Thursday, April 28, 2016

A Greener Death

We have heard about green cemeteries.  Environmentally sensitive deaths have expanded beyond green cemeteries.  According to the New York Times article from April 22, 2016 (Earth Day to those of you reading this closely), others are thinking about lowering the environmental impact a traditional burial may cause. Mushroom Suits, Biodegradable Urns and Death’s Green Frontier starts the story explaining one person's idea, a mushroom suit, or more specifically "the Infinity Burial Suit. It’s a $1,500 outfit that incorporates mushrooms meant to break down a human corpse, cleanse it of toxins and distribute nutrients back into the soil. No one has been buried in it yet, but ... a man who suffers from a chronic illness has agreed to be the first."

In addition to green burials, "[a]t Western Carolina University, researchers with the Urban Death Project are learning how best to turn corpses into compost. In Los Angeles, Undertaking LA operates a “do-your-own-death” workshop to give people the tools to plan home funerals."

What do these new businesses have in common (other than death)? "Design and innovative technology seem to be an important component of these new death products. Roger Moliné, the 24-year-old co-founder of Bios Urn, began a Kickstarter campaign after customers asked for better ways to monitor the health of the trees growing from biodegradable urns. The company raised over $83,000 to design an incubator that, through a sensor embedded in the soil, will send updates to a custom phone app. Around 60,000 urns have been ordered and 200 incubators pre-ordered."

So how do you know if burial products are truly green? Well, there is (you thought I was going to say app for that, didn't you)... there is a council that oversees this.  The Green Burial Council grants certification to products that are actually earth-friendly. The list of certified products is available here.

 

April 28, 2016 in Consumer Information, Current Affairs, Other | Permalink | Comments (0)

Wednesday, April 27, 2016

Physician-Aided Death Legislation and the Impact on the Medical Profession

JAMA's Journal of Internal Medicine ran an article in the April issue, The Challenge of New Legislation on Physician-Assisted Death .  From the legal profession, we know how these laws work. But from the medical profession, according to the article, doctors need to think about how to incorporate this into their practices.   Here is a sample of the article:

By the end of 2016, more than 80 million people in the United States and Canada will live in a jurisdiction allowing physician-assisted death. As such, this practice can no longer be considered a quirky experiment in a few states. The North American experience with physician-assisted death began in 1994, when voters in Oregon approved a ballot measure, the Death With Dignity Act, allowing a physician to prescribe a lethal dose of a medication that a patient voluntarily self-administers. Oregon stood alone for 14 years until Washington (2008), Vermont (2013), and now California (2015) approved similar laws. As of January 2016, the effective date of the California law, known as the End of Life Option Act, is uncertain. These laws are in general very similar, with safeguards that include requirements for a waiting period and that eligible patients be mentally competent, not mentally ill, and have a life expectancy of less than 6 months. In 2009, the Montana Supreme Court removed prohibitions against physician-assisted death for competent patients. There are no reporting requirements in Montana, so little is known about the actual practice of physician-assisted death in that state. In 2015, the Canadian Supreme Court unanimously reversed a federal law that prohibited physician-assisted death and gave the government until June 2016 to establish mechanisms for access to such assistance. (citations omitted)

A subscription is required to read the entire article.

April 27, 2016 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)

Tuesday, April 26, 2016

Dangers of Polypharmacy

In Elder Law world we know the dangers that may occur with taking multiple medications. The New York Times ran an article last week that focused on the topic; The Dangers of ‘Polypharmacy,’ the Ever-Mounting Pile of Pills.  "Geriatricians and researchers have warned for years about the potential hazards of polypharmacy, usually defined as taking five or more drugs concurrently. Yet it continues to rise in all age groups, reaching disturbingly high levels among older adults."

When your doctor asks you what medications you take, do you include vitamins and supplements in your answer? Many don't, according to the article, referencing a study in the Journal of American Medical Association's Journal of Internal Medicine, "A recent study in JAMA Internal Medicine, however, found that more than 42 percent of adults didn’t tell their primary care doctors about their most commonly used complementary and alternative medicines, including a quarter of those who relied most on herbs and supplements."

