Wednesday, December 23, 2020
The Hill ran an item a couple of weeks ago, Social Security Administration is preparing to bar 500,000 Americans from getting benefits.
SSA’s proposal, as described in press reports, would make it harder for older workers to receive Social Security Disability Insurance (SSDI) benefits. By law (not regulation), SSA is required to consider age, education and work experience when determining whether a person meets the statutory definition of disability.
The implications are far reaching-if this proposal is passed.
In short, SSA’s proposal to tighten SSDI benefits fails to even advance past a very basic question about the suggested policy: What is the point? Looking at recent or modern data, the current system routinely denies benefits to older individuals with serious health problems and diminished prospects in the modern economy. Amplifying these outcomes by trying to get even more denials is not a rational policy approach.
The proposal would also exacerbate inequality in the United States along the lines of race and income. More than 25 percent of denied Social Security disability applicants are Black, a percentage that far exceeds the percentage of African Americans in the overall working age population. Additionally, nearly 40 percent of denied applicants live in poverty. SSA’s proposal to get more denials seems out of touch with regard to many of the serious problems facing the country.
It remains to be seen whether the administration will continue to push this through before President-elect Biden takes office. Although the change could be undone, wouldn't it be nice if it just didn't happen?
Thanks to my colleague, Professor Mark Bauer, for sending me the article.
Tuesday, December 22, 2020
It's going to be some time before we see good news stories about residents of SNFs---although the vaccination of SNF residents is good news. So here are several recent articles regarding SNFS and COVID-but be forewarned, these first two are not easy to read.
There are just no words....
(Thanks to Morris Klein and Professor Bauer for sending me the link to this article).
This last article brings up some interesting issues for class discussion-such as consent, refusal of consent, and inability to consent.
Please everyone-stay safe and remember to thank our first responders, health care professionals and essential workers. And let us never forget those we have lost to this pandemic.
December 22, 2020 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (1)
Monday, December 21, 2020
JAMA network published this article, What Caring for My Aging Parents Taught Me That Medical Education Did Not is a first person account by the author of what he went through with his parents, and what he learned from the experience.
Slowly, however, things started to change. My parents seemed to have increasing difficulty staying organized. Instead of me calling them, they began calling me—at first weekly, then daily, and then multiple times per day. My father’s blood pressure was out of control, and he could not tell me what medications he was taking. My mother’s scoliosis, a problem since adolescence, now caused her to have significant difficulty walking. She looked thinner each time I saw her. Their physicians seemed not to be communicating well with each other. Finding their cell phones became a daily project.
Then came the identity theft: strange addresses on their credit card statements, charges to their accounts from Florida businesses when they were not living there, and even their telephone being answered by the identity thief himself. Managing these problems became my part-time job. Since credit card fraud departments are typically open only during business hours, I would sometimes spend afternoon hours on hold from my hospital office, waiting for someone to pick up, rather than charting, talking to a consultant, or doing research.
The move from their home of 30 years was the next step. They simply could not manage the house. Once spotlessly clean, it was now increasingly cluttered with tchotchkes from circa 1993. The garden was overgrown, the dishes dirty. After work, I typically spent an hour every day helping organize, donate, and throw away their belongings, so that we could put the house up for sale. Thankfully, the renovations went smoothly and the house sold quickly. Although not without drama, my parents moved to a retirement facility nearby.
The author created a list of what he wished he had known as he cared for his parents:
If you have the feeling that something may be an issue for your aging parents, it is almost definitely an issue.
- Make sure you know about all your parents’ financial accounts.
- You (and they) may need emotional support from people you would not expect.
- Advocate for your parents in the best way you can, but do not expect everything to be cut and dried.
- Use technology to help you (and them).
- Do not expect too much from the medical system.
- You must have the difficult conversations if the physicians will not.
- You may need to get them daily help.
- Do not forget to keep some perspective and occasionally laugh.
Great article! Thanks to Amos Goodall, Esq. for sending me the link.
Sunday, December 20, 2020
GeriPal, a geriatrics and palliative care blog, has released a podcast, Guardianship and End-of-Life Decision Making: A Podcast with Andy Cohen and Liz Dzeng, discussing a recent study led by Dr. Cohen.
