Advocates for homeless people in many big cities say they have seen a spike in the number of elderly homeless, who have unique health and housing needs. Some communities, including Phoenix and Orange County in California, are racing to come up with novel solutions, including establishing senior shelters and hiring specially trained staff.
Tuesday, February 20, 2024
One of the first speakers was Sahar Takshi, whose work at Justice in Aging focuses on implementing the organization's strategic initiatives on advancing equity. The initiative centers advocacy on issues that directly address systemic inequities faced by:
- Older adults of color,
- Older women,
- LGBTQ+ older adults,
- Older adults with disabilities, and
- Older adults who are immigrants or who have limited English proficiency.
Sahar offered definitions of core terms, including cultural competence and cultural humility, implicit bias, and a concept that I'm hearing more and more about, "vicarious trauma." I had thought of this as an emerging concern for health and human services providers, who may be repeatedly exposed to clients' and patients' traumas, with the potential for unacknowledged negative impacts on their ability as "helpers" to cope, or to be able to provide consistent levels of service. Sahar reminded us that lawyers may be affected in this way, and perhaps may even be subject to greater self denial. (P.S. I learned our law school is offering a course on this topic in the Fall of 2024!).
Justice in Aging also has teamed with Community Legal Services of Philadelphia (CLS) on a funded out-reach initiative to older adults in the Philadelphia region. Part of the project focused on how the concept of racial justice needs to consider the importance of Medicaid as the largest public payer for long-term services and supports. One challenge is that receiving Medicaid may hit low income families in disproportionate ways, as the state's "recovery program" may target their only asset -- their home. Presenter Pam Walz, a supervising attorney at CLS in the Health and Independence unit, explained the needs for families of color to be able to access sound legal advice in order to avoid unfair Medicaid Estate Recovery impacts.
One of the rising stars at the REPL program was Olivia Robbins who is a paralegal in the Homeownership and Consumer Rights Unit at CLS in Philadelphia. Olivia provided a fascinating, detailed history of concerns about "tangled titles" and how there is a huge need for appropriate estate planning support to avoid this phenomenon. My 1L students were definitely asking for more information on this concern.
New Jersey Elder Law specialist Crystal Edwards, CELA, helped to introduce the day's program for Penn State Dickinson Law, adding her words of support for stronger outreach to clients of color and the importance of attorneys of color for planning services. Crystal reminds us that "help" for older adults and their families comes from private attorneys too; indeed, Friday's program was a holistic overview of public, private, local and national networks for equity in aging, highlighting the significance of race, gender, immigration status, and orientation when bias factors include "growing older."
I provided an example from recent news stories about the intersection of "bias" impacting quality of care for older people who are also persons of color. The publication Nature recently published a comprehensive review of how "fingertip oxygen sensors," that are a tool for catching "low" oxygen levels for people in nursing homes and which were especially during the height of the COVID pandemic, can fail to give accurate readings on dark skin. As the article reports, "Studies --some decades old -- have established that the devices . . . can overestimate the amount of oxygen in the blood of people with dark skin which could lead health professionals to delay or decide against treatment." Penn State Dickinson Law Professor Sarah Gerke commented on the troubling history in the Nature publication.
Visiting Professor Allison Lintal presented our students with important information to close the REPL session about restrictive housing laws or policies at a state or local level that fail to support co-housing, a potentially vital need for older people who can benefit from companionship and a team approach to financial support or care.
My deep appreciation to all of the speakers at our program, helping to introduce our first-year law students to the "search for equity in aging."
Monday, February 5, 2024
Washington Continuing Care (CCRC) Residents Present Specific "Asks" for Consumer Protections to State Officials
On February 5, 2024, residents of "continuing care retirement communities" (CCRCs), also known as "life plan communities" (LPCs), made a formal presentation to officials from several departments of Washington State government, specifying key regulatory priorities when considering "financial solvency" for this segment of the "senior living industries." I was able to sit in on the meeting, as someone who has worked with Washington residents about their concerns.
