Veterans Legacy Memorial

The Veterans Legacy Memorial is the first digital platform dedicated entirely to memory preservation for the 3.7 million Veterans interred in VA national cemeteries. Each Veteran has or will have memorial page. Search the site for Veterans, find out where they are buried or interred and read the details of their lives and service. Future capabilities may be expanded to allow families, survivors, fellow Veterans and others to add photos and share memories to a deceased Veteran’s memorial page.  Check it out here. 

Aging in Place: 39 Million Home and Personal Care Robots A Year By 2024

ID 112050146 © Vladislav Kochelaevskiy | Dreamstime.com

McKnight's Senior Living recently published an article with the headline, "Report Predicts 39 Million Robot Shipments A Year By 2024."  A new report from ABI Research predicts that number of home care and personal/social robots a year will be shipped, and that almost 79 million homes around the world will have robots in them. 

According to the article, "[r]obotic capabilities will be particularly useful for older adults who are aging in place or for ambient assisted living end-users"  Ambient Assisted Living (AAL) tools are designed to be sensitive and responsive to the presence of people, and include,  for example. robots that can detect falls, or track a person's health.

According to Jonathan Collins, smart home research director at the research company: 

"Robotic device start-ups such as Intuition Robotics and Blue Frog Robotics already target the AAL market with devices that can integrate with smart home systems. “While home care robots release residents from time-consuming and repetitive tasks, social robots offer the potential to further extend into physically interacting in homes and the individuals within them in ways that can go beyond monitoring into the realm of kinship and socialization.”

Amazon and Google are positioned well to lead in social robot advances because artificial intelligence and voice recognition are the basis of their Alexa and Assistant platforms, which are already popular, the report authors stated.

This blog has repeatedly reported articles that support the proposition that technology is providing solutions for Aging in Place planning precisely at the time when these solutions are most needed.  

Increasing Blood Pressure Drugs Upon Hospital Discharge Poses Health Risks

Increasing blood pressure medications when older patients are discharged from the hospital may also increase falling, fainting or kidney injury risks, according to a new study reported by a recent article in McKnight's Long-term Care News. Investigators claim such dangers outweigh possible treatment benefits.

Researchers from University of California, San Francisco and San Francisco VA Health Care System studied more than 4,000 patients who were at least 65 years old and hospitalized for non-cardiac issues. Patients discharged with greater amounts of blood pressure drugs saw no fewer cardiovascular events and no improvement of blood pressure control after one year. At the same time, risk for readmission and serious adverse events surged for some patients within 30 days of discharge.

“Our findings suggest that making medication changes during this period is not beneficial,” said the study’s lead author, Timothy Anderson, M.D., MAS, MA, a primary care research fellow in UCSF’s Division of General Internal Medicine.  “Instead, deferring medication adjustments to outpatient doctors to consider once patients are recovered from their acute illness is likely to be a safer course,” he added. 

This blog rarely reports regarding hospital health outcomes, but this study impacts directly Aging in Place since it concerns prescriptions written at or near discharge from the hospital. Seniors and their families should be aware of the findings, and the concerns raised by these findings, and may want to independently verify the advisability of such prescriptions with a primary care physician upon discharge. 

Class-action Challenges Observation Status Determinations - Seeking Medicare Eligibility for Nursing Home Care

More than 1.3 million Medicare observation stay claims could be appealed if a class-action lawsuit filed against the Department of Health and Human Services is successful.

The lawsuit challenges a rule that requires an individual to spend three consecutive days as a hospital inpatient in order to receive Medicare skilled nursing coverage. The lawsuit was first filed in 2011 by seven Medicare observation patients but now figuratively represents hundreds of thousands.

Patients are often admitted to hospitals under observation status — and remain at that designation without their knowledge, sometimes for multiple days — before being sent to a skilled nursing facility. Medicare normally pays for some nursing home care following a three day hospitalization. Observation care, however, is considered outpatient service and doesn’t qualify as a prerequisite for Medicare’s nursing home coverage, often leaving patients responsible for unexpected medical expenses.  

