1. Empowering a Silent Generation: Conscious Aging in the LGBT Community Nova Geriatric Training Institute February 7, 2014 1776 N. Pine Island Rd, Suite 208, Plantation, FL 33322 954-382-1997 www.fl-elderlaw.com sschneider@fl-elderlaw.com www.fl-elderlaw.comsschneider@fl-elderlaw.com

2. THE HISTORY BEHIND THE PATIENT VISITATION RULE Langbehn v. Jackson Memorial Hosp. (9/28/09): ◦ Feb. 2007 SSC with 4 jointly adopted children arrive in Miami for a cruise ◦ Lisa Pond collapsed (aneurysm) ◦ Written advance directives ◦ Hospital admitting clerk denied partner & kids access for 8 hrs. ◦ SW told Langbehn she should not expect to be provided with information or access as “you are in an anti-gay city and state.” Stephanie L. Schneider PA (c) 2014

3. THE HISTORY BEHIND THE PATIENT VISITATION RULE Langbehn v. Jackson Memorial: ◦ Advance directives received and ignored ◦ Hospital allowed Lisa’s father to sign authorization ◦ No medical or legitimate reason to preclude family from being with patient Stephanie L. Schneider PA (c) 2014

4. CMS CREATES PATIENT VISITATION RULE September 7, 2011: Hospitals and CAHs must defer to patient’s choice of representative ◦ Inform patient or support person of visitation right ◦ Advise of clinical restrictions or limitations ◦ May not restrict based on sexual orientation, race, color, national original, religion, sex, gender identity or disability Stephanie L. Schneider PA (c) 2014

5. IMPLEMENTATION OF PATIENT VISITATION POLICY Admission Process: Intake form and notice of patient rights – ◦ Identify support person to visit ◦ Identify support person who has access to medical personnel and records ◦ Identify who to deny visitation Stephanie L. Schneider PA (c) 2014

6. IMPLEMENTATION OF PATIENT VISITATION POLICY (continued ) Continuing Professional Education: best practices for cultural competency, quality assessment and performance improvement program – ◦ Individual beliefs put aside ◦ Equal compassionate treatment of all ◦ No one should need to ask for ‘special treatment’ Stephanie L. Schneider PA (c) 2014

7. IMPLEMENTATION OF PATIENT VISITATION POLICY Best practices for cultural competency, quality assessment and performance improvement program (continued) ◦ Verbal designation acceptable ◦ Achieve balance when providing care intervention be sensitive to patient’s needs ◦ Restrictions: infection control; disruptive/violent behavior; interferes with care of other patients Stephanie L. Schneider PA (c) 2014

8. IMPLEMENTATION OF PATIENT VISITATION POLICY (continued) Non-Compliance: ◦ Provider termination from Medicare ◦ Provider termination from Medicaid Education is required at all levels – administrators, direct care providers and support staff. Don’t Risk It! Host the Healthcare Competency and Patient Diversity Symposium that has been approved for 3 CEUS for mental health, LCSW and nursing professionals. Stephanie L. Schneider PA (c) 2014

9. STANDARDS FOR LGBT CARE BY JOINT COMMISSION ◦ Create a welcoming environment inclusive of LGBT patients ◦ Avoid assumptions about sexual orientation and gender identity ◦ Facilitate disclosure but accept that coming out is an individual process and listen (use gender neutral language in forms and interviews) ◦ Provide information and resources for specific health issues facing the LGBT community ◦ Ensure equal treatment of LGBT employees (healthcare coverage, benefits) Stephanie L. Schneider PA (c) 2014

10. NEW FEDERAL RIGHTS Windsor: § 3 DOMA unconstitutional (definition of ‘marriage’ and ‘spouse’). The decision applies only to legally married couples. No benefits for domestic partners or SSC who enter into a civil union. § 2 intact: No state is required to give effect to another state that grants a marriage license to SSC. Stephanie L. Schneider PA (c) 2014

11. STATE DOMA Florida DOMA statute § 741.212: intact Florida does not have to honor a SSC marriage performed in another state, and it defines marriage as between one woman and one man. Florida Constitution § 27 is intact: Affirms Florida Statute. Stephanie L. Schneider PA (c) 2014

12. IMPACT OF WINDSOR DECISION Entitlement to federal benefits depends on where the client was married and where he/she lives at the time of applying for benefits. If moving to or living in a non-recognition state benefits vary by agency: ◦ Some agencies look at ‘place of celebration’ ◦ Some agencies look at domicile (residence) Stephanie L. Schneider PA (c) 2014

13. NEW FEDERAL BENEFITS FOR MARRIED SAME SEX COUPLES July 3, 2013 OPM memo – federal employees’ spouses and children receive: dental & vision; pension & annuity; health insurance; group life insurance coverage; LTCI coverage (qualified relatives) U.S. Immigration & Citizenship Services- Foreigner in same sex marriage with US citizen can obtain permanent resident visa IRS – all tax benefits Stephanie L. Schneider PA (c) 2014

14. NEW FEDERAL BENEFITS FOR MARRIED SAME SEX COUPLES SSA rules based on state of residence at time of application (or number holder’s death) & valid marriage. DOD memo 6/26/13: all military benefits immediately available to SSC married couples regardless of domicile (i.e. TRICARE, housing allowance, live off base, joint duty assignments). ERISA: employer-sponsored pension death benefit can name SS spouse. Stephanie L. Schneider PA (c) 2014

15. NEW FEDERAL BENEFITS FOR MARRIED SAME SEX COUPLES June 2011 CMS offered State Medicaid Directors option to provide spousal impoverishment benefits to married SSC. Washington is the only state to implement. Medicare coverage for SSC in same nursing home. Stephanie L. Schneider PA (c) 2014

16. TIPS FOR HEALTHCARE PROVIDERS Update your Patient Intake and Questionnaire ◦ marital status, sexual orientation and gender identification status ◦ Gender neutral language Think before you speak - Use gender neutral language http://www.thinkb4youspeak.com/GetInformed/ http://www.thinkb4youspeak.com/GetInformed/ Stephanie L. Schneider PA (c) 2014

17. STAY UP TO DATE STAY UP TO DATE www.fl-elderlaw.com www.defense.gov www.dhs.gov www.opm.gov www.irs.gov www.cms.gov www.va.gov www.ins.gov www.uscis.gov www.jointcommision.org Stephanie L. Schneider PA (c) 2014