Monday, November 4, 2019

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. 

November 4, 2019 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink

Friday, November 1, 2019

Student Views of Recent Events

My students are finding really interesting items to share with you. Here are a couple more of them.

Sara Boyko writes about an inter-generational approach to nursing homes

Nursing Home in China has a Kindergarten

(When the Young at Heart and Old Souls Cross Paths)

A nursing home in China made news recently due to some unconventional approaches to recreational activity. The nursing home boasts a kindergarten class where the children shoot ping pong balls at the nursing home employees while gray-haired onlookers enjoy some much-deserved comedic relief. There are two positive benefits to mixing the old souls with the young at heart: first, that exposure to the elderly by young children can help to break down stereotypes about what it means to be ‘old’; and second, that when elderly populations stop seeing themselves as a stereotype of an elderly person, it actually has positive health and cognitive benefits.

                Everyone ages in different ways and at different rates. It is a very individualized journey for each person. When young children are exposed to the elderly who are in different stages of aging, it helps to reinforce this notion. However, while researching the topic of stereotypes of the elderly, I came across a startling article in the Journal of Geriatrics. When older adults start to see themselves fit into the stereotype of an elderly person, it actually makes them feel older.  This, in turn, affects their health. For example, when an elderly person is exposed to a stereotype threat in an empirical setting, it has negative effects on their memory performance. The same has been shown for math performance.

                On the flip side of that coin, viewing one’s self as young and vibrant can have the opposite effect. This is why mixing together kindergartners and the elderly can have such a strong and lasting impact for all people involved. Those nursing home residents can get a break from their routine of medications and small-talk, to a genuinely engaging afternoon pastime of watching children frolic about. The children will, in turn, no longer view the elderly as a homogeneous group of declining adults and eventually come to view these residents as individuals in various stages of development.

So what do you think? Should more nursing facilities mix age groups in this way?

Peyton Marshall alerts us to a new project regarding caregivers:

Kaiser Health News published an article called “Drumbeat Builds for a Peace Corps of Caregivers”. The need for caregivers is expected to grow substantially, as “those age 85 and up, who tend to have multiple chronic illness and difficulty performing daily tasks—are set to swell to 14.6 million in 2040, up from more than 6 million now.” While the job market for caregivers is expected to grow, the job of a caregiver is difficult and low paying, and the profession has a high turnover rate.

Therefore, four organizations—Oasis Institute, the Caregiver Action Network, the National Association of Area Agencies on Aging, and the Altarum Institute—have partnered together to remedy the problem of shortage of caregivers and caregiving services. These organizations have created the Care Corps Project. The goal of the Care Corps Project is “to discover innovative, effective programs that offer services to diverse communities (geographic, racial and ethnic) and that can be replicated in multiple locations.” The Care Corps Project recently received an initial grant of 3.8 million dollars (total funding expected to be 19 million for a five-year period). While this initial grant is small in comparison to the need, it is the step in the right direction, which hopefully will spur more investment in the Care Corps.

The Care Corps project (this Fall) will be looking for organizations to submit proposals “to serve ‘non-medical’ needs of older adults and younger adults with disabilities.” The goal is that the proposals will provide details such as the specific service the organization wants to offer, the number of volunteers, and its sustainability and transferability to other regions. Then, in the spring, organizations, whose proposals were selected, will receive a grant to implement their proposal. Therefore, this program can have the potential to increase quality of life for elders throughout the country. If your organization has an innovative solution for caregiving, it is time to start writing your proposal.

November 1, 2019 in Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink | Comments (0)

Thursday, October 31, 2019

Free Webinar:Advanced Training on Medicare Part B

Sign up now for this upcoming November 20, 2019 webinar from the National Center of Law & Elder Rights.  The webinar is on Advanced Training on Medicare Part B, and is scheduled for 2 p.m. eastern.  Click here to register.  According to the announcement,

Advanced Training on Medicare Part B

When: Wednesday, November 20, 2019 at 11:00 a.m. PT/2:00 p.m. ET.

Beneficiaries and advocates face challenges navigating the benefits covered under Medicare Part B and understanding the basics of accessing these benefits.

