Tuesday, January 15, 2019

More on Merit-Based ALJ Hiring

Health & Human Services has posted information on their blog about how they are implementing the new hiring process for ALJs. Establishing a New Merit-Based Process for Appointing Administrative Law Judges at HHS explains the new process, the reasons for it, and when it became effective.

HHS is announcing how the department will implement a new ALJ selection and appointment process. The department’s ALJs work for the Office of Medicare Hearings and Appeals (101) and the Departmental Appeals Board (13). The DAB also has seven administrative appeals judges and five Departmental Appeals Board members, and the new ALJ selection and appointment process will apply to these “comparable officials” as well.

The new HHS ALJ selection and appointment process - PDF is effective immediately and is described on the websites of the OMHA and the DAB.

This process is described in the post as merit-based and does not require consultation with anyone outside of the process.  The process is described in detail in a 4 page document from November, 2018, available here.

To understand the significance of this change, read my blog post from October 26, 2018 here.

January 15, 2019 in Consumer Information, Current Affairs, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare | Permalink | Comments (0)

Sunday, January 13, 2019

Hearing Loss: The Impact is More Than Loss of Hearing

Know anyone who has hearing loss?  Maybe you yourself suffer from hearing loss-and if not now, you may in the future. Hearing loss has ramifications beyond the loss of hearing. As the article in the New York Times explains in Hearing Loss Threatens Mind, Life and Limb "[n]ot only is poor hearing annoying and inconvenient for millions of people, especially the elderly. It is also an unmistakable health hazard, threatening mind, life and limb, that could cost Medicare much more than it would to provide hearing aids and services for every older American with hearing loss." Oh and the news doesn't get any better: "[t]wo huge new studies have demonstrated a clear association between untreated hearing loss and an increased risk of dementia, depression, falls and even cardiovascular diseases. In a significant number of people, the studies indicate, uncorrected hearing loss itself appears to be the cause of the associated health problem."

Those with age-related hearing loss can tell you it doesn't happen overnight.  In fact, because it "comes on really slowly, [it makes] it harder for people to know when to take it seriously...."  The article explains the correlation between hearing loss and the impact on the brain (fascinating yet scary). And in case you didn't know "hearing aids and accompanying services are typically not covered by medical insurance, Medicare included. Such coverage was specifically excluded when the Medicare law was passed in 1965, a time when hearing loss was not generally recognized as a medical issue and hearing aids were not very effective...." 

So, do a few things now: 1.  write your Congressperson about Medicare's coverage of hearing aids, 2. schedule an appointment to have your hearing testing and 3. turn down the volume on your devices.

January 13, 2019 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Thursday, January 10, 2019

Is Hospital Care "Elder-Friendly"?

This article is a couple of months old, but I don't think the subject is at all dated.   Stat ran an opinion piece, U.S. hospitals ignore improving elder care. That’s a mistake explaining that hospitals aren't designed to be elder-friendly 

In the 21st century, health care is to elderhood as education is to childhood. But we don’t see bond measures for the “construction, expansion, renovation, and equipping” of hospitals to optimize care of old people, an investment that would surely benefit Americans of all ages.

People age 65 and older make up just 16 percent of the U.S. population but nearly 40 percent of hospitalized adults. In 2014, Americans over age 74 had the highest rate of hospital stays, followed by those in their late 60s and early 70s.

Remarkably, hospitals aren’t designed with elders in mind. Walk through one and you’ll almost invariably find cheerful decor for children, services and facilities aimed at adults, and a gauntlet of obstacles and insults to elders.

Thinking about the design of the hospitals, consider these notes from the article' "[o]ld people end up in old buildings. That usually means long walks down halls without railings or chairs with arms for rest stops. It means signs that are hard to read until you are right under them. It means a one-size-fits-all approach to both facilities and care that doesn’t acknowledge that the needs, preferences, and realities of a 75- or 95-year-old with a medical condition might differ from those of a 35- or 55-year-old with the same thing."

Noticing the volume of business from this demographic, the article highlights some efforts 

A collaboration of industry leaders, including the American Hospital Association, the John A. Hartford Foundation, and the Institute for Healthcare Improvement, has launched an age-friendly health system initiative. While its purview is limited to a few geriatric conditions, it’s a step in the right direction. (And the field of geriatrics is finally beginning to model itself after pediatrics, taking a more whole health, life stage approach to elderhood.)

