Elder Law Prof Blog

ORANJ Shares Insights into Life Plan Communities

As we first reported here almost a year ago, the segment of the senior living community traditionally identified as "Continuing Care Retirement Communities" or CCRCs is working on rebranding. Under the leadership of the trade organization LeadingAge, the preferred name is Life Plan Communities.

ORANJ, the catchy acronym for the very active Organization of Residents Associations of New Jersey, publishes quarterly newsletters and their Fall 2016 issue includes demographic and marketing reasons behind the name change.  The issue includes an essay by Brian Lawrence, President and CEO of Fellowship Senior Living on Why and How Life Plan Communities Are Evolving.

One Practitioner's Perspectives on "The Practice of Elder Law"

Stuart Bear, a practicing attorney and member of the Minnesota State Bar Association's Elder Law Section, has written an interesting first-person account of "The Practice of Elder Law" for a 2016 issue of the Mitchell-Hamline Law Review.  It turns out the 2016 piece is an updated version of a similar article he wrote for the William Mitchell Law Review in 2002, with the same title.

In both versions Bear begins with a narrative about a family member's call to ask him legal advice on how to handle care issues following an emergency hospital admission for the caller's mother. Many of the events Bear relates will resonate, both with the public (especially those of a certain age) and lawyers.

At the same time, I find that some of Bear's words -- in both versions -- could be a springboard for a broader discussion with law students and elder law specialists.  For example, he chooses to label the family member initiating the contact as "Responsible Daughter," and he refers to other siblings as "responsible sons."  What is the meaning behind this phrase?  Is he referring to "morally responsible," "financially responsible," or just generically a "good" person?  

Further, in both versions, he offers an important discussion of how he handles potential conflict of interest issues in representing the elder parent where offspring are involved in client meetings and decisions.  In the 2002 version, Mr. Bear writes about alternative choices in identifying his client:

This rule [referring to Rule 1.7 of the ABA Rules of Professional Conduct as adopted in Minnesota] is clear that should I choose Mom as my client; it is she whom I serve and no other family member. I take my marching orders based upon Mom’s goals and objectives, serving her sole interests.

 

Suppose, however, that Mom is not so definitive in articulating her goals and objectives. It may be possible for me to represent the entire family, in light of rule 2.2 of the Minnesota Rules of Professional Conduct, which addresses the lawyer as intermediary.

In the more recent 2016 version of the essay, which is the version I first encountered on Westlaw, Mr. Bear cites a different rule for his authority to represent "the family." He points to Rule 1.14 on representation of a client with "diminished capacity."  He writes:

Suppose, however, that Mom was not so definitive in articulating her goals and objectives. It may be possible for me to represent the entire family, in light of Rule 1.14 of the Minnesota Rules of Professional Conduct, which addresses clients with diminished capacity. A comment to the rule provides in pertinent part:

 

The client may wish to have family members or other persons participate in discussions with the lawyer. When necessary to assist in the representation, the presence of such persons generally does not affect the applicability of the attorney-client evidentiary privilege. Nevertheless, the lawyer must keep the client's interests foremost and . . . must look to the client, and not family members, to make decisions on the client's behalf.

 

In the situation involving Mom and Responsible Daughter, and reading the conflict of interest rule together with Rule 1.14, I may act as the lawyer for this situation, provided that no conflict of interest develops

 

Perhaps the question is whether either rule, 1.7 or 1.14, clearly authorizes the concept of "family representation" where the older client has capacity issues. While many attorneys, including elder law attorneys, do take the position this approach is appropriate, others would take the position that the daughter is acting in the role of agent or alternative decision-maker for the mother, and thus the mother is always the real party in interest, not the daughter. Neither approach eliminates the potential for conflict of interest issues for the attorney. Either way, I think the question of client identity is key to most representational roles for elder law attorneys, especially in the context of family members serving as de facto agents for their loved ones. Stuart Bear's 2002 and 2016 essays should be good food for additional thought and analysis.