This webcast will look at three areas that can often cause confusion and will provide advice on how to address common problems:

·         Advance Beneficiary Notice (ABN): What is it and what options do clients have when faced with an unexpected bill after signing an ABN?

·         Part B Drugs: What drugs are covered by Part B and what payments are required?

·         Durable Medical Equipment: For 2019 and 2020, competitive bidding has been suspended for all DME except insulin supplies. What does this mean for your client’s access to suppliers?

Presenter: Georgia Burke, Directing Attorney, Justice in Aging

NOTE: This is an advanced training and assumes participants have a general understanding of Medicare benefits. Please see NCLER's Health Training curriculum for more information on the Legal Basics of Medicare Parts A, B, and C

 

October 31, 2019 in Consumer Information, Current Affairs, Health Care/Long Term Care, Medicare, Programs/CLEs, Webinars | Permalink | Comments (0)

Tuesday, October 22, 2019

Pennsylvania's Unique Role for Older Adult Advocacy in State Government

On Monday, I participated in a panel discussion of aging services in Pennsylvania, at the invitation of Professor Patricia Aguilera-Hermida, who is on the faculty of Human Services and Family Studies at Penn State Harrisburg.  Even though I knew most of the panelists -- all experienced professionals from Pennsylvania's Department of Aging -- the occasion gave me new insight and respect for the role of advocacy on behalf of older adults.  The students were attentive and asked great questions, and I suspect some of them saved their best questions for the one-on-one time with the speakers.

Penn State Harrisburg  Panel on Aging Services 10.22.19

Robert Torres, the Secretary of Aging in Pennsylvania reminded us that our state has a uniquely strong, dedicated funding system to advocate for older adults through the Pennsylvania Lottery.  About 80% of the department's operations and outreach budget is funded by this source.  As anyone who has worked in state or federal government would know, the "fight" for adequate funding for operations can be intense, and in many states older adults would not have a strong position in the queue for necessary dollars.

The breadth of programming outlined by the panelists is impressive. For example,  Christine Miccio, Director of the Bureau of Aging Services described in detail the OPTIONS program that provides direct support for more than 55,000 older adults who are still in their homes. Pennsylvania also has more than 500 publicly supported Senior Centers -- a way to reach additional people with meals, health care information, activities and social programs.  Margaret Barajas, a dynamo who is the Statewide Long-Term Care Ombudsman, explained how a system of volunteer and paid advocates investigate and coordinate responses to concerns about senior living-based needs, including concerns about quality of services in nursing homes and assisted living facilities.  Denise Getgen, as director of the Older Adult Protective Services Office, described the ever growing need for investigation of complaints about elder abuse, neglect and exploitation.  In recent years, the number of complaints received and investigated by the state has grown to over 40,000 allegations per year, with the majority of concerns focusing on self-neglect for persons in isolated circumstances.  I've worked with several of these units directly over the years, especially when I was head of my Law School's Elder Protection Clinic.  Pennsylvania's Area Agencies on Aging continue to fund and coordinate certain free legal services for seniors in need in each county throughout the state.

One student asked about whether services from the Department are limited to "citizens" of the United States -- and it was impressive to hear the long list of services that are NOT restricted by citizenship.  Another student tossed a "softball" question -- "what is your favorite program?" -- and Christine Miccio hit it out of the park by describing the success of a new pilot program in rural Pennsylvania that matches up older adults who need housing or assistance -- with those who can provide housing or assistance.   She joked that she is now the eHarmony of housing matches, especially as the original pilot program is extending to several additional counties.  

My thanks to Professor Aguilera-Hermida for hosting this noon-time chat with so many students who are considering a wide range of aging services as part of their career goals.  One enterprising student explained to me that her interest in the field of gerontology at medical school was sparked when she found affordable housing as a student in a well-known, nearby nursing home that had "extra" space.  

October 22, 2019 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, Housing, State Statutes/Regulations | Permalink | Comments (0)

Friday, October 18, 2019

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!