How many people take multiple medications?  "More than a third were taking at least five prescription medications, and almost two-thirds were using dietary supplements, including herbs and vitamins. Nearly 40 percent took over-the-counter drugs."

Don't we all take supplements and vitamins? Although there is no age-specific time when folks start doing so, there is a difference in the impact based on age.

Though drug interactions can occur in any age group, older people are more vulnerable, said Dr. Michael A. Steinman, a geriatrician at the University of California, San Francisco, who wrote an accompanying commentary. ..Most have multiple chronic diseases, so they take more drugs, putting them at higher risk for threatening interactions...The consequences can also be more threatening.

The article suggests the need to revamp our health care system so it's not fragmented and until then, ask doctors and pharmacists about medications, and include vitamins and supplements in your list of medications.

The article about the study is available here.

April 26, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink | Comments (0)

Monday, April 25, 2016

Kudos to the Chief Justice

Last week 12 lawyers who are deaf or hard of hearing were sworn into the Supreme Court Bar.  That in and of itself is very special. It was made more so by the actions of Chief Justice Roberts.  Chief Justice Roberts learned some sign language for the occasion; "[a]fter they were presented to the court for admission, Roberts signed in American Sign Language: 'Your motion is granted.'”  Well done Chief Justice.

April 25, 2016 in Consumer Information, Current Affairs, Federal Cases, Legal Practice/Practice Management, Other | Permalink | Comments (0)

Sunday, April 24, 2016

Know Any 100 Year Olds? If Not Now, You Will Soon!!

Pew Research Center issued a recent Fact Tank on Centenarians worldwide.  World's Centenarian Population Projected to Grow Eightfold by 2050 explains the number of centenarians is growing rapidly. Check this out: "[t]he world was home to nearly half a million centenarians (people ages 100 and older) in 2015, more than four times as many as in 1990, according to United Nations estimates. And this growth is expected to accelerate: Projections suggest there will be 3.7 million centenarians across the globe in 2050."  We know that the oldest-old have been the fastest growing for some time, so it makes sense that the number of centenarians is growing as well.  The report discusses the difficulty in verification of ages for this group for various reasons.

Who has the most centenarians?  "[T]he available data suggest that the U.S. leads the world in terms of the sheer number of centenarians, followed by Japan, China, India and Italy." The U.S. population isn't aging as fast as other countries, according to the report, and is "aging at a slower rate than Japan and Italy, partly due to its higher fertility and immigration rates – there are now 2.2 centenarians per 10,000 people."  By 2050, China will have the greatest number of centenarians, and "[t]he centenarian share of the populations of the U.S. ...  will grow less rapidly. There will be 9.7 centenarians per 10,000 people in the U.S. ..."

April 24, 2016 in Consumer Information, Current Affairs, Statistics | Permalink | Comments (0)

Friday, April 22, 2016

Do We Ask Too Much of Doctors as Advisors on Death?

This semester, I took a poll with  my students in Elder Law, asking their views about right to die issues.  This year, perhaps more than in past years, the poll came out strongly in favor of honoring clear, adequately informed decisions of individuals to end their lives.  Of course, we discussed the many grey areas, and the impact of high profile cases, such as Brittany Maynard, on current thought.  We debated both the question of affirmative actions to die, particularly in states that permit physician assistance, and the potential to assume -- and or even over-assume -- that a completed "living will" is a choice to reject so-called extraordinary life-saving measures.   Just because we are now more likely to support personal choices to die, does not mean we should assume that all accept a nearer end.

Relevant to this discussion  is a Washington Post essay by Boston-based internal medicine and primary care resident Ravi Parikh on When a Doctor and Patient Disagree About Care at the End of Life. He describes his own experiences as he begins his career:

Not long ago, a frail-looking elderly patient appeared at my cardiac health clinic with a file full of hospitalizations stemming from a heart attack years before. He’d had three coronary stents put in, had had heart bypass surgery and was unable to walk for more than a block due to chest pain. I saw that a previous doctor had written “DNR” — do not resuscitate — in his chart, so I asked him to confirm his wishes.

 

No, he said, to my surprise. He actually wanted to be a “full code” — meaning that chest compressions, shocks and intubation were to be used if necessary to keep him alive.

 

I was taken aback....

