Elder Law Prof Blog

Medically-Assisted Dying Advances in Hawaii

The Hawaii legislature has approved legislation to legalize Medical Aid-in-Dying, according to the New York Times. Doctor-Assisted Suicide Close to Becoming Law in Hawaii reports that the bill now goes to the Hawaii governor, who has indicated that he will sign the bill.  The bill contains safeguards similar to other medical aid-in-dying statutes, including

a requirement that two health care providers confirm a patient's diagnosis, prognosis, ability to make decisions and that they voluntarily made the request. A counselor also must determine that the patient is capable and does not appear to be suffering from a lack of treatment of depression.

The patient must make two oral requests for the life-ending medication, with a 20-day waiting period between each. They also must sign a written request witnessed by two people, one of whom can't be a relative.

The measure creates criminal penalties for anyone who tampers with a request or coerces a prescription request.

Assuming the Governor signs the bill, Hawaii will be the 6th state to have such a law, joining Washington, Oregon, Vermont, Colorado and California, along with the District of Columbia.  Montana, although without such a statute, has a state supreme court opinion addressing the issue.

Penn State's Dickinson Law Hosts Pennsylvania Judges for Program on "Dementia Diagnosis and the Law"

On Thursday, March 29, 2018 Penn State's Dickinson Law hosted a continuing judicial education program for the Pennsylvania Judiciary, with live attendance in Carlisle by more than 30 judges and with even more judges around the state participating via a live stream.  The program was "Dementia Diagnosis and the Law," organized into three parts:

Part 1:  Medical Science and Dementia

• Welcome by Dean Gary Gildin, Dickinson Law
• Keynote Presentation: Age-Related Cognitive Decline 
  • Krish Sathian, M.D., Ph.D., Professor of Neurology and Chair of the Department of Neurology for Penn State College of Medicine and Penn State Health Milton S. Hershey Medical Center
• Medical Perspectives – Responding to Legal and Ethical Quandaries of a Diagnosis: Two Brief Vignettes
  • Associate Professor Claire Flaherty, Ph.D., Penn State College of Medicine, Department of Neurology

Panel Discussion and Audience Q & A

Part 2:  Legal Implications of a Diagnosis of Dementia

• Keynote Presentation:  Clinical, Legal and Judicial Judgments of Capacity in Persons with Dementia
  • Daniel C. Marson, Ph.D., JD., Professor Emeritus, Department of Neurology, School of Medicine, University of Alabama at Birmingham
• Why “Guardianship Oversight” is a Hot National (and State) Topic
  • Professor Katherine C. Pearson, Dickinson Law, Pennsylvania State University

Panel Discussion and Audience Q & A

Part 3:  Adjudication Exercises, facilitated by Professor Tiffany Jeffers, Dickinson Law, with Dickinson Law students in role plays on issues about capacity to contract, limited guardians, the roles of guardians ad litem and the potential for attorneys or judges to become affected by a neurocognitive disorder.

• Panel Discussion and Audience Q & A

Panel Members included:

• The Honorable Lois Murphy, Judge, Montgomery County Court of Common Pleas
• The Honorable Paula Ott, Judge Superior Court of Pennsylvania
• Sally L. Schoffstall, Schoffstall Elder Law LLC, Orefield, PA.
• Laurel S. Terry, H. Laddie Montague Jr. Chair in Law & Professor of Law, Penn State’s Dickinson Law

As the law school's organizer for the event, I know I learned a lot from this dynamic group of seasoned experts who spoke on the challenging legal, medical, and judicial issues that can arise from cognitive impairments associated with aging. The judges in our audiences were fully engaged, offering great comments, questions and experiences.

My special thanks to each and every one of the speakers, facilitators, judges, lawyers and students who made the program so informative.  It was fun to work with the Administrative Office of the Pennsylvania Courts on this project and we look forward to additional opportunities to collaborate in the future.  Once I catch up a little on my day job (and maybe on some missed sleep), I'll post again with some additional reactions and thoughts from this program.  

New Mexico, Where New Guardianship Laws Will Take Effect July 1, 2018, Struggles With Reporting Systems

Earlier this week, The Albuquerque Journal reported on continued problems with accountability for court-appointed guardians within New Mexico. Colleen Heild writes:

What’s become of Elizabeth Hamel? Hamel is among dozens of people placed under a legal guardianship or conservator in southern New Mexico over the past 20 years whose welfare is unknown – at least according to state district court records. . . . Nothing in the online court docket sheet indicates that Hamel’s case has been closed. But since being appointed, Advocate Services of Las Cruces hasn’t filed any annual reports about Hamel’s well-being or finances, the docket sheet shows.

