Sunday, September 21, 2014

Death Bed Radio

Seems like there have been several interesting developments in the past few weeks regarding end of life decision making. Thanks again to Charlie Sabatino, Executive Director of the ABA Commission on Law & Aging. former NAELA president, national expert on end of life issues and all around great guy, for sending me an email about the series run on WNYC public radio. The station ran a 3 part series on "death beds"  The first, Death Beds: Terminally Ill, But Constantly Hospitalized aired on September 8, 2014.  The second, Death Beds: Too Little, Too Late for Many New Yorkers Seeking Hospice aired the next day, and the third, Death Beds: Living Wills Slowly Take Root aired on September 10, 2014.

Each  includes the audio recording as well as the print story. Worth a listen!

September 21, 2014 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

Thursday, September 18, 2014

Institute of Medicine-New report: Committee on Approaching Death

The Institute of Medicine of the National Academies has released a new report on end of life issues. The report, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life  was released on September 17, 2014. The report brief offers an explanation of the importance of this new survey, including the sheer numbers of American elders who are living with some limitations on ADLs, chronic illness, cognitive issues and more.  As well the report points to issues with the health care system, including problems in accessing care, a lack of palliative care specialists and knowledge about end of life care, and a health care system that works out of sync, with economic incentives. The brief concludes with a call for "person-centered, family-oriented approach that honors individual preferences and promotes quality of life through the end of life [as] ... a national priority."  The report is "a comprehensive assessment of the knowledge gaps, structural problems, and financial disincentives that hamper delivery of optimal care and makes cross-sectoral recommendations to achieve compassionate, affordable, sustainable, and effective care for all Americans."

The website also includes a link to key findings, core components, an infographic and a quiz (5 questions) which is suitable for use in class.

The full report may be purchased as a book or downloaded as a pdf for free (registration is required).
Thanks to Charlie Sabatino for alerting me to this!

September 18, 2014 in Advance Directives/End-of-Life, Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

Home, Housing & Boomers

My colleague and dear friend Mark Bauer (current chair of the Aging & Law AALS section) sent me a link to an article published in CityLab.  The article is titled Where Are the Baby Boomers Going to Live Out Their Golden Years? The article mentions a recent report from Harvard's Joint Center for Housing StudiesHousing America's Older Adults. The Harvard website for this project includes a number of resources, including the report, an interactive map, an infographic, videos of the keynote address and panel discussion. If you don't have time to read the entire report, be sure to read the executive summary, available here.

The CityLab article mentions some other helpful sources, including an AARP survey on preferences regarding aging at home. The article references aging and disability, looking at the suitability of Boomers; homes for them in the future

The housing stock built for Baby Boomers largely wasn't designed with accessibility in mind. There are five universal-design housing features that tend to address a variety of disabilities that residents face as they age: no-step entries; single-floor living; switches and outlets set at lower heights; extra-wide hallways and doors; and lever-style doors and faucets. Nearly 90 percent of existing homes have one of these features, according to the report—but just 57 percent have two.

The article notes that more recently built homes are more likely to include at least some of these universal design features, but concludes

Yet these detached, single-floor, single-family homes—and the automobile-centric society that comes with them—are only going to fall further out of step with the needs of residents over time. And sooner rather than later. Homes can be retrofitted with lever-style handles and no-step entries (albeit at great expense). It's much harder to turn exurban and rural communities where older Americans live into places that nurture seniors rather than isolate them.

September 18, 2014 in Current Affairs, Housing, Retirement | Permalink | Comments (0) | TrackBack (0)

Wednesday, September 17, 2014

Moving Video from Cleveland Clinic

If you haven't seen this yet, it's worth watching--and showing to your class. Titled Empathy: The Human Connection to Patient Care, the video runs just over 4 minutes. It can be accessed here.

(Thanks to Judy Stein, Executive Director for the Center for Medicare Advocacy (CMA) for sharing this).

September 17, 2014 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

Question: What's the Green House Project? (Hint: It's Not About Growing Tomatoes)

Recently I sat in on a very interesting webinar on The Green House Project.  I had heard the phrase "green house" connected to new options for Continuing Care Retirement Communities (CCRCs), but I was not sure what it entailed, and it turns out it is not limited to CCRCs.  (When I first heard the term, I confused it with "green designs" intended to lower energy costs, or perhaps some movement to include gardening as therapy.) 

