Friday, August 23, 2019

UBER and LYFT as the Answer to Elder Transportation Needs?

The New York Times was considering that question in a recent article,Older People Need Rides. Why Aren’t They Using Uber and Lyft?

More than half of adults over 65 own smartphones, the Pew Research Center has reported. Yet among adults 50 and older, only about a quarter used ride-hailing services in 2018 (a leap, however, from 7 percent in 2015). By comparison, half of those aged 18 to 29 had used them.

In a survey by AARP last year, only 29 percent of those over 50 had used ride-hailing apps. Two-thirds said they weren’t likely to do so in the coming year, citing in part concerns about safety and privacy. (Given data breaches at Uber, that’s no baseless fear.)

So wouldn't these options help people remain more independent, especially while we wait for self-driving cars to become widely available for all of us? One expert quoted in the article said absolutely! "One reason for such optimism: evidence that with personalized instruction, older adults can master the mobile apps and take “networked transportation” to medical appointments, entertainment and leisure activities, social visits and fitness classes."

A recent study from U.S.C. covered in the article noted when the researchers "offered three free months of unlimited Lyft rides to 150 older people in and around Los Angeles (average age: 72) who had chronic diseases and reported transportation problems... [w]ith training, nearly all used Lyft, most through the mobile app (a few used a call-in service), for an average of 69 trips. On follow-up questionnaires, almost all riders reported improved quality of life."

That's great news but the companies are seeing an opportunity here. 

Lyft and Uber and others are contracting with third parties, bypassing the need for older riders to use apps or to have smartphones at all.

They’re joining forces with health care systems, for instance. In the past 18 months, more than 1,000 — including MedStar, in the Washington area, and the Boston Medical Center — have signed on with Uber Health for “nonemergency medical transportation,” the company said.

Case managers and social workers can use Uber or Lyft to ferry patients to or from clinics and offices, reducing missed appointments.

In addition, they are working with various senior communities and exploring other programs for those who have mobility issues, including the ability to order accessible transportation and training drivers of how to assist riders with mobility issues!  There are other smaller companies carving out a part of the market, whether portal-to-portal service or the ability to call for a ride by phone. The article also explores the potential costs in using ride-hailing services.

In the U.S.C. study, the typical trip cost $22; the cost per month, had users actually paid it, averaged $500. After the study, about a fifth of riders said they wouldn’t continue using ride-hailing, mostly because of cost.

Some Medicare Advantage programs now cover rides to medical appointments and pharmacies; Lyft expects to partner with most Advantage plans by next year....But most older Americans still use traditional Medicare, which doesn’t cover such transportation.

 

August 23, 2019 in Consumer Information, Current Affairs, Health Care/Long Term Care, Medicare, Other, Travel | Permalink | Comments (0)

Thursday, August 22, 2019

Filial Friday: Making Decisions about Where and How You Will Live as You Age

I suspect every elder law attorney has experienced the Friday Syndrome, where an individual calls the office to seek an emergency appointment because he or she has flown in to visit parents and has discovered new chaos.  Perhaps it is a parent who is much more ill than anyone was letting on during phone calls.  Perhaps it is discovering a huge pile of unpaid bills with no explanation for why they are overdue.  Perhaps it is because the parents have said -- finally -- we need to make a decision and we want to make it today.

There are many variations on the Friday Syndrome, and frequently they involve a common human trait, procrastination, or as my fifth grade teacher called it, "The Scarlett O'Hara Syndrome."  I didn't understand what she meant at the time, having not yet seen Gone with the Wind with Scarlett's  classic last line, "After all, tomorrow is another day."  But I did eventually figure out that my teacher was referring, in less than favorable terms, to my personal approach to homework assignments!

A friend who I often run into during early morning swims, attorney and financial planning advisor Alvin Blitz, shared with me a variation on the theme with his recent column on "Taking Control of Your Destiny."  He recounts lessons from his 20 years of travel on behalf of Masonic Villages, as he works with individuals and couples who are thinking about a move to a continuing care retirement community (CCRC).  He starts with the premise that while change is a difficult word to swallow, "resisting change usually results in a bad outcome."  He describes two scenarios involving couples facing decisions about whether to stay in their own homes.  

In the successful scenario, the couple began their reckoning with age while still in their early 70s, making a preliminary decision to downsize and live in a townhouse in a 55 plus retirement community, spending many years enjoying their neighbors and participating in activities geared to their stage in life.  "As time went on, the husband was diagnosed with dementia, which required them to make another hard decision," reports Alvin. Eventually they decided that they needed a place where the husband's mental status could be accommodated and the wife would be able to stay active and supported in her new roles with her husband.  In the CCRC, they were able to enjoy a "balance of independence and quality of life together while their health problems are addressed, without needing to rely on other individuals to make life decisions for them."