 

Editing Note:  The above Blog post was edited to refer to the correct name for the Mitchell-Hamline Law Review (rather than the "Marshall-Hamline Law Review").  Our thanks to readers for catching my error! KCP

PACE For Profits

PACE programs can be a great thing for certain Medicare beneficiaries, but the popularity of PACE programs hasn't seemed to grow as much as one might think. The New York Times ran a story on August 20, 2016 about the for-profit model for PACE programs. Private Equity Pursues Profits in Keeping the Elderly at Home explains  that "[u]ntil recently, only nonprofits were allowed to run programs like these. But a year ago, the government flipped the switch, opening the program to for-profit companies as well, ending one of the last remaining holdouts to commercialism in health care. The hope is that the profit motive will expand the services faster."  Is there a significant demand for PACE programs with the Boomers doing their aging thing?  Is a for-profit model the way to go to provide the type of services needed by PACE participants?

The article discusses these issues and presents both sides.  Recall that "[t]he goal of the program, known as PACE, or the Program of All-Inclusive Care for the Elderly, is to help frail, older Americans live longer and more happily in their own homes, by providing comprehensive medical care and intensive social support. It also promises to save Medicare and Medicaid millions of dollars by keeping those people out of nursing homes."

The article also discusses the possible role of tech in providing care, but notes the importance of socialization. CMS had a pilot before approving the for-profit model and is going to keep an eye on things.

The for-profit centers were approved, to little fanfare, after the Department of Health and Human Services submitted the results of a pilot study to Congress in June 2015. The demonstration project, in Pennsylvania, showed no difference in quality of care and costs between nonprofit PACE providers and a for-profit allowed to operate there.

The Centers for Medicare and Medicaid Services has vowed to closely track the performance of all PACE operators by measuring emergency room use, falls and vaccination rates, among other metrics. The National PACE Association, a policy and lobbying group, is also considering peer-reviewed accreditation to help safeguard the program. Oversight is now largely left to state Medicaid agencies.

Stay tuned.

Training Caregivers Gets Good Results

Kaiser Health News (KHN) ran a story about the benefits of training caregivers to give care. Teaching In-Home Caregivers Seems To Pay Off  explains that "[u]nder a pilot program, nearly 6,000 aides in Los Angeles, San Bernardino and Contra Costa counties were trained in CPR and first aid, as well infection control, medications, chronic diseases and other areas. All were workers of the In-Home Supportive Services program, who are paid by the state to care for low-income seniors and people with disabilities, many of them relatives." As a result  of the training? Emergency room visits and hospital admissions were down for this group.

We all know the need for caregivers is rising. So having well-trained caregivers seems to be a no-brainer.  Yet, the article reminds us, "[t]here are currently no federal training requirements for in-home caregivers, even if they are paid with taxpayer dollars. Around the country, however, training programs have been developed and tested, according to the Paraprofessional Healthcare Institute, an advocacy group that also provides training. Among the states that have tried different types of instruction are Massachusetts, North Carolina and Michigan."  Caregivers do a lot of tasks for the elders in their care, and many caregivers are unpaid family members. But, "some states pay caregivers for eligible low-income residents through their Medicaid programs." The article offers some details about the training program. "The results of the study show that caregivers play a pivotal role in helping keep people out of the hospital...." 

Where's the Beef? One University of Arizona Professor Apparently Knew....

We often report on crimes against older adults on this blog, but last week an 80-year-old former University of Arizona professor pleaded guilty to theft of more than $80,000 from  his employer. How did he accomplish that?  

The animal sciences professor was in charge of the land-grant university's "Meat Store" in Tucson and was charged with diverting thousands of dollars in proceeds from sales of meat into his own bank accounts. John Marchello worked for U of A for more than 50 years, and retired just days before his indictment in 2015. Indeed, I attended U of A many moons ago, and as a former 4-Her who took a few Ag Sciences courses along the way, I probably even took a "meats lab" course from him.  

Talk about alternative "long-term care" planning. Sadly, Marchello is scheduled to be sentenced in November and faces a potential sentence between one and three years for the Class 4 felony.

There is also a civil suit pending, alleging more than $200,000 in theft.  For more, see Longtime UA Professor Pleads Guilty.

 

Related articles

Longtime UA professor pleads guilty to defrauding school

The CNA Conundrum: Background Checks, Continuing Education & Licensure

The long-term care industry depends hugely on the services of "nursing assistants," also known as NAs, who provide basic but important care for residents or patients under the direction of nursing staff (who, in turn, are usually Licensed Practical Nurses or Registered Nurses). As the U.S.Department of Labor describes, NAs typically perform duties such as changing linens, feeding, bathing, dressing, and grooming of individuals. They may also transfer or transport residents and patients. Employers may use other job titles for NAs, such as nursing care attendants, nursing aides, and nursing attendants. However, the Department of Labor makes a distinction between NAs and other key players in long-term care, including "home health aides," "orderlies," "personal care aides" and "psychiatric aides." 

