Friday, August 26, 2016

The CNA Conundrum: Background Checks, Continuing Education & Licensure

The long-term care industry depends hugely on the services of "nursing assistants," also known as NAs, who provide basic but important care for residents or patients under the direction of nursing staff (who, in turn, are usually Licensed Practical Nurses or Registered Nurses). As the U.S.Department of Labor describes, NAs typically perform duties such as changing linens, feeding, bathing, dressing, and grooming of individuals. They may also transfer or transport residents and patients. Employers may use other job titles for NAs, such as nursing care attendants, nursing aides, and nursing attendants. However, the Department of Labor makes a distinction between NAs and other key players in long-term care, including "home health aides," "orderlies," "personal care aides" and "psychiatric aides." 

According to DOL statistics, the top employers of NAs include skilled nursing facilities (37% of NAs), continuing care retirement communities and assisted living facilities (together employing some 18% of NAs), and hospitals and home care agencies, which each employ about 6% of the NA workforce.  

For many years, states have offered licensing for nursing assistants.  The designation of CNA or "certified nursing assistant" meant that the nursing assistant had satisfied a minimum educational standard and had successfully passed a state exam.  As another key protection for vulnerable consumers, CNAs had to pass background checks, involving fingerprints and criminal history searches.

In Arizona, however, now I'm hearing a new label:  LNAs or Licensed Nursing Assistants.  The Arizona Board of Nursing continues to license CNAs, but now it is offers the designation of Licensed Nursing Assistants. What's the difference?  Frankly, not much, at least in terms of skill levels. Then why the change?

In Arizona, CNAs and LNAs have the same educational requirements, and must pass the same test and satisfy the same work credits. But, as of July 1, 2016, individuals seeking the LNA designation will be required to pay the state a fee to cover their mandatory background checks, including fingerprinting.  CNAs, however, will no longer be required to undergo background checks or fingerprinting.  

What is this about? Arizona is trying to save money.  It seems that state and federal laws prohibit state authorities from mandating that CNA candidates cover the cost for their own background checks.  In other words, if the candidate showed financial need in the application process, the state was required to pick up the costs for any background checks. Let's remember that the average wages of CNAs are relatively low -- the national mean is less than $30,000 per year. Presumably that is the reason behind the older laws limiting how much states can charge CNA applicants for their own background checks. By creating a new designation, LNA, Arizona takes the position it avoids the federal restriction.

But, what about the public?  Will the public understand that CNAs licensed after July 1, 2016 will not be subject to fingerprinting and background checks?   Responsible employers would, presumably, require such checks or limit their hires to LNAs.   At least, let's hope so.

I also learned that apparently Arizona does not require "continuing" education for either CNAs or LNAs.  (Again, you would hope that responsible employers would either provide or require such education.)  Arizona used to require a minimum of 120 hours every 2 years of what are, in essence, "job credits" -- i.e., proof of employment in an NA position -- to maintain the CNA license.  Recently, however, Arizona diluted that requirement to just 8 hours every two years for both CNAs and LNAs.  

Arizona does have a useful website where current or prospective employers, including families, can check the licensing status of CNAs or LNAs. The website is searchable by name or license number, and shows whether an applicant has failed the entrance exam, or has withdrawn an application or lost the license.  

Are other states creating this LNA designation as a "workaround" (loophole?) for financing background checks for CNAs?  Let us know!  

August 26, 2016 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)

Thursday, August 25, 2016

Positive Aging-The "Iron Nun"

I was happy to see Nike's latest commercial for its Unlimited campaign featuring the triathlete dubbed the Iron Nun. According to an article in the Huffington Post, "Buder said that she manages to fit her training for these races in with her daily life. The sister, who is part of a nontraditional religious order called the Sisters for Christian Community, runs to her church in Spokane, Washington. She also runs to the local jail, where she volunteers to chat with inmates."  I suspect the narration for the commercial is intended as amusing since it relies on aging stereotypes, but the Sister's accomplishments blow those stereotypes out of the water.  Ad of the Day: Nike Celebrates the 'Iron Nun', an 86-Year-Old Triathlete With God on Her Side features the ad, as well as the behind the scenes interview with the sister without the narration. The quote I liked from Sister Buder:   "the only failure is not to try".  Huffington Post quotes from an article on her in Cosmo, "Don’t pay attention to how old you are, only focus on how old you feel ... And be patient — one of my worst enemies is patience, I’m still trying to fine-tune it so that I’m able to stop and smell the roses.”

Kudos Sister for your accomplishments!

