Monday, April 10, 2023

Pennsylvania Legislators Discuss Proposed Legislation on Compassionate Aid in Dying with Penn State Dickinson Law Students

Representatives Kahn and Hill-Evans Discuss New Pennsylvania Legisation on Compassion in Dying.April 2023
It is getting near the end of the semester, but we are continuing to have important topics and guest speakers at Penn State Dickinson Law in our Elder Law modules.  Today's speakers were Representative Tarik Khan and Representative Carol Hill-Evams. who led the discussion about a bill they are sponsoring on Compaasionate Aid in Dying for Pennsylvania.   Representative Hill-Evans is the lead sponsor on the current version and opened the session with a powerful story about a constituent who explained her reasons for promoting this law.  

Pennsylvania House Bill 543 was introduced in March 2023 and is currently assigned to the Health Committee of the Pennsylvania House.  We  heard that plans are underway to begin hearings, with people tesstifying why they do -- or don't -- want to see  a legal option enacted that makes it possible  for a person who is terminally ill to choose "medical assistance in dying." After class, two of  the students approached me with good suggestions about potential clarifications for the new bill, thus contiinguing the conversation with the legislators.  

Next week is our last class of the semester, where students will be giving oral presentations on various Death with Dignity laws or movements, both in the United States and in outher nations, as well as presenting on other choices people may consider near  the end of their lives.   

Our speacial thanks to all of our guests during this busy semester, including legislators, Elder Law attorneys, the owner of a funeral home, and representatives from hospice and other health care providers.    

April 10, 2023 in Advance Directives/End-of-Life, State Statutes/Regulations | Permalink | Comments (0)

Undocumented Workers in the Caregiving World

Los Angeles Times journalist Steve Lopez has been writing recently on the financial costs of long-term care, whether in the home or a "senior living" setting.  It is part of his series of  "Golden State" columns on California's aging population.   Today, however, he has reversed the lens, and talks about the impact of the need for care on low-wage workers.  He writes: 

I’ve been in homes where the caregivers are U.S. citizens with decent wages and benefits, and I’ve been in homes where the workers are undocumented and paid less than the minimum wage  ($16.04  an hour in the city of Los Angeles)  in cash. It’s a wink-and-nod system, much like farm labor, in which cheap labor is prized over any other consideration.

 

“It’s very much a legacy of slavery and a history in this country of not valuing the work done by … people of color,” said attorney Yvonne Medrano, who heads the employee rights program at Bet Tzedek Legal Services.

 

Several weeks ago I reached out to the the Pilipino Workers Center, a Los Angeles nonprofit that has been educating domestic workers on their rights and leading a fight against a system in which labor laws are often ignored and workers — many of them old enough to be receiving elder care themselves — are cheated and exploited.

Aquilina Soriano Versoza, the center’s director, said research indicates a majority of clients appreciate the care they get and would be willing to pay more for it, but many can’t afford to.

For  a more complete picture, read They Take Care of Aging Adults, Live in Cramped Quarters, and Make Less than MInimum Wage from the Los Angeles Times.

April 10, 2023 in Consumer Information, Current Affairs, Discrimination, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Tuesday, March 28, 2023

San Diego Expands its Pilot Program for Alzheimer's Response

As described in The San Diego Union-Tribune, San Diego's Alzheimer' Response pilot program, launched in 2018  for the "East County," is a success, helping the public in better addressing people coping with Alzheiemer's Disease or other dementias.  The Alzheimer's Response Team (or ART) now covers the full San Diego region, with help from $1.5 milliion in funding and a staff of  10.5 full time employees.   Originally the program collaborated with an outside nonprofit organization, but "the county now provides its dementia training in-house."

Concerned family members have the option of asking for ART services, often as a way to avoid having problematic episodes escalate.  The article, published online on 3/27/2023 explains: 

ART focuses on two aspects of dementia care: crisis response and crisis prevention. To better respond to emergency calls related to dementia, law enforcement agents, first responders, social workers and mental health clinicians receive training on how neurodegenerative diseases like Alzheimer’s impact someone’s behavior.

