Friday, October 4, 2013
Across the US, there are some 1,800 Continuing Care Retirement Communities (CCRCs). These are typically upscale settings that offer a range of housing options, services, activities and health care. Residents of CCRCs often have common interests, not just within their individual community's setting, but in the "larger" community of residents throughout the nation, and thus the idea of a National Continuing Care Resident's Association (NaCCRA) was born.
NaCCRA has two annual gatherings, as well as regular meetings at the chapter level in individual states. NaCCRA's Fall 2013 Meeting will be in Dallas, in conjunction with the LeadingAge Annual Meeting. Here are some of the planned NaCCRA sessions and related LeadingAge sessions:
Saturday, October 26: NaCCRA Board Meeting (starting at 5:30 p.m.)
Sunday, October 27:
9:00 - 9:15: General Business Meeting
9:15 - 11:45: "Imagining CCRCs of the Future," a moderated discussion, involving residents and other guests. (Moderators: Ron Herring, resident of The Glebe, Daleville, VA & Katherine Pearson, Professor of Law, Penn State Dickinson School of Law)
1:00 - 3:00: Opening General Session for LeadingAge
3:50-5:00: LeadingAge Concurrent Educational Sessions (24 sessions!), including:
- Progress toward Resident Engagement: One Year Later: Moderator Ron Herring (NaCCRA), Speakers: Ellen Handler, President of New Jersey's resident association (ORANJ); Marilyn Kennedy (COO for Episcopal Senior Communities); May Anna Colwell (CCRC resident and board member)
- Financial Ratios for CCRCs
- Urban Design Concepts to Reinvent Aging Communities Anywhere
- Governance Roundtables: Practical Solutions for a Better Board
The LeadingAge programming, with concurrent educational sessions throughout, continues on Monday through Wednesday, October 27-30. CCRC residents can register for the combined NaCCRA/LeadingAge meetings on line. Registration for the combined Meetings is without cost for CCRC residents!
For additional thoughts on CCRCs, from informed, resident perpsectives, visit NaCCRAU, a Learning Center for current and future residents.
LeadingAge is holding its annual meeting in Dallas this year, October 27-30, with a very busy and interesting schedule of events, including educational workshops. The workshops and associated meetings offer a deep well of cutting edge information about aging services, relevant to both the industry and the public.
So what is LeadingAge? To use their words, it is an association of "6,000 nor-for-profit organizations" that provide services to seniors, persons with special needs, and their families. The history of the organization as advocates for aging service providers traces to 1961. For a number of years it was known as the American Association of Homes and Services for the Aging (AAHSA), recognized as a leading trade group for non-profit providers, especially on the housing side, including Continuing Care Retirement Communities, Assisted Living facilities, and Nursing Homes. AAHSA initiated a self study in 2008, and in 2011 announced its change of name to LeadingAge. As with any strong trade group, LeadingAge keeps a close eye on legislation, public finance, and policy developments, both at the national and state levels.
My experience is that with the name change came a broadening of the association's identity, including greater involvement by older persons as individuals, volunteers, consumers, and users of aging services.
Larry Minnix is the long-time head of LeadingAge, with deep experience in the industry of aging services.
Thursday, October 3, 2013
A new Harris Interactive/HealthDay Poll finds that "more than two-thirds of Americans are anxious and uncertain about how they'll meet nursing home or home care costs should they need them." Fair enough. Plenty of good reasons for such anxiety.
However, in summarizing the poll results, the Harris folks also conclude:
"Most people were also wrong about how most of these costs are covered under the current system. About half (49 percent) mistakenly thought the bulk of the bill was paid by individuals, while one-third guessed Medicare. Only 19 percent understood that the major funder of long-term care is actually Medicaid, the government agency that covers health services for the poor."
But were those people actually "wrong?" Perhaps it depends on what you mean by "long-term care." If you are viewing that care as provided by paid individuals, whether in the home or in a facility, then the Harris poll's conclusions accurately point to Medicaid's continuing role as a dominant payment source.
