My Elder Advocate

Managed Long-Term Care (MLTC) A New Frontier for Medicaid Home Care

2013-04-30T08:38:00-07:00

By Julia Greenberg, Esq.,Elder Law Attorney

Lamson & Cutner, P.C.

Major changes are being implemented in Medicaid's community-based long term care program.

One of the most dramatic of these changes is the mandatory enrollment of individuals who are eligible for both Medicare and Medicaid in a managed long-term care (MLTC) plan. Dually eligible individuals had previously been exempt from mandatory enrollment.

This new model requires individuals who are expected to need more than 120 days of home care to enroll in an MLTC plan that administers and oversees the home care being provided.

Until recently, the assessment, implementation and oversight of Medicaid long-term home care benefits in New York City was handled by CASA (the home care department within the NYC Human Resources Department) and by the local Departments of Social Services (DSS) in all other counties.

Now, oversight and implementation of home care services is shifting from the Medicaid agencies to MLTC plans. The phasing in of mandatory enrollment in an MLTC plan started in New York City, and is being extended to the other counties around New York State.

Under the previous model, an individual applying for home care services in New York City would submit an application to the CASA office in his or her county. Once the applicant was determined to be financially eligible for Medicaid benefits, the agency would deploy a nurse to assess the applicant. The nurse-assessor would determine how many hours of home care should be provided by Medicaid based on the applicant's needs, and a home care agency would be assigned to provide the care.

However, the CASA offices are no longer accepting home care applications (with limited exceptions including individuals on hospice and Medicaid waiver programs). A New York City applicant must now apply for community Medicaid and, once approved, must enroll in an MLTC plan. The MLTC plan will conduct the assessment for home care hours and will oversee the implementation of the care.

The previous model was a fee-for-service model, which means that the home care agency providing the services billed Medicaid for the number of hours provided, and in turn, Medicaid would pay the agency a set hourly rate for such care. The new model is based on "capitation," which means that Medicaid pays the MLTC plan a set dollar amount for every person enrolled in the plan. The amount that Medicaid pays the MLTC plan is not dependent on how many hours of care are provided, which means, for example, that Medicaid pays the MLTC plan the same amount for an individual who receives 4 hours of home care per day as an individual who receives 12 hours per day.

Individuals who are currently receiving Medicaid home care services have been, or will be, sent letters notifying them of mandatory enrollment in an MLTC plan and will have to choose an appropriate plan. Individuals who are now applying for Medicaid will also have to choose an MLTC plan to provide services. If an MLTC plan is not chosen, one will be assigned.

Choosing an MLTC plan can be confusing, as there are three broad types of plans that are available. The MLTC Medicaid Plans manage only long-term home care services (and not regular Medicaid or Medicare benefits). The Medicaid Advantage Plus Plans manage all services from Medicare and Medicaid, and the providers must be "in network." There is also a plan called PACE, which is for people 55 years and older. The PACE plan arranges all appointments, and manages and coordinates all Medicare and Medicaid services, all of which must be rendered by providers in the PACE program's network.

The MLTC Medicaid Plans will generally be the best choice, since participants can continue to see their regular doctors and specialists without concern that they are out of network.

Once participants decide which type of plan is preferable, participants will then have to choose one of several MLTC plans in which to enroll. It can easily be seen that the "capitation" model gives the MLTC plans a financial incentive to hold down costs. Since Medicaid pays them an equal amount per person in the plan, regardless of the number of hours of care provided, there are financial pressures to provide fewer hours. We are already seeing statistics that seem to indicate that some MLTC plans are being more generous with home care hours than other MLTC plans.

Queens, New York Assisted Living Facility Discriminates Against Gay Man

2013-04-14T15:21:25-07:00

By Jack Halpern, CEO, My Elder Advocate

One would not believe that in 2013, that a private assisted living facility in New York State would discriminate against a gay man, but that is exactly what happened to Carl Rizzio, the same gentleman mentioned in my last post dated March 31, 2013.

Had I not experienced it myself, I would not believe it. After Carl was accepted as a resident in the memory unit at The Brandywine at the Savoy Assisted Living Facility in Little Neck, NY, and on the eve of his admission, he was rejected because he had Hepatitis C in the past. This is highly unusual; I have never encountered another assisted living facility that did not admit a resident with Hepatitis C (Carl was later admitted to another fine facility without any problems). The Executive Director, Mark Weinberger claims that he did not know that Carl was gay, as if only gay men develop this illness. I explained to Mr. Weinberger that Carl was a gay man and he had Hepatitis C in the past, but he was never HIV Positive, and that he would not be a danger to the other residents in the memory unit. I referred him to a Department of Health memo on Hepatitis C, which states the following:

“Hepatitis C is caused by the hepatitis C virus (HCV). The virus is found in blood and certain body fluids. It is spread when a person who is not immune comes in contact with blood or body fluids from an infected person. Hepatitis C is spread through sharing needles or "works" when "shooting" drugs, through needle stick or sharps exposures in a health care setting, or sometimes from an infected mother to her baby during vaginal birth. It is possible to get hepatitis C from sex, but it is uncommon."

I also asked Mr. Weinberger to accept a letter from Carl’s doctor stating very clearly that it was highly unlikely that Carl would infect anyone in the Memory Center, unless he mixed blood with another resident. Mark Weinberger refused Carl admission. He stated that he “did not want a gay man with Hepatitis C in his facility”, because he had never accepted anyone with Hepatitis C, and he would have to teach his staff how to deal with it. He also would not accept a doctor’s note, because the doctor “did not have a crystal ball and could not give him any guarantees” that Carl would not infect anyone.

It is clear that Carl was discriminated against, just like many LGBT individuals are discriminated against in many facilities across the country. Many developers are now building facilities that are “LGBT Friendly” and admit LGBT residents exclusively. That does not mean that Brandywine should get away with this.

