Sunday, May 26, 2019

The Science of Being Susceptible To Scams

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)

Tuesday, May 14, 2019

Florida is #1.... in Fraud Reports

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

Overview

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.

Fraud

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.

Identity Theft

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

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.

Top States

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.

 

 

May 14, 2019 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Other, State Statutes/Regulations, Statistics | Permalink | Comments (0)

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. 

April 28, 2019 in Current Affairs, Ethical Issues, Health Care/Long Term Care, Housing, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Monday, April 22, 2019

Scams, Scams & Robocalls

Ok, so scams.... Ugh.  Here's a couple of new ones, now we are past tax season and don't have to worry about the fake-IRS calling us for a couple of days.  First, using DNA to commit scams and frauds. Scammers May Be Using DNA Testing to Defraud Medicare and Steal Identities reports Bloomerberg. "Authorities in several states are warning about an alleged scam in which people visit senior-living communities and low-income neighborhoods, offering to perform DNA tests and collecting information from people in government health programs. ... The alleged DNA-testing scams appear to be a new twist on an old tactic, in which people are tricked into giving away personal information or participating in medical services they don’t need. Perpetrators of such schemes can bill the government for unneeded medical tests and procedures, or use the information they collect — such as Medicare and Medicaid identification data — to commit identity theft and fraud."  I guess you can't get much more personal info than someone's DNA. Yikes!

Next, the New York Times reported that falling prey to scams may be a red flag sign of dementia. Senior's Weakness for Scams May Be Warning Sign of Dementia.

"New research suggests seniors who aren't on guard against scams also might be at risk for eventually developing Alzheimer's disease. ... Elder fraud is a huge problem, and Monday's study doesn't mean that people who fall prey to a con artist have some sort of dementia brewing. ... But scientists know that long before the memory problems of Alzheimer's become obvious, people experience more subtle changes in their thinking and judgment. Neuropsychologist Patricia Boyle of Rush University's Alzheimer's disease center wondered if one of the warning signs might be the type of judgment missteps that can leave someone susceptible to scams."

Although "[t]he study can't prove a link between low scam awareness and impending decline in thinking and memory," results point us to a need for more research. 

There are already a number of prevention efforts in existence, but yet, these crimes keep occurring. One more recent innovation is referenced in the article.  "[T]he rise in elder fraud has reached such a level that investment firms now are supposed to ask customers for the contact information of a "trusted person" they can alert if they suspect a case of financial exploitation. Just last week, federal agents broke up a Medicare scam that sold unneeded orthopedic braces to hundreds of thousands of seniors. And every tax season the government warns people not to fall for phone calls from IRS impostors — that agency won't call for payment."

And let's not get started on robocalls...  Oh, ok since I mentioned them, the current issue of Consumer Reports newsletter focuses an article on apps designed to block robocalls.  How to Protect Yourself From Robocalls shares the results of a survey of robocall blocker apps used by readers. Check them out and use one that works best for you. Have you reached the point where you no longer answer the phone if you don't recognize the number? I have.

 

April 22, 2019 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Other, State Statutes/Regulations | Permalink | Comments (0)

Monday, April 1, 2019

New Article on Planning for Beneficiaries with Special Needs

Kristen Lewis has published a really great article in the March 2019 issue of Estate Planning Magazine.  Planning Challenges for Beneficiaries With Special Needs. To accommodate adequately the particular circumstances of beneficiaries with special needs, multiple trusts may be required provides a comprehensive discussion of 10 challenges faced by estate planners when a beneficiary has special needs.

Consider the opening of this article

Disabilities do not discriminate based on a family’s socio-economic status. Families of great wealth have children or other beneficiaries with disabilities at the same rate as families of modest means. Estate planning attorneys, and the other allied professionals who serve these families, are no longer able to take the position that “We don’t do special needs planning,” or worse yet, recommend that the child or other beneficiary with a disability simply be disinherited (which is likely grounds for malpractice). A recent study by the Centers for Disease Control and Prevention concluded that the prevalence of Autism Spectrum Disorder (ASD) has risen to one in every 68 births in the U.S. A more recent study concluded that the estimated prevalence of children in the U.S. with a “parent-reported” diagnosis of ASD is now one in 40. The 2010 U.S. Census reported that almost 20% of the U.S. civilian non-institutionalized population claimed to have a disability.  With statistics like these, estate planners and allied professionals must become, and remain, educated about the tools and techniques available to help clients secure the future of beneficiaries with disabilities within the broader context of estate planning. A critical first step is recognizing, and knowing how to overcome, the most common challenges to effective special needs planning. (citations omitted)

Read this article, then save it to your library as a resource.  You will be glad you did!

PS-shameless plug: Mark your calendars for Stetson Law's 2019 Special Needs Planning Institute for October 16-18, 2019. Registration opens July 1. #StetsonSNT2019

 

April 1, 2019 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Estates and Trusts, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Sunday, March 31, 2019

Broken System(s) and Good People Who Still Care

For those who read this Blog regularly, thank you.  Especially as I have been leaving the bulk of recent postings to my wonderful  blogging colleague and all-round elder law guru, Rebecca Morgan.  Thank you most of all, Becky! 

It is early morning on a Sunday as I type this.  The Arizona sun is not quite above the eastern horizon.  A calm morning after several days ...  okay, I confess, weeks ... of small troubles.  I had time to read The New York Times, and there it is once again, an article with a title and content that seem right on point for what I am pondering:

Patients ‘Hit the Call Bell and Nobody Comes.’ Hospital Nurses Demand ‘Safe Staffing’ Levels.

For the last several weeks, my sister and I have been struggling to understand how best to help our mother in the latest part of her journey with dementia.  Recently she fell twice in single week, when rising before dawn and struggling to get dressed by herself.  She did not need to be up so early, but in a lifetime of early rising, it is hard to change. Learning new routines, such as calling for help, is never easy, but especially so when memory and awareness are impaired by dementia.  Her second fall resulted in what Mom had long feared most, a fear that will resonate for many people.  She fractured her hip, as well as a few annoying ribs.  

This put the three of us, my sister, my mother and me, squarely in the middle of doctor consultations, hospitals, rehabilitation centers, home care agencies and a search for alternatives for care.  Do you have a mental image of Queen Elizabeth in London?  Perhaps you have seen photos or news footage of her in recent weeks, walking with determination and carrying her purse, as she attends to her royal duties?  Well, Queen Elizabeth and our mother are the same age and seem to have very similar abilities to persevere.  We think of our mother as a slightly smaller version of the Queen, perhaps walking a bit slower although with equal commitment to the task, complete with her own favorite handbag.  Or she was until the recent set of events.

At age 93, Mom sailed through surgery to stabilize her fractured hip, and even did pretty well during the first phase of recovery in the hospital.  One small blessing for Mom is that she has no memory of the falls, no recollection of the surgery, and no memory of pain. Thus she's surprised when it "hurts" to try to stand, much less walk.  Of course, both pain and understanding of what pain signifies, are important reminders of the need to take things slow.  

We've done the hospital surgery stay "thing" before with Mom, and we've learned to treat such events as a marathon, rather than a sprint.  We've learned, for example, that our mother's agitation after surgery makes IVs difficult and that any form of narcotic pain medication is likely to trigger days of vivid and disturbing hallucinations. For pain, fortunately tylenol is enough with Mom.  We work hard to come up with a way for someone (usually my sister, until I can fly in) to be there each night, when we know hospital staffing levels can be low and call buttons may not be answered quickly. We know that without being there, when Mom does sometimes complain of pain, we will to need to remind the staff that tylenol is usually sufficient.

