Saturday, July 13, 2019

Maggots, amputations and naked thieves: Government watchdog details hospice deficiencies

Newly released reports showed many US hospice facilities had at least one deficiency.
Newly released reports showed many US hospice facilities had at least one deficiency.

(CNN) - Maggots growing around a dying man's feeding tube. Staff failing to treat the wounds of a patient with Alzheimer's disease, forcing the amputation of a leg. Caregivers unable to recognize injuries on a woman's pelvic area as signs of sexual assault and repeatedly trying to insert a urinary catheter instead, sending the woman to a hospital.

These are just a few of the graphic details revealed in two reports on US hospice care released Tuesday by the Office of Inspector General for the Department of Health and Human Services. More than 80% of end-of-life facilities in the United States had at least one deficiency, the report found, and more than 300 -- about 18% -- were poor performers with serious problems that jeopardized patient health and safety.

The inspector general found that "these hospices did not face serious consequences for the harm described in this report" and argued that the Centers for Medicare and Medicaid Services (CMS) needs greater legal authority to penalize hospices with life-threatening violations.

"CMS cannot impose penalties, other than termination, to hold hospices accountable for harming beneficiaries," the report said. Congress would have to give the agency permission to impose fines on hospices, which it can already levy against nursing facilities, and the inspector general urged CMS to seek that authority.

It is also nearly impossible for the public to know about hospice deficiencies like those described in the report because CMS does not include that information on its Hospice Compare website.

The agency cannot legally disclose all deficiency information it receives -- such as survey reports from outside accrediting organizations -- but the agency can publish reports from state agencies, according to the inspector general. So far, it has chosen not to.

Graphic details and serious violations, but few consequences

In a statement, a CMS spokesperson said that the agency "has zero tolerance for abuse and mistreatment of any patient, and CMS requires that every Medicare-certified hospice meet basic federal health and safety standards to keep patients safe."

Medicare spent more than $17 billion on hospice care in 2017, according to the report, and cared for more than 1.5 million patients. But some of that government-funded care actively endangered patients, according to the Office of Inspector General, and hospices suffered few consequences.

In one case, a woman was consistently abused by her daughter, who was acting as her caregiver. "The daughter would use a chain and elastic seatbelt to keep the beneficiary from getting out of bed," the report stated. "The daughter would also leave her mother in a wheelchair in the bathroom with the lights off and would spray her with water when she called out for help."

The hospice's social worker was notified of signs of abuse, the report found, but did not visit the patient for several weeks. When the social worker finally visited, he didn't assess the patient's safety.

In another case, a woman sustained significant injuries in her pelvic area, on her upper leg and on her right forearm. Hospice staff failed to recognize these as signs of a possible sexual assault, the report found, and did not report them to hospice administrators or local law enforcement.

Instead, the hospice obtained a physician's order to insert a urinary catheter, which staff tried and failed to insert multiple times. The woman was eventually sent to a hospital, where staff recognized signs of the possible sexual assault and called the police.

But the hospice said that it was under no obligation to report the possible sexual assault to CMS, according to the inspector general report. "CMS requires a hospice to report abuse, neglect, and other harm in only one circumstance: when it involves someone furnishing services on behalf of the hospice and the hospice has investigated and verified the allegation," the report notes.

Because an accusation of assault had not been leveled against a hospice employee, "the hospice claims that it had no obligation to investigate the possible assault of a beneficiary in its care," according to the inspector general.

In another case, one patient's neighbor repeatedly came into his apartment "naked, high, and drunk" and stole medications, including opioids and anti-anxiety pills. While several hospice employees were aware of the situation, "the hospice planned no further actions to notify law enforcement or to ensure the beneficiary's safety," according to the report.

While nursing facilities must report all alleged abuse or exploitation to officials, including CMS, the hospices have no such obligation under Medicare reporting requirements, according to the inspector general.

Administrators defend their record

In a letter to the inspector general that was included in the report, CMS administrator Seema Verma defended her agency's record and argued that the report highlighted only the worst violations.

"While these cases that were identified during surveys of hospices are very serious," said Verma, "we want to reassure beneficiaries considering hospice care that these cases are not indicative of the type of care the majority of hospice beneficiaries receive."

CMS agreed with most of the inspector general's recommendations, such as educating hospices on common deficiencies and increasing oversight of the most serious offenders, but argued that state reports on hospice violations should not be publicly accessible on the agency's website, Hospice Compare.

"CMS stated that while it supports increased transparency of hospice survey findings, publicly reporting survey reports only from State agencies -- while CMS is currently prohibited from sharing information from surveys by accrediting organizations -- may be misleading to consumers while researching hospice options," according to the inspector general.

Those state reports are currently required to be publicly available, according to the report, but CMS has not made them easily accessible. President Trump's 2020 budget includes a proposal to allow disclosure of survey reports from accrediting organizations, Verma said. If the agency receives that authority, she added, CMS will "evaluate the best approach for publicly disclosing these reports."

The agency said in a statement that it has taken other actions to ensure patient safety, arguing that it is "laser-focused on improving its oversight of healthcare facilities, including hospices," according to a spokesperson.

"Just this year, CMS issued new guidance to surveyors -- who inspect hospices and other facilities -- to help them more quickly identify and address the most grave patient safety situations, called 'immediate jeopardy,' " said the spokesperson. "CMS now requires surveyors to follow a standardized process when they identify immediate jeopardy situations."

But agency actions can only go so far, according to the inspector general, and actually improving conditions may fall to congress. "CMS should seek statutory authority to establish additional, intermediate remedies for poor hospice performance," said the report. "To effectively protect beneficiaries from harm, CMS must have enforcement tools."

Full Article & Source:
Maggots, amputations and naked thieves: Government watchdog details hospice deficiencies

The Strange Political Silence On Elder Care

Millions of middle-aged women struggle to care for ailing older relatives, and the crisis is only getting worse. So why is no one talking about it?

Labors of love: It took a long time for Alexis Baden-Mayer (right) to view the uncompensated care she provides her ailing mother as a political issue. (Pete Marovich)
For Alexis Baden-Mayer, who lives with and cares for her two elderly parents, the audiobook of Marcel Proust’s six-volume novel, In Search of Lost Time, has two distinct benefits. First, it provides 150 hours of literary distraction. Second, it features a character who jokes about excrement. 
“Play it in the car as you drive your loved-ones to doctors appointments,” she wrote in a blog post about her caregiving experience. “Play it each morning as you strip soiled linens from the mattresses, make beds and fold laundry. Play it, as I have, to try to calm and distract yourself as you bark commands to your dementia-addled mother to wipe her butt and drop the toilet paper in the toilet.”

