Old Prisoners Denied Their Social Security

8-3-2009 National:

AGING BEHIND BARS SERIES

From time to time, I’ve written about the growing numbers of older prisoners now filling up the country’s prisons and jails, in a series of posts called Aging Behind Bars. Many of these prisoners receive inadquate health care and are subject to special forms of cruel and inhuman punishment that have to do with age–i.e. requiring people with bad arthritis to climb to the upper bunk to sleep, or making it next to impossible for inmates in wheelchairs to access parts of prisons available to younger people, even including something as simple as handicapped showers. Among the worst incidents described to me by a medical consultant were ill women forced to get out of bed at 3 am,then stand in lines to obtain medicine in one Alabama women’s prison.

Older prisoners are also often denied the Social Security they earned for years before being convicted of a crime. Lois Ahrens, who runs the indispenable Real Cost of Prisons Project, alerted me to the situation of David Hinman, a prisoner in Iowa. Now 65, he contributed to Social Security for years while he was in the “free-world.” He is not eligible for parole for a number years. Hinman writes:

Currently the government will not pay people in prison social security. I am speaking about paying social security to those who paid into the fund. Payment is based on what they paid in. Even though I am now 65 and paid into the fund, since I am in prison I am not allowed to collect unless I am released from prison. By not paying inmates the social security to which they are entitled, I believe this is in some manner, theft.

My question to readers is: should prison inmates who paid into social security and reached 65 be allowed to collected social security while incarcerated or not.

(You can write to David Hinman, #25374, Anamosa State Penitentiary, 406 North High Street, P.O. Box 10, Anamosa, IA 52205-0010.)

Asked about this situation, Paul Wright, editor of Prison Legal News, the excellent magazine which tracks prison issues, wrote me:

Part of the problem I have with this is that someone can work their whole life, pay into Social Security, commit a crime at a later age, and go to prison for the rest of their life and never see a penny of the money they paid into SS. The lie used to justify this is prisoners have no need for money but that is not true. I think it is a backdoor way to trim the SS rolls. I think this is the exception. To put it into context, retirees can get their pensions in prison, veterans can get their VA benefits in prison. It follows that if you earn something you are entitled to it. It is not a freebie the government can take away because it doesn’t like you and that is exactly what they do here.

Wright attached an article from a 1998 isssue of Prison Legal News, describing a federal court decision on the subject, that sets the situation into the bleakest of terms.

The court of appeals for the Ninth circuit held that a statute denying Social Security benefits to prisoners is constitutional. Robert Butler is a 77 year old Nevada state prisoner. Butler was granted social security retirement benefits in 1983. He was later incarcerated and the Social Security Administration (SSA) determined he was not entitled to benefits while he was incarcerated pursuant to 42 U.S.C. § 402(X). An administrative law judge affirmed the SSA’s decision. Butler filed suit in federal court and it was dismissed for failing to state a claim upon which relief could be granted. The court of appeals affirmed. The appeals court noted that every court to consider the constitutionality of 42 U.S.C. § 402(X), this includes the Second, Fourth, Eighth, Tenth and Eleventh circuits, had upheld the law. Congress has wide discretion in administering welfare resources. The court held that § 402(X)’s ban on social security benefits to prisoners does not violate constitutional guarantees to due process, equal protection and protection against ex post facto laws and bills of attainder. The court also held that Butler was provided with ample due process before his benefits were terminated because he participated in the SSA hearing by telephone. Since the statute leaves no room for agency discretion and the only fact issue was whether or not Butler was a felon doing time in prison, the telephone hearing was sufficient to safeguard Butler’s due process interest in his social security benefits. See: Butler v. Apfel , 144 F.3d 622 (9th Cir. 1998).

..Source.. by James Ridgeway, the Unsilent Generation

IA- Hospice industry decries Medicare cuts

5-23-2009 Iowa:

The president of a group representing the nation's hospice care industry says one of Iowa's two senators is supporting a bid to rescind a rule that cuts federal payments to hospices.

Don Schumacher, president of the National Hospice and Palliative Care Organization, says last year the Bush Administration enacted a rule which cut payments to hospices for treatment of elderly patients who're on Medicare.

"We're trying to make consumers aware all around the country that hospice care, which is one of the most successful choices for care at the end of life, is experiencing some potential difficulty in that as the Bush Administration left office last year they instituted a regulation that's cutting hospice reimbursement by $2.2 billion," Schmacher says.

Specifically, Medicaid payments for hospice care were cut by just over four-and-a-half percent.

"We did an economic survey of our members over the last couple of months and it shows that even without this rate cut the economic picture right now has hospice programs struggling 'cause of the tremendous costs and the reimbursement really, essentially being on the low end as it is," Schmacher says, "and this is an additional cut to us which will cost us dramatically."

Congress reversed the reduction in Medicaid payment rates for hospice care for this year, but Schmacher's group is now lobbying congress to keep hospice care rates the same for the next two years. Iowa Senator Tom Harkin has signed onto a letter, urging the Obama Administration to make the move. Hospice groups are asking Iowa's other senator, Chuck Grassley, to join the effort to keep hospice care payments for Medicare patients the same for the next two years.

"It's quite a bit of change for programs to lose," Schmacher says.

According to Schmacher, it makes economic sense for Medicare patients to choose hospice care.

"A study came out of Duke University two years ago and it shows that for every patient admitted to hospice, we save the Medicare system about $2200 to $2500 when compared with patients of similar disease and life trajectory," Schmacher says. "...Everybody who goes through hospice, for the most part, feels as though they received the opportunity to say good-bye in the most appropriate way possible."

The Hospice and Palliative Care Association of Iowa represents 74 hospice agencies providing end-of-life care at 103 different facilities in Iowa. Schumacher leads the national group which represents about 80 percent of the hospices in the United States. ..Source.. by O.Kay Henderson

MI- Editorial: Protect patients at care facilities

5-8-2009 Michigan:

Congress should pass legislation to prevent criminals from securing jobs in long-term care fields. Those looking to abuse and steal from senior citizens should have to work harder at it than just filling out a job application at a nursing home. The bill would require a comprehensive nationwide program for background checks before a job could be given to anyone seeking elder-care employment. There is an unprecedented demand for long-term care housing because Americans are living longer. That has created more need for caregivers. More protection is needed to safeguard vulnerable residents from those who could do them harm.

While most states like Michigan require background checks for employees of long-term care facilities, there is no national or coordinated database that provides a thorough review of an applicant's criminal history. Too often predators, who frequently change states and jobs, have been able to evade detection because state-based background check systems, overall, are incomplete and inconsistent.

The bill introduced in Congress (HR 2223) by Rep. Joseph Sestak, D-PA and co-sponsored by Rep. Vernon Ehlers, R-Grand Rapids and Rep. Fred Upton, R-St. Joseph, calls for states to establish a cross-referencing system for national and state background checks of prospective employees. The checks would be applied to those people with direct access to patients in the long-term care facilities. Federal matching funds would be provided to help states pay for the system.

State information would be coordinated and applicants screened against the Federal Bureau of Investigation's criminal history database.

This legislation seeks to expand on a seven-state background check pilot program that included Michigan, operated between 2005 and 2007. Checks were done either statewide or for a few counties. As a result of that pilot, administered by the Centers for Medicare & Medicaid Services, more than 7,200 people with criminal histories of violence or abuse were prevented from working as caregivers.

