Monday, September 18, 2017

Doctors in Older Age: Should They Be Evaluated on Their Fitness?

I've heard a few times about concerns regarding doctors in their 70s and 80s who continue to practice medicine. The implication is that their age might somehow make them less fit to practice medicine. I've also heard the same concerns expressed about attorneys. Do we concern ourselves with professional fitness just based on age for any other profession? Not for us law profs.  So I was interested in reading this article from the Philadelphia Inquirer, More doctors are practicing past age 70. Is that safe for patients? 

The article opens with the story of one pediatrician who at 76, was required by his hospital to be evaluated. This hospital "is among the growing number of hospitals that are reevaluating doctors simply because they are old. Their age puts them at higher risk for physical and cognitive changes that could imperil patients." Other doctors quoted in the article oppose such actions, arguing the lack of "scientific evidence correlating such test results with physician performance. They have, however, grudgingly accepted physical testing and peer review."  The article notes a trend of sorts on this issue

In 2015, the American Medical Association called for guidelines to evaluate aging doctors, although it did not specify what they should be.  It also said doctors have a “professional duty” to self-assess.  The American College of Surgeons last year said surgeons should voluntarily undergo testing by their personal physicians and  disclose any problems to their employers.

There are likely more older physicians still practicing then you might think. To some extent, the article notes, that taking action now internally is preemptive.   There's a two-day challenging testing program, "[t]he  Aging Surgeon Program, which is available to doctors from anywhere,  involves extensive cognitive and physical testing as well as evaluation of balance, reaction time, and fine motor skills."  Penn Medicine has implemented cognitive testing for all of their doctors who are 70 or older. The article looks at what other medical facilities in the area are doing. 

I suspect this is an issue we will hear more about in the future.

September 18, 2017 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Discrimination, Health Care/Long Term Care | Permalink | Comments (1)

Friday, September 15, 2017

Is Hospice Care Misunderstood?

Hear the word hospice and what do you think? The patient is close to dying, right? Kaiser Health News did a story about hospice care that explains the patient doesn't have to be on the edge of dying. Shedding New Light On Hospice Care: No Need To Wait For The ‘Brink Of Death’ examines the misconception about hospice care.

Although hospices now serve more than 1.4 million people a year, this specialized type of care, meant for people with six months or less to live, continues to evoke resistance, fear and misunderstanding... “The biggest misperception about hospice is that it’s ‘brink-of-death care,’” said Patricia Mehnert, a longtime hospice nurse and interim chief executive officer of TRU Community Care, the first hospice in Colorado.

People who have some time left may find that using hospice gives them a better quality of life.  "New research confirms that hospice patients report better pain control, more satisfaction with their care and fewer deaths in the hospital or intensive care units than other people with similarly short life expectancies." (The article referenced in the quote requires purchase or subscription).  The KHN article explains the differences in the four levels of care offered by hospice, including respite care, routine care, general inpatient care and continuous care. Routine care is the most typical, with visits by aides and an RN, the frequency of which is dictated by the patient's condition.  One of the biggest misconceptions, according to the article, the family thinks hospice folks will be in the home with the patient continuously.  As a result, the family or patient may need to hire aides or companions to get the needed help.  The article discusses provision of medications, choice of doctors,  medication concerns, discharge and care of the patient in the last few days of life.

September 15, 2017 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Thursday, September 14, 2017

Women Who Are Older--Financial Fears?

How well-prepared are you for financing your retirement? Do you know your family's finances?  The New York Times examined the situations that may be faced by women who are older who are not involved in the handling of their family's finances. Helping Women Over 50 Face Their Financial Fears covers a lecture series, Women and Wills, designed specifically for women over 50 that cover a variety of topics, including estate planning. health care, insurance, long term care, business succession planning and more. The founders are well aware that some women may not be up to speed on their family's finances, or other circumstances such as a spouse's illness, may present challenges for them. The founders plan to take their lecture series on the road, nationwide, and publish a book on the importance of planning.

Thanks to Professor Naomi Cahn for sending a link to the article.

