Monday, October 14, 2019

Another Article on Saving for Retirement

MarketWatch published an article last week on the amount of money you need to have for your retirement,  If you want to have enough money when you retire, you need to know this.  "Calculating future savings requires numerous factors, including current age and predicted retirement age, any current assets, how the portfolio is invested and at what rate a person can realistically expect that money to grow. The latter, known as a “rate of return,” includes inflation, interest and dividend payments, and many experts disagree on what individuals can anticipate that rate to be."  There are various views regarding the percentages needed for the rate of return and there are a couple of ways to reference it, the article explains.

As with most other facets of retirement planning, an assumed rate of return can be different from one person to the next, said [one advisor]... The reality is that it is almost entirely dependent upon your own personal allocation....” Many advisers also have their own way of creating projections, and will show clients a few estimates — from conservative to aggressive — when making a financial plan. “There is no one perfect number to use....”

Still, investors may want to err on the conservative side, as it’s better to save too much than end up in retirement with too little....  And investors, especially younger ones, should not be chasing returns.

Bottom line, you need to start saving (the earlier the better) for your retirement if you plan to retire

October 14, 2019 in Consumer Information, Current Affairs, Other, Retirement | Permalink | Comments (0)

Sunday, October 13, 2019

Updated Resources in the Fight vs. Elder Abuse

NAPSA has announced two resources for the fight vs. elder abuse. The first is an updated version of the National Guidelines for Financial Institutions: Working Together to Protect Older Persons from Financial Abuse. "The Guidelines and forms [are] ... designed to promote standardization and clarity among financial institutions and Adult Protective Services."  Note that the guidelines include a variety of useful forms, which are accessible here in addition to their inclusion in the guidelines. 

NAPSA also announced  the creation of  "the National Clearinghouse on Financial Exploitation, your "go to" for for all things related to financial exploitation. The Clearinghouse will provide answers to questions, links to resources, introduction to partners and problem solving to help strengthen our resources and partnerships in our fight against financial exploitation."

Go to NAPSA-Now for more information and resources.

October 13, 2019 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Tuesday, October 8, 2019

GAO Report: Protecting Vets from Financial Exploitation

The GAO recently issued this report, Veterans Benefits: Actions VA Could Take to Better Protect Veterans from Financial Exploitation. Here are the highlights from the report

Why This Matters

Veterans with disabilities who receive benefits from the Department of Veterans Affairs (VA) can be tempting targets for exploitation and scams. Veterans and their survivors who need help performing everyday activities, like bathing and dressing, can receive increased pension benefits known as aid and attendance.

Key Takeaways

VA paid $3.2 billion in total pension benefits to 232,000 recipients of aid and attendance in fiscal year 2018. Most recipients were over 80.

Scams that target them include:

  • being overcharged for home care, or charged for services they did not receive, and
  • getting bad investment advice from financial services organizations.

VA does not centrally collect and analyze information, such as complaints made against companies, that could show the prevalence of these scams, help VA target outreach to veterans, and help law enforcement go after scammers.

Other threats to veterans include:

  • VA’s applications do not warn them about exploitation or scams: For example, forms do not warn veterans that they cannot be charged fees for filing claims.
  • Misdirected benefit payments: VA does not always verify direct deposit information on applications, which could lead to payments being stolen. In contrast, the Social Security Administration verifies this information by reviewing individuals’ checks or account statements.
  • What GAO Recommends

    We made four recommendations to VA, including that it collect better information on potential financial exploitation, post warnings on applications, and examine if it should take more steps to verify veterans' direct deposit information. VA agreed in principle with the need to collect better information, but its proposed actions do not fully address our concerns. VA agreed with the other three recommendations.

The full report is available here.

October 8, 2019 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Veterans | Permalink | Comments (0)

Monday, October 7, 2019

Hospitals in the Housing Business?

Kaiser Health News ran this story, Why Hospitals Are Getting Into The Housing Business.

The article opening with anecdotes involving patients at a Denver hospital,

In the first half of this year alone, the hospital treated more than 100 long-term patients. All had a medical issue that led to their initial hospitalization. But none of the patients had a medical reason for remaining in the hospital for most of their stay.

Legally and morally, hospitals cannot discharge patients if they have no safe place to go. So patients who are homeless, frail or live alone, or have unstable housing, can occupy hospital beds for weeks or months — long after their acute medical problem is resolved. For hospitals, it means losing money because a patient lingering in a bed without medical problems doesn’t generate much, if any, income. Meanwhile, acutely ill patients may wait days in the ER to be moved to a floor because a hospital’s beds are full.

