Wednesday, October 1, 2014

ADA settlement in behalf of disabled park worker in Las Vegas

The Justice Department announced today that it has reached a settlement with the City of North Las Vegas, Nevada to resolve allegations that the City violated the ADA by failing to accommodate, and constructively discharging, a Parks Department Maintenance Crew Leader with monocular vision. The Department alleged that the City unjustifiably revoked the employee's long standing reasonable accommodation, which exempted him from obtaining a Commercial Driver's License. The consent decree, which must be approved by the Court, requires the City to pay the employee compensatory damages, provide training on Title I of the ADA, and file periodic reports with the Department.

To find out more about this agreement or the ADA, call the Justice Department's toll-free ADA Information Line at 800-514-0301 or 800-514-0383 (TDD), or access its ADA website at www.ada.gov.

October 1, 2014 | Permalink | TrackBack (0)

On the Escalator of An Aging Society?

A few days ago I blogged about an article in The Atlantic explaining one person's thinking of 75 being his optimal "old age". In that same issue of The Atlantic is another article--about longevity and 100 year olds--what it will mean for society as more of us reach that age.  What Happens When We All Live to 100? was published on September 17, 2014.

The article starts with a history of sorts of life expectancies from human origins and notes that

Viewed globally, the lengthening of life spans seems independent of any single, specific event. It didn’t accelerate much as antibiotics and vaccines became common. Nor did it retreat much during wars or disease outbreaks. A graph of global life expectancy over time looks like an escalator rising smoothly. The trend holds, in most years, in individual nations rich and poor; the whole world is riding the escalator.

Projections of ever-longer life spans assume no incredible medical discoveries—rather, that the escalator ride simply continues. If anti-aging drugs or genetic therapies are found, the climb could accelerate. Centenarians may become the norm, rather than rarities who generate a headline in the local newspaper.

The article then moves to a discussion of those institutions intentionally working on increasing life spans, the Buck Institute, the U of Michigan, the U of Texas, UC-San Francisco, and the Mayo Clinic for example. Long-term readers of this blog may also remember a post about CALICO (Google's "spin-off called the California Life Company (known as Calico) to specialize in longevity research."). The article has a fascinating section about the research being done, including some interesting consideration of other life forms that excel in longevity (worm genes, anyone?).

I particular enjoyed reading the quote of one of the leaders in the field in describing the nascent nature of the research. "'[M]edically, we do not know what ‘age’ is. The sole means to determine age is by asking for date of birth. That’s what a basic level this research still is at.'”  There seems to be some debate amongst the experts about whether life expectancy will continue to rise at the steady escalator-smooth rate as in years past.  The article also mentions some of the theories advanced over time on increasingly longevity: vitamins, low calorie diets, education, exercise, etc.

One section of the article bears significant possibilities for class discussion, the political implications of an older society.

Society is dominated by the old—old political leaders, old judges. With each passing year, as longevity increases, the intergenerational imbalance worsens. The old demand benefits for which the young must pay, while people in their 20s become disenchanted, feeling that the deck is stacked against them. National debt increases at an alarming rate. Innovation and fresh thinking disappear as energies are devoted to defending current pie-slicing arrangements.

The author reveals this is a description of what is actually occurring in Japan. Consider as the author does, what increased longevity may also do to the judicial branch--especially the Supreme Court with lifetime appointments.

This article may be viewed as a bit of a wake-up alarm, although I suspect many of the folks in the US will just hit the snooze button

People’s retirement savings simply must increase, though this means financial self-discipline, which Americans are not known for. Beyond that, most individuals will likely need to take a new view of what retirement should be: not a toggle switch—no work at all, after years of full-time labor—but a continuum on which a person gradually downshifts to half-time, then to working now and then. Let’s call it the “retirement track” rather than retirement: a phase of continuing to earn and save as full-time work winds down.

Widespread adoption of a retirement track would necessitate changes in public policy and in employers’ attitudes. Banks don’t think in terms of smallish loans to help a person in the second half of life start a home-based business, but such lending might be vital to a graying population. Many employers are required to continue offering health insurance to those who stay on the job past 65, even though they are eligible for Medicare. Employers’ premiums for these workers are much higher than for young workers, which means employers may have a logical reason to want anyone past 65 off the payroll. Ending this requirement would make seniors more attractive to employers.

