Monday, January 14, 2019

Hebrew Home at Riverdale New York: Site for New Report on Medical Marijuana

Last week, I wrote about the possible use of medical marijuana for treatment of anxiety in patients with dementia, pointing to the importance of peer-reviewed studies.  This week, I learned of a new study on the use of medical marijuana at a nursing home, and when I read the study I was not surprised to learn the study had occurred at Hebrew Home at Riverdale in New York, a location I have come to associate with both research and thoughtful innovation.  Studies of medical marijuana are complicated by the disjunction in federal and state laws governing purchase and use.

From a study published in JAMDA, the official journal for the Society of Post-Acute and Long-Term Care Medicine, this description in a press release:  

In “Medical Cannabis in the Skilled Nursing Facility: A Novel Approach to Improving Symptom Management and Quality of Life,” the authors described a medical policy and procedure (P&P) they implemented at their New York-based SNF for the safe use and administration of cannabis for residents with a qualifying diagnosis. To be compliant with state and federal statutes, policy requires that residents must purchase their own cannabis product directly from a state-certified dispensary.

 

After the program started in 2016, the facility provided educational sessions for residents and distributed a medical cannabis fact sheet that was also made available to family members. To date, 10 residents have participated in the program and seven have been receiving medical cannabis for over a year. Participants range in age from 62 to 100. Of the 10 participants, six qualified for the program due to a chronic pain diagnosis, two due to Parkinson’s disease, and one due to both diagnoses. One resident is participating in the program for a seizure disorder.

 

Most residents who use cannabis for pain management said that it has lessened the severity of their chronic pain. This, in turn, has resulted in opioid dosage reductions and an improved sense of well-being. Those individuals receiving cannabis for Parkinson’s reported mild improvement with rigidity complaints. The patient with seizure disorder has experienced a marked reduction in seizure activity with the cannabis therapy.

This study did not address cannabis as a treatment for symptoms of dementia-related anxiety.  For more, see Medical Cannabis in the Skilled Nursing Facility:  A Novel Approach to Improving Symptom Management and Quality of Life, published January 2019.  Interestingly, the authors are a medical doctor, Zachary J. Palace, and Daniel Reingold, who lists both a Masters of Social Work and a J.D. for his background. 

January 14, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Tuesday, January 8, 2019

Medical Marijuana for Treatment of Dementia Agitation

Months ago, when my family was considering alternatives for care of my mother as her health deteriorated and her home became increasingly unsafe, I was talking with different providers about the challenges of care when the individual is a heavy smoker (as my mother, at age 92, still was at the time).  There are few options, and most licensed facilities bar smoking completely or limit it to locations that are not workable for someone with impaired movement.  I joked with one provider that smoking cigarettes was prohibited but that Arizona had recently authorized medical marijuana.  Arizona Statutes Section 36-2801 permits medical marijuana for those with debilitating medical conditions, including "agitation of  alzheimer's disease." 

The provider laughed and said, "oh, we don't permit smoking of marijuana either." I wasn't up-to-date on the technology!  Apparently the preferred dispensation at that location was via "gummies."  If you google "marijuana gummies" you get a remarkable range of products.

Medical Marijuana Gummies

In this brave new world of medical marijuana, I can see reasons for the interest, especially in the search for safe and effective ways to help individuals whose form of dementia is marked by severe agitation.  Can marijuana "take the edge off" in a safe way?  Can doses be monitored and evaluated appropriately?  Do "gummies" provide reliable or consistent doses of the active ingredient, most likely THC?  Can there be an associated positive effect -- improved appetite (the proverbial "munchies")?  Are there reporting mechanisms on the effects of use, especially in facilities that provide dementia care, that will help capture success rates and any risks?  What about individuals with dementia who suffer from both agitation and delusional thinking -- could medical marijuana potentially reduce one symptom but increase another?  Is the CDC tracking medical marijuana gummies or other products in the context of dementia care?  

The National Conference for State Legislatures (NCSL) maintains a website on state medical marijuana laws.  NCSL reported that as of 11/8/18, 33 states, plus D.C., Guam and Puerto Rico, have approved "comprehensive" public medical marijuana programs, with additional states allowing limited use of "low THC, high CBD" products in limited situations that are not deemed comprehensive medical marijuana programs.

