Elder Law Prof Blog

Free Webinar:Advanced Training on Medicare Part B

Sign up now for this upcoming November 20, 2019 webinar from the National Center of Law & Elder Rights.  The webinar is on Advanced Training on Medicare Part B, and is scheduled for 2 p.m. eastern.  Click here to register.  According to the announcement,

Advanced Training on Medicare Part B When: Wednesday, November 20, 2019 at 11:00 a.m. PT/2:00 p.m. ET. Beneficiaries and advocates face challenges navigating the benefits covered under Medicare Part B and understanding the basics of accessing these benefits. This webcast will look at three areas that can often cause confusion and will provide advice on how to address common problems: ·         Advance Beneficiary Notice (ABN): What is it and what options do clients have when faced with an unexpected bill after signing an ABN? ·         Part B Drugs: What drugs are covered by Part B and what payments are required? ·         Durable Medical Equipment: For 2019 and 2020, competitive bidding has been suspended for all DME except insulin supplies. What does this mean for your client’s access to suppliers? Presenter: Georgia Burke, Directing Attorney, Justice in Aging NOTE: This is an advanced training and assumes participants have a general understanding of Medicare benefits. Please see NCLER's Health Training curriculum for more information on the Legal Basics of Medicare Parts A, B, and C.

DC Ethics Opinion on Impaired Lawyers

The D.C. Bar recently released a new ethics opinion addressing the obligations when an attorney becomes impaired.  Ethics Opinion 377  Duties When a Lawyer is Impaired starts by explaining

The District of Columbia Legal Ethics Committee has examined the ethical duties of partners; other managerial or supervisory lawyers and subordinate lawyers; and non-lawyer employees to take appropriate measures when they reasonably believe another lawyer in the same law firm or government agency is suffering from a significant impairment that poses a risk to clients.¹ A related question involves the duties owed to clients and the profession when an impaired lawyer leaves a law firm or government agency, particularly when the lawyer may continue to practice law, regardless of whether clients are, or may be, terminating their relationship with the firm in order to remain clients of the departing lawyer.

This Opinion deals only with mental impairment, which may be a chronic or temporary condition arising out of or related to age, substance abuse, a physical or mental health condition or other circumstance affecting the lawyer. This Opinion supplements the guidance contained in Legal Ethics Opinion 246, with a specific focus on the issue of impaired lawyers, whose conduct may or may not trigger mandatory reporting obligations under the Rules, as discussed herein. This Opinion also relies, in part, upon ABA Committee on Ethics and Professional Responsibility Formal Opinion 03-429 (2003).

The impairment of a lawyer may fluctuate over time, regardless of its cause. However, if a lawyer’s periods of impairment are on-going or have a likelihood of recurrence, then partners, or other lawyers with managerial or supervisory authority may have to conclude that the lawyer’s ability to represent clients is materially impaired.

A range of ethics rules are implicated, including those setting forth the duties owed by lawyers to clients and the profession, and those addressing issues of supervising lawyers and non-lawyer employees. At the outset, and as discussed within this opinion, the Committee recognizes that there are tensions between ethical duties that arise under the D.C. Rules of Professional Conduct (the “Rules”) and requirements or prohibitions that may exist under the substantive law, specifically with respect to employee privacy and other rights. Lawyers and law firms must be cognizant of the legal landscape in which these difficult issues occur.

Mental impairment may lead to an inability to competently represent a client as required by Rule 1.1, to complete tasks in a diligent and zealous manner as required by Rule 1.3, and to communicate with clients about their representation as required by Rule 1.4.

Rule 5.1 requires partners or other lawyers with managerial or supervisory authority to make reasonable efforts to ensure that all lawyers and those under their supervision comply with the applicable Rules and to ensure that their law firm or government agency has in effect measures giving reasonable assurance that all lawyers in the firm or agency conform to the Rules. These provisions require managerial or supervisory lawyers who reasonably believe or know that a lawyer is impaired to closely supervise the conduct of the impaired lawyer because of the risk of violations of the Rules and resulting harm to clients. Rule 5.2 may also apply to subordinate lawyers if they know of and ratify the conduct of the impaired lawyer.

Rule 8.3 requires a lawyer, regardless of managerial or supervisory authority, to report an impaired lawyer to the appropriate professional authorities including, but not limited to, the District of Columbia Office of Disciplinary Counsel,if the impaired lawyer has committed a violation of the Rules that raises a substantial question as to that lawyer’s honesty, trustworthiness or fitness to practice law, unless such disclosure would be prohibited under the duty of confidentiality owed to clients under Rule 1.6 or other law.... Further, if the firm or government agency removes the impaired lawyer from a matter, it may have an obligation under Rule 1.4 to discuss with the client the change in staffing on the matter. The duty to discuss removal of government lawyers from a matter may be different because of government policies or regulations.

