Yet, no matter how good-natured everyone is, sacrifices are inevitable. [One generation] wanted a washer and dryer on the main living level for their parents’ easy access, but that required making the living space smaller. So laundry facilities went downstairs.... “Melding design, finance and emotion is an art, not a science,” said the president of one design firm interviewed for the article. "Nevertheless, 'if you’re creative, you’re willing and you have good relationships, you can make it happen. We’re average Joes and we did it,'" said another generation while a member of the third generation offered that “It’s not like some fairy tale where everyone is always happy and gets their way, but the benefits are better than the costs.”
Wednesday, May 9, 2018
Check out this new issue brief from the National Adult Protective Services Association (NAPSA) Research to Practice Series. Fraud versus financial abuse and the influence of social relationship, offers this summary
Elder financial exploitation, committed by individuals in positions of trust, and elder fraud, committed by predatory strangers, are two forms of financial victimization that target vulnerable older adults. The study presented in the webinar analyzes differences between fraud and financial exploitation APS victims in terms of their health, functional dependency, cognitive functioning, and social relationships.
In this mixed methods study, fifty-three financial exploitation and fraud cases were sampled from an elder abuse forensic center in California. Data include law enforcement and caseworker investigation reports, victim medical records, perpetrator demographic information, and forensic assessments of victim health and cognitive functioning.
The vast majority of fraud and financial exploitation victims performed poorly on tests of cognitive functioning and financial decision-making administered by a forensic neuropsychologist following the allegations. Based on retrospective record review, there were few significant differences in physical health and cognitive functioning at the time victims' assets were taken, although their social contexts were different. Fraud most often occurred when a vulnerable elder was solicited by a financial predator
in the absence of capable guardians. In other words, most fraud victims in the sample did not have trusted friends or family members assisting with financial decisions and providing care at the time the fraud perpetrators entered the picture. Fraud victims were significantly less likely to have children and also had fewer relatives nearby. In sum, fraud and financial exploitation victims had different family and friend structures that may create different opportunity structures for crime.
Social isolation was not only a potential risk factor for financial victimization, it was also a tactic of undue influence to further manipulate and control the victims. Some fraud victims in the sample developed close friendships and romantic relationships with the financial perpetrators, even in the cases where they communicated only by telephone. While these relationships were constructed to manipulate and deceive the victim, they felt authentic to the older person. Perpetrators often exploited the victim's need for companionship and began limiting and controlling their victims' social interactions to create a sense of powerlessness and emotional dependency.
Tuesday, May 8, 2018
According to news reports coming out of Louisiana, the state's Department of Health will begin sending "eviction" notices to nursing home residents later this week. This strikes me as a particularly abusive form of gamesmanship connected to state budget negotiations. See what you think!
Louisiana's Department of Health will begin sending nursing home eviction notices Thursday to more than 30,000 residents who could lose Medicaid under the budget passed by the state House of Representatives.
"The Louisiana Department of Health is beginning the process of notifying all impacted enrollees that some people may lose their Medicaid eligibility," Department of Health spokesman Bob Johannessen said. "The goal of the department is to give notice to all affected people as soon as possible in order that they begin developing their appropriate plans."
Gov. John Bel Edwards' staff has planned a press conference Wednesday for more details, a day before the notices are set to be mailed to 37,000 Medicaid recipients in nursing homes or other long-term care facilities.
"(The Department of Health) told us they're sending out the letters May 10," said Mark Berger, executive director of the Louisiana Nursing Home Association, during testimony at the Senate Finance Committee meeting Monday.
The issue was front and center in Senate Finance, which was hearing public testimony on the budget sent to it by the House for most of the eight hours the panel met.
"This sounds like mass chaos," said Sen. Regina Barrow, D-Baton Rouge, who called the letter notification "very troublesome."
For more see the Monroe New Star Report on "Nursing Home Eviction Notices to be Sent Tuesday."
Most commentaries on funding for retirement years point to insufficiency of savings or other resources. But here's a different take, drawing upon a recently published report from the Employee Benefit Research Institute (EBRI) that suggests retirees with significant savings are often exercising restraint in spending, From the St. Louis Post-Dispatch on The Myth of Outliving Your Retirement Savings:
In the EBRI study, those with the most savings — a median of $857,450 shortly after retiring — still had $756,300 two decades later. The decrease amounts to just 11.8 percent of the original sum.
