Tuesday, September 14, 2021
- A perfect kickoff with opening remarks on the theme of the conference from Syracuse Law Professor Nina Kohn, who outlined the civil rights of older persons, reminding us of existing laws and the potential for legal reforms;
- A unique "property law" perspective on the importance of careful planning about ownership or rights of use, in order to maximize the safety and goals of the older person, provided by Professor Lior Strahilevitz from University of Chicago Law School;
- Several sessions formed the heart of the conference by taking on enormously difficult topics arising in the context of Covid-19 about access to health care, including what I found to be a fascinating perspective from Professor Barbara Pfeffer Billauer from her recent work in Israel. She started with an interesting introduction of three specific pandemic responses she's identified in her research. She then focused on how "Policy Pariah-itizing" has had a negative effect on health care for older adults, with examples from Israel, Italy, and China. I was also deeply impressed by the candid presentations of several direct care providers, including nursing care professionals Esperanza Sanchez and Nelda Godfrey, about the ethical issues and practical pressures they are experiencing;
- Illinois Law Professor Dick Kaplan offered timely perspectives on incorporating cultural sensitivity in Elder Law Courses. His slides had great context, drawing in part from an article he published about ten years ago at 40 Stetson Law Review 15;
- Real world examples about tough end-of-life decisions involving family members and/or formally appointed surrogates, with Deirdre Lock and Tristan Sullivan-Wilson from the Weinberg Center for Elder Justice leading breakout groups for discussions.
I know I'm failing to mention other great sessions (there were simultaneous tracks and I was playing a bit of leap-frog). But the good news is we can keep our eyes out for the Touro Law Review compilation of the articles from this conference, scheduled for Spring 2022 publication. I know it was a big lift to pull off the conference in the middle of the fall semester. Thank you!
September 14, 2021 in Advance Directives/End-of-Life, Books, Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Housing, International, Property Management, Science | Permalink
Wednesday, August 18, 2021
The Biden Administration announced today that it will push for federal regulations to mandate employee vaccinations for COVID-19 for employees of "nursing homes," making the vaccinations a condition for nursing homes to continue receiving Medicare and Medicaid funding. It will be interesting -- or perhaps frustrating -- to see how long that rulemaking process will take! The new regulations "would apply to over 15,000 nursing home facilities, which employ approximately 1.3 million workers and serve approximately 16 million nursing home residents."
Some sources suggest to date that "only about one-quarter of nursing homes had at least 75 percent of staff vaccinated."
The announcement about nursing homes was combined with other announcements related to COVID-17 protections.
My motto for the last 18 months has been "nothing is simple."
Monday, August 16, 2021
Now here's a clever idea. The National Consumer Voice for Quality Long-Term Care is selling playing cards that contain the rights of a resident of a SNF. The playing cards sell for $8. It's not just the idea that's clever. The design is as well. "Each card highlights a different residents' right. The back of the cards features colorful artwork created by rolling wheelchairs through paint in order to represent how residents move through their facility, designed by residents in Lanai City, Hawaii." How's that for clever! The deck comes in a box--and wouldn't this be a thoughtful gift for an attorney to give a client who has just finished planning for long-term care?
Wednesday, August 4, 2021
Another surge, another rise in COVID in SNFS? According to a recent article in the New York Times, Nursing Homes Confront New Covid Outbreaks Amid Calls for Staff Vaccination Mandates, the cases are rising. Featuring one company, the article notes
The case count has ticked up again: It’s still below 100 among residents and staff, the company said, but includes many breakthrough cases of vaccinated residents testing positive. Then last week, two vaccinated residents died with Covid .... The company said it had pinpointed the cause of the spread there and at other of its facilities: The breakthroughs had happened in the same homes where unvaccinated staff were testing positive, seemingly carrying the virus into the home from the community.
The company recently announced it was requiring all staff to be vaccinated, the article notes. As we all know, vaccine mandates are controversial.