If the impaired lawyer resigns, is removed or otherwise leaves the law firm, the firm may have additional disclosure obligations under Rule 1.4 to clients who are considering whether to remain with the firm or to transfer their representation to the departing lawyer. However, the firm should be cautious to limit any disclosures to necessary information permissible to disclose under applicable law. The obligation to report misconduct under Rule 8.3 is not eliminated if the impaired lawyer leaves the firm.

Beyond the ethical obligations embodied in the D.C. Rules, a fundamental purpose of identifying and addressing lawyer impairment is to encourage individuals who are suffering from mental impairment to seek and obtain assistance and treatment. This purpose should not be forgotten as lawyers, firms and agencies seek to comply with the ethical mandates discussed herein.  (citations omitted)

The lengthy discussion examines the duties of others who supervise or have some managerial duties, as well as the duty to report.  It concludes that:

In circumstances where a law firm or government agency addresses the issue of an impaired lawyer, there is a crucial balancing between protecting the interests of the clients and properly discharging the law firm or government agency’s obligations to protect the privacy of the lawyer under substantive law. Having appropriate policies and procedures designed to encourage reporting and to address issues of impairment within the law firm or government agency are important steps in ensuring that an impaired lawyer does not violate the Rules and that partners, and managerial and supervisory lawyers properly discharge their duties under the Rules.

Student Views of Recent Events

For those of you who are regular readers, you'll remember a few weeks ago I posted a couple of students' writings about recent events. Here are a couple of more.

First, on the new provision for CMS to point out abuse:

A Stop Sign for SNFs

By Sabrina Chianese

Pictured here is a new symbol from CMS, to be put to use on October 23. If you see this symbol on CMS’s Nursing Home Compare, it’s a sign that the home you’re researching has “received inspection-report citations for abuse that led to the harm of a resident within the past year — or citations for abuse that could have potentially led to resident harm in each of the previous two years.” In other words, skilled nursing facilities with this symbol have committed some pretty serious abuses against their patients.

The reason for this symbol is simple – CMS wants to both promote safer, higher-quality SNFs and to make consumers more aware of which facilities have caused harm to patients. The American Health Care Association views this change positively; however, it is also argued that, to fully allow for consumer knowledge of these issues, there needs to be an option for the patients, families, etc. to provide public feedback on their care.

I think it’s a good idea to increase exposure to the issue of nursing home abuse, as we’ve seen some horrendous cases in just this past couple of years. A facility in Massachusetts was cited multiple times for abuses, including medication mismanagement, staff members verbally abusing patients, and patients harming other patients. Most recently, a resident of that facility used a walker to kill his roommate. During Hurricane Irma, twelve residents of a Florida nursing home died when the facility lost its air conditioning and failed to move residents to a safer, functioning building; some patients reached temperatures of over 107 degrees. Homicide charges are being pressed, and Florida law now requires “backup power sources [like generators] in Florida nursing homes and assisted-living facilities” as a direct result of this tragedy. Additionally, at a CLC for veterans, one patient passed away after being covered by and “feasted on” by fire ants, despite claims that the facility had tried to solve the problem the first time he was swarmed.

AARP has provided information on how to handle nursing home complaints from a consumer or resident standpoint. Having insurance for missing items, being aware of dietary restrictions, fostering positive relationships with staff, being engaged in a family member’s care, and reporting abuses are some of the methods that AARP advocates depending on the severity of the complaint.

While it’s important to know how to deal with complaints, potential abuse, signs of malnutrition, and other serious problems, it’s equally important for people searching for this specialized care to know which facilities have committed abuses beforehand. I would even argue that it’s more important – no one wants to be in a position where their loved one is harmed or even killed because they unknowingly selected a nursing home that had been cited for multiple serious offenses. Part of the reason for the new symbol is because positive ratings through the CMS’s star system can be misleading.

While it’s a small step, I think having the symbol is still a helpful idea – we need to make people aware of what abuses are being committed and which facilities are repeat offenders. I thus also agree that having the kind of service advocated for by the American Health Care Association – a Yelp-like service for nursing homes – will be helpful, too, because it lets people read about the experiences of others while they are in the process of researching a nursing home.

