Tuesday, September 13, 2016
A recent study was published in Health Affairs, Home-Based Care Program Reduces Disability And Promotes Aging In Place. The abstract explains:
The Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program, funded by the Center for Medicare and Medicaid Innovation, aims to reduce the impact of disability among low-income older adults by addressing individual capacities and the home environment. The program, described in this innovation profile, uses an interprofessional team (an occupational therapist, a registered nurse, and a handyman) to help participants achieve goals they set. For example, it provides assistive devices and makes home repairs and modifications that enable participants to navigate their homes more easily and safely. In the period 2012–15, a demonstration project enrolled 281 adults ages sixty-five and older who were dually eligible for Medicare and Medicaid and who had difficulty performing activities of daily living (ADLs). After completing the five-month program, 75 percent of participants had improved their performance of ADLs. Participants had difficulty with an average of 3.9 out of 8.0 ADLs at baseline, compared to 2.0 after five months. Symptoms of depression and the ability to perform instrumental ADLs such as shopping and managing medications also improved. Health systems are testing CAPABLE on a larger scale. The program has the potential to improve older adults’ ability to age in place.
A subscription is required to access the full article. A Kaiser Health News (KHN) story about the study, Study Finds Benefits When Seniors Call Shots To Help Them explains "A federally funded project that researchers say has potential to promote aging in place began by asking low-income seniors with disabilities how their lives at home could be better ... At the end of the program, 75 percent of participants were able to perform more daily activities than they could before and symptoms of depression also improved, the researchers said in the journal Health Affairs."
According to the KHN article, the study is based on two ideas: "environment influences health" and elders "should set goals to improve their health." So asking the elder what the elder needs, and then providing the right services leads to a good result, it seems. "Instead of dictating health goals to the patients, the therapist’s first two visits were about listening to what the seniors thought their biggest problems were and creating plans on how to tackle them." The positive impact continued after the study ended, according to one of the researchers interviewed for the article, who noted environment plays a big role as a barrier to aging in place.
Sunday, September 11, 2016
Over the weekend, I caught the recently released movie, Hell or High Water. Both "contract law" and "elder law" figure into the plot. Warning: Spoilers ahead -- so don't keep reading if you don't want to know.
The timeless and yet still "modern" plot -- with sons trying to save the family homestead from the bank -- has a few good West Texas twists (although the movie was mostly filmed in my old stomping grounds of New Mexico). I enjoyed the play on words with the title of the movie from a legal perspective. The bank's "reverse mortgage" on the homestead has a payoff clause that bars any excuses for nonpayment, such as Acts of God or other hardships. In legal circles such clauses have are called "come hell or high water" terms, rejecting any "force majeur" excuses for late payments. So the brothers are up against the clock. Can they steal enough from the very bank conglomerate that made the loan in order for them to get the mortgage paid off by the deadline? Good character actors abound, including two waitresses who steal the scenes in small town diners and Jeff Bridges at the other end of a Texas journey he began 45 years ago with The Last Picture Show.
The reverse mortgage is the elder law part of the plot. The movie hints the aging mother was loaned just $25,000 on the homestead (where oil may be found) -- enough to be difficult to pay off (especially with taxes and fees), but not enough money to truly save her from her debts. While the plot stretches the realities of reverse mortgages, in truth such mortgages are typically very high cost loans, and are not easily refinanced.
Thursday, September 1, 2016
Giving more evidence of the potential impact of aging boomers in America, officials in Humboldt County, a North Coast county in California, describe potential shutdowns of three area nursing homes as potentially "catastrophic." The reason for the closures? The problem isn't lack of residents. Operators find it difficult to attract adequate personnel, especially CNAs, needed to staff the care facilities. From the North Coast Journal article describing the latest problem:
Rockport Healthcare Services, the management company for five of Humboldt County's six skilled nursing facilities, announced today that they have filed relocation notices for three sites: Pacific, Seaview, and Eureka Rehabilitation and Wellness Centers. The relocation notices, filed with the California Department of Public Health, are the first step in closing these facilities, which collectively contain 258 beds, and relocating their patients.
Stefan Friedman, spokesperson for Rockport, said in a statement that the company is continuing to work with community partners to "find a solution to [a] severe staffing crisis," but it is possible that after public health approves their relocation notice they will shut down the facilities.
