Informative Article on the Occurrences of Financial Fraud Within the Senior Population

http://beforeitsnews.com/financial-markets/2013/12/protect-your-older-family-friends-2652208.html

Improvements Needed for "Paratransit"

Paratransit: Stuck in the Slow Lane

By PAULA SPAN

I have always found it reassuring to see New Jersey Transit’s striped Access Link vans motoring around my suburban town and to spot New York City’s Access-a-Ride vehicles criss-crossing Manhattan. Elderly and disabled people I know have used them, and while they have sometimes grumbled about having to wait too long for pick-ups, the vans have taken them where they needed to go.

More than 20 years have passed since the Americans With Disabilities Act required public transit operators to provide “paratransit”: door-to-door services for people whose disabilities mean they can’t use conventional buses. If I am no longer a safe driver when I get older, I have told myself, that’s how I’ll get around, too.

A recent conversation with Sandra Rosenbloom disabused me of this rosy picture, though. A longtime transportation scholar and head of the Urban Institute’s Innovation in Infrastructure program, she published an analysis this spring with a discouraging headline: “Roadblocks Ahead for Seniors Who Don’t Drive.”

Dr. Rosenbloom quickly ticked off a number of problems with paratransit. First, the transit operators are interpreting disability requirements so strictly that they bar many older people from using it. “A lot of things that make you not a competent driver aren’t serious enough disabilities to qualify,” she pointed out.

If you are in a wheelchair, you can sign up. But if you shouldn’t drive because your reaction time is too slow or you can’t turn your head enough to see behind you or you have trouble reading road signs, “none of those things qualify you for A.D.A. paratransit.”

Even if you do qualify, the law mandates paratransit only within a 1.5-mile corridor: three-quarters of a mile on either side of an existing bus route. I happen to live and work in communities well served by mass transit, so it is easy to forget how many places aren’t: rural areas, most suburbs, plenty of those 55+ “active senior” communities miles from anywhere.

Somewhere between a third and two-thirds of older Americans don’t live along a paratransit corridor. But even those who do rarely seem to take advantage of the service, judging from the limited ridership data available. “A few people ride a lot, but most people who are eligible don’t ride at all,” Dr. Rosenbloom said. “The services are just not good enough.”

Seniors may dislike the need to make appointments ahead of time, to wait for pick-ups, to have to block out half a day because by regulation, paratransit companies must arrive only within a two-hour window. “There’s no spontaneity,” Dr. Rosenbloom said. Older people also tell her they worry about telling anyone that their houses will be empty for hours.

Ridership has grown, nonetheless, rising 49 percent between 1999 and 2011. But costs have risen far more steeply. Paratransit has become shockingly expensive: an average one-way trip cost more than $34 in 2011, the Urban Institute analysis found; on average, riders paid 10 percent of that.

Strapped transit systems don’t want to foot that bill and have been cutting back, not only by adopting stricter eligibility requirements but by declining to provide service outside the required corridors, as they sometimes used to do. Lawsuits by disability advocates have also made operators less willing to be flexible.

For all these reasons, paratransit doesn’t appear able or willing to keep the growing number of older Americans mobile in the years ahead. Dr. Rosenbloom advocates expanding paratransit to areas where disabled seniors are aging in place, but she also points out that we will also need other kinds of “demand-responsive” services for those not disabled enough to qualify, along with cars made safer for older people — or anybody — to drive.

Otherwise, “by the time a 40-year-old is 70 or 75, there will be nothing out there for them,” Dr. Rosenbloom said. “People have to start working on this now.”