The big surprise finding of this study was veterans who were nursing home residents aged 65 and older with moderate to severe dementia and who had a professional guardian were no more likely to receive high‐intensity treatments than the same population who died with decision makers who were not professional guardians. We talk to Andy about his study, potential reasons behind the study, and what, if anything, we should do differently knowing these results. We also talk to Liz about whether substituted judgement is really all that it’s cracked up to be.
The article, Guardianship and End‐of‐Life Care for Veterans with Dementia in Nursing Homes and editorial, We Need a Paradigm Shift Around End‐of‐Life Decision Making, are available here and here.
December 20, 2020 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care | Permalink | Comments (0)
Friday, December 18, 2020
According to a story yesterday in the AP news, Spain’s parliament vote[d] to legalize euthanasia. The bill provides for medical aid-in-dying or euthanasia "for long-suffering patients of incurable diseases or unbearable permanent conditions." The bill next goes to their Senate. The article notes that "[e]uthanasia — when a doctor directly administers fatal drugs to a patient — is legal in Belgium, Canada, Colombia, Luxembourg, the Netherlands and Switzerland. In some U.S. states, medically-assisted suicide — where patients administer the lethal drug themselves, under medical supervision — is permitted." The bill requires multiple requests by the patient, the first 2 of which must be written and made with two weeks between the requests. Medical professionals must be involved and requests are reviewed and granted by a regional oversight board. Only adult Spanish residents or citizens who can make rational decisions would be able to make such requests.
Monday, December 14, 2020
There's absolutely nothing good at all about COVID. I could list a number of ways it has harmed us, beyond health implications, but I just want to share one article with you from the New York Times, Female Workers Could Take Another Pandemic Hit: To Their Retirements.
Now, the pandemic recession is disproportionately damaging the careers of women — so much so that some experts call it a “shecession.”
In November, the national unemployment rate dipped to 6.7 percent from 6.9 percent, the Labor Department reported last week. But the pace of job growth has stalled, and millions have dropped out of the labor market altogether, especially women. One recent study found a disproportionate decline in employment for women of prime working age, 25 to 55, compared with men — and especially so for mothers.
The losses sustained are not just right now-but must be factored over time, including "missed wage growth, retirement savings and Social Security benefits." Here is a great visual for this: a calculator developed by the center for American Progress.
The article discusses the importance of Social Security and includes info about President-elect Biden's plans for Social Security, which would
award work credit to people who cared for children or other relatives. It would also expand benefits for widows in certain circumstances, and bump up benefits for seniors who had collected payments for 20 years. Finally, it would adopt a new yardstick to determine Social Security’s annual cost-of-living adjustment — the CPI-E, an experimental Labor Department inflation measure designed to more accurately reflect the inflation experienced by seniors, especially health care expenses.
This is a good article-I plan to assign it to my students in the spring.
BTW, a shout out to the health care workers, first responders, essential personnel, everyone, who is keeping us going through this pandemic. And to the scientists who created the vaccine, THANK YOU!!!!
On Thursday, December 17, 2020, for a webinar through the National Center for State Courts Elders and Courts. The webinar covers "a new web-based interactive tool: the Judicial Response Protocol for Guardianship and Conservatorship abuses (http://www.eldersandcourts.org/guardianship_conservatorship/guardianship-conservatorship-resources-for-courts/responses-to-allegations-of-wrongdoing). This webinar will be helpful for judges and for court staff. This project was developed with the support of the State Justice Institute..'
To register, click here: https://zoom.us/webinar/register/WN_EuKscJoASJaNSY4hJs2jlg
Monday, December 7, 2020
JAMA Internal Medicine published the results of a recent study, Financial Presentation of Alzheimer Disease and Related Dementias.
Here are the key points from the study:
Question Are Alzheimer disease and related dementias (ADRD) associated with adverse financial outcomes in the years before and after diagnosis?
