Thursday, November 21, 2019

Dozens of For-Profit Hospices Fail to Visit Dying People in Their Final Days, GAO Says

Dozens of for-profit hospice providers failed to visit dying patients in their last few days, according to a recent report by the U.S. Government Accountability Office (GAO).

© Chip Somodevilla/Getty Images HIV-positive Shana Reynolds-Fairley, 34, leaves Joseph's House, a hospice that provides nursing and support services to homeless men and women dying of AIDS and cancer, to go to Georgetown University Hospital for treatment of edema on August 30, 2013.
The investigation focused on providers paid by the Centers for Medicare and Medicaid Services (CMS) in 2017. While for-profit and nonprofit hospices had similar scores on pain assessment and other quality measures, more than 450 private groups discharged patients before they died.

This is not the first troubling report on the Medicare-paid hospice system. Earlier this year, the Office of Inspector General (OIG) found that 18 percent of all hospices in a nationwide survey had serious deficiencies, like failing to vet staff.

In the recent report, eighty for-profits failed to send registered nurses, physicians or nurse practitioners to visit discharged patients even once in the last 72 hours of their lives, while only three nonprofits did the same.

Both for-profit and nonprofit hospices gave these end-of-care visits to most patients, but the dozens that didn't left at least 800 dying people and their families without guidance.

"According to researchers we interviewed and one of the studies we reviewed, provider visits near the end of a hospice beneficiary's life are critical to providing quality care, including for emotional support and for training the beneficiary's family members or other caregivers on the signs and process of dying," the GAO said.

A smaller number of for-profit hospice units (55) did not provide any visits from medical social workers, chaplains or spiritual counselors, licensed practical nurses or hospice aides in the entire week preceding more than 600 patients' deaths.

As baby boomers enter old age, there has been a substantial growth in Medicare payments for hospice services, as well as the number of Medicare beneficiaries using hospices, since 2000, according to the GAO.

Yet CMS doesn't instruct its surveyors to record information on providers' performance, the GAO said. That can impede oversight of providers doing a poor job. At the same time, the only penalty CMS can impose is kicking these hospices out of the reimbursement pool entirely, a punishment too severe for most offenses.

The GAO, together with the Department of Health and Human Services, called on Congress to give CMS more authority to create additional enforcement remedies for hospices not up to par.

"Americans at the end of life and their families expect the best care possible—it's unacceptable that too often hospice providers are falling short," Senator Ron Wyden, who requested the investigation, said in a Thursday statement.

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Dozens of For-Profit Hospices Fail to Visit Dying People in Their Final Days, GAO Says

Gov. Ivey awards $2.1 million to aid elderly and disabled abuse victims

Gov. Kay Ivey has awarded $2.1 million to the state Department of Human Resources to assist elderly and disabled adults who have been abused.

The grant will enable the department’s Adult Protective Services Division to provide several preventative options for victims who are suffering from abuse.

“No one should ever have to be the victim of abuse, and those who have unfortunately suffered from abuse need ready access to professional assistance,” Gov. Ivey said. “This grant will ensure assistance for those elderly and disabled adults who are victims of physical and mental abuse.”

The funds will help create safe surroundings for elderly and disabled adults either by providing in-home care and supervision to enable victims to remain in their homes after offenders have been removed or relocating the victims to nursing homes or assisted living facilities. Both measures are temporary until more permanent solutions are found.

The Alabama Department of Economic and Community Affairs is administering the grant from funds made available by the U.S. Department of Justice.

“Gov. Ivey is both compassionate and determined when it comes to preventing the exploitation and abuse of the elderly or disabled,” ADECA Director Kenneth Boswell said. “ADECA is pleased to join with Gov. Ivey and the Alabama Department of Resources to provide solutions to help these victims.”

ADECA administers a wide range of programs that support law enforcement, victim programs, economic development, water resource management, energy conservation and recreation.

Full Article & Source:
Gov. Ivey awards $2.1 million to aid elderly and disabled abuse victims

False Hope Found in Nursing and Rehabilitation Centers

by Stephen Louis Krasner

Inundated with medical information, health updates and making decisions while serving as a caregiver to a seriously ill person is a tough position to be in for anyone. When it results in the loss of that person while being under the premise they would recover — the shock can be devastating.

