Tuesday, October 28, 2014
Those of you watching the planning of the 2015 White House Conference on Aging will be interested in the most recent blog post from WHCOA executive director, Nora Super. Director Super mentions in her blog post that some “common threads” are emerging from her community conversations. Those threads include retirement security, healthy aging, community supports and services, and preventing abuse, neglect and exploitation. “These four issues will provide the focus areas for the 2015 White House Conference on Aging. They are intended to support the dignity, independence, and quality of life of older Americans at a time when we’re seeing a huge surge in the number of older adults.” The entire post can be read here.
Monday, October 27, 2014
Last week I was part of a panel hosted by the National Continuing Care Residents' Association (NaCCRA) in Nashville, a component of the larger (much larger!) annual meeting of LeadingAge. The theme for the panel was "Resident Engagement in Continuing Care Life" and for my part of the panel, I used an interesting Third Circuit bankruptcy court decision, In re Lemington Home for the Aged, to discuss whether residents of financially troubled CCRCs should be treated as entitled to enforce specific fiduciary duties owed by the CCRC owners to creditors generally, even unsecured creditors, fiduciary duties that may give rise to a direct cause of action connected to "deepening insolvency."
Jennifer Young (pictured on the left), a CCRC resident, talked about what it is like to "be" an unsecured creditor in a CCRC's Chapter 11 bankruptcy court proceeding. Her explanation of how creditors' committees operate in bankruptcy court (including how they hire legal counsel and how that counsel is paid out of the Debtor's estate) was both practical and illuminating. The closing speaker on the panel was Jack Cumming (below left). Jack's has deep experience as an actuary and a CCRC resident. He noted the disconnect between the intentions of providers and the realities faced by residents and called for stronger accountability in investment of resident fees. I always come away from my time with Jack with lots to think about. Our moderator was NaCCRA president Daniel Seeger (right), from Pennswood Village in Pennsylvania.
In my final comments, I reminded our audience that even though our panel was focusing on "problems" with certain CCRC operations, including some multi-site facilities, many (indeed most) CCRCs are on sound financial footing, especially as occupancy numbers rebound in several regions of the country. Both panelists and audience members emphasized, however, that for CCRCs to be able to attract new residents, the responsibility of the CCRC industry must improve. For more on these financial points, go to NaCCRA's great educational website, that includes both text and videos, here.
Interestingly, during the LeadingAge programming that began on Saturday, October 18 and continued through October 22, I was hearing a lot about a potentially major shift in the long-term housing and service market. Some of the largest attendance was for deep-dive sessions on new service models for "Continuing Care at Home," sometimes shortened to CCAH or CCaH. CCAH is often seen as a way for more traditional CCRCs to broaden their client base, particularly in the face of occupancy challenges that began with the financial crisis of 2008-2010.
As a corollary of this observation about market change, one of the topics under debate within the leadership of LeadingAge is whether Continuing Care Retirement Communities need a new name, and I can see movement to adopt a name that aligns better with the larger menu of non-facility based services that many providers are seeking to offer.
Of course, as a law professor, I wonder what these market changes mean for oversight or regulation of new models. Not all states are keeping up with the changes in the Continuing Care industry, and name changes may complicate or obscure the most important regulatory questions.
Sunday, October 26, 2014
As regular readers of the Elder Law Prof Blog may recognize, I reside and work squarely in a zone where "filial support claims" are more than just theoretical propositions. Pennsylvania continues to be Ground Zero for modern complications arising from use of a Colonial era law that permits adult children to be held liable for the cost of an indigent parent's long-term care.
The latest example is In re Skinner, 2014 WL 5033258, decided by Bankruptcy Judge Madeline Coleman in the Eastern District of Pennsylvania on October 8, 2014.
The issue is whether one sibling can prevent another sibling from "discharging" any obligation to pay an assisted living facility for their mother's care. Both brothers were sued by the facility, resulting in a default judgment against one brother (Thomas) for $32,225, who in turn sought discharge of that debt in bankruptcy court. Brother William, probably facing the prospect of picking up the full tab for his defaulting brother, initiated an adversary proceeding, seeking to prevent the discharge. The court concludes that Brother William "lacks standing" to prevent Brother Thomas' discharge of the debt to the assisted living facility.
