OUR FEDERAL SYSTEM OF HEALTH CARE ESPECIALLY FOR THE DISABLED WAS NOT COSTLY WHEN IT WORKED RIGHT. DEFUNDING AND DISMANTLING OVERSIGHT AND ACCOUNTABILITY MADE COSTS SOAR AS FRAUD AND CORRUPTION SET IN. FAST FORWARD TO TODAY AND PRIVATIZATION WILL MAKE COSTS SOAR WITH FRAUD EVEN MORE WITH DEREGULATION KILLING PUBLIC PROTECTIONS.
Below you see all of Federal funding is going to managed care corporations----to private non-profits with no oversight----and as with Amazon.com and other global corporations----is not recognizing worker disability at all. Medicaid was so gutted of funding that it is not even a program anymore so sending people over to global managed care corporations will not end well. In-home care toted as good for the person is seeing levels of abuse and neglect never seen in America and you would expect that in a profit-driven health system. Families with disabled are being given vouchers to stay home with their children and adults but most of the time this is overwhelming...AS CLINTON NEO-LIBERALS KNOW IT WILL BE. In Maryland, we have hospitals that ask every time you go if you want to opt out of resuscitation as families are soaked with medical debt and the disabled and chronically ill are made to feel guilty for the burden and lack of choices in care. Maryland has ManorCare owned by the largest global Wall Street hedge fund----HOW DO YOU THINK THAT WILL WORK?
The goal of ACA and Clinton Wall Street neo-liberals with this health care reform as it is tied to ending safety net and disability programs is that people will be treated just as Wall Street banks treat them......if you are too poor they will use you for liquid money-----if you are middle-class they will soak you with fines, fees, and corruption so they take all your personal assets in pursuit of care for you loved one-----and if you are the few that can afford full private health coverage ---you will continue to get the kind of health care and disability access everyone always had!
Below you see just one of tens of thousands of private non-profits getting VA funds to care for veterans and the disabled......
Veterans Benefits Comfort Keepers®
Is Honored to Serve Our Nation’s Veterans We feel privileged to provide home care for veterans who served our nation in its time of need. We provide you with the information to work through the paperwork to help you avoid potential pension claim delays. Once you become an approved participant in a VA program, Comfort Keepers will provide the quality home care and companionship our veterans deserve. There are several veteran in-home care programs for which an individual may qualify:
Other qualifications include specific financial criteria and documented physical need for in-home care.
To begin the application process, you will need:
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Can you imagine being a senior trapped in your apartment alone with only visits by these home-health services as your only access to health care? Aging in place is not what they make it sound. End of life can be lonely and depending on an array of strangers coming to your house is dangerous. We are already seeing the abuse and neglect from this system and people with disabilities are especially at risk.
The idea of public nursing facilities was to do just what the ACA pretends it is doing-----consolidating care under one roof for groups of aging with all the care needed on site. Shared living provides better mental health. THAT WAS HOW PUBLIC HOSPITALS AND NURSING HOME USED TO WORK. Then, Reagan/Clinton started the defunding and dismantling of oversight and accountability and these public facilities became what the ACA is creating now----neglect and abuse.
The amount of money stolen in health industry fraud can fund an entire renaissance in public care facilities that employ lots of people paid well and protected by US labor laws. Filling these corporations with immigrant workers exploited and impoverished does not do this. We need to move away from profit at any cost and back to publicly funded quality care paid for with our copious tax payments. Remember, our taxes are not going to go down simply because all of this is privatized----the more privatization the more fraud and corruption the higher the cost.
These corporate pols consider it a success with the costs of these disability programs go down----but it really means people have simply been made unable to access it or give up trying to get any quality from this privatized ACA.
Remember, people do not want to go to state nursing homes in Maryland for example because they are defunded and often neglectful and dangerous. The idea people want to stay home comes from this fear. As this article states---they are deregulating Medicare and Medicaid to allow for what used to be protections for these clients to be ignored in creating these at-home situations.
Below you see what everyone with integrity knows----you break a Federal system into at home health care and you send fraud and corruption soaring because there is no way to give oversight and accountability. You fully fund group health care living and provide quality you save tons of money. This is not rocket science folks---they know they are busting the Trusts with fraud. Keeping people out of COSTLY institutions?
For-Profit Nursing Homes Fuel Rise In Fraud And Abuse
Chargeswww.huffingtonpost.com/2012/12/31Dec 31, 2012 · ... nursing home companies, the ... Nursing Home Abuse Assisted Living and Nursing Homes Medicare Medicare Fraud Assisted Living and Nursing Homes Health ..
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Cleaning up Dodge: The challenge of home care fraud and abuse ...www.fiercehealthpayer.com
Reports of fraud and abuse in home healthcare make this benefit seem like the lawless wild west of government health insurance
Patient-centered medical homes lower costs, reduce healthcare overuse Report also finds model produces care quality improvements
January 30, 2015 | By Leslie Small Fierce Health Care
ACA offers incentives to keep elderly out of nursing homes
Christine Vestal, Pew/Stateline Staff Writer 10:31 a.m. EST January 17, 2014(Photo: Darren Cummings, AP)
In New Hampshire, Medicaid pays for in-home care for nearly all of its developmentally disabled residents. For frail elders, the opposite is true. Most wind up in nursing homes.
To remedy this imbalance, New Hampshire is taking advantage of Affordable Care Act funding for a program aimed at removing existing barriers to providing long-term care in people's homes and communities.
Known as the Balancing Incentive Payments Program, it is one of several ACA provisions designed to keep as many people as possible out of costly institutions. Arkansas, Connecticut, Georgia, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Mississippi, Missouri, New Jersey, New York, Ohio and Texas are also participating in the $3 billion incentive program.
According to a 2010 AARP survey, nine out of 10 older Americans said they would rather be cared for in their homes than in a nursing home. People with mental and physical disabilities, and those who represent them, also have pushed for community-based long-term care options and the ability to live independently in their homes.
States participating in the $3 billion program receive a higher federal match for all of their spending on home and community care through September 2015, provided they reduce the red tape and confusion that caretakers, elders and those with disabilities typically encounter when they attempt to find alternatives to nursing homes.
PROVIDER OF LAST RESORT
In 2010, nearly two-thirds of nursing home residents had their bills paid by Medicaid. Many low-income older people qualify for Medicaid before they enter a nursing home. But hundreds of thousands of higher-income people also end up in the Medicaid program after they deplete their own resources. According to the U.S. Department of Health and Human Services, the average cost of nursing home care in 2010 was $6,235 per month.
States have had the option of providing alternatives to nursing homes under a Medicaid "waiver" program developed during the Reagan administration. A major impetus for the change was that Medicaid dollars can support nearly three older people or adults with physical disabilities in their homes for every one person in a nursing home, according to a study by AARP.
Progress has been made over the last 30 years. More people are able to remain in their homes every year. In fact, the use of nursing homes has declined in recent years, despite the growing ranks of the elderly. In 2010, 1.4 million Americans resided in nursing homes, a decline of 4% since 2005, according to the AARP study.
But nearly everyone agrees that not enough has been done to give people a choice about where they receive care. Part of the problem is a morass of regulatory barriers under the Medicaid program. The balancing incentives program could eliminate some of them.
Separate from the balancing incentives program, HHS last week published a long-awaited update to its community living waiver rules, with the goal of simplifying the waiver process and eligibility requirements so that more people can receive care outside of institutions. In general, said Matt Salo, director of the National Association of Medicaid Directors, the federal government is "putting its foot on the accelerator to make more community-based services available."