August 25, 2016 in Current Affairs, Health Care/Long Term Care, Other, Sports | Permalink | Comments (0)

Aging Solo

Last week we blogged about those elders who have no kids to be their caregivers. The Washington Post featured an article on the topic of "aging solo".  Aging Solo: Okay, I don’t have a child to help me, but I do have a plan, told from the perspective of the author, is an attention-grabber from the beginning

“The trouble is: You think you have time.” That Buddhist-sounding quote from a fortune cookie rattled around the back of my head for decades, seemingly for no reason. Now that I find myself living with my 94-year-old mother in a Florida city where preacher Billy Graham got his start and being a never-wed 60-something has made me a tourist attraction of sorts, I finally understand why I thought the repercussions of growing old without a child or two would not apply to me: I was just plain delusional.

As a New Yorker flush with friends, freelance work, Broadway tickets and great Botox, I had apparently existed in some sort of fun, singles bubble. It was a lifestyle so rewarding that I never read even one article about the stresses of the “sandwich generation.” (Hey, the writers all seemed to be married women with children, so even on a boomer-to-boomer level, I could not relate.)

Of course she's not alone. The article provides statistics--almost 33% of the Boomers have no kids. "That doesn’t count boomer parents who have lost a child or have one who is severely impaired. The Aging Solo pool also includes countless members of families plagued by addiction, disease, cults, rapacious children, even married progeny who much prefer their in-laws. While millions of Aging Soloists have siblings and other kin, many of us can’t imagine (or abide) having them shepherd us to our final rest."

The author calls for an aging plan with friends rather than kids, and using her parents' story as educational,  she offers this advice "When you’re past 50 and single, location is 75 percent of the enchilada. Subways matter. Proximity to friends matters. Suburban seniors communities felt to me like slow death. I found senior centers and assisted-living facilities profoundly lonely because, it seems, the art of making friends does not grow as we age, and not everyone likes endless bingo and dominoes on Tuesdays, followed by a prayer service."

She goes on to offer further tips

It’s better to plan a more personal assisted-living future with your own friends while in your 50s or 60s. That will give you time to choose a location with diverse people and culture, with neighborhoods that have sidewalks and public transit....

Sharing resources can spawn all sorts of possibilities. Maybe my posse grabs several apartments in rental, condo or co-op buildings, or we share a group house in D.C., Manhattan or L.A. Heck, maybe we can find a way to lease a floor in one of the many overbuilt office buildings around the country. Perhaps (if yours is an anti-urban posse) you can hire an architect to design space-age yurts in Arizona. Each madly hip structure would be self-contained, but the colony would have a common dining hall, gym and tech-support center, or whatever your future selves desire.

New to the finances of aging, I had no idea how much control I gained by holding my mother’s durable power of attorney. Had I been less ethical, I could have taken her money and run. Therefore, I’ll never give that power to any one person; it will be held by at least three younger and devoted friends because elder fraud is one of the most horrifying aspects of aging solo. Trust me: That charming new friend who offers to manage your money so you don’t have to deal with “all those bills” is probably well known to the local police.

So what is the author doing to prepare for her aging without kids?  She explains

What am I doing? Well, I’ve started small, using Skype dialogues with my pals to research and download the legal papers — from wills to end-of-life instructions — that we will need, sooner or later. Now we’re aiming higher. Should we learn what to look for in a nurse’s résumé so we can find the right person to help us in our collective dotage? Should we hire a visionary architect to create a high-tech trailer park or a cluster of tiny homes built around communal buildings? Our ideas are still all over the map.

We hope we have time to execute our most appealing visions. Mostly, however, we pledge to be our own Best Friends. United. Forever.... 

August 25, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Other | Permalink | Comments (1)

Washington Post: Legal Counsel for the Elderly Is Part of One Woman's Story

The Washington Post has a fascinating piece about Wanda Witter's decades-long battle with the Social Security Administration. At the age of 80, Wanda's story appears to be one of success, after many years of living in shelters and on the streets of D.C..  

At the shelters all those years, Witter tried to get someone to listen to her. She explained at different offices providing homeless services that those suitcases contained the evidence. She was owed money, lots of money, and she could prove it.

 

Witter is not a particularly warm or outgoing person. She isn’t rude, just direct. And suspicious of just about everyone. And obsessed with Social Security.

 

“They kept sending me to mental counselors. I wasn’t crazy. I wasn’t mentally ill,” she said.

With the help of the Washington Legal Clinic for the Homeless, Legal Counsel for the Elderly (LCE) and a dedicated, patient and persistent social worker, Julie Turner, it appears that Ms. Witter is now in her own apartment and will receive some $100,000 in back Social Security payments.  

For the full story, read "'I Wasn't Crazy.' A Homeless Woman's Long War to Prove the Feds Owe Her $100,000."  

