My Elder Advocate

Continuing education seminar for 70 Financial Planners

2012-01-14T15:17:28-08:00

On Wednesday, January 11, I had the honor and the pleasure of conducting a continuing education seminar for nearly 70 certified financial planners.

Sponsored by the Financial Planners Association of New York, this two-hour, two CFP® CE credits presentation entitled How to help your clients and their families survive the black hole called ”eldercare.”

Topics covered issues pertaining to the exploding elder population in the U.S. as well as the impact that continued growth will have on eldercare both from a medical and financial standpoint. I also outlined the challenges that caregivers face and how financial planners can be better prepared to help their clients understand the demands of caregiving.

From discharge planners and chemical restraints to long distance caregiving, the basic legal documents required to keep elders safe, and the role of an independent elder advocate, participants learned how they could support their clients who are currently caregivers or could likely become caregivers in the future.

Lots of great questions and conversation followed my seminar.

A powerful message for your group or organization

2011-12-05T13:25:06-08:00

"I highly recommend Jack's talk if you are, will be, or could be in the role of caregiver but aren't 100% sure you know the rights of elders and how to safeguard them, and what to watch out for to ensure your loved one is properly cared for. The difference could be a matter of life or death."

That was the comment from one of the people who attended one of my recent talks. My topic: "How to survive the never-ending demands of caregiving for an elder parent... without losing your mind, your family, or your self."

In my talk -- that I've now shared with hundreds of caregivers -- I speak to people in their 40s and 50s who ultimately will become a caregiver for an elder parent or family member. These people, with parents in their 60s, 70s, 80s or beyond, have no training in how to be a caregiver. And they certainly don't know how to survive the never-ending demands and stresses brought about from caregiving for an elder parent or family member.

If you are a member of a civic, religious, healthcare, or eldercare group in the greater New York City area and would like to discuss the possibility of me speaking at an upcoming meeting, please send an email to me at JHalpern@MyElderAdvocate.com. Let's determine when I can bring this critical message you and your group.

Who’s Really Paying For So-Called “Free” Nursing Home Placements?

2011-11-29T15:57:11-08:00

By Jack Halpern, CEO, My Elder Advocate

Because the families we serve compensate us directly, we represent only them. We are never obligated in any way to serve or protect the needs or interests of the hospital, nursing home, insurance companies, private healthcare service providers, government agencies, and so on.

But My Elder Advocate is the exception in a world of allegedly free services that continually put elders at risk.

Here’s where I’m going with this.

A senior falls and breaks a hip or has a stroke. Suddenly there’s a scramble to find a nursing home or other long-term care facility. To meet a growing demand and lured by fast money, so-called “elder care referral services” have sprung up around the country. They claim to help in such situations.

Most elder care referral agencies in this multimillion-dollar although unregulated industry offer consumers their services for free. But free isn’t actually what’s happening. Nursing facilities and other adult care homes typically pay the referral service a sizable commission for any placement –– sometimes as much as $4,000.00.

Many of these services funnel elders to the facilities they contract with –– without regard to the facility's quality. In an investigative report last year, the Seattle Times found that placement companies in Washington state had referred seniors to facilities that had documented histories of substandard care, including “residents with dementia locked in rooms to prevent wandering; mentally ill adults drugged into submission to control behavior; and bed-bound seniors abandoned without assistance for up to 16 hours.”

According to the Seattle Times report, “in 143 cases over the past three years, seniors were victimized after companies placed them in adult family homes, or other long-term- care facilities, that had a record of serious violations, a Times analysis of Department of Social and Health Services documents reveals.”

The report continues:

“Senior-placement companies, which rely on commission-only sales people, funnel the aged only to facilities that have agreed to pay thousands of dollars in finders' fees. In addition, most placement companies do not screen homes for past violations. As a result, many have referred seniors to facilities with documented histories of substandard care, including fatal neglect.

“The nation's largest senior-placement firm is A Place for Mom, a Seattle-based company that contracts with 18,000 elder care facilities in 45 states. Companies like A Place for Mom have embraced a Web-based business model that is becoming increasingly popular among such companies.

