Elder Law Prof Blog

National Academy of Elder Law Attorneys: Announcing the 2014 Community Service Award for Advocacy

I have several "go to" experts I seek out for tough questions, tough client problems, or not-so-tough students who want a real world experience.  One of my favorite experts is Marielle Hazen and it is great to see her honored by the National Academy of Elder Law Attorneys (NAELA), in recognition of her leadership and community service as an attorney representing older people, people with special needs, and their families. 

Congratulations, Marielle, on receiving the 2014 Powley Community Service Award for Advocacy in Elder Law.  Very much deserved!   

Flying is Ageless?

When was the last time you traveled by plane? It's become a very commonplace method of travel, and we all know the various steps we take from the day of departure to arrival: from home to the airport, clearing security, arriving at the gate, boarding the plane, arriving at the destination airport, leaving the arrival gate, going to baggage claim or to the airport exit.  Have you given some thought on how easy it is for individuals who are older to do this?  The Transportation Research Board of the National Academies released a report from the Airport Cooperative Research Program (sponsored by the FAA).

Impact of Aging Travelers on Airports "describes the challenges of wayfinding, fatigue, technology and equipment, and needed amenities, as well as the practices that airports are enacting to accommodate and improve the airport experience of aging travelers.  The report is designed to help users better understand the aging demographic, and define issues and implement effective practices to accommodate aging travelers at airports."

The report discusses the characteristics of aging travelers as well as the various components of air travel. The two page summary of the report provides

The number of aging and elderly travelers is increasing, challenging airports and airlines to respond to the physical and psychological needs of this important demographic. According to the Administration on Aging, the number of persons over 65 years of age is projected by 2030. Although healthier in some respects than earlier generations, this age group is subject s, diabetes, osteoporosis, and s ability to navigate an airport. The normal effects of aging, including muscular/skeletal problems, respiratory conditions, and deteriorating sight and hearing, also play a role. Contributing psychological issues include anxiety and lack of ability to adapt to change... The stress affecting anyone undertaking a major journey can be felt more acutely by an older person because of the factors mentioned above. This study identified the following as the most prevalent issues the elderly face... A number of interventions that would clearly benefit the elderly were not yet commonly employed, most likely owing to the cost of implementing them, particularly in existing buildings...

In summary, the literature review and interviews indicate that airport operators are generally aware of the needs of over-65 travelers, who make up a significant portion of their customer base, and are trying to accommodate them. However, often their efforts are hampered by the lack of a well-coordinated policy, the constraints presented by existing buildings, and the costs of  implementation both in terms of capital investment and increased staffing. If these issues are not addressed by airport authorities and airlines, it can be expected that there will be a negative impact on airport operations. As pointed out by one of the interviewees, successful implementation of elderly-accessible facilities will require determination and strong advocacy.

A pdf of the report is available here.

 

 

 

Another Book Recommendation: "The Banana Lady & Other Stories...."

Another book recommendation, courtesy of my Penn State colleague, neuropsychologist Claire Flaherty.  The book is "The Banana Lady and Other Stories of Curious Behavior and Speech," by Andrew Kurtisz  and first published in 2006.  Professor Flaherty accompanied this recommendation with the note that the book presents "truth is stranger than fiction" tales of changes in personality, behaviors and relationships, including the gradual loss of language that can occur even in one's "middle" ages. 

The author's bio is also interesting:

Dr. Andrew Kertesz is professor of Neurology in the Department of Clinical Neurological Sciences at the University of Western Ontario. He is Director of Cognitive Neurology and Alzheimer's Research Centre at St. Joseph's Health Care London and former Chief of the Department of Neurology. He graduated from Queen's University in Kingston, Ontario, studied neurology in Toronto, and behavioral neurology in Boston. His publications deal with the classification, localization and recovery in aphasia, as well as alexia, apraxia, visual agnosia and dementia. His books include Aphasia and Associated Disorders by Grune and Stratton (1979), Localization and Neuroimaging in Neuropsychology by Academic press (1994), and his most recent book, co-authored by Dr. David Munoz, is entitled, Pick's Disease and Pick Complex by Wiley-Liss Inc. (1998). Recent research projects are the experimental treatment of Alzheimer's disease, mild cognitive impairment, vascular dementia, primary progressive aphasia, and frontotemoral dementia. He has standardized a Frontal Behavioral Inventory for the diagnosis of Frontotemporal dementia and is active in clinical trials.

