Tuesday, August 31, 2021

This CLE Is Worth Watching: #FreeBritney: Transforming & Reforming Conservatorship & Guardianship.

I had blogged a while back about this CLE, - #FreeBritney: Transforming and Reforming Conservatorship and Guardianship .  It was just excellent, and the recording is now available.  The program was sponsored by the ABA Section of Civil Rights and Social Justice, Commission on Disability Rights, and Commission on Law and Aging.   The recording is available here.

Here's a  description of the program:

Britney Spears’ conservatorship battle has shed light on the widespread problems and overuse of conservatorships/guardianships nationwide. Guardianships can be abusive and unnecessarily strip individuals of their civil rights to make their own decisions and use supports to live and direct their lives. Disability, aging, and civil rights advocates are calling for changes to reduce the overuse of guardianship and conservatorship, to strengthen recognition and use of less restrictive alternatives to guardianship like supported decision-making, and increase due process protections in guardianship proceedings and in the monitoring of guardianships. Our panel of experts discusses the risks and harms of guardianship, its systemic flaws, and the promise of alternatives like supported decision-making. They discuss reforms and changes that can address the problems that Britney Spears’ case has brought to light.

Put some time on your calendars to watch this very important CLE.  Don't forget to scroll down the page to check out the resources that are provided.

 

 

August 31, 2021 in Cognitive Impairment, Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, Programs/CLEs, State Statutes/Regulations, Webinars | Permalink | Comments (0)

NPR Morning Edition: "Antibody Tests Should Not Be Your Go-To for Checking COVID Immunity

Apparently I'm not the only person asking about the proper role of antibody tests in determining safety protocols during this current phase of COVID-19 infections.  This morning on NPR's Morning Edition program, a strongly expressed piece discounted the value of current antibody tests.  At the heart of the story was the following:  

[Washington University School of Medicine Immunologist] Ali Ellebedy says that having detectable antibodies from a blood test six months after vaccination "only means that your immune system mounted a successful response then and that you have immune memory."

 

While scientists have generated a "ton of data" on which antibodies are best at neutralizing the virus, Ellebedy says, the available antibody tests are not designed to specifically pick up whether you have enough of these protective antibodies, especially in the face of evolving variants.

 

And don't forget the immune system is more than just antibodies, so even with low detectable levels in your blood, you're not defenseless. "Antibody tests — it's really probing just one part of your immune system," says Elitza Theel, who directs the Infectious Diseases Serology Laboratory at the Mayo Clinic.

The NPR piece poses the question of whether a person can "learn anything" from antibody testing.  The piece says "Yes, as long as you don't expect it to give you a straightforward answer for how well-protected you are from catching the virus."  

For more, I recommend reading or listening (3 minutes) to the NPR segment entitled "Antibody Tests Should Not Be Your Go-To For Checking COVID Immunity."  The segment suggests that "the identity of a blood test that can eventually give consumers a reliable indication of their immunity is not far-fetched."  Okay.  But as I suggest in my previous post on this topic, are there communities available for antibody testing to further the identification of "correlates of protection" that aren't being tapped currently?  Could college and university communities and long-term care communities become part of the development of a reliable tool?  

 

August 31, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Science, Statistics | Permalink | Comments (0)

Monday, August 30, 2021

Medicare Dental Coverage a Possibility?

Here's an interesting (I don't want to say hopeful) idea.  According to the New York Times article,  Five Decades Later, Medicare Might Cover Dental Care it's a possibility that could become a reality if the odds can be overcome. "Tens of millions of older Americans who cannot afford dental care — with severe consequences for their overall health, what they eat and even when they smile — may soon get help as Democrats maneuver to add dental benefits to Medicare for the first time in its history....The proposal, part of the large budget bill moving through Congress, would be among the largest changes to Medicare since its creation in 1965 but would require overcoming resistance from dentists themselves, who are worried that it would pay them too little."

We know the implications on overall health that come from dental issues.  The article cites the statistic that 20% of older Americans have lost their teeth and dental issues can exacerbate health issues that are covered by Medicare.  Given that Medicare covers many preventive services, is it such a stretch to see the value of adding dental coverage?  But with all things political, passage is an uphill battle.  "On Capitol Hill, the proposal to add a Medicare dental benefit has near-universal support among Democrats, and many health industry and consumer groups back it, too... With the Democrats’ large policy ambitions but narrow majority, its passage is not assured."  

August 30, 2021 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Hidden Costs of Caregiving

Vox recently published The staggering, exhausting, invisible costs of caring for America’s elderly. "As someone ages, their health appears to gradually deteriorate in a way that doesn’t seem alarming. Most of the time, though, they’re inching toward a cliff — and when they fall off, they find themselves on another health cliff, and another, and another. With each cliff, it gets more difficult for a family member to catch them."  Lack of long term care insurance and a lack of understanding of what Medicare covers leaves many unprepared when the need for caregiving arises.  Nursing homes remain expensive and concerns arising as a result of COVID remain relevant today, the article notes. The impact on caregivers is highlighted in the article. Here are some excerpts:

[M]ost of this care work — both paid and unpaid — remains invisible. According to the most recent data from the AARP, an estimated 41.8 million people, or 16.8 percent of the population, currently provides care for an adult over 50. That’s up from 34.2 million (14.3 percent) in 2015.

Of those caregivers, 28 percent have stopped saving, 23 percent have taken on more debt, 22 percent have used up their personal short-term savings, and 11 percent reported being unable to cover basic needs, including food. The average age of someone providing care for an adult is 49, but 23 percent are millennials and 6 percent are Gen Z. Sixty-one percent are women, and 40 percent provide that care within their own homes, up from 34 percent in 2015.

A lot of these caregivers are really, really struggling. What’s required of them is more complex and time-consuming than just 10 years ago, as caregivers deal with overlapping diagnoses related to physical health, mental health, and memory loss as the elderly live longer. The work is much more than just clearing out the guest room or setting another place at the dinner table.

I find the article thoughtful and thought-provoking. It's worth reading and I'll use it in my class.  Consider this excerpt:

t’s only recently that we’ve settled on the understanding that care for elders is natural, moral, and ideal, even when the people providing this care are suffering or lacking the skills to provide the quality of care the recipient requires, or both. Crucially, by locating responsibility for care squarely on the family unit, it also continues to limit or excuse greater society — which is to say, the government — from the responsibility of providing care to the most vulnerable members of society. Our belief that the family is always the best and preferred care provider makes it much harder to advocate for the sort of larger, taxpayer-funded systems that would make all care, regardless of whether it’s provided by a family member, far easier.

There are other consequences to this naturalization of family responsibility. When labor is continually framed as something done out of love or instinct, it loses its connotation as labor and, by extension, its value. When women (and white middle-class women in particular) began moving into the workforce en masse in the second half of the 20th century, they didn’t quit their domestic work. They just did two jobs, one layered on top of the other; they would put in a full day in a traditional workplace for pay, then went home and kept working, unpaid.

Many women could only juggle these two separate jobs with the help of other women, both paid and unpaid. Poor working women had been doing this for some time, relying on “kith and kin” for child care in particular. Some middle-class women increasingly began to do the same, relying on friends but mostly family, while some began paying other women to do the work. This domestic labor, whether in the form of child-rearing, laundering, cleaning, or cooking, was essential, but because it had been so thoroughly normalized as unpaid work, it was also easy to normalize incredibly low wages for those who do it, even if that person had no relation to the family.

The article discusses the stresses of, and costs from caregiving and concludes with a sense of urgency regarding a looming crisis, if action isn't taken

Right now, several experts told me, the public alarm around the state of elder care is about where it was with child care 10, 15 years ago. We didn’t act on the alarm bells when it came to child care, and now the system is in a pandemic-accelerated crisis, with rippling effects across the economy. The question, then, is whether we want to wait the 10, 15 years for that implosion, right as even more Gen X-ers, millennials, and older Gen Z-ers age into caregiving roles and, shortly thereafter, need their own care. Or do we want to address the problem now, before it risks collapsing us, and our families, entirely.

Thanks to Morris Klein for sending me the link to this article.

August 30, 2021 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Medicaid, Medicare | Permalink | Comments (1)

Saturday, August 28, 2021

United Kingdom to Begin Offering Home-Finger-Prick Tests for Covid-19 Antibodies

Yesterday, I wrote here about what I'm hearing about use of antibody testing in some long-term care facilities in Pennsylvania.  The more I read about antibody testing for COVID-19, the more I'm surprised by the state of the science and the level of apparent uncertainty about appropriate uses for such tests. 

I've read published articles suggesting multiple explanations for why such tests have not been widely used as part of the response to COVID-19 and variant infections including:

  • Lack of availability of commercially-based testing products 
  • Lack of reliable testing products
  • Lack of FDA protocols to establish reliable tests
  • Disagreements (or lack of clarity) over what level of antibodies should be considered "protective"
  • Concern that any test results could be misused 
  • Lack of easily administered tests, especially tests that would not require medically-trained persons for blood draws

See, for example, these two articles by John Hopkins Center researchers:  Rachel M. West et al, Antibody (Serology) Tests for COVID-19: A Case Study (May 2021); Rachel West, et al, COVID-19 Antibody Tests: A Valuable Public Health Tool with Limited Relevance to Individuals (November 2020). 

As a non-scientist I can understand some of these concerns for the first half of this pandemic, where the issue was whether and to what extent actual infection would provide protection against reinfection. But, with almost 9 months of publicly administered vaccines, it is troubling to think that there could still be concerns about reliability of antibody testing following those vaccinations. Can an illness be called a "breakthrough" infection if the level of immunity wasn't being tested?  Or rather, if the immunity status couldn't be reliably detected?  

In any event, as I dig deeper, it seems that the U.K. is moving forward this month (August 2021) to "begin offering COVID-19 antibody testing to the general public...for the first time" via a home-administered finger-prick test.  From a Reuters report that leans on other media sources:

The government's new programme is intended to produce data on antibody protections for people following infection by different coronavirus variants, according to details of the programme published by multiple media outlets, including Sky News and BBC.

 

From Tuesday, anyone aged 18 or over in England, Wales, Northern Ireland and Scotland, will be able to opt in to the programme when receiving a PCR test, Sky News reported.

 

Participants, on testing positive for COVID-19, will be sent two finger-prick tests to complete at home to inform the UK Health Security Agency of the antibody response to different coronavirus variants, BBC reported.

Again, I find it odd that the U.K. goal -- at least so far as this report -- is to determine level of antibody protections following "infections" rather than "immunizations." Why not both? Why not especially the latter?   I'd still like to think that the U.S. can better prioritize the need for any and all protective actions, including booster shots, through intelligent use of antibody testing. 
 
One of my new (and exciting) colleagues, Penn State Dickinson Law Assistant Professor Sara Gerke, is the lead author on an article discussing appropriate safeguards for implementation of employment-based antibody testing.  See Covid-19 Antibody Testing as a Precondition for Employment: Ethical and Legal Considerations, published Summer 2021 in The Journal of Law, Medicine & Ethics. The analysis begins with a series of important research-assumptions.  The authors "assume that there is an antibody test for COVID-19 on the market that is accurate and reliable with high specificity and sensitivity." They acknowledge "FDA authorized tests meeting a reasonable threshold of accuracy and reliability" are essential to establish an ethical basis for their use.  
 
So much of COVID-19 testing is happening in an unusually public context, with new information generated every day. The intensity of a pandemic response certainly affects research and treatment priorities.  Nonetheless, the fact that some facilities are using antibody tests to facilitate care decisions seems significant.  Could certain residential institutions offer -- encourage? -- voluntary testing for COVID-19 antibodies, especially after the administration of the first doses, and  both before and after any booster doses?  Could colleges and universities, assisted living centers and nursing homes, all places where people are likely to live, work, and play together in close quarters around the clock, be uniquely good platforms for important data generation?   Could these locations be making better priority-based decisions about protective measures that both help their customers stay safe and provide better information for the public at large? 

August 28, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Science, Statistics | Permalink | Comments (0)

Friday, August 27, 2021

Are LTC Residents "Telling" Us that Antibody Testing is Important for Covid-19 Prioritization for Boosters?

