Elder Law Prof Blog

New report on residential care and assisted living--get it while it's hot

U.S. Department of Health and Human Services, Residential Care and Assisted Living Compendium: 2007

Robert Mollica and Kristin Sims-Kastelein, National Academy for State Health Policy
Janet O'Keeffe, RTI International
November 30, 2007
http://aspe.hhs.gov/daltcp/reports/2007/07alcom.htm

This compendium describes regulatory provisions and Medicaid policy for residential care settings in all 50 states and the District of Columbia. It updates an earlier report completed in 2005 with data for 2004.

The original intent for this edition of the compendium was to provide data for 2006. However, due to the increased availability of current data on states’ websites, we were able to collect data for 2007. Information was collected between February and August 2007 by reviewing state websites and regulations and calling key state contacts to verify information. Section 1 provides an overview of residential care and assisted living policy. Section 2 presents six tables, which compare states’ policy in selected areas. Section 3 provides summaries of each state’s regulations and policy for residential care settings, including assisted living facilities (ALFs).

The 2004 edition of the compendium differed from prior editions in that it used “residential care setting” or “residential care facility” (RCF) as the generic terms for all types of group residential care settings, rather than the term assisted living. The 2007 edition continues the use of these terms. Although many states use the term assisted living generically to cover virtually every type of group residential care on the continuum between home care and nursing homes, for many stakeholders the term assisted living still represents a unique model of residential care that differs significantly from traditional types of residential care such as board and care. When discussing state statutes and regulation, the compendium uses the terms that each state uses.

And now for the How Did I Miss This report

Pittsburg prof and all around wild and crazy guy Larry Frolik recently published "Residence Options for Older and Disabled Clients"

This book is a comprehensive guide to the many different types of housing available for aging and disabled individuals. It starts with the most independent type of living, proceeds through transitional forms of housing and ends with an in-depth discussion of medically assisted housing. The book covers virtually every type of senior housing possibility except the recreational r.v.  With this book you will learn not only about the various types of housing but the pros and cons of each.

Get the book here.   No free copies for law professors, sorry!

Larry will be autographing copies of the book in the lounge at the Maui Hilton next week during the NAELA meeting in Hawaii... Kidding.

 

Iowa smoking ban legislation would not apply to nursing homes

A sweeping statewide smoking ban passed the Iowa Senate Wednesday night, but whether it becomes law depends on House Democrats' ability to drum up the votes for it.  After the 29-21 vote, there was jubilation among Senate Democrats who have been fighting hard to prohibit smoking in all enclosed places of employment, including restaurants, bars and casinos.  During an eight-hour shift, she said, a worker in a smoky casino inhales the equivalent of 16 cigarettes."As our surrounding states pass legislation creating smoke-free environments in all public places and areas of work, we as Iowans cannot neglect the opportunity to protect the health of every citizen in our own state," she told lawmakers.

Nebraska, Minnesota and Illinois already have statewide smoke-free laws. Wisconsin and South Dakota are struggling to reach compromises.  The bill the Senate passed on would ban smoking in state veterans facilities, private veterans organizations, outdoor entertainment venues such as amphitheaters and tennis courts, taxicabs, homes that serve as child care centers, and other places.

Iowans would still be able to smoke in most places outdoors, and inside private homes, some hotel rooms, tobacco stores, semiprivate rooms in long-term-care facilities, some areas of the Iowa State Fair, farm machinery and most limousine services.

Source/more:  http://www.desmoinesregister.com/apps/pbcs.dll/article?AID=/20080228/NEWS10/802280394/1001/NEWS

2008 Ann F. Baum Memorial Lecture on Elder Law

The 2008 Ann F. Baum Memorial Lecture on Elder Law will be delivered on Monday, March 3 at 12:30 p.m. in the Max L. Rowe Auditorium by Professor Jon Pynoos of the University of Southern California. The lecture is entitled "Aging in Place, Housing, and the Law" and will discuss the desire of older people to stay in their own housing and communities as long as possible. “Aging in Place” is often hindered by housing which, in spite of legislation, remains inaccessible and unsupportive, pushing frail older people towards settings such as nursing homes. Professor Pynoos argues that in order to make “Aging in Place” a reality, new policies are needed to modify existing housing, create housing based on principles of universal design, and provide a range of housing types in communities. Professor Pynoos is the UPS Foundation Professor of Gerontology, Policy, Planning and Development at the Andrus Gerontology Center of the University of Southern California. He directs the National Resource Center on Supportive Housing and Home Modification, and co-directs the Fall Prevention Center of Excellence. In addition, he is on the Board of the American Society on Aging, has served as Vice President of the Gerontological Society of America, and is a member of the California Commission on Aging. Professor Pynoos has written and edited six books on housing and the elderly, including Linking Housing and Services for Older Adults: Obstacles, Options, and Opportunities; Housing the Aged: Design Directives and Policy Considerations; and Housing Frail Elders: International Policies, Perspectives and Prospects. Professor Pynoos holds undergraduate, Master's and Ph.D. degrees from Harvard and has been awarded both Guggenheim and Fulbright Fellowships. Before moving to USC in 1979, Professor Pynoos was Director of an Area Agency on Aging/Home Care Corporation in Massachusetts that provided a range of services to keep older persons out of institutional settings. A reception will be held following the lecture in the Peer and Sarah Pedersen Pavilion.

