Friday, November 17, 2017
In Pennsylvania, we awoke today to news media images of flames shooting into the night sky from a nursing home near Philadelphia. I suspect many of us feared the worst outcome, including serious injuries to helpless residents, or worse. In the region, wooden structures, narrow streets, and densely populated neighborhoods are the norm.
But, although we are still in the early aftermath of the fire which reportedly ignited around 10:30 at night in a dementia care unit, evacuations occurred swiftly and with the help of the entire community, including college students who joined in the effort. As my blogging colleague has pointed out recently in the context of hurricanes, often the real impact for seniors displaced by emergencies occurs in the days or even weeks after the event. Let's hope we hear positive news about "best practices" in this instance. Lesson number one may involve whether sprinklers in the building operated appropriately.
From one early news account:
November 17, 2017 in Consumer Information, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Property Management, State Statutes/Regulations | Permalink | Comments (0)
Recall that I had previously blogged about the impact of Irma on some nursing homes and how the Florida Governor had issued an emergency administrative rule requiring nursing homes to have emergency generators. The suit brought by facilities challenging the rule wasn't a particular surprise. The judge assigned the case ruled in late October in favor of the facilities. As reported in an article in the Wall Street Journal, the judge "ruled against state efforts to force elder-care facilities to rapidly upgrade their generators by mid-November, siding with industry groups that argued the state’s time demands were unrealistic." Florida Judge Rules Against Emergency Nursing-Home Generator Measures notes that in the lengthy opinion, the ALJ explains “it is impossible for the vast majority of nursing homes” and assisted-living facilities to comply with the orders by the deadline." The Governor's office indicated that it would appeal while also working with the Florida legislature regarding bills filed on this issue. The article notes some facilities are already in compliance and that the objection was more about the timeline than the requirement. Stay tuned....
The issue of "evictions" in residential facilities for older adults has long been on my radar screen, and I was especially interested to hear (and read) news of a lawsuit initiated by the AARP Foundation Litigation (AFL) against a California skilled nursing facility and its parent entity following the facility's refusal to "readmit" an 82 year-old resident following her temporary hospital stay. As reported by NPR for All Things Considered on November 13, 2017:
[The Defendants] say that she became aggressive with staff and threw some plastic tableware. So Pioneer House called an ambulance and sent her to a hospital for a psychological evaluation. The hospital found nothing wrong with her, but the nursing home wouldn't take her back. They said they couldn't care for someone with her needs. Jones protested his mother's eviction to the California Department of Health Care Services. The department held a hearing. Jones won.
"I expected action — definitely expected action," says Jones. Instead, he got an email explaining that the department that holds the hearings has no authority to enforce its own rulings. Enforcement is handled by a different state agency. He could start over with them.
This Catch-22 situation attracted the interest of the legal wing of the AARP Foundation. Last year, attorneys there asked the federal government to open a civil rights investigation into the way California deals with nursing home evictions. Now, they're suing Pioneer House and its parent company on Gloria Single's behalf. It's the first time the AARP has taken a legal case dealing with nursing home eviction.
For more, read AARP Foundation Sues Nursing Home to Stop Illegal Evictions.
My thanks to my always alert colleague, Dickinson Law Professor Laurel Terry, for sharing this item.
November 17, 2017 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, State Cases, State Statutes/Regulations | Permalink | Comments (0)
Wednesday, November 15, 2017
The National Academies of Sciences, Engineering, and Medicine released a new report Models and Strategies to Integrate Palliative Care Principles into Care for People with Serious Illness: Proceedings of a Workshop The website explains the purpose of the workshop
The Roundtable on Quality Care for People with Serious Illness hosted a full-day workshop on April 27, 2017 to explore Models and Strategies to Integrate Palliative Care Principles into Care for People with Serious Illness. The workshop aimed to highlight innovative models of community-based care for people of all ages facing serious illness. The workshop featured invited presentations and panel discussions exploring community-based palliative care from a population health management perspective as well as a health system perspective; pediatric palliative care, concurrent care, and palliative care within the context of a multispecialty accountable care organization; potential policy levers, as well as the challenges and opportunities to scale and spread successful palliative care models and programs. The workshop rapporteurs have prepared this proceedings as a factual summation of the workshop presentations and discussions.