Some of the best ideas for hospital design come from outside health care. Innovations developed for aging-in-place homes or continuing care communities offer prototypes of “silver architecture.” Businesses like Microsoft are investing in structural and people-flow design that meets needs across the lifespan. They are adopting the position that if you design for the mythical “average human” you create barriers, whereas if you design for those with disabilities you create systems that benefit everyone.

January 10, 2019 in Consumer Information, Current Affairs, Health Care/Long Term Care, Medicare, Other | Permalink | Comments (0)

Thursday, January 3, 2019

Do You Know Your Medicare Coverage?

As elderlaw profs, it's likely that we cover Medicare in our courses every semester. Whether you teach the subject or your are a beneficiary, how well do you know Medicare coverage basics? Kiplinger offers a short quiz on Medicare that allows you to test your Medicare IQ. The quiz, Does Medicare Cover That? is easy to complete and each question includes an explanation accompanying the answer.  And once you have finished this quiz, take the next one, True or False: Test Yourself on Social Security Claiming Strategies.

Check them out!

January 3, 2019 in Consumer Information, Current Affairs, Health Care/Long Term Care, Medicare, Retirement, Social Security | Permalink | Comments (0)

Wednesday, December 19, 2018

For Nursing Homes Trapped in A Cycle of Failure -- What Solutions Are Available?

Recently I had a chat with a lawyer I've known for years who does a very good job representing large nursing home chains. We found ourselves shaking our heads about a series of news stories reported by central Pennsylvania's Patriot News focusing on care facilities formerly operating as part of the Golden Living chain. See the investigatory report, Still Failing the Frail.

Apparently, even after pressured transfers of the facilities to different companies, presumably companies with better management and better financial resources, many of them "continue to rack up citations with the state Health Department" for substandard practices.    I asked the lawyer whether he knew of any nursing home chain that has been able to pull out of death spiral?  He couldn't remember one.   

There is very little margin when low-income residents depend on Medicaid for payments.  Once a facility is affected by fines and pressures to increase staffing, the margin becomes even tighter.   Few states want to assume the roles of trustee or receivers for such properties.  The article concludes that one necessary step is to increase Medicaid funding.   

Although researchers recommend that nursing homes provide at least 4.1 hours of care per resident per day, it remains an open question whether all nursing homes can afford to do that. 

State and federal governments are the primary payers for the vast majority of nursing home residents. Residents receiving short-term rehabilitation are generally covered by Medicare, administered by the federal government. Long-term residents are generally covered by Medicaid, administered by state governments.

 

The problem is that state Medicaid programs, as in Pennsylvania, pay nursing homes far less than federal Medicare – sometimes as much as a third.

 

Although nursing home advocates and some researchers believe for-profit nursing homes routinely skimp on care in order to paid their profits, there are also genuine concerns about whether Pennsylvania’s Medicaid funding is adequate.

 

Researchers recommend how much of existing Medicaid and Medicare dollars are going to profit and administrative costs in homes. That would help determine whether Medicaid rates need to be raised and, if staffing standards are also raised, how much additional funding they need to provide those levels.

For some states, such as Pennsylvania, the Medicaid funding formula is part of the challenge.  As discussed in the series, other states have been able to create direct payment models to assure better accountability for patient care.  

December 19, 2018 in Consumer Information, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare | Permalink | Comments (0)

Wednesday, December 12, 2018

High Number GA Nursing Homes Receive Medicare Penalties

Yesterday I blogged about a SNF chain in Texas filing bankruptcy.  Today, it's about Georgia's nursing homes. Georgia Health News reported last week that Medicare penalties hit most Ga. nursing homes. According to the article 75% of the SNFs in Ga have been hit with penalties regarding unnecessary hospital readmissions. Twenty-three percent received bonuses for avoiding such a problem.  "Kaiser Health News reported that hospitalizations of nursing home residents, while decreasing in recent years, remain a problem, with nearly 11 percent of patients in 2016 being sent to hospitals for conditions that might have been avoided with better medical oversight. ... The program of bonuses and penalties is intended to discourage nursing homes from discharging patients too quickly. That’s something that is financially tempting, because Medicare fully covers only the first 20 days of a stay and generally stops paying anything after 100 days...." The article includes a link to the bonuses/penalties list, which can be found here.

