Tuesday, January 19, 2021
PHI has released a new report, Caring for the Future: The Power and Potential of America’s Direct Care Workforce. Here are the key takeaways from the report
- Caring for the Future' describes the many profound challenges that have long faced this country’s direct care workforce.
- To our collective detriment, direct care workers remain undervalued and underutilized in the long-term care sector.
- Improving direct care jobs requires a comprehensive, national strategy that guides leaders across the public and private sectors.
The executive summary, available for download here, explains
Every day around the country, direct care workers leave their homes to ensure that older adults and people with disabilities have the care and support they need. These 4.6 million workers are the paid frontline of support for consumers and their families, growing as a workforce annually as people live longer and demand surges. They work in private homes, nursing homes, and residential care settings. They are unquestionably essential, as the COVID-19 pandemic has tragically underscored. They are predominantly women, people of color, and immigrants—diverse workers disproportionately impacted by structural racism and gender inequality. These workers are not valued, compensated, or supported at the level they deserve. Caring for the Future: The Power and Potential of America’s Direct Care Workforce explains these and other challenges and offers a clear and achievable path toward achieving quality jobs for this critical workforce.
The executive summary covers f0ur sections and lists eight recommendations. The entire 126 page report is available here.
A DOJ press released announced that a Home Health Aide [has been] Charged in Twenty-Two Count Indictment for Stealing Elderly Clients’ Identity, Banking, and Credit Card Information and Using it to Commit Financial Fraud.
According to allegations contained in the indictment and previously filed criminal complaint, for over a year starting in January 2019, Cofer worked as a home health aide servicing senior citizens in the South Florida community. During that time, Cofer gained access to her elderly clients’ social security numbers, dates of birth, bank accounts, credit cards, and other information. Without the knowledge or consent of these elderly clients, Cofer allegedly used the information to steal money from bank accounts, open unauthorized credit card accounts, deposit unauthorized checks, make herself an authorized user on credit accounts, make unauthorized purchases of items such as a mannequin head and wig stand, pay her mobile phone, insurance, and other bills, and send money to a prison inmate, among other things.
The press release notes that additional information, including "court documents and information" here www.flsd.uscourts.gov. Use case #s 20-MJ-8273 and 21-CR-80003-Middlebrooks.
Monday, January 18, 2021
There are so many stories being published about COVID and the impact on elders, I'm just going to include a few in this post.
I had mentioned a few weeks back that some states were circumventing the CDC recommendation on the second priority tier for vaccination. Florida is among those states, choosing to vaccinate those 65 and older. In case you weren't aware, Florida has a lot of folks 65 and older. And not enough vaccine doses for everyone. When the second batch of vaccines arrived, stories appeared regarding confusion and inefficiencies regarding signing up to receive the vaccine. (I and several of my friends can tell you first-hand accounts of this). As the New York Times described it, ‘It Became Sort of Lawless’: Florida Vaccine Rollout Turns Into a Free-for-All. It's not just Florida having this problem, as noted in Online Sign-Ups Complicate COVID-19 Vaccine Rollout For Older People.
We need to remember that not everyone has access to a computer or reliable internet-so are we leaving out an entire group in that 65 and over category eligible for the vaccine? With states left to administer the programs, Vaccination Disarray Leaves Seniors Confused About When They Can Get a Shot.
It seems to me that COVID news has been pushed off the news as the #1 story, replaced by the insurgency (rightfully so) but we shouldn't lose focus on the increasing spread of the pandemic. So we know things are going to get worse, before they get better---we haven't seen the surge from the Christmas holidays, but it's coming and very soon. Just look at what happened at Thanksgiving: COVID Kills Over 12,000 Nursing Home Residents in Weeks Surrounding Thanksgiving.
Finally, if you don't read any of these articles, read this one. COVID-19 And Congress Have Left The Senior Citizen Safety Net In Tatters explains the impact the pandemic and the economy is having on senior centers.
Saturday, January 16, 2021
Yes, this post is about a cat. If that doesn't interest you, stop now. I promise the next blog post will be back to the news items I usually discuss.
My sister's 18 year old cat has died. He was an old cat by any way you calculate it, but he was so much more. This cat, like all cats, had a unique personality. He was the king of the neighborhood (in his mind) and split his time equally inside and outside. He took no interest in birds, squirrels, or other outdoor creatures but he did take a great interest in inanimate objects. I don't know whether he fancied himself a one-cat beautification committee, or he viewed this as bringing "gifts" to his people, but anything left in anyone's yard was fair game for him to bring home.
He most frequently-to the point of close to daily-would bring my sister a newspaper-whether from her driveway, or a neighbor's. He got so adept at bringing the papers, he could hop a fence and maneuver through the dog door without dropping the paper. Although the paper seemed to be his favorite trophy, he had previously brought in gardening gloves, small stuffed animals, and most recently a toy sword (I have no clue how he got that through the doggy door).
Why is his passing newsworthy in my opinion? This pandemic has shown us the importance of connections, whether with each other or our pets. Pets bring great joy to the lives of people and help stem the impact of our isolation. The antics of my sister's cat delighted her, and me. This cat loved her and was loved by her in turn. He had a good life. He had a purpose. He had worth. He never complained in his old age about doing his self-appointed job. He kept doing his job up to a couple of days before he died. Isn't it wonderful to be loved , to bring joy to others, to have a purpose and be able to fulfill your purpose long through your life. I hope this story brought a smile to you.
Wednesday, January 13, 2021
Kaiser Health News ran an article (before Congress recessed), Seniors Face Crushing Drug Costs as Congress Stalls on Capping Medicare Out-Of-Pockets.
Many Americans with cancer or other serious medical conditions face ... prescription drug ordeals. It’s often worse, however, for Medicare patients. Unlike private health insurance, Part D drug plans have no cap on patients’ 5% coinsurance costs once they hit $6,550 in drug spending this year (rising from $6,350 in 2020), except for very low-income beneficiaries.
President-elect Joe Biden favors a cap, and Democrats and Republicans in Congress have proposed annual limits ranging from $2,000 to $3,100. But there’s disagreement about how to pay for that cost cap. Drug companies and insurers, which support the concept, want someone else to bear the financial burden.
That forces patients to rely on the financial assistance programs. These arrangements, however, do nothing to reduce prices. In fact, they help drive up America’s uniquely high drug spending by encouraging doctors and patients to use the priciest medications when cheaper alternatives may be available.
The article examines the cost of specialty drugs and reviews the results of a 2019 Kaiser survey on the issue. The high cost of such drugs may impede a person's ability to retire, the article noted. The article reviews the situation of some folks who have had to make treatment decisions based on costs and some choose to not have a prescription filled due to the costs.
There is help from some non-profits, but beneficiaries may not know about them. "The high drug prices and coverage gaps have forced many patients to rely on complicated financial assistance programs offered by drug companies and foundations. Under federal rules, the foundations can help Medicare patients as long as they pay for drugs made by all manufacturers, not just by the company funding the foundation."
Stay tuned to see if Congress takes up the issue when it reconvenes.
Monday, January 11, 2021
The American Bar Association Commission on Law & Aging has released its 2020 summary of guardianship legislation. The summary, Directions of Reform: 2020 Adult Guardianship Legislation Summary, American Bar Association Commission on Law and Aging is available .here.
The summary is divided into the following: pre-adjudication issues, multi-jurisdictional issues, guardian selection, guardian actions, fees, rights of the individual, capacity matters, guardian & fiduciary misconduct, and post-adjudication/monitoring matters. The summary includes a chart at the end for a quick reference. The link to the archives for prior year summaries is available here.
Sunday, January 10, 2021
Mark your calendars for a free briefing on January 14 at noon eastern for a free webinar from the Kaiser Family Foundation. A Shot in the Arm For Long-Term Care Facilities? Early Lessons from the COVID-19 Vaccine Rollout to High Priority Populations:
KFF will hold an interactive web event at Noon Eastern time on Thursday, January 14 that will provide the latest data on COVID-19 cases and deaths in long-term care facilities and examine how the effort to vaccinate residents and staff in long-term care settings is going, challenges experienced so far, and opportunities for improvement.
