Friday, September 2, 2016
I'm frequently asked by current students or recent graduates to serve as a reference and usually I'm happy to do so. I like it when students provide me with basic information, reminding me what classes they took with me, giving me their most recent resume and a copy of their transcript. Students who have taken the time to chat with me outside of class over the course of their law school careers help me provide relevant information to prospective employers about their strengths and plans.
Students who showed initiative in their studies earn strong references. Did the student "coast" with "easy A" courses, or did they seek out the courses truly relevant to their goal positions? Do they have a polished writing sample? Have they taken appropriate leadership roles in organizations? Are they hard working, punctual, willing to do second (third?) drafts?
What skills are you looking for from prospective lawyers?
My dear friend and colleague Professor Mark Bauer sent me this article from the Huffington Post about the newest market share for Uber and Lyft: Boomers! Once The Domain Of Millennials, Uber And Lyft Are Now Pursuing Seniors includes my favorite line of the day about Boomers: "It’s the Baby Boomers’ world. We’re just living in it."
"Ride-hailing services want to make sure Grandma Betty can get to bridge club just as easily as her 22-year-old grandson travels to and from ... whatever it is young folks are doing these days. ... Once the domain of 20-somethings who might have a drink or two and need a safe ride home, companies like Lyft and Uber have set their sights on a different age range entirely: senior citizens."
The article explains how the 2 companies have entered into agreements with companies-Uber with a home care company and Lyft with a company that books rides for elders without smart phones. The article notes that there are also other ride-hailing companies beyond these 2 that are providing ride-sharing services for those elders who don't have smart phones.
The companies are boldly moving into this market demographic. In fact they've started "offering non-emergency medical transport services, specifically targeting customers whose rides would be reimbursed by Medicaid."
Consider also what Lyft is doing with the city of Centennial, Colorado, "where 15 years from now at least 30 percent of the population is projected to be over the age of 65....[C]ity officials are exploring replacing current dial-a-ride services with less expensive, more efficient rides via Lyft."
“We call Centennial the Silver Tsunami,” Centennial Mayor Cathy Noon told The Atlantic blog CityLab. “As people age, one thing to go is the ability to drive. That means losing your freedom to get to doctor’s appointments and to stay social with friends. We really want to help keep the people who started Centennial engaged in it.”
We all know how the loss of driving ability can impact a person on a number of levels. I wonder whether this transportation option will be financially feasible enough to become a widespread solution. If so, it will be great, because not only does this provide transportation, but has the added benefit of socialization. I am still holding on for the availability of self-driving cars.
Thursday, September 1, 2016
A recent report about Boomers and voting made be stop for a moment and go "hmmmm". Pew Research Center's latest FactTank offered that this may be the last presidential election where the Greatest Generation, the Silents and the Boomers have a significant impact at the polls.
This may be the last presidential election dominated by Boomers and prior generations explains that although these demographic groups have dominated at the polls, that may no longer be true; "their election reign may end this November, according to a new Pew Research Center analysis of census data."
[T]he ranks of Millennial and Generation X eligible voters have been growing, thanks to the aging-in of Millennials and naturalizations among foreign-born adults. These generations matched Boomers and previous generations as a share of eligible voters in 2012 and are now estimated to outnumber them. As of July, an estimated 126 million Millennial and Gen X adults were eligible to vote (56% of eligible voters), compared with only 98 million Boomers and other adults from prior generations, or 44% of the voting-eligible population.
However, keep in mind that eligible and actual are not synonymous. In fact, the article reminds us what ultimately matters is who casts ballots. Looking at the data and focusing on actual votes, the report offers that the Boomers and prior generations voted at a rate of about 70% of eligible voters. The younger generations percentage turnout was lower, according to the article.
Not that the generations are in competition or anything. It's just interesting to think about the changing demographics at the ballot box and wonder at the impact on laws and policies as a result.
Among those in the oldest living generation, the Greatest Generation, turnout crested in the 1984 election at 76% before declining. Similarly, turnout among eligible voters in the Silent Generation peaked at 76% in the 1992 election. The Millennial and Gen X generations are likely still on the upswing in terms of their turnout rates, so it is a reasonable guess that at least 54.5% of these adults will vote, and perhaps more.
