Wednesday, March 2, 2016
The New York Times ran a story at the end of February about the appeal of a Continuing Care Retirement Community or CCRC. (Just a note that LeadingAge, a group of aging service organizations is using Life Plan Communities). The Everything-in-One Promise of a Continuing Care Community examines the appeal of CCRCs. Looking at how it works, the article discusses the often-times hefty entrance fee and compares that to a "fee for service model". The article explains what one gets (and what one doesn't) when one is signing a CCRC contract: "[k]eep in mind that few of these contracts involve direct, conventional purchase of a housing unit. In most cases, the resident buys only the lifetime right to live in a community, take advantage of its range of amenities and services, and receive care there. The units generally are not bought and sold on the open market."
My co-blogger, Professor Pearson is quoted in the article discussing regulatory oversight and transparency:
“There’s a lack of transparency with C.C.R.C.s that’s resulted in weaker trust,” said Katherine C. Pearson, a professor at the Dickinson School of Law of Pennsylvania State University who has testified before Congress on the issue. “You need to visit several facilities, talk to residents, look at past cost increases and five years of financial records.”
Professor Pearson, who talks with continuing care community residents around the country, said there was no one rule of thumb to use when evaluating these communities. A prospective resident generally wants a community that is active and engaged and “supports healthy living,” she said. But given the magnitude of the decision (after all, it is often the last major purchase someone will ever make), it deserves very careful consideration.
“Get as much financial information as you can,” she said. “This is not an impulse buy.”
The article offers some practical advice when considering a CCRC. The article notes it isn't as easy as an apples to apples comparison since there is no government rating system of CCRCs and "[t]he major drawback in evaluating continuing care communities is the complexity of their contracts, which come in a number of variations. Some may require a deposit of up to $1 million, while others may charge only monthly fees. Refunds may be difficult to obtain and depend upon the length of stay and other requirements. Contract details have to be read carefully and financial statements reviewed." The article suggests
- review of the contract by a team of professionals, and look specifically at the contract regarding refunds of the entrance fee, whether there is a rescission period, how a decision is made if the resident needs a higher level of care and the financial stability of the company.
visiting the CCRC and talking to residents and staff. Visit all areas of the CCRC.
compare several CCRCs and check with the appropriate state agency for any complaints filed vs. the CCRC. Ask around-the article suggests the local senior center might be a good place to find out more.
Tuesday, February 23, 2016
Stakeholders and Policymakers Collaborate on Proposals for Better Approach to Financing Long-Term Care
On February 22, 2016, a diverse collection of individuals, representing a broad array of stakeholders interested in long-term care, released their report and recommendations for major changes. In the final report of the Long-Term Care Financing Collaborative (LTCFC) they propose:
•Clear private and public roles for long-term care financing
•A new universal catastrophic long-term care insurance program. This would shift today’s welfare-based system to an insurance model.
•Redefining Medicaid LTSS to empower greater autonomy and choice in services and settings.
•Encouraging private long-term care insurance initiatives to lower cost and increase enrollment.
•Increasing retirement savings and improving public education on long-term care costs and needs.
ElderLawGuy Jeff Marshall wrote to supplement this post by providing details of the report, written by Howard Glecknan of the Utban Institute. Thanks, Jeff!
Members of the Collaborative included:
Gretchen Alkema, The SCAN Foundation; Robert Blancato, Elder Justice Coalition; Sheila Burke, Harvard Kennedy School; Strategic Advisor, Baker, Donelson, Bearman, Caldwell & Berkowitz; Stuart Butler, The Brookings Institution; Marc Cohen, LifePlans, Inc.; Susan Coronel, America’s Health Insurance Plans (AHIP); John Erickson, Erickson Living; Mike Fogarty, former CEO, Oklahoma Health Care Authority; William Galston, The Brookings Institution; Howard Gleckman, Urban Institute; Lee Goldberg, The Pew Charitable Trusts; Jennie Chin Hansen, immediate past CEO, American Geriatrics Society; Ron Pollack, Families USA; Don Redfoot, Consultant; John Rother, National Coalition on Healthcare; Nelson Sabatini, The Artemis Group; Dennis G. Smith, Dentons US LLP; Ron Soloway, UJA-Federation of New York (retired); Richard Teske (1949-2014), Former U.S. Health and Human Services Official; Benjamin Veghte, National Academy of Social Insurance; Paul Van de Water, Center on Budget & Policy Priorities (CBPP); Audrey Weiner, Jewish Home Lifecare, immediate past Chair, LeadingAge; Jonathan Westin, The Jewish Federations of North America (JFNA); Gail Wilensky, Project HOPE;Caryn Hederman, Project Director, Convergence Center for Policy Resolution; Allen Schmitz, Technical Advisor to the Collaborative, Milliman, Inc.
