Elder Law Prof Blog

Robot Pets Combatting Isolation?

There have been lots of discussions about the impact of isolation necessitated by COVID, especially on elders.  We have previously written about robot pets, and now the New York Times has examined the role of these robots in lessening the impact of isolation during the pandemic:  In Isolating Times, Can Robo-Pets Provide Comfort?

Such devices first appeared in American nursing homes and residences for seniors several years ago. A Japanese company began distributing an animatronic baby seal called PARO in 2009, and Hasbro started marketing robotic cats in 2015.

But the isolation caused by the coronavirus, not only in facilities but also among seniors living alone in their homes, has intensified interest in these products and increased sales, company executives said. It has also led to more public money being used to purchase them.

The article discusses the adoption of the robots by various facilities, and then the interest individuals have shown in having the robots as their companions.

Of particular interest is the Joy for All brand sold by Ageless Innovation, a spinoff of Hasbro, and available from retailers like Walmart and Best Buy for about $120.

One of the largest studies, underwritten by United HealthCare and AARP, distributed free Joy for All robots to 271 seniors living independently.

All the seniors suffered from loneliness, according to a screening questionnaire. At 30 and 60 days, “there was improvement in their mental well-being, in sense of purpose and optimism,” said [the] chief medical officer of AARP’s business subsidiary and a study co-author. The study also found “a reduction in loneliness,” ... although the questionnaires showed that participants remained lonely.

Armed with such findings, Ageless Innovation has been offering discounted robots to state agencies working with seniors. (Both Joy for All and PARO robots can be sanitized to prevent viral transmission, the companies said.)

One Medicare Advantage plan covers them and Ageless Innovation is working to get other MA plans to also cover them. The article also discusses the views of fans and critics of the use of these robot pets. Of course, nothing beats human interaction!  What do you think?

ABLE Account Webinar

Mark your calendars now for a free webinar on ABLE accounts on Tuesday October 13 at 2 eastern.

The ABLE Act offers the opportunity for 8 million individuals with disabilities to save without affecting means tested benefits. The ABLE Act builds on the Americans with Disabilities Act (ADA), recognizing the extra, significant costs that come with living with a disability. This training will cover how ABLE accounts empower people to save and invest their funds in a tax-advantaged savings vehicle to cover a wide range of qualified disability expenses, providing for a better future and enhanced quality of life.

Presenters will share:

• How an ABLE account can increase financial independence
• ABLE account basics and the interaction with SSI and Medicaid
• Resources and tools

Presenters:

• Miranda Kennedy, Director, ABLE National Resource Center
• Marlene Ulisky, Disability Benefits Expert, ABLE National Resource Center
• Pshon Barrett, Esquire, ADA Group, LLC, Attorneys for Disabled Americans and ABLE account owner and 2020 ABLE NRC Ambassador

Closed captioning will be available on this webcast. A link with access to the captions will be shared through GoToWebinar’s chat box shortly before the webcast start time.

This training will be presented in a WEBCAST format to accommodate more participants. Due to the high volume of participants, computer audio will be the only option to listen to the presentation. No telephone call-in number will be provided. Please plan accordingly. Thank you. 

This webcast will be recorded and available on our website shortly after the presentation. The recording and training materials will also be emailed to all registrants within a few days after the training.

To register, click here

 

Guardianship Court Monitoring Survey

Two researchers are collecting data on court monitoring involving conservatorships and guardianships.

The National Center for State Courts would like to learn about your experiences with court monitoring practices of guardians and conservators.

This survey is part of the research that [two researchers] are conducting in preparation for the 4^th National Guardianship Summit to be held in May 2021, at the Syracuse University Law School.

Please answer the questions with reference to the jurisdiction you are most familiar with. Responding to the survey will take less than 15 minutes of your time. You will not be identified in any manner, as findings from the study will be presented only in the aggregate.

The researchers acknowledge the assistance of the State Justice Institute in conducting this survey.

 

Updates on SNFs and COVID

Not a day goes by, or so it seems, that thee isn't some new article or announcement or data released about SNFs.  Here, in no particular order, is some of the recent ones that I've collected in my inbox.

New York Times: Nursing Homes Oust Unwanted Patients With Claims of Psychosis

CMS: Nursing Home Visitation - COVID-19

Connecticut Health I-Team:  Pandemic Deals Another Blow To Nursing Homes: Plummeting Occupancy

New York Times: Inside a Nursing Home Devoted to Treating Those With Covid-19

CMS: Response to Nursing Home Commission Report.

