Saturday, February 10, 2018

U.S. Pays Billions for ‘Assisted Living,’ but What Does It Get?

 A report provides the most detailed look to date at the role of assisted living in Medicaid, one of the nation’s largest health care programs. Credit Nam Y. Huh/Associated Press

WASHINGTON — Federal investigators say they have found huge gaps in the regulation of assisted living facilities, a shortfall that they say has potentially jeopardized the care of hundreds of thousands of people served by the booming industry.

The federal government lacks even basic information about the quality of assisted living services provided to low-income people on Medicaid, the Government Accountability Office, a nonpartisan investigative arm of Congress, says in a report to be issued on Sunday.

Billions of dollars in government spending is flowing to the industry even as it operates under a patchwork of vague standards and limited supervision by federal and state authorities. States reported spending more than $10 billion a year in federal and state funds for assisted living services for more than 330,000 Medicaid beneficiaries, an average of more than $30,000 a person, the Government Accountability Office found in a survey of states.

States are supposed to keep track of cases involving the abuse, neglect, exploitation or unexplained death of Medicaid beneficiaries in assisted living facilities. But, the report said, more than half of the states were unable to provide information on the number or nature of such cases.

Just 22 states were able to provide data on “critical incidents — cases of potential or actual harm.” In one year, those states reported a total of more than 22,900 incidents, including the physical, emotional or sexual abuse of residents.

Many of those people are “particularly vulnerable,” the report said, like older adults and people with physical or intellectual disabilities. More than a third of residents are believed to have Alzheimer’s or other forms of dementia.

The report provides the most detailed look to date at the role of assisted living in Medicaid, one of the nation’s largest health care programs. Titled “Improved Federal Oversight of Beneficiary Health and Welfare Is Needed,” it grew out of a two-year study requested by a bipartisan group of four senators.

Assisted living communities are intended to be a bridge between living at home and living in a nursing home. Residents can live in apartments or houses, with a high degree of independence, but can still receive help managing their medications and performing daily activities like bathing, dressing and eating.

Nothing in the report disputes the fact that some assisted living facilities provide high-quality, compassionate care.

The National Center for Assisted Living, a trade group for providers, said states already had “a robust oversight system” to ensure proper care for residents. In the last two years, it said, several states, including California, Oregon, Rhode Island and Virginia, have adopted laws to enhance licensing requirements and penalties for poor performance.
Senator Susan Collins of Maine was among the bipartisan group of senators who requested the government report. Credit Gabriella Demczuk for The New York Times
But the new report casts a harsh light on federal oversight, concluding that the Centers for Medicare and Medicaid Services has provided “unclear guidance” to states and done little to monitor their use of federal money for assisted living.

As a result, it said, the federal health care agency “cannot ensure states are meeting their commitments to protect the health and welfare of Medicaid beneficiaries receiving assisted living services, potentially jeopardizing their care.”

Congress has not established standards for assisted living facilities comparable to those for nursing homes. In 1987, Congress adopted a law that strengthened the protection of nursing home residents’ rights, imposed dozens of new requirements on homes and specified the services they must provide.

But assisted living facilities have largely escaped such scrutiny even though the Government Accountability Office says the demand for their services is likely to increase because of the aging of the population and increased life expectancy.

That potential has attracted investors. “Don’t miss out on the largest market growth in a generation!” says the website of an Arizona company, which adds that “residential assisted living is the explosive investment opportunity for the next 25 years.”

Carolyn Matthews, a spokeswoman for the company, the Residential Assisted Living Academy, said: “Unfortunately, there has been elderly abuse in this business. We are trying to change the industry so the elderly have better quality care and we are not warehousing them.”

The government report was requested by Senator Susan Collins of Maine, a Republican who is the chairwoman of the Special Committee on Aging; Senator Orrin G. Hatch of Utah, a Republican who is the chairman of the Finance Committee; and two Democratic senators, Claire McCaskill of Missouri and Elizabeth Warren of Massachusetts.

The Trump administration agreed with the auditors’ recommendation that federal officials should clarify the requirement for states to report on the abuse or neglect of people in assisted living facilities. The administration said it was studying whether additional reporting requirements might be needed.

“Although the federal government has comprehensive information on nursing homes providing Medicaid services, not much is known about Medicaid beneficiaries in assisted living facilities,” the report said.

Assisted living was not part of the original Medicaid program, but many states now cover it under waivers intended to encourage “home and community-based services” as an alternative to nursing homes and other institutions.

The report said that assisted living could potentially save money for Medicaid because it generally cost less than nursing home care. Under the most common type of waiver, Medicaid covers assisted living only for people who would be eligible for “an institutional level of care,” in a nursing home or hospital.

Full Article & Source:
U.S. Pays Billions for ‘Assisted Living,’ but What Does It Get?

Panel recommends 6-day suspension for Indiana judge

HARTFORD CITY, Ind. — A state panel has recommended that an Indiana judge be suspended for six days without pay following charges filed by the Indiana Judicial Qualifications Commission.

The commission filed the four misconduct charges against Blackford Circuit Court Judge Dean Young in June over a dispute with his county’s clerk.

The commission alleged Young barred then-Blackford County Clerk Derinda Shady from the courthouse while she was hospitalized in August 2015 with chest pains she suffered after refusing to attend a meeting with Young and Superior Court Judge John N. Barry without a witness. The charges also allege that Young’s conduct didn’t promote public confidence in the impartiality of the judiciary.

The panel, which was composed of three judges, said Young’s “misconduct adversely affected the integrity of and respect for the judiciary.” However, the panel also said Young’s “misconduct” wasn’t motivated “by a desire for financial personal or material gain.”

The state Supreme Court will decide what action, if any, will be taken against Young, The Star Press reported.

Attorneys for Young and the commission said they believe the recommended suspension is appropriate.

Young, a Republican, served 12 years in the Indiana House of Representatives before being elected as the circuit court judge in 2006.

Full Article & Source:
Panel recommends 6-day suspension for Indiana judge

Oregon Bill Would Allow Starving Mentally Ill Patients to Death

When Oregon became the first state in the nation to legalize the practice of assisted suicide, pro-life advocates argued this would be a slippery slope that would lead to euthanasia.
Apparently assisted suicide is not enough for the death peddlers in this Pacific Northwest State. Now they are pushing legislation in the Oregon State Legislature that would allow starving mentally ill patients to death.

A similar bill was defeated last year but the euthanasia promoters are back with a new one, Oregon Right to Life tells LifeNews. House Bill 4135 is scheduled for a hearing and possible work session in the House Health Care Committee at 3:00 pm on February 7th. It is believed this bill will move quickly because there are only 35 days in the 2018 regular session.

Last session a similar bill (SB 494) was introduced in the Senate by Senator Floyd Prozanski . It died in the House. The new bill, HB 4135, is chief sponsored by Speaker of the House, Tina Kotek.

“Supporters of this bill are touting it as a ‘fix,’ but the only fixing that is happening is fixing it so vulnerable Oregonians are left without protections and their right to basic care like food and water,” said ORTL Executive Director Lois Anderson. “One wonders what the true motivations are for this legislation.”

