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

Do you know any senior who has bought a deferred annuity? Chances are that elder was the victim of an unscrupulous sales agent. Americans aged 65 and older collectively own $15 trillion in assets, the largest pool of assets ever amassed by Americans in this age group. Insurance companies are trying to siphon off this money through independent sales agents who use unscrupulous scare tactics to sell investments that experts say most retirees should never own, according to a recent article in the New York Times.

In fact, improper sales of annuities make up one-third of all cases of financial abuse, according to the article. Seniors are attracted to annuities because they are concerned about running out of savings before they die. Annuities guarantee fixed monthly payments for the life of the investor, in exchange for an initial lump-sum investment. Unlike non-deferred annuities, where the monthly payment begin immediately, deferred annuities don't begin payouts until five to ten years after the investment, potentially leaving the elder destitute during the period where no payments are made, and raising the possibility that the elder may pass away before they ever see a dime from the insurance company. The article describes how insurance companies pay agents huge commissions to sell deferred annuities to the elderly because these policies are so profitable for the company.

Insurance companies hope that by using "independent" sales agents that they will avoid their own responsibility for the unscrupulous tactics these agents predictably use. Sales agents with bogus, but impressive-sounding credentials like ''certified elder planning specialist” are paid hefty commissions from insurance companies to target elders. They set themselves up as authorities on elder finances, and then use scare tactics to trick elders into turning over their savings for unsuitable investments.

One victim, 72-year-old Mary Ann St. Clair (pictured here) told the reporter her story. ''[The agent’s] office was filled with things saying he was certified to help seniors. . . . [But] the only one he really helped was himself.'' Yes, to her life savings of $75,000! In exchange,the sales agent, Michael DelMonico, sold her a deferred annuity which didn’t pay out for five years.

''All these insurance companies had trusted him, so I knew that I could trust him, too,'' she said (Definitely a non-sequitor, Mary Ann, as now you know!). ''And when he became a certified senior adviser, I felt good, because he had gone to school for a long time.'' (Right, he didn't tell you that it was just a mail order correspondence class, did he?)

After entering into the contract, Mrs. St. Clair had unexpected bills for dental work and repair work on her home but no money now to pay them. She contacted the insurance company, Old Mutual, and asked them to cancel the contract, telling them that DelMonico hadn’t fully explained them to her and that she had never intended to buy the annuities.

Shamefully, the insurance company refused to give her money back, and stood by DelMonico until he was sued by the Attorney General of Massachusetts for using improper sales tactics with other elderly buyers. Old Mutual is itself now the subject of a U.S. Senate investigation into the sales tactics used by their “independent" sales agents.

The Times’ article quotes Jim Nelson, an assistant secretary of State in Mississippi as saying, ''If insurers would cut off these companies, this behavior would end tomorrow. Instead, they just close their eyes or say it's not their fault when a supposedly rogue sales agent misbehaves.. . .It's scandalous that the insurance companies are working with these marketing organizations.''

DelMonico, who is still selling insurance for dozens of companies, told the Times reporter "I did what I was told. . . .If it was so wrong, why did everyone let me do it for so many years?''

That, Mr. DelMonico, is no excuse, but it is the very thing that we would all like to know.

For the New York Times article, click here..


Felicia Curran
www.ElderAdvocacyLaw.com

60 Minutes did a report tonight showing how some hospitals in the Los Angeles area, including HMO giant Kaiser Hospital, dump their disabled patients on Skid Row. Kaiser has an ad campaign that implies that its patients "thrive" with the care they provide. Take a look at this video, showing 62-year-old Carol Ann Reyes, who has dementia, walking around on the street in a hospital gown after she was dumped by Kaiser in the Los Angeles Skid Row area.

Carol Ann is walking around in her hospital gown, because Kaiser hospital lost her clothes, according to 60 Minutes. When Kaiser decided it was time for her to go, they put her in a taxicab, wearing nothing but a hospital gown, and told the taxi to head for a rescue mission on Skid Row. The taxi dumped her on the street. The head of the rescue mission saw the whole thing and came to her aid. Carol Ann was readmitted to another hospital, because she was not well enough to be discharged.

Hospitals are required by federal law to arrange for safe post-discharge plans for all patients, including homeless patients.

The 60 Minutes Report said that patient dumping by hospitals on Skid Row is commonplace: hospitals think they can get away with it because dumped homeless patients blend in with the other homeless. Homeless patients probably don’t have family to make a complaint on their behalf, and they may not even be able to reconstruct what happened to them if, like Carol Ann Reyes, they have a memory impairment such as dementia.

This is the same dynamic present in most cases of elder and dependent adult abuse, where the perpetrator exploits the victim’s impairments and vulnerabilities to get away with abuse.

Another attempted patient dumping of a paraplegic homeless man in LA was also caught on tape.

The man was brought by paramedics from Hollywood Presbyterian Medical Center, who wanted to dump him at a rescue mission without so much as a wheelchair. The rescue mission said that they couldn’t accommodate him, and he was taken back to the hospital, where he sat in the hospital waiting room all night. The next morning, a van from the hospital dumped him on the street.

The Los Angeles District Attorney charged Kaiser with criminal and civil dependent adult abuse of Carol Ann Reyes. A settlement of that case, which would change the way Kaiser deals with discharge of its homeless patients, is supposedly in the works. Ten other hospitals in the LA area have also been under investigation for patient dumping.

This story was originally reported by NPR in November of last year. To watch Anderson Cooper’s report from 60 Minutes, which discusses both incidents, click here.


