Monday, May 18, 2015

Drops in Occupancy Mark Challenges to Financial Health for Senior Living Industries

Publically-traded Brookdale Senior Living, founded in 1978, has grown to become the largest owner and operator of "senior living" communities in the U.S., including for-profit continuing care retirement communities (CCRCs). Thus, it is good to keep an eye on the finances of Brookdale for those of us interested in the long-term financial health of CCRCs and other senior housing options.

Steve Monroe at Irving Levin Associates notes that Brookdale "was no different than the rest of the market, posting sharp drops in first quarter occupancy" for 2015:

"The legacy Emeritus [a component of Brookdale, following a 2014 merger] properties posted a 110 basis point decline from the fourth quarter of 2014, and a whopping 200 basis point decline from a year ago. The legacy Brookdale properties dropped 80 basis points sequentially and 110 basis points from a year ago. This was not good news, but not unexpected. Oddly enough, the legacy Brookdale properties had a 250 basis point increase in community operating margin to 35.2% despite the occupancy declines. The Emeritus properties had a 90 basis point sequential drop in margin, which makes more sense."

How do you achieve a significant increase in "operating margin" despite "occupancy declines?" A good question to ponder.  Steve Monroe continues: "The reasons for the legacy Brookdale improvement were a combination of cost controls and more pricing flexibility. Move-ins have been increasing, which is great, but 'cost controls' always make me nervous, especially with the current acuity creep. Stay tuned."

The reference to "acuity creep" is to the increase in average age and frailty of new residents, compared with past years (especially before the financial crisis of 2008-10). This trend impacts CCRCs in several ways, both in terms of market appeal to healthier potential residents, and operating costs tied to an earlier need for higher levels of care.  An additional question may be whether low interest rates have supported a bubble in certain segments of senior housing despite the softer occupancy rates, and whether an eventual return to higher capitalization rates will result in lower values and additional consequences.

Along that same line, the Philadelphia Inquirer published a recent article in their "retirement" news edition, noting "Continuing-Care Retirement Community Choice Requires Diligence," by Harold Brubaker, with tips on what to ask if you are a consumer considering a CCRC option.

May 18, 2015 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Property Management, Retirement, Statistics | Permalink | Comments (0) | TrackBack (0)

Monday, May 4, 2015

EBRI Looks at "End-of-Life Financial Situation in America"

The Employee Benefits Research Institute (EBRI) recently published an interesting examination of financial situations of older Americans at the end of their lives.  The report documents:

  • the percentage of households with a member who recently died "with few or no assets,"
  • the continued importance of Social Security for older households,
  • the potential importance of "big data" analytics "to determine how people behave when it comes to health and retirement plans," including the potential to "get better results at lower cost," and
  • the fact that the "health sector is considerably farther down the road than the retirement sector in using data analytics in benefits plan design and management."

The report (executive summary here and full PDF here) suggests future avenues for research. 

May 4, 2015 in Housing, Retirement, Social Security, Statistics | Permalink | Comments (0) | TrackBack (0)

Wednesday, April 29, 2015

Systemic Concerns about Adult (Including Older Adult) Guardinships in Nevada

After my blog piece earlier this week about "elder guardianship" concerns in Florida, I've received communications about similar concerns in other states, including Nevada.

According to a report by Contact 13 (ABC affiliate), on April 21 Commissioners in Clark County (Las Vegas area) conducted a "first-of-its-kind" hearing on alleged guardianship abuses that were described by some as "appalling, frightening and plagued by problems." At the heart of the complaints by individuals and family members was frequent court appointment of "private guardians" rather than family members, and an alleged absence of notice to family members about court hearings. A "blue ribbon" panel or expert may be appointed to audit Clark County's court-supervised guardianships.  A recent statement by the Chief Judge for the district court, set forth in full on the Contact 13 website, pledges the court's commitment to "ensuring clarity and instilling public trust in the process of handling guardianship cases.

According to the Las Vegas Review-Journal, the Chief Judge's response follows a series of stories by the Review-Journal about "thousands of elderly and mentally ill in Clark County open to exploitation."

As reported by the Las Vegas media, the problems reported in Nevada are not unique to one county or even to one state, as demonstrated by an Associated Press series of articles in 1987 titled "Guardianships of the Elderly: An Ailing System."   See also the national Center for Elders and the Courts for more information on guardianship reforms in state courts.

