Wednesday, May 28, 2014

Dual-Eligibles Face Longer Stays & Higher Patient-to-Staff Ratios for Nursing Home Care

Led by Momotazur Rahman, Department of Health Services Policy and Practice at Brown University, researchers at Brown and Harvard have analyzed placements in nursing homes for Medicare-only and "dual-eligible" Medicare/Medicaid individuals. In their May 2014 study published (and linked here) in Medical Research and Review, they conclude that the low-income patients are more likely to be sent to lower quality (as measured by staffing radios) nursing homes.  Their abstract outlines their call for reform for referral processes:

"Medicare and Medicaid dual-eligible beneficiaries use more medical care and experience worse health outcomes than Medicare-only beneficiaries. This article points to a possible inefficiency in the skilled nursing facility (SNF) admission process, specifically that patients and SNFs are partially matched based on dual-eligibility status, and investigates its influence on patients’ SNF length of stay. Using a set of fee-for-service beneficiaries newly admitted for Medicare-paid SNF care, we document two findings: (1) compared with Medicare-only patients, dual-eligibles are more likely to be discharged to SNFs with low nurse-to-patient ratios and (2) dual-eligibles are more likely to become long-stay nursing home residents than Medicare-only beneficiaries if treated in SNFs with low nurse-to-patient ratios. We conclude that changes in the current SNF care referral process have the potential to reduce excess SNF utilization by dual-eligible beneficiaries and could help reduce spending by both Medicare and Medicaid."

One would hope that a corollary to reforming referral processes to "save money" would be improvements in the quality of life and care for dual-eligibles.  Additional analysis of the study is available at McKnights News. 

May 28, 2014 in Health Care/Long Term Care, Medicaid, Medicare | Permalink | Comments (0) | TrackBack (0)

Monday, May 26, 2014

Tobor to the Rescue? Home Medication Dispensers

When I was a child, there was a movie -- or maybe a tv show -- with a friendly robot named Tobor.  Tobor soon became an imaginary friend for the neighborhood children, and conveniently, someone we could blame when we forgot to close a door or knocked something over.  "Tobor did it!"

Fast forward many years and last week, during a meeting at my Area Agency on Aging, I learned the AAA had entered into a contract with a company that makes home medication dispensers to provide the devices at a modest cost to clients in the county.  "Tobor for the Boomer Generation!"

The device, about the size of a blender or coffee machine, can be pre-loaded with a large number of doses of different kinds of medications with different dispensing schedules, and with recorded messages such as "Drink with water."  The machine signals the client to take the revealed dose, and continues the signal until the medication is removed.  It can also be programmed to contact a family member about a missed dose.  Of course, there are limits to the utility of any automated device, as the client must still have the capacity to follow the directions and not simply discard the dose. 

It will be interesting to see, over time, whether (and which kind of ) Tobors are effective innovations with long-range satisfaction and utility.  I do seem to have a lot of ignored contraptions on my own kitchen counter. 

May 26, 2014 in Consumer Information, Current Affairs, Health Care/Long Term Care, Web/Tech | Permalink | Comments (2) | TrackBack (0)

Saturday, May 24, 2014

The Ultimate Compendium of Health Stats in the US

Centers for Disease Control

Health, United States, 2013

Nuff said!

 

May 24, 2014 in Health Care/Long Term Care, Statistics | Permalink | TrackBack (0)

Friday, May 23, 2014

International Elder Law and Policy Conference July 10-11 in Chicago

John Marshall Law School and Roosevelt University, both in Chicago, and East China University of Political Science and Law in Shanghai, are jointly sponsoring an International Elder Law and Policy Conference in Chicago on July 10-11.

Keynote speakers include Professor Israel Doron of the University of Haifa in Israel and Dr. Ellinoir Flynn and Professor Gerard Quinn, both from National Unviersity of Ireland, Galway School of Law.

Scheduled panel topics include:

  • Dignity and Rights of the Elderly
  • Elimination of Age Discrimination
  • Caregivers and Surrogate Decision Makers
  • Social Security, Pensions and Other Retirement Financing Approaches
  • Prevention of Elder Abuse
  • Access to Justice

Here's the link to the Registration website.

  •    

May 23, 2014 in Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Housing, Programs/CLEs, Retirement, Social Security | Permalink | Comments (0) | TrackBack (0)

Friday, May 16, 2014

An "Education Connection" for Senior Living

As readers may have noticed, I've been a long-time "student" of Continuing Care Retirement Communities (CCRCs), drawn to the industry because of its vibrancy and dynamic approach to senior living.  Along the way, I've come to know the many strengths -- and occasional weaknesses -- of individual operations, and the importance of resident engagement to long-range success.  One of my resident contacts shared with me a new PBS NewsHour spotlight on university-connected CCRCs, with a prime focus on Oak Hammock, a community developed under the auspices of the University of Florida.  Universities can offer a unique draw for alums and other college grads, including retired faculty, who value continued educational opportunities.

