Friday, March 25, 2016

Filial Friday: Family Caregiving & Standing Issues for Family Members

The 2012 decision of Health Care & Retirement Corp of Am. v. Pittas from Pennsylvania's Superior Court continues to intrigue law students in its application of a filial support law to compel children to pay the care expenses of their mother.  

The latest example is a 2015 article by Hamline University School of Law student Katie Sisaket, who analyzes the topic from a Minnesota perspective in "We Wouldn't Be Here If It Weren't For Them: Encouraging Family Caregiving of Indigent Parents Through Filial Responsibility Laws."  She concludes:

The advancement of technology has allowed people to live longer than before, but with more health problems. With the government’s programs not anticipating this growth in elder population, the lack of funds will limit an elder person access to the necessary basic care. Filial statutes compelling adult children to provide support to an indigent parent have been around for thousands of years. With proper drafting of a well-defined statute, a filial responsibility law will appeal to family caregivers and further its purpose of encouraging stronger family ties. Therefore, Minnesota should consider adopting its own filial responsibility laws to relieve elder persons with the worry of not being able to access the necessary medical and basic care required. Only by splitting the government’s burden by imposing some duty on adult children will this be possible.

In the meantime, a Pennsylvania-based bankruptcy court case we reported on earlier, In re Skinner, that concluded one brother lacks standing to challenge another brother's discharge in bankruptcy for liability to pay their mother's assisted living fees, was recently affirmed by the Third Circuit.  

In the March 4 decision, the Third Circuit notes that Pennsylvania's filial "support law" does not provide a right of contribution or indemnification," and therefore the only relief is to compel the trial court to "apportion liability amongst the various children."  

The Third Circuit further rejected arguments that the bankrupt son's alleged fraud, in failing to use the mother's resources to pay her debts, was not a claim the brother could make under the Uniform Fraudulent Transfer Act or under a theory of unjust enrichment.  "Because William is not a creditor of Dorothy [the mother], the UFTA does not give him a valid claim. UFTA Section 5107(a).  Thus, because William does not have a valid claim against Thomas, he lacks standing to challenge the dischargeability of Thomas' debts."    

For more see In re Skinner, ___ Fed Appx. ___, 2016 WL 850950 (3d Cir. 2016). 

March 25, 2016 in Estates and Trusts, Ethical Issues, Federal Cases, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Thursday, March 24, 2016

More on Florida CCRC's Struggle with State Regulators -- and Workers

Earlier this week, I reported on the Florida Office of Insurance Regulation's actions affecting University Village, a Continuing Care Retirement Community (CCRC) in west Florida.  Additional events are now coming to the surface in media reports, including turmoil with employees over salary and benefits:

Workers from the Nursing Center at University Village made a lot of noise walking a picket line, protesting salary caps and reductions in benefits. This labor unrest comes while the new owners of University Village, Westport Holdings of Tampa, struggle to stop the state from yanking their license and shutting them down.

 

Health care workers represented by the Service Employees International Union are protesting working without a contract since December. Westport Holdings claims through the years the University Village nursing center was overly generous to its employees, and it’s time to reel in costs.

 

“What do they consider to be generous? I’ve been working with them for over 20 years and I haven’t seen $20 an hour yet,” Scott said.

 

Management wants to cap salaries and reduce health care benefits. It contends workers at University Village are paid more than employees at other local facilities.

For more, see News Channel 8's report on Employees Protest Benefit Cuts at Embattled Hillsborough Retirement Community.

March 24, 2016 in Ethical Issues, Health Care/Long Term Care, Housing, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Wednesday, March 23, 2016

Victims Oppose California's Elderly Parole Program

My colleague Becky Morgan shared a good item this week on statistics about the number of elderly inmates, with growth of needy inmates increasing the burden on state prisons.

Another perspective on the issue comes this week via the San Jose Mercury News, reporting on California's Elderly Parole Program:

The Elderly Parole Program was instituted by a federal three-judge panel after a 2013 class-action lawsuit successfully argued that conditions in California's overcrowded prisons, including poor health care, amounted to cruel and unusual punishment. As a result, the court ordered California to reduce its inmate population. The Elderly Parole Program and a realignment program to move nonviolent convicted felons back to county jails are among the solutions. The Elderly Parole Program will be in effect at least until California meets its prison population targets.