Anderson says HB 4135 is purported to just be a bill that makes technical changes to the current statutory advance directive form found in ORS 127.531. However, over the last 25 years Oregonians at the end-of-life stage have been protected by the current advance directive and removing it from statute has legal consequences.

“The advance directive was put into Oregon statute back in 1993. I was then a state senator when a very well vetted bill was thoroughly discussed and passed. I worked hard to ensure the advance directive was in statute. If it were to be removed from statute, I fear the legal protections we carefully placed there could be jeopardized, potentially harming end of life decisions for vulnerable patients,” stated Representative Bill Kennemer (R- HD 39).

Under current Oregon law, a healthcare representative does not have the authority to make a life ending decision for an incapable person unless the representative has been given authority to do so, or the incapable person is in one of four end of life situations defined in statute.

Anderson said that if HB 4135 is passed a person who appoints a healthcare representative, but makes no decisions regarding end of life care, would be granting his or her healthcare representative the power to make a life ending decision for the principal even when the principal is not in one of the four statutorily defined end of life situations, and even if this is not the will of the principal.

Last year’s bill was touted as a good thing, but in fact it promoted the withholding or withdrawal of nutrition and hydration (food and water) from people who are incompetent and not dying.

Full Article & Source:
Oregon Bill Would Allow Starving Mentally Ill Patients to Death

Friday, February 9, 2018

7 Action News Investigation prompts probate law change, protects heirs

LANSING, Mich. (WXYZ) - A 7 Action News investigation has now changed the law in Michigan.  Earlier this week, Gov. Rick Snyder signed the legislation that will increase protections in the law for heirs after a loved one dies.

Since Nov. 2016, 7 Investigator Heather Catallo has been exposing several loopholes in the law that allowed real estate brokers and Attorney General-appointed lawyers called Public Administrators to open probate estates after a loved one dies.  Catallo’s relentless reporting showed that Macomb County real estate broker Ralph Roberts and his company, Probate Asset Recovery, used that power from the courts to sell the homes and take thousands of dollars from the probate estates.

After the 7 Investigators exposed this, Attorney General Bill Schuette shut the practice down, and supported the changes to the law. 

“Actions that came to light last year made it clear that now is the time to make changes to the public administration system,” said Schuette in a statement Tuesday. “What has happened in the system is unacceptable and these changes to an almost 40-year-old law will help ensure this never happens again. By creating a clear, current and direct path for public administrators to follow in the probate process we can better protect Michigan citizens and weed out any bad actors.”

“Establishing a more transparent process for the appointment of a personal representative when no heir can be located will prevent future fraud schemes and prevent these fraudsters from praying on innocent heirs,” said Jim Runestad, R-White Lake. “Public administrators do good work to help our citizens and these reforms provide further safeguards when families are grieving.”

Oakland County Sheriff’s detectives are also now conducting a criminal investigation into these practices.

In May 2017, Oakland County Treasurer Andy Meisner and Oakland County Clerk Lisa Brown connected with a bi-partisan group of lawmakers to close the loopholes.  Two bills sponsored by Rep. Runestad and Rep. Jim Ellison (D-Royal Oak) were signed into law Tuesday.

Meisner is pleased the bills passed, especially since several probate judges and lawyers opposed the changes to the law.  

“We reached out to the probate bench and to the bar, and solicited their input about it,” said Meisner. 

“Despite our reaching out, they didn’t connect with us, they didn’t provide any feedback – and then they submitted a letter before the committee hearing opposing the legislation… It reflects poorly on the probate bar and the judges that they came out against the legislation, and I hope in the future when they’re confronted with this sort of obvious wrong doing that they take the stand of the people.”

Here are more details from Public Act 13 of 2018:
-Heirs will now have 63 days instead of 42 days to open a probate estate, before a Public Administrator can open the estate;
-A formal hearing is now required for a Public Administrator to be appointed;
-If an estate includes a piece of property in tax or mortgage foreclosure, PA’s must post a notice of the court hearing on the property at stake and prove that that they diligently searched for heirs.

Any Public Administrator who intentionally fails to give proper notice can now be found guilty of a 90-day misdemeanor. 

Here are more details of Public Act 14 of 2018:
-Public Administrators must give a written notice to a county treasurer’s office if there is property in the estate that’s delinquent on property taxes; then the treasurer can make sure heirs who are on tax payment plans receive notice of the opening of the estate;
-Public Administrators must now give the courts copies of the settlement statements from the sale of real estate;
-Public Administrators will now have to get court approval before selling a property that they represent, and if an heir is living in the property, the State Public Administrator must be notified.

The changes to the law also cap real estate fees and the fees related to identifying estates to only 10% of the net proceeds from the property sales.

The 7 Investigators first exposed that Roberts and PAR were often taking 33% of the total value of the estate, plus 4% in real estate commissions, as well as other charges invoiced by Roberts various companies.

The bills passed the House and Senate very quickly, and the law will take effect in 90 days.

“It is an example of democracy working the way that it’s supposed to work. The interplay between the government sector and the media -- this a great example of how it’s supposed to work.  The media providing some transparency, and then the government working to act to address the issues the media brings to bear. And so in this time where the media is under such vicious attack, I think it’s a good reminder to people across the state and the country that the media is trying to help us tell the important stories like this one,” said Meisner.

Full Article & Source:
7 Action News Investigation prompts probate law change, protects heirs

7th Circuit reverses, orders special needs trust group to pay estate

The estate of a woman whose special needs trust was drained under questionable circumstances prevailed Wednesday before the 7th Circuit Court of Appeals. The founder of the organization that took the money is a suspended Indiana attorney facing charges that he stole from other clients’ trusts.  The organization must now repay the estate more than $200,000.

The court reversed Southern District Judge Tanya Walton Pratt and ordered the National Foundation for Special Needs Integrity Inc. to pay the estate of Missouri woman Theresa Givens $234,181.23 plus prejudgment interest.

“We respectfully disagree with our colleague on the district court,” Circuit Judge David Hamilton wrote for the panel in National Foundation for Special Needs Integrity, Inc. v. Devon Reese, as Personal Representative for the Estate of Theresa A. Givens, 17-1817. The 7th Circuit held that Pratt’s ruling that the estate’s claim against Special Needs Integrity were barred by the doctrine of laches “was based on clearly erroneous findings of fact.”

Further, Hamilton wrote, “We must note that the Foundation’s (former) counsel, (Kenneth) Shane Service, testified that he intentionally drafted (a section of Special Needs Integrity’s agreement dealing with distributions upon the death of a beneficiary) to confuse Missouri government officials.”

Givens had set up a special needs trust with about $255,000 in settlement proceeds from a lawsuit related to injuries she received from dialysis treatments. She died shortly after the trust was established, and her children were told by Special Needs Integrity that there would be no money left in Givens’ account. Hamilton, though, noted in the opinion that Service also had testified that Givens’ “main concern was always about her children.”