CCRCs are a relatively new focus for legislators in the state of Washington, with "registration" of CCRCs becoming an option in 2017. But examples of concerns offered by residents demonstrated their concern that a clear state system of regulation is overdue. The spokespeople for WACCRA, the state organizations of CCRC Residents in Washington, were organized, detailed and offered precedents from other states. They requested legislation that:
- Provides formal "licensure" by the state
- Provides key Resident Rights, including Ombuds' support for dispute resolution
- Requires facilities to participate in periodic financial reviews, including actuarial reports, in order for the State to better ascertain the ongoing ability of the CCRC to meet both short- and long-term commitments
- Mandates limitations or prohibitions on facilities' use of residents' payments for services not directly related to resident needs
- Some method by which residents' contracts and entrance fees are prioritized in the event of a bankruptcy
- CCRCs be required to fulfill promises of "refundable entrance fees," in a timely and fair manner, such as a system of "first out/first repaid"
- Adopts stronger safeguards for funding of "life time care," perhaps through guarantee or surety bonds
- Permits residents to participate as voting members of each CCRC's Board of Directors
- Assures "meaningful and effective enforcement" of CCRC's obligations to residents, including financial solvency
Additional stakeholders in CCRCs and LPCs including LeadingAge Washington and, of course, operators of any of these enterprises. A series of similar meetings are to take place from February through April of 2024. The goal is a final State report to the Legislature no later than July 16, 2024.
Wednesday, December 13, 2023
Recently I was one of several academics invited to provide short commentary on state efforts to provide older adults and their families with protection against elder abuse. I was interested to read the final on-line article, which offers a comparative approach, analyzing 50 state systems plus Washington D.C., for reporting, investigating and taking action where abuse of older adults is suspected or reported. The site used what are described as "16 key indicators of elder abuse protection in three overall categories."
The article is by Adam McCann, WalletHub Financial Writer, and is published online on December 13, 2023. There are several drop-down menus for additional information, including the interviews with academics speaking from a variety of perspectives, including Sharona Hoffman, Professor of Law and Bioethics at Case Western Reserve University School of Law.
December 13, 2023 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)
Thursday, October 26, 2023
Organized, Thoughtful, Collaborative Advocacy: The Maturing of Resident Organizations in Senior Living
Coast-to-coast travel can be challenging -- and inspiring. Both was true for me this last week as a result of spending hours on the road and in airplanes to attend annual meetings as an invited speaker for two resident organizations on opposite sides of the country, one in New Jersey and one in Washington state. ORANJ was established by residents of Continuing Care Retirement Communities (CCRCs) in 1991 for the purpose of "supporting, empowering, and bettering the lives of seniors" living in New Jersey. WACCRA was incorporated in 2015 with a mission of "education, collaboration and advocacy" among residents of CCRCs, and I had the privilege of watching its early organizational stages from 2012 to 2014.
Each organization has worked diligently to reach residents of Continuing Care Retirement Communities, sometimes called Life Plan Communities, in order to identify concerns that might be shared by their respective communities. Over the years, the leaders have developed deep knowledge bases and they use media (including websites, blog posts or newsletters, flyers, topic-specific Zoom meetings, and "consumer guides" relevant to future residents) to share their knowledge and to build collaborative in-state networks and to participate with other CCRC resident organizations across the country.
History has proven that the formats used by most CCRCs involve some form of high-dollar admission fee, plus monthly "service" fees, that generate substantial funds. These funds are used to develop and operate communities that offer independent living units in a supportive environment, plus key opportunities as needs change for greater assistance and skilled care and/or memory care. There are now multiple formats with different types of CCRC contracts governing the relationships between individual residents and the community.
Ongoing strength of a community has long been tied to careful management of the funds, especially the admission/entrance fees, which may put the residents in the position of unsecured creditors if serious financial problems arise. Thus, over the years, residents in several states have sought key consumer protections through legislation. WACCRA, for example, retains a seasoned, professional lobbyist. Volunteers at ORANJ, including attorneys who reside in New Jersey CCRCs, lead the way in building relationships with legislators.
The membership base for New Jersey and Washington is slightly different in approach. In New Jersey, resident associations at 25 CCRCs are members of ORANJ and had representatives of the associations, plus interested people attending the 2023 annual meeting on October 18, 2023. In Washington, membership includes individual residents of most of the 23 CCRCs in the state. Family members of residents can also have memberships, a step which is important for recognizing how CCRC living can impact the family as a whole. WACCRA's annual meeting took place on October 21 at a CCRC just outside of Seattle and the ballroom was packed, plus there were additional members who attended via a live streaming feed.