In the less successful scenario, the couple tried to stick in out in their 1950's castle.  "Finally,  the inevitable happened. the husband had a debilitating stroke. Family members from afar rallied to help, but time took its toll.  The wife had medical problems and landed in the hospital.  Decisions on care and where to live became limited and were thrust upon them by their circumstances."   

Alvin reminds us that making affirmative decisions about housing and care as you age can lead to a much "softer landing" than an alternative that depends on happenstance.   He also explains, helpfully, what it might mean to live in a CCRC where there is a clear mission, such as the fraternal mission at Masonic Villages where members of the Masonic organizations (including Eastern Star) can receive continuing compassionate care, even if the individual no longer has assets to pay for care.  

For more, read Alvin Blitz' August 2019 article, Taking Control of Your Destiny, from  his newsletter, appropriately called "The Blitz." 

 

  

August 22, 2019 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care, Housing | Permalink | Comments (0)

Wednesday, August 21, 2019

Recent Developments on Guardianship Laws

There are a couple of recent developments I wanted to point out to you. One is a bill recently introduced in the House of Representatives, H.R. 4174, the Guardianship Accountability Act of 2019.  Section Two of the bill contains findings and purposes:

 (a) FINDINGS.—Congress finds the following:

(1) An estimated 1,300,000 adults and approximately $50,000,000,000 in assets are under the care of guardians in the United States.

(2) Most guardians are selfless, dedicated individuals who play an important role in safeguarding individuals in need of support. However, unscrupulous guardians acting with little oversight have used guardianship proceedings to obtain control of individuals in need of support.

(3) Once a guardianship is imposed, there are often few safeguards in place to protect against individuals who choose to abuse the system and few States are able to report accurate or detailed guardianship data.

(4) A full guardianship order may remove more rights than necessary and may not be the best means of providing support and protection to an individual. If individuals subject to guardianship regain capacity, all or some rights should be quickly and efficiently restored.

(5) States should encourage courts to use alter natives to guardianship through State statutes, including the adoption of the Uniform Guardianship, Conservatorship, and Other Protective Arrangements Act, to ensure better protections and control for individuals being considered for guardianship and those pursuing a restoration of their rights.

(6) A national resource center on guardianship is needed to collect and publish information for the benefit of courts, policy makers, individuals subject to guardianship, guardians, community organizations, and other stakeholders.

(b) PURPOSES.—The purposes of this Act are to help States improve guardianship oversight and data collection by—

 (1) designating a National Online Resource Center on Guardianship;

(2) authorize grants for the purpose of developing State Guardianship Databases; and

(3) establishing procedures for sharing background check information related to appointed guardians with other jurisdictions.

The bill calls for the Elder Justice Coordinating Council to establish the National Online Resource Center on Guardianship as well as some steps at the state level regarding data collection and analysis.   Read the bill here.

The second item is from the Governor of New Mexico who in a recent speech at the state's conference on aging indicated improving the guardianship system is a priority. Governor vows to stop guardianship abuse  explains that in her speech the Governor

“Here in New Mexico, veterans, senior citizens and disabled adults have been taken advantage of by unscrupulous court-appointed, corporate guardians,” she told the conference....

Corporate guardians, she said, “have been stealing people’s property, separating them from their families and hiding their benefits, as well as “locking folks away where nobody can find them and nobody can visit.”

Her administration, she said, is working to prevent this and adopt the best possible standards and safeguards. McCoy, who will become the director of the state Developmental Disabilities Planning Council, will lead that effort.

There is more action that just these two items, so keep reading this blog as we report on more updates.

August 21, 2019 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)

Informal Will Creation and the Problems They Can Cause: The Aretha Franklin Example

From the New York Times, a window into what can happen when the high profile matriarch of a family either had "no" estate plan, or perhaps left behind three handwritten written documents that "could" be treated as wills.  

Family squabbles over celebrity estates are not rare, as infighting over the estates of PrinceJames Brown and, more recently, Tom Petty, have made clear. But Franklin’s case is especially complex because determining how she wanted her assets distributed involves deciphering whether any of the three hand-scrawled documents found in her home three months ago — one of them under the couch cushions — should be embraced as her will. 

 

When [Aretha] Franklin died, at age 76, her family believed she had no will. Under Michigan law, that meant her estate would be divided equally among her sons. With that understanding, the sons approved the appointment of a cousin, Sabrina Owens, as the estate’s personal representative, or executor.

 

But if any will is accepted by the probate judge overseeing the estate, that formula for the distribution of assets would be upended, with far-reaching consequences for Franklin’s sons, whose earnings could change — some drastically, depending on which will is declared legitimate. Ms. Owens’s status as executor would also be in jeopardy.

 

“The wills changed everything,” Charlene Glover-Hogan, a lawyer for Kecalf Franklin, the singer’s youngest son, said at a contentious court hearing on Aug. 6.

My thanks to my colleague, Professor Laurel Terry, for this link!

 

August 21, 2019 in Consumer Information, Current Affairs, Estates and Trusts, State Cases | Permalink | Comments (0)

Medicare Abroad? Don't Retire Abroad Without Thinking This Through.