Growing calls for vaccine mandates among health care workers have gained urgency but also met resistance in the nursing home industry, where some homes say it will cost them staff members in an industry already plagued with high turnover. Only about 60 percent of nursing home staff members are vaccinated, and some states report an even lower rate, with less than half inoculated, according to the most recent government data.
Staff immunization has been an issue in many states, especially as the highly contagious Delta variant races through regions with low vaccination rates. Some states and cities, not waiting for the nursing home industry, are imposing their own mandates for vaccinations on long-term care employees or operators may face penalties or additional testing requirements for unvaccinated staff....
Some states have reinstated visitation restrictions and the CDC is monitoring the number of cases. The article goes on to discuss in depth the issues surrounding a vaccine mandate, with some states requiring frequent testing in lieu of adopting a mandate. Looks like we are going to be dealing with this through the end of 2021. I go over with my students a list of questions regarding choosing a nursing home. I'm adding "how many of your staff and residents are vaccinated again COVID" to the list.
Friday, July 30, 2021
The Boston Herald addressed housing needs in this article, Massachusetts advocates say in-law apartments will help older adults, people with disabilities. The article advises that "[t]he region’s restrictive zoning laws around accessory dwelling units, or in-law apartments, are being reexamined by lawmakers and advocates who say easing up would be a game-changer for older adults or residents with disabilities." The author of the bill noted specific provisions of the bill apply to elders as well as those with diabilities, and allows for a special need trust "for those with disabilities 'so an owner could create a long-term housing plan for after they passed away to allow their child to stay there....'" A companion bill has also been filed in the Massachusetts Senate. Another bill has broaden the regulation of accessory dwelling units, because as noted in a "2019 study ... that only 37 of 100 of the communities closest to Boston allow for ADUs to be rented out. Another 31 municipalities allow for temporary ADUs for family members or caregivers. The remaining 32 communities have no zoning allowances for ADUs at all."
Consider the role of zoning ordinances not only on the availability of housing, but how it impacts housing specifically for elders and individuals with disabilities.
Thursday, July 29, 2021
With the eviction moratorium expiring in just a couple of days, we need to realize that housing insecurities impacts all age groups. It's timely that the Consumer Financial Protection Bureau (CFPB) just released The Rental Assistance Finder. The website allows one to search for housing assistance by location, provides info on various topics, including about help in paying rent, payment agreements, and renter rights.
In addition, the National Center on Law and Elder Rights recently offered a training, Emergency Rental Assistance Programs and Other Tools to Prevent Evictions of Older Adult Tenants. Accompanying this training is the materials, Emergency Rental Assistance Programs & Other Tools to Prevent Evictions of Older Adult Tenants, CHAPTER SUMMARY • June 2021. This will be extremely helpful with the eviction moratorium expiring in days.
Wednesday, July 28, 2021
Here is a link to the full schedule of speakers and topics for the virtual conference on "Aging, Health, Equity and the Law" hosted by Touro Law College on Monday, September 13, 2021. The program runs from noon to 6:15 and registration is free. Highlights include:
- 12:20 Keynote Address
Nina A. Kohn, the David M. Levy Professor of Law and Faculty Director of Online Education at Syracuse Law, and the Distinguished Scholar in Elder Law for the Solomon Center for Health Law & Policy at Yale Law School.
- Afternoon Tracks on Different Topics, including (you will have other great options too, so I encourage you to look at the full schedule linked above!):
1:00 "Property Law for the Ages," by University of Chicago Law Professor Lior Strahilevitz
1:30 "Allocating Scarce Medical Resources During a Public Health Crisis: Should Age Matter?" by Houston Law Center Professor Jessica Mantel
2:00 "Anti-Racism in Nursing Homes," by Elizabeth Chen, Acting Assistant Professor, NYU Law
3:00 "Incorporating Cultural Sensitivity in Elder Law Courses", by Richard Kaplan, University of Illinois Law
4:00 "End of Life, Elder Abuse, and Guardianship: An Exploration of NY's Surrogate Decision-making Framework," by Deirdre Lok and Tristan Sullivan, Counsel at the Weinburg Center for Elder Justice
Registration (Free!) is here, and New York CLE credits are available.