While the children received none of the roughly $234,000 that remained in Givens’ trust when she died in 2011, the foundation claimed the money after initially informing Givens’ children there would be no money because the proceeds most likely would be consumed by Medicaid refunds. After the children questioned distributions to the foundation, Special Needs Integrity filed a declaratory judgment action against the estate in April 2015, which Pratt awarded.

But the 7th Circuit found the contract Givens signed to be ambiguous and found no reason to believe Givens intended her money to go to the foundation rather than to her children. “The Foundation provided Givens with a service by managing her assets for what turned out to be just a few weeks before she died — a service for which Givens paid the Foundation” Hamilton wrote. “There is no plausible reason she would have intended to give it all the money that might be left upon her death.

“… We thus conclude that the agreement is best construed as providing that the remainder funds go to the Estate of Theresa Givens,” the panel held in reversing and ordering the foundation to pay the estate $234,181.23 plus prejudgment interest.

During oral arguments in September, Lewis & Kappes attorney David Gray, who represented Special Needs Integrity, faced tough questioning from Hamilton.

“You don’t even have records of a decision” by Service or by other foundation representatives to take the money, Hamilton said. “You just have money shifted from one account to another in 2013 and then again in 2014.

“… Why should we simply not decide it’s an ambiguous document that needs to be construed against the drafter and order distribution?” he asked Gray near the end of his presentation.

“If laches doesn’t work, nothing prevents you from doing it,” Gray responded.

Meanwhile, Service is awaiting trial on theft charges in Lawrence County, where he is accused of stealing more than $85,000 from two former clients’ special needs trusts.  Authorities believe Service may have other victims in different states. An Indiana State Police investigator said in September officials were looking into the possibility of “numerous victims in multiple states.”

Service’s next court date on the Lawrence County charges is set for March 21.

Full Article & Source:
7th Circuit reverses, orders special needs trust group to pay estate

West Virginia House backs aides giving nursing home drugs

CHARLESTON, W.Va. (AP) — West Virginia's House has voted to let nursing aides give various prescription medications to patients at nursing homes.

Supporters of the bill, approved 55-44 on Tuesday, say the certified nurse aides would have to be trained every two years, work under the direction of a registered nurse, couldn't give opioids and other drugs listed as having high potential for abuse and could give injections only with pre-filled insulin.

Aides would have to record every medication they give. They couldn't calculate dosages or work from verbal doctor's orders.

Opponents say their concerns are patient safety as well as the potential diversion of allowable medications, which include barbiturates that are potentially addictive.

Lawmakers on both sides note that 25 states allow the practice and 25 don't.

Full Article & Source:
West Virginia House backs aides giving nursing home drugs

Thursday, February 8, 2018

Senate approves guardianship reform

Jack Burton, an attorney from Santa Fe, Sen. Jim White, R-Albuquerque, and Sen. Daniel Ivey-Soto, D-Albuquerque
The New Mexico Senate on Wednesday approved a two-pronged measure to provide “immediate relief” to those who have struggled for years with the abuses of a closed legal guardianship/conservator system, while creating the framework for a comprehensive system overhaul by 2020.

The unanimous vote, which sends the legislation to the House of Representatives, comes after what one senator called a “Herculean” effort to address failings of the current system – as evidenced by the recent embezzlement of millions of dollars from guardian or conservator clients of two now-defunct Albuquerque firms.

Under the measure approved Wednesday, court hearings that are now closed would be open to the public as of July 1. Family members would have more access to guardianship records and visitation wouldn’t be as easily thwarted by commercial guardians, who also have been accused in some cases of profligate spending and excessive fees. Nonfamily conservators would have to post bonds in case financial impropriety occurred.

Sen. Daniel Ivey-Soto, D-Albuquerque, one of the bill’s sponsors, said the phased-in measure would give “immediate relief and to make sure we make good on a promise (for more comprehensive changes). We will keep legislating on it.”

Sen. Jim White, R-Albuquerque, who led the reform effort, told his colleagues before Wednesday’s vote that the state’s courts need more time and money to enact the more costly aspects of the measure, such as bringing all existing cases up to compliance.

Judges approve petitions for guardianship and rely on annual reports to ensure their guardian or conservator appointees are doing their jobs.

Sen. Jerry Ortiz y Pino, D-Albuquerque, a longtime advocate of reform, recounted his experience on the Supreme Court commission appointed last year after publication of a Journal series, “Who Guards the Guardians?” The commission heard testimony from the public about the issue last year.

“It was painful to hear how dysfunctional our system has become … because we as legislators haven’t been giving the judiciary the tools to make the system work better.”

Over the months of study by the commission and several legislators, a consensus emerged: Reporting requirements to allow judges to assess a protected person’s welfare and assets aren’t stringent enough. Families are sometimes shut out of their incapacitated loved ones’ lives by guardians. And judges should improve oversight. There was also the recognition that the judiciary is financially strapped and needs additional time and resources to implement more reform.

The judiciary, for instance, identified 24,000 existing cases in its computer system as being “sequestered” – meaning closed to the public. But it isn’t clear how many of those are adult guardianship cases, and there’s no way to easily tell in each case whether the protected person or the guardian is still alive.

“We don’t have that information, and that’s part of the issue before us,” White said. ” There’s not a database that keeps track of all those cases. There may be abuse out there that we don’t know about.” A provision of the bill, he said, would entail building a database of guardianship cases.

The bill, which Sen. Sander Rue, R-Albuquerque, described Wednesday as a “Herculean effort,” incorporates but delays the more expensive requirements of a new model guardianship reform law unveiled nationwide last fall.

In essence, more time and work would be required from attorneys who file petitions, from guardians and conservators, and from judges who hear the cases.

For example, guardians and conservators would have to devise plans detailing their care of a protected person and file them with the judge. Judges would have to give specific authorization for conservators to deviate from a protected person’s will, including considering the incapacitated person’s prior directives and financial needs.

“This bill is the result of a lot of work, both nationally and locally,” said Sen. Cisco McSorley, D-Albuquerque. “There is a huge need to protect elders. This is a reflection of a new American society where older people move to the Southwest to retire … without close family members, and there’s really nobody to look after them if they have some catastrophic event. Once you are incapacitated and in front of a judge, the judge literally gives somebody else total and complete control not only over your physical being, but your money, your future financial dealings, your legal dealings.”

Ortiz y Pino said that if the measure is signed into law, “We can feel very good about plugging some of the holes, such as families getting more notification (of when hearings will occur).”

But he said that if lawmakers don’t give the courts enough money for improved oversight, such as staff to review guardian and conservator reports and for field visits to check on protected people, “we’ve just hamstrung the new law and created no better situation.”

Full Article & Source:
Senate approves guardianship reform

South Texas Judge Charged With Accepting Bribes for Favorable Rulings

The FBI has charged a South Texas judge with accepting bribes after a lawyer working as a confidential informant helped agents record the jurist allegedly accepting $6,000 in cash in exchange for favorable rulings.

