Wednesday, January 20, 2016

Teaching an Elder Law Seminar This Semester?

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

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

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

Thursday, January 14, 2016

Living Closer to Mom?

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

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

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

Monday, December 21, 2015

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

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

Articles include:

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

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

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

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

Wednesday, December 16, 2015

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

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

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

 

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

 

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

 

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

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

Monday, December 7, 2015

The Costs of Dementia-Part Three

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

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

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

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

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

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

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

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

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

Sunday, December 6, 2015

The Costs of Dementia-Part Two

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

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

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

On-Line "Representation" in Real Estate Transactions?

According to one U.K. source, the current Chancellor of the Exchequer, George Osborne, supports "removing barriers for new and emerging companies, in order to create better functioning business ... the lifeblood of a thriving economy."  Apparently part of that proposal is to permit on-line real estate agents.  From The Economic Voice:

Mr Osborne’s intention is for the Government to “further reduce barriers so that it’s easier for alternative business structures, such as supermarkets and estate agents, to offer legal services such as conveyancing.” A consultation next spring will look to remove these existing barriers for alternative business models in legal services, as well as making legal service regulators independent from their representative bodies....

 

However Mr Osborne’s big statement was the Government’s intention to inject innovation into the home buying process. They want to ensure that the modernisation of the estate agency sector through the online space, continues to provide consumers with quicker, better value routes to selling their home. Mr Osborne wants to encourage new business models such as online only estate agents, to enhance price competition in the real estate sector – as he believes they are yet to properly penetrate the property market.

Hat tip to Dickinson Law Professor Laurel Terry for the link.

December 6, 2015 in Consumer Information, Current Affairs, Estates and Trusts, Ethical Issues, Housing, International | Permalink | Comments (0)

Wednesday, December 2, 2015

Nursing Home Quality: Another GAO Report

The GAO has released another report on Nursing Home Quality.  Dated October, 2015, Nursing Home Quality: CMS Should Continue to Improve Data and Oversight is a 52 page report issued by the GAO  that "examines (1) the extent to which reported nursing home quality has changed in recent years and the factors that may have affected any observed changes, and (2) how CMS oversight activities have changed in recent years."

The report notes some issues with the data collected as well as some efforts regarding oversight, and in the conclusion the GAO discusses the issues with the data and also

according to CMS officials, the agency faces the challenge of conducting effective oversight of nursing home quality with its limited resources, while meeting all of its oversight requirements. CMS has made modifications to some activities it considered essential to its oversight, without knowing whether the modifications have affected the agency’s ability to assess nursing home quality. Further, some modifications made by CMS regional offices and state survey agencies to their own nursing home oversight activities could adversely affect the CMS central office’s ability to oversee nursing home quality, while other modifications could be effective strategies that could be adopted more widely among regional offices and state survey agencies....

The GAO makes 3 recommendations: 

  • Establish specific timeframes, including milestones to track progress, for the development and implementation of a standardized survey methodology across all states.
  • Establish and implement a clear plan for ongoing auditing to ensure reliability of data self-reported by nursing homes, including payroll-based staffing
  • The Administrator of CMS should establish a process for monitoring modifications of essential oversight activities made at the CMS central office, CMS regional office, and state survey agency levels to better understand the effects on nursing home quality oversight.

A one page highlights sheet is available here and an accompanying podcast here.

 

 

 

December 2, 2015 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing | Permalink | Comments (0)

Tuesday, December 1, 2015

A More Personalized Residence Option

Smaller residences (not smaller as in a tiny home) provide more homelike care than nursing homes, according to a recent article in the New York Times. Small Residences for the Elderly Provide More Personal, Homelike Care explains the Green House homes where

Each home houses only 10 elderly people, and each person has a bedroom and bathroom. [The resident] has private space, is able to order breakfast when she wants it and enjoys home-style cooking, including some of her favorites..... Residents can gather around a fireplace in the common room, and [the resident] enjoys chatting with aides in the open kitchen.

As the article explains, a smaller size residence like this "is part of a complex of senior housing and care options, and privately owned care homes that are often unmarked in residential neighborhoods. They are usually newer, sometimes cheaper, and generally offer more customized care than most nursing homes."  The article traces the history of the development of Green Houses and notes that they are not yet widely available in all parts of the country.  Quality is important: for a residence to be a Green House, "Green House homes are trademarked and built to strict certifications. Nurturing values and a more active life are encouraged. An aide, called shahbaz — a Persian word that means a royal falcon that oversees the kingdom — functions as a leader, not just a servant."