We try to rotate nights.  My sister is a pro, and after weeks of my somewhat frantic naps on airplanes, I've become pretty good at falling into a wakeful sleep mode in an upright position.  Staying overnight in a hospital is disorienting for the healthiest person and much more so for someone like my mother who cannot understand why this "hotel" has staff members that keep waking her up at night to take her temperature and hand her medication to swallow.  I will be forever grateful to the nurse who, after my mother spit a full mouthful of water and the medicine back in her face, nonetheless returned promptly to help throughout the third shift, still offering smiles and kind words.  The nurses who advocate for change in The New York Times article have it right -- "safe staffing levels" are one key to sound hospital care; only with adequate staffing can nurses be expected to keep working in such taxing circumstances.

The next decision was about where to go after the hospital. One option presented by the discharge planner was to go to a skilled nursing facility, a/k/a nursing home.  We had previewed a wide range of places and we already had a list of possibilities. But we were pretty confident Mom could tolerate physical therapy, and therefore, after consultation, we opted for a facility that specialized in rehabilitation.  

One complication:  The rehab facility's admissions director said that they were not willing to take someone with dementia unless the family made sure there was 24/7 assistance during periods of confusion and, they emphasized, to keep her from wandering.  With gratitude, we accepted a brochure offered by the admissions director for a local home care agency that they had worked with before.  My sister, a true angel, and I, very much a mortal, knew we couldn't do this alone.

And thus began a strange variation on the "Bell Rings; Nobody Comes" theme of The New York Times article about hospital care.

The first yellow flag was when one of the line staff, a certified nursing assistant (CNA) at the rehab facility, who heard we were hiring companions from an agency, commented, "Well, okay, if you want to do that, but just so you know, these people don't do a darn thing.  They won't lift a finger to help."  I didn't know what to say; I think I said something like, "Well, let us know if there is a problem."

The "problem" emerged quickly.  Companions from the home care agency said the rehab staff were not responding to call buttons when help was needed for our mother.  The rehab staff were complaining that the companions didn't provide any help.   I talked to an administrator at the rehab center.  He assured me that their policy was for staff  to respond promptly to call buttons and that he would remind the staff that a family member or hired companion was doing "the right thing" by using the call buttons to seek help.  

But the reports continued, even as Mom began to recover more function, and thus actually needed more help in key tasks because she was more mobile.  Different companions and even friends reported that the CNAs at the rehab center would, for example, help our mother to the bathroom toilet, but then would refuse to stay until she finished.  Some reported the CNA turning to the agency's companion and saying with disdain, "You should handle it from here."  

I tried talking again with Rehab's administrators, this time the director of nursing.  She was also quick to reassure me that we were not wrong to ask the rehab staff to assist our mother in the bathroom and to remain with her till she finished, as our mother was still unable to rise on her own and also could not or would not use the pull cord.  She thought the most recent report was about one new rehab employee, who may not yet understand his or her role.

But the reports continued.  One report came from a friend visiting Mom.  She noticed buzzers ringing endlessly on Mom's floor, even when available staff were chatting nearby.  I tried talking with the management staff again.  At one point, the home care agency actually swooped in and removed a companion we hired to help our mother, after the rehab center complained to them that the companion was complaining "too loudly" about the rehab staffing and lack of coordination with staff.  In response to the turmoil my sister ended up taking another night shift in rehab (after a long-day as an administrator for a charter school).  I started planning another flight to Arizona.

I slowly began to realize that this was not a problem that could be "fixed" with polite requests or even more directly-worded complaints about staffing roles.   I learned:

  • The direct care workers at the rehab center felt seriously over-worked and under-appreciated;
  • The rehab center was often short-staffed, especially when employees called off on short notice; 
  • The direct care workers resented the agency's companions "doing nothing" when an extra pair of hands, any hands, would have made their work easier;
  • There was tension between the direct care workers, most of them CNAs, and the cehab Center's other "higher" staff, including nurses and shift supervisors;
  • Family members of other patients were also concerned and confused about what to do about unevenness of care.  They weren't required to have a companion as their loved one did not have the dreaded "dementia." But their need for prompt assistance for loved ones recovering from car accidents, strokes, or major surgery was just as great.

