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Tools to Help Choose a Good Nursing Home

By Carolyn M. Clancy, M.D.

December 6, 2011

Finding a high-quality nursing home for a family member is a daunting task.

Many people have not had to make this decision before. And it’s often made under stress, when asking good questions and thinking carefully about your options are harder than usual.

Fortunately, more information is available that can help you learn about nursing home quality and prepare you to make a well-informed decision.

Start this process with an online tool from the Federal Government called Nursing Home Compare. This lets you look up nursing homes in your area by name, city, county, State, or ZIP Code. First unveiled in 2009, Nursing Home Compare has detailed information on every nursing home certified by Medicare or Medicaid.

Nursing homes are rated using a 1- to 5-star scale, with those earning 5 stars being rated the highest. Ratings are based on how many and what type of staff members they have, how well they perform on health inspections, and how they rank on quality measures. Ratings for each measure are given individually and are also combined into an overall rating.

Starting in 2012, Nursing Home Compare will include a new measure that includes input from the nursing home residents. This new information will take the place of the quality measures that currently appear on Nursing Home Compare. Findings will be part of the ratings starting in April 2012.

Staffing and health inspection data add important information and will continue to be a factor in each nursing home’s overall rating. The staffing measure tells you the average staffing levels—such as the number of registered nurses, licensed practical nurses, and certified nursing assistants—for each resident each day. This is a good benchmark, but it has limits. It does not show the number of nursing staff present at any given time or describe the amount of care give to any one resident. The health inspection measure looks at many major aspects of care in a nursing home. This includes how medicines are managed, whether food is prepared safely, and whether residents are protected from inadequate care. Inspections take place about once a year, but they may be done more often if the nursing home has several problems to correct.

Even with so much good information, the Nursing Home Compare tool and rating system won’t answer all of your questions. For example, the ratings won’t tell you if the nursing home has improved, or gotten worse, in certain areas since it was rated. That’s why it’s important to visit any facility you are considering. Be sure to ask questions of the staff, especially people who provide care to residents. It’s also a good idea to visit a nursing home a second time on a different day of the week and another time of day. You may get a better idea of changes in staff, activities, and other factors that could make a difference in your choice.

An excellent list of questions to ask during such visits is available from a nursing home checklist (PDF File; PDF Help) by the Centers for Medicare and Medicaid Services (CMS). And a new handbook (PDF File; PDF Help) from CMS explains how to pay for nursing home care, describes residents’ rights, and gives alternatives to nursing home care. Another good resource is your State ombudsman; select to find yours.

click here to read more.

National Caregiver Support Line for Veterans

The Veterans Adminstration has established a National Caregiver Support Line for Caregivers of
Veterans — spouses, children, other family members and friends of Veterans as well as Veteran themselves.  

for more information on the program, please go to https://duttonelderlaw.com/resources/articles.html

Lewey Body Dementia Association Survey

The Lewey Body Dementia Association (LBDA) is conducting a survey to assess if there are differences in how grief is experienced by caregivers for individuals with Lewy bodies, Alzheimer’s disease, Parkinson’s disease with and without dementia, and frontotemporal degeneration.  The survey will also assess the well-being and quality of life for caregivers of individuals diagnosed with the neurodegenerative diseases. Internet access is required to participate in the study, and LBDA needs 500 caregivers who are currently providing care for each different disease that is being studied. 

http://www.lbda.org/go/caregiversurvey

Internet Scams

The Family Caregiver Toolbox

Don’t Become the Victim of a Scammer ToolBox

If you have a telephone or an e-mail address, you have no doubt been the target of a scammer. No one is immune from these criminals, who are using more sophisticated techniques every day. Some e-mail scammers have even learned how to make their correspondence appear as if it’s coming from a trusted government source, such as the IRS. The victims of Internet crime alone lose millions of dollars each year.

You can protect yourself and your loved ones. A variety of reputable agencies and organizations have compiled resources and tips that are a must-read for anyone who uses a telephone or computer.

