U.S. Pays Billions for ‘Assisted Living,’ but What Does It Get?

 A report provides the most detailed look to date at the role of assisted living in Medicaid, one of the nation’s largest health care programs. Credit Nam Y. Huh/Associated Press

WASHINGTON — Federal investigators say they have found huge gaps in the regulation of assisted living facilities, a shortfall that they say has potentially jeopardized the care of hundreds of thousands of people served by the booming industry.

The federal government lacks even basic information about the quality of assisted living services provided to low-income people on Medicaid, the Government Accountability Office, a nonpartisan investigative arm of Congress, says in a report to be issued on Sunday.

Billions of dollars in government spending is flowing to the industry even as it operates under a patchwork of vague standards and limited supervision by federal and state authorities. States reported spending more than $10 billion a year in federal and state funds for assisted living services for more than 330,000 Medicaid beneficiaries, an average of more than $30,000 a person, the Government Accountability Office found in a survey of states.

States are supposed to keep track of cases involving the abuse, neglect, exploitation or unexplained death of Medicaid beneficiaries in assisted living facilities. But, the report said, more than half of the states were unable to provide information on the number or nature of such cases.

Just 22 states were able to provide data on “critical incidents — cases of potential or actual harm.” In one year, those states reported a total of more than 22,900 incidents, including the physical, emotional or sexual abuse of residents.

Many of those people are “particularly vulnerable,” the report said, like older adults and people with physical or intellectual disabilities. More than a third of residents are believed to have Alzheimer’s or other forms of dementia.

The report provides the most detailed look to date at the role of assisted living in Medicaid, one of the nation’s largest health care programs. Titled “Improved Federal Oversight of Beneficiary Health and Welfare Is Needed,” it grew out of a two-year study requested by a bipartisan group of four senators.

Assisted living communities are intended to be a bridge between living at home and living in a nursing home. Residents can live in apartments or houses, with a high degree of independence, but can still receive help managing their medications and performing daily activities like bathing, dressing and eating.

Nothing in the report disputes the fact that some assisted living facilities provide high-quality, compassionate care.

The National Center for Assisted Living, a trade group for providers, said states already had “a robust oversight system” to ensure proper care for residents. In the last two years, it said, several states, including California, Oregon, Rhode Island and Virginia, have adopted laws to enhance licensing requirements and penalties for poor performance.

Senator Susan Collins of Maine was among the bipartisan group of senators who requested the government report. Credit Gabriella Demczuk for The New York Times

But the new report casts a harsh light on federal oversight, concluding that the Centers for Medicare and Medicaid Services has provided “unclear guidance” to states and done little to monitor their use of federal money for assisted living.

As a result, it said, the federal health care agency “cannot ensure states are meeting their commitments to protect the health and welfare of Medicaid beneficiaries receiving assisted living services, potentially jeopardizing their care.”

Congress has not established standards for assisted living facilities comparable to those for nursing homes. In 1987, Congress adopted a law that strengthened the protection of nursing home residents’ rights, imposed dozens of new requirements on homes and specified the services they must provide.

But assisted living facilities have largely escaped such scrutiny even though the Government Accountability Office says the demand for their services is likely to increase because of the aging of the population and increased life expectancy.

That potential has attracted investors. “Don’t miss out on the largest market growth in a generation!” says the website of an Arizona company, which adds that “residential assisted living is the explosive investment opportunity for the next 25 years.”

Carolyn Matthews, a spokeswoman for the company, the Residential Assisted Living Academy, said: “Unfortunately, there has been elderly abuse in this business. We are trying to change the industry so the elderly have better quality care and we are not warehousing them.”

The government report was requested by Senator Susan Collins of Maine, a Republican who is the chairwoman of the Special Committee on Aging; Senator Orrin G. Hatch of Utah, a Republican who is the chairman of the Finance Committee; and two Democratic senators, Claire McCaskill of Missouri and Elizabeth Warren of Massachusetts.

The Trump administration agreed with the auditors’ recommendation that federal officials should clarify the requirement for states to report on the abuse or neglect of people in assisted living facilities. The administration said it was studying whether additional reporting requirements might be needed.

“Although the federal government has comprehensive information on nursing homes providing Medicaid services, not much is known about Medicaid beneficiaries in assisted living facilities,” the report said.

Assisted living was not part of the original Medicaid program, but many states now cover it under waivers intended to encourage “home and community-based services” as an alternative to nursing homes and other institutions.