That, said Area 1 Agency on Aging ombudsman Suzi Fregeau, would be "catastrophic."
Although many patients stay only briefly in skilled nursing facilities, receiving rehabilitation after leaving the hospital, the facilities are often the last stop for patients who cannot afford in-home healthcare professionals and need 24-hour care. Their vital role in the continuum of care was felt last year, when the facilities — five of which are owned by the same company, Brius Healthcare — stopped accepting patients. Hospital administrators, hospice workers and families all felt the pinch, and many North Coast residents had to go to facilities far away from Humboldt County. Fregeau said the potential closure will be even worse.
"It means that residents are going to be placed in facilities a minimum of 150 miles away," she said. "People are going to be dying in communities they’ve never lived in."
Sad to think that some of the prettiest areas of California are struggling with attracting and keeping adequate numbers of trained people.
Wednesday, August 31, 2016
As we first reported here almost a year ago, the segment of the senior living community traditionally identified as "Continuing Care Retirement Communities" or CCRCs is working on rebranding. Under the leadership of the trade organization LeadingAge, the preferred name is Life Plan Communities.
ORANJ, the catchy acronym for the very active Organization of Residents Associations of New Jersey, publishes quarterly newsletters and their Fall 2016 issue includes demographic and marketing reasons behind the name change. The issue includes an essay by Brian Lawrence, President and CEO of Fellowship Senior Living on Why and How Life Plan Communities Are Evolving.
Thursday, August 25, 2016
Last week we blogged about those elders who have no kids to be their caregivers. The Washington Post featured an article on the topic of "aging solo". Aging Solo: Okay, I don’t have a child to help me, but I do have a plan, told from the perspective of the author, is an attention-grabber from the beginning
“The trouble is: You think you have time.” That Buddhist-sounding quote from a fortune cookie rattled around the back of my head for decades, seemingly for no reason. Now that I find myself living with my 94-year-old mother in a Florida city where preacher Billy Graham got his start and being a never-wed 60-something has made me a tourist attraction of sorts, I finally understand why I thought the repercussions of growing old without a child or two would not apply to me: I was just plain delusional.
As a New Yorker flush with friends, freelance work, Broadway tickets and great Botox, I had apparently existed in some sort of fun, singles bubble. It was a lifestyle so rewarding that I never read even one article about the stresses of the “sandwich generation.” (Hey, the writers all seemed to be married women with children, so even on a boomer-to-boomer level, I could not relate.)
Of course she's not alone. The article provides statistics--almost 33% of the Boomers have no kids. "That doesn’t count boomer parents who have lost a child or have one who is severely impaired. The Aging Solo pool also includes countless members of families plagued by addiction, disease, cults, rapacious children, even married progeny who much prefer their in-laws. While millions of Aging Soloists have siblings and other kin, many of us can’t imagine (or abide) having them shepherd us to our final rest."
The author calls for an aging plan with friends rather than kids, and using her parents' story as educational, she offers this advice "When you’re past 50 and single, location is 75 percent of the enchilada. Subways matter. Proximity to friends matters. Suburban seniors communities felt to me like slow death. I found senior centers and assisted-living facilities profoundly lonely because, it seems, the art of making friends does not grow as we age, and not everyone likes endless bingo and dominoes on Tuesdays, followed by a prayer service."
She goes on to offer further tips
It’s better to plan a more personal assisted-living future with your own friends while in your 50s or 60s. That will give you time to choose a location with diverse people and culture, with neighborhoods that have sidewalks and public transit....
Sharing resources can spawn all sorts of possibilities. Maybe my posse grabs several apartments in rental, condo or co-op buildings, or we share a group house in D.C., Manhattan or L.A. Heck, maybe we can find a way to lease a floor in one of the many overbuilt office buildings around the country. Perhaps (if yours is an anti-urban posse) you can hire an architect to design space-age yurts in Arizona. Each madly hip structure would be self-contained, but the colony would have a common dining hall, gym and tech-support center, or whatever your future selves desire.
New to the finances of aging, I had no idea how much control I gained by holding my mother’s durable power of attorney. Had I been less ethical, I could have taken her money and run. Therefore, I’ll never give that power to any one person; it will be held by at least three younger and devoted friends because elder fraud is one of the most horrifying aspects of aging solo. Trust me: That charming new friend who offers to manage your money so you don’t have to deal with “all those bills” is probably well known to the local police.