 

October 18, 2019 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Other | Permalink | Comments (0)

Thursday, October 17, 2019

Webinar on Self-Neglect and Hoarding

Here's an upcoming free webinar from the National Center on Law & Elder Rights on November 12 at 2 est:

Legal Basics: Self-Neglect and Hoarding Disorders

When: Tuesday, November 12, 2019 at 11:00 a.m. PT/2:00 p.m. ET.

Lawyers working with older adults are likely to encounter challenges related to self-neglect and hoarding. Intervening in self-neglect cases can be very complicated. Clients who have a hoarding disorder may be living in conditions that make it impossible for them to live in safety, resulting in self-neglecting behaviors. This Legal Basics session will discuss the most common root causes of self-neglect and hoarding disorders, provide insight into the complexity of the issues, and offer suggestions of how to offer help. The webcast will also explore legal issues and the lawyer’s role when working with older adult clients.

The webcast will cover:

  • Understanding self-neglect and helping without harming.
  • The line between self-neglect being a human services issue and a legal issue.
  • Assessing possible hoarding disorder cases. 
  • Suggestions when working with a person with hoarding disorder.
  • When hoarding becomes a legal issue.

This webcast is being presented as part of NCLER’s forthcoming Elder Justice Toolkit. Stay tuned for more!

Click here to register.

October 17, 2019 in Consumer Information, Current Affairs, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)

Tuesday, October 15, 2019

Loosening the Regs of Florida ALFs?

The Tampa Bay Times ran an article a few days ago that raises some important issues. Florida’s assisted living facilities write rules on reporting deaths, injuries . explains the current reporting requirements when a resident is injured and the proposed change to the requirement.

When a resident in one of Florida’s assisted living facilities falls, dies or is seriously injured, that facility is required to tell the state within one business day that something has gone wrong. But a bill before lawmakers would give operators weeks to report such critical incidents — potentially leaving residents in harm’s way, elder advocates warn.

Industry groups for assisted living facilities, which crafted much of the bill’s language and handed it to lawmakers, say the one-day reports are not needed, and eliminating them will reduce onerous paperwork and unnecessary administrative fines.

Hang on for a second and think about this.  There must be a reason for the current requirement... and advocates say it's because they "are necessary to inform state regulators quickly of potential incidents, and that the change is part of a decades-long deregulation of the industry that could put residents at greater risk."

The section on adverse incidents involves one of the key methods for alerting regulators when something goes wrong. Currently, an initial report must be filed if a resident dies, sustains serious injuries, goes missing or is transferred to a hospital or other facility for more intensive care — and facility administrators think they may be responsible.

Assisted living facilities are required by statute to submit up to two reports: one within one business day after an incident, and another full report within 15 days if the facility determines it is responsible. When a report is filed, the Agency for Health Care Administration can then use it to initiate an investigation if it raises concerns about resident safety.

The proposal requires just 1 report that is filed by 15 days, when the facility makes the decision that " the incident happened in the scope of its care, though it would direct the facility to begin investigating the incident within 24 hours" the article reports. The article indicates that the bill was brought by the Florida Senior Living Association, and is supported by AHCA. Advocates for residents take the opposing few-that is more regulation rather than less.  The bill's sponsor in the Florida Senate is quoted as saying "the legislation [is] a “modernization” bill that would primarily update language in the statute, and allow residents to use devices to move around more easily or prevent falls.... [and that] the language to reduce the number of adverse incident reports was meant to bring assisted living facilities in line with a recent change made to reduce those reports for nursing homes, and “to make sure the language would be as similar as possible." Although the Senator has spoken primary with the industry folks, she plans to talk to resident groups too, the article reports.

Read the bill and follow it. If you live in Florida, let your elected representative know your position on this. If you live in another state, pay attention anyway. The revisions could be proposed in other states as well.

October 15, 2019 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, Housing, State Statutes/Regulations | Permalink | Comments (0)

Monday, October 7, 2019

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!

October 7, 2019 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare | Permalink | Comments (0)

Thursday, October 3, 2019

Cognitive Impairments and Using Technology

Who among us doesn't have a smart phone or computer, or even a tablet? They are not only ubiquitous, they are integral, and perhaps essential, to our daily lives.  What happens when someone, due to cognitive impairments, is no longer able to use these devices? Kaiser Health News made that the subject of a recent article. The Delicate Issue Of Taking Away A Senior’s Smartphone describes the potential problems

Increasingly, families will encounter similar concerns as older adults become reliant on computers, cellphones and tablets: With cognitive impairment, these devices become difficult to use and, in some cases, problematic.

