Thursday, September 3, 2015
The Journal of Elder Abuse & Neglect (JEAN) is a great resource. It is the official journal of the National Committee for the Prevention of Elder Abuse (NCPEA). The Journal is published 5 times/year by Routledge. If you aren't familiar with JEAN, the website explains its purpose. It is:
the peer-reviewed journal that explores advances in research, policy and practice, and clinical and ethical issues surrounding the abuse, neglect and exploitation of older people. This unique forum provides state-of-the-art research and practice that is both international and multidisciplinary in scope. The journal’s broad, comprehensive approach is only one of its strengths — it presents research case studies, practice and policy issues, exploratory studies, commentary, and reviews on a wide range of topics designed to increase the knowledge base of scholars and professionals.
Recently JEAN's "editors' choice" article collection was posted online with free access! According to the website, "[t]hese articles were selected by the Journal of Elder Abuse & Neglect Editorial staff – Editor-in-Chief Karen Stein, PhD. and Associate Editor Sharon Merriman-Nai, MC – as key research to the field. Routledge Journals is pleased to offer FREE ACCESS to these articles until December 31, 2015." Subscription information is available here.
Third Circuit Rules Medicaid Applicants' Short-Term Annuities Are Not "Resources" Preventing Eligibility
In a long awaited decision on two consolidated cases analyzing coverage for nursing home care, the Third Circuit ruled that "short-term annuities" purchased by the applicants cannot be treated by the state as "available resources" that would delay or prevent Medicaid eligibility. The 2 to 1 decision by the court in Zahner v. Secretary Pennsylvania Department of Human Services was published September 2, 2015, reversing the decision (linked here) of the Western District of Pennsylvania in January 2014.
The opinion arises out of (1) an almost $85k annuity payable in equal monthly installments of $6,100 for 14 months, that would be used to pay Donna Claypoole's nursing home care "during the period of Medicaid ineligibility that resulted from her large gifts to family members"; and (2) a $53k annuity purchased by Connie Sanner, that would pay $4,499 per month for 12 months, again to cover an ineligibility period created by a large gift to her children.
The Pennsylvania Department of Human Services (DHS) argued that the transactions were "shams" intended "only to shield resources from the calculation of Medicaid eligibility." However, the majority of the Third Circuit analyzed the transactions under federal law's "four-part test for determining whether an annuity is included within the safe harbor and thus not counted as a resource," concluding:
Clearly, if Congress intended to limit the safe harbor to annuities lasing two or more years, it would have been the height of simplicity to say so. We will not judicially amend Transmittal 64 by adding that requirement to the requirements Congress established for safe harbor treatment. Therefore, Claypoole's and Sanner's 14-and 12-month contracts with ELCO are for a term of years as is required by Transmittal 64.
Further, on the issue of "actuarial soundness," the court ruled:
[W]e conclude that any attempt to fashion a rule that would create some minimum ratio between duration of annuity and life expectancy would constitute an improper judicial amendment of the applicable statutes and regulations. It would be an additional requirement to those that Congress has already prescribed and result in very practical difficulties that can best be addressed by policy choices made by elected representatives and their appointees.
The her short dissent, Judge Marjorie Rendell explained she would have affirmed the lower court's ruling in favor of DHS on the "grounds that the annuities ... were not purchased for an investment purpose, but, rather, were purchased in order to qualify for benefits." In addition, she accepted DHS' argument the annuities were not actuarially sound.
September 3, 2015 in Current Affairs, Estates and Trusts, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, State Statutes/Regulations | Permalink | Comments (0)
Wednesday, September 2, 2015
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?
Research shows that empowering individuals to actively participate in personal decision making improves life outcomes and can reduce the risk of abuse and exploitation. There is a risk of abuse and exploitation in all models of decision making for persons with differing abilities. An overly protective response to situations where a person with varying levels of capacity may be at risk can stifle self-determination and empowerment. Protection needs to be carefully balanced with protecting human and constitutional rights. Adults have a basic right to make choices, good or bad, and determine the course of their lives. An overly aggressive, or inappropriate protective response to limited capacity can itself be a form of abuse. This session will talk about recognizing the signs and signals of abuse, neglect (self-neglect) and exploitation, tools to maximize communication with persons with differing abilities, and promoting self-determination and choice through supported approaches that mitigate against risk and empower individuals. The session will explore the application of the Supported Decision Making model to assist persons in making choices, increase access to positive life outcomes, and reduce the risk of harm.