Here are a few highlights from what I now understand:

  • The Green House Project, about 11 years old, began with development support from a number of funding sources, including the Robert Wood Johnson Foundation, as a new approach to long-term care, requiring a major change in thinking about senior housing design and staffing.
  • The hallmark is person-centered care in a cluster setting of no more than 12 individuals, preferably 10.
  • Residents have individual bedrooms and bathrooms, thus creating "home" environments.
  • Meals are prepared and served in the central space - again, an effort to provide "home" settings.
  • No call buttons, no nursing stations, and as few wheelchairs as possible.
  • Expanded roles (and enhanced esteem) for staff members; the in-house caregivers or "shahbazim" have a wider range of responsibilities that include cooking and activity planning, and these roles involve specialized training.

Individual facilities can become "trademarked" Green Houses -- although the term has also become something of a trend in the senior housing industry, without being tied strictly to trademarking.  The Green House Project, a nonprofit organization, charges fees for formal consultations in the planning process. In some instances, fees may be covered by grants from other foundations. 

Here's the link to the Green House Project website, including information on additional upcoming (and free!)  webinars on financing, plus opportunities to participate in on-site workshops. I can see these as useful resources for students asked to consider new models for care.

September 17, 2014 in Health Care/Long Term Care, Housing, Webinars | Permalink | Comments (0) | TrackBack (0)

Tuesday, September 16, 2014

Wake Up Tired? Maybe You Are Working In Your Sleep?

Kurzweil AI (Accelerating Intelligence) ran a post on September 15, 2014, Now You Can Work in Your Sleep.  The story reports on a study from researchers that parts of our brains just keep on processing even while we are sleeping.  The study had participants (while awake) categorizing a word as representing an object or an animal. Participants pressed a button to enter their answers. So far so good. 

What happened next? Participants went to sleep, testing continued, with researchers speaking additional words.  The results?  "The researchers’ observations of brain activity showed that the participants continued to respond accurately to the words (although more slowly) as they slept."

Is this an elder law-specific post? Not really. But now there is another possible explanation besides age if you wake up tired; now you really can work 24/7.

 

September 16, 2014 | Permalink | TrackBack (0)

Going Higher, Wider and Faster ... at Age 67

Okay -- this isn't "elder law" but it certainly is a nice moment for the older competitor. Call this inspiration. 

As reported here and here, Ian Millar, age 67, had a $500,000 payday on Sunday, winning the Spruce Meadow International show jumping competition in Canada with his horse Dixson.  They topped second place finisher, 20 year-old rising star Reed Kessler and her mount Cylana, with a clean and faster finish in a two-competitor, final jump-off.  The jumps were set at maximum height and width.  And before you say, "but the horse does all the work," just imagine staying with the horse over huge jumps like this -- at any age.  Of course, Ian does have experience, twice winning this particular competition with his most famous horse, Big Ben.  But that was in 1987 and 1991, before Reed was even born! (Photo from Spruce Meadow Media Services, via Chronicle of the Horse)Ian Millar, Age 67, Wins at Spruce Meadows

September 16, 2014 in Current Affairs | Permalink | Comments (0) | TrackBack (0)

PA Attorney Disbarred After Ten Years of Involvement In "Living Trust Scams" Targeting Seniors

Following several months of investigation of complaints from older adults and their family members, in 2004 the Pennsylvania Attorney General announced a civil suit against an array of companies and individuals, including several attorneys, alleging their participation in a scheme to defraud through sales of unnecessary revocable living trusts and unsuitable annuities and insurance products. The alleged target was "senior citizens age 65 and older."

Ten years later, one of the Pennsylvania attorneys named in that original investigation, Brett B. Weinstein, has been disbarred.  This particular disciplinary action has been a lo-o-o-o-ng-time coming.

Beginning as early as 2000, the Pennsylvania disciplinary board received complaints about Weinstein's role in the sales by non-lawyer third-parties of so-called "living trusts," often packaged with high-priced annuities.  Weinstein himself rarely met with the clients, and provided little in the way of legal advice or counseling.  He was formally cautioned about his use of unsupervised non-lawyers to provide legal advice and in 2001 he entered into a written Assurance of  Voluntary Compliance. 

