Tuesday, October 5, 2021

New Brief on COVID Scams

The Adult Protective Services Technical Assistance Resource Center (APS-TARC) released a new brief, COVID-19 Fraud and Scams: What APS Needs to Know. Noting the pandemic causes greater use of technology, increased isolation and changes to personal circumstances, the Brief discusses several COVID-related scams. These include healthcare scams, government impersonator scams, money transfer scams, charity scams, mortgage relief scams, helper scams, and scams around vaccinations, treatments for COVID, and tech. The Brief offers suggestions for prevention, agencies to contact for help,  and dealing with misinformation. 

October 5, 2021 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Other, State Statutes/Regulations | Permalink | Comments (0)

Tuesday, September 28, 2021

Two Articles on Caregiving

We all know the importance of caregiving and some of the issues facing the U.S. vis a vis caregivers.  First, an article a few days ago published in the Huffington Post, Why A Transformation Of Caregiving Could Be Biden’s B.F.D. Here's one excerpt from the article

It’s got three main components. One is an initiative to provide up to three months of paid leave to take care of family members, including newborns. Another is a proposal to make child care and prekindergarten available to any family that wants it, and to improve the quality of that care for everyone. The third piece is a proposal to fund what are known as “home- and community-based services,” a clunky piece of policy-speak that refers to programs that allow disabled and elderly Americans to live on their own rather than in nursing homes and other institutions.

After discussing the politics of the plan, the article provides a history of caregiving. "Responsibility for caregiving has historically fallen disproportionately on women ― who, in turn, were expected to provide it for little or no pay. That was possible, in part, because until relatively recently in history most women didn’t have alternatives in the paid workforce. That was especially true for women of color, who were subject to discrimination (and, at one time, enslavement)."  Discussing the pay scale for caregivers, and the approach in other countries, the article discusses the "policy opportunity" at hand in Congress.

Then consider this recent article from the New York Times, Long Hours, Low Pay, Loneliness and a Booming Industry,  about the home health industry.

The industry is in the midst of enormous growth. By 2030, 21 percent of the American population will be at the retirement age, up from 15 percent in 2014, and older adults have long been moving away from institutionalized care. In a 2018 AARP survey, 76 percent of those ages 50 and older said they preferred to remain in their current residence as they age. In 2019, national spending on home health care reached a high of $113.5 billion, a 40 percent increase from 2013, according to the most recent data from the Centers for Medicare and Medicaid Services.

The ranks of home care aides are expected to grow by more than those of any other job in the next decade, according to the Bureau of Labor Statistics. It’s also among the lowest paying occupations on the list.

The article examines the wages of aides and the activities they perform. The article also covers the impact of the pandemic on them, including those who died of COVID.  The article looks at the regulations of home health agencies in NY. This particular part of the article gave me pause. "Working overnight makes an already isolating and demanding job even more so. Aides assigned to “live-in shifts” spend 24 hours a day at a patient’s home, sometimes for several days in a row. The aides are paid for only 13 hours of that time because they are expected to get eight hours of sleep and three hours of meal breaks, according to New York State guidelines and federal regulations."  And it is only recently that aide  have been protected by the Fair Labor Standards Act "Home health aides are classified as “domestic service” workers, many of whom were exempt from a set of labor protections known as the Fair Labor Standards Act until 2015, when the Department of Labor expanded its regulations."

September 28, 2021 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)

Friday, September 24, 2021

DOJ Elder Justice Initiative Fall Webinars

DOJ's Elder Justice Initiative has announced its fall webinar series.  

Thursday September 30, 2021 2-3 p.m.,  INNOVATIONS IN GUARDIANSHIP: MAXIMIZING AUTONOMY AND ENSURING ACCOUNTABILITY.

Guardianship is one approach to providing support and assistance to adults who need help with decision-making about finances and personal issues. However, as recent high-profile and less visible cases illustrate, guardianship can also infringe on personal rights and can lead to mistreatment of older adults and adults with disabilities.

 

Join us for a webinar to discuss current trends and challenges in state guardianship systems, policies and practice. Using real-life guardianship scenarios, the webinar will explore ways to maximize autonomy and ensure accountability throughout the guardianship process. Presenters will discuss less restrictive alternatives to guardianship as well as ways to improve adjudication and post-appointment oversight of guardians.

To register, click here

Thursday October 21, 2021 2-3 p.m., IMPLEMENTING ELDER ABUSE RESTRAINING ORDERS

With the growing criminalization of elder abuse, greater attention has focused on elder abuse restraining orders, which are commonly used in the domestic violence context. Approximately sixteen states have an elder abuse restraining order statute, including California, with an additional three states having a financial exploitation only restraining order statute. Learn how one county-level adult protective services program in California implemented their restraining order statute. Overcoming some initial challenges, the presenters will share their lessons learned.

