Sunday, May 26, 2019
Marketplace recently ran a story about fascinating research on whether there is a correlation between age and susceptibility to scams. Age of fraud: Are seniors more vulnerable to financial scams? opens with the story of one individual who fell victim to a "gift card" scam of almost $200,ooo. Think it can't happen to you? Here is where the science comes in.
[A researcher] and his colleagues have put a label on what they see as an all-too common condition: “age-associated financial vulnerability.”
“We are learning that there are changes in the aging brain, even in the absence of diseases like Alzheimer’s disease or other neurodegenerative illnesses, that may render older adults vulnerable to financial exploitation.”
The science is showing that older folks
ability to detect sketchy situations may decline. Or, we may become prone to seeing the upside of a risky deal and blow off the downside. Some people are more inclined to believe the last person they spoke to. Others may lose the ability to push back on a high-pressure predator. Researchers emphasize that this phenomenon goes way beyond changes in the brain.
“It also involves all of these other social and environmental factors like social isolation, like cultural factors and societal factors, like older adults having more wealth compared to younger generations,” said Marti DeLiema, a research scholar at the Stanford Center on Longevity.
Still think it can't happen to you? The researchers are examining "age-related financial vulnerability[and] are very interested in physical changes to the aging brain, the way eyesight and hearing can get less keen. In some cases, a new pattern of making mistakes with money may be a harbinger of cognitive bad things to come, the “first thing to go,” as it were"
Still think it can't happen to you? Read on. The optimal age for money management is 53 years old, according to the article. There is some advantage to age; the life experiences we acquire. Now we all know, as the article reflects, that scams don't just target older persons. There is no easy answer to the issue. How do you protect people from making bad decisions or from falling for a scam? The article references various state approaches and the federal Elder Abuse Prevention and Prosecution Act. FINRA is also asking brokers to "encourage customers to list the name of a trusted person to contact if something signals “scam.” Banks have no such rule."
The remainder of the article focuses on the responses and need for more work. Several experts offer suggestions for responses. I thought this one response was poignant: "abuse of the elderly is, at its core, lack of social support. The cure is social support. It’s possible that the best way to help vulnerable loved ones is just to be there, to be present in their lives."
Think this can't happen to you? Think again. And read this article.
May 26, 2019 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Science, State Statutes/Regulations, Statistics | Permalink | Comments (0)
Saturday, May 25, 2019
The National Center for State Courts has announced the release of a new guardianship course, Finding the Right Fit: Decision-Making Supports and Guardianship.
According to the press release, this interactive on-line course covers
• How to support friends and loved ones in making their own choices about their health, finances, and lifestyle.
• Legal options, including powers of attorney and advance directives. • How to become a guardian.
• How a guardian can support a person’s decision-making.
• Identifying and understanding the risk of abuse, neglect, and exploitation that comes with any of the above options.
The course takes about 2 hours to complete and you have to create an account to access it. Check it out!
May 25, 2019 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Programs/CLEs, Webinars | Permalink | Comments (0)
Thursday, May 16, 2019
The New York Times ran an article recently that doesn't bode well for many elder Americans. Many Americans Will Need Long-Term Care. Most Won't be Able to Afford It reviews what is referred to as
the middle-class bind ... [where the elder has t]oo much money to qualify for Medicaid or subsidized housing, but not enough to pay for long-term care, an industry that has primarily pursued the well-off. ...
A recent analysis in Health Affairs, pointedly titled “The Forgotten Middle,” investigated how many middle-income seniors will be caught in that bind. The numbers were grim.
Using data from the national Health and Retirement Study, including personal income and assets and health status, the researchers defined the middle-income cohort as Americans from the 41st to the 80th percentile in terms of financial resources....
In 2029, for people 75 to 84 (ages when they’re likely to need long-term care), that would mean access to about $25,000 to $74,000 a year in current dollars. Over age 85, the middle-income category extends to $95,000.