Thanks, Claire, for helping to keep our summer reading lists well filled. 

The Future of Aging-From the ASA 2014 Conference

The American Society on Aging (ASA) 2014 conference held in March in San Diego featured a general session with panelists Ken Dychtwald, Joseph Coughlin, Jo Ann Jenkins, and Fernando Torres-Gil on The Future of Aging: 2014 Aging in America. The nearly hour-long discussion is available on vimeo. The description of this session is listed on the website

Are we prepared for the longevity revolution?... If we apply science and technology to the challenges of aging and join forces with policymakers and leaders in business and communities, new purposes for maturity may be within reach...In this mind-stretching presentation, recorded at ASA’s 2014 Aging in America Conference in San Diego, four experienced and passionate visionaries explored the future of aging and shared their views on the topic.

 

Older Adults as Witnesses to Crimes: Should Age Be An Express Factor in Credibility?

The May 2014 issue of Series B (Psychological Sciences and Social Sciences) of the Journals of Gerontology includes three articles addressing a "relatively understudied area for the psychological science of aging: older adults interacting the legal system." An editorial introducing the articles explains (minus the footnotes): 

"In [this issue] the focus is on how aging affects what is known about cognition and eyewitness testimony.  The first article by West suggests that, based on cognitive aging alone, age differences do not contribute to worsened eyewitness accounts.  In fact, older adults may be less likely than young adults to interpolate details based on memory enhancement strategies.  The second article by Henkel, however, provides evidence that when negative feedback about memory is provided and also with misleading questions, changes in eye witness accounts are more likely for both age groups.  Among older adults, older ages were associated with lower accuracy and more changing of responses.  The third article by Dukala and Pocyzk adds the effects of an abrupt interviewing style, misleading questions, and negative feedback as factors associated with age differences in inaccurate eyewitness descriptions of what occurred, with older adults more vulnerable to changes rooted in suggestibility.  These effects were related to poorer memory rather than advanced age alone."

In his essay, Bob Knight, Ph.D. from University of Southern California, Davis School of Gerontology in Los Angeles, observes the range of results reported in the three articles demonstrates a need for "more work in this area." He concludes, "Care should be taken to make the legal system interviewers aware of potential distortions in eyewitness accounts due to memory changes that are more common in later life while also discouraging the stereotyping of all older adults as less reliable witnesses."

Vancouver---A Paragon of Access

I was interested to learn that in November of 2013 Vancouver, BC passed a code update mandating the use of levers (or door handles) instead of door knobs in new building.  An article in the HuffPost British Columbia from November 19, 2013 explains that the Vancouver Council back in September changed the building code  "unanimously at a Sept. 25 council meeting, [so that it now] states that all doors and faucets in new buildings be equipped with lever handles instead of knobs." The catalyst for change is accessibility.

The city's attention to accessibility flows out of a concept known as universal design, in which an environment is built in a way that is open to everyone ...The doorknob ban and its underlying concept have drawn enormous attention online, with Salt Lake Tribune reporter Jim Dalrymple saying, "I visited Vancouver earlier this year and found that its progressive design initiatives had actually created a wonderfully pleasant city; perhaps sometime we’ll look back at this decision with similar admiration."

The change in the building code mandating the use of levers in new construction has drawn a bit of attention of late, even though the council meeting was last fall.  Other cities in Canada are discussing following Vancouver's lead, according to the story, The March of the Lever ...  and the Demise of the Doorknob,  in The Independent on April 25, 2014. 

But the spate of articles isn't just about how levers provide access....to humans.  There are several articles about the provision of access...to bears.  Yes, you read that correctly...bears!  It appears that an "unintended consequence" of the use of levers is to give access to bears....  The Independent article goes on to mention the issue of bears

Doorknobs do keep bears from wandering into Canadian homes – the animals have learned to push down levers. George Torrens, a senior lecturer in design at Loughborough University, said this is because “bears have a form of digits and can hook or press on handles, they can’t grip”....He added: “But neither can people with severe arthritis or neuromuscular conditions which stop them using their muscles to move the digits. In order to provide security for the houses in Vancouver, they would need a button and lever action, to make the task more complex.”