Here is an excerpt from the introduction
Remarkable developments in health promotion and disease treatment and prevention have led to significant improvements in life expectancy throughout the 20th century and into the present. Concurrent with those improvements has been the reality that most Americans will experience a substantial period of time living with serious illness; an estimated 45 million Americans currently are living with one or more chronic conditions (IOM, 2015; NASEM, 2016). Those living with serious illness can be found across the age spectrum and in a broad range of care settings, from pre-birth to geriatric care. Recognizing the need to thoughtfully consider and address the challenges and opportunities to improve care for people of all ages and all stages of a serious illness, the Roundtable on Quality Care for People with Serious Illness serves to convene stakeholders from government, academia, industry, professional associations, nonprofit advocacy organizations, and philanthropies. Inspired by and expanding on the work of the 2014 Institute of Medicine consensus study report Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life (IOM, 2015),2 the Roundtable aims to foster ongoing dialogue about critical policy and research issues to accelerate and sustain progress in care for people of all ages experiencing serious illness.
Shortages of Specialists to Screen and Diagnose Early Stages of Neurocognitive Diseases Are Part of the Looming Problem
A recent study by the Rand Corporation points to related problems with diagnosis AND treatment of Alzheimer's Disease and other neurocognitive disorders. Even as there is a growing need for effective treatment, there are "too few medical specialists to diagnose patients who may have early signs of Alzheimer's" and thus become eligible for therapies that might slow or or halt progression of such diseases. From the Rand news release:
“While significant effort is being put into developing treatments to slow or block the progression of Alzheimer's dementia, little work has been done to get the medical system ready for such an advancement,” said Jodi Liu, lead author of the study and a policy researcher at RAND, a nonprofit research organization. “While there is no certainty an Alzheimer's therapy will be approved soon, our work suggests that health care leaders should begin thinking about how to respond to such a breakthrough.”
An estimated 5.5 million Americans live with Alzheimer's dementia today, with the number projected to increase to 11.6 million by 2040.
Advanced clinical trials are underway for at least 10 investigational therapies that have shown promise in slowing or blocking development of Alzheimer's disease. Researchers say the progress provides guarded optimism that a disease-modifying therapy could become available for routine use within a few years.
Liu and her team examined the pathway patients would likely take to receive an Alzheimer's therapy and created a model to simulate the pressures that such an approved therapy would put on the health care system.
The analysis assumes that a therapy is approved for use beginning in 2020 and screening would begin in 2019, although researchers stress that the date was chosen only as a scenario for the model, not as a prediction of when a therapy may be approved.
Under such a scenario, about 71 million Americans aged 55 and older would have to be screened for signs of mild cognitive impairment. After follow-up examinations and imaging to confirm evidence of Alzheimer's, the RAND analysis estimates 2.4 million people ultimately could be recommended for treatment.
For additional analysis, see The Washington Post's article from its Business Section, We're So Unprepared for Finding An Alzheimer's Treatment.
Special thanks to George Washington Law Professor (and friend) Naomi Cahn for making sure we did not miss this item.
Tuesday, November 14, 2017
Kiplinger ran a story promoting the idea of practicing for retirement. 4 Reasons to Hold a Retirement Dress Rehearsal suggests you take a trial run at retirement before making it permanent. For example, thinking about moving to a warmer climate, buying a condo on a golf course, moving into a senior housing complex, or something else, the article suggests trying out the plan temporarily. The advantages of doing so allow you to get a better idea of the expenses of living this new life, whether you physically can manage this new life, discover if more hours for hobbies translate into more (or less) fun, and learn whether you want to be closer or farther away from your family. The article offers this list of things to check out when thinking about moving:
- Availability of health care
- Recreational opportunities
- Access to transportation (area airports, major highways, etc.)
