Wednesday, January 11, 2017
I'm much overdue in writing about a terrific, recent workshop at Arizona State University's Sandra Day O'Connor College of Law on "The Aging Brain." For me it was an ideal gathering of disciplines, including experts in neurology, psychology, health care (including palliative care and self-directed aid-in-dying), the judiciary, and both practitioners and academics in law (not limited to elder law). Even more exciting, that full day workshop (11/18/15) will lead into a public conference, planned for fall 2017.
Key workshop moments included:
- Preview of a potentially ground-breaking study of early-onset Alzheimer's Disease (AD) centered on a family cluster in the country of Columbia with a genetic marker for the disease and a high incidence of onset. By "early onset," we're talking family members in their 40s. The hope is that by studying the bio-markers in this family, that not only early onset but later-in-life onset will be better understood. Eric Reiman, with professional affiliations with Banner Health, Arizona State University and University of Arizona, spoke at the workshop, and, as it turned out, he was also featured on a CBS 60 Minutes program aired a short time later about the family-based study. Here's a link to the CBS transcript and video for the 60 Minutes program on "The Alzheimer's Laboratory."
- Thoughtful discussion of the ethical, legal and social implications of dementia, including the fact that self-directed aid-in-dying is not lawful for individuals with cognitive impairment. Hank Greely from Stanford University Law and Medical Schools, and Professor Betsy Grey for ASU's Sandra Day O'Connor College of Law led discussions on key issues. As biomarkers linked to AD are identified, would "you" want to know the outcome of personal testing? Would knowing you have a genetic link to AD change your life before onset?
- Overview of recent developments in "healthy" brain aging and so-called "anti-aging" treatments or medications, with important questions raised about whether there is respected science behind the latest announcement of "breakthroughs." Cynthia Stonnington from the Mayo Clinic and Gary Marchant from ASU talked about the science (or lack thereof), and Gary raised provocative points about the role of the FDA in drug approvals, tracking histories for so-called off label uses for drugs such as metformin and rapamycin.
I very much appreciate the opportunity to participate in this program, with special thanks to Betsy Grey and federal Judge Roslyn Silver for making this possible. I've also enjoyed serving as occasional guest in Judge Silver's two-semester Law and Science workshop with ASU law students. Thank you! For more on the Aging Brain programming at ASU, see here.
January 11, 2017 in Advance Directives/End-of-Life, Cognitive Impairment, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Programs/CLEs, Science | Permalink | Comments (0)
Wednesday, January 4, 2017
I'd posted about this previously (but had the wrong date, sorry Marshall) so just a reminder, Save the Date: February 13, 2017, the 6th Annual Health Law Conference at Florida State University. This year's conference is titled Patients as Consumers: The Impact of Health Care Financing & Delivery Developments on Roles, Rights, Relationships & Risks. Topics include Evidence-based Medicine & Shared Decision-making, Impact of Cost Containment Initiatives on Patient Rights and Provider Liabilities, and Patient Populations at Particular Risk of Not Controlling Their Own Medical Choices.
Registration is free unless seeking CLE credits. For more information or registration, click here.
Tuesday, November 29, 2016
It is estimated that one in ten adults over the age of 60 is a victim. But the truth is we don’t know for certain how many older adults are suffering from abuse. In the eighth edition of Aging Matters, Nashville Public Television explores the issues behind elder abuse, neglect and exploitation.
Experts suggest that our understanding of elder abuse lies decades behind that of child abuse and domestic violence. Elder abuse is underreported. It lacks clear legal definition and is complicated by ethical challenges. The system of response is different depending on where you live.
What are the risk factors, what can we do to protect ourselves and our loved ones, and what is our responsibility to intervene for those in need? The questions are simple, but the answers are not. Find out more in Aging Matters – Abuse & Exploitation.
The story is accompanied by a panel discussion and includes background resources.
Tuesday, November 15, 2016
Mark your calendars for the Institute for Law Teaching & Learning 2017 Summer Conference. The topic is Teaching Cultural Competency and Other Professional Skills Suggested by ABA Standard 302. The conference is scheduled for July 7-8, 2017 at the U. of Arkansas Little Rock Bowen School of Law. Proposals are now being accepted, including specifically on:
addressing the many ways that law schools are establishing learning outcomes related to “other professional skills,” particularly the skills of cultural competency, conflict resolution, collaboration, self-evaluation, and other relational skills. Which, if any, of the outcomes suggested in Standard 302(d) have law schools established for themselves, and why did they select those outcomes? How are law professors teaching and assessing skills such as cultural competency, conflict resolution, collaboration, and self-evaluation? Have law schools established outcomes related to professional skills other than those suggested in Standard 302(d)? If so, what are those skills, and how are professors teaching and assessing them?
