New Online Senior Housing Locator

On July 21, 2008, the National Association of Area Agencies on Aging (n4a) introduced a new "online navigational tool to help older adults search for senior housing, no matter where they live." The resource was described in n4a's Press Release, entitled "National Association of Area Agencies on Aging rolls out nationwide senior housing resource during annual meeting in Nashville."

Powered by SNAPforSeniors®, the Senior Housing Locator makes objective, nationwide information available 24-hours a day, seven days a week through the convenience of the Internet.

Consumers and professionals alike will now have access to the n4a Senior Housing Locator through a link on n4a.org.

The tool allows users to search a database of more than 60,000 senior housing listings, including all licensed senior housing in the nation.

Member Area Agencies on Aging (AAAs) and Title VI Native American Aging Programs will be invited to add a link to the tool or use a version co-branded for their own website.* * *

The Press Release explained how the Senior Housing Locator is similar to the existing Real Estate Multi-Listing Service maintained by Realtors®, but is targeted towards the specific needs of senior citizens as residents, and Aging Agencies as facilitators searching for appropriate facilities.

It is a free service "developed by SNAPforSeniors, representing another example of cooperative relationships among the aging network and private sector organizations." It is devoid of advertising, however, which suggests a more trustworthy service.

The Senior Housing Locator is similar to the real estate industry’s Multiple Listing Service, and functions much like a traditional search engine.

Users can search a database of assisted living communities, nursing homes, residential care facilities, continuing care retirement communities and a growing list of independent living communities, all at the click of a mouse.

Many listings provide information about care services, lifestyle amenities, payment options and more, with some including photo galleries and virtual tours. * * *

Eve Stern, RN, MS, president of SNAPforSeniors, [said] * * * “[T]he fact that all licensed communities are included eliminates the bias that referral services and advertising-based listing services exhibit.”

The varieties of licenced housing available to senior citizens in the various states make searching confusing, and the new search resource attempts to sort out the facility types:

There are 247 different senior housing license types in the United States. According to SNAPforSeniors, the inconsistency from state-to-state is a common source of confusion when it comes to finding housing in another area.

To help remedy this, the n4a Senior Housing Locator provides definitions for all 247 license types. Medicare certified facility listings also include a link directly to that facility’s quality report on Nursing Home Compare.* * *

About a week later, the new senior housing online search resource was promoted in a Press Release entitled "Society of Certified Senior Advisors introduces comprehensive online resource to clients in need of senior housing" (07/29/08) issued by the Society of Certified Senior Advisors®, of Denver, CO, the world’s largest membership organization educating and certifying professionals who serve seniors.

Its immediate involvement is an example of the "co-branding" offered and sought by n4a.

Through the Alliance Network Program, SNAPforSeniors licenses and private-labels its database and search tools to the websites of leading trusted sources, including the Alzheimer's Association and the Case Management Society of America. * * *

For more information about SNAPforSeniors, read its "Frequently Asked Questions" online. It is listed in Google's online "Senior Living Directories and Helps" that offers additional online resources.

A Jewish Approach to End-of-Life

On Sunday, September 14, 2008, from 9 a.m. to 3 p.m., Yeshiva University, in New York City, will conduct a seminar entitled "The Sanctity of Life: A Jewish Approach to End of Life Challenges Adult and Pediatric End of Life Challenges."

This is the purpose of the conference:

The conference will provide a unique opportunity to interact with rabbis and physicians who are leaders in this area of medical ethics.

By enriching our education, raising our awareness, and deepening our sensitivities, the YU Student Medical Ethics Society hopes to promote continued discussion, thus enhancing the community’s ability to deal with these issues in an effective manner that holds true to the highest moral standard. * * *

The conference speakers will address the medical, psychological, social, & religious (under Jewish law) issues arising in end-of-life situations:

With expert speakers representing the medical and rabbinical professions, the conference will address the wide range of medical, ethical, psychosocial and halachic (Jewish legal) issues that arise at the end of life.

The opening plenary session of the day will begin with a general introduction to the medical background and ethical issues that are pertinent to adult terminal illness.

Presented by leading physicians, ethicists, and rabbinic authorities with extensive experience, this session will explore how medicine and halacha interact in the modern hospital setting, and will highlight some of the most pressing issues that have come up in recent cases. * * *

I highlight this conference, since it studies end-of-life issues from this religion's viewpoint:

• Pediatric end-of-life challenges
• Adult end-of-life challenges
• Health care proxy
• Assisted suicide and the value of life
• Hospice care
• Pain management

Further event information and registration arrangements are available online here.

