Elder Financial Abuse Prevalent and Family is Partly to Blame

The Met Life Mature Market Institute study Broken Trust: Elders, Family and Finances takes a close look at elder financial abuse. Elder financial abuse is more prevalent than you think and the perpetrators are often family members.

Today we will look at the warning signs Met Life offers to indicate if older adults are experiencing financial abuse.

Unusual degree of fear or submissiveness to caregiver

Example: An elder cowers in front of a caregiver or begins trembling or crying

when the caregiver discusses finances.

Isolation from family, friends, community, and other stable relationships

Example: The older person is never alone or permitted to discuss finances without the

caregiver also present.

Signs of intimidation and threat by another

Example: The older person never looks at people directly or averts their gaze.

Withdrawn behavior or disheveled appearance

Example: The older person tries to avoid talking with others, especially when asked

to respond to something specific.

Missed appointments, uncharacteristic nonpayment for services

Example: The older person, previously prompt and reliable, does not show up for medical

appointments or “forgets” to pay bills.

Anxiety about personal finances Example: The older person worries a lot

about how she will ever pay a bill or have enough to eat.

Lack of knowledge about financial status

Example: The older person seems unaware of his money.

New “best friends”

Example: The older person seems surprisingly or unseemly close and attentive to someone he has just met.

Missing belongings or property

Example: Glasses, clothes, dentures, money, or all of these are gone. The elder is dismissed as “forgetful.”

Check out the full report.

Tips to Prevent Elder Financial Abuse

The Met Life Mature Market Institute study Broken Trust: Elders, Family and Finances takes a close look at elder financial abuse. Elder financial abuse is more prevalent than you think and the perpetrators are often family members. Today we look at tips Met Life offers to prevent elder abuse.

Stay Organized

Keep belongings neat; keep track of possessions; open and send your own mail; direct deposit Social Security and other checks; complete and sign your own checks whenever possible; use an answering machine to screen calls and do not provide personal information over the telephone.

Stay Informed

Consult with an attorney about future plans, including a power of attorney; consult with an attorney about caregiving arrangements; review your will; know where to go if you suspect abuse; ask for help from police, from employees at a bank, from Adult Protective Services, if needed.

Stay Alert

Do not leave items of value out in the open; do not sign any document unless someone you trust reviews it; do not be left out of decisions about your finances. Families, particularly those who find themselves in a caregiving role, also need to be aware of situations that place their older loved ones at risk for financial abuse. Family members should periodically inquire about their older family members’ financial resources and perceived limitations that may stem from their financial situation.

Read the full report for more tips.

The Deloitte 2009 Survey of Health Care Consumers

The Deloitte 2009 Survey of Health Care Consumers is worth a read. While they tout consumerism, my take is that it is superficial a best. For example just 15% of people compare hospital data for inpatient care. Those who do seek quality data do so from physicians, web sites, friends and insurance companies. It’s more engagement with their provider than total empowerment that seems to be trending. As Deloitte points out, right now it is more about the perception of service, quality, cost based on one’s own personal experience. Some use of objective information is rising. So take consumerism with a grain of salt.

In terms of the patient experience near and dear to my heart, I would say physicians have more to worry about. Sixteen percent of people switched docs in the last year; two out of three because of bad service. So physicians need to pay attention to the patient experience and that affects the hospitals to whom they refer.

Another area of interest is Medical Tourism. Eight percent of people leave their local community for care. Cost is a driver. One percent travel outside the country. So this nagging medical tourism notion is real and picking up some momentum even if just reflected in people starting to say health care is not local (as in my town) anymore.

And a recurring theme is that people say they want wellness but do they really? It is more that they want to be spoon fed their wellness prescription with little work involved on their part. Our biggest health care problem is people who do not want to take the initiative and responsibility for their own better health.

Nursing Home Background Checks Legislation Re-Introduced

Sens. Herb Kohl (D-WI) and Susan Collins (R-ME) have reintroduced a bill to establish a nationwide system of background checks to prevent people with criminal histories from working in long-term care settings.

The bill, the Patient Safety and Abuse Prevention Act, expands on a three-year pilot program that helped to prevent applicants with a criminal record from working in long-term care. A companion bill on background checks is being introduced in the House as well.

The background check bill calls for states to establish coordinated systems that include checks against abuse and neglect registries and a state police check. It also would require screening applicants against the FBI's national database of criminal history records.

Contact your representatives in support of this legislation.

