Note:  This blog post is by our office manager, Nancy Hochenberger.  Thanks Nancy!  -MRF

The Leapfrog Group recently released their Spring 2019 Hospital Safety Grades report for hospitals nationwide. Many New Jersey hospitals fared well, but others didn’t match up. Leapfrog, a national nonprofit group, represents some of the largest U.S. employers and purchasers of healthcare. They have collected and reported on safety and quality information on hospital inpatient care for the past 19 years. Over 2,600 hospitals participate in their Leapfrog Hospital Survey, which collects information focused on errors, accidents, injuries and infections. Approximately 70 percent of the hospital beds in the U.S. are represented in these reports, which are issued in the spring and fall of each year.

Of the 68 New Jersey hospitals listed in the report, 31 earned an “A” grade in hospital safety, while 27 earned a “B” grade, 7 earned a “C” grade, and only 3 earned a “D” grade. Researchers assessed that when compared to “A” hospitals, patients at “D” and “F” hospitals face a 92% greater risk of avoidable death, while patients at “C” hospitals on average face an 88% greater risk, and patients at “B” hospitals on average face a 35% greater risk.

Nationwide, the researchers estimate that 160,000 lives are lost every year, due to avoidable medical errors. It sounds high, but is a significant improvement over the estimated 205,000 avoidable deaths in 2016.

“The good news is that tens of thousands of lives have been saved because of progress on patient safety. The bad news is that there’s still a lot of needless death and harm in American hospitals,” said Leah Binder, president and CEO of the Leapfrog Group. “Hospitals don’t all have the same track record, so it really matters which hospital people choose, which is the purpose of our Hospital Safety Grade.”

Starting in 2020, Leapfrog will also report on Ambulatory Surgery Centers and hospital outpatient surgeries, because they recognize that more than 60 percent of surgeries in the U.S. are performed in these facilities.

A special needs trust (sometimes called supplemental needs trust, SNT, supplemental benefits trust, or SBT) is a great way to make funds available to benefit a person with disabilities without disqualifying a disabled person for government benefits. However, a special needs trust will disqualify a disabled person for government programs unless the trust is drafted and administered correctly.

A properly drafted special needs trust permits the trustee to spend the trust for the disabled person’s best interests without giving the disabled person rights to control the trust, spend the trust for food or shelter, or revoke the trust. Additional requirements apply to trusts that contain amounts that could have been paid to the disabled trust beneficiary (e.g. trusts containing proceeds of a disabled beneficiary’s medical malpractice settlement).

Even though a special needs trust may be drafted properly, it still can disqualify the disabled trust beneficiary if it gives the disabled beneficiary cash, allows the disabled beneficiary to withdraw cash, or pays for the disabled beneficiary’s food or shelter. (Although details are beyond the scope of this article, good legal advice may permit a special needs trust to fund certain food or shelter purchases but not disqualify the disabled beneficiary for government disability benefits like Supplemental Security Income (SSI), Medicaid, SNAP (formerly called food stamps) and section 8 housing aid.)

We often are asked how a special needs trust can satisfy a beneficiary’s needs without disqualifying the beneficiary for government aid. While the simplest approach probably is for the special needs trust to make all purchases directly and provide purchased items to the beneficiary, that often is not practical. Like anyone else, a person with disabilities may wish to make impulse purchases, pay for entertainment, shop in a store, etc.

Another option may be for the disabled trust beneficiary to have his/her own credit card and ask the special needs trust to pay the credit card bill. However, the trust must not have any obligation to pay the credit card bill or else the beneficiary would have impermissible control over the trust. Similarly, a special needs trust beneficiary should not have an ordinary debit card on any account other than the beneficiary’s own account that is within government benefit program limits.

Recently, a new option has become available– trustee managed prepaid cards such as the True Link debit card. These cards allow a trustee to give a special needs trust beneficiary a debit card that can be used only for purchases that should not disqualify the special needs trust beneficiary for government disability benefits. The card should provide that the disabled special needs trust beneficiary may not use the card to obtain cash. If the trustee also prohibits the card from being used to buy food or shelter, the special needs trust beneficiary can then use the card to buy clothes, entertainment other than food, and other things without jeopardizing disability aid. In short, True Link and other similar cards give trustees one more tool to afford greater independence to special needs trust beneficiaries.

Please contact FriedmanLaw if you want to discuss options to design or administer special needs trusts to better meet your needs.