We won’t know until after November if Boomers and their elders will pass the torch to Gen X and Millennials as a share of voters, but all the available data suggest that the 2016 election will mark the beginning of a new era for U.S. presidential elections.
Giving more evidence of the potential impact of aging boomers in America, officials in Humboldt County, a North Coast county in California, describe potential shutdowns of three area nursing homes as potentially "catastrophic." The reason for the closures? The problem isn't lack of residents. Operators find it difficult to attract adequate personnel, especially CNAs, needed to staff the care facilities. From the North Coast Journal article describing the latest problem:
Rockport Healthcare Services, the management company for five of Humboldt County's six skilled nursing facilities, announced today that they have filed relocation notices for three sites: Pacific, Seaview, and Eureka Rehabilitation and Wellness Centers. The relocation notices, filed with the California Department of Public Health, are the first step in closing these facilities, which collectively contain 258 beds, and relocating their patients.
Stefan Friedman, spokesperson for Rockport, said in a statement that the company is continuing to work with community partners to "find a solution to [a] severe staffing crisis," but it is possible that after public health approves their relocation notice they will shut down the facilities.
That, said Area 1 Agency on Aging ombudsman Suzi Fregeau, would be "catastrophic."
Although many patients stay only briefly in skilled nursing facilities, receiving rehabilitation after leaving the hospital, the facilities are often the last stop for patients who cannot afford in-home healthcare professionals and need 24-hour care. Their vital role in the continuum of care was felt last year, when the facilities — five of which are owned by the same company, Brius Healthcare — stopped accepting patients. Hospital administrators, hospice workers and families all felt the pinch, and many North Coast residents had to go to facilities far away from Humboldt County. Fregeau said the potential closure will be even worse.
"It means that residents are going to be placed in facilities a minimum of 150 miles away," she said. "People are going to be dying in communities they’ve never lived in."
Sad to think that some of the prettiest areas of California are struggling with attracting and keeping adequate numbers of trained people.
Wednesday, August 31, 2016
As we first reported here almost a year ago, the segment of the senior living community traditionally identified as "Continuing Care Retirement Communities" or CCRCs is working on rebranding. Under the leadership of the trade organization LeadingAge, the preferred name is Life Plan Communities.
ORANJ, the catchy acronym for the very active Organization of Residents Associations of New Jersey, publishes quarterly newsletters and their Fall 2016 issue includes demographic and marketing reasons behind the name change. The issue includes an essay by Brian Lawrence, President and CEO of Fellowship Senior Living on Why and How Life Plan Communities Are Evolving.
Monday, August 29, 2016
PACE programs can be a great thing for certain Medicare beneficiaries, but the popularity of PACE programs hasn't seemed to grow as much as one might think. The New York Times ran a story on August 20, 2016 about the for-profit model for PACE programs. Private Equity Pursues Profits in Keeping the Elderly at Home explains that "[u]ntil recently, only nonprofits were allowed to run programs like these. But a year ago, the government flipped the switch, opening the program to for-profit companies as well, ending one of the last remaining holdouts to commercialism in health care. The hope is that the profit motive will expand the services faster." Is there a significant demand for PACE programs with the Boomers doing their aging thing? Is a for-profit model the way to go to provide the type of services needed by PACE participants?
The article discusses these issues and presents both sides. Recall that "[t]he goal of the program, known as PACE, or the Program of All-Inclusive Care for the Elderly, is to help frail, older Americans live longer and more happily in their own homes, by providing comprehensive medical care and intensive social support. It also promises to save Medicare and Medicaid millions of dollars by keeping those people out of nursing homes."
The article also discusses the possible role of tech in providing care, but notes the importance of socialization. CMS had a pilot before approving the for-profit model and is going to keep an eye on things.
The for-profit centers were approved, to little fanfare, after the Department of Health and Human Services submitted the results of a pilot study to Congress in June 2015. The demonstration project, in Pennsylvania, showed no difference in quality of care and costs between nonprofit PACE providers and a for-profit allowed to operate there.