This experience pushed him to rethink his approach to the topic, which in turn led him to The Conversation Project website.  His exploration concludes with the thought that "Once we listen enough to learn, maybe those 'goals of care' discussions will start focusing on the goals of the patient, not the doctor."

Our thanks to George Washington Law's Naomi Cahn for sending this piece; she and frequent writing colleague Amy Ziettlow have a thematically related piece for a recent University of Illinois  symposium on "Law, Religion and the Family Unit After Hobby Lobby: A Tribute to Professor Harry Krause." 

April 22, 2016 in Advance Directives/End-of-Life, Consumer Information, Ethical Issues | Permalink | Comments (0)

Thursday, April 21, 2016

Elders and Social Media

All of us who use social media, raise your hands. Ok, so that is a lot of us.  And social media isn't just the province of the young, even though some of us may be digital immigrants. The New York Times ran a recent article about elders on Facebook. Why Do Older People Love Facebook? Let’s Ask My Dad explains about a recent survey done by Penn State. 

The press release about the study, Sorry kids, seniors want to connect and communicate on Facebook, too explains "[o]lder adults, who are Facebook's fastest growing demographic, are joining the social network to stay connected and make new connections, just like college kids who joined the site decades ago, according to Penn State researchers." The study looks at the reasons why elders would be drawn to use Facebook, including curiosity, keeping in touch with friends, and connecting with family, as well as communicating with those with shared interests, what the authors refer to as social bonding, social bridging and social surveillance.

The authors suggest that the social media designers need to look at making the media more elder-friendly, and "emphasize simple and convenient interface tools to attract older adult users and motivate them to stay on the site longer."  The volume of elder users is growing,  so "[d]evelopers may be interested in creating tools for seniors because that age group is the fastest growing demographic among social media users. In 2013, 27 percent of adults aged 65 and older belonged to a social network, such as Facebook or LinkedIn, according to the researchers. Now, the number is 35 percent and is continuing to show an upward trend."

Returning to the New York Times article, the author asked her dad about his Facebook use; "he wanted to be better at keeping in touch with family and with the friends he remembers from my childhood. He told me over Facebook chat (naturally) that his curiosity about what others were up to was his main motivator in finally learning to navigate Facebook."  The author quotes one of the co-authors of the study: "[a]s Facebook continues to be a bigger part of American life, the ever-growing population of older Americans is figuring out how to adapt. As people grow older, peer communication through chatting, status updates and commenting will become more important ... and Facebook will need to adapt tools that are suited for an aging audience."

April 21, 2016 in Consumer Information, Current Affairs, Statistics, Web/Tech, Weblogs | Permalink | Comments (0)

The "Unbefriended" Need Trustworthy Representatives, including Rep Payees

Someone asked me recently about "alternatives" for law students interested in helping older persons or disabled adults.   I said, in essence, "figure out how to start and operate a cost-effective, soundly-managed, and reliable, nonprofit rep-payee organization in your community."  (And understand that you won't make a fortune, but you can make a good living with a well-run nonprofit!)   

Coinciding with my off-the-cuff advice is a white paper recently released by Justice in Aging, with the assistance of funding through the Borchard Center Foundation on Law & Aging.

In "Ways to Meet the Growing Need for Representative Payees," Justice in Aging recommends that the Social Security System partner with organizations, including attorney organizations, to establish a "sustainable program to help recruit representative payees who are reliable and suitable to perform all of the required duties" of a rep-payee for those receiving federal program benefits but who often are unable to manage the money soundly. In some instances they may have no easy access to reliable family or friends.  The "unbefriended," who, in turn, may be vulnerable to those with bad intentions:

Aging demographics and the predicted increase in cognitive deficits and other chronic conditions are expected to create a dramatic need for representative payees. For many of these seniors, family members and friends may be unavailable to serve in this capacity. SSA should think broadly about the groups of people eligible to serve as payees and then create standards for appointment, require a more in-depth level of training, and increased accountability.

Justice in Aging closes by urging that SSA's "recruitment efforts should be geared towards eligible individuals with legal experience as well as other fields with relevant backgrounds, such as social workers and religious community leaders."

