Category: Elderly Care

  • The Supreme Court heard oral arguments last week on a case disability, eldercare and health care advocates described as “an assault” on the rights of older adults, people with disabilities and their families. Advocates are so concerned over the potential impact of Health and Hospital Corporation of Marion County v. Talevski that they’re still pressing both sides to withdraw or settle before a decision is rendered.

    The case could radically alter Medicaid and a host of other government programs by limiting private citizens’ right to sue when those programs aren’t fairly and safely administered.

    The case centers on the late Gorgi Talevski. In 2019, his daughter Suzie Talevski filed a lawsuit against Health and Hospital Corporation of Marion County, alleging that her father had been abused in his Indiana nursing home run by the state-owned company and funded by Medicaid, which provides health care to over 76 million low-income Americans and is the primary funder of long-term care in the United States.

    Among other issues, Talevski alleges that her father was overmedicated to the point of chemical restraint — a practice in which a person is sedated so that they are easier to manage, to the detriment of that person’s own health and well-being.

    The question before the Supreme Court was not whether Gorgi Talevski was abused, but whether he and his family had the right to sue the company to seek damages.

    “There’s a lot at stake. Depending on how the court rules, if someone is abused in a nursing home and they are harmed, their families might not be able to sue the provider,” said Maria Town, president of the American Association of People with Disabilities. Her organization filed an amicus brief with other disability rights organizations.

    For months, national and local advocates have attempted to persuade the parties involved in Health and Hospital Corporation of Marion County v. Talevski to withdraw the case or settle, respectively.

    “The fear is that the composition of the Supreme Court is such that they will decide in favor of [the nursing home industry]. But also that the decision could be very broad,” Town said.

    A broad decision could also impact a variety of programs beyond long-term care, according to Jasmine Harris, a professor at University of Pennsylvania’s Carey School of Law.

    “Everything from Temporary Assistance for Needy Families, the Children’s Health Insurance Program, the Supplemental Nutrition Assistance Program, which was formerly known as food stamps” could be impacted, along with Medicaid and Medicare, Harris told The 19th.

    Madiba Dennie, a legal scholar with the Brennan Center for Justice at New York University School of Law, also expressed concern that the case may be an opportunity for “judges to close the doors of justice to ordinary people.” If the court were to limit the right of private citizens to sue government programs, then it would become much more difficult for regular people to protect themselves from harm incurred as a result of those programs.

    Town also expressed concern about the lack of recourse outside of the court system that disability advocates and advocates for older adults will have if the court rules in favor of Health and Hospital Corporation of Marion County.

    “Our ability to shift policies is more restricted because it’s just harder to get stuff done in Congress. Things have become more polarized,” Town said.

    But during oral arguments on Tuesday, some of the court’s conservative justices — whom advocates are most concerned about — expressed skepticism for the arguments made by Health and Hospital Corporation of Marion County.

    In particular, Justice Brett Kavanaugh pointed to the text of the statute under discussion, which discusses the legal rights afforded to nursing home patients. Health and Hospital Corporation of Marion County argued that the statute in question, Section 1983, was not specific enough to allow for lawsuits.

    Section 1983 is part of the bedrock of civil rights law in the United States. It was originally passed as part of the Ku Klux Klan Act of 1871, and gives private individuals the right to sue state government employees for civil rights violations.

    “It’s a very uncomfortable fact for you that the statute says ‘rights’ over and over again,” Kavanaugh said.

    More liberal justices were also critical in their questioning.

    “It seems to me odd to suggest that we as a court can reinterpret the word ‘law’ [in Section 1983] to carve anything out,” said Justice Ketanji Brown Jackson.

    Advocates can and will continue to press both sides to withdraw the case from the Supreme Court. Until a final decision is issued, it is still possible to stop it from proceeding.

    Shira Walkshlag, senior director of Legal Advocacy for the Arc of the United States, told The 19th that she “doesn’t do predictions” and therefore the strategy will be to continue to apply pressure. The Arc is one of the largest disability organizations in the United States, and also submitted an amicus briefs.

    “Now we have to wait for the decision. But we will also continue to advocate against [Health and Hospital Corporation of Marion County]’s assault on disability rights. The advocacy is to try to get [them] to withdraw the case,” she said.

    This post was originally published on Latest – Truthout.