In recent weeks, I've spoken to or read about residents of long-term care facilities being tested for Covid-19 antibodies.  Some residents, without being ill, are showing low (or even "no") levels of antibodies, despite having been fully inoculated in the spring of 2021.  This doesn't mean there was anything wrong with the original vaccinations, but it does suggest that at least for older persons, the immunity reduces over time.   As a result of these test results, the facilities are recommending that families support getting booster shots for their loved ones. That strikes me as using scientific data appropriately, to help prioritize next steps in fighting the troublesome developments with Covid-19. 

Why aren't other institutions, including universities, seeking similar information about antibodies or lack thereof?   Does it "matter" that a faculty member -- or a student -- or an administrator -- or a staff member -- was "fully vaccinated" in, for example, February 2021, if they aren't still "protected" in September 2021?  

Here's what I know so far:

  • My own health insurance company requires a "doctor's order" to permit an antibody test to be covered for reimbursement.
  • My local pharmacy advertised last spring that its onsite clinic would be offering antibody tests.  I learned recently, however, that it never actually set up that program.  The pharmacist I talked with didn't know why that decision was reversed.
  • My regular physician said I could sign up for a booster shot approximately 9 months from my last of the two-shot original vaccination, and said that therefore I didn't need an antibody test.
  • My insurance company asked whether I had a known exposure to Covid-19, implying that if the answer was yes, they would cover testing for a breakthrough-Covid infection, but not for antibody testing unless I had a doctor's order.

I realize one personal anecdote isn't evidence of much of anything.  But, is nursing home data already being generated that suggests antibody testing can supply relevant facts, perhaps facts that are "more" relevant than simply a history of immunization?     

 

August 27, 2021 in Consumer Information, Health Care/Long Term Care, Science, Statistics | Permalink | Comments (0)

Monday, August 23, 2021

Nurse Robots?

There have been stories of late about shortages of nurses, for various reasons. For example, NPR reported, Hospitals Face A Shortage Of Nurses As COVID Cases Soar. So, then a dear friend and colleague of mine today sent me a link to this story: Meet Grace, the ultra-lifelike nurse robot.  Grace, developed by a robotic company in Hong Kong, is "a humanoid robot it hopes will revolutionize healthcare.... Designed as an assistant for doctors, Grace is equipped with sensors, including a thermal camera to detect a patient's temperature and pulse, to help doctors diagnose illness and deliver treatments....The android is a companion for patients, too. Specializing in senior care, Grace speaks three languages -- English, Mandarin, and Cantonese -- and can socialize and conduct talk therapy."  The company expects to start large scale production of this robot and another robot by year's end. The article notes that this robot is attended to assist, not supplant, health care providers.  There's an accompanying video, which includes a brief clip of the robot showing Tai Chi moves to the reporter.  The robot at one point responds that her specialization is in "senior care." I don't know what the cost will be of such a robot and what patient load it can handle. Plus, I'm not sure about the lack of human connections in caregiving.  We'll have to wait to see whether the robot is at least a partial solution to the caregiving and nursing shortages.

 

August 23, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, International, Science | Permalink | Comments (0)

Thursday, August 19, 2021

The "State" of Aging in the U.S.

Let's close out the week with some data.  The Population Reference Bureau has released new data about An Improved State of Aging in America. 

Older adults in the United States are functioning better on their own and a shrinking share are living in nursing homes and assisted living settings than a decade ago, new data show.

Disability is down, as a smaller percentage of older adults receive help with daily activities and a larger share manage independently with home modifications and devices, according to 10 years of data from the National Health and Aging Trends Study (NHATS). The physical, sensory, and cognitive capacities of older adults, particularly women, are improving. And older adults are online more than ever before: They are more than twice as likely to use text or email than in 2011.

Despite these encouraging trends, NHATS data also reveal persistent racial and ethnic disparities among older adults, particularly in their ability to carry out daily tasks without help and modify their homes to meet their needs. The data also show that older adults were far less likely to participate in activities they value during the COVID pandemic than in previous years.

