Friday, October 9, 2015

Home Secure Home

We have previously blogged about technology that allows a person to more effectively age in place and about "smart homes." As well, we have mentioned the security issues with some technologies, so I was interested in a recent blog post published on the AARP blog Thinking Policy.

Making the Smart Home a Secure Home focuses on smart homes, described as  a home  designed "to help automate routine tasks and make homes more efficient."  Looking at security for smart home technologies,  the author offers 3 tips for a secure smart home: (1) "build strong security protections into all connected devices from the start...." (2) ensure that "software controlling connected devices is can be updated...." and (3) "securely transmitting and storing data gathered by connected devices"

The author concludes the article by saying:

The smart home promises to improve the lives of consumers by automating routine tasks and finding efficiencies that save money. Securing the connected devices constituting the smart home will make it more likely that consumers will adopt this technology. If the smart home industry continues to neglect the security of devices, government-mandated security protections might be necessary to resolve these issues.

October 9, 2015 in Consumer Information, Current Affairs, Housing, Web/Tech | Permalink | Comments (0)

Filial Friday: Freakonomics Asks "Should Kids Pay Back Parents for Raising Them?"

In a convergence of my teaching, research and public outreach work, this week I've found myself in several overlapping conversations about whether adult children have obligations -- moral or legal -- to care for or financially support their parents.  

This week, following my Elder Law Prof Blog post recommending Hendrik Hartog's fascinating book, Someday All This Will Be Yours, which I also recommended to my Trust & Estate students, I had a nice series of virtual conversations with Dirk about his book. What a thoughtful historian he is.  We were talking about his research-based observation in the book about adult children and needy parents:

Adult children were not legally bound to remain and to work for their parents.  Nor were they obligated to care for the old.  Adult children were, paradigmatically and legally, free individuals, "emancipated," to use the technical term. . . . Furthermore, there was little -- perhaps nothing-- to keep an uncaring or careless adult child from allowing a parent to go over the hill to the poorhouse.

I asked, "what about filial support laws?"  Turns out that was a timely question because Professor Hartog  had just been interviewed for a Freakonomics Radio episode, "Should Kids Pay Back Their Parent for Raising Them?" The program became publically available, via podcast or written transcript, on October 8, 2015.  In the interview Professor Hartog was asked to comment on filial support laws.  He said in part:

Filial responsibility statutes are very weak efforts to ensure that the young will support the old if they are needy.... They rarely are enforced.  Very, very, very, very rarely.  So, you know, in a sense, every time they are enforced they become a New York Times article or they become an article in the local newspapers. 

Professor Hartog was speaking in large measure from the perspective of his important historical research, including review of a body of case reports from New Jersey spanning some 100 years from the mid 1880s to the mid 1900s.  And based on my own historical research, I would also say that in the U.S., filial support laws have been rarely enforced, although I would characterize the enforcement as often "episodic" in nature, especially after the growth of Social Security and Medicaid benefits.  But...

I think the modern story is quite different in at least one state -- Pennsylvania.  Part of this difference is tied to the fact that Pennsylvania's filial support law permits enforcement by commercial third-parties, including nursing homes, as I discussed in my 2013 article on Filial Support Laws in the Modern Era.  Other U.S. jurisdictions with "modern" enforcement cases are South Dakota and Puerto Rico.

Indeed, I'm speaking on October 9, 2015 at the invitation of a Bench and Bar Conference in Gettysburg, PA about "The Festering Hot Topic" of Filial Support Laws in Pennsylvania. In the presentation, I report on controversies arising from recent, aggressive collection efforts by law firms representing nursing homes, as well the latest examples of successful enforcement suits by nursing homes and family members. I also analyze a disturbing additional claim, where Germany is seeking to enforce its filial support law to compel a U.S. resident to pay toward the costs of care for an ailing father in Germany. 

Ultimately, I think that Professor Hartog and I agree more than we disagree about the lack of behavioral impact flowing from filial support laws. As demonstrated by Professor Hartog in his book, much care and support is provided by children, but flowing from complicated moral or personal inclinations, rather than statute-based lawsuits.

This seems a more realistic paradigm, although  not without opportunities for misunderstanding and disappointment. But, as I often observe, the very last person I would want involved in my care would be someone who is doing it "only" because a statute -- much less a court -- is telling them they must care for me.

