Elder Law Prof Blog

HHS 2020 Poverty Guidelines

HHS has released the 2020 Poverty Level Guidelines.

2020 POVERTY GUIDELINES FOR THE48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA

Persons in family/household Poverty guideline

1 ..................................................$12,760

2 ..................................................17,240

3 ..................................................21,720

4 ..................................................26,200

5 ..................................................30,680

6 ..................................................35,160

7 ..................................................39,640

8 ..................................................44,120

"For families/households with more than 8 persons, add $4,480 for each additional person."

Alaska and Hawaii are also available in the publication.

PACE Program and Adult Day Care

Kaiser Health News (KHN) recently published a story about a PACE program, Government-Funded Day Care Helps Keep Seniors Out Of Nursing Homes And Hospitals.

The services provided by PACE, a national program primarily funded by Medicaid and Medicare, are intended to keep people 55 and older who need nursing home levels of care at home as long as possible and out of the hospital.

The program is more important than ever as baby boomers age, its proponents say.

“The rapidly growing senior population in California and across the country will put enormous strain on our current fragmented, and often inefficient, health care delivery system,” said Tim Lash, president of Gary and Mary West PACE. California officials consider PACE an integral part of the state’s strategy to upgrade care for aging residents.

Consider the cost-savings to states with PACE programs, as well as the number of folks, typically dual eligibles, who participate. According to the story,

The National PACE Association said data it collected for 2019 shows seniors enrolled in PACE cost states 13% less on average than the cost of caring for them through other Medicaid-funded services, including nursing homes.

. . .

PACE participants who do not receive government medical benefits can pay out of their own pockets. At Gary and Mary West, the tab ranges from $7,000 to $10,000 a month, depending on the level of care.

Nationally, 50,000 enrollees participate in PACE programs at over 260 centers in 31 states. In California, PACE serves nearly 9,000 vulnerable seniors at 47 locations.

PACE provides the same services as under Medicare and Medicaid, and use of team from various disciplines to provide care. Patients often have chronic conditions and  almost 2/3 of them have some level of cognitive difficulty.

Check it out.

 PACE enrollees commonly have conditions such as vascular disease, diabetes, congestive heart failure, depression and bipolar disorder.

Elder Justice Mapping Webinar

Register now for an upcoming webinar from the Department of Justice webinar on Mapping Elder Justice Networks.  The webinar is scheduled for January 21, 2020  at 2 p.m. est.   Here is info about the webinar

Join us for the webinar, Mapping Elder Justice Networks, where we will introduce the new Elder Justice Networks Locator. 

The Locator is a map designed to help elder justice professionals to locate and collaborate with elder justice networks/teams across the nation.  Networks will be added in an on-going fashion.

This webinar will discuss the development of this resource, walk through how to find and use the Locator, and explain how to submit your network for inclusion.

Mapping Elder Justice Networks

Talitha Guinn-Shaver, Presenter

The Locator represents the teams that have provided information to participate in this project. Networks interested in being included in the Locator may submit their network name, type, address, web address and email to elder.justice@usdoj.gov. Please note that for-profit organizations and dot coms cannot be included.  Other rules may apply.  Submission is not a guarantee of inclusion in the Locator.

To register for this webinar, click here.

Medicare Mistakes Need Do-Over?

Last week Kaiser Health News reported on mistakes on the Medicare website, which may have causes probelms for beneficiaries chosing their plans during open enrollment. Website Errors Raise Calls For Medicare To Be Flexible With Seniors’ Enrollment explains the extent of the problem.

The overhauled Plan Finder debuted at the end of August, and 2020 plan information was added in October. Over the past three months, Plan Finder problems reported to CMS by the National Association of Insurance Commissioners, the National Association of Health Underwriters, and state and national consumer advocates included inaccurate details about prices, covered drugs and dosages, and difficulty sorting and saving search results, among other things.