August 25, 2016 in Ethical Issues, Federal Statutes/Regulations, Housing, Legal Practice/Practice Management, Social Security | Permalink | Comments (0)

Wednesday, August 24, 2016

Sicker on Admission, Not 100% on Discharge?

The Kaiser Health Network (KHN) and U.S. News ran a story in July about elders' admission to hospitals. They may be sicker on admission and when discharged, may not be able to care for themselves, needing help with ADLs. Elderly Hospital Patients Arrive Sick, Often Leave Disabled focuses on how hospitals care for elders, and a "trend" to create a special unit just for patients who are elderly.

How hospitals handle the old — and very old — is a pressing problem. Elderly patients are a growing clientele for hospitals, a trend that will only accelerate as baby boomers age. Patients over 65 already make up more than one-third of all discharges, according to the federal government, and nearly 13 million seniors are hospitalized each year. And they stay longer than younger patients.

Many seniors are already suspended precariously between independent living and reliance on others. They are weakened by multiple chronic diseases and medications.

One bad hospitalization can tip them over the edge, and they may never recover, said Melissa Mattison, chief of the hospital medicine unit at Massachusetts General Hospital. “It is like putting Humpty Dumpty back together again,” said Mattison, who wrote a 2013 report detailing the risks elderly patients face in the hospital.

If one considers the special circumstances for elder patients, it makes sense that hospitals may want to be prepared for these patients. But, the way the medical system works currently, "the unique needs of older patients are not a priority for most hospitals... Doctors and other hospital staff focus so intensely on treating injuries or acute illnesses — like pneumonia or an exacerbation of heart disease — that they can overlook nearly all other aspects of caring for the patients" according to one expert quoted for the article.

Some hospitals have special units for these patients, referred to as Acute Care for Elders (ACE) units. "ACE units have been shown to reduce hospital-inflicted disabilities in older patients, decrease lengths of stay and reduce the number of patients discharged to nursing homes. In one 2012 Health Affairs study,  ... researchers found that hospital units for the elderly saved about $1,000 per patient visit." Not only do these units save money, according to the article, patients in these units seem to be better when discharged. 

If you discuss this in class, have your students find out whether any of the local hospitals have a similar unit.  It makes a difference.

August 24, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink | Comments (0)

Signs of Our Times? Japanese Stores Are Increasingly Convenient for Seniors

Dickinson Law Professor Laurel Terry sent me a timely link to an NPR story about Japanese convenience stores.  I was already thinking about how retail shopping has changed over the years. For example, on the corner of 7th Avenue and Indian School Road in Phoenix, there used to be a high-end Scandinavian furniture store.  I'd only been in it once, and that was to use a gift certificate for what seemed like a huge amount of money at the time as a wedding present. My husband and I realized the most we could afford in the store was a wooden bowl. A very nice wooden bowl, mind you, but still, it was a wooden bowl. 

Yesterday, as I passed that corner, I realized there was still a big, fancy sign out front, but the store is now a Goodwill franchise store.

So, with that change in mind, I enjoyed the NPR story, captioned Beyond Slurpees: Many Japanese MiniMarts Now Cater to Elders. From the written account:

Case in point is a Lawson convenience store in the city of Kawaguchi, north of Tokyo. It sells products that an American consumer would never find tucked between the aspirin and the candy bars. For example, there's a whole rack of ready-to-heat meals in colorful pouches. They're rated at levels from 1 to 5, based on how hard it is to chew what's inside.

 

Or, as the store's manager, Masahiko Terada, puts it, "the higher the level, the less need for you to chew. In the end it's porridge."

 

***

 

This Lawson store in Kawaguchi is one of six in a special line called Care Lawson. The company plans to expand to 30 by early next year. And these Care Lawson stores have another special feature: staff like Mika Kojima.

 

She's a nursing care manager and she's stationed at this Lawson store. In fact the franchise owner of this store is actually a nursing services company. Anyone who comes in can ask for Kojima's help. For example, she'll go to an older client's home to make sure it's set up so they can live there safely. And she'll connect families with adult day care services.

Convenience stories should be just that, convenient, right?  With adults over age-65 making up nearly 27 percent of Japan's population, it just makes sense for retailers to provide customer-specific merchandise that is easily accessible, especially for people who might prefer to avoid large supermarkets.  The Lawson chain also offers home deliveries. 

The story made me wonder more about Lawson. How was it that the Japanese chain came to have such a non-Japanese name?  It turns out Lawson began back to 1939 in Ohio, in the United States, where J. J. Lawson ran a dairy milk store. "'Mr. Lawson's milk store' was locally renowned for its fresh and delicious milk and many customers came to buy milk there every morning."  The first Lawson convenience store opened in Japan in 1975 and sold "party food," very different from the model of today.  

