Act 169 at PBI's POA & HCD Course

Act 169 of 2006, regarding health care directives & surrogate decision-making, will be the focus of a portion of the "Power of Attorney and Health Care Directives - 2007" course offered by the Pennsylvania Bar Institute, at three locations in March, 2007. But this course is much broader than just Act 169. The course will also address general (durable) powers of attorney, mental health declarations & powers of attorney, and out-of-hospital "do-not-resuscitate" orders.

This POA/HCD Course (the "3-hour live course in March" referenced below) is one of the "Act 169 Practice Resources" presently offered by PBI on its home page:

Act 169 Practice Resources
	New law on health care powers of attorney (living wills and more), effective Jan. 29, 2007
PBI helps you get up to speed: From our popular Jan. 16 call-in CLE program Online course (includes "e-pub") "E-Pub" with form (available for immediate download at the 20% e-pub discount), or Hard copy of the materials, and the program on CD-ROM 3-hour live course in March Health Law Institute March 13-14 in Philadelphia

This course -- although a bit longer than three hours long, and with only about two months in the planning -- traces its PBI lineage, through its substantive materials, back to 1999.

This course will integrate, consolidate, update, & expand four past PBI presentations into one. Within the 418 pages of the completed course manual, there is much content.

Location -- This course will be held at the following three locations from 9:00 am to 12:15 pm:

• Monday, March 5, 2007 -- CLE Conference Center, Wanamaker Building, 10th Floor, Suite 1010, Philadelphia, PA
• Tuesday, March 13, 2007 -- PBI Conference Center, 5080 Ritter Road, Rossmoyne Exit, Rt. 15, Mechanicsburg, PA
• Thursday, March 29, 2007 -- [Change] Omni William Penn Hotel, 530 William Penn Place, Pittsburgh, PA

The course will be videotaped in Mechanicsburg for later online replay or individual video sale by PBI.

Speakers -- These are the presenters:

Aubrey H. Glover, Esq., Cohen & Grigsby, PC, Pittsburgh (Speaking in Mechanicsburg & Pittsburgh on POAs)

Mary Jo Baum, Esq., Brian R. Price & Associates, Chalfont (Speaking in Philadelphia on POAs)

Neil E. Hendershot, Esq.,, Goldberg Katzman, P.C., Harrisburg (Speaking in Philadelphia & Mechanicsburg on HCDs)

Barbara J. Holland, Esq., Governor's Office--Healthcare Reform, Harrisburg (Speaking in Pittsburgh on HCDs)

Dianne C. Magee, Esq., Grim, Biehn & Thatcher, P.C., Quakertown (Speaking in Philadelphia on POAs)

Harriet F. Withstandley, Esq., Chief Counsel, Pennsylvania Department of Aging, Harrisburg (Speaking in Mechanicsburg & Pittsburgh on HCDs)
Robert B. Wolf, Esq., Tener, Van Kirk, Wolf & Moore, Pittsburgh (Speaking in Pittsburgh on HCDs)

Materials -- The materials focus on three subject areas.

• General (durable) powers of attorney :
  
• "The materials of this topic are a combination of written materials originally provided by Neil E. Hendershot, Esquire, of Goldberg, Katzman, P.C., Harrisburg, for PBI’s 2000 publication, The Prudent Investor Act & Power of Attorney Act (Act 39,) and Mario Santilli, Jr., Esquire, of Cohen & Grigsby, P.C., Pittsburgh, for PBI’s 2001 publication, Drafting Powers of Attorney & Healthcare Directives. These materials were reviewed, consolidated, updated and supplemented for the Power of Attorney and Healthcare Directives 2007 edition by Aubrey H. Glover, Esquire, of Cohen & Grigsby, P.C., Pittsburgh, with the assistance of Nicole L. Phatak, Esquire, also of Cohen & Grigsby, P.C., Pittsburgh."
• An annotated general power of attorney model document is included.
  

• Health care directives & health care surrogate decision-making:
• Bob Wolf's Act 169 outline is reproduced from the January 16, 2007, "call-in" course.
• Additionally, I submitted a detailed Case Outline (18 pages) reviewing the key decisions in Quinlan, Cruzan, Fiore, Duran, & Schiavo. These cases established essential common law & constitutional law principles, which now frame Act 169. These principles remain crucial to an understanding of Act 169, because the new statute specifically did not alter the holding of Fiore.
• I also submitted "Questions & Answers on Act 169" (28 pages), based on many of the practical, insightful questions submitted during the Act 169 Call-In Course or on PBA listservs.
• We reproduced the fine "Guide to Act 169", published by the Pennsylvania Medical Society.
• We included the recently-updated, newly-posted PA Department of Health DNR explanations.

• Mental health Declarations & Powers of Attorney:
• We reproduced my annotation (June, 2005) of Chapter 58 (Act 194 of 2004) regarding stand-alone "Mental Health Declarations" and "Mental Health Powers of Attorney", which now can (& should) be compared with the more refined provisions (& protections) in Act 169 of 2006.

More information about the course and online registration are available from PBI here.

I predict that the course manual will become the definitive reference on the subject matter for the next few years.

* * *

Update: 03/06/07:

The course in Philadelphia was attended by 280 people, of whom approximately 90% were attorneys. Feedback from PBI and attendees was positive. Many noted the book as a comprehensive & current reference.

I spoke for a total of two hours on the Mental Health Power of Attorney and on Act 169 (regarding Health Care Directives in all their forms).

