Thursday, July 22, 2021

Rent or Own?

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.  

July 22, 2021 in Consumer Information, Current Affairs, Housing | Permalink | Comments (0)

Wednesday, July 14, 2021

Baby Boomer Home Ownership

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."

July 14, 2021 in Consumer Information, Current Affairs, Housing | Permalink | Comments (0)

Monday, July 5, 2021

Urban Institute Study Predicts "Senior Households" Will Lead Household Growth from 2020 to 2040

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.

July 5, 2021 in Consumer Information, Current Affairs, Ethical Issues, Housing, Statistics | Permalink | Comments (0)

Tuesday, June 22, 2021

One Family's Caregiving Experience

Richard Kaplan, elite elder law professor and friend, sent me the link to this recent article from the Wall Street JournalOne 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 lawreview@nova.edu
- 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.

June 6, 2021 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Other, Programs/CLEs, State Statutes/Regulations | Permalink | Comments (0)

Friday, June 4, 2021

Webinar on Housing & Community Services

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.

Participants will:

    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.

June 4, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing | Permalink | Comments (0)

Thursday, June 3, 2021

Pushing Back Against the Disappearance of the "County Home"

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.

Save Claremont June 2021

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.  

 

June 3, 2021 in Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care, Housing, Property Management, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Monday, May 17, 2021

Texas Families Seek Legislative Changes to Better Assure Accountability for Seniors' Safety

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

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.

April 8, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Property Management | Permalink | Comments (0)

Sunday, March 21, 2021

The Storm in Texas May Be Over, But Care Gaps Still Exist

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."

March 21, 2021 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Other, State Statutes/Regulations | Permalink | Comments (0)

Thursday, March 18, 2021

California Releases Master Plan FOR Aging

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.

March 18, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Other, Retirement, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Wednesday, March 17, 2021

The Housing Market: Booming and Booming?

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.

March 17, 2021 in Consumer Information, Current Affairs, Housing, Other | Permalink | Comments (0)

Wednesday, February 17, 2021

Vatican: Rethink How Care for Elders

Recently released: The Vatican wants the world to rethink how it cares for the elderly after Covid-19 ‘massacre’.

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.

Calling for visionary thinking to develop a new way of providing care for elders,  "[t]he document praised new models of assisted living that provide companionship and care where needed but, in preserving autonomy and independence, fall short of an institutional facility. And it called for greater assistance to families who are able to care for their loved ones at home for as long as possible."

February 17, 2021 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, International, Other, Religion | Permalink | Comments (0)

Wednesday, January 20, 2021

Improving Neighborhoods Key for Aging in Place

AARP has released a new, free handbook, A Handbook for Improved Neighborhoods. The focus here is on land use and zoning regulations, many of which are not conducive to aging in place. "In some communities, the lack of walkability, opportunity and livability stems from zoning and development decisions that intentionally separated people by race, faith, ethnicity or income." It discusses "options for communities to consider as they identify and select small-scale, incremental policy changes that can be made without overhauling entire zoning codes and land use policies." I'm going to use it in my class, having students examine zoning and land use ordinances in their cities and how they would rewrite them to make their cities more conducive to aging in place.  Thanks to my colleague, friend and expert in new urbanism, Professor Mark Bauer, for sending me this.

 

January 20, 2021 in Consumer Information, Current Affairs, Housing, Other | Permalink | Comments (0)

Friday, October 9, 2020

Court Called Upon to Prevent Misuse of Law to Penalize Homeless People

As many of our regular readers know, I grew up in Phoenix, Arizona.  One of the developments I have followed over the years is the number of homeless residents of Phoenix.  I'm a cyclist in my spare time and one of my regular downtown bike routes in Phoenix takes me past an ever-growing encampment.  In addition, a large park near my parents' home now serves as a daytime gathering spot for many.  In the scorching heat of the summer, and the desert cold of the winter, there are more and more people without adequate shelter.  The New York Times recently pointed out that in contrast to historical statistics suggesting that nationwide, "elderly" persons make up a small percentage of the homeless population, in the last few years we are seeing a surge among older adults.  See Elderly and Homeless: America's Next Housing Crisis, a feature article published on September 30, 2020, that, in part, profiles the issues in Arizona.  


Stryker PhotoSo, it was with great interest that I read a report on a federal appellate decision, limiting the ability of municipalities to use criminal laws to penalize individuals, in an attempt to discourage or remove people who are living on the streets.  The report is by one of  Dickinson Law's third year law students, Jacqueline Stryker.  She writes in part:  

"The city of Boise, Idaho attempted to fight homelessness in the community through a combination of its public camping ordinance and its disorderly conduct ordinance.  In Martin v. City of Boise, 920 F.3d 584 (9th Cir. 2019), the 9th Circuit Court of Appeals considered whether the Eighth Amendment’s prohibition on cruel and unusual punishment bars a city from criminally prosecuting people for sleeping outside on public property when those people have no shelter.  The Court concluded that it does.  A municipality cannot criminalize people who sleep outside when no sleeping space is practically available in any shelter. "

Ms. Stryker observes in her conclusion, "Whether the decision of the Ninth Circuit in Martin will gain traction a local governments grapple with the growing problem of homelessness and homeless encampments is yet to be seen."