What's a hospital to do? In some cases, provide or pay for housing for  those patients. According to the article, a number of hospitals are "exploring ways to help patients find a home. With recent federal policy changes that encourage hospitals to allocate charity dollars for housing, many hospitals realize it’s cheaper to provide a month of housing than to keep patients for a single night."  Think about that statement again.... one month of housing may be cheaper than one night's hospital stay.

So the Denver hospital featured in the story is taking this a step farther, "partnering with the Denver Housing Authority to repurpose a mothballed building on the hospital campus into affordable senior housing, including about 15 apartments designated to help homeless patients transition out of the hospital."

Examine these numbers: One night in the hospital featured in the story "costs ... "$2,700 a night [and] ..... [p]atients who are prime candidates for the transitional units stay on average 73 days, for a total cost to the hospital of nearly $200,000. The hospital estimates it would cost a fraction of that, about $10,000, to house a patient for a year instead."

The KHN article references a recent report from the Urban Institute on the correlation between health and housing.  Fascinating info!

October 7, 2019 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare | Permalink | Comments (0)

New Report-SSA Needs More Oversight of Those Who Handle Vulnerable Beneficiaries $

The GAO recently released a new report, Social Security Benefits: SSA Needs to Improve Oversight of Organizations that Manage Money for Vulnerable Beneficiaries. Here are the highlights:

What GAO Found

The Social Security Administration (SSA) approves organizational payees—such as nursing homes or non-profits that manage the Social Security benefits of individuals unable to do so on their own—by assessing a range of suitability factors, such as whether the organizations have adequate staff to manage benefits for multiple individuals. However, GAO found that SSA's policy does not specify how to assess more complex suitability factors, such as whether an organization demonstrates sound financial management. Without clearer guidance, unqualified or ill-prepared organizational payees could be approved to manage benefits. Also, SSA does not currently require background checks for key employees of an organizational payee. In contrast, SSA requires background checks for individual payees—such as a relative or friend of the beneficiary. A comprehensive evaluation could help SSA determine whether and how to expand their use of background checks to organizational payees.

To ensure organizational payees are managing funds appropriately, SSA uses several monitoring tools, including resource-intensive onsite reviews. Certain organizational payees, such as those that charge fees for their services or have 50 or more beneficiaries (high-volume), receive onsite reviews every 3 to 4-years. In contrast, payees that serve fewer than 50 beneficiaries (low-volume)—the vast majority—are selected for review based on their estimated likelihood of misusing beneficiary funds, and a relatively low percent of them receive onsite reviews (see figure). SSA uses a predictive statistical model to identify higher risk low-volume payees, but the model's effectiveness cannot be fully assessed by GAO or others due to missing documentation on how it was designed. SSA officials said they will update the model in the future, but do not have a time frame for doing so. Establishing such a time frame and documenting design decisions are key steps toward assessing the model's effectiveness.

. . .

What GAO Recommends

GAO is making nine recommendations in this report, including that SSA: clarify how to assess complex suitability factors; assess requiring background checks for organizational payees; establish a timeframe for reviewing the predictive model and document design decisions resulting from that review; and establish timeframes for, and conduct revisions of the accounting form. SSA agreed with all nine recommendations and provided technical comments that GAO incorporated as appropriate.

The full report is available here.

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

Thursday, October 3, 2019

Cognitive Impairments and Using Technology

Who among us doesn't have a smart phone or computer, or even a tablet? They are not only ubiquitous, they are integral, and perhaps essential, to our daily lives.  What happens when someone, due to cognitive impairments, is no longer able to use these devices? Kaiser Health News made that the subject of a recent article. The Delicate Issue Of Taking Away A Senior’s Smartphone describes the potential problems

Increasingly, families will encounter similar concerns as older adults become reliant on computers, cellphones and tablets: With cognitive impairment, these devices become difficult to use and, in some cases, problematic.

Computer skills may deteriorate even “before [older adults] misplace keys, forget names or display other more classic signs of early dementia,” Zorowitz wrote recently on a group email list for geriatricians. (He’s based in New York City and senior medical director for Optum Inc., a health services company.)

“Deciding whether to block their access to their bank accounts, stocks and other online resources may present the same ethical dilemmas as taking away their car keys.”

