Medical Care Delivery for Occupational Therapists in Question for Memphis Elderly
MEMPHIS TN (IFS) -- No pictures, no video recordings, no audio recordings, no interviews, no mentioning of any abuse of seniors in group homes. When it's time for their breakfast, the attendants delivery their trays to the seniors in their rooms, whether or not their diapers from that night have been changed or not. When you are lying there in your own fecal matter and have not be cleaned up from the night before, breakfast does not look good at any cost.
Why do these patients have to wait to get their diapers changed? One, the help is poorly paid and they are usually verbally abused for not picking up the pace. The second cause of this abuse is no help. These facilities refuse to retain good help do to conditions and pay.
Medical personnel are prohibited from recording these abuses by law, according to the HIPA doctrine in Title I. Family members and others can not made visual records and report these items, because these reports violate the privacy acts of the patience.
The Memphis medical care system for seniors in group homes are in dire straits and the disrespect and treatment of our seniors is barely reported on. However, other states are fighting back with legal cases that are carrying forward into other states.
Title I: Health Care Access, Portability, and Renewability
Title I of HIPAA regulates the availability and breadth of group
health plans and certain individual health insurance policies. It
amended the Employee Retirement Income Security Act, the Public Health
Service Act, and the Internal Revenue Code....
Title I requires the coverage of and also limits restrictions that a
group health plan can place on benefits for preexisting conditions.
Group health plans may refuse to provide benefits relating to
preexisting conditions for a period of 12 months after enrollment in the
plan or 18 months in the case of late enrollment.
Title I allows individuals to reduce the exclusion period by the amount
of time that they had "creditable coverage" prior to enrolling in the
plan and after any "significant breaks" in coverage.
"Creditable coverage" is defined quite broadly and includes nearly all
group and individual health plans, Medicare, and Medicaid.
A "significant break" in coverage is defined as any 63 day period without any creditable coverage.
Title I
also requires insurers to issue policies without exclusion to those
leaving group health plans with creditable coverage (see above)
exceeding 18 months, and
]
renew individual policies for as long as they are offered or provide
alternatives to discontinued plans for as long as the insurer stays in
the market without exclusion regardless of health condition.
Some health care plans are exempted from Title I requirements, such
as long-term health plans and limited-scope plans such as dental or
vision plans that are offered separately from the general health plan.
However, if such benefits are part of the general health plan, then
HIPAA still applies to such benefits. For example, if the new plan
offers dental benefits, then it must count creditable continuous
coverage under the old health plan towards any of its exclusion periods
for dental benefits.
An alternate method of calculating creditable continuous coverage is
available to the health plan under Title I. That is, 5 categories of
health coverage can be considered separately, including dental and
vision coverage. Anything not under those 5 categories must use the
general calculation (e.g., the beneficiary may be counted with 18 months
of general coverage, but only 6 months of dental coverage, because the
beneficiary did not have a general health plan that covered dental until
6 months prior to the application date). Since limited-coverage plans
are exempt from HIPAA requirements, the odd case exists in which the
applicant to a general group health plan cannot obtain certificates of
creditable continuous coverage for independent limited-scope plans such
as dental to apply towards exclusion periods of the new plan that does
include those coverages.
Hidden exclusion periods are not valid under Title I (e.g., "The
accident, to be covered, must have occurred while the beneficiary was
covered under this exact same health insurance contract"). Such clauses
must not be acted upon by the health plan and also must be re-written so
that they comply with HIPAA.
To illustrate, suppose someone enrolls in a group health plan on
January 1, 2006. This person had previously been insured from January 1,
2004 until February 1, 2005 and from August 1, 2005 until December 31,
2005. To determine how much coverage can be credited against the
exclusion period in the new plan, start at the enrollment date and count
backwards until a significant break in coverage is reached. So, the
five months of coverage between August 1, 2005 and December 31, 2005
clearly counts against the exclusion period. But the period without
insurance between February 1, 2005 and August 1, 2005 is greater than 63
days.
