Understanding Facilities Involuntary Transfers/Discharges

Facilities must meet certain conditions for involuntary discharge.

Do you have a loved one in a facility? Most of the time facilities provide compassionate, quality care to their residents. However, occasionally facilities will involuntarily discharge or transfer a resident against their wishes. A facility may only transfer or discharge the resident under the following conditions:

1. It is necessary for the resident’s welfare and the resident’s needs cannot be met in the facility;
2. The resident’s health has improved sufficiently so the resident no longer needs the services provided;
3. The safety of individuals in the facility is endangered;
4. The health of individuals in the facility would otherwise be endangered;
5. The resident has failed, after reasonable and appropriate notice, to ensure payment for a stay at the facility.
6. If the facility is going out of business.

Some examples of when it would be appropriate to transfer a resident are if the resident could transfer to lower level care, the resident is continuing to physically abuse another resident, a resident persists in smoking in the facility, or a private-pay resident promises to pay but doesn’t.

Examples of situations that would not meet the criteria for discharge are if the resident aimlessly wanders, the resident is making loud sounds, the resident’s refusal for treatment as long as it doesn’t endanger another resident, or conversion from a private pay rate to a payment at the Medicaid rate. If a resident is deemed to be “difficult” that is not reason enough for a facility to seek discharge.

If there has been a significant change in the resident but it is not an emergency, the facility must conduct an assessment to determine if a new care plan would allow the facility to meet the resident’s needs.

The resident’s record must document the facility’s efforts to resolve the situation before the decision to transfer is made. In addition, the facility must give a 30-day written notice to the resident of its intent to transfer, which includes a statement that the resident has the right to appeal the action to the State, and the facility must also include the name, address and phone number of the agency responsible for the advocacy of the resident.

Facilities exist to care for people with physical and cognitive problems. Problems present opportunities for finding solutions that allow facilities and residents to work together, and for facilities to do better for the communities they serve.

Tom Packer is an Elder Law Attorney serving all of Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity.  If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

August 2017

Best results come when we consult before deciding.

In the book Getting Together by Roger Fisher and Scott Brown of the Harvard Negotiation Project, they make the following recommendation: “If I have an ongoing relationship with you, I should consult you before making a decision that would significantly affect you.” They go on to say, “To consult means to ask your advice. It is not enough to tell you a decision after it has been made. Consultation does not require that we agree or that I give up such authority as I may have to make a decision. But it does require that I inform you of a matter on which I may decide, that I request your advice and views and listen to them, and that I take them into account in making a decision.”

The practice of consulting others before we make decisions that will affect them, opens the lines of communication, builds trust, improves relationships, and produces better outcomes—outcomes that are the result of the combined ideas, interests, insights and experiences of everyone involved.

I have noticed the tendency of some children to fail to consult with their parents as their parents grow older. They assume they know what’s best for the parent and begin making decisions in their parent’s lives involving the parent’s finances, healthcare, living arrangements—and even small decisions like what restaurant to go to or where to sit at a family gathering. This can be demeaning and even embarrassing to the parent who wants to maintain their independence and control over his or her life for as long as possible. Unless a person is incapacitated, a good rule of thumb to follow is to always consult before making a decision.

My wife and I have a saying that we try to follow when it comes to communication. It goes like this: “Speak freely, trust completely and forgive immediately.” First, we agree to speak freely—we should feel free to express our thoughts and positions without fear of being criticized or put down. Second, we agree to trust completely—we make a commitment to always give the other person the benefit of the doubt, to assume that they have our best interest at heart and that they desire to communicate without offending or alienating us. And third, we agree to forgive immediately—we have learned that no matter how hard we try or how long we practice, we fall back into old patterns and make mistakes, and therefore we agree to forgive immediately if offended.

Communicating well with others is not easy, but it is worth the effort. By getting everyone’s point of view, it is more likely we will have a better result. Taking the time to consult before deciding will have a positive effect on any relationship.

Tom Packer is an Elder Law Attorney serving all of Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity.  If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

July 2017

Knowing what you’re paying for and what your rights are is vital!

