Tag: nursing home care

Elder Law, Elder Living

Nursing Homes and COVID-19 Deaths

SchulzeLawGroup

Because aging Americans are more susceptible to the coronavirus, deaths in this age group are high. Although nursing home residents are less than one percent of the total US population, according to a report from the CDC, they account for more than 40 percent or approximately 45,500 of the US 115,000 COVID-19 deaths.

Seema Verma, the administrator for the Centers for Medicare and Medicaid Services (CMS), asserts that nursing homes following federal infection control guidelines were largely able to contain the coronavirus.

Harvard researcher David Grabowski, a member of a nonpartisan commission, advising Congress about Medicare, states that “The federal government needs to own this issue,” about the need for federal efforts to routinely test nursing home staff and residents for COVID-19 and make more protective gear available. Grabowski agrees with other advocates for the elderly that the federal government has not provided consistent virus testing and sufficient protective equipment to nursing homes, its staff, and residents.

High Risk for Elderly Care During This Election Year

In this Presidential election year, the stakes could not be higher to garner support from older voters. Partisan overtones affect the discussion and subsequent policies to guide safer nursing home outcomes from the ravages of COVID-19. The blame game is on between political parties fighting for votes and states legally protecting health care workers and facilities from coronavirus lawsuits by residents or their families.

The Trump administration deflects accountability by criticizing nursing home facilities with low federal ratings for infection control and a handful of Democratic governors, New York in particular, who mandated that nursing homes accept recovering coronavirus patients. The number two House Republican, Steve Scalise of Louisiana, states that this NY policy, and other states with similar policies, “ended up being a death sentence.” Verma echoes the nursing homes with low federal rating criticism, saying CMS has data equating low safety ratings with outbreaks of COVID-19. Several academic researchers dispute this data citing their research has found no such link. Amid the finger-pointing, shamefully, more vulnerable senior nursing home residents are dying because of the coronavirus.

Nursing Home Concerns During Coronavirus

In agreement with other academic researchers, Harvard’s David Grabowski opined that neither state policies nor proverbial bad apples among nursing homes were responsible for driving the coronavirus outbreaks. The reason is simply because of the virus’s nature, which can spread via individuals displaying no symptoms and do not feel unwell. The illness’s very nature indicates it is already spread throughout communities. Without routine testing, nursing home staff can unknowingly bring COVID-19 into a facility where it then spreads easily among frail residents living in tight quarters. Ricardo Alonso-Zaldivar of the Associated Press quotes Grabowski, “The secret weapon behind COVID is that it spreads in the absence of any symptoms,” Grabowski told lawmakers at a recent briefing. “If COVID is in a community where staff lives, it is soon to be in the facility where they work.”

Advocacy group Justice in Aging’s long-term care expert Eric Carlson cites the lack of federal coordination as impeding the ability to identify people who are infected by and require care for the coronavirus. Other advocates agree that the White House directive for the testing of all residents and staff has had an uneven response, accounting for why some facilities suffer higher rates of infection than others. The Associated Press report from the end of May 2020 concurs with these opinions reporting “White House goal on testing nursing homes unmet.”

Meanwhile, at CMS, administrator Verma believes her agency has provided necessary safety guidelines, COVID-19 reporting requirements, and Medicare payment for testing residents since the outset of the virus. She continues that states have the money required from the federal government to support the nursing home staff’s testing. Let’s hope that is the case, as the nursing home industry reports one-time testing for every resident and staffer would cost 440 million dollars.

The coronavirus pandemic is not going to go away. New spikes of cases across the country are being reported and not even considered the “second wave” of infection that many experts anticipate. Third-ranking House Democrat Representative and chairman of a special panel on the coronavirus pandemic James Clyburn of South Carolina seems to match wisdom with temperance about the finger-pointing saying that the crisis in nursing homes should not be a partisan issue. Instead, stating, “Nursing home residents have died from the coronavirus in states governed by Republicans and Democrats, in big cities and in small towns, in rural and urban communities.” Capitol Hill law and policymakers seem to be very adept at identifying problems but slow in resolving them. In the meantime, our vulnerable senior nursing home population and their families are paying the price. We help families with loved ones in a nursing home deal with a variety of issues. If you have a loved one in a nursing home, please don’t hesitate to reach out to see how we can help. Please contact our Reno office by calling us at (775) 853-5700.

Elder Law, Elder Living, Estate Planning, Healthcare

American Nursing Homes Face a Dilemma

SchulzeLawGroup

Our country’s nursing facilities are home to the most vulnerable to the COVID-19 pandemic. 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 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. If you’d like to discuss your particular situation, please don’t hesitate to contact us. Please contact our Reno office by calling us at (775) 853-5700 with any questions.

