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Which States Have Been Hardest Hit by the Nursing Home Staffing Crisis?

The COVID-19 pandemic has caused nursing home staffing shortages across the United States, even forcing facilities to close, but some states have been hit harder than others. A new analysis looks at which states are confronting the worst staffing problems. 

Overwhelmed by the stress of long hours, low pay and exposure to the COVID-19 virus, nursing home workers have been quitting in record numbers. According to the Service Employees International Union, more than 420,000 workers -- nearly 10 percent of the workforce -- left the long-term care industry between the start of the pandemic and January 2022. The labor hemorrhage has turned what was already a chronic staffing problem into a full-blown crisis as understaffed facilities struggle to care for patients, accommodate family visitation, and admit new patients waiting in hospitals to be discharged.

The online platform Seniorly, which helps families find senior living facilities, recently analyzed staffing data in all 50 states and identified which ones have been hardest hit. Overall, one-quarter of nursing homes in the United States had staff shortages as of the end of February 2022, but Minnesota was reporting the most, with 41 percent of facilities experiencing a scarcity of workers. Washington and Maine also had large numbers of facilities with insufficient staff (close to 38 percent in both states). 

According to Seniorly, the biggest shortages are among nursing workers (registered nurses, licensed practical nurses, and vocational nurses) and aides (certified nursing assistants, nurse aides, medication aides, and medication technicians). These are the employees who provide the most direct care to nursing home residents. Although fewer facilities (an average of 3.5 percent) are experiencing shortages of higher paid workers, such as physicians, physician’s assistants, and advanced nurse practitioners, the number of facilities with a dearth of even these types of workers has jumped almost a percentage point since 2020.   

While most states are enduring huge staffing problems, a few states are actually trending in the right direction. Arkansas, Connecticut, and Texas have fewer facilities reporting staffing shortages than in 2020. And California has the lowest percentage of facilities with staffing issues (about 2 percent). 

To read the full analysis and see how your state is doing, click here.  

Requiring Adult Children to Pay for Aging Parents' Care

Did you know you could be responsible for your parents' unpaid bills? More than half of all states currently have laws making adult children financially responsible for their parents, including their long-term care costs. However, these laws are rarely enforced.

Filial responsibility laws obligate adult children to provide necessities like food, clothing, housing, and medical attention for their parents who cannot afford to take care of themselves. States may allow a civil court action to obtain financial support or cost recovery, impose criminal penalties on children who do not support their parents, or allow both civil and criminal actions. 

Generally, most states with such laws do not require children to provide care if they lack the ability to pay. States also vary on what factors they consider when determining whether an adult child is able to pay. Children may not be required to support their parents if the parents abandoned them or did not support them.

With regard to long-term care, most low-income parents qualify for Medicaid, making it unnecessary for a nursing home to pursue the resident's children for payment. When the Deficit Reduction Act of 2005 made it more difficult to qualify for Medicaid, experts predicted a wave of lawsuits by nursing homes under state filial responsibility statutes, but that has not happened. However, in 2012 a court in Pennsylvania ruled that a son was responsible for his mother’s $93,000 nursing home bill under the state’s filial responsibility law. 

While in most instances adult children are not held responsible for their parents’ long-term care bills under these laws, they may have to pay a nursing home in other circumstances. In some cases, children have been held liable if their parent transferred assets to them, making the parent ineligible for Medicaid. Additionally, there are cases in which children who signed an agreement affirming that they would assist their parent in paying for a nursing home have been sued for breach of contract by the nursing home. After a parent dies, Medicaid estate recovery allows the state to recoup Medicaid benefits from the parent’s estate, reducing the amount the children can inherit. 

If your parent needs long-term care, be sure to consult with your attorney to make certain you are not creating a situation in which you might be liable for your parent’s care. 

Medicare Advantage Plans Often Wrongly Deny Necessary Care, Study Finds

In an alarming number of instances, private Medicare Advantage plans are denying coverage for medical services that would be covered under original Medicare, according to a federal investigation.  These denials are likely preventing or delaying medically necessary care for tens of thousands of Medicare Advantage beneficiaries each year.

