Sunday, November 19, 2017

Philly Area Nursing Home Fire's First Lessons

As I wrote last week, the dramatic five-alarm fire at a senior nursing care unit near Philadelphia (actually, in West Chester) was something we might want to keep an eye on, to see if lessons emerge about emergency response.  The good news is that the community around the nursing home wing (which appears to be part of a CCRC rather than a stand-alone nursing home)  has been warm, loving and helpful to the residents.  Today's Sunday morning news showed donations of clothing and key supplies arriving at the door step of a local fire department, along with practical expertise:

 

Tom Short, a statistics professor at West Chester University, said he and his wife, Darlene, had just moved to the area from Cleveland. He saw the ambulances taking the seniors to the university during the fire and knew he wanted to help. The couple had already had experience helping seniors.

 

So they arrived at the firehouse early Sunday to help with crush of donations.  “I knew how to organize,” Short said.

 

“We just want to help out,” his wife said. “We printed out a list of things that were needed.”

So, the first lesson is positive -- the importance of community -- and folks with organizational skills stepping forward to volunteer.

But, there also seems to be a question about whether all of the residents of the care facilities have been accounted for.  

See:  Barclay Friends Nursing Home Fire: What We Know and Don't Know [as of late Saturday]. 

Some  of the residents are being cared for in family members' homes; others at hospitals or other care facilities, but it seems that one lesson could be that a system of accountability for individuals who could be uniquely at risk in a fire or similar disaster should be part of an emergency plan, regardless of the age of the affected individuals.   More details on the cause of fire and a casualty report are expected on Monday.  

November 19, 2017 in Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care, Housing, State Statutes/Regulations | Permalink | Comments (0)

Friday, November 17, 2017

New Lessons to Emerge from Philadelphia-Area Nursing Home Fire?

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: 

https://youtu.be/8UhX3Bo93Og

 

 

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)

"Evictions" of Nursing Home Residents Trigger Lawsuits

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)

Monday, November 13, 2017

Call for Papers-Western Sydney University Elder Law Review

Here's the info from my dear friend, Sue Field, co-editor.

Elder Law Review The Elder Law Review is an independent refereed e-journal produced by Elder Law at Western Sydney University. It is the only Australian Journal concerned with Elder Law. The Review publishes articles about legal issues relating to seniors in all areas of law, including wills, powers of attorney, substitute decision-making, guardianship, discrimination, accommodation, contracts, financial management, retirement income, taxation and property. The Review is multi-disciplinary, bringing together professionals working, researching and writing in the aged care area. It is designed to be of interest to academics, practitioners and those involved in the provision of aged care.

The Elder Law Review can be accessed at

http://www.austlii.edu.au/au/journals/ElderLawRw/recent.html

https://www.westernsydney.edu.au/elr/elder_law/elder_law_review_elr

Call for submissions for Volume 11 (due for publication early 2018).

Notes to contributors The theme of the forthcoming issue will be “Legal and Financial Issues surrounding Retirement Villages” Original, unpublished contributions are invited for any of the following sections of the Review:

  • the Refereed section containing scholarly articles about the legal/social/economic/policy issues associated with “International Perspectives on Elder Law”. While we will consider articles of any length, we prefer them to be between 3000 and 8000 words.
  • the Comments section, which consists of contributions from government, lawyers and aged care representatives, commenting on issues which the contributor perceives to be of contemporary significance within elder law.
  • News and Current Issues – including legislative changes and case notes.
  • Elder Law in Practice which profiles legal practices, community projects, social justice initiatives and pro-bono schemes from all over the world that specifically target the legal needs of older people.

Papers must conform to the Australian Guide to Legal Citation which can be accessed at

http://law.unimelb.edu.au/__data/assets/pdf_file/0007/1586203/FinalOnlinePDF-2012Reprint.pdf

In particular, contributors should note the conventions regarding footnotes and bibliographies. Submissions must be received by January 15th, 2018  and should be addressed to Sue Field S.Field@westernsydney.edu.au

For further information please contact Sue Field co-editor S.Field@westernsydney.edu.au Contributors are reminded that papers should be written in clear language accessible to specialists and non-specialists alike and that submission of articles is no guarantee of publication, as the Elder Law Review is a peer reviewed journal and ERA ranked.