To register, click here.

Thursday November 18, 2-3 p.m., IDENTIFYING AND PROSECUTING POWER OF ATTORNEY ABUSE

Financial powers of attorney are legal tools commonly used to plan for the possibility that an adult may need help with financial decision-making in the future, but they can be used to steal money and property. Presenters will discuss common scenarios and recent prosecutions.

To register, click here.

September 24, 2021 in Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations, Programs/CLEs, State Statutes/Regulations | Permalink | Comments (0)

Thursday, September 23, 2021

Senate Committee on Aging Hearing Today

The Senate's Select Committee on Aging is holding a hearing today at 9:30 a.m. on "Frauds, Scams and COVID-19: How Con Artists Have Targeted Older Americans During the Pandemic". The witnesses include three experts and one consumer.   The hearing will be available through a live feed.  Click here to watch the hearing.

September 23, 2021 in Consumer Information, Current Affairs, Federal Statutes/Regulations, State Statutes/Regulations, Webinars | Permalink | Comments (0)

Tuesday, September 21, 2021

NM Aid In Dying Law Compared to Other Statutes

A recent opinion piece in USA Today was comparing the provisions of the New Mexico Aid-in-Dying law to those in other states, Terminal patients deserve death with dignity. New Mexico aid-in-dying law sets standard.
According to the author, there are 3 sections of the statute that are improvements over statutes in other states:

  • Offsetting the growing physician shortage statewide. The law mirrors the practice of medicine found in other fields and allows advanced practice registered nurses and physician assistants to use their training to serve as either the prescribing or consulting clinician.
  • Requiring only one written request and one 48-hour waiting period between receiving and filling the prescription for aid-in-dying medication. The prescribing provider has the ability to waive the 48-hour waiting period if the terminally ill person is likely to die during that waiting period.
  • Clarifying that if a health care provider objects to participating in medical aid in dying, they must inform the terminally ill person and refer them to either a willing provider or a party who can help the terminally ill patient find assistance.

    Furthermore, providers that oppose medical aid in dying must accurately and clearly disclose that on websites and in any appropriate materials given to patients.  

The law also takes a different approach to the waiting period used in other states, and according to the author, Oregon shortened its waiting period a couple of years ago "to allow doctors to waive the 15-day waiting period" and recently, "California passed legislation to improve access ... by reducing the mandatory 15-day waiting period between the two requests for aid-in-dying medication to 48 hours." 

September 21, 2021 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, State Statutes/Regulations | Permalink

Friday, September 17, 2021

Washington State Long-Term Care Program

Morris Klein, elder law attorney, friend and frequent contributor to this blog sent me links to two articles.  Washington's first-in-the-nation long-term care program starts in January, with opt-out deadline soon and  Payroll Tax Will Fund New Washington Long-Term Care Program.

The WA Cares fund was created by [their] Legislature in 2019 as a safety net for the seven in 10 people who will ultimately need professional or personal care at some point in their lives.

The only opportunity to opt out of the program is fast approaching, raising questions for workers who may be deciding whether getting a private policy is better or worse. Here, we lay out answers to some of the common questions.

. . . 

Part of the motivation for creating the worker-funded program is the fact that private long-term care insurance policies can be too expensive for retirees to keep paying premiums on until they need to use them.

"Beginning in 2025, the plan will pay benefits to enrollees who need help with non-hospital-based health care expenses."  "As more families applied for Medicaid, [Washington's legislators] saw a greater share of the state’s future budgets going to health care expenses.  So, in 2019, the legislature ...  opted to put the state in the long-term care business."

The articles are worth reading to learn more about how the program will work.  Considerations for employees in deciding whether to stay in or opt out can be found here.

September 17, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other, State Statutes/Regulations | Permalink | Comments (0)

Sunday, September 12, 2021

Florida's Guardianship Improvement Task Force

The next public hearing of Florida's Guardianship Improvement Task Force is scheduled for September 14, 2021 (tomorrow) at noon eastern. According to the emailed announcement, "[a] live stream of the meeting can be accessed here beginning at 12:00 p.m., EDT, on September 14The meeting agenda is being finalized and will be available on the Task Force website once completed."  More info about tomorrow's meeting should be available here.

Video of the five prior meetings, as well as supporting materials, are available on the website as well.

According to the website,

The Guardianship Improvement Task Force was formed with the mission of studying the current status of Guardianships in Florida, with the goal of making recommendations to improve the protection of wards throughout the state.

To accomplish this goal, the Task Force will hear from many stakeholders and study current vulnerabilities. After careful consideration, recommendations will be made to improve the protection and best interests of wards. Some recommendations may be directed for action by the various stakeholders, but the anticipation is that most will be offered as positive legislative recommendations.

The Task Force is being sponsored and staffed by the Florida Court Clerks & Comptrollers association.

