Friday, September 18, 2020
Here's a cool idea from the National Long-Term Care Ombudsman Resource Center: Ombudsman Safety Bags! As states begin to allow visits for residents of LTC facilities, ombudsmen, among others, need to keep themselves, and others, safe. The safety bags include "an Ombudsman imprinted face mask, hand sanitizer, sanitizer wipes, and resources specifically for Ombudsman programs. The resources include tips for Ombudsman program communication, a tip sheet about self-care, NORS FAQs related to COVID-19, 25 Ombudsman program promotion postcards, and COVID-19 Recovery and Reentry Resources." It seems that these bags would be helpful for any professional who interacts with others, especially in cases where attorneys make home visits to their clients.
I just wanted to share something positive with you, so there you have it!
Wednesday, September 16, 2020
Convene a commission of experts to address safety and quality in nursing homes in relation to the public health emergency. The main purpose of the independent Coronavirus Commission for Safety and Quality in Nursing Homes (Commission) was to solicit lessons learned from the early days of the pandemic and recommendations for future actions to improve infection prevention and control measures, safety procedures, and the quality of life of residents within nursing homes.
The 25 member commission met 9 times and made the following:
27 recommendations and accompanying action steps organized into 10 themes. These themes intersect with the Commission’s four objectives, and reflect responses to:
• Ongoing supply and affordability dilemmas related to testing, screening, and personal
protective equipment (PPE)
• Tension between rigorous infection control measures and quality of life issues that exist
in cohorting and visitation policies
• A call for transparent and accessible communications with residents, their representatives
and loved ones, and the public
• Urgent need to train, support, protect, and respect direct-care providers Outdated infrastructure of many nursing-home facilities
• Opportunities to create and organize guidance to owners and administrators that is more
actionable and to obtain data from nursing homes that is more meaningful for action and
• Insufficient funding for quality nursing home operations, workforce performance, and
The commission did not unanimously adopt the report. The 186 page report is available here. Stay tuned.
The New York Times asked the hard question, whether COVID deaths in SNFs were preventable, in a recently published opinion from the editorial board. How Many of These 68,000 Deaths Could Have Been Avoided?
Around 40 percent of all coronavirus-related deaths in the United States have been among the staff and residents of nursing homes and other long-term care facilities — totaling some 68,000 people.
Those deaths were not inevitable. The novel coronavirus is adept at spreading in congregant living facilities, and older people face an increased risk of contracting and dying from it. But most of the nation’s nursing homes had months of warning about the coming threat: One of the first coronavirus outbreaks in the country was in a nursing home near Seattle, making it clear that such facilities ought to prepare.
The opinion discusses steps SNFs could have taken to reduce the chances of spread, the financial model for SNFs in the US. The opinion also discusses the reduction of oversight and notes
Every effort should be made to ensure that the bulk of the money that the government puts into this industry goes to patient care, not providers’ pockets. An investigation started by the House of Representatives into the nation’s largest for-profit homes is a meaningful step in this direction. The Justice Department should follow suit.
The opinion discusses the way SNFs get supplies for their PPEs, etc. as well as staffing shortages. The editors conclude with 3 recommendations
In the near term, lawmakers should provide for hazard pay for nursing home workers in the next relief package and should require all nursing homes to enact non-punitive sick-leave policies so that workers don’t infect colleagues or residents.
In the longer term, federal officials need to consider revising Medicaid reimbursement rates for long-term care so they support higher than minimum-wage salaries, and shifting reimbursement policies so at least some long-term care can be reimbursed with Medicare dollars.
Lawmakers and nursing home operators also would do well to consider a national initiative, perhaps involving student volunteers and internship programs, to recruit future workers to nursing home care. That work, which can be deeply rewarding, will remain urgently needed long after this crisis passes.