According to DOL statistics, the top employers of NAs include skilled nursing facilities (37% of NAs), continuing care retirement communities and assisted living facilities (together employing some 18% of NAs), and hospitals and home care agencies, which each employ about 6% of the NA workforce.  

For many years, states have offered licensing for nursing assistants.  The designation of CNA or "certified nursing assistant" meant that the nursing assistant had satisfied a minimum educational standard and had successfully passed a state exam.  As another key protection for vulnerable consumers, CNAs had to pass background checks, involving fingerprints and criminal history searches.

In Arizona, however, now I'm hearing a new label:  LNAs or Licensed Nursing Assistants.  The Arizona Board of Nursing continues to license CNAs, but now it is offers the designation of Licensed Nursing Assistants. What's the difference?  Frankly, not much, at least in terms of skill levels. Then why the change?

In Arizona, CNAs and LNAs have the same educational requirements, and must pass the same test and satisfy the same work credits. But, as of July 1, 2016, individuals seeking the LNA designation will be required to pay the state a fee to cover their mandatory background checks, including fingerprinting.  CNAs, however, will no longer be required to undergo background checks or fingerprinting.  

What is this about? Arizona is trying to save money.  It seems that state and federal laws prohibit state authorities from mandating that CNA candidates cover the cost for their own background checks.  In other words, if the candidate showed financial need in the application process, the state was required to pick up the costs for any background checks. Let's remember that the average wages of CNAs are relatively low -- the national mean is less than $30,000 per year. Presumably that is the reason behind the older laws limiting how much states can charge CNA applicants for their own background checks. By creating a new designation, LNA, Arizona takes the position it avoids the federal restriction.

But, what about the public?  Will the public understand that CNAs licensed after July 1, 2016 will not be subject to fingerprinting and background checks?   Responsible employers would, presumably, require such checks or limit their hires to LNAs.   At least, let's hope so.

I also learned that apparently Arizona does not require "continuing" education for either CNAs or LNAs.  (Again, you would hope that responsible employers would either provide or require such education.)  Arizona used to require a minimum of 120 hours every 2 years of what are, in essence, "job credits" -- i.e., proof of employment in an NA position -- to maintain the CNA license.  Recently, however, Arizona diluted that requirement to just 8 hours every two years for both CNAs and LNAs.  

Arizona does have a useful website where current or prospective employers, including families, can check the licensing status of CNAs or LNAs. The website is searchable by name or license number, and shows whether an applicant has failed the entrance exam, or has withdrawn an application or lost the license.  

Are other states creating this LNA designation as a "workaround" (loophole?) for financing background checks for CNAs?  Let us know!  

Positive Aging-The "Iron Nun"

I was happy to see Nike's latest commercial for its Unlimited campaign featuring the triathlete dubbed the Iron Nun. According to an article in the Huffington Post, "Buder said that she manages to fit her training for these races in with her daily life. The sister, who is part of a nontraditional religious order called the Sisters for Christian Community, runs to her church in Spokane, Washington. She also runs to the local jail, where she volunteers to chat with inmates."  I suspect the narration for the commercial is intended as amusing since it relies on aging stereotypes, but the Sister's accomplishments blow those stereotypes out of the water.  Ad of the Day: Nike Celebrates the 'Iron Nun', an 86-Year-Old Triathlete With God on Her Side features the ad, as well as the behind the scenes interview with the sister without the narration. The quote I liked from Sister Buder:   "the only failure is not to try".  Huffington Post quotes from an article on her in Cosmo, "Don’t pay attention to how old you are, only focus on how old you feel ... And be patient — one of my worst enemies is patience, I’m still trying to fine-tune it so that I’m able to stop and smell the roses.”

Kudos Sister for your accomplishments!

Aging Solo

Last week we blogged about those elders who have no kids to be their caregivers. The Washington Post featured an article on the topic of "aging solo".  Aging Solo: Okay, I don’t have a child to help me, but I do have a plan, told from the perspective of the author, is an attention-grabber from the beginning

“The trouble is: You think you have time.” That Buddhist-sounding quote from a fortune cookie rattled around the back of my head for decades, seemingly for no reason. Now that I find myself living with my 94-year-old mother in a Florida city where preacher Billy Graham got his start and being a never-wed 60-something has made me a tourist attraction of sorts, I finally understand why I thought the repercussions of growing old without a child or two would not apply to me: I was just plain delusional.