September 12, 2021 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Programs/CLEs, State Statutes/Regulations, Web/Tech | Permalink

Thursday, September 9, 2021

Colorado City Makes Public Apology & Pays $3 Million to Settle Lawsuit Over Violent Takedown and Arrest of Older Woman

In May of 2021, we linked to emerging information about a June 2020 arrest of a 73 year-old woman with dementia in Loveland Colorado.  

The family of the older woman, Karen Garner, filed a civil suit.  On September 8, 2021, the City of Loveland issued a press release announcing a $3 million dollar settlement and expressing an apology to the family:  

“The settlement with Karen Garner will help bring some closure to an unfortunate event in our community but does not upend the work we have left to do. We extend a deep and heartfelt apology to Karen Garner and her family for what they have endured as a result of this arrest,” said Loveland City Manager Steve Adams. “We know we did not act in a manner that upholds the values, integrity, and policies of the City and police department, and we are taking the necessary steps to make sure these actions are never repeated.” 

***

“There is no excuse, under any circumstances, for what happened to Ms. Garner. We have agreed on steps we need to take to begin building back trust. While these actions won’t change what Ms. Garner experienced, they will serve to improve this police department and hopefully restore faith that the LPD exists to serve those who live in and visit Loveland,” Chief Bob Ticer stated.

Criminal charges are still pending against the officers involved in the violent takedown,  in her arrest, and for the detention of the injured woman who was then left without medical care in a holding cell while officers sat comfortably in a booking room, reviewing their own bodycam videos, appearing to laugh over the sound of her breaking arm.  For more, read here and here. 

There is a lot of work still ahead for so many police and detention units.  

September 9, 2021 in Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Dementia/Alzheimer’s, Discrimination, Elder Abuse/Guardianship/Conservatorship, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Wednesday, September 1, 2021

Elders Still Not Vaccinated

This New York Times article from last week took me a bit by surprise. Many Older Americans Still Aren’t Vaccinated, Making the Delta Wave Deadlier explains

The United States has a far higher share of seniors without full vaccine protection than many other wealthy countries, a key risk factor driving serious Covid-19 illness and death, a Times analysis shows.

As the Delta variant has torn across the country, America’s pace of vaccinations has sped up after months of relative stagnation, and full federal approval of the Pfizer vaccine on Monday could extend that momentum. Just over half of Americans are now fully vaccinated.

But national averages mask the high rate of older Americans who remain deeply vulnerable. Older people still account for most Covid-19 deaths, and in many counties, especially in the South and Mountain West, seniors without full vaccination make up more than 10 percent of the total population.

We know from the experiences of last year how deadly COVID can be to elders. And recent data proves this still to be true. "The Delta variant has hit many areas with clusters of vulnerable seniors particularly hard. Low elderly vaccination rates in ArkansasFloridaIdahoLouisiana and Nevada have coincided with surging rates of hospitalization and death."  There are still areas of high risk, without a current outbreak, according to the article.   There are many reasons for vaccine hesitancy and whether the full FDA approval of Pfizer will move the needle (pun intended) remains to be seen. "Signing up older Americans for their first shot remains a struggle, public health experts say, as people who really wanted a vaccine have already gotten it. While getting to a vaccine provider may still be an issue for some, especially in more rural areas, many more people are resistant to immunization because of their politics and personal beliefs, and those of their friends and family."

September 1, 2021 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other, State Statutes/Regulations, Statistics | Permalink

Tuesday, August 31, 2021

This CLE Is Worth Watching: #FreeBritney: Transforming & Reforming Conservatorship & Guardianship.

I had blogged a while back about this CLE, - #FreeBritney: Transforming and Reforming Conservatorship and Guardianship .  It was just excellent, and the recording is now available.  The program was sponsored by the ABA Section of Civil Rights and Social Justice, Commission on Disability Rights, and Commission on Law and Aging.   The recording is available here.

Here's a  description of the program:

Britney Spears’ conservatorship battle has shed light on the widespread problems and overuse of conservatorships/guardianships nationwide. Guardianships can be abusive and unnecessarily strip individuals of their civil rights to make their own decisions and use supports to live and direct their lives. Disability, aging, and civil rights advocates are calling for changes to reduce the overuse of guardianship and conservatorship, to strengthen recognition and use of less restrictive alternatives to guardianship like supported decision-making, and increase due process protections in guardianship proceedings and in the monitoring of guardianships. Our panel of experts discusses the risks and harms of guardianship, its systemic flaws, and the promise of alternatives like supported decision-making. They discuss reforms and changes that can address the problems that Britney Spears’ case has brought to light.

Put some time on your calendars to watch this very important CLE.  Don't forget to scroll down the page to check out the resources that are provided.