The largest drop in retirement nest eggs, 24.4 percent, was among those with the least savings, or a median of $29,975.
Frugal behavior is consistent with research led by Anna Rappaport for the Society of Actuaries. She and her team found that most people do not plan for retirement or know what they should spend, but they adapt — even when shocked by high dental bills or a roof repair.
What can devastate financially are divorce, caring for a mentally or physically ill adult child who cannot work, and long-term care expenses, according to the actuarial society’s research.
Still, debilitating health care costs are far more rare than people fear, according to the EBRI research. Half of retirees face no nursing home expenses because Medicare covers short recoveries after hospital stays and Medicaid can help when resources run out.
The medical annual out-of-pocket spending for 90 percent of retirees is just $2,000, and the big nursing home costs over $87,000 hit only 10 percent of people living longer than 95, according to the EBRI study.
For the EBRI study itself, see the April 2018 report on Asset Decumulation or Asset Preservation? What Guides Retirement Spending?
Monday, May 7, 2018
A coalition of Wisconsin health care organizations is warning that the state's shortage of long-term care providers continues to grow.
The study, put together by several groups across the state, says 1 in 5 direct caregiver positions in the state is going unfilled. That's up from 1 in 7 positions in 2016.
Starting wages in the profession are so low that many potential workers never apply, according to the report. The median hourly starting wage for personal caregivers is $10.75 an hour, according to the study, while other positions outside health care start at $12 an hour.
The report found Wisconsin's low rate of Medicaid reimbursement is a key factor keeping provider wages low.
Sarah Bass of the Wisconsin Assisted Living Association said with so many unfilled positions, many facilities are cutting back, even though demand for long-term care continues to grow.
"Assisted living providers are closing their doors, or shutting down areas of their assisted living facilities, because they don't have the staff to safely take care of the residents," she said. "They're reducing their admissions."
These problems exist despite some increases in state funding for skilled care and family care workers in the latest budget.
May 7, 2018 in Consumer Information, Current Affairs, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, State Statutes/Regulations, Statistics | Permalink | Comments (0)
Sunday, May 6, 2018
As is true for many states, Maryland is increasing the education, support and supervision for guardians appointed by the Maryland courts. In connection with this, beginning on January 1, 2018, prospective guardians must watch a video-based "orientation program" before they are appointed guardian of a minor or disabled person. The 9-minute video introduces the "roles, duties and responsibilities" of a guardian and explains mch of what to expect if appointed by the Maryland Courts. Here is a link to the video.
What I particularly like about this video is the message "You Are Not Alone as a Guardian," and the emphasis that Court-appointed guardians are subject to the ultimate authority of the Court. I think that many courts are still struggling with their own roles in this regard, but here the lines of responsibility are explained clearly.
The balance here is delicate, requiring careful thought about how to provide threshold information essential for a candidate to make an informed decision about whether to serve, but without making the information so overwhelming that good candidates decline the role. The Maryland courts caution that this particular orientation and the related training requirements do NOT apply to public guardians or guardianships that terminate parental rights.
In my opinion, this type of video is a good first step. But just a first step.
May 6, 2018 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Legal Practice/Practice Management, Programs/CLEs, Property Management, State Cases, State Statutes/Regulations, Webinars | Permalink | Comments (0)
Thursday, May 3, 2018
Hard to believe, but this summer will mark the 21st annual Elder Law Institute in Pennsylvania. It functions as both a gathering of the clan and an educational update, and I always walk away with new ideas for my own research and writing. On the second day of the event (which runs July 19 and 20), Howard Gleckman will give the keynote address on "Long Term Care in an Age of Disruption." Doesn't that title capture the mood of the country?!
Practical workshops include:
- Using Irrevocable Trusts in Pre-Crisis and Crisis Planning - Ms. Alvear & Ms. Sikov Gross
- Guardianship for Someone Who Is 30/30 on the MMSE (Advanced Mental Health Capacity Issues) - Ms. Hee & Mr. Pfeffer
- Medicaid across State Lines: Pennsylvania vs. New Jersey - Mr. Adler
- Medicaid Annuities in Practice - Mr. Morgan & Mr. Parker
- Business Succession Planning for Elder Law Practices - Ms. Ellis, Mr. Marshall, Mr. Pappas & Ms. Wolfe
- Social Security Disability: What Elder Law Practitioners Need to Know - Mr. Whitelaw
- Drafting Trusts for Beneficiaries with Behavioral Impairments and Mental Health Problems - Mr. Hagan & Dr. Panzer
- Being a Road Warrior Attorney: Staying Organized and in Touch While Out of the Office (ETHICS) - Ms. Ellis
Mark your calendars and join us (Linda Anderson, Kimber Latsha and I are hosting a session on Day 1 about "new" CCRC issues). Registration is here.
