Monday, August 15, 2016
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...
Wednesday, July 6, 2016
In New Jersey, ORANJ is an organization for residents of "continuing care retirement communities" (or CCRCs, also sometimes known as "Life Plan Communities," following a LeadingAge marketing study and plan announced in November 2015). Founded in May 1991, members recently celebrated their 25th anniversary. In a summer 2016 newsletter, called, appropriately ORANJ Tree, residents from three communities reported on major changes in ownership of their facilities, and how such changes can affect community moral and future prospects. The CCRCs discussed were:
- 2016: Cadbury at Cherry Hill (reporting a new ownership is part of a conversion from nonprofit status to for-profit)
- 2016: Franciscan Oaks
- 2013: Fountains at Cedar Parke
In my observation, these New Jersey transactions, especially a conversion from nonprofit to for-profit, are part of a larger, national picture of communities struggling for identity in a competitive senior living market.
Tuesday, July 5, 2016
Special and Supplemental Needs Trust To Be Highlighted At July 21-22 Elder Law Institute in Pennsylvania
In Pennsylvania each summer, one of the "must attend" events for elder law attorneys is the annual 2-day Elder Law Institute sponsored by the Pennsylvania Bar Institute. This year the program, in its 19th year, will take place on July 21-22. It's as much a brainstorming and strategic-thinking opportunity as it is a continuing legal education event. Every year a guest speaker highlights a "hot topic," and this year that speaker is Howard Krooks, CELA, CAP from Boca Raton, Florida. He will offer four sessions exploring Special Needs Trusts (SNTs), including an overview, drafting tips, funding rules and administration, including distributions and terminations.
Two of the most popular parts of the Institute occur at the beginning and the end, with Elder Law gurus Mariel Hazen and Rob Clofine kicking it off with their "Year in Review," covering the latest in cases, rule changes and pending developments on both a federal and state level. The solid informational bookend that closes the Institute is a candid Q & A session with officials from the Department of Human Services on how they look at legal issues affected by state Medicaid rules -- and this year that session is aptly titled "Dancing with the DHS Stars."
I admit I have missed this program -- but only twice -- and last year I felt the absence keenly, as I never quite felt "caught up" on the latest issues. So I'll be there, taking notes and even hosting a couple of sessions myself, one on the latest trends in senior housing including CCRCs, and a fun one with Dennis Pappas (and star "actor" Stan Vasiliadis) on ethics questions.
Here is a link to pricing and registration information. Just two weeks away!
July 5, 2016 in Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Legal Practice/Practice Management, Medicaid, Medicare, Programs/CLEs, Property Management, Social Security, State Cases, State Statutes/Regulations, Veterans | Permalink | Comments (0)
Friday, July 1, 2016
The success of Airbnb and other types of vacation home sharing services seems to be particularly useful to a certain segment of the population (here's a hint-this is the elder law prof blog). The New York Times ran an article about elders renting rooms in their homes through these vacation home sharing services. Renting Rooms to Travelers Can Be a Source of Income Later in Life explains how this has become a source of income for some elders. In fact, "Airbnb, in a 2015 study, identified people over 60 as the fastest-growing cohort of its hosts, increasing by 102 percent that year, compared to its overall growth rate in the United States of 85 percent. Worldwide, the company estimates that about 260,000 of its roughly two million listings are offered by hosts 60 and older. Of those, 64 percent are women. (The company doesn’t track marital status.)" The article mentions the various businesses that offer this service and gives a sense of how they work.
Of course, there are pros and cons to opening up one's home to strangers, as the article notes, as well as some upfront costs to prepare one's home for "guests." For some, according to the article, renting out rooms provides a nice additional income. Interesting concept.
Wednesday, June 15, 2016
We've blogged on a number of occasions about the "elder tech revolution" and the technology competency of elders. We're not the only ones watching this issue. In fact, the President's Council of Advisors on Science and Technology issued a report to the President in March of this year. Report to the President Independence, Technology and Connection in Older Age is a detailed look at various issues and technologies. The executive summary sets the stage
The U.S. population is getting older, and Americans are living longer, on average, than they ever have before. As they age, people are healthier and more active than the generations before them and have fewer functional limitations such as difficulty walking or blindness. Studies show that people are happier on average as they advance into their later decades and enjoy high levels of accumulated knowledge and experience.
