Saturday, December 20, 2014

"Smart Talk" about Guardianships, POAs, Elder Abuse & Access to Justice in the Courts

Here is a link to a podcast for a Smart Talk program from WITF Public Radio, where Zygmont Pines, Esq., Court Administrator for the Commonwealth of Pennsylvania and I were invited to talk about quite a few "hot" topics from Pennsylvania Supreme Court's Elder Law Task Force.  The Task Force released its big Report and Recommendations last month. 

The topics strike me as quite universal, not Pennsylvania specific.  If you make it to the last few minutes (or skip ahead), there is an especially poignant moment with a family caregiver, who tells a real life story that will strike a chord with many. 

 

 

December 20, 2014 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

Thursday, December 18, 2014

Rural Vets Get Care via TeleMedicine

Reuters ran an interesting story last month about the use of telemedicine to deliver health care to rural vets. The story, For rural vets with PTSD, Telemedicine may help is based on a study published in the November, 2014 JAMA Psychiatry

The Reuters article explains a new study that shows using telephones and videochat can be helpful in the treatment of PTSD for these vets. This most recent study  "included 265 middle-aged vets with severe PTSD symptoms at one of the outpatient clinics without onsite psychiatrists or psychologists from 2009 through 2011.” Recruited from 3 different areas of the country, 50% of the vets “received the outpatient clinic’s ordinary care” while the remainder had access to “an additional care team at a larger medical center via telemedicine.”  This team included a variety of professionals, such as pharmacists and nurse care managers who called the vets, and video-chat consults with psychiatrists who subsequently provided “feedback and treatment recommendations to providers at the clinic through electronic medical records.” Video chat was also used by psychologists for “cognitive processing therapy, a specific behavioral therapy developed to treat PTSD…”

The story notes that the technology isn’t right for every vet, but a large number in the study were happy with it and that further research is needed to in order to determine the path to widespread use.

The JAMA article offers this conclusion “Telemedicine-based collaborative care can successfully engage rural veterans in evidence-based psychotherapy to improve PTSD outcomes.” The JAMA article abstract is available here, and the full article is available by subscription or purchase.

December 18, 2014 in Health Care/Long Term Care, Veterans | Permalink | Comments (0) | TrackBack (0)

Wednesday, December 17, 2014

Might the U.S. Have Important Lessons to Learn from Cuba About Healthcare and Aging?

Having lived several years in Miami, I have long had a bit of fascination with the island nation of Cuba. So close, and yet so far away. While working in Ireland in 2010, my interest increased, as I learned more about modern-day Cuba from Dr. Una Lynch, a public health specialist, who had frequently traveled and worked in Cuba.  She gave a presentation that opened my eyes to Cuba's WHO statistics, its reputation for a "first world" health care system, and the positve outcomes on aging and longevity.  See here and here for more comparative discussions on Cuban health care.

It was a happy surprise for many to learn of the dramatic plans to restore diplomatic relations between the U.S. and Cuba.  At the same time, I suspect that some of my Cuban-American friends in Miami may be torn, especially as many of their families were forced to flee Havana years ago. One friend has akready reacted happily, commenting,  "This is a bold move and long overdue." Feliz aňo nuevo!

December 17, 2014 in Health Care/Long Term Care, International | Permalink | Comments (0) | TrackBack (0)

Tuesday, December 16, 2014

Common Disability for Elder Americans

The Census Bureau released a report covering the survey results from the American Community Survey on the most common disability for elder Americans. Older Americans with a Disability: 2008-2012  was issued in December 2014. According to the article, almost 2/3 of elders with disabilities report a problem with mobility (e.g.,  climbing or walking). A graphic that shows the number of elders with a disability by county is also available.

The report concludes with several points, one of which is that "[t]he future of disability among older Americans will be affected by how this country prepares for and manages a complex array of demographic, fiscal, medical, technological, and other developments that will unfold in the next several decades." (citations omitted)

 

December 16, 2014 in Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

A How-To Guide for Kids Caring for Their Parents

PBS NewsHour ran a story about suggestions for siblings who are providing care for their parents. A sibling’s guide to caring for aging parents by Bonnie Lawrence of the Family Caregiving Alliance offers a list of pointers as well as several tips. These range from planning, setting a family meeting, keeping respect in mind, the value of communication, and suggestions for consensus building,

 

December 16, 2014 in Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

Did You Catch NPR's "Old and Overmedicated?" (Links and Updates Here)

Mark Friedman, an elder law and special needs attorney from New Jersey, recently wrote to comment on the important series offered by National Public Radio on use and misuse of certain medications in long-term care settings.  Here is what Mark said:

"NPR ran a story on 'chemical restraints,' - nursing homes using anti-psychotic drugs to make unruly residents more pliable. According to the article, the residents are usually Alzheimer’s or dementia patients, and anti-psychotics can make the residents easier for staff to manage. But the drugs can be dangerous, increasing a resident’s risk of falls and exacerbating health problems. At high doses, anti-psychotics can also sap away emotions and personality and put the resident into a 'stupor.'