Tuesday, September 15, 2020
The Tampa Bay Times recently reported that the Florida Governor was authorizing visitation of residents in SNFs and ALFs in certain circumstances, DeSantis says yes, but will Florida nursing homes reopen to visitors? The order, which was effective on September 1, still requires that visitors maintain social distance. "The governor’s executive order... end[ed] the five-month ban on visitors at long-term care facilities that he imposed in an effort to protect the state’s most vulnerable residents from the coronavirus. The order will continue to allow visits from those deemed essential or compassionate caregivers, including in facilities that have had recent positive tests." The order is optional and the SNFs and ALFs can choose to not allow visitors.
The final report of the task force appointed by the Florida governor is available here.
Monday, September 14, 2020
Mark your calendars now for a free webinar on How Health Plans Serving Dual Eligibles Can Center Equity During COVID-19. The webinar is set for October 6, 2020 from 2-3:30 p.m. Here's a description of the webinar.
The COVID-19 pandemic has brought to the forefront longstanding racial disparities in our healthcare system, and data show that older adults – especially older adults of color and those in residential congregate settings – are disproportionately impacted by the virus. Aging advocates play a key role in holding health plans and government agencies accountable to meeting the needs of those most at risk during this time. In this webinar, How Health Plans Serving Dual Eligibles Can Center Equity During COVID-19 , we will provide an overview of dual eligibles and the types of health plans that serve them. We will also present specific programmatic recommendations that advocates can push health plans with dual eligible members in their community to adopt. These recommendations are measures that plans can take to center equity in their ongoing response to COVID-19 and ensure they are meeting the needs of older adults of color during this challenging time.
To register, click here.
Friday, September 11, 2020
Computer Weekly recently addressed the legal issues that may occur when using technology for caregiving AI may be a solution to the social care crisis, but what are the legal concerns?, looks at the caregiving situation in the U.K. Building on the story from yesterday about the robot "Pepper" who can carry on conversations, the article highlights some legal issues, such as an individual's privacy.
Consider this-the robot could report concerns about abuse, for example, "the technology might provide a report, supported by video evidence, to family members or those with the legal responsibility of care, such as attorneys or deputies, who can then review such material. It can easily become part of a care home contract to consent to such filming, although it is vital that this is handled in a sensitive manner and regularly deleted to ensure that a resident’s privacy is protected." The article notes concerns about "sensitive personal data." Would residents provide consent? Who would consent if a resident lacks capacity. As the article concludes, "[W]e must never forget who is at the heart of these considerations, and the legal framework needs to catch up with the technology to protect them and for it to have a viable chance of success."
Thanks to Professor Feeley for sending me this article.
Thursday, September 10, 2020
The Guardian recently published an article about the use of robots in long term care facilities to combat loneliness of residents. Robots to be used in UK care homes to help reduce loneliness describes the roll these robots can play in interacting with residents. These are not your "normal" robots, but then I don't know what one would consider a "normal" robot. These robots, on wheels, "called “Pepper”, move independently and gesture with robotic arms and hands and are designed to be “culturally competent”, which means that after some initial programming they learn about the interests and backgrounds of care home residents. This allows them to initiate rudimentary conversations, play residents’ favourite music, teach them languages, and offer practical help including medicine reminders." The researchers not that these robots do not replace human caregivers but instead supplement them. The robots were tested in the U.K. and Japan and researchers found that those residents who spent time with the robots for "18 hours across two weeks had a significant improvement in their mental health. There was a small but positive impact on loneliness severity among users and the system did not increase feelings of loneliness...."
Robots, whether "Pepper" or others, do have limitations--for example, they aren't human. The article reports some of the limitations mentioned, such as their chats with residents were lacking some depth, were impersonal and lacked cultural awareness. Their movements were, shall we say, robotic. But imagine, a robot that can hold a conversation with you. This can be a great tool, to supplement human caregivers!
Thanks to Professor Feeley for sending me the article.
Thursday, August 27, 2020
Mark your calendars for the 2020 Schiller DuCanto & Fleck Family Law Center Virtual Symposium: The Current State of Elder Law. The symposium will be October 12, from 10-5:45 edt. Here's a description about the program
DePaul’s Schiller DuCanto & Fleck Family Law Center is hosting a full day virtual symposium on the area of elder law. Through various panel discussions with experts in the field, panelists and attendees will explore the intersection of family law and elder law, emergency guardianships, advance directives, public benefits, caregivers, choices in end of life matters, protecting your loved ones from financial exploitation, and LGBTQ Seniors. There will also be an elder law case law update that you don't want to miss.