Wednesday, February 17, 2016
In 2010, I spent several months of my sabbatical in Northern Ireland. I soon learned that older people there are highly organized and very visible, working together on issues such as protection from abuse, housing, utility costs, elder care options, access to benefits and more.
They knew that their best chances for success were to band together to tackle problems. They knew that they could not depend on a few to keep the work going, and they consciously brought "younger" seniors into leadership positions to keep the advocacy teams well staffed and to provide continuity of effort. Plus, they were not shy about presenting a unified national platform of concerns and recommended solutions -- as suggested by that year's "Pensioners' Manifesto," promoted at parades and public gatherings. The advocacy plan was supported by AgeNI, Age Sector Platform, Changing Ageing Partnership and other "separate" organizations.
In the US, seniors' concerns often cross jurisdictional boundaries, including state boundaries. The distances are farther apart in the U.S. than in Northern Ireland, but again there can be power in organizing. As part of my research, I've been watching several groups across the country using the power of the internet to share information and "gather " in order to advocate for solutions to common problems. A key to success seems to be advocating from a position of strength in numbers and shared concerns.
One of the U.S. organizations I've watched closely has been the National Continuing Care Residents Association or NaCCRA, a national body that grew out of early advocacy on behalf of residents in life care and continuing care residences in Florida. Residents came to recognize that as much as they appreciate and even love their individual communities, there are often common concerns about matters such as provider accountability for entrance fees and service fees paid by residents, understanding Fair Housing and ADA rules for residents with disabilities, residents' rights during changes of "ownership," resident rights during provider insolvency, reorganizations or bankruptcy, transparency of management decision-making and more.
NaCCRA has both individual members and state chapters, and recently, resident-members in the State of Washington recognized that stronger funding of the national organization through the state chapters is needed to support effective advocacy at every level. By comparison, the senior housing providers certainly share information (and money) on a national basis -- see e.,g., LeadingAge and American Seniors Housing Association -- especially when addressing their advocacy positions with regulators and government leaders.
It will be interesting to see whether residents in CCRCs and Life Care communities in other states join Washington residents in supporting a strong national team through NaCCRA.
Monday, February 15, 2016
My friend, colleague and renaissance guy, Mark Bauer, keeps an eye out for interesting articles for me, including those that focus on a community's livability for elders. He sent me this great article that looks at how a vibrant, walkable community can increase one's longevity once one reaches 80. The article, Land use mix and five-year mortality in later life: Results from the Cognitive Function and Ageing Study, appears in volume 36 of Health and Place at pages 54-60 (Mar. 2016). Here's the abstract
This study explores the potential modifying effect of age and mediation effect of co-morbidity on the association between land use mix, a measure of neighbourhood walkability, and five-year mortality among the 2424 individuals participating in the year-10 follow-up of the Cognitive Function and Ageing Study in England. Postcodes of participants were mapped onto Lower-layer Super Output Areas, a small area level geographical unit in the UK, and linked to Generalised Land Use data. Cox regression models were fitted to investigate the association. For the younger older age group (75–79 years), the effect of high land use mix on an elevated risk of mortality was mediated by co-morbidity. For older old age groups (80–84, 85+ years), a higher land use mix was directly associated with a 10% lower risk of five-year mortality. The findings suggest differential impacts of land use mix on the health of the younger and older old.
I thought this quote from the implications/future research section persuasive: "[P]olicy planning should take note of such variation within older populations, and in particular the needs of the middle and oldest old cohorts. This observation is particularly relevant to the recent movement toward age-friendly environments, which have been advocated worldwide to create inclusive and supportive living environments for active ageing... improving the mix of land uses in local areas may be a potential approach to reduce limitations in activity of daily life and support active ageing for these older age groups."
A pdf of the article is available here.