Important Legislation Regarding Special Needs Trusts

For Immediate Release

November 8, 2013

Contact: Abby Matienzo, Communications Associate

NAELA Commends Senators Nelson, Grassley, Rockefeller, and Enzi for Their Dedication to Improve the Lives of People with Disabilities With the Special Needs Trust Fairness Act

 The National Academy of Elder Law Attorneys (NAELA) strongly endorsed the introduction of the Special Needs Trust Fairness Act by Sens. Bill Nelson (D-FL), Chuck Grassley (R-IA), Jay Rockefeller (D-WV), and Mike Enzi (R-WY) (S.B. 1672). The bill addresses a problem facing many capable persons with disabilities: the inability to create their own special needs trust (SNT). Under the current law, a parent, grandparent, legal guardian of the individual, or a court must establish the SNT. The Special Needs Trust Fairness Act will help empower people with disabilities to be responsible for their life decisions. The House companion is H.R. 2123, introduced by Reps. Glenn Thompson (R-5th-PA) and Frank Pallone (D-6th-NJ).

The current law is based on an incorrect assumption that a person with disabilities lacks the mental capacity to enter into a contract. The disparity in the law creates a fairness and disability rights issue. In 1993, Congress recognized the use of SNTs in the Omnibus Budget Reconciliation Act of 1993 (OBRA 1993). SNTs allow assets to be held in a trust to supplement daily living expenses when government benefits alone are insufficient, thus protecting the individual against the risk of complete impoverishment. However, the law stipulates that a SNT can only be created by a parent, grandparent, legal guardian of the individual, or the court.

“The Special Needs Trust Fairness Act is a common-sense solution that will save individuals with disabilities from unnecessary legal costs and time spent in petitioning the courts and gives them back their dignity and constitutional right,” stated NAELA Board Member Michael Amoruso, Esq.

He continued: “Without this bill, I, a blind and moderately deaf attorney who regularly drafts SNTs for clients, would not be able to sign my own SNT in the future.”

NAELA President Howard S. Krooks, CELA, CAP, calls upon Congress to “make this important and cost-neutral change to USC§1396p (d)(4)(A) that will allow individuals to create their own special needs trusts by inserting the phrase ‘the individual’ into the statute so that people with disabilities can enjoy the dignity they deserve and remove the misplaced presumption that they lack capacity due to their disabilities.”

Other groups support this proposal, including Easter Seals and the American Association of People with Disabilities.

NAELA Video - Health Care Decision Making

Click on the link below for details on how you can effectively plan for your care as you age.


http://www.youtube.com/watch?v=7vNvMsp7y78

Federal Government Urges Schools To Tackle the Bullying Of Kids With Disabilities

In new guidance sent to educators across the country, federal education officials say that schools may be liable if they don’t properly address bullying of students with disabilities.

The guidance issued Tuesday in a four-page “Dear Colleague” letter details the unique obligations that schools have under the Individuals with Disabilities Education Act to ensure that children with disabilities are not victimized.

Specifically, officials from the U.S. Department of Education’s Office of Special Education and Rehabilitative Services said that bullying can lead to a denial of a student’s right to a free and appropriate public education, or FAPE, if it “results in the student not receiving meaningful educational benefit.”

What’s more, they warned schools not to automatically move a student with a disability who is being bullied to a more segregated environment. Such a change could be considered a denial of a student’s right to be educated in the least restrictive environment, the guidance said.

“We know that students with disabilities are disproportionately affected by bullying,” said Melody Musgrove, director of the Education Department’s Office of Special Education Programs. “Schools have a responsibility to ensure that FAPE and the least restrictive environment is available to students with disabilities.”

In cases where bullying occurs, educators should intervene immediately and respond “quickly and consistently,” according to the letter signed by Musgrove and Michael Yudin, acting assistant secretary for the Office of Special Education and Rehabilitative Services.

Additionally, a meeting of the student’s individualized education program team should be called to address any changes in a student’s services or program that might be needed as a result of bullying, officials said. However, the letter indicates that any student who experiences bullying should remain in his or her original placement unless they are no longer able to receive FAPE in that environment.

Musgrove said that the move to issue guidance is part of the Department of Education’s ongoing effort to address bullying within the nation’s schools. While the letter does not detail any new legal obligations, federal officials are encouraging schools to re-evaluate their policies and practices.