Here's the link to "Why More Seniors Are Going Back to College -- to Retire."

Although short (about 8 minutes), I find the piece to be balanced, especially in that it hints at the financing terms often needed to make such communities attractive and therefore viable. Some of the people interviewed explain the need for sophisticated mangement to counsel university-based programs, as development of CCRCs can be quite different than simply building a senior's version of  "dorms." My own university stumbled a bit at the starting gate in its early efforts to get a community fully occupied, with the 2008 recession added to the challenges.

Thanks, Karen, for sending us the link!    

May 16, 2014 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing | Permalink | Comments (0) | TrackBack (0)

Thursday, May 15, 2014

Analyzing State Trust Law and Federal Welfare Programs

Maryland Elder Law and Disability Law specialist Ron Landsman provides a thoughtful analysis of use of trusts, especially "special needs trusts," to assist families in effective managment of assets.  His most recent article, "When Worlds Collides: State Trust Law and Federal Welfare Programs," appears in the Spring 2014 issue of the National Academy of Elder Law Attorneys (NAELA) Journal.   Minus the footnotes, his article begins:

"'Special needs trusts,' which enable people with assets to qualify for Supplemental Security Income (SSI) and Medicaid, are the intersection of two different worlds: poverty programs and the tools of wealth management.   Introducing trusts into the world of public benefits has resulted in deep confusion for public benefit administrators. . . . The confusion arising from the merger of trust law with public benefits is sharply drawn in the agencies' [Social Security Administration (SSA) and Centers for Medicare and Medicaid Services (CMS)]  attempts to define what it means for a trust to be for the sole benefit of the public benefits recipient. Public benefits administrators have focused on the distributions a trustee makes rather than the fiduciary standards that guide the trustee.  The agencies have imposed detailed distribution rules that range from the picayune to the counterproductive and without regard, and sometimes contrary, to the best interests of the disabled beneficiary."

Drawing upon his experience in drafting trusts for disabled persons, Ron takes on the challenge of explaining how and where he sees the agencies' focus on "distribution" as misguided.  He contends, for example:

"The [better] task for CMS and SSA [would be] to use their authority to develop standards and guidelines that utilize, rather than thwart, competent, responsible, properly trained trustees as their partners in making special needs trusts an effective tool in serving the needs of people with disabilities.  If this were done properly, capable trustees would be the allies of the federal and state agencies in the efficient use of limited private resources.  Beneficiaries would live better, more rewarding lives to the extent that resources can make a difference, at a lower cost to Medicaid, with a greater possibility of more funds recovered through payback."

Ron is detailed in his critique of agency guidelines and manuals, and he provides clear examples of his "better" sole benefit analysis. 

May 15, 2014 in Estates and Trusts, Federal Cases, Health Care/Long Term Care, Housing, Medicaid, Property Management, Social Security, State Cases, State Statutes/Regulations | Permalink | Comments (0) | TrackBack (0)

Wednesday, May 14, 2014

Frolik & Kaplan: "Elder Law in a Nutshell" (6th Edition!)

It occurs to me that what I'm about to write here is a mini-review of a mini-book. Slightly  complicating this little task is the fact that I count both authors as friends and mentors.

The latest edition of Elder Law in a Nutshell by Professors Lawrence Frolik (University of Pittsburgh) and Richard Kaplan (University of Illinois) arrived on my desk earlier this month. (As Becky might remind us, both are definitely Elder Law's "rock stars.")  And as with fine wine, this book, now its 6th edition, becomes more valuable with age.  This is true even though achieving the right balance of simplicity and detail cannot be an easy task for authors in the intentionally brief "Nutshell" series.  Presented in the book are introductions to the following core topics:

  • Ethical Considerations in Dealing with Older Clients
  • Health Care Decision Making
  • Medicare and Medigap
  • Medicaid
  • Long-Term Care Insurance
  • Nursing Homes, Board and Care Homes, and Assisted Living Facilities
  • Housing Alternatives & Options (including Reverse Mortgages)
  • Guardianship
  • Alternatives to Guardianship (including Powers of Attorneys, Joint Accounts and Revocable Trusts)
  • Social Security Benefits
  • Supplemental Security Income
  • Veterans' Benefits
  • Pension Plans
  • Age Discrimination in Employment
  • Elder Abuse and Neglect

The authors describe their anticipated audience, including "lawyers and law students needing an overview of some particular subject, social workers, certain medical personnel, gerontologists, retirement planners and the like."  Curiously, they don't mention potential clients, including family members of older persons.  I suspect the book can and does assist prospective clients in thinking about when and why an "elder law specialist" would be an appropriate choice for consultation.  This book is a very good starting place.

