Monday, December 16, 2019

ADT and Senior Helpers Team Up to Provide Aging in Place Support

Security Systems News reports that ADT, a leading security, automation and smart home solutions provider serving residential and business customers, has partnered with Senior Helpers, a provider of in-home senior care, and will introduce its medical alert systems to Senior Helpers clients.  The new partnership will provide seniors with additional safety and support, particularly when a Senior Helpers caregiver is not present.

“Our partnership with Senior Helpers will help provide additional safety and support for its clients who require a caregiver but who also want the freedom and independence to live in their own home, maintain and enjoy their current lifestyle and stick to a budget with no long-term contract commitments,” ADT’s Sr. Vice President of Emerging Markets, Jay Darfler, said in the announcement.

ADT’s medical alert systems also send notifications to Senior Helpers caregivers and designated family and friends in the event of a medical emergency and throughout the initial term of treatment until the customer is discharged.

“Providing peace of mind for our clients is very important, and we believe that this service from ADT is one that many of our clients will find attractive,” Senior Helpers CEO & Co-Founder Peter Ross said in the announcement.

Under the new partnership, Senior Helpers clients will receive preferred pricing for ADT Medical Alert Systems, including ADT Medical Alert Plus and ADT On-The-Go units.

ADT Medical Alert Plus provides a full in-home monitoring service that offers fall detection and home temperature monitoring, along with a wide monitoring range (600 feet from the base). ADT On-The-Go is a mobile option, and the systems also provide families and caregivers with options to monitor their aging loved ones remotely. The device has fall detection and GPS capabilities, and landlines are not required for either service.

For more information on ADT Health and Senior Helpers, visit www.adt.com/health and www.seniorhelpers.com.

Tuesday, December 10, 2019

Asset May Be Available Resource for Medicaid Even if the Resource Cannot Be Sold (Converted to Cash)

An Ohio appeals court has ruled that a Medicaid applicant's real property may be counted as excess resources even though the applicant was unable to sell the  property. Communicare v. Ohio Department of Job and Family Services (Ohio Ct. App., 8th Dist., No. 106874, Sept. 19, 2019).
Mohsen Fanous owned three pieces of real property that were collectively valued at around Sixteen thousand dollars ($16,000.00). He was, apparently, unable to find anyone willing to pay anything for the properties. When he applied for Medicaid benefits, the state denied his application, finding that the properties put him over the Medicaid resource limit and that it could not verify his other resources.
Mr. Fanous appealed, arguing that the properties should not have been considered as countable resources because he was not able to sell them. Because Ohio law defines resources to includes property that the applicant has an ownership interest in and has the legal ability to convert to cash, the trial court dismissed the appeal, and Mr. Fanous appealed again.
The Ohio Court of Appeals, Eighth District, affirmed, holding that the state properly denied Mr. Fanous's application due to excess resources. According to the court, "whether [Mr.] Fanous was able to find a purchaser is a wholly different consideration from what the regulation contemplated, namely whether [Mr.] Fanous had the legal authority to sell the properties in the first place."  Because Mr. Fanous had the legal authority to sell the properties, the value of the properties were considered an available resource, notwithstanding that he could not convert the property to cash.  



This case represents why Medicaid often puts applicants and their families between a "rock and a hard place."  The applicant is unable to liquidate the assets for cash necessary to pay for long-term care, and the applicant is otherwise unable to pay for long-term care.  Often. the reality is that family members, such as children or grandchildren, are "forced" to pay for the applicant's long-term care.    

Monday, December 9, 2019

Nearly $1M Jury Award Against Grandparents Seeking Custody of Their Grandchild

This Blog generally does not include cases regarding domestic relations, excepting, of course the occasional predatory marriage case.  Nonetheless, a case involving grandparents going to extremes to attain custody of a grandchild is worthy of consideration, perhaps as an object lesson that "the ends don't justify the means." 

