Thursday, September 24, 2020
Not a day goes by, or so it seems, that thee isn't some new article or announcement or data released about SNFs. Here, in no particular order, is some of the recent ones that I've collected in my inbox.
New York Times: Inside a Nursing Home Devoted to Treating Those With Covid-19
Wednesday, September 23, 2020
The ABA Commission on Law & Aging, along with the Penn Memory Center, has announced the release of a new voting guide, Assisting Cognitively Impaired Individuals with Voting: A QUICK GUIDE.
Here's the intro to the guide
Difficulties in communication can occur when interacting with a person who has cognitive impairment. The techniques and tips described in this guide will help make sure that your communication is as effective as possible and within the limits of assistance permitted by election laws.
These techniques and tips are especially important when interacting with persons who are diagnosed with Alzheimer’s disease or another brain illness or disorder such as stroke or head injury.
The guide discusses capacity to vote, communication challenges, and listening skills. The guide offers 10 case studies with suggestions for those who may be assisting such voters.
An underlying principle here is that people should not be treated any diferently in voting rights based on any perceived impairment or other personal characteristic. People whose mental capacities are clearly intact may vote for candidates based on any whim or reason, rational or irrational. Similarly, for persons with some level of cognitive impairment, if they can indicate a desire to participate in the voting process and they can indicate a choice among available ballot selections, their reasons for such choice are not relevant.
The full guide is available here.
Prohibiting visitors to SNFs has hopefully helped limit the spread of COVID. But what is the impact of those in isolation? According to the Washington Post article, Pandemic isolation has killed thousands of Alzheimer’s patients while families watch from afar, for some the impact has been profound. According to the Post's research, the article states that
Beyond the staggering U.S. deaths caused directly by the novel coronavirus, more than 134,200 people have died from Alzheimer’s and other forms of dementia since March. That is 13,200 more U.S. deaths caused by dementia than expected, compared with previous years, according to an analysis of federal data....
Overlooked amid America’s war against the coronavirus is this reality: People with dementia are dying not just from the virus but from the very strategy of isolation that’s supposed to protect them. In recent months, doctors have reported increased falls, pulmonary infections, depression and sudden frailty in patients who had been stable for years.
This is an important consideration as states begin to allow visits to residences of LTC facilities. Data is also showing increased deaths not specifically from COVID but "occur from causes such as hypertension or sepsis. But they are occurring at much higher levels than in the past, experts say, in part because of the pandemic’s indirect effects — hospitals being overrun or care being delayed."
The article highlights a number of individuals' stories and compares reopening of SNFs in other countries to that of the US. "Countries like the Netherlands have safely reopened their nursing homes without any increase in coronavirus cases by providing ample protective equipment, testing and rigorous protocols. ... But in the United States, little of the trillions in emergency funding has gone to nursing homes. For months, the Trump administration has talked of getting more testing into nursing homes, but the effort continues to be plagued with problems."
The article includes information about the methodology used for this study. This is a helpful article to use as a basis of class discussion. I'm assigning to my students!
September 23, 2020 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations | Permalink
Tuesday, September 22, 2020
Remember when you went to the movie theater (I know, it's been a while) and before the movie, there would be displayed on the screen that the movie would be in Dolby sound. Well, guess what. Dolby is more than sound. Dolby is the man who invented it, Ray Dolby to be exact. Mr. Dolby died a few years back from Alzheimer's. It's only fitting that his son has released a new movie, The Artist's Wife, abut Alzheimer's, New Film "The Artist’s Wife" Tells the Story of a Family Navigating an Alzheimer’s Diagnosis.
The film, described as "show[ing] the difficult and often raw dynamics of a family facing an Alzheimer’s diagnosis ... stars Lena Olin and Bruce Dern, and [Dolby's] own family’s experience facing the disease." An interview with the filmmaker about the film and his family experiences is available here.