What's missing from the overview?  Not a lot, although I find it interesting that despite solid coverage of the basics of Medicaid, and even though it is unrealistic to expect exhaustive coverage in a mini-book, the authors do not hint at the bread and butter of many elder law specialists, i.e., Medicaid Planning.  Thus, there's little mention of some of the more cutting edge (and therefore potentially controversial) planning techniques used to create Medicaid eligibility for an individual's long-term care while also preserving assets that otherwise would have to be spent down. 

Modern approaches, depending on the state, may range from the simple, such as permitted use of assets to purchase a better replacement auto, to more complex planning, as in states that permit purchase of spousal annuities or use of promissory notes, allow modest half-a-loaf gifting, or recognize spousal refusal.  Even though the federal Deficit Reduction Act of 2005 succeeded in restricting assets transfers to non-spouse family members, families, especially if there is a community spouse, may still have viable options.  Without appropriate planning the community spouse, particularly a younger spouse, may be in a tough spot if forced to spend down to the "maximum" permitted to be retained, currently less than $120,000 (in, for example, Pennsylvania).  See, for example, a thoughtful discussion of planning options, written by Elder Law practitioners Julian Gray and Frank Petrich.    

Perhaps the Nutshell omission is a reflection of the unease some who teach Elder Law may feel about the public impact of private Medicaid planning?  

May 14, 2014 in Advance Directives/End-of-Life, Books, Cognitive Impairment, Dementia/Alzheimer’s, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare, Property Management, Social Security | Permalink | Comments (0) | TrackBack (0)

Tuesday, May 13, 2014

Eye of the Storm? Corporations & Liability for Negligence in Long-Term Care

One of the tough questions in the arena of "law and aging," which is arguably broader than "elder law," is the scope of liability for negligence or mismanagement in long-term care. A lot rides on this issue.  For example, recently one friend mentioned to me that a large law firm in his city was spending most of its litigation time defending nursing homes, not doctors or hospitals, on personal injury claims.  

Hints of the "scope" of corporate long-term care liability issues appear as early as 2003. In Cases and Materials on Corporations (LexisNexis 2d 2005) by Professors Thomas Hurst (Univ. of Florida) and William Gregory (Georgia State), in the chapter on "Piercing the Corporate Veil," the authors include the case of Hill v. Beverly Enterprises-Mississippi, Inc., 305 F.Supp. 2d 644 (S.D. Miss. 2003), in which the court permits a nursing home resident's personal injury case to go forward for trial against the nursing home's "administrator" and two "licensees." The court rejects the defendants' arguments that without direct involvement or personal participation in the plaintiff's care, no liability can attach. 

In the notes after the Beverly case, the textbook authors ask whether this ruling is an example of "piercing the corporate veil."  The answer appears to be no; rather, the point of the authors' inclusion of the case in that chapter is that high level administrators may still face personal liability without hands-on involvement, because they have statutory or common law "duties," such as hiring, supervision, or training of employees.  The court emphasized, "There is no requirement of personal contact, but rather of personal participation in the tort; and a breach by the administrator of her own duties constitutes direct, personal participation."

Fast forward 11 years.  As recently discussed in McKnight's News, a 2014 federal bankruptcy court recently issued a ruling analyzing parties' attempts to pierce a particular for-profit nursing home enterprise's corporate veil in order to collect some $1 billion dollars in judgments. Success in collection apparently depends upon the judgment holders' ability to recover from a "bankrupt" corporate defendant's current or former "parent" corporations, the former parent's shareholders, lenders (private equity firms), or other individuals and entities alleged to have received the bankrupt subsidiary's assets as part of a "bust-out scheme."  

In March 2014, the Bankruptcy Court for the Middle District of Florida ruled these more remote defendants can face potential liability.  The court concludes that while the plaintiffs have failed to state a claim permitting "veil-piercing," the plaintiffs have stated a claim for relief against corporate directors and "upstream" entities on either a direct allegation of breach of fiduciary duty (for a director who served in multiple boards) or on an indirect theory of liability, "aiding and abetting a breach of fiduciary duty."  The court also permits the plaintiffs to proceed on theories of fraudulent transfers or conspiracy to commit fraudulent transfers against the parent company, successor entities, and certain individuals who appear to be corporate officers or directors. Of course, a decision on a pretrial motion to dismiss does not mean the defendants will ultimately be found liable.

The judge takes pains to outline the series of corporate entities and transactions, which appear to include overlapping officers or directors, that were used to build a national long-term care empire, but also, as alleged by the plaintiffs, to give separate entities control over physical assets or daily operations or incoming revenue, and to isolate and limit liability for debts.  To highlight one of the alleged sham transactions, the court describes the debtor corporation's "sole shareholder" as "an elderly graphic artist who currently lives in a nursing home" and who may have had some recollection of being asked to invest in "computer equipment," but who did not, in fact have or spend any money for his shares. 

