Category Archives: Housing

Some nursing homes are illegally evicting elderly and disabled residents who can’t afford to pay

January 22, 2020

courtesy of NAELAeBulletin:

By Katie Engelhart
to see graphics within article, go to:

BISHOP, Calif. — When Jamie Moore arrived home on a Thursday evening in March, she was surprised to find her mother-in-law in her living room. Glenda Moore, 67, had been sitting in her wheelchair for hours. Without anyone to help her to the bathroom, she’d had an accident. She was also having trouble breathing. “It was awful,” Jamie Moore recalled.

Glenda Moore told Jamie that she had been discharged from the Bishop Care Center nursing home, in Bishop, California. She had been living at the nursing home — a sprawling brick building on the side of a state highway — for several weeks, recovering from a back surgery that unexpectedly left her unable to walk much or take care of herself.

Several days earlier, nursing home administrators had shown Glenda Moore a letter from Medicare, explaining that her rehabilitation coverage was ending. She was unable to pay the nursing home’s more-than-$7,000 monthly fee, so, thinking she had no other options, she left. (A relative dropped her off at Jamie’s home, where Glenda Moore had lived previously, without telling Jamie.)

“They pushed her out and she was not ready,” Jamie Moore, who has worked as a nursing assistant, said. “She was not ready at all.”

As the family later learned, Glenda Moore had the right to appeal the Medicare decision, or to apply for Medicaid — and, if she qualified (which she later did), to stay in the nursing home on Medicaid for as long as she needed nursing care. Instead, Moore’s family said, Moore became one of thousands of Americans discharged against their wishes or evicted from nursing homes each year. (The Bishop Care Center maintains that Moore’s health had improved and that she voluntarily left the facility, and points out that they gave her a document noting her right to appeal the Medicare decision.)

Nationally, long-term care ombudsmen, who advocate for elderly and disabled residents of nursing homes and assisted living facilities, received 10,610 complaints about discharges and transfers in 2017, up from 9,192 in 2015. The ombudsmen, whose work is federally mandated and state-funded, receive more complaints about discharges and transfers than any other grievance.

The complaints likely expose just a small fraction of the problem, said Kelly Bagby, vice president at the AARP Foundation, a nonprofit that serves vulnerable people over 50.

“Most people don’t even know they have rights,” she said. And many complaints never result in a formal state investigation.

Advocates, experts and the federal government say that nursing homes tend to evict low-income, longer-term residents who receive Medicaid, to make room for shorter-term rehabilitation patients who are covered by Medicare. Medicare reimburses nursing homes at a higher rate than Medicaid, so it’s more lucrative for facilities to house Medicare patients who stay for short stints before recovering and moving elsewhere.

In California, for example, the average state Medicaid reimbursement for a nursing home is $219 per day, according to the California Association of Health Facilities, while Medicare may reimburse more than $1,000 per day, but only for up to 20 days, when patients must begin paying part of the fees. (Medicare coverage ends completely after 100 days.) Advocates say that eviction notices are often handed out around the 20-day mark.

“It is illegal to discriminate against residents based on payment source, but it happens all the time,” said Tony Chicotel, attorney at the California Advocates for Nursing Home Reform, a nonprofit that supports long-term care residents in the state. “It feels like there’s just a tidal wave of cases.”

Chicotel said he receives calls every day from panicked residents or family members being threatened with discharge from a long-term care facility.

Deborah Pacyna, director of public affairs at the California Association of Health Facilities, a trade association representing nursing homes, told NBC News that improper and illegal discharges are “a really rare thing,” and that the issue is exaggerated by media attention.

She added that California’s Medicaid program, Medical, does not provide “adequate funding” to care for many patients with complicated health issues and behavioral disorders. “Medicare pays more. Those people are rehab patients; they’re in and out,” she said. “That is how they break even,” she added of nursing homes. “Society’s problems are manifesting themselves on the doorsteps of nursing homes.”

