About 18 percent of Americans live in multigenerational households — meaning two or more adult generations — according to a study from Pew Research Center published this year. Such arrangements have quadrupled in the United States since the 1970s, with about 60 million U.S. residents now living with adults who are of a different generation, according to the study.
Friday, August 5, 2022
Ending the week on happy note due to this Washington Post article, A ‘magical’ treatment for seniors with dementia: Horse therapy.
Painting [on the horses] is not mandatory in this equine-assisted learning program, but it is one of the many ways participants are taught to engage with horses, with the goal of stimulating their minds and bodies. Since 2017, Simple Changes Therapeutic Riding Center in Mason Neck, Va., has teamed up with Goodwin Living, a senior living and health-care facility in Alexandria, to introduce residents with cognitive impairment and anxiety to the residents of its barn.
Up to six people at a time participate in the four-week sessions, which include horse identification, grooming, feeding, leading, discussing equine literature, poetry and haiku writing, and making horse treats. The collaboration began when Barbara Bolin, a social worker at Goodwin House Alexandria and a lifelong rider and horse owner, reached out to Corliss Wallingford, the nonprofit equine therapy organization’s executive director.
Read the article and look at the accompanying photos. Doing so will end your week with a smile.
Thursday, August 4, 2022
Last month, Science magazine published an article, BLOTS ON A FIELD? A neuroscience image sleuth finds signs of fabrication in scores of Alzheimer’s articles, threatening a reigning theory of the disease. One researcher recently noted that there were concerns about the 2006 study, including concerns about "image tampering" There is no smoking gun and the article explains how this one expert became concerned. The article has technical materials in it, so read it and form your own opinion.
Wednesday, August 3, 2022
On August 3, 2022, the Pennsylvania Commonwealth Court issued its latest ruling in the long-running case of Friends Boarding Home of Western Quarterly v. Commonwealth, with an en banc opinion rejecting Friends Home's exceptions to the appellate court's earlier three-judge panel ruling. The full court focuses closely on the use of residents' fees to operate the Continuing Care Retirement Community (CCRC) and the argument that because "some" residents receive subsidized care the facility is donating the necessary "substantial" portion of its services. For example:
Between 2014 and 2017, Friends incurred annual operating losses between $386,620-$542,652. In 2018, Friends had an operating deficit of $265,569 and for 2019, $790,069. Friends maintains that these deficits lend additional support that Friends’ rates contain substantial subsidies that benefit all residents, such that it satisfied the requirement that it donates or renders gratuitously a substantial portion of its services.
We recognize that Friends incurs operating deficits that it covers with funds generated from investments and contributions. However, Friends’ argument that its operating deficits prove that it donates a substantial portion of its services by subsidizing all rates is once again refuted by the fact that there are for-profit facilities in the vicinity of Friends Home providing similar services at comparable rates. Even though Friends may incur operating deficits, it has not demonstrated that it donates “a substantial portion of its services” “to those who cannot afford the ‘usual fee.’” HUP, 487 A.2d at 1315 n.9. Thus, we discern no error in the conclusion reached [by the Panel] in Friends Boarding Home in this regard.
My Pennsylvania colleague Douglas Roeder and I recently co-authored an article about the ongoing challenges for nonprofit organizations, especially those who offer fee-based services. The latest ruling from the Pennsylvania Commonwealth Court would seem to deepen the need for certain nonprofits who seek "purely charitable" tax exemptions to carefully consider their charitable mission. I'm also thinking that nonprofit CCRCs would also be well advised to have candid discussions of their charitable missions with both potential residents and current residents. Ultimately, it will be the more solvent residents who make up the difference in support of the charitable mission.
Last week, Kaiser Health News ran a concerning article, ‘True Cost of Aging’ Index Shows Many Seniors Can’t Afford Basic Necessities. "
More than half of older women living alone — 54% — are in a similarly precarious financial situation: either poor according to federal poverty standards or with incomes too low to pay for essential expenses. For single men, the share is lower but still surprising — 45%.
That’s according to a valuable but little-known measure of the cost of living for older adults: the Elder Index, developed by researchers at the Gerontology Institute at the University of Massachusetts-Boston.
A new coalition, the Equity in Aging Collaborative, is planning to use the index to influence policies that affect older adults, such as property tax relief and expanded eligibility for programs that assist with medical expenses. Twenty-five prominent aging organizations are members of the collaborative.