 

That training helps first responders better recognize the symptoms of dementia during emergency calls. They can then call in the ART specialists to work with the person in distress and provide in-home services for clients living with dementia and their family caregivers.

 

Eugenia Welch — president and CEO for Alzheimer’s San Diego, which helped develop the initial programming — said the first responder training and specialized ART staff are key to the program’s success. Interacting with someone diagnosed with dementia, she added, is different than working with people who don’t have neurodegenerative disorders and “takes a unique skill.”

 

“I think by having the specialized team going out, they’re able to be more in tune to the services that are available for people living at home with dementia and able to more quickly connect people with those services to get them the support they need,” Welch said.
 
The ART staff may follow clients to provide support in order to prevent new crises, and to connect the families with local dementia care resources.  According to the article, while "Adult Protective Services Cases" are usually closed in a month, ART support services can continue for six months or longer.  "Staff check in with the client and their family regularly until ths situation is stablized before closing the case."
 
Family members or other concerned people can call 911 in the event of a serious situation developing and should "let disptachers know somoene in the home has either been diagnosed with dementia or is supsected to be living with the condition undiagnosed."  The article says that services can also be requested through the countys's Adult Protect Services Call number directly, rather than through 911.  

March 28, 2023 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Statistics | Permalink | Comments (0)

Monday, February 27, 2023

Did You Miss These Two Items?

A dear friend of mine sent me this short video on how to make a SNF resident's room more easily identifiable to them: https://www.tiktok.com/@designsecretsss/video/7184175944666516779

Also, the latest edition of the Journal of Elder Policy has been published and is available here. The Journal is "an interdiscplinary journal about old age and policy", and prior issues can be accessed through the landing page.

February 27, 2023 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other | Permalink | Comments (0)

Sunday, February 26, 2023

Borchard Foundation Center on Law & Aging Academic Research Grants Application Now Open

Forwarded from the Director Mary Jane Ciccarello

 

The Borchard Foundation Center on Law & Aging

Invites Applications for

 The 2023-2025 Borchard Fellowships in Law & Aging

 

Applications due April 3, 2023

 

 

Fellowship Information

The Borchard Fellowship in Law & Aging offers the opportunity to carry out a substantial project related to law and aging in partnership with a host agency. Two two-year fellowships are available to law school graduates interested in, and perhaps already in the early stages of pursuing, an academic and/or professional career in law and aging.

The fellowship is $58,000 a year for two years and is intended as a full-time position only. During the fellowship period, the Center’s director and former fellows are available to help fellows with the further development of their knowledge, skills, and contacts. Fellows may also receive from the Center financial support to attend appropriate professional education program opportunities. A fellow is expected to provide the Center with monthly activities reports. Fellows may live and work where they choose in the United States. Fellows must be either U.S. citizens or legally resident in the U.S.

A legal services or other non-profit organization involved in law and aging must serve as the fellow’s host agency and supervise a fellow’s activities and projects. The fellow’s host agency is responsible for providing employee benefits, employer’s FICA payment, administrative support, workspace, computer, telephone, and email access.

The two-year fellowship period starts typically on July 1 for those already admitted to the Bar and from not later than September 1 for those who must sit for the Bar exam after law school graduation.

Fellows participate in conference calls and other planned activities with other current and former fellows to encourage networking. Former fellows who successfully complete the fellowship period may also participate in the Center’s Former Fellows Grant Program.

