Thursday, August 6, 2015
[t]he ratings are based on agencies’ assessments of their own patients, which the agencies report to the government, as well as Medicare billing records. The data is adjusted to take into account how frail the patients are and other potential influences. Medicare intends to use the same or similar data sources when it eventually begins to pay bonuses and penalties to agencies based on performance, as it does for hospitals.
According to Medicare's blog, HHAs are rated in 9 categories, including wound care and prevention of bed sores, handling daily activities, controlling pain, and protecting the patient from harm. To learn more, click here to visit the HHA Compare website.
Wednesday, August 5, 2015
In recent weeks, I've been doing background research on "cross-border retirement" issues and therefore I was interested to read that ElderLawGuy Jeffrey Marshall's brother has retired to Mexico and "loves it."
For some, the reasons may include comparative costs for a range of services, including support for "independent" living, or more skilled care, as documented by the PBS News Hour program on "Why Foreign Retirees Are Flocking to Mexico." The program interviews retirees in central Mexican communities near Lake Chapala. The program compares "average cost for independent living" in U.S. retirement communities of "about $2,500 per month, with one Mexican community's prices for "rent, all utilities, connections for internet, television ... plus three meals a day" at "just a little over $1,000 a month."
But, as the program touches on (only briefly), Medicare benefits don't apply in Mexico (although, perhaps they should?). And there are also important questions about reciprocity in care for Mexican retirees who may have spent many working years in the U.S.
Monday, August 3, 2015
The Arizona Republic recently reported on Arizona legislation affecting home care agencies that will become effective in 2015, after a similar bill was vetoed in 2014 by a previous governor. According to news reports, the new law requires agencies to disclose to consumers whether they do background checks on employees, what type of training they use for employees, the costs of services and their hiring and firing practices.
In my experience, such a "disclosure" focus is different than setting minimum substantive standards for home care, and puts a great deal of responsibility for evaluation of "disclosed" information on consumers, who when it comes to long-term care, may already be under stress.
"We want to help the consumer understand better and make an educated decision," said Mark Young, president of the Arizona In-Home Care Association (AZNHA) who helped press for passage of the bill. "A lot of times, clients get in crisis mode when they need to make these decisions because they don't know about the industry."
The bill, sponsored by Sen. Nancy Barto, R-Phoenix, passed unanimously in the Senate and by a 51-8 margin in the House. Gov. Doug Ducey signed the bill into law April 1.
Home-care service owners could be charged with a misdemeanor if their company does not comply with the new regulations, the attorney general's office said. But the law does not apply to volunteer caregivers and home-care service organizations already licensed by the state or federal government.
The Administration for Community Living (ACL) has posted a new report on its website. The July 2015 report was prepared by RTI International pursuant to a contract with ACL. The report is titled IDD and Dementia. The executive summary explains in part:
The National Plan to Address Alzheimer’s Disease (2014) calls for a coordinated effort to develop workforces in aging, public health, and intellectual and developmental disabilities that are dementia-capable and culturally-competent. In response to this directive, the U.S. Administration on Community Living presents the findings and resources in this white paper to community of providers who primarily serve older adults. It provides a broad overview of the services and support system for persons with intellectual and developmental disabilities (IDD) affected by dementia and their caregivers, examples of cross-network initiatives, and resources for improving dementia care across agencies and organizations that serve this population.
This white paper presents the current state of services and support system for persons with IDD who have dementia. There is recognition in the aging and IDD networks that states are in a transition period where the future of services will be more person-centered and focused on integration in the community (see Appendix A).
The report is divided into 9 sections with section 4 looking at screening, diagnosis and treatment; section 5 looking at services and financing; and section 6 looking at efforts to improve community-based services. Section 7, the conclusion, includes a brief discussion of 5 issues:
Is dementia awareness education available to the IDD population and service providers?
Do the information and assistance services in both the aging and IDD networks identify those individuals with IDD and dementia and their caregivers who contact them?
Are persons with IDD and dementia being referred for appropriate diagnosis?
Are program eligibility and resource allocations taking into account the impact of cognitive disabilities on an aging population of persons with IDD?
Are the dementia-capable home and community-based services available to the general population capable of serving persons with IDD and dementia?
The report is available here.
