Wednesday, July 1, 2015
From the June 22 issue of The New Yorker magazine, an interesting, thorough -- and ultimately devastating -- account of recent developments in "death with dignity" movements around the world. The article introduced me to Wim Distelmans, described as "an oncologist and professor of palliative medicine at Free University of Brussels," and "recognized as a leading proponent" of a 2002 Belgium law "that permits euthanasia for patients who have an incurable illness that causes them unbearable physical or mental suffering."
In The Death Treatment, author Rachel Aviv uses the diary-based history of a 60+ year-old woman who struggled with depression, eventually losing her levensperspectief, a Dutch word "that refers to the sense that there is something to live for," to illuminate questions about the scope of any appropriate limits on self-directed death. The article makes clear that "lawful" self-directed death can have long-range consequences for surviving family members, drawing upon a son's challenge to permissible euthanasia in Belgium as the evidence. A very worthwhile, but not easy, read.
Monday, June 29, 2015
California Court Says Law Permitting Nursing Homes to "Make Routine Decisions for Incapacitated Residents" Is Unconstitutional
On June 24, 2015, the Superior Court for the State of California, County of Alameda, Judge Evelio Grillo presiding, issued a mandamus in a court suit filed in 2013 by California Advocates for Nursing Home Reform (CANHR). Lots of interesting and important issues here, including:
- the finding that CANHR, a nonprofit agency "dedicated to improving the quality of care for California's nursing home residents," has standing to bring a citizen action to challenge the reliance by nursing homes on California law to permit them to make decisions "for" incapacitated residents who do not have court appointed agents, family or other surrogate decision makers;
- the conclusion that the California law in question, Calif. Health & Safety Code Section 1418.8, is unconstitutional, both facially and as applied;
- the recognition that the mandate is necessary, even though it will require major changes in how care facilities operate in the daily care of patients.
The 44 page opinion concludes:
"The court is aware that this statute was the Legislature's attempt to deal with a very difficult and significant problem of how to provide timely and effective medical treatment to patients in skilled nursing facilities without delays that were often happening when a petition had to be filed in probate court. The court acknowledges that this order will likely create problems in how many skilled nursing facilities currently operate.... The court has considered this burden and weighed it against the due process concerns, and finds that the due process rights of these patients is more compelling. The stakes are simply too high to hold otherwise. Any error in these situations has the possibility of depriving a patient of his or her right to make medical decisions about his or her own life that may result in significant consequences, including death. A patient may not only lose the ability to make his or her health decisions, but also to manage his or her own finances, determine his or her visitors, and the ability to leave the facility."
Congratulations to the hard-working advocates at CANHR, and particularly to Golden Gate Law Professor Mort P. Cohen, who brought the action on behalf of CNHR and several nursing home residents. Here is a link to the full opinion in CANHR v. Chapman, Case No. RG13700100. Here is a press release from CANHR.
June 29, 2015 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care, Housing, Medicaid, Property Management, State Cases, State Statutes/Regulations | Permalink
Thursday, June 25, 2015
Recognizing that "tax credits" were a key component of health care reform enacted by Congress, six justices of the Supreme Court, led by Chief Justice Roberts, upheld application of the credits to federal exchanges, despite the statute's moments of "inartful drafting." Here is the final paragraph of the majority's surprisingly decisive opinion, issued on June 25, 2015:
Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter. Section 36B can fairly be read consistent with what we see as Congress’s plan, and that is the reading we adopt.
Here is the link to the Supreme Court's full opinion, including Justice Scalia's wrathful dissent.
From the July issue of the ABA Journal, news that "Delaware Leads the Way in Adopting Legislation Allowing Estate Executors Access to Online Accounts." The article details the use of model legislation in permitting "Fiduciary Access to Digital Assets," and related or pending legislation in other states.
Hat tip to Professor Laurel Terry -- visiting in Hawaii -- for being the first to send this our way!
Tuesday, June 23, 2015
There are four overarching themes for topics deemed critical to elders' well-being to be discussed at the White House Conference on Aging in July 2015. The planned themes are: healthy aging, retirement security, long-term supports and services, and elder justice. Here is an overview, pointing to articles used to create an agenda, from Robert Hudson, Editor-in-Chief of the Public Policy & Aging Report for 2015.
