Elder Law Prof Blog

National Guardianship Network New Video

The National Guardianship Network [Has Released A] New Video with Recommendations for Reforming Guardianship System.This video 

showcases the highlights of the Fourth National Guardianship Summit and the 22 recommendations to reform and improve state guardianship systems. The video also addresses the history of these national summits, the importance of the Fourth Summit and the main topics discussed during the Summit:

• Rights of Persons Subject to Guardianship

• Supported Decision-Making

• Limited Guardianship, Protective Arrangements, and Guardianship Pipelines

• Rethinking Monitoring and Addressing Abuse by Guardians

• Fiduciary Responsibilities and Tensions

• Developing a Guardianship Court Improvement Program

To view the video, click here.

Smart Home Tech Makes Aging in Place Easier

The Washington Post recently published this article, Aging in place can be so much easier with smart home technology. "Supporting health, safety and security are important components of successfully aging in place. So are home management systems that maintain a comfortable environment, and communication and recreation systems that enable social engagement, stimulation and entertainment."  As the article notes, the type and amount of tech is vast, ranging from pretty simple types that do just a little, to more comprehensive setups that integrate into much of every day life.  The article focuses on two couples who added tech to their homes.  It also looks at the pros and cons, as well as advances and includes a list of recommendations.  The article also mentions concerns about privacy and how to mitigate that. I would also add the topic of consent, when family want to install the tech in the home of the elder.  Lots of good info in the article.

Podcast on Nursing Home Neglect

The National Consumer Voice for Quality Long-Term Care is offering a podcast with Dr. Laura Mosqueda on Nursing Home Neglect: Preventing It and Getting Help. Here's a description of the podcast:

The pandemic has renewed concerns about the quality of care that residents receive in some nursing homes, and many family members have reported significant decline in the condition of their loved ones. Neglect and abuse of older adults is a long-standing problem that is under-reported and has not received the necessary attention and response from policymakers, yet it results in needless and preventable suffering and harm.

In this episode with Dr. Laura Mosqueda, a professor of Family Medicine and Geriatrics at the Keck School of Medicine at the University of Southern California, we talk about neglect, which is the failure to provide goods and services to an individual that are necessary to avoid physical harm, pain, mental anguish, or emotional distress. Neglect may or may not be intentional.

The link to the podcast is here. You can subscribe to the podcast series from this page as well as find information about the Consumer Voice's YouTube channel.

Webinar Elder Justice Decision-Making Capacity Symposium

Register now for this important virtual symposium from DOJ's Elder Justice Initiative, scheduled for April 19th through April 21, from 1-5 eastern.  Here's a description about the Symposium.

Every day the lives of older adults are profoundly and negatively impacted in both the criminal and civil justice systems based on mistaken assumptions and inadequate assessments of their capacity to make decisions for themselves. In order to raise greater awareness of these issues and improve how elder justice professionals approach these issues, the Department of Justice will be hosting the Elder Justice Decision-Making Capacity Symposium, a three-day virtual conference on April 19-21.

The Symposium will highlight what we know today about the aging brain and its impact on decision-making, and discuss the protocols and tools available to assess decision-making capacity. The Symposium will then focus on the myriad of ways that perceptions of an older adult’s decision-making capacity can have profound implications on their treatment in criminal and civil proceedings. These may include elder abuse or fraud prosecutions not being pursued; unnecessary or inappropriate guardianships being imposed; and civil legal remedies being denied to older victims of elder abuse, neglect and financial exploitation.

By shedding light on the latest science as well as best clinical, legal and judicial practices, the Symposium aims to increase access to justice while promoting the autonomy of older adults.

Free Symposium provided by the Elder Justice Initiative, U.S. Department of Justice.

Click here to register.