Kaiser Health News ran an article about the issues Medicare presents for beneficiaries who want to retiree to other countries. Dream Of Retiring Abroad? The Reality: Medicare Doesn’t Travel Well explains the issues:

As the number of American retirees living overseas grows, more of them are confronting choices ... about medical care. If they were living in the United States, Medicare would generally be their coverage option. But Medicare doesn’t pay for care outside the U.S., except in limited circumstances.

Expatriate retirees might find private insurance policies and national health plans in other countries. But these may not provide the high-quality, comprehensive care at an affordable price that retirees expect through Medicare. Faced with imperfect choices, some retirees cobble together different types of insurance, a mix that includes Medicare.

The article notes that the quality of the health care may be dependent on the country, and as the number of U.S. retirees move to other countries, they need to think hard about how they will pay for health care. The article discusses issues with private health insurance policies, the costs and rates, which may be different depending on the country.  Even with private health insurance, expats need to look at Medicare as the article explains:

Even when retirees buy a private policy, Medicare is another piece of the puzzle that they have to consider. Once people become eligible for Medicare coverage, usually at age 65, they face a 10% premium penalty for every 12 months they are not enrolled in Part B, which covers outpatient services. (People who are 65 but still covered by an employer plan generally do not face that penalty.)

After paying into the Medicare system for decades, it’s no wonder some expats are frustrated that they can’t generally use the program outside the United States.

That’s just the way the law is written, an official at the federal Centers for Medicare & Medicaid Services said.

...

And retirees should honestly consider whether they will spend the rest of their lives overseas.

August 21, 2019 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, International, Medicare | Permalink | Comments (0)

Tuesday, August 20, 2019

Register Now: Webinar on Access to Justice in Older Age

The Global Alliance for the Rights of Older Persons has announced an upcoming webinar on August 22, 2019 from 7-8 a.m. edt (yes that's correct 7-8 AM).   Here's info about the webinar:

Access to Justice is one of the new areas of older people’s human rights that will be discussed at the 11th session of the Open-Ended Working Group on Ageing in New York from 6-9th April 2020. The UN will soon call for written submissions on this topic, which will play an important role in shaping the debates that will happen at the 11th session.  A strong civil society response to this consultation is vital. This webinar will explore some of the key issues and barriers around access to justice in older age. It will also offer tips and support on how you can prepare high quality substantive inputs to the upcoming UN consultation.  

  • Moderator: Susan Somers (INPEA and GAROP Steering Group member)
  • Panelist: Bill Mitchell (Townsville Community Legal Service, Australia)

To register for this important webinar, click here.

August 20, 2019 in Consumer Information, Current Affairs, International, Other, Programs/CLEs, Webinars | Permalink | Comments (0)

Monday, August 19, 2019

Maine as the Bellwether State for the Nation's Elder Care Crisis

The Washington Post offers a feature story on Maine's current care employment crisis for all industries serving frail elders, including nursing, home-care agencies, nursing homes, hospice programs and hospitals.   Pointing to one town's dramatic needs, as the demographic "oldest" city in the "oldest" state in the nation, the article makes clear that the problems are likely coming to communities all across the country -- and certainly I have witnessed it first hand in Arizona.  

With private help now bid up to $50 an hour, Janet and her two sisters have been forced to do what millions of families in a rapidly aging America have done: take up second, unpaid jobs caring full time for their mother.

 

“We do not know what to do. We do not know where to go. We are in such dire need of help,” said Flaherty, an insurance saleswoman.

 

Across Maine, families like the Flahertys are being hammered by two slow-moving demographic forces — the growth of the retirement population and a simultaneous decline in young workers — that have been exacerbated by a national worker shortage pushing up the cost of labor. The unemployment rate in Maine is 3.2 percent, below the national average of 3.7 percent.

 

The disconnect between Maine’s aging population and its need for young workers to care for that population is expected to be mirrored in states throughout the country over the coming decade, demographic experts say. And that’s especially true in states with populations with fewer immigrants, who are disproportionately represented in many occupations serving the elderly, statistics show.

In terms of statistics, one "crucial milestone" is the percentage of a population older than 65, the "super-aged" label.  In Maine, one-fifth of the state's population is in that category, and by 2026, Maine is predicted to be joined by 15 other states, with another dozen reaching the same level by 2030.  

Across the country, the number of seniors will grow by more than 40 million, approximately doubling between 2015 and 2050, while the population older than 85 will come close to tripling.

There are tough statistical realities to confront, including the tension between living wages for workers and affordability for families paying for care out-of-pocket.   One of the subtle issues is how to manage pay.  Employment agencies often retain at least half of the dollars charged for hourly care.  Families who want or need to pay privately must make a very real decision on whether to pay "on" or "off" the books.  For those paying on the books, it means learning to navigate systems for withholding proper amounts for taxes, any insurance and other deductions.  