A family member of another patient in rehab commented to me, "This is a broken system."  At first I thought she meant the Rehab Center.  But she clarified.  "This is just one part of a broken care system."  She meant that all of care is a broken system.

Continue reading

March 31, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Ethical Issues, Federal Statutes/Regulations, Games, Health Care/Long Term Care, Medicare, State Statutes/Regulations | Permalink | Comments (1)

Wednesday, March 27, 2019

NJ Bill on Medical Aid in Dying

The NJ legislature has passed a medical aid in dying bill which the Governor of NJ has indicated he will sign. New Jersey approves bill allowing terminally ill patients the right to die reports that the votes were somewhat close, with the NJ House voting 41-33 and the NJ Senate, 21-16.  Safeguards similar to the laws in other states for medical aid in dying are included in the NJ legislation. "Two physicians would be required to attest that the person had less than six months to live. The patient would have to ask for the medication three times — twice orally and once in writing — before receiving it. The written request would have to be witnessed by two people, including one who is not a family member, a beneficiary of the patient's will or the attending physician... The patient would then be required to self-administer the medicine, if he or she decides to take it at all." The legislation is available here.

 

 

March 27, 2019 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)

Monday, March 18, 2019

Florida AG Creates Senior Protection Team

Florida Attorney General Ashley Moody announced last week the creation of the Senior Protection Team "an intra-agency group of experts working together to fight fraud and abuse. The team is comprised of leading members from the Attorney General’s Office of Statewide Prosecution, Consumer Protection Division and Medicaid Fraud Control Unit. Seniors v. Crime and the Florida Department of Law Enforcement will also actively assist the team with investigations and outreach efforts." The team is being led by Statewide Prosecutor, Nick Cox, a long-time advocate for the protection of elders from scams and frauds.

Kudos to General Moody!

March 18, 2019 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Florida AG Creates Senior Protection Team

Florida Attorney General Ashley Moody announced last week the creation of the Senior Protection Team "an intra-agency group of experts working together to fight fraud and abuse. The team is comprised of leading members from the Attorney General’s Office of Statewide Prosecution, Consumer Protection Division and Medicaid Fraud Control Unit. Seniors v. Crime and the Florida Department of Law Enforcement will also actively assist the team with investigations and outreach efforts." The team is being led by Statewide Prosecutor, Nick Cox, a long-time advocate for the protection of elders from scams and frauds.

Kudos to General Moody!

March 18, 2019 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Thursday, March 14, 2019

Check out the Updated Law Enforcement Guide EAGLE 2.0

EAGLE, the Elder Abuse Guide for Law Enforcement, has been updated and the newest version is now available.  The email announcing the updates explains

EAGLE 2.0 has incorporated roll call videos developed by the International Association of Chiefs of Police (IACP), Department of Justice updates and archived webinars.   EAGLE is both a systematic and streamlined tool for law enforcement to assess elder abuse, as defined by the statutes of each state.  Although EAGLE was designed for law enforcement and by law enforcement, EAGLE is for anyone who would like to learn more about the types of elder abuse and what can be done to build strong community supports to prevent future occurrences. 

The roll call videos are in six parts and based on real cases, "highlight[ing] the actions of responding officer that led to a resolution of the case."

This guide is an incredibly valuable resource. Be sure to check out the webpage!

