Wednesday, March 29, 2017

New Book from the National Academies on the Workforce Supporting Elders

The National Academies Press has released a new book, Strengthening the Workforce to Support Community Living and Participation for Older Adults and Individuals with Disabilities: Proceedings of a Workshop.  The book can be downloaded for free as a pdf or purchased as a hard copy .It can also be read online.  Here is the description of the publication:

As the demographics of the United States shift toward a population that is made up of an increasing percentage of older adults and people with disabilities, the workforce that supports and enables these individuals is also shifting to meet the demands of this population. For many older adults and people with disabilities, their priorities include maximizing their independence, living in their own homes, and participating in their communities. In order to meet this population’s demands, the workforce is adapting by modifying its training, by determining how to coordinate among the range of different professionals who might play a role in supporting any one older adult or individual with disabilities, and by identifying the ways in which technology might be helpful.

To better understand how the increasing demand for supports and services will affect the nation’s workforce, the National Academies of Sciences, Engineering, and Medicine convened a public workshop in June 2016, in Washington, DC. Participants aimed to identify how the health care workforce can be strengthened to support both community living and community participation for adults with disabilities and older adults. This publication summarizes the presentations and discussions from the workshop.

March 29, 2017 in Books, Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink | Comments (0)

Tuesday, March 28, 2017

Pre-Hospice Helps Keep People Home

I'd previously blogged about special EMTs that can help avoid trips to the ER for certain folks near the end of life.  Kaiser Health News recently ran a story about "pre-hospice":  ‘Pre-Hospice’ Saves Money By Keeping People At Home Near The End Of Life. The article explains the problem and one company's solution:

Most aging people would choose to stay home in their last years of life. But for many, it doesn’t work out: They go in and out of hospitals, getting treated for flare-ups of various chronic illnesses. It’s a massive problem that costs the health care system billions of dollars and has galvanized health providers, hospital administrators and policymakers to search for solutions.

Sharp HealthCare, the San Diego health system where [one individual] receives care, has devised a way to fulfill [the patient's] wishes and reduce costs at the same time. It’s a pre-hospice program called Transitions, designed to give elderly patients the care they want at home and keep them out of the hospital.

How does this pre-hospice work? The article explains it. "Social workers and nurses from Sharp regularly visit patients in their homes to explain what they can expect in their final years, help them make end-of-life plans and teach them how to better manage their diseases. Physicians track their health and scrap unnecessary medications. Unlike hospice care, patients don’t need to have a prognosis of six months or less, and they can continue getting curative treatment for their illnesses, not just for symptoms."

The article suggests that the need for pre-hospice programs will only grow in the near future as the Boomers keep growing older and older. But there are obstacles and one in particular is huge. If you guessed money, you'd be right. "[A] huge barrier stands in the way of pre-hospice programs: There is no clear way to pay for them. Health providers typically get paid for office visits and procedures, and hospitals still get reimbursed for patients in their beds. The services provided by home-based palliative care don’t fit that model."

The article discusses the need for and importance of palliative care, other innovations and the catalyst for the pre-hospice program.  Delving into the advantages of the pre-hospice program and how it works for patients.  The article notes that not only will there be an increased need for programs to keep folks at home, in addition to the payment hurdle, there are "not enough trained providers are available. And some doctors are unfamiliar with the approach, and patients may be reluctant, especially those who haven’t clearly been told they have a terminal diagnosis." And, of course, what will Congress do about health insurance, including Medicare.

Stay tuned.

March 28, 2017 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink | Comments (0)

Monday, March 27, 2017

Planning for End of Life: the 4 Ws and the Conversation Project

Amos Goodall sent me a link to an article he recently wrote, How to plan for end-of-life wishes.  Referencing the Conversation Project,  Amos writes about how important it is for a client to let others know what the client wants.

These questions boil down to the four Ws:

▪ Who should speak for you when you can’t?

▪ What should they be saying?

▪ When do you want these issues raised? 

▪ Where do you want to spend your final time — at home or in a hospital?

Essentially, you need to let folks know how you want to live your life at its end.

After discussing the law, Amos turns back to the Conversation Project and references the toolkit that is available and notes that his firm has adapted some resources for their clients which anyone can access via his firm's website.

