Wednesday, August 10, 2016

Accessible National Parks: A Goal by 2020?

With summer winding down, and the fall semester bearing down on us, hopefully everyone had a fabulous summer. For many of us, summer vacation included a trip to a national park.  I was lucky enough to spend some time in the Rocky Mountain National Park. One day I was walking along an accessible trail, and noticed 4 folks using wheelchairs within the first 100 feet of the trail. This particular trail also offers an accessible campsite. That got me thinking about how many trails in national parks are accessible. That led me to an internet search  (yay Google) which led me to this report, All In! Accessibility in the National Park Service 2015-2020.  The report explains the creation of a task force on accessibility which developed a "strategic plan with specific strategies on how to make parks and programs accessible to a broader range of audiences. These strategies are focused on actions needed to build momentum, augment capacity, and accelerate real improvements over the next five years (2015–2020)." 

The parks are definitely not as accessible as they could be-or should be for that matter.  "[T]he National Park Service is underserving people with varying abilities and their traveling partners. Without accessible parks, the National Park Service loses an opportunity to reach the widest possible audience and share a spectrum of experiences. This lost opportunity is a direct failure to carry out our mission. Both long- and short-term solutions are needed to build momentum and advance the program."  The report sets out 3 goals for the NPS:

  1. "Create a welcoming environment by increasing the ability of the National Park Service to serve visitors and staff with disabilities."
  2.  "Ensure that new facilities and programs are inclusive and accessible to people with disabilities."

  3.  "Upgrade existing facilities, programs, and services to be accessible to people with disabilities."

 

 

 

August 10, 2016 in Consumer Information, Current Affairs, Other, Travel | Permalink | Comments (0)

Tuesday, August 9, 2016

Aging with Special Needs

Disability Scoop ran an article recently focusing on aging issues faced by those with special needs. Aging Poses New Challenges For Those With Special Needs explains the issues that will occur as individuals with special needs age, and need different or additional services.  "In 1983, the average life expectancy for a person with Down syndrome was 25. Today, it’s 65 to 70, fueled largely by the mastery of a surgical procedure that corrects a heart defect present in 1 out of 2 people with Down syndrome ...."  Of course, there are challenges to be overcome, including increasing services and bringing health care providers up to speed. "As the first generation of individuals with disabilities reaches ages not seen before, the medical community is still catching up. Most skilled nursing facilities are still made up of residents without disabilities, so people with disabilities may be better suited to an environment where caregivers are accustomed to taking their special needs into account." 

The article highlights the need to be forward-thinking and planning ahead.  Not everyone ages the same way at the same speed.  The article focuses on how a person with Downs syndrome might experience aging issues. The "interest in caring for people with disabilities who are aging has been of such concern that the [National Down Syndrome Society] compiled an “Aging and Down Syndrome” guide in 2013. Since then, the guide has been requested tens of thousands of times, in both English and Spanish ...."

August 9, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care | Permalink | Comments (2)

Sunday, August 7, 2016

Global Retirement Security Report: We're Number .... 14!

Investment News published a story about retirement security across the globe, and reports that the U.S. ranks #14.  U.S. comes in 14th in global ranking of retirement security reports on Natixis Global Asset Management's annual ranking. The article explains that Norway, Switzerland and Iceland came in 1, 2 and 3 respectively, while the U.S. finished at 14 out of 43.  According to the article, we did better in some categories, even breaking the top 10, for example, "No. 7, in the health care part of the index." But bummer, we were "No. 30 for life expectancy." But even more of a bummer, "[o]ne area in which the U.S. had an abysmal ranking was in its high level of income inequality, which helped drive it down to No. 37 of the 43 countries. The U.S. and Singapore share the dubious distinction of being the only countries in the top five for income per capita and in the bottom 10 for their large gaps in income equality." According to the article "Norway joins a number of top 10 countries in having a compulsory workplace savings program. It requires employers to fund private retirement accounts with 2% of a worker's earnings annually. That pales next to Australia, No. 6, where employers must kick in at least 9.5%. "

The full Natixis report is available here.