Examples of some activities and projects by Borchard Fellows:

  • Working with an established legal services program to enable vulnerable, isolated, low-income seniors to age-in-place by addressing their unmet legal needs;
  • Providing holistic services to older clients facing consumer debt and foreclosure-related concerns;
  • Providing direct legal representation and holistic services to older tenants in “clutter cases”;
  • Implementation of a courthouse project to help elderly pro se tenants achieve long-term housing stabilization through the interdisciplinary use of legal representation and social services, allowing more elderly tenants to “age in place” at home; 
  • Development of mobile clinics to help Chinese-speaking elders improve their access to public benefits and health care;
  • Development of a medical-legal partnership for low-income older adults;
  • Development of educational outreach efforts and legal services for older LGBTQ+ adults;
  • Development of legal services and informational materials to caregivers working on behalf of beneficiaries with cognitive impairment;
  • Development of a non-profit senior law resource center providing direct legal services and public education;
  • Development of an interdisciplinary elder law clinical program at a major public university law school;
  • Development of a mediation component for a legal services program elder law hotline;
  • Development of an interdisciplinary project for graduate students in law, medicine, and health advocacy to foster understanding and collaboration between professions;
  • Development of training materials and statewide trainings for

lawyers, judges and other court personnel, and social service providers on new comprehensive state guardianship laws;

  • Development of legal services programs for older clients in consumer law and small claims matters, end-of-life matters, and in protection from financial and elder abuse for older clients whose first language is other than English;
  • Development of free legal clinics for older clients in suburban areas;
  • Development, administration, and interpretation of statewide senior legal hotline outcomes study;
  • Increasing access to legal representation for older adults in immigration detention facilities;
  • Organizing and/or attending national conferences on law and aging issues;
  • Writing and publication of law review articles on law and aging issues;
  • Writing and publication of state specific, consumer oriented handbooks on legal issues affecting older persons;
  • Analysis of Medicare policies;
  • Analysis of Medicaid Home and Community Based Services with a focus on improving racial equity;
  • Analysis of SSI non-disability appeals; and
  • Teaching elder law and related courses at law schools where fellows reside.

 

Application Process

Applications are due on April 3, 2023. Applicants must submit a completed online application including an information form, an explanation of the applicant’s planned activities and projects, a statement about the applicant’s interest in law and aging, a current curriculum vitae, a law school transcript, a letter of support from the proposed supervisor, and two other letters of support.

All fellowship application information and the required online application are available between March 1, 2023, and April 3, 2023, at http://www.borchardcla.org/fellowship-program.

For further information, contact Mary Jane Ciccarello, Director, at [email protected].

February 26, 2023 in Consumer Information, Current Affairs, Grant Deadlines/Awards, Other | Permalink | Comments (0)

Sunday, February 19, 2023

New Article from Professor Kaplan on IRAs

I am remiss in not telling you sooner that Professor Richard  Kaplan has a new article. Anything he publishes is a must-read in my book. Here's the info

The Declining Appeal of Inherited Retirement Accounts is now in print: 42 Va. Tax Rev. 267-85 (2023).

SSRN: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4323136

Abstract: As retirement accounts proliferate and grow in value, American retirees are increasingly leaving substantial balances in these accounts to their adult children, siblings, and other relatives. Until recently, these new owners were able to withdraw funds from these tax-favored accounts over their lifetimes as their personal circumstances dictated. But legislation enacted in late 2019 and regulations issued in February 2022 have sharply limited the flexibility that non-spousal beneficiaries now have regarding these assets. This article examines those changes, analyzes their impact on the new owners of inherited retirement accounts, and considers what planning strategies are now appropriate.

Thanks Professor Kaplan!

February 19, 2023 in Consumer Information, Current Affairs, Retirement | Permalink

Thursday, February 16, 2023

Medicare and Social Security Projections-Not Unexpected?

The news from the Congressional Budget Office underscores the reality that the SSA and Medicare Trustees have been pointing out for a while now.  According to an article yesterday in The Hill, CBO warns of sharp uptick in Social Security, Medicare spending,

Federal spending on Social Security and Medicare is projected to rise dramatically over the next decade, far outpacing revenues and the economy on the whole while putting new pressure on Congress to address accelerated threats of insolvency, according to new estimates from the Congressional Budget Office (CBO). 