Baden-Mayer, a freckled forty-five-year-old, put her house on Airbnb three years ago and moved with her husband and two kids into her parents’ home in Alexandria, Virginia. Her mom, who has Alzheimer’s disease, was no longer able to take care of her dad, who had suffered from heart failure. “I didn’t really have a good idea of what I was getting into, quite honestly,” she said, reflecting on what a truly frank conversation with her husband would have sounded like: “What do you think of living with my parents for about ten years while their health declines and they die?” 

When I went to visit one morning in May, her day had started at five a.m. Hair still wet from her shower, she steered her mother through a morning routine. She told her where to put her hands to wash herself, then placed her mom’s feet through the leg holes of her adult diaper. Without Baden-Mayer’s kind but firm instructions, her mother would start staring into space, seemingly happy but unsure of where to go next. More than once, when her mother was smiling at me, perplexed, Baden-Mayer explained my presence. (“She’s a journalist. She’s working on a story about family caregiving.”) The long dining room table was a laundry-folding assembly line, piled with six people’s clothes. 

Baden-Mayer is one of about thirty-four million Americans providing unpaid care to an older adult, often a family member. Most of these caregivers are middle-aged, and most are women. They are individually bearing most of the burden of one of America’s most pressing societal challenges: how to care for a population of frail elders that is ballooning in size.

Most people assume that Medicare will cover the type of long-term personal care older people often need; it does not. Neither does standard private health insurance. And the average Social Security check can only make a medium-sized dent in the cost of this care, which can easily exceed $100,000 a year if provided in a nursing home. Medicaid, unlike Medicare, does cover long-term care, but only for patients who have exhausted their savings, and coverage, which varies from state to state, can be extremely limited. So the safety net you thought would catch you in old age is less like a net and more like a staircase you get pushed down, bumping along until you’ve impoverished yourself enough to hit Medicaid at the bottom.

Private long-term care insurance exists, but it’s the designer bikini of insurance: too expensive, skimpy coverage. Since people tend to buy it only when they know they’ll soon be making a claim, there are never enough healthy people paying into the plans to keep them affordable. Insurance companies have realized this and jacked up premiums—or stopped selling policies altogether. 

Meanwhile, the cost of hiring a home health aide to take care of a frail parent can add up to $50,000 or more per year. So tens of millions of individual women across the United States wind up providing the care themselves for free, and bearing its cost in the form of stress, lost wages, and lost opportunities to nourish their other needs, and their families’. When we talked on the phone, Baden-Mayer wondered aloud, “Why is it that we don’t have a good system that we can plug into when our parents need care?” 

Why indeed? You might expect that a problem that affects so many people so profoundly would become a major political issue. Recent years have seen other issues, including ones that disproportionately affect women in their personal lives, become highly politically salient—from sexual harassment and pay equity to the push for universal pre-K education and improved access to child care. Yet even though American women today are politically organized and running for office in record numbers, elder care remains widely viewed as a purely personal matter. You could be a news junkie, following the 2020 race closely, and have heard nothing about it. 

Why is that? And could long-term care go from being a sleeper issue to one that boosts a candidate out of the 2020 pack? 

Demographic trends have prodded and pulled America’s long-term care problem into a long-term care crisis. A driving factor is the increasing risk of reaching a point in our lives when we can no longer perform some of the essential activities of daily life, from getting dressed to using the toilet. Approximately half of us will need some form of long-term care, and an estimated 15 percent will face related medical bills exceeding $250,000. 

Paradoxically, this is partly due to advances in medicine. Since the 1940s, for example, antibiotics have dramatically reduced the numbers of Americans dying of pneumonia, which was once a leading cause of death among older Americans. But advances like those mean more people are living long enough to contract debilitating chronic conditions like Alzheimer’s. 

On the flip side are broad public health trends like obesity and the spread of sedentary lifestyles. These have led to an epidemic of chronic diseases like diabetes that, while not necessarily fatal, leave more and more people struggling with disabling conditions for decades.

Then there’s the looming impact of Baby Boomers hitting retirement, so massive that it’s often referred to in the terminology of natural disasters, like “the gray tsunami.” If you look at a chart of the ratio of middle-aged adults (potential caregivers) to people over eighty (the people most likely to need care), it’s like the steep downhill of a roller coaster, starting at seven to one in 2010, and plummeting to four to one by 2030. In addition, average family size has shrunk significantly since the 1970s. With smaller families now the norm, the strain on individual caregivers within families has increased enormously. The imbalance will become even more acute if America cuts back on the flow of immigrants, who make up a large portion of professional caregivers.  

This was easy to see coming, by the way. As far back as 1971, Congress held hearings on the impending crisis in long-term care, and throughout the 1980s and ’90s, think tanks and blue-ribbon commissions issued a stream of reports on what to do about it, predicting catastrophic consequences by the 2020s if the problem went unaddressed. But it did go unaddressed, perhaps because, like climate change, it was both unpleasant to contemplate and seemingly far off in the future. Meanwhile, other countries with aging populations, including Japan, Canada, and most European nations, took action, offering a range of substantial benefits to family care providers, from directly compensating their work to subsidizing professional home care. But in the United States, public attention to long-term care faded even as the problem grew increasingly acute. 

Sandra Levitsky has a theory about why long-term care has not yet gained traction as a political issue. A sociologist at the University of Michigan, she’s the author of Caring for Our Own: Why There Is No Political Demand for New American Social Welfare Rights, a book she researched in part by schlepping between adult day care centers, nursing homes, and a hospital in Los Angeles, interviewing caregivers and scribbling notes at the back of support group meetings. 

Levitsky found that the lack of public outcry for long-term care didn’t reflect an absence of need. Instead, it was driven by a widely held belief that caregiving is a family responsibility, tied up with what it means to be a good son or daughter. And because it’s so time intensive and takes place in the home, caregiving is often extremely isolating, making it hard to see it as a systemic issue. One woman who was caring for her husband told Levitsky that when she went to a support group for the first time, “I just started to cry. I just thought, ‘My god! I’m not in this alone!’ ”

Rachel McCullough, an organizer affiliated with Caring Across Generations, a national campaign, noticed this while canvassing door to door in the Bronx. She found that asking people whether they were a caregiver didn’t really work; people didn’t identify themselves that way. Instead, she found that to get a conversation going, she had to ask more descriptive questions—“Have you taken care of your parents?”—or share her own stories. 

The fact that people don’t identify as “caregivers” helps to explain why even women who are otherwise politically engaged don’t view the care they provide to their aging parents as a political issue. Baden-Mayer is a good example. A former women’s studies major, her laptop is as layered with stickers as a college student’s—“Vote YES on Prop 37”—and she works full time as a political director for a nonprofit advocacy group for organic food consumers. In the foyer of her house hangs a photo of a man throwing up a peace sign in front of the U.S. Capitol. If anyone were to connect their own experience to a systemic problem, you’d expect it to be someone like her. But she admits that, for a long time, she really didn’t. And she definitely didn’t question the relative silence from lawmakers on the issue. 

Another barrier to politicizing the long-term care crisis is the fact that there’s no clear bad guy. As McCullough put it: environmentalists have the fossil fuel industry, gun control activists have the NRA, and consumer advocates have the big banks. Who, exactly, are caregivers fighting? Instead of feeling anger, which research shows is linked to political activation, people struggling with providing for their parents tend to feel guilt and shame, directing the blame inward. Once the stressful experience is over, most people want to put it behind them. Still, Levitsky found that some people come out of it wanting to improve the system, particularly middle-aged women. “It was a subset of the group, but they were really politicized,” she said. “And that’s the constituency that I do believe could be mobilized.”

But someone is going to have to mobilize them. Even when participants in Levitsky’s study were directly asked about whether their experience had changed their attitude about the government’s responsibility for helping, a common response was that they simply hadn’t thought of the government’s role. Levitsky said, “When you believe something is so natural, you can’t imagine things being another way.” 

In fact, when it comes to long-term care, it is possible for things to be another way. In mid-May, for example, Washington State Governor and long-shot presidential candidate Jay Inslee signed off on the country’s most sweeping long-term care bill. The law provides eligible residents with a lifetime benefit of up to $36,500 to pay for things like meal delivery, nursing home fees, and home help, including paying a family member who is providing care. 

Passing the bill required a diverse coalition—including the nursing home industry, home health worker unions, disability rights advocates, and the Alzheimer’s Association—to put aside their differences and get on the same page when talking to legislators. It helped that one of the law’s champions, State Representative Laurie Jinkins, had both professional public health experience—she works for a county health department—and a personal connection to the issue. In a speech on the state house floor in support of the bill, Jinkins explained how her mother-in-law ended up having to spend herself into poverty to qualify for Medicaid when she could no longer live alone. 

A crucial factor in getting the bill passed was a study, conducted by the national actuarial firm Milliman, showing that it would soon save hundreds of millions per year in Medicaid costs. “What we found was that it was critically important that legislators could have confidence in the numbers,” said Sterling Harders, president of a regional SEIU union that represents care workers, who advocated for the bill. 

The law is financed by a .58 percent state payroll tax. How can the state finance such a large new benefit with such a modest tax hike? The key is that everyone contributes, including people who are still young and healthy, and to reap the benefit, you have to pay into the system. 

This solves the problem of adverse selection that makes the private provision of long-term care ruinously expensive. Rather than trying to buy insurance only when they’re old and frail enough to expect to make a claim in the near future, Washington residents are now in effect compelled to spread out the cost of their insurance over their entire adult lives, making it much more affordable.

Washington’s approach is also much more efficient than expecting people to save up a nest egg to cover the cost of their own long-term care. Roughly half of us will never need it; among those of us who do, some will need it only for a short time, while others will consume hundreds of thousands of dollars of care over several years. And yet for most of our lives we can’t really know which group we belong to. That makes long-term care a logical candidate for financing collectively through insurance, so long as paying into the system is mandatory. When plans aren’t mandatory, not enough healthy, young people self-select to buy them, and they tank. That’s one of the reasons that the Obama administration ultimately had to pull the plug on its attempt to address long-term care; because the program was voluntary, not enough people enrolled, making premiums far too expensive.

That’s not to say that providing universal long-term care insurance wouldn’t cause sticker shock when it shows up in government budgets. But the fact is that, one way or another, society is already bearing these costs—mostly in the form of care provided by stressed-out, uncompensated women who have the misfortune of having a family member who needs care and can’t afford to pay for it. What we need is a way to distribute that burden more equitably. 

You can divide the world of politicians into two groups,” said Howard Gleckman, a senior fellow at the Tax Policy Center. “It’s not Democrats and Republicans, it’s people who have been caregivers and people who haven’t.” When he’s talking to members of Congress who recognize the problem, it’s far more likely that their understanding comes from personal experience than from an outpouring of calls from constituents. Gleckman himself started working on the issue after he and his wife struggled to care for their own parents. “Don’t underestimate the importance of policy by anecdote,” he said. 

It’s a point that several other advocates and policy experts echoed. One organizer working on caregiving issues in Michigan found an ally in a Republican legislator with a prime perch on a budget committee. That legislator’s mother, the organizer found out, had qualified for Medicaid and was placed in a nursing home because there was a long waiting list for home services. 

One lawmaker who feels strongly about an issue could be worth twenty who merely support it. A prominent example came in 2008, when Congress voted on a bill requiring insurers to cover mental illnesses at the same level as physical ones. It was the result of over a decade of determined lobbying from Senator Pete Domenici, a senior Republican, fiscal hawk, and chairman of the powerful Senate Budget Committee. Otherwise an unlikely champion, Domenici was propelled by his daughter’s experience with schizophrenia. He joined forces with one of the most liberal senators at the time, Minnesota Democrat Paul Wellstone, whose brother had suffered from mental illness, and together they built alliances with a number of other legislators who had likewise been personally affected. 

The prospects for long-term care coverage at the national level got a boost this past April, when Bernie Sanders added it to his single-payer health care plan. But if support for family caregivers is to become a priority in the coming election cycle, it may be because some of the other candidates have had their own brushes with long-term care. Amy Klobuchar, the 2020 candidate with perhaps the longest legislative history of working on issues that affect seniors, has talked about her father’s struggle with alcoholism. Cory Booker has been vocal about Parkinson’s disease, which his father suffered from, and is proposing an expansion of the Earned Income Tax Credit that would give caregivers more money. “I watched my mother be his primary caretaker, and it affected her physical health,” he told a small crowd at a campaign event in February. “The personal pain I saw it causing my mom was devastating to me.” He added, “This is a common problem in our country. We are weak in America when we let people struggle and suffer in isolation.” 

Rachel McCullough, the organizer in New York, said her group is already thinking about how to bring this issue to the forefront of the 2020 presidential campaign. They already have organizers and volunteers working on a state campaign in Iowa, which is dense with national press and where it’s relatively easy to get face time with candidates. In televised town hall meetings, their Iowa counterparts may try to force candidates to articulate a position on caregiving. McCullough said, “A case we’re trying to make, and that we will be making to the presidential candidates, is if their goal in the face of Trump and Trumpism is to speak to and unite the vast majority of Americans, with a focus on women—this is the issue.”

