Tuesday, December 26, 2017

Mark Your Calendars-Webinar on Elder Abuse Hotlines

The DOJ Elder Justice Initiative is holding a free webinar on January 12, 2018 at 2 est on What Hotline Workers Need To Know About Elder Abuse. To register, click here.  Here's the info about the webinar

Julie Childs, J.D., Consultant to the U.S. Department of Justice Elder Justice Initiative, hosts a discussion with Maria Shumar, Victim Specialist Consultant to the U.S. Department of Justice Elder Justice Initiative, and Keeley Frank, Senior Service Specialist from the National Center for Victims of Crime, on assessing and responding appropriately to calls from older adults who may have experienced elder abuse. We’ll discuss case examples to provide hotline workers tips on how to assist these callers and direct them to relevant resources and services.

December 26, 2017 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Programs/CLEs, Web/Tech, Webinars | Permalink | Comments (0)

Friday, December 22, 2017

Florida WINGS Project-Florida Guardianship Law

For those of you from Florida, The Florida Supreme Court’s Guardianship Workgroup and Florida’s Working Interdisciplinary Networks of Guardianship Stakeholders (WINGS) will be holding a public hearing on Thursday, February 1, 2018 at the Orange County Courthouse from 4-7 p.m.  The courthouse address is 425 North Orange Avenue, and the hearing will take place in  Suite 180.  According to the announcement

Members of the public will be able to share their concerns about guardianship and to identify possible solutions for those concerns. This event will help the Guardianship Workgroup and Florida’s WINGS advance guardianship reforms and increase the effectiveness of Florida’s guardianship systems.... Speakers are asked to address one of two questions: [1] If you could make one change in Florida’s guardianship system, what would it be? OR ... [2] How can courts improve their processes to better ensure protection of the person, property, and rights of individuals who are under guardianship or who need assistance making decisions? Comments should be succinct. A time limit will be imposed.

There are other ways to make your voice heard. Another public input event will take place in February in Central Florida. Comments may also be submitted through the WINGS website: https://flwings.flcourts.org/.

The website also has a link to a 29 question survey about Florida guardianship law.  Folks can also submit comments online from the link here.

 

 

 

December 22, 2017 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)

Thursday, December 21, 2017

Filial Friday: Can Americans be Compelled by Germany to Contribute to Costs for a Parent's Care in Germany?

It has been awhile since I've written a "Filial Friday" post. Perhaps any question about legal obligations for family members to pay for care of another is an unfair topic during the holiday season.  A bit too downbeat, yes?  But, in fairness it is a topic that has reemerged in my "inbox," as I've recently received two communications from American adult children of biological parents in Germany.  In each instance, the reason is that Germany authorities are writing to American citizens to notify them that an aging German parent is or may be in need of "social welfare benefits" in Germany.  As one demand letter puts it:

"The above person is your mother.  According to [the Germany Civil Code] you have a basic obligation to pay maintenance for your mother.  According to Section 94 of the [Social Security Code] the maintenance obligations of a person eligible for benefits are passed on to [the Germany regional authorities] up to the amount of the expenses we incur in so far as this is not excluded for legal reasons."

In other words, it appears the German social service agency is saying that if it is called upon to incur expenses for welfare of a Germany citizen, it has the legal authority to seek contribution or reimbursement from the family members identified in German statutory law as having a maintenance obligation, including any children living in other countries.

As readers of this Blog know, I have a long-standing interest in such filial support claims, in large part because I live and work in Pennsylvania, the U.S. state that most frequently enforces a colonial-era law, permitting third-party providers of care in certain instances to compel adult children to pay reimbursement for costs of care, usually nursing home care.  The 2012 Pennsylvania Superior Court decision in Health Care & Retirement Corporation of America v. Pittas, where an adult son was found to be liable for more than $90,000 for his mother's nursing home care, is one of the most dramatic modern example of domestic enforcement in the U.S.   

The letters from Germany undoubtedly surprise, and perhaps frighten, the American children who have probably never heard of such a claim coming from public authorities.  (In the U.S., in the modern era the occasional claim usually comes from a nursing home that isn't being paid for long-term care by private or public means, and the claims are not coming from public agencies.)

Continue reading

December 21, 2017 in Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care, International, Retirement | Permalink | Comments (2)

Social Media Job Ads Targeted to Specific Age Groups-Discriminatory Based on Age?