According to the project's website, the purpose of the Conversation Project is "to helping people talk about their wishes for end-of-life care." The project offers a 12 page starter kit (available in 8 languages) as well as a 16 page toolkit on choosing and being a health care proxy. There's a 20 page starter kit for those who have a family member or significant other with dementia, including Alzheimer's disease and an 11 page kit for talking to the patient's doctor. There's also one when the patient is your child.

 

 

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Read more here: http://www.centredaily.com/living/article139165628.html#storylink=cpy

 

March 27, 2017 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care | Permalink | Comments (0)

Wednesday, March 22, 2017

Nursing Home Regs: Admission

Justice in Aging has released a new brief on the revised nursing home regulations this one focusing on admissions,  A Closer Look at the Revised Nursing Facility Regulations Admission. Here's the executive summary:

The revised regulations broadly prohibit facilities from using admission agreements or other documents that waive a resident’s rights. A resident cannot waive the protections of federal nursing facility law, or protections derived from any state or local nursing facility law. A resident also cannot waive his or her right to Medicare or Medicaid coverage, or any responsibility that the facility may have for the resident’s personal property. A facility cannot obligate a family member or friend to become liable for the nursing facility bill, although the facility can require the resident’s agent to agree to pay the resident’s money for the nursing facility expenses. The revised regulations prohibit pre-dispute arbitration agreements, but this consumer protection currently is blocked by a court order. Prior to admission, a facility must give notice of any special characteristics or service limitations.

The brief concludes with 4 suggestions for advocates and residents: careful review of the contract, sign the contract after residency in the SNF has begun, contest contract paragraphs that are improper and get a lawyer.

March 22, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Tuesday, March 21, 2017

Health Care Bill & Impact on Elders

It's not final, it's not been passed, and changes are likely, but the current health care bill, known as the American Health Care Act, has a significant impact on elders.  Last week's CBO report engendered a lot of discussion about the impact of this new health care proposal. The New York Times ran an article last week discussing it, No Magic in How G.O.P. Plan Lowers Premiums: It Pushes Out Older People.  The article explains that lower premiums are on the way for some under this proposal. But, the way the lower premiums are achieved? "[T]he way the bill achieves those lower average premiums has little to do with increased choice and competition. It depends, rather, on penalizing older patients and rewarding younger ones. According to the C.B.O. report, the bill would make health insurance so unaffordable for many older Americans that they would simply leave the market and join the ranks of the uninsured."

We know that insurers want to have a broad pool to spread the risk. Typically, "older customers cost substantially more to cover than younger ones because they have more health needs and use their insurance more. By discouraging older people from buying insurance, the plan will lower the average sticker price of care."  Ready for some sticker shock?  Under the proposal, according to the story, the plan "increases the amount that insurers can charge older customers, and it awards flat subsidies by age, up to an income of $75,000. ... On premiums alone, prices would rise by more than 20 percent for the oldest group of customers. By 2026, the budget office projected, 'premiums in the nongroup market would be 20 percent to 25 percent lower for a 21-year-old and 8 percent to 10 percent lower for a 40-year-old — but 20 percent to 25 percent higher for a 64-year-old.'"

The story explains that it's not just the premiums that give the whole picture. Tax credits factor into this as well.  Here is where the real sticker shock comes in. "[T]he change in tax credits matters more. The combined difference in how much extra the older customer would have to pay for health insurance is enormous. The C.B.O. estimates that the price an average 64-year-old earning $26,500 would need to pay after using a subsidy would increase from $1,700 under Obamacare to $14,600 under the Republican plan."  Did you see that-an increase from $1,700 to $14,600...

The article also discusses out of pocket costs and more.  The CBO report in pdf is available here.

The semester is quickly drawing to a close, but the bill could be a basis for an interesting class discussion on social policy, if you have time.

 

March 21, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare | Permalink

Monday, March 20, 2017

The New Health Care Bill

Wonder what is in the new health care bill?  New Health Plan Broken Down appears in the Centre Daily Times on March 12, 2017. The article is written by Amos Goodall, a prominent elder law attorney (and graduate of Stetson's LL.M. in Elder Law). The article explains changes to the individual mandate (penalty repealed and replaced), preexisting conditions protection (none), age-based premiums (5:1 ratio & will be up to states which ration), cost-sharing subsidies (will be eliminated), over the counter drugs (adding reimbursement from HSA, FSA or Archer MSA), Medicaid expansion (changes financing) and per capita caps.

