Wednesday, February 22, 2017
The marketers of reverse mortgages often paint a rosy picture of how seniors will be able to draw on the equity in their homes to cover daily expenses, without risk of repayment before death. But details of these mortgages can be overlooked and as we've reported before, seniors can be surprised when terms and conditions create traps that can lead to foreclosure. However, from Florida, we're now hearing about cases where one of the simplest conditions -- the borrower continuing to live on site -- has become the subject of litigation.
“All of a sudden, we saw a spate of foreclosures where the mortgage companies alleged the seniors no longer lived in the home,” said Gladys Gerson, supervising attorney for Coast to Coast Legal Aid of South Florida’s senior unit. “This has been happening around the state.”
About a dozen similar cases reached Gerson and other attorneys at Coast to Coast, who have helped a growing number of low-income seniors fight and win dismissals despite aggressive lender litigation.
Florida is ground zero for seniors’ issues, but as the strategy has often proved effective, it’s likely to spread, according to defense attorneys. “If you see the volume of national advertising that’s geared to seniors, I can’t believe this is limited to Florida,” Corona’s father and partner, Ricardo, said. “The servicers are not even based in Florida, so I don’t see why they would limit themselves.”
Corona admits he didn’t expect a hard fight when he first reviewed El Hassan’s case, but court records show he was wrong. Over the last 10 months, the ongoing litigation yielded two hearings, 40 docket entries and attempts by both sides to collect attorney fees.
For more, read the full article, Foreclosure Litigation Strategy Takes Aim at Seniors, Attorneys Say.
Thank you to my colleague, Dickinson Law Professor Laurel Terry, for this source.
Wednesday, February 15, 2017
I think designing homes to allow a person to age in place is great (and of course, we have to make the community accessible as well). So I was interested in this article that discussed making the home accessible when the resident used a walker or wheelchair. Kaiser Health News ran the article, How To Make A Home Much More Friendly To Seniors Using Wheelchairs Or Walkers. The article offers this sobering statistic "Researchers at the Harvard center found that fewer than 10 percent of seniors live in homes or apartments outfitted with basic features that enhance accessibility — notably, entrances without steps, extra-wide hallways or doors needed for people with wheelchairs or walkers." Yet, "[a]bout 2 million older adults in the U.S. use wheelchairs, according to the U.S. Census Bureau; another 7 million use canes, crutches or walkers... [and] [t]hat number is set to swell with the aging population: Twenty years from now, 17 million U.S. households will include at least one mobility-challenged older adult, according to a December report from Harvard University’s Joint Center for Housing Studies."
The article discusses a list of items to be considered so that the home is accessible, including a ramp into the home, wider doors, turning radius, removal of under the sink cabinets, showers without curbs, and more.
Thursday, January 26, 2017
The Young Invincibles recently released a report that looks at the financial health of the Millennials. The Financial Health of Young America "compares the financial health of young Americans in 1989 compared to today’s young adults to reveal major declines across five key factors – income, assets, net wealth, home ownership and retirement savings. In summary, Boomers had higher incomes, owned more homes, and had twice the net assets that Millennials have today."
In addition, the report notes the following key findings:
Millennials have earned a net wealth half that of Boomers at the same age.
Young adult workers today earn $10,000 less than young adults in 1989, a decline of 20 percent.
Education attainment still an individual’s best pathway to financial security.
When Boomers were young adults, they owned twice the amount of assets as young adults.
Disturbing racial inequality persists and grows. Young African Americans’ median wealth declined by a third since 1989.
Student debt blunts some of education’s benefits.
The report makes various recommendations in the following categories: skills, education, income, employment benefits, housing policies, improving the ability to save and gain wealth, and improve portable retirement choices. This is the first of several reports. The full report runs 30 pages and is available here.