In January 2017, the National Academies of Sciences, Engineering, and Medicine released a report based on review of "over 10,000 scientific abstracts" for marijuana health research, offering 100 conclusions related to health and ways to improve research. The conclusions are organized according to whether there is "conclusive or substantial" evidence, moderate evidence, or limited evidence about effectiveness or ineffectiveness of medical marijuana in a variety of contexts.  One conclusion suggests there is limited evidence that cannabis or cannabinoids are effective for "improving anxiety symptoms," while a separate conclusion states there is limited evidence that such substances are ineffective for "improving symptoms associated with dementia."  

I'm relatively new to review of literature associated with medical marijuana for dementia care/treatment, and welcome hearing from others who are aware of authoritative sources of information. (And just to be clear, this isn't a product we're considering for my mother!) I can see this topic becoming more important with time in our aging world, especially as additional sources of dementia-treatment evidence may become available. 

January 8, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Federal Statutes/Regulations, Food and Drink, Health Care/Long Term Care, Science, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Monday, January 7, 2019

States Adopt "Work & Save" Programs to Promote Retirement Savings on the Job

I was chatting recently with Bill Johnston-Walsh, director of Pennsylvania's chapter of AARP.  I always enjoy catching up with Bill, as he gets involved in cutting edge issues and projects under development.

One of the hot topics he relayed to me are programs at the state level to support better on-the-job savings for retirement.  Almost gone are the days of defined benefit retirement plans and employers may not offer defined contribution plans either.  States are beginning to adopt laws that make it possible for employers to offer alternative, low-cost, voluntary approaches for employees, sometimes known as "Work & Save" programs, such as "OregonSaves."  Here's a summary from an AARP report in July 2018:

Oregon was the first-in-the-nation to launch this innovative solution with OregonSaves in 2017, and as of July 2018 they already have over 58,000 workers enrolled and nearly $4.6 million saved. Of those eligible at this time, 73% have enrolled, and participants are saving $46.42 per paycheck on average. Check out how OregonSaves is helping workers save here.



Elsewhere, this year, Washington opened the first ever marketplace version of Work & Save, Washington’s Retirement Marketplace, and Illinois started a pilot of their Work & Save program, Illinois Secure Choice, with their official launch coming this fall.

 

These states are not alone – across the nation, states are recognizing the need to help all workers grow savings so they can take control of their futures and deal with the rising cost of health care and living expenses. In the past 6 years, 40 states have acted to implement, study or consider legislation to create Work & Save programs.

Convenience and portability for the employees seem to be two key components of the new approaches.

 

January 7, 2019 in Consumer Information, Current Affairs, Retirement, State Statutes/Regulations, Statistics | Permalink

Wednesday, January 2, 2019

Conservator Financial Exploitation Background Briefs from Center for Elders & Courts

The Center for Elders & Courts has released 8 background briefs on financial exploitation by conservators. The introduction explains that "the U.S. Department of Justice Office for Victims of Crime funded the National Center for State Courts (NCSC), in partnership with the American Bar Association Commission on Law and Aging (ABA Commission), the Virginia Tech Center for Gerontology (VTCfG) and the Minnesota Judicial Branch, to assess the scope of such exploitation and explore its impact on victims."  "The ... project collected information on conservator exploitation, as well as the laws and practices in place to prevent, detect and act on such exploitation."

The purpose of the briefs is to increase public knowledge about the issues, aimed at an audience that includes attorneys, policymakers, judges, court staff, and advocated. 

The 8 topics cover: 

Examples of Conservator Exploitation: An Overview

Conservator Exploitation in Minnesota

Detecting Exploitation by Conservators: Court Monitoring

Detecting Exploitation by Conservators: Systemic Approach

Court Actions Upon Detection of Exploitation

Innovative Programs That Address Financial Exploitation by Conservators

Data Quality Undermines Accountability in Conservatorship Cases

Supporting Victims of Conservator Exploitation

In addition there is a list of resources available here, Key Resources on Conservator Exploitation

 

January 2, 2019 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, State Statutes/Regulations | Permalink | Comments (0)

Tuesday, January 1, 2019

New Twist on Grandparent Scam-Asking for Cash

The grandparent scam has been around for a while. According to the FTC, the bad guys have morphed the scam to make it harder  to catch.  New twist on popular 'grandparent scam': mail cash explains that "people 70 and older report mailing huge amounts of cash to people who pretended to be their grandchildren... [and] ...  – fully 25% of people 70 and over who reported to the FTC how they paid money told [the FTC] they sent cash." (citations omitted). The FTC noted that these grandparent scams are also called friends & family impostor scams.