Friday, July 31, 2015
AARP''s Public Policy Institute has released a new report that provides an update on the topic of family caregivers. Valuing the Invaluable 2015 Update: Undeniable Progress, but Big Gaps Remain is 25 pages long and available as a pdf. As the introduction notes:
In 2013, about 40 million family caregivers in the United States provided an estimated 37 billion hours of care to an adult with limitations in daily activities. The estimated economic value of their unpaid contributions was approximately$470 billion in 2013, up from an estimated $450 billion in 2009.
This report also explains the key challenges facing family caregivers…The report highlights the growing importance of family caregiving on the public policy agenda. It lists key policy developments for family caregivers since the last Valuing the Invaluable report was released in 2011. Finally, the report recommends ways to better recognize and explicitly support caregiving families through public policies, private sector initiatives, and research.
The report reviews progress in policies, programs and services at the federal and state levels since the previous report and makes over 20 policy recommendations in a number of categories.
To both address the growing care gap as the population ages and lessen the strain in the daily lives of caregiving families, more meaningful public policies and private sector initiatives are needed now. Better strategies will assist those who need care and their families struggling to find and afford the supportive services to live in their homes and communities—where they want to stay. It is essential to the well-being of our health care and LTSS systems, our economy, our workplaces, our families, and ourselves.
Thursday, July 30, 2015
The legislation carrying the name Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, that has now passed both the House and Senate, goes to President Obama for signature. If signed by the president, it will still be another year before its official effective date.
Sadly, it doesn't actually fix the problem for the patients with the fact that hospitals frequently attempt to hold patients on a fictional "observation only" status. Money is still the issue. Hospitals want to avoid harsh potential Medicare penalties associated with readmissions of "admitted" patients. At the same time, the lack of "admitted status" reduces the ability of patients to seek Medicare coverage for rehabilitation care post-hospitalization. But now the patients get better "notice" of their status -- and the potential for it to affect Medicare coverage and therefor out-of-pocket expense for the patients.
Wednesday, July 29, 2015
Sally Hurme, J.D., adds another useful book to her long list of consumer-friendly publications. In Checklist for Family Caregivers, published and marketed jointly by AARP and the American Bar Association, offers "to do" and "action" checklists to guide family members as key providers of care and assistance for seniors. Each topic is introduced by brief narratives of explanation, often with an emphasis on legal implications of decision-making. For example Chapter 6 is on "Deciphering Contracts," and describes different components of family caregiver agreements, home care service agreements (whether directly or through an agency), assisted living agreements, and skilled nursing care contracts, plus a few points about long-term care insurance policies.
Think of this book as the starting place -- and a wonderful opportunity to organize thoughts for meetings with doctors, agencies, social workers or lawyers. More information about the book is available on the ABA webpages (with a member discount, and "bulk discounts are available"), on AARP's webpage, or directly through Amazon.
Sunday, July 26, 2015
Many common nursing home practices are, in fact, illegal. In order to receive the best possible quality of care, a resident or resident’s family member should be familiar with the protections of the federal Nursing Home Reform Law, and understand how to use the law effectively.
This free webinar, with Directing Attorney Eric Carlson, will detail the most common problems that crop up—from evictions to excessive medication—and provide practical, clear tips to help family members and advocates navigate solutions.
This webinar complements the re-release of an updated version of our popular guide, 20 Common Nursing Home Problems and How to Resolve Them. Look for it on our website starting on Thursday, July 23, 2015.
The webinar is set for August 4, 2015 at 2 p.m. EDT. To register, click here.
Friday, July 24, 2015
On July 22, 2015 the Social Security Trustees issued its annual report about the Social Security Trust funds. According to the press release, the good news overall is SSA gained a year in solvency. The bad news, the disability insurance trust fund reserve runs out of money next year.
The combined asset reserves of the Old-Age and Survivors Insurance, and Disability Insurance (OASDI) Trust Funds are projected to become depleted in 2034, one year later than projected last year, with 79 percent of benefits payable at that time. The DI Trust Fund reserve will become depleted in 2016, unchanged from last year’s estimate, with 81 percent of benefits still payable.
