Wednesday, March 14, 2018

Dementia-Friendly City in Heart of Silicon Valley

Somehow I never thought I'd right that phrase. Yet, Palo Alto is taking steps to become a dementia-friendly city! Palo Alto looks to become a 'dementia-friendly city' explains that

Palo Alto is among a growing number of communities around the world that have begun to look at how government, businesses and residents can work together to provide better resources — like training for first responders, community support networks and policies that better aid employees who are also caregivers — for the expanding population of aging adults who are being diagnosed with dementia.

Palo Alton has a little more than 30,000 residents now who have dementia (including Alzheimer's) and it is estimated that that number will exceed 50,000 by 2030. "As part of its broader push for an "age-friendly Silicon Valley," Santa Clara County last year joined Dementia Friends, a global movement begun by the Alzheimer's Society in the United Kingdom to change the way people think about dementia."

A public hearing on this is scheduled for late March.  Thanks to my colleague and dear friend Mark Bauer for alerting me to this article.


March 14, 2018 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Other | Permalink | Comments (0)

Tuesday, March 13, 2018

Expanding the Right to Physician-Aided Dying?

The Washington Post recently ran an article about efforts underway by some folks to expand Oregon's physician-aided dying law to include those individuals who do not have terminal illnesses. In Oregon, pushing to give patients with degenerative diseases the right to die explains efforts to expand the scope of Oregon's law to cover those with degenerative diseases, such as "[p]eople with Alzheimer’s, Parkinson’s, Huntington’s, multiple sclerosis and a host of other degenerative diseases [who] are generally excluded from the Oregon law." Why? you might ask. "[B]ecause some degenerative diseases aren’t fatal. People die with Parkinson’s, for example, not because of it. Other diseases, such as advanced Alzheimer’s, rob people of the cognition they need to legally request the suicide medications."

The article notes that this effort isn't limited to just Oregon. In fact, there are "[r]elatively modest drives ... afoot in Washington state and California, where organizations have launched education campaigns on how people can fill out instructions for future caregivers to withhold food and drink, thereby carrying out an option that is legal to anybody: death by starvation and dehydration. (It is often referred to as the “voluntarily stopping eating and drinking” method.)"

Interestingly, the article reports that not all in the right to die movement are in favor of broadening the law.  In fact "groups such as Compassion & Choices, the nation’s largest right-to-die organization, and the Death With Dignity National Center, a main author of the original law, have little appetite for widening access to lethal drugs in the states where medically assisted suicide already is legal."

These initiatives aren't just limited to the U.S. The story reports in Canada The Quebec "provincial government is studying the possibility of legalizing euthanasia for Alzheimer’s patients. Unlike medically assisted suicide, a medical doctor would administer the fatal dose via injection. A survey in September found that 91 percent of the Canadian province’s medical caregivers support the idea."

The Oregon legislature has taken the first step,  the passage last month of legislation to investigate "how to improve the process of creating and carrying out advance directives. Gov. Kate Brown (D) is expected to sign it."

The article also reminds us of the Harris case where Mrs. Harris, with an advance directive, was spoon fed by the facility where she resided.  There have been a number of folks requesting language added to their advance directives to avoid the spoon-feeding issue according to the attorney for Mr. Harris.

March 13, 2018 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (1)

House to Vote on Right To Try Bill

We have previously blogged about right to try laws and the bill making its way through Congress. The House of Representatives is scheduled to vote on the bill today according to the March 12, 2018 Bloomberg's Health Care Daily Report (subscription required). The Report explains

The bill set to be voted on in the House narrowed the Senate-passed version’s definition of who could seek unapproved drugs to “strike the right balance for patients and their safety,” Reps. Greg Walden (R-Ore.), chairman of the House Energy and Commerce Committee, and Michael Burgess (R-Texas), head of the panel’s health subcommittee, said in a joint statement.

If passed, the Senate will have to vote again on the measure or, less likely, form a conference committee to work out the differences, according to a statement from House Majority Leader Rep. Kevin McCarthy (R-Calif.).

I'll report back once we know more.