The Alzheimer's Association is doing an advance screening of the film. "Visit this link to register to watch “The Artist’s Wife” before it is released in theaters and virtual cinemas on September 25. Access is limited, so please reserve your spot today. The film is currently only available to U.S. viewers."
Monday, September 21, 2020
A recent article in The Guardian highlighted a housing experiment in Sweden that combats loneliness, 'It's like family': the Swedish housing experiment designed to cure loneliness. (If you don't have an account with The Guardian, you need to register, but there is no fee).
The project, known as Sällbo, is
[A] radical experiment in multigenerational living in Helsingborg, a small port city in southern Sweden. Its name is a portmanteau of the Swedish words for companionship (sällskap) and living (bo), and neatly encapsulates the project’s goals – to combat loneliness and promote social cohesion by giving residents incentives, and the spaces, for productive interaction.
Sällbo, which opened last November, consists of 51 apartments spread over four floors of a refurbished retirement home. More than half of the 72 residents are over 70s, like Ahlsten and Bacharach; the rest are aged 18-25. All were selected after an extensive interview process to ensure a mix of personalities, backgrounds, religions, and values, and all had to sign a contract promising to spend at least two hours a week socialising with their neighbours.
Not only was this project designed to combat isolation amongst Sweden's elders, it also was designed to respond to "the 2015 refugee crisis [which] meant organisations like Helsingsborgshem were under pressure to house growing numbers of people who were struggling to integrate with – and win acceptance from – Swedish society. So a plan was hatched to mix the two, with younger Swedish people acting “as a bridge." So far the reports of the project's success have been positive despite the hurdles of starting a new endeavor in these times (think COVID). Information about the services, costs, etc. are available here.
Thanks to my colleague and dear friend, Professor Bauer, for bringing this article to me.
Friday, September 18, 2020
Here's a cool idea from the National Long-Term Care Ombudsman Resource Center: Ombudsman Safety Bags! As states begin to allow visits for residents of LTC facilities, ombudsmen, among others, need to keep themselves, and others, safe. The safety bags include "an Ombudsman imprinted face mask, hand sanitizer, sanitizer wipes, and resources specifically for Ombudsman programs. The resources include tips for Ombudsman program communication, a tip sheet about self-care, NORS FAQs related to COVID-19, 25 Ombudsman program promotion postcards, and COVID-19 Recovery and Reentry Resources." It seems that these bags would be helpful for any professional who interacts with others, especially in cases where attorneys make home visits to their clients.
I just wanted to share something positive with you, so there you have it!
Wednesday, September 16, 2020
Convene a commission of experts to address safety and quality in nursing homes in relation to the public health emergency. The main purpose of the independent Coronavirus Commission for Safety and Quality in Nursing Homes (Commission) was to solicit lessons learned from the early days of the pandemic and recommendations for future actions to improve infection prevention and control measures, safety procedures, and the quality of life of residents within nursing homes.
The 25 member commission met 9 times and made the following:
27 recommendations and accompanying action steps organized into 10 themes. These themes intersect with the Commission’s four objectives, and reflect responses to:
• Ongoing supply and affordability dilemmas related to testing, screening, and personal
protective equipment (PPE)
• Tension between rigorous infection control measures and quality of life issues that exist
in cohorting and visitation policies
• A call for transparent and accessible communications with residents, their representatives
and loved ones, and the public
• Urgent need to train, support, protect, and respect direct-care providers Outdated infrastructure of many nursing-home facilities
• Opportunities to create and organize guidance to owners and administrators that is more
actionable and to obtain data from nursing homes that is more meaningful for action and
• Insufficient funding for quality nursing home operations, workforce performance, and
The commission did not unanimously adopt the report. The 186 page report is available here. Stay tuned.
The New York Times asked the hard question, whether COVID deaths in SNFs were preventable, in a recently published opinion from the editorial board. How Many of These 68,000 Deaths Could Have Been Avoided?
Around 40 percent of all coronavirus-related deaths in the United States have been among the staff and residents of nursing homes and other long-term care facilities — totaling some 68,000 people.