Perhaps most impressive to me was the work underway in each states to present or respond to proposed legislation affecting relationships between the public, residents and the providers of this unique format for senior living. In Washington, for example, WACCRA is making careful, step-by-step progress on legislation to facilitate transparency about finances, scope of operations, and fundamental consumer protections. This effort will build on key legislation enacted in 2017 whereby CCRCs must register with the state.
In New Jersey, there is a bill pending that focuses on the timing of refundable fees and, if passed, would require such refunds within 12 months of a resident's death or departure. There was important discussion about whether and why ORANJ and LeadingAge New Jersey & Delaware may be aligned in their responses to this proposed legislation.
Both annual meetings included Q and A with panels of members active in the organizations. While I was asked to speak separately on what I see as key consumer protections for residents of CCRCs and the role of state laws, in both states it was a pleasure for me to point to the the discussions provided by the panel members who are already fully engaged in advocacy for such safeguards.
I was impressed and inspired by the work of both residents and resident organizations, and the professional approaches that are well underway, sometimes with the assistance of experienced lobbyists. I know similar advocacy is ongoing in several other states. The common goals are clear: residents appreciate their communities and they want to see them thrive, and their experiences demonstrate that better transparency about finances and protections for residents will further the goals.
My special thanks to Barbara Trought, Rick Ober, and Ron Whalin at ORANJ and to WACCRA presidents Laura Saunders (incoming) and Donna Kristaponis (outgoing) for their leadership work, and especially to Donna for her warmth, wine, and laughter as my host at Emerald Heights.
Thursday, October 19, 2023
The Elder Justice Consortium, with representatives appearing on behalf of each of the 9 law schools in Pennsylvania, made their second "in person" report to the Justices of the Pennsylvania Supreme Court, with the event this year taking place on October 16, 2023 in Pittsburgh. The Elder Justice Consortium, or EJC for short, is unique, as it brings together all of the law schools in a single state to advocate on a topic of common concern. EJC meets regularly to consider how to meet the need for effective representation, which requires effective education of law students about issues that directly impact older adults.
Among the activities reported this year include an Elder Justice Day program to introduce the public to available services, and regular meetings and forum events to highlight ongoing services, including the Elder Law Clinic at Widener University Commonwealth Law School, the Sikov Elder Law Clinic at University of Pittsburgh Law, and the most recent matters for older people handled by students at the Gittis Legal Clinics at the University of Pennsylvania Carey Law School. Deans from all of Pennsylvania's law schools were also in attendance for the oral presentation and discussion, demonstrating the high level of committment to enhanced education addressing the needs of older people.
The Consortium initiative began during the summer of 2022 in response to Chief Justice Deborah Todd's concerns about inadequate efforts within the state to represent older adults. Professor Kate Norton from Duquesne University Thomas R. Kline School of Law delivered the written report, and opened the discussion session with the Justices. My thanks to Tom Lee, Penn State Dickinson Law's Director of Career Services, for his ongoing interest in elder law, and for supporting placement of our students in Legal Service positions, including in programs directly serving older persons in Central and rural areas of Pennsylvania. Tom provided the photo used here!
Sunday, July 30, 2023
The New York Times runs a regular column called The Ethicist. It poses intriguing problems and the most recent one is definitely relevant to families, older individuals (and potentially anyone with a disability) and elder law attorneys. Because the analysis is behind a paywall for "subscribers only," I am reluctant to say too much here But I can say that the question of what happens when someone with "reduced" cognitiion becomes entangled in a well-meaning but still demeaning care setting, makes the need for experienced legal assistance exceptionally clear. This particular essay would make a great problem for a student seminar!
See My Friend Is Trapped in a Nursing Home: What Can I Do? presented by columnist Kwame Anthony Appiah, in the New York Times online edition published July 28, 2023.
Thursday, July 27, 2023
More than 300 lawyers and other professionals attended the recent Pennsylvania Elder Law Institute (July 25-26, 2023) held in Harrisburg. It was good to be back among long-time friends as well as new colleagues -- our first time together in "real time" since 2019. The programming began with a tribute to Jeffrey A Marshall, recently retired as a Williamsport, Pennsylvania attorney, who has been a guiding figure for the development of speciaized knowledge and skills for lawyers committed to helping older persons and their family members with practical concerns about care, financing, capacity, agency and more.