Second, a post from student Melissa Shafer about robotic pets:

NBC News published an article about the positive impacts robotic pets have on the elderly, specifically for individuals living with dementia. Several companies, such as Tombot and Joy for All, produce robotic pets as companions for the elderly and people with disabilities, while aiming to offer them at reasonable prices. Robotic pets are designed to replicate some of the behaviors of living pets to make them seem more lifelike, such as the ability to purr, wag their tails or move their heads. Many of these companies started producing robotic pets in response to loneliness and lack of companionship experienced by the elderly.

A 2018 study by AARP found that about one third of people aged 45 and older were lonely. In addition, the World Health Organization published an article in 2017 and determined that for individuals over 60, roughly 20% were experiencing a mental or neurological disorder, most often as a result of dementia and depression. The use of robotic pets is aimed to address these issues.

Furthermore, research by NBCI confirmed that interactions between adults and animals increase quality of life by reducing anxiety in patients with dementia, and decreasing rates of depression and loneliness. While robatic pets are not living animals, they may be a great solutions for the elderly that would benefit from companionship when they are no longer able to manage the care required of a living pet. This is especially the case for individuals that had a pet pass away, or for those that had to give up a pet because they were not able to keep up with the maintenance a living pet requires. While the trend of robotic pets is still on the rise, they may remedy loneliness, depression and anxiety that the elderly population can experience, to increase their overall quality of life.

Links:

• AARP: https://www.aarp.org/research/topics/life/info-2018/loneliness-social-connections.html?CMP=RDRCT-PRI-HOMFAM-073118

• Joy for All: https://joyforall.com/

• NBC News: https://www.nbcnews.com/mach/science/why-robotic-pets-dementia-care-may-be-next-big-thing-ncna990166

• NBCI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573436/

• Tombot: https://tombot.com/

• World Health Organization: https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults

Washington Post Offers Bold School Newsletter

Do you ever wish there's a handbook on aging to your maximum potential instead of just experiencing aging as it happens? The Washington Post has announced a 12-week newsletter, called Bold School.  

Here's where you register for the newsletter.

According to the announcement I received, this what Bold School is about:

Wine and cheese get better with age. You can, too.

Perhaps you thought getting older would be easier. And it’s not hard to see why: The toughest days of raising kids or building a career are over, and you’ve been promised time to relax. Maybe your expectations have been defied. If you’ve been looking for tried-and-true tips to get you over the speed bumps of aging, our new newsletter is for you. Bold School, a 12-week newsletter series, is here to help you approach life after 50 with curiosity and enthusiasm. The series aims to nourish, educate, inform and stimulate you, all while helping you save time and money.  In Bold School, Post journalists Vicky Fogg, 64, and Suzette Moyer, 55, will share their experiences of life after 50 and offer smart advice on how to get better with age.  . . .

Law Profs Initiative To Cut Down Academic Paper Marketing

A number of law profs are signing on to initiative to reduce paper advertisements between law schools. Here's the info about the initiative and how law profs can sign on to the pledge.

In honor of International Day of Climate Action (October 24), a group of law professors have announced the Pledge to Reduce Academic Marketing Waste, which seeks to address the routine and indiscriminate use of paper-based flyers, newsletters, offprints and postcards by law professors and law schools.  Most of this material is discarded without ever being read.  However, law schools continue to produce and distribute these materials in an effort to increase or maintain their national and international rankings.

Continuing this practice is unconscionable in the current era, given the availability of electronic marketing options.  Limiting or eliminating reliance on paper-based materials will not only reduce the destruction of forests, it will also reduce carbon emissions generated as part of the printing and transportation processes.

Given the competitive nature of higher education, it is unlikely that individual law schools will act on their own initiative to stop or significantly curtail paper-based marketing for fear of risking their rankings.  However, positive results may be obtained by coordinating actions across numerous law schools. 

Individual faculty members as well as law schools both inside and outside the United States are therefore invited to join the Pledge to Reduce Academic Marketing Waste by emailing Prof. S.I. Strong ([email protected]) to indicate their support.  The names of individual law professors and institutions who have adopted the Pledge will be published on a webpage housed at Pace University.  That webpage is regularly updated to show increased support for this initiative.

The language of the Pledge is as follows:

We, the undersigned, hereby pledge to reduce academic marketing waste, individually and institutionally, by limiting or eliminating the production and transmission of paper-based marketing materials and/or by encouraging the relevant decision makers at our institutions to adopt actions and polices consistent with that goal.  Reducing academic marketing waste can take a variety of forms, including but not limited to:  (1) reducing the size of paper-based marketing materials (eg, replacing newsletters with postcards); (2) reducing the frequency of paper-based marketing initiatives; (3) adopting an opt-in rather than opt-out approach to paper-based mailing initiatives; (4) replacing some or all paper-based marketing with electronic or other forms of marketing. 