So what is the author doing to prepare for her aging without kids? She explains
What am I doing? Well, I’ve started small, using Skype dialogues with my pals to research and download the legal papers — from wills to end-of-life instructions — that we will need, sooner or later. Now we’re aiming higher. Should we learn what to look for in a nurse’s résumé so we can find the right person to help us in our collective dotage? Should we hire a visionary architect to create a high-tech trailer park or a cluster of tiny homes built around communal buildings? Our ideas are still all over the map.
We hope we have time to execute our most appealing visions. Mostly, however, we pledge to be our own Best Friends. United. Forever....
The Washington Post has a fascinating piece about Wanda Witter's decades-long battle with the Social Security Administration. At the age of 80, Wanda's story appears to be one of success, after many years of living in shelters and on the streets of D.C..
At the shelters all those years, Witter tried to get someone to listen to her. She explained at different offices providing homeless services that those suitcases contained the evidence. She was owed money, lots of money, and she could prove it.
Witter is not a particularly warm or outgoing person. She isn’t rude, just direct. And suspicious of just about everyone. And obsessed with Social Security.
“They kept sending me to mental counselors. I wasn’t crazy. I wasn’t mentally ill,” she said.
With the help of the Washington Legal Clinic for the Homeless, Legal Counsel for the Elderly (LCE) and a dedicated, patient and persistent social worker, Julie Turner, it appears that Ms. Witter is now in her own apartment and will receive some $100,000 in back Social Security payments.
For the full story, read "'I Wasn't Crazy.' A Homeless Woman's Long War to Prove the Feds Owe Her $100,000."
Wednesday, August 17, 2016
Earlier this week, I wrote about a new publication drawing attention to "six" specific areas of need that can helped by a health/law partnership to provide more comprehensive services for the older client or patient. That post inspired one of our regular readers to write about her experiences with an important Consortium effort between the law school at UC Hastings and the medical program at UC San Francisco. Their Medical-Legal Partnership for Seniors Clinic (MLPS Clinic) sounds terrific and, not surprisingly, it attracted the attention of the New York Times from its inception:
Consider the geriatricians working at the Lakeside Senior Medical Center, an outpatient clinic at the University of California, San Francisco. Many of their patients, despite multiple chronic diseases and advanced age, have never filled out power-of-attorney documents or appointed someone to make health care decisions if they are unable to.
Sometimes, the doctors suspect their patients might qualify for public benefits they are not getting, like food stamps or MediCal, the state’s version of Medicaid. Perhaps they face problems with landlords or appear to be victims of financial abuse, or they ought to have a simple will.
In other words, they need lawyers. But trying to get frail, low-income seniors to consult an elder attorney can seem an insurmountable problem. How will they travel to a law office? Or pay a fee that can reach $300 an hour? Even if the doctors can refer them to a legal aid office, will their elderly patients actually make an appointment? Then remember to go?
At Lakeside there is a simpler solution, said Sarah Hooper, who teaches at the University of California Hastings College of the Law. “The physicians do the initial screenings, hear what their patients’ problems are, take the history — and they essentially write a prescription: ‘Go down the hall and see my friends at U.C. Hastings for help with this housing issue,’ ” she said.
Sarah Hooper, Executive Director for the clinic, provided an update, explaining, "We’ve done quite a bit of outreach within MLP and in the healthcare system, but are increasingly realizing that we need to get more elder law attorneys and legal aid advocates energized around this idea." Sarah reports that she'll be attending and presenting at the National Aging and Law Conference in D.C. in October, 2016 and hopes to inspire others to develop similar partnerships.
For more on the UC Hastings-San Francisco MLPS Clinic, read the full New York Times article (first published in 2013) by Paula Spahn, "The Doctor's New Prescription: A Lawyer." For more on the Medical-Legal Partnership concept, visit the website for the National Center for Medical Legal Partnerships.
Tuesday, August 16, 2016
Last weekend, the Arizona Republic newspaper carried a Question and Answer column that caught my eye. The question began:
My grandmother lives in Scottsdale, and my wife and I live in Chicago. We only visit her two or three times a year. Although we thought my grandmother was still able to manage her financial affairs, she recently called us to say that she was being evicted from her Scottsdale home for nonpayment of HOA dues. My grandmother owns her $450,000 hoe free and clear....