August 24, 2016 in Consumer Information, International, Statistics | Permalink | Comments (0)

Tuesday, August 23, 2016

A Cellphone Required for Social Security Online Access and Then Not

This is a story of now you need it, now you don't. Social Security recently required that a person have a cellphone to use the online benefits services.  The New York Times ran an article about this requirement that went into effect at the end of July, 2016. Social Security Now Requires Cellphone to Use Online Services explains that SSA makes it mandatory to have an access code sent by text to the recipient's cellphone.  The article notes that this requirement "may create hurdles, however, especially for older Americans, who are less likely to use mobile phones. About 78 percent of people 65 and older own a cellphone, compared with 98 percent of 18- to 29-year-olds, according to 2015 data from the Pew Research Center." Still almost 80% of elders have a cell phone-a good number, but that doesn't mean that those with cellphones use text features.  The article features a variety of complaints, including the lack of advance notice.  The article includes some FAQs, as well as a link to a website on where to get help (at least it's a website, not a cellphone #).

Now for the now you don't part of this story. Recall the quote in the prior paragraph "may create hurdles"....  So within two weeks of the regulation taking effect, Social Security has stopped it, for now.  The New York Times ran a follow up story explaining the suspension:

After an outcry from older Americans, as well as a letter from two United States senators, the agency backed off the cellphone-based code requirement.

“Our aggressive implementation inconvenienced or restricted access to some of our account holders,” said a statement emailed by an agency spokesman, Mark Hinkle. “We are listening to the public’s concerns and are responding by temporarily rolling back this mandate.”

Note the use of the word "temporarily" because Social Security is continuing to increase security to protect beneficiaries' information and will "introduce alternative authentication options, in addition to texting, within the next six months."  The FAQ for this article notes that beneficiaries can opt-in to text-verification now, it's just not a requirement.

August 23, 2016 in Consumer Information, Current Affairs, Social Security, Web/Tech | Permalink | Comments (0)

Philadelphia to Host the 27th Annual National Adult Protective Service Assoc Conference, August 29-31

Recently I received an email reminder from ElderLawGuy Jeff Marshall that Pennsylvania is hosting this year’s National Adult Protective Service Association (NAPSA) Conference from August 29 through 31 at the Loews Hotel in Philadelphia. The conference will feature many of the nation’s leading adult protective services professionals who will share their ideas, expertise and creative approaches, with workshop sessions for brainstorming application of new ideas. More details, including information about CLE credits, are available here. Immediately following the NAPSA conference, in the same Philadelphia location, is the 7th Annual Summit on Elder Financial Exploitation, on September 1.

These national meetings come at a time when elder abuse and elder justice have been the subject of growing attention in Pennsylvania, as well as around the nation.  It seems fitting that Philadelphia is hosting the national meeting, as it follows a months-long Task Force analysis of the role of Pennsylvania court systems in helping to protect at-risk seniors or other vulnerable adults.  

Thanks, Jeff!  

August 23, 2016 in Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Monday, August 22, 2016

Turning Silver Into Gold? Another "Advancement" in Non-Institutional Senior Care

The New York Times on Sunday had an exceptionally well written and important article about the latest trend in senior care.  For-profit companies are now allowed to participate in PACE, the Program of All-Inclusive Care for the Elderly, a Medicare- and Medicaid-approved program designed to permit innovation in care that doesn't require residence in high-priced settings such as traditional nursing homes.  Sarah Varney writes:

Inside a senior center here [in Denver], nestled along a bustling commercial strip, Vivian Malveaux scans her bingo card for a wining number.  Her 81-year-old eyes are warm, lively and occasionally set adrift by the dementia plundering her mind.

 

Dozens of elderly men and women -- some in wheelchairs, others whose hands tremble involuntarily -- gather excitedly around the game tables.  After bingo, there is more entertainment and activities: Yahtzee, tile-painting, beading. 

 

But this is no linoleum-floored community center reeking of bleach.  Instead, it's one of eight vanguard centers owned by InnovAge, a company based in Denver with ambitious plans.  With the support of private equity money, InnovAge aims to aggressively expand a little-known Medicare program that will pay to keep oldr and disabled Americans out of nursing homes.

The feature-length article details how "private equity firms, venture capitalizes and Silicon Valley entrepreneurs have jumped" onto the PACE niche. For more on this important development, read Private Equity's Stake in Keeping the Elderly at Home.

My thanks to Laurel Terry and Karen Miller for sharing this article with us. 

