Thursday, August 13, 2020

ABA House of Delegates Resolution on Guardianship Courts

At the recent annual meeting, the ABA House of Delegates Urges Congress to Invest in a Guardianship Court Improvement Program.

A Guardianship Court Improvement Program will provide states with the necessary federal
funding and support to improve their court processes and thus the lives of individuals with
guardians by improving outcomes for adults in the system, increasing the use of less restrictive options other than guardianship, and enhancing collaboration among courts, the legal system, and aging and disability networks.

The report, along with the proposed resolution, is available here. The final resolution reads as follows:

RESOLVED, That the American Bar Association urges Congress to create and fund a Guardianship Court Improvement Program for adult guardianship (following the model of
the State Court Improvement Program for child welfare agencies created in 1993) to
support state court efforts to improve the legal process in the adult guardianship system, improve outcomes for adults subject to or potentially subject to guardianship, increase the use of less restrictive options than guardianship, and enhance collaboration among courts, the legal system, and the aging and disability networks.

August 13, 2020 in Cognitive Impairment, Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship | Permalink

Tuesday, August 11, 2020

Rosie the Riveter-Still Making a Difference

I hope everyone knows the story of the Rosie the Riveter, and the difference they made during WWII.  One of the Rosie the Riverters is still making a difference, according to a recent story in the Washington Post.  94-year-old ‘Rosie the Riveter’ once made warplanes and red bandannas. Now she makes face masks with the same cloth. features Mae Krier, who has continued to make a difference. "For many years, Krier has paid tribute to her beloved Rosie the Riveters by making red bandannas with white polka dots — a style shown in J. Howard Miller’s iconic Rosie the Riveter “We Can Do It!” poster for Westinghouse Electric. Since the war against the novel coronavirus started, Krier shifted her energy from making Rosie bandannas to Rosie face masks, cut from the same cotton cloth."

The article provides a nice history of the Rosier the Riveters, which is a good read for our students, who may not know the story.  Ms. Krier also explains the can do attitude of the Riveters and how she sees it applying to the pandemic.   She also expressed to the reporter her reactions to the pandemic and masks:

[S]he is frustrated and disheartened to see how many Americans are fighting safety measures and refusing to wear masks. Nurses, she said, are the new Rosie the Riveters, and hospitals are the new battlefield with coronavirus patients.

“We’re fighting a different kind of war — a terrible virus,” she said. “Where is the ‘We can do it’ spirit?”
To learn more or to order a mask, visit the Honor Rosie Facebook page. To learn more about Ms. Krier and the Rosies, click here.

August 11, 2020 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other | Permalink

Friday, July 24, 2020

New Brief from APS Technical Assistance Resource Center

APS TARC has released a new brief, Trauma-Informed Approach for Adult Protective Services. This brief includes a discussion trauma and of "The Four Rs of a Trauma-Informed Approach" (realize, recognize, respond and resist). The brief includes information from experts in the field,  discusses COVID and APS, and then concludes 

As outlined in this brief and highlighted by the guest experts above, there are tools to approach recent challenges posed by COVID-19 using trauma informed approaches. APS research and practice was already beginning to understand the critical intersections between adult maltreatment and trauma and now it’s time to pivot quickly and move forward with research, practice, and training for all levels of APS staff using a trauma-informed framework.

The American Public Human Services Association (APHSA), recommends these steps for organizations to “Lead Ahead” during times traumatic times:
 Vision - Developing a vision for moving forward
 Ask questions – Be curious, be direct
 Plan – Develop a plan
 Respond – Execute the plan
 Innovate – Practice continuous quality improvement (CQI)
(American Public Human Services Association, 2020)
All the APHSA steps listed above can be conducted through a trauma-informed approach framework to  cultivate safety, support and resiliency.  The road ahead, in light of the COVID-19 pandemic, will be challenging to navigate for everyone. Let us all maintain and grow the resiliency of leadership, staff, and clients to move from urgent, trauma response to recovery response and planning in the days and weeks ahead.

July 24, 2020 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship | Permalink

Thursday, July 23, 2020

Reduced SNF Training Requirements Because of COVID

Politico reported that the Trump team relaxed training rules for nursing home staff just as pandemic hit.

Shortly after the first coronavirus outbreak ravaged a nursing home in Kirkland, Wash., the Trump administration moved to fulfill a longstanding industry goal — waiving the requirement that nurse’s aides receive 75 hours of training and allowing people who study only eight hours online to become caregivers during the pandemic.

The industry had been fighting for years to reduce training requirements, saying they make it harder to recruit staff. The day after the administration announced the change, the industry rolled out a free online training program for certifying the new role — called a "temporary nurse aide" — that has since been adopted by at least 19 states.