Consider that some folks stay in touch with family and friends through their digital lives. But also consider how scammers can use email to perpetrate a fraud.  The article notes a difficulty in using these devices---a difficulty that did not previously exist--may be an indicator of cognitive issues signaling a need for a comprehensive exam of cognition.  Family can be helpful, but still realize there are issues

[B]eware of appropriating someone’s passwords and using them to check email or online bank or brokerage accounts. “Without consent, it’s a federal crime to use an individual’s password to access their accounts,” said Catherine Seal, an elder-law attorney at Kirtland & Seal in Colorado Springs, Colo. Ideally, consent should be granted in writing.

The article notes that some with dementia lose interest in their devices, but that is not true for everyone-it depends on the type of cognitive impairment.  "More difficult, often, are situations faced by people with frontotemporal dementia (FTD), which affects a person’s judgment, self-awareness and ability to assess risk." The article then profiles the experiences of a noted elder law attorney and friend of mine, whose husband as an FTD diagnosis. She shared the steps she takes to keep her husband safe online.

Read the entire article, especially the last part where personal experiences and tips are shared.  It's an important topic-we all need to think about this and plan for the eventuality in case we need to give up our digital word.

October 3, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, Other | Permalink | Comments (0)

Wednesday, October 2, 2019

Emergency Planning & Older Adults: A New Report on Preparedness

We are still in hurricane season down here in Florida, sporting 90 degree temperatures, while Montana had a blizzard.  Natural disasters take all forms so it's important to remember that everyone needs a disaster plan. the University of Michigan National Poll on Healthy Aging  published a new report, Emergency Planning among Older Adults.

Introduction

Natural disasters and other emergencies can happen anywhere. When they do occur, older adults, including those with chronic health conditions and impaired mobility, may be particularly vulnerable to adverse effects. In May 2019, the University of Michigan National Poll on Healthy Aging asked a national sample of adults age 50–80 about their experiences with disasters and emergency planning as well as their preparedness for such events.

Preparing for emergencies

In the past year, more than one in five adults age 50–80 (22%) had experienced an emergency or disaster such as a power outage lasting more than a day, severe weather, evacuation from their home, or a lockdown, while 73% reported experiencing at least one such event during their lifetime. More than half of respondents (53%) thought they were likely to experience an emergency or disaster in the next year.

The question is then, are these folks prepared?  Not everyone, according to the poll results:

Implications 

Although more than half of older adults believe they will likely experience some type of natural disaster or emergency in the coming year and the majority generally feel confident in their ability to manage through them, many older adults have not taken key steps recommended by disaster preparedness agencies. Nearly half of respondents either did not know if their community had an emergency alert system or had not yet signed up. Having any advanced warning of a disaster or emergency, even minutes, can help people get to a safer place, so signing up for these alerts, where available, is important. 

Although most older adults who require essential medications or health supplies reported having a seven-day supply available, three in four individuals who use medical equipment that requires electricity did not have an alternative power source. Roughly half of respondents reported having a week’s supply of food or water, or tools for communication in the event of a power outage such as a solar or battery cell phone charger or a battery-powered or hand crank radio. Disaster preparedness agencies recommend such resources for everyone, and these steps may be particularly important for older adults with complex health needs or mobility challenges. 

The American Red Cross, FEMA, and AARP all offer guidance for preparing/responding to disasters and emergencies specifically designed for older adults. These groups and others tasked with promoting emergency preparedness should consider utilizing new strategies to reach and engage older adults who may not already be well-prepared for emergencies. Additionally, health care professionals who care for older adults should consider discussing disaster preparedness, particularly in areas that routinely face natural disasters. Preparing now can help older adults — and everyone — to be ready for emergencies.

The full report is available here.

October 2, 2019 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other | Permalink | Comments (0)

Tuesday, October 1, 2019

Make These a Part of Your Exercise Routine?

We all know how important it is to keep moving! But what gives us the maximum benefit, at least from the standpoint of being the most you can be (I sound like the old Army ad "Be all you can be") when you are older. The Washington Post ran this informative article, The longevity files: A strong grip? Push-ups? What actually can help you live to a ripe old age.

Here are some tips from the article--pushups, walking speed, sitting on the floor and standing up (known as sit-rise) and grip strength matter.  But those are not magic elixirs--instead they are representative of your ability,  "that you are still strong and nimble enough" to do them. "What these tests have in common is they’re good shorthand of things that matter for longevity: overall health, fitness and muscle strength. A fit person walks faster than someone out of shape, and getting up off the floor is tricky for people with weak bones and muscles."

