New law mandates screening process for seniors seeking care
Money, eldercare and privacy rights clashed Wednesday in the Hubbard County boardroom when new legislation on screening seniors for assisted living facilities turned into an imbroglio.
Commissioner Dick Devine said he'd heard that when seniors recently called the Senior Linkage Line they were asked probing questions about their finances in order to get an access code number to move to an assisted living facility.
A new law went into effect Oct. 1 mandating a screening process for seniors contemplating elevated levels of care outside the home.
But Devine asked if the seniors could afford the care themselves, why the state was acting like Big Brother. It's government intrusion at its worst, he maintains.
"I think it's unconstitutional. It's illegal," Devine fumed. He sits on the Heritage Living Center board, where the new law was discussed earlier in the week.
The Senior Linkage Line is staffed by Land of the Dancing Sky Area Agency on Aging.
Since 2007, seniors have been screened to enter nursing home facilities. That includes questions about their finances and whether they are able to remain in their homes with outside support.
Land of the Dancing Sky runs a senior health insurance program to give unbiased, free information to the elderly about nursing homes, drug coverage under Medicare Part D, senior transportation and senior meals programs.
On Oct. 1, the agency began its new mandate of screening the elderly, anyone who was contemplating a higher level of care.
Devine charged the mandate was passed during the special summer session convened after the state shut down for the month of July. Then lawmakers rushed back into session, passing a myriad of bills to solve the state's financial crisis.
"It was during a closed session actually and it came out unbeknownst to us," said Land of the Dancing Sky director Shannon Henrickson.
Special access cards have been necessary for seniors going into nursing homes. Like a Social Security card, these codes are a 16-digit number that identifies a recipient in the federal database, someone who is living in "registered housing with services," the new euphemism for eldercare.
It identifies seniors who have gone through a screening, a consultation informing them of their options. The questions attempt to gauge whether they could be kept at home longer if they only need minimal services, said Land of the Dancing Sky program developer Darla Bergquist.
Did they qualify for the elderly waiver program, Bergquist said the questions sought answers to?
"A lot of people aren't even aware that there are services out there they can get for low cost or free, so that screening is done through our senior linkage line staff," Bergquist explained.
The intent is to keep the federal and state Medical Assistance program afloat by helping seniors stay in their homes longer.
"At some point in the future with all the Baby Boomers we'll bust the MA system," Henrickson said.
But what rankled Devine was that under the new law seniors who can afford their own assisted living must nevertheless undergo the screening process now to obtain the access code for care.
"Government doesn't have the right to butt into our business," Devine said.
"And that means even if Bill Gates lives in Hubbard County in Minnesota here and wanted to put himself or a loved one into a home, even though he has the resources to pay for it, in order to get in you have to have the number," Hubbard County Social Services Director Daryl Bessler said.
"You don't have to go through, they can decline the screening, but they have to say they don't want the screening," he added. "They just need to say, 'I want my number.'"
Absolutely, Henrickson and Bergquist agree.
Seniors can opt out of the consultation and obtain the card without answering any of the questions.
"It became mandatory for people to call no matter what their income level is," Henrickson said.
"Private pay persons shouldn't have to have someone's permission" to go into assisted living, Devine said. "People wanted to rent an apartment and can't without the government's permission," he said.
"The only reason they're asking that question is that if they fill out the county paperwork, then you actually have to have proof of income," Bergquist said.
"They can even bypass the consultation and say, 'Nope, this is a choice I'm making. I'm ready to go into assisted living' and here we go."
Senior care providers aren't happy about the new legislation, either.
"It's another impediment from their perspective," Bessler said. "If you own an assisted living facility it's viewed as another obstruction you have to deal with."
"I understood the frustrations were on the provider end and I can understand that because this is change and they're concerned about their census and keeping their doors open," Bergquist agreed.
Usually, long-term care consultations are the purview of the facility, commissioners said, not the government. This law usurps a facility's prerogative to work with its own prospective patients.
Bergquist said a new data system allows assisted living facilities to apply for a temporary access card if a patient is admitted during the weekend when staffing is lower.
What questions are asked and the privacy issues
"It's basically to provide information so people can make an informed choice," Henrickson said of the long-term care screening questions.
But she acknowledged the new mandate "is very controversial and people don't like it.
"Then you hear from people who say, 'I moved in and then there were all these fees and we ended up moving my mother back home because it was a lot cheaper,'" she said. "I've seen both sides of the coin."
Bergquist said since many elderly people have turned their affairs over to their children to sort out, data privacy laws prevent an agency or provider from discussing them with the adult child unless a power of attorney agreement is in place.
"We ask things like, 'Have you visited the facility,' 'Do you have any questions about assisted living of any type,' 'Is there a reason for your move,' 'Did you receive a consumer information guide and if they have any questions about that' and then if there is family involved that is able to help you, 'Are they feeling down, depressed or hopeless, are they worried about their house and safety' because sometimes people just need somebody to come in their home and help them and they don't really need to move into assisted living," Henrickson said.
"We don't even ask for any" financial information, she said.
The money/ethics conundrum
Screening for eligibility is only part of the larger social issue facing seniors.
Some seniors feel they've worked and paid taxes all their lives and they don't want their nest eggs depleted paying for their senior care, the entitlement argument goes.
The consultations are designed "to talk to people about the resources available and in the community so they can put their loved one in a nursing home and the idea is to delay placement essentially and see if it's really warranted," Bessler said.
Others "find the appropriate attorney and if you set up the proper legal documents and get the resources put away in an irrevocable trust arrangement, and then when you have need, you can become eligible for Medical Assistance," Bessler said.
"And you can basically pass on your resources to your family or whomever you wanted them to go to. But the key is people have to do this in advance. Not everybody thinks of it and does it but (more people are) because they say they 'paid taxes all my life and I want to pass this on to my family. I'm not going to let the government have it if I go into a nursing home.'"
A five-year look back window means seniors have to plan ahead before they dispose of their assets to qualify for MA. Otherwise the transactions are considered fraudulent.
"The thing where this got a little bit out of whack was last November with the food portion, the stamp food support program, that eliminated resources and that got people rather" excited, Bessler said.
"We had people who would have never come through the door before that and said why not. 'I paid taxes I might as well capitalize on this.' And it did have that impact to some extent, "Bessler said.
"Other people, when they thought it through, decided to pull their applications," he said. "They were beginning to feel that they had resources and this should have been for the people that need it.
"There's a lot of folks out there that feel their dignity is worth something," Bessler said. "There are those that do (feel entitled.) I'd like to think there's more of the former than the latter. If there weren't we'd have a lot more people that would be receiving benefits."
Henrickson said all calls to the Senior Linkage Line are monitored and recorded. If someone didn't stick to the script for counseling and asked intrusive questions, that can be tracked, she said.
She was astounded to hear people had complained that a stranger over the phone was asking them about the money they had in the bank.
"If someone's doing that they certainly shouldn't be," she said, suggesting it be reported.
The other issue is whether seniors should pay for their own care if they can.
"I think people realize you can't keep going more and more into debt, whether it's state or federal. There's a realization that we've gotta start changing our ways and why add to it," Bessler said.
"I'm one of those tail end (Baby Boomer) people and it's like we need to start paying our way sometimes if we have the money to," Henrickson said. "So we can't always put it on the state or federal government because we've all seen what kind of a mess that has caused this year."
Bessler meanwhile said seniors should be notified up front they can refuse to answer the financial questions. Otherwise they feel intimidated into revealing information they'd rather keep private, especially if they can afford their own care.