My thanks to my colleague, Health Law Expert Matthew Lawrence, for pointing to the original Washington Post article, subtitled "This will be catastrophic." 

August 19, 2019 in Consumer Information, Current Affairs, Health Care/Long Term Care, Statistics | Permalink | Comments (0)

Sunday, August 18, 2019

Observation status trial

Last week, the class action suit against CMS on observation status finally went to trial.  According to the story from the Medicare Rights Center, Lawsuit Seeks to Improve Medicare Beneficiary Access to Nursing Facilities explains the importance of the case, as the trial started last week:

Because an observation stay is not officially considered an inpatient stay, it does not count as a qualifying hospital stay for purposes of Medicare SNF coverage—which means Medicare will not pay for any subsequent SNF care. This leaves patients on the hook for the entire cost of a needed SNF stay—potentially thousands of dollars.  Beneficiaries unable to afford this care may self-discharge against medical advice and return home before they are physically or mentally ready, and potentially suffer further devastating and expensive acute health effects.

Currently, people with Medicare cannot appeal the decision to classify a hospital stay as an outpatient stay, but a court case—Alexander v. Azar—may change that. In 2011, seven plaintiffs filed a class action lawsuit to try to gain the right to appeal the decision to classify them as outpatients in observation stay instead of as inpatients who would potentially be eligible for SNF coverage. After many twists and turns, the case has finally made it to trial.

More information about the trial that got underway last week was provided in a Kaiser Health News article, Class-Action Lawsuit Seeks To Let Medicare Patients Appeal Gap in Nursing Home Coverage which contains lots of interesting info about the issue and the litigation.  For example, "'HHS’ Office of Inspector General urged CMS to count observation care days toward the three-day minimum needed for nursing home coverage. It’s No. 1 on a list issued last month of the 25 most important inspector general’s recommendations the agency has failed to implement." The importance of this case can't be emphasized enough.  I'll update you when I know more.

August 18, 2019 in Consumer Information, Current Affairs, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare, Other | Permalink | Comments (0)

Friday, August 16, 2019

Medical Aid in Dying in NJ on Hold

The AP has reported that a judge has temporarily enjoined the NJ Medical Aid in Dying law that went into effect a few weeks ago.  The hearing is scheduled for October according to the story, New Jersey’s medically assisted suicide law put on hold. 

"The order means that New Jersey’s recently enacted measure cannot be enforced by the state attorney general and comes in response to a lawsuit brought by a doctor practicing in the state... [who argues in the lawsuit] that immediate and irreparable damage will probably result in view of the fact that if its enforcement is not immediately enjoined, New Jersey citizens can actually begin dying.”  The plaintiff, a doctor, contends "that the law is an affront to religious doctors [and] the law violates constitutional rights as well as common law barring suicide."

Stay tuned.

August 16, 2019 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, Other, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Thursday, August 15, 2019

Are Long Term Care Insurance Losses at the Heart of Financial Woes for General Electric?

The Wall Street Journal and other news sources are reporting on a financial research report released publicly today by an accounting expert -- the one who blew the whistle on the Bernie Madoff scheme -- and his investigation team, that alleges massive inaccuracies and fraudulent filings by General Electric Company.  GE officials are fighting back, alleging market manipulation is the motive behind the report.  From a Wall Street Journal article on Thursday, it seems GE's liability for losses on its long-term care insurance products is a key focus:

The Markopolos group includes John McPherson, co-founder of MMS Advisors, forensic accountants specializing in the insurance industry. The group worked for seven months to analyze GE’s accounting.

 

Mr. Markopolos said he is going public with the report now because the group just finished its work. It had been working on another insurance case when GE’s insurance problems caught its eye, he said.

 

The group claims GE’s long-term-care insurance holdings are a bigger liability than the company is letting on. The report estimates GE will need to boost its insurance reserves by $18.5 billion in cash and take a $10.5 billion charge because of an accounting change required by 2021.

 

Those figures are on top of a $15 billion reserve boost already taken by GE over seven years to cover its exposure to long-term-care policies, which cover expenses like nursing homes and assisted living. The policies have proved to be a problem for many insurers. The companies drastically underestimated the number of future claims and how long people would draw on the coverage before dying.

 

“We believe that our current reserves are well-supported for our portfolio characteristics, and we undertake rigorous reserve adequacy testing every year,” GE said in its press release. 

On the one hand, as an occasional observer of LTC industry woes, it seems hard for me to believe that at this point any company would try to hide or downplay the high-profile losses that the LTC industry has encountered for more than 10 years.  Nonetheless, the whistleblower team's  allegations are pretty bold, especially set against the market instability overall this week.  