This year the program once again began with a comprehensive "Year in Review" that focuses on recent and proposed legislation or rulemaking, demographic trends, and case law. Deep appreciation to Marielle Hazen and Rebecca Hobbs for all of their hard work on this key presentation. Important "keynote"speakers included David Lipschutz, Associate Director for the Center for Medicare Advocacy and legendary Tennessee Elder Law attorney Timothy Takacs.
I had the pleasure of teaming with Katie Dang and A.V. Powell for a 90-minute session about "What Happens When Living Isn't Easy in Senior Living?" Central topics included concerns about contract rights and obligations in nursing homes, plus we made a deep dive into factors that can affect financial soundness of continuing care retirement communities (also known as CCRCs or life plan communities).
Katie reported on successful efforts to avoid a one-sided contract of adhesion and help a family negotiate fair payment terms for a parent's admission to a nursing home. She demonstrated key language to strike or modify to reduce the potential for unintended consequences of signing such agreements.
We also reported on a recent Ohio appellate case that rejected a nursing home's attempt to argue a family members was contractually obiligated to personally pay for care.
A.V. brought to the conversation his dry wit and 40+ years of experience as a professional actuary. He has analyzed the fiinancial viability of hundreds of CCRCs around the country. He noted that Pennsylvania is the birthplace of the CCRC concept and he emphasized the significance of current residents who seek accountabiity by making requests to governing boards for timely evaluations of financial conditions. A.V. also provided us as lawyers with ways to guide clients who are prospective residents in identifying how an enterprise can provide long-range reassurances about sound finances. Trust is essential for a model that offers, on the one hand, a holistic approach to purpose-buldt housing, great food (and nutrition), activity and, if needed, nursing or dementia care, but, on the other hand also expects people to pay thousands of upfront dollars in the form of admission fees plus significant monthly maintenance fees.
Photos used here are by my summer research assistant, the great Noah Yeagley. Thank you, Noah! One of the fun aspects of this conference is being able to introduce current students to practitoners and getting to catch up with so many of my former Penn State Dickinson Law students, including Jared Childers, the incoming Chair of the Pennsylvania Bar's Elder Law Section, and who recently became an adjunct professor at Dickinson Law. Congratuatlions, Jared!
Friday, June 16, 2023
Recently I spent a fun evening helping to celebrate the good deeds of one of Penn State Dickinson Law's alums, Hubert X. Gilroy.
He was being awarded the Alexis de Tocqueville Humanitarian Award by the local chapter of United Way, and the room was full of people who know Hubert from his many roles in our community. Former and current clients were there, judges and fellow lawyers, cycling buddies, running buddies, basketball buddies, YMCA colleagues, and on and on. He has raised literally millions of dollars for charitable endeavors and he's played many leadership roles, including as a member of the Board of Governors for our law school, and as the frequent coach of our students' moot court or mock trial teams.
Last evening there were a lot of laughs, often at "Bertie's" expense (and some of the stories may have even been true!), but the laughs were always warmly shared and that made me appreciate him all the more.
Thanks for your continuing inspiration, Hubert!
Thursday, May 25, 2023
I noted a couple of developments concerning medical aid-in-dying laws that I wanted to share.
First, Vermont became the second state to eliminate the reseidency requirement for aid-in-dying. This change was pursuant to litigation by a plaintiff in Connecticutt. See Vermont Removes Residency Requirement for Medically Assisted Deaths and see VT HB 190, https://legislature.vermont.gov/bill/status/2024/H.190. The language of the bill amending the statute is available here.
And on the other side of the issue of the right to assistance-in-dying, a group in California has challenged their law. Kaiser Family Foundation (KFF) Health News reported last month that Disability Rights Groups Sue to Overturn California’s Physician-Assisted Death Law. The article notes the platinffs' argument that "that recent changes make it too easy for people with terminal diseases whose deaths aren’t imminent to kill themselves with drugs prescribed by a doctor" and that this law and its process "'steers people with terminal disabilities away from necessary mental health care, medical care, and disability supports, and towards death by suicide under the guise of ‘mercy’ and ‘dignity’ in dying,' the suit argues. The terminal disease required for assistance is, by definition, a disability under the Americans with Disabilities Act...." A story about the litigation is available on NPR here.
