Tuesday, November 18, 2014

A Window Into Long-Term-Care-Insurance "Agency" and Coverage Issues

In Gunnarson v. Transamerica Life Insurance Company, a federal district court in the state of Washington issued a November 6, 2014 order remanding the case to state court on diversity grounds, rejecting the company's argument that joinder of an individual sales agent as a defendant in the case was merely a step to prevent the out-of-state corporate entity from removing the case to federal court.

In rejecting the fraudulent joinder argument, the federal district court outlined several pending factual and legal issues between the parties arising from the dispute over long-term care insurance (LTCI) coverage.  The issues include:

  • whether the defendant agent's relationship with the insurance company, Bankers United (Transamerica's predecessor), was "disclosed" to the purchasers, relevant because under Washington Law, joint and several liability applies to agents of undisclosed principals;
  • whether written promotional materials on LTCI provided by Bankers United barred a claim for misrepresentation in light of alleged oral misrepresentations by agent at the time of sale regarding dementia care; and
  • whether a claim of misrepresentation, for a policy of LTCI sold 18 years ago, is barred by the statute of limitations, or whether there is an issue of fact about whether and when the purchaser knew or should have discovered that benefits would be paid only for "nursing home" facility care.

In Washington, as in many states, state law changed to expressly require LTCI insurers to cover non-nursing home based care; however, the statutory change apprently occured after the effective date of the policy in question. 

The federal court order linked above resulted in remand to the state court for further proceedings under Washington law. (Allegations, of course, are not the equivalent of proof.)

November 18, 2014 in Cognitive Impairment, Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care | Permalink | Comments (1) | TrackBack (0)

Friday, November 14, 2014

AARP Bulletin: Fighting Medicare Fraud on the Front Lines

The November issue of AARP's Bulletin carries a special Medicare cover story, "Inside the Medicare Strike Force" by Rick Schmitt.  The article details recent successes by a Justice Department unit formed in 2007:

"The strike force has grown from a single outpost in Miami in 200 to nine cities, with the support of 40 of the 100 attorneys in the fraud section of the Justice Department. . . . Just this September, some 280 prosecutors and agents from around the country attended a Justice Department workshop in Washington, D.C., to learn the finer points of investigating and prosecuting Medicare cases.  Increasingly, the crackdown has the look of a major narcotics operation, complete with electronic surveillance and frequent use of informants and cooperating witnesses.  Defendants' assets are now routinely seized before trial.  Sentences are being measured in decades; even some older beneficiaries are being prosecuted.  Agents are backed by forensic accountaints, health care professionals and data acquisition analysts who have a pipeline to Medicare contractors' billing information."

A side bar to the main feature focuses on Peggy Sposato, describing her as a "fraudster's worst enemy," through use of her data analysis skills to create systematic review of billing records.  Her methods successfully trace unlawful Medicare payments.  Her career as a fraud buster "began in the mid-1990s after a career as a geriatric nurse."

November 14, 2014 in Crimes, Health Care/Long Term Care, Medicare | Permalink | Comments (0) | TrackBack (0)

Wednesday, November 12, 2014

Saving for Retirement? Don't Foget to Budget for Health Care

AARP's Research released a new report on saving for retirement: Planning for Health Care Costs in Retirement: A 2014 Survey of 50+ Workers. According to the introduction, the reason AARP did this research was to understand how health care costs factor into retirement planning. This is not only an interesting point, it's an important one and worthy of research.

The key findings for this report show that as far as this issue, the news isn't good. Almost 40% aren't saving for health care costs and a bit over 40% relate they have no plans to do so.  Slightly over a quarter of respondents do plan to begin to save...within the next few years.

Why aren't these folks saving? According to the findings, right now it's unaffordable, either because they're currently caring for another or they have other expenses. Although over 60% are saving for health care costs, almost half worried they won't be able to afford health care. 

The study also shows a disconnect-between the belief of the need for saving and when the belief translates into action. I thought this finding quite interesting--this group plans to pay their own way when it comes to health care costs, with almost 90% replying that they will not rely on family for help with the costs of health care.

The survey also inquired into retirement readiness. The key findings show results that aren't particularly surprising, with about 75%  respondents reporting they are "somewhat confident" while only slightly over 30% being "very confident". Concomitantly, 75% have saved to some extent while 1/3 saved "to a large extent." The full report is available here as a pdf.