April 29, 2015 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Legal Practice/Practice Management, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0) | TrackBack (0)

Friday, April 24, 2015

How Should Decisions Be Made About Sexual Rights During Facility-Based Care?

For me, a chilling moment in the trial of State of Iowa v. Henry Rayhons came during the prosecution's case-in-chief, with the reported testimony of a physician at Mrs. Rayhons' nursing home.  According to the coverage of the trial, the doctor testified that based on her decreasing score on the BIMS (Brief Interview for Mental Status), he determined Donna Rayhons lacked the cognitive ability to give consent to sex.  In contrast, a defense expert was reported to have testified it was a "medical mistake" to have used such minimal evaluations of capacity to draw an arbitrary line between permission to kiss or hug, as opposed to engaging in more intimate relations. 

The contrasting testimony put a spotlight on the very serious questions of who makes decisions -- and how decisions are made -- about "capacity" to engage in essential behaviors such as sex for persons with dementia. This topic is further explored, with great prescience, by a law student at the University of Illinois in the current issue of the Elder Law Journal, written well before the Rayhons trial.  Stephanie Tang, who was also the managing editor for the journal in 2014-15, writes:

To best balance the interests of the elderly with those of the states, states should develop and adopt a model assessment tool that employs a clinical perspective to evaluate a person’s capacity to consent to sexual activity. Model assessment tools provide courts with a clear and objective standard, which would increase predictability and uniformity of court decisions.

 

Moreover, identifying specific cognitive functions that need to be assessed would constitute a major step forward in those states that have not yet done so.This Note advocates for the use of two tests: 1) the Socio-Sexual Knowledge and Attitudes Test (SSKAT) and 2) Cognisat. Authors have previously argued for the adoption of the SSKAT to assess sexual capacity to consent among mentally retarded patients. The American Bar Association and American Psychological Association cited use of Cognistat to assess cognitive capacity to consent to sexual activity among hypothetical patients with diminished capacity.

To put this simply, in her article,When "Yes" Might Mean "No": Standardizing State Criteria to Validate The Capacity to Consent to Sexual Activity for Elderly with Neurocognitive Disorders, Ms. Tang is arguing that far more sophisticated and appropriate tools are available and should be used to assist in evaluating capacity to participate in sex. Brava, Ms. Tang!

Ms. Tang's article draws in major part on the detailed factual reporting of Bryan Gruley for Bloomberg News, in his important series on rights of the elderly with dementia.  Mr. Gruley's articles began to appear as early as 2013, and became even more relevant with his investigation of the events underlying the 2014 charges against Mr. Rayhons.

April 24, 2015 in Cognitive Impairment, Crimes, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care, Science, Statistics | Permalink | Comments (0) | TrackBack (0)

Thursday, April 23, 2015

How Does Your Neighborhood Rate for "Aging in Place?" AARP Offers Livability Index

As outlined by The Washington Post, AARP Public Policy Institute has a new "Livability Index" offered as a way to evaluate factors such as safety, security, ease of getting around, access to health care, and housing affordability.

More intangible factors are also assessed, such as WiFi, farmers' markets and "public policies that promote successful aging."

(After following the trauma of the trial in Iowa, I wonder whether "criminal laws on sexual relations between husband and wives if one has dementia" should be added as an express factor?)

For more, read here and here.  Hat Tip to ElderLawGuy Jeffrey Marshall for the pointer. 

April 23, 2015 in Consumer Information, Housing, Retirement, Statistics | Permalink | Comments (0) | TrackBack (0)

Thursday, April 16, 2015

NYT: Nursing Homes Chase Lucrative Patients (But That's Not the Whole Story)

From the New York Times on April 14, an article from the business section, As Nursing Homes Chase Lucrative Patients, Quality of Care is Said to Lag.

Promises of “decadent” hot baths on demand, putting greens and gurgling waterfalls to calm the mind: These luxurious touches rarely conjure images of a stay in a nursing home.

 

But in a cutthroat race for Medicare dollars, nursing homes are turning to amenities like those to lure patients who are leaving a hospital and need short-term rehabilitation after an injury or illness, rather than long-term care at the end of life.

 

Even as nursing homes are busily investing in luxury living quarters, however, the quality of care is strikingly uneven. And it is clear that many of the homes are not up to the challenge of providing the intensive medical care that rehabilitation requires. Many are often short on nurses and aides and do not have doctors on staff.