 

March 14, 2019 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, State Statutes/Regulations | Permalink | Comments (0)

Friday, March 8, 2019

Maryland House Passes Physician-Aided Dying Bill

The Baltimore Sun reported that the Maryland House of Delegates has passed a measure to legalize physician-aided dying in Maryland. Maryland House of Delegates approves legalizing medically assisted suicide notes that the bill passed by a close margin and a corresponding bill is pending in the Maryland Senate.The House version contains various protections, including "[t]he patient must be 18 years old, have a terminal illness with a prognosis of less than six months to live and be able to take the drugs by themselves. The patient must request the prescription on three separate occasions, including at least once in private and at least once in writing — provisions meant to prevent patients from being coerced into obtaining the medication."  More information about the House bill is available here.

March 8, 2019 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)

Thursday, March 7, 2019

Rural Nursing Homes Closing

The New York Times ran a story that notes that nursing homes are closing in rural America, leaving residents with few options.  Nursing Homes are Closing Across Rural American, Scattering Residents   highlights the dilemma for many in rural areas when the local nursing home closes. "More than 440 rural nursing homes have closed or merged over the last decade ... and each closure scattered patients like seeds in the wind. Instead of finding new care in their homes and communities, many end up at different nursing homes far from their families. ... In remote communities ... there are few choices for an aging population. Home health aides can be scarce and unaffordable to hire around the clock. The few senior-citizen apartments have waiting lists. Adult children have long since moved away to bigger cities."  Think about the implications when the facility closes and there isn't another one near by. Not only might the resident suffer from transfer trauma, there are other implications. As the article notes, with distance comes the lack of ability for frequent visits, the time spent traveling to the new SNF, the inability to get to the new SNF quickly if a need arises and the vagaries of Mother Nature who may heap bad weather on the area, making it unsafe to travel. There are various reasons why nursing homes in rural communities are closing, including financial instability, Medicaid reimbursement rates, failure to meet the minimum health and safety standards and even the inability to hire staff.

March 7, 2019 in Consumer Information, Current Affairs, Health Care/Long Term Care, Medicaid, Medicare, State Statutes/Regulations | Permalink

Monday, March 4, 2019

Bibliography on Physician-Aided Dying

The Law Library Journal has published a comprehensive bibliography on Physician-Aided Dying. Physician-Assisted Death: A Selected Annotated Bibliography, prepared by Alyssa Thurston, who is head of Reference Services at Pepperdine University School of Law Library in Malibu, Calif.,  provides a comprehensive update on this important topic.

Here is the abstract of the paper. "Physician-assisted death (PAD), which encompasses physician-assisted suicide and physician-administered euthanasia, has long been controversial. However, recent years have seen a trend toward legalizing some form of PAD in the United States and abroad. The author provides an annotated bibliography of sources concerning PAD and the many issues raised by its legalization."

The introduction offers some helpful information for the reader:

¶3 This bibliography compiles selected secondary and primary materials on
PAD. Secondary sources include books, book chapters, law review and law journal
articles, bibliographies, websites, and current awareness materials, and are mostly
limited to publication dates of 2007–2018.10 Many of these materials discuss multiple
issues within the broader topic of PAD, and I have categorized them by subject
based on what I perceive to be their primary themes.
¶4 Most of the included materials focus on the United States, but a number of
sources also discuss other countries, and one section is devoted to international
experiences with PAD. In addition, PAD is often debated alongside other end-oflife
topics, such as withdrawal or refusal of medical treatment,11 palliative care,12
hospice care,13 or the use of advance directives,14 and some of the scholarship listed
in this bibliography concurrently address one or more of these subjects in depth.

Thanks to my colleague, Professor Brooke Bowman, for alerting me to this helpful resource!

March 4, 2019 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, International, Other, State Statutes/Regulations | Permalink | Comments (0)

Thursday, February 28, 2019

Pets and Pet Trusts

With the recent death of Karl Lagerfeld who is survived by his famous cat, Choupette, it is timely to think about pet trusts as part of estate planning. The story was covered by many news outlets. Here is info about the one that ran in CBS News, Karl Lagerfeld's cat to inherit a fortune, but may not be richest pet.