Back to the reasons for increasing longevity. One in the list above, education, seems to have a solid correlation and maybe not as obvious as other reasons that come to mind (vaccines, antibiotics, improved health care, public services, etc.).  The author considers the role of education in longevity and examining budget cuts by states, suggests

Many of the social developments that improve longevity—better sanitation, less pollution, improved emergency rooms—are provided to all on an egalitarian basis. But today’s public high schools are dreadful in many inner-city areas, and broadly across states ... Legislatures are cutting support for public universities, while the cost of higher education rises faster than inflation. These issues are discussed in terms of fairness; perhaps health should be added as a concern in the debate. If education is the trump card of longevity, the top quintile may pull away from the rest

The last section of the article hypothesizes on the impact of an aging society if the escalator continues its ascent, achieving perhaps a "grey utopia" of sorts. The article is well worth reading, but it makes me think about how society values, or devalues, aging. Is getting old a challenge or disease to be conquered?  For example, the author writes, "[i]f the passage of time itself turns out to be the challenge, interdisciplinary study of aging might overtake the disease-by-disease approach. As recently as a generation ago, it would have seemed totally crazy to suppose that aging could be “cured.” Now curing aging seems, well, only somewhat crazy."  Read this article and have your students read it, too.

October 1, 2014 in Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Other, Science, Statistics | Permalink | Comments (0) | TrackBack (0)

Tuesday, September 30, 2014

A/C-D/C's Malcolm Young has dementia

AC/DC co-founder, guitarist and songwriter Malcolm Young, whose retirement from the band was announced on Wednesday, has been moved into full-time care in a nursing home facility in Sydney's eastern suburbs specialising in dementia, sources connected to the Young family have said.  The Young family 6018507-largeconnection said: "If you were in the room with [Malcolm Young] and walked out, then came back in one minute later, he wouldn't remember who you are. He has a complete loss of short-term memory. His wife, Linda, has put him in full-time care."  While the announcement of Young's retirement from AC/DC, the band he formed and helped turn into the biggest Australian rock act of all time, has been inevitable for some months, it hasn't lessened the disappointment. Nor the sense of an era ending.  AC/DC has sold more than 200 million albums, and features at or near the top of highest grossing tour lists whenever it plays live.

Source/more:  Canberra Times

September 30, 2014 | Permalink | TrackBack (0)

Aussie way of life ideal for dementia-friendly communities

Via the Canberra Times:

Australia, with its weather, way of life and friendly people, has a unique advantage to produce "dementia-friendly" communities and help those affected lead fulfilling lives, according to a visiting British expert. Steve Milton, a director of Innovations in Dementia in Britain, was in Canberra this week to give a talk about dementia-friendly communities on behalf of Alzheimer's Australia.  There were sound economic reasons for supporting people with dementia at a community level, he said. "If you were able to prevent people with dementia going into care homes earlier than they needed to by 12 months, we're looking at a saving of $2 billion, which is not an insignificant amount to do something that people want anyway."  Alzheimer's Australia national president Graeme Samuel said it was important to help people with dementia sustain their independence, dignity and sense of community.  Milton said access to public transport, ensuring environments were easily accessible to people with dementia and things such as Australia's many sports clubs were important factors in helping those affected overcome barriers such as social isolation and stigma.  

Read more here.

September 30, 2014 in Cognitive Impairment, Housing, International | Permalink | TrackBack (0)

A Different Housing Bubble? Elders Selling Homes.

Kudos again to my friend and colleague, Professor Mark Bauer (current chair of the AALS Aging & Law section, btw) for sending me this article, The Great Senior Sell-Off Could Cause the Next Housing Crisis.  The article appeared in The Atlantic's CityLab, and although the article was published in 2013, I think it is still important to read (if you didn't when it was first published) because it predicts the busting of another housing "bubble" starting in 2020, just 6 years from now.

The article opens with looking at the various names of animals being swallowed by the python (that is, the Boomers and the American population). (As an aside, the article lists a number of animals--I'd only heard of the pig, but now I know we Boomers might also be compared to a bunny (cute) or "a really big rat" (ugh)). But I digress.

