Monday, April 11, 2016
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.
Friday, April 8, 2016
U.S. Department of Labor has a new guide book, "Paying Minimum Wage and Overtime to Home Care Workers," to assist families in understanding updated rules for payment of home care workers. These rules became fully effective on January 1, 2016.
The goal of the recently finalized "Home Care Final Rule" is to "make sure that home care workers have the same basic wage protections as most U.S. workers, including those who perform the same jobs in nursing homes and group homes." The rule applies "if you hire the worker directly, and no agency or other organization is involved," but may also apply if you hired the worker through an agency.
Employers must keep certain basic records for home care workers, and these records will be key to determining proper payment, especially for overtime:
1. Full name;
2. Social security number;
3. Home address;
4. Hours worked each day and total hours worked each workweek;
5. Total cash wages paid each week to the employee by employer, including any overtime pay; and
6. Any weekly amounts claimed by the employer as part of wages for housing or food provided to the employee/.
The guide explains special rules that apply if the paid care provider is a family member or if the paid worker is "living in."
In addition, the guideline explains the "narrow" exemption from minimum wage and overtime rules that applies for home care workers who provide only "companionship services." The key here is that the the worker can be spending no more than 20% of his or her working time on tasks such as assisting with personal care (bathing, dressing, cooking, cleaning, etc.) and the worker is not performing any medically related tasks.
Thursday, April 7, 2016
The Journal of American Medical Association (JAMA) Network, JAMA Psychiatry ran an article about a study looking at depression and dementia. Trajectories of Depressive Symptoms in Older Adults and Risk of Dementia considers that "[d]epression has been identified as a risk factor for dementia. However, most studies have measured depressive symptoms at only one time point, and older adults may show different patterns of depressive symptoms over time." The study came to the conclusion that a time line of consideration of a patient's depression may give a better picture of the patient's future potential for dementia ("Older adults with a longitudinal pattern of high and increasing depressive symptoms are at high risk for dementia. Individuals’ trajectory of depressive symptoms may inform dementia risk more accurately than one-time assessment of depressive symptoms.")
Wednesday, April 6, 2016
American Society on Aging (ASA) recently posted about 5 TED talks on Aging. 5 TED Talks on Aging to Inspire You range from curing Alzheimer's to a grandson's invention to help his grandfather with dementia from wandering. There's a talk from Diana Nyad about her historic swim ("In the pitch-black night, stung by jellyfish, choking on salt water, singing to herself, hallucinating ... Diana Nyad just kept on swimming. And that's how she finally achieved her lifetime goal as an athlete: an extreme 100-mile swim from Cuba to Florida") and a chat between Lily Tomlin and Jane Fonda where they "discuss longevity, feminism, the differences between male and female friendship, what it means to live well and women's role in future of our planet. 'I don't even know what I would do without my women friends," Fonda says. "I exist because I have my women friends.'"
Check them out!
Tuesday, April 5, 2016
a statistical resource for U.S. data related to Alzheimer’s disease, the most common cause of dementia, as well as other dementias. Background and context for interpretation of the data are contained in the Overview. This information includes descriptions of the various causes of dementia and a summary of current knowledge about Alzheimer’s disease. Additional sections address prevalence, mortality and morbidity, caregiving, and use and costs of health care, long-term care and hospice. The Special Report discusses the personal financial impact of Alzheimer’s disease on families.
The costs of caring for a relative or friend with Alzheimer’s disease or another dementia can have striking effects on a household. These costs can jeopardize the ability to buy food, leading to food insecurity and increasing the risks of poor nutrition and hunger. In addition, the costs can make it more difficult for individuals and families to maintain their own health and financial security. Lack of knowledge about the roles of government assistance programs for older people and those with low income is common, leaving many families vulnerable to unexpected expenses associated with chronic conditions such as Alzheimer’s and other dementias. Better solutions are needed to ensure that relatives and friends of people with dementia are not jeopardizing their own health and financial security to help pay for dementia-related costs.
