Trump's Continuing War Against Seniors In Long Term Care Facilities

Last Wednesday we noted the latest group Trumpanzee's Regime in targeting: senior citizens in long term care facilities. The Regime is trying to take away the right of victims of nursing home abuse to sue the nursing facilities-- something they claim in bad for business... businesses that contribute a great deal of money to corrupt conservative officials. And they tried to minimize the seriousness of old people in nursing homes being abused and neglected-- as though it rarely happens. That's just another Trump World lie, as an A.P. report made clear Monday afternoon.

More than 1 in 4 cases of possible sexual and physical abuse against nursing home patients apparently went unreported to police, says a government audit that faults Medicare for failing to enforce a federal law requiring immediate notification.

The Health and Human Services inspector general's office issued an "early alert" Monday on preliminary findings from a large sampling of cases in 33 states. The results were sufficiently alarming that investigators say corrective action is needed now.

"We hope that we can stop this from happening to anybody else," said Curtis Roy, an audit manager with the inspector general's office, which investigates fraud, waste and abuse in the health care system. The audit is part of a larger ongoing probe, and additional findings are expected.

With some 1.4 million people living in U.S. nursing homes, quality is an ongoing concern. Despite greater awareness, egregious incidents still occur.

In a statement, Medicare emphasized that nursing home safety is a high priority, but said it will await a complete report before announcing a response. That didn't impress Sen. Charles Grassley, R-Iowa, who said he will push for Medicare to take immediate action.

"A crime is a crime wherever it takes place," Grassley said in a statement. "It's unacceptable for more than one-fourth of potential crimes in nursing homes to apparently go unreported."

Of the unreported cases, about 4 out of 5 involved alleged or suspected rape or sexual abuse.

The inspector general urged Medicare to systematically scour computerized billing records for tell-tale signs of possible abuse of nursing home residents. Investigators used that approach to find the cases, matching hospital emergency room and nursing home records.

Auditors identified 134 cases in which emergency room records indicated possible sexual or physical abuse, or neglect. The incidents spanned a two-year period from 2015-2016.

Illinois had the largest number of incidents overall, with 17. It was followed by Michigan (13), Texas (9), and California (8).

In 38 of the total cases (28 percent), investigators could find no evidence in hospital records that the incident had been reported to local law enforcement, despite a federal law requiring prompt reporting by nursing homes, as well as similar state and local requirements.

The federal statute has been on the books more than five years, but investigators found that Medicare has not enforced its requirement to report incidents to police and other agencies, or risk fines of up to $300,000.

Nursing home personnel must immediately report incidents that involve a suspected crime, within a two-hour window if there's serious bodily injury. Otherwise, authorities must be notified within 24 hours.

Medicare "has inadequate procedures to ensure that incidents of potential abuse or neglect of Medicare beneficiaries residing in (nursing homes) are identified and reported," the inspector general's report said. Medicare responded it has long required immediate reporting, but to state inspectors.

Even among the 96 cases that were ultimately reported to police departments, investigators were unable to tell if the federal requirement for "immediate" notification was followed.

In one case classified as "reported to law enforcement," an elderly woman with verbal and mobility limitations was taken to the emergency room after she was allegedly sexually assaulted by a male resident of the same nursing home. The report said two silver-dollar-sized bruises were noted on her right breast.

Nursing home staff had helped the woman bathe and change clothes after the incident. "These actions could have destroyed any evidence that may have been detected using the rape kit," said the report.

Nursing home employees did not immediately report the incident to police, although the federal reporting requirement was in effect. The nursing home "should have reported the incident to law enforcement within two hours of witnessing the incident," the report said.

Instead, the following day the nursing home contacted the woman's family, who called the police, triggering an investigation.

Citing a separate probe by state officials, the inspector general's report said the nursing home "contacted local law enforcement in an attempt to keep law enforcement from investigating the incident."

The state's own report found that the nursing home told police "we were required to report it but that we were doing our own internal investigation and did not need (police) to make a site visit...no one was interested in pressing charges." The police continued their investigation.

The state later cited the nursing home for failing to immediately notify the patient's doctor and family, as well as other violations of federal regulations. But state inspectors classified the incident as resulting in "minimum harm or potential for actual harm."

