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)

Sunday, July 17, 2016

Fall Prevention: Personal Attention vs. Assistive Alerts?

Do alarms lead nurses in SNFs to interact less with residents? Do the alarms help prevent falls? According to a New York Times article from July 2, 2016,  there is a movement away from "things" to help with falls and toward an emphasis on human care.  Nursing Homes Phasing Out Alarms to Reduce Falls explains there is "a nationwide movement to phase out personal alarms and other long-used fall prevention measures in favor of more proactive, attentive care. Without alarms, nurses have to better learn residents' routines and accommodate their needs before they try to stand up and do it themselves." Over time prevention moved from restraints to alarms, floor mats, etc. and now prevention is moving from those to personal attention. This change is based on " a growing body of evidence indicates alarms and other measures, such as fall mats and lowered beds, do little to prevent falls and can instead contribute to falls by startling residents, creating an uneven floor surface and instilling complacency in staff."  

According to the article there are those who are still using alarms and it will take some time for the change to be more widespread. As one expert noted in the article, using an alarm doesn't prevent a fall. "Going alarm-free isn't yet possible for every nursing home, but it's generally becoming a best practice as nursing facilities work to create the most home-like setting for people who live there, according to John Sauer, executive director of LeadingAge Wisconsin, a network of nonprofit long-term care organizations." As one expert noted in the article, using an alarm doesn't prevent a fall.

It seems that more personal care will be a great thing-but will the facilities have enough staff to help residents? We'll have to wait and see...

July 17, 2016 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing | Permalink | Comments (0)

Thursday, July 14, 2016

Neglected to Death

My local paper ran a story recently about a vulnerable adult who was neglected to death.  66-year-old Gulfport woman dead after police say she was neglected by caretakers  reports that "[t]he caretakers told police they moved out of the apartment eight to 10 days before the woman's death. That left her alone, police said, with little ability to care for herself." A follow up story, Gulfport police: 66-year-old woman left to die in squalor and heat,  reports that the caregivers went back daily to check on her, saw her getting worse, but took no action to help her.  Both caregivers were jailed and "facing a felony charge of abuse or neglect of an aged or disabled person."

July 14, 2016 in Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship | Permalink | Comments (0)

Wednesday, July 13, 2016

Telemarketing Sales Rule Protections Against Scammers

Good news for consumers! The Federal Trade Commission (FTC) announced on June 27, 2016 that the telemarketing sales rule (TSR) prohibitions went into effect in June.

The changes to the TSR will stop telemarketers from dipping directly into consumers’ bank accounts through checks and payment orders that have been remotely created by the telemarketer or seller. Since they’re remotely created, they’re never actually signed by the account holder – and that makes it easy for telemarketers and sellers to dip directly into consumers’ bank accounts. And it’s then hard to reverse the transactions with consumers’ banks (again, a reason why con artists love using these methods).

In addition, with the updated rule in place, telemarketers now can’t get payments through traditional cash-to-cash money transfers – the type provided by companies like MoneyGram and Western Union. Scammers use these cash transfers as a quick, anonymous, and irrevocable way to get money from consumers. Once the seller picks up the transfer, the money is gone.

The TSR changes also prohibit telemarketers from accepting as payment cash reload PIN numbers. That means no requests for payment by using MoneyPak, Vanilla Reload, or Reloadit packs, used to add funds to existing prepaid cards. Because scammers use the cash reload PIN numbers to apply the funds to their own prepaid debit cards – and disappear with the money. Except not anymore, under the updated TSR.

Good news all around for consumers! More information for businesses about complying with the TSR is available here.  Thanks to blog reader Mike Polk for alerting me to this update!

 

July 13, 2016 in Consumer Information, Crimes, Current Affairs, Other | Permalink | Comments (0)

Tuesday, July 12, 2016

Register Now: Hot Topics In Elder Law Webinar

Stetson Law (full disclosure-my school) offers a new webinar on Tuesday July 19 at noon edt. This first Hot Topics in Elder Law webinar covers the subject of nursing home resident discharge. The Right or Wrong Way? Involuntary Discharge of Nursing Home Residents is a 90 minute webinar.  Here is a description about the webinar

 A recent AP story suggested that "Nursing homes are increasingly evicting their most challenging residents." Nursing home owners assert that the homes are following the discharge rules and more importantly protecting vulnerable adults from violent residents. This interactive debate will feature advocates from both sides of the issue. 

