There are approximately 16,400 nursing homes nationwide, and each year American taxpayers spend about $72.5 billion annually to subsidize nursing home care. With the amount of resources devoted to nursing home care, one would hope that patients are receiving quality care. Unfortunately, not all nursing homes are safe. This month the Bush administration released the names of 131 nursing homes that rank among the worst in the nation. The list released by the Centers for Medicare and Medicaid Services (CMS) names facilities identified as a “special focus facility”, meaning the home has a poor inspection record meriting additional governmental oversight. These homes are subject to inspection every six months rather than once a year.
Typical offenses include overmedicating patients or unnecessary medications for elderly patients, and inadequate safeguards for patients with Alzheimer’s or dementia from everyday hazards in the nursing home. While most nursing homes have some deficiencies and may receive six or seven noted deficiencies per inspection, the homes on the list averaged twice as many deficiencies. In order to be placed on the list, the home must show a demonstrated pattern of serious problems for occurring over a prolonged period of time.
The director of the CMS encourages patients and their families to use the list to enhance their awareness of any deficiencies with a facility, but cautions that “there is no substitute for visiting the nursing home in person.” The CMS notes that publicity about a home’s problems often leads to improvements within the facility; out of 54 homes listed as poor performers in a November 2007 study, 21 showed improvement. However, about 16 percent do not improve and are eventually terminated from Medicare and Medicaid. The list will be updated every quarter, with the next list to be made public in April of 2008.
To view the February 2008 list of the worst nursing homes in the nation in pdf format, visit http://www.cms.hhs.gov/CertificationandComplianc/Downloads/SFFList.pdf.
Thursday, February 21, 2008
Monday, January 21, 2008
Planning for Incapacity
When most people contemplate estate planning, their primary concern is what will happen to their estate when they pass away. However, proper estate planning also provides a plan for what will happen if you become incapacitated. If you become physically and /or mentally incapacitated due to an accident, injury or illness, who will manage your financial affairs or make medical decisions on your behalf? If you have your estate plan in order, your estate planning documents will have considered this contingency and will provide a thorough plan for incapacity.
Living Trust: The successor trustee of your living trust will assume the role and duties of the trustee upon your incapacity. Keep in mind, however, that the successor trustee will only have access and control over those assets that are held in the living trust; if you hold assets outside of your living trust, your successor trustee will not have control over those assets.
General Durable Financial Power of Attorney: Even if you have a living trust, and hold all or most of your assets in your trust, you should also have a financial power of attorney which is durable, meaning it is still valid even if you subsequently lose capacity. The power of attorney will authorize the agent named in the document to manage your financial affairs, including transferring assets into your living trust, signing your tax return, negotiating with insurance companies and financial institutions on your behalf, and making other important financial decisions on your behalf.
Advance Health Care Directive: This document allows you to appoint an agent or agents who will make medical decisions on your behalf. This document will also allow you to specify in advance your preferences regarding medical treatment. For example, you could specify that your primary care physician is to be consulted regarding your treatment, or you could specify that you do not want to be kept permanently dependent on life support if you are in a persistent vegetative state.
What happens if you fail to plan, and you become incapacitated? Unfortunately, estate planning attorneys are often contacted after a family member or loved one has already become incapacitated. If the client lacks the legal capacity to create an estate plan, the alternative is to file for a conservatorship. There are two types of conservatorships in California:
Living Trust: The successor trustee of your living trust will assume the role and duties of the trustee upon your incapacity. Keep in mind, however, that the successor trustee will only have access and control over those assets that are held in the living trust; if you hold assets outside of your living trust, your successor trustee will not have control over those assets.
General Durable Financial Power of Attorney: Even if you have a living trust, and hold all or most of your assets in your trust, you should also have a financial power of attorney which is durable, meaning it is still valid even if you subsequently lose capacity. The power of attorney will authorize the agent named in the document to manage your financial affairs, including transferring assets into your living trust, signing your tax return, negotiating with insurance companies and financial institutions on your behalf, and making other important financial decisions on your behalf.
Advance Health Care Directive: This document allows you to appoint an agent or agents who will make medical decisions on your behalf. This document will also allow you to specify in advance your preferences regarding medical treatment. For example, you could specify that your primary care physician is to be consulted regarding your treatment, or you could specify that you do not want to be kept permanently dependent on life support if you are in a persistent vegetative state.
What happens if you fail to plan, and you become incapacitated? Unfortunately, estate planning attorneys are often contacted after a family member or loved one has already become incapacitated. If the client lacks the legal capacity to create an estate plan, the alternative is to file for a conservatorship. There are two types of conservatorships in California:
- Conservatorship of the Person (to authorize the conservator to make medical decisions, arrange housing and care of the conservatee, etc.); and
- Conservatorship of the Estate (to authorize the conservator to invest the assets of the conservatee, pay the conservatee’s bills, and handle the conservatee’s finances).
The same person may serve as conservator of the person and of the estate.
Conservatorships require a formal court proceeding and the court will continue to oversee the administration of the conservatorship for as long as the conservatee is incapacitated, or until the conservatee dies. This process is often criticized as it is costly, time consuming, burdensome and subjects information about the conservatee’s finances and mental and physical condition to public scrutiny. With proper advance planning, a conservatorship may be avoided entirely.
Incapacity due to illness, accident or injury can strike at any time. It is advisable to review your estate planning documents to make sure you are adequately protected in the event of incapacity. If you have any questions, please contact me, or feel free to leave a general response to this posting. Thanks for reading.
Monday, December 17, 2007
Evaluating Nursing Homes
In today’s Los Angeles Times, there is an article entitled “A Nursing Home Death, and a Shocking Phone Call.” Elmore Kittower was an 80 year-old resident of Silverado Senior Living in Calabasas who passed away suddenly last month. His 83 year-old widow, Rita, was told by a staff member of the facility that “He just stopped breathing.” The day after Elmore’s funeral, Rita received a telephone call from a woman claiming to be an employee of the nursing home. She informed Rita that her husband had been beaten and suffocated by another employee at the nursing facility. Days later, detectives from the Los Angeles County Sheriff’s Department requested Rita’s permission to exhume Elmore’s body. Sources close to the investigation confirmed that there was trauma to the body consistent with an assault.
Rita made the decision to find a nursing facility for Elmore after he suffered a massive stroke and became combative. She perused literature and visited dozens of nursing homes before selecting Silverado Senior Living. Rita admits the $75,000 a year expense for a semi-private room was a hardship, but states “But it was a beautiful place, like a five-star hotel.”
The decision to place a loved one in a nursing facility is never easy. How do you ensure that the facility you are entrusting with the care of your loved one will provide a safe and caring environment? Here are some resources you can consult:
- Medicare Website called "Nursing Home Compare"
- U.S. Department of Health, Center for Medicare and Medicaid Services
- California Nursing Home Ombudsman Information
- California Advocates for Nursing Home Reform
- AARP Website
Thanks for reading. Please contact me if you have specific questions, or feel free to leave a general comment in response to this posting.
Subscribe to:
Posts (Atom)