The conduct, however, apparently did not stop.  An undercover investigator was used to document continued problems.   In recommending disbarrment, the Disciplinary Office concluded that from 2002 to 2012, acting on his own and in concert with others, Weinstein "assisted sales and delivery agents for a series of estate planning companies  in the un-authorized practice of law." Further, he engaged in "false and misleading conduct, failed to consult with his clients concerning their objectives and placed his own interests above his responsibilities to his clients."

In discussing the case against Weinstein and rejecting his attempts to justify his conduct, the Disciplinary opinion points to a long-history of concerns about attorneys involved with living trust "mills" in other states (including Colorado, Missouri, and Ohio), where the products are pushed on older persons with little or no analysis of the clients' real legal needs and specific financial circumstances. Read here for the complete Disciplinary findings and the PA Supreme Court Order dated July 28, 2014.

September 16, 2014 in Consumer Information, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Legal Practice/Practice Management, State Cases, State Statutes/Regulations | Permalink | Comments (0) | TrackBack (0)

Monday, September 15, 2014

Tailoring Powers of Attorney: Beyond the Minimum Statutory Requirements

One of our great readers, attorney Paul Meints from Bloomington, Illinois, has shared ideas about how to make Powers of Attorney (POAs) more responsive to practical concerns, including  the possibility that when tough times eventually occur, the principal may fail to realize or recognize his or her own waning abilities, including the ability to drive safely.  Here is language Paul has tailored to address these potential concerns:

Inability to Function as Principal; Inability to Operate a Motor Vehicle in a Safe and Proper Manner:

My successor Agent or My Attorney may execute and deliver an Affidavit that I am unwilling or unable to serve or to continue to serve, and such affidavit shall be conclusive evidence insofar as third parties are concerned of the facts set forth therein, and in such event any person acting in reliance upon such affidavit shall incur no liability to my estate because of such reliance.  The decision as to determining my inability (1) to properly, prudently, and fully function as Principal and/or (2) to operate a motor vehicle shall be made by a Committee consisting of three of the persons [or such person’s designee] named on page one together with one other person selected by my attorney or the family committee.  I authorize all health care providers who may have provided, or be providing me with any type of health care (physical and mental), to disclose all direct or Protected Health Information (HIPAA/PHI) to each member of the family committee.  If, in the Committee's sole and ab­solute judgment, I am so incapacitated by reason of illness, age, or other cause that I am incapable of expending funds for my own use and benefit or am not giving prompt attention to my financial affairs,  then my successor agent is authorized to act on my behalf.  If, in the Committee's sole and ab­solute judgment, I am so incapacitated by reason of illness, age, or other cause that I am incapable of operating a motor vehicle in a safe, proper, and prudent manner, then my successor agent, My Attorney, or both are authorized to release and terminate my driving privileges.

I like the fact that this language realizes that not all agents will feel comfortable making decisions on sensitive matters by acting alone, and that the POA actually provides guidance for how to make an ulitimate decision about the principal's inability to handle finances or drive. In essence, this POA would appear to permit the agent to override the principal's resistence. Thanks for sharing this language, Paul.  Reactions from other readers?  Would your state recognize the vailidity of such language? 

September 15, 2014 in Cognitive Impairment, Estates and Trusts, State Statutes/Regulations | Permalink | Comments (0) | TrackBack (0)

Friday, September 12, 2014

First Annual Jameson Crane III "Disability and the Law" Student Writing Competition

Thomas Jefferson School of Law  (that just happens to be located in one of my favorite cities, San Diego) is hosting a new writing competition to encourage outstanding student scholarship at the intersection of "law and medicine" or "law and social sciences." The purpose is to promote "understanding" and to further the "development of legal rights and protections" of those with disabilities.  Papers may be on any topic relating to disability law, including legal issues connected to employment, government services and programs, public accomodations, education, higher education, housing and health care.

The First Annual Jameson Crane III Disability and the Law Writing Competition is open to currently enrolled law students, medical students and doctoral candidates in related fields in the U.S.

The winner of the competition will receive a $1,500 cash prize, while two second place winners will each receive $1,000 case prizes, plus the possibility of publication. 