August 15, 2019 in Consumer Information, Current Affairs, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)

Wednesday, August 14, 2019

Mark Your Calendars: Webinar on Legal Basics: Representing a Client in a Defense of Guardianship Case

The National Center on Law & Elder Rights is offering a free webinar on September 10, 2019 at 2 p.m. edt on Legal Basics: Representing a Client in a Defense of Guardianship Case.  The speakers are David Godfrey from the ABA Commission on Law & Aging and Catherine Seal, Esq. Here's info about the webinar

Lawyers serve an essential role in protecting the due process rights of every defendant or respondent in an adult guardianship case. This can include presenting evidence that no guardian is needed or that a limited guardianship is sufficient to provide the protections that are needed. This webcast will focus on the role of an attorney representing the interests and wishes of a client who is the subject of a guardianship action.

Presenters will share:

  • How to protect the client’s due process rights; 
  • Options for when a guardian/conservator is not needed;
  • How to respond when the filing asks for more protection than is needed; and 
  • Actions to take when a guardianship order is no longer needed or a less restrictive order is needed.

This training will explore common due process concerns and substantive defenses in adult guardianship cases. Presenters will discuss how to develop and present evidence advocating for the least restrictive alternatives in an adult guardianship case. 

To register, click here

August 14, 2019 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Programs/CLEs, State Statutes/Regulations, Webinars | Permalink | Comments (0)

Caregiver Guilt: "When Will You Be Back?"

Recently I was talking with a friend about the challenges of family caregiving.  She regularly drives many miles to help her mother, who has dementia and is living in another city in her own home.  My friend tried inviting her mother to share the daughter's home.  To put it mildly, that plan did not work. 

Her mother wanted to go back to her own home.  Paid in-home caregivers are often essential components of any such plan, and my friend, as an only child, is the person "on call" whenever one of them cancels at the last minute, as well as visiting regularly to plan meals, do shopping, take her mother on outings and the many loving tasks that tend to fall to family members.   

My friend says that one of the hardest parts of each visit is that her mother always asks, "when will you be back?"  The mother probably isn't intending to put pressure on her daughter, but the pressure is still there, accompanied by the daughter's thought, "Am I doing enough? -- Should I quit my job and move here to be closer to my mother?"  

My sister felt this kind of pressure with our mother, even though she spent almost every evening with her, especially during her last year.  My sister would finish her long day as a primary school administrator and drive 45 minutes in rush hour traffic to be with Mom at dinner and to visit with her while she watched some television, helping her get ready for bed.  And my mother would ask ,"Will I see you tomorrow?"  "Of course,"  was the usual answer.   I know my sister felt guilt, even though she was doing everything imaginable to ease the strain for our mother, as her daily life became complicated by deepening dementia.

My father had slightly different questions for me as the "out-of-state" daughter.   As soon as I arrived from my latest flight on good ol' Southwest Airlines plus a taxi cab drive, he wanted to know,  "When are you leaving?"  I would chuckle and say in mock protest, "I just got here; you can't get rid of me yet." (Of course, with dementia, such questions are often asked not just once, but are repeated multiple times in the course of the same hour.) Eventually I realized that what Dad enjoyed the most was the break in the routine from being trapped at home with dementia, as he would usually ride along with whomever was taking me back to the airport.   He liked rides in general, but he especially appreciated a car trip with a purpose, a purpose he still understood.  

My mother had her own variation for me.  She would be startled when she realized I was leaving at the end of a visit, and she would ask with a worried frown, "Will you be back in time for Christmas?" Whether it was the coldest day in January or the hottest summer day in Phoenix she would ask me about my Christmas plans.  But, that's not  a bad "default" setting for someone with dementia, is it? 

I was always able to say, with sincerity, that yes, I would be back in plenty of time for Christmas. 

August 14, 2019 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care | Permalink | Comments (0)

Friday, August 9, 2019

The Borchard Foundation Center on Law & Aging RFP for 2020 Academic Research Grants

The Borchard Foundation Center on Law & Aging has released its RFP for 2020 Academic Research Grants.  Here are some details:

Legal, health sciences, social sciences, and gerontology scholars and professionals are invited to submit research proposals to The Borchard Foundation Center on Law & Aging. The objective of the Academic Research Grants is to further research and scholarship about new or improved public policies, laws, and/or programs that will enhance the quality of life for older adults, including those who are poor or otherwise isolated by language, culture, disability, lack of education, or other barriers.

Up to four grants of a maximum of $20,000 each will be awarded. The Center expects grantees to meet the objectives of the grant program through individual or collaborative research projects that either:

  • analyze and recommend changes to one or more important existing public policies, laws, and/or programs relating to older adults, or
  • anticipate the need for and recommend new public policies, laws, and/or programs necessitated by changes in the number and demographics of the country’s and the world’s elder populations, by advances in science and technology, by changes in the health care system, or by other developments.

It is expected that the research product will be publishable in a first-rate academic journal. Applicants are encouraged to disseminate research findings through additional channels such as conferences, stakeholder meetings, and white papers.