 

September 14, 2017 in Books, Consumer Information, Current Affairs, Estates and Trusts, Health Care/Long Term Care, Property Management, Retirement, Social Security | Permalink | Comments (0)

Wednesday, September 13, 2017

The Critical Importance of A.C. for Emergency Preparedness

A couple of years ago, I was present when my father's dementia care facility -- a licensed assisted living community -- was doing a test of part of their emergency preparedness plan.  The staged "emergency" for that particular test was "loss of air-conditioning," which for most of the year in Arizona and other locations in the south and southwest is a serious concern.  With climate change, heat and air-conditioning systems are going to be even more critical in the future.

I was impressed that even without back-up generators, the facility had both a short-term and long-range plan. The long-term plan required staged evacuation to other locations.  Of course, to be effective, any evacuation would depend on the "other" locations having working power systems, something that can't be certain in a large scale weather or similar emergency.  

Sadly, as reported in the New York Times on September 13, following the damage caused by Hurricane Irma, there were several deaths at a long-term care facility near the coast in southeastern Florida.  The rapidly developing story suggests that as many as eight deaths were tied to loss of air-conditioning, although not a complete loss of power to the facility. It is too early to know all of the relevant facts.  But, what about the law?  The NYT article notes that:  

Florida requires nursing homes to have procedures to ensure emergency power in a disaster as well as food, water, staffing and 72 hours of supplies. A new federal rule, which comes into effect in November, adds that whatever the alternative source of energy is, it must be capable of maintaining temperatures that protect residents’ health and safety.

Does the federal regulation mandate emergency sources of air-conditioning? Although the highlighted language in the NYT article suggests the new federal rule "comes into effect" in November of this year, my read of the regulation says the effective date was November 15, 2016 -- in other words, last year.

***

9/14/17 Correction to above paragraph:  It was bothering me that I saw more than one news article describing the Emergency Preparedness rule as not taking effect until November of this year.  The "effective date" of the Rule is clearly November 15, 2016 -- but, the New York Times is correct -- Long Term Care facilities have "until" November 15, 2017 to "implement" their preparedness plans, including any plan for maintaining safe temperatures.   The implementation deadline was in a previous version of the rule, not the version of the rule actually made "effective" on November 15, 2016.  Another lesson for me in the need for careful reading of regulations!

***

Perhaps more importantly, here's the language of the federal regulation, at 42 C.F.R Section 483.73, governing emergency preparedness at LTC facilities:

The LTC facility must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least annually. At a minimum, the policies and procedures must address the following:
 
(1) The provision of subsistence needs for staff and residents, whether they evacuate or shelter in place, include, but are not limited to the following:
    (i) Food, water, medical, and pharmaceutical supplies.
    (ii) Alternate sources of energy to maintain
        (A) Temperatures to protect resident health and safety and for the safe and sanitary storage of provisions;     
        (B) Emergency lighting;
        (C) Fire detection, extinguishing, and alarm systems; and
        (D) Sewage and waste disposal.
Does this regulation require alternative sources of air-conditioning or heat -- as necessary to "protect resident health and safety" -- or does it merely require a "policy and procedure"?  I suspect this language might be a legal issue in any post-Irma proceedings.  
 
This is still a developing story, with state authorities conducting investigations.  For more, see this NPR story

September 13, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, State Statutes/Regulations | Permalink | Comments (0)

Tuesday, September 12, 2017

Disaster Planning and Services on Our Minds

With Irma in Florida's rear view mirror (and not a moment too soon), many are focused on what, if anything, should be done differently  next time.

For us as attorneys, we should be sure to tell our clients about the importance of having a disaster plan. For clients living elsewhere, whether a long-term care facility or housing specifically for elders, they should be advised to ask a lot of questions. Does the facility have a disaster plan? Get a copy of it.  What services does the facility provide to help residents evacuate? In what evacuation zone is the facility located? Does the facility have a back-up generator in the event of a power outage? How does the facility balance having adequate staff on site before, during and after the disaster while simultaneously allowing staff to prepare for the disaster?  Does the facility's insurance policy cover property of residents? What services does the facility provide to help residents return after the disaster? What happens if the facility is now uninhabitable?  Does the admissions contract provide for any return of the resident's money (this may be more applicable to a CCRC than a SNF or apartment). Will the facility help residents find other suitable housing? What other items would you add to the list?