I always advise my clients to stay away from facilities that discriminate against anyone as a matter of policy. Mr. Mark Weinberger, Executive Director at the Brandywine, should be ashamed of himself. So should the Operators of the Brandywine chain of assisted living facilities.

While not a scientific study, the National Senior Citizens Law Center's "LGBT Older Adults in Long-Term Care Facilities: Stories from the Field" includes data from 769 adults who completed an online survey from October 2009 to June 2010. Nearly 300 respondents identified themselves as LGBT older adults; the rest were family members, friends, legal and social service providers. Almost all — 89% — predicted that staff would discriminate against a LGBT older adult. Nearly half (43%) reported 853 overall instances of mistreatment. Additionally, 24 reported denial of medical treatment while 93 reported restrictions on visitors.

My Elder Advocate responds nearly instantly to any elder or eldercare crisis… in order to provide nursing home intervention, arrange for immediate placements, prevent evictions from nursing homes, handle a hospital crisis, and respond to other eldercare challenges.

But we can’t solve an ugly and dangerous situation unless you contact us immediately. Often waiting a day is as harmful to a family member as taking no action at all.

If you and your family have an elder family member that is facing one of these challenges, don’t wait. We can resolve it quickly. Contact us TODAY by calling us directly at (212) 945-7550.

Are all nursing homes equipped to handle residents with Alzheimer's disease? Part I

2013-03-31T16:46:06-07:00

By Jack Halpern, CEO, My Elder Advocate

The answer to this question is a resounding NO. Throughout the United States, there are many thousands of people, who are afflicted with dementia and Alzheimer’s disease, and reside in nursing homes, that are not equipped to handle the special needs of this population. Instead these unfortunate souls (mostly poor) are thrown in with the general population at these facilities, and they die prematurely, not from physical illnesses, but from the rapid mental deterioration, due to the lack of meaningful therapy and stimuli.

Carl Rizzio, an elderly gentleman with advanced Alzheimer’s disease, was admitted to Mt. Sinai NY Hospital’s geriatric psychiatric locked ward, after his home health aide found him in his room “unresponsive.” I will never understand why he was placed in a locked down psych ward, other than to fill a bed. He was treated with antipsychotic drugs for 2 weeks and declared ready for discharge. Since Carl could no longer function in his home, the hospital insisted that he be sent to a nursing home. It was at this point that Mr. Rizzio’s family called me in to advocate for him.

Many families who have loved ones with Alzheimer's disease or other dementias are extremely reluctant to place them in a nursing home. The vast majority doesn’t want to do it, and many refuse to even think about it. Some feel it's the most cruel, shameful thing they could possibly do to their loved one, even if they have access to a high-quality facility nearby.

Standing back and looking at the situation more objectively, however, it becomes clear that sometimes a quality nursing home placement is the most loving course of action for the patient. In many cases, caring for the person at home actually deprives them of the amount, quality and level of care and safety they need. I have placed many homebound elders with advanced Alzheimer’s disease and other dementias, into quality nursing homes, with great results

Nursing home placement should be of special consideration for patients in the mid-to-late stages of the disease. These patients desperately need so much more care than a single person or family unit -- even with some paid help coming in -- can provide. But you can only place in a facility with a great program

After assessing Carl’s needs, it became clear to me that he would function very well in a memory care unit in an assisted living facility. This is a choice that is not available to elders without means, because a well-equipped memory care unit is expensive. The costs range anywhere from $3000.00 to $8,000.00, depending on location. Medicare and Medicaid do not cover these costs.

There are 16,000 nursing homes in the USA. 80% of these facilities or about 13,000 nursing homes are for profit facilities. My Elder Advocate estimates that only 30% of these or about 4500 facilities, plus most of the not for profit facilities have dedicated, and professionally staffed Alzheimer’s and Dementia programs. These statistics are frightening, when you consider that we are still far from a cure for these illnesses.

In PART II we will discuss what the components of a good program are, and what substitutes for a program in a sub-standard nursing home.

In PART III we will find out how elders with dementia wind up in these sub-standard homes and what we can do about it.

But we can’t solve an ugly and dangerous situation unless you contact us immediately. Often waiting a day is as harmful to a family member as taking no action at all.

If you and your family have an elder family member that is facing one of these challenges, don’t wait. We can resolve it quickly. Contact us TODAY by calling us directly at (212) 945-7550.

Elderly Patient Is Thrown Out of NY Presbyterian/Cornell Hospital And Forced Into A Nursing Home

2013-03-23T18:00:58-07:00

By Jack Halpern, CEO, My Elder Advocate

On a recent Friday afternoon Martin D. was resting in his private room at NY Presbyterian/Cornell Hospital recuperating from a MRSA Infection that he contracted at the hospital because of the negligence of one of the staff physicians. Suddenly 3 burly ambulance attendants came into his room with a stretcher, and very unceremoniously announced that he was being transferred to a nursing home in New Rochelle.

Martin an 85 year old, weighing only 95 pounds, seriously ill gentleman almost had a heart attack. He informed these bullies that he was not made aware that he was being discharged, and he did not wish to leave. His wife Anne did not tell him about any discharge either. As the bullies began to remove him from bed, he grabbed the wall. They forced his hands from the wall. He called his wife on his cell phone, but they tore the phone from his hand. All the time these bullies were verbally abusing Martin. He was treated like a criminal. Martin was restrained on a stretcher and taken away.

Carol DeJesus, Director of Social Services, who has been trying to throw Martin out of the hospital for weeks, orchestrated this hasty eviction before the weekend. DeJesus, a nasty, unprofessional, and dispassionate woman was becoming increasingly frustrated with my insistence that Martin can’t leave until he has completed his full complement of intravenous antibiotics in a safe environment instead of being sent to a sub-standard nursing home, with poor infection control. DeJesus did not even have the courage to be present during this eviction, nor were there any staff members available who could calm Martin down. It was a horrible scene.

