Medicare’s Observation Care Policy

The results of a recent study shows that low-income Medicare patients are often kept in the hospital for longer periods of time without being officially admitted than wealthier Medicare patients. Medicare requires that a patient who is admitted to the hospital to pay a fixed out-of-pocket fee that covers the bulk of the hospital stay, including follow-up acute nursing home care and repeated hospitalizations within two months of their release from the hospital. However, if the hospital only places a patient on observation status, rather than officially admitting him or her, the patient has many more out-of-pocket expenses that if he or she had been admitted to the hospital. For observation care, a patient must pay a one-time out-of-pocket fee , but also must pay 20% of all hospital service expenses and for certain drugs.

The study involved the 2013 Medicare claims of more than 67,000 patients who had combined hospital stays of more than 132,000. These patients came from 97% of the counties nationwide. When compared with the wealthiest 25% of patients, the poorest 25% of patients were 24% more likely to be hospitalized for more than three observation stays per year. Ironically, the wealthiest patients had the least risk of high out-of-pocket costs, and the risk was much higher for poorer patients. However, poorer patients also may be able to combat these high out-of-pocket costs with additional healthcare coverage, such as Medicaid.

As discussed above, there are many implications of Medicare’s observation care policy, including potentially higher costs for patients to pay for this service. Lengthier hospital and long-term care stays also can increase the potential for a loved one’s abuse and neglect. The Wisconsin elder abuse lawyers of Boller & Vaughan know how devastating it can be when you entrust your loved one to the care of others, only to have that trust completely betrayed. Our attorneys are dedicated to protecting your rights and those of your loved ones in all types of circumstances. We handle nursing home abuse and neglect cases on a daily basis, and we know how to get the relief to which you may be entitled. Don’t hesitate to fight back against a neglectful or abusive nursing care and assistance living facility that has caused harm to your loved one. Contact us today and see how we can help.

Medicare Releases Hospice Compare Website

The Centers for Medicare & Medicaid Services (CMS) has unveiled “Hospice Care,” a new website dedicated to deciding whether you need hospice care and allowing you to compare various hospice care providers. The goal of the website is to give consumers the information that will allow them to be able to make informed health care decisions. For individuals with a terminal illness and their families, this can be invaluable information during a time when decision- making can become extremely difficult.

Information about the available hospice care providers across the nation are listed on the website, which allows patients, their families, and their caregivers to compare providers based on certain metrics related to quality of care. Some of these measures offer percentages on the number of patients:

  • Who were asked to discuss treatment options at the beginning of hospice care
  • Who were invited to express values and beliefs
  • Who were checked for pain at the beginning of hospice care
  • Who received a pain assessment if he or she was in pain
  • Who were examined for shortness of breath at the beginning of hospice care
  • Who were given treatment for shortness of breath
  • Who were taking opioids and offered constipation care

With the information that the Hospice Care website provides about your local hospice providers, you can then talk to doctors, nurses, social workers, families, and friends to obtain more information about your options. CMS hopes that this information will allow families to make easier choices about end-of-life care.

No matter the type of insurance coverage involved, choosing between available hospice services and facilities can be a difficult decision. It is hard to determine not only what level of care is appropriate and ensure quality of care, but also to fund that care, whether it is needed for a short or lengthy period of time. Medicaid can be an integral part of funding that care. Hospice care also brings with it the risk of abuse or neglect of your loved one, who may not be able to protect himself or herself. If you or a loved one is in this situation, you should definitely contact an experienced Wisconsin elder abuse and neglect attorney at Boller & Vaughan. We know how to protect your rights and potentially get you compensation for any injuries that have occurred. When professional caregivers fail to meet the duty of care owed to you or your loved one, it is up to you to hold negligent Wisconsin hospice and other long-term care facilities responsible for their actions. Contact Boller & Vaughan today and see what assistance we can offer you and your family.

Study Urges Nursing Homes to Listen to Patients’ Family Members

A recent study by UK-based researchers indicates that the family members of skilled nursing facility residents may be the key to eliminating unnecessary hospital admissions. Their research, which was published in the Journal of clinical nursing, revealed that it is often the observations of family members that lead to an accurate assessment of a resident’s health. When family members were involved with their loved one to the extent that they could detect changes in the residents’ health conditions and inform facility staff about those changes, the facility could provide better care to residents. Furthermore, when facility staff listened to family members, the resident was more likely to avoid an unneeded hospital stay.