The increase is driven by a variety of factors, including Social Security’s new cost-of-living adjustment, the rising cost of medical services under Medicare and greater participation rates in both programs, as the last of the baby boomers become eligible for retirement benefits. 

Further, in Social Security set to run short of funds one year earlier than expected the director of the CBO explains

Social Security funds are set to start running a shortfall in 2032, one year earlier than previously expected, the director of the Congressional Budget Office (CBO) said on Tuesday.

“The Social Security solvency date — the exhaustion date for the trust fund — is now within the budget window,” CBO Director Phillip Swagel said, referring to the 10-year period covered by the agency’s annual report.

If the Social Security funds become insolvent and there is no change to current laws, beneficiaries would see a more than 20 percent reduction in their benefits, Swagel added. 

This is the CBO’s second update to the Social Security insolvency date in the last two months, after it adjusted its projection down to 2033 in mid-December.

And finally, in Axios today, Medicare politics are on a crash course with reality

By the numbers: Medicare spending is expected to more than double by 2033 — climbing to $1.6 trillion, or over 4% of the entire U.S. economy, according to an estimate released yesterday by the Congressional Budget Office.

[T]he program's trustees have said the fund that pays for Medicare's hospital coverage will soon reach a dangerous tipping point — paying out more than it takes in. On that trajectory, it eventually wouldn't be able to pay for the coverage it's supposed to provide.

Want to read the full CBO report? It's here.  

Misquoting Bette Davis, "Fasten your seatbelts. It's going to be a bumpy ride."

February 16, 2023 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare, Retirement, Social Security | Permalink

Wednesday, December 7, 2022

Limited Nursing Home Beds Also Impacting Hospital Availability

On December 7, NPR had a short segment during Morning Edition describing the impact of lack of staffing -- and therefore lack of "beds" --  in nursing homes and rehabilitation care facilities, which in turn means hospitals are stuck keeping the patients. Further, Medicaid often won't pay for hospital care for individuals who "only" need nursing home care. 

Listen to the 3-minute segment that uses hospitals in Vermont as the focus:  Limited Nursing Home Beds Force Hospitals to Keep Patients Longer.

The story hints at several subtle issues, including Medicaid funding priorities, especially as Medicaid involves joint federal/state funding, and how health care handles "inability to pay" by residents.   This last semester I've taught a stand alone course on Nonprofit Organizations Law and students are often surprised to learn that the single largest -- and highest income -- segment of the nonprofit world is health care, especially hospital-based health care.   Students ask how a "charity" accounts for earnings and losses -- and we discuss the fact that no organization, nonprofit or for profit, can afford to operate very long without adequate revenues to stay solvent.    The NPR story reflects a theme that my course often raises -- what does it mean to be "charitable"?  

December 7, 2022 in Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care, Housing, Medicaid | Permalink | Comments (0)

Sunday, November 27, 2022

USA's Fastest-Growing Demographic Group? Consider the Implications of People Age 50+ Who Live Alone

The New York Times Sunday edition includes a feature article about a trend, "more older Americans living by themselves than ever before."  

Using graphs, interviews and research results, the article makes a clear argument, that "'while many people in their 50s and 60s thrive living solo, research is unequivocal that people aging alone experience worse physical and mental health outcomes and shorter life spans." 

Plus, the article implies that evidence that shows a growing share of older adults (age 55 plus) do not have children, means there is a public policy concern "about how elder care will be managed in the coming decades." 

For me, this article crystalizes two legal concepts I write about frequently:  "filial support" laws that can be used to compel adult children to care for or maintain their elders, and "continuing care retirement communities," that permit people with sufficient -- make that significantly sufficient -- financial resources to plan for how their care needs may be handled in a planned community.  

Law professors can probably use the article to stimulate waves of student projects about personal and collective responsibilities in American societies and beyond.  

For more, see  "As Gen X and Boomers Age, They Confront Living Alone," by Dana Goldstein and Robert Gebeloff. 