How do the bad guys convince victims to send cash?  The blog post explains that "callers often give very specific instructions about how to send cash. Many people said they were told to divide the bills into envelopes and place them between the pages of a magazine. Then, according to reports, they were told to send them using various carriers, including UPS, FedEx, and the U.S. Postal Service."  The post does give some advice:

  • Don’t act right away, no matter how dramatic the story is.
  • Call that family member or friend, and make sure you use a phone number that you know is right. Or check it out with someone else in your circle, even if the caller told you to keep it a secret.
  • Be careful about what you post on social media. If your personal details are public, someone can use them to defraud you and people who care about you.

If you’ve mailed cash, report it right away to the Postal Service or whichever shipping company you used. Some people have been able to stop delivery by acting quickly and giving a tracking number. Also tell the FTC at FTC.gov/complaint.

BTW, the FTC website notes that the agency is closed because of the government shut down. Hopefully the bad guys aren't reading this post or checking out the FTC website.

January 1, 2019 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, State Statutes/Regulations | Permalink | Comments (0)

Sunday, December 30, 2018

Rapid Response Conservatorship Project

The Rapid Response Conservatorship Project from the Center for Elders & the Courts is using technology to create "[a] modernized proactive court process that safeguards the as sets of those placed under a conservatorship." The website offers some information about the project: "NCSC will pilot the two-year project in two courts to develop and refine implementation strategies that can be adopted nationwide. The project will result in highly efficient court processes and has the potential to end the exploitation of conservatorship assets." The website describes 3 phases: planning, implementing and replicating. The project looks at 5 steps: appointing a conservator, using technology and machine learning  to establish a "financial profile" which in turn notifies courts of unusual activities which will then allow courts to take action with the result of "[i]ntegrating monitoring, alerts, and timely resolution into the court management process [which] will improve the administration of justice—and protect the assets of the vulnerable."

Cate Boyko is the project director

 

December 30, 2018 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, State Statutes/Regulations | Permalink

Tuesday, December 18, 2018

ALFs Too Popular for Resident Safety?

Kaiser Health News recently ran a story about ALFs that focuses on resident safety. Assisted Living’s Breakneck Growth Leaves Patient Safety Behind opens with a story about one resident and then points out

Assisted living facilities were originally designed for people who were largely independent but required help bathing, eating or with other daily tasks. Unlike nursing homes, the facilities generally do not provide skilled medical care or therapy, and stays are not paid for by Medicare or Medicaid.

Dementia care is the fastest-growing segment of assisted living. As these residences market themselves to people with Alzheimer’s and other types of dementia, facilities across the country are straining to deliver on their promises of security and attentive care, according to a Kaiser Health News analysis of inspection records in the three most populous states.

We know that ALFs are regulated at the state level and thus regulations from one state may vary from another. We also know that residents of ALFs are going to need assistance with ADLs. What more do we know?

[Residents] are older and frailer than assisted living residents were a generation ago. Within a year, 1 in 5 experience a fall, 1 in 8 visit an emergency room and 1 in 12 have an overnight hospital stay, according to the Centers for Disease Control and Prevention. Half are 85 or older.

“Assisted living was created to be an alternative to nursing homes, but if you walk into some of the big assisted living facilities, they sure feel like a nursing home,” said [one expert who is] director for mission partnerships with the Alzheimer’s Association.

There is a tension between viewpoints-regulation vs. the environment the facilities market for residents. Residents with dementia may pose a challenge for the ALFs.

Nearly a quarter of the nation’s 30,000 assisted living facilities either house only people with dementia or have special areas known as memory care units. These wings have locked doors and other safeguards to prevent residents from leaving. The facilities often train staff members in techniques to manage behavior related to these diseases and provide activities to keep the residents engaged and stimulated.

These units usually are more expensive, with monthly costs averaging $6,472, compared with $4,835 for regular assisted living, according to a survey by the National Investment Center for Seniors Housing & Care, a group that analyzes elder care market trends. Senior housing investors earned nearly 15 percent in annual returns over the past five years, higher than for apartment, hotel, office and retail properties, according to the center. Beth Burnham Mace, chief economist at the center, said memory care unit construction was outpacing all other types of senior housing.

