Monday, April 18, 2016

Arizona State University Announces Preliminary Plans for Affiliated CCRC

Arizona State University is considering plans to develop a Continuing Care Retirement Community (CCRC) near its main campus, working with Pacific Retirement Services (based in Oregon) as a co-developer and operator.  From the announcement:

ASU is working with the ASU Foundation, who has hired Pacific Retirement Services to co-develop and operate the project. Artistic renderings depict a gleaming a 20-story building with 291 independent, assisted, memory care and skilled nursing units....

 

ASU is currently in discussion with Mayo Clinic, Osher Lifelong Learning Institute and ASU’s nursing, health, innovation, nutrition, arts and design and teaching programs as potential partners. Other amenities include casual dining, health club, game room, estate planning, concierge service, classroom and intergenerational childcare programming....

 

ASU is currently conducting a marketing and feasibility study about the facility, which would ground lease approval from the Arizona Board of Regents. If approved, construction could begin in 2018 and begin accepting residents in 2020. 

For more, read Arizona State University to Build CCRC on Campus, from Senior Living publication.  

My thanks to Karen Miller, J.D., who lives in a successful CCRC affiliated with the University of Florida.

Addendum:  After posting the above information about ASU's possible project, I noticed that Arizona State University is a named co-sponsor of what appears to be three-day education and business development forum called the ASU-GSV Summit. Bill Gates is a keynote speaker.  What struck me as interesting is the summit, from April 18-20, is being held in California -- San Diego to be exact -- and not in ASU's home state. As someone who grew up in the Valley of the Sun, I've been watching the increasingly entrepreneurial spirit of ASU for some time, and this is more evidence.

 

April 18, 2016 in Health Care/Long Term Care, Housing, Property Management | Permalink | Comments (0)

Friday, April 15, 2016

Multigenerational Housing-The Hot New Thing!

The New York Times ran a story recently about a new trend in housing for elders---multigenerational homes.  Multigenerational Homes That Fit Just Right are homes that, as the name implies, are designed for multiple generations of a family that live in the same house.  "[A] growing number of families ... are seeking specially designed homes that can accommodate aging parents, grown children and even boomerang children under the same roof. The number of Americans living in multigenerational households — defined, generally, as homes with more than one adult generation — rose to 56.8 million in 2012, or about 18.1 percent of the total population, from 46.6 million, or 15.5 percent of the population in 2007, according to the latest data from Pew Research. By comparison, an estimated 28 million, or 12 percent, lived in such households in 1980."

But how does one accommodate family dynamics when living together under one roof? In fact, the story notes, many of the multigenerational households do live in an "ordinary" home. But, it appears that the building industry has developed an option that is catching on, "responding quickly to this shifting demand by creating homes specifically intended for such families."  For example, one builder's homes "don’t offer just a spare bedroom suite or a “granny hut” that sits separately on the property or a room above a garage. The NextGen designs provide a separate entranceway, bedroom, living space, bathroom, kitchenette, laundry facilities and, in some cases, even separate temperature controls and separate garages with a lockable entrance to the main house. Family members can live under the same roof and not see one another for days if they so choose."

The article explains the drivers for the trend, baby boomers (of course), the 2008 recession, tough job market and higher rents facing millenials, the boomerang children and again, those baby boomers, "[m]any [of whom] are planning ahead in hopes that they can devote more attention to their children and grandchildren — and spend little, if any, time in a nursing home."

Expect to see more of these multigenerational homes over the next years. From a legal perspective, it seems that ground rules, a family contract and a care  would be important to the success of the venture (whose turn is it to cut the grass this week? No loud music after 11 p.m. as a couple of an examples).  What an interesting concept of the market changing to accommodate demand.

April 15, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Property Management, Retirement | Permalink | Comments (1)

Monday, March 28, 2016

Creativity -- Thy Name is Senior Living!