The Centers for Medicare and Medicaid Services has vowed to closely track the performance of all PACE operators by measuring emergency room use, falls and vaccination rates, among other metrics. The National PACE Association, a policy and lobbying group, is also considering peer-reviewed accreditation to help safeguard the program. Oversight is now largely left to state Medicaid agencies.
Kaiser Health News (KHN) ran a story about the benefits of training caregivers to give care. Teaching In-Home Caregivers Seems To Pay Off explains that "[u]nder a pilot program, nearly 6,000 aides in Los Angeles, San Bernardino and Contra Costa counties were trained in CPR and first aid, as well infection control, medications, chronic diseases and other areas. All were workers of the In-Home Supportive Services program, who are paid by the state to care for low-income seniors and people with disabilities, many of them relatives." As a result of the training? Emergency room visits and hospital admissions were down for this group.
We all know the need for caregivers is rising. So having well-trained caregivers seems to be a no-brainer. Yet, the article reminds us, "[t]here are currently no federal training requirements for in-home caregivers, even if they are paid with taxpayer dollars. Around the country, however, training programs have been developed and tested, according to the Paraprofessional Healthcare Institute, an advocacy group that also provides training. Among the states that have tried different types of instruction are Massachusetts, North Carolina and Michigan." Caregivers do a lot of tasks for the elders in their care, and many caregivers are unpaid family members. But, "some states pay caregivers for eligible low-income residents through their Medicaid programs." The article offers some details about the training program. "The results of the study show that caregivers play a pivotal role in helping keep people out of the hospital...."
Friday, August 26, 2016
The long-term care industry depends hugely on the services of "nursing assistants," also known as NAs, who provide basic but important care for residents or patients under the direction of nursing staff (who, in turn, are usually Licensed Practical Nurses or Registered Nurses). As the U.S.Department of Labor describes, NAs typically perform duties such as changing linens, feeding, bathing, dressing, and grooming of individuals. They may also transfer or transport residents and patients. Employers may use other job titles for NAs, such as nursing care attendants, nursing aides, and nursing attendants. However, the Department of Labor makes a distinction between NAs and other key players in long-term care, including "home health aides," "orderlies," "personal care aides" and "psychiatric aides."
According to DOL statistics, the top employers of NAs include skilled nursing facilities (37% of NAs), continuing care retirement communities and assisted living facilities (together employing some 18% of NAs), and hospitals and home care agencies, which each employ about 6% of the NA workforce.
For many years, states have offered licensing for nursing assistants. The designation of CNA or "certified nursing assistant" meant that the nursing assistant had satisfied a minimum educational standard and had successfully passed a state exam. As another key protection for vulnerable consumers, CNAs had to pass background checks, involving fingerprints and criminal history searches.
In Arizona, however, now I'm hearing a new label: LNAs or Licensed Nursing Assistants. The Arizona Board of Nursing continues to license CNAs, but now it is offers the designation of Licensed Nursing Assistants. What's the difference? Frankly, not much, at least in terms of skill levels. Then why the change?
In Arizona, CNAs and LNAs have the same educational requirements, and must pass the same test and satisfy the same work credits. But, as of July 1, 2016, individuals seeking the LNA designation will be required to pay the state a fee to cover their mandatory background checks, including fingerprinting. CNAs, however, will no longer be required to undergo background checks or fingerprinting.
What is this about? Arizona is trying to save money. It seems that state and federal laws prohibit state authorities from mandating that CNA candidates cover the cost for their own background checks. In other words, if the candidate showed financial need in the application process, the state was required to pick up the costs for any background checks. Let's remember that the average wages of CNAs are relatively low -- the national mean is less than $30,000 per year. Presumably that is the reason behind the older laws limiting how much states can charge CNA applicants for their own background checks. By creating a new designation, LNA, Arizona takes the position it avoids the federal restriction.
But, what about the public? Will the public understand that CNAs licensed after July 1, 2016 will not be subject to fingerprinting and background checks? Responsible employers would, presumably, require such checks or limit their hires to LNAs. At least, let's hope so.