October 9, 2015 in Books, Current Affairs, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Housing, International, Medicaid, Social Security, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Thursday, October 8, 2015

Sixty Minutes Profiles Self-Driving Cars

On October 4, CBS Sixty Minutes profiled self-driving cars.  I kept expecting to see Becky Morgan on the program, given her interest in technology!  I suspect, however, that she would be as perplexed as I was by the several comparisons of the car's speed controls to "driving like a little old lady." 

At this point in development, even the most advanced design periodically signals for the human driver to take over when the car encounters un-preprogrammed facts.  Plus, alas, the current version isn't prepared for driving in snow.  Perhaps that's the consequence of all those engineers working on this in Silicon Valley in California.

October 8, 2015 in Consumer Information, Current Affairs, Science | Permalink | Comments (1)

Marriage Scams: It's About Money, Not Love

Healthline News ran a story that made me sad, even though I know these scams happen. Growing Kind of Elder Abuse: Marrying Seniors for Their Money ran on September 15, 2015.  The article quotes a California attorney whose  firm handles financial exploitation cases who "[said] marrying for money is a form of elder abuse that is spreading throughout the United States." The attorney noted that this type of financial exploitation case is often unreported and hard to uncover. These "sweethart scams" happen to both sexes about equally. The article quotes the deputy director of the National Center on Elder Abuse (NCEA) that

[W]hile these scams can take many forms... a common scenario is that the elders have experienced a recent loss, such as the death of a spouse, and they find themselves befriended by someone younger.

“If children aren’t nearby or the person is isolated and depressed, they’re more vulnerable to this attention.... The difficult thing is that if the older adult has capacity to make decisions then they are entitled to do what they want with their money.”

The article provides some examples of actual cases and the variation among the states on capacity to marry as well as what actions to take if the elder is a victim of this scam.

October 8, 2015 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship | Permalink | Comments (0)

Wednesday, October 7, 2015

The Brain -- In Six Parts

PBS is premiering a six-part series on "The Brain with David Eagleman" on Wednesday evenings, beginning on  October 14, 2015.  It looks intriguing, with the following segments:

  • What is Reality?
  • What Makes Me?
  • Who is In Control?
  • How Do I Decide?
  • Why Do I Need You?
  • Who Will We Be?

The Albuquerque Journal recently profiled the creative mind behind this creative series.  Neuroscientist David Eagleman grew up in Albuquerque although he now runs a lab for "Perception and Action" at Baylor University, where he also has a special interest in "neuroscience and the law." 

October 7, 2015 in Cognitive Impairment, Current Affairs, Science | Permalink | Comments (0)

Is Elder Abuse Preventable?

I previously posted a new article from Consumer Reports on the cost of financial exploitation.  Consumer Reports also ran an article about whether elder abuse is preventable. Lies, Secrets, and Scams: How to Prevent Elder Abuse.  Seniors and their families lose billions of dollars each year to heartless fraudsters. Learn how you can help ran September 28, 2015.  The article opens with a victim of the grandparent scam. Looking at the proliferation of  financial exploitation, the article notes

Estimates of the crime’s frequency vary. A 2010 survey of seniors by the nonprofit Investor Protection Trust projected that 1 in 5 seniors had been taken advantage of financially. A study last year in the Journal of General Internal Medicine found that 4.7 percent of Americans—about 1 in 20—reported that they had been financially exploited in their later years. The study provided perspective: If a new disease struck that same percentage of older Americans, researchers wrote, “a public health crisis would likely be declared.”

The article discusses why elders are targets "[o]lder people’s vulnerabilities—including isolation, loneliness, generally trusting natures, relative wealth, and in some cases declining mental capabilities—make them ideal quarry for con artists. Even those whose cognition is intact can be swayed if they’re stressed or depressed, or recently have lost a loved one." The article paints a bleak picture regarding projection, noting that s "as baby boomers age, the pool of potential victims will expand, with assets ripe for the pickpocketing."  The article reviews the reasons why victims may not report the exploitation, how the perpetrators work a scam and why some victims are exploited multiple times.