The article also discusses other housing options that are smaller in scale than nursing homes and compares them to nursing homes.

Click here to read more about Green House projects.

December 1, 2015 in Consumer Information, Health Care/Long Term Care, Housing | Permalink | Comments (1)

Wednesday, November 25, 2015

Giving Thanks for Family Caregivers

With Thanksgiving looming, it seemed appropriate to take a moment to say thanks to all the family caregivers.  And on the subject of caregivers, I wanted to share this 5 Facts about Family Caregivers published by Pew Research Center. 

Here are the five facts:

  • In the US there are 40.4 million unpaid caregivers for those 65 and older.
  • The caregivers are most likely between 45-64 years old. 
  • The most common caregiving kids perform helping around the house, doing errands and fixing things around the house.
  • A major segment of caregiving is providing emotional support. 
  • Most kids find helping their parents rewarding, although a few find it stressful.

This is good information to share with your students as well. So read the full document, thank a caregiver and have a Happy Thanksgiving!

November 25, 2015 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Housing, Retirement | Permalink | Comments (0)

Sunday, November 22, 2015

£2.9Bn Funding Gap for UK Care Homes May Cause Half to Close

As I prepare to speak at a program at the University of Leeds this week on comparative social care systems and legal policies, a headline in The Guardian caught my eye: "Half of UK Care Homes Will Close Unless £2.9bn Funding Gap Is Plugged, Warn Charities."  The Guardian reports:

In a joint letter, 15 social care and older people’s groups urge Osborne to use his spending review on Wednesday to plug a funding gap that they say will hit £2.9bn by 2020. They warn that social care in England, already suffering from cuts imposed under the coalition, will be close to collapse unless money is found to rebuild support for the 883,000 older and disabled people who depend on personal care services in their homes.

 

[Chancellor of the Exchequer] Osborne has already decided to use his overview of public finances to give town halls the power to raise council tax by up to 2% to fund social care, in a move that could raise up to £2bn for the hard-pressed sector. However, the signatories of the letter, such as Age UK and the Alzheimer’s Society, want him to commit more central government funding to social care.

 

The looming £2.9bn gap “can no longer be ignored”, the letter says. “Up to 50% of the care home market will become financially unviable and care homes will start to close their doors,” it adds. “Seventy-four per cent of domiciliary home-care providers who work with local councils have said that they will have to reduce the amount of publicly funded care they provide. If no action is taken, it is estimated that this would affect half of all of the people and their families who rely on these vital services.”

 

Osborne’s endorsement of a hypothecated local tax to boost social care comes after intense lobbying behind the scenes and public warnings from bodies such as the King’s Fund health thinktank.

The authors warn the "NHS will be overwhelmed by frail elderly people" in search of care. I was struck by implications that without funding reallocation, England will face staggering hordes of near zombies.  There is irony in this imagery, of course, because we spend a heck of a lot of real money on best-selling books, movies and top-rated television shows about fictional zombies, while failing to come to terms with the funding needs for real people.  See e.g., this estimate that "Zombies Are Worth Over $5 billion to Economy."

November 22, 2015 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Housing, International | Permalink | Comments (0)

Wednesday, November 18, 2015

SNF rooms to hot for residents

Living in a Sunbelt state, I know how hot it can get in the summer months.  I recently ran across a July 2015 decision from HHS' Departmental Appeals Board (DAB) reviewing the imposition of a "per instance" monetary penalty CMS assessed against an Arizona SNF.

CMS’s allegations in this case are predicated on complaints that portions of Petitioner’s facility – including several residents’ rooms – were uncomfortably hot. Those allegations are supported by the complaints of several residents and by temperature readings taken by a surveyor on July 16, 2014. Readings taken by the surveyor showed portions of some of the residents’ rooms being as hot as 90 degrees Fahrenheit.... Such temperatures plainly exceed what any reasonable person would consider to be "comfortable." On their face they comprise violations of 42 C.F.R. § 483.15(h)(6).

After discussing the ways the surveyor and the SNF measured the temperatures inside the SNF, the ALJ in the opinion notes

The overwhelming evidence is that rooms at Petitioner’s facility were uncomfortably hot due to the failure of the facility’s air conditioning system. Arizona in July is a very hot place. Building interiors in that State that are not adequately air conditioned can become dangerously hot. As Petitioner admits, the air conditioning in its facility had failed to work adequately in July 2014. The failure prompted residents to complain that their rooms had become uncomfortably hot.... The staff took various measures to address the failure of the air conditioning system, including closing curtains in residents’ rooms and conducting random temperature checks....