NO WRONG DOOR
Under the balancing incentives program, states must create a so-called "no-wrong-door" approach for people looking for resources to help them keep their loved ones at home. Most people have no idea where to turn when the need for long-term care arises. To make sure people get access to the services they need, Medicaid agencies are charged with training all state and local social services organizations to help them apply. The state also works with hospital discharge personnel to make sure they inform patients about their options for care.
"In New Hampshire that means not turning them back out into the cold," said Don Hunter, who heads the state balancing incentives program. "Don't just give them a phone number. Make the appointments for them."
The program also requires states to create a standardized set of eligibility assessments for everyone so that all of their needs can be met, no matter what their age or type of disability.
States must also provide an independent case manager for every person in need – one who does not have ties to a nursing home or any other type of health care service.
To qualify for the incentive program, states must have spent less than 50 percent of their Medicaid long-term care dollars on community-based care in 2009.
When the program began in 2011, New Hampshire was ahead of most other states. Nearly 50% of its spending was on home and community care. Today, community spending exceeds 55%, Hunter said.
INCENTIVES FOR CHANGE
National advocates for community-based care are watching New Hampshire because it has made huge strides in caring for people with developmental disabilities. At least 99 percent of them are receiving care in their homes and communities, far more than in other states. Many hope the state can make the same kind of progress for elders and adults with physical and behavioral disabilities.
But transferring those policies to older people may not be so easy. Doug McNutt, AARP associate state director for advocacy, says the challenges are very different for disabled adults and older people. "Family members have had an amazing effect. Parents [of kids with developmental disabilities] take it on as a mission and that mission doesn't end when they're 18. With elders, it's not the same."
Medicaid requires states to provide nursing home beds to those who need it. Waivers for community-based services are optional. The state can limit eligibility, total spending and geographic availability. Determining eligibility under a waiver can take two months. Eligibility for a nursing home is automatic.
New Hampshire's long-term care waiver for community services is broader than the waiver in most other states. People don't have to apply for multiple programs to get the services they need. But McNutt said the process needs to be faster. "Families are in crisis, and if there aren't family members around, it's even more likely you'll end up in a nursing home."
Another impediment to shifting more care to the community is that New Hampshire, like most other states, has a well-established nursing home industry. The owners of dozens of facilities who employ thousands of workers have a vested interest in making sure they have a steady stream of business.
That issue doesn't exist for people with developmental disabilities. As the result of a lawsuit, New Hampshire in 1991 closed its only institution for people with cognitive impairment—the Laconia State School. As a result, there was no other option but to find home and community based services for its residents. "It was like lightning in a bottle," McNutt said.
Still, state officials deserve credit for creating a smooth transition, said Sue Fox of the University of New Hampshire. "New Hampshire got ahead of the game and stayed ahead with the developmental disability population. Now the goal is to bring some of those same policies to aging and mental health," she said.
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That is the consensus around the world. Amazon is known as a sweat shop operation and will be moving to robotics in just a few years so many of these jobs will not be permanent. Baltimore Development Corporation only brings global corporations known for exploitation and corporate fraud and corruption. What the citizens of Baltimore want is to get rid of these global corporations and rebuild our domestic economy with small and regional businesses. Just take away the copious corporate tax breaks, corporate tax evasion, and stop the fraud and these global corporations are history!
To see who the future disabled will be and how they are already ignored----look below at what is a growing number of college grads left unemployed because Clinton neo-liberals hand power of the economy to global corporations that want high unemployment. None of this has to happen----a domestic economy fueled by small and regional businesses will kill this hold. It doesn't take long on unemployment to burn through all of your assets and become homeless and that is what global corporations like Amazon prey on-----a desperate worker---with no Federal safety nets we move to third world beggars. TOO SCARED TO PROTEST!!!!!!! THAT'S WHAT TODAY'S CONGRESS WANTS!
A THIRD WORLD WORKER AND THAT IS WHERE CLINTON, OBAMA, AND OUR NEO-LIBERAL CONGRESS IS TAKING US!
If you don't know that the story below is happening in large numbers----you need to WAKE UP!
Please glance through this article to see what is becoming the norm under Clinton neo-liberalism and Bush neo-conservatism as safety nets disappear.
'Yep I'm hurt right now I hurt myself there and they expect the exact same thing out of me as they did when it before I was hurt'
'Being homeless is better than working for Amazon' Nichole Gracely has a master’s degree and was one of Amazon’s best order pickers. Now, after protesting the company, she’s homeless
I am homeless. My worst days now are better than my best days working at Amazon.
According to Amazon’s metrics, I was one of their most productive order pickers – I was a machine, and my pace would accelerate throughout the course of a shift. What they didn’t know was that I stayed fast because if I slowed down for even a minute, I’d collapse from boredom and exhaustion.
During peak season, I trained incoming temps regularly. When that was over, I’d be an ordinary order picker once again, toiling in some remote corner of the warehouse, alone for 10 hours, with my every move being monitored by management on a computer screen.
Superb performance did not guarantee job security. ISS is the temp agency that provides warehouse labor for Amazon and they are at the center of the SCOTUS case Integrity Staffing Solutions vs. Busk. ISS could simply deactivate a worker’s badge and they would suddenly be out of work. They treated us like beggars because we needed their jobs. Even worse, more than two years later, all I see is: Jeff Bezos is hiring.
I have never felt more alone than when I was working there. I worked in isolation and lived under constant surveillance. Amazon could mandate overtime and I would have to comply with any schedule change they deemed necessary, and if there was not any work, they would send us home early without pay. I started to fall behind on my bills.
At some point, I lost all fear. I had already been through hell. I protested Amazon. The gag order was lifted and I was free to speak. I spent my last days in a lovely apartment constructing arguments on discussion boards, writing articles and talking to reporters. That was 2012 and Amazon’s labor and business practices were only beginning to fall under scrutiny. I walked away from Amazon’s warehouse and didn’t have any other source of income lined up.
Employees of online retailer Amazon blow whistles during a strike in front of the company’s branch in Leipzig, central Germany. Photograph: Jens Meyer/AP
I cashed in on my excellent credit, took out cards, and used them to pay rent and buy food because it would be six months before I could receive my first unemployment compensation check.
I received $200 a week for the following six months and I haven’t had any source of regular income since those benefits lapsed. I sold everything in my apartment and left Pennsylvania as fast as I could. I didn’t know how to ask for help. I didn’t even know that I qualified for food stamps.
I furthered my Amazon protest while homeless in Seattle. When the Hachette dispute flared up, I “flew a sign,” street parlance for panhandling with a piece of cardboard: “I was an order picker at amazon.com. Earned degrees. Been published. Now, I’m homeless, writing and doing this. Anything helps.”
I have made more money per word with my signs than I will probably ever earn writing, and I make more money per hour than I will probably ever be paid for my work. People give me money and offer well wishes and I walk away with a restored faith in humanity.
I flew my protest sign outside Whole Foods while Amazon corporate employees were on lunch break, and they gawked. I went to my usual flying spots around Seattle and made more money per hour protesting Amazon with my sign than I did while I worked with them. And that was in Seattle. One woman asked, “What are you writing?” I told her about the descent from working poor to homeless, income inequality, my personal experience. She mentioned Thomas Piketty’s book, we chatted a little, she handed me $10 and wished me luck. Another guy said, “Damn, that’s a great story! I’d read it,” and handed me a few bucks.
