Monday, May 8, 2017
The Elder Justice Initiative (EJI) has announced the release of a guide and toolkit for creating Multi-Disciplinary Teams (MDT). The EJI has an MDT Technical Assistance Center (or MDT TAC). EJI is also offering a free webinar to help users get started creating an MDT. The email announcement explains how to get started:
The Elder Justice Initiative (EJI) is pleased to announce the launch of the new Multidisciplinary Team Guide and Toolkit. The Toolkit is designed for anyone looking to create or grow a local elder abuse MDT, regardless of their experience with MDTs. The web-based Toolkit is enhanced for use on mobile devices and contains easy-to-download PDF sample documents and citations.
On May 30, take a live walk through the Toolkit. The EJI webinar will cover many aspects of the Toolkit, including:
Layout and usability
Highlights from each chapter
Questions and feedback
Justice in Aging, the Center for Medicare Advocacy and the National Consumer Voice for Quality Long-Term Care have issued another in the series of issue briefs about the revised nursing home regulations. Return to Facility After Hospitalization covers several important topics including notice, bed holds, right to return and appeal rights. Here is the executive summary:
Bed hold rights are set by state law. Federal law complements state law by requiring facilities to notify residents of those rights. Notice of bed hold rights must be provided at two separate times: in advance of a hospitalization, and at the time of transfer to a hospital. The advance notification must include the resident’s right to a bed hold, whether the state’s Medicaid program pays for a bed hold, and the facility’s bed hold policies (which must be consistent with state and federal law). The time-of-transfer notification must describe the resident’s bed hold rights under the facility’s policy.
Federal law also establishes a resident’s right to return to the facility even if a bed hold period has been exceeded, or if the resident did not have a bed hold. The resident can return to her previous room if available, or to the next available room if the previous room is not available. The regulations specify that the resident can request a transfer/discharge hearing if the facility refuses to accept her back.
Thursday, May 4, 2017
The SEC approved: (1) the adoption of new FINRA Rule 2165 (Financial Exploitation of Specified Adults) to permit members to place temporary holds on disbursements of funds or securities from the accounts of specified customers where there is a reasonable belief of financial exploitation of these customers; and (2) amendments to FINRA Rule 4512 (Customer Account Information) to require members to make reasonable efforts to obtain the name of and contact information for a trusted contact person for a customer’s account. New Rule 2165 and the amendments to Rule 4512 become effective February 5, 2018.
The full notice is available as a pdf here. The text of the new rule starts on page 9 of the full notice.
Here is the background from the notice, to give you more information about the reasons behind this rule
With the aging of the U.S. population, financial exploitation of seniors is a serious and growing problem. FINRA’s Securities Helpline for Seniors® has highlighted issues relating to financial exploitation of this group of investors, including the need for members to be able to more quickly and effectively address suspected financial exploitation of seniors and other specified adults The amendments to Rule 4512 and new Rule 2165 provide members with a way under FINRA rules to respond to situations in which they have a reasonable basis to believe that financial exploitation has occurred, is occurring, has been attempted or will be attempted. Members can better protect their customers from financial exploitation if they have the ability to contact a customer’s designated trusted contact person and, when appropriate, place a temporary hold on a disbursement of funds or securities from a customer’s account. (citations omitted)
Take a look!
Wednesday, May 3, 2017
Justice in Aging announced the release of two additional issue briefs concerning the revised nursing home regs. One brief concerns quality of care and the other, grievances and resident/family councils.
The executive summary for the quality of care issue brief explains
The substantive requirements for quality of care are retained in the revised regulations, and the Centers for Medicare & Medicaid Services (CMS) affirms the regulations’ overriding goals: supporting person-centered care and enabling each resident to attain or maintain his or her highest level of well-being. Finding all of the requirements presents a challenge, however. CMS has significantly reorganized the quality of care provisions, moving some provisions to other regulatory sections, expanding the standards of the prior regulations, and adding several entirely new requirements.