Computer skills may deteriorate even “before [older adults] misplace keys, forget names or display other more classic signs of early dementia,” Zorowitz wrote recently on a group email list for geriatricians. (He’s based in New York City and senior medical director for Optum Inc., a health services company.)

“Deciding whether to block their access to their bank accounts, stocks and other online resources may present the same ethical dilemmas as taking away their car keys.”

Consider that some folks stay in touch with family and friends through their digital lives. But also consider how scammers can use email to perpetrate a fraud.  The article notes a difficulty in using these devices---a difficulty that did not previously exist--may be an indicator of cognitive issues signaling a need for a comprehensive exam of cognition.  Family can be helpful, but still realize there are issues

[B]eware of appropriating someone’s passwords and using them to check email or online bank or brokerage accounts. “Without consent, it’s a federal crime to use an individual’s password to access their accounts,” said Catherine Seal, an elder-law attorney at Kirtland & Seal in Colorado Springs, Colo. Ideally, consent should be granted in writing.

The article notes that some with dementia lose interest in their devices, but that is not true for everyone-it depends on the type of cognitive impairment.  "More difficult, often, are situations faced by people with frontotemporal dementia (FTD), which affects a person’s judgment, self-awareness and ability to assess risk." The article then profiles the experiences of a noted elder law attorney and friend of mine, whose husband as an FTD diagnosis. She shared the steps she takes to keep her husband safe online.

Read the entire article, especially the last part where personal experiences and tips are shared.  It's an important topic-we all need to think about this and plan for the eventuality in case we need to give up our digital word.

October 3, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, Other | Permalink | Comments (0)

Wednesday, October 2, 2019

Emergency Planning & Older Adults: A New Report on Preparedness

We are still in hurricane season down here in Florida, sporting 90 degree temperatures, while Montana had a blizzard.  Natural disasters take all forms so it's important to remember that everyone needs a disaster plan. the University of Michigan National Poll on Healthy Aging  published a new report, Emergency Planning among Older Adults.

Introduction

Natural disasters and other emergencies can happen anywhere. When they do occur, older adults, including those with chronic health conditions and impaired mobility, may be particularly vulnerable to adverse effects. In May 2019, the University of Michigan National Poll on Healthy Aging asked a national sample of adults age 50–80 about their experiences with disasters and emergency planning as well as their preparedness for such events.

Preparing for emergencies

In the past year, more than one in five adults age 50–80 (22%) had experienced an emergency or disaster such as a power outage lasting more than a day, severe weather, evacuation from their home, or a lockdown, while 73% reported experiencing at least one such event during their lifetime. More than half of respondents (53%) thought they were likely to experience an emergency or disaster in the next year.

The question is then, are these folks prepared?  Not everyone, according to the poll results:

Implications 

Although more than half of older adults believe they will likely experience some type of natural disaster or emergency in the coming year and the majority generally feel confident in their ability to manage through them, many older adults have not taken key steps recommended by disaster preparedness agencies. Nearly half of respondents either did not know if their community had an emergency alert system or had not yet signed up. Having any advanced warning of a disaster or emergency, even minutes, can help people get to a safer place, so signing up for these alerts, where available, is important. 

Although most older adults who require essential medications or health supplies reported having a seven-day supply available, three in four individuals who use medical equipment that requires electricity did not have an alternative power source. Roughly half of respondents reported having a week’s supply of food or water, or tools for communication in the event of a power outage such as a solar or battery cell phone charger or a battery-powered or hand crank radio. Disaster preparedness agencies recommend such resources for everyone, and these steps may be particularly important for older adults with complex health needs or mobility challenges. 