I also learned that apparently Arizona does not require "continuing" education for either CNAs or LNAs. (Again, you would hope that responsible employers would either provide or require such education.) Arizona used to require a minimum of 120 hours every 2 years of what are, in essence, "job credits" -- i.e., proof of employment in an NA position -- to maintain the CNA license. Recently, however, Arizona diluted that requirement to just 8 hours every two years for both CNAs and LNAs.
Arizona does have a useful website where current or prospective employers, including families, can check the licensing status of CNAs or LNAs. The website is searchable by name or license number, and shows whether an applicant has failed the entrance exam, or has withdrawn an application or lost the license.
Are other states creating this LNA designation as a "workaround" (loophole?) for financing background checks for CNAs? Let us know!
August 26, 2016 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)
Thursday, August 25, 2016
I was happy to see Nike's latest commercial for its Unlimited campaign featuring the triathlete dubbed the Iron Nun. According to an article in the Huffington Post, "Buder said that she manages to fit her training for these races in with her daily life. The sister, who is part of a nontraditional religious order called the Sisters for Christian Community, runs to her church in Spokane, Washington. She also runs to the local jail, where she volunteers to chat with inmates." I suspect the narration for the commercial is intended as amusing since it relies on aging stereotypes, but the Sister's accomplishments blow those stereotypes out of the water. Ad of the Day: Nike Celebrates the 'Iron Nun', an 86-Year-Old Triathlete With God on Her Side features the ad, as well as the behind the scenes interview with the sister without the narration. The quote I liked from Sister Buder: "the only failure is not to try". Huffington Post quotes from an article on her in Cosmo, "Don’t pay attention to how old you are, only focus on how old you feel ... And be patient — one of my worst enemies is patience, I’m still trying to fine-tune it so that I’m able to stop and smell the roses.”
Kudos Sister for your accomplishments!
Last week we blogged about those elders who have no kids to be their caregivers. The Washington Post featured an article on the topic of "aging solo". Aging Solo: Okay, I don’t have a child to help me, but I do have a plan, told from the perspective of the author, is an attention-grabber from the beginning
“The trouble is: You think you have time.” That Buddhist-sounding quote from a fortune cookie rattled around the back of my head for decades, seemingly for no reason. Now that I find myself living with my 94-year-old mother in a Florida city where preacher Billy Graham got his start and being a never-wed 60-something has made me a tourist attraction of sorts, I finally understand why I thought the repercussions of growing old without a child or two would not apply to me: I was just plain delusional.
As a New Yorker flush with friends, freelance work, Broadway tickets and great Botox, I had apparently existed in some sort of fun, singles bubble. It was a lifestyle so rewarding that I never read even one article about the stresses of the “sandwich generation.” (Hey, the writers all seemed to be married women with children, so even on a boomer-to-boomer level, I could not relate.)
Of course she's not alone. The article provides statistics--almost 33% of the Boomers have no kids. "That doesn’t count boomer parents who have lost a child or have one who is severely impaired. The Aging Solo pool also includes countless members of families plagued by addiction, disease, cults, rapacious children, even married progeny who much prefer their in-laws. While millions of Aging Soloists have siblings and other kin, many of us can’t imagine (or abide) having them shepherd us to our final rest."
The author calls for an aging plan with friends rather than kids, and using her parents' story as educational, she offers this advice "When you’re past 50 and single, location is 75 percent of the enchilada. Subways matter. Proximity to friends matters. Suburban seniors communities felt to me like slow death. I found senior centers and assisted-living facilities profoundly lonely because, it seems, the art of making friends does not grow as we age, and not everyone likes endless bingo and dominoes on Tuesdays, followed by a prayer service."
She goes on to offer further tips
It’s better to plan a more personal assisted-living future with your own friends while in your 50s or 60s. That will give you time to choose a location with diverse people and culture, with neighborhoods that have sidewalks and public transit....
Sharing resources can spawn all sorts of possibilities. Maybe my posse grabs several apartments in rental, condo or co-op buildings, or we share a group house in D.C., Manhattan or L.A. Heck, maybe we can find a way to lease a floor in one of the many overbuilt office buildings around the country. Perhaps (if yours is an anti-urban posse) you can hire an architect to design space-age yurts in Arizona. Each madly hip structure would be self-contained, but the colony would have a common dining hall, gym and tech-support center, or whatever your future selves desire.