May 3, 2018 in Books, Cognitive Impairment, Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Housing, Legal Practice/Practice Management, Medicaid, Medicare, Programs/CLEs, State Cases, State Statutes/Regulations | Permalink | Comments (0)
Frequent reader Karen Miller from Florida made a timely catch by sending me two articles that both mention the "peace of mind" that can accompany living in purpose-planned retirement communities, including CCRCs or LPCs. Thanks, Karen!
In last Sunday's edition of the New York Times, reporter Peter Finch offered "How to Talk About Moving to a Retirement Home: It's a Journey." He includes admissions by once highly reluctant residents, including one who finally gave in to his wife's desire for a new setting:
For the once-skeptical Mr. Strumsky, it took only days for him to start feeling certain that he and his wife, who is 72, had made the right decision. About a week after moving in at Charlestown [a retirement community outside of Baltimore], he went out to walk the dog at night and ran into a pair of women he didn’t know who were chatting amiably in the parking lot. About 25 minutes later, he returned home and saw the same women, still talking.
“They were so unconcerned about their personal safety, they were oblivious to anything going on around them,” Mr. Strumsky said. “And it just hit me: I really wished my mother or my sister or my aunt could have had this experience, to feel that safe and secure. At that point, it was like a light bulb going on. It was an instant turnaround for me.”
By contrast, Patricia Hunt, a columnist for the News Leader (part of the USA Today Network), writes about "friends whining about the rules of their . . . subdivision," noting that the security that some people seek can come with a regulatory price tag, even if the regulator isn't the government. She writes in part:
In retirement many people with the means to do so choose a “continuing care retirement community.” There is a big price range, but basically you pay an entrance fee, and most require that you be well enough to live independently to be admitted. They provide food service, activities, and stepped up sections for “assisted living” and for the most debilitated, “skilled nursing care.” This is the most expensive option for one’s last years.
But the rules for the residents of CCRCs are set entirely by people who do not live in them. And flexibility is the most restricted of all options. If you grandson who ran away to join the circus can be talked into living with you for a few months until he can sort things out with his parents, you cannot let him do that. If you decline in health and your granddaughter is willing to come live with you so you don’t to go to assisted living or skilled nursing care, you can’t do that either. You can hire people to come in night and day, but your family member cannot simply move in. She must have another permanent address. At least this is how most of them work.
If you[r] adult child gets sick or loses a job and needs to stay with you, it is not allowed. And you may not have the money to help him or her out if you have spent it all on the entrance fee and monthly fees.
Hunt concludes by questioning whether people "really" do hate regulation, noting "there is plenty of evidence of that some of them are not only willing to live with more regulations than many other people, they are willing to pay a lot of money to do so."
For more from Hunt, read the full column "We Hate Regulation, But We Willingly Trade Away Our Basic Freedoms for Comfort, Security."
May 3, 2018 in Consumer Information, Current Affairs, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Housing, Property Management, Retirement, State Statutes/Regulations | Permalink | Comments (0)
Wednesday, May 2, 2018
I'm often hesitant to post photos or videos from allegations about nursing home neglect. As an outsider, it can be hard to know the full facts. However, I think that one story about litigation that follows the 2015 death of a 95 year-old woman (reportedly a resident in a Georgia nursing home for some 4 years) from alleged complications associated with scabies, raises important questions from several perspectives. The questions include the roles of companies and individuals, including family members and caregivers, and about the state in its regulatory role.
Scabies, by the way, is a parasitic infection. Some of the news articles include copies of court pleadings. The facility denies all allegations of fault. Here is a television news clip that presents several key questions. Plus a word of caution, as the clip includes graphic details:
May 2, 2018 in Cognitive Impairment, Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0)
Tuesday, May 1, 2018
This proposed rule would update the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2019. This proposed rule also proposes to replace the existing case-mix classification methodology, the Resource Utilization Groups, Version IV (RUG-IV) model, with a revised case-mix methodology called the Patient-Driven Payment Model (PDPM) effective October 1, 2019. It also proposes revisions to the regulation text that describes a beneficiary’s SNF “resident” status under the consolidated billing provision and the required content of the SNF level of care certification. The proposed rule also includes proposals for the SNF Quality Reporting Program (QRP) and the Skilled Nursing Facility Value-Based Purchasing (VBP) Program that will affect Medicare payment to SNFs.