Mr. Ehlers said the pilot has proved successful in Michigan, and he is dead-on about a national background system providing "safety and peace-of-mind to people staying in these facilities, and their families." There needs to be some faith that those entrusted to care for a person or his loved one is not going to kill, beat, rape or rob that person. This bill would be a big step in achieving that confidence. Kent County has 25 licensed long-term care facilities (2,560 beds) and Ottawa County has 14 facilities (908 beds).

There is a strong case for this measure. Besides the pilot program, a 2006 Health and Human Services (HHS) study points out several challenges of individual state registries. In addition, a 2004 national survey of State Adult Protective Services agencies identified more than 500,000 reports of elder abuse, including physical, sexual and financial exploitation.

In 2005, Michigan Attorney General Mike Cox reported that 25 percent of residential care facility employees committing crimes against residents since 2002 had past criminal convictions. His statewide investigation revealed criminal histories that included homicides, armed robberies and criminal sexual conduct. This led to a law that took effect in April 2006, making it a crime not to conduct a criminal background check. The law mandates fingerprint checks and expands the number of crimes that can disqualify a job applicant, including drug and theft offenses. These are important safeguards, but the FBI screening and enhanced state-to-state information from a national database would bolster protections in the state.

America's baby boomers are beginning to turn 65. People who reach that age have a 40 percent chance of entering a nursing home, according to HHS. Those who do will stay there five years or more. According to the Census Bureau, 10.3 percent of Kent County's population was 65 or older in 2007, 10.7 percent of Ottawa County's and 12.7 percent statewide.

The bottom line is that the current background check system is not thorough enough, and allows criminals to slip through. Congress knows that. Now lawmakers need to do something about it so the elderly and disabled are not easy prey for shady characters. ..Source.. Opinion of Grand Rapids Press Editorial Board

OH- Proposed law would ensure nursing homes be informed when a sex offender moves in

This proposed law makes no sense because it puts the onus on law enforcement to do something (administrative clerical type work) that takes them away from law enforcement work. To take time to personally notify nursing homes when a registered sex offender moves into an address which is classified as a nursing home. Further, LE would have to keep track of every nursing home as well. It would be far easier and more cost justified if nursing homes would check the public registries on some regular basis for their new admissions, or on preadmission. If families of nursing home residents are concerned they can do the checking as well.

4-28-2009 Ohio:

You don't have to wait for a new Ohio law to pass to find out if a sex offender is living in the same nursing home where your mom or dad or other loved one lives.

You can find out right now.

The legislation, House Bill 98, introduced last month by State Rep. Courtney Combs, Republican of Hamilton, would require local sheriff's offices to notify nursing homes -- and other long-term care facilities -- when a sex offender moves in.

The facilities, in turn, would be required to tell patients and whoever looks out for them.

Combs introduced the law because an 18-year-old mentally retarded woman was raped by the man in the next room at a long-term care facility in his district. He doesn't want that to happen again.

The way the existing law is written, schools, day-care centers and homes -- but not long-term care facilities -- that are within 1,000 feet of where an offender lives are notified.

That means a sex offender could be sharing a room with Grandma or Grandpa and you'd never know it.

So how can you find out now? All you need is the address of the nursing home and a computer.

Go online to the Ohio attorney general's website and you can search for sex offenders. Type in the address of the nursing home. You'll get the name, photograph and address of each registered sex offender who lives within -- and you can choose this -- a quarter-mile, a half-mile, one or two miles.

Click on the offender's name, and you'll get a little more information on his or her crime.

The problem with the system, says John Saulitis, is that you have to keep checking back. A sex offender may not live in your mother's nursing home today, but he could move in next week. And that, Saulitis says, puts an unrealistic burden on nursing home residents and their families.

Saulitis runs the Youngstown office of Ohio's Long-Term Care Ombudsman Programs, part of a state and national system of people who look out for the rights and safety of those living in group homes, nursing homes and assisted-living centers, as well as those who receive in-home care.

He's also the guy who spent weeks combing through the registry to find out how many sex offenders live in Ohio's nursing homes.

It's a changing number. But when he finished his research on March 23, he'd discovered 107 offenders living in 47 nursing homes across the state.

Keeping tabs on them is a time-consuming process. That's one reason Saulitis wants to see the law changed.

He knows you can go to the attorney general's Web site listed above and sign up for an automatic e-mail alert whenever a sex offender moves close to any address -- including a nursing home's -- that you type into the site. The problem, he says, is that you get an alert whenever an offender moves into the surrounding area, not just the nursing home.

"The more notifications you get," Saulitis says, "the less you're going to pay attention to them."

And when you stop paying attention, what good is the notification?

That's another reason he's pushing for passage of House Bill 98 and urging all of us who have a loved one in long-term care to call our lawmakers.

"Contact your legislators," he says, "and say 'Look, there's a simple solution to this. It's called House Bill 98. We want to you support it.'

"It simplifies the system incredibly for the families and relatives," Saulitis says. "It's just much more efficient."

If you want a more complete picture about the safety and quality of a nursing home, make sure you go to the Department of Aging's Long-Term Care Consumer Guide.

Follow the instructions and the site will tell you how people who live in nursing homes feel about each facility. You can see, for example, what percentage of patients actually said they liked the home and what percentage would recommend it to someone else.

Not only will you get that from the patient's perspective, you'll get it from the family's, too.

You'll also find more specific survey results about things like clothing getting lost, residents being treated with respect, and how satisfied people are with the food and medical care.

What's more revealing, though, are the inspection reports you'll find when you click on the "Inspections" tab. That will lead you to a description of what Medicare/Medicaid inspectors found when they stopped by the facility -- unannounced and sometimes at night or on weekends -- to visit.

From those reports you can learn, for example, if a nursing home was cited for not providing a safe, clean environment; for medication errors that caused harm; for allowing pressure sores to develop; or for failing to notify family members when a resident was injured.

The information is even more helpful, says Beverley Laubert, the state long-term care ombudsman who oversees Ohio's 12 offices, when you click on the date under "Most Recent Annual Survey" and see the details of what officials call the "deficiencies."

What the Web site doesn't provide, though, is what action the nursing home took to solve the problem.

Each home is required to have that on hand, in an easy-to-see spot, says Laubert. Look for it at the front desk, nurses station or on a bulletin board.

If it's not there, ask for it, says Laubert. If you're not comfortable doing that, contact the state ombudsman's office at 1-800-282-1206 and someone will put you in touch with the office closest to you.

But don't stop there.

Spend some time at the nursing home and check it out for yourself.

"Nothing beats going there and visiting," says Kathy Keller, spokeswoman for AARP Ohio.

"You need to see it, you need to get the feel for the institution, you need to be able to walk around and see what is going on, you need to smell it, you need to see if the residents there seem to be happy or if they're not very happy."

That's the only way you'll know for sure if it works for you and your loved one. ..Source.. by Diane Suchetka/Plain Dealer Reporter

WA- Bill targeting those who exploit vulnerable adults approved

4-21-2009 Washington:

Legislation may soon go to governor for her signature

A bill that would prevent those who exploit elderly or otherwise vulnerable persons from inheriting money or property from their victims has passed both the House and Senate and may soon be on its way to the governor's desk.

House Bill 1103, sponsored by Rep. Jim Moeller, is the latest in a series of bills the Vancouver Democrat has sponsored in recent years to protect vulnerable adults from exploitation. Moeller has worked closely with the Clark County Vulnerable Adults Task Force to develop the legislation.

