Substantial numbers of residents may be inappropriately excluded from participating in discussions because of difficulties in determining decisional capacity to discuss future treatment wishes. The research highlights the difficulties of enhancing resident participation and autonomy in long-term care through procedural regulations such as the PSDA. More reliable methods of determining resident decisional capacity are needed to integrate the full intent of the PSDA into clinical practice in long-term care.
This study was part of a multiphase project examining the perceptions of elder law attorneys, certified financial planners, and Medicaid eligibility workers regarding Medicaid estate planning (MEP) for nursing home care. Focus group methodology (5 groups, N = 32 participants) was used to explore the perspectives and experiences of Medicaid eligibility workers, who are responsible for interpreting, administering, and enforcing federal and state regulations. Findings describe factors influencing MEP, enforcement of regulations, and potential policy responses to MEP. Participants identified numerous impediments to effective implementation of current regulations. Recommendations for improved policy include redefinition of spousal assessment policies, other valuable consideration determinations, and penalty period formulas.
The study examined the association between ownership type and community benefit as measured by organizational approaches to patient, family, and community education. As a case study of the broader class of educational efforts, the inquiry focused on educational efforts regarding a central patient care issue for nursing homes: the use of life-sustaining medical treatment. Results indicated that nonprofit and for-profit nursing homes were equally likely to conduct educational efforts concerning advance care planning. However, nonprofit nursing homes were more likely than for-profit nursing homes to have ongoing, rather than sporadic, discussions about advance care planning; to broaden such discussions beyond life-support wishes; and to have ethics committees to support advance care planning. Other empirical research has demonstrated ownership differences in both cost and quality of care. This study offers new evidence regarding additional ways in which nonprofit long-term care facilities may be distinguished from their for-profit counterparts.
This study examined Medicaid estate planning (MEP) through the experiences and perceptions of three groups in Connecticut: Medicaid eligibility workers (n = 128), elder law attorneys (n = 41), and certified financial planners (n = 29). Respondent groups varied significantly with regard to their perceptions of prevalence and magnitude of MEP, the nature of transferred assets, mechanisms for transfers, and characteristics of the "typical" client participating in asset divestiture for the purpose of qualifying for Medicaid. This substantial lack of concordance among those professionals most closely involved with MEP poses challenges for policy and research in this area.
In an empirical study of Connecticut-area for-profit and nonprofit nursing homes, authors examine use of institution-specific advance care planning forms among nursing home residents.
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