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Showing posts with label Department of Health and Human Services. Show all posts
Showing posts with label Department of Health and Human Services. Show all posts
Could A Caregiver Corps Solve the Caregiving Shortage?
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A recent report from AARP found that we are on the verge of facing a major caregiver shortage in the not-so-distant future. According to their report, in 2010, there were "more than 7 potential caregivers for every person in the high-risk years of 80-plus" and by 2030, the projected ratio will fall to 4 people for every person 80-plus. And by 2050, "it is expected to further fall to less than 3 to 1."
Aging in place has become an important part of aging in America. Whether due to the struggling economy, comfort or deeper personal reasons, people simply do not want to spend their later years in nursing homes or assisted living facilities; they prefer to grow old in their own homes, usually with the help of their grown children. For the last decade or so, this has been made possible thanks to their children and amenities offered by both private companies and local governments to assist the elderly with aging in place.
Baby Boomers, however, may not be as lucky. Boomer women had fewer children than their parents and some opted out of having children at all. Combine that with higher divorce rates -- by 2030, 36 percent of older men will have been alone for a decade or longer -- and we've got a Caregiver shortage crisis on our hands.
Senator Bob Casey, a Democrat out of Pennsylvania, sits on the U.S. Senate Aging Committee and has spent many hours listening to the testimony of people who are struggling to care for aging parents. Based on what he's heard, he's working on developing a National Caregiver Corps. According to a press release on Senator Casey's website, he plans "to introduce legislation to establish a Caregiver Corps program to foster the creation of community-based programs that can help 'fill the gap' in assisting older adults and individuals with disabilities, and in providing added support for informal caregivers." The goal of the program is to ease the burden of low-income and middle class families who have been struggling with how to balance work and family responsibility.
Volunteers who participate in the program would receive specific guidelines and structure from the Department of Health and Human Services in order to provide assistance to families by "cleaning, preparing food or even shopping for people who want to remain at home" as they age, as well as respite care for existing family caregivers. The proposal also includes providing volunteers with a stipend, tuition credit or even academic credits.
Senator Casey wasn't the first to think a Caregiver Corps was a good idea. In March 2013, the New York Times wrote about the topic on their blog, The New Old Age. Inspired by a random twitter post, Janice Lynn Schuster, senior writer for a nonprofit public health research organization, created a petition for the White House to "create a Caregiver Corps that would include debt forgiveness for college graduates to care for our elders."
Ms. Schuster described her vision as a program similar to Teach for America, a prestigious program that requires recent college grads to make a two-year commitment to teaching in a school district in need. And unlike Teach for America, there is a need for Caregivers in every town all across America, which would enable young graduates to remain close to home and involved in their local community.
While Ms. Schuster wasn't able to collect enough signatures to attract the attention of the White House, Senator Casey's proposal seems to have brought the idea back to life. Hopefully, Senator Casey's proposal might help to bring Ms. Schuster's dream to fruition and help thousands of older Americans age in place with dignity and grace.
What do you think? Is a Caregiver Corps a good idea? Share your opinion with us below in the comments or on Twitter: @MedicalGuardian
WATERFORD, Mich. — Frank Calcaterra was in his 80s in 2008 when his family hired a home care company to help the former Detroit-area funeral home owner look after his ailing wife Jonnie, who had dementia.
The company — Kentucky-based ResCare — sent Tangie Coleman, who, at the time, had a warrant out for her arrest, records show.
Jonnie's jewelry soon began to disappear, as did Frank Calcaterra's sizable fortune — estimates from court filings put the loss at anywhere from more than $500,000 to more than $1.5 million. When Jonnie Calcaterra died in a nursing home in January 2012, Coleman and her mother were living in Frank Calcaterra's lakefront home in Waterford, Mich., and he was sleeping in the basement.
A few months later, Coleman married Calcaterra in Ohio, without his family's knowledge.
In April, when Frank Calcaterra's daughters removed him from his home, he was 10 pounds lighter and so broke he no longer had a positive bank balance or a valid credit card. Coleman was driving him to a check cashing place with his monthly Social Security check, his daughters say.