June 23, 2015 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Programs/CLEs | Permalink | Comments (0)
Sunday, June 21, 2015
As negotiations over the Greek debt crisis continue, with another crisis point looming this week, much of the attention is on the issue of pension reform, with Eurozone critics demanding cuts in benefits and pointing to early "full retirement" and payments that rival real wages. However, as several accounts help to explain, individuals' public pensions are often important to entire family structures, especially as younger Greek workers are unable to find jobs with adequate wages, and unemployment compensation is unavailable.
For more see Bloomberg News: Unwed Daughters in Greece Catch "Time Bomb" in Pension Overhaul
From National Public Radio: Greece Pledges New Proposal to Resolve Debt Crisis
Thursday, June 18, 2015
Earlier this week I recommended Atul Gawande's book, Being Mortal: Medicine and What Matters in the End, and I offered an excerpt from his discussion of how doctors are impacted by practical limits on their goals as solvers of problems. But the book is about more than just medicine. Another compelling chapter traces attempts to avoid "nursing homes" and the once cutting edge trend of "assisted living" as an alternative:
The idea spread astoundingly quickly. Around 1990, based on [Keren Brown] Wilson's successes, Oregon launched an initiative to encourage the building of more homes like hers. Wilson worked with her husband to replicate their model and to help others do the same. They found a ready market. People proved willing to pay considerable sums to avoid ending up in a nursing home, and several states agreed to cover the costs for poor elders.
Not long after that, Wilson went to Wall Street for capital, to build more places. Her company, Assisted Living Concepts, went public. Others sparing up with names like Sunrise, Atria, Sterling, and Karrington, and assisted living became the fastest growing form of senior housing in the country. By 2000, Wilson had expanded her company from fewer than a hundred employees to more than three thousand. It operated 184 residents in eighteen states. By 2010, the number of people in assisted living was approaching the number in nursing homes.
But a distressing thing happened along the way. The concept of assisted living became so popular that developers began slapping the name on just about anything. The idea mutated from a radical alternative to nursing homes into a menagerie of watered-down versions with fewer services. Wilson testified before Congress and spoke across the country about her increasing alarm at the way the ideas was evolving....
For more, see Chapter 4 of Being Mortal, titled "Assistance." The other intriguingly-named chapters are "The Independent Self," Things Fall Apart," "Dependence," "A Better Life," "A Better Life," "Letting Go," "Hard Conversations," and "Courage."
June 18, 2015 in Consumer Information, Current Affairs, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Property Management, Retirement, State Statutes/Regulations | Permalink | Comments (0)
Tuesday, June 16, 2015
During the last two years I have had the fascinating opportunity to work on two major studies of laws and government policies affecting older persons and their families in Northern Ireland, studies initiated by the Commissioner for Older People for Northern Ireland (COPNI). The earlier study looked at safeguarding systems. Now the second study has been made public, with Northern Ireland Commissioner Claire Keatinge using the work to recommend major reforms of Adult Social Care laws in her country. The formal launch of her "call for change" occurred on June 16 in Belfast.
Two of my four research colleagues, Dr. Joe Duffy (far left, who led the research team) and Dr. Gavin Davidson, (far right) both of Queens University Belfast, were present for the launch, with Joe giving introductory remarks to the audience of government officials and community stakeholders. The fourth member of our team is Dr. Subhajit Basu of the University of Leeds in England. Our research evaluated government policies and law in more than ten nations, looking for legal trends, best practices and cutting edge social care programs.
Significantly, in addition to recommending a comprehensive legislative framework and funding structure to coordinate services for all adults in need of assistance, one key recommendation announced by Commissioner Keatinge (left center above) and highlighted in our investigative report, is to implement a "Support Visit" for any interested person age 75 years or older, by an appropriately trained health and social care worker. This recommendation, which draws upon Denmark's successful experience with a "preventative home visitor" program, would create an opportunity for a psychosocial dialogue aimed at advance planning. The goal is to help individuals and family members anticipate needs in the event of functional impairment, thus reducing the need for crisis planning.