The executive summary for the grievances and resident/family councils issue brief explains:
Residents have the right to file grievances and the facility must work to resolve those concerns promptly. A grievance official at the facility is responsible for complaint handling. Each facility must have a grievance policy and provide residents with information about how to file a grievance, how to contact the grievance official, a time frame for complaint review, a written decision, and information about other entities with which grievances can be filed. Written decisions must include, but are not limited to, the steps the facility took to investigate the complaint, the findings, whether the complaint was confirmed or not, and the action the facility has taken or will take to correct the problem.
The resident has a right to: form and participate in a resident council; have family member(s) or other resident representative(s) meet in the facility with the families or resident representative(s) of other residents; and participate in the family council. There must be a staff person assigned to assist both resident and family councils and the council, along with the facility, must approve this person. The councils must be given a private space in which to meet and no one outside of a resident or family member can attend without invitation. The facility must act upon council concerns and recommendations and provide a reason for its decision, although it does not have to implement all that the councils request.
All of the issue briefs are available here.
Monday, May 1, 2017
I blogged a few days ago about an upcoming hearing for the Senate Committee on Aging. That hearing, on April 27, 2017, concerned the Mental and Physical Effects of Social Isolation and Loneliness. Testimonies from the hearing can be accessed here.
The April 27, 2017 hearing was the first of two parts looking into the issue. As noted in the first hearing
The risks of social isolation and loneliness compare with smoking and alcohol consumption and exceed those associated with physical inactivity and obesity. According to researchers, prolonged isolation is comparable to smoking 15 cigarettes a day. Isolation and loneliness are associated with higher rates of heart disease; weakened immune system; depression and anxiety; dementia, including Alzheimer’s disease; and nursing home admissions.
The next hearing is set for May 10, 2017 and will focus on Aging With Community: Building Connections that Last a Lifetime.
Late last week I learned that CMS may be reversing course on prohibiting pre-dispute arbitration clauses in nursing home admission contracts. I couldn't decide if my response should be "say it isn't so" or "you have got to be kidding me". Nevertheless, Justice in Aging reported in their weekly newsletter, This Week in Health Care Defense that:
CMS Backtracks on Nursing Home Arbitration Prohibition
As part of last year’s revision of nursing facility regulations, CMS prohibited federally-certified nursing facilities from obtaining arbitration agreements at the time of admission. CMS concluded that it was unfair to have residents and families waive legal rights during such a difficult and chaotic time. Now, however, CMS has reversed course and has filed language that would revise the regulation to allow facilities to obtain arbitration agreements at admission. For more on the revised regulations, see the series of issue briefs developed by Justice in Aging in partnership with the Center for Medicare Advocacy and the National Consumer Voice for Quality Long Term Care.
Thursday, April 27, 2017
May is the time of many things. Spring is in full swing, flowers are blooming, we celebrate mothers, the school year is ending, and more. Not only that, May is also Older Americans month and National Elder Law month. The Administration for Community Living (ACL) has a website dedicated to older Americans month. The theme for 2017 is Age Out Loud. Need ideas for events? ACL offers that here. Helpful hints for using social media are offered as well.
Elder Law attorneys... are you considering an event or activity? Need ideas? Take a look at NAELA's toolkit for National Elder Law month. Although it's the end of the academic year, consider involving your students in planning and offering events.
If you have something planned, share it with the rest of us?
Wednesday, April 26, 2017
Justice in Aging has announced a free webinar for May 17th, 2017 from 2-3 edt on Elder Financial Abuse & Medicaid Denials. Here is a description of the webinar
Financial exploitation can devastate low-income older adults, especially those who rely on Medicaid for their health and long-term care. For example, older adults who are victims of financial abuse may be denied eligibility for Medicaid because their abuser won’t turn over their bank records. Without Medicaid eligibility, the older adult may be threatened with eviction or involuntary discharge from a nursing home because of nonpayment. Legal services are critical to helping older victims of financial exploitation receive the medical care and services to which they are entitled. Join us for Elder Financial Abuse and Medicaid Denials to learn how to identify victims of elder financial abuse, what problems this exploitation can cause for Medicaid eligibility, and how legal services attorneys can help their older clients receive the benefits they need and prevent future problems accessing Medicaid.
