Elder Law Prof Blog

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.

Starting 2021 with Looking at Operation of SNFs

Happy 2021. Several articles have been published examining the pandemic's longer-term impact on SNFs. I wanted to point out two.  First, consider the Washington Post article about how SNFs are structured, Profit and pain: How California’s largest nursing home chain amassed millions as scrutiny mounted.

Instead of relying upon outside vendors, Brius pursued a business practice long used by a majority of for-profit nursing homes nationwide: paying related companies for goods, services and rent.

More than 70 percent of the country’s nursing home providers use operating funds to pay themselves through so-called related parties — companies they or their family members partially or wholly own. In 2018, Brius nursing homes paid related parties $13 million for supplies, $10 million for administrative services and financial consulting, and $16 million for workers’ compensation insurance, state records show. The homes also sent a total of $64 million in rent to dozens of related land companies.

The practice is legal and widely supported by the industry, which argues that related parties help control costs and limit financial liability. Watchdog groups counter that nursing home owners can reap excessive profits from public funds by overpaying their own companies. Related parties generally do not have to disclose profits, leaving regulators with little way to assess the financial gains of owners.

Covid has changed the "business as usual" model, it would seem, as the article notes that "scrutiny has mounted in recent months as the federal government delivered about $54 million to Brius homes in coronavirus relief aid, meant as a lifeline for providers struggling to protect residents amid an unprecedented health crisis that has killed more than 92,000 nursing home residents nationwide."  The Washington Post did an in-depth look at this SNF chain. The article details what the reporters discovered regarding finances and taxes. There are California groups that have called for the California legislature to revise the oversight of SNFs.  The article indicates that efforts may also be made at a federal level. This detailed article is well worth reading and I plan to assign it to my students, so they can have a better understanding of the structure of SNFs.

Next consider this opinion from the New York Times,, This Is Why Nursing Homes Failed So Badly.

The first coronavirus outbreak in the United States occurred in a nursing home near Seattle, in late February. Since then, the country has endlessly revised its hot spot map. Yet the situation in nursing homes and assisted-living facilities has only gotten worse: More than 120,000 workers and residents have died, and residents are now dying at three times the rate they did in July.

Long-term care continues to be understaffed, poorly regulated and vulnerable to predation by for-profit conglomerates and private-equity firms. The nursing aides who provide the bulk of bedside assistance still earn poverty wages, and lockdown policies have forced patients into dangerous solitude.

Fortunately... and maybe hopefully...., with the COVID vaccine and priority given to those who work and reside in SNFs, this won't be a story that continues in the same vein. But the author of this piece aren't telling us we will return to the prior way of things. "When the pandemic is finally history, we’ll need to deal with all of this: the staffing shortages, low pay and lack of accountability — the many ways we have failed residents, family members and staffers. The awful truth is that long-term care was designed to fail years before Covid-19."  Why is this? Various stressors combined push the need for change in how long term care is provided.  "Over the past few decades, the popularity of “aging in place,” combined with new medical technologies and longer life spans, has changed the nature of care for seniors and people with disabilities. Residents of the nation’s 15,400 C.M.S.-certified nursing homes are much older, sicker and poorer than they used to be."  The article mentions the health of the residents, low pay for employees, employees working jobs at different facilities as contributing to the crisis.

The author makes a number of suggestions for changing long-term care in the U.S.  and concludes with a call for action from the incoming administration

Most important, we must transform the way we think about long-term care — treating it not as human warehousing or the duty of underpaid women, but as an integral part of our medical system.

All of these changes are possible — and modest, really, given the magnitude of the emergency. By 2050, 19 million people will be 85 or older, and many will require help to live with comfort and a modicum of dignity. What we really need, for all Americans, is single-payer health insurance that covers quality long-term care. But short of that, Mr. Biden and Kamala Harris have a chance to make amends for the deadly failures of the current administration.