Wednesday, May 24, 2023
Perhaps the age of elected officials is never really out of the news with the question being whether a candidate is too old or too young. Maybe age is garnering more attention because of the upcoming presidential election and the ages of candidates. But it's not just presidential candidates. The age of some Senators has been drawing attention. Why Dianne Feinstein, Like Many Before Her, Refuses to Let Go; Opinion,The U.S. Senate, it’s senior living made permanent. Join today! (satire); and for a different take, an article forwarded by Professor Naomi Cahn, 80 is different in 2023 than in 1776 – but even back then, a grizzled Franklin led alongside a young Hamilton.
Google "how to think about President Biden's age" and you will get a # of results which run the gamut from articles to opinion pieces. Is it really about age? Or is it about the ability to do the job? This New York Times article, How Much Do Voters Really Care About Biden’s Age? reviews polls and research and is a pretty interesting read. Age is definitely a factor, but so is party affiliation, among other factors, the article notes.
I suspect each of us will reach our own conclusions about the ideal age of candidates, whether in local, state, or national races. And it's only a matter of time before the question regarding the age of Supreme Court Justices is in the headlines again.
Tuesday, May 23, 2023
To me, it seems recently there are more articles in major publications about aging than in the past. For example, yesterday in the Washington Post, there were three:
an opinion esssay, My neighbor lived to be 109. This is what I learned from him.
The "Granny Flats" article notes that this popular name for accesssory dwelling units is someo thing of a misnomer today as the focus of the article is on the popularity of using ADUs to help with the housing crisis:
The numbers tell the tale: More than 23,000 ADU permits were issued in California last year, compared with fewer than 5,000 in 2017 — which was around when ADU permitting began to take off thanks to legislative and regulatory changes in the state. The state now requires faster permit approval by localities, and establishes that cities must allow ADUs of at least 850 square feet — though many are much bigger. A number of other bills are being debated in Sacramento, including one by Assemblymember Phil Ting (D) that would allow property owners to sell their ADUs separately from their main houses.
The second article, also on housing, is more troubling, noting the number of elders who are unhoused.
Nearly a quarter of a million people 55 or older are estimated by the government to have been homeless in the United States during at least part of 2019, the most recent reliable federal count available. They represent a particularly vulnerable segment of the 70 million Americans born after World War II known as the baby boom generation, the youngest of whom turn 59 this year.
Monday, May 22, 2023
Appearing on the front page of the Sunday edition of the Arizona Republic (5.21.23), the first paragraphs of an extended feature article point to the potential for harm to residents and the consequences of staff shortages or inattention at Arizona facilicities caring for residents with dementia. Two women in their 90s are residents of an elegantly appointed assisted living facility-- but as the article begins they are covered in blood -- and the investigation of what happened there is hampered by the inability of anyone to give clear explanations.
The feature, based on the newspaper's review of "thousands of pages of police and state regulatory reports," offers multiple reasons for such injuries in "senior living" facilities, including a lack of clear reporting rules and the absence of investigation by state agencies, especially for facilities licsenced for "assisted living" as opposed to "nursing home" care. From the feature:
In memory care units, anything can become a weapon -- toilet plungers, shoehorns, electric razors, TV remotes, metal trash grabbers and walking canes. Hundreds of vulnerable seniors, particularly those with dementia, contend with violence at the end of their lives in the very places that promise to keep them safe.
Shortages of staff-- brought on by companies looking to maximize profits or stave off financial losses -- lead to more harm. Assisted living facilities can keep resident clashes underwraps [in Arizona] because regulartors don't make facilities report incidents to their state licensing agency. Federally regulated nursing homes have to report but little attention is paid to the problem.
The Arizona Republic combed through thousands of pages of policce and state regulatory reports to find more than 200 clashes at senior living facilities from mid-2019 to mid-2022. Residents punched, hit, pushed, kicked, poked scratched, bit, elbowed or spat on other residents or employees.
Experts consulted by the Arizona Republic noted that one "key [to reducing problems] is tailoring a [resident's] care plan to each resident's needs, equipped with activities that bring their lives a sense of purpose." Further, "[a]ssisted living facilities commonly get in trouble for having inadequate, delayed or out-of-date plans for residents that outline their need or for failing to follow those plans."
