Elder Law Commons^™

Silver Tsunami Or Silver Rush? Extracting Value From Elders, Andrew Milne

Suffolk University Law School Faculty Works

I examine how the United States finances elder care, arguing that the legal processes structuring elder care tend to widen economic inequality and divide the interests of lower-income people against each other along generational, gendered, and racialized lines. I begin with two case narratives drawn from my practice experience as a poverty lawyer for older adults. One narrative involves an elder homeowner, while the other involves an elder renter. Both face crises of unmet care needs, the threat of homelessness, and ultimately the outcome that many older people dread most: institutionalization in a nursing home. I use these narratives as …

Law School News: Transforming Adversity Into Advocacy 9-4-2024, Andrew Clark, Roger Williams University School Of Law

Life of the Law School (1993- )

No abstract provided.

Legally Alone: The Redeemability Of Guardianship And Recommendations Toward Equitable Access, Patrick Hecker

Northwestern Journal of Law & Social Policy

American adult guardianship needs reform. Thankfully, there is a small but dedicated reform movement that sheds helpful light on problems of underfunding, inattention, and abuse. While the movement’s efforts are needed, this Note argues it is a mistake to focus solely on the ways the guardianship system is sometimes harmful to people who already have access to guardianship. Few reformers consider the needs of people who would benefit from a guardian but do not have anyone to petition the court on their behalf.

This Note first argues that guardianship, despite its detractors, is redeemable. It can be part of a …

Deinstitutionalization, Disease, And The Hcbs Crisis, Jacob Abudaram

Michigan Law Review

Primarily funded by Medicaid, home- and community-based services (HCBS) allow disabled people and seniors to receive vital health and personal services in their own homes and communities rather than in institutions like nursing homes and other congregant care facilities. The HCBS system is facing a growing crisis of care nationwide; more than 600,000 people are waitlisted for services, thousands of direct care workers are leaving the industry, and states are not committed to deinstitutionalization. The COVID-19 pandemic has highlighted and exacerbated these problems, as people in institutional settings face infection and death at far higher rates than those housed outside …

Two More Plumbers Look At The Leak: Purchasing An Annuity In An Institutionalized Spouse's Ira That Is Irrevocably Payable To The Community Spouse May Work For Medicaid Purposes But Runs A Risk Of Adverse Tax Treatment, David M. English, Ron M. Landsman

Faculty Publications

A recent article in NAELA ]ournal addressed the problem of how to maximize Medicaid benefits and minimize the tax burden for an institutionalized spouse who has a substantial individual retirement account (IRA) in a state where the account is not exempt. The primary problem is that most strategies require that the IRA be cashed out, triggering income tax liability for the entire withdrawal for that tax year. Once the IRA is cashed out, the proceeds can be spent down in any number of ways; one option is for the community spouse to purchase a Medicaid qualified annuity (MQA). The proposed …

Tax, Class, Women, And Elder Care, Nancy E. Shurtz

Seattle University Law Review

As the fastest-growing urban area in the United States—and due to its emerging national influence in commercial real estate development and leasing through transformational transactions such as Amazon’s recently completed national HQ2 search—the City of Seattle and related Washington State laws addressing the use of dual agency in commercial transactions present a unique backdrop for examining the findings and recommendations from a 2014 commercial real estate conflicts of interest research study and attendant report, described below, more than four years after its publication. In November 2014, a published research study report made a number of key observations about the existence …

The Health Care Costs Of Financial Exploitation In Maine, Kimberly I. Snow Mhsa, Yvonne Jonk Phd, Deborah Thayer Mba, Catherine Mcguire Bs, Stuart Bratesman Mpp, Charles A. Smith Phd, Erika C. Ziller Phd

Disability & Aging

This study sought to determine the Medicare and Medicaid costs experienced by dual eligible older adults in Maine for whom Maine Adult Protective Services (APS) substantiated allegations of elder financial exploitation and to compare them to those of Maine’s general older population. The analysis is an important step forward in estimating the medical costs associated with elder abuse.

Elder financial exploitation may result in significant public burden on Medicare and Medicaid, shouldered by taxpayers. Efforts to detect, investigate, prosecute, and mitigate this abuse will benefit not only the victims, but also the financial stewardship of these public programs.

Productivity And Affinity In The Age Of Dignity, Stephen Lee

Michigan Law Review

This Review proceeds as follows. Part I summarizes The Age of Dignity. Part II explains how this segment of immigrant workers challenges the productivity/affinity binary that dominates immigration law’s formal migration rules. Part III shows how this binary sets up dual migration streams, both of which could account for future flows of care workers. As Part III shows, the example of the eldercare industry nicely illustrates how the employment based and family-based migration systems simply represent two different ways of filling labor needs. I then conclude.

