Elder Law Prof Blog

Proposed Changes to the Provision of Long Term Care

Kaiser Health News recently provided an overview of the changes proposed by the Biden Administration to long term care.  Biden Seeks $400 Billion to Buttress Long-Term Care. A Look at What’s at Stake provides this overview:

The services in question. Home and community-based services help people who need significant assistance live at home as opposed to nursing homes or group homes.

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The need. At some point, 70% of older adults will require help with dressing, hygiene, moving around, managing finances, taking medications, cooking, housekeeping and other daily needs, usually for two to four years. 

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Medicare limitations. Many people assume that Medicare — the nation’s health program for 61 million older adults and people with severe disabilities — will pay for long-term care, including home-based services. But Medicare coverage is extremely limited.

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Medicaid options. Medicaid — the federal-state health program for 72 million children and adults in low-income households — can be an alternative, but financial eligibility standards are strict and only people with meager incomes and assets qualify.

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The article additionally reviews the impact on family caregivers and the workforce, questions about the Administration's proposal and some suggestions for reform.  Stay tuned; this isn't going to be a quick or easy journey.

Takeaways from CMS Guidance on SNF Visitation

The National Consumer Voice for Quality Long Term Care has published takeaways from the most recent CMS guidance on SNF visitation. 

Here are some of  the highlights:

• Facilities should allow indoor visitation at all times and for all residents except in certain specific circumstances.

• There are now fewer circumstances under which indoor visitation can be completely suspended.

• Fully vaccinated residents can have close contact, including touch, with visitors as long as they wear a mask and practice hand hygiene.

• Visitors should not be required to be tested or vaccinated as a condition of visitation.

• CMS continues to emphasize that facilities shall not restrict visitation without a reasonable clinical or safety cause and that nursing homes must facilitate in-person visitation consistent with the federal nursing home regulations.

• Visitation must be person-centered and “consider the resident’s physical, mental, and psychosocial well-being, and support their quality of life.”

The summaries and significant takeaways are available here.

As well the Consumer Voice has released the Summary of the Centers for Disease Control and Prevention's Guidance on Quarantine for Residents of Long-Term Care Facilities, which is available here.

State of SNFs Prior to Pandemic

WGBH, a PBS station, ran this story a bit ago.   New Studies Show Dire State Of Nursing Homes Even Before The Pandemic opens with a focus on staff turnovers and highlights recent studies:

The pandemic has shined a harsh spotlight on nursing homes. Despite less than 1% of the population living in nursing homes and longterm care facilities, they account for about a third of all COVID-19 deaths. Now, two new national studies show that, even before the pandemic, the nursing home industry was in a dire situation. The studies paint a picture of places where it is unappealing to work and risky to stay.

[T]he first national study of staff turnover in nursing homes before the pandemic, published this month in Health Affairs. The study found an extraordinarily high rate of staff turnover, with an average of over 100%.

“That means the average nursing home in the U.S. has their entire nursing home staff change over the course of the calendar year,” [said one study author]. “And we found that some nursing homes had turnover as high as 300%, suggesting the staff is turning over every four months.”

That doesn't necessarily mean that all employees leave during a year. A facility with 10 staff members could have 100% turnover if everyone leaves and is replaced by a new person or if one job is filled 10 different times because the new hires keep leaving.

The article also discusses private equity involvement in the long term care industry.

Roundup on Nursing Home Articles

First, have you read this article from the New York Times? Maggots, Rape and Yet Five Stars: How U.S. Ratings of Nursing Homes Mislead the Public

Twelve years ago, the U.S. government introduced a powerful new tool to help people make a wrenching decision: which nursing home to choose for loved ones at their most vulnerable. Using a simple star rating — one being the worst, five the best — the system promised to distill reams of information and transform an emotional process into one based on objective, government-blessed metrics.