There's a provision for exceptions for SNFs when a disaster strikes (referred to in the proposed rule as "extraordinary circumstances") adding 42 C.F.R. 413.33(d)(4).
According to InsideHealthPolicy, in their article, CMS Proposes New Payment Model For Skilled Nursing Homes describes the changes: "CMS is proposing to overhaul the way Medicare pays nursing homes so as to focus more on each resident’s particular needs and move away from volume-based reimbursements, the agency said in a proposed rule released Friday (April 27). The new payment model would tie payments to patients’ conditions and simplify nursing homes’ reporting requirements...." (a paid subscription is required to read the full article).
My thanks to Dickinson Law Professor Laurel Terry for pointing us to an upcoming seminar offered by the American Bar Association on "Competency and Cognitive Decline in the Legal Profession: Ethical Pitfalls Encountered by Lawyers with Diminished Capacity," on May 9, 2018, from 1 to 2:30 p.m. (ET).
The promotional materials are a bit lean, but discussion topics are described as follows:
- Understanding the effects of aging on the human brain
- How to recognize some of the signs of diminished capacity
- The practical and ethical considerations for intervention
- Advice on how to facilitate discussion with the impaired person (or others who can help)
- Resources and ways to locate assistance in your area
- The importance of succession planning, and resources to help you develop or review your own succession plans
The speakers include Dr. Doris Gunderson, a psychiatrist in Colorado.
Co-sponsors of the program including the ABA Center for Professional Responsibility, its Commission on Law and Aging, the Commission on Lawyer Assistance Programs, the Section for Civil Rights and Social Justice, the Senior Lawyers Division, and the Solo, Small Firm and General Practice Division.
For more information on registering, see here.
Monday, April 30, 2018
My brother (thanks big brother-I guess this means you read the blog-yay!) sent me an article published in The Hill with an interesting proposal! Published on April 26, 2018, The poor need bank accounts, and USPS has the answer highlights a bill introduced by Senator Gillebrand which would create "provide a public option in basic banking services through the U.S. Postal System."
Why, you may ask, propose that the USPS get into the banking business? Well, because there is a "persistent problem of widespread financial exclusion, which means a household is either unbanked or underbanked. Recent data shows that 7 percent of households are simply unbanked since they lack a checking or savings account at a bank." Consider the implications of not having a bank account. If you have to cash a check, where do you go? "Instead, they have to rely on the predatory alternative financial services, such as payday lenders, check cashing services and the like."
The article also introduces us to the concept of "underbanked" which means "19.9 percent of American households ... at some point during the year, they rely on high-cost alternative financial services to meet their financial needs. That leaves over one-in-four American households excluded from mainstream financial services." Although these alternatives may work for those unbanked or underbanked, they are not without costs, both financial and otherwise.
The article discusses reasons why low-income households find themselves in this situation, including a focus on higher-profit activities and closing branches. So this is where the USPS comes in under the bill.
The Gillibrand bill seeks to address the lack of universal access through the creation of a postal bank. An added bonus of this measure is that it regulates consumer financial protection abuses by making predatory lending practices uncompetitive.
The bill would allow all households to open accounts at the post office, with a $20,000 limit on checking and savings accounts. Further, the bill allows for small-dollar loans capped at $500 at one time.
The rates on these loans are reasonable, with the bill linking the interest rates to the 1-month Treasury bill constant maturity rate, though a low, fixed rate may be preferable.
Through offering financial services at post offices, the bill would provide much of the physical infrastructure needed to counteract the trend of bank-branch closings. The USPS already has the geographic infrastructure to support universal access: a post office in every ZIP code.
The article offers suggestions for services as well as pitfalls. Interesting concept.