Moderated by Professor Roberta  K. Flowers, the debate will feature Eric Carlson, directing attorney of  Justice in Aging in Los Angeles, California, and Sheila Nicholson, who specializes in nursing home defense and is a partner at Quintairos, Prieto, Wood & Boyer P.A., in Tampa, Florida.

Registration information is available here.

July 12, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Programs/CLEs, Webinars | Permalink | Comments (0)

Monday, July 11, 2016

End of Life Care-Does the Illness Make a Difference?

JAMA Internal Medicine ran an article about a study concerning quality of care in end of life, looking specifically at the illnesses. Quality of End-of-Life Care Provided to Patients With Different Serious Illnesses was published on June 26, 2016.  According to the abstract, "[e]fforts to improve end-of-life care have focused primarily on patients with cancer. High-quality end-of-life care is also critical for patients with other illnesses." The authors wanted "[t]o compare patterns of end-of-life care and family-rated quality of care for patients dying with different serious illnesses."  The study offers several findings, including:

In a large national cohort of nearly all patients dying in VA inpatient facilities, we observed important differences in the end-of-life care received by individuals with different illnesses. Overall, we found that diagnosis was significantly associated with the quality of end-of-life care as measured both by family surveys and by several established measures of quality of end-of-life care. Patients with end-organ failure and frailty generally received lower-quality end-of-life care than did patients with cancer or dementia. (citations omitted).

After discussing their findings, the authors conclude

While there is room for improvement in end-of-life care across all diagnoses, family-reported quality of end-of-life care was significantly better for patients with cancer and those with dementia than for patients with ESRD, cardiopulmonary failure, or frailty. This quality advantage was mediated by palliative care consultation, do-not-resuscitate orders, and setting of death. Increasing access to palliative care and increasing the rates of goals of care discussions that address code status and preferred setting of death, particularly for patients with end-organ failure and frailty, may improve the quality of end-of-life care for Americans dying with these conditions.

The article is free and is available here.

July 11, 2016 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink | Comments (0)

Sunday, July 10, 2016

Catastrophic Insurance for Long-Term Services & Supports?

In early June, the Urban Institute released a brief that examines whether  Catastrophic Insurance Improve Financing for Long-Term Services and Supports. The abstract explains

A catastrophic insurance program could improve the way long-term services and supports are financed. The program would require enrollees who need care to wait a few years before they could collect benefits, but then it would provide those benefits as long as necessary. Our modeling results show that such a program could reduce Medicaid spending and provide financial relief to hard-pressed states. It could also reduce out-of-pocket spending for families facing catastrophic costs and fund new services and supports. By setting aside funds to cover future spending, a catastrophic insurance program could also raise national saving.

As we well know, paying for long-term care is a challenge for many. As the authors note, "[c]urrently, most people with LTSS needs rely mostly on unpaid family caregivers for assistance. If they need more help, they generally pay out of pocket until they exhaust their financial resources and then turn to Medicaid. New financing approaches could combine public insurance for catastrophic LTSS costs with initiatives to promote private long-term care coverage for other expenses. Our projections suggest that these options could significantly reduce Medicaid spending and provide better financial protection for older people who develop LTSS needs."

Looking at the ways long-term care is financed by many, the authors consider whether an insurance model might be the answer

New LTSS insurance programs could provide better financial protection to people with disabilities; improve the care they receive; and reduce Medicaid costs, which are creating financial problems for many state governments. By setting aside funds today to cover future LTSS spending, new insurance programs could raise national saving. And they could provide families with stronger incentives to save by reducing reliance on Medicaid, which discourages saving because it only pays benefits to people with virtually no wealth outside of their home. The effectiveness of any new insurance program, of course, depends on its particular features, such as eligibility requirements, the size of the daily benefit, and the financing mechanism.