"As we age, we become more dependent upon people close to us for taking care of our basic necessities," Moeller said in a statement. "Yet some of the people closest to us, sometimes even our own children, take advantage of the situation."

Nothing in existing state law prevents a person who is found guilty of committing financial exploitation from inheriting property from the victim if the perpetrator is named in the victim's will.

Vancouver attorney Jessica Dimitrov said the new law will have significant impacts.

She is a partner in Dimitrov & Senescu, a law firm that represents exploited and vulnerable adults and works to change state law.

"We are seeing an increase in financial exploitation of vulnerable adults, and given the current economic situation, we can expect it to get much worse before it ever stops happening," she said in an e-mail. "But this law seeks to serve as a very severe and tough deterrent to this type of activity."

Moeller said he expects the House to concur with an amendment to the bill added by the Senate and then send the bill to the governor for her signature. ..Source.. by KATHIE DURBIN, COLUMBIAN STAFF WRITER

IN-Indiana bill would allow alerts for missing seniors

4-20-2009 Indiana:

INDIANAPOLIS (AP) — Indiana residents could soon get public warnings similar to Amber Alerts when seniors with Alzheimer's disease or other endangered adults go missing.

A bill that won final legislative approval Monday would create silver alerts, which would be issued by police and broadcast by media outlets.

Bill supporters say the proposal could protect thousands of Indiana residents with Alzheimer's disease or other cognitive problems. But some were concerned that the system would result in so many alerts that the public would tune them out.


At least 10 states have notification systems for people with some form of mental impairments.

The bill now goes to Gov. Mitch Daniels for his consideration. ..Source.. by SOuth Bend Tribune

In early Alzheimer's, when to give up the car keys

4-18-2009 National:

WASHINGTON — Scientists are creating tests to show when it's time for people with early Alzheimer's disease to stop driving.

It's one of a family's most wrenching decisions, and as Alzheimer's increasingly is diagnosed in its earliest stages, it can be hard to tell when a loved one is poised to become a danger.

Factor in that much of the country lacks public transportation, and quitting too soon restricts independence for someone who otherwise may function well for several years.

"That's a real cost to the individual and family and society," says Jeffrey Dawson of the University of Iowa. "You have to have some sort of trade-off between the individual's independence along with the safety of the driver and with other people on the road."

Typically, specialists say, patients gradually scale back their driving, avoiding busy freeways or night trips or left-turn intersections. Alzheimer's Association adviser Sue Pinder, 58, recently gave up big-city driving even though it meant fewer visits to a daughter in Dallas.

Shortly after Pinder's diagnosis in 2004, she signed a form designating her husband to decide when she'll quit driving altogether. He gave her a GPS system for her last birthday. It helped Pinder navigate unfamiliar streets when, to be near another daughter, the couple recently moved to West Monroe, La., from a nearby town.

"That's helped a lot where I don't have to worry, I can concentrate on my driving and not the directions," Pinder says.

Working on ways to help similar patients, Dawson's team in Iowa developed an intricate behind-the-wheel exam: A 35-mile drive through rural, residential and urban streets in a tricked-out Ford Taurus able to record just about every action the driver takes, much like an airplane "black box" does. Lipstick-size video cameras were positioned to show oncoming traffic, too.

Researchers recruited 40 people with early-stage Alzheimer's who still had their driver's licenses to take the road test, and compared how 115 older drivers without dementia handled the same trip.

The results, reported in the journal Neurology, are striking. On average, the Alzheimer's drivers committed 42 safety mistakes, compared with 33 for the other drivers.

Lane violations, such as swerving or hugging the center line as another car approaches, were the biggest problem for the Alzheimer's drivers. They performed 50 percent worse.

Overall errors rose with increasing age whether or not the driver had Alzheimer's, an extra 2 1/2 mistakes for every five years of age.

But some Alzheimer's patients drove just as well as their healthier counterparts, stresses Dawson, a biostatistics professor. Here's the key: Researchers also checked whether any of a battery of neuropsychological tests given beforehand accurately predicted who would drive worse _ and some did.

Flunking simple memory tests didn't make a difference. Standard neurologic tests of multitasking abilities did, ones that assess if people's cognitive, visual and motor skills work together in a way to make quick decisions. Examples include showing patients geometric figures for a few seconds and having them draw the shape from memory, or drawing paths between a sequence of numbers and letters.

Alzheimer's patients who scored average or better on those types of written tests were likewise no worse behind the wheel than other older drivers _ but those who scored worse than average tended to commit about 50 percent more errors on the road, Dawson says.

More research is needed but the ultimate goal is an easy doctor's-office exam to help guide when patients should give up the keys.

About 600,000 elderly adults stop driving for some health reason every year, according to the National Institute on Aging. But there's little clear guidance for the roughly 2 million people estimated to be in Alzheimer's early stages, and the disease is poised to skyrocket in two decades as the population grays.

States have varying laws on when aging drivers must pass a road test for a license renewal, but they seldom address specific diseases; California requires reporting of Alzheimer's diagnoses so driving can be assessed. The Alzheimer's Association tells families warning signs of unsafe driving.

But as Alzheimer's worsens, patients often vehemently deny that they're a hazard, says Dr. Gary Kennedy, geriatric psychiatry chief at New York's Montefiore Medical Center.

"I can be the bad guy," he tells families, sometimes reporting patients to the Department of Motor Vehicles for a driving test or advising relatives to disable the car.

"Giving up the car is not like going into the nursing home," Kennedy counsels patients, trying to recruit relatives or friends to schedule rides. "If as a society we recognize this as a danger, we need to help them compensate." ..Source.. by LAURAN NEERGAARD

Medicare's Hospice Benefit

4-17-2009 Washington DC:

Summary:
Hospice care provides an interdisciplinary approach to services for Medicare beneficiaries with a terminal illness. This care specializes in the relief of the pain and symptoms associated with a terminal illness and in the provision of supportive and counseling services to patients and their families during the final stages of a patient's illness and death.

The benefit covers a broad range of services, including prescription drugs for pain control and symptom management, skilled nursing care, physician services, home health aide services, homemaker services, patient counseling, and family bereavement counseling. Services are provided primarily in the patient's home, but may also be provided in institutional settings, such as nursing homes.

Hospice care is provided in lieu of most other Medicare services related to the curative treatment of the terminal illness. For a person to be considered terminally ill and eligible for Medicare's hospice benefit, the beneficiary's attending physician and the medical director of the hospice (or physician member of the hospice team) must certify that the individual has a life expectancy of six months or less.

Beneficiaries electing hospice are covered for two 90-day periods, followed by an unlimited number of 60-day periods. Medicare payments to hospices in 2007 totaled $10.1 billion, having more than tripled since 2000. Medicare spending for hospice is expected to continue growing and to more than double by 2018, reaching a projected $21 billion and outpacing the projected growth rates for Medicare payments in hospitals, skilled nursing facilities, physician services, and home health care.

Growth in spending to date has been driven, in part, by increased utilization of hospice as well as spending per hospice user. For example, spending per user grew between 2004 and 2005 by 8%. Growth in spending per user may be in part a result of increasing lengths of stay among certain hospice providers.

The number of hospices participating in Medicare also grew by 33.4% during the four-year period from 2003 to 2007. As of 2007, for-profit hospices constituted the majority of these hospices, and since 2000, made up over 90% of hospices participating in Medicare. Medicare pays hospices using a prospective payment system containing four categories of daily rates, which are predetermined, fixed amounts intended to pay for the costs of care for a hospice beneficiary, on average.