Friday, January 13, 2017
The plight of 108-year-old Ohio resident Carrie Rausch, facing the prospect of losing her spot in an assisted living community because she's run out of money, is generating a lot of attention in the media, including People magazine. Some states, such as New Jersey, have expanded the options for public assistance in senior living -- beyond nursing homes -- to permit eligible individuals to use Medicaid for residential care. Assisted living is usually much less expensive than a nursing home; but the pool of individuals who would might opt for assisted living rather than the "dreaded" nursing home is also larger. Ohio, along with many states, hasn't gone the AL route:
If Rausch can’t raise the money needed, she’ll have to leave what has been her home for the past three years and move into a nursing home that accepts Medicaid.
[Daughter] Hatfield worries about the toll the move would take on her mom, who is more lively and active than most people 10 or even 20 years her junior. . . . “We need a miracle,” she says.
Ms Rausch's adult daughter -- herself in her late 60s -- has turned to GoFundMe to attempt to raise the $40k needed for a year of continued residence, and as of the date of this Blog post, more than 700 donors have responded.
At a deeper level, however, this story reveals important questions about public funding for long-term care on a state-by-state basis. This funding issue is repeating itself throughout the country for seniors much younger than the frugal and relatively healthy Carrie Rausch. On a national basis, GoFundMe "miracles" seem an impractical solution.
Sunday, December 11, 2016
A recent article, We Spent a Weekend at an Assisted Living Facility, is a close look at "[a]n intimate peek at aging from the residents of Stonewall Gardens." This ALF is described by the authors as "not your typical senior community. It’s the only operating LGBT-friendly assisted living facility in Southern California (and, as of [the authors'] visit, the US)." The article is written in a conversational and entertaining style and tells stories from a number of residents.
The article mentions challenges when a person needs an ALF:
Falls, injuries, memory loss, isolation, and illness are often key determining factors for individuals and families when it comes to considering and discussing long-term planning. For many, the topic is overwhelming with much to consider: logistics, expenses, and emotions, not to mention the different personalities and opinions of those involved. But being at Stonewall has opened our eyes to the fact that there are tools and resources that can help with the transition. And plenty of options. Stonewall, like most assisted living facilities, offers private apartments, on-site caregiving, meals, housekeeping, and help with medicine and other aspects of everyday life, including the opportunity to feel like a part of a community.
If you want your students to get a look at an ALF with lots of activities (and you don't have time for a field trip) have your students read this article.
Thanks to Julie Kitzmiller for sending the article.
Monday, December 5, 2016
The 1st Annual Report of the White House Legal Aid Interagency Roundtable (WH-LAIR), Expanding Access to Justice, Strengthening Federal Programs was released last month. A fact sheet accompanying the report is available here. According to the DOJ website, the reason for WH-LAIR is
to raise federal agencies’ awareness of how civil legal aid can help advance a wide range of federal objectives including improved access to health and housing, education and employment, family stability and public safety. The Legal Aid Interagency Roundtable’s message included that providing legal assistance to people who cannot afford it can also have substantial economic benefits by preventing outcomes that are harmful to them and expensive for the communities.
WH-LAIR is made up of a number of federal agencies. The fact sheet highlights some of the accomplishments, including an ElderJustice AmeriCorp which provides teams of attorneys and paralegals to help elder abuse victims. This first report covers the 4 years of operation of WH-LAIR. The report highlights the participating agencies' efforts to incorporate legal aid into their programs. policy recommendations to improve access to justice, furthering strategic partnerships, furthering data collection, evidence-based research, and concomitant analysis. The full report has 3 sections: (1) legal aid overview and its correlation to advancing federal priorities, (2) how the agencies have incorporated legal aid into their programs and (3) future opportunities to continue and expand their work.