A U.S. Court of Appeals recently upheld a jury award of $970,000 to a woman in damages against her parents after they, among other things, conspired with law enforcement to gain custody of her daughter. Green v. Howser (7th Cir., No. 18-2757, Nov. 7, 2019).
Jack and Angela Howser were unhappy with how their daughter, Jade Green, was raising her child, E.W. They first attempted to blackmail her with nude photos to prevent her from moving away from them. When that didn't work, they met with local police, the sheriff's office, the county prosecutor, and a private investigator to come up with a plan to arrest Ms. Green while her husband was not at home and gain custody of E.W. Ms. Howser intentionally cashed a check of Ms. Green’s that she knew would bounce in order to have her arrested. While the police arrested Ms. Green, Mr. Howser entered Ms. Green's house and took E.W. away. The Howsers filed for guardianship of E.W., but eventually the court awarded Ms. Green custody of E.W.
Ms. Green sued the Howsers for conspiring with state officials to violate her due process right to make decisions about the care and custody of her child. A jury awarded Jade $470,000 in compensatory damages and $500,000 in punitive damages. The Howsers appealed.
The U.S. Court of Appeals, Seventh Circuit, affirmed, holding that there was sufficient evidence of a conspiracy and the damages award was not excessive. According to the court, the evidence showed that the "Howsers engaged in reprehensible conduct" and "their conspiracy with law enforcement officers to forcibly take E.W. was intentional, manipulative, and deceitful."

Thursday, December 5, 2019

Irrevocable Trust Fails to Protect Assets from Availability for Medicaid

"Comfort clauses" in an irrevocable trust are dangerous, and can undermine the objectives of the trust.  A New York appeals court provides another object lesson in the dangers of such planning, ruling that a Medicaid applicant's irrevocable trust is an available asset because the trust instrument gave the trustee too much discretion in the distribution of the trust principal after the trustee had used a home equity line secured by a trust asset to pay for the applicant's expenses. In the Matter of Pugliese v. Zucker (N.Y. Sup. Ct., App. Div., 4th Dept., No. 784 TP 19-00440, Oct. 4, 2019).
Anthony Pugliese was the beneficiary of a trust for which his son was the trustee. His son used a home equity line secured by a trust asset to pay Mr. Pugliese's living and caregiving expenses, which depleted much of the trust's value. Mr. Pugliese applied for Medicaid, but the state found that the trust was an available asset and denied him benefits.
Mr. Pugliese appealed, arguing that his son no longer wished to use his discretion as trustee to make distributions to Mr. Pugliese. The state affirmed the decision, and Mr. Pugliese appealed to court.
The New York Supreme Court, Appellate Division, affirmed, holding that the trust was an available asset because "the trust instrument gave the trustees broad discretion in the distribution of the trust principal, including for [Mr. Pugliese's] benefit."
An irrevocable trust for the purpose of Medicaid planning MUST provide all of the following in order to ensure that its assets are, subject to the applicable look-back, unavailable for determining Medicaid eligibility:
  • You cannot own the assets;
  • You cannot control the assets;
  • The assets may not be used for your needs, and in particularly, your health needs. 
These trusts can be fashioned as "income-only trusts," where you have no ownership, control, or privilege to the principal of the trust, but the income from the principal is distributed to you.  This way, the funds in the trust are protected and you can use the income for your living expenses. For Medicaid purposes, the principal in such trusts is not counted as a resource, provided the trustee cannot pay it to you or your spouse for either of your benefits. If you do move to a nursing home, however, the trust income is countable, and will have to go to the nursing home.

Even if the trust is crafted properly, the conduct of the parties may undermine the trust.  This may, in fact, have been part of the problem in the Zucker case.   Even a wholly discretionary trust, like that in Zucker,  can be subject to a determination that you have a right  the conduct of the parties show the beneficiary has been able to freely access trust funds by simply asking.  In the Massachusetts case of Caruso v. Caruso which considered a trust for the purpose of property division in a divorce, the court found the beneficiary’s accountant, acting as trustee, amounted to a “yes man” for the beneficiary and was, therefore, in too close a relationship to exercise independent judgment. The court held that even though a trust is purely discretionary, when the beneficiary appears to hold de facto control of the trust, its property becomes subject to invasion. 

You should also be aware of the drawbacks to such an arrangement. An irrevocable trust cannot be changed, at least by you.  Changes in circumstances and changes to the law may impact your plan so adversely that you may regret the plan.

These trusts are also very rigid, so you cannot gain access to the trust funds even if you need them for some other purpose. For this reason, you should always leave an ample cushion of ready funds outside the trust.