The New York Times ran an interesting article that was co-researched and co-written with ProPublica,   Facebook Job Ads Raise Concerns About Age Discrimination   Target marketing is nothing new. I'm sure you all have the experience of having ads for things you might "like" pop up all over webpages you are browsing. So what about target marketing for job applicants? The article notes that a number of large corporations have "placed recruitment ads limited to particular age groups ... The ability of advertisers to deliver their message to the precise audience most likely to respond is the cornerstone of Facebook’s business model. But using the system to expose job opportunities only to certain age groups has raised concerns about fairness to older workers." This then raised the question-whether such advertising would be considered discriminatory. Facebook's response "[u]sed responsibly, age-based targeting for employment purposes is an accepted industry practice and for good reason: it helps employers recruit and people of all ages find work,” said Rob Goldman,  a Facebook vice president."

The article explains how this story came about in doing research for another story regarding political ad placement. Now litigation has started, according to the story. "[A]  class-action complaint alleging age discrimination was filed in federal court in San Francisco on behalf of the Communications Workers of America and its members — as well as all Facebook users 40 or older who may have been denied the chance to learn about job openings. The plaintiffs’ lawyers said the complaint was based on ads for dozens of companies that they had discovered on Facebook."

There are a number of social media sites used to advertise jobs, and the article notes for example  that they may require advertisers to certify compliance with non-discrimination laws. The article discusses a number of legal issues, including what, if any,  liability the social media companies may have.  It's a fascinating article that presents arguments on both sides of the issue. Check it out!

December 21, 2017 in Consumer Information, Current Affairs, Discrimination, Federal Statutes/Regulations | Permalink | Comments (0)

Monday, December 18, 2017

Hawaii Starts Long-Term Care Program

The New York Times The Daily 360 series did a story about the long-term care program in Hawaii. You know the old saying-a picture is worth a 1000 words? A video must be worth many more words.  So, click here and watch the video!

December 18, 2017 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other | Permalink | Comments (0)

Thursday, December 14, 2017

Polypharmacy: an ongoing problem

There's been a lot of attention of late regarding the very serious opiod crisis. But I think it's important to keep in mind the issue of polypharmacy and elders. The Washington Post ran this article, The other big drug problem: Older people taking too many pills, which opens with this "[c]onsider it America’s other prescription drug epidemic." The article offers sobering statistics

Researchers estimate that 25 percent of people ages 65 to 69 take at least five prescription drugs to treat chronic conditions, a figure that jumps to nearly 46 percent for those between 70 and 79. Doctors say it is not uncommon to encounter patients taking more than 20 drugs to treat acid reflux, heart disease, depression or insomnia or other disorders.

In fact, some elders have health issues from polypharmacy, some which are preventable,  according to the article. The polypharmacy problems can create a vicious cycle for some folks for whom  "the side effects of drugs are frequently misinterpreted as a new problem, triggering more prescriptions, a process known as a prescribing cascade." Often, a hospitalization and new meds on top of the existing ones contribute to the problem.  Evidently the problem of polypharmacy, although not new, is increasing.  The article explains that some doctors are engaging in what is referred to as "deprescribing" which is explained as "systematically discontinuing medicines that are inappropriate, duplicative or unnecessary." The article explains a number of hurdles to this goal, including lack of research, time constraints, advertising and just changing the status quo.

This is a really interesting article and worth the read!

December 14, 2017 in Cognitive Impairment, Consumer Information, Current Affairs, Health Care/Long Term Care, Other | Permalink | Comments (0)

Good Friends-More Important than You Think.

I recall a children's song I learned about the importance of keeping your old friends while making new friends.  So the Kaiser Health News story about friends caught my eye. Good Friends Might Be Your Best Brain Booster As You Age reports on a new study from Northwestern regarding the connection between "brain health and positive relationships." The Northwestern Study, Psychological well-being in elderly adults with extraordinary episodic memory is an open source article available as well as a pdf.  Here is the abstract from the study

The Northwestern University SuperAging Program studies a rare cohort of individuals over age 80 with episodic memory ability at least as good as middle-age adults to determine what factors contribute to their elite memory performance. As psychological well-being is positively correlated with cognitive performance in older adults, the present study examined whether aspects of psychological well-being distinguish cognitive SuperAgers from their cognitively average-for-age, same-age peers.