To read more about these and other proposed changes, click here.

Thanks to Amos for sending me the link to the story.

March 20, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare | Permalink | Comments (0)

Friday, March 17, 2017

Alzheimer's and Marijuana-The Federal Block

I've blogged a couple of times recently about the fight against Alzheimer's disease.  Here's a recent story about research efforts stymied by federal law.  Big Alzheimer's research roadblock: Federal government was published by CNBC on March 9, 2017.   "Promising new research conducted last year at the Salk Institute for Biological Studies has shown that marijuana extracts may hold a key to treating Alzheimer's disease. The next step: To conduct tests on mice and, if the results are promising, move on to human trials. But Salk Institute researchers have run into a major hurdle, and not a scientific one: the federal government. The Salk Institute is based in La Jolla, California — a state that legalized marijuana last November — but it is a federally funded research institute."

The story reminds us that although marijuana use may be legal in several states, it's still not ok at the federal level-it's still a controlled substance. And when a research institute like Salk gets federal dollars for research, there's a problem.

So does this mean a dead end for marijuana/Alzheimer's research? Not necessarily. There is a path, but it won't be a quick or guaranteed one. "In order to acquire marijuana for further studies, the lab must first apply to the Drug Enforcement Agency, which carries out the application process jointly with the U.S. Department of Health and Human Services. The Salk researchers sent in their application in December...."  It takes several months for such a request to be approved.  The article discusses the costs of Alzheimer's disease  (which we have written about in prior posts)

The cost to the economy of caring for Alzheimer's and dementia patients was estimated to be about $236 billion in 2016. In 2015 a study funded by the National Institutes of Health estimated that the costs associated with late-stage dementia are greater than for any other disease.

During the last five years of a person with dementia's life, total health-care spending was more than a quarter of a million dollars per person ($287,038), about 57 percent greater than costs associated with death from other diseases, including cancer ($173,383) and heart disease ($175,136).

We all know how important it is to find an effective treatment (or even cure?) for Alzheimer's.  For now, the folks at Salk have to wait to hear if they can move forward.

BTW, those astute readers will notice the url for the story includes the phrase "major buzz kill." To  follow up, I'll close now with some my own pithy phrase,  "dude, serious bummer".  You insert your own pithy phrase here.....

March 17, 2017 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Science | Permalink | Comments (0)

Thursday, March 16, 2017

Call Congress Today on Medicaid and Medicare

Today is Call Congress About Medicaid day. Here is the information from the Medicare Rights Center:

Tell Congress to protect our care by joining today’s national call-in day. Urge your representative to vote “no” on the American Health Care Act... Call 866-426-2631 to contact your member of Congress.

The message is to vote no for changes to Medicaid and Medicare. The Medicare Rights Center also offers a one page issue brief on the proposed changes to Medicare, available here.

Regardless of your views, it is always important to make  your voice heard.

Thanks to Kim Dayton, the elderlawprof blog founder, for sending me a note on this.

 

March 16, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare | Permalink

IBM Tech to Track Mom to Help Her Stay At Home

Last week Business Insider ran a story on IBM's plan to track elders. IBM wants to protect senior citizens by tracking nearly their every move explains that IBM has been spending a lot of time on a project to discover how to help boomers continue to be healthy and happy. "That research has zeroed in on outfitting boomers' living spaces with artificially-intelligent sensors that can measure things like air quality, sleep quality, movement patterns, falls, and changes in scent and sound."  The data derived, according to the article, can help the kids and doctors "provide people with better care when needed. Critically, the sensors could detect when people deviate from a baseline to offer person-specific alerts." 

IBM is ready for beta testing their projects and in fact, the article explains " IBM announced its partnership with Avamere, a senior health care services company. Over the next six months, IBM will use Avamere's assisted living facilities to perform research on prototype sensors... Across three different locations — nursing facilities, assisted living, and independent homes — the sensors will collect data on people's environment and behavior."  This is not all that IBM is developing. IBM is also working with Rice University on a robot, known as MERA (or "the IBM Multi-Purpose Eldercare Robot Assistant (MERA), which the company has been testing at its "Aging in Place" lab in Austin, Texas....Sensors can detect when the stove's burners are on, or when a person has fallen down. Even in its prototype stage, MERA is equipped with cameras to read facial expressions, sensors to capture vital signs, and Watson-powered speech recognition to know when to call for help."