The event will be co-moderated by Tricia Neuman, a Senior Vice President of KFF and Executive Director of the Program on Medicare Policy, and Rachel Garfield, a Vice President at KFF and Co-Director of the Program on Medicaid and the Uninsured. Priya Chidambaram, a Senior Policy Analyst at KFF, will provide the latest data on cases and deaths in long-term care facilities. A panel discussion on COVID-19 vaccination efforts will follow featuring a range of perspectives, including those of patients, nursing home officials, and pharmacy providers who are performing the vaccinations.
Click here to register for the webinar.
Friday, January 8, 2021
Earlier this week the Washington Post published this article, Wealthy donors received vaccines through Florida nursing home. According to the article, the "chief executive of MorseLife Health System, a high-end nursing home and assisted-living facility in West Palm Beach, Fla., [contacted] members of the board and major donors" and offered them the opportunity to get the COVID vaccine. This also "includ[ed] members of the Palm Beach Country Club, according to multiple people who were offered access, some of whom accepted it. The precise number of invitations, and how many may have also gone to non-donors, could not be learned." The article notes the confusion in Florida regarding the vaccination protocols that basically "highlights how the country’s patchwork approach to immunization against the coronavirus — leaving decisions about eligibility to state and local authorities as well as to individual providers —[and] is creating opportunities for facilities to provide access to well-connected people while thousands of others wait in line." The article also notes that those in charge took the position that they stayed within the protocols. The article mentions that a number of those offered the opportunity fell within the age group, but did not reside at the facility and concludes with information about the two views of what happened.
Thursday, January 7, 2021
Mark your calendars for January 21, 2021 at 2 p.m. eastern for a webinar on Elder Abuse Prevention, Intervention, and Remediation from the National Center on Law and Elder Rights.
Everyone who works with older adults has a role to play in prevention, intervention, and remediation of abuse, neglect, and exploitation. Helping starts with understanding the landscape of elder abuse and the service providers and systems involved in addressing abuse. This legal basics training will provide an overview of the fundamentals of abuse, neglect, and exploitation and the signs and signals of abuse that attendees can reference in their daily lives and work.
At the end of this training, participants will be able to:
- Describe the three stages of responses to abuse
- Apply basic definitions of abuse, neglect, and exploitation
- Identify risk factors or signs of abuse, neglect, or exploitation
- Identify the differences between undue influence, exploitation, and fraud
- Describe added risks in a time of COVID-19
To register, click here.
Wednesday, January 6, 2021
The New York Times recently ran an article that focused on how elders are persevering during the pandemic. How the Oldest Old Can Endure Even This introduces us to the concept of crisis competence. That is, "[n]o visitors. No friends at the dining table. Neighbors dying without notice. But many older adults have proved resilient during the pandemic, a phenomenon known as 'crisis competence.'" For those older adults who live in long term care facilities, they have had to give up more autonomy in return for being kept safe.
Maybe it's their perspective, having a history of years on which to face their present and their future.
A surprise of the pandemic has been how well many older adults have adapted to the restrictions. “There’s crisis competence,” said Mark Brennan-Ing, a senior research scientist at Hunter College’s Brookdale Center for Healthy Aging. “As we get older, we get the sense that we’re going to be able to handle it, because we’ve been able to handle challenges in the past. You know you get past it. These things happen, but there’s an end to it, and there’s a life after that.”
While people of all ages have struggled this year, those 65 and up are still more likely to rate their mental health as excellent compared with people under 50.
The article focuses on several residents of a ltc facility, which provides us with important insights. The article wraps up and offers this advice "A motto to take into the new year: Horrible stuff happens, and people rebound from it."
Tuesday, January 5, 2021
The Wall Street Journal published this piece back in December. Covid Spurs Families to Shun Nursing Homes, a Shift That Appears Long Lasting explains the trend
The pandemic is reshaping the way Americans care for their elderly, prompting family decisions to avoid nursing homes and keep loved ones in their own homes for rehabilitation and other care.
. . .
The drop-off has persisted since spring, including at times when the virus’s spread was subdued. In the summer, when many hospitals were performing near-normal levels of the kinds of procedures that often result in nursing-home stays, referrals to nursing homes remained down.