The report said that assisted living could potentially save money for Medicaid because it generally cost less than nursing home care. Under the most common type of waiver, Medicaid covers assisted living only for people who would be eligible for “an institutional level of care,” in a nursing home or hospital.

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U.S. Pays Billions for ‘Assisted Living,’ but What Does It Get?

Panel recommends 6-day suspension for Indiana judge

HARTFORD CITY, Ind. — A state panel has recommended that an Indiana judge be suspended for six days without pay following charges filed by the Indiana Judicial Qualifications Commission.

The commission filed the four misconduct charges against Blackford Circuit Court Judge Dean Young in June over a dispute with his county’s clerk.

The commission alleged Young barred then-Blackford County Clerk Derinda Shady from the courthouse while she was hospitalized in August 2015 with chest pains she suffered after refusing to attend a meeting with Young and Superior Court Judge John N. Barry without a witness. The charges also allege that Young’s conduct didn’t promote public confidence in the impartiality of the judiciary.

The panel, which was composed of three judges, said Young’s “misconduct adversely affected the integrity of and respect for the judiciary.” However, the panel also said Young’s “misconduct” wasn’t motivated “by a desire for financial personal or material gain.”

The state Supreme Court will decide what action, if any, will be taken against Young, The Star Press reported.

Attorneys for Young and the commission said they believe the recommended suspension is appropriate.

Young, a Republican, served 12 years in the Indiana House of Representatives before being elected as the circuit court judge in 2006.

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Panel recommends 6-day suspension for Indiana judge

Oregon Bill Would Allow Starving Mentally Ill Patients to Death

When Oregon became the first state in the nation to legalize the practice of assisted suicide, pro-life advocates argued this would be a slippery slope that would lead to euthanasia.

Apparently assisted suicide is not enough for the death peddlers in this Pacific Northwest State. Now they are pushing legislation in the Oregon State Legislature that would allow starving mentally ill patients to death.

A similar bill was defeated last year but the euthanasia promoters are back with a new one, Oregon Right to Life tells LifeNews. House Bill 4135 is scheduled for a hearing and possible work session in the House Health Care Committee at 3:00 pm on February 7th. It is believed this bill will move quickly because there are only 35 days in the 2018 regular session.

Last session a similar bill (SB 494) was introduced in the Senate by Senator Floyd Prozanski . It died in the House. The new bill, HB 4135, is chief sponsored by Speaker of the House, Tina Kotek.

“Supporters of this bill are touting it as a ‘fix,’ but the only fixing that is happening is fixing it so vulnerable Oregonians are left without protections and their right to basic care like food and water,” said ORTL Executive Director Lois Anderson. “One wonders what the true motivations are for this legislation.”

Anderson says HB 4135 is purported to just be a bill that makes technical changes to the current statutory advance directive form found in ORS 127.531. However, over the last 25 years Oregonians at the end-of-life stage have been protected by the current advance directive and removing it from statute has legal consequences.

“The advance directive was put into Oregon statute back in 1993. I was then a state senator when a very well vetted bill was thoroughly discussed and passed. I worked hard to ensure the advance directive was in statute. If it were to be removed from statute, I fear the legal protections we carefully placed there could be jeopardized, potentially harming end of life decisions for vulnerable patients,” stated Representative Bill Kennemer (R- HD 39).

Under current Oregon law, a healthcare representative does not have the authority to make a life ending decision for an incapable person unless the representative has been given authority to do so, or the incapable person is in one of four end of life situations defined in statute.

Anderson said that if HB 4135 is passed a person who appoints a healthcare representative, but makes no decisions regarding end of life care, would be granting his or her healthcare representative the power to make a life ending decision for the principal even when the principal is not in one of the four statutorily defined end of life situations, and even if this is not the will of the principal.

Last year’s bill was touted as a good thing, but in fact it promoted the withholding or withdrawal of nutrition and hydration (food and water) from people who are incompetent and not dying.

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Oregon Bill Would Allow Starving Mentally Ill Patients to Death

7 Action News Investigation prompts probate law change, protects heirs

LANSING, Mich. (WXYZ) - A 7 Action News investigation has now changed the law in Michigan.  Earlier this week, Gov. Rick Snyder signed the legislation that will increase protections in the law for heirs after a loved one dies.