HOA dues only totaled $700 originally. After the late charges, interest, and legal fees, however, there was almost $8,000 owed at the foreclosure sale two weeks ago.
How often do crises involving aging loved ones begin with the words "I thought she was doing well living alone until...?" Here the concerned grandson jumped into action and the consumer advisor suggested a range of options, including working with the "investor" to resolve the ownership and equity issues. For more you can read Grandmother Loses Home to HOA Fees on the PressReader service for the Arizona Republic, August 14, 2016.
Monday, August 15, 2016
The introduction explains: "The purpose of this article is to estimate the prevalence and identify risk factors of engaging in resident aggression and abuse in assisted living facilities. Measuring the prevalence of resident aggression and abuse in assisted living facilities is needed to better understand the scope of the problem. Identifying strategies to mitigate and prevent resident aggression and abuse can help to improve social well-being and progress toward achieving public health objectives." The authors conclude that
Prior studies have found evidence of resident abuse in nursing homes (Pillemer et al., 2011; Pillemer & Finkelhor, 1988; Pillemer & Moore, 1989). Our findings build on this knowledge base with nationally representative estimates of resident aggression and abuse in assisted living settings. In conclusion, this study provides evidence of the prevalence of resident aggression and abuse in assisted living facilities. Given the rising prevalence of dementia and aging population in the United States, resident aggression and abuse is a growing problem that warrants more attention from policy makers, researchers, and long-term care providers. Furthermore, dementia and SMI were significant risk factors for physical, verbal, and sexual abuse in residential care settings. Future research is needed to develop better methods for identifying residents at greater risk of engaging in abuse as well as supporting ongoing training and prevention efforts to mitigate this risk.
In July, I drove some 2500 miles, from Pennsylvania to Arizona, to begin an exciting sabbatical opportunity. I enjoy this drive (especially since I tend to do it fairly rarely, perhaps once every seven years). I frequently visit friends along the way, and this summer I was struck by how many friends had saved up tough elder law stories for me.
A theme emerged from their stories. They would tell me, "I have an aging friend (or sometimes a family member or neighbor) who is in serious danger of physical or financial harm, but refuses to cooperate with reasonable plans to solve the problems. What are my options to help this person I care about?"
In one instance, it seemed clear the at-risk individual was affected by some level of cognitive impairment. But how to know for sure? Was the refusal to cooperate with a "better plan" the product of a sound, if somewhat eccentric mind? A neurocognitive assessment seemed warranted. We tried to arrange one. But the earliest appointment available was more than 60 days away and the potential for harm was immediate.
Thus, it was with great interest I read a preview of an article in the upcoming issue of the ABA publication, Bifocal. Professors Marshall Kapp, Shenifa Taite and Gregory Turner outline "Six Situations in Which Elder Law Attorneys and Physicians Caring for Older Patients Need Each Other." They are writing about a critical need for Medical-Legal Partnerships designed specifically to assist older persons and their family members. For example, on the topic of "self-neglect," the authors explain:
Mistreatment of older persons by others is a serious problem. Both the medical and legal conundrums became more complicated, and thus even more amenable to interprofessional collaboration, when self-neglect is entailed. A significant percentage of older adults, mainly living alone, do not regularly attend to their own needs or well-being regarding health care, hygiene, nutrition, and other matters. The majority of cases reported to APS agencies by health and social service professionals and family members are triggered by suspected self-neglect. The health care system expends considerable efforts trying to intervene in these situations to prevent increased rates of hospitalization, nursing home placement, and even death.
In situations involving suspected elder self-neglect, the physician’s role is vital in recognizing the potential problem, characterizing the nature and seriousness of the risk posed, and trying to identify clinically and socially viable intervention strategies. Among other concerns, decisional capacity issues almost always arise in these cases. The physician may look to an attorney for advice about legal reporting requirements or options, as well as the legal boundaries within which interventions may be designed and implemented in a manner that best respects the older person’s dignity and autonomy while protecting the vulnerable at-risk individual from undue foreseeable, preventable self-generated harm.
A growing number of law schools (including Penn State's Dickinson Law) have established Medical-Legal Partnership Clinics, where the collaborative relationship between attorneys and physicians is established in advance of need by clients. Often such clinics focus on younger clients, especially children. Elder-specific services are an important subset of the services that can be provided in a timely and professional setting. For more, read the full Bifocal article published in the-August 2016 issue -- and ask whether such services are available in your community.