S. Mississippi groups advocate for elderly and disabled Katrina victims

Dean Stevenson, who lives on a $910 a month medical pension from the military, rented a Biloxi apartment before Hurricane Katrina for $380 a month.  Today the 60-year-old lives in a FEMA trailer with no prospect for an apartment he can afford at post-Katrina rates.  Coast advocates for the elderly and disabled held a news conference Thursday to shed light on the plight of those on fixed incomes, thousands of whom are stuck in FEMA trailers with no hope in sight.  "Housing continues to be an issue and will continue to be because there is nothing available now," said Talatha Denison of the nonprofit Mississippi Protection and Advocacy Program.  The groups say only 25 percent of $5.4 billion the federal government allotted for recovery in Mississippi is being spent on low-income residents. The number of rental units planned for residents on limited incomes falls woefully short of the 13,800 FEMA estimates were destroyed by Katrina.

Source/more:  Gulfport Sun-Herald, http://www.sunherald.com/201/story/172933.html

New alliance will address safety, consumer issues in assisted living faciilities

Fifteen elder care, elder law, and senior advocacy groups announced today the formation of the Assisted Living Consumer Alliance.  ALCA will be a national non-profit organization advocating for stronger consumer protections for assisted living residents.  The ALCA website – www.assistedlivingconsumers.org – provides news and information for both consumers and professionals, including consumer advice and summaries of each state’s assisted living rules.

Unfortunately, most consumers know little about assisted living care. Assisted living standards vary greatly from state to state and usually give a great deal of discretion to individual facilities.  Assisted living has received scant attention from the federal government.

Too frequently, assisted living rules and policies are based on the facility’s convenience rather than the residents’ needs and preferences.  Assisted living residents are vulnerable to a host of serious problems, ranging from medication mismanagement to inadequate health care to financial or physical abuse.  The absence of national standards, combined with uneven state standards, results in consumers often not having adequate recourse when problems occur, even when those problems result in injury or eviction.

Assisted living is the fastest growing type of senior housing. Currently, over one million Americans live in assisted living facilities. Assisted living increasingly is taking the place of nursing home care for many older Americans who no longer are able to live safely on their own due to increased frailty or dementia.

ALCA’s President, Eric Carlson, stated: “Consumer voices are vitally important in making sure that assisted living facilities provide adequate care to their vulnerable residents.”  Vice-President Toby S. Edelman added, “Assisted living care is too frequently substandard.  ALCA and its members are working for necessary reforms, including appropriate standards and meaningful oversight.”

The fifteen founding members of the Alliance are Bet Tzedek Legal Services of Los Angeles, CA, California Advocates for Nursing Home Reform, the Center for Medicare Advocacy, Citizens for Better Care, Coalition of Institutionalized Aged & Disabled, Long Term Care Community Coalition, Michigan Campaign for Quality Care, National Academy of Elder Law Attorneys, National Association of Local Long-Term Care Ombudsman Programs, National Association of State Ombudsman Programs, NCCNHR (formerly, National Citizens’ Coalition for Nursing Home Reform), National Senior Citizens Law Center, Ohio State Ombudsman Office, Resident Councils of Washington, and the Washington State Long-Term Care Ombudsman Program.

More info:  http://www.assistedlivingconsumers.org/

MY slackers featured in US News and World Report!!

I opened up US News and World Report's Oct. 1 issue on "Best Places to Retire" and, lo and behold, my former home of Lawrence KS is listed in the top ten.  More important, my favorite seniors/philosophers--the Prima Tazza Slackers--are actually pictured in the article! I spent many an hour with The Slackers drinking coffee and musing about the sad state of the nation, and I miss them all.  Ok, they are not all "seniors", but they are getting close.  Chapter 32 of my treatise (addressing capacity issues, or course) is dedicated to them.   Read the article here:  http://www.usnews.com/usnews/biztech/articles/070920/20retire.lawrence.htm

Party on, DK, Keith, and Gary!

NC to ban smoking in all LTC facilities

The N.C. Senate approved a bill yesterday that will ban smoking in state-licensed buildings that provide long-term-care services. The bill was prompted by a fatal fire at a Mocksville adult-care home that was caused by a resident smoking in her room.  The N.C. House of Representatives approved a similar version of the bill two months ago. Yesterday, the bill’s chief sponsor in the House, Rep. Julia Howard, R-Davie, said she disagrees with two changes to the bill made on the Senate side. The House and Senate will now have to reconcile those changes before the bill can become law.  Assuming that happens, the bill will be the latest in a series of measures approved this year that will further restrict smoking in North Carolina. Previously in this legislative session, the General Assembly has voted to ban smoking in all state-government buildings and to make all public-school property tobacco-free.