November 12, 2014 in Health Care/Long Term Care, Retirement | Permalink | Comments (0) | TrackBack (0)

Tuesday, November 11, 2014

"Medicare Advantage Misconceptions Abound" According to Humana Inc.'s Counsel

The October 2014 issue of the American Bar Association's Health Law Section publication, The Health Lawyer, has an interesting lead essay, one that I believe would be useful both for practitioners and law students to read.  D. Gary Reed, Associate General Counsel for Humana Inc., argues that there are two distinctly different versions of the Medicare Advantage program of health coverage, the version he believes was intended by Congress and the version "found in pleadings, briefs and court decisions."

Attorney Reed starts with a concise statutory overview of coverage under Medicare Part C, leading to introduction of his central thesis:  "Litigants and courts too often depend on prior case law for their understanding of the Medicare statute, rather than on the statute itself." 

Reed writes clearly and offers helpful citations.  He points out that the Medicare statute is, at best, intimidating to the "uninitiated" and the confusion is made worse by inconsistent use of citations to provisions of the legislative Act, rather than to the United States Code. 

He offers an "ABCs of Medicare" followed by a more detailed examination of the subparts of Part C, and describes what it means to "opt out."  He outlines his approach to how the Medicare Advantage program is intended to function, using examples to show how he believes courts have gotten it wrong.  He argues there is "no such thing as a Medicare Advantage insurance policy."  The misconception that there is a "policy," he says, "lulls general practitioners and provider collection counsel into suing for breach of the nonexistent Medicare Advantage insurance policy, instead of pursing the exclusive Medicare appeals process."

Reed contends that "[t]ime and money spent by Medicare Advantage organizations defending litigation driven by these misconceptions diverts resources from caring for aged and disabled Medicare beneficiaries."  He says "a contributing factor may be the dearth of authoritative materials -- text books, law review articles, or the like -- that explain and contextualize the program in readily understandable terms." 

After reading the article, I ask whether a fair implication arises from the apparently significant numbers of claims being made, even if incorrectly and in the wrong forum.  Doesn't that suggest there could be real problems with Medicare Advantage? Reed writes that it is important to understand, and to use available statistics to demonstrate, that "the Medicare appeals process exists and is actually available to Medicare Advantage enrollees." But is Medicare Advantage meeting the real needs of health care service users in this program?

The complete article by Reed, "Medicare Advantage Misconceptions Abound," appears in the 2014 October issue of The Health Lawyer

November 11, 2014 in Health Care/Long Term Care, Medicare | Permalink | Comments (0) | TrackBack (0)

Sunday, November 9, 2014

Are There Broader Implications from Genworth Report on LTC Insurance Losses?

On November 5, Genworth Financial Inc., a major player in long-term care insurance, announced third-quarter 2014 performance results, reporting a $844 million net loss that flowed from review of the company's long-term care claims.  The review required the company to reallocate more than $530 million (pre-tax) to its LTC claim reserves.  Obviously that is not the kind of news that shareholders like to hear. But, it would also appear to hold larger implications.

Financial news reporters quickly followed with analysis.

From the Wall Street Journal: "Long-Term-Care Insurance: What Policyholders Should Know," three "takeaways:"

  • "A past rate increase doesn't forestall additional hikes down the road."
  • "You're unlikely to find a better deal by switching insurers.
  • "It may be possible to cut back benefits and still have good coverage." 

From Bloomberg News: "Genworth CEO Sees Tough Turnaround from $844 Million Loss," putting the single company's performance into context by pointing out that "larger rivals MetLife Inc. and Prudential Financial Inc. have stopped selling long-term care insurance as results are hurt by near record-low bond yields and higher-than expected claims costs."

From Business Insider, "An Insurance Company Underestimated How Long People Would Live-- and Now Its Stock is Crashing." 

Underestimating how long people will live.  Underestimating the demand for assistance with activites of daily living.  Underestimating how much it costs to cover health care and social care meeds.  These are calculation problems not just for the insurance companies but for individuals, families and (if we are at all realistic) governments. Don't we need to stop addressing these issues in silos?

November 9, 2014 in Health Care/Long Term Care | Permalink | Comments (1) | TrackBack (0)

Friday, November 7, 2014

Does Your LTC Facility Have Policies on Intimacy and Sexual Behavior?