August 15, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Housing, Legal Practice/Practice Management | Permalink | Comments (0)
Sunday, August 14, 2016
I was reading a recent report from Pew Research Center's FactTank about the rise in multigenerational households. The data might surprise you. A record 60.6 million Americans live in multigenerational households notes that almost 20% of folks in the U.S. live in a multigenerational household ("defined as a household that includes two or more adult generations, or one that includes grandparents and grandchildren....") The article reminds us of the downturn in multigenerational households back in the 1950s through the 1980s, but these households have been on the rebound since then. The increase is across the spectrum of ages, ethnicity, etc. As far as elders, "more than a fifth live with multiple generations under one roof, including Americans ages 55 to 64 (23% in 2014) and 65 and older (21%). The rise in multigenerational living among these older Americans is one reason why fewer now live alone than did in 1990." Not unsurprisingly, the most typical household is parents and adult children. However, grandparent-parent-adult children households are growing as well. "Three-generation households – for example, grandparents, parents and grandchildren – housed 26.9 million people in 2014."
Thursday, August 11, 2016
Bear with me-this is going to take a bit for me to connect the dots to my point. We have posted on several occasions about the need for caregivers as the Boomers continue their aging trek. We've also blogged about the shortage of caregivers and the impact caregiving has on family members. With me so far? So, it would seem logical that we want to make it as easy as possible for caregivers to provide care. In many instances for the family caregivers do this, the family lives together, whether the parent moves in with the adult kids or vice versa. In other instances, the home may be remodeled to make it appropriate for multi-generational families. In others, the caregivers add to their property with an auxiliary dwelling unit or ADU (popularly known as a granny flat), a medical-cottage, or even converts their garage into a "mother-in-law" apartment.
Still with me? So, when remodeling, we may need a permit. When we are adding a building, renovating or bringing in an ADU or med-cottage, we may run afoul of zoning ordinances, when zoning is for single families. Hopefully local governments, understanding the need for caregiving, would be willing to grant variances for this, although there are cases where the contrary has occurred.
So this is all a lead up to a recent story in the Washington Post. The Next big Fight Over Housing Could Happen, Literally, In Your Back Yard opens with the story of a couple who had built their home in their daughter's back yard. Here's what happened:
They were just finishing the place when a lawsuit earlier this year against the city of Los Angeles brought permits for homes like theirs — second units on single-family lots — to a halt. As a result, city officials who gave them permission to build now haven’t given them a certificate of occupancy, and the utility won’t connect them to the power grid.
Second homes, often called “granny flats,” have become a new front in the conflict that pits the need for more housing in the country’s most expensive cities against the wishes of neighbors who want to preserve their communities. The same battles flare over large developments that might loom over single-family neighborhoods. But even this modest idea for new housing — let homeowners build it in their own back yards — has run into not-in-my-back-yard resistance.
And the difficulty of implementing even such a small-scale solution shows why it will be hard to make room in crowded cities for the middle- and working-class households who increasingly struggle to afford to live there.
Not only do these "second homes" help caregivers live in proximity to the elder, these second homes could also alleviate housing shortages according to the article. So what's the objection? "Many neighbors, though, protest that a glut of back yard building would spoil the character of neighborhoods designed around the American ideal of one family on one lot surrounded by verdant lawn. They fear that more residents will mean less parking. And they question whether small homes, particularly in wealthier neighborhoods with the most room to build them, would really constitute affordable housing."
Do these concerns really apply if the purpose is to provide caregiving to a family member? I realize that it's difficult to separate out second housing units designed as rental income from second houses designed for caregiving. The article notes that several cities are considering revisions to their zoning ordinances, primarily to address the need for more affordable housing. But let's not forget about the caregivers and their parents. Let's make it as convenient as possible for them to provide care, even if it is just to allow the temporary installation of ADUs or medical cottages.
Friday, August 5, 2016
Earlier in the week, I shared the feature news story on "avoidable deaths" in Pennsylvania long-term care, often shown to be linked to inadequate staffing (whether in numbers or training, or both). The article began with a fall of a man while apparently unattended, and also identified residents "choking" on food as another documented risk associated with staffing and supervision.
But other senior care communities in the country may have their own unique complications. South Carolina has reported its first apparent "alligator attack," sadly connected to the death of a 90-year-old woman, who was earlier reported missing from her assisted living community. For more, read the Post-Courier report from July 29, 2016.