Several studies in recent years have suggested that children with disabilities more frequently encounter bullying. Findings released in 2012 from a nationwide poll indicated that 63 percent of kids with autism have been bullied. Another study published the same year found that about half of adolescents with autism, intellectual disability, speech impairments and learning disabilities were bullied at school.

Ari Ne’eman, president of the Autistic Self Advocacy Network, called the Education Department’s move a “significant step forward.”

“Right now, many autistic students experiencing bullying are sent to segregated settings,” Ne’eman said. “We believe this clarification of obligations emerging under IDEA’s (least restrictive environment) provision may have a significant impact on the inclusion of autistic students as well as those with other disabilities.”

Written by: Michelle Diament (disabilityscoop.com)

Innovations in Advance Care Planning

As an Elder Law attorney, I strive to ensure that all individuals know the importance of documenting their end of life wishes. Here is an interesting article about a new way in which those in the medical profession are working to document the wishes of their patients.

A Novel Way to Document End-of-Life Preferences

By Paula Span

Maybe we’ve been going about this all wrong.

In the continuing campaign to get people, particularly the old and sick, to discuss their preferences for end-of-life care, we’ve been pushing for them to have intimate conversations with family members.

Web sites like The Conversation Project and PREPARE, campaigns like National Healthcare Decisions Day in April, my own posts here — all reflect the idea that Americans can overcome their apparent aversion to acknowledging mortality if their children will just talk to them.

Progress on this front has been slow, however. Pew Research surveys found in 1990 that 12 percent of Americans had a “living will,” a figure that rose to just 29 percent by 2005. So on a nearly daily basis, the palliative care specialist Dr. Joshua Lakin told me in an interview, “I’d see someone who’d had lung cancer for several years, who’d been in and out of the hospital, had seen 20 doctors, and still hadn’t thought about the future and his priorities. It kind of blindsided me.”

So Dr. Lakin, who just completed a fellowship at the University of California, San Francisco, and some colleagues took an entirely different approach to what is called advance care planning. They experimented with brib . . . er, incentivizing doctors. And whaddya know, it worked.

As the team reported in JAMA Internal Medicine last week, the UCSF Medical Center has an incentive program to improve quality; each year its doctors-in-training pick one area to focus on. For the 2011-2012 academic year, the internal medicine department decided to concentrate on documenting patients’ advance care decisions.

The researchers came up with a standard form, which was inserted in patients’ electronic health records. It asked just a few questions: Does the patient have any “expressed wishes” about how much care he wants or doesn’t? Where are those preferences recorded — in a living will, a durable power of attorney, a P.O.L.S.T. form (which would be scanned into the record). Or are they expressed orally?

The researchers’ form requests a brief summary: He doesn’t want to be resuscitated or intubated? She wants a feeding tube but not a ventilator? Or she wants “all available care?” Does he have a designated decision maker? What is that person’s name and phone number, and what language does he or she speak?

If residents recorded this information for at least 75 percent of discharged patients, for three of the four quarters in the academic year, they each got a $400 bonus. If not, they didn’t.

The hospital, not the researchers, established that sum, but “it was enough to get people motivated,” Dr. Lakin noted. Residents around the country earn between $40,000 and $50,000 a year, plus housing stipends. An additional 400 dollars isn’t life-changing, but it’s not pin money, either. And the researchers sent out bar graphs via e-mail to point out if teams were hitting the goal or endangering everyone’s bonus. (“Marketing 101,” Dr. Lakin called it.)

The experiment followed nearly 1,500 patients, more than half the adults (of all ages) seen by the hospital’s medical department that year.

In July, the first month, only about 22 percent had their preferences documented, roughly the same proportion as before the incentives began. So “the template itself wasn’t enough,” Dr. Lakin said.

But by October, following Marketing 101, the proportion of patients with documented preferences hit 90 percent and stayed there. By contrast, a separate team of attending physicians who didn’t participate in the incentive program averaged less than 12 percent for the year.