More in the Winston-Salem Journal, http://www.journalnow.com/servlet/Satellite?pagename=WSJ%2FMGArticle%2FWSJ_BasicArticle&c=MGArticle&cid=1173352054013&path=!localnews&s=1037645509099

Turkey: many seniors choose institutional care over family care

A survey conducted by the Social Services and Child Protection Agency (SHCEK) reveals that a majority of senior center residents have living relatives but that they prefer to live in centers because of a lack of care from their relatives. The research was carried out in connection with the Project on Reducing Social Risk (SRAP). It also estimates that 9 percent of the Turkish population will be over the age of 65 by 2010. Nearly half, 45 percent, of participants in 63 senior centers in 46 provinces noted they were from rural areas. A majority of them are widowed and undereducated; 59 percent of the survey participants did not even finish primary school. However, the research also shows that those who are waiting for admission are relatively better educated; 90 percent of male senior center inhabitants and one in three females were previously employed. More than half of surveyed seniors do not benefit from any social security or pension system.

According to the research, 85 percent of respondents have at least one living relative, whereas 14 percent have none. Half of the seniors who have one relative noted they were able to see their relatives at least once a month and half indicated they were being financially supported by their relatives. Thirty eight percent of center residents who have been living there for a relatively long time described the center as "home," 20 percent as "place to live in," and 22 percent as "a residential place with hard conditions." Their stated reasons for living in the centers are "difficulty in living alone," a wish "not to be a burden on the family," "inability to take care of [him/herself] in daily life" and "health reasons."

Read more in Today's Zaman.

Neither rain, no snow, nor nursing homes can keep them apart

Seniors work hard to keep their marriages alive and well, even after one spouse falls ill and goes into a long-term care facility, according to a new study from the University of Alberta in Edmonton, Canada.  Researcher Robin Stadnyk was surprised to discover that community-dwelling spouses were heavily involved in the lives of their institutionalized partners, and that many of the couples stayed active together both inside and outside the nursing home.  Stadnyk, a post-doctoral researcher in the University of Alberta's Department of Human Ecology, reviewed data from a qualitative study of 52 community-dwelling spouses in three Canadian provinces: Alberta, Manitoba and Nova Scotia, for her PhD research. She found that the participants were heavily involved in their spouses' lives, not only through caretaking duties like doing laundry and helping with personal hygiene, but also through nurturing activities that brought them closer together."  Most participants described close relationships with their spouses before the placement in a long-term care home. They simply found ways they could continue that closeness within the institutional walls," Stadnyk noted. Marriage-sustaining activities included watching TV together, studying travel brochures and reviewing diaries to relive old memories, even taking painting lessons together.  Some spouses also brought their partners home for regular weekly and even daily visits. One 82-year-old man in the study took weight-training so he could lift his wife in and out of the car for the weekly trip home."The findings defy the common assumption that the partnership of marriage effectively ends when one spouse enters a care facility," Stadnyk said.  Even husbands and wives whose partners had dementia continued to nurture their marriages, shifting from roles as give-and take-partners to benevolent caretakers. They made sure favourite treats were available for their spouses, and that they were able to attend special events.   The results were published recently in the journal Topics in Geriatric Rehabilitation.

Source:   Eureka Alert

Access the journal article.

Final reg requires restraint training in LTC facilities

New federal seclusion-and-restraint regulations include a requirement that nurses and physician assistants must contact the attending physician when they believe there is a need to use these interventions.  Nursing homes, psychiatric, rehabilitation, and alcohol/drug treatment centers are among the medical facilities that will need to ensure that their training complies with new federal guidelines on the use of seclusion and restraint. The Centers for Medicare and Medicaid Services (CMS) published a final rule last month governing the use of seclusion and restraints by physicians and health care workers who treat patients in hospitals that participate in Medicare or Medicaid.  The regulations, which go into effect on February 6, establish more rigorous training requirements that aim to assure appropriate treatment and protect patients' rights.  The regulations are part of Medicare's revised conditions of participation (CoPs) in the Medicare and Medicaid programs and apply to a wide range of settings including short-term, psychiatric, rehabilitation, long-term, pediatric, and substance abuse treatment facilities.