As a New Yorker flush with friends, freelance work, Broadway tickets and great Botox, I had apparently existed in some sort of fun, singles bubble. It was a lifestyle so rewarding that I never read even one article about the stresses of the “sandwich generation.” (Hey, the writers all seemed to be married women with children, so even on a boomer-to-boomer level, I could not relate.)

Of course she's not alone. The article provides statistics--almost 33% of the Boomers have no kids. "That doesn’t count boomer parents who have lost a child or have one who is severely impaired. The Aging Solo pool also includes countless members of families plagued by addiction, disease, cults, rapacious children, even married progeny who much prefer their in-laws. While millions of Aging Soloists have siblings and other kin, many of us can’t imagine (or abide) having them shepherd us to our final rest."

The author calls for an aging plan with friends rather than kids, and using her parents' story as educational,  she offers this advice "When you’re past 50 and single, location is 75 percent of the enchilada. Subways matter. Proximity to friends matters. Suburban seniors communities felt to me like slow death. I found senior centers and assisted-living facilities profoundly lonely because, it seems, the art of making friends does not grow as we age, and not everyone likes endless bingo and dominoes on Tuesdays, followed by a prayer service."

She goes on to offer further tips

It’s better to plan a more personal assisted-living future with your own friends while in your 50s or 60s. That will give you time to choose a location with diverse people and culture, with neighborhoods that have sidewalks and public transit....

Sharing resources can spawn all sorts of possibilities. Maybe my posse grabs several apartments in rental, condo or co-op buildings, or we share a group house in D.C., Manhattan or L.A. Heck, maybe we can find a way to lease a floor in one of the many overbuilt office buildings around the country. Perhaps (if yours is an anti-urban posse) you can hire an architect to design space-age yurts in Arizona. Each madly hip structure would be self-contained, but the colony would have a common dining hall, gym and tech-support center, or whatever your future selves desire.

New to the finances of aging, I had no idea how much control I gained by holding my mother’s durable power of attorney. Had I been less ethical, I could have taken her money and run. Therefore, I’ll never give that power to any one person; it will be held by at least three younger and devoted friends because elder fraud is one of the most horrifying aspects of aging solo. Trust me: That charming new friend who offers to manage your money so you don’t have to deal with “all those bills” is probably well known to the local police.

So what is the author doing to prepare for her aging without kids?  She explains

What am I doing? Well, I’ve started small, using Skype dialogues with my pals to research and download the legal papers — from wills to end-of-life instructions — that we will need, sooner or later. Now we’re aiming higher. Should we learn what to look for in a nurse’s résumé so we can find the right person to help us in our collective dotage? Should we hire a visionary architect to create a high-tech trailer park or a cluster of tiny homes built around communal buildings? Our ideas are still all over the map.

We hope we have time to execute our most appealing visions. Mostly, however, we pledge to be our own Best Friends. United. Forever.... 

Washington Post: Legal Counsel for the Elderly Is Part of One Woman's Story

The Washington Post has a fascinating piece about Wanda Witter's decades-long battle with the Social Security Administration. At the age of 80, Wanda's story appears to be one of success, after many years of living in shelters and on the streets of D.C..  

At the shelters all those years, Witter tried to get someone to listen to her. She explained at different offices providing homeless services that those suitcases contained the evidence. She was owed money, lots of money, and she could prove it.

 

Witter is not a particularly warm or outgoing person. She isn’t rude, just direct. And suspicious of just about everyone. And obsessed with Social Security.

 

“They kept sending me to mental counselors. I wasn’t crazy. I wasn’t mentally ill,” she said.

With the help of the Washington Legal Clinic for the Homeless, Legal Counsel for the Elderly (LCE) and a dedicated, patient and persistent social worker, Julie Turner, it appears that Ms. Witter is now in her own apartment and will receive some $100,000 in back Social Security payments.  

For the full story, read "'I Wasn't Crazy.' A Homeless Woman's Long War to Prove the Feds Owe Her $100,000."  

Sicker on Admission, Not 100% on Discharge?