- Community and potential friendships
- Ease of visiting family (or visa versa)
Monday, November 13, 2017
Boots on the Ground - Fighting Financial Abuse of Elder Veterans explains the Veterans Benefits Protection Project. "One form of financial abuse targets elder veterans and their families, promising to assist them with qualifying for veterans benefits through the sale of unsuitable financial products and irrevocable living trusts. These scams threaten the health, safety, and financial well-being of thousands of elder veterans across the country." The project started "outreach and website last Veterans Day to share reliable resources for veterans and professionals working with veterans. Since then, the IOA has conducted 14 trainings to over 725 individuals, notified and trained administrators at all licensed residential care facilities and senior centers in San Francisco about the scam, and received an Aging Innovation Award from the National Association of Area Agencies on Aging."
Here's an explanation about the scam
Financial predators have been making large commissions by selling medium-and-high wealth seniors unnecessary or unsuitable financial products or services. They tell the seniors that in order to get the benefit, they need to “appear impoverished,” and they can accomplish that by converting their assets into their “veteran-friendly estate plan.” Seniors who follow their advice end up with irrevocable trusts or financial products that tie up their money so they cannot access it for the rest of their lives, while the predators walk away with large commissions or service fees for their “help.”
November 13, 2017 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Health Care/Long Term Care, Veterans | Permalink | Comments (0)
Sunday, November 12, 2017
Kaiser Health News wrote about those in their 50s and early 60s who face retirement but are not yet eligible for Medicare. Rising Health Insurance Costs Frighten Some Early Retirees focuses on the ACA's exchanges which are expected to increase costs a lot at least partially due to the "administration’s decision to stop payments to insurers to cover the discounts they are required to give to some low-income customers to cover out-of-pocket costs." The article also mentions the constant focus on repeal and replace by Congress that creates a lot of uncertainty. It's not just about costs, but the variations amongst the states can also create unease. The increased costs may lead some to forego health insurance completely, especially, it is speculated, by those who get no subsidies.
There are already signs of that, according to an analysis for this article by the Commonwealth Fund. The percentage of 50- to 64-year-olds who were uninsured ticked up from 8 percent in 2015 to 10 percent in the first half of 2017. In 2013, the figure was 14 percent.
Indeed, the ACA has been a boon to people in this age group whether they get a subsidy or not. It barred insurers from excluding people with preexisting conditions — which occur more commonly in older people. And the law restricted insurers from charging 55- to 64-year-olds more than three times that of younger people, instead of five times more, as was common.
The law also provided much better access to health insurance for early retirees and the self-employed — reducing so-called “job lock” and offering coverage amid a precipitous decline in employer-sponsored retiree coverage that began in the late 1990s.
Friday, November 10, 2017
Recently there was some coverage about a woman who was being spoon-fed by employees of the facility despite the existence of her advance directive. Kaiser Health News covers the issue in New ‘Instructions’ Could Let Dementia Patients Refuse Spoon-Feeding explains that a group in Washington State has issued “Instructions for Oral Feeding and Drinking”.
As well there's a second document that explains the pros and cons of doing so. There are limits, according to the KHN article.
The guidelines do not apply to people with dementia who still get hungry and thirsty and want to eat and drink, the authors note. ... “If I accept food and drink (comfort feeding) when they’re offered to me, I want them,” the document states. ... But if the person appears indifferent to eating, or shows other signs of not wanting food — turning away, not willingly opening their mouth, spitting food out, coughing or choking — the document says attempts to feed should be stopped. ... And the guidelines tell caregivers to respect those actions.
As well, the KHN article notes, these are guidelines and are not required to be followed.