The webinar is free. To register click here.
Tuesday, September 1, 2015
While visiting in California this summer, I began following the dispute between University of California San Diego (UCSD), a public university, and University of Southern California (USC), a private university, over control of Alzheimer's research, originally known as the Alzheimer's Disease Cooperative Study. At first the outcome seemed predicted by judicial rulings favoring UCSD in a suit filed in San Diego courts. The most recent news coverage, however, suggests that what began with USC hiring away UCSD's top researcher, has continued with USC successfully luring away major funding. As reported in a San Diego Union-Tribune article:
While the La Jolla-based campus has so far won in court — with a Superior Court judge giving it continued control of the Alzheimer’s initiative — it is losing most of the contracts, money and trust of that program’s participants across the country.
USC said it has obtained eight of the project’s 10 main contracts after convincing sponsors that it is better suited to manage their clinical trials of experimental drugs and therapies for the neurological disorder. Those sponsors are defecting from the Alzheimer’s Disease Cooperative Study, or ADCS, and shifting to an institute that USC recently opened in San Diego....
UC San Diego confirmed the major setback, but said USC may be overstating matters by claiming that the contract transfers are worth up to $93.5 million. UC San Diego is still totaling its financial losses. Officials at the La Jolla school concede that they failed to tightly manage the Alzheimer’s program and allowed it to drift away from campus life. UC San Diego Chancellor Pradeep Khosla did not respond to requests for comment on the largest loss of research funding in the university’s history.
But campus officials said they are confident about rebuilding the Alzheimer’s program.
Pharmaceutical giant Eli Lilly was reported to be moving "millions" of dollars of research to USC control earlier this summer.
The USC Provost, while sounding very "corporate" in talking about USC's plans, is quoted as offering some consolation, with the possibility of working with UCSD in getting "back to being partners for better research."
Check out the guides available from Disability.gov. There are 14 guides available:
- Assistive and Accessible Technologies Guide
- Disability Benefits Guide
- Disability Rights Laws Guide
- Emergency Preparedness and Disaster Recovery Guide
- Employment Guide
- Family Caregivers Guide
- Federal Government Grants Guide
- Financial Help for Low-Income Individuals and Families Guide
- Health Information and Resources Guide
- Housing Guide
- Self-Employment and Starting a Small Business Guide
- Student Financial Aid Guide
- Student Transition Planning Guide
- Transportation Guide
Each guide contains a brief overview, links to begin, and further information.
Monday, August 31, 2015
The Pew Research Center on August 18, 2015 released the FactTank 5 facts about Social Security (the FactTank is "[r]eal-time analysis and news about data from Pew Research writers and social scientists."). So what are those 5 facts? Here you go!
Social Security touches more people than just about any other federal program.
Social Security is, and always has been, an inter-generational transfer of wealth.
Right now, Social Security has plenty of assets.
But since 2010, Social Security’s cash expenses have exceeded its cash receipts.
Social Security’s combined reserves likely will be fully depleted by 2034....
Oliver Sacks, neurologist and author (and much more more), often wrote about issues relevant to aging, including his own. Sadly he won't be able to continue to share his insights, as he passed away on August 30, at "just" 82 years. The New York Times reported the news here. But I think that perhaps the most important words come from Dr. Sacks himself, including those from a recent essay, "The Joy of Old Age (No Kidding)." Here are some words to live by:
At nearly 80, with a scattering of medical and surgical problems, none disabling, I feel glad to be alive — “I’m glad I’m not dead!” sometimes bursts out of me when the weather is perfect. (This is in contrast to a story I heard from a friend who, walking with Samuel Beckett in Paris on a perfect spring morning, said to him, “Doesn’t a day like this make you glad to be alive?” to which Beckett answered, “I wouldn’t go as far as that.”) I am grateful that I have experienced many things — some wonderful, some horrible — and that I have been able to write a dozen books, to receive innumerable letters from friends, colleagues and readers, and to enjoy what Nathaniel Hawthorne called “an intercourse with the world.”
I am sorry I have wasted (and still waste) so much time; I am sorry to be as agonizingly shy at 80 as I was at 20; I am sorry that I speak no languages but my mother tongue and that I have not traveled or experienced other cultures as widely as I should have done.
