Did you ever think that the term "death panel" would be applied to the scenario in which you speak to your doctor about making an advanced directive, stating your wishes in the event that you became comatose, in a vegetative state, or needed to be kept on a ventilator?


That's the term that is being used by the right wing of the Republican Party (including Rush Limbaugh, Glen Beck, and Sarah Palin --who said that Americans would have to "stand in front of Obama's death panel so his bureaucrats can decide, based on a subjective judgment of their level of productivity in society, whether they are worthy of health care") to describe the provision in the healthcare reform bill that would authorize Medicare to reimburse a physician for providing counseling sessions about end-of-life directives.

Do these right wing pundits even know what an advanced directive is? The AARP, not exactly a subversive left wing group, recommends that seniors complete advance directives so that their wishes will be known to their families and doctors in case they are unable to speak for themselves in a medical emergency. Believe me, a crisis situation in an emergency room or hospital is not the time to consider for the first time how you would feel about living on a ventilator for the rest of your life, or how you would feel about being kept alive in a vegetative state for the rest of your life, or how you would feel about any one of a number of calamities that could befall you in the event of a medical emergency. The idea that your physician would be reimbursed by Medicare to discuss the matter with you, at the time of, or in advance of any medical crisis, is a good one, and by no stretch of the imagination can it be compared to a "death squad."

In fact, it was a Republican Senator, Johnny Isakson of Georgia, who originally made the Medicare proposal that is being labelled "death panel", back in 2007 when he co-sponsored a Medicare End-of-Life Planning Act. On August 10th, Senator Isakson told the Washington Post that analogizing physician counseling for advanced directives to "death panels" is "nuts."

To see President Obama address the death panel issue directly, look at this excerpt of his August 11th town hall meeting in Portsmouth New Hampshire -- click below




To read the text of the town hall meeting click here.

To read the AARP article about advanced directives, click here.

To read the Washington Post's interview with Senator Johnny Isakson,click here.

Felicia Curran
www.ElderAdvocacyLaw.com

Thought that you'd never be paying $4.79 for a gallon of gas? What if you are an elderly or homebound individual? Think the high price of gas doesn't affect you? Think again: What if you depend on Meals on Wheels or other home health support services for your very survival in your home?

The sharp increase in the price of gas is having dire effects on the nation’s home health agencies, and in turn on the elderly and homebound individuals they help. According to the National Association for Home Care & Hospice (NAHCH), there are 12 million people nationwide who are so disabled that they cannot leave home without assistance, and who are able to live in their own homes, and avoid a nursing home because of the assistance they receive from home health agencies. Collectively, the NAHCH reports that home support agencies employees drive nearly 5 billion miles each year to care for homebound individuals.

Many home health agencies operate at break-even, and 44% of home care agencies reported that they LOST money during 2007, and the rising cost of gas was reportedly a big factor in their operating in the red.

The New York Times reports that employees of home health agencies, and volunteers of federal programs such as Meals On Wheels, who are expected to use their own cars and pay for their own gas, are also being affected. Katie Clark (pictured here), a single mother of two, drives 700 miles a week in rural Michigan to provide home care for Bill Harmon, 77, and his wife Evelyn, 85 (pictured here) who has Alzheimer’s and is unable to care for herself. Katie is paid $9 an hour, or $250 a week, to care for the Harmons, but has to pay for her own gas, which now totals a whopping $100 a week. Katie says that the Harmons “are just like family to me” but she may not be able to continue to care for them because of the high price of gas. “Some weeks I have to borrow money to get here” she is quoted as saying.

When Evelyn started to develop Alzheimer’s disease 8-10 years ago, her husband promised her "Don’t worry, I’ll take care of you as long as I can.” Now he says that without Katie’s help, he would have to put his wife in a nursing home, and “probably need to live in one himself.”

The National Association for Home Care & Hospice is lobbying congress to take the following steps to help home health agencies help the elderly stay in their own homes and out of nursing homes:

1. Preserve the annual inflation updates for home health and hospice as provided in Medicare law.

2.Reinstate the 5 percent rural add on for home health services delivered to patients in rural areas.

3.Exempt home health agencies, hospices and their nurses and therapists from paying Federal gasoline taxes.
4. Recognize home telehealth between trained nurses and patients as the equivalent of in-home visits.

5. Retract the Medicare regulatory cuts of nearly 12% facing home health care in 2008-2011.

6. Withdraw the Medicare regulatory proposal to eliminate the Budget Neutrality Factor in the hospice wage index.

7. Grant home health providers priority status to fuel and supplies through “first responder” status in cases of public health emergencies and disaster situations.

To learn more about the National Association for Home Care and Hospice proposals, click here.