Federal agents arrested 93rd State District Judge Rodolfo “Rudy” Delgado of Edinburg on Feb. 2.  Delgado was charged with “bribery concerning programs receiving federal funds,” and released on $100,000 bond. The criminal complaint filed against Delgado alleges the FBI worked with an unnamed lawyer, who confessed he had a history dating back to 2008 of bribing Delgado.

The lawyer-turned-informant, listed in the complaint under the initials CHS, worked with the FBI for over a year and participated in numerous recorded phone calls and meetings with Delgado.

The attorney provided Delgado with pre-recorded government funds on two occasions, according to the complaint. In each instance, Delgado allegedly accepted a bribe to place the attorney’s clients on bond.

The attorney wore a recording device as he met with Delgado at a restaurant to hand off an envelope containing the bribery money on Jan. 17, according to the complaint. Delgado allegedly accepted the bribe and then asked for the client and case number. Delgado placed the attorney’s client on bond the next day.

However, on Jan. 29, Delgado sent a text message to the attorney, which stated, “Good evening, please call me. The campaign contribution needs to be by check. I need to return that to you so you can write a check. Sorry about the confusion, I though you knew and I did not open the envelope till today.”

The complaint alleges the text message was an attempt by Delgado to cover up the bribe.

“Delgado had solicited contributions from CHS in the past, but when CHS offered Delgado the bribe, he did not say that it was a campaign donation. Furthermore, CHS offered and Delgado accepted a thick white envelope full of prerecorded government funds,” the complaint alleges. Delgado did not return a call for comment. Neither did his attorney, Adolfo “Al” Alvarez.

Eric Vinson, executive director of the State Commission on Judicial Conduct, said Delgado will automatically be suspended from the bench upon indictment.

The commission normally suspends judges without pay automatically if they are indicted for a felony or a misdemeanor involving official misconduct. Judges are allowed to petition the commission to resume their pay or to return to the bench after an indictment, Vinson said, but the commission has historically not allowed indicted judges to sit in Texas.

“The Feds have 30 days to indict and we’re going to kind of watch and see what happens and go from there,” Vinson said.

Delgado has a history with the commission. He was suspended from the bench in 2005 after a grand jury indicted him in connection with a driving while intoxicated incident. That suspension was later lifted by the commission in 2007 after the criminal charges against Delgado were dismissed by a visiting judge—a decision that was later upheld by Corpus Christi’s 13th Court of Appeals.

Full Article & Source:
South Texas Judge Charged With Accepting Bribes for Favorable Rulings

Volunteer advocates to help incapacitated individuals with money management

Elderly or incapacitated adults no longer able to look after their own finances will soon have advocates to look after them.

An agreement to initially create 35 volunteer advocates to oversee the financial interests of incapacitated individuals was signed Monday by the Bartholomew County commissioners.

According to the agreement, which expires Dec. 31, the Indiana Office of Court Services agrees to pay up to $50,000 to Thrive Alliance, a combination of the Aging and Community Services of South Central Indiana, Inc. and Housing Partnerships, Inc.

In exchange, the Columbus-based agency will be responsible for vetting, screening, training and supervising volunteer financial guardians, as well as for maintaining court-required progress and accounting reports.

Persons incapable of caring for themselves financially includes those with a neuro-developmental disorder, mental illness, dementia or stroke, the agreement states.

The program is structurally comparable to Court-Appointed Special Advocates (CASA), trained individuals who speak up for the best interests of children within the judicial system, Bartholomew Superior Court 1 Judge Jim Worton said.

All tasks performed by Thrive Alliance will be overseen by Bartholomew County Adult Court Services. If a problem arises from a decision or action taken by a volunteer advocate, the court can remove their financial guardianship, Worton said.

With a staff of five, Adult Court Services also provides services to Bartholomew, Brown, Jennings, Decatur and Jackson counties.

When Worton first spoke on this proposal to the commissioners in December, he was joined by Lori Bland, Thrive Alliance Guardian Program manager.

Now that baby boomers are increasingly retiring, the number of incapacitated adults is expected to grow larger than it ever has been in the past, Bland told the commissioners.

There are already as many as 400 incapacitated adults within the region that have no one else able or willing to assist them with their finances, Bland said.

Until now, only one couple — Bartholomew County Adult Protective Services employees John and Brenda Defler — have been available to advocate for those hundreds of incapacitated adults, the judge said.

“There’s no doubt in my mind we’ve needed this program for years,” John Defler said during a follow-up interview.

Besides retiring baby boomers, there has also been a noticeable increase in the number of adults with Alzheimer’s Disease and other forms of dementia, he said.

Since it’s been more than 40 years since Indiana moved away from institutionalization, there are also many incapacitated adults cared for by the parents their entire lives who now suddenly find themselves alone, Defler said.

His department works with other organizations, such as Centerstone Behavioral Health, to place those persons into extended-care facilities, supportive living quarters or group homes, Defler said.

Based on his own experiences, Defler anticipates most volunteers recruited by Thrive Alliance will be recent retirees.

Not only does that group have more time and expertise, but they also have empathy for people in need, he said.

“They know they could be that person tomorrow,” Defler said. “Whether it’s a stroke or an accident, we are all vulnerable and there are no guarantees.”

The agreement can be terminated by mutual consent, or if funding is no longer available.

The commissioners are serving as a pass-through entity for the exchange of funds, as no local tax dollars will be spent for these services, commissioner Rick Flohr said.

Full Article & Source:
Volunteer advocates to help incapacitated individuals with money management

Wednesday, February 7, 2018

Temptations singer Dennis Edwards was abused before his death, court documents allege

Chicago police are investigating allegations that Dennis Edwards, a Grammy-winning singer with the Motown group the Temptations, was abused shortly before his death.

The Rock & Roll Hall of Fame inductee died at a Chicago hospital Thursday from complications of meningitis, according to his wife, Brenda Edwards. He was 74 and had lived in the St. Louis area for more than 30 years.

Court documents filed by an adult protective services investigator allege that weeks before the singer’s death, Brenda Edwards abused her husband.

An investigator with the Healthcare Consortium of Illinois filed the protection order request on behalf of Dennis Edwards Jan. 12 in Chicago, where the couple lived together before Edwards’ death.

The documents allege that Brenda Edwards had attempted to suffocate the 74-year-old by holding his head facedown on a bed. The investigator also accused Brenda Edwards of taking her husband’s hearing aids from him, according to a petition for an order of protection. The documents say Edwards was “bed bound and immobile.”

Dennis Edwards was removed from the home because of medical issues, according to the Jan. 12 document.

An emergency protective order against Brenda Edwards was granted Jan. 18, barring her from contact with Dennis Edwards. A hearing that would have allowed Brenda Edwards to respond to the allegations was scheduled for Friday, but was canceled after her husband’s death the day before.

The protective order was vacated on Friday, after Dennis Edwards’ death.

Brenda Edwards disputed the allegations in a brief statement released Monday night. “I loved Dennis, and we were married for 18 years,” she said. “I would have never done anything to harm him. These allegations are false and defamatory and will be proven as such. Until this is all over, I have no further comment.”