The star system quickly became ubiquitous, a popular way for consumers to educate themselves and for nursing homes to attract new customers. During the coronavirus pandemic, with many locked-down homes unavailable for prospective residents or their families to see firsthand, the ratings seemed indispensable.

But a New York Times investigation, based on the most comprehensive analysis of the data that powers the ratings program, found that it is broken.

Then, a couple days later, another article from the New York Times, this time about California, California Sues Nursing Home Chain, Saying It Manipulated Ratings System

California prosecutors sued the country’s largest chain of senior living communities on Monday, accusing the company, Brookdale Senior Living, of manipulating the federal government’s nursing-home ratings system.

* * * 

The lawsuit is among the first of its kind to accuse nursing homes of submitting false information to Medicare’s ratings program. The system assigns stars — one being the worst, five being the best — to the nation’s more than 15,000 nursing homes.

Health News Florida explained that COVID Cases Plummet 83% Among Nursing Home Staffers Despite Vaccine Hesitancy, "Federal records show a steep decline in staff cases since December, when health care workers at thousands of nursing homes began getting their shots. Still, many are reluctant to get vaccinated."

Then, this New York Times article from Canada,  Elderly, Vaccinated and Still Lonely and Locked Inside

Long-term care homes, as they are called in Canada, were prioritized for the first precious doses of vaccines, to few objections — they were ground zero for the pandemic’s cruel ravage. Around 66 percent of the country’s terminal Covid-19 victims lived in nursing homes, among the highest rates in the world.

But while the vaccines have given the majority of nursing-home residents protection from death by the virus, so far they have not offered more life....

The Storm in Texas May Be Over, But Care Gaps Still Exist

Kaiser Health News recently published a story, Texas Winter Storm Exposes Gaps in Senior Living Oversight. The storm

brought power failure and burst water pipes to millions of homes and businesses throughout Texas. But the impact, as is often the case in emergencies, was most profound on the state’s most vulnerable — including residents of senior living facilities.

Of the state’s 1,200 nursing facilities, about 50% lost power or had burst pipes or water issues, and 23 had to be evacuated, said [the] long-term care ombudsman for Texas. Of 2,000 assisted living facilities, about 25% had storm-related issues and 47 were evacuated. Some facilities reported building temperatures in the 50s.

The article discusses revisions to the regulations regarding emergency preparedness and the industry's responses, as well as the issues with other types of supportive housing.  The article also highlights how these "disasters of a century" are actually occurring more frequently, and the focus on disaster preparedness includes a conversation about requiring facilities to have generators. "In Texas, assisted living facilities are required to have emergency plans but not generators. The legislation introduced in the wake of  [the recent] winter storm ... seeks to change that. Independent living facilities ... might not be covered, though; they already have even fewer state guidelines to follow."

CMS Loosens Visitation Restrictions in Long-Term Care Facilities

CMS recently announced that it was expanding visitation, but with some safeguards still in place.  CMS Updates Nursing Home Guidance with Revised Visitation  addresses indoor visits, indoor visits during an outbreak, compassionate care visits, ombudsman visits, and vaccinations for both visitors as well as surveyors.  The revised guidance is available for download here.

Prior to the CMS revised guidance, there was some effort to increase visitation, including efforts by the National Consumer Voice for Quality Long-Term Care.  Consumer Voice, Other Advocates Call on CMS to Safely Open Nursing Home Doors offers this call to action: "[C]alling on CMS to restore full visitation rights as soon as possible. In the interim, and during the Public Health Emergency only, we are urging CMS to ensure that: ... [e]ach resident is allowed an essential support person (ESP) ... [and] [a]ll residents are allowed indoor and outdoor visitation in addition to visits with an ESP. " Their letter of recommendation is available here.  More info about their efforts, including a virtual rally, are available here and here.

