Vivian’s Views: Seniors
The goal of government policies and programs should be to support the ability of people to take care of themselves for as long as they can. Where government assistance is needed, it is important to have a range of options to avoid the need for more costly services later and to protect each person’s dignity and control of their lives.
NURSING HOMESVirginia is one of the few states with no minimum staffing standards for nursing homes. The seriousness of this issue is underscored by the fact that Christopher Reeve – even with all the care he received – died from bedsore complications. With the high number of frail elderly in nursing homes on Medicaid and the acuity required to be placed in a nursing home under Virginia’s minimally-financed Medicaid program, it is especially critical that we join the 37 other states who have minimum staffing requirements. Virginia’s lack of standards is directly related to the fact that reimbursement rates for Medicaid patients are significantly below actual costs. Nursing homes who do have adequate staffing do so by charging private pay patients significantly more. I see this as a hidden tax to make-up for what Virginia’s low Medicaid rates don’t cover. It would cost the state $24.5 million (matched by another $24.5 million in federal Medicaid funds) to require that patients in every nursing home throughout Virginia have at least 3.5 hours of direct care services per 24 hours. Year after year, my bills for minimum staffing standards die in the budget committee. I will not give up. I have been successful in a number of other areas, however, including
- insuring the cap on medical malpractice suits does not apply to injury or death caused by business decisions such as staffing, security, maintenance, or food preparation but only applies to healthcare services provided in nursing homes;
- establishing a Nursing Facility Quality Improvement Program to provide on-site training and quality improvement assistance at nursing homes that are not in compliance with state regulations that is funded from fines paid for violations; and
- providing geriatric mental health services to people over age 65 with serious mental illness and to providing psychiatric consultation and training to the staff of long-term care facilities.
ASSISTED LIVINGIn 2004, the Washington Post’s investigative series on shocking conditions in Assisted Living Facilities (ALF) put a face on bills I’d been carrying for several years. With that documentation, working with key legislators and responsible ALF operators, we passed much-needed protection for over 30,000 disabled people who cannot live on their own and are in assisted living throughout Virginia, which established
- oversight for dispensing medications,
- better mental health screening,
- licensure of operators so that the bad apples can’t just close one home and open another, and
- emergency help for residents in unsafe homes.
CRIMES AGAINST SENIORSIt took several years to define the crime of an elderly person being bilked out of what wealth they have by family members or companions in a position of trust. It was difficult to balance the right of the elderly person to make their own decisions versus defining undue influence on those decisions in order to commit larceny and fraud. While I worked on this financial exploitation compromise that hinges on whether the victim had the mental capacity to understand what was going on, I continue to push for more protections. There is a serious problem of door to door “repairmen” who identify problems where it’s hard for the elderly see the work, use physical intimidation, and even circulate the victim’s name to others for further exploitation. Too often, by the time the fraud involving 10’s of 1000’s of dollars is discovered and can be brought to criminal trial, the elderly person is no longer a good witness. Thus far, I’ve enabled civil prosecution by bringing multiple acts under the Consumer Protection Act – as I had done in going after multiple acts by un-licensed contractors to award consumers triple damages. At the very least, I want to put teeth in contractors violating a No Soliciting sign. Even though elder abuse has been defined as a crime, I worked extensively with child abuse as the Director of the Fairfax Court Appointed Special Advocates and know tracking of reported child abuse is better defined. I will work to ensure follow-through and provide tracking across all agencies to facilitate detecting patterns of abuse involving caretakers or institutions.
VETERANSWe’ve made real progress since I was appointed to the newly-created Board of Veteran Services. We had only one long term veteran care center – soon we will have 4 when a center opens in Fauquier and Virginia Beach in 2021. We had no services representatives located in Northern Virginia to help veterans and their spouses – I got the first two in 2005 and we now have 13. Four services representatives work out of 6564 Loisdale Ct in Springfield. I will continued to monitor needed cost of living pay differentials so personnel that Virginia trains don’t end up moving to the federal VA where the salary is considerably higher.
ESTATESWorking with the Virginia Bar, I got comprehensive reform of the Small Estates Act, saving many from the cost and hassle of probate. Heirs have immediate access to an account under $2,400 and authority to pay funeral expenses of up to $3,500. After 60 days, an heir has access to assets of up to $15,000 and, if all heirs agree in writing, no financial institution can deny access to assets of up to $50,000. Earlier, I had changed the law to waive the need for an inventory or payment of settlement fees when an estate is under $10,000 and had ended the prohibition against someone who is not a resident of Virginia being named as the sole executor of an estate. I opposed total repeal of the estate tax, which allows multi-millionaires to pass wealth to the next generation tax free, while most other seniors paid taxes on the capital gains when they had to cash-in 401Ks or other retirement savings. I do support the same limits passed by Congress to limit repeal to estates under $5 million and all estates where the majority of the assets are in a closely held business or a working farm. Collecting taxes on the capital gains from about 300 estates a year of multi-millionaires would more than fully fund humane staffing standards for the 30,000 seniors in nursing homes.
END OF LIFE DECISIONSAfter lengthy consideration by the medical community and the public, in 2018 we passed detailed requirements to insure that doctor, hospital and family decisions are properly reviewed in carrying out end of life care. I am comfortable with the balance, but as one commentator observed, “Most people have a lot more confidence in their loved ones than they do in some legislator.” Here are some good web sites to help you take control of your life:
www.aarp.com takes you to “Care and Family” where you need to click on “End of Life.” www.caringinfo.org is the National Hospice site, which has Virginia’s advance directive form. www.abanet.org/aging has a “Consumer Tool Kit for Health Care Decisionmaking” put together by the American Bar Association. www.uslivingwillregistry.com is a national registry for living wills.As you go think about your decisions, you may wish to designate someone other than a family member to make end-of-life decisions on your behalf. Prior to a change I got passed, hospitals and others would only deal with next of kin.
A PERSONAL NOTE
Dave and I know that we are incredibly lucky that both of us are still in good health. With homage to the spirit of the 83-year-old washing her 2nd story windows and to the genes I inherited from my great-grandmother, I still downhill ski! Most of my family members were not so fortunate. I believe these blessings as well as inevitable challenges give me a special obligation to being a voice for the full range of life’s experience.