The article covers some successes when the victims (or families) report the crime and initiatives to fight elder abuse, mentioning specifically the DOJ elder justice initiative. The article concludes with photos and summaries of stories of 8 victims and a list of agencies that may help.



October 7, 2015 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship | Permalink | Comments (0)

Tuesday, October 6, 2015

Gov. Brown Reflecting on "What I Would Want In The Face Of My Own Death"

California Governor Jerry Brown signed the California legislature's "right to die" act on Monday, October 5.  From coverage in the San Diego Union-Tribune:

Gov. Jerry Brown, a lifelong Catholic and former Jesuit seminarian, said he consulted a Catholic bishop, two of his own doctors and friends "who take varied, contradictory and nuanced positions."


"In the end, I was left to reflect on what I would want in the face of my own death," wrote the Democratic governor, who has been treated for prostate cancer and melanoma. "I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill."


Brown's signature on the right-to-die legislation Monday capped an intensely personal debate that dominated much of this year's legislative session and divided lawmakers. Many lawmakers also drew on personal experience to explain their decisions to support or reject legislation making California the fifth state to allow terminally ill patients to use doctor-prescribed drugs to end their lives.

California joins Oregon, Washington, Vermont and Montana in permitting certain assistance in decisions to end one's life

October 6, 2015 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Ethical Issues, State Statutes/Regulations | Permalink | Comments (0)

The Shocking Cost of Financial Exploitation

Does the amount $3 billion shock you:? What about $36 billion? According to an article in Consumer Reports, Financial Elder Abuse Costs $3 Billion a Year. Or Is It $36 Billion?,  the exact amount is unclear.  Here's how the $3 billion figure came about, according to the story:

When Consumer Reports recently reported on elder financial fraud, Lies, Secrets, and Scams: How to Prevent Elder Abuse, we used the number $3 billion. It comes from a study published in 2011 by the MetLife Mature Market Institute, in collaboration with the National Committee for the Prevention of Elder Abuse and the Center for Geronotology at Virginia Polytechnic Institute and State University. We rounded up from that study's estimate of $2.9 billion annually....


We chose that figure because a number of experts we interviewed thought it was a credible figure. But they—and an author of the study—admitted to us when we first reported it a couple of years ago that the figure probably represents the tip of the iceberg. The figure is probably far larger than that.

We have all heard the tip of the iceberg analogy with the number of cases of elder abuse, since we know that elder abuse cases are under-reported.   The article goes on to explain the $36 billion figure which came from TrueLink which "projected that financial elder abuse costs families more than $36 billion a year,"  Their study used a more expansive view of financial exploitation, including fraud and scams as well as financial exploitation.  The article notes that Investor Protection Trust estimates that 20% of elders have been victims.

The author of the article explains the title. 

Though the article focuses on financial exploitation at the hands of strangers, the headline encompasses abuse by all types of con artists, including family members and people the senior knows. When discussing stranger-initiated abuse, we couldn't arrive at a figure that made sense to us. Experts I consulted through a listserve used by professionals in the elder-abuse prevention and treatment community couldn't agree on a figure themselves. However, several professionals I interviewed said they were comfortable with saying it was in the "billions."

The point of this difficult exercise is that no really one knows how big the problem is. But clearly, it's huge. And until seniors feel comfortable reporting their victimization—and there's a standard way to define it and a central place to report it—we'll never know the total impact. Here's hoping that day comes, so the individuals working to help victims and prevent the crime can get the attention and resources they deserve.

Assign this article to your students. It illuminates a number of the issues in these cases. Regardless of whether the total is $3 billion or $36 billion, the numbers are shocking.


October 6, 2015 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship | Permalink | Comments (1)

Monday, October 5, 2015

Webinar on October 6: The "A to Zahner" on Medicaid Annuities

Sorry for the short notice, but on Tuesday, October 6, 2015 from noon to 1 p.m. (Eastern time), the Pennsylvania Bar Institute is hosting a very timely (and cleverly titled) webinar, focusing on the impact of the Third Circuit's recent decision in Zahner on Medicaid planning generally and specifically on the sue of annuities. 

Here is a link to PBI's details on "The A to Zahner on Medicaid Annuities," including how to register.