Findings In this cohort study of 81 364 Medicare beneficiaries living in single-person households, those with ADRD were more likely to miss bill payments up to 6 years prior to diagnosis and started to develop subprime credit scores 2.5 years prior to diagnosis compared with those never diagnosed. These negative financial outcomes persisted after ADRD diagnosis, accounted for 10% to 15% of missed payments in our sample, and were more prevalent in census tracts with less college education.
Meaning Alzheimer disease and related dementias were associated with adverse financial events starting years prior to clinical diagnosis.
The full article is available here.
Friday, December 4, 2020
The Tampa Bay Times ran a profile of a local long term care facility that experienced a significant COVID outbreak last spring. Death at Freedom Square is an in-depth story about the people who live and work at Freedom Square and the spread of COVID within that facility. The article provides detailed reporting (In fact the TBT refers to this story as a "project"). The article is written in a way that tells the story of the people impacted, which makes it a compelling--- and sad---- read.
Nine months into the pandemic, the virus has killed more than 19,000 Floridians. About 40 percent of the deaths have been among senior care residents. In Pinellas County alone, more than 2 out of 3 coronavirus deaths are connected to nursing homes and assisted living centers.
Freedom Square, a 15-acre retirement complex built around a town square and a gazebo, was the early epicenter in Tampa Bay.
Of course, we all know that this is not the only facility that experienced a COVID outbreak, whether inside Florida or in other states. The human interest angle makes this a compelling read, but it also includes important information about the Florida responses and about the corporate structure for this facility.
The article is as gripping as it is saddening; the reporters use of the human interest angle helps remind us that we aren't talking about numbers---we are talking about people.
December 4, 2020 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare, State Statutes/Regulations, Statistics | Permalink | Comments (0)
Thursday, December 3, 2020
Maryland elder law attorney Morris Klein sent me a link to an article recently published in the Washington Post. How government incentives shaped the nursing home business — and left it vulnerable to a pandemic explains
Federal money, through the Medicare and Medicaid systems, has long shaped the nursing home business — and in ways that left it completely vulnerable when the viral pandemic arrived in March.
For years, extra money has gone to pay for extra services, encouraging some nursing home owners to game the system and tempting unscrupulous operators to file false claims for reimbursement. In the recent past, the gold standard was physical and occupational therapy; now it’s respiratory care.
But stringent infection control, which might have kept the coronavirus at bay, has never been a revenue producer, even now during the pandemic. Similarly, there is no monetary incentive to hire more registered nurses, although studies suggest they have been crucial in minimizing covid-19 casualties in nursing homes.
According to the article, the fee for service model is centered on additional care that will bring in additional funds to the provider, "and one consequence is that employees who handle general care of residents — nursing assistants, primarily — rather than the specialty services are a low priority for operators. They are underpaid and in chronically short supply at nursing homes across the country."
The article includes specific resident stories during the time of COVID and compares the financials for SNFs from resident stays covered by Medicare and Medicaid. When COVID rampaged, folks put off surgeries, which affected the bottom line of many SNFs, per the article.
The temptation of the funding system leads some facilities to cross the line. "Working in a system that requires nursing homes to decide what extra services a resident needs, then provide those services, then bill the government, tempts some operators to game the rules and a few to commit outright fraud. Patients can be pushed into higher-paying categories of need. Services can be billed that were never rendered."
The lengthy article gives a really good picture of the funding system, how it works, the oversight and the remedies available to redress wrongdoing. I'm recommending this article to my students.
Wednesday, December 2, 2020
Concomitant with the announcement of the Medicare premiums for 2021 comes a blog post from SSA explaining how the hold harmless provision works. How the Hold Harmless Provision Protects Your Benefits explains that with some exceptions, "the “hold harmless provision” protects ... Social Security benefit payment from decreasing due to an increase in the Medicare Part B premium... To qualify for the hold harmless provision, [the recipient] must: .... Receive Social Security benefits or be entitled to Social Security benefits for November and December of the current year [and the recipient's] Medicare Part B premiums for December and January [are] deducted from [the SSA] monthly benefits."
Read the blog here.