As the article notes, there is no magic pill for longevity, but exercise does help... a lot. Even short amounts of exercise make a difference.  Oh and it's not just exercise; sleep matters as well as does diet.  Alcohol in moderation and keeping stress under control are also important.  Having friends and a purpose are also discussed in the article. 

This reminds me of so much of what we were taught in health and gym classes back in high school.  So now that you've read this post, read the article and then take walk.

 

Thanks to Professor Naomi Cahn for sending me the link to the article.

October 1, 2019 in Consumer Information, Current Affairs, Food and Drink, Health Care/Long Term Care, Other | Permalink | Comments (0)

Changing the Perceptions of Ageism Through Positive Media

One of the questions I ask my students at the beginning of the semester is to quickly tell me characteristics of someone the students consider to be old. I typically get responses that involve wrinkles, grey hair, use of assistive mobility devices and the like. I will sometimes ask them to tell me about positive aging representations in television and movies. In the past someone would mention the Golden Girls, now I'm not so sure current generations of students are familiar with the show, so instead I expect someone to mention Grace and Frankie.

To this point, I was quite interested in the project between AARP and Getty ImagesMedia Image: Age Representation in Online Images. The report from AARP reveals the common use of negative images in media to portray elders.

Visual portrayals and stock photography build and reinforce stereotypes. The current landscape of online images does not accurately reflect the 50-plus population. This portrayal may exacerbate ageism in the workplace by rarely showing adults age 50-plus at work or with technology but rather as isolated or dependent on others for assistance. Images are often intended as heartwarming, showing younger people helping the 50-plus, but this portrayal has unintended consequences.This media scan suggests that visual representations need to reflect greater diversity and authenticity. Specifically, more images are needed that portray older adults as independent and actively engaged in their communities. In addition, more images are needed that show the 50-plus in work settings and using technology with confidence.

Here are some of the key findings from AARP's study

  • Nearly half of all adults in the U.S. are 50 and older, but only 15 percent of the random sample of images studied showed people in this age group. That's fewer than 1 in 7 images.
  • Adults 50-plus are portrayed in a positive light 72 percent of the time. That's much less than people 49 or younger, who are featured in a positive light 96 percent of the time.
  • Although 1 in 3 people in the U.S. labor force are age 50-plus, only 13 percent of online media images show a middle-aged or older adult in a work setting.

To remedy this, AARP & Getty have launched an online collection of positive stock aging that can be licensed for use,  AARP and Getty Images Launch Photo Collection to Fight Ageism.

To fight ageism and illustrate the active lifestyles of adults age 50-plus, AARP has joined with Getty Images in launching a collection of more than 1,400 stock photos available for a fee to media outlets, ad agencies and other firms.

The Disrupt Aging Collection features photos of older Americans as vibrant and engaged, some of whom are singing, skiing, swimming in the sea, traveling abroad, playing team sports and hoisting adult beverages with their friends at the beach.

Check out the photos here.  Now, if only they were free....

October 1, 2019 in Consumer Information, Current Affairs, Film, Other | Permalink | Comments (2)

Monday, September 30, 2019

Special Touches in an Elder Law Practice

I'm always interested in the special touches some elder law attorneys bring to their practices, and I've written previously (not necessarily on this blog) about them. Years ago, I remember a friend and preeminent elder law attorney, Ray Parri, decided to have office pets-he was the first I'd heard to do so (really it was a long time ago).  He routinely had cats, and I know at one point he had two office cats, one named Mason and the other named Perry (if you get the reference I know your generation!).  It's not only special touches but also special events that can set elder law attorneys apart from others, IMHO.   Here's one upcoming that illustrates my point.  Our alum, Stephanie Edwards,  has an upcoming caregiver event, titled "Caregiver's Holiday Paws Pause."  With several other agencies and a local church, this event offers 3 hours of staffed respite care for for folks who have caregivers, resources for caregivers, 90 minutes to interact with adoptable animals (and maybe they will get a new home for the holidays) and a presentation by a dementia coach. I'd be interested in hearing about other unique events from elder law attorneys, so let me know!

 

September 30, 2019 in Consumer Information, Current Affairs, Other | Permalink | Comments (0)

Friday, September 27, 2019

Student Views of Recent Events

I gave my students an assignment to write a blog post on a current event that would be of interest in a class on law and aging.  Here are two that I've received---I thought you might find them interesting.

Post #1

This was supposed to have been a fun family weekend.  My sister-in-law was headed home with a car filled with special treats and presents to celebrate my niece's sweet sixteenth birthday.  The weather was clear and traffic was moving smoothly when the crash occurred.