December 12, 2018 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

High Number GA Nursing Homes Receive Medicare Penalties

Yesterday I blogged about a SNF chain in Texas filing bankruptcy.  Today, it's about Georgia's nursing homes. Georgia Health News reported last week that Medicare penalties hit most Ga. nursing homes. According to the article 75% of the SNFs in Ga have been hit with penalties regarding unnecessary hospital readmissions. Twenty-three percent received bonuses for avoiding such a problem.  "Kaiser Health News reported that hospitalizations of nursing home residents, while decreasing in recent years, remain a problem, with nearly 11 percent of patients in 2016 being sent to hospitals for conditions that might have been avoided with better medical oversight. ... The program of bonuses and penalties is intended to discourage nursing homes from discharging patients too quickly. That’s something that is financially tempting, because Medicare fully covers only the first 20 days of a stay and generally stops paying anything after 100 days...." The article includes a link to the bonuses/penalties list, which can be found here.

December 12, 2018 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Wednesday, December 5, 2018

Several Items Relating to Nursing Homes & Quality of Care

I have collected four  items regarding nursing homes, that  I thought I'd summarize in one  post.

First

Regular readers will recall that Florida now requires SNFs to have generators (after last year's hurricane).  Last month's Health News Florida reported that many nursing hones are seeking extensions of time on the requirement to have generators. Nursing Homes Seek More Time On Generator Requirements notes that "[m]ore than 40 percent of Florida nursing homes are asking health-care regulators for more time to meet backup-power requirements pushed by Gov. Rick Scott after Hurricane Irma last year... But ... the state’s top health-care regulator, said his agency won’t approve waiver requests for deadbeat facilities that haven’t worked over the past several months to carry out emergency backup-power plans."  Slightly more than 25% of the facilities are in compliance and over half of ALFs are.  Some ALFs not in compliance are the focus of penalties, "the state has moved ahead with penalizing a handful of ALFs that aren’t in compliance. In November, the state has entered into settlement agreements with more than a dozen ALF providers across the state to settle allegations that they failed to meet the requirements, according to a review of information on a state website."

Second

The  Washington Post ran an article last month, Overdoses, bedsores, broken bones: What happened when a private-equity firm sought to care for society’s most vulnerable. The article focused on the ownership of of a chain owned by "the Carlyle Group, one of the richest private-equity firms in the world [where], the ManorCare nursing-home chain struggled financially until it filed for bankruptcy in March. During the five years preceding the bankruptcy, the second-largest nursing-home chain in the United States exposed its roughly 25,000 patients to increasing health risks, according to inspection records analyzed by The Washington Post."  The article includes a response from the chain as well as the private equity group:

Carlyle and HCR ManorCare representatives said care at the nursing homes was never compromised by financial considerations. The cost-cutting trimmed administrative expenses, not nursing costs, they said. The number of nursing hours provided per patient stayed fairly constant in the years leading up to the bankruptcy, according to the figures that the company reported to the government.

HCR ManorCare officials also disputed the idea that quality at the homes had suffered in recent years. They said their nursing homes offered excellent service based on the ratings issued by Medicare, the federal government’s insurance program for older Americans. ManorCare homes averaged 3.2 stars in the years before bankruptcy, which was slightly below the U.S. average. Some watchdog groups, such as the Center for Medicare Advocacy, are critical of the five-star rating system, however, because it relies on unaudited data reported by nursing homes.

The article examined complaints in several states, reported on the views expressed by the private euity firm, including the role of Medicare reimbursements and reported that "[a]fter the bankruptcy,  the nursing home chain was bought by Promedica Health, a nonprofit group."

Third

Bloomberg Law reported last week that payroll data is being used to examine staffing. Sparse Nursing Home Staffing to Be Sniffed Out in Payroll Data explains that "[t]he payroll data will be used to identify nursing homes that have a significant drop in staff on weekends or have several days in a quarter without a registered nurse on site, the federal Medicare agency said Nov. 30. Nursing homes must have a registered nurse on site every day for eight hours, the agency said on its website."

Fourth,

In that same vein, Kaiser Health News reported Feds Order More Weekend Inspections Of Nursing Homes To Catch Understaffing. The payroll data mentioned in item #3 plays a role. "The federal Centers for Medicare & Medicaid Services said it will identify nursing homes for which payroll records indicate low weekend staffing or that they operate without a registered nurse. Medicare will instruct state inspectors to focus on those potential violations during visits."  Does this mean there will be a flurry of inspections? No. As the article explains, "[t]he new directive instructs inspectors to more thoroughly evaluate staffing at facilities Medicare flags. The edict does not mean a flurry of sudden inspections. Instead, Medicare wants heightened focus on those nursing homes when inspectors come for their standard reviews, which take place roughly once a year for most facilities."

December 5, 2018 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare, State Statutes/Regulations | Permalink

Monday, October 22, 2018

Medicare for All in the 2018 Midterms

Medicare for All is gaining more attention as more candidates for office are including that in their platforms for the 2018 midterms. Kaiser Health News ran this article, Politicians Hop Aboard ‘Medicare-For-All’ Train, Destination Unknown.  According to the article, starting primarily with Senator Sanders in his run for president, it seems that many are now using Medicare for All in their platforms, but do we really know what it entails?

After decades in the political wilderness, “Medicare-for-all” and single-payer health care are suddenly popular. The words appear in political advertisements and are cheered at campaign rallies — even in deep-red states. They are promoted by a growing number of high-profile Democratic candidates, like Alexandria Ocasio-Cortez in New York and Rep. Beto O’Rourke in Texas.

Republicans are concerned enough that this month President Donald Trump wrote a scathing op-ed essay that portrayed Medicare for all as a threat to older people and to American freedom.

It is not that. But what exactly these proposals mean to many of the people who say they support them remains unclear

Are we using single payer and Medicare for All interchangeably? Appropriately? What do we even mean?  "In precise terms, Medicare-for-all means bringing all Americans under the government’s insurance program now reserved for people 65 and over, while single-payer health care would have the government pay everyone’s medical bills. But few politicians are speaking precisely."

The article explains that in polling, health care concerns rank right up there at the top, but there doesn't seem to be one unified plan supported by everyone. But then, there is an important part of the message that may not be absorbed by voters-the potential for tax increases. The article focuses on other alternatives used to provide health care for everyone, in countries such as the U.K. and Canada, which are very close to single-payer systems. The article also notes the impact on jobs if the US were to move to a single-payer system.

Some candidates do offer specifics but others don't. How important are the details at this point? You may be surprised:

[One] pollster ... suggested that policy details simply aren’t as relevant in a midterm year and that for now we shouldn’t expect a candidate’s support for Medicare-for-all to be anything more than a way to signal his or her values. But she suggested that will change in the run-up to 2020, adding, “When we head into the presidential election, people will probably be pickier and want more details.”

That gives politicians and voters a few years to decide what they mean and what they want when they say they support Medicare-for-all or single-payer health care. For now, it’s hard to read too much into promises.

 

October 22, 2018 in Consumer Information, Current Affairs, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Monday, October 15, 2018

Demand for Nursing Homes Dwindling?

The New York Times ran an article on the demand for nursing home beds.  In the Nursing Home, Empty Beds and Quiet Halls opens by explaining that a once vibrant facility now stands closed due to a drop in demand.  According to the article, "[t]he most recent quarterly survey from the National Investment Center for Seniors Housing and Care reported that nearly one nursing home bed in five now goes unused. ... Occupancy has reached 81.7 percent, the lowest level since the research organization began tracking this data in 2011, when it was nearly 87 percent."  The occupancy rate has been trending downward; concomitantly facilities close, and according to the article, somewhere between 200-300 annually close.  The article points out what you are likely thinking-with the number of baby boomers wouldn't the demand be increasing rather than decreasing?

The article hypothesizes as to why this may be occurring and suggests:

  • Increased regulations and more financial belt-tightening

  • Hospitals' use of observation status,which thus affects Medicare coverage for subsequent SNF care.

  •  

    More surgeries on an out-patient basis

  •  

    Increasing number of Medicare Advantage plans.

  • Increased competition through other housing options

     

  • The shift to Medicaid covering care in the community, with "Money Follows the Person [having] moved more than 75,000 residents out of nursing homes and back into community settings."