A new toolkit from the National Council on Aging (NCOA), produced in partnership with the Women’s Institute for a Secure Retirement (WISER), and the Bank of America Charitable Foundation — “Savvy Saving Seniors: Steps to Avoiding Scams” — is helping to educate older adults and their caregivers about how to protect themselves from financial abuse and scams. The toolkit includes a list of signs for caregivers to look for when concerned about their loved ones. Go to www.ncoa.org/assets/files/pdf/Steps-to-Avoiding-Scam-Handbook-10-12-11.pdf.

The Internet Crime Complaint Center, a partnership between the Federal Bureau of Investigation (FBI) and the National White Collar Crime Center, provides helpful “Internet Crime Prevention Tips.” Go to www.ic3.gov/preventiontips.aspx#item-16. View more tips at www.fbi.gov/scams-safety/fraud/internet_fraud.

for more information on resources for family caregivers, go to thefamilycaregiver.org

How to Tell When Your Parents Need Help…

How Do I Know When My Parents Need Help?

As your parents age, you may begin to wonder or worry: “Are they safe at home? How can I tell if they need help?” Your parents are independent, private people who are not going to share with you incidents that make you think they are not okay. They do not want to go to a nursing home and lose their independence. They love their home and enjoy being in it. So they are not going to tell you the things that happen that may send them to a nursing home. As a matter of fact, they will hide these issues from you. They are afraid of going to a nursing home, and this is a rational fear. They have seen their friends and neighbors placed into facilities when their health begins to decline. All of their possession are sold or given away, the home they have spent years in is sold, they can no longer sleep in if they feel like it or eat whatever and whenever they want; their losses are great. You need to acknowledge that this is a rational fear, something that may happen to them that can be unpleasant.

The following is a list of indicators for change. Observing any of these things happening does not mean your parent cannot live at home. What it does mean is the situation needs to be assessed. Professional or informal and volunteer services can be put into place to allow your parent to stay in their home safely.

  • Unexplained weight loss
  • Falls, accidents or bruises
  • Forgetting food on stove (look for burned or scorched pans)
  • Unpaid bills or utilities being shut off
  • Housekeeping decline: dirty walls, floors, windows or bathtub
  • Unable to maintain home; broken items not being repaired over long time
  • Refrigerator and cabinets empty; not enough food
  • Unable to recognize or react to danger
  • Getting lost or locked out of the house
  • No longer able to transfer independently from bed to wheelchair
  • Incontinence
  • Lack of social support
  • Decreased interest in fun or social activities
  • Medication errors
  • Increased emergency room visits
  • Wearing dirty clothes
  • Needs to reminded to bathe; has dirty hair or personal odor

For more infomation, please click here

Medicaid Protection for Same-Sex Couples

When one partner in a long-term relationship needs expensive long term care, often the only way for the couple to pay for it is to look to Medicaid.  Historically, there have been no spousal impoverishment protections afforded to partners in same-sex relationships when one partner needs long term care and applies for Medicaid.  However, the combination of the new Illinois Civil Union Act and a policy change recently announced by the U.S. Department of Health and Human Services ensure that Medicaid spousal impoverishment protections are afforded to Illinois same-sex civil union partners.

 Click here to read the entire article.

Increase in Prevention of Spousal Impovershment Standards for 2012

The amounts for 2012 of monthly income, and total assets, that a person can keep when their spouse enters a long-term care nursing hom, supportive living,e or needs the services of the Illinois Community Care Program (CCP) and federal financial assistance is used to help pay for these services have been released.

Click here to read more.

44 Questions to Ask a Nursing Home

Choosing a nursing home for a family member can be one of the most difficult decisions anyone ever has to make. The fact that the family member needs to move to a nursing home means that he or she is in a vulnerable state and will be dependent on the care provided in the facility. Here are 44 questions (we counted them so you don’t have to!) that should help a family choose the best facility in an unfortunate situation.