I've become a big fan of Commissioner Keatinge; she is clear, creative, realistic, and determined to see Northern Ireland become a world leader in recognizing not just the needs but the contributions made by older adults. She does so from a platform of respecting older persons' contributions, citing research to demonstrate that over the next several decades, older adults will contribute more than £25 billion to the Northern Ireland economy through formal work, volunteering, and their roles as caretakers for both adults and children.
It had been an honor for me to work on this social care reform project. The work has given me -- and Dickinson Law students serving as research assistants, Ryan Givens and Tucker Anderson (who used his ability to speak and translate Danish to help in our field research) -- important new perspectives on proactive ways to identify and address potential needs triggered by age-related changes in demographics. Frankly, in the U.S. we spend far more time (and arguably too much time) on issues of medical care. This report is a reminder that many health-care crises could be avoided or mitigated through more proactive implementation of social care networks.For more on the Duffy, Davidson, Basu, Pearson report (June 2015), see Review of Legislation & Policy Guidance Relating to Adult Social Care in Northern Ireland.
For more on Commissioner Claire Keatinge's call for reform, see Commissioner Calls for Overhaul of Adult Social Care.
See here, for more on Denmark's approaches to services, communication and programming for older people.
Special thanks to Ryan and Tucker for their research, proofreading, editing and translation skills!
June 16, 2015 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Housing, International, Retirement, Science, Social Security, Statistics | Permalink | Comments (0)
Monday, June 15, 2015
What is unusual about this book is that it reminds us how deeply doctors themselves are affected by the strengths and limits of their profession, while also helping everyone think more deeply about key issues of living and dying. The author is a candid, persuasive writer. Early in the book, Dr. Gawande explains:
"You become a doctor for what you imagine to be the satisfaction of the work, and that turns out to be the satisfaction of competence. It is a deep satisfaction very much like the one that a carpenter experiences in restoring a fragile antique chest or that a science teacher experiences in bringing a fifth grader to that sudden, mind-shifting recognition of what atoms are. It comes partly from being helpful to others. But it also comes from being technically skilled and able to solve difficult, intricate problems. Your competence give you a secure sense of identity. For a clinician, therefore, nothing is more threatening to who you think you are than a patient with a problem you cannot solve.
There's no escaping the tragedy of life, which is that we are all aging from the day we are born. One may even come to understand and accept this fact. My dead and dying patients don't haunt my dreams anymore. But that's not the same as saying one knows how to cope with what cannot be mended. I am in a profession that has succeeded because of its ability to fix. If your problem is fixable, we know just what to do. But if it's not? The fact that we have no adequate answers to this question is troubling and has caused callousness, inhumanity, and extraordinary suffering.
This experiment of making mortality a medical experiment is just decades old. It is young. And the evidence is it is failing...."
Pretty potent stuff, right?
Thursday, June 11, 2015
The Government Accountability Office (GAO) released a report dated May, 2015 on Retirement Security: Most Households Approaching Retirement Have Low Savings. The 51 page report is available here. The GAO offered this summary:
Many retirees and workers approaching retirement have limited financial resources. About half of households age 55 and older have no retirement savings (such as in a 401(k) plan or an IRA). According to GAO's analysis of the 2013 Survey of Consumer Finances, many older households without retirement savings have few other resources, such as a defined benefit (DB) plan or nonretirement savings, to draw on in retirement (see figure below). For example, among households age 55 and older, about 29 percent have neither retirement savings nor a DB plan, which typically provides a monthly payment for life. Households that have retirement savings generally have other resources to draw on, such as non-retirement savings and DB plans. Among those with some retirement savings, the median amount of those savings is about $104,000 for households age 55-64 and $148,000 for households age 65-74, equivalent to an inflation-protected annuity of $310 and $649 per month, respectively. Social Security provides most of the income for about half of households age 65 and older...