Tech Use Among Older Adults Increased

Pew Research Center periodically releases reports about older adults using tech, with the latest one released last week. Share of those 65 and older who are tech users has grown in the past decade explains although tech use is higher among younger folks, "on several fronts, adoption of key technologies by those in the oldest age group has grown markedly since about a decade ago, and the gap between the oldest and youngest adults has narrowed, according to new analysis of a Center survey conducted in 2021."  Here's some data collected about specific technologies:  about 65% of older adults (65+) have smart phones, about 1/3 less than younger people.  There's a bigger gap between the age groups as far as social media uses. The gap on internet access is narrowing, although those 65+ are connected at about 75% of the rate of younger folks, but this gap narrows for the near old. However, the data on frequency of internet usage shows a significant gap based on age,  with less than 10% of the 65+ group indicating they were on the internet constantly.

I was a bit surprised at the numbers, thinking with social isolation, the participation by older adults would have been higher.  There is some good info in this report, so check it out.

Does Technology Combat Social Isolation

With this latest COVID surge right in time for the holidays, folks may be debating about traveling vs. staying home.  As we learned during the first lockdown, isolation can have a particularly devastating impact on many, and especially on older adults. 

A bit ago, the Washington Post published an article,  How technology can help seniors beat loneliness and isolation, which examines social platforms that provide connections, entertainment, and more. The article reviews some of these platforms. One featured, Papa, is provided through Medicare, Medicaid and some employer health plans and provides in-person connections.  Other platforms provide these connections as well, and there is an opportunity for younger generations-not just family-to connect with older folks.  Then, of course, are the platforms that connect virtually for virtual communications, some that emphasize intergenerational connections and match folks based on a common interest.  Then the more "high tech" platforms are those that provide virtual reality, with the article noting that "[t]he immersive, 3-D experience is more compelling than FaceTime or Zoom. “It’s like the difference between a phone call and a video call...."

Surveillance When Using Tech to Age in Place?

It's not "Big Brother ... Watching You." (If you are a Baby Boomer, you will likely remember the phrase.)  So who is watching if you are using tech to age in place?  The Washington Post addressed this question in For seniors using tech to age in place, surveillance can be the price of independence.

On the surface the benefits of home and health monitoring technology seem obvious. A flow of information about the older person can put a caretaker at ease and help keep track of physical or cognitive decline. It is a way to extend the amount of time they are able live in their own homes before moving to someplace like a retirement or nursing home.

But the devices, many of which grew out of security and surveillance systems, can take privacy and control away from a population that is less likely to know how to manage the technology themselves. The idea of using tech to help people as they age is not a problem, say experts, but how it’s designed, used and communicated can be. Done wrong or without consent, it is one-way surveillance that can lead to neglect. Done right, it can help aging people be more independent.

New tech is being developed according to the article, and the article points out that the tech requires maintenance. "Aside from privacy issues, Internet connected devices are also a security worry. Many are stuffed with insecure software and require regular updates and password changes so they are not vulnerable to breaches." Even though tech can offer some advantages, there are still some caregiving tasks that require a human to perform (at least for now).

Here's an important point about the use of monitoring technology. "There is an imbalance of power that often exists between the elderly and their caretakers when it comes to technological know how. In the worst case scenario, it can also play a role in elder abuse, whether it is financial, physical or emotional, experts say." The elder needs to give consent to the use of the monitoring devices and understand that "[b]eing old does not mean you lose your rights."

Thanks to Professors Bauer and Cahn for sending me the link to the article.

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 14.  The 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.

Using Digital Skills for Advocacy With State Legislators

Last week Kaiser Health News ran a story about elders in SNFs using their digital skills tor each out to their legislators, Zooming Into the Statehouse: Nursing Home Residents Use New Digital Skills to Push for Changes.

Nursing home residents who have been using digital technology to reach out to family and friends — after the covid pandemic led officials to end visitation last year — could also use it to connect with elected officials once the legislature moved to remote hearings.... 

The combination of a virtual legislature and nursing home residents equipped with internet access has created an opportunity most nursing home residents rarely have — to participate in their government up close and in real time.

