One of the rules they created after years of discussion looked especially prescient in light of the tragic deaths on Wednesday of eight nursing home residents in Florida’s post-hurricane heat. But the rule, regarding power supplies and temperature control, does not take effect until November, and even then, some patient advocates are concerned that it does not go far enough.
The debate shows how challenging it has been to overhaul health care rules even after repeated instances of power failures and flooding, from Katrina to Hurricane Sandy in 2012, to Hurricane Harvey last month and now Hurricane Irma. Hospitals and nursing homes have pushed back against some requirements, arguing that they are costly and unnecessary.
The new federal rule will require that nursing homes have “alternate sources of energy to maintain temperatures to protect resident health and safety.”
But the rule does not specifically require backup generators for air-conditioning systems — the nursing home in Florida, Rehabilitation Center at Hollywood Hills, did not have such a generator — and now some are questioning whether the rule should.
Thursday, September 14, 2017
In the developing story (see here and here) about a reported 8 deaths at a nursing home in Florida following Hurricane Irma, there is a growing debate about what a "new" federal regulation mandating Emergency Preparedness plans in Long-Term Care facilities actually requires. Is it enough to "have a plan" or must the facility actually have back-up generators or other means to "maintain" safe temperatures following an emergency? As New York Times writers Neil Reisner and Sheri Fink report on September 14, 2017:
“It’s vague, but this event is going to highlight the need,” said Dr. David Marcozzi, an associate professor at the University of Maryland School of Medicine and former director of a federal health care preparedness program. “Let me put it this way, if you were in Alaska and what was required to maintain safe temperatures was a heater, you wouldn’t say you don’t need the heater.”
For the full discussion of the Emergency Preparedness regulation, that took 11 years to get into place after the post-Katrina nursing home tragedies, but still gave another year to become mandatory, read Nursing Home Deaths in Florida Heighten Scrutiny of Disaster Planning.
As investigations begin into the report of 8 deaths of residents at a single nursing home in Broward County Florida three days after the region was impacted by Hurricane Irma, it occurred to me to look into post-Katrina legal proceedings involving nursing homes.
It turns out that very recently, in June 2017, the Louisiana Court of Appeals (4th Circuit) affirmed an award of $1,000,000 in damages for pain and suffering arising from one elderly woman's death at a nursing home four days after Hurricane Katrina hit New Orleans in August 2005. The nursing home argued comparative fault on the part of the Corp of Engineers for its "negligent design, construction and maintenance of" flood control systems in the region. The Court of Appeals rejected the nursing home's arguments regarding "non-party fault" (emphasis added below):
Following our de novo review of the proffered and record evidence regarding non-party fault, we cannot say that but-for the conduct of the Corps of Engineers, Ms. Robinette would not have died from heat stroke on the second floor of Lafon five days after the City of New Orleans had issued a mandatory evacuation order.
The record shows that flooding at Lafon was not the cause-in-fact of Ms. Robinette's death. Only one foot of water entered the building, and that water receded quickly. Ms. Robinette was not harmed by the flood water. Ms. Robinette's cause of death was heat stroke and dehydration due to her exposure to sweltering heat for four days. And Ms. Robinette's exposure to those extreme heat conditions was caused by Lafon's refusal to follow its own Evacuation Plan, and by the inadequacy of Lafon's backup emergency power generator. But for Lafon's substandard conduct, Ms. Robinette would not have succumbed to heat stroke caused by the lack of electrical power.
Because the Corps of Engineers' conduct was not the cause-in-fact of Ms. Robinette's death, we find no fault by the Corps.
How well-prepared are you for financing your retirement? Do you know your family's finances? The New York Times examined the situations that may be faced by women who are older who are not involved in the handling of their family's finances. Helping Women Over 50 Face Their Financial Fears covers a lecture series, Women and Wills, designed specifically for women over 50 that cover a variety of topics, including estate planning. health care, insurance, long term care, business succession planning and more. The founders are well aware that some women may not be up to speed on their family's finances, or other circumstances such as a spouse's illness, may present challenges for them. The founders plan to take their lecture series on the road, nationwide, and publish a book on the importance of planning.
Thanks to Professor Naomi Cahn for sending a link to the article.
