Thursday, April 24, 2014
My Penn State colleague from Hershey Medical Center, Dr. Claire Flaherty, has shared with me a another fascinating resource, "What If It's Not Alzheimer's?: A Caregiver's Guide to Dementia," by Gary Radin and Lisa Radin.
The first chapter provides "The ABCs of Neurodegenerative Dementias," including frontotemporal dementia (FTD), Lewy Body Dementia, vascular dementia, as well as Alzheimer's Disease. Key chapters including "finding the A Team" of specialists, and a guide to therapeutic interventions.
The book reminds us that with some forms of dementia, particularly early onset dementias such as FTD, changes in personality or executive function may be the first signs, and easily misunderstood. For example, the individual may manifest:
- hypersexuality, including promiscuous sexual encounters with strangers; or
- apathy or indifference to grooming and hygiene; or
- "hyperorality" with disinhibited consumption of large amounts of food; or
- poor judgment with a lack of sense of consequences, sometimes coupled with poor impulse control
One chapter is unique, emphasizing the potential importance, after death, of an autopsy of the brain, and thus providing families with a way to contribute to biomedical research and the hope for better answers in the future.
Sunday, April 13, 2014
ElderLawGuy Jeff Marshall succinctly discusses four critical issues that individuals and families should consider when using Powers of Attorney in estate and incapacity planning. Here's the link to Jeff's "Powers of Attorney: Things You Need to Know."
Wednesday, April 9, 2014
For the 11th consecutive year, Genworth has released its national survey results for long-term care costs, including statistics for nursing home care, assisted living facility care, adult day health care, home health aide services, and homemaker services. The survey draws upon information from more than 14,800 providers in 440 regions nationwide.
Genworth's 2014 information is offered in several formats, including:
- Key Findings
- Full Report
- State-by-State Statistics (with an interactive map, including search-by-region function)
In addition, and not surprising given that Genworth is an insurance company, the website offers planning guidelines, explaining the role for long-term care insurance.
Thursday, April 3, 2014
That's a frequent paper topic proposal for students in my Elder Law course, and one that usually triggers a conversation about the potential for "ageism." I remind students it will be important to provide evidence in support of their proposals, and not simply recount anecdotes about bad older drivers.
But, in truth, there is plenty of data to identify risks associated with older driving, as suggested by Elder Law Attorney Robert Fleming on his great Blog, citing statistics from the Center for Disease Control about risks for "fatal" accidents over age 75. See "Driving, Aging and Dealing with Family Dynamics."
ElderLawGuy Jeff Marshall takes a very personal look at his own driving future on his Blog, and uses that moment of self reflection to also examine strategies for encouraging older drivers to give up the keys. Read "What to Do When Dad Shouldn't Be Driving."
This is another area of "social policy" where the laws are not uniform on how to intervene when the older driver refuses to stop driving or to make other appropriate adjustments in when and where to drive. Here is a link from the insurance industry's Claims Journal to a recent "State by State Look at Driving Rules for Older Drivers."
And, for a somewhat more theoretical approach to the topic, from University of Miami Law Professor Bruce Winick, the always thoughtful guru of the therapeutic jurisprudence movement, see "Aging, Driving and Public Health: A Therapeutic Jurisprudence Approach." Professor Winick proposes creation of community-based "safe driving centers," as a means of encouraging impaired drivers "voluntarily to cease or restrict their driving by offering inducements and alternative transportation solutions."
And of course, we have Professor Becky Morgan's preferred solution, the Jetsons' car that drives (and parks) itself. Read "New Study on Autonomous Cars."
Wednesday, April 2, 2014
University of Oklahoma Professor of Law Jonathan Barry Foreman writes on "Supporting the Oldest Old: The Role of Social Insurance, Pensions, and Financial Products," for the Elder Law Journal in 2014.
He points to "longevity risk," defined as the risk of outliving one's retirement savings, as "probably the greatest risk facing current and future retirees" in the U.S. As several recent studies demonstrate, such as those cited on the Elder Law Prof Blog here, here and here, many people are not adequately prepared in terms of finances for retirement.
In responding to this risk, Professor Foreman writes thoughtfully, proposing systemic alternatives, including expansion of Social Security and SSI for "the oldest old." Professor Foreman suggests 90 years of age as the starting point for that category. In addition he proposes greater incentives for public and private employers to promote annuities and other "lifetime income products" as components of employment-based retirement packages.