The goal is to fuel a robust dialogue about “the true cost of aging in America,” which remains unappreciated, said Ramsey Alwin, president and chief executive of the National Council on Aging, an organizer of the coalition.
The Index provides data for states, cities and counties, truly a valuable amount of information. Consider in addition the inflation we are currently experiencing. Read the entire article. It's sobering.
Tuesday, August 2, 2022
Provides information and tools for probate court staff that wish to implement more rigorous conservatorship and guardianship monitoring. The series emphasizes important aspects of case management, report tracking, responses to potential fraud and abuse, and financial monitoring, including comparing assets, expenses and budgets over time and highlighting common problem areas to look out for. Intended for courts across the country and thus necessarily general in nature, the videos are particularly helpful to courts that currently lack local training resources. A separate series of videos for conservators helps them understand their role and how to prevent misuse of resources.
Next is a series for conservators.
In this short five-part video series, [the National Center for State Courts] provides information and tools for those who are thinking about becoming a conservator or conservators who have already been appointed by a court. The series gives an overview of what conservatorships are, the conservator’s responsibilities and role in protecting assets, why courts monitor expenses, and which expenses are allowable. Intended for the public and courts across the country and thus necessarily general in nature, the videos are helpful as an additional training resource but do not replace specific requirements and guidelines set by the local court.
Monday, August 1, 2022
About 2 weeks ago, I posted about an article on multi-generational housing. Since then, here are two more articles on the topic
First, a new research report from Pew Research, Young adults in U.S. are much more likely than 50 years ago to be living in a multigenerational household .
Here are a couple of points from the article. "[T]he increase has been fastest among adults ages 25 to 34." More importantly (from an elder law perspective) consider this: "[i]n 2021, 68% of 25- to 34-year-olds in a multigenerational home were living in the home of one or both of their parents. Still, 15% were living in their own home and had a parent or other older relative living with them. Another 14% of young adults in multigenerational households were living in a home headed by a family member other than their parent, such as a grandparent or sibling, or by an unmarried partner or a roommate (3%)." The article compares the data with a 1971 study, looks at education levels and other data points.
Subsequent to the Pew data release, NPR ran a story about it, 1 in 4 young adults live with a parent, grandparent or older sibling, research shows, which offers this important information "[f]inances and caregiving are the driving factors behind multigenerational households, the survey found, and there is also a correlation between education level and those who live in multigenerational households."
Friday, July 29, 2022
Last month, CMS issued an advisory that it had "Issue[d] Significant Updates to Improve the Safety and Quality Care for Long-Term Care Residents and Call[ed] for Reducing Room Crowding."
[CMS] issued updates to guidance on minimum health and safety standards that Long-Term Care (LTC) facilities ... must meet to participate in Medicare and Medicaid. CMS also updated and developed new guidance in the State Operations Manual (SOM) to address issues that significantly affect residents of LTC facilities. The surveyors who use these resources to perform both routine and complaint-based inspections of nursing homes are responsible for determining whether facilities are complying with CMS’ requirements.
A fact sheet on the updated guidance, also released last month, is available here.
Thursday, July 28, 2022
The Insurance Journal ran this article recently, Nursing Home Denied ‘Unconscionable’ Arbitration Where Patient Was Blind, Alone. The arbitration agreement in question was "to settle e a family’s wrongful death complaint where the arbitration papers had been signed by the deceased woman when she was blind, on medication and in severe pain." It wasn't just that, though for which "[t]he Pennsylvania Superior Court ... upheld a trial court in finding that the arbitration agreement was 'unconscionable....'" In addition, the resident "was alone when she was asked to sign the arbitration agreement, ... was not given a chance to read it and other admission documents before signing, ... was not given a copy of the agreement after she signed, even though it permitted her to rescind within 10 days, and the ... admissions director did not read or explain all of the arbitration agreement’s provisions."
Thanks to Morris Klein for sending me the article.
Wednesday, July 27, 2022
My local paper, the Tampa Bay Times, reported a story, A Florida nursing home lost its Medicare benefits. Residents lost a home. The article covers the impact on residents being forced to locate, the corporate structure of the SNF, and various issues regarding resident care. The article notes that "[the nursing home ... became the latest in Florida formerly affiliated with Consulate Health Care to lose its federal benefits since May because of poor patient care. The federal government considers termination of Medicare and Medicaid a “last resort,” implemented only after “all other attempts” fail to resolve health and safety deficiencies." The full article is available here.