Thursday, February 11, 2016
The Washington Post's Tara Bahrampour has a very thoughtful article this month focusing on a common fact pattern. One family member asks -- or another family promises -- that "a nursing home" will never be utilized for care needs. While fear may be driving the request, guilt and strong feelings of moral obligations may be driving the promise. Both sides, however, may need more information to make the best decision:
For many, the idea of being sent to a facility implies abandonment. Older Americans remember the poorhouse , where the old and infirm were hidden away to die. But many younger people also are repelled by the idea.
There’s now a wider spectrum of facilities catering to different levels of need, but even the best ones can feel institutional. Daily life is often rigidly regulated, robbing residents of autonomy, and the familiar faces and spaces of a person’s life are gone....
A couple of generations ago, families were more likely to care for their parents at home — but people didn’t live as long. Thanks to modern medicine, even those with devastating illnesses such as Alzheimer’s can live many years past their diagnoses. But caring for them at home becomes increasingly difficult as cognition and self-care skills worsen. Safety, of the patients and of other family members, can also become a factor.
Ultimately, as geriatrician Bill Thomas explains for the article, instead of "red herring" promises that may be impossible to keep, everyone could benefit if there were stronger advocates, including families, demanding more of the nation's long-term care industry:
"The nursing home industry has, ironically, benefited tremendously from the low expectations people have,” Thomas said. “They have successfully persuaded people that you’ve got no other choice — it’s got to be cold and sterile and rigid.”
As some family members explain, they have learned the more important promise is to keep caring, regardless of the better "place" for care. For the full piece, read "Promise You'll Never Put Me In A Nursing Home."
Special thanks to George Washington Law Professor Naomi Cahn for sharing this article.
Thursday, January 21, 2016
I spent the first week of 2016 in Cuba with Dickinson Law students -- and it was an energizing experience (even as I fear I will never catch up on my other responsibilities this semester!). The students' studies in Cuba were wide-ranging, with opportunities to engage with experienced legal professionals while discussing historic principles and modern plans for Cuba, including a close look at laws adopted just in the last two years that will affect economic development, international investment in Cuba, employment, property ownership and taxes. For a full report on the course coverage and special events (including great photos by the students), see "Experience Beyond the Classroom Proves Invaluable."
For me, it especially interesting to hear directly about Cuba's health care system, which is highly regarded throughout the world, especially for its success in primary care for pregnant women. From Dr. Yoandra Adelá (depicted left) we learned core principles that guide Cuba's plans for health care, including a goal of universal coverage, free and equally accessible to all Cubans.
Our professors freely admitted challenges that Cuba faces in trying to meet health care goals in a struggling economy, with international partners important in order for Cuba to maintain access to medicines, technology and even credit needed to improve buildings and make necessary repairs at treatment sites.
Since 1985, Cuba has recognized a medical specialization in "comprehensive care" -- which emphasizes preventative medicine and community-based contacts. We saw this in action, where doctors from a local polyclinic spend half of their appointment days meeting patients in the office and half of those days seeing patients in their homes. We learned that for the elderly, many of the problems addressed by Cuban health care professionals mirror what is seen in the U.S., with hypertension and diabetes being significant health care risks; on the other hand, Cuba reports low incidence of infectious disease in their population.
I still need to learn more -- especially as I did not have time to fully explore "elder care," which reportedly includes some 380 hogares de ancianos and casas de abuelos, in addition to primary care offices that specialize in geriatric medicine. To the right is Corey Kysor, one of our law students visiting a Havana area polyclinic, the middle level of three components of health care available to all Cubans. (And yes, our law school does plan to return to Cuba in the next academic year to offer additional opportunities for comparative legal studies.)
If you would like to read more, from the perspective of a law student who had already experienced foreign legal systems such as China before traveling for her first time to Cuba this January, read Joy Lee's "Inside Cuban Law and Culture: A Law Student's Perspective."
Wednesday, January 20, 2016
Are you teaching an elder law this semester? If so, and your students are interested in sample papers to help them think about approach, scope, organization and how to provide support for their thesis statements, I've found this batch of articles helpful, even though they are now almost 10 years "old."
The nine short articles by law students (including two former students from my own law school) were published in a student journal following a competition sponsored by the National Academy of Elder Law Attorney (NAELA) and are nicely introduced by my Blogging collaborator, Becky Morgan. They demonstrate an array of topics and writing styles, and thus are useful to discuss in a writing and research class. I'm sorry that the NAELA competition is no longer available to students, as was a very nice way for students to get further mileage from their classroom research on elder law topics, and helped encourage them to revise and polish drafts!