In dismissing Brother William's claim, the Bankruptcy Judge addresses both the Uniform Fraudulent Transfer Act and Pennsylvania's filial support law. According to the opinion, Brother William alleges that Thomas used a Power of Attorney executed by their mother in 2007, to access her bank accounts in a "scheme [with his wife] to use the Mother's assets, including her interest in long-term care benefits, to fund approximately $85,000 of their personal expenses." However, the court concludes that even accepting the truth of allegations that "suggest that the Mother was injured by the [Thomas'] conduct, that conduct was directed at the Mother and her property. The conduct was not directed at [William]." The Bankruptcy Court also rejected any theory of "derivative standing."
October 26, 2014 in Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Cases, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0) | TrackBack (0)
Wednesday, October 22, 2014
I've heard about the backlog for SSD appeals, but I had no idea how much of a backlog exists until I read the story in the October 19, 2014 Washington Post. Waiting on a Social Security disability appeal? Get in line — a very long line brings a new perspective on waiting lists. The story reports that there are 990,399 (you read that right, 990,399) SSD appeals waiting for ALJ hearings. We have been hearing a lot about the backlog with the VA (526,000 according to the story) so why haven't we heard about the SSDI case backlog? Want to know how long it takes for a backlog of almost one million cases to occur? According to the Post story, the backlog has been going on since President Ford's administration, but a significant increase occurred between 2008-20014. Why did this occur? "[T]he system became, in effect, too big to fix: Reforms were hugely expensive and so logistically complicated that they often stalled, unfinished. What’s left now is an office that costs taxpayers billions and still forces applicants to wait more than a year — often, without a paycheck — before delivering an answer about their benefits." As well, factor in the "Great Recession" and Boomers. The article also mentions budget cuts to SSA as well as the government shutdown in 2013.
A sad irony-the story quotes one of the ALJs in S. Florida who had 2 claimants die before their appeals were heard, but the ALJ still had to hear the case of one, because if the decedent were determined to have been disabled, then the decedent's surviving child might receive benefits.
Although SSD waiting lists outnumber both VA and Patents, according to the story, the wait time to decision is shorter than that for the VA and Patent office. The SSA ALJs "are the moral centerpiece of this system: a symbol that the government intends to apply the old American ideal of due process before the law to the vast new caseloads of the American welfare state. They are also the system’s biggest problem — a 40-year-old clog in the pipe." A law prof at GW, Richard Pierce, takes the position "that the government should eliminate the judges altogether and just let the bureaucrats with the paperwork decide. [Professor Pierce] said that the main thing these hearings bring to the process — that face-to-face interaction between judges and applicants — often adds only pathos, not useful information."
A push to shrink the backload resulted in a drop of both cases and wait time in 2010 but a review of the decisions noted an uptick in the award of benefits. It would seem, from reading this article, that part of the problem is outdated requirements and resources available to the judges (or lack thereof). SSA has lessened the pressure on the ALJs to some extent, so now the ALJs are "limited ... to 720 cases a year and [SSA] imposed new checks to make sure the “yes” decisions are as well thought-out as the 'noes.'" The uptick in benefits awards has dropped, with the award of benefits at 44%. Despite the fact that SSSA has hired more ALJs, the backlog is pushing one million. The Post reports that there were an additional 13,000 added in the first two weeks of October! The story concludes by noting that the backlog isn't limited to just the ALJs. The Appeals Council also has a backlog: "There are 150,383 people waiting for an Appeals Council decision. The average wait there is 374 days."
Thursday, October 16, 2014
Planning for the 2015 White House Conference on Aging (WHCOA) is in full swing. The website has been launched and there is also a WHCOA blog available. You can also sign up for email updates to stay in the loop on WHCOA developments.
