Advocates for homeless people in many big cities say they have seen a spike in the number of elderly homeless, who have unique health and housing needs. Some communities, including Phoenix and Orange County in California, are racing to come up with novel solutions, including establishing senior shelters and hiring specially trained staff.
Thursday, May 25, 2023
Updates on Aid-in-Dying Legislation
I noted a couple of developments concerning medical aid-in-dying laws that I wanted to share.
First, Vermont became the second state to eliminate the reseidency requirement for aid-in-dying. This change was pursuant to litigation by a plaintiff in Connecticutt. See Vermont Removes Residency Requirement for Medically Assisted Deaths and see VT HB 190, https://legislature.vermont.gov/bill/status/2024/H.190. The language of the bill amending the statute is available here.
And on the other side of the issue of the right to assistance-in-dying, a group in California has challenged their law. Kaiser Family Foundation (KFF) Health News reported last month that Disability Rights Groups Sue to Overturn California’s Physician-Assisted Death Law. The article notes the platinffs' argument that "that recent changes make it too easy for people with terminal diseases whose deaths aren’t imminent to kill themselves with drugs prescribed by a doctor" and that this law and its process "'steers people with terminal disabilities away from necessary mental health care, medical care, and disability supports, and towards death by suicide under the guise of ‘mercy’ and ‘dignity’ in dying,' the suit argues. The terminal disease required for assistance is, by definition, a disability under the Americans with Disabilities Act...." A story about the litigation is available on NPR here.
May 25, 2023 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink
Wednesday, May 24, 2023
Age of Elected Officials Once Again in the News
Perhaps the age of elected officials is never really out of the news with the question being whether a candidate is too old or too young. Maybe age is garnering more attention because of the upcoming presidential election and the ages of candidates. But it's not just presidential candidates. The age of some Senators has been drawing attention. Why Dianne Feinstein, Like Many Before Her, Refuses to Let Go; Opinion,The U.S. Senate, it’s senior living made permanent. Join today! (satire); and for a different take, an article forwarded by Professor Naomi Cahn, 80 is different in 2023 than in 1776 – but even back then, a grizzled Franklin led alongside a young Hamilton.
Google "how to think about President Biden's age" and you will get a # of results which run the gamut from articles to opinion pieces. Is it really about age? Or is it about the ability to do the job? This New York Times article, How Much Do Voters Really Care About Biden’s Age? reviews polls and research and is a pretty interesting read. Age is definitely a factor, but so is party affiliation, among other factors, the article notes.
I suspect each of us will reach our own conclusions about the ideal age of candidates, whether in local, state, or national races. And it's only a matter of time before the question regarding the age of Supreme Court Justices is in the headlines again.
May 24, 2023 in Consumer Information, Current Affairs, Other | Permalink
Tuesday, May 23, 2023
Aging Issues in the News
To me, it seems recently there are more articles in major publications about aging than in the past. For example, yesterday in the Washington Post, there were three:
‘Granny flats’ play surprising role in easing California’s housing woes
Seniors are flooding homeless shelters that can’t care for them;
and
an opinion esssay, My neighbor lived to be 109. This is what I learned from him.
The "Granny Flats" article notes that this popular name for accesssory dwelling units is someo thing of a misnomer today as the focus of the article is on the popularity of using ADUs to help with the housing crisis:
The numbers tell the tale: More than 23,000 ADU permits were issued in California last year, compared with fewer than 5,000 in 2017 — which was around when ADU permitting began to take off thanks to legislative and regulatory changes in the state. The state now requires faster permit approval by localities, and establishes that cities must allow ADUs of at least 850 square feet — though many are much bigger. A number of other bills are being debated in Sacramento, including one by Assemblymember Phil Ting (D) that would allow property owners to sell their ADUs separately from their main houses.
The second article, also on housing, is more troubling, noting the number of elders who are unhoused.
Nearly a quarter of a million people 55 or older are estimated by the government to have been homeless in the United States during at least part of 2019, the most recent reliable federal count available. They represent a particularly vulnerable segment of the 70 million Americans born after World War II known as the baby boom generation, the youngest of whom turn 59 this year.
...
“It’s just a catastrophe. This is the fastest-growing group of people who are homeless,” said Margot Kushel, a professor of medicine and a vulnerable populations researcherat the University of California at San Francisco.
The opinion piece is based on a forthcoming book about the author's 109 year old neighbor. ("This essay was adapted from “The Book of Charlie: Wisdom from the Remarkable American Life of a 109-Year-Old Man,” by David Von Drehle.")
And these articles are in addition to articles about the debt ceiling negotiations. Off to read more.
May 23, 2023 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Other, Retirement, State Statutes/Regulations | Permalink
Monday, May 22, 2023
Arizona Feature: "Arizona Seniors At Risk of Harm"
Appearing on the front page of the Sunday edition of the Arizona Republic (5.21.23), the first paragraphs of an extended feature article point to the potential for harm to residents and the consequences of staff shortages or inattention at Arizona facilicities caring for residents with dementia. Two women in their 90s are residents of an elegantly appointed assisted living facility-- but as the article begins they are covered in blood -- and the investigation of what happened there is hampered by the inability of anyone to give clear explanations.