But in the US the largest source of elder care is still the family, as documented by AARP Public Policy Institute's 2011 Update. Even though family members are not usually "paid" for the care with dollars per hour, there is a cost associated with that care. For example, famly care-givers are often unable to engage in other paid employment, or take time off from careers to assist with elders. And thus, perhaps interviewees for the Harris poll were correct, because they were thinking about the realities of families assuming the costs of long-term care.
In other countries, a distinction is often made between "health care" and "social care." What we call "long-term care" in the United States tends to lump these concepts together, while the most frequently needed services, such as assistance with bathing, dressing, meals, monitoring for safety or supervision with other activities of daily living, would often be characterized as social care in other countries. Caution is necessary in using labels to characterize the cost of care for older adults (or for any individuals needing assistance).
Monday, September 30, 2013
"Perdue tried to get help from Meals on Wheels Atlanta. In mid-April of 2012, she was twenty-seventh on a waiting list of 120. In November, she was still on the list, which had grown to 198. Her daughter finally found another program.
Such is the world of food rationing for the elderly—the hidden hunger few ever see. Tenille Johnson, one of two case managers at Meals on Wheels Atlanta, said there were others on the list who were even more in need than Perdue. In 2012, the program served 106,000 meals—up from 84,000 three years before—and it will serve about 114,000 this year. “We’ve been able to up our game and reduce the waiting list to between 145 and 160 seniors, but the need has outpaced us,” says executive director Jeffrey Smythe. “The numbers are going up more quickly than we projected. We have waiting lists all over the metro Atlanta area, even in suburban counties.”
The Nation writer first reported on underfunding for programs assisting home-bound elderly in 1998. "Little has changed in the last fifteen years," she reports. Except, as her article demonstrates in detail, the need is greater, on a nation-wide basis.
"The National Association of Area Agencies on Aging says nearly 60 percent of all Older Americans Act programs had waiting lists in 2010, but the ones for home-delivered meals are particularly urgent, since food is so basic to good health."
Remember the Older Americans Act (OAA), first enacted in 1965? Meals on Wheels was once a core component of OAA's programming, and administered to the states through Area Agencies on Aging. Charities, churches and other nonprofits have not been able to cover the gap in funding. As discussed earlier on this Blog, Congress still has not reauthorized the OAA,and as Lieberman's article demonstrates, there are very real consequences to Congressional gridlock and Congress's failure to address even uncontroversial programs while rehashing party-politics on the Affordable Care Act.
Hat tip to Kevin Schock, Penn State Law, for spotting this timely article.
Tuesday, September 24, 2013
For a number of years, I have taken on the interesting task of researching resident rights and financing or governance issues for "Continuing Care Retirement Communities" or CCRCs, an important part of the network of senior living options in the U.S. One of the many strengths of CCRCs is the way residents and administrators pull together to respond to a crisis or handle a challenge.
Frasier Meadow Retirement Community, a CCRC in Boulder, was hit hard by the recent devastating flooding in Colorado. The Assisted Living area was severely damaged, requiring relocation of AL residents. The good news is that the relocations were accomplished safely, and the hard work of clean-up and reorganization has begun. Regular updates on the Frasier website and social media connections have helped to keep families and friends up-to-date.
Hat Tip to Walt Boyer, board member at the National Continuing Care Resident's Association or NaCCRA, for information on Frasier's early recovery efforts.
Sunday, September 22, 2013
September 24 is the kick-off date for a world-wide Design Competition offered by Stanford's Center on Longevity. The Stanford Report explains the competition is intended to encourage innovation that helps the rising tide of seniors:
"The design contest solicits entries from student teams worldwide and is aimed at finding solutions that help keep people with cognitive impairments independent as long as possible."
The final presentations are scheduled for April 2014 with judging by a panel of academics, industry professionals, nonprofit groups and investors. The competition offers prizes, including the top prize of $10,000.
Hat tip to Professor Laurel Terry, for news on this interesting challenge.
Wednesday, September 11, 2013
On October 18, University of Kent Professor Julia Twigg, the author of "Fashion and Age: Dress, The Body and Later Life" (published by Bloomsbury Press), will be one of the featured speakers at a conference hosted by the U.K.'s Royal College of Art. The conference has an intriguing title: "(a)Dressing the Ageing Demographic."
