Monday, January 16, 2017

Health & Safety Checks by Meals on Wheels?

So Meals on Wheels has an idea. We all know the dangers of isolation and how important it can be to check in with an elder on a regular basis.  Kaiser Health News explains the idea, Meals On Wheels Wants To Be The ‘Eyes and Ears’ For Hospitals, Doctors. "Meals on Wheels, which has served seniors for more than 60 years through a network of independent nonprofits, is trying to formalize the health and safety checks its volunteers already conduct during their daily home visits to seniors. Through an ongoing campaign dubbed “More Than a Meal,” the organization hopes to demonstrate that it can play a critical role in the health care system."

Many nonprofits face challenges, including funding challenges, and Meals on Wheels is no exception. There are competitors now,  less funding and increasing demand for services.  So how would this work?  "Meals on Wheels America and several of the local programs around the country have launched partnerships with insurers, hospitals and health systems. By reporting to providers any physical or mental changes they observe, volunteers can help improve seniors’ health and reduce unnecessary emergency room visits and nursing home placements, said Ellie Hollander, CEO of Meals on Wheels America."  It's a very cost-effective system according to the article and has the potential for bigger savings in health care costs.

There has already been some research done on the effectiveness and advantages of Meals on Wheels. Consider this:

Studies conducted by Brown University researchers have shown that meal deliveries can help elderly people stay out of nursing homes, reduce falls and save states money.

Kali Thomas, an assistant professor at Brown University School of Public Health, estimated that if all states increased the number of older people receiving the meals by 1 percent, they would save more than $100 million. Research also has shown that the daily meal deliveries helped seniors’ mental health and eased their fears of being institutionalized.

There are  projects taking place, with one between Meals on Wheels, Brown U and West Health Institute.  Another is with Meals on Wheels,  Johns Hopkins Bayview Medical Center and Meals on Wheels of Central Maryland, which will attempt "to keep seniors at home and reduce their need for costly health services after hospitalization. The idea is to have trained volunteers report red flags and ensure, for example, that patients with congestive heart failure are weighing themselves regularly and eating properly."  The Maryland project is being run by Dr. Dan Hale (friend and former colleague at Stetson U).

Sounds like a great idea! 

January 16, 2017 in Consumer Information, Current Affairs, Food and Drink, Health Care/Long Term Care, Other | Permalink | Comments (0)

Sunday, January 15, 2017

Mark Your Calendar-DOJ webinar

Do you know about the DOJ Elder Justice Initiative? If not, then this webinar is for you. Even if you do know about it, still register for this webinar!  According to the email I received,

On January 26, 2017, the Elder Justice Initiative will be hosting a webinar to highlight resources and information available on the Elder Justice Website. 

This webinar will be hosted by Susan Lynch and Sid Stahl and will introduce you to the Department of Justice’s Elder Justice Website and will help you to navigate the many tools and resources available on DOJ’s website for elder abuse prosecutors, law enforcement, victim advocates, victims, families, caregivers, and elder abuse researchers.  These tools can help you find assistance when in need, get involved in combatting elder abuse and financial exploitation, and educate you on elder justice programs operating at the federal, state, and local levels. 

Registration opens the week before the webinar.

January 15, 2017 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Programs/CLEs, Webinars | Permalink | Comments (0)

Friday, January 13, 2017

Should All States Permit Use of Medicaid for Assisted Living?

The plight of 108-year-old Ohio resident Carrie Rausch, facing the prospect of losing her spot in an assisted living community because she's run out of money, is generating a lot of attention in the media, including People magazine.  Some states, such as New Jersey, have expanded the options for public assistance in senior living -- beyond nursing homes -- to permit eligible individuals to use Medicaid for residential care.  Assisted living is usually much less expensive than a nursing home; but the pool of individuals who would might opt for assisted living rather than the "dreaded" nursing home is also larger.   Ohio, along with many states, hasn't gone the AL route:  

If Rausch can’t raise the money needed, she’ll have to leave what has been her home for the past three years and move into a nursing home that accepts Medicaid.

[Daughter] Hatfield worries about the toll the move would take on her mom, who is more lively and active than most people 10 or even 20 years her junior. . . . “We need a miracle,” she says.

Ms Rausch's adult daughter -- herself in her late 60s -- has turned to GoFundMe to attempt to raise the $40k needed for a year of continued residence, and as of the date of this Blog post, more than 700 donors have responded.  