Larger budgets using outside matching funds are encouraged but not required. Favorable weight is given to proposals that indicate, where appropriate, that active attempts will be made to solicit required additional funds for the project (including a list of sources to be approached). Grant funds must be used for the approved budget purposes, which may include reasonable compensation for investigator(s), consultant(s), and research assistant(s), print and computer-based research materials, and other necessary expenses. Faculty salary support will not be approved other than for (1) summer when the applicant is not eligible for summer support from their university or (2) buying out a course. Grant funds may not be used for thesis or dissertation research, student tuition or fees, or university overhead or administrative charges.

Proposals must be submitted by one or more individual researchers who will be responsible for carrying out the project. Collaborating researchers may be affiliated with the same or different institutions. Grant funds must be administered by an academic, government, or other non-profit organization. Evidence of federal tax-exempt status is required before funds will be released.

The on-line application form on the Center’s website, www.borchardcla.org, will be available after September 15, 2019. Applications should be submitted no later than October 15, 2019. Selections will be made on or about December 15, 2019.

Proposals should include a narrative description of the research project (5 pages maximum), including proposed research activities, how the research meets the objective of the Center’s grant program, why the project is otherwise important, a description of the intended written research product(s), the journal(s) to which the work product(s) will be submitted for publication, and a statement regarding IRB approval. Required attachments are a project timeline, detailed budget (including matching support, if any), curriculum vitae of the investigator(s), and federal tax exemption letter evidencing the administrating organization is a 501(c)(3) organization not classified as a private foundation.

Within three months of project completion, grantees must submit by email a final written report that includes a description and chronology of the research and results and an accounting of grant funds. In addition, a short progress and status report must be submitted eight months following project commencement. Upon publication of any research products, either print or electronic copies should be submitted to the Foundation.

For further description of the Academic Research Grant Program, the Request for Proposals, and the application form, please see the Center’s Web site at www.borchardcla.org. For more information, contact Catheryn Koss, ck@borchardcenter.org.

The online application is available here.

August 9, 2019 in Consumer Information, Current Affairs, Grant Deadlines/Awards, Other | Permalink | Comments (0)

Thursday, August 8, 2019

Early Diagnosis of Alzheimer's Through Testing

So we don't be on the cusp of a cure for Alzheimer's but recent stories indicate the medical folks might be getting closer to diagnosing it. First, the New York Times reported that we may soon have a blood test that can diagnose it.

A Blood Test for Alzheimer’s?  It’s Coming, Scientists Report

For decades, researchers have sought a blood test for beta amyloid, the protein that is a hallmark of Alzheimer’s disease. Several groups and companies have made progress, and [last]
Thursday, scientists at Washington University in St. Louis reported that they had devised the most sensitive blood test yet.

The test will not be available for clinical use for years, and in any event, amyloid is not a perfect predictor of Alzheimer’s disease: Most symptomless older people with amyloid deposits in their brains will not develop dementia.

But the protein is a significant risk factor, and the new blood test identified patients with amyloid deposits before brain scans did. That will be important to scientists conducting trials of drugs top revent Alzheimer’s. They need to find participants in the earliest stages of the disease.

Since we can't cure it, why do we want to diagnose it?

There is no treatment for Alzheimer’s, and very early diagnosis of any disease can be problematic, since it may not progress. So the first use for this blood test will probably be to screen people for clinical trials of drugs to prevent Alzheimer’s disease, said Dr. Michael Weiner, a neurologist at the University of California, San Francisco.

Ok, a blood test. Pretty easy, not too invasive.  Here's another test on the horizon, according to another article, again in the New York Times: A Brain Scan May Predict Alzheimer’s. Should You Get One? There is "criteria developed by the Alzheimer’s Association and nuclear medicine experts, which call for PET scans only in cases of unexplained or unusual symptoms and unclear diagnoses.... But as evidence mounts that brain damage from Alzheimer’s begins years before people develop symptoms, worried patients and their families may start turning to PET scans to learn if they have this biomarker."  These tests are expensive and "[a]myloid plaques occur commonly in older people’s brains, but not everyone with amyloid will develop dementia, which probably involves multiple factors. Nor does a negative PET scan mean someone won’t develop dementia."

There's a lot of research being done and we all owe a big thank you to the researchers fighting this and all the other diseases out there that threaten us as we age.

August 8, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Other, Science | Permalink | Comments (0)

Wednesday, August 7, 2019

Coordinating Treatment, Including Cancer Treatment, for Patients Represented by Guardians or Other Agents

This summer I've been working with a dynamic interdisciplinary team to create a series of online educational modules for guardians and other agents working with adults in Pennsylvania.  Our shorthand name for the 18-month endeavor is the Pennsylvania Guardian Education Project and it is funded by an important Penn State Strategic Initiative Grant.  The work has been daunting at times, but always interesting. 