The article cautions that if a problem is not tracked, "it doesn't exist":
The Arizona Department of Health Services licenses facilities and is responsible for investigating complaints but assisted living centers don't have to report nonfatal injuries to the agency.
That's not normal. Most states require facilities to report to their licensing agency when residents get hurt, according to The Republic's review of state laws.
The feature suggests that "Arizona lawmakers and regulators have prioritized the needs of assisted living and nursing home companies over their residents," comparizing Arizona to "[a]t least 17 states [that] require assisted living facilities to get inspected about once a year, with a few even requiring two inspections per year. "
For the full Arizona Republic feature published in its print version on May 21, 2023, look for "Arizona seniors at risk of harm: Facilities experiencing staff shortage, residents with dementia enable violence," by reporters Caitlin McGlade, Melina Walling and Sahana Jayaraman. The extended Sunday feature appears to follow several shorter articles available online in May from the same reporting team.
May 22, 2023 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)
Monday, May 15, 2023
This is one of the most important and comprehensive articles I've read on dementia, consent, elder abuse, and guardianship.
The Mother Who Changed: A Story of Dementia was published on May 9, 2023. I plan to assign it to my students. I hope you read it.
Monday, May 8, 2023
In one of the earliest articles I wrote on familiy member liability under nursing home contracts, I cautioned that federal law prohibits nursing homes from requiring "guarantees" of payment by family members. Any family member who is asked to sign "on behalf" of a loved one should carefully consider the role he or she is undertaking, especially if the only role acceptable and affordable for that family member is "agent." See "The Responsible Thing to Do About 'Responsible Party' Provisions in Nursing Home Agreements," published in 2004 in the Unversity of Michigan Journal of Law Reform.
On May 1, 2023, an appellate court in Ohio cited this article when concluding that in the case before it, the daughter's role as agent acting under a power of attorney prevented her from becoming personally liable for her mother's costs of care. The daughter appears to have properly cooperated or assisted in the original Medicaid application. Further, the daughter gave authority to the nursing home to debit the bank account where her mother's SS checks were deposited each month, in order to pay itself the "patient pay portion" of the monthly allocation for costs of care when a patient has low income but is otherwise eligible for Medicaid. Thus the nursing home appears to have had at least the same ability as the daughter to avoid accumulation of a sum greater than $2,000, a resource limit that can trigger disruption of Medicaid benefits. There was still another party that could be faulted for what appears to have been an unplanned "excess resource" situation. The court pointed to the failure of the state agency to give effective notice to interested parties about when and why it was terminaating Medicaid. See National Church Residences First Community Village v. Kessler, 2023 WL 3162188 (Ohio Ct. App. 2023).
Bottom line? Family members or others attempting to help an incapacitated person get proper care are well-advised to consult with an experienced elder law attorney early in the process about how to qualify and protect eligability for Medicaid. Further, clear, direct communications between the agent, the facility and state agencies are important when seeking to facilitate prompt, proper payments.
Overwhelmed family members should not be scapegoats, even (especially?) when overwhelmed state agencies and facility billing offices are themselves missing opportunities to keep benefit payments flowing properly.
May 8, 2023 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, State Cases | Permalink | Comments (0)
Monday, April 10, 2023
Pennsylvania Legislators Discuss Proposed Legislation on Compassionate Aid in Dying with Penn State Dickinson Law Students
It is getting near the end of the semester, but we are continuing to have important topics and guest speakers at Penn State Dickinson Law in our Elder Law modules. Today's speakers were Representative Tarik Khan and Representative Carol Hill-Evams. who led the discussion about a bill they are sponsoring on Compaasionate Aid in Dying for Pennsylvania. Representative Hill-Evans is the lead sponsor on the current version and opened the session with a powerful story about a constituent who explained her reasons for promoting this law.
Pennsylvania House Bill 543 was introduced in March 2023 and is currently assigned to the Health Committee of the Pennsylvania House. We heard that plans are underway to begin hearings, with people tesstifying why they do -- or don't -- want to see a legal option enacted that makes it possible for a person who is terminally ill to choose "medical assistance in dying." After class, two of the students approached me with good suggestions about potential clarifications for the new bill, thus contiinguing the conversation with the legislators.