August 22, 2016 in Consumer Information, Ethical Issues, Health Care/Long Term Care, Medicaid, Medicare | Permalink | Comments (0)

Sunday, August 21, 2016

"Old Person" Jobs

Did you know there is such a thing?  The New York Times recently ran an article, More Older People Are Finding Work, but What Kind?, that features a new brief from the Center for Retirement Research.  The Times article explains

As men and women 55 and older looking for employment probably suspect, at a certain point the kinds of jobs available to them narrow significantly. New research by Matthew Rutledge, an economist at the Center for Retirement Research at Boston College, found that they are increasingly being funneled into what he describes as “old-person” jobs.

And not surprisingly, older workers with the least education have the narrowest set of opportunities, though Mr. Rutledge found this effect was small.

It turns out that “old-person” jobs are a mix of high-skilled service work (like managers, sales supervisors and accountants) and low-skilled service work (like truck drivers, janitors and nursing aides). Absent from the top of the list are jobs calling for a fair amount of physical labor. Jobs in farming, manufacturing and repair represent less than a quarter of all new hires in this age bracket.

The brief from CRR,  How Job Options Narrow for Older Workers by Socioeconomic Status offers these findings

  • Job-changers over age 50 increasingly end up in “old-person” jobs, with a high share of older hires relative to prime-age hires. 
  • These basic findings hold by gender and by education. 
  • However, the overall outlook has improved since the late 1990s for all groups, particularly for older women with more education.
  • Also, older job-changers hired into “old-person” jobs are paid no less than other jobs.

The full brief, available here as a pdf, examines "suitable" employment, with the introduction explaining 

The ability of older job-changers to find "suitable" employment affects both their current income and their ability to work long enough to secure an adequate retirement income. One measure of suitable employment is the range of occupations available to them. This brief, based on a recent study, assesses the extent to which occupational options narrow for workers as they age from their early-fifties to their mid-sixties and whether the pattern varies by gender or socioeconomic status, as measured by education level.

Back to the Times article, which lists most and least common "old person" jobs (hint-lawyers are in the "least common" category).  The Times story also discusses several other studies regarding elders in the work force.  This would be a great article to include in an unit on economic security or in a discussion regarding ageism.

August 21, 2016 in Consumer Information, Current Affairs, Retirement | Permalink | Comments (0)

Friday, August 19, 2016

You're Dead When SSA Says You're Dead---Even if You Are Not!

We have all heard stories about SSA determining that a beneficiary is dead, when the beneficiary isn’t. Proving you are very much alive has to be a fun experience (just joking in case anyone from SSA is reading this blog). Usually the stories about someone being “SSA-dead” is limited to a person. The Washington Post recently ran a story about a group of beneficiaries being declared dead by SSA. Dead or alive? Social Security misclassified some explains “Social Security officials have discovered 90 cases in their records where the living were listed as deceased.  That’s 90 “as of today,” Mark Hinkle, an SSA spokesman, said late Thursday. “We are not yet sure how many were in error.” The 90 are from a group of 19,000 cases.” Note that means more of the 19,000 may be “SSA-dead”.

There is some humor in all of this (the 90 of you declared SSA-dead, my sympathies (no pun intended folks--sympathies for the hassle) and really I’m not making light of your situation). “Ironically, the erroneous cases are from pilot projects in Virginia, North Dakota and South Dakota, designed “to enhance the quality of our death records,” Hinkle said. … Clearly, there is more work to be done on that point.”

Clearly this is no laughing matter if you are one of those declared dead-there are significant financial implications, including a loss of benefits. Plus other federal agencies get death info from SSA, so the impact is more widespread than just SSA. SSA is on it, and as for those other folks who may be SSA-dead and not know it, “SSA plans to send letters to the 19,000 people potentially affected with information on how to find out if the agency thinks they are dead and how to correct the record if that’s the case.”

I’m just saying, if you live in VA., ND or SD and get a letter from SSA in your mailbox, you may want to sit down before you open it…

August 19, 2016 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Retirement, Social Security | Permalink | Comments (0)

95 year old upgrades her tech

Here's a happy story to end the week. Huffington Post's Post50 ran a story last week about a lucky lottery winner. 95-Year-Old Woman Uses Lottery Winnings To Join 21st Century features the winner of a scratch-off ticket who plans to buy herself an upgraded cell phone. "Once it had all sunk in, the great-grandmother quickly began thinking about how she’d spend the cash. In the end, she decided to buy a great treat for herself: a new smartphone." Now granted, smartphones don't cost $30,000 (the amount of her winnings) so the article notes she plans to put the rest in a trust for her family.  She explained, "“I’m 95 and there’s not a hell of a lot more I can keep doing with it...."

Congratulations!

August 19, 2016 in Consumer Information, Current Affairs, Web/Tech | Permalink | Comments (0)

Want to Laugh? Read "Old Age: A Beginner's Guide," by Michael Kinsley

I'm always just a bit suspicious of books that promise to make me laugh.  I think it is because I like to be surprised by humorous moments, rather than feel duty-bound to chuckle, guffaw or giggle.  