Studies and surveys GAO reviewed provide mixed evidence about the adequacy of retirement savings. Studies range widely in their conclusions about the degree to which Americans are likely to maintain their pre-retirement standard of living in retirement, largely because of different assumptions about how much income this goal requires. The studies generally found about one-third to two-thirds of workers are at risk of falling short of this target. In surveys, compared to current retirees, workers age 55 and older expect to retire later and a higher percentage plan to work during retirement. However, one survey found that about half of retirees said they retired earlier than planned due to health problems, changes at their workplace, or other factors, suggesting that many workers may be overestimating their future retirement income and savings. Surveys have also found that people age 55-64 are less confident about their finances in retirement than those who are age 65 or older
Highlights of the GAO report are available here.
Wednesday, June 10, 2015
Mark your calendars. The date for the WHCOA has been set for July 13, 2015. The event is going to be webcast live. Folks are encouraged to watch it and even tweet questions for the panelists at the conference. For more ideas and information, click here.
Tuesday, June 9, 2015
A recent article from the Washington Post focused on an important topic, whether aging comes naturally to us. I don't mean physiologically, because as we all know, we age without any conscious effort on our parts. Instead, Aging doesn’t always come naturally. Classes are teaching boomers how. focuses on a program on how to age successfully. Is there a need for a program to tell us how to do well something that just seems to happen? "[B]oomers tend to see themselves as forever young and have sometimes been reluctant to embrace the last stage of life with the same gusto as their youthful activism, said Lylie Fisher, director of community development at Iona" (a non-profit that runs the programs). Iona offers a Take Charge/Age Well academy which according to the website, teaches students "how to navigate the opportunities and challenges of aging through presentations from Iona’s aging-in-place specialists. The specialists offer expert advice, wellness coaching, guidance on critical decision-making, and information on planning for the future. " The Post article also mentions co-housing, which is covered in one of the programs.
Check out the article, as well as the program's website. Very interesting!
Monday, June 8, 2015
The Wall Street Journal ran an interesting article on May 31 about longevity and how to have a fulfilling life with those extra years of living. How to Make the Most of Longer Lives focuses not just on planning financially for living longer, but questions what to do with those added years to be sure one has a meaningful life. The author suggests "[w]e need to marshal imagination and ingenuity to devise new strategies for enhancing the whole range of experiences in later life, including education, faith, housing, work, finance and community" and then offers six suggestions to increase the quality of life: (1) give a new name to this period of life; (2) smooth the way to transition into this part of life (or as the author explains it retirement and then "un-retirement" is "a do-it-yourself process. It’s time to help make this post-midlife passage more efficient and suited to preparing individuals emotionally and spiritually for what lies ahead."); (3) education specifically for the second half of life (4) financial security; (5) promote multi-generational housing; (6) create a model where inventors brainstorm new ideas for this part of life.
The author concludes with reference to the upcoming White House Conference on Aging and the challenges that await all of us with aging.
Sunday, June 7, 2015
Friday, June 5, 2015
The 10th Anniversary of World Elder Abuse Awareness Day will be here soon. The First Global Summit in recognition of the 10th Anniversary is set for June 15, 2015 in Washington, D.C. You can view the agenda here. To register, click here.
Thursday, June 4, 2015
PBS did a story that is compelling. Number of seniors threatened by hunger has doubled since 2001, and it’s going to get worse offers that "[n]early one in six senior citizens face the threat of hunger in the United States. Charity and food stamps reach some of these vulnerable Americans, but limited resources and isolation mean many are struggling without receiving help." The audio of the story as well as a transcript is available here. The story reviews the importance of social service programs, which may be hampered by long wait lists, food banks and more that provide some assistance. As I mentioned, this is a compelling story. It's also sad. Thanks to my colleague, Professor James Fox, for sending me the link to the story.
Wednesday, June 3, 2015
The Employee Benefits Research Institute (EBRI) has released the results of their annual retirement confidence survey. The 2015 Retirement Confidence Survey is available here. There are also 7 fact sheets that highlight specific findings, including caregivers, retirement confidence, changing expectations, preparing for retirement, age comparisons, gender & marital status, and attitudes about Social Security & Medicare.
