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Feds Order More Weekend Inspections Of Nursing Homes To Catch Understaffing

January 2, 2019

The federal government announced plans Friday to crack down on nursing homes with abnormally low weekend staffing by requiring more surprise inspections be done on Saturdays and Sundays.

The federal Centers for Medicare & Medicaid Services said it will identify nursing homes for which payroll records indicate low weekend staffing or that they operate without a registered nurse. Medicare will instruct state inspectors to focus on those potential violations during visits.

“Since nurse staffing is directly related to the quality of care that residents experience, CMS is very concerned about the risk to resident health and safety that these situations may present,” the agency said in a notification to state inspection offices.

The directive comes after a Kaiser Health News analysis found there are 11 percent fewer nurses providing direct care on weekends on average, and 8 percent fewer aides.

Residents and their families frequently complain the residents have trouble getting basic help — such as assistance going to the bathroom — on weekends. One nursing home resident in upstate New York compared his facility to a weekend “ghost town” because of the paucity of workers.

Richard Mollot, executive director of the Long Term Care Community Coalition, an advocacy group in Manhattan, welcomed the new edict but said it was only necessary because state inspectors have not been properly enforcing the rules already on the books.

“The basic problem is the states don’t take this seriously,” Mollot said. “How many studies do we have to have, year after year, decade after decade, saying it all comes down to staffing, and there are very few citations for inadequate staffing and virtually all of them are identified as not causing any resident harm?”

CMS said it will identify potential violators by analyzing payroll records that nursing homes are now required to submit. Those records, which became public this year, showed lower staffing than what facilities had previously told inspectors during their visits, according to the KHN analysis.

“CMS takes very seriously our responsibility to protect the safety and quality of care for our beneficiaries,” CMS Administrator Seema Verma said in a statement.

The nursing home industry criticized the heightened scrutiny.

“Unfortunately, today’s action by CMS will enforce policies that makes it even more difficult to meet regulatory requirements and hire staff,” said Dr. David Gifford, senior vice president of quality and regulatory affairs at the American Health Care Association, an industry trade group, in a written statement. “Rather than taking proactive steps to address the national workforce shortage long-term care facilities are facing, CMS seems to be focusing on a punitive approach that will penalize providers and make it harder to hire staff to meet the shared goal of increasing staffing.”

Currently, a tenth of inspections must occur during “off hours,” which can be either a weekend, or during a weekday before 8 a.m. or after 6 p.m. But for facilities that Medicare identifies as having lower weekend staffing, half of those off-hour inspections—or 5 percent of the total — must be performed on Saturdays or Sundays.

Medicare requires nursing homes to have a registered nurse on site for at least eight hours every day, but according to the payroll records, a quarter of nursing homes reported no registered nurses available at least one day during a three-month period. Since July, Medicare’s Nursing Home Compare website for consumers has highlighted homes that lack sufficient registered nurses and lowered their star ratings. Nursing Home Compare has downgraded ratings for 1,402 of 15,600 facilities for gaps in registered nurse staffing, records show.

The new directive instructs inspectors to more thoroughly evaluate staffing at facilities Medicare flags. The edict does not mean a flurry of sudden inspections. Instead, Medicare wants heightened focus on those nursing homes when inspectors come for their standard reviews, which take place roughly once a year for most facilities.

But what may appear to be staffing scarcities in payroll records may instead be clerical problems in which nurse hours are not properly recorded, say some nursing home officials.

Katie Smith Sloan, president of LeadingAge, an association of nonprofit providers of aging services, said in a statement that some homes are still struggling to adapt to the new data collection rules.

“We’ve been voicing our concerns to CMS and will continue to do so,” she said.

KHN’s coverage of these topics is supported by John A. Hartford Foundation and The SCAN Foundation

CFPB Releases “Managing Someone Else’s Money” Guides

January 2, 2019

Millions of Americans manage money or property for a loved one who’s unable to pay bills or make financial decisions. To help financial caregivers, we’ve released easy-to-understand guides.

About the guides

The guides help you understand your role as a financial caregiver, also called a fiduciary. Each guide explains your responsibilities as a fiduciary, how to spot financial exploitation, and avoid scams. Each guide also includes a “Where to go for help” section with a list of relevant resources.

Managing Someone Else’s Money guides

Featured video
If you are serving as a financial caregiver, navigating your role can be difficult. We’re here to help.

Find the right guide for you

The guides are tailored to the needs of people in four different fiduciary roles:

Power of attorney

Guides for those who have been named in a power of attorney to make decisions about money and property for someone else.

View power of attorney guides

Court-appointed guardians

Guides for those who have been appointed by a court to be guardians of property or conservators, giving them the duty and the power to make financial decisions on someone’s behalf.

View guides for court-appointed guardians


Guides for those who have been named as trustees under revocable living trusts.