Those deaths were not inevitable. The novel coronavirus is adept at spreading in congregant living facilities, and older people face an increased risk of contracting and dying from it. But most of the nation’s nursing homes had months of warning about the coming threat: One of the first coronavirus outbreaks in the country was in a nursing home near Seattle, making it clear that such facilities ought to prepare.
The opinion discusses steps SNFs could have taken to reduce the chances of spread, the financial model for SNFs in the US. The opinion also discusses the reduction of oversight and notes
Every effort should be made to ensure that the bulk of the money that the government puts into this industry goes to patient care, not providers’ pockets. An investigation started by the House of Representatives into the nation’s largest for-profit homes is a meaningful step in this direction. The Justice Department should follow suit.
The opinion discusses the way SNFs get supplies for their PPEs, etc. as well as staffing shortages. The editors conclude with 3 recommendations
In the near term, lawmakers should provide for hazard pay for nursing home workers in the next relief package and should require all nursing homes to enact non-punitive sick-leave policies so that workers don’t infect colleagues or residents.
In the longer term, federal officials need to consider revising Medicaid reimbursement rates for long-term care so they support higher than minimum-wage salaries, and shifting reimbursement policies so at least some long-term care can be reimbursed with Medicare dollars.
Lawmakers and nursing home operators also would do well to consider a national initiative, perhaps involving student volunteers and internship programs, to recruit future workers to nursing home care. That work, which can be deeply rewarding, will remain urgently needed long after this crisis passes.
Tuesday, September 15, 2020
The Tampa Bay Times recently reported that the Florida Governor was authorizing visitation of residents in SNFs and ALFs in certain circumstances, DeSantis says yes, but will Florida nursing homes reopen to visitors? The order, which was effective on September 1, still requires that visitors maintain social distance. "The governor’s executive order... end[ed] the five-month ban on visitors at long-term care facilities that he imposed in an effort to protect the state’s most vulnerable residents from the coronavirus. The order will continue to allow visits from those deemed essential or compassionate caregivers, including in facilities that have had recent positive tests." The order is optional and the SNFs and ALFs can choose to not allow visitors.
The final report of the task force appointed by the Florida governor is available here.
Monday, September 14, 2020
Mark your calendars now for a free webinar on How Health Plans Serving Dual Eligibles Can Center Equity During COVID-19. The webinar is set for October 6, 2020 from 2-3:30 p.m. Here's a description of the webinar.
The COVID-19 pandemic has brought to the forefront longstanding racial disparities in our healthcare system, and data show that older adults – especially older adults of color and those in residential congregate settings – are disproportionately impacted by the virus. Aging advocates play a key role in holding health plans and government agencies accountable to meeting the needs of those most at risk during this time. In this webinar, How Health Plans Serving Dual Eligibles Can Center Equity During COVID-19 , we will provide an overview of dual eligibles and the types of health plans that serve them. We will also present specific programmatic recommendations that advocates can push health plans with dual eligible members in their community to adopt. These recommendations are measures that plans can take to center equity in their ongoing response to COVID-19 and ensure they are meeting the needs of older adults of color during this challenging time.
To register, click here.
Friday, September 11, 2020
Computer Weekly recently addressed the legal issues that may occur when using technology for caregiving AI may be a solution to the social care crisis, but what are the legal concerns?, looks at the caregiving situation in the U.K. Building on the story from yesterday about the robot "Pepper" who can carry on conversations, the article highlights some legal issues, such as an individual's privacy.
Consider this-the robot could report concerns about abuse, for example, "the technology might provide a report, supported by video evidence, to family members or those with the legal responsibility of care, such as attorneys or deputies, who can then review such material. It can easily become part of a care home contract to consent to such filming, although it is vital that this is handled in a sensitive manner and regularly deleted to ensure that a resident’s privacy is protected." The article notes concerns about "sensitive personal data." Would residents provide consent? Who would consent if a resident lacks capacity. As the article concludes, "[W]e must never forget who is at the heart of these considerations, and the legal framework needs to catch up with the technology to protect them and for it to have a viable chance of success."