Tis the Season... for the Scammers

Although in truth, there is no "season" for scammers. They operate year round. The only thing that changes is the scam. The Washington Post a few weeks ago highlighted this with the following story, A professor thought he was sending money to help federal officials catch human traffickers. It was a scam.

The story seemed hard to believe, but whatever doubts the professor said he harbored melted away as the purported agent unspooled detail after detail of the man’s life. He knew his Social Security number. He listed properties the man had purchased 20 years ago and knew the banks he used.

 ** *

Government impersonation scams are an exploding category of crime with losses increasing tenfold from $12.5 million in 2017 to $124 million in 2019, according to the FBI’s Internet Crime Complaint Center. The FBI, U.S. Marshals, IRS and police departments nationwide have reported issues in recent years, but the Social Security Administration (SSA) has been one of the hardest hit.

This story has something of a happy ending-the authorities were notified and quickly acted, recovering the victim's money but the investigation continues without any arrests at this time.

 

Be smart and be safe.

Social Security Proposal to Restrict SSDI Benefits?

The Hill ran an item a couple of weeks ago, Social Security Administration is preparing to bar 500,000 Americans from getting benefits.

SSA’s proposal, as described in press reports, would make it harder for older workers to receive Social Security Disability Insurance (SSDI) benefits. By law (not regulation), SSA is required to consider age, education and work experience when determining whether a person meets the statutory definition of disability.

The implications are far reaching-if this proposal is passed.

In short, SSA’s proposal to tighten SSDI benefits fails to even advance past a very basic question about the suggested policy: What is the point? Looking at recent or modern data, the current system routinely denies benefits to older individuals with serious health problems and diminished prospects in the modern economy. Amplifying these outcomes by trying to get even more denials is not a rational policy approach.

The proposal would also exacerbate inequality in the United States along the lines of race and income. More than 25 percent of denied Social Security disability applicants are Black, a percentage that far exceeds the percentage of African Americans in the overall working age population. Additionally, nearly 40 percent of denied applicants live in poverty. SSA’s proposal to get more denials seems out of touch with regard to many of the serious problems facing the country.

It remains to be seen whether the administration will continue to push this through before President-elect Biden takes office.  Although the change could be undone, wouldn't it be nice if it just didn't happen?

Thanks to my colleague, Professor Mark Bauer, for sending me the article.

More on SNFs and COVID

It's going to be some time before we see good news stories about residents of SNFs---although the vaccination of SNF residents is good news.  So here are several recent articles regarding SNFS and COVID-but be forewarned, these first two are not easy to read.

51 lost lives: A portrait of the pandemic’s tragic toll in America’s nursing homes

South Dakota’s COVID-19 Surge Is Turning Nursing Homes Into A ‘Battle Zone’

There are just no words....

Then: 

An investment firm snapped up nursing homes during the pandemic. Employees say care suffered.

(Thanks to Morris Klein and Professor Bauer for sending me the link to this article).

and finally

With Vaccine Delivery Imminent, Nursing Homes Must Make a Strong Pitch to Residents.

This last article brings up some interesting issues for class discussion-such as consent, refusal of consent, and inability to consent.

Please everyone-stay safe and remember to thank our first responders, health care professionals and essential workers. And let us never forget those we have lost to this pandemic.

COVID and FInancial Harm

There's absolutely nothing good at all about COVID. I could list a number of ways it has harmed us, beyond health implications, but I just want to share one article with you from the New York Times, Female Workers Could Take Another Pandemic Hit: To Their Retirements.

Now, the pandemic recession is disproportionately damaging the careers of women — so much so that some experts call it a “shecession.”

In November, the national unemployment rate dipped to 6.7 percent from 6.9 percent, the Labor Department reported last week. But the pace of job growth has stalled, and millions have dropped out of the labor market altogether, especially women. One recent study found a disproportionate decline in employment for women of prime working age, 25 to 55, compared with men — and especially so for mothers.

