Wednesday, October 18, 2017
You may have read recently about a woman who had an advance directive that addressed artificial nutrition and hydration. The SNF where she lived was hand feeding her, over her husband's objections. The trial court sided with the SNF and the state ombudsman who had argued that "state rules to prevent abuse required the center to offer residents three meals each day and provide help eating, if needed." Can one provide in her advance directive that she refuses in advance oral fluids and foods at some point in the future? The Kaiser Health News article, Dementia Patient At Center of Spoon-Feeding Controversy Dies, explores the specific case as well as the issue. The patient, as the title explained, died last week.
Here's the issue illustrated in this matter.
At issue is whether patients with Alzheimer’s and other progressive diseases can stipulate in advance that they want oral food and liquid stopped at a certain point, hastening death through dehydration. It’s a controversial form of what’s known as VSED — voluntarily stopping eating and drinking — a small but growing practice among some terminally ill patients who want to end their lives. In those cases, people who still have mental capacity can refuse food and water, usually resulting in death within two weeks. .... “The right to VSED is reasonably well-established, but it’s when a person isn’t competent that’s the issue,” said Paul T. Menzel, a retired bioethicist at Pacific Lutheran University in Tacoma, Wash., who has written extensively on the topic.
So in thinking about a person saying no to food and fluids, "VSED doesn’t require a law or a doctor’s approval. But the question of whether it’s possible for people who can no longer actively consent to the procedure remains ethically and legally unclear. That’s especially true for patients who open their mouths to accept food and fluids...."
Have you looked at your state's laws to see if there is a position on this? According to the article, almost 24 states have laws on "assisted feeding" some of which "specifically prohibit withdrawing oral food and fluids. Other states address only artificial feeding or are unclear or silent on the issue [and] ... Idaho — appears to sanction withdrawal of assisted feeding by a health care proxy" according to an expert quoted in the article. However, "Idaho state law also prohibits any form of assisted suicide and requires “comfort care” for patients if artificial nutrition and hydration is withdrawn. It’s not clear whether a request to halt assisted feeding would be honored" said an expert on Idaho's statute on Medical Consent and Natural Death Act.
October 18, 2017 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Federal Statutes/Regulations, Food and Drink, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (1)
Thursday, August 10, 2017
The GAO has issued a report that examines various federal programs for low-income individuals. Federal Low-Income Programs: Eligibility and Benefits Differ for Selected Programs Due to Complex and Varied Rules offers the following findings
Six key federally funded programs for low-income people vary significantly with regard to who is eligible, how income is counted and the maximum income applicants may have to be eligible, and the benefits provided. In fiscal year 2015, the most current data available, the federal government spent nearly $540 billion on benefits for these six programs—the Earned Income Tax Credit (EITC), Medicaid, the Housing Choice Voucher program, Supplemental Nutrition Assistance Program (SNAP), Supplemental Security Income (SSI), and Temporary Assistance for Needy Families (TANF). The target population for each of these programs differs, for example, people who are elderly or disabled or who have dependent children. Further, some programs have conditions for continued eligibility, such as participation in work activities under TANF. The six programs also vary in what income is and is not counted when determining an applicant's eligibility. For example, certain programs, such as SNAP, disregard a portion of earned income, while others do not. The maximum amount of income an applicant may have and still be eligible for benefits, which is determined for some programs at the federal level and for others at the state or local level, also differs significantly. As of December 2016, this amount ranged from $5,359 per month for one state's Medicaid program to $0 per month in one state for TANF cash assistance, for a single parent with two children. Benefit levels also differed across the six selected programs, with average monthly benefits for these programs ranging in fiscal year 2015 from $258 for SNAP to $626 for Housing Choice Vouchers, and four of the six programs adjust benefits annually.Legal, administrative, and financial constraints pose challenges to efforts to streamline varying eligibility rules for federal low-income programs, according to GAO's current and previous work. A key challenge is that the programs are authorized by different federal statutes enacted at different times in response to differing circumstances. Other laws, such as appropriations laws, can also have an impact on federal programs and their rules. As a result, streamlining eligibility rules would require changing many laws and coordination among a broad set of lawmakers and congressional committees. A further challenge is that a different federal agency or office administers each program GAO reviewed. For some of these programs, such as TANF, state governments also establish some program rules, making it more difficult to streamline rules at the federal level within or across these programs. Finally, financial constraints may also affect efforts to streamline program rules. For example, if rule changes raise the income eligibility limit in a program, more people may become eligible and that program's costs may increase. Despite these challenges, Congress, federal agencies, and states have taken some steps to streamline program administration and rules, such as by making greater use of data-sharing where permitted by federal law and aligning programs' applications and eligibility determination processes. For example, SSI recipients in most states are automatically eligible for Medicaid, and GAO previously reported that some states have integrated the SNAP eligibility process with other low-income programs, such as through combined applications and common eligibility workers.