July 28, 2021 in Consumer Information, Current Affairs, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Housing, Programs/CLEs, Webinars | Permalink | Comments (0)
Thursday, July 22, 2021
The housing market in St. Pete is ridiculously hot right now---I mean ridiculously hot and I've heard from friends that it's happening in other places as well. So this recent Washington Post article, Demand rises among seniors to rent rather than own in active-adult communities, seemed incredibly timely. "While properties restricted or targeted to seniors have always been available, a newer option is to rent an apartment, villa or single-family home within an active-adult community. These communities are designed for younger residents who want plenty of recreational amenities and opportunities to socialize with people in their age group of 55 and older."
Here's some interesting data from a consultant interviewed for the article. “The average age of residents in independent-living facilities used to be in their 70s and in recent years they’re in their 80s. Developers wanted to ‘down-age’ the residents in their communities so they would stay longer. The typical renter in an active-adult community now is a divorced or widowed single woman in her mid-70s ...." The article covers the pros and cons of renting, the flexibility, affordability, the soaring costs of buying a home, rent increases, etc. The article discusses various approaches by the developers in developing and offering rental units within these communities.
Wednesday, July 14, 2021
To say the Florida real estate market is hot is a drastic understatement. The prices of housing is shocking and folks are paying a lot more than asking price. So I was interested in the article last week, the New York Times ran, Baby Boomers: Rich With Real Estate and Not Letting Go.
The concept of aging in place, already growing in popularity before the pandemic, has found renewed interest among baby boomers, some of whom are now wary of nursing homes, where at least one third of U.S. Covid-19 deaths have occurred. The trend is intensifying pandemic home-inventory shortages and price increases, frustrating younger buyers who want to grab their share of real estate wealth.
The bulk of real estate wealth was long held by baby boomers’ predecessors, the Silent Generation (those born before 1946), but they generally followed the familiar pattern of selling later in life and moving in with extended family, to assisted-living facilities or nursing homes. Aging-in-place boomers are disrupting this trend. This week’s chart, using Federal Reserve data, shows that boomers surpassed the Silent Generation in real estate wealth in 2001, and have yet to yield that position.
Although the Gen-Xers are buying...and selling, it's not at the same rate as prior generations. Are you thinking "so what?" with a shoulder shrug. Consider this. "In 2029, the youngest baby boomers will have their 65th birthdays and the oldest their 83rd. As the tail end of this generation heads to retirement, some will sell their homes, and if they don’t, eventually their estates will. But unless a lot more homes are built, and fast, the younger generations will simply have to wait for their share of real estate riches."
Monday, July 5, 2021
I'm currently working on an article that looks at senior living trends, and came across several interesting, significant data points in a January 2021 article entitled The Future of Headship and Homeownership, by Laurie Goodman and Jun Zhu for the Urban Institute.
The central prediction is that household growth will be "weak" over the next two decades, a decline associated with slowing of U.S. population growth and lower "headship rates" among most age groups. The terms are defined at the beginning of the article.
Further, key takeaways from the article include these findings:
- Almost all net household growth will be from senior households. Of the 16.1 million net new households formed between 2020 and 2040, 13.8 million will be headed by someone over 65.
- All net household growth will be from households of color. Between 2020 and 2040, there will be 16.1 million net new households. Hispanic households will grow by 8.6 million, households of other races (mostly Asian households) will grow by 4.8 million, and Black households will grow by 3.4 million. White households will decline by 0.6 million.
However, despite what at first seems like "better" (if not good news) for households of color, the authors also predict:
- The decline in the homeownership rate will be particularly pronounced for Black households headed by 45-to 74-year-olds. If current policies stay the same, the Black homeownership rate will fall well below the rate of previous generations at the same age and result in an unprecedented number of Black renters over 65; we project elderly Black renters will more than double from 1.3 million in 2020 to 2.6 million in 2040.
Tuesday, June 22, 2021
Richard Kaplan, elite elder law professor and friend, sent me the link to this recent article from the Wall Street Journal, One Family’s Lessons Learned From a Decade of Caregiving.