The Chicago Police Department confirmed Monday that there is an open criminal investigation into the matter.

Until recently, Dennis and Brenda Edwards lived in north St. Louis County, and property records show the house remains listed in Dennis Edwards’ name.

The couple recently moved to Chicago to seek better health care, according to Dennis Edwards’ daughter Denise Edwards.

Dennis Edwards lived in the St. Louis area for more than 30 years. He was born in Alabama and moved to Detroit as a young boy, but moved to the St. Louis area in the 1980s to be closer to his mother.
In an undated file photo, The Temptations singing group is pictured. From left are; Otis Williams, Melvin Franklin and Glenn Beonard. Back row from left, Richard Street and Dennis Edwards. Edwards, a former member of the famed Motown group, has died. He was 74. (AP Photo/Lennox McLendon)
By that time, Edwards had already sung lead vocals on some of the Temptations’ biggest hits

Edwards wasn’t an original singer with the classic Temptations lineup, but became the official sixth member in 1968.

He sang lead on hits including “Ball of Confusion (That’s What the World is Today),” “I Can’t Get Next to You,” and the Grammy-winning tracks “Papa Was a Rollin’ Stone” and “Cloud Nine.”

The Temptations were inducted into the Rock & Roll Hall of Fame in 1989.

In his later years, Dennis Edwards was often seen in St. Louis at the Fox Theatre and Peabody Opera House when classic soul artists passed through.

The family is working to make arrangements for a memorial service for the singer, Denise Edwards said.

Survivors of Dennis Edwards include five daughters, a son and several grandchildren.

Full Article & Source: 
Temptations singer Dennis Edwards was abused before his death, court documents allege

Judicial council takes no action against former Judge Alex Kozinski

Former Ninth Circuit Appeals Court Judge Alex Kozinski
(CNN) - Nearly eight weeks after a federal judicial council received a sexual harassment complaint against California-based US Appeals Court Judge Alex Kozinski, the council said Monday that it was dismissing the grievance because Kozinski had stepped down in December.

The council said it conducted no investigation and was not reaching a ruling the merits of the complaint.

But it maintains the charges are serious.

"We recognize that the complaint references grave allegations of inappropriate misconduct, which the federal judiciary cannot tolerate," the judicial council of the 2nd Circuit wrote.

However, since Kozinski has retired, the council has dropped the matter.

The Washington Post reported in December that six former clerks or junior staffers claimed that Kozinski subjected them to inappropriate sexual conduct or comments. Other women subsequently came forward.

The 67-year-old Kozinski is eligible for a $217,600 annual pension, a figure based on the standard appellate judge salary, according to David Sellers, spokesman for the Administrative Office of the US Courts.

Susan Estrich, Kozinski's lawyer, declined to comment.

When he announced his retirement on December 18, Kozinski said in a statement, "I've always had a broad sense of humor and a candid way of speaking to both male and female law clerks alike. In doing so, I may not have been mindful enough of the special challenges and pressures that women face in the workplace. It grieves me to learn that I caused any of my clerks to feel uncomfortable; this was never my intent."

A recent CNN investigation found that judges who are subject to a serious complaint often leave the bench, immediately halting any investigation.

The CNN report also found that, overall, very few of the more than one thousand complaints filed each year against federal judges are deeply investigated. Seldom are judges reprimanded, suspended or subject to other disciplinary action.

University of Pittsburgh law professor Arthur Hellman, who has studied the judiciary's complaint system, said, "By resigning before the investigation even began, Kozinski avoided any kind of inquiry."

It is unlikely any congressional committee would take up the Kozinski case, Hellman added, questioning why members of Congress would take the time to look specifically into the conduct of an individual who has left the bench. However, he said, lawmakers may want to look more broadly at judicial sexual harassment and other misconduct.

Sending copy of four-page report to Congress

The council said that "given the seriousness of the conduct alleged," it was asking the Committee on Judicial Conduct and Disability of the US Judicial Conference to forward a copy of the order "to any relevant Congressional committees for their information." It was not clear what the judicial council hoped would come of that action, particularly because Kozinski has already stepped down.

Congress may forcibly remove a judge from office through the process of impeachment and conviction. The House of Representatives, which is responsible for any impeachment, typically begins a proceeding only on a recommendation of the Judicial Conference.

Only three times in the past 30 years have federal judges been impeached by the House and convicted by the Senate, for issues related to bribery and perjury.

Previous complaints against Kozinski

After the Kozinski harassment claims emerged, Chief Justice John Roberts established a working group to examine the judiciary's procedures for protecting court employees from misconduct. The group is scheduled to report back to Roberts in May.

Kozinski underwent a separate disciplinary process in 2009 after the Los Angeles Times reported that Kozinski was maintaining a publicly accessible website of sexually explicit images. He publicly apologized and took the server offline. A judicial council admonished Kozinski but concluded no further discipline was warranted.

The Philadelphia-based 3rd Circuit judicial council that pursued the 2009 claim noted that, "The judge recognizes that some members of the public, upon learning he possessed the material, may have the misimpression that he has demeaning or disdainful attitudes toward women, creating in the minds of some people what he called 'a highly distorted picture' of him. The judge testified, 'It is especially unfortunate that this happened on account of images and videos that I care absolutely nothing about.'"

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Judicial council takes no action against former Judge Alex Kozinski

Nursing homes sedate residents with dementia by misusing antipsychotic drugs, report finds

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(CNN)Children complained about parents who were robbed of their personalities and turned into zombies. Residents remembered slurring their words and being unable to think or stay awake. Former administrators admitted doling out drugs without having appropriate diagnoses, securing informed consent or divulging risks.

These are just some of the findings outlined in a new Human Rights Watch report, "'They want docile:' How Nursing Homes in the United States Overmedicate People with Dementia."

The 157-page report, released Monday, estimates that each week more than 179,000 people living in US nursing facilities are given antipsychotic medications, even though they don't have the approved psychiatric diagnoses -- like schizophrenia -- to warrant use of the drugs. Most of these residents are older and have dementia, and researchers say the antipsychotic medications are administered as a cost-effective "chemical restraint" to suppress behaviors and ease the load on overwhelmed staff.

What's revealed in this report echoes the findings of a CNN investigation published in October. The CNN story described how one little red pill, Nuedexta, was being misused and overprescribed in nursing homes. What's more, CNN learned that this overuse benefited the drugmaker to a tune of hundreds of millions of dollars, largely at the expense of the US government. The CNN report prompted an investigation into a California-based pharmaceutical company.

The Human Rights Watch report shows that concerns about overmedicating nursing home residents with inappropriate drugs extends beyond this one pill.

Researchers visited 109 facilities in six states between October 2016 and March 2017. They interviewed 323 people, including residents, family members, nurses, social workers, pharmacists, long-term care experts and more.

What they found wasn't just disturbing, it was dangerous.