He concludes with a warning based on our national history of frequently failing to make significant changes in advance of a predictable crisis:
"Social insurance programs like Social Security, Supplemental Security Income, and Medicaid will certainly need to be expanded. Workers will also need to be encouraged to work longer and save more for their eventual retirements, and both workers and retirees should be encouraged to annuitize more of their retirement savings.
While these kinds of solutions seem fairly predictable, the answers to two important policy questions have yet to be decided. First, how much will the government require the oldest old to save earlier in their lives? And second, how much will the government redistribute to benefit the oldest old? Unfortunately, if the history of the Social Security system is any indication, both government mandates and redistribution will be modest, and a significant portion of the oldest old will face their final years with inadequate economic resources."
Reading Professor Foreman's tightly focused paper suggests to me that there is, perhaps, a certain irony to all of this. The irony is that by not embracing systemic change, Americans are engaging in a form of financial roulette, betting we won't live long enough to care about the outcome of our gamble.
Tuesday, April 1, 2014
Free on-site or webinar trainings are available for elder advocates this spring. The National Elder Rights Training Project provides training on a wide range of law and aging topics to legal services providers and elder advocates nationwide. Priority for on-site training is offered to states involved in the Model Approaches to Statewide Legal Assistance Systems demonstration grants. However other organizations may also apply. Preference will be given to organizations that can commit to marketing and outreach for the training event to attract the targeted audience. The training is free and the National Consumer Law Center or another partner from the National Legal Resource Center will conduct the training. While the trainings are offered on a wide range of topics, selection of the organization is in part based on availability of trainers. Currently expert trainers are available on a wide range of consumer law topics.
The training application is available at http://www.nlrc.aoa.gov/NLRC/Training_Request/Index.aspx. You may also contact Odette Williamson at email@example.com with questions.
Washington Post writer Michelle Singletary hosts a column called The Color of Money. Recently she wrote about the importance of talking with your adult children about your preferences and finances "long before a health crisis forces the issue" that may put them in the position of caregivers. At the same time, she acknowledges this conversation isn't easy to start.
For assistance she suggests the book "The Other Talk: A Guide to Talking With Your Adult Children About the Rest of You Life," by author Tim Prosch. To further the conversation, Singletary and Prosch are hosting an on-line dicussion about "The Other Talk" on Thursday, April 24 at noon, Eastern time. Here's the link to the Washington Post forum for the program.
Sunday, March 16, 2014
Remember the first time you went to camp and your mother put labels on all of your clothes? At the other end of the timeline is the need to keep track of personal items, clothing and eye glasses in senior care facilities. One of the most common complaints in residential care is "missing" things ... like your dad's favorite red sweater.
Now there is new tool to help staff get items back in their proper place -- and the tool is useful whether the location is camp, college or a nursing home.
Check out identaMe labels -- waterproof, self-sticking, laundry-friendly and colorful. You can order pre-printed labels on-line, complete with your loved one's name and a "catchy" logo.
Friday, March 7, 2014
In MetLife Home Loans v. Vareen, decided in Kings County, New York on February 11, the mortgage company attempted to foreclose on a reverse mortgage, apparently because of unpaid water bills for the property. The case was "conferenced extensively with the defendant homeowner's family in the court's Foreclosure Settlement Conference Part," with no resolution of the dispute, but the homeowner did not file a formal answer in the lawsuit. Eventually the mortgage company sought an "ex parte" default ruling.
In denying the requested relief, the judge noted that the homeowner had a contractual obligation to stay current on all items which could become charges against the property. However, the mortgage company also had the contractual option to "make the payment for the mortgagor and charge the mortgagor's account. If a pattern of missed payments occurs, the [mortgage company] may establish procedures to pay the property charges from the mortgagor's funds as if the mortgagor elected to have the mortgagee pay the property charges under this section." It appears the homeowner was receiving monthly "reverse mortgage payments," rather than a single lump sum.
This history of the case is a reminder that reverse mortgages may not be the best solution for some older homeowners, especially if the cost to maintain the house is substantial, or if the elderly homeowner (or a volunteer in the family) is unable to handle payment of bills as they come due.
Here the court stepped in to prevent loss of the home, citing the lender's contract options. The court quoted the rosy language of a HUD-approved consumer guide, appearing to assure borrowers they can "continue to live at home as long as you want," and concluded:
"As such, plaintiff cannot foreclose on defendant's reverse mortgage because of her default in paying the NYC water bill. Furthermore, serving a senior citizen holding a reverse mortgage with a complaint that fails to specify what the default is can only be described as unconscionable."
Other court challenges to attempts to foreclose on reverse mortgages where there is a "surviving" spouse, but that individual is not an owner of record, are detailed here, with the potential class of plaintiffs represented by an AARP Foundation Litigation team. Thanks to ElderLawGuy Jeff Marshall for tweeting on AARP's efforts.
