Tuesday, January 16, 2018

Choice and Customer Service in Senior Living

My sister and I have been interviewing locations for several weeks as possible residential settings for our mother, especially as she is no longer able to handle the stairs in her two-story home, but feels trapped by not being able to choose on her own where to walk.  We know that the best way to approach this task is in small doses, and to do it before there is an emergency that limits choices.  This is actually our second go-round, as we also did this with Mom when we were looking at a place for Dad almost 5  years ago.  But we have been very struck by the changes in the marketplace in just that short period of time:

  1. There are many new options, both large and small, that have come into being in just the last five or fewer years.  We have looked at "classic" versions of continuing care communities, as well as what I would call "ala carte" pricing options for communities that offer a wide range of care alternatives, but each for a separate, escalating price and with no assurances of a placement. We've looked at both modest settings and high end "assisted living centers" that are so new the paint has not quite dried. But most of all, what we have found ourselves focusing on are smaller group homes, licensed under that state's law for "assisted living," and under that law the care includes almost all necessary care, other than certain so-called skilled services (such as catheters, feeding tubes, or I.V. hydration).  We liked the small group setting because they often were in a neighborhood that would make our mother feel at home, while still offering a purposeful renovation that included carefully designed toilets, showers and flooring for easier movement.  The price range is stunningly broad between these options, too.
  2. Doctors are not always the best advisors on choices.  We have found that even though our mother has a wonderful primary care doctor, and even though that doctor makes it known that most of his patients are older, he did not seem to be aware that there are group home options.  He kept telling us we'd need a "skilled care nursing home."  But, as Mom has a pretty detailed end-of-live directive that rejects feeding tubes, and similar skilled care interventions, it seems clear to us that we can look at a well-run facility licensed for assisted living that will be able to provide appropriate care through her last days.  
  3. A lot of the smaller places are accessed through what I would call "brokers."  When you do internet research, the odds are that your first contacts will be with some kind of "finder."  Most of these are paid by the facilities, rather than the families conducting the searches.  As such, there is the clear potential for them to steer families to "their" facility clients.  I know from insiders in the industry that the fees are often the equivalent of one month's fee at the chosen location.  While not necessarily a negative, as a good broker is only successful if he or she really knows the available inventory of residential options, the fees are something that can dramatically impact smaller group homes that are operating on a narrower margin.

Additional trends we noticed? We discovered that a small group home that appears to be a  "family" operation,  may actually be part of a chain of homes with a single corporate owner.  On the other hand, at several of the places we visited, we learned the owner had recently purchased another house in the same neighborhood, and was in the process of a second renovation.  Also, as for staffing, we noticed that in certain parts of the city, all of the caregivers were immigrants from the same country, whether Poland or Pakistan or elsewhere.  Another reminder that realistic immigration policies are a key component to senior living. 

Finally, probably our strongest reaction was to differences in what can only be called old fashioned "customer service."  One "famous," established  CCRC completely lost our interest when the person at the front desk never made direct eye contact with us, instead keeping one hand on a cell phone and the other hand on a very dirty "wet wipe" she said she was using to clean surfaces because it was "flu season." It didn't help that we went through three different people to find one who could give us a tour during a scheduled visit (the first two were so new they didn't have knowledge of the full campus.) At the smaller group homes, we definitely noticed when the persons we met with greeted current residents by name as they gave us a tour.  Also, did they know the names of their own staff members  -- and did they introduce us to each other?  When a trip hazard was lying in wait on the floor, did they pick it up -- or merely avoid it?  

In addition to asking about staffing ratios and open visiting hours, we wanted to know about how long each of the staff members we met had worked at the particular place.   Finally, our whole family likes dogs and therefore it was a plus when we found a place that had a "house dog" that the residents clearly loved, but we recognize that not every place can handle the extra work it takes to maintain a pet on site.  