“Consumers looking for an elder care facility in a particular area fill out an online form and are quickly contacted by one of hundreds referral ‘advisors’ working out of home offices. While some of these ‘advisors’ are professionally equipped to handle issues dealing with the elderly, the majority are little more than ‘patient brokers’ who are dealing with a population whose needs are specialized.

“You will usually be asked to provide basic information about your senior's current living situation: age, gender, care needs (help with daily personal care, medication management and getting around), and your budget (how much you have available to pay for care). Most free placement services will stop there. A Place for Mom has on its referral list dozens of homes with histories of substandard care, including homes currently on probation for abuse or neglect violations."

In my own investigation, I found that when I questioned one advisor about a nursing home for an elder client, I was directed to a facility that is a very substandard facility. I then asked her how it is possible for the nursing home to pay her a commission, when a Medicaid facility is not allowed by law to do that? She claims that they “have a contract with the nursing home.”

10 things you should know about A Place For Mom and other so-called “free” elder care referral agencies:

Good nursing homes do not have to pay a fee to a patient broker or “advisor.” They are usually full and have an ample supply of referrals. The opposite is also true.
If a “free” service suggests a nursing home to you, you can’t and shouldn’t just assume that it is a quality facility. You must always practice due diligence and go see the facility for yourself.
You must ask the advisor about their professional qualifications. If they don’t have any, they are likely to do more harm than good.
Any service that touts itself as a free referral service is probably sub-contracting for A Place For Mom.
Ask your “advisor” if they carry liability insurance. To the contrary, they are more likely to ask you to sign a document that they are not liable for ensuring the quality of their placement, don’t use them.
Since there is no such thing as “free” ask an advisor how they get paid.
Unlike My Elder Advocate or other advocates, a free referral agency like A Place For Mom will not monitor your elder’s care at a facility. Nor will they advocate for them. Buyer beware!
Most of the so-called “advisors” are not professionals and in it just for a buck.
These advisors are certainly not equipped to deal with specialized cases like Alzheimer or Parkinson patients.
For the most part, free elder care referral agencies do not deal with indigent or Medicaid recipients. If the elder can’t afford to pay privately for the facility, there will be no fee to the agency. The placement service will then act as a “broker,” providing your contact information to the facilities they think are best suited to your needs. These facilities will contact you to provide their information and offer you a tour.

At My Elder Advocate, we have always believed that the wellbeing, protection and safety of elders must come first. Whenever a service is offered “free,” we see it as a sign that the elder’s wellbeing, protection, and safety could be severely at risk. Aging has its own inherent risks. Why add more?

That’s why we pride ourselves on our total independence when it comes to providing tailored eldercare choices to our clients. Our fee-based approach assures that we speak only for you and your elder family member.

Death Panels For New York State Elderly

2011-11-12T16:25:16-08:00

New York State Cuts Home Health Care;

Elders and Disabled Forced into Substandard Nursing Homes

By Jack Halpern, CEO, My Elder Advocate

On April 1, 2011, the 2011-2012 New York State Budget Bill changed the way payments to providers of Medicaid-funded Certified Home Health Care Agencies (CHHAs) were calculated.

As a result of that budgetary change, CHHA payment amounts were reduced significantly. Today, disbursements to elders are based on a ratio of the individual CHHAs average total Medicaid claims per patient in 2009 and the current statewide disbursement average. For CHHAs that provided a great deal of 24-hour care, the budgetary change meant a significant drop in reimbursement and revenue because of the rollback to 2009 reimbursement levels and lower statewide averages.

Here’s the net result to elders and their families: Out of fear that they will not be paid what they expect or need, CHHAs are refusing to authorize 24-hour care, reducing the number of 24-hour care cases, and refusing to reinstate services following a hospital stay.

They are illegally reducing and terminating care without adequate notice to recipients leaving poor and disabled elders without life-sustaining benefits and often in imminent danger of wallowing away in hospitals or being sent to horrible nursing homes.

A Good Idea Gone Bad

The State’s intention was and is good. They are seeking to compel all Medicaid recipients into the State’s Managed Long Term Care Program. However, unlike the CHHAs, this program only provided care as was needed and ordered by the physician. While the State might have good intentions, they simply did not provide a “safety net” for elders to transition from CHHAs to Managed Long Term Care.