March 13, 2018 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (0)

Technologies to Connect & Age in Place

There are amazing technologies out there, and I'm sure more are being invented as I write this.  Kaiser Health News ran a story about technology designed to allow elders to age in place and to satay connected. New Technologies Help Seniors Age In Place — And Not Feel Alone opens by relating a story of  one elder who agreed to the use of a long-distance monitoring system so her son across the country could keep track of her well-being. "For many, the technology offers not just the tools they need to continue to live at home, but newfound confidence and connectedness with faraway family and friends."  One expert quoted in the article has named this trend as "'monitored independence,' and it is changing how older generations age in America. 'People want to be autonomous, irrespective of age,'" said this expert.  The article notes that voice-assisted technologies are goign to play a large role in helping elders age in place as these devices can do a lot more than just play music. Pair those with apps designed to help elders and will become proactive in interactions rather than reactive. The article offers a forthcoming app as an example where it will ask the elder if the elder has remembered to take her medication. There are currently apps that remind the user to take medication and allows the user to designate a second party to get an alert if the user misses a dose of medication.

More fall detection devices are coming our way as well, some very soon and others before too long.

It's interesting to see tech moving into this market and hopefully more will be done to help us live independently longer.  Is anyone thinking about the privacy aspects of using all this tech?

March 13, 2018 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other, Web/Tech | Permalink | Comments (1)

Friday, March 9, 2018

Law and the 100 Year Life-Lecture at Illinois Law

The U. of Illinois College of Law will be holding the Ann F. Baum Memorial Elder Law Lecture on March 12 from noon-1. Professor Anne Alstott of Yale will speak on Law and the 100-Year Life.  Here's a bit of info about the lecture. "Children born in the United States today are projected to live to 100 years, on average. How should we think about adjusting elder law in light of the social and economic changes that will result?"

March 9, 2018 in Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care, Other, Programs/CLEs | Permalink | Comments (0)

Thursday, March 8, 2018

The Toughest Issue for Protective Service Agencies? Self Neglect...

Boy, did this New York Times piece by always interesting Paula Span resonate for me.  I spent several years serving as designated counsel for individuals who were facing unwanted intervention by Adult Protective Services. The issue of self-neglect is just plain tough -- and it doesn't get any easier with age.  From the article:

[T]he state adult protective services agency sent a caseworker to the man’s home. She found an 86-year-old Vietnam veteran in a dirty, cluttered house full of empty liquor bottles. His legs swollen by chronic cellulitis, he could barely walk, so he used a scooter. He missed doctor’s appointments. He had the medications he needed for cellulitis and diabetes, but didn’t take them. Though he had a functioning toilet, he preferred to urinate into plastic gallon jugs. He didn’t clean up after his dogs. He wasn’t eating well. . . . 


In the Texan’s case, “he wasn’t happy that A.P.S. was there, and he denied that he was being exploited,” said Raymond Kirsch, an agency investigator who became involved. “He also denied that he had a drinking problem.”


Grudgingly, he allowed the agency to set up a thorough housecleaning, to start sending a home care aide and to arrange for Meals on Wheels.


But on a follow-up visit a month later, the caseworker found her client markedly deteriorated. His swollen legs now oozed. He’d become personally filthy and was ranting incoherently. She returned with an ambulance and a doctor who determined that the client lacked the capacity to make medical decisions.


Off he went to a San Antonio hospital, under an emergency court order. The caseworker locked up the house and kenneled the dogs. . . . 

Our special thanks to University of Illinois Law's Professor Dick Kaplan for pointing us to this article.  For the outcome of this particular case, read to the end of the full article, Elder Abuse: Sometimes It's Self-Inflicted.

March 8, 2018 in Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Young Blood for Anti-Aging?

The subject of this story caught me off guard, having not contemplated it.  Stat ran the story, How a society gala was used to sell young-blood transfusions to baby boomers desperate to cheat death.