As part of the news coverage surrounding Irma, the Washington Post ran a story about the risks of evacuating elders. Moving Florida’s many seniors out of Irma’s path has unique risks discusses the research that has been done on the stress of evacuations on elders, noting that some evacuees will die from the stress of evacuation.  Whether to go or stay is akin to rolling the dice. On the one hand, those in the path have plenty of advance notice of the approaching storm, but as seen with Irma, the track can (and does) change, so no one knows where it will hit. 

If you stay you have risks. If you go, you have risks.  As one person quoted in the Washington Post article noted, "[t]his is one of those classic cases of damned if you do, damned if you don’t. It’s a very difficult decision: When you evacuate, there is an inherent body count for frail, older adults...”   Because these folks are frail, they need to be evacuated earlier than others might, and based on lessons learned from Andrew and Katrina, there may be more pressure from officials for facilities to evacuate their residents rather than to stay put to weather the storm.  Speaking from personal experience, the wait is stressful. It seems to take a long time for the storm to pass over once the go-no go time has passed. Then afterwards, there's the issue of utilities, clean up, services and supplies.

The media aren't the only ones focused on the issues of elders in the path of disasters. The Senate Committee on Aging has scheduled a hearing for September 20, 2017 at 9:00 a.m. on "Disaster Preparedness and Response: The Special Needs of Older Americans"  

Stay tuned.

September 12, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Other | Permalink | Comments (0)

CMS Issues ABLE letter to State Medicaid Directors

CMS released State Medicaid Director Letter #17-002, Implications of the ABLE Act for State Medicaid Programs. The letter is designed to give guidance to state Medicaid programs on implementing ABLE. The letter includes background on the ABLE Act, explains who is eligible to have an ABLE account (including an explanation about the use of the word "qualified" in the statute)), how funds in the ABLE account are treated, contributions by the beneficiary or a 3rd party, distributions, post-Medicaid eligibility treatment of income  and transfers of ABLE money to a state and estate recovery.

September 12, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid | Permalink | Comments (0)

Frustrated Expectations and Costs-of-Care in Assisted Living

We often write on this Blog about concerns or even scandals in "nursing home" care for seniors. But, increasingly senior care spans a wide spectrum of formats and identities, and the SNFs of old, both good and bad, are increasingly outnumbered by newer names.  "Assisted Living" facilities -- traditionally positioned somewhere between skilled care and independent living -- are now often the target of concerns and lawsuits.

Reading the complaint in the latest suit, a class action filed in federal court in July 2017 in California against Brookdale Senior Living Inc. and Brookdale Senior Living Communities, Inc., I can see a central frustration, regardless of any issue of poor or negligent care.  Brookdale is one of the largest, if not the largest providers of assisted living, especially after it acquired another large assisted living operator, Emeritus.  The named individual plaintiffs, who describe their extensive impairments, including physical and mental disabilities, also describe their expectations about receiving appropriate care in "assisted living" at an affordable rate.  They allege, for example:

Assisted Living facilities are intended to provide a level of care appropriate for those who are unable to live by themselves but who do not have medical conditions requiring more extensive nursing care.

 

In recent years, [Defendant] has increasingly been accepting and retaining more residents with conditions and care needs that were once handled almost exclusively in skilled nursing facilities.  This has allowed [Defendant] to increase not only the potential resident pool but also the amounts of money charged to residents and/or their family members.

The plaintiffs complain that rates charged, alleged to range between "approximately $4,000 to $10,000 per person per month," increased at a rate of  6% to 7% percent per year in each of the last two years, at the same time that staffing levels dropped to a critical, allegedly unsafe level.  

At the core of the complaint is the frustration that residents are not being provided the services they need.  The legal theories include violation of the Americans with Disabilities Act, state civil rights and consumer protection laws, unfair trade practices laws, and California's Elder Financial Abuse laws, all leading to what I see as a fundamental question:  

Can Assisted Living operators be held liable for failure to provide skilled care to residents they allegedly "know" need such care, or is the less-than-skilled label and license to operate a defense against such liability?