The losses sustained are not just right now-but must be factored over time, including "missed wage growth, retirement savings and Social Security benefits."  Here is a great visual for this: a calculator developed by the center for American Progress.

The article discusses the importance of Social Security and includes info about President-elect Biden's plans for Social Security, which would

award work credit to people who cared for children or other relatives. It would also expand benefits for widows in certain circumstances, and bump up benefits for seniors who had collected payments for 20 years. Finally, it would adopt a new yardstick to determine Social Security’s annual cost-of-living adjustment — the CPI-E, an experimental Labor Department inflation measure designed to more accurately reflect the inflation experienced by seniors, especially health care expenses.

This is a good article-I plan to assign it to my students in the spring.

BTW, a shout out to the health care workers, first responders, essential personnel, everyone, who is keeping us going through this pandemic.  And to the scientists who created the vaccine, THANK YOU!!!!

The COVID Crisis in One Florida LTC Facility

The Tampa Bay Times ran a profile of  a local long term care facility that experienced a significant COVID outbreak last spring.  Death at Freedom Square  is an in-depth story about the people who live and work at Freedom Square and the spread of COVID within that facility. The article provides detailed reporting (In fact the TBT refers to this story as a "project").  The article is written in a way that tells the story of the people impacted, which makes it a compelling--- and sad---- read.    

Nine months into the pandemic, the virus has killed more than 19,000 Floridians. About 40 percent of the deaths have been among senior care residents. In Pinellas County alone, more than 2 out of 3 coronavirus deaths are connected to nursing homes and assisted living centers.

Freedom Square, a 15-acre retirement complex built around a town square and a gazebo, was the early epicenter in Tampa Bay.

Of course, we all know that this is not the only facility that experienced a COVID outbreak, whether inside Florida or in other states. The human interest angle makes this a compelling read, but it also includes important information about the Florida responses and about the corporate structure for this facility.

The article is as gripping as it is saddening; the reporters use of the human interest angle helps remind us that we aren't talking about numbers---we are talking about people.

Read it!

The Business Side of SNFs

Maryland elder law attorney Morris Klein sent me a link to an article recently published in the Washington Post.  How government incentives shaped the nursing home business — and left it vulnerable to a pandemic explains

Federal money, through the Medicare and Medicaid systems, has long shaped the nursing home business — and in ways that left it completely vulnerable when the viral pandemic arrived in March.

For years, extra money has gone to pay for extra services, encouraging some nursing home owners to game the system and tempting unscrupulous operators to file false claims for reimbursement. In the recent past, the gold standard was physical and occupational therapy; now it’s respiratory care.

But stringent infection control, which might have kept the coronavirus at bay, has never been a revenue producer, even now during the pandemic. Similarly, there is no monetary incentive to hire more registered nurses, although studies suggest they have been crucial in minimizing covid-19 casualties in nursing homes.

According to the article, the fee for service model is centered on additional care that will bring in additional funds to the provider, "and one consequence is that employees who handle general care of residents — nursing assistants, primarily — rather than the specialty services are a low priority for operators. They are underpaid and in chronically short supply at nursing homes across the country."

The article includes specific resident stories during the time of COVID and compares the financials for SNFs from resident stays covered by Medicare and Medicaid.  When COVID rampaged, folks put off surgeries, which affected the bottom line of many SNFs, per the article.

The temptation of the funding system leads some facilities to cross the line. "Working in a system that requires nursing homes to decide what extra services a resident needs, then provide those services, then bill the government, tempts some operators to game the rules and a few to commit outright fraud. Patients can be pushed into higher-paying categories of need. Services can be billed that were never rendered."

The lengthy article gives a really good picture of the funding system, how it works, the oversight and the remedies available to redress wrongdoing. I'm recommending this article to my students.