The deadline for submission of entries is January 15, 2015. 

Additional details are available here, or by contacting Professor Susan Bisom-Rapp at Thomas Jefferson Law.  Thanks for letting us know about this new opportunity for students, Susan.

September 12, 2014 in Current Affairs, Discrimination, Grant Deadlines/Awards | Permalink | Comments (0) | TrackBack (0)

Will Americans Still Be Paying Off on Student Loans As Seniors?

In a GAO study titled "Inability to Repay Student Loans May Affect Financial Security of Small Percentage of Retirees," researchers reveal that a significant -- and growing -- proportion of "student loan" debt is owed by Americans aged 65 or older.  In addition to the growth in the total amount of "senior" student loan debt, from $2.8 billion in 2005 to $18.2 billion in 2013, the GAO findings include:

  • Relatively few households headed by individuals 65 or older hold student loan debt -- the number is about 706,000 households in the U.S. -- but the amount they owe may be significant, with estimates that the median debt owed is around $12,000, as compared to a median for those aged 64 and younger of $13,000.
  • Most -- about 82% -- of this debt was for the individual's own education.  It is not known whether how "old" the loans are.
  •  Older borrowers hold defaulted federal student loans at a higher rate -- and defaults can have conquences, including offsets on Social Security payments.  Generally speaking, student debts cannot be discharged in bankruptcy; however adjustments may be possible to keep the individual's monthly income above the poverty threshold.

For more discussion on the GAO report, see "Senior (Citizen) Student Debt Rising," in Inside Higher Ed by Michael Stratford.  Hat tip to Professor Laurel Terry for pointing out this new study. 

September 12, 2014 in Current Affairs, Ethical Issues, Federal Statutes/Regulations, Retirement | Permalink | Comments (0) | TrackBack (0)

Book Review--Government Regulation in Excess?

Our friend and health law/elder law rock star, Marshall Kapp, sent me a note about a book review  he authored (thanks Marshall) that appears in The Gerontologist Advance Access.  The review is of the book, The Rule of  Nobody: Saving America from Dead Laws and Broken Government by Phillip K. Howard.

You may be wondering why a blog for elderlawprofs is posting about laws and government regulations.  Three words: nursing home regulation. Although a subscription is required to read the full review, an excerpt is available for free, much of which I have reproduced here

The brilliant satirist Jonathan Swift said long ago, “Laws are like cobwebs, which may catch small flies, but let wasps and hornets break through.” (Brainy Quote, n.d.). Swift certainly did not intend that remark as a compliment to either laws or cobwebs. Nonetheless, almost all laws originate to accomplish some reasonably defensible public purpose, even though ... poorly drafted, inconsistently ... enforced, and perpetuated beyond ... their original justification ....             

In this latest project, Howard despairs that regulation in the United States has veered far from its proper function as a setter of boundaries or parameters within which individuals are empowered... (end of excerpt).

Since Marshall sent me a full copy of the book review, I can explain further what the abstract does not, how the author uses nursing home regulations as an example. Marshall describes this on page 1-2 of his review

One of the primary examples that author Howard utilizes throughout The Rule of Nobody to illustrate his constructive critique about the largely dysfunctional nature of the contemporary American regulatory situation is the overwhelmingly extensive and complex set of formal command and-control rules we have promulgated on the federal and state levels to govern the operation of nursing homes.

Marhsall offers a bit of history as to why we have so many laws and regulations for nursing homes and suggests that now is "the time to seriously contemplate smarter, rather than just bigger, regulation...." (review at page 2). He notes that the author provides examples of when the regulations don't end up benefitting the residents, with current regulations stifling innovation. (review at 3).  Marshall concludes his review with this summary

[T]he Rule of Nobody is noteworthy for the nation generally and for long-term care policy-makers particularly... Settling for being “in the ball park” is damning with faint praise, indeed. The only option for many vulnerable individuals is dependence on the benevolence of nursing home owners and workers and lawmakers’ careful guidance. Society owes them a system of oversight and influence that not only aspires to, but effectively achieves, a much loftier standard.

Another one to add to the reading list.

