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what's happening in our world

Not a Good Time to be Old

Modesett Williams - Wednesday, April 29, 2015

Last week, Genworth put out a report detailing long-term health care costs in the U.S., and the results are worrisome. In a previous blog post, we discussed how the cost of nursing home care is rising at about 4% per year, and that many insurance companies are exiting the market because it is proving unprofitable (check out the post here: http://www.modwill.com/blog/soaring-long-term-health-costs). In 2015, the private sector's exit of the long-term health care market will leave families responsible for $91, 250 of annual nursing home expenses.

However, it is important to point out that less-intensive forms of long-term care are significantly less expensive than nursing homes. The national average for assisted living facilities is $43, 200, but it is growing at an annual rate of 2%. In addition, the adult day health care programs average at around $17, 904 annually and are growing at about 3%. 

Luckily, the long-term health care annual costs are lower in Austin than the national average. For a private nursing home room, families can expect to pay $84, 133. If a family chooses to pursue an assisted living facility, they can expect roughly $49, 284 in annual expenses, and if they pursue an adult day health care program, they will be responsible for $15, 600 annually. The long-term health care rates are less pricey in Dallas, Houston, San Antonio, Corpus Christi, Waco, and Amarillo, making Austin the most expensive place for nursing homes in Texas.

I'll conclude with one final shocking financial figure: 30 years from today, a private nursing home room is predicted to cost $204, 213 annually. Start saving, folks.

To see nursing home costs by region, visit: https://www.genworth.com/corporate/about-genworth/industry-expertise/cost-of-care.html

Consumers Know Best

Modesett Williams - Wednesday, April 22, 2015

The federal government recently revised its nursing home ranking system to offer fairer nursing home quality evaluations for families to consider (see http://www.modwill.com/blog/1-3-of-nursing-home-industry-rocked-by-scoring-system-reform for more details). However, it has been argued by many that the new system, while improved, is not comprehensive enough. Specifically, individuals are calling for consumer input in nursing home ratings. 


Nursing home placement decisions are significant choices for families, and who better to rate a nursing home than the residents themselves? Currently, consumer reviews for nursing homes are available, but their validity is questionable at best. The reviews are offered on bias, un-monitored sites that anyone can post on. Nursing homes have long had a reputation for mistreat and abuse, and thus, the available consumer reviews could be forged attempts to alleviate the bad reputation they hold. 


John Hale, an author for the Des Moines Register, offered a convincing solution: making consumer surveys mandatory and administered through objective third parties, such as the federal government. Mr. Hale argues that with this strategy, families could make nursing home placement decisions more confidently. 



To read the full article, visit: www.desmoineregister.com/story/opinion/abetteriowa/2015/03/31/nursing-home-compare-consumer-input/70717818/

Soaring Long-Term Health Costs

Modesett Williams - Wednesday, April 15, 2015

In the 1980s, private insurance providers preached that purchasing insurance policies to cover long-term health care would financially prepare Americans for elderly life. However, these providers offered faulty advice: the insurance policies they offered have proved to be more expensive than ever anticipated. 

About 30 years ago, the long-term care market looked to be an attractive one, and many insurance providers were eager to get in the business. The industry made predictions about American lifespan, health care expenses and interest rates, all of which turned out to be skewed. The average life expectancy in the United States is the highest it has ever been: 79 years old. This life expectancy suggest that Americans are living longer than ever anticipated, meaning more individuals will live in nursing homes and perhaps spend longer periods of time there. In addition, "the rate for staying at a nursing home has gone up an average of 4 percent every year for the past five years. The 2014, the median bill for a shared room topped $6,000 a month," financial figures that were highly unanticipated by insurance providers. Lastly, the industry predicted high interest rates and the market has provided much lower rates than anticipated.