"The evidence that residents were not comfortable is overwhelming, beginning with these residents’ complaints and further evidenced by the fact that Petitioner’s own staff recognized that there were problems with overheating in the residents’ rooms."  The ALJ upheld the penalty.

 

 

November 18, 2015 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicare | Permalink | Comments (0)

Tuesday, November 10, 2015

New York Court Addresses "Medicaid Transfer" Issue in Context of Continuing Care Community (CCRC)

On November 6, 2015 the appellate division of New York's Supreme Court addressed an issue long brewing in some states, whether Continuing Care Retirement Communities (CCRCs) can insist on "private pay" for skilled nursing care despite a resident's "eligibility" for Medicaid under state and federal laws.  In Good Shepherd Village at Endwell, Inc. v. Yezzi, the unanimous panel affirmed summary judgment in favor of the CCRC on the payment question.

The decision highlights Congressional DRA action in 2005/6 that amended federal Medicaid law to expressly permit CCRCs to offer contracts that require residents to "spend on their care resources declared for the purposes of admission before applying for medical assistance."  The DRA amendment was a response to the industry's lobbying efforts, following a 2004 decision by a Maryland appellate court in Oak Crest Village, Inc. v. Murphy that held such a contractual provision violated the federal Nursing Home Residents' Bill of Rights, viewed as prohibiting nursing homes from conditioning admission on guarantees of private pay.

In the New York case history, the couple apparently signed two separate documents, beginning with a "contract" at the time of their entrance into the CCRC that required them to pay both an entrance fee ($143,850) and "basic monthly fees" of approximately  $2,550 to cover the cost of independent living.  Any need for skilled nursing care would be assessed "an additional charge."  That contract provided that residents could "not transfer assets represented as available" for less than fair market value.  When the wife needed skilled care, the couple signed a second document, referred to in the case as an "admission agreement," for treatment in the CCRC's skilled nursing unit. The "admission agreement" reportedly required the Yezzis to "pay for, or arrange to have paid for by Medicaid" all services provided by the CCRC.

Continue reading

November 10, 2015 in Consumer Information, Estates and Trusts, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, State Statutes/Regulations | Permalink | Comments (0)

Wednesday, November 4, 2015

National Continuing Care Residents Assoc. Affiliates with LeadingAge

For several years, the National Continuing Care Residents' Association (NaCCRA) has hosted annual meetings in conjunction with the LeadingAge meeting, combining its own business with the opportunity for members to participate in a broad array of educational and general sessions offered under the umbrella of LeadingAge, thus providing residents with direct insights into provider-side views of the industry. 

State Chapter Representatives at NaCCRA Meeting October 2015This year, the NaCCRA meetings on  October 31-November 1, 2015 in Boston, offered a packed agenda of topics that attracted strong attendance by officers, board members, and representatives of more than a dozen state resident chapters (photo), as well as interested individual residents.  And anyone who thinks older adults aren't tech savvy can think again, as several members were participating remotely and the sessions are recorded for later viewing through the NaCCRA website.

High on the agenda this year was finalization of a formal affiliation agreement between NaCCRA and LeadingAge.  

The prospects for affiliation troubled some within NaCCRA, especially those who became active in NaCCRA precisely because of concern about the direction taken by certain owners or management of CCRCs in recent years.  They saw LeadingAge as the voice of "providers" only, and perhaps even as representing "the enemy."  They were worried residents might be silenced by the affiliation. Others in NaCCRA have witnessed the ever-broadening membership of LeadingAge and noted the organization's strong interest in state and federal regulation, laws and tax policies affecting senior living operations. They felt that NaCCRA needed to be inside the tent to have an effective voice in future changes that can affect residents.  

Within NaCCRA, the vote in favor of affiliation lead to a change at the leadership level, with President Dan Seeger (Pennsylvania) and at least one other board member stepping down from their positions in late summer 2015. 

