Elder Law Prof Blog

Low SNF Staffing Numbers

According to a recent story published in Modern Healthcare,  Nursing home staffing levels often fall below CMS expectationsfocuses on a new study that "[n]ursing home staffing levels are often lower than what facilities report, which could compromise care quality, new research shows....Self-reported direct staffing time per resident was higher than the CMS' payroll-based metrics 70% of the time, according to a new study published in Health Affairs. Staffing levels were significantly lower during the weekends, particularly for registered nurses."

We know the importance of staffing as a quality measure and ensuring quality of care, so this study is very important. "Researchers compared facility-reported staffing and resident census data and annual inspection survey dates from the Certification and Survey Provider Enhanced Reports to the CMS' long-term care facility Staffing Payroll-Based Journal from 2017 to 2018. The payroll-based data offered a more granular look, showing how staffing evolves over time rather than relying on static point-in-time estimates that were subject to reporting bias and rarely audited...."

When comparing for-profit SNFs with NFP SNFS, the researchers found the for-profits "more likely to report higher staffing numbers ... and [s]taffing levels increased before and during the times of the annual surveys and dropped off after." 

The use of payroll data to determine staffing levels has only been in effect a little over a year.  The story focuses specifically just on staffing levels. A log-in is required to access the study.

Poor Care in Hospice: OIG Report

Ugh, this article in the Washington Post covers a serious and worrisome topic. Hospices go unpunished for reported maggots and uncontrolled pain, watchdog finds reports on a recently released HHS Office of Inspector General report,  2019: Vulnerabilities in Hospice Care.

The OIG report is actually two reports "which found that from 2012 through 2016, the majority of U.S. hospices that participated in Medicare had one or more deficiencies in the quality of care they provided to their patients. Some Medicare beneficiaries were seriously harmed when hospices provided poor care or failed to take action in cases of abuse. OIG made several recommendations in both reports to strengthen safeguards to protect Medicare hospice beneficiaries from harm and to ensure hospices are held accountable for deficiencies in their programs."

The first report, Hospice Deficiencies Pose Risks to Medicare Beneficiaries, 07-03-2019 | Report (OEI-02-17-00020), found that

[t]he most common types of deficiencies involve poor care planning, mismanagement of aide services, and inadequate assessments of beneficiaries. In addition to these, hospices had other deficiencies that also posed risks to beneficiaries. These failings-such as improperly vetting staff and inadequate quality control-can jeopardize beneficiaries' safety and lead to poor care. In addition, one-third of all hospices that provided care to Medicare beneficiaries had complaints filed against them. Over 300 hospices had at least one serious deficiency or at least one substantiated severe complaint in 2016, which we considered to be poor performers. These hospices represent 18 percent of all hospices surveyed nation-wide in 2016. Most poor performers had other deficiencies or substantiated complaints in the 5-year period. Some poor performers had a history of serious deficiencies.

The full report is available here.

The second report, Safeguards Must Be Strengthened To Protect Medicare Hospice Beneficiaries From Harm, 07-03-2019 | Report (OEI-02-17-00021) found

[s]ome instances of harm resulted from hospices providing poor care to beneficiaries and some resulted from abuse by caregivers or others and the hospice failing to take action. These cases reveal vulnerabilities in CMS's efforts to prevent and address harm. These vulnerabilities include insufficient reporting requirements for hospices, limited reporting requirements for surveyors, and barriers that beneficiaries and caregivers face in making complaints. Also, these hospices did not face serious consequences for the harm described in this report. Specifically, surveyors did not always cite immediate jeopardy in cases of significant beneficiary harm and hospices' plans of correction are not designed to address underlying issues. In addition, CMS cannot impose penalties, other than termination, to hold hospices accountable for harming beneficiaries.

The second full report is available here. In addition there is a slide show available on YouTube,  a one page flyer available here, a one-page graphic of the top issues available here, a flyer on beneficiary rights available here and more.

Two New Articles to Add to Your Reading List

Professor Tara Sklar emailed me to let me know of the publication of two new articles. Her first, Preparing to Age in Place: The Role of Medicaid Waivers in Elder Abuse Prevention appears in 28 Annals of Health Law 195 (2019) and is also available on SSRN.