The American Red Cross, FEMA, and AARP all offer guidance for preparing/responding to disasters and emergencies specifically designed for older adults. These groups and others tasked with promoting emergency preparedness should consider utilizing new strategies to reach and engage older adults who may not already be well-prepared for emergencies. Additionally, health care professionals who care for older adults should consider discussing disaster preparedness, particularly in areas that routinely face natural disasters. Preparing now can help older adults — and everyone — to be ready for emergencies.

The full report is available here.

October 2, 2019 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other | Permalink | Comments (0)

Tuesday, October 1, 2019

Make These a Part of Your Exercise Routine?

We all know how important it is to keep moving! But what gives us the maximum benefit, at least from the standpoint of being the most you can be (I sound like the old Army ad "Be all you can be") when you are older. The Washington Post ran this informative article, The longevity files: A strong grip? Push-ups? What actually can help you live to a ripe old age.

Here are some tips from the article--pushups, walking speed, sitting on the floor and standing up (known as sit-rise) and grip strength matter.  But those are not magic elixirs--instead they are representative of your ability,  "that you are still strong and nimble enough" to do them. "What these tests have in common is they’re good shorthand of things that matter for longevity: overall health, fitness and muscle strength. A fit person walks faster than someone out of shape, and getting up off the floor is tricky for people with weak bones and muscles."

As the article notes, there is no magic pill for longevity, but exercise does help... a lot. Even short amounts of exercise make a difference.  Oh and it's not just exercise; sleep matters as well as does diet.  Alcohol in moderation and keeping stress under control are also important.  Having friends and a purpose are also discussed in the article. 

This reminds me of so much of what we were taught in health and gym classes back in high school.  So now that you've read this post, read the article and then take walk.

 

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

October 1, 2019 in Consumer Information, Current Affairs, Food and Drink, Health Care/Long Term Care, Other | Permalink | Comments (0)

Thursday, September 26, 2019

Jimmy Carter Jokes About How Old Is Too Old To Be President

Per a story recently in CNN, Jimmy Carter jokes 'I hope there is an age limit' on presidency.

Former President Jimmy Carter said if he were 80 years old he would not be able to handle the responsibilities of being President and joked that he hopes there is an "age limit" on the office.

The comments from the 94-year-old former commander-in-chief are especially notable as the age of the three top Democratic 2020 presidential hopefuls, who are in their 70s, has been the subject of ongoing debate. The 39th president didn't mention any Democratic candidates by name at a town hall at the Carter Center in Atlanta on Tuesday night when he was asked if he might consider running for a second, non-consecutive term.
"I hope there is an age limit," he said as the audience laughed. "You know, if I were just 80 years old, if I were 15 years younger, I don't believe I could undertake the duties that I experienced when I was President."
Carter said the presidency requires mental fortitude and one must "be able to adapt to new ideas."
. . .
"So the things I faced then in foreign affairs, I don't think I could undertake them when I was 80 years old. So 95 is out of the question. I had a hard time walking when I came in," said Carter, whose birthday is on October 1.
Happy early birthday President Carter. This article can be part of an interesting discussion in our classes about the considerations of age.

Thanks to one of my students for sending me this article!

September 26, 2019 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other | Permalink | Comments (0)

Wednesday, September 25, 2019

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.

September 25, 2019 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Property Management, State Statutes/Regulations | Permalink | Comments (0)

Tuesday, September 24, 2019

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.

September 24, 2019 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)

Monday, September 23, 2019

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.

 

September 23, 2019 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare | Permalink | Comments (0)

Wednesday, September 18, 2019

Do You Have A When I Die File?

Do you have your estate planning documents done? Made funeral arrangements? Think you have everything covered? Well, did you make a "when I die file?"  According to an article in Time magazine, Why You Need to Make a 'When I Die' File—Before It's Too Late this file is likely

the single most important thing you do before you depart. It may sound morbid, but creating a findable file, binder, cloud-based drive, or even shoebox where you store estate documents and meaningful personal effects will save your loved ones incalculable time, money, and suffering. Plus, there’s a lot of imagination you can bring to bear that will give your When I Die file a deeper purpose than a list of account numbers. One woman told us she wants to leave her eulogy for husband in the file, so she can pay homage to him even if she goes first.