The authors examine a few models to gauge their workability and conclude

An LTSS catastrophic insurance program that requires enrollees with LTSS needs to wait a few years before collecting benefits but then extends those benefits as long as necessary could substantially improve the way LTSS needs are financed in the United States. Such a program could reduce Medicaid spending, providing financial relief to hard-pressed states. It would also reduce out-of-pocket spending for families facing catastrophic costs and fund new services for older adults with LTSS needs, although these impacts would be somewhat smaller than those from a similar-sized program that provided front-end, but time-limited, benefits. By setting aside funds today to cover future LTSS spending, a new catastrophic insurance program could raise national saving. And it could provide families with stronger incentives to save by reducing reliance on Medicaid, which discourages saving because it only pays benefits to people with virtually no wealth outside of their home. 

Program details need further analysis. We modeled only a few options, and alternative designs could have different effects. For example, a new insurance program could provide larger daily benefits, which would reduce Medicaid and out-of-pocket spending more than the plan we modeled but would also require more funding. Or new programs could require enrollees to wait even longer to receive benefits than the program we modeled, which would offset less Medicaid and out-of-pocket spending but cost less. Our research is only the first step in the analysis required to design new LTSS financing programs, but it illustrates the potential power of our simulation tool in demonstrating how new options can interact with existing programs.

 

July 10, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Medicaid, Medicare | Permalink | Comments (0)

Thursday, July 7, 2016

Consolidation of Long-Term Services & Supports-What if?

Our good friend and prolific author, Professor Marshall Kapp, let us know about his most recent article, Speculating About the Impact of Healthcare Industry Consolidation on Long-Term Services and Supports.  The article is published as the lead article in volume 25, issue 2 of the Annals of Health Law.   Here is the abstract of the article

The current health industry consolidation movement promises to exert an important and powerful array of effects on numerous different population groups seeking or receiving health services in a variety of different health care settings. Particularly regarding the potential impact of health industry consolidation on individuals contemplating, seeking, or obtaining long-term services and supports (LTSS), little is yet known but much may be plausibly speculated. This article joins in that speculation, but attempts to advance the constructive consideration of the topic by offering some suggestions for a research agenda to investigate specific empirical questions about consolidation’s impact on LTSS and thereby generate evidence and knowledge that can be used to either reduce or prevent negative aspects of consolidation for LTSS, on one hand, or foster and facilitate the achievement of positive effects, on the other.

Professor Kapp concludes:

The current, and probably continuing, consolidation of health services providers, producers, and sellers of healthcare products, as well as third-party payers for health services and products, inevitably will exert a variety of impacts on healthcare consumers generally and within specific contexts. Actual and potential consumers of LTSS, as well as their families, are likely to be affected in unique ways, differing to a large extent depending on the way that respective groups of consumers now finance their own LTSS. Little significant data is available yet regarding such effects, but speculation nonetheless abounds. This article joins in this basically uninformed but plausible speculation exercise but, I hope, adds constructively to the discussion by suggesting the rudiments of a health services research agenda that leads eventually to evidence-informed public policy making and private sector conduct that optimizes consolidation’s impact on consumers’ interests in access to, affordability of, and quality received in the realm of LTSS.

Thanks Marshall for letting us know and congratulations on the publication!

 

July 7, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Medicaid, Medicare | Permalink | Comments (0)

Wednesday, July 6, 2016

Work, Work, Work

Not everyone retires. Some don't retire because they love the work they do. Others can't afford to retire. Still others change professions, but keep working.  What will you do?

The Pew Research Center released a new FactTank report on June 20, 2016 about elders and work, More older Americans are working, and working more, than they used to. Using data from the Bureau of Labor Statistics, the Pew report explains

More older Americans – those ages 65 and older – are working than at any time since the turn of the century, and today’s older workers are spending more time on the job than did their peers in previous years ... In May, 18.8% of Americans ages 65 and older, or nearly 9 million people, reported being employed full- or part-time, continuing a steady increase that dates to at least 2000 (which is as far back as we took our analysis). In May of that year, just 12.8% of 65-and-older Americans, or about 4 million people, said they were working.

The report shows that the increase in elders working is steady across the age ranges (65-69, 70-74, and 75+) but with a slightly greater percentage of elder men over women.   And when I say working, I mean they are working.  "Not only are more older Americans working, more of them are working full-time. In May 2000, 46.1% of workers ages 65 and older were working fewer than 35 hours a week (the BLS’ cutoff for full-time status). The part-time share has fallen steadily, so that by last month only 36.1% of 65-and-older workers were part-time."