Two challenging topics for many families: how to handle death and intimacy for aging family members. We're probably doing better coming to grips with the need to address death than intimacy. When long-term care is required, involving third-parties, the question of sexual behavior can become more important.

Along that line, Bryan Gruley at Bloomberg News wrote a thoughtful series addressing the social, legal, moral -- and just plain tough -- questions connected to sexual behavior that can arise with older persons in congregate settings.

See:

Part 1: Boomer Sex with Dementia Foreshadowed in Iowa Nursing Home.

Part 2:  Sex in Geriatrics Sets Hebrew Home (Riverdale NY) Apart in Elderly Care

Bloomberg Visual Data:  Elder Care Sex Survey Finds Caregiviers Seeking More Training

The Bloomberg series quotes Albany Law School Professor Evelyn Tenenbaum, a civil rights, health care, and bioethics scholar, citing her article "To Be or to Exist: Standards for Deciding Whether Dementia Patients in Nursing Homes Should Engage in Intimacy, Sex and Adultery" from the Indiana Law Review

 

November 7, 2014 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

Wednesday, November 5, 2014

Medicare Keeps On Paying for Drugs...After Death?

I recently read an HHS Inspector General report about Medicare paying for HIV  drugs ... for the dead....The OIG report, Medicare Paid for HIV Drugs for Deceased Beneficiaries, released on Halloween (shades of trick or treat), is available here as a pdf.

OIG report # OEI-02-11-00172 focuses on HIV drugs and the prompt for the investigation was "ongoing concerns about Medicare paying for drugs and services after a beneficiary has died."

The report found  that under the existing policy (which allows this to occur), Medicare continued to pay for HIV drugs for 150 decedents.  Medicare cuts off payments "for drugs with dates of service more than 32 days after death [because] CMS's practices allow payment for drugs that do not meet Medicare Part D coverage requirements. Most of these drugs were dispensed by retail pharmacies."

Why just look at HIV drugs because isn't it likely that this continued payment could be occurring beyond just this group of drugs?  CMS agrees that "these "findings have implications for all drugs because Medicare processes PDE records for all drugs the same way. Considering the enormous number of Part D drugs, a change in practice would affect all Part D drugs and could result in significant cost savings for the program and for taxpayers."

The OIG report recommends a change in practice to "prevent inappropriate payments for drugs for deceased beneficiaries  and lead to cost savings for the program and for taxpayers. CMS concurred with [the OIG] recommendation."

November 5, 2014 in Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0) | TrackBack (0)

Will this Research Development Change Litigation in End of Life Cases?

Kurzweil Accelerating Intelligence (Kurzweil AI) reported in their October 21, 2014 news a story on new research, Hidden brain signatures’ of consciousness in vegetative state patients discoveredHere’s the opening paragraph “Scientists in Cambridge, England have found hidden signatures in the brains of people in a vegetative state that point to networks that could support consciousness — even when a patient appears to be unconscious and unresponsive. The study could help doctors identify patients who are aware despite being unable to communicate.”

The Kurzweil AI story includes the article’s abstract a segment of which we’ve included here

Going further, we found that metrics of alpha network efficiency also correlated with the degree of behavioural awareness. Intriguingly, some patients in behaviourally unresponsive vegetative states who demonstrated evidence of covert awareness with functional neuroimaging stood out from this trend: they had alpha networks that were remarkably well preserved and similar to those observed in the controls. Taken together, our findings inform current understanding of disorders of consciousness by highlighting the distinctive brain networks that characterise them. In the significant minority of vegetative patients who follow commands in neuroimaging tests, they point to putative network mechanisms that could support cognitive function and consciousness despite profound behavioural impairment.

 Click here for the full abstract.  The complete article is available here.

Consider how these findings may be introduced in litigation where the patient is diagnosed as PVS, with one party seeking to have life-prolonging procedures removed and another objecting and seeking this test for the patient.  Should we take this and other medical advances into consideration when drafting advance directives, especially instructions to our health care agents?