Tuesday, November 7, 2017
Here's the introduction to the guide:
An important part of the practice of many elder law attorneys is assisting clients to receive and then benefit from Medicaid home and community-based services (HCBS). In March 2014, the Centers for Medicare and Medicaid Services (CMS) published the first ever regulations establishing standards for the settings in which HCBS are provided.1 These regulations will impact the services, quality of life, and rights of HCBS care recipients, as well as the environment in which they receive those services. Each state must develop and implement a plan for how it will come into compliance with the HCBS rules. The involvement of advocates, including elder law attorneys, in influencing the plan and monitoring its implementation is critical. This guide is designed to provide elder law attorneys with a better understanding of the HCBS settings rule and how they can advocate for a strong, effective system that achieves the spirit and intent of the rule.
The report notes that the reason for "HCBS Medicaid services is to be an alternative to institutional settings." Thus, the rule's main reason "is to define the qualities that make a setting a home that is truly part of a larger community." Additionally, the rule is designed to confirm that those recipients really are part of their community. Last, but not least, the rule is intended to make the lives of these folks better as well as getting them more choice and protections. The report can be downloaded here.
The Future of Caregiving: The Coming Caregiving Crunch is a report released in October 2917 by Merrill Lynch and Age Wave that provides interesting data points to identify challenges and action items tied to aging in the U.S. The information in the report was generated by surveys of more than 2,200 individuals, including "nonprofessional" caregivers.
While perhaps it is tempting to assume we are already feeling the effects of retirement for the Boomer generation, this report reminds us that we still haven't had the "first" boomer hit 80 years of age, which is when the likelihood of needing care or assistance increases.
The report suggests that "denial" is a huge problem. While 7 in 10 Americans turning 65 today will need "care for prolonged periods" in their later years, only 4 in 10 Americans believe they personally are likely to "ever" need such care. Certainly Merrill Lynch has a goal to increase consumer awareness of a need for realistic financial planning, some of the most interesting parts of the report addressed not just the need for adequate savings, but the likelihood that families could benefit from "financial coordinators." The report used this term for people with the skills to handle (or monitor/oversee) such tasks as:
- paying bills from proper accounts
- monitoring bank accounts and access to accounts
- handling insurance claims
- filing taxes
- managing invested assets
The writers observe:
Financial caregiving is nearly uncharted territory, with little research identifying the flow and pace of transactions that individuals and their families experience as they navigate the caregiving journey. Similarly, little has been studied about the ways in which caregivers and care recipients need help financially. As Boomers age, the need for assistance in tracking, managing and paying for care-related expenses in complex relationships is destined to grow.
The writers warn that family members are frequently unprepared for the responsibilities that caring for an elder may involve, especially given the fact that Boomers are much more unlikely than previous generations to living near their own children.
Wednesday, November 1, 2017
I wanted to use this post to highlight some other things that I learned by visiting with folks at the conference. Fellow Floridian Nick Burton handed me a business card and a lapel pin for Florida Adaptive Sports. "Florida Adaptive Sports [is] funded by AGED, Inc. as a part of its mission to give back to the community in the form of providing resources, opportunities and awareness for Florida’s disabled community." I stopped by to chat with the folks from Stephen's Place which provides housing for individuals with special needs, but not quite the same as a CCRC since no SNF living is provided (Stephen's Place, an adult care home, is located on the west coast and offers independent and assisted living in a more urban setting) but they do work with families when a resident needs that level of care.
I was chatting as well with the folks from Mobility Support Systems, another exhibitor, about the issues in renting a wheelchair accessible van when flying into an airport. If someone is visiting mom who is in a wheelchair and wants to take mom out for dinner or shopping, what are the options? I thought renting a wheelchair van might be a good solution, but I'm not sure whether the typical rental car companies offer that vehicle. The folks at the booth told me they keep a list for the various airports. It's so helpful to have that info available when making arrangements for the family visit!
I was also pleased to chat with a number of exhibitors who offer a variety of services designed to keep folks independent, and several offer fiduciary-type services. These are just some examples of learning things both inside and outside the classroom. For more info about our conference, click here.
This week, the last session I was able to attend at LeadingAge's annual meeting was a panel talk on "Legal Perspectives from In-House Counsel." As expected, some of the time was spent on questions about "billing" by outside law firms, whether hourly, flat-fee or "value" billing was preferred by the corporate clients.