No other details were provided in the federal report. The inspector general's office reported all 134 cases to local police.

The number of nursing home residents is expected to grow in coming years as more people live into their 80s and 90s. Medicaid is the main payer for long-term care, while Medicare covers doctors' services and hospital care for elderly people and the disabled.

In a statement, the nursing home industry trade group said its members know they must immediately report alleged abuse. The American Health Care Association said it will work with the government to ensure safety.

-photo by Nirmal Gosh... Maryland

Dr. Kathie Allen, the progressive Democrat running for the open congressional seat in Utah's 4th district, offered to add an important perspective... "that many nursing home patients are unable to speak for themselves, so it is up to providers and family members to advocate for them. Sexual abuse of nursing home patients is a real and present danger and is under-reported. To force a patient to opt for arbitration instead of legal resolution of possible malpractice is to ignore the fact that many people being admitted to nursing homes are not fully lucid due to recent surgery, drugs, and innervated status. They should not be induced to compromise their rights while their mental state is suboptimal. This whole thing is a disgrace."





UPDATE: Here's An Example Of Why Dotty Nygard Will Replace Jeff Denham In Congress

Although the DCCC recruited some wealthy San Franciscan to run in CA-10 (Modesto, Tracy, Manteca, Turlock and Riverbank) Dotty Nygard, a nurse and former local elected official, is the progressive in the primary race. She told us that "It's horrifying that there are people in our communities who have the audacity to abuse the elderly. As a healthcare provider, I am mandated to report any suspicion of neglect or abuse immediately. Unfortunately, there have been several situations involving elder abuse where I have been forced to report individuals who have the nerve to harm seniors who were in an extremely vulnerable state. So many cases of negligence and harmful disrespect for our seniors have plagued our healthcare system and it's long overdue for advocates to step up and defend them. Seniors should be our most respected members of society-- it's time we provide them the support they need."

If predators are scamming billions and billions via for-profit hospice "care," isn't this why we have the death penalty?

Profits up in California: The average profit per patient has grown steadily. The combination of more patients and far greater profit per patient has pushed overall inflation-adjusted profit up more than tenfold. (click to enlarge; from washingtonpost.com)

by Ken

In a moment I'm going to back up a bit to try to enable you to understand why I was so shocked, and found my gut so clenched, upon reading an online teaser Thursday night for an investigative report in the Washington Post's "Cost of Healing" series which appeared on Friday's front page, "Medicare rules create a booming business in hospice care for people who aren't dying."

The gist of the article was that a mutibillion-dolar industry has sprung up in "for profit" hospice care, taking advantage of the daily amount Medicare pays for hospice care -- $150, according to the article, whether or not any care has been provided on any particular day -- by bulking up the rolls with large numbers of clients who, to put it bluntly, aren't really sick enough to be in hospice care, and therefore: (1) cost much less to care for than the dying people hospice care is designed for, and (2) for the same reason live much longer, thereby continuing to bulk up the predator-hospice companies' already outsize profits.

We'll come back to the article, but first, as I said, I have to back up.

In the years when -- from long distance -- I watched over my mother's final decline and passing, one lesson I kept relearning was that every situation and stage I encountered was a first time for me, all the people I was dealing with dealt with this all the time. Nearly all those people knew I had no idea what I was doing, and many of them not only counted on it but took advantage of it. Some were a little more helpful.

Miraculously, a very few people along the way showed genuine humanity, making it their business to try to help me understand what was happening and what could or needed to be done. In my state of perpetual apprehension and befuddlement, I doubt that I thanked those blessed souls enough.

The highest concentration of them worked for the hospice that was recommended to me when my mother's doctor, who had known her for many years, told me there was nothing more that could be done for her medically and he was recommending hospice care. He was aided considerably by the copy of my mother's "living will" I showed him, in which she made it absolutely clear that she wanted no heroic measures to prolong her life when there was no quality of life left to be preserved. When my mother was still relatively healthy, she had made a point of showing this to me and making sure I understood her wishes.

My first assumption was that "hospice" meant she would be "going to" a hospice when she was released from the hospital. I suspect I wasn't the first person to make the mistaken assumption that it was a place rather than a form of care for the terminally ill. I still had to figure out how to arrange her living situation.

