Thursday, October 23, 2014

Happy Birthday Kim Dayton

Kim Dayton, founder of the elderlawprof blog, co-blogger, author of many books and articles, and creator of many superb elder law projects is celebrating her birthday!

October 23, 2014 | Permalink | TrackBack (0)

UK News: Assisted suicide guidelines relaxed by Director of Public Prosecutions

Via The Telegraph:

Doctors and nurses who help severely disabled or terminally ill people to take their own lives are less likely to face criminal charges after Britain's most senior prosecutor yesterday amended guidelines on assisted suicide.  Until now all health care professionals faced a greater chance than others of being prosecuted for helping people to die because of the trust their patients placed in them.  Alison Saunders, the Director of Public Prosecutions, said this special deterrent would now only apply to those directly involved in a person's care.  Anti–euthanasia campaigners accused Ms Saunders of "decriminalising" assisted suicide by health care professionals "at a stroke of her pen".  Dr Michael Irwin, the former GP nicknamed "Dr Death" for helping several people kill themselves, said the change was a "wonderful softening" that would "make life easier" for people like him.  He said he and many other retired doctors would now feel able to help people travel to Switzerland's Dignitas centre "without worrying".  But campaigners for legalisation of assisted dying said the amendment did not go far enough.  Ms Saunders insisted the change was simply a clarification and would not offer anyone "immunity" against prosecution for assisted suicide, which is punishable by up to 14 years in jail.  Guidelines published by the former DPP, Sir Keir Starmer, in 2010 say people acting "wholly out of compassion" could avoid prosecution for helping people end their lives. But the guidelines also list circumstances that would make prosecution more likely. They include where someone is "acting in his or her capacity" as a medical doctor.

Source/more:  The Telegraph

October 23, 2014 in Advance Directives/End-of-Life, Crimes, International | Permalink | TrackBack (0)

Wednesday, October 22, 2014

The Worst Waiting List?

I've heard about the backlog for SSD appeals, but I had no idea how much of a backlog exists until I read the story in the October 19, 2014 Washington Post. Waiting on a Social Security disability appeal? Get in line — a very long line brings a new perspective on waiting lists.  The story reports that there are  990,399 (you read that right, 990,399)  SSD appeals waiting for ALJ hearings.  We have been hearing a lot about the backlog with the VA (526,000 according to the story) so why haven't we heard about the SSDI case backlog?   Want to know how long it takes for a backlog of almost one million cases to occur? According to the Post story, the backlog has been going on since President Ford's administration, but a significant increase occurred between 2008-20014.  Why did this occur?  "[T]he system became, in effect, too big to fix: Reforms were hugely expensive and so logistically complicated that they often stalled, unfinished. What’s left now is an office that costs taxpayers billions and still forces applicants to wait more than a year — often, without a paycheck — before delivering an answer about their benefits." As well, factor in the "Great Recession" and Boomers.  The article also mentions budget cuts to SSA as well as the government shutdown in 2013.

A sad irony-the story quotes one of the ALJs in S. Florida who had 2 claimants die before their appeals were heard, but the ALJ still had to hear the case of one, because if the decedent were determined to have been disabled, then the decedent's surviving child might receive benefits.

Although SSD waiting lists outnumber both VA and Patents, according to the story, the  wait time to decision is shorter than that for the VA and Patent office.  The SSA ALJs "are the moral centerpiece of this system: a symbol that the government intends to apply the old American ideal of due process before the law to the vast new caseloads of the American welfare state. They are also the system’s biggest problem — a 40-year-old clog in the pipe." A law prof at GW, Richard Pierce, takes the position "that the government should eliminate the judges altogether and just let the bureaucrats with the paperwork decide. [Professor Pierce] said that the main thing these hearings bring to the process — that face-to-face interaction between judges and applicants — often adds only pathos, not useful information."