But what if mom doesn't want all this monitoring (is anyone besides me thinking about mom's privacy?)? IBM's response-the design will not be obvious and will be a gradual and "[I]f IBM's vision becomes reality, by the mid-21st century, millennials won't be guessing how their parents are faring. They'll have all the data they need, and seniors won't feel as if they're under anyone's care — even if the safety net is sitting right beneath them."

Hal, big brother really is watching!

Thanks to Tom Moran for sending me this article.

March 16, 2017 in Consumer Information, Current Affairs, Health Care/Long Term Care, Web/Tech | Permalink

Wednesday, March 15, 2017

Alzheimer's Disease and Medicare

Yesterday I blogged about the 2017 Alzheimer's Disease Facts & Figures. An article in Huffington Post focused on the impact on Medicare as the Boomers move into that age group where Alzheimer's risk increases. Rising Numbers Of Alzheimer’s Patients Could Bankrupt Medicare offers that

This year, for the first time, total costs related to caring for patients with Alzheimer’s will surpass a quarter of a trillion dollars, according to the Alzheimer’s Association annual report, released Wednesday. 

With roughly 75 million boomers only beginning to reach the age of greatest risk for the disease, the U.S. may be disturbingly close to the tipping point for runaway Alzheimer’s-related health care costs. The 88-page report lays out some sobering statistics, including the possible bankruptcy of Medicare.

The article covers dual eligible, the need for funding and research, and some of the proposals from Congress. "Simply put, Alzheimer’s is a public health crisis. Yet due to the social stigma surrounding dementia, its full dimensions are still cloaked in shadow. Combating the disease is going to require that politicians and members of the public speak out and demand real solutions."

 

March 15, 2017 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care | Permalink | Comments (0)

Tuesday, March 14, 2017

2017 Facts & Figures from the Alzheimer's Association

The Alzheimer's Association has released the 2017 Alzheimer's Disease Facts & Figures report. The report offers an updated terminology

That is, the term “Alzheimer’s disease” is now used only in those instances that refer to the underlying disease and/or the entire continuum of the disease. The term “Alzheimer’s dementia” is used to describe those in the dementia stage of the continuum. Thus, in most instances where past editions of the report used “Alzheimer’s disease,” the current edition now  uses “Alzheimer’s dementia.” The data examined are the same and are comparable across years — only the way of describing the affected population has changed. For example, 2016 Alzheimer’s Disease Facts and Figures reported that 5.4 million individuals in the United States had “Alzheimer’s disease.” The 2017 edition reports that 5.5 million individuals have “Alzheimer’s dementia.” These prevalence estimates are comparable: they both identify the number of individuals who are in the dementia stage of Alzheimer’s disease. The only thing that has changed is the term used to describe their condition.

The report contains a lot of good information that would help our students understand dementia and Alzheimer's.  The section on prevalence is sobering. For example, "[a]n estimated 5.5 million Americans of all ages are living with Alzheimer’s dementia in 2017. This number includes an estimated 5.3 million people age 65 and older, and approximately 200,000 individuals under age 65 who have younger-onset Alzheimer’s, though there is greater uncertainty about the younger-onset estimate." (citations omitted). The report also explores the gender, ethnic and racial factors regarding prevalence of Alzheimer's.  The report gives a breakdown by state. There is an amazing amount of critical information in this report.  The report also includes a special report, Alzheimer's Disease: The Next Frontier.

I'm going to make it assigned reading to my students. Be sure to read this. It's important.

March 14, 2017 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care | Permalink | Comments (0)

Monday, March 13, 2017

Planning Ahead for the What-Ifs In Your Last Years of LIfe

We don't know what the future holds for us, especially in our final years, but we can bet that we may be faced with some health care issues. Wouldn't it be great to have a guidebook for the final years? Well now you can.  According to an article in Kaiser Health News, A Playbook For Managing Problems In The Last Chapter Of Your Life, there is "a unique website, www.planyourlifespan.org, which helps older adults plan for predictable problems during what Lindquist calls the “last quarter of life” — roughly, from age 75 on...“Many people plan for retirement,” the energetic physician explained in her office close to Lake Michigan. “They complete a will, assign powers of attorney, pick out a funeral home, and they think they’re done.”...What doesn’t get addressed is how older adults will continue living at home if health-related concerns compromise their independence." The focus isn't on end of life planning, according to the article, it's the time before. "Investigators wanted to know which events might make it difficult for people to remain at home. Seniors named five: being hospitalized, falling, developing dementia, having a spouse fall ill or die, and not being able to keep up their homes."

