Article: Nursing Homes Routinely Mask Low Staff Levels

Via New York Times By Jordan Rau

ITHACA, N.Y. — Most nursing homes had fewer nurses and caretaking staff than they had reported to the government for years, according to new federal data, bolstering the long-held suspicions of many families that staffing levels were often inadequate.

The records for the first time reveal frequent and significant fluctuations in day-to-day staffing, with particularly large shortfalls on weekends. On the worst staffed days at an average facility, the new data show, on-duty personnel cared for nearly twice as many residents as they did when the staffing roster was fullest.

The data, analyzed by Kaiser Health News, come from daily payroll records Medicare only recently began gathering and publishing from more than 14,000 nursing homes, as required by the Affordable Care Act of 2010. Medicare previously had been rating each facility’s staffing levels based on the homes’ own unverified reports, making it possible to game the system.

The payroll records provide the strongest evidence that over the last decade, the government’s five-star rating system for nursing homes often exaggerated staffing levels and rarely identified the periods of thin staffing that were common. Medicare is now relying on the new data to evaluate staffing, but the revamped star ratings still mask the erratic levels of people working from day to day.

Stan Hugo with his wife, Donna, who is a resident at the Beechtree 
Center for Rehabilitation and Nursing in Ithaca, N.Y. Mr. Hugo 
tracks staffing levels at the skilled nursing facility.

At the Beechtree Center for Rehabilitation & Nursing here, Jay Vandemark, 47, who had a stroke last year, said he often roams the halls looking for an aide not already swamped with work when he needs help putting on his shirt.

Especially on weekends, he said, “It’s almost like a ghost town.”

Nearly 1.4 million people are cared for in skilled nursing facilities in the United States. When nursing homes are short of staff, nurses and aides scramble to deliver meals, ferry bedbound residents to the bathroom and answer calls for pain medication. Essential medical tasks such as repositioning a patient to avert bedsores can be overlooked when workers are overburdened, sometimes leading to avoidable hospitalizations.

Nursing Home Abuse Lawsuits >

“Volatility means there are gaps in care,” said David Stevenson, an associate professor of health policy at Vanderbilt University School of Medicine in Nashville, Tenn. “It’s not like the day-to-day life of nursing home residents and their needs vary substantially on a weekend and a weekday. They need to get dressed, to bathe and to eat every single day.”

David Gifford, a senior vice president at the American Health Care Association, a nursing home trade group, disagreed, saying there are legitimate reasons staffing varies. On weekends, for instance, there are fewer activities for residents and more family members around, he said.

“While staffing is important, what really matters is what the overall outcomes are,” he said.

While Medicare does not set a minimum resident-to-staff ratio, it does require the presence of a registered nurse for eight hours a day and a licensed nurse at all times.

The payroll records show that even facilities that Medicare rated positively for staffing levels on its Nursing Home Compare website, including Beechtree, were short nurses and aides on some days. On its best staffed days, Beechtree had one aide for every eight residents, while on its lowest staffed days, there was only one aide for 18 residents. Nursing levels also varied.

The Centers for Medicare & Medicaid Services, the federal agency that oversees nursing home inspections, said in a statement that it “is concerned and taking steps to address fluctuations in staffing levels” that have emerged from the new data. This month, it said it would lower ratings for nursing homes that had gone seven or more days without a registered nurse.

Beechtree’s payroll records showed similar staffing levels to those it had reported before. David Camerota, chief operating officer of Upstate Services Group, the for-profit chain that owns Beechtree, said in a statement that the facility has enough nurses and aides to properly care for its 120 residents. But, he said, like other nursing homes, Beechtree is in “a constant battle” to recruit and retain employees even as it has increased pay to be more competitive.

Mr. Camerota wrote that weekend staffing is a special challenge as employees are guaranteed every other weekend off. “This impacts our ability to have as many staff as we would really like to have,” he wrote.

New rating method is still flawed

In April, the government started using daily payroll reports to calculate average staffing ratings, replacing the old method, which relied on homes to report staffing for the two weeks before an inspection. The homes sometimes anticipated when an inspection would happen and could staff up before it.

Payroll records at Beechtree show that on its highest staffed days, it had one aide for every eight residents, but there was only one aide for 18 residents at the lowest staffing level.CreditHeather Ainsworth for The New York Times

“They get burned out and they quit,” said Adam Chandler, whose mother lived at Beachtree until her death earlier this year. “It’s been constant turmoil, and it never ends.”