Nonetheless, I succumbed to the promise in the blurb for Michael Kinsley's 2016 book, Old Age: A Beginner's Guide, that it was a "surprisingly cheerful book ... and a frequently funny account of one man's journey to the finish line."  

And I'm glad I did.  I did indeed laugh, and at the most surprising of moments, as when he described the need to avoid the doors of his refrigerator because of the magnets that might interfere with the technology in his brain used to keep symptom of Parkinson's Disease at bay.  He has the knack of making wry observations about his own mortal state to think broadly about what it is for all of us to age. I can see the short essays that make up this book being useful in a class on elder law or estate planning.  

His words are perhaps most poignantly relevant to boomers.  For example, on a goal of living longer, he writes:

Even before you're dead, you may want to ask yourself whether this is what you really want.  Is being alive all that desirable if you're alive only in the technical sense?  Millions of boomers are watching their parents fade until they are no longer there. As they approach their seventies, they start observing their own peer group losing their collective marbles, one at a time. And they  reasonably conclude that the real competition should not be about longevity. It should be about cognition.

But he doesn't stop there, exploring other, potentially more important goals for the competitive boomer generation to consider.  

This is a short, deep book.  And I recommend it, not least of all because it gives readers welcome opportunities to smile. 

August 19, 2016 in Advance Directives/End-of-Life, Books, Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Science, Statistics | Permalink | Comments (0)

Thursday, August 18, 2016

A Day in the Life of Phone Scams

I'm house-sitting in Phoenix this summer, and I've been gobsmacked, to use a good British word, to realize exactly how many unwanted callers manage to circumvent the home's do-not-call registrations.  Even worse is to realize how many of the calls expressly target senior consumers.

One of the most annoying call begins, "Hello Mrs. XXXX, I see that your physician has prescribed Xarelto for you, and I'm calling to let you know that we can offer you special pricing, at less than half what you are currently paying....."

Suffice it to say that this was a scam.  No physician had shared any prescription information about the homeowner in question.  But for the older consumer worried about costs, I can just imagine how effective the scammer's "guess" could be, as the scam focused on a very expensive and important drug for many older patients.  They were after credit card information.  I bet the boilerroom for this operation has a whole list of popular "senior" prescription drugs. 

Another frequent caller poses as the IRS and claims there is a deficiency on some tax payment that can be "handled" over the phone. Again, a scam -- and certainly one that could frighten many people.  In a single week, I intercepted 7 such calls, despite each time attempting to make it clear I knew this was a scam, and then blocking the number.  

Perhaps the most frequent callers are those trying to market "solar" systems, guaranteeing tax credits or rebates  -- and I guess that one just goes with the territory when you are living in sun-drenched Arizona.

August 18, 2016 in Cognitive Impairment, Consumer Information, Crimes, Ethical Issues | Permalink | Comments (0)

Wednesday, August 17, 2016

Medicare Enrollment Periods

Investment News ran a timely article about the various Medicare enrollment periods. The alphabet soup of Medicare enrollment periods explains the initial enrollment period and special enrollment periods. It also explains succinctly how employer group health plans and Medicare interface as far as the special enrollment period.

If you have coverage through your employer or your spouse's employer consider:

• The employer provided health plan needs to be with a group of 20 or more insurance eligible members. If the group is smaller than 20, Medicare Parts A and B must be primary and cover 80% of costs. The employer plan only covers 20%. In those cases, many folks are better served by leaving the employer plan and signing up for Medicare Part D and a supplemental plan.

• The employer coverage needs to be Medicare Part D creditable, meaning that the employer coverage includes a prescription drug benefit comparable to Medicare Part D. The employer or insurance plan can provide the Medicare creditable coverage notice. Get a copy of this letter every year when your employer coverage renews. That way no one is caught off guard down the road. If a plan has not been Medicare creditable, lifelong penalties of 12% per year are levied when the individual enrolls in Medicare Part D.

Once the person leaves a health plan and is entitled to Medicare, it is important to remember a few key factors:

• Sign up for Medicare as soon as possible. Medicare enrollment can begin three months before employer coverage ends.

• While there is an eight-month window to sign up for Medicare Parts A and B, there is no primary health coverage until Medicare enrollment is complete. Even COBRA coverage is secondary coverage to Medicare. That means Medicare Parts A and B cover 80% of costs, leaving COBRA to pay 20%. The result is that when Medicare-eligible individuals do not have Medicare Parts A or B they are left to pay 80% of their costs out-of-pocket.

• If someone misses the eight-month SEP window after leaving employment, they will have to wait an extended period to of time to enroll, have coverage gaps and pay lifelong penalties.