The article reports that advocates for elders and others think this was poorly timed and may have resulted in the spread of COVID in SNFs, especially when considering that CNAs are typically  "the main caretakers of residents, some of whom need round-the-clock monitoring; nurse’s aides are also on the front lines in implementing the cleaning and disinfecting practices that prevent the spread of Covid-19." CMS emphasized this is temporary and as soon a COVID is done with us, the  CNA 75 hour training requirement will resume.

However, we don't know how well this is working. "[C]ritics are questioning why the waivers were applied so quickly and broadly, and why they’re lasting months into the pandemic when little is known about whether there are, in fact, larger-than-usual staff shortages in nursing homes. They also question the wisdom of waiving the rules for removing residents and making quarterly reports on their condition, which are among more than two dozen regulations temporarily suspended by the administration."

Stay tuned.

July 23, 2020 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare | Permalink

Wednesday, July 22, 2020

Visiting Family at SNFs-6' Apart

Some SNFs and ALFs are now allowing visits for residents, with proper precautions, rather than an absolute ban on visits.  Kaiser Health News  ran an update, States Allow In-Person Nursing Home Visits As Families Charge Residents Die ‘Of Broken Hearts’.

For the most part, visitors are required to stay outside and meet relatives in gardens or on patios where they stay at least 6 feet apart, supervised by a staff member. Appointments are scheduled in advance and masks are mandated. Only one or two visitors are permitted at a time.

Before these get-togethers, visitors get temperature checks and answer screening questions to assess their health. Hugs or other physical contact are not allowed. If residents or staff at a facility develop new cases of COVID-19, visitation is not permitted.

Slightly over half of the states have have allowed these SNF visits, after he release of revised guidance from CMS, while slightly less than half of the states have allowed ALFs to follow the same path. This change is something of a balancing act, and the article notes this can change if COVID cases show up. Although the prohibition on visits was intended as protection, 

[A]nguished families say loved ones [suffered]too much, mentally and physically, after nearly four months in isolation. Since nursing homes and assisted living centers closed to visitors in mid-March, under guidance from federal health authorities, older adults have been mostly confined to their rooms, with minimal human interaction.

A separate, but related issue, the right of visitation at the end of life, has not been evenly applied.

Although federal guidance says visitors should be permitted inside long-term care facilities at the end of life, this is not happening as often as it should, said Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, an advocacy group.

She wants family visitation policies to be mandatory, not optional. As it stands, facility administrators retain considerable discretion over when and whether to offer visits because states are issuing recommendations only.

Smetanka’s organization has also begun a campaign, Visitation Saves Lives, calling for one “essential support person” to be named for every nursing home or assisted living resident, not just those who are dying. This person should have the right to go into the facility as long as he or she wears personal protective equipment, follows infection control protocols and interacts only with his or her loved one.

The article also includes a map of states allowing visitation.

July 22, 2020 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations | Permalink

Tuesday, July 21, 2020

Has the Time Come to Reinvent the Nursing Home? Or Change the Funding?

Charlie Sabatino, the rock star of elder law and the Director of the ABA Commission on Law & Aging recently wrote an opinion piece for Next Avenue  on this important topic. OPINION: It’s Time to Defund Nursing Homes: How the traditional nursing home model can be replaced. Sabatino writes that:

[T]he COVID-19 pandemic ravaging nursing home residents underscores a deep-seated ageism inherent in our institutional model of nursing home care. I believe it is time to defund the institutional model and replace it with a radically different model.

Today’s typical nursing home has never come close to meeting the public’s desire for humane and dignified long-term care. Warehousing large numbers of frail elders in hospital-like buildings with residents in double or triple rooms along with staff turnover as high as 100% unavoidably creates a high risk for resident safety and compromises quality of care.

We've all read the stories about the horrors occurring in the nursing homes as the pandemic rolls across the country (for patients and caregivers too). A number of calls for change have been made, but as Sabatino aptly observed, "

[M]ultiple recommendations for change have gained attention. They include ensuring adequate personal protective equipment in nursing homes; disaster plans that facilitate quarantining; more and better trained staff and heightened monitoring and oversight of care.

But let’s be clear: These measures do little more than rearrange the deck chairs in a failing system.

The COVID-19 pandemic is a 9/11 moment for nursing home care and a test of our ability to reimagine nursing home care that puts the “home” into nursing homes.

Sabatino then turns to specifics regarding change and suggests the key to change is to tie it to Medicare and Medicaid funding. 

As the largest payor for nursing home care, Medicare and Medicaid hold the key. Now is the time to change facility requirements to gradually limit participation in the program only to facilities that provide the following:

  • Small home-like facilities
  • Single rooms and bathrooms
  • A flattened, more flexible staff hierarchy with cross-trained staff
  • A culture focused first on residents’ goals, interests and preferences.

Sabatino concludes "[a]s long as the nursing home industry can rely on the flow of federal money for the current model of care, it has no financial incentive to change, not even after the coronavirus catastrophe. ... Change that flow, and a major cultural change in long-term care will follow."