 

November 27, 2022 in Cognitive Impairment, Consumer Information, Current Affairs, Discrimination, Ethical Issues, Health Care/Long Term Care, Housing, Statistics | Permalink | Comments (0)

Sunday, November 6, 2022

Loss of the Ability to Evaluate Risk vs "Winning the Sweepstakes"

When I was a child, my grandfather had an ongoing relationship with Readers' Digest.  Not just their magazine or their condensed books, but with the company itself. He was always convinced he had won their latest sweepstakes and his big-dollar prize was just around the corner.  It was a bit of a family legend.  

Recently an older friend, who had celebrated a 90th birthday a few months back, called to ask for help in filling out forms for the Publishers Clearing House sweepstakes.  Over the years my friend had purchased various items from PCH, including a set of solar lights that never worked properly.   The odds of actually "winning" the PCH sweepstakes are astronomically high.  My friend thought buying something would increase the odds of winning no matter how often I explained over the years that was not true.  Sometimes new "stuff" would appear in the mail, along with a corresponding bill for the "order."  It was hard to know whether my friend had actually ordered the items.

This time, my friend was thrilled to explain the long-awaited victory was almost here -- as the latest mailing "guaranteed" the check would be arriving by mail and all that was needed was timely confirmation by return mail of a willingness to accept the prize.  Two envelopes were provided to help in "claiming" the victory.  

I walked patiently through the colorful documents with my friend, pointing out all my examples of clever language.   I showed my friend a copy of a case, Harris v.  Publishers Clearing House, an unofficially reported  federal decision from 2016, that described another person who also thought he had won for the exact same reasons as my friend. The prize never came. He was suing -- without the benefit of an attorney --  for breach of contract, fraud, and alleged violations of Deceptive Mail Prevention and Enforcement Act, 39 U.S.C. Section 2001 et seq.  But the judge ruled against him, dismissing the case with prejudice while explaining the language in the letters "merely informed the plaintiff that he had a chance to win. . . . "  

My friend seemed to understand what I was saying.  My friend asked my opinion -- "what should we do?"  I suggested we tear up the letters and throw them in the trash.  My friend put the documents -- untorn -- in the waste can.  We talked about the fact that continuing to participate with this company was wasting money, and was also an example of "feeding the troll," encouraging the company to keep sending those "too-good-to-be-true" letters to other people.   We  ended our discussion with a good hug.

The next morning I stopped by to drop off newspapers and a fresh donut.  As I waited for my friend, I saw the top of two "official" envelopes addressed to Publishers Clearing House peeking out of the top of the home's mail box for pick up -- with fresh stamps.   I couldn't help but sigh.  

Here is a link to a science-based discussion about early assessment of cognitive impairment, and the importance of histories provided by a reliable informant or care partner for diagnostic assessment.  Victimization in scams is one of several behavioral examples listed in the article that can point to changes in cognition, associated with the loss of the ability to evaluate risk or odds of winning. 

Isn't it sad that it might be easier to diagnose cognitive impairment than to get a ruling finding deceptive trade practices?  

November 6, 2022 in Cognitive Impairment, Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Monday, October 17, 2022

Within 10 Minutes, Three Friends Sent Me Links to the Same NYT Commentary on Aging

I'm going to try not to take this personally, but I realized that within the space of a few minutes three friends had emailed me links to the same New York Times opinion piece  

The amusing commentary begins:

There’s a brutal moment in youth when you go from looking up to your elders to looking somewhat down on them. Or at least seeing them with a more jaundiced eye. Maybe it happens at a party. You glance around the room and realize the gentleman you once saw as distinguished has cheerfully dipped a half-eaten chicken wing into a bowl of hummus. You see what one might politely refer to as a “not young” woman waving her arms around with a little too much gusto on the dance floor. And it hits you: They don’t realize that they’re old.

So how do you know when it’s happening to you?

For the full commentary -- that you can read while smiling, however rueful your smile might be, see Wait, Who Did you Say is Middle-Aged?  

My thanks to all of our good friends who help in shaping this Blog!  