Unfortunately, the outcome is far from the intention. The CHHAs are reducing or terminating care even though the patient’s needs for services has not decreased. They are doing so without providing the notices or opportunity for fair hearing or Aid Continuing benefits required by Federal law.

There are numerous examples of CHHAs clearly flaunting the law. The New York State Managed Long Term Care Program is refusing to pick up the cases that have been dropped and they are refusing to give 24-hour care to new cases. These people are being backed up in hospitals or forced into substandard nursing homes. Elders are being destroyed. Many are dying. Remember, that for an elder, even a room change can be devastating.

My Elder Advocate has been at the forefront of this problem dealing with numerous cases where elders and their families are forced to deal with the consequences of this new State policy and the CHHAs reluctance to find a solution. We have seen numerous cases where hospital discharge planners are ruthlessly forcing families to take their elders home even though they can’t afford to pay for home health care privately and don’t have the financial resources to care for the elder.

For example, in one case in Queens, New York, a gentleman was admitted into a hospital with a urinary tract infection. After a few days of intravenous antibiotics, without notifying the family, he was forced into an inferior local nursing home because his CHHA would not take him back. A month later he returned to the hospital with serious bedsores that were infected and smelled something awful. My Elder Advocate forced the hospital to keep him and will get his home care restored.

In another case a woman was forced into a substandard nursing home and provided her family with a nursing home horror story. Two weeks after she was forced into a nursing home, she was sent to another hospital. She had suffered a heart attack, her lungs had water in them, and she was suffering from a urinary tract infection. She now is in critical condition.

Devastating Outcomes

The stories are unending… and the outcome devastating and despicable. By illegally reducing hours and terminating existing services, CHHAs are violating the Americans with Disabilities Act because they force CHHA patients into nursing homes even though these individuals could remain at home given the provision of appropriate home health care.

The New York State Department of Health is also violating the above act by not preventing the illegal terminations, ensuring the provision of adequate care in the community, or providing basic due process rights for plaintiffs.

Although the New York State Department has forewarned CHHAs that reductions or terminations are illegal, they have not setup a safety net for elders in the event that CHHAs flaunt the law –– which they are doing in many cases. Similarly, the New York Department of Health has not set up a unit to take complaints and properly investigate them in a timely fashion. Basically New York State is prematurely sentencing elders and the disabled to death row.

Last week, I called the New York State Department of Health investigative unit for home health care agencies to file a complaint about one of the above cases. After relating the story, I asked the investigator for her last name. She told me that what her name was didn’t matter because she is the only one there. She intimated that the investigation would take a number of months. Obviously, the Department of Health is not in a hurry to protect lives.

People are dying and many more will die in the near future. Others will be psychologically scarred for the remainder of their lives.

Families will be devastated emotionally, feeling for the rest of their lives that they abandoned their elders in their hour of greatest need.

Amazingly, the only ones who benefit are the substandard nursing homes that profit by keeping the beds full that would otherwise be empty and imprisoning elders.

From my vantage point as an elder advocate the Certified Home Health Care Agencies are acting like death panels and they are killing elders while New York State and Governor Cuomo are allowing this to happen.

# # #

My Elder Advocate remains at the forefront of all problems that confront the elderly and their families. We are successfully advocating for elders who are caught in the middle of this terrible and extremely dangerous home health care situation and are having benefits restored.

In order to remain independent –– never obligated to any private or public entity –– and to provide support directly and immediately to elders and their families, My Elder Advocate remains a fee-for-service company.

For additional information call My Elder Advocate at 212-945-7550.

http://www.myelderadvocate.com

But what about the caregiver?

2011-10-09T17:00:00-07:00

By Jack Halpern, CEO, My Elder Advocate

It’s clearly traumatic to elders physically, emotionally, and psychologically when they require a hospital or nursing home.

But it’s equally traumatic to another person, too. That’s the caregiver –– usually a family member –– who has no choice but to step in and support that elder family member.