The long-term-care-policies that the private insurance companies offered have proven unprofitable due to the previously discussed financial figures. As a result, these insurance companies are either exiting the market or substantially raising their prices. As fewer private insurance options become available, analysts predict that individuals will turn to Medicaid for help, which could significantly constrain federal and state budgets. Thus, as the private sector reduces its presence in the long-term care insurance market, the United States' government will be forced to take action to properly care for the elderly. 

Read the full article: www.mysanantonio.com/business/health-care/article/high-nursing-home-bills-squeeze-insurers-driving-6166975.php

Antipsychotics used to Tame Residents

Modesett Williams - Wednesday, April 08, 2015

Growing old: it is something we all must face one day, but now, with more caution than before. Nursing homes have been under scrutiny for their abuse of prescribing antipsychotic drugs to control their residents. Specifically, a study conducted by the United States' government in 2008 revealed that "88 percent of Medicare claims for antipsychotics prescribed in nursing homes were for treating symptoms of dementia, even though the drugs aren't approved for that". Not only are antipsychotics not approved for individuals with dementia, they are highly warned against, as they have been proven to increase the risk of infection, heart failure, and death. 

So why are nursing homes unnecessarily prescribing these dangerous drugs? Many claim the reason that nursing homes are turning to antipsychotic drugs to control patients is because the homes are significantly understaffed. Unable to be provided sufficient care, nursing home residents become more restless. The staff in turn controls this restlessness with drug abuse. In addition, patients with dementia, Alzheimer's, and related diseases often suffer from increased levels of aggression and anxiety, and antipsychotic drugs have been said to suppress these symptoms. However, the suppression has been described as "mind-numbing", leaving patients in a state of confusion.

The government has become involved in the efforts to alleviate this drug-abuse issue: in 2011, the U.S. government committed to reducing antipsychotic drug use in nursing homes by 15% within one year. However, the campaign lasted two years and then left over 300,000 nursing home residents still prescribed to these drugs. Requiring informed consent has also been a mechanism used to reduce this abuse. However, nursing homes have often found ways around this required consent as many residents and  family members were unaware of the prescription drugs. Obviously, this is an issue that needs to be legally addressed. If you suspect your loved one has suffered from any sort of abuse in a nursing home, call us immediately for a free consultation at 512-472-6097.

The full article is available at: www.npr.org/blogs/health/2014/12/08/368524824/old-and-overmedicated-the-real-drug-problem-in-nursing-homes

Invasion of Privacy?

Modesett Williams - Wednesday, April 01, 2015

The use of cameras in nursing homes has been a widely-debated topic since Texas became the first state to legally support it in 2001. Many states have followed Texas' lead, while others have been more hesitant to do so. The main issue of concern is privacy, both that of the residents and that of the support staff. 


An article posted in Citizen's Voice offered the following story as a depiction of privacy issues associated with cameras in nursing homes. Last fall, a man named Stuart Sanderson lost his ability to speak and could only communicate with his family by means of lip-reading. A camera was placed in Mr. Sanderson's room so that he could speak to his family more often, and thus, enhance his quality of life. Mr. Sanderson had lived in the same nursing home for years, but the home's staff perceived the camera as a threat and removed it from his room. The staff instructed Mr. Sanderson to write a note defending his camera use, which his family argued was a "cruel hurdle for a man with limited mobility who selects each letter by pushing the back of his head against a switch". The note that Mr. Sanderson wrote exclaimed that he was note spying on anyone, and that the camera was just a means of communicating with his family.


The previous story illustrates a clear concern of nursing home staff: they do not want to be spied on. Proponents of camera use, however, claim that there should be nothing to hide. If nursing home employees are acting appropriately and within the scope of their authority, a camera could not capture anything detrimental to the staff. Issues of privacy are also a measure of concern for the nursing home residents themselves, particularly in shared-rooms. Consent and proper awareness will be the key issues here. Fair standards need to be implemented so that privacy is protected and abuse depressed.