To register for the webinar,https://attendee.gotowebinar.com/register/5875005469626032643?source=SALSA. Did I mention, it's free!
April 26, 2017 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Programs/CLEs, Webinars | Permalink | Comments (0)
Tuesday, April 25, 2017
The Senate Special Committee on Aging has a hearing scheduled for April 27, 2017 starting at 9:45 a.m. The topic of the hearing: Aging Without Community: The Consequences of Isolation and Loneliness. Four witnesses are scheduled to testify, including two academics and the head of a Council on Aging from Pima County, Arizona. Video of testimony and resources will be posted to the committee's hearings website subsequently. Stay tuned.
Monday, April 24, 2017
Last week Kaiser Health News (one of my favorite go-to sites) ran this story, How To Help Alzheimer’s Patients Enjoy Life, Not Just ‘Fade Away’. The article opens explaining that Alzheimer's is #1 on the list of diseases folks in the U.S. most fear. The loss of self is a big part of that fear. However, "a sizable body of research suggests this Alzheimer’s narrative is mistaken. It finds that people with Alzheimer’s and other types of dementia retain a sense of self and have a positive quality of life, overall, until the illness’s final stages... They appreciate relationships. They’re energized by meaningful activities and value opportunities to express themselves. And they enjoy feeling at home in their surroundings."
Just how many folks with Alzheimer's have a good quality of life? According to Dr. Peter Rabins, "[o]verall, about one-quarter of people with dementia report a negative quality of life, although that number is higher in people with severe disease.” What are the implications of this? To make sure that folks with Alzheimer's have a quality of life, "[promote] well-being [which] is both possible and desirable in people with dementia, even as people struggle with memory loss, slower cognitive processing, distractibility and other symptoms."
Folks with severe or end-stage Alzheimer's present a different challenge. For others, the article suggests the following: emphasis social connections, maximize physical health, improve communications, respond to unmet needs, and give deference to individuality and autonomy.
"None of this is easy. But strategies for understanding what people with dementia experience and addressing their needs can be taught. This should become a priority, Rabins said, adding that 'improved quality of life should be a primary outcome of all dementia treatments.'"
Sunday, April 23, 2017
Justice in Aging has released a new fact sheet, New Guidance from SSA on Spousal & Survivors Benefits for Married LGBT Individuals. "On March 1, 2017, the Social Security Administration (SSA) announced it would reopen any decision to deny spousal or survivors benefits to a same-sex spouse based on a discriminatory marriage ban, which resulted in a loss of benefits to the individual who filed the claim." The fact sheet notes an SSA ruling and POMS. "This policy change applies to applications for spousal or survivors benefits that SSA denied prior to the Windsor and Obergefell decisions because it did not recognize their marriages. Even those who began receiving SSA benefits following the Supreme Court decisions may be due retroactive benefits for the period between when they first applied (and were denied) and when SSA finally recognized their marriage." The fact sheet also explains who is not affected as well as who might be. The fact sheet concludes explaining that SSA is in the process of reaching out to 800 beneficiaries whose benefits were denied to tell them their applications are being reopened.
Click here to read the full fact sheet.
Thursday, April 20, 2017
The New York Times ran an article earlier this month about a 94 year old genius. To Be a Genius, Think Like a 94-Year-Old features Dr. John Goodenough. who "at 94, has just set the tech industry abuzz with his blazing creativity. He and his team at the University of Texas at Austin filed a patent application on a new kind of battery that, if it works as promised, would be so cheap, lightweight and safe that it would revolutionize electric cars and kill off petroleum-fueled vehicles." Back when Dr. Goodenough was 23 and starting college, he was told by a professor that he was too old to succeed in his chosen field of physics. The article mentions how for some creativity increases with age but there are biases and hurdles in their way.