Professor Twigg's latest book is an outgrowth of her sociology and social policy research into day-to-day lives. Thus, clothing and fashion choices for women may have implications for feelings of self-worth and identity as women age. Professor Twigg explains further:
"This book also touches on a second academic concern of mine which has been to bring wider perspectives to bear on the territory of ageing. For too long, later years have been analysed through the lens of social welfare, with an emphasis on frailty and dependence and, often, with an objectifying and distancing gaze. Although I have done work within this social welfare tradition -- and still value it -- I am pleased to have the opportunity this new work has given me to address a wider conception of age and its social significance, bringing to bear on it new literatures and analytical concerns."
Details of the conference are available here.
Monday, September 9, 2013
Recently a colleague described an estate planning dispute. After the death of the first spouse, it came out that the surviving spouse had never read the couple's estate plan, but had signed the documents in the attorney's office when they were presented. The individual failed to realize the documents were not entirely consistent with what the survivor believed to be the couple's plan. The problem may be hard to solve now that the first spouse has passed. Why would someone sign estate planning documents without reading them?
In this instance, the individual in question, a successful entrepreneur, was dyslexic; reportedly it would have taken the individual hours to read the will or trust carefully, and although the individual planned to read the documents upon returning home, that did not happen.
I suspect this happens far more often than lawyers would like to believe.
As explained by the International Dyslexia Association (IDA), dyslexia is a "language-based learning disability." According to the IDA, an estimated 15 to 20% of the population has a language-based learning disability, with some estimates suggesting one in nine individuals can be classified as having a severe disability. Dyslexia can involve a cluster of symptoms, but is most commonly associated with difficulty in reading.
According to some researchers, dyslexia may also by associated with problems in oral communication. For example, IDA advises:
"People with dyslexia can also have problems with spoken language, even after they have been exposed to good language models in their homes and good language instruction in school. They may find it difficult to express themselves clearly, or to fully comprehend what others mean when they speak. Such language problems are often difficult to recognize, but they can lead to major problems in school, in the workplace, and in relating to other people. The effects of dyslexia reach well beyond the classroom."
It is possible that by the time people get to the estate planning phase of life, they have developed or learned individual strategies for coping with dyslexia. Or, they may have become experts in hiding the fact of their dyslexia.
As lawyers, perhaps it is incumbent upon us to inquire tactfully about each client's comfort level in reading, especially in reading often-complex estate planning documents. Lawyers can offer alternatives to a formal "signing" session that puts pressure on even the strongest readers to sign without informed understanding of the documents.
Strategies may include remembering to provide all clients with quiet time to read the documents, before any signing session is planned. The lawyer can also "chart" the estate plan, to provide a pictorial image of the plan for clients. Lawyers and their staff can be patient in reviewing each aspect of the plan carefully, also involving the clients with conversation and dialogue (rather than monologues). I'm sure experienced practitioners and academics have developed a whole host of key strategies that can assist not only those with dyslexia, but those with other common barriers to understanding. Is dyslexia an understudied phenomenon in attorney-client relations? "Comments" open below.
And before anyone brushes off the topic as not relevant to "their" clients, let's remember that dyslexia can be present with highly successful people, and thus there is the potential for impact on families with significant estates.
Sunday, September 8, 2013
Friday, September 6, 2013
Thursday, September 5, 2013
University of California San Francisco (UCSF) researchers published a paper, made available this week in Nature, titled Video Game Training Enhances Cognitive Control in Older Adults. We can expect our students, children and grandchildren (not to mention game manufacturers) to remind us they were "right." From the abstract for the UCSF researchers' article:
Here we show that multitasking performance, as assessed with a custom-designed three-dimensional video game (NeuroRacer), exhibits a linear age-related decline from 20 to 79 years of age. By playing an adaptive version of NeuroRacer in multitasking training mode, older adults (60 to 85 years old) reduced multitasking costs compared to both an active control group and a no-contact control group, attaining levels beyond those achieved by untrained 20-year-old participants, with gains persisting for 6 months.