Without warning a sudden illness of an elderly parent or family member can thrust anyone into becoming a primary caregiver. A gradual decline in an elderly parent’s physical or mental ability to care for himself or herself can also force them into this same unfamiliar role and unwanted responsibility.

The problem is that most people with parents in their 60s, 70s, 80s or beyond have no training in how to be a caregiver. They’re just not prepared. And they certainly don’t know how to survive the never-ending demands and stresses brought about from caregiving for an elder parent or family member.

In a special free talk on Wednesday, October 26, I’ll speak directly to caregivers and eventual caregivers. My talk is titled “How to survive the never-ending demands of caregiving for an elder parent… without losing your mind, your family, or your self.”

I’ll explain precisely what you need to know in order to maintain your sanity as a caregiver for an aging parent, keep your family happy and intact, deal with the stresses and pressures of work, and still have a life of your own.

People are living longer than at any time in the history of the world. The odds that one-day you will need to come to grips with fulfilling the duties of caregiving are also greater than at any time in history.

I promise you that my talk will give you the information you need to survive the demands of caregiving for an elder parent… and tell you why you want to start thinking about this challenging transition and newfound responsibility today.

The date and time of my talk are:

Wednesday, October 26, 2011

9:00 a.m. to 10:00 a.m.

333 Park Avenue, South, Suite 5B

New York, New York

Reservations are required due to building security. no walk-ins permitted. Doors open at 8:30. I’ll allot plenty of time for questions and answers following my talk.

CLICK HERE FOR ADDITIONAL INFORMATION AND TO REGISTER

Settlement Changes New York Housing Policy for the Mentally Ill - NYTimes.com

2011-09-19T06:24:47-07:00

The settlement resolved a case that was filed in Brooklyn federal court in 2006 and that accused the state of violating the spirit of its own longstanding rules for housing mentally ill people.

via www.nytimes.com

Study Reveals Black Nursing Home Residents More Likely to Develop Bed Sores

2011-08-25T16:56:00-07:00

A study by researchers at the University of Iowa, reported on by Reuters, found that black residents of long-term care facilities are more likely to suffer from pressure sores. The difference in care is not a result of nursing homes providing better quality care for white residents, but rather that residents were more likely to develop pressure sores in nursing homes where a majority of the residents are black. Like many types of nursing home abuse or neglect, this could be a result of understaffing or fewer resources.

http://news.healingwell.com/index.php?p=news1&id=654736

Reduction of Bed Hold Days Leads to Nursing Home Eviction

2011-08-21T16:15:11-07:00

By Jack Halpern, CEO, My Elder Advocate

As readers of My Elder Advocate Blog are well aware, we often speak about the grave danger to elders who are evicted from Nursing Homes, Assisted Living Facilities, and Adult Homes. A nursing home eviction often leads to disorientation, loss of identity, depression, and death.

Nursing home residents who need to be treated in a hospital usually want to be able to return to the same bed and room in the nursing home as soon as they are discharged from the hospital. New York State many years ago had established a policy for Nursing Home residents, called the “bed hold” policy. These regulations were established to reimburse a nursing home for “holding” a bed vacant for the return of a temporarily absent Medicaid recipient that the facility would otherwise likely have been able to fill with another patient admission.

This bed hold policy applied regardless of how many hospitalizations there were in a year. In 2010, the policy changed. Nursing home residents are allowed only 14 days a year. How do you go from no limit to only 14 days? It does not have to make sense; it only has to save money… or make money!

Medicare will not make any payment to the nursing facility to reserve a bed for a Medicare beneficiary.

Medicaid will make bed reservation payments for up to 15 days if you are hospitalized. Medicaid will also pay for up to 21 days per year if you are temporarily absent for other reasons, such as short visits to family or friends on holidays. Once these payments have been exhausted, you, your family members, or others cannot be required to pay to continue to reserve your bed, but may do so voluntarily at the Medicaid per diem rate to assure that you can return to your bed.

Mary B. had a good life in one of the finer nursing homes in New York City. She had been a resident of this facility for three years. She knew the staff well. They loved Mary, too. Like many nursing home residents, if Mary had to go to the hospital, she and her family knew that when she got better she would be going back to her bed at the nursing home. She hated the hospital stays. The care was very inferior to her care at the nursing home. The nurses did not seem to care as much. All her family would hear is “when can I get back to my home?”