 

There’s no indication as to whether she is dead or alive, or if the  guardianship/conservatorship has been revoked. . . . 

 

As New Mexico prepares for a new law, effective July 1, to help its ailing guardianship system, the state’s district courts still don’t have a uniform way to ensure guardian compliance with reporting laws that have been on the books at least since 1989.

 

State Sen. Jerry Ortiz y Pino, D-Albuquerque, said last week that he was disappointed that annual reports haven’t been filed in some cases.

 

“And I’m not surprised the courts wouldn’t know,” said Ortiz y Pino, a longtime advocate for reform. “That’s what we ran into over and over again, the lack of any kind of system to make it possible to log them (annual reports) in, let alone read them, let alone send somebody out to verify whether or not what they’re reporting is the truth. Those are the kind of things we shouldn’t be missing. Somebody should be at least saying, ‘Hey, you never did file a report.’ ”

For more, read Missing Reports Plague Guardianship System (3/25/18). 

From the Boston Globe, A Story That Raises Lots of Questions about Timeliness of VA Aid & Attendance Benefits

The Boston Globe has a lengthy article about one couple's struggle to get VA approval for Aid & Attendance pension benefits when they transferred from their own home to a nursing home.  Oddly, the delays in approval appear to be tied, at least in part, to the contention that as both the husband and the wife were Marine veterans, the applications must be processed "simultaneously."  Is that really true?  Here are some of the key -- and often sad -- details of the family's struggle:

 

Moseley [an director at the couple's nursing home] said she placed several calls to the VA while Robert DiCicco [85 year-old husband] the listened from his wheelchair. Each call ended the same way — no approval, no update on where things stood, no firm information at all.

 

“I told them that these veterans could be homeless if it wasn’t for our home taking them in, and that they needed to be approved very soon,” Moseley said. “It wasn’t something that was very important to the VA. The disappointment that would come across his face was heartbreaking.” In her 35-year career, Moseley said, she has never handled a more difficult case involving the VA.

 

VA officials said the DiCicco case is complicated because, under law, pension claims for two married veterans must be processed simultaneously, and that [wife] Mary Lou DiCicco’s claim required additional, time-consuming verification of her military service. 

 

The VA said that “regrettably, our efforts to establish entitlement resulted in delays.”

The agency needed only 59 days on average to resolve pension claims in February, including aid and attendance requests, the VA said. The overall goal is to resolve all claims, including disability and pension applications, within 125 days — a standard that was met 91 percent of the time in fiscal 2017, said James Blue, spokesman for the VA’s North Atlantic District. 

 

But many veterans advocates and lawyers who work on VA claims said the process often can take 12 to 18 months. Lesa Jacob-Pollich, the veterans service officer for Saline County, where the DiCiccos live, said she watched helplessly while the family waited month after month for an answer.

For the full story, read For These Veterans, Dealing with VA Has Been A Relentless Fight, by Brian MacQuarrie for the Boston Globe, published March 24, 2018.

Friendship, Aging, Gender -- and Lawyers

The Hidden Brain is a great radio program with frequent stories relevant to aging.  A recent episode is titled Guys, We Have A Problem: How American Masculinity Creates Lonely Men.  Frankly, I think the title doesn't do the episode justice, as although the episode focuses primarily on the potentially disproportionate likelihood of isolation and loneliness for men as they get older, many of the program's most important points strike me as applying equally to anyone who finds his or her life becoming more isolated.

One interview explored the moving personal history of a lawyer, Paul Kugelman, as he went through life, starting with disconnections connected to frequent military-service-connected family relocation, followed by his own divorce and struggles with work/life balance, a temptation to drink, and a a recovery strategy that included completing an Iron-Man Marathon. But running wasn't enough. Over-reliance on a spouse put enormous pressure on the relationship. He had to learn new skills to create new friendships.

The program also explored findings from an early Harvard study of American men, now known as the Harvard Study of Adult Development, a study that has been on-going, with various adjustments based on funding sources, for 8 decades. One question asked over the entire course of the study's history was  deceptively simple:

Who would you call in the middle of the night if you were sick or afraid?

It turns out that if men had a solid answer to that question,  they were happier with their lives and their marriages.   "There were also connections with the men's answers to that question and their physical health.  Very strong connections."  

The program dug deeper into physical health and emotional connections, suggesting that we should think about how coming into work on a Monday morning.  Do you look forward to seeing people you like? That connection is energizing.  And calming.

The program explained that studies show that the people who are "happiest in retirement are those who actively work to replace colleagues with friends."  "Spending time building and nurturing your friendships might be just as important to your health as eating right and exercising."