Full story:  Psychiatry OnLine, http://pn.psychiatryonline.org/cgi/content/full/42/2/12?etoc

Final rule:  http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/2006/pdf/06-9559.pdf

Protest at Seattle U over nursing home closure

About 40 protesters held a candlelight vigil outside the Seattle University administration building Thursday, saying the scheduled closure of a campus nursing home contradicts the school's core values.  Forcing 135 residents to find a new home does not uphold the Jesuit tradition of service to others and social justice, said sophomore Matt Salazar, who organized the demonstration attended by students, staff and faculty. University officials said the Bessie Burton Sullivan Skilled Nursing Residence -- a three-story building with 60,000 square feet -- needs to be converted into dorm rooms, classrooms, science labs and faculty offices for an institution with a growing enrollment and space demands.  "They say they made this decision for the good of the students," said Salazar, 19, the student campus minister for community service. "I don't want an elderly person kicked out of their home for my benefit."  The university's decision turned on a basic question, senior university Vice President Timothy Leary said: "Does it make sense to run and operate a skilled nursing facility given the pressing needs" of space on campus and the university's educational mission?  When the nursing home opened in 1990, the university had 4,600 students. Now there are 7,200, and the average student age has dropped from 27 to 21, which has increased the demand for dorm rooms and other spaces, Leary said.

Read more at Seattle PI.com.

Class action suit filed against California nursing home chain

A class action lawsuit (Case #07CC00005), against the beleaguered residential elder care operator Sunwest Management (see listing of Sunwest California facilities at end of releases), was filed yesterday in Orange County Superior Court, on behalf of Sophie Bury by and through her Attorney in Fact, Patricia Bury, on her behalf and on behalf of all California citizens who resided in, or are residing in, a California Sunwest facilites from Jan. 15, 2003 through Jan. 15, 2007. The complaint alleges that Sunwest Management, Inc., its directors, and the approximately 16 residential elder care facilities in the state of California that it owns, operates or manages, fail to comply with applicable laws and regulations governing the operation of residential care facilities for the elderly, resulting in the defendants receiving multiple citations of deficiencies from the California Department of Social Services. "We believe Paragon Gardens is typical of a Sunwest facility," says Long Beach, Calif., plaintiff attorney Stephen Garcia of The Garcia Law Firm. "Since June 2005, Paragon Gardens earned 57 notices of deficiencies, all of which were Type A violations, considered to be the most serious. On its web site Sunwest Management claims to operate 150 'communities' nationwide. How many Paragon Gardens do they have?" The lawsuit alleges that Sunwest and its facilities deliberately understaff its "communities" by forcing each facility to operate under a
budget, approved and directed by Sunwest Management and the directors of the individual facilities, that would increase business profits by charging for services that were not provided, such as adequately staffing the residential care facility as it advertises that it does. 

Source:  PR Newswire.

CapitalSource buys 77 LTC facilities

Chevy Chase, Md.-based CapitalSource has completed sale leaseback transactions for 77 long-term care facilities in 22 states, for $462 million. The facilities are subject to triple-net leases with a nearly 9.5-year weighted average term and are managed by 29 different operators.

The widespread purchase should strengthen the company’s standing in the healthcare and specialty financing market, one of three main focused lending businesses. The company already focuses a significant portion of its healthcare business on nursing and senior living facilities.

CapitalSource is a specialized commercial finance company that operates as a REIT. It offers a variety of financing, including first mortgage, asset-based, and mezzanine financing. In addition to the healthcare market, the company also has focused lending businesses in the structured and corporate finance markets, and a total of $11 billion in outstanding loan commitments. The company is traded on the NYSE, and was trading slightly up at $28 early this afternoon.

Source:  Commercial Property Online, http://www.cpnonline.com/cpn/article_display.jsp?vnu_content_id=1003468016

Schwartzenegger signs reverse mortgage legislation

Gov. Arnold Schwarzenegger swept into Palo Alto today to sign a bill that adds new protections against scam artists offering reverse mortgages.

"Getting a reverse mortgage can be very helpful to some people, but it's also a huge decision to be made," Schwarzenegger said before signing the law, which was sponsored by state Sen. Joe Simitian, D-Palo Alto. "I want to make sure that people get all the information."

The bill-signing ceremony took place place at Avenidas, a non-profit agency serving seniors.

Most borrowers who use reverse mortgages tend to be elderly people who are house rich and cash poor. They use the equity in their homes to take out a loan without having to sell or give up title. The loans don't have to be repaid until the home is sold or passed to an heir.

But some unscrupulous dealers have taken advantage of the mortgages, especially among the elderly and people with imperfect credit.

Among the new law's provisions is that people must first receive independent counseling about the pluses and minuses of a reverse mortgage from a certified counseling agency that does not have a profit motive. Since May, Avenidas has employed two certified reverse mortgage counselors after learning such counselors were in short supply.

Get the rest of the story at http://www.mercurynews.com/mld/mercurynews/news/breaking_news/15445902.htm

DRA Alert: The bill is now law

Received from NAELA:

The President has signed the Deficit Reduction Act of 2005 (S. 1932) this afternoon.  Should you wish to look at the text of the bill, go to http://thomas.loc.gov/ Enter S. 1932 in the Search Bill Text search box.  The correct version is called the Deficit Reduction Act of 2005 (Engrossed Amendment as Agreed to by Senate)

More on 2007 budget proposal

From the Center for Budget and Policy Priorities:

THE PRESIDENT'S BUDGET: A PRELIMINARY ANALYSIS

          An Administration's budget is a statement of its priorities.
This budget's priorities are clear: it features cuts in numerous
domestic programs that serve low- and middle-income families alongside
continued - and substantially expanded - tax cuts of very large size
that concentrate their benefits on people high on the income scale. The
new budget also contains continual significant increases in defense and
homeland security spending.