Aggressive behavior, a hallmark of dementia, is a major problem in assisted living facilities. One national study, published in 2016, found that 8 percent of assisted living residents were physically aggressive or abusive toward residents or staff.

As noted earlier, regulation varies amongst the states. According to one study cited in the article, "only seven states required facilities to have a registered nurse. States required anywhere from two to 30 hours of training for dementia unit workers. A handful of states required no specialized training ... [and]  19 states set minimum staff-to-resident ratios for dementia units, while the others left it to the facilities."

December 18, 2018 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Webinar-Recognizing Elder Abuse

Mark your calendars now for a free webinar from the National Center on Law & Elder Rights on Signs of Elder Abuse, Neglect, and Exploitation. The webcast is scheduled for 2 p.m. on January 16, 2019.  Here is a description of the webinar

Lawyers and others who work with older adults should be aware of potential signs of abuse, neglect, and exploitation. This awareness requires an understanding of abuse signs, as well as the questions to ask when abuse is suspected. As the first part in the forthcoming National Center on Law and Elder Rights (NCLER) Elder Justice Toolkit, this webinar will help lawyers tune in to potential warning signals and train the audience on key questions to ask when elder abuse is suspected. The fast paced one-hour program will include checklists of physical, behavioral, and emotional signs of abuse, sexual abuse, self-neglect, caregiver neglect, and exploitation. 

To register, click here.

December 18, 2018 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, Programs/CLEs, State Cases, State Statutes/Regulations, Webinars | Permalink | Comments (0)

Monday, December 17, 2018

Ohio Supreme Court Addresses Liability of a Surviving Spouse for Nursing Home Debt

University of Cincinnati College of Law Professor of Practice Emerita Marianna Brown Bettman has a very interesting and well-written Blog report on the Ohio Supreme Court's December 12th decision in Embassy Healthcare v. Bell.  The issue is under what circumstances a surviving spouse can be held liable for her deceased husband's nursing home costs under a statutory theory of "necessaries." Lots to unpack here.   

December 17, 2018 in Consumer Information, Current Affairs, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Property Management, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Thursday, December 13, 2018

Psychiatric Advance Directives Gain Prominence

The New York Times reported last week on psychiatric advance directives in  Now Mental Health Patients Can Specify Their Care Before Hallucinations and Voices Overwhelm Them

"[A]  psychiatric advance directive, a legal document declaring what treatment he does and doesn’t want. Increasingly, patients, advocates and doctors believe such directives (called PADs) could help transform the mental health system by allowing patients to shape their care even when they lose touch with reality. Hospitals must put them in patients’ medical records and doctors are expected to follow them unless they document that specific preferences aren’t in the patients’ best medical interest."

The article notes that not everyone is in favor of these. For example, "some doctors and hospitals are wary that the documents could tie their hands and discourage treatment they consider warranted. Some worry the directives won’t be updated to reflect medical advances. Others question whether people with serious psychiatric conditions are ever capable of lucidly completing such directives."  The article notes that at least 27 states allow for the use of psychiatric advance directives-others may do so as part of the more traditional health care advance directive.  The document is seen as an alternative to involuntary commitment.

CMS now requires health care providers to include in their inquiry about health care directives any psychiatric advance directive (see here requirements that hospitals ask if patients have a directive).  The directive also allows advance permission by the patient for the health care providers to engage with friends or family, particularly important because during a crisis, the person  may "be too unstable or paranoid to give permission."  The article gives examples of what might be authorized by the directive, offers suggestions regarding drafting and signing and shares stories of some individuals who have created these directives.

On a side note, the article notes that the directives are referred to as PAD.  On an unrelated topic, physician-aided dying is also sometimes shortened to PAD. Make sure your students understand the differences.

December 13, 2018 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)

Monday, December 10, 2018

Rural & Tribal Justice Webinar Series from DOJ

Mark your calendars for a free webinar on December 13, 2018 from noon-1 from DOJ's Elder Justice Initiative on Resources for Financial Institutions to Prevent & Protect Against Elder Financial Exploitation.

Here is a synopsis from the website:

Bankers, brokers, and investment advisors are often some of the first trusted parties to see signs of financial exploitation. This presentation will support the work already done by financial services members and provide additional information about how to access training programs and support for tellers and other financial professionals who want to report financial exploitation and work collaboratively with others in their communities to prevent it.

