Tuesday, December 18, 2018

Webinar-Recognizing Elder Abuse

Mark your calendars now for a free webinar from the National Center on Law & Elder Rights on Signs of Elder Abuse, Neglect, and Exploitation. The webcast is scheduled for 2 p.m. on January 16, 2019.  Here is a description of the webinar

Lawyers and others who work with older adults should be aware of potential signs of abuse, neglect, and exploitation. This awareness requires an understanding of abuse signs, as well as the questions to ask when abuse is suspected. As the first part in the forthcoming National Center on Law and Elder Rights (NCLER) Elder Justice Toolkit, this webinar will help lawyers tune in to potential warning signals and train the audience on key questions to ask when elder abuse is suspected. The fast paced one-hour program will include checklists of physical, behavioral, and emotional signs of abuse, sexual abuse, self-neglect, caregiver neglect, and exploitation. 

To register, click here.

December 18, 2018 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, Programs/CLEs, State Cases, State Statutes/Regulations, Webinars | Permalink | Comments (0)

DC Bar's Professional Responsibilities Program Offers Interesting Topics

The DC Bar is offering a CLE program on "Faultlines and Eruptions: Legal Ethic in Perilous Times."  Here are some of the included topics:

Widespread discord in our current culture places unusual stress on professional ethics, and –
unfortunately – the legal profession is not immune.  The past year saw many legal professionals, including famous names in the law, make questionable decisions and breach legal ethics standards, providing both cautionary tales and fodder for analysis.  This challenging and interactive class will explore important developments and looming perils that every lawyer should be ready to face. 
 

Topics include:

  • Legal ethics for "fixers"
  • Direct adversity vs. "general adversity," and whether it matters
  • Sexual harassment as a legal ethics problem, and the profession's vulnerability to "The King's Pass"
  • Defying a client for the client's own good
  • Fees, referrals, and gaming the rules for fun and profit
  • Professional responsibility vs. legal ethics
  • The increasing threat to law firm independence and integrity
  • The technology ethics earthquake

All topics seem relevant to today's "interesting" times.  

December 18, 2018 in Current Affairs, Ethical Issues, Legal Practice/Practice Management | Permalink | Comments (0)

Monday, December 17, 2018

Ohio Supreme Court Addresses Liability of a Surviving Spouse for Nursing Home Debt

University of Cincinnati College of Law Professor of Practice Emerita Marianna Brown Bettman has a very interesting and well-written Blog report on the Ohio Supreme Court's December 12th decision in Embassy Healthcare v. Bell.  The issue is under what circumstances a surviving spouse can be held liable for her deceased husband's nursing home costs under a statutory theory of "necessaries." Lots to unpack here.   

December 17, 2018 in Consumer Information, Current Affairs, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Property Management, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Rob Lowe, Actor & Rob Lowe, Caregiver

The November 30, 2018  print issue of Newsweek ran an essay published earlier in  November by actor Rob Lowe, Who Cares for the Carer. The article explains the juggling required by caraegivers who work and the legislative efforts at both the federal and state levels. Mr. Lowe, in his essay, does acknowledge that his family has financial resources to hire others, and recognizes that many caregivers may not have that same option. Here are some excerpts from his opinion piece:

There are so many little ways a dedicated caregiver can be a game changer—someone who can dramatically increase the chances of a successful outcome for your loved one. It is critical, for example, for patients with a serious illness to have a third party with them at doctor’s appointments. When I was helping to promote an awareness campaign for a new chemotherapy drug in 2002, I came across a startling number: Patients often retain just 10 percent of the information they are being given. Ten percent!

He offers some heartfelt advice to the caregivers:

The people we are talking about—the friends and family members who are out there doing crucial work—are unpaid. Watching a loved one go through an illness, possibly ending in death, is stressful and depressing. Add financial and scheduling burdens, and the load for caregivers is enormous. To them I say, Don’t forget about yourself. When you get on an airplane, the crew says, “Secure your own mask first before helping others.” Why? Because without you taking care of yourself, you can’t take care of anybody else.

He closes with some final recommendations  to caregivers,  "don’t hesitate to get help. That’s why I’ve partnered with EMD Serono and EmbracingCarers.com, where you’ll find invaluable information regarding everything you’ll be, or are, going through."

I like to use real world examples in my classes and when I can use an example of someone my students know, I think it helps them understand the depth and breadth of elder law.

