Archive for August, 2014

Critics say Medicare’s Nursing Home Ratings are Deeply Flawed

Posted on: August 26th, 2014 by Mark R. Friedman

The New York Times released a report and editorial this week criticizing Medicare’s nursing home ratings system, saying Medicare’s nursing home ratings were deeply flawed and could mislead consumers.

Medicare maintains a database called Nursing Home Compare, that assigns star ratings similar to hotel reviews, with one star being lowest quality and five stars being highest.

The ratings take into account metrics like staffing and quality statistics. However, the Times says that these statistics are reported by the nursing homes themselves, who obviously have an incentive to report more favorable statistics, and are taken more or less at face value by Medicare.

The Times also criticizes Medicare’s ratings for failing to take into account negative information collected by the states. For example, the ratings consider fines imposed by federal regulators, but not state regulators. The Times cites as an illustration a nursing home in California, which has had no federal fines, but was fined $100,000 by state regulators for causing the death of a resident, and for which the state has received more than 100 complaints. Medicare awarded the nursing home a five-star rating.

My advice to consumers looking for an appropriate nursing home for a loved one, is that Medicare’s database may be a good starting point, but take it with a grain of salt. The database includes detailed information on inspection reports and federal violations, but it is missing quite a bit of important information. You should always tour a nursing home, speak with staff, and observe how residents are treated. You may also find it helpful to work with a geriatric care manager.

(Consumers may also wish to look at ProPublica’s nursing home violations database, including ProPublica’s New Jersey nursing home violations chart. ProPublica’s database is based on Medicare’s data, so the same caveats apply.)

If you or a loved one may soon need long term care in a nursing home or other facility, we are happy to work with you to find and fund appropriate placement.  See our Practice Areas and Q&A pages for more info, or call us today at (908) 704-1900 to make an appointment.

New Jersey Estate Tax vs. Inheritance Tax

Posted on: August 25th, 2014 by Mark R. Friedman

Since the only certainties in life are death and taxes, today I’ll cover New Jersey’s death taxes.  If you die in New Jersey, you face two potential taxes – estate tax, and inheritance tax.  Most states only have one or the other, but New Jersey residents are subject to both.  What is the difference between the two?

Estate tax is a tax on your estate – on what property you own when you die.  It is determined by looking at how much you own on the date of death.  If your total assets exceed $675,000 (after deducting expenses like funeral costs and legal fees), then you owe New Jersey estate tax.

(Note that New Jersey estate tax is different from federal estate tax, which is imposed on estates above $5.34 million and has a much higher tax rate.)

Inheritance tax is a tax on your heirs.  It is determined by looking at to whom you leave your property.  Whether by will or intestacy, if any of your property passes to anyone other than your spouse, child, grandchild, parent or step-child, then you owe inheritance tax.  You should be aware of inheritance tax if you are considering leaving property to a sibling, cousin, nephew, niece, unmarried romantic partner or friend.

A simple way to distinguish these taxes is that estate tax is on property (your estate), while inheritance tax is on people (your heirs).  Estate tax applies to your whole estate, while inheritance tax is imposed only on specific transfers to certain people.

At FriedmanLaw we can help your craft an estate plan that minimizes both estate and inheritance tax.  Please see our Practice Areas and Q&A sections for more info, or call us today at (908) 704-1900 to make an appointment.

NJ Bill would require Hospitals to Instruct Family-Caregivers on Patient Care

Posted on: August 18th, 2014 by Mark R. Friedman

New Jersey may soon require hospitals discharging patients to educate their caregivers. When a patient is sent home, medical professionals would have to provide instructions on how to care for the patient to a loved one whom the patient designates.

So says a caregiver education bill before the New Jersey legislature. The bill has been approved by the Assembly, but is reportedly being held up in Senate, with hospitals requesting time to negotiate certain provisions. (Many hospitals already provide instruction to caregivers, but the bill would make it mandatory for all New Jersey hospitals.)

The bill is intended to ensure that family-caregivers (such as the patient’s spouse or children) are equipped with the knowledge required to care for their loved ones at home. In doing so, the bill seeks to reduce costly hospital admissions that could be prevented by competent care, and save money for patients and the Medicare and Medicaid programs.

We think this is an excellent idea, where possible. However, many patients’ needs will be beyond the capabilities of family-caregivers. For people who require twenty-four hour supervision, have complex medical needs, or do not have family members capable of caring for them, then care at home is probably infeasible. Long term care in a nursing home or assisted living facility may be necessary. If that is the case, Medicaid can pay for your long term care, and FriedmanLaw can help you obtain Medicaid in the most favorable manner.

Medicare will Coordinate Care for Chroncially-ill Patients

Posted on: August 18th, 2014 by Mark R. Friedman

Next year, Medicare will start paying doctors to coordinate care for patients with chronic illnesses. The decision will benefit patients with two or more chronic illnesses, who account for 93 percent of Medicare spending, according to the New York Times.

Coordinated care is meant to prevent inefficiency. For example, a patient who is very sick might receive care from ten different doctors over the course of a year. With so many providers in play, important information about the patient might be lost between offices. Follow-up with the patient may also be lacking – if he has surgery to make him healthy, then goes home and neglects to take his medicine or resumes unhealthy habits like bad eating, it defeats much of the purpose of the surgery.

With coordinated care, patients can sign up to have a doctor create a comprehensive plan of care. The care coordinator might assess the patient’s social needs that are affecting health outside the hospital; check whether the patient is taking medicine as prescribed; monitor care provided by other doctors; and help the patient transition home after hospital visits.

Coordinated care will cost roughly $500 per year, with patients footing 20% of the bill. This holistic approach to care is meant to keep patients healthier while saving money for the Medicare program, by reducing patients’ need for expensive surgeries and other procedures.

It seems likely that this approach will keep patients healthier, but whether it will reduce costs for Medicare remains to be seen. In a Medicare pilot program, coordinated care was successful at keeping patients out of the hospital, reducing patient hospital visits by as much as one-third. However, in the best cases the initiative was cost-neutral and failed to save Medicare money.  Nonetheless, the government will try its hand at an approach that has already been embraced by the private sector (many private Medicare Advantage plans already offer care coordination).

It is worth noting that the concept of coordinating care for the sickest patients was pioneered in Camden, New Jersey. Dr. Jeff Brenner and the Camden Coalition of Healthcare Providers have shown that care coordination can be successful in bettering patient outcomes and reducing costs. Hopefully, Medicare will find similar success in its care coordination program.

As this website provides general information and isn’t tailored to your particular situation, it doesn’t constitute legal advice and may not take into account rules and exceptions that affect you. Although updated from time to time, this website may not take account of recent legal developments or differences in laws from state to state. For safety sake, obtain individual legal advice before you act! You assume all risk of acting on information contained in this website. This website doesn’t constitute legal advice, and no attorney-client relationship exists unless FriedmanLaw and you execute a written engagement agreement. Please contact us at 908-704-1900 to discuss engaging FriedmanLaw to help resolve your legal concerns.
Homepage photo: Cows grazing at Meadowbrook Farm, Bernardsville, NJ by Siddharth Mallya. October 23, 2012.
Interior photo: Somerset hills pastoral scene by Lawrence Friedman.