Proposals are due by February 1, 2017 and should be sent to Kelly Terry, email@example.com. Proposals are limited to 1 page and must include a title, the presenters names and contact info, a summary of the presentation and the interactive teaching methods to be used.
More information, visit the website or contact Professor Terry. Thanks to Professor Terry for sending us info about this conference.
Friday, November 11, 2016
Save the Date: February 13, 2017, the 6th Annual Health Law Conference at Florida State University. This year's conference is titled Patients as Consumers: The Impact of Health Care Financing & Delivery Developments on Roles, Rights, Relationships & Risks. The program's learning objectives include
Appreciate the ways in which the role of the individual who is purchasing and receiving health care services is changing from one of passive patient to that of a consumer who is expected to influence, if not determine, his or her own health care
Understand the legal and ethical ramifications of the individual’s changing role from patient to consumer for the physician and other health care providers with whom the patient/consumer maintains a professional relationship
Manage the physician’s legal responsibilities and risks associated with the changing professional relationship engendered by expectations that patients will take on a more consumer-like role regarding their own health car
Identify major developments (e.g., aggressive consolidation of health care insurers and providers into mega-entities, the incentivized development of new coordinated product delivery entities such as Accountable Care Organizations, the proliferation of electronic health records, and replacement—on both mandatory and voluntary bases—of fee-for-service arrangements by various value purchasing strategies such as Pay for Performance (P4P) and bundled payments) in contemporary U.S. health care delivery and financing
Topics include Evidence-based Medicine & Shared Decision-making, Impact of Cost Containment Initiatives on Patient Rights and Provider Liabilities, and Patient Populations at Particular Risk of Not Controlling Their Own Medical Choices.
Registration is free unless seeking CLE credits. For more information or registration, click here.
Tuesday, October 25, 2016
The New York Times ran an article recently on individuals voluntarily refusing nutrition and hydration as a way to speed up the end of life. The VSED Exit: A Way to Speed Up Dying, Without Asking Permission focuses on individuals who voluntarily give up eating and drinking. We know that only a handful of states offer Physician-Aided Dying and even in states where that is legalized, not everyone fits within the parameters of the statute. "In end-of-life circles, [the] option [voluntarily giving up food and fluids] is called VSED (usually pronounced VEEsed), for voluntarily stopping eating and drinking. It causes death by dehydration, usually within seven to 14 days. To people with serious illnesses who want to hasten their deaths, a small but determined group, VSED can sound like a reasonable exit strategy."
The article notes that for individuals who avail themselves of VSED, no law seems to be needed (although there is still some uncertainty on that point), no court intervention is required, but the individual needs a lot of fortitude, “'It’s for strong-willed, independent people with very supportive families,' said Dr. Timothy Quill, a veteran palliative care physician at the University of Rochester Medical Center."
One unanswered question is whether VSED is "legal".
For a mentally competent patient, able to grasp and communicate decisions, probably so, said Thaddeus Pope, director of the Health Law Institute at Mitchell Hamline School of Law in St. Paul, Minn. His research has found no laws expressly prohibiting competent people from VSED, and the right to refuse medical and health care intervention is well established.
Still, he pointed out, “absence of prohibition is not the same as permission.” Health care professionals can be reluctant to become involved, because “they want a green light, and there isn’t one of those for VSED,” he added.
The question grows much murkier for patients with dementia or mental illness who have specified VSED under certain circumstances through advance directives. Several states, including Wisconsin and New York, forbid health care surrogates to stop food and fluids. (Oregon legislators, on the other hand, are considering drafting a bill to allow surrogates to withhold nutrition.)
The article reports on a recent conference and some of the issues discussed there. The article also explains that with VSED, death doesn't come as quickly as with PAD, leading to issues for patients and caregivers. The article also notes there are (or likely could be) obstacles to using VSED, such as positions taken by long term care facilities or specific religions.
This topic would be great for a class discussion.
Friday, October 21, 2016
LeadingAge, the trade association that represents nonprofit providers of senior services, begins its annual meeting at the end of October. This year's theme is "Be the Difference," a call for changing the conversation about aging. I won't be able to attend this year and I'm sorry that is true, as I am always impressed with the line-up of topics and the window the conference provides for academics into industry perspectives on common concerns. For example, this year's line up of workshops and topics includes:
- General sessions featuring Pulitzer Prize winning journalist Charles Duhigg on the "The Science of Productivity," 2013 MacArthur Fellow and psychologist Angela Duckworth on the the importance of grit and perservance for successful leadership, and famed neurosurgeon and speaker Sanjay Gupta on "Medicine and the Media."