CMS made almost daily corrections and fixes to the website, which is the only tool that can compare dozens of private drug and medical plans ― each with different pharmacy networks, covered drugs and drug prices. The website provides information for more than 60 million people with Medicare and their families, as well as state Medicare counselors and the representatives who answer the 800-MEDICARE help line.

Unsurprisingly, the article notes that some folks signed up before corrections were made, which may not become apparent to them until they use the plan in 2020.  Which leads me to my next point.

Sen. Bob Casey of Pennsylvania, the senior Democrat on [the Senate Special Committee on Aging], also said Medicare needs to reach out so people know they can request a “special enrollment period” if they discover next year they made a wrong choice due to inaccurate Plan Finder information.

“People with Medicare must be aware that this reprieve exists and should not have to jump through hoops to qualify,” he said. The administration should “use all means necessary” to let beneficiaries know about their options for a special enrollment period.

Fifteen Senate Democrats, led by Casey, sent a letter  Thursday to Medicare Administrator Seema Verma asking the agency to “widely publicize the existing SEP for people who were misled by information” in the Medicare Plan Finder and to make switching plans easy.

The Associated Press reported on that at the end of last week. Senators urge Medicare to allow seniors a drug plan do-over:

 

In its statement Friday, Medicare said it wants to ensure that seniors “are confident in their decisions and happy in the coverage they choose.”

Medicare said it’s always had the ability to grant do-overs, “but this year we’re doubling down on ensuring that choosing their Medicare coverage is a simple and painless experience for beneficiaries.”

Medicare officials told AP that if seniors had problems with the plan finder and were unhappy with the outcome, they could call 1-800-MEDICARE and request to make a switch.

Agency officials said beneficiaries don’t need to use any technical language, only explain what their issue is to the call center representative. No documentation or screen shots will be required.

Stay tuned. This may not be over.

Elder Law Issues as Part of Candidate Platforms

Although our semester has ended, my students are still paying attention to the elder law issues in the news, including those issues that are being mentioned as part of the presidential candidates' platforms. During the semester, we talk abut news stories regarding elder law issues or elders.  We may have started with a discussion of Medicare for All, but we soon moved beyond that onto other issues.  Most recently, a student send me a link to a YouTube video about the importance of long-term care, put out by one of the Democratic candidates for President (it's important right now to state that I'm not focusing on politics or a particular candidate, but that candidates are realizing the importance of issues affecting elders in the U.S.). In this video, the 102 year old, Dorothy, has run out of money for her care. Even though it's ultimately an endorsement about a specific candidate, the points made in the video are important and are faced by so many older Americans. 

Thanks Jenna for sending this to me and good luck on your exams!

2020 Medicare Premiums Released by CMS

In case you missed this, a couple of weeks ago CMS released the Medicare premium and deductibles amounts for 2020.

Here are some of the more important numbers for 2020  from the CMS notice:

The Medicare Part A inpatient hospital deductible that beneficiaries will pay when admitted to the hospital will be $1,408 in 2020, an increase of $44 from $1,364 in 2019. ...  In 2020, beneficiaries must pay a coinsurance amount of $352 per day for the 61^st through 90^th day of a hospitalization ($341 in 2019) in a benefit period and $704 per day for lifetime reserve days ($682 in 2019). For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $176.00 in 2020 ($170.50 in 2019).

As for Part B, "[t]he standard monthly premium for Medicare Part B enrollees will be $144.60 for 2020, an increase of $9.10 from $135.50 in 2019. The annual deductible for all Medicare Part B beneficiaries is $198 in 2020, an increase of $13 from the annual deductible of $185 in 2019."

The release also includes the 2020 Part B monthly premium adjusted amounts for higher-income beneficiaries.