For more of Ms. Stryker's timely, concise case analysis, see:  Municipal Efforts to Combat Homelessness.

October 9, 2020 in Crimes, Current Affairs, Discrimination, Ethical Issues, Federal Cases, Housing, Property Management, Statistics | Permalink

Monday, September 21, 2020

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.

September 21, 2020 in Consumer Information, Current Affairs, Housing, International | Permalink | Comments (0)

Sunday, August 23, 2020

Elder Abuse, SNFs & COVID. An Article in Harper's Magazine

The September issue of Harper's Magazine has a compelling article, Elder Abuse, Nursing Homes, COVID and the Bottom Line.  Just a warning-parts of this article are heart-rending.

Inevitably ... the virus has found its most ideal conditions in the warehouses storing America’s elderly population. No one knows the current death toll. As of early July, CMS put the number at 33,509, but the count covered only federally regulated nursing homes, not assisted-living communities. The homes, moreover, were not required to report deaths that occurred before May 8, although the agency said it was confident that “the vast majority” did so. One in five nursing homes didn’t bother to report their numbers at all. A New York Times study in late June put the number of deaths in U.S. nursing homes at a staggering 55,000, but even this figure did not necessarily include all of those who became infected in a home but died in a hospital, as was the case for Sharon Mitchell. In some states, the vast majority of COVID-19 deaths were in homes: 64 percent in Massachusetts, 68 percent in Pennsylvania, 77 percent in Minnesota. In New Jersey, one in every ten people housed in nursing homes or assisted-living centers died. This was a helpless population, helpless because so often confined in a state of neglect and squalor. But despite or perhaps because of their conditions, they were worth a lot of money. In effect, they were being harvested for profit.

The article looks at the financial model of long term care facilities in the U.S. It offers a  comprehensive history of the development of LTC facilities in the U.S., culminating with a discussion of the ownership of LTC facilities by private equity firms. The article covers the impact of the pandemic and the efforts by the industry to get shield laws to provide them immunity.  

As noted by the article, it's not only U.S. facilities that have faced these deaths from the pandemic.  It notes one company that made changes early in the pandemic, which resulted in less cases, at least in some facilities.  If we are to change the way we provide ltc in this country, in my opinion, this article is important. I'm assigning it to my students. 

August 23, 2020 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare | Permalink

Thursday, July 9, 2020

Are Older Adults Now the Proverbial Canaries in the Global Mines?

During an AALS-sponsored online "hang-out" session this week, the featured host, Syracuse Law Professor Nina Kohn, helped faculty think about better ways to conduct online courses, including Elder Law.  We also talked about our research projects for the summer.  Nina commented that she has never before had "so much to write about and so little time to do so," which I suspect has something to do with her wonderfully active children!  But, I also think that most of us in the AALS Section on Law and Aging are feeling the same way.  It is as if our client base -- older persons -- are at the epicenter of so much tragedy.  Sadly, the COVID-19 illness has hugely impacted older persons, as documented frequently on this Blog.  

And now the news that in Japan, seasonal rains that have become steadily worse over the years for reasons associated with climate change, have triggered extraordinary flooding, resulting in the drowning deaths of many elders in their nursing homes or while trying to shelter at home.  From the New York Times article, Japan's Deadly Combination: Climate Change and an Aging Society:yAlthough the Japanese gird every June and July for the rainy season — known as tsuyu — this year the rainfall has set records in Kyushu, with more rain expected to blanket central Japan by the end of this week.

 

Older residents accustomed to year after year of summer rains may believe they know how to ride out the downpours at home. Yet they may not understand the growing severity of the rains or the increased dangers of flooding.

 

“Under the emerging impact of global warming, there is an increasing risk or potential that rainfall amounts could be at a level that we haven’t experienced in the past,” Professor Nakamura said. “So I think that citizens must realize that their previous experience may no longer work. We have to act even earlier or faster than what we have experienced in the past.”

 

Evacuation itself can pose a risk to the elderly. Conditions in evacuation centers inevitably fall short of those in nursing homes designed for old-age care. For the frailest patients, the moves can cause injury or destabilize long-term care plans....

 

In the case of the Senjuen nursing home, Aki Goto, its director, told The Kumamoto Nichinichi Shimbun, a local newspaper, that she had been more concerned about mudslides than flooding. When the waters came, she added, the caregivers could not move quickly enough to move all the residents upstairs.

 

Six of the workers were on call the night of the floods last weekend, the newspaper reported. That still left each caregiver in charge of more than 10 aging residents, some of whom were unable to walk without help. Even with the aid of local volunteers, they could not bring everyone to safety upstairs as the floodwaters rapidly rose and deluged the ground floor.

Whether it is hurricanes in the Carribean and US, wildfires in western US states, extraordinary storms or unique diseases around the world, our elderly are often seeming to take the heaviest blows.  Isolated and with inadequate protective equipment or assistance, the pattern of "unexpected" deaths continue.  Unexpected?  