Monday, April 4, 2016
Maddy Dychtwald, co-founder of AgeWave wrote an article for the Wall Street Journal on happy retirements. In Where People Find the Most Happiness in Retirement, she explains about a survey AgeWave conducted with Bank of America/Merrill Lynch. She explains they found that
While many of us still think of retirement as a time to wind down and take time for ourselves, two-thirds of today’s retirees have found that retirement is, in fact, the best time in life to give back: their time, their talent and their money. (This finding also echoes in many ways what Marc Agronin describes in his article in The Wall Street Journal this week–that people are happier when they are connected to family, friends and community, than spending on the latest adventure.)
Volunteerism and giving seem to play a role in whether a person has a happy retirement.
Even retirees’ definition of success relates strongly to giving back. When we think about retirement and planning for it, too many of us focus almost exclusively on money: “Will I have enough money to do the things I want for as long as I live?” There’s no doubt this is an important question. But, as it turns out, at all income levels, the study shows that retirees are almost six times more likely to define their own personal success in retirement by their generosity rather than their wealth.
The recommendation from Ms. Dychtwald? Consider what will give retirement meaning and reason. "When it comes to happiness in retirement, it seems generosity trumps wealth." The study is available here.
Sunday, April 3, 2016
Kaiser Health News (KHN) published a story on March 29, 2016 that caught my attention. Mortgages For Expensive Health Care? Some Experts Think It Can Work reports on a recent report from "[a] Massachusetts Institute of Technology economist and Harvard oncologist have a proposal to get highly effective but prohibitively expensive drugs into consumers’ hands: health care installment loans." The article was published in Science Translational Medicine and is available here. The abstract explains
A crisis is building over the prices of new transformative therapies for cancer, hepatitis C virus infection, and rare diseases. The clinical imperative is to offer these therapies as broadly and rapidly as possible. We propose a practical way to increase drug affordability through health care loans (HCLs)—the equivalent of mortgages for large health care expenses. HCLs allow patients in both multipayer and single-payer markets to access a broader set of therapeutics, including expensive short-duration treatments that are curative. HCLs also link payment to clinical benefit and should help lower per-patient cost while incentivizing the development of transformative therapies rather than those that offer small incremental advances. Moreover, we propose the use of securitization—a well-known financial engineering method—to finance a large diversified pool of HCLs through both debt and equity. Numerical simulations suggest that securitization is viable for a wide range of economic environments and cost parameters, allowing a much broader patient population to access transformative therapies while also aligning the interests of patients, payers, and the pharmaceutical industry.
The KHN article explains that this proposal is "not designed to pay for maintenance drugs that help people deal with chronic illness. It’s easier for insurers to cover maintenance drugs because they’re purchased over an extended period of time...." The KHN article offers comments from those with opposing views and discusses how outcomes effect the loan.
Thursday, March 31, 2016
A friend sent me several recent resources about elders with dementia. The Hospice and Nursing Home Blog published a video on Doctors’ End-of-Life Language, Impact on Patient-Caregiver Decisions. The Agency on Healthcare Research and Quality published Nonpharmacologic Interventions for Agitation and Aggression in Dementia. The pdf of the article is available here. Finally, in February, 2016, this article, Palliative care of patients with advanced dementia was published in UpToDate (which is "an evidence-based, physician-authored clinical decision support resource....")
Thanks to my friend Pamela Burdett for sending me the links to these 3 publications.
Wednesday, March 30, 2016
The most recent issue of Experience, the magazine of the Senior Lawyers Division of the ABA, is focused on elder driving. There are nine articles on the topic, each taking a different focus. The topics include a view from the bench, licensing, psychology issues and technology. Great resources!
Tuesday, March 29, 2016
We have written several posts about the need for caregivers, so this article in the Washington Post is particularly relevant to our classes. I needed to find care for my elderly aunt. What I found was an eldercare crisis ran on March 22, 2013. The article opens wit h a story about an elder relative who had fallen, again, not a too unfamiliar a story, unfortunately.
It’s true that aging isn’t exactly what it used to be. Thanks to Botox and Viagra and other medical innovations, anyone with some money can look and act 30 at 50 or 50 at 70. Many boomers are working past 65. Mick Jagger is still strutting around. Age is just a number!
But this approach to aging, however empowering, is a lie. Most of us won’t keep going strong until we’re felled by a painless heart attack in our sleep. Life is seldom so kind.