The rising cost of healthcare has been a talking point for politicians for many years now. While healthcare covers a wide range of situations, I focus on helping Seniors get the right care, whether it is in their home or in a facility, ensuring that they have the best quality of life possible. The rising cost of medical care, especially care for older adults, requires us to be informed consumers. We pay a lot for insurance and healthcare as Americans, and we should do so with a feeling that we are receiving quality service at a fair price.

A symposium has been scheduled on April 20, 2017 at 2:00 p.m. in the Needle Craft building at the Bingham County Fairgrounds located in Blackfoot. (See attached invitation) This is a FREE event, focusing on Senior’s needs, and the speakers will address Home Health issues and answer the question of “How Can You Get the Best Care for Your Dollar?” You are invited to come and listen to a panel of local experts discuss these matters that are so vital for Seniors to understand. In addition, your rights as a consumer will be addressed. Did you know that you have the right to challenge or change your provider if not satisfied?

Sometimes the caregiver and the patient are not the right fit. If needed, changing your provider may be necessary to ensure that your loved one receives the best care.

See you at the Symposium!

Tom Packer is an Elder Law Attorney serving all of Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity.  If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

April 2017

How to ensure your loved one receives quality care.

Home health is a broad term that describes a variety of services provided in the home. Generally speaking, home health is intermittent care provided by nurses, physical therapists, speech therapists, occupational therapists, medical social workers, and home health nursing assistants to persons confined to their homes, who are in need of short term acute health care.

Medicare funds Home Health care. Consequently, certain conditions of eligibility apply. For example, an individual must have a valid Medicare policy, be essentially homebound, have a doctor’s order for Home Health Services, require one or more of the above referenced services, and have a medical condition that will respond to treatment.

Hospice is another form of care designed to support an individual and their family during an advanced illness. Hospice care focuses on comfort and quality of life, rather than treatment or cure. Physicians, nurses and other caregivers oversee an individual’s care in the comfort of their home or assisted living facility. The goal of hospice care is to enable the individual to have an alert, pain-free life by managing symptoms and pain. Hospice promotes peace of mind to help individuals live better with their illness.

Hospice is funded by Medicare and other private insurance companies. Although many people think of hospice care in relation to terminal cancer, many other end-of-life health conditions may qualify a person for hospice.

The initial hospice benefit is for six months of coverage. However, this time can be extended in 60 day increments as long as the person continues to meet the medical criteria.

Your rights as a patient in these programs are important to understand. For example, as a Medicare beneficiary you have a right to choose your home health agency, have your property treated with respect, receive a copy of your plan of care, and to participate in decisions about your care. Each hospice patient has the right to: be treated with respect, receive quality end-of-life care, receive notice of his or her rights, receive information on advance directives including a living will and healthcare surrogate, voice concerns and not be discriminated against for doing so, receive pain management and symptom control, Be involved in developing his or her hospice plan of care, refuse care or treatment, choose his or her attending physician, and to be free from mistreatment, neglect, or verbal, mental, sexual, and physical abuse.

A symposium has been scheduled on April 20, 2017 at 2:00 p.m. in the Needle Craft building at the Bingham County Fairgrounds. You are invited to come and listen to a panel of local experts discuss these matters that are so vital for seniors to understand. For more information on the symposium you may call Paul Johnston at 208-782-1441 or you may call our office.

Tom Packer is an Elder Law Attorney serving all of Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity. If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

Don’t be too busy for elderly family members or those in the community.

Just this month, my wife and I attended a family dinner to celebrate my father-in-law’s 88^th birthday. Something he said caught my attention, and I thought I would share it with you. He said he wanted to stay here—even though getting around was becoming harder—because of the love of his family. He said he didn’t want to leave us.

I often think about all our clients, many in nursing homes, some with ailing health, and want to remind each of us not to be too busy to do what our loved ones really want—to spend time with them.