Full Article & Source:
The Strange Political Silence On Elder Care

A Paradigm Shift: The End Of Inheritance For The Middle Class

Diversity & Inclusion
I am an attorney, author and consultant on employment discrimination.
Increasingly, the old family homestead is not being passed down to the family when the parents die.

Older parents are taking advantage of reverse mortgages to pay off credit cards and to escape poverty and debt. This reduces equity in the home and often leads to foreclosure, leaving traditional heirs with nothing but memories.

Not only are reverse mortgage companies feasting upon the assets of older Americans; so too are health insurers and prescription drug companies.

Moreover, seniors on a fixed income were adversely affected by President Trump’s Tax Cuts and Jobs Act, which raised the threshold on medical expense tax deductions and placed a cap of $10,000 on the itemized deductibility of state and local taxes.

America seems to be in the midst of a paradigm shift. Wealth transfer is skipping the deceased’s traditional heirs and going directly into the pockets of mortgage companies, banks, international corporations and the government.

The Lure of Reverse Mortgages

An alarming percentage of older Americans have insufficient money to cover basic necessities. According to the Institute on Assets and Social Policy, one-third of senior households have no money left over each month or are in debt after meeting essential expenses. This makes them vulnerable to the lure of reverse mortgages.

Reverse mortgages allow homeowners age 62 and above to withdraw a portion of their home’s equity to help them pay expenses in retirement. The debt usually comes due when the borrower dies and is repaid through the sale of the home. However, borrowers can face foreclosure while living if they fall behind on property taxes or homeowner’s insurance.

USA Today recently did an investigation of foreclosure actions related to reverse mortgages and found they are disproportionately concentrated among poor minority homeowners in urban areas, including San Francisco, Chicago, Miami and Philadelphia.

It should come as no surprise that older Americans need income in retirement.

Little more than a decade ago, the U.S. was plunged into the worst recession in 100 years due to financial misdealing (involving risky mortgages) that led to the collapse of Wall Street. Many older workers lost good jobs, pensions and health care. Many spent down their savings. Few had the time or opportunity to rebuild.

Older workers today, and especially women, continue to suffer from epidemic levels of age discrimination in hiring. Many are relegated to low-wage part-time work until they are dumped into a financially insecure retirement.  The average Social Security benefit in 2019 was $17,532 but the actual benefit is far lower for women and minorities due to pay gaps, discrimination and other challenges. These groups also tend to lack pensions and savings. The Social Security Administration says 43% of single Social Security recipients aged 65+ depend on Social Security for 90% or more of their income. Meanwhile, Go Banking Rate recently estimated the cost of a comfortable retirement in the least expensive state (Mississippi) in the United States is more than $50,000 a year.

It is disappointing  for adult children to discover too late that their parents tapped out the equity of a home that, in some situations, their parents had inherited from their parents. It is  tragic when their inheritance disappeared into the coffers of a predatory lender. But what are older homeowners supposed to do in the absence of effective federal, state and local policy initiatives that allow them to age in place with dignity?

Poor Public Policy

In response to the USA Today series, Peter Bell, Chief Executive Officer of The National Reverse Mortgage Leaders Association, called reverse mortgages a “lifesaver” for seniors who “have little to no savings and rely primarily on Social Security.” He notes seniors may be ineligible for home equity loans and cash-out refinancing because of insufficient income to cover monthly payments or poor credit profiles.

However, forcing seniors to take out reverse mortgages to stave off poverty represents poor public policy at best.

For one thing, taxpayers are footing the final bill. The Federal Housing Administration, a part of the Department of Housing and Urban Development, insures reverse mortgages, otherwise known as Home Equity Conversion Mortgages or HECMs. As USA Today pointed out, the FHA fund is in the red more than $13.6 billion because of an increase in claims paid out to reverse mortgage lenders since the recession.

Congress has done nothing to help retirees. However, State Rep. John B. Larson, D-CT, the Ranking Member of the House Ways & Means Subcommittee on Social Security, has  proposed the  Social Security 2100 Act, HR 1902, which would increase Social Security benefits by about 2% and set the minimum benefit at 25% above the poverty line. It would ensure the Social Security cost-of-living adjustment reflects actual costs incurred by seniors and would cut taxes for more than 12 million Social Security recipients. Moreover, the bill, which has 210 cosponsors (all Democrats), would increase funding coming into the system. Presently, payroll taxes are not collected on wages over $132,900. This legislation would apply the payroll tax to wages above $400,000, which would affect the top 0.4% of wage earners. Initially, earnings between $139,900 in 2019 and $400,000 would not face payroll taxes but this “donut hole” would eventually disappear. The bill also would phase in an increase in the contribution rate so that by 2043 workers and employers would pay 7.4% instead of 6.2% today.

Several hearings have been held on the bill, which was originally introduced in 2017 and is supported by the NAACP, NOW and Latinos for a Secure Retirement. A final version, incorporating amendments, is expected this fall.

If Congress continues to do nothing, America’s retirees will face increasingly difficult choices. These choices will inevitably trickle down to their children, who will be deprived of an inheritance that was customary for prior generations. This will be the end of inheritance as we know it for all but the most wealthy.

Full Article & Source:
A Paradigm Shift: The End Of Inheritance For The Middle Class

Friday, July 12, 2019

Tonight on Marti Oakley's TS Radio Network, with co-host Coz Whitten-Skaife: TS Radio: The Aftermath of Predatory Guardianships...Who Really Pays the Price?

7:00 pm CST

Tonight Coz and I will be discussing the aftermath of these predatory guardianships. What happened to the victims? What happened or is happening to the family as a result of collateral damage? Joining us will be Liz and Donna who can speak to the results of being drawn into this corrupt system. Both will give us a close up view of what retaliation looks like and feels like. What actions they took trying to counter the horrific situation that was unfolding in front of them. Also, what happens when APS interferes and becomes a threat?

We will also be updating on the ongoing battle of those subjected to the "Ottholes" in Pennsylvania, along with news on a case in Alaska concerning a large, wealthy family in Anchorage.

So much to talk about...and only an hour this evening! Somebody has cakes to bake!!

This is Coz's new page:   NASGA Wisconsin.

LISTEN to the show LIVE or listen to the archive later

Guardian filed DNR orders without permission, says judge who seeks her removal from nearly 100 cases

“I have been working in the elderly and disabled industry in the Central Florida area for over 20 years,” Rebecca Fierle wrote on the website for her practice, which was taken down Thursday. “My experience helps my clients and their families tremendously.”
Thorpe also wants Fierle removed for allegedly compensating herself as a Medicaid caseworker for her wards, which included receiving payments from hospitals and other facilities without disclosing those payments to the judge, court records said.