Wednesday, March 5, 2014
Apparently a lot of us were having "driveway" moments today, listening to NPR on the way to work and lingering in the car to hear the finish of the story. My Penn State colleague Amy Gaudion popped into my office to tell me of the "amazing" piece she had just heard, and a few minutes later I received an email from a friend who recommended that same radio story.
So, here's the link to the much recommended piece from NPR's Morning Edition, "Living Wills are the Talk of the Town in La Crosse, Wisconsin."
The American Geriatrics Society and the American Board of Internal Medicine Foundation have joined in a venture called "Choosing Wisely," and recently issued "Five Things Physicians and Patients Should Question."
The items are intended to stimulate more thoughtful decision making, especially in dementia care, and address diet, restraints, and use of screening tests. Two items that hit home include:
- Don't prescribe cholinesterase inhibitors for dementia without periodic assessment for perceived cognitive benefits and adverse gastrointestinal effects.
- Don't prescribe any medication without conducting a drug regimen review.
This "Five Things" list was actually the second set of "Choosing Wisely" recommendations. Here's a link to the important first list, which includes the concern about off-label prescriptions of antipsychotic medications to treat symptoms in dementia, a topic that has also been the subject of major whistleblower cases and settlements involving the pharmaceutical industry.
Monday, March 3, 2014
While working in Ireland in 2010, I attended a conferencen in Dublin where the theme was "turning silver into gold." I was impressed when I arrived, as the conference was sold out and it was standing room only. Speakers came from a wide range of academic and business fields, and the day ended with roundtable brainstorming sessions about business opportunities in serving the needs of seniors. There was a lot of creative energy in the room.
At the same time, I recognized the possibility that the economic crisis that was in full sail at the time, deeply affecting Ireland, could be triggering both creativity and desperation. Free enterprise often seems to walk the fine line between capitalizing on need and exploiting it. Seniors may be particularly vulnerable as clients, if the fine line is breached.
I was reminded of the potential for duality as I read a very interesting article in the New York Times, by Jill Caryl Weiner, "Of Crime and Punishment, Redemption and Aerobics." Here are two paragraphs from the thoughtful exploration of a senior fitness business plan, that started small with aerobics classes in senior centers:
"Mr. Mickens dreams big. Right now, as president and C.E.O. of the Tommy Experience, a fitness company focused on older adults, he says he wants to turn his company into an international brand, as big as Bally Total Fitness and Equinox. He envisions sports merchandisers like Nike and Under Armour sponsoring his company and providing comfortable workout clothes for the 60-and-above set, 'to sponsor their grandmothers, aunts and grandfathers like they would sponsor kids or a team.'
While his stated mission is to help older people transform themselves, it is also about his own transformation — and redemption. In 1989, Mr. Mickens, then 25, was convicted of conspiracy to distribute cocaine, money laundering and tax evasion. He was fined $1 million and sentenced to 35 years in federal prison."
It is good to read about redemption and senior services coming together in healthy ways, with the hope that everyone also "exercises" healthy realisim about the business model.
Thursday, February 13, 2014
The National Senior Citizens Law Center, with offices in California and D.C., has used its close observation of laws regulating "assisted living" across the U.S., to call for stronger rules in California, on the ground that "California lags far behind" in adopting moderns standards for quality of service and care.
NSCLC's latest report, "Best Practices in Assisted Living: Considering Potential Reforms for California, coauthored by Eric Carlson and Gwen Orlowski, is available on their website, along with the latest news on hearings before California legislative bodies on assisted living regulatory issues.
Tuesday, February 11, 2014
The Borchard Foundation Center for Law and Aging reminds us that the application window is now open to apply for 2014-15 Borchard fellowship funding. The program provides three law school graduates the opportunity to pursue their research and professional interests for a year in law and aging.
The fellowship is $42,500 and is intended as a full-time position only. The fellowship period runs from July 1 to June 30 each year, or for the calendar year beginning the month after the fellow’s completion of a state bar examination.
Examples of activities and projects by Borchard Fellows:
· Working with an established legal services program to enable vulnerable, isolated, low-income seniors to age-in-place by addressing their unmet legal needs;
· Providing holistic services to older clients facing consumer debt and foreclosure-related concerns;
· Implementation of a courthouse project to help elderly pro se tenants achieve long-term housing stabilization through the interdisciplinary use of legal representation and social services, allowing more elderly tenants to “age in place” at home;
· Development of a non-profit senior law resource center providing direct legal services and public education;
· Development of an interdisciplinary elder law clinical program at a major public university law school;
· Development of a mediation component for a legal services program elder law hotline;
· Development of an interdisciplinary project for graduate students in law, medicine, and health advocacy to foster understanding and collaboration between professions.