- Hundreds of sessions, organized by "interest groups":
October 21, 2016 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, International, Legal Practice/Practice Management, Medicaid, Medicare, Programs/CLEs, Property Management, Retirement, Science, Social Security, State Cases, State Statutes/Regulations, Veterans | Permalink | Comments (2)
Friday, September 23, 2016
Professor Carl H. Coleman at Seton Hall Law School in Newark, New Jersey, sent us advance news about a works-in-progress retreat scheduled for February 10, 2017. Professor Coleman explained:
Seton Hall Law School’s Center for Health & Pharmaceutical Law & Policy is pleased to announce the inaugural Mid-Atlantic Health Law Works-in-Progress Retreat, which will be held on February 10, 2017, at Seton Hall Law School in Newark, New Jersey. The purpose of the retreat is to give regional health law scholars an opportunity to share their work and exchange ideas in a friendly, informal setting. The retreat is open to anyone with an academic appointment in health law (including professors, fellows, and visitors) in any institution of higher education in the mid-Atlantic area.
The retreat will consist of an in-depth discussion of approximately 5-6 draft papers. A designated commentator will first provide a 10-15 minute overview of each paper, as well as his or her reactions. The author will then have 5 minutes to respond, following which all retreat participants will participate in a general discussion of the draft.
Persons interested in having their papers presented should submit a preliminary draft or, if that is not possible, a detailed abstract, no later than November 18 to Carl Coleman at firstname.lastname@example.org, using the description "Mid-Atlantic Health Law Retreat" in the regarding line of the emailed submission. Papers to be presented will be selected by December 9, and final drafts will be due on January 20. Drafts will be made available to all participants on a password-protected website.
Contact Professor Coleman with any questions. This looks like a fabulous workshop opportunity. Thanks, Carl!
Thursday, September 22, 2016
Karen Miller, a lawyer and former administrative law judge from New York who has become a very good friend, recently shared with me reports about a long-time project of hers, to inspire direct dialogue between generations about aging. As an engaged resident of a CCRC in Gainesville, Florida (Oak Hammock which is affiliated with the University of Florida), Karen and others in her community embody the notion of active, healthy, and realistic aging. Karen knows that "aging in the right place" is a better goal than simply "aging in place." The right place may or may not be the long-time family home.
Over the course of three days in mid-September, Temple Shir Shalom and Oak Hammock hosted conversations on "Giving and Receiving Care" that were open to the public. From the Gainesville-Sun coverage of the events:
[Rabbi Michael] Joseph said joking around with his wife about his forgetfulness becomes less funny, as he grows older. “It becomes a real anxiety, it becomes harder to talk about,” Joseph said. “Because I don’t really want to know the answer, part of me.”
Saturday’s festivities will address Joseph’s anxiety head-on. The Oak Hammock retirement community will serve as the backdrop to a lecture about age-related cognitive changes. The 3 p.m. non-clinical presentation by guest speaker Dr. Steven DeKoskey of the University of Florida's McKnight Brain Institute will take a look at what is and isn’t normal when aging.
[Karen] Miller said that as people age they may need help with numerous things, ranging from simple things like writing a check, to more complicated things, like making medical decisions. “There will come a time, unless you get hit by a car, where your faculties are not as sharp as they were at one time,” she said.
Concluding Sunday at the temple, the program will open its doors at 10:30 a.m. to a wider audience spanning at least three generations, Joseph said.
The combination of community hosts, professional caregivers, science-based speakers, and public round tables strikes me as an inspiring model for effective conversations about aging. Well done, Karen.
Wednesday, September 21, 2016
Stetson's 18th annual National Conference on Special Needs Trusts & Special Needs Planning takes place on October 19-21, 2016 at the Vinoy Hotel in St. Petersburg, Florida. Early Bird Registration rates end September 23, 2016. The national conference spans two days, with general sessions in the mornings and three tracks of breakout sessions in the afternoons (basics, advance and administration) Information about the conference, including the agenda, speakers, and links to register is available here. (Full disclosure, I'm the conference chair. Hope to see you at the conference!)