From the New York Times, courtesy of reader and Bethesda, Maryland Elder Law Attorney Morris Klein, comes a demonstration of just how "clued in" the world of senior living has become.  A recent article begins with the background of ShantiNiketan in Florida, and continues with other descriptions of creatively-designed assisted living, nursing facilities and day programs serving ethnic communities around the country, including Chinese-Americans:

 

Indian immigrants who came to the United States in the 1960s and ’70s for educational and work opportunities have begun to downsize and contemplate their postcareer years, said Iggy Ignatius, 60, ShantiNiketan’s chairman. “Many people were thinking they’d go back to India, but pragmatically it’s not possible,” he said. “Our children are here. Our grandchildren are here.”

 

In Florida, from the architecture that reminds Dr. Chandran of Chennai, India, to the vegetarian meals and Bollywood dance classes, “we have created a mini-India, a piece of India,” Mr. Ignatius said. The Chandrans moved into their three-bedroom condominium in 2011, paying $250,000, and now they lead yoga classes in ShantiNiketan’s meditation room.

For more, read the always interesting Paula Span's full article,  A New Spin on Senior Living.

March 28, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing | Permalink | Comments (0)

Thursday, March 24, 2016

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

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

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

 

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

 

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

 

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

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

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

Sunday, March 20, 2016

Florida Authorities Issue Suspension Orders for CCRC in Tampa

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

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

 

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

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

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

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

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

Friday, March 18, 2016

Does California's New "Revocable Transfer on Death (TOD) Deed" Increase Risk of Elder Abuse and Estate Costs?

Colleagues in California recently shared with me information on California's adoption of statutory recognition of "Transfer on Death Deeds" or TODs under AB 139.  The law was signed by the Governor on September 21, 2015 and became effective on January 1, 2016.  The law includes "simple" forms, both for establishing the "revocable" transfer of title, and for any "revocation" of such a deed.  Proponents of the legislation cite simplicity and low cost as advantages of using such deeds. The legislative history for the law explains:

The bill would provide, among other things, that the deed, during the owner’s life, does not affect his or her ownership rights and, specifically, is part of the owner’s estate for the purpose of Medi-Cal eligibility and reimbursement. The bill would void a revocable TOD deed if, at the time of the owner’s death, the property is titled in joint tenancy or as community property with right of survivorship. The bill would establish priorities for creditor claims against the owner and the beneficiary of the deed in connection with the property transferred and limits on the liability of the beneficiary. The bill would establish a process for contesting the transfer of real property by a revocable TOD deed. The bill would make other conforming and technical changes. The bill would require the California Law Revision Commission to study and make recommendations regarding the revocable TOD deed to the Legislature by January 1, 2020.

Critics of the law, including California Advocates for Nursing Home Reform (CANHR), warn that despite the "simple" label, the appropriate use of such transfers in estate planning is anything but simple, and such deeds pose another opportunity for undue influence and manipulation of elders.  

The spring issue of CANHR's Advocate newsletter (available via subscription, following a "donation" to the organization) further comments:

It is important to note that thousands of California citizens who are 55 years of age or older and who have recently signed up for health care under California's Medic-Cal expansion program will now have their estates subject to Medi-Cal recovery when they die. If their homes were transferred before their deaths, transferred to an irrevocable trust or if they transferred the property and retained an irrevocable life estate (another cheap, but effective way to transfer property) there will be no estate claim on the home.  But, because the [new law's] TOD is revocable and the transfer and the transfer of the property under a TOD does not occur until the death of the owner, these TODs are subject to estate recovery, which means that those same low-income elders, who are likely to execute TODs will also be more likely to be on Medi-Cal and thus [inadvertently] subject their estates to recovery.

CANHR is "embarking on a campaign to educate consumers about the impact" of the new California law.

March 18, 2016 in Consumer Information, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Housing, State Statutes/Regulations | Permalink | Comments (0)

Wednesday, March 9, 2016

Consumer Friendly Books on Retirement Communities

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

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

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

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

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

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

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

Wednesday, March 2, 2016

Making a Decision On a CCRC?