Please feel free to forward this message to anyone at your institution or in your network who you think might be interested in joining the Pledge.  The current signatories can be seen here -

https://law.pace.edu/academics/juris-doctor-program/environmental-law-program/pledge-reduce%C2%A0academic-marketing-waste - although more are being added all the time.

 

Pennsylvania's Unique Role for Older Adult Advocacy in State Government

On Monday, I participated in a panel discussion of aging services in Pennsylvania, at the invitation of Professor Patricia Aguilera-Hermida, who is on the faculty of Human Services and Family Studies at Penn State Harrisburg.  Even though I knew most of the panelists -- all experienced professionals from Pennsylvania's Department of Aging -- the occasion gave me new insight and respect for the role of advocacy on behalf of older adults.  The students were attentive and asked great questions, and I suspect some of them saved their best questions for the one-on-one time with the speakers.

Robert Torres, the Secretary of Aging in Pennsylvania reminded us that our state has a uniquely strong, dedicated funding system to advocate for older adults through the Pennsylvania Lottery.  About 80% of the department's operations and outreach budget is funded by this source.  As anyone who has worked in state or federal government would know, the "fight" for adequate funding for operations can be intense, and in many states older adults would not have a strong position in the queue for necessary dollars.

The breadth of programming outlined by the panelists is impressive. For example,  Christine Miccio, Director of the Bureau of Aging Services described in detail the OPTIONS program that provides direct support for more than 55,000 older adults who are still in their homes. Pennsylvania also has more than 500 publicly supported Senior Centers -- a way to reach additional people with meals, health care information, activities and social programs.  Margaret Barajas, a dynamo who is the Statewide Long-Term Care Ombudsman, explained how a system of volunteer and paid advocates investigate and coordinate responses to concerns about senior living-based needs, including concerns about quality of services in nursing homes and assisted living facilities.  Denise Getgen, as director of the Older Adult Protective Services Office, described the ever growing need for investigation of complaints about elder abuse, neglect and exploitation.  In recent years, the number of complaints received and investigated by the state has grown to over 40,000 allegations per year, with the majority of concerns focusing on self-neglect for persons in isolated circumstances.  I've worked with several of these units directly over the years, especially when I was head of my Law School's Elder Protection Clinic.  Pennsylvania's Area Agencies on Aging continue to fund and coordinate certain free legal services for seniors in need in each county throughout the state.

One student asked about whether services from the Department are limited to "citizens" of the United States -- and it was impressive to hear the long list of services that are NOT restricted by citizenship.  Another student tossed a "softball" question -- "what is your favorite program?" -- and Christine Miccio hit it out of the park by describing the success of a new pilot program in rural Pennsylvania that matches up older adults who need housing or assistance -- with those who can provide housing or assistance.   She joked that she is now the eHarmony of housing matches, especially as the original pilot program is extending to several additional counties.  

My thanks to Professor Aguilera-Hermida for hosting this noon-time chat with so many students who are considering a wide range of aging services as part of their career goals.  One enterprising student explained to me that her interest in the field of gerontology at medical school was sparked when she found affordable housing as a student in a well-known, nearby nursing home that had "extra" space.  

Resources on Learning More on Opiod Pain Meds & the Public Health Emergency

Here's a new fact sheet from the Keck School of Medicine at USC on an important topic. What I should know about opioid pain medicine is a valuable 2 page fact sheet in an easy-to-use format. The topics include pain meds vs. opioids, items that interact badly with opioids, signs of overdoses and more.

Check it out!

 

Webinar on Self-Neglect and Hoarding

Here's an upcoming free webinar from the National Center on Law & Elder Rights on November 12 at 2 est:

Legal Basics: Self-Neglect and Hoarding Disorders

When: Tuesday, November 12, 2019 at 11:00 a.m. PT/2:00 p.m. ET.

Lawyers working with older adults are likely to encounter challenges related to self-neglect and hoarding. Intervening in self-neglect cases can be very complicated. Clients who have a hoarding disorder may be living in conditions that make it impossible for them to live in safety, resulting in self-neglecting behaviors. This Legal Basics session will discuss the most common root causes of self-neglect and hoarding disorders, provide insight into the complexity of the issues, and offer suggestions of how to offer help. The webcast will also explore legal issues and the lawyer’s role when working with older adult clients.