In the press release, Acting Commissioner Carolyn W. Colvin addressed the DI Trust Fund issue:
While the projected depletion date of the combined OASDI trust funds gained a year, the Disability Insurance Trust Fund's projected depletion year remains 2016. I agree with President Obama, we have to keep Social Security strong, protecting its future solvency. President Obama's FY 2016 budget proposes to address this near-term Disability Insurance Trust Fund's reserve depletion. By reallocating a portion of payroll taxes from Old Age Survivors to the Disability Trust Fund - as has been done many times in the past - would have no adverse effect on the solvency of the overall Social Security program....
The full report The 2015 Annual Report of the Board of Trustees of the Federal Old-Age and Survivors Insurance and Federal Disability Insurance Trust Funds is available as a pdf here.
The Medicare Trustees report was also released on July 22, 2015. The news from Medicare was slightly better, with the trust fund solvency still in place through 2030.
[T]he Medicare Trustees projected that the trust fund that finances Medicare’s hospital insurance coverage will remain solvent until 2030, unchanged from last year, but with an improved long-term outlook from last year's report. Under this year’s projection, the trust fund will remain solvent 13 years longer than the Trustees projected in 2009, before the passage of the Affordable Care Act.
However, the press release notes an anticipated increase in Medicare Part B premiums for next year:
[A]pproximately 70 percent of beneficiaries are expected not to see a premium increase in 2016 because it is projected that there will be no cost-of-living increases in Social Security benefits. The remaining 30 percent of beneficiaries would pay a higher premium based on this projection. These include only individuals who enroll in Part B for the first time in 2016; enrollees who do not receive a Social Security benefit; beneficiaries that are directly billed for their Part B premium; and current enrollees who pay an income related higher premium. Decisions about premium changes will be made in October and depend on a variety of factors.
Wednesday, July 22, 2015
The Associated Press and the NORC Center for Public Affairs Research are doing a series of polls on Americans' experiences and views of long-term care. As described on the website, the AP-NORC "is undertaking a series of major studies on the public’s experiences with, and opinions and attitudes about, long-term care in the United States."
Demographic projections show the population age 65 and over nearly doubling by the time the last baby boomers have reached 65. Specifically, while seniors made up only 12 percent of the U.S. population in 2000, they are expected to comprise about 22 percent by 2040, with roughly 82 million Americans over the age of 65. How to plan for and finance high quality long-term care will remain a key policy question for lawmakers in the years to come.
The AP-NORC Center, with funding from the SCAN Foundation, is conducting annual nationally representative surveys of Americans age 40 and older to monitor a series of long-term care issues. Future studies will continue to examine awareness of older Americans' understanding of the long-term care system, their perceptions and misperceptions regarding the likelihood of needing long-term care services and the cost of those services, and their attitudes and behaviors regarding planning for long-term care.
The results from 5 polls, ranging from 2013 to 2015 can be accessed here. The most recent poll, conducted in April-May, 2015, focuses on Long-Term Care in America: Americans’ Outlook and Planning for Future Care which "explores new issues, including person-centered care experiences, the role of private health insurance plans in financing long-term care, and the special challenges faced by those who provide ongoing living assistance to elderly loved ones while also providing financial support to children. At the same time, the survey continues to track long-term care attitudes and planning behaviors." A quick take away summary from this
Five Things You Should Know From The AP-NORC Center’s Long-Term Care Poll Among adults age 40 and older:
- Nearly 1 in 10 are both supporting a child and providing ongoing living assistance for a loved one.
- Only a third say they are very or extremely confident in their ability to pay for ongoing living assistance they may need in the future.
- 54 percent report doing little or no planning for these needs.
- 1 in 5 do not know if private health insurance plans cover ongoing care in a nursing home, and over a quarter do not know if Medicare does.
- Majorities support a variety of policy options that would help Americans finance long-term care.
Tuesday, July 21, 2015
A new book from the U.K. by June Andrews is titled Dementia: The One-Stop Guide, and it offers practical advice for families, professionals, and people living with dementia and Alzheimer's Disease. The Table of Contents suggests the scope:
- What is dementia?
- Getting a diagnosis
- Adjusting to the news: for carers
- Adjusting to the news: for people with dementia
- What are friends for?