These trusts may also increase the risk of institutional care.  When your Medicare hospital benefit runs out (often within a few days of your hospitalization, and very frequently before you are able to medically return home), you are left only the option of institutional care paid for by Medicaid.  This is, after all, the purpose of such planning, to make you eligible for Medicaid earlier.  If you want to age in place, you need to consider whether an irrevocable trust wholly frustrates your plan.  You may not direct payments from the trust for alternatives to institutional care, such as private nurses, home health care aids, or, in most cases, out -patient rehabilitation.  

Monday, December 2, 2019

The Myth of Rehab for Hospitalized Seniors: Forty Percent Never Return Home

Most seniors and senior caregivers believe that discharge from a hospital into a skilled nursing facility (SNF) is just  another natural and obvious step on the road to rehabilitation and recovery, with the hope of heading home on the eventual horizon.  The health care industry actively and intentionally supports this belief in the  information provided to caregivers and patients at the time of discharge.  Even the name of the SNF's sells this hope; a large number of these facilities have the word “rehabilitation” in their name.  A review of a New York’s statewide directory for example, lists 622 facilities, with over half of them having “rehabilitation” in the title. The Ohio Care Planning Council lists 802 facilities, with forty percent (40%) of them having "rehabilitation" in the title. The very name of these  facilities perpetuates a mistaken belief that a hospitalized senior whose Medicare benefit has "run out," will soon return home.

Readers of this blog know, however, that adverse health outcomes inherent to institutional skilled nursing care, and adverse health outcomes endemic, but not inherent, in these facilities, often cause short term rehabilitation to become permanent perpetual skilled care. A significant number of patients entering these facilities experience adverse outcomes, and never make it back home.  A study by the Inspector General of Health and Human Services (HHS), which incidentally only considered patients institutionalized for thirty-five (35) days or less, found that approximately one-third were injured or killed by the very nursing homes that were intended to complete the care necessary to allow them to return home.  Most of these adverse outcomes were preventable.

A 2016 study published in the journal Annals of Surgery paints a bleak picture; forty-one (41%) of patients discharged to a SNF never return home. The study examined the outcomes of patients admitted to SNFs in five states, California, Florida, New York, Texas and Washington. Worse, the researchers found an elevated risk of death with institutional care:
"It is often communicated to patients and families that discharge to an SNF is a step in the process of recovery, and because clinicians have very limited evidence about the natural history of patients discharged to SNFs, patients may be given an unreasonable expectation of return to home. This study demonstrates that a significant proportion (41%) never returns to home, and the 1- and 3-year risk of death is much greater than that in the general population."
The study concluded that "[a]mong all patients discharged to SNFs, 7.8% eventually died in an SNF and overall 1-year mortality was 26.1%." 

Previous studies suggest that health outcomes on discharge to a nursing home do not differ greatly based on the rating, or performance evaluations, of the nursing homes.  In other words, selecting a highly rated facility does not greatly improve your chance of returning home.  The choice between profit and nonprofit facilities is actually more likely to impact health outcomes with for-profit institutions lagging behind the nonprofits. 
   
Families for Better Care ("FBC"), publishes a state-by-state nursing home report card. The following are the grades, rankings, and details for the states included in the study for the  year 2019:

California:  

