Wednesday, January 22, 2014

Should We Teach Law Students "How to Sell Law," Including Elder Law?

Recently, a long-time friend, a successful business person, sent me a link to an Inc. article about an interesting course at the University of Chicago called "Entrepreneurial Selling." The course was taught in the Business School and the Inc. article included the course syllabus.  My friend asked "should lawyers -- and by extension law students -- be taking this kind of course?"  Reading the first line of the article made me shudder just a little, because it made the distinction between learning "how to sell," versus mere "marketing," especially for small businesses.  But, the more I read, the more I was intrigued.  My friend (a non-lawyer) argued that selling is the art of effective communication and lawyers are or should be all about effective communication. 

That got me thinking, and I realized that some of the most effective "sellers" of law are Elder Law attorneys, who regularly engage with the public in social and business contexts, always with their eyes open for new relationships and new clients.  As examples, I've witnessed (and participated in) an interesting variety of educational seminars for the public or other professionals that were sponsored by Elder Law firms or Elder Law attorneys. 

Elder Law is still a relatively young (and evolving) field.  Most members of the public have little understanding of what might be covered by the term.  Indeed, two summers ago, a group of law students and I were sharply reminded of that fact while doing a state-wide research project with focus groups of older adults and their families, asking them to talk about access to trustworthy legal advice and information. We frequently encountered people who thought of Elder Law as "writing wills for old people," or similar amusing, if worrisome, definitions. Thus, "selling" the field is perhaps especially important and necessary. 

But, of course, that leads to more questions. Is there an ethical model for "selling" a particular field of law, particularly a field that may not be well understood by the potential client base?  Is so, what are the elements of that model? 

What is necessary, for example, to avoid the Consumer Financial Protection Bureau's concerns about manipulation of potential clients, as addressed in an earlier post on this blog about investment products marketed to seniors?  I'm tempted to say that one possible element of an ethical model would be to de-couple the educational programming from the client-retention meetings, but perhaps I'm being very naive, trapped in my ivory tower.

Silvia Hodges, who runs a blog subtitled The Legal Firm as a Business,  recently published "I Didn't Go to Law School to Become a Salesperson -- The Development of Marketing in Law Firms."  in the Georgetown Journal of Legal Ethics.   She argues that "lawyers [often] mature in their professions without marketing training and therefore are ... ill-prepared to handle both the business and the professional part of their profession simultaneously."  She refers to the problem as "market disorientation," where lawyers "consistently underrate the importance of clients' selection clues and criteria."  She concludes that law firms "need to aspire to have marketing embedded in their firm culture, independent of whether the firm is a professional partnership or a managed professional business." 

Perhaps the first step to that culture change should occur in law school, and thus "selling law" should also be addressed specifically in Elder Law classes. 

January 22, 2014 in Current Affairs, Ethical Issues, Legal Practice/Practice Management | Permalink | Comments (0) | TrackBack (0)

Friday, January 10, 2014

Courageous Family Helps Explore the New Frontier of Dementia Diagnosis

The earliest signs of dementia are often subtle.  It can be tempting and easy to brush them off as merely the signs of fatigue or being overwhelmed.  Ironically, at the other end of the spectrum, advanced dementia, it may also be easy to jump to conclusions, believing one diagnosis fits all forms of dementia.  The modern assumption is probably most often Alzheimer's, while in earlier decades the label might have been simply "senility."

I often ask a medical or gerontology professional with expertise in the various forms of dementia, including Lewy-Body Disease, Frontotemporal Dementia (FTD), Parkinson's related dementia, vascular dementia, as well as Alzheimer's, to speak to my elder law classes.  The lectures are fascinating (okay, also a little frightening). But often, near the near the end of a class discussion, a student will ask, "if there is no cure for dementia, does diagnosis of the source really matter?"

A family's search for answers suggests there are may be very good reasons to pursue a definitive diagnosis, even if the ultimate answer is possible only after the death of a loved one impacted by disease.  The Ruhrig Family in central Pennsylvania was perplexed by the symptoms and rapid progress of confusion for the patriarch of their family.  Sixty-six year old Weston Ruhrig passed away less than a year after the family first began seeing signs of confusion:

"The 6-2, 210-pounder was up by 7 a.m. daily ... seemed always on the move. In June [2013], he conducted a charity auction for United Cerebral Palsy of Central Pennsylvania, just as he had since 1987. He seemed normal.