Thursday, March 30, 2017
The AARP Foundation Drive to End Hunger with their ambassador, Jeff Gordon, "is committed to solving the hunger crisis among older Americans." The commercial is available on You Tube. If you haven't thought about the issue of hunger amongst older Americans, you will be shocked when you look at the data. For example, over ten million folks age 50 and older are in danger of being hungry. As well, the costs of health care resulting from food insecurity is in the billions (yes billions). The website offers the opportunity to volunteer, donate and resources.
Here's some background about the initiative
Since 2011, AARP Foundation’s Drive to End Hunger campaign has been raising awareness about the problem of food insecurity among older adults, meeting the immediate daily food needs of hungry seniors, and working to establish permanent solutions to end senior hunger once and for all. Through a collaboration with NASCAR team owner Rick Hendrick of Hendrick Motorsports, four-time Sprint Cup Champion Jeff Gordon, Hendrick teammate Kasey Kahne, and both public and private sector organizations, Drive to End Hunger has donated more than 37 million meals to help feed hungry seniors across the country.
Monday, January 16, 2017
So Meals on Wheels has an idea. We all know the dangers of isolation and how important it can be to check in with an elder on a regular basis. Kaiser Health News explains the idea, Meals On Wheels Wants To Be The ‘Eyes and Ears’ For Hospitals, Doctors. "Meals on Wheels, which has served seniors for more than 60 years through a network of independent nonprofits, is trying to formalize the health and safety checks its volunteers already conduct during their daily home visits to seniors. Through an ongoing campaign dubbed “More Than a Meal,” the organization hopes to demonstrate that it can play a critical role in the health care system."
Many nonprofits face challenges, including funding challenges, and Meals on Wheels is no exception. There are competitors now, less funding and increasing demand for services. So how would this work? "Meals on Wheels America and several of the local programs around the country have launched partnerships with insurers, hospitals and health systems. By reporting to providers any physical or mental changes they observe, volunteers can help improve seniors’ health and reduce unnecessary emergency room visits and nursing home placements, said Ellie Hollander, CEO of Meals on Wheels America." It's a very cost-effective system according to the article and has the potential for bigger savings in health care costs.
There has already been some research done on the effectiveness and advantages of Meals on Wheels. Consider this:
Studies conducted by Brown University researchers have shown that meal deliveries can help elderly people stay out of nursing homes, reduce falls and save states money.
Kali Thomas, an assistant professor at Brown University School of Public Health, estimated that if all states increased the number of older people receiving the meals by 1 percent, they would save more than $100 million. Research also has shown that the daily meal deliveries helped seniors’ mental health and eased their fears of being institutionalized.
There are projects taking place, with one between Meals on Wheels, Brown U and West Health Institute. Another is with Meals on Wheels, Johns Hopkins Bayview Medical Center and Meals on Wheels of Central Maryland, which will attempt "to keep seniors at home and reduce their need for costly health services after hospitalization. The idea is to have trained volunteers report red flags and ensure, for example, that patients with congestive heart failure are weighing themselves regularly and eating properly." The Maryland project is being run by Dr. Dan Hale (friend and former colleague at Stetson U).
Sounds like a great idea!
Thursday, June 4, 2015
PBS did a story that is compelling. Number of seniors threatened by hunger has doubled since 2001, and it’s going to get worse offers that "[n]early one in six senior citizens face the threat of hunger in the United States. Charity and food stamps reach some of these vulnerable Americans, but limited resources and isolation mean many are struggling without receiving help." The audio of the story as well as a transcript is available here. The story reviews the importance of social service programs, which may be hampered by long wait lists, food banks and more that provide some assistance. As I mentioned, this is a compelling story. It's also sad. Thanks to my colleague, Professor James Fox, for sending me the link to the story.