The focus of the article is on what will happen when the Boomers reach a certain age where they decide to sell their homes...and hope there are buyers galore for them. A researcher quoted in the article indicates that in certain larger metro areas, there should be buyers, but in less populous areas, not so much.  He describes what he calls "the “great senior sell-off” .... sometime later this decade ... [that] he predicts that it could cause our next real housing crisis."

Changing demographics will also affect the housing market and demand will not be in sync with supply as housing preferences change with age and demographics.  There is something of a bleak housing future ahead for many elders, according to the expert, who predicts "there will be two classes of seniors in America: those “aging in place” voluntarily, and those “aging in place” involuntarily because they can’t sell their homes."  His concerns about aging in place are best summarized by how a person's abilities change once s/he gets to an advanced age and becomes unable to do basic upkeep or maintenance yet the housing market will tumble, leaving some only the choice of abandoning their homes.

September 30, 2014 in Current Affairs, Housing, Retirement, Statistics | Permalink | Comments (0) | TrackBack (0)

Monday, September 29, 2014

Upcoming webinar: The Workplace and People with Disabilities: Past, Present and Future, Oct. 29

The Workplace and People with Disabilities:
Past, Present and Future


Webcast Date:  Wednesday, October 29, 2014

Webcast Time:  12:00 - 1:00 p.m. EDT


The ILR Online webcast series 2014-15 line-up will feature programs with a “past, present and future” theme, to align with Cornell University’s 150th anniversary and the ILR School’s 70th anniversary in 2015.
 
The October program will focus on employment and disability to coincide with National Disability Employment Awareness Month. Academic, policy and advocacy experts will share historical perspectives, discuss current initiatives and the state of employment for people with disabilities today, and examine issues that need to be addressed to support full workplace inclusion of people with disabilities in the future.
 
The program will be hosted by Susanne Bruyere, director of ILR’s Employment and Disability Institute, and Lisa Nishii, associate professor of human resource studies.

 

ILR Online webcast series programs feature expert insight and the latest research on today's world-of-work issues, giving you practical information that can improve your workplace and advance your organization. 

For more information about upcoming webcasts, please contact Lori Biechele, Cornell University ILR School, 607-254-8941, lb274@cornell.edu.

Previous webcasts produced by the Cornell ILR School can be viewed here.

September 29, 2014 in Cognitive Impairment, Webinars | Permalink | TrackBack (0)

Catch Up on Blogs-Elder Justice

The NYC Elder Abuse Center ran a post last week that listed the 10 top blogs from the past year. 10 Elder Justice Blogs to Inform & Inspire includes summaries as well as links to "ten great blogs from the July 2013 – June 2014 stellar blog collection that collectively discuss myriad elder justice issues – from elder abuse in popular culture to podcast interviews with leaders in the field."  Check it out and make sure you haven't missed anything!

 

September 29, 2014 in Crimes, Elder Abuse/Guardianship/Conservatorship, Weblogs | Permalink | Comments (0) | TrackBack (0)

Friday, September 26, 2014

Add This to Your Vocabulary: The Grey Belt

I always love learning new lingo.  I've heard parts of the US described as the "sun belt", the "rust belt" and the "corn belt" to name a few. Now I've learned that I live in the "sun belt" and next door to the "Grey Belt."  Thanks to my friend and colleague Professor Mark Bauer for sending me the Associated Press article, Fla.'s 'Gray Belt' a glimpse at nation's future. 

According to the article, Citrus County, Florida is the heart of the "Grey Belt"  in which "more than a third of residents are senior citizens, one of the highest rates in the nation... The county isn't simply a stereotype of Florida, where in just 15 years, one in four residents will be 65 or older. It's a peek into the not-too-distant future of the nation, where the number will be one in five."

So what's the implication of living in the "Grey Belt?"  The article notes that the businesses reflect the population and the economy shows the effect of such a population. For example, the story notes that the "economy based on low-skill jobs such as health-care aides, retail clerks and food service workers."  The result of a community where people move in to retire, rather than age-in place?  "[Those who move into an area generally aren't eager to fund schools ... whereas those who remain in the communities where they worked and raised their families tend to support education and other public spending that doesn't benefit them directly. Citrus County voters lived up to that thesis as recently as two years ago when they decisively rejected a referendum to raise property taxes to fund schools."