New to the finances of aging, I had no idea how much control I gained by holding my mother’s durable power of attorney. Had I been less ethical, I could have taken her money and run. Therefore, I’ll never give that power to any one person; it will be held by at least three younger and devoted friends because elder fraud is one of the most horrifying aspects of aging solo. Trust me: That charming new friend who offers to manage your money so you don’t have to deal with “all those bills” is probably well known to the local police.
So what is the author doing to prepare for her aging without kids? She explains
What am I doing? Well, I’ve started small, using Skype dialogues with my pals to research and download the legal papers — from wills to end-of-life instructions — that we will need, sooner or later. Now we’re aiming higher. Should we learn what to look for in a nurse’s résumé so we can find the right person to help us in our collective dotage? Should we hire a visionary architect to create a high-tech trailer park or a cluster of tiny homes built around communal buildings? Our ideas are still all over the map.
We hope we have time to execute our most appealing visions. Mostly, however, we pledge to be our own Best Friends. United. Forever....
Wednesday, August 24, 2016
The Kaiser Health Network (KHN) and U.S. News ran a story in July about elders' admission to hospitals. They may be sicker on admission and when discharged, may not be able to care for themselves, needing help with ADLs. Elderly Hospital Patients Arrive Sick, Often Leave Disabled focuses on how hospitals care for elders, and a "trend" to create a special unit just for patients who are elderly.
How hospitals handle the old — and very old — is a pressing problem. Elderly patients are a growing clientele for hospitals, a trend that will only accelerate as baby boomers age. Patients over 65 already make up more than one-third of all discharges, according to the federal government, and nearly 13 million seniors are hospitalized each year. And they stay longer than younger patients.
Many seniors are already suspended precariously between independent living and reliance on others. They are weakened by multiple chronic diseases and medications.
One bad hospitalization can tip them over the edge, and they may never recover, said Melissa Mattison, chief of the hospital medicine unit at Massachusetts General Hospital. “It is like putting Humpty Dumpty back together again,” said Mattison, who wrote a 2013 report detailing the risks elderly patients face in the hospital.
If one considers the special circumstances for elder patients, it makes sense that hospitals may want to be prepared for these patients. But, the way the medical system works currently, "the unique needs of older patients are not a priority for most hospitals... Doctors and other hospital staff focus so intensely on treating injuries or acute illnesses — like pneumonia or an exacerbation of heart disease — that they can overlook nearly all other aspects of caring for the patients" according to one expert quoted for the article.
Some hospitals have special units for these patients, referred to as Acute Care for Elders (ACE) units. "ACE units have been shown to reduce hospital-inflicted disabilities in older patients, decrease lengths of stay and reduce the number of patients discharged to nursing homes. In one 2012 Health Affairs study, ... researchers found that hospital units for the elderly saved about $1,000 per patient visit." Not only do these units save money, according to the article, patients in these units seem to be better when discharged.
If you discuss this in class, have your students find out whether any of the local hospitals have a similar unit. It makes a difference.
Tuesday, August 23, 2016
This is a story of now you need it, now you don't. Social Security recently required that a person have a cellphone to use the online benefits services. The New York Times ran an article about this requirement that went into effect at the end of July, 2016. Social Security Now Requires Cellphone to Use Online Services explains that SSA makes it mandatory to have an access code sent by text to the recipient's cellphone. The article notes that this requirement "may create hurdles, however, especially for older Americans, who are less likely to use mobile phones. About 78 percent of people 65 and older own a cellphone, compared with 98 percent of 18- to 29-year-olds, according to 2015 data from the Pew Research Center." Still almost 80% of elders have a cell phone-a good number, but that doesn't mean that those with cellphones use text features. The article features a variety of complaints, including the lack of advance notice. The article includes some FAQs, as well as a link to a website on where to get help (at least it's a website, not a cellphone #).
Now for the now you don't part of this story. Recall the quote in the prior paragraph "may create hurdles".... So within two weeks of the regulation taking effect, Social Security has stopped it, for now. The New York Times ran a follow up story explaining the suspension:
After an outcry from older Americans, as well as a letter from two United States senators, the agency backed off the cellphone-based code requirement.
