Sunday, March 7, 2021
NBC News ran this story, America now knows that nursing homes are broken. Does anyone care enough to fix them? . Once COVID starting sweeping through facilities last year, more folks learned about the current model of providing long-term care, and their short-comings. Experts began calling for reform on the way we provide SNF care in the US. But did that call for reform get drowned out by the daily news about the havoc COVID was wreaking on our country?
The NBC News story ran yesterday (thanks to my colleague and dear friend Professor Bauer for sending me the link).
The pandemic turned nursing homes into a death trap for more than 170,000 long-term care residents and staff members who have lost their lives to Covid-19.
But the virus also revealed how America’s system for long-term care is fundamentally broken in ways that will continue to harm vulnerable residents and workers, long after the pandemic has faded away.
The biggest underlying problem? For all the billions of taxpayer dollars that the United States spends on a system meant to care for frail, elderly residents, not enough money is being invested in caregiving itself, according to interviews with more than a dozen nursing home researchers, advocates, industry representatives and staff members.
There are two sides to this issue, as noted in the story, as well as an opportunity for reform, complete with roadblocks to achieving it.
Nursing homes, by their nature, are ideal breeding grounds for Covid-19: Frail, elderly residents live in close quarters, often requiring support from aides to eat, get out of bed, bathe and get dressed.
This hands-on caregiving is the backbone of what a nursing home provides, and the reason that most residents are in long-term care to begin with. But a chronic failure to value this work, and compensate it accordingly, helped accelerate the pandemic’s catastrophic spread, experts said.
Staffing shortages are discussed in the article, along with explaining how those shortages contribute to a greater risk of a COVID outbreak. The work these folks provide is undervalued both in terms of salary as well as the role they play in providing care.
The section of the article on funding is quite illuminating
America’s long-term care system was created as an afterthought, when nursing home coverage for poor, frail Americans was included, without much fanfare, as part of the 1965 law .... A half-century later, the elderly population has ballooned, and life expectancy has shot up, while personal savings have not, leaving millions of aging Americans unable to pay for the care they need. But unlike most major industrialized nations, the U.S. has no universal public system that covers elder care, which means that many patients, as well as nursing homes, are ultimately left to rely on Medicaid.
The trouble with Medicaid — the only federal program that pays for long-term care — is a reimbursement rate that the industry has long complained is too low, about $200 for each day of care, on average. Medicare pays at least twice as much, but it only covers up to 90 days of post-acute care and rehabilitation, typically following a hospital stay.
The article discusses accountability, the use of third-party contractors, quality of care transparency (or a lack thereof) and lobbying efforts. The article looks at proposals to change the industry. I'm assigning it to my students and we will discuss it in class. I recommend it to you.
Friday, March 5, 2021
Let's end the week with a happy story, shall we? The New York Times featured the return to "normal" for one nursing home. After Vaccines, Joy, Relief and Game Night
The first day back was full of ordinary moments: small talk over coffee, bidding wars at an afternoon auction, a game of dice. But after a year of loss, loneliness and disruption, the very ordinariness of it all brought joy and relief.
There's losses, sadness and joy. It's a happy way to end the week.
Thursday, March 4, 2021
Two articles that bear reading, both from the New York Times.
First, an op-ed We Are Going to Keep You Safe, Even if It Kills Your Spirit’ in the New York Times, examining the impact of COVID and isolation on folks with dementia. This is an important read. The article highlights the challenges for those individuals and mask-waring and social distancing, as well as how the disruption of their routines impacts them.
People with dementia “may not adequately comprehend, execute, or recall any of the suggested public health measures,” as the Alzheimer’s Association puts it. Also, it’s not possible to social-distance when you live in a nursing home, as about 15 percent of people with dementia do, and when you need help eating and going to the bathroom.
Even those who stay free of the virus have suffered disproportionately from the disruptions of pandemic life. Dementia responds well to routine: rigid, time-blocked schedules and familiar faces. But the pandemic has shown us, and warned us, how quickly the fragile channels of dementia care — the muddled blend of formal and informal networks that sustain those routines — can collapse under strain.
Second, another New York Times article, People With Dementia Are Twice as Likely to Get Covid, Huge Study Finds
People with dementia had significantly greater risk of contracting the coronavirus, and they were much more likely to be hospitalized and die from it, than people without dementia, a new study of millions of medical records in the United States has found.