Some colorful quotes here ("patients are leaving the hospital half-cooked"), but a lot of this well-written article nonetheless seems like old news to me (okay, perhaps that's because of my chosen research focus), with reporting on trends influenced by operating margins on the "nonprofit" side of care, and "return on investment" for shareholders on the for-profit side.  Perhaps "intensity" of the pressures is the theme here? 

Tip of the hat to George Washington University Law student Sarah Elizabeth Gelfand ('16) and GW Professor Naomi Cahn for making sure we saw this article!  

April 16, 2015 in Consumer Information, Ethical Issues, Health Care/Long Term Care, Housing, Medicaid, Medicare, Retirement, Statistics | Permalink | Comments (0) | TrackBack (0)

Tuesday, April 7, 2015

Health Care Reform, Transition & Transformation in LTC

Wednesday, April 1, 2015

AARP Reports on the Struggle to Overcome Unemployment for Older Job Seekers

The AARP Public Policy Institute has recently published an Insight Report (March 2015) on older workers and unemployment following the recent economic crisis.  The report draws upon surveys of persons aged 45 to 70 affected by unemployment during the last 5 years.  The primary focus of the analysis is on "reemployment," including what strategies were used in successful efforts to find jobs. 

Lots of interesting information here.  Even though the rate of unemployment is lower for older workers, those losing their jobs later in life stayed unemployed longer than younger job seekers, and their recovery jobs reportedly paid less.  Some of the findings, however, are of equal relevance to younger job seekers.  One set of responses was especially sobering, on a question about possible working life regrets:  

"When asked whether there was anything they wished they had done differently over their working lives or careers to better position themselves for dealing with unemployment, 52 percent said 'yes.' The most common answer —65 percent — was a wish that they had saved more money. Also of note, 48 percent wished they had gone back to school to complete or get another degree, and 38 percent wished they had chosen a different field. The unemployed and the long–term unemployed were more likely than the other groups to wish they had chosen a different field. Those who elected that regret also tended to be younger (56 percent were ages 45 to 54)."

Many thanks to Professor Naomi Cahn at George Washington Law for alerting me to this report, and sending a link to related Wonk Blog coverage of the study from the Washington Post  -- lots of well-explained graphs from an oral presentation that accompanied the launch of AARP's written report. 

April 1, 2015 in Consumer Information, Current Affairs, Discrimination, Ethical Issues, Retirement, Statistics | Permalink | Comments (0) | TrackBack (0)

Monday, March 16, 2015

Family Dynamics are Complicated, Particularly When We're Talking End-of-Life "Wealth" Transfers

GW Law Professor Naomi Cahn and Amy Zeittlow, affiliate scholar with the Institute of American Values, have collaborated on a new article that is fascinating.  In "Making Things Fair: An Empirical Study of How People Approach the Wealth Transmission System," to be published in a forthcoming issue of the Elder Law Journal, they ask fundamental questions about whether traditional laws governing testate and intestate wealth transmission reflect and serve the wishes of most Americans.  Professor Cahn previews the article as follows:

Based on an empirical study of intergenerational care for Baby Boomers, the article shows how the inheritance process actually works for many Americans.  Two fundamental questions about the wealth transfer system guided our analysis  of the data: 1) does the contemporary inheritance process respond to the changing structure of American families; and 2) does it reflect the needs of the non-elite, who have not traditionally been the focus of the system?    

Our study shows that the formal laws of the inheritance system are largely irrelevant to how property is  transferred at death. While the contemporary trusts and estates canon focuses on the importance of planning for  traditional forms of wealth in nuclear families, this study focuses on the transmission of wealth that has high emotional, but low financial, value. We illustrate how the logic of “making things fair” structured how families navigated the distribution process and accessed the law. Consequently, the article recommends that law reform should be guided by the needs of contemporary  families, where not only is wealth defined broadly but also family is defined broadly, through ties that are both formal and functional.  This means establishing default rules that maximize planning while also protecting familial relationships.

The article is part of a new book by the authors titled "Homeward Bound," with planned publication in 2016, and the authors welcome comments and suggestions. 

March 16, 2015 in Books, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Property Management, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0) | TrackBack (0)

Wednesday, March 11, 2015

U.S. Department of Justice Launches Elder Justice Website

Julie Childs, Project Manager for the U.S. Department of Justice's Elder Justice Website shared with us the resources now available to researchers, students and advocates.  Some of the highlights:

Here, victims and family members will find information about how to report elder abuse and financial exploitation in all 50 states and territories. Simply enter your zipcode to find local resources to assist you.