    This analysis assesses the President's budget on three basic criteria -
fiscal responsibility, fairness and balance, and the degree to which it
is transparent. This analysis indicates that the budget falls well short
on all three standards.

http://www.cbpp.org/2-6-06bud.htm
http://www.cbpp.org/2-6-06bud.pdf  7pp.

PRESIDENT'S BUDGET WOULD CUT FOOD FOR OVER 400,000 LOW-INCOME SENIORS
 
        This analysis finds that President Bush's fiscal year 2007
budget would eliminate funding for the Commodity Supplemental Food
Program (CSFP), terminating food assistance to over 400,000 low-income
seniors in an average month.

http://www.cbpp.org/2-6-06fa.htm
http://www.cbpp.org/2-6-06fa.pdf  3pp.

Ed:  Thanks to Abigail Turner for this submission.

Here's how they voted...

                                                                                                               

	Yeas	Nays	PRES	NV
Republican	216	13		2
Democratic		200		1
Independent		1
TOTALS	216	214		3

---- YEAS    216 ---
               

Aderholt Akin Alexander Bachus Baker Barrett       (SC) Bartlett (MD) Barton       (TX) Bass Beauprez Biggert Bilirakis Bishop       (UT) Blackburn Blunt Boehlert Boehner Bonilla Bonner Bono Boozman Boustany Bradley       (NH) Brady (TX) Brown (SC) Brown-Waite,       Ginny Burgess Burton (IN) Buyer Calvert Camp       (MI) Campbell       (CA) Cannon Cantor Capito Carter Castle Chabot Chocola Coble Cole       (OK) Conaway Crenshaw Cubin Culberson Davis (KY) Davis,       Jo Ann Davis, Tom Deal (GA) DeLay Dent Diaz-Balart,       L. Diaz-Balart,       M. Doolittle Drake Dreier Duncan Ehlers Emerson English       (PA) Everett Feeney Ferguson Fitzpatrick       (PA) Flake Foley Forbes Fortenberry Fossella Foxx Franks       (AZ) Frelinghuysen

Gallegly Garrett       (NJ) Gibbons Gilchrest Gillmor Gingrey Gohmert Goode Goodlatte Granger Graves Green       (WI) Gutknecht Hall Harris Hart Hastert Hastings       (WA) Hayes Hayworth Hefley Hensarling Herger Hobson Hoekstra Hostettler Hulshof Hunter Hyde Inglis       (SC) Issa Jenkins Jindal Johnson (CT) Johnson,       Sam Keller Kelly Kennedy (MN) King (IA) King       (NY) Kingston Kirk Kline Knollenberg Kolbe Kuhl       (NY) LaHood Latham Lewis (CA) Lewis       (KY) Linder LoBiondo Lucas Lungren, Daniel       E. Mack Manzullo Marchant McCaul       (TX) McCotter McCrery McHenry McKeon McMorris Mica Miller       (FL) Miller (MI) Moran       (KS) Murphy Musgrave Myrick Neugebauer Northup

Norwood Nunes Nussle Osborne Otter Oxley Pearce Pence Peterson       (PA) Petri Pickering Pitts Platts Poe Pombo Porter Price       (GA) Pryce       (OH) Putnam Radanovich Regula Rehberg Reichert Renzi Reynolds Rogers       (AL) Rogers (KY) Rogers       (MI) Rohrabacher Ros-Lehtinen Royce Ryan (WI) Ryun       (KS) Saxton Schmidt Schwarz       (MI) Sensenbrenner Sessions Shadegg Shaw Shays Sherwood Shimkus Shuster Simpson Smith       (TX) Sodrel Souder Stearns Sullivan Tancredo Taylor       (NC) Terry Thomas Thornberry Tiahrt Tiberi Turner Upton Walden       (OR) Walsh Wamp Weldon (FL) Weldon       (PA) Weller Westmoreland Whitfield Wicker Wilson       (SC) Wolf Young (AK) Young (FL)

---- NAYS    214 ---
               

Abercrombie Ackerman Allen Andrews Baca Baird Baldwin Barrow Bean Becerra Berkley Berman Berry Bishop       (GA) Bishop       (NY) Boren Boswell Boucher Boyd Brady       (PA) Brown (OH) Brown,       Corrine Butterfield Capps Capuano Cardin Cardoza Carnahan Carson Case Chandler Clay Cleaver Clyburn Conyers Cooper Costa Costello Cramer Crowley Cuellar Cummings Davis       (AL) Davis (CA) Davis (FL) Davis       (IL) Davis       (TN) DeFazio DeGette Delahunt DeLauro Dicks Dingell Doggett Doyle Edwards Emanuel Engel Eshoo Etheridge Evans Farr Fattah Filner Ford Frank       (MA) Gerlach Gonzalez Gordon Green,       Al Green, Gene Grijalva

