Wednesday, May 4, 2016
The Wall Street Journal ran an article on May 2, 2016 that working past 65 may be good for the worker's longevity. Retiring After 65 May Help People Live Longer covers a recent study published in the Journal of Epidemiology and Community Health. "The risk of dying from any cause over the study period was 11% lower among people who delayed retirement for one year—until age 66—and fell further among people who retired between the ages of 66 and 72, the study found." One limit on the study-individuals studied were limited to those born between 1931-1941. The study noted "[postponing retirement may delay the natural age-related decline in physical, cognitive and mental functioning, reducing the risk of chronic illness...."
Here is an excerpt from the abstract:
Background Retirement is an important transitional process in later life. Despite a large body of research examining the impacts of health on retirement, questions still remain regarding the association of retirement age with survival. We aimed to examine the association between retirement age and mortality among healthy and unhealthy retirees and to investigate whether sociodemographic factors modified this association. .....
Conclusions Early retirement may be a risk factor for mortality and prolonged working life may provide survival benefits among US adults.
The full article is available for purchase here.
Thanks to Professor Dick Kaplan for sending us the link to the article.
Tuesday, May 3, 2016
The New York Times ran a story on May 2, 2016 that South Dakota is under investigation by the federal government for improperly placing many residents with disabilities in nursing homes instead of providing care in the community. South Dakota Wrongly Puts Thousands in Nursing Homes, Government Says reports that "the Justice Department said ... that thousands of patients were being held unnecessarily in sterile, highly restrictive group homes. That is discrimination, it said, making South Dakota the latest target of a federal effort to protect the civil rights of people with disabilities and mental illnesses, outlined in a Supreme Court decision 17 years ago."
As the story notes, many individuals need the level of care provided by a nursing home, but others do not. "But for untold numbers of others — with mental illnesses, developmental disabilities or chronic diseases — the confines of a nursing home can be unnecessarily isolating. Yet when patients seek help paying for long-term care, states often steer them toward nursing homes, even though it may not be needed." The article discusses the Olmstead decision and the government's strategies in these cases to challenge the placement.
South Dakota responded that they have made progress but the federal government sees it as not enough, especially since this is not a recent situation. "In-home health aides can be less expensive than nursing homes because they do not provide unnecessary services. States, though, face a chicken-or-egg conundrum. Does money go to nursing homes because beds are often more readily available than in-home services? Or are there fewer in-home services because less Medicaid money is spent on them? And nursing homes have little financial incentive to encourage patients to seek in-home care...."
This article can be a great starting point for an interesting discussion with students.
The New York Times ran an article by a doctor, When the Patient Won’t Ever Get Better, which illustrates a difficult scenario for patients and families. A patient, doing well, is hospitalized for some condition, surgery may occur and although successful, subsequently the patient develops one health problem after another, and will never recover to her condition prior to the hospitalization. Detailing the ups and downs of one patient, the doctor describes the patient "[a]nd then, things stopped getting better. Time slowed. There she was – neither dead nor truly alive – stuck, it seemed, in limbo." The patient declined again, more infections, use of a ventilator, etc. and then "[w]ith ... [the] constellation of ventilation dependence, infections and delirium, she had what doctors call 'chronic critical illness.'”
According to the author, this isn't that unusual a story.
[T]here are about 100,000 chronically critically ill patients in the United States at any one time, and with an aging population and improving medical technologies, this number is only expected to grow. The outcomes of these patients are staggeringly poor. Half of the chronically critically ill will die within a year, and only around 10 percent will ever return to independent life at home.
We can all imagine the scenario where our parent has a health crisis and all we want to know is whether she survived and is she "stable." After time passes, we learn that she is stable, but is chronically critically ill and won't improve. Here's how the author describes the situation
In the early moments of critical illness, the choices seem relatively simple, the stakes high – you live or you die. But the chronically critically ill inhabit a kind of in-between purgatory state, all uncertainty and lingering. How do we explain this to families just as they breathe a sigh of relief that their loved one hasn’t died? Should we use the words “chronic critical illness”? Would it change any decisions if we were to do so? ....