Here is the abstract

Over the last three decades, there has been a steady movement to increase access to aging in place as the preferred long-term care option across the country. Medicaid has largely led this effort through expansion of state waivers that provide Home and Community-Based Services (HCBS) as an alternative to nursing home care. HCBS include the provision of basic health services, personal care, and assistance with household tasks. At the time of this writing, seven states have explicitly tailored their waivers to support aging in place by offering HCBS solely for older adults, individuals aged 65 and over. However, there is growing concern about aging in place contributing to greater risk for social isolation, and with that increased exposure to elder abuse. Abuse, neglect, and unmet need are highly visible in an institutional setting and can be largely invisible in the home without preventative measures to safeguard against maltreatment. This article examines the seven states with Medicaid HCBS waivers that target older adults, over a 36-year period, starting with the first state in 1982 to 2018. We conducted qualitative analysis with each waiver to explore the presence of safeguards that address risk factors associated with elder abuse. We found three broad categories in caregiver selection, quality assurance, and the complaints process where there are notable variations. Drawing on these findings, we outline features where Medicaid HCBS waivers have the potential to mitigate risk of elder abuse to further support successful aging in place.

The second article, Elderly Gun Ownership and the Wave of State Red Flag Laws: An Unintended Consequence That Could Help Many will be published in the Elder Law Journal. It is currently available on SSRN here.

Here is the abstract

There is rising concern among health professionals and in legal circles to address gun ownership for older adults who display signs of cognitive decline, including dementia. However, elderly gun ownership remains underexamined, partly because incidents of gun violence among the elderly tend to occur in domestic settings and are much less visible than shootings in public areas. In contrast, there is widespread attention to curb mass gun violence through state legislation. Specifically, red flag laws, also known as Extreme Risk Protection Orders, have doubled in 2018 with thirteen states enacting red flag laws and over thirty states having introduced or planning to introduce this legislation. Although red flag laws were not intended to address elderly gun ownership, they uniquely apply where other gun control laws fall short, as red flag laws provide the legal process to temporarily remove access to guns for persons believed to be at an elevated risk of harming themselves or others.

This Article surveys the thirteen states that have enacted red flag laws and analyzes key legislative elements across these states. The state laws have notable variations, including authorized persons who can petition a court for a protection order, standard of proof requirements, and the length of time an order is in effect. These variations have implications for elderly gun owners and their families, particularly in how they relate to the climbing rates of cognitive decline, suicide in late life, and elder abuse. The current wave of red flag laws across the country offer an opportunity to provide greater awareness around elderly gun ownership and prevent crises from becoming tragedies.

I was particularly interested in this second piece, because we recently offered a webinar at Stetson for elder law attorneys on dementia and gun ownership.  Information about the webinar and how to order an audio download are available here.

Congrats Professor Sklar and thanks for letting us know about your articles!

Does the ALF Industry Need Federal Oversight?

That was the question posed in a recent article published in Cleveland.Com.  Amid growth of assisted living, some renew calls for federal oversight opens with an examiniation of hte requirements to be employed as an aide in ALFs.

Just read this to get a sense of the issues illustrated in this article:

The number of assisted-living centers in the United States has jumped more than 150 percent in the past 20 years, fueled by an increase of residents with cognitive issues, a willingness of facilities to take more frail patients, and families who wish to avoid nursing homes.

But while the centers’ clientele has changed dramatically, there have been few efforts to systemically re-evaluate staffing or training guidelines necessary to properly serve residents. This has led some advoctates of the elderly to renew the call for federal oversight of the facilities, much like nursing homes.

For instance, nearly half of the nation’s states lack extensive training programs for the facilities’ employees, with most requiring some form of a job orientation and less than a dozen hours of instruction.

When it comes to staffing, the differences are even more stark. Thirty-eight states leave the amount of personnel needed to care for residents up to individual facility owners.

These variations fuel the position that federal oversight is needed, mainly because it would provide consistency. But there are opponents of the idea who think it will make ALF oversight more bureaucratic and expensive. With Medicaid waivers covering the cost of ALFs in some situations, the argument for federal oversight gains strength. "But because Medicaid’s role is increasing in assisted living, advocates for the elderly say the U.S. Centers for Medicaid and Medicare Services, which oversees nursing homes, should also monitor assisted-living facilities."

The article discusses efforts at the state level of ensure quality of care and offers argument both in favor of and against involvement of the feds.

What do you think?