 

July 9, 2020 in Current Affairs, Ethical Issues, Health Care/Long Term Care, Housing, International | Permalink | Comments (0)

Thursday, June 18, 2020

Upcoming Webinar: Extreme Home Takeovers - Dealing with "Concerned" Relatives

On Monday, June 22, 2020, I'm joining the 3rd Annual Memorial Elder Abuse Sympsium hosted by Legal Aid Services of Oklahoma and being delivered as a webinar over the course of several sessions.  On Monday, the first set of speakers includes deeply experienced professionals in banking and securities, both potential avenues for elder fraud, as well as Judge Scott Roland of the Oklahoma Court of Criminal Appeals.  I follow them with the topic "Extreme Home Takeovers - Dealing with Concerned Relatives" -- the clever title supplied by our hosts!  

I'll be offering comparative statutory and common law approaches for recovering a house. including my own experiences while supervising Dickinson Law's Elder Protection Clinic.  The need is usually triggered by a transaction often tied to the worries of the older person, hoping or believeing that a family member, friend or new "befriender" would be more likely to save them from the dreaded nursing home if they give the hoped-for-caregiver "the house."  I'll be using cases from Ireland, Pennsylvania, Oklahoma (of course) and beyond for strategies, and discussing everything from filial support laws, to improvident tranaction laws, to the common law concept of failure of consideration in "support deeds." 

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June 18, 2020 in Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Housing, International, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Thursday, June 11, 2020

Nursing Homes and the Right to Visitors During a Pandemic

The seminal 1987 Nursing Home Reform Act requires all nursing facilities to care for their residents in a manner that that "will promote ,maintenance or enhancement of the quality of life of each resident." 12 USCA Section 1396r(b)(1)(A).  The same law, at Section 1396r(e)(3),  addresses "access and visitation rights:" 

A nursing facility must - ... 

(B) permit immediate access to a resident, subject to the resident's right to deny or withdraw consent at any time, by immediate family or other relatives of the resident;
 
(C) permit immediate access to a resident, subject to reasonable restrictions and the resident's right to deny or withdraw consent at any time, by others who are visiting with the consent of the resident;
(D) permit reasonable access to a resident by any entity or individual that provides health, social, legal, or other services to the resident, subject to the resident's right to deny or withdraw consent at any time .... 
During the pandemic lockdown, states prohibited most visitations, citing the risk of infection from the outside community that could endanger not just the visitor's loved one, but potentially all residents.  States are now beginning to lift or at least ease visitation restrictions, and families are beginning to talk more openly about the impact of the isolation on residents who have not contracted the virus.  
 
This week, NPR has begun airing stories about the challenge of balancing the risks of visitors against the benefits of not just family member visits, but family member involvement in care and socialization for residents.  From one story about Luann Thibodeau and her husband Jeff, who has multiple sclerosis:
 

It wasn't candlelight and soft music that made the 40th anniversary of Luann and Jeff Thibodeau so memorable. It was gazing at each other through the window of Jeff's nursing home in Texas and eating carryout from the Olive Garden. Just the two of them. And a nursing assistant.

 

"She fed him, and I ate mine, and that was it," Luann Thibodeau says. "So that was our 40th wedding anniversary."

 

Luann Thibodeau would bring her husband, Jeff, dinner every night, except Tuesdays, when she had Bible study. Since she's been unable to visit, she says that her husband has become increasingly disinterested in food as his multiple sclerosis has worsened.
 

The Thibodeaus have not been in the same room since mid-March. That's when visitors were banned from nursing homes to slow the spread of the coronavirus. But family members say that talking via FaceTime and holding up signs at windows are no substitute for the hands-on care and emotional support their visits provide.

 

Family members often are an integral part of the care residents in nursing homes receive. They make sure meals are being eaten, clothes are being changed. They also offer invaluable emotional support. . . . 

 

Luann Thibodeau has seen that decline in her husband. She used to bring dinner for him every night except Tuesdays when she goes to Bible Study. She says that as his multiple sclerosis has worsened, he's become increasingly disinterested in food. [She explains]. "I bully him into finishing a meal. And I'll say to him, 'Jeff, you know, this is what an adult man eats. So you need to eat this.' "

 

A staff member can't do what she does. Nursing home residents have rights. So if Jeff Thibodeau tells a nursing assistant that he's done eating after three bites, she has to abide by his wishes.

 

Without his wife's push, the results of her absence is striking.

For more, listen to the NPR podcast or read the parallel written narrative in "Banned From Nursing Homes, Families See Shocking Decline In Their Loved Ones." 

The federal Nursing Home Reform Act's Bill of Rights has never been an easily enforceable mandate, and particularly in a global crisis the needs of the many can override the rights of individuals.  But there does need to be a long-range plan on how better to facilitate visitation, recognizing it as an important part of any person's quality of life.  

 

June 11, 2020 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Medicare | Permalink | Comments (2)