December 5, 2016 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Legal Practice/Practice Management | Permalink | Comments (0)
Wednesday, November 30, 2016
The NY Times ran an article recently focusing on bias against LGBTQI residents of nursing homes. No Rest at Rest Home: Fighting Bias Against Gays and Lesbians starts with telling the story of one resident who ended up filing suit, in which the resident "accuses the housing center and its managers of failing to protect her from hostile residents who have insulted and verbally abused her. The suit says that she has been pushed, shoved and spit on, and that she was injured, including bruises on her arm, a bump on her head and a black eye." As well in the suit the resident alleges that the facility's "management not only of failing to meet its responsibility to stop the harassment but of retaliating against her for complaining about the abuse and seeking to push her out of the facility."
The article calls this suit as having the potential to "set a legal precedent establishing the responsibility of housing providers to actively address discrimination based on gender identity and sexual orientation under the federal Fair Housing Act. The law states that discrimination based on “sex” is prohibited."
The article quotes our friend Eric Carlson from Justice in Aging, as well as a survey they had previously conducted.
A survey of L.G.B.T. adults living in long-term care settings by Justice in Aging, a legal advocacy group, found that a majority believed they would face discrimination from housing staff if they were open about their sexual orientation. The report captured hundreds of stories of problems encountered by L.G.B.T. seniors with housing staff, ranging from harassment to refusals to provide basic services or care.
“You’re in a communal living setting that puts a lot of pressure on people,” says Eric Carlson, directing attorney for Justice in Aging. “Imagine how oppressive it is to have to be guarded about who you are or your family and friends.”
The article discusses another study and the scope of discrimination against LGBTQI elders as well as HUD's work to redress such discrimination.
Thursday, November 17, 2016
AARP is offering a online chat on November 21 from 3-4 p.m. on Home Sharing: A Powerful Option to Help Older Americans Stay in their Homes. The website offers a summary of this upcoming chat:
The vast majority of older adults have told AARP that they want to “age in place” by remaining in their current home and neighborhood. But much of the U.S. housing stock isn’t very aging-friendly (stairs are an example), and millions of older Americans face economic hardships that challenge their ability to afford the costs of safe and suitable housing.
The rise of home sharing — in which people rent space in their residence to a traveler or short-term tenant — is allowing people of all ages (but especially older adults) to literally earn an income from where they live.
Join AARP’s Nancy LeaMond, former Philadelphia Mayor Michael Nutter, Airbnb executive Sarah Bianchi and Gene Sperling, an economist and consultant to Airbnb, for an online discussion and Q&A about the benefits of home sharing for older adults and the new Airbnd report “Home Sharing: A Powerful Option to Help Older Americans Stay in their Homes.”
The accompanying report will be available here starting November 21.
Thursday, October 27, 2016
The Administration for Community Living (ACL) released on October 26, 2016 the unpublished final regulation for independent living programs (the reg is officially published on October 27, 2016). The rule is effective November 25, 2016.
The discussion section explains the new rule
The federal Independent Living (IL) program seeks to empower and enable individuals with disabilities, particularly individuals with significant disabilities, to exercise full choice and control over their lives and to live independently in their communities. For over 40 years, these aims have been advanced through two federal programs: Independent Living Services (ILS) and Centers for Independent Living (referred to as CILs or Centers). The Workforce Innovation and Opportunity Act (WIOA) transferred these Independent Living programs to the Administration for Community Living (ACL) and created a new Independent Living Administration within the agency, adding section 701A of the Rehabilitation Act, 29 U.S.C. 796-1.
According to the ACL news release, the new regs:
Clarifies requirements surrounding WIOA’s addition of new core services to:
- Facilitate the transition of individuals with significant disabilities from nursing homes and other institutions to home and community-based settings
- Provide assistance to individuals with significant disabilities who self-identify as being at risk of entering institutions so that the individuals may remain in the community
- Facilitate the transition of youth with significant disabilities who are no longer in school and no longer receiving services under section 614(d) of IDEA.
Clarifies several key definitions. For example:
- “Consumer control” adds specificity to definition in the context of individuals to mean that the person with a disability has control over his or her personal life choices, independent living plan and has the right to make informed choices about content, goals and implementation. Prior to the final rule, “consumer” was sometimes interpreted to include the parents or caregivers of the person with a disability
- “Personal assistance services” is now defined to explicitly include assistance with activities outside of employment, such as social activities and parenting.