 

Issue Brief on Medicare Part D

The Kaiser Family Foundation has released its November, 2019 issue brief, focused on the costs of Medicare Part D.  Medicare Part D: A First Look at Prescription Drug Plans in 2020 offers these key findings

• The average Medicare beneficiary will have a choice of 28 PDPs in 2020, one more PDP option than in 2019, and six more than in 2017, a 29% increase.A total of 948 PDPs will be offered in the 34 PDP regions in 2020(plus another 11 PDPs in the territories),an increase of 202 PDPs since 2017.

• PDP premiums will vary widely across plans in2020, as in previous years(Figure 1). Among the 20 PDPs available nationwide, average premiums will range sixfold from a low of $13 per month for Humana Walmart Value Rx Plan to a high of $83 per month for Express Scripts Medicare Choice

• Two-thirds of Part D enrollees without low-income subsidies (9.0 million enrollees) will see their monthly premium increase in 2020 if they stay in their same plan, while one-third (4.3 million) face premium decreases. As an example, the 1.9million enrollees without low-income subsidies in the Humana Walmart Rx Plan, the third most popular PDP in 2019,will see their monthly premium double in 2020, from $28 to $57, unless they switch plans.This is due to plan changes and consolidations, with Humana consolidating two of its DPs (Humana Walmart Rx and Humana Enhanced) into one PDP or 2020 and renaming it Humana Premier Rx, with a $57 monthly premium.

• The estimated national average monthly PDP premium for 2020 is projected to increase by 7% to $42.05, weighted by September 2019enrollment. The actual average premium in 2020 may be lower if current enrollees switch to, and new enrollees choose, lower-premium plans during open enrollment.

• In 2020, all PDPs will have a benefit design with five or six tiers for covered generic, brand-name, and specialty drugs,and cost sharing other than the standard 25% coinsurance, similar to 2019. More than eight in 10 PDPs (86%) will charge a deductible, with most PDPs charging the standard deductible of $435 in 2020.

• Among all PDPs, median cost sharing is $0 for preferred generics and just $3 for generics, but$42 for preferred brands and 38% coinsurance for non-preferred drugs(the maximum allowed is 50%), plus 25% for specialty drugs (the maximum allowed is 33%).

• Medicare beneficiaries receiving the Low-Income Subsidy (LIS) will have a choice of seven premium-free PDPs in 2020, on average, one more than in 2019. In 2020, nearly 20% of all LIS PDP enrollees who are eligible for premium-free Part D coverage(1.3 million LIS enrollees) will pay Part D premiums averaging $18 per month unless they switch or are reassigned by CMS to premium-free plans.

The full issue brief is available here.

Older Americans Act Reauthorization Passes House

HR 4334, Dignity in Aging, which provides appropriations for the Older Americans Act through 2024, passed the House of Representatives on October 28, 2019. The text of the bill is available here.  According to a press release from the Elder Justice Coalition which brought this good news to my email box,

EJC National Coordinator Bob Blancato said, “The bill retains the all-important Title VII of the Older Americans Act, especially maintaining funding for the work of the long-term care ombudsman program. We support a new provision in the bill which updates elder justice activities to include community outreach and education and ensures innovative projects capture programs and materials for developing partnerships in communities.”

Blancato continued, “Further, we are hopeful that the 35 percent increase in authorization provided for the five-year life of the bill will be followed by adequate appropriations to allow this new initiative to go forward without reducing any existing funding related to elder abuse prevention.”

The EJC also appreciates the continued authority contained in the bill for the National Center on Elder Abuse and the National Long-Term Care Ombudsman Resource Center, as well as the new codification of the National Resource Center on Women and Retirement.

Other new provisions in the bill include first-time social isolation screening, further coordination of services to address this issue, and creation of an advisory council on social isolation. Since social isolation is a leading risk factor for elder abuse, neglect, and exploitation, these interventions are critical to preventing abuse and neglect.

You can sign up to track the bill and get updates here.

Blancato also had special praise for the Education and Labor Committee’s Civil Rights and Human Services Subcommittee Chair Suzanne Bonamici for her leadership on this bill and noted that she is also the co-chair of the House Elder Justice Caucus.

