Minnesota Physician cover stories

august 2017

Past cover stories

The value of Medicaid

A safety net for children

 

By Kelly Wolfe

 

Imagine you’re pregnant and you unexpectedly go into premature labor, delivering your baby two months early. While you have health care coverage through your employer, you discover upon discharge from the hospital that your insurance won’t cover the 24-hour nursing care your baby will require, nor does it cover the equipment or medications your infant will need to survive. Thankfully, your child is eligible for Medicaid and you can now access these services.

 

Opioid Prescribing Improvement Project

A safety net for children

 

By Kelly Wolfe

 

Imagine you’re pregnant and you unexpectedly go into premature labor, delivering your baby two months early. While you have health care coverage through your employer, you discover upon discharge from the hospital that your insurance won’t cover the 24-hour nursing care your baby will require, nor does it cover the equipment or medications your infant will need to survive. Thankfully, your child is eligible for Medicaid and you can now access these services.

 

Quality reporting

The importance of accounting for social conditions

 

By Paul Kleeberg, MD, and Phil Deering, BA

 

Like many Minnesota physicians, Dr. Lynne Ogawa first saw her Minnesota Statewide Quality Reporting and Measurement System (SQRMS) outcomes toward the end of the last decade. At the time, the family practice doctor saw patients at the Fremont Clinic, located in the heart of North Minneapolis.

 

Why just retire?

Consider physician emeritus

 

By Michael J. Weber, JD, and Nancy Lee Nelson, JD, MPH, RN

 

If you are like many other Minnesota-licensed physicians, you might be unaware of the option to retire as a “physician emeritus.” To retire as a physician emeritus, a physician has to complete a short application with the Minnesota Board of Medical Practice.

 

Regenerative Medicine Minnesota

Transforming the future of health care

 

By Jakub Tolar, MD, PhD, and Andre Terzic, MD, PhD, FAHA

 

We have grown accustomed to the medical miracles—antibiotics to combat infection; transplantation to replace failed organs; and biologics to control high cholesterol, rheumatoid arthritis, or psoriasis—that have transformed patient care. Despite remarkable advances, many serious health problems resist conventional medicine and surgery, causing suffering and shortening lives.

 

The Minnesota Adult Abuse Reporting Center

Protecting the vulnerable

 

By Commissioner Emily Piper, JD

 

An older adult woman living in northern Minnesota was at her most vulnerable—recovering from surgery after a stroke—when she became the victim of financial exploitation by her own daughter.

 

The CARES Model

A way to engage your patients

 

By Archelle Georgiou, MD

 

Sixty-two percent of Americans say they want to deliberate with their physician about their treatment options. And, to help make the right choices, consumers have been armed with an array of health information sites, symptom checkers, cost calculators, and provider quality scores and report cards.

 

Minnesota Prescription Monitoring Program

Important updates responding to an epidemic

 

By Barbara A. Carter

 

In a recent survey conducted by the American Medical Association, in which 44 of the 49 state prescription drug monitoring programs (PDMP/PMP) responded there was a 180 percent increase, between 2014 and 2016, in the number of physicians’ and other health care professionals that had registered for an account with a PDMP/PMP.

 

Regenerative Medicine:

Efficacy, Economics, and Evolution

Get your tickets now

Be a part of the discussion on
how this industry is evolving.

The Minnesota Health Care Roundtable is a semi-annual conference featuring a panel of stakeholder group experts in a moderated discussion before a live audience covering topics that affect the evolution of health care policy.

Requesting Nominations

Seeking exceptionally designed health facilities

Before May 4th, 2018

Nominate a physician or team of physicians

Before January 10th, 2018

Recognizing Minnesota physician volunteers

The Minnesota Adult Abuse Reporting Center

Protecting the vulnerable

 

By Commissioner Emily Piper, JD

 

An older adult woman living in northern Minnesota was at her most vulnerable—recovering from surgery after a stroke—when she became the victim of financial exploitation by her own daughter.

While the mother was still recovering in the hospital and a nursing home, the daughter married. Using her temporary power of attorney over her mother’s affairs, the daughter and her new husband sold the older woman’s home, ran up her credit card balances, and took her possessions, including her car, furniture, jewelry, clothing, and antiques. They left her mother in a 500-square-foot room at an assisted living facility, without the resources to pay for her care.

 

Preventing abuse and neglect

Unfortunate cases like this one motivate us at the Minnesota Department of Human Services (DHS), as we focus on preventing abuse, neglect, and financial exploitation of vulnerable adults. As our population as a whole becomes older, we are stepping up our efforts to monitor and manage long-term care in homes and other community settings, as more of us receive this care outside of institutions.

 

By 2020, older Minnesotans will outnumber school-age children for the first time in our state’s history. By 2030, one in five Minnesotans will be over age 65. Anticipating these changes, we have worked for the past several years on strategies to promote choice, independent living, quality services, and safety for older adults. Strengthening adult protection has been among our priorities as more and more older adults live more independently than ever before, often without regular observation and oversight from family members or other caregivers.

 

Reporting maltreatment

The Minnesota Adult Abuse Reporting Center (MAARC) is a key part of this effort. MAARC’s launch in 2015 was a milestone, with a single toll-free number (1-844-880-1574) available 24 hours a day, seven days a week, for anyone to report suspected maltreatment of a vulnerable adult anywhere in Minnesota. It’s now easier to report maltreatment in Minnesota. And people are using these tools to involve authorities when they suspect maltreatment. MAARC currently receives about 1,000 reports of suspected maltreatment each week.