Tuesday, July 26, 2022
I have heard that the 7th World Congress on Adult Capacity 2022 was quite successful. I was excited to see that the conference organizers have published a link to download the various presentations. The link is available here and then choose the presentations you wish to download.
Monday, July 25, 2022
Do Federally Exempt Nursing Homes, Assisted Living, and Continuing Care Communities Also Qualify as "Institutions of Purely Public Charity?"
The latest in a series of senior-care related cases is making its way through the Pennsylvania appellate courts, asking whether a federally tax exempt senior living facility -- one that offers a range of options including independent living, "supported" independent living, personal care, and skilled care, although it isn't licensed as a CCRC -- can also qualify for state property and sales tax exemptions.
Pennsylvania, in ways similar to many states, allows a federal charitable tax exemption under Rev. Code Section 501(c)(3) to serve as the basis for state exemptions from income taxes, but a separate state statute sets tougher requirements to qualify as a "purely public charity" in order to avoid responsibilities to pay real property, sales and use taxes. Nursing homes, intermediate care settings (such as personal care or assisted living), and continuing care retirement communities (CCRCs) often rely on federal revenue rulings that recognize historical grounds to exempt "homes for the aged" from taxation. See e.g., Rev. Rul. 72-124 (also available at 1972 WL 30720). But on a fairly regular basis, Pennsylvania taxing authorities have challenged such enterprises as not being "sufficiently" charitable. Compare, for example In re St. Margaret Seneca Place, 640 A.2d 380 (Pa. 1994) (upholding state tax exemptions for a nursing home) with Appeal of Dunwoody Village, 52 A.3d 408 (Pa. Commw. 2012) (denying state tax exemption for a CCRC). In September 2021, a panel of the Commonwealth Court of Pennsylvania, using a "totality of the circumstances" approach concluded that the facility failed to donate a substantial portion of its services, and failed to show it benefits a substantial and indefinite class of persons who are subjects of charity. See Friends Boarding Home of Western Quarterly Meeting v. Commonwealth, 260 A.3d. 1064 (Pa. Commw. 2021).
The case is now under review for en banc consideration by the full Commonwealth Court, and there are indications the case might go all the way to the Pennsylvania Supreme Court. Working with my former Elder Protection Clinic colleague, Douglas Roeder, Esq., we examine a series of cases and trends under Pennsylvania law, including those involving senior living enterprises, as reasons to consider larger implications for federal and state exemptions based on charitable grounds. See Putting the Charity Back in Purely Public Charities (July 2022).
July 25, 2022 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Retirement, State Cases, State Statutes/Regulations | Permalink | Comments (0)
A recent opinion piece in the New York Times, Joe Biden Is Too Old to Be President Again, gave me pause and I realized that age (as in too old, not too young) is once again going to be a prominent part of the mid-terms and beyond. In this context, is talking about someone's age (as in, too old to hold a specific office) ageism, or is it a valid criteria for the ability to do the job dependent on the specific office held? Should the focus be on ability (physical, mental, or both) to discharge the duties of the office, the age of the person, or both? Regardless of anyone's respective position, it's going to be an issue in the campaigns. I'm preparing for a interesting discussion with my students this fall.
Friday, July 22, 2022
Center for Medicare Advocacy Senior Policy Attorney Kata Kertesz had her article, “Expansions of Medigap Consumer Protections are Necessary to Promote Health Equity in the Medicare Program,” published last week in the Stetson University College of Law Journal of Aging Law & Policy. The article starts on page 39. Check out all the other articles in the volume while you are dowloanding the Medigap article.
Check it out!
Thursday, July 21, 2022
From the Boarchard Foundation Center on Law & Aging:
The Borchard Foundation Center on Law & Aging
Requests Proposals for 2023 Academic Research Grants
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 Program 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 analyze and recommend changes in 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.
Further information about the research grant program and the application process is available on the Center’s website at www.borchardcla.org. The on-line application is available on the Center’s website as of September 15, 2022. Applications should be submitted no later than October 17, 2022. Selections will be made on or about December 15, 2022. Funded projects must begin no later than June 1, 2023 and be completed within 12 months.