 

Working Past Retirement Age, Because You Want To Do So

Not everyone wants to retire. Some folks continue to work because they need to while others continue to work because they want to do so. The Washington Post addressed this in a recent article,  Don’t want to retire? Here’s how to maintain a fulfilling career into your 80s and beyond. "People age 75 and over, including our fresh-on-the-job president, are the fastest-growing group in the labor force, even though “age discrimination is very real,” said Susan Weinstock, vice president of financial resilience at AARP." The author of the article explores the wellness advantages of continuing to work and reviews the habits of those interviewed for the article:

1. view work as pleasure
2. healthy eating and exercise is a must.
3. Keep stress in check.
4. Mentor and nurture others, as well as yourself.

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

 

Will The Nursing Home Model Finally Change?

NBC News ran this story, America now knows that nursing homes are broken. Does anyone care enough to fix them? .  Once COVID starting sweeping through facilities last year, more folks learned about the current model of providing long-term care, and their short-comings.  Experts began calling for reform on the way we provide SNF care in the US. But did that call for reform get drowned out by the daily news about the havoc COVID was wreaking on our country?

The NBC News story ran yesterday (thanks to my colleague and dear friend Professor Bauer for sending me the link).

The pandemic turned nursing homes into a death trap for more than 170,000 long-term care residents and staff members who have lost their lives to Covid-19.

But the virus also revealed how America’s system for long-term care is fundamentally broken in ways that will continue to harm vulnerable residents and workers, long after the pandemic has faded away.

The biggest underlying problem? For all the billions of taxpayer dollars that the United States spends on a system meant to care for frail, elderly residents, not enough money is being invested in caregiving itself, according to interviews with more than a dozen nursing home researchers, advocates, industry representatives and staff members.

There are two sides to this issue, as noted in the story, as well as an opportunity for reform, complete with roadblocks to achieving it.

Nursing homes, by their nature, are ideal breeding grounds for Covid-19: Frail, elderly residents live in close quarters, often requiring support from aides to eat, get out of bed, bathe and get dressed.

This hands-on caregiving is the backbone of what a nursing home provides, and the reason that most residents are in long-term care to begin with. But a chronic failure to value this work, and compensate it accordingly, helped accelerate the pandemic’s catastrophic spread, experts said.

Staffing shortages are discussed in the article, along with explaining how those shortages contribute to a greater risk of a COVID outbreak. The work these folks provide is undervalued both in terms of salary as well as the role they play in providing care. 

The section of the article on funding is quite illuminating

The typical U.S. nursing home is propped up by two programs: Medicaid, ... and Medicare, ....This is the business model that the pandemic blew up.

America’s long-term care system was created as an afterthought, when nursing home coverage for poor, frail Americans was included, without much fanfare, as part of the 1965 law .... A half-century later, the elderly population has ballooned, and life expectancy has shot up, while personal savings have not, leaving millions of aging Americans unable to pay for the care they need. But unlike most major industrialized nations, the U.S. has no universal public system that covers elder care, which means that many patients, as well as nursing homes, are ultimately left to rely on Medicaid.

The trouble with Medicaid — the only federal program that pays for long-term care — is a reimbursement rate that the industry has long complained is too low, about $200 for each day of care, on average. Medicare pays at least twice as much, but it only covers up to 90 days of post-acute care and rehabilitation, typically following a hospital stay.

The article discusses accountability, the use of third-party contractors, quality of care transparency (or a lack thereof) and lobbying efforts. The article looks at proposals to change the industry. I'm assigning it to my students and we will discuss it in class. I recommend it to you.

Upcoming Webinars

Register now for two upcoming webinars.

1. Webinar: Financial Protection for Older Adults During the COVID-19 Pandemic set for Feb 23, 2021 at 1 eastern. 

Join experts from the Consumer Financial Protection Bureau (CFPB), the Federal Communications Commission (FCC), and ACL on Tuesday, February 23 at 1 pm ET for a free webinar on financial protection of older adults during the COVID pandemic. The FCC will begin the program with an overview of coronavirus-related phone scams targeting older adults. The CFPB will share resources to help older adults address the financial impact of the pandemic. HHS will conclude the webinar with a discussion of the role of the aging services network.