The feature, based on the newspaper's review of "thousands of pages of police and state regulatory reports," offers multiple reasons for such injuries in "senior living" facilities, including a lack of clear reporting rules and the absence of investigation by state agencies, especially for facilities licsenced for "assisted living" as opposed to "nursing home" care. From the feature:
In memory care units, anything can become a weapon -- toilet plungers, shoehorns, electric razors, TV remotes, metal trash grabbers and walking canes. Hundreds of vulnerable seniors, particularly those with dementia, contend with violence at the end of their lives in the very places that promise to keep them safe.
Shortages of staff-- brought on by companies looking to maximize profits or stave off financial losses -- lead to more harm. Assisted living facilities can keep resident clashes underwraps [in Arizona] because regulartors don't make facilities report incidents to their state licensing agency. Federally regulated nursing homes have to report but little attention is paid to the problem.
The Arizona Republic combed through thousands of pages of policce and state regulatory reports to find more than 200 clashes at senior living facilities from mid-2019 to mid-2022. Residents punched, hit, pushed, kicked, poked scratched, bit, elbowed or spat on other residents or employees.
Experts consulted by the Arizona Republic noted that one "key [to reducing problems] is tailoring a [resident's] care plan to each resident's needs, equipped with activities that bring their lives a sense of purpose." Further, "[a]ssisted living facilities commonly get in trouble for having inadequate, delayed or out-of-date plans for residents that outline their need or for failing to follow those plans."
The article cautions that if a problem is not tracked, "it doesn't exist":
The Arizona Department of Health Services licenses facilities and is responsible for investigating complaints but assisted living centers don't have to report nonfatal injuries to the agency.
That's not normal. Most states require facilities to report to their licensing agency when residents get hurt, according to The Republic's review of state laws.
The feature suggests that "Arizona lawmakers and regulators have prioritized the needs of assisted living and nursing home companies over their residents," comparizing Arizona to "[a]t least 17 states [that] require assisted living facilities to get inspected about once a year, with a few even requiring two inspections per year. "
For the full Arizona Republic feature published in its print version on May 21, 2023, look for "Arizona seniors at risk of harm: Facilities experiencing staff shortage, residents with dementia enable violence," by reporters Caitlin McGlade, Melina Walling and Sahana Jayaraman. The extended Sunday feature appears to follow several shorter articles available online in May from the same reporting team.
May 22, 2023 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)
Monday, May 15, 2023
Signficant Article from NY Times
This is one of the most important and comprehensive articles I've read on dementia, consent, elder abuse, and guardianship.
The Mother Who Changed: A Story of Dementia was published on May 9, 2023. I plan to assign it to my students. I hope you read it.
May 15, 2023 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care | Permalink
Monday, May 8, 2023
Ohio Appellate Court Confirms that Agent Not "Personally Liable" for Costs of Nursing Home Care
In one of the earliest articles I wrote on familiy member liability under nursing home contracts, I cautioned that federal law prohibits nursing homes from requiring "guarantees" of payment by family members. Any family member who is asked to sign "on behalf" of a loved one should carefully consider the role he or she is undertaking, especially if the only role acceptable and affordable for that family member is "agent." See "The Responsible Thing to Do About 'Responsible Party' Provisions in Nursing Home Agreements," published in 2004 in the Unversity of Michigan Journal of Law Reform.
On May 1, 2023, an appellate court in Ohio cited this article when concluding that in the case before it, the daughter's role as agent acting under a power of attorney prevented her from becoming personally liable for her mother's costs of care. The daughter appears to have properly cooperated or assisted in the original Medicaid application. Further, the daughter gave authority to the nursing home to debit the bank account where her mother's SS checks were deposited each month, in order to pay itself the "patient pay portion" of the monthly allocation for costs of care when a patient has low income but is otherwise eligible for Medicaid. Thus the nursing home appears to have had at least the same ability as the daughter to avoid accumulation of a sum greater than $2,000, a resource limit that can trigger disruption of Medicaid benefits. There was still another party that could be faulted for what appears to have been an unplanned "excess resource" situation. The court pointed to the failure of the state agency to give effective notice to interested parties about when and why it was terminaating Medicaid. See National Church Residences First Community Village v. Kessler, 2023 WL 3162188 (Ohio Ct. App. 2023).
Bottom line? Family members or others attempting to help an incapacitated person get proper care are well-advised to consult with an experienced elder law attorney early in the process about how to qualify and protect eligability for Medicaid. Further, clear, direct communications between the agent, the facility and state agencies are important when seeking to facilitate prompt, proper payments.
Overwhelmed family members should not be scapegoats, even (especially?) when overwhelmed state agencies and facility billing offices are themselves missing opportunities to keep benefit payments flowing properly.
May 8, 2023 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, State Cases | Permalink | Comments (0)