Posts Tagged ‘Pima Council on Aging’

What Can Be Done About Driving Skills As We Age?

Driving is an enormously important issue to our elderly (and disabled) clients, their family and friends. In the western U.S. and particularly in Tucson, transportation without a car is difficult and inconvenient. Safety of both the driver and the public is paramount, but the loss of independence and self-esteem as well as easy access to groceries and medical care must be addressed when a loved one can no longer safely drive.

There is no mandatory cut-off age for giving up driving. However, even the healthiest senior citizens experience age-related “slowing down” at some point — less flexibility in movement, a decrease in night vision, blurred vision from cataracts, hearing loss, etc. When decreased physical or psychological function cause unsafe behavior —either on the road or in other activities — driving should be suspended until that behavior is evaluated.

If one has difficulty seeing to prepare meals or cannot hear when there is loud knocking at the door, driving is likely also a hazard. All drivers, but especially seniors (who tend to take increasing amounts of medication as they age) must be attuned to the fact that many medications create hazardous driving situations. For example, allergy medications as well as drugs used to treat high blood pressure often have a strong sedative effect.

Seniors and their friends/families have many information resources. Information available online includes the AAA-sponsored website and, both of which help in identifying and addressing driving problems. For drivers concerned about maintaining their skill levels, AARP’s “55 Alive Driver Safety Program” is taught locally at the Pima Council on Aging (enrollment is limited; contact them at 298-3120 first.)

In 1999, the American Medical Association changed its ethical guidelines so that physicians, despite their duty to keep confidences, may report a patient’s driving impairments in order to protect public safety. Physicians or family members concerned that a senior should not be driving may contact the AZ Dept of Motor Vehicles, Medical Review Program at 1452 N Eliseo C. Felix, Jr. Way, Avondale, AZ 85323 [(623) 925-5795]. Advanced age alone is insufficient; the letter of concern should detail the driver’s deficits and must contain the driver’s name, address, date of birth, and if possible the driver’s license number.

Revoking a driver’s license may not stop the impaired driver. In a future newsletter we will discuss some strategies to deal with that problem.

Federal Budget Battles Again Focus on Medicare, Medicaid

MAY 13, 1996 VOLUME 3, NUMBER 46

Now that the Federal government has finally adopted a budget for the current year (more than half-way through the year itself), Congress and the President are turning their attention to the 1996-1997 budget year. Both the Clinton Administration and Republican Congressional leaders have developed proposals which aim to balance the budget by 2002, though they disagree on almost every element of how to reach that goal.

Nonetheless, several themes are common between the two disparate proposals. In the next six years, both approaches aim to save over $100 billion in Medicare expenditures. Each plan proposes savings of about half as much from Medicaid and a third more from other welfare programs. Defense and other cuts will about equal the cuts in all medical and welfare programs under both sets of proposals.

One big difference: Republicans also propose a tax cut of over $100 billion, while President Clinton’s tax cut would amount to only about $6 billion (though the administration disputes this calculation and insists that his tax cut would total $30 billion).

The real issue, however, is not how much the current proposals differ from one another. This year’s offering from the Administration is essentially similar to last year’s final offer to the Republicans. Congress, on the other hand, has dramatically reduced the size of the proposed tax increase, while also paring back expenditure reductions (especially in Medicare). (Still, the Medicare program is tagged with responsibility for nearly a third of all savings by Congress.)

What has changed in the Republican agenda? Conventional wisdom holds that the Presidential tactic of painting Republicans as enemies of the elderly and friends of the undeserving wealthy was a major political success. In this election year, the rhetoric is expected to be more vigorous and the product less certain.

PCOA and Local Attorneys Start Legal Clinic

The Pima Council on Aging (PCOA) and the Arizona Chapter of the National Academy of Elder Law Attorneys (NAELA) last month announced the institution of a new service for Pima County seniors. Local NAELA members have volunteered to staff an “information-only” legal clinic at PCOA’s offices every two weeks through the summer.

The legal advice clinic will match one elder law attorney with seven or eight clients for half-hour sessions. Scheduling is being handled by PCOA; callers are being screened to see if they can be helped to utilize other resources already available in the community.

Only clients over age 60 will be eligible for assistance from the legal clinic. Interested elders can contact PCOA at 790-7262 to inquire about the availability of appointments.

The clinic will not provide full legal representation. Elders who require representation in court, or continuing legal assistance, will be advised of their needs and directed to available resources. Those requiring only legal explanations and advice, however, will be able to get that help from the volunteer lawyers.

While the clinic will not charge participants for the legal advice, a donation of $15 to PCOA is suggested. Donations will help defray the cost of staff and office time incurred by PCOA; the participating attorneys will not receive any fees.

Congressional Activity Steps Up As Senate Debates Cuts


The new Republican majority in Congress has consistently worked toward balancing the federal budget and returning governmental control to a more local level. Shortly after taking charge, the new majority was also presented with projections of shortfalls in Medicare and Medicaid.