But this is not the only mention of bears. My dear friend and colleague, Mark Bauer, actually alerted me to Vancouver's change in the building code when he sent me a link to a recent story in the April 19, 2014 The Economist.  The article, titled "Canada's War on Doorknobs: Knobless Oblige" with the subtitle "New building rules will help old folks—who now risk being eaten by bears" got my attention (and with a headline like that, how could it not?). The article mentions that the change in the building code wasn't universally supported, with some  opposition--you guessed it---from some of the doorknob professionals

The rules have provoked grumbling about the nanny state, much of it from doorknob manufacturers. The Canadian Home Builders’ Association (CHBA) complains that Vancouver, the only city in Canada with the power to determine its own building code (elsewhere it falls to provincial governments), changed the rules on its own, instead of asking for a revision of the national regulations, which would have triggered more detailed cost studies.

The article in the Economist goes on to point out that concerns about regulation are misplaced and instead we have a bigger concern... bears:

These complaints pale in comparison to a more sinister worry. True, elderly and disabled people find it easier to operate doors with handles. But so do bears. In British Columbia, bears have been known to scavenge for food inside cars—whose doors have handles, knob advocates point out. Pitkin County, Colorado, in the United States, has banned door levers on buildings for this very reason. One newspaper columnist in the pro-knob camp has noted that the velociraptors in “Jurassic Park” were able to open doors by their handles.

The article continues with a mention that the ban is under consideration in other areas of Canada and concludes with a word of advice "[i]f further bans do go ahead, those living near the woods would be wise to invest in some sturdy locks before installing doorhandles." 

The HuffPost British Columbia responded to the Economist article with one of its own, Vancouver Doorknobs Won't Get You Eaten By Bears.  Their response to the velociraptor comment from the Economist:

To set the record straight, Vancouver Coun. Geoff Meggs told The Huffington Post B.C.: "I can say categorically that the risk of bear attack was not factored in, because there hasn't been a live bear spotted in city limits in a very long time." ... Meggs did, however, disclose that he has heard of another hypothetically grizzly situation... "One writer suggested kids of a certain height would lose their eyes," he said. "I've been trying to recreate that scenario: maybe running sideways against a wall, they might bang their head into a lever, I don't know."

The article continues, noting that Meggs acknowledged the receipt of only positive feedback and then concludes, "[a]s for the naysayers, they can just grin and bear it."

Stay tuned. I suspect we have just bearly opened the door on this topic. (pun completely intended).  I for one think that Vancouver's change to door levers ROCKS!

Archived Webinar on Assessment of Everyday Decisionmaking

We previously blogged about a forthcoming webinar on An Overview of the Assessment of Everyday Decision Making (ACED) as part of the "APS Research to Practice Webinar" from National Adult Protective Services Association (NAPSA) and National Committee on the Prevention of Elder Abuse (NCPEA).  The recording of the webinar is now available on the National Council on Crime & Delinquency website and is available here.

NSCLC Director Challenges U.S. House Budget's Harsh Impact on Poor Seniors

National Senior Citizens Law Center's Executive Director Kevin Prindiville analyzes Paul Ryan's Congressional budget numbers for the Huffington Post, highlighting the effect of proposed deep cuts on federal aid programs, cuts that would dramatically impact the nation's poorest seniors.  Kevin writes:

"The U.S. House of Representatives' recent approval of the Ryan budget resolution threatens programs that help poor seniors. In a disappointing vote, 219 House members gave their blessing to a budget that leaves country's older adults to struggle with less food, income, housing and care. The Ryan budget's path to poverty must not be allowed to happen. . . . By cutting essential programs that often make life manageable for those with limited means or resources, the Ryan budget will lead to poverty numbers among seniors the nation hasn't seen since the Depression." 

Kevin then outlines specific terms of the House plan to cut $5 billion from SSI, $732 billion from Medicaid, as well as additional cuts to Meals on Wheels and food benefit programs.    

The NSCLC, a nonprofit law firm with offices on both sides of the country, is a watchdog for the nation's low income elderly, succeeding with tough-to-win cases where the nation's most at-risk seniors are adversely affected by often-hidden changes or procedural traps in Social Security, Medicare and Medicaid programs.  Additional information on NCSLC's advocacy is available on their website, along with a calendar of events including the April 29 free webinar on "Understanding and Impacting Implementation of New Medicaid Home and Community-Based Services Rules."