Life goes by too quickly and sometimes we let the more important things slide in all the hustle and bustle. One of my favorite authors, Richard L. Evans, wrote the following about older adults:

“In the eager and active years of youth, it isn’t easy to understand how parents feel as their flock, one by one, leave the family fireside. To be so long the center of a home, so much sought after, and then almost suddenly, to be on the sidelines watching the procession pass by—this is living into loneliness. We may send gifts and messages on special days…or make an occasional quick call. But passing and perfunctory performances are not enough to keep loneliness in its place the whole year round. What they need in their older years, is in part at least, what we needed in the uncertain years of our youth: a sense of belonging, an assurance of being wanted, and the kindly ministrations of loving hearts and hands; not merely dutiful formality, not merely a room in a building, but room in someone’s heart and life.”

Then there are those who have no family of their own. Can we visit them, bring some cheer into their lives and help with their needs? I’m guessing there is no limit to the good that we can do.

Tom Packer is an Elder Law Attorney serving all of Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity.  If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

October is the month to review Medicare if needed.

When you turn 65, you become eligible for federal health insurance, called Medicare. You can receive this government benefit, regardless of your income or employment. Medicare is like other health insurances – it has premiums, co-payments and deductibles.

It’s a good idea to understand just what is covered by Medicare and what isn’t. Medicare covers short stays in hospitals or nursing facilities, ambulances, medical aids, prescriptions, therapy, some home healthcare needs and some doctor visits. Medicare will cover up to 100 days in a skilled-nursing facility after a 3-day hospital stay, if you require skilled-nursing services. After the 20th day, there is a significant co-pay that some, but not all supplemental-insurance plans will pay for.

Medicare does not pay for long-term care. Medicaid, another government program, pays for long-term care; however, to qualify for Medicaid you have to meet a means test that looks at your health, assets and income before you qualify—your assets cannot exceed $2,000 and your income in 2016 cannot exceed $2,199 per month. If your income exceeds that limit, you can still qualify by setting up a Miller Trust. If you have a spouse, there are provisions in the law that allow your spouse to keep your home, one car and ½ your liquid assets up to $119,220, so that your spouse is not impoverished while paying for your care.

The initial enrollment period for Medicare begins three months before your 65th birthday, includes the month you turn 65, and ends three months after you turn 65. If you miss your Initial Enrollment Period, you can sign up between January 1 through March 31 each year but it may include a late penalty. October is a good time to review your plan. There is also an Annual Election Period from October 15 through December 7, when you can consider whether you would benefit from enrolling in or changing a Medicare Advantage Plan or a prescription drug plan.

Understanding the laws and knowing what Medicare and Medicaid cover, will allow you to get the most for your money.

Tom Packer is an Elder Law Attorney serving all of Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity. If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

Your responsibility to Medicare if you are involved in an accident

Winter driving conditions here in Idaho can be difficult at times and can lead to accidents. In a situation where a person on Medicare sustains injuries that are caused by someone else, Medicare becomes a secondary payer and the no-fault or liability insurance becomes the primary payer. When an individual who is covered by Medicare is injured in an accident, Medicare requires that person to notify Medicare of the accident.

While the process of obtaining treatment for injuries is the same, payment of the medical bills is very different. Medicare makes conditional payments to healthcare providers for their services, but Medicare is entitled to repayment from the third party responsible for the accident. This is the case whether the injury happens at work or in an automobile accident. If a person on Medicare recovers an insurance settlement for his injuries, Medicare will automatically have a lien against the settlement for any medical bills it has paid on behalf of the insured. Therefore, if a Medicare beneficiary receives a settlement from a primary payer, that person will need to reimburse Medicare for the amount of medical bills that Medicare paid.

For example, we know of one man who had an accident and settled with the liability insurance company for $1,500 and then had back surgery paid for by Medicare. When Medicare became aware that he had been in an accident, they sent the man a letter demanding reimbursement for the total cost of the surgery.

Consequently, if you are on Medicare and you are injured in an accident, make sure you or your attorney contacts Medicare before making any kind of settlement with an insurance company.

Tom Packer is an Elder Law Attorney serving all of Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity. If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

Things you can do to improve your chances of not getting Alzheimer’s.

According to Dr. Maria Norton of Utah State University, there are at least 15 million people in the U. S. who suffer from Alzheimer’s Disease, and someone develops AD every 68 seconds or roughly every minute of the day.