The story focuses on a luncheon event in south Florida where audience members were pitched on "[p]aying to participate in a soon-to-launch clinical trial testing transfusions of young blood [which] “offers the greatest potential for everyone in this room to add a lot of healthy years to their life... 'Not only do you get to potentially live longer … but you’re going to be healthier. And some of the chronic problems you have now may disappear.'”  Stat had a number of medical experts review the materials for the clinical trial "and all sharply criticized the study’s marketing, design, and scientific rationale."  Although the final price has yet to be determined, one suggested cost for the treatment was over a quarter of a million dollars.

The article discusses what is involved in clinical trials, other trials with similar goals and general reactions to the proposal.  It is a fascinating article.  It can be used as a jumping off point for a discussion about ageism.



March 8, 2018 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (0)

Wednesday, March 7, 2018

Family Fights Over Care for Mom:Subject of Academy Award

We all know that family dynamics are not always the most pleasant and can lead to strife, stress and litigation. Kaiser Health News ran a recent story that details a conflict within a family. A Tale of Love, Family Conflict And Battles Over Care For An Aging Mother focuses on the story “'Edith + Eddie,' a short documentary vying for an Academy Award Sunday,[which] is a gripping look at a couple in their 90s caught up in an intense family conflict over caring for an aging parent." The short film starts a few months after the couples' marriage and ends (spoiler alert) "months later with the couple being separated by Edith’s court-appointed legal guardian, with police on the scene, and Edith taken off abruptly to Florida. Shockingly, Eddie died only a few weeks later." Interwoven with the love story are allegations within Edith's family of fighting siblings, guardianship and financial concerns.

The movie is focused on the love story. The columnist took a broader approach, diving into the family dynamics, finding "[t]hree daughters in distress over the care of an aged mother and roiled by disputes played out in courtrooms among far-flung siblings." Eventually two of the three daughters were named co-guardians , but even so, the road was bumpy; "the sisters for years had bickered over what was best for their mother."  The marriage occurred after the guardianship was established, so the question of the validity of the marriage was also at play here.  The co-guardians didn't work well together. One wouldn't consult the other and moved her mother frequently without telling the other family members of the mother's location. Finally a non-relative guardian was appointed, but even she wasn't able too keep track of the mother's location.  The guardian wanted Edith to go to Florida for a bit so the guardian could find an appropriate ALF for her.  After more hurdles, Edith finally went to Florida where her health slowly began to improve.

The story ends with this "Edith passed away last March of natural causes at the age of 98, after living with her daughter in Florida through the end of her life. She never went to an institution. Her home wasn’t sold until after her death; there was no attempt to plunder her estate by lawyers or family members. That’s the other story of Edith+Eddie."

Watch the film. Read the article.  Lots of class discussion could come out of this.

March 7, 2018 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Film, Health Care/Long Term Care | Permalink | Comments (0)

Tuesday, March 6, 2018

Florida Moves Forward on Backup Generator Requirements for Nursing Homes

With little time left in the 2018 legislative session, will the legislature pass a rule requiring nursing homes to have emergency generator back up?  According to Health News Florida, Rules For Backup Power For Nursing Homes Go To Florida House. The bill "would require facilities to have a generator capable of keeping facilities at 81 degrees or lower for at least four days. It also requires them to keep 72 hours of fuel on site." According to the article, ALFs are not included in the requirement. Assuming approval then Florida's "577 nursing homes in Florida must be in compliance by July 1, but as of Jan. 8, 108 were already in compliance. AHCA can grant an extension until Jan. 1, 2019, for nursing homes that would face delays in installing equipment."  Stay tuned-we will know in a matter of days.

March 6, 2018 in Consumer Information, Current Affairs, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)

Monday, March 5, 2018

News Feature Focuses on Court-Appointed Guardian in Pennsylvania, Raising Important Systemic Questions

From Nicole Brambila, an investigative journalist for the Reading [Pennsylvania] Eagle, comes an article examining the history of a specific individual appointed by courts to serve as a guardian in multiple cases, in different counties in Pennsylvania.  The article raises important questions about court oversight, including but not limited to whether there should be mandatory criminal background checks for those serving as court-appointed fiduciaries:  

If [an elderly couple in Montgomery County, Pennsylvania] were astonished to learn the court-appointed guardian [for the 79-year-old husband] had not been paying the mortgage and other bills, their surprise would pale in comparison to the revelations yet to come.  Unbeknownst to them, Byars [the guardian in question] had been convicted multiple times of financial theft.