January 20, 2016 in Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Federal Cases, Health Care/Long Term Care, Housing, International, Medicaid, Medicare, Social Security, State Cases, State Statutes/Regulations | Permalink | Comments (0)
Thursday, January 14, 2016
How close do you live to your mom? If you are within 20 minutes, then you are a typical American. The New York Times ran a story on December 23, 2015 that discusses how many miles away adult kids live from their moms. The Typical American Lives Only 18 Miles From Mom explains that "[t]he typical adult lives only 18 miles from his or her mother, according to an Upshot analysis of data from a comprehensive survey of older Americans. Over the last few decades, Americans have become less mobile, and most adults – especially those with less education or lower incomes — do not venture far from their hometowns." The article discusses the importance of physical proximity of families when an elder needs caregiving. "Over all, the median distance Americans live from their mother is 18 miles, and only 20 percent live more than a couple hours’ drive from their parents. (Researchers often study the distance from mothers because they are more likely to be caregivers and to live longer than men.)"
The article discusses the factors that impact the distance the kids live from mom, including education, geographic location, marital status and culture. The article notes that caregiving goes both ways, with elders providing child care for their grandchildren. The article also covers the challenges of caregiving, and the future needs for caregiving.
Monday, December 21, 2015
The November/December 2015 issue of the ABA magazine (Volume 32, Issue 2) GPSOLO, the publication for members of the Solo, Small Firm and General Practice division of the American Bar Association, is devoted to Elder Law. The issue can be found on-line (and viewing does not seem to be restricted to division members!). The articles are also available on Westlaw.
- How to Make Money Practicing Elder Law, by Andrea G. Van Leesten, who practices in California and who is the 2015-16 Diversity Director for the Division;
- Representing Elder Physical Abuse Victims, by California practitioner Mark Redmond, who has "focused primarily on representation of elders in cases of physical and financial abuse for the last 15 years;"
- Advocating for Elders Suffering Financial Abuse and Exploitation, by Nicole Le Hudson, who focuses her San Diego practice on disability and elder law and who is a "member of the court-appointed attorney panel for conservatorships;"
- The State of Age Discrimination Law: An Update, by Brian McCaffrey, who focuses his New York practice on employment litigation;
- Estate Planning for Old Age and Incapacity, by Sheila-Marie Finkelstein, who practices estate planning in Irvine, California;
- Counseling Clients about Health Care Toward the End of Life, by Sally Balch Hurme (who I just discovered while reading her article recently retired from 23 years of consumer advocacy with AARP -- but who is still clearly very active in elder law, thank goodness!);
- How to Fund Long-Term Care Without Medicaid, by Eileen Walsh, from Louisville, and I have to admit I read her article first - she explores Medicare, insurance, VA benefits and reverse mortgage options); and
- What Every Lawyer Needs to Know About Planning for Retirement, by Cynthia Sharp who "works with motivated lawyers seeking to generate additional income."
Charlie Sabatino brings to bear his 30 years of experience and careful thought to the question of whether having older clients automatically means you are practicing "elder law," in his column "GP Mentor: When Does Serving Older Clients Become Elder Law?" Hint? The answer may depend on whether you are working in the best interests of the senior.
In addition, there is a great Resource Guide of recent texts on Elder Law and the Division Chair's essay on recognizing Elder Abuse. PLUS, there's a detailed shoppers's guide to cameras, mobile phones ans more in the 2015 Tech Gift Guide -- for those of you still searching for gift ideas for your favorite elder law attorney!
Wednesday, December 16, 2015
As reported in the San Diego Tribune, Housing for Gay Seniors Coming to San Diego
A local nonprofit is preparing to build San Diego’:s first low-income apartment complex geared for senior citizens who are lesbian, gay, bisexual or transgender. When the 76-unit complex opens in North Park, San Diego will join Chicago, Philadelphia, Los Angeles and San Francisco as cities that provide this kind of housing.
Such housing is considered crucial because members of the LGBT community often feel unwelcome in ordinary senior complexes, where the older residents tend to be less open to alternative lifestyles.
