Elder Law Prof Blog

NALC conference is Dec. 3-6, 2008

Save the Date
  National Aging and Law Conference 2008
  Setting the Agenda: Advocating for Elders after the Election
  December 3-6, 2008, Arlington, Virginia

Costs for nursing home increase at average rate of 7%/year since 2004

Via KFF Daily Health Policy Report:

Costs for nursing homes, assisted living facilities and some in-home care services have increased for a fifth consecutive year and might continue to increase as a result of an expected shortage of long-term health care workers, according to a study released on Tuesday by Genworth Financial, the AP/Houston Chronicle reports. For the study, researchers examined data from more than 10,000 nursing homes, assisted living facilities and in-home care providers nationwide.

The study found that private rooms in a nursing home this year on average cost $76,460 annually, or $209 daily, a 17% increase from $65,185 in 2004. In addition, the study found that assisted living facilities this year on average cost $36,090 annually, a 25% increase from $28,763 in 2004. The study also found that Medicare-certified home health aides this year on average cost $38 per hour and that the cost has increased by 7% annually over the past four years. Non-Medicare certified in-home care providers this year on average cost $18 per hour for homemaker services and $19 per hour for home health aide services, about the same as in 2004, the study found.

Buck Stinson, president of the long-term care insurance business at Genworth, said the study indicates that the "expense of just a few years of long-term care in a facility or at home can very quickly wipe out a lifetime of savings." He added that baby boomers "need to do more thinking about their own retirement plan and how they're going to age."

A companion study released by Genworth found that low wages and benefits, as well as a lack of training and career-advancement potential, have led to problems with recruitment and retention of employees in the elder care industry. Stinson cited a need to "recruit close to 200,000 people a year to keep pace with the aging demographic." In addition, the companion study found that adult day health care this year on average cost $15,000 annually, or $59 daily (Alt Powell, AP/Houston Chronicle, 4/29).

The studies are available online. 

                         

ABA publishes Spanish-language materials on planning for incapacity

In 2003, the ABA Commission on Law and Aging produced a Spanish version of its most popular consumer brochure Health and Financial Decisions: Legal Tools for Preserving Your Personal Autonomy.

 

The Commission also produced a 19-minute Spanish-subtitled version of the video In Your Hands: The Tools for Preserving Personal Autonomy. The video comes with a program guide that provides sample scripts and discussion points to help present the program. The video is available in DVD and VHS format.

 

The materials encourage seniors to use legal planning tools to ensure that their personal, health care and financial wishes are honored in the event they become sick, disabled or incapacitated.

 

They are wonderful tools for attorneys and advocates who work with Spanish-speaking seniors, caregivers, or family members.

 

To see the Spanish version of the brochure, go to:

http://www.abanet.org/aging/publications/docs/health_financial_desc_spa.pdf

Editor's note:  Advance directives are available a great many languages from Aging With Dignity, thanks to a large grant from the United Health Foundation.  Go here to see the list of languages in which the Five Wishes document is available:  http://www.agingwithdignity.org/translations.html

Documents are only $1/each when purchased in lots of 25 or more.

Last chance for $100 discount on Elder Mediation Training, June 13-14

Register by May 1 and save $100! 

Two-day Elder Mediation Training at William Mitchell College of Law
St. Paul, MN
June 13-14, 2008
Online registration:  http://www.wmitchell.edu/news/events/event.asp?mo=6&ye=2008&id=4003

$100 discount ends Thursday, May 1.  Register now to assure your spot and obtain access to manuals and other materials that will only be available to those who attend this training.

Elder mediation is one of the fastest growing sub-specialties of mediation.  The Washington Post, the Wall Street Journal, CBS News, and other national media have recently featured articles on the need for experienced and well-trained mediators for elder law-related disputes. 

This two-day training, sponsored by the Center for Elder Justice and Policy and the Center for Negotiation and Justice at William Mitchell, features nationally-known elder mediation specialists Bob Rhudy,  Carolyn Rhodis, and Joanne Ivancic.   The training will furnish experienced and new mediators alike with the skills they need to address intrafamily conflicts involving elders, guardianship problems, and similar matters.  CLE and mediator education credits have been approved.  A condensed agenda is set out below.