The Brookdale defendants deny the allegations of fault.    For more, see  Largest Assisted Living Chain in U.S. Sued for Poor Care of Elderly from California Healthline.

 

September 12, 2017 in Consumer Information, Ethical Issues, Federal Cases, Health Care/Long Term Care, Housing, State Statutes/Regulations | Permalink | Comments (0)

Monday, September 11, 2017

Hurricane Irma and Florida: How Will Elders Fare?

Sitting at home watching the storm tracker, and being right in the path of Irma, I wondered what efforts are being taken to protect Florida's elders, so we don't see a picture similar to that we saw from Harvey. I'm not the only one wondering about this. The New York Times ran an article the day before Irma made landfall on the continental US. Long a Refuge for the Elderly, Florida is Now a Place of Danger  describes the demographics, 20% of South Florida's residents are over 65 and in some counties, a significant number are over 75.  The numbers, as well as the variations in health, makes evacuation and care for this part of Florida's population especially challenging when a hurricane arrives.  Add to that the fact that many elders who retire to Florida don't have  support of friends or family in Florida.  Not every elder will evacuate and don't forget that the caregivers need to take care of their own homes and families at some point. As well, first responders notice everyone that once winds reach a certain speed, they will not respond to calls for help.  Then once the storm passes, getting services and utilities restored becomes another challenge. For some, delays in having power can be life-threatening.  Stay tuned and wish all of us down here well.

 

 

September 11, 2017 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Other | Permalink | Comments (0)

Thursday, September 7, 2017

Jimmo v. Sebelius-Is the End in Sight?

CMS has released a new webpage as part of its settlement of the Jimmo case. The Center for Medicare Advocacy press release explains that "[t]he Jimmo webpage is the final step in a court-ordered Corrective Action Plan, designed to reinforce the fact that Medicare does cover skilled nursing and skilled therapy services needed to maintain a patient’s function or to prevent or slow decline. Improvement or progress is not necessary as long as skilled care is required. The Jimmo standards apply to home health care, nursing home care, outpatient therapies, and, to a certain extent, for care in Inpatient Rehabilitation Facilities/Hospitals."

The CMS Jimmo website

 reminds the Medicare community of the Jimmo Settlement Agreement (January 2013), which clarified that the Medicare program covers skilled nursing care and skilled therapy services under Medicare’s skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline or deterioration (provided all other coverage criteria are met).  Specifically, the Jimmo Settlement Agreement required manual revisions to restate a “maintenance coverage standard” for both skilled nursing and therapy services under these benefits:

Skilled nursing services would be covered where such skilled nursing services are necessary to maintain the patient's current condition or prevent or slow further deterioration so long as the beneficiary requires skilled care for the services to be safely and effectively provided.

Skilled therapy services are covered when an individualized assessment of the patient's clinical condition demonstrates that the specialized judgment, knowledge, and skills of a qualified therapist (“skilled care”) are necessary for the performance of a safe and effective maintenance program.  Such a maintenance program to maintain the patient's current condition or to prevent or slow further deterioration is covered so long as the beneficiary requires skilled care for the safe and effective performance of the program. 

The Jimmo Settlement Agreement may reflect a change in practice for those providers, adjudicators, and contractors who may have erroneously believed that the Medicare program covers nursing and therapy services under these benefits only when a beneficiary is expected to improve.  The Jimmo Settlement Agreement is consistent with the Medicare program’s regulations governing maintenance nursing and therapy in skilled nursing facilities, home health services, and outpatient therapy (physical, occupational, and speech) and nursing and therapy in inpatient rehabilitation hospitals for beneficiaries who need the level of care that such hospitals provide.

The website provides links to added resources, FAQs and pdfs of resources. 

September 7, 2017 in Consumer Information, Current Affairs, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

NYT: Would an End to DACA Cause Problems for the LTC Industry?

We're seeing specific industries report on the expected impact from termination of the DACA program for otherwise undocumented workers.  Broadly speaking, long-term care (LTC)  is already experiencing a worker-shortage, as we've reported here in the past.  From the New York Times:

Mr. Sheik is the chief executive and founder of CareLinx, which matches home care workers with patients and their families. The company relies heavily on authorized immigrant labor, making the looming demise of the program — which has transformed around 700,000 people brought to this country as children into authorized workers — a decidedly unwelcome development. The move, Mr. Sheik said, would compound an already “disastrous situation in terms of shortages of supply.” He added, “This is a big issue we’re focusing on.”