Next week is our last class of the semester, where students will be giving oral presentations on various Death with Dignity laws or movements, both in the United States and in outher nations, as well as presenting on other choices people may consider near the end of their lives.
Our speacial thanks to all of our guests during this busy semester, including legislators, Elder Law attorneys, the owner of a funeral home, and representatives from hospice and other health care providers.
Los Angeles Times journalist Steve Lopez has been writing recently on the financial costs of long-term care, whether in the home or a "senior living" setting. It is part of his series of "Golden State" columns on California's aging population. Today, however, he has reversed the lens, and talks about the impact of the need for care on low-wage workers. He writes:
I’ve been in homes where the caregivers are U.S. citizens with decent wages and benefits, and I’ve been in homes where the workers are undocumented and paid less than the minimum wage ($16.04 an hour in the city of Los Angeles) in cash. It’s a wink-and-nod system, much like farm labor, in which cheap labor is prized over any other consideration.
“It’s very much a legacy of slavery and a history in this country of not valuing the work done by … people of color,” said attorney Yvonne Medrano, who heads the employee rights program at Bet Tzedek Legal Services.
Several weeks ago I reached out to the the Pilipino Workers Center, a Los Angeles nonprofit that has been educating domestic workers on their rights and leading a fight against a system in which labor laws are often ignored and workers — many of them old enough to be receiving elder care themselves — are cheated and exploited.
Aquilina Soriano Versoza, the center’s director, said research indicates a majority of clients appreciate the care they get and would be willing to pay more for it, but many can’t afford to.
For a more complete picture, read They Take Care of Aging Adults, Live in Cramped Quarters, and Make Less than MInimum Wage from the Los Angeles Times.
April 10, 2023 in Consumer Information, Current Affairs, Discrimination, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, State Statutes/Regulations, Statistics | Permalink | Comments (0)
Tuesday, March 28, 2023
As described in The San Diego Union-Tribune, San Diego's Alzheimer' Response pilot program, launched in 2018 for the "East County," is a success, helping the public in better addressing people coping with Alzheiemer's Disease or other dementias. The Alzheimer's Response Team (or ART) now covers the full San Diego region, with help from $1.5 milliion in funding and a staff of 10.5 full time employees. Originally the program collaborated with an outside nonprofit organization, but "the county now provides its dementia training in-house."
Concerned family members have the option of asking for ART services, often as a way to avoid having problematic episodes escalate. The article, published online on 3/27/2023 explains:
ART focuses on two aspects of dementia care: crisis response and crisis prevention. To better respond to emergency calls related to dementia, law enforcement agents, first responders, social workers and mental health clinicians receive training on how neurodegenerative diseases like Alzheimer’s impact someone’s behavior.
That training helps first responders better recognize the symptoms of dementia during emergency calls. They can then call in the ART specialists to work with the person in distress and provide in-home services for clients living with dementia and their family caregivers.
Eugenia Welch — president and CEO for Alzheimer’s San Diego, which helped develop the initial programming — said the first responder training and specialized ART staff are key to the program’s success. Interacting with someone diagnosed with dementia, she added, is different than working with people who don’t have neurodegenerative disorders and “takes a unique skill.”
“I think by having the specialized team going out, they’re able to be more in tune to the services that are available for people living at home with dementia and able to more quickly connect people with those services to get them the support they need,” Welch said.
Monday, February 27, 2023
A dear friend of mine sent me this short video on how to make a SNF resident's room more easily identifiable to them: https://www.tiktok.com/@designsecretsss/video/7184175944666516779
Also, the latest edition of the Journal of Elder Policy has been published and is available here. The Journal is "an interdiscplinary journal about old age and policy", and prior issues can be accessed through the landing page.
Sunday, February 26, 2023
Forwarded from the Director Mary Jane Ciccarello
The Borchard Foundation Center on Law & Aging
Invites Applications for
The 2023-2025 Borchard Fellowships in Law & Aging
Applications due April 3, 2023
The Borchard Fellowship in Law & Aging offers the opportunity to carry out a substantial project related to law and aging in partnership with a host agency. Two two-year fellowships are available to law school graduates interested in, and perhaps already in the early stages of pursuing, an academic and/or professional career in law and aging.