Mentally Ill More Prevalent in Nursing Homes

According to a new article by the Associated Press the mentally ill are becoming more prevalent in the nursing home population. Younger, stronger residents with schizophrenia, depression or bipolar disorder are living beside frail senior citizens, and sometimes taking their rage out on them.

Numbers obtained through the Freedom of Information Act and prepared exclusively for the AP by the Centers for Medicare and Medicaid Services show nearly 125,000 young and middle-aged adults with serious mental illness (9 percent) lived in U.S. nursing homes last year. That was a 41 percent increase from 2002. Utah, Nevada, Missouri, Alabama and Texas show the steepest climbs.

The closing of state mental institutions and a shortage of hospital psychiatric beds are partly to blame. And some homes have occupancy to fill.

The AP chronicled many incidents that have been a direct result of this trend.

In 2003, a 23-year-old woman in Connecticut was charged with starting a fire that killed 16 fellow patients at her Hartford nursing home. She suffered from multiple sclerosis, dementia and depression.

In January, a 21-year-old man diagnosed with bipolar disorder with aggression was charged with raping a 69-year-old fellow patient at their nursing home near Chicago. The man was admitted to the nursing home despite a history of violence and was left unsupervised.

Under federal law, nursing homes are barred from admitting a mentally ill patient unless the state has determined that the person needs the high level of care a nursing home can provide.

Mixing the mentally ill with the elderly makes economic sense for states. As long as a nursing home's mentally ill population stays under 50 percent, the federal government will help pay for the residents' care under Medicaid. Sometimes the violent behaviors are a direct result of the mentally ill resident being mad because they are in a nursing home to begin with say authorities.

Nursing home operators say protections against frivolous transfer or discharge keep the homes from throwing out some mentally ill residents.

So for my readers the bottom line is simple. Insist on knowing the ratio and number of mentally ill residents that are in a facility you are considering and that are appropriate to be there because they need a higher level of medical care. Read more here.

Lack of Primary Care Physicians Will Continue

Last week was Match Day, when graduating medical students found out where they’ll be doing their training. Just over 42% of the family medicine residency slots went to seniors receiving their M.D.s from U.S. med schools. Forty nine percent of the slots went to foreign medical school graduates and others. Nine percent of the slots went unfilled. Family medicine pays around $180,000 a year.

Compare this to anesthesiology. Median compensation is $400,000 a year. Almost 84% of the slots went to U.S. seniors. Another 15% went to everyone else. Only 1% of the slots went unfilled.

Life balance issues and the motivation of money (graduates have huge medical debts) are partly the cause. In a nation that will need more and more primary care, expect more waits and bad service. Or better yet let’s start taking care of ourselves so we don’t need the health system at all.

I smell more opportunity for physician assistants and retail clinics.

End of Life Care Less Costly When Physicians Communicate

In a follow up to yesterday’s guest post about end of life care and the engagement of health care providers comes this. The March 9 issue of Archives of Internal Medicine reports that patients with advanced cancer who discuss end-of-life care with their physicians appear to have lower health care costs in the final week of life than those who do not.

As many know, most medical costs occur at the end of life. Almost one-third of Medicare expenditures are attributable to the 5 percent of beneficiaries who die each year, and about one-third of expenses in the last year of life are spent in the final month. Most of these costs result from life-sustaining care, including resuscitation and mechanical ventilation.

The study found that in the final week of life, patients who reported having end-of-life discussions with their physicians had average aggregate healthcare costs of $1,876, compared with $2,917 for patients who did not. Caregivers who were interviewed after patients’ deaths reported that those with higher costs also had a worse quality of death.

So I am not saying that physicians and health care staff should sustain relationships with their patients after all hope is exhausted because it might imply lower health care costs. They should stay engaged because it is the right thing to do. That said some of the end of life decisions should be made by all of us well before we get sick. That requires having a living will and assigning durable medical power of attorney.

A form I have used that covers both can be found here.

By having your wishes spelled out you save your loved ones from anguish and the guilt of trying to sustain life when all hope is gone. In many cases as this study shows that prolonging can actually do more harm than good.

Advance in Long Term Care Management

Read my guest blog in Advance in Long Term Care Management about how health professionals handle the end of life care of their patients.

Be Observant of Observational Care or Face Medicare Non-Payment

There is a new category of patients that private insurers and Medicare are using called "observation" patients. Typical patients for observational care include those with chest pain, asthma attacks, kidney stones, dehydration, dizziness and mild trauma.