Elder Living

Understanding CMS Guidelines for Nursing Home Visitation

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Revised guidance for nursing home visitation has been issued by the Centers for Medicare and Medicaid (CMS). It is now possible to have visitation with nursing home residents for reasons other than urgent end-of-life scenarios and, in some instances, may include physical touch. Additionally, communal activities and dining are permissible as long as the social distancing rule of 6 feet of separation, and other precautions are observed. Encouraging outdoor visits is desirable as long as the weather permits. Indoor visits are permissible if no new cases were identified in the previous two weeks, and the facility adheres to the core principles of resident and staff testing, screening, proper hygiene, social distancing, and facility cleaning. 

The CMS memo contains “Core Principles of COVID-19 Infection Prevention” verbatim as follows:

  • Screening of all who enter the facility for signs and symptoms of COVID-19 (e.g., temperature checks, questions or observations about signs or symptoms), and denial of entry of those with signs or symptoms
  • Hand hygiene (use of alcohol-based hand rub is preferred) 
  • Face covering or mask (covering mouth and nose) 
  • Social distancing at least six feet between persons 
  • Instructional signage throughout the facility and proper visitor education on COVID19 signs and symptoms, infection control precautions, other applicable facility practices (e.g., use of face-covering or mask, specified entries, exits, and routes to designated areas, hand hygiene)
  • Cleaning and disinfecting high frequency touched surfaces in the facility often, and designated visitation areas after each visit 
  • Appropriate staff use of Personal Protective Equipment (PPE) 
  • Effective cohorting of residents (e.g., separate areas dedicated COVID-19 care)
  • Resident and staff testing conducted as required.

CMS acknowledges that the previous months of severe visitor restrictions to slow the spread of COVID-19 were at a high cost to nursing home residents’ overall wellbeing. The revision of visitor guidance compassionately addresses resident care needs beyond protection from the coronavirus. CMS Administrator Seema Verma states, “While we must remain steadfast in our fight to shield nursing home residents from this virus, it is becoming clear that prolonged isolation and separation from family is also taking a deadly toll on our aging loved ones.”

CMS is also making available Civil Monetary Penalty (CMP) funds to ensure greater and safer access to outdoor and indoor visits. The money can purchase tents for outdoor interaction and clear dividers such as plexiglass can create physical barriers, reducing the risk of transmission during in-person visits. Funding through CMP can also provide communication aids such as tablet devices and webcams that enable virtual visits. However, each facility has a limit of $3,000 to ensure a balance in distributing CMP funds.

Compassionate care situations now include more than the end-of-life scenarios and are also included in the CMS memo. Verbatim they include but are not limited to:

  • A resident, who was living with their family before recently being admitted to a nursing home, is struggling with the change in environment and lack of physical family support.
  • A resident who is grieving after a friend or family member recently passed away.
  • A resident who needs cueing and encouragement with eating or drinking, previously provided by family and/or caregiver(s), is experiencing weight loss or dehydration.
  • A resident, who used to talk and interact with others, is experiencing emotional distress, seldom speaking, or crying more frequently (when the resident had rarely cried in the past).

In addition to family members, compassionate care visits may now also include clergy or laypersons offering religious or spiritual support that meet the resident’s needs. Personal contact is permissible during these and family visits but only when following all appropriate infection prevention guidance. This more humanized approach to nursing home care encourages facility staff to work with residents, families, caregivers, and resident representatives to identify those in need of in-person compassionate care visitation. Exceptions to compassionate visits occur when facilities have experienced COVID-19 infections within the past two weeks or when a county is experiencing a high positivity COVID-19 rate. In the absence of a reasonable safety or clinical cause, the Centers for Medicare and Medicaid make clear that failure of nursing homes to facilitate in-person visitations can be cause for citations and other penalties as CMS deems appropriate.

CMS understands that nursing home residents derive physical, emotional, and spiritual value and support through family and friend visitations, especially in trying times. No one should be made to endure this pandemic alone, least of all the most vulnerable among us. This new CMS nursing home visitation guidance is designed to help American seniors remain happier, stronger, and more resilient in the face of adversity through the personal support of those who love them most.

If you have a loved one in a nursing home, check with the facility to see how or whether their visitation guidelines have changed. It may take time for local facilities to consider these new guidelines and make changes that are consistent with the recommendations from CMS.

We would be happy to discuss any questions you have, including how to choose appropriate long term care and how to pay for it. We can recommend legal ways to help ease the cost of long-term care and protect your savings and home. Please contact our Reno office by calling us at (775) 853-5700 to learn more about your legal options.

Elder Living

Alternative Views on Facility Living with Alzheimer’s Patients

SchulzeLawGroup

As the aging population rises, Alzheimer’s Disease is also on the rise for elderly moving into nursing home facilities. The National Institute of Health (NIH) Library of Medicine reports the most common form of dementia is Alzheimer’s disease, accounting for approximately two-thirds of all diagnosed cases of dementia. Alzheimer’s is also one of the most expensive diseases to treat and often results in financial strain on families trying to find and pay for the best care. In the past, care in facilities often resulted in Alzheimer’s patients being separated from others. However, as you’ll read below, facilities are now exploring better ways to treat Alzheimer’s patients while living in a facility.