But since my mother now needed around-the-clock care, and I thought a nursing home was our only option, there was someone at the hospice who guided me through every step of the Medicaid application, something I can't imagine how I would have managed on my own. It certainly wouldn't have occurred to me that I needed to talk to the funeral home (with which my mother had taken the precaution and taken on the expense of prepaying her funeral arrangements so that I wouldn't have to do that) and have them make her plan nonrefundable so that it wouldn't be counted as an "asset"! (And I should add that throughout the remainder of the process the funeral-home people, both in Florida, where my mother lived, and in New York, where she was to be buried, were also angels, handling everything with kindness and efficiency.)

There was another person at the hospice who made no secret of the fact that she hated the nursing-home option, and made me aware that there were now small assisted-living facilities where residents received invididual attention, and which might well be covered by the long-term care policy my mother had providentially scrimped to pay for, which up to that point had made it possible for her to have a home-care aide for a healthy chunk of the day. She wouldn't have been able to recommend a facility, but one of the people she suggested I talk to to better understand the small-ALF option did have a suggestion, of a facility not that far from where my mother lived run by a young woman who gave her residents the best possible care. Ana indeed turned out to be a saint, and took care of my mother till the end as if she were her own mother.

When I told the woman at the hospice of the arrangement I had made, I could hear her relief and happiness at the change from my nursing-home plan. She knew the facility, and considered it an excellent choice. As it turned out, she also made regular home visits to my mother, and in her new residence was able to provide me with information to supplement what I got from Ana. I know there were also regular visits by hospice nurses, and medical care when needed from those nurses and a doctor. The hospice also regularly supplied a range of supplies. When my mother died, there were kind expressions of sympathy from her hospice "unit."

This, then, is the background to the feelings I experienced when I saw the Washington Post report, whose online version began:

Hospice firms draining billions from Medicare


By Peter Whoriskey and Dan Keating

Hospice patients are expected to die: The treatment focuses on providing comfort to the terminally ill, not finding a cure. To enroll a patient, two doctors certify a life expectancy of six months or less.

But over the past decade, the number of "hospice survivors" in the United States has risen dramatically, in part because hospice companies earn more by recruiting patients who aren't actually dying, a Washington Post investigation has found. Healthier patients are more profitable because they require fewer visits and stay enrolled longer.

The proportion of patients who were discharged alive from hospice care rose about 50 percent between 2002 and 2012, according to a Post analysis of more than 1 million hospice patients' records over 11 years in California, a state that makes public detailed descriptions and that, by virtue of its size, offers a portrait of the industry.

The average length of a stay in hospice care also jumped substantially over that time, in California and nationally, according to the analysis. Profit per patient quintupled, to $1,975, California records show.

This vast growth took place as the hospice "movement," once led by religious and community organizations, was evolving into a $17 billion industry dominated by for-profit companies. Much of that is paid for by the U.S. government -- roughly $15 billion of industry revenue came from Medicare last year. . . .

It took me awhile to wrap my brain around this.

First I had to grasp that no, they weren't talking about he kind of hospice that had watched over my mother -- though already it occurred to me that most readers of the article wouldn't know enough about the subject to make the distinction; the message would likely be: Hospice care is a scam.

Then I had to overcome my automatic resistance to the idea that there's an entrepreneurial class so vile as to make a business out of phony hospice predation. Alas, once I understood the nature of the scam, it wasn't difficult to overcome this resistance, knowing as I do that if there's money to be made, there's no shortage of entrepreneurs for whom no degree of vileness would be an obstacle, and if there's a lot of money to be made, then it's likely to be more like a gold rush.

Today the Post published several letters to the editor about the Friday article ("The business of hospice"). But the response that struck the most responsive chord for me appeared only online, at the above link, in a comment by a reader who identified herself (wait, am I just assuming it's a woman?) as "ProgressiveCatholic":

As a former longterm social worker at a non-profit hospice in this area, my heart hurt to see the article in the Post not differentiate between the amazing care that local and national nonprofit hospices provide, but simply identify all hospice care as a way to abuse Medicare. The hospice I worked at for more than 8 years agonized over decisions about whether to take a patient and family off of our program, or to leave them on, receiving badly needed care, when they had elected the Medicare Hospice Benefit and lived longer than 6 months to a year.