October 5, 2015 in Current Affairs, Estates and Trusts, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Medicaid, Property Management, Webinars | Permalink

New Illinois Law on "Presumptively Void" Bequests to Non-Family Caregivers Has "Starring" Role

Illinois adopted a new law, Public Act 098-1093, effective on January 1, 2015 that assigns a "presumptively void" status to bequests made to non-family caregivers, if the transfer would take effect upon the death of the cared-for person.  The law applies only to post-effective date bequests that are greater than $20,000 in fair market value.  The statutory presumption can be "overcome if the transferee proves to the court" either:

1. by a preponderance of the evidence that the transferee's share under the transfer instrument is not greater than the share the transferee was entitled to receive under ... a transfer instrument in effect prior to the transferee becoming a caregiver, or


2. by clear and convincing evidence the transfer was not the product of  fraud, duress or undue influence.

The law only applies in civil actions where the transfer is challenged by other beneficiaries or heirs. 

(Fun) Spoiler Alert:  The new law plays a clever "starring role" in the Fall 2015 season premiere of  The Good Wife.  Let's see how many of our law students were watching!

October 5, 2015 in Current Affairs, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Film, Property Management, State Cases, State Statutes/Regulations | Permalink | Comments (1)

Elder Justice Americorps

DOJ's Elder Justice Initiative & Office for Victims of Crimes, along with the Corporation for National and Community Service announced the creation of the Elder Justice Americorps.  According to the website

[E]lder Justice AmeriCorps, a new grant program to provide legal assistance and support services to victims of elder abuse, neglect and exploitation and to promote pro bono capacity building in the field.  This effort will expand a partnership between the two agencies, which includes justice AmeriCorps, a legal aid program launched in 2014 by the Department of Justice and CNCS to serve vulnerable populations.


The Elder Justice AmeriCorps program, which is intended to complement existing Office for Victims of Crime grants to support the development of legal assistance networks providing comprehensive, pro bono legal services for victims of crime, will consist of a single grant to an intermediary organization that will support approximately 60 full-time AmeriCorps positions for each year of the two-year program.  Interested applicants can review the Notice of Funding Opportunity at

October 5, 2015 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Grant Deadlines/Awards | Permalink | Comments (0)

Friday, October 2, 2015

Register Now-Webinar on Proposed Nursing Home Regs

The National Consumer Voice for Quality Long-Term Care is hosting a free webinar on October 6, 2015 from 2-3:30 p.m. According to the announcement

The proposed federal nursing home regulations published by the Centers for Medicare and Medicaid Services (CMS) in July will shape nursing home care for decades to come. CMS needs to hear what consumers, their families and advocates around the country think about the rule. This is one of the most important opportunities you will ever have to impact what these new federal nursing home regulations look like. Comments are due October 14 by 5:00pm ET. 

This webinar is designed to assist advocates in understanding the proposed changes and in participating in the comment process.

Eric Carlson of Justice in Aging and Robyn Grant of the Consumer Voice are the presenters. To register for this webinar, click here.


October 2, 2015 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Programs/CLEs, Webinars | Permalink | Comments (0)

Planning Well For The End of Life (as a Foundation)

I've long been fascinated by the history of Atlantic Philanthropies (AP), starting when I first became aware of the behind-the-scenes role of the founder, Chuck Feeney, in funding extraordinary educational endeavors in Ireland, and, as I soon learned, also funding important social and health advocacy movements around the world.  The end of AP as a multi-million dollar grant-making foundation is near at hand, although not the end of its impact.

Linked here is the latest report from the CEO of AP, Christopher Oechsli, with linked reports on AP's final grants, including its support for a groundbreaking National Dementia Strategy in Ireland.

October 2, 2015 in Current Affairs, Dementia/Alzheimer’s, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, International, Retirement | Permalink | Comments (0)

Thursday, October 1, 2015

Life Expectancy and Income: A New Report

The National Academies Press has issued a new report, The Growing Gap in Life Expectancy by Income: Implications for Federal Programs and Policy Responses.  Here is a description from the book

he U.S. population is aging. Social Security projections suggest that between 2013 and 2050, the population aged 65 and over will almost double, from 45 million to 86 million. One key driver of population aging is ongoing increases in life expectancy. Average U.S. life expectancy was 67 years for males and 73 years for females five decades ago; the averages are now 76 and 81, respectively. It has long been the case that better-educated, higher-income people enjoy longer life expectancies than less-educated, lower-income people. The causes include early life conditions, behavioral factors (such as nutrition, exercise, and smoking behaviors), stress, and access to health care services, all of which can vary across education and income.