- Managing care at home
- Disturbing Behaviours
- Your dementia-friendly home
- What you should expect from the social care system
- What you should expect from the NHS
- The dangers of a hospital admission and how to avoid them
- Some important legal issues
- What to look for in a care home
- Advice on complaints and sample letter
I wonder how Chapters 9 and 10 would be written from a U.S. perspective?
July 21, 2015 in Books, Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, International | Permalink | Comments (0)
Monday, July 20, 2015
A good piece from the New York Times' Paula Span (and her always relevant New Old Age Blog), HIPAA's Use as Code of Silence Often Misinterprets the Law:
How do people use, misuse or abuse Hipaa, the federal regulations protecting patients’ confidential health information? Let us count the ways:
■ Last month, in a continuing care retirement community in Ithaca, N.Y., Helen Wyvill, 72, noticed that a friend hadn’t shown up for their regular swim. She wasn’t in her apartment, either.
Had she gone to a hospital? Could friends visit or call? Was anyone taking care of the dog? Questions to the staff brought a familiar nonresponse: Nobody could provide any information because of Hipaa.
“The administration says they have to abide by the law, blah, blah,” Ms. Wyvill said. “They won’t even tell you if somebody has died.”
Ms. Span has reported on HIPAA problems before in her column and she tracks attempts to find solutions that balance the needs for privacy with communication that would be helpful.
Another common complaint about Hipaa enforcement, by the way, is the lack of access to patients’ own health records, which they have a right to see or copy, though providers can charge copying fees.
Within families, decisions about how much health information to share, and with whom, often become complicated, as a recent study in JAMA Internal Medicine found. When researchers working to design online patient portals convened two sets of focus groups — one for people over age 75, another for family caregivers — they heard the usual tension between older adults’ need for assistance and their desire for autonomy.
“Seniors say, ‘I don’t want to burden my kids with my medical issues,’ ” said Bradley Crotty, the director of patient portals at Beth Israel Deaconess Medical Center in Boston and the study’s lead author. “And the family is saying, ‘I’m already worried. Not knowing is the burden.’ ”
My thanks to my colleague Professor Laurel Terry for sharing this piece.
Friday, July 17, 2015
ElderLawGuy Jeff Marshall Esq. has a staffer who works with therapy dogs in nursing homes and Jeff posted Josephine Reviello's interesting essay on her experiences. She begins with a surprising history of the "case law" behind the nickname for dogs as "Man's Best Friend:"
The popularization of the phrase is actually said to have come from an attorney, George Graham Vest. In 1870, Vest was in the courtroom representing a farmer who was suing for damages after his dog “Old Drum” was shot by a neighbor. Toward the closing of the trial, Mr. Vest said, “A man’s dog stands by him in prosperity and in poverty, in health and in sickness. He will sleep on the cold ground, where the wintry winds blow and the snow drives fiercely, if only he may be near his master’s side. He will kiss the hand that has no food to offer, he will lick the wounds and sores that come in encounters with the roughness of the world. He guards the sleep of his pauper master as if he were a prince. When all other friends desert, he remains. When riches take wings and reputation falls to pieces, he is as constant in his love as the sun in its journey through the heavens.”
And later, the phrase shortened to “man’s best friend”. Vest won the case and also won its appeal to the Missouri Supreme Court. A statue of the dog stands in front of the Warrensburg, Missouri courthouse.
The author's dog is an Old English Sheepdog, Hannah Bear. I can just imagine how popular she would be!
"Nothing makes me feel better inside than spending a couple of hours at a nursing home where people who want to pet our dogs. It totally lightens up the entire atmosphere -- for everyone."
Of course, occasionally Pam's critters have been known to go on vacation, especially at this time of the year when they sneak off to the beach for a little R & R. Be careful, Thelma Lou; too much time in the sun can cause wrinkles!
Thursday, July 16, 2015
Probably the best bang for your CLE buck in Pennsylvania comes from the two-day Elder Law Institute hosted each summer by the Pennsylvania Bar Institute. This year the 18th annual event is on July 23 & 24 in Harrisburg.