 

August 7, 2016 in Consumer Information, Current Affairs, International, Retirement | Permalink | Comments (0)

Thursday, August 4, 2016

Housing Resource for Elders

Legg Mason released a 142 page document on elder housing,  Aging & Its Financial Implications: Planning for Housing. The report was created "in collaboration with The Center for Innovative Care in Aging at the Johns Hopkins University School of Nursing, to bring [the reader] perspective, research and practical insights to assist [the reader] with the challenges of aging.  The document includes a discussion guide for determining one's housing needs, information about different types of housing, case studies, a check list, charts, graphs and data, resources and more. Why is thinking about housing important? Because, according to the report, "America is aging and everyone is affected by longer life expectancy. As advanced age approaches, people often need to shift the way they live and/or where they live to accommodate age-related discomforts and reduced capabilities. There are a number of trends that impact decisions related to housing during the years of retirement."

BTW, the company has more info on aging on its website, available here. I particularly liked the headline on the website about the housing document" "'NOW WHAT?' IS NOT A STRATEGY"

 

 

 

 

August 4, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing | Permalink | Comments (1)

Wednesday, August 3, 2016

Prisoners with Disabilities

We have blogged on several occasions about the graying of prisons. What about individuals in prisons who have, or develop disabilities? The Center for American Progress issued a report, Disabled Behind Bars: The Mass Incarceration of People with Disabilities in America's Jails & Prisons.   Here is an excerpt from the introduction

People with disabilities are thus dramatically overrepresented in the nation’s prisons and jails today. According to the Bureau of Justice Statistics, people behind bars in state and federal prisons are nearly three times as likely to report having a disability as the nonincarcerated population, those in jails are more than four times as likely. Cognitive disabilities—such as Down syndrome, autism, dementia, intellectual disabilities, and learning disorders—are among the most commonly reported: Prison inmates are four times as likely and jail inmates more than six times as likely to report a cognitive disability than the general population. People with mental health conditions comprise a large proportion of those behind bars, as well. The Bureau of Justice Statistics reports that fully 1 in 5 prison inmates have a serious mental illness. (Citations omitted).

The full report is available here.

 

August 3, 2016 in Consumer Information, Crimes, Current Affairs | Permalink | Comments (0)

Lifelong Housing

AARP's Livable Communities project published a recent article, How to Encourage More 'Lifelong' Housing.  The article explains a project that came out of southern Oregon, what is known as "The Lifelong Housing Certification Project."  The article explains this project:

A voluntary evaluation program, the Lifelong Housing Certification Project provides a way to assess the "age-friendliness" and accessibility of both newly constructed and existing homes..  the program includes a comprehensive checklist of features and defines levels of certification based on various universal design standards.

The certification is appropriate for all homes — rental apartments, new construction or existing houses — and is intended to help consumers and industry professionals choose the desired level of accessibility in buying, selling or modifying homes. The Lifelong Housing Certification Project helps the marketplace respond to a growing demand for accessible and adaptable homes that promote aging in place safely and independently. At the same time, the certification makes it easier for individuals of all ages to find homes that are suitable for lifelong living and promote the social and economic value of lifelong livability.   

The article explains the benefits and value, and the process for homeowners who wish to have their home "certified" (the owner receives a certificate, which can be provided, along with a "checklist to potential buyers. The certification may also be indicated on the local Multiple Listing Service in order to flag the home as being a "lifelong home" and alert potential buyers to ask the home seller or real estate agent for information regarding the home’s certification level.")  There are links at the end of the story for those readers who want to learn more.

August 3, 2016 in Consumer Information, Current Affairs, Housing | Permalink | Comments (0)

Tackling the Issue of "Avoidable Deaths" in Long-term Care Settings

Pennsylvania attorney Douglas Roeder, who often served as a visiting attorney for my former Elder Protection Clinic, shared with us a detailed Penn Live news article on what the investigative team of writers term "avoidable deaths" in nursing homes and similar care settings.  The article begins vividly, with an example from Doylestown in southeastern Pennsylvania:

Claudia Whittaker arrived to find her 92-year-old father still at the bottom of the nursing home's front steps. He was covered by a tarp and surrounded by police tape, but the sight of one of his slim ankles erased any hope it wasn't him.  DeWitt Whittaker, a former World War II flight engineer, had dementia and was known to wander. As a result, his care plan required him to be belted into his wheelchair and watched at all times. Early on Sept. 16, 2015, Whittaker somehow got outside the Golden Living home in Doylestown and rolled down the steps to his death.

 

"It wasn't the steps that killed him. But the inattention of staff and their failure to keep him safe," his daughter said.