I feel I should be trying to complete my life, whatever “completing a life” means. Some of my patients in their 90s or 100s say nunc dimittis — “I have had a full life, and now I am ready to go.” For some of them, this means going to heaven — it is always heaven rather than hell, though Samuel Johnson and James Boswell both quaked at the thought of going to hell and got furious with David Hume, who entertained no such beliefs. I have no belief in (or desire for) any post-mortem existence, other than in the memories of friends and the hope that some of my books may still “speak” to people after my death....
At 80, one can take a long view and have a vivid, lived sense of history not possible at an earlier age. I can imagine, feel in my bones, what a century is like, which I could not do when I was 40 or 60. I do not think of old age as an ever grimmer time that one must somehow endure and make the best of, but as a time of leisure and freedom, freed from the factitious urgencies of earlier days, free to explore whatever I wish, and to bind the thoughts and feelings of a lifetime together.
Nunc demittis servum tuum, with our deep thanks and lasting memories.
Wednesday, August 26, 2015
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 legalzoom.com."
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 Commission. LegalZoom 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)
Recently I was listening to satellite radio while on the road, and caught a Fresh Air interview with Robert Price, celebrated author of hardscrabble crime fiction, including Clockers (2008)and his most recent novel The Whites (2015). Is it my imagination, or are "older adults" appearing more and more often in mainstream fiction and movies? Apparently a central character in The Whites is just such an "senior." In Price's interview, I was struck by the humor of his observations about how growing older himself has influenced his writing, but also about much his grandparents' lives affected his fiction. And I couldn't help but laugh when he observed that no one likes the "math" as you get older, although he is now the first to admit that "65 is the new 64." Here's a link to the 44 minute podcast with Terry Gross.
Tuesday, August 25, 2015
An interesting approach to the topic of aging faculties in higher education recently came across my virtual desk in the form of an advertisement for an upcoming webinar (with an interesting price tag to match). The title of the program is "Managing and Supporting an Aging Workforce," offered by Academic Impressions (a company I'm not familiar with) on November 15, 2015 from 1 to 2:30 p.m. EST.
The brochure advises "Given the nature of this topic, this online training is appropriate for human resources professionals, department chairs, deans, and senior administrators who deal with faculty and personnel issues."
Here's the description, which strikes me as charting a careful approach to helping (encouraging?) older faculty members make the decision to retire, without running afoul of age discrimination laws.
Experienced academic and administrative employees are the pillars for many institutions in higher education. However, with many faculty and staff members working well into their 60’s and 70’s, administrators face the challenge of supporting an aging workforce while having the appropriate policies and procedures in place.
Learn how to better balance the interests of your employees with the needs of your institution. This webcast will cover:
Laws governing discrimination and how to remain in compliance
Appropriate steps for dealing with diminishing capabilities
Performance reviews, policies, and procedures
Monday, August 24, 2015
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.
Today Ken Dychtwald (AgeWave) will appear on NPR/KQED’s Forum with Michael Krasny. The call-in program is set from 10-11 pdt. According to the email announcement I received from AgeWave, the program host and Mr. Dychtwald "will be candidly discussing Ken’s thoughts and personal feelings about what it means to be an aging expert who just turned 65. For the first time, Ken will publicly reflect on how he is both distressed and motivated by his own aging process and how his books, such as Age Wave, may or may not jibe with what he is now experiencing personally." Listen to the interview here: http://www.kqed.org/radio/listen/.
Can't make the live program? This is the link to where the interview will be archived:
Friday, August 21, 2015
The National Center on Elder Abuse (NCEA) announced their new blog supported by the USC Davis School of Gerontology Center for Digital Aging. The announcement of the NCEA blog provides the following information:
The National Center on Elder Abuse is proud to be producing a new series of blogs featuring expert opinions and diverse views in the field.
Each month, the blogs will focus on topics brought to us by the Elder Justice Roadmap. Themes will concentrate on practice improvement, education, policy and research.
The blogs will also address trending topics based on technical assistance inquiries and social media conversations.
News and resources surrounding our monthly themes will be disseminated on our Facebook and Twitter pages.
In addition, join us the third Thursday of every month for our Twitter chat series featuring national experts!
The blog is available here.
Wednesday, August 19, 2015
Kaiser Health News (KHN) ran a story Telephone Therapy Helps Older People In Underserved Rural Areas, Study Finds, that reports that "[t]herapy provided over the phone lowered symptoms of anxiety and depression among older adults in rural areas with a lack of mental health services.... The option is important, one expert said, because seniors often have increased need for treatment as they cope with the effects of disease and the emotional tolls of aging and loss."