For more information, contact Mary Jane Ciccarello, Director, Borchard Foundation Center on Law & Aging, email@example.com.
Wednesday, July 20, 2022
Of course there are many downsides to caregiver shortgages. Add to that the hot employment market and you can see the problem-the family caregiver has an opportunity to enter the workforce but the lack of caregiver options prevents the family member from taking a job. The New York Times dicussed this dilemma in Jobs Aplenty, but a Shortage of Care Keeps Many Women From Benefiting.
A dearth of child care and elder care choices is causing many women to reorganize their working lives and prompting some to forgo jobs altogether, hurting the economy at a moment when companies are desperate to hire, and forcing trade-offs that could impair careers.
Those forced to cut back on work could face lasting disadvantages. They are missing out on an unusual moment of worker power, in which many employees are bargaining for higher wages or switching to more lucrative jobs. Right now, the fields where women are most concentrated — including service sector jobs in hospitality and health care — have some of the most openings and the most rapidpay growth.
Are we moving towards any viable solutions any time soon?
Tuesday, July 19, 2022
You may be thinking to yourself, what does that have to do with elder law? Well, read this article from the New York Times, New Dementia Prevention Method May Be Behavioral, Not Prescribed. Here's the crux of the article: "[p]ublic health experts and researchers argue that it is past time to turn our attention to a different approach — focusing on eliminating a dozen or so already known risk factors, like untreated high blood pressure, hearing loss and smoking, rather than on an exorbitantly priced, whiz-bang new drug." So now, about getting your eyes checked....
The latest modifiable risk factor was identified in a study of vision impairment in the United States that was published recently in JAMA Neurology. Using data from the Health and Retirement Study, the researchers estimated that about 62 percent of current dementia cases could have been prevented across risk factors and that 1.8 percent — about 100,000 cases — could have been prevented through healthy vision.
What other risk factors should we conside?
The influential Lancet Commission began leading the modifiable risk factor movement in 2017. A panel of doctors, epidemiologists and public health experts reviewed and analyzed hundreds of high-quality studies to identify nine risk factors accounting for much of the world’s dementia: high blood pressure, lower education levels, impaired hearing, smoking, obesity, depression, physical inactivity, diabetes and low levels of social contact.
In 2020, the commission added three more: excessive alcohol consumption, traumatic brain injuries and air pollution. The commission calculated that 40 percent of dementia cases worldwide could theoretically be prevented or delayed if those factors were eliminated.
So let me add to my initial question: when was the last time you had you had your vision and hearing checked? No time like the present...
Monday, July 18, 2022
Last week the Wt featured an article about an elder taking on a college student as her roommate. One roommate is 85, the other is 27. Such arrangements are growing. For these two roommates, they learned about each other through an agency, "Nesterly, an online home-sharing agency that matches young renters with not-so-young people looking to supplement their incomes and share their space." The arrangement is more than just renting space. For these two roommates, "[the owner] would rent the first floor of her home to [the college student] for $700 a month in exchange for help with the housework and gardening and occasional grocery runs. And [the college student] would get a safe and spacious place to live just six miles from Boston and a 30-minute drive from her robotics engineering job in Beverly, Mass.
Is multi-generational housing growing in popularity? According to the article
Wednesday, July 13, 2022
Early last month, the SSA Trustees released their annual report. Here's the bottom line:
The combined asset reserves of the Old-Age and Survivors Insurance and Disability Insurance (OASI and DI) Trust Funds are projected to become depleted in 2035, one year later than projected last year, with 80 percent of benefits payable at that time.
The OASI Trust Fund is projected to become depleted in 2034, one year later than last year’s estimate, with 77 percent of benefits payable at that time. The DI Trust Fund asset reserves are not projected to become depleted during the 75-year projection period.
The full report is available here.
The Hospital Insurance (HI) Trust Fund, or Medicare Part A, which helps pay for services such as inpatient hospital care, will be able to pay scheduled benefits until 2028, two years later than reported last year. At that time, the fund’s reserves will become depleted and continuing total program income will be sufficient to pay 90 percent of total scheduled benefits.
The Supplementary Medical Insurance (SMI) Trust Fund is adequately financed into the indefinite future because current law provides financing from general revenues and beneficiary premiums each year to meet the next year’s expected costs. Due to these funding provisions and the rapid growth of its costs, SMI will place steadily increasing demands on both taxpayers and beneficiaries.
