Monday, September 7, 2015

"Safe Travels" (but, should you pass away, can I have your Frequent Flyer Miles?)

I hope everyone is lucky enough  to have a colleague such as Professor Laurel Terry here at Dickinson Law.  In addition to being the guru on regulation of lawyers, particularly for lawyers working across international borders, she's a good friend, organized, AND a guru of travel.  Whenever I have a travel question, I know she probably has sorted out the options and will have  great advice. 

So, I wasn't surprised on this holiday Labor Day weekend that she had considered "generational" travel issues, including whether you can devise or inherit "frequent flyer miles." 

Turns out you can ... depending.  Professor Terry pointed to this Smarter Travel blog, addressing which airlines have clear policies on inheritance.  You will want to look for your own favorite (least unfavored?) airline, but to summarize:  "In sum, American, Continental, and US Airways say "yes," Air Canada says "maybe," Jet Blue and United say "no way," and the others ignore the issue."

September 7, 2015 in Consumer Information, Current Affairs, Estates and Trusts, International, Property Management, Travel | Permalink | Comments (2)

Friday, September 4, 2015

ElderTech Comes to Boomer Homes?

We have had several prior blog posts about "eldertech", that is devices, etc. designed specifically for elders (whatever age that is).  The eldertech "boom" if you will has been spreading for a while to applications in homes to allow individuals to remain in their homes longer. Who wouldn't want a smart home!

If you missed this article in the Huffington Post, Huff/Post50 Blog take a few minutes and read it: Baby Boomers Are The First Tech-Savvy Retirees -- And Have The Home Renovations To Prove It. The article notes

Some 80 percent are interested in innovative ways of reducing their home expenses, such as using smart thermostats or apps to control appliances. Another 58 percent are interested in technologies to help maintain their home, such as cleaning robots or heated driveways, says David Baxter, a senior vice president with Age Wave, a research and consulting company that teamed with Merrill Lynch to gauge what retirees are doing with their living arrangements.


In fact, Baxter says 47 percent of home renovations -- about $90 billion a year -- comes from households 55 and above. Retirees are renovating their homes to make them safer as they age, but they're also trying to make their homes more attractive and versatile with the hope they can stay in them rather than move in with family or to an institutionalized setting when they are elderly.

What are the top 5 renovations? According to the article:

  • adding a home office
  • addressing the home's curb appeal
  • kitchen upgrades
  • the addition of safety features
  • renovation in multi-story homes to allow the owner to live on the first floor.


September 4, 2015 in Consumer Information, Current Affairs, Housing, Web/Tech | Permalink | Comments (1)

Wednesday, September 2, 2015

Seniors Who Cannot Make Ends Meet -- UCLA Documents "The Hidden Poor"

UCLA's Center for Health Policy Research has issued its August 2015 report on "The Hidden Poor," using county-by-county data to demonstrate that "federal" definitions of poverty are not a sufficient measure of true poverty for seniors.  What are the "hidden poor?"  The UCLA report explains:  "The Hidden Poor are defined as those who have incomes above 100 percent of the Federal Poverty Level (FPL), but who do not have enough income to make ends meet as calculated by the Elder Index."

A recent article in the Sacramento Bee highlights key components of the analysis: 

More than 300,000 elderly Californians are officially poor, as measured by the federal government, but their numbers triple to more than 1 million when the “hidden poor” are counted, according to a new study from UCLA’s Center for Health Policy Research.


National poverty guidelines say that for a single elderly adult living alone, the poverty line is $10,890 a year, but UCLA’s “elder index” puts it at $23,364 in California.


Those “hidden poor” Californians over 65 tend to be Latino or black. Their greatest concentrations are found in rural counties with overall low income levels, topped by Imperial County, where more than 40 percent of the elderly are the hidden poor....


The study said population groups with especially large proportions of the hidden poor include grandparents raising grandchildren, elderly with adult children living at home, and single elders.

Accurate measurements of poverty are core to planning of resources for any age group, including seniors.  How does your state account for needy seniors? 