Getting older is a time of social, emotional, mental, and physical change. Retirement might change how a person interacts socially every day, affecting a person’s mood and well-being. Cognitive aging—the normal process of cognitive change as a person gets older—can begin, or a permanent change in physical function may arise. Technology offers a path for people who are navigating these changes potentially to prevent or minimize the risks associated with them and to enhance people’s ability to live their lives fully. We, the President’s Council of Advisors on Science and Technology (PCAST), sought to identify technologies and policies that will maximize the independence, productivity, and engagement of Americans in their later years.
The Committee focused on 4 areas of aging: physical and cognitive changes, hearing loss and lack of social interaction. The report contains "cross-cutting recommendations" as well as area-specific recommendations. The cross-cutting recommendations include federal support and coordination, widespread internet access, adoption of monitoring technology, and encouraging research to develop more innovation. There are 12 area-specific recommendations.
The blog post about the report is available here.
Monday, June 13, 2016
A new report from the GAO covers funding of HUD's supportive housing program. Housing for Special Needs: Funding for HUD's Supportive Housing Programs, GAO Report #16-424 was released on May 31, 2016. The GAO findings are:
Until program funding for new development ceased in fiscal year 2012, the Department of Housing and Urban Development (HUD) used a two-phase process to allocate and award capital advances for Section 202 Supportive Housing for the Elderly (Section 202) and Section 811 Supportive Housing for Persons with Disabilities (Section 811). First, HUD headquarters allocated the amount of appropriated funds for capital advances to each of the 18 regional offices using a funding formula, which accounted for regional housing needs and cost characteristics. Funding was further divided among 52 local offices using a set-aside formula and was also split between metropolitan and nonmetropolitan areas for Section 202. In 2010, HUD eliminated the set-aside which had guaranteed a minimum amount of funding for each local field office. The process for making capital advance awards did not change, but HUD was better able fund properties at a higher level. Second, applicants submitted applications to the applicable HUD regional office, and staff from these offices evaluated and scored applications based on various criteria, including capacity to provide housing and ability to secure funding from other sources. Applicants in each regional office were ranked highest to lowest and funded in that order. Any residual funds that were not sufficient to fund the next project in rank order were pooled nationwide and HUD headquarters used a national ranking to fund additional projects.
Most but not all states (including the District of Columbia and Puerto Rico) had applicants that received capital advances for Section 202 and Section 811 in fiscal years 2008 through 2011. GAO found that some states had applicants that received capital advances in each of the years reviewed, while other states did not. In the period reviewed, four states had no applicants that received Section 202 capital advance awards, and eight states had no applicants that received Section 811 capital advance awards. HUD officials cited several reasons applicants from some states may not have received funding during this period, including applications that were submitted may have been ineligible or higher-scoring applications from other states may have been selected instead. The capital advance amounts varied. For Section 202, total capital advance amounts for fiscal years 2008-2011 for states that received at least one award ranged from less than $24 million to more than $75 million. For Section 811, total capital advance amounts for fiscal years 2008-2011 for states that received at least one capital advance award ranged from less than $4 million to more than $15 million.
A pdf of the full report is available here.
Thursday, June 9, 2016
Sometimes we run into stories that really really are sad. This story in the New York Times is sad. Imagine being old and homeless, whether recently homeless or homeless for a long time. Think about the struggles one has in being homeless. Compound those struggles with the challenges faced by someone who has mobility issues or physical problems identified with being older. Old and on the Street: The Graying of America’s Homeless is an in-depth story that ran on May 31, 2016 and notes [t]he emergence of an older homeless population is creating daunting challenges for social service agencies and governments already struggling to fight poverty.
They lean unsteadily on canes and walkers, or roll along the sidewalks of Skid Row here in beat-up wheelchairs, past soiled sleeping bags, swaying tents and piles of garbage. They wander the streets in tattered winter coats, even in the warmth of spring. They worry about the illnesses of age and how they will approach death without the help of children who long ago drifted from their lives.