Medicare’s payroll records for the nursing homes showed that there were, on average, 11 percent fewer nurses providing direct care on weekends and 8 percent fewer aides. Staffing levels fluctuated substantially during the week as well, when an aide at a typical home might have to care for as few as nine residents or as many as 14.

 

A family council forms

Beechtree actually gets its best Medicare rating in the category of staffing, with four stars. (Its inspection citations and the frequency of declines in residents’ health dragged its overall star rating down to two of five.)

To Stan Hugo, a retired math teacher whose wife, Donna, 80, lives at Beechtree, staffing levels have long seemed inadequate. In 2017, he and a handful of other residents and family members became so dissatisfied that they formed a council to scrutinize the home’s operation. Medicare requires nursing home administrators to listen to such councils’ grievances and recommendations.

Sandy Ferreira, who makes health care decisions for Effie Hamilton, a blind resident, said Ms. Hamilton broke her arm falling out of bed and has been hospitalized for dehydration and septic shock.

“Almost every problem we’ve had on the floor is one that could have been alleviated with enough and well-trained staff,” Mrs. Ferreira said.

Beechtree declined to discuss individual residents, but said it had investigated these complaints and did not find inadequate staffing on those days. Mr. Camerota also said that Medicare does not count assistants it hires to handle the simplest duties like making beds.

In recent months, Mr. Camerota said, Beechtree “has made major strides in listening to and addressing concerns related to staffing at the facility.”

Mr. Hugo agreed that Beechtree has increased daytime staffing during the week under the prodding of his council. On nights and weekends, he said, it still remained too low.

His wife has Alzheimer’s, uses a wheelchair and no longer talks. She enjoys music, and Mr. Hugo placed earphones on her head so she could listen to her favorite singers as he spoon-fed her lunch in the dining room on a recent Sunday.

As he does each day he visits, he counted each nursing assistant he saw tending residents, took a photograph of the official staffing log in the lobby and compared it to what he had observed. While he fed his wife, he noted two aides for the 40 residents on the floor — half what Medicare says is average at Beechtree.

“Weekends are terrible,” he said. While he’s regularly there overseeing his wife’s care, he wondered: “What about all these other residents? They don’t have people who come in.”

This article was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. The author is a reporter for Kaiser Health News.
A version of this article appears in print on , on Page A1 of the New York edition with the headline: Nursing Homes Routinely Mask Low Staff Levels. Order Reprints | Today’s Paper | Subscribe

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JASA PETS Project: Helping NYC Seniors and Their Animal Companions

There is a little-known program in New York City that’s helping to keep some senior citizens’ pets where they belong — in their loving homes, and out of animal shelters. It’s the JASA PETS Project, and it’s making a difference for many NYC seniors and their pets.

JASA PETS Project: Helping NYC Seniors and Their Animal Companions.

JASA

Following a heart bypass operation, Ms. B. — a former teacher who lives alone with Lady, her two-year-old Dachshund — was feeling isolated, depressed, and useless. Already involved with the JASA Pets and Elder Team Support (PETS) Project, a group of international students was recruited to help Ms. B. care for her dog. In return, she has begun to work with them to improve their English conversational skills. The connection with the students has restored Ms. B. into a vibrant, involved educator interacting with a group of students who, in turn, are helping her dog.

Ms. H. suffers with multiple sclerosis. Isolated and bedridden, she relied upon her two cats for companionship. Sadly, last year one of her beloved cats died and shortly thereafter, her other cat, Foxy, wandered outside her apartment building and disappeared. Distraught over the loss, Ms. H. contacted JASA PETS. The Project Coordinator immediately posted flyers throughout the neighborhood and dispatched a team of volunteers to search for the missing cat. After two days, Foxy found her own way home, and was discovered scratching at her door. Ms. H. was thrilled that her companion was safely home, but also profoundly appreciative for the support she received from the PETS Project team throughout the ordeal.

These are just two of the many heart-warming successes that have been created by JASA PETS. JASA, the Jewish Association for Services for the Aged, is a social service agency dedicated to enhancing the lives of elderly New Yorkers. It is committed to creating innovative programs to meet the evolving and expanding needs of the aging. JASA created the PETS Project in 1997 to address the needs of elderly pet owners whose capacity to care for their pets has been compromised by frailty, illness, and/or inadequate income.