 

December 17, 2018 in Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink | Comments (0)

Thursday, December 13, 2018

Psychiatric Advance Directives Gain Prominence

The New York Times reported last week on psychiatric advance directives in  Now Mental Health Patients Can Specify Their Care Before Hallucinations and Voices Overwhelm Them

"[A]  psychiatric advance directive, a legal document declaring what treatment he does and doesn’t want. Increasingly, patients, advocates and doctors believe such directives (called PADs) could help transform the mental health system by allowing patients to shape their care even when they lose touch with reality. Hospitals must put them in patients’ medical records and doctors are expected to follow them unless they document that specific preferences aren’t in the patients’ best medical interest."

The article notes that not everyone is in favor of these. For example, "some doctors and hospitals are wary that the documents could tie their hands and discourage treatment they consider warranted. Some worry the directives won’t be updated to reflect medical advances. Others question whether people with serious psychiatric conditions are ever capable of lucidly completing such directives."  The article notes that at least 27 states allow for the use of psychiatric advance directives-others may do so as part of the more traditional health care advance directive.  The document is seen as an alternative to involuntary commitment.

CMS now requires health care providers to include in their inquiry about health care directives any psychiatric advance directive (see here requirements that hospitals ask if patients have a directive).  The directive also allows advance permission by the patient for the health care providers to engage with friends or family, particularly important because during a crisis, the person  may "be too unstable or paranoid to give permission."  The article gives examples of what might be authorized by the directive, offers suggestions regarding drafting and signing and shares stories of some individuals who have created these directives.

On a side note, the article notes that the directives are referred to as PAD.  On an unrelated topic, physician-aided dying is also sometimes shortened to PAD. Make sure your students understand the differences.

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

Wednesday, December 12, 2018

High Number GA Nursing Homes Receive Medicare Penalties

Yesterday I blogged about a SNF chain in Texas filing bankruptcy.  Today, it's about Georgia's nursing homes. Georgia Health News reported last week that Medicare penalties hit most Ga. nursing homes. According to the article 75% of the SNFs in Ga have been hit with penalties regarding unnecessary hospital readmissions. Twenty-three percent received bonuses for avoiding such a problem.  "Kaiser Health News reported that hospitalizations of nursing home residents, while decreasing in recent years, remain a problem, with nearly 11 percent of patients in 2016 being sent to hospitals for conditions that might have been avoided with better medical oversight. ... The program of bonuses and penalties is intended to discourage nursing homes from discharging patients too quickly. That’s something that is financially tempting, because Medicare fully covers only the first 20 days of a stay and generally stops paying anything after 100 days...." The article includes a link to the bonuses/penalties list, which can be found here.

December 12, 2018 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

High Number GA Nursing Homes Receive Medicare Penalties

Yesterday I blogged about a SNF chain in Texas filing bankruptcy.  Today, it's about Georgia's nursing homes. Georgia Health News reported last week that Medicare penalties hit most Ga. nursing homes. According to the article 75% of the SNFs in Ga have been hit with penalties regarding unnecessary hospital readmissions. Twenty-three percent received bonuses for avoiding such a problem.  "Kaiser Health News reported that hospitalizations of nursing home residents, while decreasing in recent years, remain a problem, with nearly 11 percent of patients in 2016 being sent to hospitals for conditions that might have been avoided with better medical oversight. ... The program of bonuses and penalties is intended to discourage nursing homes from discharging patients too quickly. That’s something that is financially tempting, because Medicare fully covers only the first 20 days of a stay and generally stops paying anything after 100 days...." The article includes a link to the bonuses/penalties list, which can be found here.

December 12, 2018 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Tuesday, December 11, 2018

Texas SNF Chain Files Bankruptcy

The Dallas Morning News ran a story about the largest SNF chain in Texas filing bankruptcy. Texas' largest nursing home operator files for bankruptcy, sparking concerns about patients, jobs explains that "Senior Care Centers, which operates more than 100 facilities in Texas, filed for reorganization in U.S. bankruptcy court for the Northern District of Texas on Tuesday, reporting more than $100 million in debt. It's at least the second troubled nursing care giant in the Dallas area to file for bankruptcy since late last year." What's happening? According to the chain's press release, "high rents and 'burdensome debts'" are to blame.  The chain puts as positive a spin as possible on their situation but others see cause for concern.  A Texas advocacy organization for the long-term care facilities points to the low Medicaid reimbursements. Two facilities owned by the chain were hit last year with violations stemming from Hurricane Harvey. The article notes that the bankruptcy judge has the ability to name a "patient-care ombudsmen to monitor care" as the bankruptcy moves forward, but one has not yet been appointed.