Recently the Washington Post ran an article about multigenerational homes increasing in popularity. Homes with multigenerational family members are a growing trend begins with a story of a three-generation family living in one household. So is that what it means to have a multigenerational household? "Pew Research Center defines a multigenerational household as one with grandparents and grandchildren or with two or more adult generations. The trend since 1980 is more people living in multigenerational homes, and a higher number of multigenerational households...." according to a Pew expert quoted for the article. In 2016 the article notes, 20% of Americans live in multigenerational households. This trend has even affected builders who are designing some homes to accommodate these families. But it's not all about the design, the article notes. There are costs, real and emotional, that come with multigenerational households. Design typically includes communal living spaces, such as a kitchen or living room. Compromise is the key to success here. As one of the families feeatured in the story offered
Thursday, April 26, 2018
In Continuing Care or Life Plan Communities, Do Operators Face Liability for "Failing" to Transfer Residents to Higher Levels of Care?
Just as spring is finally seeming to arrive in the Mid-Atlantic region and I'm catching up on non-classroom projects, I realized I hadn't fully understood the potential legal issues in a tragic fact pattern from last winter, when an 85 year old women died after being trapped overnight outside her home near Philadelphia in March. The legal issues are outlined in a suit filed against the CCRC where she was living in an "independent living" unit. The lawsuit claims her "caregivers should have known" that she needed more care, pointing to the contractual language that permitted the facility to assess and transfer her to a more supervised setting as her care needs increased. From the Philadelphia Inquirer on February 9, 2018 :
Her son, Blake Rowe, a drug company scientist, has filed suit against Shannondell at Valley Forge in Audubon and its security company, Universal Protection Service LLC, claiming that they should have done more to protect his mother. She had been allowed to stay in an independent-living apartment after Shannondell knew she had a tendency to become confused and wander aimlessly, the suit says.
“I put my trust in them. They said they would do an assessment they never did,” said Rowe, who got the “horrible” news that his mother was in the hospital as his plane landed in Florida for his honeymoon. As for the security company, he said, “If they were doing their rounds, someone would not be at a door for five hours freezing to death.”
Ironically, I often hear from family members protesting the compelled transition of a resident to a higher level of care, as the family members may disagree more help is needed, or feel the help can be provided adequately "in" the independent living unit. The Inquirer article summarizes the dilemma for operators and families:
The Hinds case also illustrates a trend in senior housing — at all levels of care, including independent living, residents are older and have more health problems than in the past — with safety implications that may surprise families. Most seniors want to be as independent as they can for as long as they can. Families shopping for senior apartments may want to look beyond the quality of the food or beauty of the grounds and ask what will happen when a loved one declines: Were your buildings and security designed with dementia in mind? Whose job is it — the family’s or the facility’s — to start the conversation when a resident needs more help?
For more on the "Hinds" case, see His Elderly Mother Wandered Out Into the Cold and Died. Whose Fault Was It?
April 26, 2018 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Housing, State Cases, State Statutes/Regulations | Permalink | Comments (0)
The San Jose paper, the Mercury News ran an important story about the impact of dementia on life savings. This isn't something new to elder law attorneys, but it's an important recognition of how Medicare covers health care based on a diagnosis. How dementia can drain a family’s life savings offers this heading " Medicare offers no help for the high costs of dementia caregiving." We know that Medicare has certain requirements for coverage. As the article explains it
”Medicare is a lifeline for seniors and the disabled, paying for “medically necessary” costs such as hospitalization, surgery, chemotherapy, transplants, medications, pacemakers and other interventions... A dementia diagnosis demands none of that. What it does require, however, is around-the-clock “custodial care,” such as help with eating and dressing, and constant supervision. That’s not covered by Medicare. And it’s extraordinarily expensive, according to a report released last month by the Alzheimer’s Association...Families’ out-of-pocket costs for a patient with dementia are 80 percent higher than the cost for someone with heart disease or cancer, according to a 2015 study in the Annals of Internal Medicine.
How much can families expect to spend caring for those with dementia? The story says 60 BILLION (yes that's not a typo-60 BILLION) based on a report from the Alzheimer's Association. That doesn't include those who have early onset Alzheimer's.
The options are few for those with this diagnosis. Long Term Care Insurance, paying privately, Medicaid quite possibly, but really not Medicare unless there is a hospitalization. Forget home care or memory care being covered by Medicare, the article notes.
This is not a new issue but it's certainly becoming a bigger issue with the significant number of Boomers. Read the article. It's important!
Happy Friday! If you haven't read the latest issue of BIFOCAL, the publication of the American Bar Association Commission on Law & Aging, check it out here. This issue contains 6 articles, including the implications of the tax bill on older Americans, POLST issues to avoid, the new Medicare cards, a book review, and a preview of the 2018 NALC conference. Access the latest issue here.