Monday, November 30, 2020
Last week with Thanksgiving, some families took their elders from the SNFs to be home for the holiday. But if grandma then goes back to the SNF, is she bringing a hitchhiker with her (COVID). The Tampa Bay Times discussed this in their article a few days before Thanksgiving, Residents may leave Florida facilities for Thanksgiving, could bring coronavirus back reminds us that "[a]state executive order issued in October mandates that facilities allow residents to visit their families’ homes. Experts and advocates worry that the state has not simultaneously put in place more safety protocols." Since the state doesn't require testing of residents, so as residents return to facilities and aren't tested, we just don't know how this is going to play out. "[T]he Florida Health Care Association ... reminded its member facilities that families should take coronavirus precautions if they bring their loved ones home ... [and while] not required, some facilities may test residents upon their return or isolate them,... and all homes will screen residents for coronavirus symptoms and potential exposure."
And on a somewhat related note, the following story from Canada examines the situation of elders who were taken home at the beginning of the pandemic. Pulled from care homes during pandemic, these seniors thrived — highlighting 'urgent' need for change: expert,
notes that some elders have improved when taken home, but the decision to do so has many things to consider, such as the family members' ability to provide the needed care. Two of the folks interviewed for the story express frustration with what they see as elected officials' failure to resolve the problems in long-term care.
Thanks to my dear friend and colleague Professor Feeley for sending me the link to the second story.
Friday, November 27, 2020
This is not a happy article for the day after Thanksgiving-but it is a darn important topic. The Conversation published this article, Nearly two-thirds of older Black Americans can’t afford to live alone without help – and it’s even tougher for Latinos explains that
Older Americans who want to live independently face serious economic challenges. Half who live alone don’t have enough income to afford even a bare-bones budget in their home communities, and nearly 1 in 4 couples face the same problem.
Those numbers add up to at least 11 million older adults who are struggling to make ends meet, a new analysis shows.
The numbers are worse for older people of color. Dramatically higher percentages of Black, Latino and Asian older adults live on incomes that don’t meet their cost of living, even with Social Security. That can mean skipping needed health care, not having enough food, living in unhealthy conditions or having to move in with family.
These disparities often reflect lifelong disadvantages that add up as people of color encounter structural racism and discrimination that shape their ability to buy property and save for the future.
The authors used some data available about elders "to measure the true cost of living for older adults. It tracks expenses for housing, health care, transportation, food and other basics, county by county. We paired the index with state-level income data to determine the percentage of people who don’t have enough income to cover their cost of living." The results show that "disadvantages people of color face can extend through their lifetimes and can pass on to future generations." Not only is income security an issue, so is health security "[s]ecuring and protecting health into later life is also more challenging for many people of color."
The results also showed state by state variations. The article concludes with various recommendations:
Today’s older adults who are struggling financially can’t go back, but there are several ways to help them now:
Policies can promote affordable housing and affordable health care, which represent the biggest components of older Americans’ budgets.
Governments can promote mechanisms that allow people to keep working into later life, which allows people to continue generating income and building wealth, and also delays drawing down other income sources such as pensions or Social Security benefits.
Social Security and Medicare — the foundations of a secure retirement for millions of Americans — are essential for these groups. Older people of color rely more heavily than their white counterparts on Social Security and are at heightened risk when these programs are threatened.
Making sure government assistance programs such as SNAP benefits for food and housing subsidies are accessible to the people who need them can also help. Ensuring access includes providing information in multiple languages and hiring outreach workers who understand the population’s needs.
Thanks to Professor Naomi Cahn for sending me the link to the article.
Wednesday, November 25, 2020
Remember those cool tools on Medicare.gov that allowed you to compare nursing homes, doctors, hospitals and more? They are being retired as of the end of the year, and replaced with Medicare's Care Compare. All the info about the various services are there-but located on one page. It's easier since you can go to any of the 8 compare services from one landing page, rather than hunting for each one from the Medicare.gov website. Here's what CMS has to say about this new website:
We’ve combined our 8 original provider compare sites, giving you one place to start finding any type of care you need. New features include updated maps, new filters that help you identify the providers right for you, and a clean, consistent design that makes it easier to compare providers and find the information that’s most important to you.
. . .
What can this tool do for me?
