Sunday, September 27, 2015
Trying to keep straight all of the preventive services available to individuals is daunting, but the Kaiser Family Foundation (KFF) has made it easy with their new tool, Preventive Services Tracker. There are separate trackers for each condition including cancer chronic conditions, immunizations, sexual health, health promotions and preganancy-based. Organized into easy-to-use charts,, each chart provides information on the required service, the target population, the recommendation, coverage clarifications and effective dates. The charts also provide links for each required service to explain more details.
You might also want to check out their article on Preventive Services Covered by Private Health Plans Under the Affordable Care Act and the accompanying fact sheet.
Thursday, September 24, 2015
If you have worked in Elder Law long enough, you have probably received a panicked call from a family caregiver who is unprepared for a loved one to be discharged on short notice from hospital care.
On September 22, the Pennsylvania Capitol in Harrisburg was crowded with individuals wearing coordinated colors, showing their support for Pennsylvania Caregivers, including family members who are often struggling with financial and practical challenges in caring for frail elders. Here's a link to a CBS-21-TV news report, with eloquent remarks from Tamesha Keel (also pictured left), who has first-hand experience as a stay-at-home caregiver for her own aging mother. Tamesha recently joined our law school as Director of Career Services.
AARP helped to rally support for House Bill 1329, the Pennsylvania CARE Act. The acronym, coined as part of a national campaign by AARP to assist family caregivers, stands for Caregiver Advise, Record and Enable Act. HB 1329 passed the Pennsylvania House in July 2015 and is now pending in the Pennsylvania Senate.
We have written on this Blog before about pending CARE legislation in other states. A central AARP-supported goal is to achieve better coordination of aftercare, starting with identification of patient-chosen caregivers who should receive notice in advance of any discharge of the patient from the hospital. Pennsylvania's version of the CARE Act would require hospitals to give both notice and training, either in person or by video, to such caregivers about how to provide appropriate post-discharge care in the home.
I'd actually like to see a bit more in Pennsylvania. It is unfortunate that the Pennsylvania CARE Act, at least in its current iteration (Printer's Number 1883), does not go further by requiring written notice, delivered at least a minimum number of hours in advance of the actual discharge. AARP's own model act suggests a minimum of 4 hours, consistent with Medicare rules.
Under Federal Law, Medicare-participating hospitals must deliver advance written notice of a discharge plan, and such notice must explain the patient's rights to appeal an inadequate plan or premature discharge. A timely appeal puts a temporary hold on the discharge. See the Center for Medicare Advocacy's (CMA) summary of key provisions of Medicare law on hospital discharges, applicable even if a patient at the Medicare-certified hospital isn't a Medicare-patient. CMA's outline also suggests some weaknesses of the Medicare notice requirement.
AARP's original CARE Act proposals are important and evidence-based, seeking to improve the patient's prospects for post-hospitalization care through better advance planning. At the same time, there's some irony for me in reading the Pennsylvania legislature's required "fiscal impact" report on HR 1329, as it reports a "0" dollar impact. That may be true from the Pennsylvania government's cost perspective, but for the hospitals, to do it right, whether in person or by video, training is unlikely to be revenue neutral. I think we need to talk openly about the costs of providing effective education or training to home caregivers.
If passed by the Senate, Pennsylvania's CARE Act would be not become effective for another 12 months. The bill further provides for evaluation of the effectiveness of the rules on patient outcomes.
As is so often true, states are constantly juggling the need for reforms to solve identified problems, with the costs of such reforms. Perhaps the current version of the Pennsylvania bill reflects some compromises among stakeholders. According to this press statement, the Hospital and Health System Association of Pennsylvania supports the current version of AARP's Pennsylvania CARE Act.
September 24, 2015 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare, State Statutes/Regulations | Permalink | Comments (0)
Friday, September 18, 2015
As we have frequently reported on this Blog (see e.g., here and here and here), the Obama Administration has been aggressive in pursuit of Medicare and Medicaid claims tied to unlawful reimbursement or kickback claims for companies involved in long-term care. But even given that history, often tied to whistleblowing by current or former employees, it is unusual to see criminal investigations. Thus recent media reports about the FBI raiding the CEO of American Senior Communities was eye-catching, including this report from the Indianapolis Star:
A cadre of federal agents raided the Carmel home of an executive of a chain of nursing homes Tuesday morning. But the most important question remains unanswered: Why?