I continued to refer to the website, PA HealthCare DecisionMaking, urging continued learning about Health Care Directives in Pennsylvania beyond the end of the half-day course. That site is available for browsing by anyone.

Various questions were submitted by participants as to Act 169. I agreed to post answers to those questions on that website in the near future. When I do, I'll note it on this blog.

Update: 03/13/07:

The course in Harrisburg was attended by 204 people.

Harriett Withstandley (Chief Counsel, PA Department of Aging) & I navigated through the Health Care Directive portion of the material using PowerPoint slides for two hours before an attentive audience.

A printed copy of those slides will be distributed with the audio (CD) and video (DVD) packaging of this presentation (which will include the 418-page book & all handouts), to be offered after production by PBI on its website.

Any attendee at the Philadelphia or Mechanicsburg sessions is entitled to receive a copy too. Just send a request to me or to Sabina McCarthy at PBI (SMcCarthy@pbi.org), and we would reply with an email attachment (in PDF format) of the handouts.

We also distributed Bob Wolf's Commentary on Act 169, entitled "Be An Agent". That article is now posted in full on this blog. See: Bob Wolf: "Be An Agent" (Part I) (03/14/07), and Bob Wolf: "Be An Agent" (Part II) (03/14/07).

The final live presentation of this course will be held on Thursday, March 29, 2007, in Pittsburgh. Due to overwhelming pre-registration, the location was moved to accommodate attendance in excess of 200. So you can still register, or even "drop in" on the day of the presentation. Just go to the right place: the Omni William Penn Hotel, 530 William Penn Place, Pittsburgh, PA.

Elder Abuse & Fraud in Atrium & Elsewhere

Recent news reports highlight that -- even though rarely reported in the media -- nursing home fraud and neglect of care-dependent residents do occur within institutions in Pennsylvania. When law enforcement officials discover serious violations, perpetrators sometimes are pursued criminally. The process, however, is long-term and time-consuming.

In western Pennsylvania, a widely-reported prosecution by the United States Attorney's Office in Federal District Court recently ended with the sentencing of a former nursing home operator, Martha Bell, 60, to a five-year term. The fraud occurred between 1999 and 2003, while Bell acted as administrator of the Ronald Reagan Atrium I Nursing & Rehabilitation Center, in suburban Robinson Township.

The prosecution alleged that Atrium I provided sub-standard care to its residents, while its administrator ordered falsification of records and expended $88,000 in charges on nursing home credit cards, including 1,400 meals at restaurants. The prosecutors further asserted that the altered records and fraudulent charges bilked the Medicare & Medicaid government programs out of $8 million.

Neglect of the residents at the home began sometime after 1996, according to witnesses, but increased in 2001. See: "Witness: Atrium Nursing Home Poorly Staffed", published January 31, 2007, in the Pittsburgh Post-Gazette. According to witnesses, the Home's Administrator then told workers to alter records, covering up the shortcomings. See: "Bell told workers to 'fix' records", published July 20, 2005, in that newspaper.

At the federal trial, which concluded in August 2005, Bell was convicted on one count of health care fraud and eight counts of making false statements. See: "Former Nursing Home Administrator Found Guilty", dated August 23, 2005, by KDKA-TV in Pittsburgh.

Prosecutors then sought a harsh sentence, as indicated in a news report, "Atrium nursing home founder given 5 years in jail for fraud", by Jason Cato, published in the Pittsburgh Tribune-Review, on October 28, 2006.

Assistant U.S. Attorney Leo Dillon said this case did not involve a typical white-collar crime, where only money was lost.

"People were hurt. People were seriously hurt," Dillon said. One patient suffered a broken hip after being assaulted by a staff member, he said. Others were not fed, bathed or given medication.

Mabel Taylor, 88, was found dead in October 2001 after she apparently wandered undetected into a courtyard and died from cardiac arrest. The temperature that night was in the 40s, and the coroner's office ruled exposure was a probable factor.

The U. S. Department of Justice and the Federal Bureau of Investigation together issued a press release, dated October 27, 2006, announcing the result in the case. See: "Former Nursing Home Administrator Sentenced to Five Years in Prison for Fraud Scheme".

The worst of the abuses at the Atrium I facility involved the death of resident Mabel Taylor, 88, in October, 2001, due to exposure when she wandered away unsupervised in cold weather. Allegheny County prosecutors alleged that Bell conspired to cover-up the death -- by ordering employees to bring her body back inside to make it appear as though she died in her sleep.

However, the incident resulted in investigations beginning in September 2002, and then the filing of separate criminal charges, based on Pennsylvania's "Neglect of Care-Dependent Person" law. It is found in Title 18 (Crimes & Offenses), in Section 2713.

A prosecutor in Allegheny County commented on the seriousness of such state crimes, in an article published on January 7, 2007, "Jury selection begins in nursing home death".

District Attorney Stephen A. Zappala Jr. said the case has prompted him to focus more on abuse of the elderly. He hopes to have a special squad focusing on health care fraud and elderly abuse consisting of assistant district attorneys, accountants and help from county police detectives.

"This particular case gave a snapshot of the bureaucracy involving senior agencies," Zappala said. "It's clear Allegheny County should be doing more in this area."

Taylor's daughter, Jane Baczewski, 60, of Hopewell, Beaver County, said she's glad the trial is starting.