 

 

November 13, 2017 in Consumer Information, Current Affairs, Housing, International, Other | Permalink | Comments (0)

Tuesday, November 7, 2017

Check Out This New Report: New Guide on HCBS Settings Rule

The National Consumer Voice for Quality Long Term Care has issued a new guide, Understanding and Advocating for Effective Implementation of the Home and Community-Based Services Settings Rule.

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.

 

 

 

November 7, 2017 in Consumer Information, Current Affairs, Discrimination, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid | Permalink | Comments (0)

Friday, November 3, 2017

Another Tech Innovation in Aging - "Illusions of Nature"

One of my favorite parts of the LeadingAge Annual Meeting is my first tour of their Expo.  Law conferences are so dull by comparison!  There are hundreds of vendors at the LeadingAge expos.  You can find a smorgasbord of senior housing options, architects eager to help you with your purpose-designed projects, all kinds of communications systems, management software and health-related devices, even cooking classes. I often find information that helps my research, including data complications by actuaries, accountants and marketing firms about trends in housing and care systems.  This year I heard about an "app" in development with a university team that included law students, to offer caregivers options to identify potential concerns, such as financial abuse. 

In the years I can attend, I keep my eyes open for my own personal "That's Creative" award.  This year, it was the Sky Factory -- where, using solar energy, the company offers a wide variety of windows, skylights, and other wall installations -- but with a twist.  These portals offer "award winning illusions of nature." Overhead views show clouds and trees, rustling in the wind.  Another window might offer a view of an especially pleasant beach, with waves in motion. That is why the designs need energy, appropriately solar energy, to keep the images in motion.   

Perhaps most unique, some of the images are designed so as to offer subtle changes triggered to the time of day (or night).  Sunlight plays across the images of nature, and shadows move with the sun.  The goal is for individuals who are house-, chair- or bed-bound to engage with nature, with the hope the engagement will stimulate mental response and circadian rhythms in the body.  The use of this product is not limited to seniors, or even disabled persons.  

November 3, 2017 in Cognitive Impairment, Consumer Information, Games, Housing | Permalink | Comments (0)

Wednesday, November 1, 2017

More From the 19th Annual Stetson Special Needs Trust Conference

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.

November 1, 2017 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Programs/CLEs | Permalink

LeadingAge: Hot Topics for Attorneys Who Advise Clients in Senior Housing and Service Industries

LeadingAge 2017 Hot Topics  for Lawyers Advising in Senior LivingThis 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)

"America Freed From Ageism" - a LeadingAge Goal

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. 

November 1, 2017 in Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care, Housing, Programs/CLEs | Permalink | Comments (0)

Tuesday, October 31, 2017

Continuum of Housing for Adults with Special Needs

There is a lot of conversation about aging in place and how to accomplish that goal.  Design and modifications may depend on the individual's needs. We think about the concept mainly with elders but what about younger people with special needs who may also desire to stay in one place and grow old there? If you search for resources about aging in place, much of what you find will be specific for elders, but many of the recommendations may be adapted to those who need accommodations to live independently. At Stetson's 19th Annual Special Needs Planning & Special Needs Trusts conference, I visited an exhibitor that provides a great housing option for individuals with special needs that's designed for exactly that. Similar to a CCRC, the concept is a continuum of housing that allows the individual to age in place. Annandale Village, located in Suwanee, GA., provides 4 levels of housing: independent living either on campus or in the community, assisted living and nursing home care for individuals with developmental disabilities or brain injuries.  It offers a variety of programs, both for residents and a day program.  One cool class teaches folks on managing independent activities of daily living.   They also offer respite services. I know they aren't the only organization providing these levels of housing, but I thought it is a really interesting to learn more about the concept., especially supporting the individual's residential needs through his/her life.