  *    *    *

So far this year, nursing home residents have testified in support of legislation to improve staffing levels, create a designated “essential support person” with special visitation privileges, and allow “technology of their choice” in their rooms to communicate with whomever they wish, among other proposals. The latter passed unanimously in both chambers, said [Connecticut AARP’s advocacy director] “and we expect the governor to sign it into law.” 

One legislator has introduced a bill to permanently allow virtual advocacy there.

Tech Trends!

AARP recently released this report, 2021 Tech Trends and The 50-PLUS: Top Ten Biggest Trends.

Here are the ten:

1. In 2020, a year when a global pandemic significantly limited social interaction, technology became more important than ever — for everyone.

2. Video-chat is here to stay.

3. The dependency on tech has created new social behaviors, although it’s too soon to tell what will stick around.

4. Older adults are doing more with their smartphones, by development over time or necessity, and using them more frequently.

5. 2020 is the year older adults adopted, updated, and modernized their tech, and many spent big bucks to do so.

6. Smart TV’s were the second-most popular tech purchase.

7. 2020 brought a dramatic shift in how adults 50-plus consume entertainment. Growth in streaming was huge, but cable tv is still important (for now).

8. Some barriers to technology adoption and use still exist for older adults.

9. Privacy is an important but misunderstood issue for many.

10. Disparities related to access have a significant impact on technology adoption and use among older adults.

Take a look at the findings for #10. This is pretty darn important:

• Sixty percent of adults 50-plus say the cost of high-speed internet is a problem for them personally.
• On average older adults spend $269 a month (16% of their budget) on tech expenses such as internet, cellphone, cable, and streaming
services (average estimated monthly costs: internet, $68; cellphone, $103; cable, $78; and streaming services, $20).
• A quarter (23%) of rural customers acknowledge that access to high-speed internet is a major problem for their community.
• And while older, urban customers have ample access to high-speed internet such as cable and fiber, they, like rural customers, indicate
that cost is a major problem (23% and 26%, respectively).
• Fifteen percent do not have any type of internet or are not sure if they have it.

Podcast: Caring for People With Dementia

The National Consumer Coalition for Quality Long Term Care announced the release of a podcast, The Care For Individuals With Dementia.  Here's a description of the podcase. 

When the needs of residents living with dementia are met, incidences of resident stress are significantly reduced. Practicing person-centered approaches and interventions increase the likelihood that the message being communicated by the resident will be heard and addressed, leading to better outcomes and more satisfaction for the individual. In this episode of the Pursuing Quality Long-Term Care podcast, Dr. Jonathan Evans and Lori Smetanka of Consumer Voice talk about caring for human beings with dementia.

The podcast can be accessed here.

New Alzheimers Website from Federal Government

If you haven't seen this yet, check out the new website, Alzheimers.gov. This site compiles a significant amount of great info. As the website explains

Alzheimers.gov is the federal government portal to information and resources on Alzheimer’s disease and related dementias, including Lewy body dementia, frontotemporal disorders, and vascular dementia. Alzheimers.gov is managed by the National Institute on Aging (NIA) at the National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services (HHS). HHS is the U.S. government’s principal agency for enhancing the health and well-being of all Americans.

. . . 

A primary goal of Alzheimers.gov is to connect people to the many federal resources available to educate and support people whose lives are touched by these devastating diseases in their various roles. Whether you are living with dementia, a family member or friend, health care provider or other health care professional, researcher, or advocate, Alzheimers.gov is designed for you.

. . . 

The Digital Divide Still Exists For Elders

Pew's recent FactTank released this, 7% of Americans don’t use the internet. Who are they? Want to take a guess who are in this 7%? "Internet non-adoption is linked to a number of demographic variables, but is strongly connected to age – with older Americans continuing to be one of the least likely groups to use the internet. Today, 25% of adults ages 65 and older report never going online, compared with much smaller shares of adults under the age of 65."  There is also a correlation between education and the income of a household with being online.  There has been some movement. "For example, 86% of adults ages 65 and older did not go online in 2000; today that figure has fallen to just a quarter."  Think about this info and recall how important technology use became during COVID.