Can We Better Assure Retirement Security in the U.S.?

Everyone agrees that we need a stronger national commitment to "retirement security" in America.  But what, exactly does that mean?  This topic will be a central focus for discussion during a Public Forum hosted at Penn State's Dickinson Law on Tuesday, November 12, 2019.  The keynote speaker is former Maryland Lt. Governor Kathleen Kennedy Townsend, who is currently the Director of Retirement Security at the Economic Policy Institute, as well as serving as a research professor at  Georgetown University.  

Along those very lines, last week I read a news article  about the latest stalemate at the federal level on specific legislation that could promote better retirement savings.  The measure in question is H.R. 1994, the "Setting Every Community Up for Retirement Enhancement" Act -- and of course that name was chosen to reinforce the goal of SECURE futures.  The bill passed the House with strong, bipartisan backing in May 2019, but is now mired in the Senate. Excerpts from The Hill describe the roadblocks to passage:

GOP senators on Thursday attempted to bring a House-passed retirement savings bill to the Senate floor with votes on a limited number of amendments, but the effort was rejected by Democrats.

 

The Republican effort and Democrats' rejection highlighted how, despite widespread bipartisan support and backing from industry groups, it is still unclear when the retirement bill will be enacted.

 

The House in May in a nearly unanimous vote approved the bill, known as the SECURE Act. The bill includes a host of provisions aimed at making it easier for businesses to offer retirement plans and for people to save for retirement. It also reverses a provision in the 2017 Republican tax-cut law that inadvertently raised taxes on military survivor benefits paid to children....

 

Sen. Patty Murray (D-Wash.) objected to the Republican request, saying that Senate Democrats want the chamber to pass the House-passed bill as-is, without any amendments.

 

“We have a few Republican senators who want to sidetrack it with last-minute amendments, including proposals that are not in the interest of working families and will kill any chance this bill has of becoming law,” she said.

 

Murray asked Toomey to modify his request in order to allow the bill to pass as-is, but Toomey said he wouldn’t modify his request.

For another perspective, see "What is the SECURE Act? How Could It Affect Your Future?"

Scams & Older Adults: The Picture Isn't Pretty

The Federal Trade Commission (FTC) recently sent a report to Congress, Protecting Older Consumers 2018-2019: A Report of the Federal Trade Commission.   Here is the introduction to the 40 page report:

As the nation’s primary consumer protection agency, the Federal Trade Commission (“FTC” or “Commission”) has a broad mandate to protect consumers from unfair, deceptive, or fraudulent practices in the marketplace.1 It does this by, among other things, filing law enforcement actions to stop unlawful practices and, when possible, returning money to consumers. The FTC also protects the public through education and outreach on consumer protection issues. Through research and collaboration with federal, state, international, and private sector partners, the FTC strategically targets its efforts to achieve the maximum benefits for consumers, including older adults. Protecting older consumers in the marketplace is one of the FTC’s top priorities. Unfortunately, in numerous FTC cases, older  adults have been targeted or disproportionately affected by fraud. For example, the FTC has brought numerous enforcement actions in federal court to stop deceptive technical support schemes that affected older consumers.As the population of older adults grows,the FTC’s aggressive efforts to bring law enforcement action against scams that affect them, as well as provide useful consumer advice, become increasingly important.

The FTC submits this second annual report to the Committees on the Judiciary of the United States Senate and the United States House of Representatives to fulfill the reporting requirements of Section 101(c)(2) of the Elder Abuse Prevention and Prosecution Act of 2017. The law requires the FTC Chairman to file a report listing the FTC’s enforcement actions “over the preceding year in each case in which not less than one victim was an elder or that involved a financial scheme or scam that was either targeted directly toward or largely affected elders.” Given the large number of consumers affected in FTC actions, this list includes every administrative and federal district court action filed in the one-year period. Appendix A to this report lists all of the FTC’s enforcement actions over the preceding year. In addition to the list, the FTC files this report to provide detail on the agency’s efforts to protect older consumers, including its research and strategic initiatives, its law enforcement actions that noted an impact on older adults, and its targeted consumer education and outreach.