I was at the facility on one occasion, when Mary returned from one of her hospitalizations. It was like she had returned from a vacation. I saw her cry with joy as staff members gathered around to welcome her back. Mary was hungry. Although it was past lunchtime, a warm tray of food suddenly appeared. After lunch her nurse reviewed her hospitalization discharge paperwork to see what changes in her care had to be made. Some of Mary’s prescriptions changed so the pharmacy had to be notified. Mary was checked for bedsores. She had lost five pounds in the hospital. The dietician asked the doctor to order a nutritional supplement.

I asked Mary what she would do if there were no bed hold policy. She told me that she would not be so quick to report illness to the staff for fear of going to the hospital and not being able to return. In other words, out of fearing the loss of her bed, she would not report being sick.

That’s the choice residents are given: Seek care only if you are willing to lose your bed in the nursing home. Imagine all the neglect and abuse that this policy will lead to. This new policy is not fiscally responsible but will cost many, many lives.

This new policy is dangerous, arbitrary, and will require a great amount of vigilance on behalf of families. Even with unlimited bed holds, many facilities are abusing the bed hold rule, and using bed holds to illegally evict what they categorize as undesirable residents.

My Elder Advocate has a 100% success rate in preventing evictions and/or in returning residents to their original facilities once they have already been evicted.

My Elder Advocate has over 36 years of experience in nursing home administration, and dealing with operators who abuse the elderly.

If you suspect that the nursing home is planning to remove your elder family member from their nursing home, call us immediately at 212-945-7550. The time to nip this in the bud is BEFORE the eviction occurs.

Wii by Nintendo: An Effective Way For Elders To Exercise and Have Fun

2011-06-20T17:21:34-07:00

By Jack Halpern, CEO, My Elder Advocate

As I travel across the country visiting with my clients in Nursing Homes and other long-term care facilities, I find that a majority of our nursing home residents aren’t getting the proper exercise to help them maintain mobility and their health.

As you may be aware, at least 70% of our elders enter a nursing home because they require physical rehabilitation after a fall or stroke. They spend a brief time in the hospital and are quickly sent (some too quickly) to a rehabilitation center that most of the time is a nursing home.

The goal of physical therapy is to restore, maintain, or promote optimal physical function. While physical therapy involves exercise, it’s a short-term program. Once a resident completes their short-term physical therapy program, they go on a maintenance program that includes exercise, but does not require a professional to administer. These programs require nurse’s aides to perform some minimal exercise like walking and stretching. Unfortunately, with severe staff shortages at most nursing homes, these maintenance programs are not carried out. No one is doing them.

A few years ago Nintendo introduced the world to Wii (pronounced WE), a home video game console. The Wii emulates the motion of real sports. Playing a Wii tennis game involves swinging the controller as if it were an actual racket. Although Wii Sports features cartoon-like graphics and characters—imagery normally aimed at children—the elders are absolutely taken with the realism offered by the Wii Remote.

“I've never been into video games, but this is addictive,” a 70-year-old client of mine told me. She tells how, when her grandkids come to visit on Saturday afternoons, they play the games together.

For elderly people, Wii can be a health provider and a friend to workout with to improve agility. The interactivity that Wii provides can ease loneliness and help physically challenged seniors or accident victims gain strength and mobility. Senior citizens can trust and have fun using the many programs available within Wii fitness without the worry of harmful effects or painful accidents.

Physical therapy is another area in which Wii can be a valuable tool by incorporating some or all of the available exercises into a physical therapy routine. You can monitor your progress without damaging injured muscles and joints, gaining improvement and strengthen to the targeted areas.

Researchers in San Diego now say their studies prove that Wii games can combat the onset of depression in elderly persons.

I am proud to say that My Elder Advocate has introduced Wii to many of our clients with great success. We have also introduced Wii to many nursing homes that have incorporated it into their exercise and recreation programs. They have also found that Dementia and Alzheimer’s residents have benefitted from using Wii.