Click on FCC live link to join the webinar on Feb 23 at 1 eastern.

2. A series of 3 webinars from the DOJ Elder Justice Initiative;

• March 4^th 2pm EST  |  Programs for Older Adults Who Have Experienced Financial Exploitation. Learn about three distinct programs designed specifically for older adults who have experienced financial exploitation. Register here.

• March 23^rd 2pm EST  |  The Path Forward: One MDT’s Journey to Address the Impact of Racial Injustice on Their Work. The Hennepin County Minnesota Adult Protection/Law Enforcement Multi-Disciplinary Team “MDT” provides a model case study of the impact of racial injustice on their work as an elder abuse MDT in Minneapolis. Register here.

• April 13^th 2pm EST  |  Tackling Transnational Robocall Scams: The Importance of State and Federal Partnerships Features a Federal and State partnership that successfully fought against computerized autodialing “robocall” scammers.  Register here

SNF Chain Exec. Gets Big Bonus

Sen. Warren calls Genesis Healthcare executive bonus act of ‘unfathomable greed’ according to the recent article published in the Washington Post.

A nursing home chain that gave its former CEO a $5.2 million “retention payment” at the height of the pandemic has received a sharp rebuke from Sen. Elizabeth Warren (D-Mass.), who sits on the Senate’s Special Committee on Aging.

Warren called the payout by Genesis Healthcare to George Hager Jr. — at a time when the death toll among residents was approaching 2,800 and the company was relying on federal emergency aid to survive financially — “inexplicable and unseemly” in a letter dated Jan. 27. She asked the company board to explain its decision and to provide the minutes of all meetings in 2020 where compensation was discussed. And she warned the company not to seek additional emergency relief from Washington.

Senator Warren's letter is available here. Stay tuned-more will come.

Justice Prevails: DOJ Announces Settlement

DOJ announced a settlement, Marketing Company Agrees to Pay $150 Million for Facilitating Elder Fraud Schemes

Epsilon Data Management LLC (Epsilon), one of the largest marketing companies in the world, has entered into a settlement with the Department of Justice to resolve a criminal charge for selling millions of Americans’ information to perpetrators of elder fraud schemes. 

Epsilon entered into a deferred prosecution agreement (DPA) with the Consumer Protection Branch of the Justice Department’s Civil Division and the U.S. Attorney’s Office for the District of Colorado in connection with a criminal information charging the company with one count of conspiracy to commit mail and wire fraud.

Under the terms of the DPA, which the parties submitted to the district court in Denver on Jan. 19, 2021, Epsilon agreed to pay a total of $150 million, with $127.5 million of that amount going to compensate victims of the fraudulent schemes that used consumer data sold by Epsilon. Epsilon also agreed to implement significant compliance measures designed to safeguard consumers’ data and prevent its sale to individuals or entities engaged in fraudulent or deceptive marketing campaigns. Further, the DPA requires Epsilon to maintain a procedure for consumers to request that it not sell their information to others.

Thanks to Professor Podgor for sending this to me.  It's nice to read good news!

COVID & SNFs: Good News

Well at least there is some good news on the vaccination front.   Last week the New York Times reported  Nursing Homes, Once Hotspots, Far Outpace U.S. in Covid Declines.

Throughout the pandemic, there has been perhaps nowhere more dangerous than a nursing home. The coronavirus has raced through some 31,000 long-term care facilities in the United States, killing more than 163,000 residents and employees and accounting for more than a third of all virus deaths since the late spring.

But for the first time since the American outbreak began roughly a year ago — at a nursing care center in Kirkland, Wash. — the threat inside nursing homes may have finally reached a turning point.

The article explains

Experts attribute the improvements in large part to the distribution of vaccines. About 4.5 million residents and employees in long-term care facilities have received at least one dose of the vaccine, according to the Centers for Disease Control and Prevention, including about 2.1 million who have been fully vaccinated.