How SSA Hold Harmless Works

Concomitant with the announcement of the Medicare premiums for 2021 comes a blog post from SSA explaining how the hold harmless provision works. How the Hold Harmless Provision Protects Your Benefits explains that with some exceptions,  "the “hold harmless provision” protects ... Social Security benefit payment from decreasing due to an increase in the Medicare Part B premium... To qualify for the hold harmless provision, [the recipient] must: .... Receive Social Security benefits or be entitled to Social Security benefits for November and December of the current year [and the recipient's] Medicare Part B premiums for December and January [are] deducted from [the SSA] monthly benefits."

Read the blog here.

Register Now-SNT Webinar January 6, 2021

The Center for Medicare Advocacy announces their next webinar, Skilled Nursing Facility Updates, scheduled for Wednesday January 6, 2021 at 2:00 PM EST. To register, click here.

Health & Income Security Gaps For Older Americans of Color

This is not a happy article for the day after Thanksgiving-but it is a darn important topic.  The Conversation published this article, Nearly two-thirds of older Black Americans can’t afford to live alone without help – and it’s even tougher for Latinos explains that

Older Americans who want to live independently face serious economic challenges. Half who live alone don’t have enough income to afford even a bare-bones budget in their home communities, and nearly 1 in 4 couples face the same problem.

Those numbers add up to at least 11 million older adults who are struggling to make ends meet, a new analysis shows.

The numbers are worse for older people of color. Dramatically higher percentages of Black, Latino and Asian older adults live on incomes that don’t meet their cost of living, even with Social Security. That can mean skipping needed health care, not having enough food, living in unhealthy conditions or having to move in with family.

These disparities often reflect lifelong disadvantages that add up as people of color encounter structural racism and discrimination that shape their ability to buy property and save for the future.

The authors used some data available about elders "to measure the true cost of living for older adults. It tracks expenses for housing, health care, transportation, food and other basics, county by county. We paired the index with state-level income data to determine the percentage of people who don’t have enough income to cover their cost of living." The results show that "disadvantages people of color face can extend through their lifetimes and can pass on to future generations."  Not only is income security an issue, so is health security "[s]ecuring and protecting health into later life is also more challenging for many people of color."

The results also showed state by state variations. The article concludes with various recommendations:

Today’s older adults who are struggling financially can’t go back, but there are several ways to help them now:

• Policies can promote affordable housing and affordable health care, which represent the biggest components of older Americans’ budgets.

• Governments can promote mechanisms that allow people to keep working into later life, which allows people to continue generating income and building wealth, and also delays drawing down other income sources such as pensions or Social Security benefits.

• Social Security and Medicare — the foundations of a secure retirement for millions of Americans — are essential for these groups. Older people of color rely more heavily than their white counterparts on Social Security and are at heightened risk when these programs are threatened.

• Making sure government assistance programs such as SNAP benefits for food and housing subsidies are accessible to the people who need them can also help. Ensuring access includes providing information in multiple languages and hiring outreach workers who understand the population’s needs.

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

Medicare's Care Compare

Remember those cool tools on Medicare.gov that allowed you to compare nursing homes, doctors, hospitals and more?  They are being retired as of the end of the year, and replaced with Medicare's Care Compare. All the info about the various services are there-but located on one page. It's easier since you can go to any of the 8 compare services from one landing page, rather than hunting for each one from the Medicare.gov website. Here's what CMS has to say about this new website:

We’ve combined our 8 original provider compare sites, giving you one place to start finding any type of care you need. New features include updated maps, new filters that help you identify the providers right for you, and a clean, consistent design that makes it easier to compare providers and find the information that’s most important to you.

. . .

What can this tool do for me?

For people with Medicare or their caregivers who want to choose a Medicare provider (like physicians, hospitals, nursing homes, and others), this tool provides a single source search and compare experience, that lets you:

• Find information about providers and facilities based on your individual needs
• Get helpful resources to choose your health care providers
• Make more informed decisions about where you get your health care

The information here should be used with other information you gather about providers and facilities in your area. In addition to reviewing the information here, you should talk to your doctor, social worker, or other health care providers when choosing a provider.