Click here for more info and to register.
Wednesday, August 26, 2020
The DOJ announced a guilty plea in a huge prize notification scam, Defendant Pleads Guilty In Multi-Million Dollar Prize Notification Scam Affecting Elderly Victims.
Here's some of the salient information
A Las Vegas area resident charged with perpetrating a prize-notification scheme that bilked victims out of more than $10 million pleaded guilty... to conspiracy to commit mail fraud based on her participation in a scheme that preyed upon hundreds of thousands of victims, many of whom were elderly and vulnerable, with fraudulent prize notices. The notices led victims to believe that they could claim a large cash prize if they paid a small fee. This was false; victims who paid the fees did not receive anything of value.
. . .
“The defendant and her co-conspirators exploited the elderly and vulnerable by bombarding them repeatedly with false promises of wealth,” said Acting Assistant Attorney General Ethan P. Davis of the Department of Justice’s Civil Division. “Today’s guilty plea demonstrates the Department’s continuing commitment to bring to justice those who prey upon the elderly.”
The good guys win! Thanks to my colleague, Professor Podgor, for alerting me to this.
Tuesday, August 25, 2020
The American Elder Abuse Conference announce its webinar, Elder Fraud Prevention and Response Networks – Building Collaboration, on September 17, 2020 at 2 p.m. edt.
This 90-minute session aims to help establish multi-disciplinary networks (MDTs) and expand the capacity of existing ones to better address the issue of elder financial exploitation. The webinar’s instructors are Jenefer Duane (Senior Program Analyst in the Office of Financial Protection for Older Americans at the Consumer Financial Protection Bureau), and Talitha Guinn-Shaver (the Elder Abuse Multidisciplinary Team Technical Assistant for the Elder Justice Initiative at the US Department of Justice). The event is hosted by the American Elder Abuse Conference, the leading multi-disciplinary national conference dedicated to protecting our elders.
If you need further information, contact the American Elder Abuse Conference at: Events@ElderAbuseConference.org.
Click here to register for the conference.
Monday, August 24, 2020
There are now four digital publications available from the landing page, including the Journal, Generations Journal (quarterly), Generations Today (news publication, six times/year), Generations Now (blog and commentary) and finally, Generations Bylines, a new podcast that interviews authors and researchers in the field of aging. It's a great resource for our students, especially if you want them to stay updated on the trends in the field. (Full disclosure, I"m on the ASA board).
Sunday, August 23, 2020
Inevitably ... the virus has found its most ideal conditions in the warehouses storing America’s elderly population. No one knows the current death toll. As of early July, CMS put the number at 33,509, but the count covered only federally regulated nursing homes, not assisted-living communities. The homes, moreover, were not required to report deaths that occurred before May 8, although the agency said it was confident that “the vast majority” did so. One in five nursing homes didn’t bother to report their numbers at all. A New York Times study in late June put the number of deaths in U.S. nursing homes at a staggering 55,000, but even this figure did not necessarily include all of those who became infected in a home but died in a hospital, as was the case for Sharon Mitchell. In some states, the vast majority of COVID-19 deaths were in homes: 64 percent in Massachusetts, 68 percent in Pennsylvania, 77 percent in Minnesota. In New Jersey, one in every ten people housed in nursing homes or assisted-living centers died. This was a helpless population, helpless because so often confined in a state of neglect and squalor. But despite or perhaps because of their conditions, they were worth a lot of money. In effect, they were being harvested for profit.
The article looks at the financial model of long term care facilities in the U.S. It offers a comprehensive history of the development of LTC facilities in the U.S., culminating with a discussion of the ownership of LTC facilities by private equity firms. The article covers the impact of the pandemic and the efforts by the industry to get shield laws to provide them immunity.
