New Rule Enacted by Bush Administration Impedes Cases Against Nursing Homes

By Cindy Skrzycki
Tuesday, February 24, 2009; D02

The Bush administration shut off a source of information last fall about abuse and neglect in long-term care facilities that people suing nursing homes consider crucial to their cases.

The change, which affects the $144 billion nursing-home industry, was enacted with no public notice or attention.

"This is pretty stunning," said Mark Kosieradzki, a plaintiff attorney in Plymouth, Minn. "Nobody was told. It was just done."

The rule designates state inspectors and Medicare and Medicaid contractors as federal employees, a group usually shielded from providing evidence for either side in private litigation.

The restrictions affect about 16,000 nursing facilities and 3 million residents in the United States. The practical effect is to force litigants to go to greater lengths, including seeking court orders, to get inspection reports or depositions for cases they are pursuing or defending.

"This change hurts nursing-home residents and their families by allowing bad practices to be kept in secret by nursing homes and inspectors," said Eric M. Carlson, an attorney with the National Senior Citizens Law Center in Los Angeles. "Government inspectors have the right to go into nursing homes and investigate, and they learn things that residents and families otherwise could never find out."

The new rule, which was issued in September, generally prohibits state health departments and contractors from participating in private lawsuits involving facilities that are in the federal assistance program without approval by the head of the Department of Health and Human Services.

The rule was justified as being necessary to accommodate the hiring of new contractors to make Medicare payments to providers, perform audit and fraud reviews, and do survey, certification and enforcement work for the program.

Requests for these employees to participate in private cases "divert employees from their federal survey, certification and enforcement responsibilities," the Bush administration said in a supporting document. "The cumulative effect of these requests can impede these activities."

The effect of the directives has started to play out in the nation's courtrooms. Requests for information, once fairly routine, now are stalled between state and federal officials.

Anne Marie Regan, an attorney with the Kentucky Equal Justice Center, a nonprofit poverty legal advocacy and research center, said the change has slowed a case she is pursuing on behalf of an 85-year-old man who was evicted from a nursing home in 2007.

Priscilla Shoemaker, legal counsel for the American Health Care Association in Washington, said nursing homes "are in the same boat" because they also have difficulty getting information on how state inspectors determine penalties, citations and orders to shut down homes.

From the Washington Post.

Update - State assumes control of nursing home

February 12, 2009 - From the Public Information Officer at the Alaska Department of Health and Social Services Division of Public Health

All the entities concerned with the operation, ownership, and management of Mary Conrad Center, including the SOA, are continuing discussions with potential new owners. Should the need arise; the provisional license will be considered for extension.

December 24, 2008 - State grants Mary Conrad home temporary license

The owner of the embattled Mary Conrad Center has agreed to sell the home within 60 days, state health officials said Wednesday.

The health department seized control of the nursing home last Thursday after a five-day investigation, revoking its license and saying it posed an "immediate danger to the health, safety or welfare" of its roughly 90 residents.

The state found medication errors, unclean kitchens and residents with unattended injuries, among other problems, said Public Health Director Beverly Wooley.

December 19, 2008 - State assumes control of nursing home

More here

State health officials said today they are taking over a long-term care center in Anchorage due to the alleged "immediate danger to the health, safety or welfare" of its residents.

he 78-unit Mary Conrad Center was sold this year to RainDance Healthcare Corp. Inc., a Seattle company owned by a controversial former nursing home executive who had stints involving corporate lawsuits and bankruptcy.

State officials said they served a notice today of immediate license revocation to RainDance following the results of a recent inspection at the nursing home. They said revoking a license is a "rare step."

The inspection last week "revealed conditions which the state believed to present an immediate danger to the health, safety or welfare of individuals receiving services at the center," the state said. It provided no details of its inspection.

The state Department of Health and Social Services said it has brought extra staff to the center to manage it. RainDance will be able to appeal the license revocation.

Last year, the Cook Inlet Housing Authority decided to sell the center after it and Providence Health and Services could not agree on terms for renewal of Providence's lease agreement to run the center.

The proposed sale generated concern among some families who said they "Googled" the owner of RainDance, Andrew Turner, after the proposed sale was announced and worried about his past business history.

When Turner visited the center after the proposed sale was announced, he told residents and families that he planned no changes in staffing levels, employee benefits and services to residents.