 

August 17, 2016 in Consumer Information, Current Affairs, Medicare | Permalink | Comments (0)

Spotlight: UC Hastings' and UC San Francisco's Medical-Legal Partnership for Seniors Clinic

Earlier this week, I wrote about a new publication drawing attention to "six" specific areas of need that can helped by a health/law partnership to provide more comprehensive services for the older client or patient.  That post inspired one of our regular readers to write about her experiences with an important Consortium effort between the law school at UC Hastings and the medical program at UC San Francisco.  Their Medical-Legal Partnership for Seniors Clinic (MLPS Clinic) sounds terrific and, not surprisingly, it attracted the attention of the New York Times from its inception:

Consider the geriatricians working at the Lakeside Senior Medical Center, an outpatient clinic at the University of California, San Francisco. Many of their patients, despite multiple chronic diseases and advanced age, have never filled out power-of-attorney documents or appointed someone to make health care decisions if they are unable to.

 

Sometimes, the doctors suspect their patients might qualify for public benefits they are not getting, like food stamps or MediCal, the state’s version of Medicaid. Perhaps they face problems with landlords or appear to be victims of financial abuse, or they ought to have a simple will.

 

In other words, they need lawyers. But trying to get frail, low-income seniors to consult an elder attorney can seem an insurmountable problem. How will they travel to a law office? Or pay a fee that can reach $300 an hour? Even if the doctors can refer them to a legal aid office, will their elderly patients actually make an appointment? Then remember to go?

 

At Lakeside there is a simpler solution, said Sarah Hooper, who teaches at the University of California Hastings College of the Law. “The physicians do the initial screenings, hear what their patients’ problems are, take the history — and they essentially write a prescription: ‘Go down the hall and see my friends at U.C. Hastings for help with this housing issue,’ ” she said.

Sarah Hooper, Executive Director for the clinic, provided an update, explaining, "We’ve done quite a bit of outreach within MLP and in the healthcare system, but are increasingly realizing that we need to get more elder law attorneys and legal aid advocates energized around this idea."  Sarah reports that she'll be attending and presenting at the National Aging and Law Conference in D.C. in October, 2016 and hopes to inspire others to develop similar partnerships.

For more on the UC Hastings-San Francisco MLPS Clinic, read the full New York Times article (first published in 2013) by Paula Spahn, "The Doctor's New Prescription: A Lawyer."   For more on the Medical-Legal Partnership concept, visit the website for the National Center for Medical Legal Partnerships.

August 17, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Legal Practice/Practice Management | Permalink | Comments (0)

Tuesday, August 16, 2016

Who Does the Caregiving When There Are No Kids?

Not everyone who needs caregiving has a family member to serve as caregiver. So what should a Boomer do when planning ahead? What resources might an elder law attorney recommend? Last October,  U.S. News Wellness ran a story on this topic, No Spouse, No Kids, No Caregiver: How to Prepare to Age Alone.  Referring to this group of our population as "elder orphans", the article paints the serious implications for those aging without a family support system. One expert is quoted that "[t]he risk of potentially finding yourself without a support system – because the majority of care provided as we get older is provided by family – may be increasing...."  Factor in loneliness and the impact becomes even more serious "older adults who consider themselves lonely are more likely to have trouble completing daily tasks, experience cognitive decline, develop coronary heart disease and even die. Those who are socially isolated are also at risk for medical complications, mental illness, mobility issues and health care access problems." The article contains 5 tips for planning to live independently, including speaking up about one's situation, planning ahead now (here's where the elder law attorney can be quite helpful), maintaining friendships while establishing new ones, name a health care agent (and do a DPOA, too)-the article gives a shout-out to elder law attorneys,  moving to a more livable community and live life well. 

The points in the article are still relevant today. Thanks to Julie Kitzmiller for sending me the article!

August 16, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink | Comments (0)

Grandmother Was Living On Her Own and Doing Just Fine Until...

Last weekend, the Arizona Republic newspaper carried a Question and Answer column that caught my eye.  The question began: 

My grandmother lives in Scottsdale, and my wife and I live in Chicago.  We only visit her two or three times a year.  Although we thought my grandmother was still able to manage her financial affairs, she recently called us to say that she was being evicted from her Scottsdale home for nonpayment of HOA dues.  My grandmother owns her $450,000 hoe free and clear....

 

HOA dues only totaled $700 originally.  After the late charges, interest, and legal fees, however, there was almost $8,000 owed at the foreclosure sale two weeks ago.

How often do crises involving aging loved ones begin with the words "I thought she was doing well living alone until...?"  Here the concerned grandson jumped into action and the consumer advisor suggested a range of options, including working with the "investor" to resolve the ownership and equity issues.  For more you can read Grandmother Loses Home to HOA Fees on the PressReader service for the Arizona Republic, August 14, 2016.