  • California was given an overall garde of "C."
  • California’s nursing home ranking plunged to No. 22 overall, that’s down ten spots from its previous report card high.
  • The percentage of California nursing homes with one or more deficiencies ticked nearly 3 percent points higher since the last report card, dropping the measure to a failing grade for the first time.
  • California’s percentage of nursing homes with severe deficiencies increased a whopping 64 percent since our initial reports, nearly 1 in 5 nursing homes were cited for actual harm or immediate jeopardy to residents.
  • While California’s direct care staffing hours remained relatively high at 2 hours and 41 minutes of care per resident daily, the percentage of facilities actually providing above average staffing levels told a very different story; the number of facilities with high levels dropped nearly 40 percent since the last report card.
  • A falling percentage of verified ombudsman complaints for the third consecutive report card netted the Golden State its first “A” grade in this quality measure.
  • California nursing home care ranked last in nursing home quality for the Pacific Region.
  • Florida received an overall grade of "B."
  • Florida dropped seven spots in its national nursing home ranking to No. 13 overall—marking the lowest overall rank for the Sunshine State in report card history.
  • Florida ranks among the best states in three critical nursing home quality indicators: direct staffing hours (No. 7), the percentage of facilities with severe deficiencies (No. 8), and the percentage of verified ombudsman complaints (No. 1).
  • While Florida moderately increased direct care staffing hours offered to residents daily, the percentage of nursing homes achieving those higher staffing standards declined considerably, down more than 30 percent since the last reporting period—dropping the state to its lowest level in any report card.
  • Inspectors issued one or more deficiencies to nearly every Florida nursing home.
  • Fewer Florida nursing homes are scoring above average inspections than ever before.
  • Nearly in 1 in 5 Florida nursing homes are on the state’s watch list for dangerous nursing home conditions.
  • Florida nursing home care ranks first out of the Southeast Region’s eight states.
  • New York garnered an overall grade of "C."
  • New York surged higher in overall nursing home care, up 20 spots from its dreadfully low No. 45 ranking in the past two report cards.
  • New York scored “A” grades in every enforcement measure for the first time.
  • Despite New York’s strong showing, the state failed two critical measures: the percentage of facilities with above average professional nursing hours and the percentage of facilities with above average direct care staffing levels, ranking No. 44 and No. 45 respectively.
  • New York’s nursing home staffing hours remained woefully stagnant for the third consecutive reporting period, clocking just 2 hours and 20 minutes of direct care per resident daily.
  • 4 in 5 New York nursing homes had middling to below direct care nursing staff levels.
  • Despite New York achieving its best ombudsman record to date, the advocacy group still verified 3 of 4 ombudsman complaints, indicating widespread concern from residents about their overall quality of care.
  • New York nursing home care ranks fourth in the Northeast Region.

Texas:

  • Texas recieved a failing "F" grade. Texas is America’s worst nursing home state for the third consecutive report card.
  • Texas nursing home care is miserably substandard as the state failed to score even one above average grade in any quality measure—in fact, flunking 5 of 8 statistical categories.
  • Despite Texas’s abysmal showing in overall ranking (No. 51) when compared to other states, there was some good news for residents; nursing home direct care staffing hours nominally improved to 2 hours and 16 minutes of care per day, that’s four minutes more care every day since the previous reporting period.
  • Although fewer than 30 percent of Texas nursing homes received an above average health inspection rating, that’s still 5 percent better than what was reported in the last report card.
  • 1 in 5 Texas nursing homes was cited one or more severe deficiencies. Texas regulators cited 93 percent of the state’s nursing homes for violations of federal or state laws.
  • Texas ombudsmen verified nearly every registered complaint for the third consecutive report card, indicating wide-ranging problems being reported by residents and their families about grossly inadequate quality.
  • Texas nursing homes struggled to employ enough licensed nursing staff to care for residents; fewer than 10 percent of the state’s nursing homes scored an above average rating in professional nurse staffing, this ranks among the lowest nationwide—only Georgia and Louisiana ranked lower than Texas in this critical safety category.
  • Texas nursing homes must do a much better job safeguarding the rights and health of those elderly and disabled adults needing nursing home care—if more money is required for reimbursement to pay for increased costs, then lawmakers must find a way to allocate these needed funds.

Washington:

  • Washington continued its nursing home rankings slide, dropping back seven spots to fall to No. 34 overall, plunging the state into below average territory for the first time.
  • Washington’s nursing home grades show that care is either good or dangerously bad; the state scored above average grades in half of the the quality measures while scoring failing grades in the remaining categories.
  • Despite above average grades in every staffing measure, Washington managed to score failing grades in every regulatory and advocacy measure.
  • With 65 percent of Washington nursing homes being cited a severe deficiency—the highest percentage nationally—that means more Washington nursing homes had citations for dangerous conditions than did not.
  • Less than 3 percent of Washington nursing homes had a deficiency free inspection—one of the nation’s worst rates.
  • Washington’s nursing home care ranks last in the Pacific Alaska Region.
  • Washington received a near-failing grade of "D."
For more, consider the following:



















    Monday, November 25, 2019

    Aging in Place: Medication Mischief Managed

    Medication concerns are among the most common to cause people to consider or choose institutional care.  Failure to manage medication properly can lead to negative outcomes, disability, and loss of life.  The concerns are well justified.  Medication non-adherence (not filling prescriptions or missing dosages)  results in 10% of hospitalizations, 125,000 deaths, and costs the healthcare system up to $300 billion/year.  Consider that 1 in 5 Medicare patients are re-admitted to the hospital within 30 days after discharge – half of them because of medication non-adherence. In a study by Walgreens, researchers found that every 1% improvement in adherence saves about $50 in healthcare spending.

