Visiting Grandma at the Nursing Home

In spots where visits have resumed, they’re much changed from those before the pandemic. Nursing homes must take steps to minimize the chance of further transmission of COVID-19. The virus has been found in about 11,600 long-term care facilities, causing more than 56,000 deaths, according to data from the Kaiser Family Foundation.

AARP’s recent article entitled “When Can Visitors Return to Nursing Homes?” explains that the federal Centers for Medicare and Medicaid Services (CMS) has provided benchmarks for state and local officials to use, in deciding when visitors can return and how to safeguard against new outbreaks of COVID-19 when they do. The CMS guidelines are broad and nonbinding, and there will be differences, from state to state and nursing home to nursing home, regarding when visits resume and how they are handled. Here are some details about the next steps toward reuniting with family members in long-term care.

When will visits resume? As of mid-July, 30 states permitted nursing homes to proceed with outdoor visits with strict rules for distancing, monitoring and hygiene. The CMS guidelines suggest that nursing homes continue prohibiting any visitation, until they have gone at least 28 days without a new COVID-19 case originating on-site (as opposed to a facility admitting a coronavirus patient from a hospital). CMS says that these facilities should also meet several additional benchmarks, which include:

  • a decline in cases in the surrounding community
  • the ability to provide all residents with a baseline COVID-19 test and weekly tests for staff
  • enough supplies of personal protective equipment (PPE) and cleaning and disinfecting products; and
  • no staff shortages.

Where visits are permitted, it should be only by appointment and in specified hours. In some states, only one or two people can visit a particular resident at a time. Even those states allowing indoor visits are suggesting that families meet loved ones outdoors. Research has shown that the virus spreads less in open air.

Health checks on visitors. The federal guidelines call for everyone entering a facility to undergo 100% screening. However, the CMS recommendations don’t address testing visitors for COVID-19.

Masks. The federal guidelines say visitors should be required to “wear a cloth face covering or face mask for the duration of their visit,” and states that allow visitation are doing so. The guidelines also ask nursing homes to make certain that visitors practice hand hygiene. However, it doesn’t say whether facilities should provide masks or sanitizer.

Social distancing. The CMS guidelines call on nursing homes that allow visitors to ensure social distancing, but they don’t provide details. States that have permitted visits, state that facilities enforce the 6-foot rule.

Virtual visits. Another option is to make some visits virtual. Videoconferencing and chat platforms have become lifelines for residents and families during the pandemic. Continued use after the lockdowns can minimize opportunities for illness to spread.

Reference: AARP (July 22, 2020) “When Can Visitors Return to Nursing Homes?”

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How Do I Keep Up My Spirits in the Pandemic?

The coronavirus has created some stressful situations that can bring out the best or worst in us. We must hope that the pandemic will eventually be brought under control, and our loved ones will survive.

AARP’s recent article entitled “Keeping Caregiver Spirits High During the Coronavirus Outbreak” says that there’s no single way to find hope.

Many family caregivers draw on their faith, and others on rely on sheer determination. However, there some other ways to create hope for caregivers and their loved ones in this pandemic.

The article provides some psychological ideas:

Watch your temperament. Through our disposition and upbringing, each one of us is inclined to look at the world as a pessimist or an optimist. These tendencies become more pronounced under the stress of a crisis. To get a sense of your natural tendency, keep a daily journal and record your current preoccupying thoughts. Keep that document and review it in a week. Rereading those entries will quickly let you know where you stand psychologically and let you to see if you need to take steps to better deal with the current pandemic.

Change your mindset. Since optimism is better, make an effort to increase your optimistic thinking. You could bring your attention more fully to some of the unforeseen benefits of this change in our normally hectic lives. Keeping a gratitude journal is another way of heightening your awareness of the good things we still have.

Rearrange your activities. Directing your activities can result in a more hopeful outlook. Don’t watch hours of cable news shows, because it can have a negative effect on your psyche. Keep informed but balance news with engaging in fun activities.

Contact your positive-minded friends. It is more crucial than ever to virtually contact your friends and family members for support by sharing experiences, fears and good wishes. Reach out to those who can sustain a more balanced and realistic view, acknowledging these negative times but also the positive possibilities.

Reference: AARP (March 31, 2020) “Keeping Caregiver Spirits High During the Coronavirus Outbreak”

For information about other topics, visit our website here.

 

Can I Get Paid to Be a Caregiver for a Family Member Who’s a Vet?

AARP’s recent article entitled “Can I Get Paid to Be a Caregiver for a Family Member?” says that you may be able to get paid to be a family caregiver, if you’re caring for a veteran. Veterans have four plans for which they may qualify.