The article is especially critical of recent data coming from for-profit nursing homes in Pennsylvania, pointing to inadequate staffing as a key factor:

In general, according to PennLive's analysis, Pennsylvania's lowest-rated nursing homes are for-profit facilities. Half of the state's 371 for-profit homes have a one-star or two-star rating – twice the rate of its 299 non-profit nursing homes.  The reason for that discrepancy, experts say, isn't complicated: Studies have found that for-profit nursing homes are more likely to cut corners on staffing to maximize profit.

Spokespeople from both the for-profit and nonprofit segments of  the industry are quoted in the article and they push back against the investigators' conclusions.  

I have to say from my own family experience that while adequate staffing in care settings is extraordinarily important, older residents, even with advanced dementia, often have very strong opinions about what they prefer.   My father is in a no restraint dementia-care setting, with a small cottage ("greenhouse") concept and lots of programming and behavioral interventions employed in order to avoid even the mildest of restraints. It was a deliberate choice by the family and my dad walks a lot around the campus and has his favorite benches in sunny spots. 

The trade-off for "no restraints" can be higher risk.  Residents, including my father, are sometimes stunningly adept at escape from carefully designed "safety"plans, such as those necessary in the summer heat of Arizona. Family members often remain essential members of the care team.  For example, this summer I plan my daily visits at the very hottest part of the day, in order to help try to lure my father, a late-in-life sunshine worshiper, back into the cool.  I watch the staff members exhaust themselves intervening with other ambulatory and wheelchair residents who are constantly on the move.

None of this "care stuff" is easy, but certainly the Penn Live article paints a strong picture for why better staffing, better financial resources, and more reality-based plans are necessary.  For more, read "Failing the Frail." Our thanks to Doug for sharing this good article. 

August 3, 2016 in Cognitive Impairment, Consumer Information, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Housing, Medicaid, Medicare, Property Management | Permalink | Comments (0)

Tuesday, August 2, 2016

HHS Guidance for Care in the Most Integrated Setting

Health and Human Services (HHS) Office for Civil Rights issued guidance in late May, 2016 for long term care facilities. The guidance, Guidance & Resources for Long Term Care Facilities: Using the Minimum Data Set to Facilitate Opportunities to Live in the Most Integrated Setting " is on using the minimum data set (MDS) so "residents receive services in the most integrated setting appropriate to their needs."

There are 3 recommendation sections  of the guidance (actually there are 4, but the 4th deals with further resources).  Why did OCR issue this guidance?

OCR has found that many long term care facilities are misinterpreting the requirements of Section Q of the MDS. This misinterpretation can prevent residents from learning about opportunities to transition from the facility into the most integrated setting. We are therefore providing a series of recommendations for steps that facilities can take to ensure Section Q of the MDS is properly used to facilitate the state’s compliance with Section 504 and to avoid discrimination.

The recommendations include a discussion of the importance of knowing about local resources and community based services, ensuring compliance with applicable civil rights laws ("[b]ecause Section Q is designed to assist residents in returning to the community or another more integrated setting appropriate to their needs, proper administration of Section Q of the MDS can further a state’s compliance with civil rights laws.") and the importance of maintaining up-to-date policies and procedures, and training employees.

 

 
 
 

August 2, 2016 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare | Permalink | Comments (0)

Sunday, July 31, 2016

Explaining Special Needs Trusts

Raymond James wealth management group has published a 5 page document for clients that explains special needs trusts.  Special Needs Trusts Providing for a Family Member with a Disability or Special Needs provides an overview of SNTs, the types of SNTs, how they work, and how they are managed. (I know that there are many such documents out there, and many are designed for the organization's clients.) I thought the graphics in this one were useful, so I'm passing on the info to you, for what it's worth.  (Full disclosure, one of our alums is the Chief Trust Officer for Raymond James). 

If you have run across any similar documents that you think are useful, let us know. After all, it's August, which means it is time for us to begin thinking about the beginning of the fall semester...and reading assignments for students.

 

July 31, 2016 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (0)

Friday, July 29, 2016

Partnerships for an Educated Work Force to Support Senior Living

My good friend (and former New York Administrative Law Judge) Karen Miller recently had successful hip replacement surgery and I was happily amused when I realized she wasn't home two hours before she was already corresponding with me about the latest hot topics in "aging."  Karen is a great example of an "active mind!"

Her latest communications focused on a topic I'd also been discussing recently with Stephen Maag, Esq., Director of Residential Communities for LeadingAge.   Steve had mentioned that one of the challenges facing senior living across the board was attracting an appropriately trained and stable work force.  