 

DNA Scams Targeting Elders

Last week Bloomberg Law ran a story about a new scam. Scammers Target Seniors With DNA Tests, Health Agency Says explains that the "free DNA test" is being sent to elders. "Companies offering the tests use the information gathered to steal identities or bill Medicare for unnecessary tests, the U.S. Department of Health and Human Services Office of Inspector General said in an agency fraud alert. The fraudsters are targeting victims through telemarketing, booths at public events and door-to-door visits." The fraud alert from HHS'Inspector General, Fraud Alert: Genetic Testing Scam offers these suggestions for elders:

• If a genetic testing kit is mailed to you, don't accept it unless it was ordered by your physician. Refuse the delivery or return it to the sender. Keep a record of the sender's name and the date you returned the items.

• Be suspicious of anyone who offers you free genetic testing and then requests your Medicare number. If your personal information is compromised, it may be used in other fraud schemes.

• A physician that you know and trust should approve any requests for genetic testing.

• Medicare beneficiaries should be cautious of unsolicited requests for their Medicare numbers. If anyone other than your physician's office requests your Medicare information, do not provide it.

• If you suspect Medicare fraud, contact the HHS OIG Hotline.

  Always remember that very little in life is free and if an offer sounds to good to be true, it isn't true.

Report on Unreported Abuse & Neglect at SNFs

The Office of Inspector General for Health & Human Services issued a report this month, Incidents of Potential Abuse and Neglect at Skilled Nursing Facilities Were Not Always Reported and Investigated.

Here's a summary of their findings

We determined that an estimated one in five high-risk hospital ER Medicare claims for treatment provided in calendar year 2016werethe result of potential abuse or neglect, including injury of unknown source, of beneficiaries residing in a SNF.We determined that SNFs failed to report many of these incidents to the Survey Agencies in accordance with applicable Federal requirements. We also determined that several Survey Agencies failed to report some findings of substantiated abuse to local law enforcement. Lastly, we determined that CMS does not require all incidents of potential abuse or neglect and related referrals made to law enforcement and other agencies to be recorded and tracked in the Automated Survey Processing Environment Complaints/Incidents Tracking System. Preventing, detecting, and combating elder abuse requires CMS, Survey Agencies, and SNFs to meet their responsibilities.

OIG's recommendations include

• work with the Survey Agencies to improve training for staff of SNFs on how to identify and report incidents of potential abuse or neglect of Medicare beneficiaries,
• clarify guidance to clearly define and provide examples of incidents of potential abuse or neglect,
• require the Survey Agencies to record and track all incidents of potential abuse or neglect in SNFs and referrals made to local law enforcement and other agencies, and
• monitor the Survey Agencies’ reporting of findings of substantiated abuse to local law enforcement.

The OIG full report is available here.

HHS Releases Final Conscience Rule

Health & Human Services in a press release, explains that HHS Announces Final Conscience Rule Protecting Health Care Entities and Individuals."that protects individuals and health care entities from discrimination on the basis of their exercise of conscience in HHS-funded programs. Just as OCR enforces other civil rights, the rule implements full and robust enforcement of approximately 25 provisions passed by Congress protecting longstanding conscience rights in healthcare. "

The final rule is available here. A fact sheet from HHS on this rule is available here.

In-Depth Story on Reverse Morgages

USA Today, ran this story, Seniors were sold a risk-free retirement with reverse mortgages. Now they face foreclosure. This is not a happy story.

Alarming reports from federal investigators five years ago led the Department of Housing and Urban Development to initiate a series of changes to protect seniors. USA TODAY’s review of government foreclosure data found a generation of families fell through the cracks and continue to suffer from reverse mortgage loans written a decade ago.

These elderly homeowners were wooed into borrowing money through the special program by attractive sales pitches or a dire need for cash – or both. When they missed a paperwork deadline or fell behind on taxes or insurance, lenders moved swiftly to foreclose on the home. Those foreclosures wiped out hard-earned generational wealth built in the decades since the Fair Housing Act of 1968 ¹

  . . .        

Borrowers living near the poverty line in pockets of Chicago, Baltimore, Miami, Detroit, Philadelphia and Jacksonville, Florida, are among the hardest hit, according to a first-of-its-kind analysis of more than 1.3 million loan records. USA TODAY worked in partnership with with Grand Valley State University, with support from the McGraw Center for Business Journalism.

The article looks at some examples of individuals who are in trouble and examines the situation that led us to this point.

Federal regulators and industry leaders cautioned that numbers alone tell only part of the story, since many foreclosures result from the natural end of reverse mortgages: the homeowner’s death. The average term of a reverse mortgage is about seven years, and if a family member is not willing or able to repay the loan, lenders push the property through foreclosure.