Wednesday, October 15, 2014
Governing ran a story about a recent court ruling, Mental Health Ruling in Washington State Could Reverberate through the Country. The article concerns the practice of "psychiatric boarding" or "[w]ith increased demand on proper mental health facilities, the practice known as psychiatric boarding -- temporarily holding mentally ill patients in hospital ERs until beds become available at certified treatment centers..." A national issue, the practice is unconstitutional in Washington state as a result of a lawsuit filed last year by a number of patients. Not only did experts testify that patients who are psychiatrically boarded get little, if any, mental health treatment, in fact, one government report shows that the patients will actually deteriorate. Implications of state laws that require involuntary detention: "states also regularly lack the space to place individuals in certified facilities. As a result, patients are held for days -- in some cases literally strapped to beds -- in emergency departments at acute-care hospitals until a bed opens up."
In August, the Washington State Supreme Court ruled this practice unconstitutional, despite the state's arguments regarding insufficient budgets and available beds. The article notes that Washington state is not alone in facing this issue, with a number of states admitting to psychiatric boarding. However, just increasing beds isn't the solution to this issue, the article goes on to discuss. Quoting the executive director of the Bazelon Center, the better solution is more beds plus broad-based community care.
Thursday, October 9, 2014
Kurzweil Accelerating Intelliegence (Kurzweil AI) ran a story that got my attention. The signature of aging in the brain reports on the results of a study that looks at a "signature" in the brain "that may be the “missing link” between cognitive decline and aging and that may in the future lead to treatments that can slow or reverse cognitive decline in older people..."
This is a technical article and perhaps not the type we typically cover in our blog, but I thought it important enough to mention. Since I don't have a scientific background, I decided to excerpt some of the findings
they identified a unique “signature of aging” that exists solely in the choroid plexus. They discovered that one of the main elements of this signature was interferon beta, a protein that the body normally produces to fight viral infection.
Turns out this protein also appears to have a negative effect on the brain. When the researchers injected an antibody that blocks interferon beta activity into the cerebrospinal fluid of the older mice, their cognitive abilities were restored, as was their ability to form new brain cells.
Why this is important? It may lead to different treatments to help with cognitive decline-the researchers "hope that this finding may, in the future, help prevent or reverse cognitive decline in old age by finding ways to rejuvenate the immunological age of the brain."
Thursday, October 2, 2014
Afghanistan is the worst country to live in as an older person, an annual index on the wellbeing of the elderly showed on Wednesday. The Asian country was ranked bottom for the second consecutive year in HelpAge International's Global AgeWatch Index, its health situation in particular the poorest in the world. Norway topped the index - up one place from last year - followed by Sweden, Switzerland, Canada and Germany, all of which remained in the top 10. Apart from Japan - ranked ninth - the 10 best performers were again in western Europe, North America and Australasia. The report, which focused on pensions and warned that half the world’s population faces a bleak future without one, comes at a time when life expectancy continues to rise. Toby Porter, chief executive of HelpAge International, said governments worldwide need to implement specific policies to respond to "this unequovical demographic shift". "Only if they act now will they have a chance to meet the needs of their citizens and keep their economies going," Porter told the Thomson Reuters Foundation.
Wednesday, October 1, 2014
A few days ago I blogged about an article in The Atlantic explaining one person's thinking of 75 being his optimal "old age". In that same issue of The Atlantic is another article--about longevity and 100 year olds--what it will mean for society as more of us reach that age. What Happens When We All Live to 100? was published on September 17, 2014.
The article starts with a history of sorts of life expectancies from human origins and notes that
Viewed globally, the lengthening of life spans seems independent of any single, specific event. It didn’t accelerate much as antibiotics and vaccines became common. Nor did it retreat much during wars or disease outbreaks. A graph of global life expectancy over time looks like an escalator rising smoothly. The trend holds, in most years, in individual nations rich and poor; the whole world is riding the escalator.