Please join us for a webinar on December 13, 2018, at 1:00 p.m. e.t., on Resources for Financial Institutions To Prevent and Protect Against Elder Financial Exploitation with host Judith Kozlowski, J.D., consultant and subject matter expert with DOJ's Elder Justice Initiative, and presenter Lisa Bleier, J.D., Managing Director and Associate General Counsel at the Securities Industry and Financial Markets Association (SIFMA), and leads its Senior Investor Protection efforts. Her primary responsibilities at SIFMA include working with Members of Congress and government regulators on retirement, IRA, and executive compensation matters. Before moving to SIFMA, Ms. Bleier was Vice President and Senior Counsel at the American Bankers Association and worked on Capitol Hill. Also presenting is Billie McNeeley, Financial Exploitation Specialist, Aging & People with Disabilities at the Oregon Department of Human Services, she is a leader in developing and training bank tellers to recognize financial exploitation and move to action. Formerly with the Oregon Bankers Association, she is a national advocate for the role that small banks and credit unions can play in addressing elder financial exploitation.

They will discuss how financial professionals in small and medium-sized firms can use available tools and training to recognize and fight elder financial exploitation. The discussion includes what tellers, back-office professionals, and those in the c-suite can do to address this important issue.

To register for the webinar, click here.

December 10, 2018 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Programs/CLEs, State Statutes/Regulations, Webinars | Permalink

Thinking about New York Time's Article on Guardianships and One Woman's Personal Story

For anyone working in legal fields where adult guardianships may be an option, for anyone teaching elder law, health care law, constitutional law or even landlord-tenant law, a recent New York Times article, "I'm Petitioning . . . for the Return of My Life," is an important read.

On a threshold level, this is a well-told tale of one woman, Ms. Funke, who becomes subject to an intervention under New York adult protective services law, and, eventually, to a full-blown guardianship proceeding.   It can be easy to become enraged on behalf of Ms. Funke as you read details about her past life as a freelance journalist and world traveler, and compare it to the limitations placed on her essential existence under a guardianship. 

The article is a rather classic example of using one tragic story, a human story, to paint a picture of a government process gone wrong.  At several points in the article, the writer, John Leland, offers questions that suggest some conclusions about how unfair the process has been to Ms. Funke.  The writer asks, for example, 

"If you were Ms. Funke, shouldn't you be allowed to withdraw into the covers [of your bed] if you wanted to?  And the clutter in your apartment -- couldn't people understand that a writer needs materials around?  Even if she were evicted, she had money to start somewhere else.  Courts evict people with lots less [than she appears to have]. " 

It's implied that the answers to those questions may outweigh the fact that the protective services intervention prevented the landlord from completing an eviction of Ms. Funke, an eviction that would have forced her out of her apartment of 40+ years.    

Other, less dramatic details in the article suggest that for every Ms. Funke, there may be other people -- an unknown number of people in New York -- who are also very alone and who have also lost control over their lives because of physical frailty, mental decline, depression or other facts, and who are rescued with the help of a protective services intervention. Sometimes the intervention interrupts the decline, usually with the help of family member or friend who volunteers to help, sometimes acting with a measure of authority under a power of attorney, making a guardianship unnecessary. 

The challenge, of course, is knowing when to help (and how far to go), and when to preserve the  individual's right  to make choices that appear unsafe.  Some of the most complex cases involve people who have spent a lifetime on a unique and often solo path, and now have few family members or friends to help them as that path becomes rockier with age or illness, especially when they have no plan for the future.  In the face of such facts, as one person interviewed in the article observes, guardianships are a "blunt instrument."

Something I wrote about last week also figures into the New York situation -- the apparent absence of a guardianship case tracking or monitoring system.  

But another issue I'm concerned with is also suggested.  At one point, an interview with one of Ms. Funke's guardians, a so-called professional (in other words, not a family member or a public guardian) discloses he does not know how far his authority as guardian extends.  For example, would he be allowed to prevent her from marrying?  He responded, he did not know.

It would seem that guardians and other agents, alleged incapacitated persons, -- and family members -- could all benefit from greater information, and to ongoing education on their rights, duties and options.  That was also a theme emerging from article asking the question  "Where's Grandma?" that I linked to last week and that I link to again here.    

My thanks to the several folks who suggested this New York Times article for discussion on our Blog, including my Dickinson Law colleague, international human rights expert, Dermot Groome.    

