Friday, May 25, 2018

Sci Fi Friday: Recommending Short Story "Today I Am Paul"

Of course, I'm supposed to be finishing my exam grading.  Instead, while stopping by my office, I find a copy of a short story from one of my colleagues.  The accompanying note says,"Not even my sci-fi 'escape' is untouched by elder care issues.  Thought you'd get a kick out of this."

And indeed, I do.  I definitely recommend "Today I Am Paul," by Martin L. Shoemaker.  The author draws upon his personal experiences in visiting his mother-in-law in a nursing home to craft a true tale ... with a difference ... as the narrating caregiver is an android.  

While my printed-page-loving self recommends reading the short story, I also found a great podcast of the story being read aloud by Kate Baker and I'm linking it here, from Clarkesworld Magazine.  

I now plan to use this story to introduce my Elder Law course in the autumn.  So much to talk about, including the roles of family, caregivers, technology, fear.....   I suspect my co-blogger Becky Morgan, with her often expressed enthusiasm for tech including driverless cars, will appreciate this story too.  Happy reading or listening for Memorial Day weekend!

Many thanks to Dickinson Law Professor Matthew Lawrence for this unique, caring experience.  

May 25, 2018 in Books, Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care, Science, Web/Tech | Permalink | Comments (0)

Sunday, May 13, 2018

"Bullying in the Nursing Home" -- Getting Beyond the Headlines

News publication sites affiliated with USA Today and the Associated Press have been running a recent piece on "bullying" among older persons, often with a provocative headline such as "It's like 'Mean Girls,' but everyone is 80": How nursing homes deal with bullies.   The title undoubtedly catches many a reader's eye, simply because of the heightened discussions of bullying at a national level, including Melania Trump's recent announcement of her Be Best platform for younger persons.  The topic isn't actually all that new from a journalism perspective.  Paula Span wrote on "Mean Girls in Assisted Living" for the New York Times in 2011, and the same publication carried a granddaughter's Op Ed on "Mean Girls in the Retirement Home" in 2015.   

On a parallel track, and perhaps more disturbing, are reports of bullying among nurses, a profession normally associated with empathy and caring.  See e.g., "When 'Mean Girls' Wear Scrubs," a 2013 post on DiversityNursing Blog, tracking a several studies and a book.  

More important than the clever headlines, however, are the reports of affirmative efforts to counter the bullying, which at the older end of the spectrum of life, seems to focus on name-calling, gossip, and ostracising behavior, rather than physical intimidation.  From the most recent USA Today writer's article:  

After the cafeteria exiles and karaoke brouhahas, the 30th Street [Senior] Center [in San Francisco]  teamed up with a local nonprofit, the Institute on Aging, to develop an anti-bullying program. All staff members received 18 hours of training that included lessons on what constitutes bullying, causes of the problem and how to manage such conflicts. Seniors were then invited to similar classes, held in English and Spanish, teaching them to alert staff or intervene themselves if they witness bullying. Signs and even place mats around the center now declare it a “Bully Free Zone.”. . . 

 

Robin Bonifas, a social work professor at Arizona State University and author of the book “Bullying Among Older Adults: How to Recognize and Address an Unseen Epidemic,” said existing studies suggest about 1 in 5 seniors encounters bullying. She sees it as an outgrowth of frustrations characteristic in communal settings, as well a reflection of issues unique to getting older. Many elderly see their independence and sense of control disappear and, for some, becoming a bully can feel like regaining some of that lost power.

I think that last line rings true.  I've certainly seen older adults sudden strike a "meaner" demeanor as their freedom is limited by physical  health issues and as their frustrations increase.  But I also think it can be important to assess whether a "mean" trait -- or at least a "meaner" dynamic -- is a reflection of cognitive impairment, such as disinhibition associated with certain types of neurocognitive impairments.   

On an even more worrisome level, is there a danger of misinterpreting fear or irritation as "meanness," perhaps arising from compelled interactions in a congregated living situation?   In one instance, I've seen an older woman who had regularly chose to sit with the same group of 3 other individuals at meals for several weeks, suddenly reject one member of their informal club.  It took careful listening to realize the rejection was actually uneasiness bordering on fear -- on some level not completely rational -- but associated with that targeted individual's tendency to wander at night into others' rooms and thus to lead the "mean girl" to try to keep the other away from her around the clock.  Targeting the "bullying" behavior could be addressing the wrong problem in the latter case.  

Finally, I think there is a danger associated with the admittedly clever tendency to use the "Mean Girls" movie as the analogy for older bullying, thus implying this is only an issue (and problem) associated with women, not men.  As a later paragraph in the most recent article makes clear, bullying behavior among older adults is not "just" about women. But perhaps that is obvious from the larger national news?  

May 13, 2018 in Books, Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Retirement | Permalink | Comments (0)

Thursday, May 3, 2018

21st Annual Elder Law Institute in Pennsylvania, July 19-20, 2018, Open for Registration

Hard to believe, but this summer will mark the 21st annual Elder Law Institute in Pennsylvania  It functions as both a gathering of the clan and an educational update, and I always walk away with new ideas for my own research and writing.  On the second day of the event (which runs July 19 and 20), Howard Gleckman will give the keynote address on "Long Term Care in an Age of Disruption."  Doesn't that title capture the mood of the country?!  

Practical workshops include:

  • Using Irrevocable Trusts in Pre-Crisis and Crisis Planning - Ms. Alvear & Ms. Sikov Gross
  • Guardianship for Someone Who Is 30/30 on the MMSE (Advanced Mental Health Capacity Issues) - Ms. Hee & Mr. Pfeffer
  • Medicaid across State Lines: Pennsylvania vs. New Jersey - Mr. Adler
  • Medicaid Annuities in Practice - Mr. Morgan & Mr. Parker
  • Business Succession Planning for Elder Law Practices - Ms. Ellis, Mr. Marshall, Mr. Pappas & Ms. Wolfe
  • Social Security Disability: What Elder Law Practitioners Need to Know - Mr. Whitelaw
  • Drafting Trusts for Beneficiaries with Behavioral Impairments and Mental Health Problems - Mr. Hagan & Dr. Panzer
  • Being a Road Warrior Attorney: Staying Organized and in Touch While Out of the Office (ETHICS) - Ms. Ellis

Mark your calendars and join us (Linda Anderson, Kimber Latsha and I are hosting a session on Day 1 about "new" CCRC issues).  Registration is here.  

May 3, 2018 in Books, Cognitive Impairment, Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Housing, Legal Practice/Practice Management, Medicaid, Medicare, Programs/CLEs, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Thursday, April 26, 2018

Commission on Law & Aging-Latest Issue of BIFOCAL

Happy Friday! If you haven't read the latest issue of BIFOCAL, the publication of the American Bar Association Commission on Law & Aging, check it out here. This issue contains 6 articles, including the implications of the tax bill on older Americans, POLST issues to avoid, the new Medicare cards, a book review, and a preview of the 2018 NALC conference.  Access the latest issue here.

April 26, 2018 in Advance Directives/End-of-Life, Books, Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare, Programs/CLEs | Permalink | Comments (0)

Tuesday, March 20, 2018

Senate Committee on Aging: Top 10 Elder Scams

A little mid-week reading for you. The Senate Committee on Aging has released their 2018 Fraud Book, listing the top 10 elder scams of 2018.  Fighting Fraud: Senate Aging Committee Identifies Top 10 Scams Targeting Our Nation’s Seniors  lists the top 10 scams of the year, based on reports to the hotline, which are (drum roll please) 

IRS Impersonation Scams

Robocalls and Unsolicited Phone Calls

Sweepstakes Scams / Jamaican Lottery Scams

"Can You Hear Me?” Scams

Grandparent Scams

Computer Tech Support Scam

Romance Scams

Elder Financial Abuse

Identity Theft

Government Grant Scams

Here is the executive summary for the report:

From January 1, 2017, through December 31, 2017, the Senate Aging Committee’s Fraud Hotline received a total of 1,463 complaints from residents all across the country. Calls pertaining to the top 10 scams featured in this report accounted for more than 75 percent of the complaints.

                The top complaint, the focus of more than twice as many calls as any other scam, involves seniors who receive calls from fraudsters posing as agents of the Internal Revenue Service (IRS). These criminals falsely accuse seniors of owing back taxes and penalties in order to scam them. Due to the extremely high call volume and continued reports from constituents from across the country, the Aging Committee held a hearing on April 15, 2015, to investigate and raise awareness about the IRS imposter scam. Prior to a large law enforcement crackdown in October 2016, nearly three out of four calls to our Hotline involved the IRS impersonation scam. In the three months after the arrests, reports of the scam into the Committee’s hotline dropped by an incredible 94 percent. Though the numbers have since rebounded somewhat, they are still far below the levels we have seen in the past.

                The second most common scam reported to the Hotline involved robocalls or unwanted telephone calls. On June 10, 2015, the Aging Committee held a hearing on the increase in these calls that are made despite the national Do-Not-Call Registry. The Committee examined how the rise of new technology has made it easier for scammers to contact and deceive consumers and has rendered the Do-Not-Call registry ineffective in many ways. On October 4, 2017, the Aging Committee held an additional hearing on robocalls, this time examining recent developments by both the private and public sectors to combat robocalls and protect seniors from fraud.

Sweepstakes scams, such as the Jamaican lottery scam, continue to be a problem for seniors, placing third on the list. A March 13, 2013, Aging Committee hearing and investigation helped bring attention to these scams and put pressure on the Jamaican government to pass laws cracking down on criminals who convinced unwitting American victims that they had been winners of the Jamaican lottery. The United States government has had some recent success in bringing individuals connected to the Jamaican lottery scam to trial, but these types of scams continue to plague seniors.

A new scam to make the top 10 list for 2017 involves consumers receiving calls in which the caller would simply ask “Are you there?” or “Can you hear me?” in order to prompt the recipient to say “yes.” According to the Federal Trade Commission (FTC), these illegal robocalls are pre-recorded, and are

designed to identify numbers that consumers are likely to answer, allowing scammers to better identify and connect with potential victims. The increased use of this tactic by scammers in robocalls last year demonstrates how sophisticated scammers are.

Grandparent scams, the focus of a July 16, 2014, Aging Committee hearing, were next on the list. In these scams, fraudsters call a senior pretending to be a family member, often a grandchild, and claim to be in urgent need or money to cover an emergency, medical care, or a legal problem.

Computer scams were sixth on the list and the subject of an October 21, 2015, Committee hearing. Although there are many variations of computer scams, fraudsters typically claim to represent a well-known technology company and attempt to convince victims to provide them with access to their computers. Scammers often demand that victims pay for bogus tech support services through a wire transfer, or, worse yet, obtain victims’ passwords and gain access to financial accounts.

Romance scams were seventh on the list. These calls are from scammers who typically create a fake online dating profile to attract victims. Once a scammer has gained a victim’s trust over weeks, months, or even years – the scammer requests money to pay for an unexpected bill, an emergency, or another alleged expense or to come visit the victim – a trip that will never occur.

Elder financial abuse was eighth on the list and the topic of a February 4, 2015, Committee hearing. The calls focused on the illegal or improper use of an older adult’s funds, property, or assets. Chairman Susan M. Collins, former Ranking Member Claire McCaskill, and current Ranking Member Robert P. Casey Jr. have introduced the Senior $afe Act, which would allow trained financial services employees to report suspected cases of financial exploitation to the proper authorities without concern that they would be sued for doing so. The Committee also examined the financial abuse of guardians and other court appointed fiduciaries at a hearing in November 2016.

Identify theft was the ninth most reported consumer complaint to the Fraud Hotline in 2017. This wide-ranging category includes calls about actual theft of a wallet or mail, online impersonation, or other illegal efforts to obtain a person’s identifiable information. On October 7, 2015, the Aging Committee held a hearing titled “Ringing Off the Hook: Examining the Proliferation of Unwanted Calls”, to assess the federal government’s progress in complying with a new law requiring the removal of seniors’ Social Security numbers from their Medicare cards, which will help prevent identity theft. Medicare will start mailing the new cards in April 2018.

            Government grant scams rounded out the top 10 scams to the Fraud Hotline last year. In these scams, thieves call victims and pretend to be from a fictitious “Government Grants Department.” The con artists then tell the victims that they must pay a fee before receiving the grant.

The report is available here.

From January 1, 2017, through December 31, 2017, the Senate Aging Committee’s Fraud Hotline received a total of 1,463 complaints from residents all across the country. Calls pertaining to the top 10 scams featured in this report accounted for more than 75 percent of the complaints.

                The top complaint, the focus of more than twice as many calls as any other scam, involves seniors who receive calls from fraudsters posing as agents of the Internal Revenue Service (IRS). These criminals falsely accuse seniors of owing back taxes and penalties in order to scam them. Due to the extremely high call volume and continued reports from constituents from across the country, the Aging Committee held a hearing on April 15, 2015, to investigate and raise awareness about the IRS imposter scam. Prior to a large law enforcement crackdown in October 2016, nearly three out of four calls to our Hotline involved the IRS impersonation scam. In the three months after the arrests, reports of the scam into the Committee’s hotline dropped by an incredible 94 percent. Though the numbers have since rebounded somewhat, they are still far below the levels we have seen in the past.

                The second most common scam reported to the Hotline involved robocalls or unwanted telephone calls. On June 10, 2015, the Aging Committee held a hearing on the increase in these calls that are made despite the national Do-Not-Call Registry. The Committee examined how the rise of new technology has made it easier for scammers to contact and deceive consumers and has rendered the Do-Not-Call registry ineffective in many ways. On October 4, 2017, the Aging Committee held an additional hearing on robocalls, this time examining recent developments by both the private and public sectors to combat robocalls and protect seniors from fraud.

Sweepstakes scams, such as the Jamaican lottery scam, continue to be a problem for seniors, placing third on the list. A March 13, 2013, Aging Committee hearing and investigation helped bring attention to these scams and put pressure on the Jamaican government to pass laws cracking down on criminals who convinced unwitting American victims that they had been winners of the Jamaican lottery. The United States government has had some recent success in bringing individuals connected to the Jamaican lottery scam to trial, but these types of scams continue to plague seniors.

A new scam to make the top 10 list for 2017 involves consumers receiving calls in which the caller would simply ask “Are you there?” or “Can you hear me?” in order to prompt the recipient to say “yes.” According to the Federal Trade Commission (FTC), these illegal robocalls are pre-recorded, and are

designed to identify numbers that consumers are likely to answer, allowing scammers to better identify and connect with potential victims. The increased use of this tactic by scammers in robocalls last year demonstrates how sophisticated scammers are.

Grandparent scams, the focus of a July 16, 2014, Aging Committee hearing, were next on the list. In these scams, fraudsters call a senior pretending to be a family member, often a grandchild, and claim to be in urgent need or money to cover an emergency, medical care, or a legal problem.

Computer scams were sixth on the list and the subject of an October 21, 2015, Committee hearing. Although there are many variations of computer scams, fraudsters typically claim to represent a well-known technology company and attempt to convince victims to provide them with access to their computers. Scammers often demand that victims pay for bogus tech support services through a wire transfer, or, worse yet, obtain victims’ passwords and gain access to financial accounts.

Romance scams were seventh on the list. These calls are from scammers who typically create a fake online dating profile to attract victims. Once a scammer has gained a victim’s trust over weeks, months, or even years – the scammer requests money to pay for an unexpected bill, an emergency, or another alleged expense or to come visit the victim – a trip that will never occur.

Elder financial abuse was eighth on the list and the topic of a February 4, 2015, Committee hearing. The calls focused on the illegal or improper use of an older adult’s funds, property, or assets. Chairman Susan M. Collins, former Ranking Member Claire McCaskill, and current Ranking Member Robert P. Casey Jr. have introduced the Senior $afe Act, which would allow trained financial services employees to report suspected cases of financial exploitation to the proper authorities without concern that they would be sued for doing so. The Committee also examined the financial abuse of guardians and other court appointed fiduciaries at a hearing in November 2016.

Identify theft was the ninth most reported consumer complaint to the Fraud Hotline in 2017. This wide-ranging category includes calls about actual theft of a wallet or mail, online impersonation, or other illegal efforts to obtain a person’s identifiable information. On October 7, 2015, the Aging Committee held a hearing titled “Ringing Off the Hook: Examining the Proliferation of Unwanted Calls”, to assess the federal government’s progress in complying with a new law requiring the removal of seniors’ Social Security numbers from their Medicare cards, which will help prevent identity theft. Medicare will start mailing the new cards in April 2018.

            Government grant scams rounded out the top 10 scams to the Fraud Hotline last year. In these scams, thieves call victims and pretend to be from a fictitious “Government Grants Department.” The con artists then tell the victims that they must pay a fee before receiving the grant.

rant.

TThe 60 page report is available here.

March 20, 2018 in Books, Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink

Monday, December 4, 2017

Professor Tamar Frankel and The Fiduciary Rule -- Still Shaking Up Wall Street

In the Wall Street Journal, there is a recent, wonderful profile of Boston University Law Professor Tamar Frankel, who has been fighting the good fight to gain adoption of "The Fiduciary Rule" for financial advisors, investment brokers and others in positions of trust for her entire academic career.  

And, at age 92, she's still fighting the good fight, as the Trump administration recently delayed full implementation.   

When Ms. Frankel began researching fiduciary law in earnest in the 1970s, she dwelled on that idea: A fiduciary is someone trusted by others because he or she has superior knowledge and expertise. People hire brokers because the brokers know what they’re doing and the clients don’t. That gives fiduciaries power and responsibility over those who trust them.

 

The unconditional trust that clients place in a fiduciary creates a paradox, argues Ms. Frankel. “When you get power, you lose the power you might otherwise have,” she says.

 

A fiduciary adviser can’t abuse the relationship of trust by collecting unreasonable compensation or harboring avoidable conflicts of interest. The relationship is meant to satisfy only the needs of the client.

Professor Frankel appears to be remarkably sanguine about the latest delays:

With the Trump administration putting parts of the fiduciary rule on hold, Ms. Frankel counsels patience.

 

“What the rule has done is sown the seed, and the longer it takes the better off we are, because what we must change is the culture and the habits in the financial industry,” she says. “Habits don’t change in one day. It takes time.”

 

After she turns 93 next July 4, Ms. Frankel says, she will stop teaching—although she will continue to research and write. What accounts for her longevity? “Caring less and less about what other people think,” she says, “and more and more about questions you don’t have answers to.”

I have a copy of Professor Frankel's thoughtful treatise on Fiduciary Law (Oxford Univ. Press, 2011) on the shelf behind my desk, complete with sticky notes and much yellow and red highlighting.  I've been meaning to write Professor Frankel to thank her for her work over the years -- and now this article reminds me to get to that task!

My thanks to my always eagle-eyed friend and correspondent, Karen Miller, in Florida for this latest find and reminder.  

December 4, 2017 in Books, Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Property Management, Retirement | Permalink | Comments (0)

Tuesday, November 21, 2017

New Publication: Old & Sick in America

Dr. Muriel Gillick, a Professor of Population Medicine at Harvard Medical School and the director of the Program in Aging at Harvard Pilgrim Health Care Institute had a new book.  Old & Sick in American: The Journey Through the Health Care System sounds like it hits the nail on the head, demonstrating topics that a wise consumer will need to recognize in order to navigate biases and weaknesses in the system. 

For a timely Q & A interview with the author, see How Older Patients Can Dodge Pitfalls Entrenched in Health Care System, published by California Healthline. 

November 21, 2017 in Books, Consumer Information, Health Care/Long Term Care, Medicaid, Medicare, Science | Permalink | Comments (0)

Wednesday, October 18, 2017

Where We Live-Publication from AARP

AARP has a new book added to its library on livable communities. Where We Live: Communities for All Ages (2017) by Nancy LeaMond is the second book in their series. This new book is ideas from community leaders, with the earlier book (2016) containing ideas from mayors of cities. Both books are free-bound copies by request from AARP and electronic copies available from many online booksellers or AARP via an email request to WhereWeLive@AARP.org .  Topics in the 2017 book include housing; arts, entertainment, fun; community engagement; public spaces (indoors and outdoors);  health & wellness; work and volunteering and transportation and infrastructure like roads and sidewalks. To learn more or order your copies, click here.

October 18, 2017 in Books, Consumer Information, Current Affairs, Housing, Other | Permalink | Comments (0)

Monday, October 9, 2017

Books on Caring for Elders

A recent column in the New York Times mentioned several books that focus on caring for elders. Hard-Won Advice in Books on Aging and Elder Care  is written by the columnist who has been authoring a series of columns about Medicaid as Congress focused on health care repeal.  As a result of those columns, some of the comments the author received were recommendations of books for the author to read.  Using the criteria of those books mentioned at least twice, the author read and wrote about 4 books, which the author describes as "in their own way utterly essential reading. Few of us are prepared for the financial and emotional complexities of managing the last several years of our lives. But as we live longer, drain what may prove to be inadequate retirement savings and lean harder on already strained government programs, we’ll probably find ourselves facing ever more challenging questions and unfortunate compromises."  The books he includes in his column are Being Mortal, the 36 Hour Day, A Bittersweet Season and Being My Mom's Mom.

What books might you recommend to your students?

October 9, 2017 in Books, Consumer Information, Current Affairs, Health Care/Long Term Care, Retirement | Permalink | Comments (0)

Thursday, September 14, 2017

Women Who Are Older--Financial Fears?

How well-prepared are you for financing your retirement? Do you know your family's finances?  The New York Times examined the situations that may be faced by women who are older who are not involved in the handling of their family's finances. Helping Women Over 50 Face Their Financial Fears covers a lecture series, Women and Wills, designed specifically for women over 50 that cover a variety of topics, including estate planning. health care, insurance, long term care, business succession planning and more. The founders are well aware that some women may not be up to speed on their family's finances, or other circumstances such as a spouse's illness, may present challenges for them. The founders plan to take their lecture series on the road, nationwide, and publish a book on the importance of planning.

Thanks to Professor Naomi Cahn for sending a link to the article.

 

September 14, 2017 in Books, Consumer Information, Current Affairs, Estates and Trusts, Health Care/Long Term Care, Property Management, Retirement, Social Security | Permalink | Comments (0)

Tuesday, September 5, 2017

A Portrait of the Dreaded "A" Disease

One of my first "real" jobs after college was working in Washington D.C. for a U.S. Senator who regularly attracted the attention of the press, including reporter Sally Quinn and her husband and executive editor Ben Bradlee at the Washington Post.  I found it especially poignant to read Sally's newly published account of her husband's last years.  She writes with great candor about the small and large changes she observed, and the drama of good days and bad days "at the office," in a very public place. Here's an excerpt:

In 2011, a reporter called Ben at the Post, where he maintained an office as a vice president at large, to interview him about something sensitive that had happened at the paper. Ben was very forthcoming — in fact, too forthcoming. He told the reporter much more than he should have, much more than he knew. After the piece came out, I went to Washington Post Company Chairman Don Graham and suggested that it might be time for Ben to stop going to the Post. Don, the kindest human being on the planet, refused to even consider it. However, we did work out a plan. All the secretaries and assistants on the floor were advised never to put a call through to Ben without checking with his secretary Carol or Don or me. Everyone was told to turn down all interview requests. Ben never knew about it.

 

It had been five years since he had been diagnosed with early-stage dementia, but few outside the family knew it. Almost every day he went down to the Post cafeteria for lunch and would be immediately surrounded by a coterie of reporters and admirers, and that seemed to perk him up. There was always a group conversation and as long as Ben gave somebody the finger or told somebody to “f--- off,” people didn’t seem to notice the forgetfulness that much.

 

I organized a lunch group at the Madison hotel across from the Post, where I had a running tab. Carol had a sign-up sheet and up to five people could join. It was always full. We called it “Tuesdays with Ben.”

Eventually it became too much to hide Ben Bradlee's diagnosis from friends and work associates:

The A-word is a killer, which is why I always said “dementia,” even though it was never clear which [type] he had. Somehow Alzheimer’s sounds like something one could catch. Dementia sounds tamer, more like gentle aging. At dinners, I would ask my friends to seat me next to Ben so that I could protect him. I’d make sure the person on his other side was aware of Ben’s situation.

The full piece, which is an excerpt from Sally's forthcoming book, Finding Magic: A Spiritual Memoir, is carried in this week's Washington Post and is well worth reading.  It is a complex portrait of a hard-driving man and his loving wife and friends

September 5, 2017 in Books, Cognitive Impairment, Dementia/Alzheimer’s, Ethical Issues | Permalink | Comments (0)

Monday, August 21, 2017

Affordable & Accessible Community-Based Housing for Vulnerable Adults

A new publication is available from the National Academies Press. Developing Affordable and  Accessible Community-Based  Housing for Vulnerable Adults: PROCEEDINGS OF A WORKSHOP is available for download as a pdf or for purchase as a print copy.   Here is an excerpt from the introduction

Accessible and affordable housing can enable community living,2 maximize independence, and promote health for vulnerable populations. However, the United States faces a shortage of affordable and accessible housing for vulnerable low-income older adults and individuals living with disabilities. This shortage is expected to grow over the coming years given the population shifts leading to greater numbers of older adults and of individuals living with disabilities.

Housing is a social determinant of health and has direct effects on health outcomes, but this relationship has not been thoroughly investigated. To better understand the importance of affordable and accessible housing for older adults and people with disabilities, the barriers to providing this housing, the design principles for making housing accessible for these individuals, and the features of programs and policies that successfully provide affordable and accessible housing that supports community living for older adults and people with disabilities ....

The forum meets to discuss how to support independence and community living for people with disabilities and older adults. The roundtable promotes health equity and the elimination of health disparities by advancing the visibility and understanding of the inequities in health and health care among racial and ethnic populations; by amplifying research, policy, and community-centered programs; and by catalyzing the emergence of new leaders, partners, and stakeholders.

The book runs 108 pages and the pdf is a free download.

August 21, 2017 in Books, Consumer Information, Current Affairs, Federal Statutes/Regulations, Housing | Permalink | Comments (0)

Tuesday, August 1, 2017

On Finding Balance in Relationships (and Technology) As One Ages

Over the weekend, I caught an interesting episode of "On Being," with public radio host Krista Tippett.  While the nominal topic was "the good, bad and the  ugly" of the internet, and especially of internet-based social media sites, I found the conversation with her guest relevant on a number of levels, including questions about the importance of healthy relationships and intellectual stimulation for individuals as they age.

The guest speaker, Danah Boyd, a researcher, book author and pro-technology blogger, especially internet technology, talked about concerns that many parents may have, that their children are negatively affected by the amount of time they spend on the internet, whether in the form of Facebook, emails, chatrooms or simply surfing.  "Why don't they just go outside and play together like we did as children, especially in the summer?"

In response, Boyd pointed out that there is a "tremendous amount of fearmongering that emerged in light of 24/7 news...."  She continued:

We created this concern that public spaces like the park were a terrible, terrible place.  We were worried about latchkey children.  We were worried about school buses.  We clamped down on young people, and we started, especially in middle to upper class environments, structuring every day of their lives.

She drew upon examples, including some from Eric Klinenberg, a sociologist who wrote Going Solo to examine the implications of living a "single life," to suggest a possible explanation for young people retreating into the internet is the need to escape the pressures of overly structured daily lives.  

If true, wouldn't the need to escape increase as you get older and encounter more pressure to work, be on time, succeed, and to multi-task?  The need to detach from one-on-one relationships might be greater.

While the program did not talk directly about the upper ages of such a trajectory, as I listened to the program I couldn't help but think there is some greater truth here.  I see some people continue to want to stay engaged in one-on-one social relationships as they move into the "older" of older ages, but I also see many, including some of my own family members, do the exact opposite.  No, they aren't retreating into the internet, but they are retreating from what they might see as pressures to communicate, to be articulate, to "chat" with long time friends or family members. Perhaps for some it is the television, rather than a cell phone or iPad that serves as the protective shield.  

But, for future generations of elders will the internet still be intriguing and continue to offer escape routes?

One of the things that I liked about the "On Being" discussion was the discussion of the importance of striving for balance in the midst of technological changes.  Boyd said:

From my perspective, it’s about stepping back and not assuming that just the technology is transformative, and saying, okay, what are we trying to achieve here? What does balance look like? What does happiness look like? What does success look like? What are these core tenets or values that we’re aiming for, and how do we achieve them holistically across our lives? And certainly, when parents are navigating this, I think one of the difficulties is to recognize that this is what your values are, and they may be different from your child’s values. And so how do you learn to sit and have a conversation of “Here’s what I want for you. What do you want? And how do we balance that?” And that’s that negotiation that’s really hard. And so I think about it in terms of all of us — how do you find your own sense of grounding?

She concludes, suggesting internet technology is an important tool for making connections and having relationships, but "reflection" about life goals is also important.  Or as Boyd says, "There are so many opportunities out there to connect, to communicate, to get information. We need to be more thoughtful about what we want to achieve and how to articulate that in our lives and how to achieve it collectively, individually, and as a community."

August 1, 2017 in Books, Ethical Issues, Science, Web/Tech | Permalink | Comments (0)

Tuesday, May 30, 2017

New Casebook: Caring For Older People in an Ageing Society

Last week I received an email from the Hastings Center with the subject line "What Do We Owe the Frail Elderly?"  This intrigued me because I often have a conversation with my students about what, if anything, we "owe" the generation before us. I typically have this conversation in the context of discussing funding of public benefits and other programs specifically for America's elders.   Here is the information about the casebook

A woman juggles caring for her aged father at home and going to work. A volunteer cares for an 83-year-old man who lives alone and wonders why the man’s son doesn’t take more of an interest. Staff members at a nursing home, discussing a patient with dementia who hits staff members, consider whether it’s acceptable to control his behavior with antipsychotic medication, knowing that antipsychotics increase the risk of stroke in people with dementia. These are three of the 10 cases in Caring for Older People in an Ageing Society, the second edition of an online bioethics casebook launched this week. The casebook aims to support professional and family caregivers by helping them recognize and respond to situations that pose ethical uncertainty... The bioethics casebook was the product of a project with the National University of Singapore Centre for Biomedical Ethics, The Hastings Center, and Oxford University’s Ethox Centre. Explore the Casebook

Additional information about the book is available from The Hastings Center website: "an innovative web-based casebook that focuses on ethical challenges of caring for people in an aging society. It is geared to those who provide community-based care to frail or chronically ill people living at home, in a family member’s home, or in a nursing home. The casebook will include fictional cases along with ethics commentaries, clinical perspectives, reflection and discussion questions, and other resources...."

This second volume of the casebook focuses on elders while the first volume focuses on difficult decisions. For more information, click here.
 

May 30, 2017 in Advance Directives/End-of-Life, Books, Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care | Permalink | Comments (0)

Tuesday, April 18, 2017

Homeward Bound: Modern Families, Elder Care, and Loss

I had mentioned a new book on Monday at the bottom of my post, congratulating the authors, Naomi Cahn and Amy Ziettlow.  The book, Homeward Bound: Modern Families, Elder Care, and Loss is published by Oxford University Press (April 2017) and runs 240 pages. The book is available to order from a number of book sellers.  Last week the authors wrote  on the Institute for Family Studies blog explaining the background of and catalyst for this book. Homeward Bound: Lessons on Modern Families and Elder Care

In 2010, we began the Homeward Bound project, hoping to study the intersection of modern families and elder care because we saw, all around us, how elder care is changing. Seven years later, it is exciting to see the results of the project in the form of a published book, Homeward Bound: Modern Families, Elder Care, and Loss, and to share some of what we learned in this post.

The catalyst for the project was a conversation with a dear friend of ours, Julie, whose Baby Boomer parents are divorced; each parent then remarried and divorced again. One of Julie’s ex-stepparents—her ex-stepmother Tina—was about to undergo critical surgery, and Julie didn’t know what to do. Tina had been married to Julie’s father for 15 years, starting when Julie was a toddler. While Julie was growing up, she spent holidays with her father and Tina. After the divorce, Julie no longer visited Tina, but they remained in regular contact by phone and email over the years. Julie fondly remembers how Tina mothered her during childhood illnesses and crises, and she felt some responsibility for Tina, especially since Tina had no children of her own. However, Julie felt overwhelmed as she thought of handling all of the medical, financial, and legal caretaking that her parents, stepparents, and ex-stepparents would need from her as they aged. Julie, who also has two young children, explained that she simply was not prepared financially or emotionally to care for all the people who might need her—and she felt alone in her worries, with few resources and little support.

So that explains the reasons and inspiration for the book.  As far as what the authors learned, they explain the 3 lessons:

  1. Families shape the quality of the elder care and grieving experience of grown children...
  2. Formal planning helps facilitate a positive experience.... and
  3. Families rely on medical, legal, and religious professionals to begin and guide the decision-making conversation in a way that is catered to their unique structure....

But, overall they learned there is room for hope but a need for action. "Many family members showed great resilience in finding ways to understand each other, to work together to each contribute something to the care process, and to decide that they would remain a family after the death of one of its members. In other families, the lack of shared norms and an absence of experienced professional support meant that caretaking and grief became a time of division, rather than unity. But, as we also learned, the time to plan is now."

Congratulations Naomi and Amy!

April 18, 2017 in Books, Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink | Comments (1)

Wednesday, March 29, 2017

New Book from the National Academies on the Workforce Supporting Elders

The National Academies Press has released a new book, Strengthening the Workforce to Support Community Living and Participation for Older Adults and Individuals with Disabilities: Proceedings of a Workshop.  The book can be downloaded for free as a pdf or purchased as a hard copy .It can also be read online.  Here is the description of the publication:

As the demographics of the United States shift toward a population that is made up of an increasing percentage of older adults and people with disabilities, the workforce that supports and enables these individuals is also shifting to meet the demands of this population. For many older adults and people with disabilities, their priorities include maximizing their independence, living in their own homes, and participating in their communities. In order to meet this population’s demands, the workforce is adapting by modifying its training, by determining how to coordinate among the range of different professionals who might play a role in supporting any one older adult or individual with disabilities, and by identifying the ways in which technology might be helpful.

To better understand how the increasing demand for supports and services will affect the nation’s workforce, the National Academies of Sciences, Engineering, and Medicine convened a public workshop in June 2016, in Washington, DC. Participants aimed to identify how the health care workforce can be strengthened to support both community living and community participation for adults with disabilities and older adults. This publication summarizes the presentations and discussions from the workshop.

March 29, 2017 in Books, Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink | Comments (0)

Friday, August 19, 2016

Want to Laugh? Read "Old Age: A Beginner's Guide," by Michael Kinsley

I'm always just a bit suspicious of books that promise to make me laugh.  I think it is because I like to be surprised by humorous moments, rather than feel duty-bound to chuckle, guffaw or giggle.  

Nonetheless, I succumbed to the promise in the blurb for Michael Kinsley's 2016 book, Old Age: A Beginner's Guide, that it was a "surprisingly cheerful book ... and a frequently funny account of one man's journey to the finish line."  

And I'm glad I did.  I did indeed laugh, and at the most surprising of moments, as when he described the need to avoid the doors of his refrigerator because of the magnets that might interfere with the technology in his brain used to keep symptom of Parkinson's Disease at bay.  He has the knack of making wry observations about his own mortal state to think broadly about what it is for all of us to age. I can see the short essays that make up this book being useful in a class on elder law or estate planning.  

His words are perhaps most poignantly relevant to boomers.  For example, on a goal of living longer, he writes:

Even before you're dead, you may want to ask yourself whether this is what you really want.  Is being alive all that desirable if you're alive only in the technical sense?  Millions of boomers are watching their parents fade until they are no longer there. As they approach their seventies, they start observing their own peer group losing their collective marbles, one at a time. And they  reasonably conclude that the real competition should not be about longevity. It should be about cognition.

But he doesn't stop there, exploring other, potentially more important goals for the competitive boomer generation to consider.  

This is a short, deep book.  And I recommend it, not least of all because it gives readers welcome opportunities to smile. 

August 19, 2016 in Advance Directives/End-of-Life, Books, Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Science, Statistics | Permalink | Comments (0)

Monday, July 25, 2016

19th Annual Elder Law Institute in Pennsylvania Includes Trend Analysis in Senior Living


19th Pennsylvania Elder Law InstituteLast week, Lancaster Pennsylvania was host to the 19th Annual Elder Law Institute, co-sponsored by the Pennsylvania Bar Institute and the Pennsylvania Bar Association's Elder Law Section.  As the image of the two, fat volumes of course materials demonstrates, there was a lot of content for  participants to digest. More than 400 professionals attended,not counting walk-ins.  (And yes, the course materials will be available for purchase eventually, from the PBI catalog here.) 

I had the privilege of welcoming two new speakers to the Pennsylvania conference, Stephen J. Maag, J.D., Director of Residential Communities for LeadingAge and Brad C. Breeding, President of My LifeSite.  Both speakers addressed options available for senior living, and focused on trends affecting Continuing Care Retirement Communities (CCRCs), now also known as Life Plan Communities.

Steve noted that with close to 2,000 communities across the nation identifying under the CCRC or Life Plan label, a majority are "still" nonprofit, especially in so-called "Type A" operations, but that there is clearly a trend in the direction of change to "for profit" ownership or management. Communities are coping with what he termed "unprecedented" change on many fronts, including changing consumer demographics, the impact of health care reform, and use of technology that can affect or delay timing of decisions to move into a Life Plan Community.  

Brad outlined the development of his company as a site for comparative information for consumers considering CCRC or Life Plan communities.  The company has a data bank with detailed, comparative information on over 400 communities, offering consumers a fee-paid option of getting side-by-side statistics on contract options, pricing, services available and more.  But he also said that collecting the information is not easy, as some state regulators, including Pennsylvania, do not "share" information in a transparent way.   Remember Medicare.gov's Nursing Home Compare?  Brad's company is working to provide consumers with comparative information beyond that narrow focus on skilled nursing care.  One of the hot topics Brad identified is the extent to which consumers can use "long-term care insurance" in the CCRC setting, and we all discussed whether such insurance should be paying a pro-rata share of entrance fees, especially in Type A life-care contracts. 

My special thanks to Steve and Brad for traveling from D.C. and North Carolina, respectively, to share their knowledge and predictions. 

July 25, 2016 in Books, Health Care/Long Term Care, Housing, Programs/CLEs | Permalink | Comments (0)

Tuesday, June 21, 2016

New Concepts from Authorities Who Investigate and Prosecute Scammers and Financial Abusers

On June 15,  I logged into the National Consumer Law Center's webinar on Financial Frauds and Scams Against Elders.  It was very good.  Both David Kirkman, who is with the Consumer Protection Division for North Carolina Department of Justice, and Naomi Karp, who is with the federal Consumer Financial Protection Bureau, had the latest information on scamming trends, enforcement issues, and best practices to avoid financial exploitation.  Here were some of the "take away" messages I heard:

  • "Age 78" -- why might that be important?  Apparently many of the organized scammers, such as the off-shore sweepstakes and lottery scams, know that by the time the average consumer reaches the age 78, there a significant chance that the consumer will have cognitive changes that make him or her more susceptible to the scammer's "pitch."  As David explained, based on 5 years of enforcement data from North Carolina, "mild cognitive impairment"  creates the "happy hunting ground" for the scammer.
  • "I make 'em feel like they are Somebody again."  That's how one scammer explained and rationalized his approach to older adults.  By offering them that chance to make "the deal," to invest in theoretically profitable ventures, to be engaged in important financial transactions, he's making them feel important once again.  That "reaction" by the older  consumer also complicates efforts to terminate the scamming relationship. David played a brief excerpt of an interview with an older woman, who once confronted with the reality of a so-called Jamaican sweepstakes lottery, seemed to make a firm promise "not to send any more money."  Yet, three days later, she sent off another $800, and lost a total of some $92k to the scammers in two years.
  • "Psychological reactives."   That's what David described as a phenomenon that can occur where the victim of the scam continues to play into the scam because the scammer is offering the victim praise and validation, while a family member or law enforcement official trying to dissuade the victim from continuing with the scam makes him or her feel "at fault" or "foolish."   An indirect, oblique approach may be necessary to help the victim understand.  One strategy to offset the unhelpful psychological reaction was to show the victim how he or she may help others to avoid serious financial losses. 
  • "Financial Institutions are increasingly part of the solution."  According to Naomi, about half of all states now mandate reporting of suspected financial abuse, either by making banks and credit unions mandatory reporters or  by making "all individuals" who suspect such fraud mandatory reporters.  Both David and Naomi said they are starting to see real results from mandatory reporters who have helped to thwart fraudsters and thereby have prevented additional losses.

The federal Consumer Financial Protection Bureau has several publications that offer educational materials to targeted audiences about financial abuse.  One example was the CFPB's 44-page manual for assisted living and nursing facilities, titled "Protecting Residents from Financial Exploitation." 

June 21, 2016 in Books, Cognitive Impairment, Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, State Cases, State Statutes/Regulations, Webinars | Permalink | Comments (2)

Thursday, May 5, 2016

A Handbook for Aging

Ever think humans need to come with a user's manual to explain the aging process? According to the Washington Post article on April 22, 2016, help is on the way.  ‘Old Age: A Beginner’s Guide’: What you really need to know about life’s later years reviews “Old Age: A Beginner’s Guide.”  The article describes the author

Kinsley is both realistic and remarkably cheerful in writing about aging, death and his own health in this brief collection of essays, some of which have appeared in Time, the New Yorker and elsewhere. The book is framed as a guide to old age for Kinsley’s contemporaries. “Sometimes I feel like a scout for my generation,” he writes, “sent out ahead to experience in my fifties what even the healthiest boomers are going to experience in their sixties, seventies or eightes.”

He describes the Boomers as wanting longevity but really wanting cognition.  The Post describes the book as a fun and informative read. 

Whether offering a final set of goals for achievement-oriented boomers, describing his DBS (deep brain stimulation) surgery, debating stem-cell research or defending his decision after the Parkinson’s diagnosis (“I chose denial”), Kinsley, a contributing columnist to The Washington Post, is refreshingly straightforward and often wickedly funny.

The New York Times review of the book is available here.

May 5, 2016 in Books, Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink | Comments (0)