The webcast will cover:

• Understanding self-neglect and helping without harming.
• The line between self-neglect being a human services issue and a legal issue.
• Assessing possible hoarding disorder cases. 
• Suggestions when working with a person with hoarding disorder.
• When hoarding becomes a legal issue.

This webcast is being presented as part of NCLER’s forthcoming Elder Justice Toolkit. Stay tuned for more!

Click here to register.

Loosening the Regs of Florida ALFs?

The Tampa Bay Times ran an article a few days ago that raises some important issues. Florida’s assisted living facilities write rules on reporting deaths, injuries . explains the current reporting requirements when a resident is injured and the proposed change to the requirement.

When a resident in one of Florida’s assisted living facilities falls, dies or is seriously injured, that facility is required to tell the state within one business day that something has gone wrong. But a bill before lawmakers would give operators weeks to report such critical incidents — potentially leaving residents in harm’s way, elder advocates warn.

Industry groups for assisted living facilities, which crafted much of the bill’s language and handed it to lawmakers, say the one-day reports are not needed, and eliminating them will reduce onerous paperwork and unnecessary administrative fines.

Hang on for a second and think about this.  There must be a reason for the current requirement... and advocates say it's because they "are necessary to inform state regulators quickly of potential incidents, and that the change is part of a decades-long deregulation of the industry that could put residents at greater risk."

The section on adverse incidents involves one of the key methods for alerting regulators when something goes wrong. Currently, an initial report must be filed if a resident dies, sustains serious injuries, goes missing or is transferred to a hospital or other facility for more intensive care — and facility administrators think they may be responsible.

Assisted living facilities are required by statute to submit up to two reports: one within one business day after an incident, and another full report within 15 days if the facility determines it is responsible. When a report is filed, the Agency for Health Care Administration can then use it to initiate an investigation if it raises concerns about resident safety.

The proposal requires just 1 report that is filed by 15 days, when the facility makes the decision that " the incident happened in the scope of its care, though it would direct the facility to begin investigating the incident within 24 hours" the article reports. The article indicates that the bill was brought by the Florida Senior Living Association, and is supported by AHCA. Advocates for residents take the opposing few-that is more regulation rather than less.  The bill's sponsor in the Florida Senate is quoted as saying "the legislation [is] a “modernization” bill that would primarily update language in the statute, and allow residents to use devices to move around more easily or prevent falls.... [and that] the language to reduce the number of adverse incident reports was meant to bring assisted living facilities in line with a recent change made to reduce those reports for nursing homes, and “to make sure the language would be as similar as possible." Although the Senator has spoken primary with the industry folks, she plans to talk to resident groups too, the article reports.

Read the bill and follow it. If you live in Florida, let your elected representative know your position on this. If you live in another state, pay attention anyway. The revisions could be proposed in other states as well.

Another Article on Saving for Retirement

MarketWatch published an article last week on the amount of money you need to have for your retirement,  If you want to have enough money when you retire, you need to know this.  "Calculating future savings requires numerous factors, including current age and predicted retirement age, any current assets, how the portfolio is invested and at what rate a person can realistically expect that money to grow. The latter, known as a “rate of return,” includes inflation, interest and dividend payments, and many experts disagree on what individuals can anticipate that rate to be."  There are various views regarding the percentages needed for the rate of return and there are a couple of ways to reference it, the article explains.

As with most other facets of retirement planning, an assumed rate of return can be different from one person to the next, said [one advisor]... The reality is that it is almost entirely dependent upon your own personal allocation....” Many advisers also have their own way of creating projections, and will show clients a few estimates — from conservative to aggressive — when making a financial plan. “There is no one perfect number to use....”

Still, investors may want to err on the conservative side, as it’s better to save too much than end up in retirement with too little....  And investors, especially younger ones, should not be chasing returns.

Bottom line, you need to start saving (the earlier the better) for your retirement if you plan to retire

Updated Resources in the Fight vs. Elder Abuse

NAPSA has announced two resources for the fight vs. elder abuse. The first is an updated version of the National Guidelines for Financial Institutions: Working Together to Protect Older Persons from Financial Abuse. "The Guidelines and forms [are] ... designed to promote standardization and clarity among financial institutions and Adult Protective Services."  Note that the guidelines include a variety of useful forms, which are accessible here in addition to their inclusion in the guidelines. 

NAPSA also announced  the creation of  "the National Clearinghouse on Financial Exploitation, your "go to" for for all things related to financial exploitation. The Clearinghouse will provide answers to questions, links to resources, introduction to partners and problem solving to help strengthen our resources and partnerships in our fight against financial exploitation."

Go to NAPSA-Now for more information and resources.