"But in the public interest, I think it's good so much time has passed because it's making people aware and keeping the pressure on administrators of other homes and the state to inspect them," Baczewski said.

Bell was schedule to report to authorities last week to begin her federal sentence, even while the other (state) proceeding continued. But, that was forestalled for five days due to her medical complaints. See: "Hospital stay delays prison for nursing home boss", published February 24, 2007, by Paula Reed Ward, of the Pittsburgh Post-Gazette.

That case may be nearly over, but another just began.

Separately, in Chester County, it was reported on February 14, 2007, that the former nursing director of an assisted-living facility was accused of neglecting a patient's head wound for so long that it filled with maggots, and of trying to conceal the poor care by altering records. See: "Neglect Charged at Pa. Nursing Home", posted on February 14, 2007, by Federal News Radio:

Authorities on Tuesday charged Donna Marie Cameron, 39, of Aston, with criminal neglect, perjury and tampering with records at St. James Retirement and Rehabilitation Center in Chester, a Philadelphia suburb.

State regulators shut down the facility last year, citing unsanitary conditions and alleged mistreatment of patients.

According to prosecutors, Cameron neglected a deep head wound suffered by a 72-year-old patient in June. In September, the woman was taken to a hospital emergency room where nurses found more than 50 maggots in the wound.

The woman recovered and now lives in another assisted-living home.

Cameron tried to hide the neglect by altering medical charts to falsely state that workers had treated the wound with antibiotic ointment and changed dressings, authorities said.

See also: Press Release, "Attorney General Corbett announces arrest of three Delaware County women in Elder Abuse case", dated February 13, 2007. In the AG's press release, charges were outlined:

Cameron is charged with one count each for neglect of a care dependent person, false swearing, and perjury, and two counts each for tampering with or fabricating physical evidence, tampering with public records, tampering with records, and unsworn falsification.

Curtis is charged with one count each of false swearing, perjury, and tampering with records; three counts each of tampering with or fabricating physical evidence and tamperingwith public records; and two counts of unsworn falsification.

Tribbey is charged with one count each of false swearing, perjury, tampering with or fabricating physical evidence, tampering with records, and unsworn falsification.

In Pennsylvania, reports of suspected health care fraud, as described here, can be made to Medicaid Fraud Control Section of the Attorney General's Office at one of its regional offices.

Reports of suspected elder abuse, as described here, can be made to the Elder Abuse Unit of the Attorney General's Office, which supports Pennsylvania's Elder Abuse Hotline (1-800-490-8505) and the Department of Aging's protective services.

* * *

Update: 02/27/07:

After posting, I noticed on the website of the Pennsylvania Bar Institute this month's free offering of an "Online CLE Course". The subject: "Understanding the Basics of Fraud and Abuse in the Health Care Industry" (PBI No. 4634, with materials 68 Pages, 566 KB, PDF). You can view the Table of Contents here (107 KB, PDF).

Update: 03/01/07:

See: "Phila. Inquirer's 'Shame of the State' Investigation", posted March 1, 2007, on this blog.

Update: 03/09/07:

For a development in the Attrium I case, see: "Atrium supervisor pleads guilty to coverup", by Cindi Lash, published in the Pittsburgh Post Gazette on March 9, 2007:

A former nursing supervisor at the defunct Ronald Reagan Atrium I Nursing, Research and Rehabilitation Center has pleaded guilty to several charges stemming from an attempt to cover up how a resident died in 2001.

Kathryn Galati, 61, of the North Side, this week pleaded guilty before Common Pleas Judge David R. Cashman to one count each of perjury, false swearing, conspiracy and tampering with evidence. Three other counts of perjury and false swearing and one count of tampering with evidence were dropped.

Ms. Galati will be sentenced June 5. She was the supervisor on duty on Oct. 26, 2001 when Atrium resident Mabel Taylor, 88, died after she was trapped overnight in an outdoor courtyard at the former nursing and personal care home in Robinson. * * *

Update: 06/09/08:

For an update on these matters, see "Conviction of former Robinson nursing home operator upheld", by Jason Cato, published by the Pittsburgh Tribune-Review on June 6, 2008.

A federal appeals court today upheld the conviction of the former administrator of a defunct Robinson nursing home on one count of health-care fraud and eight counts of making false statements on health-care matters.

Martha Ann Bell, 62, formerly of West Mifflin, was found guilty in August 2005. U.S. District Judge Terrence F. McVerry sentenced Bell in October 2006 to five years in prison.

Bell operated the Ronald Reagan Atrium I Nursing and Rehabiliation Center on Campbell's Run Road. Nursing home employees doctored records in order to receive Medicaid and Medicare payments for treatment that was never rendered.

Bell is scheduled for release in 2011, according to the U.S. Bureau of Prisons.

Bell is being held at the Allegheny County Jail pending an upcoming theft trial in state court, where she will face charges that she stole more than $50,000 from an Atrium account for her personal use.

Bell's lawyer, Thomas N. Farrell, said he might ask the U.S. Supreme Court to review today's decision by the 3rd U.S. Circuit Court of Appeals in Philadelphia. * * *

Philly's "Coming of Age" Profiles & Project

The February, 2007, issue of the Newsletter (No. 16) distributed by the Pennsylvania Department of Aging and the Pennsylvania Secretary of Aging, Nora Dowd Eisenhower, contains a brief article about the "The Coming of Age" initiative.

This multi-media educational venture has promoted the accomplishment of seniors (50+) in the greater Philadelphia area for their civic engagement, learning, and community leadership.