Karen pointed out to me that her CCRC (or, to use the latest label, Life Plan Community) in Florida was looking into partnering with a local high school and community college to provide financial support to students as well as site-based training in senior living.  For example, Certified Nursing Assistants or CNAs may often think of hospitals or "nursing homes" as primary employers, but Karen pointed out that active senior living communities may offer far more attractive opportunities for employment, while still needing workers, such as CNAs, with specialized skills . 

Karen pointed me to an article about a similar collaborative program in Maryland already under operation:

Thanks to a partnership with Ingleside at King Farm, a not-for-profit continuing care retirement community (CCRC) in Rockville, Maryland, students get first-hand experience in senior living and caregiving while residents enjoy participating in their education. And the partnership proves mutually beneficial, providing the CCRC access to a well-trained labor supply.

 

“Having a program like this exposes the younger generation to the health care field,” Adaeze Ikeotuonye, Ingleside at King Farm’s health care administrator, tells SHN. “Not many people in high school are necessarily thinking of working in the senior living industry, but bringing them in at such a young age and letting them see what the career possibilities are—that mixes up the dynamics.”

 For more about creative partnerships to deal with caregiver shortages, read Senior Housing News' "CCRC Helps Forge High School-to-Senior Living Career Path."  

Thanks to Karen for this link and best wishes for continued rapid recovery.

July 29, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Retirement | Permalink

Thursday, July 28, 2016

Medicare Part D 10 Essential Facts

Kaiser Family Foundation (KFF) published 10 Essential Facts About Medicare and Prescription Drug Spending on July 7, 2016. Here are some of the 10 facts, in no particular order.

  • "Medicare accounts for a growing share of the nation’s prescription drug spending: 29% in 2014 compared to 18% in 2006, the first year of the Part D benefit."
  •  "Prescription drugs accounted for $97 billion in Medicare spending in 2014, nearly 16% of all Medicare spending that year."
  • "Medicare Part D prescription drug spending – both total and per capita – is projected to grow more rapidly in the next decade than it did in the previous decade."
  • "As a result of the Affordable Care Act (ACA), Medicare beneficiaries are now paying less than the full cost of their drugs when they reach the coverage gap (aka, the “doughnut hole”) and will pay only 25% by 2020 for both brand-name and generic drugs."
  • "High and rising drug costs are a concern for the public, and many leading proposals to reduce costs for all patients – including Medicare beneficiaries – enjoy broad support."

To read all 10 facts and review the corresponding charts and explanations, click here.

July 28, 2016 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Wednesday, July 27, 2016

Do you know a Geriatrician?

If your answer is no, you don't know a doctor who specializes in geriatric medicine, then take heart, you aren't alone. One would think, with the sheer number of baby boomers aging away, that there would be a number of doctors specializing in geriatric medicine.  Kaiser Health Network (KHN) and West Virginia Public Broadcasting ran a story on July 13, 2016 about the lack of geriatricians.  Few Young Doctors Are Training To Care For U.S. Elderly  reports that West Virginia is 3rd in the country with a sizeable elder population, but only has 36 geriatricians practicing in West Virginia.   It's not just West Virginia, though, who needs more geriatricians.  "The deficit of properly trained physicians is expected to get worse. By 2030, one in five Americans will be eligible for Medicare, the government health insurance for those 65 and older."

The lack of geriatricians is not due to the lack of training programs in the U.S. "The United States has 130 geriatric fellowship programs, with 383 positions. In 2016, only 192 of them were filled." Why is this, you ask? According to the story, one reason may be the cost of a medical education and "they think that they need to get into something without the fellowship year where they can start getting paid for their work."  An audio of the story is also available here.

July 27, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

New Article: "Life, Death and Medicare Fraud: The Corruption of Hospice..."

Georgetown University's American Criminal Law Review recently hosted a symposium on health care fraud and one of the articles to come out of that program is by University of Alabama Law School Adjunct Professor James F. Barger, Jr. His article uses the 2013 criminal case of U.S. v. Kolodesh, which resulted in a "guilty verdict on all thirty five counts," to examine "the general trend of Medicare Hospice fraud enforcement actions."   The author reports:

The vast majority of False Claims Act hospice cases in which the United States has intervened have settled in favor of the United States without consideration by a jury, and every criminal hospice fraud prosecution by the United States to date has resulted in a guilty plea or a conviction by jury. Every such case—whether civil or criminal—was initiated by a whistleblower under the public-private partnership of the False Claims Act.