Our major entitlement programs ? Medicare, Medicaid, Social Security, and Supplemental Security Income ? have come to deliver disproportionately larger lifetime benefits to higher-income people because, on average, they are increasingly collecting those benefits over more years than others. This report studies the impact the growing gap in life expectancy has on the present value of lifetime benefits that people with higher or lower earnings will receive from major entitlement programs. The analysis presented in The Growing Gap in Life Expectancy by Income goes beyond an examination of the existing literature by providing the first comprehensive estimates of how lifetime benefits are affected by the changing distribution of life expectancy. The report also explores, from a lifetime benefit perspective, how the growing gap in longevity affects traditional policy analyses of reforms to the nation?s leading entitlement programs. This in-depth analysis of the economic impacts of the longevity gap will inform debate and assist decision makers, economists, and researchers.

You can download the report as a pdf for free, read the report online, or purchase a hard copy of the report for $64.  Click here for more information.

October 1, 2015 in Current Affairs, Federal Statutes/Regulations, Retirement, Social Security | Permalink | Comments (0)

Wednesday, September 30, 2015

Mark Your Calendars-Webinar on Social Security Fraud, Similar Fault & Penalties.

The Center for Elder Rights Advocacy (CERA) has announced their upcoming webinar on October 8th, 2015.  The webinar, Social Security Fraud, Similar Fault & Penalties will take place from 2 - 3:30 p.m. eastern.  According to the website

CERA presents a webinar regarding the issue of clients reporting an overpayment involving allegations by Social Security of “fraud or similar fault.” These cases present unique challenges for the hotline attorney. Social Security’s rules on overpayments differ when Social Security finds that the overpayment resulted from “fraud or similar fault.” Normal due process rules for overpayments do not apply, and Social Security can assess additional financial penalties when an administrative determination is made that “fraud or similar fault” is applicable. This webinar will address ways to advise clients who receive a notice from Social Security alleging an overpayment involving “fraud and similar fault,” or who have an overpayment on their record with such a determination. The webinar is particularly directed toward legal hotline advocates and managers.

This webinar addresses:

  • A review of rules applicable to “fraud and similar fault” findings.
  • A discussion of differences in normal overpayment collection cases vs. fraud cases.
  • Giving competent advice to clients faced with an overpayment arising from fraud or similar fault.

To register, click here.


September 30, 2015 in Current Affairs, Federal Statutes/Regulations, Programs/CLEs, Social Security, Webinars | Permalink | Comments (0)

Tuesday, September 29, 2015

Does LegalZoom Compete with Law Firms? Co-Founder Brian Liu Says "No"

Over the weekend I caught an interview with Brian Liu, co-founder of LegalZoom, broadcast on From Scratch, a radio show about "entrepreneurial life."  The host, Jessica Harris, who has an interesting business background of her own, is a very good interviewer, encouraging guests to explore strengths and weaknesses of their ideas, moving from first inspiration to current goals.  She also asks "work/life balance" questions, often getting candid admissions of the private struggles some have to achieve balance.

I was intrigued with Liu's central premise, that his company does not compete, at least not directly, with law firms for business.  Rather, he believes that the vast majority of clients are drawn to his company precisely because they would never go to a lawyer, whether because of cost, unease about attorneys, or perceptions about value. 

It was also interesting to hear that Legal Zoom's first ten clients, accessing the company's on-line document portal on a Friday night, were seeking "living wills."  That fact tells us a lot about underserved legal and health care needs, doesn't it.  

September 29, 2015 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Legal Practice/Practice Management, Web/Tech | Permalink | Comments (0)

A Village to Age in Place

My dear friend and colleague, Mark Bauer, sent me this article, Why More Seniors Are Forming Their Own 'Villages' . 

The story features the establishment of Beacon Hill Village, where twelve

like-minded neighbors ...  founded the Beacon Hill Village, a local group for independent seniors to meet and support one other through the elder years. By pooling yearly membership fees, members of the village pay for a small staff that helps them find services like drivers, cleaners, and handymen.