A sad irony is that it is unlikely our mother will live in the same care setting that was so perfect for our father.  That place is an assisted living center with four cottages, purpose built for Alzheimer's care, on a five acre setting.  But it has become clear to us that even though Mom was the one who chose it for Dad, and it is a wonderful place, with people we still love, our mother probably doesn't want it for herself.  In the last few months of our father's residence there before his death, she visited less and less often, and we came to realize she had "already" rejected it for herself.  It wasn't about memories of Dad; rather, it was about what it meant to "also" have the same cognitive impairment.  The director, who has become a good friend of mine, said that is not unusual -- that even successful residential settings are rarely chosen by families for second or third placements because the next loved one can be hypersensitive to the reality of that choice.  Senior care living -- a tough business in which to generate repeat business. 

January 16, 2018 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care, Housing, State Statutes/Regulations | Permalink | Comments (0)

Thursday, December 14, 2017

"Nursing Home Compare" Subject to Errors through Self-Reporting "Inflation"

In a new article published by Xu Han (Florida Atlantic), Niam Yaraghi (University of Connecticut) and Ram Gopal (University of Connecticut), their analysis of data used over a 4 year period for nursing home ratings  in CMS' "Nursing Home Compare" system reveals key concerns.  From the abstract:

We argue that the rating system is prone to inflation in self-reported measures, which leads to biased and misleading ratings. We use the CMS rating data over 2009–2013 and the corresponding financial data reported by Office of Statewide Health Planning and Development and patients’ complaints data reported by California Department of Public Health for 1219 nursing homes in California to empirically examine the key factors affecting the star rating of a nursing home.

 

We find a significant association between the changes in a nursing home's star rating and its profits, which points to a financial incentive for nursing homes to improve the ratings. We then demonstrate that this association does not always lead to legitimate efforts to improve service quality, but instead can induce inflation in self-reporting in the rating procedure. A prediction model is then developed to evaluate the extensiveness of inflation among the suspect population based on which 6% to 8.5% of the nursing homes are identified as likely inflators. We also summarize the key characteristics of likely inflators, which can be useful for future audit.

For more, see the full article, Winning at All Costs: Analysis of Inflation in Nursing Homes' Rating System, published November 20, 2017 in the journal Production and Operations Management.

December 14, 2017 in Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicare, Statistics | Permalink | Comments (0)

Wednesday, December 13, 2017

When "Emergencies" Last for Months -- and the Impact on Seniors

Over the last several weeks, I've been in an ongoing conversation with a good friend who operates a court-appointed special advocate program and guardianship agency in St. Croix, Virgin Islands.  I've visited her several times over the years, and in fact, was just there in May. We talked then about whether she would evacuate in the event of any predicted hurricane strike on her island.  Her answer was "probably not," in large part because of her commitment to sharing the workload for a community already under stress from lack of jobs and other financial pressures.  

She rode out the two hurricanes that hit her part of the Caribbean in September and while her own home was spared serious damage, she could provide only sporadic reports -- when she had cell phone service and enough battery power -- about the aftermath for her clients.  When she mentioned the trauma caused by the "simple" fact that having no way to escape heat and humidity, especially at night, was one of the most exhausting parts of the post-storm struggle for all ages, I searched my local stories for battery operated fans to send (and then we had the challenge of finding a way to get them to her island).  

The reality for seniors living day-after-day, week-after-week, and now several months in a row without a reliable source of power is part of the picture painted in a recent article in The New York Times.  

With large areas of Puerto Rico still in the dark three months after the first of the storms — according to government reports, only 60.4 percent of the pre-storm power grid load has been restored — older residents and those with chronic medical conditions are suffering in even more ways than their neighbors. Many nursing homes have no power. The failure to re-establish functioning telephone networks and transportation systems in many areas makes it difficult to get regular medical care. Fire safety systems are inoperable, posing special dangers for those who cannot easily escape.