At a deeper level, however, this story reveals important questions about public funding for long-term care on a state-by-state basis. This funding issue is repeating itself throughout the country for seniors much younger than the frugal and relatively healthy Carrie Rausch.  On a national basis, GoFundMe "miracles" seem an impractical solution.

January 13, 2017 in Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care, Housing, Medicaid, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Thursday, January 12, 2017

Superagers, the New Super Heroes?

Who doesn't want to be a super "something"? How about a Superager? What is a Superager anyway? (and no, capes and tights are not needed). According to a recent story in the NY Times, Superagers are "those whose memory and attention isn’t merely above average for their age, but is actually on par with healthy, active 25-year-olds." How to Become a ‘Superager’ reports on a study of the brains of Superagers to figure out what makes them so.

How do you become a Superager?  Well, the researchers aren't quite ready to tell us that yet. 

Of course, the big question is: How do you become a superager? Which activities, if any, will increase your chances of remaining mentally sharp into old age? We’re still studying this question, but our best answer at the moment is: work hard at something. Many labs have observed that these critical brain regions increase in activity when people perform difficult tasks, whether the effort is physical or mental. You can therefore help keep these regions thick and healthy through vigorous exercise and bouts of strenuous mental effort.

There is a downside to becoming a Superager, according to the story.  The author explains

The road to superaging is difficult, though, because these brain regions have another intriguing property: When they increase in activity, you tend to feel pretty bad — tired, stymied, frustrated. Think about the last time you grappled with a math problem or pushed yourself to your physical limits. Hard work makes you feel bad in the moment. The Marine Corps has a motto that embodies this principle: “Pain is weakness leaving the body.” That is, the discomfort of exertion means you’re building muscle and discipline. Superagers are like Marines: They excel at pushing past the temporary unpleasantness of intense effort. Studies suggest that the result is a more youthful brain that helps maintain a sharper memory and a greater ability to pay attention.

This means that pleasant puzzles like Sudoku are not enough to provide the benefits of superaging. Neither are the popular diversions of various “brain game” websites. You must expend enough effort that you feel some “yuck.” Do it till it hurts, and then a bit more.

The author points to the desire of Americans to pursue happiness, which leads us to" consistently sidestep the discomfort of mental effort or physical exertion, this restraint can be detrimental to the brain. All brain tissue gets thinner from disuse. If you don’t use it, you lose it."

So shall we all work on becoming Superagers?  The author closes the article with this bit of advice, "make a New Year’s resolution to take up a challenging activity. Learn a foreign language. Take an online college course. Master a musical instrument. Work that brain. Make it a year to remember."

Also remember, capes and tights are optional!

 

January 12, 2017 in Cognitive Impairment, Consumer Information, Current Affairs, Health Care/Long Term Care, Other | Permalink | Comments (0)

Should Home Care Providers Be Permitted to Seek Broad Waivers of Liability from Elderly Clients? (And if so, are there clear standards for a knowing waiver?}

Recently an attorney wrote to me about an elderly client who had been victimized by a home care worker hired through an agency; the allegations included physical abuse, intimidation, identity theft, failure to provide care, theft of personal possessions and false imprisonment.  Not too surprisingly, the specific worker was long gone once the harm was discovered by non-resident family members.  Significantly, the family also learned that the mother had signed the agency's standard contract withtwo pages of single-spaced type that covered everything from hours to wages, and which included a numbered paragraph purporting to grant a broad waiver of the agency's liability for actions of the individuals sent to the home of the elderly client. Key language provided:

"CLIENT and/or CLIENT's agent/responsible party agrees on behalf of CLIENT, CLIENT's agent/responsible party, beneficiaries, heirs, and/or family/household members to release [agency], owner, officers, directors, agents and employees, office, office directors, office employees, and Caregiver from any and all liability, potential or real, for any injury, claim, damage, or loss, including attorney's fees, incurred in connection with the performance of this agreement and all services, incurred in connection with the performance of this agreement and all services performed by Caregiver for the CLIENT, including but no limited to assisting CLIENT with his/her medications and providing transportation to Client or any member of CLIENT's family/household, except for gross negligence...."  