[The initiative] is now an award winning project. WHYY TV-12 of Philadelphia produced a series of video profiles for the Coming of Age program that feature Pennsylvanians over 50 who have taken a creative approach to the second half of life.

The videos were honored with the Gold Award at the 15th Annual National Mature Media Awards, the nation’s largest award program recognizing the best advertising, marketing and educational materials for older adults. In addition, the Coming of Age video profiles were nominated for a Mid-Atlantic Emmy.

Coming of Age is a joint partnership among the Pennsylvania Department of Aging, Temple University's Center for Intergenerational Learning, WHYY Wider Horizons, AARP Pennsylvania, and the United Way of Southeastern Pennsylvania, with financial support by those organizations, Verizon, and many individuals.

To appreciate in what ways the prior media "initiative" has become a full-service, regional "project", visit the Coming of Age website, and see what now is offered. It is now a complete resource center for seniors in southeastern Pennsylvania, with a mission statement (PDF).

The Coming of Age website posts seniors' stories, suggests work opportunities, promotes learning sessions, provides working tools, and even responds to individual's questions submitted by email.

It also indexes web links relevant to concerns of seniors:

• Caregiving
• Health
• Financial planning
• Aging services
• Creating community
• Spirituality
• Housing

On that site, you could subscribe to its emailed announcements regarding events scheduled or profiles published.

This is a resource that can benefit more than just the residents of eastern Pennsylvania. Check it out.

Update: 01/28/08:

The successful "Coming of Age" model will be duplicated and exported into other regions of this country. See: PA EE&F Law Blog posting "Coming of Age" in PA to be Replicated (01/28/08).

PA's "2020 VISION" Project: Part II

The "2020 Vision" Project, currently underway in the administration of Governor Edward G. Rendell, carries a name that is just a bit misleading. The true meaning of the project relates to perceiving the likely needs of Pennsylvania's population in the target year 2020, so that adequate services can be designed before then to meet those needs. See: PA's "2020 VISION" Project: Part I (EE&F Law Blog, 02/22/07).

But, to most people, the term "20/20", suggests the quality of one's eyesight as clear and reliable. This is an explanation from HowStuffWorks online:

"If you have 20/20 vision, it means that when you stand 20 feet away from the [eye] chart you can see what the 'normal' human being can see. In other words, if you have 20/20 vision your vision is "normal" -- a majority of people in the population can see what you see at 20 feet."

There are very few "normal" people who can clearly see what the year 2020 will bring, much less how state government could encourage or design policies, services, facilities, finances, and other resources to meet those future needs.

The 2020 Vision Project began with issuance by the Governor on June 16, 2006, of Executive Order No. 2006-04. It opened with a statement of the problem:

WHEREAS, the generation of Americans born between 1946 and 1964, commonly referred to as the "Baby Boomer" generation, has had a significant impact on social and civic institutions; and

WHEREAS, the "Baby Boomer" generation begins to turn age 60 this year and nears retirement; Pennsylvania currently ranks third in the nation in the percentage of people age 65 and older; and, by the year 2020, one in every four (4) Pennsylvanians will be 60 or older; and

WHEREAS, Pennsylvania also ranks fourth among states in the number of people age 85 and older, a number that is projected to increase by more than 40 percent by 2020, presenting major challenges to the Commonwealth; and

WHEREAS, by 2020, the number of Pennsylvanians age 65 and older will equal the number of children under age 15; the oldest of the "Baby Boomer" generation will be age 74; and

WHEREAS, the Commonwealth is on the leading edge of another historic era that has significant implications for state government over the next decade and a half, requiring all government agencies, commissions, and departments to consider the demands and opportunities that will result from demographic forces; and

WHEREAS, the Governor recently established the Long Term Living Council to lead reform efforts of the Commonwealth's long term living system and to assure the accountability of designated agencies for their assigned powers, duties, and responsibilities in support of this effort; and

WHEREAS, the Pennsylvania Department of Aging was established for the advancement of the well-being of older Pennsylvanians, the coordination of the Commonwealth's programs and promotion of efficient delivery of services to this group, and to encourage their involvement in social, economic, and political affairs, which makes the Department of Aging uniquely positioned to coordinate policy development and planning for the impact of the "Baby Boomer" generation on the institutions of state government.

To face the challenges, the Governor established the Pennsylvania "2020 Vision" Project:

The purpose of this project will be to facilitate the development of a Commonwealth-wide, multi-agency strategic response to the anticipated dramatic growth in the state's older population through the year 2020. All agencies and departments under the Governor's jurisdiction will participate in the planning in response to the approaching challenges and opportunities presented by this demographic change.

These are the objectives of the 2020 Vision Project:

The Pennsylvania 2020 Vision Project shall evaluate the impact that the growth in Pennsylvania's older population is expected to have on the programs and services of state government by identifying strategies for addressing the demands that this growth will place on existing programs, the need for new or expanded programs and services, and the resources that will be necessary to allow state government to address the demand for these programs and services.

The project shall also evaluate the impact of this aging population on the economy, workforce, and tax base and on the social service, health care, and public infrastructure of the Commonwealth. The Secretary of Aging shall head the project.

Long-term plans are commonplace for PennDOT in its planning for transportation facilities. A 14-year plan is unusual for the whole of state government in its planning for human resources. It does appear necessary.