Fierle also “failed to disclose related interests and employees” and violated practice standards for professional guardians, including considering the ward’s preferences when making medical treatment and end-of-life decisions, Thorpe said.

“The Court finds that Ms. Fierle has abused her powers, developed conflict of interest with the Ward, and become a disqualified person, thereby establishing grounds for removal as guardian of the person and/or property of the ward,” Thorpe wrote in the removal notice.

Attorneys for Fierle filed a motion Wednesday to disqualify Thorpe from the cases because the guardian “has a well-founded fear that she will not receive a fair trial or hearing.”

“Fierle has no knowledge or notice of what witnesses or evidence the Court has relied upon to make its findings, or if the evidence relied upon was under oath, or what witnesses and evidence will be brought forward at the hearing,” the motion said.

Fierle and her attorney did not immediately respond to a request for comment.

On the website for her practice, Fierle said she was a “professional guardian,” as well as a “certified geriatric care manager for over 10 years.” The site was taken down Thursday.

“I have been working in the elderly and disabled industry in the Central Florida area for over 20 years,” Fierle wrote on the website. “My experience helps my clients and their families tremendously.”

Full Article & Source:
Guardian filed DNR orders without permission, says judge who seeks her removal from nearly 100 cases

Legislation approved this session to assist seniors, disabled

With the dust settling after the adjournment of the 2019 legislative session on June 30, 2019, Rhode Island Governor Gina Raimondo halfheartedly signed the state’s 2020 fiscal year $9.9 billion budget into law.

The newly enacted budget closes a $100 million budget gap while avoiding new taxes for businesses, fully funding the state’s education aid formula, continuing to phase-out the car-tax, maintaining fiscal support for municipalities. And, lawmakers did not forget older Rhode Islanders and disabled persons, putting tax dollars into programs assisting them.

Included in the state budget signed by Raimondo is $499,397 to fund the Rhode Island Livable Home Modification Grant Act that was introduced by Rep. Joseph M. McNamara, D-Warwick, Cranston and Sen. Walter S. Felag Jr., D-Bristol, Tiverton, Warren. The grant allows eligible homeowners and renters to retrofit their residence to nationally recognized accessibility standards and receive 50 percent of the total sum spent, up to $5,000, to retrofit their existing residence. The intent of this state program is to assist older Rhode Islanders and disabled persons to stay safely in their homes longer rather than being admitted to costly nursing homes, which costs taxpayers millions of dollars each year in Medicaid costs. With the graying of state’s population, there is a need for housing that is safe and adapted to the needs of their older occupants. (The Livable Home Modification Grant Application and Post-Retrofit Claim form can be found

Meanwhile, aging advocates gave the thumbs-up to Rhode Island lawmakers who eliminated a sunset provision in the state budget for a program that provides fare-free bus passes to low-income seniors and elderly Rhode Islanders, making this program permanent.

Awaiting the governor’s signature

The General Assembly passed legislation (S 0691A, H 6219), introduced by Senator Frank S. Lombardi, D-Cranston and Rep. Evan P. Shanley, D-Warwick, that would help caregivers to build onto their houses to provide space for relatives. The measure now moves to the governor’s office for consideration. The legislation expands the definition of family member for purposes of zoning ordinances to include child, parent, spouse, mother-in-law, father-in-law, grandparents, grandchildren, domestic partner, sibling, care recipient or member of the household.

Under the legislation, the appearance of the home would remain that of a single-family residence with an internal means of egress between the home and the accessory family dwelling unit. If possible, no additional exterior entrances would be added. Where additional entrance is required, placement would generally be in the rear or side of the structure. This legislative session, State lawmakers also approved legislation sponsored by Sen. Adam J. Satchell D-West Warwick and Rep. Robert E. Craven, D-North Kingstown, to establish a formal process recognizing supported decision making, a structure of support for disabled or aging individuals. The legislation, which now heads to the governors desk, establishes a system of personal support that is less restrictive than guardianship to help individuals maintain independence while receiving assistance in making and communicating important life decisions. It is aimed at providing an alternative with more self-determination for individuals who are aging or who have developmental or intellectual disabilities. Under the bill (2019-S 0031A, 2019-H5909), Rhode Islanders would be able to designate another person, or a team of people, as a supporter who would help them gather and weigh information, options, responsibilities and consequences of their life decisions about their personal affairs, support services, medical or psychological treatment, education and more. The supporter would also help the individual communicate the persons wishes to those who need to know. The legislation creates a legal form that establishes the agreement between individuals and their supporters, and designates the types of decisions with which the supporter is authorized to help. The bill establishes that decisions made with support under such an agreement are legally valid, and allows supporters to assist with the accessing of an individuals confidential health and educational records. It also requires that any other person who is aware that an individual is being abused, neglected or exploited by their supporter is obligated to report that abuse to the proper authorities.

Protecting Rhode Island’s seniors, disabled from financial exploitation

Sen. Valarie J. Lawson, D-East Providence and Rep. Joe Serodios D-East Providence, legislation (2019-0433A, 2019-H 6091A), Senior Savings Protection Act, was passed by the General Assembly and now heads to the Governor’s desk for signature. The act would require certain individuals to report the occurrence or suspected occurrence of financial exploitation of persons who are age 60 and over or those with a disability between the ages of 18 and 59 years old. According to the legislation, if a qualified individual, a person associated with a broker-dealer who serves in a supervisory, compliance or legal capacity, believes that financial exploitation is taking place, or being attempted, the individual must notify Rhode Island’s Department of Business Regulation and Division of Elderly Affairs, and law enforcement. The individual may also alert immediate family members, legal guardians, conservators, or agents under a power of attorney of the person possibly being financially exploited. The legislation also calls for the Department of business Regulation and the Division of Elderly Affairs to develop websites that include training resources to assist in the prevention and detection of financial exploitation against Rhode Islands seniors and disabled.

Combating Alzheimer’s disease

With the number of persons with Alzheimer’s disease expected to increase in the coming years, the General Assembly approved bills to better support Rhode Islanders affected by debilitating mental disorder and to protect against elder abuse. There are an estimated 23,000 Rhode Islanders age 65 and older living with Alzheimer’s disease. In just six years, the number is expected to increase to 27,000.