Bottom line:  Don't miss the warning signs that your social circles are shrinking, regardless of gender.  

Florida Governor Signs Generator Bill

Florida's governor signed into law a bill that requires nursing homes and ALFs to have generators. The Tampa Bay Times reports  that facilities will be required to not only have the generators but sufficient fuel.  Rick Scott signs bills requiring generators in nursing homes, assisted living facilities  explains that "[t]he bills require the facilities to keep backup generators capable of running air conditioners when the power goes out. They must provide at least 30 square feet of cool space for each resident – at a temperature of no more than 81 degrees – and keep several days worth of fuel on hand."

With hurricane season starting June 1, 2018, it's time to be prepared!

Residents and Industry Watchers Point to Key Indicators of Financial Health for CCRCs

The New York Times has a good overview on 7 Ways to Judge a Retirement Community's Financial Health, by Peter Finch, published on March 9, 2018.  Many of the tips come from savvy residents at Continuing Care Retirement Communities (CCRCs, also called LifePlan Communities) around the country, as well as from actuaries and industry experts.

As consumers grow more aware of risk at all levels of financial markets, senior living providers are facing good questions about how upfront entrance payments and monthly fees are used.  Other topics include appropriate occupancy levels, the history of rate increases, debt ratings that can affect cost of operations and loans, capital improvements, reserves and the right of residents to be engaged on governance issues.  

From the article: 

Retirement community managers will not be shocked by these sorts of questions, promised Stephen Maag, director of residential communities at LeadingAge, an association of aging-service providers. “As we get the people born in the late ’30s and the baby boomers, they’re much more thorough in their research” than their parents and grandparents were, he said.

My thanks to my colleague Laurel Terry, for sending me this article. I especially enjoyed seeing two friends highlighted in the article, Jack and Valerie Cumming, residents of a CCRC in Carlsbad, California.  When I visited with them a few years ago, I was happily amused to realize their lovely CCRC was once the hotel where my own parents spent their honeymoon.  How about that for a sign of the times - -  honeymoon spots that become retirement villages! 

Guess Which Segment of the Senior Living Market is Experiencing the Largest Growth...

I was a bit surprised to read an article this month reporting that Continuing Care Retirement Communities (CCRCs), also known as Life Plan Communities, are experiencing not just growth in occupancy over the last 12 months, but comprise "the only segment of senior living and long-term care to see increased occupancy in 2018."  Lois Bowers, senior editor at McKnight's Senior Living provides the summary of the study:  

The stabilized occupancy rate for CCRCs has increased 30 basis points to 91.5% over the past 12 months and has stayed in the low 90s for the past 10 years, according to the company's senior housing research national report for the first half of 2018.

 

“Rent growth remains strong, with the average advancing 3.2 percent to $3,322 per month in 2018,” the authors wrote about CCRCs, also known as life plan communities.

 

Independent living is the big draw in these communities, where many operators are reducing the number of skilled nursing beds, according to the report.

For more, read CCRCs Alone in Occupancy Increase This Year, Report Says. 

 

Maryland Courts Tackle the Challenge on Guardianship Reform

Maryland is among the several states putting serious energy into modernizing and reforming rules governing guardianships, with major new rules that took effect on January 1, 2018.  In Bifocal, the journal of the ABA Commission on Law and Aging, the Honorable Karen Murphy Jensen, who chaired a multidisciplinary workgroup tackling the state reforms, describes the process during an interview.  She notes the work ahead for many: 

Judge Jensen: These are big changes and courts, attorneys, and guardians need time to navigate them. Maryland’s circuit courts are not uniform and the changes will affect each court differently. Guardianship attorneys need to familiarize themselves with the new requirements and procedural changes. The orientation and training requirements add a step to the process that may overwhelm some prospective guardians and each individual court will have to respond to that reality. 

 

Along the way, the Workgroup consulted with and got feedback from judges, court staff, private attorneys, public agencies, and other service providers outside of the Workgroup. It was clear that the Workgroup would need to provide ongoing technical assistance and develop resources to help everyone navigate these changes once in effect. While sensitive to the impact on family guardians, we believe it is important for guardians to understand what is expected of them and know what tools are available upfront, and for courts to screen out those unable to take on the responsibility.

For more, read: Maryland Judicial Workgroup Spearheads Guardianship Reforms, Vol. 39, Issue 3, Bifocal. 

NAELA Past President Howard Krooks Writes Thoughtfully About Effect of Parkland Shooting on His Family

Seasoned Elder Law attorneys often make the news, but today the sober reason was because I was reading two of Elder Law guru Howard Krooks's Op-Ed pieces for a Florida newspaper, about his son's fortunate escape from the Parkland School shooting and the aftermath for his family and for many, many others, especially those with more tragic outcomes.

