Sunday, July 12, 2015

NYT: Specialists with Team Skills May Help with Planning

From the New York Times, Making Decisions about Elder Housing May Take a Team Effort, by John Wasik:

But for elderly people like Ms. Renninger, now 83, deciding what to do next can be an almost overwhelming task. Is it time to move to a nursing home or some other type of assisted living? Or will home care with a variety of support services work?

 

It is an issue millions of people — especially baby boomers and their parents — are grappling with now. The choices are so complex that more and more people are finding they cannot make the decisions alone. As a result, with the number of Americans age 85 and older growing faster than any other age group, as the Congressional Budget Office reports, so is the demand for elder care specialists.

Detailing what many Elder Law Attorneys also provide, the article gives several examples of professionals with multi-disciplinary skills, such as a geriatric care manager, or a doctor who is also a certified financial planner.  Thanks to Professor Laurel Terry for sending this timely link.

July 12, 2015 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Legal Practice/Practice Management, Property Management | Permalink | Comments (0)

Friday, July 10, 2015

Louisiana Governor Signs Amended "Lifetime Necessities" Law Obligating "Ascendants & Descendants"

Louisiana Governor Bobby Jindal, one of (now many) candidates for the Republican nomination for President,  has been making a fair amount of press of late, for his positions on so-called medical marijuana, Common Core education standards, and how his state will handle same-sex marriage. Lower on the radar screen, however, was his signing of Act 260, an interesting package of legal changes affecting obligations between various family members.

One of these changes was to adopt a new provision affecting the obligations of "ascendants and descendants" to provide "basic necessities of life" for family members "in need."  In other words, filial support. 

Louisiana already had a provision, Section 229, providing that "children are bound to maintain their father and mother and other ascendants who are in need."  The new provision continues this statutory obligation, but makes enforcement "personal" only.  The substitute provision was signed into law on June 29 and becomes effective on January 1, 2016.  New Article 237 of Act 260 provides:

Descendants are bound to provide the basic necessities of life to their ascendants who are in need, upon proof of inability to obtain these necessities by other means or from other sources, and ascendants are likewise bound to provide for their needy descendants, this obligation being reciprocal.

 

This obligation is strictly personal and is limited to the basic necessities of food, clothing, shelter, and health care.

 

This obligation is owed by descendants and ascendants in the order of their degree of relationship to the obligee and is joint and divisible among obligors. Nevertheless, if the obligee is married, the obligation of support owed by his descendants and ascendants is secondary to the obligation owed by his spouse.

Official comments explaining the revisions emphasize that the necessities obligation kicks in only when the needy family member is unable to obtain necessities "by other means" or from "other sources," thus signaling any filial support obligation is secondary to the individual's eligibility for public assistance or other welfare benefits. Further "for the first time" Louisiana law "provides a ranking of those descendants and ascendants who owe this reciprocal, lifetime obligation."

The commentary explains that the revision makes the obligation "strictly personal," and there it precludes enforcement by "a third person."  Thus, it would appear that unlike in Pennsylvania (or Germany?) nursing homes and the state may not use these statutes in order to sue family members to collect necessities for indigent elders.

According to the comments, the obligation is also not "heritable."  This appears to reflect a Louisiana Court of Appeals decision from 2010, In re Succession of Elie,denying a mother's claims for funds from a deceased son's estate brought under former Section 229.     

July 10, 2015 in Current Affairs, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Housing, Medicaid, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Thursday, July 9, 2015

If You Can't Beat Alzhemier's, Can You at Least Delay It?

In Alzheimer's Spurs the Fearful to Change Their Lives to Delay It, Washington Post writer Fredrick Kunklen details various ways that individuals and groups are working to buy more time from genetic profiles or family histories that suggest a greater likelihood of dementia: 

When Jamie Tyrone found out that she carries a gene that gives her a 91 percent chance of developing Alzheimer’s disease beginning around age 65, she sank into a depression so deep that at times she wanted to end her life.