Perhaps this reality would be a good situation to use to discuss with our students whether they can draft language in an advance directive to deal with these situations.
Sunday, May 1, 2016
We've all been reading the articles about global warming and the impact on the planet, and on us. Although Earth Day is a couple of weeks past us, there's even more reason to think about the future of the planet. The Washington Post ran the article Why living around nature could make you live longer. The article highlights a recent study that indicates that not only is living near nature good for your health, it may help you live longer! The study was published on April 14, 2016 in the journal, Environmental Health Perspectives (EHP), Exposure to Greenness and Mortality in a Nationwide Prospective Cohort Study of Women. Here are some excerpts from abstract from the EHP article: "Objectives: We aimed to examine the prospective association between residential greenness and mortality... Conclusions: Higher levels of green vegetation were associated with decreased mortality. Policies to increase vegetation may provide opportunities for physical activity, reduce harmful exposures, increase social engagement, and improve mental health. While planting vegetation may mitigate effects of climate change, evidence of an association between vegetation and lower mortality rates suggests it also might be used to improve health."
Now, back to the Washington Post story, which tells us "[t]his is all in line with the ways previous research has suggested greenness can affect health. Places with more vegetation are generally thought to be less polluted, and the presence of vegetation, itself, can help keep air cleaner. And green spaces like parks can help encourage people to get outside, exercise and engage with other people — all factors that can improve overall health. The effects on mental health may be somewhat less straightforward, but nonetheless important, as this study suggested." As far as mental health, the article notes that social engagement and human's long term connection with nature is rejuvenating.
The article quotes one of the authors that more study is needed on the "finer details" of our interacting with nature. But for now, go outside and take a walk (and maybe buy some houseplants, too).
Friday, April 29, 2016
It seems nursing home operators are calling upon some of the same "trade practice" laws they are sometimes accused of violating, in an effort to thwart what the operators see as misleading advertising by personal injury attorneys.
One of the latest suits has reached the Georgia Supreme court, where the Mississippi-based law firm of McHugh Fuller Group is seeking to overturn a lower court's injunction preventing it from running a statewide ad campaign, including full-page color ads, seeking potential clients who "suspect that a loved one was NEGLECTED or ABUSED" by a nursing home run by PruittHealth, Inc. From an April 27, 2016 Georgia Courts' summary of parties' arguments before the high court:
PruittHealth sued the law firm under the Georgia Deceptive Trade Practices Act, which authorizes a court to issue an injunction (a court order requiring a certain action be halted) against anyone who uses someone’s trade name without permission if there is even a “likelihood” that the use will injure the business reputation of the owner or dilute its trade name or mark. The trial court entered a temporary restraining order against the law group, scheduled a hearing and notified the parties that it intended to consider PruittHealth’s request for a permanent injunction. The trial court issued another order on June 1, 2015, permanently stopping the law group from running ads that used PruittHealth’s trade names, service marks, or other trade styles. The law group filed a motion for reconsideration, which the trial court denied. The law firm is now appealing to the Georgia Supreme Court....
The law group argues, among other things, that the court erred in determining the ads violated Georgia Code section 10-1-451(b), which is called Georgia’s “antidilution statute.” That statute says dilution occurs “where the use of the trademark by the subsequent user will lessen the uniqueness of the prior user’s mark with the possible future result that a strong mark may become a weak mark.” The law firm argues that it is not eroding the strength of PruittHealth’s mark, but is only identifying specific nursing homes against which it is accepting cases, and that PruittHealth failed to demonstrate that actual injury occurred as a result of the ads.
This isn't the first time that the McHugh Fuller Law Group has been on the receiving end of a lawsuit by a nursing home company. In February 2015, Heartland of Portsmouth in Ohio and McHugh Fuller Law Group were in federal court arguing about diversity jurisdiction over Heartland's claim the law firm was using "false and misleading advertising in order to encourage tort litigation" against the nursing home's operations in Ohio. Similar litigation, seeking injunctive relief, was underway by Genesis Healthcare Corporation against the McHugh Fuller firm in West Virginia in 2007, although it is unclear from my research whether either of those cases reached a final resolutions.