Choupette, a Burmese cat, stands to inherit a chunk of the designer'sestimated $300 million net worth, after he wrote her into his will in 2015, according to Le Figaro. Lagerfeld confirmed in an interview with Numéro last year that she, among others, would be an heiress to his vast fortune. "Don't worry, there is enough for everyone," he said. Among Choupette's most admired traits? "She doesn't talk," Lagerfeld told Numero in an earlier interview... Though Lagerfeld is German, the pair resided in France, where the law prohibits pets from inheriting their owners' wealth. German law, however, allows one's wealth to be transferred to an animal. 

In the U.S., as the article notes, pet trusts are recognized but there may be limits on the amount, referencing the case of Leona Helmsely's dog, Trouble.

 

February 28, 2019 in Consumer Information, Current Affairs, Estates and Trusts, Other, State Statutes/Regulations | Permalink

Monday, January 14, 2019

Hebrew Home at Riverdale New York: Site for New Report on Medical Marijuana

Last week, I wrote about the possible use of medical marijuana for treatment of anxiety in patients with dementia, pointing to the importance of peer-reviewed studies.  This week, I learned of a new study on the use of medical marijuana at a nursing home, and when I read the study I was not surprised to learn the study had occurred at Hebrew Home at Riverdale in New York, a location I have come to associate with both research and thoughtful innovation.  Studies of medical marijuana are complicated by the disjunction in federal and state laws governing purchase and use.

From a study published in JAMDA, the official journal for the Society of Post-Acute and Long-Term Care Medicine, this description in a press release:  

In “Medical Cannabis in the Skilled Nursing Facility: A Novel Approach to Improving Symptom Management and Quality of Life,” the authors described a medical policy and procedure (P&P) they implemented at their New York-based SNF for the safe use and administration of cannabis for residents with a qualifying diagnosis. To be compliant with state and federal statutes, policy requires that residents must purchase their own cannabis product directly from a state-certified dispensary.

 

After the program started in 2016, the facility provided educational sessions for residents and distributed a medical cannabis fact sheet that was also made available to family members. To date, 10 residents have participated in the program and seven have been receiving medical cannabis for over a year. Participants range in age from 62 to 100. Of the 10 participants, six qualified for the program due to a chronic pain diagnosis, two due to Parkinson’s disease, and one due to both diagnoses. One resident is participating in the program for a seizure disorder.

 

Most residents who use cannabis for pain management said that it has lessened the severity of their chronic pain. This, in turn, has resulted in opioid dosage reductions and an improved sense of well-being. Those individuals receiving cannabis for Parkinson’s reported mild improvement with rigidity complaints. The patient with seizure disorder has experienced a marked reduction in seizure activity with the cannabis therapy.

This study did not address cannabis as a treatment for symptoms of dementia-related anxiety.  For more, see Medical Cannabis in the Skilled Nursing Facility:  A Novel Approach to Improving Symptom Management and Quality of Life, published January 2019.  Interestingly, the authors are a medical doctor, Zachary J. Palace, and Daniel Reingold, who lists both a Masters of Social Work and a J.D. for his background. 

January 14, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Tuesday, January 8, 2019

Medical Marijuana for Treatment of Dementia Agitation

Months ago, when my family was considering alternatives for care of my mother as her health deteriorated and her home became increasingly unsafe, I was talking with different providers about the challenges of care when the individual is a heavy smoker (as my mother, at age 92, still was at the time).  There are few options, and most licensed facilities bar smoking completely or limit it to locations that are not workable for someone with impaired movement.  I joked with one provider that smoking cigarettes was prohibited but that Arizona had recently authorized medical marijuana.  Arizona Statutes Section 36-2801 permits medical marijuana for those with debilitating medical conditions, including "agitation of  alzheimer's disease." 

The provider laughed and said, "oh, we don't permit smoking of marijuana either." I wasn't up-to-date on the technology!  Apparently the preferred dispensation at that location was via "gummies."  If you google "marijuana gummies" you get a remarkable range of products.