Addresses the roles and responsibilities of the State Independent Living Council, as defined by WIOA. For example, the final rule:
Includes additional details of what must be a part of the SILC Resource Plan to carry out the functions of the SILC
Addresses the SILC’s authority to conduct resource development activities to support the provision of services by Centers for Independent Living
Clarifies the expanded role of the SILC in the development of the State Plan for Independent Living.
Monday, October 24, 2016
Kaiser Health News ran a story, Staying Out Of The Closet In Old Age. The article explores the issues faced by elders who are out and become frail and need caregivers or supportive housing. How significant are the issues faced by these elders? According to one expert quoted in the article, very.
“It is a very serious challenge for many LGBT older people,” said Michael Adams, chief executive officer of SAGE, or Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders. “[They] really fought to create a world where people could be out and proud. … Now our LGBT pioneers are sharing residences with those who harbor the most bias against them.”
Efforts are underway to move long term care providers to a point of understanding. Such efforts include
Nationwide, advocacy groups are pushing to improve conditions and expand options for gay and lesbian seniors. Facilities for LGBT seniors have opened in Chicago, Philadelphia, San Francisco and elsewhere.
SAGE staff are also training providers at nursing homes and elsewhere to provide a more supportive environment for elderly gays and lesbians. That may mean asking different questions at intake, such as whether they have a partner rather than if they are married (even though they can get married, not all older couples have). Or it could be a matter of educating other residents and offering activities specific to the LGBT community like gay-friendly movies or lectures.
The article mentions a report this summer from Justice in Aging (formerly the National Senior Citizens Law Center), How Can Legal Services Better Meet the Needs of Low-Income LGBT Seniors? in which it was reported that 1/5 of those elder LGBTQI individuals in LTC facilities felt ok with being open about being an LGBTQI elder.
The article discusses the difficulty in finding housing and reports on some options that have developed, such as "the Los Angeles Gay & Lesbian Elder Housing organization opened Triangle Square Apartments in 2007. In the building, the first of its kind, residents can get health and social services through the Los Angeles LGBT Center. The wait for apartments with the biggest subsidies is about five years."
Friday, October 21, 2016
LeadingAge, the trade association that represents nonprofit providers of senior services, begins its annual meeting at the end of October. This year's theme is "Be the Difference," a call for changing the conversation about aging. I won't be able to attend this year and I'm sorry that is true, as I am always impressed with the line-up of topics and the window the conference provides for academics into industry perspectives on common concerns. For example, this year's line up of workshops and topics includes:
- General sessions featuring Pulitzer Prize winning journalist Charles Duhigg on the "The Science of Productivity," 2013 MacArthur Fellow and psychologist Angela Duckworth on the the importance of grit and perservance for successful leadership, and famed neurosurgeon and speaker Sanjay Gupta on "Medicine and the Media."
- Hundreds of sessions, organized by "interest groups":
October 21, 2016 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, International, Legal Practice/Practice Management, Medicaid, Medicare, Programs/CLEs, Property Management, Retirement, Science, Social Security, State Cases, State Statutes/Regulations, Veterans | Permalink | Comments (2)
Tuesday, October 18, 2016
We've blogged on several occasions about aging in place. So a recent article in the New York Times caught my eye. The Future of Retirement Communities: Walkable and Urban starts out noting our dependence on cars to get where we want to go, but perhaps that is about to change. "Few people in America walk to work. Most of us drive to the supermarket. But more older people these days are looking for a community where they can enjoy a full life without a car." Focusing on one couple's search for the perfect community, the couple explained, "'[w]e realized ‘aging in place’ means a lot more than just a comfortable house ... [s]o we began thinking more about ‘aging in community.’ That means an urban neighborhood where you can walk or take transit to just about everything you need.'”