Veteran Directed Care. Similar to Medicaid’s self-directed care program, this plan lets qualified former service members manage their own long-term services and supports. Veteran Directed Care is available in 37 states, DC, and Puerto Rico for veterans of all ages, who are enrolled in the Veterans Health Administration health care system and require the level of care a nursing facility provides but want to live at home or the home of a loved one. A flexible budget (about $2,200 a month) lets vets choose the goods and services they find most useful, including a caregiver to assist with activities of daily living. The vet chooses the caregiver and may select any physically and mentally capable family member, including a child, grandchild, sibling, or spouse.

Aid and Attendance (A&A) Benefits. This program supplements a military pension to help with the expense of a caregiver, and this can be a family member. A&A benefits are available to veterans who qualify for VA pensions and meet at least one of the following criteria. The veteran:

  • Requires help from another to perform everyday personal functions, such as bathing, dressing, and eating
  • Is confined to bed because of disability
  • Is in a nursing home because of physical or mental incapacity; or
  • Has very limited eyesight, less than 5/200 acuity in both eyes, even with corrective lenses or a significantly contracted visual field.

Surviving spouses of qualifying veterans may also be eligible for this benefit.

Housebound Benefits. Veterans who get a military pension and are substantially confined to their immediate premises because of permanent disability are able to apply for a monthly pension supplement. It’s the same application process as for A&A benefits, but you can’t get both housebound and A&A benefits simultaneously.

Program of Comprehensive Assistance for Family Caregivers. This program gives a monthly stipend to family members, who serve as caregivers for vets who require help with everyday activities because of a traumatic injury sustained in the line of duty on or after Sept. 11, 2001. The vet must be enrolled in VA health services and require either personal care related to everyday activities or supervision or protection, because of conditions sustained after 9/11. The caretaker must be an adult child, parent, spouse, stepfamily member, extended family member or full-time housemate of the veteran.

For more information about this or other elder law subjects, click here.

Reference: AARP (May 15, 2020) “Can I Get Paid to Be a Caregiver for a Family Member?”

 

How Else Can Nursing Homes Be Impacted by COVID-19?

Lack of funding is a big issue for nursing homes.“You layer COVID on top of that and… it’s a crisis on top of a crisis,” David Grabowski, a professor of health care policy at Harvard Medical School, told Yahoo Finance. “And that you started with a lot of nursing homes that didn’t have adequate staffing models, weren’t exactly strong at infection control, lacked resources in many, many regards, and then this hits, it’s definitely the industry.”

Yahoo Finance’s recent article entitled “U.S. nursing homes face ‘a crisis on top of a crisis’ with coronavirus and funding woes” explains that the nursing home industry has been facing a financial shortfall since at least 2013, particularly for non-Medicare margins, according to the American Health Care Association (AHCA). Non-Medicare margins are the revenues and costs associated with Medicaid and private payers for all lines of business. They dropped 3% in 2018, an increase from the year prior.

“Over 60% of people in the country that live in nursing facilities are dependent upon Medicaid,” AHCA President and CEO Mark Parkinson told Yahoo Finance. “And unfortunately, in most states, the Medicaid rates have been set at less than the actual cost to take care of the residents. So, it makes it very difficult to provide the kind of care that providers want when they’re underfunded so dramatically.”

In addition, Parkinson commented, “most of the people don’t understand that Medicaid is really a middle-class benefit, because if people live long enough to outlive their resources, it’s the only way that they can afford to be taken care of in a facility.”

Medicaid is a federal benefits program that gives health coverage to seniors, pregnant women, children, people with disabilities and eligible low-income adults. However, the federal government permits states to level the payment amounts long as they meet federal requirements.

“The failure to adequately fund Medicaid is primarily a problem with the states,” Parkinson said. “Each state gets to make its own decision on what its reimbursement will be for Medicaid. Although the national average is around $200 a day, the rate varies dramatically by states, and some states are as low as less than $150 a day. In the low funding states, like Illinois and Texas, the politicians just haven’t decided it’s an important enough priority to adequately fund it.”

According to the New York Times, COVID-19 has infected more than 282,000 people at about 12,000 facilities as of June 26. It has killed more than 54,000. There are roughly 15,600 nursing homes in the U.S., with more than 1.3 million residents and over 1.6 million staff.

“It’s important to note that COVID hasn’t discriminated, so it’s not just those worst-quality nursing homes that have seen cases,” Grabowski said. “It’s been equally apparent across the high quality and low-quality facilities, high Medicaid and low Medicaid facilities. We’ve found that it’s really about where you’re located that has driven these cases.”