Their risk could not be entirely explained by characteristics common to people with dementia that are known risk factors for Covid-19: old age, living in a nursing home and having conditions like obesity, asthma, diabetes and cardiovascular disease. After researchers adjusted for those factors, Americans with dementia were still twice as likely to have gotten Covid-19 as of late last summer.
Wednesday, March 3, 2021
Will the administration provide support for family caregivers? This was the subject of an opinion published in the New York Times. 50 Million Americans Are Unpaid Caregivers. We Need Help. focuses on the author's personal experiences as a family caregiver. Consider this: "It’s often noted that the United States is alone among rich nations in not providing maternity leave; support for child care is likewise abysmal. Similarly — but often more invisibly — we leave millions of caregivers with little or no support in managing the financial, logistical and emotional difficulties of helping ailing parents, spouses and children." Referencing the pledge made during the campaign, the author notices the benefits:
The changes would help not just caregivers like me; what’s good for caregivers also benefits those who need assistance. Expanding home care can keep frail elderly people out of nursing homes, the drawbacks of which have been painfully exposed by the pandemic. Easing financial strains and burnout for caregivers can mean better, more compassionate treatment, which in turn can improve quality of life and outcomes for our most vulnerable citizens.
Monday, March 1, 2021
The End of Life Options Act has been reintroduced in Massachusetts. This article notes an overwhelming support by U.S. adults for aid-in-dying. The article also includes a short podcast of the story. If this bill passes, Massachusetts will join a handful of other states where aid-in-dying is legal Stay tuned.
The annual Ann F. Baum Memorial Elder Law Lecture at the University of Illinois College of Law is scheduled for March 10, 2021 at noon (central) virtually. This year's lecture, "Ways of Thinking About Medical Care: Alternative Models and Structures and Their Policy Significance" will be presented by James F. Blumstein, Vanderbilt University of the University Professor of Constitutional Law and Health Law & Policy and Professor of Management, Owen Graduate School of Management, Director, Vanderbilt Health Policy Center.
Here's a description of the presentation:
Traditionally, medical care has been understood to function under a professional paradigm; medical decisions are considered purely scientific under a standard of “medical necessity.” Medicare and Medicaid were based on this model, where economics has little sway. Over time, an alternative model, an economic paradigm, has gained traction. Under the alternative model, economics plays an important role in medical decisionmaking. The professional model had a strong influence on the design and structure of Medicare and Medicaid, with significant consequences in terms of cost escalation. Medicaid, in particular, has been an uncapped entitlement program of federal/state spending. About 20 years ago, Medicaid introduced managed care, which allowed for consideration of economic factors in medical decisionmaking. And, at the same time, the Children’s Health Insurance Program (CHIP) developed a competing model for federal/state healthcare spending. The Affordable Care Act (ACA) relied on cost savings from projected Medicare spending to fund increased access to care, a clear recognition of the salient role of economics in supporting expanded access to care. Most recently, the federal government has approved a Tennessee Medicaid waiver, essentially transferring the CHIP funding model to the context of Medicaid. The interplay of economics and program design/structure in healthcare programs, culminating in the recent Medicaid waiver for Tennessee, will form the centerpiece of this year’s Baum Memorial Lecture.
Here is the info to attend
Join by Zoom Meeting
Meeting ID: 860 8008 4604
Join by Skype for Business
Thanks to Professor Kaplan for letting me know about this wonderful program!
Sunday, February 28, 2021
Still? Yes still. Seniors Seeking Vaccines Have a Problem: They Can’t Use the Internet tells us something we already know (and I have already blogged about).
The chaotic vaccine rollout has come with a maze of confusing registration pages and clunky health care websites. And the technological savvy required to navigate the text alerts, push notifications and email reminders that are second nature to the digital generation has put older adults like Ms. Carlin, who need the vaccine the most, at a disadvantage. As a result, seniors who lack tech skills are missing out on potentially lifesaving shots.
The article explains various agencies and efforts to help those without internet access but more needs to be done.
There's got to be a better way. Is it really this hard?