. . .

Although the tool was created for people with Medicare in mind, many of the measures shown here apply to people who may not have Medicare.

 

Recent AP Report on Nursing Homes-It's Not Just About COVID

Last week I tweeted a link to an article from the AP about poor care in SNFs that wasn't due to COVID, Not just COVID: Nursing home neglect deaths surge in shadows. The National Consumer Voice for Quality Long Term Care wrote a response;  and their full statement is available here.

Consumer Voice has heard from hundreds of families whose loved ones have been harmed by neglect. Family members report that many residents have experienced significant physical decline, such as losing their ability to move, or sit up or stand up without assistance. Others no longer talk because almost no one has spoken to them since March. There are residents who have not been bathed nor had their teeth brushed for months, and residents who have been confined to their rooms -while missing their eyeglasses and hearing aids. One resident sat in her room with a fractured hip for a month – the result of a fall and lack of medical attention, despite complaints of pain for weeks. Weight loss, bed sores, infections, and cognitive decline are ravaging nursing home residents. Much of this suffering could have been prevented.

The statement called on Congress for changes, including '"[ensuring] adequate numbers of well-trained and well-compensated staff. ... [and] [opposition of] any kind of immunity from civil liability for nursing homes" They also called on CMS to "[i]ncrease oversight of resident care ... [and] [r]equire facilities to permit family to conduct compassionate care visits."

Changes to Social Security for Those Still Working?

A little over a week ago, the Motley Fool ran this article, Working and Collecting Social Security? Big Changes May Be on the Way in 2021. The article opens discussing the importance of Social Security to recipients. "Without this guaranteed monthly benefit, the elderly poverty rate would be close to 40%, according to an analysis from the Center on Budget and Policy Priorities (it's under 9% with Social Security payouts)." For those who are working, there are changes coming, according to the article.

"Some choose to continue working, either part-time or full-time, while collecting their retired worker benefit from the program. If you're one of these people, or you expect to claim benefits very soon while continuing to stay employed in some capacity, you should be aware of a handful of changes expected to occur in 2021." 

The retirement earnings test amount (a formula that provides a deduction from SSA checks based on earnings amount for those who claim Social Security before reaching their full retirement age) is being increased (the article does a good job of explaining the earnings test).

Back in August the president issued an administrative order for a payroll tax deferral through the end of the year and for those who chose the deferral, 2021 is just around the corner when they have that bill coming due. Also in 2021, the payroll tax earnings cap will increase.  

The full article is available here. My thanks to my dear friend and colleague Professor Feeley for sending me the article.

Catching up on Nursing Home Articles

It's hard to keep track of all the articles coming out, most of which are about COVID and SNFs. There have been so many recently, I decided to just list them here.

COVID-19 Is Still Devastating Nursing Homes. The Trump Administration Isn't Doing Much to Stop It  (Sept. 11, 2020)

They Work in Several Nursing Homes to Eke Out a Living, Possibly Spreading the Virus (Nov. 2, 2020)

Judge says care home residents in England are legally allowed visitors (Nov. 3, 2020) (Thanks to my dear friend Professor Feeley for sending this to me)

Nontraditional nursing homes have almost no coronavirus cases. Why aren’t they more widespread? (Nov. 3, 2020)

40 Dead, Now 40 Laid Off: Inside a Nursing Home in Crisis (Oct. 29, 2020).

It has the highest death rate of any nursing home in the US. Families want to know why (Oct. 28, 2020)

Kansas nursing home faces severe federal penalties after deadly coronavirus outbreak (Oct. 27, 2020)

and finally, but maybe most significantly, this obituary,  Carter Williams, Who Unshackled Nursing Home Residents, Dies at 97 (Oct. 5, 2020).  Thank you Ms. Williams!

With the COVID numbers skyrocketing, I expect we will see more of these stories-and restrictions on visitation that have been previously lifted, are likely going to be imposed again.