Wednesday, September 13, 2017
A couple of years ago, I was present when my father's dementia care facility -- a licensed assisted living community -- was doing a test of part of their emergency preparedness plan. The staged "emergency" for that particular test was "loss of air-conditioning," which for most of the year in Arizona and other locations in the south and southwest is a serious concern. With climate change, heat and air-conditioning systems are going to be even more critical in the future.
I was impressed that even without back-up generators, the facility had both a short-term and long-range plan. The long-term plan required staged evacuation to other locations. Of course, to be effective, any evacuation would depend on the "other" locations having working power systems, something that can't be certain in a large scale weather or similar emergency.
Sadly, as reported in the New York Times on September 13, following the damage caused by Hurricane Irma, there were several deaths at a long-term care facility near the coast in southeastern Florida. The rapidly developing story suggests that as many as eight deaths were tied to loss of air-conditioning, although not a complete loss of power to the facility. It is too early to know all of the relevant facts. But, what about the law? The NYT article notes that:
Florida requires nursing homes to have procedures to ensure emergency power in a disaster as well as food, water, staffing and 72 hours of supplies. A new federal rule, which comes into effect in November, adds that whatever the alternative source of energy is, it must be capable of maintaining temperatures that protect residents’ health and safety.
Does the federal regulation mandate emergency sources of air-conditioning? Although the highlighted language in the NYT article suggests the new federal rule "comes into effect" in November of this year, my read of the regulation says the effective date was November 15, 2016 -- in other words, last year.
9/14/17 Correction to above paragraph: It was bothering me that I saw more than one news article describing the Emergency Preparedness rule as not taking effect until November of this year. The "effective date" of the Rule is clearly November 15, 2016 -- but, the New York Times is correct -- Long Term Care facilities have "until" November 15, 2017 to "implement" their preparedness plans, including any plan for maintaining safe temperatures. The implementation deadline was in a previous version of the rule, not the version of the rule actually made "effective" on November 15, 2016. Another lesson for me in the need for careful reading of regulations!
Perhaps more importantly, here's the language of the federal regulation, at 42 C.F.R Section 483.73, governing emergency preparedness at LTC facilities:
The LTC facility must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least annually. At a minimum, the policies and procedures must address the following:
(1) The provision of subsistence needs for staff and residents, whether they evacuate or shelter in place, include, but are not limited to the following:(i) Food, water, medical, and pharmaceutical supplies.(ii) Alternate sources of energy to maintain—
(A) Temperatures to protect resident health and safety and for the safe and sanitary storage of provisions;(B) Emergency lighting;(C) Fire detection, extinguishing, and alarm systems; and(D) Sewage and waste disposal.
Tuesday, September 12, 2017
With Irma in Florida's rear view mirror (and not a moment too soon), many are focused on what, if anything, should be done differently next time.
For us as attorneys, we should be sure to tell our clients about the importance of having a disaster plan. For clients living elsewhere, whether a long-term care facility or housing specifically for elders, they should be advised to ask a lot of questions. Does the facility have a disaster plan? Get a copy of it. What services does the facility provide to help residents evacuate? In what evacuation zone is the facility located? Does the facility have a back-up generator in the event of a power outage? How does the facility balance having adequate staff on site before, during and after the disaster while simultaneously allowing staff to prepare for the disaster? Does the facility's insurance policy cover property of residents? What services does the facility provide to help residents return after the disaster? What happens if the facility is now uninhabitable? Does the admissions contract provide for any return of the resident's money (this may be more applicable to a CCRC than a SNF or apartment). Will the facility help residents find other suitable housing? What other items would you add to the list?
As part of the news coverage surrounding Irma, the Washington Post ran a story about the risks of evacuating elders. Moving Florida’s many seniors out of Irma’s path has unique risks discusses the research that has been done on the stress of evacuations on elders, noting that some evacuees will die from the stress of evacuation. Whether to go or stay is akin to rolling the dice. On the one hand, those in the path have plenty of advance notice of the approaching storm, but as seen with Irma, the track can (and does) change, so no one knows where it will hit.
If you stay you have risks. If you go, you have risks. As one person quoted in the Washington Post article noted, "[t]his is one of those classic cases of damned if you do, damned if you don’t. It’s a very difficult decision: When you evacuate, there is an inherent body count for frail, older adults...” Because these folks are frail, they need to be evacuated earlier than others might, and based on lessons learned from Andrew and Katrina, there may be more pressure from officials for facilities to evacuate their residents rather than to stay put to weather the storm. Speaking from personal experience, the wait is stressful. It seems to take a long time for the storm to pass over once the go-no go time has passed. Then afterwards, there's the issue of utilities, clean up, services and supplies.