The attorney asked about any state regulatory language that would limit liability waivers or require, at a minimum, bold faced type or large type for such attempted waivers when used with elderly or disabled clients. Those receiving home care may be uniquely vulnerable to unwitnessed abuse, and also less likely to report abuse because of the fear of the "worse" alternative, a nursing home.   In the state in question, regulations  require certain disclosures to be made in a form "easily read and understood," but the regulations don't specifically address (nor prohibit) waivers of the company's liability. See e.g. PA Code Section 611.57.    

What about in your state? Is there relevant regulation? Alternatively, is there a "best" (or at least better) practice in the home care industry when seeking contractual waivers of liability?  The issue reminds me of an article written in the mid-1990s by Charlie Sabbatino discussing the one-sided nature of nursing home contracts in the absence of careful regulation protecting patient rights.  He wrote:

Broadly worded waivers of liability for personal injury are likely to be unenforceable and void as a matter of public policy in most states. Residents are most commonly asked to consent to absolute waivers for injury caused by other patients or by independent contractors in the facility, or for injury occurring outside of the facility, such as on a field trip. Federal and state nursing home laws have not squarely addressed personal injury waivers. even though the whole thrust of the regulatory framework is expressly intended to set standards for the protection of residents' health, safety, and welfare.

And the subtitle of the article on Nursing Home Contracts is "Undermining Rights the Older Fashioned Way." 

January 12, 2017 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Wednesday, January 11, 2017

When Was the Last Time You Looked at Your Retirement Account?

A recent article in the Washington Post by Michelle Singletary suggested a New Year's resolution, knowing your retirement account. Resolve to take a closer look at your retirement account offers insights from author (Empire of the Fund: The Way We Save Now), William A. Birdthistle, who participated recently in her online discussion.   The article contains 3 questions and Mr. Birdthistle's answers, one of which discusses in what types of investments to invest retirement funds. Ms. Singletary closes her article with this advice to readers: "Let 2017 be the year that you take a closer look at your retirement savings. Don’t just blindly throw money in your account. No one can predict the unpredictable when it comes to your nest egg. But at least you can become better informed about what there is to know for sure."

Thanks to Professor Naomi Cahn for sending us this article.

January 11, 2017 in Consumer Information, Current Affairs, Retirement | Permalink | Comments (0)

"The Aging Brain" as a Focus for Collaborative Analysis and Research

I'm much overdue in writing about a terrific, recent workshop at Arizona State University's Sandra Day O'Connor College of Law on "The Aging Brain." For me it was an ideal gathering of disciplines, including experts in neurology, psychology, health care (including palliative care and self-directed aid-in-dying), the judiciary, and both practitioners and academics in law (not limited to elder law).  Even more exciting, that full day workshop (11/18/15) will lead into a public conference, planned for fall 2017.  

Key workshop moments included:

  • Preview of a potentially ground-breaking study of early-onset Alzheimer's Disease (AD) centered on a family cluster in the country of Columbia with a genetic marker for the disease and a high incidence of onset.  By "early onset," we're talking family members in their 40s.  The hope is that by studying the bio-markers in this family, that not only early onset but later-in-life onset will be better understood. Eric Reiman, with professional affiliations with Banner Health, Arizona State University and University of Arizona, spoke at the workshop, and, as it turned out, he was also featured on a CBS 60 Minutes program aired a short time later about the family-based study.  Here's a link to the CBS transcript and video for the 60 Minutes program on "The Alzheimer's Laboratory."  
  • Thoughtful discussion of the ethical, legal and social implications of dementia, including the fact that self-directed aid-in-dying is not lawful for individuals with cognitive impairment. Hank Greely from Stanford University Law and Medical Schools, and Professor Betsy Grey for ASU's Sandra Day O'Connor College of Law led discussions on key issues.  As biomarkers linked to AD are identified, would "you" want to know the outcome of personal testing?  Would knowing you have a genetic link to AD change your life before onset? 
  • Overview of recent developments in "healthy" brain aging and so-called "anti-aging" treatments or medications, with important questions raised about whether there is respected science behind the latest announcement of "breakthroughs." Cynthia Stonnington from the Mayo Clinic and Gary Marchant from ASU talked about the science (or lack thereof), and Gary raised provocative points about the role of the FDA in drug approvals, tracking histories for so-called off label uses for drugs such as metformin and rapamycin.  