One interesting point in the article-in discussing steps taken by the chain to improve its bottom line, it sought a reduction in rent and now is in debt to one landlord for more than $31 million.

 

December 11, 2018 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid | Permalink | Comments (0)

Monday, December 10, 2018

Rural & Tribal Justice Webinar Series from DOJ

Mark your calendars for a free webinar on December 13, 2018 from noon-1 from DOJ's Elder Justice Initiative on Resources for Financial Institutions to Prevent & Protect Against Elder Financial Exploitation.

Here is a synopsis from the website:

Bankers, brokers, and investment advisors are often some of the first trusted parties to see signs of financial exploitation. This presentation will support the work already done by financial services members and provide additional information about how to access training programs and support for tellers and other financial professionals who want to report financial exploitation and work collaboratively with others in their communities to prevent it.

Please join us for a webinar on December 13, 2018, at 1:00 p.m. e.t., on Resources for Financial Institutions To Prevent and Protect Against Elder Financial Exploitation with host Judith Kozlowski, J.D., consultant and subject matter expert with DOJ's Elder Justice Initiative, and presenter Lisa Bleier, J.D., Managing Director and Associate General Counsel at the Securities Industry and Financial Markets Association (SIFMA), and leads its Senior Investor Protection efforts. Her primary responsibilities at SIFMA include working with Members of Congress and government regulators on retirement, IRA, and executive compensation matters. Before moving to SIFMA, Ms. Bleier was Vice President and Senior Counsel at the American Bankers Association and worked on Capitol Hill. Also presenting is Billie McNeeley, Financial Exploitation Specialist, Aging & People with Disabilities at the Oregon Department of Human Services, she is a leader in developing and training bank tellers to recognize financial exploitation and move to action. Formerly with the Oregon Bankers Association, she is a national advocate for the role that small banks and credit unions can play in addressing elder financial exploitation.

They will discuss how financial professionals in small and medium-sized firms can use available tools and training to recognize and fight elder financial exploitation. The discussion includes what tellers, back-office professionals, and those in the c-suite can do to address this important issue.

To register for the webinar, click here.

December 10, 2018 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Programs/CLEs, State Statutes/Regulations, Webinars | Permalink

Thinking about New York Time's Article on Guardianships and One Woman's Personal Story

For anyone working in legal fields where adult guardianships may be an option, for anyone teaching elder law, health care law, constitutional law or even landlord-tenant law, a recent New York Times article, "I'm Petitioning . . . for the Return of My Life," is an important read.

On a threshold level, this is a well-told tale of one woman, Ms. Funke, who becomes subject to an intervention under New York adult protective services law, and, eventually, to a full-blown guardianship proceeding.   It can be easy to become enraged on behalf of Ms. Funke as you read details about her past life as a freelance journalist and world traveler, and compare it to the limitations placed on her essential existence under a guardianship. 

The article is a rather classic example of using one tragic story, a human story, to paint a picture of a government process gone wrong.  At several points in the article, the writer, John Leland, offers questions that suggest some conclusions about how unfair the process has been to Ms. Funke.  The writer asks, for example, 

"If you were Ms. Funke, shouldn't you be allowed to withdraw into the covers [of your bed] if you wanted to?  And the clutter in your apartment -- couldn't people understand that a writer needs materials around?  Even if she were evicted, she had money to start somewhere else.  Courts evict people with lots less [than she appears to have]. " 

It's implied that the answers to those questions may outweigh the fact that the protective services intervention prevented the landlord from completing an eviction of Ms. Funke, an eviction that would have forced her out of her apartment of 40+ years.    

Other, less dramatic details in the article suggest that for every Ms. Funke, there may be other people -- an unknown number of people in New York -- who are also very alone and who have also lost control over their lives because of physical frailty, mental decline, depression or other facts, and who are rescued with the help of a protective services intervention. Sometimes the intervention interrupts the decline, usually with the help of family member or friend who volunteers to help, sometimes acting with a measure of authority under a power of attorney, making a guardianship unnecessary. 