Read more here:

September 2, 2015 in Consumer Information, Current Affairs, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Housing, Medicaid, Statistics | Permalink | Comments (0)

Tuesday, September 1, 2015

Guides from Disability.Gov

Wednesday, August 26, 2015

LegalZoom Touts "Legal Advice"

Traditional estate practice attorneys are facing ever-increasing competition from commercial sites offering document preparation for set fees, usually through use of on-line templates for wills and similar estate planning documents.  LegalZoom, Inc., the brainchild of attorneys, including Brian Lee and Robert Shapiro (of O.J. Simpson trial fame) and begun in 2001, is one of the biggest commercial document companies. 

Traditional lawyers point out that they provide not just "documents" but core counseling and advice about the larger issues that may be involved in proper estate planning.  Recently, however, I've noticed LegalZoom is also touting availability of "legal help" through its television commercials, with the tagline "Real Attorneys. Real Advice."  Here's a link to one recent example.   

The small print at the bottom of the page at the end includes full names and locations of the several attorneys who say "hi" during the television commercial, plus the following: 

"This is an advertisement of a prepaid legal services plan, not for an individual attorney. This is not an attorney recommendation or legal advice. No comparative qualitative statements intended.... For the attorneys' full addresses, a list of non-appearing attorneys and more information, please visit" 

Earlier this year, LegalZoom filed an antitrust lawsuit against the North Carolina Bar, asserting that the organization was "unreasonable barring" the company from offering a prepaid legal services plan in its state.  The suit cites the February 2015 decision by the U.S. Supreme Court in North Carolina State Board of Dental Examiners v. Federal Trade CommissionLegalZoom filed an amicus brief in that case outlining its theory that misuse of state bar regulatory authority to restrict access to legal advice harms consumers. 

August 26, 2015 in Consumer Information, Current Affairs, Estates and Trusts, Ethical Issues, Federal Cases, Legal Practice/Practice Management, Property Management, State Statutes/Regulations | Permalink | Comments (0)

Monday, August 24, 2015

20 Common Nursing Home Problems & How to Resolve Them

Justice In Aging has released an updated version of their guide, 20 Common Nursing Home Problems
and How to Resolve Them. Originally published in 2005, the guide has been updated and released in July, 2015. The guide is free and downloadable after registering your name, email address and indicating whether you are a professional or family member of a resident.  The guide is authored by Eric Carlson, a well-know leader in the field on representing residents of nursing homes. Eric is also the author of Long Term Care Advocacy, published by LexisNexis.

August 24, 2015 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing | Permalink | Comments (0)

Tuesday, August 18, 2015

Federal Court Applies "Doctrine of Reasonable Expectations" to Long-Term Care Insurance Policy

An interesting dispute is moving forward in federal court in California, involving interpretation of coverage under a long-term care insurance (LTCI) policy.   The case is Gutowitz v. Transamerica Life Insurance Company, (Case No. 2:14-cv-06656-MMM) in the Central District of California.   UPDATE: link to Order dated August 14, 2015. 

In 1991, plaintiff Erwin Gutowitz purchased a long-term care insurance policy, allegedly requesting the "highest level of long-term care coverage available," and presumably paying the annual premiums for more than 20 years.  Eventually, following a 2013 diagnosis of Alzheimer's, Erwin Gutowitz needed assistance, moving into an apartment at Aegis Living of Ventura, which was licensed in California as a "Residential Care Facility for the Elderly" (an RCFE).  With the help of his son as his designated health care agent, he then made a claim for long-term care benefits under his policy.  The claim was denied by Transamerica on the ground that the location was not a "nursing home" as defined in the LTCI policy.  

Insurers understandably prefer not to pay claims if they can avoid doing so.  In this case the insurer attempted to avoid the claim on the grounds that only certain types of facilities (or a higher level of care) were covered under this policy's "Daily Nursing Home Benefit." 

On August 14, 2015, United States District Judge Margaret Morrow issued a comprehensive (34 page) order, copy linked above, denying key arguments made by Transamerica in its summary judgment motions.

Continue reading

August 18, 2015 in Cognitive Impairment, Consumer Information, Dementia/Alzheimer’s, Ethical Issues, Federal Cases, Health Care/Long Term Care, Housing, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Thursday, August 13, 2015

North Carolina Appellate Court Ruling Permits "Membership Fee" in Condo-Continuing Care Contracts

Earlier this summer, a North Carolina appellate court reversed a trial court's finding that "membership fees" tied to condominium purchases in a retirement community were "unconscionable." In a class action suit filed by residents against Cedars of Chapel Hill LLC., this summer's ruling permits the defendant company to continue to market and sell its retirement condos as "fee simple" units  in combination with "continuing care member" contracts, although the court also remanded for a jury trial before the lower court.

