CDC Issues Antibiotic Guide To Nursing Homes

Scanning electron micrograph of
human neutrophil ingesting MRSA

The Centers for Disease Control (CDC) believes that skilled nursing facilities (SNFs) need to improve their relationships with antibiotic experts and find leaders within to lead stewardship efforts in the administration of antibiotics.  As a result, CDC released Core Elements of Antibiotic Stewardship for Nursing Homes to guide antibiotic prescribing practices and help reduce the harmful effects of antibiotic resistant infections such as C. difficile.  The guide builds on the CDC's recommendation last year that all acute care facilities design an antibiotic stewardship program.

According to an article in McKnight's:

"[t]he core elements described in the guide include gaining access to experts with experience in improving antibiotic use, tracking how antibiotics are used and identifying leaders within the facility who are responsible for overseeing antibiotic stewardship activities. The guide includes a checklist that providers can use to assess existing practices and review the progress of improvement activities."

"Superbugs that are hard to treat pose a health risk to all Americans, particularly the elderly whose bodies don't fight infection as well," said CDC Director Tom Frieden, M.D., M.P.H., in a press release. "One way to keep older Americans safe from these superbugs is to make sure antibiotics are used appropriately all the time and everywhere, particularly in nursing homes."

For a recent article regarding the risk of SNF infection risk, go here. 

Nearly 1 Million Veterans Have Pending Applications For Health Care At VA-- A Third May Already Be Dead

The continuing, enduring theme of this blog is that seniors, their families, and caregivers should plan their affairs, plan for for their care, and plan for the use and disposition of assets, consciously refusing to rely upon (or trust) the legal and government systems supposedly protecting them.  If the wisdom of planning privately and eschewing public support is lost upon anyone, s/he should read the Washington Post article, entitled, "Nearly 1 million veterans have pending applications for health care at VA — and a third may already be dead."  The only way one can read the first three paragraphs without wanting to scream, weep, or both, is to believe the government "get's it," and/or will soon "fix it."  Really?

The excellent article reads as follows (emphasis added):

"Despite promises for widespread reform, nearly 900,000 military veterans have pending applications to access health care from the Department of Veterans Affairs, the department’s inspector general said Wednesday in a scathing report which recommended a total overhaul of their record-keeping system that could take years.

One-third of those veterans are thought to be dead, but problems with the data makes it tough to know how many former troops were still struggling to get care, the report says. VA has said it has no way to purge the list of dead applicants.

Over half the applications listed as “pending,” as of last year do not even say when the applications were dated, and the Associated Press reported on Wednesday that investigators “could not reliably determine how many records were associated with actual applications for enrollment” in VA health care, the report said.

“Data limitations” [note: a  term selected because it suggests that programming engineers can't program a simple database, ignoring that no computer system could report information unavailable to the agency since the agency consciously refused to properly compile that information in order to protect performance incentives, and salaries, and political progress; in other words a term synonymous with "institutional corruption] prevent investigators from determining how many now-deceased veterans applied for health-care benefits or when.

Linda Halliday, the VA’s acting inspector general, told the AP that the agency’s Health Eligibility Center “has not effectively managed its business processes to ensure the consistent creation and maintenance of essential data.” [note: that's like an drunken alcoholic who intentionally climbs behind the wheel and drives through a school yard full of children claiming he did not "effectively manage" the automobile to ensure avoidance of the school zone].

The report also says VA workers incorrectly marked thousands of unprocessed health-care applications as completed. They may have deleted 10,000 or more electronic “transactions” over the past five years.

Whistleblowers have been warning that more than 200,000 veterans with pending applications for VA health care were likely deceased. The inspector general’s report substantiated those claims.

To read the entire article, go here.

To read a Summary of the Inspector General's Report, go here.

To read the Inspector General's Report, go here.

You Can Look Up Nursing Home Fines, ER Wait Times On Yelp!

Consumers have one more tool available to help in making informed health and long term care decisions. The website Yelp, which is perhaps best known for publishing crowd-sourced reviews about local businesses, is adding health-care data to its review pages for medical businesses to give consumers more access to government information on hospitals, nursing homes and dialysis clinics.