 

The FCA’s whistleblower provisions have been highly effective at detecting fraud and recovering misappropriated Medicare dollars, but deterrence and prevention remain unattained goals.

 

The calculated business decision to settle False Claims Act allegations has proven over time to have a neutral-to-positive effect on corporate profitability in the hospice sector. For-profit hospice giants such as SouthernCare and Odyssey, who have paid eight figure settlements, have rebounded quickly and actually gained position over their competitors.....

 

Nevertheless, while the whistleblower provisions of the False Claims Act have proven extremely effective at discovering hospice fraud and at recovering at least some of the lost Medicare funds, alone the statute has demonstrated very little deterrent effect. Outside of a legislative overhaul of the Medicare Hospice Benefit, the only effective deterrent scheme will be for enforcement officials to supplement their use of the civil False Claims Act with traditional criminal fraud statutes. For this to work, however, criminal penalties must be imposed not only on the relatively small-scale players, like Matthew Kolodesh and Home Care Hospice, but also on the mega hospice companies and their executives and owners.

For more, read "Life, Death and Medicare Fraud: The Corruption of Hospice and What the Private Public Partnership Under the Federal False Claims Act is Doing About It," published in the 2016 issue of the American Criminal Law Review.

July 27, 2016 in Consumer Information, Crimes, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Tuesday, July 26, 2016

As the Suburbs Gray....

My friend and colleague, Professor Mark Bauer sent me this recent article (thank you!) Can car-centric suburbs adjust to aging Baby Boomers?  We want to age in place, but neither or houses, or their locations, are always designed for us to do that.

In fact, the American suburbs, built for returning GIs and their burgeoning families, are already aging. In 1950, only 7.4 percent of suburban residents were 65 and older. By 2014, it was 14.5 percent. It will rise dramatically in the coming decades, with the graying of 75.4 million baby boomers mostly living in suburbia.

But car-centric suburban neighborhoods with multilevel homes and scarce sidewalks are a poor match for people who can’t climb stairs or drive a car.

“Most [boomers] are in a state of denial about what really is possible and what’s reasonable for them as they age,” said John Feather, a gerontologist and the CEO of Grantmakers in Aging, a national association of foundations for seniors.

Staying put is not without costs, and not just for retrofitting the house to make it accessible. Instead, the article notes,  "[r]etirees who want to stay in the suburbs will have to cover the rising costs of property taxes and utilities, and they may have to shell out big sums to retrofit their homes if they become frail or disabled. One study found that it can cost $800 to $1,200 to widen a doorway to accommodate a wheelchair, $1,600 to $3,200 for a ramp, and up to $12,000 for a stair lift. Major remodeling, such as adding first-floor bedrooms or bathrooms, can cost much more." 

Then of course, there is the issue of transportation. Out in the suburbs, we may not be able to walk to the stores and services we need, and some of us may no longer be able to drive.  Transportation is critical and we all know about Americans' love of automobiles.  So, what's the answer?

Even if a suburb has a regional transit system, the routes are often limited and geared to help commuters get to and from work in the city. The nearest bus or train stop may be miles from the subdivisions where aging boomers live. And while the Americans with Disabilities Act requires most public transit systems to provide pickup “paratransit” for people with disabilities who are unable to use regular bus or train services, that applies only to people who meet certain criteria.

One alternative is transportation services overseen by a federally funded network of local agencies that offer services and support to older adults to help them age at home and in the community. In many regions, these Area Agencies on Aging contract with local providers that offer door-to-door van services to older adults who qualify. But those programs, often geared to taking seniors to medical appointments and grocery stores, usually offer little flexibility and require clients to make reservations.

The article examines whether such an option will work for Boomers and what local governments need to do to prepare for this demographic change in suburbia.  Of course, some elders choose to move to communities that provide the services and amenities they want and the article discusses these briefly.

But what about transportation?  Doesn't that remain the elephant in the room?  So, off on a tangent...I read another article this morning about Uber selling passes in NY for ride-sharing. Lyft is partnering with GM so drivers can rent cars.   Are we going to see ride-sharing services as an option (or solution) for elders who have had to give up driving? But will this only be an option for those elders who can afford ride-sharing services?  I'm still hopeful about self-driving cars....