Kaiser Health News:  Hospitals, Nursing Homes Fail to Separate COVID Patients, Putting Others at Risk

The Consumer Voice: Taking Care of You. TIPS FOR RESIDENTS OF LONG-TERM CARE FACILITIES

Voting Guide for Individuals with Cognitive Impairment

The ABA Commission on Law & Aging, along with the Penn Memory Center,  has announced the release of a new voting guide, Assisting Cognitively Impaired Individuals with Voting: A QUICK GUIDE.

Here's the intro to the guide

Difficulties in communication can occur when interacting with a person who has cognitive impairment. The techniques and tips described in this guide will help make sure that your communication is as effective as possible and within the limits of assistance permitted by election laws.
These techniques and tips are especially important when interacting with persons who are diagnosed with Alzheimer’s disease or another brain illness or disorder such as stroke or head injury.

The guide discusses capacity to vote, communication challenges, and listening skills. The guide offers 10 case studies with suggestions for those who may be assisting such voters.

An underlying principle here is that people should not be treated any diferently in voting rights based on any perceived impairment or other personal characteristic. People whose mental capacities are clearly intact may vote for candidates based on any whim or reason, rational or irrational. Similarly, for persons with some level of cognitive impairment, if they can indicate a desire to participate in the voting process and they can indicate a choice among available ballot selections, their reasons for such choice are not relevant.

The full guide is available here. 

Dying from Isolation?

Prohibiting visitors to SNFs has hopefully helped limit the spread of COVID. But what is the impact of those in isolation? According to the Washington Post article, Pandemic isolation has killed thousands of Alzheimer’s patients while families watch from afar, for some the impact has been profound. According to the Post's research, the article states that

Beyond the staggering U.S. deaths caused directly by the novel coronavirus, more than 134,200 people have died from Alzheimer’s and other forms of dementia since March. That is 13,200 more U.S. deaths caused by dementia than expected, compared with previous years, according to an analysis of federal data....

Overlooked amid America’s war against the coronavirus is this reality: People with dementia are dying not just from the virus but from the very strategy of isolation that’s supposed to protect them. In recent months, doctors have reported increased falls, pulmonary infections, depression and sudden frailty in patients who had been stable for years.

This is an important consideration as states begin to allow visits to residences of LTC facilities.  Data is also showing increased deaths not specifically from COVID but "occur from causes such as hypertension or sepsis. But they are occurring at much higher levels than in the past, experts say, in part because of the pandemic’s indirect effects — hospitals being overrun or care being delayed."

The article highlights a number of individuals' stories and compares reopening of SNFs in other countries to that of the US.  "Countries like the Netherlands have safely reopened their nursing homes without any increase in coronavirus cases by providing ample protective equipment, testing and rigorous protocols. ... But in the United States, little of the trillions in emergency funding has gone to nursing homes. For months, the Trump administration has talked of getting more testing into nursing homes, but the effort continues to be plagued with problems."

The article includes information about the methodology used for this study. This is a helpful article to use as a basis of class discussion. I'm assigning to my students!

A New Movie About Alzheimer's

Remember when you went to the movie theater (I know, it's been a while) and before the movie, there would be displayed on the screen that the movie would be in Dolby sound. Well, guess what. Dolby is more than sound. Dolby is the man who invented it, Ray Dolby to be exact. Mr. Dolby died a few years back from Alzheimer's. It's only fitting that his son has released a new movie, The Artist's Wife, abut Alzheimer's, New Film "The Artist’s Wife" Tells the Story of a Family Navigating an Alzheimer’s Diagnosis. 

The film, described as  "show[ing] the difficult and often raw dynamics of a family facing an Alzheimer’s diagnosis ... stars Lena Olin and Bruce Dern, and [Dolby's] own family’s experience facing the disease." An interview with the filmmaker about the film and his family experiences is available here.

The Alzheimer's Association is doing an advance screening of the film. "Visit this link to register to watch “The Artist’s Wife” before it is released in theaters and virtual cinemas on September 25. Access is limited, so please reserve your spot today. The film is currently only available to U.S. viewers."

The Swedish Housing Experiment

A recent article in The Guardian highlighted a housing experiment in Sweden that combats loneliness,  'It's like family': the Swedish housing experiment designed to cure loneliness. (If you don't have an account with The Guardian, you need to register, but there is no fee).

The project, known as Sällbo,  is 

[A] radical experiment in multigenerational living in Helsingborg, a small port city in southern Sweden. Its name is a portmanteau of the Swedish words for companionship (sällskap) and living (bo), and neatly encapsulates the project’s goals – to combat loneliness and promote social cohesion by giving residents incentives, and the spaces, for productive interaction.