 

August 16, 2016 in Cognitive Impairment, Consumer Information, Dementia/Alzheimer’s, Estates and Trusts, Housing, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Monday, August 15, 2016

ALF Residents with Agression

The current issue of the Journal of Applied Gerontology features an article, Resident Aggression and Abuse in Assisted Living. The full article is available as an html here or a pdf here.

The introduction explains: "The purpose of this article is to estimate the prevalence and identify risk factors of engaging in resident aggression and abuse in assisted living facilities. Measuring the prevalence of resident aggression and abuse in assisted living facilities is needed to better understand the scope of the problem. Identifying strategies to mitigate and prevent resident aggression and abuse can help to improve social well-being and progress toward achieving public health objectives."  The authors conclude that

Prior studies have found evidence of resident abuse in nursing homes (Pillemer et al., 2011; Pillemer & Finkelhor, 1988; Pillemer & Moore, 1989). Our findings build on this knowledge base with nationally representative estimates of resident aggression and abuse in assisted living settings. In conclusion, this study provides evidence of the prevalence of resident aggression and abuse in assisted living facilities. Given the rising prevalence of dementia and aging population in the United States, resident aggression and abuse is a growing problem that warrants more attention from policy makers, researchers, and long-term care providers. Furthermore, dementia and SMI were significant risk factors for physical, verbal, and sexual abuse in residential care settings. Future research is needed to develop better methods for identifying residents at greater risk of engaging in abuse as well as supporting ongoing training and prevention efforts to mitigate this risk.

 

August 15, 2016 in Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Housing | Permalink | Comments (0)

Medical-Legal Partnerships Are Needed For Elder Advocacy and Protection

In July, I drove some 2500 miles, from Pennsylvania to Arizona, to begin an exciting sabbatical opportunity.  I enjoy this drive (especially since I tend to do it fairly rarely, perhaps once every seven years).  I frequently visit friends along the way, and this summer I was struck by how many friends had saved up tough elder law stories for me.  

A theme emerged from their stories.  They would tell me, "I have an aging friend (or sometimes a family member or neighbor) who is in serious danger  of physical or financial harm, but refuses to cooperate with reasonable plans to solve the problems. What are my options to help this person I care about?"

In one instance, it seemed clear the at-risk individual was affected by some level of cognitive impairment.  But how to know for sure?  Was  the refusal to cooperate with a "better plan" the product of a sound, if somewhat eccentric mind?  A neurocognitive assessment seemed warranted.  We tried to arrange one. But the earliest appointment available was more than 60 days away and the  potential for harm was immediate.

Thus, it was with great interest I read a preview of  an article in the upcoming issue of the ABA publication, Bifocal.  Professors Marshall Kapp, Shenifa Taite and Gregory Turner outline "Six Situations in Which Elder Law Attorneys and Physicians Caring for Older Patients Need Each Other."  They are writing about a critical need for Medical-Legal Partnerships designed specifically to assist older persons and their family members.   For example, on the topic of "self-neglect," the authors explain:

Mistreatment of older persons by others is a serious problem. Both the medical and legal conundrums became more complicated, and thus even more amenable to interprofessional collaboration, when self-neglect is entailed. A significant percentage of older adults, mainly living alone, do not regularly attend to their own needs or well-being regarding health care, hygiene, nutrition, and other matters. The majority of cases reported to APS agencies by health and social service professionals and family members are triggered by suspected self-neglect. The health care system expends considerable efforts trying to intervene in these situations to prevent increased rates of hospitalization, nursing home placement, and even death.

 

In situations involving suspected elder self-neglect, the physician’s role is vital in recognizing the potential problem, characterizing the nature and seriousness of the risk posed, and trying to identify clinically and socially viable intervention strategies. Among other concerns, decisional capacity issues almost always arise in these cases. The physician may look to an attorney for advice about legal reporting requirements or options, as well as the legal boundaries within which interventions may be designed and implemented in a manner that best respects the older person’s dignity and autonomy while protecting the vulnerable at-risk individual from undue foreseeable, preventable self-generated harm.

A growing number of  law schools (including Penn State's Dickinson Law) have established Medical-Legal Partnership Clinics, where the collaborative relationship between attorneys and physicians is established in advance of need by clients. Often such clinics focus on younger clients, especially children.  Elder-specific services are an important subset of the services that can be provided in a timely and professional setting.  For more, read the full Bifocal article published in the-August 2016 issue -- and ask whether such services are available in your community.   

August 15, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Housing, Legal Practice/Practice Management | Permalink | Comments (0)