 

In Sacramento, prosecutors and victims rights groups have been working to prevent this temporary program from becoming state law. They scored a small victory last week when, after a call from this newspaper, state Sen. Mark Leno, D-San Francisco, gutted Senate Bill 1310, which he introduced last month. The original bill would not only make the Elderly Parole Program state law, but it would also lower the eligibility age to 50 and the time in prison to 15 years.

 

The withdrawal was unexpected and came with little explanation. Leno said in a statement Thursday that the bill would be used as a place holder for "other criminal justice reforms" and that "the bill will not deal with the issue of elder parole."

 

The article reports that since the Elderly Parole Program began in February 2014, more than 1,000 inmates have had parole hearings, with 371 granted parole, 89 deemed "not ready," and 781 denied release.  In the article, the reality of the hearings is seen through the eyes of one victim, who faced the trauma of attending a parole hearing to argue that the man who sexually assaulted her and others some 30 years ago, should serve his full sentence or die in prison -- 141 years.

No easy answers here.  For more read, "California's Elderly Parole Program Forcing Victims to Face Attackers Decades Later."   

March 23, 2016 in Crimes, Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care, Statistics | Permalink | Comments (0)

Tuesday, March 22, 2016

LTC Insurance: More $ or Less Benefits?

Kaiser Health News ran a story on March 17, 2016 about long term care insurance policies. Long-Term Care Insurance: Less Bang, More Buck explains how one insured saw her premiums cost almost four times as much if she kept her same coverage. Although an important option for many middle-income Americans, it seems, from the article, that the industry has specific challenges facing it.

[I]insurers botched just about every aspect of the policies they sold in the early days of the industry, said Joseph Belth, a retired professor of insurance at Indiana University known as one of the insurance industry’s toughest critics. They underestimated how long people would live and how long they’d need nursing home care — but overestimated how many people would drop their policies and how much interest insurers could earn on the premiums they banked.

Hemorrhaging money, many insurers left the business. Those that remain are in financial trouble on their long-term care policies. They’re charging far more for new policies, and sharply raising the premiums of old ones.

Not as many companies are offering the coverage as once was and many policy holders may be facing a choice of increased premiums, reducing or dropping coverage. As well, the article notes that many folks don't know the limits of Medicare coverage for long term care.  Fewer people are purchasing the policies, but there are now some hybrid options on the market

Fewer people today are buying traditional long-term care insurance policies, which only adds to insurers’ financial woes. Some are considering newer “hybrid” products such as life insurance or annuities that provide a long-term care benefit, but they’re also expensive and some require a large up-front payment.

That’s why pressure is mounting for state and federal lawmakers to come up with ways to finance long-term care for millions of aging baby boomers. Policy proposals abound, such as requiring people to buy subsidized long-term care insurance, much as they now need to buy health insurance. Other ideas include creating a government-run catastrophic plan or allowing people to convert their life insurance policies to long-term care policies. But all of these would require legislative action, and lawmakers at the state and federal level have been slow to act because of the sheer scope of financing Americans’ long-term care.

March 22, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Medicaid, Medicare, State Statutes/Regulations | Permalink | Comments (1)

Monday, March 21, 2016

Capacity to Change Health Care Agent?

There was an update recently in the litigation concerning the capacity of Sumner Redstone to change the agent under his health care directive.  The case starting making the papers last fall. The New York Times ran an article on November 25, 2015, Court Filing Challenges Competence of Sumner Redstone. This article noted that a prior companion of Mr. Redstone filed suit claiming that she "was improperly removed on Oct. 16 from control of an advance health care directive that gave her authority over his health decisions." The article summarizes some of the allegations made in the petition by the companion.  A series of other articles followed, two of which are referenced here.

