Residents of Nursing Homes Are Protected by the Policies of the Centers for Medicare and Medicaid Services

December 12, 2022Filed Under: Elder Law, Long Term Care

Nursing homes face a variety of public health challenges from infectious diseases like the flu and COVID-19. The Center for Medicare and Medicaid Services, CMS, outlines specific policies and protocols for residential health facilities. These measures outline policies related to visitations, nursing aid certification, and more. Nursing homes must comply with these policies to qualify for Medicare or Medicaid funds. The CMS goal is to ensure a minimum level of care for residents nationwide.

Nursing home residents are especially vulnerable to public health problems, such as infectious diseases. Their vulnerability comes from the inherent risks of congregate living and residents’ often fragile health, making strong public health policies especially important.

The Pandemic Health Emergency (PHE) from COVID-19 revealed a host of underlying problems in nursing homes across the United States. CMS guidelines changed to respond to the PHE and evolved again to reflect lessons learned from the PHE. While CMS regulates a minimal quality of care federally, states often supplement those policies.

State Legislation Goes Beyond Nursing Home Guidelines

A review of state legislatures finds twenty-three politically and geographically diverse states passed more than seventy new provisions affecting the operations of nursing homes. The laws cover a wide range of issues to benefit nursing home residents.

Connecticut law now permits its nursing home residents to designate an “essential support person” who can care for a loved one even during a public health emergency. In March 2021, the Alabama legislature enacted the “No Patient Left Alone Act.” Like Connecticut’s law, it ensures that residents have an advocate by their side, not merely a visitor stopping in for a quick hello.

Other states are ramping up efforts to provide tablets and other devices through lending libraries. Residents can borrow devices to communicate with their families and loved ones. Digital contact becomes necessary for some nursing home residents with families spread across the country and unable to visit frequently. These digital communications also help loved ones make appropriate care decisions and advocate for the resident’s needs.

Illinois reduced the cost of providing this equipment through grants via state funds received when health and safety violations of nursing homes reach a financial settlement.

Staffing levels are another issue the states are tackling. Addressing staffing shortages is a long-time response to a 1987 federal law requiring CMS facilities to maintain nursing staff sufficient to “attain or maintain the highest practicable well-being of each resident.” The vagueness of this law led several states to add more specific staffing requirements.

The office of the Attorney General of New York State in the Nursing Home Response to COVID-19 Pandemic report findings show lower COVID-related death rates in nursing homes with higher staffing levels. Arkansas Advocates for Nursing Home Residents Martha Deaver concurs that the standard of care decreases with less staff.

States are also ensuring facilities are not receiving excessive profits from government payouts to care for residents. New Jersey requires nursing homes to spend ninety percent of their revenues on direct care. New York deems the number to be seventy percent, including 40 percent to pay direct-care workers. Massachusetts regulations mandate nursing homes devote seventy-five percent to direct-care staffing costs and have no more than two people living in one room.

These states’ patchwork protections for nursing home residents are part of the nation’s nursing home care regulatory system. CMS sets the minimum requirements providers must meet in their facilities to participate in the Medicare/Medicaid programs at the federal level. It is permissible for states to implement specific additional requirements as long as they do not conflict with existing federal requirements.

Inequalities Among States for Residential Facilities

Because each state can implement additional nursing home regulatory improvements, there are uneven nursing home care provisions throughout the country. These differences may exacerbate healthcare disparities of financial status, race, or gender. Richard Mollot, executive director for the Long Term Care Community Coalition advocacy group, finds this hodgepodge approach “a poor substitute for comprehensive federal rules if they were rigorously enforced.” If you or a loved one is a nursing home resident, you should know the additional measures your state provides. Depending on how your state supplements the CMS minimum standards of care, you may need to do research that your chosen facility goes above and beyond the minimum requirements.

We hope you found this article helpful. If you’d like to discuss your particular situation, please don’t hesitate to reach out. Please contact our Cincinnati office by calling us at 513-771-2444 and schedule a consultation.

Here Are a Few Tips to Help You Plan for the Growth of the Sandwich Generation

October 24, 2022Filed Under: Estate Planning, Long Term Care

The sandwich generation includes anyone who struggles to care for both their children and their aging parents. Although generation is part of the phrase, it does not refer to people born at a specific time. Typically, these “sandwich” family caregivers will be in the thirty to forty-year-old age range and balancing duties to provide for their families and provide care duties for both children and parents.