Want to live longer and happier, then be nice to your good friends (maybe call them up now and tell them hi!). The article's concluding summary offers this

SuperAgers endorse higher levels of Positive Relations with Others compared to their cognitively healthy but average-for-age same-age peers suggesting that this aspect of psychological well-being may be an important factor for exceptional cognitive aging. Investigation of the longitudinal effects of psychological well-being on subsequent cognitive performance and investigation of the conceivable relationship between psychological well-being and von Economo neurons in SuperAgers represent intriguing future directions.

 

December 14, 2017 in Cognitive Impairment, Consumer Information, Current Affairs, Health Care/Long Term Care, Other | Permalink | Comments (0)

Wednesday, December 13, 2017

"Snake Oil," Tattoos & Why Some Hospice Doctors Prefer Medical Powers of Attorney

Are games and food supplements that promise to stave off the onset of dementia the modern day version of "snake oil?" I promised to write more about the Aging Brain Conference at Arizona State University's Sandra Day O'Connor College of Law on December 8, 2017.  Speaker Dr. Cynthia Stonnington, Mayo Clinic, offered an important look at ways in which law, ethics, medicine, and commerce can collide with her survey of a host of approaches receiving "popular" press treatment.  

She examined self-described "brain-training" programs, miracle diets, supplements and targeted exercise programs, noting that most studies that purport to demonstrate positive results from these items have serious flaws.  Thus, at best, programs that claim to provide "protection" against dementia are usually promising more than has been proven.  Dr. Stonnington, along with the morning keynote speaker, former U.S. Surgeon General Richard Carmona, reminded us that

  • maintaining social engagement,
  • engaging in lifelong learning,
  • getting regular exercise of any type,
  • having good blood pressure control,
  • getting adequate sleep, and
  • focusing on good nutrition (including eating plans such as the Mediterranean, DASH or MIND diets)

are  far more important than any single, magic game or exercise.

One of the most lively discussions of the day came near the end, in response to presentations by Dr. Patrica Mayer of Banner Health in Phoenix, Amy McLean of Hospice of the Valley. and Life Sciences Professor Jason Robert (ASU) speaking for himself and Susan Fitzpatrick (James S. McDonnell Foundation), about end-of-life considerations for persons with dementia or other serious illnesses.  What would be the most likely response of a physician or emergency personnel confronted with a "do not resuscitate" tattoo on the chest of an emergency patient?  Dr. Mayer stressed that she is seeking reliable methods of communicating end-of-life wishes, and for her that means a preference for a written, Medical Power of Attorney.  She wants that "live" interaction whenever possible, in order to fully explore the options for care for individuals unable to communicate for themselves.  But she also noted a frequent frustration when she contacts designated  POAs about the need to make tough decisions, only to learn they were completely unaware before that moment of having been named as the designated agent.  

LSI_Aging Brain 120817 Competency_and_Incapacity_1 SPEC (1)I was part of a panel of court-connected speakers, including Arizona Superior Court Judge Jay Polk (Maricopa County), neuropsychologist  (and frequent expert witness) Elizabeth Leonard, and experienced Phoenix attorney Charles Arnold.  I was interested to hear about  -- and will pursue more information on -- the psychologists' use of evaluative tools for clients that use scenarios that would appear to test not just for loss of memory, but impaired judgment.  I was speaking on the unfortunate need for judicial inquiries into "improvident transactions" by persons with problematic cognition and I used litigation approaches from other locations -- Ireland (common law) and Maine (statutory) -- as examples.  The Arizona legal experts reminded me to take a closer look at Arizona's financial exploitation laws.

For more from this conference, see Learning to Say the Word "Die"  --  about a pilot program developed by Dr. Mayer while she was an advanced bioethics fellow at the Cleveland Clinic.  I also recommend Dr. Mayer's article on CPR & Hospice: Incompatible Goals, Irreconcilable Differences

 

December 13, 2017 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Games, Health Care/Long Term Care, Legal Practice/Practice Management, Programs/CLEs, Science, Statistics | Permalink | Comments (0)

When "Emergencies" Last for Months -- and the Impact on Seniors

Over the last several weeks, I've been in an ongoing conversation with a good friend who operates a court-appointed special advocate program and guardianship agency in St. Croix, Virgin Islands.  I've visited her several times over the years, and in fact, was just there in May. We talked then about whether she would evacuate in the event of any predicted hurricane strike on her island.  Her answer was "probably not," in large part because of her commitment to sharing the workload for a community already under stress from lack of jobs and other financial pressures.  