To see Wii in the nursing home, check these out links:

http://www.youtube.com/watch?v=B6B7WDM02Fs

http://www.youtube.com/watch?v=OlDl161wb1g&feature=related

http://www.youtube.com/watch?v=x8AKYpJhpMw&feature=related

What some nursing homes won’t do to make a buck! It’s downright disgusting!

2011-06-11T18:10:58-07:00

By Jack Halpern

One of my pet peeves with is that there is no rhyme or reason to how they choose their residents. The only goal is to “fill” a bed without regard to how a potential resident will get along with other residents.

Often, when I tour many a nursing home, I find that residents who are mentally ill are not segregated. Alzheimer’s Disease residents are mixed in with alert residents, young with old, short-term rehabilitation residents with long-term residents. Mixing residents with different needs is detrimental to the patient as well as to the staff.

Having said that, you can imagine my distress at seeing this question posted by an Executive Director of a Nursing Home, on a Group Page on LinkedIn.

QUESTION: Does anyone have experience recruiting potential residents at homeless shelters to raise census??? I have heard of some nursing homes going to shelters looking for people that would qualify for Medicaid...I have heard they send the potential resident to the hospital for a (h&p) history & physical to get a diagnosis. Does anyone know how the process works and if it is a good idea or successful to raise census??? I have heard mixed results.

While many nursing home administrators are concerned about increasing their census (and they should be), there are numerous innovative and appropriate ways to do this before they resort to placing their currents residents at risk from this population. The homeless elderly certainly deserve good care, but a program has to be specifically tailored to them.

In my opinion, this was a very callous question. It amplifies what I have been saying for many years: The elderly residents in our nursing homes have a right to care that meets their needs. This question proves that many administrators and owners of nursing homes are putting them at risk in order to make a buck.

To the credit of other administrators in this LinkedIn group, many responded that it was a bad idea. My response was anger.

Medicaid Home Health Cuts Hurting Consumers

2011-05-31T17:11:24-07:00

The State budget enacted in late March 2011 included extensive changes in how certified home health agencies (CHHAs) are paid by Medicaid for home health services. Some of these changes are effective immediately - on April 1, 2011 - and will likely result in reduced reimbursement for CHHA services. See changes described here Fundamental Changes to NYS Medicaid in 2011 State Budget -- and information about CHHA services generally posted at Medicaid Certified Home Health Agency (CHHA) Services. None of these changes requires or allows immediate reduction or termination of CHHA services.

via hosted.verticalresponse.com

The Sick Looting of Home Health Care

2011-05-30T06:57:42-07:00

All these candidates insisting they can clean up Albany should take a good look at the case of a truly stubborn taxpayer leech to see what they're up against: The culprit is a Brooklyn-based firm misnamed Excellent Home Care Services, and it has been happily pillaging state coffers for years without interference.

via www.villagevoice.com

Nursing Home Lobbying Group Seeking Exemption from Health Care Law Due to High Costs

2011-05-18T08:17:00-07:00

May 16, 2011 - Nursing homes are seeking exemptions from the new health care law, claiming an inability to fund new insurance coverage mandates, according to the New York Times.

via maplight.org

Nursing Home Lobbying Group Seeking Exemption from Health Care Law Due to High Costs Contributed $4.5 Million in Last Decade

Antipsychotic Drugs Called Hazardous for the Elderly

2011-05-10T16:53:17-07:00

More than half of the antipsychotics paid for by the federal Medicare program in the first half of 2007 were “erroneous,” the audit found, costing the program $116 million for those six months.

via www.nytimes.com

I have been warning people about this for years. These drugs are destroying the elderly with dementia. It is mind control and chemical restraints of the first order. We must stop this now.

Jack Halpern

Ten Tips for Communicating with an Alzheimer’s Patient

2011-05-09T11:22:58-07:00

By Carole Larkin
Alzheimer's Reading Room

Ever feel like your loved one is ignoring you or that you just weren’t getting through to your loved one? Try some of these tips to see if they help.

via www.alzheimersreadingroom.com

US Nursing Homes Have Poor Record of Infection Control

2011-05-06T05:39:58-07:00

May 5, 2011 — American nursing homes have a poor track record of keeping infections at bay, a new study shows.

via www.medscape.com