Monday, September 19, 2016
On Friday, November 18, 2016, Mitchell Hamline School of Law and Children's Minnesota are hosting a one day seminar on "Ethics, Law and Futility" in Minneapolis. The target audience is described as "Nurses, Physicians, Social Workers, Lawyers, Patient Advocates, Parents/Guardians or anyone interested in ethics, law and futility." The premise is intriguing, as explained in conference promotion materials:
There is a knowledge gap between what is presumed as one’s ethical and legal obligations to patients during cases of futility and what actually their responsibility is. This conference will assist in clarifying these issues and provide the audience with tools for managing futility cases.
Thaddeus Pope, Director of the Health Law Institute at Mitchell Hamline School of Law, speaking on "When may you stop life-sustaining treatment without consent? Leading Dispute Resolution Mechanisms for Medical Futility Conflicts.”
Emily Pryor Winston, Associate General Counsel at Children’s Hospitals and Clinics of Minnesota, on "Minnesota Law and Medical Futility Analysis."
Jack Schwartz, Adjunct Professor at the University of Maryland School of Law and Former Maryland Assistant Attorney General, on "The Ethics of Legal Risk."
For more, see the home page for the symposium, which provides registration materials.
September 19, 2016 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care, Programs/CLEs, State Statutes/Regulations | Permalink | Comments (0)
Monday, July 25, 2016
Last week, Lancaster Pennsylvania was host to the 19th Annual Elder Law Institute, co-sponsored by the Pennsylvania Bar Institute and the Pennsylvania Bar Association's Elder Law Section. As the image of the two, fat volumes of course materials demonstrates, there was a lot of content for participants to digest. More than 400 professionals attended,not counting walk-ins. (And yes, the course materials will be available for purchase eventually, from the PBI catalog here.)
I had the privilege of welcoming two new speakers to the Pennsylvania conference, Stephen J. Maag, J.D., Director of Residential Communities for LeadingAge and Brad C. Breeding, President of My LifeSite. Both speakers addressed options available for senior living, and focused on trends affecting Continuing Care Retirement Communities (CCRCs), now also known as Life Plan Communities.
Steve noted that with close to 2,000 communities across the nation identifying under the CCRC or Life Plan label, a majority are "still" nonprofit, especially in so-called "Type A" operations, but that there is clearly a trend in the direction of change to "for profit" ownership or management. Communities are coping with what he termed "unprecedented" change on many fronts, including changing consumer demographics, the impact of health care reform, and use of technology that can affect or delay timing of decisions to move into a Life Plan Community.
Brad outlined the development of his company as a site for comparative information for consumers considering CCRC or Life Plan communities. The company has a data bank with detailed, comparative information on over 400 communities, offering consumers a fee-paid option of getting side-by-side statistics on contract options, pricing, services available and more. But he also said that collecting the information is not easy, as some state regulators, including Pennsylvania, do not "share" information in a transparent way. Remember Medicare.gov's Nursing Home Compare? Brad's company is working to provide consumers with comparative information beyond that narrow focus on skilled nursing care. One of the hot topics Brad identified is the extent to which consumers can use "long-term care insurance" in the CCRC setting, and we all discussed whether such insurance should be paying a pro-rata share of entrance fees, especially in Type A life-care contracts.
My special thanks to Steve and Brad for traveling from D.C. and North Carolina, respectively, to share their knowledge and predictions.
Tuesday, July 19, 2016
Registration is now open for Stetson's 18th annual National Conference on Special Needs Planning and Special Needs Trusts (full disclosure-I'm the conference chair). The program is scheduled for October 18-20. October 18th has 2 pre-conferences, one on tax issues and one on pooled SNTs. The National Conference starts on October 19th with general sessions on both mornings and break-out sessions in the afternoons. Afternoon sessions offer 3 tracks: basics, administration and advanced. For more information, click here. Registration information is here.
Tuesday, July 12, 2016
Stetson Law (full disclosure-my school) offers a new webinar on Tuesday July 19 at noon edt. This first Hot Topics in Elder Law webinar covers the subject of nursing home resident discharge. The Right or Wrong Way? Involuntary Discharge of Nursing Home Residents is a 90 minute webinar. Here is a description about the webinar
A recent AP story suggested that "Nursing homes are increasingly evicting their most challenging residents." Nursing home owners assert that the homes are following the discharge rules and more importantly protecting vulnerable adults from violent residents. This interactive debate will feature advocates from both sides of the issue.
Moderated by Professor Roberta K. Flowers, the debate will feature Eric Carlson, directing attorney of Justice in Aging in Los Angeles, California, and Sheila Nicholson, who specializes in nursing home defense and is a partner at Quintairos, Prieto, Wood & Boyer P.A., in Tampa, Florida.