These amounts are adjusted annually by the hospice market basket. Hospice payments are also adjusted for geographical differences. Total payments to hospices may not exceed an aggregate per beneficiary cap amount. Some analysts have expressed concerns about Medicare margins earned by certain types of hospice providers, the growing number of hospices exceeding the aggregate per beneficiary cap, increasing lengths of stay, and the three-year phase out of the budget neutrality factor authorized under regulation in August of 2008. All of these topics are discussed in this report, which will be updated as necessary.

For the full report: by Medicare

OR- Bill would admit some sex-crime confessions

4-17-2009 Oregon:

A bill that cleared the Oregon House without dissent Wednesday would allow admission of confessions to sex crimes against vulnerable adults and children as evidence in a trial, even when the victim is unable to speak in court.

"When the defendant has confessed, it is heartbreaking that justice cannot be served because of the victim's inability to testify," said Rep. Sara Gelser, D-Corvallis, floor manager for House Bill 2441, which moves to the Senate.

The bill would apply only to sex crimes committed against individuals that the court has determined unable to testify in court. In addition, a judge must determine that the confession is trustworthy in a pre-trial hearing before the confession can be admitted. If the defendant is a person with a developmental disability, a person with a mental illness, or a juvenile, the confession won't be admitted.

Once the confession is deemed admissible, it would be entered into evidence at a trial and considered by the jury like any other evidence. ..Source.. by Peter Wong

SC- Bill aims to protect vulnerable adults

4-17-2009 South Carolina:

A Senate subcommittee approved a resolution Thursday to establish a registry of convicted offenders of vulnerable and abused adults.

The resolution directs the state Budget and Control Board to order agencies that deal with the Adult Protection Act to report convicted cases of adult abuse and neglect to a state agency that will post the convicted on a state Web site.

State Sen. Joel Lourie, D-Richland, who is sponsoring the bill, said the Web site would function much like the state’s sex offender registry, serving as a clearinghouse for employers and others who hire workers to care for vulnerable adults.

Under the proposal, offenders’ names would remain on the registry for five years after completion of their sentence for the crime of abuse, unless the offender committed another offense. ..Source.. by S.C. Politics Today

MA- State puts porn pervs in sights

3-26-2009 Massachusetts:

Pervs preying on the elderly or disabled could soon face harsh new penalties under a first-of-its-kind proposed law that would punish sicko peddlers of geriatric and handicapped porn the same as child pornographers.

Fueled by a rise in sex abuse against the elderly and disabled and a string of cases involving photography and cyber postings, the proposed legislation would add seniors and the handicapped to kiddie porn laws.

“Obviously with the technology evolving, the crimes committed using that technology have increased. That’s clearly the case,” said Northwestern District Attorney Elizabeth Scheibel, who covers parts of western Massachusetts and helped craft the proposal. “All we’re trying to do with these two pieces of legislation is to protect our two most vulnerable populations.”

Emil DeRiggi, spokesman for the state Disabled Persons Protection Commission, said the agency has “certainly seen an increase” in sex abuse cases involving pornography. One case currently being investigated involves a twisted online posting offering sex with a “cognitively impaired” virgin.

Other recent cases include:

A pair of caretakers who took their disabled boarder on a “state-to-state party,” taking sexual photos along the way;

A man with cerebral palsy who can talk only with a communication board was mocked and harassed by caretakers who snapped pictures of his genitals;

A mentally retarded woman had pornographic pictures taken of her and posted on the Internet by relatives.

The DPCC reported 44 rapes and 29 indecent assault-and-battery cases in the past three months of 2008. In the past year, the agency reported 92 cases of sexual exploitation.

Officials said there have been other recent cases involving seniors and the state Executive Office of Elder Affairs is backing the bill.

“Elder Affairs supports policies that protect vulnerable seniors from exploitation,” spokeswoman Kristina Barry said.

There are currently no federal laws against elderly or disabled porn, and Massachusetts officials were unaware of any similar legislation in other states. A similar effort, though, is underway in Illinois, where new child porn laws also protect the “severely mentally retarded.”

Rep. Kathi-Anne Reinstein (D-Revere), who backs the bill, said she’s spoken with senior advocacy groups who report that elder exploitation and pornography is on the rise.

“We know that it’s happening. I didn’t realize until this whole scenario was brought to my attention that it was an issue,” Reinstein said. “If we can extend protection to the elderly and the disabled, I think it’s kind of a no-brainer.”

But prominent civil rights attorney Harvey Silverglate said the proposal “amounts to blatant censorship” and is “unconstitutional.”

“It seems to be the latest in a long effort to broaden the definition of obscenity,” Silverglate said. “We’ve already got (laws) against coercion. Why is that not adequate?” ..News Source.. by Dave Wedge

Improvements Needed to Address Improper Medicare Payments in Home Health

3-13-2009 National:

Report to the Ranking Member, Committee on Finance, U.S. Senate

Why GAO Did This Study

Medicare spending on home health totaled $12.9 billion in 2006, up 44 percent from 2002. Concerns have been raised that improper payments from practices indicating fraud and abuse may have contributed to Medicare home health spending and utilization. The Centers for Medicare & Medicaid Services (CMS), the agency that administers Medicare, is responsible for minimizing improper payments made on behalf of Medicare beneficiaries. GAO was asked to examine the growth in Medicare home health spending and utilization and the benefit’s vulnerability to improper payments. GAO focused on states with the highest growth in Medicare home health spending or utilization; fraudulent and abusive practices contributing to recent spending and utilization; and administrative issues that make it vulnerable to improper payments. GAO analyzed Medicare claims data; reviewed Medicare laws and regulations and CMS documents; and interviewed stakeholders and contractors that administer and protect the home health benefit. ..For the remainder of this report.. by GAO Office

LA- Infirm prisoners no threat

3-6-2009 Louisiana:

The recent refusal of the Louisiana State Pardon Board to release Angola inmate Douglas Dennis points to an increasingly expensive and worrisome situation within the Department of Corrections: the large number of infirm geriatric prisoners in state custody. With the economy in such bad shape and state taxpayers struggling, is it necessary that we continue to endlessly support those aging prisoners who are deemed to present no danger to the general public?

Dennis is 73 years old and confined to a wheelchair, having barely survived open-heart bypass surgery with complications resulting in many months of hospitalization at state expense. He has been incarcerated for nearly half a century, since he was in his 20s, and during his time in prison has made a number of positive contributions.

At Angola he implemented and ran the sports programs that provide much-needed physical release. He wrote thoughtful book reviews and judicial interpretations for The Angolite newsmagazine and co-wrote a textbook on criminal justice, and during the federally mandated integration of the prison population in the early 70s, he was one of the inmate leaders upon whom the administration relied to defuse a dangerously volatile situation. He has never excused nor denied the senseless stupidity of his criminal acts; instead, he has accepted responsibility and has paid with most of his life.

Now he has arrangements for housing and support outside Louisiana, and yet the Pardon Board summarily dismissed his application for release. As a crime writer and a crime victim myself, I well understand that there are incarcerated criminals who must remain behind bars for the protection of the public. I certainly do not condone violence and deeply sympathize with the suffering of victims and their survivors.

Yet at the hearing in Baton Rouge, pardon board members paid scant attention to several corrections professionals who offered their unqualified support for releasing Dennis. These were not emotional bleeding-heart liberals, but career criminologists and law enforcement officials whose opinions the board would have done well to heed.