‘You’re just a piece of garbage’

Nursing homes are legally permitted to evict residents under several conditions: if a resident’s health improves sufficiently; if his presence in a facility puts others in danger; if the resident’s needs cannot be met by the facility; if he stops paying and has not applied for Medicare or Medicaid; or if the facility closes. Facilities are obligated under federal law to give 30 days’ notice, in writing, and also to work with the resident on a transition plan.

Bagby, of the AARP, said that while some residents are issued formal discharge letters with advance notice, others are asked or pressured to leave with “no due process rights, no notice.”

In one case in Los Angeles, in April 2018, Ronald Anderson said he was woken at night by the nursing home staff at the Avalon Villa Care Center and told he was being evicted. Anderson, 51 at the time, had moved into the facility over a year earlier to recover from a partial foot amputation. He said he was loaded into a van and dropped off on a sidewalk in downtown Los Angeles, which has one of the largest homeless populations in the country, according to a report from the California Department of Public Health.

Anderson, who is diabetic, was left in a wheelchair without his insulin or testing supplies — on a street cluttered with tent encampments and broken glass. The Department of Public Health report noted that he could have slipped into a coma or died.

“You’re just a piece of garbage,” Anderson said, from the Union Rescue Mission homeless shelter in Los Angeles where he now lives. “They’ll kick you right out on the curb.”

Avalon Villa Health Care, which runs the nursing home, later paid $450,000 to settle a civil complaint filed by the Los Angeles city attorney in response to Anderson’s case and other evictions of homeless residents, with the money going toward civil penalties, hiring and training Avalon Villa staff and finding temporary housing for the facility’s homeless residents. The city attorney set up an emergency hotline and invited members of the public to report cases of resident abandonment.

A lawyer for the Avalon Villa Care Center told NBC News that the facility “strongly disputes that it has inappropriately discharged any patients” and “rejects the allegations of the city attorney.”

The Rev. Andy Bales, director of the Union Rescue Mission, said “resident dumping” from nursing homes and hospitals is so common that the shelter set up a security camera outside — which Bales calls “the dump cam” — to capture evidence of it. He said he is aware of at least four instances from the last year in which people have been dropped off on nearby streets by hospitals or nursing homes — though he believes the number is higher. As a result of the security camera, he said, “They won’t dump them off in front of us anymore.”

California’s long-term care ombudsmen received 1,404 complaints about nursing home evictions in 2018, up from 1,022 in 2014. Several lawsuits concerning nursing home discharges have recently been filed in the state.

Molly Davies, a California long-term care ombudsman, said that in addition to receiving more complaints about evictions, “there has also been an uptick in the egregiousness of some of these cases.”

In some instances, she and other experts said, nursing homes drop residents off at a low-cost motel and pay for a night or two. “We’ve seen cases with residents who have dementia put into a van and dropped downtown onto the streets, without the ability to care for themselves,” she said.

The California Department of Public Health does not track where nursing homes discharge patients, according to a department spokesman, nor does the California long-term care ombudsman program. In some instances, however, routine state inspections and inspections following complaints uncover problems.

In a 2018 incident, described in a California Department of Health and Human Services report, a Rosemead nursing home discharged a resident to a hotel without any medical equipment and without ensuring that the hotel was “a safe environment.” The female resident still required assistance with activities such as using the toilet and bathing, and was found to lack “the capacity to make her needs known.” The nursing home received a federal “deficiency” citation.

In another case that resulted in a deficiency citation, a nursing home resident who “needed extensive assistance” to move between locations in his bedroom was discharged to a motel — and, a few days later, ended up in a hospital for emergency care.

These practices are not unique to California. In Maryland, one nursing home resident was dropped off in Baltimore, a city she had never been to, according to the state attorney general’s office. In another instance, a Washington County Sheriff’s deputy accused a nursing home of discharging a resident to a storage unit on a hot summer day.

Even when residents appeal eviction decisions through a state process and win the right to return to a nursing home, that nursing home sometimes refuses to readmit them, a group of plaintiffs told the Ninth Circuit Court of Appeals found in July. The case is still pending, but the appeals court agreed with the plaintiffs that federal law does not allow “meaningless show trials that allow nursing homes to persist in improper transfers and discharges.”