The jobs elders hold fall across a spectrum of mainly white-collar type jobs, "older workers are more likely to be in management, legal and community/social service occupations than the overall workforce, and less likely to be in computer and mathematical, food preparation, and construction-related occupations."

July 6, 2016 in Consumer Information, Current Affairs, Retirement, Statistics | Permalink | Comments (1)

Residents Offer Their Perspectives on Three CCRC "Sales" in New Jersey

In New Jersey, ORANJ is an organization for residents of "continuing care retirement communities" (or CCRCs, also sometimes known as "Life Plan Communities," following a LeadingAge marketing study and plan announced in November 2015). Founded in May 1991, members recently celebrated their 25th anniversary.  In a summer 2016 newsletter, called, appropriately ORANJ Tree, residents from three communities reported on major changes in ownership of their facilities, and how such changes can affect community moral and future prospects.  The CCRCs discussed were:

  • 2016: Cadbury at Cherry Hill (reporting a new ownership is part of a conversion from nonprofit status to for-profit)
  • 2016: Franciscan Oaks
  • 2013: Fountains at Cedar Parke

In my observation, these New Jersey transactions, especially a conversion from nonprofit to for-profit, are part of a larger, national picture of communities struggling for identity in a competitive senior living market.

July 6, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Property Management, Retirement | Permalink | Comments (0)

Tuesday, July 5, 2016

Will Mandatory Retirement Come to the Medical Profession?

Modern Healthcare ran an article that got me thinking about whether we will see mandatory retirement being applied to the certain doctors. More hospitals screen aging surgeons to make sure their skills are still sharp was published on June 11, 2016. The article starts with relating the story of  one facility and a 79 year old surgeon returning to work after some health problems. The facility had concerns but the article notes, "[t]hey had few tools at their disposal, though. Hospital policy limited interventions to clinicians who had made medical mistakes. [The surgeon] had never had an adverse event with a patient under his care." The chief of surgery at this hospital suggested a program from "Maryland that provides cognitive and physical examinations for aging surgeons."

We all know that conversations with someone about their diminished abilities are very difficult to have. The article offers a nod to that. Everyone is living longer, even doctors, and  longevity along with "[a]dvances in medicine, personal wellness and public health, along with the desire to preserve a sense of purpose and their lifelong identity, have led many to work well beyond traditional retirement age."  Some facilities are developing policies to evaluate their continued practice of medicine, "policies that require clinicians of a certain age to undergo physical, cognitive and clinical testing. Those programs have been met with ire by career practitioners, who argue that age is just a number. Doctors—no matter what their age—already must renew their medical licenses at regular intervals with state medical boards."  Critics note that renewals of licenses don't test "for age-related cognitive and physical decline that could harm the quality of care provided to patients." (does this debate sound familiar to anyone?)

The article then moves into a discussion of the ADEA and mandatory retirement and whether mandatory retirement should be applied to doctors. The American Medical Association (AMA) issued a report in 2015 on age-related declines with clinicians and is working on the beginnings of "research opportunities to inform preliminary guidelines for assessing senior and late-career physicians." This year the American College of Surgeons (ACS) "recommended that surgical specialists undergo voluntary and confidential baseline physical examinations at regular intervals starting between ages 65 and 70."

The article notes that some health care facilities have instituted their own requirements. "The policies vary in terms of the ages at which clinicians begin screening and what the exams require. Some call for clinicians to complete clinical skill and physical health screening every couple of years. Others require a more controversial cognitive test, which the AMA is leery of supporting." There is no uniformity yet with these programs. As far as the doctor at the beginning of the article? He did go through a program and passed. The surgeon "did recently decide to shift some of his responsibilities and now spends more time on training and education with another physician taking the role of chief of vascular surgery.  [The surgeon] also became an advocate who encourages his colleagues to consider it."

July 5, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Health Care/Long Term Care, Retirement | Permalink | Comments (0)

Special and Supplemental Needs Trust To Be Highlighted At July 21-22 Elder Law Institute in Pennsylvania

In Pennsylvania each summer, one of the "must attend" events for elder law attorneys is the annual 2-day Elder Law Institute sponsored by the Pennsylvania Bar Institute.  This year the program, in its 19th year, will take place on July 21-22.  It's as much a brainstorming and strategic-thinking opportunity as it is a continuing legal education event.  Every year a guest speaker highlights a "hot topic," and this year that speaker is Howard Krooks, CELA, CAP from Boca Raton, Florida.  He will offer four sessions exploring Special Needs Trusts (SNTs), including an overview, drafting tips, funding rules and administration, including distributions and terminations.