In a highly technical ruling that examined state real estate transfer fee rules, the North Carolina's  marketable title act, and arguments under the common law about  unequal bargaining power, the appellate court rejected summary judgment in favor of the residents.  The court addressed allegations of both procedural and substantive unconscionability in the contracting process.  The court explained in part:

Substantive unconscionability “refers to harsh, one-sided, and oppressive contract terms.” … The terms must be “so oppressive that no reasonable person would make them on the one hand, and no honest and fair person would accept them on the other.” Brenner v. Little Red Sch. House Ltd., 302 N.C. 207, 213, 274 S.E.2d 206, 210 (1981). Plaintiffs, in raising this issue, contended that the fees in question were “exorbitantly high,” that the documents at issue were “decidedly one-sided in favor of the Company,” and that plaintiffs lacked “ability ... to negotiate any of the terms of the covenants and conditions in question in this case.” Plaintiffs further noted that the market for CCRCs in Chapel Hill is very small, leaving few alternatives.


…[W]e find plaintiffs' arguments unavailing. We recently held that “the times in which consumer contracts were anything other than adhesive are long past.” Torrence v. Nationwide Budget Fin., ––– N.C.App. ––––, ––––, 753 S.E.2d 802, 812 (quoting AT&T Mobility LLC v. Concepcion, –––U.S. ––––, ––––, 131 S.Ct. 1740, 1750, 179 L.Ed.2d 742, 755 (2011)), review denied, cert. denied, 367 N.C. 505, 759 S.E.2d 88 (2014). The mere fact that plaintiffs lacked the ability to negotiate contract terms does not create substantive unconscionability, nor does the fact that defendants were among the only providers of CCRC facilities. We hold that plaintiffs did not adequately demonstrate unconscionability as a matter of law, and that a genuine issue of material fact existed as to unconscionability, which precluded summary judgment.

For more of this ruling, see Wilner v. Cedars of Chapel Hill LLC., 773 S.E 2d. 333 (N.C. Ct. App., 2015).

For reactions from the parties' representatives, see NC Appeals Court Ruling Favors Cedars of Chapel Hill Condo Fees. 

For an additional, interesting discussion of business perspectives on retirement developer control, written prior to the most recent appellate court ruling, see Two Pitfalls of Leveraging Developer Influence, from a North Carolina law firm blog.

This case -- revealing the range of complexities in contracts for senior housing and services --  is another example of why I added "Contracts" law to my teaching package, with elder law!

August 13, 2015 in Consumer Information, Ethical Issues, Health Care/Long Term Care, Housing, Property Management, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Tuesday, August 11, 2015

Private Law Firms Pursuing State Suits Against Nursing Homes, Hired by AGs

Avenging angels or unholy alliance? A lawsuit filed by the New Mexico Attorney General in December 2014 against Preferred Care Partners Management Group, a large, privately held management company operating nursing homes in New Mexico and nationally, raises interesting questions about whether AGs should be teaming with private lawyers to pursue cases of alleged malpractice, abuse or fraud affecting consumers.  The  Plano, Texas-based defendant asserts that "lobbying" of state attorney generals by private firms to pursue questionable claims is improper, pointing to campaign contributions paid by law firms or individual lawyers, as well as contingent fee arrangements that defendants argue reduce the States' accountability.

The current New Mexico AG has defended his state's relationship with the Washington D.C. law firm of Cohen Milstein.  According to the Santa Fe New Mexican:

Current Attorney General Hector Balderas blasted back at the company through a spokesman. “Bilking taxpayers for inadequate care and denying helpless and vulnerable residents basic services will not be tolerated,” he said. “Our office will continue to aggressively protect New Mexico’s taxpayers and our most vulnerable populations.”

Currently, the New Mexico case is in federal court, following the defendant's removal from the original filing in state court.   The law suit -- and the issue of private/public partnerships in pursuing claims on behalf of consumers and/or taxpayers --  is generating a lot of attention in the business world. Recent coverage includes linked news stories by the New York Times, the Albuquerque Journal, and McKnight's LTC News.