She rode out the two hurricanes that hit her part of the Caribbean in September and while her own home was spared serious damage, she could provide only sporadic reports -- when she had cell phone service and enough battery power -- about the aftermath for her clients.  When she mentioned the trauma caused by the "simple" fact that having no way to escape heat and humidity, especially at night, was one of the most exhausting parts of the post-storm struggle for all ages, I searched my local stories for battery operated fans to send (and then we had the challenge of finding a way to get them to her island).  

The reality for seniors living day-after-day, week-after-week, and now several months in a row without a reliable source of power is part of the picture painted in a recent article in The New York Times.  

With large areas of Puerto Rico still in the dark three months after the first of the storms — according to government reports, only 60.4 percent of the pre-storm power grid load has been restored — older residents and those with chronic medical conditions are suffering in even more ways than their neighbors. Many nursing homes have no power. The failure to re-establish functioning telephone networks and transportation systems in many areas makes it difficult to get regular medical care. Fire safety systems are inoperable, posing special dangers for those who cannot easily escape.

 

A look inside the 356 units that make up Puerto Rico’s largest housing project for low-income seniors, Comunidad del Retiro, or Retirement Community, helps explain the hurricanes’ continuing impact on the vulnerable. Inside the complex, there is a man with apnea who cannot sleep at night without power to his oxygen machine. A woman with dementia who was scheduled for transfer to a nursing home before the storm. And Ms. Rodriguez de Jesus, who mistakenly drank a poison in the dark and came close to becoming another uncounted hurricane death.
There have been falls in dimly lit apartments. Special diets that could no longer be followed. Medical interventions, drugs and treatments missed or delayed.....

For more, read Lives at Risk Inside a Senior Complex in Puerto Rico With No Power

December 13, 2017 in Current Affairs, Ethical Issues, Health Care/Long Term Care, Housing | Permalink | Comments (0)

Tuesday, December 12, 2017

Legal Implications of Biomarkers for Dementia Highlight ASU's Conference on "The Aging Brain"

The "Aging Brain" Conference hosted by Arizona State University's Sandra Day O'Connor College of Law held on December 8, 2017 at the Sandra Day O'Connor United States Courthouse in Phoenix (that's a double helping of Sandra!) proved to be a fascinating, deep dive into the intersection of medicine, ethics and law with a focus on neurocognitive diseases, including Alzheimer's Disease.  The panelists and audience included academics in a wide range of fields, plus practitioners in medicine, law, social services, and more, along with both state and federal judges.  United States District Judge Roslyn Silver is a long-time supporter of law and science programming with ASU. LSI_Aging Brain 120817 Competency_and_Incapacity_5 SPEC (2)

One of the important themes that emerged for me was the growing significance of pre-symptomatic tests that can disclose genetic markers associated with greater incidence of an eventual, active form of a degenerative brain disease.  Neurologist Richard Caselli from Mayo Clinic and Jessica Langbaum, principal scientist with Banner Alzheimer's Institute laid out the latest information on a variety of genetic testing options, including the possibly mixed results for "risk" connected to positive results for specific genetic markers.  A provocative question by a morning speaker, Law and Biosciences Professor Henry T. Greely at Stanford, captured the personal dilemma well, when he asked the audience to vote on how many would want to to know the results of a genetic test that could disclose such a connection, especially as there is, as yet, no known cure or even any clear way to prevent most neurocognitive diseases from taking hold.  

Taking that a step further, how many of us would want our employer to know about that genetic marker results?  How about our health insurers? As we discussed at the conference, some consumer information is already available through "popular" ancestry testing sites such as "23 and Me," which expressly offers testing for "genetic health risks," including "late-onset Alzheimer's Disease and Parkinson's Disease."  Arizona State Law Professor Betsy Gray, director of the Law & Neuroscience Program for ASU's Center for Law, Science and Innovation, who master-minded the conference, helped to identify a host of legal and ethical issues connected to this developing world of science and medicine. Jalayne J. Arias, a full-time researcher at University of California San Francisco's Neurology, Memory and Aging Center (and clearly a rising academic star and graduate of ASU Law) outlined the implications of pre-symptomatic testing from the perspective of long-term care insurance.  For more from Professor Arias, I recommend her 2015 paper for the Journal of Clinical Ethics on Stakeholders' Perspectives on Preclinical Testing for Alzheimer's Disease.