If the US supreme court rules against the Amazon workers and determines they should not be paid while waiting in line – I’ll protest some more.
I’ve applied for many jobs, and any prospective employer that runs a Google search of my name can see my discontent with my last employer.
I couldn’t afford to be working poor and now I’m chronically homeless. My homelessness isn’t really a mystery. I simply could not afford to keep a roof over my head and asking my family was not an option. I’ve met other intelligent, hard-working homeless people. Many put in years of service before becoming disabled and summarily tossed outside without any money. We’re expected to be dumb. We didn’t choose homelessness.
I don’t know what the picture of the average American homeless person is, but I’m sure it wouldn’t include me. I graduated college. I have been published in a scholarly journal and a social-justice oriented website. I have completed my MA in American Studies. I ditched plans to pursue a PhD because it clearly wasn’t going to be a viable career option: I did not appreciate the so-called privilege to become volunteer labor and work for less than minimum wage as a graduate student, and then maybe, if I were so fortunate, become an adjunct professor. It didn’t take long for me to realize that I was living a fantasy, thinking that a student of the humanities would be tolerated, and paid decently, in the corporate world of the modern university. I could never afford to perform an unpaid internship and that damaged my long-term career prospects. I had to work at jobs that paid money, jobs like the one at Amazon, while I went to school and took out loans.
I did not simply perish when I lost all sources of income and could no longer afford to pay the bills. A survival instinct that I didn’t even know I possessed manifested itself. I learned to live without money and without a home. I worked at REI in Eugene, Oregon back in 2002 and I know how to live outside. I refuse to live within oppressive walls. I stopped worrying myself with terrifying numbers. They aren’t even real any more.
We don’t care about profits. We don’t care about workers. Read between the lines. Amazon founder Jeff Bezos. Photograph: Murdo Macleod I’ve camped and protested for the right to construct modern-day Hoovervilles.
I slept on cardboard and concrete throughout Seattle’s rainiest March on record. Camped on DOT land off Interstates. Rubber tramped then leather tramped, carrying sleeping bag, tarp, and a change of clothes, not knowing where I was going to sleep for the night, hiding so I could get some rest.
My wallet does not contain a single bill. I need glasses. I need winter clothes. I need cash and an opportunity. Anything! I’ve applied for jobs, both professional and with physical labor. Taken my MA off my resume so I don’t look overqualified. I’ve tried everything. Maybe it’s because I protested Amazon; maybe it’s because my credit is wrecked. Maybe it’s because I used homeless services as addresses. Maybe it’s because there really aren’t many jobs available.
The homeless and cash-starved are merely kept alive while nothing changes. In actuality, austerity measures are felt on the ground and essential social services are woefully inadequate. We’ve woken up outside on most days and often walked miles before breakfast with a pack on my back.
I’ve worked for places to live in Oregon, mostly cooking and feeding families. It was a kind of Maoist re-education program– a little too much like slavery for my comfort. I became a capitalist. I flew a sign to escape harrowing conditions in Oregon and I arrived in Seattle with nothing. When I landed I saw green. I created carefully crafted signs with cardboard and a Sharpie and, just like that, I was making money again. Hundred-dollar hours became the norm, not the exception. I learned that capitalism is fun when you’re winning. I needed a laptop to use as a professional tool. Social services couldn’t help. But I got one by flying a sign in Seattle. It’s been an incredibly useful tool.
My partner and I have actively sought out gainful employment, a place to call home, and community. We enjoyed lovely days in intelligent, civilized Seattle and we left, because we’ve learned that it’s best to keep moving. It’s not easy to start up anywhere with absolutely nothing.
My heart has expanded and I have learned that the American people are much better than our political and economic systems. I have been the recipient, and giver, of acts of kindness that I never before knew were possible.
Anyone who bemoans the weakening of Americans should look at the hardy homeless. It takes tremendous strength to get through a day. I’m stronger, healthier and happier than ever. There’s more respect for a homeless woman out on the streets than there is in a warehouse for Amazon workers.
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The most important issue with the dismantling of our Federal safety nets is what happens when the seniors, poor, and disabled fall into one of the most predatory global corporate health and senior care systems in US history? Affordable Care Act makes staying at home for care the answer and that means families with disabled will be overwhelmed with care------families with seniors will be overwhelmed with care----and most people will fall prey to a warehousing level of care where the only goal of that business is to find ways to profit from that client. With no oversight and accountability and complete deregulation of the health care industry-----THAT IS WHAT IS ALREADY HAPPENING.
Our Federal agencies for disability are now funded as vouchers and local control means the money is hijacked and sent to the rich as happens in Baltimore. Making health care long distance and online mirror sending people to call centers and then ignoring or giving them really bad service.
Remember, America used to have lots and lots of public hospitals, day care facilities, senior care and nursing homes. When they were well-funded they worked absolutely fine as a intermediate care venue. Whether workmans' comp and disability-----whether special needs with complicated care needs----or whether seniors aging into chronic illness ----
ALL OF THIS WAS HANDLED WITH A PUBLIC HEALTH SYSTEM FUNDED BY THE TAXES PAID THROUGH INCOME TAXES, PAYROLL TAXES, AND THINGS LIKE THE WORKMANS' COMP TAX. IT IS ALL PAID FOR FOLKS!
Institutions like Johns Hopkins simply captured the politics of the city and took all that money and allowed these public care systems disappear. They now are preparing for what I describe above. These Federal laws creating the safety nets do not just disappear-----they are still there only being ignored which is illegal. Stop allowing them to tell us we have no rights as citizens and that public taxpayer revenue will go to profit and not people!
To Collect Debts, Nursing Homes Are Seizing Control Over Patients
By NINA BERNSTEINJAN. 25, 2015 The New York Times
Dino and Lillian Palermo at the Mary Manning Walsh Nursing Home, which had tried to obtain guardianship over Mrs. Palermo.
Piotr Redlinski for Lillian Palermo tried to prepare for the worst possibilities of aging. An insurance executive with a Ph.D. in psychology and a love of ballroom dancing, she arranged for her power of attorney and health care proxy to go to her husband, Dino, eight years her junior, if she became incapacitated. And in her 80s, she did.
Mr. Palermo, who was the lead singer in a Midtown nightclub in the 1960s when her elegant tango first caught his eye, now regularly rolls his wife’s wheelchair to the piano at the Catholic nursing home in Manhattan where she ended up in 2010 as dementia, falls and surgical complications took their toll. He sings her favorite songs, feeds her home-cooked Italian food, and pays a private aide to be there when he cannot.
But one day last summer, after he disputed nursing home bills that had suddenly doubled Mrs. Palermo’s copays, and complained about inexperienced employees who dropped his wife on the floor, Mr. Palermo was shocked to find a six-page legal document waiting on her bed.
The Palermos at the Mary Manning Walsh Nursing Home, which had tried to obtain guardianship over Mrs. Palermo. Credit Piotr Redlinski for The New York Times It was a guardianship petition filed by the nursing home, Mary Manning Walsh, asking the court to give a stranger full legal power over Mrs. Palermo, now 90, and complete control of her money.
Few people are aware that a nursing home can take such a step. Guardianship cases are difficult to gain access to and poorly tracked by New York State courts; cases are often closed from public view for confidentiality. But the Palermo case is no aberration. Interviews with veterans of the system and a review of guardianship court data conducted by researchers at Hunter College at the request of The New York Times show the practice has become routine, underscoring the growing power nursing homes wield over residents and families amid changes in the financing of long-term care.