The challenge, of course, is knowing when to help (and how far to go), and when to preserve the  individual's right  to make choices that appear unsafe.  Some of the most complex cases involve people who have spent a lifetime on a unique and often solo path, and now have few family members or friends to help them as that path becomes rockier with age or illness, especially when they have no plan for the future.  In the face of such facts, as one person interviewed in the article observes, guardianships are a "blunt instrument."

Something I wrote about last week also figures into the New York situation -- the apparent absence of a guardianship case tracking or monitoring system.  

But another issue I'm concerned with is also suggested.  At one point, an interview with one of Ms. Funke's guardians, a so-called professional (in other words, not a family member or a public guardian) discloses he does not know how far his authority as guardian extends.  For example, would he be allowed to prevent her from marrying?  He responded, he did not know.

It would seem that guardians and other agents, alleged incapacitated persons, -- and family members -- could all benefit from greater information, and to ongoing education on their rights, duties and options.  That was also a theme emerging from article asking the question  "Where's Grandma?" that I linked to last week and that I link to again here.    

My thanks to the several folks who suggested this New York Times article for discussion on our Blog, including my Dickinson Law colleague, international human rights expert, Dermot Groome.    

December 10, 2018 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Housing, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Sunday, December 9, 2018

Grandma Goes Apple... or Apple Goes for Grandma?

Well, I guess it was only a matter of time. I've blogged on numerous occasions about "elder tech" and now it seems Apple, at least its watch, is moving into that market. Kaiser Health News reported In Grandma’s Stocking: An Apple Watch To Monitor Falls, Track Heart Rhythms.

[W]hen Apple unveiled its latest model in September — the Series 4, which starts at $399 — it was clear it was expanding its target audience. This Apple Watch includes new features designed to detect falls and heart problems. With descriptions like “part guardian, part guru” and “designed to improve your health … and powerful enough to protect it,” the tech giant signaled its move toward preventive health and a much wider demographic.

One expert quoted in the article noted that the older generation is used to wearing watches and thus this would be a much easier wearable for them.  Here's how the fall monitoring feature works. "The fall-monitoring app uses sensors in the watchband, which are automatically enabled for people 65 and older after they input their age. These sensors track and record the user’s movements, and note if the wearer’s gait becomes unsteady. ... If a fall is detected, the watch sends its wearer a notification. If the wearer doesn’t respond within a minute by tapping a button on the watch to deactivate this signal, emergency services will be alerted that the wearer needs help."  We all know how falls can lead to devastating complications for older persons.

The heart monitor feature again using wristband sensors  is used  "to monitor a patient’s heartbeat and send alerts if it gets too fast or too slow. Specifically, the app is meant to detect atrial fibrillation, which is a type of arrhythmia, also described as a problem with the speed or rhythm of the heartbeat." The article notes some doctors have concerns that this feature will send folks needlessly to the ER.

The article notes that the FDA has "cleared" but not approved the feature, which means "that means they haven’t faced as much rigorous testing as something that has gained the agency’s formal OK."

More to come.

December 9, 2018 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other, Web/Tech | Permalink | Comments (0)

Thursday, December 6, 2018

Kansas Disciplinary Case on Fees

The Kansas Supreme Court released a lengthy disciplinary opinion on November 30, 2018  that concerns, among other things, excessive fees. The case, In re: Crandall, resulted in a 6 month suspension.  The opinion is available here.   The Kansas Supreme Court addressed several procedural issues in its opinion. As far as fees, the court found that "testimony provides clear and convincing evidence and establishes that the representation of [clients] was straightforward and did not require the time and labor needed to justify the amount ... charged." The opinion goes step-by-step through the  provisions of Rule 1.5(a) criteria to determine reasonableness of a fee. The Court found that there was clear and convincing evidence that the attorney had violated Rule 1.5.  The opinion also examines other issues and concludes "that the fees in two cases were unreasonable in violation of KRPC 1.5(a) and that [the attorney] violated KRPC 1.1 (competence), 1.3 (diligence), 1.4(b) (communication), 1.7(a) (concurrent conflict of interest), and 8.4(d) (conduct prejudicial to the administration of justice)."

December 6, 2018 in Consumer Information, Current Affairs, Legal Practice/Practice Management, State Cases | Permalink

Wednesday, December 5, 2018

Several Items Relating to Nursing Homes & Quality of Care

I have collected four  items regarding nursing homes, that  I thought I'd summarize in one  post.