September 12, 2014 in Books, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

Thursday, September 11, 2014

Fed Court in NY Takes Hard Line on Effect of "Partial Cure" for Medicaid Ineligibilty

Judge Geraci of the U.S. District Court, Western District of New York, is the latest judge to address an important topic in Elder Law regarding eligibility for long-term care benefits under Medicaid.  The court defines the issue as follows:  "When an uncompensated transfer of assets has been made and a [Medicaid] penalty period imposed, how does a partial return of the transferred funds affect the beginning of the penalty period?"  

In its August 2014 decision in Aplin v. McCrossen, the court addresses summary judgment motions in two separate cases that were filed on behalf of 80-year-old Florence Aplin and 85-year old Sergio Ciardi, both residents of nursing homes.  In one case, for example, the Aplin case, the transfers totaled approximately $450,000; however, approximately $76,000 was later returned by the donees. The hope of the plaintiffs was that "return" of the money would permit them to shorten their penalty periods tied to the original transfers.  This approach, when planned in advance, is a post-Deficit Reduction Act technique sometimes known in Elder Law circles as a "partial cure" (as part of "reverse half-a-loaf" gifting).

Judge Geraci denied the relief sought by the plaintiffs.  He followed the hardline approach of "nonprecedential" rulings on New Jersey disputes about partial cures, ruling that "return" of money permits the state agency to recalculate the start of the penalty period. The court decided that NY administrative rules do not conflict with federal policy and not only permit but require the state agency to, in effect, restart the penalty period on the ground that the later date is when the "applicant becomes otherwise eligible for Medicaid." This phrase is a key concept in federal Medicaid law.  The plaintiffs had argued that phrase applied only to an earlier date, from their original application. Judge Geraci concluded:

"I find no circumstances in this case which indicated that Defendants' interpretation and application of the provisions of [New York administrative directives] contravene Congress' articulated purpose in enacting the Medicaid Act -- to provide medical care, services and supplies for the financially needy.  Essentially, the assessment of an applicant's income and resources which results in a determination that such applicant has transferred resources for less than fair market value during the statutory look-back period and that an appropriate penalty period must be imposed, ensures that the applicant has not falsely impoverished himself or herself in order to qualify for medical assistance at public expenses which, by law, is undeserved."

While it is apparent that the New York federal judge was not eager to give applicants any benefit tied to partial cures on transfers, the decision also appears to approve or at least ignore what some would describe as a "perverse effect" of the New York policy.  By imposing a new, later "start date" for the ineligibility period following the return, New York can actually impose a penalty that is longer than the original penalty period for the full transfer. 

Also at issue in the case was the effect of a series of statements on the federal government's side, including the so-called "McGreal Letter" from CMS that was relied on by the plaintiffs in making the returns. (The court did not expressly address a May 2014 GAO study, where it was reported at page 28 that "[a]ccording to CMS, states can choose whether or not to consider a partial return of transferred assets on Medicaid planning.")

Should there be uniformity among the states, not just on whether but how families can seek any relief from "resource" limits set by federal law?  (The GAO study linked above indicates a range of different state-specific options are in play.) The answer to that question may depend on one's point of view.

For more background on the complex interaction between Medicaid applications, ineligibility periods triggered by uncompensated transfers, partial cure attempts and penalty start dates, see ElderLawGuy Jeff Marshall's blog post from 2011.    

September 11, 2014 in Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid | Permalink | Comments (0) | TrackBack (0)

Put Me In Coach!

Put me in coach---a phrase often associated with a competitive sport of some sort. We think about coaches for teams, but we need to broaden our perspective, to think about coaches in a much broader aspect:  life coaches, marriage coaches, business coaches, study coaches, and now... retirement coaches.  The NY Times ran an article, Finding an Identity Beyond the Workplace:  There's More to Retirement Than Financial Planning.  We have heard stories before of people whose identities are so intertwined with working, that they are lost when they retire.  Coaches can help those folks, and others, in finding goals for their post-work time.

This entry in the non-sport coaching field, retirement coaching, can help with goals and motivation, according to the article. "Retirement coaches ... are popular these days. The cadre has emerged in the crowded coaching field to cater to a growing number of boomers who are grappling with what’s next."  According to one expert quoted in the article, part of this need for assistance is longevity--with the years post-working stretching out longer in the future, people are looking for help in defining what to do in those years.