“The people who will live here paved the way for younger LGBT generations, and many of them are forced back into the closet in traditional senior communities because of a lack of acceptance,” said Delores Jacobs, chief executive of the San Diego LGBT Community Center.
The $27 million complex will be open to all seniors, but the nonprofit building it — Community HousingWorks — plans to create a welcoming environment for LGBT seniors that will encourage them to move in, including on-site supportive services coordinated by the local LGBT Community Center.
Monday, December 7, 2015
Money Magazine's final article in the series on the costs of dementia focuses on the costs in the final stages of the disease. Coping With the Costs of Dementia: The Final Stage discusses the costs and the options for caring for an individual in the final stage of this disease.
In the final stages of dementia, which typically last four to five years, the need for care intensifies. [One's] spouse eventually will require around-the-clock assistance with most activities of daily living. [One's] toughest decision: whether to try to continue caregiving at home or move [one's] loved one to an assisted-living facility or a nursing home. [One] may feel guilty at the prospect of putting someone [one] love[s] in “a home”—that’s common and understandable—but a setting where professionals are providing the intense level of care needed at this point is often the best path, especially if they’re trained in the needs of dementia patients. That said, it’s also the most expensive care option by far.
The article urges caregivers to take proactive action, suggests caregivers pick a nursing home with a memory care unit, get advice on the order in which to spend assets and start planning for the caregiver's own future. "Caring for someone with dementia is emotionally exhausting and financially draining, but it comes with one particular satisfaction: knowing that you’ve done whatever you can to make the last years easier for someone you love."
During my recent visit in England, I had the fortunate experience of having lunch with Bernard Casey, Associate Professor at the Personal Social Services Research Unit at the London School of Economics and Principal Research Fellow at the University of Warwick. He has deep interest and experience as a social economist in evaluation of the economic implications of societal ageing. We could have talked for hours -- so much so that I almost missed my train from London to Leeds.
Bernard introduced me to a fascinating network of academics and policy makers with related interests, the International Long Term Care Policy Network. I encourage you to check out their website, and especially to browse the short interviews with international experts who are following long-term care system developments around the world.
Mark Your Calendars: The ILP Network is hosting its 4th International Conference on Evidence-based Policy in Long-term Care at the London School of Economics and Political Science (LSE) in London from the 4th to the 7th of September in 2016. Key themes of the conference will include: care models, case management, economics of long-term care, equity and efficiency, funding systems, health and social care integration, housing, institutional dynamics, local vs. central policy interactions, personalization of the care system, policy implications of dementia, technology and long-term care, unpaid carers, and workforce and migrant workers. More information about registration and submission of abstracts will be available in the near future.
Sunday, December 6, 2015
Money Magazine's second article on the costs of dementia focuses on the middle stage of dementia. Coping With the Costs of Dementia: The Middle Stage discusses a series of steps for the caregivers and family to take, not only for the present, but in positioning themselves for the final stage of the disease. The article discusses a number of suggestions:
- greater levels of care, including adult day care and respite care and recommends only hiring caregivers with experience in caring for individuals with dementia;
- examine the terms of any long term care insurance policy, if the individual has one;
- if the individual is a veteran, look into VA benefits;
- examine the individual's and family member's investment portfolio; rearranging allocations to more conservative investments may be needed;
- investigate a reverse mortgage;
- caregivers should talk to employers about options; and
- begin to research nursing homes.
December 6, 2015 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare | Permalink | Comments (0)
According to one U.K. source, the current Chancellor of the Exchequer, George Osborne, supports "removing barriers for new and emerging companies, in order to create better functioning business ... the lifeblood of a thriving economy." Apparently part of that proposal is to permit on-line real estate agents. From The Economic Voice:
Mr Osborne’s intention is for the Government to “further reduce barriers so that it’s easier for alternative business structures, such as supermarkets and estate agents, to offer legal services such as conveyancing.” A consultation next spring will look to remove these existing barriers for alternative business models in legal services, as well as making legal service regulators independent from their representative bodies....
However Mr Osborne’s big statement was the Government’s intention to inject innovation into the home buying process. They want to ensure that the modernisation of the estate agency sector through the online space, continues to provide consumers with quicker, better value routes to selling their home. Mr Osborne wants to encourage new business models such as online only estate agents, to enhance price competition in the real estate sector – as he believes they are yet to properly penetrate the property market.