The full article can be read here: www.citizensvoice.com/news/do-nursing-home-cameras-protect-or-intrude-1.1855568

Nursing Home Deaths Improperly Reported

Modesett Williams - Wednesday, March 25, 2015

This past Saturday, an elderly woman was found dead at the bottom of a staircase while still strapped into her wheelchair at a nursing home in Illinois. The nurse who found her failed to contact the authorities to report her death. The woman claimed that she did not call the police because she was afraid of loosing her job. Belleville Nursing Home, the location of this occurrence, maintains a one-star rating by Medicare, a nursing home ranking system managed by the federal government. It is also worth mentioning that the woman who owns the Belleville Nursing Home also owns 10 other nursing homes with 1 star ratings.

Atypical nursing home deaths like these often go improperly reported. Take, for example, the case of an elderly man named Mister Giles. Mr. Giles wandered off from his nursing home and was found frozen to death in a nearby creek. The staff of the nursing home in which he was residing neglected to inform the authorities of Mr. Giles' disappearance in a timely manner. Tragic incidences like these occur far too often. Proper reporting methods for nursing home deaths need to be created and enforced in order to minimize tragedy.

The following is a link to the full report: www.bnd.com/2015/03/21/3724900_owner-operates-11-nursing-homes.html?rh=1

A Threatening Trend: Inexperienced Trial Lawyers

Modesett Williams - Thursday, March 12, 2015

An article titled “Honesty is the Best Policy: It’s Time to Disclose Lack of Jury Trial Experience” was posted in the March 2015 edition of the Texas Bar Journal and discusses a threatening trend in today’s legal world: a lack of experience in trial. Modern lawyers lack the jury-trial experience that more “traditional” lawyers have gained throughout their years. There is a distinction to be made between the terminology “litigator” and “trail lawyer”. According the Kimberlee Kovach, a professor at South Texas College of Law, a litigator in “an attorney who tries cases in court”, while a trial lawyer is simply one who resolves disputes outside of a jury trial. It is important to note that the number of cases resolved outside of trial is increasing, and thus many modern attorneys lack trial experience. Consider the following statistics as an example of this new trend:

·         Within 5 years of litigation experience, 30% of attorneys had tried a case in court, and only 8% had tried more than two cases in court

·         Of these individuals, 93% had settled at least one case through mediation or negotiation

·         Within 10 years of litigation experience, 30% of attorneys had never tried a case in court, and only 36% had tried more than two cases in court


These statistics confirm that there are many lawyers who lack proper knowledge of the trial process and court system. This inexperience poses potential harm to clients that hire these individuals. Examples of the negative effects associated with this lack of knowledge is discussed below.

Trial inexperience conversely effects an attorney’s decisions on how to handle a client’s situation. Without experience, a lawyer cannot adequately consider the benefits of trial. For example, a case that could produce better results in court often dismisses trial as an option due to fear.  Inexperienced lawyers can be afraid of taking cases to trial because in trial, there are definite winner and losers, and thus, a lawyer’s reputation is at stake. Pre-trial settlement is the safer option to resolve disputes, and thus clients who hire inexperienced trial lawyers are likely to engage in this type of resolution. In addition, lawyers who lack trial experience may not fully understand the discovery process: their inexperience often leads to extensive and unnecessarily costly discovery process. Lastly, a lack of court experience is negatively associated with the capacity to understand jury-value. Jury value is the ability to predict a jury’s reaction to evidence, and further, the value of that evidence. A lawyer who is incapable of estimating this value cannot produce the most effective results, even through means of mediation or arbitration.

Currently, a lawyer has no legal obligation to disclose information regarding their trial experience. However, the results of a recent study reveal that clients expect that their attorney has trial experience, and thus, do not ask these questions. Therefore, a lack of disclosing trial experience has evolved into an ethical issue. Clients trust that their lawyers are knowledgeable in how to properly handle their complex cases, and as it turns out, that trust is often misplaced. At Modesett Williams, we proudly employ two highly experienced litigation lawyers with ample experience in court. Consider Modesett Williams to realize the full potential of your case.