I very much appreciate the opportunity to participate in this program, with special thanks to Betsy Grey and federal Judge Roslyn Silver for making this possible.  I've also enjoyed serving as occasional guest in Judge Silver's two-semester Law and Science workshop with ASU law students. Thank you! For more on the Aging Brain programming at ASU, see here.    

January 11, 2017 in Advance Directives/End-of-Life, Cognitive Impairment, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Programs/CLEs, Science | Permalink | Comments (0)

Tuesday, January 10, 2017

Register Now: Free Webinar on Recognizing and Preventing Scams

The American Bar Association Senior Lawyers Division is offering a free webinar on January 19 at noon on scams, as part of its series on preventing elder abuse.  The webinar will include panelists from the Consumer Financial Protection Bureau, DOJ and the Harry & Jeanette Weinberg Center for Elder Abuse Prevention.  Topics to be covered include the frequency of elder abuse, trends in scams, scam prevention, what to do if a victim, and civil remedies. Click here to register.

 

 

 

January 10, 2017 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Webinars | Permalink | Comments (0)

Medicare Overpayments

Kaiser Health News ran a story last week on the failure of CMS to recover significant overpayments from some Medicare Advantage plans. Medicare Failed To Recover Up To $125 Million In Overpayments, Records Show explains

An initial round of audits found that Medicare had potentially overpaid five of the health plans $128 million in 2007 alone, according to confidential government documents released recently in response to a public records request and lawsuit.

But officials never recovered most of that money. Under intense pressure from the health insurance industry, the Centers for Medicare and Medicaid Services quietly backed off their repayment demands and settled the audits in 2012 for just under $3.4 million — shortchanging taxpayers by up to $125 million in possible overcharges just for 2007.

The story reports the overpayments occur for various reasons, including billing errors and from "overcharge[ing] Medicare, often by overstating the severity of medical conditions...."  The story reports on CMS audits of some health plans, events that led up to the settlement of the overpayment claims and a May, 2016 GAO report.

January 10, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Oregon Supreme Court Rejects Medicaid Estate Recovery for Asset Transfers between Spouses

In late December 2016, the Oregon Supreme Court ruled that state efforts to use Medicaid Estate Recovery regulations to reach assets transferred between spouses prior to application were improper. In Nay v. Department of Human Services, __ P.3d ___, 360 Or. 668, 2016 WL 7321752, (Dec. 15, 2016), the Supreme Court affirmed in part and vacated in part the ruling of the state's intermediate appellate court (discussed here in our Blog in 2014).  The high court concluded:

Because “estate” is defined to include any property interest that a Medicaid recipient held at the time of death, the department asserted that the Medicaid recipient had a property interest that would reach those transfers. In doing so, it relied on four sources: the presumption of common ownership in a marital dissolution, the right of a spouse to claim an elective share under probate law, the ability to avoid a transfer made without adequate consideration, and the ability to avoid a transfer made with intent to hinder or prevent estate recovery. In all instances, the rule amendments departed from the legal standards expressed or implied in those sources of law. Accordingly, the rule amendments exceeded the department's statutory authority under ORS 183.400(4)(b). The Court of Appeals correctly held the rule amendments to be invalid.

Our thanks to Elder Law Attorney Tim Nay for keeping us up to date on this case.  His firm's Blog further reports on the effects of the final ruling in Oregon:

"Estate recovery claims that were held pending the outcome of the Nay case can now be finalized, denying the claim to the extent it seeks recovery against assets that the Medicaid recipient did not have a legal ownership interest in at the time of death. Estate recovery claims that were settled during the pendency of Nay contained a provision that the settlement agreement was binding on all parties to the agreement no matter the outcome in Nay and thus cannot be revisited."

January 10, 2017 in Estates and Trusts, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Property Management, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Monday, January 9, 2017

Social Security Full Retirement Age in 2017

Social Security's blog, Social Security Matters, posted the full retirement age info for 2017. 2017 Brings New Changes to Full Retirement Age explains that for those between 1955-1956, full retirement age is 66 and 2 months.  The post also explains what the increase in full retirement age means to benefits: "[a]s the full retirement age continues to increase, there are greater reductions in benefits if you claim them before you reach full retirement age.  For example, if you apply for benefits in 2017 at age 62, your monthly benefit amount will be reduced nearly 26 percent." The blog also offers tips to those who are contemplating retirement along with helpful links.