Misleading Names and Messaging

It is reasonable to believe that most people would infer that upon the discharge of a patient from a hospital and into a skilled nursing facility (SNF) that they would be on the road to rehabilitation and recovery — heading home in the not too distant future. This is due in large part to information provided to caregivers upon plans made to have a patient admitted there.

A great number of these facilities have the word “rehabilitation” in their name — a look at New York’s statewide directory lists 622 facilities — with over half of them having “rehabilitation” in the title. Hence the very name of these places is misleading to some extent when evidence suggests a significant number of patients entering these facilities meet adverse outcomes — and never make it back home.

You Can Never Go Home Again

A study published in the journal Annals of Surgery examined the outcomes of patients admitted to these facilities in five states, being California, Florida, New York, Texas and Washington. It concluded that 41% of patients discharged into a skilled nursing facility never returned home.
It is often communicated to patients and families that discharge to an SNF is a step in the process of recovery, and because clinicians have very limited evidence about the natural history of patients discharged to SNFs, patients may be given an unreasonable expectation of return to home. This study demonstrates that a significant proportion (41%) never returns to home, and the 1- and 3-year risk of death is much greater than that in the general population.
Looking through the data in such a study brings up the question as to what other factors outside this study might also be contributing to large numbers of patients not making it home again. Examining the quality of care people are receiving, and the variables at play behind that care, provides some answers.

Money Versus Mission

Comparing these types of centers by looking at the non-profit sector versus those operating in the private sector is disconcerting.

In a 2018 report published in the journal Gerontology, findings involving for-profit nursing homes raise several red flags. In commenting on the report its lead researcher, Lee Friedman, stated the following:
We saw more — and more serious — diagnoses among residents of for-profit facilities that were consistent with severe clinical signs of neglect, including severe dehydration in clients with feeding tubes which should have been managed, clients with stage 3 and 4 bed sores, broken catheters and feeding tubes, and clients whose medication for chronic conditions was not being managed properly.
The motivations behind the nursing facilities in each sector likely play a role in the quality of care and qualifications of the staff working there — especially when one considers mission driven work versus the goals of profit driven work.

Touching on this Friedman said, “For-profit nursing facilities pay their high-level administrators more, and so the people actually providing the care are paid less than those working at nonprofit places. So staff at for-profit facilities are underpaid and need to take care of more residents, which leads to low morale for staff, and it’s the residents who suffer.”

With upwards of 70% of these types of facilities falling in the for-profit ownership category — one has to wonder as to the extent negligence plays a role for those patients that are never able to go home.

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Wednesday, November 20, 2019

November 12 2019 - BBO v Belanger

November 12, 2019 - Catch of the Day Video News was given permission to record the Boston Bar Overseers public hearing regarding LIsa Belanger, ESQ. Contact Janet Aldrich at 978-388-2457 for more information. Some of the Video portion is blocked, per request of BBO (audio only)

November 12 2019 - BBO v Belanger

Emergency situation calls for temporary guardianship

By Sandra Reed

Evelyn, who lives one hundred miles away, visits her mother, Marie, who suffers from dementia, and finds she is in a seriously weakened state from diarrhea and dehydration. She contacts sister, Jane, who lives a similar distance from their mother, to inform her. Upon further investigation, Evelyn discovers that her brother, Ralph, has been mixing a box of X-Lax into their mother’s food over the past three weeks. Ralph, who is in debt, is apparently attempting to rush his inheritance of one-third of the family ranch. What can Evelyn do to protect her mother?

Emergency situations, such as the one in the hypothetical situation, call for the remedy of a temporary guardianship. The existence of financial exploitation by a relative, friend or caregiver represents another example in which a temporary guardianship is appropriate.

Evelyn should immediately contact a lawyer who can file an application to establish a temporary guardianship for her mother. Applications for temporary guardianship take precedence over any other matter that the court must hear except other matters of a similar nature. Therefore, Evelyn can count on quick results.

If the temporary guardianship is granted, it will be automatically terminated at the end of 60 days, unless it is contested. If contested, the court will have the authority to extend the temporary guardianship until the contested issues are resolved in court.

The applicant must give Marie notice that the guardianship is being filed. Although it is not necessary to give Ralph notice, Evelyn realizes that, as a practical matter, Ralph will undoubtedly learn of the filing. Therefore, she anticipates he will contest it.

