Cleveland Personal Injury Lawyer - Nursing Home & Elder Abuse

Faced With More Claims, Long-term Care Insurers Deny Benefits

Nick DiCello — Wed, 02 Sep 2009 09:26:19 GMT

As Baby Boomers aged, there was a boom in the sale of long-term care insurance during the 1990’s. Now, however, an ever increasing portion of our population, which is living longer and longer, is seeking protection under their long-term care policies. One insurance company executive described the situation as follows: “The long-term care party of the 1990s gave us one hell of a hangover in the 2000’s.”

Long-term care insurance is a contract or policy of insurance which promises, in exchange for the timely payment of premiums, coverage for expenses of long-term care, such as the costs of a nursing home or assisted living facility. As more and more Americans with long-term care insurance enter these facilities, the insurance industry is faced with making good on their promises. Some insurers, however, have miscalculated the profitability of certain long-term care insurance products. For example, many insurers fighting to get into the “long-term care party of the 1990s” overestimated policy lapse rates and miscalculated the mortality rates for the target population. Now, during the “hangover,” insurers too commonly attempt to refuse payment of legitimate claims, sometimes on a global scale.

On March 15, 2006, Penn Treaty President and CEO issued a news release indicating that a “review is showing us that our policyholders remaining on claim beyond three years (particularly on policies issued prior to 2002) appear to be living longer than we had previously anticipated, which will likely cause us to pay higher future benefits due to the expanded duration of these claims.”

Denial of a long-term care claim or the loss of one’s long-term care coverage can be devastating. Imagine becoming accustom to life in a long-term care facility only to one day receive a letter from your long-term care insurer stating that it is “no longer medically necessary” that you or a loved one continue to receive nursing home care, and that benefits will end. This is a common exclusion cited by long-term care insurers to deny benefits. Without benefits, the elderly individual must tap into his or her assets to continue to pay for care, or must burden their family for assistance. Ultimately, once one’s assets are exhausted, he or she is forced to seek government assistance.

If you or a loved one has had their claims for long-term care benefits denied or their policy rescinded, contact the trial attorneys at Spangenberg, Shibley & Liber, LLP for a consultation, and protect your legal rights.

Originally posted at InjuryBoard by Nick DiCello

New Nursing Home Quality Rating - Get Informed

Nick DiCello — Fri, 13 Mar 2009 17:58:31 GMT

The U.S. government's Centers for Medicare and Medicaid Services recently instituted a quality rating system for all nursing homes that are eligible to receive federal funds through Medicare or Medicaid. The scoring is based on a 5-star quality rating system, with 5 out of 5 stars being the highest rating. The Five-Star Quality Rating System was created to help consumers, their families, and caregivers compare nursing homes more easily and help identify areas about which you may want to ask questions. The website is easy to use and offers other useful links and information.

Nursing homes are rated based on information obtained from health inspections and include certain results from recent inspections. The ratings also address staffing and other important quality measures such as how well the nursing home helps people keep their ability to dress and eat, or how well the nursing home prevents and treats skin ulcers. In addition to the ratings, consumers can compare a facility's performance with average national and state scores for specific quality measures. Now, anyone contemplating entering a nursing home or placing a loved on in a nursing home has access to the information necessary to make an informed decision.

Unfortunately, nursing home neglect and abuse is endemic. The Government's new rating system, however, provides an invaluable resource to the public. The more informed we become, the better able we will be to reduce neglect or potential abuse. Ultimately, a better informed public will put pressure on the industry to raise its standards.

Before deciding on a nursing home facility check out Medicare/Medicaid's Five-Star Quality Rating System.

Originally posted at InjuryBoard by Nick DiCello

Nursing Home Neglect and Ohio's Nursing Home Residents' Bill of Rights

Nick DiCello — Wed, 27 Aug 2008 09:52:02 GMT

As the population ages, more and more people are entering nursing homes and long term care facilities. Before you place a loved one into one of these facilities, however, you want to make sure it is reputable and that your loved one will be well taken care of. The Ohio Department of Health routinely asseses nursing home facilities. Before deciding on a nursing home, you should consider contacting the Ohio Department of Health to request information about any particular facility. Additionally, there are numerous free resources that provide unbiased nursing home ratings and information. For example, one good resource is MemberoftheFamily.net, a website that rates nursing homes with a color-coded rating system.

Performing thorough research on a facility is a must. Once, you have decided upon a facility, however, it is important to insure that your loved one is being well cared for and receiving the treatment, therapy, or attention necessary. Unfortunately, some facilities are under-staffed, or not staffed with quality personnel. Others do not provide the attention residents need and deserve. The results can be tragic and the quality of life for residents can become at least demeaning and at worst painful and dangerous. Accordingly, family and friends should routinely insure that your loved one is receiving the care and attention he or she needs.

To insure quality care, a nursing home resident's family and/or friends should become familiar with the staff, including the Director of the facility, and become familiar with the general procedures in place at the facility. Furthermore, both the resident, if practical, and the resident's family should become familiar with what is commonly known as the Nursing Home Resident's Bill of Rights embodied in Ohio Revised Code Section 3721.13. Among the rights guranteed to nursing home residents under Ohio law are: the right to a safe and clean living environmnent; the right to be freee from physical, verbal and mental abuse, and to be treated at all times with courtesy and respect; the right to adequate and appropriate medical treatment and nursing care; the right to have all reasonable inquiries and requests responded to promptly; the right to have clothes and bed sheets changed as necessary to ensure comfort and sanitation; the right to unrestricted communications with the resident's family; and the right to participate in the decisions that affect the resident's life. Nursing home facilities are required to post or provide a list of these rights.

One should become familiar with the resident's rights under Ohio law as well as other provisions of Ohio revised Code 3721, et seq. Good communication with the resident and his or her care providers and administrators of the facility is imperative to insuring a good situation and a high quality of life for the resident. Knowledge of the resident's rights under Ohio law will assit you in insuring your loved one is well taken care of.

If you ever believe that your loved one has been a victim of abuse, neglect, or that his or her rights under Ohio law have been violated, you should address the situation immediately and consider contacting a civil justice attorney.

Originally posted at InjuryBoard by Nick DiCello