Federal, State, and local prosecutors will find three different databases containing sample pleadings and statutes.

Researchers in the elder abuse field may access a database containing bibliographic information for thousands of elder abuse and financial exploitation articles and reviews.

Practitioners -- including professionals of all types who work with elder abuse and its consequences -- will find information about resources available to help them prevent elder abuse and assist those who have already been abused, neglected or exploited.

This website is intended to be a living and dynamic resource. It will be updated often to reflect changes in the law, add new sample documents, and provide news in the rapidly evolving elder justice field.

It will be interesting to watch this site develop. 

March 11, 2015 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, State Statutes/Regulations, Statistics | Permalink | Comments (1) | TrackBack (0)

Monday, March 2, 2015

Dementia -- A Triple Whammy for Women

Alzheimer's Research UK is releasing a report this month about the impact of dementia on women. Details released in advance of the formal launch are eye-opening.

As reported in The Guardian, “'Dementia is a life-shattering condition and represents a ‘triple whammy’ for women,' said Hilary Evans, director of external affairs at Alzheimer’s Research UK. 'More women are dying of dementia, more women are having to bear the burden of care, while a disproportionate number of women currently working in dementia research are having to leave science.'”

The full study calls for the government to make a significant increase in its funding of dementia research and an improved investment in care. Further, the report will explain that:

■ More than 500,000 women [in the U.K.] are now affected by dementia. About 350,000 men have the condition.

■ Women over 60 are now twice as likely to get dementia as breast cancer.

■ Women are more than two-and-a-half times more likely than men to be care-givers of people with dementia.

■ Most care- givers do not choose or plan to take on this role and often find the experience highly stressful.

Thanks to friends at CARDI, the Centre for Ageing Research and Development in Ireland for sharing this news.  The formal launch of the Alzheimer's Research UK report appears timed to coincide with their "sold-out" 2015 Conference on March 10-11 in London. 

March 2, 2015 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, International, Science, Statistics | Permalink | Comments (0) | TrackBack (0)

Thursday, February 26, 2015

Graying of American Voters: One of Top Ten Demographic Trends Affecting Policies & Politics

A new research project on demographics of the U.S., with funding from The William and Flora Hewlett Foundation, brings together the Center for American Progress, the American Enterprise Institute, and demographer William H. Frey of the Brookings Institution.   The project goals are:

  • To document and analyze the challenges to democracy posed by the rapid demographic evolution from the 1970s to 2060
  • To project the race-ethnic composition of every state to 2060, which has not been done for 20 years
  • To promote a wide-ranging and bipartisan discussion of America’s demographic future and what it portends for the nation’s political parties and policy

The team's first report identifies a Top Ten list of demographic factors likely to impact the future of both policy-decisions and politics, including #6 on the "Graying of America."  Graphics illustrate each of the projections, including this one on aging.

Graying of American Electorate

For more complete results, see The States of Change: Demographics and Democracy, 1974 to 2060.

Thanks to GW Law Professor Naomi Cahn for sending this report! The statistics should  be useful for generating student discussion in a wide range of courses. 

February 26, 2015 in Current Affairs, Discrimination, Ethical Issues, Statistics | Permalink | Comments (0) | TrackBack (0)

Tuesday, February 24, 2015

Home Care Workers Join Forces to Advocate for Fair Wages

USA Today reports on home care workers "joining a nationwide movement" to raise wages,  with rallies planned for "more than 20 cities in the next two weeks." 

As described by journalist Paul Davidson,

"Like the fast food workers, the 2 million personal care and home health aides seek a $15 hourly wage and the right to unionize, which is barred in some states. Their median hourly wage is about $9.60 and annual pay averages just $18,600 because many work part-time, according to the Labor Department and National Employment Law Project. That puts the industry among the lowest paying despite fast-growing demand for home-based caregivers to serve aging  Baby Boomers over the next decade.

 

'Home care providers living in poverty don't have a stable standard of living so they can provide quality care,' says Mary Kay Henry, president of the Service Employees International Union, which is spearheading the home care aides' movement and backed the fast-food worker strikes."

According to a representative of "Home Care Association of America, which represented agencies that employ personal-care aides," companies attempt to "balance the ability to keep care affordable with attracting employees."

Thanks to Dickinson Law 3L student Jake Sternberger for pointing me to this news item.

February 24, 2015 in Consumer Information, Discrimination, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0) | TrackBack (0)

Sunday, February 15, 2015

Should We be Addressing Social Security Funding Problems at the Front End? New CAP Study

George Washington University Law Professor Naomi Cahn sent us a link to an interesting study that seeks to demonstrate the impact of income equality -- and wage stagnation for low and middle income workers -- on the long-term solvency of Social Security. 

In a release accompanying the release of its study, the  Center for American Progress (CAP) explains: 

"Specifically, CAP’s issue brief finds that the trust funds would be $753.8 billion larger had the average worker’s wages kept pace with productivity growth between 1983 and 2013, thereby reducing the expected 75-year shortfall of the trust funds by 6.8 percent. The brief also shows that the trust funds would be greater by more than $1.1 trillion had the maximum taxable wage base remained fixed at 90 percent of earnings over the same time period, reducing the expected 75-year shortfall by 10.1 percent. Both scenarios would have added years of additional solvency to the Social Security trust funds. These findings come on top of Social Security trustees’ projections that, looking ahead, freezing the taxable wage base at 90 percent today would on its own close more than one-quarter of the projected 75-year shortfall....

CAP’s brief outlines how, as a result of the [existing] cap on taxable earnings--$118,500 for 2015—Social Security’s funding is tied directly to the full wages that low- and middle-income workers earn—but not to the full wages that higher-earning workers receive. The brief finds that in 2013, the top 1 percent of earners took home nearly the same share of the nation’s total wage income as the entire bottom half of workers. As a result, income has shifted away from workers whose full earnings are subject to payroll taxes and toward high-income workers whose additional dollars are exempt."

The CAP report is the work of Rebecca Vallas (a former Borchard Fellow), Christian Weller, Rachel West, and Jackie Odum.Thanks for sharing this report, Naomi!

February 15, 2015 in Retirement, Social Security, Statistics | Permalink | Comments (1) | TrackBack (0)

Thursday, February 12, 2015

More Millennials than Boomers

We know there are a lot of Boomers and we expect the Boomers to have a significant impact on aging issues. But, although there are a lot of Boomers, the Boomers aren't the largest cohort of the U.S. population, In fact, the Millennials are #1. According to an article in the New York Times, Millennials Set to Outnumber Baby Boomers.  The Millennials are the cohort born between 1981-1997. according to the article, they will hit 75.3 million living members, which will make them a larger cohort than the Boomers. Here's a question-since we are c18 years out, how does this generation continue to grow?  According to the article,  it is because of "[a]n influx of immigrants, according to a new report from the Pew Research Center. And, of course, members of the boomer generation, currently at 74.9 million, are beginning to die in greater numbers."

The article goes on to discuss how demographers determine the years that define a cohort and what is expected regarding the actions of Millennials. Boomers, take heart.  The Millennials  may outnumber us, but we still rock on!  The Pew Research article, This Year,  Millennials Will Overtake Baby Boomers,  referenced in the NY Times piece may be accessed here.

 

February 12, 2015 in Current Affairs, Statistics | Permalink | Comments (0) | TrackBack (0)

Friday, February 6, 2015

"The 4% Fallacy" in Long-Term Care Statistics

H. R. Moody edits an electronic newsletter, called "Teaching Gerontology," under the auspices of the Creativity, Longevity & Wisdom Program at Fielding Graduate University in Santa Barbara, California.  It is distributed by the Association for Gerontology in Higher Education. A recent newsletter contained this interesting item:

"We've all heard that famous statistic: only 4% of people over 65 are in a long-term care facility (sometimes called simply "nursing home").  But there's a reason why this statistic has been called the "4 Percent Fallacy." The reason is that it's simply a cross-sectional figure, a snapshot at a single point in time. What is the likelihood of being in a long-term care facility when we look at it  longitudinally, that is, over the life-course?  The bad news is that the risk is not 4% but more like 50%: 44% for men and 58% for women.   The good news is the stays in a nursing home may not necessarily be long: 11 months for a single man and 17 months for a single woman."

H.R. Moody suggests that for more details, visit:http://crr.bc.edu/briefs/long-term-care-how-big-a-risk/

Further, he notes that CRR's calculation of average length-of-stay has been challenged and is worth closer examination:  http://centerltc.com/bullets/latest/1070.htm 

February 6, 2015 in Consumer Information, Health Care/Long Term Care, Statistics | Permalink | Comments (0) | TrackBack (0)

Thursday, January 29, 2015

ABA Commission Fellow Examines Restoration of Rights for Adults Under Guardianship

Jenica Cassidy, a recent graduate of Wake Forest University School of Law, has been serving as a Fellow with the ABA Commission on Law and Aging since August 2014.  It appears she's been making very good use of her time, working on a study that examines termination of guardianships and restoration of rights for adults. 

BiFocal, the journal of the ABA Commission is publishing a short overview of the study -- a sneak peek -- in its February issue. What I especially appreciate is the clear documentation provided by the author on the methodology, including "(1) statutory review; (2) case law search and analysis; (3) online questionnaires for attorneys and judges; and (4) stakeholder interviews." Jenica and the Commission staff analyzed 104 cases, including 57 cases occurring between 1984 and 2014, where individuals petitioned for restoration of rights.  The study highlights the challenges that face any individual seeking to terminate a guardianship, as well as the impact of guardian testimony or opposition to such petitions. 

The full report will be published in the Elder Law Journal (University of Illinois), but in the meantime, read the intriguing summary available through BiFocal.  

January 29, 2015 in Elder Abuse/Guardianship/Conservatorship, State Statutes/Regulations, Statistics | Permalink | Comments (1) | TrackBack (0)

Thursday, January 22, 2015

What About Inadequately Funded Municipal and Local Public Pensions?

We have written many posts about underfunded benefit programs at the federal and state levels (see e.g., here), but another looming problem is underfunding of pension programs at the local levels.  The potentially affected employees include firefighters and sanitation workers and police officers. 

This week WITF-Radio's Smart Talk program explored the issue in Pennsylvania:

"More than 500 Pennsylvania municipalities' pension funds are considered "distressed" because they're funded at less than 90%.  Some Pennsylvania cities, boroughs, and townships currently have pension funds at lower than 50%. State law impacts public employees' ability to negotiate their contracts, making this issue of particular concern to lawmakers in Harrisburg.

 

Last week, Pennsylvania Auditor General Eugene DePasquale announced that in total Pennsylvania's municipal pension funds have a $7.7 billion liability. Legislation is expected to be proposed this year that will seek to eliminate some of the liability over the long term."

It seems unlikely that Pennsylvania is the only state with a local-level pension funding problem.

The primary speaker on the program, Pennsylvania Municipal League Executive Director Richard Schuettler, pointed to an interesting aspect of the problem, what he sees as unrealistic decisions by arbitrators in collective bargaining labor disputes over pay and retirement benefits.

For the full radio program, go to the podcast here. 

January 22, 2015 in Retirement, State Statutes/Regulations, Statistics | Permalink | Comments (0) | TrackBack (0)

Wednesday, December 10, 2014

Comparative Legal News on the CARE Act: A Report from Pennsylvania's AARP Family Caregiver Summit

Earlier this year, Kim Dayton reported in our Blog (here) about the new CARE Act, enacted in Oklahoma as a means to provide better transition from facility-based care to home care for individuals needing support.  The CARE Act is a nation-wide project sponsored by AARP and thus I was excited to be invited to participate in an AARP Pennsylvania Family Caregiver Summit, as part of the discussion about introduction and passage of a CARE Act in my state. 

The Summit was held yesterday with administrative agency heads, legislators and their staff invited to attend.  The turnout was probably a bit affected by the weather reports for the day.  (What happened to the predicted Nor'easter, anyway?  Not that I'm complaining about winter weather that proves to be milder than predicted!)  I found the event very interesting.  As so often happens, I ended up being more of a student than a teacher, even while serving as a panelist.

It was quickly clear that virtually everyone in the room had experience with or personal awareness of the challenges of serving as a family caregiver under stress.  The room was practically vibrating with stories about how tough it can be to know what to do when you confront the reality that a parent or other aging family member needs significant support.  The keynote speaker, Cate Barron, a vice president of the PennLive and Patriot-News media group and by her own admission a take-charge kind of gal, spoke with great candor and humor about the process of realizing that a "diagnosis" of what is wrong did not necessarily provide answers to her mother's need for assistance.  We are so pre-programmed to believe that if we can find the right diagnosis of the problem, there must be a "solution" worth pursuing.

The opening presentation by Glenn Fewkes from the AARP National office provided the latest statistics and graphics about aging in the U.S.  What I found especially interesting were his graphics about Long-Term Services and Supports (LTSS) for individuals with caregiving needs.  It turns out Pennsylvania ranks near the bottom (42nd, according to the most recent statistics) on a national scorecard. evaluating LTSS for affordability and access.  That means the state with the fourth "oldest" population has some real challenges ahead.