 Howard, who is a CELA and past president of the National Academy of Elder Law Attorneys (NAELA), writes in part:  

Now it’s Wednesday morning. We decide Noah will go to school today. Zachary Cruz [the brother of the school shooter] is being held on $500,000 bond. He will undergo a psychological evaluation. His home in Lake Worth will be searched for weapons. And Gov. Rick Scott has requested that an armed law enforcement officer “secure every point of entry” at the school.

 

Good, I think. I feel safe now sending my son to school. Not.

 

My wife came home this morning from dropping off Noah, sobbing. “Why are you crying?” I ask. “Because I just dropped our son off at school, and I don’t know if he will be safe. Will he come home this afternoon? Will we ever see him again? And what if we beef up security at MSD so that nobody unauthorized can enter the campus — but our other son’s middle school is right next door, so the person can just go there and wreak havoc on the middle school campus, instead?”

 

She is sitting on our bed, head in her hands, filled with fear. Post-Traumatic Stress Disorder is real.

 

We need to do better. The legislation Gov. Scott signed on March 9 was a start. But it was just the beginning of the sweeping structural change needed in this country to send our children safely to school each day.

 

We in Parkland want to remain positive. We want to move forward. And we want to honor those who lost their lives or were injured on that terrible day. But most of all, we want to use this tragedy to bring about positive change. . . . 

Thank you, Howard.  For the full Opinion piece, see A Parkland Father's Plea for Help, and his earlier article, As School Shooter Stalks, Texts Between A Father and Son, both in the Sun Sentinel.

National Council on Disability Calls for Nationwide Reforms for Guardianships

On March 22, 2018, the National Council on Disability (NCD) released a new 200-page report and recommendations,  calling for substantial reform of the rules and processes used to place individuals with disabilities or the elderly under guardianships. 

As set forth in the press release, NCD's findings include:

• Guardianship is often imposed when not warranted by facts or circumstances, because guardianship proceedings often operate under erroneous assumptions that people with disabilities lack capability to make autonomous decisions.
• Capacity determinations often lack sufficient scientific or evidentiary basis.
• Although guardianship is considered a protective measure, courts often lack adequate resources, technical infrastructure, and training to monitor guardianships effectively and hold guardians accountable, which at times allows for guardians to use their positions to financially exploit people subject to guardianships or subject them to abuse or neglect.
• People with disabilities are often denied due process rights in guardianship proceedings. 
• Although most state laws require consideration of less-restrictive alternatives, courts do little to enforce those requirements.
• Similarly, though every state has a process for the restoration of one’s rights lost through guardianship, the process is rarely used.
• There is a lack of data on existing guardianships and newly filed guardianships, which frustrates efforts of policymakers to make determinations about necessary areas for reform.

NCD also makes seven sets of specific recommendations, often calling upon the U.S. Department of Justice to take a leadership position in protecting the civil rights of individuals, including providing states with guidance and support for review of existing guardianships with a goal of assessing the potential for restoration of rights.  

Here is a link providing access to the full report, Beyond Guardianship: Toward Alternative That Promote Greater Self-Determination, and to a literature review, and to a qualitative research report summary in support of the NCD recommendations.

My special thanks to Pennsylvania Superior Court Judge Paula Ott for sending me timely information on these publications.

Free Webinar Protecting Elders From Scams

The National Center of Law & Elder Rights has announced their next webinar,  Legal Basics: Protecting Older Adults Against Fraudulent Schemes and Scams. The webinar is scheduled for April 10, 2018 at 2 edt.  Here's a description of the webinar:

With savings and assets accumulated over a lifetime, older adults are attractive targets for individuals promoting fraudulent schemes and scams. Scammers use deception, misrepresentation and threats to convince older adults to send money or provide personal financial information. Most frauds and scams go unreported. 

This webcast will provide an overview of the frauds and scams aimed at older adults, discuss legal protections, and provide resources to aid older adults defrauded by the individuals and business that promote these scams. The webcast will also focus on efforts by the Federal Trade Commission to prevent older adults from falling victim to these scams. 

To register for this free webinar, click here.

The Perils of Serving as a Financial Caregiver

At the invitation of the editor for the ABA Commission on Law and Aging's journal, Bifocal, I wrote a recent article on The Perils of Serving as a Financial Caregiver. I described a fundamental challenge:

What are the family dynamics? Will appointment of one individual create a trap whereby an overlooked or disgruntled offspring, sibling or spouse demands an accounting?  Even successful defense against a weak claim will involve costs to the financial caregivers and to the principal's estate.  Family dynamics can also change over time, especially as feelings of resentment, guilt or denial begin to color relationships. Consider whether greater transparency within the family at all phases of the relationship involving handling of financial matters will deter later problems.