The fellowship is $58,000 a year for two years and is intended as a full-time position only. During the fellowship period, the Center’s director and former fellows are available to help fellows with the further development of their knowledge, skills, and contacts. Fellows may also receive from the Center financial support to attend appropriate professional education program opportunities. A fellow is expected to provide the Center with monthly activities reports. Fellows may live and work where they choose in the United States. Fellows must be either U.S. citizens or legally resident in the U.S.
A legal services or other non-profit organization involved in law and aging must serve as the fellow’s host agency and supervise a fellow’s activities and projects. The fellow’s host agency is responsible for providing employee benefits, employer’s FICA payment, administrative support, workspace, computer, telephone, and email access.
The two-year fellowship period starts typically on July 1 for those already admitted to the Bar and from not later than September 1 for those who must sit for the Bar exam after law school graduation.
Fellows participate in conference calls and other planned activities with other current and former fellows to encourage networking. Former fellows who successfully complete the fellowship period may also participate in the Center’s Former Fellows Grant Program.
Examples of some activities and projects by Borchard Fellows:
- Working with an established legal services program to enable vulnerable, isolated, low-income seniors to age-in-place by addressing their unmet legal needs;
- Providing holistic services to older clients facing consumer debt and foreclosure-related concerns;
- Providing direct legal representation and holistic services to older tenants in “clutter cases”;
- Implementation of a courthouse project to help elderly pro se tenants achieve long-term housing stabilization through the interdisciplinary use of legal representation and social services, allowing more elderly tenants to “age in place” at home;
- Development of mobile clinics to help Chinese-speaking elders improve their access to public benefits and health care;
- Development of a medical-legal partnership for low-income older adults;
- Development of educational outreach efforts and legal services for older LGBTQ+ adults;
- Development of legal services and informational materials to caregivers working on behalf of beneficiaries with cognitive impairment;
- Development of a non-profit senior law resource center providing direct legal services and public education;
- Development of an interdisciplinary elder law clinical program at a major public university law school;
- Development of a mediation component for a legal services program elder law hotline;
- Development of an interdisciplinary project for graduate students in law, medicine, and health advocacy to foster understanding and collaboration between professions;
- Development of training materials and statewide trainings for
lawyers, judges and other court personnel, and social service providers on new comprehensive state guardianship laws;
- Development of legal services programs for older clients in consumer law and small claims matters, end-of-life matters, and in protection from financial and elder abuse for older clients whose first language is other than English;
- Development of free legal clinics for older clients in suburban areas;
- Development, administration, and interpretation of statewide senior legal hotline outcomes study;
- Increasing access to legal representation for older adults in immigration detention facilities;
- Organizing and/or attending national conferences on law and aging issues;
- Writing and publication of law review articles on law and aging issues;
- Writing and publication of state specific, consumer oriented handbooks on legal issues affecting older persons;
- Analysis of Medicare policies;
- Analysis of Medicaid Home and Community Based Services with a focus on improving racial equity;
- Analysis of SSI non-disability appeals; and
- Teaching elder law and related courses at law schools where fellows reside.
Applications are due on April 3, 2023. Applicants must submit a completed online application including an information form, an explanation of the applicant’s planned activities and projects, a statement about the applicant’s interest in law and aging, a current curriculum vitae, a law school transcript, a letter of support from the proposed supervisor, and two other letters of support.
All fellowship application information and the required online application are available between March 1, 2023, and April 3, 2023, at http://www.borchardcla.org/fellowship-program.
For further information, contact Mary Jane Ciccarello, Director, at [email protected].
Sunday, February 19, 2023
I am remiss in not telling you sooner that Professor Richard Kaplan has a new article. Anything he publishes is a must-read in my book. Here's the info
The Declining Appeal of Inherited Retirement Accounts is now in print: 42 Va. Tax Rev. 267-85 (2023).
Abstract: As retirement accounts proliferate and grow in value, American retirees are increasingly leaving substantial balances in these accounts to their adult children, siblings, and other relatives. Until recently, these new owners were able to withdraw funds from these tax-favored accounts over their lifetimes as their personal circumstances dictated. But legislation enacted in late 2019 and regulations issued in February 2022 have sharply limited the flexibility that non-spousal beneficiaries now have regarding these assets. This article examines those changes, analyzes their impact on the new owners of inherited retirement accounts, and considers what planning strategies are now appropriate.
Thanks Professor Kaplan!