As do many families, the spouse committed to caring for his spouse with dementia.
The family learned much along their decade-long caregiving journey, about setting up trusts, getting help in the home and respecting each other’s decisions. They think about a few things they would have done differently. And they found that caregiving, while relentless and heartbreaking at times, can also be rewarding.
Being a family caregiver is one of the most difficult jobs and one that nearly everyone will have at some point. An estimated 42 million people in the U.S. provide unpaid care to those 50 and older, a 14% increase since 2015, according to the Caregiving in the U.S. 2020 report by the National Alliance for Caregiving and AARP.
Each family is different, and what works for one family may not work for another, says ... [the] chief executive of the National Alliance for Caregiving. Family members don’t always agree about when to call in hospice or sell a house, but it’s important to be supportive, she says. “The hardest thing to say is, ‘It’s not the choice I would make, but I want to honor their choice.’ ”
The story is heartfelt, and compelling. The caregiver spouse offers this advice as to what changes he would have made.
He would have gone to an elder-law attorney earlier to make sure their assets were in a trust that would better protect them from having to be spent down to qualify, if needed, for Medicaid’s coverage of long-term care costs.
And he would have bought a single-story patio home within walking distance of their church and shopping center when [his spouse] suggested it 20 years ago. “It was what [she] wanted to do, but I wanted the yard. My own little domain. I wish I would have,” he says. “Here I am now with this big house, by myself. I’ll probably reach a point where I can’t take care of it.”
Knowing how hard it is to provide hands-on care, and not wanting to be a burden, he recently told his daughters, “Just put me in a nice place. You don’t have to do what I did for mom. You don’t have to take me into your house. I don’t want that.”
I'm assigning this reading to my students. Thanks Professor Kaplan!
June 22, 2021 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Estates and Trusts, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid | Permalink | Comments (0)
Sunday, June 6, 2021
Call for Papers: Under Pressure: Legal And Systemic Responses To The Psychological Trauma Associated With Covid-19
Shepard Broad College of Law @ Nova SE has announced a call for papers for their Spring 2022 Symposium, Under Pressure: Legal And Systemic Responses To The Psychological Trauma Associated With Covid-19.
Nova Southeastern University (“NSU”) Shepard Broad College of Law and the Nova Law Review
seek submissions for the Law Review’s annual Symposium on March 11, 2022. Since January
2020, COVID-19 has ravaged the United States’ population physically, economically, and
psychologically. Caused by the novel coronavirus SARS-CoV-2 (“COVID-19”), the pandemic
simultaneously decimated the population, shuttered businesses, and traumatized those
experiencing its effects. Consequently, increased prevalence of mental, neurological, and
substance use disorders already has and will continue to present the legal system with challenges of previously unknown proportions. As mental health professionals substantiate and address the negative impacts of uncertainty, fear, isolation, and economic hardship, legal issues are multiplying.
The Nova Law Review invites academics, scholars, practitioners, and stakeholders to submit
proposals for panel presentations on topics involving the legal impact of the psychological trauma produced by COVID-19 in the United States. (see website for topic ideas).
SUBMISSIONS & IMPORTANT DATES:
Please submit materials to email@example.com
- Submission Deadline for Abstracts: July 16, 2021
- Submission Deadline for Articles: January 14, 2022
- Symposium Date: March 11, 2022
LAW REVIEW PUBLISHED ARTICLES: The Nova Law Review will review, edit, and publish
submissions in the 2022 Symposium issue. Articles, as well as case studies and abstracts of
research in progress, will be considered for the Symposium Program for presentation purposes.
Only complete articles, however, will be published in the Law Review. Abstracts for these papers will be due no later than the July 16, 2021 deadline and will be accepted on a rolling basis until that time
There are also opportunities to present without submitting an article for consideration for publication. More information is available here.