Projections of ever-longer life spans assume no incredible medical discoveries—rather, that the escalator ride simply continues. If anti-aging drugs or genetic therapies are found, the climb could accelerate. Centenarians may become the norm, rather than rarities who generate a headline in the local newspaper.
The article then moves to a discussion of those institutions intentionally working on increasing life spans, the Buck Institute, the U of Michigan, the U of Texas, UC-San Francisco, and the Mayo Clinic for example. Long-term readers of this blog may also remember a post about CALICO (Google's "spin-off called the California Life Company (known as Calico) to specialize in longevity research."). The article has a fascinating section about the research being done, including some interesting consideration of other life forms that excel in longevity (worm genes, anyone?).
I particular enjoyed reading the quote of one of the leaders in the field in describing the nascent nature of the research. "'[M]edically, we do not know what ‘age’ is. The sole means to determine age is by asking for date of birth. That’s what a basic level this research still is at.'” There seems to be some debate amongst the experts about whether life expectancy will continue to rise at the steady escalator-smooth rate as in years past. The article also mentions some of the theories advanced over time on increasingly longevity: vitamins, low calorie diets, education, exercise, etc.
One section of the article bears significant possibilities for class discussion, the political implications of an older society.
Society is dominated by the old—old political leaders, old judges. With each passing year, as longevity increases, the intergenerational imbalance worsens. The old demand benefits for which the young must pay, while people in their 20s become disenchanted, feeling that the deck is stacked against them. National debt increases at an alarming rate. Innovation and fresh thinking disappear as energies are devoted to defending current pie-slicing arrangements.
The author reveals this is a description of what is actually occurring in Japan. Consider as the author does, what increased longevity may also do to the judicial branch--especially the Supreme Court with lifetime appointments.
This article may be viewed as a bit of a wake-up alarm, although I suspect many of the folks in the US will just hit the snooze button
People’s retirement savings simply must increase, though this means financial self-discipline, which Americans are not known for. Beyond that, most individuals will likely need to take a new view of what retirement should be: not a toggle switch—no work at all, after years of full-time labor—but a continuum on which a person gradually downshifts to half-time, then to working now and then. Let’s call it the “retirement track” rather than retirement: a phase of continuing to earn and save as full-time work winds down.
Widespread adoption of a retirement track would necessitate changes in public policy and in employers’ attitudes. Banks don’t think in terms of smallish loans to help a person in the second half of life start a home-based business, but such lending might be vital to a graying population. Many employers are required to continue offering health insurance to those who stay on the job past 65, even though they are eligible for Medicare. Employers’ premiums for these workers are much higher than for young workers, which means employers may have a logical reason to want anyone past 65 off the payroll. Ending this requirement would make seniors more attractive to employers.
Back to the reasons for increasing longevity. One in the list above, education, seems to have a solid correlation and maybe not as obvious as other reasons that come to mind (vaccines, antibiotics, improved health care, public services, etc.). The author considers the role of education in longevity and examining budget cuts by states, suggests
Many of the social developments that improve longevity—better sanitation, less pollution, improved emergency rooms—are provided to all on an egalitarian basis. But today’s public high schools are dreadful in many inner-city areas, and broadly across states ... Legislatures are cutting support for public universities, while the cost of higher education rises faster than inflation. These issues are discussed in terms of fairness; perhaps health should be added as a concern in the debate. If education is the trump card of longevity, the top quintile may pull away from the rest
The last section of the article hypothesizes on the impact of an aging society if the escalator continues its ascent, achieving perhaps a "grey utopia" of sorts. The article is well worth reading, but it makes me think about how society values, or devalues, aging. Is getting old a challenge or disease to be conquered? For example, the author writes, "[i]f the passage of time itself turns out to be the challenge, interdisciplinary study of aging might overtake the disease-by-disease approach. As recently as a generation ago, it would have seemed totally crazy to suppose that aging could be “cured.” Now curing aging seems, well, only somewhat crazy." Read this article and have your students read it, too.