At least in Silicon Valley, the article notes, youth seems to be the common denominator. But, for others "there’s plenty of evidence to suggest that late blooming is no anomaly. A 2016 Information Technology and Innovation Foundation study found that inventors peak in their late 40s and tend to be highly productive in the last half of their careers." Even someone from the Patent Office has noticed that “there’s clear evidence that people with seniority are making important contributions to invention.”
The author asks Dr. Goodenough for his thoughts.
When I asked him about his late-life success, he said: “Some of us are turtles; we crawl and struggle along, and we haven’t maybe figured it out by the time we’re 30. But the turtles have to keep on walking.” This crawl through life can be advantageous, he pointed out, particularly if you meander around through different fields, picking up clues as you go along. Dr. Goodenough started in physics and hopped sideways into chemistry and materials science, while also keeping his eye on the social and political trends that could drive a green economy. “You have to draw on a fair amount of experience in order to be able to put ideas together,” he said.
Plus being a 94 year old scientist is freeing. "Last but not least, he credited old age with bringing him a new kind of intellectual freedom. At 94, he said, 'You no longer worry about keeping your job.'"
Wednesday, April 19, 2017
Kiplinger ran an article in their April issue on Dealing With Debts After Death explaining what adult children should do when their parents die with debts. Oftentimes the adult kids get an unpleasant surprise when they learn that their parents left debts behind. The article explains how in many instances the parents don't tell their kids about the debts, for various reasons. The article also references some statistics about increasing amounts of debt of elders. The article stresses how important it is for the adult kids to understand the implications of these debts and what, if any, debt for which they are responsible. The article discusses credit card debt, student loan debt, and mortgages. The article is useful not only for a quick discussion in classes, but to help students understand debt and liability. Check it out!
Tuesday, April 18, 2017
I had mentioned a new book on Monday at the bottom of my post, congratulating the authors, Naomi Cahn and Amy Ziettlow. The book, Homeward Bound: Modern Families, Elder Care, and Loss is published by Oxford University Press (April 2017) and runs 240 pages. The book is available to order from a number of book sellers. Last week the authors wrote on the Institute for Family Studies blog explaining the background of and catalyst for this book. Homeward Bound: Lessons on Modern Families and Elder Care
In 2010, we began the Homeward Bound project, hoping to study the intersection of modern families and elder care because we saw, all around us, how elder care is changing. Seven years later, it is exciting to see the results of the project in the form of a published book, Homeward Bound: Modern Families, Elder Care, and Loss, and to share some of what we learned in this post.
The catalyst for the project was a conversation with a dear friend of ours, Julie, whose Baby Boomer parents are divorced; each parent then remarried and divorced again. One of Julie’s ex-stepparents—her ex-stepmother Tina—was about to undergo critical surgery, and Julie didn’t know what to do. Tina had been married to Julie’s father for 15 years, starting when Julie was a toddler. While Julie was growing up, she spent holidays with her father and Tina. After the divorce, Julie no longer visited Tina, but they remained in regular contact by phone and email over the years. Julie fondly remembers how Tina mothered her during childhood illnesses and crises, and she felt some responsibility for Tina, especially since Tina had no children of her own. However, Julie felt overwhelmed as she thought of handling all of the medical, financial, and legal caretaking that her parents, stepparents, and ex-stepparents would need from her as they aged. Julie, who also has two young children, explained that she simply was not prepared financially or emotionally to care for all the people who might need her—and she felt alone in her worries, with few resources and little support.
So that explains the reasons and inspiration for the book. As far as what the authors learned, they explain the 3 lessons:
- Families shape the quality of the elder care and grieving experience of grown children...
- Formal planning helps facilitate a positive experience.... and
- Families rely on medical, legal, and religious professionals to begin and guide the decision-making conversation in a way that is catered to their unique structure....
But, overall they learned there is room for hope but a need for action. "Many family members showed great resilience in finding ways to understand each other, to work together to each contribute something to the care process, and to decide that they would remain a family after the death of one of its members. In other families, the lack of shared norms and an absence of experienced professional support meant that caretaking and grief became a time of division, rather than unity. But, as we also learned, the time to plan is now."