Homelessness is not just an issue for elders, but it is an issue that is growing since all of us age. "The homeless in America are getting old... There were 306,000 people over 50 living on the streets in 2014, the most recent data available, a 20 percent jump since 2007, according to the Department of Housing and Urban Development. They now make up 31 percent of the nation’s homeless population."
There are the "recently" homeless some of whom lost jobs and others who can't afford a home on fixed-income, and then there are the long-term homeless.
Many older homeless people have been on the streets for almost a generation, analysts say, a legacy of the recessions of the late 1970s and early 1980s, federal housing cutbacks and an epidemic of crack cocaine. They bring with them a complicated history that may include a journey from prison to mental health clinic to rehabilitation center and back to the sidewalks.
The article notes the incidences of homelessness is somewhat geographic and is rising in the larger metropolitan areas. The article features interviews with several elders in California who are homeless.
How do cities respond to the challenges of individuals who are homeless, and especially those elders who are homeless? "The challenges faced ... have forced advocates for the homeless and government agencies to reconsider what kinds of services they need: It is not just a meal, a roof and rehabilitation anymore."
Assign this article to your students and ask them to create a plan for their city to provide services. It should be an interesting class discussion.
Wednesday, June 8, 2016
A recent New York Times article sheds light on a frequent topic I've encountered in my own research on the convergence of elder law, contract law, and nonprofit organizations law: when will a nonprofit nursing home or similar senior living operation be "allowed" to convert or sell-off to a for-profit operation? And what if the "real" plan is to convert to an entirely new type of for-profit operation?
The potential for conversion appears to be the heart of a dispute over two nonprofit nursing homes in Manhattan, where State and City authorities are seeking to prevent their purchase by a for-profit company known as Allure Group. From the New York Times:
Citing misrepresentations and broken promises, the New York State attorney general’s office is seeking to prevent the purchase of two nursing centers by a company that was involved in transactions that put a Manhattan nursing home in the hands of luxury condominium developers....
“Allure made clear and repeated promises to continue the operation of two nursing homes for the benefit of a vulnerable population — promises that proved to be false,” said Matt Mittenthal, a spokesman for the attorney general, referring to Rivington House and a nursing home bought by Allure in the Bedford-Stuyvesant section of Brooklyn, which were closed within a year of a court petition’s being filed. “Until we conclude our investigation, we will object to Allure buying additional nursing homes.”
In New York, any nonprofit seeking to sell its assets must petition a state court for approval; the attorney general reviews all such requests and can object if there are grounds to do so. The court has the final say....
Tuesday, June 7, 2016
We've reported earlier, including here and here, about recent financial and management issues at a Tampa, Florida continuing care retirement community that operates under the name of University Village. The latest event is the May 31, 2016 order of an administrative law judge that would uphold the decision of the Florida Agency for Health Care Administration to revoke the license for operation of a skilled nursing facility at University Village..
Many of the concerns appear to focus on the alleged action (or inaction) of an individual, John Bartle, who is described as holding various titles in the company that controls the CCRC's operations. At one point, the Administrative Law Judge made clear his view on Bartle's testimony:
The letter and the email reveal Mr. Bartle’s view that deadlines established by regulatory authorities performing the duties imposed on them for the protection of the public by the Legislature are not significant. This disregard, if not disdain, for the statutes and rules governing nursing home services and the enforcement of them is patent in the letter and e-mail, Mr. Bartle’s dismissive testimony about the shifting relationships of the various entities, his demeanor when testifying, and his evasive manner of answering questions when testifying. For these reasons, Mr. Bartle’s denial of the March 3 letter and much of his uncorroborated testimony are not accepted as credible.
My thanks to Karen Miller, Esq. for sharing this unusual ruling.
Friday, June 3, 2016
The Pew Research Center reports that for the first time in the modern era, more adult children ages 18 through 34 are living with their parents than living in other arrangements:
Broad demographic shifts in marital status, educational attainment and employment have transformed the way young adults in the U.S. are living, and a new Pew Research Center analysis of census data highlights the implications of these changes for the most basic element of their lives – where they call home. In 2014, for the first time in more than 130 years, adults ages 18 to 34 were slightly more likely to be living in their parents’ home than they were to be living with a spouse or partner in their own household.
It seems likely that this trend has long-range significance for both young adults and aging families.