Saturday, December 14, 2013
New York Times writer Alina Tugend reports on community and state responses to concerns over older drivers in "An Alternative to Giving Up the Car Keys." An excerpt:
"While that is a scary thought for some people, the common perception, that the only real choice is between ignoring the difficulties faced by elderly drivers and taking away the car keys, is wrong. 'We’re evolving in our thinking,' said Jodi Olshevski, a gerontologist and executive director of the Hartford insurance company’s Center for Mature Market Excellence. 'We’re not just looking at the transition from driver to passenger, but how we can empower drivers to extend their driving as long as possible.'”
Sunday, December 8, 2013
Recently I was invited to give the keynote address for an annual meeting of MaCCRA, the Maryland Continuing Care Residents Association, held at Vantage House in Columbia, Maryland. As always happens, I learned a great deal from the opportunity to meet with individuals who care deeply about their communities and want to see them continue to succeed. Maryland is home to some 37 Continuing Care Retirement Communities (CCRCs), with close to 20,000 residents.
MaCCRA has a long and especially interesting history of advocating for appropriate protections for current and future residents of Continuing Care Retirement Communities. Most recently, between 2008 and 2012, MaCCRA supported a series of legislative efforts, including some that were ignored or soundly defeated, but culminating in passage of Senate Bill 485 and House Bill 556 in 2012 that amended of Maryland's CCRC oversight laws (Md. Code. Ann. Hum. Serv. Sections 104-1 et seq.). For example, the amendments require:
- greater disclosure of how entrance fees will be used or held, including a requirement of express disclosure about whether fees will or can be used for purposes unrelated to the community;
- greater disclosure of ownership interests in the community;
- disclosure of annual budgets (not just financial statements);
- increase of operating reserves from 15% of net operating expenses to 25%, with a ten-year phase-in; and
- certain restrictions on encumbrances of operating reserves
Such successes have required perseverance, with MaCCRA playing an important role in educating residents across the state as well as legislators. Indeed, MaCCRA understands that grass root movements alone may not be enough, and the organization has worked for twenty years with an experienced lobbyist, thus helping to assure institutional memory while working in small and large ways to urge greater accountability by providers.
One of the questions I frequently am asked during interactions with CCRC resident groups around the country is whether the most appropriate administrative unit of state government to provide oversight is the department of insurance. My response is that the name on the door is not as important as the state's commitment to hiring knowledgeable individuals with finance-specific training and who are not captives to the industry, regulators who are willing to take a balanced approach to oversight. The current operation of the unit of Maryland's Department of Aging charged with oversight of CCRCs strikes me as providing a good example of that commitment.
MaCCRA is a chapter of the National Continuing Care Residents Association (NaCCRA); during my visit to Maryland I learned that a MaCCRA member was an early leader in forming NaCCRA.
Friday, December 6, 2013
A recent issue of the ABA's Dispute Resolution Magazine (Fall 2013) included an article on "Elder Mediation: Coming of Age," authored by two mediation trainers, that tracks the growth of mediation for elder disputes in a variety of settings. The authors conclude: "Skilled, dedicated professionals can help parties find paths to agreements on some of the toughest and most emotional issues that families face."
Included within the article was a listing of elder dispute resolution resources:
- Alaska Court Program
- ABA Commission on Law and Aging
- Bet Tzedek
- Center for Civic Mediation, Elder Care Mediation Program
- Center for Dispute Resolution, Missouri State University
- Center for Social Gerontology
- Circuit Court of Cook County Elder Law & Miscellaneous Remedies Division
- Elder Decisions
- Elder Mediation Program of Mosaica Center for Consensual Conflict Rsolution
- Good Shepherd Elder Dispute Services Program
- LGBT Elder Care Intitiative
- Multi-Door Division of the Superior Court of the District of Columbia
- Northern Virginia Mediation Service
- Wise and Healthy Aging
Hat tip to my colleague at Penn State Dickinson, Professor Nancy Welsh, for sharing a copy of the issue. Nancy is co-chair for the editorial board for Dispute Resolution Magazine.
Tuesday, December 3, 2013
First Court Challenge FiledTo State Statute Restricting Assistance to Consumers Seeking ACA Coverage
Monday, December 2, 2013
At the heart of comparative research is the opportunity to rethink your own system. I was reminded of this point last week when meeting Claire Keatinge, the Commissioner for Older People in Northern Ireland (COPNI). Commissioner Keatinge is -- in a word -- dynamic, and it is impossible not to be impressed with her dedication to meeting the needs of older persons in her country. She is a leader, both actually and symbolically, for a hard-working team tackling a number of issues in ageing policy.