Selective Issues In Effective Medicaid Estate Recovery Statutes, Raymond C. O'Brien

Catholic University Law Review

Medicaid is a joint federal-state partnership program that provides medical care to the elderly, blind, and disabled poor. Unlike Medicare, Medicaid will pay for long-term care, leading millions of persons in need of such care to “spend-down” income or assets to qualify as sufficiently needy or poor. However, the state can eventually seek recovery of expenditures made through estate recovery programs following the death of both spouses. As it currently stands, states have no choice but to become increasingly vigilant in pursuing private funds in order to pay for Medicaid expenditures. As a result, elderly citizens and their families will …

Wage Theft As Public Larceny, Elizabeth J. Kennedy

Brooklyn Law Review

Home care for the elderly and disabled is a rapidly expanding industry in which structural and regulatory factors contribute to worker vulnerability and exploitation. Systemic exclusion from core federal employment and labor laws, as well as many state and local regulations, results in minimal consequences for employers who violate standards. Despite recent movement at the federal level to create a “new mindset” of rights and regulations, home care workers must be equipped with creative ways to enforce these new rights and to challenge existing gaps in enforcement. With the understanding that two-thirds of the home care industry is financed by …

The Home: Where Our Heart Resides, David M. English

Faculty Publications

Helping a client maximize the use of his or her home for these purposes is no simple task. It requires knowledge of options and resources across many domains. But stepping back and taking a broader look at these strategic opportunities and pitfalls is useful in appreciating the knowledge and skill set needed to competently counsel and represent aging clients. This article looks first at a variety of consumer protection issues, examines the interrelationship between the home and a variety of government benefits, and concludes with a discussion of technology that may enable an elderly person to remain in the place …

The Medicaid Gamble, Ann Marie Marciarille

Faculty Works

The Patient Protection and Affordable Care Act (ACA) was an unprecedented gamble. The ACA transformed Medicaid from an unevenly and underfunded program for the poor and disabled to a program to offer those priced out of commercial insurance markets government-funded health insurance similar to Medicare, the single-payer system for seniors and the disabled. In a sense, the ACA gambled that Medicaid could be more like Medicare.

The ACA, as it was transformed by the Supreme Court of the United States, became a gamble on the part of the Court that good things would follow from empowering each of the states …

Financial Security Scorecard: A State-By-State Analysis Of Economic Pressures Facing Future Retirees, Christian Weller, Nari Rhee, Carolyn Arcand

Public Policy and Public Affairs Faculty Publication Series

As Americans increasingly worry about their retirement prospects, states play an important and growing role in retirement security policy. States already manage long-term care programs for the elderly through Medicaid. Concerned about the impact of future elder poverty on state and local budgets and their local economies, a number of states are exploring the creation of low-cost and low-risk retirement savings plans for private sector workers who lack access to pensions or 401(k)s on the job. Some states have developed programs to help older workers find work.

This report presents the Financial Security Scorecard, designed to inform state-level stakeholders and …

Observing Observational Status -- Auditors And Inequities

Marquette Elder's Advisor

No abstract provided.

Implications Of Rhode Island’S Global Consumer Choice Compact Medicaid Waiver For Rebalancing Long-Term Care Under The Affordable Care Act, Edward Alan Miller, Divya Samuel, Susan Allen, Amal Trivedi, Vincent Mor

Gerontology Institute Publications

Federal approval of Rhode Island’s Global Consumer Choice Compact Global Waiver in 2009 provided Rhode Island with greater flexibility to modify its Medicaid program. Because 96% of long-term care expenditures in Rhode Island were directed toward institutional settings, a primary goal was to facilitate the state’s efforts to shift the locus of long-term care to non-institutional settings. This study draws lessons from Rhode Island’s experience with the Global Waiver for the long-term care rebalancing provisions of the Patient Protection and Affordable Care Act of 2010. Data derive from 325 archival sources and 26 semi-structured interviews. Results suggest that prospectively documenting …

Implications Of Rhode Island’S Global Consumer Choice Compact Medicaid Waiver For Designing And Implementing State Health Reform, Edward Alan Miller, Divya Samuel, Susan Allen, Amal Trivedi, Vincent Mor

Gerontology Institute Publications

Provisions in the Medicaid statute permit states to apply for waivers from traditional program requirements. On January 16, 2009, the federal government approved Rhode Island's Global Consumer Choice Compact Waiver. In exchange for a cap on combined federal and state spending of $12.075 billion through 2013, Rhode Island received greater flexibility to adopt certain Medicaid program changes. This study analyzes the design and implementation of the Global Waiver to draw general lessons for health reform at the state-level, a key concern given ongoing state discretion to improve their health care systems under the Patient Protection and Affordable Care Act. Data …

Implications Of Rhode Island’S Global Consumer Choice Compact Medicaid Waiver For Block Granting Medicaid And Other Retrenchment, Edward Alan Miller, Divya Samuel, Susan Allen, Amal Trivedi, Vincent Mor