 

***

Surveys of DACA beneficiaries reveal that roughly one-fifth of them work in the health care and educational sector, suggesting a potential loss of tens of thousands of workers from in-demand job categories like home health aide and nursing assistant.  At the same time, projections by the government and advocacy groups show that the economy will need to add hundreds of thousands of workers in these fields over the next five to 10 years simply to keep up with escalating demand, caused primarily by a rapidly aging population.

 

“It’s going to have a real impact on consumers,” Paul Osterman, a professor at the Sloan School at MIT and author of a new book on long-term care workers, said of the DACA move.

For more, read What Older Americans Stand to Lose if  "Dreamers" Are Deported.

September 7, 2017 in Consumer Information, Discrimination, Ethical Issues, Health Care/Long Term Care | Permalink | Comments (0)

Wednesday, September 6, 2017

Medicaid 101 Webinar

The National Center on Law & Elder Rights  has announced an upcoming free webinar on Medicaid 101.

Here is the info about the webinar

Understanding Medicaid is a key to understanding the health and long-term care delivery system for older adults. Every year, over 6 million older Americans rely on Medicaid every year to pay for necessary health services. Over two-thirds of all older adults who receive long-term care at home or in a nursing facility, participate in the Medicaid program.

This free webinar, Legal Basics: Medicaid 101, will provide participants with a basic primer on the Medicaid program. It will explain the formation of Medicaid, Medicaid funding, key Medicaid protections, and Medicaid’s role in paying for health and long-term care for older adults.

The webinar is set for September 12, 2017 at 2:00 p.m. edt. To register, click here.

September 6, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Programs/CLEs, Webinars | Permalink | Comments (0)

Tuesday, September 5, 2017

Dual Eligibles and Medicare Coordination of Benefits

The National Center of Law & Elder Rights has announced an upcoming free webinar on Managed Care for Dual Eligibles and Medicare Coordination Programs on September 20, 2017 at 2:00 p.m. edt.  Here's a description of the webinar

Dual eligible individuals, those with both Medicare and Medicaid coverage, represent the most medically needy and costly population for both Medicare and Medicaid. In an effort to improve health outcomes and reduce healthcare spending, the Centers for Medicare and Medicaid Services (CMS) has been testing  financial alignment demonstrations in thirteen states to better coordinate and integrate care for dual eligibles.

What has been learned from these demonstrations so far? What are the take-aways for states that did not participate? This webinar will provide an update on these dual eligible demonstrations and review early evaluations of the programs. The webinar will also cover other recent efforts by CMS to address issues unique to dual eligible including issues around access to durable medical equipment.

Following the training, the audience will have a better understanding of the two models being tested in the demonstration, the fully capitated model and the managed fee-for-service model. They will also know about challenges and innovations during the almost four years since the demonstrations were launched and what further evaluation is being planned.

This is an advanced webinar. Legal service attorneys and aging and disability network professionals who work with dual eligibles are encouraged to attend.

Click here to register.

September 5, 2017 in Consumer Information, Current Affairs, Health Care/Long Term Care, Medicaid, Medicare, Programs/CLEs, Webinars | Permalink | Comments (0)

Sunday, September 3, 2017

Early Alert from CMS-SNF Abuse

Here's something to give you pause. The HHS Office of Inspector General has released an early alert. The Centers for Medicare & Medicaid Services Has Inadequate Procedures To Ensure That Incidents of Potential Abuse or Neglect at Skilled Nursing Facilities Are Identified and Reported in Accordance With Applicable Requirements (A-01-17-00504)  dated August 24, 2017, 

alert[s] [the CMS administrator about] ... the preliminary results of our ongoing review of potential abuse or neglect of Medicare beneficiaries in skilled nursing facilities (SNFs). This audit is part of the ongoing efforts of the Office of Inspector General (OIG) to detect and combat elder abuse. The objectives of our audit are to (1) identify incidents of potential1 abuse or neglect of Medicare beneficiaries residing in SNFs and (2) determine whether these incidents were reported and investigated in accordance with applicable requirements.