Full disclosure-I'm the conference chair for this Stetson conference.

October 31, 2017 in Consumer Information, Current Affairs, Housing | Permalink

Monday, October 30, 2017

The Continuing Need for Objective Advice About Continuing Care and Life Plan Communities

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. 

October 30, 2017 in Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care, Housing, Property Management, State Statutes/Regulations | Permalink | Comments (0)

Tuesday, October 24, 2017

Radio Diaries: Oral Histories from a "Retirement Home"

One of my colleagues shared with me recently a 30-minute podcast from Radio Diaries, on "The Last Place."  The focus is on residents at Presbyterian Homes in Evanston, Illinois, which is sometimes described in the segment as a "nursing home." However, it seems to me to be a continuing care community (CCRC) offering a wide range of residential options, from independent living to skilled care.

The voices on this segment are far more upbeat than the title -- "The Last Place" --  would imply!  Good fuel for a family or a classroom discussion.  For me, it is a reminder that when someone says "I never want to live in that place," what they usually mean is they never want to be disabled nor in need of care.  I think that distinction can be important for families who struggle to live up to a pledge "never" to place their loved ones in care.  It's not the place, it's the disability that is the biggest issue.  I continue to encounter reminders that the "right" place (for the person's situation, including any disability) is the best place.    

Thank you, Mathew Lawrence, for sharing this link!

October 24, 2017 in Current Affairs, Health Care/Long Term Care, Housing | Permalink | Comments (0)

Wednesday, October 18, 2017

Where We Live-Publication from AARP

AARP has a new book added to its library on livable communities. Where We Live: Communities for All Ages (2017) by Nancy LeaMond is the second book in their series. This new book is ideas from community leaders, with the earlier book (2016) containing ideas from mayors of cities. Both books are free-bound copies by request from AARP and electronic copies available from many online booksellers or AARP via an email request to WhereWeLive@AARP.org .  Topics in the 2017 book include housing; arts, entertainment, fun; community engagement; public spaces (indoors and outdoors);  health & wellness; work and volunteering and transportation and infrastructure like roads and sidewalks. To learn more or order your copies, click here.

October 18, 2017 in Books, Consumer Information, Current Affairs, Housing, Other | Permalink | Comments (0)

Monday, October 9, 2017

Is There a "Diversity Problem" in Senior Living?

Steve Moran, who writes for Senior Housing Forum, a website that offers itself as a "place for conversation and collaboration," always seems willing to take on sensitive topics.  Recently, in a commentary piece entitled Black Consumers and Senior Living, he nonetheless began:

I am terrified to be writing and publishing this article.  It seems that writing anything about race is fraught with all kinds of downsides and very little in the way of upside. Except that we have an ethnic problem in senior living.  Today, based on resident populations, only white people (and Asians) seem to like senior living.

He addresses provider attempts to "explain away" the problem and arguments about whether "Blacks and Whites have different world views."  Ultimately, recognizing the need for both sensitivity and fearlessness, he concludes, "[I]f senior living is really a great thing, and I believe it is, then we have an obligation" to make it available to everyone.  

Certainly there are "marketing" reasons to reach out to a broader circle of perspective clients to offer supportive, attractive community living.  But, I think Steve's short post is a good start on other fundamental questions about what consumers want, need, expect, and cherish as they approach some invisible line that makes them eligible for senior living.  

October 9, 2017 in Consumer Information, Discrimination, Ethical Issues, Housing, Retirement | Permalink | Comments (0)

Sunday, October 8, 2017

Emergency Readiness of SNFs

Justice in Aging has released a new issue brief focuses on the emergency readiness of nursing homes. Why Many Nursing Facilities Are Not Ready For Emergency Situations explains the situation in the executive summary: 

Nursing facility residents can be particularly at risk during natural disasters, as has been demonstrated yet again during Hurricanes Harvey, Irma, and Marie. The hurricanes resulted in death and injury in nursing facilities across the region, including twelve deaths in one Florida facility.