Family members are an integral part of a loved one’s long-term care plan, and long-term care facilities should use the valuable information that they can provide. With the advocacy and involvement of family members, staff members at skilled nursing facilities are better able to care for their residents. Family members may be more cognizant of subtle changes in a resident’s emotional or physical condition that might necessitate treatment or medication than a staff member who has known a resident for only a short period of time. By having this valuable information sooner rather than later, staff members can head off health problems before they become so serious as to require hospitalization. Residents also can receive quicker treatment of problems as they arise, which can lessen periods of pain or discomfort.

At Boller & Vaughan, we are all too familiar with the rampant abuse and neglect that often occurs in understaffed, underfunded, overcrowded nursing homes. We have investigated many allegations of abuse and neglect, including those that have resulted in serious injuries to elderly residents, thus giving rise to a claim for damages against the responsible person and facility. Allow us to look into the background of your situation, evaluate the many options that may be available to you, and help you decide what move to make next. Contact the Wisconsin nursing home abuse and neglect attorneys of Boller & Vaughan, and see what help we have to offer you.

What if I Suspect a Loved One is Being Abused in a Nursing Home?

The Division of Quality Assurance (DQA) of the Wisconsin Department of Health Services (DHS) has the responsibility of ensuring that Wisconsin residents are healthy and safe. If you ever believe that a nursing home or other long-term care facility has violated state or federal laws or that a health care provider committed any type of abuse or neglect, you have the right to file a complaint with DQA.

If you have a complaint about a nursing home, you should contact your regional DQA office. You also can file a complaint online by emailing DQA at Complaints also can be made by calling the DQA’s toll-free number, 1-800-642-6552. To make a complaint against a particular caregiver about a specific incident or pattern of behavior, including nurses, nurse’s aides, and doctors, you can contact the Caregiver Intake Unit of DQA at (608) 261-8319.

If you suspect that a loved one who is over the age of 60 has been the victim of abuse, you can call your County Help Line for assistance. You can find information about your county’s elder abuse agency here. It is the responsibility of elder abuse agencies to record complaints, investigate complaints, and report incidents of abuse to the proper local and state authorities. Keep in mind that abuse is not limited to physical abuse. You can and should still make a complaint if the abuse is emotional or financial in nature.

If your loved one has suffered abuse or neglect at the hands of a caretaker, whether in a home setting, nursing home or other healthcare facility, you may have a valid personal injury claim. This type of situation makes it essential to contact your experienced Madison elder abuse attorneys in order to protect your rights and obtain the financial relief that you deserve. Certain individuals have an obligation under the law to report suspected abuse or neglect of an elderly individual or nursing home or other facility resident. Those who fail to do so must face the consequences of their actions. Hold negligent Wisconsin care providers responsible for their actions. Contact Boller & Vaughan today and learn how we can help you.

What are the Differences Between Nursing Homes, Other Care Centers?

There are a number of different options when it comes to medical care and assistance with activities of daily living for senior citizens, depending on the level of care needed. Fortunately, there are different types of facilities that offer varying levels of care that older individuals and their families can choose from.

Assisted living facilities house individuals who need some level of care, monitoring, and services, but who can live relatively independently. Individuals who live in assisted living facilities do not need 24-hour nursing care. Assisted living facilities allow individuals to continue to live independently while still receiving some care and monitoring.

A Community-Based Residential Facility (CBRF) is a type of assisted living facility where five or more unrelated persons who are over the age of 18 live together in a community setting. CBRFs are often senior-based communities, but they also may offer housing for adults with developmental disabilities, mental health problems, and physical disabilities. The type of care available at CBRFs is above the level of room and board, and may include up to three hours per week of nursing care per resident.

Nursing homes are residential facilities for five or more adults who need access to 24-hour nursing care, whether it is limited nursing care, intermediate nursing care, or skilled nursing services. Individuals in nursing homes are unable to live independently or even semi-independently. In most cases, nursing home residents have medical problems that are significant enough that they require constant nursing care.

No matter which type of long-term care facility is right for you or your loved one, you have the right to expect quality care and protection from abuse and neglect. Unfortunately, some facilities do not provide the quality that you expected, which can result in abuse or neglect of its residents. We are the Wisconsin abuse lawyers to whom you can turn if you suspect or become aware of abusive actions taken toward your loved one while residing in any type of long-term care facility, including nursing homes, assisted living facilities, and CBRFs. Regardless of the complexity or difficulty of your situation, the Madison long-term care abuse and neglect attorneys of Boller & Vaughan are prepared to advocate on behalf of your loved one and hold assisted living or other long-term care facilities responsible for any abuse that has occurred.

