The Connecticut Elder Law Blog

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.

Filing Complaints Against Nursing Homes in Connecticut

There has been a great deal of media coverage regarding the quality of care in Connecticut nursing homes these days, as well as on a national level.  So a post about how to file a complaint against a nursing home seems timely.

The very first thing to keep in mind is that both state law and federal law offer protection against reprisal when you file a complaint.

Complaints should be filed with the Connecticut Department of Public Health (DPH), Facility Licensing and Investigations Section, 410 Capitol Avenue, MS# 12 HSR, Hartford, CT 06134-0308.  Their phone number is (860) 509-7400, fax is (860) 509-7538.

The DPH does not require a specific form for the complaint, but they should be made in writing and copies of all correspondence should be maintained.  Provide specific information, such as what exactly occurred, times and dates, names, witnesses, medical treatment triggered by the alleged abuse, etc.  You should also indicate the corrective action that you feel needs to take place.

If a complaint claims that a resident is in "jeopardy", then the State must begin an investigation within two days.  Language indicating that you believe the resident is in jeopardy of physical or mental harm if immediate corrective action is not taken should prompt the expedited response by DPH.  If some sort of jeopardy is not alleged then it may be months before something happens. 

DPH should keep you updated on the status of the investigation and you are entitled to a copy of the completed investigation report.  If DPH determines that there has been any violation of law then the nursing home must complete a corrective plan.  DPH can also order corrective action and impose sanctions, fines, and license suspension or revocation.

If there was an injury to your loved one and you want to ge beyond the complaint process, then you should contact an attorney that specializes in personal injury law.  By the way, that would not be me!  But if you are in Connecticut I am always happy to refer you to a competent PI attorney.

Nursing Home Admission Agreements...Read the Fine Print!

The length of nursing home admission agreements often goes into double-digits, and responsible family members are often desperate to sign anything to get mom or dad onto a waiting list.  This can result in a legal nightmare when the family is unpleasantly surprised later when they find out what they agreed to.  This issue was recently covered in this article by the Columbia Tribune out of Missouri, and it's worth a quick read.

Things to keep an eye out for: liberal guidelines regarding when a resident can be evicted, very restrictive visiting hours for family members, and requiring that a family member accept financial responsibility for the resident.  These types of requirements may violate federal law; specifically, the Nursing Home Reform Act of 1987.  This law is summarized nicely by AARP here.

So before you sign such an agreement, take a deep breath, set aside some time and go through it carefully.  As a conservator for several elderly nursing home residents, I often cross out and initial certain provisions of nursing home admission agreements that I do not agree with and then sign it.  If the facility has a problem with your alterations, they will let you know about it and then you will have to hash it out with them.  But if they accept the agreement with your changes without objecting to them then they, arguably, are bound to the amended agreement.

And, although this is a self-serving plug, ask an elder law attorney to review the agreement for you if you're not 100% comfortable with it.

Surge in Nursing Home Citations

USA Today is reporting that the number of citations for nursing homes puttting patients in "immediate jeopardy" increased by 22% from 2000 to 2006.  These citations are the most serious reprimands that federal inspectors can issue.  So it appears that the nursing home care concerns that have been widely publicized in Connecticut over the last month or so are not exclusive to the Nutmeg State.

The article points out that the statistic does not necessarily mean that nursing home care is getting worse, but perhaps inspectors are now doing a better job of discovering care problems. 

In any case, this seems to be a widening national issue, and it may evolve into a presidential campaign issue in the coming months.  Some candidates have already called for the U.S. Centers for Medicare and Medicaid Services to release their full list of the 120 "special focus facilities".  Only 54 names from that list have been released to the public so far.

Click here for the full USA Today article.

List of Worst Nursing Homes in U.S. Released by Feds

In keeping with the spirit of the list contained in the Mitchell Report, the federal government has released a damning list of its own, only this one names the 54 nursing homes in the Unites States that have the most room for improvement.

The 54 names comes from a list of 120 nursing facilities that the federal government's Center for Medicare and Medicaid Services (CMS) has identified as "special focus facilities".  From what I have read, I cannot determine why the entire list of names has not been released, but there are several U.S. Senators who are currently calling for exactly that.

The entire list is here.  In light of the current problems that the Hartford Courant has highlighted with Haven Health's chain of nursing homes in Connecticut, I was mildly shocked to see that only one Connecticut facility, Wethersfield Health Care Center, is on the list.  If/when the rest of the list is released, I will let you know and we might find more Connecticut names turn up.

Beware of How You Sign the Nursing Home's Admission Application

I have many clients who have been appointed as an agent under one of their parent's durable powers of attorney in order to help mom and/or dad manage their personal and financial affairs.  And many times their duties include helping their parents get into a local nursing home, at which point there is a liability landmine that they need to be aware of.

I always tell my clients in such a situation to make it clear when they sign the application for admission to the nursing home that they are signing the document strictly as mom or dad's agent...not in their own individual capacity.  Because if something goes wrong with mom or dad's Medicaid application in the future and it appears that the son or daughter signed the application as a "responsible party" in their individual capacity, then the nursing home could go after the son or daughter for the unpaid balance resulting from the failed Medicaid application.  This nerve-wracking scenario has played out with many of my clients in the past.

How can you avoid this?  The best way is to sign the application with the acronym "POA" following your name every time you sign something.  For example, "John Q. Public, POA" instead of just "John Q. Public".  It would also help to write out a sentence at the end of the document specifically stating that you are signing the document in your capacity as an agent under a POA and not in your own individual capacity. 

Of course, I can't tell you that this is a guaranteed shield against liability.  If you make a big enough mistake acting as POA then the nursing home will find a way to claim that you are liable as an individual.  But this approach is a good way to make it harder for the nursing home to make such a claim.

Nursing Home Checklist

I ran across a very good, comprehensive nursing home checklist that has been generated by Medicare.  If you think your loved one may need a nursing home in the foreseeable future then it would be helpful to run through the questions on this list with the nursing home director for each facility that you are considering.  Asking these types of thoughtful questions is also a way to send a message to the nursing home's administrators that you are serious about the quality of care provided to your loved one.

Another good approach is to chat with visitors who have a family member residing in the facility.  They are the ones who can give you a relatively accurate and honest assessment of the overall quality of that particular nursing home.