The Kaiser Health Network (KHN) and U.S. News ran a story in July about elders' admission to hospitals. They may be sicker on admission and when discharged, may not be able to care for themselves, needing help with ADLs. Elderly Hospital Patients Arrive Sick, Often Leave Disabled focuses on how hospitals care for elders, and a "trend" to create a special unit just for patients who are elderly.

How hospitals handle the old — and very old — is a pressing problem. Elderly patients are a growing clientele for hospitals, a trend that will only accelerate as baby boomers age. Patients over 65 already make up more than one-third of all discharges, according to the federal government, and nearly 13 million seniors are hospitalized each year. And they stay longer than younger patients.

Many seniors are already suspended precariously between independent living and reliance on others. They are weakened by multiple chronic diseases and medications.

One bad hospitalization can tip them over the edge, and they may never recover, said Melissa Mattison, chief of the hospital medicine unit at Massachusetts General Hospital. “It is like putting Humpty Dumpty back together again,” said Mattison, who wrote a 2013 report detailing the risks elderly patients face in the hospital.

If one considers the special circumstances for elder patients, it makes sense that hospitals may want to be prepared for these patients. But, the way the medical system works currently, "the unique needs of older patients are not a priority for most hospitals... Doctors and other hospital staff focus so intensely on treating injuries or acute illnesses — like pneumonia or an exacerbation of heart disease — that they can overlook nearly all other aspects of caring for the patients" according to one expert quoted for the article.

Some hospitals have special units for these patients, referred to as Acute Care for Elders (ACE) units. "ACE units have been shown to reduce hospital-inflicted disabilities in older patients, decrease lengths of stay and reduce the number of patients discharged to nursing homes. In one 2012 Health Affairs study,  ... researchers found that hospital units for the elderly saved about $1,000 per patient visit." Not only do these units save money, according to the article, patients in these units seem to be better when discharged. 

If you discuss this in class, have your students find out whether any of the local hospitals have a similar unit.  It makes a difference.

Signs of Our Times? Japanese Stores Are Increasingly Convenient for Seniors

Dickinson Law Professor Laurel Terry sent me a timely link to an NPR story about Japanese convenience stores.  I was already thinking about how retail shopping has changed over the years. For example, on the corner of 7th Avenue and Indian School Road in Phoenix, there used to be a high-end Scandinavian furniture store.  I'd only been in it once, and that was to use a gift certificate for what seemed like a huge amount of money at the time as a wedding present. My husband and I realized the most we could afford in the store was a wooden bowl. A very nice wooden bowl, mind you, but still, it was a wooden bowl. 

Yesterday, as I passed that corner, I realized there was still a big, fancy sign out front, but the store is now a Goodwill franchise store.

So, with that change in mind, I enjoyed the NPR story, captioned Beyond Slurpees: Many Japanese MiniMarts Now Cater to Elders. From the written account:

Case in point is a Lawson convenience store in the city of Kawaguchi, north of Tokyo. It sells products that an American consumer would never find tucked between the aspirin and the candy bars. For example, there's a whole rack of ready-to-heat meals in colorful pouches. They're rated at levels from 1 to 5, based on how hard it is to chew what's inside.

 

Or, as the store's manager, Masahiko Terada, puts it, "the higher the level, the less need for you to chew. In the end it's porridge."

 

***

 

This Lawson store in Kawaguchi is one of six in a special line called Care Lawson. The company plans to expand to 30 by early next year. And these Care Lawson stores have another special feature: staff like Mika Kojima.

 

She's a nursing care manager and she's stationed at this Lawson store. In fact the franchise owner of this store is actually a nursing services company. Anyone who comes in can ask for Kojima's help. For example, she'll go to an older client's home to make sure it's set up so they can live there safely. And she'll connect families with adult day care services.

Convenience stories should be just that, convenient, right?  With adults over age-65 making up nearly 27 percent of Japan's population, it just makes sense for retailers to provide customer-specific merchandise that is easily accessible, especially for people who might prefer to avoid large supermarkets.  The Lawson chain also offers home deliveries. 

The story made me wonder more about Lawson. How was it that the Japanese chain came to have such a non-Japanese name?  It turns out Lawson began back to 1939 in Ohio, in the United States, where J. J. Lawson ran a dairy milk store. "'Mr. Lawson's milk store' was locally renowned for its fresh and delicious milk and many customers came to buy milk there every morning."  The first Lawson convenience store opened in Japan in 1975 and sold "party food," very different from the model of today.  