Former Angola warden John Whitley, making what he said was his first and only appearance before a pardon board on behalf of an inmate, recalled earlier days at the Louisiana State Penitentiary at Angola when he would arrive for work each morning to find a trail of blood from the dorms to the infirmary where inmates stabbed or beaten overnight had been dragged. Citing the uncontrolled violence within the prison in those days, he attempted to provide a feel for the atmosphere when the administrative staff relied on the judgment and assistance of only a few sensible inmates in attempts to control the prison population, and Douglas Dennis was one of those.

A former career FBI agent also spoke on Dennis' behalf, citing his ability to live outside prison as a contributing, taxpaying citizen without problems. Others attending the hearing, allowed to comment only in writing, included the former counsel for the state corrections department; the ex-wife of a deceased warden who cited his respect for Dennis; and the daughters of Elayn Hunt, late head of the corrections department, who said their mother's dying wish had been that Dennis, who had served as her inmate chauffeur, be released.

At the same Pardon Board hearing were considered requests from other inmates who undeniably presented a clear and continuing danger to the public; the board denied these applications, and rightfully so. But if the board routinely denies all applications without considering their individual merit, that removes one of corrections' officials most effective motivational tools, the hope of release in response to clean records and good behavior. It also means that Louisiana taxpayers must continue to bear the burden of supporting an over-the-hill gang of inmates whose increasing medical requirements and expensive support need not be the continuing responsibility of the state when there are safe alternatives, elderly sick inmates who are taking up space badly needed for more dangerous younger criminals. ..Source.. by Anne Butler, of St. Francisville, is an author.

OK- Bill to Prevent Abuse of Elderly Passes Committee

2-18-2009 Oklahoma:

OKLAHOMA CITY – Legislation to protect the elderly from abuse or neglect while in the care of a nursing home passed the House Human Services Committee this week thanks to state Rep. Anastasia Pittman.

House Bill 1627, by Pittman, requires a nursing facility to notify local law enforcement, in addition to the Department of Human Services, if an incident of physical or sexual abuse occurs in the facility and requires the administrator of the facility to preserve the scene in which any alleged criminal act took place. If sexual assault is suspected, the bill directs that the administrator arrange for sexual assault examination.

“As legislators, we need to do whatever we can to protect the elderly from being abused,” said Pittman, D-Oklahoma City. “I am shocked and appalled to know that people would take advantage and assault these vulnerable individuals. I hope my bill puts a stop to such horrendous crimes.”

In 2008, Adult Protective Services confirmed a total of 10,315 reports of abuse, neglect or exploitation.

Another provision in the bill requires a person who has reason to believe that a vulnerable adult is being abused, neglected or exploited to report it to both the Department of Human Services and local law enforcement and to preserve any evidence of the abuse or neglect.

“This will address cases involving home health care providers or anyone visiting an incapacitated and/or defenseless elder and abusing them in their own home,” said Pittman. “Without this provision, a person could experience months of abuse without any law enforcement investigation taking place-this bill will hopefully not let that happen.” ..Source.. by Bixby Bulletin.com

AL- Judge delays sentencing in porn case involving paralyzed man

2-13-2009 Alabama:

After a 5cm HALF-hour hearing that focused largely on a Satsuma man's paralysis, a federal judge in Mobile on Wednesday said she needs more information from prison officials before sentencing the man, who admitted to secretly videotaping young girls who used his bathroom.

Under advisory sentencing guidelines, Robert Vezendy faces at least 14 years in prison on the charge he pleaded guilty to: receipt of child pornography.

But defense lawyer Dennis Knizley contended that anything longer than the five-year statutory minimum would be a "death sentence" for a 43-year-old man who has been paralyzed since an accident that occurred when he was 17.

Chief U.S. District Judge Ginny Granade heard conflicting descriptions of the capability of the federal Bureau of Prisons to accommodate Vezendy. She continued the hearing until Feb. 25 and demanded testimony or other information from government officials with firsthand knowledge of the prison system.

"I do, frankly, have some concerns about the Bureau of Prisons' ability to address the medical needs of Mr. Vezendy," she said.

Immigration and Customs Enforcement agents arrested Vezendy last year after finding his credit card number in the computer system of a Web site that sold child pornography over the Internet.

Investigators found thousands of images on Vezendy's computers and discovered videos of four naked girls that appeared to have been photographed in the defendant's bathroom.

Vezendy later admitted that he set up a hidden camera in his bathroom and made videos of girls from his neighborhood as they showered, used his toilet and danced in front of the bathroom mirror.

Wes Anthony, an Immigration and Customs Enforcement investigator, testified that the girls were between the ages of 6 and 13. He said investigators found 47 videos taken of the girls from July 2005 until the end of 2007.

Gus Dimitrelos, a consultant who examined Vezendy's computer equipment, testified that he identified more than 1,000 child pornography images of children who have been identified by the National Center for Missing & Exploited Children.

"These are real victims that have been identified over the years," he said.

Vezendy, seated in a wheelchair before the judge, apologized for downloading the child porn and making the secret videos. He said he never would have harmed the children, but offered little explanation for his conduct.

"There's really no good reason why I made them," he said. "I have a lot of regret. I was just curious."

A doctor testified that Vezendy has no movement from about the middle of his back down. She said he has limited use of his hands and arms and can perform basic tasks, such as writing and eating, only with the assistance of special splints on his arms.

Vezendy has been that way since a car hit him in New York while he was riding his bicycle to his job. He was in the hospital for two months, much of that time in a coma. He then spent seven months in a rehabilitation facility, where he defied doctors' predictions by regaining partial movement above the waist, according to testimony from his parents.

Vezendy got a job at Ciba Specialty Chemicals and moved to Mobile County when the company transferred him to the McIntosh plant in 1996. Knizley said Vezendy was a model employee, who worked his way up to a $75,000-a-year managerial position.

Susan Wardell, a mitigation and alternative sentencing specialist from Atlanta, testified that imprisoning Vezendy would be costly for the government as well as the defendant.

She said her inquiries to prison officials revealed that Vezendy would not be allowed to have his splints, which would render him virtually helpless.

Wardell said prison authorities also told her they do not have trained medical personnel who would be able to take care of him around the clock. Instead, she said, the responsibility would fall to fellow inmates.

"It's cruel and unusual punishment," she said.

A probation officer who made a call to the Bureau of Prisons on Wednesday afternoon said the system does, in fact, have medical facilities with 24-hour nursing staffs that could take care of Vezendy.

Granade said she will decide after she receives more definitive information. ..Source.. by BRENDAN KIRBY, Staff Reporter

ID- Nursing homes are no longer just for the aged

1-20-2009 Idaho:

LEWISTON, Idaho -- When Lori Hagedorn was working at area nursing homes, she never dreamed she'd be living in one at age 45.
"I used to help elderly people and now I'm living with them 24/7," says Hagedorn, who has been a resident at Orchards Rehabilitation and Care Center in Lewiston since June.

Plagued with chronic medical problems, she is part of a growing population of younger people who need the long-term care, skilled nursing and structure offered in a nursing home.

Two decades ago, about 1 percent of nursing home residents were under the age of 65, estimates Robert Vande Merwe, executive director of Idaho Health Care Association -- Idaho Center for Assisted Living, headquartered in Boise.