The media aren't the only ones focused on the issues of elders in the path of disasters. The Senate Committee on Aging has scheduled a hearing for September 20, 2017 at 9:00 a.m. on "Disaster Preparedness and Response: The Special Needs of Older Americans"
CMS released State Medicaid Director Letter #17-002, Implications of the ABLE Act for State Medicaid Programs. The letter is designed to give guidance to state Medicaid programs on implementing ABLE. The letter includes background on the ABLE Act, explains who is eligible to have an ABLE account (including an explanation about the use of the word "qualified" in the statute)), how funds in the ABLE account are treated, contributions by the beneficiary or a 3rd party, distributions, post-Medicaid eligibility treatment of income and transfers of ABLE money to a state and estate recovery.
We often write on this Blog about concerns or even scandals in "nursing home" care for seniors. But, increasingly senior care spans a wide spectrum of formats and identities, and the SNFs of old, both good and bad, are increasingly outnumbered by newer names. "Assisted Living" facilities -- traditionally positioned somewhere between skilled care and independent living -- are now often the target of concerns and lawsuits.
Reading the complaint in the latest suit, a class action filed in federal court in July 2017 in California against Brookdale Senior Living Inc. and Brookdale Senior Living Communities, Inc., I can see a central frustration, regardless of any issue of poor or negligent care. Brookdale is one of the largest, if not the largest providers of assisted living, especially after it acquired another large assisted living operator, Emeritus. The named individual plaintiffs, who describe their extensive impairments, including physical and mental disabilities, also describe their expectations about receiving appropriate care in "assisted living" at an affordable rate. They allege, for example:
Assisted Living facilities are intended to provide a level of care appropriate for those who are unable to live by themselves but who do not have medical conditions requiring more extensive nursing care.
In recent years, [Defendant] has increasingly been accepting and retaining more residents with conditions and care needs that were once handled almost exclusively in skilled nursing facilities. This has allowed [Defendant] to increase not only the potential resident pool but also the amounts of money charged to residents and/or their family members.
The plaintiffs complain that rates charged, alleged to range between "approximately $4,000 to $10,000 per person per month," increased at a rate of 6% to 7% percent per year in each of the last two years, at the same time that staffing levels dropped to a critical, allegedly unsafe level.
At the core of the complaint is the frustration that residents are not being provided the services they need. The legal theories include violation of the Americans with Disabilities Act, state civil rights and consumer protection laws, unfair trade practices laws, and California's Elder Financial Abuse laws, all leading to what I see as a fundamental question:
Can Assisted Living operators be held liable for failure to provide skilled care to residents they allegedly "know" need such care, or is the less-than-skilled label and license to operate a defense against such liability?
The Brookdale defendants deny the allegations of fault. For more, see Largest Assisted Living Chain in U.S. Sued for Poor Care of Elderly from California Healthline.
Monday, September 11, 2017
Sitting at home watching the storm tracker, and being right in the path of Irma, I wondered what efforts are being taken to protect Florida's elders, so we don't see a picture similar to that we saw from Harvey. I'm not the only one wondering about this. The New York Times ran an article the day before Irma made landfall on the continental US. Long a Refuge for the Elderly, Florida is Now a Place of Danger describes the demographics, 20% of South Florida's residents are over 65 and in some counties, a significant number are over 75. The numbers, as well as the variations in health, makes evacuation and care for this part of Florida's population especially challenging when a hurricane arrives. Add to that the fact that many elders who retire to Florida don't have support of friends or family in Florida. Not every elder will evacuate and don't forget that the caregivers need to take care of their own homes and families at some point. As well, first responders notice everyone that once winds reach a certain speed, they will not respond to calls for help. Then once the storm passes, getting services and utilities restored becomes another challenge. For some, delays in having power can be life-threatening. Stay tuned and wish all of us down here well.