 

Administering drugs in this manner, any drugs, including anti-psychotics, without medical need and for the convenience of staff, is contrary to federal regulations. Unfortunately, it may also be widespread.

 

The NPR story includes a tool drawn from CMS data that shows the rate of residents on anti-psychotics at nursing homes across the country. You can look up the facility in which your loved one resides.

 

The news coverage shows that this issue is getting increased attention, and that’s a good thing. I think that as Americans age and more people have spouses and parents in nursing homes, the use of anti-psychotics as chemical restraints will have to diminish or end. People won’t stand for their loved ones being drugged into a stupor."

Thanks, Mark, for making sure we included this topic and the latest links for more coverage and your additional commentary.  Along the same lines, I listened to an interesting follow-up conversation on AirTalk, a Los Angeles public radio affiliate's program, discussing "How California is Doing in the National Fight to Curb Over-Medication of Nursing Home Patients."  That program, now available as a 23-minute podcast, included an articulate medical professional, Dr. Karl Steinberg, who described how he sees medication practices changing in long-term care, including better use of behavior health techniques, rather than medication, to help residents.

Continue reading

December 16, 2014 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Science | Permalink | Comments (0) | TrackBack (0)

Monday, December 15, 2014

Caregivers-It's A Role for Everyone

We have blogged on several occasions about family caregivers, and who in particular assumes the role of caregiver. Although some studies point to women as the caregivers, a new article shows that the caregiving role isn't just performed by women. Men as caregivers of the elderly: support for the contributions of sons was published in the Journal of Multidisciplinary Healthcare in November. According to the abstract

Emerging practice research on filial sources of health care support has indicated that there is a growing trend for sons to assume some responsibility for the health care needs of their aging parents. The purpose of this work is to propose that outcomes observed through a secondary analysis of data from a previous mixed methods research project, conducted with a sample of 60 elderly women residing in independent living centers, supports this concept in elder care. The present study is a retrospective interpretation utilizing the original database to examine the new question, “What specific roles do sons play in caregiving of their elderly mothers?” While daughters presently continue to emerge in existing health care studies as the primary care provider, there is a significant pattern in these data for older patients to depend upon sons for a variety of instrumental activities of daily living. As the baby-boomers age, there is more of cohort trend for their families to be smaller, adult daughters to be employed, and for adult children to be more geographically mobile. These factors may combine to make health care support networks more limited for the current aging population, challenging the elderly and their health care providers to revisit the cultural gender norms that are used to identify caregivers.

Professor Collins, the author of the article, opens the article with recognition that "[w]ithin the current context of an aging population, men can no longer be considered bystanders as caregivers to their aging parents.... [and that] [t]here is an emerging, yet largely unrecognized, societal trend for men to begin to fill the gaps as caregivers to community-dwelling elder parents." (citations omitted). Professor Collins cites some interesting statistics on the number of male caregivers and of those, how many are the sons of the elder.  The author goes on to examine how other reports on caregiving have analyzed the role of males as caregivers.  The author concludes that "[t]he findings of this study support the literature previously cited that suggests sons do contribute to the care of their elderly parents, particularly in the provision of IADL support." (citations omitted). A pdf of the full article is available here.

December 15, 2014 in Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

Saturday, December 13, 2014

Los Angeles Public Radio Affilliate Continues Discussion on Capacity and Consent

AirTalk, a program aired daily by Public Radio affilliate KPCC in Southern California, hosted a discussion about the issues identified in news articles about the Iowa criminal case, where a husband faces "statutory rape" charges for having sexual relations with his wife after she was diagnosed with advanced dementia and began residing in a nursing home.

Here's the link to a podcast of the December 12, 2014 segment.