July 26, 2016 in Consumer Information, Current Affairs, Housing, Other | Permalink | Comments (0)

Monday, July 25, 2016

Who Spends Most on End of Life Care?

The answer might surprise you.  It turns out that the older the person, the less the person spends Kaiser Family Foundation reports in a recently released Medicare data note. Medicare Spending at the End of Life: A Snapshot of Beneficiaries Who Died in 2014 and the Cost of Their Care was published July 14, 2016.

Of the 2.6 million people who died in the U.S. in 2014, 2.1 million, or eight out of 10, were people on Medicare, making Medicare the largest insurer of medical care provided at the end of life. Spending on Medicare beneficiaries in their last year of life accounts for about 25% of total Medicare spending on beneficiaries age 65 or older. The fact that a disproportionate share of Medicare spending goes to beneficiaries at the end of life is not surprising given that many have serious illnesses or multiple chronic conditions and often use costly services, including inpatient hospitalizations, post-acute care, and hospice, in the year leading up to their death. (footnotes omitted)

The authors examine the data on a number of points, with explanations and corresponding charts. Among their findings

Our analysis shows that Medicare per capita spending for beneficiaries in traditional Medicare who died at some point in 2014 was substantially higher than for those who lived the entire year, as might be expected. It also shows that Medicare per capita spending among beneficiaries over age 65 who die in a given year declines steadily with age. Per capita spending for inpatient services is lower among decedents in their eighties, nineties, and older than for decedents in their late sixties and seventies, while spending is higher for hospice care among older decedents. These results suggest that providers, patients, and their families may be inclined to be more aggressive in treating younger seniors compared to older seniors, perhaps because there is a greater expectation for positive outcomes among those with a longer life expectancy, even those who are seriously ill.

In addition, we find that total spending on people who die in a given year accounts for a relatively small and declining share of traditional Medicare spending. This reduction is likely due to a combination of factors, including: growth in the number of traditional Medicare beneficiaries overall as the baby boom generation ages on to Medicare, which means a younger, healthier beneficiary population, on average; gains in life expectancy, which means beneficiaries are living longer and dying at older ages; lower average per capita spending on older decedents compared to younger decedents; slower growth in the rate of annual per capita spending for decedents than survivors, and a slight decline between 2000 and 2014 in the share of beneficiaries in traditional Medicare who died at some point in each year.

The report is also available as a pdf here.

July 25, 2016 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Sunday, July 24, 2016

New article: Retirement Account Planning

Stetson Law Elder Law LL.M. alum and president of NELF, Amos Goodall, sent me the link to his most recent article. Retirement account planning can greatly benefit descendants.

The article opens

Many folks have large retirement accounts. According to the Investment Company Institute 2016 Yearbook, in 2015, members of 60 percent of U.S. households had invested $24 trillion in retirement market assets, including individual retirement accounts, 401(k)s, 403(b)s, simple IRAs and others. This article discusses IRAs, and someone with any others should consult legal and financial advisers. In fact, every general rule stated in this article is subject to exceptions, and there may also be specific situations where these rules should be purposefully ignored. This article should be considered as simply a guide for asking questions of your adviser, rather than a road map for do-it-yourself action.

Congratulations Amos and thanks for bringing the article to our attention!

July 24, 2016 in Consumer Information, Current Affairs, Retirement | Permalink | Comments (0)

Thursday, July 21, 2016

Progress on End of Life Care?

The National Academy of Medicine (NAM) held a meeting in late May, 2016 to update progress since the release of the major report on Dying in America. NAM "hosted “Assessing Progress in End-of-Life and Serious Illness Care,” a private working meeting for stakeholders to assess progress since the September 2014 release of Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life."  The meeting recap is available here. The recap includes transcripts of remarks and discussions as well as slides if used by presenters. The focus of the day was on 5 topics that included "(1) delivery of person-centered, family-oriented care; (2) clinician-patient communication and advance care planning; (3) professional education and engagement; (4) policies and payment systems; and (5) public education and engagement."  After breakout sessions,"participants generated 3-5 top priority action items in each area .... [which] will inform the strategic planning of a new Roundtable on Quality Care for People with Serious Illness at the National Academies of Sciences, Engineering, and Medicine (the Academies)."

July 21, 2016 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink | Comments (0)

Wednesday, July 20, 2016

More on Physician-Aided Dying

I wanted to make sure you didn't miss these developments.