This concept, walkable living, isn't a new one, but is one that has somewhat fallen to the wayside with our dependence on cars and cities designed for vehicles rather than people. "Developments for independent retirees typically come in two flavors: isolated, gated subdivisions or large homes on golf courses, often in the same bland package of multiple cul-de-sacs. Both require driving everywhere, which is a problem for those who either don’t want to drive or can’t."
With new urbanism, an emphasis on walkable communities is gaining traction. Of course, walkability leads to more activity, which we know has benefits to those walking. There are challenges to building communities for aging. The article mentions the hurdles. "Age-friendly communities within cities may require extensive infrastructure improvements, including wider sidewalks, bike lanes, more public transportation options and longer pedestrian signal walk times. Local officials may not want to rezone or invest in the improvements or even permit them." Then factor in costs, because some currently walkable cities are also costly for residents. There are tradeoffs, however, so don't rule those out.
Have you students read this article, and have them judge your community for "aging in community."
Tuesday, October 4, 2016
The GAO has issued a new report of interest to all of us who read this blog or teach elder law. Elder Housing: HUD Should Do More to Oversee Efforts to LInk Residents to Services was released on October 3, 2016. The 66 page report is available here as a pdf and the highlights are available here.
Here are the findings:
While limitations in the Department of Housing and Urban Development's (HUD) data make an accurate assessment difficult, GAO estimates that roughly half of the 7,229 Section 202 Supportive Housing for the Elderly (Section 202) properties have HUD-funded service coordinators—staff who link residents to supportive services such as transportation assistance or meals. HUD's data indicate that 38 percent of Section 202 properties have a HUD-funded service coordinator, but these data likely underestimate the true number. GAO surveyed a generalizable sample of Section 202 properties not identifiable in HUD's data as having a service coordinator and, on this basis, estimates that an additional 12 percent of Section 202 properties actually had one—bringing the actual total of Section 202 properties with service coordinators to about 50 percent. Federal internal control standards note that it is important for management to obtain relevant data from reliable sources. Properties with service coordinators are subject to additional monitoring, but without accurate information, HUD risks not taking steps to monitor Section 202 properties with service coordinators to help ensure they are connecting residents to supportive services.
Properties without service coordinators connect residents to services in a variety of ways—for example, property managers may serve this function themselves, or they may utilize other local organizations. Several stakeholders told GAO that property managers are well-positioned to know their residents, and have some insight into their needs. Others noted that property managers generally lack the time and expertise to effectively manage this responsibility, and that the manager's role can conflict with that of the service coordinator. Through GAO's survey and site visits, managers of Section 202 properties without service coordinators cited a variety of reasons for not employing them, including lack of funding and having too few units to justify hiring someone to focus on supportive services for the elderly residents.
HUD requires its staff to monitor Section 202 properties' adherence to program requirements. However, HUD lacks written policies and procedures that describe how its staff should monitor the requirement for Section 202 property managers to coordinate the provision of supportive services. Available guidance describes general monitoring procedures for multifamily properties but does not address Section 202 specifically. HUD officials told GAO they plan to develop guidance on monitoring Section 202 properties with service coordinator grants by December 2016. Federal internal control standards note the importance of documenting responsibilities through policies. Without written policies and procedures, HUD cannot be assured that elderly residents are receiving assistance obtaining services. In addition, HUD collects performance data, such as the number of services provided, from Section 202 properties that have service coordinators but does not have policies or procedures in place to verify the accuracy of the data or for analyzing the data collected. Federal internal control standards also note the importance of evaluating data for reliability and processing data into quality information to evaluate performance. Until HUD takes steps to assess service coordinator performance data for reliability and analyze the data reported, its ability to use that information to monitor whether service coordinators are performing effectively and helping to fulfill the goals of the Section 202 program will likely be limited.
Make note that HUD plans to have Section 202 monitoring guidance with grants for service coordinators by December. Stay tuned!