These deaths and injuries, and the desire to prevent harm in the future, have directed renewed attention on emergency preparedness. This issue brief discusses existing federal and state law, and makes recommendations to address gaps in current law.

Federal regulations on nursing facility emergency preparedness were issued in September 2016, and are scheduled for full implementation in November 2017. The regulations address five primary areas: emergency plans, facility procedures, communication plans, training and testing, and emergency power systems.

Unfortunately, these new regulations are inadequate to protect residents, in part because some of the regulatory standards are excessively vague, and in part because the regulations only govern nursing facilities and cannot mandate the broader coordination that would be advisable for community-wide emergency preparedness. Federal, state, and local governments should take additional steps to ensure adequate preparation for the natural disasters that inevitably will envelop nursing facilities and other health care providers in years to come.

The issue brief offers 7 recommendations including requiring  (1) emergency generators, (2) prior  coordination between government, healthcare providers and nursing homes, (3) arrangements for emergency evacuations, (4) local governments to keep the pertinent information "on an ongoing, community-wide basis", (5) governments or providers to create resources designed to help in drafting the emergency plan, (6) governments to mandate outside review of the facilities' emergency plans and (7) federal surveyors to impose appropriate sanctions for those facilities that don't comply with the emergency plan.

 

October 8, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare, State Statutes/Regulations | Permalink | Comments (0)

Thursday, October 5, 2017

Former Secretary of Commerce Penny Pritzker: On Her Early Business Career in "Senior Living" & Avoiding Conflicts of Interest

I'm a fan of early morning podcasts of high-profile interviews.  For me there is something about listening to them in dim light before my day gets fully started.  It allows me to fully "hear" little nuggets of information, ideas about innovations or even law-related gems.  

Recently I listened to the August 28, 2017 podcast of David Axelrod's interview of Penny Pritzker, who was Secretary of Commerce during the second term of President Obama.  I'd forgotten that Pritzker's early business career included a start-up with "Classic Residence by Hyatt," later rebranded as Vi, a form of high-end senior living communities, operated mostly in the "CCRC" model.  Pritzker talks about a family tradition of "graduating from law into business." From the interview transcript, where shes discusses her entry into the family business:

I went to law school [and] I went to business school [at Stanford]. I came back to Chicago and and arrived. And it wasn't obvious what I was going to do but I wanted I had seen my family build businesses and I figured I wanted to do that too. And but it was an environment where there were no women. There were no women, there were no women vice presidents, there were no women in the organization. There was--there were no women parking in the parking garage if you will know women eating in the dining room if you will. And so it required me to I think find what I call the white space. I had to figure out where did I fit. And I felt that the place that I fit best was to really actually create new businesses. And so I became an entrepreneur within two years of arriving back in Chicago. I--there was talk of starting a new business in senior living and I basically said to my uncle I want to do that. And that's how I started my first business which was Classic Residence by Hyatt. And it was you know I was 27 years old. I had a terrific education and I had worked during school as well but there was so much I needed to learn and I had to learn by doing. And I made a ton of mistakes. I didn't know. Some of the people I hired were wrong, some of the decisions I made were wrong. 

She speaks candidly about the experience, admitting "we didn't really know what we were doing and we weren't sure exactly what the market [of senior living] wanted or needed."  At one point, she realized a $40 billion family investment in her business was at risk, and she talked to the then-patriarch of the Pritzker family, her uncle Jay Pritzker , and said that "if we can't turn this around in six months you should fire me and we should liquidate."  

Continue reading

October 5, 2017 in Consumer Information, Ethical Issues, Health Care/Long Term Care, Housing | Permalink | Comments (0)

Wednesday, September 27, 2017

"Assisted Living Compare" Database in the Works?