The need for decisions at the end-of-life, is real; and such decisions should be made with reference to the patient's beliefs. Otherwise, the decisions rely more on medical possibilities, however fruitless, and familial expectations, however hopeless.

For one physician's perspective on the need for reference to concerns other than medical diagnoses & prognoses, read "As death draws near, patients and families face agonizing decisions [in] End-of-life care", by Dr. Patrick Neustatter, a family practitioner in North Stafford, Virginia, posted by The Free Lance-Star (Fredricksburg, VA) on August 24, 2008.

He related that "deciding whether to fight for life at all costs, or prepare for death, is a heart-wrenching decision some patients face."

It's bad enough to be dying of terminal cancer, but when your medical specialists are pulling you in opposite directions, advising conflicting treatment plans, it generates more anguish and requires the patient and the family to make some heartfelt decisions.

A patient I'll call Mr. X already went through surgery and radiation therapy for his cancer. Now, unfortunately, the biopsy of the lump that recently appeared shows recurrence.

He is in the care of an enthusiastic, dare I say gung-ho, surgeon who is urging him to have surgery. But his oncologist, together with his daughter, is asking him: "Is another five years of life, but in a nursing home with a feeding tube, really what you want?"

In cases like these, quantity is pitted against quality. Stay alive at any cost, or prepare for the inevitable sooner with less intervention? It's a decision that can put a terrible strain on the bravest patient and most devoted of families and medical staff. * * *

In concluding with his recommendation for patients to prepare, in advance, a "living will" to address medical decision-making, Dr. Neustatter referenced the need to implement the patient's wishes, not rely upon medical possibilities regardless of pain:

At church the other morning, one of the congregants told of her father-in-law just having finally died after a long illness.

She described the heartache her husband had gone through arguing with the other siblings over the whole business, and closed with the question, "Where's the Hemlock Society -- or whatever it's called now -- so my death is not like that?"

The principle of making some preparation for your death is a sound one.

With the aid of a living will, in which you can spell out what medical efforts you do or don't want taken in your final days, you may save untold heartache amongst the family members -- not to mention possibly massive savings on futile medical expenses.

The conference at Yeshiva University will address the concern that "my death is not like that" from a Jewish perspective.

LTCI Scrutinized by Feds

On July 24, 2008, the U.S. House Committee on Energy and Commerce held the second in a series of hearings on the subject "Long-Term Care Insurance: Are Consumers Protected for the Long Term?"

The hearing was preceded by issuance on July 23rd of a Press Release, entitled "Senate, House Members Release Results of GAO Report on Long-Term Care Insurance."

The referenced report issued by the U.S. Government Accountability Office (GAO), entitled "Long-Term Care Insurance: Oversight of Rate Setting and Claims Settlement Practices" (June, 2008; GAO No. 08-712; PDF, 41 pages), surveyed "the consumer protections states have in place for those who purchase long-term care insurance (LTCI)."

The Press Release noted the purpose of the GAO's Report:

Due to the rapid aging of America’s population, the marketplace for long-term care services is expected to expand significantly. Private LTCI has emerged as one possible way individuals can prepare for their long-term care needs later in life.

In their request to GAO, members of Congress expressed their interest in examining the frequency with which consumers are experiencing denial of benefits and exorbitant rate increases.

In light of such practices, the GAO report examined the robustness of states’ rate setting standards and the rules for settling of benefit denials. * * *

These were the essential findings of the GAO's Report on LTCI:

GAO found that rate increases for LTCI policies fluctuate widely from state to state and plan to plan. For example, one company cited in the report repeatedly raised premiums, resulting in a cumulative increase of more than 70 percent since 1991, while another company has raised premiums only once since 1975.

According to the report, rate stability standards, which are designed to protect consumers against sharp premium increases, have now been adopted by more than half of all states.

However, because many states have not yet adopted these standards, a vast number of consumers are still left unprotected. Additionally, because the rate standards are so new, state regulators are unsure of how successful they will be in moderating future premium increases.

GAO also reviewed claims settled by LTCI companies in ten states by evaluating consumer complaints. The report found that standards for the timely payment of consumer claims varied significantly by state, with “timely” being defined as five days in one state and 45 days in another. One state did not have a timeliness requirement at all.