Medicaid Spousal Impoverishment Protections for Same – Sex Civil Union Partners

When one partner in a long-term relationship needs expensive long term care, often the only way for the couple to pay for it is to look to Medicaid. Historically, there have been no spousal impoverishment protections afforded to partners in same-sex relationships when one partner needs long term care and applies for Medicaid. However, the combination of the new Illinois Civil Union Act and a policy change recently announced by the U.S. Department of Health and Human Services ensure that Medicaid spousal impoverishment protections are afforded to Illinois same-sex civil union partners.
On April 1, 2011, U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced that, effective immediately “[t]he Centers for Medicare & Medicaid Services will notify states of their ability to provide same-sex domestic partners of long-term care Medicaid beneficiaries the same treatment as opposite-sex spouses in the contexts of estate recovery, imposition of liens, and transfer of assets. This includes not seizing or imposing a lien on the home of a deceased beneficiary if the same-sex domestic partner still resides in the home. It also includes allowing Medicaid beneficiaries needing long-term care to transfer the title of a home to a same-sex domestic partner, allowing the partner to remain in the home.” In additional to these protections, the partner in the community is allowed to receive assets, in addition to the home, from the nursing home partner in an amount sufficient to bring the community partner’s assets to the Community Spouse Asset Allowance standard – presently $109,560. The community partner may also be eligible to receive income from the nursing home partner when Medicaid is paying for that partner’s long term care.
The new Civil Union law which became effective on June 1, 2011 provides that a “party to a civil union” is to be included in any definition used in state law where the term “spouse,” “family,” “immediate family,” “dependent,” “next of kin” and other terms that denote “spousal relationship” are stated. The Civil Union Act stops short of granting same-sex couples the right to “marry”; however, it does guarantee “[a] party to a civil union … the same legal obligations, responsibilities, protections, and benefits as are afforded or recognized by the law of Illinois to spouses.
The Civil Union Act in Illinois mandates that the Illinois State Medicaid agency, the Department of Healthcare and Family Services, treat partners in civil unions the same as married partners. The federal Medicaid agency, the Department of Health and Human Services, is allowing states to treat same-sex partners as opposite sex spouses for purposes of Medicaid. Therefore, same-sex partners in Illinois Civil Unions should be afforded Medicaid spousal impoverishment protections if Medicaid coverage of long term care becomes necessary for one of the partners. Dutton & Casey, P.C. is available to represent civil union partners needing long term care in accessing Medicaid and Medicaid spousal impoverishment protections. Please note, federal Medicaid spousal impoverishment protections apply to the Medicaid programs covering nursing homes and assisted living (supportive living) facilities, as well as to the home based services program, the Community Care Program, administered by the Illinois Department on Aging.

Alzheimer’s: Early Planning Critical to Financial Health

In a recent article in Reuters Magazine, Alzheimer’s: Early Planning Critical to Financial Health, working with a certified elder law attorney is an important step in planning for the future.

Janna Dutton, founder of Dutton & Casey, is one of only 8 certified elder law attorneys in Illinois.

Click here to read the article.

For additional information on how Dutton & Casey can assist you, or someone who you care about, please go our website.

Planning for a Hospital……Discharge

An admission to, and a discharge from,  the hospital can be scary for the patient, and the family. The National Family Caregiver Alliance published a guide on the hospital discharge process. It is vital to pay attention, and be involved, in the plans being for when your relative leaves the hospital.

read the entire article.

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The law firm of Dutton & Casey concentrates in assisting older adults, people with disabilities, and their families. Many times, plans following a hospital stay also include the need for legal planning.  With over 50 years in expertise and offices in Chicago, Skokie, Arlington Heights, and Vernon Hills, the advocates at Dutton & Casey are available to assist. Please click here to read more about how we can assist you or those you care about.

Center for Medicare Advocacy Says: You Can Leave the Nursing Home

December is a time of holidays, celebrations and school vacations. Nursing home residents often want to join in family festivities and visit with children and grandchildren but may be under the impression that they will lose Medicare coverage if they leave the facility to do so. According to the Center for Medicare Advocacy, Inc. (CMA) this is not true.