First

Regular readers will recall that Florida now requires SNFs to have generators (after last year's hurricane).  Last month's Health News Florida reported that many nursing hones are seeking extensions of time on the requirement to have generators. Nursing Homes Seek More Time On Generator Requirements notes that "[m]ore than 40 percent of Florida nursing homes are asking health-care regulators for more time to meet backup-power requirements pushed by Gov. Rick Scott after Hurricane Irma last year... But ... the state’s top health-care regulator, said his agency won’t approve waiver requests for deadbeat facilities that haven’t worked over the past several months to carry out emergency backup-power plans."  Slightly more than 25% of the facilities are in compliance and over half of ALFs are.  Some ALFs not in compliance are the focus of penalties, "the state has moved ahead with penalizing a handful of ALFs that aren’t in compliance. In November, the state has entered into settlement agreements with more than a dozen ALF providers across the state to settle allegations that they failed to meet the requirements, according to a review of information on a state website."

Second

The  Washington Post ran an article last month, Overdoses, bedsores, broken bones: What happened when a private-equity firm sought to care for society’s most vulnerable. The article focused on the ownership of of a chain owned by "the Carlyle Group, one of the richest private-equity firms in the world [where], the ManorCare nursing-home chain struggled financially until it filed for bankruptcy in March. During the five years preceding the bankruptcy, the second-largest nursing-home chain in the United States exposed its roughly 25,000 patients to increasing health risks, according to inspection records analyzed by The Washington Post."  The article includes a response from the chain as well as the private equity group:

Carlyle and HCR ManorCare representatives said care at the nursing homes was never compromised by financial considerations. The cost-cutting trimmed administrative expenses, not nursing costs, they said. The number of nursing hours provided per patient stayed fairly constant in the years leading up to the bankruptcy, according to the figures that the company reported to the government.

HCR ManorCare officials also disputed the idea that quality at the homes had suffered in recent years. They said their nursing homes offered excellent service based on the ratings issued by Medicare, the federal government’s insurance program for older Americans. ManorCare homes averaged 3.2 stars in the years before bankruptcy, which was slightly below the U.S. average. Some watchdog groups, such as the Center for Medicare Advocacy, are critical of the five-star rating system, however, because it relies on unaudited data reported by nursing homes.

The article examined complaints in several states, reported on the views expressed by the private euity firm, including the role of Medicare reimbursements and reported that "[a]fter the bankruptcy,  the nursing home chain was bought by Promedica Health, a nonprofit group."

Third

Bloomberg Law reported last week that payroll data is being used to examine staffing. Sparse Nursing Home Staffing to Be Sniffed Out in Payroll Data explains that "[t]he payroll data will be used to identify nursing homes that have a significant drop in staff on weekends or have several days in a quarter without a registered nurse on site, the federal Medicare agency said Nov. 30. Nursing homes must have a registered nurse on site every day for eight hours, the agency said on its website."

Fourth,

In that same vein, Kaiser Health News reported Feds Order More Weekend Inspections Of Nursing Homes To Catch Understaffing. The payroll data mentioned in item #3 plays a role. "The federal Centers for Medicare & Medicaid Services said it will identify nursing homes for which payroll records indicate low weekend staffing or that they operate without a registered nurse. Medicare will instruct state inspectors to focus on those potential violations during visits."  Does this mean there will be a flurry of inspections? No. As the article explains, "[t]he new directive instructs inspectors to more thoroughly evaluate staffing at facilities Medicare flags. The edict does not mean a flurry of sudden inspections. Instead, Medicare wants heightened focus on those nursing homes when inspectors come for their standard reviews, which take place roughly once a year for most facilities."

December 5, 2018 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare, State Statutes/Regulations | Permalink

The Importance of Guardianship Tracking Systems (and a related CLE Program!)

I've been a bit busier than usual lately and haven't felt I could take the time to Blog regularly even though I'm constantly seeing intriguing topics to discuss.  I'm buried in a manuscript with a looming deadline!  Fortunately, I'm seeing that Becky Morgan is keeping everyone updated and I've been benefiting from her regular reports.  I hope to get back to daily posts of my own by January.  