But the panelists, including Jodi Hirsch, Vice President and General Counsel for Lifespace Communities with headquarters in Des Moines, Iowa; Ken Young, Executive VP and General Counsel for United Church Homes, headquartered in Ohio; and "outhouse" counsel Aric Martin, managing partner at the Cleveland, Ohio law firm of Rolf, Goffman, Martin & Long, offered a Jeopardy-style screen, with a wide array of legal issues they have encountered in their positions. I'm sorry I did not have time to stay longer after the program, before heading to the airport. They were very clear and interesting speakers, with healthy senses of humor.
The topics included responding to government investigations and litigation; vetting compliance and ethics programs to reduce the likelihood of investigations or litigation; cybersecurity (including the need for encryption of lap tops and cell phones which inevitably go missing); mergers and acquisitions; contract and vendor management; labor and employment; social media policies; automated external defibrillators (AEDs); residency agreements; attorney-client privilege; social accountability and benevolent care (LeadingAge members are nonprofit operators); ACO/Managed Care issues; Fair Housing rules that affect admissions, transfers, dining, rooms and "assistance animals"; tax exemption issues (including property and sale tax exemptions); medical and recreational marijuana; governance issues (including residents on board of directors); and entertainment licensing.
Whew! Wouldn't this be a great list to offer law students thinking about their own career opportunities in law, to help them see the range of topics that can come up in this intersection of health care and housing? The law firm's representative on the panel has more than 20 lawyers in the firm who work solely on senior housing market legal issues.
On that last issue, entertainment licensing, I was chatting after the program with a non-lawyer administrator of a nursing and rehab center in New York, who had asked the panel about whether nonprofits "have" to pay licensing fees when they play music and movies for residents. The panelists did not have time to go into detail, but they said their own clients have decided it was often wisest to "pay to play" for movies and videos. Copyright rules and the growing efforts to ensure payments are the reasons.
The administrator and I chatted more, and she said her business has been bombarded lately by letters from various sources seeking to "help" her company obtain licenses, but she wanted to know more about why. For the most part, the exceptions to licensing requirements depend on the fairly broad definition of "public" performances, and not on whether the provider is for-profit or nonprofit.
It turns out that LeadingAge, along with other leading industry associations, negotiated a comprehensive licensing agreement for showing movies and videos in "Senior Living and Health Care Communities" in 2016. Details, including discussion of copyright coverage issues for entertainment in various kinds of care settings, are here.
November 1, 2017 in Current Affairs, Estates and Trusts, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Legal Practice/Practice Management, Medicaid, Medicare, Programs/CLEs, Property Management, State Cases, State Statutes/Regulations | Permalink | Comments (0)
LeadingAge President and CEO Katie Smith Sloan spoke at the Sunday morning (10/29/17) session of NACCRA's meetings in New Orleans. Having taken the reins of LeadingAge after Larry Mannix, it's long time leader who retired in 2015, Katie seems to be settling in well. She identified several themes for LeadinAge's immediate future, including:
- Advocating for an "America Freed From Ageism." Katie observing that this negative bias stands in the way of policy, philanthropy, and hiring in all of the nonprofit senior living and senior service sectors.
- Making LeadingAge "the" trusted voice for aging. She emphasized this goal is all about building relationships and she pointed to several recent high level policy meetings in DC where LeadingAge was invited as a key voice for older adults or the industry.
- Katie also reported that LeadingAge received an outpouring of donations for its disaster relief fund, with over 600 donations. So far the total is more than a half million dollars. She gave examples of how these donations were already helping nonprofit providers affected by the recent hurricanes and fires, including helping staff members who had lost their homes to find housing and helping 3 affordable senior housing communities maximize insurance relief by using donations to pay-down deductibles.
In the Q and A with NaCCRA members, Katie said that LeadingAge and NaCCRA can and should work together to identify common topics for joint efforts, especially on public policy advocacy.