At a Seminar Dr. Norton recently presented in Idaho Falls, she indicated that we can improve our chances of not getting Alzheimer’s. Like many other health conditions, there are things we can change in our lives and things we cannot. For example we can’t control our increasing age, our genes or our family history of AD. However, we can control our knowledge of the subject, our nutrition, our exercise and our stress level, to name a few. Dr. Norton hypothesized that only 1/3 of the total Alzheimer’s risk factors come from genetics, leaving 2/3 that we can control.

According to Dr. Norton, there are six behavioral domains in which we can make wise choices each day that can decrease our likelihood of getting AD. They are the following:

1. Healthy food choices
2. Physical activity
3. Stress management
4. Cognitive / mental activities
5. Social engagement
6. Sleep quality

There is a new app called “Gray Matters, “The Alzheimer’s Prevention App”, to help remind us of the importance of doing the things we can control. Studies show that this smart phone app motivated better engagement in each of the six areas mentioned above by well over 50% in each domain. You can download the app and visit the demo at graymatters.org@graymattersapp.

Quality of life is so important. When trying to avoid a disease as devastating as Alzheimer’s, doing something is always better than doing nothing.

Tom Packer is an Elder Law Attorney serving all of Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity. If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

Tip: Consider the benefits of attending a caregiver support group.

In my Elder Law Practice I meet regularly with families who are caring for a loved one with Alzheimer’s or dementia. The families I meet with come to me with legal, financial and healthcare problems that have arisen. I have a social worker who assesses the needs of these families, and the stress of caring for a loved one becomes very apparent.

Beginning in October, there is a new resource in Blackfoot available to caregivers. A caregiver support group is being offered for people who care for someone who suffers from Alzheimer’s. Laura Bingham, a social worker with Access Homecare and Hospice, is facilitating the group. She hopes to educate, share ideas, and support each other in a warm and welcoming atmosphere. The first session is Wednesday, October 21, 2015. It will be held at 6 p.m. at the Gables Assisted Living, located at 2815 Hunters Loop, Blackfoot, Idaho . The class will be held every 3rd Wednesday of the month from 6:00 to 7:00 p.m.

You can learn more about caregiver programs and resources at Alzheimer’s Association at www.alz.org.

Tom Packer is an Elder Law Attorney serving all of Southeast Idaho . As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity. If you have a question about a Senior’s legal, financial or healthcare needs, please call us.

Wrinkles and gray hair are not the proof that the best of life is over.

I thought that since it was summer, it might be nice to have a tip on the lighter side. Recently I was reading a book written by Bryant S. Hinckley that had a thought about aging. It stated: “Some people are young a long time; they never seem to get old. Accomplishing this is a priceless achievement, and it is within the reach of most of us. ” An often quoted poem is entitled,

Age is a Quality of Mind
“Age is a quality of mind:
If your dreams you’ve left behind,
If hope is cold,
If you no longer look ahead,
If your ambition’s fires are dead,
Then you are old.
But if from life you take the best,
And if in life you keep the zest,
If love you hold;
No matter how the years go by,
No matter how the birthdays fly,
You are not old.”

Bryant S. Hinckley continues, saying, “The way to grow old with satisfaction and dignity is through the cultivation of our inner resources. Wrinkles and gray hair are not the proof that the best of life is finished… Most people who age before their time do so because their minds and not their muscles stiffen… We all need to cultivate kindness, human understanding, sympathy, tolerance for other people’s views, generosity and a sense of humor… These are the qualities of mind and heart that endure and enrich our lives forever. They do not diminish with the passing years. These are the panaceas for disillusionment and loneliness which so often embitter age…”

Each day can be a masterpiece if we let it. Don’t let what you can’t do keep you from doing what you can do! The popular saying, “Live, Love, Laugh” can be applied at any age. Why not start now to cultivate this frame of mind and enjoy life to the fullest?

Tom Packer is an Elder Law Attorney serving all of Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity. If you have a question about a Senior’s legal, financial or healthcare needs, please call us.