Posts Tagged ‘nursing homes’

Nursing Home Residents Will Soon Have Greater Rights

Tuesday, November 22nd, 2016

Update (12/1/2016): “The rule was supposed to take effect Nov. 28, but the American Health Care Association, an industry group that represents most nursing homes in the U.S., filed a lawsuit in October to block the rule, which it called “arbitrary and capricious.” To read more, click here.

 

A rule change by a federal agency will provide nursing home residents with major new legal protections by preventing facilities from forcing disputes into arbitration.

littman krooks long-term-careThe Centers for Medicare and Medicaid Services (CMS), part of the Health and Human Services Department, issued a rule preventing nursing homes from requiring that residents resolve disputes in arbitration rather than through a lawsuit. The rule applies to all facilities that receive federal funding, protecting the rights of 1.5 million residents. The arbitration ban is one of several new nursing home regulations promulgated by CMS, including new standards for nutrition and infection control.

Many families must make the decision about a nursing home under time pressure and in emotional turmoil, and they often are not able to consider the implications of all the contract terms. Nursing home contracts often contain fine print requiring that disputes be resolved through arbitration, taking away the right to sue for elder abuse, neglect and even wrongful death.

The nursing home industry said that the rule change, “clearly exceeds the agency’s authority.” Arbitration has reduced legal costs for nursing homes, but advocates for seniors say that it has prevented residents and their families from getting justice. Officials in 16 states and the District of Columbia had urged government action, arguing that private arbitration kept patterns of abuse hidden.

The new rule goes into effect on Nov. 28. It does not apply to contracts signed prior to that date, but current nursing home residents or their families can review their contracts and attempt to renegotiate or choose to move to another facility. After Nov. 28, nursing homes may still ask for a dispute to be settled through arbitration, but residents and their families have the right to file a lawsuit instead.

 

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Settlement Reached for Seniors Who Must Leave Assisted Living Home

Tuesday, July 5th, 2016

An assisted living home for seniors in New York City is closing and five residents who had refused to move will accept a $3.35 million settlement.

In March 2014, the management of a home for seniors in Brooklyn announced that the facility was closing and the residents would have to move within 90 days. Many of those affected were angry, alleging that the building owners wanted to sell to a developer. Most moved out as requested, but one group filed a lawsuit to halt the closing.

Littman Krooks Elder LawThe New York State attorney general, investigated the matter, saying that giving seniors 90 days to leave their homes was unreasonable. Some had Alzheimer’s disease or other dementia; family members worried that they would not be able to find the same level of care at another facility and that moving would be traumatic.

By November 2014, there were eight holdouts in the building, faced with empty halls and dwindling services. Now there are five, ranging in age from 91 to 101. Each of them will receive more than $500,000 in the settlement, but they must leave their apartments by the end of the summer.

Attorneys for the residents said the settlement was a victory, giving the seniors the time and money they need to find other accommodations. An attorney for the building’s owner said he was satisfied.

The lawsuit also named the New York State Health Department as a defendant, claiming that the agency did not follow federal and state rules regarding the closing of the home. A resolution to that part of the lawsuit has not been reached at the time of this writing.

 

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When Medicare Covers Nursing Home Care

Tuesday, May 28th, 2013

Many Americans of various income levels expect to make use of Medicare for health care costs after age 65. However, it is important to note that Medicare does not pay for care at a nursing facility except in certain circumstances.

First, let’s review what Medicare does cover. Medicare Part A covers care in a hospital and Part B covers outpatient services. For these benefits, there is a choice between traditional Medicare or a network plan, Medicare Part C or Medicare Advantage, in which the government pays for private coverage. Finally, Medicare Part D covers outpatient prescription medications.

So where does nursing home care fit in? Nursing home care is only covered for a limited time if it is necessary after a hospital stay. If a patient is hospitalized for three consecutive days or more and is then admitted to a nursing home within 30 days and a doctor certifies that the patient needs care that can only be provided on an inpatient basis at a nursing facility, then Medicare will cover a stay of up to 100 days. Only facilities approved by the Centers for Medicare and Medicaid Services (CMS) can be covered. If the stay lasts longer than 100 days, then patients are expected to pay for the care out-of-pocket until the point that they become eligible for Medicaid.

The rules above are confusing enough, but their interpretation can get even more complicated. Some families have been denied Medicare coverage for a nursing home stay because the hospital deemed their stay an “observation” rather than an “admission.” In other cases, because a hospital day is usually measured as midnight-to-midnight, patients may believe they have been in the hospital for three days, but find that the hospital measures their stay as less than three days.

To monitor Medicare charges, CMS employs private contractors who receive contingency fees based on the overcharges that they discover, so they are motivated to deny coverage whenever they can.

For a doctor to certify that treatment in a skilled nursing facility is required, the patient must need rehabilitation services for at least five days a week, or skilled services for seven days a week. Services such as, for instance, tube feedings would qualify for nursing home admission. Other services, such as rehabilitation services that could be given 3 or 4 times a week on an outpatient basis, would not be covered.

Even if Medicare covers a nursing home stay, there is only full coverage for the first 20 days. After that, a co-payment is required. These co-payments, and the cost of a nursing home after 100 days, may be covered by Medicare supplemental insurance, if the patient has such insurance and submits a claim.

Many middle-class families, facing the prospect of seeing an older loved one’s life savings consumed by nursing home costs, are turning to trust planning to protect their assets while still allowing them to be eligible for Medicaid. An elder law or estate planning attorney can create a trust for an older person to transfer assets, thus reducing the person’s wealth level enough to become eligible for Medicaid. Another strategy for dealing with nursing home and other long-term health care costs is long-term care insurance. With proper planning, families can manage the costs of a stay in a nursing home.

 

Some New York Nursing Home Evacuees Still Displaced

Tuesday, February 5th, 2013

After Hurricane Sandy, hundreds of disabled and elderly New Yorkers were evacuated from assisted living facilities and nursing homes near the coast.  Now, more than two months after the storm hit, some evacuees are still getting by in temporary quarters.

The evacuees were moved to places like Brooklyn’s Bishop Henry B. Hucles Episcopal Rehabilitation and Skilled Nursing Center.  The center was already operating at capacity before the storm hit and is now packed with more than twice the number of residents it is licensed to care for.  One hundred ninety patients from the Rockaway Care Center in Queens, which flooded due to the storm, have had to sleep on cots in multi-purpose rooms and in the center’s chapel.

About 160 residents of an assisted living facility in Queens called Belle Harbor Manor had to be evacuated to the grounds of the Creedmor Psychiatric Center, a partly-unused mental health facility.  The evacuees complained of being mixed in with patients suffering from severe mental disorders, and losing freedoms such as the ability to have visitors in their rooms.

According to New York’s Health Department, more than 6,200 people were evacuated from 47 different nursing homes and assisted living facilities as a result of Hurricane Sandy, and storm damage has meant that about a dozen were still closed two months later, with others only able to accept a limited number of residents back.

The majority of patients were evacuated after the storm, under flood conditions, and were unable to bring extra clothing and personal belongings.

Officials said it may be weeks before facilities with some of the worst flood damage are able to re-open.

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