Elder Law Prof Blog

Call for Papers: AALS Section on Aging and the Law 2022 Annual Meeting

The AALS Section on Aging and the Law will focus its annual meeting program on inequality and aging. The conception of the program is broad and intended to encompass all matters of legal concern that involve age and inequality. Potential topics include but are not limited to aging in the criminal justice system, contact between family and nursing home residents during the COVID-19 pandemic, the disparate impact of policies within the Medicare and Medicaid programs, vaccine distribution policies, the rights and wages of care workers, the impact of technology on access to legal assistance, and economic inequality in later life based on disability, gender, race, sexual orientation, or other characteristics.

If you are interested in participating, please send a 400-600 word description of what you would like to discuss. We particularly encourage submissions from junior scholars and members of underrepresented groups in legal academia. Submissions should be sent to Professor Alexander A. Boni-Saenz, [email protected] by June 1, 2021.

Call for Proposals Aging, Health, Equity, and the Law Conference

Touro College Jacob D. Fuchsberg Center is pleased to host the virtual Aging, Health, Equity, and the Law Conference on September 13, 2021. The conference theme focuses on structural and systemic questions about discrimination and equity that older adults experience, and on policies recognizing these different challenges and promoting equity. The conference features individual presentations, panel presentations, and discussion groups. The conference will be held online with no registration fee. New York CLE credit will be available.

A non-exhaustive list of presentation topics might include:

Inequities in COVID-19 Care for Seniors, including State Responses to Deaths of Nursing Home Residents from COVID-19, and Caregiving

Vaccination Priorities in the COVID-19 Pandemic

Rationing of Health Care

Disparities in Wealth Creation, Housing,  Employment, or Planning Based on Age, Race, Ethnicity, Class, Sexual Orientation, Disability, Gender or Gender Identity

Social Determinants of Health for Seniors

Age and Disability Discrimination

Elderly Prisoners, including Perspectives on Incarceration as a Public Health Issue and Compassionate Release

Elder Abuse

Telehealth Digital Divide

Historical and Current Perspectives on Elder Law, Health Care, and Race

Anti-Racism Approaches to Teaching and Learning Elder Law and Related Topics

Incorporating Cultural Sensitivity in Elder Law Courses

Presentation Guidelines, Deadline, and Submission Instructions

The program committee welcomes individual proposals and panel or discussion group proposals. Individual presentations will be 25 minutes including questions. Panels or discussion groups will be 50 minutes including questions. Presentation proposals are due by June 18, 2021. 

The proposal should include:  

1. Presenter name(s), email, title, school affiliation, and mailing address
2. Title of the proposed presentation or discussion group
3. Presentation format: presentation, panel presentation, or discussion group
4. A description of what you would like to discuss (300-500 words)

Submit your proposal through the conference website www.tourolaw.edu/ahelc. Email Professor Joan Foley at [email protected] with any questions. The program committee may not be able to accommodate all proposals.

Presentation proposals are due June 18, 2021.

New Research Briefs from NCEA

The National Center on Elder Abuse has released two new research briefs.  First, Mistreatment of Chinese Elders offers these takeaways;

• Despite being referred to as the “model minority”, elder abuse is prevalent in the Chinese community.

• Core values of filial piety and family harmony profoundly shape the response to elder mistreatment among this population.

• Definitions of psychological abuse and financial exploitation in the Chinese community are unique compared to other populations.

• Experiences of immigration and acculturation shape an older Chinese immigrant’s experience of elder mistreatment.

• Intervention recommendations include involving family members in educational/support programs, improving communication between elders and adult children, emphasizing traditional cultural values, and increasing care and support for victims, especially women.

After discussing a number of factors, the research brief offers tips for working with the victims and adding to the body of research.

The next research brief, Mistreatment of Korean Elders , offers these takeaways:

• Filial piety, family harmony, and patriarchal values profoundly shape the response to elder mistreatment in the Korean community.