April 21, 2016 in Consumer Information, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Social Security | Permalink | Comments (0)

Wednesday, April 20, 2016

Physician-aided Dying in Canada

Prime Minister Justin Trudeau was the focus of an article in the New York Times last week on physician-aided dying in Canada. Justin Trudeau Seeks to Legalize Assisted Suicide in Canada reports that a proposed law was introduced that would allow physician-aided dying  "for Canadian residents and citizens who have "a “serious and incurable illness,” which has brought them 'enduring physical or psychological suffering.'"

Under Canada’s proposed law, people who have a serious medical condition and want to die will be able to commit suicide with medication provided by their doctors or have a doctor or nurse practitioner administer the dose for them. Family members and friends will be allowed to assist patients with their death, and social workers and pharmacists will be permitted to participate in the process.

The legislation follows a ruling by the Canadian Supreme Court which eliminated a criminal ban on physician-aided dying. A copy of that decision is available here.

One striking difference in the proposed legislation in Canada compared to those states in the U.S. where physician-aided dying is legal is that "a doctor or nurse practitioner [may] administer the dose for them. Family members and friends will be allowed to assist patients with their death, and social workers and pharmacists will be permitted to participate in the process."

Not all in Canada are in favor of the legislation. CBC Canada ran a story,  Religious groups react to physician-assisted dying bill LIVE where a number of groups stated concerns about the legislation.  The video is available here.

If any of our readers are from Canada, we would be very interested in hearing more about the discussion in Canada on this proposal.

April 20, 2016 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, International | Permalink | Comments (0)

Tuesday, April 19, 2016

More on Medicare LTC

After my post on an article about adding  a long term care benefit to Medicare, Professor Dick Kaplan (prolific author, elder law guru and friend) sent me an email reminding me about an article he wrote in 2004 that discussed the topic. "Cracking the Conundrum: Toward a Rational Financing of Long-Term Care,” is available from his SSRN page. Here is the abstract  

This article provides a comprehensive solution to the financing of long-term care for older Americans that balances government and family responsibility, while recognizing the different settings in which long-term care is provided. The article begins by examining the spectrum of long-term care in the United States from home health care to assisted living to nursing homes, as well as hybrids such as continuing care retirement communities. Successive sections of the article then analyze the federal government's health care program for older persons (Medicare), the joint state and federal program for poor people of any age (Medicaid), and private long-term care insurance in terms of how these mechanisms treat long-term care in each setting.

Finding serious deficiencies and inconsistencies in all three mechanisms, the article then offers a co-ordinated alternative: expand Medicare to cover long-term care in nursing homes but maintain responsibility for other long-term care settings with the affected individuals and their families. This approach recognizes that nursing home care substitutes for hospital care that Medicare would otherwise cover, while other long-term care settings substitute for family-provided care. Long-term care insurance would then be used as a means of financing long-term care in settings other than nursing homes, thereby making it more appealing. In addition, such insurance would be less expensive than presently, because it would no longer be priced to cover costly nursing home care. The article also recommends that such insurance be improved by standardizing policy options and features into a fixed set of packages that would be uniform among carriers. Other recommendations include ensuring price stability of issued policies and providing independent reviews of gatekeeper claim denials. The article concludes with some observations regarding financing of these proposals.
Professor Kaplan directs the reader to pages 82-88 for more on this topic.
Thanks Dick!

 

April 19, 2016 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Lessons About Protecting the Teenage Brain Can Resonate in Later Life

I recently caught a rebroadcast of  a Terry Gross interview -- from early 2015 and linked here -- with Dr. Frances Jensen, a neuroscientist from the University of Pennsylvania, on the "teenage brain."  It was fascinating, especially as Dr. Jensen explained the latest thinking on trauma on the younger brain, and the potential for alcohol and drug use -- both illegal and legal -- to be especially significant to the still developing teenage brain. Given that we need those brains to last for a very long time, the broadcast seems relevant to our Elder Law Prof Blog topics.  

This insulation process  [from myelin] starts in the back of the brain and heads toward the front. Brains aren't fully mature until people are in their early 20s, possibly late 20s and maybe even beyond, Jensen says.

 

"The last place to be connected — to be fully myelinated — is the front of your brain," Jensen says. "And what's in the front? Your prefrontal cortex and your frontal cortex. These are areas where we have insight, empathy, these executive functions such as impulse control, risk-taking behavior."

