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Reducing Medicaid fraud and waste has been a talking point among many administrations, but with recent reports that 10% of Medicaid payments last year contained an error, several government offices are ready to take action. A meeting between the House Oversight Committee’s Subcommittee on Government Operations and the Subcommittee on Intergovernmental Affairs was planned for this past Wednesday and then cancelled. It was expected that lawmakers from both sides of the table would offer suggestions for reducing waste within the program.  No future meeting date has been announced.

Medicaid Recipients Fearful of Losing Benefits

It’s estimated that fraud and erroneous payments in all public assistance programs cost federal and state governments nearly $140 billion in 2015. Medicaid is considered particularly vulnerable to fraud because there are so many parties involved in the administration of the program. Each state is tasked with day-to-day management of Medicaid, but there are also managed care companies and companies they subcontract with to offer plans. It’s hard for states to police all of the groups involved, making Medicaid a relatively easy area for things to slip between the cracks.

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The family of an elderly man who was caught on camera being abused at a Detroit-area nursing home is suing the facility. Staff members at Autumnwood of Livonia are accused in the lawsuit of abusing now 89 year old Husein Younes, pushing him into his wheelchair, telling him to shut up, and insulting him. The lawsuit says the insults hurled at Mr. Younes were racial in nature, leading the family to believe the abuse was racially motivated. Mr. Younes is Lebanese American.

Hidden Camera Catches Abuse in Just 2 Days

In 2015, Mr. Younes’ son, Salim Younes, noticed his father was losing weight and had bumps and bruises all over his body. Mr. Younes also told his son that he was being mistreated. Immediately, Salim Younes  questioned Autumnwood staff, who brushed off his injuries as the result of multiple falls. Unsatisfied, Salim Younes installed a hidden camera in his father’s room. Within 2 days, the hidden camera footage revealed over 100 instances of abuse of Husein Younes, including verbal assaults and incredibly aggressive handling of him in and out of his wheelchair.

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Earlier this month, it was decided that nearly 28,000 low-income Illinois caregivers for people with disabilities will finally receive the $.48 raise that the General Assembly approved in last summer’s budget deal. The $.48 raise was supposed to have gone into effect on August 5, 2017 per state law that says, “Within 30 days after the effective date of this amendatory Act of the 100th General Assembly, the hourly wage paid to personal assistants and individual maintenance home health workers [in the DHS Home Services Program] shall be increased by $0.48 per hour.” P.A. 100-0023, Article 30, Section 30-20.

The workers have waited nearly seven months for the wage increase after Governor Rauner moved to withhold it, but the Cook County Circuit Court’s new ruling orders say that the State must implement the $.48-cent raise for all hours worked since August 5, 2017 by March 21, 2018. This is the first pay raise these workers have received since 2014.

Poverty rates are high among caregivers for people with disabilities and most of these workers in Illinois earn a mere $10 an hour, driving nearly 40 percent to rely on some form of public assistance and 26 percent to live in households below the federal poverty line, compared to 7 percent of the state’s workers.

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The Centers for Medicare and Medicaid Services (CMS) has lightened up on the 3 hour time requirement for daily inpatient rehabilitation therapy. Beginning March 23rd, providers will no longer have to provide 3 hours of direct daily rehab services to patients in order to receive reimbursement. Now, CMS requires providers to assess the patient’s health and treatment plan and submit a clinical judgment as to whether or not a patient should have inpatient rehab services covered by Medicare. Many providers had complained that 3 hours was not always necessary, or that they had been just minutes shy of the 3 hour time minimum and had not received reimbursement. In fact, it has been estimated that nearly 1/4 of all inpatient rehab claims are denied by Medicare contractors, something that many providers consider when deciding where to refer patients for rehabilitation services. Instead of referring patients to facilities specifically geared towards rehabilitating patients with the intent to eventually send them home, many providers are steering patients to skilled nursing facilities to ensure they’ll receive payment. A patient in need of rehab for serious injuries would receive better treatment at a facility dedicated to rehabilitation services, but the fear of nonpayment has providers pushing patients towards those places guaranteed to pay, never a fair choice when it comes to health care.

With more than $660 million recovered for our clients and nearly 3 decades of experience, the elder abuse attorneys of Levin & Perconti are committed to passionately fighting for families who have been devastated by poor treatment of a loved one entrusted to the care of a nursing home or rehabilitation facility.

If you believe someone you love has been harmed as the result of abuse or neglect within a nursing home or rehabilitation facility, please call our elder abuse attorneys at 312-374-1417 or fill out our online case evaluation form. Consultations are free and confidential.

 

 

 

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Theresa Brown, a home hospice nurse penned an article this month for the New York Times in which she described the need for a universal medication list for every patient in America, backed up with her own experience having rarely received a 100% accurate patient drug record, as well as statistics that show medication errors are alarmingly prevalent.