The result of the work is an interactive website that deals with issues such as falls, hospitalization, dementia, finances and conversations. The website offers that "Plan Your Lifespan will help you learn valuable information and provide you with an easy-to-use tool that you can fill in with your plans, make updates as needed, and easily share it with family and friends."  Try it!

March 13, 2017 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Housing, Web/Tech | Permalink | Comments (0)

Friday, March 10, 2017

Preventing Alzheimer's?

We all want a cure for Alzheimer's no question.  If not a cure, then a way to prevent it. I blogged twice this week about Alzheimer's so I wanted to add one more story. Newsweek 's cover story for February 24, 2017 focused on prevention of Alzheimer's: The New Offensive on Alzheimer’s Disease: Stop it Before it Starts. The story opens with the news last year that an experimental drug failed to make much of an impact on those in the early stages of the disease. The story focuses on prevention:

This aggressive attempt to prevent Alzheimer’s rather than treating it is the most exciting new development in decades, as well as a radical departure for researchers and the pharmaceutical industry. Traditionally, drug companies have tested their therapies on patients who already have memory loss, trouble thinking and other signs of dementia. It’s been a losing tactic: More than 99 percent of all Alzheimer’s drugs have failed tests in the clinic, and the few that have made it to the market only ameliorate some symptoms. Not a single medicine has been shown to slow the relentless progression of the disease.

But with this new approach, even partial success—an appreciable slowing of brain degeneration—could have a big impact, says Dr. Reisa Sperling, a neurologist who directs the Center for Alzheimer’s Research and Treatment at Boston’s Brigham and Women’s Hospital. If a drug therapy can push back the onslaught of dementia by five or 10 years, she says, “many more people would die of ballroom dancing instead of in nursing homes.”

There are several ongoing clinical trials focusing on prevention, according to the article. There are also new tools to diagnosis Alzheimer's (where in the past, a brain autopsy was needed),   We need to hope for a success, because otherwise, as the article points out, the numbers are very very bad:

The consequences of failure could be dire. Approximately 5.4 million Americans suffer from Alzheimer’s, and if no disease-delaying therapies are found soon, that number is expected to nearly triple by 2050, at which point the cost of treating and caring for all those people could top $2 trillion per year, after adjusting for inflation. That’s up from $236 billion today. O ne in every five Medicare dollars is now spent on people with Alzheimer's and other dementias. In 2050, it will be one in every three dollars. And those figures don’t even include the hundreds of billions more in lost wages for family members who take time away from their jobs to care for loved ones. It’s not a question of a day off now and again. People with Alzheimer’s require around-the-clock care—and more than one-third of all dementia caregivers develop clinical depression.

The article also discusses the costs and coverage of any medication that proves successful in preventing Alzheimer's. Stay tuned.

March 10, 2017 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care | Permalink | Comments (0)

Medicare Observation Status-NBC News Story

NBC Nightly News ran a story on March 8 about Medicare Observation Status and the Notice Act. Law Aims to Protect Medicare Patients from Surprise Hospital Bill explains the hospital's disclosure requirement for patients and notes that a bill has been introduced to once and for all solve the problems caused when patients are on observation status. "A bill reintroduced Wednesday by Congressman Joe Courtney, D-Connecticut, would make days spent "under observation" count towards qualification for Medicare coverage."  The story featured comments from Judy Stein, executive director of the Center for Medicare Advocacy and former NAELA President (full disclosure, I serve of the Center's board).