The story continues, the relative was sent home but needing assistance with multiple ADLs, struggled, and ultimately fell again. "[W]hat happened after showed me how difficult it is for the elderly and their families to navigate health care in this country. Once she got home, [the relative] struggled with everything from eating to dressing to washing. Four days later, I got another call: She’d fallen again, trying to get out of the armchair she was sleeping in because lying flat in bed was too uncomfortable." The author discusses the options explored, but to no avail-no Medicare rehab coverage, LTC insurance wouldn't yet kick in, and no option of living with relatives. Finding the right home health agency required effort and research to find the right fit of agency that provided the right level of services the relative needed.
The author then learned some reasons why caregivers may be hard to find: "[d]espite the critical need for eldercare, getting the workers to do it is not easy. Sharona Hoffman, author of “Aging with a plan: How a Little Thought Today Can Vastly Improve Your Tomorrow,” (note-we had previously blogged about Professor Hoffman's work) explained ... that the tedious work of caring for people at home carries risks, such as back injuries from lifting a patient after a bath or dealing with a patient who gets violent or handsy due to dementia. The pay isn’t great; the night caregiver we found for [the relative] confided in her that her take-home pay was about $10 an hour, or minimum wage in California. (We paid the agency who oversaw her $16 an hour.) Unsurprisingly, turnover among these workers is as high as 60 percent."
The article turns to the issue of workers' rights, noting some efforts in California. There is a balancing act occurring here-workers' rights and affordable care. An Hawaiian state senator has introduced a bill for "universal home care" and some of the presidential candidates have at least acknowledged the issue.
The author's relative has improved and the author acknowledges she's learned some lessons along the way. The relative "no longer needs night care, though we have a plan in place when she does.Even with all the problems that have plagued her in the last 18 months, she remains the woman I hope to be should I make it, mostly unscathed, into my 90s. I may even buy a hat or two. And I’ll definitely have a number of home care agencies on speed dial."
Thanks to my colleague Professor Bauer for sending me the article.
Monday, March 28, 2016
Kaiser Health News ran a story on March 18, 2016 about co-insurance trends in drug coverages. Coinsurance Trend Means Seniors Likely To Face Higher Out-Of-Pocket Drug Costs, Report Says explains that a new report shows that "Medicare beneficiaries may get dinged with higher prescription drug bills this year because more than half of covered drugs in standalone plans require them to pay a percentage of the cost rather than a flat fee...." This report notes that over half of the Part D covered drugs have a coinsurance payment rather than a fixed copayment. This means greater out of pocket costs for Medicare beneficiaries. As a result, predicting a beneficiary's out of pocket costs is more difficult.
The report, Majority of Drugs Now Subject to Coinsurance in Medicare Part D Plans is available here. A pdf of the report is available here.
From the New York Times, courtesy of reader and Bethesda, Maryland Elder Law Attorney Morris Klein, comes a demonstration of just how "clued in" the world of senior living has become. A recent article begins with the background of ShantiNiketan in Florida, and continues with other descriptions of creatively-designed assisted living, nursing facilities and day programs serving ethnic communities around the country, including Chinese-Americans:
Indian immigrants who came to the United States in the 1960s and ’70s for educational and work opportunities have begun to downsize and contemplate their postcareer years, said Iggy Ignatius, 60, ShantiNiketan’s chairman. “Many people were thinking they’d go back to India, but pragmatically it’s not possible,” he said. “Our children are here. Our grandchildren are here.”
In Florida, from the architecture that reminds Dr. Chandran of Chennai, India, to the vegetarian meals and Bollywood dance classes, “we have created a mini-India, a piece of India,” Mr. Ignatius said. The Chandrans moved into their three-bedroom condominium in 2011, paying $250,000, and now they lead yoga classes in ShantiNiketan’s meditation room.
For more, read the always interesting Paula Span's full article, A New Spin on Senior Living.