December 10, 2018 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Housing, State Cases, State Statutes/Regulations | Permalink | Comments (2)

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

The Importance of Guardianship Tracking Systems (and a related CLE Program!)

I've been a bit busier than usual lately and haven't felt I could take the time to Blog regularly even though I'm constantly seeing intriguing topics to discuss.  I'm buried in a manuscript with a looming deadline!  Fortunately, I'm seeing that Becky Morgan is keeping everyone updated and I've been benefiting from her regular reports.  I hope to get back to daily posts of my own by January.  

In the meantime, I can report on a smaller, interim task of  serving as a co-presenter for a half-day Continuing Legal Education program at the Pennsylvania Bar Institute on  new developments in Guardianship Practice and Procedure on Friday, December 7.   Among the important developments, the Pennsylvania Courts is nearing completion on its statewide implementation of a Guardian Tracking System or GTS.  In 2014, the Supreme Court's Elder Law Task Force strongly recommended adoption of such a system, having determined just how little was actually known across the state about open guardian cases.  Implementation of the new system began with a pilot in Allegheny County in July 2018.  As of today, 60 counties are "live" in the system.  The remaining 7 counties are scheduled to be included by the end of this month.

With the help of the new tracking system, I learned that we currently have more than 14,000 active guardianships in Pennsylvania.

Key features of the GTS system include:

  • Automation:  a means of automatically running a process to check specific aspects of guardianship reports for missing information or other concerns;
  • Flagging:  when a concern is detected, the item is automatically flagged, allowing court personnel to review and respond to the potential problem;
  • State-wide Court Communications: providing the court system with a means of immediate and cost-effective state-wide communications whenever a judge in one case is alerted to suspicion of neglect or other improper conduct by a guardian; and
  • Alerts on Specific Guardians:  when an "alert" is triggered on a specific guardian in one case, the system will generate notices to all of the other courts in the state, alerting them to the potential need for action on that individual in their cases.  

Such a system required entirely new software, new reporting forms, and new court rules to make implementation effective.  We will be talking extensively about the new rules and forms on Friday.  The migration  from the older system of record-keeping imposes a huge learning curve on many involved in guardianship matters, including lawyers.

The need for better systems in Pennsylvania has been highlighted during the last year of controversies surrounding appointment of one particular individual as guardian for alleged incapacitated persons in three Pennsylvania counties.  She is accused of mismanaging cases, plus it turned out she had a criminal history for fraud in another state. 

See also the recent news reports about another Pennsylvania guardianship matter that asks the troubling question "Where's Grandma?" The  reporter on this case, Cherri Gregg, who also happens to be a lawyer, opines that everyone in the case, including the lawyer appointed as guardian, and the family members of the person subject to the guardianship, needed better education about their roles after the grandmother's own children passed away, as the grandmother became more vulnerable, and especially when it became necessary to place her in a nursing home.  

My special thanks to Karen Buck, Executive Director of the SeniorLAW Center in Philadelphia, and the good folks at Pennsylvania Courts' Office of Elder Justice for helping me with my part of the presentation for Friday!

December 5, 2018 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Legal Practice/Practice Management, Programs/CLEs, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Advance Directives: Counseling Guide for Lawyers

The American Bar Association Commission on Law & Aging has published the   Advance Directives: Counseling Guide for Lawyers. The website explains the usefulness of the guide: "designed to assist lawyers and health care professionals in formulating end-of-life health decision plans that are clearly written and effective... The guide provides detailed information on how to bridge the chasm between lawyers and health care providers. It helps lawyers to provide guidance that is more in harmony with the clinical and family realities that clients face. The foundation for it is a set of eight principles to guide patients and clients through the advance care planning process." The three sections include the planning principles, a checklist for attorneys, and resources.  All are available for download individually, or the entire guide may be downloaded for free or purchased from the ABA.  The guide contains a lot of helpful info for attorneys, including checklists for a first and second interview, a sample letter to the client's doctor and a HIPAA access form. Check it out! 

 

December 5, 2018 in Advance Directives/End-of-Life, Books, Consumer Information, Current Affairs, Health Care/Long Term Care, State Statutes/Regulations | Permalink

Tuesday, December 4, 2018

SNF Silver Tsunami Hitting Texas?