January 9, 2017 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Retirement, Social Security | Permalink | Comments (0)

Diving Deeper into Approval of Short-Term Annuities in Medicaid Planning

3L Villanova Law Student Jennifer A. Ward has an interesting analysis of the Third Circuit's decision in Zahner v. Sec'y Pa Dept. of Human Servs., 802 F.3d 497 (3d Cir. 2015), published in a recent issue of the Villanova Law Review.  She begins with a summary of the Zahner decision and an outline of her analysis:

[T]he Third Circuit examined whether short-term annuities, a specific instrument used in Medicaid planning, qualified for the DRA's safe harbor provision. If so, assets used to purchase short-term annuities would be sheltered from factoring into individuals' eligibility for Medicaid. Holding that short-term annuities can qualify for protection, the Third Circuit's decision signifies that the DRA did not completely foreclose the “use of short-term annuities in Medicaid planning.”
 
This Casebrief argues that the Third Circuit's Zahner decision is a win for elder law attorneys and their clients, as it solidifies the viability of the use of short-term annuities in Medicaid planning. Part II examines how individuals take part in Medicaid planning, including a discussion of the DRA and the use of annuities in planning. Part III presents the facts of Zahner and reviews the Third Circuit's analysis. Part IV analyzes the Third Circuit's decision to approve the use of short-term annuities. Part V advises elder law practitioners on the use of short-term annuities going forward. Part VI concludes by discussing the long-term viability of short-term annuities.
 
The author recognizes the potential for Congress to change the outcome of the Zahner ruling: 
 
After Zahner, elder law practitioners are free to use short-term annuities while guiding their clients through the Medicaid planning process. The Third Circuit will not bar the use of qualified short-term annuities in Medicaid planning, instead leaving any change in policy to Congress. Therefore, until Congress acts, short-term annuities are a viable planning tool in the Third Circuit for the foreseeable future.For people who wish to leave assets to loved ones, Zahner presents good news. Rather than causing people to exhaust their savings on long-term care, Zahner provides individuals greater ability to protect resources through Medicaid planning.
 
The title of the article is Doctor's Orders: The Third Circuit Approves Short Term Annuities As a Viable Planning Tool, and is available through subscription on Westlaw and Lexis and appears to be forthcoming on a digital commons platform via the Villanova Law Review. 

January 9, 2017 in Estates and Trusts, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid | Permalink | Comments (0)

Friday, January 6, 2017

Alzheimer's: Greater Impact on Women?

I was reading a recent blog post on the Scientific American  that featured a guest blog by Dr. Snyder, the Senior Director of Medical and Scientific Operations, Medical and Scientific Relations for the Alzheimer's Association. The blog, Alzheimer's Falls More Heavily on Women Than on Men, opens with two vignettes of women who early-onset Alzheimer's.

Alzheimer’s dementia disproportionately affects women in a variety of ways. Compared with men, 2.5 times as many women as men provide 24-hour care for an affected relative. Nearly 19 percent of these wives, sisters and daughters have had to quit work to do so. In addition, women make up nearly two-thirds of the more than 5 million Americans living with Alzheimer’s today.

The blog explains that researchers are studying this to see if they can find the answer, but longevity alone isn't likely it.  The post also reports on the work of the Alzheimer's Association including a funding initiative for 9 research projects. Some are looking at lifestyle factors including stress and education. The article concludes with a discussion of the role and importance of advocacy

January 6, 2017 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Science | Permalink | Comments (0)

Thursday, January 5, 2017

Medicaid Pocket Primer

Kaiser Health News has released a Medicaid Pocket Primer. The Primer succinctly explains what is Medicaid, its structure, those covered, services, the impact of the ACA, how beneficiaries access care, the program's impact on beneficiaries' ability to get care, its costs, and financing.  The conclusion to the primer explains

Medicaid provides comprehensive coverage and financial protection for millions of Americans, most of whom are in working families. Despite their low income, Medicaid enrollees experience rates of access to care comparable to those among people with private coverage. In addition to acute health care, Medicaid covers costly long-term care for millions of seniors and people of all ages with disabilities, in both nursing homes and the community. Medicaid funding is a major source of support for hospitals and physicians, nursing homes, and jobs in the health care sector. Finally, the guarantee of federal matching funds on an open-ended basis permits Medicaid to operate as safety net when economic shifts and other dynamics cause coverage needs to grow. Because proposals to restructure the Medicaid program could have significant consequences for enrollees and the health care system, the potential implications of such proposals warrant careful consideration.