View guides for trustees

Government fiduciaries

Guides for those who have been appointed by a government agency to manage another person’s income benefits, such as Social Security or Veterans Affairs benefit checks.

View guides for government fiduciaries

Handbook for Helping People Living Alone with Dementia Who Have No Known Support

January 2, 2019

2018 NADRC:
Handbook for Helping People Living Alone with Dementia Who Have No Known Support

The Handbook for Helping People Living Alone with Dementia Who Have No Known Support provides practical guidance as well as tools for helping a person living alone who does not have informal supports, including people with dementia who have a caregiver that cannot provide support. The handbook includes practical strategies for identifying people who are living alone without support, assessing risk, building trust, identifying family and friends willing to help, determining decision-making capacity, options for helping the person maintain their independence, and the basics of guardianship or conservatorship.

Also: Living Alone: living alone with dementia, live alone, single, widowhood, unmarried, no support, no family, autonomy, capacity, care planning, competency, ethics, financial capacity, informed consentFile: 


2018 NADRC: Handbook for Helping People Living Alone with Dementia Who Have No Known Support

2018’s States with the Best Elder-Abuse Protections

January 2, 2019

Abuse happens every day and takes many forms. But vulnerable older Americans are among the easiest targets for this misconduct, especially those who are women, have disabilities and rely on others for care. By one estimate, elder abuse affects as many as 5 million people per year, and more than 95 percent of all cases go unreported.

Unless states take action to prevent further abuse, the problem will grow as America becomes an increasingly aging nation. The U.S. Census Bureau expects the population aged 65 and older to nearly double from 43.1 million in 2012 to 83.7 million in 2050, much to the credit of aging Baby Boomers who began turning 65 in 2011. And by just 2030, 1 in 5 U.S. residents will be retirement age.

View the full Article

Aging in (Whose?) Place?

December 11, 2018

Almost twenty years after Maryland established Medicaid “home and community-based services” waiver programs designed to keep older Marylanders and Marylanders with disabilities in their own homes rather than in a nursing home, Marylanders are still unable to “age-in-place.” Maryland continues to underfund the Maryland Medicaid Home & Community-Based Options Waiver, despite the program’s over 22,000-person, eight-year waiting list. Not only are many Marylanders unable to get the services they want and need to continue living at home, Maryland fails to save millions of dollars that can be realized by adopting a strong policy of avoiding unnecessary nursing home admissions.

To find out more, and what your legislators can do about this problem, read Jason A. Frank’s opinion-editorial published in The Baltimore Sun, available online at:

A Comparison of 529 ABLE Accounts, Pooled Special Needs Trusts, and Special Needs Trusts

December 11, 2018

This article and the accompanying chart were originally published in 2016 by Joanne Marcus, MSW, and Theresa M. Varnet, MSW, JD.
The 2018 updates were provided by Karen Dunivan Konvicka, JD.

The ABLE Act allows an individual with a disability to have a tax-preferred savings account without jeopardizing his or her Medicaid and SSI eligibility. See a comparison chart of ABLE accounts and trusts at the end of this article.

Download PDF of article (19 pages)

How Long $1 Million in Retirement Will Last in Every State

September 12, 2018

Anywhere between 12 and 26 years, depending on the state.

By Joel Anderson
ELA News
August 6, 2018

About 10,000 people turn 65 in the U.S. every single day. The average American retirement age is 63, and the life expectancy for retirees is about 79. That means Americans should plan to spend 16 years in retirement. However, many Americans lack the savings needed to survive retirement.

Conventional wisdom suggests a retirement income nest egg of at least $1 million, but the buying power of $1 million varies wildly depending on where you live. So if you’re asking “how long will my money last in retirement,” the answer is “it depends on your state.”

In order to determine how long $1 million will last the average retiree in every state, GOBankingRates found the average total expenditures for people 65 and older, which includes groceries, housing, utilities, transportation and healthcare, then factored in the cost of living index in each state to find the average budget for a retiree.

Dividing a theoretical $1 million by the costs per state reveals the number of years $1 million will last retirees in every state. Click through to learn just how long that is, and see if $1 million is enough for retirement in your state.

Read full article: How Long $1 Million in Retirement Will Last in Every State.

Medigap Enrollment and Consumer Protections Vary Across States

September 12, 2018

By Pam Belluck
ELA News
July 25, 2018

One in four people in traditional Medicare (25 percent) had private, supplemental health insurance in 2015—also known as Medigap—to help cover their Medicare deductibles and cost-sharing requirements, as well as protect themselves against catastrophic expenses for Medicare-covered services. This issue brief provides an overview of Medigap enrollment and analyzes consumer protections under federal law and state regulations that can affect beneficiaries’ access to Medigap. In particular, this brief examines implications for older adults with pre-existing medical conditions who may be unable to purchase a Medigap policy or change their supplemental coverage after their initial open enrollment period.