March 10, 2017 in Consumer Information, Current Affairs, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Wednesday, March 8, 2017

Register Now-Webinar on Older Adults and Health Care Decision-Making in Clinical Setting

Justice in Aging has sent out a notice about an upcoming webinar at 1p.m. edt on March 22, 2017. Here is the information about the webinar:

When older adults lack the capacity to make important health care decisions for themselves and have nothing in writing naming a person to make decisions for them, how can the right health care decisions be made in clinical settings? Over the past 40 years, nearly every state has passed statutes on health care decision-making. The laws vary from state-to-state, from authorizing living wills or powers of attorney for health care to defining the conditions when withholding or withdrawing life sustaining care is permitted for patients who lack capacity. Despite years of legal guidance, questions remain regarding the statutory applicability in clinical practice. In 2016, the American Bar Association Commission on Law and Aging (ABA COLA) initiated a national survey to explore health care clinicians’ perspectives on questions regarding capacity and decision-making. Findings explore instances when the law and clinical practice clearly align, when there are consultation differences between lawyers and clinical providers, and outline the areas that still present the greatest challenges for health care decision making in clinical settings.  

In this webinar, David Godfrey, Senior Attorney to the ABA COLA, will detail the survey findings and implications for the health and aging network working with older adults with diminished capacity. The webinar will be accompanied by an Issue Brief that highlights the survey findings and provides recommendations for the field.

To register for this free webinar, click here.

March 8, 2017 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, Webinars | Permalink | Comments (0)

Thursday, March 2, 2017

A Special 911 for Hospice Patients

Kaiser Health News ran a story about specialized 911 responders for those under hospice care. For Some Hospice Patients, A 911 Call Saves A Trip To The ER explains a project in Fort Worth where

Fort Worth paramedics [are] trained for this type of hospice support — part of a local partnership with VITAS Healthcare, the country’s largest hospice organization — is to spend a longer stretch of time on the scene to determine if the symptoms that triggered the 911 call can be addressed without a trip to the emergency room. MedStar Mobile Healthcare, a governmental agency created to provide ambulance services for Fort Worth and 14 nearby cities, is one of several ambulance providers nationwide that have teamed up with local hospice agencies. The paramedic backup, enthusiasts argue, not only helps more hospice patients remain at home, but also reduces the potential for costlier and likely unnecessary care.

The article reports that almost 20% of hospice patients make a trip to the ER and this specialized paramedic may help the patient to avoid that trip. The article explains that these specialized paramedics are known as "community paramedics [and] they can offer a range of in-home care and support for home health patients, frequent 911 callers and others to reduce unnecessary ambulance trips." 

The article explains how this works, noting that the community paramedic is dispatched along with other paramedics.  The community paramedic provides many patients with an alternative to a trip to the ER. 

Patients or their family members can still insist on going to the emergency room, and sometimes they do. Of the 287 patients enrolled in Fort Worth’s program for the first five years — all of whom had been prescreened as highly likely to go to the hospital — just 20 percent, or about 58 patients, were transported, according to MedStar data. In Ventura, ambulance transports for hospice patients calling 911 also have declined — from 80 percent shortly before the program’s start to 37 percent from August 2015 through December 2016 .....

March 2, 2017 in Consumer Information, Current Affairs, Health Care/Long Term Care, Medicare | Permalink

Tuesday, February 28, 2017

Being a Guardian: Stories By Guardians for Guardians

The National Center on Elder Abuse is creating stories from guardians for guardians, with the first released February 20, 2017. Here's some information about the series.

The National Center on Elder Abuse asked various types of guardians to share their experience of being a guardian and offer advice for other guardians. We are delighted to share the first of two stories. If you would like to offer your story of being a guardian, please email us at ncea@med.usc.edu.

The first story  is titled Living into Guardianship is available here. The second story, dated February 27, 2017, is titled A Unique Model to Addressing Guardianship and is available here.

February 28, 2017 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, Weblogs | Permalink

More on Supreme Court Nominee Neil Gorsuch on End-of-Life Issues

Paula Span, the thoughtful columnist on aging issues from the New York Times, offers "Gorsuch Staunchly Opposes "Aid-in-Dying." Does It Matter?"   The article suggests that the "real" battle over aid-in-dying will be in state courts, not the Supreme Court.

I'm in the middle of reading Judge Gorsuch's 2006 book, The Future of Assisted Suicide and Euthanasia. There are many things to say about this book, not the least of which is the impressive display of the Judge's careful sorting of facts, legal history and legal theory to analyze the various advocacy approaches to end-of-life decisions, with or without the assistance of third-parties.  