Trends that Lead to an Increase in the Sandwich Generation

The rise in the numbers in the sandwich generation is a byproduct of influential trends. Two obvious and long-term trends are women who opt to give birth later in life and the increasing numbers of the senior US population. The third influence is the COVID-19 pandemic. Fear of placing aging parents into long-term care facilities where thousands have perished due to the coronavirus prompts many families to care for their elder loved ones in their homes or their parents’ homes nearby. Additionally, many in the sandwich generation continue to work remotely to balance income needs with care for their children and aging adult loved ones.

If this scenario reads familiar, you are not alone. You are most likely experiencing significant anxiety and stress as you juggle, in some cases, limited in-person schooling and activities for your children, career and increased financial expectations, family dynamics, and daily caregiver duties. Though this is a challenging time in your life, it does not have to be as impossible as it may seem. There are steps to take to help you provide the best outcomes possible in your sandwich generation endeavor.

How the Sandwich Generation Can Plan for Their Family’s Future

Start with a simple first step by reprioritizing “daily.” Suppose there seems an overwhelming number of tasks to accomplish in a day; prioritize between urgent and non-urgent categories to triage what needs addressing first. Also, make time for self-care to avoid caregiver burnout. Focusing on basics like nutritious meals, adequate sleep, and exercise will serve you and your loved ones well. Know your rights at your workplace. Programs like the Family Medical Leave Act (FMLA) offer job security to those taking a leave of absence for family medical reasons. While it is not a paid benefit, you will maintain access to your health insurance benefits for up to twelve weeks of time off. If you haven’t, explore working remotely to put you in the same physical location as those you care for in your home. And, of course, share your feelings about your burdens and get extra help when you need it. Talking things through with family members can better manage everyone’s expectations. There are also forums and community resources that can put you in touch with others in the sandwich generation, where you can share information and offload burdens.

Make an honest evaluation of your available resources before determining a course of action. Are your parents able to pay for their care on their own, even within your own home? Do they carry long-term care insurance or whole life insurance policies with living benefits? Do you have other family members willing to contribute financially, or is a public assistance option viable?

Talk things through with your parents about their preferences and abilities to pay. Include any siblings you may have and figure out who can help provide care and whose home provides the best solution. If external help is a must, research local resource possibilities and at what cost. Most importantly, consult an elder law attorney to ensure all relevant legal document requirements are at hand if a sudden financial or medical decision presents itself.

While your parents are a huge responsibility, it is crucial not to overlook the needs of your retirement that will protect your children’s lifestyle and future. College funds need to be a priority, as is a 401(k) plan if your place of employment offers one. Consider the purchase of a term or whole life insurance policy to protect your family’s future in the event a tragedy befalls you and your ability to care for your family. Start an emergency fund right away, as life is unpredictable. This fund can help cover incidental costs, unexpected medical bills, and a long-term hospital stay. Unexpected costs can throw your budget out of whack so try to be prepared ahead of time with some emergency cash on hand.

If your sandwich generation status continues for a long time, re-evaluate your finances periodically. Goals will change, and updating your estate plan and possibly your parents’ plan too may help you stay on track to meet your nuclear family’s long-term goals. You may need to renovate your home as your parents’ age for both their comfort and safety.

Money management and estate planning are critical elements to creating a mutually beneficial living experience as part of the sandwich generation. While this may not be the easiest time of your life with the multitude of demands placed upon you, it is survivable, indeed a situation where you can all thrive with adequate planning. Speak with an elder law attorney familiar with structuring these types of plans and get started today for the extreme likelihood you too will become part of the sandwich generation.

We hope you found this article helpful. If you have questions or would like to discuss your personal situation, please don’t hesitate to contact us at 513-771-2444.

Some Nursing Homes in the U.S. Are in Dire Straits

October 10, 2022Filed Under: Elder Law, Long Term Care

Americans who live in nursing homes are among the most vulnerable. When the novel coronavirus did hit, these nursing homes became its ground zero as many residents and workers did not receive testing, and staff found obtaining personal protective equipment a struggle. Some facilities tended to downplay the severity of the outbreaks. Couple these issues with some state governments mandating the reintroduction of recovering COVID-19 patients back into nursing home facilities, and the perfect storm came into being. The Washington Post reports that according to the best estimates, about half of COVID-19 deaths have been among nursing home residents. Currently, that half represents more than 52,500 of our senior population.