Key Findings

  • The share of beneficiaries with Medigap varies widely by state—from 3 percent in Hawaii to 51 percent in Kansas.
  • Federal law provides limited consumer protections for adults ages 65 and older who want to purchase a supplemental Medigap policy—including, a one-time, 6-month open enrollment period that begins when they first enroll in Medicare Part B.
  • States have the flexibility to institute consumer protections for Medigap that go beyond the minimum federal standards. For example, 28 states require Medigap insurers to issue policies to eligible Medicare beneficiaries whose employer has changed their retiree health coverage benefits.
  • Only four states (CT, MA, ME, NY) require either continuous or annual guaranteed issue protections for Medigap for all beneficiaries in traditional Medicare ages 65 and older, regardless of medical history (Figure 1). Guaranteed issue protections prohibit insurers from denying a Medigap policy to eligible applicants, including people with pre-existing conditions, such as diabetes and heart disease.
  • In all other states and D.C., people who switch from a Medicare Advantage plan to traditional Medicare may be denied a Medigap policy due to a pre-existing condition, with few exceptions, such as if they move to a new area or are in a Medicare Advantage trial period.

To read the entire article, see Medigap Enrollment and Consumer Protections Vary Across States at

Social Security Issues Warning About Scams Similar To Those IRS Phone Scams

July 20, 2018

with the permission of NAELA News:

It may be summer, but the bad guys aren’t taking a vacation. The Acting Inspector General of Social Security, Gale Stallworth Stone, has issued a warning about an ongoing phone scam from thieves pretending to be from the Social Security Administration (SSA).

upset senior woman with phoneShutterstock

As part of the con, scammers try to convince you to give up personal information, like Social Security numbers and bank account numbers, over the phone. In another case, a caller claims to be from “SSA headquarters” and asks you to confirm personal information, such as an SSN, “new” Medicare number, address, and date of birth.

Many of these calls are “robocalls” or automated calls. In one robocall version of the scam, an automated recording declares that your Social Security number (SSN) “has been suspended for suspicion of illegal activity,” and advises to contact a specific phone number immediately. The robocall or caller may also warn that if you don’t call back, your assets or benefits will be frozen until your alleged issue is resolved.

Robocalls from scammers pretending to be from government agencies, like the Internal Revenue Service (IRS), continue to be problematic. They are cheap and easy and allows thieves to reach the largest number of victims possible.

You may recall that a “Robocall Strike Force” was established in 2016 to develop solutions to prevent, detect, and filter unwanted robocalls. The task force was made up of communications companies including cell and landline service providers, phone manufacturers, operating system (OS) developers and the Federal Communications Commission (FCC). Members included such communications leaders as Apple, Bandwidth, Comcast, Google, Microsoft, Sprint, T-Mobile, and Verizon. However, two years later, there doesn’t seem to be any real progress made to stop robocalls.

According to an FCC spokesperson, “This industry-led effort produced two detailed reports to the Commission and which were instrumental in laying the groundwork for both on-going FCC policy-making efforts and industry technological work. FCC work that used the Strike Force’s recommendations includes work to reduce robocalls to reassigned numbers, the new FCC rules allowing phone companies to proactively block calls that are likely to be fraudulent, and FCC work to encourage implementation of call authentication. The Commission continues to consult with a wide variety of stakeholders though there are no current plans to formally reconvene this group. Rather, the Strike Force’s reports served their purpose by spurring and framing on-going Commission and industry action to help consumer avoid illegal robocalls.”

The FCC has issued some tips for dealing with robocalls. They include:

  • If you answer the phone and the caller – or a recording – asks you to hit a button to stop getting the calls, you should just hang up. Scammers often use this trick to identify potential targets.
  • Do not respond to any questions, especially those that can be answered with “Yes.” (You can find out more about the dangers of saying “yes” to robocalls here.)
  • Talk to your phone company about call blocking tools they may have and check into apps that you can download to your mobile device to block unwanted calls.
  • If you use robocall-blocking technology already, it often helps to let that company know which numbers are producing unwanted calls so they can help block those calls for you and others.
  • To block telemarketing calls, register your number on the Do Not Call List.

(Click here for more from FCC on how to stop unwanted calls and texts.)

Getting a call from a Robocall, Retro red phone handset with a yellow sticky note and text Robocall
Getting a call from a Robocall, Retro red phone handset with a yellow sticky note and text RobocallShutterstock

In the meantime, robocalls and phone calls made by scammers and thieves continue to be problematic. It’s especially confusing because the IRS has repeatedly advised taxpayers that they will not reach out by phone to resolve taxpayer issues. However, SSA employees do occasionally reach out by telephone for customer-service purposes. Further, the SSA says that in “a few limited special situations” which are “usually” already known to the citizen, an SSA employee may confirm personal information over the phone.