 

 

August 31, 2021 in Cognitive Impairment, Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Health Care/Long Term Care, Programs/CLEs, State Statutes/Regulations, Webinars | Permalink | Comments (0)

Tuesday, August 17, 2021

Register Now: Webinar on Guardianship Rights in the Era of Britney Spears

Register now for a free webinar next Monday, August 23, at 3 eastern, #FreeBritney: Transforming and Reforming Conservatorship and Guardianship.

Britney Spears’ conservatorship battle has shed light on the widespread problems and overuse of conservatorships/guardianships nationwide. Guardianships can be abusive and unnecessarily strip individuals of their civil rights to make their own decisions and use supports to live and direct their lives. Disability, aging, and civil rights advocates are calling for changes to reduce the overuse of guardianship and conservatorship, to strengthen recognition and use of less restrictive alternatives to guardianship like supported decision-making, and increase due process protections in guardianship proceedings and in the monitoring of guardianships. Our panel of experts will discuss the risks and harms of guardianship, its systemic flaws, and the promise of alternatives like supported decision-making. They will discuss reforms and changes that can address the problems that Britney Spears’ case has brought to light.

Panelists include:
- Jonathan Martinis, Senior Director for Law and Policy at The Burton Blatt Institute at Syracuse University
- Zoe Brennan-Krohn, Staff Attorney, Disability Rights Program, American Civil Liberties Union, San Francisco
- Jasmine Harris, Professor of Law, University of Pennsylvania Carey School of Law
- Hon. Lauren S. Holland – Judge, Lane County Circuit Court
- Charles Sabatino (Moderator) – Director, ABA Commission on Law and Aging

To register, click here.

August 17, 2021 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Programs/CLEs, State Statutes/Regulations, Webinars | Permalink | Comments (0)

Friday, August 13, 2021

Paying for Old Age

The New York Times recently published an opinion piece, Getting Old Is a Crisis More and More Americans Can’t Afford.  The article has some good statistics in it. Focusing on long-term care needs, the article compares demand and supply and costs. "[M]ost seniors will require long-term care. Almost 70 percent of Americans turning 65 today are expected to need extended services and supports at some point. About 20 percent will need care for more than five years. Despite this, the majority of those age 40 and over have done no planning for their long-term care, according to a 2021 survey by the AP-NORC Center for Public Affairs Research."  The article notes the scope and limitations of Medicare, Medicaid and long-term care insurance and examines the work of  "a broad cross-section of policy experts, consumer advocates and industry representatives [who] formed the Long-Term Care Financing Collaborative to explore more sustainable funding models. The central recommendation of the group’s final report, issued in 2016, was the creation of a universal public insurance program." Noting challenges of making this a reality, the author  suggests that "[t]he outlook may be more promising at the state level. In 2019, Washington State passed the nation’s first state-run long-term-care insurance program. The WA Cares Fund is to be funded by a 0.58 percent payroll tax on employees. Starting in 2025, eligible residents can receive benefits of $100 per day, with a lifetime cap of $36,500."

August 13, 2021 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare, Other, State Statutes/Regulations | Permalink | Comments (0)

Friday, July 30, 2021

Are In-Law Apartments the Answer to Housing for Elders and Folks with Disabilities?

The Boston Herald addressed housing needs in this article, Massachusetts advocates say in-law apartments will help older adults, people with disabilities.   The article advises that "[t]he region’s restrictive zoning laws around accessory dwelling units, or in-law apartments, are being reexamined by lawmakers and advocates who say easing up would be a game-changer for older adults or residents with disabilities."  The author of the bill noted specific provisions of the bill apply to elders as well as those with diabilities, and allows for a special need trust "for those with disabilities 'so an owner could create a long-term housing plan for after they passed away to allow their child to stay there....'" A companion bill has also been filed in the Massachusetts Senate. Another bill has broaden the regulation of accessory dwelling units, because as noted in a "2019 study ... that only 37 of 100 of the communities closest to Boston allow for ADUs to be rented out. Another 31 municipalities allow for temporary ADUs for family members or caregivers. The remaining 32 communities have no zoning allowances for ADUs at all."

Consider the role of zoning ordinances not only on the availability of housing, but how it impacts housing specifically for elders and individuals with disabilities.

July 30, 2021 in Consumer Information, Current Affairs, Housing, State Statutes/Regulations | Permalink | Comments (0)

Thursday, July 29, 2021

Rental Assistance for Older Adults

With the eviction moratorium expiring in just a couple of days, we need to realize that housing insecurities impacts all age groups.  It's timely that the Consumer Financial Protection Bureau (CFPB) just released The Rental Assistance Finder. The website allows one to search for housing assistance by location, provides info on various topics, including about help in paying rent, payment agreements, and renter rights.