The case highlights what experts say is a significant and growing problem in the U.S. — financial exploitation of elderly people by caregivers. Many cases go unreported and accurate estimates are hard to pin down, but studies suggest there are at least tens of thousands of such cases each year.
In Michigan, more than 10% of the 33,710 adult abuse complaints the state received in 2013 — up from about 21,000 in 2011 — related to alleged financial exploitation. The state substantiated financial exploitation in more than 1,000 cases.
"We're seeing more and more of these cases where people pose as legitimate caregivers, befriend the elderly, become a part of their lives, and then start taking advantage of them," said Jim McGuire, director of research for the Area Agency on Aging 1-B in Southfield, Mich., which serves about 30% of the state's senior population in six counties.
The elderly population continues to grow, many elderly people have significant resources, and because they can live longer in their own homes they are often more vulnerable, he said. Who's accountable?
Residential home care companies don't require state licensing, and criminal background checks for their workers are only mandatory if public funds are used to pay them.
Though Michigan has recently toughened laws and penalties related to financial exploitation of seniors, making background checks mandatory for all home care workers could have helped Calcaterra, said McGuire, as could a bill stalled in the state Legislature making it mandatory for financial institutions to report suspicious banking activity affecting seniors' accounts.
On Oct. 25, 2012, when Coleman, who was 35, and Frank Calcaterra, who was 86, were married in Ohio, at least two complaints alleging financial exploitation had been filed with the Michigan Department of Human Services' division of Adult Protective Services.
In May of this year, an Oakland County, Mich., judge appointed a conservator for Calcaterra, citing fraud and financial exploitation, which Coleman denies.
Oakland County Public Administrator Jon Munger, Calcaterra's court-appointed conservator, is seeking to annul the marriage, alleging it was a fraud Coleman perpetrated "solely for her financial gain."
Calcaterra's daughters are looking for answers and accountability, too. They're unhappy the state failed to act and that it has been difficult to get police agencies to launch criminal investigations, with some officials saying the 2012 marriage makes the case a civil matter.
"Our concern is that no other family ever go through this," said Calcaterra's daughter Charlotte Knutson, who lives in Minnesota.
Michigan — which was criticized in a recent auditor general's report for failing to properly investigate such allegations — determined the complaints were unfounded and never notified law enforcement.
Coleman, who declined to discuss her history with Calcaterra during a brief encounter with a Detroit Free Press reporter, denied wrongdoing in an answer she filed to the annulment/divorce petition.
She said Calcaterra gave her permission to sign his name to checks and his daughters are biased against her because she is black.
"Frank always gave me stacks of money ... and always promised to take care of me," said Coleman, whose Facebook page featured photos of her fanning a stack of $100 bills.
"They kidnapped my husband," Coleman said in a court filing. "I want him back." Fraud or marriage?
Records show Coleman was married when she was hired to help Calcaterra, but got divorced on Oct. 11, 2012 — two weeks before her marriage to Calcaterra. Of the many checks drawn on Calcaterra's bank account in 2011, more than 20 totaling more than $10,000 were payable to Coleman's husband at the time, for services such as painting, lawn care and moving.
Calcaterra said Coleman told him she needed to marry him in order to receive a significant legal settlement resulting from a lawsuit she brought against an Oakland County police department for an alleged police assault against her. Calcaterra had earlier given her money to hire a lawyer.
"They went to court and got a settlement," Calcaterra said. But Coleman told him officials told her she is a spendthrift, and in order to be paid the settlement she first had to get married so she would have someone to watch over how she handled the money.
"That's why we got married," Calcaterra said. "I don't think there ever was a police report of this ever happening."
There also is no record of any such lawsuit.
Text messages and handwritten notes exchanged between Calcaterra and Coleman show he was smitten with her. And Calcaterra pushed back hard when his daughters tried to convince him he was being used.
"He stated he is aware of the allegations and confirmed that he gave Ms. Coleman his debit card, allowed her to make purchases, and paid her rent last month," a state adult protective services investigator wrote in a report after interviewing Calcaterra at his home in April 2012 — six months before he and Coleman got married.
"He denied that he is being financially exploited and reported he does not need assistance from the police."