Monday, April 27, 2015
Occasionally I feel a little "push-pull" from the different directions that writing about "laws and policies of aging" takes me. One minute I'm writing about hunger for seniors in our nation's capitol, a dynamic driven by poverty, and then there is today's story from NPR on Drop-In Chefs Help Seniors Stay in Their Own Homes.
"Part of the business plan is keeping the service affordable. In addition to the cost of the food, the client pays $30 an hour for the chef's time. That's usually a couple of hours a week of cooking and cleaning up the kitchen. There's also a $15 charge for grocery shopping. So clients pay on average $45 to $75 a week.
And while there are lots of personal chefs out there and services that deliver meals for seniors there are few services specifically for older adults that prepare food in their homes."
All part of the big, complex picture of "aging."
Thursday, April 23, 2015
As summarized in a recent article in the Washington Post, a new study places Washington D.C. fourth in the nation for seniors at hunger risk:
"The report says that more than 20 percent of the District’s elderly have concerns about eating enough food or the right kind of food, compared with more than 24 percent of seniors in Mississippi.
The estimates of senior hunger range from about 8 percent in Minnesota to more than 26 percent in Arkansas, which was ranked highest among states where seniors face the threat of hunger. Virginia and Maryland both had rates of about 14 percent.
The analysis – conducted by two university researchers on behalf of the nonprofit National Foundation to End Senior Hunger and the National Association of States United for Aging and Disabilities – says nearly 15.5 percent of elders, or 9.6 million people, in the United States face the threat of hunger...."
My thanks to George Washington Law Professor Naomi Cahn for sharing this article. We agree -- depressing news.
Friday, October 10, 2014
Although some think substance abuse is a problem for the young, a recent story in the New York Times dispels that thought. More Older Adults Are Struggling With Substance Abuse ran October 3, 2014 looks at the number of elders who are substance abusers-whether drugs or alcohol. The numbers are surprising:
An estimated 2.8 million older adults in the United States meet the criteria for alcohol abuse, and this number is expected to reach 5.7 million by 2020, according to a study in the journal “Addiction.” In 2008, 231,200 people over 50 sought treatment for substance abuse, up from 102,700 in 1992, according to the Substance Abuse and Mental Health Services Administration, a federal agency.
Although alcohol abuse seems to rank first, the "rate of illicit drug use among adults 50 to 64 increased from 2.7 percent in 2002 to 6.0 percent in 2013" according to the story. The article mentions several studies, not only looking at the extent of the abuse, but the reasons behind these addictions. Although for some, retirement may be a catalyst, many times it is not the sole reason, "'with the conditions leading to retirement, and the economic and social nature of the retirement itself, having a far greater impact on substance use than simple retirement itself..."' Some of the "firsts" experienced in later life, such as deaths of spouses and friends, may be a contributing factor that requires "coping skills" these folks haven't had to yet possess.
The article also touches on the potential lack of doctor training on dealing with elder patients with substance abuse issues, and notes some symptoms associated with dementia may have similar symptoms to those of addictions.
Wednesday, January 22, 2014
Last week I wrote about a dispute involving a gathering spot for elderly Koreans at a McDonald's restaurant in Flushing, New York. The owners were trying to eject the seniors, arguing that they weren't ordering food and had turned the seating into a defacto senior center that wasn't pleasing to other patrons. In response, supporters of the seniors were calling for a boycott.
On Sunday, communities leaders announced a settlement of the dispute, with the owner agreeing the seniors can stay as long they want, except from 11 a.m. to 3 p.m.
Stacy Torres, a PhD student at NYU, wrote an op-ed for the New York Times on the controversy, arguing we should encourage public-private partnerships that benefit older adults and businesses. She concludes: "Battles over public spaces are as old as the city itself, but we have an opportunity to reimagine overlooked resources like McDonald's as new generations of older people find themselves needing places to hang out."
Friday, January 17, 2014
Recently I blogged about NORCs (for Naturally Recurring Retirement Communities) and Villages, two community-based models for aging in place that are popping up around the country, often in larger cities. Apparently the label "NORC" could also be applied to a not-so "natural" retirement setting -- your local McDonald's restaurant.