Since Medicare provides the vast majority of medical care for elderly citizens and Medicaid pays for about half of all nursing home costs nationally, any proposals for change in those two programs would necessarily have a disproportionate impact on the elderly and disabled. Recent discussions in the House and in several key Senate committees show just how dramatic that impact is likely to be.

Earlier this year, the House of Representatives and the Senate agreed to a budget for fiscal year 1996 which included a $270 billion cut in Medicare, $182 billion cut in Medicaid, elimination of many federal programs, reductions in other social programs, and a tax cut of $245 billion. The expressed goal is to balance the budget in seven years.

As the House and Senate begin to work out minor differences in their respective proposals, several common themes have emerged. It is now almost certain that the Republican plan will contain the following elements:

  • Elimination of Medicaid by converting it to a program consisting of federal block grants to the states.
  • Elimination of the Nursing Home Reform Act of 1987.
  • Major modifications to the funding and reimbursement elements of Medicare.
  • Dramatic funding cuts and restrictions on the Legal Services Corporation.
  • Drastic reductions in funding under the Older Americans Act.

Medicaid Block Grants

The largest impact might well be felt in connection with the conversion of the federal Medicaid program into a block grant to the states. Under the House proposal, for example, Arizona’s anticipated increases in Medicare funding would be reduced by a total of $711 million less over the next seven years (the 1996 payment would actually increase by $110 million). The Senate version would reduce Arizona’s anticipated Medicaid subsidy by over $1.1 billion over the same seven years, including a $141 million reduction in 1996.

At the same time that federal subsidies are drastically reduced, federal mandates on service would also be cut. Although there are differences between the House and Senate versions, both would eliminate most eligibility standards, allowing states to set their own rules for participation, copayments and deductibles. While childhood immunizations must be covered in both versions, the Senate does not expressly require nursing home coverage (though it does require coverage for elderly and disabled individuals earning less than $1142/month.

Most insidiously of all, however, the House version eliminates any requirement of rules governing spousal impoverishment. States would be free to return to the pre-1987 rules, under which an nursing home patient would receive assistance only if his spouse had spent down to $3,000 in countable assets. Even the current exemption for the patient’s home could be limited, and liens could be required at the state’s option.

Repeal of Nursing Home Standards

The Nursing Home Reform Act of 1987 set national standards of care for the industry. Among the most important consequences of the NHRA has been the dramatic reduction in use of restraints. In fact, recent studies suggest that the implementation of NHRA standards has reduced hospitalization among nursing home residents by as much as 25%.

Both the House and Senate would repeal the Nursing Home Reform Act. This would leave the adoption and enforcement of regulations to the same state governments whose inaction and failure generated bipartisan federal action in the first place.

Medicare Financing

Both the House and Senate have acted to increase premiums for all recipients. Next year, for example, premiums would be expected to rise from $46.10 per month for Medicare Part B to $54 (the premium had been scheduled to drop slightly next year). For the first time Medicare would be partially means-tested, with high income individuals (over $75,000) and couples (over $125,000) paying higher premiums. The Senate would also increase the age for Medicare coverage to 67, to match the scheduled increase in Social Security eligibility.

Originally, a significant portion of the savings was scheduled to come from reductions in payments to doctors. Facing possible American Medical Association opposition to the proposals, House Speaker Newt Gingrich last week agreed to as-yet unspecified limitations on those reductions. News reports indicate that the AMA has voted to approve the changes, after having been promised another $300 million in fees.

Legal Services Cutbacks

The national Legal Services Corporation (“Legal Aid” to most) has been the target of many previous budget cutting cycles. This time, the current budget of $415 million is slated to be cut by between 18% (Senate version) and 33% (House version). In addition, Legal Services programs will be prohibited from various activities seen as threatening the pace of welfare or regulatory reform. In the Senate version, for example, LSC lawyers would be prohibited from filing class actions.

Among the specific proposals being debated regarding Legal Services, training and education programs now provided by the National Senior Citizen’s Law Center would be eliminated. LSC lawyers would be specifically prohibited from filing any action challenging the legality of welfare reform measures or from handling fee generating cases in Medicaid, Medicare or similar litigation, even though private attorneys have not been interested in such cases.

Long Term Care Ombudsman

Since Richard Nixon’s administration, in 1972, the Long Term Care Ombudsman program has been an integral part of funding under the Older Americans Act. The Ombudsman program has been a mainstay of assistance and support for institutionalized patients and their families and advocates. Anyone working in the field for the past 25 years would be able to recall nursing home conditions and the quality of long term care prior to the activist work of local Ombudsmen.

The House Appropriations Bill would zero out funding for the Long Term Care Ombudsman, as well as elder abuse prevention. These actions would save $4.4 million and $4.7 million, respectively (remember that the Doctors’ lobby asked for and was given approximately $300 million in restored funding). The Senate would continue these programs, plus $1.3 million for legal hotline programs like the one administered by Southern Arizona Legal Aid.

The House bill also would reduce funding for the Older Americans Act by 13%. Services provided under the OAA include much of the funding for Area Agencies on Aging (such as the Pima Council on Aging in the Tucson area).

Congressional Activity Steps Up As Senate Debates Cuts

Arizona’s White House Conference on Aging


In May, delegates from around the country will convene in Washington, D.C., for the fourth White House Conference on Aging. Arizona’s delegation will include 34 representatives from advocacy groups, professional organizations and agencies. Elder Law Issues publisher Robert Fleming will be one of the delegates.

Last weekend Arizona’s delegates (together with about 100 delegates to the State Conference) met in Phoenix at the “Arizona White House Conference on Aging” to discuss the issues and make preliminary recommendations for the national Conference. Presentations focused on:

  • Elder’s legal rights,
  • Health (and mental health) care,
  • Minority and other special populations,
  • Financial security for the elderly, and
  • Long term care.

Tremendous amounts of timely information were provided. For the next few issues of Elder Law Issues, we will be synopsizing some of that information; at the conclusion, we will report some of the Arizona Conference’s final recommendations.

Elder Rights

Estimates are that as many as 1.5 million elderly Americans may be victims of abuse and exploitation. Only 1 in 8 elderly individuals receives protective services. Nationally (and locally), police and prosecutors often decline to pursue abusers and exploiters, claiming that such cases are difficult to win.

Elderly citizens routinely find their personal autonomy and dignity compromised or lost through institutionalization, even in the best nursing facilities. Legitimate concerns for safety often become the basis for unnecessary or even counterproductive guardianship actions.

Government benefit programs require bewilderingly complicated application procedures, frequently overlap and are not well-understood by seniors. Appeal procedures are often unknown to seniors who have lost benefits or been denied eligibility. Millions of older citizens may be unaware of programs which they should benefit from.

Guardianship, advance directive and exploitation laws in Arizona (and in many other states) have been reformed, but progress is uneven and often incremental. The “ombudsman” program (operated in Pima County by the Pima Council on Aging) is an excellent example of available resources, but is not well enough known among the elderly population (nor well enough funded) to be as effective as might be possible. Similarly, case management agencies and adult protective services help protect elders, but are insufficient to ensure full protection to all.

To complicate this picture, current expectations are for dramatic reductions in funding for many existing government programs. Against that background, the preservation of legal rights of the elderly is especially difficult.

[Next issue: Health Care]

Choosing a Caregiver

JUNE 6, 1994 VOLUME 1, NUMBER 28

By Joan Ardern, Community Liaison, Care Coordinators, Inc.

(Third of three parts)

An advantage of case management firms is that they have developed personal relationships with many professionals in the community and therefore have a larger network of caregivers and services at their fingertips.

The case management company should also be checked for experience and reputation in the community. Unfortunately, case management is relatively new. There are no licensure requirements. Presently, there are reputable organizations such as the National Guardianship Association and the National Association of Geriatric Case Managers that are in pursuit of accreditation. However, until a form of accreditation is in place, here is a list of questions you can ask in a phone interview:

  • How many years total experience? (More is better)
  • Who are the officers in the company?
  • What are the hourly fees?
  • Does the company have liability insurance? (A must)
  • Does the company have employee dishonesty insurance?
  • Does the company have a 24 hour on-call service? (A must)
  • Does the company have an RN on staff?
  • Is the company bonded?
  • Does the company offer personal financial services? (bill paying and insurance papers can become cumbersome)
  • Can the company provide local references?

Take your time in choosing caregivers and case managers. Don’t let a crisis situation rush you into making hasty decisions. Ask all the questions you can think of and continue to research the material. The good news is there are a lot of good caregivers out there and among them is the right one for you. After walking through the telephone book, include a phone call to your Area Agency on Aging. In Pima County call the Pima Council on Aging, 790-7262 and Senior Resource Network, 795-7480.

Assisted Suicide

A Federal Court judge in Seattle has ruled that the State of Washington may not prohibit physicians from assisting their patients to commit suicide. The judge, in a ruling handed down May 3, found that the U.S. Constitution requires the State to permit competent, terminally ill patients to seek medical assistance with the decision to end their lives.

The ground-breaking lawsuit was brought by Compassion in Dying, a non-profit organization located in Seattle and established for the purpose of assisting a select category of patients to end their lives. In order to receive assistance from Compassion in Dying, a patient must be fully competent, must have been diagnosed as terminally ill, and must have an attending physician willing to remain involved during the suicide. In addition to Compassion in Dying, the lawsuit was brought by three terminally ill patients (two of whom have since died) and four physicians who treat terminally ill patients.

The judge found that the individual’s right to privacy includes the right to end one’s life when terminally ill, and that the Constitution’s equal protection clause prohibits different treatment of the patient based solely on whether the patient is receiving life-sustaining treatment (which can be refused). An appeal is being prepared.

[Arizona’s assisted suicide law is very similar to Washington’s. Still, the ruling has no immediate effect on Arizona law.]

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