Calcaterra, who hired Coleman privately after she left ResCare in 2008, said Coleman changed for the worse after the wedding: She became "domineering," and didn't want him cooking eggs on the stove because she said he might cause a fire; or opening the refrigerator because he would cough and get germs inside it, he said.
But Calcaterra also sent investigators away after the wedding, telling one as recently as February that Coleman "is not taking advantage of him and he wish (sic) these allegations would stop," according to state records obtained under Michigan's Freedom of Information Act.
Calcaterra explained the loss of his 2.75-karat diamond ring, set with sapphires, which had been on his finger since 1950. His family said it was valued at more than $100,000.
"This is beautiful — I'd really like to show it to my friends," Calcaterra said Coleman told him. "I said, 'OK, but ... you take care of it, don't forget I want it back.' " As time went by and Calcaterra kept asking about it, Coleman's response became: "You dropped it in the basement," he said. No background check?
Scott Lewis, a private investigator hired by Calcaterra's family, found that Coleman had a warrant out for her arrest from 2002 through July 2010 for failing to appear in court after she was cited for unlawfully driving away a motor vehicle. That charge was ultimately dropped after a witness did not come forward. But Coleman was convicted in July 2010 of writing bad checks, records show.
Coleman has not had a valid driver's license since her July 2010 conviction for impaired driving, and has been cited four times since 2010 for driving with a suspended or revoked license, records show.
Karen Woodside, an attorney and former Wayne County prosecutor representing Calcaterra's daughters, said the state's adult protection unit — which records show received at least four referrals about Calcaterra between April 2012 and February 2014 — should have run a background check on Coleman and then referred the case to the police.
Bob Wheaton, a spokesman for the Department of Human Services, said the department doesn't comment on specific cases, but if a client is "lucid, aware of his or her finances, and says that he or she is not being taken advantage of, we're probably not going to determine that the person is vulnerable, and we're probably not going to file a petition for financial exploitation."
Calcaterra and his family are also suing Coleman and ResCare, alleging a ResCare official said all home care workers received regular background checks, but instead "placed a thief into the plaintiff's home."
Coleman has not yet been served with the lawsuit and has not filed a response. ResCare denied most of the allegations and any liability in its answer to the suit.
Medicare-certified home health agencies are required by state law to perform background checks on workers with direct access to patients, Wheaton said.
ResCare spokeswoman Nel Taylor said ResCare is not Medicare-certified in Michigan, but performs background checks on its workers whether they are required by law or not. The check turned up no criminal issues on Coleman, she said.
A July 2012 study published in the Journal of the American Geriatrics Society, found that of 180 agencies surveyed, nearly half did not conduct a federal background check of caregivers.
Calcaterra's 1998 marriage to Jonnie was the second marriage for both, and each had children from their first marriage, all living out of state. Woodside and daughters of both parents said Coleman was able to exploit the geographical separation and conflicts between and among the two sets of children to enhance her influence over Calcaterra.
"This was a textbook case of elder abuse," said Woodside. "The children live out of state, they think they've got someone in the house to help, and it turns out she is a predator."
Take precautions
Children of parents should take precautions when hiring residential caregivers, including:
• Lock private papers and valuables in a filing cabinet, safe deposit box or safe.
• Have someone trusted (other than the caregiver) pick up the mail, or get it sent to a post office box.
• Regularly review all bank and credit card statements (at least once a month) and periodically request a credit report from a major credit bureau.
• Consider having Social Security or pension checks deposited directly into the bank.
• Check phone bills for unauthorized calls.
• Protect checkbooks and credit cards.
• Always get receipts when the caregiver shops for the older adult. Source: Michigan Office of Services to the Aging
Deaths at 2 senior homes highlight sharp rise in abuse, neglect
Article by: CHRIS SERRES , Star Tribune
Updated: August 22, 2014 - 12:10 AM
Reports of maltreatment in nursing homes nearly tripled from 2010 to 2013.
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Staff members at two Minnesota homes for elderly people failed to provide adequate medical care and monitoring, resulting in the deaths of two residents, according to investigation reports released Thursday by the Minnesota Department of Health.