For more details on how to apply before April 15, 2014 deadline, see details here.
Thursday, February 6, 2014
What are "limited license legal technicians" or LLLTs? As defined by the Supreme Court of Washington in an order issued in June of 2012, LLLTs are individuals who achieve certification through a new state program, authorizing them to provide specific legal services within specific substantive areas of law and law-related practice.
Why create the LLLT alternative, especially in a country and during an economy where there are, arguably, more than enough underemployed lawyers? As the Washington Supreme Court carefully details, the current civil legal system "is unaffordable not only to low income people but, as a [2003 state study] documented, moderate income people as well...." For low income people, the "underfunded civil legal system is inadequate" to meet their very real needs. For many who are moderate in income, "existing market rates for legal services are cost-prohibitive." A new means of meeting public need is warranted, says the Court.
Why is a system of licensing LLLTs in the State of Washington potentially very significant to the practice of Elder Law? Washington has identified four areas of unmet civil law needs: Family Law, Immigration, Landlord/Tenant, and... yes, Elder Law.
Very interesting! The first practice area to be certified in Washington will be "Domestic Relations," with the Limited License Legal Technician Board expecting to begin accepting applications for a licensing examination in late summer or early fall of 2014. No indication yet on when "Elder Law" LLLTs might be certified. In the roll-out design, applicants must first satisfy threshold educational standards, including holding at least an associate level degree, plus 45 credit hours at an ABA-approved program (which, for the moment at least, means an ABA approved law school). Details on the certification process are available on the Washington State Bar Association's website, here. The University of Washington's School of Law has announced its "inaugural program" for LLLTs in family law to begin in the winter quarter of 2014.
While I suspect this movement might make existing Elder Law attorneys a bit nervous, my own research points to the very real need for more widely available, trustworthy legal advice. For example, Penn State Dickinson law students, with financial support of the Borchard Foundation's Center on Law and Aging, helped me to conduct focus groups drawn from a wide range of income, race, ethnicity and gender orientation, from locations all across Pennsylvania. In English and in Spanish, in inner cities and rural senior centers, we asked about their views and experiences with accessing legal assistance with Social Security, Medicare, Medicaid, insurance and other legal questions of concern to older persons. As summarized here, fear of the cost of seeing a lawyer, and the difficulty in finding free or affordable attorneys who were "trustworthy," were concerns clearly raised in each of the focus group sessions. That study pointed to the need for elder law specialists -- but not necessarily to a need for "just" Elder Law attorneys.
Big thanks go to Penn State Dickinson Professor Laurel Terry, our in-house guru on all things cutting edge in the practice of law, for sharing with me the latest materials on Washington's LLLT program.
CVS Caremark is drawing a lot of attention with the recent announcement of its decision to stop selling tobacco products in its drug store operations. Many, including the NYT and McKnights, are highlighting this decision as a pro-health measure, and certainly that should be true. News coverage of CVS suggests that other drug store chains are considering whether to adopt the same policy. But, the decision also highlights CVS' role in a major consumer trend; consumers are seeking what might be called retail health care at the corner drug store. This trend is arguably a move away from, or at least a major supplement to, a more traditional setting where a primary care physician's office is the access point for health care assessments. CVS' decision is part of its enhanced image as "health care provider."
I've been fascinated to see the popularity, especially among my parents' generation (in their 80s!), of using the "clinic" at the drug store to get complaint-specific treatment. Ease of access is certainly a major part of the appeal. I suspect that another factor is the decision of many trusted family physicians to retire. Indeed, my parents have now outlived the working lives of several sets of doctors.
At the same time, I worry about what might be missed when a customer uses the local drugstore "clinic" for a specific complaint -- and when those visits start to multiply. The pharmacy clinic does not have the decades of records that can help to explain a patient's symptoms and progress. Are there missed opportunities for whole person health care? And is the drug store clinic potentially "eager" to prescribe -- and sell -- drugs?
Tuesday, February 4, 2014
National Disability Navigator Resource Collaborative Helps People with Disabilities Find Health Insurance
The American Association on Health and Disability has launched a new website that aims to help personw with disabilities secure health insurance. Navigators and other enrollment specialists can now access better information to help people with disabilities find health care coverage in the federal and state exchanges. The tools are cross-disability programs developed by the National Disability Navigator Resource Collaborative (NDNRC). The 12-month collaborative was made possible by a one-year grant from the Robert Wood Johnson Foundation.