In a random, anonymized sample of 700 guardianship cases filed in Manhattan over a decade, Hunter College researchers found more than 12 percent were brought by nursing homes. Some of these may have been prompted by family feuds, suspected embezzlement or just the absence of relatives to help secure Medicaid coverage. But lawyers and others versed in the guardianship process agree that nursing homes primarily use such petitions as a means of bill collection — a purpose never intended by the Legislature when it enacted the guardianship statute in 1993.
At least one judge has ruled that the tactic by nursing homes is an abuse of the law, but the petitions, even if they are ultimately unsuccessful, force families into costly legal ordeals.
“It’s a strategic move to intimidate,” said Ginalisa Monterroso, who handled patient Medicaid accounts at the Mary Manning Walsh Nursing Home until 2012, and is now chief executive of Medicaid Advisory Group, an elder care counseling business that was representing Mr. Palermo in his billing dispute. “Nursing homes do it just to bring money.”
“It’s so cruel,” she added. “Mr. Palermo loves his wife, he’s there every single day, and they just threw him to the courts.”
Brett D. Nussbaum, a lawyer who represents Mary Manning Walsh and many other nursing homes, said Mr. Palermo’s devotion to his wife was irrelevant to the decision to seek a court-appointed guardian in July, when the billing dispute over his wife’s care reached a stalemate, with an outstanding balance approaching $68,000.
“The Palermo case is no different than any other nursing home bill that they had difficulty collecting,” Mr. Nussbaum said, estimating that he had brought 5,000 guardianship cases himself in 21 years of practice. “When you have families that do not cooperate and an incapacitated person, guardianship is a legitimate means to get the nursing home paid.”
Guardianship transfers a person’s legal rights to make some or all decisions to someone appointed by the court — usually a lawyer paid with the ward’s money. It is aimed at protecting people unable to manage their affairs because of incapacity, and who lack effective help without court action. Legally, it can supplant a power of attorney and a health care proxy.
Although it is a drastic measure, nursing home lawyers argue that using guardianship to secure payment for care is better than suing an incapacitated resident who cannot respond.
Mr. Palermo, 82, was devastated by the petition, brought in the name of Sister Sean William, the Carmelite nun who is the executive director of Mary Manning Walsh. “It’s like a hell,” he said last fall, speaking in the cadences of the southern Italian village where he grew up in poverty in a family of eight. “Never in my life I was sued for anything. I just want to take care of my wife.”
A court evaluator eventually reported that Mr. Palermo was the appropriate guardian, and questioned why the petition had been filed. But the matter still dragged on, and Mr. Palermo, who had promised to pay any arrears once Medicaid completed a recalculation of the bill, grew distraught as his expenses fighting the case reached $10,000.
In the end, Medicaid’s recalculation put his wife’s monthly copay at $4,558.54, almost $600 less than the nursing home had claimed, but still far more than the $2,642 Mr. Palermo had been paying under an earlier Medicaid calculation. As soon as the nursing home cashed his check for the outstanding balance, it withdrew the guardianship petition.
“They chose to use a strong-arm method, asking for somebody to be appointed to take over her funds, hoping for a rubber stamp to do their wishes,” said Elliott Polland, Mr. Palermo’s lawyer.
Many judges go along with such petitions, according to lawyers and others involved in the process. One judge who has not is Alexander W. Hunter Jr., a longtime State Supreme Court justice in the Bronx and Manhattan. In guardianship cases in 2006 and 2007, Justice Hunter ordered the nursing homes to bear the legal costs, ruling they had brought the petitions solely for the purpose of being paid and stating that this was not the Legislature’s intent when it enacted the statute, known as Article 81 of the Mental Hygiene Law.
Mrs. Palermo, now 90, has been living at the nursing home since 2010. Last year Justice Hunter did appoint a guardian in response to a petition by Hebrew Home for the Aged at Riverdale, but in his scathing 11-page decision, he directed the guardian to investigate and to consider referring the case for criminal prosecution of financial exploitation.
The decision describes a 94-year-old resident with a bank balance of $240,000 who had been unable to go home after rehabilitative treatment because of a fire in her co-op apartment; her only regular visitors were real estate agents who wanted her to sell. After Hebrew Home’s own doctor evaluated her as incapable of making financial decisions, the decision says, the nursing home collected a $50,000 check from her; it sued her when she refused to continue writing checks, then filed for guardianship.
“It would be an understatement to declare that this court is outraged by the behavior exhibited by the interested parties — parties who were supposed to protect the person, but who have all unabashedly demonstrated through their actions in connection with the person that they are only interested in getting paid,” he wrote.
Jennifer Cona, a lawyer for the nursing home, called the decision “grossly unfair to Hebrew Home,” but said she could not discuss details because the record was sealed.
Many cases in which judges grant nursing homes’ guardianship petitions never come to light. But one that challenges the legal propriety of such petitions for bill collection is now pending before the Appellate Division of the State Supreme Court. Without explanation, that record, too, is sealed from public scrutiny.
“There is no transparency in the whole process,” said Alexandra Siskopoulos, a lawyer who represents a relative of the nursing home resident in the appellate case — a relative who had wanted to take the resident home. “Unfortunately, people’s eyes are not opened until it’s their family member, and at that point, it’s too late.”
Throughout the country, data is lacking on the most basic facts about guardianships, even how many there are. In New York State, with different rules in 62 counties and no centralized database, it has taken a team of researchers more than two years to collect information from a fraction of case files in 14 counties, said Jean Callahan, the director of the Brookdale Center on Healthy Aging at Hunter College.
Preliminary findings of the center’s study are not expected until later this year, but at the request of The Times, the researchers undertook a breakdown of the petitioners in a sample of the 3,302 guardianship cases filed in Manhattan from 2002 to 2012. More frequent petitioners than nursing homes (12.4 percent) were hospitals (16.1 percent), friends and family (25.3 percent) and Adult Protective Services (40.1 percent).
New York’s guardianship statute was part of a national movement to limit guardianships to the least restrictive alternatives necessary to prevent harm. A petition is supposed to be brought only by someone with the person’s welfare at heart, and guardianship is to be tailored to individual needs, taking into account the person’s wishes.
Instead, Ms. Callahan said, “it has become a system that’s very focused on finances.”
One afternoon, Mrs. Palermo dozed in her wheelchair while her husband described their careful preparations for old age, and the shock of discovering that papers drawn up by an elder law specialist were insufficient protection.
He recalled the fear and anger he felt when he first read the nursing home’s petition, on his bus ride back to a rent-stabilized apartment on East 36th Street filled with mementos of their happy marriage. They have no children. “Who better than me, the husband for 47 years, that she gave power of attorney?” he asked.
As his voice grew anguished, Mrs. Palermo began to moan and cry out incoherently. “Are you O.K., baby?” he asked, jumping up to embrace her. “Now, don’t do that. Come on, give me a hug.”
He soothed her in Italian, speaking of the polenta he had made for her that morning. He wheeled her to the dining room. Later, he would serenade her.
But in the night, again he could not sleep for worry. He fingered drafts of his own petitions, hand-lettered pages that he debated sending to nursing home administrators. One was addressed “To God and to whom it may concern.”