GAO Report: Protecting Vets from Financial Exploitation

The GAO recently issued this report, Veterans Benefits: Actions VA Could Take to Better Protect Veterans from Financial Exploitation. Here are the highlights from the report

Why This Matters

Veterans with disabilities who receive benefits from the Department of Veterans Affairs (VA) can be tempting targets for exploitation and scams. Veterans and their survivors who need help performing everyday activities, like bathing and dressing, can receive increased pension benefits known as aid and attendance.

Key Takeaways

VA paid $3.2 billion in total pension benefits to 232,000 recipients of aid and attendance in fiscal year 2018. Most recipients were over 80.

Scams that target them include:

• being overcharged for home care, or charged for services they did not receive, and

• getting bad investment advice from financial services organizations.

VA does not centrally collect and analyze information, such as complaints made against companies, that could show the prevalence of these scams, help VA target outreach to veterans, and help law enforcement go after scammers.

Other threats to veterans include:

• VA’s applications do not warn them about exploitation or scams: For example, forms do not warn veterans that they cannot be charged fees for filing claims.

• Misdirected benefit payments: VA does not always verify direct deposit information on applications, which could lead to payments being stolen. In contrast, the Social Security Administration verifies this information by reviewing individuals’ checks or account statements.

• What GAO Recommends

  We made four recommendations to VA, including that it collect better information on potential financial exploitation, post warnings on applications, and examine if it should take more steps to verify veterans' direct deposit information. VA agreed in principle with the need to collect better information, but its proposed actions do not fully address our concerns. VA agreed with the other three recommendations.

The full report is available here.

Hospitals in the Housing Business?

Kaiser Health News ran this story, Why Hospitals Are Getting Into The Housing Business.

The article opening with anecdotes involving patients at a Denver hospital,

In the first half of this year alone, the hospital treated more than 100 long-term patients. All had a medical issue that led to their initial hospitalization. But none of the patients had a medical reason for remaining in the hospital for most of their stay.

Legally and morally, hospitals cannot discharge patients if they have no safe place to go. So patients who are homeless, frail or live alone, or have unstable housing, can occupy hospital beds for weeks or months — long after their acute medical problem is resolved. For hospitals, it means losing money because a patient lingering in a bed without medical problems doesn’t generate much, if any, income. Meanwhile, acutely ill patients may wait days in the ER to be moved to a floor because a hospital’s beds are full.

What's a hospital to do? In some cases, provide or pay for housing for  those patients. According to the article, a number of hospitals are "exploring ways to help patients find a home. With recent federal policy changes that encourage hospitals to allocate charity dollars for housing, many hospitals realize it’s cheaper to provide a month of housing than to keep patients for a single night."  Think about that statement again.... one month of housing may be cheaper than one night's hospital stay.

So the Denver hospital featured in the story is taking this a step farther, "partnering with the Denver Housing Authority to repurpose a mothballed building on the hospital campus into affordable senior housing, including about 15 apartments designated to help homeless patients transition out of the hospital."

Examine these numbers: One night in the hospital featured in the story "costs ... "$2,700 a night [and] ..... [p]atients who are prime candidates for the transitional units stay on average 73 days, for a total cost to the hospital of nearly $200,000. The hospital estimates it would cost a fraction of that, about $10,000, to house a patient for a year instead."

The KHN article references a recent report from the Urban Institute on the correlation between health and housing.  Fascinating info!

New Report-SSA Needs More Oversight of Those Who Handle Vulnerable Beneficiaries $

The GAO recently released a new report, Social Security Benefits: SSA Needs to Improve Oversight of Organizations that Manage Money for Vulnerable Beneficiaries. Here are the highlights:

What GAO Found

The Social Security Administration (SSA) approves organizational payees—such as nursing homes or non-profits that manage the Social Security benefits of individuals unable to do so on their own—by assessing a range of suitability factors, such as whether the organizations have adequate staff to manage benefits for multiple individuals. However, GAO found that SSA's policy does not specify how to assess more complex suitability factors, such as whether an organization demonstrates sound financial management. Without clearer guidance, unqualified or ill-prepared organizational payees could be approved to manage benefits. Also, SSA does not currently require background checks for key employees of an organizational payee. In contrast, SSA requires background checks for individual payees—such as a relative or friend of the beneficiary. A comprehensive evaluation could help SSA determine whether and how to expand their use of background checks to organizational payees.