Pennsylvania Guardian Education ProjectWe have law students researching and writing detailed outlines on Pennsylvania law and national best practice standards for guardians, and then refining those outlines to create scripts under the guidance of Penn State experts in health care, behavioral sciences and online adult education.  We are also filming interview segments featuring  judges, guardians (both lay guardians and certified professionals), social workers, lawyers, advocates and ombudsmen.  Last week we were in the greater Philadelphia area while filming (that's Ben Franklin on the top of City Hall in the background, with filming crew Mimi Miller, Christoper Riley, and Luke Gibson, all Dickinson Law students). Philadelphia Filming Team August 2019

Our hope is that most of the camera work will be completed before Dickinson Law classes resume later this month, but the additional hard work of editing and crafting the interactive units for publication will continue over the fall.  

Mimi Miller  Class of 2021  Presentation at Penn State Cancer Institute August 2019Our lead research assistant, Mimi Miller (Dickinson Law, '21) has pre-law experience as a Certified Nursing Assistant (CNA) working with older adults, and thus has uniquely practical insights into the challenges for families when coordinating care for impaired loved ones.  Her work with health care members of the grant team, including Dr. Eugene Lengerich, a member of Penn State's Cancer Institute and on the faculty of Penn State's Public Health Sciences program, led to an invitation to "flip" our educational efforts, by making a presentation to health care researchers and clinicians about what guardians are -- and aren't -- permitted to do when making health care decisions for their clients.  The first step in this new collaboration occurred yesterday at Penn State's Cancer Institute Retreat, where Mimi was one of more than 60 presenters and the only law student to present.  Congratulations, Mimi!  

August 7, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (1)

Got a Question About Social Security Retirement?

The New York Times recently ran an article, 7 of Your Most Burning Questions on Social Security (With Answers).

The questions include the future of Social Security, spousal and survivors benefits, the length of benefits, delayed retirement vs. "break even" claiming,  the lowered amount of benefits for those who temporarily leave the work force for caregiving, taxing benefits, and self-employment. 

These are all really good questions (I hope they do another article, cause we all know there are more than 7 burning questions.)  The answers are clear and to the point. I plan to have my students read the article before we cover the topic this fall semester (which will be starting before we know it!) You should read it, too!

August 7, 2019 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Retirement, Social Security | Permalink | Comments (0)

Tuesday, August 6, 2019

8 States Now Provide Aid in Dying Laws; 9th State Will in About a Month

With the New Jersey law going into effect last week (August 1, 2019), there are now 8 states that allow medical aid in dying, according to a recent New York Times story, Aid in Dying Soon Will be Available to More Americans. Few Will Choose It.

 

Maine's law becomes effective September 15, 2019, about 5 weeks from now.   So with 9 states providing that option, "by October, 22 percent of Americans will live in places where residents with six months or less to live can, in theory, exercise some control over the time and manner of their deaths. (The others: Oregon, Washington, Vermont, Montana, California, Colorado and Hawaii, as well as the District of Columbia.)"  Even with these laws in place, there are still issues facing the patients, the story explains.  There is "an overly complicated process of  requests and waiting periods" as well as the  sections of the law that allows doctors to opt-out, so access may be limited.

 

The article also discusses why there seems to be a "trend" (if you call 9 states a trend) toward changing attitudes regarding medical aid-in-dying:

All these laws require states to track usage and publish statistics. Their reports show that whether a state has six months or 20 years of experience, the proportion of deaths involving aid in dying (also known, to supporters’ distaste, as physician-assisted suicide) remains tiny, a fraction of a percentage point.

California, for example, in 2017 received the mandated state documents for just 632 people who’d made the necessary two verbal requests to a physician, after which 241 doctors wrote prescriptions for 577 patients. More than 269,000 Californians in all died that year.

With such data showing no slippery slope toward widespread use or abuse, “a lot of the hypothetical claims our opponents made no longer carry so much weight with lawmakers,” said Kim Callinan, chief executive of Compassion & Choices.

There is even a change within the health care profession re: this issue, but there are still opponents to it. Even those who support it may not use it, and the process within the law may provide barriers to patients, according to the article.  Safeguards in the laws may be imposing obstacles to some including the waiting period, the 6 month limit and others.

Clearly this is a topic on which we still will see developments. So....stay tuned.

August 6, 2019 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Sunday, August 4, 2019

"Intensive Grandparenting": The Glue for Working Parents & Kids

The New York Times ran a story about "intensive grandparenting," a term that makes sense to me, but one I hadn't seen used before this. When Grandparents Help Hold It All Together explains that the phrase, developed by sociologists, which "refer[s] to a commitment to providing regular child care, often accompanied by housekeeping or other tasks."  The story shares experiences of some grandparents who have committed to their families in helping out while the parents are working.  As the article explains, this type of grandparenting goes beyond the stereotypical view of grandkids visiting grandparents for short visits or fun trips.

How many hours are intensive grandparents putting in?  How many are doing so?  Who knows for sure, "but a recent study reports that about half of young children, a third of those in elementary school and even 20 percent of teenagers spend at least some time with grandparents in a typical week... [and one] sociologist ... and author of “Grandmothers at Work,” analyzed federal data for grandparents aged 51 to 70 who had jobs, most working full-time. About 45 percent had provided care for grandchildren during the previous two years, a proportion she expects to increase."