    Technology and modern service-oriented solutions, however, increasingly offer medication management solutions.  Free apps, like Pill Reminder (iPhone) and PillsOnTime (Android) track doses to prevent non-adherence to a prescribed regime. Tracker by Medisafe (iPhone and Android), not only reminds you when it’s time for a refill but enables you to track vitals like blood pressure. Davis’ Drug Guide (iPhone) even contains detailed drug information for patients who have questions about a drug, the possible side effects, or its interactions with other medications.  Traditional retail pharmacies such as CVS, offer packaged medication helping to ensure that patients don't accidentally exclude a medicine from the regime.

    For some individuals, a plastic 7-day pill container provides enough structure to enable them to manage their medications. For those who need additional help, technology-enabled containers help prevent both missing a dose or taking the wrong pill. Units are easily connected to the Internet for communication to caregivers about whether the unit was opened at the right time.

    Some examples of possible solutions include:
    • Tabtime Vibe Vibrating Pill Timer Reminder is a more modern version of the classic plastic pill case.  For less than $20, the Tabtime Vibe Vibrating Pill Timer Reminder has five compartments with different alarms that beep and vibrate when it’s time to take your medicine.
      • PillPack (recently acquired by Amazon) delivers  packaged medication doses and has an accompanying app to track information about them. 
      • TabSafe is a dispenser and management system that  reminds the user, dispenses medications, alerts caregivers before a dose time is missed, and monitors adherence. TabSafe advertises that it improves medication adherence to over 96%.
      • MedMinder is  an automated dispensing box that can be pre-loaded by the pharmacy.
      • Guardian Angels HomeCare Medication Dispensing Management Solution (Personal Medication System) will automatically dispense medication and vitamins in accordance with your prescribed treatment program. This device is a low-cost, practical solution to ensure patients get the right dose of medications at the right time. When medicine is not taken within 30 minutes of the prescribed time, a care center is notified. A. representative will call to remind the patient to take their medicine. If the representative does not get a response from the patient, a caregiver or medical contact is then called to ensure adherence.
      The cost of these solutions are surprisingly reasonable. PillPack and MedMinder, for example, charge just the co-pay medication cost.  Regardless, there is little question that the peace of mind, security, and safety afforded these solutions are well worth the expense.

      Tuesday, November 19, 2019

      Sexual Assaults Continue to Plague Nursing Home Patients

      General security risks are inherent with institutional care. One species of concern regards the safety of residents from sexual assaults.  Sexual assaults and rape continue to plague nursing homes.  A recent case in San Diego, California involved an 88-year old woman, who was sexually assaulted in a nursing home while other patients were in the room.  A DNA match led San Diego police to arrest Lusean Arline, a 48-year old the man after a DNA sample collected from the scene of the assault matched that of Arline.

      Arline allegedly entered the nursing home illegally, went into the 88-year-old victim’s room, and sexually assaulted her with other patients in the room.  Screams from the victim and the other patients alerted staff to the alleged assault, but when staff responded to the room, Arline ran away, according to police.

      In a second case in Dallas, Texas, police say a disabled woman was sexually assaulted by a convicted rapist who was a patient at the nursing home.  The age of the victim was not reported.  Olander Grant, 59, allegedly forced a fellow patient at Brentwood Place Nursing Home into his room, and sexually  assaulted her repeatedly.  Court records show Grant was convicted of rape in 1982 and served 25 years in prison. He remains in the Dallas County jail on an aggravated sexual assault charge.

      In a third case, in Seattle, Washington, repeated sexual abuse was caught on a hidden camera. A 50-year-old woman living in an  assisted living facility complain to her family about sexual abuse.  The woman reported she was sexually assaulted by a care provider.  A family member reported the alleged assaults to local police on July 2, 2019.  After notifying police, a family member installed a hidden camera in the woman’s room. 