With respect to what might reach the Supreme Court Court, he writes (at page 220 of the paperback edition): 

The [Supreme Court's] preference for state legislative experimentation in Gonzales [v. Oregon] seems, at the end of the day, to leave the state of the assisted suicide debate more or less where the Court found it, with the states free to resolve the question for themselves.  Even so, it raises interesting questions for at least two future sorts of cases one might expect to emerge in the not-too-distant future.  The first sort of cases are "as applied" challenges asserting a constitutional right to assist suicide or euthanasia limited to some particular group, such as the terminally ill or perhaps those suffering grave physical (or maybe even psychological) pain....

 

The second sort of cases involve those like Lee v. Oregon..., asserting that laws allowing assisted suicide violate the equal protection guarantee...."

While most of the book is a meticulous analysis of law and policy, in the end he also seems to signal a personal concern, writing "Is it possible that the Journal of Clinical Oncology study is right and the impulse for assistance in suicide, like the impulse for old-fashioned suicide, might more often than not be the result of an often readily treatable condition?" 

My thanks to New York attorney, now Florida resident, Karen Miller for pointing us to the NYT article.

February 28, 2017 in Advance Directives/End-of-Life, Consumer Information, Crimes, Dementia/Alzheimer’s, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Cases, Health Care/Long Term Care, Religion, Science, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Sunday, February 26, 2017

CNN Report: Sexual Assaults in Nursing Homes

CNN has published an investigative report on sexual assault of residents in nursing homes.  Sick, dying and raped in America's nursing homes opens with these paragraphs "Some of the victims can't speak. They rely on walkers and wheelchairs to leave their beds. They have been robbed of their memories. They come to nursing homes to be cared for... Instead, they are sexually assaulted... The unthinkable is happening at facilities throughout the country: Vulnerable seniors are being raped and sexually abused by the very people paid to care for them."

The report looks at a variety of issues and the failings of the system in responding to the attacks.

In cases reviewed by CNN, victims and their families were failed at every stage. Nursing homes were slow to investigate and report allegations because of a reluctance to believe the accusations -- or a desire to hide them. Police viewed the claims as unlikely at the outset, dismissing potential victims because of failing memories or jumbled allegations. And because of the high bar set for substantiating abuse, state regulators failed to flag patterns of repeated allegations against a single caregiver.

The facts of the cases are hard to read but important in understanding the scope and significance of these crimes.   The perpetrators were as young as teenagers or as old as the victims.  Some were caregivers, others residents.

Rather than summarizing any further, just read the story.  Nothing I can add here would give you the same impact.

Responses to the report from the National Consumer Voice for Quality Long Term Care and others can be accessed here.

February 26, 2017 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (0)

Friday, February 24, 2017

Washington State Discusses Expansion of Limited License Legal Technicians to Estate & Health Care Law

In 2012, the Washington Supreme Court approved Admission to Practice Rule 28, which created a new program for authorization of "limited license legal technicians," also known as LLLTs or "Triple L-Ts." The express purpose of the program was to meet the legal needs of under-served members of the public with qualified, affordable legal professionals, and the first area of practice chosen was domestic relations.  With that first experience in hand, in January 2017, the Washington State Bar Association has formally proposed expansion of the LLLT program to enable service to clients on "estate and health law."  

As described in the Washington State Bar Association materials, this expansion will include "aspects of estate planning, probate, guardianship, health care law, and government benefits. LLLTs licensed to practice in this area will be able to provide a wide range of services to those grappling with issues that disproportionately affect seniors but also touch people of all ages who are disabled, planning ahead for major life changes, or dealing with the death of a relative."  The comment period is now open on the proposed expansion.

For more about this important innovation, there was an excellent 90 minute-long webinar hosted by the Washington Bar in February 2017, with members of the Limited License Legal Technician Board explaining the ethical rules (including mandatory malpractice insurance), three years of education and 3000 hours of experience required for LLLTs to qualify.  Now available as a recording, the comments from the Webinar audience, including lawyers concerned about the potential impact on their own practice areas, are especially interesting.  

Many thanks to modern practice-trends guru, Professor Laurel Terry at Dickinson Law, for helping us to keep abreast of the Washington state innovation. 

February 24, 2017 in Consumer Information, Current Affairs, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Legal Practice/Practice Management, Programs/CLEs, State Statutes/Regulations, Webinars | Permalink | Comments (0)