Friday, September 8, 2017
Legal History: President Celebrates Young Lawyers' Commitment to "Fundamental Balance" Under "The Rule of Law"
Today a friend dropped off an interesting item of legal history, a news article about the merger of two law school student organizations, Phi Delta Delta and Phi Alpha Delta (often referred to as PAD). The merger occurred at an annual convention that was somewhat fraught, as some of the students were struggling with the notion that one organization could serve both male and female law students. The U.S. president, once a member of PAD himself, offered words of encouragement:
Today in America the opportunities are greater than ever for young people to find profound meaning in their lives through the practice of law. The processes of justice and of legal practice are going through a period of intensive reform. This will mean new challenges for the new minds entering our profession and new scope for ingenuity, imagination and hard work.
At the same time, there has never been a greater national need for capable attorneys who, while breaking fresh ground, are staunchly committed to the basic principles of our constitutional government. For while law is an avenue of change, it is also an instrument for defining and directing change in the interests and for the security of all of our people. The rule of law, among much else, ensures that innovation and stability are in fundamental balance. The gains which our society makes are therefore not transient, but enduring.
As history would prove, this writer lost his own way in the law, but, eventually, the system of checks and balances worked to restore order for "the people."
The date on the White House correspondence was August 4, 1972. The signature was that of President Richard Nixon.
Thursday, September 7, 2017
CMS has released a new webpage as part of its settlement of the Jimmo case. The Center for Medicare Advocacy press release explains that "[t]he Jimmo webpage is the final step in a court-ordered Corrective Action Plan, designed to reinforce the fact that Medicare does cover skilled nursing and skilled therapy services needed to maintain a patient’s function or to prevent or slow decline. Improvement or progress is not necessary as long as skilled care is required. The Jimmo standards apply to home health care, nursing home care, outpatient therapies, and, to a certain extent, for care in Inpatient Rehabilitation Facilities/Hospitals."
The CMS Jimmo website
reminds the Medicare community of the Jimmo Settlement Agreement (January 2013), which clarified that the Medicare program covers skilled nursing care and skilled therapy services under Medicare’s skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline or deterioration (provided all other coverage criteria are met). Specifically, the Jimmo Settlement Agreement required manual revisions to restate a “maintenance coverage standard” for both skilled nursing and therapy services under these benefits:
Skilled nursing services would be covered where such skilled nursing services are necessary to maintain the patient's current condition or prevent or slow further deterioration so long as the beneficiary requires skilled care for the services to be safely and effectively provided.
Skilled therapy services are covered when an individualized assessment of the patient's clinical condition demonstrates that the specialized judgment, knowledge, and skills of a qualified therapist (“skilled care”) are necessary for the performance of a safe and effective maintenance program. Such a maintenance program to maintain the patient's current condition or to prevent or slow further deterioration is covered so long as the beneficiary requires skilled care for the safe and effective performance of the program.
The Jimmo Settlement Agreement may reflect a change in practice for those providers, adjudicators, and contractors who may have erroneously believed that the Medicare program covers nursing and therapy services under these benefits only when a beneficiary is expected to improve. The Jimmo Settlement Agreement is consistent with the Medicare program’s regulations governing maintenance nursing and therapy in skilled nursing facilities, home health services, and outpatient therapy (physical, occupational, and speech) and nursing and therapy in inpatient rehabilitation hospitals for beneficiaries who need the level of care that such hospitals provide.
The website provides links to added resources, FAQs and pdfs of resources.
We're seeing specific industries report on the expected impact from termination of the DACA program for otherwise undocumented workers. Broadly speaking, long-term care (LTC) is already experiencing a worker-shortage, as we've reported here in the past. From the New York Times:
Mr. Sheik is the chief executive and founder of CareLinx, which matches home care workers with patients and their families. The company relies heavily on authorized immigrant labor, making the looming demise of the program — which has transformed around 700,000 people brought to this country as children into authorized workers — a decidedly unwelcome development. The move, Mr. Sheik said, would compound an already “disastrous situation in terms of shortages of supply.” He added, “This is a big issue we’re focusing on.”
Surveys of DACA beneficiaries reveal that roughly one-fifth of them work in the health care and educational sector, suggesting a potential loss of tens of thousands of workers from in-demand job categories like home health aide and nursing assistant. At the same time, projections by the government and advocacy groups show that the economy will need to add hundreds of thousands of workers in these fields over the next five to 10 years simply to keep up with escalating demand, caused primarily by a rapidly aging population.