These patients are a step up from an emergency department patient but not classified as being formally hospitalized. Obviously insurers pay less if the patient is not "formally" hospitalized. This type of care is typically provided to patients who don't seem well enough to discharge, but clearly aren't well enough to be admitted.

This is particularly worrisome for Medicare patients. Hospitals billing for an inpatient stay not meeting the program's standards could be charged with fraud. The observation period is typically about 24 hours. If it goes longer, Medicare may refuse to pay for treatments since they're not classified as inpatient care. So who gets billed? The patient. And hospitals aren't required to tell patients that they're in observational care, which means they have no idea what is being paid for and what they might receive a bill for in the future.

In this age of transparency even if hospitals are not required to tell they should, even in the chaos of the emergency department. And consumers now have one more thing to add to their list to ask their providers. Do ask and demand an answer. Don't be caught in a black hole.

Social Networking for Physicians - Good for Medicine or Bad? A Second Opinion You Might have an Opinion About

Physician Danine Rydland, MD was searching for a drug that would suppress her patient's menstruation in preparation for her hysterectomy. But she didn't know exactly what to prescribe. Unsure of how to proceed, Rydland requested permission from the patient to post a description of the condition and history on Sermo, a social networking website for physicians. The patient consented, and a lively discussion ensued. One physician suggested a drug that suppresses menstruation. A consensus quickly emerged.

Rydland spends about two hours on the site each weekday and six hours over the weekend. "I like the community of doctors," she says. The average age of Sermo members is 49.

But not all physicians are sold on social networking. Critics cite concerns over doctor-patient privacy, usefulness of shared information, and the looming specter of malpractice implications. What's more, some argue that Sermo, in particular, exploits its members by selling access to investment firms and other outside groups to observe physician interactions.

Former Starbucks IT executive Tobin Arthur launched iMedExchange. He says there is a key distinction between iMedExchange and Sermo. "We view physicians as human beings first and doctors second," Arthur says. "We're most interested in having physicians connect on issues unrelated to the practice of medicine." One forum on the iMedExchange forum is for wine connoisseurs, another devoted to the financial aspects of retirement.

I am a little concerned that physicians are turning to social networking to practice better medicine though I believe that it, coupled with juried, peer-reviewed content would offer a balanced medical opinion. For consumers, here is yet another question to throw out to your physician. Ask him/her if they use these sites. And more importantly make absolutely sure they are not using these sites to discuss your condition unless you have specifically gave permission to do so.

Who’s Reading Your Scan?

I am sure you have heard of radiologists in Australia reading the scans you had today at your hospital or imaging center. The upsurge in imaging studies, demand for fast turnaround and a shortage of radiologists has prompted this. For some that spells opportunity.

Telerays, a Houston company, has started an eBay type service in which radiologists can bid on reading imaging studies. Lowest bidder wins the contract, downloads the cases and uploads the report. The marketing angle is that this will cuts costs for hospitals and imaging centers and allow swamped radiologists to pick and choose what they want.

As one physician noted, all the incentives are economic. Where is the quality control? Even if you assume that quality across the board is equal, some fear that radiologists will see their prices lowered so much that it will force them to take on too much work just to even what they may have made before doing fewer scans. So they question whether the radiologist will be able to provide the type of quality and thoroughness for each scan.

When is the last time you saw a radiologist actually come out and speak with you after reading a scan? This will further remove them from patient contact. In an earlier blog I mentioned how some are experimenting with including patient pictures with the scan so that radiologists actually remember these are human beings they are reporting on.

So bottom line is that healthcare entities need to be transparent in letting people know who is reading their scans. And patients need to ask.

If Your Doctor Asks Say No!

To what you ask?

In this era of transparency, doctors’ ratings are all the rage. In a case of freedom of speech meets the bureaucracy, Dr. Jeffrey Segal, I’m afraid to say from my state of North Carolina has made a business of helping doctors monitor and prevent online criticism.

His company, Medical Justice, is based in Greensboro, N.C. For a fee, it provides doctors with a standardized waiver agreement. Patients who sign agree not to post online comments about the doctor, "his expertise and/or treatment."

Segal's company advises doctors to have all patients sign the agreements. If a new patient refuses, the doctor might suggest finding another doctor. Segal said he knows of no cases where longtime patients have been turned away for not signing the waivers.

