Broadcasting ran a story on July 13, 2016 about the lack of geriatricians. Few Young Doctors Are Training To Care For U.S. Elderly reports that West Virginia is 3rd in the country with a sizeable elder population, but only has 36 geriatricians practicing in West Virginia. It's not just West Virginia, though, who needs more geriatricians. "The deficit of properly trained physicians is expected to get worse. By 2030, one in five Americans will be eligible for Medicare, the government health insurance for those 65 and older."
The lack of geriatricians is not due to the lack of training programs in the U.S. "The United States has 130 geriatric fellowship programs, with 383 positions. In 2016, only 192 of them were filled." Why is this, you ask? According to the story, one reason may be the cost of a medical education and "they think that they need to get into something without the fellowship year where they can start getting paid for their work." An audio of the story is also available here.
Georgetown University's American Criminal Law Review recently hosted a symposium on health care fraud and one of the articles to come out of that program is by University of Alabama Law School Adjunct Professor James F. Barger, Jr. His article uses the 2013 criminal case of U.S. v. Kolodesh, which resulted in a "guilty verdict on all thirty five counts," to examine "the general trend of Medicare Hospice fraud enforcement actions." The author reports:
The vast majority of False Claims Act hospice cases in which the United States has intervened have settled in favor of the United States without consideration by a jury, and every criminal hospice fraud prosecution by the United States to date has resulted in a guilty plea or a conviction by jury. Every such case—whether civil or criminal—was initiated by a whistleblower under the public-private partnership of the False Claims Act.
The FCA’s whistleblower provisions have been highly effective at detecting fraud and recovering misappropriated Medicare dollars, but deterrence and prevention remain unattained goals.
The calculated business decision to settle False Claims Act allegations has proven over time to have a neutral-to-positive effect on corporate profitability in the hospice sector. For-profit hospice giants such as SouthernCare and Odyssey, who have paid eight figure settlements, have rebounded quickly and actually gained position over their competitors.....
Nevertheless, while the whistleblower provisions of the False Claims Act have proven extremely effective at discovering hospice fraud and at recovering at least some of the lost Medicare funds, alone the statute has demonstrated very little deterrent effect. Outside of a legislative overhaul of the Medicare Hospice Benefit, the only effective deterrent scheme will be for enforcement officials to supplement their use of the civil False Claims Act with traditional criminal fraud statutes. For this to work, however, criminal penalties must be imposed not only on the relatively small-scale players, like Matthew Kolodesh and Home Care Hospice, but also on the mega hospice companies and their executives and owners.
For more, read "Life, Death and Medicare Fraud: The Corruption of Hospice and What the Private Public Partnership Under the Federal False Claims Act is Doing About It," published in the 2016 issue of the American Criminal Law Review.