A push to shrink the backload resulted in a drop of both cases and wait time in 2010 but a review of the decisions noted an uptick in the award of benefits.  It would seem, from reading this article, that part of the problem is outdated requirements and resources available to the judges (or lack thereof).  SSA has lessened the pressure on the ALJs to some extent, so now the ALJs are  "limited ... to 720 cases a year and [SSA] imposed new checks to make sure the “yes” decisions are as well thought-out as the 'noes.'"  The uptick in benefits awards has dropped, with the award of benefits at 44%.  Despite the fact that SSSA has hired more ALJs, the backlog is pushing one million. The Post reports that there were an additional 13,000 added in the first two weeks of October!  The story concludes by noting that the backlog isn't limited to just the ALJs.  The Appeals Council also has a backlog: "There are 150,383 people waiting for an Appeals Council decision. The average wait there is 374 days."

October 22, 2014 in Current Affairs, Federal Cases, Federal Statutes/Regulations, Social Security | Permalink | Comments (0) | TrackBack (0)

Seoul To Slow Down Traffic Signals For Elderly

Via the Wall St. Journal

As South Korea ages more quickly than most other countries on the planet, it’s doing something new to help those in the twilight of their lives: slowing down changes in traffic signals to allow more time to cross the road.  The Seoul city government said on Monday it will lengthen intervals between changes in traffic signals by the end of this year in 59 areas where welfare centers are located for the aged.  Traffic signals in those areas will be adjusted for a walking speLights bwed of 0.8 meter per second, slower than the current speed of one meter per second. The new standard will allow people an additional 7.5 seconds to complete a 30-meter crosswalk.  The city government said it also plans to make traffic lights transition more slowly from red to green in the same areas because the elderly react slowly to signal changes.  South Koreans are known for a  “pali-pali” (hurry up) culture and often walk quickly or run on the streets.  “Most regular pedestrians, especially the young, may feel like the new traffic signal changes are too slow,” said Kim Kyoung-woo, a Seoul city government official in charge of the safety of pedestrians.  The new policy is partly a response to an increasing number of senior citizens falling victim to the traffic accidents in recent years. Official data show the number of traffic accidents involving those aged 65 or older in the capital totaled 4,500 in 2013, up 20% from in 2011.  Last year in Seoul, 34% of total deaths in traffic accidents were of people aged 65 or older.

Read more.

October 22, 2014 | Permalink | TrackBack (0)

Glen Campbell's Last Song

We posted back in August about Glen Campbell's status with Alzheimer's disease.  A recent story on NBC News, covering his status reported that he still plays guitar and his label released his last song, I’m Not Gonna Miss You.” .

His final tour was filmed and a documentary, Glen Campbell: I'll Be Me, will be released October 24th, 2014. The article explains that he was in stage 2 when the tour started and stage 4 when it ended.  Throughout, though, he played a mean guitar.

The NBC story includes three video clips, one which shows his last recording session.

Thanks to law student Erica Munz for sending me the link to the story. Calendar October 24, 2014 and go see this movie.

October 22, 2014 in Cognitive Impairment, Dementia/Alzheimer’s, Health Care/Long Term Care, Music | Permalink | Comments (0) | TrackBack (0)

Tuesday, October 21, 2014

Alberta care homes fight to prevent release of financial reports

Via the Calgary Herald:


A continuing care operator is fighting a recent ruling by Alberta’s information czar that would reveal how hundreds of millions in taxpayer dollars are spent each year at the province’s nursing homes and supportive living facilities.  A continuing care operator is fighting a recent ruling by Alberta’s information czar that would reveal how hundreds of millions in taxpayer dollars are spent each year at the province’s nursing homes and supportive living facilities.  Shepherd’s Care Foundation is asking the courts to overturn a decision by the Office of the Information and Privacy Commissioner ordering the release of the complete annual financial returns it and other operators file with Alberta’s health authority.  In a notice seeking judicial review, the Edmonton-based organization says making the returns public under the province’s freedom of information legislation would cause significant harm to its business and labour relations interests.  Filed as a condition of the facility’s contract with Alberta Health Services, the returns show the amounts a facility derives each year from the public purse and from resident fees.  The document also details how much of that money is spent on care, food and administration and whether any surplus or profit is left over at the end of 12 months.  The OIPC ruling stems from requests filed with AHS by the Alberta Union of Provincial Employees several years ago for the returns of 15 continuing care operators with which it was involved in collective bargaining on behalf of workers.