 

But his family began noticing odd behavior. Ruhrig became withdrawn. He continually locked doors, sometimes locking out his wife after she had gone to the yard or garage during daylight. Ruhrig was known for harping on people to turn off lights to save electricity. Now he switched on lights for no reason and left the room.

 

By September [2013], his family had persuaded him to see his family doctor. The doctor found no medical problems but referred him to a neurologist.  Ruhrig felt nothing was wrong. In November, the neurologist gave Ruhrig cognitive tests. Ruhrig named the president and recalled facts including his wife’s birth date. But he couldn’t correctly state her age or calculate it. Still, he joked during the visit."

As carefully detailed by Patriot News writer David Wenner, eventually doctors suggested the problem was Alzheimer's.  But the family, contrasting their father's symptoms with those of others they knew with more traditional presentations of Alzheimer's related dementia, persisted in seeking a more precise diagnosis.  An MRI was viewed as normal.  Another test was a spinal tap.  Unfortunately, Mr. Ruhrig died suddenly in December 2013, after a fall that led to a rapid decline. 

The diagnosis occurred after his death, based on the results of the spinal fluid analysis:  Creutzfeldt-Jakob Disease, a very rare variation of the family of diseases associated with "Mad Cow" and "chronic wasting" in deer, but a form that is not considered to be caused by eating or handling contaminated meat.  Deterioration associated with the condition is rapid, usually leading to death within a year, and the cause of the disease is currently unknown, and there are no cures.

But the courage of the family in pursuing and talking about the diagnosis could help others, as better understanding of the various forms and causes of dementia should help the larger community of physicians, epidemiologists and other experts chart the frontiers of dementia.  Heredity, life-style, diet, viruses, environmental impacts  -- with the help of families, all of these factors and others might better be understood in the search for causes and solutions for the different forms of dementia. 

For more, read "Hampton Township Man Dies of Mysterious Disease Sometimes Associated with Mad Cow and Chronic Wasting."  Thanks to my colleague, Professor Laurel Terry, for pointing me to this interesting local article.

January 10, 2014 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Statistics | Permalink | Comments (0) | TrackBack (0)

Sunday, December 29, 2013

Hospice Care Manipulated by Providers: Washington Post Report

Washington Post reporters Peter Whoriskey and Dan Keating use more than ten years of data from California to provide a detailed portrait of hospice, with national implications, concluding that providers are pursuing "healthier" patients to increase their margin.  While acknowledging the importance of Medicare-supported hospice for individuals legitimately diagnosed with less than six months to live, the Washington Post article uses survival rates to suggest manipulation of the diagnosis for financial gain:

"[T]he survival rates at AseraCare are emblematic of a problem facing Medicare, which has created a financial incentive for hospice companies to find patients well before death. Medicare pays a hospice about $150 a day per patient for routine care, regardless of whether the company sends a nurse or any other worker out on that day. That means healthier patients, who generally need less help and live longer, yield more profits.

 

The trend toward longer stays on hospice care may be costing Medicare billions of dollars a year. In 2011, nearly 60 percent of Medicare’s hospice expenditure of $13.8 billion went toward patients who stay on hospice care longer than six months, MedPAC, the Medicare watchdog group created by Congress, has reported."

For the full Washington Post story, itemizing factors contributing to misuse of hospice, see "Hospice Firms Drain Millions from Medicare."

December 29, 2013 in Current Affairs, Health Care/Long Term Care, Medicare, Statistics | Permalink | Comments (0) | TrackBack (0)

Tuesday, December 17, 2013

UK news: Front-liners trained to recognize signs of dementia

Via the Telegraph:

Tens of thousands of pharmacists, bus drivers and bank staff are being trained to recognise the signs of dementia as part of a “front-line force” against the disease.  Managers of some of the Busbiggest firms have pledged to educate staff to recognise the effects of dementia.  Boots, Lloyds bank and First Group have all committed to do as much as possible to help dementia sufferers after David Cameron promised to lead a national “fightback” against the illness. Jeremy Hunt, the Heath Secretary, said “every section of society” must “step up” to help tackle the illness, which affects 800,000 people in the country.  “Britain’s biggest companies will build up a front-line force of thousands of people able to spot the signs of dementia and understand the needs of sufferers, helping people with the disease to live a normal life for longer,” Mr Hunt told The Daily Telegraph.  The Prime Minister said this week that a cure for dementia could be found within 12 years as he announced funding for research into the disease would be doubled.