 

Then she decided to fight back. She exercised. She changed her diet. She began taking nutritional supplements, including fish oil, vitamin D, vitamin B12, curcumin, turmeric and an antioxidant called CoQ10. She started meditating and working mind-bending puzzles, such as Brain HQ. She joined a health clinic whose regimen is shaped by a UCLA medical study on lifestyle changes that can reverse memory loss in people with symptoms of dementia. She started a nonprofit group, Beating Alzheimer’s By Embracing Science (BABES), to raise money and awareness about dementia.

 

“I found my voice,” said Tyrone, 54, a registered nurse who lives in San Diego.

Here is the link to "BABES" for those who want to read more about that group.

July 9, 2015 in Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Science, Statistics | Permalink | Comments (0)

Wednesday, July 8, 2015

Check Out This Blog

I always spend some time at the beginning of the semester talking with my students about language used to describe elders as well as attitudes and stereotypes. I was interested in seeing this blog, This Chair Rocks. As the blog author explains

So how come so many of us unthinkingly assume that aging equals a grim slide into depression, diapers, and dementia? That 20th century’s astonishing leap in life expectancy is a disaster-in-the making? Underlying all the hand-wringing is ageism: discrimination that sidelines and silences older people. And unlike racism and sexism, it has barely bleeped onto our radar.

So I’m on a crusade to get people of all ages to wake up to the ageism in and around us, cheer up, and push back.

The author also has a question & answer blog, Yo, Is This Ageist? that allows readers to submit questions that the author answers. What a great tool for students!

 

July 8, 2015 in Current Affairs, Discrimination, Weblogs | Permalink | Comments (0)

Tuesday, July 7, 2015

NYT: Starting Your Own "Conversation Project" With Family

Many have written with great sensitivity and candor about attending the death of a loved one, including a parent.  Ellen Goodman had a lovely op-ed recently, How to Talk About Dying, in the New York Times.  But more important even than her personal journey with her own parents, was how she and others have used their mutual  experiences and concerns to start The Conversation Project. 

As background, Ms. Goodman writes:   

When my mother died from heart failure and dementia, I began to talk with others. It was extraordinary. Everyone seemed to have a piercing memory of a good death or a hard death. Some of these stories had been kept below the surface for decades, and yet were as deep and vivid as if they’d just happened.

 

Too many people we love had not died in the way they would choose. Too many survivors were left feeling depressed, guilty, uncertain whether they’d done the right thing.

With these experiences in common, Ms. Goodman and others established a nonprofit and a website, and they offer a "Conversation Starter Kit" for how to begin -- and continue -- thinking about what you want and how to share personal values and choices with family members.  The kit is free, downloadable, and you can take notes and tailor the plan easily. 

Many of my own friends and working colleagues have stories to share about "end of life" decisions with their parents. (Perhaps because I teach and write about aging, I get more than the average number of opportunities to hear from a lot of people about how well things are going on the homefront....) It seems like a "conversation about the conversation," shared among friendship groups, or workout-groups, or workplace groups, might facilitate using the starter kit and working on the more personal family conversations. 

Thanks to Professor Laurel Terry for sharing these links! 

July 7, 2015 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues | Permalink | Comments (0)

Friday, July 3, 2015

Pennsylvania AG Files Consumer Protection Suit Against Golden Living Nursing Homes

On July 1, 2015, Pennsylvania's Attorney General filed a complaint in the Commonwealth Court against Golden Gate National Senior Care LLC (GGNSC) which manages and operates Golden Living Centers nationally.  The AG's suit focuses on 14 facilities in Pennsylvania. From the AG's press statement:

The legal action asserts Golden Living violated the Unfair Trade Practices and Consumer Protection Law by deceiving consumers through its marketing practices.

  

The company advertised it would keep its residents clean and comfortable while providing food and water at any time. But its facilities were understaffed, leaving residents thirsty, hungry, dirty, unkempt and sometimes unable to summon anyone to help meet their most basic needs, such as going to the bathroom, the legal action asserts.   