November 5, 2014 in Advance Directives/End-of-Life, Cognitive Impairment, Health Care/Long Term Care, Science | Permalink | Comments (1) | TrackBack (0)

Monday, November 3, 2014

Ohio Appellate Court Upholds Spousal Annuity in Medicaid Case

The Ohio Court of Appeals, relying on a Sixth Circuit decision that interpreted Ohio law in Hughes v. McCarthy (2013), has now determined that a wife's purchase of an annuity with funds in excess of her community spouse resource allowance after her husband's admission to a nursing home, was not an improper transfer.  The court's ruling permits her husband to qualify for Medicaid coverage for his long-term care without any penalty period. 

A key to the court's October 22 ruling in Koenig v. Dungey, 2014 WL 5361644, was recognition that use of $121k of "joint funds" to purchase a five-year, actuarially sound spousal annuity was permitted by the language of federal laws, when the "transfer occurred after institutionalization but preeligibility."

In part, the attempts by some states to block use of annuities to convert at least a portion of marital assets into exempt spousal income, depends on states that have adopted tighter language than the federal law.  Along that line, Pennsylvania attorney Kemp Scales shared with me potentially relevant language from the U.S. Supreme Court, when construing the purported effect of one state's attempt to capture proceeds of a tort recovery in order to reimburse the state for its expenditures under Medicaid. In Wos v. E.M.A., 133 S.Ct. 1391, 1400 (2013), the Court rejected application of a state lien, noting the conflict with federal law:

"A [particular state] statute that singles out Medicaid beneficiaries in this manner cannot avoid compliance with the federal anti-lien provision merely by relying upon a connection to an area of traditional state regulation."

In September, a federal district court judge in the case of Wagner v. McCarthy, pending in the Southern district of Ohio, granted preliminary injunctive relief favoring community spouses and prohibited state officials from imposing penalties "due to the transfer of community resources to purchase an actuarily sound anuity for the sole benefit of thier respective community spouse." In granting the injunction, the judge observed "there is little doubt that Plaintiffs will succeed on the merits," citing Hughes v. McCarthy.      

In August, a somewhat more complicated Medicaid planning case, involving one spouse's transfer and sale of the couple's home, was argued before the Ohio Supreme Court and in an earlier Elder Law Prof Blog post we linked to the court's recording of the argument.  A decision on that case, Estate of Atkinson, is still pending.

November 3, 2014 in Health Care/Long Term Care, Medicaid | Permalink | Comments (0) | TrackBack (0)

Sunday, November 2, 2014

Laughter is Great Medicine-Even When Talking About Zombies

Start your week with a laugh, or at least a smile.

One of the many blogs I read, GeriPal, ran an excellent parody for Halloween that had me howling....with laughter at the author's cleverness. Addressing Unmet Palliative and Geriatric Needs of Zombies  is a hysterical must-read. The title gives you an excellent preview. And don't ignore the links in the article to the other sources, especially the one regarding the speed with which the Grim Reaper walks (at least the section on strengths and limitations).

 

November 2, 2014 in Advance Directives/End-of-Life, Cognitive Impairment, Health Care/Long Term Care, Other | Permalink | Comments (0) | TrackBack (0)

Friday, October 31, 2014

Seniors, LTC Workers and Flu Shots (Who Gets What and Who Should?)

ElderLawGuy Jeff Marshall has an interesting blog post, inspired by a recent visit to his doctor where he was asked whether he wanted a "high dose" flu shot. He hadn't heard of high-dose shots.   He demonstrates the same careful approach to this personal decision -- lots of research! -- that he uses with legal analysis for his clients.

But, along the same line, I wonder whether we should be asking related questions of long-term care workers and agencies.  In Arizona, where my parents (both age 89) live, I learned that many home-care agencies (at least those not "Medicare-Certified") do not provide their employees with such vaccinations, and indeed such workers are often treated by their agencies as independent contractors, so they may be without employer-sponsored health insurance coverage.  Such workers struggle to make ends meet -- and flu shots can seem like a luxury.  But those same workers probably need to be immunized to better protect their clients.  It may be up to the seniors themselves to be aware of this issue, and to pay for and make arrangements for their aides to get flu shots (of any strength).  

What are the rules and practices in your state for immunization of in-home care-providers for the elderly?

I often struggle with how far to go in asking for government regulation of risk-factors; but at a minimum, it seems like families need to make their own cost-benefit analysis on immunization of home-aides. 

 

October 31, 2014 in Consumer Information, Ethical Issues, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

Wednesday, October 29, 2014

Non-Profit versus For-Profit Long-Term Care Providers: Does It Make a Difference?