Past President Ruth Walsh (Connecticut, center in photo below) had several weeks as Interim President.  During the October 31 meeting, new officers were elected, including Rev. Bob Nicholson (Washington, below left) as incoming President, Walt Boyer (North Carolina) as President Elect, and Jack Cumming (California) as Treasurer, joining William Ratcliff as Secretary. NaCCRA Meeting October 2015 

At the meeting the results of a recent survey of the more than 2,000 paid members of NaCCRA (including those representing affiliated state NaCCRA chapters or resident councils, thus giving NaCCRA an interest group of at least 38,000 residents) was announced.  The survey provides a prioritized action list for upcoming projects. Advocating for clearer written statements of "resident rights" (matched with better understanding of resident responsibilities) came out on top of the list of objectives for the coming year

November 4, 2015 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing | Permalink | Comments (0)

Sunday, November 1, 2015

And the New Name for CCRCs Is...

At the opening general session for LeadingAge's 2015 Annual meeting on November 1,  the results of two years of research into consumer preferences for LTC and senior housing, including consumer and provider surveys and focus groups, has culminated in a new identity for Continuing Care Retirement Communities (CCRCs).  And  -- drum roll,  please -- the new name is Life Plan Communities.

The thinking is interesting.  First,  LeadingAge researchers learned that while current residents embrace the name "Continuing Care Retirement" for their communities, younger persons reject the notion of both "retirement" and "care."  Thus, Life Plan Communities are viewed as playing to the "engagement" model of aging, where individuals have more control over their options, and are less likely to be passive in their response to provider-defined theories of care. 

In announcing the new name, outgoing LeadingAge CEO Larry Minnix and other leaders emphasized that the change is intended to be part of a conversation, to stimulate thinking and reaction to what it means to plan for future needs.  They recognize that states may or may not embrace the name change, including whether state laws will be amended to reflect the new identity for purposes of licensing and regulation.

Will a rose by any other name smell as sweet -- or, perhaps, even sweeter? 

 

November 1, 2015 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Retirement | Permalink | Comments (0)

LeadingAge 2015 Meeting Begins in Boston

LeadingAge Annual Meeting Program 2015.htmThe four-day annual meeting for LeadingAge, a trade association for providers of senior services with "6,000+ members and partners including not-for-profit organizations representing the entire field of aging services, 39 state partners, hundreds of businesses, consumer groups, foundations and research partners," starts today, November 1, in Boston  The program offerings are impressive with as many as two dozen choices per educational session and keynote addresses by high profile individuals, such as Monday's speaker, Dr. Atul Gawande, famed author of a best selling and much discussed book that challenges thinking on end-of-life case, Being Mortal.

I find LeadingAge as an organization to be fascinating, not least of all because of the scope of providers under its umbrella, but also because it has proven itself to be very responsive to changes in the market place.  It was once known as AAHSA or American Association of Homes and Services, but voted to change its name to LeadingAge in 2010. 

More changes are in the works, as long-time and much respected Larry Minnix is retiring as the head honcho of LeadingAge.  Nonprofit Continuing Care Retirement Communities (CCRCs) were once a major (perhaps even the most dominate) part of the membership, but as the senior care and services market is changing that is less and less true, especially with trends in favor of mergers and acquisitions, including not infrequent  transitions to for-profit operations.  Interestingly, during this year's meeting, LeadingAge is announcing a new for name for CCRCs.  Stay tuned!

This organization clearly understands the need for change to stay attractive to consumers.  At the same time, name changes can also complicate understanding by consumers of the choices available to them -- and can complicate state efforts to evaluate and, where appropriate, regulate different models of senior and adult housing and care services.

November 1, 2015 in Current Affairs, Health Care/Long Term Care, Housing, Programs/CLEs, Property Management, Statistics | Permalink | Comments (0)

Thursday, October 22, 2015

LTC Facilities Monitoring in Illinois

I was interested to learn about a new law in Illinois that allows for electronic monitoring in long term care facilities in certain cases.  Protecting Our Own: The Practical Implications of Illinois’s Authorized Electronic Monitoring in Long-Term Care Facilities notes that this new law goes into effect at the beginning of 2016 and  "permits nursing home residents in facilities that are licensed under certain state legislation such as the ID/DD Community Care Act or Nursing Home Care Act to use audio or video surveillance in their room at their own expense."  There are criminal penalties if anyone interferes with the monitoring devices and there is some money available for those facilities unable to afford the devices.

Illinois joins 4 other states (New Mexico, Oklahoma, Texas and Washington) with electronic monitoring laws.  There are other states that have guidelines for those LTC facilities who want to allow monitoring based on a desire of a resident.  The article discusses the pros and cons of monitoring and offers concerns regarding quality of care.