The folks in the study suffered from generalized anxiety disorder. Fifty percent of the participants "received cognitive behavioral therapy, which focused on the recognition of anxiety symptoms, relaxation techniques, problem solving and other coping techniques." The remaining fifty percent received "less intensive phone therapy in which mental health professionals provided support for participants to discuss their feelings but offered no suggestions for coping." The results show that both groups benefited from the therapy but those in the first group did better.
There are roadblocks to using phone therapy, according to the article. "Medicare only pays for telehealth services done in rural areas with provider shortages; patients cannot do a phone call in their home, but must drive to a physician’s office or hospital to connect with the mental health professional at another site" according to a Professor quoted in the article. As well, some states require those who are providing "medical care must be licensed in the state where the patient resides."
The study, Telephone-Delivered Cognitive Behavioral Therapy and Telephone-Delivered Nondirective Supportive Therapy for Rural Older Adults With Generalized Anxiety Disorder was published in JAMA Psychiatry and is available here.
Monday, August 17, 2015
Money magazine ran an article recently about a new pattern in elder migration post-retirement. Seniors Are Seeking Out States Where Marijuana is Legal explains that "there is anecdotal evidence that people with health conditions which medical marijuana could help treat, are relocating to states with legalized marijuana,” quoting a UCLA professor of public policy. Using data from a moving company,
The Mountain West – including Colorado, which legalized medical marijuana in 2000, and recreational use in 2012 – boasted the highest percentage of people moving there to retire .... One-third of movers to the region said they were going there specifically to retire.
The article notes that marijuana is good for what typically ails elders, such as "[c]hronic pain, inflammation, insomnia, loss of appetite: All of those things are widespread among seniors" according to the deputy director of the National Cannabis Industry Association. The sales data show that a large portion of purchases is made by elder customers.
Thanks to my colleague and friend, Professor Mark Bauer, for telling me about this story.
Friday, August 14, 2015
At the 2015 White House Conference on Aging on July 13, 2015, during the discussion from the first panel on Empowering All Generations: Elder Justice in the Twenty-First Century, one panelist from Minnesota mentioned dementia-friendly communities and the Dementia-Friendly America initiative. Six cities were mentioned as examples. Minnesota has a website that offers many tools on making a community dementia-friendly or dementia-capable. A dementia-capable community is "[a] dementia capable community is informed, safe and respectful of individuals with the disease, their families and caregivers and provides supportive options that foster quality of life." The toolkit is available here.
Wednesday, August 12, 2015
The Pew Research Center released a map showing the aging of America by county. Where do the oldest Americans live? provides a map of the U.S. that shows the percentage of a county's population 65 and older. As the website explains, due to the aging of the Boomers and increased longevity,
more counties across America are graying. A new Pew Research Center analysis of the Census Bureau’s 2014 population estimates finds that 97% of counties saw an increase in their 65-and-older population since 2010.
On average, a U.S. county’s 65-and-older population grew by 12.4% from 2010 to 2014. (Our analysis of population change over time included only counties or county equivalents with a population of 1,000 or more adults ages 65 and older in 2014.)
And yes, Florida is still one of the "grayest" states, with 3 Florida counties ranking in the top 4 of the grayest counties. The report notes as well that some states are getting "younger" with
a tiny share of counties (3%) saw a drop in the 65-and-older demographic since 2010. Oklahoma’s small Alfalfa County, on the Kansas border, had the highest rate of decrease in the 65-and-older population, at 9.5%... North Dakota ... had two counties, Williams and Wells, rank among the top five for rate of decrease of adults 65 and older. Three counties experienced no change since 2010... Alaska is the “youngest” state based on its share that is 65 and older (9.4%). Fully 26 of 29 Alaska counties have percentages of people 65 and older that fall below the U.S. average.
Tuesday, August 11, 2015
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.
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
Friday, August 7, 2015
PBS ran a brief story in July as part of its Rundown blog regarding the variations in costs of long-term care by state. Long-term care costs vary greatly by state and type uses the Genworth 2015 Cost of Care Survey for the story. If you haven't reviewed the Genworth Survey results, do so. It's a useful tool for your students to understand the various costs of different types of long-term care.