“Our aggressive implementation inconvenienced or restricted access to some of our account holders,” said a statement emailed by an agency spokesman, Mark Hinkle. “We are listening to the public’s concerns and are responding by temporarily rolling back this mandate.”
Note the use of the word "temporarily" because Social Security is continuing to increase security to protect beneficiaries' information and will "introduce alternative authentication options, in addition to texting, within the next six months." The FAQ for this article notes that beneficiaries can opt-in to text-verification now, it's just not a requirement.
Philadelphia to Host the 27th Annual National Adult Protective Service Assoc Conference, August 29-31
Recently I received an email reminder from ElderLawGuy Jeff Marshall that Pennsylvania is hosting this year’s National Adult Protective Service Association (NAPSA) Conference from August 29 through 31 at the Loews Hotel in Philadelphia. The conference will feature many of the nation’s leading adult protective services professionals who will share their ideas, expertise and creative approaches, with workshop sessions for brainstorming application of new ideas. More details, including information about CLE credits, are available here. Immediately following the NAPSA conference, in the same Philadelphia location, is the 7th Annual Summit on Elder Financial Exploitation, on September 1.
These national meetings come at a time when elder abuse and elder justice have been the subject of growing attention in Pennsylvania, as well as around the nation. It seems fitting that Philadelphia is hosting the national meeting, as it follows a months-long Task Force analysis of the role of Pennsylvania court systems in helping to protect at-risk seniors or other vulnerable adults.
Sunday, August 21, 2016
Did you know there is such a thing? The New York Times recently ran an article, More Older People Are Finding Work, but What Kind?, that features a new brief from the Center for Retirement Research. The Times article explains
As men and women 55 and older looking for employment probably suspect, at a certain point the kinds of jobs available to them narrow significantly. New research by Matthew Rutledge, an economist at the Center for Retirement Research at Boston College, found that they are increasingly being funneled into what he describes as “old-person” jobs.
And not surprisingly, older workers with the least education have the narrowest set of opportunities, though Mr. Rutledge found this effect was small.
It turns out that “old-person” jobs are a mix of high-skilled service work (like managers, sales supervisors and accountants) and low-skilled service work (like truck drivers, janitors and nursing aides). Absent from the top of the list are jobs calling for a fair amount of physical labor. Jobs in farming, manufacturing and repair represent less than a quarter of all new hires in this age bracket.
The brief from CRR, How Job Options Narrow for Older Workers by Socioeconomic Status offers these findings
Job-changers over age 50 increasingly end up in “old-person” jobs, with a high share of older hires relative to prime-age hires.
These basic findings hold by gender and by education.
However, the overall outlook has improved since the late 1990s for all groups, particularly for older women with more education.
Also, older job-changers hired into “old-person” jobs are paid no less than other jobs.
The full brief, available here as a pdf, examines "suitable" employment, with the introduction explaining
The ability of older job-changers to find "suitable" employment affects both their current income and their ability to work long enough to secure an adequate retirement income. One measure of suitable employment is the range of occupations available to them. This brief, based on a recent study, assesses the extent to which occupational options narrow for workers as they age from their early-fifties to their mid-sixties and whether the pattern varies by gender or socioeconomic status, as measured by education level.
Back to the Times article, which lists most and least common "old person" jobs (hint-lawyers are in the "least common" category). The Times story also discusses several other studies regarding elders in the work force. This would be a great article to include in an unit on economic security or in a discussion regarding ageism.
Friday, August 19, 2016
We have all heard stories about SSA determining that a beneficiary is dead, when the beneficiary isn’t. Proving you are very much alive has to be a fun experience (just joking in case anyone from SSA is reading this blog). Usually the stories about someone being “SSA-dead” is limited to a person. The Washington Post recently ran a story about a group of beneficiaries being declared dead by SSA. Dead or alive? Social Security misclassified some explains “Social Security officials have discovered 90 cases in their records where the living were listed as deceased. That’s 90 “as of today,” Mark Hinkle, an SSA spokesman, said late Thursday. “We are not yet sure how many were in error.” The 90 are from a group of 19,000 cases.” Note that means more of the 19,000 may be “SSA-dead”.