Thursday, August 4, 2016
Legg Mason released a 142 page document on elder housing, Aging & Its Financial Implications: Planning for Housing. The report was created "in collaboration with The Center for Innovative Care in Aging at the Johns Hopkins University School of Nursing, to bring [the reader] perspective, research and practical insights to assist [the reader] with the challenges of aging. The document includes a discussion guide for determining one's housing needs, information about different types of housing, case studies, a check list, charts, graphs and data, resources and more. Why is thinking about housing important? Because, according to the report, "America is aging and everyone is affected by longer life expectancy. As advanced age approaches, people often need to shift the way they live and/or where they live to accommodate age-related discomforts and reduced capabilities. There are a number of trends that impact decisions related to housing during the years of retirement."
Wednesday, August 3, 2016
AARP's Livable Communities project published a recent article, How to Encourage More 'Lifelong' Housing. The article explains a project that came out of southern Oregon, what is known as "The Lifelong Housing Certification Project." The article explains this project:
A voluntary evaluation program, the Lifelong Housing Certification Project provides a way to assess the "age-friendliness" and accessibility of both newly constructed and existing homes.. the program includes a comprehensive checklist of features and defines levels of certification based on various universal design standards.
The certification is appropriate for all homes — rental apartments, new construction or existing houses — and is intended to help consumers and industry professionals choose the desired level of accessibility in buying, selling or modifying homes. The Lifelong Housing Certification Project helps the marketplace respond to a growing demand for accessible and adaptable homes that promote aging in place safely and independently. At the same time, the certification makes it easier for individuals of all ages to find homes that are suitable for lifelong living and promote the social and economic value of lifelong livability.
The article explains the benefits and value, and the process for homeowners who wish to have their home "certified" (the owner receives a certificate, which can be provided, along with a "checklist to potential buyers. The certification may also be indicated on the local Multiple Listing Service in order to flag the home as being a "lifelong home" and alert potential buyers to ask the home seller or real estate agent for information regarding the home’s certification level.") There are links at the end of the story for those readers who want to learn more.
Pennsylvania attorney Douglas Roeder, who often served as a visiting attorney for my former Elder Protection Clinic, shared with us a detailed Penn Live news article on what the investigative team of writers term "avoidable deaths" in nursing homes and similar care settings. The article begins vividly, with an example from Doylestown in southeastern Pennsylvania:
Claudia Whittaker arrived to find her 92-year-old father still at the bottom of the nursing home's front steps. He was covered by a tarp and surrounded by police tape, but the sight of one of his slim ankles erased any hope it wasn't him. DeWitt Whittaker, a former World War II flight engineer, had dementia and was known to wander. As a result, his care plan required him to be belted into his wheelchair and watched at all times. Early on Sept. 16, 2015, Whittaker somehow got outside the Golden Living home in Doylestown and rolled down the steps to his death.
"It wasn't the steps that killed him. But the inattention of staff and their failure to keep him safe," his daughter said.
The article is especially critical of recent data coming from for-profit nursing homes in Pennsylvania, pointing to inadequate staffing as a key factor:
In general, according to PennLive's analysis, Pennsylvania's lowest-rated nursing homes are for-profit facilities. Half of the state's 371 for-profit homes have a one-star or two-star rating – twice the rate of its 299 non-profit nursing homes. The reason for that discrepancy, experts say, isn't complicated: Studies have found that for-profit nursing homes are more likely to cut corners on staffing to maximize profit.
Spokespeople from both the for-profit and nonprofit segments of the industry are quoted in the article and they push back against the investigators' conclusions.
I have to say from my own family experience that while adequate staffing in care settings is extraordinarily important, older residents, even with advanced dementia, often have very strong opinions about what they prefer. My father is in a no restraint dementia-care setting, with a small cottage ("greenhouse") concept and lots of programming and behavioral interventions employed in order to avoid even the mildest of restraints. It was a deliberate choice by the family and my dad walks a lot around the campus and has his favorite benches in sunny spots.
The trade-off for "no restraints" can be higher risk. Residents, including my father, are sometimes stunningly adept at escape from carefully designed "safety"plans, such as those necessary in the summer heat of Arizona. Family members often remain essential members of the care team. For example, this summer I plan my daily visits at the very hottest part of the day, in order to help try to lure my father, a late-in-life sunshine worshiper, back into the cool. I watch the staff members exhaust themselves intervening with other ambulatory and wheelchair residents who are constantly on the move.