“I’m trapped in a web of people and lawyers that will exhaust my 50 years of sacrifices and savings,” he wrote. “Please, dear God, grant me strength and wisdom to take care of my wife.”
Below you see all of Federal funding is going to managed care corporations----to private non-profits with no oversight----and as with Amazon.com and other global corporations----is not recognizing worker disability at all. Medicaid was so gutted of funding that it is not even a program anymore so sending people over to global managed care corporations will not end well. In-home care toted as good for the person is seeing levels of abuse and neglect never seen in America and you would expect that in a profit-driven health system. Families with disabled are being given vouchers to stay home with their children and adults but most of the time this is overwhelming...AS CLINTON NEO-LIBERALS KNOW IT WILL BE. In Maryland, we have hospitals that ask every time you go if you want to opt out of resuscitation as families are soaked with medical debt and the disabled and chronically ill are made to feel guilty for the burden and lack of choices in care. Maryland has ManorCare owned by the largest global Wall Street hedge fund----HOW DO YOU THINK THAT WILL WORK?
The goal of ACA and Clinton Wall Street neo-liberals with this health care reform as it is tied to ending safety net and disability programs is that people will be treated just as Wall Street banks treat them......if you are too poor they will use you for liquid money-----if you are middle-class they will soak you with fines, fees, and corruption so they take all your personal assets in pursuit of care for you loved one-----and if you are the few that can afford full private health coverage ---you will continue to get the kind of health care and disability access everyone always had!
Below you see just one of tens of thousands of private non-profits getting VA funds to care for veterans and the disabled......
Veterans Benefits Comfort Keepers®
Is Honored to Serve Our Nation’s Veterans We feel privileged to provide home care for veterans who served our nation in its time of need. We provide you with the information to work through the paperwork to help you avoid potential pension claim delays. Once you become an approved participant in a VA program, Comfort Keepers will provide the quality home care and companionship our veterans deserve. There are several veteran in-home care programs for which an individual may qualify:
- Improved Pension Benefit Program
- Homemaker/Home Health Aide Program
- In-Home Respite Program
Other qualifications include specific financial criteria and documented physical need for in-home care.
To begin the application process, you will need:
- Original discharge certificate
- Marriage certificate (divorce papers from any prior marriages, if applicable)
- Death certificate of veteran (if applicable)
- Social Security numbers for the veteran and spouse
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Can you imagine being a senior trapped in your apartment alone with only visits by these home-health services as your only access to health care? Aging in place is not what they make it sound. End of life can be lonely and depending on an array of strangers coming to your house is dangerous. We are already seeing the abuse and neglect from this system and people with disabilities are especially at risk.
The idea of public nursing facilities was to do just what the ACA pretends it is doing-----consolidating care under one roof for groups of aging with all the care needed on site. Shared living provides better mental health. THAT WAS HOW PUBLIC HOSPITALS AND NURSING HOME USED TO WORK. Then, Reagan/Clinton started the defunding and dismantling of oversight and accountability and these public facilities became what the ACA is creating now----neglect and abuse.
The amount of money stolen in health industry fraud can fund an entire renaissance in public care facilities that employ lots of people paid well and protected by US labor laws. Filling these corporations with immigrant workers exploited and impoverished does not do this. We need to move away from profit at any cost and back to publicly funded quality care paid for with our copious tax payments. Remember, our taxes are not going to go down simply because all of this is privatized----the more privatization the more fraud and corruption the higher the cost.
These corporate pols consider it a success with the costs of these disability programs go down----but it really means people have simply been made unable to access it or give up trying to get any quality from this privatized ACA.
Remember, people do not want to go to state nursing homes in Maryland for example because they are defunded and often neglectful and dangerous. The idea people want to stay home comes from this fear. As this article states---they are deregulating Medicare and Medicaid to allow for what used to be protections for these clients to be ignored in creating these at-home situations.
Below you see what everyone with integrity knows----you break a Federal system into at home health care and you send fraud and corruption soaring because there is no way to give oversight and accountability. You fully fund group health care living and provide quality you save tons of money. This is not rocket science folks---they know they are busting the Trusts with fraud. Keeping people out of COSTLY institutions?
For-Profit Nursing Homes Fuel Rise In Fraud And Abuse
Chargeswww.huffingtonpost.com/2012/12/31Dec 31, 2012 · ... nursing home companies, the ... Nursing Home Abuse Assisted Living and Nursing Homes Medicare Medicare Fraud Assisted Living and Nursing Homes Health ..
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Cleaning up Dodge: The challenge of home care fraud and abuse ...www.fiercehealthpayer.com
Reports of fraud and abuse in home healthcare make this benefit seem like the lawless wild west of government health insurance
Patient-centered medical homes lower costs, reduce healthcare overuse Report also finds model produces care quality improvements
January 30, 2015 | By Leslie Small Fierce Health Care
ACA offers incentives to keep elderly out of nursing homes
Christine Vestal, Pew/Stateline Staff Writer 10:31 a.m. EST January 17, 2014(Photo: Darren Cummings, AP)
In New Hampshire, Medicaid pays for in-home care for nearly all of its developmentally disabled residents. For frail elders, the opposite is true. Most wind up in nursing homes.
To remedy this imbalance, New Hampshire is taking advantage of Affordable Care Act funding for a program aimed at removing existing barriers to providing long-term care in people's homes and communities.
Known as the Balancing Incentive Payments Program, it is one of several ACA provisions designed to keep as many people as possible out of costly institutions. Arkansas, Connecticut, Georgia, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Mississippi, Missouri, New Jersey, New York, Ohio and Texas are also participating in the $3 billion incentive program.
According to a 2010 AARP survey, nine out of 10 older Americans said they would rather be cared for in their homes than in a nursing home. People with mental and physical disabilities, and those who represent them, also have pushed for community-based long-term care options and the ability to live independently in their homes.
States participating in the $3 billion program receive a higher federal match for all of their spending on home and community care through September 2015, provided they reduce the red tape and confusion that caretakers, elders and those with disabilities typically encounter when they attempt to find alternatives to nursing homes.
PROVIDER OF LAST RESORT
In 2010, nearly two-thirds of nursing home residents had their bills paid by Medicaid. Many low-income older people qualify for Medicaid before they enter a nursing home. But hundreds of thousands of higher-income people also end up in the Medicaid program after they deplete their own resources. According to the U.S. Department of Health and Human Services, the average cost of nursing home care in 2010 was $6,235 per month.
States have had the option of providing alternatives to nursing homes under a Medicaid "waiver" program developed during the Reagan administration. A major impetus for the change was that Medicaid dollars can support nearly three older people or adults with physical disabilities in their homes for every one person in a nursing home, according to a study by AARP.
Progress has been made over the last 30 years. More people are able to remain in their homes every year. In fact, the use of nursing homes has declined in recent years, despite the growing ranks of the elderly. In 2010, 1.4 million Americans resided in nursing homes, a decline of 4% since 2005, according to the AARP study.
But nearly everyone agrees that not enough has been done to give people a choice about where they receive care. Part of the problem is a morass of regulatory barriers under the Medicaid program. The balancing incentives program could eliminate some of them.
Separate from the balancing incentives program, HHS last week published a long-awaited update to its community living waiver rules, with the goal of simplifying the waiver process and eligibility requirements so that more people can receive care outside of institutions. In general, said Matt Salo, director of the National Association of Medicaid Directors, the federal government is "putting its foot on the accelerator to make more community-based services available."