Before being admitted to NY Presbyterian, Martin had spent 5 weeks at just such a facility. While at that facility he lost 22 pounds, had numerous seizures, was gashed on his arm, and sustained many more indignities. Yet, after 7 days at NY Presbyterian, DeJesus was insisting that Martin go back to the same nursing home.

The receiving facility admitted Martin only because they were told that Martin and his wife had agreed to the transfer. When they found out the truth, they were appalled and very apologetic. It was too dangerous to send him back.

The day of this horrible event was a day, when many of Carol Dejesus’s co-workers were ashamed of their hospital, and ashamed of Carol DeJesus. One coworker suggested that she should lose her license. I agree. Martin could very well have died as a result of this hasty move. Lucky for the hospital, he survived.

But we can’t solve an ugly and dangerous situation unless you contact us immediately. Often waiting a day is as harmful to a family member as taking no action at all.

If you and your family have an elder family member that is facing one of these challenges, don’t wait. We can resolve it quickly. Contact us TODAY by calling us directly at (212) 945-7550.

Music & Memory: Treating Nursing Home Patients With Music

2013-03-16T07:29:47-07:00

PHOTOGRAPH BY BRANDON STANTON, HUMANS OF NEW YORK

For so many people, the music we listen to from childhood to adulthood is not just something playing in the background, but the bonding of music and memories. Every song is a scribbled note in the margin of a diary and the music of our lives becomes a soundtrack to the emotional scrapbooks we keep in our heads. Some songs have stronger memories attached than others. The obvious ones are tunes that remind us of emotional moments in our lives; romance, happiness, milestones. Some songs remind us of certain days or specific people. The simple playing of a particular tune can open up a page in that scrapbook and we’re suddenly ten or twenty or thirty again, reliving a moment from our lives.

via www.forbes.com

Hospital Refuses to Report Nursing Home Abuse and Neglect

2013-03-10T18:35:55-07:00

By Jack Halpern, CEO, My Elder Advocate

A patient advocate employed by Brookhaven Hospital in Brookhaven, New York flatly refused on two seperate occasions to report to the Department of Health, that a newly arrived resident of a local nursing home at been neglected and abused, as the law requires.

I would like to make it clear that my client, Joe B. has been receiving excellent care at Brookhaven Hospital. Unlike at the nursing home, Lakeview Nursing Home, Brookhaven has healed his urinary tract infection, which was due to the fact that the nursing home never cleaned his Foley Catheter. They have also dealt with the various other medical conditions that he arrived with because of the neglect and abuse he suffered at the hands of the very incompetent staff at Lakeview.

On two separate occasions, I requested that Mr. Christopher Banks, a patient advocate employed by Brookhaven Hospital that he investigate the medical records that reported the conditions that Joe had developed as a result of the neglect and abuse that he suffered at the hands of the staff at Lakeview Nursing Home. He categorically refused, telling me “it was not his job to report anything that did not occur at the hospital.” I began to remind him that the law said different, but he slammed the phone down on me.

From abandonment, to broken bones, financial exploitation or neglect, elder abuse takes a horrific toll on one of America's most vulnerable populations. In recent years, nursing homes and residential care facilities have undergone tougher scrutiny from the news media and regulators looking to answer the challenge. State legislatures have responded to public outcry by making it mandatory for professionals like counselors, doctors and social workers to report abuse or neglect, and holding them accountable when they fail to do so.

Reporting requirements generally divided along mandatory and non-mandatory lines in many states. Illinois law, for example, creates a class of mandatory reporters, such as clergy, doctors, nurses, nursing-home aides, health care providers, psychologists and social workers. Professionals in this category who fail to report elder abuse risk losing their licenses and may even face fines or criminal charges. The law also encourages non-mandatory, or voluntary, reporting of abuse from the victim's friends, relatives and neighbors.

I also requested that Dr. M Hani Salam, who did not report the abusive treatment of Joe B. at the Nursing Home over a long period of time (according to Joe’s family), although he was his physician and often ordered that Joe be sent to the hospital with Urinary Tract Infections due to clogged and filthy Catheters, report his condition at the hospital. Yes, Dr. Salam was both his physician at the Nursing Home and at the Hospital. Dr. Salam has an office at 76 Southaven Ave #5, Medford, NY 11763.

For obvious reasons, Dr. Salam refused to report the abuse and neglect. One of the reasons that so much elder abuse in Nursing Home goes unreported is because hospital and nursing homes have a very lucrative association, including sharing physicians, who cover up abuse going both ways.

By maintaining this incestuous relationship, both can milk the reimbursement system. Hospitals are able to send elderly patients to nursing home very quickly, although they may not be ready, thus emptying their beds. It does not matter what diagnosis a patient in the hospital has, they will send them to the nursing home for rehabilitation. I would estimate based on my experience, 30 to 40% of hospital patients don’t need rehabilitation services as described by Medicare. Hospitals are glad to get rid of them, and nursing homes are thrilled to get them (they get $650.00 per day as opposed to $300.00 per day from Medicaid.

On the other hand, Nursing Homes send their residents, more often than necessary, out to the hospital with ailments that nursing homes are equipped professionally to handle.

If hospitals and nursing homes reported abuse and neglect on each other, this wonderful financial arrangement would topple. It’s all about $MONEY$. It’s not a problem since no one is enforcing the law.

But we can’t solve an ugly and dangerous situation unless you contact us immediately. Often waiting a day is as harmful to a family member as taking no action at all.

If you and your family have an elder family member that is facing one of these challenges, don’t wait. We can resolve it quickly. Contact us TODAY by calling us directly at (212) 945-7550.

Nursing Homes fail to report deaths, injuries

2013-02-24T07:43:25-08:00

By Sarah Karon Wisconsin Center for Investigative Journalism

via www.wisconsinwatch.org

Attorney Warns Hospital Patient: Go to Sub-Standard Nursing Home, or Face Court Ordered Eviction.