Follow the story on ADN.

Fairbanks - Demolition to begin on Fairview Manor complex

"The entire property will be strictly residential now for senior citizens and low-income families."

Read the entire article here.

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New Website for National Center on Elder Abuse Includes Resources for Caregivers

The U.S. Administration on Aging (AoA) introduced a new website for its National Center on Elder Abuse. The redesigned website provides local resources for caregivers, information about how to find help if you are worried about a senior in your community, and definitions, signs and risks of elder mistreatment. The website includes a database of promising practices related to elder abuse prevention, intervention, and public education and other statistics and research. The Center "is committed to helping national, state, and local partners in the field be fully prepared to ensure that older Americans will live with dignity, integrity, independence, and without abuse, neglect, and exploitation." For more information, visit:

National Center on Elder Abuse

If you suspect elder abuse, neglect, or exploitation, call 1-800-677-1116.

If someone is in immediate danger, call 911 or the local police for immediate help.

Age 60 and older get free rides - Anchorage

Senior citizens 60 and older can ride the People Mover bus free every Wednesday by showing People Mover operators proof of age. "Although we started this as a demonstration for the summer, we received many requests to continue the program to help increase the mobility of our senior citizens," said Jody Karcz, director of public transportation. Since Seniors Ride Free started this summer, Wednesday ridership has increased by 550 trips on average.

People Mover sells reduced-fare monthly passes for seniors and people with disabilities for $15. These passes offer unlimited rides for a calendar month. For more information, call 343-6332 or 343-6543.

"Oh man have I taken some heat over this," Rep. Coghill

To elderly, health stipend no gray issue $120 A MONTH: Seniors blast Coghill for killing attempt to extend program.

By JULIA O'MALLEY, jomalley@adn.com

Published: June 15, 2007

Lynn Cragholm lived 73 years without walking the street in protest, but her lack of experience didn't show Thursday at the corner of Fireweed Lane and A Street.

Facing traffic, her hair swept into a graceful, gray top-knot, she waved a sign that read: "Work Hard, Pay Taxes, Raise a Family, Get Shafted by Rep. Coghill."

Cragholm joined about 60 seniors who demonstrated on all four corners of the intersection in support of SeniorCare, a program that provides $120 a month to low-income people over 65. SeniorCare is set to end June 30, but supporters hope to pressure the Legislature to extend it in a special session that begins here on June 26.

You can read the full story online at:

http://www.adn.com/news/alaska/anchorage/story/8978567p-8893993c.html

Rally in support of SeniorCare scheduled for June 14 in Anchorage

Seniors and advocates for low-income seniors are scheduled to carry signs and join in a public rally in support of Alaska’s “SeniorCare” program Thursday, June 14 at 11:30 a.m. at Access Alaska 121 W. Fireweed Lane, Anchorage.

SeniorCare provides $120 a month to low-income seniors (singles over 65 with annual incomes of less than $16,133 and couples with annual incomes of less than $21,641). Most recipients use the benefit for utilities, food, rent, or medications. Recipients of the assistance program as well as senior advocates are expected to make comments. Legislators have also been invited to attend.

WHAT: Public rally in support of the SeniorCare program
WHERE: Access Alaska Offices, on the corner of “A” and W. Fireweed
WHEN: Thursday, June 14, 2007 from 11:30 am – 1:00 pm
WHO: Seniors and senior advocates

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Justices to Hear Case on Wages of Home Aides

March 25, 2007

By Steven Greenhouse

Evelyn Coke sat in her wood-frame home in Corona, Queens, a hobbled figure, not realizing that this is supposed to be her moment in the spotlight.

For 20 years, she had cared for clients in their homes, bathing them, cooking for them, helping them dress and take their medications. But now, suffering from kidney failure, she is too ill to work.

Her mind and memory are not what they once were, she acknowledges, and as a result she is hazy about the important events that will take place on April 16. On that day, the Supreme Court of the United States is scheduled to hear oral arguments in a case in which Ms. Coke, a 73-year-old immigrant from Jamaica, is the sole plaintiff.

She is challenging Labor Department regulations that say home care attendants, who number 1.4 million, are not covered by federal minimum-wage and overtime laws.

"I loved my work, but the money was not good at all," Ms. Coke said in a whispering voice, noting that she often worked three or four 24-hour days a week, sleeping at a client's home, while hardly ever receiving time-and-a-half pay for overtime.