For people with Medicare or their caregivers who want to choose a Medicare provider (like physicians, hospitals, nursing homes, and others), this tool provides a single source search and compare experience, that lets you:
- Find information about providers and facilities based on your individual needs
- Get helpful resources to choose your health care providers
- Make more informed decisions about where you get your health care
The information here should be used with other information you gather about providers and facilities in your area. In addition to reviewing the information here, you should talk to your doctor, social worker, or other health care providers when choosing a provider.
. . .
Although the tool was created for people with Medicare in mind, many of the measures shown here apply to people who may not have Medicare.
Tuesday, November 24, 2020
Last week I tweeted a link to an article from the AP about poor care in SNFs that wasn't due to COVID, Not just COVID: Nursing home neglect deaths surge in shadows. The National Consumer Voice for Quality Long Term Care wrote a response; and their full statement is available here.
Consumer Voice has heard from hundreds of families whose loved ones have been harmed by neglect. Family members report that many residents have experienced significant physical decline, such as losing their ability to move, or sit up or stand up without assistance. Others no longer talk because almost no one has spoken to them since March. There are residents who have not been bathed nor had their teeth brushed for months, and residents who have been confined to their rooms -while missing their eyeglasses and hearing aids. One resident sat in her room with a fractured hip for a month – the result of a fall and lack of medical attention, despite complaints of pain for weeks. Weight loss, bed sores, infections, and cognitive decline are ravaging nursing home residents. Much of this suffering could have been prevented.
The statement called on Congress for changes, including '"[ensuring] adequate numbers of well-trained and well-compensated staff. ... [and] [opposition of] any kind of immunity from civil liability for nursing homes" They also called on CMS to "[i]ncrease oversight of resident care ... [and] [r]equire facilities to permit family to conduct compassionate care visits."
November 24, 2020 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare | Permalink | Comments (0)
Monday, November 23, 2020
A little over a week ago, the Motley Fool ran this article, Working and Collecting Social Security? Big Changes May Be on the Way in 2021. The article opens discussing the importance of Social Security to recipients. "Without this guaranteed monthly benefit, the elderly poverty rate would be close to 40%, according to an analysis from the Center on Budget and Policy Priorities (it's under 9% with Social Security payouts)." For those who are working, there are changes coming, according to the article.
"Some choose to continue working, either part-time or full-time, while collecting their retired worker benefit from the program. If you're one of these people, or you expect to claim benefits very soon while continuing to stay employed in some capacity, you should be aware of a handful of changes expected to occur in 2021."
The retirement earnings test amount (a formula that provides a deduction from SSA checks based on earnings amount for those who claim Social Security before reaching their full retirement age) is being increased (the article does a good job of explaining the earnings test).
Back in August the president issued an administrative order for a payroll tax deferral through the end of the year and for those who chose the deferral, 2021 is just around the corner when they have that bill coming due. Also in 2021, the payroll tax earnings cap will increase.
Friday, November 20, 2020
The ABA Commission on Law & Aging released recently this paper, WINGS Briefing Paper
Advancing Guardianship Reform and Promoting Less Restrictive . Here are some highlights from the report.
The Administration for Community Living (ACL) awarded a grant to the American Bar Association Commission on Law and Aging (ABA Commission) to establish, expand or enhance state Working Interdisciplinary Networks of Guardianship Stakeholders (WINGS)…
This briefing paper discusses the ABA Commission’s WINGS Project, its results, and its potential for positive changes. Specifically, it (1) describes the challenges of adult guardianship reform and the rationale for creating WINGS; (2) presents project findings and conclusions about WINGS; (3) discusses the potential for applying the CIP model to the adult guardianship system; and (4) makes recommendations for next steps in federal policy.
The ACL funding was awarded with the goal of testing whether WINGS is an approach that can advance guardianship reform to:
(a) avoid unnecessary and overbroad guardianship when less restrictive options are available, promoting self-determination; and
(b) prevent, detect and address abuses in the guardianship system.