In terms of quality of care, having cameras in the rooms may also affect the important relationships developed between facility caregivers and their residents.  The staff may choose to rely on the cameras to monitor residents rather than engaging in direct communication, potentially leading to mistrust and even a greater substandard of care that such legislation was meant to combat in the first place.  Residents may never truly feel comfortable without the bond usually fostered between the two parties, contributing to a negative experience.

The Illinois statute is available here. One section of the statute addresses consent to monitoring. Written consent by the resident (or the resident's guardian) is required on a specific form from the state agency.  If the resident's doctor determines the resident lacks the capacity to consent, the statute provides a priority list of individuals who may provide consent.  Among other things, the statute addresses monitoring when the resident has a roommate. The statute also provides for conditions to be set on monitoring. The "standard" conditions set out in the statute include no audio recording, no transmission of either video or audio,  powering off the devices or blocking taping when a health care professional is caring for the resident or roommate or during bathing and dressing or during visits by certain folks such as attorney, financial planner, and  ombudsman. Other restrictions beyond the statutory ones can be imposed.  The statute addresses other matters, such as notice, reporting and more.   Read the Illinois statute here.

October 22, 2015 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, State Statutes/Regulations | Permalink | Comments (0)

Wednesday, October 21, 2015

The Importance of Understanding Trusts in Family Law, Especially If Divorce Looms

The ABA Section on Family Law has devoted the entire Fall 2015 issue of its Family Advocate magazine to "Crossing Paths with a Trust."   The paper copy of the issue just appeared on my desk. The opening editorial advises family law attorneys advising clients considering divorce not to fear trusts:

Lawyers who simply take a deep breath and read the trust will often be surprised to learn that they have in their hands a road map for how assets will be managed, who gets what, when they get it, and under what terms. 

The articles in the issue include a "plain English guide to trusts as a means of orchestrating assets in divorce cases," how trusts can interact with disclosure requirements for premarital agreements, how to address equitable division of interests assigned to trusts, the use of child support or alimony trusts, and the unique potential advantages for using trusts for "special needs" planning for disabled children.  The issue ends with a bonus -- a primer on "will basics."

The articles underscore what I sometimes find myself saying to law students, that courses on "wills, trusts and estates" are about advanced family law issues, and that if families fail to address disputes among family members while they are still living, the issues may not be any less complicated when the asset-holding family member passes away. 

The entire issue seems like a good resource for a wide audience, including law students.  Unfortunately, the on-line version of Family Advocate issues is restricted to ABA Family Law Section members, at least during the first few weeks of  publication.  Apparently you can purchase paper copies (see for example the rates for the previous issue, for  Summer 2015) , including bulk orders, although I find there is often a lag time for specific issues to become available to purchase.  I guess you have to keep checking!    

October 21, 2015 in Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Housing, Legal Practice/Practice Management, Property Management, Retirement, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Monday, October 19, 2015

Market Trends in Financing for Senior Housing Options

Recently I was reading an issue of The Senior Care Investor, a subscription-based news service that reports on the "World of Senior Care Mergers, Acquisitions, and Finance," and doing so since 1948. 

For approximately the last three years, most of the M & A activity has been in assisted living (AL) and memory care (MC).  Senior Care Investor reports that CCRCs are "beginning to make a comeback" as the housing market recovers and prospective residents are again able to use equity in their homes to finance transitions into CCRCs.  The most recent issue also indicates some development money is returning to the skilled nursing facility market, even as overall M & A activity in senior housing is lower in 2015 than in 2014.  

I've been watching quite a bit of activity over the last few years in conversions of nonprofit senior housing operations to "for profit" and there is more evidence of that in the latest report. But the most recent issue (Issue 9, Volume 27) also reports on a "rare for-profit to not-for-profit deal," with a New Mexico-based company, Haverland Care LifeStyle Group, purchasing a new AL/MC community in Oklahoma.  

Also, the Senior Care Investor reports on a faith-based, not-for-profit CCRC provider that has decided to sell an entrance fee model (one that's in transition to an "all rental" model) that will offer independent living, AL, MC units and nursing home beds.  What happens when senior housing operations are fully "private pay" AND "rental" models AND disconnected from a faith-based organization?  Can they maintain their tax-exempt status? In other words, if the public is paying market rates (and thus higher rates based on any market increases) with no promises of future care if the residents run out of money, is that senior housing enterprise still a nonprofit operation entitled to be treated as exempt from federal income taxes?   

October 19, 2015 in Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Property Management, Retirement, State Statutes/Regulations | Permalink | Comments (1)