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

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

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

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

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

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

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

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

     

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

Tuesday, February 23, 2016

Stakeholders and Policymakers Collaborate on Proposals for Better Approach to Financing Long-Term Care

On February 22, 2016, a diverse collection of individuals, representing a broad array of stakeholders interested in long-term care, released their report and recommendations for major changes.  In the final report of the Long-Term Care Financing Collaborative (LTCFC) they propose:

•Clear private and public roles for long-term care financing

•A new universal catastrophic long-term care insurance program. This would shift today’s welfare-based system to an insurance model.

•Redefining Medicaid LTSS to empower greater autonomy and choice in services and settings.

•Encouraging private long-term care insurance initiatives to lower cost and increase enrollment.

•Increasing retirement savings and improving public education on long-term care costs and needs.

The full report is available here.  

ElderLawGuy Jeff Marshall wrote to supplement this post by providing details of the report, written by Howard Glecknan of the Utban Institute.  Thanks, Jeff!  

Members of the Collaborative included:

Gretchen Alkema, The SCAN Foundation; Robert Blancato, Elder Justice Coalition; Sheila Burke, Harvard Kennedy School; Strategic Advisor, Baker, Donelson, Bearman, Caldwell & Berkowitz; Stuart Butler, The Brookings Institution; Marc Cohen, LifePlans, Inc.; Susan Coronel, America’s Health Insurance Plans (AHIP); John Erickson, Erickson Living; Mike Fogarty, former CEO, Oklahoma Health Care Authority; William Galston, The Brookings Institution; Howard Gleckman, Urban Institute; Lee Goldberg, The Pew Charitable Trusts; Jennie Chin Hansen, immediate past CEO, American Geriatrics Society; Ron Pollack, Families USA; Don Redfoot, Consultant; John Rother, National Coalition on Healthcare; Nelson Sabatini, The Artemis Group; Dennis G. Smith, Dentons US LLP; Ron Soloway, UJA-Federation of New York (retired); Richard Teske (1949-2014), Former U.S. Health and Human Services Official; Benjamin Veghte, National Academy of Social Insurance; Paul Van de Water, Center on Budget & Policy Priorities (CBPP); Audrey Weiner, Jewish Home Lifecare, immediate past Chair, LeadingAge; Jonathan Westin, The Jewish Federations of North America (JFNA); Gail Wilensky, Project HOPE;Caryn Hederman, Project Director, Convergence Center for Policy Resolution; Allen Schmitz, Technical Advisor to the Collaborative, Milliman, Inc.

February 23, 2016 in Current Affairs, Ethical Issues, Health Care/Long Term Care, Housing, Medicaid, Medicare, Property Management, Retirement, Science, Statistics | Permalink | Comments (1)

Wednesday, February 17, 2016

Advocacy, Aging and the NaCCRA Example

May Day Parade in Belfast 14 Pensioners' ManifestoIn 2010, I spent several months of my sabbatical in Northern Ireland.  I soon learned that older people there are highly organized and very visible, working together on issues such as protection from abuse, housing, utility costs, elder care options, access to benefits and more.

They knew that their best chances for success were to band together to tackle problems. They knew that they could not depend on a few to keep the work going, and they consciously brought "younger" seniors into leadership positions to keep the advocacy teams well staffed and to provide continuity of effort.  Plus, they were not shy about presenting a unified national platform of concerns and recommended solutions -- as suggested by that year's "Pensioners' Manifesto," promoted at parades and public gatherings.  The advocacy plan was supported by AgeNI, Age Sector Platform, Changing Ageing Partnership and other "separate" organizations.  

In the US, seniors' concerns often cross jurisdictional boundaries, including state boundaries.  The distances are farther apart in the U.S. than in Northern Ireland, but again there can be power in organizing.  As part of my research, I've been watching several groups across the country using the power of the internet to share information and "gather " in order to advocate for solutions to common problems.  A key to success seems to be advocating from a position of strength in numbers and shared concerns.

