Friday, October 21, 2016

LeadingAge's Annual Meeting Begins October 30 in Indianapolis

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:

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 (0)

Tuesday, October 18, 2016

Aging in Community

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."

October 18, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Retirement | Permalink | Comments (0)

Tuesday, October 4, 2016

Elder Housing: Linking Residents to Services

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!


October 4, 2016 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Housing | Permalink | Comments (0)

Monday, October 3, 2016

Over 50 and Homeless

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.

October 3, 2016 in Consumer Information, Current Affairs, Housing | Permalink | Comments (1)

Wednesday, September 21, 2016

18th Annual CLE: Special Needs Trusts & Special Needs Planning: Early Bird Ends 9/23/16

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!)

September 21, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Medicaid, Medicare, Other, Programs/CLEs | Permalink | Comments (0)

Friday, September 16, 2016

Person Under Limited Guardianship of Person & Capacity to Sign a Deed

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 2007The 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.

(citations omitted)



September 16, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Housing | Permalink | Comments (2)

Thursday, September 15, 2016

A New Approach to Designing ALFs

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?)




September 15, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Housing | Permalink | Comments (0)

Tuesday, September 13, 2016

Asking The Elder What She Needs Leads to Good Results

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.


September 13, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Health Care/Long Term Care, Housing | Permalink | Comments (1)

Sunday, September 11, 2016

"Come Hell or High Water" at the Movies

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. 

September 11, 2016 in Consumer Information, Current Affairs, Ethical Issues, Housing, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Thursday, September 1, 2016

Shortages of CNAs and Qualified Staff Trigger "Relocation" Notices for NHs in Northern California

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.

September 1, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Medicaid, Medicare | Permalink | Comments (3)

Wednesday, August 31, 2016

ORANJ Shares Insights into Life Plan Communities

As we first reported here almost a year ago, the segment of the senior living community traditionally identified as "Continuing Care Retirement Communities" or CCRCs is working on rebranding. Under the leadership of the trade organization LeadingAge, the preferred name is Life Plan Communities.

ORANJ, the catchy acronym for the very active Organization of Residents Associations of New Jersey, publishes quarterly newsletters and their Fall 2016 issue includes demographic and marketing reasons behind the name change.  The issue includes an essay by Brian Lawrence, President and CEO of Fellowship Senior Living on Why and How Life Plan Communities Are Evolving.

August 31, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing | Permalink | Comments (1)

Thursday, August 25, 2016

Aging Solo

Last week we blogged about those elders who have no kids to be their caregivers. The Washington Post featured an article on the topic of "aging solo".  Aging Solo: Okay, I don’t have a child to help me, but I do have a plan, told from the perspective of the author, is an attention-grabber from the beginning

“The trouble is: You think you have time.” That Buddhist-sounding quote from a fortune cookie rattled around the back of my head for decades, seemingly for no reason. Now that I find myself living with my 94-year-old mother in a Florida city where preacher Billy Graham got his start and being a never-wed 60-something has made me a tourist attraction of sorts, I finally understand why I thought the repercussions of growing old without a child or two would not apply to me: I was just plain delusional.

As a New Yorker flush with friends, freelance work, Broadway tickets and great Botox, I had apparently existed in some sort of fun, singles bubble. It was a lifestyle so rewarding that I never read even one article about the stresses of the “sandwich generation.” (Hey, the writers all seemed to be married women with children, so even on a boomer-to-boomer level, I could not relate.)

Of course she's not alone. The article provides statistics--almost 33% of the Boomers have no kids. "That doesn’t count boomer parents who have lost a child or have one who is severely impaired. The Aging Solo pool also includes countless members of families plagued by addiction, disease, cults, rapacious children, even married progeny who much prefer their in-laws. While millions of Aging Soloists have siblings and other kin, many of us can’t imagine (or abide) having them shepherd us to our final rest."