Medical Marijuana Gummies

In this brave new world of medical marijuana, I can see reasons for the interest, especially in the search for safe and effective ways to help individuals whose form of dementia is marked by severe agitation.  Can marijuana "take the edge off" in a safe way?  Can doses be monitored and evaluated appropriately?  Do "gummies" provide reliable or consistent doses of the active ingredient, most likely THC?  Can there be an associated positive effect -- improved appetite (the proverbial "munchies")?  Are there reporting mechanisms on the effects of use, especially in facilities that provide dementia care, that will help capture success rates and any risks?  What about individuals with dementia who suffer from both agitation and delusional thinking -- could medical marijuana potentially reduce one symptom but increase another?  Is the CDC tracking medical marijuana gummies or other products in the context of dementia care?  

The National Conference for State Legislatures (NCSL) maintains a website on state medical marijuana laws.  NCSL reported that as of 11/8/18, 33 states, plus D.C., Guam and Puerto Rico, have approved "comprehensive" public medical marijuana programs, with additional states allowing limited use of "low THC, high CBD" products in limited situations that are not deemed comprehensive medical marijuana programs.

In January 2017, the National Academies of Sciences, Engineering, and Medicine released a report based on review of "over 10,000 scientific abstracts" for marijuana health research, offering 100 conclusions related to health and ways to improve research. The conclusions are organized according to whether there is "conclusive or substantial" evidence, moderate evidence, or limited evidence about effectiveness or ineffectiveness of medical marijuana in a variety of contexts.  One conclusion suggests there is limited evidence that cannabis or cannabinoids are effective for "improving anxiety symptoms," while a separate conclusion states there is limited evidence that such substances are ineffective for "improving symptoms associated with dementia."  

I'm relatively new to review of literature associated with medical marijuana for dementia care/treatment, and welcome hearing from others who are aware of authoritative sources of information. (And just to be clear, this isn't a product we're considering for my mother!) I can see this topic becoming more important with time in our aging world, especially as additional sources of dementia-treatment evidence may become available. 

January 8, 2019 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Federal Statutes/Regulations, Food and Drink, Health Care/Long Term Care, Science, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Monday, January 7, 2019

States Adopt "Work & Save" Programs to Promote Retirement Savings on the Job

I was chatting recently with Bill Johnston-Walsh, director of Pennsylvania's chapter of AARP.  I always enjoy catching up with Bill, as he gets involved in cutting edge issues and projects under development.

One of the hot topics he relayed to me are programs at the state level to support better on-the-job savings for retirement.  Almost gone are the days of defined benefit retirement plans and employers may not offer defined contribution plans either.  States are beginning to adopt laws that make it possible for employers to offer alternative, low-cost, voluntary approaches for employees, sometimes known as "Work & Save" programs, such as "OregonSaves."  Here's a summary from an AARP report in July 2018:

Oregon was the first-in-the-nation to launch this innovative solution with OregonSaves in 2017, and as of July 2018 they already have over 58,000 workers enrolled and nearly $4.6 million saved. Of those eligible at this time, 73% have enrolled, and participants are saving $46.42 per paycheck on average. Check out how OregonSaves is helping workers save here.



Elsewhere, this year, Washington opened the first ever marketplace version of Work & Save, Washington’s Retirement Marketplace, and Illinois started a pilot of their Work & Save program, Illinois Secure Choice, with their official launch coming this fall.

 

These states are not alone – across the nation, states are recognizing the need to help all workers grow savings so they can take control of their futures and deal with the rising cost of health care and living expenses. In the past 6 years, 40 states have acted to implement, study or consider legislation to create Work & Save programs.

Convenience and portability for the employees seem to be two key components of the new approaches.