Regulators said actual evictions of seniors are rare. There’s no way to verify that, though, since HUD, the top government regulator of Home Equity Conversion Mortgage ⁴ loans, does not sign off on evictions – or even count them.

The article is lengthy but full of important information. Read it yourself, and then assign it to your students.

Thanks to my colleague and dear friend, Professor Bauer, for sending me the article.

DOJ Transnational Elder Fraud Strike Force

DOJ announced the creation of a multi-agency strike force to fight elder fraud. Justice Department Announces New Transnational Elder Fraud Strike Force. Law Enforcement Effort Will Coordinate Action Against Foreign Fraud Schemes that Target American Seniors announces

the establishment of the Transnational Elder Fraud Strike Force, a joint law enforcement effort that brings together the resources and expertise of the Department of Justice’s Consumer Protection Branch, the U.S. Attorneys’ Offices for six federal districts, the FBI, the U.S. Postal Inspection Service, and other organizations. The Strike Force will focus on investigating and prosecuting individuals and entities associated with foreign-based fraud schemes that disproportionately affect American seniors. These include telemarketing, mass-mailing, and tech-support fraud schemes.

The Transnational Elder Fraud Strike Force will be comprised of prosecutors and data analysts from the Consumer Protection Branch, prosecutors with six U.S. Attorneys’ Offices (Central District of California, Middle and Southern Districts of Florida, Northern District of Georgia, Eastern District of New York, Southern District of Texas), FBI special agents, Postal Inspectors, and numerous other law enforcement personnel. The Strike Force will also collaborate with the Federal Trade Commission and industry partners, who have pledged to engage with the Department to help end the scourge of elder fraud. It will further benefit from the help of the Elder Justice Coordinators now assigned in every U.S. Attorney’s Office.

GAO Report on Elder Justice

The Government Accounting Office released a new report on Elder Justice.  Elder Justice: Goals and Outcome Measures Would Provide DOJ with Clear Direction and a Means to Assess Its Efforts explains the reason for this report

Why GAO Did This Study

Researchers estimate that as many as 1 in 10 older adults in the United States—age 60 or older—experience abuse each year. Elder abuse may involve physical, sexual, emotional, or financial abuse or neglect. It can occur by family, guardians, or caregivers as well as by strangers and international criminal enterprises, which operate schemes for monetary gain or to facilitate other criminal activities. According to media reports and congressional testimony, some older U.S. citizens who have traveled abroad have unwittingly participated in illicit activities, and in some cases, have been arrested in foreign countries.

EAPPA included a provision for GAO to review elder justice efforts in the federal criminal justice system. This report examines (1) the ways DOJ works to address crimes against older adults, and to what extent DOJ is planning for and assessing its efforts; and (2) how the Departments of State and Homeland Security address the arrest of older U.S. citizens abroad, including arrests involving international criminal enterprises. GAO reviewed agency policy documents, and interviewed agency officials, as well as a nongeneralizable sample of elder abuse stakeholders and state and local officials selected for their experience in this area.

Along with offering examples of scams and frauds targeting elders, the GAO report included a recommendation for DOJ "that DOJ develop and document elder justice goals and outcome measures to better guide its elder justice efforts."

The full report is available here.

 

 

Update on Litigation of Medicare's 2 Midnight Rule

The Center for Medicare Advocacy (CMA-full disclosure, I'm on their board) has been litigating with CMS on the observation status issue. The latest litigation on the observation status, Alexander v. Azar, has a new opinion decided on June 4, 2019.  On a motion for clarification and reconsideration filed by CMS, as well as a motion to seal, the Court in the June 4 order grants in part and denies in part the motion to seal and denies the motion for reconsideration and clarification.

Stay tuned.  This case is going to trial in the fall!

Elder Justice Resources Hub from ACL

The Administration for Community Living (ACL) unveiled the Elder Justice Resources Hub which incorporates the work of several agencies, including NCEA (National Center on Elder Abuse),  NCLER, (National Center on Law & Elder Rights), NAMRS,(National Adult Maltreatment Resource Center),  NORC (National Long-Term Care Ombudsman Resource Center), PHA (Pension Help America), NRCWRP (National Resources Center on Women & Retirement Planning) and APS-TARC (APS Technical Assistance Resource Center) The website explains

No matter how old we are, justice requires that all people are equal and full members of our communities, and the safety and dignity of all its members are preserved, including older adults and people with disabilities. Unfortunately, we do not always live up to this ideal. Committed to developing systems and programs that encourage justice, prevent abuse, and provide protection and support to those in need, the Administration of Community Living (ACL) seeks to change how our society thinks of older people and those with disabilities and what we can do to enable their participation. Just like a stable building requires a strong set of support beams, we need a solid social structure so that older people and those with disabilities can live their lives to the fullest, participate in our communities, and live free from abuse and neglect.