December 13, 2014 in Cognitive Impairment, Crimes, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0) | TrackBack (0)

Friday, December 12, 2014

Another Filial Friday: Rest Haven York v. Deitz

"Nonprecedential decisions" sometimes make me a little crazy.  Talk about them? Ignore them?  What if that's where all the action is happening on a tough topic? 

This time I think it is important to report a nonprecedential decision, one of the few to emerge from the appellate courts in Pennsylvania in recent years where sons or daughters are not held liable under Pennsylvania's filial support law, and thus were not required to pay for the parent's nursing home care.

In the case of Rest Haven York v. Deitz, Case No. 426 MDA 2014, the Pennsylvania Superior Court issued a nonprecedential memorandum ruling on August 22, 2014.   Mom resided in the plaintiff-nursing home for about two and a half years, and when she died there was an alleged unpaid bill of approximately $55k.  No details are provided in the opinion about why that debt accrued or whether Medicaid was used for any payments.  The amount is large enough to suggest something went wrong somewhere on the payment side of the ledger, but it also is not large enough to suggest that no payments were made.

The facility sued the resident's daughter, who was alleged to have "signed the admitting papers as agent under a power of attorney" executed by her mother.  The complaint, filed three months after the mother's death, alleged breach of contract, implied contract, unjust enrichment, fraud, "and breach of duty to support" under Pennsylvania's filial support law, 23 Pa.C.S.A. Section 4603.

Daughter was granted summary judgment by the trial court, dismissing the entire suit.  The only issue on appeal was whether the nursing home had "failed to provide evidence that could have allowed the trial court to declare [the mother] indigent." Indigency, an undefined term in the statute, is one element of Pennsylvania's filial support law. 

The appellate court rejected the daughter's argument that indigency must somehow be declared or established by a judgment before a family member's support obligation can be triggered.  However, the court also concluded that attaching a copy of the contract signed by the daughter, as agent for her mother, and attaching a copy of "overdue" charges on the mother's account did not suffice. Interestingly, the court then went on to offer a bit of a lesson on how nursing homes "could" prove their case -- so, a nonprecedential opinion with a moral?

"To present competent evidence to prove indigence, Rest Haven should have provided a bank statement or similar documentation attesting to [the mother's] financial condition." 

In giving this lesson, the court cited two very precedential cases decided by the same court, Healthcare & Retirement Corp. of America v. Pittas (2012) and Presbyterian Medical Center v. Budd (2003).

As I often say to family members or lawyers who are startled to read about filial support law obligations, Pennsylvania appellate courts take this law very seriously when it comes to unpaid nursing homes.  There are some defense strategies available, but a successful defense is not easy.    

December 12, 2014 in Health Care/Long Term Care, Medicaid, State Cases, State Statutes/Regulations | Permalink | Comments (0) | TrackBack (0)

Wednesday, December 10, 2014

Comparative Legal News on the CARE Act: A Report from Pennsylvania's AARP Family Caregiver Summit

Earlier this year, Kim Dayton reported in our Blog (here) about the new CARE Act, enacted in Oklahoma as a means to provide better transition from facility-based care to home care for individuals needing support.  The CARE Act is a nation-wide project sponsored by AARP and thus I was excited to be invited to participate in an AARP Pennsylvania Family Caregiver Summit, as part of the discussion about introduction and passage of a CARE Act in my state. 

The Summit was held yesterday with administrative agency heads, legislators and their staff invited to attend.  The turnout was probably a bit affected by the weather reports for the day.  (What happened to the predicted Nor'easter, anyway?  Not that I'm complaining about winter weather that proves to be milder than predicted!)  I found the event very interesting.  As so often happens, I ended up being more of a student than a teacher, even while serving as a panelist.

It was quickly clear that virtually everyone in the room had experience with or personal awareness of the challenges of serving as a family caregiver under stress.  The room was practically vibrating with stories about how tough it can be to know what to do when you confront the reality that a parent or other aging family member needs significant support.  The keynote speaker, Cate Barron, a vice president of the PennLive and Patriot-News media group and by her own admission a take-charge kind of gal, spoke with great candor and humor about the process of realizing that a "diagnosis" of what is wrong did not necessarily provide answers to her mother's need for assistance.  We are so pre-programmed to believe that if we can find the right diagnosis of the problem, there must be a "solution" worth pursuing.