The author calls for an aging plan with friends rather than kids, and using her parents' story as educational,  she offers this advice "When you’re past 50 and single, location is 75 percent of the enchilada. Subways matter. Proximity to friends matters. Suburban seniors communities felt to me like slow death. I found senior centers and assisted-living facilities profoundly lonely because, it seems, the art of making friends does not grow as we age, and not everyone likes endless bingo and dominoes on Tuesdays, followed by a prayer service."

She goes on to offer further tips

It’s better to plan a more personal assisted-living future with your own friends while in your 50s or 60s. That will give you time to choose a location with diverse people and culture, with neighborhoods that have sidewalks and public transit....

Sharing resources can spawn all sorts of possibilities. Maybe my posse grabs several apartments in rental, condo or co-op buildings, or we share a group house in D.C., Manhattan or L.A. Heck, maybe we can find a way to lease a floor in one of the many overbuilt office buildings around the country. Perhaps (if yours is an anti-urban posse) you can hire an architect to design space-age yurts in Arizona. Each madly hip structure would be self-contained, but the colony would have a common dining hall, gym and tech-support center, or whatever your future selves desire.

New to the finances of aging, I had no idea how much control I gained by holding my mother’s durable power of attorney. Had I been less ethical, I could have taken her money and run. Therefore, I’ll never give that power to any one person; it will be held by at least three younger and devoted friends because elder fraud is one of the most horrifying aspects of aging solo. Trust me: That charming new friend who offers to manage your money so you don’t have to deal with “all those bills” is probably well known to the local police.

So what is the author doing to prepare for her aging without kids?  She explains

What am I doing? Well, I’ve started small, using Skype dialogues with my pals to research and download the legal papers — from wills to end-of-life instructions — that we will need, sooner or later. Now we’re aiming higher. Should we learn what to look for in a nurse’s résumé so we can find the right person to help us in our collective dotage? Should we hire a visionary architect to create a high-tech trailer park or a cluster of tiny homes built around communal buildings? Our ideas are still all over the map.

We hope we have time to execute our most appealing visions. Mostly, however, we pledge to be our own Best Friends. United. Forever.... 

August 25, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Other | Permalink | Comments (1)

Washington Post: Legal Counsel for the Elderly Is Part of One Woman's Story

The Washington Post has a fascinating piece about Wanda Witter's decades-long battle with the Social Security Administration. At the age of 80, Wanda's story appears to be one of success, after many years of living in shelters and on the streets of D.C..  

At the shelters all those years, Witter tried to get someone to listen to her. She explained at different offices providing homeless services that those suitcases contained the evidence. She was owed money, lots of money, and she could prove it.


Witter is not a particularly warm or outgoing person. She isn’t rude, just direct. And suspicious of just about everyone. And obsessed with Social Security.


“They kept sending me to mental counselors. I wasn’t crazy. I wasn’t mentally ill,” she said.

With the help of the Washington Legal Clinic for the Homeless, Legal Counsel for the Elderly (LCE) and a dedicated, patient and persistent social worker, Julie Turner, it appears that Ms. Witter is now in her own apartment and will receive some $100,000 in back Social Security payments.  

For the full story, read "'I Wasn't Crazy.' A Homeless Woman's Long War to Prove the Feds Owe Her $100,000."  

August 25, 2016 in Ethical Issues, Federal Statutes/Regulations, Housing, Legal Practice/Practice Management, Social Security | Permalink | Comments (0)

Wednesday, August 17, 2016

Spotlight: UC Hastings' and UC San Francisco's Medical-Legal Partnership for Seniors Clinic

Earlier this week, I wrote about a new publication drawing attention to "six" specific areas of need that can helped by a health/law partnership to provide more comprehensive services for the older client or patient.  That post inspired one of our regular readers to write about her experiences with an important Consortium effort between the law school at UC Hastings and the medical program at UC San Francisco.  Their Medical-Legal Partnership for Seniors Clinic (MLPS Clinic) sounds terrific and, not surprisingly, it attracted the attention of the New York Times from its inception:

Consider the geriatricians working at the Lakeside Senior Medical Center, an outpatient clinic at the University of California, San Francisco. Many of their patients, despite multiple chronic diseases and advanced age, have never filled out power-of-attorney documents or appointed someone to make health care decisions if they are unable to.