- "The Year in Review" with attorneys Marielle Hazen and Robert Clofine sharing duties to report on key legislative, regulatory and judicial developments from the last 12 months;
- How to "maximize" eligibility for home and community based services (Steve Feldman and Pam Walz);
- Cross disciplinary discussions of end-of-life care with medical professionals and hospice providers;
- LTC "provider" perspectives (Kimber Latsha and Jacqueline Shafer);
- Latest on proposals to change Veterans' Pension Benefits (Dennis Pappas);
- Implementation of the Pa Supreme Court's Elder Law Task Force Recommendations (Judges Lois Murphy, Paula Ott, Sheila Woods-Skipper & Christin Hamel);
- A closing session opportunity, "Let's Ask the Department of Human Services Counsel" (with Addie Abelson, Mike Newell & Lesley Oakes)
There is still time to registration (you can attend one or both days; lunches are included and there is a reception the first evening).
I think this is the first year I have missed this key opportunity for networking and updates; but I'm sending my research assistant!
July 16, 2015 in Advance Directives/End-of-Life, Cognitive Impairment, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Federal Cases, Health Care/Long Term Care, Legal Practice/Practice Management, Medicaid, Medicare, Programs/CLEs, Property Management, Social Security, State Cases, State Statutes/Regulations, Veterans | Permalink | Comments (0)
Wednesday, July 15, 2015
Community Legal Services of Philadelphia (CLS) recently issued an important report, examining statistics on complaints and enforcement actions under the purview of Pennsylvania's Department of Health, the chief regulatory body for nursing homes. To put it bluntly, the regulators are getting a failing grade here, with a new Governor (and an uncooperative Legislature on funding issues) facing the need for action. From the executive summary:
The Pennsylvania Department of Health (DOH) has been failing to protect elderly and disabled nursing home residents. Community Legal Services of Philadelphia (CLS) regularly advocates on behalf of nursing home residents, representing them in matters relating to the preservation and protection of their rights. Over the past several years, under the previous governor’s administration, CLS has witnessed DOH significantly decrease its enforcement of nursing home regulations and patient protections. In an analysis of DOH nursing home investigations and inspections that occurred in Philadelphia from 2012-2014, CLS has found that DOH’s conduct has put elderly and disabled Pennsylvanians at risk of physical harm or death.
During this time period, DOH dismissed an extraordinary number of complaints against nursing homes, failed to properly follow up when a violation was found, mischaracterized harm against patients, and dramatically decreased its penalties against nursing homes. Unfortunately, DOH’s failures have not only placed residents at risk, but they have also resulted in inaccurate publicly available information that forces potential residents and their families to make major life decisions without all of the important facts. Pennsylvania must fix this crisis and ensure the safety of elderly and disabled nursing home residents.
The CLS authors make recommendations for change, including a commitment to "better transparency to the public regarding investigations and characterization of harm."
Tuesday, July 14, 2015
In conjunction with the 2015 White House Conference on Aging, on July 13, 2015 CMS announced proposed changes to nursing home regulations. The proposed changes will be published in the Federal Register on July 16, 2015, but an advance look at the proposal is available here.
Monday, July 13, 2015
McKnight's News has an interesting essay reporting on the potential significance of a research project underway in Kansas:
In 2002, Kansas created a pay-for-performance Medicaid program designed to improve residents' lives. Starting this month, the Center for Applied Research at LeadingAge and Kansas State University will delve into statistical evaluation of whether the program has helped resident health, resident quality of life and employee job satisfaction. The $149,776 grant was awarded by the Retirement Research Foundation.
The 18-month CFAR project will be one of a few large-scale analyses of the potential benefits of adopting culture change. Smaller-scale studies have shown, modestly, that resident quality of life improves with culture change, and larger studies have suggested some positive outcomes related to a decrease in physical restraints and feeding tubes, says researcher Linda Hermer, Ph.D.
“I am hoping one of the things we will be able to tell, with finer precision, is to be able to understand whether there are truly benefits from culture change to a resident's health and quality of life,” she told McKnight's.
Sunday, July 12, 2015
From the New York Times, Making Decisions about Elder Housing May Take a Team Effort, by John Wasik:
But for elderly people like Ms. Renninger, now 83, deciding what to do next can be an almost overwhelming task. Is it time to move to a nursing home or some other type of assisted living? Or will home care with a variety of support services work?
