Long Term Care Law

Danish Nursing Homes Address Problems Differently than in the US

I have not posted anything to this website for quite some time, but I thought this article was interesting enough to get me started back.  It appears that Danish nursing homes treat the problem on sexual urges by those with dementia somewhat differently than United States homes do.

Many Danish nursing homes do not shy away from helping residents contact prostitutes, the Politiken newspaper reported.

The newspaper quoted a recent survey conducted by the Danish Nurses Organization that suggested the practice was not uncommon.

"In general our approach is to help the elderly with that kind of need," said a nurse at a nursing home in Charlottenlund, near Copenhagen, according to the report.

Decisions about whether or not staff were allowed to assist elderly residents get in touch with sex-workers rested with local municipal authorities, the report said.

An exception was Copenhagen where such assistance is not allowed since 2006 when the city council adopted a programme to combat prostitution.

Sexologist Judith Rosenkrantz, who has earlier been head of a nursing home and now advises health workers, said that the needs of elderly residents have to be taken into account.

The most common category were men, often suffering from dementia.

"If the elderly person is not able to channel his sexuality, he can become aggressive and start attacking staff," Rosenkrantz said.

Rosenkrantz said that the main need was often physical contact, a cuddle or help to masturbate rather than actual sexual intercourse. 

Many of my clients have had residents exhibiting "inappropriate" sexual behavior, most men with dementia.  The treatment of choice in the United States is Depo-Provera, a female hormone.  I wonder which treatment is more humane?

First Baby Boomer Signs Up For Social Security

No doubt about it - the Boomers are coming of age.  The first baby boomer, a former school teacher, signed up for Social Security.  The first wave of 3.2 million baby boomers turns 62 next year — 365 an hour.  Also, persons are retiring every 7.5 seconds.  As the Boomers age, they are going to expect different health care services than the typical nursing home.  Providers of skilled nursing facilities need to re-think their business model to prosper in the next few decades. 

Concierge service is already happening in some parts of the country, offering such items as

• Gourmet meal room service
• A complimentary fruit and snack         basket in your suite
• Complete bath care package
• Luxurious towels, comfortable quilts,         coffee maker
• An Internet Café
• Pubs or Bars for cocktail hour.

Some Assisted Living Facilities have expanded its clientele by offering short term stays for recovery from cosmetic surgery.  Providers that can adapt to the changing needs of the Boomer generation will do well.

Hidden Cameras in Nursing Homes

Hidden cameras have been used in nursing homes for a number of years by families, and more recently by law enforcement agencies.  Using a hidden camera in a Cortland nursing home, the New York's Attorney General's Medicaid Fraud and Abuse Office showed that on numerous occasions the nursing home staff failed to reposition a comatose patient, treat his bedsores or provide other care.  The owners of the facility were found guilty on 6 counts of violating public health law and 3 counts of second degree falsifying business records.

This is not the first time the New York Medicaid Fraud and Abuse Office has used hidden cameras to convict nursing home staff and sue owners.  While the practice is more prevalent in New York than other states, it may not be that way forever now that States' Medicaid Fraud Units have more federal money to prosecute quality of care issues.

The best way to avoid the care problems seen in these cases is to have alert and attentive management staff making rounds on the units where residents are receiving care, spot checking the care and getting rid of employees consistently fail to provide the care required.

Request for a Deceased Person's Medical Records

A client called today about a family requesting a deceased person's medical records.  She could not remember my website but thought for sure information on this issue would be here.  It was not - so here it is. 

In Missouri, only the legal representative of the estate can obtain the records.  The person requesting the records would need to have proof that he or she is the legal representative of the estate, either by Court Order, Letters Testamentary or Refusal of Letters Testamentary.  The Probate Court in the county the deceased lived will issue one of these documents.  A Durable Power of Attorney will not suffice after the person is dead, at least as authority to release medical records. 

There are sometimes tricky issues with the release of medical records.  Therefore, you should obtain legal advice if you have any questions.  This information is the opinion of the writer's only.  Other persons may have different interpretations of the law.

Annual Alzheimer's Association Convention

I will be speaking on Legal Issues in Care of Patients with Progressive Dementia: A Case Study with Elisabeth Belmont, in-house counsel to Maine Health, and Peter Leibold, with the American Health Lawyers Association, at the Alzheimer's Association's Annual Convention in Chicago this next week.  I am looking forward to it, knowing from personal experience the tragedy of this disease.  Our discussion will include choosing the appropriate level of care, legal issues related to in-home care, issues arising with end-of-lfe decisions, hospice and pain management.

Wristwatch with Built-In Lighter Causes Fire in Hospital

Katharine Achor, CMS's Life Safety Code person in Kansas City, sends me important updates about defective and counterfeit electronic devices (see previous post).  She also sent me this interesting note:

A patient in a psychiatric hospital unit set bedding on fire with a  wristwatch that has a built-in lighter.  Information on the wristwatch lighter can be found on the website below. Please share this information with the appropriate staff in your facilities.