Adding to the financial situation is the fact that testing for coronavirus in the thousands of nursing homes across the country can be very expensive. The AHCA and National Center for Assisted Living (NCAL) found that testing every U.S. nursing home resident and staff member just once, would cost $440 million. As the pandemic continues, more supplies are also needed. A recent NCAL survey found that many assisted living communities are running low on PPE (N95 masks, surgical face masks, face shields, gowns, and gloves).

Parkinson says, it’s a “failure to recognize the importance of the elderly. It’s a conscious political decision to underfund elder care,” he said. “It’s not defensible on any level, but it’s occurring in the vast majority of states.”

He went on to say that with more funding, nursing homes can be better prepared for the next health crisis.

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Reference: Yahoo Finance (June 30, 2020) “U.S. nursing homes face ‘a crisis on top of a crisis’ with coronavirus and funding woes”

Will the Sunshine State Crack Down on Crimes against the Elderly?

Florida Governor Ron DeSantis signed a bill recently approving the creation of elder abuse fatality review teams.

These teams are authorized by Senate Bill 400, which permits, but doesn’t require the creation of elder death review teams in each of Florida’s 20 judicial circuits. The teams would review cases in their judicial circuit where abuse or neglect has been found to be linked to or the cause of an individual’s death.

The Naples Daily News’ recent article entitled “Deaths of Florida’s elderly who were abused or neglected to get increased scrutiny under new law” reports that for many years, the state has authorized teams to examine child deaths and domestic-violence deaths where abuse is involved. However, the state hasn’t had a comparable review when an elderly adult dies, even under suspicious circumstances.

State Senator Audrey Gibson, D-Jacksonville, has sponsored the bill for the last four years and remarked that it’s “incumbent upon us as a state” to review cases of elder abuse and to look for gaps in service and possible policy changes to better protect the elderly.

“It can help to reduce elder abuse, if somebody knows that it’s going to be up for review if something happens to that senior,” said Gibson, the Senate minority leader. “The other thing is to prevent what happened in the cases they’re reviewing, to keep that from happening to another senior.”

Elder advocates believe that the new elder death review teams could help decrease the number of cases of nursing home neglect and mistreatment, like those identified in a recent USA TODAY Network – Florida. The investigation looked at 54 nursing home deaths from 2013 through 2017 where state inspectors cited neglect and mistreatment as factors.

The investigation found that Florida’s Agency for Health Care Administration seldom investigated the deaths.

The new law states that these elder abuse fatality review teams can be established by state attorneys and would be part of the Department of Elder Affairs. They would be composed of volunteers and open to people from a variety of disciplines, such as law enforcement officers, elder law attorneys, prosecutors, judges, nurses and other elder care advocates.

The teams are restricted to looking at files that have been closed by the State Attorney’s Office, whether or not it resulted in criminal prosecution. Remarkably, state attorneys didn’t prosecute any of the 54 nursing home deaths reviewed in the network’s investigation.

Reference: Naples Daily News (June 11, 2020) “Deaths of Florida’s elderly who were abused or neglected to get increased scrutiny under new law”

How is a Guardianship Determined?

Because the courts call guardianship “a massive curtailment of liberty,” it’s important that guardianship be used only when necessary.

The Pauls Valley Democrat’s recent article asks, “Guardianship – What is sufficient incapacity?” As the article explains, courts must be certain that an individual is truly “incapacitated.”

For example, Oklahoma law defines an incapacitated person as a person 18 years or older, who is impaired by reason of:

  1. Mental illness;
  2. Intellectual or developmental disability;
  3. Physical illness or disability; or
  4. Drug or alcohol dependency.

In addition, an incapacitated person’s ability to receive and evaluate information or to communicate decisions is impaired to such a level that the person (i) lacks capacity to maintain health and safety; or (ii) is unable to manage financial resources.

A person who is requesting to be appointed guardian by the court must show evidence to prove the person’s incapacity. This evidence is typically presented with the professional opinion of medical, psychological, or administrative bodies.

In some instances, a court may initiate its own investigation with known medical experts. In these cases, the type of professional chosen to provide an opinion should match the needs of the person (the “ward”), who will be subject to guardianship.

The court will receive this evidence and if it’s acceptable, in many cases, require that the experts provide a plan for the care and administration of the ward and his assets. This plan will become a control measure, as well as guidance for the guardian who’s appointed.

These controls will include regular monitoring and reports of performance back to the court.

If you are interested in more information about guardianship in Utah, visit our website here.

Reference: Pauls Valley Democrat (Jan. 23, 2020) “Guardianship – What is sufficient incapacity?”