      Tragically, from the time the assaults were reported, the victim suffered an additional four sexual assaults.  These assaults were caught on video as a result of the hidden camera.  The family promptly turned the evidence over to the police, starting the chain of events that ultimately led to formal charges and an arrest. The victim and her family say she suffered sexual abuse on multiple occasions between June 1, 2019 and July 3, 2019.

      There is no more horrifying form of elder abuse.  There is no greater reason to implement a legal, financial, and social plan to age in place.  It always seems too early; until its too late.   




      Monday, November 18, 2019

      Aging in Place Wearables

      ID 108749319 © Leowolfert | Dreamstime.com
      Wearables are devices that hang around your neck, are strapped to your wrist like a watch, or are affix edin any fashion to your body or clothing.  These may collect and assemble data for a wide variety of purposes, for your own use, or the use by professionals. For those who see a wearable in a health context, they may be disappointed to learn that some doctors doesn’t seem to care or know what to do with your heart rhythm data, but you can benefit, nonetheless, from tracking your performance (exercise, heart rate), competing with yourself, and feeling the satisfaction from any improvement over time.  Simply, these devices, at a minimum can aid and encourage your efforts to live a more healthy lifestyle: 

      • Wearables can measure your heart rate. Tracking heart rate is one of the most basic functions of wrist-worn wearables—and a basic element of tracking includes knowing the target (and maximum) heart rate ranges for your particular age group. The objective is to exercise to the point where your heart is beating at up to 85% of its capacity.  Seniors need to be aware that medications can impact heart rate, and for those starting out, focusing on the lower end of the range is safer.
      • Wearables can track your exercise. Are you walking, running, swimming or doing an exercise that devices can detect as motion—and even count, as with steps? Whether you are exercising  to lose or maintain weight, or become or stay fit, the combination of motion and measured heart rate can be compared against goals and even recommended fitness levels. The goals can be entered into a smartphone application, such as Apple Health or Samsung Health, and the Bluetooth-synchronized device coaching feature will buzz and/or display encouragement as you move and as goals are achieved.
      Wearables are often protective, safety, or security devices.  Probably the most well-known are devices that provide aid or assistance in the event of a fall.  Fall detection has been a feature of wearable Personal Emergency Response Pendants (or Medical Alerts) for the past decade. Increasingly, these devices automatically provide protection, rather relying upon the wearer to, for example,  press a button. These devices have a built-in accelerometer and gyroscope which are designed to be activated if you fall. These devices sometimes will automatically place a call to emergency services. These developments are attractive to seniors who live in retirement communities, live alone, or spend time alone such as while walking a dog or playing golf.  

      Wearables can also help you findd where you’re going, ensure that you can be found by others, and can help prevent the fear and disorientation that comes with feeling lost. We are increasingly dependent on GPS location-tracking as part of mapping and directions. GPS location can be enabled in newer wearables, like Samsung’s or Apple’s

      Some GPS wearables work independently from a smartphone or work even if the phone is turned off. A GPS-enabled device can be a lifesaver. When enabled and integrated with a service, for example, it enables responders to find your location and display that on a map. And if you lose or misplace the device, its GPS location capability can enable you to find it, similar to the Find my Phone feature.

      As technology advances, wearables can provide more fundamental and necessary health information. FOR example, new wearables permit you to perform an Electrocardiogram (ECG). Checking for heart arrythmia is an even newer feature of wearables, and is included in the Apple Watch Series 4 and likely in a future Samsung Galaxy Watch Active. For individuals who are worried about abnormal heart rhythms, or AFib, which mostly affects those age 65+, these devices are useful and comforting. Experts have expressed cautious optimism, noting a high level of accuracy and ease of use.

      Smartphone app integration is increasingly not required for these devices to perform capably, but integration can, nonetheless be useful.  For some wearables, the data collection from the device is collected and presented through an application on the smartphone—for example, Samsung Health or MyFitnessPal. The applications can be set up to enable you to be part of a tracking group, for example, comparing results. As with the Apple Watch (which is paired with a smartphone) or UnaliWear’s Kanega Watch (which doesn’t require a smartphone), the watch can be useful by itself—when the phone is turned off or there is no smartphone.