 I plan to write more about this conference, as many perspectives on legal, ethical and medical questions were offered.      

December 12, 2017 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Discrimination, Ethical Issues, Programs/CLEs, Science | Permalink | Comments (0)

Sunday, December 10, 2017

If You Made a List, What Would You Do Differently When You are Older?

I was reading the article, Things I’ll Do Differently When I’m Old, in the New York Times.  The author writes about a do and not do list.  What is this type of list? "It was a highly judgmental, and super secret, accounting of all the things I thought my parents were doing wrong. . .  It was all too easy to call them out, and I recognized over and over just how awful it is to become feeble, sick and increasingly absent-minded, or worse." 

Why such a list? According to the author, it arose out of watching the impact of their poor decisions on his parents. For example, his mother continued driving past the time of her capability or his father's refusal to use an assistive mobility device.  Learning from our elders' "mistakes" is nothing new, but making a list that applies specifically to one's older age is an interesting concept. Wonder what is on the author's list?  Items include driving ability, accepting help to maintain independence,  maintaining physical appearance, not lash out at others and treat them with respect and kindness. 

The author notes that his grandmother had a similarly intended list that he found going through his dad's papers.  He concludes "I certainly hope to learn from her errors, and my parents’, and avoid making too many of my own. Mostly I hope to be able to judge when to stop adding to the list, and start following its advice."

December 10, 2017 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other | Permalink

Friday, December 8, 2017

As The Oldest Generation Ages in Japan . . .

A haunting story and visual images of growing old alone in Japan, from the New York Times, including this excerpt:

To many residents in Mrs. Ito’s complex, the deaths were the natural and frightening conclusion of Japan’s journey since the 1960s. A single-minded focus on economic growth, followed by painful economic stagnation over the past generation, had frayed families and communities, leaving them trapped in a demographic crucible of increasing age and declining births. The extreme isolation of elderly Japanese is so common that an entire industry has emerged around it, specializing in cleaning out apartments where decomposing remains are found.

For more, see A Lonely Death, by Norimitsu Onishi, published November 30, 2017.

December 8, 2017 in Advance Directives/End-of-Life, Current Affairs, Housing, International | Permalink | Comments (0)

Thursday, December 7, 2017

Planning for Workshop on Physician-Aided Death

The National Academies of Science, Engineering and Medicine released information about planning for a workshop Physician-Assisted Death: Scanning the Landscape and Potential Approaches - A Workshop

The 2014 case of Brittany Maynard, a 29-year old woman suffering from terminal brain cancer who made public her desire to have an option to end her life through medication, brought to the forefront of the public eye the age-old question of whether terminally ill patients should have access to a physician's assistance to hasten death. To gain the option, Ms. Maynard relocated from California to Oregon, where a "death with dignity" law has been in effect for nearly 20 years. More recently, five jurisdictions (California, Colorado, District of Columbia, Vermont, and Washington) have legalized physician-assisted death, and physician-assisted death is also legal in one state (Montana) by virtue of a ruling of that state's Supreme Court. The question of whether and under what circumstances terminally ill patients can access life-ending medications with the aid of a physician is receiving increasing attention as a matter of public opinion and of public policy. Ethicists, clinicians, patients and their families debate whether physician-assisted death ought to be a legal option for patients. While public opinion is divided, and public policy debates include moral, ethical, and policy considerations, a demand for physician-assisted death still persists among some patients, and the inconsistent legal terrain leaves a number of questions and challenges for health care providers to navigate when presented with these patients. The Board on Health Sciences Policy of the National Academies of Sciences, Engineering, and Medicine will convene an ad hoc committee to plan a workshop that will explore current practices and challenges associated with physician-assisted death, and highlight potential approaches for addressing those challenges.

Stay tuned for more info.

December 7, 2017 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, Programs/CLEs, State Statutes/Regulations | Permalink | Comments (0)

Wednesday, December 6, 2017

When a Tattoo is an Advance Directive?