 

This research also explains why teenagers can be especially susceptible to addictions — including drugs, alcohol, smoking and digital devices.

And as to that last item  on the list  -- digital devices -- Dr. Jensen emphasized her concerns about constant stimulation, especially when it lasts into time meant for sleeping.  The intense light alone may be interfering with with sleep and brain development. She explains:

First of all, the artificial light can affect your brain; it decreases some chemicals in your brain that help promote sleep, such as melatonin, so we know that artificial light is not good for the brain. That's why I think there have been studies that show that reading books with a regular warm light doesn't disrupt sleep to the extent that using a Kindle does.

I'm from a generation that didn't pay much attention to closed head injuries -- indeed, I think we more or less thought of "mild concussion" as a right of passage for young athletes.  Only in the last few years are we beginning to accept the connection between such injuries and later brain degenerative processes.  Now, even as we're getting better about physical risks from sports, we need to work harder to avoid the almost round-the-clock effects of our computerized lives.

Dr. Jensen closed the interview with sound advice for everyone:

GROSS: We are out of time, but I just want to ask you if there's any quick tip you can give us to preserve our brain health - something that you would suggest that adults do?

 

JENSEN: I think [take] time to reflect on what you've done every day, to underscore for yourself the most important things that happen to you that day and to not respond to conflict - to try to not respond to conflict in the midst of your working environment, for instance, because it will color your efficacy.

For more, look for Dr. Jensen's book: The Teenage Brain: A Neuroscientist's Survival Guide to Raising Adolescents and Young Adults.

 

April 19, 2016 in Cognitive Impairment, Consumer Information, Dementia/Alzheimer’s, Health Care/Long Term Care, Science | Permalink | Comments (0)

Monday, April 18, 2016

Safe Banking for Seniors Campaign

The American Bankers Association Foundation has released  resources for banks as part of its "Safe Banking for Seniors" campaign. The introduction explains:

​​Financial abuse against older Americans can take many forms, from illegal debits, to third-party scams and even unauthorized withdrawals by an approved caregiver. And with the share of the U.S. population 60 years and over projected to reach 30 percent by 2025, the opportunities to take advantage of these at-risk bank customers become more prevalent—by the minute. 

Join us in o
ur pledge to empower customers and communities with the facts, tools and best practices they need to bank more securely. Together, we can help eliminate the almost $2.9 billion lost annually to fraud against older Americans. ​​​​​​​​​​​​​​

Registration is required to receive access to the resources page and banks receive resources on the following: prevention of ID theft, choosing a financial caregiver, spotting and evading scams and being a responsible financial caregiver. Consumer resources include information on joint bank accounts and protecting someone from financial exploitation. There are a number of other resources for bankers. as well as a list of participating banks.

April 18, 2016 in Consumer Information, Current Affairs | Permalink | Comments (0)

Sunday, April 17, 2016

Time for Medicare Part LTC?

Periodically we will see observations about whether Medicare should offer a long term care benefit as part of Medicare coverage (would this be Part E or maybe Part LTC?).  It isn't a secret that many often think Medicare has a long term nursing home benefit, confusing what Medicare covers with what Medicaid does. Health Affairs Blog ran a story recently about  Medicare and long term care. Medicare Help At Home offers some sobering data

Nine million community-dwelling Medicare beneficiaries—about one-fifth of all beneficiaries—have serious physical or cognitive limitations and require long-term services and supports (LTSS) that are not covered by Medicare. Nearly all have chronic conditions that require ongoing medical attention, including three-fourths who have three or more chronic conditions and are high-need, high-risk users of Medicare covered services.

Gaps in Medicare coverage and the lack of integration of medical care and LTSS have serious consequences. Beneficiaries are exposed to potentially high out-of-pocket expenses. Medicaid covers LTSS for very low-income Medicare beneficiaries, but only one-fourth of Medicare beneficiaries with serious physical or cognitive limitations are covered by Medicaid.