      Emergency notifications can alert family, professional caregivers, or emergency services.  Although it may sound sensible to contact 911, those responders have complained about false alerts from accidental or incidental contacts. One firm, Fall Call Solutions, has created an app for the Apple Watch that will contact a screening call center first, as is done by MobileHelp Smart.    If you’re over 65, Apple Watch can notify emergency responders if you fall, as in a recent incident involving an 80-year-old woman.  After the product was launched, however, emergency responders expressed concerns about too many false calls.  The devices must be configured with a set of caregiving responders, which could include family, professional caregivers, or a call center.   That can be set up directly on a device or through the use of an app, like Fall Call’s Elder Check Now.

      Wearables can be set up to share information with a doctor. For example, if a person has had heart trouble in the past, they may want the doctor to be informed. One of the concerns about health-related wearables is the role of the health provider. While the device can transmit information to your doctor, does the doctor even want it or know what to do with it?  Increasingly, these devices will become associated with a form of telemedicine, where the data is analyzed in real time, resulting in a doctor contacting you proactively in the event that data raises concern or suggests an emergent health event. 

      Although there have been periods of pessimism about the staying power of wearables, most agree that they are here to stay—with a greater role in the future for baby boomers and beyond, whether they reside at home or in a senior living setting. Some think that baby boomers will drive market growth in 2019, with 8 million of those aged 55+ owning a smartwatch by the end of the year. One reason for a surge in adoption has been a drop in prices—some are now under $200. For the older adult, a wearable may help a person who lives alone feel safer knowing that a fall will be detected, or a useful warning will be provided, as in the case of irregular heart rhythms. 

      Hearables are recent innovations designed to be more stylish than hearing aids and fit in or around the ear. Each of the functions, such as in-ear amplification, translation, fitness, predictive analytics, are available now, synchronizing activity data with a smartphone.

      Smart clothing refers to any clothing item enhanced with some functionality-adding technology, including smart socks, smart shoes, active wear, and even a smart business suit.

      Smart glasses may  help the legally blind actually see what’s around them.  Smart glasses can also perform just social or personal functions such as Snapchat smart glasses that can capture photos in real time and upload them to Snapchat.

      Technology is providing solutions precisely at a time at which they are most needed.   

      This article relies heavily upon "Can wearables help you be healthier and safer?" published on the 

      Friday, November 15, 2019

      Medicare Part A and Part B Costs to Rise in 2020

      Daily coinsurance rates for seniors in skilled nursing facilities will be rising next year. 

      The Centers for Medicare & Medicaid Services on Friday announced the 2020 premiums, deductibles and coinsurance amounts for the Medicare Part A and Part B programs. 

      Beneficiaries living in skilled nursing facilities will see their daily coinsurance for days 21 through 100 of extended care services during the benefit period rise from $170.50 in 2019 to $176 in 2020. 

      Medicare Part B premiums will also be rising for seniors. The standard monthly premium will increase from $135.50 in 2019 to $144.60 for 2020. Annual deductibles also will increase from $185 for 2019 to $198 for 2020. 

      “The increase in the Part B premiums and deductible is largely due to rising spending on physician-administered drugs. These higher costs have a ripple effect and result in higher Part B premiums and deductible,” CMS stated in a release

      Medicare Part A covers inpatient hospital, skilled nursing facility, and some home health care services, while Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.

      Thursday, November 14, 2019

      VA Caregivers Support Line

      As part of National Family Caregivers Month, we want to remind everyone that  VA's Caregiver Support Line assistance is just a quick phone call away. Whether you are in need of immediate assistance or have questions about what services you may be eligible for, the caring licensed social workers who answer the support line can:

      • Provide you with information about assistance available from VA;
      • Help you access services;
      • Connect you with the Caregiver Support Coordinator at a VA Medical Center near you, or; 
      • Just listen, if that's what you need right now.

      If you're just getting started with VA, calling the Caregiver Support Line at 1-855-260-3274 is a great first step to learn more about the support that is available to you.

      Wednesday, November 13, 2019

      FTC Report to Congress Details Fraud Reports from Older Consumers

      The Federal Trade Commission (FTC) recently sent a report to Congress, Protecting Older Consumers 2018-2019: A Report of the Federal Trade Commission. The FTC "conducts research and analysis, publishes information about patterns and trends, and engages in coordinated efforts to protect older adults from financial loss and assist them with other consumer issues such as identity theft protection." The agency identifies "patterns and trends" and "works closely with stakeholders to learn about the top issues concerning older adults. According to the report, nearly 3.1 million consumers reported some form of financial scheme, 1.5 million reporting fraud, 444,383 reporting identity theft, and all others totaling 1.2 million. Consumers reported losing nearly $1.6 billion to fraud. About 45 percent of fraud reports filed in 2018 included consumer age information. Consumers who said they were 60 and older (older adults) filed 256,404 fraud reports with reported losses of nearly $400 million. 