In addition, the National Center on Law and Elder Rights recently offered a training, Emergency Rental Assistance Programs and Other Tools to Prevent Evictions of Older Adult Tenants. Accompanying this training is the materials, Emergency Rental Assistance Programs & Other Tools to Prevent Evictions of Older Adult Tenants, CHAPTER SUMMARY • June 2021. This will be extremely helpful with the eviction moratorium expiring in days.

 

July 29, 2021 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Housing, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Filial Friday? Court Holds Son Liable for Attorneys Fees Incurred While Securing Medicaid Coverage for Father's NH Care

Pennsylvania courts use "filial" responsibility laws in, shall we say, creative ways, especially when they catch any whiff that children helped themselves to their parent's money rather than using that money to pay for their parents' nursing home care.  One of the key modern-era cases for filial support law in Pennsylvania is Presbyterian Med. Ctr. v. Budd, 832 A.2d 1066 (Pa. Superior Ct, 2003), where the court remanded a case for decision on filial support law grounds, in the absence of other viable theories, in order  to hold a daughter liable for her mother's costs of nursing home care. The court was clearly annoyed by the evidence the daughter had transferred some $100k of her mother's funds to herself using a "valid" power of attorney, instead of paying the nursing home.

It probably doesn't make the court any happier if the defendant/child is also a lawyer.  

In the latest Pennsylvania decision decided by the Court of Common Pleas in Montgomery County,  Coates v. Salmon, No. 2018-16878, both the plaintiffs and the defendant are lawyers.  The trial court was asked to determine whether a son was personally liable for attorneys fees incurred when the son "engaged" another attorney, one experienced in Medicaid issues, regarding a penalty period assessed against his father.  The penalty made his father ineligible for 296 days in Medicaid funding for his nursing home care.  The lawyer was able to negotiate a reduced penalty period, with a successful argument that certain pre-admission transfers were not made in anticipation of applying for Medicaid.  The settlement reduced the dollar effect of the penalty by more than $68,000. 

Nonetheless, the son declined to pay the attorney his requested fee of $7,606, arguing there was no contract as the attorney had failed to comply with Pennsylvania Rule of Professional Responsibility 1.5(b) that requires "the basis or rate of the fee" to be "communicated to the client in writing, before or within a reasonable time after commencing the representation."  The lawyer-son seemed to be arguing, at least indirectly, that the only fee he'd "agreed" to pay was a $500 up-front "consultation" fee.  

The court agreed with the defendant-son on the contract issue, but granted the full sum of the requested fees as "reasonable" under a theory of quantum meruit.  And that's where Pennsylvania's filial support law came into play to support the court's decision on the son's liability:

Mr. Salmon [the defendant/son] contended, however, that any claim in quantum meruit could be asserted only against his Father, and not against Mr. Salmon personally. The argument was that Father was liable to the Nursing Home for any services not reimbursed by Medicaid and Father was therefore the sole beneficiary of the substantial reduction in the penalty.  It is true that to establish a claim in quantum meruit against Mr. Salmon, Plaintiffs [the Elder Law attorney and his firm] were required to show that he benefited from Mr. Coates's services. . . . Plaintiffs clearly met that requirement, however, because Mr. Salmon himself would have been liable to the Nursing Home for the $86,786 penalty if it had not been successfully diminished by Mr. Coates.  

 

The doctrine of filial responsibility is codified in Section 4603(a)(1)(ii) of the Domestic Relations Code, 23 Pa. C.A. Section 4603(a)(1)(ii). . . .

 

This provision and its predecessor statute have been repeatedly cited as authorizing a suit by a nursing home or other medical provider to recover fees for the care of an indigent patient from the patient's adult child with the means to make payment. . . . It is thus clear that without the reduction of the penalty to a relatively trivial sum, Mr. Salmon would have been liable for -- or, at the least, substantially at risk of liability for -- the amount of Nursing Home fees denied by Medicaid.  

 

Further, the imposition of liability on Mr. Salmon in quantum meruit is fully consistent with principles of equity. The evidence clearly showed that Mr. Salmon, in engaging Plaintiffs' services, understood his obligation to pay for those services. . . . And, most significantly, in Mr. Salmon's letter of May 6, 2016, responding to Plaintiffs' bill, he disputed the reasonableness of Mr. Coates's fees and the quality of his services, but he never suggested that Plaintiffs were billing the wrong person. . . . [I]t was compelling evidence that Mr. Salmon understood his responsibility to pay Plaintiffs' legal fees and that his later contention that only his Father was responsible was a post hoc excuse for his unwillingness to pay.

The detailed, well-written opinion dated June 23, 2021 is available at the link above, and the case is on appeal to Pennsylvania's intermediate court of appeals, the Superior Court.  In Pennsylvania, trial judges have the opportunity to write their full opinion, rather than just their final decision, after a party has appealed the ruling and after that party has identified all claims of errors.  In my experience, a detailed, well-written Pennsylvania trial court opinion has a good chance of being affirmed on appeal. For an additional perspective on this case, see the Elder Law Answer summary here.  