Sällbo, which opened last November, consists of 51 apartments spread over four floors of a refurbished retirement home. More than half of the 72 residents are over 70s, like Ahlsten and Bacharach; the rest are aged 18-25. All were selected after an extensive interview process to ensure a mix of personalities, backgrounds, religions, and values, and all had to sign a contract promising to spend at least two hours a week socialising with their neighbours.

Not only was this project designed to combat isolation amongst Sweden's elders, it also was designed to respond to "the 2015 refugee crisis [which] meant organisations like Helsingsborgshem were under pressure to house growing numbers of people who were struggling to integrate with – and win acceptance from – Swedish society. So a plan was hatched to mix the two, with younger Swedish people acting “as a bridge."  So far the reports of the project's success have been positive despite the hurdles of starting a new endeavor in these times (think COVID). Information about the services, costs, etc. are available here.

Thanks to my colleague and dear friend, Professor Bauer, for bringing this article to me.

Ombudsman Safety Bags

Here's a cool idea from the National Long-Term Care Ombudsman Resource Center:  Ombudsman Safety Bags! As states begin to allow visits for residents of LTC facilities, ombudsmen, among others, need to keep themselves, and others, safe.  The safety bags include  "an Ombudsman imprinted face mask, hand sanitizer, sanitizer wipes, and resources specifically for Ombudsman programs. The resources include tips for Ombudsman program communication, a tip sheet about self-care, NORS FAQs related to COVID-19, 25 Ombudsman program promotion postcards, and COVID-19 Recovery and Reentry Resources."  It seems that these bags would be helpful for any professional who interacts with others, especially in cases where attorneys make home visits to their clients. 

I just wanted to share something positive with you, so there you have it!

Coronavirus Commission Releases Report on SNFs

Hot off the press.  CMS has released the report of the Coronavirus Commission for Safety and Quality in  Nursing Homes.  The purpose and objectives of the Commission:

Convene a commission of experts to address safety and quality in nursing homes in relation to the public health emergency. The main purpose of the independent Coronavirus Commission for Safety and Quality in Nursing Homes (Commission) was to solicit lessons learned from the early days of the pandemic and recommendations for future actions to improve infection prevention and control measures, safety procedures, and the quality of life of residents within nursing homes. 

The 25 member commission met 9 times and made the following:

27 recommendations and accompanying  action steps organized into 10 themes. These themes intersect with the Commission’s four objectives, and reflect responses to:
• Ongoing supply and affordability dilemmas related to testing, screening, and personal
protective equipment (PPE)
• Tension between rigorous infection control measures and quality of life issues that exist
in cohorting and visitation policies
• A call for transparent and accessible communications with residents, their representatives
and loved ones, and the public
• Urgent need to train, support, protect, and respect direct-care providers  Outdated infrastructure of many nursing-home facilities
• Opportunities to create and organize guidance to owners and administrators that is more
actionable and to obtain data from nursing homes that is more meaningful for action and
research
• Insufficient funding for quality nursing home operations, workforce performance, and
resident safety.

The commission did not unanimously adopt the report. The 186 page report is available here. Stay tuned.

COVID and SNFs: Deaths Preventable?

The New York Times asked the hard question, whether COVID deaths in SNFs were preventable, in a recently published opinion from the editorial board. How Many of These 68,000 Deaths Could Have Been Avoided?

Around 40 percent of all coronavirus-related deaths in the United States have been among the staff and residents of nursing homes and other long-term care facilities — totaling some 68,000 people.

Those deaths were not inevitable. The novel coronavirus is adept at spreading in congregant living facilities, and older people face an increased risk of contracting and dying from it. But most of the nation’s nursing homes had months of warning about the coming threat: One of the first coronavirus outbreaks in the country was in a nursing home near Seattle, making it clear that such facilities ought to prepare.

The opinion discusses steps SNFs could have taken to reduce the chances of spread, the financial model for SNFs in the US. The opinion also discusses the reduction of oversight and notes

Every effort should be made to ensure that the bulk of the money that the government puts into this industry goes to patient care, not providers’ pockets. An investigation started by the House of Representatives into the nation’s largest for-profit homes is a meaningful step in this direction. The Justice Department should follow suit.

The opinion discusses the way SNFs get supplies for their PPEs, etc. as well as staffing shortages. The editors conclude with 3 recommendations

In the near term, lawmakers should provide for hazard pay for nursing home workers in the next relief package and should require all nursing homes to enact non-punitive sick-leave policies so that workers don’t infect colleagues or residents.

