By a Proclamation signed on April 30 and reprinted below, President Obama declared that May is Older Americans Month.
May is also National Elder Law month. Let us make sure we honor our seniors by assuring that they receive all the protection and support they deserve.
For half a century, communities in every corner of our country have come together to honor older Americans in a special way during the month of May. We carry that tradition forward again this year by recognizing their accomplishments, sharing their stories, and showing support and appreciation for our elders.
With groundbreaking advances in medicine and health care, Americans are living longer and achieving more. Many seniors are using a lifetime of experience to serve those around them. Even after decades of hard work, men and women are taking on new roles after retirement — organizing, educating, innovating, and making sure they leave the next generation with the same opportunities they had. It is a commitment that shines brightly in programs like Senior Corps, which connects more than half a million people to service opportunities from coast to coast.
As older Americans strive to lift up their neighborhoods, my Administration is working to make sure they get the tools they need to make a difference. We are helping more seniors get involved in volunteer service and give back to those around them. We are also finding new ways to make sure seniors live with dignity as full members of their communities — from improving access to health care to broadening employment opportunities. And to ensure older Americans have resources they can count on, my Administration will continue to protect and strengthen Medicare and Social Security not just for this generation, but also for those to come.
Our seniors deserve the best our country has to offer. This month, we pay tribute to the men and women who raised us, and we pledge anew to show them the fullest care, support, and respect of a grateful Nation.
The “fiscal cliff” deal signed by President Obama at the end of 2012 established a new Commission on Long-Term Care. This is the first time that Congress has recognized the need to make a a comprehensive evaluation of long-term supports and services since the U.S. Bipartisan Commission on Comprehensive Health Care (the Pepper Commission) more than twenty years ago.
Last month, a group of members of the Life Care Planning Law Firms Association (www.lcplfa.org) met to discuss what we would like to suggest to the Commission. We came up with the following list (in no particular order!):
- All private long-term care insurance and state Medicaid agencies should cover home health and assisted living, as well as nursing home care
- Home health and nursing home aides should receive a fair wage, including overtime, so that high quality individuals are attracted to this career
- The immigration law that allows foreign young people to serve as nannies or au pair girls should be expanded to allow foreign nationals to serve as caregivers for seniors
- Some sort of training should be provided to seniors when they enroll in Medicare to make sure they understand that Medicare does not cover long-term or custodial care
- State pooled trusts for Special Needs Trusts should be allowed for individuals over 65
- A tax credit should be allowed for Long Term Care Insurance premiums
- Access to Palliative care should be expanded
- Make it easier to coordinate care among physicians as a way to manage cost and improve that care
One of the Commission members is a past president of the National Academy of Elder Law Attorneys (www.naela.com), and we are eager to reach out to her to share our thoughts and learn about what the commission is doing.
What would you tell them? Join the conversation!
Under current law, a patient must have been admitted to the hospital for at least three days before Medicare will cover subsequent skilled nursing care. If the time that the patient has spent in the hospital has been considered “observation status,” no matter how long it lasts, the patient will not be eligible for Medicare coverage if she is then discharged to a skilled nursing facility. This has created a hardship for untold numbers of patients who have no idea that it is important to be formally admitted to the hospital in order to have Medicare cover the care they need.
Congressman Joe Courtney (D-CT), Congressman Tom Latham (R-IA), and Senator Sherrod Brown (D-OH) have introduced legislation, which would allow for the time patients spend in the hospital under “observation status” to count toward the requisite three-day hospital stay for coverage of skilled nursing care.
Congressman Courtney, Congressman Latham and Senator Brown are working to obtain additional co-sponsors and garner support for the bill. Additionally, a “Dear Colleague” letter is currently circulating on Capitol Hill. If your Congressman is not listed among the co-sponsors for H.R. 1179 (see list below), we ask that you please contact him or her now and ask that they co-sponsor the legislation. If they are listed, please let them know that you strongly support this bill, and you appreciate their efforts.