It is an issue millions of people — especially baby boomers and their parents — are grappling with now. The choices are so complex that more and more people are finding they cannot make the decisions alone. As a result, with the number of Americans age 85 and older growing faster than any other age group, as the Congressional Budget Office reports, so is the demand for elder care specialists.
Detailing what many Elder Law Attorneys also provide, the article gives several examples of professionals with multi-disciplinary skills, such as a geriatric care manager, or a doctor who is also a certified financial planner. Thanks to Professor Laurel Terry for sending this timely link.
Friday, July 10, 2015
Louisiana Governor Bobby Jindal, one of (now many) candidates for the Republican nomination for President, has been making a fair amount of press of late, for his positions on so-called medical marijuana, Common Core education standards, and how his state will handle same-sex marriage. Lower on the radar screen, however, was his signing of Act 260, an interesting package of legal changes affecting obligations between various family members.
One of these changes was to adopt a new provision affecting the obligations of "ascendants and descendants" to provide "basic necessities of life" for family members "in need." In other words, filial support.
Louisiana already had a provision, Section 229, providing that "children are bound to maintain their father and mother and other ascendants who are in need." The new provision continues this statutory obligation, but makes enforcement "personal" only. The substitute provision was signed into law on June 29 and becomes effective on January 1, 2016. New Article 237 of Act 260 provides:
Descendants are bound to provide the basic necessities of life to their ascendants who are in need, upon proof of inability to obtain these necessities by other means or from other sources, and ascendants are likewise bound to provide for their needy descendants, this obligation being reciprocal.
This obligation is strictly personal and is limited to the basic necessities of food, clothing, shelter, and health care.
This obligation is owed by descendants and ascendants in the order of their degree of relationship to the obligee and is joint and divisible among obligors. Nevertheless, if the obligee is married, the obligation of support owed by his descendants and ascendants is secondary to the obligation owed by his spouse.
Official comments explaining the revisions emphasize that the necessities obligation kicks in only when the needy family member is unable to obtain necessities "by other means" or from "other sources," thus signaling any filial support obligation is secondary to the individual's eligibility for public assistance or other welfare benefits. Further "for the first time" Louisiana law "provides a ranking of those descendants and ascendants who owe this reciprocal, lifetime obligation."
The commentary explains that the revision makes the obligation "strictly personal," and there it precludes enforcement by "a third person." Thus, it would appear that unlike in Pennsylvania (or Germany?) nursing homes and the state may not use these statutes in order to sue family members to collect necessities for indigent elders.
According to the comments, the obligation is also not "heritable." This appears to reflect a Louisiana Court of Appeals decision from 2010, In re Succession of Elie,denying a mother's claims for funds from a deceased son's estate brought under former Section 229.
Monday, July 6, 2015
The State Bar of California offers an on-line "guide for maturing Californians," available in PDF format. This is an updated, 2015 version. At first I was a bit dubious, as the length is just 12 pages and the print is small. However, on closer look (and with the help of that little built-in magnifying class for reading PDF documents on line), I found it fairly comprehensive and a good starting place. It works not just for seniors but the whole family.
Written in a logical Q & A format, often starting with "yes or no" answers before offering a more detailed explanation and suggested resources, the brochure covers topics such as:
- What is Supplemental Security Income?
- Can my landlord evict me for any reason at all?
- Can I install grab bars, lower my counters or make other needed modifications over my landlord's objections?
- How is Medi-Cal different from Medicare?
- How can I help ensure that my affairs will be handled my way if I become incapacitated?
- If my elderly mother gives away her assets, will Medi-Cal pay for a nursing home?
In addition, the brochure describes more subtle topics such as how "assisted living communities," may differ (and be covered by different regulations ) than "continuing care retirement communities," or why "living trust mills" are something to avoid. It warns that insurance brokers and agents other investment advisors are prohibited in California from using "senior specific" certificates or designations to mislead consumers.
According to the July 215 issue of the California Bar Journal, the senior guide is available in both Spanish and English, although I could only find the English version on-line. Free print copies are available for order (although donations to offset costs are accepted!)
Thank you to Professor Laurel Terry for sharing this resource!
July 6, 2015 in Books, Consumer Information, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Health Care/Long Term Care, Housing, Medicare, Programs/CLEs, Social Security, State Statutes/Regulations | Permalink | Comments (0)