The Medicare Benefit Policy Manual recognizes that although most beneficiaries are unable to leave their facility, “an outside pass or short leave of absence for the purpose of attending a special religious service, holiday meal, family occasion, going on a car ride, or for a trial visit home, is not, by itself evidence that the individual no longer needs to be in a SNF for the receipt of required skilled care.

for more information, go to www.medicareadvocacy.org/infobytopic/skillednursingfacility/snf_youcanleavethe snf.htm

Encouraging Comfort Care: A Guide for Families of People with Dementia Living in Care Facilities

The Alzheimer’s Association-Greater Illinois Chapter is pleased offer a free online resource, Encouraging Comfort Care: A Guide for Families of People with Dementia Living in Care Facilities. This 21-page booklet provides useful information to families and staff of long-term care facilities about Alzheimer’s disease and related dementias, particularly care issues related to the late and final stages.

For families, this guide will enable them to make informed choices about a variety of medical decisions they may face on behalf of loved ones with dementia living in nursing homes, assisted living facilities, and other types of care facilities. It will also equip families to ask good questions aimed at obtaining the best care for their loved ones, including a handy checklist of comfort care measures to be discussed with staff members of care facilities.

 To view and download the free guide, click here: http://www.alzheimers-illinois.org/pti/comfort_care_guide.asp

For more resources or to read about the elder law firm of Dutton & Casey P.C.’s  areas of concentration, visit www.duttonelderlaw.com or call (312)899-0950.

The Patient Protection and Affordable Care Act

Late into the day on Wednesday, November 18th, Senate Majority Leader Harry Reid ( Dem.- NV) unveiled the proposed health care reform bill senate leaders plan to bring to a floor debate at the end of November. The bill, named the Patient Protection and Affordable Care Act, is a combination of the health bill approved by the HELP (Health, Education, Labor and Pensions) Committee and the Senate Finance Committee bill.

Key elder issues:

  • Nursing Home Transparency and Improvement
  • The Elder Justice Act
  • Criminal Background Checks on Long-Term Care Workers
  • The CLASS (Community Living Assistance Services and Supports) Act 

According to the NCCNHR, there’s no word yet on whether Senator Reid has enough votes to pass the bill, but he is expected to call for a procedural vote by this weekend.

Keeping up with all the recent health care reforms and bills can be quite a task. Luckily, Senate leaders prepared an overview and section-by-section analysis of the Patient Protection and Affordable Care Act.  Click here to view it.

For more information on how these proposals will affect-term care planning for yourself or a loved one, contact the attorneys at Janna Dutton & Associates.

11/23 UPDATE: On November 21st, the U.S. Senate Democrats got a “fililbuster proof 60 votes that will allow them to bring their version of health care reform to the Senate floor for debate.”  While the vote is considered historic, the passage of this bill is in no way a sure thing.  Read here for complete details from the Examiner.com.

Consider Dementia’s Physical Effects When Making Treatment Decisions

When thinking about the effects of dementia, most people view it as a disease that solely affects the mind– a debilitating illness that strips an individual of his/her memories, but appears to leave the rest of the body untouched.  However, a recent article in the New York Times reminds us that the body undergoes a physical attack as well as a mental attack.  The illness is progressive and as it weakens the brain it also shuts down the body.  Doctors advise that these often-overlooked physical tolls must be understood and taken into consideration when considering the future care of your loved ones. 

 The article explains that the lack of understanding about the physical effects of dementia means that many patients near the end of life are subjected to aggressive treatments, many of which cannot possibly help them, or can even increase symptoms such as confusion and anxiety.  Researchers in a recent Harvard study found there were stark differences in treatment decisions depending on what family members knew about dementia.  Dr. Susan L. Mitchell, the study’s lead author, explained, “When family members understood the clinical course of dementia and the poor prognosis, the patients were far less likely to undergo these distressing interventions.”  She concluded that, “Dementia is a terminal illness and needs to be recognized as such so these patients receive better palliative care.” 

For the full article, click here.

For more information on long-term care planning for yourself or a loved one, contact the attorneys at Janna Dutton & Associates.

Medical Students Experience Nursing Home Life

The New York Times posted a very interesting article about medical residents who spent a short time living in a nursing home to find out what it’s like to be a nursing home  resident.  One of the goals of the program is to generate interest in geriatric medicine, which continues to be one of the most underrepresented fields in medicine.  Additionally, participants found that their experience offered invaluable insight into how to be better physicians.

Click here to read the full article

For legal assistance, contact the experienced elder law attorneys at Janna Dutton & Associates.