The Rhode Island General Assembly approved legislation (20223, 2019-H 5178) sponsored Sen. Senator Cynthia A. Coyne, D-Barrington, Bristol, East Providence, and House Majority Leader K. Joseph Shekarchi, D-Warwick, to establish a program within the Department of Health dedicated to Alzheimer’s disease, and create a 13-member advisory council that would provide policy recommendations, evaluate state-funded efforts for care and research and provide guidance to state officials on advancements in treatment, prevention and diagnosis. The bill is based on legislation signed into law last year in Massachusetts. The legislation requires the Department of Health to assess all state programs related to Alzheimer’s, and maintain and annually update the states plan for Alzheimer’s disease. It would also require the Department of Health to establish an Alzheimer’s disease assessment protocol specifically focused on recognizing the signs and symptoms of cognitive impairments, and appropriate resource information for effective medical screening, investigation and service planning. The legislation would also require caseworkers working with the Department of Elderly Affairs to become familiar with those protocols. Additionally, the legislation would require a one-time, hour-long training on diagnosis, treatment and care of patients with cognitive impairments for all physicians and nurses licensed in the state. Most importantly, adoption of the legislation would enable Rhode Island to qualify for federal funding that is available to help states with their efforts to support those with Alzheimer’s disease. Also gaining final Rhode Island General Assembly approval was legislation (2019-S 0302A, 2019-H 5141) sponsored by Sen. Coyne and Rep. Joseph M. McNamara, D-Warwick, Cranston, to allow the spouses or partners of patients residing in Alzheimer’s or dementia special care unit or program to live with them, even if they do not meet the requirements as patients-themselves.

Finally, Sen. Coyne, who lead the Senates Special Task Force to Study Elderly Abuse and Financial Exploitation, successfully spearheaded an effort this session to pass legislative proposals to beef up the states efforts to combat elder abuse, that is growing and vastly under reported. For details, go to, to access the June 30 commentary, Senate Task Force Calls for Action to Combat States Growing Elder Abuse.

Full Article & Source:
Legislation approved this session to assist seniors, disabled

Hospital errors lead to "dead" patient opening eyes during organ harvesting

By Michelle Castillo 

A Syracuse, N.Y. hospital is facing $22,000 in fines due to improper handling of patients, including one "dead" patient who opened her eyes as doctors were about to remove her organs.

The Syracuse Post-Standard reported that the New York State Health Department found St. Joseph's Hospital Health Center negligent in the case, and admonished the hospital for not adequately looking into how this mistake was made.

Patient Colleen S. Burns was reportedly admitted into St. Joseph's emergency department in 2009 after overdosing on Xanax, Benadryl and a muscle relaxant. Hospital notes obtained by the Post-Standard revealed that the doctors thought she had undergone "cardiac death." After doctors consulted with the family, they agreed to withdraw life support and donate her organs.

What actually happened was that Burns was in a deep coma from her overdose, and did not have irreversible brain damage.

The Health Department discovered that the staff did not perform a recommended treatment to stop the drugs from being absorbed into her stomach and intestines, did not test to see if she was free of all drugs and did not complete enough brain scans. They also did not wait long enough before recommending the patient was taken off life support.

In addition, her doctors did not pay attention to a nurse's notes which stated that Burns was not brain dead and in fact was getting better. A nurse performing a routine reflex test had discovered that Burns' toes had curled downward after the bottom of her foot was touched.

Despite all the signs that Burns was still alive and had brain function, a nurse injected her with a sedative and failed to note it on the chart.

Even when she was being prepped outside the operating room for organ harvesting, her nostrils flared, and she could breathe independently from the respirator. She was also moving her lips and tongue. But, it was only when Burns was actually in the operating room and had opened her eyes that doctors called off the procedure.

"Dead people don't curl their toes," said Dr. Charles Wetli, a nationally known forensic pathologist out of New Jersey who reviewed the case for the Post-Standard, said. "And they don't fight against the respirator and want to breathe on their own."

The hospital's quality assurance program did not complete an objective peer review and root cause analysis until the Department of Health stepped in. In fact, there was no review at all until the Health Department made a surprise visit. That resulted in a one-page document that said the mistake was made because of "perception differences."

Lucille Kuss, Burns' mother, told the Post-Standard that the hospital never told her why they almost had removed her daughter's organs while she was still alive.

"They were just kind of shocked themselves," she said. "It came as a surprise to them as well."

Kuss added that her daughter was so depressed that the incident did not "make any difference to her." Burns committed suicide in January 2011.

The hospital told the New York Daily News that it regretted what happened and had contacted Burns' family to try and rectify the mistake.

"St. Joseph's provides compassionate care to more than 2,000 people every day throughout our system," the hospital told the New York Daily News in a statement. "Anytime something doesn't go right, we take it extremely seriously. In this case, we have made personnel and policy changes and re-examined everything we do related to quality."

The hospital was fined $6,00 for its handling of Burns' case. In addition, the hospital incurred another $16,000 fine due to the case of an unattended patient who fell and injured her head in 2011.

Full Article & Source:
Hospital errors lead to "dead" patient opening eyes during organ harvesting

Thursday, July 11, 2019

Tonight on Marti Oakley's TS Radio Network: TS Radio Network: Whistleblower’s! Fleeing guardianship…Escaped Human Property?

5:00 pm PST…6:00 pm MST…7:00 pm CST…8:00 pm EST

Join us this evening as former Minnesota resident Joanne Bougalis, tells of her mother's capture by a professional guardian and the subsequent deterioration in her mothers', Katherine Bougalis, health and psychological conditions that resulted from being unnecessarily institutionalized, by the guardian, and forcibly drugged with Ativan and Seroquel. After several attempts to free her mother from the guardianship which were of course rejected by the probate civil tribunal (which appears to be the protection arm of this dirty business), Joanne and her mother fled the country and are living safely and happily in Greece. Katherine's assets which were sizable are steadily being accessed by profiteers even as she is denied any access to those same assets. While still living in Minnesota a hearing for Katherine was scheduled. She was also made unavailable for her own hearing by the guardian after a doctor's appointment was scheduled conveniently for the same time as the hearing.

The guardian has been made aware in writing three years in a row where his ward is located. He continues to fraudulently report her missing and her whereabouts unknown in his annual reports. He ignores requests to step down claiming his position is supported by the Judge. He was notified both by Katherine's son and by Social Security of her whereabouts. He took specific steps to delay her social security, and took no steps to provide living and medical expenses for his ward, although it appears from reports the guardian is still paying (someone’s) medical expenses.

Having been stripped of all her rights, via the designation of "ward" of the state and suffering a "civil death", could Katherine now be viewed as escaped human property? Apparently so! As her owner of record continues to bill her estate each year.