Tuesday, September 30, 2014
Kudos again to my friend and colleague, Professor Mark Bauer (current chair of the AALS Aging & Law section, btw) for sending me this article, The Great Senior Sell-Off Could Cause the Next Housing Crisis. The article appeared in The Atlantic's CityLab, and although the article was published in 2013, I think it is still important to read (if you didn't when it was first published) because it predicts the busting of another housing "bubble" starting in 2020, just 6 years from now.
The article opens with looking at the various names of animals being swallowed by the python (that is, the Boomers and the American population). (As an aside, the article lists a number of animals--I'd only heard of the pig, but now I know we Boomers might also be compared to a bunny (cute) or "a really big rat" (ugh)). But I digress.
The focus of the article is on what will happen when the Boomers reach a certain age where they decide to sell their homes...and hope there are buyers galore for them. A researcher quoted in the article indicates that in certain larger metro areas, there should be buyers, but in less populous areas, not so much. He describes what he calls "the “great senior sell-off” .... sometime later this decade ... [that] he predicts that it could cause our next real housing crisis."
Changing demographics will also affect the housing market and demand will not be in sync with supply as housing preferences change with age and demographics. There is something of a bleak housing future ahead for many elders, according to the expert, who predicts "there will be two classes of seniors in America: those “aging in place” voluntarily, and those “aging in place” involuntarily because they can’t sell their homes." His concerns about aging in place are best summarized by how a person's abilities change once s/he gets to an advanced age and becomes unable to do basic upkeep or maintenance yet the housing market will tumble, leaving some only the choice of abandoning their homes.
Friday, September 26, 2014
I always love learning new lingo. I've heard parts of the US described as the "sun belt", the "rust belt" and the "corn belt" to name a few. Now I've learned that I live in the "sun belt" and next door to the "Grey Belt." Thanks to my friend and colleague Professor Mark Bauer for sending me the Associated Press article, Fla.'s 'Gray Belt' a glimpse at nation's future.
According to the article, Citrus County, Florida is the heart of the "Grey Belt" in which "more than a third of residents are senior citizens, one of the highest rates in the nation... The county isn't simply a stereotype of Florida, where in just 15 years, one in four residents will be 65 or older. It's a peek into the not-too-distant future of the nation, where the number will be one in five."
So what's the implication of living in the "Grey Belt?" The article notes that the businesses reflect the population and the economy shows the effect of such a population. For example, the story notes that the "economy based on low-skill jobs such as health-care aides, retail clerks and food service workers." The result of a community where people move in to retire, rather than age-in place? "[Those who move into an area generally aren't eager to fund schools ... whereas those who remain in the communities where they worked and raised their families tend to support education and other public spending that doesn't benefit them directly. Citrus County voters lived up to that thesis as recently as two years ago when they decisively rejected a referendum to raise property taxes to fund schools."
The article discusses the dilemma these cities face-they need younger folks to work in the service jobs that cater to the elder residents, but these folks don't always want to move to a community that is primarily elder residents. One pastor even described his church as a "hospice church" because "congregants either die or move back north to spend their last years near relatives. Changes that might attract younger families for the almost 500-member congregation often meet resistance..."
Although Citrus County might be the center of the Florida Grey Belt, the phrase actually refers to a swath of 8 counties with "among the oldest populations in the nation, not to mention in Florida, which has long had the highest rate of seniors in the nation, and will for decades yet... [with] Sumter [county] ... home to the largest concentration of seniors of any county in the nation..."
Ok but really--is Florida the only location of the "Grey Belt"? We all know the US population is aging, so what about it--do we have more grey belts? Depends on how you look at it. According to the AP article, "North Dakota, Texas, and Michigan have pockets of seniors on par with the Gray Belt counties in Florida. But unlike the Florida counties, which have grown from the migration of new seniors, they have gotten grayer as a result of younger residents leaving."
Keep in mind that the Florida grey belt only encompasses 8 counties. The state is a bit of a hodgepodge, demographically speaking, since the grey belt "contrasts starkly with the state's younger and more diverse major metro areas ... and the interests of Gray Belt residents will diverge politically, socially and economically from Florida's more youthful cities." Competing interests based on age will show up at the ballot box as well--talk about a tightrope for state leaders!