The second article referenced here ran in the Times on February 29, 2016.  Sumner Redstone Competency Case Will Go Forward notes that the case is scheduled for trial in May of 2016. The 21 page ruling discussed in the article outlines the two sides' dispute.  The article notes that Mr. Redstone was at one time estranged from his daughter, although the article indicates she notes a repair of the relationship.  The article quotes the judge: "[d]uring the hearing, Judge Cowan remarked on Mr. Redstone’s notable absence from the legal battle. Notoriously outspoken and combative at his prime, Mr. Redstone has not appeared before the court or submitted a statement of his own. “There are a lot of things that have been said about what Mr. Redstone wants,” Judge Cowan said, “'but unfortunately I have no declaration from him.'”

The third article, published March 18, 2016 in the New York Times gives an update. Sumner Redstone’s Medical Records to Stay Private, Judge Rules reports that some 15 documents will be unsealed but the rest remain confidential. The judge explained that "the medical records would remain sealed because the case was a personal matter centered on Mr. Redstone’s medical issues, not a case involving his public business dealings." The trial is scheduled for May 6 and depositions will be taken in April.

There are a number of other articles reporting this story for those who are interested in learning more about this case.

March 21, 2016 in Cognitive Impairment, Current Affairs, Health Care/Long Term Care | Permalink | Comments (0)

Sunday, March 20, 2016

Old and Behind Bars

We have previously written about the topic of elder inmates and the implications for prisons with the graying of the prison population. Here is one more story on the topic, published March 17, 2016. Pew Charitable Trust's Stateline (which "provides daily reporting and analysis on trends in state policy....") ran the story, Elderly Inmates Burden State Prisons.

Nearly every state is seeing that upward tick in elderly state prisoners. In Virginia, for example, 822 state prisoners were 50 and over (corrections officials usually consider old age for prisoners to begin at 50 or 55) in 1990, about 4.5 percent of all inmates. By 2014, that number had grown to 7,202, or 20 percent of all inmates.

For state prisons, the consequence of that aging is money, more and more of it every year. Health care for aging prisoners costs far more than it does for younger ones, just as it does outside prison walls. Corrections departments across the country report that health care for older prisoners costs between four and eight times what it does for younger prisoners.

In terms of reducing the number of elder inmates, according to the study, some states are using diversion programs, early release or compassionate release.  We all have heard about increasing longevity, but that doesn't necessarily explain the rise in elder inmates. The story notes that correctional personnel offer two factors to explain this rise: "[o]e is a steady increase in the rate of older adults entering prison. The second, and more potent, factor is changes enacted in the get-tough-on-criminals 1990s that resulted in longer prison sentences."

Knowing about the physical limitations some may have as they age, one can only imagine the accommodations prisons have had to make, including the use of "ramps and shower handles and ... other physical modifications. Many prisons have had to create assisted living centers with full-time nursing staffs.... In addition, at least 75 U.S. prisons ..., provide hospice services for dying prisoners...."

One prison mentioned in the story has an ALF, but the waiting list is such that prisoners must need assistance with 2 or more ADLs to be considered. Poor health when entering prison is not unusual. And being old and in prison may be even tougher than for younger inmates.

Prison is a particularly treacherous place to get old. Getting to a top bunk is difficult for many aging prisoners, as is climbing stairs. Hearing loss, dementia and general frailty can make it difficult to comprehend or obey rules. And being infirm in an institution full of young predators can make older prisoners vulnerable. “If there’s an old lion or gazelle... the young ones are going to take advantage.”

Once they get out, finding a place to go becomes another challenge according to the article. Some states have taken different approaches to deal with the graying prison population, from financing the facilities that provide the needed care (such as a dementia unit in the prison) to  contracting with a private facility to provide the care to "geriatric conditional release."

And what about the likelihood of reoffending?  "Studies have found that older ex-offenders are less likely than younger ones to commit additional crimes after their release. But politicians and the public don’t seem willing to release former murderers, rapists and sex offenders, even though they are decades removed from their crimes and physically incapable of repeating them...."