The opening presentation by Glenn Fewkes from the AARP National office provided the latest statistics and graphics about aging in the U.S.  What I found especially interesting were his graphics about Long-Term Services and Supports (LTSS) for individuals with caregiving needs.  It turns out Pennsylvania ranks near the bottom (42nd, according to the most recent statistics) on a national scorecard. evaluating LTSS for affordability and access.  That means the state with the fourth "oldest" population has some real challenges ahead.

That is where AARP's CARE Act project comes into play as a first step to improve supports for individuals needing care.  As we reported earlier, CARE is an acronym for "Caregiver Advise, Record and Enable" and AARP's model has straight-forward objectives.  To me, a key goal in adopting the model CARE Act is to create smoother transitions.  This can be facilitated  by making sure that hospitals or rehab facilities have clear information about any designated "caregiver," that they give notifice of discharge at least 4 hours in advance,  and that they offer practical instruction on any medical tasks that will need to be performed in the home.  For example, under the model CARE Act, the instruction shall include:

  • a live demonstration of needed "after-care tasks"
  • an opportunity for caregiver and patient to ask questions
  • answers to the caregiver and patient questions "provided in a culturally competent manner and in accordance with the hospital's requirements to provide language access services under state and federal law."

My own research has shown that family members often cite "access to accurate information" as one of the most important first needs for families responding to caregiving crises.  The CARE Act is clearly intended to respond to a critical first window of need -- hospital discharge --  by requiring facilities to give useful information and relevant instruction.

During the Family Caregiver Summit, there were a lot of good questions about the CARE Act, and it was great to have Pennsylvania State Representative Tim Hennessey on the panel. In his role as majority chair of the House Aging and Older Adult Services Committee, it is likely he will be able to provide early analysis and support for the CARE Act in Pennsylvania. 

As part of my own preparation for the Summit, I took a closer look at Oklahoma's result with the CARE Act.   Title 63 Okla. St. Ann. Sections 3113- 3117 (the statutory provisions created by the April 2014 passage of Senate Bill 1536) became effective on November 1, 2014.  The law requires that  hospitals "provide each patient or patient's legal guardian with an opportunity to designate one lay caregiver" following admission, and to record the designated caregiver and the caregiver's contact information in the patient's medical record.  Such a choice then triggers the hospital to "request the written consent" of the patient or guardian to release medical information to the patient." Only if the patient both designates a lay caregiver AND gives "written" consent is the hospital then obligated to do anything further with respect to discharge planning with the caregiver.

But what happens in Oklahoma when the written consent to share information with the designated caregiver is given? 

Continue reading

December 10, 2014 in Consumer Information, Current Affairs, Health Care/Long Term Care, State Statutes/Regulations, Statistics | Permalink | Comments (0) | TrackBack (0)

Friday, December 5, 2014

Is "Ambivalence" Sometimes a Component of Elder Financial Abuse?

I've written often in our Blog, including here and here, about our growing awareness and national concern about the issue of financial exploitation of older persons.  In brainstorming a bit with another attorney about a thorny case -- and trying to decide where a parent/child relationship went wrong --  I was reminded of the work of Professor Karen Hooker, PhD at Oregon State University's School of Social and Behavioral Sciences.  Karen-hooker-webA major focus of Professor Hooker's work is the influence of "personality" in aging across the lifespan.  She has examined spousal caregivers for persons with dementia, looking to see how the individual's view of self and the relationship affects "success," including successful caregiving.  Another part of her work has examined closely the issue of "ambivalence" in family relationships.

For example, in Dr. Hooker's research, her team used qualitative study methods to examine older parent/adult child relationships.  One of the major themes emerging when parents (each aged 67+) talked about their children was awareness that their children were "busy," and thus there were often ambivalent feelings of need and dissatisfaction about the parent's interactions with their children.  The study revealed feelings both of resentment and pride about their busiest children.

That has led me to think that "ambivalence" may also be a component of voluntary "principal and agent" relationships, where the adult children are asked by the parent to serve as an agent under a power of attorney, for example.  But as the adult child exercises more control over financial matters, might that parent also begin to have second thoughts, thoughts that are not acted on until "too late."  The children believe they had authority to "pay themselves" for their roles in handling matters for their aging parent; the parent initially agrees, or at least does not object, and only later, after the money is gone, asserts some "agreement" about the financial matters, arguing there was an "understanding," even if never express at the outset?  There is room for more research here, yes?

For more on Professor Hooker's interesting work in personality and life-span issues, read this great interview, with links to her publications and biography here.   