Don't forget as well, the DOJ Elder Justice Initiative, which also has a lot of research and resources!

This website highlights some of ACL’s efforts to build public and professional understanding about elder abuse and strengthen the social supports needed to prevent it. Strong, stable communities with structures to support people of all ages and abilities not only ensure justice and dignity for older people and adults with disabilities, but also secure the wellbeing and quality of life for us all.

The Science of Being Susceptible To Scams

Marketplace recently ran a story about fascinating research on whether there is a correlation between age and susceptibility to scams.  Age of fraud: Are seniors more vulnerable to financial scams? opens with the story of one individual who fell victim to a "gift card" scam of almost $200,ooo. Think it can't happen to you? Here is where the science comes in.

[A researcher] and his colleagues have put a label on what they see as an all-too common condition: “age-associated financial vulnerability.”

“We are learning that there are changes in the aging brain, even in the absence of diseases like Alzheimer’s disease or other neurodegenerative illnesses, that may render older adults vulnerable to financial exploitation.”

The science is showing that older folks

ability to detect sketchy situations may decline. Or, we may become prone to seeing the upside of a risky deal and blow off the downside. Some people are more inclined to believe the last person they spoke to. Others may lose the ability to push back on a high-pressure predator. Researchers emphasize that this phenomenon goes way beyond changes in the brain.

“It also involves all of these other social and environmental factors like social isolation, like cultural factors and societal factors, like older adults having more wealth compared to younger generations,” said Marti DeLiema, a research scholar at the Stanford Center on Longevity.

Still think it can't happen to you? The researchers are examining "age-related financial vulnerability[and]  are very interested in physical changes to the aging brain, the way eyesight and hearing can get less keen. In some cases, a new pattern of making mistakes with money may be a harbinger of cognitive bad things to come, the “first thing to go,” as it were"

Still think it can't happen to you? Read on.  The optimal age for money management is 53 years old, according to the article.  There is some advantage to age; the life experiences we acquire.  Now we all know, as the article reflects, that scams don't just target older persons.   There is no easy answer to the issue. How do you protect people from making bad decisions  or from falling for a scam?  The article references various state approaches and the federal Elder Abuse Prevention and Prosecution Act. FINRA is also asking brokers to "encourage customers to list the name of a trusted person to contact if something signals “scam.” Banks have no such rule."

The remainder of the article focuses on the responses and need for more work. Several experts offer suggestions for responses. I thought this one response was poignant: "abuse of the elderly is, at its core, lack of social support. The cure is social support. It’s possible that the best way to help vulnerable loved ones is just to be there, to be present in their lives."

Think this can't happen to you? Think again. And read this article.

Needing LTC but Unable to Afford It

The New York Times ran an article recently that doesn't bode well for many elder Americans.  Many Americans Will Need Long-Term Care. Most Won't be Able to Afford It reviews what is referred to as

the middle-class bind ... [where the elder has t]oo much money to qualify for Medicaid or subsidized housing, but not enough to pay for long-term care, an industry that has primarily pursued the well-off. ...

A recent analysis in Health Affairs, pointedly titled “The Forgotten Middle,” investigated how many middle-income seniors will be caught in that bind. The numbers were grim.

Using data from the national Health and Retirement Study, including personal income and assets and health status, the researchers defined the middle-income cohort as Americans from the 41st to the 80th percentile in terms of financial resources....

In 2029, for people 75 to 84 (ages when they’re likely to need long-term care), that would mean access to about $25,000 to $74,000 a year in current dollars. Over age 85, the middle-income category extends to $95,000.

The projection is that two-thirds are going to need some type of long-term care, yet "more than half will be unable to pay assisted living fees and medical costs in 2029, the study found." Even those owning a home aren't as house-rich as they may think.  Plus this group has a lot of debt, and not that much in savings.

Consider this:

The United States, unlike many Western democracies, has never created a broad public program covering long-term care. Medicare pays for doctors, hospitals, drugs and short-term rehab after hospitalization — not for independent or assisted living.

That could change one day — imagine a new Medicare Part LTC — but “that will be incredibly difficult to achieve politically,” [said one expert].

