The Connecticut Elder Law Blog

Effective Care Plan Meetings

If you have a loved one in a nursing home then you will be invited to attend a quarterly meeting to discuss how your loved one is doing and determine what course her care should follow going forward.  These meetings are usually called "care plan meetings/conferences" and they are required if the facility accepts Medicaid and/or Medicare.  

These meetings should not be taken lightly.  You should attend the meeting if at all possible and you should go there fully prepared with a list of specific questions for the nursing home staff.  This is your best opportunity to voice your concerns and determine whether your loved one is getting the best possible care.  This is also your chance to provide the staff with background information that could prove helpful in formulating the care plan.

I have been appointed many times by local probate courts to act as the conservator for seniors when family members and friends are unable to do so.  This means I have attended innumerable care conferences and I usually pose the following questions to the staff:

Have there been any notable changes in the resident's condition since the last meeting?  If so, what was the cause?

Is the resident participating in the facility's recreational/social events?  If not, can steps be taken to facilitate his/her participation?

Have there been any visitors for the resident since the last meeting?  If so, have those visits been helpful or detrimental to the resident's spirits?

What specific therapies are being provided?

Is the resident short on any personal items (toiletries, clothes, reading material, etc.)?

These are some of the standard questions I usually ask.  However, every resident is different.  So I suggest asking the above-mentioned questions as well as questions that are specific to your loved one's situation.

 

 

Connecticut's "Filial Responsibility" Law

Concerns about "filial responsibility" or creating a legal obligation for children to financially support their parents, has recently surfaced as a national concern (with good reason) in the nursing home / Medicaid context.

Much to my surprise, it turns out that Connecticut is one of the 30 states with such a law.  I say "surprise" because in nearly 15 years of practice I have never heard of the Department of Social Services citing or enforcing this law.  Nonetheless, it is on the books, so you should be aware of it.

On the bright side, it is not as troubling as other state laws since it creates a legal obligation to support indigent parents who are under age 65.  That means it's not a concern for the vast majority of families in Connecticut facing nursing home placement issues.  Still, it could be an issue for some families if the State ever begins enforcing this law.

On the down side, it does carry a prison sentence if the support duty is not fulfilled without good cause. 

Click here for an online Forbes article on this topic.

Click here for the statute itself.

New T19 Application-Processing Approach at DSS

I'm happy to report on a positive development at Connecticut's Department of Social Services (DSS), which is the entity that is in charge of processing Medicaid applications and determining eligibility.

You're probably aware that there is a five-year look-back period (it was a three-year look-back until 2006) associated with Medicaid applications.  In other words, DSS will essentially audit your financial records for the five-year period leading up to the filing of your Medicaid application.  Up until now, that required your submission of five years worth of monthly statements for every account/asset that has (or had) your name on it.  That's an awful lot of paperwork.

Well, now DSS has apparently acknowledged that IF a Medicaid applicant has gifted money out of her name with the intent of protecting it from the nursing home, that transfer has most likely taken place in the past two years.  I'm not sure if this conclusion is based on hard data or if it's just a guess.  But either way, I suppose the logic makes sense.

Anyway, in light of this conclusion, DSS is now going to require monthly statements for assets over the past TWO years (no longer five) and then one statement for every six-month period for the other three years of the look-back. 

In other words, it's still a five-year look-back, but now they're going to take a "hard" look at the past two years and a "soft" look at the other three years.  The result is much less paperwork to collect and submit. 

And, presumably, applications will be processed more quickly.  This may be the main driving force behind this change since most DSS caseworkers seem to be struggling with an unholy backlog of applications to review.

IMPORTANT: Please note that I'm providing this update based on a brand new memo that is being circulated through DSS regional offices.  However, I do not have any first-hand experience with this new process, and I'm not aware of any elder law colleagues who have any first-hand experience with this either. 

So now we just need to hope that this new approach is actually implemented.  We'll see...

 

 

Comparing Nursing Homes on the Web

Once the decision is made that a loved one needs a nursing home, the selection of which particular nursing home is vitally important.  As you can imagine, the quality of care at nursing homes runs a rather wide spectrum.

A good starting point is actually the Federal government's Medicare website which has a nursing home comparison page.  The federal data there provides extensive information on Medicaid and Medicare-certified skilled nursing facilities in your area.  They compare the quality of care for both rehab and long-term patients by including information on the percentage of patients whose walking has improved and patients with certain types of infections, such as bladder infections and bedsores. 

Please note that facilities with high percentages of bladder infections may indicate that they have trouble keeping their residents well-hydrated.  And unsually high percentages of bedsores hint at facilities not turning residents side-to-side in bed often enough and not keeping them clean.   