December 5, 2014 in Dementia/Alzheimer’s, Health Care/Long Term Care, Science, Statistics | Permalink | Comments (0) | TrackBack (0)

Thursday, December 4, 2014

Canada: Alzheimer's health club offering new type of care for seniors

Via the Toronto Star:

Ever since she was a teenager, Ashley Kwong knew she wanted to open her own seniors’ home. Now, almost two decades later, her dream is finally becoming a reality.  Kwong is launching Memory & Company next spring — and she’s touting the Markham facility as Canada’s first private Alzheimer’s program.  Kwong says Memory & Company will have a spalike feel, with well-lit rooms, secured outdoor spaces and programming such as music therapy, gardening and yoga. There will be a five-to-one staffing ratio and an on-site nurse.  Costs, which range from $100 per day for basic care to $150 for those with more advanced Alzheimer’s, are on a par with many long-term care facilities and retirement homes. While more expensive than many day programs, Memory & Company will offer a different type of experience, catered specifically to the needs of people with Alzheimer’s and dementia, Kwong says.  Clients will be free to roam the health club’s 11,000-square-foot space with a circular design to decrease their dementia-related agitation while wandering through the rooms. Clients will also have access to a salon, gym, dance studio and hydrotherapy spa, alongside outside services like massages and physiotherapy.  “We’re also using iPad technology to provide more individualized care, instead of planning the whole program for the month and not caring what people are in the building,” Kwong says. “It’s a different approach than the assembly style of day programs right now.”

Read more at the Toronto Star.

December 4, 2014 in Cognitive Impairment, Dementia/Alzheimer’s, Health Care/Long Term Care, International | Permalink | TrackBack (0)

Saturday, November 29, 2014

Oregon Court Invalidates State's Attempt to Expand Medicaid Estate Recovery

On November 26, 2014, in Nay v. Department of Human Services, the Oregon Court of Appeals invalidated a 2008 attempt by the state to expand Medicaid estate recovery rules to reach assets conveyed prior to death by the Medicaid recipient to his or her spouse. 

The court's ruling analyzes the portion of federal statutory law that permits, but does not require, states to expand Medicaid estate recovery programs to cover "any other real or personal property and other assets in which the [deceased] individual had any legal title or interest at the time of death... including such assets conveyed to a survivor, heir, or assign of the deceased individual through joint tenancy, tenancy in common, survivorship, life estate, living trust or other arrangement."  Analysis of this language, which was mirrored by Oregon statutory law, leads the court to conclude that some ownership interest at time death of the Medicaid recipient must be present to make the asset a valid target of Medicaid estate recovery:

"Therefore, we conclude that 'other arrangement' in the context of the definition of “estate” means that assets transferred from the deceased 'individual'—the Medicaid recipient—by operation of law on account of or occurring at the recipient's death are included in that definition. Thus, the 'including' clause in the federal permissive definition of 'estate' incorporates nonprobate assets that are transferred from the Medicaid recipient to a third party by operation of law or other mechanism, but in which the deceased Medicaid recipient retained legal title or 'any' interest at the time of his or her death."
The appellate court then analyzes property law principles and elective share rules in Oregon, concluding that the state rulemaking attempt to reach pre-death interspousal transfers is not within the scope of the federal (or state) authorization:
 
"By including the 'interspousal transfer' text in the pool of assets from which the state can recover from the surviving spouse's estate, the rule includes assets that necessarily were transferred before the recipient's death. Because we have concluded that such predeath transfers are antithetical to the definition of estate as provided by federal and state law (requiring that the recipient have an interest in the property at the time of his or her death), we conclude that DHS's amendments of OAR 461–135–0835(1)(e)(B)(iii) relating to interspousal transfers exceeded its statutory authority granted by ORS 416.350 and 42 USC section 1396p, and we hold those provisions invalid."
The petitioner in this case, Tim Nay, is a Portland, Oregon attorney and former president of NAELA. By ruling in favor of the petitioner on the scope of authority for rule making issue, the appellate court found it unnecessary to address the petitioner's alternative argument on constitutionality of the rule

November 29, 2014 in Estates and Trusts, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, State Cases | Permalink | Comments (0) | TrackBack (0)

Wednesday, November 26, 2014

Interprofessional Educational Initiatives "Spreading Like Wildfire"

Dr. Peter Beurhaus from Vanderbuilt University uses a question and answer format with colleagues at his university to explain how Vanderbilt's Program in Interprofessional Learning (VPIL), established in 2010, has involved "challenges, successes and surprises" for participants. The dialogue, published in Health Affairs Blog, emphasizes key points, including:

  • "Initially, we thought only of nursing and medicine but the more we examined the clinical situation, the more we realized that other health care providers were integral. So we looked at adding pharmacy and then social work. The challenge was to identify the place in the curriculum where our health professions students and interprofessional education would best fit."
  • "The notion of having one program that would meet requirements for four very different professions was quite challenging."
  • "Faculty representing each of the four health professions had to become liaisons between VPIL and their home professional school. Their work included negotiating the alignment of the home school’s goals, objectives, competencies, credit requirements, etc. with the innovative vision of an IPE curriculum in order to eliminate the 'add on' effect for the program. They had to be creative when identifying where a VPIL experience could be substitutive and simultaneously nurture their own role as part of the interprofessional faculty team charged with creating a meaningful educational program that met IPE goals."
  • "We intentionally partnered with people who had the same level of commitment that we did, and were conscious not to let extraneous things get in the way."

For more, see "Spreading Like Wildfire: Interprofessional Education - The Vanderbilt Experience."

 Along a similar line of interprofessional programming, see the commentary on "Interprofessional Education for Future Physicians: Including Legal Competencies," by Amy T. Campbell and our long-time friend Marshall Kapp. 

Hat tip to Delaware health law attorney Jennifer Davis-Oliva for sending links to both of these commentaries. 

November 26, 2014 in Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

Tuesday, November 25, 2014

Thank a Caregiver

Ramping up into Thanksgiving celebration, thinking about the things for which we are thankful---how about adding caregivers to that list? Huffintong Post Third Metric ran a three-part series earlier this month on Unsung Heroes: The Face of American Caregiving. The Unsung Heroes Who Give Up Everything To Take Care Of A Sick Partner, the first installment in the series, focused on eleven extraordinary caregivers providing care to spouses/partners.  The second,  The Unsung Heroes Who Give Up Everything To Take Care Of A Sick Parent covers 10 family members providing care for their parents., 9 of whom are over the age of 50.  The final installment, The Unsung Heroes Who Give Up Everything To Take Care Of Multiple Loved Ones covers ten amazing individuals who have provided care for multiple generations.

Knowing the statistics on caregiving, a number of us will be called upon to provide the care. These folks will inspire you.  Happy Thanksgiving.

November 25, 2014 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Retirement | Permalink | Comments (0) | TrackBack (0)

Sunday, November 23, 2014

California's Managed Care Project Frustrates Elders Who Are Ill and Poor

From Kaiser Health News, this report of "confusion, frustration and resistence," associated with California's first six months of efforts to move 500,000 low-income seniors and disabled persons into managed care: 

"'The scope and the pace are too large and too rapid for what is supposed to be a demonstration project,' said Dr. William Averill, executive board member of the Los Angeles County Medical Association, which filed a lawsuit to block the project. 'We are concerned that [the project] is ill-conceived, ill-designed and will jeopardize the health of many of the state’s most vulnerable population – the poor, the elderly and the disabled.'

 

There is a lot riding on the pilot — the largest of its kind in the nation. The patients involved are among the most expensive to treat – so-called 'dual eligibles,' who receive both Medicare, the health insurance program for the elderly and disabled, and Medicaid, which provides coverage for the poor. Over the three years of the demonstration project, California is focusing on 456,000 of the state’s 1.1 million dual eligibles.

 

State officials acknowledge some transition problems but say the project will provide consumers with more coordinated care that improves their health, reduces their costs and helps keep them in their homes. In addition, officials estimate the program could save the state more than $300 million in fiscal year 2014-2015."

For more, read "California's Managed Care Project for Poor Seniors Faces Backlash," by Anna Gorman.

November 23, 2014 in Health Care/Long Term Care, Medicaid, Medicare | Permalink | Comments (0) | TrackBack (0)

Friday, November 21, 2014

Oral Argument Before Third Circuit on Use of Short Term Annuities in Medicaid Planning

On November 19, attorneys representing families and the Commonwealth of Pennsylvania argued consolidated cases before a panel of the Third Circuit Court of Appeals,  involving use of short-term annuities in connection with applications for Medicaid-funded care.  The argument follows appeals from a January 2014 decision on summary judgment motions by the Western District of Pennsylvania in the case of  Zahner et al. v. Commonwealth of Pennsylvania

A key issue on appeal is whether use of "shorter" term annuities is permitted by the language of federal Medicaid statutes referring to actuarially-sound annuities, or whether such use automatically constitutes a transfer of assets for less than fair value, and thus is treated as a prohibited gift.  HCFA Transmittal 64 is the subject of much of the very technical debate.