Patients were often wholly unaware of the fact that they were being treated under observation status, prompting passage of the NOTICE Act, about which you can read more here.  Even with the protections of the Act, however, patients are often unable to make real decisions regarding their care and status, and consequently, patients often find themselves responsible for large nursing home bills which remain uncovered by Medicare if the care follows a hospital stay deemed under observation status.

Worse, the determination that the stay is under observation status cannot be appealed to Medicare. The class-action lawsuit challenges the provision that Medicare disputes involving observation claims are not subject to appeal.

“This is about whether the government can take away healthcare coverage you may be entitled to and leave you no opportunity to fight for it,” Alice Bers, litigation director at the Center for Medicare Advocacy, one of the groups representing the plaintiffs, told Kaiser according to an article in Kaiser Health News.

If successful, people with Medicare who received observation care services for three days or more from January 2009 through 2017 would be able to file an appeal and seek reimbursement for bills the program should have paid, according to the report. About 1.3 million observation claims reportedly meet that criteria.

In March, industry advocates praised legislative efforts that would allow patients under observation stay to be eligible for Medicare skilled nursing coverage.  In a statement to the U.S. House Ways and Means Health Subcommittee in May, the Observation Stays Coalition urged Congress to address observation stays while discussing surprise medical billing. The coalition is composed of several beneficiary and provider organizations, including LeadingAge, the American Health Care Association, the American Association of Post-Acute Care Nursing and the National Association for the Support of Long Term Care.

“Unfortunately, there have been countless heart-wrenching stories from older people and their families who have had to pay high out-of-pocket charges since they were deemed to be on observation status, and Medicare did not cover their necessary skilled nursing facility care. Often, these individuals didn’t even know they were on observation status — or know to ask,” the statement said. “It is simply not right to limit access to quality care for those most in need.”

Less Than One-Third of New Medicare Beneficiaries Enroll in Medicare Advantage

The Kaiser Family Foundation recently released new findings about what coverage new Medicare enrollees choose. This information is important in understanding what beneficiaries want from their coverage, and may shed insight into whether beneficiaries are availing themselves of available options. Some thought that the aging Baby Boom generation, having had more experience with HMOs and PPOs during their working years, would select the private plans over traditional Medicare at relatively high rates.  In fact, the share of new beneficiaries choosing Medicare Advantage has increased only modestly over the years.  

When you first become eligible for Medicare, either upon turning 65 or because you have a disability that makes you eligible, you have a decision to make: will you stay in the default program, referred to as original or traditional Medicare, or will you choose a Medicare Advantage (MA) plan? There is no one right choice. The best choice for an individual depends on their personal circumstances and their preferences. If  you have a trusted adviser, such as one the professionals at Harding & Harding and Associates, you may have someone that can assist you in navigating the array of choices and decisions. Our office highly recommends Harding & Harding, particularly for those new clients seeking to implement Aging in Place Planning.  

Often, your decision will be based on practicalities rather than financial considerations.  If you have a trusted medical provider, for example, you may not want to join an MA plan that might require you to change doctors.  If you are more concerned with financial objectives, you may prefer MA’s out-of-pocket maximum, especially if you expect your health care costs to be high.  The decision is not a simple decision, and recent changes may make the decision even more difficult than it has been in the past.  Readers of this blog are aware that recent changes to Medicare incentive and encourage long-term care planning, and Aging in Place benefits to be added to new MA plans.   

According to the report, around 22% of new enrollees chose Medicare Advantage in 2011. This number increased to around 29% in 2016, the most recent year of the report. These numbers are nationwide, but the rate of enrollment varies considerably depending on the enrollee’s geographic location, age, and whether they are eligible for Medicaid in addition to Medicare.