• Definitions of psychological abuse and financial exploitation among Korean elders are unique compared to other populations

• Immigration and acculturation experiences shape an older Korean’s experience of elder mistreatment.

• Korean elders are less likely to seek outside help or disclose family problems.

• Promising intervention strategies include providing educational information on financial abuse, improving communication between elders and adult children, involving indigenous healthcare providers and religious leaders in elder abuse education, and increasing help-seeking behaviors.

After the discussion of the issues, the research brief offers tips for working with Korean elders and adding to the body of research.

55 and Older and In Debt

The New York Times took a look at the amount of debt of those 55 and over, including information since the start of the pandemic.  Rising Debt, Falling Income: How to Dig Out explains

According to the Employee Benefit Research Institute, the share of households headed by someone 55 or older with debt — from credit cards, mortgages, medical bills and student loans — increased to 68.4 percent in 2019, from 53.8 percent in 1992. Bankruptcy rates among older adults are also rising.

The Covid-19 pandemic may be adding to their woes. A survey at the end of 2020 by Clever, an online service that connects home buyers and sellers with real estate agents, found that on average, retirees had doubled their nonmortgage debt in 2020 — to $19,200. .. [B]usiness cutbacks had forced many older adults to retire earlier than planned. Others left work for health reasons or to care for family members ... 

Also driving this rising debt load are soaring medical costs, the steep decline in pensions, growing housing expenses and low interest rates on savings. To make ends meet, many older adults are known to skip meals and to cut pills to stretch prescriptions, according to a survey by the National Council on Aging.

The article continues with advice to readers on how to work their way out of debt. 

Proposed Changes to the Provision of Long Term Care

Kaiser Health News recently provided an overview of the changes proposed by the Biden Administration to long term care.  Biden Seeks $400 Billion to Buttress Long-Term Care. A Look at What’s at Stake provides this overview:

The services in question. Home and community-based services help people who need significant assistance live at home as opposed to nursing homes or group homes.

  *  *  *  

The need. At some point, 70% of older adults will require help with dressing, hygiene, moving around, managing finances, taking medications, cooking, housekeeping and other daily needs, usually for two to four years. 

*  *  *

Medicare limitations. Many people assume that Medicare — the nation’s health program for 61 million older adults and people with severe disabilities — will pay for long-term care, including home-based services. But Medicare coverage is extremely limited.

  *  *  *  

Medicaid options. Medicaid — the federal-state health program for 72 million children and adults in low-income households — can be an alternative, but financial eligibility standards are strict and only people with meager incomes and assets qualify.

  *  *  *  

The article additionally reviews the impact on family caregivers and the workforce, questions about the Administration's proposal and some suggestions for reform.  Stay tuned; this isn't going to be a quick or easy journey.

Takeaways from CMS Guidance on SNF Visitation

The National Consumer Voice for Quality Long Term Care has published takeaways from the most recent CMS guidance on SNF visitation. 

Here are some of  the highlights:

• Facilities should allow indoor visitation at all times and for all residents except in certain specific circumstances.

• There are now fewer circumstances under which indoor visitation can be completely suspended.

• Fully vaccinated residents can have close contact, including touch, with visitors as long as they wear a mask and practice hand hygiene.

• Visitors should not be required to be tested or vaccinated as a condition of visitation.

• CMS continues to emphasize that facilities shall not restrict visitation without a reasonable clinical or safety cause and that nursing homes must facilitate in-person visitation consistent with the federal nursing home regulations.

• Visitation must be person-centered and “consider the resident’s physical, mental, and psychosocial well-being, and support their quality of life.”

The summaries and significant takeaways are available here.

As well the Consumer Voice has released the Summary of the Centers for Disease Control and Prevention's Guidance on Quarantine for Residents of Long-Term Care Facilities, which is available here.

Podcast: Caring for People With Dementia

The National Consumer Coalition for Quality Long Term Care announced the release of a podcast, The Care For Individuals With Dementia.  Here's a description of the podcase. 