Hat tip to Dickinson Law Professor Laurel Terry for the link.
Wednesday, December 2, 2015
The GAO has released another report on Nursing Home Quality. Dated October, 2015, Nursing Home Quality: CMS Should Continue to Improve Data and Oversight is a 52 page report issued by the GAO that "examines (1) the extent to which reported nursing home quality has changed in recent years and the factors that may have affected any observed changes, and (2) how CMS oversight activities have changed in recent years."
The report notes some issues with the data collected as well as some efforts regarding oversight, and in the conclusion the GAO discusses the issues with the data and also
according to CMS officials, the agency faces the challenge of conducting effective oversight of nursing home quality with its limited resources, while meeting all of its oversight requirements. CMS has made modifications to some activities it considered essential to its oversight, without knowing whether the modifications have affected the agency’s ability to assess nursing home quality. Further, some modifications made by CMS regional offices and state survey agencies to their own nursing home oversight activities could adversely affect the CMS central office’s ability to oversee nursing home quality, while other modifications could be effective strategies that could be adopted more widely among regional offices and state survey agencies....
The GAO makes 3 recommendations:
- Establish specific timeframes, including milestones to track progress, for the development and implementation of a standardized survey methodology across all states.
- Establish and implement a clear plan for ongoing auditing to ensure reliability of data self-reported by nursing homes, including payroll-based staffing
- The Administrator of CMS should establish a process for monitoring modifications of essential oversight activities made at the CMS central office, CMS regional office, and state survey agency levels to better understand the effects on nursing home quality oversight.
Tuesday, December 1, 2015
Smaller residences (not smaller as in a tiny home) provide more homelike care than nursing homes, according to a recent article in the New York Times. Small Residences for the Elderly Provide More Personal, Homelike Care explains the Green House homes where
Each home houses only 10 elderly people, and each person has a bedroom and bathroom. [The resident] has private space, is able to order breakfast when she wants it and enjoys home-style cooking, including some of her favorites..... Residents can gather around a fireplace in the common room, and [the resident] enjoys chatting with aides in the open kitchen.
As the article explains, a smaller size residence like this "is part of a complex of senior housing and care options, and privately owned care homes that are often unmarked in residential neighborhoods. They are usually newer, sometimes cheaper, and generally offer more customized care than most nursing homes." The article traces the history of the development of Green Houses and notes that they are not yet widely available in all parts of the country. Quality is important: for a residence to be a Green House, "Green House homes are trademarked and built to strict certifications. Nurturing values and a more active life are encouraged. An aide, called shahbaz — a Persian word that means a royal falcon that oversees the kingdom — functions as a leader, not just a servant."
The article also discusses other housing options that are smaller in scale than nursing homes and compares them to nursing homes.
Click here to read more about Green House projects.
Wednesday, November 25, 2015
With Thanksgiving looming, it seemed appropriate to take a moment to say thanks to all the family caregivers. And on the subject of caregivers, I wanted to share this 5 Facts about Family Caregivers published by Pew Research Center.
Here are the five facts:
- In the US there are 40.4 million unpaid caregivers for those 65 and older.
- The caregivers are most likely between 45-64 years old.
- The most common caregiving kids perform helping around the house, doing errands and fixing things around the house.
- A major segment of caregiving is providing emotional support.
- Most kids find helping their parents rewarding, although a few find it stressful.
This is good information to share with your students as well. So read the full document, thank a caregiver and have a Happy Thanksgiving!
Sunday, November 22, 2015
As I prepare to speak at a program at the University of Leeds this week on comparative social care systems and legal policies, a headline in The Guardian caught my eye: "Half of UK Care Homes Will Close Unless £2.9bn Funding Gap Is Plugged, Warn Charities." The Guardian reports:
In a joint letter, 15 social care and older people’s groups urge Osborne to use his spending review on Wednesday to plug a funding gap that they say will hit £2.9bn by 2020. They warn that social care in England, already suffering from cuts imposed under the coalition, will be close to collapse unless money is found to rebuild support for the 883,000 older and disabled people who depend on personal care services in their homes.
[Chancellor of the Exchequer] Osborne has already decided to use his overview of public finances to give town halls the power to raise council tax by up to 2% to fund social care, in a move that could raise up to £2bn for the hard-pressed sector. However, the signatories of the letter, such as Age UK and the Alzheimer’s Society, want him to commit more central government funding to social care.
