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Changes to Assisted Living Regulations in Pennsylvania

Wednesday, July 21st, 2010 by Angela Stringfellow

The assisted living industry is experiencing regulation changes across many states, due in part to changes to funding and federal policy, but also due to shortcomings in current outdated regulations. Some changes, such as those set to occur in Pennsylvania over the next few months, can mean a big overhaul for facilities.

Interestingly, the state of Pennsylvania actually has no official “assisted living” category of assisted senior living. As a result, facilities with a wide range of capabilities use the term in advertising, and facilities housing four or five residents are regulated in the same manner as facilities housing more than 100 residents. Currently, 1,600 facilities are regulated by the Department of Public Welfare to provide non-medical care and housing to resideassisted livingnts.

Three years ago, Pennsylvania approved legislation that would create an “assisted living” category, but it was never implemented due to objections to the proposed changes by industry and consumer groups, according to the Pittsburgh Post-Gazette. So the Department of Public Welfare (DPW) made some changes that were approved on June 3rd by the state’s Independent Regulatory Review Commission, and expect to implement the new regs within the next six months.

 The DPW anticipates that about 150 facilities will apply for approval as an assisted living facility in the first few months after legislation takes effect, says spokeswoman Beth Myers — most likely the largest of the facilities currently regulated by the department. A facility denied approval may not use the term “assisted living” in their marketing efforts.

One welcome change is the utilization of federal funds — Medicare and Medicaid — to help residents pay for assisted living care. Currently, Pennsylvania assisted living facilities are considered largely private pay and are therefore accessible only to more affluent residents.

Image Copyright Mesa Royale, licensed under the Creative Commons license on Flickr

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POLST Program Aids in End-of-Life Compliance

Monday, July 19th, 2010 by Angela Stringfellow

POLST is an acronym meaning Physician Orders for Life Sustaining Treatment. Initiated in Oregon in 1991, the POLST Paradigm Initiative aims to improve compliance with end-of-life treatment wishes of individuals, through the creation of local task forces composed of physicians and other health professionals. Local task forces develop and implement a community-based program by educating the public and training local health professionals in the use of the POLST form.

The POLST form is developed and standardized in each region, although it always contains a physician’s signature and specific orders about medical interventions, such as tube feedings, CPR, antibiotics, and comfort measures, the patient’s desired limits on interventions, and more. The form travels with the patient — from an assisted living facility to a nursing home, to a hospital, and so on. POLST Paradigm Initiatives currently exist in more thahospitaln 30 states.

The National Institute of Nursing Research (NINR), a part of the National Institutes of Health (NIH) sponsored a study evaluating the program’s effectiveness, which concluded earlier this year. The study, published in the July issue of the Journal of the American Geriatrics Society, found that compliance with patients’ end-of-life wishes related to medical interventions was significantly greater if a POLST form was used, compared to traditional Do-Not-Resuscitate orders (DNR):

  • Residents who used a POLST form were 59% less likely to receive unwanted life-sustaining treatments than residents who had standard DNR orders.
  • Residents with POLST orders for comfort care only were 67% less likely to receive life-sustaining treatments than those who indicated that they wanted full treatment on their POLST forms.
  • Residents with POLST forms were more likely to have their treatment preferences documented as medical orders.
  • 98% of residents with POLST forms had specific end-of-life wishes related to other medical interventions (beyond resuscitation) compared to 16% of residents without POLST forms.

If your area does not yet have a POLST Paradigm Initiative, you can find information on developing a program on the POLST website.

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Posted in Aging, Health News, Legal News, Senior Living News | 1 Comment »

Newest Elder Care Resource: Your Bank

Friday, July 2nd, 2010 by Angela Stringfellow

bankIf you were looking for information on elder care, you probably wouldn’t think to check with your bank. But the Wall Street Journal reports that banks are increasingly offering elder care resources to their customers, including managing medical bills or the sale of a home, or even hiring care providers.

Wells Fargo, Merrill Lynch, and Bessemer Trust are just a few of the financial institutions expanding their elder care offerings. In some cases, banks will charge an additional fee for service, but in others, services are included in asset management fees.

Banks sometimes contract out services, as well. Broadspire Care Management, for instance, is a geriatric care management organization that contracts with wealth management firms and banks. They report a 10-12% increase in referrals from financial institutions in the past three years.

Obvious services include estate planning and powers of attorney, but financial institutions are also offering crisis management (after a broken hip, for instance), assistance selecting the appropriate Medicare plan for your needs, insurance claims managment, assisting with assisted living, nursing home, or other long-term care provider selection, and health and home assessments.

While this broad range of services can be useful, it’s not easily accessible for everyone. Banks are aiming to build long-term relationships with their clientele in hopes of retaining the business of future generations, so access to geriatric management services involves a financial commitment and sometimes hefty fees. For instance, a minimum deposit may be required — often $1 to $3 million. Most average families don’t have estates that large. But those that do may find it advantageous to have one institution overseeing most or all of their elder care needs — and why not the same company they already trust to manage their assets?

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OIG Addresses Financial Incentives for Referrals

Thursday, June 17th, 2010 by Angela Stringfellow

In May, the U.S. Department of Health and Human Services Office of the Inspector General (OIG) addressed a rewards program occurring in some Continuing Care Retirement Communities (CCRCs), according to Benesch Attorneys at Law. Under these programs, employees and residents would receive a gift card, cash incentive, or credit towards their own living fees, for referring a potential resident to the CCRC.

At first glance, this looks like it violates the Medicare and Medicaid Anti-Kickback Law. The Anti-Kickback Law imposes penalties for anyone offering incentives or cash rewards in exchange for referrals or recommendations for programs and services reimbursable under the Medicare and Medicaid programs. This includes anything from assisted living facilities to durable medical equipment.

Surprisingly, the OIG concluded that the incentive programs taking place at CCRCs are not in violation of anti-kickback laws, primarily because independent living is not reimbursable under Medicare or Medicaid, and technically the referrals are going to the independent living unit of the CCRCs. A CCRC is designed to offer independent living, assisted living, and skilled nursing facility services from the same campus, but the incentives do not apply to residents who move directly into the assisted or skilled units.

The OIG reasoned that many of the independent living referrals will never utilize the CCRC’s assisted or skilled nursing services, and whether or not they do at some point in the future is out of the immediate control of the referring resident or employee.

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Posted in Legal News, Long Term Care, Senior Living News | 2 Comments »

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