In the longer term, federal officials need to consider revising Medicaid reimbursement rates for long-term care so they support higher than minimum-wage salaries, and shifting reimbursement policies so at least some long-term care can be reimbursed with Medicare dollars.

Lawmakers and nursing home operators also would do well to consider a national initiative, perhaps involving student volunteers and internship programs, to recruit future workers to nursing home care. That work, which can be deeply rewarding, will remain urgently needed long after this crisis passes.

Florida Allows LImited Visits to SNF/ALF

The Tampa Bay Times recently reported that the Florida Governor was authorizing visitation of residents in SNFs and ALFs in certain circumstances, DeSantis says yes, but will Florida nursing homes reopen to visitors? The order, which was effective on September 1, still requires that visitors maintain social distance. "The governor’s executive order...  end[ed] the five-month ban on visitors at long-term care facilities that he imposed in an effort to protect the state’s most vulnerable residents from the coronavirus. The order will continue to allow visits from those deemed essential or compassionate caregivers, including in facilities that have had recent positive tests." The order is optional and the SNFs and ALFs can choose to not allow visitors.

The final report of the task force appointed by the Florida governor is available here.

Dual Eligibles and COVID Coverage

Mark your calendars now for a free webinar on How Health Plans Serving Dual Eligibles Can Center Equity During COVID-19.  The webinar is set for October 6, 2020 from 2-3:30 p.m.  Here's a description of  the webinar.

The COVID-19 pandemic has brought to the forefront longstanding racial disparities in our healthcare system, and data show that older adults – especially older adults of color and those in residential congregate settings – are disproportionately impacted by the virus. Aging advocates play a key role in holding health plans and government agencies accountable to meeting the needs of those most at risk during this time. In this webinar, How Health Plans Serving Dual Eligibles Can Center Equity During COVID-19 , we will provide an overview of dual eligibles and the types of health plans that serve them. We will also present specific programmatic recommendations that advocates can push health plans with dual eligible members in their community to adopt. These recommendations are measures that plans can take to center equity in their ongoing response to COVID-19 and ensure they are meeting the needs of older adults of color during this challenging time.

To register, click here.

Legal Issues in Using AI for Caregiving

Computer Weekly recently addressed the legal issues that may occur when using technology for caregiving AI may be a solution to the social care crisis, but what are the legal concerns?,  looks at the caregiving situation in the U.K.  Building on the story from yesterday about the robot "Pepper" who can carry on conversations, the article highlights some legal issues, such as an individual's privacy. 

Consider this-the robot could report concerns about abuse, for example, "the technology might provide a report, supported by video evidence, to family members or those with the legal responsibility of care, such as attorneys or deputies, who can then review such material. It can easily become part of a care home contract to consent to such filming, although it is vital that this is handled in a sensitive manner and regularly deleted to ensure that a resident’s privacy is protected." The article notes concerns about "sensitive personal data." Would residents provide consent? Who would consent if a resident lacks capacity. As the article concludes, "[W]e must never forget who is at the heart of these considerations, and the legal framework needs to catch up with the technology to protect them and for it to have a viable chance of success."

Thanks to Professor Feeley for sending me this article.

Lonely? Robot Companions May Help

The Guardian recently published an article about the use of robots in long term care facilities to combat loneliness of residents. Robots to be used in UK care homes to help reduce loneliness describes the roll these robots can play in interacting with residents.  These are not your "normal" robots, but then I don't know what one would consider a "normal" robot. These robots, on wheels, "called “Pepper”, move independently and gesture with robotic arms and hands and are designed to be “culturally competent”, which means that after some initial programming they learn about the interests and backgrounds of care home residents. This allows them to initiate rudimentary conversations, play residents’ favourite music, teach them languages, and offer practical help including medicine reminders."  The researchers not that these robots do not replace human caregivers but instead supplement them.  The robots were tested in the U.K. and Japan and researchers found that those residents who spent time with the robots for "18 hours across two weeks had a significant improvement in their mental health. There was a small but positive impact on loneliness severity among users and the system did not increase feelings of loneliness...." 

Robots, whether "Pepper" or others, do have limitations--for example, they aren't human.  The article reports some of the limitations mentioned, such as their chats with residents were lacking some depth, were impersonal and lacked cultural awareness. Their movements were, shall we say, robotic. But imagine, a robot that can hold a conversation with you.  This can be a great tool, to supplement human caregivers!

Thanks to Professor Feeley for sending me the article.