According to the New York Times, that's what's been happening in Flushing, New York, where a group of elderly Korean men and women have been gathering to socialize, starting as early as 5 a.m. and staying on well into the evening hours. The restaurant owners were not happy, especially as the size of the group increased and members weren't placing orders. Management eventually called the police, seeking removal of those who seemingly ignored posted time limits, requests to vacate or stronger language. Now politicians and television cameras are involved:
"Whether the Koreans, many in their 70s and 80s, were right or wrong to spend their days at the restaurant, arriving as early as 5 a.m. and paying as little as $1.09 for a cup of coffee during their daylong stays, seemed not to matter much to the small but vocal group protesting against McDonald’s before an assortment of television cameras and photographers. What seemed to nettle the Korean community most was the perception that in asking police officers to remove the group, the business had been rude."
The New York Times coverage of the on-going dispute seems to suggest that heritage and cultural traditions play a part in the "imbroglio," interviewing "Officer Hee-Jin Park-Dance from the Community Affairs Bureau of the Police Department [who] works out of Flushing. She said: “In Korea or any other Asian cultures, the elder is treated like gold. When you see an elder you get up, you give a seat right away. It’s a sign of respect.”
Wednesday, November 13, 2013
Via the Chicago Tribune:
As Vietnam veterans age, many discover they have more time to contemplate their lives. The time for reflection — as well as retirement, reunions with war buddies and the deaths of loved ones — can stir memories from a long-ago war. An estimated 2.7 million men and women served in Vietnam; Their average age is 64, according to Vietnam Veterans of America. "Most are approaching retirement," said Tom Berger, director of the health council at Vietnam Veterans of America. "Once they retire, their spouse has passed and the kids have left home, without that structure, they begin to think about things." Anniversary dates and holidays such as Veterans Day may begin to bother people. But even when a veteran seeks treatment late in life, experts say, in many cases the post-traumatic stress disorder had been there all along.
That was likely the case for Steve Aoyagi, 63, of Des Plaines, who said that when he returned from war, he struggled with anger and anxiety. To deal with those feelings, he said, "I buried myself in my work. I worked 50 to 60 hours a week. A lot of overtime. Whatever time I didn't spend at work, I would occupy myself with my kids." When a neuromuscular disorder forced him to retire in 2002, he began thinking more about the war. "I started having nightmares about the time I spent in Vietnam. The bombs we dropped, the people who were left behind, my best friend getting killed, not being there for him." When his son deployed to Afghanistan, Aoyagi began to dream of the body bags that were once loaded onto his C-130 aircraft in Vietnam. In his dreams, he looked down at one of the bags and realized it carried the body of his son.
Now, he goes to group therapy three times a week at Captain James A. Lovell Federal Health Care Center in North Chicago. "The way that I'm dealing with my PTSD now — this is so true for the others — is by occupying my time," he said. "Keeping busy keeps me going."
Memories form a complex web of images and emotions. It's hard to know how one event might trigger recollections from decades before, experts say. At Lovell, more Vietnam veterans are reporting symptoms of late-onset PTSD. "I think that's due to the fact that Vietnam veterans are at an age when they're experiencing more loss and all the life changes that can be triggers," said Anthony Peterson, who runs the center's treatment programs for post-traumatic stress. The passing of a spouse can stoke feelings of survivor guilt. A serious illness can force a veteran to confront death in the same way he once did in Vietnam.
Tuesday, October 22, 2013
On yesterday's ride over the Blue Mountains between my Law School's campus in Carlisle and the campus in State College, I caught a great public radio program, interviewing folks at a "Memory Cafe."
As anyone involved in care for a person with dementia knows, especially those who are "stuck" at home, it can be a challenge. Both the caregiver and the cared-for person could use a good break now and then.
That's where the concept of Memory Cafes come in -- a place where folks won't judge about how Alzheimer's or similar cognitive impairments might affect the ability to have a traditional conversation. Where canes and walkers are welcome. A place that is warm and friendly. Where people understand -- and can share a laugh, along with good coffee.
From Wisconsin Public Radio, here's a bit of history and a description of a cafe in Appleton, Wisconsin:
“'Memory Cafes' got their start in the Netherlands and are common now both there and in England. They are 'judgment-free zones' for people with mild dementia or memory loss.