I've told my students urban myths before about a tattooed advance directive and use that story to talk about the requirements for making a valid directive. So I was interested in reading the article about the DNR tattoo. Health News Florida ran the story, Did 'Do Not Resuscitate' Tattoo Reflect Patient's True Wish?  reports the story of a patient at Jackson Memorial in Miami with a DNR tattoo.  A tattoo presents some significant ethical questions for doctors. As this story reflects, the immediate questions are "is it legal and ... is it truly the man's wishes,"  In this case the patient presented at the ER alone with no ID  and no family were reachable. Taking this to the hospital ethics committee, the committee ultimately determined this was a valid expression of the patient's directions.  In this case, the tattoo contained the patient's signature. The Atlantic also ran a story, What to Do When a Patient Has a 'Do Not Resuscitate' Tattoo which reports a split of opinions from experts regarding whether the hospital should honor the tattoo. One expert offers

It’s the discussion that matters, not the words on the form (or the tattoo), says Joan Teno from the University of Washington, who studies end-of-life wishes. And in many cases, those discussions don’t happen, or aren’t respected. In a study of bereaved family members, she found that one in 10 say that something was done in the last month of a patient’s life that went against their wishes. “The fact that someone has to resort to a tattoo to have their wishes honored is a sad indictment of our medical system,” Teno says. “We need to create systems of care where patients have the trust and confidence that their wishes will be honored. That’s the important message from this case.”

 Note to readers: republished to correct typo. Note to self-don't post with head cold.

 

 

 

December 6, 2017 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (1)

California Law, Amended in 2017, Sets Process for Contesting Transfer Decisions in Continuing Care Communities

Following my recent post about "evictions" in Continuing Care and Life Plan Communities, Margaret Griffin, the president of the California Continuing Care Residents Association (CALCRA) provided me with a copy of legislation that was signed into law by the Governor in October this year, amending California law on Continuing Care Retirement Community (CCRC) contracts.  This history is another window on how to handle involuntary transfers of residents.  California's law already provided detailed topics that must be addressed in admission contracts.  The newest provision requires greater sharing of any reasons for an involuntary transfer.  For "disputed" transfers the law now mandates that the provider:

"... shall provide documentation of the resident's medical records, other documents showing the resident's current mental and physical function, the prognosis, and the expected duration of relevant conditions, if applicable. The documentation shall include an explanation of how the criteria [supporting the involuntary transfer decision] are met.  The provider shall make copies of the completed report to share with the resident and the resident's responsible person. "

Further, the amended law provides that even though the CCRC has the right -- under certain conditions -- to transfer the resident, the resident may "dispute" the decision and have the reasons reviewed in a timely manner by the "Continuing Care Contracts Branch of the State Department of Social Services" in California.  That office has statutory authority to determine whether the facility has followed its own contractual basis and process for transfers, and "whether the transfer is appropriate and necessary."  

Ms. Griffin explains that the law "basically . . . requires an assessment be done to establish a functional reason for the transfer (as opposed to merely having the administrator’s whim be sufficient), and it allows the resident to appeal the actual decision (previously we were limited to requesting a review of the process)."

Thank you, Margaret, both for sharing the latest information on CALCRA's successful advocacy with California Assembly Bill 713, and for your additional commentary.  

December 6, 2017 in Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care, Housing, Property Management, Retirement, State Statutes/Regulations | Permalink | Comments (0)

More on Nursing Home Issues

There have been a spate of articles of late regarding various issues surrounding nursing homes, and to some extent ALFs, arising from the hurricanes that hit Florida, Puerto Rico and Texas this past summer.  For example, Health News Florida reported that ALFs in Florida were facing a whopping $280 million for generators, Assisted Living Facilities Face $280 Million Tab For Generators     resulted from a cost estimate from Florida's Department of Elder Affairs, which "published a summary of the estimated regulatory costs on Wednesday after it received a three-page letter from the Joint Administrative Procedures Committee flagging potential problems with the proposed rule, initially published on Nov. 14. The estimated costs were published in the Florida Administrative Register."  The Florida Governor had issued an emergency rule shortly after Irma and the agency has now released a permanent rule to replace the emergency rule.  It looks as though there are over 4,500 ALFs in Florida, so it's understandable how the cost of compliance would reach that estimate. 

Meanwhile, Health News Florida was also reporting that the cost of generators for nursing homes is less than that estimate for ALFs but still high-$186 million high. Nursing Home Generator Costs Estimated At $186 Million     explains this figure, again an estimate, again resulted from the new rule with the total based on "estimates on information provided from the nursing home industry, which said the costs for a generator at a 120-bed facility would be $315,200. Using those figures, [the Florida Agency] estimated the average cost per bed at $2,626.66."