Americans Often Feel Rushed in Choosing Nursing Facility

The Journal of the American Geriatrics Society recently published a study by researchers at Brown University. The study found that older adults often feel rushed and unprepared when they must choose a skilled nursing facility following a hospitalization.  The experience overall was generally negative; doctors and health-care providers offered little guidance or education, discharge planners at hospitals merely provide names and addresses of potential facilities, and the patients often were rushed through the process of choosing a facility. Since unexpected emergencies led to hospitalization most of the time, quick decisions about facilities were often necessary. In most cases, patients made their choice of facilities either the day before or the day of their discharge from the hospital. When combined with a total lack of information about their options, patients often chose facilities based on location rather than quality.

The study suggests that health care workers, and hospital discharge planners, in particular, familiarize themselves with available facility options so that they can better guide patients and their families to a facility that will meet their needs and desired quality of care. Ensuring that workers are familiar with these facilities could lead to patients having a more positive overall admission experience. According to the study results, the combination of an emergency hospitalization and a short period in which to make decisions about nursing homes created a mostly unfavorable experience overall.

Deciding between different long-term care facilities can be a difficult and time-consuming decision. Above all, you really want your loved one to be safe and well-cared for, no matter what option you choose. At Boller & Vaughan, our nursing home abuse and neglect lawyers want to help protect those who can protect themselves the least. This is why we focus our efforts on protecting these individuals in long-term care facilities such as nursing homes. We are skilled at investigating your case and assessing your situation in order to decide whether you have any potential legal claims against the facility that took the neglectful and abusive actions toward your loved one. Don’t hesitate to contact Boller & Vaughan right away and find out how our legal skills can help your family through this difficult situation.

Nursing Home Deficiencies Drop, but Staff Numbers Still Low

A new report from the Kaiser Family Foundation found that while the average number of deficiencies in nursing homes has dropped in recent years, staffing levels are still falling short of the recommended levels. The study looked at data from 2009 to 2015. During this timeframe, the average number of deficiencies in general declined. There was a larger decrease from 2009 to 2013, and then a small increase between 2013 and 2015. Still, in 2015, more than one-fifth of facilities had a deficiency indicating actual harm or immediate jeopardy. The most common types of deficiencies include infection control, accident prevention, sanitation, and quality of care in general.

On the other hand, staffing levels remained fairly stagnant. There was a slight increase from 2009, in which total nursing hours averaged 3.9 per resident day, to 2015, in which total nursing hours averaged 4.1 per resident day. These levels of staffing still did not rise to the level suggested by some experts, who indicated that the target staffing goal should be 4.55 nursing hours per resident day.

The report detailed some other findings, as well, that relate to current conditions in nursing homes. For instance, the study found that nursing staff still may not be receiving adequate training to properly care for residents with higher needs, or those with behavioral issues. Although nursing home capacity has remained relatively flat, occupancy rates in nursing homes declined slightly between 2009 and 2015. However, the number of for-profit companies operating nursing homes increased slightly from 2009 to 2015.

You entrust your loved one to a nursing home or other long-term care facility with the intention that staff members will properly care for him or her. When that facility’s staff members fail to provide your loved one with an even basic level of reasonable care, it is likely that negligence occurred, which may make that facility and the guardian liable for the resulting injuries. If you find yourself in this situation, you may be entitled to compensation for the losses that you or your family member has suffered. Contact our Wisconsin nursing home abuse attorneys at Boller & Vaughan and learn what we can do for you and your family.

How Trumpcare Could Lead to More Nursing Home Abuse

As our country continues to age and individuals live longer lives, their need for medical care and long-term care increases. Health care policy, therefore, has a significant effect on older Americans. At least one version of the Senate’s healthcare bill has major consequences for those individuals who need long-term care. The Medicaid program supports almost two-thirds of long-term care residents, so the proposed cuts to Medicaid in the bill will have a drastic impact on those who need long-term care and the industry itself.

Back in the 1970s, there was a nationwide wave of abuse in nursing homes and long-term care facilities. Poor funding of these facilities, which led to a lack of proper staffing, caused many long-term care residents to be neglected, at best, and severely abused, in the worst cases. This systemic neglect and abuse resulted in patients left unwashed and medically untreated for days on end, with no rehabilitation efforts whatsoever. Infection ran rampant in these institution and conditions like dehydration and bedsores in nursing home residents were commonplace. Even worse, in some nursing homes, large numbers of patients were immobilized for hours on end, simply because there was no one to care for them.  If patients created “trouble” by having a need, or complained about conditions, staff members often would “punish” them through abusive actions.