The home is owned by James G. Burkhart, the CEO of American Senior Communities, according to Hamilton County property records. FBI investigators also were at the Southside headquarters of American Senior Communities, at 6900 Gray Road, according to reports.
American Senior Communities manages nearly 100 senior care facilities and is one of the largest nursing home management companies in Indiana. Among those are 60 sites, including skilled nursing facilities and assisted living facilities throughout the state, that the company manages under a contract with Marion County’s public health agency.
According to media reports, American Senior Communities (ASC) issued the following press statement following the raid:
"American Senior Communities’ most important priority is to continue to provide excellent care to our patients and residents. ASC has been contacted by the federal government in connection with an investigation into certain individuals or practices. ASC is fully cooperating with the government and is conducting its own review to ascertain the relevant facts. ASC is in compliance with all federal, state and local laws and regulations and will continue to conduct its business in accordance with the highest standards of integrity."
Stay tuned...(but don't hold your breath).
Tuesday, September 8, 2015
Deadline 9/14/2015: Comments Due to CMS re "Binding Arbitration" in Nursing Home Admission Agreements
Erica Wood, a director for the ABA Commission on Law and Aging, writing for the August 2015 issue of the ABA's Bifocal Journal, reminds us that the Centers for Medicare and Medicaid Services (CMS) is seeking comments on proposed changes to rules affecting Long-Term Care Facilities that participate in Medicare and Medicaid programs, including the issue of whether CMS should prohibit "binding" pre-dispute arbitration provisions in nursing home contracts. The deadline for public comments is 5 p.m., on Monday, September 14, 2015. Electronic comments, using the file code CMS-2360-P, can be submitted through this portal: http://www.regulations.gov.
How do you feel about pre-dispute "agreements" binding consumers, including consumers of long-term care, to arbitration? Your comments to CMS can make a difference!
I remember my first encounter with "binding" pre-dispute arbitration provisions in care facilities. In the early years of my law school's Elder Protection Clinic, a resident of a nursing home had purportedly "given away" possessions to an aide at nursing home, who promptly sold them on EBay. The resident was lonely and the "friendship" included the aide taking her out the front door of the facility, via a wheel chair, on little outings, including trips where the resident could visit her beloved house, still full of a life-time of antiques and jewelry. (The resident might have recovered enough to go home -- although eventually a second stroke intervened.)
September 8, 2015 in Cognitive Impairment, Consumer Information, Current Affairs, Estates and Trusts, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare, Property Management | Permalink | Comments (0)
Wednesday, August 26, 2015
The Centers for Medicare & Medicaid Services (CMS) provides the Medicare Learning Network (MLN). MLN provides, among other things, articles, trainings, and national provider calls. The next national provider call is scheduled for September 3, 2015 at 1:30 p.m. edt on the National Partnership to Improve Dementia Care and QAPI. Here is the description of this call
During this MLN Connects® National Provider Call, two nursing homes share how they successfully implemented person-centered care approaches and overcame the barriers of cost and staff. Additionally, CMS subject matter experts update you on the progress of the National Partnership and Quality Assurance and Performance Improvement (QAPI). A question and answer session follows the presentations.
The National Partnership to Improve Dementia Care in Nursing Homes and QAPI are partnering on MLN Connects Calls to broaden discussions related to quality of life, quality of care, and safety issues. The National Partnership was developed to improve dementia care in nursing homes through the use of individualized, comprehensive care approaches to reduce the use of unnecessary antipsychotic medications. QAPI standards expand the level and scope of quality activities to ensure that facilities continuously identify and correct quality deficiencies and sustain performance improvement.
Should you register for this program? The intended audience is "[c]onsumer and advocacy groups, nursing home providers, surveyor community, prescribers, professional associations, and other interested stakeholders." So, if you fall into one of those groups, the answer is yes, you should register. Registration information is available here.
More information about the National Partnership to Improve Dementia Care in Nursing Homes is available here.
Thursday, August 20, 2015
Attorneys Don Romano and Jennifer Colagiovanni have a useful article in the August issue of The Health Lawyer, published by the ABA. In The Alphabet Soup of Medicare and Medicaid Contractors, the authors spell out the many players involved in claims processing, payment and oversight for federal/state health care payments:
Healthcare providers, suppliers, and their staff, as well as attorneys representing healthcare entities are faced regularly with a barrage of private contractors tasked with a variety of responsibilities for administering the Medicare program, including claims processing, reimbursement, enrollment and auditing activities. Given the number of different contractors (and different acronyms, for that matter), it can be difficult to identify the role of the particular contractor one is dealing with, the focus of goal of the program the contractor is involved in , and the responsibilities it is tasked with managing, as well as the statutory and regulatory scope of its authority. This article seeks to identify the various Medicare and Medicaid contractors and outline their authority, focus and responsibilities.
