In 2004, California legislatures passed a law that provided California nursing homes with $590 million by raising Medi-Cal (California’s Medicaid program) payments. The purpose of this law was to give nursing homes more financial resources to help poor residents. From 2004 through 2006, a UC-San Francisco study found that nursing homes not only received the $590 million, but their total revenues rose by $1.1 billion.
The increase in funding and profits does not appear to have translated into better care. The same UCSF study reports the following statistics in 2006:
1. A 3.6% decrease in nursing home spending on direct patient care
2. A 6% increase in state and federal citations of nursing homes
3. A 38% increase in complaints of patient mistreatment
4. 16% of nursing homes still did not meet California’s minimum staffing levels
5. 88% of nursing homes did not comply with federal regulations
6. 22% of nursing homes had violations that harmed patients or jeopardized patient care
The study also found that nursing assistant wages increased an average of 71 cents per hour (or 6%), licensed nurses increased by 9% and administrators pay rose by 13%. Nursing homes also enjoyed a rise in net profits of 233% to $248,047.
Nursing Home Residents Bill of Rights
The California Health and Safety Code, Section 1771.7(b) provides that all residents in residential living units (such as nursing homes) shall have all of the following rights:
1. To live in an attractive, safe, and well maintained physical environment.
2. To live in an environment that enhances personal dignity, maintains independence, and encourages self-determination.
3. To participate in activities that meet individual physical, intellectual, social, and spiritual needs.
4. To expect effective channels of communication between residents and staff, and between residents and the administration or provider's governing body.
5. To receive a clear and complete written contract that establishes the mutual rights and obligations of the resident and the continuing care retirement community.
6. To maintain and establish ties to the local community.
7. To organize and participate freely in the operation of resident associations.
The increase in funding was meant to help California nursing homes comply with California statutes such as Section 1771.7(b). It appears from the UCSF study that nursing homes have not really improved; while administrator salaries benefitted from the influx of funds, patient care actually became worse. It is important to keep a watchful eye on your loved ones who reside in nursing homes. Be especially on the look-out if the nursing home has difficulty keeping staff. With nursing assistant wage increases not even keeping up with inflation, a high turn-over is likely, leading to poorly trained employees and a high likelihood of neglected patients. If any of the rights listed above has been violated, it is important that you consult an elder law attorney as soon as possible.
Thanks for reading our blog. If you have a question or comment, feel free to respond to this posting, but keep in mind that any response will not be confidential. If you or a loved one is a victim of elder abuse and have questions on how to protect your rights, contact us for a free, confidential consultation.
Monday, April 21, 2008
Medi-Cal Benefit Increase for Nursing Homes Fails to Improve Care
Tuesday, April 1, 2008
Financial Elder Abuse-Mortgage Scams
Several people in Southern California were recently arrested for mortgage fraud. Many of their victims were elderly people who didn’t realize they were being scammed, and ultimately lost their homes. For many seniors, their primary asset is their home. Seniors are also a likely target for mortgage loan fraud or being defrauded out of title to their property; many seniors have homes which are fully paid for or have substantial equity in their homes.
Help is Available
If you receive a letter from a mortgage company informing you of a mortgage that you never applied for, or if you receive a notice from the County regarding the recording of a deed to your property, call the San Diego City Attorney’s Consumer Hotline at (619) 533-5600 Monday through Friday, 9-11am or 1-3pm.
Points to Consider
Some lenders have violated consumer protection laws by offering loans to seniors that do not fully disclose the costs associated with the loan. Lenders are required by law to disclose all loan costs and payment amounts. If you are considering refinancing your home, be aware of the following:
Don’t be pressured into signing anything until you have had the opportunity to review all the disclosures. Review all fees, payments and closing costs carefully before you sign.
Never sign anything without being fully aware of the consequences of what you’re signing. If in doubt, don’t sign. Have someone you trust review the documents with you.
Don’t give out personal information, such as your social security number, to a loan salesperson. You could be exposing yourself to identity theft.
Don’t take loans out on your house to loan someone else, such as a caretaker, money. If the person doesn’t repay you, you will be placing yourself in financial jeopardy.
Don’t transfer title to your house to someone else without consulting with your attorney first. There may be tax consequences to such a transfer that you didn’t contemplate. Don’t put a caregiver or someone else on title to your home; they may take out loans against your home, and if they fail to make the payments on the loans, you could lose your house in foreclosure.
If you feel you have been the victim of loan fraud, contact an attorney to find out your legal rights and options. If you have a question or comment, feel free to respond to this posting, but keep in mind your response will not be confidential. You can also call or e-mail me to discuss your matter confidentially. Thanks for reading.
Help is Available
If you receive a letter from a mortgage company informing you of a mortgage that you never applied for, or if you receive a notice from the County regarding the recording of a deed to your property, call the San Diego City Attorney’s Consumer Hotline at (619) 533-5600 Monday through Friday, 9-11am or 1-3pm.
Points to Consider
Some lenders have violated consumer protection laws by offering loans to seniors that do not fully disclose the costs associated with the loan. Lenders are required by law to disclose all loan costs and payment amounts. If you are considering refinancing your home, be aware of the following:
Don’t be pressured into signing anything until you have had the opportunity to review all the disclosures. Review all fees, payments and closing costs carefully before you sign.
Never sign anything without being fully aware of the consequences of what you’re signing. If in doubt, don’t sign. Have someone you trust review the documents with you.
Don’t give out personal information, such as your social security number, to a loan salesperson. You could be exposing yourself to identity theft.
Don’t take loans out on your house to loan someone else, such as a caretaker, money. If the person doesn’t repay you, you will be placing yourself in financial jeopardy.
Don’t transfer title to your house to someone else without consulting with your attorney first. There may be tax consequences to such a transfer that you didn’t contemplate. Don’t put a caregiver or someone else on title to your home; they may take out loans against your home, and if they fail to make the payments on the loans, you could lose your house in foreclosure.
If you feel you have been the victim of loan fraud, contact an attorney to find out your legal rights and options. If you have a question or comment, feel free to respond to this posting, but keep in mind your response will not be confidential. You can also call or e-mail me to discuss your matter confidentially. Thanks for reading.
Thursday, February 21, 2008
The Worst Nursing Homes
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.
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.
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.
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