The Acting Inspector General of Social Security, Gale Stallworth Stone, warns folks to be cautious, and to avoid providing information such as your SSN or bank account numbers to unknown persons over the phone or internet unless you are certain of who is receiving it. “Be aware of suspicious calls from unknown sources, and when in doubt, contact the official entity to verify the legitimacy of the call,” Stone said. The SSA advises that if you receive a suspicious call from someone alleging to be from SSA, report that information to the OIG at 1.800.269.0271 or online.

I would go a step further: When in doubt, assume it’s a scam. If you’re not sure whether a call is legitimate, hang up and call back using an official number (don’t just use the caller ID number on your phone since those can be spoofed). To reach IRS, call 1.800.829.1040. To contact Social Security, call 1.800.772.1213.

If you know that it’s a scam, don’t engage with scammers or thieves, even if you want to tell them that you know it’s a scam, or you think that you can best them. Just hang up.

Six Reasons Not To Engage With Scammers, No Matter What Your Facebook Friends Tell You

The IRS says that phone scams are still “a major threat to taxpayers.” In early 2018, phone scams held down the top spot on the IRS “Dirty Dozen” list of tax scams, and the Treasury Inspector General for Tax Administration (TIGTA) reported they have become aware of over 12,716 victims who have collectively paid over $63 million as a result of phone scams since October 2013.

Remember that the IRS will never:

  • Call to demand immediate payment over the phone, nor will the agency call about taxes owed without first having mailed you a bill.
  • Threaten to immediately bring in local police or other law-enforcement groups to have you arrested for not paying.
  • Demand that you pay taxes without giving you the opportunity to question or appeal the amount they say you owe.
  • Require you to use a specific payment method for your taxes, such as a prepaid debit card, gift card or wire transfer.
  • Ask for credit or debit card numbers over the phone.

For more tips on protecting yourself from identity-theft-related tax fraud, click here.

(Author’s note: Updated to include a statement from the FCC.)

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New Law Provides Free Security Freezes and Increased Fraud Alert Protection

July 18, 2018

with the permission of NAELA News:

Jeremiah Battle, National Consumer Law Center

On May 24, 2018, the President signed Public Law 115-174 into law. Section 301 of Public Law 115- 174 amends the Fair Credit Reporting Act, to establish a new federal right for consumers to implement a security freeze of their credit file.1 The freezes are free of charge. The new legislation is effective September 21, 2018.

A security freeze is the single most effective tool to minimize the risk of identity theft. Identity thieves often target unsuspecting older adults, luring them into giving out personal information. The scammers then use this information to steal the older adults’ identity and ruin a lifetime of positive credit.

As a general rule, security freezes allow a consumer to prohibit the release of their credit report. When
a thief applies for credit in the victim’s name, often the intended creditor will attempt to obtain the victim’s credit report or score. The idea behind a security freeze is that, when the credit reporting agency returns no information or a notice that the consumer has frozen the file, the creditor will deny the thief ’s application, thereby thwarting the thief and protecting the consumer’s credit reputation as well as the business interests of the creditor.

The legislation establishes standards for the creation, temporary lifting or “thaw,” and permanent removal of security freezes from the nationwide consumer reporting agencies. The security freezes are essentially limited to parties seeking the consumer’s information for credit purposes.

The freeze does not apply to parties who seek the report for employment, insurance, or tenant-screening purposes. It also does not apply to existing creditors or their agents or assignees conducting an account review, collecting on a financial obligation owed them, or seeking to extend a “firm offer of credit” (i.e., prescreening).

The legislation also preempts state security freeze laws and extends initial fraud alerts from 90 days to one year. A fraud alert notifies users that the consumer has been or may become a victim of fraud or identity theft. The legislation’s preemption extends to any state requirement or prohibition with respect to subject matter regulated by the statute’s provisions relating to security freezes. For example, some state statutes
are stronger than the new federal standards by allowing consumers to freeze access to credit reports for employment or insurance purposes.

Finally, the legislation adds section 1681c-1(j), which establishes standards governing situations where a representative of a minor or incapacitated individual seeks to freeze the individual’s consumer report.2

The new legislation should help older adults avoid identity theft. For more information on security freezes and state laws that are now preempted, see NCLC’s Fair Credit Reporting § and Appendix H.

  1. 1  The FCRA is codified at 15 U.S.C. §§ 1681 to 1681x.
  2. 2  An incapacitated person is one for whom a guardian or conservator has been appointed.

The National Consumer Law Center provides legal professionals with advice on consumer issues as part of NCLER’s case consultation service. Through this service, Justice in Aging, the National Consumer Law Center, and the ABA Commission on Law and Aging provide free case consultations to legal and aging network professionals on a range of legal issues impacting older adults.

Please contact for free case consultation assistance. Sign up for our email list and access more resources at