A recent article mentioned that the number of elders in Texas who will need SNF care is going to be a "silver tsunami."  The Houston Chronicle published this article, Silver Tsunami set to hit Texas nursing homes where the article acknowledges "[m]ore than 12 percent of the Texas population is over 65, and that number is growing. According to the Texas Demographic Center, the over-65 population across the state is projected to increase by more than 262 percent by 2050." But it is more than the numbers creating this "silver tsunami: the impact is magnified "by the increasingly complex medical conditions — such as Parkinson’s and Alzheimer’s — of aging Texans needing nursing home care. According to data from the Alzheimer’s Association “2018 Texas Facts and Figures,” more than 380,000 of the state’s residents have already developed Alzheimer’s disease or other dementia. In Texas, Alzheimer’s is the sixth leading cause of death, and its prevalence is expected to increase by almost 30 percent by 2025."

The article also highlights the fact that in many instances the caregivers themselves will be elders.

We all need to be planning ahead.....

December 4, 2018 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Housing, State Cases, State Statutes/Regulations | Permalink

Friday, November 30, 2018

Senate Special Committee on Aging-Guardianship Hearing

Earlier I had blogged about the upcoming hearing on guardianships scheduled for the Senate Special Committee on Aging The hearing was held on November 28, 2018, and a report as well as the video of the hearing are now available.  You can also access the witness statements here.

November 30, 2018 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink

Tuesday, November 27, 2018

Senate Special Committee on Aging

The  Senate Special Committee on Aging is holding its next hearing tomorrow, November 28, on guardianships.  “Ensuring Trust: Strengthening State Efforts to Overhaul the Guardianship Process and Protect Older Americans.” is scheduled for 2:30 p.m. and will feature 4 witnesses. Testimony and remarks will be posted to the website after the hearing.

November 27, 2018 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Other, State Statutes/Regulations | Permalink

Thursday, November 8, 2018

Call for Proposals-National Center for Victims of Crime

The National Center for Victims of Crime has released a call for proposals for its 2019 training institute. The website announcing the call for proposals explains:

The National Center is pleased to present the National Center for Victims of Crime 2019 National Training Institute. As in past years, this training will emphasize a multidisciplinary approach to sharing promising practices, current research, and effective programs and policies that are victim-centered, practice-based, and research-informed. Our National Training is a forum for law enforcement, victim service professionals, allied practitioners, policymakers, and researchers to share current developments and build new collaborations. Conference sessions will highlight practical information to better support services for the wide range of persons victimized by crimes of all types.

 Call for Workshop Proposals

The National Center for Victims of Crime is seeking presenters for its National Training Institute, to be held September 4-6, 2019, in Denver, Colorado. Workshops will address a wide range of topics organized into separate conference tracks. Workshops are scheduled for 90 minutes (1.5 hours) in length, unless otherwise specified in the proposal. Accepted presenters will be assigned day and presentation time by the Institute planning committee.

Click here  to submit a proposal.

November 8, 2018 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Programs/CLEs, State Cases, State Statutes/Regulations | Permalink | Comments (0)

8 Briefs-Financial Exploitation by Conservators

The National Center for State Courts project on  Elders & Courts, with other organizations have published  a series of 8 research briefs on Financial Exploitation by Conservators.  The topics include

  • Examples of Conservator Exploitation: An Overview
  • Conservator Exploitation in Minnesota: An Analysis of Judicial Response
  • Detecting Exploitation by Conservators – Court Monitoring
  • Detecting Exploitation by Conservators – Systemic Approach
  • Court Actions Upon Detection of Exploitation
  • Innovative Programs that Address Financial Exploitation by Conservators
  • Data Quality Undermines Accountability in Conservatorship Cases
  • Supporting Victims of Conservator Exploitation

as well as key resources for these cases.

The introduction explains the impetus for the work, the 8 briefs, definitions of common terms and the reason for the project

NCSC in 2016 estimated, based on projections, that there are approximately 1.3 million active adult guardianship or conservatorship cases in the United States and at least $50 billion in assets under conservatorships (see Data Quality Brief). Also in 2016, the U.S. Government Accountability Office (GAO) found that “the extent of elder abuse by guardians nationally is unknown due to limited data . . .” While many conservators are trustworthy, dedicated, and provide critically needed services, multiple media accounts over many years profile instances in which conservators have breached their fiduciary duty – taking advantage of those they were charged with protecting. (citations omitted)

 

November 8, 2018 in Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, State Cases, State Statutes/Regulations | Permalink | Comments (0)