I suspect we will see a lot more on this area of research in the near future. Funding should be robust. Of course, I also suspect that not every game is equally helpful to cognitive enhancement and thus caution and consumer protections may be appropriate.
Over the Labor Day weekend, I happened to catch a great public radio interview with author Will Schwable about the book inspired by his two-year conversation with his mother about books. The End of Your Life Book Club describes how their mutual love of reading provided opportunities for the two to discuss life and death, both directly and indirectly. Why was this important? The conversations took place while his mother was receiving chemotherapy for pancreatic cancer. He said they never had "the big talk" you might expect when confronted with mortality -- rather, they had dozens and dozens of small talks.
It made me think about conversations with my own family members. We live far apart and while I try to make it home frequently (at this point, I'm the only family member who flies), I know I don't make it home often enough. But we talk a lot on the phone and I think we have also developed ways of speaking directly and indirectly about the present and the future. Lately, with my parents that has often been through funny conversations about Dancing with the Stars. (Thank goodness for on-demand television access, since I rarely catch the show on first airing.) We talk about who is "doing well for their age" or who isn't. We suggest who we would like to see on the show (Julie Andrews?), and who makes us cringe (sorry, Cloris Leachman). It has become shorthand for talking about memory, mobility, capacity, and our own aches and pains.
What works for your family? Or are you part of a (rare?) family who talks about such topics directly? (Comments open below)
Friday, August 30, 2013
NBC's Today Show featured Edythe Kirchmaier, who at 105+, uses her humor and upbeat personality to banter with talk show hosts and interviewers. She redefines the meaning of "spry," recently passing the test to renew her driver's license, after more than 85 years without so much as a parking ticket, much less a driving violation. Best of all, she's celebrating 40 years of volunteer service at Direct Relief International, calling it her second home.
Edythe is an important part of the national economy. Seniors contribute huge numbers of volunteer hours, with rates of older volunteers increasing over the last several years. One study reports:
"The proportion of older adults who volunteer 100 or more hours a year is 46 percent higher today than in 1974. Today, 46.1 percent of older adults volunteer 100 or more hours a year while 31.6 percent of older adults volunteered 100 or more hours in 1974."
Tuesday, August 27, 2013
Following up on Becky's posting today on same-sex marriages and federal benefits, it is timely to report that another state, New Mexico, has taken a major step towards confirming marriage rights for same-sex couples.
On Monday, August 26, New Mexico District Court Judge Alan Malott granted mandatory injunctive relief in the state's most populous county (Bernalillo, surrounding the city of Albuquerque), ruling that New Mexico's Constitution prohibits discrimination in marriage licensing on the basis of sexual orientation. Last week a similar ruling in favor of same-sex marriages was issued in Santa Fe County's District Court.
News reports indicate that the Bernalillo County Clerk's office began issuing marriage licenses to same sex couples today, August 27, 2013.
For those who might ask "why are these cases case reported on an Elder Law blog?," remember the lead plaintiff in U.S. v. Windsor, 133 S. Ct. 2675, decided June 26, 2013, was an older adult, challenging the adverse estate tax consequences of the IRS's refusal to recognize the validity of her marriage, following the death of her long-time partner.
Monday, August 19, 2013
Pennsylvania has become the hotbed of "filial support law" enforcement suits, with health and long-term care facilities leading the charge.
In 2012, in Health Care & Retirement Corp.(HCR) v. Pittas, an intermediate court of appeals held an adult son liable for more than $92k in nursing home costs incurred by his mother under Pennsylvania's filial support law, 23 Pa.C.S.A. Section 4603. For a brief video analysis of the Pittas case and Pennsylvania law, see here.
The Pittas case was controversial in part because the court did not point to any fault on the part of the son as justification for enforcement. For example, there was no discussion of "improper" transfers or theft of the parent's assets, facts that had sometimes been the background of previous cases.
The Pennsylvania trend certainly has not gone unnoticed by the media or courts and legislatures in other states. I receive regular calls from attorneys and parties on all sides of the "filial support" enforcement controversies asking me to compare their state's (or even foreign countries') laws to Pennsylvania. For more on comparative analysis of filial support enforcement issues, see my recent Elder Law Journal (University of Illinois School of Law) article here.
