The Connecticut Elder Law Blog

Cancer Takes an Enormous Toll on Those Over 55

Many of my clients struggle with dementia, but I never realized the disproportionate manner in which cancer strikes those 55 and over.  According to this article from WSOC's website out of Charlotte, NC, a whopping 77% of all cancer cases diagnosed in the United States are diagnosed in those 55 years of age and older (please note that although the title of the article is "Cancer in the Elderly", I absolutely do NOT consider a 55 year-old to be elderly.  Please take note, mom and dad!).

Another troubling issue pointed out in the article is that seniors have a unique set of problems when it comes to cancer treatment, such as pre-existing medical conditions, the use of many different medicines, dementia and social isolation.

Thankfully, it appears that the American medical community is taking steps to address this issue as the baby boomers continue to flood into the "over 55" category.  In the meantime, valuable information on cancer prevention can be found at the American Cancer Society and the National Cancer Institute.   

Deceased Veterans Now Guaranteed Gravestone Markers

Thanks to a nine-year-long effort on the part of West Hartford, Connecticut resident, Tom Guzzo, the United States Congress has approved legislation that will guarantee U.S. Department of Veterans Affairs gravestone markers for families of deceased veterans. 

The bill also provides medallions or bronze plates for veterans' headstones that were privately purchased.

Guzzo was motivated to take up this cause in 1989 when his father, Agostino Guzzo, died at the age of 70 after rebuilding roads in the Philippines during World War II.  The family then discovered that Mr. Guzzo did not qualify for a government-funded marker.

Congratulations to Tom Guzzo for his patient persistence in pursuing this campaign.  We're proud to know that the efforts of a Connecticut resident resulted in this legislation.

A full article on this story appears in the Christmas Day edition of Newsday.

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.

Bookmark this Elder Abuse Website

I'd like to bring your attention to a wonderful online resource for families with older loved ones.  The National Center on Elder Abuse, which falls under the federal Department of Health & Human Services, has a revamped website which definitely warrants a bookmark.  There is an absolute wealth of very useful information here regardless of where you live.  It provides assistance to the public and professionals; everything from practical articles on elder abuse, to comprehensive data and statistics to a listserv.

To say that elder abuse is an important issue for U.S. society is a huge understatement, so it's great that families can have a resource like this.  If you have the slightest suspicion that a loved one is a victim of elder abuse, the NCEA website would be an excellent place to begin the self-education process on this important subject.

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.

Terminate Conservatorship of the Estate When T19 is Granted

As many of my clients will readily attest to, finding out that Medicaid has been granted for a loved one is cause for celebration.  The harrowing process usually takes months and the amount of information that needs to be generated, organized and sent to the State is mind-boggling.  So when the journey ends you feel like doing cartwheels.

But there's another benefit to achieving Medicaid eligibility; if you are acting as "conservator of the estate" (managing the finances for an incapacitated person with Probate Court oversight) for someone who has been granted Medicaid eligibility, the path should be clear for terminating the conservatorship.  Since the person now has less than $1,600 in assets and all of the person's income is going to the nursing home, the Probate Judge is usually happy to terminate the conservatorship of the estate since there are not enough funds left to warrant the continued Probate Court involvement in the person's finances.  That means no more preparing and filing annual "periodic" accountings, and no more hearings regarding finances.

So, unless there is an extraordinary situation which would require the conservatorship of the estate to continue, you can go ahead and file a final accounting and request termination.  Please note that any "conservatorship of the person" (when a person is in charge of managing personal affairs for an incapacitated person, with Probate Court oversight) will probably have to continue since health care decisions will still need to be made.

The Tricky "Medicaid Pick-Up Date"

A lot of my Medicaid clients get confused over the date that Medicaid coverage kicks in (also known as the Medicaid "pick up date) once Medicaid eligibility has been determined by the State of Connecticut.

The short answer is that Medicaid can start as early as the first day of the month during which the Medicaid "spend-down" was completed, assuming that there are no issues with periods of ineligibility that have been triggered by gifting during the look-back period.  So, if an applicant spends his/her assets down below the Medicaid asset limit ($1,600) today, then Medicaid coverage can begin retroactively on December 1st.

Why would it start later than the first of the month?  Because if the spend-down included private payments to the nursing home which effectively paid for nursing home care past the first of the month, then the nursing home would not need Medicaid coverage until later in the month.  So, in the above example, let's assume that the Medicaid applicant made a partial payment to the nursing home as part of her spend-down and that payment covered her up until December 10th.  In that case, the Medicaid pick-up date would be December 11th so that the payment for care would be "seamless" for the nursing home.

The Brain: Use it or Lose it!

It is relatively common knowledge at this point that the human brain is similar to a muscle in the sense that you need to "exercise" it in order to maintain its fitness.  Many of my elderly clients regularly do puzzles (Sudoku is all the rage these days), knitting, reading, remaining in the workforce, etc., and that helps them keep their mental edge.  However, I ran into some fascinating information on this issue in this Fosters.com article (from Fosters Daily Democrat, a newspaper out of New Hampshire). 

Apparently up to 2/3 of cases in which autopsies are performed on elderly decedents who were mentally sharp throughout their lives, the doctors discover evidence of Alzheimer's or some other form of dementia in the decedent's brain.  In other words, in these cases a Pathologist sees an Alzheimer's victim while the family saw a fully-functioning and highly-cognitive person!

This phenomenon has prompted a the theory of "cognitive reserve", which argues that by staying mentally active and stimulated, the brain is capable of producing extra neurons which compensates for dementia-related brain pathology which often occurs later in life.

And some relevant information for those of us who are not quite in the "elderly/senior" category: it's never too early for us to shore up our cognitive reserve.  In fact, individuals with advanced education seem to be able to ward off cognitive decline much better than others.  So intellectual stimulation in our early years can reap enormous benefits in our later years.

The message: use that brain as early as possible and as often as possible!

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.