“It’s going to have a real impact on consumers,” Paul Osterman, a professor at the Sloan School at MIT and author of a new book on long-term care workers, said of the DACA move.
Wednesday, September 6, 2017
The National Center on Law & Elder Rights has announced an upcoming free webinar on Medicaid 101.
Here is the info about the webinar
Understanding Medicaid is a key to understanding the health and long-term care delivery system for older adults. Every year, over 6 million older Americans rely on Medicaid every year to pay for necessary health services. Over two-thirds of all older adults who receive long-term care at home or in a nursing facility, participate in the Medicaid program.
This free webinar, Legal Basics: Medicaid 101, will provide participants with a basic primer on the Medicaid program. It will explain the formation of Medicaid, Medicaid funding, key Medicaid protections, and Medicaid’s role in paying for health and long-term care for older adults.
The webinar is set for September 12, 2017 at 2:00 p.m. edt. To register, click here.
Recently I heard an account of an especially disturbing fact pattern, and I suspect it is all too common. A loan company called the "employer" of a borrower, superficially to ask to speak to the employee. When the employer said "this isn't [the employee's] shift time," the caller said, "Well, then I'll talk to you. Your employee is X dollars in debt to our company and hasn't paid. Would you like to make a payment on his account today by phone to help him out?"
The "employer" in this case is the care-needing client. Apparently the client has dementia and has enough understanding to be frightened by the call --"if I don't pay, I could lose my helper" -- but not enough to truly understand what happened.
Let's be clear. Such a communication appears to be a violation of the federal Fair Debt Collection Practices Act on several levels. State debt collection laws may be even more relevant to the improper conduct involved here. For example, as a starting place federal law governing "communication in connection with debt collection" provides at 15 U.S.C. Section 1692(c):
(b) Communication with third parties
Except as provided in section 1692b of this title, without the prior consent of the consumer given directly to the debt collector, or the express permission of a court of competent jurisdiction, or as reasonably necessary to effectuate a postjudgment judicial remedy, a debt collector may not communicate, in connection with the collection of any debt, with any person other than the consumer, his attorney, a consumer reporting agency if otherwise permitted by law, the creditor, the attorney of the creditor, or the attorney of the debt collector.
The employee in this situation can and should immediately instruct any debt collector not to call his or her employer or client. (The employee also has the right to demand all calls cease, even to the employee's own home numbers and to direct that any further communications be in writing only.) Further, by releasing personal details about the employee's debt to the employer, the debt collector would appear to have triggered substantial financial penalties for the loan company, with sanctions of up to $1,000 per violation, as explained here and here and here. In the context of a caregiver's workplace, this entire scenario seems uniquely abusive to both employer and employee. A home telephone is often a key lifeline for older adults and disabled persons. They do not need another reason to fear calls from manipulative people.
Tuesday, September 5, 2017
The National Center of Law & Elder Rights has announced an upcoming free webinar on Managed Care for Dual Eligibles and Medicare Coordination Programs on September 20, 2017 at 2:00 p.m. edt. Here's a description of the webinar
Dual eligible individuals, those with both Medicare and Medicaid coverage, represent the most medically needy and costly population for both Medicare and Medicaid. In an effort to improve health outcomes and reduce healthcare spending, the Centers for Medicare and Medicaid Services (CMS) has been testing financial alignment demonstrations in thirteen states to better coordinate and integrate care for dual eligibles.
What has been learned from these demonstrations so far? What are the take-aways for states that did not participate? This webinar will provide an update on these dual eligible demonstrations and review early evaluations of the programs. The webinar will also cover other recent efforts by CMS to address issues unique to dual eligible including issues around access to durable medical equipment.
Following the training, the audience will have a better understanding of the two models being tested in the demonstration, the fully capitated model and the managed fee-for-service model. They will also know about challenges and innovations during the almost four years since the demonstrations were launched and what further evaluation is being planned.
This is an advanced webinar. Legal service attorneys and aging and disability network professionals who work with dual eligibles are encouraged to attend.
Click here to register.
One of my first "real" jobs after college was working in Washington D.C. for a U.S. Senator who regularly attracted the attention of the press, including reporter Sally Quinn and her husband and executive editor Ben Bradlee at the Washington Post. I found it especially poignant to read Sally's newly published account of her husband's last years. She writes with great candor about the small and large changes she observed, and the drama of good days and bad days "at the office," in a very public place. Here's an excerpt:
In 2011, a reporter called Ben at the Post, where he maintained an office as a vice president at large, to interview him about something sensitive that had happened at the paper. Ben was very forthcoming — in fact, too forthcoming. He told the reporter much more than he should have, much more than he knew. After the piece came out, I went to Washington Post Company Chairman Don Graham and suggested that it might be time for Ben to stop going to the Post. Don, the kindest human being on the planet, refused to even consider it. However, we did work out a plan. All the secretaries and assistants on the floor were advised never to put a call through to Ben without checking with his secretary Carol or Don or me. Everyone was told to turn down all interview requests. Ben never knew about it.
It had been five years since he had been diagnosed with early-stage dementia, but few outside the family knew it. Almost every day he went down to the Post cafeteria for lunch and would be immediately surrounded by a coterie of reporters and admirers, and that seemed to perk him up. There was always a group conversation and as long as Ben gave somebody the finger or told somebody to “f--- off,” people didn’t seem to notice the forgetfulness that much.
I organized a lunch group at the Madison hotel across from the Post, where I had a running tab. Carol had a sign-up sheet and up to five people could join. It was always full. We called it “Tuesdays with Ben.”
Eventually it became too much to hide Ben Bradlee's diagnosis from friends and work associates:
The A-word is a killer, which is why I always said “dementia,” even though it was never clear which [type] he had. Somehow Alzheimer’s sounds like something one could catch. Dementia sounds tamer, more like gentle aging. At dinners, I would ask my friends to seat me next to Ben so that I could protect him. I’d make sure the person on his other side was aware of Ben’s situation.
The full piece, which is an excerpt from Sally's forthcoming book, Finding Magic: A Spiritual Memoir, is carried in this week's Washington Post and is well worth reading. It is a complex portrait of a hard-driving man and his loving wife and friends.
Monday, September 4, 2017
The Borchard Foundation Center on Law & Aging has announced the opening of the RFP period for academics to apply for academic research grants. The Borchard Foundation Center on Law & Aging Requests Proposals for 2018 Academic Research Grants explains that the foundation "awards up to 4 grants of $20,000 each year. This Request for Proposals is open to all interested and qualified legal, health sciences, social sciences, and gerontology scholars and professionals. Organizations per se, whether profit or non-profit are not eligible to apply, although they may administer the grant."
The grants support "research and scholarship about new or improved public policies, laws, and/or programs that will enhance the quality of life for the elderly, including those who are poor or otherwise isolated by lack of education, language, culture, disability, or other barriers." For more information about the grants, click here. The deadline for submission is October 16, 2017.
A recent article focuses on what is sometimes called "granny dumping," and the author urges states to examine carefully whether "abandonment" of a care-dependent person is addressed by the state's elder protection laws. Author Stephanie Rzeszut, a recent graduate of Hofstra Law, writes (footnotes omitted):
The only states that currently include elder abandonment as a form of elder abuse in their statutes are Alaska, California, Connecticut, Illinois, New Jersey, Oregon, Pennsylvania, Utah, Washington, and Wyoming. Although each of these states includes elder abandonment in their statutes, each statute varies as to how they define elder abandonment.[For example, the] state of California lists elder abandonment as a form of elder abuse without defining or describing what elder abandonment actually is. Conversely, the state of Oregon defines what elder abandonment is under their statute as the “desertion or willful forsaking of an elderly person or a person with a disability or the withdrawal or neglect of duties and obligations owed to an elderly person or a person with a disability by a caregiver or other person.”***Not only do a majority of the states not include elder abandonment in their statutes, but there is currently no uniformity among each state's statutes for what constitutes elder abuse in general. This is problematic because in some states a caregiver may not be prosecuted for elder abuse or not prosecuted for committing elder abandonment when it has in fact occurred.