Then there's the story about the plan to recycle Rx meds from Pro Publica that Health News Florida picked up, More States Hatch Plans to Recycle Drugs Being Wasted in Nursing Homes     explains "how the nursing home industry dispenses medication a month at a time, but then is forced to destroy it after patients pass away, stop using it or move out. Some send the drugs to massive regional incinerators or flush them down the toilet, creating environmental concerns." Although there are a few programs to "recycle", most of the time leftover drugs are destroyed, some by flushing and others by incinerating.  Although in many states, donations of drugs is possible, the story explains "[m]any states ... don’t have programs that get the drugs safely from nursing homes to those who need them."

December 6, 2017 in Consumer Information, Current Affairs, Health Care/Long Term Care, Medicaid, Medicare, State Statutes/Regulations | Permalink | Comments (1)

Arizona State Presents Legal, Policy and Ethical Perspectives on "The Aging Brain"

On December 8, 2017, I'm excited to be participating in a conference on The Aging Brain: Legal, Policy & Ethical Perspectives, in Phoenix, Arizona.  This program is a follow-up to an interdisciplinary workshop hosted at Arizona State University's Sandra Day O'Connor School of Law in the fall of 2016. This year's presentations will take place at the the United States Courthouse in Phoenix.

The planned schedule is jam-packed with speakers I'm looking forward to hearing, including:

Welcome: Betsy Grey, Sandra Day O’Connor College of Law, ASU

Introduction: Dean Douglas Sylvester, Sandra Day O’Connor College of Law, ASU

Keynote Speaker:Richard H. Carmona, M.D., M.P.H., FACS, 17th Surgeon General of the United States, Chief of Health Innovations, Canyon Ranch, Distinguished Professor, University of Arizona

Scientific Developments in Aging and Dementia: Pre-Symptomatic Screening for Neurodegenerative Diseases

    Panel Chair: Hon. Roslyn O. Silver, U.S. District Court for the District of Arizona

  • Dr. Richard Caselli, Mayo Clinic
  • Dr. Jessica Langbaum, Banner Alzheimer's Institute
Ethical, Legal, and Social Implications
       Panel Chair:  Michael Saks, Sand Day O'Connor College of Law
  • Dr. Cynthia M. Stonnington, Mayo C;inic
  • Jalayne J. Arias, UCSF Neurology, Memory and Aging Center
  • Henry T. Greely, Stanford Law School

Aging at Home

    Panel Chair: Larry J. Cohen, The Cohen Law Firm

  • David Coon, College of Nursing & Health Solutions, ASU
  • Kent Dicks, Life365, Inc.
Competency and Incapacity: Assessment and Consent

    Panel Chair: Charles L. Arnold, Frazer Ryan Goldberg & Arnold, LLP

  • Hon. Jay M. Polk, Probate Dep’t. Associate Presiding Judge, Superior Court of Arizona for Maricopa County
  • Katherine Pearson, Dickinson School of Law, Pennsylvania State University
  • Dr. Elizabeth Leonard, Neurocognitive Associates
  • Betsy Grey, Sandra Day O’Connor College of Law, ASU

End of Life

    Panel Chair: Dr. Mitzi Krockover, Health Futures Council at ASU

  • Jason Robert, Lincoln Center for Applied Ethics, ASU
  • Amy McLean, Hospice of the Valley
  • Dr. Patricia A. Mayer, Banner Baywood & Banner Health Hospitals

Keynote:

Dr. Susan Fitzpatrick, President, James S. McDonnell Foundation
Introduction by Jason Robert, Lincoln Center for Applied Ethics, ASU

December 6, 2017 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Federal Cases, Health Care/Long Term Care, Science, Statistics | Permalink | Comments (0)

Tuesday, December 5, 2017

Your Digital Property

Our friend and colleague, Professor Naomi Cahn at GW Law, sent us a link to a story published in Slate. The Digital Afterlife Is a Mess recounts the tangle created by the number of accounts a person may have, knotted up by company policies and wrapped around various laws.

Today’s world is different. Many of us have chosen to go paperless, so all of our financial statements are delivered electronically; we even file digital tax returns. Our love letters may no longer be written in ink on paper, our reading and listening and viewing interests no longer documented by hardcover books and magazines, record albums, and VCR tapes, and our photos no longer stored in boxes under out beds.