You can do your part by contacting your Congressperson or Senator and demanding that they pass and support THe NAHCH proposals. Click here for contact information for Congress and the Senate.

The read the New York Times article, click here.


Felicia Curran
www.ElderAdvocacyLaw.com

California Advocates for Nursing Home Reform (CANHR), a nonprofit group that spearheaded the law Arnold just vetoed, has issued the following press release:

"FOR IMMEDIATE RELEASE
October 17, 2007

Governor Vetoes Bill to Protect Nursing Home Abuse Victims

San Francisco -- On Sunday night, just hours before it would become law, Governor Schwarzenegger vetoed AB 399, striking down an immensely popular bill to aid elder abuse victims in nursing homes by improving investigations of abuse and neglect. The bill would have required the California Department of Public Health to complete investigations within reasonable time limits and to notify complainants of findings.

Abuse and neglect have reached crisis proportions in California nursing homes. Complaints and facility reports of abuse and neglect have more than doubled in recent years and continue to grow at double-digit rates each year. More than 15,000 complaints and facility reports are expected to be investigated this year.

Introduced by Assembly Member Mike Feuer, AB 399 responds to the California Department of Public Health's longstanding failures to conduct timely and effective investigations of nursing home complaints. The failures are well documented in a series of government reports, including an April 2007 report by the California State Auditor. It shows the Department failed to timely complete more than 60 percent of 15,275 investigations conducted between July 2004 and April 2006, and that more than 500 complaints remained open for more than one year.

For nursing home residents, the broken investigation system is a matter of life and death. The slow investigations subject residents to continued mistreatment and also compromise the Department's ability to collect evidence. Most nursing homes face no consequences for abuse or neglect because the Department substantiates so few complaints (only one in six according to a 2007 study by the California Healthcare Foundation).

Even complaints involving deaths suffer extreme delays. This is especially true in cases involving AA citations, which involve a finding that neglect or abuse led to the death of a nursing home resident. Typical delays range from one to two years. See attached CANHR summary of recent AA citations.

"The veto is devastating to elder abuse victims in nursing homes," said Patricia McGinnis, CANHR's Executive Director. "It is shocking that the Governor won't commit to timely investigations of abuse and neglect."

Other than the Governor [picture here with President Bush], AB 399 faced no opposition. The California Legislature voted 117 - 1 in favor of it. AB 399 is supported by dozens of organizations, the nursing home industry, and citizens throughout California who see it as an historic opportunity to restore integrity to California's nursing home complaint investigation system.

For more information contact:
Pat McGinnis, Executive Director, CANHR (415) 974-5171
Michael Connors, Advocate (626) 796-6178
California Advocates for Nursing Home Reform (CANHR)
www.canhr.org"

The veto is just one of a series of vetoes of pro-family bills by Governor Schwarzenegger. For more information, read Julius Young's article in the California Progress Report:
"Schwarzenegger Vetoes Pro-Family Bills As Corporate Interests Trump Family Values"

Email the Governor and tell him what you think and that you vote - click here.

Felicia Curran
www.ElderAdvocacyLaw.com

When Arnold Schwarzenegger played Los Angeles narcotics detective John Kimble in Kindergarten Cop, he was said to be “the toughest undercover cop in LA. If you're bad, he'll know it. If you're hiding something, he'll find out. If you cheat, he can tell.”

Some of Arnold’s funniest lines in the movie were when Arnold, as Detective Kimble, took charge and demanded action. Remember such lines as:

“You lack discipline!”

“Well I've got news for you! You are mine now! You belong to me!”

“Who is your daddy, and what does he do?“

"You tell him you didn't do your homework"

“I'm going to ask you a bunch of questions, and I want them answered immediately.”

“Stop whining!”

Arnold is now governor of our state. Unlike Detective John Kimble, Governor Schwarzenegger seems ready to accept excuses for inept and incompetent performance by government agencies that operate under his command. There is a bill sitting on Arnold’s desk, Assembly Bill 399 (Feuer), passed by the California legislature, that only requires the governor’s signature to become law. The bill would require the California Department of Health Services to complete investigations of complaints against nursing homes within 40 business days. The governor’s spokesperson says that he “hasn’t yet taken a position on whether he will sign the bill.”

What is he waiting for? All I can say is it’s time for the Governor to sign that bill and to tell the Department of Health Services to “stop whining.”

The Los Angeles Times did an article describing the types of delays that have prompted the bill.

In July 2006, 81-year-old Octavio “Nito” Jimenez (pictured here) was rushed from an Oxnard nursing home, Maywood Acres, by ambulance to an acute care hospital, where doctors found advanced, infected wounds on his heel and buttocks. The nursing home had told Octavio’s family only that he had “a little sore” on his foot.