July 29, 2021 in Cognitive Impairment, Current Affairs, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Medicaid, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Wednesday, July 21, 2021

Is Shared Decision-Making A Better Route for Effective Communication?

Elizabeth Moran, a relatively new staff attorney for the ABA's Commission on Law and Aging, has an interesting article in the latest issue of Bifocal, Vol. 42, Issue 6 (July-August 2021).  Moran outlines several key recommendations made by the National Guardianship Network during their May 2021 national Summit.  She points to two of the 22 recommendations that bear on "effective communication" for persons with disabilities, especially when involved in court proceedings that may affect any determination of "legal capacity."  

Recommendation 1.2 advocates for courts and state authorities "must ensure that all judicial proceedings" that can impact a determination of an adult's legal capacity must provide "meaningful due process" which includes respect for the individual's "preferred communication accommodations."  

Recommendation 2.4 provides that federal and state authorities "should recognize that supported decision-making can be a reasonable accommodation under the Americans with Disabilities act of 1990, as amended, in supporting an individual in making their own decisions and retaining their right to do so."

Moran acknowledges there is weak understanding within some courts for how supported decision-making will work, even as she advocates strongly for its use.  She writes:

While there is growing awareness of “supported decision-making” (SDM), particularly as an alternative to guardianship, SDM does not have a universally accepted legal definition. It is, however, becoming a more commonly understood concept of integrated supports which honors an individual’s integrity of choice with the underlying principle that, with enough appropriate supports and services, nearly every individual has the capacity to make decisions. When people use SDM as a communication accommodation, they use family members, friends, professionals, and others they trust and who know them well to help them understand the situations and choices they face, but with the ultimate choice left to the adult. This eliminates a substitute decision-maker and maximizes autonomy for the individual who may need communication supports for speaking, reading, writing, or understanding in order to meaningfully participate. The need for this kind of support necessarily includes and can provide for meaningful participation in court services, programs and activities.

For more on this important topic, read Moran's full piece, "Something to Talk About: Supported Decision Making and Access to Justice for All."

July 21, 2021 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, State Statutes/Regulations | Permalink | Comments (0)

Tuesday, July 13, 2021

Home Care Worker Shortage Means Long Waits for Help

Kaiser Health News ran this story last month, Desperate for Home Care, Seniors Often Wait Months With Workers in Short Supply.  Using Maine as an example, the article explains

The Maine home-based care program, which helps Shackett and more than 800 others in the state, has a waitlist 925 people long; those applicants sometimes lack help for months or years, according to officials in Maine, which has the country’s oldest population. This leaves many people at an increased risk of falls or not getting medical care and other dangers.

The problem is simple: Here and in much of the rest of the country there are too few workers. Yet, the solution is anything but easy.

The article reminds us that the President had included funding for home and community-based care in the infrastructure bill ("human infrastructure") and that this shortage was not unexpected. "For at least 20 years, national experts have warned about the dire consequences of a shortage of nursing assistants and home aides as tens of millions of baby boomers hit their senior years." 

And here we are.  The article emphasizes money--the lack of it, the low wages and more.

 

 

July 13, 2021 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)

Monday, July 12, 2021

California Bar Seeking Input on Proposed Formal Opinion on Clients with Diminished Capacity

The California Bar has asked for input on Proposed Formal Opinion Interim No. 13-0002 (Client with Diminished Capacity).  According to the announcement

Proposed Formal Opinion Interim No. 13‑0002 considers: What are the ethical obligations of a lawyer for a client with diminished capacity?

The opinion interprets rules 1.0.1(e), 1.1, 1.2, 1.4, 1.6, 1.7, and 8.4.1 of the Rules of Professional Conduct of the State Bar of California; Business and Professions Code section 6068(e).

The opinion digest states: A lawyer for a client with diminished capacity should attempt, insofar as reasonably possible, to preserve a normal attorney client relationship with the client, that is, a relationship in which the client makes those decisions normally reserved to the client. The lawyer’s ethical obligations to such a client do not change, but the client’s diminished capacity may require the lawyer to change how the lawyer goes about fulfilling them. In particular, the duties of competence, communication, loyalty, and nondiscrimination may require additional measures to ensure that the client’s decision-making authority is preserved and respected. In representing such a client, a lawyer must sometimes make difficult judgments relating to the client’s capacity. Provided that such judgments are informed and disinterested, they should not lead to professional discipline. In some situations, the client’s lack of capacity may require that the lawyer decline to effectuate the client’s expressed wishes. When the lawyer reasonably believes that the client’s diminished capacity exposes the client to harm, the lawyer may seek the client’s informed consent to take protective measures. If the client cannot or does not give informed consent, the lawyer may be unable to protect the client against harm. A lawyer representing a competent client who may later become incapacitated may propose to the client that the client give advanced consent to protective disclosure in the event that such incapacity occurs. If appropriately limited and informed, such a consent is ethically proper.