  • The prospect of increased impairment and frailty among the elderly is a growing concern of health care providers.

    Ronald Lindquist, 87, has been active all his life. So, he wasn’t prepared for what happened when he stopped going out during the coronavirus pandemic and spent most of his time, inactive, at home.

    “I found it hard to get up and get out of bed,” said Lindquist, who lives with his wife of 67 years in Palm Springs, California. “I just wanted to lay around. I lost my desire to do things.”

    Physically, Lindquist noticed that getting up out of a chair was difficult, as was getting into and out of his car. “I was praying ‘Lord, give me some strength.’ I kind of felt, I’m on my way out — I’m not going to make it,” he admitted.

    One little-discussed, long-term toll of the pandemic: Large numbers of older adults have become physically and cognitively debilitated and less able to care for themselves during 15 months of sheltering in place.

    No large-scale studies have documented the extent of this phenomenon. But physicians, physical therapists and health plan leaders said the prospect of increased impairment and frailty in the older population is a growing concern.

    “Anyone who cares for older adults has seen a significant decline in functioning as people have been less active,” said Dr. Jonathan Bean, an expert in geriatric rehabilitation and director of the New England Geriatric Research, Education and Clinical Center at the Veterans Affairs Boston Healthcare System.

    Bean’s 90-year-old mother, who lives in an assisted living facility, is a case in point. Before the pandemic, she could walk with a walker, engage in conversation and manage going to the bathroom. Now, she depends on a wheelchair and “her dementia has rapidly accelerated — she can’t really care for herself,” the doctor said.

    Bean said his mother is no longer able to benefit from rehabilitative therapies. But many older adults might be able to realize improvements if given proper attention.

    “Immobility and debility are outcomes to this horrific pandemic that people aren’t even talking about yet,” said Linda Teodosio, a physical therapist and division rehabilitation manager in Bayada Home Health Care’s Towson, Maryland, office. “What I’d love to see is a national effort, maybe by the CDC [U.S. Centers for Disease Control and Prevention], focused on helping older people overcome these kinds of impairments.”

    The extent of the need is substantial, by many accounts. Teodosio said she and her staff have seen a “tremendous increase” in falls and in the exacerbation of chronic illnesses such as diabetes, congestive heart failure and chronic obstructive pulmonary disease.

    “Older adults got off schedule during the pandemic,” she explained, and “they didn’t eat well, they didn’t hydrate properly, they didn’t move, they got weaker.”

    Dr. Lauren Jan Gleason, a geriatrician and assistant professor of medicine at the University of Chicago, said many older patients have lost muscle mass and strength this past year and are having difficulties with mobility and balance they didn’t have previously.

    “I’m seeing weight gain and weight loss, and a lot more depression,” she noted.

    Mary Louise Amilicia, 67, of East Meadow, New York, put on more than 100 pounds while staying at home round-the-clock and taking care of her husband Frank, 69, who was hospitalized with a severe case of covid-19 in early December. While Amilicia also tested positive for the virus, she had a mild case.

    “We were in the house every day 24/7, except when we had to go to the doctor, and when he got sick I had to do all the stuff he used to do,” Amilicia told me. “It was a lot of stress. I just began eating everything in sight and not taking care of myself.”

    The extra weight made it hard to move around, and Amilicia fell several times after Christmas, fortunately without sustaining serious injuries.

    After coming home from the hospital, Frank couldn’t get out of a chair, walk 10 feet to the bathroom or climb the stairs in his house. Instead, he spent most of the day in a recliner, relying on his wife for help.

    Now, the couple is getting physical therapy from Northwell Health, New York state’s largest health care system. Just before the pandemic, Northwell launched a “rehabilitation at home” program for patients who otherwise would have seen therapists in outpatient facilities. (Medicare Part B pays for the treatments.)

    The program is serving more than 100 patients on Long Island, in Westchester County and in parts of New York City. “The demand is very strong and we’re in the process of hiring another 20 therapists,” said Nina DePaola, Northwell’s vice president of post-acute services.

    Sabaa Mundia, a physical therapist working with the Amilicias, said Mary Louise can walk up to 400 feet without a walker, after doing strengthening exercises twice a week over the course of three weeks. Frank had been using a wheelchair and is now regularly walking 150 feet with a walker after more than a month of therapy.