Here's how one retirement coach describes what they do  "[w]hen someone retires, they tend to be literally levitating with excess productivity that can’t be channeled ... We help them slowly build a basket of activities."

So what's in the basket? It could be a veritable potpourri of activities, such as "part-time work, humanitarian endeavors, entrepreneurial adventures and artistic pursuits, [as well as] ... a search for legacy and significance ...."  A significant number of clients  of one coach are described by the coach as "hav[ing] some kind of ‘give back’ gene. They want to get involved with a charitable board, or find ways to be a teacher or tutor.”

There are plays to be run in retirement coaching, just like in sports. It takes time for the recently retired to learn those plays and to be prepared for the "game."   This means the first play run will be "a self-assessment that examines values and strengths and clarifies goals, hopes and dreams for the future."  The playbook involves running numbers, too, using "retirement calculators to be sure they won’t outlive their savings."  But although a football coach can use a stop watch to see how fast a player can run the 100, it's more intangible with retirement coaching.  "[I]t’s far harder to compute in advance how to best navigate the intangibles like building a new social network and finding value in how you spend your time in retirement."

How long do you need your coach? It simply depends.  Cost does as well.  There isn't quite as much regulation for these types of coaches as there are in sports, but there still are at least two organizations, according to the article.  So why use a coach? One of the coaches is quoted: “This is a fresh track adventure ....Be patient. For the first time in your life, you need to be able to deal with white space. People get addicted to busyness. White space is the source of creativity and strategic thinking, so don’t fill up your dance card too fast.”

Since all of us are "in the game" of life and aging, we all need to think about our retirement readiness. Now we can have our own coach for that, and maybe there will be an app as well. (Please note my sports analogies are an attempt, feeble as it may be, to have a bit of fun in writing this post. Any sports analogy errors are definitely my own).

 

 

 

September 11, 2014 in Consumer Information, Current Affairs, Retirement | Permalink | Comments (0) | TrackBack (0)

Wednesday, September 10, 2014

U.S. Department of Justice Opens New "Elder Justice" Portal

The U.S. Department of Justice recently established an on-line Elder Justice Initiative, intended to assist the public, practitioners, and prosecutors with identifying and responding to all types of elder abuse.  Here are some of the highlighted resource links from the website:

Here, victims and family members will find information about how to report elder abuse and financial exploitation in all 50 states and the territories. Simply enter your zipcode to find local resources to assist you.
 
 
Federal, State, and local prosecutors will find three different databases containing sample pleadings and statutes.
 
 
Researchers in the elder abuse field may access a database containing bibliographic information for thousands of elder abuse and financial exploitation articles and reviews.
 
 

Practitioners -- including professionals of all types who work with elder abuse and its consequences -- will find information about resources available to help them prevent elder abuse and assist those who have already been abused, neglected or exploited.

September 10, 2014 in Crimes, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations | Permalink | Comments (0) | TrackBack (0)

Tuesday, September 9, 2014

Intergenerational Housing--A Cool Idea From Oregon

One of the things (among the many things) I like to post about is the concept of age-friendly communities that allow a person to age in place.  Governing ran an article last month, showcasing a cool project in Oregon that provides intergenerational housing. Young and Old Find Common Ground in Oregon Housing Community explains about Bridge Meadows where elders and foster children reside in the same housing complex, where the units are provided for free to the foster parents.  "Bridge Meadows, a 36-unit apartment complex in [Portland] ... mixes incomes, generations and skill sets in a way that enlivens and enriches the lives of young and old alike." Twenty-seven of the units are for lower-income elders with the rest for those who will be foster parents (or even legal guardians) for at least 3 children within 5 years. Not only do the elders get a break on the housing costs they get to be involved!

[E]lders volunteer their time to work with the kids in the complex. For at least 100 hours per quarter, they tutor, cook, babysit, participate in outdoor activities and so forth. The complex also offers a computer room, library, public courtyard and community garden to help foster connections.

As far as the kids, the program has had a pretty significant impact. Of the "29 children ... 24 were formerly in foster care. Of those 24, just over half are either adopted or in legal guardianship and the rest are on their way to adoption or legal guardianship. In other words, they're all now part of functional families, in permanency or on their way."