It is clear to me that "independence" is at the core of the role for the COPNI. What do I mean by independence? The COPNI is funded with public dollars, but the job includes making an independent evaluation of the needs and interests of the demographic, and then reporting and advocating for appropriate response by the government or other sectors. By comparison, I wonder whether state officers or offices charged with policy and laws in the U.S.are more likely to be serving a governmental agenda, and trying to sell that agenda to voters. This strikes me as a potentially important, if subtle, difference in systems.
A small example of the importance of independence: One of the COPNI's several goals is to identify and improve "uptake" of benefits available to older persons in the country. In Northern Ireland, and elsewhere in the U.K., there are official statistics on the dollars (whoops, I mean pounds) left on the table by individuals who fail to seek available public benefits or services. In N.I., there is a known gap. By comparison, I would be surprised to learn that we keep similar statistics on either the state or federal level in the U.S., much less have a policy of trying to reduce any gap.
Claire Keatinge also stressed that an individual assessment of need for health care, social care and security, should be exactly that, and not simply an assessment of what services are available. Helping individuals or their family members access services in the public, private and voluntary sectors is part of the COPNI plan of action, but, it strikes me that the emphasis on evidence-based policies may result in development of new services or better funding for existing programs.
Tuesday, November 26, 2013
From WBUR public radio in Boston Massachusetts, a story and podcast on "at-home funerals."
For a number of years I have invited an attorney with expertise in alternative funerals to speak to my classes. In fact, that is how I first learned that Costco carries urns and caskets (with a choice of standard or expedited shipping -- which strikes me as a trick question). As outlined by WBUR in the article, there is a surprising amount of freedom, if that is the right word, in the law of many states for families to choose informal funerals and burials.
Hat tip to Ann Murphy at Gonzaga Law for sharing this link. Our readers definitely are the key in helping to make this a "full service" blog!
Thursday, November 21, 2013
Somehow I had missed this particular incarnation of predatory lending. The National Consumer Law Center (NCLC) recently circulated a consumer impact statement on pension-based loan scams. Often advertised as "cash advances," in reality the individual is agreeing to assign future pension payments to the lender, with repayment terms that include an outrageously high interest rate. In 2011, NCLC and attorneys with the National Association of Consumer Advocacy were successful in a class action suit in state court in California, in which they challenged loans requiring "assignments" of military pay or pensions as violating federal law. The court ordered restitution to the class members.
The New York Times ran a 2013 feature on "Loans Borrowed Against Pensions Squeeze Retirees," by Jessica Silver-Greenberg, part of a series on "A Vulnerable Age," that examined financial traps that can face older adults, especially during a tight economy. A sidebar to the article detailed an example of a loan to a disabled military veteran for $10,000, with a $353 monthly payment for 60 months, leading to total costs over the life of the loan of $21,180, representing an interest rate of 36.4%.
Thursday, November 14, 2013
Via the Senate Special Committee on Aging:
If you or someone you know suspect you’ve been victim of a scam or fraud aimed at seniors, the U.S. Senate Special Committee on Aging has set up a new toll-free hotline to help. The hotline was unveiled today to make it easier for senior citizens to report suspected fraud and receive assistance. It will be staffed by a team of committee investigators weekdays from 9 a.m. to 5 p.m. EST. The investigators, who have experience with investment scams, identity theft, bogus sweepstakes and lottery schemes, Medicare and Social Security fraud, and a variety of other senior exploitation issues, will directly examine complaints and, if appropriate, refer them to the proper authorities.
Anyone with information about suspected fraud can call the toll-free fraud hotline at 1-855-303-9470, or contact the committee through its website, located at http://www.aging.senate.gov/fraud-hotline. As chairman and ranking member of the committee, Sens. Bill Nelson (D-FL) and Susan Collins (R-ME) have made consumer protection and fraud prevention a primary focus of the committee’s work. This year the panel has held hearings examining Jamaican lottery scams, tax-related identity theft, Social Security fraud and payday loans impact on seniors.
The hotline’s unveiling also coincides with the committee’s launch of an enhanced senior-friendly website. The site’s new features include large print, simple navigation and an uncluttered layout that enables seniors to find information more easily and conveniently. Online visitors can also increase text size, change colors or view a text-only version of the site.