The Bankruptcy Court's memorandum opinion, in In re Fundamental Long Term Care Inc., Jackson v. General Electric Capital Corp., 507 B.R. 359 (M.D. Fla. March 14, 2014), is "colorful" in the way that only legal geeks probably appreciate, although at one point the court observes that the "'bust-out' scheme alleged in the complaint . . . has all the makings of a legal thriller."  Plus, there are political implications of the Florida decision reverberating in Illinois, as described by the Chicago Tribune, here.  Scott Turow, this is in your backyard.  Are you taking notes? 

As for the $1 billion in judgments that triggered the collection efforts, they apparently represent 6 separate cases, and it appears that at least one was entered when no lawyer appeared to defend the nursing home at a jury trial against claims of negligence, as explained in a Tampa Bay Times news account in 2012 about one of the cases, where a wheelchair-bound resident was alleged to have fallen to her death in an unlocked stairwell. 

And by the way, just because a nursing home is organized as a nonprofit corporation does not mean that it can necessarily escape liability for officers and directors, as we recounted last December in discussing In re Lemington Home for the Aged. 

May 13, 2014 in Federal Cases, Health Care/Long Term Care, State Cases | Permalink | Comments (0) | TrackBack (0)

Monday, May 12, 2014

Oklahoma Passes First in the Nation “Care Act” Supporting Family Caregivers

 

With the signature of Governor Mary Fallin on Senate Bill 1536, Oklahoma today becomes the first state in the nation to pass The CARE ACT.  Backed by AARP, the Caregiver Advise, Record, Enable (CARE) Act has been introduced in IL, NJ and HI.  Other states are working to pass a State Plan in Support of Family Caregivers or advancing additional initiatives to support family caregivers such as workplace protections and respite care.  Following is a statement from AARP Vice President of State Advocacy and Strategy Integration (SASI) in AARP's Government Affairs group on the new Oklahoma Law:

 

“I was a family caregiver for my Mom and Pop for more than 15 years.After all they’d done for me it was my pleasure to care for them.  But the tasks were intimidating.  Like me, 42 Million family caregivers in America are eager to help but are challenged by medical responsibilities that come home from the hospital with our loved ones.

 

“Today, with the signing of The CARE Act, Oklahoma’s 600,000 family caregivers will have new support when their loved ones go into the hospital as well as consultation on the tasks they must provide to safely care for their loved ones when they’re discharged home.

 

“As the first state to pass The CARE Act, Oklahoma is the pacer for many other states ready to introduce or vote out The CARE Act and state plans and initiatives to help family caregivers as they assist their loved ones to live independently at home as they age.  We look also forward to seeing many more state legislatures get behind bills to support family caregivers.  After all, we know that family caregiving is an act of love, but that doesn’t mean that it isn’t real work that requires real support.”

 

The CARE Act requires hospitals to:

 

  • Record the name of the family caregiver when a loved one is admitted into a hospital;
  • Notify the family caregiver if the loved one is to be discharged to another facility or back home; and,
  • Consult and prepare the family caregiver on the medical tasks – such as medication management, injections, wound care, and transfers – that he/she may perform at home.

 

May 12, 2014 in Health Care/Long Term Care, State Statutes/Regulations | Permalink | TrackBack (0)

Elder Law Attorneys Get "Props" During Fresh Air Interview with Cartoonist

Roz Chast, well known for her cartoons in The New Yorker, has been getting well deserved coverage of her new graphic book, "Can't We Talk About Something More Pleasant?"   She brings her light, dark touch to bear on a tough topic, a daughter's relationship with her increasingly frail and sometimes stubborn parents. Roz Chast Memoir

Despite the obvious relevance of her book to this Blog, I was nonetheless pleasantly surprised when I heard Chast interviewed recently on the radio by Terry Gross for Fresh Air.  Roz Chast recounts how a lawyer specializing in "elder care law" (the phrase I increasingly hear used by lay people, displacing "elder law") helped her and her parents get to the heart of some very tough issues they'd been avoiding, as suggested by the title of her memoir.  As captured on the NPR website report, in describing the lawyer during the interview, Chast said:

"This person was really good.  And I think he was able to ... somehow make them trust him enough that they could open up a little bit about things that they really never wanted to open up about, like money and talking about the future.  I was there with them when he came over and we talked about things like health care proxy forms.  Things I had never thought about, things I had never heard of.  It was very, very helpful."

Reading between those few lines, I see the type of caring, tactful attorney -- and someone who makes home visits -- that I often have the pleasure of working with in Elder Law.