NO WRONG DOOR
Under the balancing incentives program, states must create a so-called "no-wrong-door" approach for people looking for resources to help them keep their loved ones at home. Most people have no idea where to turn when the need for long-term care arises. To make sure people get access to the services they need, Medicaid agencies are charged with training all state and local social services organizations to help them apply. The state also works with hospital discharge personnel to make sure they inform patients about their options for care.
"In New Hampshire that means not turning them back out into the cold," said Don Hunter, who heads the state balancing incentives program. "Don't just give them a phone number. Make the appointments for them."
The program also requires states to create a standardized set of eligibility assessments for everyone so that all of their needs can be met, no matter what their age or type of disability.
States must also provide an independent case manager for every person in need – one who does not have ties to a nursing home or any other type of health care service.
To qualify for the incentive program, states must have spent less than 50 percent of their Medicaid long-term care dollars on community-based care in 2009.
When the program began in 2011, New Hampshire was ahead of most other states. Nearly 50% of its spending was on home and community care. Today, community spending exceeds 55%, Hunter said.
INCENTIVES FOR CHANGE
National advocates for community-based care are watching New Hampshire because it has made huge strides in caring for people with developmental disabilities. At least 99 percent of them are receiving care in their homes and communities, far more than in other states. Many hope the state can make the same kind of progress for elders and adults with physical and behavioral disabilities.
But transferring those policies to older people may not be so easy. Doug McNutt, AARP associate state director for advocacy, says the challenges are very different for disabled adults and older people. "Family members have had an amazing effect. Parents [of kids with developmental disabilities] take it on as a mission and that mission doesn't end when they're 18. With elders, it's not the same."
Medicaid requires states to provide nursing home beds to those who need it. Waivers for community-based services are optional. The state can limit eligibility, total spending and geographic availability. Determining eligibility under a waiver can take two months. Eligibility for a nursing home is automatic.
New Hampshire's long-term care waiver for community services is broader than the waiver in most other states. People don't have to apply for multiple programs to get the services they need. But McNutt said the process needs to be faster. "Families are in crisis, and if there aren't family members around, it's even more likely you'll end up in a nursing home."
Another impediment to shifting more care to the community is that New Hampshire, like most other states, has a well-established nursing home industry. The owners of dozens of facilities who employ thousands of workers have a vested interest in making sure they have a steady stream of business.
That issue doesn't exist for people with developmental disabilities. As the result of a lawsuit, New Hampshire in 1991 closed its only institution for people with cognitive impairment—the Laconia State School. As a result, there was no other option but to find home and community based services for its residents. "It was like lightning in a bottle," McNutt said.
Still, state officials deserve credit for creating a smooth transition, said Sue Fox of the University of New Hampshire. "New Hampshire got ahead of the game and stayed ahead with the developmental disability population. Now the goal is to bring some of those same policies to aging and mental health," she said.
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That is the consensus around the world. Amazon is known as a sweat shop operation and will be moving to robotics in just a few years so many of these jobs will not be permanent. Baltimore Development Corporation only brings global corporations known for exploitation and corporate fraud and corruption. What the citizens of Baltimore want is to get rid of these global corporations and rebuild our domestic economy with small and regional businesses. Just take away the copious corporate tax breaks, corporate tax evasion, and stop the fraud and these global corporations are history!
To see who the future disabled will be and how they are already ignored----look below at what is a growing number of college grads left unemployed because Clinton neo-liberals hand power of the economy to global corporations that want high unemployment. None of this has to happen----a domestic economy fueled by small and regional businesses will kill this hold. It doesn't take long on unemployment to burn through all of your assets and become homeless and that is what global corporations like Amazon prey on-----a desperate worker---with no Federal safety nets we move to third world beggars. TOO SCARED TO PROTEST!!!!!!! THAT'S WHAT TODAY'S CONGRESS WANTS!
A THIRD WORLD WORKER AND THAT IS WHERE CLINTON, OBAMA, AND OUR NEO-LIBERAL CONGRESS IS TAKING US!
If you don't know that the story below is happening in large numbers----you need to WAKE UP!
Please glance through this article to see what is becoming the norm under Clinton neo-liberalism and Bush neo-conservatism as safety nets disappear.
'Yep I'm hurt right now I hurt myself there and they expect the exact same thing out of me as they did when it before I was hurt'
'Being homeless is better than working for Amazon' Nichole Gracely has a master’s degree and was one of Amazon’s best order pickers. Now, after protesting the company, she’s homeless
I am homeless. My worst days now are better than my best days working at Amazon.
According to Amazon’s metrics, I was one of their most productive order pickers – I was a machine, and my pace would accelerate throughout the course of a shift. What they didn’t know was that I stayed fast because if I slowed down for even a minute, I’d collapse from boredom and exhaustion.
During peak season, I trained incoming temps regularly. When that was over, I’d be an ordinary order picker once again, toiling in some remote corner of the warehouse, alone for 10 hours, with my every move being monitored by management on a computer screen.
Superb performance did not guarantee job security. ISS is the temp agency that provides warehouse labor for Amazon and they are at the center of the SCOTUS case Integrity Staffing Solutions vs. Busk. ISS could simply deactivate a worker’s badge and they would suddenly be out of work. They treated us like beggars because we needed their jobs. Even worse, more than two years later, all I see is: Jeff Bezos is hiring.
I have never felt more alone than when I was working there. I worked in isolation and lived under constant surveillance. Amazon could mandate overtime and I would have to comply with any schedule change they deemed necessary, and if there was not any work, they would send us home early without pay. I started to fall behind on my bills.
At some point, I lost all fear. I had already been through hell. I protested Amazon. The gag order was lifted and I was free to speak. I spent my last days in a lovely apartment constructing arguments on discussion boards, writing articles and talking to reporters. That was 2012 and Amazon’s labor and business practices were only beginning to fall under scrutiny. I walked away from Amazon’s warehouse and didn’t have any other source of income lined up.
Employees of online retailer Amazon blow whistles during a strike in front of the company’s branch in Leipzig, central Germany. Photograph: Jens Meyer/AP
I cashed in on my excellent credit, took out cards, and used them to pay rent and buy food because it would be six months before I could receive my first unemployment compensation check.
I received $200 a week for the following six months and I haven’t had any source of regular income since those benefits lapsed. I sold everything in my apartment and left Pennsylvania as fast as I could. I didn’t know how to ask for help. I didn’t even know that I qualified for food stamps.
I furthered my Amazon protest while homeless in Seattle. When the Hachette dispute flared up, I “flew a sign,” street parlance for panhandling with a piece of cardboard: “I was an order picker at amazon.com. Earned degrees. Been published. Now, I’m homeless, writing and doing this. Anything helps.”
I have made more money per word with my signs than I will probably ever earn writing, and I make more money per hour than I will probably ever be paid for my work. People give me money and offer well wishes and I walk away with a restored faith in humanity.
I flew my protest sign outside Whole Foods while Amazon corporate employees were on lunch break, and they gawked. I went to my usual flying spots around Seattle and made more money per hour protesting Amazon with my sign than I did while I worked with them. And that was in Seattle. One woman asked, “What are you writing?” I told her about the descent from working poor to homeless, income inequality, my personal experience. She mentioned Thomas Piketty’s book, we chatted a little, she handed me $10 and wished me luck. Another guy said, “Damn, that’s a great story! I’d read it,” and handed me a few bucks.