Sometimes, the doctors suspect their patients might qualify for public benefits they are not getting, like food stamps or MediCal, the state’s version of Medicaid. Perhaps they face problems with landlords or appear to be victims of financial abuse, or they ought to have a simple will.


In other words, they need lawyers. But trying to get frail, low-income seniors to consult an elder attorney can seem an insurmountable problem. How will they travel to a law office? Or pay a fee that can reach $300 an hour? Even if the doctors can refer them to a legal aid office, will their elderly patients actually make an appointment? Then remember to go?


At Lakeside there is a simpler solution, said Sarah Hooper, who teaches at the University of California Hastings College of the Law. “The physicians do the initial screenings, hear what their patients’ problems are, take the history — and they essentially write a prescription: ‘Go down the hall and see my friends at U.C. Hastings for help with this housing issue,’ ” she said.

Sarah Hooper, Executive Director for the clinic, provided an update, explaining, "We’ve done quite a bit of outreach within MLP and in the healthcare system, but are increasingly realizing that we need to get more elder law attorneys and legal aid advocates energized around this idea."  Sarah reports that she'll be attending and presenting at the National Aging and Law Conference in D.C. in October, 2016 and hopes to inspire others to develop similar partnerships.

For more on the UC Hastings-San Francisco MLPS Clinic, read the full New York Times article (first published in 2013) by Paula Spahn, "The Doctor's New Prescription: A Lawyer."   For more on the Medical-Legal Partnership concept, visit the website for the National Center for Medical Legal Partnerships.

August 17, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Legal Practice/Practice Management | Permalink | Comments (0)

Tuesday, August 16, 2016

Grandmother Was Living On Her Own and Doing Just Fine Until...

Last weekend, the Arizona Republic newspaper carried a Question and Answer column that caught my eye.  The question began: 

My grandmother lives in Scottsdale, and my wife and I live in Chicago.  We only visit her two or three times a year.  Although we thought my grandmother was still able to manage her financial affairs, she recently called us to say that she was being evicted from her Scottsdale home for nonpayment of HOA dues.  My grandmother owns her $450,000 hoe free and clear....


HOA dues only totaled $700 originally.  After the late charges, interest, and legal fees, however, there was almost $8,000 owed at the foreclosure sale two weeks ago.

How often do crises involving aging loved ones begin with the words "I thought she was doing well living alone until...?"  Here the concerned grandson jumped into action and the consumer advisor suggested a range of options, including working with the "investor" to resolve the ownership and equity issues.  For more you can read Grandmother Loses Home to HOA Fees on the PressReader service for the Arizona Republic, August 14, 2016.


August 16, 2016 in Cognitive Impairment, Consumer Information, Dementia/Alzheimer’s, Estates and Trusts, Housing, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Monday, August 15, 2016

ALF Residents with Agression

The current issue of the Journal of Applied Gerontology features an article, Resident Aggression and Abuse in Assisted Living. The full article is available as an html here or a pdf here.

The introduction explains: "The purpose of this article is to estimate the prevalence and identify risk factors of engaging in resident aggression and abuse in assisted living facilities. Measuring the prevalence of resident aggression and abuse in assisted living facilities is needed to better understand the scope of the problem. Identifying strategies to mitigate and prevent resident aggression and abuse can help to improve social well-being and progress toward achieving public health objectives."  The authors conclude that

Prior studies have found evidence of resident abuse in nursing homes (Pillemer et al., 2011; Pillemer & Finkelhor, 1988; Pillemer & Moore, 1989). Our findings build on this knowledge base with nationally representative estimates of resident aggression and abuse in assisted living settings. In conclusion, this study provides evidence of the prevalence of resident aggression and abuse in assisted living facilities. Given the rising prevalence of dementia and aging population in the United States, resident aggression and abuse is a growing problem that warrants more attention from policy makers, researchers, and long-term care providers. Furthermore, dementia and SMI were significant risk factors for physical, verbal, and sexual abuse in residential care settings. Future research is needed to develop better methods for identifying residents at greater risk of engaging in abuse as well as supporting ongoing training and prevention efforts to mitigate this risk.