The investigation by the Department of Health and Human Services’ Office of Inspector General found that 13 percent of Medicare Advantage plan denials should have been covered under Medicare.  The findings were based on a review by doctors and coding experts of service denials by 15 of the largest Medicare Advantage plans during the first week of June 2019.   Extrapolating from their findings, investigators estimate that nearly 85,000 beneficiary requests for medical care -- everything from MRIs to skilled nursing facility care -- could have been wrongly denied in 2019.

In an even higher proportion of cases, plans are incorrectly refusing to pay claims. Nearly one-fifth of claims that Medicare Advantage plans initially declined to pay were for services that met Medicare coverage and plan billing rules.  This translates to an estimated 1.5 million refused payments for all of 2019, delaying or blocking payments for services that providers had already delivered.

Hidden Barriers to Care

Some 26 million Medicare beneficiaries were in Medicare Advantage plans as of 2021, more than double the figure a decade ago.  The Congressional Budget Office projects that by 2030 more than half of Medicare beneficiaries will be in a private Medicare plan. Unlike original Medicare, where the federal government is the insurer, Medicare Advantage plans are run by private insurance companies. The government pays the plans a fixed monthly fee to provide services to each Medicare beneficiary under their care. The less money the plans spend on patient care, the more they and their investors make. In this way, plans have an incentive to keep costs down.

For many beneficiaries, Medicare Advantage plans’ most disagreeable cost-cutting strategy is “preauthorization” -- the common requirement that doctors and other medical providers obtain the plan's approval before a beneficiary can receive certain medical services. If the plan administrators disagree that a procedure is medically necessary, the plan may refuse to pay for it.

Medicare Advantage plans often look attractive because they offer the same basic coverage as original Medicare at a seemingly lower cost, plus some additional benefits and services like vision and dental care that traditional Medicare doesn't offer. (One reason Medicare Advantage plans can offer such enhanced services is because the federal government gives them additional payments compared to original Medicare.) The inspector general’s report highlights one of Medicare Advantage’s downsides.

“Beneficiaries enrolled in Medicare Advantage may not be aware that there may be greater barriers to accessing certain types of health care services in Medicare Advantage than in original Medicare,” the report states.

One example highlighted in the report tells of a Medicare Advantage plan that refused to approve a follow-up MRI to find out whether an adrenal lesion was malignant because the lesion was allegedly too small. In fact, Medicare’s rules do not restrict the use of follow-up MRIs based on the size of a lesion. (The plan reversed its initial denial on appeal.)

Denial Appeals Can Work

The report identified two common causes of service denials. First, even though Medicare Advantage plans’ clinical criteria cannot be “more restrictive” than Medicare’s coverage rules, plans often used tighter clinical criteria, such as requiring an x-ray before approving more advanced imaging. Second, plans often claimed that the request for services lacked sufficient documentation, even though investigators who reviewed the denied claims found that the existing medical records were sufficient to support the request.

When a Medicare Advantage plan denies a preauthorization or payment request, the beneficiary can file an appeal with the plan.  The inspector general found that when a beneficiary or provider appealed or disputed the denial of a service that met Medicare’s coverage rules, plans sometimes reversed the denial.  And in certain cases, Medicare Advantage plans corrected their own errors.

The inspector general’s report offers several recommendations for the Centers for Medicare and Medicare Services, which oversees Medicare Advantage plans, including better auditing of plans.   

To read the inspector general’s report, “Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care,” click here.  

Medicare Enrollment Period Extended for Those Who’ve Been Getting a Busy Signal

Medicare is part of the Social Security Administration (SSA), so if you need to enroll in Medicare, that’s whom you contact. But in recent months, phone lines at the SSA were experiencing major technical issues, preventing some individuals from being able to reach the SSA via telephone in a timely manner. These issues affected the SSA’s national 800 number as well as its field office general inquiry phone lines. At the same time, because of the pandemic, SSA offices had not been permitting in-person appointments until early April.

Certain beneficiaries — particularly those without Internet access — were therefore unable to reach the SSA before the end of Medicare’s annual general enrollment period, which typically closes March 31.