In the meantime, I can report on a smaller, interim task of  serving as a co-presenter for a half-day Continuing Legal Education program at the Pennsylvania Bar Institute on  new developments in Guardianship Practice and Procedure on Friday, December 7.   Among the important developments, the Pennsylvania Courts is nearing completion on its statewide implementation of a Guardian Tracking System or GTS.  In 2014, the Supreme Court's Elder Law Task Force strongly recommended adoption of such a system, having determined just how little was actually known across the state about open guardian cases.  Implementation of the new system began with a pilot in Allegheny County in July 2018.  As of today, 60 counties are "live" in the system.  The remaining 7 counties are scheduled to be included by the end of this month.

With the help of the new tracking system, I learned that we currently have more than 14,000 active guardianships in Pennsylvania.

Key features of the GTS system include:

  • Automation:  a means of automatically running a process to check specific aspects of guardianship reports for missing information or other concerns;
  • Flagging:  when a concern is detected, the item is automatically flagged, allowing court personnel to review and respond to the potential problem;
  • State-wide Court Communications: providing the court system with a means of immediate and cost-effective state-wide communications whenever a judge in one case is alerted to suspicion of neglect or other improper conduct by a guardian; and
  • Alerts on Specific Guardians:  when an "alert" is triggered on a specific guardian in one case, the system will generate notices to all of the other courts in the state, alerting them to the potential need for action on that individual in their cases.  

Such a system required entirely new software, new reporting forms, and new court rules to make implementation effective.  We will be talking extensively about the new rules and forms on Friday.  The migration  from the older system of record-keeping imposes a huge learning curve on many involved in guardianship matters, including lawyers.

The need for better systems in Pennsylvania has been highlighted during the last year of controversies surrounding appointment of one particular individual as guardian for alleged incapacitated persons in three Pennsylvania counties.  She is accused of mismanaging cases, plus it turned out she had a criminal history for fraud in another state. 

See also the recent news reports about another Pennsylvania guardianship matter that asks the troubling question "Where's Grandma?" The  reporter on this case, Cherri Gregg, who also happens to be a lawyer, opines that everyone in the case, including the lawyer appointed as guardian, and the family members of the person subject to the guardianship, needed better education about their roles after the grandmother's own children passed away, as the grandmother became more vulnerable, and especially when it became necessary to place her in a nursing home.  

My special thanks to Karen Buck, Executive Director of the SeniorLAW Center in Philadelphia, and the good folks at Pennsylvania Courts' Office of Elder Justice for helping me with my part of the presentation for Friday!

December 5, 2018 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Legal Practice/Practice Management, Programs/CLEs, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Advance Directives: Counseling Guide for Lawyers

The American Bar Association Commission on Law & Aging has published the   Advance Directives: Counseling Guide for Lawyers. The website explains the usefulness of the guide: "designed to assist lawyers and health care professionals in formulating end-of-life health decision plans that are clearly written and effective... The guide provides detailed information on how to bridge the chasm between lawyers and health care providers. It helps lawyers to provide guidance that is more in harmony with the clinical and family realities that clients face. The foundation for it is a set of eight principles to guide patients and clients through the advance care planning process." The three sections include the planning principles, a checklist for attorneys, and resources.  All are available for download individually, or the entire guide may be downloaded for free or purchased from the ABA.  The guide contains a lot of helpful info for attorneys, including checklists for a first and second interview, a sample letter to the client's doctor and a HIPAA access form. Check it out! 

 

December 5, 2018 in Advance Directives/End-of-Life, Books, Consumer Information, Current Affairs, Health Care/Long Term Care, State Statutes/Regulations | Permalink

Tuesday, December 4, 2018

SNF Silver Tsunami Hitting Texas?

A recent article mentioned that the number of elders in Texas who will need SNF care is going to be a "silver tsunami."  The Houston Chronicle published this article, Silver Tsunami set to hit Texas nursing homes where the article acknowledges "[m]ore than 12 percent of the Texas population is over 65, and that number is growing. According to the Texas Demographic Center, the over-65 population across the state is projected to increase by more than 262 percent by 2050." But it is more than the numbers creating this "silver tsunami: the impact is magnified "by the increasingly complex medical conditions — such as Parkinson’s and Alzheimer’s — of aging Texans needing nursing home care. According to data from the Alzheimer’s Association “2018 Texas Facts and Figures,” more than 380,000 of the state’s residents have already developed Alzheimer’s disease or other dementia. In Texas, Alzheimer’s is the sixth leading cause of death, and its prevalence is expected to increase by almost 30 percent by 2025."

