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Changes in Medicare Allow Seniors to Receive Care Even if Not Improving

Nursing home lawyers at Pintas & Mullins announce that a judge recently ordered that physically improving is not required to have Medicare pay for certain therapies. Previous Medicare regulation required seniors to demonstrate that their conditions were improving in order to receive government assistance.

The same stipulations were required for other types of skilled care, including rehabilitation and speech therapy, among others: no improvements meant no assistance. The requirement was extremely detrimental to seniors in particular, as some simply reach a plateau in their physical well-being and fail to improve due to advancing age or chronic disability.

Despite their lack of improvement, however, they still require habitual care to maintain the level of health they do have. The change is set to take effect immediately, applying to care provided by a skilled professional in outpatient therapy, nursing homes, and home health care settings. The lawsuit verdict did not, however, require Medicare inform its beneficiaries about the change.

Medicare has until January 2014 to notify its employees who work at the 1.800.MEDICARE information line and other health providers of the change. For this reason, if your provider tells you your coverage must end or services cannot be paid for, it is important you ask if they are aware of this recent change.

It is of greater importance for health care providers of all types and levels to be able to recognize signs of elder abuse and neglect. Although abuse does often occur by such health care providers, it is often up to visiting family and other members of the community to spot and report any suspected cases of abuse. Some possible indicators of elder abuse or negligence include, but are far from limited to: malnourishment or dehydration, bedsores, unexplained injuries, hypothermia, unusual bank activity, mismatching signatures, withholding mail, and signs of psychological abuse.

If abuse or neglect is suspected in a nursing home, it should be reported to the state department of health immediately, which will then investigate the incident and, if necessary file official complaints and citations. One such incident recently occurred in Ormond Beach, Florida. The nursing home, Avante at Ormond Beach, was already on the federal watch-list of problematic nursing homes when it was sued by two of its patients.

The plaintiffs claimed they suffered serious health problems due to the negligence of nursing home staff. Their health problems include cases of malnutrition, pneumonia, infections, broken bones, and bedsores. According to the U.S. Department of Health and Human Services, Avante is signified as a ‘special focus facility,’ meaning that it has a pattern of very serious problems that have persisted without remedy for a long period of time.

One of the patients filing complains was admitted to the facility in 2010, and has since suffered bouts of pneumonia, multiple urinary tract infections, sepsis, malnutritions, bedsores, and MRSA (a staph infection resistant to antibiotics common in group-home settings). The patient also suffered a fall at Avante, fracturing her right hip.

The other plaintiff was admitted to Avante in 2006 and left in 2012. During those six years, she suffered from malnutrition, skin tears, extreme weight loss, and multiple urinary tract infections. The lawsuits claim that the patients suffered bodily injury, disability, disfigurement, mental anguish, loss of capacity for the enjoyment of life, hospitalization, and aggravation of previous conditions.

In April 2013, Florida fined Avante $36,000 after inspectors found the facility fraudulently mishandled a sex abuse claim. The executive director of Families for Better Care, however, stated that the fine to them is nothing more than a slap on the wrist, as they continue to haul in profits “by the truckload.”

Nursing home abuse and neglect lawyers at Pintas & Mullins have decades of experience advocating on behalf of those injured or sickened by inadequate care at assisted-living facilities. If you or a loved one was seriously injured by an abusive employee of a nursing home, you have important legal rights, and may be entitled to significant compensation through a lawsuit against the perpetrator or facility.

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