Monday, November 11, 2013
The November 7 issue of the Chronicle of Philanthropy provides great coverage on the importance of Legal Aid organizations in disaster relief. But what first caught my eye were the photos that accompanied "A Nonprofit Pushes to Make Legal Aid Key Part of Disaster Services," by Nichole Wallace, depicting a mobile "Legal Help Center" operated by New York Legal Assistance Group.
The article explains:
"Less than a year old when [Hurricane Sandy] struck, the 41-foot vehicle is a joint project with the New York State Court's Access to Justice Program. The idea is to take legal services into neighborhoods to reach people who have trouble getting assistance because they lack transportation or child care, have a disability, speak little English, or fear coming into the office because of their immigration status.
The Mobile Legal Help Center can accomodate up to 17 people at a time, and has videoconferencing capabilities that allow access to judges for emergency proceedings, such as unlawful evictions and orders for protection in domestic-violence cases."
What a creative approach! And wouldn't mobile units be useful in providing legal services for older clients, with or without a natural disaster as the reason?
Monday, November 4, 2013
In a lengthy article, Pro Publica (in collaboration with Frontline) discusses quality of care problems along with the history of assisted living regulation. As an additional resource, Pro Publica also has developed a state-specific summary of key assisted living regulations.
In addition, California Advocates for Nursing Home Reform released a report on problems in California's assisted living facilities. The report's recommendations for reform include adoption of a tiered level of care system, annual inspections, and an on-line consumer information system.
The Assisted Living Consumer Alliance played a role in each of these examinations. ALCA board members Eric Carlson, Toby Edelman, Richard Mollot and Lori Smetanka each were quoted in the Pro Publica quality of care article. ALCA board member Jody Spiegel was part of the CANHR team that produced the report on California assisted living.
Friday, November 1, 2013
The theme of the recent LeadingAge national meeting was "Expanding the Possibilities." Consistent with that theme, at one of the general sessions, the speaker was Dan Pallotta, author of two books:
Uncharitable: How Restraints on Nonprofits Undermine Their Potential (Tufts Univ. Press 2008)
Charity Case: How the Nonprofit Community Can Stand Up for Itself and Really Change the World (Jossey-Bass Press 2012)
The presentation was both interesting and provocative, using Pallotta's experience in nonprofit fundraising and advocacy, to frame an argument that the nonprofit sector is functionally constrained by outmoded policies, thus inappropriately limiting effectiveness. His talk was organized around five points: Compensation, Advertising and Marketing, New Revenues, Time, and Risk.
Nonprofits are, of course, a huge segment of the long-term care, senior living and aging services industries. In fact, after teaching elder law and running an elder protection clinic, a few years ago I added a course on Nonprofit Organizations Law to my Penn State Law teaching package because of my growing appreciation for the importance of nonprofits.
Pallotta made the case that in analyzing the success of any nonprofit, it is wrong to focus narrowly on what percentage of a donation goes to services versus overhead. As he asks, what makes us think "overhead" is not an integral part of the cause? He urged a role for "charity defense councils" to counteract the image of nonprofits as mere handmaidens to a larger for-profit industry. He rejected an image that ties nonprofits to low wages or volunteer-only staffing.
Good food for thought, yes?
Thursday, October 31, 2013
Since 1999, Remembering When has been implemented in communities throughout North America to help thousands of older adults learn strategies to help them live safely at home for as long as possible. The program’s foundation remains the same: the 16 key safety messages–eight fire prevention and eight fall prevention–developed by experts from national and local safety organizations and focus group testing in high fire-risk states. The program will continue to be implemented through group presentations, home visits, and as part of smoke alarm installation and fall intervention programs. All of the revised training materials are available online.
“Over the next decades, the population of older adults will increase dramatically,” said Karen Berard-Reed, senior project manager for NFPA. “The new version targets adults who are just entering their older years. We hope to encourage these ‘younger’ older adults to develop important safety habits that will carry them through their senior years and help those around them develop safer behaviors.”
Representatives of fire departments and home visit agencies across the United States and Canada that have been chosen to participate in the Remembering When conference December 1-3, 2013 in Boston, will be the first trained with updated materials.
Photo by Kim Dayton. All rights reserved.