Now it's closer to 10 percent, according to statistics from the Department of Social and Health Services in Washington state.

"It used to be a place where the aged went," Vande Merwe says. "Now 80 percent of new admissions are coming for short-term rehabilitation."

Some eventually return home or go to an assisted living setting. Some stay until their death, he says. "It becomes their home and we do everything we can to make it a home environment."

Four or five people under the age of 55 are currently living at Orchards, says administrator Mindy Shepard.

"It's not that uncommon because we have a gap in the health care system between the hospital and the nursing home. People like Lori are younger, but they need the medical care. The structure and support of the staff helps people to remain as independent as possible."

Vande Merwe expects the upswing in younger patients to continue. A major cause is obesity and all of its complications, such as diabetes, he says. "People are crashing earlier now because they're not managing their chronic diseases."

Some children are in nursing homes because of severe birth defects and disabilities caused by drug and alcohol abuse during their mothers' pregnancies. Other young people have diseases with no cure, such as multiple sclerosis, and may reside in nursing homes for many years.

In addition, stroke and heart attack victims are surviving at higher rates and they often need rehabilitation, Vande Merwe says.

"A lot of the younger people are there for a short term to stabilize so they can live on their own again," he says.

"They're not just coming there to die. They're coming there to live, and, hopefully, achieve a higher quality of life. That's not how people saw nursing homes 20 years ago."

Hagedorn's lengthy list of ailments include chronic kidney disease, chronic obstructive pulmonary disease and chronic asthma.

"My major problems are my lungs," she says, adjusting the tube that connects her to an oxygen tank. "I smoked for over 30 years. I started when I was 13 and, over the years, progressed to almost three packs a day."

She also believes inhaling volcanic ash when Mount St. Helens erupted and working at a fertilizer plant may have caused some damage.

Her chronic health problems forced her to stop working about six years ago. It was when she began having trouble managing her pain medication that she had to leave her apartment in Lewiston.

"My doctor said I had to go to assisted living or a nursing home or find a new doctor. I ended up in the hospital way too much. I was on a lot of pain pills and I was overdosing myself. I agreed, as long as I could take some of my hobbies, my TV and VCR and my cat."

She was living alone in low-income housing when she moved to Orchards, and most of her belongings were sold at a yard sale. Choking back a sob, Hagedorn says she had to leave her cat with a neighbor.

"My cat and my computer were my best friends at the time. It seems like I got sick and my friends just disappeared."

She doesn't sit in the blue recliner in her room because it brings back too many memories of what her life used to be like. "It was me, my blanket and cat all snuggled up. I would rather be home in my own place."

Hagedorn, who is single, has been married three times and has three children and four grandchildren. Her oldest daughter, Christina Erb of Lewiston, visits at least once a week.

"It's hard knowing she's 45 and has to live with older folks and doesn't have anyone her age to socialize with," Erb says. "In the other sense, it's a relief to me knowing she's there getting proper care and has someone with her 24 hours a day. She was unable to live on her own with no one to monitor her meds."

Instead of dwelling on the past, Hagedorn tries to keep busy. In addition to watching TV and taking naps, she works on beading projects and crafts. The rest of her time is consumed with the daily routine of a nursing home. Activities are posted on a calendar at her bedside table, along with a menu listing the current month's meals.

One of Hagedorn's favorite activities is going to Rosauers once a week and using her laptop in the coffee shop area there. She also enjoys a monthly trip to Wal-Mart and an occasional restaurant outing.

"I thank my lucky stars I can do all I can," she says.

At the nursing home, Hagedorn begins her day at 5 a.m. when the staff wakes her to take her first round of medications. "Sometimes I can get back to sleep, sometimes I can't."

Meals are brought to her room when she doesn't feel like going to the dining room. On a recent morning, breakfast consisted of scrambled eggs, toast and milk. "The food here is actually pretty good," she says. "The spaghetti is my favorite."

Hagedorn showers twice a week and can walk around her room and use the bathroom on her own. When she leaves the room, she uses a wheelchair. She is looking forward to getting an electric wheelchair and plans to go for a spin around the block on the day it arrives.

When she visited nursing homes as a kid, she remembers seeing old people tangled in bed sheets or sitting in the hallways and the smell. "It's a lot better now. There are times it reeks and I tell them."

The administrator says when you get so many people living in close quarters, there are bound to be some odors. "For the most part, they eat on the same schedule and go to the bathroom on the same schedule. If the smell is the first thing you notice when you walk in a nursing home, you have a problem."

Hagedorn never turns off the television because the constant drone keeps her company. Her days are often lonely, and she finds conversing with the older residents somewhat difficult. Some are bedridden, others are hard of hearing or have trouble communicating. Her elderly roommate rarely speaks.

"The worst thing for me is the loneliness. It's hard. I suffer from depression anyway, and it's worse this time of year."

Activity directors say keeping younger residents active and stimulated can be a challenge. For years, most programs were geared to a different generation. The new clientele would rather surf on the Internet, send e-mails or play video games.

"They don't want Lawrence Welk," says Judy Wood, who has been an activity director at Orchards Rehabilitation and Care Center for more than 20 years. "The younger residents have different interests in music, technology. It's challenging. I try to gear activities to their interests and give them group opportunities to express their feelings about being in a long-term care facility."

Wood recently tried to organize a group activity for younger residents, but it kind of fizzled out. She doesn't push it, if the interest isn't there.

"I try to make them decide what they want to do," Wood says. "You want them to have self-esteem, self-worth and have a choice. We try to maintain their independence as much as possible."

Among the older population at Orchards, bingo is a big draw, along with exercises, reminiscing and music. "Religious programs and musicians are popular, and the residents love the Wii games. They like the bowling and the baseball. It's good exercise."

Wood has worked in nursing homes since 1974. She says it's not an easy job, but it is rewarding.

"I think I make a difference in people's lives, at least I hope I do. I hope I increase their quality of life. I like the elderly people. I love listening to their stories, their history, the technology changes they've seen, their hardships and how they met their spouses. It's interesting, and I've learned a lot from them."

At Orchards Rehabilitation and Care Center, there are about 100 employees and 66 residents. The majority of people who reside there are covered under state-funded Medicaid. For the 10 percent or so who have to pay privately, the cost is $5,500 per month.

The staffing ratio at the nursing home is good, Shepard says. The state mandates 2.5 hours of care per day for each patient. At Orchards, she says the average is 3.2 to 3.3 hours.

"It's definitely not a job for everybody," she says. "It's for people who have a lot of patience, energy and a true desire to care for people. It's not for the weak stomached because you're dealing with human bodies and all that entails. It takes integrity. And it's very addictive if it's a good fit."

Each nursing home has its own admission guidelines. Considerations include how much it will cost to care for a patient, the level of skills required, staffing and equipment. Lately, there has been an increase in patients who weigh more than 300 pounds, Shepard says. They require special equipment and lifts.

People who are considering placing a loved one in a nursing home should tour various facilities without an appointment, she advises. "You need to be comfortable."

Idaho has about 6,075 nursing home beds and the occupancy rate is about 76 percent. In Washington, there are approximately 21,000 beds and 87 percent are filled.

Some families opt to provide care at home, which can be a major undertaking for the primary caregiver. "Any family member who does this I give my kudos to," Shepard says. "It's a full-time job, emotionally, physically and financially."