Other factors, including the steep drop in new infections nationwide in recent weeks, may have contributed as well.

Just good news....finally, for this important group of our population.  

ABA BIFOCAL Latest Issue Released

The ABA Commission on Law and Aging has published vol. 42, Issue 3 (Jan.-Feb.2021),  its current issue of BIOFOCAL. The issue contains several articles, including a couple on Social Security Rep Payees, with the lead article, How Does Social Security Select Representative Payees for Adults? Results of an Independent Research Study

Almost four million older adults and adults with disabilities have representative payees appointed by the Social Security Administration (SSA) to manage their Social Security or SSI payments. How does SSA determine if a payee is needed? How do SSA staff select a payee? How do they choose an individual versus an organizational payee?  What are the considerations in long-term care residential facilities serving as the payee?  What about guardians serving as payee? How and to what extent does SSA maintain consistency in payee determinations?

In 2018, the Social Security Advisory Board (SSAB) charged researchers at Virginia Tech and the ABA Commission on Law and Aging to conduct an independent study focusing on these compelling questions.  The study team addressed SSA processes for selection of payees for adults. The underlying assumption was that a better understanding of selection practices ultimately could lead to process improvements, as well as a reduction in the potential for misuse and abuse of beneficiary funds while maintaining beneficiary rights.

A pdf of the full issue is available here.

GAO Report on State Reporting of Elder Abuse

A new GAO report was released last week. ELDER JUSTICE: HHS Could Do More to Encourage State Reporting on the Costs of Financial Exploitation offers fast facts, highlights and the report, all available for download or access via the links.  Here are the fast facts:

Financial exploitation of elders—illegal use of their funds or property—affects the victims, their families, and society. Estimated financial costs to victims are in the billions.

Most state-run adult protective services agencies have provided some data on financial exploitation of elders to the Department of Health and Human Services. But it's hard to collect the data because

not all incidents of exploitation are reported to state agencies

victims can be reluctant to implicate family members or caregivers

HHS and state data systems may not align

We recommended that HHS work with state agencies to improve the data on financial exploitation.

The highlights, fast facts, and recommendations are all accessible from here.  The full report is available here.

Consider this from the report:

Studies estimate some of the costs of financial exploitation to be in the billions,
but comprehensive data on total costs do not exist and NAMRS [National Adult Mistreatment Reporting System]  does not currently collect cost data from APS agencies. The Consumer Financial Protection Bureau found actual losses and attempts at elder financial exploitation
reported by financial institutions nationwide were $1.7 billion in 2017. Also, studies published from 2016 to 2020 from three states—New York, Pennsylvania, and Virginia—estimated the costs of financial exploitation could be more than $1 billion in each state alone. HHS does not currently ask states to submit cost data from APS casefiles to NAMRS, though officials said they have begun to reevaluate NAMRS with state APS agencies and other interested parties, including researchers, and may consider asking states to submit cost
data moving forward. Adding cost data to NAMRS could make a valuable contribution to the national picture of the cost of financial exploitation. Recognizing the importance of these data, some APS officials GAO interviewed said their states have developed new data fields or other tools to help caseworkers collect and track cost data more systematically. HHS officials said they plan to share this information with other states to make them aware of practices that could help them collect cost data, but they have not established a timeframe for doing so.

Medically Vulnerable and in Prison

There have been some stories about the impact COVID is having on the prison population.  A news station in Denver, CO ran this story a while back, Broncos players join campaign to release medically-vulnerable inmates during pandemic. The ACLU in Colorado has an effort underway to get the Colorado governor to grant clemency to low-risk prisoners.  The sidebar on the ACLU page gives examples of folks in prison who are medically-compromised but likely low risk if released.  The Marshall Project has a state by state list of COVID in prisons, concluding about 20% of prisoners have COVID. The Federal Bureau of Prisons also has information covering COVID in prisons, which includes their modified operations plans. Although in person visits were suspended, a November update indicated those would be resumed, with safeguards. With the latest surges, I expect those will again be suspended. 