Part of my recent legal research and writing focuses on state regulation, accountability, and resident rights at Continuing Care Retirement Communities or CCRCs. In one of my early articles I wrote about what I thought might be a niche for elder law attorneys who could advise prospective CCRC residents about the ins and outs of CCRCs, particularly on contracting issues.
Turns out a Financial Planner and CPA have decided to make a business out of offering advice to consumers on CCRCs. Recently I had the chance to talk to Brad Breeding (the financial planner) and Ken Taylor (the accountant). The idea started when they were getting questions from clients about CCRCs near their base in North Carolina and realized there was a wider consumer market for critical information. In 2009 they started working on a web-based consulting tool for prospective CCRC residents and others who are thinking about retirement options.
The resulting company is LifeSite Logics, offering "a central database of objective data" about CCRCs across the country. Sounds like Brad and Ken have the start on a strong data set, and are already offering comparable data on several hundred CCRCs. The search price is about $40. Most important, the two seem determined to stay objective about their data points; they report they aren't backed by any CCRC operators or developers.
In addition, their LifeSite Logics website offers some free background and educational documents on CCRCS, including some information on contract (A, B, C or "other") types.
I have to say I've often thought "A, B & C" labels are potentially confusing to the public. This is especially true for the financial risks assoicated with "refundable fee" contracts which may look to the average consumer like "life-care" contracts that are usually associated with the "A" label, but are closer to "Type C" fee-for-service contracts when carefully analyzed. Further, these letters are not "grades" for the facilities or contract types, another point of potential confusion.
Good luck, Ken and Brad, on a promising start for what looks to be a very consumer-friendly product.
Monday, October 28, 2013
The fall meeting of the National Continuing Care Residents' Association (NaCCRA) in Dallas on October 27 was attended by CCRC residents from at least a dozen states, including Arizona, California, Connecticut, Florida, New Jersey, North Carolina, Oregon, Pennsylvania, Texas, Virginia, Washington, and D.C.
The morning workshop focused on "Imagining CCRCs of the Future," starting with round table discussions that identified 25 topics deemed important to the future of the industry, including planning for consumers who may have less financial resources while also seeking greater services; interest in building more diverse communities; and the importance of training for emerging leaders. From the broad list, the group identified 7 priorities for NaCCRA in the coming year and beyond, accompanied by specific action recommendations. Stay tuned!
In the afternoon, members of NaCCRA were part of a panel discussion on "Resident Engagement" led by Ron Herring, the President-Elect of NaCCRA. The panelists were Ellen Handler, President of ORANJ, the residents' organization in New Jersey; Marilyn Kennedy, Chief Operating Officer for Episcopalian Senior Communities in the San Francisco area, and Mary Ann Colwell, a resident at St. Paul's Towers, one of Episcopalian Senior Communities' CCRCs.
Handler presented highlights from successful advocacy on the part of the New Jersey group in achieving state legislation requiring resident membership on governing boards of CCRCs, and, most recently, mandating threshold rights for residents in "independent living." Kennedy and Colwell talked about the 10 year history of progress in their communities, building multiple pathways for residents to participate in the life of their communities, including working with provider representatives to plan for the future. Kennedy discussed the role of California state law that helped to frame the provider/resident discussions.
The audience included provider representatives. During the Q & A that followed the panelist presentations, the interaction generated observations about effective roles for residents on governing boards and key board committees (such as finance and quality), including success stories from communities. Several people remarked on the "process" of resident engagement, as it takes time for true engagement to become engrained as the culture of the community.
The NaCCRA meeting was part of the opening day action at the national meeting of LeadingAge, the national trade group for nonprofit senior living providers, which runs through October 29.
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Monday, October 21, 2013
On October 16, New Jersey Governor Chris Christie signed into law a detailed "Bill of Rights" for residents of New Jersey's Continuing Care Retirement Communities (CCRCs).
Key features of the law (S2052/A3132) include:
- clarification of the circumstances under which residents can be transferred from independent living to skilled care,
- the right for prospective residents to have at least 30 days to review mandatory disclosure statements before signing the admission agreement, and
- further specification of the state's right to enforce the law, including sanctions or fines.
The new legislation serves to amend New Jersey's Continuing Care Retirement Community Regulation and Financial Disclosure Act, N.J. Stat. Ann. Sections 52:27D-330 through 360. The law was first enacted in 1986, becoming effective in March 1987.
My first reading of the final legislation suggests it covers rights about which even the most paternalistic provider would agree.