The Pennsylvania Department of Aging was designated to lead and coordinate the effort. The Governor's Executive Order directed other state departments and agencies to participate and cooperate, upon request.

This is how the Department of Aging was directed to function for the 2020 Vision Project:

• Conduct demographic analyses, as necessary to facilitate discussions and planning for population changes, as part of the Pennsylvania 2020 Vision Project;
• Convene work group meetings, made up of selected agency representatives and outside organizations and individuals to be named by the Secretary of Aging, to develop work plans and formats for a final Pennsylvania 2020 Vision Project response plan;
• Coordinate Pennsylvania 2020 Vision Project activities with other agencies under the Governor's jurisdiction;
  
• Deliver a final Pennsylvania 2020 Vision Project response plan to the Governor and the Long Term Living Council;
• Based on this response plan, pursue follow-up activities and disseminate project results, so that agencies under the Governor's jurisdiction can be prepared to effectively respond to coming demographic changes; and
• Provide such resources as may be necessary to complete the work of the project, including the hiring of outside consultants and staff.

The original Executive Order, dated June 16, 2006, is found within a Press Release, dated June 22, 2006, entitled "Governor Rendell Directs State to Prepare to Serve Larger Population of Older Adults".

An amended Executive Order, dated December 30, 2006, extended the original order beyond its original expiration of December 31, 2006. The Amended Executive Order, and the "2020 Vision" Project, both will expire on June 30, 2007.

The website of the Pennsylvania Department of Aging maintains a series of pages regarding the "2020 Vision" Project. I reproduce the current links below:

PA 2020 Vision Project

What is PA 2020? To find out more, click here to view the Lifestate Matrix 2020 Vision Presentation.

Click on a link below to access the PA 2020 Vision Project Manual or Agency Template:

• Manual for the PA 2020 Vision Project
• 2020 Vision Agency Template

2020 Trends and Projections in Pennsylvania and Nationwide:

• Aging
• Demographic Projections
• Economics
• Education
• Health and Long Term Care
• Technology, Environmental and Rural
• Transportation
• Workforce

The Presentation offers an excellent overview of the "2020 Vision" Project, by paid consultants. The key points are outlined in crisp text, with many clever graphics & photos (a few are even provacative), and some colorful, fancy charts plotting statistics.

But I must warn you that the link for the "Lifestate Matrix 2020 Vision Presentation" will lead you to a 36 MB PowerPoint file.

I would not try downloading that sized file at home on a 56K telephone modem. You might not be done until 2020, when the presentation already would be moot.

The "2020 Vision" Project Report should be issued sometime after June 30, 2007. Likely its findings will influence much state policy and legislation over the next ten years.

* * *

PA's "2020 VISION" Project: Part I

It is often repeated that "Pennsylvania has the third highest senior population in the United States, behind Florida and West Virginia". This ranking is based on the last available United States Census Bureau data, stated as of April 1, 2000.

According to the 2000 Census, Pennsylvania has the third highest percentage of people over the age of 65 in the nation (15.6%). Twenty percent (19.8%) is aged 60 and older. By the year 2020, Pennsylvania's 60 and older population is expected to number more than 3 million people -- 25% of the Commonwealth's population.

Such statistics have been cited in presentations by a federal EPA Regional Administrator in April, 2003 in addressing environmental concerns affecting the elderly in the Pittsburgh area, by the Pennsylvania Housing Finance Agency in 2006 in making a health in housing program award, by the Pennsylvania Attorney General in August, 2006 in announcing creation of an "Elder Abuse Task Force", and by the Governor and the Secretary of Aging in October, 2006 in announcing grants to senior centers, among many others.

Let's look at some 2000 Census figures for Pennsylvania, according to the U.S. Census Bureau's "People QuickFacts" on the Commonwealth:

People QuickFacts	Pennsylvania	USA
Population, 2005 estimate	12,429,616	296,410,404
Population, percent change, April 1, 2000 to July 1, 2005	1.2%	5.3%
Population, 2000	12,281,054	281,421,906
Persons under 5 years old, percent, 2005	5.8%	6.8%
Persons under 18 years old, percent, 2005	22.7%	24.8%
Persons 65 years old and over, percent, 2005	15.2%	12.4%

This summary is further parsed into more defined age groups in the U.S. Census Bureau's "Quick Tables" on the Commonwealth.

Graphically, the 2000 census data was plotted for individual Pennsylvania's counties in a "Pennsylvania Age 65 Plus Thematic Census Map", posted 03/23/2006, which is copied above. The map shows the percentage of households with someone age 65+ (a lighter color indicates a lesser percentage, a darker color indicates a higher percentage).

Statistically, the youngest population in Pennsylvania is in Centre County -- Pennsylvania's "Happy Valley".

National trends in aging of the population have been the subject of analysis and projections. See: "The Elderly Population", by Frank B. Hobbs, of the Age and Sex Statistics Branch (01/18/01). See also: "Statistical Brief: Sixty-Five Plus in the United States", posted by the Census Bureau from the Economics and Statistics Administration, of the U.S. Department of Commerce (May, 1995).

Other states might catch up with Pennsylvania's ratio of seniors in the population, or even exceed it soon. And even the ratios within Pennsylvania counties likely will change due to current trends not fully developed in 2000. See: "Young leaders step up as aging population slows", by Andrew Conte, of the Pittsburgh Tribune-Review (11/12/06), which notes, in part:

Through 2030, Pennsylvania is projected to have the slowest growth in seniors of any state, with the number of people older than 65 increasing by just slightly more than half.

