Teenagers and young adults with severe autism are spending weeks or even months in emergency rooms and acute-care hospitals, sometimes sedated, restrained or confined to mesh-tented beds, a Kaiser Health News investigation shows. These young people — who may shout for hours, bang their heads on walls or lash out violently at home — are taken to the hospital after community social services and programs fall short and families call 911 for help, according to more than two dozen interviews with parents, advocates and physicians in states from Maine to California. There, they wait for beds in specialized programs that focus on treating people with autism and other developmental disabilities, or they return home once families recover from the crisis or find additional support. The hospital “is the incredibly wrong place for these individuals to go in the beginning,” said Michael Cummings, the Buffalo facility’s associate medical director and a psychiatrist who worked on Ben’s case. “It’s a balancing act of trying to do the … least harm in a setting that is not meant for this situation.” Nationally, the number of people with an autism diagnosis who were seen in hospital ERs nearly doubled from 81,628 in 2009 to 159,517 five years later, according to the latest available data from the federal Agency for Healthcare Research and Quality. The number admitted also soared, from 13,903 in 2009 to 26,811 in 2014. The problem parallels the issue known as psychiatric boarding, which has been an increasing concern in recent years for a range of mental illnesses. Both trace to the shortcomings of deinstitutionalization, the national movement that aimed to close large public facilities and provide care through community settings. But the resources to support that dwindled long ago, and then came the Great Recession of 2008, when local, state and federal budget woes forced sharp cuts in developmental and mental health services.
The latest ACA repeal bill would hurt the economy and reduce coverage levels, according to a new report released Monday. The S&P Global Ratings report found that the bill, sponsored by GOP Sens. Lindsey Graham (SC) and Bill Cassidy (LA), would reduce coverage levels among those making between 133 percent and 400 percent of the federal poverty line, or between $16,040 and $48,240 for an individual. Some eligible for the traditional Medicaid program may also lose coverage, S&P says. The ratings agency also found the bill could cost about 580,000 jobs and $240 billion in lost economic activity by 2027 while limiting the gross domestic product growth to about 2 percent a year over the next decade. The bill would end ObamaCare’s expansion of Medicaid and repeal much of the law, replacing it with block-grant funding for states. Some states, typically those that didn’t expand Medicaid, would get more funding, while others would get less. S&P said this increased flexibility comes with "fewer federal dollars, creating increased fiscal and operational burdens on the states." The bill could also cause disparity among states in terms of rules for insurance markets and uninsured levels, the report says.
New Medicare cards — the ones that won't make it easy for ID thieves to steal your Social Security number — will find their way into wallets next year. But we're already hearing warnings about scams that are bubbling up before the big changeover. The design for the new Medicare card is expected to be revealed in September. And TV ads have already begun talking about the new cards and featuring the tagline "Guard Your Card." The Centers for Medicare and Medicaid Services will mail new cards to those receiving Medicare benefits beginning in April 2018 through April 2019. The new cards will use a unique, randomly assigned code — not your Social Security number. Seniors do not have to do anything to get a new card. The new ID is called a Medicare Beneficiary Identifier, which is 11-characters in length. The unique ID will be made of numbers and uppercase letters. Susan Bowen, who works for the Area Agency on Aging Region 9 serving northeast Michigan, has been trying to get the word out at various events, including conferences this summer relating to elder abuse, about the potential for new scams. Bowen envisions scammers crafting stories that scare seniors into thinking they won't receive their new cards in time if they don't hand over bank account information and Social Security numbers.
Or maybe some fraudsters, as they have in the past, will say there's a fee connected to receiving a new Medicare card. There is no such fee. Or scammers might threaten that you'd lose your benefits if you don't react to their demands right away, such as putting cash to pay a bill on a gift card.
On August 14, 2017, the American Bar Association’s (ABA) House of Delegates adopted Resolution 113, urging state, territorial, and tribal legislatures to (1) amend their guardianship statutes to require that supported decision making be identified and fully considered as a less restrictive alternative, before guardianship is imposed, and (2) require that decision-making supports that would meet the individual’s needs be identified and fully considered in proceedings for termination of guardianship and restoration of rights. The Resolution further urges courts to consider (1) supported decision making as a less-restrictive alternative to guardianship, and (2) decision making supports that would meet the individual’s needs as grounds for termination of a guardianship and restoration of rights. An individual’s right to make decisions about his or her life is a fundamental value in American law. Sponsored by the ABA Commission on Disability Rights, the Commission on Law and Aging, and the Sections of Civil Rights and Social Justice (Disability Rights Committee), and Real Property, Trust and Estate Law, this Resolution continues and furthers the ABA’s long-standing interest in, and commitment to, ensuring that guardianship is a “last resort,” after other, less-restrictive options have been considered. The Resolution recognizes the newly denominated modality of supported decision making — in which people with disabilities make their own decisions with supports, rather than rely on a surrogate — and urges that it be explicitly included in guardianship statutes requiring consideration of less-restrictive alternatives.
Medicare has launched a website aimed at helping families choose a hospice — but experts say it doesn’t help very much. The Centers for Medicare & Medicaid Services has released Hospice Compare, a consumer-focused website that lets families compare up to three hospice agencies at a time, among 3,876 nationwide. Following similar websites for hospitals and nursing homes, the site aims to improve transparency and empower families to “take ownership of their health,” according to a press release. Through the website, families can see how hospices performed in seven categories, including how many patients were screened for pain and breathing difficulties, and how many patients on opioids were offered treatment for constipation. But the measurements of quality, which are self-reported by hospices, have limited utility, some experts say. Over three-quarters of hospices scored at least 91 percent out of 100 on six of the seven categories, a recent paper in Health Affairs found. Because so many hospices reported high marks, there is “little room” for using these metrics to measure hospice quality, argued the authors, led by Dr. Joan Teno at the University of Washington. The Hospice Compare grades are based on hospices reporting whether they followed a specific process, such as screening for pain when the patient arrives. This type of metric may lead staff to just check a box to indicate they completed the desired process, resulting in high grades for everyone, which is not helpful for consumers or for quality improvement, the authors wrote.