 

 

 

October 17, 2022 in Consumer Information, Current Affairs | Permalink | Comments (0)

Sunday, October 16, 2022

Enjoying Experienced Interviewers and Experienced Interviewees Talk Intriguing Career Details

When my overworked eyes are too tired to read even one more word or watch another moment of TV, I can still enjoy listening.  Over the weekend I caught two interviews of experienced professionals, made especially interesting because of the great exchanges between the "entertainers" and the well-prepared, dynamic questioners.

Jamie Lee Curtis -- of Scream fame (among other career highlights) -- interviewed by Alesha Roscoe on NPS's Weekend Edition Sunday.

and

Béla Fleck of all-things-banjo musical fame, interviewed by WTF host Marc Maron.  

What do these interviews have to do with "Elder Law"?  Thankfully, not much.  But both of the actress and the musician were talking from the perspective of their "age" about how and why they kept going in their crafts.  

October 16, 2022 in Current Affairs | Permalink | Comments (0)

Wednesday, October 5, 2022

Justice Department Expands Strike Force to Protect Older Americans from Fraud

The U.S. Justice Department issued a press release yesterday, announcing the expansion of its Transnational Elder Fraud Strike Force.  The Strike Force was organized in 2019, involving the Justice Department's Consumer Protection Bureau,  U.S. Attorneys Offices, the FBI, Homeland Security, and -- I was interested to see -- the United States Postal Inspection Service

I've actually worked with the Postal Inspector on an elder fraud case.   A woman in her 90s was mailing an unusually fat envelope and asked a friend to give her a ride to a local branch of the post office.  The friend, knowing the woman was quite frail when walking unassisted, offered to get the postage, or to accompany her, but the older woman, who the friend thought seemed unsure of herself, declined.  The friend thought about this, was alerted by what struck her as unusual behavior, and called the woman's daughter and explained what had just  happened. 

The daughter had dismissed a home caregiver recently after learning the caregiver was asking her mother for -- and receiving --  two  or more "pay checks" per week, as well as asking for additional cash that seemed to disappear in mysterious ways.  The daughter went to the post office with a copy of a certified Power of Attorney, granted to her by her mother several years before she was diagnosed with multiple conditions, including cognitive issues, following a stroke.  In fact the reason the caregiver had been hired was precisely because the mother was vulnerable and sometimes confused. 

The Post Office at first seemed to be reluctant to take action, but the daughter was able to describe the envelope and also to provide the name of the former employee who had already been fully paid for his work, and had signed a receipt to that effect. The Post Office's worker agreed to search, but when the daughter departed, it seemed unlikely any action would be taken.  That is, it seemed unlikely until the next day, when a representative of the Postal Inspector set up an appointment.  Having identified and been given the daughter/agent's permission to open the envelope, the federal authorities found several hundred dollars in the envelope that was, indeed, addressed to the former worker.  The officers interviewed the mother and then went to see the suspect, who claimed it was merely an additional paycheck that was "owed."  He  claimed the mother was fully supportive of giving him cash, but he was unable to explain the receipt he'd signed, the burner phones he had used to call the woman, nor the many "payments" he'd received in the last 60 days, payments that the daughter had since documented as more than tripling his agreed wage rate during that period. 

I'm the daughter; my 90+ mother was the person defrauded.  (She has since passed away, so I feel more able to tell this story.)  I learned the Postal Service already understood such a fact pattern very well.  Even at that time, several years ago, the official investigating the facts told us that similar transactions happened all too often.  It is good to see, with this latest press release, that the U.S. Justice Department is coordinating authorities on enhanced fraud prevention and recovery efforts in support of elder justice.  

My thanks to Associate Dean for Academic Affairs Amy Gaudion at Penn State Dickinson Law, who shared the Justice Department notice with me, and whose own research focuses on national security and privacy issues.  