Her most recent arrest came in 2005.  She pleaded guilty to felony fraud and was sentenced to 37 months in a federal prison after cashing $20,000 in blank checks [she] found while rummaging through trash cans at a Virginia post office. 

The article points to another case in Philadelphia Orphans Court, where an attorney representing family members of a different person alleged to be in need of a guardian, looked into the background of Byars, and discovered records detailing her history.  The attorney was successful in having her removed as the court-appointed guardian in that case.  The Reading Eagle reporter writes:

For six months she continued serving as guardian to 52 incapacitated Philadelphians. No other Philadelphia judge removed her until after the Reading Eagle made dozens of inquiries in January with the court, Adult Protective Services, the Pennsylvania Department of Aging and state lawmakers about her appointments. . . . 


Philadelphia Orphans Court works with more than a dozen professional guardians. Ten of these, including Byars, carry some of the highest caseloads: 22, 48, 54 and more. But none more than Byars, who was appointed in Philadelphia alone 75 times from 2014 through 2016, according to court dockets.

For more, read Unguarded: Montgomery County Couple's Trust Betrayed, published March 4, 2018 in the Reading Eagle [paywall protected, although there is a $1 fee for single day access].  


March 5, 2018 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (1)

Surgery Late in Life?

Kaiser Health News ran the story, Never Too Late To Operate? Surgery Near End Of Life Is Common, Costly that opens with this startling statistic: "Nearly 1 in 3 Medicare patients undergo an operation in their final year of life." Several paragraphs into the story the quote is repeated, but with this additional information: "[n]early 1 in 3 Medicare patients undergo an operation in the year before they die, even though the evidence shows that many are more likely to be harmed than to benefit from it."

So why does this happen? According to the article, there are financial incentives plus we are dealing with a "medical culture" where "patients and doctors are reluctant to talk about how surgical interventions should be prescribed more judiciously.... "  The article discusses several surveys regarding surgeries in the older population with the benefits and burdens from such surgeries.  As well, there are significant implications for elders undergoing surgery, including longer recovery time and less tolerance with anesthesia.

Thinking through medical treatment options takes time. One tool being developed by "[m]any hospitals and health systems is ... “decision aids,” easy-to-understand written materials and videos to help patients make more informed medical decisions, giving them time to develop more realistic expectations." Another approach discussed in the article is a move away from the use of statistics and instead have the focus on narratives where the "doctors should lay out the best, worst and most likely outcomes."  If the best cases scenario resulting from the medical intervention isn't something that the patient finds acceptable, then that's a big indicator that the patient should not undergo the medical intervention.

Interesting ideas!

March 5, 2018 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Wednesday, February 28, 2018

Conversations on Living with Dementia

Kaiser Health Network offered this moderated discussion with 5 panelists, Conversation On Living Well With Dementia.

On Feb. 13, Kaiser Health News hosted an informative and important discussion about improving care and services for people with dementia and supporting their caregivers. It was opportunity to learn from experts in the field about the challenges and difficulties facing the patient, the caregiver, the community and policymakers. Topics included understanding the stages of dementia from a medical, social, psychological and environmental perspective (it’s not just memory loss); how to find help; how to manage difficult behaviors; and understanding medications for people with dementia.

The 90 minute discussion can be viewed by clicking here.

February 28, 2018 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Programs/CLEs, Webinars | Permalink | Comments (0)

Tuesday, February 27, 2018

Medicare Good News...and not... out of the Bipartisan Budget Act of 2018

As part of the Bipartisan Budget Act of 2018,  signed into law earlier in February, Medicare's therapy caps were repealed!  As explained by Justice in Aging in a recent fact sheet, ""[t]he law permanently repeals the payment cap on outpatient physical, occupational, and speech therapies effective January 1, 2018, and makes changes to the medical necessity review process for these services." As well, the law closes the donut hole one year earlier, "at which time beneficiaries will be required to contribute 25% to the cost of prescription drugs. This provision does not affect coverage for beneficiaries who receive the Part D low-income subsidy known as “Extra Help,” since they already don’t experience the donut hole."

