By Mulligan Law 0

Hospitals across the country are discussing the possibility of universal do-not resuscitate orders for coronavirus patients. According to an article in the Washington Post, hospitals are facing the reality of balancing the risk to hospital staff posed by resuscitating infected patients and attempting life-saving treatment. https://www.washingtonpost.com/health/2020/03/25/coronavirus-patients-do-not-resucitate/. According to the article, ‘[s]everal large hospital systems … are looking at guidelines that would allow doctors to override the wishes of the coronavirus patient or family members on a case-by-case basis due to the risk to doctors and nurses, or a shortage of protective equipment, say ethicists and doctors involved in those conversations. But they would stop short of imposing a do-not-resuscitate order on every coronavirus patient.”

These conversations are happening in the context of a larger discussion about the availability of resources such as hospital beds, intensive care unit beds, and ventilators in the face of rising demand as the Covid-19 pandemic continues to spread. Hospitals are also struggling to provide necessary protective equipment to nurses and doctors providing lifesaving care to these critically ill patients. “[A]s cases mount amid a national shortage of personal protective equipment, or PPE, hospitals are beginning to implement emergency measures that will either minimize, modify or completely stop the use of certain procedures on patients with covid-19.” https://www.washingtonpost.com/health/2020/03/25/coronavirus-patients-do-not-resucitate/

These news stories have caused many families to consider whether they should have advanced directives in place.

La Crosse, Wisconsin, a town with about 50,000 people, has some interesting lessons we can learn about the benefits of making informed decisions about our end-of-life care. Several decades ago, public health officials and major health organizations began developing a model for end-of-life planning and decision making. By 2009, 96 percent of the residents in La Crosse County had an advanced directive in place. This public policy initiative has benefited families and patients in many ways. Families are relieved from some of the emotional and financial stress that comes along with end-of-life care. https://www.forbes.com/sites/offwhitepapers/2014/09/23/how-to-die-in-america-welcome-to-la-crosse/#70188126e8c6.

“There is no more gut-wrenching decision to make for family members than when to let go allowing a loved one to end life peacefully. Knowing in advance the patient’s desires can relieve anxiety and grief by ‘following their final wishes.’” https://www.forbes.com/sites/offwhitepapers/2014/09/23/how-to-die-in-america-welcome-to-la-crosse/#70188126e8c6.

These are important decisions that every individual and family must consider. You have a choice to make informed decisions about the care that you receive and plan in advance.

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By Mulligan Law 0

In response to the COVID-19 crisis, California health officials have extended the special enrollment period for eligible individuals to sign up for health insurance through Covered California. These health insurance plans are subsidized plans for individuals without employer-sponsored health insurance. Several states around the country are re-opening their own health insurance exchanges for a special enrollment period as well. https://www.npr.org/sections/health-shots/2020/03/20/818981380/9-states-reopen-aca-insurance-enrollment-to-broaden-health-coverage.

Although Congress has passed legislation that provides for free coronavirus testing, the subsequent healthcare you might require is expensive. Individuals who do not have health insurance could end up with large medical bills through no fault of their own. A hospitalization lasting several weeks could cost tens of thousands of dollars without insurance according to some studies. https://www.healthsystemtracker.org/brief/potential-costs-of-coronavirus-treatment-for-people-with-employer-coverage/. Many uninsured individuals will find themselves in a difficult position deciding whether they should seek treatment and risk suffering from the dire financial consequences. Public health officials and experts have expressed concern about the impact of individuals avoiding testing and treatment stating that “uninsured residents who don’t get tested for the novel coronavirus because of the fear of the costs of testing and treatment would represent an ‘extremely weak link in the response chain and would make things much worse.’ ” https://www.npr.org/sections/health-shots/2020/03/20/818981380/9-states-reopen-aca-insurance-enrollment-to-broaden-health-coverage.

According to the US Census Bureau, the number of people in the United States that do not have health insurance is approximately 28 million. https://www.census.gov/library/publications/2019/demo/p60-267.html. If you are uninsured, please contact Covered California to discuss your options.

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By Mulligan Law 0

In light of the recent COVID-19 crisis, California Advocates for Nursing Home Reform (CANHR) is demanding new directives to keep residents safe.

The CDC has issued updated guidance to all nursing homes in an attempt to prevent the spread of COVID-19 in nursing homes. These measures include:  restricting all visitation except compassionate care situations; restricting all volunteers and non-essential healthcare personnel; canceling all group activities and communal dining; and active screening of residents and healthcare providers.    https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/prevent-spread-in-long-term-care-facilities.html

Here in California, the restrictions are being extended to state nursing home surveyors who normally provide oversight to detect “life-threatening infection control problems” and understaffing.  CANHR is calling for the California Department of Public Health take action to protect nursing home residents when they need it the most.

  • Reassigning nurse evaluators to monitor nursing homes onsite throughout the state until the crisis passes;
  • Closely monitoring nursing home staffing levels on a daily basis;
  • Issuing a moratorium on involuntary transfers and discharges of residents;
  • Ensuring nursing homes provide meaningful, frequent, and safe opportunities for residents to maintain contact with loved ones remotely until visitation is restored.