 

A look inside the 356 units that make up Puerto Rico’s largest housing project for low-income seniors, Comunidad del Retiro, or Retirement Community, helps explain the hurricanes’ continuing impact on the vulnerable. Inside the complex, there is a man with apnea who cannot sleep at night without power to his oxygen machine. A woman with dementia who was scheduled for transfer to a nursing home before the storm. And Ms. Rodriguez de Jesus, who mistakenly drank a poison in the dark and came close to becoming another uncounted hurricane death.
There have been falls in dimly lit apartments. Special diets that could no longer be followed. Medical interventions, drugs and treatments missed or delayed.....

For more, read Lives at Risk Inside a Senior Complex in Puerto Rico With No Power

December 13, 2017 in Current Affairs, Ethical Issues, Health Care/Long Term Care, Housing | Permalink | Comments (0)

Friday, December 8, 2017

As The Oldest Generation Ages in Japan . . .

A haunting story and visual images of growing old alone in Japan, from the New York Times, including this excerpt:

To many residents in Mrs. Ito’s complex, the deaths were the natural and frightening conclusion of Japan’s journey since the 1960s. A single-minded focus on economic growth, followed by painful economic stagnation over the past generation, had frayed families and communities, leaving them trapped in a demographic crucible of increasing age and declining births. The extreme isolation of elderly Japanese is so common that an entire industry has emerged around it, specializing in cleaning out apartments where decomposing remains are found.

For more, see A Lonely Death, by Norimitsu Onishi, published November 30, 2017.

December 8, 2017 in Advance Directives/End-of-Life, Current Affairs, Housing, International | Permalink | Comments (0)

Wednesday, December 6, 2017

California Law, Amended in 2017, Sets Process for Contesting Transfer Decisions in Continuing Care Communities

Following my recent post about "evictions" in Continuing Care and Life Plan Communities, Margaret Griffin, the president of the California Continuing Care Residents Association (CALCRA) provided me with a copy of legislation that was signed into law by the Governor in October this year, amending California law on Continuing Care Retirement Community (CCRC) contracts.  This history is another window on how to handle involuntary transfers of residents.  California's law already provided detailed topics that must be addressed in admission contracts.  The newest provision requires greater sharing of any reasons for an involuntary transfer.  For "disputed" transfers the law now mandates that the provider:

"... shall provide documentation of the resident's medical records, other documents showing the resident's current mental and physical function, the prognosis, and the expected duration of relevant conditions, if applicable. The documentation shall include an explanation of how the criteria [supporting the involuntary transfer decision] are met.  The provider shall make copies of the completed report to share with the resident and the resident's responsible person. "

Further, the amended law provides that even though the CCRC has the right -- under certain conditions -- to transfer the resident, the resident may "dispute" the decision and have the reasons reviewed in a timely manner by the "Continuing Care Contracts Branch of the State Department of Social Services" in California.  That office has statutory authority to determine whether the facility has followed its own contractual basis and process for transfers, and "whether the transfer is appropriate and necessary."  

Ms. Griffin explains that the law "basically . . . requires an assessment be done to establish a functional reason for the transfer (as opposed to merely having the administrator’s whim be sufficient), and it allows the resident to appeal the actual decision (previously we were limited to requesting a review of the process)."

Thank you, Margaret, both for sharing the latest information on CALCRA's successful advocacy with California Assembly Bill 713, and for your additional commentary.  

December 6, 2017 in Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care, Housing, Property Management, Retirement, State Statutes/Regulations | Permalink | Comments (0)

Monday, December 4, 2017

Second Phase of Changes to Nursing Home Regs

Last year CMS released some changes to the Nursing Home regs, some of which went into effect last, year and others that recently went into effect this year in late November. Consumer Voice has released a summary of significant provisions that just went into effect. Federal Requirements of Participation for Nursing Homes: Summary of Key Changes in the Final Rule Issued September 2016 Phase 2, a 9 page document,  highlights both new rules and edited ones. For example, a new rule involves baseline care plans which have to be done within 2 days of admission. One of the modified rules going into effect involves nursing services: requiring not only enough staff, but with needed specific skills and competencies. There's also a new rule regarding nutrition staffing and competencies.