His granddaughter Josie Valdez (pictured here) asked the county Ombudsman to investigate. The Ombudsman referred the matter to the state Department of Health Services, stating, “the family is very concerned that they will lose their father from neglect.”

Unfortunately, they were right. A few days later, Octavio passed away from an apparent heart attack. In the 15 months since the complaint was filed, the Department of Health Services still hasn’t investigated the complaint. “To this day, nobody has been able to tell me what the findings were.” Josie Valdez is quoted as saying. “It hurts families and it hurts the person unable to care for themselves.”

The Department of Health Services has proved time and time again that they will not complete investigations on their own accord. They need the fixed deadines provided by 399 to force them to complete investigations on time.

Consider these other delays documented by The Los Angeles Times:

“* One year to investigate and impose a $100,000 fine against Westgate Gardens Care Center after an unattended 77-year-old resident choked on a grape and later died. Instructions in the resident's records indicated she was not to be served whole fruits or left alone when she ate.

* Eleven months to investigate and fine Beverly Healthcare Center in Stockton $80,000 after its air conditioner failed during a heat wave in July 2006. One resident died from hyperthermia caused by the high temperatures, and another resident was taken to the hospital with the same condition, the state said. The home has since changed its name to Golden Living Center-Stockton.

* Fourteen months to cite Manorcare Health Services in Hemet after an 83-year-old dementia patient fell out of his wheelchair, suffered a brain hemorrhage and died. He was supposed to be placed in chair with a lap cushion to prevent falls. The home was fined $75,000.

As Assemblyman Feuer says, the bill is needed to quickly flag problems at nursing homes and ensure they are corrected.”

"A timely investigation with timely results can make the difference literally between life and death sometimes," Feuer said. "Forty days is plenty of time to conduct a meaningful, finely grained, detailed investigation."

Arnold, residents of nursing homes need your help. Tell Department of Health Services, “Don’t procrastinate,” “I own you. You are mine now.” Give them some deadlines.

Let the Governator know what you think - send him an email – click here.

Felicia Curran
www.ElderAdvocacyLaw.com

In a few days Democrats in the U.S. House of Representatives will introduce a bill which, if enacted, will provide important protections for Medicare recipients. The Children’s Health and Medicare Protection Act started out as a bill designed to expand insurance coverage nationwide for low-income children. Republicans in the Senate Finance Committee voted last week with Democrats to approve that bill which would provide financing for health insurance for all low-income children by raising cigarette taxes.

Democrats have announced that they will attempt to push through an expanded version of the bill, which would reverse the free ride that private Medicare plans currently enjoy at elder tax payers' expense. In 1997, the Republican Congress passed a law allowing seniors to replace traditional Medicare health coverage with enrollment in a fee-for-service health insurance plan. Congress actually pays these private plans - called Medicare Advantage Plans – huge subsidies, paying 19% more on average per senior than for the same services under traditional Medicare. No wonder Medicare is scheduled to go broke!

Not only do these plans get higher reimbursement rates from the government than services provided under traditional Medicare, these Medicare Advantage plans often have much larger co-pays for hospital stays, home health aides, nursing home stays and prescription drug plans than traditional Medicare does. Seniors often don’t realize that there are higher co-pays until they get the hospital or other bill, and by then it is too late. (See Elder Advocacy Blog: "Government Subsidizes Insurance Companies Who Push Private Fee-For-Service Medicare Plans On Unwary Seniors" May 8, 2007).

The bill proposed by Democrats would prohibit private Medicare plans from charging higher co-pays than traditional Medicare, and would give State insurance commissioners power to regulate marketing of these private plans to Medicare recipients. The bill also contains provisions to eliminate the outrageous government subsidies given to these private plans.

To gain the support of physicians, Democrats have shrewdly added provisions that would block cuts in Medicare payments to physicians. That was evidently enough to prompt the American Medical Association to join with AARP in endorsing the bill. Olay!

Bush was quoted as saying that the bill is a step "down the path to government-run health care for every American." All I can say is, "I HOPE SO."

Needless to say, insurance companies are up in arms against the bill. The insurance and tobacco industries are pulling out all stops to block this bill, and they know they can count on President Bush to veto it. These Medicare Advantage plans have received a lot of well-deserved negative publicity, however, and Republicans will be under pressure to vote for the bill.

Do your part, and contact your Representatives in Congress and the Senate and urge them to support the Children’s Health and Medicare Protection Act.

The information in this entry came from a July 23, 2007 front page article of the New York Times. To read the article, click here.

Click here for email addresses and phone numbers for your representatives.


Felicia Curran
www.ElderAdvocacyLaw.com