March 20, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Florida Authorities Issue Suspension Orders for CCRC in Tampa

On March 16, 2016, the Florida Office of Insurance Regulation issued suspension orders affecting University Village, a Continuing Care Retirement Community (CCRC) in Tampa, Florida. Long-Term Living publication reports:

The first order states the facility was acquired illegally. IMH Healthcare, LLC, the general partner of the new ownership, does not have approval to operate as a licensed CCRC provider.

 

The second order makes several allegations against University Village for violating provisions of Florida’s Insurance Code for:

  • failing to comply with the OIR’s target examination and filing false information;
  • failing to fulfill statutory and contractual obligations to residents, estates of former residents and prospective residents, including failing to pay more than $4 million in refunds owed to residents;
  • continuing to accept new residents while being financially insolvent; and
  • engaging in fraudulent or dishonest management practices.

For more on the OIR action, read Tampa Times coverage, "Florida Officials Move to Suspend  Tampa's University Village Retirement Home." 

The events that led to this state action are somewhat unusual. For earlier reports on the long-simmering issues, see Channel 8 News Report from September 2015: "Owner Claims, State Lying, Retirees Suffer."   See also a Tampa Bay Times article from February 2015, "State Looks into Alleged Financial Problems at Tampa Retirement Community."

March 20, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Property Management, State Statutes/Regulations | Permalink | Comments (0)

Sunday, March 13, 2016

Drug Price Spikes Studied by Senate Special Committee on Aging

Have you seen the stories about the sudden increase in prices for particular drugs? That has caught the eye of the Senate Special Committee on Aging. There will be another hearing on the topic on March 17, 2016 at 10 a.m. “Senate Special Committee on Aging to hold the second hearing in a series on sudden price spikes in decades-old Rx drugs.” 

As well, last week "Senators Susan Collins (R-ME) and Claire McCaskill (D-MO), the Chairman and Ranking Member of the Senate Special Committee on Aging, ...  introduced the Increasing Competition in Pharmaceuticals Act to help ensure that a clear process is in place for FDA to prioritize the review of generic drug applications."  As the press release notes "the Committee’s investigation revealed that some older drugs lack an FDA-approved generic competitor.  This lack of competition is a significant contributing factor that can allow companies to acquire and sharply increase the cost of these older drugs that are no longer protected by patents." 

The text of the bill is available here.

March 13, 2016 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (1)

Thursday, March 10, 2016

New Issue of eNewsletter from National Academy on an Aging Society

The Gerontological Society of America has released the latest issue of its e-newsletter from the National Academy on an Aging Society.  The March 2016 Public Policy & Aging Report is focused on elder wealth, cognition and abuse.  As the forward explains

This edition of Public Policy & Aging Report is the fourth coproduced issue between the National Academy on an Aging Society and Age UK in 4 years. It comes at a prescient moment and deals with an increasingly recognized and important challenge: the impact of cognitive decline on the financial health of older people. Age UK has, for many years, been interested in cognitive aging and is recognized as an authority in this area. We were participants in the G7 Summit on Dementia, we contributed to the many G7 legacy meetings, and we were members of the 2014 World Innovation Summit on Health (WISH) dementia working group. In October 2015, we were cofounders of the Global Council on Brain Health, working with our partner in the United States, AARP. We also are very pleased to be hosting the World Economic Forum symposium on “Ageing, Cognitive Decline and Impact on Banking and Insurance” in London on February, 2016. In research, we pioneered one of the world’s leading studies on cognitive aging at the University of Edinburgh, the “Disconnected Mind,” a longitudinal study that is revealing the secrets of cognitive performance and age, in a way in which cross-sectional studies cannot.

We also have been partners in some of the United Kingdom’s leading research on elder financial abuse, notably with Brunel University in London. Our concern in all these endeavors is not only to generate evidence but also to use this knowledge and apply it to the benefit of our aging populations. Our mission is to improve later life, in the United Kingdom and internationally, and to achieve our vision of a world in which people can love later life. So, I welcome this edition, bringing together as it does leading experts from both sides of the Atlantic and distilling their accumulated wisdom into a volume which I hope will inspire, inform, and lead to action in this critical area.