Occupancy in U.S. nursing homes is down by 15%, or more than 195,000 residents, since the end of 2019, driven both by deaths and by the fall in admissions, a Wall Street Journal analysis of federal data shows.
The decline in nursing-home patients covered by Medicare, which provides payments vital to the homes’ business model, is even steeper. That has left the industry in precarious financial shape. The biggest U.S. nursing-home company said in August it might not have enough money to pay its obligations.
I always ask my students two questions when we cover the topic of nursing homes: 1. do they believe nursing homes are important to our society for the provision of long term care? (they answer yes). 2. How many of them want to reside in a SNF at some point in their lives? (they answer no).
Surveys have long shown many patients don’t want to go to nursing homes. The pandemic has made them even less popular, according to a September survey of adults 40 and older by AARP. Just 7% said they would prefer a nursing home for family members needing long-term care, and 6% said they would choose one for themselves. Nearly three in 10 respondents said the pandemic had made them less likely to choose institutional care.
The article notes that the SNF industry has already begun to pivot, and home health care agencies are expanding their services. Medicare's changes to allow for more services in homes also help as some of the Advantage plans have already moved in that direction. The article provides some interesting anecdotes about some of the services available. It's past time for us to rethink how we provide long term care in this country. Long past time....
A subscription is needed to access the full article.
Thanks to Professor Dick Kaplan for sending me this article.
Monday, January 4, 2021
Happy 2021. Several articles have been published examining the pandemic's longer-term impact on SNFs. I wanted to point out two. First, consider the Washington Post article about how SNFs are structured, Profit and pain: How California’s largest nursing home chain amassed millions as scrutiny mounted.
More than 70 percent of the country’s nursing home providers use operating funds to pay themselves through so-called related parties — companies they or their family members partially or wholly own. In 2018, Brius nursing homes paid related parties $13 million for supplies, $10 million for administrative services and financial consulting, and $16 million for workers’ compensation insurance, state records show. The homes also sent a total of $64 million in rent to dozens of related land companies.
The practice is legal and widely supported by the industry, which argues that related parties help control costs and limit financial liability. Watchdog groups counter that nursing home owners can reap excessive profits from public funds by overpaying their own companies. Related parties generally do not have to disclose profits, leaving regulators with little way to assess the financial gains of owners.
Covid has changed the "business as usual" model, it would seem, as the article notes that "scrutiny has mounted in recent months as the federal government delivered about $54 million to Brius homes in coronavirus relief aid, meant as a lifeline for providers struggling to protect residents amid an unprecedented health crisis that has killed more than 92,000 nursing home residents nationwide." The Washington Post did an in-depth look at this SNF chain. The article details what the reporters discovered regarding finances and taxes. There are California groups that have called for the California legislature to revise the oversight of SNFs. The article indicates that efforts may also be made at a federal level. This detailed article is well worth reading and I plan to assign it to my students, so they can have a better understanding of the structure of SNFs.
The first coronavirus outbreak in the United States occurred in a nursing home near Seattle, in late February. Since then, the country has endlessly revised its hot spot map. Yet the situation in nursing homes and assisted-living facilities has only gotten worse: More than 120,000 workers and residents have died, and residents are now dying at three times the rate they did in July.
Long-term care continues to be understaffed, poorly regulated and vulnerable to predation by for-profit conglomerates and private-equity firms. The nursing aides who provide the bulk of bedside assistance still earn poverty wages, and lockdown policies have forced patients into dangerous solitude.
Fortunately... and maybe hopefully...., with the COVID vaccine and priority given to those who work and reside in SNFs, this won't be a story that continues in the same vein. But the author of this piece aren't telling us we will return to the prior way of things. "When the pandemic is finally history, we’ll need to deal with all of this: the staffing shortages, low pay and lack of accountability — the many ways we have failed residents, family members and staffers. The awful truth is that long-term care was designed to fail years before Covid-19." Why is this? Various stressors combined push the need for change in how long term care is provided. "Over the past few decades, the popularity of “aging in place,” combined with new medical technologies and longer life spans, has changed the nature of care for seniors and people with disabilities. Residents of the nation’s 15,400 C.M.S.-certified nursing homes are much older, sicker and poorer than they used to be." The article mentions the health of the residents, low pay for employees, employees working jobs at different facilities as contributing to the crisis.