Gutierrez Harman Hastings       (FL) Herseth Higgins Hinchey Hinojosa Holden Holt Honda Hooley Hoyer Inslee Israel Jackson       (IL) Jackson-Lee (TX) Jefferson Johnson       (IL) Johnson, E. B. Jones (NC) Jones       (OH) Kanjorski Kaptur Kennedy       (RI) Kildee Kilpatrick       (MI) Kind Kucinich Langevin Lantos Larsen       (WA) Larson       (CT) LaTourette Leach Lee Levin Lewis       (GA) Lipinski Lofgren,       Zoe Lowey Lynch Maloney Markey Marshall Matheson Matsui McCarthy McCollum       (MN) McDermott McGovern McHugh McIntyre McKinney McNulty Meehan Meek       (FL) Meeks       (NY) Melancon Michaud Millender-McDonald Miller       (NC) Miller, George Mollohan Moore       (KS) Moore (WI) Moran       (VA) Murtha Nadler Napolitano Neal       (MA) Ney Oberstar

Obey Olver Ortiz Owens Pallone Pascrell Pastor Paul Payne Pelosi Peterson       (MN) Pomeroy Price       (NC) Rahall Ramstad Rangel Reyes Ross Rothman Roybal-Allard Ruppersberger Rush Ryan       (OH) Sabo Salazar Sánchez, Linda       T. Sanchez,       Loretta Sanders Schakowsky Schiff Schwartz       (PA) Scott (GA) Scott       (VA) Serrano Sherman Simmons Skelton Slaughter Smith       (NJ) Smith       (WA) Snyder Solis Spratt Stark Strickland Stupak Sweeney Tanner Tauscher Taylor       (MS) Thompson (CA) Thompson       (MS) Tierney Towns Udall       (CO) Udall (NM) Van       Hollen Velázquez Visclosky Wasserman       Schultz Waters Watson Watt Waxman Weiner Wexler Wilson       (NM) Woolsey Wu Wynn

---- NOT VOTING    3 ---
               

Blumenauer

Istook

Miller, Gary

Ed:  Res ipsa loquitur...

Today vote on the Budget Reconcilion bill: editorials from around the country

Trenton (NJ) Times: A second chance to do right

Washington Post:  Where's the budget outrage?

Minneapolis Star Tribune:  An egregious budget in Congress

Albany Times-Union: Federal budget harms students

Western Farm Express:  Farm Bureau delegates support extension of farm bill

Feb. 1 vote on budget will determine the fate of millions of children and elderly

Kaiser Network has summarized the nation's newspaper reporting on tomorrow's vote on the budget bill.  The time is now to contact your state's representatives in the House and tell them that protecting the nation's most vulnerable seniors and children should be a budget and policy priority.
   
Spending Cut Bill Would Lead to Many Beneficiaries Paying More for Medicaid, Some Ending Enrollment, Foregoing Care, CBO Report Says

About 45,000 Medicaid beneficiaries would lose coverage in 2010 because of premiums included in the fiscal year 2006 budget reconciliation bill (S 1932), and 65,000 would lose coverage in 2015, according to a new report from the Congressional Budget Office, the New York Times reports. The bill would save $38.8 billion over five years and $99.3 billion over 10 years. Medicaid and Medicare spending reductions would account for 50% of the savings, with 27% from Medicaid and 23% from Medicare over 10 years (Pear, New York Times, 1/30). The House on Dec. 19, 2005, voted 212-206 to approve the bill, but procedural moves in the Senate require the House to vote on the bill a second time before the legislation can move to President Bush for consideration. The Senate on Dec. 21, 2005, voted 51-50 to approve the legislation (Kaiser Daily Health Policy Report, 1/12). The second House vote is expected on Wednesday. "In response to the new premiums, some beneficiaries would not apply for Medicaid, would leave the program or would become ineligible due to nonpayment," the CBO report states. Children would account for 60% of the Medicaid beneficiaries who would lose coverage, according to the report. The report also estimates that 13 million Medicaid beneficiaries would have new or higher copayments for services such as physician visits and hospital care. In addition, 13 million Medicaid beneficiaries would pay more for prescription drugs by 2010, and 20 million would pay more by 2015, the report states. According to the report, "About 80% of the savings from higher cost-sharing would be due to decreased use of services." The report estimates that 1.3 million Medicaid beneficiaries would have to pay premiums and that 1.6 million would lose benefits, most likely for dental, vision and mental health services. In addition, the report estimates that 15% of Medicaid long-term care beneficiaries would have their coverage delayed because of additional restrictions on asset transfers.