March 10, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care | Permalink | Comments (0)

Wednesday, March 9, 2016

Consumer Friendly Books on Retirement Communities

This week is Spring Break for our law school and I've had a bit of time to catch up on my  stack of "must read" books.  Here are two that caught my attention:

Settling In: My First Year in a Retirement Community, by Richard L. Morgan (2007):

    "At age seventy-four, I left my home in the state of North Carolina, which I dearly loved and where I had lived for fifty years, to come to a retirement community in Pennsylvania.  In a real way, I left my identity, forged over years of hard work and experience, to start a new life as a relative nobody.  At times I endured sleepless nights, worrying if I had made the right decision."  

With that beginning, the writer tracks his evolution in thinking about a retirement community, candidly describing excitement and depression, while achieving a growing sense of engagement with his new environment.  A retired Presbyterian minister, the writer uses both religious and non-religious texts to supplement his thinking. There's a real honesty here that transcends any religion, and the book seems useful not just for new or prospective residents but also for adult children and care-givers.

What's the Deal with Retirement Communities?, by Brad C. Breeding, Certified Financial Planner (2014):

    I met the author a few years ago while he was in the development phase of a project to provide consumer-friendly internet materials on continuing care retirement communities (and more on that in a few days!).  But he also has a helpful little book that offers objective information on how to assess a community, including chapters on understanding various types of contracts and financial viability factors.  A good place to start for someone who wants to ask the right questions. 

March 9, 2016 in Books, Consumer Information, Health Care/Long Term Care, Housing | Permalink | Comments (0)

New Survey-Public Views on Alzheimer's

WebMD and the Shriver Report did a survey on people's knowledge, actions and attitudes about Alzheimer's Disease which revealed "[p]eople recognize the seriousness of Alzheimer’s disease, but they aren’t taking steps to learn about their personal chances of getting the disease or to prepare for it financially...."  Survey Reveals Beliefs, Behaviors on Alzheimer’s was published on February 25, 2016 and reveals some startling information, such as a large percentage of those surveyed indicated they aren't prepared, financially or otherwise, to deal with the disease.  The survey results note that there is "a disconnect in how much respondents really want to know about their risk of getting the disease — it’s the sixth leading cause of death in the U.S. and has no cure. Two-thirds of people say they’d want to know their risk for developing Alzheimer’s later in life. But when presented with a list of ways to do that, a much smaller percentage say they have taken or would take steps to do it."  The survey also inquired about caregiving, attitudes about a likely cure for Alzheimer's and whether the respondents knew someone with Alzheimer's; 78% responded they knew someone with the disease. An infographic with key findings is available here.  An earlier issue of the Shriver Report on the topic is available here.

WebMD's special report on Alzheimer's is available here.

 

A companion survey of doctors was done by Medscape.

March 9, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care | Permalink | Comments (0)

Tuesday, March 8, 2016

Continuing Legal Education Courses on Alzheimer's Disease

The promotional material catches your eye: "Every 67 seconds someone in the U.S. develops Alzheimer's Disease.  5.3 million Americans have the disease."

I'm seeing more programming being offered to practicing lawyers on dementia-related issues generally and specifically about Alzheimer's Disease.  An example is an upcoming program (June 2016) from the Pennsylvania Bar Institute, describing a program on Alzheimer's Disease: "From diagnosis to legal documents, everything you need to counsel your client."  The speakers for the day include three medical professionals, Paul J. Eslinger, PhD from Penn State Hershey Medical Center, Barry V. Rovner, M.D. from Thomas Jefferson University in Philadelphia, and Oscar L. Lopez, M.D., from University of Pittsburgh.

For more about the program, see PBI's website here.  

 

March 8, 2016 in Cognitive Impairment, Dementia/Alzheimer’s, Estates and Trusts, Health Care/Long Term Care, Programs/CLEs | Permalink | Comments (0)

Monday, March 7, 2016

The Casey Kasem Legacy? States Adopt "Notice, Communication and Visitation" Laws

In the last months before the death of Casey Kasem, children from his first marriage and his second wife engaged in a high profile struggle over where, how and with whom the aging celebrity would spend time, with the disputes -- and the famous disc jockey himself -- crossing state borders. The controversies lasted even after his death on June 15, 2014, as his second wife reportedly flew his body out of the U.S. for burial in Oslow, Norway.  