Two of the most popular parts of the Institute occur at the beginning and the end, with Elder Law gurus Mariel Hazen and Rob Clofine kicking it off with their "Year in Review," covering the latest in cases, rule changes and pending developments on both a federal and state level.  The solid informational bookend that closes the Institute is a candid Q & A session with officials from the Department of Human Services on how they look at legal issues affected by state Medicaid rules -- and this year that session is aptly titled "Dancing with the DHS Stars." 

I admit I have missed this program -- but only twice -- and last year I felt the absence keenly, as I never quite felt "caught up" on the latest issues.   So I'll be there, taking notes and even hosting a couple of sessions myself, one on the latest trends in senior housing including CCRCs, and a fun one with Dennis Pappas (and star "actor" Stan Vasiliadis) on ethics questions.

Here is a link to pricing and registration information.  Just two weeks away!

 

July 5, 2016 in Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Legal Practice/Practice Management, Medicaid, Medicare, Programs/CLEs, Property Management, Social Security, State Cases, State Statutes/Regulations, Veterans | Permalink | Comments (0)

Nursing Home Resident Abuse-Who is the Perpetrator?

We know anyone can be a victim of elder abuse. We also know anyone can be a perpetrator. With that in mind, the results of a study published in the Annals of Internal Medicine might be surprising to you.... or not.  The study found that in about 20% of the cases, the perpetrator was another resident. The Prevalence of Resident-to-Resident Elder Mistreatment in Nursing HomesResident-to-Resident Elder Mistreatment in Nursing Homes explained that "[r]esident-to-resident elder mistreatment (R-REM) in nursing homes can cause physical and psychological injury and death, yet its prevalence remains unknown."  The full article requires a subscription but the summary available offers this information:

Results: 407 of 2011 residents experienced at least 1 R-REM event; the total 1-month prevalence was 20.2% (95% CI, 18.1% to 22.5%). The most common forms were verbal (9.1% [CI, 7.7% to 10.8%]), other (such as invasion of privacy or menacing gestures) (5.3% [CI, 4.4% to 6.4%]), physical (5.2% [CI, 4.1% to 6.5%]), and sexual (0.6% [CI, 0.3% to 1.1%]). Several clinical and contextual factors (for example, lower versus severe levels of cognitive impairment, residing on a dementia unit, and higher nurse aide caseload) were associated with higher estimated rates of R-REM...

Conclusion: R-REM in nursing homes is highly prevalent. Verbal R-REM is most common, but physical mistreatment also occurs frequently. Because R-REM can cause injury or death, strategies are urgently needed to better understand its causes so that prevention strategies can be developed.

There was a webinar on the topic earlier in the spring. Slides from the webinar are available here. There is also an abstract from the 2014 report available on the National Criminal Justice Reference Service and the report is here.

July 5, 2016 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care | Permalink | Comments (0)

Friday, July 1, 2016

A Senior "Airbnb" of Sorts?

The success of Airbnb and other types of vacation home sharing services seems to be particularly useful to a certain segment of the population (here's a hint-this is the elder law prof  blog). The New York Times ran an article about elders renting rooms in their homes through these vacation home sharing services.  Renting Rooms to Travelers Can Be a Source of Income Later in Life explains how this has become a source of income for some elders. In fact, "Airbnb, in a 2015 study, identified people over 60 as the fastest-growing cohort of its hosts, increasing by 102 percent that year, compared to its overall growth rate in the United States of 85 percent. Worldwide, the company estimates that about 260,000 of its roughly two million listings are offered by hosts 60 and older. Of those, 64 percent are women. (The company doesn’t track marital status.)" The article mentions the various businesses that offer this service and gives a sense of how they work.

Of course, there are pros and cons to opening up one's home to strangers, as the article notes, as well as some upfront costs to prepare one's home for "guests." For some, according to the article, renting out rooms provides a nice additional income.  Interesting concept.

July 1, 2016 in Consumer Information, Current Affairs, Housing | Permalink | Comments (1)