GAO also noted that some states are considering implementing an external appeals process for adjudicating disputed claims. * * *

In prior blog entries, I noted the increased promotion by the federal and many state governments, including Pennsylvania, of private long-term care insurance. See: PA EE&F Law Blog postings "PA Joins "Own Your Future" LTCI Campaign" (03/28/08), and "PA to Promote Long-Term Care Insurance" (03/12/08). I expressed concerns about adequate state regulatory review and remedies for policy purchasers & claimants of LTCI coverage.

The GAO's Report acknowledges such concerns, notes varying enforcement measures presently, and recommends further scrutiny of LTCI issuers and policies, given the increasing federal and state government promotion of such private coverage:

The federal government expects that as many as 30 states will have Long-Term Care Partnership programs in place by the end of this year. These programs encourage the private purchase of LTCI and feature state-approved plans that combine private LTCI with possible add-on Medicaid coverage in policies that allow consumers to protect some portion of their accumulated financial assets.

Many state officials, as well as LTCI providers, are enthusiastically supporting rollout of these Partnership programs. As programs of this nature unfold across the country, the GAO report’s findings make it clear that consumers who are urged by state governments to purchase these plans must have access to comprehensive, accurate information about Partnership-approved plans to determine whether they are a sound and affordable choice for them. * * *

Those witnesses who offered testimony at the recent House subcommittee hearing regarding LTCI included two from Pennsylvania. Each witness provided a prepared statement or presentation, available online, as follows:

Panel I:

• Statement of Ms. Bonnie Burns (PDF, 18 pages), Training and Policy Specialist, California Health Advocates, of Scotts Valley, CA

• Power Point Slide Presentation and Statement of Marc A. Cohen, Ph.D. (PDF, 12 pages), President, LifePlans, Inc., of Waltham, MA

• Statement of Mr. Al Bode (PDF, 17 pages), retired teacher & son of a parent in long-term care, of Charles City, IA

• Statement of Mr. Jack E. Vogelsong (PDF, 14 pages), Chief, Division of Long Term Living, Outreach and Education, Pennsylvania Department of Aging, of Harrisburg, PA

• Statement of Mr. John E. Dicken (PDF, 23 pages), Director, Health Care, U.S. Government Accountability Office, of Washington, D.C.

Panel II:

• Statement of The Honorable Sean Dilweg (PDF, 28 pages), Commissioner of Insurance, State of Wisconsin, of Madison, WI

• Statement of The Honorable Eric Dinallo (PDF, 15 pages), Superintendent, New York State Insurance Department, of New York, NY

• Statement of The Honorable Kevin M. McCarty (PDF, 18 pages), Commissioner of Insurance, State of Florida, of Tallahassee, FL

• Statement of The Honorable Mike Kreidler (PDF, 9 pages), Commissioner, Office of the Insurance Commissioner, State of Washington, of Olympia, WA

Panel III:

• Statement of Mr. Thomas M. “Buck” Stinson (PDF, 13 pages), President, Genworth Long Term Care, of Richmond, VA

• Statement of Mr. John Wells (PDF, 11 pages), Senior Vice President, Long Term Care, Conseco, Inc., of Chicago, IL

• Statement of Mr. Thomas E. Samoluk (PDF, 19 pages), Vice President & Counsel, Government Affairs, John Hancock Insurance Co., of Boston, MA

• Statement of Mr. Cameron B. Waite (PDF, 10 pages), Executive Vice President, Strategic Operations, Penn Treaty Network America, of Allentown, PA

You can watch the hearing on your computer using Windows Media Player and a high-speed Internet connection.

Seven elected senators or representatives had requested such a Report from the GAO and urged hearings about LTCI. Some were quoted in the Press Release as expressing deep concern about LTCI after reviewing the GAO's Report.

Such investigations are not ended. At the conclusion of the GAO's Report, the principal author, John E. Dicken Director, Health Care, made an offer for further input about it.

If you or your staffs have any questions about this report, please contact me at (202) 512-7114 or dickenj@gao.gov.

Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this report. GAO staff who made major contributions to this report are listed in appendix II.

That is an invitation for participation in this envisioning process.

Study Gauges Elder Mistreatment

On August 19, 2008, the University of Chicago released a study about elder abuse, as described in its Press Release entitled "More than 10 percent of older Americans suffer mistreatment, University of Chicago study shows."