So, if you're looking for a nursing home for a loved one, or suspect you may need one in the foreseeable future then you may want to begin the search by taking a spin on the Medicare website.

Nursing Home Admission and Timing the Medicaid Spend-Down

In this post I would like to mention that there is a distinct advantage if your loved one applies for admission into a nursing home while still having significant assets in his name. 

Federal law dictates that once someone is a resident in a nursing home then the facility must provide the same level of care that it provides to all other residents regardless of whether the nursing home's bill is being paid privately or by Medicaid. 

In other words, everyone gets treated the same.  At least that's the story once you're in a nursing home, but it's a whole different story before you get in.

Here's one thing most people don't realize: a nursing home receives only about 60% of their private rate when the resident is on Medicaid. 

Why is this significant?  Because if a nursing home has two applicants for admission and one empty bed, and one applicant has private funds while the other applicant is on Medicaid then the nursing home will take the private-pay applicant over the Medicaid applicant ten times out of ten.

So...when you're planning for nursing home admission, Medicaid eligibilty and the spend-down make sure that you discuss this important issue with your elder law attorney and plan carefully.

I hope everyone enjoys the weekend!

Check Out CMS Nursing Home Rankings

The Centers for Medicare & Medicaid Services (CMS) has released its star-based ratings (one to five stars) of 16,000 nursing homes across the country, including 241 homes in Connecticut.  The ratings are based on state inspections, staffing and ten other quality-of-care measurements.

Click here to see CMS's nursing home comparisons and please bookmark it if you have senior family members who may need nursing home placement in the foreseeable future.  This will prove to be an invaluable resource, but don't forget to take the initiative and visit nursing homes that you are considering as well.

CT Nursing Home Reform Hopes Quashed

Everyone can calm down now...all of the hype and momentum that promised to culminate in sweeping and sorely-needed nursing home reform in Connecticut has disappeared into thin air.  The legislative session ended at midnight on Wednesday with all of the nursing home reform proposals left on the table.  Apparently the governor and a lot of legislators were scared off by the price tag in light of the ever-worsening state revenue outlook.  So, it's a sad day for those of us in Connecticut who are directly and indirectly involved in the long-term health care scene.

Click here for the full article in the Hartford Courant.

CT Dems Seek to Double Hours of Care Per Nursing Home Resident

An important bill addressing the staffing levels at Connecticut nursing homes is working its way through the state legislature.  Nursing homes would have until May of 2009 to provide 4.2 hours of care per resident.  That more than doubles the current 1.9-hour requirement and slightly exceeds a federal recommendation of 4.1 hours.  The bill also calls for $9.5 million to be allocated to nursing homes to help them meet this new standard. 

So it appears that more positive legislation is resulting from Haven Healthcare's recent fallout.  Bravo!

Click here for the full Hartford Courant article.

The Fear of Moving to a Nursing Home

I recently ran across this article in Spectrum Online, which is an online news publication, and it confirms what I continuously hear from my elderly clients; they fear moving into a nursing home, on a permanent basis, more than anything...literally.  Including death.

A study commissioned by Clarity and the EAR Foundation has determined that 89% of American seniors prefer to live in their own homes for the rest of their lives, even if they have to go to great lengths in adapting their houses to accomplish this.  These results were echoed by surveys of the adult children of such seniors, 94% of which feel that it's important for their senior parents to age in place.

And although seem seniors generally reluctant to adopt many of the latest lifestlye technologies into their day-to-day lives, this rule-of-thumb certainly does not apply to technologies which would make it easier for seniors to live indepently at home.  The study concluded that most seniors would welcome such technological developments in their homes.

My general advice to clients and their families is to start early in regards to planning on how to keep mom and/or dad at home on a permanent basis.  This may not always be practical, but it is a worthwhile goal to shhot for.  And this Spectrum Online article (a quick read) should prompt you to include researching the latest technologies and services (Lifeline, for example) when mapping out such a plan.

Ode to Social Workers

For those of you with a loved one in a nursing home, you have probably become very familiar with his/her social worker.  I have worked closely with many social workers over the last ten years, and I always have a soft spot for them.  In fact, due to the nature of my practice, I consider myself as sort of a part-time social worker (I definitely couldn't cut it as a full-time one!). 

Anyway, it has been my experience that nearly every social worker that I have worked with has proven to be caring and genuinely interested in making the world a better place.  Remember, these people are not in it for the money and their job is deeply challenging, to put it mildly. 

If you're interested in taking a peek into the world of a social worker, you can check out Social Work World Blog which contains a lot of fascinating insights and stories regarding the world of social work, as well as useful information.