Related articles

NSCLC Joins Oregon Advocates to Stop Suspension of Social Security Payments

Ryan Budget Would Cut Food Stamps and Medicaid Deeply

Press #1 for Frustration: Automation, Hospitality and Aging

During the years when I supervised Penn State Dickinson's Elder Protection Clinic, I was often struck by how much time our law students spent tracking down basic information on behalf of clients, such as credit card or mortgage histories, Social Security records, or insurance coverage details. The information was, in theory, equally available to the clients themselves, but often our clients, who tended to be on the older side of "aging," simply didn't have the energy, patience or skills needed to navigate the dense, automated systems typically associated with modern record-keeping and billing.  One of our student-lawyers made the apt observation that if you weren't "old" before you called some of the customer service "help" lines, you would be by the time you got an answer.

I was reminded of this recently while attempting to make a hotel reservation by telephone.  In my first attempt, I didn't have enough time to wait, so after 10 minutes of less-than-interesting music, I gave up. The second time, a day later, I was routed through a series of automated messages, apparently intended to entice me into becoming an "honors" guest of the hotel's larger chain.  I was using a cell phone, so each time the automated voice indicated a series of choices available, I had to take the phone away from my ear and look for the button in question.  I listened to four sets of automated instructions, even though each time my goal was the same, pressing whatever button I was told to press "if" I wanted to book a reservation.  Gee, are there that many other reasons why someone calls a hotel reservation number?  It took several minutes before I reached a live person, who with a very bored tone insisted I give several items of personal information before I was allowed to ask whether there was a room available for my specific date. You could tell she was reading from a script. By this point I had become distinctly grumpy about the lack of hospitality in this so-called hospitality venue.

As you have probably already guessed, there was "no room at the inn" for that date.  I asked to speak to a supervisor, not so much because I thought I could change the outcome, but because I wanted to register my feeble complaint about frustration with their system. That took another 10 minutes with more "music." But I was determined not to give up.

Amusingly, once I finally reached a "supervisor," the individual immediately agreed with my comments about the weakness of their automated system. That did a lot to dispel my annoyance.  And then -- shock -- she actually offered to solve the problem by calling the local hotel (which as it turns out I was not speaking with).  She found me an available room to book for the night in question. The encounter with the real human wasn't particularly fast, but I was content to wait, knowing a caring individual was trying to help.

This micro-experience, a minor annoyance, nonetheless gave me reason to think about two things:  (1) how much more difficult automation could be for someone who has a hearing problem, slowed reflexes, impaired vision, or diminished cognitive abilities, and (2) how often I'm positively impressed during my communications with well-run long-term care facilities.

When I telephone my father's assisted living community, for example, a live person answers the phone and often recognizes my name and my father's name. My whole family notices how well the staff members know their residents and remember helpful details about the residents' families. It isn't a fancy place, but the staff outshines most high-end resorts with their professionalism and good-natured hospitality.  And it is contagious, as I often see my father smiling in response to the staff members' kind words.

Also, when I visit CCRCs across the country for work-related reasons, I'm impressed by the very personal relationships I witness between residents and front-office management.  Admittedly, CCRCs are often at the upper end of the long-term care "pay" spectrum, but my impression over the years that I've been visiting such multi-level care facilities, including their skilled care units, is that management and staff at the most successful operations place a high value on human contact with residents and the public.  The best ones seem to embrace the notion that a hospitable, caring demeanor during direct interactions goes a long way to lowering the potential for confusion or angry disputes and thus increases the likelihood that someone will be a "client" and recommend new clients. 

So, is it possible that the long-term care industry, often portrayed negatively in the media, has something important to teach other segments of  industry about why automation is not the best, nor even the most cost effective, solution to customer relations, and why the personal touch still makes a difference?  

Male MDs earn more than females in Medicare payments

Via CNBC:

Male doctors on average make 88 percent more in Medicare reimbursements than female physicians, according to an analysis of recently released government data, which suggests that the gender of a medical provider could play a role in the number of services they provide patients.  NerdWallet research found that male physicians on average were paid $118,782 in Medicare reimbursements by the federal government in 2012, compared with $63,346 for women doctors.  The difference is particularly striking because Medicare—the government's health insurance program for people 65 and older—pays men and women doctors the same amount for the individual services they perform on patients in the same geographic area.  But the reasons for that very wide gap in total reimbursements included the fact that male doctors on average saw 60 percent more Medicare patients than their female counterparts.  Men saw 512 patients on average, versus 319 for women.