According to the AG's office, evidence comes from residents' family members and former employees of Golden Living, including certified nursing assistants.  The allegations focus on an alleged "widespread pattern of understaffing and omitted care."

Further, the AG makes the following specific allegations:  

  • Continent residents left in diapers because they were unable to obtain assistance going to the bathroom.    
  • Incontinent residents left in soiled diapers, in their own feces or urine, for extended periods of time.    
  • Residents at risk for bedsores from not being turned every two hours as required.   
  • Residents not receiving range of motion exercises.    
  • Residents not receiving showers or other hygiene services as required.     
  • Residents being woken at 5 a.m. or earlier to be washed and dressed for the day.    
  • Residents not being timely dressed in order to attend their meals.    
  • Residents not being escorted to the dining hall and sometimes missing meals entirely.   
  • Long waits for responses to call bells or no responses at all.   
  • Staff, under the direction of management or fear of management, falsifying records to indicate residents received services when in fact they did not.  
  • Improved staffing when state inspections occurred, leading to deceit about the true conditions at the facility.     
  • The investigation also included a review of staffing levels self-reported by Golden Living facilities and deficiencies cited in surveys conducted by the state Department of Health. 

According to one news source, Golden Living responded to the suit with a statement expressing the company's confidence that the "claims made by the Attorney General are baseless and wholly without merit," and further alleging the suit is the "unfortunate result of Kathleen Kane's inappropriate and questionable relationship with a Washington D.C.-based plaintiff's firm that preys on legitimate businesses and is paid by contingency fees."  (For those of you not privy to the local news on Pennsylvania politics generally and AG Kathleen Kane specifically, I think it is fair to say that the press frequently refers to her as the "embattled AG."  She first took office in January 2013).

The Pennsylvania AG's suit comes on the heels of a broader report released in June by Community Legal Services of Philadelphia, asserting that from 2012 through 2014 the Pennsylvania Department of Health under former Governor Corbett's administration, failed significantly to conduct proper investigation of complaints about a large number of nursing homes (not limited to Golden Living) and failed to enforce existing regulations designed to protect residents. 

For Golden Living, allegations are not limited to Pennsylvania. For example, in June 2015, claims about chronic understaffing of 12 Golden Living Center nursing homes in Arkansas were certified to be litigated as a class action. 

Hat tip to Douglas Roeder, Esq., for bringing the latest Pennsylvania AG's suit to my attention. Last month I reported on the A.G.'s suit for unfair trade practices filed against a law firm that was alleged to be improperly using Pennsylvania's filial support law as a basis for collection demands against family members of the debtor. 

July 3, 2015 in Cognitive Impairment, Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Housing, Medicaid, Medicare, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Thursday, July 2, 2015

Germany Makes Int'l Claim for Filial Support Against U.S. Relative, Seeking Nursing Home Costs

Imagine this fact pattern:   You are a young professional, just getting your career started (still making payments on college and graduate degree loans, and only dreaming of the day you could make a down payment on a house). You receive an official-looking letter. The letter advises that under another state’s law, you may have a statutory duty to pay monthly “financial support” for a father who is unable to support himself, following a stroke that has put him in a public nursing home. Fairly stunning news, yes? 

Now imagine that the father in question is someone you have seen only a handful of times since the age of about 10, when he and your mother divorced.  The custody case that took place in the father’s home state was a tough one.  Review of the evidence shows the father was either unable or unwilling to provide support for the family while they were together.  Your father borrowed money from your mother’s family. He was manipulative, even to the point that he once kidnapped you as a young child and held you away from your mother. Ultimately, the court in that other state agreed that your mother should have sole custody. Your father never paid alimony to your mother or support for you as a child.  Those college degrees were earned without your father’s support of any kind. 

Tough to believe that authorities in the other state could possibly believe, even if they work in one of the few U.S. states that occasionally enforce claims made by nursing homes for filial support, that any support or maintenance award under these circumstances would be “fair.” 