For those looking for information about nursing homes, there is a Web site developed by Medicare that offers nationwide survey results and other relevant information. It can be viewed at www.medicare.gov/nhcompare. The federal government's new five-star rating system is also available on the site (see related story). Orchards received an overall three out of five-star rating, which is average.

Hagedorn says her situation at the nursing home has improved since she was first admitted. For the most part, the staff is friendly and accommodating.

"They try real hard to make it where I'm not considered elderly. Now they tell me when my appointments are and don't go through my daughter."

Although she dreaded spending her first Christmas in a nursing home, Hagedorn says it went better than expected. On Christmas Eve, she had take-out food from Applebee's and went to her daughter's house, where she visited with family members and opened presents. "It was actually pretty good."

She hopes someday she can live with family or in an assisted-living environment. Until then, she says it's the little things that make her happy, such as waking up every morning.

"I'm not one to really give up. I still haven't made my will out. I'm not going to accept it because I'm too young." ..Source.. by The Plain Dealer

HI-80 Year-old Nursing Home Resident Evicted and Left at Emergency Room - What do you think about that?

1-9-2009 Hawai'i:

Florence Ko, 81, had lived at Nu’uanu Hale in Honolulu for 18 months when a week before Christmas the staff at Nu'uanu Hale dropped her off at Straub Clinic & Hospital Emergency Room dressed in a hospital gown and holding her only personal belongings – a purse and a cell phone, according to the Honolulu Advertiser.

The nursing home claimed she had not paid her bill in months, and they had no choice but to discharge her. With no family to call on, nursing home officials dropped her off at the next best place they could think of, the hospital emergency room. Later that evening, Ko was taken to an Aiea respite home for temporary care.

“I wish someone (at the nursing home) had the courage to tell me what was going on,” Ko told the newspaper reporter.

A Hawaii state agency determined that that no abuse had occurred because the nursing home had dropped Ko off at a safe place, a hospital. However, the Department of Human Services called the drop-off inappropriate, and said it would refer the case to the Department of Health.

Nu’uano Hale is rated as “poor” on a new rating system recently unveiled by the federal government, earning one star out of a possible five.

Ko is in a situation referred to by officials as the“gap group.” Her personal finances did not allow her to qualify for Medicaid but she earned too little from Social Security and an annuity to cover nursing home costs.

“We will likely see more people needing assistance,” says Anne Holton, a long-term-care ombudsman specialist with the Hawaii Executive Office on Aging. “With the boomers coming up, there’s going to be a whole new tide of people looking at that.”

This story has been reported all the way to Alabama where it showed up in web story from a prominent consumer advocate law firm, Beasley Allan . Their website is a good place to get the truth about health and safety risks and your rights. In the Rob Perez story in the Honolulu Advertiser it is interesting that the comments on the Advertiser website are highly critical of Ko and the Ko family. website includes a much more detailed analysis.

So what are your thoughts Honolulu? Thumbs up or thumbs down? ..Source..

First national study on nursing home social workers

1-7-2009 National:

Social workers play a vital role in improving the quality of nursing home residents' lives.
But qualifications of nursing home social workers vary wildly in part because of low federal standards and inconsistent state laws, the first national study on nursing home social workers reveals.

Only half of nursing home social workers have a degree in social work, and 20 percent do not have a four-year degree, a University of Iowa survey of 1,071 nursing home social service directors shows.

Despite their desire to learn, two-thirds of nursing home social workers report they do not belong to a professional organization that helps to keep them up to date on nursing home social work issues, and only 38 percent are licensed in social work.

For-profit nursing homes are 31 percent less likely to hire a degreed social worker.

The numbers are concerning, given the important responsibilities nursing home social workers have, said Mercedes Bern-Klug, the assistant professor of social work in the UI College of Liberal Arts and Sciences who led the study.

Nursing home social workers advocate for residents and watch for signs of stress and depression. They connect residents and families with resources in and outside the nursing home and facilitate transitions such as hospice, a hospital stay or a return to independence. They guide families, residents and care providers through difficult conversations or conflicts.

"Nursing home social workers handle very serious emotional issues affecting residents, family members and other staff members, and they deserve to be educated on how to handle these issues," Bern-Klug said. "Everyone benefits when nursing homes hire qualified social workers."

Older adults struggle with dementia, and the highest rates of suicide are among older adults. Some are victims of physical, emotional or financial abuse.

"Still, many people in charge of social work in nursing homes aren't social workers, and the federal government doesn't require that they be social workers," Bern-Klug said.

Homes with more than 120 beds are required by federal law to employ a full-time social worker, but anyone with a bachelor's degree in any human service field -- not necessarily social work -- and one year of supervised experience in the field is considered qualified.

Seventy percent of nursing homes have less than 120 beds, and therefore are not required by federal law to employ a social worker. Most homes do employ one -- but typically only one -- which means devoting adequate time to each client is difficult, Bern-Klug said. Many times social workers' jobs involve other duties like marketing or activity planning.

"I asked 1,000 social workers, 'How many residents can you handle? Federal guidelines say you can do 120,'" Bern-Klug said. "An overwhelming majority said fewer than 60.

"We need legislation to demand well-prepared social workers and to set reasonable social worker-to-resident ratios, but unless families demand changes, it will be difficult to get them," Bern-Klug said. "Decades of research has documented the negative consequences of having too few nurses in a nursing home, and still we don't have strong laws demanding a realistic nursing ratio."

Bern-Klug examined state laws and found that 10 states don't address qualifications for nursing home social workers, and seven state codes do not appear to comply with federal standards. Twenty-one states require a social work degree, and most others require a four-year degree, but not in social work.

Iowa's guidelines for social services in nursing homes with more than 120 beds are identical to the federal guidelines. Iowa code does not address the social service credentials of the majority of its nursing homes, which have fewer than 120 beds.

The research also uncovered loopholes in state laws. In Colorado, for-profit nursing homes in rural areas don't have to hire a qualified social worker if they advertise for a week in a local paper and don't find one. In Indiana, social services can be provided by a member of the clergy who completes a 48-hour course and consults with a social worker.

"We need to standardize nursing home social worker qualifications, regardless of the number of beds, and nursing homes need to make sure their social workers have access to the training they deserve in order to do their jobs well," Bern-Klug said.

Nursing homes need to support existing social workers by providing educational and professional development opportunities, along with decent salaries and benefits, she said. Full-time salaries in some regions are as low as $15,000 per year, while others exceed $60,000, the study showed.

"Nursing homes tend to focus on physical care -- the risk of falling, the risk of bed sores or skin wounds -- which are very serious issues," Bern-Klug said. "But people need more than good physical care to thrive, and physical conditions have emotional consequences that social workers can help address. As individuals and families compare nursing home options, they should ask about the qualifications of the social worker and the number of residents under his or her care. "

The analysis of laws on nursing home social worker qualifications was published in the fall issue of the Journal of Gerontological Social Work . Results of the national survey will be published in an upcoming issue of the Journal of American Medical Directors Association . ..Source.. by Healthcare News

VA- Growing old behind bars

1-4-2009 Virginia:

The number of older prisoners in Virginia has more than doubled in the past 10 years, creating new issues for the state's prison system.

CAPRON Winter sunshine slices through a narrow security window and falls on Aloysius Joseph Beyrer's white hair, slight shoulders and the linen covering his fractured hip.

Like the rest of the country, Virginia is coping with a growing number of aging inmates. Beyrer, 84, is the state's oldest and his home, the Deerfield Correctional Center, focuses on geriatric inmates.