Conducted annually, NHATS collects information on the functional ability of older Medicare recipients, aiming to guide efforts to improve quality of life. Many NHATs findings are now available in new interactive dashboards and a companion chartbook, allowing users to dig into the data by demographic subgroup and create a custom picture of how the lives of older Americans—a rapidly growing segment of the population—are changing. (citations omitted)

Click here to access the report and all the nifty charts.

August 19, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other, Statistics | Permalink | Comments (0)

Wednesday, August 18, 2021

When Do You Start To Get "Old"?

There was a bit of a buzz last week with the publication of a new study about metabolism.  What We Think We Know About Metabolism May Be Wrong explains the recent study: "[u]sing data from nearly 6,500 people, ranging in age from 8 days to 95 years, researchers discovered that there are four distinct periods of life, as far as metabolism goes. They also found that there are no real differences between the metabolic rates of men and women after controlling for other factors."

We probably only think about our metabolisms when we are trying to lose weight. But as the article explains, the implications are far beyond weight gain and loss.

Central to [the researchers'] findings was that metabolism differs for all people across four distinct stages of life.

  • There’s infancy, up until age 1, when calorie burning is at its peak, accelerating until it is 50 percent above the adult rate.

  • Then, from age 1 to about age 20, metabolism gradually slows by about 3 percent a year.

  • From age 20 to 60, it holds steady.

  • And, after age 60, it declines by about 0.7 percent a year.

For us in elder law, here  is the point: "And around age 60, no matter how young people look, they are changing in a fundamental way...'There is a myth of retaining youth, [one expert said] That’s not what the biology says. In and around age 60, things start to change. ... There is a time point when things are no longer as they used to be.'"

Thanks to Professor Naomi Cahn for sending the link to the article.

 

August 18, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other, Science, Statistics | Permalink | Comments (0)

Biden Administration to Mandate COVID Vaccinations for Nursing Home Employees

The Biden Administration announced today that it will push for federal regulations to mandate employee vaccinations for COVID-19 for employees of "nursing homes," making the vaccinations a condition for nursing homes to continue receiving Medicare and Medicaid funding.  It will be interesting -- or perhaps frustrating -- to see how long that rulemaking process will take!  The new regulations "would apply to over 15,000 nursing home facilities, which employ approximately 1.3 million workers and serve approximately 16 million nursing home residents."  

Some sources suggest to date that "only about one-quarter of nursing homes had at least 75 percent of staff vaccinated." 

The announcement about nursing homes was combined with other announcements related to COVID-17 protections.  

My motto for the last 18 months has been "nothing is simple."  

August 18, 2021 in Consumer Information, Current Affairs, Discrimination, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicare | Permalink | Comments (0)

Tuesday, August 17, 2021

Register Now: Webinar on Guardianship Rights in the Era of Britney Spears

Register now for a free webinar next Monday, August 23, at 3 eastern, #FreeBritney: Transforming and Reforming Conservatorship and Guardianship.

Britney Spears’ conservatorship battle has shed light on the widespread problems and overuse of conservatorships/guardianships nationwide. Guardianships can be abusive and unnecessarily strip individuals of their civil rights to make their own decisions and use supports to live and direct their lives. Disability, aging, and civil rights advocates are calling for changes to reduce the overuse of guardianship and conservatorship, to strengthen recognition and use of less restrictive alternatives to guardianship like supported decision-making, and increase due process protections in guardianship proceedings and in the monitoring of guardianships. Our panel of experts will discuss the risks and harms of guardianship, its systemic flaws, and the promise of alternatives like supported decision-making. They will discuss reforms and changes that can address the problems that Britney Spears’ case has brought to light.

Panelists include:
- Jonathan Martinis, Senior Director for Law and Policy at The Burton Blatt Institute at Syracuse University
- Zoe Brennan-Krohn, Staff Attorney, Disability Rights Program, American Civil Liberties Union, San Francisco
- Jasmine Harris, Professor of Law, University of Pennsylvania Carey School of Law
- Hon. Lauren S. Holland – Judge, Lane County Circuit Court
- Charles Sabatino (Moderator) – Director, ABA Commission on Law and Aging

To register, click here.