Add one additional complexity.  Admittedly, it is a big one.  The “state” requesting monthly payments is not next door to where you live, or even in the same country.  It is across the Atlantic.  The state is Germany. And you gave up your citizenship as a German long ago. 

I have been given permission to write about this set of facts by the American adult child in question. Perhaps this post may generate additional legal assistance from someone with experience in a cross-border claim.  These are the facts as I understand them.

Germany has its own version of what I call a "filial support" law, although it is far broader than Pennsylvania's controversial law.  The German Civil Code at Sections 1601-1615, provides that when a person is "incapable" of maintaining himself, "lineal relatives are under an obligation to maintain" the individual.  If one family member in the line of descent cannot pay in whole or part, the claim goes to the next. 

The amount of any maintenance obligation is usually set according to the family member's "ability to pay," with a court having the power to decide what amount that might be if a request is not paid voluntarily. In their first letter, the German authorities warn that failure to cooperate can be a criminal offense; in a second letter, they seek records of annual earnings, but only certain expenses (rent, insurance and student debt), from the American.

Continue reading

July 2, 2015 in Current Affairs, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, International | Permalink | Comments (0)

Wednesday, July 1, 2015

New Yorker Article on Death with Dignity and Losing "Levensperspectief"

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.

July 1, 2015 in Advance Directives/End-of-Life, Current Affairs, Ethical Issues, International | Permalink | Comments (0)

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

King v. Burwell: USSC Rules Tax Credits Apply to Federal Exchanges

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. 

June 25, 2015 in Current Affairs, Ethical Issues, Federal Cases, Health Care/Long Term Care | Permalink | Comments (0)

ABA Journal: Delaware is First State to Grant Access to Digital Assets for Fiduciaries

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! 

June 25, 2015 in Current Affairs, Estates and Trusts, Legal Practice/Practice Management, Property Management, State Statutes/Regulations | Permalink | Comments (1)

Tuesday, June 23, 2015

Agenda & Issues Framed for July 2015 White House Conference on Aging

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

Pensions at Heart of Greek Debt Crisis

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

Daily MailAlex Brummer:  Could This Weekend be a Lehman Moment for Greece?  

June 21, 2015 in Current Affairs, Ethical Issues, International, Social Security | Permalink | Comments (2)

Thursday, June 18, 2015

What Do We (and Should We) Mean by "Assisted Living?"

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

Northern Ireland Advocate Calls for Overhaul of Adult Social Care Legislation

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. COPNI Claire Keatinge Launch of Call for Reform of Adult Social CareThe 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

On the Importance of "Being Mortal"

During the last six months, the book most often recommended to me has been Being Mortal, written by Boston surgeon (he's more than that...) Atul Gawande.  Now I too can recommend this book to others.

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? 

June 15, 2015 in Books, Current Affairs, Ethical Issues, Health Care/Long Term Care, Science | Permalink | Comments (1)

Thursday, June 11, 2015

Another Report on Retirement Security Preparedness

The Government Accountability Office (GAO) released a report dated May, 2015 on Retirement Security: Most Households Approaching Retirement Have Low SavingsThe 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.

June 11, 2015 in Consumer Information, Current Affairs, Retirement, Social Security | Permalink | Comments (0)

Wednesday, June 10, 2015

White House Conference on Aging July 13, 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.

June 10, 2015 in Current Affairs, Health Care/Long Term Care, Housing, Other, Programs/CLEs, Retirement, Webinars | Permalink | Comments (0)

Tuesday, June 9, 2015

Aging Comes Naturally?

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!

June 9, 2015 in Consumer Information, Current Affairs, Health Care/Long Term Care, Housing, Programs/CLEs, Retirement | Permalink | Comments (0)

Monday, June 8, 2015

Living a Longer, Fulfilling Life?

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.

June 8, 2015 in Current Affairs, Other, Retirement | Permalink | Comments (0)