Friday, June 4, 2021
The National Center on Law & Elder Rights has opened registration for an upcoming webinar on June 17 starting at noon eastern. What it Takes to Age in Place: Bringing Housing and Home and Community-Based Services (HCBS) Together will cover:
Most people want to age in place and stay near their friends and family and in their community. This ideal can become complicated when housing becomes unstable or unaffordable, or when supportive services are not available in the home and community. This training will explore the intersection of health and housing to support aging in place. It will provide information about Medicaid home and community-based services, as well as what housing-related services can be funded through Medicaid.
1. Understand the connection between health and housing;
2. Learn the different ways that Medicaid can fund HCBS to keep people in their homes or create housing for people experiencing homelessness; and
3. Hear about examples of different community models that have integrated housing and health care to support housing stability, including for previously homeless older adults.
Presenters: • Patti Prunhuber, Senior Housing Staff Attorney, Justice in Aging • Claire Ramsey, Senior Health Staff Attorney, Justice in Aging
Click here to register.
Thursday, June 3, 2021
In Carlisle, a classic college town in Central Pennsylvania, the hottest topic at the moment is, surprisingly enough, the "county" nursing home.
"Save Claremont" signs outnumbered the political signs in the recent primary election.
A robust advocacy movement seeks to prevent the sale of Claremont Nursing & Rehabilitation Center, a publicly-administered facility with 282-beds to private enterprise. In a detailed story carried by local newspaper, The Patriot News, both sides of the issue are making their pitches:
The members of Citizens Saving Claremont are arguing the county not only can keep Claremont afloat, but with some effort, investment and leadership, they can make it thrive.
"It has been sustained for 192 years," said Tim Potts, one of the founding members of Citizens Saving Claremont. "This year, 2021, is the first year that we've had to use county money to support Claremont, and that's only on a temporary basis because of the impact of COVID." . . .
But that doesn't change the fact that Claremont is hemorrhaging money, Cumberland County Commissioner Gary Eichelberger said. Projections show it will only get worse and will have to be propped up by taxpayer dollars.
And the completion of a sales agreement could be just days away.
For some advocates, keeping the facility in public hands is about maintaining a commitment to citizens of all income levels, and they point out that Claremont's Medicare "star" rating has usually been higher than private enterprise nursing homes in the region. As recently as 2002, as many as 40 of Pennsylvania's 67 counties had "public homes"; but, currently just 21 remain in county hands.
For more see Citizens Group Pushes to Save Claremont, published online behind a paywall on June 1, 2021 and on the front page of the traditional newspaper format on June 4, 2021.
Monday, May 17, 2021
Families in Texas have been hard at work the last two years, responding to the deaths of loved ones in Dallas-area senior-living communities who may have been killed by a serial murder suspect. Organizing under the name "Secure Our Seniors Safety," they have pressed for an array of legislation to compel care-giving communities to provide greater accountability, including reporting suspicious activity such as employee concerns, where there is potential risk to vulnerable adults. One of the bills, "Marilyn's Law," or HB 723 was named after one of the suspect's victims. Marilyn's daughter had initially been told her mother, who was living in a care center, had died of "natural causes." The death certificate was later amended, but the daughter only learned from news reports that her mother may have been one of the suspect's victims, suffocated with a pillow.
From a recent Dallas News article:
The first bill filed in response to a string of slayings at Dallas-area senior living communities passed the Texas Senate on Thursday and now awaits Gov. Greg Abbott’s signature.
For the families who say their loved ones were killed by a serial murder suspect, it’s a moment more than two years in the making. . . .
The bill passed Thursday is named for Pangburn’s mother, Marilyn Bixler. Marilyn’s Law, or HB 723, was introduced by two Collin County lawmakers — Sen. Angela Paxton and Rep. Jared Patterson — after The Dallas Morning News first reported Pangburn’s story.
The new law will require officials to notify next of kin if a cause of death is amended.
The bill was signed into law by the Texas Governor on May 15, 2021.
Chemirmir, a suspect in at least 17 murder, theft or attempted murder cases, awaits trial because of delays related to Covid-19, according to news reports, including national news profiles.
For more on related legislation pending in Texas, see "Death Certificate Bill Filed in Response to Chemirmir Case Passes in Austin."