Some family members in dark over dangers

The Food and Drug Administration has not deemed antipsychotic drugs an effective or safe way to treat symptoms associated with dementia -- including dementia-related psychosis, for which there is no approved drug. In fact, the FDA cautions that these drugs pose dangers for elderly patients with dementia, even doubling the risk of death, the report shows. Other possible side effects outlined in the report include an onset of nervous system problems that may cause "severe muscular rigidity" or "jerking movements," as well as low blood pressure, high blood sugar, blood clots and other problems.

Researchers heard from family members who hadn't been informed of the dangers. Others felt they had no choice but to agree to the administration of drugs for fear that their loved ones would be otherwise evicted from their facilities.

When residents were taken off antipsychotic drugs, they and their family members often saw improvement. One daughter, who'd assumed her 90-year-old mother's decline was irreversible, said she saw her mom come back to life after the two years of being on antipsychotic drugs stopped.

"Lo and behold, she can talk again. She can read again ... It's not just that she can walk now ... it's her personality," the report quotes the daughter saying. "She had been sleeping all the time. She was totally incoherent. She had no memory at all. She recognized no one. On the meds, she couldn't remember if you were there while you were there."

Laurel Cline visits her mother, Lenora, in a Los Angeles nursing home. She said she had to persuade staff to stop giving her mother antipsychotic drugs.

There are plenty of ways to deal with dementia-related symptoms or behaviors that don't involve pharmaceuticals, the report lays out. Improvements can be achieved through providing activities, reducing loneliness, creating routines, encouraging relationships with familiar staff members, offering exercise and promoting programs like music therapy and pet therapy.

All of this is important to keep in mind as America ages. There are currently about 50 million Americans over age 65, and that number is expected to double by 2060, according to the US Census Bureau. And while today there are 5 million people with Alzheimer's disease or other forms of dementia, the Alzheimer's Association projects that there may be as many as 16 million people with Alzheimer's by 2050.

The industry that cares for the country's aging population, whether that be nursing homes, assisted living centers or other long-term care options, is largely funded by Medicare and Medicaid -- which raises the question: Who is responsible? 

Recent improvements noted

Human Rights Watch points a finger at the government, which is required under the Nursing Home Reform Act of 1987 to protect the rights of residents. And what's raised in this report is not new. The government has long-recognized the problem of overusing antipsychotic medications and is required to monitor the use of such drugs, the report shows. In fact, in 2012, the Centers for Medicare & Medicaid Services established the National Partnership to Improve Dementia Care in Nursing Homes in acknowledgement of this issue.

That move made a difference, reducing the use of antipsychotic drugs by 35%, according to a statement emailed to CNN.

Human Rights Watch, too, acknowledged that there have been improvements in recent years, with some facilities slashing use of the drugs after studying the needs of residents. A director of one of these nursing homes in Kansas acknowledged to researchers that the facility "used to be like a death prison" in which "half our residents were on antipsychotics."

While some places like this one in Kansas are taking heed, the human rights group contends that the problem is persistent. Between 2014 and mid-2017, inspectors issued more than 7,000 citations to facilities for violations tied to the use of antipsychotic medications, the report shows. But without meaningful penalties, researchers say, little has changed.

The Centers for Medicare & Medicaid Services agree that more can be done -- and insist it will be.

"CMS appreciates the work done by the Human Rights Watch on this vital issue and is working towards a goal that ensures America's nursing home residents receive safe, high-quality care that is clinically appropriate," the division said in its statement.

The previous administration under President Barack Obama planned to beef up regulations, but the human rights group points out that the Centers for Medicare & Medicaid Services placed a moratorium on strengthened regulations in November 2017.

"The US government pays nursing homes tens of billions of dollars per year to provide safe and appropriate care for residents," said Hannah Flamm, a New York University Law fellow at Human Rights Watch. "Officials have a duty to ensure that these often vulnerable people are protected rather than abused."

The government can do its part in a number of ways, the report suggests. It can end the inappropriate administration of antipsychotic medications by enforcing regulations and penalties, improving inspections, requiring informed consent, and ensuring adequate staffing and training in care facilities.

The Centers for Medicare & Medicaid Services said it's already hard at work to make further improvements, having instituted new goals as of the end of 2017. Among the goals is an expectation that nursing facilities which still overuse antipsychotic medications will decrease their use by 15% by the end of 2019.

As for a moratorium on such efforts, the division says there's no change in requirements "that residents must be free from unnecessary medications and must not be chemically restrained." Rather, there is now an 18-month "transition period" wherein those that fall short are not being fined and instead are being asked to invest in education and compliance.

This is all part of an effort "to reduce [the] burden on providers while still protecting the health, safety, welfare, and rights of residents," the statement said. 

GAO finds gaps in reporting

A separate government-issued report released Monday, completed at the request of a bipartisan group of US senators, looked at oversight of care in assisted living facilities.

The Government Accountability Office investigation examined the care provided to Medicaid enrollees and found significant gaps in the reporting of safety and serious health incidents including physical and sexual abuse, medication errors, inappropriate discharge and unexplained death.

More than 20,000 incidents were reported for 2014 in the 22 states that tracked such information. But 26 other states had not tracked "critical incidents," and therefore could not report the relevant statistics to the accountability office.

"Our nation's seniors, who depend on Medicaid for long-term care services and support, must be safe and protected wherever they call home," said Sen. Orrin Hatch, a Utah Republican. "Given that each year the Medicaid program spends billions on assisted living facilities to ensure beneficiaries receive the high-quality care that they deserve, we must be vigilant that these programs are working as intended."

The accountability office outlined recommendations to the Centers for Medicare & Medicaid Services, including clarifying state reporting requirements, the report states. HHS agreed with that recommendation and stated that it would consider annual reporting requirements for critical incidents after completing an ongoing review.

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Nursing homes sedate residents with dementia by misusing antipsychotic drugs, report finds

Tuesday, February 6, 2018

How Nursing Homes in the United States Overmedicate People with Dementia

Lenora Cline, 88, has lived in a nursing home for years. She has Alzheimer’s disease. Laurel Cline, her daughter, visits her twice a day and assists staff with the care-taking, fearing that otherwise, with the shortage of staff, her mother will not be turned, fed, or changed. She had to persuade the facility to discontinue antipsychotic medications. Before successfully objecting to their use, Ms. Cline said, “Every little thing, they want to put you on psych meds.” Los Angeles, California, August 2017.
© 2017 Ed Kashi for Human Rights Watch
In an average week, nursing facilities in the United States administer antipsychotic drugs to over 179,000 people who do not have diagnoses for which the drugs are approved. The drugs are often given without free and informed consent, which requires a decision based on a discussion of the purpose, risks, benefits, and alternatives to the medical intervention as well as the absence of pressure or coercion in making the decision. Most of these individuals—like most people in nursing homes—have Alzheimer’s disease or another form of dementia. According to US Government Accountability Office (GAO) analysis, facilities often use the drugs to control common symptoms of the disease.