A pdf of the primer is available here.

January 5, 2017 in Consumer Information, Current Affairs, Health Care/Long Term Care, Medicaid | Permalink | Comments (0)

Wednesday, January 4, 2017

Just a Reminder-6th Annual Health Law Conference at FSU

I'd posted about this previously (but had the wrong date, sorry Marshall) so just a reminder, Save the Date: February 13, 2017, the 6th Annual Health Law Conference at Florida State University. This year's conference is titled Patients as Consumers: The Impact of Health Care Financing & Delivery Developments on Roles, Rights, Relationships & Risks.  Topics include Evidence-based Medicine & Shared Decision-making, Impact of Cost Containment Initiatives on Patient Rights and Provider Liabilities, and Patient Populations at Particular Risk of Not Controlling Their Own Medical Choices.

Registration is free unless seeking CLE credits.  For more information or registration, click here.

January 4, 2017 in Consumer Information, Current Affairs, Health Care/Long Term Care, Programs/CLEs | Permalink | Comments (0)

Tuesday, January 3, 2017

What's in a name?

I always have a discussion with my students about the name we use to refer to our clients: "senior citizen", "elderly", "elder" or "person who is older." I know there's been discussions periodically about whether elder law attorneys should describe themselves (and their practices) in that way. So I was very interested in a recent study from researchers at the National University of Ireland, Gallway. Trends in the use of terms to describe older people in the medical literature 1950 - 2015 explains the researchers study and their conclusion that over time the word used has changed, with "older" being the current favored term. Here is a brief explanation:

Goal:

Background: There has been much debate about the most appropriate terms to use when describing older people. We examined changes in the popularity of different terms in the medical literature from 1950 to 2015.
Methods: The advanced search facility in PubMed was used to search titles and abstracts of the clinical English-language literature for use of ‘geriatric’, ‘aged’, ‘old’, ‘older’ and ‘elderly’ to describe older people.
Results: ‘Aged’ was the most popular term from 1950 to 1961 but declined to 3.4% of references to older people in 2015. ‘Geriatric’ was relatively common (more than 10% of references) from 1955 to 1976 but occurred in only 1.8% of references by 2015. ‘Elderly’ was the most popular term for all but one year from 1962 to 2007 and accounted for 37.8% of references in 2015. ‘Older’ was been the most popular term from 2008 to 2015, when it accounted for 54.6% of references.
Conclusions: The preferred descriptive terms for older people have changed greatly over the last 65 years. ‘Older’ is now the most common descriptor and is increasingly displacing ‘elderly’ which had dominated for four decades. 

The study has been published in the Journal of the American Geriatrics Society (subscription required)

January 3, 2017 in Consumer Information, Current Affairs, Other | Permalink | Comments (2)

Sunday, January 1, 2017

More on Family Caregivers

The New England Journal of Medicine published Supporting Family Caregivers of Older Americans on December 28, 2016.  The authors were part of a committee of "the National Academies of Sciences, Engineering, and Medicine Committee" dealing with family caregivers of elders.  The report that resulted, according to the authors, "raises serious concerns about the current and future state of this caregiving in the United States."The authors include in their definition of family caregivers "relatives, partners, friends, or neighbors who provide help because of a personal relationship rather than financial compensation."

Here's a highlight

Our report challenges public and private stakeholders to transform policies and practices to make the delivery of person- and family-centered care a reality. We found that appropriate engagement and tailored support of family caregivers have the potential to improve caregivers’ experiences and quality of life and facilitate shared decision making while enhancing the quality of care provided to older adults and reducing the use of unnecessary services. But the United States currently lacks the infrastructure and knowledge base that practitioners and policymakers need to make support of caregiving families a reality. Moving to person- and family-centered care will require coordinated changes in several areas.

A pdf of the story is available here.