The Washington Post ran an article on March 17, 2016 about the work on Alzheimer's researchers at MIT have been doing . MIT scientists find evidence that Alzheimer’s ‘lost memories’ may one day be recoverable explains that "[a] new paper published Wednesday by the Massachusetts Institute of Technology's Nobel Prize-winning Susumu Tonegawa provides the first strong evidence of this possibility and raises the hope of future treatments that could reverse some of the ravages of the disease on memory." The research and results were featured in an article in Nature The abstract explains
Alzheimer’s disease (AD) is a neurodegenerative disorder characterized by progressive memory decline and subsequent loss of broader cognitive functions. Memory decline in the early stages of AD is mostly limited to episodic memory, for which the hippocampus has a crucial role. However, it has been uncertain whether the observed amnesia in the early stages of AD is due to disrupted encoding and consolidation of episodic information, or an impairment in the retrieval of stored memory information. Here we show that in transgenic mouse models of early AD, direct optogenetic activation of hippocampal memory engram cells results in memory retrieval despite the fact that these mice are amnesic in long-term memory tests when natural recall cues are used, revealing a retrieval, rather than a storage impairment. Before amyloid plaque deposition, the amnesia in these mice is age-dependent, which correlates with a progressive reduction in spine density of hippocampal dentate gyrus engram cells. We show that optogenetic induction of long-term potentiation at perforant path synapses of dentate gyrus engram cells restores both spine density and long-term memory. We also demonstrate that an ablation of dentate gyrus engram cells containing restored spine density prevents the rescue of long-term memory. Thus, selective rescue of spine density in engram cells may lead to an effective strategy for treating memory loss in the early stages of AD.
(citations omitted). A subscription or fee is required to access the full article.
Thursday, March 24, 2016
We don't use this blog to promote a specific product, so please don't read the following as that. There is some educational value in learning about efforts of world-renowned corporations to provide products for people with special needs. I'd heard Nike had shoes in the works for people with special needs so I wanted to share this article regarding their availability. Nike Expands Shoe Line For People With Special Needs was published in the March 16, 2016 issue of Disability Scoop. "The company was inspired to develop the unique system after hearing from then-16-year-old Matthew Walzer in 2012. Walzer, who has cerebral palsy, requested more accessible footwear so that he would be able to go off to college without needing assistance tying his shoes." According to the story, there are several models of the shoe from which to choose.
There was an article in Motherboard last week that intrigued me. Companies Want to Replicate Your Dead Loved Ones With Robot Clones explains how many struggle with grief and moving on after the death of someone well-loved.
Many grieving people feel n emotional connection to things that represent dead loved ones, such as headstones, urns and shrines, according to grief counselors. In the future, people may take that phenomenon to stunning new heights: Artificial intelligence experts predict that humans will replace dead relatives with synthetic robot clones, complete with a digital copy of that person's brain.
According to the article, one research company has taken the first step down this path, with the goal " to 'transfer human consciousness to computers and robots.' The firm has already created thousands of highly detailed “mind clones” to log the memories, values and attitudes of specific people. Using the data, scientists created one of the world's most socially advanced robots, a replica of [the wife of the] ... founder...."
According to the article, creating these "mind clones" achieves "[t]he goal ... to capture a person’s attitudes, beliefs and memories and create a database that one day will be analogged and uploaded to a robot or holograph, according to the Lifenaut website. Everything down to a person’s mannerisms and quirks can be recreated."
Why you might ask, would one want a have a robot clone of oneself? According to the article, there are several reasons. "Some users simply like the idea of living forever. Others want to document themselves as a part of human history. Some hope to pass on an artistic project or genealogical information to offspring. Fewer will use it to “memorialize” and “communicate with” the dead...."
Google has also filed a patent, according to the article, that focuses on duplicating a personality and would use, the article notes " a cloud-based system in which a digital “personality” can be downloaded like an app." The article continues, discussing the pros and cons of moving forward with this technology and debates whether humans can really be replicated.
To reference Aldous Huxley, it's a "brave new world."
Tuesday, March 22, 2016
Kaiser Health News ran a story on March 17, 2016 about long term care insurance policies. Long-Term Care Insurance: Less Bang, More Buck explains how one insured saw her premiums cost almost four times as much if she kept her same coverage. Although an important option for many middle-income Americans, it seems, from the article, that the industry has specific challenges facing it.