The projection is that two-thirds are going to need some type of long-term care, yet "more than half will be unable to pay assisted living fees and medical costs in 2029, the study found." Even those owning a home aren't as house-rich as they may think. Plus this group has a lot of debt, and not that much in savings.
The United States, unlike many Western democracies, has never created a broad public program covering long-term care. Medicare pays for doctors, hospitals, drugs and short-term rehab after hospitalization — not for independent or assisted living.
That could change one day — imagine a new Medicare Part LTC — but “that will be incredibly difficult to achieve politically,” [said one expert].
Policy types instead suggest more incremental changes by both government and industry. Perhaps Medicaid could cover seniors with slightly higher incomes, or modify its regulations to include housing costs along with health care.
Wednesday, May 15, 2019
Professor Naomi Cahn sent us the link to this recent article, 7 maps that tell the incredible story of aging in America. "Census projections show a major demographic shift already underway and accelerating in the years to come. ...At the same time, populations are not aging evenly, and issues related to aging will impact individual communities in vastly different ways, boosting economic opportunity in some areas while putting a strain on social services in others."
One way to sort out who will be most impacted by aging is to look at age demographics across the country and how they will change over time. Using data from the U.S. Census Bureau and its own updated demographics, spatial-analytics firm Esri put together for Fast Company an exclusive map series that examines the issue from a number of angles, including a district-by-district breakdown of the median age in 2010 and the projected median age in 2023. The result is a compelling visual record of both who we are right now and where we are heading–a temporal snapshot for the ages, so to speak.
There are links to maps on the following topics:
Tuesday, May 14, 2019
That headline may have elicited a shoulder shrug from you and a fleeting thought as to why I thought this was newsworthy enough to be the subject of a blog post. So how about if I add some info for you? What if the story's title is this? Medi-Cal recipient, 101, evicted from Santa Rosa assisted living facility for being unable to pay. This is a situation where the elder outlived her savings. As the story explains
[The resident] like most people, probably never thought she’d live to be 101, and she clearly did not expect to be paying nearly $7,000 a month to be living in a senior residential care facility.
The expense drained her of all the money she had after selling her modest home in Santa Rosa’s Holland Heights neighborhood in 2013. By November of last year, all [the resident] could afford to give ... the assisted living facility, was her monthly Social Security check of about $1,300 — it wasn’t enough. ...
On April 18, [the resident], who suffers from dementia, was wheeled into Sonoma County eviction court on Cleveland Avenue. With her bank account drained, the former real estate agent was now receiving Medi-Cal, the state’s version of Medicaid health insurance, which the private-pay [ALF] le did not accept.
The story ultimately has an ending-a Medi-Cal bed was located for the resident. The story goes on to focus on the lack of beds in the area, the cost of long-term care, and the problem for folks like the elder in this story who outlives her savings.
Thanks to Julie Kitzmiller for alerting me to this story.
There are a lot of great things about Florida and a lot of wacky things (don't believe me about the wacky things? check out "A Florida Man") One of the sad things recently about Florida is our #1 ranking for fraud in the U.S.
Security.org crunches the numbers from the Federal Trade Commission and comes up with a report on the common frauds by state. In addition to the frauds by state, they also report on the top scams for the year. The #1 scam in the U.S. for the last year is impostor scam, followed by debt collection, identity theft, telephone/mobile sales, catalog/shop-at-home, banks/lenders, credit info, the old standard--lotteries, cars and internet.
So when I looked at Florida, here we are ranked #1 in the nation for fraud and other reports according to the Consumer Sentinel Network Data Book 2018 (issued by the FTC in February 2019). There's a lot of good info in the Data Book, beyond individual state rankings.
Here's the executive summary from the Data Book
During 2018, the Consumer Sentinel Network took in nearly 3 million reports, an increase from 2017. - Fraud: 1.4 million (48% of all reports) - Identity theft: 444,602 (15%) - Other: 1.1 million (38%).
Imposter Scams are the top report category in 2018 (18% of all reports). Debt collection reports declined by 24% percent in 2018 (16% of all reports) and moved to #2. Identity theft (15% of all reports) rounds out the top three reports to Sentinel.