Hello Congress??

Stay safe and healthy everyone.

July 21, 2020 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare | Permalink

Sunday, July 19, 2020

Assessing Your COVID Risk To Go Outside When You Are Older?

When I read the following New York Times article, all I could think of was the Clash song, "Should I Stay or Should  I Go?  The article, You’re a Senior. How Do You Calculate Coronavirus Risk Right Now? focuses on the decision to stay home or to venture out into the world (with precautions of course) when you are in a high risk group (or any group for that matter but this is the elderlawprof blog!)

"Early on in the pandemic, most public health officials warned older adults to simply stay at home, except to buy food or medicine or exercise outdoors apart from others. Now, with states and cities reopening (and some re-closing) at varying paces, the calculations grow steadily more complicated."

What to do? What to do? One study from MIT economists "in a recent paper suggesting age-targeted lockdowns ... proposed protecting people over 65 by having them isolate for an estimated 18 months until a vaccine becomes available; younger people, facing less health risk, would return to work."  As the article notes, that "approach also assumes that older adults’ only  interest lies in not dying."  Well, that is a big one, but still.....

There's so much info out there, what is one to do?  The article offers a couple of insights

calculator developed by researchers at the Cleveland Clinic may provide a clearer sense of individual risk.

Geography matters too. Older people in New Hampshire or Maine — where new cases were falling last week — may reasonably opt for less restrictive behavior than those in Florida and Arizona, where Covid has been surging. Pay attention to which counties are seeing cases rise and which are doing a good job at observing guidelines.)

 

July 19, 2020 in Consumer Information, Current Affairs, Health Care/Long Term Care, Statistics, Travel | Permalink

Thursday, July 16, 2020

NYT: Boom(er?) Time for Planning where Death Triggers Next Events

The New York Times has an article that might be particularly useful for faculty members teaching Wills, Trusts & Estates or Elder Law courses in the Fall.  

From the article, titled "Boom Time for Death Planning:"

The coronavirus pandemic has drawn new buiness to startups that provide end-of-life services, from estate planning to a final tweet. . . . 

Before the pandemic, end-of-life start-ups — companies that help clients plan funerals, dispose of remains and process grief — had experienced steady to moderate growth. Their founders were mostly women who hoped a mix of technology, customization and fresh thinking could take on the fusty and predominantly male funeral and estate-planning industries.

Still, selling death to people in their 20s and 30s wasn’t easy. Cake’s team sometimes received emails from young adults, wondering if the site wasn’t a tad morbid. Since Covid-19, this has changed. Millennials are newly anxious about their mortality, increasingly comfortable talking about it and more likely to be grieving or know someone who is.

July 16, 2020 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Estates and Trusts, Ethical Issues | Permalink | Comments (0)

Monday, July 6, 2020

What Does It Mean to Do Contact Tracing for Communicable Diseases, Especially for Air Travelers?

Last month I made my first roundtrip, domestic airline flight following 90+ days of lockdown and gradual easing of travel restrictions.  I scheduled this quick trip cautiously, for family-related reasons, and with a goal of returning to my Pennsylvania home well in advance of any return to work with students in my law school. I'm not a timid flyer, but I did my best to try to minimize risk factors, including selection of an airline that advertised "vacant" middle seats, masking requirements, and updated standards for cleaning the airplane and social distancing. I am writing here because an individual on the return leg of my flight in my same row (but across the aisle) became seriously ill during the flight. This post is about my growing concern about what it means to respond to the potential for a communicable illness while traveling, especially but not exclusively in the time of COVID-19. 

When the individual became ill (seeming to lose consciousness and vomiting-- more ill than what I associate with "mere" air sickness), the flight attendants responded to his needs with plastic bags and napkins.  On the positive side, they kept everything low key and talked to the individual softly.  I think it was another, closer passenger who summoned them and everyone tried to respect the privacy of the individual.  Eventually, the ill passenger was moved to the rear of the plane.  Shortly after that, all passengers were informed the seatbelt signs had been activated and everyone should stay in their seats for the remainder of the flight.   There were no further announcements and nothing said about the ill passenger specifically. When the flight arrived at its regular destination, I did not see the individual leave the plane.

What does it mean for any state health department or CDC program official to say they will follow a plan for contact tracing?  Each step of the process needs clarity, including that first step of identifying the ill traveler and other potentially affected travelers, right?   

I received a traditional customer satisfaction "survey" form from the airline the morning of my return via email, asking me to describe the flight. This made me realize that I should be talking directly to the airline about this specific incident.  Was the individual in question experiencing a communicable illness, especially COVID-19?  I made a short, emailed report to the airline less than 12 hours after the end of the flight, and made a follow up inquiry and a second report by telephone and email.   The most I have learned is that the airline is "researching" whether there is any record of the incident or illness on board that flight.  Taking a week (or more?) to determine whether the crew made a report is not reassuring. At a minimum, shouldn't there be a record of that plane being taken out of service for some period of time for cleaning?  