The article speculates whether this trend will reverse itself once the boomers start reaching 80 and beyond. The article also discusses whether the lower demand provides more options for those in need of nursing home care.

October 15, 2018 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare | Permalink | Comments (0)

Tuesday, October 9, 2018

Medicare Advantage Plans Shifting Financial Risk to Drs?

According to a recent Kaiser Health News article,  Medicare Advantage Plans Shift Their Financial Risk To Doctors,   Medicare Advantage (MA) Plans pay medical groups "a fixed monthly payment ... to cover virtually all of their members’ health needs, including drugs and physician, hospital, mental health and rehabilitation services."

This model — known as “full-risk” or “global risk” — is increasingly used by Medicare plans such as Humana and UnitedHealthcare to shift their financial exposure from costly patients to WellMed and other physician-management companies. It gives the doctors’ groups more money upfront and control over patient care. ... As a result, they go to extraordinary lengths to keep their members healthy and avoid expensive hospital stays.

As the article notes, there is a financial incentive for the health care providers with this model, and experts disagree whether it results in better care or less care for patients. As the article notes, beneficiaries choose an MA plan and pick doctors within the plan, often without knowing if the MA plan has delegated oversight of the beneficiaries' health to these physician groups.  And the impact of this full-risk approach should not be understated:

Nearly one-third of the 57 million Medicare beneficiaries are covered by private Medicare Advantage plans — an alternative to government-run Medicare — and federal officials have estimated that the proportion will rise to 41 percent over the next decade. The government pays these plans to provide medical services to their members.

The “global risk” system has been used in South Florida and Southern California since the late 1990s and nearly half of Medicare Advantage members in those regions get care in the model. The use has spread further in the past two years as large physician companies have become more common, and about 10 percent of Medicare Advantage plan members across the nation are in them now, health consultants say.

... 

Under the “global risk” arrangements, the health plans give the physician companies the bulk of their Medicare funding when they take on the mantle of being financially responsible for all patient care.

 Keep an eye on this -- it's important.

October 9, 2018 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (1)

Thursday, October 4, 2018

Save Medicare Now and Midterm Elections

The Center for Medicare Advocacy (full disclosure-I'm on their board) has unveiled a new website, Save Medicare Now.

The call to action explains that "Medicare as we know it is under attack. Current efforts and proposals will privatize Medicare and increase costs.  Against the wishes of most Americans, some lawmakers want to cut Medicare benefits, driving up costs to you, and making health care and prescription drugs even less affordable." (emphasis in the original). The website covers "why now", stories, facts, "take action" and has a link to donate.  The "take action" page includes questions to ask Congressional candidates and an action kit, among other tools. Test your Medicare IQ on the facts page.  And if you want to feel the urgency, look at the countdown clock to the midterm elections on the home page.

October 4, 2018 in Consumer Information, Current Affairs, Health Care/Long Term Care, Medicare, Other | Permalink | Comments (0)

Monday, October 1, 2018

Medicare Advantage Costs Dropping

Last week, CMS released an updated fact sheet on the outlook for Medicare Advantage plans for 2019.  2019 Medicare Advantage and Part D Prescription Drug Program Landscape   provided some udpates:

offered in 2019:

  • Enrollment in Medicare Advantage is projected to be at an all-time high in 2019 with 22.6 million Medicare beneficiaries. This represents a projected 2.4 million (11.5 percent) increase from 20.2 million in 2018. Based on projected enrollment, 36.7% of Medicare beneficiaries will be enrolled in Medicare Advantage in 2019.
     
  • Medicare Advantage premiums, on average, have steadily declined since 2015 from the actual average premium of $32.91. For 2019, CMS estimates the Medicare Advantage average monthly premium will decline by $1.81 to $28.00 from 2018.
     
  • Approximately 83 percent of Medicare Advantage enrollees will have the same or lower premium in 2019 if they continue in the same plan. About 26 percent of enrollees staying in current plans will see their premiums decline in 2019. Approximately 46 percent of enrollees in their current plan will have a zero premium in 2019.
     
  • Access to Medicare Advantage and prescription drug plans will remain nearly universal, with about 99 percent of Medicare beneficiaries having access to at least one health plan in their area. All Medicare beneficiaries will have access to at least one stand-alone prescription drug plan. 
     