Monday, October 3, 2016
Homelessness is a serious problem. For elders, it may be even more so. Statistics in a recent article are sobering; nearly 1/3 of those who are homeless are over 50. A recent article in Vox highlighted this problem. "Elderly homelessness is on the rise. A combination of slow economic recovery from the recession and an aging baby boomer population has contributed to the rise of the 51 and older homeless population. The percentage has spiked by almost 10 points since 2007 — in 2014, the 51-and-older group represented nearly a third of the national homeless population." The story is told in the first person to a free lance reporter, the woman, 66, explaining how she came to this point in her life.
Everywhere in our country, people are having a hard time finding affordable places to live. The housing crash and its chilling effect on mortgage lending have hit the poor the hardest. Affordable housing rates, defined as a unit that costs less than $800 a month, dropped by 12 percent in the past few years. Homeowners are being replaced by renters, as the American dream of owning your own property is becoming increasingly a luxury for the rich and upper middle class...I used to be middle class. Now I’m nouveau poor.
In the story she details her health problems, loneliness, the lack of privacy and loss of dignity and how her dog is her one bright spot in her life.
On some days, I’ll drive to the beach. I’ll walk my dog in the parking lot, then sit in my car and watch the waves and listen to the birds. The sounds of the ocean are calming and soothing. The sun on my face warms me... I try to remember what’s important in life. I try to remember that there’s beauty everywhere and good people in the world. I try to remember my previous life, filled with interesting characters, connections, wondrous places I have lived and visited... If I’m lucky, I’ll fall asleep and dream about living in a home again during a short, heavenly nap.
Wednesday, September 21, 2016
Stetson's 18th annual National Conference on Special Needs Trusts & Special Needs Planning takes place on October 19-21, 2016 at the Vinoy Hotel in St. Petersburg, Florida. Early Bird Registration rates end September 23, 2016. The national conference spans two days, with general sessions in the mornings and three tracks of breakout sessions in the afternoons (basics, advance and administration) Information about the conference, including the agenda, speakers, and links to register is available here. (Full disclosure, I'm the conference chair. Hope to see you at the conference!)
Friday, September 16, 2016
Jeffrey Skatoff, Esq. sent me a link to his firm's recent blog post (written by an associate) about a Florida appellate case concerning capacity to sign a deed. I thought this was an interesting case, and wanted to share it with you. Here is the post, Partially Incapacitated Ward Makes Valid Deed
When a person is found incapacitated and placed under a guardianship, the exercise of some or all of that person’s rights are exclusively delegated to the guardian. That is, those rights which the court finds the person (ward) unable to personally exercise can only be exercised by the guardian. Thus, when a ward takes an action which he or she has lost the right to take, that act is typically void ab initio and treated by the courts as if it never happened.
Recently, Florida’s Third District was called upon to review a trial court’s judgment invalidating a deed executed by a ward in Marcinkewicz v. Quattrocchi, 2016 Fla. App. LEXIS 13403. The facts in Marcinkewicz were as follows: The Ward’s son moved into her home in 2007. The son maintained that he had reached an understanding with his mother that she would leave the home to him upon her death in exchange for his agreeing to care for her. In 2009, the Ward moved into the home of her daughter and son-in-law. A year later, the Ward was declared incapacitated and her daughter became guardian of her person and property. Two years later, the guardianship over the Ward’s property was dissolved but a limited guardianship over her person remained. In 2013, the Ward visited her longtime attorney and executed a deed transferring her home to the son-in-law.
Upon receiving the deed, the son-in-law filed suit to eject the son from the property. The son counter-sued to invalidate the deed and for other relief. The trial court found that the Ward lacked capacity to execute the deed and that, as a result, the deed was void. The trial court further found that because the deed was void, the Ward still owned the property and the son had to vacate the property.