Monday, February 22, 2021
Despite projects to vaccinate those elders who are homebound or lack internet access, we are still lagging behind on reaching them, according to a story today in Kaiser Health News. Countless Homebound Patients Still Wait for Covid Vaccine Despite Seniors’ Priority starts with the good news-recognizing the unique outreach efforts by hospitals, health systems, and paramedics, for example. These folks are home are highly vulnerable. Described by one expert in the article as a "hidden group", they are at great risk, "[b]y virtue of their age and medical status, these seniors are at extremely high risk of becoming seriously ill and dying if they get covid-19. Yet, unlike similarly frail nursing home patients, they haven’t been recognized as a priority group for vaccines, and the Centers for Disease Control and Prevention only recently offered guidance on serving them." The article notes that those professionals whoa are regularly in contact with them are not those with access to vaccines. Medicare's reimbursement rates for time-consuming house calls doesn't allow the health care professionals to recoup their costs, notes the article. Not only that, knowing the storage requirements for the vaccines doesn't mean a health care professional can just hop into their car and drive around with the vials in a cooler.
So this brings us to this story, a new hero for all of us! Last week in the New York Times, Woman, 90, Walked Six Miles in the Snow for a Vaccine
explained how after that recent snow storm, driving was out for her, but given all her previous failed efforts to get the vaccine, she wasn't going to miss this opportunity.
Where's Rosie the Riveter when we need her?? Surely "we can do it" or at least do better?
Friday, February 19, 2021
A week or so ago, stories started to emerge that SNF employees were passing on the opportunity to get the COVID vaccine. Kaiser Health News ran this article, explaining some views Vaccine Hesitancy vs. Vaccine Refusal: Nursing Home Staffers Say There’s a Difference.
The reluctance of one staffer interviewed for the article was noted to be shared by others: "[this] hesitancy has been echoed by nursing home staff members across the state and country. But [the staffer's] reasoning — as well as that of her colleagues who also opted against the vaccine that day — goes far beyond a simple yes or no. The decision is complicated and multifaceted, they said, which means persuading them to say yes will be, too."
In reaction to the stories that SNF employees were refusing the vaccine, the article goes on to explain: "[S]ome nursing home staffers say their reluctance is being misconstrued. Most are not saying they’ll never take the vaccine, but simply that they have concerns about such a new product. They understand it went through months of clinical trials, but what about possible long-term side effects, for instance? Or how did politics play into the development process? For communities of color, their historical mistreatment by the medical system can also factor into the decision."
The article also reports on various approaches taken by SNFs to get their employees to get vaccinated.
Wednesday, February 17, 2021
The Vatican is calling for a new paradigm of care for older people after what it calls the "massacre" wrought by the coronavirus pandemic, which has disproportionately killed people living in nursing homes.
The Vatican's Pontifical Council of Life issued a position paper Tuesday that made the case for a global rethink of how to care for people in their final years, including resisting any rush to institutional care in favor of adapting home environments to the needs of people as they age.
First, good news from California. Recognizing the issue with elders who may not be able to get to vaccine sites (or sign up online....), Kaiser Health News reports on one solution in California. Vaccines Go Mobile to Keep Seniors From Slipping Through the Cracks
The team of county nurses and nonprofit workers is targeting Contra Costa County residents who are eligible for covid vaccines but have been left out: residents of small assisted-living facilities that haven’t yet been visited by CVS or Walgreens, and occasionally people who live in low-income senior housing. The retail pharmacy giants have a federal government contract to administer vaccines in most long-term care facilities.
Launched a few weeks ago, the strike team moves through each vaccination clinic with practiced choreography. At a small group home in Antioch recently, a nurse filled syringes while another person readied vaccine cards and laid them on a table. An administrative assistant — hired specifically for these clinics — checked everyone’s paperwork and screened them for symptoms and allergies before their shots, logging them into the state’s database afterward. After the shots, a strike team member told each person when their 15 minutes of observation was up.
The endeavor is going to take time because there are so many of these facilities, many of which have just a handful of residents. It may be slow-going, but it's going!!!!
So that was the good news. Now for the not-so-good, but not surprising news from this article also published in Kaiser Health News: Family Caregivers, Routinely Left Off Vaccine Lists, Worry What Would Happen ‘If I Get Sick’.
Tens of thousands of middle-aged sons and daughters caring for older relatives with serious ailments but too young to qualify for a vaccine themselves are ... terrified of becoming ill and wondering when they can get protected against the coronavirus.
Like aides and other workers in nursing homes, these family caregivers routinely administer medications, monitor blood pressure, cook, clean and help relatives wash, get dressed and use the toilet, among many other responsibilities. But they do so in apartments and houses, not in long-term care institutions — and they’re not paid.