The discount hotel rate of $155 will not be available after May 1. 

For detailed information on this program, visit http://cejp.org/eldmed.pdf

To register online, visit http://www.wmitchell.edu/news/events/event.asp?mo=6&ye=2008&id=4003

For more information about the program, email Professor Kim Dayton, Director of the Center for Elder Justice and Policy at William Mitchell, at [email protected].

Agenda:

Agenda: DAY ONE

8:00 – 8:45 Registration and continental breakfast
8:45 – 9:00 Welcome
9:00 – 10:00 Introduction and gathering
    What is elder mediation?
    How is elder mediation different from other mediations?
    Mediation in Maryland and around the country

10:00 – 10:45 Intake: Johnson family
    Role play
10:45 – 11:00 Break
11:00 – 12:30 The Aging Process and its possible impact on mediation, working with the aging
and persons with disabilities
    Ageism
    Social
    Psychological/Mental
12:30 – 1:15 Lunch: Guided Discussion
1:15 – 2:00 Aging process cont’d
    Physical Changes
2:00 – 2:45 Capacity Issues
2:45 – 3:00 Break and assign roles
3:00 – 4:15 continuation of the role play
    De-brief
4:15 – 5:00 Family Dynamics and Cultural Awareness

Agenda DAY TWO

8:45 – 9:15 Welcome Continental breakfast
9:15 – 10:00 Elder Abuse
    Relation to Confidentiality
10:00 – 10:15 Break
10:15 – 11:45 Ethical considerations
    ABA standards
    Case studies
    Developing resource list : categories, several choices
11:45 – 12:45 Legal and Financial Issues
    Guardianship
    Financial Management
    Medicare and Medicaid
    End of Life Decision-Making
    Surrogate Decision-Making
    Red flags
12:45 – 1:30 Lunch
1:30 – 3:30 Role Play
3:30 – 3:45 Break
3:45 – 4:30 Debrief role play
4:30 – 5:00 Wrap Up and closing exercise, evaluation

ABA posts health care issues legislative updates

2007 Health Decisions Legislative Summary PDF

Surrogate Consent in the Absence of an Advance Directive - January 2008 PDF

Health Care Power of Attorney and Combined Advance Directive Legislation - January 2008  PDF

Senate fast tracks Medicaid bill

Senate Majority Leader Harry Reid (D-Nev.) on Thursday granted fast-track status to legislation (HR 5613) that would block for one year seven new Medicaid regulations, the Wall Street Journal reports (Zhang, Wall Street Journal, 4/25). The legislation would delay implementation of the regulations until April 1, 2009. Under the regulations, proposed by the Bush administration, states could not use federal Medicaid funds to help pay for physician training. The regulations also would place new limits on Medicaid reimbursements to hospitals and nursing homes operated by state and local governments and limit coverage of rehabilitation services for individuals with disabilities and mental illnesses. In addition, the bill would provide $25 million annually for efforts to fight Medicaid fraud (Kaiser Daily Health Policy Report, 4/24).  The bill will bypass the Senate Finance Committee and head straight to the Senate floor as early as next week.  The bill passed the House on Wednesday with more than a veto-proof majority. Sen. Charles Schumer (D-N.Y.) said, "These rules are unwise, unvetted and unrealistic," adding, "The Senate is moving closer to joining with the House to make sure these rules never see the light of day." However, some Senate Republicans "are preparing for a fight by circulating a letter to Minority Leader Mitch McConnell (Ky.) to reject" the bill.  Meanwhile, House Democratic leaders also could include language to block the Medicaid regulations in a tentative second economic stimulus package.

Not elder law: our ancestors were were one, then two, then one species. Hmmm....

