Improvements On The Way For Nursing Home Rating System

The Obama administration recently announced efforts to improve the quality of care in the nation’s nursing homes and strengthen the reporting system by which consumers obtain information about them.
Through executives actions and the president signing into law the bipartisan Improving Medicare Post Acute Care Transformation Act of 2014, the administration is seeking to strengthen Medicare’s widely-used Five Star Quality Rating System for Nursing Homes, also known as Nursing Home Compare, and streamline quality measures for nursing homes, home health agencies, and other post-acute care providers participating in Medicare.
“The Five Star Quality Rating System offers the most comprehensive overview of nursing home quality in the U.S., in an easy to understand format, based on data from onsite inspections conducted by trained, objective surveyors from state public health departments and (Centers for Medicare and Medicaid Services); quality measures submitted by the nursing homes is used to calculate certain quality measures, such as the prevalence of pressure ulcers, use of restraints, and the extent of injurious falls; and information about the staffing levels in nursing homes,” according to the announcement from the White House Press Office. “While the onsite inspections form the core of the rating system, CMS has been concerned that the quality measures and information about staffing levels rely on self-reported data from nursing homes that have been difficult to verify.”
Among other things, the Improving Medicare Post Acute Care Transformation Act, which takes effect in January, will require that staffing levels being reported by nursing homes can be verified through payroll records, the White House announcement stated.
In addition, the law will revise the scoring methodology for calculating a facility’s rating under the Five Star Quality Rating System.
“The Act will facilitate patients comparing outcomes across different care settings, supporting better choices and better outcomes for patients,” according to the Press Office. In addition, the IMPACT Act funds a key improvement to nursing home oversight, the collection of staffing data. Nursing and other staffing levels are closely correlated with quality in nursing homes and current data collection efforts have produced data of uneven reliability. The IMPACT Act also institutes more routine surveys of hospice providers, ensuring program standards are met for the benefit and safety of patients.”

Advice On Making Right Choice For Help With Elderly Care

The cost of hiring someone to help care for an elderly relative has remained fairly steady in recent years, according to a recent item in The New York Times.
It’s still about $19 an hour for a hired homemaker, someone takes care of things like cooking and cleaning. A home health aide, who can assist with personal care such as dressing or bathing, costs only $1 more an hour, according to the article by Ann Carrns.
Those figures represent an increase of only about 1 percent over five years ago, according to the story.
Something else that hasn’t changed, the writer points out, is that it takes some digging to make certain the homemaker or health aide is the right person to be given the job.
Carrns offers these suggestions, with a little help from experts:

  • How do I know what kind of caregiver my family member needs?
    You can assess needs, like his or her ability to handle activities of daily living such as dressing, eating and bathing, using a checklist, like one provided by the National Caregivers Library. Or, you can have a professional conduct the evaluation, which is advisable, said Amy Goyer, a specialist in home and aging with AARP. To find someone qualified to do the assessment, you can contact your local office of the National Association of Area Agencies on Aging for a referral. You can find the one nearest you on the federal government’s Eldercare Locator site.
  • How do I go about finding a home caregiver?
    One option is to use a home care agency, which will screen and train caregivers to make sure they can provide the level of care needed. Since the agency employs the caregiver, it also handles payroll tasks. An agency can also schedule alternative caregivers if your primary caregiver is ill or unable to work. Because the agency offers these services, its hourly rates may be higher.
  • What if I prefer to hire someone myself?
    You may be able to obtain a lower rate by hiring someone directly. But if you hire a caregiver yourself, you’ll have to handle payroll and possibly taxes, said Leah Eskenazi, director of operations for the Family Caregiver Alliance, a nonprofit that helps people caring for relatives. Ms. Eskenazi advises that word of mouth is often a good way to start your search; friends or family members who can vouch for a caregiver’s skill and reliability can be good first references. The AARP website offers a tool to search for an agency by ZIP code.

In addition, Carrns advise that websites like also help find independent candidates in a given geographic area.

Ethical Guidelines For Helping Older Clients Offered By ABA

For attorneys who focus all or part of their practice on the needs of older clients, the American Bar Association advises adhering to the “Four C’s of Elder Law Ethics.”
They are:

  • Client identification
  • Conflicts of interest
  • Confidentiality
  • Competence

“First, all lawyers have an ethical obligation to make it very clear who their client is,” the ABA advises on the first point. “The client is the person whose interests are most at stake in the legal planning or legal problem. The client is the one, the only one, to whom the lawyer has professional duties of competence, diligence, loyalty and confidentiality.”

ElderlyWomanInGlasses (Photo credit: Wikipedia)

ElderlyWomanInGlasses (Photo credit: Wikipedia)

Avoiding a conflict of interest relates directly to client identification, in that “in most situations, a lawyer may only represent one individual.”
“For example, when legal planning involves property, such as a family home, in which several people have an interest, these interests are actually or potentially conflicting,” the newsletter states. Sometimes joint representation is possible, even with potential conflicts of interest, but it is more likely that we will be representing only the older person whose interests are at stake.”
Confidentiality, which is at the very heart of all attorney-client matters, simply means the lawyer may not share any information with other family members unless given permission to do so.
“Some clients want all information shared and family members involved in discussions,” the ABA points out. “Some merely want family members to be given general updates. Some want complete confidentiality. It differs from person to person.”
The final “C” is a special ethical responsibility when handling the legal affairs of older clients, according to the newsletter.
“Lawyers must treat the impaired person with the same attention and respect to which every client is entitled. This means meeting privately with the client and giving him or her enough time to explain what he or she wants.
“Assessing a client’s capacity to make decisions is part of our getting to know the client. While most clients can explain a problem and what it is they want, there will be some clients who cannot. Speaking privately allows us to find this out. When family members answer all the questions, it makes it difficult for us to determine our client’s level of understanding.”