So maybe we don’t have to keep nudzhing our parents, bracing for uncomfortable discussions. Maybe a doctor, at a hospital or not, can do this in 10 minutes without angst.

Of course, the study doesn’t answer some major questions. We don’t know how much of an incentive, if any, would motivate practicing physicians, who are paid more than residents. We also don’t know whether simply having a standard form in your medical records means that you will actually have your wishes respected — that you’ll be put on a ventilator if you said you’d want that, but not if you said you didn’t.

But we do have some idea of the scenario that ensues when people have never discussed their wishes. The medical conveyor belt cranks up. “There’s a set of default choices in the hospital system, which does things unless told not to,” Dr. Lakin said.

I’d still rather have the family conversation. But so often, it never takes place. Stricken families, sometimes bitterly at odds, wonder what Mom would want if she could speak. Maybe nobody really knows. Maybe, for a paltry sum compared with the cost of a single day in intensive care, her doctor could have found out.

Forty Percent of Adults Care For Sick, Elderly Relatives

Four in 10 U.S. adults are now caring for a sick or elderly family member as more people develop chronic illnesses and the population ages, a new study has found. "More health care is happening at home," said Susannah Fox, Associate Director of the Pew Research Center's Internet and American Life project and the study's lead author. "As more people are able to be saved by medical advances, their lives are being extended, but they're also being sent home medically fragile. It's caregivers who are the first line of defense." Researchers surveyed 3,014 adults nationwide and found that most caregivers were between 30 and 64 years old. They found that the number of caregivers increased 10 percent between 2010 and 2013. Fox also said the slow U.S. economy could explain why family members are becoming more responsible for care. With fewer or depleted savings, many people are less able to hire professional help, she said. About half of the United States population has at least one chronic condition, according to the Centers for Disease Control and Prevention. Adults ages 65 and older, 75 percent of whom have chronic conditions, are expected to make up 19 percent of the population by 2030, compared with 12 percent in 2000.

Source: Reuters

Updates to State Medicaid Eligibility and Enrollment Systems - CIOs Survey

This weekend, the final 100-day countdown to open enrollment begins. Will state Medicaid eligibility and enrollment systems be ready? Results from a recent survey published by the National Association of State Chief Information Officers (NASCIO) and the Healthcare Information and Management Systems Society (HIMSS) indicate that 72% of the 26 states and/or territories that responded report that their state or territory will be implementing a new system before 2014, when new eligibility and enrollment processes kick in.

States that participated in the survey overwhelmingly responded that most of the funding comes from the 90 percent federal match that is available for eligibility and enrollment systems development and implementation through 2015. Two-thirds (68%) of the state chief information officers (CIO) indicate they currently leverage the Medicaid eligibility system to benefit other social service programs. (Other programs can benefit from the Medicaid upgrade.

If the Medicaid system needs a feature, other programs can benefit and pay any additional cost for integrating the other program. Disappointingly, only 22 percent of states with state-based marketplaces (SBM) were definite about integrating Medicaid and the SBM systems. Over half (56%) were still undecided.

But let’s get back to the system readiness question. CMS is busily working with state Medicaid and CHIP agencies on contingency planning. To the extent that, even temporarily, states will be implementing “work-arounds,” it is important for navigators, assisters and other stakeholders to understand how any interim eligibility and enrollment processes will work. Some states are discussing their contingency plans in open door meetings, but others may be planning behind the scenes. As we get closer to open enrollment, it’s important for states to be transparent about how things will work on day one, and beyond as changes are introduced. By setting expectations openly, states may save themselves a lot of headaches even when things are working according to the contingency plan because stakeholders didn’t know what to expect.

Don’t know what your state is up to? Ask for a copy of the contingency plan, or better still, ask to participate in the contingency planning process so that the needs of consumers are well represented as key decisions are being made.

Source: Tricia Brooks

             ccf.georgetown.edu