In 2002 they formally launched Beacon Hill village as a nonprofit (despite its name, the village doesn't own any property and has no physical housing component), and today count nearly 350 members. Their example has since spurred more than 170 other villages across the country, a growing experiment in how urban seniors can network with their peers—and empower themselves.

Members pay an annual fee which includes access to staff who assist residents in obtaining needed services (the village does not provide "direct services"). There are intangible benefits as well to this model.  The story discusses the sense of community provided by this concept and its benefit to residents.  The concept appears to be gaining fans.

In 2010 a national organization called the Village to Village Network emerged to help found new villages and connect existing ones. ... the network’s St. Louis-based director, said she expects the number of villages to double within two years. The average village has about 100 members, meaning such a rapid expansion would still only reach about 35,000 Americans in all. [The director] ... said lower-income members are underrepresented in the network at large, and that she and her colleagues hope to change that.

As the model expands across 40 states, managers ...  are trying to reconcile exponential growth with an emphasis on neighborhood-scale relationships. Fundraising, too, presents a challenge. By design, membership fees barely cover costs at many villages, including Beacon Hill, so grants and foundations often make up the rest. That presents future villages with a tough choice: commit to the fundraising grind and the uncertainty that comes with it, or raise membership fees and risk shutting out lower-income neighbors.

The Beacon Hill Village website offers this description

Beacon Hill Village, a member-driven organization for Boston residents 50 and over, provides programs and services so members can lead vibrant, active and healthy lives, while living in their own homes and neighborhoods.

Benefits include access to discounted  providers who can help you manage your household, stay active and healthy, and serve your driving needs. Our social and cultural programs are always changing to support member interests.

To learn more about Beacon Hill Village, click here.  The Village to Village Network website describes the village concept as "Aging's new frontier".  The website contains information about the various villages in the U.S., information about how to start a village, an interactive map, information about upcoming conferences, and more.  Click here to learn more about the network.  This is an interesting grass-roots effort that seems to be flourishing.

September 29, 2015 in Current Affairs, Health Care/Long Term Care, Housing | Permalink | Comments (0)

Friday, September 25, 2015

Does An Inheritance Improve Your Retirement Security?

The Center for Retirement Research at Boston College released an issue brief this month on How Do Inheritances Affect the National Retirement Risk Index?

You might immediately conclude that receiving an inheritance would definitely improve one's retirement security, but the answer really is the classic law school "it depends" answer.  "The bottom line is that, while anything that boosts households’ assets is beneficial to their financial situation, inheritances are not likely to be decisive in determining retirement preparedness for many households."  The report notes that the very wealthy have achieved retirement security so an inheritance won't make much difference.

On the one hand, past research has shown that higher-income households – who are less likely to be unprepared for retirement – are more likely to receive inheritances and to receive larger amounts than their lower-income counterparts. On the other hand, the anticipated inheritance receipts of low- and middle-income households represent a much larger percentage of their current wealth, suggesting that inheritances could potentially be more influential in boosting their retirement security.

A pdf of the report is available here. Key findings from the report are available here.



September 25, 2015 in Current Affairs, Retirement | Permalink | Comments (0)

Thursday, September 24, 2015

Family Caregivers Show Support for Pennsylvania State Assistance at State Capitol

If you have worked in Elder Law long enough, you have probably received a panicked call from a family caregiver who is unprepared for a loved one to be discharged on short notice from hospital care.

2015-capitol-caregiving-event-tamesha-keelOn September 22, the Pennsylvania Capitol in Harrisburg was crowded with individuals wearing coordinated colors, showing their support for Pennsylvania Caregivers, including family members who are often struggling with financial and practical challenges in caring for frail elders. Here's a link to a CBS-21-TV news report, with eloquent remarks from Tamesha Keel (also pictured left), who has first-hand experience as a stay-at-home caregiver for her own aging mother.  Tamesha recently joined our law school as Director of Career Services.

AARP helped to rally support for House Bill 1329, the Pennsylvania CARE Act.  The acronym, coined as part of a national campaign by AARP to assist family caregivers, stands for Caregiver Advise, Record and Enable Act.  HB 1329  passed the Pennsylvania House in July 2015 and is now pending in the Pennsylvania Senate.