One of the U.S. organizations I've watched closely has been the National Continuing Care Residents Association or NaCCRA, a national body that grew out of early advocacy on behalf of residents in life care and continuing care residences in Florida. Residents came to recognize that as much as they appreciate and even love their individual communities, there are often common concerns about matters such as provider accountability for entrance fees and service fees paid by residents, understanding Fair Housing and ADA rules for residents with disabilities, residents' rights during changes of "ownership," resident rights during provider insolvency, reorganizations or bankruptcy, transparency of management decision-making and more. NACCRAlogo   

NaCCRA has both individual members and state chapters, and recently, resident-members in the State of Washington recognized that stronger funding of the national organization through the state chapters is needed to support effective advocacy at every level.  By comparison, the senior housing providers certainly share information (and money) on a national basis -- see e.,g., LeadingAge and American Seniors Housing Association -- especially when addressing their advocacy positions with regulators and government leaders.

It will be interesting to see whether residents in CCRCs and Life Care communities in other states join Washington residents in supporting a strong national team through NaCCRA.  

February 17, 2016 in Health Care/Long Term Care, Housing, Retirement, State Statutes/Regulations | Permalink | Comments (0)

Monday, February 15, 2016

A Walkable Life Matters

My friend, colleague and renaissance guy, Mark Bauer, keeps an eye out for interesting articles for me, including those that focus on a community's livability for elders.  He sent me this great article that looks at how a vibrant, walkable community can increase one's longevity once one reaches 80.  The article, Land use mix and five-year mortality in later life: Results from the Cognitive Function and Ageing Study, appears in volume 36 of Health and Place at pages 54-60 (Mar. 2016). Here's the abstract

This study explores the potential modifying effect of age and mediation effect of co-morbidity on the association between land use mix, a measure of neighbourhood walkability, and five-year mortality among the 2424 individuals participating in the year-10 follow-up of the Cognitive Function and Ageing Study in England. Postcodes of participants were mapped onto Lower-layer Super Output Areas, a small area level geographical unit in the UK, and linked to Generalised Land Use data. Cox regression models were fitted to investigate the association. For the younger older age group (75–79 years), the effect of high land use mix on an elevated risk of mortality was mediated by co-morbidity. For older old age groups (80–84, 85+ years), a higher land use mix was directly associated with a 10% lower risk of five-year mortality. The findings suggest differential impacts of land use mix on the health of the younger and older old.

I thought this quote from the implications/future research section persuasive: "[P]olicy planning should take note of such variation within older populations, and in particular the needs of the middle and oldest old cohorts. This observation is particularly relevant to the recent movement toward age-friendly environments, which have been advocated worldwide to create inclusive and supportive living environments for active ageing... improving the mix of land uses in local areas may be a potential approach to reduce limitations in activity of daily life and support active ageing for these older age groups."

 

A pdf of the article is available here.

February 15, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, International, Retirement, Statistics | Permalink | Comments (0)

Thursday, February 11, 2016

A Dangerous Promise to Loved Ones?

The Washington Post's Tara Bahrampour has a very thoughtful article this month focusing on a common fact pattern.  One family member asks -- or another family promises -- that "a nursing home" will never be utilized for care needs.  While fear may be driving the request, guilt and strong feelings of moral obligations may be driving the promise.  Both sides, however, may need more information to make the best decision:  

For many, the idea of being sent to a facility implies abandonment. Older Americans remember the poorhouse , where the old and infirm were hidden away to die. But many younger people also are repelled by the idea.

 

There’s now a wider spectrum of facilities catering to different levels of need, but even the best ones can feel institutional. Daily life is often rigidly regulated, robbing residents of autonomy, and the familiar faces and spaces of a person’s life are gone....

 

A couple of generations ago, families were more likely to care for their parents at home — but people didn’t live as long. Thanks to modern medicine, even those with devastating illnesses such as Alzheimer’s can live many years past their diagnoses. But caring for them at home becomes increasingly difficult as cognition and self-care skills worsen. Safety, of the patients and of other family members, can also become a factor.

Ultimately, as geriatrician Bill Thomas explains for the article, instead of "red herring" promises that may be impossible to keep, everyone could benefit if there were stronger advocates, including families, demanding more of the nation's long-term care industry:

"The nursing home industry has, ironically, benefited tremendously from the low expectations people have,” Thomas said. “They have successfully persuaded people that you’ve got no other choice — it’s got to be cold and sterile and rigid.”