The fatalities come amid a sharp rise in reports of abuse and neglect at homes for senior citizens across Minnesota. The number of maltreatment complaints received by state authorities involving nursing homes, home care and assisted-living facilities nearly tripled to 1,217 in 2013 from 451 in 2010, according to a report issued last month by the Department of Health.
In the latest reports, an elderly resident with dementia was not provided with any fluids, food or monitoring for more than 18 hours in May because staffers at the home, Summit Hill Senior Living in St. Paul, were unaware that the client had been transferred to the facility’s “memory care” unit. The resident was found on the toilet with multiple abrasions and died the following morning, state investigators found.
In another case, a nursing assistant at Boundary Waters Care Center in Ely, Minn., stopped providing oxygen to a resident who was having difficulty breathing and then sent the resident in a nonemergency transport van to an appointment more than two hours away. The resident later died of cardio-respiratory arrest.
Elder care advocates attribute the increase in the number of complaints to better reporting, poor staffing levels and heightened public awareness of senior abuse.
In an unusual move, the state Department of Health in June seized control of Camden Care Center, a Minneapolis nursing home, after inspections turned up more than 80 infractions, many of them serious. Regulators found that two residents required hospitalization after accessing drugs or alcohol while under the facility’s care, among other violations.
“It’s really disturbing to see the numbers of complaints going up,” said Iris Freeman, director of the Vulnerable Adult Justice Project at William Mitchell College of Law. “It could be a measure of stronger action on the part of people who suspect they are observing abuse.”
In response to rapid growth in the senior care industry, the Department of Health has roughly doubled its investigative staff to 20 people over the past five years.
In investigating the recent fatalities, state officials found failures of staff oversight.
On May 24, a resident at Summit Hill Senior Living was moved from the assisted-living portion of the facility to the memory care unit, which is designed for people with dementia. However, the staff persons on both the night and day shifts were not told that the resident had been moved, and they both neglected to do their required “walking rounds” to check on the status of their clients.
As a result, the resident went without personal care and supervision for 18 hours and 38 minutes. Staffers found the resident “on the toilet with her/his head wedged between the toilet and the wall,” with an abrasion on her right forehead and red areas on her thighs. The resident was unable to tell staff how she got to the bathroom or how long she had been sitting on the toilet.
The resident, who is not identified in the report because the state prohibits the release of names, died the following morning. The cause of death was atherosclerotic cardiovascular disease, and the medical examiner’s report indicated the person suffered rib fractures and a narrowing of the right coronary artery.
In interviews, state investigators found that some staff members at Summit Hill felt they did not need to do “walking rounds” at shift changes because they trusted the work was already done. Although the facility used a book to report changes with clients, the staff did not document the fact that the resident had moved to the memory care unit of the facility.
“The facility is responsible for the neglect, due to multiple breakdowns in policies/procedures by more than one staff,” the state concluded.
The state also substantiated neglect at Boundary Waters Care Center in Ely. There, a nursing assistant administered supplemental oxygen to a resident who began having “heavy, labored breathing,” but failed to notify a physician. When a van arrived to transport the resident to a routine appointment, the caregiver removed the oxygen without checking the resident’s vital signs. Two-and-a-half hours later, “the resident was found slumped over and had no pulse.” The van driver took the resident to a nearby hospital emergency room, but the person’s heart had stopped.
Immediately after the resident’s death, the facility moved to provide more training on the process of notifying physicians of resident changes in condition, said Lynn Hickey, administrator of Boundary Waters Care Center.
This marks the third time in two years that state investigators have substantiated neglect or abuse at the Ely nursing home. In 2012, a resident at the facility was left in a room with the door closed, light off and the call light not within reach. The resident was unable to call for assistance and fell, sustaining a fractured leg and wrist, state investigators found.
In a separate case in 2012, investigators found that a staff member at Boundary Waters Care Center had “demonstrated a pattern of verbal abuse” by repeatedly using a derogatory name toward a resident. The facility was aware that the caregiver had a history of being rude to residents but took no action to stop the behavior, the state found. State investigators also found that the facility was aware of a resident’s pain but failed to reassess and notify the medical provider.