Policy types instead suggest more incremental changes by both government and industry. Perhaps Medicaid could cover seniors with slightly higher incomes, or modify its regulations to include housing costs along with health care.

Florida is #1.... in Fraud Reports

There are a lot of great things about Florida and a lot of wacky things (don't believe me about the wacky things? check out "A Florida Man") One of the sad things recently about Florida is our #1 ranking for fraud in the U.S. 

Security.org crunches the numbers from the Federal Trade Commission and comes up with a report on the common frauds by state. In addition to the frauds by state, they also report on the top scams for the year. The #1 scam in the U.S. for the last year is impostor scam, followed by debt collection, identity theft, telephone/mobile sales, catalog/shop-at-home, banks/lenders, credit info, the old standard--lotteries, cars and internet.

So when I looked at Florida, here we are ranked #1 in the nation for fraud and other reports according to the Consumer Sentinel Network Data Book 2018  (issued by the FTC in February 2019).  There's a lot of good info in the Data Book, beyond individual state rankings.

Here's the executive summary from the Data Book

Overview

During 2018, the Consumer Sentinel Network took in nearly 3 million reports, an increase from 2017. - Fraud: 1.4 million (48% of all reports) - Identity theft: 444,602 (15%) - Other: 1.1 million (38%).

Imposter Scams are the top report category in 2018 (18% of all reports). Debt collection reports declined by 24% percent in 2018 (16% of all reports) and moved to #2. Identity theft (15% of all reports) rounds out the top three reports to Sentinel.

Fraud

There were over 535,000 imposter scam reports to Sentinel. Nearly one in five of those also reported a dollar loss, totaling nearly $488 million lost to imposter scams. These scams include, for example,romance scams, people falsely claiming to be with the government, a relative in distress, a well-known business, or a technical support expert, to get a consumer’s money.

Of the 1.4 million fraud reports, 25% indicated money was lost. In 2018, people reported losing nearly$1.48 billion to fraud – an increase of $406 million over what consumers reported losing in 2017.

The median loss for all fraud reports in 2018 is $375. The median individual losses were highest in these fraud categories: - Mortgage Foreclosure Relief and Debt Management ($1,377) - Business and Job Opportunities ($1,304) - Foreign Money Offers and Counterfeit Check Scams ($1,214).

Telephone was the method of contact for 69% of fraud reports with a contact method identified. Only eight percent of those people reported losing money to the scammer – but that 8% reported an aggregate loss of $429 million, and an $840 median loss.

Wire transfers continue to be the most frequently reported payment method for fraud, with a reported aggregate loss of $423 million.

Of people who reported their age, those aged 20-29 reported losing money to fraud in 43% of reports filed with the FTC, while people aged 70 – 79 reported losing money in 15% of their reports and people80 and over reported losing money in just 13% of their reports. But when they did experience a loss,people aged 70 and older reported much higher median losses than any other age group.

Identity Theft

Credit card fraud tops the list of identity theft reports in 2018. The FTC received more than 167,000reports from people who said their information was misused on an existing account or to open a new credit card account.

Military

Military consumers reported more than 59,000 fraud complaints, including over 36,000 imposter scams that cost them $34 million in 2018. Imposter scams were the largest single category of reportsfrom military consumers.

Top States

The states with the highest per capita rates of reported fraud in 2018 were Florida, Georgia, Nevada,Delaware, and Maryland. For reported identity theft, the top states in 2018 were Georgia, Nevada,California, Florida, and Texas.

 

 

Correlation to Medicare Ratings & Staffing

Kaiser Health News ran a story, Short-Staffed Nursing Homes See Drop In Medicare Ratings.  "In its update in April to Nursing Home Compare, the Centers for Medicare & Medicaid Services gave its lowest star rating for staffing — one star on its five-star scale — to 1,638 homes. Most were downgraded because their payroll records reported no registered-nurse hours at all for four days or more, while the remainder failed to submit their payroll records or sent data that couldn’t be verified through an audit." The payroll records analyzed provide a good picture of various nursing homes and how they comply with the regulations. "CMS has been alarmed at the frequency of understaffing of registered nurses — the most highly trained category of nurses in a home — since the government last year began requiring homes to submit payroll records to verify staffing levels." In addition KHN has an interactive tool, Look-Up: How Nursing Home Staffing Fluctuates Nationwide.