Gerontology Institute Publications

On January 16, 2009, the Federal government approved Rhode Island’s application for a Global Consumer Choice Compact Medicaid Waiver whereby the state became the first granted permission to operate its entire Medicaid program under the state plan and a single 1115 “research and demonstration” waiver. The Global Waiver has been implemented in the context of Republican proposals to turn Medicaid into a block grant which would give states substantially more flexibility administering the program in exchange for receiving an upfront allotment from the Federal government. Proponents have held up the Global Waiver as a successful example of what might be …

Medicaid Managed Long-Term Care: Is Florida Ready, Rebecca C. Bell

St. Thomas Law Review

Medicaid is a nationwide health insurance program, created in 1965 as Title XIX of the Social Security Act for the poorest and sickest individuals. The Medicaid program operates through a federal and state partnership with the Centers for Medicare and Medicaid Services ("CMS") providing federal oversight. States must provide coverage of certain groups and services in order to receive federal funds for their Medicaid programs. However, states may include additional "optional" groups and services in each state plan. States use different methods of service delivery to Medicaid beneficiaries. In July 2011, a national average of 74.22% of Medicaid beneficiaries were …

Preserving Wealth And Inheritance Through Medicaid Planning For Long-Term Care, John A. Miller

Articles

No abstract provided.

Filial Support Laws In The Modern Era: Domestic And International Comparison Of Enforcement Practices For Laws Requiring Adult Children To Support Indigent Parents, Katherine C. Pearson

Faculty Scholarship

Family responsibility and support laws have a long but mixed history. When first enacted, policy makers used such laws to declare an official policy that family members should support each other, rather than draw upon public resources. This article tracks modern developments with filial support laws that purport to obligate adult children to financially assist their parents, if indigent or needy. The author diagrams filial support laws that have survived in the 21st Century and compares core components in the United States (including Puerto Rico) and post-Soviet Union Ukraine. While the laws are often similar in wording and declared intent, …

Disclaimer And Elective Share In The Medicaid Context, Cynthia L. Barrett

Marquette Elder's Advisor

Disclaimers of inheritance must be handled with care to ensure that they do not harm the long-term benefits provided by the federal Medicaid program. This article explores recent developments in Medicaid law, some disclaimer situations in practice, and effects of forced elective shares on Medicaid benefits. This article also discusses various means to plan for Medicaid, including the use of a Special-Needs Right-of-Election Trust.

Ethical Issues In Medicaid Planning, C. Michael Shallowy

Marquette Elder's Advisor

This article presents the importance of understanding the fairness exceptions to Medicaid. The elderly appear to have a general discomfort with getting something for free. Medicaid is a government program that almost all elderly individuals have contributed to over their life times. This article argues that Medicaid can reduce the psychological harm associated with the need for long-term nursing care.

Finding Internet Sites On Elder Issues: Health And Human Services, Robin C. Schard

Marquette Elder's Advisor

Have you ever heard the term information over load? Do you feel it every time you try to find an exact piece of information on the Internet? Here's the place to start.

The Use Of Special Needs Trusts In The Settlement Of Personal Injury Cases, Roger M. Bernstein, Margrit S. Bernstein

Marquette Elder's Advisor

This article explores the ins and outs of special needs trusts, which can offer your client improved protection against the loss of public benefits. These narrowly defined, specific trusts can help to avoid disqualification from Medicaid.

Handling Tort Recoveries For Persons Over And Under Age 65, Cheryl C. Mitchell, Ferd H. Mitchell

Marquette Elder's Advisor

Winning the case is only the first step in creating a satisfactory outcome for an injured elderly or disabled individual. Myriad rules pertain to the distribution of the award and distribution arrangements may affect current and future eligibility for programs such as Medicaid and SSI.

Spousal Refusal: Preserving Family Savings By "Just Saying No" To Long-Term Care Impoverishment, Scott M. Solkoff

Marquette Elder's Advisor

This is a case study of an elderly couple who executed a pre-nuptial agreement to keep their assets separated. When the husband required long-term care, the state required the assets of both to be considered in determining Medicaid eligibility. This article explores the effect and applicability of the Just Say No rule and the difficulty of preserving the assets of the non-institutionalized spouse.

Naela White Paper On Long-Term Care Reform

Marquette Elder's Advisor

The current system for addressing long-term care is a non-system. It is a hodgepodge of services that fail to meet its intended needs and is economically inefficient. This White Paper analyzes the problems and proposes recommendations to serve as policy solutions for citizens and government

Be Careful What You Wish For: The Maryland Medicaid Waiver Experience, Jason A. Frank

Marquette Elder's Advisor

No abstract provided.

State Court And Administrative Medicaid Litigation-A Case Study, Steven C. Perlis

Marquette Elder's Advisor

The article examines a case study discussing an elderly couples access to Medicaid. The case was created to determine whether to approve the elderly couples Medicaid request.

A Medicaid Long-Term Care Eligibility Primer: Basic Eligibility Rules

Marquette Elder's Advisor

Determining Medicaid eligibility for elders who need nursing home care is central to the practice of elder law. The purpose of various Medicaid rules, which vary from state to state, can seem incomprehensible- even for those who provide excellent Medicaid planning services.