I'm aware that some NaCCRA members are discouraged (or perhaps frustrated is a better word) by a perception that LeadingAge tends to ignore policy points urged by NaCCRA, while still expecting NaCCRA members to support LeadingAge's positions. Time will tell whether NaCCRA was being too tactful in raising this partnership project concern.
Tuesday, October 31, 2017
We are in the thick of Medicare enrollment, so the story from Kaiser Health News explaining the differences between original Medicare and Medicare Advantage is quite timely. Medicare Vs. Medicare Advantage: How To Choose reports that the Part C offerings are pretty stable for 2018 and in fact there are available the highest number plans for purchase all over the US. The article explains some of the foundational concepts for Part C plans:
Medicare Advantage plans must provide the same benefits offered through traditional Medicare (services from hospitals, physicians, home health care agencies, laboratories, medical equipment companies and rehabilitation facilities, among others). Nearly 90 percent of plans also supply drug coverage.
Pros from CMS:
Little paperwork. (Plan members don’t have to submit claims, in most cases.)... An emphasis on preventive care...Extra benefits, such as vision care, dental care and hearing exams, that aren’t offered under traditional Medicare....An all-in-one approach to coverage. (Notably, members typically don’t have to purchase supplemental Medigap coverage or a standalone drug plan.)....Cost controls, including a cap on out-of-pocket costs for physician and hospital services (Medicare Part A and B benefits).
Cons from CMS:
Access is limited to hospitals and doctors within plan networks. (Traditional Medicare allows seniors to go to whichever doctor or hospital they want. ...Techniques to manage medical care that can erect barriers to accessing care (for example, getting prior approval from a primary care doctor before seeing a specialist).... Financial incentives to limit services. (Medicare Advantage plans receive a set per-member-per-month fee from the government and risk losing money if medical expenses exceed payments.) ... Limits on care members can get when traveling. (Generally, only emergency care and urgent care is covered.) ... The potential for higher costs for specific services in some circumstances. (Some plans charge more than traditional Medicare for a short hospital stay, home health care or medical equipment such as oxygen, for instance.) ... Lack of flexibility. Once someone enrolls in Medicare Advantage, they’re locked in for the year. There are two exceptions: a special disenrollment period from Jan. 1 to Feb. 14 (anyone who leaves during this time must go back to traditional Medicare) and a chance to make changes during open enrollment (shifting to a different plan or going back to traditional Medicare are options at this point).
The article also discusses the implications for Medigap policies if the beneficiary switches enrollment to original Medicare and the premium costs for Part C plans. The article recommends a close look at the drug costs under the plan. The article concludes with a discussion of selecting doctors that participate in the beneficiary's plan.
Helpful article! Assign it to your students.
On Monday I did a presentation in New Orleans for a conference sponsored by a professional liability insurance organization. My topic was "legal implications of a diagnosis of dementia" as a risk management concern and part of my task was to talk about alternative diagnoses of neurocognitive disorders, especially for clients.
In part, my message was a note of caution. Lack of "short term memory" may not be present, and thus attorneys, families and colleagues may not have this early warning sign of cognitive disease. For example, a frontal lobe disorder can be "early" onset (usually meaning onset before the individual reaches the age of 60). Language or short term memory problems may not be noticeably impaired, while higher executive functions, especially judgment, can be seriously impacted. Changes in personality, loss of inhibition (including sexual inhibition), recklessness with money or investments may be signs, but these changes may be mistaken for "a mid-career crisis," or other personality problems unrelated to disease.
The lawyer who invited me to do this program with him, Mark Tuft from California, has long experience and knowledge of ethical and disciplinary standards for attorneys. On a related point, he pointed me to a recent Washington Post article, where an individual had been living for two decades with a "fatal" diagnosis of early onset "Alzheimer's Disease," which, as it turns out, may not have been accurate. The author writes in his essay:
Two neurologists have stated [recently] that I fall into a fairly new category called suspected non-Alzheimer’s pathophysiology, or SNAP. According to one study, about 23 percent of clinically normal people ages 65 and older and about 25 percent of people with MCI[Mild Cognitive Impairment] have SNAP. For people with both MCI and SNAP, the risk of cognitive decline and dementia is higher than for clinically normal people with SNAP.