If the US supreme court rules against the Amazon workers and determines they should not be paid while waiting in line – I’ll protest some more.
I’ve applied for many jobs, and any prospective employer that runs a Google search of my name can see my discontent with my last employer.
I couldn’t afford to be working poor and now I’m chronically homeless. My homelessness isn’t really a mystery. I simply could not afford to keep a roof over my head and asking my family was not an option. I’ve met other intelligent, hard-working homeless people. Many put in years of service before becoming disabled and summarily tossed outside without any money. We’re expected to be dumb. We didn’t choose homelessness.
I don’t know what the picture of the average American homeless person is, but I’m sure it wouldn’t include me. I graduated college. I have been published in a scholarly journal and a social-justice oriented website. I have completed my MA in American Studies. I ditched plans to pursue a PhD because it clearly wasn’t going to be a viable career option: I did not appreciate the so-called privilege to become volunteer labor and work for less than minimum wage as a graduate student, and then maybe, if I were so fortunate, become an adjunct professor. It didn’t take long for me to realize that I was living a fantasy, thinking that a student of the humanities would be tolerated, and paid decently, in the corporate world of the modern university. I could never afford to perform an unpaid internship and that damaged my long-term career prospects. I had to work at jobs that paid money, jobs like the one at Amazon, while I went to school and took out loans.
I did not simply perish when I lost all sources of income and could no longer afford to pay the bills. A survival instinct that I didn’t even know I possessed manifested itself. I learned to live without money and without a home. I worked at REI in Eugene, Oregon back in 2002 and I know how to live outside. I refuse to live within oppressive walls. I stopped worrying myself with terrifying numbers. They aren’t even real any more.
We don’t care about profits. We don’t care about workers. Read between the lines. Amazon founder Jeff Bezos. Photograph: Murdo Macleod I’ve camped and protested for the right to construct modern-day Hoovervilles.
I slept on cardboard and concrete throughout Seattle’s rainiest March on record. Camped on DOT land off Interstates. Rubber tramped then leather tramped, carrying sleeping bag, tarp, and a change of clothes, not knowing where I was going to sleep for the night, hiding so I could get some rest.
My wallet does not contain a single bill. I need glasses. I need winter clothes. I need cash and an opportunity. Anything! I’ve applied for jobs, both professional and with physical labor. Taken my MA off my resume so I don’t look overqualified. I’ve tried everything. Maybe it’s because I protested Amazon; maybe it’s because my credit is wrecked. Maybe it’s because I used homeless services as addresses. Maybe it’s because there really aren’t many jobs available.
The homeless and cash-starved are merely kept alive while nothing changes. In actuality, austerity measures are felt on the ground and essential social services are woefully inadequate. We’ve woken up outside on most days and often walked miles before breakfast with a pack on my back.
I’ve worked for places to live in Oregon, mostly cooking and feeding families. It was a kind of Maoist re-education program– a little too much like slavery for my comfort. I became a capitalist. I flew a sign to escape harrowing conditions in Oregon and I arrived in Seattle with nothing. When I landed I saw green. I created carefully crafted signs with cardboard and a Sharpie and, just like that, I was making money again. Hundred-dollar hours became the norm, not the exception. I learned that capitalism is fun when you’re winning. I needed a laptop to use as a professional tool. Social services couldn’t help. But I got one by flying a sign in Seattle. It’s been an incredibly useful tool.
My partner and I have actively sought out gainful employment, a place to call home, and community. We enjoyed lovely days in intelligent, civilized Seattle and we left, because we’ve learned that it’s best to keep moving. It’s not easy to start up anywhere with absolutely nothing.
My heart has expanded and I have learned that the American people are much better than our political and economic systems. I have been the recipient, and giver, of acts of kindness that I never before knew were possible.
Anyone who bemoans the weakening of Americans should look at the hardy homeless. It takes tremendous strength to get through a day. I’m stronger, healthier and happier than ever. There’s more respect for a homeless woman out on the streets than there is in a warehouse for Amazon workers.
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The most important issue with the dismantling of our Federal safety nets is what happens when the seniors, poor, and disabled fall into one of the most predatory global corporate health and senior care systems in US history? Affordable Care Act makes staying at home for care the answer and that means families with disabled will be overwhelmed with care------families with seniors will be overwhelmed with care----and most people will fall prey to a warehousing level of care where the only goal of that business is to find ways to profit from that client. With no oversight and accountability and complete deregulation of the health care industry-----THAT IS WHAT IS ALREADY HAPPENING.
Our Federal agencies for disability are now funded as vouchers and local control means the money is hijacked and sent to the rich as happens in Baltimore. Making health care long distance and online mirror sending people to call centers and then ignoring or giving them really bad service.
Remember, America used to have lots and lots of public hospitals, day care facilities, senior care and nursing homes. When they were well-funded they worked absolutely fine as a intermediate care venue. Whether workmans' comp and disability-----whether special needs with complicated care needs----or whether seniors aging into chronic illness ----
ALL OF THIS WAS HANDLED WITH A PUBLIC HEALTH SYSTEM FUNDED BY THE TAXES PAID THROUGH INCOME TAXES, PAYROLL TAXES, AND THINGS LIKE THE WORKMANS' COMP TAX. IT IS ALL PAID FOR FOLKS!
Institutions like Johns Hopkins simply captured the politics of the city and took all that money and allowed these public care systems disappear. They now are preparing for what I describe above. These Federal laws creating the safety nets do not just disappear-----they are still there only being ignored which is illegal. Stop allowing them to tell us we have no rights as citizens and that public taxpayer revenue will go to profit and not people!
To Collect Debts, Nursing Homes Are Seizing Control Over Patients
By NINA BERNSTEINJAN. 25, 2015 The New York Times
Dino and Lillian Palermo at the Mary Manning Walsh Nursing Home, which had tried to obtain guardianship over Mrs. Palermo.
Piotr Redlinski for Lillian Palermo tried to prepare for the worst possibilities of aging. An insurance executive with a Ph.D. in psychology and a love of ballroom dancing, she arranged for her power of attorney and health care proxy to go to her husband, Dino, eight years her junior, if she became incapacitated. And in her 80s, she did.
Mr. Palermo, who was the lead singer in a Midtown nightclub in the 1960s when her elegant tango first caught his eye, now regularly rolls his wife’s wheelchair to the piano at the Catholic nursing home in Manhattan where she ended up in 2010 as dementia, falls and surgical complications took their toll. He sings her favorite songs, feeds her home-cooked Italian food, and pays a private aide to be there when he cannot.
But one day last summer, after he disputed nursing home bills that had suddenly doubled Mrs. Palermo’s copays, and complained about inexperienced employees who dropped his wife on the floor, Mr. Palermo was shocked to find a six-page legal document waiting on her bed.
The Palermos at the Mary Manning Walsh Nursing Home, which had tried to obtain guardianship over Mrs. Palermo. Credit Piotr Redlinski for The New York Times It was a guardianship petition filed by the nursing home, Mary Manning Walsh, asking the court to give a stranger full legal power over Mrs. Palermo, now 90, and complete control of her money.
Few people are aware that a nursing home can take such a step. Guardianship cases are difficult to gain access to and poorly tracked by New York State courts; cases are often closed from public view for confidentiality. But the Palermo case is no aberration. Interviews with veterans of the system and a review of guardianship court data conducted by researchers at Hunter College at the request of The New York Times show the practice has become routine, underscoring the growing power nursing homes wield over residents and families amid changes in the financing of long-term care.