For the sixth consecutive year, the Trustees are issuing a determination of projected excess general revenue Medicare funding, as is required by law whenever annual tax and premium revenues of the combined Medicare funds will be below 55 percent of projected combined annual outlays within the next 7 fiscal years. Under the law, two such consecutive determinations of projected excess general revenue constitute a “Medicare funding warning.” Under current law and the Trustees’ projections, such determinations and warnings will recur every year through the 75-year projection period.
Oh, and remember the hefty increase in the Part B premiums for 2022? It's going to be rolled back-just not this year.
[T]he Centers for Medicare & Medicaid Services (CMS) released a report that recommends cost savings from lower-than-expected Medicare Part B spending be passed along to people with Medicare Part B coverage in the calculation of the 2023 Part B premium. Earlier this year, Department of Health and Human Services (HHS) Secretary Xavier Becerra instructed CMS to reassess the 2022 Part B premium amount in response to a price reduction for Aduhelm™, a monoclonal antibody directed against amyloid for use in treating Alzheimer’s disease. Given the information available today, it is expected that the 2023 premium will be lower than 2022. The final determination will be made later this fall
Stetson is seeking 3 entry level tenture track faculty for Fall 2023 for several subject areas. The ad follows.
POSITION: TENURE-TRACK PROFESSOR OF LAW
STETSON UNIVERSITY COLLEGE OF LAW seeks to fill at least three entry-level tenure-track positions. While our needs are flexible, we are particularly focused on Contracts, Torts, and Legal Research and Writing, as well as the areas of the Uniform Commercial Code, Professional Responsibility, Intellectual Property (emphasis on Patent Law), and Health Law. We may also have a need for Spring 2023 visitors in Legal Research and Writing and Torts. Other doctrinal areas may be considered depending on our developing institutional needs.
Located in Florida’s Tampa Bay area, the nation’s nineteenth largest metro area, Stetson was established in 1900 and is Florida’s oldest law school. Our main campus is in Gulfport, just outside St. Petersburg. We also have a part-time program with classes on both the main campus and our satellite campus in downtown Tampa. Stetson has earned a national reputation for its advocacy program, which is ranked #3 in U.S. News and World Report, and its elder law and higher education programs, with Centers for Excellence in Advocacy, Elder Law, and Higher Education Law and Policy. Stetson also has achieved a national reputation in legal writing, with its legal writing program also ranked #3 in the nation by U.S. News and World Report. Stetson is the home for the Institute for the Advancement of Legal Communication, the Institute for Biodiversity Law and Policy, and the Veterans Law Institute.
Stetson nurtures a vibrant intellectual community, situated on a beautiful campus. We encourage potential applicants to visit our website at https://www.stetson.edu/portal/law/ to learn more about our school, our community, and our programs. The law school is a part of Stetson University, which is located in DeLand, Florida, approximately three hours from the law school. The University features include a College of Arts and Sciences, a School of Music, and a School of Business Administration, the latter of which supports the law school’s JD/MBA program.
Stetson encourages applications from women, persons of color, LGBTQ+ candidates, and others who will contribute to our stimulating and diverse cultural and intellectual environment. Applicants must have a strong academic record and be committed to outstanding teaching and scholarship. Stetson’s Equal Employment Opportunity policy is available at https://www.stetson.edu/administration/human-resources/media/hotline/eeo-non-discrimination.pdf.
SALARY: Salary is competitive
STARTING DATE: August 2023
Applicants should send a cover letter indicating teaching and scholarly interests, a current curriculum vitae, and contact information for at least three professional references to Professors Jason Palmer and Rebecca Morgan at firstname.lastname@example.org or by standard mail to Professors Palmer and Morgan at Stetson University College of Law, 1401 61st Street South, Gulfport, FL 33707. The Faculty Appointments Committee will continue to review applications until positions are filled.
Tuesday, July 12, 2022
Having not blogged in a while, I have a few articles in my inbox from May that I thought at least deserved a mention. (The titles are pretty self-explanatory). Some are more feel-good stories (which we can all use right now) and others are more serious. Read when you have time.
7. States with the Most Improved Outlook for Older Adults (apologies to Morris Klein who sent me the link back in May).