Doctors are notified when a negative rating appears on a Web site, and, if the author's name is known, physicians can use the signed waivers to get the sites to remove offending opinion.
Nearly 2,000 doctors have signed up. John Swapceinski, co-founder of RateMDs.com, said that in recent months, six doctors have asked him to remove negative online comments based on patients' signed waivers. "They're basically forcing the patients to choose between health care and their First Amendment rights, and I really find that repulsive," Swapceinski said.
Segal said the waivers are aimed more at giving doctors ammunition against Web sites than against patients. Still, the company's suggested wording warns that breaching the agreement could result in legal action against patients.

Attorney Jim Speta, a Northwestern University Internet law specialist, questioned whether such lawsuits would have much success.

For the good, the bad and the ugly, these rating sites are here to stay. Frankly I think Segal’s company is just out to make a buck. What do you think?

Community Based Services Key But Can We Pay For Them?

A new report from the AARP shows that nursing home residents, beds, and occupancy rates have remained nearly constant in the last five years, even though the older population has increased. Specifically, the report finds that spending for long-term care services is not a primary force behind escalating Medicaid costs. Medicaid funds spent on home and community-based services (HCBS) can serve three older people or adults with disabilities for each resident in a nursing home.

And that is the shift that is slowly taking place - home and community based service programs. I am all for the shift though I believe as a country with a World Health Ranking of 37^th, one plagued with chronic disease conditions, and a boomer onslaught approaching that we will need nursing homes like it or not. So first issue we can’t duck away from the fact that some will need care in nursing homes and that care has to be planned for and paid for differently in the future.

Sure everyone wants to stay in their homes and community based programs are key. However here is an issue. Medicaid covers a specific segment of the population not all. So while community and home based care may be paid for by people who qualify the fact is there are many more people that need community and home based services and can not access them because they can not afford them. For those people they face the same fate as many others – spending down their assets until they do qualify for Medicaid. For some reason it doesn’t seem right that you have to become poor and destitute before you can be served.

The report emphasizes, however, that family caregivers remain the main providers of long-term care services in all the states and nationwide. By providing personal care and even health care, family caregivers help to contain costs by delaying or preventing the use of nursing home and hospital care. But that says nothing about the personal cost to the caregiver. Those costs are financial costs, worsened health, emotional distress and more. Many caregivers die before the one they are caring for.

So health care reform can not just be about acute care hospital reform. It must address the whole continuum. More about this study here.

Resident Wandering Leads to Death

Sarah Wentworth, 89, died at an Itasca, NY nursing home after she wandered into the courtyard and froze to death. A nurse assistant has been charged with negligence in the death of the 89-year-old nursing home resident.

Before dawn on February 5, Wentworth wandered down a hall and out a door into the subfreezing cold. She was wearing only her bed clothes. She eventually collapsed and froze to death in a courtyard. She had an alarm on her ankle, which went off when she left the building but her caretaker allegedly was watching television and didn't check when hearing the alarm. If convicted, she could face up three to seven years in jail.

This is not the first nor probably the last incident of patient wandering in a facility. When evaluating facilities, find out their protocols for handling such situations. And question whether they have unannounced drills for staff to practice for such emergencies.

Make the Call

Passing this along from AAHSA. I am a proponent of nursing home care reform if it is true reform. If that means better funding so there is better staffing, better pay and ultimately better care then I endorse this national call in day.

Today is the day to help ensure long-term services and supports are part of health care reform. Call (800) 958-5374 between 8 a.m. to 5 p.m. Eastern to tell Senators Boxer and Feinstein that this problem, which will affect virtually every American family, can be solved in a financially sound way. Although Boxer and Feinstein do not sit on the Senate Aging Committee, their support is critical as they have significant influence on the final outcome of the health reform package.

We also want to make sure the U.S. House of Representatives includes long-term services and supports in its consideration of health care reform. After calling your senators, please email your representatives using AAHSA's Contact Congress.

Sample Phone Script

"Hello. I’m calling to ask the senator to help make sure long-term services and supports are part of health care reform. We must make it affordable to care. We want to see all people with chronic illnesses and disabilities get the support they need. Including long-term services and supports in health care reform will achieve greater efficiency, promote personal responsibility and sustain our safety net programs like Medicaid. This problem is too big to ask individuals and families to solve on their own. We need a national solution for this national problem. I thank the senator in advance for demonstrating his leadership by ensuring that long-term services and supports are included in upcoming hearings and legislation. Thank you."