LeadingAge is an organization representing "nonprofit" long-term care providers, including operators of CCRCs, home health agencies, day-care centers, nursing homes, Section 8 public housing, and similar companies.  During the recent national meeting of LeadingAge in Nashville, one topic was an "alarming trend" in the growth of the for-profit long-term care sector.  As reported in McKnight's,  during the conference LeadingAge Chairman David Gehm warned the audience that the for-profit sector is "growing nearly eight times as fast as the nonprofoit sector ... citing figures from investment bank Ziegler."  Gehm is reported as pointing to reduced access to affordable capital as as one factor contributing to the pressures on the nonprofit industry.  He argued a "vibrant nonprofit long-term care sector benefits the whole country."  

On the consumer-cost side of the equation, it does seem that what was once a price differential between the two sectors for cost of care is narrowing.  Nonetheless, historically there has been a certain additional trustw0rthiness factor associated with monprofit providers that often gave them an edge in the marketplace. But is that still true? 

As my students in my Nonprofit Organizations class come to realize, there is often a difference between "charitable" care and "nonprofit" care.  But is the difference between nonprofit care and for-profit care becoming harder to evaluate? 

October 29, 2014 in Consumer Information, Health Care/Long Term Care, Housing | Permalink | Comments (1) | TrackBack (0)

Tuesday, October 28, 2014

November 5-9 Gerontological Society of America's Annual Meeting in D.C.

The Annual Meeting of the Gerontological Society of America  (GSA) will take place on November 5-9 in Washington D.C., bringing together more than 4,000 researchers in an interdisciplinary setting to examine cutting edge issues in science, health care, social care, and governance, including related legal issues.  The conference draws many from around the world, including my friend Roger O'Sullivan from the Centre for Ageing Research and Development in Ireland (CARDI).   There are more than 400 sessions to choose from!

By the way,  GSA has a very useful Facebook page, chock full of links to latest research and  scientific developments. 

October 28, 2014 in Health Care/Long Term Care, International, Programs/CLEs, Science | Permalink | Comments (0) | TrackBack (0)

Monday, October 27, 2014

Washington Post Series on Hospice Leads to Consumer Guide

Has anyone else noticed an uptick in eye-catching articles from the Washington Post?  Maybe it it just that they are writing about things I'm interested in, but I also notice that I'm getting more recommendations from readers, based on Post pieces.  Nice to see this resurgence in a traditional news source.

Along that line, the Washington Post has been running a series on the "Business of Dying," looking at hospice and finding lots of areas for concern.  Sunday's piece focuses on the inconsistencies among hospice providers, with gaps in services that may be hard for families to respond to, especially in the midst of end-of-life trauma.

The Washington Post has now published on line an interactive "Consumer Guide to Hospice," co- written by Dan Keating and Shelly Tan.  You can search by state or by provider -- and it is free!

October 27, 2014 in Advance Directives/End-of-Life, Health Care/Long Term Care, Medicare | Permalink | Comments (0) | TrackBack (0)

Debating Fiduciary Duties and Resident Rights in Continuing Care Communities

Last week I was part of a panel hosted by the National Continuing Care Residents' Association (NaCCRA) in Nashville, a component of the larger (much larger!) annual meeting of LeadingAge.  The theme for the panel was "Resident Engagement in Continuing Care Life" and for my part of the panel, I used an interesting Third Circuit bankruptcy court decision, In re Lemington Home for the Aged, to discuss whether residents of financially troubled CCRCs should be treated as entitled to enforce specific fiduciary duties owed by the CCRC owners to creditors generally, even unsecured creditors, fiduciary duties that may give rise to a direct cause of action connected to "deepening insolvency."  NaCCRA LeadingAge Meeting October 2014

Jennifer Young (pictured on the left), a CCRC resident, talked about what it is like to "be" an unsecured creditor in a CCRC's Chapter 11 bankruptcy court proceeding.  Her explanation of how creditors' committees operate in bankruptcy court (including how they hire legal counsel and how that counsel is paid out of the Debtor's estate) was both practical and illuminating.  The closing speaker on the panel was Jack Cumming (below left). Jack's has deep experience as an actuary and a CCRC resident.  He noted the disconnect between the intentions of providers and the realities faced by residents and called for stronger accountability in investment of resident fees.Jack Cumming October 2014  I always come away from my time with Jack with lots to think about. Our moderator was NaCCRA president Daniel Seeger (right), from Pennswood Village in Pennsylvania.  Dan Seeger October 2014