A ninety year old drove through a stop sign and directly into traffic, causing a multi-car accident.  My sister-in-law had to be cut from her SUV and taken to the trauma center.  I saw her crumpled vehicle first-hand, and it is an absolute wonder she survived.  It is uncertain how long her injuries will significantly impact her life.  Yet, she was the incredibly lucky one.

A young couple and their infant was also struck by the elderly driver's car.  Seeing this family's vehicle was horrific.  I knew the infant was in critical condition at the hospital.  When I saw this car, it looked as if it had been in a compactor; it didn't seem possible for anyone to survive.  Unfortunately, the infant didn't. 

As those involved in the accident struggle to heal and make sense of the tragedy, my heart goes out to the family of the elderly driver.  I have so many questions.  I wonder...did family members recognize the signs that their loved one should no longer be driving?  Did they try to intervene?  Was the driver aware of taking the wheel?  Is he aware now?  How will the driver and family cope with the legal and emotional burden of this accident?  What more can be done to prevent this kind of heartbreak?

https://www.msn.com/en-us/autos/news/multi-car-crash-injuries-four-people-including-an-infant/ar-AAHgwJn

https://seniordriving.aaa.com/resources-family-friends/conversations-about-driving/facts-research/

https://www.agingcare.com/Articles/signs-elder-unsafe-driver-153264.htm

Post #2

Elders in Politics: Perceptions of elders in the 2020 election

Brandy Orth Becker

While the perception and social utility of elders in the United States has always been a topic of discussion, throughout American history, there is a revamping of this discussion with the perspective of another elder ( 65+) as President of the United States of America.

Some common associations with the concept of getting older are memory loss, confusion, social dissonance, etc. All of these factors go to the sharpness of the mind and the ability to understand and process information. These factors are such that if relevant, any leader of a nation could be called into question.

Vice President Joe Biden has been the most clearly targeted in this 2020 election as far as ageism. Despite the fact that many who take the stage at a political debate have a tendency to jumble words, forget details, or misspeak, his errors are being connected automatically to senility and attributed to his age. After an inconsistent statement by Biden in the democratic presidential primary debate in Houston, co-candidate Julian Castro insinuated that Biden was unable to recall the statements that he had just made moments ago (See article). The internet in a quick response, picked up on the insinuations of Mr. Castro. As a result, any actual factual or political statements made by Biden in the debate were overshadowed by a discussion/parody of his age and capacity to lead as an elder.

At 72, Vice President Joe Biden is the oldest among the democratic candidates in the 2020 election. However, with his age comes a very impressive career in the political realm, making him one of the most politically experienced candidates among the bunch. It will be up to the American People in anticipation of, and at the polls, to weigh these facts, and to decide if age will in fact play a factor in disqualifying a presidential candidate.

See article: https://www.dailywire.com/news/51715/elder-abuse-julian-castro-shreds-joe-biden-over-eric-quintanar

September 27, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Discrimination, Other | Permalink | Comments (0)

Thursday, September 26, 2019

Jimmy Carter Jokes About How Old Is Too Old To Be President

Per a story recently in CNN, Jimmy Carter jokes 'I hope there is an age limit' on presidency.

Former President Jimmy Carter said if he were 80 years old he would not be able to handle the responsibilities of being President and joked that he hopes there is an "age limit" on the office.

The comments from the 94-year-old former commander-in-chief are especially notable as the age of the three top Democratic 2020 presidential hopefuls, who are in their 70s, has been the subject of ongoing debate. The 39th president didn't mention any Democratic candidates by name at a town hall at the Carter Center in Atlanta on Tuesday night when he was asked if he might consider running for a second, non-consecutive term.
"I hope there is an age limit," he said as the audience laughed. "You know, if I were just 80 years old, if I were 15 years younger, I don't believe I could undertake the duties that I experienced when I was President."
Carter said the presidency requires mental fortitude and one must "be able to adapt to new ideas."
. . .
"So the things I faced then in foreign affairs, I don't think I could undertake them when I was 80 years old. So 95 is out of the question. I had a hard time walking when I came in," said Carter, whose birthday is on October 1.
Happy early birthday President Carter. This article can be part of an interesting discussion in our classes about the considerations of age.

Thanks to one of my students for sending me this article!

September 26, 2019 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other | Permalink | Comments (0)

Wednesday, September 25, 2019

Special Needs Trust Failing?