Read more here.

Kansas gets serious about financial elder abuse

Via the Kansas City Star:

Kansas Attorney General Derek Schmidt says elderly residents will have new protections against fraud and financial abuse under a new state law.  Legislation creating the crime of mistreatment of an elder person was signed by Gov. Sam Brownback last week.  The law is aimed at protecting people 70 and older who are victims of financial abuse. People convicted of large-scale abuse could be sentenced to more than 40 years in prison.  Schmidt said Monday the law adds protections against misusing a financial trust or power of attorney for the purpose of misappropriating a person’s life savings.

Source/more:  KC Star

Read more here: http://www.kansascity.com/2014/04/22/4974460/new-kansas-law-could-mean-40-years.html#storylink=cpy

Toolkit for Medicare Set Asides in Comp Cases

CMS has issued a toolkit for MSAs in workers compensation cases, Self-Administration Toolkit for Workers' Compensation Medicare Set-Aside Arrangements (WCMSAs).  This toolkit is for those MSAs approved by Medicare and provides section-by-section instructions as well as samples and forms.  The introduction explains

If you have decided to self-administer your CMS-approved Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA), this Toolkit can help you manage your account appropriately and satisfy Medicare’s interests related to future medical care. Following this Toolkit will also ensure that if you are entitled to Medicare and you have Medicare-coverable costs related to your Workers’ Compensation (WC) injury, illness, or disease, Medicare will pay those costs when your WCMSA is used up ("exhausted" or "depleted").

The toolkit is written in an easy to understand format and many sections have common questions with explanations and helpful charts.

 

Prof. Alexander Boni-Saenz on "Personal Delegations"

Chicago-Kent Law Professor Alexander A. Boni-Saenz shared a copy of his law review article, "Personal Delegations," published recently in the Brooklyn Law Review.  Here is an intriguing excerpt from the introduction, minus the footnotes:

"Donald and Gloria Luster married on October 5, 1963 and had four children. Donald retired in 2005, and it was about this time when Jeannine Childree, his youngest daughter and a registered nurse, noticed that he was exhibiting signs of dementia. After a number of consultations with doctors, Donald was officially diagnosed with Alzheimer's disease in 2009 due to his memory loss, disorientation, and other cognitive impairments. Based on these medical evaluations, a Connecticut probate court declared Donald incapable of handling his personal or financial affairs and appointed Jeannine and his other daughter, Jennifer Dearborn, as his guardians. Shortly thereafter, Gloria filed for a legal separation from Donald, and in response, the daughters counterclaimed for divorce, suspecting their mother of financial and emotional abuse. Should the guardian-daughters have the authority to sue for divorce on behalf of their father?"

The author then offers a second fact pattern, involving a man serving as agent for his incapacitated brother under a power of attorney, asking whether the agent should have "authority to execute a will on his brother's behalf," where only a small percentage would be left to the brother's biological child. 

Professor Boni-Saenz suggests that the numbers of people lacking "decisional capacitiy" are in the millions and "will only increase with an aging population."  This likelihood "presents many difficult questions" while also creating "an opportunity to rethink and reevaluate how the law treats people with cognitive impairments."  He then introduces his "personal delegation" thesis, in support of giving greater deference to agents in certain circumstances, permitting them to make binding decisions that might otherwise be questioned under what he outlines as a bias or presumption in current law:

 "The central claim of this article is that in the case of decisional incapacity, decisions that implicate fundamental human capabilities should generally be delegable. Thus, it rejects the rationale employed by courts to justify nondelegation--that these types of decisions are too personal to be made by another. This line of reasoning confuses nondelegation for nondecision, and it only serves to privilege a status quo outcome over the expression of fundamental human capabilities by individuals with cognitive impairments."

The full article is easily available on SSRN and on Professor Boni-Saenz' faculty web page, linked above.