The Pennsylvania governor, for reasons unrelated to my account above, has recently asked all residents returning from the departure state in question (and certain other states experiencing surges in COVID-19) to self-quarantine for 14 days. That makes sense.  Even though I had been exceptionally careful during my time out-of-state, the airline incident was a stark reminder that travel, even with the lessons learned during the last several months, involves factors that are completly outside the control of any of the passengers.  "Being careful" on an individual basis may not be enough and when something happens that involves risk to others, we need clear lines  for any investigation and communication.    

Everyday we are learning new things about how to deal with communicable illnesses, including ones that may be life-threatening. I think what I'm realizing is that as individuals and consumers, we cannot be passive about these steps.

I contacted the CDC and was told there is a process for "contact investigations" by the CDC, but that triggering such an investigation cannot be done easily, at least not if you are a mere passenger.  They recommended I contact the health department in the state where my plane landed.  Here is what CDC sent me by email:  https://www.cdc.gov/quarantine/contact-investigation.html

Weaknesses clearly exist in the protocols. The airline and CDC have been quick to warn me that they cannot give any information about the "patient."  I'm not asking to know the patient's identity in any way. But shouldn't any potentially affected traveler be entitled to know:

a. Whether there was a report of the illness made by the crew to the airline and/or other authorities.

b. The result of any investigation, especially in terms of public health implications.

c.  Whether a specific, communicable illness or disease was identified.

d.  Whether there are specific steps that should be taken by passengers in light of the history.

Shouldn't the CDC want to know whether others on that plane have experienced similar symptoms? (Thankfully, I have not, but although I was in the line of sight of his seat, there were others between us, and in front and behind him, who were much closer.)  I have realized that short of contacting every passenger on the plane, it might be difficult  for some airlines to help with "contact" tracing. They may be relying on a manifest rather than a chart for assigned seats.  Certainly, no one asked me or other, closer passengers on the flight for contact information. I hope the ill individual has recovered fully and quickly, and that for his sake this was a temporary illness.  I'm being calm, even as I'm frustrated.  I'm frustrated not just for myself, but for the larger public.  The  passengers on this plane included all ages, including older individuals.  Earlier during my trip, I overheard one older traveler say to another, "I just want to live long enough to see my grandchildren again."

July 6, 2020 in Consumer Information, Ethical Issues, Health Care/Long Term Care, Science, Statistics, Travel | Permalink | Comments (0)

Thursday, July 2, 2020

CMS Coronavirus SNF Commission

More good news from CMS-the members of the Independent Coronavirus Commission on Safety and Quality in Nursing Homes have been announced.  The 25 experts

The commission members are:

  • Roya Agahi, RN, MS HCM, WCC; Chief Nursing Officer, formerly of NYC Health + Hospitals, soon to be of CareRite, New York
  • Lisa M. Brown, PhD, ABPP; Professor of Psychology, Palo Alto University, California
  • Mark Burket, CEO, Platte Health Center Avera, South Dakota
  • Eric M. Carlson, JD; Directing Attorney, Justice in Aging, California
  • Michelle Dionne-Vahalik, DNP, RN; Associate Commissioner, State Health and Human Services Commission, Texas
  • Debra Fournier, MSB, BSN, ANCC RN-BC, LNHA, CHD, CPHQ; COO, Veterans’ Homes, Maine
  • Terry T. Fulmer, PhD, RN, FAAN; President, The John A. Hartford Foundation, New York
  • Candace S. Goehring, MN, RN; Director, State Department of Social and Health Services, Aging and Long-Term Support Administration, Washington
  • David C. Grabowski, PhD; Professor of Healthcare Policy, Harvard University, Massachusetts
  • Camille Rochelle Jordan, RN, BSN, MSN, APRN, FNP-C, CDP; Senior Vice President of Clinical Operations & Innovations, Signature Healthcare, Kentucky
  • Jessica Kalender-Rich, MD, CMD, AGSF, FAAHPM, FACP; Medical Director, Post-Acute Care, University of Kansas Health System, Kansas
  • Marshall Barry Kapp, JD, MPH; Professor Emeritus of Law, Florida State University, Florida
  • Morgan Jane Katz, MD, MHS; Assistant Professor of Medicine, Johns Hopkins University, Maryland
  • Beverley L. Laubert, MA; State Long-Term Care Ombudsman, State Department of Aging, Ohio
  • Rosie D. Lyles, MD, MHA, MSc, FACA; Director of Clinical Affairs, Medline Industries, Illinois
  • Jeannee Parker Martin, MPH, BSN; President and CEO, LeadingAge California
  • G. Adam Mayle, CHFM, CHC, CHE; Administrative Director of Facilities, Memorial Healthcare System, Florida
  • David A. Nace, MD, MPH, CMD; President, AMDA – The Society for Post-Acute and Long-Term Care Medicine, Pennsylvania
  • Lori Porter, LNHA, CNA; CEO, National Association of Health Care Assistants, Missouri
  • Neil Pruitt, Jr., MBA, MHA, LNHA; Chairman and CEO, PruittHealth, Inc., Georgia
  • Penelope Ann Shaw, PhD; Nursing Home Resident and Advocate, Braintree Manor Healthcare, Massachusetts
  • Lori O. Smetanka, JD; Executive Director, National Consumer Voice for Quality Long-Term Care, Maryland
  • Janet Snipes, LNHA; Executive Director, Holly Heights Nursing Home, Colorado
  • Patricia W. Stone, PhD, MPH, FAAN, RN, CIC; Professor of Health Policy in Nursing, Columbia University, New York
  • Dallas Taylor, BSN, RN; Director of Nursing, Eliza Bryant Village, Ohio