The authors offer a 3-part proposal that would expand Medicare coverage to include home and community-based coverages:

  1. A Medicare home and community-based benefit for those with two or more functional limitations, Alzheimer’s, or severe cognitive impairment, according to an individualized care plan based on beneficiary goals. This would cover up to 20 hours a week of personal service worker care or equivalent dollar amount for a range of home and community-based LTSS.
  2. Creation of new Integrated Care Organizations (ICOs) accountable for the delivery and coordination of both medical care and LTSS that meet quality standards, honor beneficiary preferences, and support care partners.
  3. Innovative models of health care delivery including a team approach to care in the home building on promising models of service delivery that improve patient outcomes, reduce emergency department use, prevent avoidable hospitalization, and delay or reduce long-term institutional care.

The article goes on to explain eligibility, beneficiary cost-sharing, financing, care delivery and coverage. The article concludes, offering that with the Baby Boomers " the Medicare program ... was not designed to support their [boomers] preferences for independent living and functioning.

Moving forward, adoption of a home and community based benefit in Medicare would constitute an important first step to helping beneficiaries afford the services and support they need to continue living independently. Adoption of innovative models of care emphasizing care at home or in independent living settings would reduce the difficulty and risk of obtaining services in traditional health care settings such as physician offices and hospitals. It would also reduce beneficiary reliance on Medicaid’s safety-net coverage of institutional care. It is a policy proposal worthy of serious consideration as the nation grapples with Medicare redesign to meet the needs of an aging population.

 

 

 

April 17, 2016 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (2)

Friday, April 15, 2016

What's the Connection Between "Living Wills" for Banks vs Humans?

Lately, I've been hearing and seeing the phrase "living wills" in mainstream news sources such as the New York Times, but at first the context was confusing to me because the media were speaking and writing about Big Banks, not humans. So, how did it come about that following the 2008 financial crisis, regulators started requiring large financial institutions to have "living wills?"

The Wall Street Journal explains in What You Need to Know About Living Wills [in the context of Big Banks]:

A living will is a document from a financial firm that describes how it would go through bankruptcy without causing a broader economic panic or needing a bailout from taxpayers. The largest U.S. banks have filed several versions of them since the 2010 Dodd-Frank law, which ​required living wills from financial firms ​that were judged to pose a potential risk to the broader economy. The documents are also known as resolution plans. “Resolution” is regulatory parlance for dealing with a failing financial firm.  Living wills are separate from other regulatory requirements, such as annual “stress tests” that measure whether could banks survive a severe recession.

I've not yet determined who first came up with "living wills" to describe what Dodd-Frank, at 12 U.S.C. Section 5361(d), refers to as "resolution plans." Without accurate, full disclosure, addressing all aspects of the financial institution's operations, such plans -- by any name -- seem unlikely to achieve the goal of greater market stability.  As another WSJ writer points out, the utility of Big Banks' living wills comes if not just regulators, but the Bank executives, are paying attention:

The point of the living wills, like the stress tests, is to sit banks down and make them comb through their businesses in excruciating detail, with a focus on grim aspects like liquidity crunches and operational risks in bankruptcy. A useful result of the living wills is that, if they're done correctly, they give regulators a good overall picture of how a bank works, how money flows between its parts, what its pressure points are, and how it responds to crisis. But a much more important result is that, if they're done correctly, they give bankers themselves that same overall picture: They force a bank's executives and directors to understand the workings of the bank in a detailed and comprehensive way. And if they're done incorrectly, that's useful too: They let the regulators and bankers know what they don't know.   

The full article on this point is titled, with nice irony, Living Wills Make Banks Think About Death.  There, a least, is one similarity in living wills for humans and banks.  

April 15, 2016 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Estates and Trusts, Ethical Issues, Federal Cases | Permalink | Comments (2)

Multigenerational Housing-The Hot New Thing!

The New York Times ran a story recently about a new trend in housing for elders---multigenerational homes.  Multigenerational Homes That Fit Just Right are homes that, as the name implies, are designed for multiple generations of a family that live in the same house.  "[A] growing number of families ... are seeking specially designed homes that can accommodate aging parents, grown children and even boomerang children under the same roof. The number of Americans living in multigenerational households — defined, generally, as homes with more than one adult generation — rose to 56.8 million in 2012, or about 18.1 percent of the total population, from 46.6 million, or 15.5 percent of the population in 2007, according to the latest data from Pew Research. By comparison, an estimated 28 million, or 12 percent, lived in such households in 1980."