None of this "care stuff" is easy, but certainly the Penn Live article paints a strong picture for why better staffing, better financial resources, and more reality-based plans are necessary. For more, read "Failing the Frail." Our thanks to Doug for sharing this good article.
August 3, 2016 in Cognitive Impairment, Consumer Information, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Housing, Medicaid, Medicare, Property Management | Permalink | Comments (0)
Friday, July 29, 2016
My good friend (and former New York Administrative Law Judge) Karen Miller recently had successful hip replacement surgery and I was happily amused when I realized she wasn't home two hours before she was already corresponding with me about the latest hot topics in "aging." Karen is a great example of an "active mind!"
Her latest communications focused on a topic I'd also been discussing recently with Stephen Maag, Esq., Director of Residential Communities for LeadingAge. Steve had mentioned that one of the challenges facing senior living across the board was attracting an appropriately trained and stable work force.
Karen pointed out to me that her CCRC (or, to use the latest label, Life Plan Community) in Florida was looking into partnering with a local high school and community college to provide financial support to students as well as site-based training in senior living. For example, Certified Nursing Assistants or CNAs may often think of hospitals or "nursing homes" as primary employers, but Karen pointed out that active senior living communities may offer far more attractive opportunities for employment, while still needing workers, such as CNAs, with specialized skills .
Karen pointed me to an article about a similar collaborative program in Maryland already under operation:
Thanks to a partnership with Ingleside at King Farm, a not-for-profit continuing care retirement community (CCRC) in Rockville, Maryland, students get first-hand experience in senior living and caregiving while residents enjoy participating in their education. And the partnership proves mutually beneficial, providing the CCRC access to a well-trained labor supply.
“Having a program like this exposes the younger generation to the health care field,” Adaeze Ikeotuonye, Ingleside at King Farm’s health care administrator, tells SHN. “Not many people in high school are necessarily thinking of working in the senior living industry, but bringing them in at such a young age and letting them see what the career possibilities are—that mixes up the dynamics.”
For more about creative partnerships to deal with caregiver shortages, read Senior Housing News' "CCRC Helps Forge High School-to-Senior Living Career Path."
Thanks to Karen for this link and best wishes for continued rapid recovery.
Tuesday, July 26, 2016
My friend and colleague, Professor Mark Bauer sent me this recent article (thank you!) Can car-centric suburbs adjust to aging Baby Boomers? We want to age in place, but neither or houses, or their locations, are always designed for us to do that.
In fact, the American suburbs, built for returning GIs and their burgeoning families, are already aging. In 1950, only 7.4 percent of suburban residents were 65 and older. By 2014, it was 14.5 percent. It will rise dramatically in the coming decades, with the graying of 75.4 million baby boomers mostly living in suburbia.
But car-centric suburban neighborhoods with multilevel homes and scarce sidewalks are a poor match for people who can’t climb stairs or drive a car.
“Most [boomers] are in a state of denial about what really is possible and what’s reasonable for them as they age,” said John Feather, a gerontologist and the CEO of Grantmakers in Aging, a national association of foundations for seniors.
Staying put is not without costs, and not just for retrofitting the house to make it accessible. Instead, the article notes, "[r]etirees who want to stay in the suburbs will have to cover the rising costs of property taxes and utilities, and they may have to shell out big sums to retrofit their homes if they become frail or disabled. One study found that it can cost $800 to $1,200 to widen a doorway to accommodate a wheelchair, $1,600 to $3,200 for a ramp, and up to $12,000 for a stair lift. Major remodeling, such as adding first-floor bedrooms or bathrooms, can cost much more."
Then of course, there is the issue of transportation. Out in the suburbs, we may not be able to walk to the stores and services we need, and some of us may no longer be able to drive. Transportation is critical and we all know about Americans' love of automobiles. So, what's the answer?
Even if a suburb has a regional transit system, the routes are often limited and geared to help commuters get to and from work in the city. The nearest bus or train stop may be miles from the subdivisions where aging boomers live. And while the Americans with Disabilities Act requires most public transit systems to provide pickup “paratransit” for people with disabilities who are unable to use regular bus or train services, that applies only to people who meet certain criteria.