The looming £2.9bn gap “can no longer be ignored”, the letter says. “Up to 50% of the care home market will become financially unviable and care homes will start to close their doors,” it adds. “Seventy-four per cent of domiciliary home-care providers who work with local councils have said that they will have to reduce the amount of publicly funded care they provide. If no action is taken, it is estimated that this would affect half of all of the people and their families who rely on these vital services.”
Osborne’s endorsement of a hypothecated local tax to boost social care comes after intense lobbying behind the scenes and public warnings from bodies such as the King’s Fund health thinktank.
The authors warn the "NHS will be overwhelmed by frail elderly people" in search of care. I was struck by implications that without funding reallocation, England will face staggering hordes of near zombies. There is irony in this imagery, of course, because we spend a heck of a lot of real money on best-selling books, movies and top-rated television shows about fictional zombies, while failing to come to terms with the funding needs for real people. See e.g., this estimate that "Zombies Are Worth Over $5 billion to Economy."
Wednesday, November 18, 2015
Living in a Sunbelt state, I know how hot it can get in the summer months. I recently ran across a July 2015 decision from HHS' Departmental Appeals Board (DAB) reviewing the imposition of a "per instance" monetary penalty CMS assessed against an Arizona SNF.
CMS’s allegations in this case are predicated on complaints that portions of Petitioner’s facility – including several residents’ rooms – were uncomfortably hot. Those allegations are supported by the complaints of several residents and by temperature readings taken by a surveyor on July 16, 2014. Readings taken by the surveyor showed portions of some of the residents’ rooms being as hot as 90 degrees Fahrenheit.... Such temperatures plainly exceed what any reasonable person would consider to be "comfortable." On their face they comprise violations of 42 C.F.R. § 483.15(h)(6).
After discussing the ways the surveyor and the SNF measured the temperatures inside the SNF, the ALJ in the opinion notes
The overwhelming evidence is that rooms at Petitioner’s facility were uncomfortably hot due to the failure of the facility’s air conditioning system. Arizona in July is a very hot place. Building interiors in that State that are not adequately air conditioned can become dangerously hot. As Petitioner admits, the air conditioning in its facility had failed to work adequately in July 2014. The failure prompted residents to complain that their rooms had become uncomfortably hot.... The staff took various measures to address the failure of the air conditioning system, including closing curtains in residents’ rooms and conducting random temperature checks....
"The evidence that residents were not comfortable is overwhelming, beginning with these residents’ complaints and further evidenced by the fact that Petitioner’s own staff recognized that there were problems with overheating in the residents’ rooms." The ALJ upheld the penalty.
Tuesday, November 10, 2015
On November 6, 2015 the appellate division of New York's Supreme Court addressed an issue long brewing in some states, whether Continuing Care Retirement Communities (CCRCs) can insist on "private pay" for skilled nursing care despite a resident's "eligibility" for Medicaid under state and federal laws. In Good Shepherd Village at Endwell, Inc. v. Yezzi, the unanimous panel affirmed summary judgment in favor of the CCRC on the payment question.
The decision highlights Congressional DRA action in 2005/6 that amended federal Medicaid law to expressly permit CCRCs to offer contracts that require residents to "spend on their care resources declared for the purposes of admission before applying for medical assistance." The DRA amendment was a response to the industry's lobbying efforts, following a 2004 decision by a Maryland appellate court in Oak Crest Village, Inc. v. Murphy that held such a contractual provision violated the federal Nursing Home Residents' Bill of Rights, viewed as prohibiting nursing homes from conditioning admission on guarantees of private pay.
In the New York case history, the couple apparently signed two separate documents, beginning with a "contract" at the time of their entrance into the CCRC that required them to pay both an entrance fee ($143,850) and "basic monthly fees" of approximately $2,550 to cover the cost of independent living. Any need for skilled nursing care would be assessed "an additional charge." That contract provided that residents could "not transfer assets represented as available" for less than fair market value. When the wife needed skilled care, the couple signed a second document, referred to in the case as an "admission agreement," for treatment in the CCRC's skilled nursing unit. The "admission agreement" reportedly required the Yezzis to "pay for, or arrange to have paid for by Medicaid" all services provided by the CCRC.