The stakes in her case are considerable, not least because home care attendant is one of the nation's fastest growing occupations. There are expected to be nearly two million aides by 2014, as the elderly population grows and government pushes for the elderly to be cared for at home rather than in nursing homes, where costs are high.

Ms. Coke's lawsuit has attracted powerful supporters and opponents.

The nation's largest health care union, the Service Employees International Union, is backing Ms. Coke's effort because a victory for her could mean larger paychecks for hundreds of thousands of home care aides, many of whom live in poverty.

AARP plans to file a brief backing Ms. Coke, arguing that the increased pay that would result from requiring overtime coverage would reduce turnover among home care aides and help prevent a shortage.

The federal government and the Bloomberg administration have lined up against her, arguing that a victory for Ms. Coke could greatly increase Medicare and Medicaid costs, perhaps causing a budget shortfall that could leave many of the elderly without home-care aides.

In a friend-of-the-court brief, the Bloomberg administration, joined by the New York State Association of Counties, argued, "In the worst cases, some clients, especially those with high hour needs, might no longer be able to be serviced in their homes and might have to be institutionalized."

The Bloomberg administration said a victory for Ms. Coke could force the city, state and federal governments, which all finance home care through Medicaid, to pay $250 million more a year to the 60,000 home attendants who work in the city.

Some advocacy groups have criticized the city's position, saying it conflicts with Mayor Michael R. Bloomberg's push to reduce poverty because keeping these aides exempt from overtime coverage would hold down their pay.

The defendant in Ms. Coke's case is Long Island Care at Home, which is based in Westbury and employs 50 aides.

MaryAnn Osborne, Long Island Care's vice president, said that a defeat in court could put her agency out of business because, with many aides working 60 or 70 hours a week, it might face huge overtime costs. Her agency pays aides $8 to $11 an hour, but a defeat in the Supreme Court would require the agency to pay time and a half, meaning $12 to $16.50 an hour, for overtime.

"This would be horrendous for the entire industry because the reimbursement rate we get won't cover that type of money," she said.

But supporters of Ms. Coke's lawsuit say that if she wins, the government would most likely increase reimbursement rates to compensate for the overtime costs.

Ms. Coke said that Long Island Care made a lot of money off her, saying she earned just $7 an hour when she last worked there in 2001.

Moreover, she said, she did not get paid overtime for her 24-hour stints at homes in Great Neck, Roslyn, Manhasset and other communities.

She said she stopped working because she was hit by a car, injuring her shoulder, and she later had colon and kidney problems. "The job didn't even give us health insurance," said Ms. Coke, who goes to a dialysis clinic three times a week.

The Supreme Court agreed to hear her case after the United States Court of Appeals for the Second Circuit overturned Labor Department regulations that exempted home care aides from federal minimum-wage and overtime coverage, saying the exemption conflicted with Congress's intent.

Before 1974, home care aides were generally covered by minimum- wage and overtime laws if they were employed by agencies. (Aides hired directly by families were not covered and will remain exempt from overtime regardless of the outcome of Ms. Coke's case.)

In amending the Fair Labor Standards Act in 1974, Congress extended minimum-wage and overtime coverage to household workers like maids and cooks but said that baby sitters and "companions" for the elderly and infirm would be exempt.

When the Labor Department first proposed regulations to enforce the changes in the law, it said that home care workers employed by agencies should continue to get overtime. But the department reversed itself in 1975, saying Congress had not intended to allow those workers overtime when it created the exemptions the year before.

But the Court of Appeals, sitting in Manhattan, wrote, "It is implausible, to say the least, that Congress, in wishing to expand F.L.S.A. coverage, would have wanted the Department of Labor to eliminate coverage for employees of third-party employers who had previously been covered."

Those urging the Supreme Court to overturn that ruling say the Court of Appeals failed to show proper deference to the Labor Department's decision-making authority.

Even with the exemption, few home care workers receive less than the federal minimum wage of $5.15 an hour. But many do not receive any overtime premium even when they work more than 40 hours a week. (Under federal rules, workers who sleep in are generally paid for all extra hours on the job, less eight hours' sleep time.)