Chaz also talks humorously -- and with great candor -- about the dollars and "sense" of long-term care, and how she as a daughter felt about her parents' money going to pay for assisted living. 

Refreshing Fresh Air! 

 

May 12, 2014 in Health Care/Long Term Care, Legal Practice/Practice Management | Permalink | Comments (0) | TrackBack (0)

Thursday, May 8, 2014

National Senior Citizens Law Center Shares Advocates' Guide

The National Senior Citizens Law Center (NSCLC), drawing upon the nonprofit firm's experience in successful advocacy about access to benefits, is sharing its recommendations on how to help individuals obtain Medicaid funding for Home and Community Based Services (HCBS).  The guide is titled "Just Like Home: An Advocate's Guide to Consumer Rights in Home and Communit Based Services." The authors, Eric Carlson, Hannah Weinberger-Divack and Fay Gordon, explain:

"New federal Medicaid rules, for the first time, set standards to ensure that Medicaid-funded HCBS are provided in settings that are non-institutional in nature.  These standards, which took effect in March 2014, apply to residential settings such as houses, apartments, and residential care facilities like assisted living facilities.  The standards also apply to non-residential settings such as adult day care programs.

 

This guide provides consumers, advocates and other stakeholders with information regarding multiple facets of the new standards, including consumer rights in HCBS, and the guidelines for determining which settings are disqualified from HCBS reimbursement.  This guide is based on the federal rules and subsequently issued guidance, and will be updated as further information becomes available."

The twenty-page guide is free and downloadable -- more reasons to appreciate the hard-working folks at NSCLC. The NSCLC lawyers remind us that implimentation of HCBS is far from uniform from state to state.  Knowing what is happening outside your own state will increase the odds of successfullly advocating for change, and securing threshold, quality care in your state.

May 8, 2014 in Federal Cases, Health Care/Long Term Care, Medicaid, State Cases | Permalink | Comments (0) | TrackBack (0)

Tuesday, May 6, 2014

Honor Older Veterans by Helping Them Access Services

Last Sunday, the Philadelphia Inquirer carried an Op-Ed by Patrick Murphy, an Iraq war veteran, and Karen Buck, executive director for SeniorLAW Center in Philadelphia.  Their words provide a welcome reminder, contrasting with the news I reported earlier today about allegations of inadequate care for veterans in Arizona.  In part they write:

"Experts estimate that 14 percent of the adult homeless population has served in the U.S. military. After valiant service, beterans deserve the most basic of human needs:  safe shelter, protection from abuse, enought to eat. 

 

What can we do to change this story for older veterans? 

 

First, know who the veterans are in  your daily life and thank them for their service.  Peace at home is a gift made possible by the harsh sacrifice of others; it's easy to take for granted.  Join  us in doing more by showing gratitude through action.

 

...Help connect an older veteran with the services he needs -- and encourage him to access them.  Many older veterans don't know what resources are available or they associate asking for help with weakness.  Yet, from the VA, they may be eligible for income supports, home-based or nursing home care, health care, burial assistance, education, and other benefits.  Nonprofits can help provide free legal assistance to address issues that arise over housing, family, health care, consumer issues, elder abuse, and financial exploitation.  Legal services rank among the top unmet needs of veterans, but we can all become advocates to help vets get the support they need and deserve."

As Patrick and Karen demonstrate, support for local legal service organizations in your area can be effective in helping veterans access key benefits, while also providing another important watchdog to help reduce or prevent the likelihood of fullblown VA scandals.

Experts estimate that 14 percent of the adult homeless population has served in the U.S. military. After valiant service, veterans deserve the most basic of human needs: safe shelter, protection from abuse, enough to eat.

What can we do to change this story for older veterans?

First, know who the veterans are in your daily life and thank them for their service. Peace at home is a gift made possible by the harsh sacrifice of others; it's easy to take for granted. Join us in doing more by showing gratitude through action.

Volunteering is one form of action. Help connect an older veteran with the services he needs - and encourage him to access them. Many older veterans don't know what resources are available or they associate asking for help with weakness. Yet, from the VA, they may be eligible for income supports, home-based or nursing home care, health care, burial assistance, education, and other benefits. Nonprofits can help provide free legal assistance to address issues that arise over housing, family, health care, consumer issues, elder abuse, and financial exploitation. Legal services rank among the top unmet needs of veterans, but we can all become advocates to help vets get the support they need and deserve.

Read more at http://www.philly.com/philly/opinion/20140504_Don_t_forget_key_work_of_U_S__vets.html#qwbXm13qk5jXlIby.99

Experts estimate that 14 percent of the adult homeless population has served in the U.S. military. After valiant service, veterans deserve the most basic of human needs: safe shelter, protection from abuse, enough to eat.