There were over 535,000 imposter scam reports to Sentinel. Nearly one in five of those also reported a dollar loss, totaling nearly $488 million lost to imposter scams. These scams include, for example,romance scams, people falsely claiming to be with the government, a relative in distress, a well-known business, or a technical support expert, to get a consumer’s money.
Of the 1.4 million fraud reports, 25% indicated money was lost. In 2018, people reported losing nearly$1.48 billion to fraud – an increase of $406 million over what consumers reported losing in 2017.
The median loss for all fraud reports in 2018 is $375. The median individual losses were highest in these fraud categories: - Mortgage Foreclosure Relief and Debt Management ($1,377) - Business and Job Opportunities ($1,304) - Foreign Money Offers and Counterfeit Check Scams ($1,214).
Telephone was the method of contact for 69% of fraud reports with a contact method identified. Only eight percent of those people reported losing money to the scammer – but that 8% reported an aggregate loss of $429 million, and an $840 median loss.
Wire transfers continue to be the most frequently reported payment method for fraud, with a reported aggregate loss of $423 million.
Of people who reported their age, those aged 20-29 reported losing money to fraud in 43% of reports filed with the FTC, while people aged 70 – 79 reported losing money in 15% of their reports and people80 and over reported losing money in just 13% of their reports. But when they did experience a loss,people aged 70 and older reported much higher median losses than any other age group.
Credit card fraud tops the list of identity theft reports in 2018. The FTC received more than 167,000reports from people who said their information was misused on an existing account or to open a new credit card account.
Military consumers reported more than 59,000 fraud complaints, including over 36,000 imposter scams that cost them $34 million in 2018. Imposter scams were the largest single category of reportsfrom military consumers.
The states with the highest per capita rates of reported fraud in 2018 were Florida, Georgia, Nevada,Delaware, and Maryland. For reported identity theft, the top states in 2018 were Georgia, Nevada,California, Florida, and Texas.
Thursday, May 9, 2019
City Lab wrote about an interesting concept whose time is past-due. Dementia-Friendly Cities Prepare for an Aging Populace explains "a movement [that] is growing across the country to create dementia-friendly communities. Business owners, police officers, bank tellers, college students, and others are training to learn to recognize signs of cognitive impairment, and how they can assist someone who is demonstrating impairment." Look at Middleton, Wisconsin, which was part of the leading edge of this trend, starting with "a resolution to become dementia-friendly, working with the Alzheimer’s and Dementia Alliance of Wisconsin. The city trained its employees and more than 50 businesses soon followed."
Here in the U.S., the efforts "to create dementia-friendly communities gained traction in 2015 with the launch of Dementia Friendly America at the White House Conference on Aging. Modeled after a successful program in Minnesota, the newly minted initiative announced pilot programs in six cities and communities, among them, Denver." This is no cookie cutter project, although there are some commonalities amongst the various projects.
The article notes that it's hard to measure success of the various projects, with various obstacles, including "reaching a critical mass of business owners, particularly in larger cities. Also, as many as 40 percent of people living with Alzheimer’s or dementia do not have an official diagnosis—making them, or their caregivers, unlikely to seek out the kind of services or respite care from which they could benefit."
Thanks to my colleague and dear friend, Professor Bauer, for sending me this article.
Wednesday, May 8, 2019
The Consumer Financial Protection Bureau released two items to help us in the fight against identity theft. The first is a bit unique-a placemat, "Identity protection crossword puzzle" which is described as an "interactive educational placemat is for meal sites, senior centers, and other places older adults gather and are a great way to share information at mealtime in groups of all sizes." The second is the Identity Protection Guide, Protect Your Identity: What Older Adults Should Know providing "steps to help you protect your personal information and explores several options to help you decide what’s right for your situation. The guide can be ordered separately and should be included with each Identity Theft Placemat."