Evelyn’s elder sister, Jane, who has always thought her judgment was superior to her sister’s, insists they be named as co-guardians. The lawyer explains that Texas does not allow co-guardians to be appointed. Jane eventually consents to Evelyn’s filing as proposed guardian.

A physician’s statement of incapacity that would be required for a permanent guardianship is not necessary for the temporary. At the hearing, Evelyn must show substantial evidence that Marie is incapacitated and that the circumstances present probable cause to appoint a temporary guardian.

Full Article & Source:
Emergency situation calls for temporary guardianship

Stockbroker fleeced elderly woman’s accounts and ran up credit card

Both federal and state laws have been enacted to protect seniors from elder financial abuse. (Dreamstime)
By Rafael Olmeda

James Marino’s plan to cheat his client out of her fortune began to unravel in 2014, when an accountant noticed an American Express card he had opened in his name but under her account.

Marino, 33, pleaded guilty Monday to one count of grand theft of a victim over age 65, becoming only the latest to admit to exploiting Florida’s vulnerable older residents.

Florida has by far the greatest proportion of residents over 65, many with significant wealth — creating what the Florida Bar calls “a sea of opportunities for exploitation of the elderly."

A survey by Florida’s Department of Elder Affairs in 2016 found that 6 of 10 seniors were at least somewhat concerned about becoming the victim of consumer fraud or a swindle. Nearly one-fifth reported that they had already been exploited, often by family members, health providers and financial advisers like Marino.

In pleading guilty, the former stockbroker agreed to five years of probation. He also repaid $27,500 he stole from the woman, according to the Broward State Attorney’s Office.

Calls to his attorney were not returned Monday.

Court papers do not identify the victim, who was in her 80s and showing signs of dementia in 2013 when she agreed to turn over a $3.9 million Merrill Lynch account to his stewardship at Edward Jones, according to court records.

Investigators said he gained the victim’s trust in March 2014 by “helping her with daily tasks and errands.”

Marino cashed eight checks amounting to $20,500 from her account from March until September 2014, according to his arrest record. Around the same time, he had one of the victim’s American Express cards issued in his own name, using it to at grocery stores, hardware stores, restaurants and gas stations. He racked up $6,715 on the card.

When confronted in 2015, Marino told investigators he had noticed a decline in the victim’s mental capacity but insisted she wanted to help him rebuild his own credit.

Assistant Broward State Attorney Al Guttman said there was no indication that Marino exploited other people, but crimes like his are not unusual in South Florida.

In June 2018, a husband and wife were accused of siphoning the bank accounts of an 87-year-old Pembroke Pines woman and selling her condo. They also faced a civil lawsuit from the Florida Attorney General’s Office alleging they swindled at least 50 other seniors.

Two months earlier, former caretakers for a late Fort Lauderdale woman were accused of stealing $1.4 million in cash and jewelry from her and her estate,

According to the Aging and Disability Resource Center of Broward County, several signs could indicate that an elderly person is being abused: new close friends, unusual activity in bank accounts, bank statements no longer coming to the person’s home, unpaid bills and questionable withdrawals.

Cases of elder abuse can be reported at 800-96ABUSE, which is 800-962-2873.

Full Article & Source:
Stockbroker fleeced elderly woman’s accounts and ran up credit card

Tuesday, November 19, 2019

SPECIAL REPORT | Unguarded: How Richmond’s guardianship process leaves vulnerable people unprotected

Guardianship, the legal process of taking away an adult’s rights to make life decisions, is intended to protect vulnerable people from neglect and abuse.

In Richmond, VCU Health System and other health care providers have used the process to remove poor patients from hospital beds, sometimes against the wishes of family members, with the help of a local law firm.

A year-long Richmond Times-Dispatch investigation has found that what happens to the patients after they’re discharged is left up to a system that fails to provide the one justification for the power it wields – protection.

Ora Lomax felt in her bones that her husband of 63 years would die that day.
Four days before Christmas, something in William Lomax had changed. He was praying and singing “This Little Light of Mine” and “Jesus Loves Me.”

He must have felt death, she thought.

She couldn’t stand to see it happen. But before she left him, he squeezed her hand and told her he loved her for the last time.