Drawing upon these traumatic experiences, one daughter, Kerri Kasem, advocates for passage of state legislation in an effort to better define family members' rights of access and communication in such complicated family matters. Her foundation, Kasem Cares, will host a "Conference on Aging" on April 21-23, 2016 in Orange County California and it seems likely from the agenda that proposed better practices will be discussed.  

To date, at least three states have adopted new laws that appear to reflect the legal issues in the Casey Kasem family disputes, including:

  • Iowa, I.C.A. Section 635.635 (amended) and Section 633.637A (added), providing that all adult wards subject to a court-ordered guardianship continue to have the right to communicate, visit and interact with other persons, and that a court will approve a guardian's denial of such interaction "only upon a showing of good cause."  Changes to the law became effective on July 1, 2015.
  • Texas, Estates Code, Section 1151.055, "Application by Certain Relatives for Access to Ward; Hearing and Court Order, and Section 1151.056 on "Guardian's Duty to Inform Certain Relatives About Ward's Health and Residence," effective June 19, 2015. Together these guardianship-connected rules permit designated family members to apply for a court order permitting communication or visitation with a ward, and obligate a guardian to give family members notice of the ward's admission to medical facilities, change of residence, or death, unless the family member makes a written "waiver" of such communications.  For more see the Texas Guardianship Law Update in the September/October 2015 issue of The Houston Lawyer.
  • California, Assembly  Bill No. 1085, amended Cal. Prob. Code Section 2351, to provide that not only does a person who is the subject of a guardianship or conservatorship continue to have "personal rights" such as the "right to receive visitors," but that the court may issue an order that "grants the conservator the power to limit or enforce the conservatee's rights, or that "directs the conservator to allow those visitors, telephone calls and personal mail."  The California Probate Code was further changed to add provisions, Section 2361 and Section 4691, expressly providing that conservators shall mail notice of a conservatee's death to any spouse, domestic partner or, in essence, any person who has "requested special notice," and imposing a similar duty of notice regarding death of a principal, for certain agents acting under specified powers in a power of attorney for health care.  For more on the California legislation, signed by California  Governor Brown on July 14, 2015, and made effective on January 1, 2016, see the Los Angeles Times article, Casey Kasem Controversy Leads to New Rights for Children of Ill Parents.

These three new pieces of legislation, despite similarities in purpose -- i.e., recognition of family members' interest in continued communications with a loved one who has become a "court ward," -- are quite different in effect.  It will be important to see whether such provisions can be used to ease family tensions or instead serve as a frustrating, procedural gauntlet for warring factions. The Texas law seems to me to go the furthest in recognizing an affirmative right of a family member to challenge an attempt by a guardian or conservator to limit access.

Continue reading

March 7, 2016 in Cognitive Impairment, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (1)

Sunday, March 6, 2016

An App For Medication Reminders

People Magazine ran a story last week about six Kentucky Middle-Schoolers (you read that right) who have created an app to help those with dementia and Alzheimer's to remember to take their medications. "The Meyzeek Middle School seventh-graders recently became one of eight teams to win the prestigious Verizon Innovative App Challenge, earning $20,000 for their school's STEM learning and a chance to bring their app to life with the help of Massachusetts Institute of Technology coding experts."

Kentucky Middle School Girls Develop App to Assist Alzheimer's and Dementia Patients: 'This Is a Tribute to My Grandfather' explains the project is the brainchild of Ellie Tilford who experienced first-hand the struggle for many of those with dementia to remember to take meds. "The girls' concept, Pharm Alarm, sends alert messages to patients when it's time to take their meds – if they forget, family members and doctors are immediately notified." Not only does the app have the alarm that alerts the phone-tree of contacts, it also  includes "a pill log, which allows caregivers to scan in medicinal information through a pill container's labeled barcode, and a compliance graph for doctors to measure what percentage patients are taking their pills and attending doctor appointments."  The article notes that the app should be available for download in June of this year.  