Second only to Florida with its percentage of seniors in 2000, Pennsylvania will drop out of the top 10 over the next quarter-century, according to census projections.

Sun Belt states already popular with retirees could see their senior populations double or even triple. Even Florida can expect its number of seniors to grow by 176 percent.

Nevertheless, data projections for Pennsylvania predict that, in the year 2020, one-quarter of our population is anticipated to be aged 65 or older. The Governor's administration took these projections seriously, and, in June, 2006, the Governor proclaimed an administration-wide, short-term "2020 Vision" project.

It is in process now. It is mandated to produce a report by June 30, 2007. I'll review it in Part II.

* * *

Update: 02/23/07:

For Part II of this posting, see: PA's "2020 VISION" Project: Part II (EE&F Law Blog, 02/23/07).

Atty Blattmachr to Speak at EPC on Feb 27th

The Central Pennsylvania Estate Planning Council will host a session on Tuesday, February 27, 2007, with nationally-known attorney Jonathan G. Blattmachr, Esq., who will speak on the topic "Estate Planning for Middle Class Married Clients". The session is underwritten in part by The Hershey Trust Company.

Mr. Blattmachr will appear through the courtesy of the National Association of Estate Planners and Councils, of which CP EPC is a long-time, organizational member.

Mr. Blattmachr's credentials & accomplishments are impressive, and his influence in the estate planning field is extensive. He is a graduate of Bucknell University and Columbia University School of Law. He is a partner at Milbank, Tweed, Hadley & McCloy, in New York City.

Jonathan Blattmachr’s practice involves estate and gift tax planning, tax exempt organizations and estate and trust administration. He is recognized as one of the most creative trusts and estates lawyers in the country and is listed in the Best Lawyers in America. He was listed in 1985, before he was 40 years old, as among the best 250 lawyers in the country and has been listed as one of the best 50 lawyers in New York. He has written and lectured extensively on estate and trust taxation and charitable giving. He currently serves as chair of the Milbank Trusts and Estates Department.

He is a member of the Alaska, California, and New York Bars. He served as a lecturer-in-law of the Columbia University School of Law, and is an Adjunct Professor of Law at New York University Law School in its masters in Tax Program. He is a former Chairperson of the Trusts & Estates Law Section of the New York State Bar Association and the American Bar Association.

He authored a book, entitled The Complete Guide to Wealth Preservation and Estate Planning, published by Regnery Publications, Inc.

[This book] is a comprehensive treatise dealing with a broad spectrum of financial issues of critical importance to business owners. The Guide discusses (in layman's language) tax and non-tax aspects of accumulation, preservation and disposition of assets by and between family members and others. * * *

Written by top estate planning expert Jonathan Balttmachr, the Guide shares personal experiences and observations that help identify and address estate, business succession and wealth management issues. It sets out an excellent and persuasive plan of action for concerned business owners who want their heirs -- not the government -- to inherit their estates.

Get answers to many everyday questions you encounter from your clients:

• When is a will needed?
• Should probate be avoided?
• Should I acquire life insurance?
• How can I save on estate related taxes?

The CP EPC session is described in a promotional brochure that has been distributed widely to the membership of various other estate planning councils in mid-Pennsylvania (listed in the sidebar of this Blog). The session is open to members of an estate planning council, and non-members, alike.

The presentation is described as follows:

Come learn more about:

• How big is the Formula Marital Deduction if there is no Marital Deduction?
• Carryover Basis Matters,
• Ways to Structure the Marital Bequest,
• And Much More!

This session is billed as CP EPC's "6th Annual Hors D’oeuvres Social". It will be held at the West Shore County Club, 100 Brentwater Road, Camp Hill, PA (off Rt. 15 in the Harrisburg area's "west shore").

The schedule is as follows:

• 5:00 p.m. – 6:30 p.m. -- Networking & Heavy Hors D’oeuvres
• 6:30 p.m. – 8:00 p.m. -- Program, with Mr. Blattmachr

Continuing education credit is available to participants, including 1.5 PA Insurance Credits, 1.5 CFP® Credits, 1.5 Attorney (CLE) Credits, or 1.5 CTFA (Trust) Credits, if one attends the entire program.

Cost for the program is $45.00 for an estate planning council member, and $65.00 for a non-member. After February 22, 2007, a $10 late registration charge must be applied.

For further information, contact Melissa Goulet, CP EPC Administrator, at 717-258-4844, or by e-mail (mag.goulet@comcast.net).

You can register by completing & then delivering to her a downloadable form, available here.

This is a rare opportunity in Central Pennsylvania. I'm going. Hope you can too.

"The Caregivers" Series & Naomi Judd on CBS News

The Gerontological Society of America circulated an email message announcing that the CBS network will broadcast a three-part series on television entitled "The Caregivers", which will address the struggles of helping aging parents.

Segments will be broadcast during CBS Evening News with Katie Couric, on February 19 (Mon), 20 (Tue), & 21 (Wed), 2007, sometime after 6:30 EST pm each evening.

"The Caregivers" . . . looks at issues confronting the so-called sandwich generation as they struggle to help their aging parents. The series will look not only at some of the problems – from high costs to sibling conflict over care – but check out some innovative solutions as well.

This will air Monday, Tuesday and Wednesday (February 19th, 20th, and 21st) * * * at 6:30 PM ET on CBS. Please check the CBS website on Monday for more information and links related to this subject, as well as the pieces themselves for those who can’t tune in.