August 11, 2015 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Cases, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink

Monday, August 10, 2015

Will "Single Seniors" Change the Face of Long-Term Living and Supports?

The Public Policy Institute (PPI) of California recently profiled demographic changes likely to affect that state in coming decades, including the impact of a projected increase, to 20%, of the proportion of the population aged 65+.  One especially interesting component is the impact of seniors who are likely to be "single," especially those without the assistance of  children, spouses, or other close family members, a trend that seems likely to be true nationwide. From PPI's report (minus charts and footnotes):

Family structures in this age group will also change considerably—in particular, marital status will look quite different among seniors in 2030 than it does today.... The fastest projected rates of growth are among the divorced/separated and never married groups. Between 2012 and 2030, the number of married people over age 65 will increase by 75 percent—but the number who are divorced or separated will increase by 115 percent, and the number who are never married will increase by 210 percent....


Another significant change will be in the number of seniors who have children. Those who have never been married are much less likely to have children than those who have been married at some point. As a result, seniors in the future will be more likely to be childless than those today.... In 2012, just 12 percent of 75-year-old women had no children. We project that by 2030, nearly 20 percent will be childless. Since we know that adult children often provide care for their senior parents, these projections suggest that alternative non-family sources of care will become more common in the future.

Thus, just as we're making noise about supporting seniors' preference to "age at home," we may be over-assuming that family members will be available to provide key care without direct cost to the states.  Hmmm.  That's problematic, right?

More from the California PPI report, including some conclusions: 

California's senior population will grow rapidly over the next two decades, increasing by an estimated 87 percent, or four million people.  This population will be more diverse and less likely to be married or have children than senior are today.  The policy implications of an aging population are wide-ranging.  We estimate that about one million seniors will have some difficulties with self-care, and that more than 100,000 will require nursing home care. To ensure nursing home populations do not increase beyond this number, the state will need to pursue policies that provide resources to allow more people to age in their own homes....


The [California In-Home Service & Supports] IHSS program provides resources for seniors to hire workers, including family members, to provide support with personal care, household work, and errands. One benefit of hiring family members is that they may provide more culturally competent care. Medi-Cal is already the primary payer for nursing home residents, and the state could potentially save money by providing more home- and community-based services that support people as they age, helping to keep them out of institutions. Finally, the projected growth in nursing home residents and in seniors with self-care limitations will require a larger health care workforce. California’s community college system will be a critical resource in training qualified workers focused on the senior population.

The San Diego Union-Tribune follows up on this theme in California Will Have More Seniors Living Alone, by Joshua Stewart.

August 10, 2015 in Consumer Information, Dementia/Alzheimer’s, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Retirement, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Friday, August 7, 2015

Pennsylvania Names Nursing Home "Quality of Care" Task Force

In the wake of devastating reports about poor accountability following inspections of nursing homes in Pennsylvania under a previous governor, plus a new civil lawsuit filed by the Pennsylvania Attorney General's office, the current Pennsylvania Secretary of Health has announced a state task force to study certain issues. 

According to the state press release, the task force "will be charged with identifying ways the department can advance quality improvement in Pennsylvania's long-term care facilities. The goal is to review current regulations and identify areas that the department may improve to ensure that nursing homes are operating at the highest level regarding the quality and safety of their residents."'

The Secretary's office indicates that in addition to "members of the Governor's Office, the secretaries of the Pennsylvania departments of Aging, Human Services, and State," appointed task force members include:

Jaqueline Zinn, PhD - Temple University (Business School)
Mary Naylor, PhD, FAAN, RN - University of Pennsylvania (Nursing, Gerontology)
Steven Handler, MD - University of Pittsburgh (Medical School, Biometric Informatics)
Rachel Werner, MD, PhD - University of Pennsylvania (Medical School, Quality of Care)
Dana Mukamel, PhD – University of California, Irvine (Public Health, Quality of Care)
David Grabowski PhD - Harvard University (Medical School, Health Care Policy)
Barbara Bowers RN, PhD, FAAN - University of Wisconsin (Institute of Aging, Long Term Care)
Pennsylvania State Senator Pat Vance 
Pennsylvania State Representative Mathew Baker

On the positive side, it is good to see non-Pennsylvanians appointed to the team, all with excellent credentials.  Perhaps on the less positive side, it seems to be a very large team, made up mostly of very prominent but busy "volunteers," two factors which in my experience can reduce efficiency. 