To ensure organizational payees are managing funds appropriately, SSA uses several monitoring tools, including resource-intensive onsite reviews. Certain organizational payees, such as those that charge fees for their services or have 50 or more beneficiaries (high-volume), receive onsite reviews every 3 to 4-years. In contrast, payees that serve fewer than 50 beneficiaries (low-volume)—the vast majority—are selected for review based on their estimated likelihood of misusing beneficiary funds, and a relatively low percent of them receive onsite reviews (see figure). SSA uses a predictive statistical model to identify higher risk low-volume payees, but the model's effectiveness cannot be fully assessed by GAO or others due to missing documentation on how it was designed. SSA officials said they will update the model in the future, but do not have a time frame for doing so. Establishing such a time frame and documenting design decisions are key steps toward assessing the model's effectiveness.

. . .

What GAO Recommends

GAO is making nine recommendations in this report, including that SSA: clarify how to assess complex suitability factors; assess requiring background checks for organizational payees; establish a timeframe for reviewing the predictive model and document design decisions resulting from that review; and establish timeframes for, and conduct revisions of the accounting form. SSA agreed with all nine recommendations and provided technical comments that GAO incorporated as appropriate.

The full report is available here.

Cognitive Impairments and Using Technology

Who among us doesn't have a smart phone or computer, or even a tablet? They are not only ubiquitous, they are integral, and perhaps essential, to our daily lives.  What happens when someone, due to cognitive impairments, is no longer able to use these devices? Kaiser Health News made that the subject of a recent article. The Delicate Issue Of Taking Away A Senior’s Smartphone describes the potential problems

Increasingly, families will encounter similar concerns as older adults become reliant on computers, cellphones and tablets: With cognitive impairment, these devices become difficult to use and, in some cases, problematic.

Computer skills may deteriorate even “before [older adults] misplace keys, forget names or display other more classic signs of early dementia,” Zorowitz wrote recently on a group email list for geriatricians. (He’s based in New York City and senior medical director for Optum Inc., a health services company.)

“Deciding whether to block their access to their bank accounts, stocks and other online resources may present the same ethical dilemmas as taking away their car keys.”

Consider that some folks stay in touch with family and friends through their digital lives. But also consider how scammers can use email to perpetrate a fraud.  The article notes a difficulty in using these devices---a difficulty that did not previously exist--may be an indicator of cognitive issues signaling a need for a comprehensive exam of cognition.  Family can be helpful, but still realize there are issues

[B]eware of appropriating someone’s passwords and using them to check email or online bank or brokerage accounts. “Without consent, it’s a federal crime to use an individual’s password to access their accounts,” said Catherine Seal, an elder-law attorney at Kirtland & Seal in Colorado Springs, Colo. Ideally, consent should be granted in writing.

The article notes that some with dementia lose interest in their devices, but that is not true for everyone-it depends on the type of cognitive impairment.  "More difficult, often, are situations faced by people with frontotemporal dementia (FTD), which affects a person’s judgment, self-awareness and ability to assess risk." The article then profiles the experiences of a noted elder law attorney and friend of mine, whose husband as an FTD diagnosis. She shared the steps she takes to keep her husband safe online.

Read the entire article, especially the last part where personal experiences and tips are shared.  It's an important topic-we all need to think about this and plan for the eventuality in case we need to give up our digital word.

Emergency Planning & Older Adults: A New Report on Preparedness

We are still in hurricane season down here in Florida, sporting 90 degree temperatures, while Montana had a blizzard.  Natural disasters take all forms so it's important to remember that everyone needs a disaster plan. the University of Michigan National Poll on Healthy Aging  published a new report, Emergency Planning among Older Adults.

Introduction

Natural disasters and other emergencies can happen anywhere. When they do occur, older adults, including those with chronic health conditions and impaired mobility, may be particularly vulnerable to adverse effects. In May 2019, the University of Michigan National Poll on Healthy Aging asked a national sample of adults age 50–80 about their experiences with disasters and emergency planning as well as their preparedness for such events.

Preparing for emergencies

In the past year, more than one in five adults age 50–80 (22%) had experienced an emergency or disaster such as a power outage lasting more than a day, severe weather, evacuation from their home, or a lockdown, while 73% reported experiencing at least one such event during their lifetime. More than half of respondents (53%) thought they were likely to experience an emergency or disaster in the next year.

The question is then, are these folks prepared?  Not everyone, according to the poll results:

Implications 

Although more than half of older adults believe they will likely experience some type of natural disaster or emergency in the coming year and the majority generally feel confident in their ability to manage through them, many older adults have not taken key steps recommended by disaster preparedness agencies. Nearly half of respondents either did not know if their community had an emergency alert system or had not yet signed up. Having any advanced warning of a disaster or emergency, even minutes, can help people get to a safer place, so signing up for these alerts, where available, is important. 