While these symptoms can be distressing for the people who experience them, their families, and nursing facility staff, evidence from clinical trials of the benefits of treating these symptoms with antipsychotic drugs is weak. The US Food and Drug Administration (FDA) never approved them for this use and has warned against its use for these symptoms. Studies find that on average, antipsychotic drugs almost double the risk of death in older people with dementia. When the drugs are administered without informed consent, people are not making the choice to take such a risk.

The drugs’ sedative effect, rather than any anticipated medical benefit, too often drives the high prevalence of use in people with dementia. Antipsychotic drugs alter consciousness and can adversely affect an individual’s ability to interact with others. They can also make it easier for understaffed facilities, with direct care workers inadequately trained in dementia care, to manage the people who live there. In many facilities, inadequate staff numbers and training make it nearly impossible to take an individualized, comprehensive approach to care. Many nursing facilities have staffing levels well below what experts consider the minimum needed to provide appropriate care.

Federal regulations require individuals to be fully informed about their treatment and provide the right to refuse treatment. Some state laws require informed consent prior to the administration of antipsychotic drugs to nursing home residents. Yet nursing facilities often fail to obtain consent or even to make any effort to do so. While all medical interventions should follow from informed consent, it is particularly egregious to administer a drug posing such severe risks and little chance of benefit without it.

Such nonconsensual use and use without an appropriate medical indication are inconsistent with human rights norms. The drugs’ use as a chemical restraint—for staff convenience or to discipline or punish a resident—could constitute abuse under domestic law and cruel, inhuman, and degrading treatment under international law.

The US has domestic and international legal obligations to protect people who live in nursing facilities from the inappropriate use of antipsychotic drugs, among other violations of their rights. These obligations are particularly important as people in nursing facilities are often at heightened risk of neglect and abuse. Many individuals in nursing facilities are physically frail, have cognitive disabilities, and are isolated from their communities. Often, they are unable or not permitted to leave the facility alone. Many depend entirely on the institution’s good faith and have no realistic avenues to help or safety when that good faith is violated.

US authorities, in particular the Centers for Medicare & Medicaid Services (CMS) within the US Department of Health and Human Services, are failing in their duty to protect some of the nation’s most at-risk older people. On paper, nursing home residents have strong legal protections of their rights, but in practice, enforcement is often lacking. Although the federal government has initiated programs to reduce nursing homes’ use of antipsychotic medications and the prevalence of antipsychotic drug use has decreased in recent years, the ongoing forced and medically inappropriate use of antipsychotic drugs continues to violate the rights of vast numbers of residents of nursing facilities. The US government should use its full authority to enforce longstanding laws, including by penalizing noncompliance to a degree sufficient to act as an effective deterrent, to end this practice.

This report documents nursing facilities’ inappropriate use of antipsychotic drugs in older people as well as the administration of the drugs without informed consent, both of which arise primarily from inadequate enforcement of existing laws and regulations. The report is based on visits by Human Rights Watch researchers to 109 nursing facilities, mostly with above-average rates of antipsychotic medication use, between October 2016 and March 2017 in California, Florida, Illinois, Kansas, New York, and Texas; 323 interviews with people living in nursing facilities, their families, nursing facility staff, long-term care and disability experts, officials, advocacy organizations, long-term care ombudsmen, and others; analysis of publicly available data; and a review of regulatory standards, government reports, and academic studies.

This report is especially relevant at this time because the US is aging rapidly. Most of the people in the nursing facilities Human Rights Watch visited are over the age of 65. Older people now account for one in seven Americans, almost 50 million people. The number of older Americans is expected to double by 2060. The number of Americans with Alzheimer’s disease, the most common form of dementia, is expected to increase from 5 million today to 15 million in 2050. The system of long-term care services and supports will have to meet the needs—and respect the rights—of this growing population in coming years.

Social Harm and Health Risks Caused by Antipsychotic Drugs Used Unnecessarily or as Chemical Restraints

The American Psychiatric Association (APA) Practice Guideline on the Use of Antipsychotics to Treat Agitation or Psychosis in Patients with Dementia states that, after eliminating or addressing underlying medical, physical, social, or environmental factors giving rise to manifestations of distress associated with dementia, antipsychotic drugs “can be appropriate” as a means to “minimize the risk of violence, reduce patient distress, improve the patient’s quality of life, and reduce caregiver burden.” However, given the “at best small” potential benefits and the “consistent evidence that antipsychotics are associated with clinically significant adverse effects, including mortality,” it is essential that the drug treatment is only attempted when appropriate.

Nursing facility staff, individuals living in facilities, their families, long-term care advocates, and others told Human Rights Watch that the drugs are not used only as a last resort, after all factors potentially giving rise to a person’s distress have been ruled out, and after nonpharmacologic interventions have been attempted unsuccessfully. Instead, antipsychotic drugs are used sometimes almost by default for the convenience of the facility, including to control people who are difficult to manage.

One facility social worker said that one of the most common “behaviors” leading to antipsychotic drug prescriptions was someone constantly crying out, “help me, help me, help me.” An 87-year-old woman reflected that at her prior facility, which gave her antipsychotic drugs against her will, “they just wanted you to do things just the way they wanted.” A social worker who used to work in a nursing facility said the underlying issue is that “the nursing homes don’t want behaviors. They want docile.” A state surveyor said: “I see way too many people overmedicated.... [Facilities] see it as a cost-effective way to control behaviors.”

Human Rights Watch interviewed people who live in nursing homes and their family members who described the harmful cognitive, social, and emotional consequences of the medications that all too often should never have been administered in the first place: sedation, cognitive decline, fear, and frustration at not being able to communicate. Most or all antipsychotic drugs are associated with sedation and fatigue in people with dementia.

A 62-year-old woman in a nursing facility in Texas who said she was given Seroquel, a common antipsychotic drug, without her knowledge or consent said: “[It] knocks you out. It’s a powerful, powerful drug. I sleep all the time. I have to ask people what the day is.” The daughter of a 75-year-old woman in Kansas said that when the nursing facility began giving her mother an antipsychotic drug, her mother “would just sit there like this. No personality. Just a zombie.... The fight is gone.”

Nursing staff, social workers, long-term care ombudsmen, and state surveyors echoed this perception. One director of nursing said: “You actually see them decline when they’re on an antipsychotic. I think it’s sadder than watching someone with dementia decline.”

Lack of Informed Consent Prior to Antipsychotic Medication Administration

The use of antipsychotic drugs to control people without their knowledge or against their will in nonemergency situations violates international human rights. The practicalities of obtaining consent from an older person with dementia can be fraught. However, in many of the cases Human Rights Watch documented, nursing facilities made no effort to obtain meaningful, informed consent from the individual or a health proxy before administering the medications in cases where it clearly would have been possible to do so.