Though I can easily imagine that for profit hospices have abused this benefit, the fact remains that many hospices who are in this field are here, and have been for decades, to provide care, not make a profit. PLEASE DIFFERENTIATE between hospices in this community, and in many, who have been providing care, many times at a financial loss, for those on the Medicare Hospice benefit, and those for-profit hospices who have moved in to the field in the last 20-30 years, and may be (?) abusing the Medicare benefit.

A long term joke among our workers was that Hospice care 'caused people to live,' in that when a patient and family have their stress relieved, when caregivers get respite and when patients get adequate pain management, they do indeed, get better for a time. This then leads to the difficult choice of taking that care away, because they no longer meet the Medicare Benefit criteria vs. leaving the care in place, but potentially misusing the benefit.

This is a drastically different issue than "making money" off of hospice care. Hospices face the dilemma of being sued for trying to take someone off of hospice care (it happened to our hospice) versus being sanctioned by Medicare if they leave someone on hospice care. Though I agree for profit hospices have created a number of problems, the way this article reads misleadingly indicates that all hospices out there are "making money off of" dying patients.

Yes, please differentiate, and then take the masterminds of the for-profit hospice ripoff and give them fair trials -- I'm thinking 15 minutes apiece should do it -- in preparation for their executions.

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Here's one tip I've been meaning to offer to caregivers for declining elders

by Ken

Earlier today I mentioned that I've written a bunch of initial drafts of never-finished posts based on my trip to Florida last month for my mother's 90th birthday. The one I most regret not being able to complete had the working title:

TIP FOR CAREGIVERS FOR THE ELDERLY

Here's as much as I actually wrote in the most extended draft. (Note that "my journey into the Land of Aging and Decline" refers not to my trip to Florida, as one might easily presume given the present context, but my experience trying to help my mother since she suffered -- and survived! -- a brain hemorrhage 13 years ago, only a couple of years after my stepfather's merciful death ended the five years or so she had spent as sole caregiver to an Alzheimer's sufferer, with no resources beyond Social Security and a small amount of savings.)

TIP FOR CAREGIVERS FOR THE ELDERLY

I sure haven't learned much from my journey into the Land of Aging and Decline. One thing you have to stop being constantly surprised by is that you've ventured into a territory where everyone you deal with, by virtue of dealing with the subject on a daily basis, knows everything about it and you know nothing. The people you deal with will generally fall into one of three categories:

* Many of them simply forget the knowledge gap and simply assume that you know what they do. In my (admittedly abject) experience, the chances aren't good of correcting this misimpression -- it usually seems as if they've "forgotten" for good reason. Nevertheless, it's worth pointing out that they are masters of this universe while you are a pathetic ignorant wretch and throw yourself at their mercy. I don't recall that it ever worked for me, but you never know.

* And then there are the sharps who know perfectly well that they've got you over a knowledge barrel and take full advantage of it.

* And then, every once in a while, you encounter someone who understands exactly what it's like to be in your position and offers up his/her (more likely her) knowledge. Take merciless advantage. Some of what you're told could be (a) correct and (b) useful.

I did promise you an actual tip, though, and here it is.

Growing old is another of those walks of life where a sharp separation is enforced between Them What Can Pay and Them What Can't. You can't change the ultimate destination, but at every step along the way it makes the most astounding difference if you can pay to cushion the trip. Assuming you're in the overcrowded bus, or perhaps troop transport, with the rest of us who can't buy our way through, however, and assuming your loved one reaches the all-too-common point where you have to find full-time care for him/her, you may think you have no choice but to submit to the horror of a Medicaid application to cover the cost of a nursing home.

I know, I know, you don't want to hear the words "nursing home." Again, if you're really loaded, your experience of nursing homes is going to be different, but for most of us, while there are undoubtedly worse and less worse ones, it's the ultimate betrayal of the loved one, consigning him/her to warehousing. I know, because I had reached that point, I thought, and I went through those Medicaid application horrors.