““In all but name, they’re essential health care workers, taking care of patients who are very sick, many of whom are completely reliant upon them, some of whom are dying... Yet, we don’t recognize or support them as such, and that’s a tragedy.”
If the caregiver is older and meets the age-threshold for the caregiver's particular state, then the caregiver is eligible for vaccination that way. But the younger caregivers are out of luck right now. This is an important article. Read it!
Monday, February 15, 2021
Read these three articles, to get a full picture of what happened. First, the AP story: AP: Over 9,000 virus patients sent into NY nursing homes. Next, the CNN story: New York governor's top aide apologizes and says administration 'froze' after inquiries on Covid-19 deaths at long-term care facilities. Finally, Politico's story: Top Republicans call for Cuomo's ouster following nursing home revelation.
Thursday, February 11, 2021
Sen. Warren calls Genesis Healthcare executive bonus act of ‘unfathomable greed’ according to the recent article published in the Washington Post.
A nursing home chain that gave its former CEO a $5.2 million “retention payment” at the height of the pandemic has received a sharp rebuke from Sen. Elizabeth Warren (D-Mass.), who sits on the Senate’s Special Committee on Aging.
Warren called the payout by Genesis Healthcare to George Hager Jr. — at a time when the death toll among residents was approaching 2,800 and the company was relying on federal emergency aid to survive financially — “inexplicable and unseemly” in a letter dated Jan. 27. She asked the company board to explain its decision and to provide the minutes of all meetings in 2020 where compensation was discussed. And she warned the company not to seek additional emergency relief from Washington.
Wednesday, February 10, 2021
Periodically I will see items about businesses seeking protection against liability for injuries to others that occurred during the pandemic. It's not just SNFs seeking protection. Here are a couple of updates on the topic.
First, a Florida-specific article, Brandes bill shielding business from coronavirus suits gets backing in Senate.
The Senate Judiciary Committee on Monday approved a proposal that would give Florida businesses that “substantially” comply with public-health guidelines broad protection from coronavirus-related lawsuits filed by customers and employees.
The bill (SB 72) would not apply to health-care providers such as hospitals, nursing homes and physicians, who have been clamoring for protections since spring. Instead, the bill would help shield other types of businesses and educational and religious institutions from claims for damages, injuries or deaths.
Then, an article from NPR, Why Nursing Homes' COVID-19 Legal Shields May Interfere With Other Cases. Here is a summary: "[o]ver the course of the pandemic, 27 states have granted legal immunity to nursing homes. Some advocates worry this temporary reprieve is being used to hide misconduct not related to the coronavirus." The link includes the podcast as well as a transcript.
Monday, February 8, 2021
A couple of weeks ago the New York Times ran this article, Filing Suit for ‘Wrongful Life’, which asks this question: "More Americans are writing end-of-life instructions as the pandemic renders such decisions less abstract. But are medical providers listening?" The article features one case in litigation where the surviving spouse claimed that the health care providers failed to honor the patient's directive claiming the health care providers "disregarded a New York State MOLST — medical orders for life-sustaining treatment — form and his spouse’s explicit instructions to a doctor who called to seek her guidance." The article gives a good explanation of the issues and a review of prior cases on similar topics. This is an important issue and I'm going to have my students read the article.
Thursday, February 4, 2021
A couple of recent articles about NY SNFs will make you stop and think.... hmmmm.. First, Politico noted a recent NY AG report New York undercounted nursing home deaths by as much 50 percent, report finds.. Nursing Home Response to COVID-19 Pandemic report includes preliminary findings
OAG’s preliminary findings are:
» A larger number of nursing home residents died from COVID-19 than DOH data reflected.
» Lack of compliance with infection control protocols put residents at increased risk of harm during the COVID-19 pandemic in some facilities.
» Nursing homes that entered the pandemic with low U.S. Centers for Medicaid and Medicare Services (CMS) Staffing ratings4 had higher COVID-19 fatality rates than facilities with higher CMS Staffing ratings.
» Insufficient personal protective equipment (PPE) for nursing home staff put residents at increased risk of harm during the COVID-19 pandemic in some facilities.
» Insufficient COVID-19 testing for residents and staff in the early stages of the pandemic put residents at increased risk of harm in some facilities.
» The current state reimbursement model for nursing homes gives a financial incentive to owners of for-profit nursing homes to transfer funds to related parties (ultimately increasing their own profit) instead of investing in higher levels of staffing and PPE.