Here's the info about the Commission's mission:

The Commission will conduct a comprehensive assessment of the overall response to the COVID-19 pandemic in nursing homes. Based on its assessment, the Commission will make recommendations on actions and best practices for immediate and future actions.  Three key areas of focus for the Commission include:

  • Ensuring nursing home residents are protected from COVID-19 and improving the responsiveness of care delivery to maximize the quality of life for residents;
  • Strengthening efforts to enable rapid and effective identification and mitigation of COVID-19 transmission (and other infectious disease) in nursing homes; and
  • Enhancing strategies to improve compliance with infection control policies in response to COVID-19.

Crossing my fingers....

July 2, 2020 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Wednesday, July 1, 2020

Washington State Bar ended Limited License Legal Technician Program

Although not specifically elder law, still an important update for us. According to a recent article in the ABA Journal, Washington Supreme Court sunsets limited license program for nonlawyers. As originally planned, the program would focus on family law and then expand into elder law.  "The court’s 7-2 vote last Thursday to prohibit anyone not already in the LLLT pipeline to pursue the license comes just eight years after the court approved the creation of the first such legal license for nonlawyers in the country. Several other states have since approved—or have considered approving—similar programs." The article notes that costs of the program and the lack of interest in the program as the reasons for the Court's decision. Those licensed will be able to continue as an LLLT but no new individuals will be licensed after July 31, 2021.

July 1, 2020 in Consumer Information, Current Affairs, Legal Practice/Practice Management | Permalink

Tuesday, June 30, 2020

Good News from CMS-Resumption of Staffing Data

A recent press release from CMS notes that CMS ... Plans to End the Blanket Waiver Requiring Nursing Homes to Submit Staffing Data

[T]he Centers for Medicare & Medicaid Services (CMS) announced plans to end the emergency blanket waiver requiring all nursing homes to resume submitting staffing data through the Payroll-Based Journal (PBJ) system by August 14, 2020. The PBJ system allows CMS to collect nursing home staffing information which impacts the quality of care residents receive. The blanket waiver was intended to temporarily allow the agency to concentrate efforts on combating COVID-19 and reduce administrative burden on nursing homes so they could focus on patient health and safety during this public health emergency.

The memorandum released today also provides updates related to staffing and quality measures used on the Nursing Home Compare website and the Five Star Rating System.

The memorandum is available here.

June 30, 2020 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (0)

Monday, June 29, 2020

CMA Releases Family Caregiver Brief

The Center for Medicare Advocacy (CMA) has released an issue brief on Medicare and Family Caregivers. "This Issue Brief examines the role Medicare currently plays, and could play, in assisting
beneficiaries and their family caregivers." The issue brief covers Medicare law, the need for coverage, issues with receiving Medicare home health care services, problems with access to coverage, the limited number of aides, and more. The Brief also discusses Medicare Advantage and in-home services.

CMA makes theses recommendations 

  1. Ensure the scope of current allowable home health benefits, generally, and home health aides, specifically, are actually provided. Simply put, ensure that current law is followed;
    2. Create a new stand-alone home health aide benefit that would provide coverage without the current skilled care or homebound requirements, using Medicare’s existing infrastructure as the vehicle for the new coverage; and
    3. Identify other opportunities for further exploration within and without the Medicare program, including additional Medicare revisions, demonstrations, and initiatives overseen by the Center for Medicare and Medicaid Innovation (CMMI).

After providing some actual examples, the Brief provides insights into other additions to Medicare that would provide more services to beneficiaries.  The conclusion  provides that "Medicare home health coverage is not being implemented to the full extent of the law. If it were,
countless beneficiaries and families would be better off. Nonetheless, at best, the current Medicare benefit leaves far too many patients and caregivers behind. In order to provide quality home-based
care for individuals, and support for their caregivers, significant changes are needed to the
Medicare program and the broader health insurance system." (citations omitted).