Intensive grandparenting--why now?  The article offers reasons: changing views of parenting and "an indictment of a country that pays lip service to families while providing little real support."

Today’s parents work at demanding, often insecure jobs. Many employers still don’t provide adequate (or any) parental leave, sick days or health insurance. Quality day care often costs a small fortune; schools operate on calendars that don’t accommodate parents’ work schedules.

It's so wonderful grandparents are available to step in and the article mentions the value to grandparents in doing so, but also the costs to grandparents, including fatigue, the sense of obligation, and worry about their kids. It's important for these intensive grandparents to make informed decisions before changing their lives to step into the role: "[E]xperts worry ... about people who cut back on work hours, retire too early or otherwise imperil their own financial security to provide intensive grandparenting.... Grandparents [may end up] shelving their own projects and interests to care for grandkids. They may lose social connections, an important factor in older adults’ psychological and physical well-being."

Oh and by the way, parents--be sure to thank your parents, these "intensive grandparents" for all they are doing. As the article notes-it is darn important to do so.

 

 

August 4, 2019 in Consumer Information, Current Affairs, Other | Permalink | Comments (0)

NJ Medical Aid in Dying Now in Effect

The New Jersey law allowing medical aid in dying went into effect at the beginning of the month.  According to a story from one of the ABC affiliates,

The law requires two doctors to sign off on the request and that the terminally ill patient be deemed an adult resident of New Jersey who can make such a decision and who voluntarily expresses a wish to die.

It requires patients to request the medication twice and says they must be given a chance to rescind the decision. At least one of the requests must be in writing and signed by two witnesses.

At least one witness cannot be a relative, entitled to any portion of the person's estate, the owner of the health care facility where the patient is getting treatment or a worker there, or be the patient's doctor.

Under the law, patients must administer the drug to themselves, and his or her attending physician would be required to offer other treatment options, including palliative care.

August 4, 2019 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)

Friday, August 2, 2019

State Payroll Tax for Long-Term Care?

I debated a bit about the title to this post, thinking I should call it-outliving your ability to pay for long-term care. But I think the interesting point to this post is not that potential but what one state has done to fund public long-term care.  Pew Stateline ran this story, Getting Older, Going Broke: Who’s Going to Pay for Long-Term Care? Here's what is going on.

Washington state created the first public long-term care insurance plan, which will be funded through payroll taxes.

In 2017, Hawaii began providing up to $70 a day to residents who work while also taking care of elderly family members at home. Hawaii pays for the program, Kupuna Caregivers, out of its general budget.

The state estimates 154,000 residents are the unpaid caregivers of elderly family members. Kupuna Caregivers currently helps 134 Hawaiians pay for transportation, adult day care, personal care services and home-delivered meals.

Another Hawaii program, Kupuna Care, provides services to seniors in need of help with daily activities. This year, lawmakers passed a series of elder care bills, adding $11.2 million to the $9.7 million appropriated in the state’s budget.

A handful of other states, including Arizona, California, Michigan and Minnesota, also are exploring public long-term care options for people who otherwise might have to spend down their assets to qualify for Medicaid.

The article also notes that one member of the U.S. Congress has proposed a Medicare long term care benefit (would this be Part F?)

Here's a little more about the various states' actions

Minnesota is considering two private-sector options to address the problem. One would be to require insurers’ supplemental Medicare policies to include limited home chore benefits. That approach would cost beneficiaries about $8 a month... [and the] other would be to allow the sale of term life insurance policies that convert to a long-term care product once the beneficiary reaches retirement age....

In October, Michigan officials will begin studying what the state can do to help residents pay for long-term care. Illinois lawmakers this year also ordered a study to calculate how many seniors are likely to need long-term care; the possible financial impact on their families; the availability of caregivers and the tax implications of a state-run long-term care program.

The Arizona Senate passed a bill in April that would create a pilot program providing grants of up to $1,000 a year to reimburse caregivers taking care of disabled family members at home. The program would be paid for out of a $1.5 million a year fund included in the state budget....

And in California, where the population over 65 is projected to nearly double to 8.6 million in the next decade, lawmakers recently approved a $1 million study to weigh the costs of different long-term care plans.

. . .
 Washington’s new state-operated plan will pay lifetime benefits of up to $36,500 to help people pay for in-home care (provided by a professional or a family member), assisted living, or a nursing home. It will be funded through a payroll tax of 0.58% for all workers. (Self-employed people can opt in.) But the state won’t begin making payroll deductions until 2022, and benefits won’t kick in until 2025.

Not every state is on this bandwagon, however.  "Last year, Maine voters overwhelmingly rejected a ballot initiative that would have raised income taxes by 3.8% to pay for a long-term care plan." Interesting stuff.

August 2, 2019 in Consumer Information, Current Affairs, Health Care/Long Term Care, Medicaid, Medicare, State Statutes/Regulations | Permalink | Comments (0)