CANHR has a website specifically dedicated to provider alerts, news and resources regarding the COVID-19 Crisis as it relates to nursing homes. http://canhrcovidnews.com/ If you believe a loved one has been injured through neglect or abuse at a nursing home or residential care facility for the elderly, contact our offices at (619)238-8700.

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By Mulligan Law 0

Nursing homes and assisted living facilities have now gone to stricter measures to try to contain the threat of COVID-19.

Due to the novel coronavirus, homes have gone from asking guests to sign in and disclose prior travel, then to taking their temperature, to now requesting all nonessential visits be postponed indefinitely and ordering that residents not leave the facility nor their rooms. Many of these homes have graduated levels of care, from relatively independent living to more intensive physical and memory care. The continuing care community is at high risk as is widely known. Many individuals who succumb to the worst ravages of the virus already have underlying medical conditions. For safety of individuals and the community, administrators do not want residents with the ability to come and go on their own to participate in events with crowds or groups of more than ten people. The extreme precautions being undertaken at some homes include ordered complete isolation simply due to risk, aside from any testing or suspicion of infection.

At this point, as of this writing, most of these facilities have suspended group exercise classes and all other activities, and have made changes to their dining rooms, allowing only take-out meals, or delivering food or food choices on trays to rooms of individuals ordered isolated there.

Those who think they must visit any group living facility for elders should be ready to have explicit, important reasons to be there. Many homes are running low on supplies, and do not have the items needed to properly protect their residents, nor the resources to deal with visitors who must be turned away. Many homes were ill-equipped in the first place, through understaffing or undertraining. Compare your home’s track record:
https://www.medicare.gov/nursinghomecompare/search.html

Aside from providing love, company and a familiar friendly face, families also provide important monitoring and oversight of the care people are receiving. There are of course also concerns for those with dementia deteriorating without routine and regular stimulation and communications. The timing is bad in these situations, because family would like to be there more frequently and prevent the decline of the disease of dementia often exacerbated by isolation, loneliness and depression.

Stopping physical visits shouldn’t mean curtailing all communications from family and friends. Contact the home directly and ask that they help your family member get on-line, work email and do Skype or Facetime. A useful device to make authorized drop-in virtual visits without a lot of tech to handle for the elder is “Echo Show” which you can interface with through the Amazon Alexa app on the iphone app store. At the very least, make regular old-fashioned phone calls to keep tabs on your elder. Here are some useful links:
https://www.aarp.org/home-family/personal-technology/info-2020/vr-social-connections.html ;
https://www.aarp.org/caregiving/health/info-2020/preventing-coronavirus-in-nursing-homes.html

In some cases, families may want to take their loved one home with them, and that is being encouraged in some facilities, with the proviso that they then may not be permitted to re-enter until further notice. It may not always be the most wise choice. (See the second link in paragraph above for more details.) However, it may be hard to remove a resident, especially if they are very frail, have a chronic condition, or need a high level of care, or memory assistance. Be sure to have a plan in place for bathing, feeding and taking medicine. If you hire a home health agency, be sure to check them out well. Ask the agency what measures and precautions they will be taking when caring for your loved one. Monitor them. Anyone providing hands-on care should be following the current recommendations by the CDC.

Hope this information is helpful in some way to flatten the curve. Or, at the very least, hope it helps you stay as close as you can to your loved ones during these unprecedented circumstances. (Remind them to hydrate!) Be well.

If you believe a loved one has been injured through neglect or abuse at a nursing home or residential care facility for the elderly, please call us at (619) 238-8700

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By Mulligan Law 0

Just as we must collaborate to safeguard our society and banish COVID-19, so too is it necessary for us to unite in order protect the legal rights of our elderly citizens.

Healthcare lawyers can help in this crisis by providing patient advocacy, protecting the most severely affected including the elderly who are often not represented, especially when they are in nursing homes.

To slow the rising tide of the pandemic, family members and visitors are barred from visiting nursing home residents.  In a troubling, but not entirely surprising display of lousy timing, the Trump administration is also considering relaxing federal oversight on nursing homes, including rules meant to curb deadly infections among elderly residents. This is a foolhardy move on the heels of and in addition to CMS restricting nursing home visitors and non-essential personnel.

Who will protect our elderly and most vulnerable citizens if family and friends are denied access to them and nursing home oversight is relaxed NOW, in the middle of a pandemic? In these difficult times, we need more patient safety, not less.

Nursing homes house about 2.5 million people nationwide. Nursing home residents have already been identified as especially vulnerable to COVID-19. Because of their age and pre-existing health problems, the elderly are at an increased risk of not only contracting this virulent virus but also from dying from it. Nonetheless, the Trump administration announced plans to eliminate the requirement that nursing homes keep at least one infection-prevention specialist on hand.  These anti-infection specialists serve a key role, making sure nursing home staff stick to crucial safety rules, such as consistently washing their hands.

Recently, 31 coronavirus deaths were linked to a single long-term nursing home in Kirkland, Washington. The New York Times points out that as recently as last year, this same Life Care Center facility received multiple citations related to failings in its infection control systems.  This is precisely the type of risks anti-infection specialists are employed to prevent and to manage.

Now is the time to ramp up oversight of our countries’ nursing homes– when their loved ones are banned from visiting them and there is no one else able to watch over their care.

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