The federal Medicare website offers a"Nursing Home Compare" website, which provides useful information on Medicare and Medicaid certified skilled care facilities across the country.  The available information includes: 

  • How nursing homes have performed on health and fire safety inspections
  • How the nursing home is staffed with nurses and other healthcare providers
  • How well nursing homes care for their residents

But, as we write about so often on this Blog, the majority of senior care occurs outside of nursing homes, with exponential growth in Assisted Living facilities.  Thus, it is interesting to hear that a commercial entity has announced it will soon offer access to data on assisted living places.  From McKnight's Senior Living News:  

“For the first time, the seniors housing industry will have a single source for assisted living asset analysis, reputation evaluation, portfolio monitoring, operator benchmarking, clinical analytics, market analysis and consumer education, with a key benefit being that the burden is not on assisted living providers to submit the data,” Arick Morton, CEO of VisionLTC, said in a statement.

 

“We've categorized the citations so you can see where areas of concerns are within the different assisted living facilities based on some of the citation standardization work that we've done,” Jessica Curtis, Formation Healthcare Group vice president of clinical systems and analytics, told McKnight's Senior Living.

Unfortunately, in the short run, it appears the database will be marketed exclusively to commercial players, including "operators, real estate investment trusts, lenders, investment groups and clients [of developer Formation Healthcare Group] who have expressed interest."  Curtis explained:  

“It will be a paid subscription-type service for them,” Curtis said. “As a future development opportunity, we certainly see the need for this type of information to be available for consumers and the general public, and so that may be a consideration for a future version,” she added.

For more, read "Nursing Home Compare-Like Site For Assisted Living to Launch Next Month."

September 27, 2017 in Consumer Information, Ethical Issues, Health Care/Long Term Care, Housing | Permalink | Comments (0)

Tuesday, September 26, 2017

Nursing Home Abuse: Reporting to Law Enforcement

Check out this updated policy brief, Policy Brief: Requirements for Reporting to Law Enforcement When There is a Suspicion of a Crime Against a Nursing Home Resident.  The Long Term Care Community Coalition  (as an aside, take a look at their cool url) released this updated brief with information about changes and 2017 updates

2017 Updates:
1. The potential fines for violations of the law are subject to adjustment for inflation. The fines indicated below are current as of September 2017.
2. New CMS guidelines for these (and other) requirements are in effect as of November 28,
2017. A summary of the guidelines for reporting can be found at the end of this brief. The
full federal Guidance can be found on the CMS website:

https://www.cms.gov/Medicare/Provider-Enrollment-and-
Certification/GuidanceforLawsAndRegulations/Downloads/Advance-Appendix-PP-Including-Phase-2-.pdf.

The overview explains that

The law broadens and strengthens the requirements for crime reporting in all long term care
facilities (including Nursing Facilities, Skilled Nursing Facilities, LTC Hospices, and Intermediate Care Facilities ...) that receive $10,000 or more in federal funds per year. The facility must inform the individuals covered under the law - its employees, owners,
operators, managers, agents, and contractors - of their duty to report any "reasonable
suspicion" of a crime (as defined by local law) committed against a resident of the facility. After forming the suspicion, covered individuals have twenty-four hours to report the crime to both the State Survey Agency and to a local law enforcement agency. If the suspected crime resulted in physical harm to the resident, the report must be made within two hours.

The brief explains the policy requirements and offers recommendations for consumers, state agency folks and long term care facilities. There is also a summary of the regs as well as definitions of commonly used words.

The brief can be downloaded as a pdf here.

September 26, 2017 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare, State Cases | Permalink | Comments (0)

Rental Housing and Seniors -- the Live-In Care-Giver Problem?

Recently, our law school's Community Law Clinic represented a woman who had been living with her brother for more than a year at his 2-bedroom rental apartment.  The landlord was fully aware of the situation.  Both brother and sister were 70+, and the sister's presence meant that the brother had appropriate assistance, including assistance in paying his bills (and rent!) on time.  However, a few weeks ago the brother was hospitalized on an emergency basis, and then required substantial time in a rehabilitation setting, and may not be able to return to his apartment.  