Natasha Maye, a home care aide in Philadelphia who is part of a separate suit concerning the minimum wage, is rooting for Ms. Coke. She said that she earned, in effect, less than $5.15 an hour at her former agency because she was not paid for the two hours spent each day traveling between her three clients' homes. Including travel time, she said, she often put in 60 hours a week and earned $300.

"I don't think that's fair," she said. "We should be entitled to overtime and travel time."

The Clinton administration, in its next-to-last day in office in 2001, proposed regulations that would restore minimum-wage and overtime protections to home care aides employed by agencies, arguing that the 1975 exemption clashed with Congressional intent. But in 2002, the Bush administration scrapped that proposal, concluding the revised rules would have a severe economic impact on clients, government budgets and home care agencies.

In its brief, Long Island Care at Home argued that exempting aides who worked for agencies was consistent with Congressional intent because some lawmakers back in 1974 voiced concerns about holding costs down. "The need to restrain costs in the case of third-party employees has only become more acute as agencies provide an increasing amount of needed care," Long Island Care said.

But Craig Becker, the chief lawyer for Ms. Coke, argued that legislative history showed that the exemption to minimum wage and overtime laws was to apply only to baby sitters and companions who were employed directly by families and were not regular breadwinners.

"In its exemption for baby sitters and companions Congress had in mind the quintessential neighbor-to-neighbor relations," Mr. Becker said. "Increasingly this is not a casual form of work akin to baby-sitting but a full-time regular type of employment."

Ms. Coke became a plaintiff through unusual circumstances. After she was hit by the car six years ago, she hired a lawyer, Leon Greenberg. When seeking to determine her economic losses, Mr. Greenberg learned that she sometimes worked 70 or more hours a week without receiving any overtime premium.

He invited her to bring a test case challenging the federal exemption. Ms. Coke agreed. Mr. Greenberg is no longer involved in the case; her current legal costs are being paid by the service employees union.

And because of her condition, Ms. Coke now has her own, unpaid, home care aide: her son Michael, a computer technician.

She said she brought the lawsuit to help hundreds of thousands of home care workers like her for years to come. But she also said there was another reason. "I just hope I get some money from this," she said.

Source: The New York Times
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'Help us live where we want to live, how we want to live.'

Minnesota / Independence leads list of baby boomers' old-age wishes
Study urges fresh options to support in-home care

Minnesota's baby boomers want exactly what the state's long-term care system lacks: technology and creative programs that will help them remain independent and at home in their frail and elderly years.

That is one of the main conclusions of a study and survey being released today by Ecumen, a Shoreview-based provider of nursing homes and community services for the elderly.

Executives with the organization hope the results will inspire lawmakers and caregivers to try new approaches and programs before the massive boomer generation reaches retirement age.

Nine of 10 boomers in the survey said they want to live in their own homes rather than in rental apartments or nursing facilities. Most of the 564 survey respondents, ages 42 to 60, said they would pay more for a long-term care system that provides better community services.

"Boomers are saying, 'Give us some more options,' " said Eric Schubert, Ecumen's communications director. " 'Help us live where we want to live, how we want to live.' "

More here

Mahala Dickerson, Alaska's first black lawyer, dead at 94

Mahala Ashley Dickerson, the state's first black lawyer, died on Monday at her homestead in Wasilla after a short illness, according to her son. She was 94 years old.

Dickerson, who was still practicing at age 91, had a reputation as a fierce advocate for the poor and underprivileged and argued many cases involving racial and gender discrimination.

More in the Fairbanks Daily News-Miner

Senior bonus could be swapped in

Gov. Sarah Palin wants to extend for another five years the life of a program that gives monthly cash payments to low-income seniors plus end a little-used benefit that helps seniors pay for prescription drugs.

More from Anchorage Daily News

Study links seniors' loneliness to higher risk of dementia

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Loneliness may put people at risk of an Alzheimer's-like dementia, a study reported Monday. "People who described themselves as lonely were twice as likely to develop dementia," says researcher Robert Wilson of the Rush University Medical Center in Chicago.

Other studies have found that people who are unmarried and socially isolated are at higher risk for dementia, including Alzheimer's. But this study is one of the first to show a link between loneliness — or the feelings of disconnection from other people — and a higher risk of developing dementia late in life, says Laurel Coleman, a spokeswoman for the Alzheimer's Association and a geriatrician in Portland, Maine.

Read it with a friend here.

Check out Alaska support groups here.