 

MAARC’s hotline replaced the previous system of more than 169 phone numbers designated by counties throughout Minnesota. MAARC also provides an online portal where people who are required to report maltreatment—mandated reporters including physicians and other health care providers, social services workers, educators, law enforcement officers, and other licensed professionals—can make reports. (Mandated reporters can also use the toll-free number.)

Many vulnerable adults are reluctant to report maltreatment. When asked about it directly, they may even deny that they have been harmed. Maltreatment can occur anywhere, from a person’s own home to a nursing home or another place where a vulnerable adult receives services or spends time.

 

Many of us will be considered vulnerable adults at points in our lives simply by virtue of receiving care in a particular setting. People in hospitals, nursing homes, transitional care units, assisted living, housing with services, board and care, foster care, and other licensed care facilities are considered vulnerable adults. So are adults who receive services such as home care, day services, personal care assistance, or other licensed services.

Maltreatment can take many forms, including abuse, neglect, and financial exploitation. Abuse can be physical, emotional, sexual, or verbal; signs can include bruises, black eyes, or broken bones, but also less immediately obvious changes in mental functioning or unexplained behavior. Neglect—failure to provide food, shelter, clothing, health care, or supervision—may be happening if a person is suffering from dehydration, weight loss, poor hygiene, repeated falls, or isolation. Financial exploitation can be involved if bills are going unpaid, if someone is being asked to sign unfamiliar documents, or if things like cash, credit cards, or jewelry are missing.

What happens after a report?

When someone reports suspected maltreatment of a vulnerable adult, MAARC assesses the report for immediate risks, makes all necessary referrals, and promptly submits reports to the appropriate investigative agency, which may be the county, Minnesota Department of Health (MDH), or DHS. Reports alleging criminal activity are also forwarded to law enforcement. The identity of the person who made the report remains protected.

 

An increase in reports

In its first year of operation ending in mid-2016, MAARC received more than 51,000 reports of suspected maltreatment, up 33 percent from the previous year. The most common allegations were caregiver neglect and self-neglect. Allegations also included financial exploitation, by people with or without a fiduciary relationship such as power of attorney; emotional or mental abuse; physical abuse; and sexual abuse.

 

Of these reports:

  • MDH received more than 22,500 reports in facilities licensed as hospitals, home care providers, nursing homes, residential care homes, and boarding care homes.
  • DHS received more than 5,700 reports in programs licensed as adult day care and adult foster care and programs serving people with developmental disabilities, mental illness, and substance abuse.
  • County social services agencies received more than 23,000 reports, including reports involving no licensed services and vulnerable adults receiving services from personal care assistance provider organizations, which are not licensed.

 

While it’s not clear what drove people to make more reports of maltreatment, we believe two factors may be relevant. For one, MAARC made it easier to report maltreatment, including for mandated reporters. And our public awareness campaign, “The Power of Could,” has highlighted MAARC through social and print media and radio advertising. We aim to make people more aware of maltreatment by showing possible signs, such as a bruise on a person’s face, poor hygiene, unpaid bills, or sudden changes in wills—signs that “could be nothing” or “could be maltreatment.” We emphasized the power of reporting suspected maltreatment and the difference such reporting could make in the lives of vulnerable adults.

 

Maltreatment in nursing homes

MAARC is part of our strategy to improve the lives of vulnerable adults, as well as the larger population of older adults and people with disabilities. We are also working on other fronts to improve transparency, safety, and quality in our system of long-term services and supports.

The Legislature this year approved additional funding for MDH to add staff who investigate allegations of maltreatment in nursing homes. Also this year, Gov. Mark Dayton proposed an Assisted Living Report Card, which would give people another tool to make informed decisions about the care they choose in assisted living settings. While legislators did not approve the proposal this year, we are hopeful that a Minnesota Assisted Living Report Card will move closer to reality in future sessions.

 

The proposed Assisted Living Report Card is modeled on Minnesota’s successful Nursing Home Report Card, which helps people compare nursing homes while making decisions about their options. MDH and DHS created the Nursing Home Report Card in collaboration with the University of Minnesota and introduced it in 2006. It rates facilities on eight quality measures, including state inspection results and hours of direct care. Minnesota’s Nursing Home Report Card is the nation’s most comprehensive because it measures resident quality of life and family satisfaction for the 366 nursing homes certified to participate in Minnesota’s Medical Assistance Program—nearly every nursing home statewide.

 

Conclusion

In the case of the woman whose daughter sold her house and took her possessions, she reached out for help and was connected with Minnesota’s Office of the Ombudsman for Long-Term Care, which worked with Adult Protection at DHS to line up the housing and support services she needed. Today, the woman’s health has improved and she is no longer considered a vulnerable adult. Her daughter did not face criminal prosecution because the mother couldn’t bring herself to press charges.

 

Had the MAARC existed during the time of this woman’s problems, it is possible she and others might have felt better-informed and more empowered to report the first signs of abuse before the situation became more dire. This event shows that vigilance matters when it comes to protecting vulnerable adults from harm and responding quickly to maltreatment when it occurs. Over time, the data collected by MAARC will help us focus future prevention efforts to improve both the safety and quality of life for vulnerable adults.

 

We can all play a role in making vulnerable adults safer in Minnesota by being vigilant, knowing the signs of maltreatment, and reporting suspected maltreatment.

 

Emily Piper, JD, is commissioner of the Minnesota Department of Human Services, the state’s largest agency. Before joining DHS in 2015, Piper served as general counsel and deputy chief of staff to Gov. Mark Dayton and as deputy commissioner and chief of staff for the Minnesota Department of Commerce.

Minnesota Physician Publishing Inc. © 2017