Sunday, September 3, 2017
Here's something to give you pause. The HHS Office of Inspector General has released an early alert. The Centers for Medicare & Medicaid Services Has Inadequate Procedures To Ensure That Incidents of Potential Abuse or Neglect at Skilled Nursing Facilities Are Identified and Reported in Accordance With Applicable Requirements (A-01-17-00504) dated August 24, 2017,
alert[s] [the CMS administrator about] ... the preliminary results of our ongoing review of potential abuse or neglect of Medicare beneficiaries in skilled nursing facilities (SNFs). This audit is part of the ongoing efforts of the Office of Inspector General (OIG) to detect and combat elder abuse. The objectives of our audit are to (1) identify incidents of potential1 abuse or neglect of Medicare beneficiaries residing in SNFs and (2) determine whether these incidents were reported and investigated in accordance with applicable requirements.
The 14 page letter provides a lot of detail about the situation and offers a number of recommendations, including immediate action: "implement procedures to compare Medicare claims for [ER] treatment with claims for SNF services to identify incidents of potential abuse or neglect of Medicare beneficiaries residing in SNFs and periodically provide the details of this analysis to the Survey Agencies for further review and ... continue to work with ... HHS ... to receive the delegation of authority to impose the civil monetary penalties and exclusion provisions of section 1150B." Longer term the alert suggests new regulations among other ideas.
September 3, 2017 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)
Thursday, August 31, 2017
USA Today ran a story, Can this eye scan detect Alzheimer's years in advance? This short article explains that according to scientists "early indicators of Alzheimer's disease exist within our eyes, meaning a non-invasive eye scan could tip us off to Alzheimer's years before symptoms occur... It turns out the disease affects the retina — the back of the eye — similarly to how it affects the brain, notes neuroscience investigators at Cedars-Sinai Medical Center in California. Through a high-definition eye scan, the researchers found they could see buildup of toxic proteins, which are indicative of Alzheimer's." The study on which this article is based was published in the Journal of Clinic Investigation. Retinal amyloid pathology and proof-of-concept imaging trial in Alzheimer’s disease is downloadable as a pdf by clicking here. The 19 page article offers this intriguing statement. "Such retinal amyloid imaging technology, capable of detecting discrete deposits at high resolution in the CNS, may present a sensitive yet inexpensive tool for screening populations at risk for AD, assessing disease progression, and monitoring response to therapy." (Warning-there are a lot of detailed photos of eyes in this article).
Wednesday, August 30, 2017
Kaiser Health News ran this story, Elder Abuse: ERs Learn How To Protect A Vulnerable Population, a few days ago.
Because visits to the emergency room may be the only time an older adult leaves the house, staff in the ER can be a first line of defense, said Tony Rosen, founder and lead investigator of the Vulnerable Elder Protection Team (VEPT), a program launched in April at the New York-Presbyterian Hospital/Weill Cornell Medical Center ER.
The most common kinds of elder abuse are emotional and financial, Rosen said, and usually when one form of abuse exists, so do others. According to a New York study, as few as 1 in 24 cases of abuse against residents age 60 and older were reported to authorities.
The project consists of a team of doctors and social workers who rotate being on call, with backup from other professionals when the case so requires. The team trains the entire ER staff about identifying elder abuse. "A doctor interviews the patient and conducts a head-to-toe physical exam looking for bruises, lacerations, abrasions, areas of pain and tenderness. Additional testing is ordered if the doctor suspects abuse."
The team looks for specific injuries. For example, radiographic images show old and new fractures, which suggest a pattern of multiple traumatic events. Specific types of fractures may indicate abuse, such as midshaft fractures in the ulna, a forearm bone that can break when an older adult holds his arm in front of his face to protect himself.
When signs of abuse are found but the elder is not interested in cooperating with finding a safe place or getting help, a psychiatrist is asked to determine if that elder has decision-making capacity. The team offers resources but can do little more if the patient isn’t interested. They would have to allow the patient to return to the potentially unsafe situation.
Patients who are in immediate danger and want help or are found not to have capacity may be admitted to the hospital and placed in the care of a geriatrician until a solution can be found. Unlike with children and Child Protective Services, Adult Protective Services won’t become involved until a patient has been discharged, so hospitalization can play an important role in keeping older adults safe.
There have been a number of cases of suspected abuse identified by the team with a fair percentage of those confirmed as abuse cases. Ultimately, the team wants "to optimize acute care for these vulnerable victims and ensure their safety. They plan to work at continually tweaking VEPT to improve the program and to connect to emergency medical, law enforcement and criminal justice services. Eventually, they hope to help other emergency departments set up similar programs."