As a result, the Centers for Medicare and Medicaid Services (CMS) has announced it will provide what is known as equitable relief to anyone who, due to these challenges, was unable to submit their Medicare enrollment or disenrollment requests after January 1, 2022. These individuals will now have extra time — through Friday, December 30, 2022 — to submit Medicare Part A or Part B enrollment or disenrollment requests without penalty. This relief from penalties also applies to the 2022 Initial Enrollment Period and Special Enrollment Periods.

Individuals who were eligible to be on Medicare and incurred medical care costs during this time period can request retroactive Medicare coverage going back to January 1, 2022. Note, however, that premiums must be paid as a lump sum or else can be deducted from any Social Security benefits the individual currently receives.

Contact the SSA’s national 800 number at 1-800-772-1213 for more information, or find an SSA office near you via the SSA’s online office locator.

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When to Leave a Nursing Home and Move Back Home

Leaving a nursing home to return home is a goal for many residents and their families, but it requires careful consideration. While returning home is a good move for some, it won't work for everyone.

A nursing home stay does not have to be permanent. Many residents enter a facility temporarily to recover from an illness or accident and are able to easily transition back to living at home. For residents who continue to need care but would rather be at home, moving out of a nursing home is more complicated. 

Before considering moving out of a nursing home, here are some questions to bear in mind:

• Can you receive the care you need at home? Some patients require help with eating, dressing, and going to the bathroom. You need to consider whether you can adequately get that care at home. 
• Who will be providing the care? The care can come from family members or hiring in-home health care. If family members aren’t available, is there money to hire help? All 50 states have Medicaid programs that offer at least some home care. You will need to check with your state to see if you qualify.  
• Will you be able to take the medications you need at home? 
• How is your physical and emotional stamina? Moving back home requires determination and an ability to manage problems, since not everything will be taken care of as in a facility. 
• Is the house set up to safely accommodate you? Are there a lot of stairs? Does the bathroom have rails? If the patient has dementia, there may be other considerations to take into account. 
• Is there transportation available to get to doctor’s or other appointments? 

If you determine that moving back home is the best option, then you can begin to craft a plan based on where you will live and who will provide care. Contact your local Area Agency on Aging to get help finding and coordinating services. 

There is a federal program called Money Follows the Person that is designed to make it easier for nursing home residents who qualify for Medicaid to move out. Currently, 34 states and the District of Columbia participate in the program, which provides personal and financial support to help eligible nursing home residents live on their own or in group settings.

For tips on transitioning from a nursing home to the community, click here.

What to Do If Your Medicaid Application Is Denied

If you apply for long-term care assistance through Medicaid and your application is denied, the situation may seem hopeless. The good news is that you can appeal the decision. 

Medicaid is a program for low-income individuals, so it has strict income and asset eligibility requirements. Qualifying for Medicaid requires navigating the complicated application process, which has many potential stumbling blocks. However, a Medicaid denial does not mean you will not eventually qualify for benefits. 

The Medicaid agency may deny a Medicaid application for a number of reasons, including the following: 

• Missing documentation. You need to show proof that you are eligible for benefits, which usually means providing Social Security statements, bank records, property deeds, retirement accounts, and insurance records, among other things. 
• Excess assets. In order to be eligible for Medicaid benefits a nursing home resident may have no more than $2,000 in "countable" assets (in most states). 
• Transferred assets. If you transferred assets for less than market value within five years before applying for benefits, you may be subject to a penalty period before you become eligible for benefits. 

The Medicaid agency is required to issue the denial notice with 45 days of the application (or 90 days if you filed for benefits on the basis of a disability). When you get a denial notice, read it carefully. The notice will explain why the application was denied and specify how to file an appeal. 

Before filing a formal appeal, you can try informally asking the agency to reverse the decision. If you made a mistake on the application, this is the easiest and quickest way to proceed. If the caseworker made a mistake, it may be more complicated and require escalation to a supervisor or a formal appeal. 

Appealing a Decision
The denial notice will tell how long you have to file an appeal—the deadline may be as short as 30 days or as long as 90 days after the denial notice. It is important to file the appeal before the deadline. Whether the denial notice requires it or not, you should submit your request for an appeal in writing, so that there is a record of it.