There is some humor in all of this (the 90 of you declared SSA-dead, my sympathies (no pun intended folks--sympathies for the hassle) and really I’m not making light of your situation). “Ironically, the erroneous cases are from pilot projects in Virginia, North Dakota and South Dakota, designed “to enhance the quality of our death records,” Hinkle said. … Clearly, there is more work to be done on that point.”
Clearly this is no laughing matter if you are one of those declared dead-there are significant financial implications, including a loss of benefits. Plus other federal agencies get death info from SSA, so the impact is more widespread than just SSA. SSA is on it, and as for those other folks who may be SSA-dead and not know it, “SSA plans to send letters to the 19,000 people potentially affected with information on how to find out if the agency thinks they are dead and how to correct the record if that’s the case.”
I’m just saying, if you live in VA., ND or SD and get a letter from SSA in your mailbox, you may want to sit down before you open it…
Here's a happy story to end the week. Huffington Post's Post50 ran a story last week about a lucky lottery winner. 95-Year-Old Woman Uses Lottery Winnings To Join 21st Century features the winner of a scratch-off ticket who plans to buy herself an upgraded cell phone. "Once it had all sunk in, the great-grandmother quickly began thinking about how she’d spend the cash. In the end, she decided to buy a great treat for herself: a new smartphone." Now granted, smartphones don't cost $30,000 (the amount of her winnings) so the article notes she plans to put the rest in a trust for her family. She explained, "“I’m 95 and there’s not a hell of a lot more I can keep doing with it...."
I'm always just a bit suspicious of books that promise to make me laugh. I think it is because I like to be surprised by humorous moments, rather than feel duty-bound to chuckle, guffaw or giggle.
Nonetheless, I succumbed to the promise in the blurb for Michael Kinsley's 2016 book, Old Age: A Beginner's Guide, that it was a "surprisingly cheerful book ... and a frequently funny account of one man's journey to the finish line."
And I'm glad I did. I did indeed laugh, and at the most surprising of moments, as when he described the need to avoid the doors of his refrigerator because of the magnets that might interfere with the technology in his brain used to keep symptom of Parkinson's Disease at bay. He has the knack of making wry observations about his own mortal state to think broadly about what it is for all of us to age. I can see the short essays that make up this book being useful in a class on elder law or estate planning.
His words are perhaps most poignantly relevant to boomers. For example, on a goal of living longer, he writes:
Even before you're dead, you may want to ask yourself whether this is what you really want. Is being alive all that desirable if you're alive only in the technical sense? Millions of boomers are watching their parents fade until they are no longer there. As they approach their seventies, they start observing their own peer group losing their collective marbles, one at a time. And they reasonably conclude that the real competition should not be about longevity. It should be about cognition.
But he doesn't stop there, exploring other, potentially more important goals for the competitive boomer generation to consider.
This is a short, deep book. And I recommend it, not least of all because it gives readers welcome opportunities to smile.
Wednesday, August 17, 2016
Investment News ran a timely article about the various Medicare enrollment periods. The alphabet soup of Medicare enrollment periods explains the initial enrollment period and special enrollment periods. It also explains succinctly how employer group health plans and Medicare interface as far as the special enrollment period.
If you have coverage through your employer or your spouse's employer consider:
• The employer provided health plan needs to be with a group of 20 or more insurance eligible members. If the group is smaller than 20, Medicare Parts A and B must be primary and cover 80% of costs. The employer plan only covers 20%. In those cases, many folks are better served by leaving the employer plan and signing up for Medicare Part D and a supplemental plan.
• The employer coverage needs to be Medicare Part D creditable, meaning that the employer coverage includes a prescription drug benefit comparable to Medicare Part D. The employer or insurance plan can provide the Medicare creditable coverage notice. Get a copy of this letter every year when your employer coverage renews. That way no one is caught off guard down the road. If a plan has not been Medicare creditable, lifelong penalties of 12% per year are levied when the individual enrolls in Medicare Part D.
