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Pennsylvania Health Care Association CEO Stuart Shapiro, M.D.
Pennsylvania Health Care Association CEO Stuart Shapiro, M.D.

SOUTHEAST

First adult abuse registry

KENTUCKY – Lawmakers hope a new state-funded database will root out personal caregivers who abuse, neglect or exploit disabled or elderly adults.

Senate Bill 98 would create a registry of workers linked with cases substantiated by Adult Protective Services. More than 7,400 adult-abuse allegations have been substantiated by the state's Cabinet for Health and Family Services since 2009, but efforts have failed until recently to document those tied to such cases. One such database already exists for people implicated in child abuse and neglect cases.

Under the proposed law still being debated in the House, personal care agencies would be required to check workers' names against the registry. Registry records also would be made available to families seeking home-based caregivers.

The bill was received in the state House and referred to the Health and Welfare committee in late February.

Bill gives investors immunity

FLORIDA – Trial lawyers and nursing home industry officials are sharply divided as the state inches closer to passing a law that would provide complete immunity from lawsuits to nursing home investors.

Under the proposed legislation, only nursing home owners and staff could be sued and plaintiffs would face significantly higher barriers to collect punitive damages. The Florida Justice Association, which represents trial lawyers, was reported to gain small concessions by an amendment to the bill that would make it easier and less costly for families to obtain care documentation in neglect or wrongful death cases involving loved ones.

Judicial approval would be needed to pull investors into a lawsuit, but that's not enough to quell sharp ongoing criticism of the bill. The case has pitted resident advocates against the state's nursing home industry, which has long disputed trial lawyers' assertions that so-called “passive investors” who make budget decisions that negatively affect care should not be given immunity in neglect cases.

SOUTHWEST

SNF reform bill tabled

OKLAHOMA – Lawmakers put off a comprehensive piece of legislation advocates say would go a long way toward reducing elder abuse in the state's nursing homes.

House Bill 2901 was tabled so legislators could revise and review at a later date. But lawmakers such as State Rep. David Dank (R-Oklahoma City) have vowed to see the reforms make it to the governor's desk soon.

About 3,500 state residents die each year from nursing home abuse and neglect, claims A Perfect Cause, a private advocacy group. A Perfect Cause also estimates that the typical Oklahoman has a 1-in-36 chance of becoming a nursing home victim of preventable death.

The bill would boost nursing home staffing, provide for more thorough investigations and add medical director oversight in abuse and neglect cases.

LTC partnerships floated

UTAH – Long-term care insurance has become an increasingly hard sell during the sluggish economic recovery, but Utah hopes to change that.

Under SB14, passed by both houses in the Legislature, the state would be allowed to engage in partnerships with private industry to incentivize people to obtain private long-term insurance. The provision would make it easier for residents to obtain such insurance and be shielded from Medicaid eligibility requirements that would have deemed such financial products as assets. If signed into law, the plan would go a long way toward easing the burden of nursing home care in a state where the average cost of a private room is more than $67,000 a year.

Long-term care partnerships have a long, successful track record. California and New York reportedly saved $33 million and $19 million, respectively, after implementing them. Utah is one of only nine states left without laws allowing for such arrangements, which became legally possible under the Deficit Reduction Act of 2006.

MIDWEST

Moratorium sought

INDIANA – Nursing homes in the state rallied around failed legislation (S.B. 173) to impose a five-year moratorium on new construction. They took fire from critics who claimed the plan would only add to fattening bottom lines.

Nearly two-thirds of those facilities (about 330 homes) are enjoying a near doubling of their existing 2% profit margins, thanks in large part to a Medicaid provision that allows them to partner with and pay management fees to county-owned hospitals. Such arrangements trigger higher federal matching funds, according to an Indianapolis Business Journal report. Opponents of the moratorium claimed profits should be used to improve care and upgrade facilities, something that lack of competition would dissuade.

Moratorium proponents said much of the additional funding already is used to improve their facilities. Moreover, they argued, nursing home occupancy rates in the state are dropping significantly faster than in most other areas of the country.

NORTHEAST

New dementia standards

MASSACHUSSETS – Patient advocates are lauding new rules beefing up training requirements for nursing home workers engaged in dementia care.

The state Department of Public Health in February unveiled the rules, which will require dementia care workers to receive eight hours of specialized training by August 2014. The rules also require four hours of additional training annually, as well as designated therapeutic activities directors on those units.

Provisions that didn't make the final cut would have prohibited overhead paging systems and required 6-foot-high walls on the property of facilities with dementia care units. Instead, paging systems may be used in emergencies and walls of unspecified heights are required.

Dental care expansion

MAINE – Legislative efforts are underway to provide nursing home residents with greater access to oral care and hygiene.

Proponents of LD 1230 say the pending bill allowing dental hygiene therapists to provide services and even open clinics inside nursing homes will go far in addressing an acute shortage of dentists across the state. Nearly one-fourth of practicing dentists in the state are reportedly reaching retirement age and newcomers to the field aren't replacing them fast enough.

The law would allow the therapists to perform only routine procedures such as cleanings, fillings and extractions in both skilled nursing facilities and assisted living facilities. They also would undergo additional rigorous education and training and secure supervisory agreements with licensed dentists — something that could get tricky since many practicing dentists oppose such a measure.

State's long-term care industry on brink of financial ruin: study

PENNSYLVANIA – The state's nursing home operators say they are approaching fiscal disaster as facilities look at razor-thin margins half the national average.

Considering the national average is 2.1%, this comes as dire news in a state where one out of six residents currently receives Medicaid benefits, according to the Department of Public Welfare (DPW). That agency's $28 billion budget constitutes 39% of the state's annual budget, with Medicaid being the No. 1 cost driver (30% of Pennsylvania's General Fund), DPW notes on its website.

The finding, released in late February in an independent study, could not come at a worse time for the state's nursing homes, which are bracing for an explosion of incoming baby boomer residents. 

Gov. Tom Corbett (R), announced earlier in the month the creation of the Pennsylvania Long-Term Care Commission to study ways to improve the Commonwealth's long-term care system. 

Stuart Shapiro, M.D., told local media that the average 1.2% margins for facilities are “unsustainable.” Shapiro is CEO of the Pennsylvania Health Care Association. 


WEST

Bill: No ‘gender pricing'

CALIFORNIA – At least one state lawmaker hopes to force long-term care insurance companies to stop charging women higher premiums simply because they are expected to live longer than men.

When she introduced AB 1553 in January, Assemblywoman Mariko Yamada (D-4th) said so-called “gender pricing” is an unfair and unwarranted industry practice. Women may see premium increases of as much as 40%, Yamada noted. 

Until now, California has avoided Affordable Care Act mandates against health insurance gender pricing because it classifies long-term care insurance under the umbrella of disability.

Two-thirds of nursing home residents are women, according to the American Association of Long-Term Care Insurance. Moreover, the majority of women older than 75 also are likely to not have living spouses or partners; this makes them more likely to need skilled nursing and assisted living services. 


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