January 1, 2017 in Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink

Thursday, December 29, 2016

Revised Nursing Home Regs-Resources Part II

The National Consumer Voice for Quality Long-Term Care has issued its second summary of the revised nursing home regulations. Summary of Key Changes in the Rule-Part II is a 19 page summary of phase 1 that covers changes to the resident assessment, comprehensive person-centered care planning, quality of life, quality of care, doctors and nursing services, behavioral health services, pharmacy services, lab, diagnostic and radiology services, dental, nutrition, and specialized rehab services, administration (the section that includes the ban on pre-dispute arbitration agreements), quality assurance, physical environment, controlling infection, and training (which includes training on recognizing, reporting and preventing abuse, neglect and exploitation). Read this, bookmark it, print it and save it!

December 29, 2016 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink

Wednesday, December 28, 2016

Student Loans and Social Security

Imagine a person who has at last retired, is drawing Social Security and still has outstanding student loans. Farfetched? Not at all. And, in fact, the GAO issued a report noting how Social Security checks are being reduced to repay these student loans. The Wall Street Journal explains about the report in the article, Social Security Checks Are Being Reduced for Unpaid Student Debt:

The report highlights the sharp growth in baby boomers entering retirement with student debt, most of it borrowed years ago to cover their own educations but some used to pay for their children’s schooling. Overall, about seven million Americans age 50 and older owed about $205 billion in federal student debt last year. About 1 in 3 were in default, raising the likelihood that garnishments will increase as more boomers retire.

Student loan debt isn't dischargeable in bankruptcy, but the effect of the government's actions is to leave some Social Security recipients below the poverty level.  "[C]onsumer advocates and some congressional Democrats say the government’s tactics have become too aggressive, targeting many borrowers who are destitute and have no hope of repaying. Most Social Security recipients rely on their checks as their primary source of income, other research shows."

The GAO report, Social Security Offsets: Improvements to Program Design Could Better Assist Older Student Loan Borrowers with Obtaining Permitted Relief offers the following findings

 Older borrowers (age 50 and older) who default on federal student loans and must repay that debt with a portion of their Social Security benefits often have held their loans for decades and had about 15 percent of their benefit payment withheld. This withholding is called an offset. GAO’s analysis of characteristics of student loan debt using data from the Departments of Education (Education), Treasury, and the Social Security Administration (SSA) from fiscal years 2001-2015 showed that for older borrowers subject to offset for the first time, about 43 percent had held their student loans for 20 years or more. In addition, three-quarters of these older borrowers had taken loans only for their own education, and most owed less than $10,000 at the time of their initial offset. Older borrowers had a typical monthly offset that was slightly more than $140, and almost half of them were subject to the maximum possible reduction, equivalent to 15 percent of their Social Security benefit. In fiscal year 2015, more than half of the almost 114,000 older borrowers who had such offsets were receiving Social Security disability benefits rather than Social Security retirement income.

In fiscal year 2015, Education collected about $4.5 billion on defaulted student loan debt, of which about $171 million—less than 10 percent—was collected through Social Security offsets. More than one-third of older borrowers remained in default 5 years after becoming subject to offset, and some saw their loan balances increase over time despite offsets. However, nearly one-third of older borrowers were able to pay off their loans or cancel their debt by obtaining relief through a process known as a total and permanent disability (TPD) discharge, which is available to borrowers with a disability that is not expected to improve.

GAO identified a number of effects on older borrowers resulting from the design of the offset program and associated options for relief from offset. First, older borrowers subject to offsets increasingly receive benefits below the federal poverty guideline. Specifically, many older borrowers subject to offset have their Social Security benefits reduced below the federal poverty guideline because the threshold to protect benefits—implemented by regulation in 1998—is not adjusted for costs of living (see figure below). In addition, borrowers who have a total and permanent disability may be eligible for a TPD discharge, but they must comply with annual documentation requirements that are not clearly and prominently stated. If annual documentation to verify income is not submitted, a loan initially approved for a TPD discharge can be reinstated and offsets resume.

A pdf of the 90 page report is available here. An accompanying podcast is available here.

December 28, 2016 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Social Security | Permalink | Comments (0)

Tuesday, December 27, 2016

DC Aid-in-Dying Legislation

The mayor of DC signed aid-in-dying legislation for the District which now has to be sent to Congress for a 30 day review period. Bowser quietly signs legislation allowing terminally ill patients to end their lives explains that the law is based on Oregon's statute. Congress has 30 days to approve or override it, Washington, D.C., Approves Aid-in-Dying Bill.

December 27, 2016 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, State Statutes/Regulations | Permalink