If you ever had any question about why Medicare and Medicaid are expensive programs, this article suggests that payment for services is not the "only" significant cost factor.
Wednesday, August 19, 2015
Kaiser Health News (KHN) ran a story Telephone Therapy Helps Older People In Underserved Rural Areas, Study Finds, that reports that "[t]herapy provided over the phone lowered symptoms of anxiety and depression among older adults in rural areas with a lack of mental health services.... The option is important, one expert said, because seniors often have increased need for treatment as they cope with the effects of disease and the emotional tolls of aging and loss."
The folks in the study suffered from generalized anxiety disorder. Fifty percent of the participants "received cognitive behavioral therapy, which focused on the recognition of anxiety symptoms, relaxation techniques, problem solving and other coping techniques." The remaining fifty percent received "less intensive phone therapy in which mental health professionals provided support for participants to discuss their feelings but offered no suggestions for coping." The results show that both groups benefited from the therapy but those in the first group did better.
There are roadblocks to using phone therapy, according to the article. "Medicare only pays for telehealth services done in rural areas with provider shortages; patients cannot do a phone call in their home, but must drive to a physician’s office or hospital to connect with the mental health professional at another site" according to a Professor quoted in the article. As well, some states require those who are providing "medical care must be licensed in the state where the patient resides."
The study, Telephone-Delivered Cognitive Behavioral Therapy and Telephone-Delivered Nondirective Supportive Therapy for Rural Older Adults With Generalized Anxiety Disorder was published in JAMA Psychiatry and is available here.
Sunday, August 16, 2015
The National Aging & Law Conference is scheduled for October 29-30, 2015 at the Hilton Arlington, Arlington, VA. A number of ABA commissions and divisions are sponsors of this conference including the Commission on Legal Problems of the Elderly, the Coordinating Committee on Veterans Benefits & Services, the Senior Lawyers Division and the Real Property, Trust & Estate Law Section. The website describes the conference
The 2015 National Aging and Law Conference (NALC) will bring together substantive law, policy, and legal service development and delivery practitioners from across the country. The program will include sessions on Medicare, Medicaid, guardianship, elder abuse, legal ethics, legal service program development and delivery, consumer law, income security, and other issues.
The 2015 National Aging and Law Conference marks the second year that this conference has been hosted by the American Bar Association. This year’s agenda will include 24 workshops and 4 plenary sessions on key topics in health care, income security, elder abuse, alternatives to guardianship, consumer law, and legal service development and delivery. The focus of the agenda is on issues impacting law to moderate income Americans age 60 and over and the front line advocates that serve them.
August 16, 2015 in Advance Directives/End-of-Life, Cognitive Impairment, Dementia/Alzheimer’s, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare, Programs/CLEs, Social Security, Veterans | Permalink | Comments (0)
Tuesday, August 11, 2015
To view the relationship between health care quality and spending in your state or local area, use the graph, known as a scatter plot, or map. Choose a health care setting, such as hospitals, and then a quality measure to view performance. Curious about how your region compares to someplace else? Click on your selected location and then drag your mouse to the state or local area you want to compare it to and hover. You can see which location has lower spending and higher quality relative to the U.S. median.
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.
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.
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.
Friday, July 17, 2015
On July 7, 2015, in U.S. ex rel Hartpence v. Kinetic Concepts, Inc., the Ninth Circuit, sitting en banc, created an easier path for whistleblowers to recovery under the False Claims Act for disclosure of fraudulent claims for Medicare reimbursement. From its introduction to the ruling in consolidated civil qui tam suits:
If a whistleblower informs the government that it has been bilked by a provider of goods and services, and that scheme is unmasked to the public, under what conditions can that same whistleblower recover part of what the guilty provider is forced to reimburse the government? We hold today that there are two, and only two, requirements in order for a whistleblower to be an “original source” who may recover under the False Claims Act: (1) Before filing his action, the whistleblower must voluntarily inform the government of the facts which underlie the allegations of his complaint; and (2) he must have direct and independent knowledge of the allegations underlying his complaint. Abrogating our earlier precedent, we conclude that it does not matter whether he also played a role in the public disclosure of the allegations that are part of his suit. We also hold that the district court erred in its application of the rule that a whistleblower must be the first to file an action seeking reimbursement on behalf of the government based on the fraudulent scheme.