My thanks to Professor Laurel Terry, Dickinson Law, for pointing me to this ABA Journal post that encouraged my search for more about these cases.
Thursday, April 28, 2016
We have heard about green cemeteries. Environmentally sensitive deaths have expanded beyond green cemeteries. According to the New York Times article from April 22, 2016 (Earth Day to those of you reading this closely), others are thinking about lowering the environmental impact a traditional burial may cause. Mushroom Suits, Biodegradable Urns and Death’s Green Frontier starts the story explaining one person's idea, a mushroom suit, or more specifically "the Infinity Burial Suit. It’s a $1,500 outfit that incorporates mushrooms meant to break down a human corpse, cleanse it of toxins and distribute nutrients back into the soil. No one has been buried in it yet, but ... a man who suffers from a chronic illness has agreed to be the first."
In addition to green burials, "[a]t Western Carolina University, researchers with the Urban Death Project are learning how best to turn corpses into compost. In Los Angeles, Undertaking LA operates a “do-your-own-death” workshop to give people the tools to plan home funerals."
What do these new businesses have in common (other than death)? "Design and innovative technology seem to be an important component of these new death products. Roger Moliné, the 24-year-old co-founder of Bios Urn, began a Kickstarter campaign after customers asked for better ways to monitor the health of the trees growing from biodegradable urns. The company raised over $83,000 to design an incubator that, through a sensor embedded in the soil, will send updates to a custom phone app. Around 60,000 urns have been ordered and 200 incubators pre-ordered."
So how do you know if burial products are truly green? Well, there is (you thought I was going to say app for that, didn't you)... there is a council that oversees this. The Green Burial Council grants certification to products that are actually earth-friendly. The list of certified products is available here.
Wednesday, April 27, 2016
JAMA's Journal of Internal Medicine ran an article in the April issue, The Challenge of New Legislation on Physician-Assisted Death . From the legal profession, we know how these laws work. But from the medical profession, according to the article, doctors need to think about how to incorporate this into their practices. Here is a sample of the article:
By the end of 2016, more than 80 million people in the United States and Canada will live in a jurisdiction allowing physician-assisted death. As such, this practice can no longer be considered a quirky experiment in a few states. The North American experience with physician-assisted death began in 1994, when voters in Oregon approved a ballot measure, the Death With Dignity Act, allowing a physician to prescribe a lethal dose of a medication that a patient voluntarily self-administers. Oregon stood alone for 14 years until Washington (2008), Vermont (2013), and now California (2015) approved similar laws. As of January 2016, the effective date of the California law, known as the End of Life Option Act, is uncertain. These laws are in general very similar, with safeguards that include requirements for a waiting period and that eligible patients be mentally competent, not mentally ill, and have a life expectancy of less than 6 months. In 2009, the Montana Supreme Court removed prohibitions against physician-assisted death for competent patients. There are no reporting requirements in Montana, so little is known about the actual practice of physician-assisted death in that state. In 2015, the Canadian Supreme Court unanimously reversed a federal law that prohibited physician-assisted death and gave the government until June 2016 to establish mechanisms for access to such assistance. (citations omitted)
A subscription is required to read the entire article.
Southern California attorney and mediator Jill Switzer, who writes columns for Above the Law as "Old Lady Lawyer," uses lyrics from Kenny Rodger's The Gambler as part of her theme in a recent essay. She asks whether lawyers prepare themselves, not just financially, but emotionally, to retire at the right time. Suggesting the answer is "probably not," Switzer draws on data from a recent California State Bar survey:
On its website, the State Bar of California recently asked its lawyers “how long do you plan to keep practicing law?” The poll was completely unscientific, as it didn’t tally the results by age, years in practice, or any other criteria whatsoever. However, the result was not surprising, at least to this dinosaur: more than fifty percent of the responding lawyers said they would continue to practice as long as they are able. (Ten percent or so said they were looking to switch careers as soon as possible, approximately twenty percent said that they hoped to take early retirement, and approximately fifteen percent said they’d practice until they turned sixty-five. Note to millennials: the retirement age at which you can start receiving full Social Security benefits is creeping upward.)
And speaking of "farewell," did you notice that Above the Law recently terminated the "comments" option for readers of the frequently sharp-tongued blog? Details here, and I suspect a few readers might view this change as somewhat ironic.
Tuesday, April 26, 2016
In Elder Law world we know the dangers that may occur with taking multiple medications. The New York Times ran an article last week that focused on the topic; The Dangers of ‘Polypharmacy,’ the Ever-Mounting Pile of Pills. "Geriatricians and researchers have warned for years about the potential hazards of polypharmacy, usually defined as taking five or more drugs concurrently. Yet it continues to rise in all age groups, reaching disturbingly high levels among older adults."
When your doctor asks you what medications you take, do you include vitamins and supplements in your answer? Many don't, according to the article, referencing a study in the Journal of American Medical Association's Journal of Internal Medicine, "A recent study in JAMA Internal Medicine, however, found that more than 42 percent of adults didn’t tell their primary care doctors about their most commonly used complementary and alternative medicines, including a quarter of those who relied most on herbs and supplements."
How many people take multiple medications? "More than a third were taking at least five prescription medications, and almost two-thirds were using dietary supplements, including herbs and vitamins. Nearly 40 percent took over-the-counter drugs."
Don't we all take supplements and vitamins? Although there is no age-specific time when folks start doing so, there is a difference in the impact based on age.
Though drug interactions can occur in any age group, older people are more vulnerable, said Dr. Michael A. Steinman, a geriatrician at the University of California, San Francisco, who wrote an accompanying commentary. ..Most have multiple chronic diseases, so they take more drugs, putting them at higher risk for threatening interactions...The consequences can also be more threatening.
The article suggests the need to revamp our health care system so it's not fragmented and until then, ask doctors and pharmacists about medications, and include vitamins and supplements in your list of medications.
The article about the study is available here.
I was bemused to realize that I was on my way to vote today in the primaries in Pennsylvania without knowing in advance the outcome of a dispute over language to be used on an a referendum issue on the ballot. The issue was mandatory retirement ages for judges in Pennsylvania. In Pennsylvania, state judges are elected.
An early formulation of the referendum question was as follows:
Shall the Pennsylvania Constitution be amended to require that justices of the Supreme Court, judges, and magisterial district judges be retired on the last day of the calendar year in which they attain the age of 75 years?
An alternative proposal for the wording was:
Shall the Pennsylvania Constitution be amended to require that justices of the Supreme Court, judges and justices of the peace (known as magisterial district judges) be retired on the last day of the calendar year in which they attain the age of 75 years, instead of the current requirement that they be retired on the last day of the calendar year in which they attain the age of 70?
Interesting, yes? The wording does appear to potentially influence the outcome on the referendum, particularly in a state where there has been a fair amount of turmoil about behavior of members of the judiciary, unrelated to age issues, but also unlikely to make the average member of the public eager to vote to extend time in office. From an education-of-the-voter standpoint, I was relieved when I saw the latter version on the ballot.
For more, read Penn Live's recent coverage on the "age" issue here. Plus, look for the outcome on the issue in news coverage after Tuesday's primary election.
4/26/16 Noon UPDATE: It turns out that even though "my" precinct's electronic ballot contained a referendum regarding the mandatory retirement age for judges, any vote on that issue doesn't actually count. The Pennsylvania legislature voted to take the judicial age question off the primary ballot. So, despite my own preference for an "educate-the-voter" version for such a referendum, on November 8 the "first" version of the language quoted above will appear. Hmmmmm. Here's more on this topic.
Monday, April 25, 2016
Last week 12 lawyers who are deaf or hard of hearing were sworn into the Supreme Court Bar. That in and of itself is very special. It was made more so by the actions of Chief Justice Roberts. Chief Justice Roberts learned some sign language for the occasion; "[a]fter they were presented to the court for admission, Roberts signed in American Sign Language: 'Your motion is granted.'” Well done Chief Justice.
Sunday, April 24, 2016
Pew Research Center issued a recent Fact Tank on Centenarians worldwide. World's Centenarian Population Projected to Grow Eightfold by 2050 explains the number of centenarians is growing rapidly. Check this out: "[t]he world was home to nearly half a million centenarians (people ages 100 and older) in 2015, more than four times as many as in 1990, according to United Nations estimates. And this growth is expected to accelerate: Projections suggest there will be 3.7 million centenarians across the globe in 2050." We know that the oldest-old have been the fastest growing for some time, so it makes sense that the number of centenarians is growing as well. The report discusses the difficulty in verification of ages for this group for various reasons.
Who has the most centenarians? "[T]he available data suggest that the U.S. leads the world in terms of the sheer number of centenarians, followed by Japan, China, India and Italy." The U.S. population isn't aging as fast as other countries, according to the report, and is "aging at a slower rate than Japan and Italy, partly due to its higher fertility and immigration rates – there are now 2.2 centenarians per 10,000 people." By 2050, China will have the greatest number of centenarians, and "[t]he centenarian share of the populations of the U.S. ... will grow less rapidly. There will be 9.7 centenarians per 10,000 people in the U.S. ..."
Here's is a new podcast of an interview with Rick Black on All Talk Radio (about 15 minutes, starting at the 3:25 minute mark), who has strong words about elder abuse based on his family's experiences with a guardianship in Clark County Nevada, plus his own additional research about guardianship systems in Nevada and beyond. (You may have to give this time to load, as it is an embedded video file).
For more, read the April 4, 2016 Editorial from the Las Vegas Review-Journal, entitled "Elder Abuse."
April 24, 2016 in Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Property Management, State Cases, State Statutes/Regulations | Permalink | Comments (0)
Friday, April 22, 2016
This semester, I took a poll with my students in Elder Law, asking their views about right to die issues. This year, perhaps more than in past years, the poll came out strongly in favor of honoring clear, adequately informed decisions of individuals to end their lives. Of course, we discussed the many grey areas, and the impact of high profile cases, such as Brittany Maynard, on current thought. We debated both the question of affirmative actions to die, particularly in states that permit physician assistance, and the potential to assume -- and or even over-assume -- that a completed "living will" is a choice to reject so-called extraordinary life-saving measures. Just because we are now more likely to support personal choices to die, does not mean we should assume that all accept a nearer end.
Relevant to this discussion is a Washington Post essay by Boston-based internal medicine and primary care resident Ravi Parikh on When a Doctor and Patient Disagree About Care at the End of Life. He describes his own experiences as he begins his career:
Not long ago, a frail-looking elderly patient appeared at my cardiac health clinic with a file full of hospitalizations stemming from a heart attack years before. He’d had three coronary stents put in, had had heart bypass surgery and was unable to walk for more than a block due to chest pain. I saw that a previous doctor had written “DNR” — do not resuscitate — in his chart, so I asked him to confirm his wishes.
No, he said, to my surprise. He actually wanted to be a “full code” — meaning that chest compressions, shocks and intubation were to be used if necessary to keep him alive.
I was taken aback....
This experience pushed him to rethink his approach to the topic, which in turn led him to The Conversation Project website. His exploration concludes with the thought that "Once we listen enough to learn, maybe those 'goals of care' discussions will start focusing on the goals of the patient, not the doctor."
Our thanks to George Washington Law's Naomi Cahn for sending this piece; she and frequent writing colleague Amy Ziettlow have a thematically related piece for a recent University of Illinois symposium on "Law, Religion and the Family Unit After Hobby Lobby: A Tribute to Professor Harry Krause."
Thursday, April 21, 2016
All of us who use social media, raise your hands. Ok, so that is a lot of us. And social media isn't just the province of the young, even though some of us may be digital immigrants. The New York Times ran a recent article about elders on Facebook. Why Do Older People Love Facebook? Let’s Ask My Dad explains about a recent survey done by Penn State.
The press release about the study, Sorry kids, seniors want to connect and communicate on Facebook, too explains "[o]lder adults, who are Facebook's fastest growing demographic, are joining the social network to stay connected and make new connections, just like college kids who joined the site decades ago, according to Penn State researchers." The study looks at the reasons why elders would be drawn to use Facebook, including curiosity, keeping in touch with friends, and connecting with family, as well as communicating with those with shared interests, what the authors refer to as social bonding, social bridging and social surveillance.
The authors suggest that the social media designers need to look at making the media more elder-friendly, and "emphasize simple and convenient interface tools to attract older adult users and motivate them to stay on the site longer." The volume of elder users is growing, so "[d]evelopers may be interested in creating tools for seniors because that age group is the fastest growing demographic among social media users. In 2013, 27 percent of adults aged 65 and older belonged to a social network, such as Facebook or LinkedIn, according to the researchers. Now, the number is 35 percent and is continuing to show an upward trend."
Returning to the New York Times article, the author asked her dad about his Facebook use; "he wanted to be better at keeping in touch with family and with the friends he remembers from my childhood. He told me over Facebook chat (naturally) that his curiosity about what others were up to was his main motivator in finally learning to navigate Facebook." The author quotes one of the co-authors of the study: "[a]s Facebook continues to be a bigger part of American life, the ever-growing population of older Americans is figuring out how to adapt. As people grow older, peer communication through chatting, status updates and commenting will become more important ... and Facebook will need to adapt tools that are suited for an aging audience."
Someone asked me recently about "alternatives" for law students interested in helping older persons or disabled adults. I said, in essence, "figure out how to start and operate a cost-effective, soundly-managed, and reliable, nonprofit rep-payee organization in your community." (And understand that you won't make a fortune, but you can make a good living with a well-run nonprofit!)
In "Ways to Meet the Growing Need for Representative Payees," Justice in Aging recommends that the Social Security System partner with organizations, including attorney organizations, to establish a "sustainable program to help recruit representative payees who are reliable and suitable to perform all of the required duties" of a rep-payee for those receiving federal program benefits but who often are unable to manage the money soundly. In some instances they may have no easy access to reliable family or friends. The "unbefriended," who, in turn, may be vulnerable to those with bad intentions:
Aging demographics and the predicted increase in cognitive deficits and other chronic conditions are expected to create a dramatic need for representative payees. For many of these seniors, family members and friends may be unavailable to serve in this capacity. SSA should think broadly about the groups of people eligible to serve as payees and then create standards for appointment, require a more in-depth level of training, and increased accountability.
Justice in Aging closes by urging that SSA's "recruitment efforts should be geared towards eligible individuals with legal experience as well as other fields with relevant backgrounds, such as social workers and religious community leaders."
Wednesday, April 20, 2016
Prime Minister Justin Trudeau was the focus of an article in the New York Times last week on physician-aided dying in Canada. Justin Trudeau Seeks to Legalize Assisted Suicide in Canada reports that a proposed law was introduced that would allow physician-aided dying "for Canadian residents and citizens who have "a “serious and incurable illness,” which has brought them 'enduring physical or psychological suffering.'"
Under Canada’s proposed law, people who have a serious medical condition and want to die will be able to commit suicide with medication provided by their doctors or have a doctor or nurse practitioner administer the dose for them. Family members and friends will be allowed to assist patients with their death, and social workers and pharmacists will be permitted to participate in the process.
One striking difference in the proposed legislation in Canada compared to those states in the U.S. where physician-aided dying is legal is that "a doctor or nurse practitioner [may] administer the dose for them. Family members and friends will be allowed to assist patients with their death, and social workers and pharmacists will be permitted to participate in the process."
Not all in Canada are in favor of the legislation. CBC Canada ran a story, Religious groups react to physician-assisted dying bill LIVE where a number of groups stated concerns about the legislation. The video is available here.
If any of our readers are from Canada, we would be very interested in hearing more about the discussion in Canada on this proposal.
CSLSA is an organization of law schools dedicated to providing a forum for conversation and collaboration among law school academics. The CSLSA Annual Conference is an opportunity for legal scholars, especially more junior scholars, to present working papers or finished articles on any law-related topic in a relaxed and supportive setting where junior and senior scholars from various disciplines are available to comment. More mature scholars have an opportunity to test new ideas in a less formal setting than is generally available for their work. Scholars from member and nonmember schools are invited to attend.
Registration will formally open in July. Hotel rooms are already available, and more information about the CSLSA conference can be found on our website at www.cslsa.us.
Tuesday, April 19, 2016
After my post on an article about adding a long term care benefit to Medicare, Professor Dick Kaplan (prolific author, elder law guru and friend) sent me an email reminding me about an article he wrote in 2004 that discussed the topic. "Cracking the Conundrum: Toward a Rational Financing of Long-Term Care,” is available from his SSRN page. Here is the abstract
This article provides a comprehensive solution to the financing of long-term care for older Americans that balances government and family responsibility, while recognizing the different settings in which long-term care is provided. The article begins by examining the spectrum of long-term care in the United States from home health care to assisted living to nursing homes, as well as hybrids such as continuing care retirement communities. Successive sections of the article then analyze the federal government's health care program for older persons (Medicare), the joint state and federal program for poor people of any age (Medicaid), and private long-term care insurance in terms of how these mechanisms treat long-term care in each setting.
Finding serious deficiencies and inconsistencies in all three mechanisms, the article then offers a co-ordinated alternative: expand Medicare to cover long-term care in nursing homes but maintain responsibility for other long-term care settings with the affected individuals and their families. This approach recognizes that nursing home care substitutes for hospital care that Medicare would otherwise cover, while other long-term care settings substitute for family-provided care. Long-term care insurance would then be used as a means of financing long-term care in settings other than nursing homes, thereby making it more appealing. In addition, such insurance would be less expensive than presently, because it would no longer be priced to cover costly nursing home care. The article also recommends that such insurance be improved by standardizing policy options and features into a fixed set of packages that would be uniform among carriers. Other recommendations include ensuring price stability of issued policies and providing independent reviews of gatekeeper claim denials. The article concludes with some observations regarding financing of these proposals.
I recently caught a rebroadcast of a Terry Gross interview -- from early 2015 and linked here -- with Dr. Frances Jensen, a neuroscientist from the University of Pennsylvania, on the "teenage brain." It was fascinating, especially as Dr. Jensen explained the latest thinking on trauma on the younger brain, and the potential for alcohol and drug use -- both illegal and legal -- to be especially significant to the still developing teenage brain. Given that we need those brains to last for a very long time, the broadcast seems relevant to our Elder Law Prof Blog topics.
This insulation process [from myelin] starts in the back of the brain and heads toward the front. Brains aren't fully mature until people are in their early 20s, possibly late 20s and maybe even beyond, Jensen says.
"The last place to be connected — to be fully myelinated — is the front of your brain," Jensen says. "And what's in the front? Your prefrontal cortex and your frontal cortex. These are areas where we have insight, empathy, these executive functions such as impulse control, risk-taking behavior."
This research also explains why teenagers can be especially susceptible to addictions — including drugs, alcohol, smoking and digital devices.
And as to that last item on the list -- digital devices -- Dr. Jensen emphasized her concerns about constant stimulation, especially when it lasts into time meant for sleeping. The intense light alone may be interfering with with sleep and brain development. She explains:
First of all, the artificial light can affect your brain; it decreases some chemicals in your brain that help promote sleep, such as melatonin, so we know that artificial light is not good for the brain. That's why I think there have been studies that show that reading books with a regular warm light doesn't disrupt sleep to the extent that using a Kindle does.
I'm from a generation that didn't pay much attention to closed head injuries -- indeed, I think we more or less thought of "mild concussion" as a right of passage for young athletes. Only in the last few years are we beginning to accept the connection between such injuries and later brain degenerative processes. Now, even as we're getting better about physical risks from sports, we need to work harder to avoid the almost round-the-clock effects of our computerized lives.
Dr. Jensen closed the interview with sound advice for everyone:
GROSS: We are out of time, but I just want to ask you if there's any quick tip you can give us to preserve our brain health - something that you would suggest that adults do?
JENSEN: I think [take] time to reflect on what you've done every day, to underscore for yourself the most important things that happen to you that day and to not respond to conflict - to try to not respond to conflict in the midst of your working environment, for instance, because it will color your efficacy.
For more, look for Dr. Jensen's book: The Teenage Brain: A Neuroscientist's Survival Guide to Raising Adolescents and Young Adults.