According to an economist with the U. of Florida ("in the nieghborhood" of the grey belt), "[s]ince voting power will tilt in favor of the older residents because of their higher voter-participation rates, the key to keeping both sides happy is to devolve all kinds of governmental decisions on taxes, planning and education from the state level to the local level so that residents in areas with both high and low concentrations of seniors will feel like their voices are being heard."
Here we go....and please, no jokes about Florida and voting. Deal?
Wednesday, September 24, 2014
We have blogged on several occasions about the issues surrounding caregiving, including the need for caregivers, who provides care, etc. Ever wonder what caregiving costs the caregiver? If I said $5,000 per year, would you say that was more than you thought, or less? What if I told you almost 30% of caregivers spend $10,000 or more? Surprised?
Caring ran a story on the costs of caregiving based on a report they recently compiled. Nearly Half of Family Caregivers Spend Over $5,000 Per Year on Caregiving Costs reports that nearly 50% of the "family caregivers spend more than $5,000 per year on caregiving expenses" (the study considers a family caregiver to be "someone who takes care of a family member or friend, but is unpaid for ... services.... [and] caregiving expenses include out-of-pocket costs for medications, medical bills, in-home care, nursing homes and more." What are the breakdowns for this group of caregivers? "16% spend from $5,000 to $9,999 * 11% spend from $10,000 to $19,999 * 7% spend $20,000 to $29,999 * 5% spend $30,000 to $49,999 * 7% spend $50,000 or more each year." The report includes some other interesting statistics and includes this interesting observation
Caregiving not only has an effect on finances, but it can also impact current employment and future retirement plans, too. One-third of family caregivers (33%) spend more than 30 hours per week on caregiving, making it almost the equivalent of a full-time job. Half of caregivers have made changes to their work schedule to accommodate caregiving, while 30% often arrived late or left early and 17% missed a significant amount of work.
More details about the report and the cost of caregiving are available here
Tuesday, September 23, 2014
Naomi Cahn, Harold H. Greene Professor of Law at GW Law sent me a link to an interesting article that she co-authored. Women, Eldercare, and the Honor Commandment appears in the Berkley Center for Religion, Peace & World Affairs.
Starting the article with the story of Naomi and Ruth, the article explains the authors' "work exploring modern expressions of the Honor Commandment – the Biblical command to honor one’s mother and father – ... [with] many stories of how daughters (and sons) honor their parents." The article mentions that although the gender gap is closing as far as child care, there is still a significant gap for elder care, with the bulk of caregiving being provided by women. The article proceeds with summaries of several stories and includes quotes from the women caregivers.
"Overall, our research shows that the Honor Commandment not only continues to motivate the providing of elder care, but also reflects the full complexity of practical, emotional, and spiritual care of the family." But the caregiver dilemmas are not limited to the Jewish or Christian religions and are found throughout the world, regardless of religion.
As a society, we may be better off if a sense of honor is the motivation for care of our elders, rather than coercive or regulatory measures. The Honor Commandment and its analogues in other religions and cultures provide a moral framework and path forward that respects both individual wishes and family integrity. But the path of honor can become a “daughter track,” ... where responsibility for caregiving falls disproportionately on women. Providing more adequate support for caregiving would have a particularly significant effect for women, ensuring their ability to provide care while also making available the fullness of their services as equally respected worker-citizens. Strengthening our secular laws to help support caregiving can profoundly affect how people live the Honor Commandment, improving the lives of those who receive and give family care—especially women... (citations omitted)
The full article will appear in volume 30 of the Journal of Law and Religion (June 2015). In addition, keep an eye out for a symposium volume in the Journal (co-editors Naomi and Amy Ziettlow) (forthcoming 2016) "will ... feature a slate of international, interdisciplinary, and interfaith scholars addressing the world-wide impact of the Honor Commandment."