But how does one accommodate family dynamics when living together under one roof? In fact, the story notes, many of the multigenerational households do live in an "ordinary" home. But, it appears that the building industry has developed an option that is catching on, "responding quickly to this shifting demand by creating homes specifically intended for such families."  For example, one builder's homes "don’t offer just a spare bedroom suite or a “granny hut” that sits separately on the property or a room above a garage. The NextGen designs provide a separate entranceway, bedroom, living space, bathroom, kitchenette, laundry facilities and, in some cases, even separate temperature controls and separate garages with a lockable entrance to the main house. Family members can live under the same roof and not see one another for days if they so choose."

The article explains the drivers for the trend, baby boomers (of course), the 2008 recession, tough job market and higher rents facing millenials, the boomerang children and again, those baby boomers, "[m]any [of whom] are planning ahead in hopes that they can devote more attention to their children and grandchildren — and spend little, if any, time in a nursing home."

Expect to see more of these multigenerational homes over the next years. From a legal perspective, it seems that ground rules, a family contract and a care  would be important to the success of the venture (whose turn is it to cut the grass this week? No loud music after 11 p.m. as a couple of an examples).  What an interesting concept of the market changing to accommodate demand.

April 15, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Property Management, Retirement | Permalink | Comments (1)

Wednesday, April 13, 2016

Hoarding-More Prevalent Than You May Think.

I ran across a couple of articles recently about hoarding.  We all have "stuff" and the older we get, the more "stuff" we may have as we accumulate a lifetime of memories. Does that mean we are hoarders? According to the article in the Washington Post, Hoarding is a serious disorder — and it’s only getting worse in the U.S.,

While the stockpiling of stuff is often pinned on America’s culture of mass consumption, hoarding is nothing new. But it’s only in recent years that the subject has received the attention of researchers, social workers, psychologists, fire marshals and public-health officials.

They call it an emerging issue that is certain to grow with an aging population. That’s because, while the first signs often arise in adolescence, they typically worsen with age, usually after a divorce, the death of a spouse or another crisis.

So you have a lot of stuff. And maybe you are disorganized (I once had someone tell me people do two kinds of organizing, some are "pilers" and others are "filers").  Does that mean you are a hoarder? Not necessarily, according to the article, because "[h]oarding is different from merely living amid clutter, experts note. It’s possible to have a messy house and be a pack rat without qualifying for a diagnosis of hoarding behavior. The difference is one of degree. Hoarding disorder is present when the behavior causes distress to the individual or interferes with emotional, physical, social, financial or legal well-being." 

The article offers some interesting insights into hoarding and the research (such as it runs in families) but it isn't until recently that it's been thought of as a brain disorder.  Not only may hoarding have lacked attention in the past, it's one of those situations where the person may not know to seek treatment and the response requires a multi-disciplinary approach. The article has a lot of good information and is insightful in covering the issues.

Then look at this article in Huffington Post's Post 50, 5 Signs That Someone You Love May Be A Hoarder where one expert is quoted as predicting about 4 million people in the U.S. are hoarders. "Hoarding ...  is associated with a number of things including difficulty processing information, the inability to make decisions when confronted with a large amount of information and a failure to categorize things — meaning you can’t see the commonality of objects and they instead all look unique to you." This article offers 5 signs that someone is a hoarder, including constant attendance at garage sales and swap meets, never inviting visitors to the person's home, never giving anything away, keeping every scrap of paper and getting upset at the suggestion of discarding possessions.  Sound like anyone you may know?

 

April 13, 2016 in Cognitive Impairment, Consumer Information, Current Affairs, Health Care/Long Term Care, Other | Permalink | Comments (0)

Tuesday, April 12, 2016

What is Old? Watch the video!

Huffington Post's Huff/Post 50 ran a story with an accompanying video, Millennials Show The World What They Believe ‘Old’ Looks Like.  Not unexpectedly, their initial impressions involved some stereotypical perceptions of those who are older. Then watch the video to see what they have learned and how their views changed.  Show the video to your class!

Also, take a look at the new book, Disrupt Aging, from the CEO of AARP, Jo Ann Jenkins.