Once your appeal is submitted, the Medicaid agency will set a hearing date. Applicants must attend the hearing or their cases will be dismissed. You have a right to have witnesses testify at the hearing and to question the Medicaid agency’s witnesses. It is a good idea to have an attorney to help you through the appeal process. An attorney can make sure you have all the correct documentation and information to present at the hearing. 

If you win the appeal, your benefits will be retroactive to the date of your eligibility—usually the date of your application. If you lose the appeal, the notice will explain how to appeal the decision. The next step in the appeal process usually involves submitting written arguments. If the next appeal is unsuccessful, then you will have to appeal to court. It is crucial to have the assistance of an attorney for this. 

Reapplying for Benefits
If your application was denied correctly due to excess assets or income, there are steps you can take to spend down your assets or put your income in a trust. Contact an attorney to find out what actions you can take to qualify for benefits. Once you do this, you can then reapply for benefits. Note that when you reapply for benefits, your eligibility date will change to the date of the new application. 

Should You Prepare a Medicaid Application Yourself?

Navigating the Medicaid application process can be complicated, especially if you are applying for long-term care benefits. Hiring an attorney to help you through the process can be extremely helpful. 

Whether you should prepare and file a Medicaid application by yourself or should hire help depends on answers to the following questions:

• How old is the applicant?
• How complicated is the applicant's financial situation?
• Is the individual applying for community or nursing home benefits?
• How much time do you have available?
• How organized are you?

Medicaid is the health care program for individuals who do not have another form of insurance or whose insurance does not cover what they need, such as long-term care. Many people rely on Medicaid for assistance in paying for care at home or in nursing homes.

For people under age 65 and not in need of long-term care, eligibility is based largely on income and the application process is not very complicated. Most people can apply on their own without assistance.  

Matters get a bit more complicated for applicants age 65 and above and especially for those of any age who need nursing home or other long-term care coverage. In these cases, availing yourself of the services of an attorney is practically essential.

Medicaid applicants over age 65 are limited to $2,000 in countable assets (in most states). It's possible to transfer assets over this amount in order to become eligible, but seniors need to be careful in doing so because they may need the funds in the future and if they move to a nursing home, the transfer could make them ineligible for benefits for five years. Professional advice is also crucial because there is a confusing array of different Medicaid programs that may be of assistance in providing home care, each with its own rules.

All of that said, the application process itself is not as complicated for community benefits (care that takes place outside of an institutional setting, such as in the beneficiary’s home). In short, those over 65 may need to consult with an elder law attorney for planning purposes, but they or their families may be able to prepare and submit the Medicaid application themselves.

But submitting an application for nursing home benefits without an attorney's help is not a good idea. This is because Medicaid officials subject such applications to enhanced scrutiny, requiring up to five years of financial records and documentation of every fact. Any unexplained expense may be treated as a disqualifying transfer of assets, and many planning steps -- such as trusts, transfers to family members, and family care agreements -- are viewed as suspect unless properly explained. Finally, the process generally takes several months as Medicaid keeps asking questions and demanding further documentation for the answers provided.

Many elder law attorneys offer assistance with Medicaid applications as part of their services. This has several advantages, including expert advice on how best to qualify for benefits as early as possible, experience in dealing with the more difficult eligibility questions that often arise, and a high level of service through a long, grueling process. The one drawback of using an attorney rather than a lay service is that the fee is typically substantially higher. However, given the high cost of nursing homes, if the law firm's assistance can accelerate eligibility by even one month that will generally cover the fee. In addition, the payments to the attorney are generally with funds that would otherwise be paid to the nursing home -- in other words, the funds will have to be spent in any event, whether for nursing home or for legal fees.

Medicare Now Covers the Cost of COVID At-Home Tests

If you have Medicare, you can now receive up to eight free rapid at-home Covid-19 tests a month at participating pharmacies. 

The free tests are available without a prescription to all Medicare beneficiaries with Part B, including those enrolled in a Medicare Advantage plan. If you only have Medicare Part A, Medicare won’t cover the cost. 