Tuesday, May 7, 2019
NPR's recent story, From Gloom To Gratitude: 8 Skills To Cultivate Joy reports on a new study of caregivers "all of whom had the stressful job of taking care of a loved one with dementia. The study found that following a five-week course, participants' depression scores decreased by 16 percent and their anxiety scores decreased by 14 percent. The findings were published in the current issue of Health Psychology." The lessons taught "include mindfulness and deep breathing, setting an attainable daily goal, keeping a gratitude journal and — yes, it works — performing small acts of kindness."
Here's a quick summary of the eight techniques used in Moskowitz' study:
Take a moment to identify one positive event each day.
Tell someone about the positive event or share it on social media. This can help you savor the moment a little longer.
Start a daily gratitude journal. Aim to find little things you're grateful for, such as a good cup of coffee, a pretty sunrise or nice weather.
Identify a personal strength and reflect on how you've used this strength today or in recent weeks.
Set a daily goal and track your progress. "This is based on research that shows when we feel progress towards a goal, we have more positive emotions," Moskowitz says. The goal should not be too lofty. You want to be able to perceive progress.
Try to practice "positive reappraisal": Identify an event or daily activity that is a hassle. Then, try to reframe the event in a more positive light. Example: If you're stuck in traffic, try to savor the quiet time. If you practice this enough, it can start to become a habit.
Do something nice for someone else each day. These daily acts of kindness can be as simple as giving someone a smile or giving up your seat on a crowded train. Research shows we feel better when we're kind to others.
Practice mindfulness by paying attention to the present moment. You can also try a 10-minute breathing exercise that uses a focus on breathing to help calm the mind.There is also an audio of the story, available here.Thanks to Professor Naomi Cahn for sending us the link to this story.
Monday, May 6, 2019
Kaiser Health News ran a story, Short-Staffed Nursing Homes See Drop In Medicare Ratings. "In its update in April to Nursing Home Compare, the Centers for Medicare & Medicaid Services gave its lowest star rating for staffing — one star on its five-star scale — to 1,638 homes. Most were downgraded because their payroll records reported no registered-nurse hours at all for four days or more, while the remainder failed to submit their payroll records or sent data that couldn’t be verified through an audit." The payroll records analyzed provide a good picture of various nursing homes and how they comply with the regulations. "CMS has been alarmed at the frequency of understaffing of registered nurses — the most highly trained category of nurses in a home — since the government last year began requiring homes to submit payroll records to verify staffing levels." In addition KHN has an interactive tool, Look-Up: How Nursing Home Staffing Fluctuates Nationwide.
Friday, May 3, 2019
Kaiser Health News ran a sobering story last week. In 10 Years, Half Of Middle-Income Elders Won’t Be Able To Afford Housing, Medical Care reports on a recently published study by Health Affairs that concluded "In 10 years, more than half of middle-income Americans age 75 or older will not be able to afford to pay for yearly assisted living rent or medical expenses, according to a study published ... in Health Affairs." Here is the abstract for the article, The Forgotten Middle: Many Middle-Income Seniors Will Have Insufficient Resources For Housing And Health Care.
As people age and require more assistance with daily living and health needs, a range of housing and care options is available. Over the past four decades the market for seniors housing and care—including assisted living and independent living communities—has greatly expanded to accommodate people with more complex needs. These settings provide housing in a community environment that often includes personal care assistance services. Unfortunately, these settings are often out of the financial reach of many of this country’s eight million middle-income seniors (those ages seventy-five and older). The private seniors housing industry has generally focused on higher-income people instead. We project that by 2029 there will be 14.4 million middle-income seniors, 60 percent of whom will have mobility limitations and 20 percent of whom will have high health care and functional needs. While many of these seniors will likely need the level of care provided in seniors housing, we project that 54 percent of seniors will not have sufficient financial resources to pay for it. This gap suggests a role for public policy and the private sector in meeting future long-term care and housing needs for middle-income seniors.
A pdf of the article is available here.