The California Department of Health Care Services, the California Department of Public Health and the federal Centers for Medicare & Medicaid Services all declined to comment, citing department policy not to comment on pending litigation.

A push for enforcement

In 2016, the Centers for Medicare & Medicaid Services strengthened regulatory requirements around nursing home discharges and transfers, specifying that residents cannot be evicted for nonpayment while they are in the process of applying for Medicaid or appealing a Medicaid denial. A year later, the agency announced an initiative to prevent illegal nursing home discharges, acknowledging that “some discharges are driven by payment concerns, such as when Medicare or private pay residents shift to Medicaid as the payment source.”

So far, the agency has approved $784,630 for a program in California that focuses on training nursing home staff on discharge regulations, a spokeswoman said in an email. The agency also provided $84,00 for a smaller project in Montana. Beyond that, the agency is not acting directly to address illegal evictions but is instead encouraging states “to propose projects that seek to address facility-initiated discharges that violate federal regulations,” the spokeswoman said by email.

Advocates for nursing home patients said more is needed. They want both federal and state agencies to do more to enforce existing rules on evictions.

“We haven’t seen any change in practice,” said Davies, the California long-term care ombudsman. “We haven’t seen a reduction in inappropriate transfers and discharges. There are certain enforcement tools that they have that they aren’t using consistently.” These tools, she said, include substantial fines.

But the federal government has made changes that reduced fines against nursing homes that harm or endanger residents. Nursing homes used to receive fines for each day a violation was observed, but after a change the Trump administration implemented in July 2017, nursing homes are now usually fined just once per retroactive violation.

Robyn Grant, director of public policy and advocacy at the National Consumer Voice for Quality Long-Term Care, an advocacy group, says this change can affect the way illegal evictions are punished. For instance, a nursing home that evicts a patient and refuses to readmit the person may be fined one time, instead of every day that the resident is denied access to a bed.

In the first 18 months following the change in guidelines, nursing homes across the country paid about $47 million less in fines for all violations compared to the previous 18-month period, said Dr. David Gifford, senior vice president of quality and regulatory affairs at the American Health Care Association, the nursing home industry’s main lobbying group.

Gifford told NBC News that the change was not about saving the industry money, but was meant to ensure consistent standards. He said the new fine structure incentivizes nursing homes to report violations and improve resident care.

‘I thought I was completely covered’

After she left the Bishop Care Center nursing home in March, Glenda Moore grew sicker. Over the following weeks, she cycled among her son and daughter-in-law’s home, several emergency rooms and another nursing home an hour away. According to her son and daughter-in-law, she was diagnosed with a bladder infection and pneumonia.

“I don’t want to be a burden on the kids,” Glenda Moore told NBC News in an interview in April. “I had retirement insurance, I had Medicare, I thought I was completely covered. That doesn’t count for anything … I had no idea.”

In May, her family appealed her discharge from the center. At a hearing conducted by the California Department of Health Care Services, the nursing home’s administrator said Glenda Moore had left willingly, according to the state’s summary report.

The state’s hearing officer ultimately found that the facility “failed to meet all of the regulatory-mandated discharge planning requirements.” However, the hearing officer ruled in favor of the nursing home, noting that Glenda Moore agreed to leave and was given paperwork notifying her of her right to appeal Medicare’s noncoverage decision.

By late July, her weight had dropped to about 80 pounds. She was hospitalized, and on Aug. 2 she died from acute renal failure and cardiopulmonary arrest.

Her family believes she wouldn’t have become so sick if she had been able to stay in the Bishop Care Center for a few weeks longer, until she was more stable.

Jamie Moore said her mother-in-law’s experience has changed the way she thinks about her own retirement.

“I never thought about it much until now. It scares the crap out of me,” she said. “The system is the system. What are you doing to do?”