Defeat of Bill 'Unlikely'
The CBO report "gives Democrats new ammunition to attack" the budget reconciliation bill, but they "appear unlikely to defeat it," the Times reports (New York Times, 1/30). However, opponents have "stepped up their attacks on legislation they contend is written to protect insurance companies, drug manufacturers and other entrenched corporate interests," CQ Today reports (Dennis, CQ Today, 1/27). Rep. Rob Simmons (R-Conn.), who had supported the bill, last week announced his opposition to the legislation, a move that has led to some "nervousness about more potential GOP defections," CongressDaily reports. Rep. John Sweeney (R-N.Y.), who had supported the bill, said that currently he is undecided on the legislation, and Reps. Jim Gerlach (R-Pa.), Jim Ramstad (R-Minn.) and Frank LoBiondo (R-N.J.) also are "seen as potential vote-switchers," CongressDaily reports. In addition, Rep. Walter Jones (R-N.C.), who last month did not vote on the bill, is expected to vote against the legislation because of spending reductions for rural pharmacies (CongressDaily, 1/27).

Health Grades rates US nursing homes

Nursing home deficiencies causing actual harm to residents declined from 7.0 percent to 6.5 percent from 2003 to 2004, while patient abuse remained stable at 17 percent of complaints, according to a new analysis of the ratings HealthGrades annually gives to nearly every nursing home in the country. Overall, the deficiencies cited per nursing home declined 2.0 percent from 2003 and 2004, the analysis found.

"We are not seeing the declines in actual harm to the nation's 1.6 million nursing home residents that we should," said Samantha Collier, MD, vice president of medical affairs for HealthGrades, the leading healthcare ratings company. "But we did discover some interesting facts that will help people make a smarter decision, including the finding that the top ten nursing homes in each state tend to have nearly half as many beds as the worst ten in each state – something everyone should think about when choosing a nursing home."

The ratings for each of 15,375 Medicare/Medicaid certified nursing homes can be found in HealthGrades' Nursing Home Quality ReportsTM, available for a fee to consumers at www.healthgrades.com.

Read more at Eureka Alerts.  Then access CMS's nursing home comparison information at
http://www.medicare.gov/NHCompare/Home.asp

UK: Housing association turns elderly residents into silver surfers

Older residents at a Dominion Housing Group sheltered accommodation scheme are learning how to use computers for the very first time in their lives.

Enthusiastic residents at the Orwell Close scheme in Hayes, Hillingdon, have been getting to grips with surfing the web, sending emails, playing games and typing on the PC in their communal lounge, with the support of a volunteer IT trainer.

Scheme Manger, Ann Hallett, said: “There was an unused PC in the communal lounge just gathering dust. I really wanted to encourage the residents to use the computer for internet access, emails, writing letters or just to play games.

"Initially, many of them thought they were too old to learn but decided to give it a try.”

Orwell Close resident, 82-year-old Donald Dennis, pictured, said: “Our IT trainer is terrific. He’s helped me set up a hotmail email account and got me into using the internet. It has been very interesting.”

Orwell Close is one of Dominion’s three sheltered housing schemes, which supports active elderly people. The schemes are a positive housing choice for older people, providing good quality housing, independence, security and 24-hour care and support.

Read more at 24Dash.com.

Not elder law: regular blog reader questions turtle link to Kansas School Board science standards

A regular reader of Elder Law Prof Blog has very politely requested (via email) that I do not use this blog "as a a stage to make disparaging remarks directed to those persons who don't share your world view" .  The writer objected to my link from the story on Harriet the turtle (who was actually handled by Charles Darwin) to the Kansas School Board's recent mandate that science teachers in Kansas must include the theory of "intelligent design" in its high school science curriculum.  Mindful as I am that this blog is supposed to be about elder law, I'd like to post my response to this reader:

Thank you for your comments.  I know better than to argue religion with anyone.  It is my blog, however, and I have used it from the very first day as a vehicle to express my world view on everything from poverty to greed to the cost of the war in Iraq.  At any rate, as you may or may not know, I have lived most of my life in Kansas, and I care very much about what its children (including my son, who is in high school there) must learn in school.  As I am sure you know, the Kansas School Board is led by a fundamentalist Christian who has no experience either as an educator or a scientist.  "Intelligent design" is a belief system with as much legitimacy as any other belief system grounded in "faith". It is not a science.  The imposition on science teachers of educational standards that are based on a particular religious viewpoint will likely cost Kansas some of its best educators; in addition, newly graduating teachers are indicating their intention to leave the state rather than teach as a legitimate "science" an idea that is creationism masked in a different name.  I have no problem with teaching "intelligent design" (or the creation myths of deism, theism, Hinduism, the ancient Greeks, or Scott Adams) in a religion or philiosophy class.  I do object to requiring science teachers to do so in science classes.

I believe the efforts of those who consider themselves to be religious persons are better directed towards ending hunger and poverty, assuring adequate health care for all, and preventing discrimination against persons who are different in some way from themselves.  This is what Jesus imagined for his followers and taught that they should do; I rather doubt he cared at all about the content of high school science classes.  Imagine what could be accomplished if the energy that has been spent on getting intelligent design theory into the classroom had been instead directed towards assuring that impoverished children have an adequate breakfast.