Thanks to Professor Feeley for sending me this article.
Thursday, September 10, 2020
The Guardian recently published an article about the use of robots in long term care facilities to combat loneliness of residents. Robots to be used in UK care homes to help reduce loneliness describes the roll these robots can play in interacting with residents. These are not your "normal" robots, but then I don't know what one would consider a "normal" robot. These robots, on wheels, "called “Pepper”, move independently and gesture with robotic arms and hands and are designed to be “culturally competent”, which means that after some initial programming they learn about the interests and backgrounds of care home residents. This allows them to initiate rudimentary conversations, play residents’ favourite music, teach them languages, and offer practical help including medicine reminders." The researchers not that these robots do not replace human caregivers but instead supplement them. The robots were tested in the U.K. and Japan and researchers found that those residents who spent time with the robots for "18 hours across two weeks had a significant improvement in their mental health. There was a small but positive impact on loneliness severity among users and the system did not increase feelings of loneliness...."
Robots, whether "Pepper" or others, do have limitations--for example, they aren't human. The article reports some of the limitations mentioned, such as their chats with residents were lacking some depth, were impersonal and lacked cultural awareness. Their movements were, shall we say, robotic. But imagine, a robot that can hold a conversation with you. This can be a great tool, to supplement human caregivers!
Thanks to Professor Feeley for sending me the article.
Thursday, August 27, 2020
Mark your calendars for the 2020 Schiller DuCanto & Fleck Family Law Center Virtual Symposium: The Current State of Elder Law. The symposium will be October 12, from 10-5:45 edt. Here's a description about the program
DePaul’s Schiller DuCanto & Fleck Family Law Center is hosting a full day virtual symposium on the area of elder law. Through various panel discussions with experts in the field, panelists and attendees will explore the intersection of family law and elder law, emergency guardianships, advance directives, public benefits, caregivers, choices in end of life matters, protecting your loved ones from financial exploitation, and LGBTQ Seniors. There will also be an elder law case law update that you don't want to miss.
Click here for more info and to register.
Wednesday, August 26, 2020
The DOJ announced a guilty plea in a huge prize notification scam, Defendant Pleads Guilty In Multi-Million Dollar Prize Notification Scam Affecting Elderly Victims.
Here's some of the salient information
A Las Vegas area resident charged with perpetrating a prize-notification scheme that bilked victims out of more than $10 million pleaded guilty... to conspiracy to commit mail fraud based on her participation in a scheme that preyed upon hundreds of thousands of victims, many of whom were elderly and vulnerable, with fraudulent prize notices. The notices led victims to believe that they could claim a large cash prize if they paid a small fee. This was false; victims who paid the fees did not receive anything of value.
. . .
“The defendant and her co-conspirators exploited the elderly and vulnerable by bombarding them repeatedly with false promises of wealth,” said Acting Assistant Attorney General Ethan P. Davis of the Department of Justice’s Civil Division. “Today’s guilty plea demonstrates the Department’s continuing commitment to bring to justice those who prey upon the elderly.”
The good guys win! Thanks to my colleague, Professor Podgor, for alerting me to this.
Tuesday, August 25, 2020
The American Elder Abuse Conference announce its webinar, Elder Fraud Prevention and Response Networks – Building Collaboration, on September 17, 2020 at 2 p.m. edt.
This 90-minute session aims to help establish multi-disciplinary networks (MDTs) and expand the capacity of existing ones to better address the issue of elder financial exploitation. The webinar’s instructors are Jenefer Duane (Senior Program Analyst in the Office of Financial Protection for Older Americans at the Consumer Financial Protection Bureau), and Talitha Guinn-Shaver (the Elder Abuse Multidisciplinary Team Technical Assistant for the Elder Justice Initiative at the US Department of Justice). The event is hosted by the American Elder Abuse Conference, the leading multi-disciplinary national conference dedicated to protecting our elders.