Using an article in the The New York Times today, my words of caution appear mildly framed, compared to the reality of what appears to be one family's deeply embedded dynamic following the death of the parents, pitting two sons against a daughter and her husband over the family fortune in Arkansas.  

“I want this finished, over and done,” Sanders McKee [one son] said in his deposition. “I am tired of wasting my life. She needs to stop wasting her own. And I’m tired of this. I’m absolutely exhausted with it.”

 

But that was in August 2014, and the legal battle continues, costing all sides money and time. The Noels [daughter and son-in-law] estimated that they have spent $1 million on legal fees in the case, and they’re not resting. 

 

Aside from the cost, the case also demonstrates the strain being a trustee can put on family members.

For the full cautionary tale, read Are Millions Missing? Some Relatives Want to Know.  Others Don't, by Paul Sullivan.

Hat tip to my Dickinson Law colleague, Professor Laurel Terry, for the pointer to this interesting New York Times  piece.

World Elder Abuse Awareness Day is June 15, 2018

With World Elder Abuse Awareness Day just a few months away, it's time to think about any events your organization might offer.  According to the USC Center on Elder Mistreatment NCEA email, a microsite has been created  that offers suggestions, helpful hints, events and more. Want to take some kind of action? Check the information here for 13 ideas in a number of categories. Planning an event? List it there. It's never too early to start planning!  And let others know using #WEAAD.

Senate Committee on Aging: Top 10 Elder Scams

A little mid-week reading for you. The Senate Committee on Aging has released their 2018 Fraud Book, listing the top 10 elder scams of 2018.  Fighting Fraud: Senate Aging Committee Identifies Top 10 Scams Targeting Our Nation’s Seniors  lists the top 10 scams of the year, based on reports to the hotline, which are (drum roll please) 

IRS Impersonation Scams

Robocalls and Unsolicited Phone Calls

Sweepstakes Scams / Jamaican Lottery Scams

"Can You Hear Me?” Scams

Grandparent Scams

Computer Tech Support Scam

Romance Scams

Elder Financial Abuse

Identity Theft

Government Grant Scams

Here is the executive summary for the report:

From January 1, 2017, through December 31, 2017, the Senate Aging Committee’s Fraud Hotline received a total of 1,463 complaints from residents all across the country. Calls pertaining to the top 10 scams featured in this report accounted for more than 75 percent of the complaints.

                The top complaint, the focus of more than twice as many calls as any other scam, involves seniors who receive calls from fraudsters posing as agents of the Internal Revenue Service (IRS). These criminals falsely accuse seniors of owing back taxes and penalties in order to scam them. Due to the extremely high call volume and continued reports from constituents from across the country, the Aging Committee held a hearing on April 15, 2015, to investigate and raise awareness about the IRS imposter scam. Prior to a large law enforcement crackdown in October 2016, nearly three out of four calls to our Hotline involved the IRS impersonation scam. In the three months after the arrests, reports of the scam into the Committee’s hotline dropped by an incredible 94 percent. Though the numbers have since rebounded somewhat, they are still far below the levels we have seen in the past.

                The second most common scam reported to the Hotline involved robocalls or unwanted telephone calls. On June 10, 2015, the Aging Committee held a hearing on the increase in these calls that are made despite the national Do-Not-Call Registry. The Committee examined how the rise of new technology has made it easier for scammers to contact and deceive consumers and has rendered the Do-Not-Call registry ineffective in many ways. On October 4, 2017, the Aging Committee held an additional hearing on robocalls, this time examining recent developments by both the private and public sectors to combat robocalls and protect seniors from fraud.

Sweepstakes scams, such as the Jamaican lottery scam, continue to be a problem for seniors, placing third on the list. A March 13, 2013, Aging Committee hearing and investigation helped bring attention to these scams and put pressure on the Jamaican government to pass laws cracking down on criminals who convinced unwitting American victims that they had been winners of the Jamaican lottery. The United States government has had some recent success in bringing individuals connected to the Jamaican lottery scam to trial, but these types of scams continue to plague seniors.

A new scam to make the top 10 list for 2017 involves consumers receiving calls in which the caller would simply ask “Are you there?” or “Can you hear me?” in order to prompt the recipient to say “yes.” According to the Federal Trade Commission (FTC), these illegal robocalls are pre-recorded, and are

designed to identify numbers that consumers are likely to answer, allowing scammers to better identify and connect with potential victims. The increased use of this tactic by scammers in robocalls last year demonstrates how sophisticated scammers are.