Importantly, when people with high needs enter the Medicare program, they are less likely to choose MA. This could mean that these new enrollees want to avoid potential issues with narrow provider networks and are not drawn to MA benefits like gym memberships, preventive care, and the like, that may be tailored to enrollees who are in excellent health.  Time will tell how individuals view the recent additions to MA plans.

The reasons newcomers choose to remain in traditional Medicare or switch to MA are important. But whatever the reason, it is clear that the majority of people with Medicare prefer the original program. 

HHS Seats RAISE Family Caregiver Act Advisory Council

The RAISE Family Caregiver Act, which became law in January 2018, was created to support the development and execution of a national family caregiving strategy through the convening of a Family Caregiving Advisory Council. On August 28th-29th, the Advisory Council will meet for the first time.

The Department of Health and Human Services's (HHS) announcement also includes the complete list of advisory council members. In keeping with the RAISE Family Caregiver Act’s mandate, the council includes 15 voting members, representing the diversity of family caregivers and those who receive support. The council also includes 14 non-voting federal members from The Administration for Community Living (ACL), Centers for Medicaid and Medicare Services, Veterans Affairs, and other relevant departments and agencies overseeing labor and workforce, economic, government financial policies, community service, and other impacted populations. View the list of council members and get more information on the first meeting HERE.

The first meeting of the Supporting Grandparents Raising Grandchildren Advisory Council has also been announced, and is set to occur on August 28-29th. Information on this meeting can be found HERE. Both the RAISE Family Caregiving and the Supporting Grandparents Raising Grandchildren Advisory Council meetings are open to the public and will be available on live stream.

Recording Fees Increase in Ohio

Effective October 16, 2019, recording fees for most documents will increase by $6.00 due to the passage of HB 166 by the Ohio Legislature, which modifies Ohio Revised Code §§ 317.32 and 317.36, per the Ohio Recorders Association.  The Ohio Recorders Association maintains a schedule of fees here. 

The Association's website has other vitally important information such as a list, by county, describing:

• availability of online search of indexes;
• availability of online search of indexes and images;
• availability of E-recording;
• restrictions on availability of recording conveyances by mail, and; 
• different office hours. 

The Recorders perform a vital public function, usually without thanks or acclaim.  They and their staffs should be commended for their dedication, and patient service. The Recorders do NOT set fees, so please direct your dissatisfaction, if you have any, to your elected representatives in the Ohio House and Senate.  

Fraud Alert: Genetic Testing Scam

The U.S. Department of Health and Human Services (HHS) Office of Inspector General has issued a fraud alert warning that free DNA tests are being sent and offered to  seniors in a sophisticated scheme to commit fraud and identity theft.   Scammers are offering Medicare beneficiaries free cheek swabs for genetic testing to obtain their Medicare information. The fraudsters are targeting beneficiaries through telemarketing calls, booths at public events, health fairs, and door-to-door visits.

If a beneficiary agrees to genetic testing or verifies personal or Medicare information, a testing kit is sent even if it is not ordered by a physician or medically necessary. Companies offering the tests use the information gathered to steal identities and/or to bill Medicare for unnecessary tests.  

The fraud alert offers these suggestions for elders:

• If a genetic testing kit is mailed to you, don't accept it unless it was ordered by your physician. Refuse the delivery or return it to the sender. Keep a record of the sender's name and the date you returned the items.

• Be suspicious of anyone who offers you free genetic testing and then requests your Medicare number. If your personal information is compromised, it may be used in other fraud schemes.

• A physician that you know and trust should approve any requests for genetic testing.

• Medicare beneficiaries should be cautious of unsolicited requests for their Medicare numbers. If anyone other than your physician's office requests your Medicare information, do not provide it.

• If you suspect Medicare fraud, contact the HHS OIG Hotline.

Please share this information with your senior family members and friends, particularly vulnerable seniors who may not be able tp protect themselves.  Remind your family and loved ones that if a deal sounds too good to be true, it probably is not true. 