The author makes a number of suggestions for changing long-term care in the U.S. and concludes with a call for action from the incoming administration
Most important, we must transform the way we think about long-term care — treating it not as human warehousing or the duty of underpaid women, but as an integral part of our medical system.
All of these changes are possible — and modest, really, given the magnitude of the emergency. By 2050, 19 million people will be 85 or older, and many will require help to live with comfort and a modicum of dignity. What we really need, for all Americans, is single-payer health insurance that covers quality long-term care. But short of that, Mr. Biden and Kamala Harris have a chance to make amends for the deadly failures of the current administration.
Wednesday, December 30, 2020
It's the end of 2020---finally---so here are a few recent items about Elders and COVID to close out 2020.
There is a lot to unpack in these articles. COVID has had a significant impact on elders, and it will be some time before we learn the full impact on elders, their families and the professionals who serve them. I expect several of my students in my spring seminar will write papers on these various issues.
Sorry to not end 2020 on a happy note. Here's to 2021 and rapid availability of the vaccine to all. Stay smart, stay masked and stay home. Thanks to our health care providers, first responders and those who keep us going.
Tuesday, December 29, 2020
Before the holidays, The Washington Post ran an article that really resonated. At my age, it’s time to fight everyday ageism — especially when I’m guilty of it starts with a mention of birthday cards that make old age jokes, compliments (you don't look your age), and even lying about one's age. The author explains that this type of action is indicative of everyday ageism, that is "reinforcing the stereotype that old is bad (and young is good). I’d absorbed the negative messages about being older." Please don't think this is something that happens occasionally. (Just think about greeting cards and party decorations). The article notes that "the University of Michigan in conjunction with AARP reported the findings of its National Poll on Healthy Aging, which described how those .... 50 to 80 ... are bombarded with negative and hostile stereotypes."
Here are some telling results from that poll:
The poll examined older adults’ experiences with nine different forms of ageism, which fall into three buckets: exposure to ageist messages (like advertising), ageism in interpersonal relationships (what friends or family say) and internalized ageism (negative beliefs we absorb).
According to the poll, “more than 80 percent of those polled say they commonly experience at least one form of ageism in their day-to-day lives.” And 40 percent said they routinely experience three or more forms of this everyday ageism...."
The article notes the physical and psychological impact on those subjected to everyday ageism. And it's just not in person interactions. [T]he more time we spend watching television, browsing the Internet or reading magazines, the more likely we are to experience everyday ageism, meaning negative — and incorrect — images of older people such as those depicting us as frail or dependent, or unable to use new tech devices or social media platforms." The article offers some steps we can take to push back against this everyday ageism.
I plan to use this article in my class. My hope is it will make my students think...and change their behaviors.
Thanks to Professor Naomi Cahn for sending me the link to the article.
Monday, December 28, 2020
The Tampa Bay Times reported recently on an uptick in the numbers of COVID deaths in Florida . Why are coronavirus deaths doubling in Florida’s nursing homes? references a recent report from AARP "that the COVID-19 death rate among Florida nursing home residents doubled in the three weeks around the Thanksgiving holiday, and infections continue to climb among the state’s most vulnerable residents. The death toll spike was so alarming that AARP decided to report on the data rather than wait for its scheduled monthly release on Jan. 10." One expert quoted for the article pointed to the state's failure to "to provide accurate, rapid-result testing of everyone entering elder-care facilities — staff, visitors, family caregivers and vendors." The AARP report with the Florida data is available here.
We all need good news these days. So here's one story for the holidays that should make you smile. Santa’s ‘Grandchildren’ Spread Joy In Italian Nursing Homes explains the Santa's grandkids project:
Despite a grim year marked by death and loneliness, the holiday spirit is descending on the Zanchi nursing home, one of the first in Italy to shut its doors to visitors after a COVID-19 case was confirmed in the nearby hospital on Feb. 23.