Ancient humans started down the path of evolving into two separate species before merging back into a single population, a genetic study suggests. The genetic split in Africa resulted in distinct populations that lived in isolation for as much as 100,000 years, the scientists say. This could have been caused by arid conditions driving a wedge between humans in eastern and southern Africa. Details have been published in the American Journal of Human Genetics. It would be the longest period for which modern human populations have been isolated from one another. But other scientists said it was still too early to reconstruct a meaningful picture of humankind's early history in Africa. They argue that other scenarios could also account for the data. At the time of the split - some 150,000 years ago - our species, Homo sapiens, was still confined to the African continent.

CMA report discusses true truth about Medicare cost-sharing

>Guidance released recently by the Centers for Medicare & Medicaid Services (CMS) sheds new light on an issue that has created hardships for beneficiaries and challenges for advocates trying to help them. The guidance addresses two issues:  balance billing of Qualified Medicare Beneficiaries (QMBs) and payment of Medicare cost-sharing for dually eligible beneficiaries enrolled in Medicare Advantage plans. For details on the guidance see the CMS Memo "Medicaid Cost Sharing for Medicaid Beneficiaries" at <http://www.medicareadvocacy.org/MedSavProg_08_04.24.ARACostShare.pdf>, as well as the supporting information in "Balance Billing of Qualified Medicare Beneficiaries (QMB) Q & A" and "Capitation for Medicare Cost Sharing in Medicare Advantage (MA) Plans Q & A" at <http://www.medicareadvocacy.org/MedSavProg_08_04.24.ARABalanceBilling.pdf> and http://www.medicareadvocacy.org/MedSavProg_08_04.24.ARACapitation.pdf.

Source/more:  Center for Medicare Advocacy

Some really cool upcoming conferences...

June 1-16, 2008
World Elder Awareness 2008: Online Global Forum
Online

June 3-4, 2008
OECD Forum 2008
Paris, France

June 4-7, 2008
6th International Conference of Gerontechnology (ISG08)
Pisa, Italy

 

Too bad I ran out of conference money last October...

NCSL spring forum in DC will focus in part on Medicaid issues

The National Conference of State Legislatures will host its annual Spring Forum where legislators will share ideas, strategies and best practices as well as hear the latest happenings on Capitol Hill.

NCSL's Spring Forum will take place at the Hyatt Regency Capitol Hill, 400 New Jersey Avenue NW from April 24-26. In addition to sessions covering REAL ID, immigration and Medicaid regulations, Sen. Lamar Alexander and Rep. Barney Frank will give key note addresses on the effectiveness of the state-federal partnership and the home mortgage foreclosure situation. Also, European Union's Ambassador to the United States, John Bruton will speak at Saturday's general session breakfast.

More information about the agenda.

2008 Conference on Aging in San Antonio

The 2008 29th Annual Conference on Aging is titled "Geriatric Primary Care: Current Perspectives and New Horizons.  It will be held on August 20-22 at the San Antonio Airport Hilton. For more
information, visit http://www.sagrecc.org

Not elder law: World's oldest living tree confirmed

The world's oldest tree has been found  -  9,550 years after taking root. The spruce began growing in central Sweden shortly after the Ice Age and is still going strong. Researchers carbon-dated genetic material to suggest it hails from 7,542BC.

More.

HHS must release Medicare claims data

Via Kaiser Daily Health Policy Report:

HHS last week in the U.S. Court of Appeals for the District of Columbia filed an appeal of an August 2007 court decision that requires the department to release Medicare claims data on more than 40 million beneficiaries and 700,000 physicians, the Los Angeles Times reports (Alonso-Zaldivar, Los Angeles Times, 4/19).

In August 2007, the U.S. District Court for the District of Columbia ruled that HHS must release Medicare physician claims data for Illinois, Maryland, Virginia, Washington state and Washington, D.C. In the case, Consumers' CHECKBOOK/Center for the Study of Services filed a lawsuit to obtain access to the data. HHS argued that the release of the data would violate the privacy of physicians. However, the court rejected that argument because Medicare claims account for only a portion of the incomes of physicians. According to the court, the release of the data would "help the public make more informed Medicare decisions" and provide "more information of how government funds are spent."