Here is a link to the recording of the oral argument.

The jurists on the panel are Judge Theodore McKee (the male judge's voice on the recording), Judge Marjorie Rendell, and Senior Judge Dolores Sloviter (the softer voice on the recording).  Interestingly, rather early in the argument, at least two of the judges interject to make the observation that "there is nothing wrong with Medicaid planning, per se," noting, rather, that the issue is the extent to which specific planning approaches have been directly addressed by federal law.

The attorney arguing the position of the appellant families is René Reixach; the attorney arguing the case for the state appellee is Jason Manne

Listening to the oral argument in this case provides an opportunity for students in advanced legal studies on asset planning to consider cutting edge legal issues and policy concerns.  The argument is also an opportunity for even first-year law students to discuss argument techniques, and to consider what does or does not work well with judges (and vice versa). It was a "hot" bench and there was a lot of interruption from both sides.  

November 21, 2014 in Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, State Statutes/Regulations | Permalink | Comments (0) | TrackBack (0)

Thursday, November 20, 2014

Explaining Palliative Care in Graphic Format

The Institute of Medicine (IOM) has released a great graphic on palliative care. What Should You Know About Palliative Care? has six graphics on topics including scope, function, location, family services and the benefits of palliative care.   The infographic can be downloaded or a poster can be ordered by sending an email.  The webpage also includes a link to the IOM report, Dying In America

November 20, 2014 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

Wednesday, November 19, 2014

Ranking Last on Health?

This is one list where we don't want to be last-yet we are. According to a Commonwealth Fund November 19, 2014 story, U.S. elders are the sickest when compared to 10 other countries. 11-Nation Survey: Older Adults in U.S. Sickest, Most Likely to Have Problems Paying for Care notes that  "[c]ompared with their counterparts in other developed countries, older adults in the United States are sicker, see more doctors, take more prescription drugs, and have a harder time affording the care they need, according to a new Commonwealth Fund survey of people age 65 and up."  The survey is published in Health Affairs .  The abstract for the article explains

Industrialized nations face the common challenge of caring for aging populations, with rising rates of chronic disease and disability. Our 2014 computer-assisted telephone survey of the health and care experiences among 15,617 adults age sixty-five or older in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States has found that US older adults were sicker than their counterparts abroad. Out-of-pocket expenses posed greater problems in the United States than elsewhere. Accessing primary care and avoiding the emergency department tended to be more difficult in the United States, Canada, and Sweden than in other surveyed countries. One-fifth or more of older adults reported receiving uncoordinated care in all countries except France. US respondents were among the most likely to have discussed health-promoting behaviors with a clinician, to have a chronic care plan tailored to their daily life, and to have engaged in end-of-life care planning. Finally, in half of the countries, one-fifth or more of chronically ill adults were caregivers themselves.

The full article is available on the web as a pdf here.

November 19, 2014 in Health Care/Long Term Care, International | Permalink | Comments (0) | TrackBack (0)

The Law of Medicare and Medicaid at 50

Earlier this month, Yale Law School hosted a conference marking the 50th anniversary of the passage of Medicare and Medicaid.  The program speakers were encouraged to examine the precedents set by these two major programs, against the backdrop of recent health care reform initiatives.  Videos from sessions on "The Law of Medicare and Medicaid at 5o"  are now available to the public, including segments on:

  • Medicare, Then and Now
  • Historical Context, Legislation & Administration
  • Policy Making and Innovation
  • Health Law Federalism, Especially After NFIB
  • Looking Ahead

In addition, the presentation by keynote speaker Ezekiel Emanuel, Vice President of Global Initaitives and Chair, Medical Ethics and Health Policy at the University of Pennsylvania is available. 

The video segments, while interesting, may be a little difficult to sit through, as they are not edited, and some of the speakers are not using the microphones.  Fortunately, Professor Allison Hoffman from UCLA School of Law and others have written a wonderful series of pieces, stemming from the Yale program sesssions, and the articles are posted on Health Affairs Blog. 

November 19, 2014 in Health Care/Long Term Care, Medicaid, Medicare | Permalink | Comments (0) | TrackBack (0)