What can we do to change this story for older veterans?

First, know who the veterans are in your daily life and thank them for their service. Peace at home is a gift made possible by the harsh sacrifice of others; it's easy to take for granted. Join us in doing more by showing gratitude through action.

Volunteering is one form of action. Help connect an older veteran with the services he needs - and encourage him to access them. Many older veterans don't know what resources are available or they associate asking for help with weakness. Yet, from the VA, they may be eligible for income supports, home-based or nursing home care, health care, burial assistance, education, and other benefits. Nonprofits can help provide free legal assistance to address issues that arise over housing, family, health care, consumer issues, elder abuse, and financial exploitation. Legal services rank among the top unmet needs of veterans, but we can all become advocates to help vets get the support they need and deserve.

Read more at http://www.philly.com/philly/opinion/20140504_Don_t_forget_key_work_of_U_S__vets.html#qwbXm13qk5jXlIby.99

May 6, 2014 in Consumer Information, Health Care/Long Term Care, Retirement | Permalink | Comments (1) | TrackBack (0)

Wait Times for Sick Veterans: Looking at the Phoenix VA Whistleblower Claims

While in Arizona over the weekend, I had time (while hiding from the first days of this summer's 100+ degree days) to catch up on the latest news about allegations involving the Veterans Administration Health Care System in Phoenix.  As reported in the Arizona Republic, key concerns focus on allegations that:

  • Veterans were forced to wait unreasonable lengths of times for needed health care appointments (including allegations of waits of over 200 days);
  • "Forty or more" veterans died while awaiting care;
  • Records were falsified or improperly maintained regarding wait times, with allegations of a "secret list" showing more accurate information;
  • Records have been or will be destroyed.

The U.S. House Committee on Veterans' Affairs has reportedly issued orders to the VA to preserve documents.  The key allegations of failure to provide necessary care come from two physicians, including one who worked for the VA for 24 years before retiring in December.  

I'm not seeing concrete details about the wait times or deaths, although at least one death by suicide of a 20-year veteran is described by a family member in a letter to the editor of the Arizona Republic.  It seems unlikely that wait-time delays would be a facility-specific practice and would seem more likely to be a larger system issue. Some allege the problems can be tied to specific administrators.  Pinning down such practices is difficult at best, but is there more bad news ahead

May 6, 2014 in Federal Cases, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

Friday, May 2, 2014

Impact of Change in Assisted Living: Social Science Research

"The Facade of Stability in Assisted Living," an article by social scientists at University of Maryland Baltimore County, published in the May issue of the Journal of Gerontology (Series B: Social Sciences), takes a hard look at assisted living settings, using research from 17 different facilities.  Key findings include:

"Our ethnographic research in 17 diverse AL settings (2004-to the present) has found evidence that what may appear to be quite stable is, in fact, a facade.  First, our research indicates that stability -- in many senses -- is not the norm for ALs. . . . Changes occur at multiple levels of person (residents, family members, staff, or managers) collectives (groups or types of residents, staff or managers), organizations (owners or corporations) and external environments (economies or competitors). . . . Second, among these multiple levels and dimensions of change/instability, only a few have been examined substantially in research to date. . . . The changes in AL communities contradict their outward appearance or facade of stability and may profoundly affect the quality of life for residents."

The research, which the authors recognize has limitations because, for example, it was based on evaluation of AL facilities in a single state (Maryland), nonetheless is a reminder that families seeking reliable information about placements for aging loved ones should use caution about "old" data about any specific facility or provider "branding."  The authors caution, "changes driven by new owners or managers and altered competitive pressures challenge contemporary ALs to provide services beyond the original intention of this sector under the social model of care that dominated its origins." 

May 2, 2014 in Consumer Information, Health Care/Long Term Care, Housing | Permalink | Comments (0) | TrackBack (0)

Thursday, May 1, 2014

May Day Topic: Do We Need Better U.S. Understanding of "The Social Care Network?"

May Day Parade in Belfast 14 Pensioners' ManifestoWhen I was in Northern Ireland in 2010, I happened to catch the May Day parade in downtown Belfast.  One of my favorite parts of the parade was the Pensioners' Manifesto team, including many smiling marchers I had come to know as friends during my sabbatical in the U.K.  Can you imagine U.S. retirees calling themselves "pensioners?"  Even AARP no longer calls itself the American Association of Retired Persons.  I enjoyed the candor of those marchers in Belfast.

As a result of my time there, I became a fairly regular reader of Irish and U.K. newspapers, which are still remarkably robust, especially by comparison to latter-day U.S. newspapers.  The Guardian has a great regular feature on the Social Care Network, a concept I'm not sure we acknowledge in the U.S.  Here's a link to the Guardian's Social Care Network feature section.