Tuesday, June 2, 2015
A few days back I wrote about a new study on family caregivers published by Pew. The Employee Benefits Research Institute (EBRI) has added to the body of literature on the topic with its 2015 Fact Sheet #7 from EBRI's 2015 Retirement Confidence Survey. Financial Support & Unpaid Care Provided by Americans The purpose of the annual survey is to gather data about "potential barriers in building up assets or maintaining them." One question "[I]n particular, [asked about] the amount of financial support provided for relatives or friends and the amount of unpaid care provided for them as well." Perhaps the results will surprise you. "Three in 10 (29 percent) workers and 2 in 10 (20 percent) retirees report they are currently providing financial support to a relative or friend." The survey also inquired about unpaid care, which as we know has a cost to the caregiver. When asked respondents whether they provided unpaid care, the survey found "[t]wenty-three percent of workers and 16 percent of retirees responded that they did so."
The fact sheet offers a couple of other interesting data points. The spouse is actually not frequently the recipient of the care, with "5 percent of retirees and 4 percent of workers name their spouse as a recipient of their care." As far as the amount of time spent providing care, slightly over 40% of workers and a little under 40% of retirees provided fewer than 9 hours a week in care.
Sunday, May 31, 2015
The GAO has issued a new report on how Home & Community Based Services & Supports are delivered. Older Adults Federal Strategy Needed to Help Ensure Efficient and Effective Delivery of Home and Community-Based Services and Supports is a 60 page report that "addresses (1) federal programs that fund these services and supports for older adults, (2) how these services and supports are planned and delivered in selected localities, and (3) agencies’ efforts to promote a coordinated federal system of these services and supports." The GAO recommends in the report "that HHS facilitate development of a cross agency federal strategy to ensure efficient and effective use of federal resources for HCBS. HHS concurred and HUD, DOT, and USDA did not comment." A number of topics are covered, including transportation, aging in place, information and referral, housing, in-home services, and food assistance. The report discusses the importance of cross-agency collaboration. The GAO concludes that
As the older population continues to grow, communities will find it increasingly difficult to meet the demand for the HCBS and supports many older adults will need to age in their own homes and communities. Based on recent trends, federal funding at AoA, HUD, and DOT for HCBS and supports is not likely to keep pace with demand for these services and supports, making it important to ensure that the federal resources available for this purpose are used effectively and efficiently. Development of a cross-agency federal strategy could better position the federal agencies to assist area agencies on aging and community-based organizations with providing HCBS and supports in the most efficient and effective manner. Under the Older Americans Act, AoA is responsible for facilitating the provision of home and community-based services and supports for older adults in this country, in coordination with CMS and other federal agencies. As a result, AoA is well-positioned to lead collaboration among the five federal agencies covered in our review. However, because of increases in Medicaid spending and emphasis on the role of HCBS in supporting health care patients, CMS has become an even more important partner to AoA in meeting older adults’ expected demand for HCBS. Thus, it may be most appropriate for the HHS Secretary to take the initiative in developing such a cross-agency federal strategy.
Saturday, May 30, 2015
The Washington Post recently profiled Alzheimer's activist Michael Ellenbogen, including the possibility that the very disease he's urging public authorities to confront by committing to find a cure, has impaired his ability to use sound judgment about his tactics:
When Michael Ellenbogen calls for a more aggressive fight against Alzheimer’s disease, he speaks with passion that comes from experience. As someone who was diagnosed with early-onset dementia, Ellenbogen can convey firsthand the pain and frustration at what he sees as insufficient government support for research to find a cure or better treatments.
But to some, Ellenbogen’s passion recently went too far.
After he submitted remarks to the national Advisory Council on Alzheimer’s Research, Care and Services that mentioned the Columbine massacre — asking whether it would require a mass shooting by someone with dementia to draw more attention to the crisis — the Department of Health and Human Services deemed Ellenbogen a security threat. The federal agency, which hosts the council’s meetings, banned him from its premises.
For the full story, see Frederick Kunkle's article More People with Alzhemier's Are Becoming Activists -- Which Brings Its Own Challenges.