The head of Bridge Meadows is pretty enthused about this model's ability to be duplicated, noting that it serves as a solution for 2 serious problems our society is facing, (1) "how to civically attend to our rapidly aging population and" (2) "how to place all the troubled kids peppering children and family services systems in the country."

The author has some concerns about effective replication but still considers this program jan important addition to the spectrum of strategies.  It is a nifty idea! More information about the project, as well as photos, are available on their website.

September 9, 2014 in Current Affairs, Housing, Other | Permalink | Comments (0) | TrackBack (0)

A Psychiatrist Shares Her Personal Journey with Grief

In Psychiatric Times, Dr. Anandhi Narasimhan, California-based and board certified in psychiatry and neurology, compares her professional and personal experiences with grieving following the death of her father.  She writes well, and in additional to offering suggestions for coping, she shares this poignant detail from her father's life, which also served to introduce me to a new and intriguing idea, "dialysis at sea."   She writes:

"My father was a distinguished scientist who placed value on education. Although he did not believe in lavishness, he always liked to present himself in a well-groomed fashion. I miss his sense of humor, and I have discovered how important such a quality can be when faced with tough times. Remembering his witty repertoire reminds me to celebrate his life.

 

The picture I have included [with her essay in Psychiatric Times] is from an Alaskan cruise my family took. We had talked about taking a cruise as a family in the past; this had been a dream of my father’s. When he was placed on regular dialysis treatments, he said, 'I guess now I won’t ever be able to go on a cruise.'

 

It wasn’t until I saw a poster advertising 'Dialysis at Sea' that I realized we could make his dream come true. With some logistical planning, transferring of medical records and such, we were able to take my father on an Alaskan cruise, an experience he both treasured and loved.When I was growing up, my father had a sort of utilitarian view of vacations—we often had to be doing and seeing things; they had to be productive. This vacation was different—it was nice to see him relax and enjoy the awesome beauty of Alaskan glaciers. His smile in the picture is how I would like to remember him: intelligent, positive, humorous, and charming."

Read more of "My Father's Influence" here

September 9, 2014 in Health Care/Long Term Care, Science, Travel | Permalink | Comments (0) | TrackBack (0)

Monday, September 8, 2014

Living In the Moment--When a Family Member Has Dementia

Have you ever considered the similarities between caregiving and improv? Probably not--who would-they certainly seem to be quite dissimilar occupations. Yet when you think about their characteristics, they are quite similar.   The website, In the Moment, which is focused on "creative ideas for training staff" lists on the landing page characteristics that apply to both, including being flexible, adaptable, courageous, spontaneous, generous, selfless and trusting.

So the idea is very intriguing. Wonder how the founder came up with this concept?  She talks about receiving a phone call almost a decade and a half ago about her mom about her dad's imminent death:

and within twenty four hours ... was on a plane flying to be with ... family and wait for ... Dad to pass away. During that time of sitting, laughing, thinking, crying and rambling -[she]...realized that the world of Improvisation was very similar to the world of caregiving and Alzheimer's disease and dementia.... [unsure] why the idea hit ... then, maybe it was divine inspiration, maybe someone was telling [her] the reason why [her] ... Dad had Alzheimer's or maybe [she] ...was sleep deprived. Probably all of the above... [Having]... attended a lot of very informative and well executed workshops and trainings... [yet] not a very good learner... [she] remember[s] sitting in a class and listening to the instructor talking about effective communication with persons with dementia."

Then inspiration struck, as she says in her own words  "[a]ll  I could think of was how tired I was of sitting . If she would just do this improv exercise it would illustrate her point more clearly and get everyone up and moving. Hmmmm...." She wrote grant applications, with this excerpt from her abstract, explaining the parallels

The rules of Improvisation parallel the “ rules “ of Caregiving for a person with Alzheimer’s. Each rule of Improv has exercises, hands on techniques to illustrate points of care. Improv itself teaches characteristics that are essential to the caregiver : listening, validation, accepting others’ realities, problem solving and creativity to name only a few. I see improvisation as another tool for caregivers and for trainers to use to create a better quality of life for each person with Alzheimer’s. I want to clarify that this this is not training of how to do Improvisation. But training that uses Improvisation to teach Alzheimer care.