In recognition of the critical role that pets play in the lives of older people — particularly those who are homebound — the program is designed to keep seniors and their pet companions together. Studies show senior citizens with pets suffer less from depression, require fewer doctors’ visits, and have lower blood pressure than those without animal companions.

Often, increasing age and declining health create obstacles to providing proper care for pets. Seniors afflicted with arthritis lose the ability to walk their dogs or groom long-haired cats; fixed incomes often cannot be stretched to cover routine veterinary bills; and pet owners with complex health problems may refuse hospitalization because they have no one to care for their animals in their absence.

How JASA PETS Can Help

The JASA PETS Project matches volunteers with elderly pet owners to provide assistance tailored to the needs of each client. By matching a volunteer with an elderly client, the program provides for the care and well-being of both the senior and the pet.

The client-volunteer teams are overseen by a full-time coordinator, a social worker with prior work experience in pet care, who conducts an initial in-home assessment and is fully involved in the service plan, including reviews of pet care routines. Volunteers help with dog walking, litter box cleaning, emergency feeding, shopping for pet food and supplies, transportation to veterinarians and groomers, training, and pet sitting.

In some instances, a skilled volunteer is able to assist with administering medication to sick pets. In addition, the program provides foster care during client hospitalization periods and participates in pet placement after the death of the human companion. A small relief fund has been established to assist clients who cannot afford to pay for needed pet services and/or their own expenses. The availability of this fund helps relieve financially strapped seniors from the need to make financial choices that compromise their health or the health of their pets.

The program also provides seniors with information about low-cost pet care and will help them make arrangements for their pets in their will. And it can assist in finding a good adopter for a pet if a client dies or can no longer keep a pet.

For some clients, the program helps them through one of the most difficult situations imaginable — the loss of a pet. Such was the recent case of Ms. M., an isolated, homebound client who agonized for several weeks over the difficult decision to put her terminally ill companion cat, Samantha, to sleep. The JASA PETS team visited Ms. M. regularly, coordinated efforts with two veterinarians, assisted in the planning for burial services, and called her daily to provide support. When Samantha died naturally on May 23, the PETS team was there within 30 minutes to console Ms. M. An informal but meaningful memorial service was held at her apartment, and the JASA team took Samantha’s body to the burial provider that had been designated by Ms. M. The team continued to provide bereavement support to help their client through the mourning period.

JASA PETS is making a difference in the lives of many seniors and their pets. The program has been praised by other organizations that serve the senior population. Mary Dodd, Director of the Homebound Unit of the Carter Burden Center for the Aging, says, “On behalf of the Burden Center, I would like to extend my gratitude to the Project. The Project provides unique and vital services to the most vulnerable and forgotten segment of our society. It is imperative that the program be celebrated and receive the continuing support needed to sustain its existence.”

Wendy Golub, Director of Programs at The Caring Community, says, “The PETS Project provides a unique service to the seniors in our community. We at The Caring Community have enjoyed and profited from working with them as they are not only responsible and reliable, but collegial and a pleasure to work with.”

The program is available to senior citizens — regardless of race or religious affiliation — who are sixty years of age or older and are unable to fully provide for the care of their pet companions. Currently, JASA offers this program to residents of Manhattan only. However, it is the aim of PETS eventually to expand the program to include the five boroughs.

To contact JASA PETS for services, simply call (212) 273-5217 to schedule a meeting at the client’s home. Once the client has provided information about the pet and any pet care concerns, the client will be matched with a volunteer to assist them in addressing those concerns.

If you are interested in volunteering for the JASA PETS Project or making a contribution, please contact Paul Domin, Project Coordinator, at pdomin@jasa.org or call (212) 273-5217.

The JASA PETS Project is funded by the Tuttle, Leibovitz, and Ahimsa Foundations.

– See more at: http://www.animalalliancenyc.org/media/ootc/2006-09/aao.htm#sthash.ZCRvYkuD.4t8krsYb.dpuf

Free Tax Help & Filing for Low- and Middle-Income Taxpayers

The United States Internal Revenue Service (IRS) is sponsoring the largest free tax counseling and preparation program in the country, available through AARP.

As seen in: SeniorLiving.about.com
As seen in: SeniorLiving.about.com

Who Can Use this Free Tax Help and Free Filing Service?

Most people who work need to file a tax return. AARP Tax-Aide is a free tax help service for people who meet the following criteria:

  • Low- or middle-income taxpayers who want tax help and free filing of their U.S. federal income tax returns
  • You must have a simple tax return. People seeking tax help who have more complex returns will be advised to get professional tax assistance.
  • You do not need to be a member of AARP or a senior to receive tax help from Tax-Aide, however special attention is paid to people age 60 and over.