Tech to Block Spam Calls

Phone companies are developing tech that will block spam calls. Yes, please and right away! (BTW, how do the spammers know the most inopportune time to call?) The New York Times explains the work in this article, Phone Companies Are Testing Tech to Catch Spam Calls. Let’s Hope It Works.

This data ought to frighten you:  "[t]he seemingly endless stream of robocalls reached a new monthly high of 5.23 billion nationwide in March, according to the call-blocking service YouMail. Some were spammy pitches for unwanted vehicle warranties or debt-relief services. Nearly half were straight-up scams. And there was often one common thread: They frequently came from somewhere other than they said they did."

But the article tells us there is hope for us.  "New technology is providing a glimmer of hope that, someday, you might be able to safely pick up your phone again. Mostly, you’ll now be more likely to know callers are who they say they are." But wait, now for some bad news. "[D]on’t expect any silver bullets that will put an end to robocalls. Pending regulatory changes could even add to the flood." 

The anti-spoofing technology is already being used by T-Mobile ("known by the acronym Stir/Shaken, a tortured reference to James Bond and martini preparation — in January, although it’s currently compatible only with certain devices. ") AT&T and Comcast have been doing some work on caller verification and Verizon should have theirs available by early fall.

But wait-do you have a land-line? This need tech won't help you then. There are also limits on tracing calls from abroad.  Congress is also helping.

A Senate bill that would establish a deadline has gained bipartisan traction. The Traced Act, introduced by Senators John Thune, Republican of South Dakota, and Edward J. Markey, Democrat of Massachusetts, passed a committee vote this month. Along with stiffening penalties and giving the F.C.C. more time to punish perpetrators, the bill would require all voice service providers — including those over the internet, such as Skype and Google Voice — to adopt call authentication technology within 18 months of the bill’s enactment. 

Watch for new regs coming from the F.C.C., especially the one on the definition of auto-dialers, the article explains. There is the potential for opening us to even more spam calls.  Here's how the two sides see that issue

“If they define auto-dialer the way the industry wants it defined, it will be so narrow it won’t cover any of the auto-dialers out there,” said Margot Saunders, senior counsel at the National Consumer Law Center. “The scourge of robocalls will skyrocket.”

The F.C.C. said those concerns were speculative. The agency has solicited public comments on the issue twice lastyear, but declined to say how long it might take to come up with a new definition. A spokesman said the commission “will continue to combat all illegal robocalls with every tool we have.”

I don't know if you do like I do now--when my phone rings-if I don't recognize the number I don't answer it. Is that how we have to operate now? Do the folks at the F.C.C. get all of these spam calls too?

Pentagon Officials Point to Need for Elder Care at Guantanamo Bay

In January 2018, Donald Trump issued an order to keep the detention facility at Guantanamo open, with the potential for the Pentagon to add new prisoners. Following that decision, Pentagon officials, described in some accounts as being "unusually frank," discussed the need for long-term care facilities for aging prisoners who will grow old and frail.  From an article in The Military Times:

The Pentagon was investing in upgrades at the Navy base under President Barack Obama, whose push to shutter the detention center couldn’t overcome opposition in Congress. But those projects, including the $150 million barracks, were funded with the understanding that they could be used by the personnel of the Navy base that hosts the detention center. Now they are viewed as part of a broader effort to be able to operate the prison for many years to come.

 

“Now my mission is enduring,” said Adm. John Ring, commander of the task force that runs the jail. “So I have all sorts of structures that I have been neglecting or just getting by with that now I’ve got to replace.” . . . 

 

Officials say Camp 7 is in need of major repairs, with cracking walls and a sinking foundation, and it is not suitable to hold men who will likely be in custody for many years to come. The new unit, which would be known as Camp 8, would have cell doors wide enough for wheelchairs and hospice beds and communal areas so elderly prisoners could help each other as they grow old.

For more, read the June 2018 article, "U.S. Military Plans for Future at Guantanamo Because of Trump."

I drafted the above language for this post on Sunday, April 28, after reading a more recent, more detailed story in another publication, Defense One, titled "Guantanamo Is Becoming A Nursing Home for its Aging Terror Suspects."  

From that article we hear again from Admiral John Ring, the commander in charge of the Guantanamo Task Force:

The aging population at Gitmo poses unique challenges for Adm. John Ring, the latest in a string of officers who have led the prison on one-year deployments. Defense attorneys say many detainees suffer the ill effects of brutal interrogation tactics now considered to be torture. The United States has committed to providing the same health care to the remaining detainees that it provides to its own troops, as required by the Geneva Conventions. But the secure medical facilities built to treat the detainees — Ring calls them “guests” — can’t cope with every kind of surgery geriatric patients typically need, and weren’t built to last forever. Congress has prohibited the transfer of detainees to the continental United States, which means any treatment they receive will have to take place at a remote outpost on the tip of Cuba.