I was initially diagnosed with MCI. But for the past 10 years, the diagnosis has been Alzheimer’s. It is still officially the diagnosis because information gained in trials — which is how I found out that my amyloid scan was negative and that I probably did not have Alzheimer’s — does not go on a medical record. . . .
I will have to wait for science to catch up before I know for sure. Who knows, I may even be part of the next new term. I just hope it means that what I have will not be progressive and lead to death. The one thing we all should learn from my experience is to take advantage of all the tools we have access to so we can make the best decision possible.
What is next for this individual? He received the latest news with mixture of relief and confusion. Read "I lived with an Alzheimer’s diagnosis for years. But a recent test says I may not have it after all," by .
Thanks, Mark, for sharing your podium in New Orleans with me on Monday and for pointing all of us to this article, which is another reminder of the rapidly changing world of scientific knowledge about cognitive impairments.
Monday, October 30, 2017
Over the Halloween weekend, I arrived in New Orleans for overlapping annual meetings involving law and aging issues. Whoa! The Big Easy can be a crazy place at this time of the year! Once I recovered from mistaking the annual "Voodoo Festival" at one end of the convention center for the meetings sponsored by LeadingAge and the National Continuing Care Residents Association (NaCCRA) at the other end, I was safely back among friends. (I suspect a better comedienne than I am could come up with a good "undead" joke here!)
Settling down to work, I participated in half-day NaCCRA brainstorming sessions on Saturday and Sunday. Members of the NaCCRA board and other community representatives worked to identify potential barriers to growth of this segment of senior housing. Why is it that there is still so little public understanding of communities that are purpose-designed to meet a wide range of interests, housing and care needs for seniors who are thinking about how best to maximize their lives and their financial investments over the next 10, 15, 20 or more years?
During the Sunday session led by Brad Breeding of MyLifeSite.net, we heard how Brad's experience as a financial planning advisor for his older clients (who were eager for advice on how to evaluate contracts and financial factors when considering communities in North Carolina), led him and a business partner to develop a more nationwide internet platform for comparative information and evaluations.
I first wrote about Brad's concept on this Blog in 2013 when his My LifeSite company was just getting started, and it is exciting to see how far it has come in less than 5 years. They now offer a searchable data base on over 1,000 continuing care and life plan communities. Best of all, they have managed to stay remarkably independent and objective in the information they offer, and have both consumer and providers as customers for their information. They haven't gone down the slippery slope of reselling potential resident information to providers as "leads."
One audience member, a CCRC resident, who is frustrated about a lack of lawyers in her area with knowledge about the laws governing CCRCs, asked "is there a way to get more 'elder law' attorneys to understand regulations and contracts governing this part of the market so as to be informed advisors for prospective residents seeking objective advice?"
I believe the answer is "yes," particularly if current clients in CCRC-dense areas reach out to Elder Law Sections of Bar Associations in their states, suggest hot topics, and offer to work together on Continuing Legal Ed programs to develop that expertise. I know that almost every year at the annual summer 2-day-long Elder Law Institute in Pennsylvania offers breakout sections for lawyers on the latest laws, cases, and regulations affecting individuals in CCRC settings. Indeed, for "future" attorneys I often use CCRC contracts and related issues as teaching tools in my 1L basic Contracts course.
Thursday, October 26, 2017
Kaiser Health News ran a story last week regarding electronic storage of POLST forms. In Oregon, End-of-Life Wishes Are Just A Click Away highlights a project at Oregon Health & Science University to make POLST forms available electronically. OSHU, working with a tech company, "allow[s] health care providers to electronically find any of the 172,000 active forms in Oregon’s POLST registry with a single click, no matter where they were filed." In 5 months, OSHU doctors have accessed the forms 14,000, according to the story.