2013-02-23T17:04:21-08:00

By Jack Halpern, CEO, My Elder Advocate

In the last few week, among the many horrible cases that I have been dealing with, is the case of a 52 year old Multiple Sclerosis sufferer, who has been a patient at Brookhaven Hospital in Patchogue for a severe infection, that he developed as a result of the neglectful and abusive care he received as a resident, in a dangerous and sub-standard facility called Lakeview Nursing Home in Middle Island, NY.

How ironic it is that a nursing home that abuses residents should have a name like Lakeview. There is pain but no view of a lake. More on this nursing home on a later post. I have already been contacted by this facility's attorney to stop telling the truth about a facility that on it's last survey had 40 pages of serious violations.

Anyway, back to our story. After a few weeks in the hospital my client (let's call him GEORGE,) and his family were notified that he could no longer stay in the hospital and had to go to a nursing home. He was certainly not able to leave so early. He still needed more hospital care. Although I would never allow him to go back to Lakeview, they preemted by refusing to readmit him, which is a violation of the law.

The hospital referred George's family to some very bad places like Avalon Nursing Home, and John J. Foley Nursing Home. The NY State Department of Health ratess these facilities as very below average. They have received a 1 star rate out of 5 in the arcaic and poor Federal Government rating system. These facilities are severely understaffed.

I said no. As George's advocate I would not place him in a substandard facility, especially since he has special needs, that most nursing homes are not equipped to handle. The hospital put extreme pressure on George and his family to accept admission to these horrible places. They claim that a patient in a hospital must accept the first bed available in a nursing home, regardless of the quality or rating.

I SAY NO!

The hospital suggested two other facilities. I called them to find out if they have any experience with Multiple Sclerosis residents. I was told no, but they want to try. Many hospitals don't even try to send difficult residents to good nursing homes, because they have profitable relationships with them and they don't want to refer an undesirable resident. I don't know if this is the case with George, but it is very unusual that none of the better facilities would even consider him.

Today an attorney for the hospital called me apparently in a failed effort to intimidate me and the family to accept transfer to one of these horrible facilities. Eve Green Koopersmith, an attorney at Garfunkel Wild, P.C. called me to threaten a court proceeding that will force George to accept any available bed in any of the local nursing home. She warned me that she always wins at these proceedings, and she can get it accomplished very quickly. I informed her that the facilities thus far that had empty beds, were very dangerous and sub-standard. What she told me next pretty much summed up her compassion. "All nursing homes are inspected by the Department of Health, and therefore are qualified places." I'm sure that Eve would not want her mom in these nursing homes, but it's ok for George.

As the readers of My Elder Advocate Blog are well aware, this is total nonsense. I have asked my clients and my readers before and I will repeat it now. Never use an Elder Law Attorney whose firm represents nursing homes and hospitals in actions against patients, even if they are in seperate divisions of the firm.

Brookhaven Hospital is refusing to do what it can possibly do to get George into a good facility. They don't want to rock the boat with their local nursing homes. It's going to take a lot more than a loud mouth attorney to make me allow George into a facility that will kill him, or treat him, like he was treated at Lakeview Nursing Home.

Feeding Tubes For Elders: Benefit or Abuse?

2013-01-23T17:25:11-08:00

By Jack Halpern, CEO, My Elder Advocate

Imbedded in today’s nursing home culture is a practice that has been notoriously associated with elder abuse in nursing homes. Nationwide, many nursing home residents with advanced cognitive impairment are tube fed (35% according to some studies), despite no demonstrable benefits of this intervention in this population. Studies suggest that organizational features of nursing homes are associated with this practice, but underlying reasons for these associations are poorly understood. A feeding tube in a sub-standard nursing home can be a death sentence. My Elder Advocate has been very successful in preventing this abuse from occurring in many cases, where we were called in early to advocate for clients who were losing weight in nursing homes.

Older adults in nursing homes may require feeding tubes for a variety of reasons including swallowing difficulties and as a precautionary measure to attempt to prevent aspiration pneumonia in certain types of patients. These feedings tubes can be temporary or permanent and require close monitoring in order to avoid potentially life-threatening complications.

Margaret Mino has had a tough time, grappling with one of the crossroads decisions that family members have to so often, shoulder for ailing elders. “It’s been a harrowing experience,” she said.

She has known and loved her Uncle Rufus, now 89 and living in a Staten Island nursing home, since he moved into her parents’ home when she was a little girl.

A onetime coal miner, he has always needed family help — a cyst in his brain caused lifelong cognitive difficulties. He hasn’t eaten solid food for three years, but has done reasonably well on thickened liquids. And at their weekly visits, he can still talk with her, though mostly about the past.

Lately, however, he’s grown awfully thin. When his weight reached 132 pounds, down from 165, she took her concerns to the staff. “He might be a candidate for a feeding tube,” a nurse suggested. Sometimes, the nurse added, people improve and start eating again and the tube can be removed.

“I just don’t think that’s very likely,” Ms. Mino told me. She knows a fair amount about the pluses and minuses of tube feeding in the elderly, having faced a similar decision for her father last spring. (I probably should have said that when it comes to caregiving, Ms. Mino, a federal employee, has had a tough 10 years.)

She also knows that her uncle’s dementia will not abate.

Few questions are more upsetting to families than this one. Providing nourishment is, from the first moments of life, an elemental way for humans to demonstrate love and care. Saying no to a feeding tube can feel tantamount to allowing a loved one to starve. I sometimes wonder if it’s actually easier, emotionally, to decline CPR or a ventilator; we may not feel responsible for keeping relatives’ hearts beating or lungs functioning, but we have trouble overriding our impulse to feed them.

Hospitals that insert feeding tubes into patients with advanced dementia and discharge them to skilled nursing homes may, in fact, cause harm by making these patients more susceptible to pressure ulcers, according to a review of Medicare claims.