What Are the Details of This Free Tax Help and Filing Service?
Every year, from February 1st through April 15th, about 32,000 trained and certified Tax-Aide volunteers across the country are available to provide tax help for preparing and filing your federal tax return.

  • Many Tax-Aide locations are equipped to file your return electronically, allowing you to receive your tax refund much faster.
  • Some Tax-Aide locations offer bilingual assistance.
  • In most situations, you must visit an AARP Tax-Aide site in person to have your tax returns prepared by Tax-Aide volunteers. However, special arrangements can be made to assist shut-ins and homebound disabled persons by providing tax help at locations including hospitals, nursing homes, assisted living facilities, etc. To make a special tax help request, contact AARP at taxaide@aarp.org[/Email”>.
  • Volunteers are not available to provide tax help by phone, so visit the online tax counseling site for a list of frequently asked questions or to submit your own questions.
  • What Do I Need to Bring When I Receive Free Tax Help?
    • Photo identification
    • Social Security card
    • Wage and earning statements
    • Interest and dividend statements
    • A copy of last year’s federal and state returns if available
    • Your bank account and bank routing numbers so you can arrange for direct deposit of your tax refund
  • Where Can I Find the Closest Tax-Aide Site?

    What If There’s No Tax-Aide Site Near Me?
    If you cannot find a Tax-Aide location near you, the IRS offers other tax help options. For more information:

Tips for Seniors in Preparing their Taxes

As April 15th is around the corner, the IRS has these tips for seniors preparing their taxes:

Embed from Getty Images

Current research indicates that individuals are likely to make errors when preparing their tax returns. The following tax tips were developed to help you avoid some of the common errors dealing with the standard deduction for seniors, the taxable amount of Social Security benefits, and the Credit for the Elderly and Disabled. In addition, you’ll find links below to helpful publications as well as information on how to obtain free tax assistance.

Standard Deduction for Seniors – If you do not itemize your deductions, you can get a higher standard deduction amount if you and/or your spouse are 65 years old or older. You can get an even higher standard deduction amount if either you or your spouse is blind. (See Form 1040 and Form 1040A instructions.)

Taxable Amount of Social Security Benefits -When preparing your return, be especially careful when you calculate the taxable amount of your Social Security. Use the Social Security benefits worksheet found in the instructions for IRS Form 1040 and Form 1040A, and then double-check it before you fill out your tax return. See Publication 915Social Security and Equivalent Railroad Retirement Benefits.


Credit for the Elderly or Disabled – You must file using Form 1040 or Form 1040A to receive the Credit for the Elderly or Disabled. You cannot get the Credit for the Elderly or Disabled if you file using Form 1040EZ. Be sure to apply for the Credit if you qualify; please read below for details.

Who Can Take the Credit: The Credit is based on your age, filing status and income. You may be able to take the Credit if:

Age: You and/or your spouse are either 65 years or older; or under age 65 years old and are permanently and totally disabled.

AND 

Filing Status: Your income on Form 1040 line 38 is less than $17,500, $20,000 (married filing jointly and only one spouse qualifies), $25,000 (married filing jointly and both qualify), or $12,500 (married filing separately and lived apart from your spouse for the entire year).

And, the non-taxable part of your Social Security or other nontaxable pensions, annuities or disability income is less than $5,000 (single, head of household, or qualifying widow/er with diependent child); $5,000 (married filing jointly and only one spouse qualifies); $7,500 (married filing jointly and both qualify); or $3,750 (married filing separately and lived apart from your spouse the entire year).

Calculating the Credit: Use Schedule R (Form 1040 or 1040A), Credit for the Elderly or Disabled, to figure the amount of the credit.  See the instructions for Schedule R (Forms 1040 or 1040A) if you want the IRS to figure this credit for you.

Also see Publications 524 (Credit for the Elderly or Disabled); and 554 (Tax Guide for Seniors). 

Free IRS Tax Return Preparation –  IRS-sponsored volunteer tax assistance programs offer free tax help to seniors and to low- to moderate-income people who cannot prepare their own tax returns.

If you have recently done some Estate Planning, check with us and your accountant to make sure you are filing your returns properly.