As noted by the article, it's not only U.S. facilities that have faced these deaths from the pandemic. It notes one company that made changes early in the pandemic, which resulted in less cases, at least in some facilities. If we are to change the way we provide ltc in this country, in my opinion, this article is important. I'm assigning it to my students.
Friday, August 14, 2020
Earlier this week, the GAO issued a new report, CHILD WELFARE AND AGING PROGRAMS: HHS Could Enhance Support for Grandparents and Other Relative Caregivers.
Here are the highlights
In 2018, an estimated 2.7 million children lived with kin caregivers— grandparents, other relatives, or close family friends—because their parents were unable to care for them. Most of these children were cared for outside the foster care system, which can affect the types of services and supports available. While children did not live with parents for a variety of reasons, parental substance abuse and incarceration were often cited in data and in interviews with program officials.
Challenges faced by kin caregivers include having limited financial resources and needing legal assistance, particularly when caring for children outside foster care, according to survey data and studies GAO reviewed. This is, in part, because licensed foster parents generally receive foster care maintenance payments and other services. Officials in selected communities said they have addressed some challenges by, for example, providing temporary payments or legal representation to eligible kin caregivers. However, officials also said that program eligibility criteria or insufficient funds can limit availability or result in waiting lists.
The Department of Health and Human Services (HHS) provides technical assistance and other support to help states use federal programs and initiatives established to serve kin caregivers. HHS officials said that these programs are optional, so they mainly provide assistance in response to states' requests. However, this approach has not led to widespread use. For example, 23 states used the option under the National Family Caregiver Support Program to serve older relative caregivers with 1 percent or more of their fiscal year 2016 funds (spent through 2018). State officials said they would like more guides or tools for using these programs. By not proactively sharing information and best practices, HHS may be missing opportunitiesto help states better support kin caregivers.
GAO is making two recommendations to HHS on sharing information and best practices with states about federal programs that serve kin caregivers. HHS did not concur, stating that the agency already provides ongoing support. GAO maintains that implementing these recommendations would be helpful.
The full report is available here.
Thursday, August 13, 2020
At the recent annual meeting, the ABA House of Delegates Urges Congress to Invest in a Guardianship Court Improvement Program.
A Guardianship Court Improvement Program will provide states with the necessary federal
funding and support to improve their court processes and thus the lives of individuals with
guardians by improving outcomes for adults in the system, increasing the use of less restrictive options other than guardianship, and enhancing collaboration among courts, the legal system, and aging and disability networks.
RESOLVED, That the American Bar Association urges Congress to create and fund a Guardianship Court Improvement Program for adult guardianship (following the model of
the State Court Improvement Program for child welfare agencies created in 1993) to
support state court efforts to improve the legal process in the adult guardianship system, improve outcomes for adults subject to or potentially subject to guardianship, increase the use of less restrictive options than guardianship, and enhance collaboration among courts, the legal system, and the aging and disability networks.
Tuesday, August 11, 2020
I hope everyone knows the story of the Rosie the Riveter, and the difference they made during WWII. One of the Rosie the Riverters is still making a difference, according to a recent story in the Washington Post. 94-year-old ‘Rosie the Riveter’ once made warplanes and red bandannas. Now she makes face masks with the same cloth. features Mae Krier, who has continued to make a difference. "For many years, Krier has paid tribute to her beloved Rosie the Riveters by making red bandannas with white polka dots — a style shown in J. Howard Miller’s iconic Rosie the Riveter “We Can Do It!” poster for Westinghouse Electric. Since the war against the novel coronavirus started, Krier shifted her energy from making Rosie bandannas to Rosie face masks, cut from the same cotton cloth."
The article provides a nice history of the Rosier the Riveters, which is a good read for our students, who may not know the story. Ms. Krier also explains the can do attitude of the Riveters and how she sees it applying to the pandemic. She also expressed to the reporter her reactions to the pandemic and masks:
[S]he is frustrated and disheartened to see how many Americans are fighting safety measures and refusing to wear masks. Nurses, she said, are the new Rosie the Riveters, and hospitals are the new battlefield with coronavirus patients.
“We’re fighting a different kind of war — a terrible virus,” she said. “Where is the ‘We can do it’ spirit?”
