Issues es in t the e Repres esen entative Payee P Prog ogram - PowerPoint PPT Presentation

Issues es in t the e Repres esen entative Payee P Prog ogram f for Older Ad Adults Kate Lang, Senior Staff Attorney September 24, 2019 1

Justice in Aging is a national organization that uses the power of law to fight senior poverty by securing access to affordable health care, economic security, and the courts for older adults with limited resources. Since 1972 we’ve focused our efforts primarily on populations that have traditionally lacked legal protection such as women, people of color, LGBT individuals, and people with limited English proficiency.

Older Adults (Age 65+) with a Payee (Dec 2016) Beneficiaries/Recipients with Payee 14 12.2 12 10 Percentage 7.42 8 6 4 1.55 2 0 OASDI only SSI only Concurrent From SSAB Representative Payee Chart Collection, Chart 5 (Jan 2018) https://www.ssab.gov/Details-Page/ArticleID/1238/Representative-Payee- Chart-Collection 3

Social Security Demographics Beneficiaries 85 & older (in millions) 25 21 20 15 Millions 10 10 4.2 5 0 Projections by year 2000 2030 2050 From Anguelov, Ravida, and Weathers, Adult OASDI Beneficiaries and SSI Recipients Who Need Representative Payees: Projections for 2025 and 2035, May 2015 4

Social Security Demographics Payees for Older Adults (in millions) 4 3.56 3.5 3.26 2.9 3 2.5 Millions 2 1.5 1 0.5 0 Payee Needed 2013 2025 2035 From Anguelov, Ravida, and Weathers, Adult OASDI Beneficiaries and SSI Recipients Who Need Representative Payees: Projections for 2025 and 2035, May 2015 5

Percentage of Households Ages 70+ with Payee 10 9 8 7 6 5 4 3 2 1 0 No cognitive impairment Mild cognitive impairment Dementia Cognitive impairment status From Belbase, Sanzenbacher and King, Are Many Retirees with Dementia Lacking Help? August 2017 6

Sources of Financial Assistance for Individuals with Dementia All forms of assistance Power of attorney for health care Non-resident adult child Live-in adult child Non-impaired spouse Nursing home care Representative payee 0 10 20 30 40 50 60 70 80 90 100 From Belbase, Sanzenbacher and King, Are Many Retirees with Dementia Lacking Help? August 2017 7

Relationship to Payee for All Adults Relationship Family member Social agency Financial organization Public official Mental health insitution Non-mental health institution Other From SSAB Representative Payee Chart Collection, Chart 8 (Jan 2018) https://www.ssab.gov/Details-Page/ArticleID/1238/Representative-Payee- Chart-Collection 8

All Adults with Non-Mental Health Institution as Payee Percentage of all adults with a representative payee 18 16 14 12 10 8 6 4 2 0 OASDI only SSI only Concurrent 9

Institutional Payees • Federal • State and Local • Private, For-Profit • Non-profit • Mental • Non-mental POMS GN 00501.013(A)(2) 10

Creditors as Payees • Creditor provides the beneficiary with goods or services for monetary consideration. • Some examples of a creditor payee may be: • Nursing Homes • Assisted Living Facilities • Group Homes • Legal Guardian

Creditors as Payees “Do not select a creditor payee applicant unless the applicant is the most suitable and is . . . a facility that is licensed or certified as a care facility under the laws of the state or a political subdivision of a state.” POMS GN 00502.135 20 C.F.R. § 404.2022 Special procedure SSA should be following when screening institution applying to be payee POMS GN 00502.160

Creditors as Payees • Conflicts of interest • Representative payment should not be a convenience for the payee • Resident’s right to manage own financial affairs, as part of right to self-determination 42 C.F.R. § 483.10 (f)(10)

Trouble Transferring Facilities or Transitioning Home • Difficulty transferring to new facility • Difficulty moving back into the community ( Olmstead ) 14

Requiring Residents to Have Creditor as Payee • Provision in admissions contract • Pressure on prospective resident • Change from family member serving as payee to facility serving as payee 15

Confusion over Personal Needs Allowance • Only released to beneficiary • If beneficiary owes facility, money accrued in PNA account should be used to pay debt • Difficulty accessing funds for out-of-pocket medical expenses 16

Creditors as Payees - Recommendations • Need to be identified/tracked, with additional monitoring • Prohibit requirements that institution be appointed payee for admission • Require disclosures to beneficiaries and family members prior to appointment

Resources • Skilled Nursing Facilities and Other Creditors Acting as Representative Payees (issue brief, January 2018) • Nursing Homes Kate Lang (202) 683-1997 klang@justiceinaging.org 18