The Third District reversed the trial court’s finding that the deed was void but affirmed its ruling that the son had no rights in the property. The appellate court began by noting that the validity of the document is presumed and that this presumption can only be overcome with “clear, strong and convincing evidence." (quoting Espriella v. Delvalle, 844 So. 2d 674, 676 (Fla. 3d DCA 2003) (internal citations omitted). The appellate court noted that the trial court erred in assigning the burden of proving the deed’s validity to the son-in-law/grantee when it was the son who should have had to produce evidence in support of a finding that the Ward lacked capacity to execute the deed. Because the son failed to produce any evidence that the Ward lacked capacity at the time she executed the deed, the trial court’s finding was without evidentiary support. Because the deed was valid, the son had no rights in the property, equitable or otherwise. Accordingly, the trial court’s order that the son vacate the premises was upheld.
Thursday, September 15, 2016
One of our recent grads sent me an article about a new design for an ALF, This Assisted Living Facility Is Designed To Look Like Homes On A Golf Course. Another article, published in the local newspaper, the design is for residents with dementia. Svayus takes a different approach to Alzheimer's explains that this ALF is a place out of time
What they’re about to enter is a world more reminiscent of one that existed in the 1930s and 1940s. The exteriors of the residences are designed to look like homes commonly found during that time period, down to the color of the paint.
The world of Svayus houses 22 residents, most of whom have Alzheimer’s disease. As the disease progresses, Makesh said, people begin to revert back to their childhood. Svayus serves as something of a time capsule.
The reasoning behind this is emotional: to provide the residents with a familiar "feel" to their residences. The company has several ALFs designed with the residents in mind. One of them offers this:
Entering into Svayus is like walking outside. In addition to the period-accurate home exteriors, residents are also greeted with a grass-green floor, (artificial) plants, a small waterfall and audio of birds chirping. Overhead is the sky ceiling, designed to help with residents’ physiological clock. During the day, residents will see a sunny sky, even on the grayest Northeast Ohio days. ...
At night, the sky ceiling darkens and the porch lights come on.
“Every little thing you see, the wall color, the paint, actually has a therapeutic benefit, a therapeutic value" ...[according to the CEO].
Different aromas also are pumped into the air, providing a therapeutic benefit. Peppermint and frankincense, for example, help with anxiety.
As far as the ALF designed as though the residents live on a golf course, "rooms designed to look like houses on a golf course. Not only is this aesthetically pleasing, the point is to help residents feel more at home. Compared to your average retirement or assisted living facility, this place looks so much more inviting and calming. The hallway features a ceiling painted like the sky, porches and even porch lights that turn on at night."
Very cool idea. I wonder what one designed for the Boomers would look like? (tie-dye curtains, peace symbols, Beatles posters anyone?)
Tuesday, September 13, 2016
A recent study was published in Health Affairs, Home-Based Care Program Reduces Disability And Promotes Aging In Place. The abstract explains:
The Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program, funded by the Center for Medicare and Medicaid Innovation, aims to reduce the impact of disability among low-income older adults by addressing individual capacities and the home environment. The program, described in this innovation profile, uses an interprofessional team (an occupational therapist, a registered nurse, and a handyman) to help participants achieve goals they set. For example, it provides assistive devices and makes home repairs and modifications that enable participants to navigate their homes more easily and safely. In the period 2012–15, a demonstration project enrolled 281 adults ages sixty-five and older who were dually eligible for Medicare and Medicaid and who had difficulty performing activities of daily living (ADLs). After completing the five-month program, 75 percent of participants had improved their performance of ADLs. Participants had difficulty with an average of 3.9 out of 8.0 ADLs at baseline, compared to 2.0 after five months. Symptoms of depression and the ability to perform instrumental ADLs such as shopping and managing medications also improved. Health systems are testing CAPABLE on a larger scale. The program has the potential to improve older adults’ ability to age in place.