Thursday, May 2, 2019
If you answered yes to the title question, you are not along. Last month, Financial Advisor published an article, More Than Half Of Americans Want To Live To 100 reporting on a survey by AIG Life & Retirement. Why does someone want to live to be 100? Why not? There are various reasons, and the respondents offered these: "Thirty-nine percent of respondents cited deeper family relationships as the main reason for wanting to live 100 years. Another 32 percent said they wanted to see the world change, and 17 percent wanted to remain productive."
The respondents note that longevity can be accompanied by various issues. "Of the 53 percent whose goal is to be a centenarian, 51 percent are worried that their savings won't last for that long a life." As well, the likelihood of significant health issues took first place among concerns "(35 percent) ... followed by the likelihood of burdening their family (27 percent) and running out of the money needed to live comfortably in retirement (25 percent)." Planning for longevity is important. Although aging happens organically, planning for longevity is responsible aging.
Wednesday, May 1, 2019
Phone companies are developing tech that will block spam calls. Yes, please and right away! (BTW, how do the spammers know the most inopportune time to call?) The New York Times explains the work in this article, Phone Companies Are Testing Tech to Catch Spam Calls. Let’s Hope It Works.
This data ought to frighten you: "[t]he seemingly endless stream of robocalls reached a new monthly high of 5.23 billion nationwide in March, according to the call-blocking service YouMail. Some were spammy pitches for unwanted vehicle warranties or debt-relief services. Nearly half were straight-up scams. And there was often one common thread: They frequently came from somewhere other than they said they did."
But the article tells us there is hope for us. "New technology is providing a glimmer of hope that, someday, you might be able to safely pick up your phone again. Mostly, you’ll now be more likely to know callers are who they say they are." But wait, now for some bad news. "[D]on’t expect any silver bullets that will put an end to robocalls. Pending regulatory changes could even add to the flood."
The anti-spoofing technology is already being used by T-Mobile ("known by the acronym Stir/Shaken, a tortured reference to James Bond and martini preparation — in January, although it’s currently compatible only with certain devices. ") AT&T and Comcast have been doing some work on caller verification and Verizon should have theirs available by early fall.
But wait-do you have a land-line? This need tech won't help you then. There are also limits on tracing calls from abroad. Congress is also helping.
A Senate bill that would establish a deadline has gained bipartisan traction. The Traced Act, introduced by Senators John Thune, Republican of South Dakota, and Edward J. Markey, Democrat of Massachusetts, passed a committee vote this month. Along with stiffening penalties and giving the F.C.C. more time to punish perpetrators, the bill would require all voice service providers — including those over the internet, such as Skype and Google Voice — to adopt call authentication technology within 18 months of the bill’s enactment.
Watch for new regs coming from the F.C.C., especially the one on the definition of auto-dialers, the article explains. There is the potential for opening us to even more spam calls. Here's how the two sides see that issue
“If they define auto-dialer the way the industry wants it defined, it will be so narrow it won’t cover any of the auto-dialers out there,” said Margot Saunders, senior counsel at the National Consumer Law Center. “The scourge of robocalls will skyrocket.”
The F.C.C. said those concerns were speculative. The agency has solicited public comments on the issue twice lastyear, but declined to say how long it might take to come up with a new definition. A spokesman said the commission “will continue to combat all illegal robocalls with every tool we have.”
I don't know if you do like I do now--when my phone rings-if I don't recognize the number I don't answer it. Is that how we have to operate now? Do the folks at the F.C.C. get all of these spam calls too?
Tuesday, April 30, 2019
Apparently researchers and gamers are collaborating -- on a "game" that could be used to "identify individuals who might have early and mild symptoms of dementia that medical test aren't able to detect." The game, developed in Germany, and called Sea Hero Quest, reportedly uses virtual reality technology to have a "player" manipulate a virtual boat on a game board. Players are "given a map and shown checkpoints, then the map is taken away and players must navigate to these checkpoints in the game world without the map."
Some of the data reported strike me as, hmmm, surprising. I suspect this game might have greater validity if the players have established, previous skills in using the gaming tools, as well as interest or patience with the technology. There might also be some serious ethical questions for how the "game" is employed as a diagnostic tool. For more details, read "A Video Game Developed to Detect Alzheimer's Disease Seems to Be Working."