The website she listed is www.shockinglighters.net

I know this wasn't her intention but I may have found some Christmas gifts on this website.  Thanks again, Kathy.

Counterfeit Surge Protectors

NORTHBROOK, Ill. - August 21, 2007 - Underwriters Laboratories (UL) is notifying consumers and retailers that

surge protectors bearing the brand name "Fussion" bear a counterfeit UL Mark for the United States. The surge protectors have not been evaluated for safety by UL and are not eligible to bear the UL Mark.

Identification: On the packaging:  The surge protectors have six outlets and display a counterfeit UL Mark on the packaging. Model PBR-4506 appears on the package with the brand name "Fussion".

Identification: On the Product: A molded marking on the back of the surge protector identifies the unit as Model MDE-28.

Hazard: The product does not contain a ground wire or surge protection. It has undersized wire and insulation that does not meet UL's Standard for Safety for surge protectors. Using the product could pose a potential electric shock or fire hazard.

Thanks to Katharine Achor (CMS/MC) for the heads up.

Study Compares Quality in U. S. Long Term Care with Other Countries

The AARP Public Policy Institute Issue a paper in February of this year titled “Quality Assurance for Long-Term Care: The Experiences of England, Australia, Germany and Japan.” This research examines the long-term care quality assurance systems in four developed countries—England, Australia, Germany, and Japan.  AARP found the following issues emerging from its reseach:

• Long-term care financing makes a difference in the quality of care, but not simply along public versus private lines.... The key strategy should be to structure the financing system so that it supports improved quality.
• Inspection and regulation are the cornerstones of quality assurance for long-term care in the four countries and the United States, but dissatisfaction with traditional inspection is leading to new approaches.
• Countries are looking for ways other than regulation to promote quality by providing more information to consumers, providing workforce training, funding demonstration projects, and disseminating promising practices.
• All of the countries are shifting their delivery systems to encourage more consumer choice and more home and community services.

Thanks to Chris Puri who sent me a link to this article.  Chris is a valuable resource for me and a great lawyer.

In reading the article I was reminded of the "7 Congresso Europeo" meeting I attended in Venice in 2001.  This was an international "Congress" on long term care.  We had the translating earphones and everything.  Eight ladies from all over the U.S., all associated with long term care, traveled through Italy for several weeks before the conference.  While traveling the group visited 2 nursing homes - one in rural Italy and one in Florence.  There were vast differences between the two and vast differences from long term care in Italy and the U.S.   Each has its pros and cons.  Very interesting (and fun) trip.  Thanks Chris for reminding me.

A New Book Reports on the Supernatural in Nursing Homes

According to "A Dying Man Never Lies," written by Eathel Ann Kerperien, a registered nurse, all sorts of supernatural events occur in nursing homes and hospitals.  Ms. Kerperien writes about her 20 years' experiences in hospitals and nursing homes.  The promo for her book states:

A DYING MAN NEVER LIES" are true documented supernatural events witnessed in Nursing Homes and Hospitals in the St. Louis area. It is not uncommon for the medical profession to see things they cannot explain. They surely don't tell the public about them for fear of losing credibility. Not until now. This book has true documented accounts of flashing lights, floating heads, spirits, smells, apparitions, and yes even ghost. Almost everyone at sometime in their life has seen something they could not explain. You can call it what you like, but strange is strange.

This might be an interesting read.  I'm going to check with my nurse and nursing home friends to see if they have had similar experiences.  I will report no names, promise.

Program for Distributing Unused Drugs May Not Be Effective

Missouri like many other states passed a law that allows nursing homes, hospitals and pharmaceutical companies to distribute unused medications to the needy.  However, according to a recent report, the program has not gotten off the ground in Missouri.  Kaiser Family Foundation notes that Missouri has no way of evaluating the effectiveness of the program and that the

state knows of just one organization that offers to collect drugs and distribute them to facilities that have trouble affording medications, and a phone number listed on the program's Web site is disconnected, according to the AP/Post-Dispatch.

The St. Louis Post Dispatch describes how the program works (or doesn't work, depending on the outcome you are looking for):

The law allows a dispenser of drugs, such as a hospital, a wholesale drug distributor or an individual to donate medication. But there's a big catch — the person must never have had control of the medication.

In other words, if a person is prescribed a drug while staying at a nursing home, but then the doctor changes to a different medicine, the unused portion of the prescription could be donated to another clinic, if the individual agrees. But the family of a person living at home who died before finishing a three-month supply of medicine would still have to throw it away.

Jon Dolan, Executive Director of the Missouri Health Care Association, the largest health care association in Missouri, says the "rules don't allow a nursing home to take drugs destined for one patient and give them to another within the home with the same prescriptions, but instead would have to send them to an outside clinic, pharmacy or hospital that's part of the program."

The rules are strict because the state must make sure that drugs are safe; they must be properly stored to prevent them from being altered and cause adverse side effects said Susan McCann, who runs the Missouri Bureau of Narcotics and Dangerous Drugs.