June 29, 2020 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Sunday, June 28, 2020

FAQ from CMS on SNF Visits

A few days ago CMS released a four page FAQ re: visiting residents in SNFs. Frequently Asked Questions (FAQs) on Nursing Home Visitation.

The FAQs include

1.What steps should nursing homes take before reopening to visitors? 

2. The reopening recommendations maintain that visitation should only be allowed for
“compassionate care situations.” Do compassionate care situations only refer to
end-of-life situations?

3. Can facilities use creative means, such as outside visits, to begin to allow for
visitation within the CMS and CDC guidelines; even before reaching phase three?

4.Can nursing home residents participate in communal activities before reaching
phase 3 of the nursing home reopening plan?

5.What factors should nursing homes consider when making decisions about
visitation?

6. Should residents or visitors who have tested positive for COVID-19 participate in
visits?

7. Are nursing homes required to allow visits from the ombudsman when requested by
a resident?

June 28, 2020 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare | Permalink | Comments (0)

Friday, June 26, 2020

Nursing Homes: Making Room for COVID-19 Residents?

Each day I get a email from Kaiser Health News (KHN) that contains articles collected from the prior day on various health topics.  Since COVID-19 arrived, the number of articles concerning nursing homes has greatly increased. I've refrained from writing about those-mainly because there are so many of them.  But here's a recent article that I felt was too important to pass by.

The New York Times,ran an article with this eye-popping headline:  ‘They Just Dumped Him Like Trash’: Nursing Homes Evict Vulnerable Residents. "Nursing homes across the country are kicking out old and disabled residents and sending them to homeless shelters and rundown motels." The article makes the point that caring for COVID-19 patients is more lucrative than long-term care residents. 

"Many nursing homes are struggling in part because one of their most profitable businesses — post-surgery rehab — has withered as states restricted hospitals from performing nonessential services. ... Treating Covid-19 patients quickly became a popular way to fill that financial void... Last fall, the Centers for Medicare and Medicaid changed the formula for reimbursing nursing homes, making it more profitable to take in sicker patients for a short period of time. COVID-19 patients can bring in at least $600 more a day in Medicare dollars than people with relatively mild health issues, according to nursing home executives and state officials."  Don't forget, however, that profit isn't the motive in every instance-remember back when the hospitals were jammed with COVID-19 patients and asked nursing homes to take some?

With SNFs shut down to outside visitors, Ombudsman visits may also be curtailed. And although the law requires that SNFs "find a safe alternative location for the resident to go, whether that is an assisted living facility, an apartment or, in rare circumstances, a homeless shelter... some homes have figured out a workaround: They pressure residents to leave. Many residents assume they have no choice, and the nursing homes often do not report them to ombudsmen."  Only a handful of facilities have a moratorium on resident evictions during the pandemic.

Hello CMS-are you watching this?

 

June 26, 2020 in Consumer Information, Current Affairs, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Thursday, June 18, 2020

More Reasons for a Serious Bi-Partisan Commitment to Citizenship for DACA Health & Long-Term Care Workers

Shared by my colleague, Professor Medha Makhlouf, who heads Dickinson Law's Medical-Legal Partnership Clinic, this thoughtful article explaining the importance of DACA-recipient health care workers in the United States, especially now:    

The Covid-19 pandemic is stretching our public health system to its limits and challenging our ability to meet the urgent and critical medical needs of the country as never before. As executives responsible for the legal affairs of major hospitals and lawyers working in Covid-19 hot spots, we know how crucial it is to have every available front-line medical worker fighting this pandemic. . . . 

 

New data from the Center for American Progress reveals that the DACA-recipient health care work force includes more than 6,000 diagnosing and treating practitioners, including respiratory therapists, physicians assistants and nurses; some 8,000 health aides, including nursing assistants and orderlies; more than 7,000 other health care support workers; and some 5,500 health technologists and technicians.

 

The Association of American Medical Colleges told the Supreme Court that nearly 200 physicians, medical students and residents depend on DACA for their ability to practice medicine and serve their communities. Those 200 trainees and physicians alone would care for hundreds of thousands of patients per year in normal times — the association estimates as many as 4,600 patients per year, per person. Under the demands of the Covid-19 pandemic, those numbers will be much higher.

 

The Center for Migration Studies found that 43,500 DACA recipients work in the health care and social-assistance industries, including more than 10,000 in hospitals....

The decision on the DACA case is expected this week.  "If the Supreme Court upholds the decision to terminate DACA, nearly 700,000 people — including those health care workers — will lose their ability to work and live in the United States."  For more, ready the full NYT article, There's Only One Thing Stopping Trump From Deporting Health Care Workers.  

For once, the members of Congress from both sides of the aisle should be ready with emergency legislation for citizenship (or at a minimum, permanent residency status) for these essential workers.  It is the least we can do for people who are doing the most. And it is vital for the best interests of public health across the nation.  A win-win, if we can just focus on what's important.  