And with that, I'll go back to blogging on pension crises around the world, the coming national implosion in health care financing, and the scary rise in elder abuse and exploitation being reported from as far away as Japan, China, and India.

Senator Plans To Push Elderly Home Monitor System

I don't know if this is a good thing, or just really Big Brother-creepy...truly.

From The Iowa Channel on-line:

DES MOINES, Iowa -- An Iowa senator is planning to push for a new program to save the state in Medicaid costs.Marguerite Avant, 81, lives alone in big house, and is surrounded by pictures of her family.Now, her family can keep tabs her with a new monitoring system called QuietCare, which is made by a division of the ADT security company.

There are motion detectors in the refrigerator, near Avant's medications, and in her bedroom that report her activities to a Web site."You can see by the activity index she woke up on Monday at 4 a.m.," said Tom Vasquez, of ADT. Caregivers can then watch her activities online.

"I'm excited about it, until I do something wrong," Avant said. The computer keeps track of how often she reaches for her pills, how many times she opens the refrigerator and learns how active she is on a daily basis. If something changes, the system alerts the family with a phone call.

A sensor is set up inside and outside the bathroom to monitor how long the person is in there, since bathroom falls are common.  State Sen. Matt McCoy said the system can give peace of mind to children and save the state money.

"The average cost of a nursing home is $2,500," McCoy said. He said taxpayers would say $30,000 per year if an elderly person were prevented from entering a nursing home for a year.

Avant said the $90 monthly fee for the service is worth it. "It makes me feel not so alone," she said.
Avant wants to stay in her home and welcomes in modern technology like an old friend.  "It will stop my family from worrying about me so much," she said.

...next thing you know, she'll have a chip in her head....

AARP Research Report: Mobility Issues

AARP RESEARCH REPORT: "Community Mobility Options: The Older Person's Interest," by Ari N. Houser (August 2005, HTML and .pdf format, 2p.).

Abstract:

As America ages, an increasing proportion of the population risks becoming immobile and isolated due to a lack of transportation options and loss of driving ability. This AARP Public Policy Institute Fact Sheet by Ari Houser looks at the needs of this population and presents a variety of strategies designed to extend the years of independent mobility.

http://www.aarp.org/research/housing-mobility/transportation/fs44r_com_mobility.html
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A New Model for Elder Care

Robert Kuttner of the American Prospect reports on virtual assisted living...

Beyond 50: A Report to the Nation on Livable Communities

Andrew Kochera and Audrey Straight of the  AARP Public Policy Institute and Thomas  Guterbock of the  University of Virginia are the authors of Beyond 50.05:  A Report to the Nation on Livable Communities: Creating Environments for Successful Aging.  The report:

This report, the fifth in AARP's Beyond 50 series, presents a new agenda for examining, building and retrofitting our communities   to support successful aging. Specifically, it...

• explores how people age 50 and older can continue to be   independent and able to exercise choice and control in ways that are beneficial to and affordable for them and society
• demonstrates the connections among community engagement, housing, transportation, and successful aging
  
• highlights the consequences of community features that fail   to account for the diversity of, and continual change in, residents' needs
  
• illustrates how persons age 50 and older contribute to, and   benefit from, well-designed communities that promote community engagement.

The Report features an interactive quiz for grading a community according to its "livability" for older individuals. 

Other "Beyond 50" reports are available from the Public Policy Institute at AARP.

 

CMS and Nursing Home Staffing Ratios

The Center for Medicare Advocacy, Inc. reports in its weekly newsletter:

"Most advocates and researchers agree that nurse staffing is the single most critical factor determining nursing home quality. Beginning this month, Nursing Home Compare, the online service of the Centers for Medicare & Medicaid Services (CMS) that provides facility-specific information about nursing homes, will exclude certain facilities’ nurse staffing data. CMS is rightly concerned about the accuracy of its data reporting. At present, CMS’ Nursing Home Compare disseminates self-reported nurse staffing information that is collected at the time of the annual survey. CMS has long-recognized that this unedited and unverified information is flawed and now admits that Nursing Home Compare overstates some facilities’ actual staffing. For example, some facilities’ practice of reporting nurse staffing levels for all beds while reporting residents for the smaller number of Medicare- or Medicaid-certified beds leads to inflated staffing ratios. Beginning in late April, as part of its effort to improve the accuracy of information on Nursing Home Compare, CMS will send state survey agencies a list of facilities whose staffing data will be excluded. After state agencies verify that the data submitted by facilities have been correctly inputted, or after correcting any errors, they will send the forms to facilities to confirm or correct the information. Facilities will be required to provide additional information as proof of staffing; affirming the accuracy of data will not be sufficient."

For more information on this initiative, see CMS Memorandum Re:  Changes to Staffing Data on the Nursing Home Compare Web Site (Ref: S&C-05-24).  Related links:

• Nursing Home Compare
• Report to Congress: Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes--Phase II Final Report