The article also highlights the fact that in many instances the caregivers themselves will be elders.

We all need to be planning ahead.....

December 4, 2018 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Housing, State Cases, State Statutes/Regulations | Permalink

Monday, December 3, 2018

Decline in US Life Expectancy

U.S. life expectancy has declined. What's up with that? According to an article in the Washington Post, this is not good news for us. U.S. life expectancy declines again, a dismal trend not seen since World War I emphasizes the impact of the opioid and suicide crises.

The data continued the longest sustained decline in expected life span at birth in a century, an appalling performance not seen in the United States since 1915 through 1918. That four-year period included World War I and a flu pandemic that killed 675,000 people in the United States and perhaps 50 million worldwide.

The U.S. trend seems to be opposite of what is happening in other countries, and although the decline may not seem very large, it is still part of an overall concerning trend. The numbers re: opioid deaths cited in the article are shocking. Read the article to absorb the data and look at the geographical info detailing where opioid deaths are highest and lowest.  It's just not drug deaths attributing to the decline. "Other factors in the life expectancy decline include a spike in deaths from flu last winter and increases in deaths from chronic lower respiratory diseases, Alz­heimer’s disease, strokes and suicide. Deaths from heart disease, the No. 1 killer of Americans, which had been declining until 2011, continued to level off. Deaths from cancer continued their long, steady, downward trend."

December 3, 2018 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care, Other, State Cases, Statistics | Permalink

Friday, November 30, 2018

Senate Special Committee on Aging-Guardianship Hearing

Earlier I had blogged about the upcoming hearing on guardianships scheduled for the Senate Special Committee on Aging The hearing was held on November 28, 2018, and a report as well as the video of the hearing are now available.  You can also access the witness statements here.

November 30, 2018 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink

Tuesday, November 27, 2018

Senate Special Committee on Aging

The  Senate Special Committee on Aging is holding its next hearing tomorrow, November 28, on guardianships.  “Ensuring Trust: Strengthening State Efforts to Overhaul the Guardianship Process and Protect Older Americans.” is scheduled for 2:30 p.m. and will feature 4 witnesses. Testimony and remarks will be posted to the website after the hearing.

November 27, 2018 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Other, State Statutes/Regulations | Permalink

Friday, November 23, 2018

The Latest Robot Caregiver

With Thanksgiving 2018 behind us and family on our minds, it seemed timely that the New York Times ran an article about the newest entry into robot caregivers.  Meet Zora, the Robot Caregiver explains that this small robot, perhaps "more cute toy than futuristic marvel ...  is at the center of an experiment in France to change care for elderly patients." The nursing home using Zora found that residents, with dementia or needing 24 hour care,forrmed emotional attachments to it. A nurse, out of sight of residents, controls the robot via a laptop, giving it commands to speak and do activities such as exercises and games. 

The article focuses as well on the shortcomings of any robotic caregivers-that is, they aren't human.  Regardless, we all know about the looming caregiver shortage. Will robot caregivers fill that shortage? 

The experience at Jouarre provides a window into a future when we will rely more on robots to help care for loved ones as they age.

Zora Bots, the Belgium-based provider of the robot at Jouarre, says it has sold over 1,000 of the robots to health care facilities around the world, including in the United States, Asia and Middle East. It is part of a growing emphasis on robotics focused on care. A robot dog made by Sony has been marketed as a companion for older adults.

France, the article explains faces ongoing and serious issues regarding health care

[H]ospitals have been facing a national crisis, with health care professionals striking and protesting budget cuts and staff shortages. A rise of suicides of nurses and doctors has made national headlines, and France’s health minister acknowledged that the hospital system was “running out of steam.”

The challenge will be creating machines capable of doing more complex jobs. Lifting a patient’s mood with a song is different from providing health care. The French hospital, which bought the robot with the help of a charitable grant, brings out Zora just a few times a month.

In Australia, a hospital using a Zora robot studied the effects on patients and staff. The researchers found that it improved the mood of some patients, and got them more involved in activities, but required significant technical support.

The experience of the French hospital staff has been similar.

However, these robot caregivers are not health care providers-at least not yet. What the research has shown is that the residents can feel emotional bonds with the robots and they can help residents feel happier, or even, as the article notes, confide things in the robots that they won't tell human caregivers.

Stay tuned....

November 23, 2018 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, International | Permalink