Ohio Receives Near Failing Grade on Nursing Home Report Card

Families for Better Care ("FBC"), recently  published its state-by-state nursing home report card. Ohio received  a near failing "D" grade, ranking fortieth among the fifty states. The current ranking represents a decrease in Ohio's relative ranking, down from 34th last year, but no change in Ohio's near failing "D" grade from last year. 

FBC scores, ranks, and grades states on eight different federal quality measures ranging from the number of caregiver hours residents received on a given day to the percentage of nursing homes cited severe deficiencies. The Report Cards include information from the newly revamped Nursing Home Compare reporting, requiring nursing homes to prove staffing levels, a sharp departure from previous administrations that accepted, without proof, representations from nursing homes regarding sufficiency of staffing.  More than one-third of nursing homes saw CMS ratings drop under the new, more deliberate, and more reliable system.

Regarding the Ohio ranking, the Report Card noted:

• "Ohio’s nursing home care continued its ratings slump, falling to No. 40 after dropping six spots.
• Ohio is a testament to nursing home mediocrity as the state failed to muster a Top Ten ranking or above average grade in any quality measure.
• Severe deficiencies in Ohio’s nursing homes swelled six percent, pushing the number of potentially dangerous nursing homes to nearly 1 in 5 statewide.
• Seventy-five percent of Ohio nursing homes failed to score an above average health inspection.
• Nearly 90 percent of Ohio’s nursing homes cited a regulatory deficiency—the state’s highest percentage thus far.
• Ohio’s nursing home residents received little more than 2 hours and 18 minutes of direct care each day.
  

Families for Better Care, Inc., is a Texas-based nursing home resident advocacy group dedicated to creating public awareness of the conditions in our nation’s nursing homes and other long-term care settings and developing effective solutions for improving quality of life and care.

“This year’s nursing home report card exposed an alarming trend that should serve as a wake-up call for us all,” said Brian Lee, Families for Better Care’s executive director. “Nursing home inspection ratings have soured.”

According to survey data collected by federal and state governments, fewer than 30 percent of nursing homes were capable of scoring an above average inspection rating, that’s nearly a 15 percent decline since the last reporting period.

“America’s nursing home care is worsening,” Lee exclaimed. “Erratic inspection performance is, by and large, traceable to a singular reason, the failure by so many nursing home operators to hire enough staff to safely care for residents.”

While Families for Better Care has repeatedly warned that nursing home staffing shortfalls are a grievous problem, the organization is calling for a new solution, one that the nursing home industry should welcome and would be embraced by residents and their families.

“The best way to heal America’s nursing homes is to appropriate additional funding to be used solely for hiring more staff,” Lee stated. “No more excuses, no more threats, no more scare tactics from lobbyists, politicians, operators—or anyone else for that matter—it’s time to do what’s right and stop the infliction of our loved ones with unnecessary injury or harm because of negligent policy making.”

According to the report’s findings, the majority of nursing homes (54 percent) were incapable of scoring an above average staffing rating. Residents received just 2 hours and 33 minutes of direct care daily—an average that’s unchanged from the previous report card. Nearly every state—with the exception of Alaska, the District of Columbia, and New Mexico—suffered a net loss in the percentage of nursing homes with above average staffing levels over the past three report cards.

“Before any checks are written to nursing homes, a rock solid staffing standard must accompany any new funding; otherwise, taxpayer monies could end up being diverted to subsidize the lifestyles of the rich and not-so-famous instead of getting back to the residents and their care,” Lee stated. “Too many nursing homes have demonstrated an unfaithfulness in self-governing their staffing levels to safely care for residents, so it’s time we help them out a little, as a nation, by federally mandating the most stringent staffing requirement that leaves no loopholes through which violators could squeeze.”

 As for the state’s nursing home rankings, the states highly rated in past report cards, once again, dominated the top spots while the chronic underachievers continued to disappoint.