As some family members explain, they have learned the more important promise is to keep caring, regardless of the better "place" for care.  For the full piece, read "Promise You'll Never Put Me In A Nursing Home."   

Special thanks to George Washington Law Professor Naomi Cahn for sharing this article. 

February 11, 2016 in Consumer Information, Dementia/Alzheimer’s, Health Care/Long Term Care, Housing | Permalink | Comments (0)

Thursday, January 21, 2016

A Closer Look at Goal Setting in Public Health: The Cuban Experience

I spent the first week of 2016 in Cuba with Dickinson Law students -- and it was an energizing experience (even as I fear I will never catch up on my other responsibilities this semester!).  The students' studies in Cuba were wide-ranging, with opportunities to engage with experienced legal professionals while discussing historic principles and modern plans for Cuba, including a close look at laws adopted just in the last two years that will affect economic development, international investment in Cuba, employment, property ownership and taxes.  For a full report on the course coverage and special events (including great photos by the students), see "Experience Beyond the Classroom Proves Invaluable."

Dr. Yoandra Adela Explaining Three Levels of Cuban Health Care SystemFor me, it especially interesting to hear directly about Cuba's health care system, which is highly regarded throughout the world, especially for its success in primary care for pregnant women.  From Dr. Yoandra Adelá (depicted left) we learned core principles that guide Cuba's plans for health care, including a goal of universal coverage, free and equally accessible to all Cubans.

Our professors freely admitted challenges that Cuba faces in trying to meet health care goals in a struggling economy, with international partners important in order for Cuba to maintain access to medicines, technology and even credit needed to improve buildings and make necessary repairs at treatment sites.

Since 1985, Cuba has recognized a medical specialization in "comprehensive care" -- which emphasizes preventative medicine and community-based contacts.  We saw this in action, where doctors from a local polyclinic spend half of their appointment days meeting patients in the office and half of those days seeing patients in their homes.   2L Student Corey Kysor Visits a Polyclinic in HavanaWe learned that for the elderly, many of the problems addressed by Cuban health care professionals mirror what is seen in the U.S., with hypertension and diabetes being significant health care risks; on the other hand, Cuba reports low incidence of infectious disease in their population.

I still need to learn more -- especially as I did not have time to fully explore "elder care," which reportedly includes some 380 hogares de ancianos and casas de abuelos, in addition to primary care offices that specialize in geriatric medicine. To the right is Corey Kysor, one of our law students visiting a Havana area polyclinic, the middle level of three components of health care available to all Cubans.  (And yes, our law school does plan to return to Cuba in the next academic year to offer additional opportunities for comparative legal studies.)

If you would like to read more, from the perspective of a law student who had already experienced foreign legal systems such as China before traveling for her first time to Cuba this January, read Joy Lee's "Inside Cuban Law and Culture: A Law Student's Perspective."  

January 21, 2016 in Current Affairs, Health Care/Long Term Care, Housing, International, Science | Permalink | Comments (0)

Wednesday, January 20, 2016

Teaching an Elder Law Seminar This Semester?

Are you teaching an elder law this semester?  If so, and your students are interested in sample papers to help them think about approach, scope, organization and how to provide support for their thesis statements, I've found this batch of articles helpful, even though they are now almost 10 years "old."  

The nine short articles by law students (including two former students from my own law school) were published in a student journal following a competition sponsored by the National Academy of Elder Law Attorney (NAELA) and are nicely introduced by my Blogging collaborator, Becky Morgan.  They demonstrate an array of topics and writing styles, and thus are useful to discuss in a writing and research class. I'm sorry that the NAELA competition is no longer available to students, as was a very nice way for students to get further mileage from their classroom research on elder law topics, and helped encourage them to revise and polish drafts!

January 20, 2016 in Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Federal Cases, Health Care/Long Term Care, Housing, International, Medicaid, Medicare, Social Security, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Thursday, January 14, 2016

Living Closer to Mom?