August 15, 2016 in Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Housing | Permalink | Comments (0)

Medical-Legal Partnerships Are Needed For Elder Advocacy and Protection

In July, I drove some 2500 miles, from Pennsylvania to Arizona, to begin an exciting sabbatical opportunity.  I enjoy this drive (especially since I tend to do it fairly rarely, perhaps once every seven years).  I frequently visit friends along the way, and this summer I was struck by how many friends had saved up tough elder law stories for me.  

A theme emerged from their stories.  They would tell me, "I have an aging friend (or sometimes a family member or neighbor) who is in serious danger  of physical or financial harm, but refuses to cooperate with reasonable plans to solve the problems. What are my options to help this person I care about?"

In one instance, it seemed clear the at-risk individual was affected by some level of cognitive impairment.  But how to know for sure?  Was  the refusal to cooperate with a "better plan" the product of a sound, if somewhat eccentric mind?  A neurocognitive assessment seemed warranted.  We tried to arrange one. But the earliest appointment available was more than 60 days away and the  potential for harm was immediate.

Thus, it was with great interest I read a preview of  an article in the upcoming issue of the ABA publication, Bifocal.  Professors Marshall Kapp, Shenifa Taite and Gregory Turner outline "Six Situations in Which Elder Law Attorneys and Physicians Caring for Older Patients Need Each Other."  They are writing about a critical need for Medical-Legal Partnerships designed specifically to assist older persons and their family members.   For example, on the topic of "self-neglect," the authors explain:

Mistreatment of older persons by others is a serious problem. Both the medical and legal conundrums became more complicated, and thus even more amenable to interprofessional collaboration, when self-neglect is entailed. A significant percentage of older adults, mainly living alone, do not regularly attend to their own needs or well-being regarding health care, hygiene, nutrition, and other matters. The majority of cases reported to APS agencies by health and social service professionals and family members are triggered by suspected self-neglect. The health care system expends considerable efforts trying to intervene in these situations to prevent increased rates of hospitalization, nursing home placement, and even death.


In situations involving suspected elder self-neglect, the physician’s role is vital in recognizing the potential problem, characterizing the nature and seriousness of the risk posed, and trying to identify clinically and socially viable intervention strategies. Among other concerns, decisional capacity issues almost always arise in these cases. The physician may look to an attorney for advice about legal reporting requirements or options, as well as the legal boundaries within which interventions may be designed and implemented in a manner that best respects the older person’s dignity and autonomy while protecting the vulnerable at-risk individual from undue foreseeable, preventable self-generated harm.

A growing number of  law schools (including Penn State's Dickinson Law) have established Medical-Legal Partnership Clinics, where the collaborative relationship between attorneys and physicians is established in advance of need by clients. Often such clinics focus on younger clients, especially children.  Elder-specific services are an important subset of the services that can be provided in a timely and professional setting.  For more, read the full Bifocal article published in the-August 2016 issue -- and ask whether such services are available in your community.   

August 15, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Housing, Legal Practice/Practice Management | Permalink | Comments (0)

Sunday, August 14, 2016

Multigenerational Households on the Rise

I was reading a recent report from Pew Research Center's FactTank about the rise in multigenerational households. The data might surprise you. A record 60.6 million Americans live in multigenerational households notes that almost 20% of folks in the U.S. live in a multigenerational household ("defined as a household that includes two or more adult generations, or one that includes grandparents and grandchildren....")  The article reminds us of the downturn in multigenerational households back in the 1950s through the 1980s, but these households have been on the rebound since then.  The increase is across the spectrum of ages, ethnicity, etc. As far as elders, "more than a fifth live with multiple generations under one roof, including Americans ages 55 to 64 (23% in 2014) and 65 and older (21%). The rise in multigenerational living among these older Americans is one reason why fewer now live alone than did in 1990."  Not unsurprisingly, the most typical household is parents and adult children.  However, grandparent-parent-adult children households are growing as well. "Three-generation households – for example, grandparents, parents and grandchildren – housed 26.9 million people in 2014."