Thus, this is a significant break in coverage, and any coverage
prior to it cannot be deducted from the exclusion period. So, this
person could deduct five months from his exclusion period, reducing the
exclusion period to seven months. Hence, Title I requires that any
preexisting condition begin to be covered on August 1, 2006.
Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform
Title II of HIPAA defines policies, procedures and guidelines for
maintaining the privacy and security of individually identifiable health
information as well as outlining numerous offenses relating to health
care and sets civil and criminal penalties for violations. It also
creates several programs to control fraud and abuse within the health
care system.
However, the most significant provisions of Title II are its Administrative Simplification rules. Title II requires the
Department of Health and Human Services
(HHS) to draft rules aimed at increasing the efficiency of the health
care system by creating standards for the use and dissemination of
health care information.
These rules apply to "covered entities" as defined by HIPAA and the
HHS. Covered entities include health plans, health care clearinghouses,
such as billing services and community health information systems, and
health care providers that transmit health care data in a way that is
regulated by HIPAA.
Per the requirements of Title II, the HHS has promulgated five rules
regarding Administrative Simplification: the Privacy Rule, the
Transactions and Code Sets Rule, the Security Rule, the Unique
Identifiers Rule, and the Enforcement Rule.
Privacy Rule
The effective compliance date of the Privacy Rule was April 14, 2003,
with a one-year extension for certain "small plans". The HIPAA Privacy
Rule regulates the use and disclosure of
Protected Health Information (PHI)
held by "covered entities" (generally, health care clearinghouses,
employer sponsored health plans, health insurers, and medical service
providers that engage in certain transactions.)
By regulation, the Department of Health and Human Services extended the
HIPAA privacy rule to independent contractors of covered entities who
fit within the definition of "business associates".
PHI is any information held by a covered entity which concerns health
status, provision of health care, or payment for health care that can be
linked to an individual.
This is interpreted rather broadly and includes any part of an individual's
medical record or payment history. Covered entities must disclose PHI to the individual within 30 days upon request.
They also must disclose PHI when required to do so by law such as reporting suspected
child abuse to state child welfare agencies.
Covered entities may disclose protected health information to law
enforcement officials for law enforcement purposes as required by law
(including court orders, court-ordered warrants, subpoenas) and
administrative requests; or to identify or locate a suspect, fugitive,
material witness, or missing person.
A covered entity may disclose PHI (Protected Health Information) to
facilitate statment, payment, or health care operations without a
patient's express written authorization.
Any other disclosures of PHI (Protected Health Information) require the
covered entity to obtain written authorization from the individual for
the disclosure.
However, when a covered entity discloses any PHI, it must make a
reasonable effort to disclose only the minimum necessary information
required to achieve its purpose.
The Privacy Rule gives individuals the right to request that a covered entity correct any inaccurate PHI.
It also requires covered entities to take reasonable steps to ensure the confidentiality of communications with individuals.
For example, an individual can ask to be called at his or her work number instead of home or cell phone numbers.
The Privacy Rule requires covered entities to notify individuals of
uses of their PHI. Covered entities must also keep track of disclosures
of PHI and document privacy policies and procedures.
They must appoint a Privacy Official and a contact person
responsible for receiving complaints and train all members of their workforce in procedures regarding PHI.
An individual who believes that the Privacy Rule is not being upheld can file a complaint with the
Department of Health and Human Services Office for Civil Rights (OCR).
However, according to the
Wall Street Journal,
the OCR has a long backlog and ignores most complaints. "Complaints of
privacy violations have been piling up at the Department of Health and
Human Services. Between April of 2003 and November 2006, the agency
fielded 23,886 complaints related to medical-privacy rules, but it has
not yet taken any enforcement actions against hospitals, doctors,
insurers or anyone else for rule violations. A spokesman for the agency
says it has closed three-quarters of the complaints, typically because
it found no violation or after it provided informal guidance to the
parties involved."
However, in July 2011, UCLA agreed to pay $865,500 in a settlement
regarding potential HIPAA violations. An HHS Office for Civil Rights
investigation showed that from 2005 to 2008 unauthorized employees
repeatedly and without legitimate cause looked at the electronic
protected health information of numerous UCLAHS patients.