About a dozen people gathered last week at a cafe session at a coffee shop in Appleton. John McFadden is a co-coordinator of the memory cafe and plays the ukulele to welcome participants. Betty Ann Nelson came with her husband, Duane. The Nelsons have been married 58 years and have attended several cafe sessions since they began earlier this year."
Some sessions might involve activities, such as a program called "Time Slips" where participants pass around amusing photos and are invited to tell the story. One photo showed nuns on bumper cars at an amusement park, leading a customer to describe them as "Holy Rollers."
For more on the concept, follow the links on Wisconsin Public Radio to listen to this radio account.
Monday, September 30, 2013
"Perdue tried to get help from Meals on Wheels Atlanta. In mid-April of 2012, she was twenty-seventh on a waiting list of 120. In November, she was still on the list, which had grown to 198. Her daughter finally found another program.
Such is the world of food rationing for the elderly—the hidden hunger few ever see. Tenille Johnson, one of two case managers at Meals on Wheels Atlanta, said there were others on the list who were even more in need than Perdue. In 2012, the program served 106,000 meals—up from 84,000 three years before—and it will serve about 114,000 this year. “We’ve been able to up our game and reduce the waiting list to between 145 and 160 seniors, but the need has outpaced us,” says executive director Jeffrey Smythe. “The numbers are going up more quickly than we projected. We have waiting lists all over the metro Atlanta area, even in suburban counties.”
The Nation writer first reported on underfunding for programs assisting home-bound elderly in 1998. "Little has changed in the last fifteen years," she reports. Except, as her article demonstrates in detail, the need is greater, on a nation-wide basis.
"The National Association of Area Agencies on Aging says nearly 60 percent of all Older Americans Act programs had waiting lists in 2010, but the ones for home-delivered meals are particularly urgent, since food is so basic to good health."
Remember the Older Americans Act (OAA), first enacted in 1965? Meals on Wheels was once a core component of OAA's programming, and administered to the states through Area Agencies on Aging. Charities, churches and other nonprofits have not been able to cover the gap in funding. As discussed earlier on this Blog, Congress still has not reauthorized the OAA,and as Lieberman's article demonstrates, there are very real consequences to Congressional gridlock and Congress's failure to address even uncontroversial programs while rehashing party-politics on the Affordable Care Act.
Hat tip to Kevin Schock, Penn State Law, for spotting this timely article.
Wednesday, June 6, 2012
Via United Cerebal Palsy:
Arizona’s Medicaid program provides the best services for people with intellectual and developmental disabilities, according to a national ranking released Wednesday.
The annual list produced by United Cerebral Palsy compares services and quality of life for people with disabilities all 50 states and the District of Columbia.
Arizona, Michigan, California, New Hampshire and Vermont came in at the top of the list this year. Meanwhile, for the sixth year in a row, Mississippi was dead last, with Illinois, Arkansas and Texas rounding out the low performers. (Find out where your state stands »)
The analysis looks at a number of factors including the way people with disabilities live and participate in their communities in each state, how satisfied people are with their lives and how easily they are able to access services and supports. The latest ranking is based primarily on data from 2010, the most recent available. Even though some states outperformed others in the ranking, those behind the report caution that all states have room for improvement. They point out that 268,000 Americans with disabilities are currently on waiting lists for Medicaid waivers which would allow them to receive home and community based services. On a positive note, however, the analysis found that in 36 states at least 80 percent of residents with developmental disabilities are now being served in the community.
Wednesday, March 14, 2012
Five million seniors will experience hunger this year, but only 1 out of every 3 eligible seniors receives SNAP (formerly known as the Food Stamp Program).
In this webinar, we will discuss:
- The basics of the SNAP benefit.
- Why seniors don’t apply for SNAP and what aging network advocates can do about it.
- Opportunities to expand your resources to help older adults obtain this valuable benefit.
Nora Dowd Eisenhower, Vice President, Center for Benefits Access
Lura Barber, Senior Policy Analyst, Center for Benefits Access
This Webinar will be offered twice:
Tuesday, March 20th at 3:00 PM eastern daylight time
Thursday, March 22nd at 10 AM eastern daylight time.
Monday, January 11, 2010