How close do you live to your mom? If you are within 20 minutes, then you are a typical American.  The New York Times ran a story on December 23, 2015 that discusses how many miles away adult  kids live from their moms. The Typical American Lives Only 18 Miles From Mom explains that     "[t]he typical adult lives only 18 miles from his or her mother, according to an Upshot analysis of data from a comprehensive survey of older Americans. Over the last few decades, Americans have become less mobile, and most adults – especially those with less education or lower incomes — do not venture far from their hometowns."  The article discusses the importance of physical proximity of families when an elder needs caregiving. "Over all, the median distance Americans live from their mother is 18 miles, and only 20 percent live more than a couple hours’ drive from their parents. (Researchers often study the distance from mothers because they are more likely to be caregivers and to live longer than men.)"

The article discusses the factors that impact the distance the kids live from mom, including education, geographic location, marital status and culture. The article notes that caregiving goes both ways, with elders providing child care for their grandchildren.  The article also covers the challenges of caregiving, and the future needs for caregiving.

January 14, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Other | Permalink | Comments (0)

Monday, December 21, 2015

If Your Clients are Mostly "Older," Are You Practicing Elder Law?

The November/December 2015 issue of the ABA magazine (Volume 32, Issue 2) GPSOLO, the publication for members of the Solo, Small Firm and General Practice division of the American Bar Association, is devoted to Elder Law. The issue can be found on-line (and viewing does not seem to be restricted to division members!).  The articles are also available on Westlaw.

Articles include:

  • How to Make Money Practicing Elder Law, by Andrea G. Van Leesten, who practices in California and who is the 2015-16 Diversity Director for the Division;
  • Representing Elder Physical Abuse Victims,  by California practitioner Mark Redmond, who has "focused primarily on representation of elders in cases of physical and financial abuse for the last 15 years;" 
  • Advocating for Elders Suffering Financial Abuse and Exploitation, by Nicole Le Hudson, who focuses her San Diego practice on disability and elder law and who is a "member of the court-appointed attorney panel for conservatorships;"
  • The State of Age Discrimination Law: An Update, by Brian McCaffrey, who focuses his New York practice on employment litigation;
  • Estate Planning for Old Age and Incapacity, by Sheila-Marie Finkelstein, who practices estate planning in Irvine, California; 
  • Counseling Clients about Health Care Toward the End of Life, by Sally Balch Hurme (who I just discovered while reading her article recently retired from 23 years of consumer advocacy with AARP -- but who is still clearly very active in elder law, thank goodness!); 
  • How to Fund Long-Term Care Without Medicaid, by Eileen Walsh, from Louisville,  and I have to admit I read her article first - she explores Medicare, insurance, VA benefits and reverse mortgage options); and 
  • What Every Lawyer Needs to Know About Planning for Retirement, by Cynthia Sharp who "works with motivated lawyers seeking to generate additional income."   

Charlie Sabatino brings to bear his 30 years of experience and careful thought to the question of whether having older clients automatically means you are practicing "elder law," in his column "GP Mentor: When Does Serving Older Clients Become Elder Law?"  Hint?  The answer may depend on whether you are working in the best interests of the senior.

In addition, there is a great Resource Guide of recent texts on Elder Law  and the Division Chair's essay on recognizing Elder Abuse. PLUS, there's a detailed shoppers's guide to cameras, mobile phones ans more in the 2015 Tech Gift Guide -- for those of you still searching for gift ideas for your favorite elder law attorney!  

December 21, 2015 in Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Health Care/Long Term Care, Housing, Legal Practice/Practice Management, Retirement | Permalink | Comments (0)

Wednesday, December 16, 2015

San Diego Joins Other Major Cities in Offering LGBT Seniors a Lower-Cost Housing Option

As reported in the San Diego Tribune, Housing for Gay Seniors Coming to San Diego

A local nonprofit is preparing to build San Diego’:s first low-income apartment complex geared for senior citizens who are lesbian, gay, bisexual or transgender. When the 76-unit complex opens in North Park, San Diego will join Chicago, Philadelphia, Los Angeles and San Francisco as cities that provide this kind of housing.