The bearers of glad tidings were the so-called “grandchildren of Santa Claus,” people who answered a charity’s call to spread cheer to elderly nursing home residents, many of whom live far from their families or don’t have any family members left.
The program, in its third year, continues to grow in popularity, with almost 6000 gits distributed to 228 SNFs. The featured nursing home had 43 residents participating which included virtual visits with Santa's grandkids, during which the SNF residents opened presents. It is worth noting that the volunteer grandkids also benefited from participating in the project.
Well done everyone!
Thursday, December 24, 2020
A couple of days ago, the Washington Post ran an uplifting article about a hug room in a SNF. After months of isolation, a ‘hug room’ lets Italian nursing home residents touch family for the first time tells us about "a 7-foot-tall piece of plexiglass, molded into a three-sided booth. It had four cutout holes, where protective sleeves would be added for arms. It was known, in the strange language of the pandemic, as a “hug room,” but it was less a room than a barrier: residents on one side, relatives on the other." Although not as ideal as living in a COVID free world (or at least a vaccinated one), this "plexiglass represented the sort of modest step some nursing homes are now taking in a year when they have faced excruciating decisions about how protective to be and how best to reduce their risks." The article references similar efforts taken by other SNFs.
A little bit of good news, then, for Christmas.
PPS-remember to thank first responders, health care professionals and all who keep us safe and going through this trying time. Stay safe and stay healthy.
Although in truth, there is no "season" for scammers. They operate year round. The only thing that changes is the scam. The Washington Post a few weeks ago highlighted this with the following story, A professor thought he was sending money to help federal officials catch human traffickers. It was a scam.
The story seemed hard to believe, but whatever doubts the professor said he harbored melted away as the purported agent unspooled detail after detail of the man’s life. He knew his Social Security number. He listed properties the man had purchased 20 years ago and knew the banks he used.
** *Government impersonation scams are an exploding category of crime with losses increasing tenfold from $12.5 million in 2017 to $124 million in 2019, according to the FBI’s Internet Crime Complaint Center. The FBI, U.S. Marshals, IRS and police departments nationwide have reported issues in recent years, but the Social Security Administration (SSA) has been one of the hardest hit.
Wednesday, December 23, 2020
The Hill ran an item a couple of weeks ago, Social Security Administration is preparing to bar 500,000 Americans from getting benefits.
SSA’s proposal, as described in press reports, would make it harder for older workers to receive Social Security Disability Insurance (SSDI) benefits. By law (not regulation), SSA is required to consider age, education and work experience when determining whether a person meets the statutory definition of disability.
The implications are far reaching-if this proposal is passed.
In short, SSA’s proposal to tighten SSDI benefits fails to even advance past a very basic question about the suggested policy: What is the point? Looking at recent or modern data, the current system routinely denies benefits to older individuals with serious health problems and diminished prospects in the modern economy. Amplifying these outcomes by trying to get even more denials is not a rational policy approach.
The proposal would also exacerbate inequality in the United States along the lines of race and income. More than 25 percent of denied Social Security disability applicants are Black, a percentage that far exceeds the percentage of African Americans in the overall working age population. Additionally, nearly 40 percent of denied applicants live in poverty. SSA’s proposal to get more denials seems out of touch with regard to many of the serious problems facing the country.
It remains to be seen whether the administration will continue to push this through before President-elect Biden takes office. Although the change could be undone, wouldn't it be nice if it just didn't happen?
Thanks to my colleague, Professor Mark Bauer, for sending me the article.
Tuesday, December 22, 2020
It's going to be some time before we see good news stories about residents of SNFs---although the vaccination of SNF residents is good news. So here are several recent articles regarding SNFS and COVID-but be forewarned, these first two are not easy to read.
There are just no words....
(Thanks to Morris Klein and Professor Bauer for sending me the link to this article).
This last article brings up some interesting issues for class discussion-such as consent, refusal of consent, and inability to consent.
Please everyone-stay safe and remember to thank our first responders, health care professionals and essential workers. And let us never forget those we have lost to this pandemic.
December 22, 2020 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (1)