About 13 percent of elderly Americans are mistreated, most commonly by someone who verbally mistreats or financially takes advantage of them, according to a University of Chicago study that is the first comprehensive look at elder mistreatment in the country. * * *

Other studies have been based on small, non-representative samples of the population or on data gathered from the criminal justice system or welfare agencies such as adult protection services. They are not as comprehensive as the new study, which was made in response to a report from the National Research Council calling for scientific study of elder mistreatment. * * *

The findings of this new study were summarized in the Press Release with reference to its lead author, Professor Edward Laumann, of the University's Sociology Department:

Laumann and his research team found that

• 9 percent of adults reported verbal mistreatment,
  
• 3.5 percent reported financial mistreatment and
  
• 0.2 percent reported physical mistreatment.
  

Physical impairment apparently plays a role in mistreatment, the study found.

"Older people with any physical vulnerability are about 13 percent more likely than those without one to report verbal mistreatment but are not more likely to report financial mistreatment," said co-author Linda Waite, the Lucy Flower Professor in Sociology at the University. * * * [Formatting added.]

As to the reporting of alleged elder abuse, the study showed that "adults in their late 50s and 60s are more likely to report verbal or financial mistreatment than those who are older."

Regarding mistreatment, respondents were asked about the past 12 months and answer three questions:

• "Is there anyone who insults you or puts you down?" (verbal);
  
• "Is there anyone who has taken your money or belongings without your OK or prevented you from getting them, even when you ask?" (financial); and
  
• "Is there anyone who hits, kicks, slaps or throws things at you?" (physical).

Of the people reporting verbal mistreatment,

• 26 percent identified their spouse or romantic partner as being responsible,
  
• 15 percent said their children mistreated them verbally, while
  
• the remainder said that a friend, neighbor, co-worker or boss was responsible.

Among people who reported financial mistreatment, 57 percent reported someone other than a spouse, parent or child, usually another relative, was taking advantage of them. * * * [Formatting added.]

Professor Linda Waite noted some "good news" revealed by the study:

Few older adults reported mistreatment by family members, with older adults quite insulated from physical mistreatment.

However, the authors pointed to the need for sensitivity on the part of physicians and other medical personnel to the possibility, although infrequent, of physical mistreatment of their patients. * * *

The study's findings were reported in "Elder Mistreatment in the U.S.: Prevalence Estimates from a Nationally-Representative Study" (PDF, 7 pages), published in the current issue of the Journal of Gerontology: Social Sciences (2008, Vol. 63B, No. 4, S248–S254).

Sometimes elder abuse rises to the level of alleged criminal behavior. A trial is now underway in York County Court regarding alleged elder abuse in the form of gross neglect towards a care-dependent elder, who died. When a jury verdict would be reported in that case, I'll note it here.

"Working with Older Adults" Training Events

The Pennsylvania Behavioral Health & Aging Coalition announced three, free, one-day training sessions for certified peer specialists, recovery specialists, and aging & mental health professionals on the topics described in an online flyer (Word format, 1 page):

• "Behavioral Health Issues in Older Adults" and
• "Understanding and Accessing Medicare Services for Mental Health Consumers."

The Behavioral Health Connection is a new, innovative resource center developed by the Pennsylvania Department of Aging through its APPRISE health insurance counseling program.

This training * * * will include actual case studies to help understand issues involved in serving Baby Boomers, other older adults, and those dealing with substance use.

The training is also designed to assist professionals in utilization of Behavioral Health Connection, APPRISE, and assisting consumers having difficulty accessing treatment needs.

A basic understanding of Medicare will be provided in working with Medicare beneficiaries.

In a discussion forum sponsored by the Pennsylvania Mental Health Consumers' Association, and in an invitation posted on the PBHAC website, Lynn Patrone explained the new "Behavioral Health Connection" and its mission:

Behavioral Health Connection is a brand new program that assists ALL mental health consumers in accessing necessary treatment, especially prescription medication. The training will assist all mental health professionals working with consumers and provide access to this unique resource.

Behavioral Health Connection serves consumers of all ages. There is no cost for the training but seating is limited!

Lynn referenced the online flyer, with registration form, for the training sessions (Word format, 1 page).