CBS News has broadcast various segments over the past years about senior-related topics:

• "Caring For Aging Parents" -- Authors Discuss How To Broach The Topic, Share The Burden (04/25/05).
• Synopsis: "Millions of Americans learned to care for their aging parents through trial and error, often without much-needed support from relatives and friends. Hugh Delehanty and Elinor Ginzler offer plenty of advice for people in this growing situation in the new book, "Caring For Your Parents: The Complete AARP Guide." Delehanty says it not just a how-to-do book, but also a "how-to-think" book about care-giving."

• "Elderly Struggle With Debt" -- Growing Number Of Seniors In Bankruptcy Court (07/22/04).
• Synopsis: "Did you know credit card debt among seniors age 65 and over has increased 89 percent to $4,041 between 1992 and 2001. According to several published reports, ordinary older Americans are having trouble making ends meet. The Early Show financial adviser Ray Martin offers suggestions on how deal with debt issues and how to avoid them before it is too late."

• "Dying On Life Support: Is It Fair?" -- Should Doctors Prolong Lives Artificially When The End Is Near? (06/23/04).
• Synopsis: "Because people are living longer and doctors can prolong lives artificially when the end is near, hospital beds are filling up with elderly patients with no hope of recovery and no choice to avoid painful treatment. It is becoming such a serious national problem that physicians at one of the biggest and best hospitals in America – Bellevue Hospital in New York City - have decided to speak out."

• "Burdened By Retirees And Kids" -- Tips For Adult Children To Protect Themselves From Parents In Financial Holes (07/19/03).
• Synopsis: "There's no question that reduced interest rates and retirement funds lost to the bear market have hurt seniors. But these developments are also hitting the pocketbook of another group — the children of retirees. More adult children are finding themselves helping their parents make ends meet. Financial advisor Ray Martin gave some tips for adult children on The Saturday Early Show on how to help their parents without hurting their own financial future."

But, according to another CBS News broadcast recently aired, the "boomer" generation should think positively about the challenges of aging. See: "Naomi Judd Says "Age Gratefully" (Interview, 01/24/07). "Country singer Naomi Judd's book, "Naomi's Guide To Aging Gratefully: Facts, Myths, And Good News For Boomers," encourages baby boomers to embrace aging and appreciate themselves."

Experts predict that the baby boomers will change what it means to be old. Country legend Naomi Judd is already doing her part with her book, "Naomi's Guide To Aging Gratefully: Facts, Myths, And Good News For Boomers."

Judd, a cancer survivor and six-time Grammy winner, said her experiences have made her realize the importance of gratitude.

"It's that old thing about when you can't control the way things are, you know, we can't control our circumstances. But the good news is we get to control our reaction to our circumstances," she told The Early Show co-anchor Hannah Storm. "Change is inevitable, aging is inevitable."

Judd said her book is full of cutting edge research that tells people how to live 15 years longer and how to change your attitude about growing older. She said people can live 7 1/2 years longer simply by adjusting their attitude.

According to information posted by the book's publisher, Simon & Schulster:

"Freedom is the focus, and there's no better time than now to free yourself from untrue and outdated ideas about your own potential. Naomi is full of fresh ideas to help readers look at their futures in a whole new way. The aging process, as Naomi shows, is an opportunity for new experiences, original routines, and more contentment than ever before."

So, a "boomer", who is also a "caregiver" to another, should adopt a positive view of aging, and then search for innovative solutions to improve the situation.

"End-of-Life" Lecture at Allegheny College on Feb. 21st

On February 13, 2007, Allegheny College, in Meadville, PA, announced that its annual "Lehman Medical Ethics Lecture Series", will focus on "End-of-Life Decisions". The speaker will be bioethicist Stuart Youngner, M.D.

His lecture, entitled “End-of-Life Decisions: The Illusion of Control and the Sense of Responsibility”, will be presented on Wednesday, February 21, 2007, beginning at 7:30 p.m., in the Quigley Auditorium at Allegheny College. The event is free and open to the public.

The College's Press Announcement tells about the speaker:

An internationally recognized scholar in biomedical ethics, Youngner teaches at Case Western Reserve University, where he is the Susan E. Watson Professor and chairman of the department of bioethics. He serves on the editorial advisory boards of the “Journal of Medicine and Philosophy,” the “Kennedy Institute of Ethics Journal” and the “Journal of Law, Medicine, and Ethics.” He has been elected a fellow of the Hastings Center and the American Psychiatric Association and has been certified by the American Board of Psychiatry and Neurology.

Youngner has served as a consultant to the U.S. Congress Office of Technology Assessment, the Robert Wood Johnson Foundation, the Institute of Medicine and the Pontifical Academy of Sciences. He has served as president of the Society for Bioethics Consultation and is a founding member of the board of directors of the American Society for Bioethics and Humanities. He co-directed a national task force that examined the need for standards for ethics committees and clinical ethics consultation and is the chair of the ethics committee of the Musculoskeletal Foundation.

Youngner has published over 90 articles in peer-reviewed scholarly journals and is the editor or coeditor of eight books, including “The Definition of Death: Contemporary Controversies” and “Transplanting Human Tissue: Ethics, Policy and Practice.”

The Lehman Medical Ethics Lecture Series is made possible by a gift from Allegheny College alumnus and retired orthopedic surgeon John W. Lehman, M.D. (1954), and his wife, Deborah.