      Key findings from the 2018 data include:

      • In 2018, older adults were still the least likely of any age group to report losing money to fraud, but their individual median dollar losses remained higher than for younger adults;
      • Compared to 2017 numbers, reported median individual losses among consumers 60 and over increased, and the increase was particularly large for people 80 and over;
      • Older adults were much more likely than younger consumers to report losing money on tech support scams, prize, sweepstakes and lottery scams, and family/friend impersonation;
      • Phone scams were the most lucrative against older consumers in terms of aggregate losses, and online scams were a distant second;
      • Gift cards became the payment of choice for scammers, but wire transfers persisted in the top spot for total dollars paid. 

      There was good news in the report; the overwhelming majority of  fraud reports filed in 2018 by consumers 60 or older did not indicate any monetary loss.  Older adults filed "no-loss" reports about fraud they had spotted or encountered at nearly twice the rate of consumers ages 20-59.  Moreover, it remained true through 2018 that older adults were less likely than younger consumers (ages 20-59) to report losing any money to fraud.  This suggests that older adults may be more likely to avoid losing money when exposed to fraud, more inclined to report fraud when no loss has occurred, or a combination of these or other factors. The FTC fraud survey  found that the rates of victimization for the various categories of frauds included in the survey were generally lower for those 65 and older than for younger consumers. 

      On the more bleak side of the data, older consumers who did report losing money, reported much higher individual losses. In addition, the median individual losses reported by older consumers rose significantly in 2018. In 2018, median reported losses were fairly stable for younger adults as compared to 2017, but increased for older adults. Consumers ages 80 and older reported the largest median losses of $1,700 as well as the largest increase as compared to 2017. The median dollar loss for this 80 and over age group was more than four times the median loss amount reported by consumers in their 20s and 30s and more than two to three times that of other age groups. This striking growth for people 80 and older was driven in large part by increases in reported median dollar losses on prize, sweepstakes and lottery scams, and family and friend imposter scams (often called the “grandparent scam”). For people ages 60-79, a surge in reports of losses to imposters posing as the Social Security Administration during the second half of 2018 contributed to the upward trend in median losses.

      As the nation’s primary consumer protection agency, the FTC has a broad mandate to protect consumers from unfair, deceptive, or fraudulent practices in the marketplace.  It does this by, among other things, filing law enforcement actions to stop unlawful practices and, when possible, returning money to consumers. The FTC also protects the public through education and outreach on consumer protection issues. Through research and collaboration with federal, state, international, and private sector partners, the FTC strategically targets its efforts to achieve the maximum benefits for consumers, including older adults. Protecting older consumers in the marketplace is one of the FTC’s top priorities. Unfortunately, in numerous FTC cases, older  adults have been targeted or disproportionately affected by fraud. For example, the FTC has brought numerous enforcement actions in federal court to stop deceptive technical support schemes that affected older consumers. As the population of older adults grows,the FTC’s aggressive efforts to bring law enforcement action against scams that affect them, as well as provide useful consumer advice, become increasingly important.

      The FTC submits an annual report to the Committees on the Judiciary of the United States Senate and the United States House of Representatives to fulfill the reporting requirements of Section 101(c)(2) of the Elder Abuse Prevention and Prosecution Act of 2017. The law requires the FTC Chairman to file a report listing the FTC’s enforcement actions “over the preceding year in each case in which not less than one victim was an elder or that involved a financial scheme or scam that was either targeted directly toward or largely affected elders.” Given the large number of consumers affected in FTC actions, this list includes every administrative and federal district court action filed in the one-year period. Appendix A to this report lists all of the FTC’s enforcement actions over the preceding year. In addition to the list, the FTC files this report to provide detail on the agency’s efforts to protect older consumers, including its research and strategic initiatives, its law enforcement actions that noted an impact on older adults, and its targeted consumer education and outreach.

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