December 17, 2013 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s | Permalink | TrackBack (0)

Monday, December 2, 2013

Comparative Systems: NI's Independent Commissioner for Older People

Clair KeatingeAt the heart of comparative research is the opportunity to rethink your own system.  I was reminded of this point last week when meeting Claire Keatinge, the Commissioner for Older People in Northern Ireland (COPNI).  Commissioner Keatinge is -- in a word -- dynamic, and it is impossible not to be impressed with her dedication to meeting the needs of older persons in her country.  She is a leader, both actually and symbolically, for a hard-working team tackling a number of issues in ageing policy. 

It is clear to me that "independence" is at the core of the role for the COPNI.  What do I mean by independence?   The COPNI is funded with public dollars, but the job includes making an independent evaluation of the needs and interests of the demographic, and then reporting and advocating for appropriate response by the government or other sectors. By comparison, I wonder whether state officers or offices charged with policy and laws in the U.S.are more likely to be serving a governmental agenda, and trying to sell that agenda to voters.  This strikes me as a potentially important, if subtle, difference in systems.

A small example of the importance of independence:  One of the COPNI's several goals is to identify and improve "uptake" of benefits available to older persons in the country.  In Northern Ireland, and elsewhere in the U.K., there are official statistics on the dollars (whoops, I mean pounds) left on the table by individuals who fail to seek available public benefits or services.  In N.I., there is a known gap. By comparison, I would be surprised to learn that we keep similar statistics on either the state or federal level in the U.S., much less have a policy of trying to reduce any gap.

Claire Keatinge also stressed that an individual assessment of need for health care, social care and security, should be exactly that, and not simply an assessment of what services are available.  Helping individuals or their family members access services in the public, private and voluntary sectors is part of the COPNI plan of action, but, it strikes me that the emphasis on evidence-based policies may result in development of new services or better funding for existing programs. 

December 2, 2013 in Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care | Permalink | Comments (1) | TrackBack (0)

Tuesday, November 26, 2013

Beware of Befrienders -- A New Hampshire Case Example

While working in Europe, I first heard the label "befrienders," as applied to people who work their way into the lives of disabled or elderly persons.  The relationship often starts with the befriender doing small, helpful tasks; over time, the helper gains trust that enables him or her to have a greater role in the elder's life, thus opening the door to exploitation of the person's diminishing powers of judgment, while gaining complete control over finances. 

On November 5, the New Hampshire Supreme Court affirmed convictions on nine of eleven criminal counts for "befriender" Karen Gagne, accused of stealing over $500,000 from a ninety year old woman in a retirement center. The case is State of New Hampshire v. Karen Gagne, 2013 WL 512499 (2013).   

I plan to write more in the future about the technical details of the crimes charged in this context, but one of the clear lessons from the history in this particular case is how much time it may take for the befriending pattern to develop and "ripen" into fraud that is recognized by third-parties.  For example, Karen Gagne's involvement with the victim spanned years: 

"The defendant met the victim in the 1980s when the defendant performed landscaping services at the victim's home. The two became friends and subsequently lived together as companions in the victim's home for at least one year until the victim asked the defendant to move out. In the summer of 2006, the defendant and the victim rekindled their friendship. The victim moved to Pleasant View Retirement Home (Pleasant View), and the defendant began driving the victim to doctors' appointments and nail appointments, and taking her to lunch. In addition, although the victim had previously had an accountant pay her larger bills, the defendant began handling the victim's bills, including payment of her rent at Pleasant View."

At some point, "helpful" friend Gagne began liquidating the elder woman's annuities or other property and borrowing additional money under the elder's name. 

The fact that Gagne was giving herself gifts might not have been discovered, except that by the fall of 2008, Gagne was no longer making regular rent payments to the retirement home.  She offered excuses, such as blaming a "grandson or nephew" for stealing money, and claimed that she, Gagne, was trying to "recover" the money in order to pay the victim's bills. By late 2009, the victim was so far behind in rental payments -- and the excuses had become so unbelievable -- that the facility's executive director contacted the Attorney General's office, thus leading to the criminal charges.