  • ... 
  • Due to new flexibilities available for the first time in 2019, nearly 270 Medicare Advantage plans will be providing an estimated 1.5 million enrollees new types of supplemental benefits:
    • Expanded health-related supplemental benefits, such as adult day care services, and in-home and caregiver support services; and
    • Reduced cost sharing and additional benefits for enrollees with certain conditions, such diabetes and congestive heart failure due to the agency’s reinterpretation of uniformity requirements. 
       
  • Access to important supplemental benefits, such as dental, vision, and hearing continues to grow. 

Read the entire fact sheet here.

 

October 1, 2018 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (1)

Monday, September 17, 2018

Hospitals Selling Insurance?

The Tampa Bay Times ran this story recently,  In Florida and everywhere, a big shift is underway. It’s changing the way we go to the doctor.  "Hospitals are getting into the insurance end of the business. Insurers, along with drug stores, are delivering front-line health care...And consumers, confronted with blurring lines and a host of new options, may need a scorecard to keep up. The shifting ground continues to change where and how they go to the doctor." The article notes the trend of insurers buying doctors' practices with the result of a coordinated group of medical offices providing health care under the company's name.  The article also notes the drug stores' offerings of health care services, so you can get more than just a prescription filled. 

What is driving this evolution? The article offers "[d]riving many of the changes is the Affordable Care Act, which helped usher in a shift in thinking about the cost of health care. Hospitals are penalized more often by insurance companies and the government when patients have more frequent stays. The focus now ...  is keeping patients out of the emergency room... population growth, new technology, government rules and evolving patient preferences."

This is a significant shift in the role of insurance companies in the provision of health care. Just think about the ramifications.

September 17, 2018 in Consumer Information, Current Affairs, Health Care/Long Term Care, Medicare | Permalink

Tuesday, September 11, 2018

Attracting Adequate, Qualified Staff: The Impact of Payment Issues in Long-Term Care

I've been reading articles for several weeks about a "troubled" nursing home in Connecticut where staff members were reportedly being paid late, and not receiving payments on related benefit claims (including health care and pensions).   

The reports sound unusually mysterious, with indications of an executive's "loan" to a related charity from operating reserves.   Suddenly more than $4 million was apparently restored to a key pension account:  

As News 12 has reported, federal agents raided the center back in May. When the raid happened, that account was down to $800. For years, workers have complained about missing retirement money. In a lawsuit, the Labor Department claims the facility's owner illegally funneled their money into his own private charity.

 

Now, according to new court documents, the $4 million was unexpectedly deposited into the pension account last week. It's unclear where the money came from, and even the bankruptcy trustee running the facility was unsure.

 

"I don't truly know the source, but I do know that there's $4.1 million in this bank," bankruptcy trustee Jon Newton said at a court hearing yesterday.

 

But in a recent court hearing, owner Chaim Stern's lawyer said the money "was meant to represent the $3.6 million transferred from the (retirement) plan to Em Kol Chai." That's the charity authorities say Stern controls.

 

Workers may not get as much of that money as they think. Bridgeport Health Care has a long list of creditors, and they could potentially get a share.

 

News 12 reported back in July that part of the facility, called Bridgeport Manor, is shutting down. Lawyers say they hope to wrap that process up within a month.

For more read:  Millions Mysteriously Appear in Account of Troubled Nursing Home.

September 11, 2018 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare | Permalink | Comments (0)

Thursday, August 16, 2018

Senator Letter to CMS on SNF Staffing Ratings

Senator Ron Wyden has sent a letter to the CMS  administrator about CMS' staffing ratings of SNFs. His letter points out discrepancies between self-reported data and the newly required payroll data that leads to his concerns that the correctness of the information shared with residents and families

Senator Wyden has asked five  questions, seeking replies by August 24, 2018.

  1. What are the requirements and safeguards CMS has in place to ensure SNFs provide accurate information as part of the 5-Star Quality Rating System. How are these requirements enforced?
  2. Please provide an analysis of the difference in staffing levels of SNFs between the self-reported methodology and the payroll data methodology?
  3. What does CMS plan to do in the instances where payroll data illustrates the self-reported staffing data was inaccurate?
  4. Would CMS consider updating the current staffing quality measures to, in addition to measuring average staffing levels, take into account inappropriate fluctuations in staffing that may lead to patients receiving inadequate care?
  5. Would CMS consider measuring patient and/or family satisfaction as part of the 5-Star Quality Rating System?