 

“I’m sort of caught between a rock and a hard place,” Ring said. “The Geneva Conventions’ Article III, that says that I have to give the detainees equivalent medical care that I would give to a trooper. But if a trooper got sick, I’d send him home to the United States.

So, it was with interest that I read a third new story, on Monday morning, April 29, reporting that Admiral Ring has been discharged from his post, with the briefest of explanation, "loss of confidence in his ability."  See  The New York Times article: Guantanamo Bay Prison Commander Has Been Fired. 

SSA & Medicare Trustees Reports

I hope you know by now that the SSA and Medicare Trustees have released their annual reports. The news is about what you would expect, if you follow the news on their annual reports. One might say that the SSA Trustees gave us good news this year. Social Security Combined Trust Funds Gain One Year Says Board of Trustees. Disability Fund Shows Strong Improvement—Twenty Years projects that the fund will "run out of money" after 2034, meaning we have gained a year. "Running out of money" means that starting in 2035, SSA will pay 80% of benefits, rather than 100%.  For years, I've explained to students about the SSA Trust Fund and the Trustees Report. This year it dawned on me, when talking about the folks affected by the short fall, I'm part of those who will be affected.  I'm no longer teaching something abstract. I know people, including myself and my colleagues, who will be in that group absent action by Congress.  The SSA Trustees report is available here. With Medicare, the trustees really didn't have good news for us. Medicare Trustees Report shows Hospital Insurance Trust Fund will deplete in 7 years tells us "that the HI Trust Fund will be able to pay full benefits until 2026, the same as last year’s report."  The Medicare Trustees report is available here.

Hello Congress??

 

Scams, Scams & Robocalls

Ok, so scams.... Ugh.  Here's a couple of new ones, now we are past tax season and don't have to worry about the fake-IRS calling us for a couple of days.  First, using DNA to commit scams and frauds. Scammers May Be Using DNA Testing to Defraud Medicare and Steal Identities reports Bloomerberg. "Authorities in several states are warning about an alleged scam in which people visit senior-living communities and low-income neighborhoods, offering to perform DNA tests and collecting information from people in government health programs. ... The alleged DNA-testing scams appear to be a new twist on an old tactic, in which people are tricked into giving away personal information or participating in medical services they don’t need. Perpetrators of such schemes can bill the government for unneeded medical tests and procedures, or use the information they collect — such as Medicare and Medicaid identification data — to commit identity theft and fraud."  I guess you can't get much more personal info than someone's DNA. Yikes!

Next, the New York Times reported that falling prey to scams may be a red flag sign of dementia. Senior's Weakness for Scams May Be Warning Sign of Dementia.

"New research suggests seniors who aren't on guard against scams also might be at risk for eventually developing Alzheimer's disease. ... Elder fraud is a huge problem, and Monday's study doesn't mean that people who fall prey to a con artist have some sort of dementia brewing. ... But scientists know that long before the memory problems of Alzheimer's become obvious, people experience more subtle changes in their thinking and judgment. Neuropsychologist Patricia Boyle of Rush University's Alzheimer's disease center wondered if one of the warning signs might be the type of judgment missteps that can leave someone susceptible to scams."

Although "[t]he study can't prove a link between low scam awareness and impending decline in thinking and memory," results point us to a need for more research. 

There are already a number of prevention efforts in existence, but yet, these crimes keep occurring. One more recent innovation is referenced in the article.  "[T]he rise in elder fraud has reached such a level that investment firms now are supposed to ask customers for the contact information of a "trusted person" they can alert if they suspect a case of financial exploitation. Just last week, federal agents broke up a Medicare scam that sold unneeded orthopedic braces to hundreds of thousands of seniors. And every tax season the government warns people not to fall for phone calls from IRS impostors — that agency won't call for payment."

And let's not get started on robocalls...  Oh, ok since I mentioned them, the current issue of Consumer Reports newsletter focuses an article on apps designed to block robocalls.  How to Protect Yourself From Robocalls shares the results of a survey of robocall blocker apps used by readers. Check them out and use one that works best for you. Have you reached the point where you no longer answer the phone if you don't recognize the number? I have.