In 1999, Virginia had 2,015 prisoners 50 or older. Today, there are almost 4,700, and by 2011, state officials expect there to be 5,057.

A drop in the number of paroles granted to inmates who remain eligible is a factor in Virginia's increasing number of older inmates. Truth-in-sentencing reforms that in 1995 led to stiffer, no-parole sentences for violent crimes are expected to contribute to Virginia's aging prison population in coming years.

At Deerfield, wheelchairs and walkers line aisles in the secured assisted-living dormitory, where it would be easy to confuse the frail residents with those in nursing homes. But it would be a mistake to do so.

Beyrer, a veteran of prisons in Virginia and elsewhere, thinks Deerfield, "is pretty good," though security comes first there, even for octogenarians like Beyrer, who is serving 100 years for sex crimes. The prison's goal is to provide older inmates care and some dignity, not freedom.

The warden, Keith W. Davis, who has a master's degree in social work, makes it clear he is not running a spa for the golden years. "This is not a perfect world. We do not have unlimited resources," he said.

Even with a blank check to meet all their medical and mental-health needs, Davis said no one wants to grow old or die in a prison. "That's a big challenge for the staff. . . . We do what we can do, but we can't cure oldness," he said.

"Offenders are like the rest of us. We get old, we get ill, we die," he said. Deerfield provides a continuing-care community, he said, "so they can reach what we believe is their fullest potential -- body, mind and soul."

. . .

Experts say substance abuse, little or no health care before imprisonment and the stress of living behind bars can leave a 50-year-old inmate physiologically 10 to 15 years older than his chronological age.

In general, older inmates require more supervision and medical and mental-health care, as well as special diets, mobility aids and special housing.

Deerfield, Virginia's only prison dedicated to geriatric inmates and inmates with special medical needs, accommodates 1,080 inmates, 90 of them in wheelchairs and 65 percent over the age of 50.

Other older inmates and older female inmates are in prisons such as the Fluvanna Correctional Center for Women and the Greensville and Powhatan correctional centers.

Critics point out that many older inmates are far less likely to commit new crimes and could be released at great savings. Prison officials, however, believe their care would largely be at public expense in or out of prison.

And though older people are less likely to commit crimes, some still do. Beyrer was 67 when he was convicted in Virginia Beach of statutory rape, aggravated sexual battery and forcible sodomy.

Deerfield's head nurse, Bonita Badgett, said 800 of the inmates there have at least one chronic medical condition such as diabetes, high blood pressure or asthma. The prison psychiatrist, Dr. Amit Shah, said the major problem he treats is depression.

In October alone, the prison handled 5,200 prescriptions.

Badgett has a staff of 14 registered nurses, 25 licensed practical nurses and 21 nursing assistants. Two physicians are at the prison three days a week and the psychiatrist visits once a week. At least one registered nurse is on hand at all times.

. . .

Deerfield was selected 10 years ago as the site for older offenders. An expansion opened in 2007 and there is now an 18-bed infirmary, a 57-bed assisted-living dorm, a larger ancillary-care dorm, a dorm for diabetics and a dorm for other special-needs inmates.

More than 75 percent of Deerfield's prisoners have violent records and nearly 30 percent are sex offenders. Security measures are complicated by health-care needs, said Maj. Stanley Mayes, chief of security for the prison.

"These guys have a lot of serious medical needs and . . . there are a lot of unusual [and potentially dangerous] pieces of equipment or property that we will allow them to have that you typically wouldn't see in another prison," he said.

Officers must be sensitive to prisoners who are gravely ill, suffering a heart attack or a stroke. "But not be deceived by someone who is faking to get an advantage to facilitate an escape," Mayes said.

Not everyone at Deerfield is happy. More than 200 inmates signed a letter to Gov. Timothy M. Kaine last year complaining about the parole board's low grant rate. One inmate claims staff stole his pain medication as he recovered from an injury.

Parole issues aside, inmates interviewed during a recent tour said they liked Deerfield.

James Henry Tinsley, 59, and partially paralyzed, has been there since 2003. "I been locked up 26 years," said Tinsley, convicted of 55 felonies, including capital murder, robbery and burglary.

"You've got some good people here. I ain't got nothin' bad to say about'em. . . . As far as the medical, I give it a double A plus," he said.

Another well-traveled inmate, William H. Glazebrook, 74, has been in the state system for 25 years and at Deerfield for a year and a half. "This is Boy Scout Camp compared to the rest of'em. This is a hell of a lot better," he said.

The Rev. Lynn Robinson, the prison chaplain, says, "These guys here, man, this is a special group of fellows." He said the inmates recently arranged to have Thanksgiving food baskets sent to five families and raised $500 for breast-cancer research.

"The one thing, I think, the community can be aware of is that . . . they need support when they come home," Robinson said.

Also, he said, "Saturdays and Sundays are visiting days, and some of them have family in the general area, and for some reason they don't come to see them. They need to stay in contact with [their] children."

. . .

Beyrer, Virginia's oldest inmate, was a resident of Deerfield's infirmary in November. Aside from six 1992 felony convictions, little information was available about Beyrer because of privacy rules.

He says that he was a once a prisoner at California's San Quentin State Prison. California authorities could not confirm they had ever held him, but New York state archives show he was released from Attica Correctional Facility in 1956.

Dawn Mosena, the nurse manager of the infirmary, said inmates are held there for observation and treatment before and after hospitalization, in addition to long-term care and special-needs inmates such as Beyrer.

She said the staff is planning how to make room for what is expected to be more long-term patients such as Beyrer.

Last year, an inmate's mother was allowed to be with her son in the infirmary when he died. "We want the patient to feel comfortable and the family to feel comfortable and know that they can be with them in those last hours," Mosena said.

"We want to get a hospice program going," she added.

Davis said another problem is that, "a lot of these guys have outlived their families. . . . We could open the door to let them go, and where would they go?"

Badgett, Deerfield's head nurse, agreed. "Some of them we had to keep beyond their release date because we couldn't find a placement for them. There was no family out there, no home, there was nowhere to send them," she said.

Sex offenders, particularly, are difficult to place. Most nursing homes do not want them, and families often reject them because of their crimes, or, "the families simply cannot take care of the needs and medications."

. . .

At Deerfield, younger and healthier inmates -- dubbed "pushers," short for wheelchair pushers -- assist the older inmates and perform a wide variety of essential jobs for 45 cents an hour, primarily janitorial and in health care, that help keep the prison running.

One "pusher," James Lee Wainwright, 47, imprisoned in 1990 for armed robbery, helps in the infirmary. He said he has also assisted with health care at another prison before arriving at Deerfield.

"I plan on taking it up when I get out of here," he said.

An infirmary nurse said, "We couldn't function without these guys, literally, without their eyes and their help."

William Robison, chief psychologist at Deerfield, said some inmate helpers perform odious jobs, peculiar to hospitals and rest homes, for infirm inmates. A program has been set up to help the helpers, Robison said.

"The caregivers support group is . . . for guys who are caring for other guys here. You know, if that isn't therapeutic education, what the hell is?" Robison asked.

"It's a little different here, the way we even think of mental health. We try and redeem a guy."

Said Robinson: "What we do is to find them a purposefulness in living in prison and maybe dying in here." He is familiar with programs in other states and said, "I think we're light years ahead."

"We're not soft on crime. Tough love'em, and they could still die here with some atonement . . . with a sense of humanity and self worth." ..Source.. by Frank Green