It had been believed that in patients with dementia, who often have eating disorders, nutritional imbalances cause and exacerbate pressure ulcers and prevent their healing. Feeding tubes delivering protein supplements were presumed to have been helpful. But prior studies were inconclusive and some studies revealed exactly the opposite. Up to a third of nursing home patients with advanced dementia have a feeding tube. In two-thirds of these cases, the tube was inserted while a patient was in the hospital.

Recognition is growing that dementia is a terminal illness that affects the body as well as the mind, and when a patient with dementia begins having trouble eating, this indicates the final stage of the illness has arrived. For these patients, she added, careful hand feeding can offer a safer and more comfortable alternative to feeding tube insertion, but it takes staff time and effort, which is a great problem in today’s severely understaffed nursing homes. It takes a substantial amount of time and effort to feed residents by mouth.

Statistically, For-profit hospitals were more likely to use feeding tubes, as were larger hospitals and those with the highest level of intensive care unit use for patients in their last six months of life. Likewise, for-profit nursing homes (80 percent of the nh's in the country) are more likely to encourage families to get feeding tubes for their elders, than not for profit nursing homes.

Nursing homes and hospitals together have "a strong financial incentive" to deal with patients with dementia by inserting PEGs, or percutaneous gastrostomy tubes rather than hand feeding them, which takes more time and patience.

The majority of the people who get these feeding tubes have already been in a nursing home for a while. They've exhausted their wealth and now qualify for Medicaid, and then become "dual-eligible," qualifying for both Medicare and Medicaid. If the patient gets an infection, even a minor one, rather than treating the infection in the nursing home, they send them to the hospital.

The patients then become eligible for skilled nursing facility services for up to 100 days, "which qualifies the nursing home to get paid roughly three to four times what would have been paid if the patient remains at the nursing home on Medicaid.

Because of the setting change, these patients develop disruptive behaviors, which usually leads to physical or pharmacological restraint with anti-psychotics. The nutritional supplements they're getting can produce diarrhea. "Now, with the immobility, the incontinence, and diarrhea, they end up with pressure ulcers."

It becomes a pathway. The nursing home wants to maximize its money so they send the patient to the hospital. The hospital wants to get that person out of there quickly so they can have a short stay and be under the number of hospital days they're reimbursed for under that DRG. So the system is not focused on really doing a good job of talking with families about the risks and benefits of these feeding tubes. Instead, there's a rush to put these in, and send the patients back to the nursing home.

My Elder Advocate responds nearly instantly to any elder or eldercare crisis… in order to provide nursing home intervention, arrange for immediate placements, prevent evictions from nursing homes, handle a hospital crisis, and respond to other eldercare challenges.

But we can’t solve an ugly and dangerous situation unless you contact us immediately. Often waiting a day is as harmful to a family member as taking no action at all.

If you and your family have an elder family member that is facing one of these challenges, don’t wait. We can resolve it quickly. Contact us TODAY by calling us directly at (212) 945-7550.

Americare Home Care Agency Continues To Operate Despite Criminal Behaviour

2013-01-06T15:15:05-08:00

By Jack Halpern, CEO, My Elder Advocate

When you are politically connected in New York, and you have tons of money, much of which was fraudulantly obtained, and you are billing New York State and the Federal Governement hundred of millions of dollars for elderly recepients of Medicare and Medicaid, what is a couple of million dollars in fines here and there?

Elly Kleinman, founder and CEO of Americare, would probably tell you that $15,000,000 in fines over a 5 year period is the cost of doing business.

Americare CEO Elly Kleinman, is a major player in the Orthodox Jewish community with close ties to the state’s top Jewish lobbyist organization, Agudas Yisroel.

According to a Daily News article, The Flatbush home care agency with a troubled past is back to its old Medicaid billing tricks, whistleblowers charged.

A company bigwig advised Jack and Goldie Gold to divide their Flatbush home with a wall so Medicaid would pay for two home healthcare aides. “It was suggested,” the elderly couple’s daughter Chani Gold told the Daily News.

New York State tries to control Medicaid costs by limiting coverage to one health aide per home.

Three different whistleblowers have made Medicaid fraud allegations to law-enforcement groups, sources told the News.

The state Attorney General and the Brooklyn U.S. Attorney’s office declined to prosecute the Kings Highway firm in 2010, but allowed the accusers to bring cases on the government’s behalf.

One has filed a lawsuit; the other two are hiring lawyers and plan to sue, sources said.

An Americare representative was quick to respond to these allegations by stating that the whistleblowers were disgruntled former employees. That’s what all criminal enterprises say when they are caught by whistleblowers.

AMERICARE’S PAST CRIMINAL BEHAVIOUR

Americare has been in the hot seat before over Medicaid billing practices.

Then-Attorney General Eliot Spitzer fined the company a whopping $7 million in 2005 after his investigators found Americare billed for bogus hours at adult homes for eight years.

As attorney general, Cuomo also fined Americare $8 million in 2008 for falsely claiming home health aides had been trained to care for Medicaid patients.

In a borough like Brooklyn that has almost as many home health care agencies as blocks, the question begs as to why New York State and the Federal Government continues to do business with a criminal enterprise? Is it connections? Is it payoffs? Expensive attorneys? A combination? I can’t say.

Americans have been told that Medicaid and Medicare Fraud will not be tolerated anymore, and that the savings from ending this fraud will help pay for our expensive health care programs. Yet, Elly Kleinman has been fined $15,000,000 by two Attorney Generals in a three-year period, is again being accused of fraud, and continues to collect hundreds of millions of dollars in Medicaid and Medicare funds. How much does this criminal have to steal before any ramifications?

I urge all my readers and the honest people of Brooklyn to boycott Americare and use other agencies. Let us send a message to criminals and the Government that health care must stay honest.