ORANJ, the Organization of Residents Associations in New Jersey, was very active in raising resident concerns during the several year process that led to the bill's passage.
Hat tip to David Hibberson for keeping us up-to-date on New Jersey developments. Congratulations to New Jersey CCRC residents on their hard work.
Thursday, October 17, 2013
A company called CyberCycles sent me an advertisement recently. Normally I would resist promoting a product on our Blog, but I have to say that I enjoyed using these interactive cycles at university gyms while on my sabbatical, especially when avoiding the rains of Oregon and Northern Ireland. You could keep track of your results, compare them to other riders' times, and there were different "courses" for new challenges. I became quite fond of the competitive circuits on the interactive programs and found myself riding just a bit harder every session. (The photo here, howevver, is from a sunny day, watching the pros in Belfast. Yes, there are sunny days in Northern Ireland!)
As it turns out, there is research to support use of such "exergames," not just for the bodies but the brains of older adults, according to a study by the Healthy Aging and Neuropsychology Lab and Department of Psychology at Union College in Schenectady, New York. The article is "Exergaming and Older Adults Cognition: A Cluster Randomized Clinical Trial," by C. Anderson-Hanley and colleagues, published in the American Journal of Preventative Medicine, February 2012.
So, CyberCycles, do you still have the scary Abominable Snowman ride?
Tuesday, October 15, 2013
Thursday, October 10, 2013
Center for Medicare Advocacy Alert: Proposed Legislation Would Implement Home Health Episode Payment Caps
Caution: Home Health Episode Payment Caps Legislation was introduced on October 4th that could lead to a cap on the home health services available to a Medicare beneficiary. In the midst of a government shutdown, Representatives Matheson (D-Utah) and Guthrie (R-Kentucky) introduced the "Medicare Home Health Fraud Reduction Act" (H.R. 3245). This bill would establish maximum annual reimbursements to Medicare home health agencies. Instead of a payment cap for each beneficiary, such as the current annual cap on Medicare-covered outpatient therapy, this bill would impose an aggregate payment cap for each home health agency's caseload. While promoted as an anti-fraud measure that would have little impact on beneficiaries, to the contrary, the Matheson-Guthrie proposal is a dangerous policy that would create barriers to care for individuals with long-term, chronic conditions. Further, it would jeopardize implementation of the Jimmo v. Sebelius settlement. That settlement reiterates Medicare policy that medical improvement is not the deciding factor in determining the availability of Medicare-covered nursing and therapy services for persons with chronic conditions.
Over the past several years, legislators, think tanks, and other entities have offered policy proposals to reduce Medicare expenditures. Many of these proposals purport to save federal dollars by shifting additional costs directly to Medicare beneficiaries. Examples include: raising premiums for middle and higher income people; increasing deductibles and copays; prohibiting or discouraging the purchase of the most generous Medigap plans; and instituting copays (cost-sharing) for home health services. Many players potentially affected by proposals to reduce Medicare expenditures – including provider groups – act to thwart proposals that would adversely impact them. The home health industry opposes requiring copays on home health services, a position with which the Center for Medicare Advocacy strongly agrees. In an effort to ward off home health copays, elements of the home health industry have offered alternative proposals that could potentially save federal dollars by limiting the home health benefit for beneficiaries.
Friday, October 4, 2013
LeadingAge is holding its annual meeting in Dallas this year, October 27-30, with a very busy and interesting schedule of events, including educational workshops. The workshops and associated meetings offer a deep well of cutting edge information about aging services, relevant to both the industry and the public.
So what is LeadingAge? To use their words, it is an association of "6,000 nor-for-profit organizations" that provide services to seniors, persons with special needs, and their families. The history of the organization as advocates for aging service providers traces to 1961. For a number of years it was known as the American Association of Homes and Services for the Aging (AAHSA), recognized as a leading trade group for non-profit providers, especially on the housing side, including Continuing Care Retirement Communities, Assisted Living facilities, and Nursing Homes. AAHSA initiated a self study in 2008, and in 2011 announced its change of name to LeadingAge. As with any strong trade group, LeadingAge keeps a close eye on legislation, public finance, and policy developments, both at the national and state levels.
My experience is that with the name change came a broadening of the association's identity, including greater involvement by older persons as individuals, volunteers, consumers, and users of aging services.
Larry Minnix is the long-time head of LeadingAge, with deep experience in the industry of aging services.