Thanks to Stetson Law alum Erica Munz for sending me the link to the story.

March 6, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Web/Tech | Permalink | Comments (0)

Wednesday, March 2, 2016

Making a Decision On a CCRC?

The New York Times ran a story at the end of February about the appeal of a Continuing Care Retirement Community or CCRC.  (Just a note that LeadingAge, a group of aging service organizations is using Life Plan Communities). The Everything-in-One Promise of a Continuing Care Community examines the appeal of CCRCs.  Looking at how it works, the article discusses the often-times hefty entrance fee and compares that to a "fee for service model". The article explains what one gets (and what one doesn't) when one is signing a CCRC contract: "[k]eep in mind that few of these contracts involve direct, conventional purchase of a housing unit. In most cases, the resident buys only the lifetime right to live in a community, take advantage of its range of amenities and services, and receive care there. The units generally are not bought and sold on the open market."

My co-blogger, Professor Pearson is quoted in the article discussing regulatory oversight and transparency:

“There’s a lack of transparency with C.C.R.C.s that’s resulted in weaker trust,” said Katherine C. Pearson, a professor at the Dickinson School of Law of Pennsylvania State University who has testified before Congress on the issue. “You need to visit several facilities, talk to residents, look at past cost increases and five years of financial records.”

Professor Pearson, who talks with continuing care community residents around the country, said there was no one rule of thumb to use when evaluating these communities. A prospective resident generally wants a community that is active and engaged and “supports healthy living,” she said. But given the magnitude of the decision (after all, it is often the last major purchase someone will ever make), it deserves very careful consideration.

“Get as much financial information as you can,” she said. “This is not an impulse buy.”

The article offers some practical advice when considering a CCRC. The article notes it isn't as easy as an apples to apples comparison since there is no government rating system of CCRCs and "[t]he major drawback in evaluating continuing care communities is the complexity of their contracts, which come in a number of variations. Some may require a deposit of up to $1 million, while others may charge only monthly fees. Refunds may be difficult to obtain and depend upon the length of stay and other requirements. Contract details have to be read carefully and financial statements reviewed."  The article suggests

  • review of the contract by a team of professionals, and look specifically at the contract regarding refunds of the entrance fee, whether there is a rescission period, how a decision is made if the resident needs a higher level of care and the financial stability of the company.
  • visiting the CCRC and talking to residents and staff. Visit all areas of the CCRC.

  • compare several CCRCs and check with the appropriate state agency for any complaints filed vs. the CCRC. Ask around-the article suggests the local senior center might be a good place to find out more.

     

March 2, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Retirement, State Statutes/Regulations | Permalink | Comments (4)

Tuesday, March 1, 2016

New Report on Family Caregiving

The Population Reference Bureau (PRB) has released a new report on caregiving. Today's Research on Aging: Family Caregiving

This report highlights recent National Institute on Aging-supported research on the impact of caregiving on family members, the dynamics of caregiving within extended families, and the future need and availability of family care. As policies deemphasize nursing home care in favor of community-based long-term support services, a better understanding of the family’s central role in caregiving is needed. This perspective can help policymakers, health care providers, and planners identify and implement strategies that better meet the care needs of older Americans and improve the lives of the family members who care for them.

The report looks at economics, the impact on the caregiver, policy implications and more. The report is also available as a pdf here.

March 1, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink | Comments (0)

NPR Story on Nursing Home Evictions

Previously I wrote about a story in Kaiser Health News about nursing home residents stuck in hospital "limbo" and the ensuing litigation.  NPR also did a story about this. Nursing Home Evictions Strand The Disabled In Costly Hospitals was released on February 25 and features an audio of the story as well as the print version.  Although the suit is filed in California, this is not a California-specific issue.  As the story notes

This is not just a California issue. Nationwide, between 8,000 and 9,000 people complain to the government about nursing home evictions every year. It's the leading category of all nursing home complaints, according to the federal Administration for Community Living.

Robyn Grant thinks the problem is even larger than reported. Grant would know: She's the public policy director for the nonprofit National Consumer Voice for Quality Long-Term Care, so she hears about many nursing home evictions around the country like the ones in California.