The last phase of implementation doesn't occur until Nov. 28, 2019. For a pdf of the summary of key changes, click here.

December 4, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare | Permalink | Comments (0)

Thursday, November 30, 2017

Questions Arise With Evictions of Residents from Continuing Care (Life Plan) Communities

Recently I wrote about a high profile suit filed by AARP attorneys on behalf of residents at a California skilled care (nursing home) facility to challenge evictions.  

I've also been hearing about more attempts to evict residents from  Continuing Care Communities, also known as CCRCs or Life Plan Communities.   For example, in late 2016 a lawsuit was filed in San Diego County, California alleging a senior's improper eviction from a high-end CCRC.  The woman reportedly paid a $249k entrance fee, plus additional monthly fees for 15 years.  When she reached the age of 93, however, the CCRC allegedly evicted her for reasons unconnected to payment. The resident's diagnosis of dementia was an issue.  Following negotiations, according to counsel for the resident, Kelly Knapp, the case reportedly settled recently on confidential terms.  

Is there a trend?  Are more CCRC evictions happening, and are they more often connected to a resident's diagnosis of dementia and/or the facility's response to an increased need for behavioral supervision?  If the answer is "yes," then there is a tension here, between client expectations and marketing by providers.  Such tension is unlikely to be good news for either side.    

CCRCs are often viewed by residents as offering a guarantee of life-time care. Even if any promises are conditional, families would not usually expect that care-needs associated with aging would be a ground for eviction.  

The resident and family expectations can be influenced by pricing structures that involve substantial up-front fees (often either nonrefundable or only partially refundable), plus monthly fees that may be higher than cost-of-living alone might explain.  Marketing materials -- indeed the whole ambiance of CCRCs -- typically emphasize a "one stop shopping" approach to an ultimate form of senior living.      

In one instance I reviewed recently, the materials used for incoming residents explained the pricing with a point system. The prospective resident was told that in addition to the $100+k entrance fee, an additional daily fee could increase as both "medical and non-medical" needs increased.  A resident who "requires continual and full assistance of others . . . is automatically Level C" and billed at a higher rate. The graded components included factors such a need for assistance with "cognition, mood, or behavior," or "wandering."  All of that indicates dementia care is part of the "continuing" plan.

CCRCs, on the other hand, may turn to their contract language as grounds for an eviction. Contracts may have language that attempts to give the facility sole authority to make decisions about a resident's "level" of care.  Sometimes that authority is tied to decisions about "transfers" from independent living to assisted living or to skilled care units within the same CCRC, as the facility sees care needs increasing.  Even same-community transfer decisions can sometimes be hard for families. Complete evictions can be even harder to accept, especially if it means a married couple will be separated by blocks or even miles, rather than hallways in the same complex.

Continue reading

November 30, 2017 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare, Property Management, State Cases, State Statutes/Regulations | Permalink | Comments (1)

Housing Options-Information for Caregivers

The National Institute on Aging has information for caregivers about various housing options for an elder when the elder can no longer live at home alone.  When It's Time to Leave Home offers information for caregivers, not only about housing options, but about things to consider and questions to ask. For example,

Older adults, or those with serious illness, can choose to:

  • Stay in their own home or move to a smaller one
  • Move to an assisted-living facility
  • Move to a long-term care facility
  • Move in with a family member

Some families find a conference call is a good way to talk together about the pros and cons of each option. The goal of this call is to come up with a plan that works for everyone, especially your parent. If the decision involves a move for your mom or dad, you could, even from a distance, offer to arrange tours of some places for their consideration.

Before deciding on moving the parent into the caregiver-child's home, the website offers these questions for consideration and discussion:

  • Is there space in your home?
  • Is someone around to help the older person during the whole day?
  • What are your parents able to do for themselves?
  • What personal care are you willing and able to provide—moving your parent from a chair to a bed or toilet, changing adult diapers, or using a feeding tube, for example?
  • What kinds of home care services are available in your community?
  • What kind of specialized medical care is available nearby?