Webinar on Robocalls

DOJ's Elder Justice Initiative is offering this webinar, Tackling Transnational Robocall Scams: The Importance of State and Federal Partnerships  on April 13 at 2 eastern time. Here's info about the webinar

Consumers report losing approximately $500 million per year to phone scams. Phone scammers often impersonate government officials, such as officials with the Social Security Administration, FBI, IRS, and local law enforcement entities. This webinar will discuss what the scams are and how they work. It will delve into local and state law enforcement’s vital role in the fight against these scams. It will also describe investigative techniques that state and local law enforcement can use in the fight against transnational scammers. Finally, it will touch upon public education tools that can help community members protect themselves from scammers.  

Speakers:

Jolee Porter, Assistant US Attorney, Northern District of Georgia, currently detailed to the Transnational Elder Fraud Strike Force at the US DOJ Consumer Protection Branch

Senior Special Agent Jon Heslep, Office of Inspector General, Social Security Administration 

Detective Margaret Moore, Aiken Department of Public Safety, South Carolina

To register, click here.

Medicare's Care Compare

Remember those cool tools on Medicare.gov that allowed you to compare nursing homes, doctors, hospitals and more?  They are being retired as of the end of the year, and replaced with Medicare's Care Compare. All the info about the various services are there-but located on one page. It's easier since you can go to any of the 8 compare services from one landing page, rather than hunting for each one from the Medicare.gov website. Here's what CMS has to say about this new website:

We’ve combined our 8 original provider compare sites, giving you one place to start finding any type of care you need. New features include updated maps, new filters that help you identify the providers right for you, and a clean, consistent design that makes it easier to compare providers and find the information that’s most important to you.

. . .

What can this tool do for me?

For people with Medicare or their caregivers who want to choose a Medicare provider (like physicians, hospitals, nursing homes, and others), this tool provides a single source search and compare experience, that lets you:

• Find information about providers and facilities based on your individual needs
• Get helpful resources to choose your health care providers
• Make more informed decisions about where you get your health care

The information here should be used with other information you gather about providers and facilities in your area. In addition to reviewing the information here, you should talk to your doctor, social worker, or other health care providers when choosing a provider.

. . .

Although the tool was created for people with Medicare in mind, many of the measures shown here apply to people who may not have Medicare.

 

Robot Pets Combatting Isolation?

There have been lots of discussions about the impact of isolation necessitated by COVID, especially on elders.  We have previously written about robot pets, and now the New York Times has examined the role of these robots in lessening the impact of isolation during the pandemic:  In Isolating Times, Can Robo-Pets Provide Comfort?

Such devices first appeared in American nursing homes and residences for seniors several years ago. A Japanese company began distributing an animatronic baby seal called PARO in 2009, and Hasbro started marketing robotic cats in 2015.

But the isolation caused by the coronavirus, not only in facilities but also among seniors living alone in their homes, has intensified interest in these products and increased sales, company executives said. It has also led to more public money being used to purchase them.

The article discusses the adoption of the robots by various facilities, and then the interest individuals have shown in having the robots as their companions.

Of particular interest is the Joy for All brand sold by Ageless Innovation, a spinoff of Hasbro, and available from retailers like Walmart and Best Buy for about $120.

One of the largest studies, underwritten by United HealthCare and AARP, distributed free Joy for All robots to 271 seniors living independently.

All the seniors suffered from loneliness, according to a screening questionnaire. At 30 and 60 days, “there was improvement in their mental well-being, in sense of purpose and optimism,” said [the] chief medical officer of AARP’s business subsidiary and a study co-author. The study also found “a reduction in loneliness,” ... although the questionnaires showed that participants remained lonely.

Armed with such findings, Ageless Innovation has been offering discounted robots to state agencies working with seniors. (Both Joy for All and PARO robots can be sanitized to prevent viral transmission, the companies said.)