Just three months earlier, he’d been living with her in their small home near Virginia Union University. Ever since a car accident in 2016 left William, 87, with a brain injury, Ora, also 87, needed help from 24-hour home health aides to take care of him. She couldn’t change him or help him out of bed because of her own physical limitations, but she was there to make sure the aides did.

He’d spent his final weeks in a nursing home where Ora said she frequently found him unwashed, cold and begging for water. He’d become agitated and inconsolable.

He was angry with her for leaving him in this place.

“You have forsaken me,” he told her.

He didn’t understand that she had no choice.

Full Article & Source:
SPECIAL REPORT | Unguarded: How Richmond’s guardianship process leaves vulnerable people unprotected

Amid Guardianship Scrutiny, DeSantis Wants $6.4M to Boost Oversight

Rebecca Fierle appears in court on July 25, 2019 in this file image. She's the subject of multiple criminal investigations stemming from her activities as a professional guardian. (File)
By Greg Angel

TALLAHASSEE, Fla. — Gov. Ron DeSantis unveiled his $91.4 billion budget request Monday, including a plea for more money to help expand oversight of the state's professional guardians.
  • DeSantis's budget proposal includes $6.4 million for state guardian office
  • Guardianship program has been under fire after death of Brevard man
  • Agency says it is anticipating more complaints, increase in legal costs
The funding request comes amid growing scrutiny of a system that some family advocates say is plagued by a lack of oversight, leading to neglect and, in some cases the death of seniors.

"I think it’s a seriously important issue that deserves more of a quick fix," Florida’s Elder Affairs Secretary Richard Prudom told Spectrum News Watchdog reporter Curtis McCloud in August. "It is something that I will be working with the governor and his policy staff, and we will be working with the Legislature and I think the judicial branch as well."

In his budget proposal, DeSantis is requesting lawmakers provide $6.4 million to support the Office of Public and Professional Guardians through the Florida Department of Elder Affairs.

OPPG is seeking an increase of $454,930 specifically for professional guardian investigative services and legal fees.

"With the increased public awareness of guardianship, concerns about guardianship abuse and exploitation and outreach about the program’s responsibilities, OPPG anticipates an increase in the number of professional guardian complaints, investigations, administrative complaints and subsequent legal costs," the agency wrote in a pitch to lawmakers.

The increased public awareness has come from a series of investigations into the system.

Spectrum News first reported on the case of Steven Stryker in July 2019. State investigators say he died in part because of neglect by his court-appointed guardian, Rebecca Fierle.

Orange County Judge Janet Thorpe appointed Fierle as Stryker's guardian in September 2018. The court appointment gave Fierle full legal authority to make health-care decisions for Stryker as well as control of his money and assets.

Spectrum News later learned Fierle was registered as a guardian for at least 450 people, or "wards," in 13 counties.

Fierle has not been charged in the death, although she is the focus of multiple criminal investigations into at least two underway as of November 2019: one by the Florida Department of Law Enforcement and the other by the Florida Attorney General’s Office.

Additionally, two investigations by the Orange County Comptroller’s Office accuse Fierle of mishandling cash and assets belonging to her wards, as well as receiving almost $4 million by overbilling AdventHealth and the court system.

Family advocates also place blame on the court system itself, saying judges routinely fail to provide the necessary oversight.

"Except for maybe one brief appearance in front of a judge, a judge never sees these wards ever again, and — in fact, one of our biggest complaints — do they not only not see them, but they forget about them and they fail to do their job of monitoring every guardianship they create," said Dr. Sam Sugar, founder of the group Americans Against Abusive Guardianships.

Spectrum News’ extensive investigation found that Thorpe later revealed, when revoking Fierle’s guardianship status, that Fierle had not been insured as a guardian in six years and failed to notify the court of several employees.

While Florida lawmakers are still crafting specific legislation that state officials say is necessary to provide appropriate oversight, federal lawmakers have also taken steps to improve guardian programs across the country.

Full Article & Source:
Amid Guardianship Scrutiny, DeSantis Wants $6.4M to Boost Oversight

‘Replace denial with proposal’ on long-term care, House committee told

“All viable proposals deserve to be vetted, studied and moved forward,”
Robert Blancato, national coordinator of the Elder Justice Coalition,
told the House Ways and Means Committee. (YouTube)
Congress must “replace denial with a detailed, bipartisan legislative proposal on long-term care” to address the needs of a growing older population facing high costs for healthcare and housing, Robert Blancato, national coordinator of the Elder Justice Coalition, told the House Ways and Means Committee at a hearing Thursday.