At its meeting on October 23, 2020, and in accordance with their procedures, the State Bar Standing Committee on Professional Responsibility and Conduct tentatively approved Proposed Formal Opinion Interim No. 13-0002 for a 90-day public comment distribution. Subsequently, at its meeting on June 11, 2021, COPRAC revised the opinion in response to public comment and approved Proposed Formal Opinion Interim No. 13-0002 for an additional 60-day public comment distribution.

The text of the proposed  opinion is available here.

Republished July 19 to correct error in title.

Seems like a good time to remind everyone of the fabulous resource from the ABA Commission on Law and Aging, Assessment of Older Adults with Diminished Capacities: A Handbook for Lawyers, 2nd Edition. It's a must have for every attorney's library.

July 12, 2021 in Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, State Statutes/Regulations | Permalink | Comments (0)

Sunday, July 11, 2021

Analyzing Britney Spears' Conservatorship: How Should Courts Respond to Allegations of a Toxic Guardianship?

This summer, J. Collin Fulton, a rising 2L student at Dickinson Law, with a prelaw background in journalism, has been doing a fantastic job while working on projects with me.  He put together this very thoughtful overview of how Britney Spears' concerns, arising in the context of the California-based proceeding, may be relevant to the larger analysis of guardianships and conservatorships across the nation.  

Joshua Collin Fulton 2021From J. Collin Fulton:

In the areas of guardianship and conservatorship law, perhaps no recent case has captured the attention of the American public as thoroughly as the conservatorship of Britney Spears. The Pop singer’s conservatorship was established in California in 2008 and has become one of the best-known examples of how, under U.S. law, a person can have the management of both their personal life and financial affairs placed under the control of a court-appointed guardian/conservator, typically as a result of mental or physical conditions or advanced age.

While a legion of Ms. Spears’ fans has routinely called into question both the necessity and nature of the singer’s conservatorship, it was the release of the New York Times' 2019 documentary “Framing Britney Spears” which brought the details of Ms. Spears conservatorship to the attention of the broader public. I personally became aware following the Times’ publication on June 22nd of an article detailing how Ms. Spears herself feels about the conservatorship. Based on court records acquired by the NYTimes, the article details both Ms. Spears opposition to the continuance of her conservatorship in its present form as well as Ms. Spears claims concerning some of the effects the conservatorship has had on her life. Based on court documents going back to 2014, the NYTimes article reports that:

  • Spears “feels the conservatorship has become an oppressive and controlling tool against her.”
  • Spears has informed the court that, as a result of the conservatorship, she felt compelled to perform against her will and compelled to stay at a mental health facility against her will.
  • The conservatorship restricted a broad range of Ms. Spears decision making, ranging from who she was allowed to date to the manner in which she could decorate her home.

Ms. Spears’s June 23 public testimony further cast the conservatorship in a negative light. In the testimony, the singer claimed that, against her will, she was forced to take mood-altering drugs and forced onto contraception. Ms. Spears again called for her conservatorship to be ended and generally for the laws surrounding conservatorships to be changed. This call has been echoed by numerous other singers in support of Ms. Spears, including Justin Timberlake, Halsey, Brandy, and Mariah Carrey, as reported by the BBC.

Given what Ms. Spears claims has transpired as a result of her conservatorship and the public support she has received, I became deeply curious about how a conservatorship can actually be terminated. Given the complexity of guardianship/conservatorship laws, this is a question without a simple answer.

First, state laws vary significantly regarding who, how, and why a person can be placed under a guardianship/conservatorship. As Ms. Spears’s case takes place in California, I focus there.

There are two types of conservatorships under California law: Lanterman-Petris-Short (LPS) and Probate conservatorships, the latter of which is exemplified by Ms. Spears’s situation.

Such conservatorships are typically permanent affairs in California; however, they can be terminated in the following ways:

  • The conservatorship ends due to the death of the conservatee.
  • A judge may end the conservatorship upon petition to do so resulting from the conservatee regaining the ability to manage their own affairs (The argument Ms. Spears appears to be currently making).
  • A conservatorship of the estate can be ended if the conservatee ceases to possess any assets to protect.

Learning this raised a new question for me: why would a court allow a conservatorship such as Ms. Spears’s to continue given her allegations? I believe the answer to this question lies in the purpose of guardianship/conservatorship laws.