Sunday, September 21, 2014
Seems like there have been several interesting developments in the past few weeks regarding end of life decision making. Thanks again to Charlie Sabatino, Executive Director of the ABA Commission on Law & Aging. former NAELA president, national expert on end of life issues and all around great guy, for sending me an email about the series run on WNYC public radio. The station ran a 3 part series on "death beds" The first, Death Beds: Terminally Ill, But Constantly Hospitalized aired on September 8, 2014. The second, Death Beds: Too Little, Too Late for Many New Yorkers Seeking Hospice aired the next day, and the third, Death Beds: Living Wills Slowly Take Root aired on September 10, 2014.
Each includes the audio recording as well as the print story. Worth a listen!
Thursday, September 18, 2014
The Institute of Medicine of the National Academies has released a new report on end of life issues. The report, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life was released on September 17, 2014. The report brief offers an explanation of the importance of this new survey, including the sheer numbers of American elders who are living with some limitations on ADLs, chronic illness, cognitive issues and more. As well the report points to issues with the health care system, including problems in accessing care, a lack of palliative care specialists and knowledge about end of life care, and a health care system that works out of sync, with economic incentives. The brief concludes with a call for "person-centered, family-oriented approach that honors individual preferences and promotes quality of life through the end of life [as] ... a national priority." The report is "a comprehensive assessment of the knowledge gaps, structural problems, and financial disincentives that hamper delivery of optimal care and makes cross-sectoral recommendations to achieve compassionate, affordable, sustainable, and effective care for all Americans."
The website also includes a link to key findings, core components, an infographic and a quiz (5 questions) which is suitable for use in class.
My colleague and dear friend Mark Bauer (current chair of the Aging & Law AALS section) sent me a link to an article published in CityLab. The article is titled Where Are the Baby Boomers Going to Live Out Their Golden Years? The article mentions a recent report from Harvard's Joint Center for Housing Studies, Housing America's Older Adults. The Harvard website for this project includes a number of resources, including the report, an interactive map, an infographic, videos of the keynote address and panel discussion. If you don't have time to read the entire report, be sure to read the executive summary, available here.
The CityLab article mentions some other helpful sources, including an AARP survey on preferences regarding aging at home. The article references aging and disability, looking at the suitability of Boomers; homes for them in the future
The housing stock built for Baby Boomers largely wasn't designed with accessibility in mind. There are five universal-design housing features that tend to address a variety of disabilities that residents face as they age: no-step entries; single-floor living; switches and outlets set at lower heights; extra-wide hallways and doors; and lever-style doors and faucets. Nearly 90 percent of existing homes have one of these features, according to the report—but just 57 percent have two.
The article notes that more recently built homes are more likely to include at least some of these universal design features, but concludes
Yet these detached, single-floor, single-family homes—and the automobile-centric society that comes with them—are only going to fall further out of step with the needs of residents over time. And sooner rather than later. Homes can be retrofitted with lever-style handles and no-step entries (albeit at great expense). It's much harder to turn exurban and rural communities where older Americans live into places that nurture seniors rather than isolate them.
Tuesday, September 16, 2014
Okay -- this isn't "elder law" but it certainly is a nice moment for the older competitor. Call this inspiration.
As reported here and here, Ian Millar, age 67, had a $500,000 payday on Sunday, winning the Spruce Meadow International show jumping competition in Canada with his horse Dixson. They topped second place finisher, 20 year-old rising star Reed Kessler and her mount Cylana, with a clean and faster finish in a two-competitor, final jump-off. The jumps were set at maximum height and width. And before you say, "but the horse does all the work," just imagine staying with the horse over huge jumps like this -- at any age. Of course, Ian does have experience, twice winning this particular competition with his most famous horse, Big Ben. But that was in 1987 and 1991, before Reed was even born! (Photo from Spruce Meadow Media Services, via Chronicle of the Horse)
Friday, September 12, 2014
Thomas Jefferson School of Law (that just happens to be located in one of my favorite cities, San Diego) is hosting a new writing competition to encourage outstanding student scholarship at the intersection of "law and medicine" or "law and social sciences." The purpose is to promote "understanding" and to further the "development of legal rights and protections" of those with disabilities. Papers may be on any topic relating to disability law, including legal issues connected to employment, government services and programs, public accomodations, education, higher education, housing and health care.