The Eyes of Cameras are Upon You

Modesett Williams - Monday, March 09, 2015

Recently, Illinois and Missouri have been lobbying to allow cameras in nursing home resident's bedrooms. The proponents of these efforts insist that the use of these cameras would make nursing home faculty more conscious of their behavior and reduce abuse. However, there are significant concerns that are preventing the legislation from moving forward.

Legal barriers such as HIPPA and wiretapping laws will need to be considered before the legislation can pass. HIPPA, which is the Health Insurance Portability and Accountability Act, is concerned with protecting the confidentiality of medical providers and of healthcare information. Therefore, recording behavior could pose a possible violation of HIPPA. CBS reports that consent will be the "key legal question in any legislation allowing video cameras". It is likely that in order for this legislation to pass in Illinois and Missouri, the law will have similar provisions to those in Texas. 

Texas does allow the use of "hidden cameras" in nursing home bedrooms, so long as proper procedures are followed beforehand. The procedures include informing the nursing home of the use of cameras and posting a note on the door that discloses that the room is being electronically monitored.

The full article is available here: http://stlouis.cbslocal.com/2015/03/09/hipaa-wiretapping-laws-pose-legal-questions-for-granny-cams/

Monthly Allowance Increase for Nursing Home Residents

Modesett Williams - Wednesday, March 04, 2015

Legislation that would raise the elderly's "monthly allowance" is in the works. On Tuesday, Nebraska's Legislature proposed a bill that would distribute more money to Medicaid beneficiaries in nursing homes. Currently, Medicaid recipients must use all but $50 a month to pay for nursing home expenses. The proposed legislation would raise that amount to a $75 personal allowance. 

Proponents of the legislation argue that the current amount of money that these elderly individuals receive is insufficient, undignified even. The aim of their petition is to raise the standards of living in nursing homes by giving the elderly more purchasing power. Lincoln Senator Colby Coash endorsed the bill, recalling the tale of a nursing home who had a Christmas tree in their lobby where the residents could write "Christmas wish lists". The nursing home residents were asking for basic necessities, such as a pair of socks, a gift certificate for a haircut, or a bottle of shampoo. It is evident, therefore, that a $50 monthly allowance does not provide what our elderly need, and thus, the proposed increase in allowance could benefit their quality of life.

For the full article, visit: www.netnebraska.org/article/news/962546/more-spending-money-medicaid-nursing-home-patient-drivers-licenses-dreamers

1/3 of Nursing Home Industry Rocked by Scoring System Reform

Modesett Williams - Wednesday, February 25, 2015

Medicare's "Nursing Home Compare" website rates more than 15,000 nursing homes across the United States on a scale of 1-5, and this past Friday, they changed their ranking system to endorse stricter standards. The magnitude of this change is enormous: the majority of nursing home's ratings fell dramatically. 

Let's talk about the stats that came as a direct result of this stricter ranking system:

-1/3 of nursing home's star ratings declined (that's right, 1/3 of the industry)
-63% of nursing homes saw a decline in their quality-measure rating
-Before the change, 80% of nursing homes received 4/5 stars. After the change, less than half did. 
-13% of nursing homes saw a decline in their staffing scores
-Before the recalibration, 8.5% of nursing homes were ranked 1/5 stars. After, 13% were.

Before the introduction of this reformed rating system, nursing homes were able to report their own measures without being monitored. However, the new system cross-checks all submitted information to avoid false documentation. In the end, Medicare's new nursing home standards will raise the bar for nursing home quality and will force these institutions to offer better care to their residents. Medicare's new system is helping families across the U.S. get accurate information they can trust about these facilities. This is the right path Texas should be on to offer improved care to our elderly loved ones.

For the full article, check out: www.nytimes.com/2015/02/21/business/nursing-home-ratings-fall-as-tougher-standards-take-effect.html?_r=2

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