Monday, April 29, 2019
My dear friend and colleague, Professor Mark Bauer, a frequent reader of this blog, shared a recent story about bumps in the road for elders in the family as they gathered for a funeral. He has given me permission to share this with you.
Sometimes many of us forget when we are privileged. I was reminded of this last week. Those of us who are fully able-bodied and adept at new technology already have every advantage. Those of us with disabilities are already at a disadvantage, and the modern world rarely considers their needs.
A member of my family is an elder with devastating claustrophobia and two artificial knees. Before making any hotel reservation, she needs to speak to the hotel and find out whether there are rooms on the ground floor because she has difficulty riding an elevator. Sometimes a second floor room can work, but her knees prohibit her from long stairways, and frequently a dark, narrow, and foreboding staircase can be worse for claustrophobia than an elevator. Substantially all hotel reservations are handled by national call centers and sometimes even outsourced to third parties. They don’t have access to information about whether there are ground floor rooms, and they can rarely make a reservation for a specific floor. Systems are designed today to prevent people from calling specific hotels. Even if you can speak to the hotel, they often are prohibited from taking reservations directly.
We arrived in the Washington, DC area only to find out that the first floor of the hotel was actually on the sixth floor; the lower floors were a parking garage. A desk clerk at the hotel had told us by phone in advance that there were ground floor rooms and even noted in our reservation the need for one.
I spent the next two hours trying to find some hotel within a few miles with ground floor rooms. Even after looking up the hotel’s local number, calls fed directly into national reservations lines that were of no help at all.
I found a nearby corporate apartment complex that rented apartments on a nightly basis. It took 30 minutes, but a supervisor at the national reservations number was willing to make a series of phone calls to the local property to verify they had an apartment available on the second floor.
I called an Uber and brought the two family members over to their new lodging. While fairly close to the hotel where the other seven of us were staying, it was not walking distance for two elders. The only thing that made sense at the time was to install Uber on their phones and give them a crash course in how to use a smart phone for more than calls, texting, and a few games.
I grabbed family member #1’s phone and tried to install Uber, only to find out he had already downloaded it. But it froze up every time I tried to open the app because he had created a password, forgotten it, and then became locked out of the app. I then deleted Uber and reinstalled it, and the same problem occurred. It makes sense as a security matter to prevent reinstallation, but how many elders forget passwords and enter them incorrectly.
Since I thought myself clever, I tried to download Lyft. But family member #1 couldn’t recall his Apple ID, so I was locked out of the app store.
I turned to family member #2’s phone. I was able to successfully download Uber on to her phone and gave her a 20 minute course in how to use it, writing down the instructions and even going through several scenarios. I knew it would probably work out (and it did) or we might never see them again.
Because I am a (slightly) younger and able-bodied person, it never occurred to me that hotels centralizing reservations at call centers could be an impediment to elders and those with disabilities. And while I knew Uber was unavailable to anyone without a smart phone, or anyone who doesn’t know how to use their smart phone, I had never previously considered Uber to be an indispensable utility.
It seems to me that if we’re smart enough as a society to save all this money with call centers, and to create paradigm shifting inventions like smart phones and Uber, we should also be smart enough to figure out how not to further disenfranchise elders and persons with disabilities in the process.
In January 2018, Donald Trump issued an order to keep the detention facility at Guantanamo open, with the potential for the Pentagon to add new prisoners. Following that decision, Pentagon officials, described in some accounts as being "unusually frank," discussed the need for long-term care facilities for aging prisoners who will grow old and frail. From an article in The Military Times:
The Pentagon was investing in upgrades at the Navy base under President Barack Obama, whose push to shutter the detention center couldn’t overcome opposition in Congress. But those projects, including the $150 million barracks, were funded with the understanding that they could be used by the personnel of the Navy base that hosts the detention center. Now they are viewed as part of a broader effort to be able to operate the prison for many years to come.