We all know the problems that may occur when health care providers don't have ready access to a patient's advance directive documents. This project is designed to alleviate the issue of access to POLST forms, regardless of whether the forms were signed at OSHU or elsewhere. New York has something similar that is web-based allowing patients to complete and access forms throughout New York. End of life wishes of patients in Oregon are more likely followed than any other state in the US according to the article. Making completed POLST forms easily accessible by providers is one step in making that outcome more possible.
Research suggests that POLST forms guide end-of-life care, whether patients die at home or in a health care facility. A 2014 study of deaths among Oregon POLST users found that 6.4 percent of patients who specified comfort-only measures died in a hospital, compared with 44.2 percent of those who chose full treatment — and 34.2 of people with no POLST form on file.
A recent analysis found that seriously ill patients in Oregon are more likely to have their end-of-life wishes honored than those in nearby Washington state — or the rest of the U.S.
The New Mexico Adult Guardianship Study Commission has submitted its initial status report to the New Mexico Supreme Court.
As we have reported earlier (here), New Mexico is one of a number of states that experienced high-profile and very serious incidents of alleged financial abuse of adult clients by their court-appointed guardians.
The report makes some 17 recommendations for prompt action aimed at increasing the quality and accountability of guardians, especially so-called "professional guardians or conservators," including:
- Require certification by statute or court rule of professional guardians and conservators by a national organization, such as the Center for Guardianship Certification. This recommendation is not intended to preclude New Mexico from developing its own certification requirements.
- Require bonding or an alternative asset-protection arrangement by statute or court rule for conservators to protect the interests of the individual subject to the conservatorship.
- Establish stringent reporting and financial accountability measures for conservators, including the following:
1. require conservators, upon appointment, to sign releases permitting the courts
to obtain financial documents of protected persons;
2. require annual reports to include bank and financial statements and any other
documentation requested by the court auditor, with appropriate protections
to prevent disclosure of confidential information;
3. require conservators to maintain a separate trust account for each protected
person to avoid commingling of funds; and
4. require conservators to maintain financial records for seven years.
The report warns that "meaningful reform of the guardianship system will not be easy or inexpensive and cannot be achieved by a single branch of government acting alone."
Rather, true change will require the legislature, the executive, and the judiciary to work together in their respective roles to enact the laws, allocate the resources, and implement the changes that are necessary to improve the guardianship system. The Commission therefore offers its initial status report for consideration, not only to the Supreme Court, but to all who are interested in improving the guardianship system.
The Court invites comments on the proposed recommendations, as well as on additional issues identified by the Commission as requiring further study. The deadline for the comments is November 8, 2017.
My thanks to my good friend Janelle Thibau for sending me timely news of the New Mexico R & R. Janelle and I started off as lawyers together in Albuquerque just a "few" years ago!
October 26, 2017 in Cognitive Impairment, Crimes, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0)
Tuesday, October 24, 2017
We have blogged several times about the issues for Medicare beneficiaries who are not admitted to the hospital but instead are on observation status. The Center for Medicare Advocacy (CMA) has released a toolkit for those Medicare beneficiaries. Here's some information from CMA about their toolkit along with helpful links.
The information in our Toolkit can help beneficiaries, families, advocates and providers understand and respond to an “outpatient” Observation Status designation. The Toolkit contains our Observation Status Infographic; Frequently Asked Questions; A Fact Sheet, Summary & Stories from our partners in the Observation Coalition; A Sample Notice (the MOON); our Recorded Webinar (slides in the printable .pdf); Beneficiary/Advocate Q&A; and our Self-Help Packet.
The Toolkit can be downloaded in its entirety or browsed online at http://www.medicareadvocacy.org/medicare-hospital-outpatient-observation-status-toolkit.
There's a great infographic explaining the observation status dilemma. You could post it or hand it out to clients. Get permission from CMA to post it on your website in the client info section! Check out the FAQ as well as the self-help packet. In addition to accessing the toolkit online, you can download the toolkit as a pdf, by clicking here.
Full disclosure-I'm a member of the CMA board.