In my final comments, I reminded our audience that even though our panel was focusing on "problems" with certain CCRC operations, including some multi-site facilities, many (indeed most) CCRCs are on sound financial footing, especially as occupancy numbers rebound in several regions of the country.  Both panelists and audience members emphasized, however, that for CCRCs to be able to attract new residents, the responsibility of the CCRC industry must improve.  For more on these financial points, go to NaCCRA's great educational website, that includes both text and videos, here.

Interestingly, during the LeadingAge programming that began on Saturday, October 18 and continued through October 22, I was hearing a lot about a potentially major shift in the long-term housing and service market.  Some of the largest attendance was for deep-dive sessions on new service models for "Continuing Care at Home," sometimes shortened to CCAH or CCaH.  CCAH is often seen as a way for more traditional CCRCs to broaden their client base, particularly in the face of occupancy challenges that began with the financial crisis of 2008-2010.  

As a corollary of this observation about market change, one of the topics under debate within the leadership of LeadingAge is whether Continuing Care Retirement Communities need a new name, and I can see movement to adopt a name that aligns better with the larger menu of non-facility based services that many providers are seeking to offer. 

Of course, as a law professor, I wonder what these market changes mean for oversight or regulation of new models.  Not all states are keeping up with the changes in the Continuing Care industry, and name changes may complicate or obscure the most important regulatory questions.       

October 27, 2014 in Current Affairs, Ethical Issues, Federal Cases, Health Care/Long Term Care, Housing, Retirement, State Cases, State Statutes/Regulations | Permalink | Comments (0) | TrackBack (0)

Sunday, October 26, 2014

Filial Liability + Bankruptcy = Trouble

As regular readers of the Elder Law Prof Blog may recognize, I reside and work squarely in a zone where "filial support claims" are more than just theoretical propositions.  Pennsylvania continues to be Ground Zero for modern complications arising from use of a Colonial era law that permits adult children to be held liable for the cost of an indigent parent's long-term care. 

The latest example is In re Skinner, 2014 WL 5033258, decided by Bankruptcy Judge Madeline Coleman in the Eastern District of Pennsylvania on October 8, 2014.

The issue is whether one sibling can prevent another sibling from "discharging" any obligation to pay an assisted living facility for their mother's care.  Both brothers were sued by the facility, resulting in a default judgment against one brother (Thomas) for $32,225, who in turn sought discharge of that debt in bankruptcy court.  Brother William, probably facing the prospect of picking up the full tab for his defaulting brother, initiated an adversary proceeding, seeking to prevent the discharge.   The court concludes that Brother William "lacks standing" to prevent Brother Thomas' discharge of the debt to the assisted living facility.

In dismissing Brother William's claim, the Bankruptcy Judge addresses both the Uniform Fraudulent Transfer Act and Pennsylvania's filial support law.  According to the opinion, Brother William alleges that Thomas used a Power of Attorney executed by their mother in 2007, to access her bank accounts in a "scheme [with his wife] to use the Mother's assets, including her interest in long-term care benefits, to fund approximately $85,000 of their personal expenses." However, the court concludes that even accepting the truth of allegations that "suggest that the Mother was injured by the [Thomas'] conduct, that conduct was directed at the Mother and her property. The conduct was not directed at [William]."  The Bankruptcy Court also rejected any theory of "derivative standing."  

Continue reading

October 26, 2014 in Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Cases, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0) | TrackBack (0)

Wednesday, October 22, 2014

Glen Campbell's Last Song

We posted back in August about Glen Campbell's status with Alzheimer's disease.  A recent story on NBC News, covering his status reported that he still plays guitar and his label released his last song, I’m Not Gonna Miss You.” .

His final tour was filmed and a documentary, Glen Campbell: I'll Be Me, will be released October 24th, 2014. The article explains that he was in stage 2 when the tour started and stage 4 when it ended.  Throughout, though, he played a mean guitar.

The NBC story includes three video clips, one which shows his last recording session.

Thanks to law student Erica Munz for sending me the link to the story. Calendar October 24, 2014 and go see this movie.