 This year’s top nursing home states were Hawaii, Delaware and Alaska while Texas, North Carolina, and Illinois scraped the bottom of the barrel. States with the biggest gains in overall ranking were New York (↑20), Mississippi (↑17), and Nevada (↑14) while Vermont (↓27), Massachusetts (↓24), and Arkansas suffered the biggest losses.

Three of the last report card’s best nursing home states slid out of the top ten, including Vermont, which plunged from No. 3 to No. 31 overall. The remaining states were New Hampshire (down from No. 2 to No. 11) and Florida (falling seven spots from No. 6 to No. 13).

Other key findings included:

• 500,000 elderly living in dangerous conditions—Nearly half-a-million elderly nursing home residents are living in facilities that tolerate below average staffing scores.
• Abuse and neglect vexes nursing home quality—1 in 5 nursing homes abused, neglected, or mistreated residents in almost half of all states for the second consecutive report card.
• States that are downright awful—Texas, Illinois, New Mexico, Michigan, Oklahoma, Louisiana, and Indiana consistently linger at, or near, the bottom in state nursing home care, scoring failing grades in every nursing home report card.

Families for Better Care argues that America desperately needs a nursing home cultural transformation, and the best way for that to happen is for nursing homes to saturate facility hallways with a brigade of well-trained frontline caregivers.

“Nursing home staffing levels must be ratcheted up if care is ever going to improve,” said Lee. “Since nursing homes rely so heavily on federal and state reimbursements, it’s incumbent upon us to pull up our bootstraps and find a way to inject much needed staffing currency as soon as possible.”


Readers of this blog should not be, and probably are not, shocked by either the report card grades, or the news that nursing home quality is generally worsening. These are compelling, but hardly new, reasons for implementing an Aging in Place plan.  If you haven't already, ask to attend an Aging in Place workshop.  

More:

State's [Pennsylvania] Failing Grade for Nursing Home Care is Unconscionable
Nursing Home Care Declines in Florida
Illinois Nursing Homes Rank Third Worst in the Country
Texas Ranked Last on 2019 Nursing Home Report Card
Delaware Ranked No. 2 on Nursing Home Report Card
Hawaii Grabs Nursing Home Report Card's Top Spot
Strong Staffing Boosts Alaska To No. 3 On 2019 Nursing Home Report Card
Rhode Island Slips to No. 4 On 2019 Nursing Home Report Card
Utah Ranks No. 5 On 2019 Nursing Home Report Card
Idaho Ranks No. 6 in 2019 Nursing Home Report Card
Arizona Ranked No. 7 on 2019 Nursing Home Report Card
Washington D.C. Surges To No. 8 On 2019 Nursing Home Report Card
Maine Drops to No. 9 on 2019 Nursing Home Report Card
North Carolina Drops to Second Worst in Nursing Home Quality

Nursing Home Occupancy Rates Rise- Financial Struggles Persist

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According to an article in McKnight's Long-term Care News, nursing home occupancy had its first year-over-year increase since January 2015, reaching 83.7% in the first quarter of 2019.  The statistics come from the National Investment Center for Seniors Housing & Care (NIC).  

The continuing upward trend likely relates to more than just  flu cases and other seasonal factors, said Bill Kauffman, senior principal at NIC:  

“Occupancy was also up between March 2018 and 2019, suggesting supply and demand are becoming more closely aligned,” he said in a statemet. “NIC will continue to monitor reimbursement, labor costs and other data to see if any of these factors might be contributing to facility closures, especially in some rural areas.”

Despite the increase in occupancy, facilities continue to struggle financially, however, due to case mix, specifically since Medicaid patients account for most of the patient population in skilled nursing facilities, NIC experts said.

“Skilled nursing is increasingly reliant on Medicare Advantage and Medicaid for revenue, which is challenging many facilities’ financial wellbeing,” Beth Mace, NIC’s chief economist, said in a statement. “Reimbursement rate pressures, competition from other care settings, and high personnel costs are also impacting the sector.”