LISTEN to the show LIVE or listen to the archive later

NASGA Director Debby Valdez Guests on "Free Talk Live"

Debby Valdez has actively worked for reform in her home state of Texas for many years before accepting a Director position with NASGA.    She has been a strong and instrumental voice for victims and their families in TX; and now with NASGA, she has expanded her efforts nationally, while still keeping her focus on guardianship and guardianship reform in TX.   

Debby is also an avid defender of alternatives to guardianship, including supported decision-making.
NASGA thanks our lucky stars to have Debby on our team!

In this interview, Debby gives a concise overall summary about the guardianship industry, guardianship abuse, and guardianship reform.

Listen to Debby's interview starting at  the 120.05 mark, with host, Mark Edge

Bill protecting seniors passes Assembly

Assembly member Monica Wallace recently announced that legislation she authored to help protect seniors living independently under long-term managed-care plans has passed the Assembly (A.7458).

The passage of Wallace’s bill comes after World Elder Abuse Month and World Elder Abuse Day on June 15, which brought together communities around the world to re-commit to protecting older adults from financial, physical, mental and other forms of abuse.

“Many older New Yorkers require assistance from others in daily living,” said Wallace.

“Unfortunately, that leaves them vulnerable to abuse and exploitation. This measure ensures that seniors in long-term-care plans have an advocate looking out for their interests without having to give up their independence.”

The Long-Term-Care Ombudsman Program is an important resource for residents of nursing homes and other assisted living facilities to ensure they are receiving the care they require.

In addition, the Long-Term-Care Ombudsman Program is currently authorized to advocate on behalf of seniors living at home under long-term managed-care programs as a result of legislation Wallace introduced and passed in 2017 to renew the Long-Term-Care Ombudsman Program for managed long-term-care plans for two years.

However, without legislative action, it is set to expire in December of this year. This legislation extends the authorization of the Long-Term-Care Ombudsman Program to advocate on behalf of managed long-term-care participants through December 2021. For those seeking additional information or assistance, the Long-Term-Care Ombudsman Program can be reached at 1-855-582-6769.

Last month, Wallace joined Western New York leaders in Buffalo to recognize June as World Elder Abuse Month, bringing attention to the vulnerability and abuse that older adults are subjected to. In doing so, Wallace and her colleagues in government and non-profits aim to eradicate elder abuse in Western New York.

“The ombudsman program has proven itself to be critical resource in combatting elder abuse, and I’m proud to pass legislation to build upon its record of success,” said Wallace.

Full Article & Source:
Bill protecting seniors passes Assembly

Maggots found in wound at aged care home

Annunziata Santoro's daughter has told a royal commission of maggots in her mother's foot wound.

A woman has told how maggots were found in a wound in her mother's heel shortly before her death which had been left untreated for months in a Melbourne aged care home.

Anamaria Ng wept while telling the Royal Commission into Aged Care about how horrified she was about had happened to her mother Annunziata Santoro.

The Assisi Centre nursing unit manager Jamuna Jacob had tried to stop her GP Eric Tay telling Ms Ng and other family members about the maggots, she said.

Dr Tay confirmed that on Wednesday.

Mrs Santoro, who had dementia, died only days later at the age of 94 in October 2018 with a bone infection in her heel contributing to her death, according to Dr Tay.

The wound was allowed to deteriorate for at least two months before the family or Dr Tay were told about it, the commission heard.

Assisi staff told Ms Ng and Dr Tay that Mrs Santoro's increasing agitation was a behavioural problem, that she was "not in much pain at all" and did not give her painkillers over three months as the wound became a bone infection.

That mistake led to Dr Tay prescribing anti-psychotic medicine she did not need.

It also led to Ms Ng and her two brothers paying extra for physiotherapy for their mother that included weight bearing exercises that would have added to her excruciating pain.

Her last days were spent in pain and heavily sedated, which also resulted in rapid weight loss that Assisi did not address, an emotional Ms Ng said.

Ms Jacob had made light of the maggots and blamed it on family members who had taken her on a day trip, she said.

"I was appalled that she was essentially not prepared to take responsibility for what happened," Ms Ng told the Royal Commission.

She relocated her mother to palliative care elsewhere but Mrs Santoro died within a couple of days.
"At this point my mother's management had been so poor, her pain management and her care and I had just completely lost faith," said Ms Ng.

"I just wanted her out of there.

"I believe would still be alive today if her pain and care had been properly managed."

She contacted the Aged Care Complaints Commissioner, also angry about repeated falls and another infection when staples were not removed after hip surgery.

The aged care commissioner made scathing findings of "significant gaps" in Mrs Santoro's care, including them not telling the family or doctor about the heel wound "until it was too late".

"It's really hard to imagine a more serious finding being made about an organisation that exists solely to provide care for elderly people isn't it?" Counsel assisting the commissioner Peter Rozen asked Assisi's chairman Don Smarrelli.

"Correct, it is," Mr Smarrelli replied.

The not for profit organisation was doing a "root cause analysis" to "ensure that this type of incident or any incident for that matter never occurs again", he said.

Assisi's CEO at the time - who cannot be named - was recently sacked, having been accused by Mr Smarrelli of withholding information and possibly misleading the royal commission.

The Australian Health Practitioner Regulation Agency are investigating Ms Jacob and another unit manager, Anna Yow.

Full Article & Source:
Maggots found in wound at aged care home

Wednesday, July 10, 2019

Hospices go unpunished for reported maggots and uncontrolled pain, watchdog finds

A sign supporting Medicare on Capitol Hill in 2015. (Jacquelyn Martin/AP)
By Christopher Rowland

A state inspector in Missouri documented the grim details: a deep, poorly treated pressure wound on the patient’s tailbone, apparent pain that caused grimacing and — in a crisis requiring a trip to the emergency room — a “maggot infestation’’ where the feeding tube entered his abdomen.

The official cited Vitas Healthcare, the nation’s largest hospice chain, for putting the patient in “immediate jeopardy,” the most severe category of violation. The inspector found that Vitas staffers had skipped home visits and failed to assess the amount of pain the patient endured.

The case is among the most severe of a dozen examples of patient suffering cited in a strongly worded inspector-general report on the hospice industry released Tuesday. The report takes Medicare to task for what it describes as weak oversight and enforcement of the growing ranks of hospice providers and recommends stronger safeguards “to protect Medicare hospice beneficiaries from harm.’’

The report, by the Office of Inspector General for the Department of Health and Human Services, withheld information about the individual hospice providers and the states where the examples of harm occurred. Vitas Healthcare, which did not comment on the case, is not named in the inspector general’s report. The Washington Post identified the 2016 Missouri case by reviewing state inspection records and matching them to the specific circumstances described by the inspector general.