Average retiree health costs could overtake Social Security benefits

Via Investment News:

Average health care costs for middle-income retirees are on a path to exceed their Social Security benefits, according to a newly created Retirement Health Care Cost Index.  The index devised by HealthView Services, a provider of Medicare, Social Security and long-term-care planning tools, measures the percentage of Social Security benefits required to pay for health care-related costs in retirement for a healthy couple receiving the average expected Social Security benefit at full retirement age.  Retirement health care costs will increase from 69% of Social Security benefits for a couple retiring next year to 98% of Social Security benefits for a healthy couple retiring 10 years from now, according to the index. For couples retiring two decades from now, the gap will be even more dramatic. They would need 127% of average Social Security benefits to cover their health care costs in retirement.  Total retirement health care costs measured by the index include all Medicare premiums, including Parts B and D, and Medigap premiums, as well as out-of-pocket costs, including co-pays not covered by Medicare. The index assumes that the primary income earner will generate the Social Security average of $1,294 per month in today's dollars and $817 per month for the lower-earning spouse. The index measures the lifetime average of health care costs, which tend to increase as retirees age.

Source/more:  Investment News Retirement

Veterans die after being placed on VA Hospital’s secret waiting list

Via CNN:

At least 40 U.S. veterans died waiting for appointments at the Phoenix Veterans Affairs Health Care system, many of whom were placed on a secret waiting list.  The secret list was part of an elaborate scheme designed by Veterans Affairs managers in Phoenix who were trying to hide that 1,400 to 1,600 sick veterans were forced to wait months to see a doctor, according to a recently retired top VA doctor and several high-level sources.  For six months, CNN has been reporting on extended delays in health care appointments suffered by veterans across the country and who died while waiting for appointments and care. But the new revelations about the Phoenix VA are perhaps the most disturbing and striking to come to light thus far.  Internal e-mails obtained by CNN show that top management at the VA hospital in Arizona knew about the practice and even defended it.

Read more at CNN Wire.

Register Now-Webinar on Home & Community-Based Services Rules

The National Senior Citizens Law Center (NSCLC) announces an upcoming webinar on April 29, 2014 on Understanding and Impacting Implementation of New Home and Community-Based Services Rules. The announcement describes the webinar as

New federal Medicaid rules would, for the first time, set standards that seek to ensure Medicaid HCBS is provided in non-institutional settings, however, many details remain to be determined by individual states. Consumers, advocates and other stakeholders need to understand transition issues including the standards, what qualifies as HCBS, protections needed, consumer rights and service planning details in the new rules.

Stakeholder involvement and advocacy will be critical as state Medicaid programs transition through implementation of the new rules. For many states with waiver programs, the deadlines for submitting transition plans will be coming up this year. Throughout the transition process, both the states and the federal Centers for Medicare and Medicaid Services (CMS) must accept and consider recommendations from consumers and other stakeholders.

This webinar and a new NSCLC guide to the new rules will provide consumer advocates and other stakeholders with a clear explanation of the rules and share guidance for state engagement. Advocates, state policymakers, national advocates, and regulators are encouraged to attend and learn about what the rule means for residential settings, service planning, and the community-integration transition process.

Click here to register for this free webinar.

"What If It's Not Alzheimer's?"

My Penn State colleague from Hershey Medical Center, Dr. Claire Flaherty, has shared with me a another fascinating resource, "What If It's Not Alzheimer's?: A Caregiver's Guide to Dementia," by Gary Radin and Lisa Radin. 

The first chapter provides "The ABCs of Neurodegenerative Dementias," including frontotemporal dementia (FTD), Lewy Body Dementia, vascular dementia, as well as Alzheimer's Disease.  Key chapters including "finding the A Team" of specialists, and a guide to therapeutic interventions. 

The book reminds us that with some forms of dementia, particularly early onset dementias such as FTD, changes in personality or executive function may be the first signs, and easily misunderstood.  For example, the individual may manifest:

• hypersexuality, including promiscuous sexual encounters with strangers; or
• apathy or indifference to grooming and hygiene; or  
• "hyperorality" with disinhibited consumption of large amounts of food; or
• poor judgment with a lack of sense of consequences, sometimes coupled with poor impulse control

One chapter is unique, emphasizing the potential importance, after death, of an autopsy of the brain, and thus providing families with a way to contribute to biomedical research and the hope for better answers in the future.