Perhaps we are now seeing the pendulum swing the other way, rejecting modern enforcement attempts. One of the latest rulings on filial support law occurred in Montana. In a July 2013 decision, the trial court granted summary judgment in favor of a son on a nursing home's claim of close to $15k incurred for his mother's care. The court declined to enforce a cause of action for filial support, citing a bar on "third-party guarantees" under federal Medicare and Medicaid law, and thus suggesting enforcement of the state's separate filial law was preempted. For a scanned copy of the decision in Heritage Place, Inc. v. Jarrell, Case No. DV-11-430(D), in the 11th Judicial District Court, Flathead County, Montana, see the link available through ElderLawAnswers.
Perhaps even more significant is recent action by the New Hampshire legislature, changing state law to eliminate a statutory basis for an adult child to be held liable to support his or her parents. See 2013 New Hampshire Laws Ch. 212 (H.B. 481), approved July 10, 2013 and effective on January 1, 2014, amending N.H. Rev. Stat. Sections 167.2 and 546.A:2.
Will Pennsylvania legislators take similar action? For an answer to that question, follow Pennsylvania Senate Bill 70 and House Bill 224, for the 2013-2014 legislative session. Both the nursing home industry and the Pennsylvania Department of Public Welfare have opposed repeal efforts in recent years, while the Pennsylvania Bar Association has supported repeal.
Tuesday, August 13, 2013
The 66th Annual Meeting for the Gerontological Society of America (GSA) takes place in New Orleans on November 20-24, 2013. As lawyers and law professors are aware, "Elder Law" is an inherently multi-disciplinary field. The GSA meeting is an opportunity to discover and share the latest in interdisciplinary research on medicine, clinical care, basic science, social science, behavioral science, and public policy for issues connected to aging. The meeting attracts an international audience, with more than 4,000 attendees, and some 400 substantive sessions.
The theme for this year's meeting is "Optimal Aging through Research," and there is a special workshop on the topic of family caregiving for persons with dementia, which should be particularly interesting for those seeking the latest in evidentiary bases for state or federal legislation to support caregivers. Further, the deadline for "late-breaking" abstracts for poster submissions is September 15.
Full details on the annual meeting are available at GSA's website.
Wednesday, May 16, 2012
A new study that looked at the hunger trends over a 10-year period found that 14.85 percent of seniors in the United States, more than one in seven, face the threat of hunger. This translates into 8.3 million seniors. "In 2005, we reported that one in nine seniors faced the threat of hunger," said Craig Gundersen, University of Illinois associate professor of agricultural and consumer economics and executive director of the National Soybean Research Laboratory who led the data analysis on the study. "So, unlike the population as a whole, food insecurity among those 60 and older actually increased between 2009 and 2010." According to the study, from 2001 to 2010, the number of seniors experiencing the threat of hunger has increased by 78 percent. Since the onset of the recession in 2007 to 2010, the number of seniors experiencing the threat of hunger has increased by 34 percent. Gundersen said that the fact that seniors in our country are going without enough food due to economic constraints is a serious problem that will have greater implications for senior health. The increases in senior hunger were most pronounced among the near poor, whites, widows, non-metro residents, the retired, women, and among households with no grandchildren present.
Monday, November 1, 2010
China began tallying its population on Monday for the first time since 2000, an arduous task likely to be made even tougher by the need to count scores of millions of migrant workers in the nation’s big cities.
The government said it had sent more than six million census-takers out to survey 400 million households, including the shantytowns and dormitories that often house rural men who have flooded into the cities to work in factories and on construction projects.
In the five censuses since the Communist government took power in 1949, migrants were listed as living where their homes were registered instead of where they actually lived. By disregarding the hukou, as the registration regime is called, the government hopes to get its first accurate count of city dwellers.
The last major census a decade ago counted 1.265 billion mainland Chinese citizens, of which 807 million were placed in rural areas. The latest United Nations estimate two years ago projected that the population would reach 1.396 billion this year, and the organization’s 2003 estimate projected that by this year the population would be split about equally between cities and rural areas.