According to the Missouri inspection documents, the patient had been living at home under hospice care for more than 18 months when the discovery of “maggots around the opening of his wound” triggered an urgent call by the family in the middle of the night.

The patient was taken to a hospital for removal of the pests and stayed there for two days. One reason the patient was in hospice care was to avoid unnecessary pain and trauma associated with hospitalizations, the Missouri report said. In a “plan of correction” included in the Missouri documents, Vitas neither disputed nor agreed with the state inspector’s findings. It outlined steps it would take to improve supervision and assessment of patients.

Other dire cases listed by the inspector general included a patient whose pressure ulcers developed gangrene, resulting in an amputation; a patient whose injuries from an apparent sexual assault were missed and discovered only at a hospital; and another who did not receive appropriate medication and died in pain.

Despite the seriousness of the harm, the hospices in each of the dozen cases did not face serious consequences — largely because Medicare has few disciplinary tools at its disposal, the inspector general said.

“When hospices do not fulfill their obligations, there can be real human costs,” Nancy Harrison, deputy regional HHS inspector general, said in an interview. Medicare, she said, “needs to hold hospices accountable.”

While the report describes a poorly regulated hospice system, it also found that Medicare gives consumers limited options to screen for quality on their own or lodge complaints.

A Post investigation in 2014 documented patient hazards and industry financial abuses. Although improvements have been made since then — including the national Hospice Compare consumer website launched in 2017 — the gaps in enforcement and quality appear large, according to the report.

Medicare pays for most hospice care in the United States, with billings reaching $18 billion in 2017, double the amount a decade ago. The number of hospices has risen to around 4,500.

But Medicare’s oversight of hospice is not as strong as its oversight of nursing homes.

The frequency of hospice inspections by state or private accreditation agencies increased from once every six years to once every three years in 2018. About 300 hospice providers, or nearly 20 percent of all hospices inspected in 2016, had a serious deficiency or a substantiated severe complaint, making them “poor performers,’’ the report said.

There are few requirements for hospice companies to alert Medicare when they detect violations. And when problems are discovered, Medicare has limited tools to discipline providers for neglecting or harming patients, even in cases of “immediate jeopardy.”

Other than removing them from the Medicare program, a step that is very rarely taken, Medicare has no ability to levy fines or other sanctions on poorly performing hospice providers, the report said.

It also found fault with Medicare’s Web portal, Hospice Compare, which is supposed to help patients and families shop for hospice providers based on quality and other metrics. But Hospice Compare does not list hospice provider deficiencies or state inspection results.

“We live in a time when we don’t even think about going to a restaurant without checking its reviews. Why do we demand less from hospices?’’ Harrison said. “The information is already collected. We just need to make that extra step and make it publicly available in a way that patients can understand.’’

The Missouri case provides an example of the gap. A Post review showed that someone checking Hospice Compare would see that the Vitas Healthcare office in St. Louis responsible for the patient with a maggot infestation has a 96.4 percent quality rating, 11 percentage points above the national average. Nothing is mentioned about the “immediate jeopardy” finding or other serious deficiencies cited by inspectors.

The Centers for Medicare and Medicaid Services (CMS), which is in charge of Medicare, said it has taken steps to improve Hospice Compare, including adding information from consumer surveys.

It said it is prohibited by law from posting inspection reports by private accreditation agencies and has told the inspector general previously that it would be “misleading” to post state inspection reports alone. CMS has asked Congress in its budget for authority to post accreditation agency reports.

“CMS has zero tolerance for abuse and mistreatment of any patient, and CMS requires that every Medicare-certified hospice meet basic federal health and safety standards to keep patients safe,” the agency said in response to the inspector general’s report. It called the inspector general’s individual findings of patient harm a “selective sample” of cases found between 2012 and 2016.

In the example of the maggots in the patient’s feeding tube, the local Vitas Healthcare provider was put on a track to be terminated as a Medicare provider, but it corrected its deficiencies before that step was taken, CMS said.

“CMS does not have the statutory authority to impose remedies, such as fines, on hospices,” the agency said. “Additionally, CMS cannot close any facility.”

The hospice industry trade group in Washington, the National Hospice and Palliative Care Organization, which had not seen the report as of Monday, said it supports accountability and transparency in hospice. It pointed out that it supportedincreasing oversight, including raising in inspection frequency to once every three years. “However, ­NHPCO continues to stress that outliers in the field do not adequately reflect the vast majority of hospice care provision in the U.S.,” Edo Banach, the organization’s president, said in a statement.

Congress told Medicare to begin reimbursing for hospice in 1982. Since then, the practice ofhospice has steadily become mainstream, routinely serving patients with dementia and other ailments of the elderly, and has attracted for-profit investment and chain ownership.

“At the first meetings of our national hospice organization, we were nearly all women, mostly volunteers working on making our communities better,’’ said Joanne Lynn, a hospice physician and director of the program to improve elder care at Altarum, a nonprofit health-care consulting organization. “Once Medicare started paying for hospice, it was more men in suits, and the focus shifted to administration and sustainable financing.’’

Most hospice care continues to be delivered at home or in a nursing home, with routine visits by nurses and aides, but companies also run inpatient hospice facilities. The focus remains the same: comfort and palliative care, including pain medications, in a patient’s final months of life.

To qualify for hospice coverage under Medicare, a patient must be terminally ill with a prognosis of living less than six months. But as increased numbers of patients with Alzheimer’s disease and other forms of dementia enter hospice, many are living far longer than six months. Their Medicare coverage continues.

“You increasingly have diagnoses of dementia, patients who are dying at home, but their life expectancy is extremely difficult to estimate,” said Melissa D. Aldridge, a professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai, in New York.

Meanwhile, Medicare pays providers the same amount for each day a patient is in hospice — around $200 each day for the first 60 days and about $150 each day after 60 days — without regard to how much care is provided.

“They’re paying for a day of hospice with no accountability for what was done on that day. How is Medicare going to oversee that?’’ Aldridge said. She estimated two-thirds of providers are now for-profit, “with a payment mechanism that is completely opaque as to what is being done.’’

While Hospice Compare does not list any documented problems at hospices, Missouri and Alabama are examples of two states that list complaints and link to full inspection reports.

“We want to be as transparent as we can,” said Dean A. Linneman, director of regulation and licensure for Missouri’s Department of Health and Senior Services. “The intent is for families seeking a good place for their relatives to view reports, and it’s not too far-fetched to believe that is a good learning tool for others in the industry.’’

Full Article & Source:
Hospices go unpunished for reported maggots and uncontrolled pain, watchdog finds