November 30, 2017 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing | Permalink | Comments (0)

Wednesday, November 22, 2017

Thanks Giving For Caregivers

One of the many things that I am thankful for is the assistance of kind and patient individuals who have helped my mother and father for more than five years, as age-related issues make my parents' lives more challenging.  On the top of my list is my sister -- who is a constant, loving presence -- and who makes it all possible.  She tolerates my jet-fueled attempts to help on my drop-in visits to Arizona from Pennsylvania.  

Our father was at home with progressing dementia for more than two years before it became necessary to find a dementia-care living center that could provide a safer setting.  For most of that time, we had 24/7 assistance in the home -- and we still have help now for our mother at home.  

But, it just become too hard for Dad at home, especially as the multilevel, 90-year old house was full of traps for his unsteady steps.  Mom participated in the search for a better setting.  When the time came, she made the ultimate decision about where and when.  While the transition was anything but easy, with every passing day we knew more clearly it was the right decision.  


Dad's Bench (2)On good days, Dad would declare to anyone who was passing, "this is a very good place." He was usually sitting on his favorite bench in the center courtyard, holding "court" with everyone who walked by on the five acre campus.  (On a bad day, he might ask rather insistently for a cigarette, something he hadn't done in 50 years!).  

My sister and I came to revel in the holiday parties organized by the caring staff.  We knew the parties would be festive, with great food and often with music and dancing, and that extended families would join together. One holiday, another visiting son who looked about my age, asked my name and it turned out we had attended high school together, not far down the road.  A modern way to hold a "high school reunion," right?My sister joins the dancing

Dad's center was entirely devoted to residents with dementia, with or without additional physical disabilities.  Once a resident was admitted, and as long as they did not need certain types of skilled medical care (such as IVs), the Center could be their home until the last days.  I'm still in touch with members of the staff who helped my Dad, and I think of all of them with fondness and gratefulness.

Each year we celebrated a traditional Thanksgiving meal at Dad's center (usually a few days before the actual holiday) as a big group. On Dad's last Thanksgiving, in 2016, families gathered on the covered porches of each of the four cottages in the community.  It was a typically warm -- but also an atypically rainy -- November day in Phoenix.  November 2016

A key to the success at Dad's center is a setting that facilitates behavioral approaches to dementia care, rather than drugs or restraints.  The 48 residents -- 12 per cottage -- have free run of the secure campus, and in Dad's case he used every inch. His walking grew stronger in the early days after his admission (even with his "bad" knee), while the agitation and anger he had while at home eased significantly.  For the first time in more than a decade, his blood pressure stabilized and we soon realized even his hearing and vision improved.  

Dad was at the center just a week shy of three years, passing at age 91.  Of course, after the initial improvement in strength with his regular walking, his fragility over the years increased slowly, but he was still out and about until his last two weeks.  Two of his former judicial law clerks visited Dad close to Thanksgiving last year.  Such kindness from everyone. 

I commented near the end of Dad's time at the center, while chatting with the Director, that perhaps some of the residents might enjoy having more "reasons" to walk.  I suggested the possibility of a mail box, where residents could collect or deliver cards and letters, both real and "created" especially for the holiday.  

Active Living with DementiaThis is a community that welcomes suggestions -- and doesn't ignore them -- and thus I was pleased but not really surprised to get an email this week from the Director.  Dad passed away some 10 months ago, but the staff nonetheless took action -- installing an old-fashioned mailbox outside each cottage, with decorations to help residents identify their home spot.  I hear deliveries are made regularly -- even on holidays!  I like to think how much Dad would have enjoyed being part of the postal delivery.

My thanks to everyone who is part of a care-giving team.  You mean so much to all of us.  Happy Thanksgiving to all of you and your families! 

November 22, 2017 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Housing | Permalink | Comments (1)

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)