October 22, 2014 in Cognitive Impairment, Dementia/Alzheimer’s, Health Care/Long Term Care, Music | Permalink | Comments (0) | TrackBack (0)

Monday, October 20, 2014

Improvements Coming to Nursing Home Compare

Earlier this month, CMS announced that it was going to update and improve the Nursing Home Compare site, which should result in more accurate information available for consumers. According to the October 6, 2014 press release, "the expansion and strengthening of the agency’s widely-used Five Star Quality Rating System for Nursing Homes will improve consumer information about individual nursing homes’ quality."

Starting in January, "CMS and states will implement focused survey inspections nationwide for a sample of nursing homes to enable better verification of both the staffing and quality measure information that is part of the Five-Star Quality Rating System." CMS is also adding to the quality measures used. Also CMS will be doing some "focused survey inspections" for verification purposes  of the information that is being submitted.

According to the Center for Medicare Advocacy October 16, 2014 weekly alert, a new law, "[t]he Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act of 2014) ... supports one of the key changes –providing funding to implement a provision of the Affordable Care Act (ACA) that requires nursing home staffing data reported on Nursing Home Compare to be electronically-submitted and "based on payroll and other verifiable and auditable data."

Check it out!

October 20, 2014 in Consumer Information, Health Care/Long Term Care, Housing, Medicare | Permalink | Comments (0) | TrackBack (0)

Friday, October 17, 2014

Watch the Arizona Election for This Proposal

With the mid-term elections in a few weeks away, there are some interesting proposals to watch, according to a series in Governing. A story that was published on October 16, 2014 focused on Arizona.  Arizona Tests Popularity of the Dying's Right to Try Unapproved Drugs focuses on the ability of terminally ill individuals to try experimental drugs. Proposition 303 would allow the patients to not wait for FDA ok if the drug maker is willing to get the drug to the patient.  Arizona is not the first state to consider this. Similar provisions have been approved in Colorado, Missouri, Michigan and Louisiana.

Even though FDA approval wouldn't be required, it still isn't the wild west of experimental drug use.  "The drug must have passed initial toxicity and dosage testing under the FDA’s clinical trial process. Doctors also can’t prescribe an unapproved drug unless the patient has exhausted other options. Manufacturers are under no obligation to provide the drugs and insurers aren’t required to pay for them."

The article discusses the opposition to such laws, giving reasons such as providing false hopes and the likely decrease in clinical trials. Supporters refute the agrument, noting that the terminally ill folks are not typically eligible for clinical trials. These laws are different than the FDA's "compassionate use" provisions which  "allows for experimental drugs for even seriously ill patients, and the program rarely denies an application, but “right-to-try” supporters again argue that the process is too complex and slow, as evidenced by application figures averaging about 1,000 a year."

One thing different about Arizona's proposal-the residents are voting on the provision.

October 17, 2014 in Health Care/Long Term Care, Science | Permalink | Comments (0) | TrackBack (0)

Wednesday, October 15, 2014

"Psychiatric Boarding"

Governing ran a story about a recent court ruling, Mental Health Ruling in Washington State Could Reverberate through the Country. The article concerns the practice of "psychiatric boarding" or     "[w]ith increased demand on proper mental health facilities, the practice known as psychiatric boarding -- temporarily holding mentally ill patients in hospital ERs until beds become available at certified treatment centers..." A national issue, the practice is unconstitutional in Washington state as a result of a lawsuit filed last year by a number of patients. Not only did experts testify that patients who are psychiatrically boarded get little, if any, mental health treatment, in fact, one government report shows that the patients will actually deteriorate.  Implications of state laws that require involuntary detention:  "states also regularly lack the space to place individuals in certified facilities. As a result, patients are held for days -- in some cases literally strapped to beds -- in emergency departments at acute-care hospitals until a bed opens up."

In August, the Washington State Supreme Court ruled this practice unconstitutional, despite the state's arguments regarding insufficient budgets and available beds. The article notes that Washington state is not alone in facing this issue, with a number of states admitting to psychiatric boarding. However, just increasing beds isn't the solution to this issue, the article goes on to discuss.  Quoting the executive director of the Bazelon Center, the better solution is more beds plus broad-based community care.

 

October 15, 2014 in Current Affairs, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)