 

Such housing is considered crucial because members of the LGBT community often feel unwelcome in ordinary senior complexes, where the older residents tend to be less open to alternative lifestyles.

 

“The people who will live here paved the way for younger LGBT generations, and many of them are forced back into the closet in traditional senior communities because of a lack of acceptance,” said Delores Jacobs, chief executive of the San Diego LGBT Community Center.

 

The $27 million complex will be open to all seniors, but the nonprofit building it — Community HousingWorks — plans to create a welcoming environment for LGBT seniors that will encourage them to move in, including on-site supportive services coordinated by the local LGBT Community Center.

December 16, 2015 in Consumer Information, Current Affairs, Discrimination, Housing | Permalink | Comments (0)

Monday, December 7, 2015

The Costs of Dementia-Part Three

Money Magazine's final article in the series on the costs of dementia focuses on the costs in the final stages of the disease. Coping With the Costs of Dementia: The Final Stage discusses the costs and the options for caring for an individual in the final stage of this disease.

In the final stages of dementia, which typically last four to five years, the need for care intensifies. [One's] spouse eventually will require around-the-clock assistance with most activities of daily living. [One's] toughest decision: whether to try to continue caregiving at home or move [one's] loved one to an assisted-living facility or a nursing home. [One] may feel guilty at the prospect of putting someone [one] love[s] in “a home”—that’s common and understandable—but a setting where professionals are providing the intense level of care needed at this point is often the best path, especially if they’re trained in the needs of dementia patients. That said, it’s also the most expensive care option by far.

The article urges caregivers to take proactive action, suggests caregivers pick a nursing home with a memory care unit, get advice on the order in which to spend assets and start planning for the caregiver's own future.  "Caring for someone with dementia is emotionally exhausting and financially draining, but it comes with one particular satisfaction: knowing that you’ve done whatever you can to make the last years easier for someone you love."

December 7, 2015 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare | Permalink | Comments (1)

News from the International Long Term Care Policy Network (Mark Your Calendars!)

During my recent visit in England, I had the fortunate experience of having lunch with Bernard Casey, Associate Professor at the Personal Social Services Research Unit at the London School of Economics and Principal Research Fellow at the University of Warwick.  He has deep interest and experience as a social economist in evaluation of the economic implications of societal ageing.  We could have talked for hours -- so much so that I almost missed my train from London to Leeds. 

Bernard introduced me to a fascinating network of academics and policy makers with related interests, the International Long Term Care Policy Network. I encourage you to check out their website, and especially to browse the short interviews with international experts who are following long-term care system developments around the world. 

Mark Your Calendars: The ILP Network is hosting its 4th International Conference on Evidence-based Policy in Long-term Care  at the London School of Economics and Political Science (LSE) in London from the 4th to the 7th of September in 2016.  Key themes of the conference will include: care models, case management, economics of long-term care, equity and efficiency, funding systems, health and social care integration, housing, institutional dynamics, local vs. central policy interactions, personalization of the care system, policy implications of dementia, technology and long-term care, unpaid carers, and workforce and migrant workers. More information about registration and submission of abstracts will be available in the near future.

December 7, 2015 in Current Affairs, Health Care/Long Term Care, Housing, International, Programs/CLEs, Science, Statistics | Permalink | Comments (0)

Sunday, December 6, 2015

The Costs of Dementia-Part Two

Money Magazine's second article on the costs of dementia focuses on the middle stage of dementia. Coping With the Costs of Dementia: The Middle Stage discusses a series of steps for the caregivers and family to take, not only for the present, but in positioning themselves for the final stage of the disease.  The article discusses a number of suggestions:

  • greater levels of care, including adult day care and respite care and recommends only hiring caregivers with experience in caring for individuals with dementia;
  • examine the terms of any long term care insurance policy, if the individual has one;
  • if the individual is a veteran, look into VA benefits;
  • examine the individual's and family member's investment portfolio; rearranging allocations to more conservative investments may be needed;
  • investigate a reverse mortgage;
  • caregivers should talk to employers about options; and
  • begin to research nursing homes.

December 6, 2015 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare | Permalink | Comments (0)