Nurse Aid Fired for Slapping Dementia Patient's Support Doll

It is tragic that humans find more and unique ways to harm each other.  From an article published in McKnight's Long Term Care News, we learn that an Illinois continuing care retirement community (CCRC) fired a certified nursing assistant for slapping a resident’s baby doll.

The incident at the St. Vincent’s Home, in Quincy, Illinois, first occurred in June, but reached the public eye only recently after the Illinois Department of Public Health released its quarterly violations report. State officials hit the home with a $2,200 penalty, after the CNA slapped a resident’s doll, reportedly to get her “riled up.” 

According to the Herald-Whig, the resident had been diagnosed with dementia, anxiety and depression, and suffered from confusion and short- and long-term memory impairment.  

Brian Inman, assistant administrator at the home, agreed the incident constituted mental abuse.  St. Vincent’s suspended the CNA pending investigation, later deciding to terminate the CNA. Prior to the incident, the CNA had undergone special training for dementia treatment.

While the incident might seem minor to some, it meant a lot to the resident, who views the three dolls as her children, a family member said in an interview with state officials.  Those baby dolls are her everything,” the family member said. “I know this [slapping the baby doll] would have really disturbed her. She thinks those baby dolls are her babies.”

The CNA reportedly told coworkers, who did not immediately report the incident, as required by the state, that slapping those dolls was good way to “keep from being bored during a shift,” later telling state investigators, “[i]t’s kind of cute but probably not to the resident.”

Hopefully the CNA will find another line of work.

Medicare Advantage Plans Receive Additional Enhancements

The Trump Administration announced a broad array of changes to Medicare Advantage plans last week in hopes the changes will further pressure providers to improve senior care.

Centers for Medicare & Medicaid Services (CMS) officials said the “innovations” will include everything from customizing plans based on beneficiaries’ chronic conditions and socioeconomic status to increasing access to telehealth services. CMS also wants to improve incentives for individual plans improve the health of seniors.

CMS Administrator Seema Verma said in a statement that Medicare Advantage was launched over 13 years ago, and was due for a facelift. "The American healthcare system is very different today than it was thirteen years ago when the Medicare Advantage and Part D programs were launched in their current forms, but due to the slow pace of change in government, these programs have not been fully updated to reflect today’s realities,” said Verma. The new CMS Center for Medicare and Medicaid Innovation (CMMI) will ideally spur greater competition among plans, while also “creating pressure to improve quality and lower costs in order to attract beneficiaries.” 

“Today’s announcements are prime examples of how CMMI can test policies to modernize CMS programs and ensure that our seniors can access the latest benefits,” Verma said.

The changes will be tested out as part of the Value Based Insurance Design model for 2020. Eligible plans in all 50 states will be able to apply for the innovations, according to a CMS fact sheets available here and here. Starting in 2021, they’ll also start testing the inclusion of hospice benefits as part of Medicare Advantage. CMS said it is also planning to extend the performance period of its VBID model another three years, to 2024, to sufficiently evaluate the impact of these changes. 

These new innovations supplement prior changes which, among other things, embrace Aging-in-Place:

2019 Medicare Advantage Plans Incorporate Long Term Care, Aging in Place Benefits 

Trump Administration Embraces Aging In Place- 2019 Advantage Plans Permitted to Incorporate Long Term Care

New Ohio Law Gives Probate Courts New Tools to Protect Wards Under Guardianship

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A new law in Ohio is designed, in part, to protect people under court-appointed guardians.  

House Bill 595, signed into law Dec. 21 by outgoing Gov. John Kasich, among other things, allows county probate courts to establish adult guardianship services boards and funds to provide for the oversight of services and care for those under guardianship.  Several probate courts have implemented similar voluntary programs, but the new law enables every probate court to implement what many contend is much-needed oversight over court-appointed guardians. 

When an adult becomes incapable of managing personal decisions or property, a probate court may appoint a guardian to make decisions on behalf of that adult. These decisions can be related to property, medical care, living arrangements, and financial issues. Guardianship cases for adults can be expensive, time consuming and complex. Guardianship, however, can be an indispensable tool in protecting an adult, and the adult's estate.  Guardians can even help prevent elder abuse and financial exploitation.

Guardianship, unfortunately, can itself be abusive, and a guardian with extensive authority, can be a threat to the adult's estate.  This blog contains numerous articles (several listed below) detailing the risk of guardianship abuse, ranging from guardianship appointments that are not well-founded or justified, to financial and physical abuse of adults by their court-appointed guardians.      

The lack of quality court monitoring in guardianship is one factor that can lead to  abusive situations, and sometimes a court will lose track of a ward and the ward's condition, the ward's money, or even the guardian. State courts are responsible for monitoring guardians' performance and ensuring that individuals under guardianship are protected and treated appropriately.  AARP has found that follow-up with reporting requirements and accounting required by guardians is lacking in many states across the country, in part, due to the sheer overload of cases in the system.  

“Cutting red tape for county courts to work together to provide services to individuals under guardianship could save time, money for the individual, their families/caregivers, and the state,” AARP State Director Barbara A. Sykes said in a statement. “Additionally, when state courts work together on such cases, they could not only be more efficient and effective, but they could also potentially detect signs of abuse and exploitation earlier in the legal process.”

Of course, effective planning, especially "Aging-in-Place" planning, does not rely upon the legal or financial system for success.  Reform should always be applauded, because, so often, real change takes time.  Whether and when these changes will reduce the incidence or effect of abusive guardianship remains to be seen.  Regardless, the wise plan for the worst, and with an effective estate, financial, and health care plan in place, hope for the best.       

The new law, is known as the Probate Omnibus Bill, and thus is not limited to just guardianship reform; the law amends several state statutes including those concerning probate, trusts and estates, and elderlaw.  Future articles will discuss other areas impacted by the new law.  

Previous articles include the following:

• Guardianship Reform Helps, but Planning Shouldn't Wait;
• Astronaut Buzz Aldrin Subject of Guardianship Dispute;
• Health Care Ageism And Senior Profiling;
• Contesting Guardianship or Challenging Guardians Is Problematic;
• Estate Plans Should Consider and Attempt to Resolve Guardianship;
• Illinois Permits Guardian Authority to Petition for Termination of a Ward's Marriage;
• GAO reports on Guardianship Abuse;
• National Groups Acknowledge Need for Guardianship Reform;
• Report on Abuse by Guardians and the Guardianship Process Released;
• Another Reason for Guardianship Planning: Guardian Convicted of Homicide in Death of Ward