August 17, 2021 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Programs/CLEs, State Statutes/Regulations, Webinars | Permalink | Comments (0)

Monday, August 16, 2021

Proper Use of POLST

Elder Law attorney and friend Morris Klein sent me the link to this article, Some NHs Use POLST Inappropriately; Practice, Policy, Research Considerations Can Help. In discussing the importance of advance care planning, the authors note "[o]ne [step] involves the POLST (Physician Orders for Life Sustaining Treatment) paradigm. POLST is intended for persons who are at risk of a life-threatening clinical event due to a serious life-limited medical condition. However, according to the authors of an article in the August issue of JAMDA, some nursing homes (NHs) are using it in potentially inappropriate ways with patients who are ineligible because they are not at such risk. They also make recommendations for NHs to implement the appropriate use of POLST."  The article, POLST Is More Than a Code Status Order Form: Suggestions for Appropriate POLST Use in Long-Term Care, can be found here.  The abstract explains

POLST (Physician Orders for Life-Sustaining Treatment) is a medical order form used to document preferences about cardiopulmonary resuscitation (CPR), medical interventions such as hospitalization, care in the intensive care unit, and/or ventilation, as well as artificial nutrition. Programs based on the POLST paradigm are used in virtually every state under names that include POST (Physician Orders for Scope of Treatment), MOLST (Medical Orders for Life-Sustaining Treatment), and MOST (Medical Orders for Scope of Treatment), and these forms are used in the care of hundreds of thousands of geriatric patients every year. Although POLST is intended for persons who are at risk of a life-threatening clinical event due to a serious life-limiting medical condition, some nursing homes and residential care settings use POLST to document CPR preferences for all residents, resulting in potentially inappropriate use with patients who are ineligible because they are too healthy. This article focuses on reasons that POLST is used as a default code status order form, the risks associated with this practice, and recommendations for nursing homes to implement appropriate use of POLST.

The article in pdf is available here.

August 16, 2021 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care, Other | Permalink | Comments (0)

Playing Cards About Resident Rights

Now here's a clever idea. The National Consumer Voice for Quality Long-Term Care is selling playing cards that contain the rights of a resident of a SNF. The playing cards sell for $8.  It's not just the idea that's clever. The design is as well. "Each card highlights a different residents' right.  The back of the cards features colorful artwork created by rolling wheelchairs through paint in order to represent how residents move through their facility, designed by residents in Lanai City, Hawaii."  How's that for clever!  The deck comes in a box--and wouldn't this be a thoughtful gift for an attorney to give a client who has just finished planning for long-term care?

 

August 16, 2021 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Games, Health Care/Long Term Care, Housing, Other | Permalink

Friday, August 13, 2021

Paying for Old Age

The New York Times recently published an opinion piece, Getting Old Is a Crisis More and More Americans Can’t Afford.  The article has some good statistics in it. Focusing on long-term care needs, the article compares demand and supply and costs. "[M]ost seniors will require long-term care. Almost 70 percent of Americans turning 65 today are expected to need extended services and supports at some point. About 20 percent will need care for more than five years. Despite this, the majority of those age 40 and over have done no planning for their long-term care, according to a 2021 survey by the AP-NORC Center for Public Affairs Research."  The article notes the scope and limitations of Medicare, Medicaid and long-term care insurance and examines the work of  "a broad cross-section of policy experts, consumer advocates and industry representatives [who] formed the Long-Term Care Financing Collaborative to explore more sustainable funding models. The central recommendation of the group’s final report, issued in 2016, was the creation of a universal public insurance program." Noting challenges of making this a reality, the author  suggests that "[t]he outlook may be more promising at the state level. In 2019, Washington State passed the nation’s first state-run long-term-care insurance program. The WA Cares Fund is to be funded by a 0.58 percent payroll tax on employees. Starting in 2025, eligible residents can receive benefits of $100 per day, with a lifetime cap of $36,500."

August 13, 2021 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare, Other, State Statutes/Regulations | Permalink | Comments (0)

Thursday, August 12, 2021

Why Doesn't Medicare Cover More?