Since Nov. 2016, 7 Investigator Heather Catallo has been exposing several loopholes in the law that allowed real estate brokers and Attorney General-appointed lawyers called Public Administrators to open probate estates after a loved one dies.  Catallo’s relentless reporting showed that Macomb County real estate broker Ralph Roberts and his company, Probate Asset Recovery, used that power from the courts to sell the homes and take thousands of dollars from the probate estates.

After the 7 Investigators exposed this, Attorney General Bill Schuette shut the practice down, and supported the changes to the law. 

“Actions that came to light last year made it clear that now is the time to make changes to the public administration system,” said Schuette in a statement Tuesday. “What has happened in the system is unacceptable and these changes to an almost 40-year-old law will help ensure this never happens again. By creating a clear, current and direct path for public administrators to follow in the probate process we can better protect Michigan citizens and weed out any bad actors.”

“Establishing a more transparent process for the appointment of a personal representative when no heir can be located will prevent future fraud schemes and prevent these fraudsters from praying on innocent heirs,” said Jim Runestad, R-White Lake. “Public administrators do good work to help our citizens and these reforms provide further safeguards when families are grieving.”

Oakland County Sheriff’s detectives are also now conducting a criminal investigation into these practices.

In May 2017, Oakland County Treasurer Andy Meisner and Oakland County Clerk Lisa Brown connected with a bi-partisan group of lawmakers to close the loopholes.  Two bills sponsored by Rep. Runestad and Rep. Jim Ellison (D-Royal Oak) were signed into law Tuesday.

Meisner is pleased the bills passed, especially since several probate judges and lawyers opposed the changes to the law.  

“We reached out to the probate bench and to the bar, and solicited their input about it,” said Meisner. 

“Despite our reaching out, they didn’t connect with us, they didn’t provide any feedback – and then they submitted a letter before the committee hearing opposing the legislation… It reflects poorly on the probate bar and the judges that they came out against the legislation, and I hope in the future when they’re confronted with this sort of obvious wrong doing that they take the stand of the people.”

Here are more details from Public Act 13 of 2018:

-Heirs will now have 63 days instead of 42 days to open a probate estate, before a Public Administrator can open the estate;

-A formal hearing is now required for a Public Administrator to be appointed;

-If an estate includes a piece of property in tax or mortgage foreclosure, PA’s must post a notice of the court hearing on the property at stake and prove that that they diligently searched for heirs.

Any Public Administrator who intentionally fails to give proper notice can now be found guilty of a 90-day misdemeanor. 

Here are more details of Public Act 14 of 2018:

-Public Administrators must give a written notice to a county treasurer’s office if there is property in the estate that’s delinquent on property taxes; then the treasurer can make sure heirs who are on tax payment plans receive notice of the opening of the estate;

-Public Administrators must now give the courts copies of the settlement statements from the sale of real estate;

-Public Administrators will now have to get court approval before selling a property that they represent, and if an heir is living in the property, the State Public Administrator must be notified.

The changes to the law also cap real estate fees and the fees related to identifying estates to only 10% of the net proceeds from the property sales.

The 7 Investigators first exposed that Roberts and PAR were often taking 33% of the total value of the estate, plus 4% in real estate commissions, as well as other charges invoiced by Roberts various companies.

The bills passed the House and Senate very quickly, and the law will take effect in 90 days.

“It is an example of democracy working the way that it’s supposed to work. The interplay between the government sector and the media -- this a great example of how it’s supposed to work.  The media providing some transparency, and then the government working to act to address the issues the media brings to bear. And so in this time where the media is under such vicious attack, I think it’s a good reminder to people across the state and the country that the media is trying to help us tell the important stories like this one,” said Meisner.

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7 Action News Investigation prompts probate law change, protects heirs

7th Circuit reverses, orders special needs trust group to pay estate

The estate of a woman whose special needs trust was drained under questionable circumstances prevailed Wednesday before the 7^th Circuit Court of Appeals. The founder of the organization that took the money is a suspended Indiana attorney facing charges that he stole from other clients’ trusts.  The organization must now repay the estate more than $200,000.

The court reversed Southern District Judge Tanya Walton Pratt and ordered the National Foundation for Special Needs Integrity Inc. to pay the estate of Missouri woman Theresa Givens $234,181.23 plus prejudgment interest.

“We respectfully disagree with our colleague on the district court,” Circuit Judge David Hamilton wrote for the panel in National Foundation for Special Needs Integrity, Inc. v. Devon Reese, as Personal Representative for the Estate of Theresa A. Givens, 17-1817. The 7^th Circuit held that Pratt’s ruling that the estate’s claim against Special Needs Integrity were barred by the doctrine of laches “was based on clearly erroneous findings of fact.”

Further, Hamilton wrote, “We must note that the Foundation’s (former) counsel, (Kenneth) Shane Service, testified that he intentionally drafted (a section of Special Needs Integrity’s agreement dealing with distributions upon the death of a beneficiary) to confuse Missouri government officials.”

Givens had set up a special needs trust with about $255,000 in settlement proceeds from a lawsuit related to injuries she received from dialysis treatments. She died shortly after the trust was established, and her children were told by Special Needs Integrity that there would be no money left in Givens’ account. Hamilton, though, noted in the opinion that Service also had testified that Givens’ “main concern was always about her children.”

While the children received none of the roughly $234,000 that remained in Givens’ trust when she died in 2011, the foundation claimed the money after initially informing Givens’ children there would be no money because the proceeds most likely would be consumed by Medicaid refunds. After the children questioned distributions to the foundation, Special Needs Integrity filed a declaratory judgment action against the estate in April 2015, which Pratt awarded.

But the 7^th Circuit found the contract Givens signed to be ambiguous and found no reason to believe Givens intended her money to go to the foundation rather than to her children. “The Foundation provided Givens with a service by managing her assets for what turned out to be just a few weeks before she died — a service for which Givens paid the Foundation” Hamilton wrote. “There is no plausible reason she would have intended to give it all the money that might be left upon her death.

“… We thus conclude that the agreement is best construed as providing that the remainder funds go to the Estate of Theresa Givens,” the panel held in reversing and ordering the foundation to pay the estate $234,181.23 plus prejudgment interest.

During oral arguments in September, Lewis & Kappes attorney David Gray, who represented Special Needs Integrity, faced tough questioning from Hamilton.

“You don’t even have records of a decision” by Service or by other foundation representatives to take the money, Hamilton said. “You just have money shifted from one account to another in 2013 and then again in 2014.

“… Why should we simply not decide it’s an ambiguous document that needs to be construed against the drafter and order distribution?” he asked Gray near the end of his presentation.

“If laches doesn’t work, nothing prevents you from doing it,” Gray responded.

Meanwhile, Service is awaiting trial on theft charges in Lawrence County, where he is accused of stealing more than $85,000 from two former clients’ special needs trusts.  Authorities believe Service may have other victims in different states. An Indiana State Police investigator said in September officials were looking into the possibility of “numerous victims in multiple states.”

Service’s next court date on the Lawrence County charges is set for March 21.

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7th Circuit reverses, orders special needs trust group to pay estate

West Virginia House backs aides giving nursing home drugs

CHARLESTON, W.Va. (AP) — West Virginia's House has voted to let nursing aides give various prescription medications to patients at nursing homes.

Supporters of the bill, approved 55-44 on Tuesday, say the certified nurse aides would have to be trained every two years, work under the direction of a registered nurse, couldn't give opioids and other drugs listed as having high potential for abuse and could give injections only with pre-filled insulin.

Aides would have to record every medication they give. They couldn't calculate dosages or work from verbal doctor's orders.

Opponents say their concerns are patient safety as well as the potential diversion of allowable medications, which include barbiturates that are potentially addictive.

Lawmakers on both sides note that 25 states allow the practice and 25 don't.

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West Virginia House backs aides giving nursing home drugs

Senate approves guardianship reform

Jack Burton, an attorney from Santa Fe, Sen. Jim White, R-Albuquerque, and Sen. Daniel Ivey-Soto, D-Albuquerque

The New Mexico Senate on Wednesday approved a two-pronged measure to provide “immediate relief” to those who have struggled for years with the abuses of a closed legal guardianship/conservator system, while creating the framework for a comprehensive system overhaul by 2020.

The unanimous vote, which sends the legislation to the House of Representatives, comes after what one senator called a “Herculean” effort to address failings of the current system – as evidenced by the recent embezzlement of millions of dollars from guardian or conservator clients of two now-defunct Albuquerque firms.

Under the measure approved Wednesday, court hearings that are now closed would be open to the public as of July 1. Family members would have more access to guardianship records and visitation wouldn’t be as easily thwarted by commercial guardians, who also have been accused in some cases of profligate spending and excessive fees. Nonfamily conservators would have to post bonds in case financial impropriety occurred.

Sen. Daniel Ivey-Soto, D-Albuquerque, one of the bill’s sponsors, said the phased-in measure would give “immediate relief and to make sure we make good on a promise (for more comprehensive changes). We will keep legislating on it.”

Sen. Jim White, R-Albuquerque, who led the reform effort, told his colleagues before Wednesday’s vote that the state’s courts need more time and money to enact the more costly aspects of the measure, such as bringing all existing cases up to compliance.

Judges approve petitions for guardianship and rely on annual reports to ensure their guardian or conservator appointees are doing their jobs.

Sen. Jerry Ortiz y Pino, D-Albuquerque, a longtime advocate of reform, recounted his experience on the Supreme Court commission appointed last year after publication of a Journal series, “Who Guards the Guardians?” The commission heard testimony from the public about the issue last year.

“It was painful to hear how dysfunctional our system has become … because we as legislators haven’t been giving the judiciary the tools to make the system work better.”

Over the months of study by the commission and several legislators, a consensus emerged: Reporting requirements to allow judges to assess a protected person’s welfare and assets aren’t stringent enough. Families are sometimes shut out of their incapacitated loved ones’ lives by guardians. And judges should improve oversight. There was also the recognition that the judiciary is financially strapped and needs additional time and resources to implement more reform.

The judiciary, for instance, identified 24,000 existing cases in its computer system as being “sequestered” – meaning closed to the public. But it isn’t clear how many of those are adult guardianship cases, and there’s no way to easily tell in each case whether the protected person or the guardian is still alive.

“We don’t have that information, and that’s part of the issue before us,” White said. ” There’s not a database that keeps track of all those cases. There may be abuse out there that we don’t know about.” A provision of the bill, he said, would entail building a database of guardianship cases.

The bill, which Sen. Sander Rue, R-Albuquerque, described Wednesday as a “Herculean effort,” incorporates but delays the more expensive requirements of a new model guardianship reform law unveiled nationwide last fall.

In essence, more time and work would be required from attorneys who file petitions, from guardians and conservators, and from judges who hear the cases.

For example, guardians and conservators would have to devise plans detailing their care of a protected person and file them with the judge. Judges would have to give specific authorization for conservators to deviate from a protected person’s will, including considering the incapacitated person’s prior directives and financial needs.

“This bill is the result of a lot of work, both nationally and locally,” said Sen. Cisco McSorley, D-Albuquerque. “There is a huge need to protect elders. This is a reflection of a new American society where older people move to the Southwest to retire … without close family members, and there’s really nobody to look after them if they have some catastrophic event. Once you are incapacitated and in front of a judge, the judge literally gives somebody else total and complete control not only over your physical being, but your money, your future financial dealings, your legal dealings.”

Ortiz y Pino said that if the measure is signed into law, “We can feel very good about plugging some of the holes, such as families getting more notification (of when hearings will occur).”

But he said that if lawmakers don’t give the courts enough money for improved oversight, such as staff to review guardian and conservator reports and for field visits to check on protected people, “we’ve just hamstrung the new law and created no better situation.”



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Senate approves guardianship reform

South Texas Judge Charged With Accepting Bribes for Favorable Rulings

The FBI has charged a South Texas judge with accepting bribes after a lawyer working as a confidential informant helped agents record the jurist allegedly accepting $6,000 in cash in exchange for favorable rulings.

Federal agents arrested 93rd State District Judge Rodolfo “Rudy” Delgado of Edinburg on Feb. 2.  Delgado was charged with “bribery concerning programs receiving federal funds,” and released on $100,000 bond. The criminal complaint filed against Delgado alleges the FBI worked with an unnamed lawyer, who confessed he had a history dating back to 2008 of bribing Delgado.

The lawyer-turned-informant, listed in the complaint under the initials CHS, worked with the FBI for over a year and participated in numerous recorded phone calls and meetings with Delgado.

The attorney provided Delgado with pre-recorded government funds on two occasions, according to the complaint. In each instance, Delgado allegedly accepted a bribe to place the attorney’s clients on bond.

The attorney wore a recording device as he met with Delgado at a restaurant to hand off an envelope containing the bribery money on Jan. 17, according to the complaint. Delgado allegedly accepted the bribe and then asked for the client and case number. Delgado placed the attorney’s client on bond the next day.

However, on Jan. 29, Delgado sent a text message to the attorney, which stated, “Good evening, please call me. The campaign contribution needs to be by check. I need to return that to you so you can write a check. Sorry about the confusion, I though you knew and I did not open the envelope till today.”

The complaint alleges the text message was an attempt by Delgado to cover up the bribe.

“Delgado had solicited contributions from CHS in the past, but when CHS offered Delgado the bribe, he did not say that it was a campaign donation. Furthermore, CHS offered and Delgado accepted a thick white envelope full of prerecorded government funds,” the complaint alleges. Delgado did not return a call for comment. Neither did his attorney, Adolfo “Al” Alvarez.

Eric Vinson, executive director of the State Commission on Judicial Conduct, said Delgado will automatically be suspended from the bench upon indictment.

The commission normally suspends judges without pay automatically if they are indicted for a felony or a misdemeanor involving official misconduct. Judges are allowed to petition the commission to resume their pay or to return to the bench after an indictment, Vinson said, but the commission has historically not allowed indicted judges to sit in Texas.

“The Feds have 30 days to indict and we’re going to kind of watch and see what happens and go from there,” Vinson said.

Delgado has a history with the commission. He was suspended from the bench in 2005 after a grand jury indicted him in connection with a driving while intoxicated incident. That suspension was later lifted by the commission in 2007 after the criminal charges against Delgado were dismissed by a visiting judge—a decision that was later upheld by Corpus Christi’s 13th Court of Appeals.

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South Texas Judge Charged With Accepting Bribes for Favorable Rulings

Volunteer advocates to help incapacitated individuals with money management

Elderly or incapacitated adults no longer able to look after their own finances will soon have advocates to look after them.

An agreement to initially create 35 volunteer advocates to oversee the financial interests of incapacitated individuals was signed Monday by the Bartholomew County commissioners.

According to the agreement, which expires Dec. 31, the Indiana Office of Court Services agrees to pay up to $50,000 to Thrive Alliance, a combination of the Aging and Community Services of South Central Indiana, Inc. and Housing Partnerships, Inc.

In exchange, the Columbus-based agency will be responsible for vetting, screening, training and supervising volunteer financial guardians, as well as for maintaining court-required progress and accounting reports.

Persons incapable of caring for themselves financially includes those with a neuro-developmental disorder, mental illness, dementia or stroke, the agreement states.

The program is structurally comparable to Court-Appointed Special Advocates (CASA), trained individuals who speak up for the best interests of children within the judicial system, Bartholomew Superior Court 1 Judge Jim Worton said.

All tasks performed by Thrive Alliance will be overseen by Bartholomew County Adult Court Services. If a problem arises from a decision or action taken by a volunteer advocate, the court can remove their financial guardianship, Worton said.

With a staff of five, Adult Court Services also provides services to Bartholomew, Brown, Jennings, Decatur and Jackson counties.

When Worton first spoke on this proposal to the commissioners in December, he was joined by Lori Bland, Thrive Alliance Guardian Program manager.

Now that baby boomers are increasingly retiring, the number of incapacitated adults is expected to grow larger than it ever has been in the past, Bland told the commissioners.

There are already as many as 400 incapacitated adults within the region that have no one else able or willing to assist them with their finances, Bland said.

Until now, only one couple — Bartholomew County Adult Protective Services employees John and Brenda Defler — have been available to advocate for those hundreds of incapacitated adults, the judge said.

“There’s no doubt in my mind we’ve needed this program for years,” John Defler said during a follow-up interview.

Besides retiring baby boomers, there has also been a noticeable increase in the number of adults with Alzheimer’s Disease and other forms of dementia, he said.

Since it’s been more than 40 years since Indiana moved away from institutionalization, there are also many incapacitated adults cared for by the parents their entire lives who now suddenly find themselves alone, Defler said.

His department works with other organizations, such as Centerstone Behavioral Health, to place those persons into extended-care facilities, supportive living quarters or group homes, Defler said.

Based on his own experiences, Defler anticipates most volunteers recruited by Thrive Alliance will be recent retirees.

Not only does that group have more time and expertise, but they also have empathy for people in need, he said.

“They know they could be that person tomorrow,” Defler said. “Whether it’s a stroke or an accident, we are all vulnerable and there are no guarantees.”

The agreement can be terminated by mutual consent, or if funding is no longer available.

The commissioners are serving as a pass-through entity for the exchange of funds, as no local tax dollars will be spent for these services, commissioner Rick Flohr said.

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Volunteer advocates to help incapacitated individuals with money management