Kiplinger recently ran an article, How a Special Needs Trust for Your Child Can Fall Apart,  which explains

Parents of disabled children must juggle a lot of responsibilities: work, bills and of course caregiving. But one ball they can’t afford to drop is special needs planning. One wrong move in this complicated ballet balancing benefits and services with asset rules could be disastrous. While every family’s situation is unique, the laws regulating special needs trusts are complex and can require some strategizing by families and trust companies — and if necessary, utilization of available government and nonprofit support programs. 

The article reviews the laws, the requirements for a valid third party SNT and highlights one person's experiences, an attorney's advice for the person and advice for parents of children with special needs.

The key takeaway from this story is that it is essential that parents of a disabled child learn about federal, state, local community, charitable and other nonprofit support programs that may help. They must also discuss eligibility rules with relatives who may want to make gifts for the child, leave a share of their estate, include the child in a beneficiary designation for a retirement plan or life insurance or provide other types of in-kind support and maintenance.

Finally, setting up a special needs trust requires planning, legal and financial expertise, and the proper and compassionate administration of a professional trustee.

September 25, 2019 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Property Management, State Statutes/Regulations | Permalink | Comments (0)

Tuesday, September 24, 2019

Elder Justice Policy Highlights

USC has published  Elder Justice Policy Highlights for March-August 2019. The introduction explains that

"[t]he elder justice legislation found in this document was elicited and finalized from the National Center on Elder Abuse (NCEA) Listserv and independent websites in August 2019. The compilation is intended to reflect highlights across the nation and does not include all legislation related to elder justice. However, updates will be sent quarterly and states are encouraged to send updates on significant legislative action to Ageless Alliance. This document reflects activity in 17 states and highlights at the federal level.

The report divides the information by federal and state, includes a summary for each development as well as a link to view the information online. It also includes a section of pending activity that deserves a look.

This is a great resource and provides students with a quick snapshot of activities across the country.

September 24, 2019 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)

Monday, September 23, 2019

GAO Report on Elder Abuse & Oversight

The GAO has issued another report on quality in nursing homes and ALFs. This report, Elder Abuse: Federal Requirements for Oversight in Nursing Homes and Assisted Living Facilities Differ

reports

The Centers for Medicare & Medicaid Services (CMS) oversees the Medicare and Medicaid programs and is responsible for safeguarding the health and welfare of beneficiaries living in nursing homes and assisted living facilities. This includes safeguarding older residents from abuse—referred to as elder abuse. CMS delegates responsibility for overseeing this issue to state survey agencies, which are responsible for overseeing nursing homes. When assisted living facilities provide services to Medicaid beneficiaries, they are indirectly subject to CMS oversight through the agency’s oversight of state Medicaid agencies. GAO found that there are specific federal requirements for nursing homes and state survey agencies for reporting, investigating, and notifying law enforcement about elder abuse in nursing homes. (See table below). For example, state survey agencies must prioritize reports of elder abuse in nursing homes based on CMS’s specified criteria and investigate within specific time frames. In contrast, there are no similar federal requirements for assisted living facilities—which are licensed and regulated by states. Instead, CMS requires state Medicaid agencies to develop policies to ensure the reporting and investigation of elder abuse in assisted living facilities. For example, CMS requires that state Medicaid agencies establish their own policies and standards for prioritizing reports when investigating incidents in assisted living facilities. Officials from the three selected states in GAO’s review said they apply certain federal nursing home requirements and investigation time frames for assisted living facilities when overseeing elder abuse.

Here's part of what the GAO did in investigating the issue:

To describe federal requirements for reporting, investigating, and notifying law enforcement about elder abuse in nursing homes and assisted living facilities, we reviewed relevant statutes and regulations and CMS guidance, including the State Operations Manual and HCBS waiver guidance and interviewed CMS officials regarding the agency’s oversight of the requirements. We selected a non-generalizable sample of three states—Connecticut, Oklahoma, and South Dakota—that have implemented HCBS waivers and vary in HCBS waiver program size and geography.10 In each state, we reviewed their waiver agreements and spoke with officials from the state survey agency, state Medicaid agency, and the state agency responsible for licensing assisted living facilities and investigating complaints.11 We also interviewed CMS officials, including regional office officials, about their oversight of state survey agencies and HCBS waivers in our selected states. We interviewed representatives from national stakeholder groups representing consumers, facilities, Medicaid directors, and investigators to obtain their perspectives on elder abuse in nursing homes and assisted living facilities. We also reviewed related audits issued by the HHS-OIG and state auditors between 2014 and 2018 related to reporting and investigating elder abuse in nursing homes and assisted living facilities and included them with a discussion of related GAO reports.