WOW!  Moments after I posted the above, I see the news flash that Supreme Court Rules Against Trump Administration Attempt to End DACA, A Win for Undocumented Immigrants Brought to U.S. As Children.  

After reading the opinion(s), it is clear that while DACA recipients have a temporary reprieve, the real need is serious consideration of true relief from fear of deportation.  Must they really wait until after the election?  

June 18, 2020 in Consumer Information, Current Affairs, Discrimination, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, International | Permalink | Comments (0)

Wednesday, June 17, 2020

This "Should" Be Easy: Support DACA Workers in Health Care and Long-Term Care

The Supreme Court 's ruling on the fate of DACA-residents and workers in the U.S. could be issued this week.  Regardless of the outcome on the case itself, everyone who cares about quality of health care, including long-term care, should also care about the United States' need to be honest about how much health care depends on the hard work and commitment to care provided by temporary-status and undocumented-status  workers in health and personal care jobs.  I've seen DACA workers in action in elder care, and I've seen their families ripped apart by harsh immigration rulings.

NPR's Morning Edition had a short and yet deeply important segment today on Health Care Workers Who Are Awaiting Supreme Court DACA Decision.   Do listen to the podcast replay --  it is just 4 minutes -- and think about whether this is a key opportunity for a true, bipartisan solution for DACA-children (families) who so often are working in some of the most challenging (and dangerous) U.S. jobs during the COVID-19 pandemic.  Let's do the right thing.  

June 17, 2020 in Consumer Information, Current Affairs, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, International, Medicaid, Medicare | Permalink | Comments (0)

Thursday, June 11, 2020

Nursing Homes and the Right to Visitors During a Pandemic

The seminal 1987 Nursing Home Reform Act requires all nursing facilities to care for their residents in a manner that that "will promote ,maintenance or enhancement of the quality of life of each resident." 12 USCA Section 1396r(b)(1)(A).  The same law, at Section 1396r(e)(3),  addresses "access and visitation rights:" 

A nursing facility must - ... 

(B) permit immediate access to a resident, subject to the resident's right to deny or withdraw consent at any time, by immediate family or other relatives of the resident;
 
(C) permit immediate access to a resident, subject to reasonable restrictions and the resident's right to deny or withdraw consent at any time, by others who are visiting with the consent of the resident;
(D) permit reasonable access to a resident by any entity or individual that provides health, social, legal, or other services to the resident, subject to the resident's right to deny or withdraw consent at any time .... 
During the pandemic lockdown, states prohibited most visitations, citing the risk of infection from the outside community that could endanger not just the visitor's loved one, but potentially all residents.  States are now beginning to lift or at least ease visitation restrictions, and families are beginning to talk more openly about the impact of the isolation on residents who have not contracted the virus.  
 
This week, NPR has begun airing stories about the challenge of balancing the risks of visitors against the benefits of not just family member visits, but family member involvement in care and socialization for residents.  From one story about Luann Thibodeau and her husband Jeff, who has multiple sclerosis:
 

It wasn't candlelight and soft music that made the 40th anniversary of Luann and Jeff Thibodeau so memorable. It was gazing at each other through the window of Jeff's nursing home in Texas and eating carryout from the Olive Garden. Just the two of them. And a nursing assistant.

 

"She fed him, and I ate mine, and that was it," Luann Thibodeau says. "So that was our 40th wedding anniversary."

 

Luann Thibodeau would bring her husband, Jeff, dinner every night, except Tuesdays, when she had Bible study. Since she's been unable to visit, she says that her husband has become increasingly disinterested in food as his multiple sclerosis has worsened.
 

The Thibodeaus have not been in the same room since mid-March. That's when visitors were banned from nursing homes to slow the spread of the coronavirus. But family members say that talking via FaceTime and holding up signs at windows are no substitute for the hands-on care and emotional support their visits provide.

 

Family members often are an integral part of the care residents in nursing homes receive. They make sure meals are being eaten, clothes are being changed. They also offer invaluable emotional support. . . . 

 

Luann Thibodeau has seen that decline in her husband. She used to bring dinner for him every night except Tuesdays when she goes to Bible Study. She says that as his multiple sclerosis has worsened, he's become increasingly disinterested in food. [She explains]. "I bully him into finishing a meal. And I'll say to him, 'Jeff, you know, this is what an adult man eats. So you need to eat this.' "

 

A staff member can't do what she does. Nursing home residents have rights. So if Jeff Thibodeau tells a nursing assistant that he's done eating after three bites, she has to abide by his wishes.

 

Without his wife's push, the results of her absence is striking.

For more, listen to the NPR podcast or read the parallel written narrative in "Banned From Nursing Homes, Families See Shocking Decline In Their Loved Ones." 