April 26, 2018 in Advance Directives/End-of-Life, Books, Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare, Programs/CLEs | Permalink | Comments (0)
Wednesday, April 25, 2018
On April 24, 2018, members of the Organization of Residents Association of New Jersey, or ORANJ, held a plenary meeting at Cedar Crest Retirement Community in Pompton Plains, New Jersey. ORANJ President Ron Whalen began the meeting with an update on pending legislation attempting to resolve residents' concerns about timeliness of payments on "refundable fee agreements." Part of the message is reflected in the history of Pat Lund, a resident of a CCRC in Waterford Township, New Jersey, who waited eight years for her "refundable fee" to be paid after moving out of her apartment. Under the terms of her contract, the refund was not "payable" until someone else occupied her specific unit but the facility seemed to have little interest or incentive to market her particular unit. For more on this topic, see my update post from last week. As summarized by Ron Whalen, "many of the 10,000 New Jersey residents in CCRCs (also known as Life Plan Communities or LPCs) have this type of contract."
James McCracken, the new president and CEO of LeadingAge New Jersey was the afternoon speaker and he provided a roundup of topics affecting older adults in New Jersey as the legislative season draws to a close, including concerns about "earned sick leave," delayed Medicaid payments by the state to care facilities, proposed minimums on CNA staffing at care facilities, and changes to minimum wage.
I spoke in the morning about issues I see affecting CCRCs and LPCs nationally and in New Jersey, including topics that challenge tax-exempt CCRCs, such as pressure to make payments in lieu of taxes to state and local authorities. On the topic of resident concerns, I addressed what I call the "big three": lack of transparency on cost and funding issues, the need for effective resident voices in governance, and excessively paternalistic attitudes of some management.
This is at least my third time speaking with ORANJ members over a period of several years, and each time I visit I'm impressed with the strength of their resident organization and their ability to get the state legislature to listen. ORANJ helped their state to be one of the first to get legislative support for CCRC residents gaining the statutory right to serve as voting members on boards of governance, and ORANJ advocacy was also instrumental in passage of an enhanced "bill of resident rights" for CCRC operations.
New Jersey has approximately 40 CCRC/LPC communities within the state. Some 87 percent operate as not-for-profit, while another 13 percent are for profit. The majority of the communities are now part of "multi-site" organizations, and I spoke with several residents who reported on pending conversions of not-for-profit to for-profit.
April 25, 2018 in Consumer Information, Current Affairs, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Housing, Property Management, Retirement, State Cases, State Statutes/Regulations | Permalink | Comments (0)
Kiplinger offers a quiz for you to test your knowledge of Social Security. Do You Really Understand Social Security? offers a ten question quiz with explanations. After you take that quiz, then take the Do You Know the Best Social Security Claiming Strategies? another 10 question quiz with explanations. These would also be really good to have students take to test their knowledge after you have covered Social Security in your courses.
Tuesday, April 24, 2018
We have had several blog posts about the issues with Medicare's Observation Status. A recent story on NPR (thanks to our friend Professor Naomi Cahn for sending it to us) gives us a first-person account of the impact observation status has on a patient's checkbook. How Medicare's Conflicting Hospitalization Rules Cost Me Thousands Of Dollars tells the story of a daughter who had to pay $12k for a nursing home stay for her mother's care because her mother didn't have a qualifying three-day hospital stay even though her mother was in the hospital for 4 nights. Why wouldn't Medicare pay? Say it with me now-observation status. As the daughter relates, her "mother was caught in an administrative wonderland where she slept at a hospital for four nights, but the paperwork said she was an inpatient only one of those nights. Medicare's rules, dating back to the 1960s, require people to spend three nights in a hospital before the federal program will pay for inpatient rehabilitative care." She notes her frustration with the explanations that focused on rules rather than her mother's medical care:
The doctor couldn't admit her as an inpatient because she didn't have a qualifying diagnosis.
Her status was changed from observation to inpatient on the third day because Medicare requires that.
They could not change her status to inpatient for the entire stay because they didn't want to be audited.
She couldn't go to acute rehabilitation, which Medicare pays for, because there was no evidence she had had a stroke or heart attack.