» Lack of nursing home compliance with the executive order requiring communication with family members caused avoidable pain and distress; and,
» Government guidance requiring the admission of COVID-19 patients into nursing homes may have put residents at increased risk of harm in some facilities and may have obscured the data available to assess that risk.
Then consider this article in the Washington Post. Andrew Cuomo’s bad ‘who cares’ answer on coronavirus nursing home data
Facing a brutal report from his own party’s state attorney general that said the state had undercounted nursing home deaths from the virus, Cuomo essentially argued that it’s neither here nor there.
“Look, whether a person died in a hospital or died in a nursing home, it’s — the people died,” Cuomo said. “People died. ‘I was in a hospital, I got transferred to a nursing home, and my father died.' ‘My father was in a nursing home, got transferred to a hospital, my father died.’ People died.”
It does matter. As the article notes "there are major and very valid questions about whether nursing home policies led to unnecessary ones. To the extent that more deaths occurred in or came from that setting, it allows us to evaluate how significant that problem was and how much corrective action is needed."
Monday, February 1, 2021
Well at least there is some good news on the vaccination front. Last week the New York Times reported Nursing Homes, Once Hotspots, Far Outpace U.S. in Covid Declines.
Throughout the pandemic, there has been perhaps nowhere more dangerous than a nursing home. The coronavirus has raced through some 31,000 long-term care facilities in the United States, killing more than 163,000 residents and employees and accounting for more than a third of all virus deaths since the late spring.
But for the first time since the American outbreak began roughly a year ago — at a nursing care center in Kirkland, Wash. — the threat inside nursing homes may have finally reached a turning point.
The article explains
Experts attribute the improvements in large part to the distribution of vaccines. About 4.5 million residents and employees in long-term care facilities have received at least one dose of the vaccine, according to the Centers for Disease Control and Prevention, including about 2.1 million who have been fully vaccinated.
Other factors, including the steep drop in new infections nationwide in recent weeks, may have contributed as well.
Just good news....finally, for this important group of our population.
Sunday, January 31, 2021
The articles about the rollout are varied, but many of them focus on the issues getting elders vaccinated. So fwiw, here's a round up of some recent ones. Draw what conclusions that you will.
Some states could vaccinate their seniors twice as fast as others, CNN analysis finds (scroll down for article).
Thursday, January 28, 2021
A new GAO report was released last week. ELDER JUSTICE: HHS Could Do More to Encourage State Reporting on the Costs of Financial Exploitation offers fast facts, highlights and the report, all available for download or access via the links. Here are the fast facts:
Financial exploitation of elders—illegal use of their funds or property—affects the victims, their families, and society. Estimated financial costs to victims are in the billions.
Most state-run adult protective services agencies have provided some data on financial exploitation of elders to the Department of Health and Human Services. But it's hard to collect the data because
not all incidents of exploitation are reported to state agencies
victims can be reluctant to implicate family members or caregivers
HHS and state data systems may not align
We recommended that HHS work with state agencies to improve the data on financial exploitation.
Consider this from the report:
Studies estimate some of the costs of financial exploitation to be in the billions,
but comprehensive data on total costs do not exist and NAMRS [National Adult Mistreatment Reporting System] does not currently collect cost data from APS agencies. The Consumer Financial Protection Bureau found actual losses and attempts at elder financial exploitation
reported by financial institutions nationwide were $1.7 billion in 2017. Also, studies published from 2016 to 2020 from three states—New York, Pennsylvania, and Virginia—estimated the costs of financial exploitation could be more than $1 billion in each state alone. HHS does not currently ask states to submit cost data from APS casefiles to NAMRS, though officials said they have begun to reevaluate NAMRS with state APS agencies and other interested parties, including researchers, and may consider asking states to submit cost
data moving forward. Adding cost data to NAMRS could make a valuable contribution to the national picture of the cost of financial exploitation. Recognizing the importance of these data, some APS officials GAO interviewed said their states have developed new data fields or other tools to help caseworkers collect and track cost data more systematically. HHS officials said they plan to share this information with other states to make them aware of practices that could help them collect cost data, but they have not established a timeframe for doing so.
January 28, 2021 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (1)
Tuesday, January 26, 2021
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
January 26, 2021 in Consumer Information, Crimes, Current Affairs, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0)