The First Annual Jameson Crane III Disability and the Law Writing Competition is open to currently enrolled law students, medical students and doctoral candidates in related fields in the U.S.
The winner of the competition will receive a $1,500 cash prize, while two second place winners will each receive $1,000 case prizes, plus the possibility of publication.
The deadline for submission of entries is January 15, 2015.
In a GAO study titled "Inability to Repay Student Loans May Affect Financial Security of Small Percentage of Retirees," researchers reveal that a significant -- and growing -- proportion of "student loan" debt is owed by Americans aged 65 or older. In addition to the growth in the total amount of "senior" student loan debt, from $2.8 billion in 2005 to $18.2 billion in 2013, the GAO findings include:
- Relatively few households headed by individuals 65 or older hold student loan debt -- the number is about 706,000 households in the U.S. -- but the amount they owe may be significant, with estimates that the median debt owed is around $12,000, as compared to a median for those aged 64 and younger of $13,000.
- Most -- about 82% -- of this debt was for the individual's own education. It is not known whether how "old" the loans are.
- Older borrowers hold defaulted federal student loans at a higher rate -- and defaults can have conquences, including offsets on Social Security payments. Generally speaking, student debts cannot be discharged in bankruptcy; however adjustments may be possible to keep the individual's monthly income above the poverty threshold.
For more discussion on the GAO report, see "Senior (Citizen) Student Debt Rising," in Inside Higher Ed by Michael Stratford. Hat tip to Professor Laurel Terry for pointing out this new study.
Our friend and health law/elder law rock star, Marshall Kapp, sent me a note about a book review he authored (thanks Marshall) that appears in The Gerontologist Advance Access. The review is of the book, The Rule of Nobody: Saving America from Dead Laws and Broken Government by Phillip K. Howard.
You may be wondering why a blog for elderlawprofs is posting about laws and government regulations. Three words: nursing home regulation. Although a subscription is required to read the full review, an excerpt is available for free, much of which I have reproduced here
The brilliant satirist Jonathan Swift said long ago, “Laws are like cobwebs, which may catch small flies, but let wasps and hornets break through.” (Brainy Quote, n.d.). Swift certainly did not intend that remark as a compliment to either laws or cobwebs. Nonetheless, almost all laws originate to accomplish some reasonably defensible public purpose, even though ... poorly drafted, inconsistently ... enforced, and perpetuated beyond ... their original justification ....
In this latest project, Howard despairs that regulation in the United States has veered far from its proper function as a setter of boundaries or parameters within which individuals are empowered... (end of excerpt).
Since Marshall sent me a full copy of the book review, I can explain further what the abstract does not, how the author uses nursing home regulations as an example. Marshall describes this on page 1-2 of his review
One of the primary examples that author Howard utilizes throughout The Rule of Nobody to illustrate his constructive critique about the largely dysfunctional nature of the contemporary American regulatory situation is the overwhelmingly extensive and complex set of formal command and-control rules we have promulgated on the federal and state levels to govern the operation of nursing homes.
Marhsall offers a bit of history as to why we have so many laws and regulations for nursing homes and suggests that now is "the time to seriously contemplate smarter, rather than just bigger, regulation...." (review at page 2). He notes that the author provides examples of when the regulations don't end up benefitting the residents, with current regulations stifling innovation. (review at 3). Marshall concludes his review with this summary
[T]he Rule of Nobody is noteworthy for the nation generally and for long-term care policy-makers particularly... Settling for being “in the ball park” is damning with faint praise, indeed. The only option for many vulnerable individuals is dependence on the benevolence of nursing home owners and workers and lawmakers’ careful guidance. Society owes them a system of oversight and influence that not only aspires to, but effectively achieves, a much loftier standard.
Another one to add to the reading list.