Grandparent scams, the focus of a July 16, 2014, Aging Committee hearing, were next on the list. In these scams, fraudsters call a senior pretending to be a family member, often a grandchild, and claim to be in urgent need or money to cover an emergency, medical care, or a legal problem.

Computer scams were sixth on the list and the subject of an October 21, 2015, Committee hearing. Although there are many variations of computer scams, fraudsters typically claim to represent a well-known technology company and attempt to convince victims to provide them with access to their computers. Scammers often demand that victims pay for bogus tech support services through a wire transfer, or, worse yet, obtain victims’ passwords and gain access to financial accounts.

Romance scams were seventh on the list. These calls are from scammers who typically create a fake online dating profile to attract victims. Once a scammer has gained a victim’s trust over weeks, months, or even years – the scammer requests money to pay for an unexpected bill, an emergency, or another alleged expense or to come visit the victim – a trip that will never occur.

Elder financial abuse was eighth on the list and the topic of a February 4, 2015, Committee hearing. The calls focused on the illegal or improper use of an older adult’s funds, property, or assets. Chairman Susan M. Collins, former Ranking Member Claire McCaskill, and current Ranking Member Robert P. Casey Jr. have introduced the Senior $afe Act, which would allow trained financial services employees to report suspected cases of financial exploitation to the proper authorities without concern that they would be sued for doing so. The Committee also examined the financial abuse of guardians and other court appointed fiduciaries at a hearing in November 2016.

Identify theft was the ninth most reported consumer complaint to the Fraud Hotline in 2017. This wide-ranging category includes calls about actual theft of a wallet or mail, online impersonation, or other illegal efforts to obtain a person’s identifiable information. On October 7, 2015, the Aging Committee held a hearing titled “Ringing Off the Hook: Examining the Proliferation of Unwanted Calls”, to assess the federal government’s progress in complying with a new law requiring the removal of seniors’ Social Security numbers from their Medicare cards, which will help prevent identity theft. Medicare will start mailing the new cards in April 2018.

            Government grant scams rounded out the top 10 scams to the Fraud Hotline last year. In these scams, thieves call victims and pretend to be from a fictitious “Government Grants Department.” The con artists then tell the victims that they must pay a fee before receiving the grant.

The report is available here.

From January 1, 2017, through December 31, 2017, the Senate Aging Committee’s Fraud Hotline received a total of 1,463 complaints from residents all across the country. Calls pertaining to the top 10 scams featured in this report accounted for more than 75 percent of the complaints.

                The top complaint, the focus of more than twice as many calls as any other scam, involves seniors who receive calls from fraudsters posing as agents of the Internal Revenue Service (IRS). These criminals falsely accuse seniors of owing back taxes and penalties in order to scam them. Due to the extremely high call volume and continued reports from constituents from across the country, the Aging Committee held a hearing on April 15, 2015, to investigate and raise awareness about the IRS imposter scam. Prior to a large law enforcement crackdown in October 2016, nearly three out of four calls to our Hotline involved the IRS impersonation scam. In the three months after the arrests, reports of the scam into the Committee’s hotline dropped by an incredible 94 percent. Though the numbers have since rebounded somewhat, they are still far below the levels we have seen in the past.

                The second most common scam reported to the Hotline involved robocalls or unwanted telephone calls. On June 10, 2015, the Aging Committee held a hearing on the increase in these calls that are made despite the national Do-Not-Call Registry. The Committee examined how the rise of new technology has made it easier for scammers to contact and deceive consumers and has rendered the Do-Not-Call registry ineffective in many ways. On October 4, 2017, the Aging Committee held an additional hearing on robocalls, this time examining recent developments by both the private and public sectors to combat robocalls and protect seniors from fraud.

Sweepstakes scams, such as the Jamaican lottery scam, continue to be a problem for seniors, placing third on the list. A March 13, 2013, Aging Committee hearing and investigation helped bring attention to these scams and put pressure on the Jamaican government to pass laws cracking down on criminals who convinced unwitting American victims that they had been winners of the Jamaican lottery. The United States government has had some recent success in bringing individuals connected to the Jamaican lottery scam to trial, but these types of scams continue to plague seniors.

A new scam to make the top 10 list for 2017 involves consumers receiving calls in which the caller would simply ask “Are you there?” or “Can you hear me?” in order to prompt the recipient to say “yes.” According to the Federal Trade Commission (FTC), these illegal robocalls are pre-recorded, and are

designed to identify numbers that consumers are likely to answer, allowing scammers to better identify and connect with potential victims. The increased use of this tactic by scammers in robocalls last year demonstrates how sophisticated scammers are.