“Now my mission is enduring,” said Adm. John Ring, commander of the task force that runs the jail. “So I have all sorts of structures that I have been neglecting or just getting by with that now I’ve got to replace.” . . .
Officials say Camp 7 is in need of major repairs, with cracking walls and a sinking foundation, and it is not suitable to hold men who will likely be in custody for many years to come. The new unit, which would be known as Camp 8, would have cell doors wide enough for wheelchairs and hospice beds and communal areas so elderly prisoners could help each other as they grow old.
For more, read the June 2018 article, "U.S. Military Plans for Future at Guantanamo Because of Trump."
I drafted the above language for this post on Sunday, April 28, after reading a more recent, more detailed story in another publication, Defense One, titled "Guantanamo Is Becoming A Nursing Home for its Aging Terror Suspects."
From that article we hear again from Admiral John Ring, the commander in charge of the Guantanamo Task Force:
The aging population at Gitmo poses unique challenges for Adm. John Ring, the latest in a string of officers who have led the prison on one-year deployments. Defense attorneys say many detainees suffer the ill effects of brutal interrogation tactics now considered to be torture. The United States has committed to providing the same health care to the remaining detainees that it provides to its own troops, as required by the Geneva Conventions. But the secure medical facilities built to treat the detainees — Ring calls them “guests” — can’t cope with every kind of surgery geriatric patients typically need, and weren’t built to last forever. Congress has prohibited the transfer of detainees to the continental United States, which means any treatment they receive will have to take place at a remote outpost on the tip of Cuba.
“I’m sort of caught between a rock and a hard place,” Ring said. “The Geneva Conventions’ Article III, that says that I have to give the detainees equivalent medical care that I would give to a trooper. But if a trooper got sick, I’d send him home to the United States.
So, it was with interest that I read a third new story, on Monday morning, April 29, reporting that Admiral Ring has been discharged from his post, with the briefest of explanation, "loss of confidence in his ability." See The New York Times article: Guantanamo Bay Prison Commander Has Been Fired.
Sunday, April 28, 2019
PA Supreme Court's Choice of Law Ruling Obligates New Jersey Family Members to Provide Filial Support For Disabled Adult Son In Pennsylvania
In what appears likely to be the final chapter in a long-running "reverse" filial support case in Pennsylvania, a unanimous Pennsylvania Supreme Court ruled on April 26, 2019 that Pennsylvania statutory law applies to determine the liability of older New Jersey parents on the issue of whether they must pay for the long-term care costs for their son in a private institution in Pennsylvania. New Jersey law, unlike Pennsylvania law, expressly exempts any person "55 years of age or over" from a support obligation for an adult child.
I've been following the case of Melmark v. Schutt since at least 2016, and you can review some of the history of the case here, here and here. Until this ruling, the parents had successfully argued that New Jersey's law controlled the case. From the Supreme Court's opening footnote, however, where it outlined evidence of the parent's annual income, it was apparent the Court was outraged that parents who could be characterized as wealthy could refuse to pay a nonprofit care provider. The Court ruled that there was a "true conflict" between the laws of New Jersey and Pennsylvania, and recognized that while many factors such as the domicile of the parents and the stipulated 'residency" of the son pointed to the application of New Jersey law, the most significant contact factor was the "harm" of nonpayment, occuring in Pennsylvania. The Court concluded:
"[A]lthough New Jersey's welfare laws apparently provide for Alex's support at public expense, there is no reason to suppose that New Jersey has adopted a public policy favoring imposition of the ongoing cost of care for indigent adults on an unwilling private third party [i.e., Melmark].... [T]he exemption in New Jersey's statutory support law for parents over 55 years of age cannot justifiably override Pennsylvania's governing statute -- at least for the period between April 1, 2012 to May 1, 2013 -- so that the financial burden of Alex's care falls upon Melmark."
I have long thought the case has uniquely "tough facts," and Pennsylvania has a history of using Pennsylvania's law to obligate families to cover certain costs of care for indigent family members. Further, the Court also ruled that the institution had a viable related theory of recovery under Pennsylvania common law, sounding in quantum meruit or unjust enrichment.