For Boomers Reframing Aging, Age-Proofing A Home Won’t Come Cheap

November 18, 2019

courtesy of NAELAeBulletin:

AUSTIN, Texas — Dennis and Chris Cavner, in their early 70s, are preparing to move less than two blocks away into a 2,720-square-foot, ranch-style house they bought this year. But first a renovation is underway, taking the 45-year-old property all the way back to its studs. When the work is finished, these baby boomers are confident the move will land them in their forever home.

“We wanted to find a house that we could live in literally for the rest of our lives,” Dennis Cavner said. “We were looking specifically for a one-story house and one that had a flat lot, to age in place.”

For most of American history, people have moved in with relatives or gone to a care facility to live out their final years. Baby boomers don’t want either, and those with resources have generally created the modern idea of remaking old age to fit their lifestyle and retrofitting their homes for aging in place. Design and construction firms are coming up with safety features that look good as well. Think of it as the age-defying home.

Aging in place is a major financial commitment, one that may be at odds with retirees’ plans to downsize their lives and budgets and squirrel away cash in anticipation of rising health care costs. The Cavners are rebuilding this house — assessed at $700,000 around the time of the sale — from a shell. The remodel could easily cost $300,000 in the hot Austin market.

Leaving nothing to chance, the Cavners are paying for a number of modifications they might never need. For instance, neither uses a wheelchair, but contractors are making all doorways 3 feet wide — just in case. The master bath roll-in shower, flat and rimless, will provide room to maneuver. In the kitchen, drawers, rather than cabinets, will allow easy access in a wheelchair.

The Cavners are closely watching details of the renovation, but this dramatic late-life relocation wasn’t a hard decision.

For some seniors, aging in place might amount to simple modifications, such as adding shower grab bars or replacing a standard toilet with one that sits taller. But many seniors anticipate a financial crunch as they try to plan for their future on a fixed income, uncertain how far their savings and retirement funds will stretch.

A report released last week by the Harvard Joint Center for Housing Studies may fuel these concerns. It cites growing income disparity for older Americans in the wake of the Great Recession, and says “ensuring financial and housing security in retirement will be a struggle.”

For those 65 and older, it said, “the number of households with housing cost burdens has reached an all-time high. By 2050, almost one-quarter of Americans will be 65 or older, according to the Census. Surveys conducted over the past decade show that older adults overwhelmingly want to age in their homes.

Yet many houses aren’t suited to “aging in place,” said Abbe Will, associate project director of the Remodeling Futures Program at Harvard.

“Currently, a lot do not have single-floor living — especially in certain parts of the country. There are lots of stairs and multistory homes when land is more valuable,” she said. And “many homeowners don’t necessarily have the funds to do aging in place.”

Home modifications and costs vary widely — starting with those simple safety features in the bathroom or lever doorknobs throughout the house — to more extensive changes, such as widening doorways or lowering light switches to wheelchair height. Will said simple retrofits, such as grab bars, “could be several hundred dollars,” but a “whole bathroom remodel would be in the thousands or tens of thousands.”

In a recent survey of 1,000 people age 65 and older by the California-based nonprofit SCAN (formerly the Senior Care Action Network), 80% of respondents were concerned about their ability to age in place. The driver appears to be financial: About 60% said they have less than $10,000 in savings (including investments and retirement plans).

“We don’t know what’s coming down the pipeline as we age,” said sociologist Deborah Thorne of the University of Idaho, lead author of a study that found skyrocketing bankruptcy rates among those 65 and older.

The research, recently published in the journal Sociological Inquiry, finds the share of older Americans filing for bankruptcy has never been higher. “And bankrupt households are more likely than ever to be headed by a senior — the percent of older bankrupt filers has increased almost 500 percent since 1991,” the study found.

The Harvard report also cited the burden of debt among those ages 65 to 79, with nearly half of those homeowners carrying a mortgage in 2016. And people are carrying substantially more student loan and credit card debt into retirement as well.

James Gaines, an economist with the Real Estate Center at Texas A&M University, attributes the increase “to the labor market and employment downsizing and letting older people go first. It can force them into retirement whether they’re ready for it or not. Retirement income may not be enough to carry their debts, and they don’t have enough savings.” 