Read more here.

October 21, 2014 in Consumer Information, Housing, International | Permalink | TrackBack (0)

The Straightforward Pension System

The New York Times ran a story on October 11, 2014 about the Dutch pension system. No Smoke, No Mirrors: The Dutch Pension Plan focuses on the straightforward way that the Netherlands runs their pension program. "The Dutch system rests on the idea that each generation should pay its own costs — and that the costs must be measured accurately if that is to happen."  The Dutch system works well, but it isn't without costs. The workers put away almost 2% more than U.S. workers but the Americans are including Social Security, which is not intended to fully replace pre-retirement earnings, but instead should  "provide just 40 percent of a middle-class worker’s income in retirement."

The article notes that Dutch employers, like those in the U.S., contribute as well, but usually with a ceiling on contributions. Seem odd to have it capped? The article offers that this is actually an incentive for employers to stay with the plans. There's also another advantage to the Dutch system-if the markets do well and the pension has a surplus, the employer can't access it.

There are additional provisions that ensure success and checks and balances put into the system. Check out the article.

 

 

October 21, 2014 in International, Retirement, Social Security | Permalink | Comments (1) | TrackBack (0)

Monday, October 20, 2014

Improvements Coming to Nursing Home Compare

Earlier this month, CMS announced that it was going to update and improve the Nursing Home Compare site, which should result in more accurate information available for consumers. According to the October 6, 2014 press release, "the expansion and strengthening of the agency’s widely-used Five Star Quality Rating System for Nursing Homes will improve consumer information about individual nursing homes’ quality."

Starting in January, "CMS and states will implement focused survey inspections nationwide for a sample of nursing homes to enable better verification of both the staffing and quality measure information that is part of the Five-Star Quality Rating System." CMS is also adding to the quality measures used. Also CMS will be doing some "focused survey inspections" for verification purposes  of the information that is being submitted.

According to the Center for Medicare Advocacy October 16, 2014 weekly alert, a new law, "[t]he Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act of 2014) ... supports one of the key changes –providing funding to implement a provision of the Affordable Care Act (ACA) that requires nursing home staffing data reported on Nursing Home Compare to be electronically-submitted and "based on payroll and other verifiable and auditable data."

Check it out!

October 20, 2014 in Consumer Information, Health Care/Long Term Care, Housing, Medicare | Permalink | Comments (0) | TrackBack (0)

Friday, October 17, 2014

Watch the Arizona Election for This Proposal

With the mid-term elections in a few weeks away, there are some interesting proposals to watch, according to a series in Governing. A story that was published on October 16, 2014 focused on Arizona.  Arizona Tests Popularity of the Dying's Right to Try Unapproved Drugs focuses on the ability of terminally ill individuals to try experimental drugs. Proposition 303 would allow the patients to not wait for FDA ok if the drug maker is willing to get the drug to the patient.  Arizona is not the first state to consider this. Similar provisions have been approved in Colorado, Missouri, Michigan and Louisiana.

Even though FDA approval wouldn't be required, it still isn't the wild west of experimental drug use.  "The drug must have passed initial toxicity and dosage testing under the FDA’s clinical trial process. Doctors also can’t prescribe an unapproved drug unless the patient has exhausted other options. Manufacturers are under no obligation to provide the drugs and insurers aren’t required to pay for them."

The article discusses the opposition to such laws, giving reasons such as providing false hopes and the likely decrease in clinical trials. Supporters refute the agrument, noting that the terminally ill folks are not typically eligible for clinical trials. These laws are different than the FDA's "compassionate use" provisions which  "allows for experimental drugs for even seriously ill patients, and the program rarely denies an application, but “right-to-try” supporters again argue that the process is too complex and slow, as evidenced by application figures averaging about 1,000 a year."