She describes the competing Medicare Rules that produce this dilemma, and hospitals' concerns about audits. She also describes software that hospitals use to decide whether to admit a patient or maintain the patient on observation status. To admit or not to admit, that is the question! (with apologies to William Shakespeare). This long-standing problem rule is well-known, and Congressional bills to fix it haven't gotten traction, she writes. Why not shelve the three-night requirement? The article mentions money as a likely explanation, but it appears that it is not 100% certain that is the reason, as the author cites to two studies from the '70s.
Regardless, I do think we can agree that the requirement catches some folks off guard (despite the NOTICE Act) and costs many folks who need SNF care subsequently a lot of money.
For more on the issue of observation status, visit the Center for Medicare Advocacy.
Monday, April 23, 2018
You've heard the phrases such as "60 is the new 40." Now we learn there may be some truth to the thought that you feel younger than your chronological age.The Washington Post recently published this article, Cliches about only being as old as you feel are starting to have scientific backing.
The article focuses on research that indicates many folks who are older feel good about themselves and about the negative messages about aging that affect us all. The article references "[o]ne study ... [that] found that as people get older, they consistently say they feel younger — much younger — than their actual age. Another study examining the attitudes of the offspring of centenarians concluded that the centenarians’ children — if they, too, were healthy and long-lived — have a strong sense of purpose and meaning to their lives, compared with the general population. Finally, there is evidence that positive attitudes about aging may reduce the risk of dementia, among the most dreaded consequences of aging." Yet, we start being bombarded with negative messages about aging at a very young age. One expert noted that kids even age 3 or 4 already have absorbed "the age stereotypes of their culture,” which it seems come from "many sources, ranging from stories to social media. Individuals of all ages can benefit from bolstering their positive images of aging.” Another expert quoted in the article explains that “[n]egative views about aging are communicated to us early in life, through media, books and movies, and what our friends and family tell us... [and that such] attitudes are present and pervasive already in childhood, so naturally it’s hard to enact meaningful change to these attitudes....”
Several studies are referenced in the article. The studies bear out the idea that folks who are older feel younger than their chronological ages, but as far as younger people's perceptions, they consider old to be a lower number than those who are old would offer. For example, one researcher offered that "teenagers and young adults equated turning 50 with hitting old age."
And we've all heard the saying about attitude is everything. It turns out those with positive views of aging help with reducing stress and decreasing chances of dementia. One research summarizes her findings: She "evaluated 4,765 older people — average age, 72 — who were free of dementia at the start of the study and followed them for four years. The participants answered a series of questions about their beliefs about aging [and the researchers] found [that] those who expressed more-positive age beliefs at baseline were less likely to develop dementia . . . than those who expressed more-negative age beliefs...."
So remember, the class is half-full and aging is not a bad thing!
Friday, April 20, 2018
Recently the Washington Post published an article comparing generational alcohol intake. Teenagers and college-age people drink less while this group pours another round opens with this observation "[e]xperts on alcohol abuse have found one demographic group that’s drinking at an alarming rate. Not teenagers. Not college-age people. It’s baby boomers." The first few paragraphs of the article focus on younger individuals and then turns to Boomers, noting that it's "been known for half a century is that baby boomers tend to like alcohol more than the “silent generation” that preceded them."
"Researchers see a steady rise in alcohol use and binge drinking — as well as what’s known as Alcohol Use Disorder (AUD), an umbrella term for mild, moderate and severe abuse of alcohol — in the 65-plus demographic. Between 2005 and 2014, the percentage of older Americans who reported engaging in past-month binge drinking (defined as women consuming four or more drinks in about two hours, and men consuming five or more) increased from 12.5 percent to 14.9 percent ... [and] [t]he increase in drinking among older Americans is most pronounced among people with greater levels of education and income, and among women.... At continuing care communities, alcohol is typically available as a social lubricant for the majority of residents who haven't graduated to assisted living...."
according to one expert quoted in the article.
One thing that is implicated in this is the perception or impression that moderate alcohol consumption is healthy. "[M]any boomers have embraced the notion that moderate drinking is good for them, compared to abstaining. The evidence there is mixed. A number of studies have shown a reduction in heart attacks among moderate drinkers. But a new study published in the Lancet last week showed no overall improvement in life expectancy among people who had one drink a day compared to those who abstained, and a decrease in life expectancy with any additional drinking. The study's authors concluded that the reduction in heart attacks was offset by other health risks."