Dementia Diagnosis and the Law

On April 24, I have the good fortune to be working with a neuropsychologist from the neurology department at Penn State Hershey Medical Center in presenting a program on "Dementia Diagnosis and the Law," for a meeting of the Estate Planning Council in York, Pennsylvania.  Professor Claire Flaherty and I have "traded" presentations in the past, with her speaking at the law school and me speaking at the medical school, but this will be our first time presenting together.  We're excited. 

One of the important lessons that I've learned in working with Claire is the clear potential for cognitive impairment to exist without the "usual" symptoms associated with "Alzheimer's."  For example, much of Claire's work is with patients and families coping with early onset dementias.  Because Frontotemporal Dementia or FTD (sometimes also referred to as Frontotemporal Lobar Degeneration or FTLD) can begin to manifest in persons aged 45 to 64 years, the onset may be overlooked or misunderstood. Plus, as Claire reminds me, "FTD is primarily a disease of behavior and language dysfunction, while the hallmark of Alzheimer's Disease is loss of memory."

For legal professionals, including those asked to prepare deed transfers, wills or estate planning documents, the potential for subtle presentations of cognitive impairment can be especially significant.  Making sure the client is oriented as to "time, place and person" may not be enough to address the potential for loss of judgment, thus opening the door for unusual gifts, risky financial decisions or even of adamant rejection of once trusted family members. 

A good place to turn for information about early onset forms of dementia, including FTD, is the Association for Frontotemporal Degeneration or AFTD -- or join us for the York Estate Planning Council meeting this week.  

Related articles

Frontotemporal Dementia and the Importance of Accurate Diagnosis

GP in warning over dementia targets

The younger face of dementia: Ottawa man shares wife's battle with the disease

ACL Webinar on Elder Abuse and Neglect of Persons with Dementia- What We Know and Where We Are Going

When:  Thursday, May 8, 2014 from 3:00 p.m. to 4:15 p.m. Eastern

This webinar is the next session of the ACL Alzheimer’s Disease Supportive Services Program Technical Assistance Webinar Series.  The purpose of the webinar series is to provide helpful, current, and applicable information for professionals who work with people with dementia and/or their caregivers.

This particular webinar will focus on elder abuse and neglect as it relates to people with dementia.  Participants will learn about: 

• The incidence and prevalence of elder abuse, especially abuse of those with dementia
• Tips for screening and assessing for elder abuse in the population of people with dementia
• Programs that are addressing elder abuse among the population of people with dementia

Registration is required.  After registering, you will receive a confirmation email that includes the link you will need to enter the webinar on May 8th.

For instructions on how to connect to the webinar by telephone, contact Sari Shuman by email at [email protected] or by telephone at 312-335-5823.

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The ACA & Medicaid for People with Disabilities

Kaiser Family Foundation has released an issue brief by MaryBeth Musumeci, The Affordable Care Act's Impact on Medicaid Eligibility, Enrollment, and Benefits for People with Disabilities.  According to the executive summary "Medicaid is an important source of health insurance coverage for people with disabilities.  This issue brief explains how Medicaid eligibility and benefits for people with disabilities are affected by the .. ACA... as of 2014.  Marketplace rules are discussed to the extent that they relate to Medicaid eligibility determinations for people with disabilities."  The final section of the report, titled "looking ahead" concludes that

The ACA’s Medicaid eligibility and enrollment changes can affect applicants and beneficiaries with disabilities.  The 2014 rules seek to allow people with disabilities to enroll in coverage as quickly as possible (either in Medicaid based solely on their low income or in a Marketplace QHP with APTC, where eligible), even while their Medicaid eligibility in a disability-related coverage group is being determined.   The 2014 rules also seek to ensure that people who qualify in a disability-related Medicaid coverage group or who are medically frail can access the most appropriate benefits package for their needs.  As the ACA’s 2014 eligibility and enrollment rules are implemented, it will be important to continue to assess how eligibility determinations and benefits for people with disabilities are affected by the new streamlined eligibility, enrollment and renewal procedures, coordination between state Medicaid agencies and the Marketplaces, the application screening questions, and the extent to which states align their new adult ABPs with state plan benefits.

The issue brief also contains some excellent charts and helpful eligibility comparisons. A pdf of the issue brief is available here.