Then there is the change to Home Health Care, starting in 2020, where "[t]he home health payment episode will be reduced from 60 days to 30 days and therapy thresholds will be eliminated. Beginning in 2019, Medicare will be allowed to base eligibility determinations for home health services on a review of the patient’s medical record including a home health agency’s record beginning in 2019."  As well, the Part B and D premiums for higher income beneficiaries will go up starting in 2019.

To read the entire fact sheet, click here.


February 27, 2018 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink

U.S. Supreme Court Agrees to Hear Death Penalty Case; Inmate Has Suffered Multiple Strokes & Dementia

One of my well-rounded Contracts students, Andrew Ford, pointed out to me that this week the Supreme Court agreed to hear the case of Madison v. Alabama, wherein the issue is whether execution of a prisoner violates the 8th Amendment if the inmate, who has experienced multiple strokes and vascular dementia, is now severely impaired and no longer has any memory of his crime.  From the Petition for Writ of Certiorari:

[T]he State seeks for the second time to execute Vernon Madison, a 67-year-old man who has been on Alabama’s death row for over 30 years. Mr. Madison suffers from vascular dementia as a result of multiple serious strokes in the last two years, and no longer has a memory of the commission of the crime for which he is to be executed. His mind and body are failing: he suffers from encephalomacia (dead brain tissue), small vessel ischemia, speaks in a dysarthric or slurred manner, is legally blind, can no longer walk independently, and has urinary incontinence as a consequence of damage to his brain.

Thank you, Andrew!  Here's the link to comprehensive coverage on the case from SCOTUS Blog

February 27, 2018 in Cognitive Impairment, Crimes, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Federal Cases, Federal Statutes/Regulations | Permalink | Comments (0)

Monday, February 26, 2018

Center for Medicare Advocacy Upcoming Conference

Registration is open for the Center for Medicare Advocacy's 5th Annual National Voices of Medicare Summit & Sen. Jay Rockefeller Lecture on March 22, 2018. The conference runs from 8:30 a.m. to 5 p.m. at the Kaiser Family Foundation, 1330 G Street, NW in Washington, D.C.  Here's a brief description about the program

Join us for our 5th annual National Voices of Medicare Summit & Senator Jay Rockefeller Lecture! Connect with leading experts and advocates to discuss best practices, challenges and successes in efforts to improve access to quality health coverage and care. Be a part of the conversation on health care activism, civic engagement, and efforts to preserve (and enhance) the Affordable Care Act, Medicare, and Medicaid. We're honored to have Senators Chris Murphy and Jay Rockefeller present to help participants think about building a healthy future for all Americans.

Senator Murphy from Connecticut will present the Rockefeller lecture.  For more information, click here.  To register, click here.

February 26, 2018 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare, Programs/CLEs | Permalink

PA Appellate Court Rules Against Elder Care Planning Company Suing Elder Law Attorney for Defamation

In a "nonprecedential memorandum" -- but still interesting opinion -- filed on February 14, 2018, the Pennsylvania Superior Court affirmed summary judgment in favor of defendants on an issue of defamation. The plaintiff is a retirement or planning company and the defendants are a law firm and an elder law specialist attorney in that firm.  The plaintiff alleged defamation and intentional interference with business relationships via letters on the law firm's letterhead that were signed by the defendant Attorney while serving on a county senior citizens board. 

The letters allegedly pointed to certain marketing presentations from companies that present programs on living trusts and estate planning, referencing plaintiff as "one such company." According to the court opinion, the "correspondence characterized the presentations as a 'sinister form of financial exploitation of the elderly' that 'often result in seniors losing thousands of dollars in unnecessary fees for documents they do not need,' and that 'can also result in the sale of investments that are not appropriate for seniors.'”   

The plaintiff Company's lawsuit was filed in January 2008.

The defendants sought summary judgment on the defamation count in October 2016.  