Alleged Nursing Home Rape in the Bronx

2012-12-06T09:13:09-08:00

Jack Halpern

NY State Department Of Health Shares Responsibility For Death Trap Nursing Home

2012-11-13T18:35:14-08:00

By Jack Halpern, CEO, My Elder Advocate

Hurricane Sandy announced itself by tossing a section of Boardwalk against the Promenade nursing home in Rockaway Park, Queens, blowing out its windows and sending waves washing through the first floor.

Read New York Times Article http://ow.ly/fgEMY

This nursing home like so many others in New York State has been consistantly rendering sub-standard care to thousands of elderly and disabled adults, never even complying with minimum standards of care as required by State and Federal Law. Every year the negligent and irresponsible New York State Department of Health rubber stamps the horrendous care in these facilities.

If dogs were given the type of care that is given to these residents, the whole world would be protesting in huge numbers, arrests would be made, and reform would be swift. Politicians would be lining up in front of the media with an outcry for justice.

The Rockaway Peninsula in Queens, NY is dotted with some of the worst nursing homes, and adult homes in the country. Also lining the peninsula are many adult homes that are just storage places for neglected elderly mental patients. I call this stretch of Nursing and Adult Homes, "DESOLATION ROW".

Again I have to use the dog analogy. Imagine a kennel that has young dogs, old dogs, sick dogs, starved dogs, tortured dogs, and dogs of all shapes and sizes, and place them in the same cage, and add minimal supervision. You get the picture?

While most Americans envision a nursing home as a place that has only elders, these facilities do not limit their population to just the elderly. They are only interested in filling a bed for Medicare or Medicaid reimbursement. These facilities typically have a greater share than most, of residents with moderate to severe mental disease, residents with Dementia and Alzheimer's Disease, young and old. There are also many homeless people in these facilities.All these residents are mixed together in the same wards. Special programs is non-existent.

These nursing homes like many in New York State are severly understaffed. 90 percent of the staff members work two shifts a day, sometimes three. Patients are routinely chemically restrained with some of the most dangerous drugs around.

While staff members have to go through backround checks (many of the nursing homes don't comply), residents do not. Danger is a way of life for the residents in these facilities.

Year after year the NY State Department of Health's poorly trained inspectors come to do their supposedly unannounced annual inspection (while the homes don't know the exact date that surveyors will be arriving, they always arrive within a month or two before or after the last year. I worked in a nursing home in 1988 that had it's unannounced inspection in August or September every year. In 2011 it was still in August), and every year they cite the facilities with the same violations they had the year before, and life goes on.

Promenade Nursing Home, the subject of the NY Times Article, is one of the worst of the bad homes in the Rockaways.

Over the past few years inspectors determined that operators have failed to:

1. Provide necessary care and services to maintain the highest well being of each resident.

2. Make sure that residents receive proper treatment and assistive devices to maintain their vision and hearing.

3. Allow the residents to refuse treatment or refuse to take part in an experiment and formulate advance directives.

4. Make sure each resident has the right to have a choice over activities, their schedules and health care according to his or her interests, assessment, and plan of care.

5. Make sure menus meet the resident's nutritional needs and that there is a prepared menu by which nutritious meals have been planned for the resident and followed.

6. Store, cook, and serve food in a safe and clean way.

7. Make sure that each resident's drug regimen is free from unnecessary drugs; each resident's entire drug/medication is managed and monitored to achieve highest well being.

8. Provide enough notice before discharging or transferring a resident.

9. Protect each resident from all abuse, physical punishment, and being separated from others.

Inspectors determined that the building did not have:

1. Corridor and hallway doors that block smoke.

2. Construction that can resist fire for one hour or an approved fire extinguishing system.

3. Exits that are accessible at all times.

4. Portable fire extinguishers.

5. Proper medical gas storage and administration areas.

Sandy brought a hurricane, but Promenade Nursing Home was already a disaster. The DOH will investigate and blame all on the owners, and Promenade will reopen just in time to ruin many more lives. In Rockaway Nursing Homes, life is not a beach.

But we can’t solve an ugly and dangerous situation unless you contact us immediately. Often waiting a day is as harmful to a family member as taking no action at all.

If you and your family have an elder family member that is facing one of these challenges, don’t wait. We can resolve it quickly. Contact us TODAY by calling us directly at (212) 945-7550.

Broken Bones, Broken Lives: Falls In Nursing Homes

2012-09-24T10:33:10-07:00

By Jack Halpern, CEO, My Elder Advocate

Falls among nursing home residents occur frequently and repeatedly. According to the CDC, about 1,800 older adults living in nursing homes die each year from fall-related injuries and those who survive falls frequently sustain hip fractures and head injuries that result in permanent disability and reduced quality of life.

For an elderly person, a broken bone can lead to many other physical and mental health issues. Different types of nursing home abuse and nursing home neglect can cause broken bones in nursing homes.

Families who place a loved one in a nursing home expect the staff to take care of the elderly family member. Unfortunately, some families find that nursing home staff neglect or improperly care for family members placed in such facilities. Problems like broken bones, dehydration or cuts and bruises are indicators that the nursing home might not offer the care families expect.

How big is the problem?

In 2003, 1.5 million people 65 and older lived in nursing homes. If current rates continue, by 2030 this number will rise to about 3 million.
About 5% of adults 65 and older live in nursing homes, but nursing home residents account for about 20% of deaths from falls in this age group.
Each year, a typical nursing home with 100 beds reports 100 to 200 falls. Many falls go unreported.
Between half and three-quarters of nursing home residents fall each year.5 That’s twice the rate of falls for older adults living in the community.
Patients often fall more than once. The average is 2.6 falls per person per year.6
About 35% of fall injuries occur among residents who cannot walk.

How serious are these falls?