“The leading edge of baby boomers has not hit 75 yet,” said Jennifer Molinsky, lead author of the Harvard report. “When you think about the next five, 10 or 15 years when they’re in their 80s, you’re really going to see the needs shift.”

Molinsky said just what financially challenged seniors should do about housing “is a good question and is a tough question.” Many states have loan and grant programs for home modifications if individuals have a documented disability, she said, yet “what we need more of are programs that help you do this before you need it.”

Molinsky said communities need to create housing near city centers so seniors don’t have to drive. And in the suburbs, communities need to offer more multifamily options, including condos and apartments to buy and rent.

“We just need options,” she said. “It’s important to think about housing options that help people stay in that community. Low-income people need housing that’s affordable. Some people want to trade that single-family home for a condo. Others want to reassess their money and sell their home for a rental. Not everybody wants the same thing.”

Don and Lynn Dille, both 75, built their Austin home with the intention of staying there for a long time. After living in California, Virginia and elsewhere in Texas, they moved to Austin in 2012 and, within a year, began drawing plans with an architect for an energy-efficient home to age in place. Their home was featured this summer in Austin’s annual Cool House Tour for its design making the most of natural light, cross-ventilation and solar panels, as well as wider-than-normal doorways and level floors for wheelchair use.

One key feature of the construction acknowledges that they might need live-in help down the road to avoid long-term nursing care. Just as the Cavners may convert a bedroom and bath on the opposite side of their new home into caregiver quarters, the Dilles constructed a second floor above their detached garage that could convert into living space.

“We think having a separate apartment where we could have a caretaker or part-time help to maintain our property makes us able to stay where we’d like to be and be independent,” said Don Dille, who retired from the federal government.

The renovations are meant to meet very personal needs, but that doesn’t mean they wouldn’t appeal to others and even add to the resale value down the road.

For his part, Cavner, an investment adviser and co-founder of a new health care startup, said he believes what they’re spending to renovate the house for the years ahead will prove a sound investment: “The modifications we’re making are not going to make it less desirable. It will feel more spacious.”

HUD Releases New Condo Rules for Reverse Mortgages

October 15, 2019

The U.S. Department of Housing and Urban Development (HUD) issued a new Mortgagee Letter (ML) late Thursday updating the origination requirement for FHA mortgages on condominium units, applicable to both the traditional, forward mortgage and reverse mortgage programs simultaneously. The letter provides additional clarification ahead of the rule’s implementation on October 15.

“FHA published ML 2019-17, Home Equity Conversion Mortgage (HECM) Program – Condominium Requirements, which outlines the updated origination requirements for HECMs in condominium projects in accordance with the recently published Single-Family (SF) Handbook guidance,” said HUD in a press release. “It also includes certain borrower eligibility requirements for seniors seeking to obtain a HECM for a condominium unit using FHA’s Single-Unit Approval process.”

Read the FHA INFO notice and the full Mortgagee Letter at HUD for further details on the changes.

Last month, HUD announced a forthcoming rule designed to make it easier for condo owners to get reverse mortgages and other FHA financing. The new rules related to condominiums going into effect next month will expand FHA financing for qualified first-time homebuyers as well as seniors looking to age in place, according to an August press memo released by HUD.

“For seniors, part of our mission is to provide affordable options to age in place. Condominiums can make a lot of sense for many seniors [for reasons of affordability],” said FHA Commissioner and Acting Deputy HUD Secretary Brian D. Montgomery on an August conference call with reporters. “Our single unit review now also includes reverse mortgages, known as Home Equity Conversion Mortgages (HECMs), designed to help seniors age in place.”

FHA estimated the new policy will notably increase the amount of condominium projects that will be able to gain FHA approval. 84% of FHA-insured condominium buyers have never owned a home before, according to agency data. Only 6.5% of the more than 150,000 condominium projects in the United States are approved to participate in FHA’s mortgage insurance programs.

Web Design by Accent Interactive