But analyses vary widely, and the sheer volume of migrants — 160 million is the middle ground of estimates — are a demographic wild card that could reshape perceptions of China’s population. The 2010 census is expected not only to better document the rural-to-urban migration, but to shed new light on a number of impending demographic shifts, including a rapid fall in the number of young people, a similarly sharp growth in the number of elderly and a decline in the size of the workforce.
Those and other trends may lessen some of the social and economic pressures on Chinese society, like the furious scramble to create enough jobs for new workers. But they are also likely to create others, including rising costs for social services like pensions and changes in the structure of the economy.
Census officials said in a briefing last week that they were taking extra steps to encourage cooperation from some classes of citizens who might hide from census-takers, including undocumented migrant laborers and families that have quietly violated a 30-year-old policy limiting many households to one child.
Wednesday, October 13, 2010
A group of 23 Communist Party elders in China has written a letter calling for an end to the country's restrictions on freedom of speech. The letter says freedom of expression is promised in the Chinese constitution but not allowed in practice. They want people to be able to freely express themselves on the internet and want more respect for journalists. The call comes just days after the Chinese dissident Liu Xiaobo was awarded this year's Nobel Peace Prize.
Mr. Liu was sent to prison for 11 years in 2009 for expressing his desire to see peaceful political change in China. The letter's release also comes ahead of a key party meeting that is expected to promote future leaders and shape policy for the next few years.
The authors of the letter describe China's current censorship system as a scandal and an embarrassment. The signatories describe the propaganda department as "invisible black hands". The letter says: "They violate our constitution, often ordering by telephone that the works of such and such a person cannot be published, or that such and such an event cannot be reported in the media. "The officials who make the call do not leave their names, and the secrecy of the agents is protected, but you must heed their phone instructions." Many who signed the letter were once influential officials. They include a former personal secretary to the revolutionary leader Mao Zedong, and a former editor of the People's Daily, the official Communist Party newspaper. The letter, addressed to China's parliament, makes a number of proposals for change.
The letter's eight demands for change:
* Dismantle system where media organisations are all tied to higher authorities
* Respect journalists, accept their social status
* Revoke ban on cross-province supervision by public opinion
* Abolish cyber-police; control Web administrators' ability to delete/post items at will
* Confirm citizens' right to know crimes and mistakes committed by ruling party
* Launch pilot projects to support citizen-owned media organisations
* Allow media and publications from Hong Kong and Macau to be openly distributed
* Change the mission of propaganda authorities, from preventing the leak of information to facilitating its accurate and timely spread
Saturday, October 9, 2010
Check out this webinar series sponsored by the American Association on Intellectual and Developmental Disabilities
Series Title: Public Policy & Aging Report on Healthy Aging and the Environment
The American Association on Intellectual and Developmental Disabilities (AAIDD) presents a distinguished panel of guest speakers to bring you a groundbreaking series of webinars on aging, environmental health, and disability. This series, which begins October 12, is sponsored by the John Merck Fund.
The series mirrors the contents of a thematic issue on healthy aging and the environment of the Public Policy & Aging Report of the Gerontological Society of America's http://www.geron.org/ policy institute, the National Academy on an Aging Society http://www.agingsociety.org/agingsociety/ . An electronic version of this publication will be made available for free to all webinar attendees.
To access additional information and register for any of the webinars below, please go to http://aaidd.org/ehi/content_3919.cfm?navID=306 of the AAIDD web site.
Environmental Threats to Healthy Aging with Ted Schettler, Maria Valenti
Tues Oct 12th from 2-3pm Eastern Time
Built Environment with Kathy Sykes, Rodney Harrell, Regina Gray
Tues Oct 19th from 2-3pm Eastern Time
Psychosocial Environment with Danny George, Peter Whitehouse
Tues Oct 26th from 2-3pm Eastern Time
Chemical Environment with Maye Thompson, Marybeth Palmigiano
Tues Nov 2nd from 2-3pm Eastern Time
Food Environment with Michelle Gottlieb, Emma Sirois
Tues Nov 9th from 2-3pm Eastern Time