One thing different about Arizona's proposal-the residents are voting on the provision.

October 17, 2014 in Health Care/Long Term Care, Science | Permalink | Comments (0) | TrackBack (0)

Thursday, October 16, 2014

White House Conference on Aging Website Launch

Planning for the 2015 White House Conference on Aging (WHCOA)  is in full swing. The website has been launched and there is also a WHCOA blog available. You can also sign up for email updates to stay in the loop on WHCOA developments.

October 16, 2014 in Consumer Information, Current Affairs, Programs/CLEs | Permalink | Comments (0) | TrackBack (0)

Wednesday, October 15, 2014

"Psychiatric Boarding"

Governing ran a story about a recent court ruling, Mental Health Ruling in Washington State Could Reverberate through the Country. The article concerns the practice of "psychiatric boarding" or     "[w]ith increased demand on proper mental health facilities, the practice known as psychiatric boarding -- temporarily holding mentally ill patients in hospital ERs until beds become available at certified treatment centers..." A national issue, the practice is unconstitutional in Washington state as a result of a lawsuit filed last year by a number of patients. Not only did experts testify that patients who are psychiatrically boarded get little, if any, mental health treatment, in fact, one government report shows that the patients will actually deteriorate.  Implications of state laws that require involuntary detention:  "states also regularly lack the space to place individuals in certified facilities. As a result, patients are held for days -- in some cases literally strapped to beds -- in emergency departments at acute-care hospitals until a bed opens up."

In August, the Washington State Supreme Court ruled this practice unconstitutional, despite the state's arguments regarding insufficient budgets and available beds. The article notes that Washington state is not alone in facing this issue, with a number of states admitting to psychiatric boarding. However, just increasing beds isn't the solution to this issue, the article goes on to discuss.  Quoting the executive director of the Bazelon Center, the better solution is more beds plus broad-based community care.

 

October 15, 2014 in Current Affairs, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

Monday, October 13, 2014

Graying of Federal Prisons

We have blogged in the past about the topic of the aging of the prison population. A report was released in August that focused on the issue in the federal prison system. Aging Behind Bars: Trends and Implications of Graying Prisoners in the Federal Prison System was released in August of 2014 by the Urban Institute. Unsurprisingly, the report notes the growing cohort of prisoners who are elderly.  From the executive summary this is one conclusion that surprised me "[t]he proportion of older female prisoners is growing faster than that of older male prisoners, and providing health care services to aging women generally costs substantially more."  In addition to aging and rate of growth, the report looks at costs, with a substantial cost based on age, including "[t]he fiscal burden of aging prisoners is applicable to a wide range of prison operations (e.g., medical supplies, welfare services, treatment, training), not just the upkeep of medical housing units." 

Among the conclusions and recommendations, (1) "[c]losely monitor the growth of the older prisoner population, as recent years have witnessed a considerable demographic shift in the BOP population, and it is expected to continue in the near future." (2) "[d]evelop an empirically driven definition of older prisoners." 

Elder Law profs will be interested in the need for this definition because

[t]here is no definitive consensus as to the definition of older or “geriatric” prisoners, typically ranging from 50 to 65. Given that one of the primary motivations for examining aging prisoners is the economic burden facing all levels of governments, we recommend using data to empirically identify the age threshold at which older prisoners pose minimal risk of recidivism and can be more cost-effectively managed through noncustodial means."

Another recommendation also calls for better data collection,  since "[t]he risk of recidivism drops as prisoners get older, and there will come a time when an additional year of prison time no longer yields a meaningful reduction in the risk of recidivism among older prisoners. Identifying such a point in one’s incarceration history would have direct policy implications for the management of aging prisoners."

The report includes a recommendation for  "cost-effective management plans..."  The report also addresses to some extent the policy issues of incarceration.

Raising awareness of the needs of aging prisoners and equipping BOP with policy options to address such needs may not closely conform to some of the fundamental principles of punishment, such as retribution. However, it is important to recognize that poor management of prison systems can affect the rest of the criminal justice system, responsible for ensuring public safety, and potentially lead to a violation of prisoners’ constitutional or statutory rights. These concerns are increasingly more relevant and should be balanced with the question of how well our prison system serves the principles of punishment.

October 13, 2014 | Permalink | Comments (0) | TrackBack (0)

Nominate Inspiring Caregivers

Know a caregiver who inspires you?  Nominate that caregiver for recognition.  Huff/Post50, in recognition of National Family Caregivers Month in November is seeking nominations for inspirational caregivers.  Rita Wilson, editor at large for Huff/Post50 explains this in her letter to readers

In 2011, we made clear our generation was not ready to "go gentle into that good night." Our belief is that age doesn't define us -- and that we can still accomplish great things while also having a lot of fun whether we're 21 or 51 or 81. But our focus on the positive doesn't exclude reality. And the reality is that many people over 50 have become caregivers to elderly parents, unhealthy partners or ailing friends.

The deadline for nominations is October 22, 2014 at 11:59 p.m. edt.  To nominate someone send an email to Shelley.Emling@huffingtonpost.com, subject line: caregivers, and include the name, contact info and hometown of nominee as well as a narrative (up to 500 words) of why this person is an inspiring caregiver.  Include a photo or a video of the nominee. Selected caregivers will be featured in November issue of the Huffington Post.

October 13, 2014 | Permalink | Comments (0) | TrackBack (0)

NSCLC Hosts Webinar on "Assisted Living State by State"

Our friends at National Senior Citizens Law Center, in cooperation with the Assisted Living Consumer Alliance, are hosting a free webinar on Wednesday, October 22 on "Assisted Living State by State."

The program will offer several perspectives on regulatory systems that may affect the range of care options that are not defined as "skilled care."  The program will use California has part of the focus, while explaining what regulations are already in use and whether improvements are needed across the nation.

Here's additional information the link for registration for this free, hour-long program.   

October 13, 2014 in Housing, Webinars | Permalink | Comments (0) | TrackBack (0)

Sunday, October 12, 2014

Research Demonstrates Lasting Importance of Stimulus to Emotions of Those With Dementia

NPR's Weekend Edition Sunday highlighted a new study that suggests people with Alzheimer's may  hold on to happy or sad emotions beyond the event that triggers those feelings.  Here's the link to the audio.

The University of Iowa researchers published their article in the September 2014 issue of the journal Cognitive and Behavioral Neurology, and it follows preliminary studies they published in 2010.  The study used 20 minute movie clips with "happy" or "sad" themes with test groups.  As summarized by Iowa Now:

About five minutes after watching the movies, the researchers gave participants a memory test to see if they could recall what they had just seen. As expected, the patients with Alzheimer’s disease retained significantly less information about both the sad and happy films than the healthy people. In fact, four patients were unable to recall any factual information about the films, and one patient didn’t even remember watching any movies.

 

Before and after seeing the films, participants answered questions to gauge their feelings. Patients with Alzheimer’s disease reported elevated levels of either sadness or happiness for up to 30 minutes after viewing the films despite having little or no recollection of the movies.

 

Quite strikingly, the less the patients remembered about the films, the longer their sadness lasted. While sadness tended to last a little longer than happiness, both emotions far outlasted the memory of the films.

The studies suggest the importance of positive stimuli from caregivers.  The researchers emphasized that their findings "should empower caregivers by showing them that their actions toward patients really do matter." Researcher Edmarie Guzman-Velez said "Frequent visits and social interactions, exercise, music, dance, jokes, and serving patients their favorite foods are all simple things that can have a lasting emotional impact on a patient's quality of life and subjective well-being."   

October 12, 2014 in Cognitive Impairment, Dementia/Alzheimer’s | Permalink | Comments (0) | TrackBack (0)

Friday, October 10, 2014

Substance Abuse-No Age Limits

Although some think substance abuse is a problem for the young, a recent story in the New York Times dispels that thought. More Older Adults Are Struggling With Substance Abuse ran October 3, 2014  looks at the number of elders who are substance abusers-whether drugs or alcohol. The numbers are surprising:

An estimated 2.8 million older adults in the United States meet the criteria for alcohol abuse, and this number is expected to reach 5.7 million by 2020, according to a study in the journal “Addiction.” In 2008, 231,200 people over 50 sought treatment for substance abuse, up from 102,700 in 1992, according to the Substance Abuse and Mental Health Services Administration, a federal agency.

Although alcohol abuse seems to rank first,  the "rate of illicit drug use among adults 50 to 64 increased from 2.7 percent in 2002 to 6.0 percent in 2013" according to the story. The article mentions several studies, not only looking at the extent of the abuse, but the reasons behind these addictions. Although for some, retirement may be a catalyst, many times it is not the sole reason, "'with the conditions leading to retirement, and the economic and social nature of the retirement itself, having a far greater impact on substance use than simple retirement itself..."'  Some of the "firsts" experienced in later life, such as deaths of spouses and friends, may be a contributing factor that requires "coping skills" these folks haven't had to yet possess.

The article also touches on the potential lack of doctor training on dealing with elder patients with substance abuse issues, and notes some symptoms associated with dementia may have similar symptoms to those of addictions.

October 10, 2014 in Cognitive Impairment, Food and Drink, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

Thursday, October 9, 2014

Cognitive Decline in Aging Brains-New Research

Kurzweil Accelerating Intelliegence (Kurzweil AI) ran a story that got my attention. The signature of aging in the brain reports on the results of a study that looks at a "signature" in the brain "that may be the “missing link” between cognitive decline and aging and that may in the future lead to treatments that can slow or reverse cognitive decline in older people..."

This is a technical article and perhaps not the type we typically cover in our blog, but I thought it important enough to mention. Since I don't have a scientific background, I decided to excerpt some of the findings

they identified a unique “signature of aging” that exists solely in the choroid plexus. They discovered that one of the main elements of this signature was interferon beta, a protein that the body normally produces to fight viral infection.

Turns out this protein also appears to have a negative effect on the brain. When the researchers injected an antibody that blocks interferon beta activity into the cerebrospinal fluid of the older mice, their cognitive abilities were restored, as was their ability to form new brain cells.

Why this is important? It may lead to different treatments to help with cognitive decline-the researchers "hope that this finding may, in the future, help prevent or reverse cognitive decline in old age by finding ways to rejuvenate the immunological age of the brain."

October 9, 2014 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Science | Permalink | Comments (0) | TrackBack (0)

Wednesday, October 8, 2014

The Value of a Grey Economy.

A few blogs ago, I posted about the Florida "Grey Belt".  This blog is about the value of a grey economy to the states. The story in the Tampa Bay Times, was about a new study from Florida AARP:  AARP study: Older workers, retirees Florida's biggest economic generators focuses on the positive financial impact that elders can have on an economy, at least in Florida:

The older generation generates 54 percent of the state's economic output, works in 58 percent of the state's jobs, and pays 67 percent of state and local taxes. It also accounts for 58 percent of total consumer spending, the chief driver to keep the economy churning.... Those numbers ...  are part of a concerted effort to tout the value of Florida's so-called "Longevity Economy" and urge state leaders to do more to support and attract the 50-and-up set.

Although Florida still is one of the top retirement destinations, it does have competition. Other states have realized the economic value of retired individuals and have marketing campaigns to attract those individuals to their states.

How much does this segment of the population bring to the Florida economy? A LOT, as in $429 BILLION to Florida's gross domestic product (GDP) and 6 MILLION jobs according to a story about the study that is posted on the Florida AARP website.

The full report is available here.

October 8, 2014 | Permalink | Comments (0) | TrackBack (0)

Monday, October 6, 2014

Sharing As Our Future?

Remember as little kids our parents taught us that sharing was a good thing?  Sharing has its benefits, as we all know, and I'm sure we have all talked about shared housing in our classes. One of the hottest trends right now is car sharing.

There is an organization that is devoted to shareablity. The website,  Shareable "is an award-winning nonprofit news, action and connection hub for the sharing transformation. What’s the sharing transformation? It’s a movement of movements emerging from the grassroots up to solve today’s biggest challenges, which old, top-down institutions are failing to address."

It appears that Seoul, South Korea has taken sharing to an entirely new dimension as they are the "sharing city." Sharing City Seoul: A Model for the World reports on Seoul's Sharing City initiative, started in 2012.   The story Is Seoul the Next Great Sharing City? explains that city leaders determined  to position "it... to be a model city for sharing. A new, city-funded project called Sharing City, Seoul aims to bring the sharing economy to all Seoul citizens by expanding sharing infrastructure, promoting existing sharing enterprises, incubating sharing economy startups, utilizing idle public resources, and providing more access to data and digital works." The laudable goals of becoming the model sharing city include "to create jobs and increase incomes, address environmental issues, reduce unnecessary consumption and waste, and recover trust-based relationships between people."

How does this connect to elder law? The Next Great Sharing story explains that part of the sharing initiative includes shared housing, "connecting senior citizens who have extra rooms with students who need a room."  There is also information about shared meals and other initiatives. Think how the sharing model could help eliminate isolation amongst elders! 

Is it working? The Model story from June of 2014 provides an update: Housing and Inter-generational Connection: To address the housing crisis and reduce the social isolation of seniors, a program was created to match young people with idle rooms in seniors’ houses. There have been 28 matches to date."

There is also a working group on a sharing economy movement in San Francisco. There are policies  for a shareable community available for city leaders (request here).

Thanks to my dear friend and colleague, Professor Mark Bauer, for sharing the article with me. 

 

October 6, 2014 in Consumer Information, Housing, International | Permalink | Comments (0) | TrackBack (0)

Sunday, October 5, 2014

Dying in Your Own Bed Isn't Easy

I've been posting quite a bit about end of life issues.  I wanted to be sure everyone saw the story in the NY Times on September 25, 2014 about one child's struggle to honor her dad's wish to die at home.  Unfortunately, this isn't a new issue, and clearly one that isn't near resolution. The story, Fighting to Honor a Father’s Last Wish: To Die at Home tells the story of Joseph Andrey and his daughter's efforts "to fulfill her father’s dearest wish, the wish so common among frail, elderly people: to die at home...But it seemed as if all the forces of the health care system were against her — hospitals, nursing homes, home health agencies, insurance companies, and the shifting crosscurrents of public health care spending." On many occasions her dad had been discharged from the hospital to a SNF for rehab.  This time she wanted to have him discharged to home, but was unsuccessful and her dad was transferred to a SNF, again.

The blog post illustrates the catch-22 within which Mr. Andrey and his daughter found themselves. The post also explains the recently-released Institute of Medicine report  on Dying in America (we blogged about it earlier).  Returning to Mr. Andrey's story, the article includes  a short biography of his life (including a brief tenure as a child in Vaudeville), his wife's decline from Alzheimer's, his up close and personal...and ongoing...experience with the U.S. health care system, and ends with  his final years.  He had frequent stays at SNFs because of the inability to secure home health care in a system where there were financial incentives for SNFs but not the same profitability, if you will, for the home health agencies.

Despite all of his daughter's efforts, Mr. Andrey didn't die at home, but in a hospice within a hospital. If you read the entire article, by turns you will be appalled and saddened. If you assign this to your students, there are many opportunities for discussion about the U.S. health care system as well as end of life care in our country.

October 5, 2014 in Advance Directives/End-of-Life, Cognitive Impairment, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)