And although prisons are "COVID hotspots," prisoners may not be high in priority for the COVID vaccine per a recent article in the Washington Post, Prisons are covid hot spots. But few countries are prioritizing vaccines for inmates.

Since this is the elderlawprof blog, are you wondering what this has to do with Elder Law? Just google "elderly prisoners and covid" and look at the results. Here are a few:

• Supreme Court denies request from geriatric prisoners seeking Covid relief
• COVID-19 and the Compassionate Release of the Elderly, Infirm or High Risk
• Sick, elderly prisoners are at risk for covid-19. A new D.C. law makes it easier for them to seek early release.
• Pandemic underscores need to release more elderly prisoners | COMMENTARY

SNFS and Vaccination for COVID

Since it's been a few weeks since the vaccine rollout, and with residents of SNFs in the top priority for vaccination, how successful has it been? I have posted a few articles previously, and I wanted to pass on a few more.

In my geographic area, The Tampa Bay Times reported, Tampa Bay nursing homes have all offered coronavirus vaccines to residents and staff. Note here in the headline "offered."  Some folks may refuse to get the vaccine, whether residents or staff. Which brings me to two more articles.

Inside a Nursing Home as Vaccine Arrives: ‘I Hope Everybody Takes It’ is an interesting look at a day inside a SNF when folks from Walgreens were onsite to vaccinate folks.

The approval of Pfizer’s novel coronavirus vaccine in December brought hope to the residents and staff members at Staten Island’s Clove Lakes Health Care and Rehabilitation Center. The facility was hit hard: It lost more than 40 residents to the virus last year and struggled financially as the number of new residents plummeted, along with their income.

The employees and residents had counted on the vaccine to help them return to some semblance of their old routine — including family visits — and were determined not to waste any time. Weeks before a single person got the vaccine staff had been preparing for the rollout, contacting residents and families by mail, email, robocalls and social service workers to reassure everyone about its safety and effectiveness.

And although the Tampa Bay Times reported the successes of vaccine availability in our area, that is not the case elsewhere.  The New York Times also reported a few days ago, Frustrations Boil at Pace of Vaccinations at Long-Term Care Facilities

CVS and Walgreens, which are largely responsible for vaccinating residents and workers in long-term care facilities, are on track to make at least initial vaccination visits to nearly all nursing homes they are working with by Jan. 25. The two pharmacy chains have already given out more than 1.7 million vaccine doses at long-term care facilities.

But the progress is uneven across the country and not nearly as comprehensive for different types of long-term care. For example, thousands of assisted living facilities — for older people who need less care than those in nursing homes — do not yet even have an appointment for their first visit from the pharmacy teams, in large part because states have given such facilities lower priority in their vaccine-distribution plans.

The length of time it is taking is causing some states to come up with alternate plans. The article stresses the critical nature of the situation. 

[T]he rapidly spreading virus continues to decimate nursing homes and similar facilities. The virus’s surge since November has killed about 30,000 long-term care staff and residents, raising the total of virus-related deaths in these facilities to at least 136,000, according to a New York Times tracker. Since the pandemic began, long-term care facilities have accounted for just 5 percent of coronavirus cases but 36 percent of virus-related deaths.

Also noted in the Times article, there are "other things are slowing the campaign. A significant number of long-term care workers have balked at receiving the vaccine. The virus’s spread is also delaying the process. People should not be vaccinated while they still have Covid-19 symptoms or are isolating, according to the C.D.C."

 

DOJ Announces Charges vs. Home Health Aide

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.  

COVID, Vaccination Confusion & More

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.

Whew.

Medicare Drug Out of Pocket Costs

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. 

Will COVID Change the Future of Long Term Care?

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.