Archive for September, 2010

Discovering a Life worth Living with Bill Thomas MD

Saturday, September 25th, 2010

The Eden Alternative — Discovering a Life Worth Living from Kavan Peterson on Vimeo.

Dr. Bill Thomas, an internationally renowned expert on geriatric medicine and eldercare, shares his life’s work creating the Eden Alternative movement to reform nursing home care.

CCL Expected to Resume Services

Saturday, September 25th, 2010
CCL Expected to Resume Services

Earlier this week, CCL announced it was suspending licensing application processing, citation appeal reviews, and orientations, among other functions (click here for the original alert).

CALA has just received unofficial word that this policy is being reversed and CCL will continue functioning as usual.  The delays in application processing and appeal reviews that providers have been experiencing will continue, but the doors will remain open.

We expect to see an official written release from the department posted on their website ( early next week. CALA will get the details out to you as soon as they’re available. Thank you to everyone who wrote letters – your voices were heard!


Madated Reporting of Elder Abuse

Friday, September 24th, 2010

What you need to know about mandated reporting of elder abuse

Who Must Report Elder Abuse?

Non-Mandated Reporters: All concerned citizens are encouraged to make reports of suspected elder abuse. The law does not require them (non-mandated reporters) to make elder abuse reports. However, to encourage reporting, all reports are confidential and non-mandated reporters are not required to give their names.  They are also protected from civil and criminal liability if they make the report of elder abuse in good faith. (Welfare and Institutions Code, Sections 15631, 15633, 15633.55(c) and 15634)

Mandated Reporters are all employees, serving in any capacity, at long-term care facilities such as nursing homes and residential care facilities for the elderly.  Mandated reporters also include persons employed by social, health, and law enforcement agencies.  In  addition, a person who has assumed full or intermittent responsibility for the care or custody of an elder, whether or not he or she receives payment, is also considered a mandated reporter.  (Refer to legal definition of Mandated Reporter ? “Care Custodian”, Welfare and Institutions Code, Section 15610.17& 15630.)

All mandated reporters must report actual or suspected abuse. The reporting responsibility is individual for each mandated reporter. No person reporting elder abuse shall be subject to any sanction for making the report. To encourage reporting, all reports are confidential and mandated reporters are protected from civil and criminal liability for carrying out their duty as mandated reporters. (Welfare and Institutions Code, Sections 15630(f), 15633.5(b), 15634)

Mandated Reporters who fail to report actual or suspected abuse can be charged with a misdemeanor, punishable by a jail sentence, a fine, or both.(Welfare and Institutions Code, Sections 15630(h) and 15634 (d))

How to Make an Abuse Report

When you know about or even suspect elder abuse, REPORT IT! Elder Abuse is a hidden problem – for every abuse reported at least another five (5) go unreported.

Where to Report

(Refer to the section on Where to Report Abuse)

Abuse that occurs in institutions must be reported to either law enforcement or the Ombudsman and to the appropriate licensing agency. For nursing homes, contact the California State Department of Health Services, Licensing and Certification and for residential care facilities for the elderly, the California Department of Social Services, Community Care Licensing.

When elder abuse occurs in a community setting, report the abuse to either Adult Protective Services or law enforcement.

Mandated Reporters: If you are a mandated reporter, then you must make a report. Reporting responsibilities are individual. Use the following guidelines.

Mandated Reporters MUST report actual or suspected physical and sexual abuse, neglect, including self-neglect, abandonment, isolation, abduction, and financial abuse.

Make the report immediately or as soon as possible by telephone.

Make a written report within two (2) working days of the event. Use the standard reporting form, SOC 341, “Report of Suspected Elder/Dependant Adult Abuse.” A copy of the form is available from DSS.


CCLD Community Care Licensing Meltdown

Monday, September 20th, 2010

CCL Meltdown

CALA has just engaged in a lengthy conversation with CCL leadership and has learned that CCL is temporarily suspending application processing (with minor exceptions) and appeal processing effective immediately. In addition, orientations will be suspended effective October 1, 2010. According to CCL, this is due to the cumulative effect of the budget shortfalls and repeated cuts to CCL staffing.

With very limited exceptions, application processing will cease immediately. Application specialists are being reassigned to other duties. CCL is reviewing pending applications to see if any can be processed quickly. On a case by case basis, CCL will make exceptions for immediate health and safety such as an unlicensed operator and situations involving communities where residents are already in care (change of management company, change of owner). These will be determined by Mary Jolls on a case by case basis.

Appeal processing has been put on hold, although licensees should continue to submit them. Health condition relocations will be the only exception. LPAs are being instructed to call their manager before citing a licensee if there is any doubt about a regulatory requirement in order to avoid the need for an appeal in the first place.

No orientations will take place after October 1, 2010. Those already conducted will not expire while this suspension is in place.

CCL is also suspending all internal training, limiting staff involvement in community events and meetings, and reducing phone coverage for the public.

What Will CCL be Doing?
CCL’s top priority is complaint investigations. Depending on the staffing level of the individual office, 5-year inspections and 30% random sample inspections will take place if staffing allows. CCL also intends to continue processing waivers and exceptions.

What is CALA Doing?
CALA is exploring a budgetary solution to this situation, investigating the possibility of outsourcing these vital functions, and will continue to talk with CCL regarding the details and the “temporary” nature of this new approach. And of course keep members posted!

SOURCE: The California Assisted Living Association (CALA)

PacificCare Lawsuit 1.3 Billion for 130,000 Violations

Wednesday, September 8th, 2010

PacifiCare Faces $1.3 Billion in Penalties for Over 130,000 Violations

California Insurance Commissioner Steven Poizner and the Director of the California Department of Managed Care (DMHC), Cindy Ehnes, announced that they are seeking $1.3 billion for over 130,000 alleged claim violations made by PacifiCare. It is the first action ever taken by both departments against a single health care provider.

Details of the violations

The Department of Insurance conducted market examinations that reviewed PacifiCare files between July 1, 2005 and May 31, 2007. It identified over 130,000 violations – each subject to penalties of $5,000 for non-willful violations and up to $10,000 for willful violations. When you add those numbers up, PacifiCare faces fines of between $650,000 to a staggering $1.3 billion (and this is not a typo – that’s billion, with a ‘B’.) The examinations were conducted in response to hundreds of complaints received from both consumers and providers.

The alleged violations include:

  • Wrongful denials of covered claims
  • Incorrect payment of claims
  • Lost documents including certificates of creditable coverage and medical records
  • Failure to timely acknowledge receipt of claims
  • Multiple requests for documentation that was previously provided
  • Failure to address all issues and respond timely to member appeals and provider disputes
  • Failure to manage provider network contracts and resolve provider disputes

Other violations / recoveries

According to a joint press release, the DMHC has already assessed the company, which was acquired by United Healthcare in 2005, a $3.5 million penalty for its practices – the largest fine it has ever imposed. The Department of Insurance also directed a self-audit of the company for unfairly denying coverage for pre-existing conditions. That audit resulted in over $750,000 in claims recoveries.

Putting an end to unfair claims practices

According to Poizner, this joint effort is meant to put an end to unfair claims practices in California. In a press release, he said:

Paying claims is the heart of the insurance business model and the most fundamental job insurers must perform. After years of broken promises to California regulators, it became crystal clear that PacifiCare simply could not or would not fix the meltdown in its claims paying process. We’re going to put an end to that. If PacifiCare can’t understand the ABC’s of basic claims payment, maybe it will understand the dollars and cents of regulatory action.

To view the press release, go to: