Monday, July 16, 2018

The Future For The Aging Demographic?

The National Academies Press has released Future Directions for the Demography of Aging.This volume contains the proceedings of a workshop and the overview explains

Almost 25 years have passed since the Demography of Aging (1994) was published by the National Research Council. Future Directions for the Demography of Aging is, in many ways, the successor to that original volume. The Division of Behavioral and Social Research at the National Institute on Aging (NIA) asked the National Academies of Sciences, Engineering, and Medicine to produce an authoritative guide to new directions in demography of aging. The papers published in this report were originally presented and discussed at a public workshop held in Washington, D.C., August 17-18, 2017.

The workshop discussion made evident that major new advances had been made in the last two decades, but also that new trends and research directions have emerged that call for innovative conceptual, design, and measurement approaches. The report reviews these recent trends and also discusses future directions for research on a range of topics that are central to current research in the demography of aging. Looking back over the past two decades of demography of aging research shows remarkable advances in our understanding of the health and well-being of the older population. Equally exciting is that this report sets the stage for the next two decades of innovative research–a period of rapid growth in the older American population.

Part 1 looks at trends in health and health disparities, Part 2 examines the implications of social and environmental factors, Part 3 covers families and intergenerational issues, Part 4 covers employment and retirement, Part 5 discusses cognitive issues and disability, Part 6 reviews global aging and Part 7 offers new approaches. You can purchase the softcover book here, download a free pdf of the book by clicking here or read the book online.

 

July 16, 2018 in Books, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, International, Retirement, Science, Statistics | Permalink | Comments (0)

PA Elder Law Institute Session on CCRCs and LPCs Will Discuss Pending Legislation and Indicators on Financial Performance

As I mentioned earlier, Pennsylvania's annual Elder Law Institute is July 19 and 20 in Harrisburg.  On the morning of the first day, I'm on a panel examining new issues in Continuing Care Retirement Communities (and Life Plan Communities), along with Linda Anderson, an elder law attorney, Kimber Latsha, who frequently represents health care and senior living providers including CCRCs, and  Dr. David Sarcone, a Dickinson College business professor with background in accounting and health care management.  

I'm especially looking forward to the discussion of Pennsylvania 2018 House Bill 2291, introduced in April of this year, but already moving from one committee, to its first of three considerations on the floor, to the Rules Committee, with amendments.  In other words, this bill seems to have "legs."  The sponsors of the bill are calling it an "Independent Senior Living Facility Privacy Act."  As with most catchy titles for pending legislation, the details are a bit more complicated.  In this instance the bill's lead sponsor is from a county where a single CCRC was investigated by the State Department of Human Services following a complaint that "staffing levels" were inadequate, leaving certain residents allegedly at risk.  The Department of Human Services issued an adverse order in May 2017 related to certain aspects at the facility and apparently that order is the subject of administrative appeals.  

The provider contests the order, and in written testimony submitted to the Pennsylvania House Committee on Aging and Older Adults Services, the CEO explained his company's position that the investigators were abusing their authority by entering independent living (IL) units, questioning IL residents, and thus failed to respect the individual autonomy of residents not actually living in "personal care" facilities, facilities that would be subject to HS authority:

"We feel that DHS is inappropriately applying the term 'premises' [from the personal care regulations] as the grounds and building on the same grounds, used for providing personal care services.  Each senior apartment is a 'separate individual leasehold,' where an inhabitant, the lessee of the apartment leases an apartment and is afforded the enjoyment and freedom to engage family and third party services."

At the core of this issue is a question about expectations of the public and the residents about care in "independent living" units of a licensed "continuing care community." (Pennsylvania has at least one pending wrongful death suit involving an entirely different CCRC, where one issue is whether the CCRC's alleged awareness of an IL resident's worsening dementia was ignored.  She allegedly died of complications of exposure after wandering and being locked out of her IL apartment complex on a cold night.) 

The proposed legislation would exclude "independent senior living facilities" (including public housing outside of the CCRC context) from future state Human Services investigations, including investigations by the Long-Term Care Ombudsman. 

I expect we will also be talking about financial performance numbers of both for-profit and nonprofit CCRCs -- especially as some of the numbers suggest that some operations both sides of the industry "profit" line may be struggling to "live within their means."  

In other words, there will be some especially "hot" topics for discussion.  

July 16, 2018 in Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care, Housing, Property Management, Retirement, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Friday, July 13, 2018

More on California's Aid-in-Dying Law

We have blogged a couple of times at least about California's Aid-in-Dying law, most recently about the judge declaring the law unconstitutional. While the constitutionality issue makes its way through the court system, California in late June released statistics to show how many folks had previously availed themselves of the law. The New York Times reported that Nearly 400 People Used California Assisted Death Law in 2017.

Here are some statistics from the article:

374 terminally ill people took drugs to end their lives in 2017, the first full year after a law made the option legal....

577 people received aid-in-dying drugs last year, but not everyone used them....

Of the 374 who died, about 90 percent were more than 60 years old, about 95 percent were insured and about 83 percent were receiving hospice or similar care. The median age was 74....

Most of the recipients were college educated and receiving hospice or similar care....

The 374 people who died include 11 people who were prescribed drugs in 2016 but died last year.

Another 86 people were prescribed the lethal drugs but died without taking them, while the fate of the remaining 128 people wasn't reported.

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

Wednesday, July 11, 2018

How "Liveable" is Your Community?

AARP has named the top 10 cities with populations  500,000 and over that are the most "liveable." I'm not living in one of the top ten-are you? Nor am I living in one of the top 10 mid-sized (100,000-499,999) "liveable" communities. Nope, not living in one of the top 10 small (25,000-99,999) "liveable" communities either. 

How does AARP determine if a community meets their liveability scale?  The website explains that "AARP developed the Livability Index, a ground-breaking tool—now in its third year—that uses more than 50 national data sources and 60 indicators spread across seven categories to jump-start community conversations about livability and encourage action by consumers and policymakers alike.It turns out that many of the characteristics that make a community “livable” are the same across all ages: safety and security, affordable and appropriate housing and transportation, and the ability to live near family and friends who can be relied upon." The index looks at housing, environment, health, community engagement, employment, neighborhoods and transportation. How does your city fare?

BTW, this could be a really good exercise for students to do in their elder law course. The fall semester will be here before we know it!

July 11, 2018 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Other, Statistics | Permalink | Comments (0)

Thursday, June 28, 2018

New Infographic on Dementia Trends

The Population Reference Bureau (PRB) has  published a new infographic on trends in dementia in the US. The infographic explains

The share of older Americans with dementia is decreasing, but the total number will rise as the large baby boomer population ages and more people live longer. While education gives older adults an edge, reducing their dementia risk, racial and socioeconomic disparities in dementia are large and persistent. The most effective way to reduce dementia prevalence in the future is to postpone its onset through preventive strategies and treatments.

This infographic summarizes the latest demographic research on dementia trends, published in a 2018 special supplement to Journals of Gerontology.[1] It distills key findings from the supplement’s seven articles for policymakers and public health professionals as they plan for an aging population.

The infographic addresses age, education, gaps, costs and prevention. Check it out!

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

Friday, June 22, 2018

Where the Elders Are

CityLab recently ran a story about populations and particularly, where elders are residing. Mapping America’s Aging Population explains that "Demographers and geographers have watched as this aging cohort transformed the U.S., from young children in the 1950s and 1960s to senior citizens today. This graying of America has left a distinctive geographical fingerprint."

Want to guess where elders are living?  If you started with the sunbelt you would be somewhat correct. "Unsurprisingly, popular retirement states like Florida and Arizona have high concentrations of older Americans... What may be more of a surprise is the broad swaths of elderly running through the Midwest and the Appalachians. These regions have aged significantly, as many younger residents headed toward the coasts."  The demographic maps provide good pictorial representations of the locations where elders are living.

The article looks at births and deaths and relocation. Interestingly, "[p]eople are less likely to move as they age. In 1968, parents of the baby boomers were in their highly mobile, young adult years, but today boomers are older and more apt to stay where they are."

The Boomers seem to be clustering in certain geographic areas:

Baby boomers have contributed to this trend. Fifty years ago, this group was spread out evenly among the rest of the general population. By 1990, they had became more bicoastal and were concentrated in a small number of dynamic, growing metropolitan areas.

Between 1990 and 2000, a substantial number of boomers flocked from these metro areas to amenity-laden retirement and pre-retirement regions, like the Pacific Northwest, Florida, northern Wisconsin and Michigan, as well as some areas of the South, like the Ozark region and the Western Carolinas.

These areas have continued to grow, while baby boomers moved away in their greatest numbers from the southern Great Plains and the area along the Mississippi River Valley.

Thanks to my colleague and dear friend, Mark Bauer, for sending me the article.

 

 

June 22, 2018 in Consumer Information, Current Affairs, Housing, Other, Property Management, Retirement, Statistics | Permalink | Comments (0)

Monday, June 11, 2018

AARP's 2018 Where We Live: Order Now!

AARP's 3rd edition (2018) of Where We Live: Communities for All Ages is available for pre-order now.  You can request one hard copy free, following these instructions

1. Email Fulfillment@AARP.org with the subject line: Where We Live 2018

2. In the email body, include:

  • your name
  • street address 
  • town/city, state, zip code
  • publication number D20439

Bulk orders may also be possible. If you prefer to read the report online, a link to the pdf of the report will be available on June 13, 2018, here.

June 11, 2018 in Books, Consumer Information, Current Affairs, Housing, Statistics | Permalink | Comments (0)

Aging: "The One Shark We Cannot Escape"

My good friend and colleague, Pennsylvania Elder Law Attorney Linda Anderson, has a thoughtful essay about her personal journey in elder law in a recent issue of  GPSolo,  the ABA journal for solo, small firm, and general practitioners.  Her closing paragraphs address several core issues, comparing her elder law focus with traditional tax and estate planning concerns.  I enjoyed her use of classic lines from the movie Jaws.  

My early work with elder clients or their adult children across a variety of asset levels certainly involved tax and estate planning. But it became clear that serving and protecting these clients demanded more than just good lawyering, that good planning needed “a bigger boat.” It entailed comprehensive knowledge of the Social Security, Medicaid, and VA benefits bureaucracies, close engagement with insurance providers, geriatric care managers, social workers, and other professionals, as well as close monitoring of state and federal regulatory and policy changes and housing and age discrimination laws, among others. The eventual next step for me was completing the requirements to become a certified elder law attorney (CELA).
 
 
Solo or general practice attorneys do not have to become dedicated elder law experts when taking on clients seeking long-term care and funding planning. Take those clients, but be prepared to augment tax and estate planning expertise with a deep dive into areas of elder and special needs law and funding mechanisms. All this is doable, of course, but the biggest difference is in mindset. Attorneys often approach estate and long-term care planning as transactional or episodic--needs arise, documents are drafted or revised, and we and the clients move on. But the nature of the legal work I've touched on above demands a continuing, flexible outlook and a lot of homework. When in doubt, consult with or refer your client to a CELA-qualified attorney. These attorneys are listed in the website for the National Elder Law Foundation (NELF, nelf.org). Another resource for lawyers (who may or may not be CELA-qualified) is the National Academy of Elder Law Attorneys (NAELA, naela.org). Both organizations are excellent sources for information and referrals.
 
 
Finally, as we all learn in time, everything that we've covered here will become very personal for each of us. This may first happen through our parents or siblings as they transition and age, but it's necessarily part of our own futures as well. That's true whether you're a Baby Boomer looking at 70, a Gen Xer thinking that 40 is “old,” or any age in between.
 
 
Aging is the one shark we cannot escape. But as attorneys, we know how to plan and can build our clients' (and our own) “boats” to manage aging as well as possible.
 
The full article is currently behind a paywall on the ABA website. For more of Linda's wise words, it is worth tracking down a copy of An Elder Care Lawyer's Story.  It is in Volume Issue No. 2 (March/April, 2018) of GPSolo.  It is also available on Westlaw, although, of course, that's another paywall.   

 

June 11, 2018 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Estates and Trusts, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Legal Practice/Practice Management, Medicaid, Medicare, Property Management, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Thursday, June 7, 2018

BBB: Sweepstakes & Lottery Scams

The Better Business Bureau recently released a new report, Sweepstakes, Lottery and Prize Scams. So why, you ask, am I writing about this report?Because of this:

BBB found these frauds concentrate disproportionately on older people, who suffer the largest losses by far. A vast worldwide industry of sweepstakes mailings specifically targets older victims. Major law enforcement efforts are focused on the millions of deceptive mailings that have flooded the mailboxes of seniors across the country. In addition to money loss, victims often are emotionally devastated when they realize they have been defrauded. Some have even resorted to committing suicide.

In particular, the report offers data for the past 3 years by age group and shows the number of complaints by age and the amount of losses (and the total is staggering). The report ponders why elders are targets, offering

While some studies suggest older consumers are somewhat less likely to be fraud victims than the general population, perhaps because they have more life experience to guide them, there is evidence suggesting they are more likely to become victims of sweepstakes fraud. Complaint data shows more than half of victims are over 60, and those over 70 years old account for more than two thirds of the losses related to this scheme.

Why is this? It is speculated that the fraudsters hope to find victims with mild cognitive impairment, dementia or Alzheimer’s disease. These people often continue sending hundreds of thousands and even millions of dollars to fraudsters. A retired college president sent tens of thousands of dollars to scammers. CNN reported that an older man suffering from Alzheimer’s sent all of his funds to scammers and then committed suicide when the prize money never came. A San Diego TV station explains how one senior victim was defrauded.

In addition, seniors may simply have more money and may have been at the same address, with the same phone number, for a longer time and therefore may be easier to locate.

The 16 page report offers insight onto scams from Jamaica, Costa Rica and social media, provides profile stories of some victims and perpetrators, and offers suggestions and recommendations with contact info for agencies that handle cases of scams and frauds.

There is a lot of information packed into this 16 page report. Check it out!

June 7, 2018 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, International, Other, Statistics | Permalink | Comments (0)

Monday, May 28, 2018

NYT: Safety Issues When Guns Are In Elderly Hands

Here's a challenging but potentially important topic for many families on this holiday weekend. 

Becky has a post last week about the importance of doctors asking older patients about guns as a safety risk.  I've posted in the past, here and here,  about related issues, including laws affecting registration of gun ownership when intervivos or testamentary trusts are used as the legal vehicle to pass down weapons to succeeding generations.  

The New York Times continues the conversation with In Elderly Hands, Firearms Can Be Even Deadlier.  From Paula Span's article: 

While older adults make many fewer suicide attempts than younger cohorts, they die more often, in part because they use such lethal methods. Yet health care providers who ask older patients about driving and wandering may not ask about guns.

 

“Safety planning for adults with dementia is something every clinician thinks about, but I don’t think firearms are often on the radar,” said Dr. Donovan Maust, a psychiatrist at the University of Michigan Medical School and co-author of a recent article on guns and dementia in the Annals of Internal Medicine.

 

They should be. At various stages of dementia, people may grow unable to distinguish loved ones from intruders. Their decision-making ability deteriorates. They can become paranoid, depressed, impulsive, agitated or aggressive.

Dr. Maust's co-authored commentary, linked above, is worthy of closer reading.  Perhaps in an attempt to allay the fears of gun owners that dementia is not an automatic disqualifier for gun ownership, the piece suggests that doctors consider the stage of any neurocognitive impairment as part of a multi-party discussion about access:

A diagnosis of cognitive impairment or dementia does not in itself mean that a person should not have access to firearms—the level of cognitive impairment is probably most important. In a recent review, Patel and colleagues proposed using the clinical dementia rating scale to estimate the stage of dementia and the person's ability to safely complete complex tasks, including firearm handling. 

 

For patients with minimal cognitive impairment, approaches could be similar to those related to driving, including acknowledging the emotions involved and allowing the PWD [person with dementia]  to maintain agency in the decision for as long as it is safe. As with an “advance driving directive”, PWDs, their family members, and their health care providers may proactively discuss firearm access and consider setting a “firearm retirement date”. This patient-centered approach may allow an older adult to maintain decisional control and identify trusted family members or providers as future surrogate decision makers. To our knowledge, no one has tested the acceptability or efficacy of this approach.
Did you catch that acronym above, perhaps a new one for many of us?  PWDs? My thanks to colleague Laurel Terry for her early morning reading habits -- and  for sharing the NYT article with us. 

May 28, 2018 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care, Property Management, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Thursday, May 24, 2018

Not Everyone Is Driving Along the Information Highway

Believe it or not, there are those in the US who are not on the Internet. Although the numbers are growing, some still haven't gotten onto the information highway. We are seeing an increase in the use of the Internet by those we consider elders, but there are still others who don't use it.

Pew Research periodically releases a report on internet use. The last one, a Fact Tank from a couple of months ago, showed a gradual increase.  11% of Americans don’t use the internet. Who are they?explains that "[t]he size of this group has changed little over the past three years, despite ongoing government and social service programs to encourage internet adoption in underserved areas. But that 11% figure is substantially lower than in 2000, when the Center first began to study the social impact of technology. That year, nearly half (48%) of American adults did not use the internet."

The report looks at all age groups, but since this is the elderlawprof blog, I'm interested in the internet usage by elders. The report gives us that:  "[s]eniors are the age group most likely to say they never go online. Although the share of non-internet users ages 65 and older decreased by 7 percentage points since 2016, about a third today do not use the internet, compared with only 2% of 18- to 29-year-olds."

So basically one-third of elders still are off the information highway.  As more and more Boomers move past age 65, it will be interesting to see if that number drops or holds steady.  Our students need to understand that figure, too, since so many of them are online non-stop. 

May 24, 2018 in Consumer Information, Current Affairs, Other, Statistics, Web/Tech | Permalink | Comments (0)

Banking Industry and the New Senior Safe Act

The "Senior Safe Act," part of a federal banking reform law that will modify Dodd-Frank, has been passed by both houses of Congress with bi-partisan support.  Note the sometimes clever spelling for "Safe" as "$afe," used by proponents.  From a McKnight's Senior Living report on  May 23, 2018:

A bipartisan bill intended to help protect older adults from financial exploitation and fraud is on its way to the president's desk to be signed into law.

 

The Senior $afe Act, authored by U.S. Sens. Susan Collins (R-ME) and Claire McCaskill (D-MO), passed in the House of Representatives on Tuesday as part of a bipartisan banking reform package after previously being passed by the Senate in March. President Trump tweeted on Wednesday that he plans to sign the legislation into law.

 

Collins and McCaskill had introduced the Senior $afe Act in 2017 when they were chairman and ranking member, respectively, of the Senate Special Committee on Aging. Collins still leads the committee, and McCaskill remains a member.

 

The legislation protects banks, credit unions, investment advisers, broker-dealers, insurance companies and insurance agencies from being sued for reporting suspected exploitation or fraud as long as they have trained their employees about how to identify the warning signs of common scams and make reports in good faith to the proper authorities.

 

“The Senior $afe Act, based on Maine's innovative program, will empower and encourage our financial service representatives to identify warning signs of common scams and help prevent seniors from becoming victims,” Collins said in a statement.

 I'll report more once I have a close look at the language, as enacted.  

May 24, 2018 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Federal Statutes/Regulations, Statistics | Permalink | Comments (0)

Wednesday, May 23, 2018

Myths & Mistakes About New Medicare Cards: AARP Research Survey

As we all know, CMS has been rolling out the new Medicare cards without SSN on them.  AARP Research conducted a survey about the new cards, and the results are quite interesting.  2018 AARP Survey: Experience and Knowledge of Medicare Card Scams explains:

n March 2018, AARP engaged Alan Newman Research to conduct a national research study among U.S. adults ages 65 and older about their experience and knowledge around the new Medicare cards being issued in April 2018 and potential vulnerability to scams related to the new card and benefits. 

Key findings include the following:

  • Most (76%) U.S. adults ages 65 and older indicate they have not seen, read, or heard much or anything at all about the new Medicare cards (or are not sure).
  • Three in four (75%) Medicare beneficiaries are not sure or are incorrect about the key change with the new cards being new identification number.
  • Nearly two-thirds (63%) of Medicare beneficiaries are unsure or are incorrect in believing that Medicare will charge new beneficiaries a $25 processing fee for the new card. 
  • Over half (56%) are not sure or are wrong in thinking that Medicare will call them to verify their Social Security number before they can receive their new card.
  • At least one in three are extremely/very concerned about being a target of Medicare scam (33%) or victim of identity theft (40%).

A pdf of the survey results is available here.

 

May 23, 2018 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare, Statistics | Permalink | Comments (0)

A Closer Look at Continuing Care at Home Contracts (Sometimes Known as Continuing Care Without Walls)

As I prepare for some summer writing and speaking projects, I've been taking a closer look at Continuing Care at Home (CCaH), sometimes also called Continuing Care Without Walls.  Pennsylvania was among the early states to license CCaH providers, doing so under the Pennsylvania Department of Insurance's regulatory authority for Continuing Care Retirement Communities (CCRCs).

CCaH is something of a hybrid, contract-based product, sort of a combination of “home care agency” and “long-term care insurance.” The customer makes a prepayment for access to specific services, to be provided in the customer's own home,  The services offered tend to emphasize care coordination; several different types of plans may be offered by a single provider.

From the providers I've reviewed, CCaH contracts typically have an upfront “entry” or membership fee, plus monthly service fees.  In some of the plans there is also cost sharing and deductibles for services.  Overall, the fees, as one would expect, are lower than for traditional CCRCs, but can still be significant.

For example, in a recent report I reviewed, one operation described a series of contracts available.  One contract involved a 90% "refundable" entry fee plan.  In 2012,  a prospective member who qualified at age 88 could expect to pay an entry fee of $147,160, plus monthly service fees ranging from $290 to $584.

In some instances, the company may charge annual fees, rather than a single entry fee plus monthly fees. For example, another Pennsylvania CCaH provider offers "life care plans," "home care plans," and "traditional life care plans."  The first two contracts have annual fees, while the third, "traditional life care plan," is structured with a single upfront entry fee, plus monthly fees of 1% of the entrance fee. 

At that company, for the "life care plan" with annual fees,  a prospective member could select a "life time benefit" of between 1 and 7 years, plus a maximum daily benefit of between $75 per day to $250 per day, with options for a waiting period, cost of living adjustments, and "shared care."  As of April 2016, if a prospective member at age 80 chose a life care plan with a 7 year "maximum life time benefit," no waiting period, no cost of living adjustment and no shared care, he or she could expect to pay annual fees of around $7,880 for a $100 per day benefit -- or up to $15,60o per year for a $200 per day benefit.   Fees would be discounted by 20% for two or more people per household and the benefits and annual fee "may vary based on the member's health status at time of enrollment."  Further, the provider cautions, "though not anticipated, the annual fee for members of life care and home care plans may be adjusted after the fifth anniversary of their continuing care agreement," and any such adjustments would be on a uniform basis for all members in a specific plan.  

In Pennsylvania, all of the current providers of CCaH are connected to or developed by operators of brick and mortar CCRCs, and therefore the CCaH contracts sometimes offer priority admission to the related CCRC if resident care is desired.  I don't think this connection between a CCaH program and a CCRC facility is necessarily required in other states. 

Traditional long-term care insurance has had a troubled history nationally and in Pennsylvania, CCaH providers seem to avoid that history by staying closely tied to the positive reputation of a visible, attractive brick and mortar CCRC.  However, CCaH contracts do not necessarily promise to use the staff or services from the related CCRC, and if so, the CCaH provider may turn to third parties, such as home care agencies, in the search for workers.  The contract terms are key and require careful reading.

Pennsylvania currently licenses five CCaH providers.  The longest operating provider is Friends Life Care at Home, a not-for-profit operation in southeastern Pennsylvania.   It was organized in 1985 and according to registration information at the Pennsylvania Department of Insurance it has approximately 2,500 contracts in existence.   Friends Life Care recently entered into a joint marketing agreement with SpiritTrust Lutheran Life

Continue reading

May 23, 2018 in Consumer Information, Current Affairs, Health Care/Long Term Care, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Monday, May 21, 2018

Asia Begins to Focus on New Senior Housing Models -- and Foreign Investors

From Singapore, comes a recent article in The Independent titled "Asia's Ageing Crisis Calls for Innovative Senior Housing Models and Foreign Investment."  The article begins:

Asia is facing an ageing crisis with rising life expectancies and record low birth rates in some countries, as a result there is an increasing need for senior housing to cater to Asia’s ageing population. In a new report released today, Colliers International identified key trends in Asia’s demographic shift as well as innovative senior housing models around the globe which may be applicable to this region. . . .

 

Mr. Govinda Singh, Executive Director, Valuation and Advisory Services at Colliers International, said, "Singapore's greying population presents many opportunities for both policymakers and private developers to further invest in senior housing solutions. Demand for such accommodation will be also spurred by the rising awareness of  healthcare and wellness benefits, and retirees having the financial capacity to take advantage of senior living services and facilities." . . . 

 

On May 12, 2018, Singapore Prime Minister Lee Hsien Loong officially opened the country’s first retirement community Kampung Admiralty in Woodlands – an integrated residential development with a range of healthcare, elder and childcare facilities, together with commercial space to serve residents of the area. The concept was conceived by the Housing and Development Board more than four years ago.

The article noted population trends in the region, including the prediction that Asia's population of people over age 65 will "nearly triple by 2050 to 945 million, while the percentage of people over age 75 will often be "staggering," especially in Japan (36.4%), South Korea (35.3%), Hong Kong (33.9%), and Thailand (29%) by 2050.

May 21, 2018 in Consumer Information, Current Affairs, Housing, International, Retirement, Statistics | Permalink | Comments (0)

Friday, May 18, 2018

Doctors Discussing Gun Safety With Elder Patients

Kaiser Health News published a compilation of recent stories about gun safety and one caught my eye: the advantage of doctors discussing gun safety with elder patients. Doctors Should Be Discussing Gun Safety With Aging Patients, Researchers Say.

The reference to the story  from the LA TImes, As more older Americans struggle with dementia, what happens to their guns?seemed particularly on point and the KHN story published the opening from the LA Times article

The man had been a patient for decades, retired now from a career in which firearms were a part of the job. He was enjoying his days hunting, or at the shooting range with friends. But episodes of confusion had led to a suspicion of dementia, and the nights were the worst: At sundown, he became disoriented, anxious and a little paranoid, and had started sleeping with his loaded pistol under the pillow. One night, he pointed it at his wife as she returned from the bathroom. It wasn't clear whether he recognized her, but he was certainly confused — and she was terrified. Thankfully, the incident did not end in disaster.

Regardless of your position on the gun control debate, consider these statistics from the LA Times article

Roughly 1 in 3 adults over 65 in the United States is thought to own a gun. An additional 12% live in a household with someone who does.

As seniors turn 70, their odds of developing Alzheimer's disease in a given year jump from less than 1% (among those 65 to 69) to 2.5% (among those 70 to 74), and keep rising from there. By 2050, the number of older Americans with Alzheimer's is expected to reach 13.8 million.

The article discusses driver safety and draws corollaries to gun safety. The article highlights the lack of response to this issue at the state level:

No federal laws prohibit the purchase or possession of firearms by a person with dementia. Only two states, Hawaii and Texas, explicitly mention dementia or similar conditions in their firearms statutes.

In Hawaii, any person under treatment for "organic brain syndromes" is prohibited from owning a gun. Texas law makes individuals diagnosed with "chronic dementia" ineligible for a license to carry a handgun in public. But it does not limit such a person's right to purchase or possess firearms.

One expert quoted in the article describes this as not an issue of taking away someone's guns but instead a decision that focuses on the person's safety.

May 18, 2018 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Other, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Wednesday, May 16, 2018

Grandparent Rights and Responsibilities -- and New Laws

Last Sunday, CBS' 60 Minutes ran an extended feature story on the role of grandparents as primary caregivers for grandchildren, often because of untrustworthy parents with opioid or other addiction problems.  The story reported that "stoked by the opioid crisis, 21,000 children -- just in Utah -- live with their grandparents."

The feature also suggested some of the financial consequences for the extended family, as grandparents were exhausting their own retirement savings in order to provide for the younger children.  Nonprofit programs, such as Grandfamilies, sometimes are able to provide informal support for the grandparents.  

Along the same lines, Pennsylvania's Governor Wolf signed new laws, Senate Bill 844 (Printer's No. 1531), which became Act No. 21, on May 4, 2018.  The law recognizes expanded standing for grandparents to seek physical or legal custody for grandchildren, if they can show "clear and convincing evidence" of all of the following: 

(I) The individual has assumed or is willing to assume responsibility for the child. 


(II) The individual has a sustained, substantial and sincere interest in the welfare of the child.

 

In determining whether the individual meets the requirements of this subparagh, the court may consider, among other factors, the nature, quality, extent and length of the involvement by the individual in the child's life.

 

(III) Neither parent has any form of care or control of the child.

Pennsylvania estimates that there are 82,000 grandparents acting as sole caregivers for roughly 89,000 grandchildren.  Other related bills still pending in Pennsylvania include support for creation of a "Kinship Caregiver Navigation Program," and a means to appoint a temporary guardian when a parent enters drug or alcohol treatment.     

Additional history on the shifts in thinking on grandparent rights can be important.  For example see this Pennsylvania law firm's blog post from 2013 on amendments that removed "automatic" standing for grandparents to seek custody.     

The Pennsylvania Bar Institute, responding swiftly to the latest changes, is offering a Webinar  tomorrow (May 17, 2018) on the new laws.   

May 16, 2018 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Programs/CLEs, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Monday, May 14, 2018

Which States Mandate Certification or Licensure of Guardians?

As I have written in a recent post, Maryland has adopted mandatory training for guardians, effective January 1, 2018.  The Administrative Office for the Maryland Courts is rapidly developing educational materials, including an orientation and topic-specific videos.  In-person training programs are also under development, on a county-by-county basis. 

I recently had a great conversation with Attorney Nisa Subasinghe at the AOMC and I was impressed by all her office is accomplishing in a relatively short time, with a pro-active approach to the topic of court-appointed guardians and the use of orientation videos to get the process rolling.  

Nisa also provided links to the new Maryland Rules on mandatory training for guardians:  Md. Rules 10-108, 10.205.1, and 10-304.1.  In addition, these rules refer to  Guidelines for Court-Appointed Guardians of the Person and Property.  Thank you, Nisa! 

The state of Washington also is developing a program for "lay/family (non-professional) guardians training."  

County-by-county training can be a real problem, as I'm realizing in Pennsylvania where we have 67 counties and probably almost that many views on the need for (or best approach to) oversight of guardians.  

Other states have also been active in establishing education and testing for prospective or current guardians.  Several states' programs have been developed following allegations of improper appointments or lack of oversight.  We've highlighted some of these states in recent Elder Law Prof Blog posts, including Arizona, New Mexico, Nevada and Florida.   

A key decision point is whether to mandate certification or licensure only for so-called professional guardians or also for individuals serving as a guardian for a family member or friend, sometimes  described in legislation or court rules as "nonprofessional guardians."   Driven by complaints by family members about perceived high costs, mistakes, or abuse by fee-paid guardians, some states have focused only on professionals, perhaps on the theory they are affecting larger numbers of alleged incapacitated persons.  Other states, such as Maryland, have taken the position that a minimum threshold of education and oversight is appropriate for all persons serving in guardian or conservator roles, including family members. 

The Center for Guardianship Certification (CGC) offers a map showing certain states with mandatory guardianship programs or rules.  As depicted on the map, some states have adopted  CGC certifications as the state standard for approval of "professional" guardians.  In addition, I noticed that CGC has a list (by exam numbers) of the recent results -- pass or fail -- of certification exams conducted by CGC.   

The ABA also has an online chart (March 2018), prepared by attorney Sally Hurme for the ABA Commission on Law and Aging, with additional information about state certification or licensing rules for guardians. 

You can tell there is a lot of movement in this area -- understandably so given reports across the country. As I was preparing this post, I noticed that neither of these two state charts had identified Maryland as one of the mandatory training states and I suspect I'm missing a few more states that have certification programs in the works.  

May 14, 2018 in Consumer Information, Current Affairs, Estates and Trusts, Ethical Issues, Property Management, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Wednesday, May 9, 2018

Do You Know the Difference Between Fraud & Financial Abuse?

Check out this new issue brief from the National Adult Protective Services Association (NAPSA) Research to Practice SeriesFraud versus financial abuse and the influence of social relationship, offers this summary

Elder financial exploitation, committed by individuals in positions of trust, and elder fraud, committed by predatory strangers, are two forms of financial victimization that target vulnerable older adults. The study presented in the webinar analyzes differences between fraud and financial exploitation APS victims in terms of their health, functional dependency, cognitive functioning, and social relationships.

In this mixed methods study, fifty-three financial exploitation and fraud cases were sampled from an elder abuse forensic center in California. Data include law enforcement and caseworker investigation reports, victim medical records, perpetrator demographic information, and forensic assessments of victim health and cognitive functioning.

The vast majority of fraud and financial exploitation victims performed poorly on tests of cognitive functioning and financial decision-making administered by a forensic neuropsychologist following the allegations. Based on retrospective record review, there were few significant differences in physical health and cognitive functioning at the time victims' assets were taken, although their social contexts were different. Fraud most often occurred when a vulnerable elder was solicited by a financial predator

in the absence of capable guardians. In other words, most fraud victims in the sample did not have trusted friends or family members assisting with financial decisions and providing care at the time the fraud perpetrators entered the picture. Fraud victims were significantly less likely to have children and also had fewer relatives nearby. In sum, fraud and financial exploitation victims had different family and friend structures that may create different opportunity structures for crime.

Social isolation was not only a potential risk factor for financial victimization, it was also a tactic of undue influence to further manipulate and control the victims. Some fraud victims in the sample developed close friendships and romantic relationships with the financial perpetrators, even in the cases where they communicated only by telephone. While these relationships were constructed to manipulate and deceive the victim, they felt authentic to the older person. Perpetrators often exploited the victim's need for companionship and began limiting and controlling their victims' social interactions to create a sense of powerlessness and emotional dependency.

May 9, 2018 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Other, Statistics | Permalink | Comments (0)

Tuesday, May 8, 2018

Do You Have Enough Retirement Savings? -- Here's An Encouraging Report

Most commentaries on funding for retirement years point to insufficiency of savings or other resources.  But here's a different take, drawing upon a recently published report from the Employee Benefit Research Institute (EBRI) that suggests retirees with significant savings are often exercising restraint in spending,  From the St. Louis Post-Dispatch on The Myth of Outliving Your Retirement Savings:

In the EBRI study, those with the most savings — a median of $857,450 shortly after retiring — still had $756,300 two decades later. The decrease amounts to just 11.8 percent of the original sum.

 

The largest drop in retirement nest eggs, 24.4 percent, was among those with the least savings, or a median of $29,975.

 

Frugal behavior is consistent with research led by Anna Rappaport for the Society of Actuaries. She and her team found that most people do not plan for retirement or know what they should spend, but they adapt — even when shocked by high dental bills or a roof repair.

 

What can devastate financially are divorce, caring for a mentally or physically ill adult child who cannot work, and long-term care expenses, according to the actuarial society’s research.

 

Still, debilitating health care costs are far more rare than people fear, according to the EBRI research. Half of retirees face no nursing home expenses because Medicare covers short recoveries after hospital stays and Medicaid can help when resources run out.

 

The medical annual out-of-pocket spending for 90 percent of retirees is just $2,000, and the big nursing home costs over $87,000 hit only 10 percent of people living longer than 95, according to the EBRI study.

For the EBRI study itself, see the April 2018 report on Asset Decumulation or Asset Preservation?  What Guides Retirement Spending? 

May 8, 2018 in Consumer Information, Current Affairs, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Medicaid, Medicare, Retirement, Statistics | Permalink | Comments (0)