The Wall Street Journal is reporting that according to two studies, nursing home residents who are dying from COVID-19 on average could have expected to live for another decade. Even the more senior residents, 90 and older, with multiple ailments, are losing more than one year of life. These studies challenge the perception that the coronavirus tends to kill elderly people who were likely to die soon anyhow.

A New Perspective on Elder Care

The coronavirus pandemic is forcing us to take a hard look at where our loved one should receive care if care at home is not a safe option. As the number of nursing home deaths continues to increase, the news media is finding it harder than ever to gloss over the unpalatable reality of these deaths.

Now more than ever it is important for families to come together when a decision must be made about a loved one’s care. We help families discuss options for care and how to plan to pay for appropriate care.

We hope you found this article helpful. If you have questions or would like to discuss your personal situation, please don’t hesitate to contact us at 513-771-2444.

The Health Challenges Posed by Dementia Are Significant

August 22, 2022Filed Under: Long Term Care, Senior Health and Wellness

A person with dementia is diagnosed every three seconds somewhere in the world. Dementia is a catchall phrase that refers to many types of neurodegenerative diseases. Neurodegenerative diseases bring about the onset of dementia including but not limited to: Alzheimer’s disease, Lewy body dementia, Parkinson’s disease dementia, vascular dementia (currently the second most common form of dementia), amyotrophic lateral sclerosis, and the most recently identified LATE (limbic-predominant age-related TDP-43 encephalopathy) which mimics Alzheimer’s symptoms but is caused by a different brain mechanism.

There is a long-held view that cognitive decline is a normal consequence of aging; however, this has been disproven by the successful aging of many individuals who remain in full control of their mental faculties. Just because you get old does not mean you will get dementia; and yet, the likelihood that you will get dementia does increase (doubling every five years) over the age of 65, in particular, if you carry the apolipoprotein E gene variant APOE ε4.

The economic impact of dementia is profound. The Center for Disease Control and Prevention (CDC) projects that by 2040, the US cost of treating Alzheimer’s disease alone is estimated to be a staggering $379 to $500 billion annually. These costs include the direct costs of social and medical care as well as care provided by unpaid family care providers. It is very costly to create a secure scenario for those who have dementia. Although Alzheimer’s can now be detected 20 years before the onset of symptoms, there is no known cure for it or other forms of dementia. Research efforts to find a cure have been expensive without much reward, and as such many drug companies are halting their efforts to find a cure for economic reasons. Those who have dementia have a disability and dependence on loved ones and a health care system that is woefully unprepared for the scale and cost of maintaining their lives. Some biomarkers that identify Alzheimer’s disease early on may accelerate the development of new therapies as the disease timeline progression is substantial, but it remains unknown which treatments will be most effective and at what point in the disease continuum.

The number of people suffering from dementia diseases is rising, but that is most likely because the overall number of aging people is increasing. Even though dementia is not an inevitable consequence of aging, the increase in its probability plays into the laws of large numbers. There are reports of certain modifiable lifestyle choices that can increase the chance of not developing dementia disease. In particular, diet seems to influence oxidative stress and inflammation in the brain. A Mediterranean diet appears to have a positive effect on brain health in general. Exercising and maintaining positive social relationships also help maintain balanced brain health. Combining these three aspects is most effective for brain health. Diet, exercise, and positive social relationships may reduce the risk of a dementia diagnosis. These modifiable habits are proactive to keep the brain from neurodegeneration rather than reactive to a dementia diagnosis.

The World Health Organization (WHO) identifies the principal goals for dementia care as: “early diagnosis in order to promote early and optimal management, optimizing physical health, cognition, activity, and well-being, identifying and treating accompanying physical illness, detecting and treating challenging behavioral and psychological symptoms, and providing information and long-term support to careers.”

Though there is always hope for a future dementia solution, there are still the issues at hand today. A diagnosis of dementia has profound consequences for health and wellness, relationships, retirement, and economic well-being. Some states already have dementia health directive templates to address future issues of dementia while a person is still mentally capable of making sound decisions. Like all things in life, it is best to proactively manage circumstances rather than react to problems.

We can help you and your loved ones prepare for the possibility of a dementia diagnosis. We help families determine the best type of care, how to pay for that care, and how to put the proper legal documents in place to make sure appropriate persons are named to step in and make decisions for you if needed. We hope you found this article helpful.

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