Our research suggests that in many other cases, facilities that purport to seek consent fail to provide sufficient information for consent to be informed; pressure individuals to give consent; or fail to have a free and informed consent procedure and documentation system in place. Under international human rights law, in the absence of free and informed consent, a nonemergency medical intervention that is not necessary to address a life-threatening condition is forced treatment.
One former nursing facility administrator explained:
The facility usually gets informed consent like this: they call you up. They say, “X, Y, and Z is happening with your mom. This is going to help her.” Black box warning (the government’s strongest warning to draw attention to serious or life-threatening risks of a prescription drug)? “It’s best just not to read that.” The risks? They gloss over them. They say, “That only happens once in a while, and we’ll look for problems.” We sell it. And, by the way, we already started them on it.
A current director of nursing admitted, “We are supposed to be doing informed consent. It’s on the agenda. But really antipsychotics are a go-to thing. ‘Give ‘em some Risperdal and Seroquel.’ We tell the family as we’re processing the order. The family is notified.” The daughter of a woman in a nursing facility described having consented to antipsychotic drugs for her mother without understanding the risks: “I had no idea, not at all, that the drugs were dangerous. I had no idea.... I’m guessing most people have no idea.”

A detailed examination of the question of legal capacity—the right to exercise one’s own rights and to make decisions on one's own behalf—is outside the scope of this report. Because many people living in nursing facilities have dementia and other progressive conditions that affect their cognitive ability, it is a highly complex question how medical and other decisions concerning their care should be made in a rights-respecting manner. In US nursing facilities, substituted decision-making—where a family member or other third party, whether voluntarily designated in advance or not, makes decisions on an individual’s behalf—is common.

Government Obligations

In 2012, CMS created the National Partnership to Improve Dementia Care in Nursing Homes, in recognition of the unacceptably high prevalence of antipsychotic drug use. While the initiative—which set targets for the industry to reduce antipsychotic drug rates—may have contributed to the reduction of the use of antipsychotic medications over the last six years, it cannot substitute for the effective regulation of nursing homes, including by ensuring that facilities face meaningful sanctions for noncompliance with mandatory standards. Our research found that CMS is not using its full authority to address this issue. Recently, CMS is in fact moving in the opposite direction, limiting the severity of financial penalties and the regulatory standards with which facilities must comply.

CMS and the state agencies with which it contracts to enforce federal regulations are not meeting their obligation to protect people from the nonconsensual, inappropriate use of antipsychotic drugs. Human Rights Watch identified several key areas of concern:
  • Failure to adequately enforce the right to be fully informed and to refuse treatment or to require free and informed consent requirement. The Nursing Home Reform Act of 1987 grants residents the right “to be fully informed in advance about care and treatment,” to participate in care planning, and to refuse treatment without penalty. If it were enforced fully, these protections would not differ substantially from the right to free and informed consent. However, without adequate enforcement, current practice falls far short of this protection.
  • Lack of minimum staffing regulations. Adequate numbers of sufficiently competent staff are at the crux of nursing facility care. Yet government regulations do not set a minimum staffing requirement for nursing facilities, instead requiring that facilities determine for themselves what amounts to “sufficient” and “competent” staff for their residents. While experts put minimum adequate nursing staffing time at 4.1 to 4.8 hours per resident per day, most facilities self-reported to the government providing less than that; almost one thousand facilities self-reported providing less than three hours of staff time per day.
  • Weak enforcement of federal regulations specifically banning chemical restraints and unnecessary drugs. Federal regulations prohibit chemical restraints—drugs used for the convenience of staff or to discipline residents without a medical purpose—and unnecessary drugs: a technical term meaning drugs used without adequate clinical indication, monitoring, or tapering. The regulations also provide for the right to refuse treatment. However, federal and state enforcement of these regulations is so weak that the drugs are routinely misused without significant penalty. Almost all antipsychotic drug-related deficiency citations in recent years have been determined to be at the level of causing “no actual harm,” curtailing the applicability and severity of financial sanctions.
With such vast numbers of nursing facility residents still getting antipsychotic drugs that many do not need, do not want, and that put their lives and quality of life at risk, federal and state governments need to do more to ensure that the rights of residents are adequately protected. An industry entrusted to provide care—and paid billions of public and private dollars to do so—cannot justify compounding the vulnerabilities, challenges, and loss that people often experience with dementia and institutionalization.

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How Nursing Homes in the United States Overmedicate People with Dementia

US care homes over-prescribing drugs for residents with dementia, report finds

Nursing homes in the US are inappropriately medicating an estimated 179,000 residents with dementia each week, in what amounts to use of “chemical restraints”, according to a new Human Rights Watch report.

The 157-page report, titled ‘They Want Docile’ claims thousands of long-term nursing-home patients with dementia are inappropriately given antipsychotic drugs not designed for them. In many cases, the report states, antipsychotics are prescribed because of their sedating effects, making dementia patients easier for staff to handle.

Antipsychotic drugs carry a serious warning from the US Food and Drug Administration called a “black box” because the drugs increase dementia patients’ risk of death. The drugs were developed to treat psychiatric conditions such as schizophrenia.

Hannah Flamm, an NYU law school fellow at Human Rights Watch: “People with dementia are often sedated to make life easier for overworked nursing home staff, and the government does little to protect vulnerable residents from such abuse.

“All too often, staff justify using antipsychotic drugs on people with dementia because they interpret urgent expressions of pain or distress as disruptive behavior that needs to be suppressed.”

The report comes as lawmakers and researchers are warning of a wave of aging baby boomers. Currently, more than 5 million Americans have Alzheimer’s, and one in three seniors dies with Alzheimer’s or another dementia. The number of people with Alzheimer’s could triple by 2050.

Researchers with Human Rights Watch interviewed 323 people and visited 109 nursing homes in California, Florida, Illinois, Kansas, New York and Texas between October 2016 and March 2017. They used federal data to estimate the percentage of patients nationally who inappropriately receive such drugs.

Researchers found instances where patients or their proxies (such as family members) were not told of the risks of antipsychotic drugs, or felt their loved ones would be removed from a facility if they were taken off the drugs.

“[It] knocks you out,” a 62-year-old woman from a nursing facility in Texas told HRW. She said she was given Seroquel, an antipsychotic drug, without her knowledge. “It’s a powerful, powerful drug. I sleep all the time. I have to ask people what the day is.”

In another instance, the director of a nursing facility in Kansas told HRW that, “antipsychotics are a go-to thing”.

Rates of nursing home residents on antipsychotic drugs have declined in recent years, but government reports have said there is more work to do.

The HRW report chimes with others, including a recent government report, which found high rates of antipsychotic drug use in US nursing homes.

For example, a federal government report found that in 2012, 33% of older adults with dementia who lived in nursing homes were prescribed antipsychotics, versus 14% who lived outside nursing homes.

The most common antipsychotics address conditions such as schizophrenia and bipolar disorder. However, the FDA has found the drugs are commonly prescribed for “off-label” disorders.

“The trend now is to reduce the use of antipsychotic medication, and to monitor and to use them as appropriate,” said a spokeswoman for LeadingAge, a lobbying group for nursing facilities.

The report follows the Trump administration relaxing regulations on nursing homes, which discouraged regulators from levying fines on violators.

HRW called on the government to step up efforts against antipsychotics use in nursing homes.The federal government pays for the majority of nursing home residents’ care through the public health program Medicaid.

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US care homes over-prescribing drugs for residents with dementia, report finds