A subscription is required to access the full article. A Kaiser Health News (KHN) story about the study, Study Finds Benefits When Seniors Call Shots To Help Them explains "A federally funded project that researchers say has potential to promote aging in place began by asking low-income seniors with disabilities how their lives at home could be better ... At the end of the program, 75 percent of participants were able to perform more daily activities than they could before and symptoms of depression also improved, the researchers said in the journal Health Affairs."
According to the KHN article, the study is based on two ideas: "environment influences health" and elders "should set goals to improve their health." So asking the elder what the elder needs, and then providing the right services leads to a good result, it seems. "Instead of dictating health goals to the patients, the therapist’s first two visits were about listening to what the seniors thought their biggest problems were and creating plans on how to tackle them." The positive impact continued after the study ended, according to one of the researchers interviewed for the article, who noted environment plays a big role as a barrier to aging in place.
Sunday, September 11, 2016
Over the weekend, I caught the recently released movie, Hell or High Water. Both "contract law" and "elder law" figure into the plot. Warning: Spoilers ahead -- so don't keep reading if you don't want to know.
The timeless and yet still "modern" plot -- with sons trying to save the family homestead from the bank -- has a few good West Texas twists (although the movie was mostly filmed in my old stomping grounds of New Mexico). I enjoyed the play on words with the title of the movie from a legal perspective. The bank's "reverse mortgage" on the homestead has a payoff clause that bars any excuses for nonpayment, such as Acts of God or other hardships. In legal circles such clauses have are called "come hell or high water" terms, rejecting any "force majeur" excuses for late payments. So the brothers are up against the clock. Can they steal enough from the very bank conglomerate that made the loan in order for them to get the mortgage paid off by the deadline? Good character actors abound, including two waitresses who steal the scenes in small town diners and Jeff Bridges at the other end of a Texas journey he began 45 years ago with The Last Picture Show.
The reverse mortgage is the elder law part of the plot. The movie hints the aging mother was loaned just $25,000 on the homestead (where oil may be found) -- enough to be difficult to pay off (especially with taxes and fees), but not enough money to truly save her from her debts. While the plot stretches the realities of reverse mortgages, in truth such mortgages are typically very high cost loans, and are not easily refinanced.
Thursday, September 1, 2016
Giving more evidence of the potential impact of aging boomers in America, officials in Humboldt County, a North Coast county in California, describe potential shutdowns of three area nursing homes as potentially "catastrophic." The reason for the closures? The problem isn't lack of residents. Operators find it difficult to attract adequate personnel, especially CNAs, needed to staff the care facilities. From the North Coast Journal article describing the latest problem:
Rockport Healthcare Services, the management company for five of Humboldt County's six skilled nursing facilities, announced today that they have filed relocation notices for three sites: Pacific, Seaview, and Eureka Rehabilitation and Wellness Centers. The relocation notices, filed with the California Department of Public Health, are the first step in closing these facilities, which collectively contain 258 beds, and relocating their patients.
Stefan Friedman, spokesperson for Rockport, said in a statement that the company is continuing to work with community partners to "find a solution to [a] severe staffing crisis," but it is possible that after public health approves their relocation notice they will shut down the facilities.
That, said Area 1 Agency on Aging ombudsman Suzi Fregeau, would be "catastrophic."
Although many patients stay only briefly in skilled nursing facilities, receiving rehabilitation after leaving the hospital, the facilities are often the last stop for patients who cannot afford in-home healthcare professionals and need 24-hour care. Their vital role in the continuum of care was felt last year, when the facilities — five of which are owned by the same company, Brius Healthcare — stopped accepting patients. Hospital administrators, hospice workers and families all felt the pinch, and many North Coast residents had to go to facilities far away from Humboldt County. Fregeau said the potential closure will be even worse.
"It means that residents are going to be placed in facilities a minimum of 150 miles away," she said. "People are going to be dying in communities they’ve never lived in."
Sad to think that some of the prettiest areas of California are struggling with attracting and keeping adequate numbers of trained people.