Consumers' CHECKBOOK plans to post the data online for public use. Researchers could analyze the data to determine the number of times physicians perform certain procedures and to compare the mortality rates among patients of certain physicians, and health insurers could use the data to improve their analyses of physician quality (Kaiser Daily Health Policy Report, 8/27/07).

Consumer groups, employers and health insurers support the decision, and physician groups oppose the decision.  The American Medical Association, which has petitioned to join the HHS appeal, maintains that the data could be misleading because they do not take into account differences in patients treated by different doctors, the Times reports.  

NAELA student writing competition -- deadline extended

The deadline for the 2008 NAELA Student Journal Writing Competition has been extended to June 1, 2008. All entries must be submitted electronically by 12:00 p.m. EDT on June 1, 2008 in order to be eligible. Submit entries to: [email protected]. The following information must be included in the body of the submittal email: 1. Title of submission 2. Date the paper was submitted for academic credit, if applicable. 3. Name 4. Law School 5. Year of Graduation 6. Mailing address, telephone number and email addresses. A confirmation email will be sent within 72 hours of receipt of the submission, and winners will be announced on September 2, 2008. For details about the competition, visit http://www.naela.org/pdffiles/NSJ_Letter.pdf

Elder mediation training--Early bird registration ends May 1!

Senior Mediation and Decision-Making: Training for Mediators,
Elder Law Attorneys, and Other Aging Service Professionals
A Two Day (14 hour) Elder Mediation Program
William Mitchell College of Law
St. Paul, MN
June 13-14, 2008

Hosted by the Center for Elder Justice and Policy and the Center for Negotiation and
Justice at William Mitchell.
Early bird registration (by May 1): $650
Registration after May 1: $750

Registration fee covers training, materials, continental breakfasts, lunches, and beverages.
Enrollment is limited to 30 persons   Continuing legal education and mediation education credit have been applied for.

A limited number of hotel rooms will be available at a special conference rate of $155 plus tax
at the historic St. Paul Hotel in downtown St. Paul, https://www.saintpaulhotel.com/. Contact
Hotel Registration (800) 292-9292 or 651-292-9292 and be sure to ask for theWilliam Mitchell
College of Law rate. Shuttle service will be available from the hotel to William Mitchell at the
beginning and end of each day.

Detailed information about the training is available at http://cejp.org/eldmed.pdf

ONLINE REGISTRATION AT http://www.wmitchell.edu/news/events/event.asp?mo=6&ye=2008&id=4003

Health Beat Blog on the high cost of Medicare "Advantage"

Here's how it starts:

On Monday, the Bush Administration announced that next year payments to private insurers who offer Medicare to seniors will rise by 3.6 percent. This is a mistake. The last thing that the Medicare Advantage (MA) program needs is more money thrown at it. Indeed, MA has turned out to be a money-eating monster—in large part because the government gave it a blank check when the program was born, under the cover of darkness, in 2003.

More here:  http://www.healthbeatblog.org/2008/04/the-high-cost-o.html

New CRS report discusses impact of SS reform proposals on elderly poor

Social Security Reform: Possible Effects on the Elderly Poor and Mitigation Options
April 04, 2008

Download Locations:

>Open CRS (User submitted)