For news accounts of the potential political factors that may be play in this recent history, see here and related articles linked below. 

August 7, 2015 in Consumer Information, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Housing, State Cases, State Statutes/Regulations | Permalink

Thursday, August 6, 2015

Medicare 5 Star Rating System Now Available For Home Health Agencies

In July, CMS announced the release of its 5 Star Rating System for Home Health Agencies (HHA). According to an article in the Kaiser Health News (KHN),

[t]he ratings are based on agencies’ assessments of their own patients, which the agencies report to the government, as well as Medicare billing records. The data is adjusted to take into account how frail the patients are and other potential influences. Medicare intends to use the same or similar data sources when it eventually begins to pay bonuses and penalties to agencies based on performance, as it does for hospitals.

According to Medicare's blog, HHAs are rated in 9 categories, including wound care and prevention of bed sores, handling daily activities, controlling pain, and protecting the patient from harm. To learn more, click here to visit the HHA Compare website.

August 6, 2015 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Wednesday, August 5, 2015

PBS News Hour: Why Foreign Retirees Are Flocking to Mexico

In recent weeks, I've been doing background research on "cross-border retirement" issues and therefore I was interested to read that ElderLawGuy Jeffrey Marshall's brother has retired to Mexico and "loves it." 

For some, the reasons may include comparative costs for a range of services, including support for "independent" living, or more skilled care, as documented by the PBS News Hour program on "Why Foreign Retirees Are Flocking to Mexico." The program interviews retirees in central Mexican communities near Lake Chapala.  The program compares "average cost for independent living" in U.S. retirement communities of "about $2,500 per month, with one Mexican community's prices for "rent, all utilities, connections for internet, television ... plus three meals a day" at "just a little over $1,000 a month." 

But, as the program touches on (only briefly), Medicare benefits don't apply in Mexico (although, perhaps they should?).  And there are also important questions about reciprocity in care for Mexican retirees who may have spent many working years in the U.S.

August 5, 2015 in Consumer Information, Ethical Issues, Health Care/Long Term Care, Housing, International, Retirement | Permalink | Comments (0)

Tech Innovations Announced in Conjunction With the White House Conference on Aging

I was reading a blog post from Aging in Place Technology Watch which offered a roundup of tech announcements coming out of the 2015 White House Conference on Aging. I was intrigued by the UberAssist project which according to the announcement on Uber's website

Today, Uber will participate in the White House Conference on Aging and discuss Uber’s efforts to engage the senior community. At the event, we will announce the launch of a pilot program for community-based senior outreach. In cities across the country, Uber will offer free technology tutorials and free rides at select retirement communities and senior centers. Alongside public and private sector representatives, we hope to further the conversation about the way technology adoption can improve older adults’ day-to-day lives.

Uber has some projects going in Florida, for example, in Gainesville, Uber 

is working with the City ...  to offer on-demand transportation for residents of two senior centers as part of a six month program. Anytime a resident at a participating senior center needs a ride, he or she can request one at an even more affordable rate because of support from the city. Free technology tutorials will be available throughout, so residents of the participating centers can feel comfortable and at ease using Uber. Uber is also piloting a similar senior ride program in partnership with the Town of Miami Lakes.

I also was interested to learn about the announcement from Phillips about the AgingWell Hub which is

a unique new collaborative research and development initiative for open innovation that will  examine and share solutions for aging well. The initiative will identify new  technologies, products and services, as well as provide thought leadership in  collaboration with older adults, caregivers, healthcare systems, payers, policy  makers, corporate innovators, entrepreneurs and academia.  The AWH will also  seek solutions to improve technology adoption among older adults and make aging  well a reality for more people, by enabling them to better connect with their  communities and healthcare providers. 

You can read all of the WHCOA partner press releases and announcements here.