Kaiser Health News published a story,  Why Doesn’t Medicare Cover Services So Many Seniors Need?  Noting that eye glasses, dentures, and hearing aids aren't covered under original Medicare, the story reports that "On Monday, Senate Majority Leader Chuck Schumer released an outline of a coming budget bill that includes a directive to the Senate Finance Committee to expand Medicare “to include dental, vision, hearing benefits.” The catch — all the Democrats in the Senate and almost all in the House will have to agree on the entire budget bill for it to become law."  But why haven't those been added to Medicare before now? "[I]n the 56 years since Medicare became law, only a few benefits have been added to the package, which was created to emulate a 1965 Blue Cross/Blue Shield plan. During the 1980s and ’90s some preventive care was added, like pneumonia vaccines and mammograms. Republicans spearheaded the addition of prescription drug coverage in 2003, when they controlled both Congress and the White House. But they decided to make that coverage separate from the program’s traditional benefit package."  The article details the hurdles in expanding coverage and asks, why now and why these items are proposed to be added.  The article suggests a couple of reasons, both of which involve politics to some degree. Hopefully the winner here will be the Medicare beneficiaries.

August 12, 2021 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Wednesday, August 11, 2021

More News on the SNF Front

Two recent developments worth mentioning.  First, at the ABA annual meeting, the ABA passed resolution #800 from the Commission on Law & Aging, the Section on Civil Rights and Social Justice, and the Senior Lawyers Division, concerning density and size for nursing homes.  The report, proposed resolution and final resolution are available here.  The direct link to the final resolution can be found here.  Here are the 3 resolutions:

RESOLVED, That the American Bar Association urges the U.S. Congress and the Department of Health and Human Services to institute a review of the advisability and feasibility of phasing in size and design standards for nursing homes that would require small, household model facilities with single rooms and private baths, given their safety and infection control advantages in public health emergencies such as the Covid-19 pandemic;

FURTHER RESOLVED, That the American Bar Association urges Congress and the executive branch to provide financial incentives for the development and operation of nursing homes meeting  size and design standards developed pursuant to this review through means such as, but not limited to, restructuring the Section 202 Supportive Housing for the Elderly Program of the Department of Housing and Urban Development (HUD), tax incentives under the Internal Revenue Service, or actions by other executive branch agencies to provide or encourage low cost financing for the redesign, remodeling, building and rebuilding of nursing homes meeting these standards; and

FURTHER RESOLVED, That the American Bar Association urges the Centers for Medicare and Medicaid Services to change Medicare and Medicaid regulations and payment policies to pay for single private rooms and bathrooms for all residents, with reasonable reimbursement rates for such rooms.

Second, Sens. Ron Wyden of Oregon and Bob Casey of Pennsylvania and others introduced a Senate bill, the Nursing Home Improvement and Accountability Act of 2021.  The bill has 3 parts,  (1) transparency and accountability, (2) staffing improvements, and (3) "building modification and staff investment demonstration program." The full bill is available here. A summary is available here. And a section analysis is available here.  Here are some key points of the bill, from the AP story about it:

— Raise salaries and benefits for nursing home staff by giving states the option of an increase in federal Medicaid matching funds, available over six years. Low wages in the nursing home industry make for constant turnover, a critical problem even before the pandemic. The bill also starts a process for setting minimum staffing thresholds.

— Require nursing homes to have an infection prevention and control specialist.

— Require nursing homes to have a registered nurse available 24 hours a day, instead of the current eight hours.

— Bolster state inspections of nursing homes, and add more low-performing facilities to a “special focus” program that helps them improve quality.

— Forbid nursing homes from requiring residents and families to agree in advance to arbitration, thereby waiving their rights to go to court over disputes involving care.

 

August 11, 2021 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare | Permalink | Comments (0)

Friday, August 6, 2021

Penalties for SNF Deficiencies Reinstated After Roll Back

I'm closing out the week with another post regarding SNFs.  This one came from a recent article from The National Consumer Voice on Quality Long Term Care,  which reported on the actions of CMS to roll back the prior administration's loosening of penalties for SNF deficiencies. CMS Reinstitutes Tougher Penalties for Past Nursing Home Deficiencies explains that subsequent to a lawsuit filed by them and others, CMS changed positions on penalties for deficiencies. The article notes that about 15 days ago, CMS rescinded the change in policy, "reinstituting stronger penalties for nursing home violations."  The notice of rescission is available here. The notice to State Survey Directors about the change is available here,  which notes CMS is returning to the position of having discretion to enter per-day penalties.