Summary:  Social Security has significantly reduced elderly poverty. The elderly poverty rate has fallen from 35% in 1959 to an all-time low of 9% in 2006, in large part because of Social Security. If Social Security benefits did not exist, an estimated 44% the elderly would be poor today assuming no changes in behavior. The Supplemental Security Income (SSI) program, also provides benefits to the poorest elderly, many of whom do not qualify for Social Security benefits. However, despite these programs, about 3.4 million elderly individuals remained in poverty in 2006. The Social Security system faces a long-term financing problem. The Social Security Trustees project cash-flow deficits beginning in 2017 and trust fund insolvency in 2041. Many recent proposals to improve system solvency would reduce Social Security benefits in the future. Benefit reductions could affect the lowincome elderly, many of whom rely on Social Security benefits for almost all of their income. Such potential benefit reductions could lead to higher rates of poverty among the elderly compared to those projected under the current benefit formula. Because the low-income elderly are especially vulnerable to benefit reductions, many recent Social Security reform proposals have included minimum benefits or other provisions that would mitigate the effect of benefit cuts on the elderly poor. This report analyzes the projected effects of four possible approaches to mitigating the effects of Social Security benefit reductions on elderly poverty in 2042, the first full year of projected trust fund insolvency. The options are compared to a payable baseline, which assumes current-law benefits would need to be cut across the board to balance Social Security's annual income and spending at the point of insolvency. The four options examined are (1) a poverty-line Social Security minimum benefit; (2) a sliding-scale Social Security minimum benefit; (3) a povertyline SSI benefit; and (4) a poverty-line SSI benefit with liberalized eligibility.

Dateline show to expose annuity scams aimed at seniors

Here's the promo for the show, which airs Sunday evening Sunday, April 13 (7:00 PM/ET)

"With an estimated 15 trillion dollars under their control American seniors have become more of a sales target than ever for insurance agents seeking to sell them annuities. On Sunday, April 13 (7:00 PM/ET), "Dateline" goes undercover in "Tricks of the Trade" -- a hidden camera investigation revealing what some insurance agents say, and what they don't say, when they think they are alone with a senior. In his signature style, Chris Hansen then confronts agents about their questionable sales pitches.

NBC News footage shows the widespread practice of agents cloaking themselves in fancy titles and insurance agents attending a seminar to learn these sales tactics. Minnesota Attorney General Lori Swanson, who reviewed "Dateline's" footage, and who has filed several suits alleging fraud in the sale of annuities to seniors, tells Hansen: "...what is tragic about it is when those agents go into the seniors' homes, it is literally the wolf among the lambs."      

MedPAC send recommendations to Congress re reimbursements

The Medicare Payment Advisory Commission on Wednesday voted to approve several recommendations to Congress focused on Medicare reimbursements for skilled nursing facilities and primary care.  The commission recommended amending the Medicare payment system for skilled nursing facilities to add a "separate nontherapy ancillary component" that includes prescription drugs and intravenous therapy. MedPAC also recommended revising the therapy component of the system to base reimbursements on "predicted patient care needs" and implementing a provision for "outlier payments" for unusual financial losses. In addition, the commission recommended a proposal under which HHS Secretary Mike Leavitt would require skilled nursing facilities to report diagnosis information, dates of services on claims filed and "services they furnish separately" on patient assessments. Facilities with the highest profits would receive the largest payment cuts, while those losing money would receive the largest increases.  The commission also recommended an increase in payments to physicians designated by Leavitt as primary care-focused practitioners in an attempt to address a growing shortage of such physicians, CQ HealthBeat reports.  In addition, MedPAC considered a recommendation to establish a pilot program that would provide Medicare beneficiaries with a "medical home" to oversee their care. Under the proposal, physicians would be required to establish their capability to provide primary care; coordinate preventive, maintenance and acute health care services; employ health care information technology for active medical support; conduct care management; provide access and communication to patients at all times; and keep updated records of patients' advance directives, including the types of treatments they should receive if they are incapacitated.

Source:  KFF Daily Health Policy Report, http://kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=51463

New CRS reports on spouses' federal retirement benefits

Retirement and Survivor Annuities for Former Spouses of Federal Employees
April 03, 2008
Open CRS (User submitted)

A former spouse of a federal employee may be entitled to a share of the employee's retirement annuity under the Civil Service Retirement System (CSRS) or the Federal Employees' Retirement System (FERS) if this has been authorized by a state court decree of divorce, annulment, or legal separation. An employee also may voluntarily elect a survivor annuity for a former spouse. A state court can award a former spouse a share of the employee's retirement annuity, a survivor annuity, or both. A court also can award a former spouse of a federal employee a portion of the employee's Thrift Savings Plan (TSP) account balance as part of a divorce settlement. This report will be updated as legislative developments warrant.