Grandparent scams, the focus of a July 16, 2014, Aging Committee hearing, were next on the list. In these scams, fraudsters call a senior pretending to be a family member, often a grandchild, and claim to be in urgent need or money to cover an emergency, medical care, or a legal problem.

Computer scams were sixth on the list and the subject of an October 21, 2015, Committee hearing. Although there are many variations of computer scams, fraudsters typically claim to represent a well-known technology company and attempt to convince victims to provide them with access to their computers. Scammers often demand that victims pay for bogus tech support services through a wire transfer, or, worse yet, obtain victims’ passwords and gain access to financial accounts.

Romance scams were seventh on the list. These calls are from scammers who typically create a fake online dating profile to attract victims. Once a scammer has gained a victim’s trust over weeks, months, or even years – the scammer requests money to pay for an unexpected bill, an emergency, or another alleged expense or to come visit the victim – a trip that will never occur.

Elder financial abuse was eighth on the list and the topic of a February 4, 2015, Committee hearing. The calls focused on the illegal or improper use of an older adult’s funds, property, or assets. Chairman Susan M. Collins, former Ranking Member Claire McCaskill, and current Ranking Member Robert P. Casey Jr. have introduced the Senior $afe Act, which would allow trained financial services employees to report suspected cases of financial exploitation to the proper authorities without concern that they would be sued for doing so. The Committee also examined the financial abuse of guardians and other court appointed fiduciaries at a hearing in November 2016.

Identify theft was the ninth most reported consumer complaint to the Fraud Hotline in 2017. This wide-ranging category includes calls about actual theft of a wallet or mail, online impersonation, or other illegal efforts to obtain a person’s identifiable information. On October 7, 2015, the Aging Committee held a hearing titled “Ringing Off the Hook: Examining the Proliferation of Unwanted Calls”, to assess the federal government’s progress in complying with a new law requiring the removal of seniors’ Social Security numbers from their Medicare cards, which will help prevent identity theft. Medicare will start mailing the new cards in April 2018.

            Government grant scams rounded out the top 10 scams to the Fraud Hotline last year. In these scams, thieves call victims and pretend to be from a fictitious “Government Grants Department.” The con artists then tell the victims that they must pay a fee before receiving the grant.

rant.

TThe 60 page report is available here.

Med Students Learn to Talk About Dying

Kaiser Health News featured a story about teaching med students how to talk about death to patients and families. Oregon Medical Students Face Tough Test: Talking About Dying features a test administered to med students in Oregon. " OHSU officials say they’re the first medical students in the U.S. required to pass a tough new test in compassionate communication."

Compassionate communication test requires that the med students "[b]y graduation this spring ... be able to show that, in addition to clinical skills, they know how to admit a medical mistake, deliver a death notice and communicate effectively about other emotionally and ethically fraught issues."  The curriculum was revamped to incorporate "communication, ethics and professionalism" throughout.   Communication is required learning in all medical schools but the OSHU approach may be groundbreaking with the evaluation component.  

No Right To Try Law Yet

Two weeks ago we reported that the House of Representatives were scheduled to vote on the Right to Try Bill that had previously passed the Senate.  If you were betting that the House would also pass the bill, you would be .... wrong.  House Rejects Bill to Give Patients a ‘Right to Try’ Experimental Drugs explains the vote wasn't particularly close.  "The bill was considered under special fast-track procedures that required a two-thirds majority for passage, and it fell short. When the roll was called, 259 House members supported the bill, and 140 opposed it." Those that voted against the bill, the majority Democrats, were worried about patient harms, whether creating false hope or harming patients since the drugs wouldn't have gone through the rigorous FDA process. The article quotes one of the House leadership that the bill will be brought back for another vote, but even so there is no guarantee of passage. There are a number of opponents to the bill, including medical personnel and patient advocaates.  "[M]ore than 75 patient advocacy groups, including the lobbying arm of the American Cancer Society, opposed the bill. .. The American Medical Association said it “does not believe that the bill will substantially improve patient access to investigational therapies.” And the American Society of Clinical Oncology, representing cancer doctors, said the bill “could do more harm than good for patients with life-threatening illnesses” because it would remove the Food and Drug Administration from the evaluation of the risks and potential benefits of some treatments."

A House Committee will address the bill on March 19, according to a March 16, 2018 post from Bloomberg BNA Health Care Daily report so stay tuned.

Who Doesn't Want to Live in Margaritaville?