According to one lawyer interviewed here, the impact of the decision to reverse 25-year old case precedent, though important, may be limited to older cases, "since 2010 amendments to the False Claims Act have further clarified the 'original source' requirements.
Additional history -- and predicting clarifications -- about the public disclosure provisions of the False Claims Act comes from Albany Law Emeritus Professor Beverly Cohen, in an article from Mercer Law Review, titled "Trouble at the Source: The Debates Over the Public Disclosure Provisions of the False Claims Act's Original Source Rule." For more, see Professor Cohen's interesting article (in my own law school's law review, I was happy to discover!), "Kaboom! The Explosion of Qui Tam False Claims Under the Health Reform Law."
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)
Friday, July 10, 2015
On July 8, 2015, the Centers for Medicare and Medicaid Services (CMS) announced the proposed 2016 Physician Fee Schedule that includes a provision for paying doctors to talk to patients about end of life care. Referenced in the proposed rule as advance care planning, comments are due by 5 p.m. on September 8, 2015. The proposed rule will appear in the Federal Register on July 15, 2015. For more information see Kaiser Health News (KHN) Medicare Proposes Paying Doctors For End-Of-Life Discussions.
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)
Friday, July 3, 2015
On July 1, 2015, Pennsylvania's Attorney General filed a complaint in the Commonwealth Court against Golden Gate National Senior Care LLC (GGNSC) which manages and operates Golden Living Centers nationally. The AG's suit focuses on 14 facilities in Pennsylvania. From the AG's press statement:
The legal action asserts Golden Living violated the Unfair Trade Practices and Consumer Protection Law by deceiving consumers through its marketing practices.
The company advertised it would keep its residents clean and comfortable while providing food and water at any time. But its facilities were understaffed, leaving residents thirsty, hungry, dirty, unkempt and sometimes unable to summon anyone to help meet their most basic needs, such as going to the bathroom, the legal action asserts.
According to the AG's office, evidence comes from residents' family members and former employees of Golden Living, including certified nursing assistants. The allegations focus on an alleged "widespread pattern of understaffing and omitted care."
Further, the AG makes the following specific allegations:
- Continent residents left in diapers because they were unable to obtain assistance going to the bathroom.
- Incontinent residents left in soiled diapers, in their own feces or urine, for extended periods of time.
- Residents at risk for bedsores from not being turned every two hours as required.
- Residents not receiving range of motion exercises.
- Residents not receiving showers or other hygiene services as required.
- Residents being woken at 5 a.m. or earlier to be washed and dressed for the day.
- Residents not being timely dressed in order to attend their meals.
- Residents not being escorted to the dining hall and sometimes missing meals entirely.
- Long waits for responses to call bells or no responses at all.
- Staff, under the direction of management or fear of management, falsifying records to indicate residents received services when in fact they did not.
- Improved staffing when state inspections occurred, leading to deceit about the true conditions at the facility.
- The investigation also included a review of staffing levels self-reported by Golden Living facilities and deficiencies cited in surveys conducted by the state Department of Health.
According to one news source, Golden Living responded to the suit with a statement expressing the company's confidence that the "claims made by the Attorney General are baseless and wholly without merit," and further alleging the suit is the "unfortunate result of Kathleen Kane's inappropriate and questionable relationship with a Washington D.C.-based plaintiff's firm that preys on legitimate businesses and is paid by contingency fees." (For those of you not privy to the local news on Pennsylvania politics generally and AG Kathleen Kane specifically, I think it is fair to say that the press frequently refers to her as the "embattled AG." She first took office in January 2013).
The Pennsylvania AG's suit comes on the heels of a broader report released in June by Community Legal Services of Philadelphia, asserting that from 2012 through 2014 the Pennsylvania Department of Health under former Governor Corbett's administration, failed significantly to conduct proper investigation of complaints about a large number of nursing homes (not limited to Golden Living) and failed to enforce existing regulations designed to protect residents.
For Golden Living, allegations are not limited to Pennsylvania. For example, in June 2015, claims about chronic understaffing of 12 Golden Living Center nursing homes in Arkansas were certified to be litigated as a class action.
Hat tip to Douglas Roeder, Esq., for bringing the latest Pennsylvania AG's suit to my attention. Last month I reported on the A.G.'s suit for unfair trade practices filed against a law firm that was alleged to be improperly using Pennsylvania's filial support law as a basis for collection demands against family members of the debtor.