The navigator website was launched December 1, 2013 at www.nationaldisabilitynavigator.org. There is also an accompanying training guide, the Guide to Disability for Healthcare Insurance Marketplace Navigators. The guide describes the barriers to health insurance people with disabilities have encountered in the past, how disability laws affect the marketplace, what navigators need to know about disability, and much more. It is available at: http://www.nationaldisabilitynavigator.org/ndnrc-materials/disability-guide/.
The recently launched website also features the latest health coverage news and resources of interest to those helping consumers with disabilities find health coverage (and to consumers as well). The website also features a blog, which, among other things, gives everyone the opportunity to tell their own health coverage enrollment story. In the near future, the website will publish 17 fact sheets with more information on disability-specific issues and individual state information as well.
Thursday, January 23, 2014
Sponsored by NCLC and NACA
Grand Hyatt, San Antonio, Texas
March 7-8, 2014 (Friday & Saturday)
This 2 day training is only for NACA members, long-time NACBA members with practices limited to consumer debtors, assistant attorneys general, employees of state, federal financial enforcement agencies, and legal aid lawyers. Private attorneys should join the National Association of Consumer Advocates well in advance of the training.
Scholarship Application due this Monday, January 27th.
Set in a blend of the historic and the modern, the Grand Hyatt San Antonio Hotel has a premier location adjacent to the HemisFair Park and the Riverwalk with its enticing variety of restaurants and shopping along the San Antonio River. The hotel is within walking distance of the Alamo and the Tower of the Americas. Special hotel room rate of $169 per night.
Please pass this on to any legal aid, assistant attorney generals, NACA or NACBA members that you think might be interested.
Tuesday, January 21, 2014
Recently, a Pennsylvania friend was describing her aging father's situation in one of the sunshine states. When her father, a widower, began to show signs of diminishing capacity, the adult children discussed options, including moving Dad closer to one of them. But, he liked his retirement spot in the sunshine, had friends, and, in fact, there were more care options where he was living.
Eventually, my friend hired a local geriatric care manager in the sunshine state, with the cost shared by her and two siblings. In our most recent conversation, my friend described that decision as perhaps the best move the family made. She said that at first she had a hard time getting her father's facility to accept the fact that they should call the care manager first. But having an informed person -- an experienced advocate for her father -- in the community has often been essential, as questions arose over insurance, level of care, medications, transfers between facilities, nutrition and whether to hospitalize. My friend still makes regular trips to visit her father, but the local manager meant there were fewer emergency trips.
Geriatric care managers, sometimes called care coordinators, elder care coordinators, or professional care managers, could -- and perhaps should -- be an increasingly important part of planning. One of the questions about this emerging profession is credentials. At least two national trade groups exist, including the National Association for Professional Geriatric Care Managers (NAPGCM) and the National Academy of Certified Care Managers (NACCM).
In addition, law firms specializing in elder law frequently offer care management services, often employing non-lawyer professionals as part of the team.
Geriatric care management may be very important to "elder boomers," both as they become seniors caring for their even-more-senior-aged parents, and as future care-needing individuals themselves. Unfortunately, a big question may be cost. Medicare and Medicaid -- and most insurance -- does not cover the cost of care management. As reported by the New York Times a few years ago in "Care Coordination: Too Expensive for Medicare?," attempts to secure public funding for care managers has been stymied by studies that show care management does not necessarily reduce the costs of care.
Nonetheless, such coordination may be particularly important in a nation where family members often live far apart. In my friend's situation, she expected the need to last for a couple of years, but in fact, her father is approaching age 98, and the "healthy" relationship between the children, their father and his care coordinator has lasted for more than 10 years.
January 21, 2014 in Cognitive Impairment, Consumer Information, Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care, Legal Practice/Practice Management, Medicare | Permalink | Comments (0) | TrackBack (0)
Thursday, January 16, 2014
Hayley is investigating DIY funerals. Who is Hayley? Of course, she's a character on the British night-time soap opera, Coronation Street (a/k/a "Corrie"), that's been running continuously in the U.K. since 1960. Hayley doesn't want to "waste good money on oak caskets and brass handles. "
Here's an essay from the Irish Times, inspired both by the fictional Corrie debate, and preferences expressed by the County Down author's real-life partner, including a discussion of an Irish tradition, the wake.
I especially like the line from the essay, "She was waked in her own home."
Thank you, Una Lynch, for sending the link from across the Atlantic!