The 14 page letter provides a lot of detail about the situation and offers a number of recommendations, including immediate action: "implement procedures to compare Medicare claims for [ER] treatment with claims for SNF services to identify incidents of potential abuse or neglect of Medicare beneficiaries residing in SNFs and periodically provide the details of this analysis to the Survey Agencies for further review and ... continue to work with ... HHS ... to receive the delegation of authority to impose the civil monetary penalties and exclusion provisions of section 1150B." Longer term the alert suggests new regulations among other ideas.

 

September 3, 2017 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Thursday, August 31, 2017

The Eyes Have It? A New Tool To Detect Alzheimer's?

USA Today ran a story, Can this eye scan detect Alzheimer's years in advance? This short article explains that according to scientists "early indicators of Alzheimer's disease exist within our eyes, meaning a non-invasive eye scan could tip us off to Alzheimer's years before symptoms occur... It turns out the disease affects the retina — the back of the eye — similarly to how it affects the brain, notes neuroscience investigators at Cedars-Sinai Medical Center in California. Through a high-definition eye scan, the researchers found they could see buildup of toxic proteins, which are indicative of Alzheimer's." The study on which this article is based was published in the Journal of Clinic Investigation.  Retinal amyloid pathology and proof-of-concept imaging trial in Alzheimer’s disease is downloadable as a pdf by clicking here. The 19 page article offers this intriguing statement. "Such retinal amyloid imaging technology, capable of detecting discrete deposits at high resolution in the CNS, may present a sensitive yet inexpensive tool for screening populations at risk for AD, assessing disease progression, and monitoring response to therapy." (Warning-there are a lot of detailed photos of eyes in this article).

 

August 31, 2017 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Other, Science | Permalink | Comments (0)

Tuesday, August 29, 2017

SNF Residents Stranded After Harvey

There was a lot of sad news this past week, especially the news about the damage that Hurricane Harvey has brought to Texas.  I read a story about SNF residents in waist-high water awaiting evacuation. This brought back memories of Katrina and stranded residents then.  The New York Times article, Behind the Photo of the Older Women in Waist-High Water in Texas, notes that there was some back and forth regarding the authenticity of the photo as the photo went viral.  Ultimately, the residents were evacuated, as the article explains

On Sunday afternoon ...  An evacuation was underway and the residents — more than a dozen — were being relocated... [A] Galveston County commissioner, confirmed on Sunday that the residents had been rescued, though he could not say for sure how many... He said the furor over the photo was not what brought emergency responders to the scene...“We knew about it before it hit social media,” he said. “We were working on a solution for the nursing home, and it was in progress, so social media can sometimes leave one with the wrong impression.”

A follow-up article in the Times, Houston’s Hospitals Treat Storm Victims and Become Victims Themselves discusses the impact on the "medically vulnerable" and what lessons were learned from Katrina.  A number of improvements were made, as the article notes, but "[w]hile some vulnerable hospitals and nursing homes opted to move their patients out of the region in the hours before the storm, ... others “did not know to necessarily expect this level of chaos.” A large coalition of medical providers had drilled and planned regularly for catastrophes ... 'but honestly, not at this epic level.'"  The article notes a change in the federal rule after Katrina has helped; it "requires a wide range of health providers to establish emergency plans —[which has] ... led to significantly better preparedness among nursing homes."

Federal health officials also analyzed Medicare claims to provide Texas officials with the likely addresses of homebound people who rely on power-dependent ventilators, oxygen concentrators and electric wheelchairs, among other needs. Responders also used the state’s voluntary registry to locate them and offer assistance.

So this is a good time to remind everyone about having an disaster plan. There are a number of resources on the web providing guidance on how to create a plan and to have an evacuation "go box" ready.  It also is good to know what the SNF's plan is and under what circumstances do they evacuate residents or shelter in place. The stakes are too high not to ask about the plan.

I suspect that we will be posting more entries about the aftermath of Harvey for a while.  Stay tuned.

August 29, 2017 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other | Permalink | Comments (0)

Helping Texas Flood Victims: Diapers for Babies (and, yes, for the elderly, too!)