The full report is available here.

 

September 23, 2019 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare | Permalink | Comments (0)

Thursday, September 19, 2019

Should Chronological Age Be A Factor In Deciding Someone Is Too Old To Be President?

The American Federation on Aging Research (AFAR) released a white paper, Longevity and Health of
U.S. Presidential Candidates for the 2020 Election:  White paper from the American Federation for Aging Research. Here is the abstract from the white paper:

Abstract: The oldest person ever elected president of the U.S. could take office in 2021 – but questions about the health and longevity prospects of presidential candidates are now relevant given the advanced age of many of the candidates. In the absence of medical records, assessing health, longevity, and survival prospects for candidates requires the use of data from national vital statistics. Here we estimate the lifespan, healthspan, disabled lifespan, and four-year survival probabilities for U.S. citizens that match the attributes of all of the candidates and the sitting president for the next two election cycles. Results suggest that chronological age should not be a relevant factor in the forthcoming election.

There has been some discussion about the age of candidates, so it's interesting to think about the research on the topic, and it can be a useful tool for a discussion with students. Here's the conclusion to the report:

Conclusion

Dr. David Scheiner stated that it is not acceptable to take the word of candidates or sitting presidents that they are healthy, and therefore candidates should make their medical records public so voters can make decisions based on a full disclosure of any medical conditions. At one level this makes sense because harboring a lethal condition that could lead to death while in office, might influence how people vote -- or at the least, lead voters to pay more attention to the choice for vice president. Yet, if a candidate is healthy today, it is unclear whether future health status should ever be a criterion used to judge a presidential candidate. The voting public and legal scholars need to weigh in on whether or not medical records should be required to be disclosed by candidates or a sitting president.

With regard to the relevance of age in deciding whom to vote for, estimates of healthspanr ealistically suggest that some of the presidential candidates are at a higher risk of experiencing some level of frailty and disability during a first or second term in office because they are older.

Health and longevity challenges are closer for candidates now in their 70s relative to those younger because age is an established risk factor for fatal and disabling conditions; but despite this, many survive to their 80s and 90s with their mental and physical capacities largely intact. Without an ability to know in advance who among the candidates might fall into this category, chronological age itself should not be used as a sole disqualifier to run for or become president.

If the lower limit of age 35 was chosen by America’s founding fathers because they envisioned the presidency requiring the experience, maturity, and wisdom that comes with age; or that time allows the voting public to make judgments based on a candidate’s established track record; then one could make the case that the most qualified among the available candidates are older. Given the favorable health and longevity trajectories of almost all of the presidential candidates relative to the average member of the same age and gender group in the U.S., and the apparent current good health of all of the candidates, there is reason to question whether age should be used at all in making judgments about prospective presidential candidates.

September 19, 2019 in Consumer Information, Current Affairs, Other | Permalink | Comments (0)

Wednesday, September 18, 2019

Do You Have A When I Die File?

Do you have your estate planning documents done? Made funeral arrangements? Think you have everything covered? Well, did you make a "when I die file?"  According to an article in Time magazine, Why You Need to Make a 'When I Die' File—Before It's Too Late this file is likely

the single most important thing you do before you depart. It may sound morbid, but creating a findable file, binder, cloud-based drive, or even shoebox where you store estate documents and meaningful personal effects will save your loved ones incalculable time, money, and suffering. Plus, there’s a lot of imagination you can bring to bear that will give your When I Die file a deeper purpose than a list of account numbers. One woman told us she wants to leave her eulogy for husband in the file, so she can pay homage to him even if she goes first.

Without such a file, the process of compiling the information can be time-consuming and emotionally draining for the family. Here are some of the tips from the article

First, call the companies behind your cable, internet, cell phone, club memberships, and anything else that bills for services on an ongoing basis and add your partner or kids to the account as a joint owner. If billing accounts are not in both your and a loved one’s name, your survivors will end up spending hours on the phone and in offices begging bureaucrats to shut them down or convert the accounts to their name so they can manage them. Think of every frustrating call you’ve had with your cell provider, and then multiply it by 10.

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Here are a few of the things you’ll put into your “When I Die” file:

□ An advance directive that’s signed (and notarized if necessary)

□ A will and living trust (with certificate of trust)

□ Marriage or divorce certificate(s)

□ Passwords for phone, computer, email, and social media accounts

(We recommend using an online password manager to collect them all, sharing the master password with someone you trust, and then designating emergency contacts within the program who are allowed to gain access.)