(citations omitted)

The full report is available here.

Medicare Simplified?

Social Security recently posted on the SSA Blog a quick explanation of the basics of Medicare.   Medicare, A Simple Explanation  first explains original Medicare which "includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). If you want drug coverage, you can join a separate Part D plan. To help pay your out-of-pocket costs in Original Medicare (like your deductible and 20% coinsurance), you can also shop for and buy supplemental coverage." The blog then explains Part C (Medicare Advantage):

Medicare Advantage is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D. Part C plans may have lower out-of-pocket costs than Original Medicare. They also may offer extra benefits that Original Medicare doesn’t cover — like vision, hearing, dental, and more.

If you can’t afford to pay your Medicare premiums and other medical costs, you may be able to get help from your state. States offer programs for people eligible for or entitled to Medicare who have low income. Some programs may pay for Medicare premiums and some pay Medicare deductibles and coinsurance. To qualify, you must have limited income and resources.

I assigned the post to my students. I think it will help them get the parts right in their heads before we start drilling down into the details of each program. 

Resources on Learning More on Opiod Pain Meds & the Public Health Emergency

Here's a new fact sheet from the Keck School of Medicine at USC on an important topic. What I should know about opioid pain medicine is a valuable 2 page fact sheet in an easy-to-use format. The topics include pain meds vs. opioids, items that interact badly with opioids, signs of overdoses and more.

Check it out!

 

GAO Report: Protecting Vets from Financial Exploitation

The GAO recently issued this report, Veterans Benefits: Actions VA Could Take to Better Protect Veterans from Financial Exploitation. Here are the highlights from the report

Why This Matters

Veterans with disabilities who receive benefits from the Department of Veterans Affairs (VA) can be tempting targets for exploitation and scams. Veterans and their survivors who need help performing everyday activities, like bathing and dressing, can receive increased pension benefits known as aid and attendance.

Key Takeaways

VA paid $3.2 billion in total pension benefits to 232,000 recipients of aid and attendance in fiscal year 2018. Most recipients were over 80.

Scams that target them include:

• being overcharged for home care, or charged for services they did not receive, and

• getting bad investment advice from financial services organizations.

VA does not centrally collect and analyze information, such as complaints made against companies, that could show the prevalence of these scams, help VA target outreach to veterans, and help law enforcement go after scammers.

Other threats to veterans include:

• VA’s applications do not warn them about exploitation or scams: For example, forms do not warn veterans that they cannot be charged fees for filing claims.

• Misdirected benefit payments: VA does not always verify direct deposit information on applications, which could lead to payments being stolen. In contrast, the Social Security Administration verifies this information by reviewing individuals’ checks or account statements.

• What GAO Recommends

  We made four recommendations to VA, including that it collect better information on potential financial exploitation, post warnings on applications, and examine if it should take more steps to verify veterans' direct deposit information. VA agreed in principle with the need to collect better information, but its proposed actions do not fully address our concerns. VA agreed with the other three recommendations.

The full report is available here.

Hospitals in the Housing Business?

Kaiser Health News ran this story, Why Hospitals Are Getting Into The Housing Business.

The article opening with anecdotes involving patients at a Denver hospital,

In the first half of this year alone, the hospital treated more than 100 long-term patients. All had a medical issue that led to their initial hospitalization. But none of the patients had a medical reason for remaining in the hospital for most of their stay.

Legally and morally, hospitals cannot discharge patients if they have no safe place to go. So patients who are homeless, frail or live alone, or have unstable housing, can occupy hospital beds for weeks or months — long after their acute medical problem is resolved. For hospitals, it means losing money because a patient lingering in a bed without medical problems doesn’t generate much, if any, income. Meanwhile, acutely ill patients may wait days in the ER to be moved to a floor because a hospital’s beds are full.