Medical breakthroughs that increase our understanding of how to best treat and introduce disease modification therapies for people living with Alzheimer’s and other neurodegenerative diseases provides future hope. However, according to the Alzheimer’s Association, there are already more than 5.8 million Americans living with Alzheimer’s disease. These individuals may not live long enough to benefit from new therapy discoveries since new treatments must undergo rigorous testing and clinical trial phases. Current projections indicate that unless some of these medical breakthroughs have practical applications very soon, more than 14 million Americans will be clinically diagnosed to be living with Alzheimer’s by 2050, with many more struggling in the long-preclinical phase of the disease.

As senior living facilities become more saturated with dementia patients in all stages of progression, there is a shift underway towards non-segregated memory care living. Alzheimer’s patient reintegration into general senior living residence status is shifting dementia care into a human-centric model. It provides insights and lessons into eldercare facility living, its providers and staff, family members of residents, and all of the patients, not just memory care patients. This human-based approach is a kinder, more medically practical and appropriate, and in the long term, a more cost-effective method for facility residents who have dementia.

Before there were outcome-based clinical research findings to support the segregating of dementia patients care facilities began creating stand-alone memory care units, floors, and facilities.  Families knew their loved ones were safely locked away in a highly monitored unit, and staff could focus their training and efforts in a more specified range of care. Because this isolation model became overwhelmingly profitable for business operators, it became the de facto standard of memory care operation. Profits were trumping the human condition. At the outset, it seemed rational enough to put like-patients together, yet because everyone’s memory disease progression is unique, the concept was flawed. Living circumstances for humans is an emotional experience, and the sad outcome for assembled memory care patients was faster disease progression in their isolated, shrinking worlds. This accelerated mental decline was partially due to the lack of broader social and emotional connection with non-dementia residents. It seems integrating patients of all types and generations enriches and expands what residents can do, creating a diverse human model focusing on the positive aspects of life and personal interaction.

Some of the conditions all aging adults share, not just those living with dementia, include difficulty hearing and seeing, finding mental focus more demanding, becoming more concerned about being in large crowds, and noises that increase their stress levels. For a community of residents, no matter what the patient illness, facilities can create an atmosphere that addresses these common concerns. These shared needs include not only medical care but activities that are available in a 24-hour cycle and the encouragement of socialization in smaller, quieter circles. Interactions among residents in this calming style of environment tend to create friendships organically and provide enriching connections among patients irrespective of their illness type. The overall common conditions of aging require sameness in approach, no matter how varied the residents’ medical conditions are.

Technology that allows for digital wrist monitoring of patient location and vital signs permits ease of monitoring residents, particularly as they wander their living space.  Even the proper lighting, carpeting, and circular hallway architecture reassure residents’ feelings of safety, comfort, and familiarity, which appeals to all, regardless of diagnosis. When an entire senior living facility is dementia friendly, and all staff is trained in memory illness and care, every employee can add value to a resident’s enjoyment of life from the medical professionals to the social workers to the landscapers.

A diagnosis of Alzheimer’s can strike fear and worry in America’s aging population because of the emotional, physical, and financial upheaval associated with it. An older person might recognize the onset of some memory problems and become terrified, thinking about Alzheimer’s and the possibility of being relocated from their home and community to a dementia unit. There is a sense of dread that you may never feel seen, heard, and loved again by other people. Interpersonal relationships and connectedness are a hallmark of the aging communities in America. AARP reports large percentages of technology use in older Americans is related to interpersonal connections like email, viewing photos of family and friends, and using social media and the internet. Even in digital spaces and experiences, elderly community residents are looking to create personal networks, connecting to the world at large. The human spirit inclines to be expansive.

Appropriate social and physical environments play a significant role in healthy aging. Compartmentalizing memory care patients into homogeneous units will increase their memory decline, isolate their human connection, and spiral the patient into an ever-shrinking world of interaction, often making them non-verbal. Alzheimer’s patients who experience higher levels of social integration respond conversely, expanding their horizons as they experience and feel the extension of human love and support. There is no one set of symptoms for Alzheimer’s patients, and all patients are on their own trajectory of the disease. Mistakenly putting them together in a one size fits all approach of care has been a disservice to their health and well being and to the future care of others who will become afflicted with Alzheimer’s. The memory care model is shifting for the better and not a moment too soon.

We help families who have a loved one with dementia. We explore possible sources to help pay for care, like Medicaid, and we make sure our client’s wishes are stated in properly drafted legal documents. If you have a loved one with dementia, give us a call and let’s work on a plan to ensure your loved one has the best care possible, and their home and savings are protected. If you have questions, please do not hesitate to contact our Reno office by calling us at (775) 853-5700.