Margaritaville, at least the Jimmy Buffett version, is no longer a state of mind. The Washington Post ran a story about Jimmy Buffett's foray into senior housing. Adopting a laid-back attitude at Latitude Margaritaville  explains that the "Key West-inspired houses are being built along streets linked to lyrics of Buffett’s 1977 hit 'Margaritaville.'" Continuing the them, the pet spa is "Barkaritaville" and the fitness center is "Fins up!" Guess what's on the menu at the local restaurant? If you guessed "Cheeseburger in Paradise" you'd be right! And as the article makes clear,  Buffett is a significant business entrepreneur.

How's this for fun in a 55+ community. "[O]ne element of Latitude Margaritaville that makes it unusual for an active-adult community: Live music shows will be scheduled five to seven nights a week."  But why a 55+ community for Jimmy Buffett? "he decision to expand the Margaritaville brand into active-adult communities seems like a natural fit, particularly because Buffett’s fans tend to be aging baby boomers who have followed his career for decades."  And fans have come-with over 100,000 requesting information about the planned community.  The homes are selling like hot cakes (or maybe sponge cake would be better to say) with over 225 selling within two months. However, there's a ways to go to full occupancy once the 2 developments of 7,000 are finished over the next decade. The community is around 10 miles away from Daytona  Beach and close to hospitals and other services.  Many other amenities are planned, and of course, there is always the chance that Jimmy Buffett might perform!

Who would want to pass up the chance to live on Spongecake Court?  Come on-admit it, that song is going through your head now....

Dementia-Friendly City in Heart of Silicon Valley

Somehow I never thought I'd right that phrase. Yet, Palo Alto is taking steps to become a dementia-friendly city! Palo Alto looks to become a 'dementia-friendly city' explains that

Palo Alto is among a growing number of communities around the world that have begun to look at how government, businesses and residents can work together to provide better resources — like training for first responders, community support networks and policies that better aid employees who are also caregivers — for the expanding population of aging adults who are being diagnosed with dementia.

Palo Alton has a little more than 30,000 residents now who have dementia (including Alzheimer's) and it is estimated that that number will exceed 50,000 by 2030. "As part of its broader push for an "age-friendly Silicon Valley," Santa Clara County last year joined Dementia Friends, a global movement begun by the Alzheimer's Society in the United Kingdom to change the way people think about dementia."

A public hearing on this is scheduled for late March.  Thanks to my colleague and dear friend Mark Bauer for alerting me to this article.

 

Expanding the Right to Physician-Aided Dying?

The Washington Post recently ran an article about efforts underway by some folks to expand Oregon's physician-aided dying law to include those individuals who do not have terminal illnesses. In Oregon, pushing to give patients with degenerative diseases the right to die explains efforts to expand the scope of Oregon's law to cover those with degenerative diseases, such as "[p]eople with Alzheimer’s, Parkinson’s, Huntington’s, multiple sclerosis and a host of other degenerative diseases [who] are generally excluded from the Oregon law." Why? you might ask. "[B]ecause some degenerative diseases aren’t fatal. People die with Parkinson’s, for example, not because of it. Other diseases, such as advanced Alzheimer’s, rob people of the cognition they need to legally request the suicide medications."

The article notes that this effort isn't limited to just Oregon. In fact, there are "[r]elatively modest drives ... afoot in Washington state and California, where organizations have launched education campaigns on how people can fill out instructions for future caregivers to withhold food and drink, thereby carrying out an option that is legal to anybody: death by starvation and dehydration. (It is often referred to as the “voluntarily stopping eating and drinking” method.)"

Interestingly, the article reports that not all in the right to die movement are in favor of broadening the law.  In fact "groups such as Compassion & Choices, the nation’s largest right-to-die organization, and the Death With Dignity National Center, a main author of the original law, have little appetite for widening access to lethal drugs in the states where medically assisted suicide already is legal."

These initiatives aren't just limited to the U.S. The story reports in Canada The Quebec "provincial government is studying the possibility of legalizing euthanasia for Alzheimer’s patients. Unlike medically assisted suicide, a medical doctor would administer the fatal dose via injection. A survey in September found that 91 percent of the Canadian province’s medical caregivers support the idea."

The Oregon legislature has taken the first step,  the passage last month of legislation to investigate "how to improve the process of creating and carrying out advance directives. Gov. Kate Brown (D) is expected to sign it."

The article also reminds us of the Harris case where Mrs. Harris, with an advance directive, was spoon fed by the facility where she resided.  There have been a number of folks requesting language added to their advance directives to avoid the spoon-feeding issue according to the attorney for Mr. Harris.