I suspect many of our readers have been thinking the same thing:  "How can I help Texas residents in the wake of Hurricane Harvey?"  I was particularly struck by the images of residents of an assisted living center in Dickinson, Texas, waist deep in the flood waters.  It is frustrating to feel you have nothing to contribute as lawyers. In our official capacity, we are rarely needed as first-line responders, although certainly free and low-cost legal services can be critical in the many months to come.  

Of course, members of the legal community can and do donate needed items and money.  The challenge is sometimes how "best" to make those donations effective, especially if you want to help a specific group or population of folks. With that in mind, I was interested to hear an NPR radio report on the Texas Diaper Bank today. It was an example of a targeted program, that has been around long enough to have an established network for providing relief in Texas, and the story focused on "working to get supplies to evacuating families with young children."

I wondered, "What about seniors?"  Sure enough, when I went to the website for the Texas Diaper Bank, I learned that the nonprofit organization's mission is to address "the diaper gap and its impact on individuals in crisis," including providing "incontinence supplies" to  adults.  Cute photos of babies may be the key to recruiting volunteers and donations, but I was pleased to read that the "Bank" mission specifically includes helping "seniors" to "live healthier" through provision of "essential items, education, and more." It turns out that Texas' Diaper Bank program is part of a "National Diaper Bank Network."

So, if you aren't too embarrassed to talk about "adult diapers," here is an organization you can share with those who want to help seniors "too."  Maybe a short note with your donation is appropriate, saying you want your contribution to help seniors.  

Perhaps NPR will do a follow-up story on how the "diaper bank network" programs serve the elderly?

 

August 29, 2017 in Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care | Permalink | Comments (0)

Monday, August 28, 2017

Limits on the Right To Self-Determination (when you have dementia)

From Oregon, known for its "death with dignity" laws, the dilemma facing a couple who are learning the limits of the laws:  

Bill Harris is blunt: For more than a year, he has been trying to help his wife die.

 

The 75-year-old retired tech worker says it’s his duty to Nora Harris, his spouse of nearly four decades, who was diagnosed with early-onset Alzheimer’s disease in 2009.

 

“Let me be honest: Yes. It’s what she wanted,” he said. “I want her to pass. I want her to end her suffering.”

 

Nora Harris, 64, a former librarian, signed an advance directive after her diagnosis to prevent her life from being prolonged when her disease got worse. Now, her husband said, she’s being kept alive with assisted eating and drinking against her stated wishes.

For more of the story, read "Despite Advance Directive, Dementia Patient Denied Last Wish, Says Spouse." 

August 28, 2017 in Advance Directives/End-of-Life, Cognitive Impairment, Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Sunday, August 20, 2017

Hospice Compare

CMS has announced the release of the Hospice Compare website.  Here's the information from the Medicare website:

The Centers for Medicare & Medicaid Services (CMS) is working diligently to make healthcare quality information more transparent and understandable for consumers in all stages of life to empower them to take ownership of their healthcare choices. This includes decisions about end-of-life care, when consumers in a time of vulnerability need transparent, digestible information to make the best choice for their care or the care of their loved ones.

We at CMS understand that there are many difficult decisions that come with a terminal illness—including deciding if hospice is right for you and which hospice to choose—which is why we have launched Hospice Compare. This new website will help empower you by allowing you to easily and quickly compare hospice providers on various aspects of care and assess the quality of care that potential hospices provide.

Hospice Compare provides information on hospices across the nation and allows patients, family members, caregivers, and healthcare providers to compare hospice providers based on some key quality metrics, like what percentage of a hospice provider’s patients were screened for pain or difficult or uncomfortable breathing and if their patients’ preferences are being met. Specifically, the quality measures look at the percentages of patients who received recommended treatment, for example:

  • Patients or caregivers who were invited to discuss treatment preferences, like hospitalization and resuscitation, at the beginning of hospice care;
  • Patients or caregivers who were invited to discuss beliefs and values at the beginning of hospice care;
  • Patients who were checked for pain at the beginning of hospice care;
  • Patients who received a timely and thorough pain assessment when pain was identified as a problem;
  • Patients who were checked for shortness of breath at the beginning of hospice care;
  • Patients who got timely treatment for shortness of breath; and
  • Patients taking opioid pain medication who were offered care for constipation.