House – Rep David N. Cicilline (RI-1), Rep Rosa L. DeLauro (CT-3), Rep Raul M. Grijalva (AZ-3), Rep James R. Langevin (RI-2), Rep John B. Larson (CT-1), Rep Tom Latham (IA-3), Rep David Loebsack (IA-2), Rep Richard M. Nolan (MN-8), Rep Eleanor Holmes Norton (DC) and Rep Janice D. Schakowsky (IL-9).
You may be aware of a recent event in the news whereby a nurse at an independent living facility called 911 for a resident in apparent cardiac arrest, but then refused to initiate CPR while waiting for the paramedics to arrive. She stated that it was against facility policy for her to perform CPR or to “recruit” someone else to assist. The resident was pronounced dead at the hospital.
Perhaps this senior and her family were well aware of the policy and agreed to it. Or maybe the nurse was simply afraid of losing her job if she went against policy. Whatever the reason, the situation brought to light the importance of knowing what you’re getting (or not getting) when you move into a particular senior living facility, and making sure that your end-of-life decisions are documented and known to those who need to know.
Most independent living facilities are no different than living on your own in an apartment. Therefore, it may be reasonable that the facility does not want to incur potential liability for initiating CPR on an “independent” senior. And they may take no responsibility for knowing what the senior would want for end-of-life care.
Assisted living and skilled nursing facilities provide actual hands-on nursing care to varying degrees, so they typically ensure that residents have Living Wills and Medical Powers of Attorney on file, with more of an implicit understanding that staff will act accordingly in an emergency.
Completing, reviewing and updating advance directives is the cornerstone of any law firm practicing life care planning. So is assisting seniors in selecting appropriate senior living facilities to meet their specific needs. Initiating end-of-life discussions, choosing agents and documenting wishes are critical. So is making sure that the Medical Power of Attorney retains the original documents, and copies are provided to all healthcare providers and appropriate family members.
Apparently, this family felt their loved one received appropriate care. And that may very well be because they were aware of what “independent living” meant and had an understanding of this particular senior’s end-of-life wishes. Let’s make sure that’s true for all of us.
Following the repeal of the Community Living Assistance Services and Supports (CLASS) Act in January, Congress legislated the formation of a bi-partisan Commission on Long-Term Care to develop a plan to make long-term care services available to elderly individuals, individuals with substantial cognitive or functional limitations, and other individuals who require assistance. This 15-member, bi-partisan Commission on Long-Term Care has been charged with developing “a plan for the establishment, implementation, and financing of a comprehensive, coordinated, and high-quality system that ensures the availability of long-term services and supports…[for] elderly individuals, individuals with substantial cognitive or functional limitations, other individuals who require assistance…” The President and the minority and majority leaders of the House and the Senate each appointed three commission members., which resulted in six Republican appointments and nine Democratic appointments. Among the appointees is Judy Stein, the Executive Director of the Center for Medicare Advocacy and a Past President of The National Academy of Elder Law Attorneys (www.naela.org)
The commission is charged with submitting a report within six months, with recommendations for legislative or administrative action. The report will be
introduced as a Senate bill if approved by a majority of the commission members. It is estimated that 70% of all people who reach age 65 will need long-term care services, and, according to the 2012 Met-Life survey of long-term care services , the national daily average cost for a semi-private room in a nursing home increased 3.7% from 2011 to 2012, and the cost of a room in an assisted living facility, or similar care at home , increase 2.1% in the same time period. This expense is overwhelming for many of the people I see in my practice, and is only going up. I wish the Commission the best of luck, and look forward to reporting their recommendations.
Last Thursday we celebrated our move to City North in Phoenix by hosting a reception. We wanted to show appreciation to our professional associates for their past and future collaboration and support. It was an opportunity for people to learn more about our life care planning law firm, to network, enjoy good food and receive some meaningful education.
We appreciated the excellent turnout and plan to host future educational and networking events in the future.