[I]insurers botched just about every aspect of the policies they sold in the early days of the industry, said Joseph Belth, a retired professor of insurance at Indiana University known as one of the insurance industry’s toughest critics. They underestimated how long people would live and how long they’d need nursing home care — but overestimated how many people would drop their policies and how much interest insurers could earn on the premiums they banked.
Hemorrhaging money, many insurers left the business. Those that remain are in financial trouble on their long-term care policies. They’re charging far more for new policies, and sharply raising the premiums of old ones.
Not as many companies are offering the coverage as once was and many policy holders may be facing a choice of increased premiums, reducing or dropping coverage. As well, the article notes that many folks don't know the limits of Medicare coverage for long term care. Fewer people are purchasing the policies, but there are now some hybrid options on the market
Fewer people today are buying traditional long-term care insurance policies, which only adds to insurers’ financial woes. Some are considering newer “hybrid” products such as life insurance or annuities that provide a long-term care benefit, but they’re also expensive and some require a large up-front payment.
That’s why pressure is mounting for state and federal lawmakers to come up with ways to finance long-term care for millions of aging baby boomers. Policy proposals abound, such as requiring people to buy subsidized long-term care insurance, much as they now need to buy health insurance. Other ideas include creating a government-run catastrophic plan or allowing people to convert their life insurance policies to long-term care policies. But all of these would require legislative action, and lawmakers at the state and federal level have been slow to act because of the sheer scope of financing Americans’ long-term care.
Monday, March 21, 2016
There was an update recently in the litigation concerning the capacity of Sumner Redstone to change the agent under his health care directive. The case starting making the papers last fall. The New York Times ran an article on November 25, 2015, Court Filing Challenges Competence of Sumner Redstone. This article noted that a prior companion of Mr. Redstone filed suit claiming that she "was improperly removed on Oct. 16 from control of an advance health care directive that gave her authority over his health decisions." The article summarizes some of the allegations made in the petition by the companion. A series of other articles followed, two of which are referenced here.
The second article referenced here ran in the Times on February 29, 2016. Sumner Redstone Competency Case Will Go Forward notes that the case is scheduled for trial in May of 2016. The 21 page ruling discussed in the article outlines the two sides' dispute. The article notes that Mr. Redstone was at one time estranged from his daughter, although the article indicates she notes a repair of the relationship. The article quotes the judge: "[d]uring the hearing, Judge Cowan remarked on Mr. Redstone’s notable absence from the legal battle. Notoriously outspoken and combative at his prime, Mr. Redstone has not appeared before the court or submitted a statement of his own. “There are a lot of things that have been said about what Mr. Redstone wants,” Judge Cowan said, “'but unfortunately I have no declaration from him.'”
The third article, published March 18, 2016 in the New York Times gives an update. Sumner Redstone’s Medical Records to Stay Private, Judge Rules reports that some 15 documents will be unsealed but the rest remain confidential. The judge explained that "the medical records would remain sealed because the case was a personal matter centered on Mr. Redstone’s medical issues, not a case involving his public business dealings." The trial is scheduled for May 6 and depositions will be taken in April.
There are a number of other articles reporting this story for those who are interested in learning more about this case.
Sunday, March 20, 2016
We have previously written about the topic of elder inmates and the implications for prisons with the graying of the prison population. Here is one more story on the topic, published March 17, 2016. Pew Charitable Trust's Stateline (which "provides daily reporting and analysis on trends in state policy....") ran the story, Elderly Inmates Burden State Prisons.
Nearly every state is seeing that upward tick in elderly state prisoners. In Virginia, for example, 822 state prisoners were 50 and over (corrections officials usually consider old age for prisoners to begin at 50 or 55) in 1990, about 4.5 percent of all inmates. By 2014, that number had grown to 7,202, or 20 percent of all inmates.
For state prisons, the consequence of that aging is money, more and more of it every year. Health care for aging prisoners costs far more than it does for younger ones, just as it does outside prison walls. Corrections departments across the country report that health care for older prisoners costs between four and eight times what it does for younger prisoners.