 

January 7, 2019 in Consumer Information, Current Affairs, Retirement, State Statutes/Regulations, Statistics | Permalink

Wednesday, January 2, 2019

Conservator Financial Exploitation Background Briefs from Center for Elders & Courts

The Center for Elders & Courts has released 8 background briefs on financial exploitation by conservators. The introduction explains that "the U.S. Department of Justice Office for Victims of Crime funded the National Center for State Courts (NCSC), in partnership with the American Bar Association Commission on Law and Aging (ABA Commission), the Virginia Tech Center for Gerontology (VTCfG) and the Minnesota Judicial Branch, to assess the scope of such exploitation and explore its impact on victims."  "The ... project collected information on conservator exploitation, as well as the laws and practices in place to prevent, detect and act on such exploitation."

The purpose of the briefs is to increase public knowledge about the issues, aimed at an audience that includes attorneys, policymakers, judges, court staff, and advocated. 

The 8 topics cover: 

Examples of Conservator Exploitation: An Overview

Conservator Exploitation in Minnesota

Detecting Exploitation by Conservators: Court Monitoring

Detecting Exploitation by Conservators: Systemic Approach

Court Actions Upon Detection of Exploitation

Innovative Programs That Address Financial Exploitation by Conservators

Data Quality Undermines Accountability in Conservatorship Cases

Supporting Victims of Conservator Exploitation

In addition there is a list of resources available here, Key Resources on Conservator Exploitation

 

January 2, 2019 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, State Statutes/Regulations | Permalink | Comments (0)

Tuesday, January 1, 2019

New Twist on Grandparent Scam-Asking for Cash

The grandparent scam has been around for a while. According to the FTC, the bad guys have morphed the scam to make it harder  to catch.  New twist on popular 'grandparent scam': mail cash explains that "people 70 and older report mailing huge amounts of cash to people who pretended to be their grandchildren... [and] ...  – fully 25% of people 70 and over who reported to the FTC how they paid money told [the FTC] they sent cash." (citations omitted). The FTC noted that these grandparent scams are also called friends & family impostor scams.

How do the bad guys convince victims to send cash?  The blog post explains that "callers often give very specific instructions about how to send cash. Many people said they were told to divide the bills into envelopes and place them between the pages of a magazine. Then, according to reports, they were told to send them using various carriers, including UPS, FedEx, and the U.S. Postal Service."  The post does give some advice:

  • Don’t act right away, no matter how dramatic the story is.
  • Call that family member or friend, and make sure you use a phone number that you know is right. Or check it out with someone else in your circle, even if the caller told you to keep it a secret.
  • Be careful about what you post on social media. If your personal details are public, someone can use them to defraud you and people who care about you.

If you’ve mailed cash, report it right away to the Postal Service or whichever shipping company you used. Some people have been able to stop delivery by acting quickly and giving a tracking number. Also tell the FTC at FTC.gov/complaint.

BTW, the FTC website notes that the agency is closed because of the government shut down. Hopefully the bad guys aren't reading this post or checking out the FTC website.

January 1, 2019 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, State Statutes/Regulations | Permalink | Comments (0)

Sunday, December 30, 2018

Rapid Response Conservatorship Project

The Rapid Response Conservatorship Project from the Center for Elders & the Courts is using technology to create "[a] modernized proactive court process that safeguards the as sets of those placed under a conservatorship." The website offers some information about the project: "NCSC will pilot the two-year project in two courts to develop and refine implementation strategies that can be adopted nationwide. The project will result in highly efficient court processes and has the potential to end the exploitation of conservatorship assets." The website describes 3 phases: planning, implementing and replicating. The project looks at 5 steps: appointing a conservator, using technology and machine learning  to establish a "financial profile" which in turn notifies courts of unusual activities which will then allow courts to take action with the result of "[i]ntegrating monitoring, alerts, and timely resolution into the court management process [which] will improve the administration of justice—and protect the assets of the vulnerable."

Cate Boyko is the project director

 

December 30, 2018 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, State Statutes/Regulations | Permalink