August 6, 2021 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Thursday, August 5, 2021

Level of COVID Immunity for W.Va. SNF Residents?

I wanted to follow up yesterday's post on the rise of COVID cases in SNFs with this article about West Virginia's efforts, Amid Covid Booster Debate, West Virginia to Check Immunity of Vaccinated Nursing Home Residents.

West Virginia raced ahead of the country last winter to get people in nursing homes vaccinated against covid-19, but with cases and hospitalizations on the rise again, state officials want to know whether immunity levels are falling for residents who had their shots... Starting [this month], the state plans to begin measuring the levels of disease-fighting antibodies in the blood of vaccinated nursing home residents, which could help indicate whether they need a booster shot. The process will be voluntary and the data will be shared with federal health agencies evaluating the need for boosters."

The article points out there there is no authorization yet from the federal government for the boosters.W.VA. has done better than most states and the number of cases (at the time of the article was published at the end of July) bears this out. In addition to measuring residents anti-body levels, the state will look at the number of COVID hospitalizations, deaths, and "break-through" infections.

August 5, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other | Permalink | Comments (1)

Wednesday, August 4, 2021

Nursing Homes & Covid: Here We Go Again?

Another surge, another rise in COVID in SNFS? According to a recent article in the New York Times, Nursing Homes Confront New Covid Outbreaks Amid Calls for Staff Vaccination Mandates, the cases are rising.  Featuring one company, the article notes

The case count has ticked up again: It’s still below 100 among residents and staff, the company said, but includes many breakthrough cases of vaccinated residents testing positive. Then last week, two vaccinated residents died with Covid .... The company said it had pinpointed the cause of the spread there and at other of its facilities: The breakthroughs had happened in the same homes where unvaccinated staff were testing positive, seemingly carrying the virus into the home from the community.

The company recently announced it was requiring all staff to be vaccinated, the article notes.  As we all know, vaccine mandates are controversial.

Growing calls for vaccine mandates among health care workers have gained urgency but also met resistance in the nursing home industry, where some homes say it will cost them staff members in an industry already plagued with high turnover. Only about 60 percent of nursing home staff members are vaccinated, and some states report an even lower rate, with less than half inoculated, according to the most recent government data.

Staff immunization has been an issue in many states, especially as the highly contagious Delta variant races through regions with low vaccination rates. Some states and cities, not waiting for the nursing home industry, are imposing their own mandates for vaccinations on long-term care employees or operators may face penalties or additional testing requirements for unvaccinated staff.... 

Some states have reinstated visitation restrictions and the CDC is monitoring the number of cases. The article goes on to discuss in depth the issues surrounding a vaccine mandate, with some states requiring frequent testing in lieu of adopting a mandate.  Looks like we are going to be dealing with this through the end of 2021. I go over with my students a list of questions regarding choosing a nursing home. I'm adding "how many of your staff and residents are vaccinated again COVID" to the list. 

August 4, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Other, Science | Permalink | Comments (1)

Tuesday, August 3, 2021

Casual Relationships Provide Benefits

Following up on yesterday's post about friendship, here's an article from Kaiser Health News, Restoring a Sense of Belonging: The Unsung Importance of Casual Relationships for Older Adults. "These relationships with people we hardly know or know only superficially are called “weak ties” — a broad and amorphous group that can include anyone from your neighbors or your pharmacist to members of your book group or fellow volunteers at a school... [and]  many older adults are renewing these connections with pleasure after losing touch during the pandemic."  These kinds of relationships have a positive impact on us. "These ties can cultivate a sense of belonging, provide bursts of positive energy, motivate us to engage in activities, and expose us to new information and opportunities — all without the emotional challenges that often attend close relationships with family and friends." So next time you are out for a walk, say hi to the folks you pass on the street. It's good for both of you!

August 3, 2021 in Consumer Information, Current Affairs, Other | Permalink | Comments (0)