* * *
While the project WINGS, and indeed all state WINGS, have advanced adult guardianship reform, their modestly funded efforts are not enough to significantly improve outcomes for adults subject to, or potentially subject to, guardianship… Programs like WINGS should exist in every state under a national infrastructure with consistent, ongoing technical assistance and support… [T]he Commission on Law and Aging offers the following … Recommendations:
- Recommendations for Federal Policy
ACL, in coordination with other federal entities, should provide funding to support the following recommendations:
- Support WINGS Through Systems Change Grants
- Administer a five-year WINGS systems change grant initiative.
- Include programmatic requirements for monitoring guardians.
- Create a WINGS capacity-building/technical assistance entity.
- Support local or regional WINGS.
- Take Steps Toward Establishment of a Guardianship Court Improvement Program
Plan for establishment and implementation of a Guardianship Court Improvement Program. Pilot the program and support a capacity-building center.
• Secure federal legislation with appropriations to implement and sustain a Guardianship Court Improvement Program.
The full report is available here.
Thursday, November 19, 2020
I love the Marvel movies and always enjeoyed seeing the cameos of Stan Lee in the movies. I'd heard stories about the last few years of his life.
The Last Days of Stan Lee: A heartbreaking tragedy about the (alleged) abuse of the Marvel Comics creator by those who swear they loved him opens with the telling of a video of Mr. Lee filmed at a Comic Con, followed a few days later by a story in another publication. The article notes that almost 2 years after Mr. Lee's death, there are many unanswered questions and several cases pending in courts:
[A] half-dozen civil suits are pending and a criminal elder-abuse prosecution by the Los Angeles County District Attorney’s office remains mired in pretrial maneuverings. The courts have yet to shed light on many of the details and the veracity of the elder-abuse charges against several people. Elder-abuse cases are difficult to bring to trial, tough to litigate and hard to win. Was Stan Lee, like 1 in 10 Americans over age 60, a true victim of elder abuse, which can include physical violence, emotional torment, financial exploitation and willful deprivation? Plenty of evidence and testimony suggests that may be true.
The article details the decades of his career and his personal life. The article focuses on Mr. Lee's relationship with those close to him, including his daughter.. As the story wraps up, the writer tells us
THE LAWSUITS churn through the system. Delays give way to delays, and the accused sit mostly at home like the rest of us this year. As with so many elder-abuse cases, those involving the Lee estate will likely come down to “he said, she said.” Except, in this situation, there’s a three-ring circus of barkers and performers who may not have had Lee’s best interest at heart, in a charade that went on for years. Call it the long con, but “those types of relationships are much more difficult to pinpoint as being perpetrators,” said elder-abuse prosecutor Paul Greenwood. “I always say that the longer the victim and suspect have known each other, the more difficult it becomes to establish beyond a reasonable doubt that undue influence was exerted over that person, because sometimes loyalty is rewarded.”
In a less lawyerly explanation, the villain in this story is love. Abuse of the elderly routinely cloaks itself in love, which is, in many cases, returned by the victim. The perpetrators might even call love their motivation.
It will be a while before we know the full story (if ever). Stay tuned.
November 19, 2020 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0)
Wednesday, November 18, 2020
Billboard published a recent feature on Dolly Parton. Dolly Parton Steers Her Empire Through the Pandemic—and Keeps It Growing! Now you may wonder why I'm blogging about Dolly Parton on the elderlawprof blog? Well, she's 74. But that's not why I thought this article was worth inclusion. The bulk of the article is about her life, her music portfolio, and her businesses. Here's why:
Though there is an air of immortality to Parton, thanks to her immutable image and lyrics like “You’re never old unless you choose to be,” she and Nozell have spent the past few years preparing for a world without her. Unlike Prince or Aretha Franklin, who died without wills, Parton has worked to get her estate in order, and Nozell says that most decisions now are made with Parton’s legacy in mind. (Parton and Carl Dean, her husband of 54 years, have no children.) “I would not want to leave that mess to somebody else,” Parton says, before offering a little advice. “A word to all the other artists out there: If you haven’t made those provisions, do that. You don’t want to leave that mess to your family for people to have to fight over. You need to take care of that yourself, even if it’s a pain in the ass — and it is.”
This is good advice for everyone-regardless of the size of their estates. Take it from Ms. Parton-planning is important!