If you need further information, contact the American Elder Abuse Conference at: Events@ElderAbuseConference.org.
Click here to register for the conference.
Monday, August 24, 2020
There are now four digital publications available from the landing page, including the Journal, Generations Journal (quarterly), Generations Today (news publication, six times/year), Generations Now (blog and commentary) and finally, Generations Bylines, a new podcast that interviews authors and researchers in the field of aging. It's a great resource for our students, especially if you want them to stay updated on the trends in the field. (Full disclosure, I"m on the ASA board).
Sunday, August 23, 2020
Inevitably ... the virus has found its most ideal conditions in the warehouses storing America’s elderly population. No one knows the current death toll. As of early July, CMS put the number at 33,509, but the count covered only federally regulated nursing homes, not assisted-living communities. The homes, moreover, were not required to report deaths that occurred before May 8, although the agency said it was confident that “the vast majority” did so. One in five nursing homes didn’t bother to report their numbers at all. A New York Times study in late June put the number of deaths in U.S. nursing homes at a staggering 55,000, but even this figure did not necessarily include all of those who became infected in a home but died in a hospital, as was the case for Sharon Mitchell. In some states, the vast majority of COVID-19 deaths were in homes: 64 percent in Massachusetts, 68 percent in Pennsylvania, 77 percent in Minnesota. In New Jersey, one in every ten people housed in nursing homes or assisted-living centers died. This was a helpless population, helpless because so often confined in a state of neglect and squalor. But despite or perhaps because of their conditions, they were worth a lot of money. In effect, they were being harvested for profit.
The article looks at the financial model of long term care facilities in the U.S. It offers a comprehensive history of the development of LTC facilities in the U.S., culminating with a discussion of the ownership of LTC facilities by private equity firms. The article covers the impact of the pandemic and the efforts by the industry to get shield laws to provide them immunity.
As noted by the article, it's not only U.S. facilities that have faced these deaths from the pandemic. It notes one company that made changes early in the pandemic, which resulted in less cases, at least in some facilities. If we are to change the way we provide ltc in this country, in my opinion, this article is important. I'm assigning it to my students.
Friday, August 14, 2020
Earlier this week, the GAO issued a new report, CHILD WELFARE AND AGING PROGRAMS: HHS Could Enhance Support for Grandparents and Other Relative Caregivers.
Here are the highlights
In 2018, an estimated 2.7 million children lived with kin caregivers— grandparents, other relatives, or close family friends—because their parents were unable to care for them. Most of these children were cared for outside the foster care system, which can affect the types of services and supports available. While children did not live with parents for a variety of reasons, parental substance abuse and incarceration were often cited in data and in interviews with program officials.
Challenges faced by kin caregivers include having limited financial resources and needing legal assistance, particularly when caring for children outside foster care, according to survey data and studies GAO reviewed. This is, in part, because licensed foster parents generally receive foster care maintenance payments and other services. Officials in selected communities said they have addressed some challenges by, for example, providing temporary payments or legal representation to eligible kin caregivers. However, officials also said that program eligibility criteria or insufficient funds can limit availability or result in waiting lists.
The Department of Health and Human Services (HHS) provides technical assistance and other support to help states use federal programs and initiatives established to serve kin caregivers. HHS officials said that these programs are optional, so they mainly provide assistance in response to states' requests. However, this approach has not led to widespread use. For example, 23 states used the option under the National Family Caregiver Support Program to serve older relative caregivers with 1 percent or more of their fiscal year 2016 funds (spent through 2018). State officials said they would like more guides or tools for using these programs. By not proactively sharing information and best practices, HHS may be missing opportunitiesto help states better support kin caregivers.
GAO is making two recommendations to HHS on sharing information and best practices with states about federal programs that serve kin caregivers. HHS did not concur, stating that the agency already provides ongoing support. GAO maintains that implementing these recommendations would be helpful.
The full report is available here.
Thursday, August 13, 2020
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.
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.
Tuesday, August 11, 2020
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?”