Without such a file, the process of compiling the information can be time-consuming and emotionally draining for the family. Here are some of the tips from the article

First, call the companies behind your cable, internet, cell phone, club memberships, and anything else that bills for services on an ongoing basis and add your partner or kids to the account as a joint owner. If billing accounts are not in both your and a loved one’s name, your survivors will end up spending hours on the phone and in offices begging bureaucrats to shut them down or convert the accounts to their name so they can manage them. Think of every frustrating call you’ve had with your cell provider, and then multiply it by 10.

***

Here are a few of the things you’ll put into your “When I Die” file:

□ An advance directive that’s signed (and notarized if necessary)

□ A will and living trust (with certificate of trust)

□ Marriage or divorce certificate(s)

□ Passwords for phone, computer, email, and social media accounts

(We recommend using an online password manager to collect them all, sharing the master password with someone you trust, and then designating emergency contacts within the program who are allowed to gain access.)

□ Instructions for your funeral and final disposition

□ An ethical will

□ Letters to loved ones

There is more information about the file in the book on which this article is based, Beginner’s Guide to the End

September 18, 2019 in Advance Directives/End-of-Life, Books, Consumer Information, Current Affairs, Health Care/Long Term Care, Other | Permalink | Comments (0)

Tuesday, September 17, 2019

Faith Based Colorado Hospital Fires Dr. Who Planned to Help With MAD

Although it's been a bit of time since Colorado 's medical aid-in-dying (MAD) law went into effect, but recent events suggest the topic has not been settled. According to Kaiser Health News, Firing Doctor, Christian Hospital Sets Off National Challenge To Aid-In-Dying Laws

A Christian-run health system in Colorado has fired a veteran doctor who went to court to fight for the right of her patient to use the state’s medical aid-in-dying law, citing religious doctrine that describes “assisted suicide” as “intrinsically evil... [the doctor] had planned to help her patient...   end his life at his home [the patient] is eligible to use the state’s law, overwhelmingly approved by Colorado voters in 2016."

This illustrates the clash between faith-based hospitals and state laws. "As hospitals across the country have consolidated, five of the top 10 hospital systems by net patient revenue are associated with the Roman Catholic Church ...  [t]hat includes hospitals that did not previously have any religious affiliation. Meanwhile, there are 10 U.S. jurisdictions where aid-in-dying has been approved and public support for the option is increasing."

Stay tuned-this is going to take a while to be resolved through the courts.

September 17, 2019 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, Medicare, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Monday, September 16, 2019

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.

 

September 16, 2019 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Sunday, September 15, 2019

How to Make Health Care Age-Friendly

A story in Kaiser Health News, In Search Of Age-Friendly Health Care, Finding Room For Improvement highlights needed design improvements within health care facilities.

For older adults, especially those who are frail, who have impaired cognition, or who have trouble seeing, hearing and moving around, health care facilities can be difficult to navigate and, occasionally, perilous.

Grab bars may not be placed where they’re needed. Doors may be too heavy to open easily. Chairs in waiting rooms may lack arms that someone can use to help them stand up.

Toilets may be too low to rise from easily. Examination tables may be too high to get onto. Lettering on signs may be too small to read. And there may not be a place to sit down while walking down a hallway if a break is needed.

Examining the changes from the "ground-up" so to speak, the article starts with the issues from poorly thought-out parking: inconvenient location of the lot to insufficient spaces for those with disabilities. Don't forget signage---is there enough? Is it logically located? Is it hard-to read? (think poor contrast, glare or hard-to read fonts). Then there are steep ramps, a lack of available walkers and wheelchairs to borrow at the facility's entrance and a lack of automatic doors. Ever been asked by the receptionist to take a clipboard of forms to fill out at your seat? Of course-no big deal--unless you use a walker or two canes--talk about having your hands full!  Oh and let's get started about seats--too low, too soft, no arms or all with arms!

The article is an interesting read and hopefully those who design health care facilities will think about these things--because humans don't all come in one size or all have the same abilities or needs.

September 15, 2019 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other | Permalink | Comments (0)

Wednesday, September 11, 2019

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.

September 11, 2019 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare, Programs/CLEs, Social Security, Webinars | Permalink | Comments (0)