Felicia Curran
www.ElderAdvocacyLaw.com

Do you know what a pressure ulcer is? I didn’t, until my mother acquired a Stage 4 pressure ulcer during a hospital stay ten years ago. I had no idea what they were, or how they were formed. I learned quickly, though, and helped my mother get appropriate care that got her back home with my Dad -- though only after a two-month stay at a convalescent hospital.

Pressure ulcers can be a red flag of poor care at a hospital or a nursing home. A pressure ulcer is an area of skin that breaks down when you stay in one position for too long without shifting your weight. The constant pressure against the skin reduces the blood supply to that area, and the affected tissue dies. Also referred to as “wounds,” "bed sores” and “decubitus ulcers,” a pressure ulcer starts as reddened skin but gets progressively worse, forming a blister, then an open sore, and finally a crater.

The most common places for pressure ulcers are over a bony prominence such as the shoulders, back of the head, elbows, sacrum, hips, heels, and ankles.

Residents of nursing homes who are immobile are at high risk for developing pressure ulcers because they may sit or lie for long periods of time in one place or position. They may be too weak or too ill to move themselves, and they are totally dependent on nursing home staff to help them reposition.

Pressure ulcers are preventable. For pressure relief, immobile individuals need to repositioned at least every two hours in bed, and at least every 15 minutes if they are sitting in a chair or wheelchair. The nursing home should use a written schedule, posted on the wall for verification, for systemically turning and repositioning the resident.

At poorly managed nursing homes and rest homes, residents develop pressure ulcers because they are left unattended sitting or lying in bed for long periods of time, due to staffing shortages or because staff are poorly trained.

Poorly trained nursing home staff may cause pressure ulcers by even dragging the resident’s body across the bed onto the chair, instead of using a lifting device, such as a trapeze, to move the resident. Shearing of the skin can occur when a resident is pulled up in bed, instead of using a technique such as placing a half sheet under the person’s torso to lift the resident up off of the bed.

Another red flag of poor care at a nursing home is when the pressure ulcer gets worse, and not better, or multiple ulcers develop in different locations. Signs that the ulcer is getting worse include:

the ulcer gets wider, deeper, longer;
the ulcer develops dead tissue (usually black);
the ulcer develops “undermining” (a thin lip of tissue around the edges of the wound);
the ulcer turns black (indicating dead tissue);
the ulcer has drainage (watch out for yellow, green, or grey drainage);
the ulcer has a foul odor.


Pressure ulcers are staged 1 to 4 according to the degree of tissue damage involved, with Stage four being the worst.

Stage 1: A reddened area on the skin that, when pressed, is "non-blanchable" (does not turn white). This indicates that a pressure ulcer is starting to develop.



Stage 2: The skin blisters or forms an open sore. The area around the sore may be red and irritated.

Progression of a pressure ulcer beyond Stage 2 most likely means that the nursing home or care home is not providing appropriate care, or that they have not fixed the problem that caused the pressure ulcer in the first place - for example, they are still dragging the person across the bed, or they leaving the person sitting in a chair all day.


Stage 3: The skin breakdown now looks like a crater where there is damage to the tissue below the skin.







Stage 4: The pressure ulcer has become so deep that there is damage to the muscle and bone, and sometimes tendons and joints.


If a pressure ulcer becomes infected, the infection can spread to the rest of the body and cause serious problems, including blood infection (sepsis) and bone infection (osteomyelitis). Either of these are life-threatening conditions.

A red flag of poorly trained staff at a nursing home is that the staff does not know the signs and symptoms of infection.

Signs of an infected ulcer include:

A foul odor from the ulcer
Yellow, green, or grayish discharge from the ulcer
Redness or tenderness around the ulcer
Skin close to the ulcer is warm and swollen

Fever, weakness, and confusion are signs that the infection may have spread to the blood or elsewhere in the body.

The pressure ulcer that my Mom had was able to heal because, after two months of failed treatment at the convalescent hospital, we found out about a new technology, a vacuum pump, that helped draw the fluid out and close the wound up. She was able to go home with the pump, and her wound completely healed in another three weeks. Previously, the wound had been so deep that you could see her sacrum bone.

Don’t let pressure ulcers happen to your Mom or Dad. Educate yourself on the causes of pressure ulcers. If your loved one develops a pressure ulcer, be pro-active in getting appropriate treatment, and don't let them tell you that it can't be healed. A general guide to prevention from the National Pressure Ulcer Advisory Panel (NAPUAP) is available online, in PDF format.


Felicia Curran
www.ElderAdvocacyLaw.com

California is considering legislation prohibiting employment discrimination against individuals with caregiving responsibility for aging parents, children, or ill spouses.

The proposed law is based on evidence that employees with caregiving responsibilities are often passed over for jobs, dinged on performance reviews or blocked from promotions. Some employers assume they would be absent more frequently and won't work as hard or be as committed to their careers as those without caregiving duties.

California law expressly bars job discrimination on the basis of sex and marital status, among other factors, but not caregiving. Federal law requires employers to accommodate the needs of disabled workers and grant employees leave to care for sick or disabled relatives. But no federal statute expressly forbids job discrimination on the basis of an individual's caregiving status.

"Today’s families are under enough pressure,” said Senator Sheila Kuehl, sponsor of the legislation, SB 836. “No one should have to worry about losing their job just because they are taking care of their family.”

Alaska and nine cities and counties, including Atlanta, Chicago and Washington, have passed similar legislation. Lawmakers in Pennsylvania and New York are also considering such measures.

SB 836, would amend the Fair Employment and Housing Act to prohibit employment discrimination based on familial caregiving status, extending that protection to parents and to employees with an ill or disabled parent or spouse. It is scheduled for a vote in the Senate Appropriations Committee today.

To contact your state representatives in support of the bill, go to www.leginfo.ca.gov.

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Felicia Curran
www.ElderAdvocacyLaw.com