This purpose is perhaps best exemplified in the California “Handbook for Conservators,” which the state mandates for conservator cases. The Handbook has a clear message for every new conservator: “You have been appointed conservator because someone – your parent, spouse, child, or other relative or friend – needs help, and you are willing to lend a hand.” This simple message, in my opinion, captures the thought behind guardianship and conservatorship laws. There are, sadly, situations in which a person is unable to manage their affairs. Guardianships and conservatorships allow for a legal redress to such situations, enabling courts to appoint a trusted individual to provide assistance in such circumstances.

The California Handbook also highlights another important fact central to the functionality of conservatorships: “The position of conservator is one of great trust and responsibility. The court and conservatee are trusting you to follow the law and to act in the conservatee’s best interests.” Given the incredible responsibilities assumed by a guardian/conservator, it is indeed imperative that guardians/conservators execute their duties with the utmost understanding and respect for the individual's own values and goals, while also complying with the legal obligation to make decisions in the best interest of the individual they have been appointed to protect.

With the purpose of guardianships/conservatorships now understood, I turn back to Ms. Spears and the question of why, given her allegations, her conservatorship still remains. The answer is, simply, that legal process such as this take time.

Just as a court needed to consider a multitude of factors in determining that Ms. Spears should become a conservatee, the court must now perform proper inquiries into the allegations that Ms. Spears has raised and then determine an appropriate response to take based on the validity of these allegations. This is true not only for Ms. Spears, but for any person in a guardianship/conservatorship situation. Guardianships/conservatorships are serious affairs, ones in which a person’s ability to control their own lives have been taken from them and handed to another individual, hopefully one who is trustworthy and will act in their best interest. Should doubts emerge about the actions of a guardian/conservator, or indeed the necessity of an established guardianship/conservatorship itself, investigating the situation thoroughly is paramount to the integrity of not only the guardianship/conservatorship in question but also the legal system of guardianships/conservatorships at large.

Mr. Fulton concludes:  I thus believe that while a quick response from the court may satiate the immediate public outcry for change, a proper inquiry which establishes the truth and, in turn, enables the court to act based on the facts will not only improve Ms. Spears' situation but enhance public knowledge on the current state of guardianship/conservatorship laws in the United States.

July 11, 2021 in Cognitive Impairment, Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Friday, July 9, 2021

How Does Market Concentration Affect Long-Term Care in the US?

Klobuchar. Antitrust  Taking on Monopoly Power from the Gilded Age to the Digital Age (2)During the first part of my summer, I wrote a review on Senator Amy Klobuchar's April 2021 book, Antitrust: Taking On Monopoly Power From the Gilded Age to the Digital Age. That turned out to be a very enjoyable, stimulating task and my article will be published late summer or early fall.  This gave me the incentive to rethink how antitrust law, as a form of pro-consumer-protection "competition" rules might affect long-term care, including the concentration of ownership and operation of nursing homes and other types of "senior living." The  student editor for the Law Review,  Claudia Bernstein (Dickinson Law, Class of 2022), also has been captured by the topic, and she sent me an article today from the New York Times that furthered this inquiry.  A key passage:

[In the U.S.] Fewer new businesses are starting. Existing businesses have slowed the pace at which they hire new workers . . . . Workers are less likely to switch jobs or move to a new city. Companies are investing in new buildings and equipment at a lower rate. And small businesses make up a shrinking share of the economy.

 

Together, these trends suggest that the economy suffers from a lack of fair competition, many economists believe. Large corporations are often able to increase profits not by providing better products than their rivals but instead by being so big that they exercise power over workers and consumers. The government also plays a role, through policies that protect existing companies at the expense of start-ups and new entrants into an industry.

 

The technical term for excess profits from a lack of competition is “monopoly rents.” Just think about how frustrated you may have been by the customer service from an airline, cable-television provider or health insurer. And then imagine how frustrating it may be to work there. Despite the problems at these companies, consumers and workers don’t always have good alternatives.

In my local area, there is a variation on this problem.  As I have written about recently, county officials are proposing to close the county's "nursing home," which in my experience has been well run and  served as a viable alternative for necessary services, including memory care.  The likely purchaser will be a for-profit company (a modest-size, relatively new tri-state regional player).  The county hopes to cease "having to subside the facility with general tax money."  But, without those "subsidies," consumers' payment for care will have to increase, affecting residents unlikely to have the ability to pay more.  As one article on the history of Pennsylvania's county nursing home conversions concludes:

County-owned homes, once ubiquitous, are becoming less common in Pennsylvania. Facilities that have been privatized generally have lower ratings on common metrics; a York Dispatch study in 2018 found that 15 formerly county-owned facilities sold since 2005 had an average rating of 1.9 stars out of five on the common scale used by the Centers for Medicare and Medicaid Services, while the state’s 21 county-owned homes averaged 3.1 stars [out of a possible 5 stars].

July 9, 2021 in Consumer Information, Current Affairs, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations, Statistics | Permalink | Comments (0)