To get the tests, you can visit one of the pharmacies participating in the program.  (For a partial list of participating pharmacies, click here.) You do not have to be a current customer of the pharmacy in order to receive the tests, and Medicare Advantage plan enrollees may use an out-of-network pharmacy. You should bring your red, white, and blue Medicare card (even if you have a Medicare Advantage or Medicare Part D plan), but the pharmacy may be able to get the information it needs to bill Medicare without the card. 

Unlike with private insurance, there is no upfront cost for the tests. As long as you do not order more than eight tests in a calendar month, you will not pay anything. Note that tests are often packaged with two in each box, so eight tests may not mean eight boxes. If you pay for a test yourself, Medicare will not reimburse you. Medicare enrollees who order tests from covidtests.gov do not need to count those tests against Medicare's eight-test-per-month limit.

When the Biden administration originally announced it was requiring private insurers to reimburse the cost of up to eight rapid at-home Covid tests a month purchased at retail stores and pharmacies, this news left out the nation’s 62 million Medicare beneficiaries – seniors and people with disabilities who are at the highest risk of death from Covid-19. If paid for out-of-pocket, tests typically cost more than $20 for a package of two, which can discourage many Americans from getting tested. 

The problem in the case of tests for Medicare beneficiaries was that the federal program’s rules did not permit coverage of over-the-counter tests. Amid pressure from Congress and advocacy groups, officials scrambled to find a regulatory workaround.  

For more information about the free COVID tests from the Centers for Medicare & Medicaid Services, click here.

Is Bankruptcy Considered Financial Hardship?

There is no doubt that bankruptcy can be difficult for people. No one wants to declare being bankrupt unless and until they have no way out of the debts. So, if you are asking whether or not bankruptcy is considered as a financial hardship, then the answer is - definitely, YES! A bankruptcy can cause a very lasting impact on the creditworthiness and life as well, to ensure that you are rectifying the situation and getting back to normal, you have to restructure your debts and cut back on the costs. To do that you will need the best bankruptcy attorneys by your side.

We, at Fong Law Group, can ensure that you are getting the best legal help to go through the bankruptcy procedure and all the legal proceedings and meetings efficiently. We offer the best legal services related to bankruptcy in Monterey Park, California and in the surrounding areas.

What is financial hardship?

Financial hardship means when you find it difficult to repay your debts and loans. When you are in extreme financial hardship that you couldn't pay off your bills and debts or the loans, you apply for bankruptcy. Financial hardships can be considered when you are:

• Unable to pay of your bills
• Unable to repay the debts that you have
• Unable to pay off your loans to the creditors

Hence, a bankruptcy is considered a financial hardship. Declaring bankruptcy is considered as the last resort to get out of the financial hardships that you are facing. Many are relieved when they finally take the leap, and decide to file bankruptcy. It means the creditors stop calling, you can finally answer your phone again. It means a new start, and less stress worrying how you will be able to pay all your bills. But the main question is when can you file the bankruptcy?

 

When to declare bankruptcy?

Now that you know what financial hardship is, it is time for you to know when you can declare bankruptcy to start afresh. There are times when you can hit the rock bottom. Your liabilities i.e. the debts and loans can exceed your assets or income. This can be the worst thing and you need to get out of this situation immediately. The best way to get out of this situation is by filing bankruptcy.There can be different reasons to file bankruptcy. If your creditors are filing lawsuit against you or you are not able to pay off the debts properly, consulting with a bankruptcy lawyer is the best way to get out of this. Understanding bankruptcy and when to file it or how to file it can be quite difficult at times.

Moreover bankruptcy and financial hardship has a direct connection that an experienced lawyer can help you to know in a better way. So, look for the best lawyers or attorney in your area. Fong Law Group is here to help you in such situations when you are confused about bankruptcy. What to do? When to file bankruptcy? How to file bankruptcy? You can get all the answers straight away from the best lawyers of Monterey Park California

Call Fong Law Group at (626) 289-8299 for a FREE consultation, and talk to an attorney today. We are here to help you get through this difficult time in your life, and help you with a Fresh Start.