About 1,800 people living in nursing homes die each year from falls.1
About 10% to 20% of nursing home falls cause serious injuries; 2% to 6% cause fractures.1
Falls result in disability, functional decline and reduced quality of life. Fear of falling can cause further loss of function, depression, feelings of helplessness, and social isolation.5

Major Reasons For Falls

Poor Staffing-In many cases, injuries are the result of understaffing and inadequately trained employees. When nursing homes try to cut corners by not hiring enough qualified staff members, there are simply not enough workers to monitor residents. Because many residents require constant care and supervision, it is easy to see how understaffing can lead to serious injury and even wrongful death.
Physical Plant Hazard-wet floors, poor lighting, improper bed heights, improperly maintained wheelchairs, or equipment left out of place.

Overrmedication- Giving seniors too much medication can make them dizzy and cause them to lose their balance. When this happens, they can easily fall and injure themselves.

Malnutrition - Like overmedication, if a senior is not getting the nutrients and food they need because of nursing home neglect, medication complications, or even depression, they can lose coordination and fall.

Physical Abuse- In my extensive experience with nursing home abuse, the greatest cause of falls and broken bones is abuse or neglect. While it may be hard to think about, there are abusive nursing homes that restrain residents violently. During the evening and night shifts many staff members refuse to answer call bells, causing residents to climb out of bed or void in bed. Of course there are beatings all the time. Your family member may feel embarrassed or scared to tell you about this, so it is important that you take the time to investigate the circumstances of their broken bones. IF YOU SUSPECT ABUSE YOU SHOULD CALL THE POLICE AND LET THEM SORT IT OUT OR CALL MY ELDER ADVOCATE IMMEDIATELY AT 212-945-7550.

Falls and Broken Bones Can and Should Be Prevented.

Falls can and should be prevented without using restraints. Although restraints (such as bedrails) have often been used for nursing home residents with a history or high risk of falls, studies have shown that limiting a resident’s freedom of movement can actually contribute to fall-related injuries.

Alternative interventions that can reduce the risk of falls include physical conditioning and walking programs, lowering bed heights and removing clutter from around the bed, installing raised toilet seats, fixing or replacing substandard wheelchairs and furniture, using properly fitted shoes, and having enough staff to assist with transfers (i.e. between bed, chair, toilet)—all simple actions and adjustments that cost little to implement but a lot (your loved one’s health and, possibly, life) if they aren’t.

Research on falls reduction has identified several effective approaches to reducing falls risk. Current evidence-based programs exist and can be used to reduce the risk of falls among older adult falls reduction program participants. Still uncertain, however, is how to recruit and retain older adult participants to falls reduction programs.

A recent qualitative study suggests that attending to an individual’s sense of identity when trying to recruit them for falls reduction programming is essential.

The authors of the study argue that falls reduction research should consider “the psychosocial effect of a fall on the health and well-being of older people”, or simply, the attitudes, feelings, and social life of the individual. In particular, the authors argue that identity is an important aspect to consider when examining the experience of a fall and falls prevention in general. The authors define identity as “knowing who you are and what is meaningful to you,” and refer to both self-identity and collective identity, or sense of belonging to a group or category.

But we can’t solve an ugly and dangerous situation unless you contact us immediately. Often waiting a day is as harmful to a family member as taking no action at all.

If you and your family have an elder family member that is facing one of these challenges, don’t wait. We can resolve it quickly. Contact us TODAY by calling us directly at (212) 945-7550.

Finally, A Bit Of Sanity: Some Medicaid Home Care Cuts in New York Are Stopped by Court

2012-09-10T12:07:55-07:00

Earlier this year, he received a notice saying that his help was being cut to one live-in aide per day, who would sleep through the night, rather than two aides working for 12 hours each. Mr. Strouchler and others like him filed a class-action lawsuit, challenging reductions in care.

via www.nytimes.com

The Rampant Abuse of Elders By Using Guardianship

2012-08-28T12:44:08-07:00

By Jack Halpern, CEO, My Elder Advocate

It is an often occurrence, that My Elder Advocate is called in to Advocate for a resident in a Nursing Home who has been placed there against their will by a court appointed guardian, and generally is being abused or neglected. In many of these guardianship cases, close family members have been banned from visiting their loved ones by guardians. In other cases nursing homes have been declared guardians and they have pillaged the personal accounts of the people they are supposed to protect.

As the number of seniors increase, so will the number of individuals with cognitive disabilities such as Alzheimer’s disease and dementia. This trend has produced an increasing demand to invoke guardianship on behalf of incapacitated seniors. However, guardianship - a legal tool which gives one person or entity the power to make personal and/or property decisions for another - has the potential of harming older adults rather than protecting them if not carefully administered. The rising incidence of elder abuse in this country and continuing reports of the failure of courts and the states to prevent exploitation of incapacitated adults by their guardians have long been of concern to My Elder Advocate and other advocates across the country.

Take the case of a former cab driver who befriended an 87-year old customer with Alzheimer's. The cab driver was also a convicted bank robber. Somehow, he was granted guardianship of the elderly man. He embezzled more than $640,000. He used some of it to pay for exotic dancers and a new Humvee. He's now in prison. The money's gone forever.

The appointment of a guardian occurs when a judge decides an individual lacks capacity to make decisions on his or her own behalf. Adult guardianship protects at-risk individuals and provides for their needs while at the same time removing fundamental rights.

The major functions of a guardian of an adult include:

• Making decisions the person is unable to make for himself or herself, and giving consents the person is not able to give.

• Exercising rights on behalf of the adult that the adult is unable to exercise for himself or herself.

• Acting as an advocate for the adult's best interests.

• Taking action to protect the adult from abuse, neglect, self-neglect, financial exploitation and violation of rights.

Villa Fontana, a San Jose residential care facility for the elderly, prevents some residents from receiving visitors, phone calls, and mail. In a recent interview, Adrian laughed when asked if resident Gisela Riordan would be allowed visitors or phone calls.