EXAMPLE OF MEDICAID APPLICATION HORRORS

My mother is, or was (she isn't so much now, alas), the kind of person who years ago, I guess after my stepfather died, dug deep into her pretty bare pockets to fund a "pre-needs" contract with a funeral home that should cover all the costs associated with that inevitable eventuality, thereby sparing my ever having to negotiate all of that. I bless her for it. (And there's no point being sentimentally superstitious about it. It's not as if there's some way she's going to avoid making use of the deal.) However, when it comes to a Medicaid application, you discover, unless such a contract is clearly indicated as being "irrevocable," it qualifies as -- and I hope you're ready for this, because I sure wasn't -- an asset! Because, you see, you could cash it in. And I guess you could.

This is where it helps to realize you're not the first person who's traveled down this path. Of course the funeral home has encountered this before, and is familiar with the form for making the contract (ta-da!) irrevocable. It's just that when you're 1500 miles away, and doing the paperwork by fax, which in turn is being faxed to the hospice case worker who then has to fax it on the state agency screening the application for pre-approval

Oh wait, I guess I didn't mention that by the time of the Medicaid application my mother had already been recommended for hospice care, and I now actually had people on my team

The draft breaks off there. (Honestly, I didn't remember I'd written that much. Until now I hadn't looked at this since I wrote it.) I'm guessing the draft broke off because: (a) I felt uncomfortable burdening readers with that degree of personal detail, unlikely to be of interest to anyone not involved; and, worse, (b) I realized I still hadn't gotten to the damned tip!

Now, by choosing to withhold most of the personal detail, I may have left room for misunderstanding. A commenter commented on my post:

You stated

I took my frenzied two-day trip to Florida to help celebrate my mother's 90th birthday in the little assisted-living facility where she will probably live out her days

congratulations to your mom for making it to 90. You and she must be very wealthy.

I started writing a reply to the commenter, and eventually realized that I was covering the missing material from that old draft post. Here's what I wrote:

I'll take that as a friendly comment. You would have no way of knowing, nor is there any reason why you should care, the financial ordeal we've been through in recent years, or how much debt I've racked up.

I will just say that there's no way my mother, like so many seniors, could have survived without Medicare, which I'm here to tell one and all is a government program that works right well.

If you think being able to afford such a nice ALF is a sign of riches, then you should know that my mother many years ago made the decision to take out a long-term home health care insurance policy. It cost her money she could ill afford, but it went on to provide her with some form of home care when the need arose, as it has more or less continuously in the last dozen years. It's that insurance policy that is now paying for the ALF.

One of the pieces I started drafting and haven't been able to finish yet contains a couple of tips for the caregivers of elders. One of these was that if the person in question has LTC insurance, it's possible that the policy will cover an ALF, and there are now quite small ones where residents may receive the kind of individual attention my mother does in hers.

Now the first point I want to call attention to iin the above is how totally Medicare has been woven into my mother's later years -- as indeed it was in my late stepfather's, though it offered essentially no help with the Alzheimer's ordeal. In the course of the debate on health care reform, there has been a certain amount of sneering about Medicare, and also -- I'm relieved to say -- occasional loud and proud declarations of how completely Medicare has transformed the experience of being old in the U.S. My folks also relied on their Medigap supplementary policies, but without Medicare there would have been nothing to supplement.

And then, finally, there's the tip: If your cared-for elder had the foresight to take out an LTC policy, check the policy and check with your insurer to see whether "home health care" benefits may be payable if the insured person's home becomes an assisted-living facility. It wasn't till I'd been through the nightmare of assembling all the materials for the Medicaid application -- and that was with the invaluable assistance of the hospice case worker (I don't think I could ever have done it on my own) -- that somebody mentioned this possibility to me, while also mentioning this new breed of non-warehouse-type ALFs (as far as I'm concerned, the traditional ones aren't much better than nursing homes). Our insurance company confirmed that a properly accredited ALF would indeed qualify, and the hospice social worker happened to know about this splendid one.


POSTSCRIPT

Yes, I guess we were lucky again to have the assistance of the hospice case worker and social worker. All you have to do to get that is have your doctor give up hope for your recovery, which my mother's doctor did in February 2008. I guess luck comes in many forms.

I hope the above tip (and perhaps also the testimony on behalf of Medicare) will be of help to someone somewhere. I might have gotten to it sooner if I'd been able to process the overriding reality of the trip to Florida, which is that I still don't know whether my mother knew that was me there.

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