Having sat through trials of similar cases, and having read transcripts of other cases, I can just imagine how Gagne would try to justify her thefts, arguing that "her friend wanted her to have the money" to explain why the 90-year old woman had "signed" checks she wrote out for her.  In fact,  this "gift" argument actually worked as a defense to two of the criminal counts in the case, where the older woman had personal involvement in transactions.  Nonetheless, on the majority of criminal counts, the Supreme Court concluded "the defendant was not privileged to infringe upon the victim's interest" in joint accounts, nor was Gagne justified in misapplication of funds she was handling as a "financial representative" of the elder. 

Karen Gagne was originally sentenced to "an aggregate of 10 to 30 years in New Hampshire State Prison for Woman." It is not clear from the opinion whether remand on the overturn of two of the elevent counts would trigger a resentencing. 

New Hampshire, by the way, is the state that recently passed a new law, permitting long-term care facilities to sue "fiduciaries" who misuse assets of a resident, if that misuse results in "disqualification" of the resident for Medicaid, as we discussed earlier this month.   

November 26, 2013 in Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

A Boomer Trend in DIY Funerals?

From WBUR public radio in Boston Massachusetts, a story and podcast on "at-home funerals." 

For a number of years I have invited an attorney with expertise in alternative funerals to speak to my classes. In fact, that is how I first learned that Costco carries urns and caskets (with a choice of standard or expedited shipping -- which strikes me as a trick question).  As outlined by WBUR in the article, there is a surprising amount of freedom, if that is the right word, in the law of many states for families to choose informal funerals and burials. 

Hat tip to Ann Murphy at Gonzaga Law for sharing this link.  Our readers definitely are the key in helping to make this a "full service" blog!

November 26, 2013 in Consumer Information, Current Affairs, State Statutes/Regulations | Permalink | Comments (0) | TrackBack (0)

Friday, November 22, 2013

Modern Concepts for Aging in Place: NORCs and Villages

A fascinating article in The Gerontologist analyzes Naturally Occurring Retirement Communities (NORCs) and a similar community-based model for aging in place, known as the Village.  Frankly, it was only recently that I realized these labels may be used for developments with different identities.

Researchers in social work, welfare and public health programs at Rutgers, Berkeley, Michigan, and Maryland surveyed program leaders representing 69 Villages and 62 NORCS in early 2012, gathering data on services, activities, beneficiaries and funding sources.  

Their analysis, presented in "A Tale of Two Community Initiatives for Promoting Aging in Place: Similarities and Differences in the National Implementation of NORC Programs and Villages," suggests that while both programs "aim to promote aging in place by offering a diverse range of supports and services to older adults within a locally defined geographic area," the means by which they achieve their aims differ.  For example, "NORC programs reported offering more traditional health and social services, had more paid staff, and relied more on government funding than Villages."  

The article also identified topics for further study, including the potential for longitudinal studies.  Regional differences may also exist.  "For example, NORC programs in New York likely differ in some ways from NORC programs nationally, given different organizations overseeing their development, . . . as well as distinct public policies defining the programs and eligibility criteria."

As a bit of history, Beacon Hill Village in Boston was begun in 2001 by a group of seniors who wanted to remain at home as long as possible in their neighborhood. An early model for NORCs is widely attributed to a co-op in New York City, begun in 1986 with support from private philanthropy and local government funding.     

November 22, 2013 in Current Affairs, Health Care/Long Term Care, Housing | Permalink | Comments (0) | TrackBack (0)

Thursday, November 21, 2013

Worse than Payday Lending? Loans that Tie Pensions to Repayment

Somehow I had missed this particular incarnation of predatory lending.  The National Consumer Law Center (NCLC) recently circulated a consumer impact statement on pension-based loan scams.  Often advertised as "cash advances," in reality the individual is agreeing to assign future pension payments to the lender, with repayment terms that include an outrageously high interest rate.  In 2011, NCLC and attorneys with the National Association of Consumer Advocacy were successful in a class action suit in state court in California, in which they challenged loans requiring "assignments" of military pay or pensions as violating federal law.  The court ordered restitution to the class members

The New York Times ran a 2013  feature on "Loans Borrowed Against Pensions Squeeze Retirees," by Jessica Silver-Greenberg, part of a series on "A Vulnerable Age," that examined financial traps that can face older adults, especially during a tight economy.  A sidebar to the article detailed an example of a loan to a disabled military veteran for $10,000, with a $353 monthly payment for 60 months, leading to total costs over the life of the loan of $21,180, representing an interest rate of 36.4%.   