    “Older adults can lose about 20% of their muscle mass if they don’t walk for up to five days,” Mundia said. “And their endurance decreases, their stamina decreases, and their range of motion decreases.”

    Recognizing that risk, some health plans have been reaching out to older members to assess how they’re faring. In Massachusetts, Commonwealth Care Alliance serves more than 10,000 older adults who are poor and eligible for both Medicare and Medicaid, the federal-state program for people with low incomes. On average, they tend to have more medical needs than similarly aged seniors.

    Between March and September last year, the plan’s staffers conducted “wellness outreach assessments” by phone every two weeks, asking about ongoing medical care, new physical and emotional challenges, and the adequacy of available help, among other concerns. Today, calls are made monthly and staffers have resumed seeing members in person.

    An increase in physical deconditioning is one of the big issues that have emerged. “We’ve had physical therapists digitally engage with members to coach them through strength and balance training,” said Dr. Robert MacArthur, a geriatrician and Commonwealth Care’s chief medical officer. “And when that didn’t work, we sent therapists into people’s homes.”

    In California, SCAN Health Plan serves a similarly vulnerable population of nearly 15,000 older adults dually eligible for Medicare and Medicaid through its Medicare Advantage plans. Care navigators are calling these members frequently and telling them “now that you’re vaccinated, it’s safe to go see your doctor in person,” said Eve Gelb, SCAN’s senior vice president of health care services. Doctors can then evaluate unmet health needs and make referrals to physical and occupational therapists, if necessary.

    Another SCAN program, Member2Member, pairs older adult “peer health advocates” with members who have noted physical or emotional difficulties on health risk assessments. That’s how Lindquist in Palm Springs connected with Jerry Payne, 79, a peer advocate who calls him regularly and helped him come up with a plan to emerge from his pandemic-induced funk.

    “First, he said, ‘Ron, you should try getting up every hour and taking a few steps’ — that was the start of it,” Lindquist told me. “Then, he’d suggest walking another block when I would take my dog out. It was painful. Walking was not pleasant. But he was very encouraging.”

    A month ago, Payne had a Fitbit sent to Lindquist. At first, Lindquist walked about 1,500 steps a day; now, he’s up to more than 5,000 steps a day and has a goal of reaching 10,000 steps. “I’m sleeping better and I feel so much better all around,” Lindquist said. “My whole attitude and physicality has changed. I tell you, this has been an answer to my prayers.”

    This post was originally published on Latest – Truthout.

  • New research reveals nursing homes owned by private equity investors have higher death rates.

    As the nation’s population ages, the need for more care workers and safer, more affordable care options is urgent.

    By 2050, the number of individuals in need of long-term care services will likely double from 13 million in 2000 to over 27 million people.

    To address the growing demand, President Biden has earmarked $400 billion of his $2 trillion jobs plan to expand access to quality, affordable home or community-based care for aging and disabled Americans.

    “Even before Covid-19, our country was in the midst of a caregiving crisis,” notes a Biden administration fact sheet on the plan. “These investments will help hundreds of thousands of Americans finally obtain the long-term services and support they need, while creating new jobs and offering caregiving workers a long-overdue raise, stronger benefits, and an opportunity to organize or join a union and collectively bargain.”

    Specifically, President Biden’s plan would expand access to long-term, home-based care services under Medicaid, in addition to providing a $5,000 tax credit for family caregivers.

    This will allow millions of people who need care to stay in their homes and avoid unnecessary placements in nursing homes — over 70 percent of which are for-profit and owned by private investors.

    New analysis from the National Bureau of Economic Research found that between 2004 and 2016, private equity ownership of nursing homes increased the mortality rate of residents by 10 percent compared to those living in homes with other ownership structures, suggesting that more than 20,000 people died as a consequence of living in nursing homes run by private equity firms during this period.

    The Covid-19 pandemic exacerbated the risks of the for-profit model for vulnerable nursing home residents and employees.

    A study published in the Journal of the American Medical Association found that throughout the pandemic, for-profit nursing homes had lower supplies of personal protective equipment for their workers when compared to other types of nursing homes.

    In New Jersey, the state with the highest nursing home death rates during the pandemic, for-profit nursing homes had infection rates 24.5 percent higher than the statewide nursing home average and death rates more than 10.2 percent higher.

    This post was originally published on Latest – Truthout.