One Medicare Advantage plan covers them and Ageless Innovation is working to get other MA plans to also cover them. The article also discusses the views of fans and critics of the use of these robot pets. Of course, nothing beats human interaction!  What do you think?

Using Technology to Enhance Family Caregiving (and grieving)

The increasing use and sophistication of various  new technical products and remote platforms for monitoring patients and family members is profiled in this article from the New York Times.  I can remember when my very rudimentary way of checking daily on my Mom  was watching her yahoo email account to see whether there was a green oval to indicate she was typing!  Somewhere along the way, the ethical implications of monitoring other's online activity eliminated that option, and that makes sense. 

And speaking of technology, tomorrow is my first participation in an online memorial.  A Zoom send-off.  A another step in the brave new world of finding new ways to be together alone.  

 

 

 

ABA Commission Releases App on Mind Your Loved Ones

The ABA Commission on Law & Aging  has released their smart phone app, Mind Your Loved Ones (MYLO):

Mind Your Loved Ones, known as MYLO, is a mobile app that gives individuals the ability to store their own and their loved one’s critical medical information, health care directives, and other related data on their Apple or Android phones, iPads® or tablets. Users can send this information directly to health care providers (e.g. their doctors, hospitals, insurance companies, etc.), to their family members or trusted friends by email, fax, text, or print.

Whether away at college, in a retirement community or nursing home, traveling for work or leisure, MYLO has your information and documents, and those of your loved ones, accessible 24/7 with just a click.  That’s the power of MYLO–the perfect "just-in-case" app.

Here's some additional info about the app's capabilities:

With this app individuals can store on their smartphones their health care advance directives along with other key medical information-- such as medications, physician contacts, insurance information, medical notes, and any other material important to them. Loved ones whom the individual chooses can carry the same information on their phones. They don’t have to hunt for the information in their files or sign on to a web page to get it. There is no limit to the number of profiles that can be stored. Individuals and their loved ones will have immediate access to all the information if an event occurs when that information is needed, so that they can view it, email it, or fax it to whomever or wherever it is needed.

In the midst of this pandemic, having this info so easily accessible is definitely a plus.

Stay safe everyone!

APS and COVID-19

APS Technical Assistance Resource Center (APS-TARC) has unveiled a new web page on APS and COVID-19. Here's the explanation for the website: "The COVID-19 pandemic presents unique challenges for adult protective services professionals. Visits to clients' homes have been curtailed or eliminated in many areas and community services may be unavailable or reduced. This page details information about the effects of the pandemic on APS programs and additional information that may be helpful to APS professionals." The site includes resources and state responses, as well as other information on intake, investigations, post-investigations and quality assurance. Check it out.

More on Social Isolation and Elders During the Pandemic

Another article from Professor Naomi Cahn provides  Five Tips To Decrease Social Isolation For Older People During COVID-19. First, recognize "that approximately one-third of those 65 and older may have never used the internet and may not have internet access at home; among those who do use the internet, almost half need someone's help when it comes to setting up or using a new device.  And substantial differences in the adoption of technology adoption exist based on factors such as income and educational level."

First, most older adults do own a smartphone or have a desktop or tablet. That means that, even if they have not yet found youtube or figured out how to attend a Zoom’ed yoga class or even used Skype or Facetime, they have a digital device that will enable them to do so once they know what’s available on the web and once they have the appropriate hardware....

Second, using that device to stay connected then becomes a matter of finding the appropriate programs to do so. ....

Third, while much of going online may seem intuitive for many of us, that was not true at the beginning. As someone who has been both patiently walked through learning how to use Google hangouts, and as someone who has taught a family member how to use iMessage, I appreciate the importance of practice and of the patience of those teaching me.  ... 

Fourth, as older people go online, there is the risk of scams and fake information.  ....

Finally, for those who don’t have a smartphone or tablet, a landline remains a good way to stay connected. Family members can set up a schedule of who will call, and maybe, during those calls, even talk about connecting through the internet.