First, Colorado voters in November may see a ballot initiative on physician-aided dying.  Proponents are collecting signatures according to an article in the Denver Post, Right-to-die initiative headed for Colorado’s November ballot. It's not a slam-dunk however. The article notes that there is opposition to the proponents efforts to place the initiative on the ballot.  Proposed legislation failed previously. Stay tuned.

Second, in case you missed it, on June 30, 2016, the New Mexico Supreme Court issued its ruling in Morris v. Brandenburg,  a physician-aided dying case that has been making its way through the appeals process.  The court held "we decline to hold that there is an absolute and fundamental constitutional right to a physician’s aid in dying and conclude that Section 30-2-4 is not  unconstitutional on its face or as applied to Petitioners in this case." The court relied heavily on the U.S. Supreme Court opinion in Washington v. Glucksberg and found no specific reasons under the NM Constitution to depart from that precedent since physician-aided dying is not a fundamental right.  Here's an excerpt from the opinion:

New Mexico, like the rest of the nation, has historically sought to deter suicides and to punish those who assist with suicide, with limited exceptions in the HCDA and the Pain Relief Act. However, these exceptions occurred as a result of debates in the legislative and executive branches of government, and only because of carefully drafted definitions and safeguards, which incidentally are consistent with the safeguards urged by Petitioners. Numerous examples of such definitions and safeguards exist in the UHCDA. In addition to those previously identified in paragraph 35 of this opinion, the following reflect other safeguards relevant to our analysis... These and other provisions of the UHCDA further many of the government interests recognized by the Glucksberg Court as unquestionably legitimate, and which made Washington’s ban on physician aid in dying reasonably related to their promotion and protection…Indeed, if such exceptions and carve-outs to the historical national public policy of deterring suicide properly exist, they are certainly borne of the legislature and not the judiciary.

A summary of the opinion appeared in the July 13, 2016 eBulletin (full disclosure-I'm one of the editors).

July 20, 2016 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Tuesday, July 19, 2016

Register Now for the 18th Annual National Conference on Special Needs Trusts

Registration is now open for Stetson's 18th annual National Conference on Special Needs Planning and Special Needs Trusts (full disclosure-I'm the conference chair).  The program is scheduled for October 18-20. October 18th has 2 pre-conferences, one on tax issues and one on pooled SNTs. The National Conference starts on October 19th with general sessions on both mornings and break-out sessions in the afternoons. Afternoon sessions offer 3 tracks: basics, administration and advanced.  For more information, click here.  Registration information is here.

July 19, 2016 in Consumer Information, Current Affairs, Programs/CLEs | Permalink | Comments (0)

Monday, July 18, 2016

Coach Pat Summitt

We were all saddened at the news of  Coach Pat Summit's death from early-onset Alzheimer's at the age of 64.  I found this article in the Washington Post  so moving that I wanted to share it with you. You should read it and encourage your students to read it as well.  Pat Summitt’s last great gift was sharing her fight with Alzheimer’s is more than just a tribute to Coach Summitt. It's also a call-out on how we treat people with cognitive decline and how we need to improve our actions.  Here's an excerpt from the article:

Pat was just one of four people I know with dementia, and from what I’ve seen, across the board, Alzheimer’s care is a national scandal in our midst, yet few are willing to address it, because it’s just too distressing.

When a friend or family member is diagnosed, this is what you quickly learn: Once-brilliant people who still have vast reserves of brain cells are discounted, forced into retirement, and many are warehoused in facilities where the food is patently awful and the most meaningful activity is bingo. And we wonder why they decline so swiftly. Their care is infantilizing and schedule-oriented, with full-grown adults fed at 6 and forced to bed at 8, and when they can’t communicate as they used to we lack the imagination to try to find other ways to reach them, so their pain or discomfort often goes unaddressed, leading to interactions that, as Stettinius says, “exhaust, frustrate, and deplete everyone involved.” Creative new forms of care that can enhance quality of life — art, poetry, music and animal therapies for Alzheimer’s patients — are the rare exception. Ignorance about the disease is the rule. We give lip service to preserving dignity but devote precious little thought to the fact that the quickest way to rob someone of that dignity is to tell them what time to go to bed.

Use this in class for a discussion on how to support an individual's autonomy and how we can do better for people with Alzheimer's.

 

July 18, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s | Permalink | Comments (1)