A Cellphone Required for Social Security Online Access and Then Not

This is a story of now you need it, now you don't. Social Security recently required that a person have a cellphone to use the online benefits services.  The New York Times ran an article about this requirement that went into effect at the end of July, 2016. Social Security Now Requires Cellphone to Use Online Services explains that SSA makes it mandatory to have an access code sent by text to the recipient's cellphone.  The article notes that this requirement "may create hurdles, however, especially for older Americans, who are less likely to use mobile phones. About 78 percent of people 65 and older own a cellphone, compared with 98 percent of 18- to 29-year-olds, according to 2015 data from the Pew Research Center." Still almost 80% of elders have a cell phone-a good number, but that doesn't mean that those with cellphones use text features.  The article features a variety of complaints, including the lack of advance notice.  The article includes some FAQs, as well as a link to a website on where to get help (at least it's a website, not a cellphone #).

Now for the now you don't part of this story. Recall the quote in the prior paragraph "may create hurdles"....  So within two weeks of the regulation taking effect, Social Security has stopped it, for now.  The New York Times ran a follow up story explaining the suspension:

After an outcry from older Americans, as well as a letter from two United States senators, the agency backed off the cellphone-based code requirement.

“Our aggressive implementation inconvenienced or restricted access to some of our account holders,” said a statement emailed by an agency spokesman, Mark Hinkle. “We are listening to the public’s concerns and are responding by temporarily rolling back this mandate.”

Note the use of the word "temporarily" because Social Security is continuing to increase security to protect beneficiaries' information and will "introduce alternative authentication options, in addition to texting, within the next six months."  The FAQ for this article notes that beneficiaries can opt-in to text-verification now, it's just not a requirement.

Philadelphia to Host the 27th Annual National Adult Protective Service Assoc Conference, August 29-31

Recently I received an email reminder from ElderLawGuy Jeff Marshall that Pennsylvania is hosting this year’s National Adult Protective Service Association (NAPSA) Conference from August 29 through 31 at the Loews Hotel in Philadelphia. The conference will feature many of the nation’s leading adult protective services professionals who will share their ideas, expertise and creative approaches, with workshop sessions for brainstorming application of new ideas. More details, including information about CLE credits, are available here. Immediately following the NAPSA conference, in the same Philadelphia location, is the 7th Annual Summit on Elder Financial Exploitation, on September 1.

These national meetings come at a time when elder abuse and elder justice have been the subject of growing attention in Pennsylvania, as well as around the nation.  It seems fitting that Philadelphia is hosting the national meeting, as it follows a months-long Task Force analysis of the role of Pennsylvania court systems in helping to protect at-risk seniors or other vulnerable adults.  

Thanks, Jeff!  

Turning Silver Into Gold? Another "Advancement" in Non-Institutional Senior Care

The New York Times on Sunday had an exceptionally well written and important article about the latest trend in senior care.  For-profit companies are now allowed to participate in PACE, the Program of All-Inclusive Care for the Elderly, a Medicare- and Medicaid-approved program designed to permit innovation in care that doesn't require residence in high-priced settings such as traditional nursing homes.  Sarah Varney writes:

Inside a senior center here [in Denver], nestled along a bustling commercial strip, Vivian Malveaux scans her bingo card for a wining number.  Her 81-year-old eyes are warm, lively and occasionally set adrift by the dementia plundering her mind.

 

Dozens of elderly men and women -- some in wheelchairs, others whose hands tremble involuntarily -- gather excitedly around the game tables.  After bingo, there is more entertainment and activities: Yahtzee, tile-painting, beading. 

 

But this is no linoleum-floored community center reeking of bleach.  Instead, it's one of eight vanguard centers owned by InnovAge, a company based in Denver with ambitious plans.  With the support of private equity money, InnovAge aims to aggressively expand a little-known Medicare program that will pay to keep oldr and disabled Americans out of nursing homes.

The feature-length article details how "private equity firms, venture capitalizes and Silicon Valley entrepreneurs have jumped" onto the PACE niche. For more on this important development, read Private Equity's Stake in Keeping the Elderly at Home.

My thanks to Laurel Terry and Karen Miller for sharing this article with us. 