The sessions will be held from 8:30 A.M.-3:00 P.M. in the western, central, and eastern sections of Pennsylvania, as follows:

• October 9, 2008, at Mountain View Inn, 121 Village Drive, Greensburg, PA 15601
• November 19, 2008, at Inn at Chester Springs, 815 North Pottstown Pike, Exton, PA 19341
• December 10, 2008, at Radisson Penn-Harris, 1150 Camp Hill Bypass, Camp Hill, PA 17011

A continental breakfast and lunch will be provided to attendees. For further information, you may call 717-541-4219.

Advance registration is required. Registrations can be submitted to the attention of Lynn Patrone, at PABHAC/BHC, via fax (717-541-4217) or by email to: lynn@olderpennsylvanians.org.

Elders and Marriage

On the occasion of my eldest son's wedding this coming Saturday, I am wondering about the view of older folks, as a group, about marriage.

The Pew Research Center posted an article on July 1, 2007, entitled "As Marriage and Parenthood Drift Apart, Public Is Concerned about Social Impact Generation Gap in Values, Behaviors" that announced and summarized the findings of a Report, entitled "As Marriage and Parenthood Drift Apart, Public is Concerned About Social Impact" (07/01/07; PDF, 91 pages).

The Report's Executive Summary lists & explains its key findings, including these points:

• Younger adults attach far less moral stigma than do their elders to out-of-wedlock births and cohabitation without marriage. They engage in these behaviors at rates unprecedented in U.S. history.
  

• Adults of all ages consider unwed parenting to be a big problem for society.
  

• Even though a decreasing percentage of the adult population is married, most unmarried adults say they want to marry.

• Married adults are more satisfied with their lives than are unmarried adults.

• Children may be perceived as less central to marriage, but they are as important as ever to their parents. As a source of adult happiness and fulfillment, children occupy a pedestal matched only by spouses and situated well above that of jobs, career, friends, hobbies and other relatives.

• With marriage exerting less influence over how adults organize their lives and bear their children, cohabitation is filling some of the vacuum.
  

• Americans by lopsided margins endorse the mom-and-dad home as the best setting in which to raise children. But by equally lopsided margins, they believe that if married parents are very unhappy with one another, divorce is the best option, both for them and for their children.
  

Were individual views different due to the age of survey respondents?

[T]he Pew survey finds that older adults – who came of age prior to the social and cultural upheavals of the 1960s – are more conservative than younger and middle-aged adults in their views on virtually all of these matters of marriage and parenting.

Thus, some of the overall change in public opinion is the result of what scholars call "generational replacement." That is, as older generations die off and are replaced by younger generations, public opinion shifts to reflect the attitudes of the age cohorts that now make up the bulk of the adult population.

Even among the younger generations (ages 18 to 64), however, our survey finds substantial differences in attitudes that fall along the fault lines of religion and ideology rather than age.* * *

For those senior citizens contemplating a second (or more) marriage, consider the advice given by Ashlea Ebeling in her extensive article "The Second Match" (11/12/07), posted by Forbes magazine.

She asks, "Should you remarry or just shack up?" Then she answers, "Consult your financial adviser and lawyer, as well as your conscience."

In 2006, 1.8 million Americans aged 50 and above lived in heterosexual "unmarried-partner households," a 50% increase from 2000, figures Bowling Green State University demographer Susan Brown.

Much of that growth is due to the baby boomers passing 50. But it also reflects the problems of blending finances later in life. Ninety percent of older heterosexual live-ins are widowed, separated or divorced. * * *

She suggests considering these aspects of the decision, which are explored in detail:

• Estate Planning

• Alimony and Palimony

• Social Security

• Survivors' Annuities

• College Financial Aid

• Nursing Home Costs

• Income Taxes

• Real Estate

In a shorter article posted by ElderCare Answers, entitled "Is It Better to Remarry or Just Live Together?", similar points are raised, including:

• Estate Planning


• Long-Term Care


• The Family Home
  


• Social Security
  


• Alimony
  


• Survivor's Annuities
  


• College Financial Aid

When couples are young, such factors are far from mind, and love alone might be the singular motivation. But for some older Americans contemplating remarriage, the question might be asked: "What's love got to do with it?"

In answering that question, I suggest that you first consult your conscience, and then "[c]onsult your financial adviser and lawyer."

Consider, also, the results of the survey (noted in the graph above) concerning "what makes a marriage work?"