November 21, 2013 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Retirement | Permalink | Comments (0) | TrackBack (0)

Wednesday, November 13, 2013

China: Brokering love for aging lonely hearts

(Reuters) - Wearing her favourite black dress, 53-year-old Liu Fenqin sat nervously in a corner at an official match-making event in Shanghai, hoping to find a husband after her first marriage ended in divorce more than 10 years earlier.  With China's divorce rate rising, Liu was one of thousands of middle-aged and senior lonely hearts who took part in the annual event sponsored by the Shanghai government after the upper age limit was raised from 45 to 60 this year.  The event, which drew 30,000 people last year, attracted an estimated 40,000 this year after organisers lifted the age limit to satisfy demand from the growing number of divorcees, said Xu Tianli, vice chairman of the Shanghai Matchmaking Agency Management Association.

With some people there in their 60s and even 70s, the age limit was not absolute.  Divorce rates in China have climbed for seven years in a row. In 2012, the year-on-year rise in divorces outpaced that of marriages for the first time, according to official data.  The Chinese city with the highest divorce rate is Beijing, at 39 percent, according to local media. The issue has not escaped the notice of China's government, which is concerned that broken homes will erode social stability.  "It's likely that children from divorced families will become social outcasts and vagrants. So it does have a negative impact on society."  To mend ailing marriages and encourage senior singles to date, China has introduced a range of measures.

Source/more:  Reuters

November 13, 2013 in Current Affairs, Other | Permalink | TrackBack (0)

Wednesday, October 23, 2013

State POA Laws: The Potential for Problems with Powers of Attorney

Powers of Attorney (POAs) are a key tool in estate planning and Medicaid planning. A thoughtfully drafted POA can avoid the need for a guardianship, for example, and thus avoid delays, embarrassment and greater expense for a principal who later becomes incapacitated.  

Unfortunately, POAs can also be a tool for misuse by agents who can't resist the temptation to help themselves, rather than their principals.  For a number of years, states have been struggling to balance utility against risk.  

In Pennsylvania, for example, prior to 1999, statutory law governing POAs permitted principals to grant agents the authority to make gifts.  Civil case law interpreted such gift-giving authority, unless expressly limited, as permitting agents to make "self-gifts." Even if the agent's self-gifting put the principal in serious financial jeopardy, some prosecutors declined to prosecute.  Following a series of troubling reports and cases, in 1999 the Pennsylvania legislature amended state law to declare that all agents appointed under POAs were subject to specific fiduciary duties.  The change also imposed a statutory presumption of limited gift authority (tied to annual federal gift tax exclusions) unless the principal expressly granted the agent "unlimited" gift authority.

Concern about misuse of powers of attorney has grown on a nationwide basis,especially after high profile cases such as that of New York heiress Brooke Astor, where her son used a POA to sell off artwork and other valuable property, while reportedly keeping his mother isolated from friends. 

Even before the Brooke Astor case came to light, academics, legislators, judges and practitioners worked together in the Uniform Law Commission to propose amendments to statutory authority governing POAs, resulting in the Uniform Power of Attorney Act of 2006 (UPOAA),  which superseded prior uniform law proposals.  The UPOAA attempts to rebalance risk and power, or as the Commission summarizes:

"The UPOAA seeks to preserve the durable power of attorney as a low-cost, flexible, and private form of surrogate decision making while deterring use of the power of attorney as a tool for financial abuse of incapacitated individuals.  It contains provisions that encourage acceptance of powers of attorney by third persons, safeguard incapacitated principals, and provide clearer guidelines for agents."

Adoption of the UPOAA has been fairly slow.  As of today, only 13 states plus the U.S. Virgin Islands, have enacted the UPOAA. 