Congratulations Naomi and Amy!
Monday, April 17, 2017
Register now for Justice in Aging's latest webinar, Older Adults & Immigration. The webinar is set for Friday April 21, 2017 from 2 p.m. to 3 p.m. edt. Oh, and did I mention, it is free! Here's a description of the webinar
Are your immigrant senior clients coming to you with immigration-related questions? Recent events may leave your immigrant senior clients understandably confused. Need clarification on an immigrant older adult’s eligibility for safety net programs like Medicaid or SSI? Join Justice in Aging as we host a special immigration law webinar with our partners from the National Immigration Law Center. Intended for an audience who work with low income seniors but who are not familiar with immigration law, this webinar will cover basic topics, like:
• Different types of immigrants in our communities;
• Rights and protections for immigrant seniors;
• Immigrant senior eligibility for SSI, Social Security, Medicare, and Medicaid; and
• Resources for individual assistance
This free webinar will also highlight some of the recent events affecting immigrant seniors and how they may be affected by changes in government policies.
To register, click here.
Sunday, April 16, 2017
The New York Times ran a story a few days ago about preventing financial exploitation. Declaring War on Financial Abuse of Older People starts with the story of a woman who acts when she finds out her grandmother had lost her life savings. (Just fyi, her grandmother's case was featured in a story in the New York Times in 2015). The woman didn't stop with just her grandmother's case, however. First she pushed to get action for her grandmother. Then, the story explains, she "[became] an activist, traveling around her home state of Washington to lecture and testify about the financial exploitation of older Americans. She has also become a lobbyist, exhorting state lawmakers to pass legislation that would toughen penalties for people who take financial advantage of vulnerable older people like her grandmother."
The article notes the variations among state financial exploitation statutes and how some states don't have specific elder financial exploitation statutes
A number of states have laws like this on the books, but they vary widely. According to the National Conference of State Legislatures, which tracks such laws, this type of financial abuse is an active topic in state capitals. Last year, 33 states, as well as the District of Columbia and Puerto Rico, considered measures against the illegal or improper use of seniors’ money, property or assets, in addition to fraud or identity theft targeting the older people.
Some states have shored up their existing laws. Last year, Idaho revised its definition of neglect of vulnerable adults to include exploitation. Illinois extended the statute of limitations to seven years from three for prosecuting a person accused of taking financial advantage of an older person or a person with disabilities.
Also, last year, Alabama passed the Protection of Vulnerable Adults from Financial Exploitation Act, to add a layer of protection to existing laws by requiring brokers and investment advisers who believe a vulnerable adult is being exploited to notify the Human Resources Department and the Alabama Securities Commission.
In those states without the specific statutes, convictions come with lesser penalties than those with specific elder financial exploitation statutes. "Stiffer penalties are necessary to combat a growing drain on the savings of those 60 and over, according to the National Center for Elder Abuse, a federal clearinghouse. In 2015, in Washington state alone, there were nearly 8,000 complaints to adult protective services about financial exploitation, a more than 70 percent increase over 2010. And such crimes are likely to climb simply because the retiree population is growing."
The article also discusses efforts at the federal level, including the Elder Justice Act and the efforts of the Department of Justice.
Thanks to Professor Naomi Cahn for bringing the article to our attention. Congratulations to Naomi and her co-author Amy Ziettlow on the publication of their book, Homeward Bound: Modern Families, Elder Care, and Loss.
Friday, April 14, 2017
The AARP blog, Thinking Policy last week posted about new data: Labor force participation rate for people ages 55+ edges up in March
The monthly Employment Situation Report from the Bureau of Labor Statistics (BLS) shows the economy added 98,000 jobs in March 2017 — an unexpectedly smaller increase from the first two months of the year. The number of persons ages 55+ who are employed increased slightly from February. Meanwhile, the unemployment rate for those ages 55 and older remained unchanged, at 3.4 percent and approximately 1.2 million unemployed. The percentage of the 55+ population that is either working or actively seeking work, i.e. the labor force participation rate, increased slightly to 40.1 percent. The labor force participation rate of persons ages 55+ has remained at around 40 percent throughout the past year. In March the labor force participation rate of men ages 55+ was 46.1 percent, compared with 34.9 percent for women ages 55+.