Related articles

As the For-Profit World Moves Into an Elder Care Program, Some Worry

"Old Person" Jobs

Did you know there is such a thing?  The New York Times recently ran an article, More Older People Are Finding Work, but What Kind?, that features a new brief from the Center for Retirement Research.  The Times article explains

As men and women 55 and older looking for employment probably suspect, at a certain point the kinds of jobs available to them narrow significantly. New research by Matthew Rutledge, an economist at the Center for Retirement Research at Boston College, found that they are increasingly being funneled into what he describes as “old-person” jobs.

And not surprisingly, older workers with the least education have the narrowest set of opportunities, though Mr. Rutledge found this effect was small.

It turns out that “old-person” jobs are a mix of high-skilled service work (like managers, sales supervisors and accountants) and low-skilled service work (like truck drivers, janitors and nursing aides). Absent from the top of the list are jobs calling for a fair amount of physical labor. Jobs in farming, manufacturing and repair represent less than a quarter of all new hires in this age bracket.

The brief from CRR,  How Job Options Narrow for Older Workers by Socioeconomic Status offers these findings

• Job-changers over age 50 increasingly end up in “old-person” jobs, with a high share of older hires relative to prime-age hires. 

• These basic findings hold by gender and by education. 

• However, the overall outlook has improved since the late 1990s for all groups, particularly for older women with more education.

• Also, older job-changers hired into “old-person” jobs are paid no less than other jobs.

The full brief, available here as a pdf, examines "suitable" employment, with the introduction explaining 

The ability of older job-changers to find "suitable" employment affects both their current income and their ability to work long enough to secure an adequate retirement income. One measure of suitable employment is the range of occupations available to them. This brief, based on a recent study, assesses the extent to which occupational options narrow for workers as they age from their early-fifties to their mid-sixties and whether the pattern varies by gender or socioeconomic status, as measured by education level.

Back to the Times article, which lists most and least common "old person" jobs (hint-lawyers are in the "least common" category).  The Times story also discusses several other studies regarding elders in the work force.  This would be a great article to include in an unit on economic security or in a discussion regarding ageism.

You're Dead When SSA Says You're Dead---Even if You Are Not!

We have all heard stories about SSA determining that a beneficiary is dead, when the beneficiary isn’t. Proving you are very much alive has to be a fun experience (just joking in case anyone from SSA is reading this blog). Usually the stories about someone being “SSA-dead” is limited to a person. The Washington Post recently ran a story about a group of beneficiaries being declared dead by SSA. Dead or alive? Social Security misclassified some explains “Social Security officials have discovered 90 cases in their records where the living were listed as deceased.  That’s 90 “as of today,” Mark Hinkle, an SSA spokesman, said late Thursday. “We are not yet sure how many were in error.” The 90 are from a group of 19,000 cases.” Note that means more of the 19,000 may be “SSA-dead”.

There is some humor in all of this (the 90 of you declared SSA-dead, my sympathies (no pun intended folks--sympathies for the hassle) and really I’m not making light of your situation). “Ironically, the erroneous cases are from pilot projects in Virginia, North Dakota and South Dakota, designed “to enhance the quality of our death records,” Hinkle said. … Clearly, there is more work to be done on that point.”

Clearly this is no laughing matter if you are one of those declared dead-there are significant financial implications, including a loss of benefits. Plus other federal agencies get death info from SSA, so the impact is more widespread than just SSA. SSA is on it, and as for those other folks who may be SSA-dead and not know it, “SSA plans to send letters to the 19,000 people potentially affected with information on how to find out if the agency thinks they are dead and how to correct the record if that’s the case.”

I’m just saying, if you live in VA., ND or SD and get a letter from SSA in your mailbox, you may want to sit down before you open it…

95 year old upgrades her tech

Here's a happy story to end the week. Huffington Post's Post50 ran a story last week about a lucky lottery winner. 95-Year-Old Woman Uses Lottery Winnings To Join 21st Century features the winner of a scratch-off ticket who plans to buy herself an upgraded cell phone. "Once it had all sunk in, the great-grandmother quickly began thinking about how she’d spend the cash. In the end, she decided to buy a great treat for herself: a new smartphone." Now granted, smartphones don't cost $30,000 (the amount of her winnings) so the article notes she plans to put the rest in a trust for her family.  She explained, "“I’m 95 and there’s not a hell of a lot more I can keep doing with it...."

Congratulations!

Want to Laugh? Read "Old Age: A Beginner's Guide," by Michael Kinsley

I'm always just a bit suspicious of books that promise to make me laugh.  I think it is because I like to be surprised by humorous moments, rather than feel duty-bound to chuckle, guffaw or giggle.  