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KXAN’s Investigation into alleged sexual assaults at an Austin assisted living facility has triggered coming changes to help better protect your elderly loved ones. In May we first told you about the allegations Longhorn Village, a retirement community and assisted living center created by the University of Texas Alumni Association – the Texas Exes. During our investigation the Texas Department of Aging and Disability (DADS) services admitted it broke state law in the course of its investigation of the allegations.
We discovered that despite having a court ordered guardianship stating she was mentally incapacitated and incapable of making her own decisions, DADS investigators didn’t have it before determining the sexual assault allegations were unsubstantiated. Neither Longhorn Village nor DADS reported the allegations to law enforcement, as required by state law.
Now, because of what we uncovered, elder care facilities in Texas will be required to keep guardianship orders on file for residents who have them.
“We are going to have positive change,” said state representative Elliot Naishtat, who saw our story and took immediate action. Naishtat is the Vice Chairman of the House Committee on Public Health and also sits on the House Committee on Public Health and House Committee on Aging. He says since our investigation aired he has been in discussions with top officials at the Texas Health and Human Services Commission (HHSC) and DADS.
DADS, which oversees elder care facilities in Texas, will also have new marching orders.
“Any investigator or case worker who has a situation where there are concerns about the resident who has been abused or neglect will be able to go to the file and see whether or not letters of guardianship have been issued for this individual and then to act accordingly,” said Rep. Naishtat.
First, DADS will direct facilities to keep guardianship orders in a resident’s file. Then the state will adopt new rules officially requiring it. Representative Naishtat says he will introduce a bill in the upcoming legislative session proposing penalties for those who don’t follow the new rules.
“We support the idea of having some notation on a medical record that a person has a guardian,” said DADS spokesperson, Melissa Gale.
But does that go far enough? For the alleged victim in our investigation, maybe not. Her family alleges in a lawsuit against Longhorn Village that a male resident sexually assaulted her there in 2012. The suit also alleges staff did nothing to protect her even though she had a guardianship order.
DADS reopened the case after our investigation and finally reported the allegations to law enforcement, but again determined the allegations to be “unsubstantiated.”
“The facility believed it was protecting this resident’s rights,” said Gale, “…the right to engage in a relationship. The right to privacy and independence,” she continued.
“Even though she was ruled incapacitated by a court, they still felt like they didn’t need to communicate what was going on to the family or the state or a law enforcement agency?” asked Brian Collister.
“After interviewing residents, staff, they concluded, the investigator determined that the facility had not violated any regulations in protecting this woman,” Gale responded.
A federal appeals court has upheld a $10,000 fine against a skilled nursing facility for leaving a suicidal patient unattended, who then walked out of the facility and killed himself.
The U.S. Court of Appeals for the Ninth Circuit said the Department of Health and Human Services' ruled that the decision (Del Rosa Villa v. Sebelius, 2013 BL 330965, 9th Cir., No. 12-71685, 11/26/13) to fine petitioner Del Rosa Villa was supported by substantial evidence. The court denied a petition to overrule decisions that led to the fine.
The unidentified patient first received care at Del Rosa Villa in May 2009 after he broke his leg in a suicide attempt. Hospital employees who treated the man noted psychiatric issues and a risk of self-harm.
After admission to Del Rosa Villa, a nurse noted that the patient should be put on 24-hour suicide watch. The patient was sent to the emergency room after Del Rosa Villa staff couldn't calm him June 5. The patient returned two days later and resumed the unusual behavior. On June 9, the nursing staff allowed him to go outside the facility to smoke, according to court records. He was found 20 minutes later hanging from his belt.
The incident was self-reported and CMS subsequently cited and fined Del Rosa Villa for failure to adequately supervise a resident to prevent an accident.
Before resorting to federal court, the facility appealed the citation to an administrative law judge and the HHS Departmental Appeals Board, both of which upheld the ruling.
The appeals court announced Nov. 26 that it was “reasonably foreseeable” that allowing the agitated and injured patient to leave the facility unattended was justification for the fine. The original CMS citation found that facility personnel were either unaware of the need or failed to implement heightened supervision; failed to increase the patient's supervision due to his deteriorating condition; and ignored the foreseeable risk of letting the patient outside unattended.
