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

• gram 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)

3 1.55 12.2 7.42 2 4 6 8 10 12 14 Percentage

Beneficiaries/Recipients with Payee

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

Social Security Demographics

4 4.2 10 21 5 10 15 20 25 Projections by year Millions

Beneficiaries 85 & older (in millions)

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

Social Security Demographics

5 2.9 3.26 3.56 0.5 1 1.5 2 2.5 3 3.5 4 Payee Needed

Millions

Payees for Older Adults (in millions)

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

Percentage of Households Ages 70+ with Payee

1 2 3 4 5 6 7 8 9 10 No cognitive impairment Mild cognitive impairment Dementia Cognitive impairment status 6

From Belbase, Sanzenbacher and King, Are Many Retirees with Dementia Lacking Help? August 2017

Sources of Financial Assistance for Individuals with Dementia

10 20 30 40 50 60 70 80 90 100 Representative payee Nursing home care Non-impaired spouse Live-in adult child Non-resident adult child Power of attorney for health care All forms of assistance 7

From Belbase, Sanzenbacher and King, Are Many Retirees with Dementia Lacking Help? August 2017

Relationship to Payee for All Adults

8

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

All Adults with Non-Mental Health Institution as Payee

9 2 4 6 8 10 12 14 16 18 OASDI only SSI only Concurrent

Percentage of all adults with a representative payee

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

18

• Skilled Nursing Facilities and Other Creditors

Acting as Representative Payees (issue brief, January 2018)

• Nursing Homes

Kate Lang (202) 683-1997 klang@justiceinaging.org