October 5, 2022 in Consumer Information, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Widener Univ. Commonwealth Law School's Clinical Students to Serve as Monitors in Pennsylvania Guardianship Program

Mary Catherine Scott, Director of the Central Pennsylvania Law Clinic at Widener University Commonwealth Campus, has recently partnered with Dauphin County Orphans' Court in Harrisburg, Pennsylvania to expand her clinical students' opportunities for service. Law students will now have roles as monitors in guardianship cases, seeking to maximize the interests of protected persons.  The Pro Bono Guardianship Monitoring Program was begun in central Pennsylvania by the Honorable Todd Hoover, and is now overseen by Dauphin County Court of Common Pleas Judge Jeffrey Engle, involving as many as 400 active cases.  The monitor program is another component of the Pennsylvania courts' enhanced protections for older persons and other persons found to be in need of certain assistance.  Pennsylvania also has a state-wide Guardianship Tracking System

Elder-Justice-Consortium (1)This is another example of expanding services to older adults in Pennsylvania, an outgrowth of the Elder Justice Consortium, supported by representatives of all nine law schools in Pennsylvania.    

October 5, 2022 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Property Management, State Cases | Permalink | Comments (0)

Tuesday, October 4, 2022

MA Plans May Not Cover All Medicare-Allowed Days for SNF Stay?

Kaiser Health News just released this story, Nursing Home Surprise: Advantage Plans May Shorten Stays to Less Time Than Medicare Covers.

Health care providers, nursing home representatives, and advocates for residents say Medicare Advantage plans are increasingly ending members’ coverage for nursing home and rehabilitation services before patients are healthy enough to go home.

Half of the nearly 65 million people with Medicare are enrolled in the private health plans called Medicare Advantage, an alternative to the traditional government program. The plans must cover — at a minimum — the same benefits as traditional Medicare, including up to 100 days of skilled nursing home care every year.

But the private plans have leeway when deciding how much nursing home care a patient needs.

One expert interviewed for the story  noted that "[a]s Medicare Advantage enrollment has spiked in recent years, ... disagreements between insurers and nursing home medical teams have increased. In addition, [the expert] said, insurers have hired companies, such as Tennessee-based naviHealth, that use data about other patients to help predict how much care an individual needs in a skilled nursing facility based on her health condition. Those calculations can conflict with what medical teams recommend...."

This is an important issue. Read this story.

October 4, 2022 in Consumer Information, Current Affairs, Health Care/Long Term Care, Medicare | Permalink

Friday, September 23, 2022

Another Article on the Impact of Family Caregiving

On several occassions we've pointed out issues surrounding the need for caregiving and families stepping up to fill the role.  Add this article from the New York Times to the library of articles on the topic. The Quiet Cost of Family Caregiving focuses on the impact on the individuals providing care, especially if they are working. For example, "Caregivers who are employed often reduce their work hours or leave the workplace altogether, research has shown. Several recent studies, however, reveal the impact of these decisions in more detail, not only on working caregivers but on employers and the general economy." The article looks at the data on those who reduce hours or leave the workforce and the gender differences on those leaving the work force.  This is an important article-read it!

September 23, 2022 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other, Statistics | Permalink | Comments (0)

Thursday, September 22, 2022

Some Critical Access Hospitals Overpaid by Medicare?

And another report from the HHS Office of Inspector General,  Medicare Part B Overpaid and Beneficiaries Incurred Cost-Share Overcharges of Over $1 Million for the Same Professional Services.  Here is their findings:

Not all Medicare Part B payments made to CAHs for professional services and payments made to health care practitioners complied with Federal requirements. For the 40,026 claims we audited, CAHs and health care practitioners each submitted an equal number of claims. However, for each date of service, only one of the claims complied with Federal requirements. As a result, Medicare administrative contractors (MACs) paid providers $907,438 more than they should have been paid, and beneficiaries were held responsible for $281,321 more than they should have been.

These overpayments occurred because CMS did not have claim system edits to prevent and detect duplicate professional services claims for the same date of service, beneficiary, and procedure.

The full report with comments and recommendations is available here.