One alternative is transportation services overseen by a federally funded network of local agencies that offer services and support to older adults to help them age at home and in the community. In many regions, these Area Agencies on Aging contract with local providers that offer door-to-door van services to older adults who qualify. But those programs, often geared to taking seniors to medical appointments and grocery stores, usually offer little flexibility and require clients to make reservations.
The article examines whether such an option will work for Boomers and what local governments need to do to prepare for this demographic change in suburbia. Of course, some elders choose to move to communities that provide the services and amenities they want and the article discusses these briefly.
But what about transportation? Doesn't that remain the elephant in the room? So, off on a tangent...I read another article this morning about Uber selling passes in NY for ride-sharing. Lyft is partnering with GM so drivers can rent cars. Are we going to see ride-sharing services as an option (or solution) for elders who have had to give up driving? But will this only be an option for those elders who can afford ride-sharing services? I'm still hopeful about self-driving cars....
Monday, July 25, 2016
Last week, Lancaster Pennsylvania was host to the 19th Annual Elder Law Institute, co-sponsored by the Pennsylvania Bar Institute and the Pennsylvania Bar Association's Elder Law Section. As the image of the two, fat volumes of course materials demonstrates, there was a lot of content for participants to digest. More than 400 professionals attended,not counting walk-ins. (And yes, the course materials will be available for purchase eventually, from the PBI catalog here.)
I had the privilege of welcoming two new speakers to the Pennsylvania conference, Stephen J. Maag, J.D., Director of Residential Communities for LeadingAge and Brad C. Breeding, President of My LifeSite. Both speakers addressed options available for senior living, and focused on trends affecting Continuing Care Retirement Communities (CCRCs), now also known as Life Plan Communities.
Steve noted that with close to 2,000 communities across the nation identifying under the CCRC or Life Plan label, a majority are "still" nonprofit, especially in so-called "Type A" operations, but that there is clearly a trend in the direction of change to "for profit" ownership or management. Communities are coping with what he termed "unprecedented" change on many fronts, including changing consumer demographics, the impact of health care reform, and use of technology that can affect or delay timing of decisions to move into a Life Plan Community.
Brad outlined the development of his company as a site for comparative information for consumers considering CCRC or Life Plan communities. The company has a data bank with detailed, comparative information on over 400 communities, offering consumers a fee-paid option of getting side-by-side statistics on contract options, pricing, services available and more. But he also said that collecting the information is not easy, as some state regulators, including Pennsylvania, do not "share" information in a transparent way. Remember Medicare.gov's Nursing Home Compare? Brad's company is working to provide consumers with comparative information beyond that narrow focus on skilled nursing care. One of the hot topics Brad identified is the extent to which consumers can use "long-term care insurance" in the CCRC setting, and we all discussed whether such insurance should be paying a pro-rata share of entrance fees, especially in Type A life-care contracts.
My special thanks to Steve and Brad for traveling from D.C. and North Carolina, respectively, to share their knowledge and predictions.
Sunday, July 17, 2016
Do alarms lead nurses in SNFs to interact less with residents? Do the alarms help prevent falls? According to a New York Times article from July 2, 2016, there is a movement away from "things" to help with falls and toward an emphasis on human care. Nursing Homes Phasing Out Alarms to Reduce Falls explains there is "a nationwide movement to phase out personal alarms and other long-used fall prevention measures in favor of more proactive, attentive care. Without alarms, nurses have to better learn residents' routines and accommodate their needs before they try to stand up and do it themselves." Over time prevention moved from restraints to alarms, floor mats, etc. and now prevention is moving from those to personal attention. This change is based on " a growing body of evidence indicates alarms and other measures, such as fall mats and lowered beds, do little to prevent falls and can instead contribute to falls by startling residents, creating an uneven floor surface and instilling complacency in staff."
According to the article there are those who are still using alarms and it will take some time for the change to be more widespread. As one expert noted in the article, using an alarm doesn't prevent a fall. "Going alarm-free isn't yet possible for every nursing home, but it's generally becoming a best practice as nursing facilities work to create the most home-like setting for people who live there, according to John Sauer, executive director of LeadingAge Wisconsin, a network of nonprofit long-term care organizations." As one expert noted in the article, using an alarm doesn't prevent a fall.
It seems that more personal care will be a great thing-but will the facilities have enough staff to help residents? We'll have to wait and see...