The "rules" she references can be accessed here. The website also provides information about the 6 week training program, training tips, and other resources. Ultimately, the goal of this project is to "[e]Employ ... theater games with creativity exercises ... [to] provide[] caregivers with the methods to become better at what they do." 

Live in the moment--and enjoy that moment with a family member who has dementia---very good advice indeed.

 

September 8, 2014 in Cognitive Impairment, Dementia/Alzheimer’s, Games | Permalink | Comments (0) | TrackBack (0)

Anyone Can Be a Victim of a Scam...Anyone.

We all know how prevalent financial scams are, and that they are becoming more and more sophisticated. One of my colleagues, and dear friend, forwarded an email to me purportedly from his financial institution-and the email had the correct last 4 #s of his credit card!  He promptly contacted the financial institution because it looked so authentic, only to find out it was a scam.  The institution insisted there was no data breach. He promptly closed that account. I'm sure you have had similar experiences, or know someone who has (every semester I ask my students whether any of them have been victims of identity theft. Unfortunately, there is always at least one).

Governing ran a story a couple of weeks ago about state efforts to combat financial scams that target elders. The article, States Fight Financial Scams Aimed at Seniors,  quotes Mary Twomey of the National Center on Elder Abuse, that the advancement in fighting scams is happening at the state level. For example, the article indicates that in 2014 "lawmakers in at least 28 states and the District of Columbia introduced legislation addressing the issue. Some measures focus on enhancing criminal penalties. Others target caregivers who exploit elderly charges. Some require financial institutions to report suspected exploitation."

We all know the dearth of statistics makes it a challenge to really understand the magnitude of the problem.  The article quotes some studies with statistics, including a recent one from the Journal of General Internal Medicine "that found that one in 20 older adults in New York state reported that they had been financially exploited, usually by a family member, but sometimes by a friend or home-care aide."

The article also reviews some of the innovations in certain states, such as Colorado which requires training of law enforcement to recognize exploitation and abuse, with each department required to have a minimum of 1 trained officer by 01/01/2015;  and North Carolina, which allows "courts ... to freeze the assets of a defendant charged with financial exploitation of a senior or disabled adult, if the victim has lost more than $5,000."

September 8, 2014 in Consumer Information, Crimes, State Statutes/Regulations | Permalink | Comments (0) | TrackBack (0)

Tragedy on Many Fronts: South Korea Story on Aging Women Near U.S. Base

From the Associated Press in Pyeongtaek, South Korea, an especially troubling history with issues of abuse, human rights, comparative law, international relations, military accountability, and aging:

"More than 70 aging women live in a squalid neighborhood between the rear gate of the U.S. Army garrison here and half a dozen seedy nightclubs. Near the front gate, glossy illustrations posted in real-estate offices show the dream homes that may one day replace their one-room shacks. They once worked as prostitutes for American soldiers in this "camptown" near Camp Humphreys, and they've stayed because they have nowhere else to go. Now, the women are being forced out of the Anjeong-ri neighborhood by developers and landlords eager to build on prime real estate around the soon-to-be-expanded garrison.

 

'My landlord wants me to leave, but my legs hurt, I can't walk, and South Korean real estate is too expensive,' says Cho Myung-ja, 75, a former prostitute who receives monthly court eviction notices at her home, which she has rarely left over the last five years because of leg pain. 'I feel like I'm suffocating,' she says.

 

Plagued by disease, poverty and stigma, the women have little to no support from the public or the government. Their fate contrasts greatly with a group of Korean women forced into sexual slavery by Japanese troops during World War II. Those so-called "comfort women" receive government assistance under a special law, and large crowds demanding that Japan compensate and apologize to the women attend weekly rallies outside the Japanese Embassy.

 

While the camptown women get social welfare, there's no similar law for special funds to help them, according to two Pyeongtaek city officials who refused to be named because of office rules. Many people in South Korea don't even know about the camptown women."

For more of the story, see "Aging South Koreans, Once Prostitutes for U.S. Troops, Being Pushed Away from Base They Never Left."

September 8, 2014 in Current Affairs, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, International | Permalink | Comments (0) | TrackBack (0)