For more information about the presentation, contact Kirsten Peterson at 814-332-2845.

PA AG Polices Charitable Trusts & Organizations

According to two recent newspaper reports, the Pennsylvania Attorney General's Office, through its Charitable Trusts & Organizations Section, is exercising its review and intercessory powers over the administration of charitable funds in response to actions taken, or proposed to be taken, by trustees or directors.

Regarding a case of alleged trustee abuse, an article appeared on January 26, 2007, in the Times Tribune here, and in The Citizen's Voice, entitled "Attorney general pursues removal of trust overseers", by Dave Janoski. It reported, in part, as follows:

The trustees of a charitable trust created by the late labor leader Anthony F. Kane Jr. should be removed, state attorneys say, for lending most of the trust’s money to a business partner and friend of one of the trustees.

The state attorney general’s office, in a petition filed Wednesday, asked Luzerne County Orphans’ Court Judge Michael Conahan to strip control of the trust from Gloria Bartnicki Riegel and her husband, Joel Riegel.

Reading the newspaper report, the removal request in this case is founded upon past actions taken by the individual trustees alleged to benefit their self-interests, not the charitable beneficiary. Furthermore, expenditures for fees and commissions also are questioned by the Attorney General's Office:

Kane, a widower with no children, directed that about $730,000 be placed in a trust, with investment and interest income going to the United Way of Wyoming Valley.

In 2005, the United Way and the state attorney general’s office challenged the Riegels’ handling of the trust in Orphans’ Court, questioning fees paid to lawyers, commissions paid to the trustees and investments in mortgages, which, they said, violated state laws governing investments by non-profits.

Since then, the three parties have been entangled in legal arguments over whether the Riegels should be required to reveal the details of those mortgages, including the identities of the borrowers.

Last week, responding to an order from Conahan, the Riegels supplied information on the loans to the attorney general’s office.

State attorneys, in their petition, claim that about three-quarters of the trust’s money, more than $588,000, was loaned to Kathryn Cubillo, described as the “best friend” and business partner of Gloria Bartnicki Riegel. * * *

The Riegels have “committed a serious breach of the trust,” the petition argues and their removal is “in the best interest of the beneficiary of the trust,” that is, the United Way.

Regarding a case of already-committed use of charitable reserve funds, an article appeared on February 1, 2007, in the Delaware County Times entitled "Judge permits SPCA’s plan to withdraw $4.2M from fund", by Kathleen E. Carey.

Delaware County Common Pleas Court President Judge Edward Zetusky Friday ruled that the Delaware County SPCA could use $4.2 million of its reserve fund to pay off some of its bills, but mostly to finance a renovation and expansion of the Upper Providence facility.

Board members had been trying since last summer to use the funds to make substantial changes, but confronted another obstacle when a legal challenge arose. After the SPCA withdrew money in May, its auditor notified the state Attorney General’s office, which took issue with the move.

A petition was filed in Delaware County Orphans Court and the case was heard before Zetusky Jan. 24. On Friday, Zetusky signed the order allowing the SPCA to use the $4.2 million from the $9.4 million fund, comprised of bequeaths dating back to the 1950s. "It will help us do our work better," new SPCA board President Ann Morris said.

An auditor for the SPCA had notified the board that court approval was needed to withdraw money from its reserve fund. The SPCA notified the Attorney General’s Office about the needed, substantial withdrawal from its reserve funds. But the PA AG's Office objected.

Thereafter, the SPCA sent a petition to the Delaware County Orphans Court in December, asking for permission to withdraw $4,211,000 for the reserve fund.

To prove intent, the SPCA had to craft a 22-page business plan -- penned mostly by Beeman -- outlining what they planned to do with the money and by when.

"The case we were making to the Orphans Court is, ‘Times have changed and we need this money to make serious infrastructure improvements,’" he said.

Beeman took the stand Jan. 24 in Delaware County Court of Common Pleas for an hour and a half, as he laid out the SPCA’s plans.

"Judge Zetusky needed some convincing that this organization was getting on the right track," Beeman said. "The huge chunk of the money from this reserve fund is for the renovation and expansion of the shelter."

The article was quoting SPCA board Vice President Rick Beeman regarding the entire Orphans Court matter. He also said, "I don’t understand how this came to be a matter of contention." However, he did not fault the auditor or the Attorney General’s office, which did not contest the petition approved by the Orphans' Court Division.

Neither of these actions were announced in press releases by the Attorney General's Office. But reporting of them in local newspapers reveals the ongoing involvement of that Office in matters of charitable trusts & organizations.

* * *

Update: 02/17/07:

On February 11, 2007, an article appeared in the Delaware County Times entitled "Delco SPCA 'clawing' its way to improved, expanded facilities", by Kathleen E. Carey. She reports, in part:

On Jan. 26, Delaware County Judge Edward Zetusky ruled that the SPCA could use $4.2 million of its reserve fund to pay its bills, but also to renovate and expand the existing 6,000-square-foot facility that was built in the 1930s and modified in the 1950s and 1970s.

"It can’t handle the overpopulation (of animals) that we have for our county," Spraga said.

Of the fund, $3.5 million would be earmarked for the 8,500- to 10,000-square-foot addition that would include a new lobby area with adoption rooms that would allow visitors to spend time with prospective pets.

Engineering work is expected to begin shortly and the project is scheduled to be finished by the end of 2009.