April 12, 2016 in Books, Consumer Information, Current Affairs, Film, Other, Web/Tech | Permalink | Comments (0)

Learning is a Lifetime Habit

As law profs, that title doesn't surprise us. Learning is something we continually do (and so too, hopefully, our students). The Pew Research Center released a new report, Lifelong Learning and Technology. The report looks at learning from a variety of points, including learners who learn for employment and learners who learn for personal reasons.

As far as age for the personal learners, the report provides a breakdown for the percentage "of adults in each group who participated in at least one of a variety of activities in the past 12 months related to personal growth and enrichment...." for those age 65 and older, the percentage engaged in personal learning was 72%. For professional learners ("[a]mong employed adults, % of those who took a course or got extra training in the past 12 months for job-related reasons...") the percentage for those 65 and older was 47%.

The study doesn't just look at age of the learner, but looks at a number of variables, including education, income, ethnicity, race, access to and ownership of tech devices and internet, etc. A pdf of the report is available here.

April 12, 2016 in Consumer Information, Current Affairs, Other, Statistics, Web/Tech | Permalink | Comments (0)

Monday, April 11, 2016

When Remittiturs in Nursing Home Awards Trigger Inquiry into Campaign Finances for Judges...

I think it is safe to say that in recent years, juries have not been shy about awarding substantial damages in trials involving claims of negligent care, even -- or perhaps especially -- when the resident is very old.  Lately, several of our Elder Law Prof Blog posts have focused on nursing home providers' efforts to avoid jury trials through the use of pre-dispute, binding arbitration clauses in admission agreements.  See e.g. here and here.  However, there's another way in which litigation of nursing home care claims have triggered collateral legal disputes, and this time it is for the judicial system itself.  

In March 2016, former Arkansas state court judge Mike Maggio, age 54, was hit with a maximum prison sentence of 10 years, following his plea of guilty to federal charges for taking a bribe to reduce a verdict in a nursing home negligence case.  Maggio was alleged to have reduced a jury verdict in a nursing home case from $5.2 million to $1 million, after the owner of the facility reportedly made multiple campaign contributions to "PACs that were to funnel the money to Maggio for a planned race" for the state's Court of Appeals.  

In issuing the sentence, United State District Judge Brian Miller emphasized that while he had earlier rejected the prosecution's argument that any sentence should be guided by the multi-million dollar size of the remittitur, the maximum sentence was still warranted because "corruption in the judicial system especially erodes public trust in the system," noting "a judge is the system."  Details of the investigation -- as well as on-going litigation -- are provided in the Arkansas Times' Arkansas Blog.  

By comparison, in West Virginia, news media questioned a business transaction and contributions to a judge's re-election campaign, asking whether they affected the decision of the State Supreme court justice when she wrote the lead opinion in an appellate decision that reduced a 2011 jury verdict in nursing home negligence case from $90.5 million to $36.6 million.  The justice denied any improper influence or relationship with defense-side parties; following an investigation, the West Virginia Judicial Investigation Commission concluded the justice had no knowledge of the transactions in question, and it dismissed the ethics complaint in June 2015. 

The potential for campaign contributions to influence judicial election campaigns has long been one source of criticism of elections for judges.

April 11, 2016 in Consumer Information, Crimes, Ethical Issues, Federal Cases, State Cases | Permalink | Comments (0)

Is Aging Something to Be Cured?

We have all seen advertisements for "anti-aging" products and claims of products and research to defeat aging, reverse the effects of aging or at least slow down time.  Last month Fortune ran the article, The Obsession With 'Curing' Aging Is Now Big Business. Opening with statistics about Baby Boomers, the article next notes that "[i]t comes as little surprise, then, that finding ways to extend a healthy life has become big business, attracting many tens of millions in investment dollars from the likes of Google ...  and numerous biotechnology companies."  The article looks at six "tech titans" who are financing research for "longevity solutions," including the co-founder of the Methuselah Foundation who explains "[t]he Methuselah Prize has been credited for encouraging scientists to work on anti-aging research and treat aging as a "medical condition...." The research is fascinating. Check out the article and consider including this topic in a class discussion.

April 11, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Science | Permalink | Comments (0)