The opinion has potential implications for cross border claims of filial support in the more typical Pennsylvania fact pattern, where adult children are asked to pay the costs of care for an aging parent who fails to qualify for Medicaid. E.g., Health Care & Retirement Corp. of America v. Pittas. I can see the potential for out-of-state children to be subject to a claim for reimbursement, especially if they have any role in choosing a Pennsylvania facility where Medicaid is unavailable to pay, facts that might also give the Pennsylvania court personal jurisdiction over the out-of-state children.
Thursday, April 25, 2019
I hope you know by now that the SSA and Medicare Trustees have released their annual reports. The news is about what you would expect, if you follow the news on their annual reports. One might say that the SSA Trustees gave us good news this year. Social Security Combined Trust Funds Gain One Year Says Board of Trustees. Disability Fund Shows Strong Improvement—Twenty Years projects that the fund will "run out of money" after 2034, meaning we have gained a year. "Running out of money" means that starting in 2035, SSA will pay 80% of benefits, rather than 100%. For years, I've explained to students about the SSA Trust Fund and the Trustees Report. This year it dawned on me, when talking about the folks affected by the short fall, I'm part of those who will be affected. I'm no longer teaching something abstract. I know people, including myself and my colleagues, who will be in that group absent action by Congress. The SSA Trustees report is available here. With Medicare, the trustees really didn't have good news for us. Medicare Trustees Report shows Hospital Insurance Trust Fund will deplete in 7 years tells us "that the HI Trust Fund will be able to pay full benefits until 2026, the same as last year’s report." The Medicare Trustees report is available here.
I wanted to write a post about some good news and I have two good news items, both courtesy of AARP. First, on April 23, 2019, Florida's Governor and AARP announced that Florida is the nation's fourth state to be part of AARP's age-friendly state network. I bet you are asking yourself, what does it mean to be an age-friendly state? According to the article, Governor Ron DeSantis and AARP Announce Florida’s Designation as an Age-Friendly State, it means "Florida [has a] commitment to building livable communities that enrich the lives of people of all ages. Member states develop and implement plans that address any or all of the eight Age-Friendly domains: Transportation, Housing, Public Spaces, Respect and Social Inclusion, Civic Participation and Employment, Social Participation, Community and Health Services, and Communication and Information." So that's exciting news.
And second, in a demonstration of age-friendliness, Florida AARP and the City of St. Petersburg, Florida dedicated the first of its kind in the country, #AARPFitPark which is, according to AARP's CEO, Joann Jenkins who was in town for the dedication, "a nationwide network of outdoor exercise spaces designed for users of all ages and abilities. They’re free and open to the public and there will be 53 across then nation."
Shout out to AARP Florida State Director Jeff Johnson who tweets as @Name_u_know for inviting me to the ribbon cutting of this very cool park.
Wednesday, April 24, 2019
Kaiser Health News published a story that was the work of Kaiser and PBS NewsHour jointly. Lethal Plans: When Seniors Turn To Suicide In Long-Term Care. Their "six-month investigation ... finds that older Americans are quietly killing themselves in nursing homes, assisted living centers and adult care homes."... "Poor documentation makes it difficult to tell exactly how often such deaths occur. But a KHN analysis of new data from the University of Michigan suggests that hundreds of suicides by older adults each year — nearly one per day — are related to long-term care. Thousands more people may be at risk in those settings, where up to a third of residents report suicidal thoughts, research shows."
The article acknowledges that "[t]racking suicides in long-term care is difficult. No federal regulations require reporting of such deaths and most states either don’t count — or won’t divulge — how many people end their own lives in those settings." The article includes comments from those in the industry that points out the amount of regulation of facilities by CMS and the facilities' supervision of their residents. The article provides some general examples as well as specifics. The article is hard to read when you get to those examples, but this is a very important topic. The article also discusses and distinguishes rational suicide. The article concludes with a discussion of interventions.