What's a hospital to do? In some cases, provide or pay for housing for  those patients. According to the article, a number of hospitals are "exploring ways to help patients find a home. With recent federal policy changes that encourage hospitals to allocate charity dollars for housing, many hospitals realize it’s cheaper to provide a month of housing than to keep patients for a single night."  Think about that statement again.... one month of housing may be cheaper than one night's hospital stay.

So the Denver hospital featured in the story is taking this a step farther, "partnering with the Denver Housing Authority to repurpose a mothballed building on the hospital campus into affordable senior housing, including about 15 apartments designated to help homeless patients transition out of the hospital."

Examine these numbers: One night in the hospital featured in the story "costs ... "$2,700 a night [and] ..... [p]atients who are prime candidates for the transitional units stay on average 73 days, for a total cost to the hospital of nearly $200,000. The hospital estimates it would cost a fraction of that, about $10,000, to house a patient for a year instead."

The KHN article references a recent report from the Urban Institute on the correlation between health and housing.  Fascinating info!

New Report-SSA Needs More Oversight of Those Who Handle Vulnerable Beneficiaries $

The GAO recently released a new report, Social Security Benefits: SSA Needs to Improve Oversight of Organizations that Manage Money for Vulnerable Beneficiaries. Here are the highlights:

What GAO Found

The Social Security Administration (SSA) approves organizational payees—such as nursing homes or non-profits that manage the Social Security benefits of individuals unable to do so on their own—by assessing a range of suitability factors, such as whether the organizations have adequate staff to manage benefits for multiple individuals. However, GAO found that SSA's policy does not specify how to assess more complex suitability factors, such as whether an organization demonstrates sound financial management. Without clearer guidance, unqualified or ill-prepared organizational payees could be approved to manage benefits. Also, SSA does not currently require background checks for key employees of an organizational payee. In contrast, SSA requires background checks for individual payees—such as a relative or friend of the beneficiary. A comprehensive evaluation could help SSA determine whether and how to expand their use of background checks to organizational payees.

To ensure organizational payees are managing funds appropriately, SSA uses several monitoring tools, including resource-intensive onsite reviews. Certain organizational payees, such as those that charge fees for their services or have 50 or more beneficiaries (high-volume), receive onsite reviews every 3 to 4-years. In contrast, payees that serve fewer than 50 beneficiaries (low-volume)—the vast majority—are selected for review based on their estimated likelihood of misusing beneficiary funds, and a relatively low percent of them receive onsite reviews (see figure). SSA uses a predictive statistical model to identify higher risk low-volume payees, but the model's effectiveness cannot be fully assessed by GAO or others due to missing documentation on how it was designed. SSA officials said they will update the model in the future, but do not have a time frame for doing so. Establishing such a time frame and documenting design decisions are key steps toward assessing the model's effectiveness.

. . .

What GAO Recommends

GAO is making nine recommendations in this report, including that SSA: clarify how to assess complex suitability factors; assess requiring background checks for organizational payees; establish a timeframe for reviewing the predictive model and document design decisions resulting from that review; and establish timeframes for, and conduct revisions of the accounting form. SSA agreed with all nine recommendations and provided technical comments that GAO incorporated as appropriate.

The full report is available here.

Special Needs Trust Failing?

Kiplinger recently ran an article, How a Special Needs Trust for Your Child Can Fall Apart,  which explains

Parents of disabled children must juggle a lot of responsibilities: work, bills and of course caregiving. But one ball they can’t afford to drop is special needs planning. One wrong move in this complicated ballet balancing benefits and services with asset rules could be disastrous. While every family’s situation is unique, the laws regulating special needs trusts are complex and can require some strategizing by families and trust companies — and if necessary, utilization of available government and nonprofit support programs. 