May 17, 2021 in Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Housing, State Cases, State Statutes/Regulations | Permalink | Comments (0)
Thursday, April 8, 2021
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.
Sunday, March 21, 2021
Kaiser Health News recently published a story, Texas Winter Storm Exposes Gaps in Senior Living Oversight. The storm
brought power failure and burst water pipes to millions of homes and businesses throughout Texas. But the impact, as is often the case in emergencies, was most profound on the state’s most vulnerable — including residents of senior living facilities.
Of the state’s 1,200 nursing facilities, about 50% lost power or had burst pipes or water issues, and 23 had to be evacuated, said [the] long-term care ombudsman for Texas. Of 2,000 assisted living facilities, about 25% had storm-related issues and 47 were evacuated. Some facilities reported building temperatures in the 50s.
The article discusses revisions to the regulations regarding emergency preparedness and the industry's responses, as well as the issues with other types of supportive housing. The article also highlights how these "disasters of a century" are actually occurring more frequently, and the focus on disaster preparedness includes a conversation about requiring facilities to have generators. "In Texas, assisted living facilities are required to have emergency plans but not generators. The legislation introduced in the wake of [the recent] winter storm ... seeks to change that. Independent living facilities ... might not be covered, though; they already have even fewer state guidelines to follow."
Thursday, March 18, 2021
California has released its Master Plan FOR Aging. Here's the rationale for having a master plan:
Aging is changing and it’s changing California. California’s over-6o population is projected to diversify and grow faster than any other age group. By 2030, 10.8 million Californians will be an older adult, making up one-quarter of the state’s population.
The Master Plan for Aging outlines five bold goals and twenty-three strategies to build a California for All Ages by 2030. It also includes a Data Dashboard on Aging to measure our progress and a Local Playbook to drive partnerships that help us meet these goals together.
This is not a plan simply for today’s older adults. Instead, the Master Plan is a blueprint for aging across the lifespan. The Master Plan calls on all California communities to build a California for All Ages: for older Californians currently living through the many different stages of the second half of life; for younger generations who can expect to live longer lives than their elders; for communities of all ages – family, friends, neighbors, coworkers, and caregivers – surrounding older adults. As Californians, we can create communities where people of all ages and abilities are engaged, valued, and afforded equitable opportunities to thrive as we age, how and where we choose.
The five goals address health, housing, equity and inclusion, affordable aging, and caregiving. The plan is available here.
PHI issued a report regarding the direct care workers and the California Master Plan For Aging. Quality Jobs Are Essential: California’s Direct Care Workforce and the Master Plan for Aging
[P]rovides a detailed overview of the state’s direct care workforce and examines how California’s Master Plan for Aging can improve jobs for this rapidly growing workforce. It describes how the Master Plan supports this workforce, highlights where it incorporated the LTSS Subcommittee’s recommendations, and proposes where and how the Master Plan can be strengthened. This report also includes various stories from direct care workers in the state.
The report is available here for download.
Wednesday, March 17, 2021
The housing market is hot! We didn't need this New York Times article to tell us that, but it does and tells us more. In this article, Where Have All the Houses Gone? let's start with this quote: "[a] majority of homeowners in America are baby boomers or older — a group at heightened risk from the coronavirus. If many of them have been reluctant to move out and downsize over the past year, that makes it hard for other families behind them to move in and upgrade.... There are lots of steps along the “property ladder,” ... that are hard to imagine people taking mid-pandemic: Who would move into an assisted living facility or nursing home right now (freeing up a longtime family home)?"
This article is not about the Boomers and home ownership, but since this is the elderlawprof blog, I thought it was important to mention the elder-aspect of this housing boom. There are lots of reasons why the housing market is so tight, and the article explains them well.
Wednesday, February 17, 2021
The Vatican is calling for a new paradigm of care for older people after what it calls the "massacre" wrought by the coronavirus pandemic, which has disproportionately killed people living in nursing homes.
The Vatican's Pontifical Council of Life issued a position paper Tuesday that made the case for a global rethink of how to care for people in their final years, including resisting any rush to institutional care in favor of adapting home environments to the needs of people as they age.