□ Instructions for your funeral and final disposition

□ An ethical will

□ Letters to loved ones

There is more information about the file in the book on which this article is based, Beginner’s Guide to the End

September 18, 2019 in Advance Directives/End-of-Life, Books, Consumer Information, Current Affairs, Health Care/Long Term Care, Other | Permalink | Comments (0)

Tuesday, September 17, 2019

Faith Based Colorado Hospital Fires Dr. Who Planned to Help With MAD

Although it's been a bit of time since Colorado 's medical aid-in-dying (MAD) law went into effect, but recent events suggest the topic has not been settled. According to Kaiser Health News, Firing Doctor, Christian Hospital Sets Off National Challenge To Aid-In-Dying Laws

A Christian-run health system in Colorado has fired a veteran doctor who went to court to fight for the right of her patient to use the state’s medical aid-in-dying law, citing religious doctrine that describes “assisted suicide” as “intrinsically evil... [the doctor] had planned to help her patient...   end his life at his home [the patient] is eligible to use the state’s law, overwhelmingly approved by Colorado voters in 2016."

This illustrates the clash between faith-based hospitals and state laws. "As hospitals across the country have consolidated, five of the top 10 hospital systems by net patient revenue are associated with the Roman Catholic Church ...  [t]hat includes hospitals that did not previously have any religious affiliation. Meanwhile, there are 10 U.S. jurisdictions where aid-in-dying has been approved and public support for the option is increasing."

Stay tuned-this is going to take a while to be resolved through the courts.

September 17, 2019 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, Medicare, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Monday, September 16, 2019

Long-Term Care Hospitals

A recent story from the New York Times highlights the role of long-term care hospitals in carrying for elders. For Older Patients, an ‘Afterworld’ of Hospital Care explains that for these long-term care hospitals, sometimes referred to as " a long-term acute care hospital"... is where patients often land when an ordinary hospital is ready to discharge them, often after a stay in intensive care.But these patients are still too sick to go home, too sick even for most nursing homes." 

Never heard of these LTCH?  There are a fair number of them, and they treat quite a large number of individuals."Close to 400 such hospitals operate around the country, some free-standing, others located within other hospitals, most for-profit. They provide daily physician visits, high nurse-to-patient ratios and intensive therapy...In 2017, they accounted for about 174,000 hospital stays. Medicare covered about two-thirds of them, at a staggering cost of $4.5 billion, the Medicare Payment Advisory Commission has reported."

A recent study published in the Journal of American Geriatrics Society notes poorer outcomes for these individuals. The article notes that there is a decline in the use of these hospitals, with tighter regulations and more stringent patient requirements.  Oftentimes the LTCH is a stop between the hosptial and nursing home.  This "should prompt frank discussions among families, doctors and patients about whether a frail older person leaving an intensive care unit or standard hospital truly wants to spend another month or more in an L.T.C.H. and then move to a nursing home, which is the likely scenario."  There are other options and the article notes the importance of having a conversation with the patient and family about them.

 

September 16, 2019 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Sunday, September 15, 2019

How to Make Health Care Age-Friendly

A story in Kaiser Health News, In Search Of Age-Friendly Health Care, Finding Room For Improvement highlights needed design improvements within health care facilities.

For older adults, especially those who are frail, who have impaired cognition, or who have trouble seeing, hearing and moving around, health care facilities can be difficult to navigate and, occasionally, perilous.

Grab bars may not be placed where they’re needed. Doors may be too heavy to open easily. Chairs in waiting rooms may lack arms that someone can use to help them stand up.

Toilets may be too low to rise from easily. Examination tables may be too high to get onto. Lettering on signs may be too small to read. And there may not be a place to sit down while walking down a hallway if a break is needed.

Examining the changes from the "ground-up" so to speak, the article starts with the issues from poorly thought-out parking: inconvenient location of the lot to insufficient spaces for those with disabilities. Don't forget signage---is there enough? Is it logically located? Is it hard-to read? (think poor contrast, glare or hard-to read fonts). Then there are steep ramps, a lack of available walkers and wheelchairs to borrow at the facility's entrance and a lack of automatic doors. Ever been asked by the receptionist to take a clipboard of forms to fill out at your seat? Of course-no big deal--unless you use a walker or two canes--talk about having your hands full!  Oh and let's get started about seats--too low, too soft, no arms or all with arms!

The article is an interesting read and hopefully those who design health care facilities will think about these things--because humans don't all come in one size or all have the same abilities or needs.

September 15, 2019 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other | Permalink | Comments (0)