September 22, 2022 in Consumer Information, Current Affairs, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Certain SNF non-compliance on infection control and more?

The Office of the Inspector General for HHS has released a report,  Certain Life Care Nursing Homes May Not Have Complied With Federal Requirements for Infection Prevention and Control and Emergency Preparedness.

Here is a summary of their findings

Selected Life Care nursing homes may not have complied with Federal requirements for infection prevention and control and emergency preparedness. Specifically, 23 of the 24 nursing homes selected had possible deficiencies. Actual deficiencies can only be determined following a thorough investigation by trained surveyors. At 22 nursing homes, we found 35 instances of possible noncompliance with infection prevention and control requirements related to annual reviews of the Infection Prevention and Control Program, training, designation of a qualified infection preventionist, and Quality Assessment and Assurance Committee meetings. We also found at 16 nursing homes 20 instances of possible noncompliance with emergency preparedness requirements related to the annual review of emergency preparedness plans and annual emergency preparedness risk assessments. Life Care officials attributed the possible noncompliance to: (1) leadership turnover, (2) staff turnover, (3) documentation issues (i.e., information was not documented or documentation was either lost or misplaced), (4) staff members who were unfamiliar with requirements (i.e., requirements stipulating that there is no grace period for infection preventionists to complete specialized training and that emergency preparedness plans needed to be reviewed annually), (5) qualified personnel shortage, and (6) challenges related to the COVID-19 public health emergency. We also believe that many of the conditions noted in our report occurred because CMS did not provide nursing homes with communication and training related to complying with the new, phase 3 infection control requirements, or clarification about the essential components to be integrated in the nursing homes’ emergency plans. 

The full report with recommendations is available here.

September 22, 2022 in Consumer Information, Current Affairs, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Wednesday, September 21, 2022

Practice Tip for Older Student Loan Debtors

The National Center on  Law & Elder Rights has released a new practice tip, Cancellation of Debt & Other Changes to the Federal Student Loan System that Impact Older Borrowers.

Student loan debt is one of the biggest contributors to the rise in the amount of debt held by older adults. According to AARP, in 2020 8.4 million borrowers age 50 and older held 22% of the total federal student debt load, amounting to $336.1 billion. The average amount of student loan debt carried by families headed by adults 50 or older was $36,421 in 2019. This includes older borrowers who took out loans for their own education or to pay for a family member’s education. Default on student loans can result in aggressive collection actions, including the garnishment of wages and Social Security benefits, and an accumulation of fees and interest. Older adults consistently report difficulty managing their student loan debt while trying to stay on track to save for retirement or pay for other necessary expenses on reduced retirement incomes. This results in financial instability, especially for low-income older adults and those on f ixed-incomes.

The practice tip includes discussion of the moratorium on student loan collections, debt cancellation, public service loan foregiveness, changes under discussion for income-based repayment plans, and links to helpful resources. 

September 21, 2022 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Other | Permalink | Comments (0)

Tuesday, September 20, 2022

Canada Medically-Assisted Death

The New York Times recently ran this article, Is Choosing Death Too Easy in Canada? "Last year, Canada changed its assisted death law, permitting people with chronic, “grievous and irremediable” conditions and physical disabilities to commit suicide, even if they are not terminally ill."  As far as how Canada compares to other countries, "Canada is among 12 countries and several American states where assisted death is permitted in certain circumstances. Since last year, it has been one of at least three — including Belgium and the Netherlands — that allow an assisted death if the person is suffering from a chronic painful condition, even if that condition is not terminal."  Part of what is causing debate, according to the article, is a change that takes effect in March of 2023, when "the law will expand again, to apply to people with some mental disorders. A Parliamentary committee of lawmakers is studying what standards should govern those cases; its report is expected in the fall."  The article discusses views of opponents and proponents and includes some stories of Canadians. Read the article. It will be great for a basis for class discussion!

 
 

September 20, 2022 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, International | Permalink | Comments (0)