Nonetheless, I succumbed to the promise in the blurb for Michael Kinsley's 2016 book, Old Age: A Beginner's Guide, that it was a "surprisingly cheerful book ... and a frequently funny account of one man's journey to the finish line."  

And I'm glad I did.  I did indeed laugh, and at the most surprising of moments, as when he described the need to avoid the doors of his refrigerator because of the magnets that might interfere with the technology in his brain used to keep symptom of Parkinson's Disease at bay.  He has the knack of making wry observations about his own mortal state to think broadly about what it is for all of us to age. I can see the short essays that make up this book being useful in a class on elder law or estate planning.  

His words are perhaps most poignantly relevant to boomers.  For example, on a goal of living longer, he writes:

Even before you're dead, you may want to ask yourself whether this is what you really want.  Is being alive all that desirable if you're alive only in the technical sense?  Millions of boomers are watching their parents fade until they are no longer there. As they approach their seventies, they start observing their own peer group losing their collective marbles, one at a time. And they  reasonably conclude that the real competition should not be about longevity. It should be about cognition.

But he doesn't stop there, exploring other, potentially more important goals for the competitive boomer generation to consider.  

This is a short, deep book.  And I recommend it, not least of all because it gives readers welcome opportunities to smile. 

A Day in the Life of Phone Scams

I'm house-sitting in Phoenix this summer, and I've been gobsmacked, to use a good British word, to realize exactly how many unwanted callers manage to circumvent the home's do-not-call registrations.  Even worse is to realize how many of the calls expressly target senior consumers.

One of the most annoying call begins, "Hello Mrs. XXXX, I see that your physician has prescribed Xarelto for you, and I'm calling to let you know that we can offer you special pricing, at less than half what you are currently paying....."

Suffice it to say that this was a scam.  No physician had shared any prescription information about the homeowner in question.  But for the older consumer worried about costs, I can just imagine how effective the scammer's "guess" could be, as the scam focused on a very expensive and important drug for many older patients.  They were after credit card information.  I bet the boilerroom for this operation has a whole list of popular "senior" prescription drugs. 

Another frequent caller poses as the IRS and claims there is a deficiency on some tax payment that can be "handled" over the phone. Again, a scam -- and certainly one that could frighten many people.  In a single week, I intercepted 7 such calls, despite each time attempting to make it clear I knew this was a scam, and then blocking the number.  

Perhaps the most frequent callers are those trying to market "solar" systems, guaranteeing tax credits or rebates  -- and I guess that one just goes with the territory when you are living in sun-drenched Arizona.

Medicare Enrollment Periods

Investment News ran a timely article about the various Medicare enrollment periods. The alphabet soup of Medicare enrollment periods explains the initial enrollment period and special enrollment periods. It also explains succinctly how employer group health plans and Medicare interface as far as the special enrollment period.

If you have coverage through your employer or your spouse's employer consider:

• The employer provided health plan needs to be with a group of 20 or more insurance eligible members. If the group is smaller than 20, Medicare Parts A and B must be primary and cover 80% of costs. The employer plan only covers 20%. In those cases, many folks are better served by leaving the employer plan and signing up for Medicare Part D and a supplemental plan.

• The employer coverage needs to be Medicare Part D creditable, meaning that the employer coverage includes a prescription drug benefit comparable to Medicare Part D. The employer or insurance plan can provide the Medicare creditable coverage notice. Get a copy of this letter every year when your employer coverage renews. That way no one is caught off guard down the road. If a plan has not been Medicare creditable, lifelong penalties of 12% per year are levied when the individual enrolls in Medicare Part D.

Once the person leaves a health plan and is entitled to Medicare, it is important to remember a few key factors:

• Sign up for Medicare as soon as possible. Medicare enrollment can begin three months before employer coverage ends.

• While there is an eight-month window to sign up for Medicare Parts A and B, there is no primary health coverage until Medicare enrollment is complete. Even COBRA coverage is secondary coverage to Medicare. That means Medicare Parts A and B cover 80% of costs, leaving COBRA to pay 20%. The result is that when Medicare-eligible individuals do not have Medicare Parts A or B they are left to pay 80% of their costs out-of-pocket.

• If someone misses the eight-month SEP window after leaving employment, they will have to wait an extended period to of time to enroll, have coverage gaps and pay lifelong penalties.