When the needs of residents living with dementia are met, incidences of resident stress are significantly reduced. Practicing person-centered approaches and interventions increase the likelihood that the message being communicated by the resident will be heard and addressed, leading to better outcomes and more satisfaction for the individual. In this episode of the Pursuing Quality Long-Term Care podcast, Dr. Jonathan Evans and Lori Smetanka of Consumer Voice talk about caring for human beings with dementia.

The podcast can be accessed here.

Aid in Dying in Montana

Kaiser Health News ran an interesting story about aid in dying in Montana.  Getting a Prescription to Die Remains Tricky Even as Aid-in-Dying Bills Gain Momentum

[I]n 2009, the Montana Supreme Court had, in theory, cracked open the door to sanctioned medically assisted death. The court ruled physicians could use a dying patient’s consent as a defense if charged with homicide for prescribing life-ending medication.

However, the ruling sidestepped whether terminally ill patients have a constitutional right to that aid. Whether that case made aid in dying legal in Montana has been debated ever since. “There is just no right to medical aid in dying in Montana, at least no right a patient can rely on, like in the other states,” said former state Supreme Court Justice Jim Nelson. “Every time a physician does it, the physician rolls the dice.”

The article discusses the legislative efforts on both sides of the issue. Fascinating story!

Elder Justice Policy Highlights

The National Center on Elder Abuse has released the latest elder justice policy highlights.  Here is a summary:

The elder justice legislation found in this document was elicited and finalized from the National
Center on Elder Abuse (NCEA) Listserv and independent websites in February 2021. The
compilation is intended to reflect highlights across the nation and does not include all legislation related to elder justice. However, updates will be sent biannually and states are encouraged to send updates on significant legislative action to Ageless Alliance. This document reflects activity in 15 states and highlights at the federal level.

In addition to summaries by state, the highlights include links to the individual legislation. 

 

Oh and btw, mark your calendars now for the 2021 World Elder Abuse Awareness Day, June 15, 2021.

State of SNFs Prior to Pandemic

WGBH, a PBS station, ran this story a bit ago.   New Studies Show Dire State Of Nursing Homes Even Before The Pandemic opens with a focus on staff turnovers and highlights recent studies:

The pandemic has shined a harsh spotlight on nursing homes. Despite less than 1% of the population living in nursing homes and longterm care facilities, they account for about a third of all COVID-19 deaths. Now, two new national studies show that, even before the pandemic, the nursing home industry was in a dire situation. The studies paint a picture of places where it is unappealing to work and risky to stay.

[T]he first national study of staff turnover in nursing homes before the pandemic, published this month in Health Affairs. The study found an extraordinarily high rate of staff turnover, with an average of over 100%.

“That means the average nursing home in the U.S. has their entire nursing home staff change over the course of the calendar year,” [said one study author]. “And we found that some nursing homes had turnover as high as 300%, suggesting the staff is turning over every four months.”

That doesn't necessarily mean that all employees leave during a year. A facility with 10 staff members could have 100% turnover if everyone leaves and is replaced by a new person or if one job is filled 10 different times because the new hires keep leaving.

The article also discusses private equity involvement in the long term care industry.

New Alzheimers Website from Federal Government

If you haven't seen this yet, check out the new website, Alzheimers.gov. This site compiles a significant amount of great info. As the website explains

Alzheimers.gov is the federal government portal to information and resources on Alzheimer’s disease and related dementias, including Lewy body dementia, frontotemporal disorders, and vascular dementia. Alzheimers.gov is managed by the National Institute on Aging (NIA) at the National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services (HHS). HHS is the U.S. government’s principal agency for enhancing the health and well-being of all Americans.

. . . 

A primary goal of Alzheimers.gov is to connect people to the many federal resources available to educate and support people whose lives are touched by these devastating diseases in their various roles. Whether you are living with dementia, a family member or friend, health care provider or other health care professional, researcher, or advocate, Alzheimers.gov is designed for you.