FREE ESTATE PLANNING GUIDE

Regards, Brian

The Law Offices of Brian A. Raphan, PC

The 10 Most Overlooked Tax Deductions for Care Givers

Thanks to AgingCare.com &  for contributing these often forgotten tips:

Before filing your taxes, don’t miss out on deductions related to medical expenses and other costs that come out of your wallet as you care for a family member throughout the year.

An estimated one-third of U.S. taxpayers, or about 45 million people, itemize their taxes instead of taking IRS’ standard deduction. An estimated $1.26 trillion worth of deductions are claimed annually, according to experts with TurboTax.

See if you can get a break on your taxes, with these 10 tax deductions.

1. Medical expenses

Nearly 100 medical costs can be deducted, related to the diagnosis, treatment, cure or prevention of disease or costs for treating any part of the body. Those include equipment, services and supplies, ranging from glasses to eye surgery to acupuncture to prescriptions.

“Lots of adults are paying for prescriptions for their elderly parents,” says Melissa Labant, a CPA and technical manager for the American Institute of CPAs.

Even artificial limbs, bandages, hearing aids and wigs are accepted medical expenses (for others, see IRS’ Publication 502). The medical and dental costs must total more than 7.5 percent of your adjusted gross income to be deducted.

2. Long-term health care costs

An often-missed expense is the amount paid for long-term care services and long-term care insurance (that’s a more limited deduction, depending on age). Rehabilitation, therapeutic, preventative and personal care services are among those that qualify as long-term care services, if your family member is chronically ill and if it’s part of a plan set by a health care practitioner.

Someone is considered chronically ill if they can’t perform at least two activities of daily living (such as eating, toileting, bathing and dressing) without substantial assistance from someone else.

3. Mileage

From weekly doctor’s appointments to out-of-town visits with a specialist or for a procedure, the miles you log for your parents’ medical needs can be deducted.

“You can take that if they qualify as your dependent. Keep a log as you’re running around,” says Mary Beth Saylor, a CPA and tax principal with Windham Brannon, an Atlanta-based accounting firm. “I’ve hardly seen anybody really keep up with that.” You can take approximately 19 cents a mile for 2012, for medical mileage.If you’re staying overnight for a medical purpose, deduct $50 per night, for each person, for lodging.

4. Dental expenses

Go ahead and smile – dental expenses are among the costs that some people ignore, including dentures and artificial teeth.

5. Home improvements for aging adults

Investing in ramps for a wheelchair-bound parent, handrails and grab bars in the bathroom or a stepless shower can be part of a deduction. It doesn’t matter if the improvements are in your home or your parents’ home, as long as it doesn’t add value to the house, Saylor says.

The IRS says that the cost of the improvement is reduced by the increase in your property value. Other changes, such as widening doorways and hallways, lowering kitchen cabinets and installing lifts, also typically do not add value to houses.

6. Energy-saving home improvements

Whether or not you did this in the course of being a caregiver, any energy-saving changes are eligible for a credit. For more traditional items such as insulation and windows, it’s 10 percent of the cost (a maximum of $500). For alternative energy equipment, like a solar hot water heater, the credit is up to 30 percent of the cost. Find more details from the federal EnergyStar program.(www.energystar.gov)

7. Mortgage interest

If you are paying interest on your or your parents’ home loans, construction loans or home equity lines of credit, it’s deductible. There are some limitations, though, so you need to discuss with your accountant.

8. State and local sales tax

This is an excellent idea if you live in a state that doesn’t have income tax. If you do, you’ll need to make a choice: Deduct state and local sales taxes, or state and local income taxes. You may find that the best financial benefit, in that case, is to stick with the income tax deduction, according to experts with TurboTax. Take some time to figure out your best option by using the IRS sales tax calculator.

9. Estate tax on an inherited IRA

This is not as easy as deducting medical expenses or charitable contributions, but is worth checking out. If you inherited an IRA from your parents, you could take an deduction for the federal estate tax paid on IRA income.

10. Charitable contributions

Of course, you may know to estimate the value of items you or your parents donate to charity. But you also can include other out-of-pocket costs related to volunteering. If you or your parents bought ingredients to make meals for the homeless or elderly, or if you drove a personal vehicle while volunteering or assisting a charity, those and other costs can be deducted.

Tax planning as well as considering other estate planning methods can help you save money. Visit our website. We offer free initial consultation to seniors.

Regards,

Brian A. Raphan

http://www.RaphanLaw.com

How will the Affordable Care Act affect Seniors…

How will the Affordable Care Act affect Seniors…

How will the ACA (Obamacare) affect senior citizens