The federal Nursing Home Reform Act's Bill of Rights has never been an easily enforceable mandate, and particularly in a global crisis the needs of the many can override the rights of individuals.  But there does need to be a long-range plan on how better to facilitate visitation, recognizing it as an important part of any person's quality of life.  

 

June 11, 2020 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare | Permalink | Comments (2)

Monday, June 8, 2020

Oklahoma Legal Aid Services Update: 3rd Annual Memorial Elder Abuse Symposium Goes Virtual, Starting June 15

This year, the Sonya L. Patterson Elder Abuse Symposium hosted annually by Legal Aid Services of Oklahoma, will take place over the course of several weeks, in bite-size programming, rather than in a single, all-day conference format.  In light of the online setting, the organizers are also able to open up registration and attendance to interested people outside of Oklahoma; however, there are limits on the number who can attend each session, so I recommend registering early. In past years, the symposium has drawn an audience of attorneys, law enforcement and social workers, with CLE credits available.

I'm very pleased for the opportunity to be a speaker this year. In addition to attorneys and judges, the speakers include health care professionals and bankers.  The program honors the life and advocacy of a young Oklahoma public interest attorney, Sonya L. Patterson, who passed away far too soon in 2015, as the result of an accident at the age of just 30. 

Here's the line up for the midday Symposium Webinar Series , with all sessions taking place on Central Daylight Savings Time:

Session 1: Monday, June 15th (11:00 am to 1:45 pm)

  1. The Psychic Effect on Victims of Elder Abuse by Family and/or Caregivers- Dr. Nancy Needell, M.D., Weill Cornell Medicine
  2. Attorney Responsibility to Client’s Ward or Principal- Rick Goralewicz, Staff Attorney, Legal Aid Services of Oklahoma

 

Session 2: Monday, June 22nd (11:00 am to 1:15 pm)

  1. Financial Exploitation of the Elderly- Justice Scott Roland, Oklahoma Court of Criminal Appeals with Elaine Dodd, Executive Vice President/ Fraud Division at Oklahoma Banker's Association and Jennifer Shaw, Oklahoma Securities Commission
  2. Extreme Home Takeover: Dealing with the “Concerned Relative”- Katherine C. Pearson, Professor of Law at Dickinson Law, Pennsylvania State University, Carlisle Pennsylvania

 

Session 3: Wednesday, June 24th (11:00 am to 1:15 pm)

  1. Elder Abuse General Topic- Stacey Morey, Oklahoma Attorney General’s Office, Chief of Consumer Protection Division
  2. Experts: Identifying and Utilizing in Elder Abuse Litigation- Kara Vincent, Attorney, Barber and Bartz

 

Session 4: Monday, June 29th (11:00 am to 1:15 pm)

  1. Domestic Violence and Seniors- Melissa Brooks, Staff Attorney at Legal Aid Services of Oklahoma and Gail Stricklin, Attorney at Law
  2. Abuse in Institutional Settings- William Whited, State Long Term Care Ombudsman and Nicole Snapp-Holloway, Attorney at Maples, Nix and Diesselhorst

 

Session 5: Wednesday, July 1st (11:00 am to 1:15 pm)

  1. Incompetency, Incapacity and Vulnerability- Mark Holmes, Attorney at Holmes, Holmes and Niesent, PLLC, Travis Smith, Attorney at Holmes, Holmes and Niesent, PLLC and Cathy Wood, Adult Protective Services
  2. Isolation and Loneliness- Laurel Dinkel, LCSW, Norman, Oklahoma

Click HERE for access to registration information for individual sessions or  the entire series. My thanks to Oklahoma Legal Aid Staff Attorney Rick Goralewicz for the invitation.  

June 8, 2020 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Housing, State Cases, State Statutes/Regulations, Statistics, Webinars | Permalink | Comments (0)

Another Roundup of COVID articles

I wanted to make you aware of a few more articles. Here are the links:

Covid-19 Pandemic Hits Nursing-Home Finances (Wall Street Journal-subscription required)

For Seniors, COVID-19 Sets Off A Pandemic Of Despair (Kaiser Health News) (this article talks about isolation, but note this quote from the article: "Making it worse, some seniors fear that their lives may be seen as expendable in the rush to reopen the country.... “[Older adults] are wondering if their lives are going to end shortly for reasons out of their control,” said Dr. Linda Fried, dean of the Mailman School of Public Health at Columbia University, in a university publication. 'They’re wondering if they’ll be able to get the care they need. And most profoundly, they’re wondering if they are going to be cast out of society. If their lives have value.'"

From the UK, The scandal of Covid-19 in care homes (thanks to Professor Nagle for sending this to me).

Finally, this article from Rolling Stone, Why Older People Might Suffer Most, Post-Pandemic If you work in the field of aging, that article is a must-read.

June 8, 2020 in Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink | Comments (0)