. . . 

The Digital Divide Still Exists For Elders

Pew's recent FactTank released this, 7% of Americans don’t use the internet. Who are they? Want to take a guess who are in this 7%? "Internet non-adoption is linked to a number of demographic variables, but is strongly connected to age – with older Americans continuing to be one of the least likely groups to use the internet. Today, 25% of adults ages 65 and older report never going online, compared with much smaller shares of adults under the age of 65."  There is also a correlation between education and the income of a household with being online.  There has been some movement. "For example, 86% of adults ages 65 and older did not go online in 2000; today that figure has fallen to just a quarter."  Think about this info and recall how important technology use became during COVID.

Multi-Generational Housing Increasing

A recent study, Family Matters: Multigenerational Living Is On The Rise And Here To Stay, was recently published.

Generations United wanted to learn more about the effect of the vast COVID-19 pandemic on multigenerational living specifically, and at the end of January 2021 commissioned a public opinion poll, conducted online by The Harris Poll, to determine if multigenerational households were growing and what makes them tick. The survey results reported here give us insights as to the growth, why families plan to continue living together – and why it helps them be strong and resilient.

The findings are very interesting:

Our results are clear: multigenerational living is indeed on the rise in 2021, with more than 1 in 4 Americans (26%) living in a household with 3 or more generations. Given our finding in 2011 that 7 percent of Americans lived in a multigenerational household,4 this means that multigenerational living has nearly quadrupled in the past decade (a 271 percent increase from 20115 to 2021). This finding is incredibly striking, and our survey reveals some of the impetus for this staggering growth. As expected, the pandemic does play a strong role. Among those living in a multigenerational household, nearly 6 in 10 (57%) say they started or are continuing to live with multiple generations because of the pandemic.

The full report is available here.

New Documentary on Death With Dignity

Published recently in the Washington Post,  Diane Rehm tackles ‘death with dignity’ again, this time in a new documentary. "In 2016, Diane retired from NPR station WAMU after working there for more than 30 years. Since then, she has championed what she and other advocates call “death with dignity.” On Wednesday, PBS will broadcast her new documentary, 'When My Time Comes.'"  The article is a Q&A with the author about her book and the resulting documentary. Check it out!

Webinar on Ageism in SNFs

The Long Term Care Community Coalition is offering a webinar on April 20, 2021 at 1 eastern on an Antidote to Ageism in Nursing Homes. Here's the description

Residents thrive when helped to achieve their highest practicable level of physical, mental, and psychosocial wellbeing. When the requirements of the Nursing Home Reform Act of 1987 are realized, the colonial, custodial injustice of long-term scare will finally end. In this webinar, Cathy Unsino, LCSW, will talk about how to transform nursing homes into warm, vibrant communities in which residents and staff thrive.

Click here to register.

Recent Study on POLST

POLST and other advance medical planning should not be a one-time conversation according to a recent study.

Two new studies from Indiana University and Regenstrief Institute focus on POLST, a medical order form widely used in nursing homes that documents what life-sustaining treatments a person prefers to receive or not receive, such as hospitalization or comfort-focused care. The studies, published online ahead of print in the Journal of the American Geriatrics Society (JAGS), found discrepancies between medical orders recorded in the POLST form and nursing home residents’ (or surrogate decision-makers, for those unable to make their own decisions) current treatment preferences and explore reasons for the lack of agreement.

Further

The researchers found that less than half of all POLST forms of the 275 study participants matched current treatment preferences for resuscitation, medical interventions, and artificial nutrition. However, the POLST was more than five times as likely to agree with current treatment preferences when these orders reflected preferences for comfort-focused care. In interviews, participants reported the mismatch was due to factors including a lack of key information when they filled out the form and not revisiting POLST when the resident experienced a change in condition.

Thanks to my friend Morris Klein for sending me the link to this story.