The fear is that in the era of Trumpcare, nursing homes and long-term care facilities will return to the nightmarish living conditions of the past. While the workers in these facilities may have perpetrated the abuse and neglect of their residents, it was the administrators and policymakers that created the conditions in the first place. Declining funds lead directly to declining conditions, and the situation becomes even worse as the demand for long-term care continues to rise.

If your loved one has suffered injuries due to abuse or neglect at the hands of medical staff at a nursing home or other healthcare facility, you may have a valid personal injury claim. This type of situation makes it essential to contact an experienced Wisconsin nursing home abuse attorney in order to protect your rights and obtain the financial relief that your family deserves. Certain healthcare providers have an obligation under the law to report suspected abuse or neglect of a nursing home or other facility resident. Those who fail to do so must face the consequences of their actions. Hold negligent Wisconsin healthcare providers responsible for the injuries that they cause. Contact Boller & Vaughan today and learn how we can help you.

How to Protect Nursing Home Residents and Report Abuse

While most nursing home residents receive excellent, quality care, there also are some residents of nursing homes who may not only receive substandard care, but may actually be the victims of nursing home abuse or neglect. In many cases, it is staff members who neglect their duties to care for a nursing home resident or are actually abusive, either physically or emotionally, to the resident. However, there also are cases in which a nursing home resident is the perpetrator of the abuse toward another resident. In either case, it is essential that all individuals who have a loved one living in any type of facility know how to protect their loved and one and report any signs of abuse or neglect.

If you suspect that someone is abusing or neglecting a resident in a nursing home, assisted living facility, or community based residential facility, you should try and document as much evidence as possible about the incidents of abuse or neglect. You should take pictures of any physical injuries and seek medical treatment for the victim’s injuries, if needed. Try to document the times and locations at which abuse or neglect has occurred, as well as the name and position of the perpetrator, if the perpetrator is known to the victim. You also should document the statements of any witnesses to the abuse or neglect, such as other family members visiting your loved one, roommates, or visitors of roommates.

Once you have gathered all of this information, you can make a complaint to the appropriate authorities. In the state of Wisconsin, you can contact the appropriate regional office of the Division of Quality Assurance (DQA), which is the state agency responsible for ensuring the health, safety, and welfare of Wisconsin residents. You also can file a complaint with DQA by sending an email to or by calling DQA at 1-800-642-6552.

The nursing home abuse lawyers of Boller & Vaughan pride themselves on advocating on behalf of clients who suffer injuries at the hands of their caregivers, no matter whether those injuries from result from abuse or neglect in a nursing home or in any type of long-term care facility. We can seek compensation for you through the legal system, while you and your family can concentrate on healing, recovering from any trauma that you might have experienced, and moving on with your life. Don’t hesitate to contact our office today and learn how we can help.

What Are the Different Types of Elder Abuse?

According to the National Center for Elder Abuse, there are seven different types of elder abuse:

  1. Physical abuse – use of physical force to cause bodily injury, pain, or impairment
  2. Sexual abuse – nonconsensual sexual contact of any kind
  3. Emotional abuse – infliction of anguish, pain, or distress
  4. Financial/material exploitation – illegal or improper usage of an elderly person’s funds or assets
  5. Neglect – refusal or failure to fulfill any part of a person’s obligations or duties to an elderly person
  6. Abandonment – desertion of an elderly person by an individual who is responsible for him or her
  7. Self-neglect – behaviors of an elderly person that threaten his or her health or safety

Current research indicates that anywhere from one to two million Americans who are over the age of 65 have been abused or neglected by a person whom they trust for care and protection. More victims of elder abuse are female than male, and more perpetrators of elder abuse are male than female. The most common elder abuse situation involves an adult child who abuses or neglects his or her parent. As a result, elder abuse most often occurs at home. Family stressors, such as financial or psychological issues, often contribute to elder abuse. Furthermore, children who were exposed to family violence are more likely to grow up to become perpetrators of violence.

Unfortunately, there are countless situations that can lead to abuse or neglect by caregivers. If you or a loved one is seriously injured as a result of elder abuse, or your family has suffered the loss of a loved one due to negligence by nursing home or assisted living facility staff, you may be entitled to compensation. This inquiry involves determining which party or entity was at fault for the accident, acted negligently, or otherwise caused the incident that led to your injuries or your loved one’s death. At Boller & Vaughan, our Madison assisted living facility and nursing home elder abuse lawyers can help you with these determinations, and support you through any personal injury or wrongful death claims that you may have. Contact us to learn how we can help.

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