The
Center for Public Integrity recently revealed that hundreds of the
country's lowest-rated nursing homes are receiving federally-backed,
guaranteed mortgages. This assistance is worth billions of dollars, so
why is it being given to facilities that harm residents and do not meet
federal safety standards?
Nursing home lawyers at Pintas & Mullins offer an investigation into this issue.
The Department of Housing and Urban Development (HUD) insures
mortgage loans through a little-known program with little to no
oversight. Throughout the country, nursing homes (and particularly
for-profit chains) routinely receive HUD-guaranteed loans, regardless of
the quality of care they provide.
Another federal agency, the Department of Health and Human Services
(HHS) rates the country's nursing homes based on annual health
inspections, staffing levels, and resident care. Take, for example, the
Alden Alma Nelson Manor nursing home in Rockford, Illinois, which
consistently earns the lowest possible quality rating from HHS, and has
earned these abysmal ratings for the better part of a decade. Alden Alma
recently paid hundreds of thousands of dollars in fines for the deaths
of three residents and incidents of abuse and sexual assault. Despite
this, Cambridge Realty Capital approved a $12 million mortgage for the
facility, and the HUD insured the loan.
Another Illinois facility that received an HUD loan, the Crossroads
Care Center in Woodstock, has a federal one-star rating. It was also
fined about $360,000 for the deaths of six residents, including
allegations that a nurse purposefully overmedicated and killed
residents. That nurse, Marty Himebaugh, was found guilty of felony
criminal neglect.
Again, despite this, in 2013 Crossroads Care received $4.4 million in
a HUD-backed loan, it's second since 2001. Similarly, the Alden
Wentworth Rehabilitation nursing home on Chicago's South Side received a
$10.6 million HUD loan, even after a beloved resident fell four stories
at the home, prompting a senate hearing. Two years before the loan,
another resident died after wrongfully receiving narcotics for three
weeks.
Stories like this abound throughout Illinois and the rest of the
country. HUD officials claim that they are not made aware of safety and
health issues, yet how this can be true is disconcerting. Why is there
no system by which HUD employees must check a facility's quality of care
before financing it? Why is there no emphasis put on regulatory
enforcement, or communication between agencies - particularly when it
comes to our nation's most vulnerable citizens?
The
Center for Public Integrity states
that this type of situation is not uncommon: since 2001, hundreds of
the worst-ranked nursing homes in the country have received
HUD-guaranteed loans, worth about $2.5 billion. In fact, the number of
one-star nursing homes receiving HUD insurance rose every year between
2009 and 2012.
An
esteemed nursing professor
at University of California at San Francisco said that this HUD pattern
points to serious issues about the communication - or lack thereof -
between government agencies, an outrageous lack of oversight, and the
improper use of public funding. There hasn't been any public scrutiny
over the HUD's practices, which makes a bad problem even worse.
How, When, and Why This is Allowed
As mentioned, these loans are made possible by a little-known federal
program: the National Housing Act of 1959, which was enacted by Congress
to make it easier for nursing homes to secure loans on reasonable
terms. It was created in effort to provide a reliable stream of income
to nursing homes, which previously had trouble finding loans.
This may seem like a good thing, but the program means that if
nursing homes default on the loans, the public pays (about $187 million
in defaults have been incurred since 1959). These mortgages have been
granted to over 7,000 nursing homes; currently, about 13% of all nursing
homes have HUD-guaranteed loans.
About 240 nursing homes with a one-star rating have HUD loans, with
Ohio having the most of any other state (30). In Illinois, 20 one-star
nursing homes have HUD loans, and California ranked third among states.
For-profit nursing homes make up the large majority of one-star loan
recipients, with corporations owning two-thirds (despite representing
only about half of all nursing homes nationwide). Experts believe that
the HUD should restrict its guaranteed loans to only non-profit nursing
homes, which generally run higher quality and safer facilities. This
makes sense. The government should not be financing large, for-profit,
multi-billion dollar corporations.
Part of the reason these facilities are able to get away with the
death and demise of residents while still securing financial backing is
because the owners spend hundreds of thousands in donations to political
candidates.
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