So once the digital asset owner dies, how does the executor gain access to these digital assets and further, determine their value, if any?  The article explains the hurdles, including the potential for committing a crime unwittingly by using the decedent's account and password to access digital files.  The article turns to the Uniform Act designed to address this growing problem:  the Uniform Fiduciary Access to Digital Assets Act, Revised, which has been adopted by almost 2/3 of the states.  The Act "allows a fiduciary to manage much of a decedent’s digital property, giving access to many things other than the content of electronic communications (unless this access has been limited by the user or by a court order) and even permitting access to content in certain limited situations." The article explains the 4-tiered system the Act uses for prioritizing and offers practical suggestions such as starting with inventorying your own digital assets, subscribing to an online account management program,  and include coverage of digital assets in estate planning documents.

December 5, 2017 in Consumer Information, Current Affairs, Estates and Trusts, Federal Statutes/Regulations, Property Management, State Statutes/Regulations, Web/Tech | Permalink | Comments (1)

Monday, December 4, 2017

Second Phase of Changes to Nursing Home Regs

Last year CMS released some changes to the Nursing Home regs, some of which went into effect last, year and others that recently went into effect this year in late November. Consumer Voice has released a summary of significant provisions that just went into effect. Federal Requirements of Participation for Nursing Homes: Summary of Key Changes in the Final Rule Issued September 2016 Phase 2, a 9 page document,  highlights both new rules and edited ones. For example, a new rule involves baseline care plans which have to be done within 2 days of admission. One of the modified rules going into effect involves nursing services: requiring not only enough staff, but with needed specific skills and competencies. There's also a new rule regarding nutrition staffing and competencies.

The last phase of implementation doesn't occur until Nov. 28, 2019. For a pdf of the summary of key changes, click here.

December 4, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare | Permalink | Comments (0)

Growth of Mediation Programs in Orphans' and Probate Courts

Last Saturday, I had the unique privilege to sit in on a day of Advanced Probate Mediation Training, a component of a larger ADR program at the Orphans/ Court for Prince George's County, Maryland.  The attendees included long-serving mediators from other court divisions, judges and attorneys and individuals interested in a formal mediation process for probate cases. The facilitators for the training were Mala Malhotra-Ortiz and Cecilia Paizs, very experienced educators and ADR specialists. Chief Judge Wendy Cartwright welcomed us all and made it clear that mediation, collaborative probate and structured settlements are three vital programs for the probate division.  Certainly this is part of a trend favoring ADR, now applying to post-death disputes. 

My strongest impression of the day was the warm and positive demeanor of the folks I met, especially as they were giving up most of their Saturday.  I had the feeling that they were eager to share this experience.

Part of the training involved role plays -- and everyone in the room took the exercises seriously.  In Maryland, a challenge to a will is called a "caveat" proceeding, and a threshold question for court administrators is whether a specific dispute seems to be a good candidate for referral to mediation.  

In one exercise, I played a minor role (a "grandchild") of the testator, in a fact pattern that involved two named beneficiaries, a biological child and a second beneficiary who wasn't a direct blood relation. The fact pattern was realistic, as both sides wanted "accountings" for pre-death expenses by those serving as the caregiver or  POA for the elderly testator before her death.  The dispute included a long-history of difficult family dynamics, and was realistic as there was a temptation for other family members to take sides with the primary disputants. We even had an "obstructionist" attorney as an assigned role, someone who was still advocating for the purely "legal" outcome during the mediation.  

The majority of the participants were also lawyers -- and I could quickly see how uneasy the fact pattern made some attorneys. One option for the mediated outcome was distinctly "nonlegal" -- i.e., permitting the parties to split the proceeds of the estate in a way that was not the same as the testator's directions in her will.   The facilitators did an excellent job in counseling the lawyers on how to change their thinking, so as to allow consensus to emerge for a final, written settlement agreement. The fact pattern also put us in the position of needing to think about whether there had been any pre-death elder exploitation, and if so, to discuss how mediators should handle the possibility of a "crime."

I know our law students are going to be very lucky to have Mala Malhotra-Ortiz join us at Dickinson Law in the near future as an adjunct professor.   And, by the way, for anyone interested in why probate courts are sometimes called  "orphans' courts," I recommend the Court's link above on the history of Orphans' Courts in Maryland. 

December 4, 2017 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, State Cases, State Statutes/Regulations | Permalink | Comments (0)