Once the person leaves a health plan and is entitled to Medicare, it is important to remember a few key factors:
• Sign up for Medicare as soon as possible. Medicare enrollment can begin three months before employer coverage ends.
• While there is an eight-month window to sign up for Medicare Parts A and B, there is no primary health coverage until Medicare enrollment is complete. Even COBRA coverage is secondary coverage to Medicare. That means Medicare Parts A and B cover 80% of costs, leaving COBRA to pay 20%. The result is that when Medicare-eligible individuals do not have Medicare Parts A or B they are left to pay 80% of their costs out-of-pocket.
• If someone misses the eight-month SEP window after leaving employment, they will have to wait an extended period to of time to enroll, have coverage gaps and pay lifelong penalties.
Earlier this week, I wrote about a new publication drawing attention to "six" specific areas of need that can helped by a health/law partnership to provide more comprehensive services for the older client or patient. That post inspired one of our regular readers to write about her experiences with an important Consortium effort between the law school at UC Hastings and the medical program at UC San Francisco. Their Medical-Legal Partnership for Seniors Clinic (MLPS Clinic) sounds terrific and, not surprisingly, it attracted the attention of the New York Times from its inception:
Consider the geriatricians working at the Lakeside Senior Medical Center, an outpatient clinic at the University of California, San Francisco. Many of their patients, despite multiple chronic diseases and advanced age, have never filled out power-of-attorney documents or appointed someone to make health care decisions if they are unable to.
Sometimes, the doctors suspect their patients might qualify for public benefits they are not getting, like food stamps or MediCal, the state’s version of Medicaid. Perhaps they face problems with landlords or appear to be victims of financial abuse, or they ought to have a simple will.
In other words, they need lawyers. But trying to get frail, low-income seniors to consult an elder attorney can seem an insurmountable problem. How will they travel to a law office? Or pay a fee that can reach $300 an hour? Even if the doctors can refer them to a legal aid office, will their elderly patients actually make an appointment? Then remember to go?
At Lakeside there is a simpler solution, said Sarah Hooper, who teaches at the University of California Hastings College of the Law. “The physicians do the initial screenings, hear what their patients’ problems are, take the history — and they essentially write a prescription: ‘Go down the hall and see my friends at U.C. Hastings for help with this housing issue,’ ” she said.
Sarah Hooper, Executive Director for the clinic, provided an update, explaining, "We’ve done quite a bit of outreach within MLP and in the healthcare system, but are increasingly realizing that we need to get more elder law attorneys and legal aid advocates energized around this idea." Sarah reports that she'll be attending and presenting at the National Aging and Law Conference in D.C. in October, 2016 and hopes to inspire others to develop similar partnerships.
For more on the UC Hastings-San Francisco MLPS Clinic, read the full New York Times article (first published in 2013) by Paula Spahn, "The Doctor's New Prescription: A Lawyer." For more on the Medical-Legal Partnership concept, visit the website for the National Center for Medical Legal Partnerships.
Tuesday, August 16, 2016
Not everyone who needs caregiving has a family member to serve as caregiver. So what should a Boomer do when planning ahead? What resources might an elder law attorney recommend? Last October, U.S. News Wellness ran a story on this topic, No Spouse, No Kids, No Caregiver: How to Prepare to Age Alone. Referring to this group of our population as "elder orphans", the article paints the serious implications for those aging without a family support system. One expert is quoted that "[t]he risk of potentially finding yourself without a support system – because the majority of care provided as we get older is provided by family – may be increasing...." Factor in loneliness and the impact becomes even more serious "older adults who consider themselves lonely are more likely to have trouble completing daily tasks, experience cognitive decline, develop coronary heart disease and even die. Those who are socially isolated are also at risk for medical complications, mental illness, mobility issues and health care access problems." The article contains 5 tips for planning to live independently, including speaking up about one's situation, planning ahead now (here's where the elder law attorney can be quite helpful), maintaining friendships while establishing new ones, name a health care agent (and do a DPOA, too)-the article gives a shout-out to elder law attorneys, moving to a more livable community and live life well.
The points in the article are still relevant today. Thanks to Julie Kitzmiller for sending me the article!