August 14, 2016 in Consumer Information, Current Affairs, Housing | Permalink | Comments (0)

Thursday, August 11, 2016

Are "Granny Flats" The New NIMBY?

Bear with me-this is going to take a bit for me to connect the dots to my point. We have posted on several occasions about the need for caregivers as the Boomers continue their aging trek. We've also blogged about the shortage of caregivers and the impact caregiving has on family members.  With me so far? So, it would seem logical that we want to make it as easy as possible for caregivers to provide care. In many instances for the family caregivers do this, the family lives together, whether the parent moves in with the adult kids or vice versa. In other instances, the home may be remodeled to make it appropriate for multi-generational families.  In others, the caregivers add to their property with an auxiliary dwelling unit or ADU (popularly known as a  granny flat), a medical-cottage, or even converts their garage into a "mother-in-law" apartment.  

Still with me? So, when remodeling, we may need a permit. When we are adding a building, renovating or bringing in an ADU or med-cottage, we may run afoul of zoning ordinances, when zoning is for single families. Hopefully local governments, understanding the need for caregiving, would be willing to grant variances for this, although there are cases where the contrary has occurred.

So this is all a lead up to a recent story in the Washington Post. The Next big Fight Over Housing Could Happen, Literally, In Your Back Yard opens with the story of a couple who had built their home in their daughter's back yard. Here's what happened:

They were just finishing the place when a lawsuit earlier this year against the city of Los Angeles brought permits for homes like theirs — second units on single-family lots — to a halt. As a result, city officials who gave them permission to build now haven’t given them a certificate of occupancy, and the utility won’t connect them to the power grid.

Second homes, often called “granny flats,” have become a new front in the conflict that pits the need for more housing in the country’s most expensive cities against the wishes of neighbors who want to preserve their communities. The same battles flare over large developments that might loom over single-family neighborhoods. But even this modest idea for new housing — let homeowners build it in their own back yards — has run into not-in-my-back-yard resistance.

And the difficulty of implementing even such a small-scale solution shows why it will be hard to make room in crowded cities for the middle- and working-class households who increasingly struggle to afford to live there.

Not only do these "second homes" help caregivers live in proximity to the elder, these second homes could also alleviate housing shortages according to the article.  So what's the objection?  "Many neighbors, though, protest that a glut of back yard building would spoil the character of neighborhoods designed around the American ideal of one family on one lot surrounded by verdant lawn. They fear that more residents will mean less parking. And they question whether small homes, particularly in wealthier neighborhoods with the most room to build them, would really constitute affordable housing."

Do these concerns really apply if the purpose is to provide caregiving to a family member? I realize that it's difficult to separate out second housing units designed as rental income from second houses designed for caregiving. The article notes that several cities are considering revisions to their zoning ordinances, primarily to address the need for more affordable housing.  But let's not forget about the caregivers and their parents. Let's make it as convenient as possible for them to provide care, even if it is just to allow the temporary installation of ADUs or medical cottages.


August 11, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing | Permalink | Comments (0)

Friday, August 5, 2016

And then there is the "Alligator Problem"....

Earlier in the week, I shared the feature news story on "avoidable deaths" in Pennsylvania long-term care, often shown to be linked to inadequate staffing (whether in numbers or training, or both).  The article began with a fall of a man while apparently unattended, and also identified residents "choking" on food as another documented risk associated with staffing and supervision.

But other senior care communities in the country may have their own unique complications.  South Carolina has reported its first apparent "alligator attack," sadly connected to the death of a 90-year-old woman, who was earlier reported missing from her assisted living community.  For more, read the Post-Courier report from  July 29, 2016.   


August 5, 2016 in Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care, Housing | Permalink | Comments (1)