And here's a link to a Guardian article forwarded to me by Jocelynne Scutt, a visiting scholar at Penn State Dickinson School of Law in Carlisle, with law-related roots in Australia, Fiji, Tasmania, and Cambridge, U.K.  Titled "Ageing Without Children: Why is No One Talking About It,"  it discusses the very real dynamic of the growing number of older people in the U.K. (and, of course, world wide) without family to serve as caregivers.

Thanks, Jocelynne.   

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

Sunday, April 27, 2014

Press #1 for Frustration: Automation, Hospitality and Aging

During the years when I supervised Penn State Dickinson's Elder Protection Clinic, I was often struck by how much time our law students spent tracking down basic information on behalf of clients, such as credit card or mortgage histories, Social Security records, or insurance coverage details. The information was, in theory, equally available to the clients themselves, but often our clients, who tended to be on the older side of "aging," simply didn't have the energy, patience or skills needed to navigate the dense, automated systems typically associated with modern record-keeping and billing.  One of our student-lawyers made the apt observation that if you weren't "old" before you called some of the customer service "help" lines, you would be by the time you got an answer.

I was reminded of this recently while attempting to make a hotel reservation by telephone.  In my first attempt, I didn't have enough time to wait, so after 10 minutes of less-than-interesting music, I gave up. The second time, a day later, I was routed through a series of automated messages, apparently intended to entice me into becoming an "honors" guest of the hotel's larger chain.  I was using a cell phone, so each time the automated voice indicated a series of choices available, I had to take the phone away from my ear and look for the button in question.  I listened to four sets of automated instructions, even though each time my goal was the same, pressing whatever button I was told to press "if" I wanted to book a reservation.  Gee, are there that many other reasons why someone calls a hotel reservation number?  It took several minutes before I reached a live person, who with a very bored tone insisted I give several items of personal information before I was allowed to ask whether there was a room available for my specific date. You could tell she was reading from a script. By this point I had become distinctly grumpy about the lack of hospitality in this so-called hospitality venue.

As you have probably already guessed, there was "no room at the inn" for that date.  I asked to speak to a supervisor, not so much because I thought I could change the outcome, but because I wanted to register my feeble complaint about frustration with their system. That took another 10 minutes with more "music." But I was determined not to give up.

Amusingly, once I finally reached a "supervisor," the individual immediately agreed with my comments about the weakness of their automated system. That did a lot to dispel my annoyance.  And then -- shock -- she actually offered to solve the problem by calling the local hotel (which as it turns out I was not speaking with).  She found me an available room to book for the night in question. The encounter with the real human wasn't particularly fast, but I was content to wait, knowing a caring individual was trying to help.

This micro-experience, a minor annoyance, nonetheless gave me reason to think about two things:  (1) how much more difficult automation could be for someone who has a hearing problem, slowed reflexes, impaired vision, or diminished cognitive abilities, and (2) how often I'm positively impressed during my communications with well-run long-term care facilities.

When I telephone my father's assisted living community, for example, a live person answers the phone and often recognizes my name and my father's name. My whole family notices how well the staff members know their residents and remember helpful details about the residents' families. It isn't a fancy place, but the staff outshines most high-end resorts with their professionalism and good-natured hospitality.  And it is contagious, as I often see my father smiling in response to the staff members' kind words.

Also, when I visit CCRCs across the country for work-related reasons, I'm impressed by the very personal relationships I witness between residents and front-office management.  Admittedly, CCRCs are often at the upper end of the long-term care "pay" spectrum, but my impression over the years that I've been visiting such multi-level care facilities, including their skilled care units, is that management and staff at the most successful operations place a high value on human contact with residents and the public.  The best ones seem to embrace the notion that a hospitable, caring demeanor during direct interactions goes a long way to lowering the potential for confusion or angry disputes and thus increases the likelihood that someone will be a "client" and recommend new clients. 

So, is it possible that the long-term care industry, often portrayed negatively in the media, has something important to teach other segments of  industry about why automation is not the best, nor even the most cost effective, solution to customer relations, and why the personal touch still makes a difference?  

April 27, 2014 in Consumer Information, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

Thursday, April 24, 2014

Average retiree health costs could overtake Social Security benefits

Via Investment News:

Average health care costs for middle-income retirees are on a path to exceed their Social Security benefits, according to a newly created Retirement Health Care Cost Index.  The index devised by HealthView Services, a provider of Medicare, Social Security and long-term-care planning tools, measures the percentage of Social Security benefits required to pay for health care-related costs in retirement for a healthy couple receiving the average expected Social Security benefit at full retirement age.  Retirement health care costs will increase from 69% of Social Security benefits for a couple retiring next year to 98% of Social Security benefits for a healthy couple retiring 10 years from now, according to the index. For couples retiring two decades from now, the gap will be even more dramatic. They would need 127% of average Social Security benefits to cover their health care costs in retirement.  Total retirement health care costs measured by the index include all Medicare premiums, including Parts B and D, and Medigap premiums, as well as out-of-pocket costs, including co-pays not covered by Medicare. The index assumes that the primary income earner will generate the Social Security average of $1,294 per month in today's dollars and $817 per month for the lower-earning spouse. The index measures the lifetime average of health care costs, which tend to increase as retirees age.