We have written on this Blog before about pending CARE legislation in other states.  A central AARP-supported goal is to achieve better coordination of aftercare, starting with identification of patient-chosen caregivers who should receive notice in advance of any discharge of the patient from the hospital.  Pennsylvania's version of the CARE Act would require hospitals to give both notice and training, either in person or by video, to such caregivers about how to provide appropriate post-discharge care in the home. 

I'd actually like to see a bit more in Pennsylvania. It is unfortunate that the Pennsylvania CARE Act, at least in its current iteration (Printer's Number 1883), does not go further by requiring written notice, delivered at least a minimum number of hours in advance of the actual discharge. AARP's own model act suggests a minimum of 4 hours, consistent with Medicare rules.

Under Federal Law, Medicare-participating hospitals must deliver advance written notice of a discharge plan, and such notice must explain the patient's rights to appeal an inadequate plan or premature discharge. A timely appeal puts a temporary hold on the discharge. See the Center for Medicare Advocacy's (CMA) summary of key provisions of Medicare law on hospital discharges, applicable even if a patient at the Medicare-certified hospital isn't a Medicare-patient. CMA's outline also suggests some weaknesses of the Medicare notice requirement.

AARP's original CARE Act proposals are important and evidence-based, seeking to improve the patient's prospects for post-hospitalization care through better advance planning. At the same time, there's some irony for me in reading the Pennsylvania legislature's required "fiscal impact" report on HR 1329, as it reports a "0" dollar impact.  That may be true from the Pennsylvania government's cost perspective, but for the hospitals, to do it right, whether in person or by video, training is unlikely to be revenue neutral.  I think we need to talk openly about the costs of providing effective education or training to home caregivers.

If passed by the Senate, Pennsylvania's CARE Act would be not become effective for another 12 months.  The bill further provides for evaluation of the effectiveness of the rules on patient outcomes.   

As is so often true, states are constantly juggling the need for reforms to solve identified problems, with the costs of such reforms.  Perhaps the current version of the Pennsylvania bill reflects some compromises among stakeholders. According to this press statement, the Hospital and Health System Association of Pennsylvania supports the current version of AARP's Pennsylvania CARE Act.

September 24, 2015 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare, State Statutes/Regulations | Permalink | Comments (0)

Technology to Age in Place

The Huffington Post blog recently carried a post from Paul H. Irving, of the Milken Institute Center for the Future of Aging and a Distinguished Scholar in Residence at the USC Davis School of Gerontology. Professor Irving opens his blog post, Why Technology Is The Catalyst For A New Era Of Aging In Place, with a reference to the movie, 2001 A Space Odyssey and a mention of a recent report from the Milken Institute with the finding that most older Americans want to age in place at their homes. "Technological advances may be an answer to that challenge."  Here's why he thinks so. Professor Irving writes

The proliferation of the "Internet of things" is in full swing, and older adults will be beneficiaries. Wearables and digital devices monitor health and movement data and enhance safety. Phones, computers and social networks provide connections to family, friends, physicians and caregivers, and almost instant access to a wide range of products and services. Virtual workplaces and distance learning elevate knowledge, productivity and purpose. Thoughtful architecture and computer-assisted design create new-generation homes that are built to accommodate aging, with navigable floors, doorways and rooms, counter heights for standing or sitting, thermostats that are easy to set and entertainment options that would have been unimaginable a generation ago. Older adults can look to technology for help in preparing meals and ensuring that the right medicine is taken at the right time. Tuned to particular needs and preferences, home environments will be customized and personalized as technological innovation brings out the best of both human and machine.

Recognizing as well that local governments play a role in successful aging in place, Professor Irving discusses the need for a community to provide services, transportation, etc. After noting that it will take time to move communities in this direction, he concludes that "[a]ll ages have a stake in this -- and the true beneficiaries of these advances may well be aging generations to come. In the meantime, as concerns about the impacts of technology weigh on some, we should celebrate technology's potential to empower older adults and brighten the future of aging."

September 24, 2015 in Consumer Information, Current Affairs, Housing, Web/Tech | Permalink | Comments (0)