For Now, Patients in Charge of Their Own Medication Lists

Theresa Brown cites a 2010 study by the Journal of Geriatric Internal Medicine in which it was discovered that 309 medication errors existed in a sample of 651 hospital patients. More than half of these errors had the ability to cause side effects for the patient. The problem is that as patients, we see multiple health care providers throughout our lifetime, from a primary care doctor, to a provider at a hospital or urgent care, to a gynecologist, dermatologist, cardiologist, oncologist, or gastroenterologist. We’d like to assume that our health care provider has a detailed history of all of our medications, previous surgeries, and ailments each time they see us, but that couldn’t be further from the truth. Not all electronic medical record (EMR) systems are connected and a primary care doctor might not have any information from a gynecologist or dermatologist, much less the drugs you’ve been prescribed.  A medication prescribed by one provider may not interfere with a drug prescribed by another, but it could. Even failing to give the doctor information about herbs, vitamins, or supplements you’re taking can impact the efficacy of a drug and could leave you missing out on important information regarding interference.

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The Journal of the American Geriatrics Society has reported that at least 5,000 deaths each year are due to nursing home injuries and negligence. The statistic has been jarring for years yet the numbers don’t seem to be decreasing and the injuries that occur in nursing homes remain incline. Falls remain one of the highest causes of both nursing home resident injuries and deaths. In fact, 20 percent of all elderly falls and accidents occur in a nursing home or long-term care facility. Sadly, another 2,000 residents will die each year from a fall while many more suffer from other serious, fall-related injuries.

While we know that every injury can’t be prevented, and some are caused by an aging population that is more apt to injury due to failing health, our experience representing nursing home neglect victims has also shown us that if a facility does not provide sufficient staff training and resident safety systems are not set in place to protect against falls, the risk of injury among residents will go up. And those are the times a family may have a case for neglect. In addition, here are several other reasons why a nursing home could be held liable for a fall injury.

  • Some nursing homes in Illinois are guilty of overmedicating their residents with powerful sedatives, antipsychotics, and anti-anxiety medication and increasing a patient’s injury risk.
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Nursing homes and long-term care facilities are busting at the seams with type 2 diabetes patients. Nearly 30 percent of this elderly population is living with diabetes along with a host of other health issues or disabilities, while relying on the care of someone else to manage the disease’s burden with medication, diet, monitoring, and exercise. Unmanaged diabetes can create deeper medical complications like organ damage or even death.

 
American Diabetes Association Standards for Long-Term Care

 
In recent years, the American Diabetes Association (ADA) has issued detailed care standards for elderly patients in long term care facilities living with diabetes. 2018 standards now include things such as:

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We know there are many high-quality nursing home facilities committed to ensuring the residents in their care are receiving the best attention possible but that doesn’t stop the common misconceptions and myths family members may fear in regard to what it may be like for a loved one to live in a nursing home or long-term care residence. Our team has collected six myths we often hear about nursing home care facilities and provided a response to each one in hopes to better prepare you or your family member for a care stay.

Reality No. 1: Residents May Get to Go Home

 
Most nursing facilities have a job to rehabilitate residents to the point that they can safely return to their own community, enter an independent facility or be moved to their own home or the home of a loved one. An ideal situation would be for patients to be in the comforts of their home where they would receive at-home care. This would only occur though if programs like Medicare and Medicaid could pay more for them, and if services were not so focused on which cases would profit them and which would not.

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Research supports that family involvement during a nursing home stay is likely to ensure that the facility is providing the quality care necessary for residents to thrive. Our nursing home attorneys agree that this couldn’t reign any truer as it is typically family members who are speaking up for the care their loved one is receiving and they are also the ones bringing neglect or malpractice concerns to our firm. That is why it is so important family members know of their specific legal rights to participate in nursing home issues, especially those related to their loved one’s care. In fact, family members do not need special legal authority to exercise the right to participate in assessments and developing meaningful and effective care planning.

What is Involved in Care Planning?

If you are the family member tasked with ensuring your loved one’s care is being appropriately planned and handled, it should start with their initial health assessment on the day of admission. The assessment information along with a care meeting with family members, staff, and medical professionals will be used to develop a plan that will serve as a guide to discuss the resident’s needs and progress. The nursing home must work with you to develop this individualized, written care plan and must update it every 90 days and any time the resident’s condition changes. The care plan will be used to help a resident on a daily basis and clarifies what each staff person will do and when they will do it. It may also include information such as what kind of equipment or supplies are needed, dietary restrictions, what type of staff should be in charge of each of the services and how often they will be needed.

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The choice to move a family member into a nursing home or long-term care facility is often anxiety driven. Choosing the best home will require a full evaluation of a facility’s ability to give the constant care and supervision needed so your loved one will not be neglected, abused, or forgotten. Because of this, we often advise family members to consider taking time to research and prepare before making any nursing home decisions on behalf of their loved one.

1) Decide What Is Best

First, above all else, consider what is most important when it comes to the needs of your loved one. Will they need hospice or memory care support? Do they have special dietary restrictions or require physical therapy? What about health insurance coverage? Would they do best in a setting that has a religious connection or is close to family? If you are able to have these discussions with your family member and their treating physician before you make any formal inquiries about services, it can help narrow down the best facilities to choose from.