What's the problem?  When the landlord learned that the brother had been living away from the apartment for several weeks, and was not likely to return, the landlord notified the sister she could not "hold over" and eventually began eviction proceedings against her.  Fortunately, the Clinic was able to use state landlord-tenant law to gain some time for the sister to find alternative housing (and to arrange for her brother's possessions to be moved), but both brother and sister were unhappy with the compelled move.

Lots of lessons here, including the need to read leases carefully to determine what that contract says about second tenants, who aren't on the lease.  In this situation, the landlord's attempted ouster was probably triggered by the sister making a few reasonable "requests" for improvements to the apartment.  The landlord didn't want a "demanding" resident!

The question of "rights" of non-tenant residents happens often in rental housing -- without necessarily being tied to age.  

I was thinking about this when I read a recent New York Times column, which offered an additional legal complication -- New York City's rent control laws, and the needs for "dementia-friendly" housing, that can involve caregivers. See Renting a Second Apartment for a Spouse Under Care. 

 

September 26, 2017 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Housing, Property Management, State Cases, State Statutes/Regulations | Permalink | Comments (2)

Thursday, September 21, 2017

The "Well-Meaning Friday Child" Syndrome and Long-Distance Caregiving


St._Nicholas_(serial)_(1873)_(14596944999)There's an old rhyme that's been running through my head lately, the one about Monday's child (who was fair of face) and so on.  In the rhyme, "Friday's child is loving and giving."

I like to think of myself as Friday's child, even as I confess I don't quite live up to the standard of being truly giving.  For example, I haven't changed jobs or given up my job to be a more direct caregiver for my parents. I'm the child who flies across the country on long-weekends to my parent's home town, and tries to demonstrate my loving and giving nature by fixing all of their problems.  I have the "well-meaning Friday child" syndrome.  And there are a lot of us out there; I'm often seated next to someone attempting this same care mission on red-eye airplane flights.

Mostly, this pattern tends to drive my folks and my sister, who lives about 30 minutes from my parents' home, a bit crazy.  I rationalize my behavior by telling myself, "They asked me to fix XYZ problem!" But doing so on the run is often a less-than-successful strategy.  When my father was alive and still at home, he used to respond to my arrival with an immediate question, "when are you leaving?"  I used to try to explain away that response by thinking, "he just wants to know so that he can get in an extra ride to the airport, one of his favorite outings."  But now my mom is asking me the same question and she doesn't enjoy airport rides.    

Over time, one of the things I've learned is that rather than trying to impose solutions, it's better to use these short trips to identify options.  For example, as it became clear (at least to me) that my father might not be able to stay at home for the rest of his life, even with round-the-clock assistance, I suggested to my mother that we make a long list of different types of care settings and visit one each time I was home.  Sometimes we even saw two spots.  Sometimes we made a second visit to a spot we'd looked at earlier. Eventually my mother, worn out and worn down by the care needs of her husband, called me and suggested it "was time" to select a spot, and she already knew which spot was the right one. That process took more than eight months of visits.  It meant my sister, my mom and I needed to be on the same team for this big change.

The spot Mom chose -- one of the first on our visit list -- wasn't the fanciest, but it proved to be perfect for Dad.  The first few weeks were rough on everyone, but Dad did settle in and sometimes, out of the blue, he would say, "This is a wonderful place, isn't it?" For him it was actually a better place because he had five safe acres of freedom to roam, rather than being trapped in a multi-storied house that made movement much more dangerous and him more anxious. He calmed down, my mom calmed down, my sister got some breathing space, and I relaxed a bit on those still-frequent weekend visits.

Elder Law attorneys know all about the well-meaning child, and they tend to keep the decks clear on Fridays for the meetings with "out-of-town" children, often with one or both parents in tow.  The experienced attorney knows how to find the balance between "rush" and "enough time," in order to help families make the best decisions for the future.    

September 21, 2017 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Housing | Permalink | Comments (0)