The article reviews the laws, the requirements for a valid third party SNT and highlights one person's experiences, an attorney's advice for the person and advice for parents of children with special needs.

The key takeaway from this story is that it is essential that parents of a disabled child learn about federal, state, local community, charitable and other nonprofit support programs that may help. They must also discuss eligibility rules with relatives who may want to make gifts for the child, leave a share of their estate, include the child in a beneficiary designation for a retirement plan or life insurance or provide other types of in-kind support and maintenance.

Finally, setting up a special needs trust requires planning, legal and financial expertise, and the proper and compassionate administration of a professional trustee.

Elder Justice Policy Highlights

USC has published  Elder Justice Policy Highlights for March-August 2019. The introduction explains that

"[t]he elder justice legislation found in this document was elicited and finalized from the National Center on Elder Abuse (NCEA) Listserv and independent websites in August 2019. The compilation is intended to reflect highlights across the nation and does not include all legislation related to elder justice. However, updates will be sent quarterly and states are encouraged to send updates on significant legislative action to Ageless Alliance. This document reflects activity in 17 states and highlights at the federal level.

The report divides the information by federal and state, includes a summary for each development as well as a link to view the information online. It also includes a section of pending activity that deserves a look.

This is a great resource and provides students with a quick snapshot of activities across the country.

GAO Report on Elder Abuse & Oversight

The GAO has issued another report on quality in nursing homes and ALFs. This report, Elder Abuse: Federal Requirements for Oversight in Nursing Homes and Assisted Living Facilities Differ

reports

The Centers for Medicare & Medicaid Services (CMS) oversees the Medicare and Medicaid programs and is responsible for safeguarding the health and welfare of beneficiaries living in nursing homes and assisted living facilities. This includes safeguarding older residents from abuse—referred to as elder abuse. CMS delegates responsibility for overseeing this issue to state survey agencies, which are responsible for overseeing nursing homes. When assisted living facilities provide services to Medicaid beneficiaries, they are indirectly subject to CMS oversight through the agency’s oversight of state Medicaid agencies. GAO found that there are specific federal requirements for nursing homes and state survey agencies for reporting, investigating, and notifying law enforcement about elder abuse in nursing homes. (See table below). For example, state survey agencies must prioritize reports of elder abuse in nursing homes based on CMS’s specified criteria and investigate within specific time frames. In contrast, there are no similar federal requirements for assisted living facilities—which are licensed and regulated by states. Instead, CMS requires state Medicaid agencies to develop policies to ensure the reporting and investigation of elder abuse in assisted living facilities. For example, CMS requires that state Medicaid agencies establish their own policies and standards for prioritizing reports when investigating incidents in assisted living facilities. Officials from the three selected states in GAO’s review said they apply certain federal nursing home requirements and investigation time frames for assisted living facilities when overseeing elder abuse.

Here's part of what the GAO did in investigating the issue:

To describe federal requirements for reporting, investigating, and notifying law enforcement about elder abuse in nursing homes and assisted living facilities, we reviewed relevant statutes and regulations and CMS guidance, including the State Operations Manual and HCBS waiver guidance and interviewed CMS officials regarding the agency’s oversight of the requirements. We selected a non-generalizable sample of three states—Connecticut, Oklahoma, and South Dakota—that have implemented HCBS waivers and vary in HCBS waiver program size and geography.10 In each state, we reviewed their waiver agreements and spoke with officials from the state survey agency, state Medicaid agency, and the state agency responsible for licensing assisted living facilities and investigating complaints.11 We also interviewed CMS officials, including regional office officials, about their oversight of state survey agencies and HCBS waivers in our selected states. We interviewed representatives from national stakeholder groups representing consumers, facilities, Medicaid directors, and investigators to obtain their perspectives on elder abuse in nursing homes and assisted living facilities. We also reviewed related audits issued by the HHS-OIG and state auditors between 2014 and 2018 related to reporting and investigating elder abuse in nursing homes and assisted living facilities and included them with a discussion of related GAO reports.