August 5, 2015 in Consumer Information, Current Affairs, Other, Web/Tech | Permalink | Comments (0)

Tuesday, August 4, 2015

Virtual Heartbreak

The New York Times ran a story on July 17, 2015 on how scammers are targeting older individuals on internet dating sites. Swindlers Target Older Women on Dating Websites tells the stories of several elders who ended up sending significant sums of money to scammers who had developed virtual relationships with these elders.  This high-tech version of the "romance con" has resulted in the legislature in at least one state, Vermont, to consider "pass[ing] a law requiring online dating sites to notify members quickly when there is suspicious activity on their accounts or when another member has been barred on suspicion of financial fraud." As well, the story explains, the proliferation of the virtual version of the romance con was the impetus for action from AARP.

Despite warnings, the digital version of the romance con is now sufficiently widespread that AARP’s Fraud Watch Network in June urged online dating sites to institute more safeguards to protect against such fraud. The safeguards it suggests include using computer algorithms to detect suspicious language patterns, searching for fake profiles, alerting members who have been in contact with someone using a fake profile and providing more education so members are aware of romance cons.

The AARP network recommends that from the beginning, dating site members use Google’s “search by image” to see if the suitor’s picture appears on other sites with different names. If an email from “a potential suitor seems suspicious, cut and paste it into Google and see if the words pop up on any romance scam sites,” the network advised.

On AARP's site, individuals can learn more about these digital romance cons, sign an on-line petition to dating sites to adopt safety measures, and learn 10 tips on how to spot a romance scammer and 5 tips to protect oneself from this "virtual heartbreak".

August 4, 2015 in Consumer Information, Current Affairs, Other, Web/Tech | Permalink | Comments (0)

Monday, August 3, 2015

Arizona Law Seeks Greater Accountability to Consumers for Home Care Companies

The Arizona Republic recently reported on Arizona legislation affecting home care agencies that will become effective in 2015, after a similar bill was vetoed in 2014 by a previous governor. According to news reports, the new law requires agencies to disclose to consumers whether they do background checks on employees, what type of training they use for employees, the costs of services and their hiring and firing practices.  

In my experience, such a "disclosure" focus is different than setting minimum substantive standards for home care, and puts a great deal of responsibility for evaluation of  "disclosed" information on consumers, who when it comes to long-term care, may already be under stress. 

From "New Arizona Law Requires Caregivers to Be More Transparent:"

"We want to help the consumer understand better and make an educated decision," said Mark Young, president of the Arizona In-Home Care Association (AZNHA) who helped press for passage of the bill. "A lot of times, clients get in crisis mode when they need to make these decisions because they don't know about the industry."


The bill, sponsored by Sen. Nancy Barto, R-Phoenix, passed unanimously in the Senate and by a 51-8 margin in the House. Gov. Doug Ducey signed the bill into law April 1.


Home-care service owners could be charged with a misdemeanor if their company does not comply with the new regulations, the attorney general's office said. But the law does not apply to volunteer caregivers and home-care service organizations already licensed by the state or federal government.

August 3, 2015 in Consumer Information, Ethical Issues, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)

New Report: Intellectual & Developmental Disability & Dementia

The Administration for Community Living (ACL) has posted a new report on its website. The July 2015 report was prepared by RTI International  pursuant to a contract with ACL. The report is titled IDD and Dementia. The executive summary explains in part:

The National Plan to Address Alzheimer’s Disease (2014) calls for a coordinated effort to develop workforces in aging, public health, and intellectual and developmental disabilities that are dementia-capable and culturally-competent. In response to this directive, the U.S. Administration on Community Living presents the findings and resources in this white paper to community of providers who primarily serve older adults. It provides a broad overview of the services and support system for persons with intellectual and developmental disabilities (IDD) affected by dementia and their caregivers, examples of cross-network initiatives, and resources for improving dementia care across agencies and organizations that serve this population.

This white paper presents the current state of services and support system for persons with IDD who have dementia. There is recognition in the aging and IDD networks that states are in a transition period where the future of services will be more person-centered and focused on integration in the community (see Appendix A).

The report is divided into 9 sections with section 4 looking at screening, diagnosis and treatment; section 5 looking at services and financing; and section 6 looking at efforts to improve community-based services.  Section 7, the conclusion, includes a brief discussion of 5 issues:

  • Is dementia awareness education available to the IDD population and service providers?
  • Do the information and assistance services in both the aging and IDD networks identify those individuals with IDD and dementia and their caregivers who contact them?
  • Are persons with IDD and dementia being referred for appropriate diagnosis?
  • Are program eligibility and resource allocations taking into account the impact of cognitive disabilities on an aging population of persons with IDD?
  • Are the dementia-capable home and community-based services available to the general population capable of serving persons with IDD and dementia?