The information on Hospice Compare can be used along with other information you gather about hospice providers in your area. In addition to reviewing the information on Hospice Compare, you’re encouraged to talk to your doctor, social worker, other healthcare providers, and other community resources when choosing the best hospice for care for you or your loved one.

In addition to Hospice Compare, Medicare also offers a number of other websites that can help you select providers and facilities to meet a wide range of care needs, including Inpatient Rehabilitation Facility Compare; Long-Term Care Hospital Compare; Hospital Compare; Physician Compare; Nursing Home Compare; Medicare Plan Finder; Dialysis Compare; and Home Health Compare.

Hospice Compare is available here

August 20, 2017 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Thursday, August 17, 2017

House Hearing on Right to Try Bill

The federal right to try law's next stop is the House of Representatives. The article in Kaiser Health News, House Expected To Hold Hearings On ‘Right-To-Try’ Bill That Senator Tied To FDA Funding  provides this background

The Senate quickly passed the bill that would allow dying patients access to experimental drugs after Sen. Ron Johnson (R-Wis.) had threatened to slow down consideration of a separate bill to renew the FDA’s fee-collection authority. In other drug industry news, the FDA is implementing new rules about hiring foreign scientists, industry tightens controls to keep out counterfeit drugs, cancer trials are low on patients and costs of old drugs rising quickly for Medicaid.

Although given priority by the Senate, the bill isn't expected to get the same treatment by the House. According to an article in Roll Call,  ‘Right to Try’ Bill Could Face Slower Action in House if the House committee changes the bill from the Senate version, things will slow down.  Here's a bit of an overview from the article:

Currently, when a patient seeks access to an experimental drug, his or her physician must work with the drug company, the FDA and an institutional review board that signs off on drug testing to approve the treatment’s use. When originally introduced in January, Johnson’s bill would have taken the FDA and other government entities out of that process. It would have let the states define “terminal illness,” potentially leading to dozens of different standards across the country about who would qualify for access. It also would have prevented the FDA from using outcomes associated with the experimental use when considering the drug’s application.

The new bill, instead of leaving the definition of terminal illness to the states, says that eligible patients should have a “life-threatening disease or condition” as defined by current federal law. It also gives the FDA the right to use outcome data if the administration determines that it is critical to assessing the drug’s safety — or if the drug company wants the outcomes used.

The drug companies would also have to provide the FDA with information about the experimental uses. Like the original bill, the new version shields companies against liability, but extends that protection to manufacturers who chose not to grant access to treatments. The bill would also limit the drugs that can be provided to those that have already completed the first phase of formal clinical trials, which are conducted to assess drug safety.

 

 

August 17, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (0)

Tuesday, August 15, 2017

Marshall Kapp Recent Article on Factors Affecting End of Life Care in Elders

Professor Marshall Kapp has recently had an article published in 33 Ga. State Law Review 869. Distinctive Factors Affecting the Legal Context of End-Of-Life Medical Care For Older Persons is the lead article in a symposium volume on end of life issues.  Here is the abstract for this article

Current legal regulation of medical care for individuals approaching the end of life in the United States is predicated essentially on a factual model emanating from a series of high-profile judicial opinions concerning the rights of adults who become either permanently unconscious or are clearly going to die soon with or without aggressive attempts of curative therapy.

The need for a flexible, adaptable approach to medically treating people approaching the end of their lives, and a similar openness to possible modification of the legal framework within which treatment choices are made and implemented, are particularly important when older individuals are involved. Of the approximately 2.5 million people who die each year in the U.S., about three-quarters of deaths occur among persons aged sixty-five and older. As stated succinctly by historian Jill Lepore, “[t]he longer we live, the longer we die.”

This article outlines a few of the most salient clinical and social factors that distinguish the large and growing cohort of older persons, in potentially legally and policy relevant ways, from other population groups for whom end-of-life medical treatment choices may come into play. Some practice and policy implications are alluded to briefly.

Thanks to Professor Kapp for letting me know about his article!

 

August 15, 2017 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink