Thursday, November 26, 2015
NPR's Morning Edition carried a recent story about studies conducted by University of California San Diego researcher Paul Mills that is timely for all of us on this Thanksgiving Day:
A positive mental attitude is good for your heart. It fends of depression, stress and anxiety, which can increase the risk of heart disease, says Paul Mills, a professor of family medicine and public health at the University of California San Diego School of Medicine. Mills specializes in disease processes and has been researching behavior and heart health for decades. He wondered if the very specific feeling of gratitude made a difference, too.
So he did a study. He recruited 186 men and women, average age 66, who already had some damage to their heart, either through years of sustained high blood pressure or as a result of heart attack or even an infection of the heart itself. They each filled out a standard questionnaire to rate how grateful they felt for the people, places or things in their lives.
It turned out the more grateful people were, the healthier they were. "They had less depressed mood, slept better and had more energy," says Mills.
Happy Thanksgiving to all -- all year round!
Wednesday, November 25, 2015
With Thanksgiving looming, it seemed appropriate to take a moment to say thanks to all the family caregivers. And on the subject of caregivers, I wanted to share this 5 Facts about Family Caregivers published by Pew Research Center.
Here are the five facts:
- In the US there are 40.4 million unpaid caregivers for those 65 and older.
- The caregivers are most likely between 45-64 years old.
- The most common caregiving kids perform helping around the house, doing errands and fixing things around the house.
- A major segment of caregiving is providing emotional support.
- Most kids find helping their parents rewarding, although a few find it stressful.
This is good information to share with your students as well. So read the full document, thank a caregiver and have a Happy Thanksgiving!
Tuesday, November 24, 2015
While preparing for my part of a program this week in England on comparative social care policies, I was encouraged to look at a visiting health services program in New York City, under the supervision of the Mount Sinai Health System. Karen Miller, a lawyer and former New York administrative judge who now lives in Florida, told me how helpful it had been to have the assistance of a Mount Sinai social worker to coordinate medication, treatment and doctor's visits for her elderly aunt in New York City.
Reading about the Mt. Sinai program, in turn, lead me to a short and very moving essay by David Muller, M.D., a physician and Dean for Medical Education at The Icahn School of Medicine at Mount Sinai, based on his home visit in "Haiti."
Make sure you read your way to page two....there message is eye-opening.
Sunday, November 22, 2015
Prior to the Bipartisan Budget Act of 2015 , all indications pointed to a pretty significant increase in the 2016 Part B premiums for Medicare. However, the increase was much less than expected in part because of the compromise in the Budget Bill. The Kaiser Family Foundation released a very helpful issue brief on November 11, 2015, explaining the developments and the impact on beneficiaries. What's in Store for Medicare's Part B Premiums and Deductible in 2016, and Why? explains the premium increase, the hold harmless provision and a $3 repayment surcharge to make up the deficit Part B will incur in 2016 because of the lower premium. ("includes a $3 repayment surcharge, which will be added to monthly premiums over time to cover the cost of the reduced premium rate in 2016.")
The brief explains the hold harmless provision, identifies the categories of beneficiaries who will have to pay the higher premiums (and why) and the amount of premiums paid by higher income beneficiaries. The brief also offers a projection for 2017 and concludes that but for Congressional intervention, "in the face of flat Social Security benefits and rising out-of-pocket costs, many people on Medicare could have greater difficulty affording their medical care costs in the coming year."
As I prepare to speak at a program at the University of Leeds this week on comparative social care systems and legal policies, a headline in The Guardian caught my eye: "Half of UK Care Homes Will Close Unless £2.9bn Funding Gap Is Plugged, Warn Charities." The Guardian reports:
In a joint letter, 15 social care and older people’s groups urge Osborne to use his spending review on Wednesday to plug a funding gap that they say will hit £2.9bn by 2020. They warn that social care in England, already suffering from cuts imposed under the coalition, will be close to collapse unless money is found to rebuild support for the 883,000 older and disabled people who depend on personal care services in their homes.
[Chancellor of the Exchequer] Osborne has already decided to use his overview of public finances to give town halls the power to raise council tax by up to 2% to fund social care, in a move that could raise up to £2bn for the hard-pressed sector. However, the signatories of the letter, such as Age UK and the Alzheimer’s Society, want him to commit more central government funding to social care.
The looming £2.9bn gap “can no longer be ignored”, the letter says. “Up to 50% of the care home market will become financially unviable and care homes will start to close their doors,” it adds. “Seventy-four per cent of domiciliary home-care providers who work with local councils have said that they will have to reduce the amount of publicly funded care they provide. If no action is taken, it is estimated that this would affect half of all of the people and their families who rely on these vital services.”
Osborne’s endorsement of a hypothecated local tax to boost social care comes after intense lobbying behind the scenes and public warnings from bodies such as the King’s Fund health thinktank.
The authors warn the "NHS will be overwhelmed by frail elderly people" in search of care. I was struck by implications that without funding reallocation, England will face staggering hordes of near zombies. There is irony in this imagery, of course, because we spend a heck of a lot of real money on best-selling books, movies and top-rated television shows about fictional zombies, while failing to come to terms with the funding needs for real people. See e.g., this estimate that "Zombies Are Worth Over $5 billion to Economy."
Thursday, November 19, 2015
CMS has released the 2016 amounts for deductibles, premiums, and co-pays for Medicare A and B. The Inpatient Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts are available in the Federal Register here. (The inpatient deductible is $1,288 for 2016). The Part B amounts are available here. Remember because there is no COLA this year, the hold harmless provision keeps the Part B premium the same as last year for many Medicare Beneficiaries. For those not protected by the hold harmless provision, their Part B premiums will be $121.80+ $3. Don't forget that higher income beneficiaries will pay a higher premium, referred to as the income-related monthly adjustment. The higher premium amounts can be found here as well.
On November 26, 2015, the University of Leeds' School of Law in England will be host to a program on "Yours, Mine or Ours: Who is Responsible for Social Care of Older Persons?" I'm very pleased to be part of the panel, under the leadership of Professor Subhajit Basu, PhD. We will use a research report we completed with colleagues in 2015 for the Commissioner of Older People in Northern Ireland (COPNI), to offer comparative international examples of legislation and public policy initiatives that support the wide array of potential care needs for older persons. We'll be looking beyond the needs for health care.
One likely focus of the discussion is a proposal for a state-supported home visits by trained professionals, including social work professionals, for individuals age 75 or older, with a goal of providing advance assistance to the individual or family in meeting needs. The proposal now under consideration in Northern Ireland has roots in other jurisdictions we studied, including Denmark.
In Denmark, one of the inspirational leaders for "preventative home visits" is Mikkel Vass, M.D. at the University of Copenhagen. Beginning in 1998, Danish laws established an obligation for municipalities to offer "all citizens 75 years and older two annual preventative home visits." A great deal of freedom to design the content of the home visits was given to the municipalities, but the goals are:
- to support personal resources and networking; and
- to offer social support, thereby preserving functional ability
In his study of 15+ years of home visit operations, Dr. Vass concludes that with a nationally-supported home visitation program:
- Functional decline can be prevented;
- Education of professionals makes a difference to the interview success;
- Interdisciplinary education makes a greater difference to the program success;
- To maintain effectiveness, education must be ongoing and based on simple messages and professional routines that respect local healthcare cultures; and
- Operation can be cost-neutral.
Cost neutrality -- that will be important to every element of modern social care programs -- including home visits.
Wednesday, November 18, 2015
Living in a Sunbelt state, I know how hot it can get in the summer months. I recently ran across a July 2015 decision from HHS' Departmental Appeals Board (DAB) reviewing the imposition of a "per instance" monetary penalty CMS assessed against an Arizona SNF.
CMS’s allegations in this case are predicated on complaints that portions of Petitioner’s facility – including several residents’ rooms – were uncomfortably hot. Those allegations are supported by the complaints of several residents and by temperature readings taken by a surveyor on July 16, 2014. Readings taken by the surveyor showed portions of some of the residents’ rooms being as hot as 90 degrees Fahrenheit.... Such temperatures plainly exceed what any reasonable person would consider to be "comfortable." On their face they comprise violations of 42 C.F.R. § 483.15(h)(6).
After discussing the ways the surveyor and the SNF measured the temperatures inside the SNF, the ALJ in the opinion notes
The overwhelming evidence is that rooms at Petitioner’s facility were uncomfortably hot due to the failure of the facility’s air conditioning system. Arizona in July is a very hot place. Building interiors in that State that are not adequately air conditioned can become dangerously hot. As Petitioner admits, the air conditioning in its facility had failed to work adequately in July 2014. The failure prompted residents to complain that their rooms had become uncomfortably hot.... The staff took various measures to address the failure of the air conditioning system, including closing curtains in residents’ rooms and conducting random temperature checks....
"The evidence that residents were not comfortable is overwhelming, beginning with these residents’ complaints and further evidenced by the fact that Petitioner’s own staff recognized that there were problems with overheating in the residents’ rooms." The ALJ upheld the penalty.
Coinciding with the presentation yesterday at the National Press Club in Washington, D.C., the journal Health Affairs released a report by Melissa Favreault, Howard Gleckman, and Richard W. Johnson, titled "Financing Long-Term Services And Supports: Options Reflect Trade-Offs For Older Americans And Federal Spending." Noting the history of weak buy-in for existing long-term care insurance products, the authors' study, funded by the SCAN Foundation, AARP and LeadingAge, looks to future alternatives. From the abstract:
To show how policy changes could expand insurance’s role in financing these needs, we modeled several new insurance options. Specifically, we looked at a front-end-only benefit that provides coverage relatively early in the period of disability but caps benefits, a back-end benefit with no lifetime limit, and a combined comprehensive benefit. We modeled mandatory and voluntary versions of each option, and subsidized and unsubsidized versions of each voluntary option. We identified important differences among the alternatives, highlighting relevant trade-offs that policy makers can consider in evaluating proposals. If the primary goal is to significantly increase insurance coverage, the mandatory options would be more successful than the voluntary versions. If the major aim is to reduce Medicaid costs, the comprehensive and back-end mandatory options would be most beneficial.
Tuesday, November 17, 2015
The National Consumer Law Center (NCLC) has announced a free one hour webinar set for November 24, 2015 from 2-3 p.m. est. Protecting Your Bank Account from Unauthorized and Recurring Payments will cover consumers rights in protecting accounts.
The constant news about data breaches and scams targeting seniors has left people worried about their rights if an unauthorized charge is taken out of their account. Consumers also face problems when a gym, unwanted membership club or payday lender will not stop debiting the account. This webinar will cover consumers' rights to challenge unauthorized payments and to stop recurring payments.
The webinar is limited to the first 3000 registrants so don't delay. Click here to register.
The Washington Post's magazine section runs a Work Advice column by Karla Miller. A recent question was intriguing:
As a longtime colleague of Susan’s, I’ve been asked by her boss to feel out whether she really means to leave the office only if “taken out in an ambulance or a coffin” (the boss’s words). I agree that it is probably time for her to retire (she is financially well off), but I also know she gets great satisfaction from her work. Should I broach the subject with Susan as a caring co-worker?
The response urges caution in participating in the employer's plan, observing bluntly "that smells like a steaming heap of age discrimination."
For the full discussion, See @Work Advice: Putting the Old, Gray Co-Worker Out to Pasture.
Monday, November 16, 2015
Psychology Researchers, William Damon and Anne Colby, in Stanford University's Graduate School of Education, are teaming with a San Francisco-based nonprofit organization, Encore.org, on a three phased study to understand the nature and determinants of "purposeful" living in the so-called "encore" years of life, ages 50 to 75.
The $1.8 million study was inspired by a troubling fact: Relatively few older adults have found purposeful engagements that they act on in a sustained way. Yet research suggests that there is significant untapped potential for this kind of engagement. In one recent Encore.org survey, 87 percent of older respondents said they felt a responsibility to help those less fortunate than themselves, and 70 percent said that it was important to leave the world a better place.
The projects phases include:
- Part 1 is a study to be conducted by the Stanford research team which will include a national survey and in-depth interviews to investigate how Americans with varied histories, values, needs, and opportunities make sense of their lives between midlife and old age, what they wish for, and whether they’re able to realize their aspirations.
- Part 2 is a data collection effort to create an up-to-date database of existing programs that help people in their later years develop and maintain purposeful lives.
- Part 3 is an engagement and implementation phase, which will bring the insights of Part 1 and the resources identified in Part 2 to the general public and to many different kinds of organizations and programs that support purpose in later life. In doing so, Part 3 intends to shift popular conceptions of the encore years and strengthen institutional mechanisms that support many varieties of purposeful aging.
Thanks to Dickinson Law Professor Laurel Terry for sharing news of this interesting study.
Sunday, November 15, 2015
One of my regular "must reads" is Aging In Place Technology Watch. I love reading about all the new cool tech and how companies are innovating to make lives better for us as we age. So catching up on reading emails, I was reading the post on the LeadingAge2015 Annual meeting. The technologies reported in this post were fascinating, but the one that really caught my attention was HipHope. Looking at the website, the best way I can describe the technology is wearable air bags.
The website describes the device. "Hip-Hope™ is a revolutionary active hip protector device, providing unprecedented fall impact absorption effectiveness, combined with highly reliable real-time fall detection capability. Hip-Hope™ unique achievements are a result of “out-of-the-box” design concepts and technological innovations."
According to the website, the device deploys in the blink of the eye, and it looks compact and easily wearable. Check out the video demonstrating it.
Friday, November 13, 2015
Studies have shown that those with deep interest in "fun" have healthier, happier lives as they age. Or at least, that's what I hope the studies show. Along that line, I discovered a new definition for the "Century Club," offered by the Dressage Foundation, for the "exclusive group of horse and rider pairs who perform a dressage test at a recognized [horse] show when their combined ages total 100 years or more."
An issue of The Chronicle of the Horse, in an article titled "Older, Wiser and Still Having Fun," features 24-year old dressage mount Toblerone and 77-year old rider Donna Donaghy. Donna is "not done yet" and she plans to keep on riding and showing as long as she can still throw a leg over the back of her horse.
Thursday, November 12, 2015
The ABA is offering a webinar on VA Pension: Income Security for Veterans and Their Family. The 90 minute webinar is scheduled for November 17th, 2015 from 1-2:30 p.m. est. The website offers the following description of the webinar
This webinar will cover eligibility of veterans and their dependents for VA pension.
Panelists will discuss how to get the best results for a client looking to obtain a VA pension. Practical pointers on obtaining the highest amount for pension will be discussed, as well as how a client can keep that amount each year. Practice tips on dealing with a VA debt—due to an overpayment issue related to a VA pension—will also be provided. This presentation will give practitioners an understanding of the law and provide practical tips on how to work within the confines of the VA.
To register, click here.
Kudos to my Stetson colleague, Stacey-Rae Simcox, one of the panelists!
On Tuesday, November 17, from 9 to 11 a.m., the National Press Club in Washington, D.C., will be the site for a fascinating mix of industry experts, government leaders and commentators interested in aging to talk about "Financing Long-Term Services and Supports." The event will spotlight a forthcoming article in the monthly journal, Health Affairs.
A forthcoming "Web First" article in Health Affairs, "Financing Long-Term Services And Supports: Options Reflect Trade-Offs For Older Americans And Federal Spending," examines how policy changes could expand insurance's role in financing these needs. The study, by authors Melissa M. Favreault, Howard Gleckman and Richard W. Johnson of the Urban Institute, contains several policy modeling options to address the long-term care financial crisis affecting millions of Americans, as well as baseline findings on the long-term care landscape. The work was funded by The SCAN Foundation, AARP, and LeadingAge.
The panel speakers scheduled to appear include:
- Bruce A. Chernof, M.D., President and CEO, The SCAN Foundation
- Melissa M. Favreault, Senior Fellow, Income and Benefits Policy Center, Urban Institute
- Richard Frank, Assistant Secretary for Policy Evaluation, US Department of Health and Human Services
- Chris Giese, Actuary, Milliman, Inc.
- Richard W. Johnson, Senior Fellow, Income and Benefits Policy Center, and Director, Program on Retirement Policy, Urban Institute
- Larry Minnix, President and CEO, LeadingAge
- Al Schmitz, Principal, Consulting Actuary, Milliman, Inc.
- Eileen Tell, Long Term Care Group
- Debra Whitman, Executive Vice President, Policy, AARP
More information on registration here. Special thanks to my Dickinson Law Colleague and health care expert, Jennifer Davis-Oliva, for the reminder of this event.
Renowned Cornell educators and specialists in geriatric medicine, Mark S, Lachs, M.D., and Karl A. Pillemer, PhD, have an important review essay in the current issue of the New England Journal of Medicine on "Elder Abuse" (linked above). The authors articulate roles for physicians and health care staff as the first line of help for many older persons who are victims of elder abuse, including the "virtual epidemic" of financial exploitation. From the introduction:
In the field of long-term care, studies have uncovered high rates of interpersonal violence and aggression toward older adults; in particular, abuse of older residents by other residents in long-term care facilities is now recognized as a problem that is more common than physical abuse by staff. The use of interdisciplinary or interprofessional teams, also referred to as multidisciplinary teams in the context of elder abuse, has emerged as one of the intervention strategies to address the complex and multidimensional needs and problems of victims of elder abuse, and such teams are an important resource for physicians. These new developments suggest an expanded role for physicians in assessing and treating victims of elder abuse and in referring them for further care.
In this review, we summarize research and clinical evidence on the extent, assessment, and management of elder abuse, derived from our analysis of high-quality studies and recent systematic studies and reviews of the literature on elder abuse.
One of the perhaps surprising observations in the article is that the "young-old" actually have a higher potential to become victims of abuse than the "old-old," in part because they are most likely to be living under the control of a spouse or adult child, the most often-identified perpetrators.
Further, the authors advise that "the most important tasks for the physician are to recognize and identify elder abuse, to become familiar with resources for intervention that are available in the local community, and to refer the patient to and coordinate care with those resources." The article includes community services and organizations that may provide help to victims.
I was especially interested to see the authors' thoughts on the importance of interdisciplinary teams, especially given my own law school's current involvement in creating a Medical Legal Partnership Clinic. The authors write:
The most promising response to the complex nature of cases of elder abuse has been the development of interprofessional teams. Evidence suggests that interprofessional teams, also referred to as multidisciplinary teams, consisting of physicians, social workers, law-enforcement personnel, attorneys, and other community participants working together in a coordinated fashion, are the best practical approach to assisting victims.
Our thanks to "devoted reader" Professor Dick Kaplan, University of Illinois Law, for providing us with early notice of this important article.
Wednesday, November 11, 2015
I was reading a recent article in the New York Times on estimating longevity in the context of the Social Security Trust Fund. Your Kids Will Live Longer Than You Thought ran in the NY Times on November 10, 2015. The article discusses statistics and probabilities, explaining how life expectancies are calculated. Looking at the Social Security projections of life expectancy, the article notes that SSA is likely too conservative in their longevity projections.
The Technical Panel on Assumptions and Methods established by the Social Security Advisory Board, an independent government agency that advises Social Security’s trustees on matters including actuarial assumptions, says Social Security is systematically underestimating future declines in mortality rates, and therefore underestimating the likely life spans of young Americans.
So this is a good news-bad news scenario. Good news for those who get more years of life, bad news for Social Security. "[O]ne quirk of Social Security is that a piece of obvious good news (People will live longer than we thought!) is bad news from the narrow perspective of paying for retirement benefits (The government will have to pay benefits longer!)." So how to handle Social Security's too conservative projections? The Congressional Budget Office "tweaked" them by increasing them.
Tuesday, November 10, 2015
On November 6, 2015 the appellate division of New York's Supreme Court addressed an issue long brewing in some states, whether Continuing Care Retirement Communities (CCRCs) can insist on "private pay" for skilled nursing care despite a resident's "eligibility" for Medicaid under state and federal laws. In Good Shepherd Village at Endwell, Inc. v. Yezzi, the unanimous panel affirmed summary judgment in favor of the CCRC on the payment question.
The decision highlights Congressional DRA action in 2005/6 that amended federal Medicaid law to expressly permit CCRCs to offer contracts that require residents to "spend on their care resources declared for the purposes of admission before applying for medical assistance." The DRA amendment was a response to the industry's lobbying efforts, following a 2004 decision by a Maryland appellate court in Oak Crest Village, Inc. v. Murphy that held such a contractual provision violated the federal Nursing Home Residents' Bill of Rights, viewed as prohibiting nursing homes from conditioning admission on guarantees of private pay.
In the New York case history, the couple apparently signed two separate documents, beginning with a "contract" at the time of their entrance into the CCRC that required them to pay both an entrance fee ($143,850) and "basic monthly fees" of approximately $2,550 to cover the cost of independent living. Any need for skilled nursing care would be assessed "an additional charge." That contract provided that residents could "not transfer assets represented as available" for less than fair market value. When the wife needed skilled care, the couple signed a second document, referred to in the case as an "admission agreement," for treatment in the CCRC's skilled nursing unit. The "admission agreement" reportedly required the Yezzis to "pay for, or arrange to have paid for by Medicaid" all services provided by the CCRC.
Monday, November 9, 2015
Professor Janet Dolgin from Hofstra University has a very good article in the October 2015 issue of ABA's The Health Lawyer on "Reimbursing Clinicians for Advance-Care Planning Consultations: The Saga of a Healthcare Reform Provision." The article offers facts, analysis, historical perspective and opinion about the need to approve payment to health care providers in order for them to be able to engage fully with clients and their families in careful conversations about advance care planning, including end-of-life decisions. The article is concise, but the downside for interested readers is the digital version of the article is currently behind a pay-wall for ABA Health Care Section members only.
To stimulate your interest in tracking down a hard copy, perhaps through your law colleagues or local law libraries, here are a few highlights. Professor Dolgin writes:
Advance care planning is part of good healthcare. Thus, paying clinicians to talk with patients about advance care planning makes sense: it enhances advance care planning and thereby serves to effect good healthcare. "If end-of-life discussions were an experimental drug," writes Atul Gawande in his recent book, Being Mortal, "the FDA would approve it." Yet efforts to provide for reimbursement to clinicians for time and attention given to advance-care-planning conversations with Medicare patients have been stymied since 2009 (at least until quite recently) by the politics of healthcare reform....
Published, peer-reviewed research shows that ACP [Advance Care Planning] leads to better care, higher patient and family satisfaction, fewer unwanted hospitalizations, and lower rates of caregiver distress, depression and lost productivity....
In July 2015 CMS accepted the recommendation [supported by AARP, the AMA and others identified in the article] and opened the proposal to [pay health care clinicians for such consultations] to a two month-comment period in its proposed physician payment schedule for 2016.... If the proposed rule is accepted by CMS, payments for advance-care planning consultations are slated to begin in early January 2016.
The article demonstrates well the tension between the use of administrative law options to achieve what Congress finds unable or unwilling to address as a matter of Congressional laws. Of course, administrative processes can gore the ox of either side on a politically-charged debate.
Perhaps I am alone in being sad that it takes billing codes approved by insurance providers and CMS to achieve appropriate consultation between health care staff and families about advance decision-making. But Professor Dolgin's article is a realistic explanation for exactly why that "is" necessary.
November 9, 2015 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, State Statutes/Regulations | Permalink