Under Pennsylvania statutory law, 42 Pa. C.S.A. Section 8343(a)(6), a plaintiff has the burden of proving specific elements of defamation including "special harm resulting to the plaintiff from . . . publication" of the alleged defamatory communication.  The defendants argued the plaintiff was unable to satisfy that element.

In the memorandum opinion, the Superior Court concluded:

Appellant incorrectly maintains that it did not have to prove the existence of any harm because the letter in question accused it of engaging in misconduct or fraud in marketing living trusts to senior citizens. While it did not have to establish economic loss, it did have to adduce some proof that its business reputation was affected by the communication. Appellant admitted to the trial court that it could present no witness to attest that its reputation in the community was harmed due to the dissemination of the correspondence in question. Since Appellant had the burden of proving that aspect of its defamation cause of action, summary judgment was properly entered herein.

For more, read the nonprecedential opinion in United Senior Advisors Group, Inc., v. Leisawitz Heller Abromowitch, Phillips., PC., and William R. Blumer.  The final footnote in the opinion suggests the summary judgment ruling resolves only the defamation count in this long running suit.  

February 26, 2018 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Sunday, February 25, 2018

Australia's 5th Annual National Elder Abuse Conference

I had the honor of attending and speaking at Australia's 5th Annual National Elder Abuse Conference, held recently in Sydney.  Speakers at the two day conference included many government dignitaries,  a series of concurrent sessions and a number of abstract presentations.  The conference offered a multi-disciplinary, multi-cultural focus and included a wide-range of topics over the conference.   I found the energy level and interest at this conference to be high.  I moderated a panel of law enforcement and community activists and their efforts are outstanding. One of the interesting points to me was that the problems they're facing here are so similar to those in the US.  Exchanging information about prevention and responses was very useful. Post-conference information about recordings of the  sessions will be available soon on the conference website.  This is a conference well worth attending, even though Australia is a bit of a trek from the US.  The conference rotates locations within Australia, so the website will also have information about dates and locations for the 2019 conference.

February 25, 2018 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, International, Programs/CLEs | Permalink

Md Court of Appeals Permits AG's "Improper Discharge" Suits Against Nursing Homes

As we've highlighted in recent posts on this blog, discharge or eviction of residents by nursing homes  -- also known as "patient dumping" -- is a hot topic right now, and the latest important news is from the highest tribunal in the State of Maryland, the Court of Appeals.  The Court tackles head-on the issue of who has the power to take action to address improper discharges.   

On February 20, 2018, the Maryland Court of Appeals concluded that as a matter of first impression, the Maryland Attorney General has the authority to bring suit on behalf of "multiple facility residents for unlawful discharge."  Further, the AG is permitted to seek injunctive relief to require a facility to assist residents receiving Medicaid benefits. 

In so ruling, the Court relied on specific provisions of Maryland's statutory Patient Bill of Rights (rather than similar federal law) enacted in the mid 1990s, saying the legislation demonstrated the General Assembly's clear "intent to limit involuntary discharges and transfers and to ensure that when they do occur, they are subject to procedural controls ensuring  a resident's health and safety." The Court did, however, look to federal precedent for authority to grant specific injunctive relief.

The Court rejected arguments by the challenging party, Neiswanger Management Services LLC, that operated 4 nursing facilities in Maryland.  The company claimed its signing of a Memorandum of Understanding with state authorities rendered moot all issues it had with the state.  As part of its ruling, the Court reviewed the history of State violations alleged against Neiswanger, including the State's assertion that during one 17-month period, Neiswanger had issued involuntary discharge notices to "at least 1,601 residents," in contrast to only 510 such notices issued during the same period of time by all of Maryland's other 225 licensed nursing facilities. The Court concluded, "Neiswanger has not met its burden of demonstrating to this Court that the case is moot."

There is a lot of meat to the ruling by the Maryland Court of Appeals, especially with respect to the impact of low reimbursement rates under Medicaid, as compared to Medicare's 100 days of coverage. For the full ruling, see  State of Maryland v. Neiswanger Management Services LLC.