Source/more:  Investment News Retirement

April 24, 2014 in Health Care/Long Term Care, Social Security | Permalink | TrackBack (0)

Veterans die after being placed on VA Hospital’s secret waiting list

Via CNN:

At least 40 U.S. veterans died waiting for appointments at the Phoenix Veterans Affairs Health Care system, many of whom were placed on a secret waiting list.  The secret list was part of an elaborate scheme designed by Veterans Affairs managers in Phoenix who were trying to hide that 1,400 to 1,600 sick veterans were forced to wait months to see a doctor, according to a recently retired top VA doctor and several high-level sources.  For six months, CNN has been reporting on extended delays in health care appointments suffered by veterans across the country and who died while waiting for appointments and care. But the new revelations about the Phoenix VA are perhaps the most disturbing and striking to come to light thus far.  Internal e-mails obtained by CNN show that top management at the VA hospital in Arizona knew about the practice and even defended it.

Read more at CNN Wire.

April 24, 2014 in Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care | Permalink | TrackBack (0)

"What If It's Not Alzheimer's?"

My Penn State colleague from Hershey Medical Center, Dr. Claire Flaherty, has shared with me a another fascinating resource, "What If It's Not Alzheimer's?: A Caregiver's Guide to Dementia," by Gary Radin and Lisa Radin. 

The first chapter provides "The ABCs of Neurodegenerative Dementias," including frontotemporal dementia (FTD), Lewy Body Dementia, vascular dementia, as well as Alzheimer's Disease.  Key chapters including "finding the A Team" of specialists, and a guide to therapeutic interventions. 

The book reminds us that with some forms of dementia, particularly early onset dementias such as FTD, changes in personality or executive function may be the first signs, and easily misunderstood.  For example, the individual may manifest:

  • hypersexuality, including promiscuous sexual encounters with strangers; or
  • apathy or indifference to grooming and hygiene; or  
  • "hyperorality" with disinhibited consumption of large amounts of food; or
  • poor judgment with a lack of sense of consequences, sometimes coupled with poor impulse control

One chapter is unique, emphasizing the potential importance, after death, of an autopsy of the brain, and thus providing families with a way to contribute to biomedical research and the hope for better answers in the future.

April 24, 2014 in Books, Cognitive Impairment, Consumer Information, Dementia/Alzheimer’s, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

Monday, April 14, 2014

New Report Finds That Spouses Who Are Caregivers Are More Likely Than Other Caregivers to Perform Demanding Medical/Nursing Tasks

The United Hospital Fund and AARP Public Policy Institute has issued a report today showing that spouses who are caregivers not only perform many of the tasks that health care professionals do—a range of medical/nursing tasks including medication management, wound care, using meters and monitors, and more—but they are significantly more likely to do so than other family caregivers, who are mostly adult children. Nearly two-thirds of spouses who are family caregivers performed such tasks (65 percent), compared to 42 percent of nonspousal caregivers.

Despite these demanding responsibilities, spouses were less likely than nonspousal caregivers to receive in-home support from health care professionals; 84 percent of spousal care recipients received no professional health care on site, compared to 65 percent of nonspousal care recipients. Compounding the challenge, spouses were also less likely to receive help from family or friends or home care aides: 58 percent of the spouses reported no additional help from others, compared to 20 percent of nonspouses. This lack of support elicited special concern from the authors: “‘Taking care of one another’ in an era of complicated medication regimens, wound care, and tasks associated with complex chronic care is a challenge that no one should have to face alone,” they state in the report.
In addition, spouses who are caregivers were on average a decade older than nonspousal caregivers (median age 64 versus 54). They were also poorer, less likely to be employed, and less educated than nonspousal caregivers.
Family Caregivers Providing Complex Chronic Care to Their Spouses, a publication in the “Insight on the Issues” series, summarizes the new findings drawn from additional analysis of data based on a December 2011 national survey of 1,677 family caregivers, 20 percent of whom were spouses or partners. Earlier findings were published in the groundbreaking PPI/UHF report Home Alone: Family Caregivers Providing Complex Chronic Care and in an earlier publication in the “Insight on the Issues” series, Employed Family Caregivers Providing Complex Chronic Care.

April 14, 2014 in Dementia/Alzheimer’s, Health Care/Long Term Care, Statistics | Permalink | TrackBack (0)