 

 

August 16, 2018 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink

Tuesday, August 14, 2018

Webinar-Sexual Abuse in Nursing Homes

Register now for a free webinar from the National Consumer Voice for Quality Long Term Care.  The webinar is scheduled for September 5, 2018 at 2 edt.  Here is some info about the webinar

Join this webinar to learn about sexual abuse in nursing homes.  Presenters will discuss a variety of topics to help you recognize the signs of sexual abuse and immediately respond to it. 

We will examine the full scope of sexual abuse in nursing homes, including: (1) its prevalence, (2) the physical and social signs of sexual abuse, (3) who is most at risk, and (4) who the perpetrators are.  In addition, you will learn the protections the federal nursing home rule provides for nursing home residents against this abuse and how to respond to the needs of victims.  Finally, we will equip you with concrete knowledge on how ombudsmen can advocate for nursing home residents who are victims of this type of abuse, including hearing from a special presenter on the ombudsman role in the Washington Alliance to End Sexual Violence in Long-Term Care

To register, click here

August 14, 2018 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare, Programs/CLEs, Webinars | Permalink

Monday, August 13, 2018

Should Legislation Mandate Care Facility Staffing Ratios?

I'm a fan of WITF-Radio's Smart Talk program even though it often "interferes" with my work day, as I linger to catch the entire broadcast. I'm such a fan that even when I'm out of town, I'll often listen to the program via live streaming or podcasts -- and when I'm the western part of the U.S. I can listen live without feeling guilty because of the time difference (3 hours in the summer ).  One of the recent broadcasts had me listening twice.

The program began with a report on pending legislation in Pennsylvania, that could mandate lower patient-to-nurse ratios in hospitals.  During the current legislative session, the two key items are House Bill 1500 and Senate Bill 214.  A coalition of Pennsylvania nurses hand-carried a petition with 10,000 signatures to the Capitol demanding support for  better staffing at hospitals.  On the radio program the speakers -- all nurses -- agreed about the need for adequate coverage, but disagreed about whether mandated ratios were the right solution.  Not surprising is opposition to mandated ratios coming from the hospital industry representatives; however the Pennsylvania State Nurses Association also resists mandatory ratios, arguing such ratios are "not flexible enough."  HB 1500 would call for different ratios according to the type of unit, such as ratio of one nurse for every two patients in the neo-natal intensive care unit, with a higher ratio of 1 to 4 permitted in a pre-surgical unit.  

The program drew a lot of callers.  In fact there were so many callers, host Scott LaMar deferred plans for a different topic for the second half of the hour-long program in order to continue the staffing discussion.  What I found particularly interesting was that many of the callers wanted to talk about staffing ratios in rehab facilities and nursing homes, not "just" hospitals, and part of the conversation was about whether the key ratios should consider all care staff and not focus solely on registered nurses.  Here is the link to the podcast:   

https://features.witf.org/stpodcast/feed/podcast/

The calls reminded me of one terrifying, long night in a hospital with a relative after she had emergency surgery.  She was "allowed" to use the toilet in the bathroom, rather than a bed pan, but because she wanted to go frequently, the night time staff began insisting she use a bedpan, so that they wouldn't  have to attend her in the bathroom.  The staff was hostile to my efforts to help (and in fact, I didn't have a clue as how best to help), but also would have left their patient perched uncomfortably on the bed pan for a half hour or more if I hadn't intervened. She began refusing to use her call button, insisting I help her to the bathroom, even though she was still attached to various lines and monitors.  It was a catch-22 situation for me as a family member -- and also for the overworked staff. I remember my one firm conviction that night was that without a family member with her, we would have been adding broken bones to the list of woes for my loved one because of the staffing issues. 

August 13, 2018 in Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care, Medicare, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Friday, August 10, 2018

Filial Friday: N.D. Nursing Home's Claim Against Adult Children for Father's Unpaid Bills Set for September Trial

According to news reports, here and here,  three siblings are facing a September 2018 trial date after being sued by a North Dakota nursing home for more than $43,000 in unpaid costs of care for their father, incurred during a seven month stay at the facility.  The children maintain they have no contractual obligation with the nursing home, and were not involved in their father's application for Medicaid, nor did they receive disqualifying gifts from their father.   A denial of a Medicaid application can arise if there is an uncompensated transfer of assets within a five year look back period, or because of certain other unexplained failures to use the father's "available" resources to pay for his care.  