The post specifically examines the data about women in the workforce, with the highest percentage of those 55 and older hitting the high in 2013. "Education has been a key factor influencing women’s labor force participation and is likely to continue to have an impact in the future. Over the past several years, women earned the majority of college degrees of all levels. If this trend continues, employers faced with the need for college-educated workers are likely to seek more ways to attract and retain female employees. This in turn may influence the number of women in the labor market – and the number who continue to work at older ages."
Thursday, April 13, 2017
Registration is now open for Stetson's annual Fundamentals of SNT Administration webinar. This half-day webinar is scheduled for May 5, 2017 from 1-5 p.m. The 4 speakers will cover topics on how to become a SNT administrator, Tax issues when making distributions, services and products a SNT administrator can provide, and an update on the laws, regs and POMS. The agenda is available here and registration is available here. (you can register online and fill out and submit a pdf).
Full disclosure, I'm the conference chair. Hope to see you virtually at this webinar!
Wednesday, April 12, 2017
NAPSA and NCPEA have released a research to practice brief on Correlates of Depression in Self-Neglecting Older Adults: A Cross-Sectional Study Examining the Role of Alcohol Abuse & Pain in Increasing Vulnerability Here is the summary from this one page brief:
Older adults with confirmed self-neglect report high rates of depressive symptoms. It has been estimated that between 50-62% of older adults with confirmed self-neglect suffer from at least sub-clinical levels of depressive symptomatology. Depressive symptoms in this population have been linked to untreated medical conditions. Further study is needed to understand the association between elder self-neglect and depressive symptoms, including studies determining potential correlates of depression in this population. Identifying such correlates could inform clinical social work and other mental health approaches for reducing depressive symptoms and self-neglect behaviors in this population. The cur-rent cross-sectional study reviewed a host of self-reported cognitive, functional, demo-graphic and clinical measures and identified a positive history of alcohol abuse, low self-rated health and pain as significant correlates of depressive symptomatology in older adults with Adult Protective Services (APS) validated self-neglect. Those with a positive screen for prior alcohol abuse were approximately 3 times more likely to have at least sub-clinical depression (Geriatric Depression Scale-15 >4). Having lower self-rated health was associated with a 53% increase in the likelihood of reporting at least sub-clinical depression. Reporting pain was associated with a 37% increase in the likelihood of reporting at least sub-clinical depression. These findings did not allow for establishing a temporal direction between depression, history of alcohol abuse, low self-rated health or pain. Nevertheless, they do provide insight into possible targets for improving out-comes in elder self-neglect populations given their evidence-based associations with both depression and self-management activities including accessing healthcare and completing activities critical for safety and protection.
Tuesday, April 11, 2017
The National Center on Elder Abuse released a new research to practice brief on Decision-Making Ability and Risk of Elder Mistreatment. This is the introduction to the brief:
There are many factors relevant to decision-making ability of older people including changes in the brain and cognition and social functioning. These changes can result in decision-making impairments that affect an older person’s ability to pay bills, drive, follow recipes, adhere to medication schedules, or refuse medical treatment (Braun & Moye, 2010; IOM, 2015). Decision-making ability may fluctuate at a given point in time (Falk et al., 2014), and while an older person may lack decision-making ability in one area, they may retain it in other areas (Braun & Moye, 2010). Decision-making ability is of special concern for the field of elder mistreatment because impaired decision-making can lead to an increased risk for abuse and exploitation among older people (Spreng et al., 2016). Thus, understanding the many factors relevant to decision-making ability is imperative to reduce risk of abuse and exploitation while maintaining and promoting autonomy among older people.
The 4 page brief covers key terms, explains how cognitive aging and capacity affect decision-making, the differences between medical decisional capacity and financial capacity and risk factors for financial exploitation. This would be great to use in our classes!