In a random, anonymized sample of 700 guardianship cases filed in Manhattan over a decade, Hunter College researchers found more than 12 percent were brought by nursing homes. Some of these may have been prompted by family feuds, suspected embezzlement or just the absence of relatives to help secure Medicaid coverage. But lawyers and others versed in the guardianship process agree that nursing homes primarily use such petitions as a means of bill collection — a purpose never intended by the Legislature when it enacted the guardianship statute in 1993.
At least one judge has ruled that the tactic by nursing homes is an abuse of the law, but the petitions, even if they are ultimately unsuccessful, force families into costly legal ordeals.
“It’s a strategic move to intimidate,” said Ginalisa Monterroso, who handled patient Medicaid accounts at the Mary Manning Walsh Nursing Home until 2012, and is now chief executive of Medicaid Advisory Group, an elder care counseling business that was representing Mr. Palermo in his billing dispute. “Nursing homes do it just to bring money.”
“It’s so cruel,” she added. “Mr. Palermo loves his wife, he’s there every single day, and they just threw him to the courts.”
Brett D. Nussbaum, a lawyer who represents Mary Manning Walsh and many other nursing homes, said Mr. Palermo’s devotion to his wife was irrelevant to the decision to seek a court-appointed guardian in July, when the billing dispute over his wife’s care reached a stalemate, with an outstanding balance approaching $68,000.
“The Palermo case is no different than any other nursing home bill that they had difficulty collecting,” Mr. Nussbaum said, estimating that he had brought 5,000 guardianship cases himself in 21 years of practice. “When you have families that do not cooperate and an incapacitated person, guardianship is a legitimate means to get the nursing home paid.”
Guardianship transfers a person’s legal rights to make some or all decisions to someone appointed by the court — usually a lawyer paid with the ward’s money. It is aimed at protecting people unable to manage their affairs because of incapacity, and who lack effective help without court action. Legally, it can supplant a power of attorney and a health care proxy.
Although it is a drastic measure, nursing home lawyers argue that using guardianship to secure payment for care is better than suing an incapacitated resident who cannot respond.
Mr. Palermo, 82, was devastated by the petition, brought in the name of Sister Sean William, the Carmelite nun who is the executive director of Mary Manning Walsh. “It’s like a hell,” he said last fall, speaking in the cadences of the southern Italian village where he grew up in poverty in a family of eight. “Never in my life I was sued for anything. I just want to take care of my wife.”
A court evaluator eventually reported that Mr. Palermo was the appropriate guardian, and questioned why the petition had been filed. But the matter still dragged on, and Mr. Palermo, who had promised to pay any arrears once Medicaid completed a recalculation of the bill, grew distraught as his expenses fighting the case reached $10,000.
In the end, Medicaid’s recalculation put his wife’s monthly copay at $4,558.54, almost $600 less than the nursing home had claimed, but still far more than the $2,642 Mr. Palermo had been paying under an earlier Medicaid calculation. As soon as the nursing home cashed his check for the outstanding balance, it withdrew the guardianship petition.
“They chose to use a strong-arm method, asking for somebody to be appointed to take over her funds, hoping for a rubber stamp to do their wishes,” said Elliott Polland, Mr. Palermo’s lawyer.
Many judges go along with such petitions, according to lawyers and others involved in the process. One judge who has not is Alexander W. Hunter Jr., a longtime State Supreme Court justice in the Bronx and Manhattan. In guardianship cases in 2006 and 2007, Justice Hunter ordered the nursing homes to bear the legal costs, ruling they had brought the petitions solely for the purpose of being paid and stating that this was not the Legislature’s intent when it enacted the statute, known as Article 81 of the Mental Hygiene Law.
Mrs. Palermo, now 90, has been living at the nursing home since 2010. Last year Justice Hunter did appoint a guardian in response to a petition by Hebrew Home for the Aged at Riverdale, but in his scathing 11-page decision, he directed the guardian to investigate and to consider referring the case for criminal prosecution of financial exploitation.
The decision describes a 94-year-old resident with a bank balance of $240,000 who had been unable to go home after rehabilitative treatment because of a fire in her co-op apartment; her only regular visitors were real estate agents who wanted her to sell. After Hebrew Home’s own doctor evaluated her as incapable of making financial decisions, the decision says, the nursing home collected a $50,000 check from her; it sued her when she refused to continue writing checks, then filed for guardianship.
“It would be an understatement to declare that this court is outraged by the behavior exhibited by the interested parties — parties who were supposed to protect the person, but who have all unabashedly demonstrated through their actions in connection with the person that they are only interested in getting paid,” he wrote.
Jennifer Cona, a lawyer for the nursing home, called the decision “grossly unfair to Hebrew Home,” but said she could not discuss details because the record was sealed.
Many cases in which judges grant nursing homes’ guardianship petitions never come to light. But one that challenges the legal propriety of such petitions for bill collection is now pending before the Appellate Division of the State Supreme Court. Without explanation, that record, too, is sealed from public scrutiny.
“There is no transparency in the whole process,” said Alexandra Siskopoulos, a lawyer who represents a relative of the nursing home resident in the appellate case — a relative who had wanted to take the resident home. “Unfortunately, people’s eyes are not opened until it’s their family member, and at that point, it’s too late.”
Throughout the country, data is lacking on the most basic facts about guardianships, even how many there are. In New York State, with different rules in 62 counties and no centralized database, it has taken a team of researchers more than two years to collect information from a fraction of case files in 14 counties, said Jean Callahan, the director of the Brookdale Center on Healthy Aging at Hunter College.
Preliminary findings of the center’s study are not expected until later this year, but at the request of The Times, the researchers undertook a breakdown of the petitioners in a sample of the 3,302 guardianship cases filed in Manhattan from 2002 to 2012. More frequent petitioners than nursing homes (12.4 percent) were hospitals (16.1 percent), friends and family (25.3 percent) and Adult Protective Services (40.1 percent).
New York’s guardianship statute was part of a national movement to limit guardianships to the least restrictive alternatives necessary to prevent harm. A petition is supposed to be brought only by someone with the person’s welfare at heart, and guardianship is to be tailored to individual needs, taking into account the person’s wishes.
Instead, Ms. Callahan said, “it has become a system that’s very focused on finances.”
One afternoon, Mrs. Palermo dozed in her wheelchair while her husband described their careful preparations for old age, and the shock of discovering that papers drawn up by an elder law specialist were insufficient protection.
He recalled the fear and anger he felt when he first read the nursing home’s petition, on his bus ride back to a rent-stabilized apartment on East 36th Street filled with mementos of their happy marriage. They have no children. “Who better than me, the husband for 47 years, that she gave power of attorney?” he asked.
As his voice grew anguished, Mrs. Palermo began to moan and cry out incoherently. “Are you O.K., baby?” he asked, jumping up to embrace her. “Now, don’t do that. Come on, give me a hug.”
He soothed her in Italian, speaking of the polenta he had made for her that morning. He wheeled her to the dining room. Later, he would serenade her.
But in the night, again he could not sleep for worry. He fingered drafts of his own petitions, hand-lettered pages that he debated sending to nursing home administrators. One was addressed “To God and to whom it may concern.”
“I’m trapped in a web of people and lawyers that will exhaust my 50 years of sacrifices and savings,” he wrote. “Please, dear God, grant me strength and wisdom to take care of my wife.”
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