Friday, July 24, 2020
APS TARC has released a new brief, Trauma-Informed Approach for Adult Protective Services. This brief includes a discussion trauma and of "The Four Rs of a Trauma-Informed Approach" (realize, recognize, respond and resist). The brief includes information from experts in the field, discusses COVID and APS, and then concludes
As outlined in this brief and highlighted by the guest experts above, there are tools to approach recent challenges posed by COVID-19 using trauma informed approaches. APS research and practice was already beginning to understand the critical intersections between adult maltreatment and trauma and now it’s time to pivot quickly and move forward with research, practice, and training for all levels of APS staff using a trauma-informed framework.
The American Public Human Services Association (APHSA), recommends these steps for organizations to “Lead Ahead” during times traumatic times:
Vision - Developing a vision for moving forward
Ask questions – Be curious, be direct
Plan – Develop a plan
Respond – Execute the plan
Innovate – Practice continuous quality improvement (CQI)
(American Public Human Services Association, 2020)
All the APHSA steps listed above can be conducted through a trauma-informed approach framework to cultivate safety, support and resiliency. The road ahead, in light of the COVID-19 pandemic, will be challenging to navigate for everyone. Let us all maintain and grow the resiliency of leadership, staff, and clients to move from urgent, trauma response to recovery response and planning in the days and weeks ahead.
Thursday, July 23, 2020
Politico reported that the Trump team relaxed training rules for nursing home staff just as pandemic hit.
Shortly after the first coronavirus outbreak ravaged a nursing home in Kirkland, Wash., the Trump administration moved to fulfill a longstanding industry goal — waiving the requirement that nurse’s aides receive 75 hours of training and allowing people who study only eight hours online to become caregivers during the pandemic.
The industry had been fighting for years to reduce training requirements, saying they make it harder to recruit staff. The day after the administration announced the change, the industry rolled out a free online training program for certifying the new role — called a "temporary nurse aide" — that has since been adopted by at least 19 states.
The article reports that advocates for elders and others think this was poorly timed and may have resulted in the spread of COVID in SNFs, especially when considering that CNAs are typically "the main caretakers of residents, some of whom need round-the-clock monitoring; nurse’s aides are also on the front lines in implementing the cleaning and disinfecting practices that prevent the spread of Covid-19." CMS emphasized this is temporary and as soon a COVID is done with us, the CNA 75 hour training requirement will resume.
However, we don't know how well this is working. "[C]ritics are questioning why the waivers were applied so quickly and broadly, and why they’re lasting months into the pandemic when little is known about whether there are, in fact, larger-than-usual staff shortages in nursing homes. They also question the wisdom of waiving the rules for removing residents and making quarterly reports on their condition, which are among more than two dozen regulations temporarily suspended by the administration."
Wednesday, July 22, 2020
Some SNFs and ALFs are now allowing visits for residents, with proper precautions, rather than an absolute ban on visits. Kaiser Health News ran an update, States Allow In-Person Nursing Home Visits As Families Charge Residents Die ‘Of Broken Hearts’.
For the most part, visitors are required to stay outside and meet relatives in gardens or on patios where they stay at least 6 feet apart, supervised by a staff member. Appointments are scheduled in advance and masks are mandated. Only one or two visitors are permitted at a time.
Before these get-togethers, visitors get temperature checks and answer screening questions to assess their health. Hugs or other physical contact are not allowed. If residents or staff at a facility develop new cases of COVID-19, visitation is not permitted.
Slightly over half of the states have have allowed these SNF visits, after he release of revised guidance from CMS, while slightly less than half of the states have allowed ALFs to follow the same path. This change is something of a balancing act, and the article notes this can change if COVID cases show up. Although the prohibition on visits was intended as protection,
[A]nguished families say loved ones [suffered]too much, mentally and physically, after nearly four months in isolation. Since nursing homes and assisted living centers closed to visitors in mid-March, under guidance from federal health authorities, older adults have been mostly confined to their rooms, with minimal human interaction.