Although most older adults who require essential medications or health supplies reported having a seven-day supply available, three in four individuals who use medical equipment that requires electricity did not have an alternative power source. Roughly half of respondents reported having a week’s supply of food or water, or tools for communication in the event of a power outage such as a solar or battery cell phone charger or a battery-powered or hand crank radio. Disaster preparedness agencies recommend such resources for everyone, and these steps may be particularly important for older adults with complex health needs or mobility challenges. 

The American Red Cross, FEMA, and AARP all offer guidance for preparing/responding to disasters and emergencies specifically designed for older adults. These groups and others tasked with promoting emergency preparedness should consider utilizing new strategies to reach and engage older adults who may not already be well-prepared for emergencies. Additionally, health care professionals who care for older adults should consider discussing disaster preparedness, particularly in areas that routinely face natural disasters. Preparing now can help older adults — and everyone — to be ready for emergencies.

The full report is available here.

Make These a Part of Your Exercise Routine?

We all know how important it is to keep moving! But what gives us the maximum benefit, at least from the standpoint of being the most you can be (I sound like the old Army ad "Be all you can be") when you are older. The Washington Post ran this informative article, The longevity files: A strong grip? Push-ups? What actually can help you live to a ripe old age.

Here are some tips from the article--pushups, walking speed, sitting on the floor and standing up (known as sit-rise) and grip strength matter.  But those are not magic elixirs--instead they are representative of your ability,  "that you are still strong and nimble enough" to do them. "What these tests have in common is they’re good shorthand of things that matter for longevity: overall health, fitness and muscle strength. A fit person walks faster than someone out of shape, and getting up off the floor is tricky for people with weak bones and muscles."

As the article notes, there is no magic pill for longevity, but exercise does help... a lot. Even short amounts of exercise make a difference.  Oh and it's not just exercise; sleep matters as well as does diet.  Alcohol in moderation and keeping stress under control are also important.  Having friends and a purpose are also discussed in the article. 

This reminds me of so much of what we were taught in health and gym classes back in high school.  So now that you've read this post, read the article and then take walk.

 

Thanks to Professor Naomi Cahn for sending me the link to the article.

Changing the Perceptions of Ageism Through Positive Media

One of the questions I ask my students at the beginning of the semester is to quickly tell me characteristics of someone the students consider to be old. I typically get responses that involve wrinkles, grey hair, use of assistive mobility devices and the like. I will sometimes ask them to tell me about positive aging representations in television and movies. In the past someone would mention the Golden Girls, now I'm not so sure current generations of students are familiar with the show, so instead I expect someone to mention Grace and Frankie.

To this point, I was quite interested in the project between AARP and Getty Images,  Media Image: Age Representation in Online Images. The report from AARP reveals the common use of negative images in media to portray elders.

Visual portrayals and stock photography build and reinforce stereotypes. The current landscape of online images does not accurately reflect the 50-plus population. This portrayal may exacerbate ageism in the workplace by rarely showing adults age 50-plus at work or with technology but rather as isolated or dependent on others for assistance. Images are often intended as heartwarming, showing younger people helping the 50-plus, but this portrayal has unintended consequences.This media scan suggests that visual representations need to reflect greater diversity and authenticity. Specifically, more images are needed that portray older adults as independent and actively engaged in their communities. In addition, more images are needed that show the 50-plus in work settings and using technology with confidence.

Here are some of the key findings from AARP's study

• Nearly half of all adults in the U.S. are 50 and older, but only 15 percent of the random sample of images studied showed people in this age group. That's fewer than 1 in 7 images.
• Adults 50-plus are portrayed in a positive light 72 percent of the time. That's much less than people 49 or younger, who are featured in a positive light 96 percent of the time.
• Although 1 in 3 people in the U.S. labor force are age 50-plus, only 13 percent of online media images show a middle-aged or older adult in a work setting.

To remedy this, AARP & Getty have launched an online collection of positive stock aging that can be licensed for use,  AARP and Getty Images Launch Photo Collection to Fight Ageism.

To fight ageism and illustrate the active lifestyles of adults age 50-plus, AARP has joined with Getty Images in launching a collection of more than 1,400 stock photos available for a fee to media outlets, ad agencies and other firms.

The Disrupt Aging Collection features photos of older Americans as vibrant and engaged, some of whom are singing, skiing, swimming in the sea, traveling abroad, playing team sports and hoisting adult beverages with their friends at the beach.

Check out the photos here.  Now, if only they were free....