The article discusses the dilemma these cities face-they need younger folks to work in the service jobs that cater to the elder residents, but these folks don't always want to move to a community that is primarily elder residents.   One pastor even described his church as a "hospice church" because "congregants either die or move back north to spend their last years near relatives. Changes that might attract younger families for the almost 500-member congregation often meet resistance..."

Although Citrus County might be the center of the Florida Grey Belt, the phrase actually refers to a swath of 8 counties  with "among the oldest populations in the nation, not to mention in Florida, which has long had the highest rate of seniors in the nation, and will for decades yet... [with] Sumter [county] ...  home to the largest concentration of seniors of any county in the nation..."

Ok but really--is Florida the only location of the "Grey Belt"? We all know the US population is aging, so what about it--do we have more grey belts?  Depends on how you look at it. According to the AP article, "North Dakota, Texas, and Michigan have pockets of seniors on par with the Gray Belt counties in Florida. But unlike the Florida counties, which have grown from the migration of new seniors, they have gotten grayer as a result of younger residents leaving."

Keep in mind that the Florida grey belt only encompasses 8 counties. The state is a bit of a hodgepodge, demographically speaking, since the grey belt "contrasts starkly with the state's younger and more diverse major metro areas ...  and the interests of Gray Belt residents will diverge politically, socially and economically from Florida's more youthful cities."  Competing interests based on age will show up at the ballot box as well--talk about a tightrope for state leaders!

According to an economist with the U. of Florida ("in the nieghborhood" of the grey belt), "[s]ince voting power will tilt in favor of the older residents because of their higher voter-participation rates, the key to keeping both sides happy is to devolve all kinds of governmental decisions on taxes, planning and education from the state level to the local level so that residents in areas with both high and low concentrations of seniors will feel like their voices are being heard."

Here we go....and please, no jokes about Florida and voting. Deal?

September 26, 2014 in Current Affairs, Housing, Retirement | Permalink | Comments (0) | TrackBack (0)

Thursday, September 25, 2014

October 1: International Day of Older Persons

In 1990, the United National General Assembly, by Resolution 45/106, designated October 1 each year as the International Day of Older Persons (actually, the original resolution referred to "International Day for the Elderly") .  As observed by UN Secretary-General Ban Ki-moon, the international focus on aging-related concerns becomes more important each year:

"By 2050, the number of older persons will be twice the number of children in developed countries, and the number of older persons in developing countries is expected to double. This trend will have profound effects on countries and individuals."

John Marshall Law School, in conjunction with Roosevelt University  in Chicago, will use the occasion to further the discussion on "next steps" for the Chicago Declaration on the Rights of Older Persons, a statement formulated over the last year and presented before the UN in August.  Here are details of their planned October 1 event.

Will your school also be furthering the discussion? 

September 25, 2014 in Discrimination, Ethical Issues, International | Permalink | Comments (0) | TrackBack (0)

Nursing Homes--Does Your State Make A Passing Grade?

Families for Better Care recently released a report card to grade states on nursing homes.  Check it out to see if your state gets a passing grade! Families for Better Care is a Florida-based "non-profit citizens advocacy group" devoted to "creating public awareness of the conditions in our nation’s nursing homes and other long-term care settings and developing effective solutions for improving quality of life and care."

Their Nursing Home Report Cards is a "project that analyzes, compares and ranks state’s nursing home quality." The website allows a user to look at overall grades for states in various categories as well look at a specific ranking for a state that includes key findings, grade and rank for 2014 compared to 2013. There is also an interactive map that allows the user to quickly look at a state's "grade." The website also includes a list of the top states and the worst states.

Check it out.

September 25, 2014 in Consumer Information, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

Wednesday, September 24, 2014

Are Many Americans Making "Aging at Home" a Fetish?

In the Washington Post, Columnist Michelle Singletary warns that "Reverse Mortgages Must be Understood to Avoid Regrets."  One of the points of her column is that reverse mortgages may not be the most cost-effective plan for aging.

I've begun to worry that the problem is bigger than just mortgages.  I worry that too many Americans are making aging at home a fetish, rather than a plan.  While heading our Elder Protection Clinic at Penn State Dickinson Law for more than ten years, I often had opportunities to work with my students and their clients on various financial issues related to aging, including reverse mortgages.  While I have certainly seen reverse mortgages alleviate specific needs for older adults, I've more often seen that the struggle to stay in the home is, arguably, misguided.  What the older person is really hoping for is "not to age any more than necessary."  In other words, not to "need" care.  Hoping is different than planning.

Some of the wisest people I've known have made "aging in place" a fluid concept, rather than "home"-based.  I'm thinking of one of my long influences, Mrs. Parker, who was a salty cowgirl.  She'd grown up on horses in the Southwest and married the foreman of one of the biggest cattle ranches in Arizona.  One of my favorite stories was about the Parkers' honeymoon, when they rode a string of fresh horses from northern to southern Arizona, breaking the colts along the way.   

When ranching was no longer a way of life, the Parkers ran a riding school.  Mrs. Parker nominally taught children how to ride horses -- but really she was constantly teaching about life.  How well you actually rode the horses was often incidental to her lessons. 

One of the things I noticed was that Mrs. Parker planned "aging" for herself and her husband, who was several years older.  She knew he was very tied to place, and so they stayed in their home, a modern, but narrow "mobile home" (a/k/a "trailer") for many years beyond what their riding school income required.  After his passing, she downsized, from the trailer on 10+ acres of horse-property complete with barns, pastures and riding arenas, to an easy-care home, with a small pasture for a few "old friends."  

And then she did the most amazing thing of all.  She carefully chose a distant relative as the most trustworthy person from among her large circle of friends and family to serve as her "agent." Mrs. Parker granted this individual Power of Attorney, with an express paragraph authorizing her agent the power to choose a personal care home or other long-term care setting if that became necessary.  Which it did.  Mrs. Parker lived a very long time as a widow.  On one of my last visits with her, she said, poignantly, "I think I remember that I used to know you." 

Mrs. Parker's transition from phase to phase was financed by downsizing and by selling their property and her "retirement" home in an orderly way, without a loss of dignity and without a crisis. 

September 24, 2014 in Advance Directives/End-of-Life, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

The Cost of Caregiving? Expensive or Priceless?

We have blogged on several occasions about the issues surrounding caregiving, including the need for caregivers, who provides care, etc.  Ever wonder what caregiving costs the caregiver? If I said $5,000 per year, would you say that was more than you thought, or less? What if I told you almost 30% of caregivers spend $10,000 or more? Surprised?

Caring ran a story on the costs of caregiving based on a report they recently compiled.  Nearly Half of Family Caregivers Spend Over $5,000 Per Year on Caregiving Costs reports that nearly 50% of the "family caregivers spend more than $5,000 per year on caregiving expenses" (the study considers a family caregiver to be "someone who takes care of a family member or friend, but is unpaid for ... services.... [and] caregiving expenses include out-of-pocket costs for medications, medical bills, in-home care, nursing homes and more." What are the breakdowns for this group of caregivers? "16% spend from $5,000 to $9,999 * 11% spend from $10,000 to $19,999 * 7% spend $20,000 to $29,999 * 5% spend $30,000 to $49,999 * 7% spend $50,000 or more each year."  The report includes some other interesting statistics and includes this interesting observation

Caregiving not only has an effect on finances, but it can also impact current employment and future retirement plans, too. One-third of family caregivers (33%) spend more than 30 hours per week on caregiving, making it almost the equivalent of a full-time job. Half of caregivers have made changes to their work schedule to accommodate caregiving, while 30% often arrived late or left early and 17% missed a significant amount of work.

More details about the report  and the cost of caregiving are available here

September 24, 2014 in Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

Tuesday, September 23, 2014

The Jordan Liebhaber Scholarship Fund and Elder Decisions accepting applications for scholarship


The
Jordan Liebhaber Scholarship Fund and Elder Decisions® are, for the second time, jointly sponsoring a scholarship for a young adult between the ages of 18 to 30 to attend Elder Decisions® Elder / Adult Family Mediation Training.

The Jordan Liebhaber Scholarship Fund was created in loving memory of Jordan Washor Liebhaber, May 22, 1986 - March 29, 2013, with the intention to carry forward Jordan’s clear values and good works to help make the world a better, more caring place for our elders.  The fund seeks to help young adults with interest in the elder services field.

If you or someone you know is between the ages of 18 to 30, a trained mediator, and interested in participating in Elder Mediation Training held in Newton, MA, on
October 28-30, 2014, please submit an application directly to the fund (a link to the application is below).  The selected applicant may enroll in the Elder Decisions® October training at a rate of $75, with the remaining registration fee shared equally by The Jordan Liebhaber Scholarship Fund and Elder Decisions®.  (Note that transportation and lodging costs, if any, are the responsibility of the recipient.)   

Proposals will be reviewed on a rolling basis, and are due for the training no later than October 1st, 2014Applications for other uses of the scholarship fund are also welcome. 
 
For more information about the fund, and to read about recent award recipients, please visit www.bnaior.org/JLscholarship.html.   
 
For questions about the Elder Decisions® Elder / Adult Family Mediation training programs, please visit www.elderdecisions.com/pg19.cfm or contact Crystal Thorpe at 617-621-7009 x24

September 23, 2014 in Other, Programs/CLEs | Permalink | TrackBack (0)

The Honor Commandment & Women as Caregivers

Naomi Cahn, Harold H. Greene Professor of Law at GW Law sent me a link to an interesting article that she co-authored. Women, Eldercare, and the Honor Commandment appears in the Berkley Center for Religion, Peace & World Affairs.

Starting the article with the story of Naomi and Ruth, the article explains the authors' "work exploring modern expressions of the Honor Commandment – the Biblical command to honor one’s mother and father – ... [with] many stories of how daughters (and sons) honor their parents."  The article mentions that although the gender gap is closing as far as child care, there is still a significant gap for elder care, with the bulk of caregiving being provided by women. The article proceeds with summaries of several stories and includes quotes from the women caregivers.

"Overall, our research shows that the Honor Commandment not only continues to motivate the providing of elder care, but also reflects the full complexity of practical, emotional, and spiritual care of the family." But the caregiver dilemmas are not limited to the Jewish or Christian religions and are found throughout the world, regardless of religion.

As a society, we may be better off if a sense of honor is the motivation for care of our elders, rather than coercive or regulatory measures. The Honor Commandment and its analogues in other religions and cultures provide a moral framework and path forward that respects both individual wishes and family integrity. But the path of honor can become a “daughter track,” ...  where responsibility for caregiving falls disproportionately on women.  Providing more adequate support for caregiving would have a particularly significant effect for women, ensuring their ability to provide care while also making available the fullness of their services as equally respected worker-citizens.  Strengthening our secular laws to help support caregiving can profoundly affect how people live the Honor Commandment, improving the lives of those who receive and give family care—especially women...  (citations omitted)

The full article will appear in volume 30 of the Journal of Law and Religion (June 2015).  In addition, keep an eye out for a symposium volume in the Journal (co-editors Naomi and Amy Ziettlow) (forthcoming 2016) "will ... feature a slate of international, interdisciplinary, and interfaith scholars addressing the world-wide impact of the Honor Commandment."

Thanks Naomi!

September 23, 2014 in Current Affairs, International, Religion | Permalink | Comments (0) | TrackBack (0)

Sunday, September 21, 2014

An Optimum Age to Die?

A more positive way perhaps to word the question might be "how old do you want to live to be?"  The Atlantic ran an article that phrased it a bit differently, but still focused on at what age is long lived enough?  The author, Ezekiel Emanuel, serves as Director, Clinical Bioethics Department, National Institutes of Health & chairs U. of Pa. Department of Medical Ethics & Health Policy. Why I Hope to Die at 75 appeared in the September 17, 2014 issue.  Dr. Emanuel writes about his decision that 75 is his "magic number" and how others have tried to convince him that he should change his mind on this.  Why 75? He explains

By the time I reach 75, I will have lived a complete life. I will have loved and been loved. My children will be grown and in the midst of their own rich lives. I will have seen my grandchildren born and beginning their lives. I will have pursued my life’s projects and made whatever contributions, important or not, I am going to make. And hopefully, I will not have too many mental and physical limitations. Dying at 75 will not be a tragedy. Indeed, I plan to have my memorial service before I die. And I don’t want any crying or wailing, but a warm gathering filled with fun reminiscences, stories of my awkwardness, and celebrations of a good life. After I die, my survivors can have their own memorial service if they want—that is not my business.

He makes it clear that he is not supporting physician-aided dying and if he lives past 75, so be it-he's not going to take steps to end his life. Where his wish comes into play is the type of health care he will consent to receiving once he hits that age.  He argues that more years don't necessarily mean good years, noting that seventy is NOT the "new fifty".  Although older folks may be more active or in better health, there is still a rise in disability which he points to as a reason that the focus shouldn't just be on quantity.  He quotes another expert, "health care hasn’t slowed the aging process so much as it has slowed the dying process."  The fact of living longer but more incapacitated holds no appeal for him. 

Dr. Emanuel looks at examples of health care issues, such as stroke and dementia, using statistics and real stories to illustrate his point.  Regarding Alzheimer's, after citing to statistics on the correlation between aging and dementia, he offers

[e]ven if we aren’t demented, our mental functioning deteriorates as we grow older. Age-associated declines in mental-processing speed, working and long-term memory, and problem-solving are well established. Conversely, distractibility increases. We cannot focus and stay with a project as well as we could when we were young. As we move slower with age, we also think slower.

He also discusses the correlation between age and creativity-an inverse relationship it seems--the older you are, the less creative, unless you are one of those rare individuals (we all know of someone quite famous who did something remarkably creative at an advanced age---think Grandma Moses).

As we age, to accommodate our "current selves" we constrict how we live, and as Dr. Emanuel describes, we find ourselves "aspiring to and doing less and less".  Yet we each enjoy different things. This calls to mind some of the arguments we hear about the use of substituted judgment in health care/end of life decision-making. We each define a quality of life in different ways, and Dr. Emanuel recognizes that his view may be a bit harsh.

Yet, he contends, it is not about the elder individual racking up the years.  There is a burden on the family to be considered, and he says "I will leave aside the very real and oppressive financial and caregiving burdens that many, if not most, adults in the so-called sandwich generation are now experiencing, caught between the care of children and parents. Our living too long places real emotional weights on our progeny."

Back to his plan when he reaches 75. As far as health care, here is his plan: to "stop getting any regular preventive tests, screenings, or interventions ... [and] accept only palliative—not curative—treatments if ... suffering pain or other disability."  He makes it clear that this is his view and he respects the views of others that are contrary to his.

This article provides a wealth of topics for discussions with our students and is worthwhile reading, even though you may hold a contrary view to Dr. Emanuel.

September 21, 2014 in Advance Directives/End-of-Life, Cognitive Impairment, Dementia/Alzheimer’s, Health Care/Long Term Care | Permalink | Comments (1) | TrackBack (0)

Death Bed Radio

Seems like there have been several interesting developments in the past few weeks regarding end of life decision making. Thanks again to Charlie Sabatino, Executive Director of the ABA Commission on Law & Aging. former NAELA president, national expert on end of life issues and all around great guy, for sending me an email about the series run on WNYC public radio. The station ran a 3 part series on "death beds"  The first, Death Beds: Terminally Ill, But Constantly Hospitalized aired on September 8, 2014.  The second, Death Beds: Too Little, Too Late for Many New Yorkers Seeking Hospice aired the next day, and the third, Death Beds: Living Wills Slowly Take Root aired on September 10, 2014.

Each  includes the audio recording as well as the print story. Worth a listen!

September 21, 2014 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

Thursday, September 18, 2014

Institute of Medicine-New report: Committee on Approaching Death

The Institute of Medicine of the National Academies has released a new report on end of life issues. The report, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life  was released on September 17, 2014. The report brief offers an explanation of the importance of this new survey, including the sheer numbers of American elders who are living with some limitations on ADLs, chronic illness, cognitive issues and more.  As well the report points to issues with the health care system, including problems in accessing care, a lack of palliative care specialists and knowledge about end of life care, and a health care system that works out of sync, with economic incentives. The brief concludes with a call for "person-centered, family-oriented approach that honors individual preferences and promotes quality of life through the end of life [as] ... a national priority."  The report is "a comprehensive assessment of the knowledge gaps, structural problems, and financial disincentives that hamper delivery of optimal care and makes cross-sectoral recommendations to achieve compassionate, affordable, sustainable, and effective care for all Americans."

The website also includes a link to key findings, core components, an infographic and a quiz (5 questions) which is suitable for use in class.

The full report may be purchased as a book or downloaded as a pdf for free (registration is required).
Thanks to Charlie Sabatino for alerting me to this!

September 18, 2014 in Advance Directives/End-of-Life, Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

Home, Housing & Boomers

My colleague and dear friend Mark Bauer (current chair of the Aging & Law AALS section) sent me a link to an article published in CityLab.  The article is titled Where Are the Baby Boomers Going to Live Out Their Golden Years? The article mentions a recent report from Harvard's Joint Center for Housing StudiesHousing America's Older Adults. The Harvard website for this project includes a number of resources, including the report, an interactive map, an infographic, videos of the keynote address and panel discussion. If you don't have time to read the entire report, be sure to read the executive summary, available here.

The CityLab article mentions some other helpful sources, including an AARP survey on preferences regarding aging at home. The article references aging and disability, looking at the suitability of Boomers; homes for them in the future

The housing stock built for Baby Boomers largely wasn't designed with accessibility in mind. There are five universal-design housing features that tend to address a variety of disabilities that residents face as they age: no-step entries; single-floor living; switches and outlets set at lower heights; extra-wide hallways and doors; and lever-style doors and faucets. Nearly 90 percent of existing homes have one of these features, according to the report—but just 57 percent have two.

The article notes that more recently built homes are more likely to include at least some of these universal design features, but concludes

Yet these detached, single-floor, single-family homes—and the automobile-centric society that comes with them—are only going to fall further out of step with the needs of residents over time. And sooner rather than later. Homes can be retrofitted with lever-style handles and no-step entries (albeit at great expense). It's much harder to turn exurban and rural communities where older Americans live into places that nurture seniors rather than isolate them.

September 18, 2014 in Current Affairs, Housing, Retirement | Permalink | Comments (0) | TrackBack (0)

Wednesday, September 17, 2014

Moving Video from Cleveland Clinic

If you haven't seen this yet, it's worth watching--and showing to your class. Titled Empathy: The Human Connection to Patient Care, the video runs just over 4 minutes. It can be accessed here.

(Thanks to Judy Stein, Executive Director for the Center for Medicare Advocacy (CMA) for sharing this).

September 17, 2014 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

Question: What's the Green House Project? (Hint: It's Not About Growing Tomatoes)

Recently I sat in on a very interesting webinar on The Green House Project.  I had heard the phrase "green house" connected to new options for Continuing Care Retirement Communities (CCRCs), but I was not sure what it entailed, and it turns out it is not limited to CCRCs.  (When I first heard the term, I confused it with "green designs" intended to lower energy costs, or perhaps some movement to include gardening as therapy.) 

Here are a few highlights from what I now understand:

  • The Green House Project, about 11 years old, began with development support from a number of funding sources, including the Robert Wood Johnson Foundation, as a new approach to long-term care, requiring a major change in thinking about senior housing design and staffing.
  • The hallmark is person-centered care in a cluster setting of no more than 12 individuals, preferably 10.
  • Residents have individual bedrooms and bathrooms, thus creating "home" environments.
  • Meals are prepared and served in the central space - again, an effort to provide "home" settings.
  • No call buttons, no nursing stations, and as few wheelchairs as possible.
  • Expanded roles (and enhanced esteem) for staff members; the in-house caregivers or "shahbazim" have a wider range of responsibilities that include cooking and activity planning, and these roles involve specialized training.

Individual facilities can become "trademarked" Green Houses -- although the term has also become something of a trend in the senior housing industry, without being tied strictly to trademarking.  The Green House Project, a nonprofit organization, charges fees for formal consultations in the planning process. In some instances, fees may be covered by grants from other foundations. 

Here's the link to the Green House Project website, including information on additional upcoming (and free!)  webinars on financing, plus opportunities to participate in on-site workshops. I can see these as useful resources for students asked to consider new models for care.

September 17, 2014 in Health Care/Long Term Care, Housing, Webinars | Permalink | Comments (0) | TrackBack (0)