Registration information is available here.
Tuesday, July 5, 2016
Special and Supplemental Needs Trust To Be Highlighted At July 21-22 Elder Law Institute in Pennsylvania
In Pennsylvania each summer, one of the "must attend" events for elder law attorneys is the annual 2-day Elder Law Institute sponsored by the Pennsylvania Bar Institute. This year the program, in its 19th year, will take place on July 21-22. It's as much a brainstorming and strategic-thinking opportunity as it is a continuing legal education event. Every year a guest speaker highlights a "hot topic," and this year that speaker is Howard Krooks, CELA, CAP from Boca Raton, Florida. He will offer four sessions exploring Special Needs Trusts (SNTs), including an overview, drafting tips, funding rules and administration, including distributions and terminations.
Two of the most popular parts of the Institute occur at the beginning and the end, with Elder Law gurus Mariel Hazen and Rob Clofine kicking it off with their "Year in Review," covering the latest in cases, rule changes and pending developments on both a federal and state level. The solid informational bookend that closes the Institute is a candid Q & A session with officials from the Department of Human Services on how they look at legal issues affected by state Medicaid rules -- and this year that session is aptly titled "Dancing with the DHS Stars."
I admit I have missed this program -- but only twice -- and last year I felt the absence keenly, as I never quite felt "caught up" on the latest issues. So I'll be there, taking notes and even hosting a couple of sessions myself, one on the latest trends in senior housing including CCRCs, and a fun one with Dennis Pappas (and star "actor" Stan Vasiliadis) on ethics questions.
Here is a link to pricing and registration information. Just two weeks away!
July 5, 2016 in Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Legal Practice/Practice Management, Medicaid, Medicare, Programs/CLEs, Property Management, Social Security, State Cases, State Statutes/Regulations, Veterans | Permalink | Comments (0)
Friday, June 3, 2016
"He Died with Guns in His Closet." That's the provocative (and effective) title of an upcoming continuing legal education program (3 credits) in Pennsylvania. The half-day Pennsylvania Bar Institute program will be offered live in Pittsburgh on June 8, and both in-person (Mechanicsburg) and by webcast/simulcast on June 16. The program will address "new regulations for gun trusts that go into effect on July 13, 2016;" acquisition, possession disposition and transportation of firearms; how people become disqualified to interact with firearms; gun trusts; and the National Firearms Act's implications for trust and estate practitioners.
Last fall, I was at a statewide meeting of continuing care community residents in the Southeastern part of the US, and I admit I was startled when residents raised the topic of "what to do about guns" in their CCRCs.
Here's a link to the CLE details. My thanks to Pennsylvania practitioner and great estate planning adjunct professor Vicky Trimmer for alerting me both to the changes in the law and this upcoming program.
Tuesday, May 31, 2016
The annual American Society on Aging (ASA) conference is scheduled for March 20-24, 2017 in Chicago. The planning committee is now accepting proposals to present at the conference. For more information or to submit a proposal, click here. The deadline for submitting a proposal is June 30, 2017.
May 31, 2016 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, Programs/CLEs | Permalink | Comments (0)
Monday, May 30, 2016
The Association for Gerontology in Higher Education's (AGHE) annual conference is scheduled for March 9-12, 2016 in Miami, Florida. The call for abstracts for one of the six themes for the conference closes at noon on June 1, 2016. For more information, click here.
Monday, May 23, 2016
The Association for Gerontology in Higher Ed annual meeting is set for March 9-12, 2017 in Miami. The call for abstracts closes June 1, 2016 with the conference's theme "The Future is Here: Educating a New Generation of Professionals in Aging Worldwide." A number of tracks will be offered, including on these topics:
Curriculum and Policy Issues
Translating Research to Education and Training
Program and Curriculum Development
Diversity and Social Justice for Older Persons
More information about submitting an abstract is available here.
Wednesday, April 20, 2016
CSLSA is an organization of law schools dedicated to providing a forum for conversation and collaboration among law school academics. The CSLSA Annual Conference is an opportunity for legal scholars, especially more junior scholars, to present working papers or finished articles on any law-related topic in a relaxed and supportive setting where junior and senior scholars from various disciplines are available to comment. More mature scholars have an opportunity to test new ideas in a less formal setting than is generally available for their work. Scholars from member and nonmember schools are invited to attend.
Registration will formally open in July. Hotel rooms are already available, and more information about the CSLSA conference can be found on our website at www.cslsa.us.