In 2013, legislatures in Mississippi (H.B. 468) and Pennsylvania (S.B. 620) are considering adoption.  In Pennsylvania, the need for clarification has been heightened by reaction to the Pennsylvania Supreme Court's opinion in Vine v. Commonwealth, 9 A.3d 1150 (Pa. 2010), where a POA was signed by a hospitalized principal, and  used by the husband/agent to make self-benefiting changes to his wife's retirement accounts, while his wife was incapacitated.   

Court practice and enforcement policies on POAs, guardianships and elder abuse are also under consideration by the Pennsylvania Elder Law Task Force (2013), chaired by Justice  Debra Todd of the Pennsylvania Supreme Court.

In Pennsylvania, views on what changes to POA laws are necessary differ in small or large ways among bankers, estate attorneys, elder law attorneys and district attorneys, just to name a few of the interested parties. 

The scholarship of law professors has been important to the debate over proper use of POAs, including two articles by Valparaiso Law Professor Linda Whitton, "Durable Powers of Attorney as Alternatives to Guardianship: Lessons We Have Learned" and "The New Power of Attorney Act: Balancing Protection of the Principal, the Agent and Third-Persons." 

By the way, when I first drafted this post, I titled it "The Problem(s) with Powers of Attorney."  Overnight, I rethought that title, because many POAs are never abused and agents frequently go above and beyond in performing uncompensated services, including financial management, for aging principals.  I therefore retitled the post. What law reform movements are attempting to do is reduce the potential for abuse.  Human nature being what it is, there is probably no law that can prevent abuse by a wrongly motivated agent.  Who to trust with powers granted under a POA will always be an important matter for families to consider and discuss with their legal and financial advisors.

October 23, 2013 in Advance Directives/End-of-Life, Current Affairs, Estates and Trusts, Ethical Issues, Medicaid, Property Management, State Cases, State Statutes/Regulations | Permalink | Comments (0) | TrackBack (0)

Friday, October 4, 2013

National Continuing Care Resident's Association Meeting: October 26-27+

NaCCRA ImageAcross 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 26NaCCRA 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.   

October 4, 2013 in Current Affairs, Health Care/Long Term Care, Housing | Permalink | Comments (0) | TrackBack (0)

Upcoming: LeadingAge Annual Meeting, Dallas, October 27-30

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. 

October 4, 2013 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing | Permalink | Comments (0) | TrackBack (0)

Thursday, October 3, 2013

Documenting Confusion Over Paying for Long-Term Care: Who is Most Confused?

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).   

Additional thought on using labels to characterize types of care and care-givers is provided by The National Care Planning Council.   

October 3, 2013 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid | Permalink | Comments (1) | TrackBack (0)

Monday, September 30, 2013

The Waiting Game: Food Insecurity for Older Adults

In the October 14 issue of The Nation, writer Trudy Lieberman's article on "The Real Hunger Games" describes the struggle of a 64 year-old widow for food:

"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.

September 30, 2013 in Current Affairs, Federal Statutes/Regulations, Food and Drink, Housing | Permalink | Comments (0) | TrackBack (0)

Tuesday, September 24, 2013

Surviving the Colorado Floods: Frasier Meadows Retirement Community Report

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. 

September 24, 2013 in Current Affairs, Housing, Retirement | Permalink | Comments (0) | TrackBack (0)

Sunday, September 22, 2013

Stanford University's Center on Longevity Offers Design Challenge for Students

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.   

September 22, 2013 in Consumer Information, Current Affairs, Grant Deadlines/Awards, Web/Tech | Permalink | Comments (0) | TrackBack (0)

Wednesday, September 11, 2013

UK Conference & New Book Topic: The Fashion Industry & the Ageing Demographic

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.  

September 11, 2013 in Current Affairs, Dementia/Alzheimer’s | Permalink | Comments (0) | TrackBack (0)

Monday, September 9, 2013

Estate Planning and Dyslexia

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. 

September 9, 2013 in Consumer Information, Current Affairs, Estates and Trusts, Legal Practice/Practice Management, Science | Permalink | Comments (0) | TrackBack (0)

Sunday, September 8, 2013

Tale of Long Lives in New York City

A fine portrait of a long-lasting, supportive relationship, from the New York Times, in  "Two Men, 58 Years and Counting. A Love Story," by John Leland.

September 8, 2013 in Current Affairs | Permalink | TrackBack (0)