A North Dakota's statute, N.D.C.C. Section  14-09-10, with language that can be traced back to filial support laws of  Elizabethan England,  provides: 

It is the duty of the father, the mother, and every child of any person who is unable to support oneself, to maintain that person to the extent of the ability of each. This liability may be enforced by any person furnishing necessaries to the person. The promise of an adult child to pay for necessaries furnished to the child's parent is binding.

One news report quotes the executive director of the North Dakota Long Term Care Association, Shelly Peterson, as saying nursing homes use the law to go after adult children in only one circumstance:  "When parents transfer income or assets to their children, and then the parents don't qualify for Medicaid."  The director is reported as further contending that "facilities are 'legally obligated' under Medicaid to pursue every avenue possible to collect that debt, including suing, before they can get reimbursed from the state Department of Human Services for a debt that cannot be recovered."

According to some sources, local legislators, aroused by this suit, are looking at whether North Dakota should continue to permit nursing home collections under North Dakota's indigent support law.  Such laws have been blocked or repealed in most other U.S. states.  North Dakota and my own state, Pennsylvania, are the two most notable exceptions. 

My reaction to the news articles on this case is "something doesn't add up here" and some key facts seem to be missing. 

  • First, if the father was in the nursing home for 7 months, who did the children think was paying for his care?  I can't imagine no one in the family asked that question for that period of time (although certainly Medicaid applications can take time to process and perhaps the denial came in after the father's death). 
  • What was the basis for any denial for Medicaid?  I've seen Medicaid denied for inability of the applicant (or applicant agent) to track down some old resource, such as a demutualized life insurance policy. Also, what is the source of the contention that Medicaid law "requires the facility to sue" to collect the debt?  I'm not aware of any such rule at the federal level.
  • Is there another member of the family involved in the application -- someone other than the three target children --  or is there another family member involved in any "transfers" causing an alleged ineligibility period?  In the U.S., filial support laws don't prioritize collection, nor require recovery from so-called "bad" children, rather than more "innocent" children.
  • Finally, why weren't there care planning meetings with the family that included discussions of costs of care?  It always raises a red flag for me when the "first" alleged notice of such a claim arises after the death or discharge of a resident.  

Perhaps we will hear the results of the trial or any settlement, and thus hear a more complete picture of how these bills came to accumulate.  

  

August 10, 2018 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Legal Practice/Practice Management, Medicaid, Medicare, State Cases, State Statutes/Regulations | Permalink | Comments (1)

Monday, August 6, 2018

Rutger Law's Reid Weisbord Proposes "Postmortem Austerity" Measures


Professor Reid Weisbord
, who serves as vice dean and the Judge Norma L. Shapiro Scholar at Rutgers Law School in Newark, has a new and very timely essay posted on  Stanford Law Review OnlineWeisbord_imgThe provocative premise should certainly spark responses! 

From the abstract:

This Essay proposes a novel policy of "postmortem austerity" to address the unsustainable, rapidly escalating cost of federal entitlement programs following the 2017 tax reforms. If Social Security and Medicare continue on their current path to insolvency, then they will eventually require austerity reforms absent a politically unpopular tax increase.

 

This Essay argues that, if austerity becomes necessary, federal entitlement reforms should be implemented progressively in a manner that minimizes displacement of benefits on which individuals relied when saving for old age. A policy of postmortem austerity would establish new eligibility criteria for Social Security and Medicare that postpone the effective date and economic consequences of benefit ineligibility until after death.

 

All individuals would continue to collect federal entitlements during life, but at death, wealthy decedents would be deemed retroactively disqualified from part or all of Social Security and Medicare benefits received during life. The estates of such decedents would then be liable for repayment of disqualified benefits.

For the full essay, read Postmortem Austerity and Entitlement Reform, published July 16, 2018.

August 6, 2018 in Current Affairs, Estates and Trusts, Ethical Issues, Medicaid, Medicare, Social Security, State Statutes/Regulations | Permalink | Comments (1)