That is where AARP's CARE Act project comes into play as a first step to improve supports for individuals needing care.  As we reported earlier, CARE is an acronym for "Caregiver Advise, Record and Enable" and AARP's model has straight-forward objectives.  To me, a key goal in adopting the model CARE Act is to create smoother transitions.  This can be facilitated  by making sure that hospitals or rehab facilities have clear information about any designated "caregiver," that they give notifice of discharge at least 4 hours in advance,  and that they offer practical instruction on any medical tasks that will need to be performed in the home.  For example, under the model CARE Act, the instruction shall include:

  • a live demonstration of needed "after-care tasks"
  • an opportunity for caregiver and patient to ask questions
  • answers to the caregiver and patient questions "provided in a culturally competent manner and in accordance with the hospital's requirements to provide language access services under state and federal law."

My own research has shown that family members often cite "access to accurate information" as one of the most important first needs for families responding to caregiving crises.  The CARE Act is clearly intended to respond to a critical first window of need -- hospital discharge --  by requiring facilities to give useful information and relevant instruction.

During the Family Caregiver Summit, there were a lot of good questions about the CARE Act, and it was great to have Pennsylvania State Representative Tim Hennessey on the panel. In his role as majority chair of the House Aging and Older Adult Services Committee, it is likely he will be able to provide early analysis and support for the CARE Act in Pennsylvania. 

As part of my own preparation for the Summit, I took a closer look at Oklahoma's result with the CARE Act.   Title 63 Okla. St. Ann. Sections 3113- 3117 (the statutory provisions created by the April 2014 passage of Senate Bill 1536) became effective on November 1, 2014.  The law requires that  hospitals "provide each patient or patient's legal guardian with an opportunity to designate one lay caregiver" following admission, and to record the designated caregiver and the caregiver's contact information in the patient's medical record.  Such a choice then triggers the hospital to "request the written consent" of the patient or guardian to release medical information to the patient." Only if the patient both designates a lay caregiver AND gives "written" consent is the hospital then obligated to do anything further with respect to discharge planning with the caregiver.

But what happens in Oklahoma when the written consent to share information with the designated caregiver is given? 

Continue reading

December 10, 2014 in Consumer Information, Current Affairs, Health Care/Long Term Care, State Statutes/Regulations, Statistics | Permalink | Comments (0) | TrackBack (0)

Friday, December 5, 2014

Is "Ambivalence" Sometimes a Component of Elder Financial Abuse?

I've written often in our Blog, including here and here, about our growing awareness and national concern about the issue of financial exploitation of older persons.  In brainstorming a bit with another attorney about a thorny case -- and trying to decide where a parent/child relationship went wrong --  I was reminded of the work of Professor Karen Hooker, PhD at Oregon State University's School of Social and Behavioral Sciences.  Karen-hooker-webA major focus of Professor Hooker's work is the influence of "personality" in aging across the lifespan.  She has examined spousal caregivers for persons with dementia, looking to see how the individual's view of self and the relationship affects "success," including successful caregiving.  Another part of her work has examined closely the issue of "ambivalence" in family relationships.

For example, in Dr. Hooker's research, her team used qualitative study methods to examine older parent/adult child relationships.  One of the major themes emerging when parents (each aged 67+) talked about their children was awareness that their children were "busy," and thus there were often ambivalent feelings of need and dissatisfaction about the parent's interactions with their children.  The study revealed feelings both of resentment and pride about their busiest children.

That has led me to think that "ambivalence" may also be a component of voluntary "principal and agent" relationships, where the adult children are asked by the parent to serve as an agent under a power of attorney, for example.  But as the adult child exercises more control over financial matters, might that parent also begin to have second thoughts, thoughts that are not acted on until "too late."  The children believe they had authority to "pay themselves" for their roles in handling matters for their aging parent; the parent initially agrees, or at least does not object, and only later, after the money is gone, asserts some "agreement" about the financial matters, arguing there was an "understanding," even if never express at the outset?  There is room for more research here, yes?

For more on Professor Hooker's interesting work in personality and life-span issues, read this great interview, with links to her publications and biography here.   

December 5, 2014 in Dementia/Alzheimer’s, Health Care/Long Term Care, Science, Statistics | Permalink | Comments (0) | TrackBack (0)