Consumers can now look up a hospital emergency room's average wait time, fines paid by a nursing home, or how often patients getting dialysis treatment are readmitted to a hospital because of treatment-related infections or other problems.

The review site is partnering with ProPublica, a nonprofit news organization based in New York. ProPublica compiled the information from its own research and the Centers for Medicare and Medicaid Services. The data is for 4,600 hospitals, 15,000 nursing homes, and 6,300 dialysis clinics in the United States, and it will be updated quarterly.

Much of the information about hospitals, for example, is available on Medicare's Hospital Compare Web page. Yelp executives say the information is sometimes difficult to find and more difficult for consumers to understand.  Yelp is therefore adding the information to it's website in a usable consumer friendly format.

Efforts to Change Will Without Legal Counsel Backfire

Making a will without the help of a qualified attorney can be dangerous.  Trying to change an existing will on your own can fail or have unintended consequences . A recent court decision in Minnesota serves as a cautionary reminder to anyone thinking about altering their estate plan without legal advice and counsel.

Esther Sullivan executed a will in 2006, that gave half of her property to her former employee, Tara Jean Johnson. Ms. Sullivan, left a small share of her estate to Joseph VanHale, her grandson. Two years later, in 2008, Ms. Sullivan allegedly attempted to change her 2006 will by marking up a photocopy of it and writing her initials next to each change and signing and dating the bottom of each page. She allegedly wrote on top of the 2008 photocopy, “[t]he Will dated January 19, 2006 is void and to be replace[d] with this and all written in changes.” Among the changes was that Mr. VanHale would replace Ms. Johnson as the beneficiary of half her estate. In 2010, Ms. Sullivan allegedly attempted to execute another will using a form she downloaded from the Internet. This document named Mr. VanHale as her only beneficiary.

After Ms. Sullivan’s death in 2013, the probate court had to decide which of the three wills should be followed. Mr. VanHale contended that the 2010 document was a valid will, while Ms. Johnson argued for the 2006 will. The probate court ruled that the 2008 photocopy and the 2010 downloaded document were invalid because they did not comply with the state’s requirements for a valid will, which include that the will must be signed by at least two witnesses. The court held that although Ms. Sullivan probably intended to revoke the 2006 will, she did not do so successfully. Mr. VanHale appealed, arguing that Ms. Sullivan clearly intended to revoke the 2006 will and that the 2010 document was valid.

On August 17, 2015, the Court of Appeals of Minnesota agreed with the lower court that the 2006 will should be the one admitted to probate. The court ruled that only an original will, not a photocopy, can be revoked. The court also agreed with the lower court that the 2010 document had not been validly executed.

If Ms. Sullivan did change her mind and decide that she wanted her grandson to inherit her estate, the fact that she didn’t do it properly meant that far from helping her grandson, she cost him a tidy sum in legal fees. People change their minds, and circumstances can change as well – marriage, divorce, the birth of children – and estate plans need to be revised along with these changes. If you want to alter your will or another element of your estate plan, contact your elder law attorney.

To read the court’s decision in the case, In re the Estate of Sullivan (Minn. Ct. App., No. A14– 2112, Aug. 17, 2015), click here.

170 Million Pages Why You Should Avoid Probate

"You can learn a lot about people from their wills.

You can see who was happily married and who was disappointed in their families. You can see who prized brevity and who parceled out every item as if handled by a loquacious auctioneer with lambskin gloves. 

Death may come for us all, but it doesn't necessarily still our voices." 

So begins an excellent article by Todd Leopold, writer for CNN, entitled, "Paul Revere, J.P Morgan wills among millions now online." 

The article continues:

"There's always emotion involved when someone's writing a will," said Jennifer Utley, senior manager of research at Ancestry, the genealogy company. "People make really interesting statements on how much they left people."

Ancestry has now made it much easier to research old wills, whether they're from your family or someone of historical import. The company's website, Ancestry.com, has more than 170 million pages of wills and probate records available, legal records that until recently had been accessible only offline.

Historically significant, no doubt.  These records, culled from probate courts and legal archives serve as an important object lesson; your Will is a public record.  Once filed with a probate court, it is available to anyone, and with the movement to online public records, will one day be online. If you value the privacy of your most intimate thoughts, desires, and emotions, plan your estate to avoid probate.