The report is available here.

August 3, 2015 in Cognitive Impairment, Consumer Information, Dementia/Alzheimer’s, Health Care/Long Term Care | Permalink | Comments (0)

Friday, July 31, 2015

Which is More Terrifying? "Dying Early" or "Living Long" (and Doing Financial Planning Necessary for the Latter)?

The New York Times recently carried a column that probably hit home with many -- if, that is, one could bring oneself to read it.  While some people keep postponing "the conversation" discussion about how they want to die, there is plenty of evidence many people are also avoidant of conversations about financial planning for a long life. 

Educating consumers to be better purchasers seems a sensible idea, but an example from recent history illustrates the problem with that. For a long time, the simple investment advice given to consumers has been “buy an index fund.” Index funds are such standardized products — mirroring the Standard & Poor’s 500-stock index does not require much management — that just about all of them were initially low cost while offering wonderful diversification.


Consumers have been buying index funds, and the market has responded by providing hundreds of them. Nearly all E.T.F.s are index funds.


But the market has also responded by charging high fees for this standardized product. In 2004, Ali Hortacsu and Chad Syverson, economists at the University of Chicago, found that index funds had as much variability in fees as their more labor-intensive actively managed counterparts. And these fees are nothing to be scoffed at — paying 1 percent more every single year in fees can compound over a lifetime to noticeably lower returns.

For more on the problem with financial advice -- with encouragement to "face up to something [you too] may have been dreading," read Why Investing Is So Complicated, and How to Make it Simpler, by Sendhil Mullainathan. 

My thanks to Prof. Laurel Terry and Jack Bennett, Esq. for sharing this column.

July 31, 2015 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Estates and Trusts, Property Management, Retirement | Permalink | Comments (0)

Update on Family Caregivers

AARP''s Public Policy Institute has released a new report that provides an update on the topic of family caregivers. Valuing the Invaluable 2015 Update: Undeniable Progress, but Big Gaps Remain is 25 pages long and available as a pdf. As the introduction notes:

In 2013, about 40 million family caregivers in the United States provided an estimated 37 billion hours of care to an adult with limitations in daily activities. The estimated economic value of their unpaid contributions  was approximately$470 billion in 2013, up from an estimated $450 billion in 2009.

This report also explains the key challenges facing family caregivers…The report highlights the growing importance of family caregiving on the public policy agenda. It lists key policy developments for family caregivers since the last Valuing the Invaluable report was released in 2011. Finally, the report recommends ways to better recognize and explicitly support caregiving families through public policies, private sector initiatives, and research.

The report reviews progress in policies, programs and services at the federal and state levels since the previous report and makes over 20 policy recommendations in a number of categories.

To both address the growing care gap as the population ages and lessen the strain in the daily lives of caregiving families, more meaningful public policies and private sector initiatives are needed now. Better strategies will assist those who need care and their families struggling to find and afford the supportive services to live in their homes and communities—where they want to stay. It is essential to the well-being of our health care and LTSS systems, our economy, our workplaces, our families, and ourselves.

July 31, 2015 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (0)

Thursday, July 30, 2015

Hospital "Observation Status" Medicare Bill Goes to President Obama for Signature

The legislation carrying the name Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, that has now passed both the House and Senate, goes to President Obama for signature. If signed by the president, it will still be another year before its official effective date.

Sadly, it doesn't actually fix the problem for the patients with the fact that hospitals frequently attempt to hold patients on a fictional "observation only" status.  Money is  still the issue. Hospitals want to avoid harsh potential Medicare penalties associated with readmissions of "admitted" patients.  At the same time, the lack of "admitted status" reduces the ability of patients to seek Medicare coverage for rehabilitation care post-hospitalization.  But now the patients get better "notice" of their status -- and the potential for it to affect Medicare coverage and therefor out-of-pocket expense for the patients.

ElderLawGuy Jeff Marshall has posted a good blog review of the new law, supplementing his earlier coverage of the problems.  See his Observation Status Bill Heads to President's Desk

July 30, 2015 in Consumer Information, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)