For the AG's own description of the ruling, see the Maryland AG Press Release on February 21, 2018.

See also the recent Business Section article from the New York Times, How to Challenge a Nursing Home Eviction Notice and Other Tips.  

February 25, 2018 in Consumer Information, Current Affairs, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Friday, February 23, 2018

NYT: Focus is on Nursing Home Evictions and the Reality of Underfunding of Long-Term Care

The New York Times offers an important feature article, entitled Complaints About Nursing Home Evictions, and Regulators Take Note.  From the opening paragraphs:

Six weeks after Deborah Zwaschka-Blansfield had the lower half of her left leg amputated, she received some news from the nursing home where she was recovering: Her insurance would no longer pay, and it was time to move on.


The home wanted to release her to a homeless shelter or pay for a week in a motel.“That is not safe for me,” said Ms. Zwaschka-Blansfield, 59, who cannot walk and had hoped to stay in the home, north of Sacramento, until she could do more things for herself — like getting up if she fell.


Her experience is becoming increasingly common among the 1.4 million nursing home residents across the country. Discharges and evictions have been the top-ranking category of grievances brought to state long-term care ombudsman programs, the ombudsman agencies say.

This article is definitely worth a careful read.    

February 23, 2018 in Consumer Information, Current Affairs, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Thursday, February 22, 2018

Federal Authorities Coordinate Filing of Charges Against Individuals and Companies on Telemarketing and Postal Mail Fraud Schemes

On Thursday, February 22, 2018, federal authorities released news of formal charges filed against individuals and companies accused of telemarketing and postal fraud schemes targeting seniors.  The charges focus on more than 250 defendants, located both in and outside of the U.S.

The Federal Trade Commission's press release provides specific details from two cases filed in coordination with authorities in the State of Missouri.  In the first case:

[T]he FTC and the State of Missouri charged two men and their sweepstakes operation with bilking tens of millions of dollars from people throughout the United States and other countries.


The FTC and Missouri allege that the defendants, doing business under dozens of different names, sent tens of millions of personalized mailers falsely indicating that the recipient had won or was likely to win a substantial cash prize, as much as $2 million, in exchange for a fee ranging from $9 to $139.99.

 The Defendants distributed three types of phony mailers:        

  • Notices such as “Congratulations, You Have Just Won $1,230,946.00,” when the consumer hasn’t actually won anything;
  • Fliers that claim the recipient can win a substantial cash prize by answering a simple arithmetic question and paying  a registration fee, but that don’t disclose that there are multiple rounds to the “game of skill,” that the consumer will have to pay additional fees to advance to each round, and that in order to win, the consumer will have to answer a final, complex puzzle that few people, if any, can solve; and
  • Mailers that appear to be notices that the consumer has won a prize of $1 million or more, but that are really just newsletter subscription solicitations.

In the second case: 

[T]he FTC alleges that the defendants worked with Indian telemarketers to trick older Americans into buying bogus technical support services. Specifically, the defendants set up business accounts for the telemarketers, collected and deposited consumer payments, and provided a gloss of legitimacy to the scheme.

During my sabbatical last year, I often had occasion to answer the phone in my elderly mother's home. The majority of calls were from scammers, including those posing as the IRS, those offering "specialized health insurance," or seeking to "confirm" the homeowners' bank numbers for deposit of some kind of "winnings."  I was stunned by the volume of the calls -- and the persistence of the callers. If you tried to hang up, the callers would often ring back within seconds.  

Also, during my time as director of  Dickinson Law's Elder Protection Clinic, I can remember one particularly troublesome case involving a so-called Jamaican lottery scam, where the senior in question had been a sophisticated investor for her entire adult life, but was unable to resist the siren song of a scammer who managed to convince her to repeatedly send him money.  It was one of my first personal experiences with how dementia and financial abuse can intersect, through a particular form of early onset dementia known as FTD (frontotemporal disease).  The impairment often impacts judgment and the ability to evaluate risk, including financial risk.  

February 22, 2018 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Cases, Federal Statutes/Regulations, State Cases, State Statutes/Regulations | Permalink | Comments (0)