Blancato, one of six hearing witnesses, and Rep. Richard Neal (D-MA), chairman of the committee, both noted that assisted living costs more than $40,000 per year, on average.

“Navigating a fragmented and insufficient long-term care system can be not only confusing and emotionally taxing, but also enormously expensive – even unaffordable. …These high price tags weigh heavily on aging Americans and their families as they try to plan for future long-term care needs,” Neal said in prepared remarks, noting costs associated with nursing homes and home healthcare as well.

Long-term care-related costs are the biggest unfunded liability facing baby boomers, Blancato said in his prepared remarks. “Many older adults rely on Medicaid to fund their long-term care needs. However, states are increasingly considering waivers that would block-grant Medicaid, which could lead to individual caps on care funding,” he said.

Approximately 16.5% of assisted living residents rely on Medicaid to cover their assisted living services, according to the National Center for Assisted Living.

The National Investment Center on Seniors Housing & Care-funded study that found that 54% of the 14.4 million middle-income older adults in 2029 in the United States will lack the financial resources to pay for senior living and care, Blancato said, indicates that “future ability to privately pay [for long-term care needs] may be in jeopardy.”

The witness said “all viable proposals deserve to be vetted, studied and moved forward,” including those involving Medicare and Medicaid reform, to address long-term care costs. “I believe we can all agree that something needs to be done,” he said.

A “real national solution,” Blancato said, should include:
  • A strong Medicaid program that continues to support home- and community-based services over institutional care.
  • Possibly a long-term care benefit in Medicare.
  • Use of the tax code to provide a “meaningful” tax credit for family caregivers and a tax deduction for the purchase of private long-term care insurance.


‘Disturbing pattern of abdication’

In addition to cost issues, Blancato noted in his prepared remarks, “We see a disturbing pattern of abdication by certain federal agencies vested by law with the responsibility to ensure quality care in nursing homes, assisted living and long-term care facilities.” He in part called for additional funding and training for long-term care ombudsmen “so they can expand their important work into assisted living.”

Hearing witness Richard Mollot, executive director of the Long Term Care Community Coalition, told committee members that alternatives to nursing home must be affordable, accessible and safe.

“Seniors and families want and deserve options to nursing homes that provide safety in a more home-like setting,” he said. “While most states are rightfully opening up assisted living to Medicaid beneficiaries, the utter lack of federal standards in this sector has, unsurprisingly, led to increasing reports of rampant abuse and neglect. Our seniors and their families deserve better.”

Mollot also cited “inadequate access to humane dementia care” as an issue involving assisted living and nursing home operators.

“Far too many facilities fail to anticipate the needs of individuals with dementia or equip their staff with the knowledge and skills necessary to provide comfort and care to residents who are experiencing common behavioral and psychological symptoms of the disease,” he said. “In what other industry would it be acceptable to be unable to meet the needs of the majority of one’s customers?”

Care planning benefit eludes most

Hearing witness Robert Egge, chief public policy officer of the Alzheimer’s Association, shared the findings of a recent study that found that in 2017, less than 1% of Medicare beneficiaries living with dementia received comprehensive dementia-specific care planning that could improve care, quality of life and medication management as well as reduce hospitalizations and emergency department visits. This is despite the fact that since 2017, physicians and other healthcare professionals have been able to obtain reimbursement for providing such care planning.

“For the benefits of care planning to reach more Americans affected by Alzheimer’s, more clinicians must use the care planning benefit,” he said. The bipartisan Improving Hope for Alzheimer’s Act (H.R. 1873 / S. 880), Egge added, would help achieve this goal by requiring the Department of Health and Human Services to educate clinicians and report to Congress on ways to increase the benefit’s use and on related barriers.

“This bill has already garnered significant bipartisan support in both chambers, and we urge the Committee on Ways and Means to hold a markup,” he said. “We look forward to working with the bill’s sponsors and committee leadership to ensure its movement in the full House and Senate.”

Watch the hearing here. Read witness testimony here. Read Neal’s opening statement here.

Full Article & Source:
‘Replace denial with proposal’ on long-term care, House committee told