In terms of reducing the number of elder inmates, according to the study, some states are using diversion programs, early release or compassionate release. We all have heard about increasing longevity, but that doesn't necessarily explain the rise in elder inmates. The story notes that correctional personnel offer two factors to explain this rise: "[o]e is a steady increase in the rate of older adults entering prison. The second, and more potent, factor is changes enacted in the get-tough-on-criminals 1990s that resulted in longer prison sentences."
Knowing about the physical limitations some may have as they age, one can only imagine the accommodations prisons have had to make, including the use of "ramps and shower handles and ... other physical modifications. Many prisons have had to create assisted living centers with full-time nursing staffs.... In addition, at least 75 U.S. prisons ..., provide hospice services for dying prisoners...."
One prison mentioned in the story has an ALF, but the waiting list is such that prisoners must need assistance with 2 or more ADLs to be considered. Poor health when entering prison is not unusual. And being old and in prison may be even tougher than for younger inmates.
Prison is a particularly treacherous place to get old. Getting to a top bunk is difficult for many aging prisoners, as is climbing stairs. Hearing loss, dementia and general frailty can make it difficult to comprehend or obey rules. And being infirm in an institution full of young predators can make older prisoners vulnerable. “If there’s an old lion or gazelle... the young ones are going to take advantage.”
Once they get out, finding a place to go becomes another challenge according to the article. Some states have taken different approaches to deal with the graying prison population, from financing the facilities that provide the needed care (such as a dementia unit in the prison) to contracting with a private facility to provide the care to "geriatric conditional release."
And what about the likelihood of reoffending? "Studies have found that older ex-offenders are less likely than younger ones to commit additional crimes after their release. But politicians and the public don’t seem willing to release former murderers, rapists and sex offenders, even though they are decades removed from their crimes and physically incapable of repeating them...."
On March 16, 2016, the Florida Office of Insurance Regulation issued suspension orders affecting University Village, a Continuing Care Retirement Community (CCRC) in Tampa, Florida. Long-Term Living publication reports:
The first order states the facility was acquired illegally. IMH Healthcare, LLC, the general partner of the new ownership, does not have approval to operate as a licensed CCRC provider.
The second order makes several allegations against University Village for violating provisions of Florida’s Insurance Code for:
failing to comply with the OIR’s target examination and filing false information;
failing to fulfill statutory and contractual obligations to residents, estates of former residents and prospective residents, including failing to pay more than $4 million in refunds owed to residents;
continuing to accept new residents while being financially insolvent; and
engaging in fraudulent or dishonest management practices.
For more on the OIR action, read Tampa Times coverage, "Florida Officials Move to Suspend Tampa's University Village Retirement Home."
The events that led to this state action are somewhat unusual. For earlier reports on the long-simmering issues, see Channel 8 News Report from September 2015: "Owner Claims, State Lying, Retirees Suffer." See also a Tampa Bay Times article from February 2015, "State Looks into Alleged Financial Problems at Tampa Retirement Community."
Friday, March 18, 2016
I was mulling over some recent press surrounding the announcement about the 5th Indiana Jones movie, starring Harrison Ford. The articles I saw were stories about Harrison Ford's age as far as playing the character. I first saw an article in The Guardian, titled Indiana Jones and the Tide of Ageism: why such a reaction to the fifth film? The Guardian article reported on the reactions regarding Mr. Ford's age: "[y]et the bulk of the backlash to the announcement instead concerned Ford’s age: 73 at the moment, 77 when the movie will be released in late summer 2019. The Noël Cowards of social media were swift to deploy their finest...." The article then includes some tweets where references were made (suggesting other movie titles that are pointed references to his age). I wondered how wide-spread these social media remarks had become, so I went looking for a few other articles, and found this one from USA Today, The world has loads of fake titles ready for 'Indiana Jones 5' which reports on more tweets and notes "[n]ow, Indy has never fought off pits of snakes in the digital age, therefore we welcome him to the future with a host of crowd-sourced titles for the currently untitled Indiana Jones 5. (Spoiler: ageism affects men too.)" I liked this statement in the Guardian article "[a]ll of this can be done just as easily at 77 as 37. Indeed, it could also be achieved at 87. Just as academia is not a young person’s game, neither is archeology."
Did I miss these types of stories when Mr. Ford reprised his Han Solo role in the most recent Star Wars movie?
All I can think is hmmm....