Gisela has been isolated from nearly all contact with the outside world for over two years, according to her son Marcus Riordan. Gisela was allowed a 15-minute visit with Marcus in honor of Mother's Day 2012.

Gisela is a conservatee of the Santa Clara Public Guardian, who has full knowledge of the isolation. Representatives of the Public Guardian's office refuse to discuss the situation with advocates who call on Gisela's behalf.

For months, elder advocates have encouraged Villa Fontana to honor residents’ rights. Many advocates have tried to establish contact with Gisela and check on her welfare.

According to stopguardianabuse.org

Over the years, a growing uncaring and unjust judicial system has helped convert guardianship/conservatorship from an appropriate law to one which, if misused, is damaging to the general public. At present, it operates to ensnare the most vulnerable people in a larger and larger trawling net, now including those merely physically "incapacitated"! It has become a feeding trough for unethical lawyers and other "fiduciaries" appointed by the courts to protect, but many of whom become nothing more than predators.

Wards, instead of being protected by the system, are victimized by it. Strangers are given total and absolute control of life, liberty, and property of their wards. Wards of the state lose all rights involving self-determination, including:

• the right to contract, including the right to choose a lawyer;
• the right to control their assets and make financial decisions;
• the right to remain in their own home and protect it from sale;
• the right to protect and enjoy their personal property;
• the right to choose where to live;
• the right to accept or refuse medical treatment, including antipsychotic drugs;
• the right to decide their social environments and contacts;
• the right to assure prompt payment of taxes and liabilities;
• the right to vote;
• the right to drive;
• the right to marry; and
• the right to complain.

The best way to avoid these abuses is to PLAN ahead of time.

But we can’t solve an ugly and dangerous situation unless you contact us immediately. Often waiting a day is as harmful to a family member as taking no action at all.

If you and your family have an elder family member that is facing one of these challenges, don’t wait. We can resolve it quickly. Contact us TODAY by calling us directly at (212) 945-7550.

Nursing Homes Tell LGBT Elders, “Get back into the closet.”

2012-08-13T11:37:44-07:00

By Jack Halpern, CEO, My Elder Advocate

My Elder Advocate, in the course of each day, deals with many problems that elders face in nursing homes, hospitals, and at home. While all forms of discrimination in long-term care settings are egregious, the LGBT elders face a unique set of discriminatory policies and fears. The federal Nursing Home Reform Act (NHRA) protects nursing home residents, regardless of sexual orientation or gender identity.

Most adults dread needing long-term care and want to avoid spending time in a nursing home. Loss of independence and admission into a nursing home facility are the two most common fears of older Americans. For LGBT adults the fear is especially intense. A recent study found that more than three-quarters of those surveyed would not be open about being LGBT in a nursing home.

Two ladies I know, Sara and Betti, had been together for 58 years. When Sara’s Alzheimer’s became too much, Betti moved her to an assisted living facility. Betti could barely trust family or neighbors with the truth, let alone strangers, so she and Sara became “sisters.” Much later, after Sara’s death, Betti needed to move into an assisted living facility herself. She had many, many photos of the love of her life, but dared not display them in her new home. The other residents would talk about husbands, children and grandchildren, but she felt too vulnerable to tell the truth. Betti was in hiding and terribly isolated.

A recent survey of 649 LGBT elders was undertaken by six organizations seeking to better understand the experiences of LGBT older adults in long-term care settings.

When asked what issues they feel an LGBT older adult faces or might face if open about his/her sexual orientation and/or gender identity? List all that apply: abuse and/or neglect by staff; isolation from other residents; discrimination by residents; discrimination by staff.

A majority of respondents (578 of the 649 respondents or 89%) predicted that staff would discriminate against an LGBT elder who was out of the closet. A majority also thought that other residents would discriminate (526 or 81%) and, more specifically, that other residents would isolate an LGBT resident (500 or 77%). More than half also predicted that staff would abuse or neglect the person (346 or 53%).

Altogether, 328 respondents (43%) reported 853 instances of mistreatment. Of those who reported instances of mistreatment, 124 were LGBT older adults. The results are compiled from four questions on the survey:

Have you, a loved one or a client ever experienced any of the following because of actual or perceived sexual orientation and/or gender identity? Refusal of admission, abrupt discharge, attempted discharge, refusal of readmission; restriction of visitors; none of the above; other/comments.

Has the staff of a facility that you, a loved one or a client lived in ever done any of the following? Refused to provide basic services; verbally or physically harassed or ostracized you/client/loved one; refused to refer to a transgender resident with his or her preferred name or pronoun; refused to let the spouse, partner, or person with the medical power of attorney or other health care directive make decisions for an LGBT resident?

Have you, a loved one or a client ever experienced verbal harassment or other abuse by residents because of your/his/her actual or perceived sexual orientation and/or gender identity?

Has the staff of a long-term care facility denied you, a loved one or a client medical treatment because of actual or perceived sexual orientation and/or gender identity?

LGBT fear these possibilities in a long-term care setting.

Fear of Being Out and Vulnerable

Verbal or Physical Harassment by Residents

Verbal or Physical Harassment by Staff

Refusal to Accept Medical Power of Attorney

Staff Refusal to Refer or Use Preferred Name

Staff Refusal to Provide Basic Services or Care

Failure to Provide Proper Medical Care

Abrupt or Attempted Discharge; Refusal to Admit or Re-Admit

READ FULL SURVEY- Download NSCLC_LGBT_report

Aging LGBT Elder Resources http://www.lgbtagingcenter.org/resources/index.cfm?a=3

But we can’t solve an ugly and dangerous situation unless you contact us immediately. Often waiting a day is as harmful to a family member as taking no action at all.

If you and your family have an elder family member that is facing one of these challenges, don’t wait. We can resolve it quickly. Contact us TODAY by calling us directly at (212) 945-7550.