March 1, 2016 in Consumer Information, Current Affairs, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (1)

Monday, February 29, 2016

Five Star Rating System: Clarity or Confusion?

You recall Medicare's 5 Star Rating System to aid consumers in making choices regarding services and facilities. Kaiser Health News (KHN) ran a story on February 23, 2016 about the difference between how consumers rate facilities vs. how Medicare rates facilities.  Dueling Star Ratings May Confuse Some Home Health Patients explains that Medicare assigns stars "primarily based on Medicare’s assessment of how often patients got better. But [looking] further ... may lead to confusion. Medicare also posts stars to convey how patients rate agencies after their care is over."

KHN did a survey on the frequency of these disparities  and found that "[s]uch contradictory results between how patients view home health agencies and how the government rates them are hardly unusual."  

In a statement, the Centers for Medicare & Medicaid Service said the different star ratings should not be confusing. “CMS stresses that website users should look at all of the different types of measures available for a given provider type, including for home health care agencies,” the statement said. “By providing both clinically based and survey-based measures, CMS hopes to make available to the public a range of perspectives and information that consumers can evaluate to help inform their decision about an agency.”

The disparity at least in part is explained: "[s]ome of the differences between home health care patient experience and clinical quality stars can be chalked up to the fact that the two domains focus on different facets of home health care." The article goes on to quote elder care experts on their views about the reasons for the differences in the rankings.  The article wraps up noting it is unknown how many Medicare beneficiaries use the 5-star rating system, and understand them.

February 29, 2016 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Genworth Announces "Refocus" for Sales for Its Insurance Products

Genworth is one of the three surviving companies still offering Long-Term Care Insurance.  So, when it reports plans for the future, that is important.  In February 2016 Genworth's CEO released a letter saying, "We will be refocusing our sales efforts to develop solutions that meet the financial challenges of aging, including individual and group long term care (LTC) insurance, and over time, the development of other products and services that meet this growing need."

Genworth’s strategic priorities remain to improve the performances of our businesses and increase our financial and strategic flexibility — while keeping our promises to policyholders. To support these priorities, Genworth has decided to suspend sales of all our traditional life insurance and fixed annuity products. Our decision to suspend new sales of these products in no way diminishes our commitment to providing service to our existing 2.8 million life and annuity policy and contract holders and their beneficiaries.

Exactly what this means for financing options for long-term care remains to be seen.  

McKnight's Senior Living News sees this as a move in the right direction, as discussed here.  

February 29, 2016 in Consumer Information, Estates and Trusts, Health Care/Long Term Care | Permalink | Comments (0)

Sunday, February 28, 2016

Abandoned Nursing Home Residents?

Kaiser Health News (KHN) ran a story titled The Agonizing Limbo Of Abandoned Nursing Home Residents. The story focuses on the refusal of some California nursing homes to readmit residents after a hospital stay.  The story opens with a story of one resident who "had been living[in a nursing home] for four years... [and] the home refused to readmit him, even after being ordered to do so by the state. Nearly nine months later, [the resident] is still in the hospital."  It seems that these residents are trapped in a sort of limbo.

Nursing home residents are entitled to hearings under federal law to determine whether they should be readmitted after hospitalization. The state Department of Health Care Services holds the administrative hearings, but has said it is not responsible for enforcing the rulings.

But the state Department of Public Health, which oversees nursing homes, neglects to enforce the rulings and sometimes disagrees with them, according to advocates and court documents.

That leaves residents .... [even those] who won ... [the]  hearing .... with little recourse — and not many places to go. And since many nursing home residents have publicly-funded insurance, it means taxpayers are on the hook for hospital stays long after the patients are ready for discharge.

California Advocates for Nursing Home Reform (CANHR) in November, 2015 filed suit against California Health & Human Services on behalf of some of these residents with an upcoming hearing in March of 2016. The suit seeks "to require California to establish a hearing process that complies with federal law and to enforce the rulings." The defendant has filed a motion to dismiss.

February 28, 2016 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid | Permalink | Comments (0)