July 3, 2015 in Cognitive Impairment, Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Housing, Medicaid, Medicare, State Cases, State Statutes/Regulations | Permalink | Comments (0)
Wednesday, June 10, 2015
An essay I read when it was first published in the New York Times Magazine in 2010, "What Broke My Father's Heart," has stayed with me. It is the deeply personal tale of a journalist-daughter's observation of her father's last years, as his pacemaker kept his heart pumping while dementia destroyed his quality of life. The daughter, Katy Butler, later turned the story, supplemented by impressive research, into a book, Knocking on Heaven's Door: The Path to a Better Way of Death.
In the essay, one of the key moments in the chronology was when Katy's father faced the prospect of surgery for a painful inguinal hernia, which doctors were not willing to perform unless his weak heart was first aided by implementation of a pacemaker. Earlier, his father, while still competent, had rejected a pacemaker, but the decision was now in the hands of his wife because of his dementia:
"When [Dr.] Rogan suggested the pacemaker for the second time, my father was too stroke-damaged to discuss, and perhaps even to weigh, his tradeoffs. The decision fell to my mother — anxious to relieve my father’s pain, exhausted with caregiving, deferential to doctors and no expert on high-tech medicine. She said yes. One of the most important medical decisions of my father’s life was over in minutes."
Ms. Butler makes it pretty clear that if the decision had been hers alone, she would not have made the same choice as her mother. Additional research demonstrates the medical, moral and legal dilemmas faced by all parties in considering the use of pacemakers for the elderly. For example, in "Pacing Extremely Old Patients: Who decides -- the doctor, the patient, or the relatives?," two physicians in the U.K. report on a three-case study where individuals, family members and doctors were not in agreement about implantation of pacemakers for patients aged 101, 90, and 87.
Monday, June 1, 2015
The Florida Joint Public Policy Task Force for the Aged and Disabled urges individuals, families and attorneys to bring emerging problems with Medicaid Managed Care in Florida to the attention of administrators at the Agency for Health Care Administration (AHCA). Only by staying on top of any problems can the new systems be evaluated and corrected.
In the Florida Bar News, the Task Force writes:
One issue the Task Force — a combined effort of the Academy of Florida Elder Law Attorneys and The Florida Bar’s Elder Law Section — is concerned about is that seniors on Medicaid may be signing forms allowing their Medicaid managed care plans (MCP) to take control over who receives information from the state, including notices for annual deadlines for ongoing eligibility, without understanding what they are signing. This led to an MCP missing the deadline for at least one client.
“A wife was understandably very upset when she found out her husband’s Medicaid had been cancelled,” says Emma Hemness, the president of the Academy of Florida Elder Law Attorneys, Task Force member and elder law attorney in Brandon. “The MCPs are supposed to make sure this doesn’t happen. The wife says she never received a notice and she doesn’t remember giving any authority to the MCP.
Wednesday, May 27, 2015
In my preparation for an upcoming talk show on WPSU on "Caring for Mom & Dad," I had the incentive to get to my stack of "must read" books to focus on The Aging of Dignity: Preparing for the Elder Boom in a Changing America, by Ai-Jen Poo (New Press 2015). What I very much like about this book is the broad lens it brings to aging demographics, focusing not on "burdens" but on "opportunities" to be a more productive, healthy society by dealing realistically with the need for both professional caregivers and family caregivers. Ai-Jen Poo writes:
Aging at home necessitates home care workers. Yet the 3 million people currently in the home care workforce cannot meet even the current need, let alone the demand for care that will accompany the elder boom. We will need at least 1.8 million additional home care workers in the next decade. As a result, care giving, specifically home care, is the fastest growing of all occupations in the nation....
With some course corrections in our culture and in our institutions, we can have the care infrastructure that will enable us to live our full potential. . . . The moral of this story is that a caring America is entirely within reach.
Not surprisingly, given her inspiring call for action, Ai-Jen Poo was a MacArthur "genius" grant recipient in 2014. She is one of the commentators on Caring for Mom & Dad, and in Pennsylvania, she will be part of our panel for WPSU's Conversations Live following the airing of the documentary on Thursday, May 28. The documentary is at 8 p.m., and the audience can "call-in, e-mail or text-in"beginning at 9 p.m. More details and links available here about the documentary and schedules here.
May 27, 2015 in Consumer Information, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Grant Deadlines/Awards, Health Care/Long Term Care, Medicaid, Medicare, Statistics, Television | Permalink | Comments (0) | TrackBack (0)