A separate, but related issue, the right of visitation at the end of life, has not been evenly applied.
Although federal guidance says visitors should be permitted inside long-term care facilities at the end of life, this is not happening as often as it should, said Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, an advocacy group.
She wants family visitation policies to be mandatory, not optional. As it stands, facility administrators retain considerable discretion over when and whether to offer visits because states are issuing recommendations only.
Smetanka’s organization has also begun a campaign, Visitation Saves Lives, calling for one “essential support person” to be named for every nursing home or assisted living resident, not just those who are dying. This person should have the right to go into the facility as long as he or she wears personal protective equipment, follows infection control protocols and interacts only with his or her loved one.
The article also includes a map of states allowing visitation.
July 22, 2020 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations | Permalink
Tuesday, July 21, 2020
Charlie Sabatino, the rock star of elder law and the Director of the ABA Commission on Law & Aging recently wrote an opinion piece for Next Avenue on this important topic. OPINION: It’s Time to Defund Nursing Homes: How the traditional nursing home model can be replaced. Sabatino writes that:
[T]he COVID-19 pandemic ravaging nursing home residents underscores a deep-seated ageism inherent in our institutional model of nursing home care. I believe it is time to defund the institutional model and replace it with a radically different model.
Today’s typical nursing home has never come close to meeting the public’s desire for humane and dignified long-term care. Warehousing large numbers of frail elders in hospital-like buildings with residents in double or triple rooms along with staff turnover as high as 100% unavoidably creates a high risk for resident safety and compromises quality of care.
We've all read the stories about the horrors occurring in the nursing homes as the pandemic rolls across the country (for patients and caregivers too). A number of calls for change have been made, but as Sabatino aptly observed, "
[M]ultiple recommendations for change have gained attention. They include ensuring adequate personal protective equipment in nursing homes; disaster plans that facilitate quarantining; more and better trained staff and heightened monitoring and oversight of care.
But let’s be clear: These measures do little more than rearrange the deck chairs in a failing system.
The COVID-19 pandemic is a 9/11 moment for nursing home care and a test of our ability to reimagine nursing home care that puts the “home” into nursing homes.
Sabatino then turns to specifics regarding change and suggests the key to change is to tie it to Medicare and Medicaid funding.
As the largest payor for nursing home care, Medicare and Medicaid hold the key. Now is the time to change facility requirements to gradually limit participation in the program only to facilities that provide the following:
Small home-like facilities
Single rooms and bathrooms
A flattened, more flexible staff hierarchy with cross-trained staff
A culture focused first on residents’ goals, interests and preferences.
Sabatino concludes "[a]s long as the nursing home industry can rely on the flow of federal money for the current model of care, it has no financial incentive to change, not even after the coronavirus catastrophe. ... Change that flow, and a major cultural change in long-term care will follow."
Stay safe and healthy everyone.
Sunday, July 19, 2020
When I read the following New York Times article, all I could think of was the Clash song, "Should I Stay or Should I Go? The article, You’re a Senior. How Do You Calculate Coronavirus Risk Right Now? focuses on the decision to stay home or to venture out into the world (with precautions of course) when you are in a high risk group (or any group for that matter but this is the elderlawprof blog!)
"Early on in the pandemic, most public health officials warned older adults to simply stay at home, except to buy food or medicine or exercise outdoors apart from others. Now, with states and cities reopening (and some re-closing) at varying paces, the calculations grow steadily more complicated."
What to do? What to do? One study from MIT economists "in a recent paper suggesting age-targeted lockdowns ... proposed protecting people over 65 by having them isolate for an estimated 18 months until a vaccine becomes available; younger people, facing less health risk, would return to work." As the article notes, that "approach also assumes that older adults’ only interest lies in not dying." Well, that is a big one, but still.....
There's so much info out there, what is one to do? The article offers a couple of insights
Geography matters too. Older people in New Hampshire or Maine — where new cases were falling last week — may reasonably opt for less restrictive behavior than those in Florida and Arizona, where Covid has been surging. Pay attention to which counties are seeing cases rise and which are doing a good job at observing guidelines.)