The full report is available here.

 

Long-Term Care Hospitals

A recent story from the New York Times highlights the role of long-term care hospitals in carrying for elders. For Older Patients, an ‘Afterworld’ of Hospital Care explains that for these long-term care hospitals, sometimes referred to as " a long-term acute care hospital"... is where patients often land when an ordinary hospital is ready to discharge them, often after a stay in intensive care.But these patients are still too sick to go home, too sick even for most nursing homes." 

Never heard of these LTCH?  There are a fair number of them, and they treat quite a large number of individuals."Close to 400 such hospitals operate around the country, some free-standing, others located within other hospitals, most for-profit. They provide daily physician visits, high nurse-to-patient ratios and intensive therapy...In 2017, they accounted for about 174,000 hospital stays. Medicare covered about two-thirds of them, at a staggering cost of $4.5 billion, the Medicare Payment Advisory Commission has reported."

A recent study published in the Journal of American Geriatrics Society notes poorer outcomes for these individuals. The article notes that there is a decline in the use of these hospitals, with tighter regulations and more stringent patient requirements.  Oftentimes the LTCH is a stop between the hosptial and nursing home.  This "should prompt frank discussions among families, doctors and patients about whether a frail older person leaving an intensive care unit or standard hospital truly wants to spend another month or more in an L.T.C.H. and then move to a nursing home, which is the likely scenario."  There are other options and the article notes the importance of having a conversation with the patient and family about them.

 

Two Upcoming Webinars on Important Topics

There are two upcoming webinars that I wanted to alert you about so you can register.  The National Center on Elder Abuse is hosting a webinar on September 18, 2019 from 3-4 edt, on Recognizing and Addressing Abuse in Long-Term Care Facilities. According to the email announcement

People living in long-term care (LTC) facilities can be vulnerable to abuse and neglect. Recognizing and addressing abuse and neglect in LTC facilities as well as knowing their rights is crucial for both residents and their family members.   

This webinar presented by the Paralysis Resource Center will help to understand the rights of residents of LTC facilities, identify the signs of abuse and neglect, and learn how to report concerns and complaints to the appropriate agencies. Attendees will learn about the important role of the Long-Term Care Ombudsman Program in addressing complaints and how to contact the program. The webinar will also seek to empower people with paralysis and their family members by providing information on choosing a long-term care facility and tips for advocating for quality care. 

The webinar will be presented by Amity Overall-Laib, Director of the National Long-Term Care Ombudsman Resource Center (NORC). Amity served as a local long-term care ombudsman in Texas for six years advocating for residents in 65 nursing homes and 130 assisted living facilities in a 12-county region. During her tenure in Texas, she led the formation of the Gulf Coast Culture Change Coalition, resulting in two free conferences for long-term care consumers, providers, advocates and regulators promoting culture change practices and has presented at local, state, and national conferences. She also had the pleasure of representing fellow local ombudsmen on the Board of Directors for NALLTCO (National Association of Local Long-Term Care Ombudsmen). Amity was previously a consultant to NORC then served as Manager for Program and Policy. 

To register, click here.

Next, the National Center on Law & Elder Rights is hosting a webinar on Issues at the Intersection of Social Security and Medicare on October 8 at 2 eastern time. According to the email announcement,

Social Security benefits and Medicare benefits are closely intertwined, and most people who receive one also receive the other. The close connection means that a problem with one benefit will sometimes cause problems with the other benefit. It can be difficult to figure out which agency is responsible and where to go for relief. This webcast will focus on why cross-program issues occur and what advocates can do to resolve them.

Presenters will share:

• Agencies and key players: Who is in charge of what?
• Situations when Medicare and Social Security benefits are linked and when they are not.
• Issues that arise and strategies for resolving them, including state buy-in issues for Medicare Part B premiums, and challenges keeping Medicare active during an appeal of the termination of Social Security disability benefits.

To register, click here.